Oral Answers to Questions

Rosie Duffield Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Stephen Hammond]

I know that my hon. Friend has worked with the National Centre for Rural Health and Care and chairs the all-party group on rural health and social care. She is right to mention the fact that there are particular challenges in the delivery of the best-quality healthcare that we want to see in rural areas. I would be delighted to work with her and the all-party group on the matter.

[Rosie Duffield (Canterbury) (Lab)]

It has now been almost 18 months since health commissioners proposed that the two options for acute medical care in east Kent be put forward for public consultation. My constituents, particularly those in rural areas, are simply fed up with waiting for a new hospital. Will the Minister please confirm for me today just when a full public consultation on the future provision of acute services in east Kent will finally take place?

[Stephen Hammond]

The hon. Lady asks a good question on behalf of her constituents. I cannot confirm today when that will happen, but I will look into the matter and write to her to make sure that she gets the answer.

Oral Answers to Questions

Rosie Duffield Excerpts

Tuesday 24th July 2018 Commons Chamber

[Jackie Doyle-Price]

The hon. Lady’s starting point was “since 2009”. It is certainly true that there was a decline then, for a number of reasons, not least the fact that we are improving treatment in community settings rather than acute in-patient beds. Our Five Year Forward View began in 2014, and we have been delivering improvements in the number of beds and staff since that date.

[Rosie Duffield (Canterbury) (Lab)]

8. What recent assessment he has made of the effect on the health and social care sector of the UK leaving the EU.

[The Minister for Health (Stephen Barclay)]

The Government are undertaking a wide range of analysis in support of our EU exit negotiations and preparations. Our overall programme of work is comprehensive, thorough and continuously updated.

[Rosie Duffield]

Brexit poses major challenges for the NHS and, in particular, the beleaguered and neglected hospitals of East Kent. Can the Minister reassure me—and the Royal College of Midwives and other bodies—that we will be able to recruit much needed migrant worker staff to the health and social care sector and will encourage them to stay after March 2019?

Perinatal Mental Illness

Rosie Duffield Excerpts

Thursday 19th July 2018 Westminster Hall

[Rosie Duffield (Canterbury) (Lab)]

It is a pleasure to serve under your chairship, Mr Davies, and I congratulate my hon. Friend the Member for Stockton South (Dr Williams) and the hon. Member for South West Bedfordshire (Andrew Selous) on securing this debate.

We should judge the success of our society by how we treat our new mothers—it really is that simple. I am here today to speak up for better-quality, more consistent and well-funded services for perinatal women.

I am not a new mother. In fact, my youngest teenage son is sitting just over there in the Public Gallery and Members may be able to tell from his towering 6-foot frame just how long it has been since I was recovering from giving birth to him, the second of my two gigantic children. Even so, I remember those special early days for all the many wonderful, and some horrible, reasons that all mothers will know.

We do not discuss post-natal truths enough in the UK. Women will sometimes share with their friends the gory details of their experience of giving birth, but we rarely ever see in the print media, on TV, or in films what happens after a baby is born. If the fairy tale does not end when Cinderella weds her prince, as most fairy tales do, it most certainly has ended by the time Cinderella has entered her third trimester and is waddling around the palace. Nobody wants to hear about Cinderella’s third-degree tear, the fact that her boobs leak, the possibility that she may experience incontinence, or the fact that, even though she has a wonderful, healthy baby in her arms, she just cannot stop crying. But fairy tales are out of date and so is the fact that we do not talk about perinatal experiences—both external and internal experiences—with the honesty we need.

Things are changing, however. After all, we are here today saying that what is on offer to post-partum women in the UK just is not good enough. It is outrageous that women in one quarter of the UK are still without access to specialist perinatal mental health services. How can the mental healthcare of new mothers still be a postcode lottery? It is not as if mental health changes are uncommon after a woman has given birth. In fact, 81% of women say they have experienced at least one perinatal mental health condition either during or after their pregnancy.

I know from talking to friends, family and, indeed, constituents how imperative perinatal mental health support is. We must remember that three quarters of women who say they have experienced a perinatal mental health condition had no previous history of mental health problems. For those who have experienced mental health problems before giving birth, changes to the brain’s chemistry post-birth, combined with post-partum isolation, can trigger the return of symptoms that they had previously experienced, often in their teenage years.

