Independent Medicines and Medical Devices Safety Review: Progress Report

Maria Caulfield Excerpts

Monday 12th December 2022 Written Statements

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

In July 2021, the Government published their response to the recommendations of the independent medicines and medical devices safety review (the review). In this, we accepted the overarching conclusion of the review that the system failed to listen to patients, or to put patients at the centre of their care. We accepted the majority of the review’s nine strategic recommendations and 50 actions for improvement.

We also committed to publishing an update on progress made in the following year to implement the accepted strategic recommendations and actions for improvement. I am happy to be able to publish that report today, which shows that we have made substantial progress and sets out the remaining next steps. The key points are set out below.

Putting patient voice at the centre of patient safety

Dr Henrietta Hughes was appointed as the first patient safety commissioner in July 2022. Dr Henrietta Hughes is already championing the value of listening to patients to seek improvements to patient safety around the use of medicines and medical devices.

Pelvic mesh

In April 2022, the ninth specialist mesh centre opened in Bristol. Women from every region now have access to the specialist support services they need, including pain management, psychological support and surgical mesh removal. As of October 2022, over 1,900 patients had been referred for treatment.

The first annual clinical summit took place on 6 December 2022, where all nine mesh centres came together to share best practice in setting up the centres, delivering patient-centred care, and ensuring robust data collection to support continued improvement. To ensure these centres are supporting women as intended, I have asked the Department to work with NHS England to review mesh centre outcomes and patient experience.

Sodium valproate

Government take safety concerns associated with sodium valproate very seriously. Significant measures were introduced by the Medicines and Healthcare products Regulatory Agency (MHRA) in 2018 to further reduce the use of valproate during pregnancy, including the introduction of the pregnancy prevention programme and smaller pack sizes to encourage monthly prescribing with a pictogram/warning image on valproate packaging.

The MHRA and NHS Digital have developed the medicines and pregnancy registry to improve our ability to monitor implementation and compliance with the pregnancy prevention programme. This tracks all women in England who are taking NHS-prescribed valproate and identifies when they are pregnant and accessing NHS care for that pregnancy. The latest data from the registry shows that the number of pregnant women prescribed valproate in a six-month period has fallen from 68 women in April to September 2018, to 17 women in October 2021 to March 2022. Last year the registry was also expanded to cover other anti-epileptic drugs in addition to sodium valproate.

Existing approaches to reduce the number of pregnant women exposed to sodium valproate are important and are making a difference, but there is no room for complacency, and we still need to do more. For that reason, the independent Commission on Human Medicines (CHM) has considered a comprehensive assessment by MHRA which included input from patients and other key stakeholders and a review of the available data.

The CHM has advised that there should be greater scrutiny of the way sodium valproate is prescribed and that further risk minimisation measures are required, in particular that two specialists should independently consider and document that there is no other effective or tolerated treatment. The CHM has established an implementation group to support the safe introduction of the new measures into clinical practice. The implementation group includes representation from across the healthcare system.

The proposed new measures will be implemented over the coming months according to patient priorities so that they can be introduced safely. In the meantime, health professionals are being reminded that sodium valproate should not be used in female children and women of childbearing potential unless other treatments are ineffective or not tolerated, and the pregnancy prevention plan should be closely adhered to. It is important to note that patients taking sodium valproate are strongly advised to continue to do so until reviewed by a healthcare professional.

I will also be hosting a roundtable on valproate prescribing with key stakeholders on 19 December 2022, to discuss how we can work together to further improve monitoring and compliance with the regulatory controls.

Last year we held a consultation on original pack dispensing and whole pack dispensing of medicines containing sodium valproate, which included a proposal that medicines containing sodium valproate are always dispensed in the original manufacturer’s packaging. This would ensure patients, and particularly women and girls of childbearing potential, always receive the patient information leaflet with warnings about taking the medicine while pregnant. The Government have considered the responses received and will shortly publish a response to the consultation.

Medical device information system

Following extensive scoping work we have concluded that the best and fastest way to deliver a medical devices information system is by increasing the scope and coverage of outcome registries.

We aim to increase the scope and coverage of medical device outcome registries from 15% to 80% of high-risk procedures over the next three years. As well as device tracking the registries will include patient outcomes and patient experience, helping us deliver on wider objectives such as better information about individual consultants’ performance, which was highlighted in the Paterson inquiry.

Declaration of interests

The IMMDS review stated that transparency of payments made to clinicians needs to improve. We are in a piloting phase for the declaration of doctor’s interests in NHS and independent settings. Healthcare providers will publish this information to ensure it is more accessible to patients.

During the pilot, we will seek feedback from healthcare providers, doctors, and patients on the feasibility and cost of establishing and maintaining systems across different healthcare settings; the content of standardised templates and guidance; and the accessibility of information for patients. Full implementation will begin in 2023. Once we have a system in place for doctors, we will consider systems for other healthcare professionals.

Next steps

We know there is more work to do to improve women’s experiences of the healthcare system, and patient safety. The Government are committed to continuing to work with partners across the health and care system to implement the accepted recommendations and actions for improvement.

The review also brought into sharp focus the importance of listening to women's voices and was a key driver behind the decision to develop the first ever women’s health strategy for England, which we published this summer. Through the women’s health strategy, we will continue to improve the health and wellbeing of women and girls.

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Foetal Valproate Spectrum Disorder: Fatalities

Maria Caulfield Excerpts

Wednesday 7th December 2022 Commons Chamber

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

I congratulate my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) on securing this important debate on fatalities relating to foetal valproate spectrum disorder. We all know the devastating effect that the drug can have during pregnancy, which is why we took seriously the recommendation in Baroness Cumberlege’s report. I have met the campaigners, Janet and Emma, when I was previously a Minister and since being reappointed—I can confirm that they are definitely not blacklisted by the Department. I look forward to meeting them again shortly to hear the concerns that they still have, which my right hon. Friend set out well this evening.

To reaffirm what the hon. Member for Lancaster and Fleetwood (Cat Smith) said, we all know that sodium valproate can be a highly effective drug that is used to manage and treat epilepsy as well as other disorders, such as bipolar disorder and migraines, often when many other medications do not work or have stopped working. It is absolutely right to say that if a woman is on sodium valproate, it is crucial that they do not stop that medication suddenly but discuss it with their GP.

We know that there are teratogenic side effects that mean that, if taken during pregnancy, sodium valproate can have harmful effects on a foetus and increase the risk of a child being born with physical defects and neurodevelopmental disorders. In relation to the point made by my right hon. Friend the Member for Romsey and Southampton North about possible death, I do not know about that specific case but I am happy to ask officials to go away and look at it, because that would be an important development.

The risk of birth defects following the use of sodium valproate is about 11%, but with a high maternal dose, the risk can increase to 24%. There are significant risks of taking that drug and effects on babies once they are born.

[Cat Smith]

I thank the Minister for the time that she makes available for the subject, which is much appreciated. While she is on the topic of the percentage risk of harm to the unborn baby, at that stage in pregnancy, many women and couples have a very much wanted pregnancy, which is perhaps planned for and longed for, but are suddenly advised by a doctor to terminate it. Does she agree that that tragedy needs to end? We need to come together to ensure that pregnancy prevention plans really work.

