North East Ambulance Service

Sharon Hodgson Excerpts

Wednesday 4th May 2016 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I beg to move,

That this House has considered the performance of the North East Ambulance Service.

We as a country pride ourselves on our world-class NHS services, which are the envy of the world. It is therefore always important that we highlight failures and shortcomings to ensure that our services do not fail our constituents when they need them most.

Strains on services are part and parcel of life in the NHS, but in recent years the pressures have been exacerbated by the Government’s policies. Ever since the Conservatives were elected to office in 2010, the NHS has struggled due to their mismanagement. In particular, the Health and Social Care Act 2012 implemented a costly, top-down reorganisation, which was neither needed nor wanted. It led to a disjointed funding model and resulted in my local ambulance trust, the North East Ambulance Service, running an expected budget deficit of £3.5 million for 2015-16. It comes as no surprise that I have received a growing number of complaints and concerns about the NHS in recent years, which is why this northern group of MPs decided that we had to call for the debate.

All the services that the NHS provides are important, but when someone suddenly falls ill in an emergency such as a stroke or a heart attack, or has a fall or an accident, it is understandable that they have high expectations of our ambulance service. The important work that paramedics do in our region day in, day out is undeniable, but, as the cases that my constituents have brought to my attention and those that have been reported in the press show, patient safety is in jeopardy. That is mainly due to waiting times, which, as the cases I will outline illustrate, have increased and are causing distress to many of my constituents.

For red 1 and red 2 cases—potentially life-threatening incidents—the trust remains below the national standard. Although that is reflected across the country—only two ambulance trusts in England met red 1 standards—it is concerning that, in our region, that failure has continued for the past three years, despite the fact that our response time of eight minutes is higher than the national average. That is exacerbated by the fact that red demand calls have increased by 21.3% in the past 12 months. The performance targets for the fourth quarter of 2015-16 were breached, leading to the trust’s third consecutive quarter breach.

I called this debate to give myself and my fellow north-eastern colleagues the opportunity to raise cases and concerns directly with the Government to ensure that our constituents receive the very best standard of service, which they rightly expect. It is right that we raise concerns with the Government, who are ultimately responsible for the service and can ensure that something is done about the problems we raise. I will touch on some of the many cases ranging from 2012 to 2016 that my constituents have brought to my attention, and I know that other Members will do the same.

[Helen Goodman (Bishop Auckland) (Lab)]

I am most grateful to my hon. Friend for securing this extremely important debate. I am very concerned about the management. That was highlighted to me when I wrote a letter to the North East Ambulance Service about ambulance services in Teesdale. I got a letter back headed, “Ambulance services in Weardale”. The worst thing that happened was to Violet Alliston, whose partner rang three times in an hour. No ambulance came, and she died. That is obviously totally unacceptable.

[Mrs Hodgson]

I thank my hon. Friend for that very sad example, which I fear and predict will be one of many—perhaps not all with such a tragic ending—that we will hear this afternoon.

The correspondence I have received about ambulance waiting times in my constituency makes it clear this has been a persistent problem since 2012. I was first told about the problem with waiting times by the league chairman of the Wearside football league after he raised concerns with the North East Ambulance Service directly about numerous incidents. In his correspondence, he said that waiting times for football players who had broken their leg had continually gone over 70 minutes. In one case, after a player broke his leg, the league chairman called 999 at 11.40 am, but he was called back and informed that no ambulance was available and that he should take the player by car. He rang 999 back and complained that that went against what trained first aiders were told about not moving people with broken bones. An ambulance then arrived at 1 pm—80 minutes after the initial call—and the young man was taken to hospital.

Ever since that case, I have received a range of correspondence from other constituents highlighting failures and shortcomings in ambulances going out to emergencies. An issue particular to my local area—I do not think it is replicated in other parts of the region, although we may hear differently when other colleagues speak—is that ambulances struggle to get to certain parts of my constituency due to confusion in finding the address. That has been repeatedly brought to my attention by my constituent, Mr Walker, who for the past two years has highlighted the difficulty that ambulance crews have getting to the Usworth Hall estate in Washington. When a shocking murder took place in the area in 2014, the ambulance did not arrive for more than an hour and the man died.

An example of that failure happened when a woman was in labour and her sister-in-law had to deliver the baby because the ambulance went to the wrong street. The children of the woman in labour had to search the streets for the ambulance. When they found it, they guided it by foot, as they were not allowed on board, for more than a mile to where it should have been.

I could give many other examples. It has been a persistent issue for the residents of Usworth Hall, who, through Mr Walker, have highlighted their concerns and their exasperation at those problems. On each occasion, I forwarded their concerns to the North East Ambulance Service, which looked into each issue. To its credit, it has tried to address them. That was highlighted in a letter to me in July 2014, in which it explained that it had set up an electronic flag system for all residents in Usworth Hall and had a duty manager from its control room go out and survey the area for problems. However, Mr Walker contacted me again at the beginning of April and informed me that an ambulance was parked outside his house one evening. When he went out to speak to the staff, he found that they were lost and supposed to be in another street.

Paramedics understandably do not have the local knowledge that residents have, but sat-nav equipment is provided to help ambulances get to the right destination at the right time.

[Mary Glindon (North Tyneside) (Lab)]

Does my hon. Friend think that those delays could be because of the shortage of paramedics and the fact that, as the service has admitted, it uses volunteers and private contractors to provide ambulances? That exacerbates the problem of people not knowing how to get to where they need to be.

[Mrs Hodgson]

My hon. Friend makes a very good point. I will come on to the shortage, which is running at about 15%, and the stress on paramedics, to which she alluded.

If the sat-nav equipment continues to fail, and if my interventions on behalf of my constituents and the ambulance trust’s action do not rectify the situation, there needs to be a serious investigation into what is going wrong. We cannot have our ambulances driving round lost on estates looking for the right street.

My most recent piece of casework is from February and is deeply concerning. It concerns my constituent, Mrs Ellen Sherriff. I feel that using the words emailed to me by my constituent’s husband, Mr David Sherriff, can help to highlight the situation and the distress that can come from having to wait hours and hours for an ambulance to arrive. I hope that you will allow me a moment to read out Mr Sherriff’s words, Mr Bailey. He said:

“Ellen became unwell at 10.35am yesterday morning with severe head pain on the right-hand side. She felt like she was going to pass out. I checked her blood pressure which was very high, so phoned 111 at 11am and spoke to a call handler who told me he was sending an emergency ambulance and not to be worried if it arrived with blue lights.

Two and a half hours later no one had come. Ellen remained unwell and could not stand any light.

I phoned 999 and was told the ambulance that was coming had been diverted to Cramlington but that we would be next unless a more urgent call came in.

At 2.40pm, a patient transportation ambulance arrived with two ambulance men. I asked why it had taken so long. They said given the circumstances Ellen should have been seen earlier. They had no equipment, not even a blood pressure machine. They said they couldn’t risk moving Ellen in case they caused the bleed in her brain to become life threatening and they would send for a paramedic. They would also remain here till he arrived. They also complained to the control room regarding the wait.

They sat outside until 5.30pm, 6 and a half hours after I first phoned. When the paramedic first arrived he examined Ellen and said she should have been in hospital 5 hours earlier.”

It was not until 6 pm, more than eight hours after the initial phone call, that my constituent, Mrs Sherriff, was admitted to hospital, where it was discovered that she did indeed have a bleed in the brain and that she should have been there much sooner.

Until Friday, Mr Sherriff was still awaiting a response to his complaint, which was sent in February. Perhaps the prospect of this debate ensured that he eventually got it. The trust has admitted errors in the handling and categorising of Mrs Sherriff’s condition, meaning that it was continually not treated with the urgency required. The trust has apologised and said that a “reflection and learning session” has been given to the original call handler, but this case could easily have had a tragic ending.

[Pat Glass (North West Durham) (Lab)]

I thank my hon. Friend for securing the debate, which is important to all of us. Does she agree that the issue is not only with the ambulance service? Last summer, in the middle of the night, I took a relative to the university hospital in Durham. In the morning, when I came outside, I counted 12 ambulances stood outside the hospital and unable to discharge their passengers and get patients admitted. The whole system in the north-east is now simply not working.

[Mrs Hodgson]

My hon. Friend makes a valid point—we often hear about the queues of ambulances at accident and emergency. Patients have waited hours and hours for the ambulance to come, but when they get to the hospital, they sit in a queue outside. I have raised that with my local hospital. There is a huge breakdown in the system. Something is going seriously wrong, and it is completely unacceptable. Mrs Sherriff, a patient who had a suspected bleed in the brain, had to wait for more than eight hours before getting to A&E. That is truly shocking, and all those cases mentioned highlight concerns that the Government and the North East Ambulance Service must address.

I have one more issue to discuss before concluding, and that is to do with the numbers of qualified paramedics, which my hon. Friend the Member for North Tyneside (Mary Glindon) mentioned in her intervention. When waiting times are going up and demand is rising, we clearly need to look at workforce retention and recruitment. Our paramedics do an amazing job, but they cannot be in two places at the same time.

At this point, I want to place clearly on the record that I am not apportioning any blame or criticism at all to any paramedic or ambulance crew. They do an amazing job, under very difficult and trying circumstances, day in, day out, and they should not be placed in situations whereby, once allocated, they race through traffic to a call, within the appropriate time allowed, only to be faced with stressed and sometimes angry people, who say, “Where’ve you been? I’ve been waiting four, five, six or seven hours.”