Speedy referrals and access to early treatment is vital for those who experience mental health issues during or after pregnancy. What is so worrying is that it takes more than four weeks for 38% of women in the UK who are referred to be seen. In fact, there are cases of women suffering post-partum who have the courage to seek help from their doctors and health visiting teams but who still have to wait beyond a year for help after referral. That is a whole year that these women are waiting for help in what is often one of the most turbulent, joyous, change-filled and complicated times in any mother’s life. Any service that keeps people waiting for more weeks that I can count on the fingers of one hand is completely unfit for purpose.

We must close the funding gaps that cause huge waits—it is reassuring to hear that the Government intend to do that—and end omissions in service provision. We must also ensure that maternity services do not remain overstretched and understaffed. We must bring back full bursaries for midwives and related healthcare qualifications, which will allow staffing gaps to be filled with the much-needed new caring talent that will have the capacity to offer continuity of care to high-risk women in pre and post-natal moments of vulnerability. The erosion of higher education bursaries, especially for nurses, midwives and other healthcare students, was yet another example of this Government knowing the cost of everything but the value of nothing.

There is another reason why we must act and act soon. A study by the department of anthropology at the University of Kent, which is in my constituency, shows that post-partum depression discourages mothers from having more than two children. The decision to have children, or the decision to have more children, is a woman’s choice alone. However, that choice must be made without the pressures and limitations that come with poor funding of post-natal care. A choice made through fear is no free choice at all.

I completely echo colleagues’ calls for there to be much greater depth in the maternal six-week check. The baby’s check by the doctor and the mother’s check by her doctor must be separate. A woman’s six-week check cannot be limited, as I so often hear it is, to a few rushed questions. I have been told of women being asked only about the contraception they plan to use, with no questions at all about their physical or mental wellbeing. I have heard from friends that their doctors simply asked them, “Are you feeling okay?” That is not a proper question. As any mother will say, the moment their new new-born is in their arms, the definition of what was previously considered “okay” is thrown of out the window. Time must be put aside for proper, in-depth questions and for real insight.

After all, as we have already heard, according to the Royal College of Midwives 42% of women with post-natal depression never even mention it to a healthcare professional, and three quarters of those women stay quiet because they feel guilty about having such thoughts. Moreover, many women are led to believe that serious mental health issues are merely a bout of the baby blues. We urgently need proper training and proper conversations to create an environment where mothers feel safe, well-informed and able to talk about any difficult experiences.

I acknowledge that even the most thorough six-week check for women would not always pick up on everything. Post-natal depression can sometimes manifest slowly. One study suggested that the majority of women experiencing symptoms did not report them until six months post-partum or later. To tackle that, I urge that the maternal mental health check by health visitors at three to four months is reinstated. Even taking more time at that early point when a woman is sat with her GP at the six-week check will save lives. A couple of weeks ago, I attended the NCT’s #HiddenHalf event, where several brave women attested to just that.

[Andrew Selous]

Has the hon. Lady had a chance to look at the clinical evidence base for the effectiveness of the three to four-month check? Is she aware of a good base of evidence from clinicians that it is a sensible use of money at that point?

[Rosie Duffield]

I thank the hon. Gentleman for that intervention. I have not looked at the issue in that kind of depth. I have been working on it with local women and local groups who suggest that it would be good to reinstate it. I will look into it further.

The women at the #HiddenHalf campaign event said that their lives had been saved by a fortuitous visit to the right GP at the right time, but they know they were the lucky ones. The mother’s six-week check must also allow time for a full physical health check to prevent long-term and often totally avoidable health complications resulting from difficult deliveries. Furthermore, it is my belief that a course of pelvic floor physio should be provided for every single woman who has experienced a vaginal birth, as happens in France. I am working with a group of women on health policy for post-partum women. This debate focuses on the perinatal health symptoms of the hidden half, but many of the mental health conditions that health visitors report are triggered by the physical trauma of a difficult birth and women having to reconcile themselves to a completely new sort of body.

Those of us here today will not stop campaigning and raising the issue until the situation changes for new mothers and new families who need our help. We should get the full truth of post-natal motherhood out there and become a country that can rightly say, “There’s lots of help here for you. We will assist you and your families for as long as it takes. We are here to champion and celebrate you in being the happy, healthy, supported mother that you ought to be able to be.”