[Maria Caulfield]

I absolutely agree with the hon. Lady, and I will come on to some of the changes that are being made on that point. When I have met Janet and Emma, they have very much represented women who feel that those risks were not explained and that if they had known, they would have been on contraception or spoken to their team about stopping the medication before getting pregnant. Often, those are women with complex epilepsy for whom pregnancy is a difficult enough decision in the first place.

We have known for a long time that the drug should not be used by any woman or girl who can have children, unless they are in the proper pregnancy prevention programme. That is why, in 2018, the programme was introduced to reduce and prevent the number of pregnancies, which was high at the time, in women taking the drug. Being part of the programme means that women are supposed to have an annual review by a specialist, but I have concerns and have heard from campaigners that that does not always happen and is not always the case. There is also the valproate registry, which has now been created so that we can track every woman who is taking that medicine and ensure that the records of when they are prescribed it, when it is dispensed and what is happening to them are followed through, which has never happened before.

The programme is designed to make sure that, each year, those women have a discussion with their health team, so should they wish to become pregnant, they can get that advice there and then. When I was in this post previously, I had concerns about the overview of the register, the annual checks and some of the other safeguards around the dispensing and packaging of the drug, which have been touched on. That is why we have reviewed the programme.

I have met the MHRA, which has taken both campaigners’ and my concerns very seriously. It is looking at the programme, and it will be making an announcement shortly on stronger advice to GPs, but also to pharmacists, about some of the technical issues with dispensing medication, and on some safeguards we need in place so that women—once again, whether they mean to get pregnant or happen to get pregnant—have the advice they need and the reminder on the packaging when they pick up their medication.

The registry tracks all women in England who are taking the prescribed valproate, and it identifies if they become pregnant are accessing care for pregnancy. We can track pretty accurately when pregnancy happens, so we have a handle on how many women are getting pregnant while on the medication. I can reassure the House that the numbers are falling. They are still too high in my view, but they are falling. In the six-month period from April to September 2018 68 women prescribed valproate became pregnant, and from October 2021 to March 2022 that number fell to 17 women. That is still 17 women too many, although we are making progress in reducing that number of pregnancies, but that is why the MHRA is looking at further safeguards for prescribing and dispensing such medicine. It will be making that announcement fairly soon.

A national clinical audit is being undertaken by all community pharmacy contractors, as agreed with NHS England and the Pharmaceutical Services Negotiating Committee, which will measure adherence to current MHRA regulations. The audit will look at whether all patients are provided with a patient card and a patient guide every time the medicine is dispensed. It will also look at whether patients who are supposed to be getting a review every 12 months actually are, and what then happens to them if they are being signposted for additional advice.

I am appearing before the Health and Social Care Committee next week to go through the Cumberlege review on its anniversary and follow up on the progress that has been made. This week, I have met the new patient safety commissioner, Henrietta Hughes, who has also met Janet and Emma, and the issue of valproate is one of her key priorities in her first few weeks in post. I have discussed with her my concerns about its dispensing and packaging, and about the monitoring of women, including whether they are getting the advice they need for a planned pregnancy or, if they are not planning to get pregnant, whether they have had reliable advice and discussion about contraception. I plan to meet the patient safety commissioner on a regular basis to make sure that the measures in place are actually reducing the number of those pregnancies and providing women with the support and information they need.

The Department and the MHRA are consulting on a proposal that medicines containing sodium valproate should always be dispensed in the original manufacturer’s packaging. This would ensure that patients, particularly women and girls of child-bearing age, always receive the patient information leaflet about the medicine they are taking. We will shortly publish a response to that consultation, and we will keep Members updated.

To touch on the issue of redress, it was not one of the recommendations accepted in the original response to Baroness Cumberlege’s report. However, last year I was concerned about the issues, which my right hon. Friend the Member for Romsey and Southampton North raised, for women seeking legal advice and taking on the huge challenge of getting compensation. What we have done as an interim measure is to work with NHS Resolution to launch a claims gateway, so that individual women can go to NHS Resolution and get their individual case looked at and be provided with support if they want to make a claim, without having to go independently to solicitors and lawyers. That has only just started, and we are looking at how effective it is in helping women get access to some of the compensation they feel they need. However, in my conversations with the patient safety commissioner I have asked her to look at what a potential redress scheme could look like. I am not going to make commitments on that from the Dispatch Box because it is not necessarily my decision to make—that would have to be in discussion with the Chancellor—but I am keen to look at what a redress scheme would look like, and I will follow up on that with the patient safety commissioner and see what is possible. I hope I have been able to reassure colleagues.

[Cat Smith]

Will the Minister commit on the Floor of the House this evening that after she has had conversations with the commissioner about the possibilities of the scheme she will talk to the Chancellor or someone from his team about the recommendations and how they might be implemented?

[Maria Caulfield]

I have had those discussions about what a scheme could look like with the patient safety commissioner only this week. I will need to see the details, but I hope that reassures the House that I am listening to the concerns of parliamentarians and campaigners such as Emma and Janet, who represent a huge number of affected women. I understand the situation they are facing: they have lifetime costs for their children through no fault of the women or the children. They took that medication not realising the effect it could have. We now have that information, but we did not know it at the time. My commitment is that I am exploring options and will update the House on that later.

I want to reassure the House once again that we take very seriously the safety issues around this drug. It is an important drug in the management of epilepsy, and for some women it is the only way of managing their condition, but we need to make sure that women are aware of the implications of taking such a drug during pregnancy, that they are monitored annually to make sure those discussions are ongoing, and that every time their medicine is prescribed and dispensed that message is reinforced. We are reducing the numbers involved, which is great news, but we need to make sure they go even lower, and we need to look at how we support women who have been affected through no fault of their own.

We will be giving evidence at the Health and Social Care Committee next week. I think I am also meeting the hon. Member for Lancaster and Fleetwood shortly, and I am sure other parliamentary colleagues too. I just want to say that I want to support women who have been affected by taking sodium valproate and that we are in listening mode on what more we can do to support them and make sure the help they need and the support for their children are at the forefront of our minds.

Question put and agreed to.

Fuller Inquiry Update

Maria Caulfield Excerpts

Thursday 1st December 2022 Written Statements

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

Following my statement on 16 December 2021, I am pleased to inform the House that a compensation scheme to facilitate compensation payments to the family members of David Fuller’s victims has been established today.

The scheme, which will be administered by NHS Resolution on behalf of Maidstone and Tunbridge Wells NHS Trust, will ensure that compensation is paid to relatives as soon as practicable. The scheme will operate on a tiered approach. All qualifying family members will receive a fixed amount of compensation. Increased payments will then be made for psychiatric trauma and/or financial loss, subject to evidence. Entry into the scheme is entirely voluntary and the scheme will be advertised nationally to help ensure all eligible family members are aware of it.

The scheme represents a highly co-operative effort between NHS Resolution, Maidstone and Tunbridge Wells NHS Trust and the families’ representatives and I would like to thank all those involved for their work in developing this compensation scheme for families.