[Alex Cunningham (Stockton North) (Lab)]

I congratulate my hon. Friend on securing this debate. I have an example from my constituency. A young lad, a teenager, had a road traffic accident, getting a compound fracture of the leg, but it took three hours for an ambulance to get to him.

When I met the ambulance chief executive, she told me that the problem is that the organisations that do employment and support allowance assessments are poaching qualified paramedics from the ambulance service, creating a great hole. There is a role there for Government, perhaps, to talk to the whole organisation, to see what can be done to put a stop to that.

[Mrs Hodgson]

My hon. Friend makes a valid point, which I will touch on, although he made the case well. We have to look at the slippage, to where in the rest of the health service the paramedics are haemorrhaging, and why. I will say more about that in a moment.

Paramedics are there to treat people and give them emergency—perhaps life-saving—healthcare, but before they can even start to treat them, they might first have to calm the patient and relatives down, because of something that was completely out of their hands. It is therefore no surprise that, nationally, there is a shortage of qualified paramedics, and all trusts are struggling to fill vacancies so that they can operate at full capacity. The North East Ambulance Service has a 15% shortage, and is plugging the gap with private and voluntary organisations, as my hon. Friend the Member for North Tyneside mentioned. The service has said, however, that it will be up to full establishment in a year, but how many more people will wait for hours and hours before we get to that stage?

Something therefore needs to be done about the recruitment and retention of paramedics, especially since evidence has shown that more staff are leaving the profession than ever. Also, mental health charity Mind reported that 62% of blue-light emergency service workers have experienced a mental health problem and, worryingly, one in four has considered ending their own life. It is shocking to think about the stress that those people are working under.

It is no surprise that research conducted jointly by Unite, Unison and the GMB revealed at the end of last year that more than 1,500 paramedics had left the service in 2014-15, compared with 845 in 2010-11—still a high number, but a little more than half the later figure. Of paramedics surveyed as part of other research by the three unions, 75% had considered leaving the profession due to stress and pay.

Action therefore needs to be taken on recruitment, which is why I welcome the work of my local university, the University of Sunderland, which in partnership with the North East Ambulance Service has launched a diploma programme in paramedic practice. It will pair theoretical study with practical training over two years, and it will help to address the shortages faced by not only our regional trust, but other trusts around the country. That innovative work by my local university, alongside that of the outstanding paramedic practice degree at Teesside University, which is seen as a beacon of best practice in our region, if not the country, is important and will help.

It is, however, unsustainable not to address strategically the staffing shortages and the increasing demoralisation of a workforce who are haemorrhaging away, because that is clearly having an impact on waiting and call-out times for emergencies. That is why I hope that the Minister will address those concerns, and outline what the Government are doing to deal with recruitment and retention. How will she work with my local ambulance service trust to ensure that it reaches the target of being fully operational by this time next year? How will the ambulance trust ensure that those who are recruited into the field are retained and do not slip off to work for other parts of the health service, so that we do not see further shortages down the line?

It is important that our emergency ambulance services are up to the standard that we all expect. That means working collaboratively among ourselves, as the local Members of Parliament who represent our constituents and their concerns, and with the Department of Health, NHS England and the North East Ambulance Service Trust. Our constituents deserve the best standards in our NHS, and it is up to the Government seriously to address pressures on our NHS services, especially the case of the workforce in the ambulance service.

I hope that the Minister has listened carefully to my concerns, and will listen to those that my colleagues from the north-east who have attended the debate today express. I look forward to hearing what she has to say at the end of the debate.

[Mr Adrian Bailey (in the Chair)]

I will call the Front-Bench spokespersons at 3.40 pm. Simple arithmetic will demonstrate that if I am to get everyone who wants to speak to speak—I want you to speak as well—you need to confine your remarks to about six or seven minutes. I will be grateful if you follow that guidance.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I thank all who have contributed to this important debate. Some extremely serious issues of principle and general practice and some very serious constituency cases have been raised. I doubt that I will be able to deal with some of the specific issues, particularly in relation to individual constituents, during the debate, but I have made a careful note, as have my officials, of some of the specific points and we will go through Hansard after the debate and ensure that we pick up individual points. I am extremely disappointed to hear that colleagues have not always found the trust as responsive as they would wish. I spoke to the chief executive yesterday in preparation for the debate and will certainly go back to that specific point, but I will come to some of the other general points as I move through my speech.

[Mrs Hodgson]

Will the Minister give way?

[Jane Ellison]

It is quite early, but I will.

[Mrs Hodgson]

I just want to say that we are all aware that the chief executive, Yvonne Ormston, is new and has obviously inherited many of the cases. I would like to say that things have massively improved. I know that she is trying to turn the situation around, but what has happened will not all have been on her watch.

[Jane Ellison]

The hon. Lady makes that point very well and with her characteristic generosity of spirit. I am sure that that will be noted. I will take the issue forward with that very much in mind and I thank her for her comments.

Ambulance services are obviously vital to the healthcare system. We have heard this afternoon some of the reasons why. They provide rapid assistance to people in urgent need of help. Hon. Members on both sides of the Chamber have rightly put on the record their appreciation of the work done by staff in trusts across the country and by the front-line staff in the NEAS. I add my thanks to theirs. Inevitably, we bring problems before the House—that is right, because we want to talk about how we can move things on for our constituents—but it is possible for a member of staff reading the record of a debate afterwards to think that we had only blame and criticism. Today, however, all hon. Members have been careful to praise the very hard-working staff. As has been said, they are working under quite considerable pressure.

It will probably be helpful to provide some context about the national picture. We recognise that the NHS is busier than ever, which is why we are backing the NHS’s own plan for its future, the Five Year Forward View, with an extra £10 billion by 2020-21. The challenges faced by the North East Ambulance Service are reflected in many services across the country. Ambulance services are facing unprecedented demand, delivering over 2,800 more emergency journeys every day compared with 2010. That demand has an impact on performance indicators, such as response times, with ambulance services continuing to struggle with their targets. The Department is working closely with NHS England and with NHS Improvement to monitor and support performance in 2016-17.

In relation to the North East Ambulance Service, I spoke briefly to the service yesterday, in addition to having received quite a detailed briefing from it ahead of the debate. I am advised by the NEAS that the average number of the most serious incidents—red incidents—that it has responded to within eight minutes has changed very little over the past three financial years, but the volume of red incidents to which the NEAS has to respond to reach the 75% performance target has increased by more than 20%, from 370 a day in August 2015 to more than 440 a day now. That change in demand in particular has placed our front-line emergency care services under real pressure, rather than the responsiveness and capacity of service provision.

Meningitis B Vaccine

Sharon Hodgson Excerpts

Monday 25th April 2016 Westminster Hall

[Geoffrey Clifton-Brown]

My hon. Friend is right. I pay tribute to the charity based in his constituency and to the other meningitis charity, because they have been campaigning for many years on meningitis B and all the other strains.

The point about rolling out the vaccine to the cohorts—I urge the Minister to go further than that—is that my understanding is that once someone is vaccinated for meningitis B with Bexsero, they are covered for life. Therefore, if more cohorts are covered by the roll-out, more of the population will be covered and the entire population will become less susceptible.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

My question follows on nicely from the point made by the hon. Member for Stroud (Neil Carmichael) in his intervention about the long-term costs. I first came across this issue at a reception held by Meningitis Now. I commend that charity and the Meningitis Research Foundation for their excellent work. In terms of special educational needs, long-term costs can come in when a child reaches 12 or 13 and it becomes apparent that they are not developing at the same rate as other children. All sorts of educational implications should be factored into the long-term costs.

[Geoffrey Clifton-Brown]

I could not agree more. That is why the CEMIPP group study should look at not only the medical costs but the educational costs, the cost of carers and so on. There are considerable costs to the public purse. We tend, under our democratic system, to be quite short-termist in our view of such matters. I am involved at the moment in work on drugs for cystic fibrosis, to which exactly the same issues apply. After the considerable cost at the outset, there is a lifelong benefit to babies from getting such drugs. If we are going to carry out a cost-benefit analysis for the meningitisusb B vaccination, that is what we should consider.

Brain Tumours

Sharon Hodgson Excerpts

Monday 18th April 2016 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I start by thanking the Petitions Committee for introducing this important debate and commending my hon. Friend the Member for Warrington North (Helen Jones) for her excellent opening speech, in which she eloquently made the case on behalf of the 120,129 citizens who have signed the online petition. I also commend the hon. Member for Castle Point (Rebecca Harris), who is the chair of the all-party group on brain tumours, for her leadership on the issue and her very emotional speech, which I thank her for.

Over the years, I have had to deal with a number of individual cases, as I am sure other hon. Members have. Currently, I have three, and 132 of my constituents have signed the online petition. The response from our constituents on the issue is not surprising when we realise that, as we have just heard, malignant brain tumours are the biggest killer among all types of cancer of people under the age of 40 and of children.

Also, survival rates for brain tumours have not improved in the last 30 years; if anything, on some measures they have got worse. Currently, only 40% of patients will live for more than a year after diagnosis and less than 20% will survive for more than five years. However, as we have heard, despite those shocking figures, cancer research funding into brain tumours amounts to little more than 1% of the spend on cancer research. Due to the chronic and continuous underfunding of brain tumour research, there are clear knock-on effects to the services and treatments that patients access and receive. If we continue to limit the potential progress that properly funded research might make, those outcomes will never improve. That probably explains the 30-year plateau that I have just highlighted.