NHS Outsourcing and Privatisation

Rosie Duffield Excerpts

Wednesday 23rd May 2018 Commons Chamber

[Rosie Duffield (Canterbury) (Lab)]

A few weeks ago, my local NHS trust in east Kent announced that more than 1,000 employees—more than 800 Serco employees and more than 200 NHS employees—working in cleaning, catering, estates and facilities will now be employed by an arm’s length management organisation.

Most of us in this House will be familiar with ALMOs, but for those watching, listening and reading about them for the first time, although ALMOs may sound a bit like that well-known cuddly Muppets character, they are nowhere near as fun. This is not “Toy Story” but Tory story, a story of endless austerity and endless cuts to our vital and much-loved health and public services.

ALMOs have become a mechanism by which primarily local authorities, but now it seems NHS trusts too, can avoid responsibility by keeping things such as housing departments and cleaning facilities at arm’s length—away from too much scrutiny, and away from the managers and councillors whose jobs might depend on keeping themselves as far away as possible from that scrutiny.

[Judith Cummins (Bradford South) (Lab)]

My hon. Friend is making an excellent speech. Staff in Bradford have real concern about the plans to create a wholly owned company that could see 300 members of staff at Bradford Teaching Hospitals NHS Foundation Trust transferred out of the NHS, creating a two-tier workforce. Does she agree that we need to keep our health service, in the words of Unison’s campaign, 100% NHS?

[Rosie Duffield]

Absolutely. I was just about to speak about Unison, which is my union.

Leading unions have called the move in my local NHS trust—the East Kent Hospitals University NHS Foundation Trust—a “wolf in sheep’s clothing” and fear, with good reason, that workers’ conditions, including pay, will be eroded. I know many of those workers personally and they include some of my friends. The unions are right: workers’ conditions will be eroded, and it is already happening in other public services across Kent.

The Conservative-run Kent County Council, for instance, has introduced another ALMO called the Education People. Educational psychologists currently working directly for the council are being transferred to be employed by the Education People. The terms and conditions being offered by the ALMO to new educational psychologists are significantly worse than existing terms and conditions for those employed by the county, so no new educational psychologists have been recruited for Kent. We already have a serious shortage.

Of course, Kent County Council is doing that because central Government have starved it of funds and, perhaps because it is the same shade of blue, it is too timid to make that big a noise about things, so I will do it instead: Conservative central Government cuts are reducing our ability to care for people properly. In my constituency, the local NHS is potentially doing the same by setting up an ALMO to make yet more cuts by stealth. More money, less responsibility.

My union, Unison, represents nearly half a million healthcare staff employed in the NHS. That is one in every 60 or so working adults in one sector in the UK represented by one union standing up with one voice against injustice.

In Canterbury, rooms at the once thriving city hospital can now be found stacked with old equipment, and staff tell me that whole wings of old, neglected hospitals, such as the Buckland in Dover, lie abandoned, underused and under-occupied while waiting rooms in our not-so-local accident and emergency departments remain rammed. In Canterbury, services that were removed “temporarily” in 2017 look likely never to return to those old buildings. Proposals are afoot for a new hospital, but it simply will not be built if the central Government funding is not there to fill it. I am the only Labour MP in Kent and, as such, I am proud to make a loud noise about and stand up against the Conservative cuts that have caused vital hospital services to disappear in my county in recent years.

Things need to change drastically, and the new university medical school in Canterbury will be part of that much-needed change. If someone in my constituency is sick, they currently have to travel a long way to Ashford or Margate to get the emergency care they need.

Combine an underfunded NHS with a South East Coast Ambulance Service in special measures, and we have the ingredients for chaos. Chaos and a lot of sadness are apparent in all the letters I receive from constituents about the NHS week in, week out. Members will get the idea. The funding is not there, so the services have gone.

[Helen Whately]

I have a question about what the hon. Lady said regarding the loss of services at Canterbury Hospital. She and I both oppose that. Does she acknowledge that services were lost under a Labour Government?

[Rosie Duffield]

I agree that services started to be cut under a Labour Government, but they have got so much worse that our hospital is now underused, unusable and unrecognisable.