I would also like to take the opportunity to update the House on the timescales of the inquiry. The inquiry is progressing well and due to the significant amount of evidence being received, the report on matters relating to Maidstone and Tunbridge Wells NHS Trust is now planned for the first half of 2023.

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Health and Social Care

Maria Caulfield Excerpts

Friday 25th November 2022 Ministerial Corrections

The following is an extract from the Backbench Business debate on International Men’s Day om 17 November 2022.

[Maria Caulfield]

The Government have increased funding by 60% for community-based support focused primarily on male survivors, and we will update the supporting male victims statement in August this year to outline the further work that we will do in this area.

[Official Report, 17 November 2022, Vol. 722, c. 928.]

Letter of correction from the Under-Secretary of State for Health and Social Care (Maria Caulfield):

An error has been identified in the debate on International Men’s Day.

The correct response should have been:

[Maria Caulfield]

The Government have increased funding for community-based support focused primarily on male survivors, and we will update the supporting male victims statement in August this year to outline the further work that we will do in this area.

Manchester Mental Health Trust: Edenfield Centre

Maria Caulfield Excerpts

Wednesday 23rd November 2022 Written Statements

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

Yesterday, NHS England announced an independent review will be taking place regarding the unacceptable incidents that took place at the Greater Manchester Mental Health Trust this year. It will focus on how these incidents were able to happen and why the failings were not picked up.

The abhorrent treatment of vulnerable people at the Edenfield Centre shown in the Panorama episode was completely unacceptable. Every patient has the right to be treated with dignity and respect, in a caring and therapeutic environment where their rights are upheld, their needs are met, and they feel supported and listened to.

This is why I welcome the steps taken by colleagues in the NHS to investigate those events. As the Minister of State, Department of Health and Social Care, my hon. Friend the Member for Colchester (Will Quince), stated in Parliament on 13 October 2022, this should not have happened. Therefore, it is vital that we get to the bottom of what went wrong so that we can make sure we do better in the future. As I said at the Dispatch Box, I have also instructed my officials to consider what is needed on wider issues for mental health inpatient care, separately to this independent review. I will give an update on this in due course.

[HCWS383]

Worker Protection (Amendment of Equality Act 2010) Bill

Maria Caulfield Excerpts

Committee stage
Wednesday 23rd November 2022 Public Bill Committees

[Tulip Siddiq]

I agree with the hon. Lady. The truth is that this is about culture change—and legislative change. I am grateful for the Bill because it empowers employers to take their duty of care to their employees seriously. Employees will respond by returning increased profits, productivity and motivation, so it will help the workforce economically as well—for anyone who doubts the importance of such measures.

The Bill on its own will of course not achieve the transformation that all workers need. This is not a silver bullet—I am sure the hon. Member for Bath agrees—because much more remains to be done. The Labour party is committed to creating safe, equal and fair workplaces where everyone succeeds, regardless of their gender or background. Among other things, the Labour party has been working on its new deal for working people. In that policy, we hope to tackle workplace discrimination and inequalities as a priority.

The Bill sponsored by the hon. Lady is the chance to make some progress right now. We owe that to victims of sexual harassment. Over the years, many of us have said, “Me too!” When the movement emerged, I was so shocked, because nearly every friend I spoke to and every family member turned around to say to me, “Me too!” I wondered whether I had met even one person who had not had that experience. That is a shocking statistic, which I hope we can change as we move forward.

The Bill is what we owe to our workers, present and future, and to our children. It heartens me to see so much cross-party support. Once again, I applaud the hon. Member for Bath for using the opportunity; she could have chosen any topic under the sun, but she chose this topic. I applaud her for championing it.

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

It is a pleasure to serve under your chairmanship, Mr Paisley.

I thank all hon. Members present for their forthright support for the Bill, which is echoed by the Government. As the shadow Minister, the hon. Member for Hampstead and Kilburn, pointed out, in particular we thank male colleagues who have come along and supported the Bill from the start, because that sends a strong message to the country that not only is there cross-party support, but that both male and female MPs support the legislation.

I thank the hon. Member for Bath for sponsoring this important legislation. As has been said, this is just one of many campaigns that she has run to protect women’s rights, especially on violence against women and girls. The Bill is a follow-on to her legacy in that space. Today, she set out clearly that workplace harassment is a pervasive issue, which should not be tolerated in modern Britain.

Sadly, however, as my predecessor referenced on Second Reading, an experimental survey by the Government Equalities Office in 2020 exposed that nearly three quarters of the UK population have experienced sexual harassment in their lifetime, with nearly a third of people in employment experiencing some form of sexual harassment in their working environment within the past 12 months. Those figures are, unfortunately, not surprising.

The Equality Act 2010 already provides employees with legal protection against workplace harassment, but the measures in the Bill take a significant step forward. The Government believe that such a shift will not only provide increased legal security for employees, but instigate wider cultural change by motivating employers to prioritise prevention and, ultimately, to improve workplace practices and culture.

I will shortly address the points made by hon. Members today, but I will first outline the Government’s ongoing commitment to change in this space, and in particular to the measures in the Bill. In 2019, in response to an inquiry by the Women and Equalities Committee, the Government consulted on the legal protections to do with sexual harassment in the workplace. The consultation exercise included a public questionnaire, alongside the technical consultation, and received more than 4,000 responses detailing people’s lived reality of harassment in the workplace, as we have heard so much about.

Listening carefully to the experiences and opinions shared, the Government committed to a package of new measures aimed at reducing incidences of workplace harassment. That includes the two legislative measures being brought forward in the Bill: explicit protections for employees from workplace harassment by third parties, such as customers and clients; and a duty on employers to take all reasonable steps to prevent their employees from experiencing sexual harassment.

Those measures were announced in July 2021 and continue to form a key part of the Government’s national strategy for tackling violence against women and girls. We therefore welcome the fact that the hon. Member for Bath is taking the measures forward in her Bill. In supporting the Bill, we look to honour the commitments that the Government set out last summer and to deliver real change for workers and working culture across the UK.

I want to point out that clauses 2 to 6 are about sexual harassment specifically, but I highlight the fact that clause 1—the employer liability for harassment—will require employers legally to consider harassment risks that third parties may pose. However, that will apply to all types of harassment, not just sexual harassment. It will include racial harassment, harassment in relation to disability or any other type. That is an important step forward as well.

To conclude, I reiterate my appreciation of the hon. Members present today. It is good to see such cross-party support in this space for this new legislation, which we hope will have a profound impact on working culture, and further protect and support employees at risk of harassment in the workplace. Support for the Bill is not isolated to this room, and I also thank the numerous organisations, individuals and parliamentarians who have been involved in the development of the new measures. Those include, but are certainly not limited to, the Government Equalities Office, the Fawcett Society, the Equality and Human Rights Commission and the Women and Equalities Committee. The last of those, along with the Joint Committee on Human Rights, sent a letter in support of the new legislation to the hon. Member for Bath. We hope to see such a collaborative spirit maintained as the Bill continues its progress through Parliament. Personally, I look forward to working with the hon. Lady to ensure that it does.

Question put and agreed to.

