Baby Loss Awareness Week

Patricia Gibson Excerpts

Tuesday 8th October 2019 Commons Chamber

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I begin by thanking the hon. Member for Eddisbury (Antoinette Sandbach) for bringing forward this debate. She and I and other Members of the House share a particular interest in this issue. I can hardly believe that another year has passed and we are once again reflecting on Baby Loss Awareness Week, which culminates in Baby Loss Awareness Day on 15 October. Once again, I wish to say that that day is particularly special to me, not just because it is international Baby Loss Awareness Day, but because it was on that day that my son was born stillborn at full term in 2009. He would now have been 10—a baby no more. I think of him every day; in that respect, I am no different from any other parent who has gone through this terrible trauma.

Every single bereaved parent who has lost a baby feels exactly the same about their baby whose life was ended before it could properly begin. That is why I have used my position as an MP, as far as I can, to raise awareness of this issue and help break the taboo around this awful experience. Many Members across this House have done the same. Baby Loss Awareness Day and this week are important. Sadly, every year more people are drawn into the appalling statistics of those who have lost their baby in whatever circumstances.

The theme of this year’s reflection is access to mental health support for those who need it in the wake of baby loss. Who could argue with that? Indeed, only last week some of us were in this very Chamber discussing women’s mental health. Access to mental health support in the wake of baby loss is important not just for mums, but for dads, too, and indeed extended family members struggling with the loss of a baby whom they had expected to be welcoming to the family. Today, more families will have suffered a stillbirth and will somehow have to try to cope with this appalling trauma.

Mental health support is very important for bereaved parents who need it, not just from a compassionate or moral point of view, although those are important, but from a practical, social and economic point of view. In past debates on the issue, I and others have spoken about the fog of grief that comes from having to bury your baby—the bewildering sense of the world being turned completely on its head. While 50% of marriages end in divorce, parents who suffer the loss of a child are eight times more likely again to separate and divorce, heaping heartbreak on top of heartache. Easier and more prompt access to the correct mental health support could help mitigate that awful statistic, and perhaps help parents who are struggling with grief to stay married, return to the world of work, and remain economically active, which can in time prevent the isolation that grief brings with it too often.

[Sarah Champion (Rotherham) (Lab)]

Before this job, I ran a children’s hospice. We were able to provide wraparound care to the whole family. We worked with hundreds of families in my time there, and I am really proud to say that because of that care, not one family separated.

[Patricia Gibson]

I thank the hon. Lady for her intervention. That is the kind of support we need to put in place, and I am about to talk about wraparound care.

We know that bereaved parents are more likely to develop depression and other mental health issues, perhaps turning to drink or other forms of self-medication, because we know that those who experience stillbirth or baby loss are at a higher risk of mental health challenges. Given what we know, there is really no excuse not to have measures in place in this awful eventuality for those affected by baby loss. The aftermath of baby loss is no more or less traumatic for those affected than living through the immediate experience and the years following it.

[Gareth Thomas]

I thank the hon. Lady for giving way. She is making a powerful speech, and I strongly support her call for better access to mental health support. I think of the difference that the four-hour target made to quality of care and access to accident and emergency doctors and nurses where needed, and I wonder whether we need a similar target in place, to ensure that trusts and the NHS in general can be accountable for whether access to mental health support is given quickly enough to people who are bereaved in these circumstances.

[Patricia Gibson]

I thank the hon. Gentleman for his intervention. The point I am trying to make is that because we know that these mental health challenges very often arise following baby loss, there is no reason why the infrastructure should not be in place for when these issues arise. Sometimes the demand is immediate, and sometimes it is months or years after. Sometimes people will choose not to call on these services, but the infrastructure needs to be there to ensure that people have access to it in a timely fashion.

Someone pointed out to me today a comment on social media from a chap who spoke about “awareness day fatigue”, but he also acknowledged the importance of those with lived experience feeling able and willing to speak about their experience of baby loss, because this can encourage others to talk of their own loss and perhaps seek the support and help they need. We with lived experience who choose to talk about it can also prevent others from going through the awful experience we had by raising that awareness, to stop other people joining the terrible club of which no one would ever wish to be a member.

Raising awareness is very important. It is not and must not ever become some trite stock phrase, although it may sometimes sound so. It is important because every day I wish to God that I had had some more awareness of pre-eclampsia and HELLP syndrome. I may then have been in a better position—I am sure many mothers would say the same—to articulate what was happening to me, instead of being told by the Southern General Hospital that I was wasting their time when I turned up on the day I was due to deliver my baby and that the terrible pain I was in was normal. What did I expect? It wasn’t labour—go home and lie down. Could I not see they were busy? Had I known more about pre-eclampsia, I would have been able to ask to be checked specifically for that condition, because I was not tested for it. I would have been more assertive, instead of being made to feel like an hysterical older expectant mother.

Raising awareness really does matter. Information matters because it can make a difference between life and death. We know that, too often, mothers are not listened to. Raising awareness cannot be seen as a trite phrase or a box-ticking exercise, and I know that many who have lived with the loss of their baby would say exactly the same.

The chap commenting on these matters on social media is right to say that the lack of mental health support must be addressed. We cannot be discharging mums to send them home to their partners and families and leave them to get on with it. They must have the mental health support they need to help them navigate as best they can the biggest loss and the most appalling experience it is possible for them to have.

We have, over the years, come a distance in the realms of baby loss. We have, with some success, shone a light on it and worked to remove the taboo, but we still need to do more to ensure that the isolation of grief does not swallow up those affected by this loss, which goes against everything that nature would suggest. We need to continue to work to break down the isolation, and we can do that with the proper mental health support to help those affected to find their way back to some semblance of normality and find a path through their fog of grief, so that they can rebuild their lives, albeit around the loss that they have suffered.

It is shocking to learn that the majority of bereaved parents who need help cannot access it in an appropriate place and at an appropriate time. This is because perinatal mental health services are focused on women who are pregnant or have a live baby. Last week in the debate on women’s mental health, many of us spoke about new mums needing mental health support—and that is true: they do—but this need not mean and must not mean that those mums whose babies have died are forgotten. They must not be forgotten; they must be given the support they need because we know that they are at risk of developing mental health challenges. We need to do more to ensure that the mental health infrastructure they need is in place to support them. Women who have experienced stillbirth, miscarriage or ectopic pregnancy are at a higher risk of post-traumatic stress disorder, anxiety and depression than those who have not. They also display clinically significant levels of post-traumatic stress symptoms from five to 18 years after stillbirth.

As I was reading some of the testimony from the Lullaby Trust in preparation for this debate, from women who had suffered stillbirth and described walking out of the hospital with no further contact about the support they might need, I recognised that because that, too, was my experience. I did not feel able to discuss my experience or participate in counselling, but that was just as well because it was never offered. In my case, the hospital was trying to dodge questions and withhold information about how my baby died.

In response to the point made by the hon. Member for East Worthing and Shoreham (Tim Loughton), who is no longer in his place, the demand for coroners’ inquests—or, in Scotland, fatal accident inquiries—into stillbirths, where they are deemed to be in the public interest, has risen only because of hospital trusts and health boards pulling down the shutters when things go wrong. That is where that demand comes from, and that has to stop: it has to change. Parents do not want to consult a lawyer when their baby dies; they just want to know what went wrong and how it can be avoided. That is something health boards and health trusts really need to do more to get their head around.

I am pleased that in Scotland there has been new investment in perinatal mental health to ensure that there is support for bereaved parents prior to discharge and that there is appropriate signposting to third sector services that can provide bereavement and other mental health support. We can no longer turn a blind eye to or overlook those who fall through the gaps in our health system. There must be psychological support for those affected by the death of a baby if they need it.

[Alison Thewliss (Glasgow Central) (SNP)]

My hon. Friend is making an excellent speech, and I commend her bravery in speaking up on this again; I know how hard that is for her. Does she agree with me that there needs to be support for women entering a subsequent pregnancy after that as well? That could be quite retraumatising for some women and quite challenging to deal with, and they need special support for that as well.

[Patricia Gibson]

I thank my hon. Friend, and I think she has made an excellent point. The shadow of a stillbirth will hang over any subsequent pregnancy, should it take place, and we need to be mindful of that.

[Carolyn Harris (Swansea East) (Lab)]

Will the hon. Lady join me in this poignant debate in saying how dreadfully sorry we all are that, on 27 September in Bronzefield women’s prison, a baby was born and died? We know no more than that at the moment, but it seems appropriate in this debate that we pay our respects to that baby and their mam.

[Patricia Gibson]

Absolutely. I absolutely share the hon. Lady’s sentiments. I think the important thing for all the people affected by that terrible loss is that they get the answers they need. We cannot turn back time, but what parents want are answers and explanations. To know that their baby mattered and that their loss is not going to be swept under the carpet is extremely important at those times.

I know there might be awareness day fatigue, but this particular awareness day does matter to those affected by baby loss. It is a week of remembrance, culminating in International Baby Loss Remembrance Day on 15 October. It is a space—a day—where we can collectively remember our babies, comforted by the knowledge that others have also experienced this indescribable loss and can understand the pain we feel. When you have experienced this, it really is easy to feel that no one could ever comprehend the scale of such a loss, but of course others who have gone through it do.

This day is not just about remembrance of our lost babies, although that is extremely important; it is a reminder that those who live with this are not on their own. Sadly, thousands of people in the UK and millions worldwide have suffered this loss. There are many who do understand, and more and more of us are willing to speak out. If we can take some of the isolation out of the grief for our lost babies and if we can give better aftercare to the parents who have suffered this loss, perhaps we could all have better mental health, despite suffering a loss of such huge magnitude in our lives.

