Early Parenthood: Supporting Fathers

Tracey Crouch Excerpts

Wednesday 30th January 2019 Westminster Hall

[Tracey Crouch (Chatham and Aylesford) (Con)]

I beg to move,

That this House has considered supporting fathers in early parenthood.

As always, Mr Davies, it is a pleasure to serve under your chairmanship. I hope you will forgive me if I make any minor procedural errors; it has been a while since I have been on the Back Benches of the Westminster Hall Chamber, rather than closer to the wise counsel of the Chair.

I begin with two quick disclaimers. First, although my debate is about supporting fathers in early parenthood, I am extremely conscious that there is still much to do to combat inequality during maternity. I am an avid follower of Maternity Action and support many of its campaigns, some of which I know are making good progress. Secondly, this debate is not meant as a dismissal of the wonderful mums out there who are single or in same-sex couples. It is not about mums versus dads, nor am I pontificating only about married parents—not least because that would make me a hypocrite. I simply want to speak up for the many brilliant dads out there who, in an evolving society, are doing an incredible job of bringing up children. I want to highlight some of the real challenges that they too face.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

I am grateful to the hon. Lady for giving way so early in her speech. She is making a fantastic return to Westminster Hall from the dizzying heights; she is a principled person and we on the Opposition Benches all love her.

The hon. Lady mentions challenges. Is she aware of Dads House, which does all sorts of things to represent single dads? There are 400,000 single-parent families headed up by dads, which is 13.7% of all single-parent families. Dads House has its own food bank and does buddying, breakfast clubs and football—a sport that is close to the hon. Lady’s heart. Would she be interested in meeting members of the group? In fact, everyone in this House has a good opportunity to meet them, because after Prime Minister’s questions on 20 March they are coming to Speaker’s House for a reception with the all-party parliamentary group on single parent families—and all hon. Members are invited. The group does great work.

[Tracey Crouch]

I would love to come. Single parents play an incredibly important role, but for various reasons they are often maligned. Meeting single dads who are doing their very best, in whatever circumstances they find themselves bringing up their children, is an incredibly important part of that conversation. I would be delighted to come to the event on 20 March.

I want to address three points: perinatal support, loneliness in new dads, and shared parental leave. The first comes wholly under the Department of Health and Social Care; the second does partially; the third might not, but is important to the debate because it relates to the overall wellbeing of our children.

In December, the Centre for Social Justice published a really interesting report, “Testing Times: Supporting fathers during the perinatal period and early parenthood”. It looked in detail at written evidence submitted to the Select Committee on Health and Social Care inquiry into the first 1,000 days of life by the Fatherhood Institute, which described support for fathers as “toothless” and noted criticisms that within health services,

“well-meaning…father-inclusive policy-making…has been more ‘rhetoric than reality’”.

On the back of those comments, the CSJ did some additional polling. It found that seven in 10 new fathers

“were made to feel like a ‘spare part’”,

six in 10 said that they had

“had no conversations at all with a midwife about their role”,

and nearly half said that they had

“received little or no advice at all…on their role as a dad.”

However, it also found that

“more than 9 in 10 are present ‘at the scans and the birth’”

and that there is

“strong correlation between active father engagement and improved childhood outcomes.”

That is a recurring theme in a really interesting book on equal parenting co-authored by one of our own lobby journalists, James Millar. It includes several quotations from the 2015 UN-backed report, “State of the World’s Fathers”, about how engagement in the first year of a baby’s life is good for the dad as well as the baby. Substantial and high-quality father involvement can encourage a child’s positive social interaction and lead to higher cognitive development scores.

[Tim Loughton (East Worthing and Shoreham) (Con)]

I congratulate my hon. Friend on securing a debate on this important issue. It is hardly surprising that so many dads feel left out when the NHS guidance refers to them not as fathers or dads but as “birthing partners”. Perinatal depression in mums is linked to depression in teenagers: there is a 99% likelihood that a 16-year-old suffering from depression had a mother with perinatal mental health problems, including depression. What is overlooked is that 20% of fathers also experience perinatal mental health problems, which has a big influence on their parenting skills and on their engagement with and attachment to their own children. We need to do more about that.

[Tracey Crouch]

I am grateful to my hon. Friend for raising that point. I saw those statistics while researching my speech; perhaps the Minister’s reply will describe her Department’s work on post-natal depression for mums and dads. I do not have time to cover everything, but I agree that language is incredibly important. I appreciate that the term “birthing partners” is used in order not to cause offence, because our society and how we bring up children are very different now, but it is important that we think about the language and make our communication with fathers as inclusive as possible.

[Michael Tomlinson (Mid Dorset and North Poole) (Con)]

I congratulate my hon. Friend on securing this important debate. Was she struck, as I was, by the statistic cited in the CSJ report that

“95 per cent of births in the UK are to couples…with 85 per cent of these parents living together”?

Far more needs to be done to encourage and support the family and the community at that stage, to help improve life chances.

[Tracey Crouch]

I did see that interesting statistic. I do not want to get into the details of family make-up in a modern society, because I do not want us to inadvertently criticise those who are not in such relationships—it is important that we respect different family make-ups. The point that I wish to raise today is about fathers and the role that they play.

The excellent book on equal parenting co-authored by James Millar notes the “State of the World’s Fathers” report’s finding that

“fathers who report close, non-violent connections with their children live longer, have fewer mental or physical health problems…and report being happier than fathers who do not report this connection”.

Given the well-understood positive outcomes of fathers’ engagement in their children’s development, it is only right that we should have the infrastructure and systems in place to support them. As the CSJ report states, we need to collect more data at the point of birth to get a better understanding of participation by fathers, but also identify “cold spots” for investment in supporting father engagement.