Clause 1 accordingly ordered to stand part of the Bill.

Clauses 2 to 6 ordered to stand part of the Bill.

[The Chair]

Before I put the final question to report the Bill to the House, I offer the sponsor of the Bill the opportunity to say a few thank yous.

International Men’s Day

Maria Caulfield Excerpts

Thursday 17th November 2022 Commons Chamber

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

I am very pleased to be able to join this year’s debate to celebrate International Men’s Day. I thank the Backbench Business Committee for granting this debate so that we can join 80 countries around the world in marking this day.

I thank my hon. Friend the Member for Don Valley (Nick Fletcher) not just for leading the debate, but for his consistent campaigning on the issues that affect men, and for his work as chair of the APPG on issues affecting men and boys, which continues to shine a spotlight on issues from mental health and wellbeing to boys’ education. As my hon. Friend the Member for Watford (Dean Russell) pointed out, it is disappointing that so few Labour and Lib Dem Members are in the Chamber, because they have missed a tremendous debate.

We heard from my hon. Friend the Member for Ynys Môn (Virginia Crosbie) about the tragic suicide of her brother. The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) spoke so well about the body-image issues that men face, which are rarely talked about enough. My hon. Friend the Member for Penistone and Stocksbridge (Miriam Cates) spoke about a multitude of issues that affect men, including in particular their roles and importance in family life, and pornography and how it affects young men.

My hon. Friend the Member for Watford made a moving speech on a range of issues, and I will start by addressing some of the points he made about suicide. It is tragic and unacceptable that, on average, 13 male suicides occur every day, and that suicide is the leading cause of death for men under 50. About 75% of all suicides are by men, so it is so important that we tackle the mental health issues that men face.

It is no surprise that after a number of years of tackling covid, which raised distress, anxiety and isolation over lockdown, as well as fears about jobs, before going straight into cost of living pressures, everyone—both men and women—has felt an impact on their mental health. However, we know that, for a variety of reasons, men are less likely to seek help. My hon. Friend the Member for Watford pointed out some of those reasons.

It is incumbent on all of us, across the House, to urge all men across our constituencies to reach out to the available support. In recent years, we have seen huge strides forward in the provision of support. We now have the Every Mind Matters campaign, which provides practical help and tips to improve our mental wellbeing. The NHS website supporting Every Mind Matters is easy to access and provides a range of tools that men can use themselves.

Importantly, we now have self-referral to talking therapies, so that men and women—but particularly men who are reluctant to seek help—no longer have to see their GP to get a referral. More than 1 million people have accessed talking therapies through self-referral. We are investing in those services by putting in an extra £2.3 billion a year to grow mental health services and meet demand. It is not enough simply to expect men to seek help themselves, however.

[Dean Russell]

I thank my hon. Friend the Minister for her kind words and feedback. A couple of years ago, I introduced a ten-minute rule Bill to make mental health first aid part of workplace first aid. Will she take that idea back to her colleagues across Government to see whether we could look at it again? I would like to introduce that again. Ensuring that people in the workplace know that they have someone to go to in the same way as if they had a physical issue could be transformative.

[Maria Caulfield]

I am very happy to discuss that with my hon. Friend. He might be pleased to know that there are mental health first aiders on the floors of the Department of Health and Social Care offices. They support staff there and do a great job. I am keen to speak to him about that.

We need a whole-systems approach, as the APPG highlighted in its report, which I have read. It makes for interesting reading in terms of how we support men, particularly around their different experiences of health services and how we can improve outcomes. A number of organisations are helping to support mental health for men, such as Men’s Sheds, which was mentioned in the debate. Men’s Sheds offers new opportunities to learn skills, build friendships and reduce isolation, and is helping men to meet in different ways from traditional settings, and to build relationships where they may feel comfortable to speak out and ask for help.

We also need to look at how different approaches can work in tandem. Earlier this year, we put out a call for evidence to support the development of a new 10-year plan for mental health. I am pleased that groups such as James’ Place, Men’s Sheds and Andy’s Man Club are among the many involved. We want to reduce suicide rates, and to do that we have to support men, who account for 75% of suicides currently. We are looking to bring forward some specific work on that shortly, and I will happily meet my hon. Friend the Member for Don Valley to see how we can take it forward.

We are taking significant action in terms of mental health, but a number of illnesses affect men in particular, including heart disease, cancer, smoking, and drug and alcohol addiction. While life expectancy in the UK is lower for men, women spend significantly more time than men in ill health and disability. That is why we have a women’s health strategy: because we want to tackle the basis for why women spend so much of their lives in ill health. We can improve life expectancy for men by ensuring that we tackle the illnesses that they face. My hon. Friend has challenged me on that before, because he feels so strongly that there should be a men’s health strategy, but I will happily discuss it with him after the debate to see what more we can do.

Not having a men’s strategy, or indeed a men’s Minister, does not mean that the Government or the NHS take men’s health any less seriously. We will continue to look for ways we can support men’s health. There are a number of exciting initiatives, such as the Man Van, which is an innovative outreach programme launched this year that provides free health checks for men and aims to boost early diagnosis of prostate and other urological cancers. That mobile health clinic visits workplaces and churches in London to improve healthcare access for men who are less likely either to come forward or to receive regular health checks.

The Man Van was developed by the Royal Marsden NHS Foundation Trust. I declare an interest, as I have worked for the hospital in the past and still do some shifts there. Its specialty is enabling us to target the men most at risk of developing prostate cancer and who have poorer outcomes if they are diagnosed, particularly those in manual jobs who often struggle to access healthcare. Black men, who have roughly double the risk of developing prostate cancer, and an increased risk of death once diagnosed, are also being encouraged to get checked. If the results of the pilot studies that are being rolled out show that they were successful, we will roll them out across the country.

In the short time that I have, I will touch on stereotypes, which have been raised throughout the debate. Phrases such as “man up” and outdated beliefs about what it means to be a man do not help men to get the help that they need. One issue that was not touched on much is domestic violence that affects men. The recent crime survey for England and Wales suggests that 13.8% of men aged 16 to 74 have experienced domestic abuse behaviours. That is an estimated 2.9 million male victims. While the figure is much higher for women, that is a considerable number of men who are experiencing domestic violence, and we need to ensure that we are reaching out to them and supporting them. The Government have increased funding by 60% for community-based support focused primarily on male survivors, and we will update the supporting male victims statement in August this year to outline the further work that we will do in this area.

In terms of getting equality for men, I think my hon. Friend the Member for Don Valley will be happy with the work being done to support fathers, particularly new fathers who want to take on a full role in family life. In terms of the work around shared parental leave, men are still more likely than women to have their requests for flexible working turned down by their employer, and men still struggle to get paternity leave rights. We recognise the vital role that dads play in helping to raise their children—that is why we are establishing the family hubs and Start for Life programme—and we are committed to ensuring that men get the parental leave they are entitled to.

