NHS Whistleblowers

Patricia Gibson Excerpts

Wednesday 18th July 2018 Westminster Hall

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

I thank my hon. Friend the Member for Central Ayrshire (Dr Whitford) for bringing forward this important debate. I think we all agree that when malpractice and failure in our NHS threaten the public interest, and when concerned staff do not have the confidence to speak up and share their concerns, our public services are threatened across the board. Of course, that does not apply just to the NHS—we know it has happened in other sectors.

My hon. Friend, who focused on the NHS, pointed to recent examples that underline the need for staff who raise concerns to be protected. Indeed, almost all the official reports and the inquiries that have followed have shown that co-workers had seen the dangers but had been too afraid to raise the alarm, or had raised it with the wrong person or in the wrong way. We need only cast our minds back to the Clapham rail disaster, the Zeebrugge ferry disaster and the empire of Robert Maxwell—in all those cases and others, people already had concerns, but they were either unable or unwilling to come forward, for whatever reason.

[Paul Girvan (South Antrim) (DUP)]

Numerous NHS staff have indicated to me their unwillingness to come forward because they believe there is a culture of bullying in the NHS. If they make a complaint, they are targeted. Even though complainants want to remain totally anonymous, that does not seem to happen. I know one doctor, in particular, who raised an issue and who feels he has been sidelined from promotion and everything else because of the stance he took against his peers.

[Patricia Gibson]

Sadly, we have heard that point several times during the debate. We hear it far too often. The culture must change.

We have focused on the NHS, which we all understand is an important public service. If the public cannot trust and have faith in the NHS, we are in a sorry state indeed. I am sure my hon. Friend the Member for Central Ayrshire would tell us that the reason we need to ensure there are robust mechanisms in place to protect whistleblowers is that, ultimately, whistleblowing is about saving lives.

We will never know whether safer whistleblowing, with protection for those who raised concerns, would have halted the activities of Ian Paterson in the NHS and the private sector, given that concerns about his surgical procedures and his desire to carry out harmful and unnecessary mastectomies had apparently been circulating since 2003. Professor Ian Kennedy, who reviewed Paterson’s practice, put it like this:

“Whistleblowers do not fare well in the NHS. This is one of the major indictments of management in the NHS: that it is inwards-looking, over-defensive, and prone to destroy, by a variety of means, those who suggest that the Emperor has no clothes…It is a blight on the NHS and is one of the principal areas where lessons must be learned.”

As the hon. Member for Stirling (Stephen Kerr) reminded us, where provisions to further protect whistleblowers are required, they should be put in place.

It has been reported that up to 10 doctors who worked with Paterson are under investigation by the GMC, apparently for failing to act on concerns. I make no comment about that, but one has to ask how it is possible that there is a culture in which fellow medics can even be suspected of failing to act on such concerns. How on earth could such an ethos ever develop and, apparently, thrive? That monster has lurked in the NHS, and that culture has to be changed. As the hon. Member for Hartlepool (Mike Hill) said, it is changing, but not as quickly as we would like.

As my hon. Friend the Member for Central Ayrshire outlined, the Scottish Government have implemented a number of measures to help protect whistleblowers and ensure they feel confident to speak out. Extra legal protections are now in place for student doctors and other postgraduate trainees who speak up if they are unfairly treated by their training body. However, as she pointed out, those are—and must be—quite separate from standard employment issues.

Importantly, the Scottish Government have committed to the function of the independent national whistleblowing officer for NHS Scotland being held by the Scottish public services ombudsman, creating a mechanism for independent external review where an individual has a concern about the handling of their whistleblowing case. That will be in place by the end of 2018. Importantly, the intention is to ensure that whistleblowing cases are concluded in a reasonable timescale. We heard from the hon. Member for Stirling about a case that dragged on for many years, which is far too long. That is simply not acceptable.

As my hon. Friend the Member for Central Ayrshire pointed out, we are building a consistent approach in Scotland. Staff will have access to an independent external body that can review their case and bring it to a clear, final and fair conclusion. I urge the Minister to study the improvements in Scotland carefully to ensure that the system in England is as robust as it can be and as supportive as possible to whistleblowers who raise genuine concerns. Of course, that is not to suggest that Scotland has nothing left to learn. We all must continue to be very vigilant, as the hon. Member for Stirling pointed out.

Gagging clauses have been used to suppress, or potentially suppress, information about patient care, which can lead to failings being repeated. I think we would all agree that that is completely unacceptable. My hon. Friend gave us a timely reminder—if we needed reminding —about the tragedy of Mid Staffordshire, which led to the deaths of as many as 1,200 patients. That must not be allowed to happen again.

Such malpractice and failings can thrive only in a culture where people are afraid to speak out and where fear and secrecy reign, as the hon. Member for Hartlepool reminded us. We have learned from Mid Staffordshire, but we must go on learning from it. I urge the Minister to be ever vigilant and watchful. Of course, genuine concerns have to be raised responsibly, but they must be raised. The NHS as an institution must encourage that, as the hon. Members for Stirling and for Hartlepool set out.

A whistleblower must be seen not as a problem but as someone who genuinely seeks to improve how things are done. Every Member who spoke alluded to that. That requires a culture change in the many corridors and management offices of our health system, which will take time. We are getting there, but we are not there yet. We must never be complacent. Openness and transparency are key to ongoing learning and improvement, and such a culture will give patients the confidence they need. I am keen to hear the Minister’s response to those concerns.

National Bereavement Care Pathway

Patricia Gibson Excerpts

Tuesday 24th April 2018 Commons Chamber

[Will Quince]

My hon. Friend is absolutely right, and I thank him for the support he has given to the APPG since its formation. He is right that just one stillbirth or neonatal death is one too many, and while we should rightly campaign for reductions—we have ambitious targets in that regard—it is absolutely right to ensure that even if we hit those targets, as I will come to later, we make sure we have world-class bereavement care for those parents and families who sadly suffer the loss of a child. Through the pathway, we can work to ensure that they receive the best-quality bereavement care that the NHS can deliver.