We definitely need to be a bit more dad-friendly in our language and correspondence about children’s healthcare. I agree with the National Society for the Prevention of Cruelty to Children that a “dad check” would be a valuable way for our health services to ensure that resources are open and accessible to new fathers. I also agree with the recommendation that NHS England should roll out schemes that increase support to fathers. That support should include either creating a new fatherhood fund or making the maternity challenge fund a general parental support fund and putting in additional investment.

The CSJ makes commendable recommendations for the Department of Health and Social Care to improve inspection frameworks, develop a dad test for the perinatal period and extend the reach of digital communications for new fathers. Those all seem sensible ideas; I accept that resources are always a challenge, but the long-term health and wellbeing outcomes must surely justify their consideration.

[Chris Elmore (Ogmore) (Lab)]

I thank the hon. Lady for her well-informed discussion of this important issue. She may be aware of my constituent Mark Williams, who has been a campaigner for the best part of a decade on fathers’ mental health after childbirth. He has been fundamental in pushing the campaign in all nations of the UK, including in the English NHS. He tells me frequently that—as the hon. Lady says—in the services that follow a baby’s birth the father is almost forgotten.

Mark had a breakdown—I know he will not mind my saying that on the Floor of this Chamber. It took him years to understand what was wrong, but now he champions the issue. Does the hon. Lady agree that we need more fathers like Mark to stand up and say that this is a problem? As she will be aware from her former role as a Minister, loneliness and mental health are an issue, and it is worse in men because we do not like talking about it. We need more people like Mark to speak up about what they face after having children.

[Tracey Crouch]

I could not agree more. It is almost as if the hon. Gentleman has seen my speech, because I am about to start talking about loneliness in new fathers. We need to talk more about men’s mental health and to look at the triggers for poor mental health. It is a well-established consideration for mothers—health visitors and other members of the health services regularly ask about the mother’s mental health after a birth. It is not necessarily the same for men’s mental health. Quite often—although as I far as I can remember, it was not the case when my son was born, nearly three years ago—mothers are asked questions by health visitors that relate to the father of the child, rather than the father being asked directly, even when they might be in the same room.

[Chris Elmore]

Does the hon. Lady agree that there needs to be far more training in midwifery or mental health services on focusing on the father’s mental health as well—not just asking the mother about her partner, but creating a structure from very basic training that recognises that fathers are a person, too, in this context? They need the questions put directly. Often husbands and partners will simply not tell their partner how they are feeling or how they are responding to the birth of their child, so the partner might think that everything is fine, and it is all missed. That is the important point.

[Tracey Crouch]

One reason why I wanted to hold this debate is that I feel it is hard for male colleagues to raise the subject. As a mother, I know that if my other half had come to me and said, “I am feeling a bit down,” I would have said, “But you didn’t give birth to the child!” For many years, we have forgotten that it is very much about a partnership. There are many issues that mothers still face—there are still huge issues around discrimination in maternity and everything else—but that must not mean that we forget the issues that fathers face, and that is why this is an important debate.

I completely understand why male colleagues might not have felt comfortable in raising this issue, because they may well feel that they would be accused of forgetting all the other issues around maternity discrimination. I feel very honoured to be raising it on behalf of all the dads out there. Perhaps I can talk about it with more ease.

The constituent of the hon. Member for Ogmore (Chris Elmore) is doing a brilliant job in raising the issue of men’s mental health, post-baby. It is important that we do that. If that equates to having more training, that is what must happen, although I am always loth to say that our hard-working health professionals need any more training than they already get. They have a very important job to do, and by and large they are all doing it brilliantly.

One aspect of parenthood that can impact on wellbeing is loneliness. When Jo Cox stood in the Chamber and spoke of her own challenges with loneliness, including the example of becoming a mother, she widened discussion on the subject. I, too, had my own brushes with maternity-leave loneliness. While the rest of the world here was discussing the referendum campaigns, I was on maternity leave. I dealt with that by going to the supermarket every day, just for a chat.

For new fathers, it can be harder. When my other half took his three months shared parenting leave, he felt isolated from baby groups, as many were either branded “mother and baby” or were predominantly made up of mums, making him feel less inclined to go in. There are excellent apps connecting mums, such as Mush, which we profiled in the loneliness strategy, as did the CSJ in its report, but there are hardly any dad apps set up to connect full-time fathers. The Secretary of State for Health and Social Care, with his digital background, may be interested in upscaling that from a health perspective.

The loneliness strategy, which I was privileged to publish on behalf of the Government in October 2018, specifically, on my request, used an infographic of a dad pushing a baby to highlight becoming a parent as a trigger for loneliness while at the same time reflecting that it is not a gender issue. The more we all acknowledge loneliness as an issue, the quicker we will reduce the stigma and instead create connections that help to combat it. I was pleased that the Department of Health and Social Care was a core partner in the delivery of the strategy.

The CSJ noted that children's centres are a key part of delivering opportunities for dads to connect, and that many were not doing so, despite its being a legal requirement. I know that children’s centres are a politically contentious issue because of funding and I would hate the debate to be bogged down by that, but the centres in my constituency, some of which have restructured, could play an enormously important role in creating support networks for dads. It is a shame that because of funding pressures, gaps in services are occurring.

[Tim Loughton]

My hon. Friend makes a very important point. The problem with the children’s centres—a fantastic asset—at the moment is that they are closed most of the time when dads can access them, particularly at weekends. Some of the best children’s centres are those that open at weekends, have football teams that dads and their children can come along to, and have computer-reading facilities latched on to that. It is a way of getting dads into the children’s centres. The centres need to be used much more at weekends and outside of working times when many fathers cannot access them.

[Tracey Crouch]

I agree with my hon. Friend, but it is very important that we do not fall into the trap of talking about dads as weekend parents. The point of the debate is to discuss how society has evolved; there is a lot more equal parenting. I completely understand his point. I shall come on to talk about shared parenting. The take-up of shared parenting is so low that many fathers can play that meaningful role in parenting only at weekends, so we would want those services to be open. Children’s centres have an incredibly important role, which is not just about creating a connection, but also about, for example, trying to break the cycle in domestic abuse. They play a fundamental role. I know that the Stefanou Foundation is doing some excellent work in supporting such initiatives.