Madam Deputy Speaker, you will hear the same thing repeatedly from my concerned Labour colleagues this afternoon. The impact of austerity on our health service has been truly dreadful. Trusts are beginning to look to PFIs to keep walls from crumbling, and the desire for a short-term fix has meant that private companies, such as Virgin, Serco and Spire, have stepped in, especially near me in Kent, to profit from sickness, which is fundamentally abhorrent.

So much must change. The privatisation of the NHS and supporting services must be stopped and funding must be fully restored to the levels it was at under the last Labour Government. If Conservative Members continue to erode our health service and encourage private companies to step in to fill in the gaps, there will be little left when they finally realise what they have done. With so many pieces given away, the NHS jigsaw will certainly never look the same again.

Labour Members are constantly accused of running down, criticising and putting down our health service. The fact is that we are telling the truth about the urgent state of our broken NHS, which is staffed by amazing, dedicated and selfless people who deserve so much better from this Government.

NHS Winter Crisis

Rosie Duffield Excerpts

Wednesday 10th January 2018 Commons Chamber

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

It is interesting to follow the hon. Member for Sleaford and North Hykeham (Dr Johnson). I have to say respectfully that I wholeheartedly disagree with her. She speaks of some kind of NHS utopia, but that is not the reality that I have seen on our A&E frontline. I am an A&E specialist and I have worked in our NHS for the past 12 years.

When we look around an A&E department, everything is on display in high definition: people’s pain, fears, courage and hopes; the unfailing dedication, expertise and strength of the staff who work there; and yes, the state of the NHS, which is in turmoil. It is in crisis, which is turning into disaster. From hospitals across the country, we have heard that the problem is not a surface or temporary issue.

The symptoms of the NHS crisis are all connected and multiply into new problems. That is not seen in statistics alone, but it is seen in A&E departments, which are completely overcrowded. People feel forced to come to A&E who should not be there: people who could not get a GP appointment or who had to wait too long for a hip replacement and are now in severe pain. Taken together with the emergency cases—from heart attacks and strokes to road traffic accidents—it is simply too much for the resources that we have.

The reality is stark. Cubicles are full because there is no space to move patients on to wards. The wards are full because our social care system is woefully inadequate and broken. When all beds are full, we see ambulances queuing up outside hospitals. They are full of patients who cannot get hospital care. What do we say to a mother or a father who is in an ambulance with their child, scared and anxious, and has to wait outside the hospital for another hour?

Doctors are too stretched to do the job we are trained to do. We are the recipients of first-class education and training in the UK and we cannot deliver the very thing that we know to be right: to treat the cause, not just the symptoms. There is little time for prevention.

On new year’s eve, when I worked in A&E, we had a teenage girl who fainted. We treated her and spent time talking to her, but we pride ourselves on being able to find root causes: is there an underlying eating disorder or is she being bullied at home or at school? To have those conversations, we need to build trust, which takes time. If we do not do that, the patient is more likely to return, sometimes in pain because their operation has been cancelled. A teenager who faints at school might need to be part of child and adolescent mental health services. That all places a burden on our already stretched NHS. It will not change until this Government decide to live up to their most sacred duty: the protection of the health and security of us all. The NHS is underfunded and overwhelmed.

[Rosie Duffield (Canterbury) (Lab)]

Does my hon. Friend agree that desperate patients should never have to resort to smuggling out secretly filmed footage of trolley-lined corridors with people sitting on the floors, such as the footage I have received from my constituents visiting and working at William Harvey Hospital in Ashford?

[Dr Allin-Khan]

I agree that it is deplorable that patients should feel that they have to do that. The historic underfunding of the NHS is not an economic necessity; it is a political choice made by this Government, which is why they will not change their direction to protect us.

So, what must we do? We must change the Government. Until we do, the NHS will continue to crumble around its heroic staff, who will carry on giving their all; I am honoured to stand alongside them. We see their work not in the headlines, but in the most harrowing, important and joyful moments of people’s lives. As NHS practitioners, we cannot always change the outcome; but with time and resources, we can change the journey. It is time that we saw a change in our A&Es, our hospitals and our Department of Health.

Valproate and Foetal Anticonvulsant Syndrome

Rosie Duffield Excerpts

Thursday 19th October 2017 Commons Chamber

[Fiona Bruce]

The hon. Lady makes a very good point.