Bereavement care has been a priority for the APPG for two reasons. First, there is sadly an inconsistency in the quality and standard of bereavement care across the country. Every parent and family who suffer the loss of a child should receive the same high-quality bereavement care no matter where they live, yet that is not the case at the moment. A report from Sands in 2016 found that only 46% of trusts with maternity units provided mandatory bereavement care training for maternity unit staff. Further, of those who did provide the training, 86% provided their staff with just one hour or less of training each year.

A separate report by Bliss in 2015 on neonatal units found that 41% of units had no access to trained mental health workers and that while some units had dedicated bereavement facilities, many relied on normal accommodation or quiet rooms. That is very important. In the case of 50% of bereaved mothers, care after their baby had died was considered poor enough to have affected their psychosocial wellbeing and any plans that they might have for a future baby. We should therefore be ensuring that parents who suffer the loss of a child receive the best possible care wherever they are in the country, and that is exactly what the bereavement care pathway does.

The second reason, however, is that 15 babies sadly die every single day before, during, or shortly after birth. This takes me to the point made by the hon. Member for Strangford (Jim Shannon). Even given the Government’s ambitious target of a 50% reduction in stillbirth and infant death by 2025, there will still be tens of thousands of stillbirths and neonatal deaths, and tens of thousands of parents, grandparents and wider family members will still go through the tragedy of baby loss. While it is right that we work to reduce baby loss rates by, for instance, tackling smoking among pregnant women, we also need to ensure that there is high quality-care throughout the NHS for the parents who do, sadly, lose a child.

Last month, I had the opportunity to visit one of the first pathway pilot sites, established by Chelsea and Westminster and West Middlesex University hospitals, to see it in action. It was great to chat with staff and discuss what challenges they faced in implementing the pathway, and what benefits they had found for parents. My experience during that visit has been backed up by the recent early evaluation of the first phase of the pathway. Feedback from the pilot sites found that it had helped to raise the profile of bereavement care in hospitals—a vital change, now that that will be assessed as part of inspections by the Care Quality Commission—and that it had also encouraged different teams in hospitals and departments to work more closely together.

That independent report showed not only the need for the programme, but its obvious impact. For example, where bereavement midwives are in post, they are making a significant and positive difference in their trusts. However, more work is clearly needed to ensure that good practice is shared across hospital trusts, so that all staff who come into contact with bereaved parents are equipped and helped to deliver the high-quality care that we all want to see. The findings show the huge potential for improving bereavement care in pregnancy and baby loss, something that I, and the all-party parliamentary group, will continue to proudly support. It has also been useful for healthcare professionals to suggest ways in which the pathway can be refined, and, in particular, how it can be ensured that the documents and guidance that are issued are more practical in terms of implementation.

Last Monday, our APPG hosted a reception to mark the launch of the second wave of pathway sites. A further 21 trusts are now piloting the pathway, providing sites where bereaved parents will be able to experience better care.

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

I congratulate the hon. Gentleman on securing the debate and on all the work that he has done in this field, including his work in the all-party group. Earlier, he gave the chilling statistic that 15 babies die each day in the United Kingdom. Of course we all know that the loss of a baby—the death of a child—is the last taboo. The irony is that, although the rolling out of bereavement pathway sites throughout the UK is welcome and much needed, it is because baby loss is so hard to discuss that it has taken us so long to reach this point.

[Will Quince]

The hon. Lady—and I will call her my hon. Friend—has made a very valid point, and I thank her for all her contributions to the formation and the continuing work of the APPG. She is right: there is a taboo surrounding baby loss, and we must break it. I remember the first debate about it that we held here, in November 2015, and the floods of e-mails and messages that we received from parents out there who were saying, “Thank heavens, someone is now talking about baby loss.” They had felt so enclosed, and unable to talk about it, to the extent that people would cross the street to avoid having to have that awkward conversation.

That is exactly why the pathway is so important. Although NHS professionals up and down our country are caring and compassionate to their very core, not everyone has experienced this kind of grief. It is important that the pathway is parent-led, because that enables parents to share the experience of what they went through, how they were feeling, and how things could possibly improve in the future. I encourage the hon. Lady to continue her work in the APPG and continue to participate in debates like this, because that shows the country as a whole that we are willing, ready and able to talk about baby loss, and will not stop talking about it until as have addressed some of these big issues.

Autism

Patricia Gibson Excerpts

Thursday 29th March 2018 Commons Chamber

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

Like all the speakers who have gone before me, I am delighted to speak in this important debate on autism, particularly as it takes place during World Autism Awareness Week. In common with colleagues across the House, I also want to put on the record my thanks to the right hon. Member for Chesham and Amersham (Dame Cheryl Gillan), who has blazed a trail in this area.

Today’s debate is important because for far too many people living with autism there is not just the actual condition to cope with, but, as we have heard, the isolation and often bullying and judgmental attitudes from a society or community that too often does not comprehend the condition. That is why we all need to work hard to raise awareness of it. In the longer term, the challenges that the condition brings can leave those living with it emotionally scarred, which in turn can lead to difficulties accessing employment and living a fulfilling life.

We know that 700,000 people in the UK are autistic, but many others we do not know about will be awaiting a diagnosis. Even if we take the 700,000 figure, however, and then factor in the relatives, it means that living with autism is a fact of life every single day for 2.8 million people. It is right and proper, therefore, particularly during World Autism Awareness Week, that we debate this important matter and recognise the challenges of the condition and how much more we must do as a society to meet them. Attitudes towards and awareness of autism are changing, but we still have some way to go.

We also need to understand, as the right hon. Lady pointed out, that autism is not a mental health condition. That said, as many as 71% of children with autism also live with a mental health challenge, such as anxiety, depression or obsessive compulsive disorder. Such mental health challenges are not inevitable, however, but the result, it seems, of the social isolation that autism too often brings. The Association of Graduate Careers Advisory Services found that 26% of graduates on the autism spectrum were unemployed—by far the highest rate of any disability group and more than double the average unemployment rate for disabled adults—and, although figures are hard to establish, it is thought that only 15% of autistic adults in the UK are in full-time work.