Women’s Mental Health

Patricia Gibson Excerpts

Thursday 3rd October 2019 Commons Chamber

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I thank the hon. Member for Bath (Wera Hobhouse) for bringing forward this important debate about women’s mental health.

As the hon. Member for Southend West (Sir David Amess) and the right hon. Member for North Durham (Mr Jones) indicated, the prevalence of poor mental ill health among women is similar to that among men, but there is undoubtedly a marked gender difference in the rates for different types of mental illness: as we have heard, women are more likely than men to experience anxiety, depression, post-traumatic stress disorder and eating disorders, and we know that young women and girls are at more risk of self-harm. Recently, in my constituency, I had the privilege of visiting a mental health charity called Penumbra, which is in Ardrossan. It supports young people living with self-harm, as well as a range of other mental health challenges.

Reports published recently by organisations such as the Women’s Mental Health Taskforce have highlighted the fact that particular social inequalities faced by women, such as having greater caring responsibilities and sexual and/or domestic abuse, can have a negative impact on their mental health. Most commonly linked to poor mental health is the issue of living in poverty. In view of those facts, it is helpful and informative to debate mental health challenges faced by women in particular.

As the hon. Member for East Worthing and Shoreham (Tim Loughton) reminded us, there was a time, not so long ago, when poor mental health was not really talked about, but now we are more enlightened. There is a recognition that our mental health is as important as our physical health and that, when we face challenges with mental health, it is nothing to be ashamed of. It is therefore right and fitting for the subject to be debated in the House. Our concern with mental health ought not to be a party political matter. We are all concerned about it. Resourcing the illness and safeguarding those who are at risk matters a great deal.

Let me now say a few words about measures that we are taking in Scotland to try to deal with this problem, although whatever action is taken, it will never be enough to provide the treatment and support that women who suffer from poor mental health—and, indeed, anyone who suffers from poor mental health—need and deserve.

In Scotland, as in every other nation, we face challenges relating to mental health provision. I am pleased that, in the face of those challenges, the Scottish Government were the first Government in the United Kingdom to have a ministerial post dedicated to mental health, I am also pleased that they invested £1 billion in mental health in 2017-18, and that mental health spending increased by 3.2% over that period. With some innovation, I think, they have outlined their vision for approaching women’s mental health in their “Mental Health Strategy 2017-2027”, adopting a rights-based approach to mental health which realises the rights of women as outlined in the United Nations convention on the elimination of all forms of discrimination against women.

The Scottish Government’s “Programme for Government,” published only a couple of weeks ago, pledged to improve existing mental health support for women throughout Scotland, including perinatal support, and support for women who need more specialist help and those with the most severe illness. In terms of pounds and pence, that commitment was part of a programme budget for mental health increasing by £15.3 million, from £70.2 million last year to £85.5 million—an increase of nearly 22%. Of course, in the face of what some people may call a poor mental health epidemic, there is always a need for more resources, and it is the challenge of all Governments to work to meet those demands.

I want to say a word or two about the particular mental health challenges that can affect new mothers. They have been mentioned by a number of Members today, including the hon. Member for Bath, the hon. Member for Lewisham West and Penge (Ellie Reeves) and the hon. Member for East Worthing and Shoreham. New mothers and expectant mothers are an “at risk” group when it comes to poor mental health, and I am pleased that the First Minister of Scotland has given a commitment to spend £50 million on improving access to mental health services for them.

Of course treating mental health and providing support services for women who live with, or are at risk of developing, poor mental health is important, but it is also important that we all understand how much more can be done to safeguard women’s mental health in the first place. We obviously need a more joined-up approach. In Scotland, child and adolescent mental health services are working with schools, which is very important, but we should seek to deliver better training for teachers as well as GPs—who were mentioned by the hon. Member for Thurrock (Jackie Doyle-Price)—to deal with, and identify more confidently, poor mental health in children. We can always do better in that regard, as well as, of course, not forgetting to address the mental health of the GPs and teachers who are in the front line.

It is also important and necessary to mention—and it would be remiss of me not to do so—the effect of austerity measures on women and their mental health. We know that they are most affected by such measures, because much research by, for example, the Joseph Rowntree Foundation bears that out. Psychologists Against Austerity has made clear that cuts to public services are directly linked to mental health problems, and that women living in poverty are more likely to suffer post-natal depression. That finding was backed up by a study in The Lancet, which found that poverty increased maternal depression.

Actually, that should not surprise us. Poverty can be very isolating. If people are living in poverty, they have few choices about how to spend their time. They cannot always afford to meet up with friends, or afford the bus services that provide access to local services and amenities. They cannot simply leave their home for a change of scene, as they may struggle to visit the local cafe. All around, the world shrinks when living in poverty. Sometimes finances are so desperate that the world shrinks to simply their own four walls, and that sense of isolation can form a direct bridge into poor mental health. As the hon. Member for Thurrock set out, that overlaps with conditions such as autism, which often lead to poor mental health, as a sense of isolation of any kind has a significant impact on our mental health.

We know that austerity disproportionately affects women and, sadly, we also know that single household payments as the default for universal credit payments can exacerbate that isolation and loss of financial control. The loss of financial control is a common element in abusive relationships. I am proud that my former colleague, the former MP for the constituency of Banff and Buchan, Eilidh Whiteford, brought forward a private Member’s Bill to ratify the Istanbul convention. Sadly, the convention has not yet been ratified by the UK Government, which is deeply disappointing.

When we know that universal credit has been implemented in ways that negatively impact claimants’ mental health, we should seek to do something about it, as the hon. Member for Bath has pointed out. We know that single parents, 90% of whom are women, are more than twice as likely as any other group to experience persistent poverty. There are obvious things we can do to better safeguard the mental health of those women. As the right hon. Member for North Durham has said, that could actually save money in the end.

I sincerely hope that the Minister will be persuaded, in the light of the debate today, to have conversations, which may not always be easy, across Government Departments about how women’s mental health—and, indeed, mental health in general—can be better supported. This is not just about us thinking about resources to treat poor mental health, important though that is. It is also about giving more thought, more effort and more understanding to what is needed. It is about determining what factors lead to poor mental health and dealing with them, so that ultimately we see fewer people, fewer women, needing treatment for poor mental health, which affects far too many of our constituents. Dealing with the underlying causes of poor mental health is not just about what we can afford to do; it is about what we can afford to leave undone.

Living with Dementia

Patricia Gibson Excerpts

Tuesday 25th June 2019 Westminster Hall

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I am delighted to participate in this important debate on improving the lives of people with dementia. I begin by extending my thanks to the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) for securing the debate, and by applauding the excellent work in my constituency carried out by Quarriers dementia befriending service—I met people from the service only a few weeks ago—and its wonderful volunteers, who work so hard and do so much to improve the lives of those with dementia.

I must declare an interest in the debate, as my husband’s mother—my mother-in-law—is living with dementia. Watching an older person—I appreciate that we have heard about cases of younger people being diagnosed with this disease—make the descent from the person they used to be into someone who is so far removed from their former self is really distressing. My mother-in-law’s name is Iris Gibson, and before the illness took hold she was the longest-serving SNP councillor on Glasgow City Council at the time; she was a woman who was a keen runner, having participated in marathons all over the world; she was a woman who was never home but was always out at meetings or events in her council ward, or representing Glasgow City Council in her role as bailie at official functions; and she was a woman who was perfectly comfortable exploring foreign lands on her own when she took time for a holiday. Over an extremely short period of time, her children and I have watched her go from being all those things to being a woman who is easily confused, who is not always able to recognise her grown-up children and who has lost all sense of herself. If she could have seen, and if she had known, how her elderly years would play out, she would have been distressed beyond measure at the prospect. Her grown-up children, twins Kenneth and Janis, find her descent into dementia very distressing to see, as might be expected. This illness is cruel beyond words, and if anything can be done to improve the lives of those who are living with the disease and the lives of their families—we cannot forget their families—we need to do all in our power to deliver that.

Iris has had to surrender her own home and lives in a care home in Largs called Haylie House. She seems happy there, but the disease has robbed her of decades of memories. She appears to have forgotten so much of her life before dementia, which was a life she lived to the full. Sadly, that story of dementia can be told by every single person who has watched a precious family member fall victim to this disease, be robbed of the recollections of a life lived to the full in glorious colour and have that replaced by blank, empty spaces, where decades have simply vanished and are beyond the grasp of the person struck by the illness.

In the UK, 850,000 people are living with dementia. By 2025, which is not far away, that figure will rise to more than 1 million, and by 2050 it will rise to more than 2 million. I am concerned about how we protect those living in our communities who have this disease—they may not even have been diagnosed. Too often, as we have discussed in this place, such individuals are seen as rich pickings by those who seek to part them from their savings. As a society, we need to put structures in place to protect them, in every way. Some financial institutions have put measures in place to protect our older, vulnerable people. I am referring to measures such as monitoring their bank accounts and having a few days buffering the removal of unusually large amounts from their account to help to safeguard them against fraud.

What is really needed, as we have discussed in this Chamber before, is a legal duty of care from the business world and from the state towards older people—especially those with dementia—who need that extra layer of protection in a world where rogues and thieves are creative and cunning and older people, even those with dementia, are isolated in their own homes without sufficient support. That protection must be put in place. In my view, it should be a legal, statutory duty for all financial institutions to deliver that protection. Those living with dementia deserve nothing less.