As with all cancers, early detection is key to boosting survival rates. That is why it is so dismaying to find that brain tumours are not included in the Government’s Be Clear on Cancer campaign. Early diagnosis not only helps to prevent avoidable death, but can relieve the stress on a patient’s life, as one recent case brought to my attention by a constituent exemplifies. After visiting their local GP twice about feeling generally unwell, my constituent was told that they had all the classic signs of stress and they were prescribed antidepressants.

[Sue Hayman (Workington) (Lab)]

My constituent, Rita Magorrian, got in touch with me about her granddaughter, Helen, who collapsed just before Christmas with a brain tumour. Helen had been to see her GP several times and had been told her problems were down to stress, but she had also been to see her optician and was told the same. As well as considering further training for GPs, does my hon. Friend agree that we need to widen the process to include opticians?

[Mrs Hodgson]

That is an excellent point, well made, and I thank my hon. Friend for it.

Two days later, when my constituent lost all strength on the left side of their body, they went straight to A&E, where it was eventually found they had three brain tumours. After receiving brilliant treatment by NHS staff and support from the Bobby Robson centre in Newcastle, thankfully my constituent is now in remission. However, that case clearly shows the need for improved awareness, as the situation would have been better if the GP had been able to spot the signs of a brain tumour sooner. We in the north-east have an excellent research facility in the Bobby Robson centre, but there are always concerns about its future, as it depends greatly on legacy and charitable donations.

It is also important that research considers the needs of patients. According to studies by Brainstrust, patients believe that more research and funding must focus on the quality-of-life issues, such as function and symptom relief, to help to improve life after diagnosis, whether the diagnosis is terminal or not.

That is reflected in the case of another of my constituents, Malcolm, who was given a terminal diagnosis of a glioblastoma multiforme, or GMB, 4 brain tumour. Despite being told by his doctor in the north-east that he was too sick for further treatment, Malcolm, along with his family, sought out specialists in London. He took the difficult and expensive decision to self-fund the life-extending drug, Avastin, which, although licensed for use in the treatment of some other cancers, was not available on the NHS for use in his case.

Malcom is due to receive another dose of Avastin, but he wants it to be administered locally and is unable to find an oncologist in the north-east who is able to do so, even privately, so Malcolm is faced with either travelling up and down to London for that treatment every two weeks, or perhaps up to Scotland, or to Leeds or Manchester. Although Malcolm has responded well to the Avastin treatment, more options need to be available to people in his position, with treatments to improve the quality of life and, where possible, to extend life. However, that is all for nothing when there is a clear postcode lottery on access to specialists and services, as seen by Malcolm and his family.

The chronic underfunding of research into brain tumours is clearly having an impact on the lives of those who are diagnosed with brain tumours, and that cannot and should not go on any longer.

Childhood Obesity Strategy

Sharon Hodgson Excerpts

Thursday 21st January 2016 Commons Chamber

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I congratulate the hon. Member for Totnes (Dr Wollaston) on proposing and securing this important debate, and she will be pleased to hear that I agreed with almost everything she said. Many here in the Chamber will be aware of my strongly held passion to provide all children with a hot and healthy school meal, especially one that is free. The debate around the Government’s impending childhood obesity strategy, both here in Parliament and in the outside world, has focused on the reformulation of foods that are high in sugar and salt and the introduction of a sugar tax. Although I support those measures, I want quickly to discuss how school food can play a significant role in addressing the obesity crisis facing our children today.

I want to say at the outset—I am sure people are thinking this, if not here then definitely on social media—that I am rather overweight myself and that some may say I should practise what I preach. I do try. But that is why I am so passionate about this agenda: I know how much harder this becomes as you get older. I was allowed to adopt bad habits that are hard to break, and that shows why we need to educate the next generation to do much better.

School food has played a role in public policy for more than 100 years. It was first discussed in this place in 1906 when Fred Jowett, former Member of Parliament for Bradford West, used his maiden speech in the Chamber to launch his campaign to introduce free school meals when compulsory education was being rolled out. That led to the passing of the Education (Provision of Meals) Act 1906, which was originally Jowett’s private Member’s Bill.

Jowett’s campaign was driven by his experience as a member of the Bradford school board, where he witnessed the malnourishment of children who then fell behind their more affluent peers. Here we are, more than 100 years later, and those arguments are still being made today.

[Andrew Gwynne (Denton and Reddish) (Lab)]

I was just thinking the same as my hon. Friend about how far we have come in some respects but not in others. She will be aware of the private Member’s Bill of my right hon. Friend the Member for Birkenhead (Frank Field). Does she support it?

[Mrs Hodgson]

Yes, that private Member’s Bill is an excellent initiative, and should be adopted by the Government and local authorities. It is very simple to share the data that we already have on families who are entitled to benefits, to ensure that the entitlement of their children to the pupil premium is not lost when universal free school meals are rolled out. That is a very important point.

Although we do not always think about obesity in this way, it is a form of malnourishment. What we are seeing today is very similar to what we saw more than 100 years ago, with children lacking the right nutrients to see them living a healthy childhood and growing into healthy adults. That is especially concerning given that today more than one third of children are leaving school overweight or obese.

The school setting is one of the most important interventions in a child’s life; it is where we nurture and educate future generations. Why should we not feed these children so that they are fuelled to receive the best education and life chances possible? That notion was strongly supported by the previous Labour Government, who introduced a raft of measures that addressed the food eaten by children in our schools. They included nutrition-based school food standards that provide children with the proper nutrition to learn, fully costed plans to extend our universal free school meal pilots, and the introduction of healthy, practical cooking on the national curriculum.

Although much, or all, of those measures were scrapped when the coalition Government were formed in 2010, it was very welcome when, in 2013, the school food plan was published, calling for the reinstatement of lots of those measures as well as new and improved measures in our schools to address the health of our children. Those included introducing food-based standards for all schools, training head teachers in the benefits of food and nutrition, improving Ofsted inspections on school food, and the roll-out of universal free school meals for primary school children, when funding was found.

As we know, that funding was found, thanks to David Laws and the right hon. Member for Sheffield, Hallam (Mr Clegg). Fortunately, universal infant free school meals were secured by the Chancellor in the comprehensive spending review. All those measures came out of concerns for the health of our children and the growing obesity crisis, especially given that 57% of children were not eating school lunches. Some were opting to take in packed lunches, only 1% of which met the nutritional standards of a hot lunch, while others were opting to go off site to eat junk food at local takeaways.

As research has found, health problems associated with being overweight or obese cost the NHS more than £5 billion a year, and, with obesity rates continuing to rise for 11 to 15-year-olds, especially in deprived areas, it is now clearer than ever that we need seriously to address childhood obesity.

Giving children a healthy and balanced diet during the school day can only be a positive intervention in helping to address obesity. I cannot stress how strongly I believe that one of the most important interventions to help address health issues in childhood is universal free school meals.

[Helen Whately (Faversham and Mid Kent) (Con)]

The hon. Lady mentioned that children are consuming junk food from outlets near schools. Does she believe that councils should have powers, as part of planning guidance, to take action on junk food outlets being so close to schools?

[Mrs Hodgson]

Yes, I do. I really welcome that intervention, because it not only makes the point, but stresses it very strongly. Some councils are very good and introduce byelaws to ensure that burger vans cannot pull up outside a school, and that, if there is already a number of takeaway shops nearby, no more can open. Matters such as that need to be addressed by councils.

The pilots introduced by the previous Labour Government in Durham and Newham to look into the benefits of universal free school meals found many benefits to a child’s health, and research continues now that we have universal infant school meals. The pilots in Durham and Newham found a 23% uptake in vegetable consumption at lunchtime and a steep decline in the typical unhealthy packed lunch foods. For example, there was a 16% decline in soft drinks and an 18% decline in crisps. Those are all-important figures that the Government should remember, and both the Department of Health and Department for Education should look further into how best they can use the vehicle of universal free school meals to help improve children’s health.

Although universal free school meals are protected in the Government’s comprehensive spending review—this followed a concerted campaign by school food campaigners, myself and others in the House—there is another area that the Government must consider when looking to improve the health of our children: holiday hunger. Children are in school for just 190 days of the year, and the rest—a total of 170 days—is totally down to their parents. Some may say that that is how it should be and that when we lock the school gates for the holidays it is none of our business what children eat, whether they eat or what they get up to. None the less, with the growing use of food banks in school holidays and the reports that children return from the longer school holidays noticeably thinner and unhealthier, the issue is one that we can no longer ignore.

If there is a push for better food provision in our schools, then we need to be doing much more during the holidays so as not to undo the hard work that goes into improving the life chances of children during term time. That is why the school food all-party group, which I chair, has established a holiday hunger task group, which last year launched its “Filling the Holiday Gap” guidelines to provide organisations and local authorities wishing to provide food during holidays with the resources to offer healthy and nutritious food. Late last year, it published its update report, which called for action to be taken by the Government.

When the Government’s childhood obesity strategy is published, I hope that there will be significant mention of the benefits that school food, especially universal free school meals, can have on a child’s health, and of how it can be used to address the growing childhood obesity crisis. There is evidence out there to support using universal free school meal provision to its fullest, instead of squandering its potential, to improve the health of our children.