A large scale study in the British Journal of Psychiatry in November 2015 found that people with autism were more than twice as likely as their peers in the wider population to die prematurely, and recent work by the National Autistic Society found that only 16% of those living with autism and their families felt that the general public had a meaningful understanding of autism. Moreover, young people with autism are 28 times more likely than their peers who do not live with autism to have suicidal thoughts. That is the scale of the challenge; we have a significant way to go, despite having made some progress.

[Dame Cheryl Gillan]

I do not know if, in common with me, the hon. Lady received a briefing from the Royal College of Psychiatrists for this debate, but I was surprised to find that one in 10 psychiatry consultant posts were unfilled. We have a shortage of psychiatrists, which inhibits progress in this area, particularly in diagnosis and treatment.

[Patricia Gibson]

As the right hon. Lady’s intervention shows, meeting the challenge will not be easy. We still have huge mountains to climb to make life better for people living with this condition.

All these challenges show why we must continue to highlight the condition. It is important not just that people living with this condition can access the support they need but that they feel supported and that they live in a society that does not overlook, shun or ignore them, as has happened too often in the past. The challenges facing those living with autism are not inevitable. With work and education, and by raising awareness and understanding of autism in our communities, much can be done to counteract the negative outcomes they too often face. That is why I want to put on the record the sterling work done in my constituency by community campaigners Suzanne Fernando and her family, Jordan, Arron and Kester. The Fernando family live with autism every day and have worked tirelessly to raise awareness of the condition in their local community of Ardrossan and beyond, and have met with considerable success in doing so. Every year, they put in a huge amount of work to hold a coffee morning to disseminate information on the issue and offer support to those in the community living with the challenges of autism every day. As I have said, we know how isolating this condition can be.

[Mr Sheerman]

We are very impressed by the work that the hon. Lady’s group is doing, but I am slightly nervous about one thing that I am picking up in her speech. A lot of people I meet in the autism community do not like the word “condition”, because it presupposes that it is an illness, which it is not.

[Patricia Gibson]

The hon. Gentleman makes an excellent point. I shall try to refrain from using that word in the future, as I am sure we all will.

If we raise awareness and understanding of autism, the wider public will necessarily display more sensitivity, kindness and compassion towards those living with this condition, and it is this that will help to remove the shadow of loneliness and isolation that autism too often brings. We know that loneliness and isolation are very damaging to general health and wellbeing—their corrosive effects are as damaging as smoking cigarettes—so we could actually be saving lives.

It is not all bad news, however—progress has been made. I am proud that the Scottish Government in 2011 launched the Scottish strategy for autism, declaring that autism was a national priority. But the job is not done—not by a long way. We know that there is no room for complacency, and we can all play our part in developing our awareness and displaying understanding of the challenges and difficulties that those living with autism face every day. I hope that this debate and World Autism Awareness Week have played some small part in that, and that they demonstrate how seriously the House takes the issue.

 Orkambi and Cystic Fibrosis

Patricia Gibson Excerpts

Monday 19th March 2018 Westminster Hall

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

The development of the treatment offered by Orkambi has offered renewed hope to those living with cystic fibrosis and their families. Orkambi is suitable to treat around 50% of those with cystic fibrosis in the UK and, as we have heard today, that treatment can now be extended to those from aged six years, as opposed to the original licence, which was to treat those aged 12 and over.

We have heard today at some length about the controversy over the cost of the drug. As a Scottish MP, I was heartened by the Scottish Government Cabinet Secretary for Health and Sport, Shona Robison MSP, who strongly encouraged the manufacturer Vertex to take forward discussions with the patient access scheme assessment group secretariat. Those conversations continue. It is easy, and perhaps obvious, to point out the high cost of the drug—we have heard much about it—but who in this Chamber would not stretch every sinew for their child or loved one to access the drug if they could benefit from it? That is why parents and relatives of those living with cystic fibrosis have been campaigning so hard. What else can they do?

We have heard about the cost of the drug, but as we have also heard, the costs can be offset by reduced hospital admissions. NHS funding will always be under pressure as our technology advances. One consequence is that the cost of treatment is always likely to be driven upwards. Costs are important, and we have to be mindful of them, but I ask hon. Members, “If your child or loved one could benefit from a treatment, however expensive, what would you not do to help them to access it?” That is what drives those campaigning for access to Orkambi.

The campaign has been effective and moving, as we have heard. We must keep listening and empathising with what those people are saying, because we cannot just talk about pounds and pence when it comes to treatment. We are dealing with real lives, which must guide progress. Progress must be made—we all hope that happens sooner rather than later.

[Bob Stewart]

My point is very straightforward. It seems grossly unfair that some people can get hold of this drug and some people cannot. We ought to level the playing field.

--- Later in debate ---

[Patricia Gibson]

The hon. Gentleman makes an excellent point. That is why in Scotland we are setting up bodies to ensure that care and access to treatment is standardised across Scotland, and that it does not depend on the health board where someone lives or what route they can take to access the drug.

We heard from the hon. Member for Dudley North (Ian Austin) that there is a cost in not funding Orkambi. We have to keep that in mind, and find a way forward as soon as possible. We clearly need a more cost-effective proposition from Vertex, the production company. A constructive solution must be worked out with the Scottish Medicines Consortium, with an equivalent solution found for the English NHS. I am hopeful that a solution can be reached in Scotland and across the United Kingdom.

However, as we have heard, it is important that the processes about decisions for the approval of drugs are transparent and fair, and that we can be confident that a proper and extremely robust cost-benefit analysis is carried out. We hope that a way forward can be found and that progress can be made with the pharmaceutical companies about the cost of treatment—in particular, with Vertex and the cost of Orkambi, which can make a difference to the many people living with cystic fibrosis and their families. We owe it to them to do all we can to work with the pharmaceutical industry to find a way to make this happen. I sincerely hope we can do that.