I accept that my own experience is based on good fortune, and that it could easily be criticised as coming from a comfortably-off middle-class professional, but we need to do so much more on shared parenting than we do at the moment. We lag very far behind other countries on shared parenting, particularly Scandinavian countries.

What I see from my other half taking shared parenting is a very special bond between him and our son. Sadly, there are still a significant number of men who are ineligible for parental leave, and for those that are eligible there is a financial disincentive to take it. The Fawcett Society found that nearly seven in 10 people believed that men who took time off work to look after a baby should be entitled to the same pay and amount of leave as women. In Germany, fathers on leave are paid two thirds of their salary and in Sweden it is 80% of their income. Here it is £145 per week. We managed because I am paid well, but an average or low-income family would inevitably struggle, so while many might want to, it is unsurprising that take-up of parental leave is so low.

I know that much work is being undertaken to improve the situation. I thought the speeches in our debate on proxy voting on Monday evening encouraging male colleagues to take shared parenting leave were really helpful, and we could set an example in this place. I commented earlier on the wider societal and health benefits of a father’s meaningful engagement in the upbringing of a child. To me, doing more to improve our shared parenting policies is a no-brainer.

There is so much more I could have spoken about this morning, including the emerging organisations that help support fathers, such as workingdads.co.uk, which seeks employment with flexible, child-friendly hours, and the really funny social media accounts, such as Man vs. Baby, which might make light of some of the challenges that fathers face but also highlights that they exist in the first place. Ultimately, if we accept that meaningful fatherly engagement with their children is good for the health and wellbeing not just of the child but of the dad, making sure that we provide the infrastructure to support them, from neonatal to perinatal and beyond, is simply common sense, fair and equal—good economics but also really good politics.

[Geraint Davies (in the Chair)]

Order. We have six speakers, which with my maths makes about six minutes each. I would like to introduce an advisory limit of six minutes. As with the EU referendum, it is not mandatory, but I strongly advise it. I invite Paul Masterton to start.

Oral Answers to Questions

Tracey Crouch Excerpts

Tuesday 15th January 2019 Commons Chamber

[Matt Hancock]

Yes, 100%. That is exactly what is in the plan, and I am delighted to have such support. This is precisely the direction in which we need to go in integrating care to ensure that patients are served better, whoever is the ultimate funder of the service.

[Tracey Crouch (Chatham and Aylesford) (Con)]

In the event of an out-of-hospital cardiac arrest, access to a defibrillator can make the difference between life and death. Although there are tens of thousands of defibs across the United Kingdom, the majority are not known to the ambulance service, so will the Minister join me in welcoming the British Heart Foundation’s efforts to map the location of all defibs so that ambulance services can direct people to their nearest heart restarter in an emergency and, hopefully, we can save more lives?

[Steve Brine]

Yes, I will. We work closely with partners such as the BHF to harness new technology. Ultimately, this is about using data—big data—to ensure that patients benefit, and that is at the heart of the health service.

Oral Answers to Questions

Tracey Crouch Excerpts

Tuesday 27th November 2018 Commons Chamber

[Tracey Crouch (Chatham and Aylesford) (Con)]

Earlier this year, I had the pleasure of joining volunteer leader John Goodwin and others on a health walk around Capstone park in my constituency—one of a number of health walks supported by Medway Council. Will the Secretary of State join me in encouraging more GPs to prescribe walking as a gentle, low-impact form of exercise that is suitable for all ages and abilities?

[Matt Hancock]

With enthusiasm, I endorse the call from my hon. Friend, who did so much work on this at the Department for Digital, Culture, Media and Sport, both before I was in that Department and when I was Secretary of State there. She made the case brilliantly, and she continues to do so. She is absolutely right.

Hormone Replacement Therapy Implant

Tracey Crouch Excerpts

Wednesday 28th January 2015 Commons Chamber

[Tracey Crouch (Chatham and Aylesford) (Con)]

I am very pleased to have the opportunity this evening to speak on behalf of not only my constituents but many women across the country on the issue of commissioning and funding the hormone replacement therapy implant.

While I appreciate that for the overwhelming majority of women experiencing the menopause alternative HRT treatments are perfectly effective in addressing their symptoms, for a small number this is not the case, and the impact is significant. This issue was first brought to my attention by a group of my constituents who were being treated with the implant from the well woman clinic at Lordswood community healthy living centre in my constituency. In March 2014, after Medway clinical commissioning group announced that it would no longer be providing funding for the insertion of HRT implants, they sent me a copy of a petition signed by 200 women, one of whom has since sadly passed away.

After receiving the petition, I met a number of the individuals concerned to discuss why the alternative treatments were inadequate. They described the effect on their quality of life of no longer having access to the implant, and the problems that they had experienced with other formats of the therapy not addressing their menopausal symptoms.

The purpose of today’s debate is not to advocate access to the implant for all women going through the menopause. I am aware that many women either go through the menopause without any major problems or can sufficiently negate their symptoms with the cheaper licensed alternatives such as patches and gels. However, for a selection of women, the HRT implant provides benefits not addressed by alternative forms of the therapy.

A small percentage of women are severely affected by this issue. They include women with a history of breast cancer in the family. HRT has been thought to increase the risk of breast cancer, especially when used over long periods of time. However, the implant is seen as a preferable option for those seeking HRT treatment as there is a reduced risk, because it is absorbed directly into the blood and bypasses the liver. They also include women who experience some of the more severe symptoms. Symptoms such as joint pain and depression, which cannot be eased by the other licensed formats of the therapy, can also be improved by the implant. These more severe symptoms can have a huge impact on the quality of daily life and on well-being, affecting factors such as employment and mental health, which have cost and health implications of their own, both to the economy and to the individual. The small percentage of women severely affected by this issue also includes women who suffer from early menopause. This means that they are likely to suffer symptoms over a protracted period, and they have also been seen to have much better results from the implant.