As our population ages and people live longer, there are huge cost and care challenges to face in terms of how we look after our older people, and especially those who live with this cruel disease. Those challenges are faced by societies right across Europe and, indeed, the world, and we must do all we can to meet them, despite the difficulties. The Scottish Government are working hard to improve dementia care and have published a three-year dementia strategy, but one challenge, to which money is perhaps not the answer, is recruiting and retaining care staff, whether the care is carried out in an older person’s home or in a care home. Integration of health and social care services allows for more joined-up delivery of services, but the story cannot end there. It is the case that 43% of the Scottish Government’s entire budget—43%—is spent on health. That is before one penny is spent on schools, housing, roads, local authorities or anything else. The costs of social care can only grow and will continue to be hugely challenging, and we must continue to work to meet the challenges. The Scottish Government are looking very carefully at a report from Alzheimer Scotland called “Delivering Fair Dementia Care For People With Advanced Dementia” and some of the issues that it raises about continuing to work to improve the lives of those living with this condition.

I echo many of the comments that have been made today about the need for continuing and improved research into this condition. Given the numbers affected and the cruel erosion that this illness inflicts on those struck down by it, caring for those in our society who are living with dementia will never be easy. That will always be challenging, not least because of recruitment and retention challenges. We need to recruit and retain staff to carry out the caring that is required—that is very difficult—and we will need more people to carry out those caring roles. We can all agree that our older people must have the care and support that they need throughout this shocking illness. We must not lose sight of that. Our older people with this illness need us to get this right.

--- Later in debate ---

[Caroline Dinenage]

That is an interesting question. I do not know the answer, but I would be keen to look into it to find out. We are looking to explore ways to encourage the take-up of tier 2 dementia training. I recently co-signed a letter to health and care organisations with the chief executives of Skills for Care and Health Education England to highlight the importance of dementia training and education, which is a really important part of our discussions.

We are also meeting our commitment on Government funding for dementia research of £60 million or more each year, to reach at least £300 million invested over the five years up to 2020. The figure is actually more than £60 million this year—it is £83.5 million. In addition, we have the UK Dementia Research Institute, which is funded to the tune of £290 million: £190 million from Government and £50 million each from the Alzheimer’s Society and Alzheimer’s Research UK.

[Patricia Gibson]

I thank the Minister for giving way and apologise for the earlier interruption; I am glad it did not put her off her stride.

Much of what we have discussed today—the issues around this illness—are devolved to Scotland, but I want to press her on an issue that is not devolved: legal protection for older people with dementia. What measures can be put in place for financial institutions to have a legal duty of care to look after those people? In the debate we have focused on the practicalities of care, which is important, but we have to think about how we protect people in law in financial terms.

[Caroline Dinenage]

I thank the hon. Lady for that intervention. I am sure the slight disturbance caused by her mobile created a welcome distraction for everybody from my speech. I took note of what she said in her speech and she makes an excellent point about protections.

To go back to research funding, the incredible dementia discovery fund, which other Members have mentioned, was launched by David Cameron in 2015. It is the world’s largest venture fund aimed at a single disease area that looks to develop novel pre-clinical therapies. Our continued commitment to support research has also seen increasing numbers of people involved in the joint dementia research programme, with 20,000 people taking part in dementia research studies. To answer the question asked by the hon. Member for Vale of Clwyd (Chris Ruane), I am happy to meet and discuss any other research that comes forward.

Ahead of developing new treatments, we need to be able to support people to live well with dementia in their communities. The Dementia Friends programme, which a lot of people have mentioned—I am also a Dementia Friends champion—is a great example of increasing public awareness. Through the dementia-friendly communities programme—365 so far this year in England— we are making society more inclusive. We are supporting the National Dementia Action Alliance’s work to promote dementia-friendly hospitals across England through its charter to improve the care that people receive.

My hon. Friend the Member for Witney asked me about writing to the Department for Work and Pensions about improving its guidance to employers, which I will commit to do. We know that careful reforms are required to ensure that the social care system is prepared for the challenges of an ageing society, including for those with dementia. Many Members, including the hon. Member for Cambridge, mentioned adult social care funding. Many Members also talked about cuts to local authorities, but over the past year we have given councils access to an additional £10 billion: an 8% real-terms increase.

However, the fact that we are still talking about the social care system being on the point of crisis, at a tipping point or under huge pressure, shows the scale of the problem. That is why we have committed to publishing the adult social care Green Paper at the earliest opportunity. I share everybody’s frustration about the delays, but it will set out ideas for an element of risk pooling to save individuals from catastrophic costs, which some have spoken about today. We are committed to ensuring that everybody has access to the care and support they need. More short-term social care funding will be agreed alongside the rest of the local government settlement in the forthcoming spending review.

The NHS long-term plan sets out a 10-year strategy, outlining how the NHS will spend the £33.9 billion cash terms annual increase that will go into the NHS budget. We now know that around a third of dementia cases are preventable. Since 2018, every person attending an NHS health check in England—the hon. Member for Burnley (Julie Cooper) mentioned prevention—receives information about how to reduce the risk of developing dementia. It includes advice on smoking, safe levels of alcohol and being physically active. Between 2013 and 2018, nearly 7 million people attended health checks.

My hon. Friend the Member for Chichester (Gillian Keegan) mentioned Careline in her constituency. There are lots of innovative ways that technology can improve the lives of people with dementia. Jelly Drops are an ingenious way to tackle dehydration using sweet-like capsules. My local county council in Hampshire uses existing technology such as Amazon and wearable technology to help people maintain their independence, stay safe and combat isolation. All those achievements, brought together in the dementia challenge 2020, help to improve the lives of people with dementia, but we know that more needs to be done. We are committed to continuing to improve the lives of people with dementia, and of their families and carers.

Pre-eclampsia

Patricia Gibson Excerpts

Thursday 9th May 2019 Westminster Hall

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I beg to move,

That this House has considered pre-eclampsia.

I am delighted to have secured a debate on this important issue, and I thank my colleagues on the Backbench Business Committee for supporting it. The debate is timely because we are approaching World Pre-Eclampsia Day on 22 May. According to the House of Commons Library, the House has never had a debate about this extremely important matter, which affects every constituency, and every country in the world. Although I am surprised that there has been no previous debate, I am delighted that we are here today to put that right and to have what I hope will be a constructive, illuminating and considered debate. Before I proceed, however, I must say that I am extremely disappointed by the apparent lack of concern about this issue across the House, as we can see from the number of Members in the Chamber. Women and families who are concerned about pre-eclampsia will be equally disappointed by the poor turnout.

I want to pay particular tribute to Marcus Green, the chief executive of Action on Pre-Eclampsia, and all his team for all the support and information they have provided to me and all Members to help ensure that this debate is as well-informed as it needs to be. I applaud the work of Marcus, his team and others, including at the University of Liverpool, who expend huge personal and professional effort to combat and better understand the appalling condition of pre-eclampsia. I thank those who research this illness to help us better treat and manage it, because their work is ultimately about improving survival rates for mothers and babies when this condition occurs.

Pre-eclampsia is a very serious disease related to high blood pressure. It can strike out of the blue with no apparent warning—the word “eclampsia” is Greek for lightning. It can strike any pregnant woman, most notably in the second half of pregnancy, or up to six weeks after delivery. It is a symptom of new-onset hypertension and significant protein in the urine after the 20th week of pregnancy. There is no cure for pre-eclampsia, which is why treatment and management of the condition matter so much.

Identifying pre-eclampsia early is so important for mothers and babies; it can literally mean the difference between life and death. Globally, pre-eclampsia accounts for 14% of all maternal deaths, killing 40,000 women every year. Five women every hour die from pregnancy complications related to pre-eclampsia. Not surprisingly, poor outcomes for mother and baby are associated with poor care, which is most often found in low-income countries. Across the United Kingdom, our NHS services still face significant challenges with regards to pre-eclampsia.

The hon. Member for Banbury (Victoria Prentis), who is very sorry not to be here, suffered a stillbirth due to pre-eclampsia. My personal interest in this issue was sparked by the death of my son Kenneth, who was stillborn two days after his due date, after his birth was delayed while he was still alive and healthy. No reason was given for that delay; in fact, when I reported back to the hospital the same day in terrible pain—a few hours after being told my baby would not be delivered that day as planned—I faced obstruction and argument. I was repeatedly told to go home as there was nothing wrong. How that could have been established when I had not been examined was a question that was never answered, then or since. My husband insisted that I be admitted to hospital. I was later informed that had he not done so, I would certainly have died.

According to a leading consultant obstetrician, Professor Edward Shaxted of Northampton General Hospital, had NHS Greater Glasgow and Clyde reacted to the clear signs of my pre-eclampsia when I attended the maternity unity in pain, our otherwise healthy 8 lb 7 oz son would in all likelihood have survived. My husband and I commissioned a report from Professor Edward Shaxted after waiting for over a year in vain for NHS Greater Glasgow and Clyde to engage with us after the stillbirth.

When I reported to the hospital, I was neither examined, tested nor treated, but I was—bizarrely—injected with morphine twice. By the following morning, baby Kenneth was dead. I had developed a very severe form of pre-eclampsia called HELLP syndrome, a condition that is life-threatening to mother and baby. Not only did my baby die, but my husband was summoned to be told to say his goodbyes to me, as I was not expected to survive following a rupture of the liver. I was in a critical condition, and spent a number of weeks in a high-dependency unit.