Autism Community: Mental Health and Suicide

Patricia Gibson Excerpts

Thursday 30th November 2017 Commons Chamber

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

I add my thanks to my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron). I think I am the first person to pronounce the name of her constituency correctly. I am pleased once again to participate in a debate about autism, a condition that, as we all know, for too many years has not been sufficiently recognised or its challenges fully appreciated. That is starting to change, which is good news for all who are living with autism and who have been either not recognised or misunderstood for too long.

Autism is not a mental health condition, but autistic people are more likely to develop mental health problems such as anxiety disorders, OCD and depression. That is for a host of reasons, such as not being supported and experiencing social isolation. Research shows that a diagnosis of autism can lead to an increased risk of mental health conditions.

Support for those living with autism is very important, as has been widely recognised in the Chamber this afternoon. Anxiety disorders are very common among those on the autism spectrum. Roughly 40% have symptoms of at least one anxiety disorder at any one time, compared with around 15% of people in the general population, and such disorders in themselves can lead to depression.

It is very worrying that young people living with autism are 28 times more likely to consider suicide than other young people are, and it also affects adults who have not been diagnosed. There is no doubt that people with the condition have an increased risk of suicide, as my hon. Friend has pointed out. That could well be because 66% of autistic people and 67% of their families have reported feeling socially isolated.

[Mrs Moon]

Does the hon. Lady recognise that another major problem for families of autistic children is that should one of their children take their own life, the postvention support—the after-suicide support—is not there either, so the social isolation that they experienced in life continues after death and complicates families’ grief? That area must also be tackled.

[Patricia Gibson]

I absolutely agree with the hon. Lady’s excellent point. Should such a tragedy occur and a suicide take place, it is important that the family is supported through that as much as possible.

Some 70% of autistic people are reported to have mental health disorders, such as anxiety or depression. As we have heard, suicide is one of the leading causes of death in the autism community, and that alone tells us that this issue demands our attention. As the hon. Member for Blaydon (Liz Twist) pointed out, diagnosis is important because it should be the foundation on which effective support for autistic individuals and their families is built. Similarly, a delay in diagnosis can hinder effective support and prevent intervention strategies from being put in place.

The National Autistic Society Scotland reported in 2013 that 61% of those it had surveyed said they felt relieved when they received a diagnosis, because such a diagnosis can end years of feeling misunderstood and isolated. We have talked a lot about this as a UK issue, but as a Scottish MP, I want to mention the Scottish Government’s strategy for autism. The strategy, which is based on research, is working to improve waiting times for diagnosis and assessment to create consistent service standards across Scotland, and is providing training opportunities. The entire autism spectrum needs to be addressed, as well as the whole lifespan of people living with autism in Scotland. This is the logic behind this autism strategy, so it is a very positive step.

We have heard about initiatives such as autism hours in supermarkets and special autism-friendly cinematic screenings, and these are all very important and positive steps. There is a greater awareness and understanding of autism in this country but, as we have recognised today, we still have a long way to go. I will end by saying that we often think of those with autism as finding it difficult to see the world as we see it, but the truth is that we need to see the world as they see it, because if we do so we may then be able to start to make real progress.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I call David Linden.

Baby Loss Awareness Week

Patricia Gibson Excerpts

Tuesday 10th October 2017 Commons Chamber

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

I am delighted to participate in what is now the annual debate on Baby Loss Awareness Week, although, sadly, the only reason why such a debate and such a week of remembrance are necessary is to mark the 3,500 babies stillborn each year across the UK, with one in three of those stillbirths occurring at full-term. That of course does not take into account the babies who die within a year of birth.

All the experts, including Professor Jim Thornton, Professor of Obstetrics and Gynaecology at the University of Nottingham, agree that

“For an otherwise healthy baby to die undelivered near term is, with hindsight, an easily avoidable event. Research to make it avoidable in practice is a priority.”

That is why debates such as this, and any and all measures to highlight stillbirth, are vital.

Although the UK’s stillbirth rate has fallen slightly in recent years, it remains unacceptably and stubbornly high. For too long, this taboo was left in the shadows, too difficult, too upsetting to talk about. As politicians, we all know, what is not discussed, what is not acknowledged, is not addressed and, if not addressed, it cannot be improved. We in this House have been and will continue to work to break that deafening silence. That is our duty on behalf of all those trapped in the isolating silence of grief. Some of us in the Chamber today have experienced that silence first hand.

I think back to 9 June 2016, when I had a Westminster Hall debate on stillbirth, which was hugely emotional, not just because of my own experience but because of the realisation that so many of our babies have been lost over generations, with parents isolated in grief, as this was something that was never talked about in our society, except in whispers. However, since 2016 we have come quite a way. The all-party group on baby loss has done so much to ensure that the issue stays firmly on the agenda. Gradually, as a society, we are becoming more willing to acknowledge this awful event, which affects 3,500-plus babies every year in the United Kingdom, with all the devastation, grief and fallout that it inevitably brings.

Since 2016, I have been in contact with a number of stillbirth organisations such as Sands and Safer Births UK—in fact, too many to mention. Early on, I became convinced that if we accept the analysis of the experts, such as Professor Jim Thornton and others, that for an otherwise healthy baby to die undelivered near-term is, with hindsight, an easily avoidable event—why would we not accept what the experts tell us?—then surely it makes sense to have full investigations when otherwise healthy babies do die undelivered near-term. One third of babies across the UK who are stillborn die at the end of the pregnancy. One in three—this is something that requires serious attention.

That is why last year I asked both the Secretary of State for Health in the United Kingdom Government and the Cabinet Secretary for Health in Scotland, Shona Robison MSP, to instigate coroner inquests in England and fatal accident inquiries in Scotland when stillbirths at full term occurred in an otherwise healthy baby. I appreciate that such processes are expensive, complicated and difficult, but if we consider the lessons that could be learned—what has been missed, what was overlooked and what could have prevented the loss of a baby so close to birth—that can inform good practice and improve the care for future babies. Logically, the need for inquests or fatal accident inquiries would surely diminish gradually over time, as fewer babies would be lost. Of course, we would not just be preventing the loss of babies late in pregnancy either; the lessons learned would inform practice and improve it across the whole maternity service at any and every stage of pregnancy.