Further warnings were issued. In 2000, a patient information leaflet from the producer, Sanofi, said:

“It is known that women who have epilepsy have a slightly higher risk of having a child with an abnormality than other women. Women who have to take Epilim in the first 3 months of pregnancy to control their epilepsy have about a 1-2% chance of having a baby with Spina Bifida.”

In 2005, Sanofi added:

“Some babies born to mothers who took Epilim during pregnancy may develop less quickly than normal and may require additional educational support”

and that some

“babies born to mothers who took Epilim…during pregnancy may develop less quickly than normal or have autistic disorders.”

Warnings were emerging over the years, but nothing was done to ensure that patients were told. Why did patients have to wait almost 30 years to be warned of the risks?

Janet Williams and Emma Murphy, whom the right hon. Member for North Norfolk (Norman Lamb) mentioned and whom I have had the privilege of meeting, are tenacious and brave women who have campaigned for years and set up a support group for affected families. I pay tribute to them, and I want to tell the House a little bit about their family situations. Janet has two sons aged 26 and 28: Lee and Philip. Janet took Epilim, but nothing else, during both pregnancies. She told me:

“I wasn’t offered anything else—and no one told me of the risks.”

Lee, at 26, has curvature of the spine, Asperger’s, learning difficulties and memory problems, and he cannot hold down a job. Philip, at 28, has even more problems. He has problems with hearing, vision, speech, language and walking, as well as floppy joints. He is still fully dependent on Janet.

Emma had her children a generation later. She has five children, aged eight to 14: Chloe, Lauren, Luke, Erin and Kian. They have all been diagnosed with a number of symptoms. All have varied problems, including autism, incontinence, deafness, cerebral palsy and curvature of the spine, and all are slow to develop. Emma took the same dose of Epilim during each pregnancy. She told me that she questioned that, but was told that it was the best drug to control her seizures and that her baby would be fine. She took no other drugs during her pregnancies. No one warned her of the risks.

The tragedy is that those two women represent more than 1,000 others in their support group, the Fetal Anti Convulsant Syndrome Association. Together, they founded the Independent Fetal Anti Convulsant Trust, a registered charity, to campaign for better awareness of the risks of taking valproate, to prevent further such difficulties occurring, and to challenge the Government. There is, as I say, a case to answer, and I do not believe that we would be here today were it not for these two women.

[Rosie Duffield (Canterbury) (Lab)]

Does the hon. Lady agree that women such as Janet and Emma are ideally placed to get compensation, should the Government agree to a system similar to the €10 million French compensation scheme for Depakine?

[Fiona Bruce]

I certainly think that has to be looked at as part of the case that Ministers have to answer.

I would like to say much more but time prohibits me. We have heard some of the terrible statistics that have already been cited about the 20,000 children who could have been affected since the risks were first known about, the 400 children who are still born each year with symptoms, the 28,000 women of childbearing age—according to ONS figures—who are still being prescribed the drug, and the 68% of women in this situation who say that they are not properly informed of the risks.

What do I ask of Ministers? I ask the Minister to agree that significantly more needs to be done urgently to raise awareness of the risks of taking sodium valproate among pregnant women and those who could become pregnant. Does he agree that although Ministers might have come to know about the risks only relatively recently, the producer Senofi, the MHRA and its predecessor, the Committee on Safety of Medicines, knew about them and should have done more to address them? They should have published information and improved warnings years ago.

Does the Minister accept that the support needed by mothers such as Janet and Emma, who have to care for their children with foetal valproate syndrome, is major and may be lifelong, and that much more needs to be done to consider how that support can be improved and funded? Janet and Emma tell me that the current provision through local councils and health authorities is wholly insufficient and that care plans are needed for the many affected children.

Is there any reason why, as I said at the outset, Ministers cannot look at what we in this country can do to support these families now, without further delay, and certainly without awaiting the final decision of the European Commission regarding the link between sodium valproate and birth defects? After all, we are leaving the EU. Does the Minister now have full confidence in the MHRA’s ability to effectively inform and guide healthcare professionals on the use of the prescription of sodium valproate for epilepsy, and does he think the same can be said of the MHRA’s involvement over the years? Finally, will the Minister, at an early date, meet Janet Williams and Emma Murphy, as well as a group of Members who are concerned about this issue, to respond to their concerns and to my call that our Government at the very least have a case to answer?