In conclusion, today’s debate has raised some prominent issues that are affecting men, but we have not had much time to celebrate men. We all have dads, grandads, husbands, brothers, friends and colleagues who are men and who do a tremendous job. Men sometimes get a raw deal in terms of criticism. When my mum died, my dad had to take me and my brother on when we were teenagers, at a time when there was no such thing as childcare or support for single fathers. He did an incredible job. He used to take me to the football at the weekend, whether I liked it or not, which is why I am now an Arsenal supporter. He used to have to take me to work as well, where I learned to paint and decorate, because childcare was not available in those days.

All of us in this place who are married to men are thankful for the role they play. As my hon. Friend the Member for Penistone and Stocksbridge (Miriam Cates) said, they support us in our roles, and when we have had a terrible week or the online trolls are particularly active, we are very grateful for them just having that cup of tea with us and making us realise that there is a life outside this place.

The opportunity today to debate the issues that matter to men is important, and I will meet my hon. Friend the Member for Don Valley to make sure we pick up on many of the points raised in the debate. It is also an opportunity to celebrate and thank men for all they do for us, not just on International Men’s Day but all year round.

Health and Social Care

Maria Caulfield Excerpts

Monday 7th November 2022 Ministerial Corrections

The following is an extract from the response to the urgent question asked by the hon. Member for Tooting (Dr Allin-Khan) on abuse and deaths in secure mental health units on 3 November 2022.

[Maria Caulfield]

NHS England has commissioned a system-wide investigation into the safety and quality of services across the board, particularly around children and adolescent mental health services. I am pushing for those investigations to be as swift as possible.

[Official Report, 3 November 2022, Vol. 721, c. 1020.]

Letter of correction from the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield).

An error has been identified in my response to the urgent question on abuse and deaths in secure mental health units.

The correct response should have been:

[Maria Caulfield]

NHS England has commissioned a system-wide investigation into the safety and quality of services at the Tees, Esk and Wear Valleys NHS Foundation Trust, particularly around children and adolescent mental health services. I am pushing for those investigations to be as swift as possible.

Abuse and Deaths in Secure Mental Health Units

Maria Caulfield Excerpts

Thursday 3rd November 2022 Commons Chamber

[Dr Rosena Allin-Khan (Tooting) (Lab)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on abuse and deaths in secure mental health units.

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

I am grateful to the hon. Lady for raising this important question. Everyone in any mental health facility is entitled to high-quality care and treatment and should be kept safe from harm. The findings from the investigation into the deaths of Christie, Nadia and Emily make for painful reading. The death of any young person is a tragedy, and all the more so when that young person should have been receiving care and support. My thoughts and, I am sure, the thoughts of the whole House are with their families and friends, and I want to apologise for the failings of the care that they received.

As I told the House on Tuesday, these incidents are completely unacceptable. The Secretary of State and I are working closely with NHS England and the Care Quality Commission, and they have updated us on the specific situation and the steps that the Tees, Esk and Wear Valleys NHS Foundation Trust is taking to improve the care at its services. Those include investing £5 million in reducing ligature risks across the estate; improving how it develops and implements care plans for young people; strengthening its policy on observation; and improving staff training and the culture that can exist within the trust.

I recognise that these worrying findings come in the context of broader concerns highlighted by other recent scandals. The Minister for Health and Secondary Care, my hon. Friend the Member for Colchester (Will Quince), was at the Dispatch Box last month responding to an urgent question on the unacceptable abuses at the Edenfield Centre. These challenges are, rightly, the subject of sharp focus in my Department, and we understand that every part of our system has a responsibility to keep patients safe. That is the driving motivation behind our new mental health safety improvement programme and the patient safety incident response framework.

I am not just the Minister for Mental Health; I am also responsible for patient safety, and I am not satisfied that the failings we have heard about today are necessarily isolated incidents at a handful of trusts. The Secretary of State and I are urgently meeting the national director of mental health to look at the system as a whole, the role of CQC inspections and the system for flagging concerns. I will also be meeting the new patient safety commissioner to seek her guidance, and based on that, we will make a decision on how we proceed in the coming days.

[Dr Allin-Khan]

It pains me that we are here again after failings in patient care and I send my heartfelt condolences to all the families affected. Emily Moore, Nadia Sharif, Christie Harnett: these are the names of three young women who tragically lost their lives after systemic failings to mitigate self-harm. This cannot go on. I thank my hon. Friend the Member for Middlesbrough (Andy McDonald) for his tireless work with the families involved.

Sadly, those are not the only cases. In the last five weeks, there have been reports on the Huntercombe Group, the Essex Partnership University NHS Trust and the Edenfield Centre. Why do undercover reporters seem to have a better grip on the crisis than the Government? Patients are dying. They are being bullied, dehumanised and abused, and their medical records are being falsified—a scandalous breach of patient safety.

The Government have failed to learn from past failings. I wrote to the previous Secretary of State, the right hon. Member for Suffolk Coastal (Dr Coffey), yet I never received a response. I have written to the new Secretary of State and he has not replied. Are the Secretary of State and the Government taking this seriously? It certainly does not seem so.

Will the Government be conducting a rapid review into mental health in-patient services? What are the Government doing to ensure that patients’ complaints about their care are taken seriously? These reports are becoming a weekly occurrence. I ask the Minister to put herself in the shoes of patients in these units and understand what their relatives are feeling. Will she apologise for the anguish that families are experiencing? This is a scandal and the Government should be ashamed.

[Maria Caulfield]

I will not stand at the Dispatch Box and deny any of the instances that we have seen, their consequences or the failings that have been identified. I apologised in my opening remarks for the care that failed the most vulnerable patients in our system. I commit to right hon. and hon. Members from the Dispatch Box that we are urgently looking not just at these cases but across all mental health in-patient services, and not just at adult mental health, but at offenders and other users of mental health facilities.

We have brought in a number of measures. We introduced new legislation, which was enacted in March, on the use of force and restraint. We are identifying best practice and trying to get that rolled out across the country. We are looking at putting in place a number of measures to improve safety and to support staff in units where staff shortages have been identified as a cause of the problems.

With regard to the hon. Lady writing to the Secretary of State, I signed off a letter to her early on Tuesday, which she should receive any day now. I apologise that she did not previously get responses in a timely manner.

NHS England has commissioned a system-wide investigation into the safety and quality of services across the board, particularly around children and adolescent mental health services. I am pushing for those investigations to be as swift as possible.

On the issue of a public inquiry, I am not necessarily saying that there will not be one, but it needs to be national, not on an individual trust basis. As we have seen in maternity services, when we repeat these inquiries, they often produce the same information and we need to learn systemically how to reduce such failings. My issue with public inquiries is that they are not timely and can take many years, and we clearly have cases that need to be urgently reviewed and to have some urgent action taken on them now. I will look at the hon. Lady’s request but, as I said, the Secretary of State and I are taking urgent advice, because we take this issue extremely seriously. One death from a failing of care is one death too many.

[Mr Speaker]

I call the Father of the House, Sir Peter.

[Sir Peter Bottomley (Worthing West) (Con)]

Lessons need to be learned and I am glad that the authorities and the Government will do that.

From the time that I served on the council of Mind, which was known as the National Association for Mental Health, I have tried to emphasise the importance of recruiting good people to work in the various categories of profession and assistance in secure units and in the whole mental health field.