When I lobbied for that, I was told by some that it was simply not doable—that I should spend my efforts improving practice in other areas of maternity care: surely it would be best to focus on, for example, ensuring minimum and consistent standards of care across the board. Well, yes and no. The minimum and consistent standards of care that everybody in this Parliament seeks should be embedded in improvement and research, and the use of coroner inquiries and fatal accident inquiries could be a hugely important part of that. It is not an either/or question. 

I am hugely heartened by the fact that, after an initial refusal, the Cabinet Secretary for Health in Scotland, Shona Robison MSP, has agreed that the Crown Office in Scotland should investigate whether there could be fatal accident inquiries for babies lost late in pregnancy. Such a move is not about bringing prosecutions but about learning lessons, informing practice and making sure that when our children are about to be born but something goes wrong, we find out why and use that knowledge to make other babies safer.

Make no mistake: this is a monumentally significant step forward, which has largely been ignored by the mainstream media. I do not know why, but it means that so many who would be comforted by it may not even know that it has happened. However, the significance of this development cannot be overstated. If, after consideration, the Crown Office in Scotland decides for whatever reason that this measure cannot be implemented, at least we will know where we are. We will know what obstacles we are dealing with and can set about removing them. I am also convinced that this measure will mean that fewer of our babies die. When that is shown to be the case, I am hugely optimistic that a similar measure will be adopted in England. That, I feel, has been a huge step forward in the 16 months since my first debate on stillbirth. Credit must also go to the campaigners who have worked hard to achieve this.

This coming Sunday, 15 October, is Pregnancy and Infant Loss Remembrance Day and also would have been my wee boy’s eighth birthday. It is very important that his death, and the deaths of all the babies who have been lost, should not have been in vain. The campaign goes on, so that other babies do not have their lives ended before they even begin.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

My hon. Friend is giving an excellent and emotive speech, and she is conveying an important message about inquiries. Does she agree that it is also extremely important that early miscarriage is well researched? I know from my own experience of early miscarriage that when it happens, people say, “It’s just natural, and there is nothing that can be done.” But the more we look into it and research the causes, the more we can prevent that grief.

[Patricia Gibson]

I absolutely agree with my hon. Friend. If we start our research at the end of pregnancy and work back the way, I think we will be able to spot things much earlier in pregnancy as we learn the lessons that were missed at the end.

No parent should have to bury their child without knowing or understanding why they did not live. That is what drives me on, and I know it drives on many of us who are taking part in this debate. The tragedy of the loss of so many of our babies is that it does not have to be this way. To change that must be, in the words of Professor Jim Thornton, our “priority”.

Alcohol Harm

Patricia Gibson Excerpts

Thursday 2nd February 2017 Westminster Hall

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

I am delighted to speak in this important debate and I warmly thank the hon. Member for Congleton (Fiona Bruce) for securing it.

The costs that alcohol imposes on our society—the social cost, the health cost and the cost to families and communities—simply cannot be counted, because of course that cannot always be measured in pounds and pence. Across the UK, alcohol accounts for 10% of our burden of disease and death, and it is one of the three biggest lifestyle risk factors for disease and death. Alcohol is 60% less expensive now than it was in 1980, and everyone knows that when the price of a commodity goes down, consumption goes up.

I will share with the Chamber today the alcohol-related challenges that we face in Scotland. NHS Health Scotland has reported that in 2014 retail sales data demonstrated that alcohol sales in Scotland were 20% higher than in England and Wales. Scottish sales of low-cost vodka are more than twice as high as those in England and Wales. It is estimated that one in three Scots are affected by a mental health problem each year, with depression and anxiety the most common illnesses. Alcohol and problems with mental wellbeing are closely related.

We in Scotland therefore have much greater and more pronounced challenges than the rest of the United Kingdom. The damage that alcohol is doing to our population is extreme, so bold solutions are required. In Scotland, such bold solutions have not been shied away from. The overall strategic approach in Scotland is different—I would argue that it has to be different—from that of the rest of the UK. A whole-population approach is required to reduce the harm caused by alcohol.

The important point is that, in addition to analysing existing data such as alcohol-related deaths and hospital admissions, our approach uses sales and price data from market research organisations to examine the relationship between price, consumption and harm. The effects of specific policies have also been examined, such as the policy on multi-buy discounts—it is worth noting that such discounts are now banned in Scotland. Scotland is the only part of the UK to produce such detailed information on alcohol, including sales data.

Whether we are talking about alcohol, gambling, obesity or lack of physical activity, we need to consider how all of our high streets and neighbourhoods can support good health, rather than contributing to our ill health. For example, we know that deprived areas have 40% more places to buy alcohol than more affluent areas. The more widely available and easily accessible alcohol is, the more we drink, and therefore the more harm that is caused.

As well as knowing that 20% more alcohol is sold in Scotland than in England and Wales, we know that Scottish male death rates are approximately 50% higher than those of other UK countries, while women’s mortality is 30% higher in Scotland than in other UK countries.

[Kelvin Hopkins]

I think this statistic is true: life expectancy in central Glasgow is the lowest in the United Kingdom.

[Patricia Gibson]

Indeed. That appalling and very sad statistic is one that has touched my own family, as I will come on to explain. Alcohol continues to cause premature deaths in some of our most socioeconomically deprived areas and we must take action—I will go on to say how the Scottish Government have taken action.

The hon. Gentleman’s intervention came at a very personal moment in my speech. Indeed, I have a very personal stake in this debate. By all accounts my own father, of whom I have no memory, was an extremely heavy drinker. Was he an alcoholic? He probably was, but alcoholism was not readily talked about in working-class communities in Glasgow in the 1960s. I did not witness my father’s heavy drinking, because he died when I was nine months old, not least because of his heavy drinking. My husband’s father was an alcoholic, which led to his early death. In Glasgow, where both my husband and I grew up, such deaths were not unusual in the past, and even today alcohol-related deaths are still more common in our communities across Scotland than many people would think.