While the mortality rate for HELLP syndrome is estimated by some to be as high as a massive 30%, Professor Shaxted’s report described the errors made in my case as “extraordinary”. He said:

“With a little thought it would have been recognised that Mrs Gibson had developed pre-eclampsia.”

My concerns were ignored despite the fact that my baby was due for delivery. The professor went on to say:

“Delivery of Mrs Gibson’s baby while still alive”—

on my due date, as planned—

“would more likely than not have led to the birth of a live child who would have survived intact.”

His conclusion was echoed by Professor Benjamin Stenson of the Royal Infirmary of Edinburgh, from whom we also commissioned a report. Anecdotally, I know that this experience is not unique to me.

We must continue to strive to do better at monitoring pregnant women and to listen to what they tell us, because being aware of, looking out for and dealing with pre-eclampsia must be on the radar of all professionals dealing with expectant mothers on the frontline. Recognition of the condition and early intervention are vital. When the signs are present, it is important they are not missed. Overall, maternal mortality across the UK has much reduced over the generations, but there must be no room for complacency, as there appeared to be in my case, and as I know there has been in others. I was labelled high risk, having undergone five years of in vitro fertilisation and being over 40.

When mistakes are made, they cannot be undone, but if we do not learn from them, that is disgraceful and completely unacceptable. Despite low levels of maternal deaths, there are still unacceptable levels of stillbirths and babies born being prematurely and/or underweight because of pre-eclampsia. Significant numbers of women suffer from pre-eclampsia in pregnancy. We know that screening and diagnosis are the cornerstones of safe management, and that deaths are preventable with good-quality routine antenatal care in pregnancy and evidence-based guidelines for antenatal care and the management of hypertension in pregnancy.

However, according to the Library, no NHS in the UK collects official statistics on the number of women who develop pre-eclampsia during pregnancy. We do know that there are around two maternal deaths due to pre-eclampsia every year in the UK, but no figures are recorded for how many babies die due to pre-eclampsia-related issues, although research by Imperial College London puts the figure at around 1,000 babies each year across the UK.

There is also no information published about how much pre-eclampsia costs the NHS across the UK. The lack of detailed information on this issue is quite staggering. I urge the Minister to ensure that such information is collected and recorded. I will lobby the Scottish Government to do the same. We need clear information to know the true scale of the challenge we are facing. One of the keys to meeting such a significant challenge is clear information.

This is a complex illness. It cannot be predicted with certainty who will develop pre-eclampsia or what causes it, although risk factors can be identified, including having a strong family history of pre-eclampsia, being over 40 years old, and being overweight or obese. Evidence appears to suggest that black and Asian women are more likely than white women to develop pre-eclampsia, which requires further investigation. It seems that black women are five times more likely than white women to develop pre-eclampsia, and that Asian women are twice as likely to develop it. We need to understand better why that is and to treat such patients accordingly.

There is also evidence that women who develop pre-eclampsia in pregnancy are at greater risk of developing cardiovascular disease and kidney disease in the longer term, shortening their life expectancy. At the moment, no part of the UK has standard care pathways to monitor the long-term health of women who have had pre-eclampsia. That needs to change. I urge the Minister to address that, and I will continue my conversations on that matter with the Cabinet Secretary for Health in Scotland, Jeane Freeman MSP.

The only cure for pre-eclampsia—if we can call it a cure—is the delivery of the baby, but that often means the baby being delivered dangerously prematurely, which throws up all kinds of moral dilemmas and is not always straightforward. Of course, pre-eclampsia is a progressive condition, which gets worse, so mother and baby need close and careful monitoring. We know that babies born underweight or prematurely are at greater risk of cardiovascular disease and diabetes in later life. We need ongoing research to find better treatments that reduce the risks to children whose mothers suffer from pre-eclampsia.

Let me say a little about the placental growth factor test. The symptoms and signs of pre-eclampsia are not always reliable or consistent, meaning that women may be admitted to hospital unnecessarily or have a severe case of pre-eclampsia that goes undiagnosed. Like too many other women, I know how tragic that can be. The PLGF test is a new blood test that indicates whether an expectant mother has the disease. When it is used on a woman with suspected pre-eclampsia, it can reliably indicate whether they will need delivery soon and whether the baby is at risk. It can also show whether the woman needs to be admitted to hospital and requires intensive monitoring to determine when delivery should take place, or whether it is safe to discharge her. Its use means that several other tests, which may not be so reliable, do not need to be done, saving our hospitals time and other resources. The PLGF test is available, and it must be provided regardless of where in the UK people live. I urge the Minister to do all she can to ensure that that is the case.

The PLGF test is an important tool that will help us make progress in combating pre-eclampsia by improving its diagnosis and treatment. NHS England will soon make the test available, and I am in negotiations with Jeane Freeman about it being made available in Scotland, too. The test is too important and too accurate, and the information it can yield too informative, for it not to be made available where necessary by health services across the UK. It will not just save lives; it will save money, and it will offer expectant parents huge reassurance about the health of their baby.

The Lancet published a study of implementation in England, which demonstrated that the test improved cost and clinical outcomes, with a 64% reduction in time to diagnosis, a 37% reduction in out-patient visits, and a 35% reduction in the use of bed nights for neonatal care. It seems that it is something of a breakthrough, and I think it has the potential to save many lives. With around 1,000 babies dying every year in the UK due to complications related to pre-eclampsia, this simple test offers real hope and gives us cause for optimism. It is a real milestone in how we treat this horrible condition, which can strike expectant mothers with no warning but with devastating, life-changing consequences for families. I hope that, one day, it offers real hope to women across the world—especially those in poorer countries—that mothers and their babies need no longer die.

World Pre-Eclampsia Day on 22 May deserves a place on our calendars. It deserves to be recognised this year and every year. More than 30 organisations recognise it, including Action on Pre-Eclampsia, Save the Children, the Preeclampsia Foundation and a whole range of others around the world. I urge the Government to ensure that more research is carried out into the condition so that better preventive work, as well as more and better treatments, can be developed. I urge the Minister to do all she can to ensure that women are educated about the condition and about how they might recognise and mitigate it.

As we approach World Pre-Eclampsia Day, this debate matters. Pre-eclampsia is killing our babies, and I believe we can and should be able to detect and treat it more effectively. I absolutely support the call from Action on Pre-Eclampsia to prioritise research into stillbirths from pre-eclampsia and to increase resources to support parents through the trauma of that. The UK has the lowest incidence of maternal mortality from pre-eclampsia in the world—that is not an accident; it is down to better care and attentive clinicians—but we have not found a cure. Until we do, and until we completely stop babies dying from this condition, we need to do more.

This is the very first debate on pre-eclampsia, and it is long overdue. I urge the Minister and the Government to commit to doing all they can to improve research, treatment and detection. We have come some way—we can see that from the number of deaths of mothers—but we must remember that 1,000 babies are stillborn as a result of this condition every year, so we certainly are not there yet. Let us work together to make as much progress as we possibly can.

--- Later in debate ---

[Patricia Gibson]

We clearly have a lot of work to do to raise awareness of this condition. The poor attendance in this Chamber is a clear testament to that, although I extend heartfelt thanks to my colleagues who have made the effort to come here today and speak.

As we have said—we cannot say this too often— 1,000 babies across the UK die each year from pre-eclampsia-related complications. That demands our attention and requires our action. We know and have heard today that diagnosis and treatment are not what they could be and often not what they should be. If we do not talk about difficult issues, we are extremely unlikely to tackle them or, indeed, prioritise them. With pre-eclampsia affecting about—this is an estimate —6% of pregnancies in the UK, it affects every single constituency. I say this to all constituents who are watching the debate now or who may watch it later if they catch a bit of the news on social media about it: if this is an issue about which you are concerned, I urge you to contact your MP and ask them to raise it at every opportunity, because that is how change happens.

I welcome the Minister’s constructive response to the debate, and I look forward to continuing to work with her through the all-party parliamentary group on baby loss, which deals with neonatal death. As she says, we know which women are likely to be at risk, so we need to ensure that the treatment of those women takes pre-eclampsia into account—that it is on the radar—so that we can better monitor them, and their babies’ lives can be saved as a result. It is also extremely important that women are listened to when they present to any medical professional. That cannot be stressed enough.

It is also important that the placental growth factor test is delivered, especially to those women we know are in at-risk groups. I am encouraged by the Minister’s mentioning the PHOENIX study, because I am hopeful that that will yield additional understanding that will improve treatment for pre-eclampsia.

As the Minister said at the close of her remarks, this is the first debate on pre-eclampsia, but I am pretty confident that it will not be the last.

Question put and agreed to.

Resolved,

That this House has considered pre-eclampsia.

Oral Answers to Questions

Patricia Gibson Excerpts

Tuesday 7th May 2019 Commons Chamber

[Stephen Hammond]

The hon. Gentleman will know that nursing and nursing associate training places are being increased; that more funding is going in to increase nurse training places by 25% every year, from last September; and that we are announcing an expansion of nursing associates. He will see tomorrow, when new figures are announced, that more nurses are working in the NHS than this time last year.

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

13. What recent discussions he has had with Cabinet colleagues on recognising 17 May as diffuse intrinsic pontine glioma awareness day.

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

The NHS long-term plan makes it clear that cancer survival is a Government priority, and we wholly support any activity to raise awareness of devastating cancers such as DIPG. The overwhelming message from two powerful debates last year, here and in the other place, spearheaded by the late Baroness Tessa Jowell, was that better outcomes for children and adults with brain tumours lie in better research. That is why we announced £40 million, over five years, to stimulate innovative brain tumour research, working alongside the Tessa Jowell Brain Cancer Research Mission.