The personal experience of my constituent Sarah clearly highlights the reality and severity of the effects involved, as well as the benefits that the implant can provide. Sarah King is suffering early menopause. She is a lovely young married mum with three young boys. For most of her life she had been healthy, active and happy, but in recent years she suffered a number of accumulating health problems. These included joint pain—to the point of hospitalisation—skin problems, depression, headaches and lethargy. After a number of years of various treatments and no real improvement, she was sent for a simple blood test which revealed extremely low hormone levels, indicating that she was suffering an early menopause.

Owing to a family history of breast cancer, Sarah was first offered the opportunity to try the HRT implants. Within a short time, all her poor health issues had gone. When the HRT implant service stopped, she tried the HRT patches and then the gel, but neither gave her the same result that she had experienced with the implants. Her health deteriorated to the point that she had to quit her full-time job as a teaching assistant. She started researching on the internet and discovered that the Chelsea and Westminster hospital in London had a specialist menopause clinic and HRT implant service.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for bringing this delicate issue to the House for our consideration. My understanding is that this hormone replacement therapy is available only in certain locations across the United Kingdom. Does she agree that we need consistency of availability, from Aberdeen to London and from Cardiff to Belfast, and that it should be available to everyone?

[Tracey Crouch]

I am grateful to the hon. Gentleman for his intervention. The implant is no longer uniformly available nationally. The decisions being taken locally are affecting people who might not be able to travel to London, for example. I shall come to that later in my speech.

Sarah contacted Medway CCG to ask whether it would object to her being referred to the Chelsea and Westminster hospital as an NHS patient. The CCG told her that there was no objection and that the patient’s well-being was its priority. Following that consultation, Sarah had her first appointment at the Chelsea and Westminster on Monday 12 January this year. She was accompanied by her husband, and he was able to tell the medical practitioner who interviewed Sarah what it had been like before she received HRT implants at the Lordswood clinic, what it had been like after she had the implants, and what it had been like to see her health deteriorate again when that treatment was no longer available. He said:

“I just want my happy, healthy Sarah back.”

The medical practitioner that Sarah saw said she was an ideal candidate for the HRT implant and did not hesitate in giving it to her during that first visit. Within a week Sarah says she is already feeling much better, and she has now set up a website dedicated to supporting women suffering severe menopausal symptoms. I am sure that Sarah is just one woman of many who have found themselves in this predicament, but not all have had such positive outcomes.

I would like to take this opportunity to thank the constituents of mine, especially Val Weeden, who have tirelessly researched and campaigned on this issue. They have actively searched for solutions and continuously shared their information with me. They have constantly supported each other through what has clearly been a very tough situation for many. It is extremely unlikely that this issue is unique to my constituency; I am sure that many women across the country and beyond who suffer from severe symptoms no longer have access to this potentially life-enhancing treatment because of localised commissioning structures. They may not all come across information for Chelsea and Westminster’s specialised service, and women in the far north or far south of the country who do may struggle to travel to London, at a potentially extortionate cost. Although I appreciate that this is not a cost to be incurred by the health care system, it is one that I would like the Minister to consider today.

After some research into this issue, I identified that on 5 July 2011 MSD, the only licensed provider of the Estradiol implant here in the UK, issued a letter to GPs stating that it was to cease manufacture of the product. It stated:

“the company’s global decision to discontinue the manufacturing of Estradiol was made after consideration of commercial factors and the fact that therapeutic alternatives are available in most countries. The decision is not related to a product quality or safety issue”.

For most women, this issue of cost has no impact on their treatment and well-being, but the 200 women in my constituency, and, I imagine, many others beyond for whom the alternative forms of HRT are not suitable, have been left with a void in their health care. The UK now has no licensed provider for a treatment that enables sufferers to live a normal, high-quality, day-to-day existence.

I recognise that the lack of a licensed provider is not necessarily a problem, as GPs are able to prescribe unlicensed medicines if they feel there is a special need and an unlicensed provider of the product exists in the UK. However, in my constituency this process has not adequately represented the women for whom this treatment is so important, because when our CCG made the announcement in March 2014 that it would no longer be providing funding, the justification was that 200 women was far too great a number to be treated with an unlicensed medicine when licensed alternatives were available.

Although I disagree with the idea that an increased demand for treatment somehow de-legitimises its suitability, I am aware of the potential concerns about licensing. However, just because a product is unlicensed, it does not necessarily mean that it is unsafe, as has been highlighted in MSD’s notice of cessation. In fact, in this case the unlicensed treatments being provided have been widely used across the country and the world. The only reason they are currently unlicensed is that the license holder deemed its provision economically unviable.

That brings me to my conclusion. My constituents found the Chelsea and Westminster clinic through independent research on the internet. That is not a good enough procedure to ensure that women have access to the vital services they need in our health care system. I, for one, recognise the positive changes that this Government have made to our health care system—namely the emphasis on the importance of well-being. I also believe that, for the most part, our doctors are best placed to commission our local services, but this case is an example of where the economics of devolved commissioning are perhaps having a negative impact on specialist services.

The Chelsea and Westminster clinic is proof that there is clearly a recognised medical need for the HRT implant to be made available, as a uniquely successful treatment, to a significant minority of women. I therefore ask the Minister to commit to take steps to ensure that our shared vision of our health care system is a reality for all who use it, including these women. I urge the Minister to take steps to make sure that this specialised service is available to all women who may need it, in an appropriate location, and that appropriate referrals take place. To follow any actions that he may take on this issue, will he make a commitment to publish new guidance or write to GPs to inform them about best practice for their patients in this position.