Here is the main point: I am extremely proud of the fact that against much opposition—some of it, unfortunately, on tribal grounds—the Scottish National party Government in Scotland took a very bold decision. They decided that the damage that alcohol was doing to our population, our families and our communities could no longer simply be measured and talked about and that action was needed. What else could kill 22 people each week in Scotland, cause 670 hospital admissions each week in Scotland, cost Scotland £3.6 billion each year and not require bold action?

Such action came in the form of minimum unit pricing. In our supermarkets and similar outlets, alcohol can cost less than bottled water; in some cases, it sells for as little as 18p per unit, which is disgraceful. There is clear evidence from research that shows there is a direct link between changes in minimum pricing, and changes in alcohol harm and consumption. Estimates show that a 10% increase in the minimum price of alcohol is associated with a 32% reduction in the number of deaths that are wholly attributable to alcohol. Work undertaken by the University of Sheffield shows that a minimum unit price of 50p is estimated to result in 121 fewer deaths a year, a fall in hospital admissions of just over 2,000 a year, and a fall in hospital admissions of just over 2,000 a year by year 20 of the policy.

Minimum unit pricing is more effective than taxation, because it is better able to target the cheap, high-strength alcohol favoured by the heaviest drinkers. Such a public health measure is supported by Ireland, Norway, Finland, Sweden and the Netherlands. I know that England is looking at this measure and I urge everybody in this Chamber to support its introduction. It is bold, but it needs to be bold to help deal with the blight that alcohol has cast over too many of our communities.

Global corporations in the alcohol industry fought a hard legal battle against Scotland’s introduction of minimum unit pricing, but the measure was passed with overwhelming support in the Scottish Parliament. It has been tested in the European courts. The appeal against it in the Supreme Court, following victory for the Scottish Government when the measure was tested at the Court of Session, is the final stumbling block to the introduction of the policy. I hope and believe that it will be resolved by the summer at the latest and introduced in short order thereafter.

Responding to the points made by the hon. Members for Congleton and for Luton North (Kelvin Hopkins), in Scotland we have already reduced the drink-driving limit to 50 mg per 100 ml of blood. That means that the rest of the UK—this is a cause for great alarm—has the highest limit in the EU, alongside Malta. I urge the Minister to follow the lead of Scotland and the rest of our EU partners. Reducing the blood alcohol level for drivers saves lives.

[Fiona Bruce]

I am interested to know from the hon. Lady directly how that change has not only saved lives, but changed the drinking culture. How have people changed their attitude towards drinking? One of the points that has been made to us about the Scottish experience is, “Well, it’s only a very few lives that have been saved,” but there is a bigger picture, is there not?

[Patricia Gibson]

There is indeed a bigger picture. Laws do not necessarily change attitudes, but what they do over time is change a culture. They send out a clear signal. The point was made earlier that when people are out and using a car, they tend not to drink. They are more likely not to drink at all due to the reduction in the drink-driving limit. It has also been a great educator for people who are out drinking and not driving, but who might be driving the following day. They decide, “I had better not drink tonight, because I might still be over the limit tomorrow when I get in my car.” We know that many of the people who have been pulled over, had their blood alcohol level tested and been found to be over the drink-driving limit were simply not aware of it, because it was from the previous evening; they had not considered that they might still be over the limit.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

On that point, does my hon. Friend agree that the lower drink-driving limit has been particularly effective with younger drivers?

[Patricia Gibson]

Indeed. Our younger drivers are the most likely to be inexperienced. They are therefore not willing to risk it, after all the blood, sweat and tears to pass their test. The limit is helping to reduce the alcohol intake of young people for a whole variety of reasons.

Alcohol is killing too many people in our communities prematurely—I do not think anyone in the Chamber would dispute that. It is splitting up too many families. Its pervasive, insidious influence is the context in which too many of our children grow up. It is costing our NHS billions. It is exacerbating mental health challenges for too many people. It is rendering too many people economically inactive.

Alcoholism is a disease and, as with any disease, we need to find the cure. One silver bullet will not cure the disease. We need minimum unit pricing. We need all our high streets and neighbourhoods to look at how they can support and contribute to good health. There must be a presumption against an over-concentration of outlets selling alcohol, preying on our socially disadvantaged communities. All those things combined can make a difference, because they tackle price, availability and consumption. A serious problem and disease such as alcohol addiction or misuse requires a serious, bold solution. I urge the UK and Welsh Governments to look at the measures and the determination of the SNP Government in Scotland to tackle the issue head-on. It is one of the most serious health challenges of our time.

Children’s Wellbeing and Mental Health: Schools

Patricia Gibson Excerpts

Tuesday 10th January 2017 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Nuttall. As a former secondary school teacher with more than 23 years’ experience, I am pleased to be speaking in the debate, and I am grateful to the right hon. Member for North Norfolk (Norman Lamb) for bringing it forward. He has direct personal experience of the issue and has spoken movingly about it. I think that we would all agree that he has moved the debate forward, certainly in England, where much more focus has been placed on the matter.

There is no doubt that over the past 20 years we have all started to become more aware of mental health, and of how widespread its challenges are in our society. The right hon. Member for North Norfolk articulated the importance of continuing to move the agenda forward, and that is a very good thing, because the greater our awareness of different mental health issues, the forms they can take and the challenges they pose to our society, the better equipped and educated we are as we try to deal with them, and that is never more true than in a school setting.

We know that the teenage years can be challenging in and of themselves, as young people grow, discover who they are and try to find their own path in life, and mental health issues that are not addressed in those formative years can scar a young life forever. Indeed, as the hon. Member for Bury St Edmunds (Jo Churchill) pointed out, the whole family unit is scarred and caused real pain and anxiety.

We often hear Governments talking about attainment, teaching and learning, nurturing and citizenship, and inclusion, but none of those things are possible in their truest sense unless our children and young people enjoy good health, including good mental health. The statistics outlined by the hon. Member for Bridgend (Mrs Moon) are truly shocking. Apart from the human cost, we of course need to consider the huge economic cost.