I pay tribute to those who, day in, day out and at all hours of the day, cope with some of the most challenging situations and try to help some of the most desperate people. In each of our constituencies, we have tragic suicides; many more are prevented because of the work of these good workers. Let us try to support them and recruit more people to work with them.

[Maria Caulfield]

I thank the Father of the House for his very important point, because staff shortages often contribute to some of the failings we have seen. We are aiming to recruit 27,000 more mental health workers. As of June this year, there were over 133,000 full-time equivalent people working in the mental health workforce, which is an increase of more than 5.4% compared with June 2021. We are increasing the workforce, but it is a particularly difficult area to work in both in dealing with people with mental health problems and the environments in which they are working. This is not just about recruiting more staff; it is about training, developing and retaining them.

[Janet Daby (Lewisham East) (Lab)]

Mental health services often feel like the poor relative of the NHS, and financial investment is just not there in the same way. Mental health nurses and support staff work long shifts and are often experiencing burnout, while wards are repeatedly short of staff. There is a high turnover of psychiatrists and many are moving to work overseas. So it stands to reason that there are repeat failures within mental health services and mental health settings. What will the Government do to bring about urgent change and the long-term change that is so desperately needed?

[Maria Caulfield]

I want to reassure hon. and right hon. Members across the House that mental health is not seen as a poor relation by this Government. We are investing record levels of funding in mental health services—£2.3 billion annually—and we are recruiting record numbers of staff into the service as well. As I said to the shadow Minister, I fully accept the failings that have been laid bare, whether by media investigations or by internal investigations of the individual trusts. I am not shying away from those challenges, and I have set out the urgency with which I and the Secretary of State will be looking at this problem. I want to be satisfied that, across the country, safety is as good as it can be, and that where flags are being raised, they are acted on as quickly as possible, which does mean now, not in 18 months or two or three years. We are seeing young people die because of failings of care, and I understand the urgency of the situation.

[Paul Howell (Sedgefield) (Con)]

I would like to acknowledge what has been said already about the difficulty for staff working in this environment. It is a very challenging space, and my respect goes to anybody and everybody there. My respect also goes to people who work in suicide prevention, whether in Mind, the Samaritans or organisations like them, because this is a very difficult place.

I would like to come back to the specifics, and I will start by expressing my sincere thanks to the hon. Member for Middlesbrough (Andy McDonald) for his lead on the stuff going on up in our part of the world. It is a tremendous effort, and I applaud him and thank him for it. This week finally saw the publication of the independent investigation into the deaths of the three young ladies in the care of the Tees, Esk and Wear Valleys NHS Foundation Trust. Christie Harnett, one of those young ladies, was a constituent of mine, and her stepfather is among those calling for a public inquiry. I hear what the Minister is saying, but I really would encourage her to have this looked into very closely. I very strongly support the family on this.

Christie, along with Nadia and Emily, were badly let down. In Christie’s case, the report identified 21 care delivery problems and 20 service delivery problems. It was not an isolated mistake; this is systemic and massive, and it really needs to be looked at. May I ask the Minister to support this call for a public inquiry, please, and may I also ask her to confirm that a reply is imminent to the letters delivered by Mr Harnett to Downing Street on 10 October? He cycled from Newton Aycliffe down to here, a distance of 250 miles, to hand them in. This is emotional, but Christie’s family’s description of her in their statement in the report was:

“Family was everything to Christie and we all miss her so much, nothing will ever be the same again now our sunshine has gone.”

It is imperative that we do all we can to give the families of these young ladies what little satisfaction can be delivered by a proper and full inquiry into these atrocious failings.

[Maria Caulfield]

I thank my hon. Friend for his comprehensive question about the issues we face. He is absolutely right to say that systemic failings were identified, and as I have said, at this stage I have not said no to a public inquiry. We need urgently to address these issues, and ensure that, nationally, the same failings are not happening across the board. My concern about a public inquiry is the time that such inquiries take, and whether a rapid review would be more appropriate. I will make that decision in the coming days once advice has been taken. Nationally, some work is being done. For example, the Care Quality Commission is introducing a new approach into how it undertakes inspections. As with maternity services, one concern I have is that the CQC can do an inspection and rate a service as good, yet soon afterwards incidents are happening. I want to be satisfied that the CQC inspection process and the new approach it is taking will address issues and flag them as quickly as possible.

The National Mental Health Director wrote to every mental health and learning disability trust on 30 September, to ask them urgently to review their services in light of the findings we are seeing. The Secretary of State and I will meet her soon to follow up on that. NHS England is also reviewing everyone with a learning disability or autistic people in long-term segregation mental health in-patient units, because they are extremely vulnerable patients who may not have the ability to speak out when there are problems. I also want to look at whistleblowing, and support staff who want to flag problems but may not feel confident in doing so. We need to look at range of areas, but I very much take my hon. Friend’s points and I will look into the petition urgently today.

[Wera Hobhouse (Bath) (LD)]

Mental health services are overstretched not only in hospitals but in those services that provide support before patients become so ill that they need to go into hospital. What are the Government doing to support the very overstretched early intervention services?

[Maria Caulfield]

As I highlighted to the Father of the House, we are increasing the mental health workforce dramatically, with 27,000 extra mental health workers in the system. We have already increased those numbers this year, compared with last year. We are also providing self-referral mechanisms for patients. For psychological and talking therapies patients can now refer themselves without having to go and see a GP, and more than 1 million patients have taken up that offer. I fully agree with the hon. Lady that early intervention is a key factor, and we are supporting early intervention services so that patients can access them more easily and we have the staff to make that happen.

[Andy McDonald (Middlesbrough) (Lab)]

I thank colleagues across the House for their kind remarks. We must also pay tribute to the parents, who have so resolutely stuck at this campaign for two and a half years, and we now have these reports. I recognise what the Father of the House said: we admire the work that people do in this sector. It is so difficult. But in these particular instances, we had three young women whose needs were known. It was not as if they came by surprise —those families camped outside the hospital saying, “This hospital is killing my child”. Michael, Christie’s dad, cycled down to London. These issues were known by the families and by the parents. I welcome the Minister’s consideration of a public inquiry and a wider inquiry, but I ask that she meet me, the families and colleagues to discuss these matters. The purpose of this is to secure truth, justice and change. We need change in this environment hook line and sinker. A fundamental review is needed, and I trust the Minister will meet us to discuss these matters further.

[Maria Caulfield]

May I put on record my thanks to the hon. Gentleman for all he has done in raising these issues and supporting families? He is right. One area of concern with mental health care—we have also seen inquiries into maternity services—is that often patients and families have flagged issues and raised concerns to regulators and the individual trust, but they go unheard.

That is why I want to look at things such as making the whistleblowing process easier. The CQC recognises that and is changing its inspection process to ensure that families, staff, friends and patients have input into inspections. That is also why we introduced the patient safety commissioner, who took up her role in September, so that patients, staff and families have another avenue for raising concerns. If they feel that they are not being listened to at a local level, they have someone to go to who will raise concerns on their behalf.

It is absolutely devastating that the families recognised the problems and their voices were not heard. I would be very happy to meet him and the families to discuss that further.