This is a moment when the Government can really make a difference to children’s lives and I hope that all options and avenues will be pursued so that children are given the healthy food that they need to fuel their education and to make them as healthy a version of themselves as possible so that they grow into fit and healthy adults.

--- Later in debate ---

[Alison Thewliss (Glasgow Central) (SNP)]

I am glad to be able to speak in this debate and hope that what I say will provide a different kind of insight into the debate on childhood obesity.

I am a great enthusiast for breastfeeding. Breast milk has many exceptional qualities, the most obvious being that it is exactly the right thing for infants to be eating. In the beginning, there is the double cream of breast milk, colostrum, which appears before a baby is even born in preparation for those first feeds. The milk that comes thereafter changes and adapts over time as the baby’s needs change. Breast milk has everything that a baby needs and, taken directly from source, it has the advantage of being at the correct temperature. It is easily absorbed by the infant gut. It is a miracle of nature.

What breastfeeding contributes to this debate is the impact that it can have on reducing childhood obesity. An excellent study was pulled together by UNICEF a few years ago called, “Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK”. The report analysed data from many studies to ensure that there was a sound scientific basis for the claims that it made. Although I accept that giving precise figures and modelling on this is difficult, the UNICEF report estimates that:

“A modest increase in breastfeeding rates could result in a reduction in childhood obesity by circa 5%. If this was the case, the number of obese young children would fall by approximately 16,300, and annual health-care expenditures would reduce by circa £1.63 million.”

That would be no mean contribution. Breastfeeding starts babies off on the right track and, with the accompanying health benefits, such an increase could result in a generation of healthier babies and young people.

The Government should bear that in mind and ensure that services to promote, protect and support breastfeeding are well maintained. This is too important to be left to the good will of the wonderful network of voluntary organisations across the country. It needs to be an identified priority of this Government. The newly formed all-party parliamentary group on infant feeding and inequalities, which I established this week with colleagues from across the House, aims to examine the matter further. We will consider the issues of inequality, because there are multiple deprivation issues, with lower rates of breastfeeding in deprived communities.

What is less well known about infant formula is the specific contents of that product. It takes a complex chemical process to produce formula that involves either dry blending or wet mixing and spray drying, in which cow’s milk is treated with added lactose or other carbohydrates, vegetable and other oils, vitamins and minerals. According to the First Steps Nutrition Trust, the current regulations require infant formula and follow-on formula to have an energy content of between 60 kcal and 70 kcal per 100 ml. Those figures are based on the energy content of breast milk, but, as I mentioned earlier, breast milk composition changes in response to the baby as it grows. Breast milk also has more unsaturated fats than cow’s milk and the fats in infant formula tend to come from the vegetable oil. If anyone has an interest in finding out more about this, I recommend that they seek out the “Infant milks in the UK” report that is produced by the First Steps Nutrition Trust. The level of detail is fascinating.

There are differences between the growth curves of breastfed and formula-fed babies, with the formula-fed babies gaining more weight in the first year. Some studies suggest that that may, in part, contribute to childhood obesity. Pressure is also put on mothers to ensure that their baby is gaining the correct amount of weight. We should consider how formula milk is delivered. I have heard many people describe how many millilitres of formula their baby has drunk at any given time, comparing and contrasting this with others. There is an expectation of how much is normal.

There is a risk in the making up of formula milk, because one must ensure that the correct dosage of powder is dissolved in the water. If this is not done accurately, there is a risk of babies being overfed or, indeed, underfed. The risk of that is far lower for breastfed babies, although I admit that I could only really tell how much breast milk my babies had by the amount that they both threw up all over me. There is not really any other way of telling.

[Mrs Hodgson]

I agree with everything the hon. Lady has said so far. As she knows, I took part in the debate that she led in Westminster Hall on this issue. The point that she is making is very important. I was an evangelical breastfeeder myself and still encourage everyone to do it in every which way they can. She makes the point that breastfed babies feed on demand, so they take as much or as little as they need, whereas when babies are bottle fed, there is an obsession with whether they have taken half a bottle, 8 ml or whatever. Parents inadvertently force-feed their baby the amount they think they should have, rather than what the baby needs, so babies get used to being full. As we all know, that is not necessarily good and can lead to the bad habits in adulthood that I spoke about earlier.

[Alison Thewliss]

I absolutely agree with what my good friend says. Bottle feeding tends to be at a set time—“Is it time for the baby’s feed yet?”—rather than when the baby actually needs to be fed, whereas breastfed babies are fed little and often on demand, which is a slightly better habit to get into.

There is also a beneficial effect on breastfeeding mothers. As well as reducing the risk of cancer and diabetes, breastfeeding burns calories and helps to get mothers back to their pre-maternity weight—for me the prospect of burning an extra 400 to 500 calories just by breastfeeding my baby was very attractive, and it certainly helped me to fit back into the clothes that I wore before I had my children, both of whom were breastfed for two years.

I was interested in the findings of the Select Committee report, and I particularly note the points about marketing and sugar content in foods. I was a wee bit disappointed that it does not contain much discussion on baby foods and toddler milks, as there are significant issues in that area regarding the advertising and the content of the products. In evidence to the Committee, Dr Colin Michie of the Royal College of Paediatrics and Child Health stated:

“Follow-on formulas are not necessary for human beings, but it would not seem so if you watch television. The problem is we are all very convinced by the stories. There are other issues that have parallels for what was said earlier in that the milk companies sponsor education, training, events and an awful lot of professional activities, which again does exactly, to our minds, what we heard it does to infants’ minds: when we see brand names, we equate certain things with them. It is an insidious business that we know enough of to be very wary of.”

The artificial creation of a market for follow-on or toddler milks is of some concern, because those products are not subject to the same level of scrutiny as formulas for very young babies. Research gathered by the First Steps Nutrition Trust suggests that

“Growing-up milks and toddler milks contain almost twice as much sugar per 100 ml as cow’s milk, and some Aptamil and Cow & Gate growing-up milks and all SMA growing-up milks contain vanilla flavouring. It is unclear whether repeated exposure to sweet drinks in infancy and toddlerhood might contribute to the development of a preference for sweet drinks in later life.”

It is important to take cognisance of that and consider the issue as part of the obesity strategy.

--- Later in debate ---

[Mrs Flick Drummond (Portsmouth South) (Con)]

I am delighted to follow the hon. Member for Glasgow Central (Alison Thewliss), who has established the fantastic all-party group on infant feeding and inequalities. I am looking forward to being part of that as it progresses, and I thank her for setting it up.

The chief executive of NHS England describes obesity as “the new smoking”, and in many ways he is right. Obesity leads to a multitude of health complications, ranging from lack of mobility to cancer. There are also many hidden health risks for people who are obese or severely overweight. Obesity can lead to a lack of self-worth or depression, and it can affect relationships and careers. Because of the growing obesity problem, and the very serious threat to our children’s futures, I am happy that this debate is taking place, and I congratulate my hon. Friend the Member for Totnes (Dr Wollaston) on securing it.

In my constituency of Portsmouth South, 20% of children and 25% of adults are obese, which is above the average for England. In other ways, obesity is unlike smoking—there is no “vaping” technology for people who struggle to maintain a healthy diet. We know that fast food is an immediate satisfaction, whereas healthy food can take longer to prepare. I am concerned, however, that some studies suggest that healthy food is more expensive than the fast and unhealthy food that we see on offer every day, or positioned conveniently at supermarket checkouts.

I am particularly concerned by a fairly recent report by the University of Cambridge, which found that healthy food was three times more expensive than unhealthy food. I would dispute that. It is perfectly possible to eat healthily on a low budget. As Baroness Jenkin from the other place has shown, someone can live healthily on £1 a day, and I know from my own busy household that it is possible to live healthily on a very small budget. At the local food bank where I volunteered before the election we handed out healthy recipes for the food that was provided, which should have lasted people for three days. I am sure that I do not need to repeat what that issue means for those living in deprived areas, except to say that in my constituency of Portsmouth South, where deprivation is higher than the English average, the challenge to encourage people to eat healthy food is even greater.

The whole House will agree that today our nation’s children are more susceptible and at risk of becoming obese. Children do not control their diets—it is the parents who do the weekly shop—and we would never blame a child for their poor dietary choices. Children who develop obesity at a young age are at risk of developing lifelong conditions, some of which are also life-limiting; as we have heard, cases of diabetes are increasing. During childhood, people develop habits that can last the rest of their lives. A lot of facts have been flying around in this debate, and although I understand the financial burden that a growing obesity problem poses for our NHS, the human cost cannot be quantified.

The solution to this problem is not simply more money. As other Members have said, it requires the energy and commitment of central and local government, health organisations, and our local charities, to educate the population on how to live on a low wage. I am really pleased that the Roberts Centre in my constituency is a family-focused charity. It offers a range of services offering support and assistance, including making healthier lifestyle choices, to some of the most disadvantaged families in the city.

[Mrs Hodgson]

On the hon. Lady’s point about living healthily on a low wage, I take on board that it is very possible to make healthy food very cheaply, but people need the skills and knowledge to be able do that. I wonder whether she will say a bit more about that. The School Food Plan says that education should start with children learning the skills they need to be able to look after themselves as adults.

[Mrs Drummond]

That is exactly what I was going to come on to, so I thank the hon. Lady very much indeed.