Looking forward, we also need to understand early menopause better and how it may be affecting women from an earlier age. I urge the Minister to engage with national organisations such as the Daisy Network, which was set up for this age group to see how best we can do that. We also need more research into severe menopausal symptoms and treatment for them. Will the Minister commit to look at this whole area of concern?

Finally, I thank Val, Sarah and the rest of my constituents who have campaigned tirelessly on this issue. Their support has enabled me to raise this issue in the House not just for them but for many, many women across the nation in similar circumstances.

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

I congratulate my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) on securing this debate on the funding of hormone replacement therapy implants. She gives me the opportunity to discuss the issues she has raised on behalf of her constituent, Sarah, and others more generally.

Hormone replacement therapy is effective for treating women who are entering the menopause and experiencing hot flushes and night sweats as well as sleep and mood disturbances. There are a number of different types of hormone replacement therapies available, including an oral tablet taken daily, or a transdermal patch applied once or twice weekly.

We should acknowledge that there are risks for those who are prescribed hormone replacement therapy, and the guidance of the National Institute for Health and Care Excellence suggests that, among other risks, there is a small increased risk of breast cancer, stroke and gallbladder disease.

Turning to the issues raised today concerning hormone replacement therapy implants, I have been advised by the Health and Social Care Information Centre that the number of items prescribed and dispensed for hormone replacement therapy implants has been declining since 1996, from around 36,700 prescription items per year to around 5,300 in 2010, the year prior to the licence being withdrawn. HRT implant prescriptions are now down to negligible levels.

HRT implants are no longer routinely offered as a treatment for menopausal symptoms, as my hon. Friend said, and that has been the case since 2011 when the manufacturer of the licensed product, the pharmaceutical company MSD, stopped making the implants. The decision to cease manufacture was based on two main factors. First, therapeutic alternatives are available in the UK, including tablets taken by mouth, patches and gels. Secondly, cost-effective manufacturing processes are unsustainable because few countries use the implant formulation.

GPs and prescribers were advised in 2011 that treatment should be continued until a discussion could take place between the patient and their prescriber. I understand that most GPs and prescribers reviewed their patients at that time and agreed suitable alternative treatments to switch to. The Medicines and Healthcare Products Regulatory Agency advises me that the only HRT implant preparations now available are not licensed for use in England, as my hon. Friend pointed out.

There has been a change in the prescribing culture surrounding HRT implants. In the past, they were popular as they gave a steady amount of oestrogen over a period of time and women did not experience fluctuating hormone levels. However, the insertion of HRT implants requires a small surgical procedure, and that can only be done by certain clinicians. Some women increased their tolerance to HRT as a result of having an implant, and returned for higher and higher doses at reducing intervals.

Newer hormone replacement therapy patches now provide steady amounts of oestrogen hormone without the disadvantages of the implant, and this phenomenon of HRT tolerance occurs less frequently.

[Tracey Crouch]

I understand what the Minister is saying, but does he recognise that some women have allergic reactions to the patches? Certainly, my constituents who came to see me found that neither the patches nor the gel offered a suitable alternative to the implant, not least because the patches often fall off or there is some kind of reaction to them.

[Dr Poulter]

Indeed. My hon. Friend makes a fair point, and I shall make some reassuring comments in that regard in a moment. It is possible to have a reaction to a device or implant, and one would hope that if people have an allergy or reaction to any product, that would be taken into account before it is used. If it causes discomfort, irritation or any adverse reaction, its use should be discontinued and alternative therapies considered.

Clinical commissioning groups are responsible at local level for commissioning the majority of NHS services, and decisions about those services should be made, we would all agree, as close to patients as possible by those who are best placed to work with the patients and the public to understand their needs. Local NHS commissioners now have the freedom and autonomy to take responsibility for meeting the needs of patients in their area, and other health care professionals can work with the CCG, including in secondary care, to help to integrate and join up services more effectively. While clinical commissioning groups are led by primary care professionals, they are also guided by the expertise of other local clinicians.

I understand that my hon. Friend’s local CCG—Medway CCG—released new guidance on HRT implants in 2014. The guidance states that from April 2014, patients will no longer be able routinely to receive hormone replacement therapy implants from their GP. Medway CCG has advised me that the guidance was developed for HRT treatment following clinical input and review through a clear governance process. Because HRT implants are no longer licensed and more suitable alternatives are generally available, the CCG decided that it would no longer pay GPs for inserting such implants from 1 April 2014. The CCG’s policy is in accordance with General Medical Council guidance on prescribing unlicensed medicines, and my hon. Friend will appreciate that medical professionals and doctors have to have regard to those requirements under the licence that they hold, and because they are regulated by the GMC. The CCG has assured me that it does not prevent doctors from inserting an HRT implant if they think it is clinically necessary for an individual patient, having assessed their needs and tried alternatives, and providing that they have sufficient evidence to demonstrate the treatment’s safety and effectiveness.

In exceptional circumstances, where a licensed medicine is considered unsuitable or ineffective for an individual, I would expect those patients to be referred for expert opinion. I am pleased that that is exactly what happened in Sarah’s case, and that Chelsea and Westminster hospital provided her with excellent care and support. We would expect a similar process to be in place in other CCGs. If someone needs more expert support and care, perhaps because they are suffering from the menopause and their GP finds their symptoms and presentation complicated, there should always be a facility for referral to specialist care and support. What happened in Sarah’s case—thankfully, it has resulted in a positive outcome for her—is available at other centres of excellence. Expert care and advice is there, and available for patients.

Medway CCG has written to GPs locally to issue information that they can share with all patients who are still using HRT implants, and to ask them to discuss alternative forms of HRT with them at their next routine appointment.