[Patricia Gibson]

As the Minister will be aware, having DIPG awareness day on 17 May is very important in raising the awareness of this fatal illness, which is often overlooked and where the prognosis has not improved in the past 40 years, despite 40 children in the UK dying from it each year. How will the people suffering from DIPG benefit directly from the funding that she has outlined? Does she commit to keeping the House updated on measures to combat this serious illness?

[Seema Kennedy]

Let me begin by paying tribute to my constituent Paula Holmes, who made me aware of DIPG, and to all the work she has done in memory of her daughter Katy, one of the 40 children who died from it. We rely on researchers to submit high-quality research proposals in this difficult area, and the National Institute for Health Research has put out a highlight notice asking for research teams. We stand ready to translate any new discoveries as quickly as possible into new treatments and diagnostics for patients, and I am happy to keep the House updated.

--- Later in debate ---

[Matt Hancock]

My right hon. Friend is right to raise that. That money is already committed. Of the extra £33.9 billion that is going into the NHS, the biggest increase is going into community and primary care, because I understand how important it is for people to get decent access to their GP services in Witham and across England.

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

T2. The council chair of the British Medical Association recently said:“The only thing that is certain, is how disastrous leaving the EU will be for the NHS… no type of Brexit can ever offer the same benefits we currently have.”Does the Secretary of State agree with that sentiment, or can he tell the House how he thinks Brexit will improve the NHS?

[Matt Hancock]

No, the NHS is going to be there for us no matter what the outcome of Brexit is. The British people voted for Brexit, and we are going to deliver Brexit, and then we are going to get on to doing all the other things. Even over the last few months, we have been able to put extra money into the NHS to ensure that its future is guaranteed.

Leaving the EU: Health and Social Care

Patricia Gibson Excerpts

Tuesday 19th March 2019 Westminster Hall

[Brendan O'Hara]

Perhaps the Minister will answer that when he gets to his feet to respond.

How in the name of the wee man did the United Kingdom ever end up in this appalling, self-inflicted mess, in which the sick, the elderly and the vulnerable do not know who will be there to look after them, while healthcare professionals are unable to provide the comfort to their patients that everything will be all right? Only last week, Professor Andrew Goddard, president of the Royal College of Physicians, said that

“the public rightly expects candour from health professionals, and we have ultimately been unable to reassure our patients that their care won’t be negatively impacted by the UK exit from the EU.”

When the BMA wrote to the Prime Minister on 27 February, it left her in no doubt as to its thoughts, stating that

“there is no clearer immediate threat to the nation’s health than the impact of Brexit.”

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

Does my hon. Friend agree that part of the reason why members of the public and our constituents are so concerned is that we have no guarantee against predatory procurement in the NHS or against an interrupted supply of medicines, so how can people be reassured?

[Brendan O'Hara]

I could not have put it better myself. I thank my hon. Friend for that intervention.

Much more could be said on this topic, but I am keen for other Members to have their say. I will conclude with a number of questions, in addition to my earlier one, for the Minister to address when he gets to his feet. What assurances will he offer to each of the 102 organisations that supported my private Member’s Bill that the health and social care sector will not be adversely impacted by the UK leaving the European Union? What plans are being put in place to guarantee that the sector will be able to recruit the workforce it needs post Brexit? Will he support moves to amend the £30,000 minimum income threshold proposed for the immigration Bill, which will be so devastating for those seeking to work in the sector? Will he confirm once and for all that there will be no detrimental impact on the supply of medicines or devices if the UK proceeds to leave the European Union in a catastrophic crashing out? Finally, will he support my call for an urgent, full and independent evaluation of the effects of leaving the European Union on the UK’s health and social care sector?

--- Later in debate ---

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I thank my hon. Friend the Member for Argyll and Bute (Brendan O’Hara), whose constituency is almost as picturesque and beautiful as mine, for securing this debate.

The debate is extremely important, since we have had no evaluation, independent or otherwise, of the effect of leaving the EU on the UK’s health and social care sector. I heard what the hon. Member for Henley (John Howell) said, but the Royal College of Nursing pointed out that the Brexit process is presenting new and exacerbating existing

“challenges around workforce sustainability, recruitment and retention of the existing and future nursing community”.

That should be of concern to everyone in Parliament.

We know the health and social care sector already faces a recruitment and retention crisis, for a whole host of reasons, including poor pay, the lack of recognition of the important work and professional commitment of those in the sector, and the statutory and voluntary demands of a growing elderly population. We face similar challenges across the UK, but social care in England faces a critical situation, for a variety of reasons. I am therefore extremely disappointed that so few Labour and Conservative Members are present.

The context of this debate is important. The sector relies heavily on workers from the EU, but we have no plan for filling the gaps that are increasingly being left. I have been told in previous debates that no EU workers will necessarily be forced to leave the UK post Brexit if they have been here for a certain number of years and fulfilled certain conditions, but the Minister must recognise that the environment that has been created around Brexit means we will lose many of those workers, in the health and social care sector and beyond. Why should any worker stay in the UK when they can take their skillset and professionalism anywhere they wish in the EU, where they will be welcomed and appreciated? Sadly, that is something they do not feel very often in the current UK environment.

It is deeply concerning, because it is expected that by 2035 we will need 650,000 social care workers in the UK simply to keep pace with rising demand. That is in a sector that, as we heard from my hon. Friend the Member for Argyll and Bute, already faces a range of challenges. The challenges in England are well documented, but we in Scotland are not immune to them. The Care Inspectorate and the Scottish Social Services Council found that more than 38% of social care services report unfilled staff vacancies, even before Brexit has happened. Around 104,000 of the current health and social care workforce are EU nationals, and at any one time around 110,000 positions are unfilled. In addition, about 320,000 of those working in the sector are 55 or older, so they will retire in the next 10 years or so.

The situation is alarming, and the strains are affecting not just our social care sector but our entire national health service across the UK—our nurses, our doctors and our GPs. The situation could throw rural care in particular into real danger. For example, one in five of our rural GPs in Scotland is an EU national, and it seems likely that EU-qualified clinicians are already located disproportionately in hard-to-fill specialisms and shortage occupations such as radiology.

Medical isotopes are used to diagnose and treat cancers. In 2016-17, the NHS used radioactive materials in nearly 600,000 procedures. Those medical radioisotopes have a short half-life and cannot be stockpiled, even if one was minded to do so. The Royal College of Radiologists is preparing for difficulties in accessing radioactive materials by planning a lighter workload for the week following the date of our exit from the EU. However, that will hit patients who need and deserve treatment for their cancer. I mentioned that very point in a debate in the main Chamber two years ago and I was jeered and accused of scaremongering, despite the fact that I was simply quoting the Royal College of Radiologists. The jeering has stopped, but the challenges posed by Brexit are in no way receding; they are growing.

I do not have the relaxed attitude to these challenges that the hon. Member for Henley seems to have. Throw into the mix the UK Government’s inability to guarantee uninterrupted supplies of medicine, and the future looks grim indeed. That inevitably will affect our ability to look after the vulnerable and ill people in our communities in every constituency—the people who need care and the people who need support. Of course, that is in the wider context of NHS services across the UK being open to predatory procurement, which the UK Government refuse to guarantee will not happen.

No evaluation has been undertaken of the effect of leaving the EU on the UK’s health and social care sector. That is an absolute disgrace. The Government of the day have a duty to serve and protect those they seek to represent. Too little attention has been given to the calamitous situation that awaits us unless this Brexit madness, which has been characterised by confusion, incompetence, a complete breakdown of Cabinet responsibility and not a little arrogance, ends. Those who will bear the brunt and pay the price have not featured prominently enough in this unfolding tragedy. Today, their voices and concerns are being set out clearly. The Government should—they simply must—listen and do all they can to protect our health and social care sector, on which we all at some point will rely.

--- Later in debate ---

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bone. I am grateful to the hon. Member for Argyll and Bute (Brendan O’Hara) for bringing this time-sensitive subject to the Chamber for debate. It is my pleasure to speak on what must be the most important subject of the day.

It is true that in June 2016, the majority of people in the UK voted to leave the EU. However, they did not vote for a worsening of health and social care provision, for reduced access to medicines or for fewer nurses, doctors and care workers. They did not vote to damage medical research or to leave vulnerable people without social care. It is therefore important that we turn to some of the specifics and seek reassurance on behalf of the British people.

The question of medicines has been much talked about, not least this week in this place. Coming from a pharmaceutical background, I am extremely worried about the Government’s complacency. This is not about scaremongering; it is about listening to the real concerns of patients, patient groups and medical professions. Contrary to the comments made by the hon. Member for Henley (John Howell), it is not only helpful but vital for those groups to raise their serious concerns. I agree with the Minister that not only is it not Government advice to stockpile medication, but it is dangerous for patients to do so. One can understand why they might be driven to do so, however; it is an indication of the Government’s failure to provide reassurance on that point.

Medication forms an important part of NHS care. Each year, 1 billion prescriptions are dispensed by community pharmacies. For patients with long-term conditions, such as diabetes, asthma, epilepsy and many more, daily medication is an essential part of staying well. Whether we are talking about medication to treat cancer or heart disease, medication for the management of high blood pressure or the occasional prescription for antibiotics, we take it for granted that the medication that we need will be available when we need it.