Last week, I met Home Start, a national family charity with a strong presence in Portsmouth. It has an army of volunteers who offer unconditional help and support to all families who need help in getting it right, and show them how to cook healthily. There is, however, a major role for our schools in tackling obesity. The school where I am a governor, Milton Park primary, is taking the lead locally in educating children about healthier choices. The cooks at the school have won awards and I can recommend their so-called “chocolate muffins,” which in fact are made of beetroot.

I would like to see cooking classes become mandatory in schools. I know it would be difficult to re-establish kitchens, but the rewards would be worth it. I see that as the only way to prevent future generations from continuing poor eating habits. The only way to do that is by teaching them how to cook healthily and how to budget. Like some of my colleagues, I was against a sugar tax to start with. If we can use the sugar tax to fund cooking classes in schools, however, then I am all for it.

In Portsmouth, there are a number of charitable organisations actively engaging with the community to help to tackle obesity through a more active lifestyle. Affiliated with Portsmouth football club, Pompey in the Community provides education and opportunities for children in the city.

National Breastfeeding Week

Sharon Hodgson Excerpts

Wednesday 24th June 2015 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Thank you very much, Mr Bone, for chairing this debate this afternoon. I also thank the hon. Member for Glasgow Central (Alison Thewliss) for securing this important debate, and other Members for their excellent contributions.

We need to keep our focus on this issue, and I am very pleased that all the Members who have spoken so far share my passion for extolling the virtues of breastfeeding. I am also pleased to note that the Minister present today is the Under-Secretary of State for Life Sciences, who I respect hugely. Although at first I thought it was rather strange that breastfeeding came under his brief, I am now sure that it is simply the case that the issue is so important to the Government, and crosses so many departmental boundaries, that they settled on him, and it was not just a case of Ministers perhaps playing “pass the parcel” with this important debate. As I say, I am very pleased to see that he is here to respond to it.

I will start my remarks by putting my cards firmly on the table—for me, wherever possible breast is best. I breastfed both my children, as all the Members who have spoken so far breastfed their children, and I am evangelical about the merits of breastfeeding.

As other Members have said, and shared, breastfeeding sometimes hurts at first—although not for everyone—and that is why the right support is vital, to help women and encourage them to carry on breastfeeding. Having someone physically there really makes the difference, especially when a woman has a baby like my son, who did not like to open his mouth very wide when latching on. If he could get away with it, he would just suck on the nipple until it was red raw, and obviously he then got no milk. If nobody had told me that that is not how it is supposed to happen, I would have given up immediately. Support is vital. As with my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes), my second child—my daughter—could not tolerate cows’ milk. Fortunately, I was able to carry on feeding her to about 16 months, but feeding a toddler in public draws lots of frowns, and eventually I succumbed. We went on to soya milk, and even now she does not really like milk.

We have a fabulous support network in the north-east called Bosom Buddies, which helps, supports and encourages new mums as they get to grips with breastfeeding during the early days. The network provides much-needed guidance and advice for mothers who may otherwise be unsure about even starting to breastfeed. Those services are replicated in various parts of the country, and many are in Sure Start centres. I have had the great pleasure of visiting many breastfeeding support groups in those centres, and I have seen their great work. I would love every new mother across the UK to have access to such services, because that support makes a huge difference, as we have all attested today. Sadly, as we have seen across the country in recent years, Sure Start centres are closing. More than 700 have closed since 2010, which limits the amount of support that mothers can get. What assessment have the Government made of the number of support services that have been lost as a result of the closure of more than 700 Sure Start centres?

National Breastfeeding Week is a brilliant idea, and over the years it has successfully highlighted, across the world, the importance of breastfeeding. I fully endorse and support the campaign, and I hope this debate will go some way towards making even more people aware of the virtues of breastfeeding. As we have heard, numerous studies have shown breastfeeding to be the healthiest way to feed a baby. Not only does breastfeeding provide essential nutrients and sustenance, it also greatly reduces the risk of a baby developing health problems such as gastroenteritis, asthma, diabetes and obesity. Furthermore, breastfeeding helps to protect women from breast and ovarian cancer. The World Health Organisation is unequivocal that, if possible, babies should be totally breastfed until they are at least six months old. On top of all that, there is the additional bonus that breast milk from source is always at the right temperature for babies, with no bottles needing to be sterilised. Best of all, it is 100% free. Breastfeeding is cheap; it is good for babies; it comes highly recommended; and, by preventing illnesses, it keeps babies safe while saving millions of pounds from stretched NHS budgets. Put simply, what is not to like?

Unfortunately, despite all of the positives that other Members and I have outlined today, certain obstacles remain for mothers who are looking to breastfeed their children. One such obstacle comes when mothers return to work after maternity leave. Breastfeeding mothers face a heightened sense of anxiety when they return to work from maternity leave, as they have the additional worry of how their baby will be fed in their absence. The hon. Member for Glasgow Central and other hon. Members spoke of their personal experience. Women may have to raise with their employer the issues of expressing and storing breast milk and fitting in feeds around their work and lunch hour. If they harbour fears that their employer lacks an understanding of, or concern about, such accommodations, it may delay their return to work, or stop their return altogether. Alternatively, such fears may make women give up breastfeeding sooner than they had planned.

Maternity discrimination, such as prohibiting mothers from breastfeeding in cafés or restaurants, is now against the law under the Equality Act 2010, but the Act does not apply in the workplace. Mothers can be told not to express milk or be denied breastfeeding breaks. Employers do not have to provide facilities for breast milk to be expressed or stored. Good employers provide such facilities, but they do not have to do so. I can tell hon. Members, as the Health and Safety Executive already has, that toilets are no place for expressing milk or breastfeeding. We all want parents to get back to work if they wish to do so. I hope the Government understand that breastfeeding responsibilities are holding mothers back from returning to work, and I hope the Minister will assure us that he is looking into ways to address that issue.

Over the past few years, we have seen that women in general are finding it harder at work. There were more unemployed women over the past five years than at any time under the previous Labour Government, and real wages for women have fallen year on year since 2010. There has also been a dramatic fall in sexual discrimination and pregnancy discrimination cases made against employers since women were priced out of justice when expensive tribunal fees were introduced. Figures comparing the years before and after the introduction of those fees show a truly staggering 91% fall in sex discrimination cases and a 46% fall in pregnancy discrimination cases. Such dramatic falls are utterly unacceptable in a country that wants to treat women with respect in the workplace. A Labour Government would have scrapped those unfair barriers to justice. I would love to hear the Minister say that his Government will reverse that unfair policy.

Alongside the structural issues affecting breastfeeding, there is a growing cultural obstacle that prevents new mums from breastfeeding their children. It is particularly striking, as we have heard, in working-class communities. The Department for Health figures show that in Brighton almost 70% of new mothers were partially or totally breastfeeding at six to eight weeks—that is relatively early to be taking a measure, given that the recommendation is that children should be breastfed for up to six months, but we can use it as a comparison—while in Hartlepool and south Tyneside the figure falls to 19.3% and 22.6% respectively.

In some communities today, there seems to be an anti-breastfeeding culture among young mothers, which we need to challenge and reverse. National Breastfeeding Week and this debate are great ways of starting to do that. Breastfeeding must be seen as normal and natural, and new mothers should feel utterly comfortable doing it. We need to focus on the areas and communities in which new mums do not even consider starting to breastfeed because it seems so strange or even repulsive to them. Government support is required. Role models must come forward to extol the virtues of breastfeeding and we need more mums on TV—[Interruption.] Hon. Members may laugh. We need mums in our soaps and even on “The Only Way is Essex”, breastfeeding naturally and happily. We rarely see breastfeeding, and if we do it is usually by mums such as us—middle class, professional, older mums—which reinforces the image in some young mums’ minds that breastfeeding is something for a certain type of people, not for them and their friends.

We need to work to reverse that image and let new mums and young mums know that breastfeeding is not only good for their health and that of their babies, but it has immediate benefits, such as helping them lose their pregnancy weight much faster, as the hon. Member for Glasgow Central said. I was never as slim as when I was breastfeeding my children. If I could have carried on breastfeeding, I would, because the weight really drops off. It also means not having to get cold in the middle of the night making up bottles, and it helps mums to bond in such a special way with their babies, which cannot be imagined until it has been experienced.

Come on, TV producers, soap writers, celebrities and “TOWIE” stars watching this debate—get to it. Get breastfeeding on TV and get mums seeing it. I want mums to feel comfortable in public—even in Claridge’s, for goodness’ sake. We need to show that it is totally normal, natural and acceptable, and that those who have a problem with it simply need to get over it.

I once again thank the hon. Member for Glasgow Central for securing this important debate and for all she has said and done on this issue in the short time she has been in this House. I thank the other hon. Members for coming along and making their expert contributions. I have rarely heard such strong and powerful arguments for the benefits of breastfeeding and I thank every hon. Member who came to speak here today. I am sure that with such powerful advocacy from hon. Members and from groups and organisations throughout the country, National Breastfeeding Week will be a huge success in raising even greater awareness among parents.

I hope that the Government will listen to the concerns about women getting back into work after having a baby and will address the specific issues that affect them to ensure that that transition is best for both the mother and her baby. We all want to see the best outcomes for all parties, but only by taking action to help can we see progress. Simply hoping for the best will not be enough, so for the sake of babies, their mums and our society in general, let us hope for a successful awareness campaign and an equally successful response from the Government.