The CCG advises me that patients should be referred to a gynaecologist for expert opinion if the GP and their patient consider that there is no suitable alternative to the HRT implant. I hope that that is reassuring to my hon. Friend. At a local level the CCG has taken the issue seriously and has written to local GPs and reminded them of the importance of reviewing the current treatment plan for women who have the implant, but if they need more specialist support and advice, to make sure that a referral is made to a specialist centre of care. That process should be available to patients throughout the country. Where specialist support is required, CCGs should routinely refer those patients on. That is part and parcel of good medical practice.

Most of the time, HRT therapy and the expertise of GPs in supporting patients through menopause is enough for the majority of patients, as my hon. Friend outlined, but sometimes there is a need for more specialist support. Centres of excellence such as the Chelsea and Westminster can provide that and consider alternative treatments and therapies where they may be appropriate.

I hope my hon. Friend finds that reassuring. I thank her once again for bringing the issue to the attention of the House. I hope I have been able to provide some reassurance to her on the issues she raised regarding support for women in Medway who need HRT therapy and potentially implants, and more generally on the process that is in place to ensure that women who need specialist care and support can receive it, and that all CCGs and all doctors would always be mindful to take the right action for the patients they look after.

Question put and agreed to.

Foetal Alcohol Syndrome

Tracey Crouch Excerpts

Tuesday 14th October 2014 Westminster Hall

[Tracey Crouch (Chatham and Aylesford) (Con)]

It is a pleasure to serve under your chairmanship, Mr Turner. I congratulate the hon. Member for Sefton Central (Bill Esterson) on bringing forward an incredibly important debate at a pivotal time, when political parties are considering alcohol-related issues and how they might form part of our election manifestos. The problems are important to many people out there.

I cannot yet speak from my own experience, but I imagine that there can be no more exciting time for a family than when they are bringing a child into the world. There is all the expectation and preparation throughout pregnancy; there are the classes that future mums and dads go to, with varying degrees of enthusiasm; there is the need to make the home baby-proof for the arrival of the newest member of the family; and there is an endless amount of information read and digested in preparation for becoming parents. That is all part of the nervy but exciting process that millions of parents go through each year. They take every precaution that they can to ensure that they give their child the best and healthiest possible start in life. Why, then, is there an ongoing problem with children being born with foetal alcohol syndrome disorder?

FASD refers to several diagnoses of permanent brain damage and can vary in severity from case to case. It could affect up to one in every 100 babies in England. One thing that does not vary from case to case is the fundamental cause: pre-natal exposure to alcohol, or the alcohol intake of women during pregnancy. We need to be careful, as the hon. Gentleman said, that we do not demonise or frighten women who may have drunk before they realised that they were pregnant, but that is not a reason for us not to discuss the issue.

The prevalence of FASD is particularly concerning because the link between pre-natal exposure to alcohol and FASD is quite clear. Expectant mothers can prevent it by taking precautions when it comes to drinking alcohol, as of course many do. No expectant mother in possession of all the facts would wilfully jeopardise the health of their unborn child by not taking precautions, so why is FASD still a problem? I would respectfully say that one thing missing from the hon. Gentleman’s speech was the point that there is a generational issue here. Many people with children of child-bearing age will say to their young daughters, “I smoked and drank throughout my pregnancy and you turned out fine,” but there is a difference in consumption. My parents did indeed drink and smoke while pregnant with me, and I turned out fine, or so I would argue; my parents might disagree. Their level of alcohol consumption was different from the level that women are consuming these days.

FASD is at root poorly understood, and little has been done by way of meaningful study into it. Our understanding of the true scale of the problem is limited, and it is feared, with some justification, that those diagnosed with FASD are just the tip of the iceberg. Nobody knows just how bad the situation is, and how bad the rate of misdiagnosis is among children who display similar symptoms, such as those associated with autism. The misdiagnosis of a child’s symptoms can have a severe impact on their development, and that really needs to be addressed. Even with this relatively limited understanding, knowledge of what to do about FASD and awareness of the dangers of drinking alcohol during pregnancy are patchy. There is so much conflicting information out there for expectant mothers, and so much uncertainty about what might be safe to drink and when. Some sources say not to drink at all. Some say that one glass of wine a week is fine. Some say that one glass of wine a day is fine. The messages are inconsistent, which is a major problem. That is not good enough, and while there is uncertainty in our understanding and in the messaging around FASD, nothing will change.

The all-party parliamentary group on alcohol misuse, which I chair, often discusses the lack of co-ordination in tackling alcohol-related harms. Whatever the topic, one of the key solutions to which we always return is raising awareness and education, which can succeed only if we know the facts. When it comes to policy, we talk of nothing being a silver bullet; in this instance, except in extreme cases, investing in a full-scale, holistic campaign to raise awareness of FASD, based on a full and proper study, is as close as we will get.

As often appears to be the case with alcohol and health policy, the Government could and perhaps should look to Canada for ideas and guidance on how to tackle FASD. In Canada, there is already much greater understanding of and emphasis on the risks associated with drinking while pregnant. As the hon. Gentleman said, warning statements are visible in pubs and clubs, and containers carry an explicit message about the dangers of drinking alcohol when pregnant.

The all-party group published a manifesto in August that set out key commitments that we would like all three political parties to adopt in their 2015 manifestos. One such measure was to support further health warnings on all alcohol labels. That commitment was considered rather controversial; as chair of the group, I got quite a lot of criticism for suggesting that alcohol bottles should carry better health warnings, as if that somehow infringed people’s civil liberties. In fact, having better information on alcohol labels enhances people’s liberties, because it gives them the right information.

[Kelvin Hopkins]

The hon. Lady makes an important point. Does she not suspect, as I do, some influence from the drinks industry, which is trying to calm fears that alcohol causes problems for babies?

[Tracey Crouch]

I will not criticise the drinks industry fully, because it is trying to improve its labelling. It is strongly committed to having better labels on its products. The problem is the inconsistency in labelling, not least depending on whether the product was imported or produced here in the United Kingdom. Before the APG manifesto announcement, I looked at the wine bottles in my house; there were, for example, differences between French bottles of wine, which had a warning label and an image of a pregnant lady, and Chilean bottles of wine, which had nothing on them.