The pharmaceutical industry is, by definition, an international business. Key ingredients are often manufactured in India and the far east, and transported to specialist manufacturing plants. Many of the plants that supply the UK are located elsewhere in Europe, and the finished products have to be imported into the UK and distributed to hospitals and pharmacies for use with patients. The entire process has to be carefully managed to ensure that everything happens in a timely way. That is particularly true for medicines with short shelf lives, such as the lifesaving EpiPens needed by those with severe allergies. It is also true for medicines with special storage requirements, such as insulin, which has to be kept refrigerated.

[Patricia Gibson]

A number of us are deeply concerned that because some people in this place are enthusiastic about Brexit, they are wilfully blind to some of the challenges that the hon. Lady is talking about. Does she agree?

[Julie Cooper]

I absolutely agree. We cannot dismiss concerns just because we do not like their implications; it would be irresponsible to do so. Delivery into the UK is currently a just-in-time service for the pharmaceutical industry, for many of the reasons I have mentioned. It is true that in the long term, there is some manufacturing capacity in the UK and we could change the way we get our supplies, but that is not going to happen overnight. It would take a considerable amount of time, given the stringent safety requirements involved in the manufacture of safe medicines, for us to be able to do that.

I am not convinced that we have sufficient supplies or that sufficient steps are in place to ensure an uninterrupted supply. People, including those who rely on insulin, are legitimately worried. Breast cancer care organisations have raised the issue of access to radioactive isotopes needed in the vital treatment of breast cancer. It would be irresponsible of them not to raise that. It is extremely worrying, given that we have only 10 days until the UK leaves the EU, that there are still no arrangements in place. There is no doubt that the UK will need time to establish new supply chains, which is perfectly possible. It is not scaremongering. [Interruption.] I thank the Minister for the comments he has just made from a sedentary position, but we are not convinced. It we were to leave without a deal, the effects would be catastrophic.

--- Later in debate ---

[The Minister for Health (Stephen Hammond)]

It is a pleasure to see you in the Chair this morning, Mr Bone. I will start by addressing the remark by the hon. Member for Burnley (Julie Cooper). She should know that the whole of the Department of Health and Social Care, and indeed the whole of the Government, are absolutely committed to ensuring that there are in place detailed plans, which I hope I will be able to outline and reassure hon. Members about, to ensure that in any post-Brexit scenario the health and social care of our country’s citizens is our top priority.

I thank the hon. Member for Argyll and Bute (Brendan O'Hara) for securing the debate and commend him for his private Member’s Bill. He will know that the Government do not support his Bill—although we support the spirit of it—in part because, as the contribution from the SNP Front Bench showed, it is unnecessary. He is arguing for an independent evaluation and careful analysis of Brexit, but I thought the contribution from the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), frequently citing the Health and Social Care Committee, proved that there is a huge amount of independent evaluation, accountability and scrutiny of the plans.

The hon. Member for Argyll and Bute raised a number of questions. I have with me a prepared speech, but I am not sure I will get on to it, because I want to address as fully as I can some of the concerns that hon. Members have raised. He raised a number of concerns about the social care sector, and he is right to do so. Brexit or no Brexit, it is a fragile sector and any event could hinder care provision. That is why, in the light of Brexit, we are working with the sector and local authorities to ensure that we have contingency plans in place.

I will speak more, if I have time, about what we have done regarding EU nationals in the short term, but I want to stress, as the hon. Member for Burnley did, my thanks to all EU nationals who work in either the healthcare system or the social care system. They play a crucial role in delivering high-quality health and social care, and we all recognise that. It is a fact, of course, that the number of EU nationals in adult social care has increased each year, from about 5% in 2012-13 to 8% in 2017-18, but that is no reason to be complacent. That is why we have put in mitigations regarding the EU settlement scheme and are implementing long-term policies to deliver the workforce and address the supply-demand gap that exists.

The hon. Member for Argyll and Bute will of course have noticed the recent recruitment plan, Every Day is Different, which started only last month. As he challenged me directly on this, I can say that we are currently in discussions with the Home Office about the salary threshold for social care.

My hon. Friend the Member for Henley (John Howell) spoke eloquently, as he always does—I have heard him speak in several of these debates—about Henley and other matters. He challenged me to visit Henley, which I would be delighted to do—perhaps on a Friday in July, when other events are on as well.

The hon. Member for North Ayrshire and Arran (Patricia Gibson) asked a number of questions. I made this clear at the start of my speech, and I will make it clear again directly to her: we value all the professionals who work in the national health service and the social care sector. We are putting plans in place, both short term and long term, to ensure that our words are followed by actions and there is practical support, and to ensure that people know how much they are valued. I heard her charge of arrogance, but she might like to reflect on the fact that some might consider it arrogant to suggest in any way that this Government are not putting in place all the necessary preparations to protect the NHS.

[Patricia Gibson]

Will the Minister give way?

[Stephen Hammond]

I will not take an intervention. If the hon. Lady listens carefully to my remarks, she will understand why some of us feel that her charge was unfair.

[Patricia Gibson]

Well, explain it.

[Stephen Hammond]

I am about to, if the hon. Lady will give me time, which is why I will not take her intervention.

The hon. Member for Strangford (Jim Shannon) asked about NHS investment. He knows, of course, about the increase in cash terms of £33.9 billion by 2023-24, which reflects, as I said at the outset, our top priority. He also challenged me about the cancer workforce. Baroness Dido Harding, the chair of NHS Improvement, is carrying out a rapid programme of work for the Secretary of State, engaging with relevant stakeholders across the system to build a workforce implementation plan, which the hon. Gentleman mentioned. We have charged her with making sure that her plan matches the long-term plan’s ambitions. The hon. Gentleman will know that the long-term plan superseded previous plans to establish a larger cancer workforce, and Health Education England is now working with Baroness Harding to make sure that is in place.

I listened carefully to the hon. Member for Glasgow East (David Linden), who asked important questions about insulin and the financial impact of leaving the EU on cancer patients. My officials spoke this morning to insulin suppliers, who have increased their buffer stocks so that they will hold 16 weeks of additional stocks over and above their normal supply. [Interruption.] Yes, it is stockpiling, but it is stockpiling that we have asked the whole pharmaceutical industry to undertake. As the hon. Member for Burnley rightly pointed out, there should be no stockpiling by individuals or pharmacists. I will explain the whole stockpiling issue and why we are rightly putting in place buffer stocks to ensure continuity of supply. The hon. Gentleman asked me whether buffer stocks of insulin are in place, and I can confirm that they are.

The hon. Gentleman also asked me what assessment has been made of the financial impact of EU exit on cancer patients, and what measures are in place to protect services. He will know that the long-term plan contains clear proposals for improving cancer diagnoses. That plan is fully costed. As I just said in response to the hon. Member for Strangford, the workforce implementation plan is putting in place the cancer workforce.

I also listened carefully to the hon. Member for East Kilbride, Strathaven and Lesmahagow, who asked whether my door was open to chairs of all-party parliamentary groups. The answer is yes, of course. If she wishes to contact me, I would be delighted to engage with her, and with chairs of other all-party parliamentary groups.

It is also worth putting on the record the relationship that we are likely to have with the European Medicines Agency post Brexit. The Government are clearly striving for a deal, and in the light of the withdrawal agreement being signed, the political declaration sets out that it is the UK’s intention to explore the possibility of EMA co-operation during negotiations on the future framework. In the event of no deal, we would clearly no longer be any part of the EMA, and the Medicines and Healthcare products Regulatory Agency is ready to carry out EMA functions as a sovereign regulator.

To ensure the continuity of supply, the UK will continue to accept batch testing of human medicines carried out in countries named on a list by the MHRA, including EU, European economic area and European Free Trade Agreement countries, and most third countries with which the EU already has in place a mutual recognition agreement.

[Patricia Gibson]

I thank the Minister for giving way; I know there is a lot that he wants to say. As he is talking about ensuring the supply of medicines, can he reassure the House that that includes medical isotopes?

[Stephen Hammond]

I reassure the hon. Lady that we have been working since last August to ensure that companies understand the routes available to maintain continuity of supply, including air freight routes. We will ensure the potential use of those alternative shipping or air freight routes because, as she rightly points out, these are short-life products. The worst-case scenario—no deal—has been looked at, and routes will be available to ensure that medical isotopes can continue to come into this country.

The hon. Lady referred in her speech to the operationalisation of those plans, which is relevant. Normally, if sea routes are used, it can be ensured that medical isotopes or short-life products are at hospitals by 9 am. She referred to the likelihood that, if air freight routes are used, those products would not arrive until midday, which the NHS advises us would mean that some clinics would be likely to be rescheduled to later in the day. People’s opportunities to undergo treatment will not be interrupted.

Eating Disorders Awareness Week

Patricia Gibson Excerpts

Wednesday 27th February 2019 Westminster Hall

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I thank the hon. Member for Angus (Kirstene Hair) for having secured this important debate, and I am delighted to participate in it, although I wish it was not necessary. A debate about Eating Disorders Awareness Week is, of course, very important.

Despite what we have heard, in so many ways, we have come so far with regards to this illness. I think back to someone of the stature of Karen Carpenter, who died in 1983 at the age of 32, when I was 15 years old. Those of us among the general population who mourned her passing did not appreciate what an eating disorder was. It has to be said that we are still learning, but we are having this debate during Eating Disorders Awareness Week, at a time when the general public are more aware—and becoming much more aware—of an illness that so many people can fall prey to. This week is an international event that aims to raise further awareness of the issue of eating disorders, and the stigma that too often goes with them. Charities work hard to encourage people from all walks of life to come forward, because as we have heard, this illness respects no gender, no class and no race.