Health and Social Care

Sharon Hodgson Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I would like first to take this opportunity to thank the people of Washington and Sunderland West for re-electing me as their representative. It has been a privilege working on their behalf over the past decade; I look forward to continuing to do so over the next five years.

Today’s debate focuses on health and social care, which is one of the issues I heard a lot about on the doorstep during the election campaign. The Gracious Speech included sections on health that were similar in tone to policies that Opposition Members campaigned on during the election. However, as too many have learned the hard way over the past five years, we should always take Tory promises on the NHS with a rather large pinch of salt. The Gracious Speech spoke of securing the future of our NHS. That is the same future that five years of Conservative policies have put in dire jeopardy, which is why Labour in opposition must work harder than ever to push the Government to do what is necessary to help our struggling NHS services.

I would like to focus my remarks on the specific problem of continuing health inequalities experienced in many parts of the UK. Compared with the rest of the country, my region, the north-east, has ingrained health inequalities. That is clear from the persistently lower life expectancy, and we also have the highest national rate of early deaths from cancer. The situation will only get worse if the investment into the NHS is not forthcoming and properly tailored. The coalition Government oversaw a number of disastrous policies that put our NHS under increasing strain in the north-east. It will be my job and that of my north-east colleagues to make sure that this Government do not keep ignoring our needs and that something is done not only to cure the problems we currently have but, crucially, to invest in prevention to stop them from taking root in the first place.

Similarly, all across the country, other health inequalities exist that this Government must do more to address, none more so than the diagnosis and treatment of cancer. It is estimated that by 2020 half the entire population can be expected to be diagnosed with cancer at some point in their lives, so it is crucially important to make sure that we have a system that works for everyone. This will mean boosting greater awareness, more innovative training of doctors, investing in the drugs needed to treat the conditions, and having the staff available to help people as they go through what is likely to be the most traumatic period of their lives. This takes investment, but it also takes the will to do it. We need the Government to be truly proactive and positive in getting to grips with this issue. I can assure Ministers here today that I will continue to press them on this as, I hope, co-chair of the all-party group on breast cancer, and again I hope, if I am re-elected, as chair of the all-party group on ovarian cancer. I am sure that my colleagues will do likewise.

In my capacity as shadow Women and Equalities Minister, I have been very aware of the shocking health disparities seen among people from BAME—black, Asian and minority ethnic—backgrounds. Incidence rates of myeloma for African and African-Caribbean men and women are twice as high as for white men and women. Mouth cancer rates in Asian females are 50% higher than they are for white women. Black men have higher rates of prostate cancer than men of other ethnicities. These and many other equally alarming statistics make for worrying reading. I was proud to see in Labour’s BAME manifesto that our party made a commitment to focusing on delivering greater health equality. Over the past five years of the coalition Government, however, I have seen nothing to suggest that reducing health inequalities has been anything like a priority for a Conservative Administration. I fear that if that remains the case for the next five years, the situation is only going to get worse.

I fought the general election with a desire not just to save our NHS but to make it the best service anywhere in the world. Our policies would have made great strides towards achieving that, not only helping patients but improving the way we treat the brilliant medical, care and support staff who are the lifeblood of our NHS. Over the past five years, those staff have been overburdened and undervalued. That needs to change immediately, as does our over-reliance on agency staff, which has been all over the news today. According to a recent report from the Royal College of Nursing, spending on agency nurses in 2014-15 stands at £980 million, and the overall spend on agency staff is a staggering £3.3 billion. Surely this is not prudent or value for taxpayers’ money by any measure.

Worrying developments outlined in the Gracious Speech about workers’ rights undermine the already ridiculous assertion by the Conservative party that it is the party of working people. The Prime Minister and Chancellor like to don a high-visibility jacket now and again for a photo opportunity, but that does not fool the people of my constituency that they have their best interests at heart. If they banned exploitative zero-hour contracts, pursued tax dodgers and those who do not pay the minimum wage, tackled the blight of low pay all across the country, stopped punishing and demonising the most vulnerable, and upheld rather than sought to scrap the hard-won rights of working people across our country, then perhaps they would start to earn the right to call themselves champions of working people. Perhaps they will surprise us, but I, for one, will not be holding my breath.

I will finish by looking at another area that has been much harder for ordinary working people over the past five years—the provision of childcare. In my newly reprised role as shadow Children and Families Minister, I listened very carefully to the passage of the Gracious Speech on the Government’s commitment to increase free childcare for working parents. In principle, of course, this is a policy that Labour Members believe in. Indeed, we championed it during the election, and then the Tories copied us. Childcare for three and four-year-olds has suffered underfunding problems for some time now, with nurseries in the north-east suffering the worst. That has gone hand in hand with parents being consistently hit hard over the past few years, with childcare costs having reached simply unsustainable levels, going up a staggering 47% in the north-east. I hope the Government understand how badly they need to do something about this and that they cannot cut precious child benefit to plug the funding gap. I will be watching out for that very closely.

--- Later in debate ---

[Jim Dowd (Lewisham West and Penge) (Lab)]

It is an unexpected pleasure to see you in the Chair, Mr Howarth—although Mr Speaker is now taking over just as I say that. It is a pleasure to serve under you both. The maiden speeches that have been given this afternoon have been uniformly excellent, and I am sure that they betoken a bright parliamentary future for those Members. To the hon. Member for Colchester (Will Quince), may I say that I knew Bob Russell well for the 18 years he served here. Our offices were a few doors apart on the Upper Committee corridor. If the hon. Gentleman can serve the people of Colchester one tenth as well as Sir Bob Russell did, he will be doing very well indeed.

In my reflections on the Queen’s Speech, I would like to say something about health, if I have the time, but there are other things that I want to say before that. First, perhaps surprisingly, I welcome the inclusion of the European Union Referendum Bill. I have been a supporter of a referendum on our future relationship with Europe, and a few years ago served on the Committee for the European Union (Referendum) Bill, which was introduced by the hon. Member for Stockton South (James Wharton). I noticed that he retained his seat with a swing of 4.5% to the Conservatives, as opposed to the 2% swing to Labour in Stockton North, and think that it might have something to do with the role he played in picking up the Bill. It was a reward for his effort.

The Bill was known by the denizens of the fourth estate as the Wharton Bill, but that is not actually true. It was a No. 10 Bill that the hon. Gentleman picked up having been drawn first in the private Members’ ballot. The Committee was an interesting experience, not to mention entertaining, because it was entirely led by the Minister for Europe, the right hon. Member for Aylesbury (Mr Lidington). The hon. Member for Stockton South said not a word until the final sitting and the pleasantries that conclude every Committee stage. We were also entertained by the bizarre sight of the Prime Minister having to pay obeisance to the Eurosceptic right wingers on the Committee, to whom he was in thrall, by sitting in the Public Gallery of the Committee Room on a Tuesday evening. I have tried to check whether any previous Prime Minister has been forced to suffer such humiliation, but so far I have drawn a complete blank. The Bill was a device to hold the Tory party together more than anything else, and it foundered as a consequence.

My support for a referendum is based on the belief that our relationship with and position in the EU needs to be clarified, and only the electorate at large can do that. Polls show majority support for the referendum, even among those who would vote for the UK to remain a member of the EU. I felt that my party’s position at the general election—refusing to support a referendum on the grounds of uncertainty—was always untenable. The only way to remove uncertainty is to deal with it, not to ignore it. Denying people a say on the grounds that they might come up with the wrong answer is unworthy of any truly democratic party. I am neither a Europhile nor a Europhobe; I am what I prefer to call a Europragmatist. I believe that the interests of this country, its economy and its people are best served by remaining in the EU, but I see that there can be life outside the EU, even though I do not think that that is the optimal solution.

I speak as someone—I think I am in the minority in the House—who actually voted in the 1975 referendum, and voted no. However, I offer the Prime Minister a word of caution. Harold Wilson devised the referendum in 1975 largely as a device to hold the Labour party together, and it did so in the short term, but that did not endure. It also resulted in defeat at the next general election in 1979, which left the Labour party languishing on these Opposition Benches for the next 18 years.

Childcare was mentioned in the Queen’s Speech and it is immensely important to hundreds of thousands of families. The Labour party promised an extra 10 hours of childcare on top of the current 15 hours, and the Conservatives promised an additional 15 hours, so there is no real difference on the principle. Everything revolves around the practicalities of capacity and cost.

At the moment, it is estimated that under the 15-hour scheme there is a 20% funding shortfall. The average amount that most local authorities pay is £3.88 per hour, but the true cost to those providing the service is 70p an hour more than that. The Family and Childcare Trust, the National Day Nurseries Association and the Pre-school Learning Alliance have all expressed grave reservations about what is being proposed, as well as saying that it is necessary to get things right.

Just a week after the general election I received a letter from somebody who runs a Montessori nursery in my constituency. He is actually a constituent of my hon. Friend the Member for Lewisham East (Heidi Alexander) and also sits on the executive of the private providers, Bromley council partnership group, which represents about 200 private providers in the borough of Bromley. He wrote:

“The reason so many of us are concerned is that MPs and certainly a minister in charge of this portfolio must know how private providers in London and South East are currently subsidising the ‘free’ 15 hours with the additional time purchased by families above the 15 hours at a rate more in line with the real cost of provision. You will also know that raising the ‘free’ entitlement to 30 hours will almost eliminate this approach and I am sure you will not insult our intelligence by suggesting the promised increases in the Government’s rate of funding will get anywhere near replacing this revenue.”