As the hon. Member for Sefton Central mentioned, other countries have labels that include the Surgeon General’s advice. We do not have anything as specific as a consistent message on all our alcohol products. While one might appear on some bottles of wine, there is no such warning on bottles of beer, given the assumption—untrue, as we know—that women do not drink beer or lager products. We need to learn a lesson from Canada, which has much better labelling, which is focused on pregnant women in particular and better targeted.

The APG manifesto also stated that we would like commitments to introducing mandatory training on FASD for all social workers, midwives and health care professionals. Interestingly, 23% of midwives are not aware of the guidelines on alcohol and only 59% were comfortable asking about alcohol consumption. People are nervous about asking pregnant women what their alcohol consumption is, in case that somehow offends them or perhaps concerns them unnecessarily, but we have to get to grips with asking the difficult questions, so that the right advice can be given to pregnant women.

If we are to understand FASD better and to reduce its prevalence, those who come into contact with pregnant women who might be drinking alcohol play a crucial role in making brief but important interventions to give good, accurate and consistent information. Ensuring that those people are trained sufficiently and are confident enough to make those interventions would be another welcome and logical step in preventing FASD, or at least in enabling us to spot the signs and give an accurate diagnosis.

I am conscious that the debate is on FASD, but I wish to touch on the wider problem of alcohol misuse. Without doubt, more needs to be done to tackle binge drinking and alcohol-related harm in the UK. It is not difficult to assume that, in a country where alcohol is consumed in large quantities, that might have some influence on the prevalence of FASD. If we can get our approach right to tackling alcohol misuse more generally from the start, especially with young women who binge drink, we could see a drop in the number of FASD cases.

I was surprised to learn that 18% of women still binge drink while pregnant. Binge drinking is defined as drinking six units or more in one session, which is two large glasses of wine. Until we have a thorough understanding of how little alcohol it takes to put unborn children at risk, we will not make adequate progress. Although some people will disagree with some of the policy measures proposed in the alcohol misuse group’s manifesto, the entire package of measures sought to address alcohol misuse as a whole. That is relevant to the debate, and I hope that the Government will consider that.

In conclusion, FASD is preventable and its prevalence should be reduced. As I mentioned earlier, save in some extreme cases, I do not believe that any women would jeopardise the health of their unborn child if they knew all the facts. It is therefore essential that we establish the facts and invest in resources now to raise awareness throughout our society. I am interested to hear what the Minister has to say on where we are on developing a coherent strategy to tackle FASD, because it being poorly understood is not a reason to delay action. Let us put in the resources, get the issue understood and deliver meaningful measures, such as those outlined thus far today.

[Several hon. Members]

rose—

Stillbirths and Infant Mortality

Tracey Crouch Excerpts

Wednesday 26th March 2014 Westminster Hall

[Tracey Crouch (Chatham and Aylesford) (Con)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Davies, although there is certainly no pleasure in the subject matter of this debate. The issue of stillbirth and infant mortality is a complete and utter tragedy for parents who lose their child. I have met a number of my constituents who have experienced the loss of a baby. Mothers, fathers and siblings have been devastated, left bereft and unable to comprehend what has happened and why. It was heartbreaking to meet them. However, what is equally heartbreaking is that here in the UK, which has arguably one of the best health services in the world, we have one of the highest rates of infant mortality in Europe and other parts of the developed world. It is shocking that we have higher infant mortality rates than countries such as Croatia, Lithuania, Estonia and Slovenia.

Sadly, unlike other countries we have barely seen any reduction in infant mortality rates in the last 20 years. Almost three quarters of child deaths under the age of 15 in the UK happen during the first year of a child’s life; more than half in the child’s first 28 days; and almost 40% in the child’s first week. These statistics do not include the one in 200 pregnancies in the UK that end in stillbirth. Stillbirths account for the death of a further 4,000 babies a year.

There are many reasons for perinatal, early neonatal and neonatal deaths, but I will concentrate today only on stillbirths and on sudden infant death syndrome or, as it is perhaps more commonly known, cot death. That is not because I have no interest in other forms of infant mortality, but so I can focus the Minister’s mind on a few actions that might make the difference sooner rather than later. That said, I wanted to give a wide title to the debate today because I am aware that colleagues have other issues they may wish to raise.

The figure of 4,000 stillbirths per annum is far too high. I cannot imagine the horror of having to go through labour knowing that your baby is already dead. I met one lady who gave birth to her son, Henry, at 38 weeks, but he had not grown for 16 weeks. In the intervening weeks, she had forged a bond with her unborn son, named him and planned a life ahead, but it was one that would never be fulfilled.

Our NHS is brilliant and our midwives are fantastic, but I have yet to meet a woman who has gone through pregnancy without seeing more than one midwife. One lady told me that she had seen 12 different midwives during her pregnancy, which sadly ended in stillbirth. She felt that all 12 of them had different ways of measuring her. I am not going to criticise the midwives—they do not deserve criticism—but we need to ensure continuity of care throughout gestation, to give mothers some peace of mind.

Research that the National Childbirth Trust carried out with the Women’s Institute last year into women’s experiences of maternity services highlighted the shocking statistic that 34% of women were not given the name and phone number of a midwife to contact with any concerns. We must do more to encourage people to go into midwifery, and I hope the Government’s pledge to increase the number of health visitors will help in that regard.

However, we also need to improve our standard monitoring and measuring systems, making the most of modern technology. In the case of poor Henry, who had not grown for 16 weeks, it was clear that the measuring was not as good as it could have been. I accept that not everyone agrees with me on this, but I believe that we should be looking to increase the number of scans expectant mothers receive. Having a scan at 12 weeks and again at 20 weeks is fine, but unless a mother is anticipating complications, those are the only scans she will receive.