This week, the UK eating disorder charity Beat has continued to work very hard to break down the barriers that so many people face when they try to access support. It is important that those living with this condition and their families know that they are not alone, so sharing stories of how an eating disorder has affected others from all walks of life can be a powerful tool. Those who are in the darkest days of this disorder can be greatly comforted by hearing the stories and experiences of those who have lived with it, but have come through it and are in recovery. However, we also need to remember, as we heard earlier, that eating disorders can still be present during the process of recovery, and indeed can overshadow a person’s entire life, even when recovery might seem a long time ago.

One of the key barriers to tackling eating disorders is that too often, they are stereotyped and not taken seriously. Only by continuing to raise awareness of the struggles that sufferers go through, by talking about eating disorders in places like this and by supporting charities in their outreach work, can we make the change happen that we all want. We have heard—it is worth repeating—that social media has brought added complications to dealing with an already complex condition. Our young people are immersed in social media, a forum that projects so-called “perfect” images of lifestyles and bodies, and given how much young people are exposed to those images, it is not difficult to see how a young, vulnerable person could lose sight of what looks healthy or real. We know about the scandal of particular websites advising people on how to not eat without it being noticed by friends and family, which is very chilling indeed.

We need to continue to drive improvements in mental health services and ensure that everyone who needs high-quality mental health services, including people with eating disorders, has access to the care that they need when they need it. There is no denying that there have been positive first steps in increasing the visibility and public awareness of eating disorders and mental health challenges over the past decade. However, the demand on mental health services is so great that we must always seek ways to do better by those who need the specialist support that those conditions require.

Challenges remain for mental health services across the United Kingdom, and it is worth remembering that since the year 2000, the number of people diagnosed with eating disorders has risen by 15%, and that hospital admissions for adult males suffering from an eating disorder have risen by 70% over the past six years. That demonstrates the scale of the challenge that we face. On top of that, on average, it takes about 149 weeks before those experiencing an eating disorder even begin to seek help—that is almost three years lost. Offering support in ways that match young people’s lives—in fact, these days, all people’s lives—means increasing the amount of online peer support that can assist with recovery. That peer support allows someone living with this disorder to pair with a trained volunteer who has recovered from an eating disorder, who can share their experiences and offer support as and when it is needed.

Having this week dedicated to raising the profile of this illness, talking about it, and recognising its complexities and its stigma is a good start, and represents very good progress from where we were in the 1980s, when so many of us could not understand how Karen Carpenter died or appreciate the full extent of the difficulties that her family had gone through. We have come a long way, but we have a long way to go, and this debate shows that we are keen to go further down that road.

Appropriate ME Treatment

Patricia Gibson Excerpts

Thursday 24th January 2019 Commons Chamber

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I have a very short time, but I hope this debate will raise awareness of this condition. It is still an illness that people very often do not know much about, despite the fact that 250,000 people in the UK are affected by it, with about 20,000 of those living in Scotland. Despite all this, there are still no effective treatments for this life-changing, life-stealing and cruel condition. We need our frontline GPs to have proper training so they feel equipped to diagnose and are more confident in the treatment of this condition.

Although recent investment by the Scottish Government is very welcome, it is nothing more than a start for this very long-neglected and misunderstood condition. I am keen to hear what action the UK Government will take to increase awareness and understanding of this condition, and to help us understand the causes of the illness, so that we can improve its diagnosis and treatment.

Having listened to speeches from across the House, I have no doubt that we need a concerted effort right across the UK to tackle this illness. I very much look forward to hearing the response from the Minister. Before I sit down, I want to extend my thanks to my hon. Friend the Member for Glasgow North West (Carol Monaghan) for bringing forward this debate, and for all the work she has invested in bringing the subject to the House and raising Members’ awareness of it.

Baby Loss Awareness Week

Patricia Gibson Excerpts

Tuesday 9th October 2018 Commons Chamber

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I want to begin by echoing the words of the hon. Member for Banbury (Victoria Prentis), who is no longer in her place, that this is indeed one of the most difficult debates—if not the most difficult, debate—in the entire parliamentary calendar. It must be debated because it is too important for us not to. A number of my colleagues would have dearly liked to participate in this debate today, but, sadly, our conference is not accommodated in the recesses of Parliament, so therefore they were unable to be here.

As the hon. Member for Colchester (Will Quince) has pointed out, this is the third year that we have made a special effort in this House to mark Baby Loss Awareness Week, which culminates in International Pregnancy and Infant Loss Remembrance Day 2018 on 15 October. In a cruel twist of fate, sadly, that is the same date that my own baby was stillborn at full term in 2009. Kenneth would have celebrated his ninth birthday on that day. It is in his honour that I began to talk and to campaign—and will continue to talk and continue to campaign—about this issue. I want to shine a light on it to break the taboo around it and to break the silence that we all know exists and that we are all working to change.

I want to thank my fellow members of the all-party group—the hon. Members for Colchester, for Eddisbury (Antoinette Sandbach) and for Banbury. As a Scottish member of that group, I like to think that I am able to provide a Scottish perspective. Health in Scotland is devolved, but on this issue, as in all issues, I believe that where we can work together and learn from each other then we most certainly should do so, because this issue is certainly above politics. I also want to thank all those across the House who have championed the issue of baby loss and shared their personal and painful experiences and circumstances, as well as the charities that work on the frontline every single day, helping bereaved parents through this life-changing and traumatic event, as the hon. Member for Eddisbury reminded us and others in this debate have pointed out.

It is important for all the parents, grandparents, aunts, uncles, brothers and sisters who have been affected by such an appalling tragedy as baby loss to know that even though they feel isolated in their grief, they are not alone. Sadly, the tragedy of baby loss and stillbirth is terrifyingly common, with around 6,500 babies dying before or shortly after birth—one baby every hour and a half. During this debate, two babies have died. Some 4,000 of these 6,500 babies are stillborn, with another 2,500 surviving for less than a month after birth.

We are all working to the same end in this House and across the UK—to reduce these terrible statistics. Behind each one is a family devastated by grief, living under the shadow of the pain of this for the rest of their lives, while appearing to function normally on the surface, because the grief of losing a baby and all the hope invested therein does not go away. Families and parents simply find a way to learn to live with it somehow. However, I am pleased to say that progress is being made. The hon. Member for Colchester made a good point about back-slapping, but I do think that we have to acknowledge it when we make progress.

Although we are not yet there, Scotland is now close to the high standard set by Nordic nations in minimising stillbirths and early infant deaths. I was very pleased to read that, according to a University of Leicester study, rates have fallen across the entire UK, with Scotland leading the way, although of course there can be no room for complacency. The rate of stillbirths and deaths of babies within 28 days in Scotland was 4.72 per 1,000 live births in 2017, which compares with the Nordic rate of 4.3. Probably everybody here who has an interest in these matters—I think that we all do—will know that Norway, Sweden, Denmark, Finland and Iceland are generally regarded as having the gold standard in neonatal survival. The 2015 rate of stillbirths and deaths of babies within 28 days of birth for the entire UK was 5.61 per 1,000 live births—a drop from 6.04 in 2013. So, yes, improvement has been made, but this is not job done; far from it. Nevertheless, it is extremely welcome progress. Prevention is, and absolutely must remain, the key.

Mary Ross-Davie, director of the Royal College of Midwives in Scotland, has said that in recent years Scotland has undertaken very important work in this area that has improved outcomes for Scotland, with the national stillbirth group established in 2013. In addition, we have had the Maternity and Children Quality Improvement Collaborative since that time. Moreover—as we have heard about today with regard to England—the Scottish Government have funded the national bereavement care pathway, which will benefit bereaved parents across Scotland. I think that this is being rolled out in parallel with the care pathway in England.

The pathway is important because it seeks to improve the quality of bereavement care experienced by parents and families at all stages of pregnancy and baby loss, so that all bereaved parents across the UK can expect the same high-quality, sensitive bereavement care that they need and deserve. It is still in the process of being established, and it will involve collaboration and partnership with baby loss charities and stakeholders, and so it should. The stillbirth and neonatal death charity, Sands, is working with—and will continue to work with—the Scottish Government, other baby loss charities and other healthcare partners in Scotland to develop the approach over the next two years, with the plan to pilot, implement and embed the pathway across Scotland by March 2020.

When the worst happens and parents must face this nightmare, it is important that the correct support mechanisms are in place. That is the least that can be done, but sadly this was not always the case in the past, when bereavement care experienced by parents and families during pregnancy or shortly after birth could be patchy and variable, as the hon. Member for Banbury pointed out and to which I can personally testify. Support and the right kind of care in the immediate aftermath of such a life-changing event can make all the difference to those affected, as we heard from the hon. Member for Eddisbury.

I have lobbied the Scottish Government, who are now also investigating the provision of fatal accident inquiries for stillbirths in some circumstances, as was mentioned earlier. This is another mark of how far we have come and it is a huge step. Nobody should underestimate the complexity of this step forward—of the fact that the issue is even under discussion and investigation. It is also being explored by the Department of Health in England.