[Mrs Hodgson]

My hon. Friend is making some extremely valuable points in expanding on what I said towards the end of my speech. Is he as concerned as I am that the Government have not come forward with any proposals about how they will pay for this scheme? Indeed, the only benefit that we have heard might be at risk is child benefit. Is he also worried about that?

[Jim Dowd]

Yes—I am worried about anything that has not been specifically stated in the Queen’s Speech. I know that the Government have engaged in a review of the implications of this proposal, but they should have engaged in that before promising anything. To put the promise up front and then say, “Well, we’ll sort something out afterwards”, is a recipe for chaos.

What will happen if the Government are not careful is that we will move to the disgraceful position that we have had for many years in residential care for the elderly, whereby it is the private payers who subsidise the local authority residents, because the local authority residents’ rates are fixed and the private payers have to pay a premium on top of those rates. If that is what this proposal results in, it will be a complete and utter disgrace, and it will not work because there is not the capacity in the private nursery sector for everybody to take advantage of it.

Finally, the reservations of the hon. Member for South Dorset (Richard Drax), who is not in his place, about the right to buy for housing association tenants are entirely justified. That proposal is little more than a scandalous bribe to those who are already adequately housed. A discount of anything up to £102,000 in London is not only grossly unfair but an insult to those in the private sector who would dearly love to be given £100,000 to buy a house or to rent. This will add nothing at all; it does nothing to deal with the housing crisis, either here in London or anywhere else. It is a sordid Government-sponsored corruption scheme worthy of FIFA.

Improving Cancer Outcomes

Sharon Hodgson Excerpts

Thursday 5th February 2015 Commons Chamber

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I am pleased to speak in this important debate. I thank the Backbench Business Committee for granting such an important debate and the hon. Member for Basildon and Billericay (Mr Baron) for applying for it. His excellent speech showed his knowledge on and passion for this subject. I commend him for all the work that he has done over the years.

I would also like to acknowledge the dedicated work of three amazing women who sadly lost their lives to ovarian cancer: Eilish Hoole, who sadly lost her battle in July last year; Chris Shagouri, who worked tirelessly with her MP, the hon. Member for Pudsey (Stuart Andrew); and Jenny Bogle, who, thanks to her MP, my hon. Friend the Member for Islington South and Finsbury (Emily Thornberry), was the only patient to give evidence to the Health and Social Care Public Bill Committee in 2011. They were fearless campaigners who regularly attended events in this House to lobby us all for greater awareness of this terrible disease, and they will be sorely missed.

It is estimated that by 2020, roughly half the population of this country can expect to be diagnosed with a form of cancer in their lifetime, so improving outcomes has never been more important. One major way to do that is to push for ever-greater awareness of the many different forms of the disease, from causes and symptoms through to treatments. With that in mind, I will focus on ovarian cancer—a subject that I know well as chair of the all-party parliamentary group on ovarian cancer.

Ovarian cancer is the fourth most deadly cancer for women in this country, with more than 4,000 women a year dying of the disease. That is 12 mothers, sisters or daughters dying every single day. One of the biggest reasons why it is so deadly is that the vast majority of women are diagnosed too late, meaning that their chances of survival are extremely poor. That contrasts hugely with those who are diagnosed early, up to 90% of whom survive. Put simply, if all cases were caught early enough, thousands more women would survive this terrible disease each year.

The biggest barrier to that happening is a profound lack of awareness of ovarian cancer and its symptoms. If I were to ask women up and down the country to name the key symptoms of early-stage ovarian cancer, such as persistent bloating, difficulty eating, feeling full quickly and persistent abdominal pain, the vast majority would not be able to do so.

A study by Target Ovarian Cancer last year found that only 3% of women surveyed were really confident about spotting any of the symptoms of the disease, and another study found that nearly half of women believed incorrectly that cervical screening is able to detect ovarian cancer, making them much less likely to be on the lookout for symptoms themselves—even if they knew what those symptoms were. It is also believed that GPs have a harder time spotting symptoms of ovarian cancer than many other types of cancer, as it is classed as a rarer cancer and, according to the NHS “Five Year Forward View”, it is estimated that the average GP will see a rare cancer only once in their entire career.

Disappointingly, that was one of the few mentions of cancer in that report. In fact, the only section on the disease features in the last two pages. It appears to have been a late addition, as it does not even feature in the contents page. However brief the mention, it does make a couple of good points. It says that we need an NHS that

“works proactively with other partners to maintain and improve health”.

It also recommends that, because of the rarity of some forms of cancer, we need to give GPs support to

“spot suspicious combinations of symptoms”.

It also says that

“as well as supporting clinicians to spot cancers earlier, we need to support people to visit their GP at the first sign of something suspicious”.

It predicts that achieving that would mean 8,000 more patients living longer than five years post-diagnosis.

After reading that commendable statement, I was disappointed to hear from the NHS’s national clinical director for cancer, Sean Duffy, at our last all-party group meeting on ovarian cancer, that ovarian cancer may not be included in the Be Clear on Cancer campaign. That seems to me to be contrary to what the NHS report recommends. Perhaps the Minister will be able to tell the House whether any such decision has been taken and, if not, that she will work with me to ensure that ovarian cancer is included.

I would also like to know from the Minister whether the lack of focus on cancer more generally is a result of the Health and Social Care Act 2012. As co-chair of the all-party group on breast cancer, I have spoken to several leading breast cancer charities, which have told me that the Government’s reorganisation has ended up reducing the capacity of the NHS to deal with cancer services, not least through the dissolution of the cancer policy team in the Department of Health and the dedicated cancer networks locally. At a time when more people than ever are getting cancer, it is worrying to see changes to our NHS that have significantly reduced our ability to deal effectively with this awful disease.

Cancer is life-threatening, but in many cases ignorance can be the biggest killer. In 2013, the all-party group on breast cancer published an excellent report that highlighted the fact that older women are lagging behind in early diagnosis of breast cancer, partly through a lack of awareness of the symptoms, and we laid out a clear set of recommendations to help deal with the problem. If that is the case for a cancer as common and as well understood as breast cancer, it is even more difficult for the rarer cancers such as ovarian cancer to be understood, spotted, diagnosed and treated in good time. That is why raising awareness among the general public is more critical now than ever. Unlike with breast cancer, there is no workable national screening programme for ovarian cancer, so it is even more important to get the message out about it. We have the tools at our disposal to do so almost straight away.

The Government’s Be Clear on Cancer campaign ran a pilot study in 2013, in which areas of the country were the subject of ovarian cancer awareness campaigns. I commend the former Minister, the right hon. Member for Sutton and Cheam (Paul Burstow), on his excellent work in this area. He met members of the all-party group to discuss the awareness campaign, which ultimately led to the pilots. The results from the campaign were extremely positive. More women remembered seeing the awareness campaign materials, there were higher levels of women going to see their GPs about possible symptoms and, crucially, more women than ever recognised key symptoms and demonstrated greater overall knowledge of ovarian cancer than women from other parts of the country who were not part of the campaign.

Last year, another pilot was launched in the north-west region. Sean Duffy reported back to the all-party group on ovarian cancer that the pilot may not lead to the desired roll-out, so perhaps the Minister will be able to let the House know when the full results of that study will be released and whether they differ significantly from the previous report, which pointed to greater awareness having been generated by the campaign. By making sure that ovarian cancer features in the national Be Clear on Cancer campaign, we can make sure that everyone is better informed. We can get women to see their GPs earlier and, ultimately, we can save lives. To that end, I have continually pressed hard for the full inclusion of ovarian cancer in the national campaign. I ask the Government to look at the evidence and the potential life-saving outcomes that could come from its inclusion, and commit to making sure it forms part of the national strategy. Most paths to reducing cancer deaths are time-consuming, costly and hard to achieve, but this decision could be taken quickly and easily, and it will save lives.

Cancer treatment is not just about survival rates; it is also about post-treatment care and quality of life. No matter what kind of cancer people are living with, we must ensure that the NHS and the Government are committed to helping them at all stages. This is only possible, however, once we raise enough awareness of all forms of the disease. We will then be able to make the improvement in cancer outcomes that every patient needs and deserves.

Finally, on the broader point of awareness, I was shocked recently to discover, after a meeting with Orin Lewis of the National BME Cancer Alliance, the huge disparities that exist in cancer awareness, diagnosis and treatment between white patients and those of a black and minority ethnic background. Incident rates of myeloma in African and African-Caribbean people are twice as high as for white people. Similarly, rates of mouth cancer among Asian women are 50% higher than for white women. Before the great work of Orin, there were a shockingly low number of BME bone marrow donors on the national register. I pay tribute to his work on this: it has led to a substantial improvement, although it still remains disproportionately low.

BME patients routinely rate their care experiences less positively than white patients. Even things as simple as having racially sensitive prosthetics or wigs when going through already traumatic experiences and cancer treatments are not properly taken into consideration. The list of discrepancies throughout every stage of the cancer journey for BME patients is long, shocking and deeply alarming. Alongside promoting greater awareness of cancer in general, it is critical that the Government and the NHS work with BME communities to make sure that national campaigns are designed to be absorbed by as many different people as possible, each with their own distinct cultures, religious practices and biological differences.

Improving cancer outcomes means improving cancer outcomes for everyone. I will continue to work on this specific issue to address the clear and present problems in the current system. I urge the Government and the NHS to give this real thought. If the Minister would like more information on any of the issues I have raised today, I am more than happy to meet her to discuss them further. I know we both share the same goal: to improve cancer outcomes for all.