All those who have contact with young people are charged with creating a supportive, positive and fostering environment. Of course parents have a role to play, but things might manifest themselves in school and not at home, so all those who have contact with children must be vigilant. Schools have a privileged and important role in child protection. I can think of examples from my time in education when it was through the vigilance of a teacher that a young person who was struggling was identified and offered vital support, shielding the young person from falling into a downward spiral of problems and despair.

In Scotland, child and adolescent mental health services are linked to schools, and they work with young people referred to them by schools. The number of mental health professionals in those services has more than doubled under the current Scottish Administration. We all of course welcome the extra £15 million announced by the UK Government to help tackle mental health issues in young people, because we know that it is important in achieving positive outcomes.

I want to say a word or two, if you will permit me, Mr Nuttall, about some of the work that has been ongoing in Scotland for a number of years. In Scotland we have already built up support networks at the early intervention level to ensure that young people, parents and health professionals, as well as schools, are much more aware of how to help young people who begin to show signs of mental distress. In addition, we have already seen good examples of staff in schools being upskilled in areas such as mental health first aid, and some schools have involved young people themselves in the training programmes, so that they can support their peers. That might go some way towards tackling the stigma, which the right hon. Member for North Norfolk outlined.

In Scotland we are getting better at this work. The demand for child and adolescent mental health services has increased year on year, with 10% to 20% more young people starting treatment every year. That is being driven in part by the unmet need that we know has always existed across the entire UK, which is now being picked up by GPs, staff in schools and other children’s services. We are getting better, but we are not there yet, and there can be no room for complacency on such a serious, widespread and important issue. I will point out, however, that for a number of years now Scotland has had a dedicated Minister for mental health, which is a symbol of the kind of commitment required by the enormous social issue with which we are confronted.

The new measures announced by the UK Government are good—of course they are, as far as they go—but let us not forget that, as the fierce advocate for mental health, the right hon. Member for North Norfolk, has already pointed out, mental health funding has not always made it to the frontline services where it is desperately needed, and that must be addressed. I note the comments about waiting times, and I say to the Minister that Scotland was the first nation in the world to introduce, in 2010, waiting time targets for child and adolescent mental health services. That is a good path that the UK Government should think about going down. Unfortunately, in 2015 people in England were told that it was not feasible to have such targets. Why is it not feasible? If it can be done in Scotland, there is absolutely no reason why it should not be done in England.

Every constituent part of the UK needs a coherent, ambitious and bold mental health strategy to address the scourge of poor mental health, which has a huge effect on society. The Scottish National party Government is in the process of setting out their vision for mental health for the next 10 years, to transform mental healthcare in Scotland—including for children and young people—funded to the tune of £5 billion over this parliamentary term, funding that has been prioritised despite enormous budgetary pressure.

It is that kind of big thinking—that joined-up thinking—that is needed by those living with poor mental health wherever they live in the United Kingdom. I am interested in the plans that the Minister will set out today. Will she look at some of the excellent work being done in Scotland to see what lessons can be learnt to improve the situation in England?

Social Media and Young People's Mental Health

Patricia Gibson Excerpts

Wednesday 2nd November 2016 Westminster Hall

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

I am grateful to the hon. Member for Cheltenham (Alex Chalk) for securing this debate, which is a reflection of how fundamentally our society has changed. Technology is a huge part of that. Young people today are growing up in a world that is markedly different from any experience we had of growing up, with the possible exception of my hon. Friend the Member for West Aberdeenshire and Kincardine (Stuart Blair Donaldson).

As we have heard today, social media are a double-edged sword. Social media can be an important social outlet and an extraordinary source of information and education, and they enable people to connect with each other over vast distances. The benefits that social media offer to both young and old are plainly obvious but they can also be a dangerous, insidious tool. Social media are a stick with which too many of our young people can be beaten. They can be a yoke of oppression around their necks as they are pressured to conform, to be governed and even to be alienated by the false reality that is too often projected to and targeted at our young people.

It is alarming that research has associated online social networking with severe psychiatric disorders, including depressive symptoms, anxiety and low self-esteem, as well as poor sleeping patterns—sleeping patterns are so important to physical and mental wellbeing. The conclusion has been reached that young people’s immersion in social media should be considered a serious public health concern.

We all know that people fill their Facebook pages with pictures of their apparently perfect lives, which pressures others to portray and edit their lives in the same way for Facebook. It is thought that that is why young women are now three times more likely than young men to exhibit common mental health symptoms. That statistic has risen alongside the growth of social media, so we need to pay attention to it.

Barnardo’s has carried out important work on the effects of social media on the mental health and wellbeing of young people. It has concluded that access to online pornography and other harmful online content can distort not only young people’s body image but their view of healthy relationships. It can even lead to harmful sexual behaviour, often due to distorted ideas of consent and what a healthy relationship actually looks like.

Of course, as we have heard, social media can also be an insidious tool for those who use them as a vehicle for bullying. Social media can be extremely intimidating for victims, who can find them very difficult to escape because of their sheer prevalence in young people’s lives.

I am delighted that the Scottish Government’s “Respect Me” campaign recognises the importance of this issue and the essentialness of addressing it and taking it extremely seriously. Young people inhabit a different world from us as they develop, grow and find themselves, which makes them vulnerable and poses all sorts of challenges. It is our job to do all we can to protect them, and I am interested to hear how the Minister will proceed.

Baby Loss

Patricia Gibson Excerpts

Thursday 13th October 2016 Commons Chamber

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

I am deeply honoured to participate in this debate on an issue that could not be closer to my heart, and I am grateful to the cross-party group on baby loss for bringing this forward.

As we have heard, the loss of a baby is what every parent dreads. Those to whom it occurs are irrevocably changed for ever—their lives scarred by unspeakable tragedy. A year before I was elected, I had no notion that I would ever have the honour of being elected to represent the good people of North Ayrshire and Arran, but here I am, and because of my own horrific experience of stillbirth I feel profoundly that I should use that experience to help shine a light on this issue, which truly is the last taboo.