[Alex Cunningham (Stockton North) (Lab)]

I join in the tributes to my hon. Friend the Member for Middlesbrough (Andy McDonald). As he and others have said, the report into the tragedy that saw three young women die in the north-east points to multiple failures by the Tees, Esk and Wear Valleys NHS Foundation Trust, which still struggles to deliver the services that our community needs.

The Minister will agree that the trust must learn from the tragedy, but it needs much more support to drive up standards and avoid more deaths. The trust, like many others, struggles to recruit the professional staff that it needs, because they are simply not available. I also question whether it has the capacity to drive the rapid improvement that we need. What plans does she have to intervene at the trust? What will she do to ensure that it and others can recruit the people they desperately need?

[Maria Caulfield]

As I said in my opening remarks, the trust is taking a number of steps urgently to improve its services, from investing £5 million on reducing ligature risks right through to looking at how it develops and implements care plans. However, the response must be wider than the individual trust. We must ensure that when inspections take place, they pick up the red flags that will alert someone to the problems happening in a unit. The CQC is also changing its inspection processes. It is vital that patients, staff and families can raise concerns if they have them and that they are properly inspected. We need to address this issue at a national level. The trust is not an isolated example—there have been a number of incidences—and both I and the Secretary of State want to be satisfied about exactly where the problems are occurring and that we have a national response, not just individual trusts having to deal with problems themselves.

[Liz Twist (Blaydon) (Lab)]

With young people’s mental health, we often talk about access to preventive services. That is hugely important, but here we have a tragedy of three young people who were in a mental health facility and sadly lost their lives. One can only send out our thoughts to their families and friends. As we review the mental health strategy and the suicide prevention strategy, what steps will the Minister take to ensure that the lessons learned are incorporated?

[Maria Caulfield]

I take the hon. Lady’s points. Indeed, legislation on the use of restraint has recently come in, which would have influenced some of the actions that perhaps happened previously. We also have the draft Mental Health Bill undergoing pre-legislative scrutiny in the other place, which may provide an opportunity to reconsider some of these issues. This place can inform that legislation going forward. I will obviously update the House on its progress.

[Rachel Hopkins (Luton South) (Lab)]

I refer the House to my entry in the Register of Members’ Financial Interests. Too many families are concerned about their loved ones as they wait ever longer for treatment, particularly in children’s mental health services. The Minister said that she wants to look at the system as a whole, so what conversations is she having with the Secretary of State for Levelling Up regarding local government, and local government finances in particular, ahead of the fiscal statement in a couple of weeks? Overstretched and underfunded children’s services in local councils up and down our country are often on the frontline of the crisis in children’s mental health.

[Maria Caulfield]

The Secretary of State will be having discussions around the autumn statement with colleagues not just in local government but across Departments. The failings that we have seen are of in-patient facilities—these young women had accessed treatment—so the issues are interlinked, but my main concern is about the safety of in-patient facilities. That is where my focus will be over the coming days.

[Rachael Maskell (York Central) (Lab/Co-op)]

The challenges are not confined to the Tees, Esk and Wear valleys, because the trust also extends to York. The extent of the trust and the size of the organisation perhaps explain some of the challenges. The reality is that the challenges are systemic and widespread. The trust has had 10 years of failed CQC reports, which should have easily raised a flag with the Department way before these tragedies occurred. As well as the steps that the Minister has proposed today, there should be a judge-led public inquiry into what is happening across mental health facilities. Nothing less will do.

[Maria Caulfield]

I thank the hon. Lady for making those points. As she knows, one of the facilities was closed in 2019 because of failing inspections and it has since reopened under another organisation, so action is taken where failings are found. My concern is that failings are often missed. That is why the director of mental health at NHS England wrote to every single trust on 13 September asking them urgently to review their services. As I said, I am taking advice and will report to the House in the coming days about what action we will be taking.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister very much for her answers. It feels like new cases of abuse of our vulnerable are coming to light weekly and it shakes our society to its very core. Every one of us is annoyed at what has happened. Humanity is judged by how we treat our most vulnerable and it appears that failures just continue to happen over and over again. How can the thousands of facilities that are doing right by their patients have trust in a system that sees them judged by the gross actions of others? Can the Minister confirm the additional support to ensure every facility has adequate staff and that controls are in place?

[Maria Caulfield]

The hon. Member is right and that is why I want to review at a national level. We are seeing a number of cases coming forward of unacceptable care in in-patient facilities. As more cases come forward, that gives confidence for others to speak out about the care that they or their loved ones received. That is why I want to take a national approach. Whether looking at staffing levels, practice, the ability to whistleblow when there are concerns, or the inspection process itself, we need to make sure that wherever someone is receiving mental health provision they are safe while they are receiving that care.

Black Maternal Health Awareness Week 2022

Maria Caulfield Excerpts

Wednesday 2nd November 2022 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 Gray. I thank the hon. Member for Streatham (Bell Ribeiro-Addy) for securing this debate. As she highlighted, we had a similar debate recently. I hope that my comments reassure her that we are taking action and making progress in this area.

I take the issue of maternal disparities very seriously; that is why when I was in post previously I set up the maternity disparities taskforce, which has brought together a range of specialists and campaigners. We have heard from groups such as Five X More and the Muslim Women’s Network to hear their views on what is going wrong right now, what systems we need to put in place to improve outcomes and also the experiences of black women in maternity services.

The data shows the disparities in black maternal health. We have heard about them clearly this morning, and I do not think anyone is in any disagreement about the scale of the problem we are facing. As the hon. Member for Streatham said, it is harrowing to hear those figures. The MBRRACE annual surveillance report shows that women of black ethnicity are four times more likely to die from pregnancy and birth compared with white women. I do not think there is a dispute about that; we fully acknowledge it and we want to reverse that trend as quickly as possible.

[Caroline Nokes]

I want to make a quick point about MBRRACE and the data. Data collection remains tricky, with some hospitals not reporting women’s deaths—not necessarily maternal deaths—until up to 500 days after they have happened. Then there is a delay with the medical records and notes, which might indicate the reasons for that. What reassurance can the Minister give that she will work to reduce those times?

[Maria Caulfield]

My right hon. Friend is absolutely right. Although Five X More does its surveys about the experience of women, the data on outcomes is very delayed. When we put measures in place, we cannot see the difference they make until the data comes through, roughly 18 months to two years later, as my right hon. Friend said. That lag does not help us determine whether the measures we are putting in place are actually making a difference. Getting that on track is a key priority for me so that we can accurately measure what is happening.

From the data that we do have, The Lancet series in April last year found that black women have an increased relative risk of 40% of miscarriage compared with white women, and the stillbirth rate in England for black babies is 6.3 per 1,000 births, compared with 3.2 per 1,000 births for white women. That is completely unacceptable, and as the hon. Member for Streatham said, we cannot come back here, debate after debate, without seeing those figures move. One potential cause for optimism is that we do not have up-to-date data on the benefits of the interventions that we have put in place, so it might be better than we think. However, we absolutely need that data, not only to measure what is happening, but to know whether we are heading in the right direction if we set targets in the future.