National Health Service

Sharon Hodgson Excerpts

Wednesday 21st January 2015 Commons Chamber

[Angela Smith (Penistone and Stocksbridge) (Lab)]

I feel privileged to take part in this important debate, which has focused on how the state of the NHS is playing out in Members’ local areas. The contribution of my right hon. Friend the Member for Manchester, Gorton (Sir Gerald Kaufman) encouraged me to reflect on just how recently the NHS was formed. It was launched by Nye Bevan on 5 July 1948, which means that anybody alive today who is in their late 60s or older would have been born before the NHS was created.

My parents, for instance, were war babies, born well before the NHS was launched. That reflection serves as a reminder not just of how recent the NHS is, but of how easy it might be to let the NHS slip away from our grasp. It is not something that we can take for granted. It is the responsibility of all of us in this place who truly believe in the NHS not only to fight for its survival—that is not good enough—but to see it strengthened and always fit for the challenges of our time. Currently, those challenges are many.

In an intervention earlier, I referred to the sickness and absence levels beginning to emerge across the country, including in Barnsley, in my constituency, and in Sheffield, and how much that is costing the NHS, but also how much it reflects the problems that the NHS faces.

I want to focus briefly on ambulance services, because they have not featured very much in today’s debate yet they are a pressing issue in my constituency. I represent an outlying area of South Yorkshire, which extends well into the national park. It is predominantly rural and is suffering from serious problems. I will use two cases to demonstrate the problems that we are facing.

Mr Offord collapsed on 16 April 2013, at approximately 11 pm. A 999 call was made, but a double-staffed ambulance did not get to Mr Offord until 11.25, by which time he was in respiratory arrest. On being transferred to the floor from the sofa, he was determined to be in cardiac arrest. He died the following day. The coroner ruled that there was a serious lost opportunity in the failure to consider alternative sources of support for a lone paramedic—the first response to the call—and that Mr Offord would probably have survived if he had received medical attention earlier. Mr Offord’s family, obviously very distressed, have settled that case out of court, but they want a wider justice for their son and brother. They want to see ambulance services and response times improved.

Mr Bailey, who I mentioned in my parliamentary question earlier today, collapsed in a shop. As I said, it took an hour and four minutes—and it was a Red 2 priority call—for an ambulance to get to him, despite the fact that the symptoms described in the emergency call were apparently those of a stroke; indeed, he had suffered a major stroke. This detail is horrific, but I must place it on the record: he had to have part of his skull removed because of the severity of the stroke. In summary, the dispatcher made two errors, which contributed to the delay in an ambulance attending to Mr Bailey, and—these are the words of the Yorkshire ambulance trust itself—“no checks” were

“made for an available ambulance from 13:31 until 14:03; and no allocation”

was made

“of one of the nearer ambulances identified at 14:11.”

All the ambulance trust has to say is:

“Please pass on my sincere apologies to both Mr and Mrs Bailey for the errors and the delay caused.”

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I am so pleased that my hon. Friend has raised this important issue. I have had so many people write to me about the state of the ambulance service. One gentleman, over a year ago, had to wait for two hours. I have also been contacted by a whistleblower from the call centre who is discouraged from sending ambulances—they have to dig and try and find any way. Does my hon. Friend agree that this is desperate and needs to be sorted out?

[Angela Smith]

I thank my hon. Friend for that intervention and I am really sorry to hear of the cases she raises. The situation really does need to be sorted out, because the Yorkshire ambulance trust goes on to say that

“the service was experiencing a high level of demand in the South Yorkshire area around the time of Mr Bailey’s incident. Overall, demand was 12% above predicted levels and the level of ‘Red’ call demand was 55% above predicted levels…Rising demand on all health care resources continues which requires changes to deliver improvements in urgent and emergency care.”

I shall say no more about Mr Bailey’s case because it will be referred elsewhere and it may well go to law—I have simply set out the facts of the case as they have been put to me—but the point is this: why are we experiencing these problems with response times in the ambulance service? Why are we hearing, week after week in Prime Minister’s questions and on the Floor of the House in other debates, that the ambulance service is letting people down—even in the most serious cases, when people are going into cardiac arrest or having a major stroke?

We need to establish the reasons, and I suggest that there are three obvious ones. There may be more—there may be problems with the management of ambulance services, and in many cases there clearly is a problem in the case of YAS—but I would suggest that there are three obvious problems. One problem is the increasing difficulty that people have in getting access to GPs’ surgeries. The evidence was laid before the people present for this debate earlier, by the shadow Secretary of State, so I will not go through it again.

Secondly, there has been the closure of NHS Direct and the establishment of NHS 111. There is no way that NHS 111 can be compared with NHS Direct; it is like comparing apples and pears. I have used NHS Direct in the past. It was a superb service that enabled me to decide which was the appropriate place to go to for my treatment and to get the right treatment at the right time. I can assure hon. Members that the one place I did not end up, having used NHS Direct, was A and E—that would have been the last place I had to go to.

Thirdly, social care cuts represent one of the most fundamental problems of our time. As my right hon. Friend the Member for Wentworth and Dearne (John Healey) said, £1 in every £10 has already been cut from social care budgets. It is obvious, even to the most disinterested observers of the debate on health, that cutting social care budgets at local authority level will ultimately impact on the health service. I was in local government for 10 years, and I saw for myself the importance of the local authority and the local NHS working together to enable elderly people to stay in their own homes and to keep them out of the health system—the acute health system, in particular—as much as possible.

The shadow Secretary of State, my right hon. Friend the Member for Leigh (Andy Burnham), outlined what needs to be done in the very long term, strategically, to get the NHS in the right shape. He also outlined the more immediate actions that a Labour Government would have to take if they gained power in May: providing more clinically trained staff to handle NHS 111 calls; restoring the GP guarantee of an appointment within 48 hours; and ensuring that councils, the NHS and the local voluntary sector work together to identify older people at the highest risk of hospital admission and link them up with the right support. I cannot wait for 8 May to see that strategy for the short term being put in place.

Ambulance services are crucial to the trust that people have, and need to have, in their local health services. One can broadly measure the trust that people have in their local health service by how much they can rely on their ambulances. Everybody likes to think that if they need an ambulance they will get one, and get it quickly. I was disappointed this afternoon that the Prime Minister used my question to indulge in petty political point-scoring. These issues are too serious for that. He did not even express sympathy for the family affected and instead made a cheap point about NHS staff. That was disgraceful. It is not good enough, and it is not good enough—

Oral Answers to Questions

Sharon Hodgson Excerpts

Tuesday 21st October 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

My hon. Friend makes an excellent point. Following the appalling systemic abuse and neglect described in the Francis report, our response, set out in “Hard Truths”, focused relentlessly on hearing the patient voice, learning tough lessons on patient safety and care, and, in particular, the creation of the new independent chief inspector of hospitals, who is looking closely at all complaints. The health ombudsman has increased its caseload and we are also taking measures to display information on how to complain in every hospital and ward across the country.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Will the Secretary of State join me in paying tribute to Eilish Hoole, who sadly passed away in July from ovarian cancer. She was only 47 and the mother of five children. Following her diagnosis of late-stage ovarian cancer she campaigned tirelessly in Parliament with Target Ovarian Cancer, which led to the recent successful pilot of the awareness campaign in the north-west. Will the Secretary of State commit to roll that out to the rest of the country so that other women in her position get to see their children grow up?

[Mr Jeremy Hunt]

I am very happy to pay tribute to Eilish Hoole, to the many cancer campaigners and to the many people who have survived cancer and put their lives back together again. There is still a huge job to do in getting earlier diagnosis. I think there is agreement across the House about the need for much earlier cancer diagnosis, particularly for ovarian cancer, which makes a huge difference. I know that we would all like to pay tribute to her work.

Oral Answers to Questions

Sharon Hodgson Excerpts

Tuesday 15th July 2014 Commons Chamber

[Mr Speaker]

I call Michael Connarty—he is not here.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

16. What assessment he has made of the adherence by NHS trusts and clinical commissioning groups to the healthy child programme (a) in general and (b) in respect of the provision of perinatal mental health services.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

NHS England commissions the healthy child programme and the NHS England mandate includes an objective to reduce the incidence and impact of post-natal depression. NHS England is held to account through its regular assurance processes and we are well on track to deliver an additional 4,200 health visitors by 2015 who will provide individual one-to-one support for women in the post-natal period.

[Mrs Hodgson]

The National Childbirth Trust found that just 3% of clinical commissioning groups have strategies to provide these services and 60% have no plans to put them in place at all. The Minister might be aware that the all-party group on conception to age two, superbly chaired by the hon. Member for East Worthing and Shoreham (Tim Loughton), has recently announced an inquiry into factors affecting child development, with the first session last week considering this very issue. In advance of its conclusions, will the Minister give a pre-emptive guarantee that all expectant mothers will have access to perinatal mental health services and that it will not just depend on where they live?

[Dr Poulter]

The hon. Lady makes a very important point. We know the importance of good perinatal mental health not just for the mother but for the life chances of the child. That is very important if we are to ensure that we get the commissioning of maternity services right in the future. There is a commitment in the Health Education England mandate that by 2017 all maternity units will have specialist perinatal mental health staff available to support mums with perinatal mental health problems.