For too long, too many of those to whom this has happened understandably did not feel equal to the task of speaking out about this issue, and in turn those who have no direct experience of this issue simply do not know how to broach it and are often surprised to find out how prevalent stillbirth is across the UK. Around 3,500 babies each year across the UK are stillborn and another 3,000 die shortly after birth. To put this into context, that is around one baby every hour and a half, the equivalent of 16 jumbo jets crashing every year. It is inconceivable that this should continue. But it will, unless we remove the taboo and shine a light on this awful, awful phenomenon and do all we can for all the mums and dads of the future and all the babies yet to be born. It is sobering to think that in the course of this debate, somewhere in the UK two more little babies will have died, and two families will have been destroyed. It does not bear thinking about, but think about it we must. Yes, it is extremely difficult to talk about this, but we have a duty to all the babies who have been lost and a duty to all the bereaved parents who are struggling to put the pieces of their lives back together.

The fact is that, in Scotland, 34% of stillbirths are babies at the full term of pregnancy, and in England the figure is 33%. This is shocking, since medics at all levels will say that, barring some terrible freak accident, no baby who has survived a full pregnancy need die—not if proper monitoring and procedures are in place—yet such babies do die. In Scotland, some progress has been made in recent years to reduce the incidence of stillbirth, but we still do not compare favourably with our European neighbours. Across the UK, we still have a long way to go.

I know, as many others do, the horror of losing a baby. My baby, Kenneth, would have been seven years old this Saturday, the very day when we reach the culmination of Baby Loss Awareness Week—international pregnancy and infant loss awareness day—when we will see a wave of light for all our babies.

When children lose their parents, they are called orphans. When a husband loses his wife, he is called a widower. When a wife loses her husband, she is called a widow. When parents lose their child, there is no name for that. The reason that there is no name for it is that there are no words. It goes against nature. And in other loss of loved ones, all those who knew and loved them can share memories such as the last holiday, the last Christmas or the last important family milestone, but it is not like that with a stillbirth, so people understandably do not know what to say. How on earth could they? Sometimes, people are so keen to avoid saying the wrong thing that they say nothing at all. I have heard reports of women after a stillbirth seeing their neighbours cross the road to avoid speaking to them, such is the discomfort and anxiety about saying the wrong thing, because there is no right thing to say. There simply are no words; just a deafening silence and a terrible sense of being utterly isolated in consuming grief.

Like so many parents who have lost their babies, my husband and I are haunted by the loss of how we expected our lives to be after five years of fertility treatment. We are haunted by the potential wiped away so cruelly, so suddenly and so unexpectedly; haunted by the fact that it was completely avoidable; haunted by the fact that all this grief and sense of waste was because the Southern general hospital in Glasgow, now called the Queen Elizabeth university hospital, made a series of basic errors; haunted by the fact that that same hospital pulled the shutters down and for six and a half years refused to recognise that any mistakes were made at all and to this day has still not done so; and haunted by the fact that that same hospital, despite independent experts flatly contradicting it, insists that it did nothing wrong.

And this matters. It matters because this is an all too common story and demonstrates an unwillingness openly to engage in a learning process when mistakes are made. That shows the real culture—a fear even—of improvement if people cannot accept it when mistakes are made. How many parents must go through this horrific ordeal only to feel swept aside, ignored, dismissed and told, “It’s just one of those things,” as they try somehow to cope with the crushing weight of grief?

As we have heard already, bereavement care for parents is simply not good enough. Sands has done very important work in this field, and I want today to pay tribute to it. It understands the importance of listening to mothers’ concerns. It found that 45% of the mothers it surveyed who had undergone a stillbirth felt something was wrong before any problems were diagnosed, yet too many of those women were told that their concerns were unfounded and sent home, only for their babies to die shortly afterwards. Antenatal care must be a collaborative process. Mothers’ concerns must be paid attention to. Women know their own bodies.

We must have better monitoring of pregnancies, particularly those of women at risk of experiencing a stillbirth or neonatal death. The truth is that we are failing to identify many babies at risk. In addition, we must have more knowledge, data and research to help us to tackle this issue. The more we know about why our babies are dying, the more measures we can take to militate against it happening. It is very important that if mistakes are made—and remember that one in three stillbirths are at full-term babies—health boards and trusts should not investigate themselves. For investigations to be credible, they must be independent and carried out by people outside the situation. That is the right and proper thing to do to challenge the culture of secrecy.

Where it is believed to be merited, we should allow coroners in England to investigate stillbirths, so that errors in care can be addressed, where they have occurred. In Scotland, the equivalent would be a fatal accident inquiry. These are not straightforward or easy asks, but such an investment now will increasingly mean that, as expertise grows and intelligence is gathered, the need for such measures will necessarily decrease over time.

[Mr Kevan Jones (North Durham) (Lab)]

Does the hon. Lady agree that local authorities need to take into account the registration of deaths? I have heard of cases where people have had to register deaths at the same place where people were registering births. That is most upsetting for those parents.

[Patricia Gibson]

Indeed. I take on board what the hon. Gentleman says. It is an extremely traumatic experience to register the death at the same place where people are registering births. That simply makes the experience much more traumatic.

In my own case, my notes recorded that I was asked if I wanted a post mortem performed on my son. My notes did not record who asked me this question, what information I was given, or when I was asked it. I was so drowsy on morphine in intensive care, since my liver had ruptured after my body tried for 48 hours to deliver my baby naturally and the hospital repeatedly refused to perform a caesarean section, that I have no idea if I was actually asked this question. Why was the conversation not properly recorded in my notes? It is all pretty suspicious and only feeds into the sense of cover up and evasion by hospitals in such circumstances.

I am delighted that we are finally putting this very important issue firmly on the political agenda, and that is where it must stay. For those of us inside the Chamber and those of us outside—all the grieving parents watching today—it is too late to save our little boys and girls. But there are other boys and girls—other people out there, thinking of starting their own families, for whom it is not too late. It is our duty to do all we can to ensure that those little boys and girls enter the world as safely as possible. It is our duty to commit ourselves to this cause for their sakes and for the sake of all the babies who have been lost but will never be forgotten.