Currently, until a baby lives independently of its mother, any change in the law here would be profound and require the law around it to be looked at very carefully. Of course, no one would expect a fatal accident inquiry—in England, a coroner’s inquiry—to be carried out routinely following a stillbirth, although it may be appropriate in very specific circumstances, not as a way of seeking to punish anyone who may have made mistakes, but as a learning tool to better inform medical practitioners as they carry out and seek to improve antenatal care. The only reason that this idea has even been raised at all is that in the past many hospitals have been extremely reluctant to investigate stillbirths fully and transparently. Parents often report feeling excluded from the process and denied proper answers to the question, “Why did our baby die?” We know that sometimes it is not possible to answer that question; sometimes we just do not know. But when explanations or information can be given, they should be. Any relevant information needs to be shared with bereaved parents. The fact that it has not been in the past is not good enough, and it is hoped that the bereavement care pathway and a more transparent ethos around baby loss will help to address these issues.

Of course, we could not measure progress and the support that parents and families can access without mentioning the Parental Bereavement (Leave and Pay) Act 2018, which we heard about earlier in the debate. This legislation means that, for the first time ever, bereaved parents who lose a child up to the age of 18 years old are entitled to statutory paid leave under the law. Parents who go through a stillbirth are also protected.

An age-old wrong has been corrected in this legislation. The law has rightly recognised the enormity of losing a child and the protection in the workplace that parents should be entitled to expect as a right, not as a gift conferred on them by their employer. I thank everyone in the House whom I had the privilege to work alongside on this legislation, particularly the hon. Member for Thirsk and Malton (Kevin Hollinrake), whose approach was sensitive and reflective; for that, I think we all thank him. The Act is not perfect, but it is ground-breaking and I am sure that it will evolve over time.

Another measure that will help with baby loss is the move in England to permit the registration of babies lost before 24 weeks’ gestation. The Scottish Government are also actively looking at this with input from professionals in the field and baby loss charities, examining the current system, its effects and how a potential voluntary registration process or other kind of process could work in practice. Certainly, parents who lose their baby before the 24-week threshold—when it is classified as a miscarriage, rather than a stillbirth—often feel that their loss is dismissed, officially at least, because there is no documentation to testify to the fact that their baby existed, was eagerly awaited and that their loss has left a lasting impact on the entire family.

In such cases, the opportunity to register their baby’s death may provide many parents with some comfort at an extraordinarily difficult time. For that, if nothing else, such a provision must be seriously examined. We are all mindful of cases we have heard about whereby twins are lost—one before the 24-week threshold and the other after it—but only one baby is eligible for registration. Imagine being the parents going through that. It is not hard to see how much worse that makes parents and families feel. That is something that we are looking at in both England and Scotland—it is something that we should look at, and it is time that we did so. All that can be done to ease the trauma of losing a child must be done.

The speech that I have delivered today on this issue is, thankfully, more optimistic than previous speeches that I have delivered on it. Progress has been made, and I am delighted about that. Slowly—very slowly, but we are getting there—we are beginning to break the taboo on this issue, which demands that we move forward. We have come some way, but there is still much to do, and the hon. Member for Eddisbury pointed out some sobering examples in England and Wales. According to Embrace, 15 babies are stillborn or die within the first 28 days of life, and 80% of stillbirths and deaths that are investigated could have been avoided with better care. We can and must do better, and progress in recent years shows that we are capable of doing so. For my part, as a Scottish MP, I will continue to communicate with the Scottish Government and maintain a dialogue on this matter. I will also work with the all-party parliamentary group on baby loss.

We have discussed the emotional trauma of baby loss, but we should remember that there is also a social cost. Parents who lose a child, whatever the circumstances, are eight times more likely than their counterparts to divorce. They are more likely to drop out of the workforce, perhaps never to return. We have to do everything that we can to support parents in this position. The former Cabinet Secretary for Health and Sport, Shona Robison MSP, was receptive to concerns that I raised with her. Her successor, Jeane Freeman MSP, has continued very much in the same vein. I very much look forward to next year and continuing to work to challenge the silence, taboo and difficulties surrounding baby loss and neonatal death. Cross-party work has never been so constructive, I suspect, and on an issue that we all care about and which impacts all too often on too many families in every single constituency across the United Kingdom. We have a duty to work together, we have a duty to make things better, and we have a duty to break the silence.

Care Homes: CCTV

Patricia Gibson Excerpts

Wednesday 5th September 2018 Westminster Hall

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I thank the right hon. and learned Member for Beaconsfield (Mr Grieve) for securing this debate and for the considered way in which he set out his powerful case. Increasingly in recent years allegations of abuse in care homes have been the subject of television documentaries and newspaper reports, as the right hon. and learned Gentleman pointed out. They have even given rise to parliamentary petitions.

We heard today the case for the installation of CCTV cameras in communal areas in care homes. It is easy to see how cameras could help to prevent the abuse of vulnerable and elderly people. We have certainly seen in the past how hidden surveillance has exposed disturbing and serious abuse of very vulnerable people, much of it long standing, such as in, to name one example, the Winterbourne View hospital, as the hon. Member for Montgomeryshire (Glyn Davies) pointed out. As the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) said, we do not want to let the shocking examples of poor care that have been publicised to allow us to forget that some care homes, perhaps the vast majority, provide excellent care to some of the most vulnerable members of our communities across the United Kingdom.

Some of the information set out for us today by the right hon. and learned Member for Beaconsfield is truly shocking, but we can all agree that there is a balance to be struck between protecting the vulnerable in care homes and protecting their privacy. There can be no doubt that CCTV can be helpful in some circumstances. The Mental Welfare Commission for Scotland stated:

“There are serious human rights considerations in relation to the use of hidden surveillance, but we do not argue that it should never happen.”

The right hon. and learned Gentleman pointed out that if CCTV is to be introduced purely in communal areas, the arguments about invasion of privacy become less urgent. If those receiving care have the capacity to consent to being filmed, they must also have the right to refuse, as suggested by the hon. Member for Montgomeryshire. No one should be placed under surveillance without their agreement, but if there is concern that a vulnerable person is being mistreated or abused in some way, the local authority can consider other adult protection measures.

Regardless of how well intentioned, there can be no denying that the use of CCTV inevitably intrudes upon a person’s privacy, even if it is restricted to communal areas. We also have to be mindful that care homes are people’s homes, and people need to feel safe, secure and supported in their home.

As for the suggestion that CCTV cameras in communal areas should become the norm, which might well be the case, I cannot help feeling that it is a sad indictment of our society when, across the board, staff as well as residents are subjected to monitoring. Some might say that that would afford additional protection to staff as they go about their duties as well as to residents, but it would be sad if such monitoring were to become the norm, although I accept the argument from the hon. Member for Kingston upon Hull West and Hessle about reassuring relatives who are concerned about their elderly loved one.

The reason we are debating this subject is the alarming cases of abuse of vulnerable and elderly people that have been exposed through secret filming. We must take those examples extremely seriously, but it is important that we do not allow ourselves to believe that they provide a template for what happens everywhere and for how all staff behave. My mother-in-law, a former Glasgow City councillor, has dementia and is cared for in an excellent care home—Haylie House in Largs. Its first-class staff are cheerful and good-natured, and the care provided is second to none. When we put our vulnerable and elderly relatives into care homes, often with great reluctance, we need to be able to trust the staff. That is an essential part of the care process. We cannot allow the reports of abuse to allow us to forget the good work in the vast majority of our care homes.

It would be wise at this juncture to take cognisance of the view of Age UK that we must take care that CCTV might provide false assurances in addition to potentially compromising the privacy of residents in care homes. The chief executive of Age UK, Caroline Abrahams, has warned:

“With all the media stories about abuse and neglect in care homes it can be tempting to see installing security cameras as ‘the answer’, but Age UK very much doubts this is the case.”

[Mr Grieve]

I entirely endorse that. CCTV cannot be a substitute for good quality care. The examples I gave showed that, in areas where there is an attempt at delivering really good quality care, CCTV has served to improve it, but clearly if a care home simply relied on CCTV as a failsafe, that might be even worse than the current position.

--- Later in debate ---

[Patricia Gibson]

I absolutely agree. I will move on to address the right hon. and learned Gentleman’s point about high-quality care, but will first finish the point I was making.

Cameras offer some protection to vulnerable and elderly people in care homes—I do not think anyone would dispute that—but they cannot be everywhere on the premises, so their impact will necessarily be limited. It is important that relatives of elderly residents and those who work in care homes and seek to improve them do not see CCTV as promising more protection than it can deliver in reality.

It is important to remember that abuse and neglect can be subtle and disguised. Cameras might pick up such subtlety and studied disguise but they might not. To go back to the point I made earlier about trust between residents, staff and the families of residents, if care homes do not operate on trust they are truly lost. It is essential that care homes command the trust of residents and their families, whether or not cameras are in place.

The hon. Member for Kingston upon Hull West and Hessle talked about raising the standards in care homes. We can all agree on that and it is why we are here. Returning to the point that the right hon. and learned Member for Beaconsfield made, we all understand that care homes find it increasingly difficult to recruit and retain suitable staff. We need more effort and more support for care homes, because that is the most positive way forward.

The sad fact is that our elderly relatives are in care homes because they need good-quality and very patient support in their senior years, but too often those providing that support are underpaid and undervalued by wider society. Those who do the extremely challenging job of looking after our elderly relatives need more recognition for the demanding and challenging work they do. I am sure we all agree on that. The right hon. and learned Gentleman set out the challenges in staff morale, which demand our attention.

We agree that caring for people with dementia every single day can be extremely challenging, and those who do it well deserve to be applauded. CCTV may well have a place, but it is not and cannot be—I do not think anybody is suggesting it is—the answer to the important question of how we better support and care for our older people in their twilight years, with the best possible and most highly motivated support staff, who are suitably and appropriately valued by society. If we can achieve that, we will have done a huge amount to improve our care homes and the care experience of older people.