To reassure Members, I want to clarify the point about not setting a target because the problem is too small. I do not agree that the problem is too small; it is a significant problem. Even if it is affecting one or two women, it is a significant problem, so that is not a reason not to set a target. As the hon. Member for Putney (Fleur Anderson) pointed out, there are multiple factors in why black women often face poorer outcomes in pregnancy and birth, and for their babies. It is a mix of personal, social, economic and environmental factors. Air quality, which the hon. Member touched on, also has an impact on overall health. The maternity disparities taskforce found that being in a lower socioeconomic group has a significant effect on maternal outcomes, and black and ethnic women are often in those groups and so face a double whammy in terms of their likely outcomes.

We cannot just fix this in isolation at the Department of Health and Social Care. That is why I am pleased that in my role for women’s health—I am also the Minister for Women, across the board—I can bring in other Departments, because we need to take a cross-Government approach to this issue. Whether it is the Department for Environment, Food and Rural Affairs on air quality, the Department for Levelling Up, Housing and Communities on housing, or the Department for Work and Pensions on employment, we need to work together so that all the factors affecting black maternal health are addressed in tandem to address this issue.

We know from a health perspective that pregnant black women are more likely to suffer from some chronic diseases that will affect their maternity outcomes, and in particular cause poorer mental health. There are health initiatives that we can put in place to ensure that we improve the outcomes for black women, but that cannot be done in isolation from the other factors that also negatively affect them.

Given the risks that such conditions pose in pregnancy, there is a need for safe personalised care for black women and women from ethnic backgrounds, because the needs of women from each and every community are so different. Just nationally introducing blanket systems will not address some of the problems; there is no one single solution that will improve the statistics and improve the outcomes for women.

The issue is not just the outcomes from maternity services. As we heard from the hon. Member for Streatham, the Five X More survey also reflects the general experience by black women of the healthcare system. Although black women are often at a more difficult point to start with, when they engage with health services they often have a very negative experience. We have seen that in the recent publication of the East Kent maternity report and in the Ockenden maternity review, which highlighted that there is racial discrimination present in some parts of the maternity services.

We cannot allow that to continue, because if we want black women to come and engage with services and to come forward when they have concerns, if they feel that they are not being listened to or if they raise concerns and they are dismissed, why would we be surprised when they do not engage with services in the future? Regarding the East Kent report in particular, I will look at the calls for action on how we improve black women’s experience of the healthcare system and considering how we can address those issues as urgently as possible.

When we consider the actions that we are putting in place, and I will touch on some of the ones that have already started, I am very much a supporter of Professor Marmot’s idea of proportionate universalism, whereby we introduce good services across the country but then we target those people who are most in need; in the case of black maternal health, that is clearly women from the black community. We need to go to them rather than expecting them to come to the health service: we have a universal offer, but ensure that it is targeted specifically at those who do not experience the best outcomes.

On targets, as my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) touched on earlier, we have an issue with data collection across the board in health services, including in maternity services. Black women often experience the worst outcomes, although some of the data that we are seeing is from 2020. For some of the initiatives that we have put in place in the last year or 18 months, we are not yet seeing the benefit of those initiatives in terms of outcomes. I am being very candid here: we have not got a handle on what is making a difference, or on which parts of the country are doing well—as was acknowledged by the hon. Member for Bolton South East (Yasmin Qureshi), the shadow Minister, there are some very good practices in place—and which parts of the country are still not supporting women in the way that women want.

We are working with NHS England, the Office for National Statistics, MBRRACE-UK and the National Neonatal Research Database, because there are also multiple sources of data. We need to pull all the data together and get it as close to real-time data as we can, so that when we introduce interventions and measures we can know whether they work.

As part of the maternity disparities taskforce, I am also keen to make sure that we include black women more in the national patient survey, because the shadow Minister was quite right that we had over 100,000 responses to the women’s health strategy but only a small percentage of those responses came from black and ethnic minority women. That illustrates the problem that we are talking about—that black women do not feel represented, or do not feel engaged with the process. So we have to change things and work is being done to address that situation.

We are introducing some measures. First, we have set guidance that each local maternity system is now working in partnership with women and their families and their local areas to draw up equity and equality action plans. For each local maternity system’s local area, there has to be a plan in place about how to improve the outcomes for women. The plans are agreed by the local maternity systems and the new integrated care boards, which were set up in the summer. They were published last week, so I encourage hon. Members to look at their local action plans to see what they are putting forward and to challenge them if they feel that they are not meeting local community needs. That is why they are done on a local basis: what is appropriate in my constituency of Lewes may be different to what is needed in Streatham, Putney, Leicester East, or Romsey and Southampton North. It is really important that we look at those action plans to make sure that they address the problems that we are concerned about. Every plan is being reviewed by NHS England, which will identify areas of good practice and the support that is needed to drive them forward.

In addition, we have also commissioned 14 maternal medicine networks covering the whole of England, which will ensure that women have access to specialist management. We know that black women are more at risk of high blood pressure, diabetes and sickle cell anaemia and yet many of those risk factors for their pregnancy and birth are not dealt with or managed. The maternal medicines network will bring in specialists so that, at an early stage of their pregnancy, those women can access those specialists to help them manage their pregnancy. They will also be offered pre-conception advice for further pregnancies. We have never done that before. We are targeting the risk factors of black women, and all women who are at risk, to make sure that they get the medical support and advice that they need during and after their pregnancy.

The Department also launched the £7.6 million health and wellbeing fund last year, which is supporting 19 projects throughout England to try to generate best practice guidelines that we can introduce to help reduce disparities. These projects include supporting expectant young black fathers in child development and providing perinatal mental health support for black mothers. If we can get some evidence-based best practice, we can look to roll that out across the country in the coming months and years. There is a lot of work going on.

I will touch on the issue of racial discrimination. It is clearly unacceptable that black, Asian and ethnic minority women feel that the health service is not accessible or not responsive to their needs. There is education and training for NHS staff on health disparities to eliminate bias and racism in obstetrics and gynaecology. The Royal College of Obstetricians and Gynaecologists’ race equality taskforce has developed e-learning cultural competencies. They now form part of the colleges’ members continuing professional development. The Nursing and Midwifery Council is also looking at how to promote and embed equality and respect in professional practice, so that they can create an environment where everyone feels that they can access the services they need. We will obviously continue to look at this with the maternity disparities taskforce, which is bringing in campaigners, experts and professionals to try to drive momentum on this issue.

Data is the key. I can give a commitment here that has been highlighted already. We need that data. We cannot be working with data that is two years old to see if we are making a difference because, if we are, we will not know about it for two years and will not be able to roll out good practice in other parts of the country. In my brief as the Minister for Women, I am aiming to bring that across other Departments as well.

I hope I have reassured hon. and right hon. Members in today’s debate that I am committed to continuing the work to tackle the disparities in outcomes to ensure that everyone has the opportunity to live a long and happy life. I am happy to work with the APPG on black maternal health, which is chaired by the hon. Member for Streatham, because it is only by working together to identify good practice and raising it when things are not working well that we can eliminate the disparity: it is unacceptable that black women are four times more likely to die during pregnancy simply because they are black women.