There are examples of the successful use of increased measuring and monitoring. The Rainbow clinic at St Mary’s hospital in Manchester, which is funded by Tommy’s baby charity, has taken huge and groundbreaking steps forward in understanding the risk profiling of mothers, and it has a great success rate because of its extra monitoring and measurement. I would like to see its work rolled out. The clinic’s test on those who are deemed to be at risk—possibly due to previous multiple stillbirths or miscarriages, which we know increase the risk of future stillbirths or miscarriages—allows those in the “at risk” category to receive further monitoring and measuring in the third trimester, when placenta problems usually occur, to allow earlier delivery if necessary to prevent stillbirth.

These preventive measures involve awareness raising and risk profiling, followed by improved measuring, with new techniques and monitoring through an increased number of scans. They have led to a significant increase in healthy babies being born to women in the “at risk” group. Although the study at the Rainbow clinic is on a small scale, it has a very high success rate. However, the clinic does not have the funding to expand its work and I urge the Minister to examine its work and give it her full support.

I am not an expert on placenta. However, given that we know it starts to break down at 38 weeks but we do not induce mothers until 42 weeks—a point when we know women carrying later are more at risk of losing their baby—we need extra research into this process and to determine whether this delivery time frame is still viable. I will not dwell on that now, but it would be helpful if the Department examined both the risks and the benefits of reconsidering induction as late as 42 weeks. I have spoken to women who have had stillbirths and many of them raised this issue with me. There is genuine concern about the length of time that women are carrying babies for, particularly those at the higher risk end of the spectrum.

This issue is not all the responsibility of the NHS and it is important that we raise awareness of reduced foetal movements, so that expectant mothers can spot early signs of distress. The Count the Kicks charity has fabulous self-monitoring support, empowering mums-to-be with knowledge and confidence, including a mobile phone app and tips for dads. This understanding should be universal.

If a stillbirth does occur, it is important that the parents receive all the support they need. The third sector does an amazing job of providing advice and bereavement support for parents who lose a child before, during or shortly after birth. However, we need to ensure that parents receive good care from the health service, whether that is by ensuring the appropriate equipment is available—such as cameras and other equipment to take handprints and footprints, with staff available who know how to use it—or by providing access to all the literature and available support and advice, including bereavement services. We must also ensure that parents receive correctly handled treatment; we must remember to treat them as parents even if they do not have a baby.

[Dr Phillip Lee (Bracknell) (Con)]

I congratulate my hon. Friend on securing this debate. As someone who has professional first-hand experience of dealing with parents who have had a stillbirth, I know that it is an emotive topic but it is essential that we discuss it. Recently, Scotland produced a report outlining that its infant mortality rates are improving and it appears that it has a different approach to education, assessment and analysis of at-risk groups.

[Tracey Crouch]

I am grateful to my hon. Friend for his intervention. It was a coincidence that the Scottish Government released their statistics on infant mortality yesterday, which showed that Scotland now has the lowest infant mortality rates in the United Kingdom. It has managed to do that by introducing some of the measures I have already proposed in this debate, such as extra monitoring, extra targeted intervention and support for those at highest risk. That work should be rolled out across the United Kingdom.

We must be very clear about the bereavement services and support that people receive. A local charity in Kent, Abigail’s Footsteps, is working with the Royal College of Nursing to establish a national standard of bereavement training that it would like to see universally implemented. That is absolutely fantastic. On top of that, however, one of the best ways to accomplish good care in all the areas I have mentioned is to create the job specification of bereavement midwives within the NHS. This suggestion is supported by Sands, the leading stillbirth and neonatal deaths charity. I fully support this proposal and urge the Minister to consider introducing a nationally recognised job specification for bereavement midwives, which I believe would ensure the best possible mental health of, and support for, parents whose babies die before, during or shortly after birth.

I am aware that people have suggested that this will be an additional cost to the NHS, but we need to remember that the cost to the NHS of supporting people with mental health concerns, as well as loss of productivity because they have lost a child, is significant—some £1.5 billion to £2.5 billion. Therefore, an early investment in such support services will make a massive difference.

A bereavement midwife would be familiar with all relevant policies and procedures. They could ensure that all protocols are up to date and that relevant paperwork and equipment is always available; ensure that there are high standards in bereavement care in every relevant hospital department; and liaise with others within the hospital, such as chaplains, neonatal and paediatric pathologists and mortuary staff. They would also be able to promote good communication and building relationships with primary care providers such as GPs, as well as external bodies, including the registrar of births and deaths, and to ensure that patients have access to all appropriate available support and literature.

We are lagging behind on stillbirths, and I think the Minister will agree that we need to do more. I have outlined just a few suggestions that would help, as proposed by those who work in maternity care and who have suffered the loss of their own baby during pregnancy.

As tragic as a stillbirth is, the sudden death of a baby who was born, named, taken home and then fell asleep never to wake again is something I cannot even begin to imagine. Sudden infant death syndrome, or cot death, was dramatically reduced due to the outstanding success of the “Back to Sleep” campaign that the Government launched in the mid-1990s. The campaign, reminding parents that babies should sleep on their back, not side or front, was highly successful and led to an outstanding drop in the number of cases of babies who died of sudden infant death syndrome. As a result of that campaign, the number dropped from five babies a day in the mid-1980s to five babies a week, where it has stubbornly remained ever since, even 20 years later.

Access to information is vital. The first thing we need to do is reinstate the literature that new mothers used to receive when they left hospital with healthy babies. Unfortunately, the helpful “Safer sleep” guide was caught up in the Cabinet Office’s bonfire of public sector communications, and now new mothers are expected to rely on other organisations providing information. The Bounty pack is brilliant, although it is not necessarily immediately available or universal; however, the information provided in it could be life-saving. Risk profiling is essential if we are to reduce SIDS. Mothers need to understand the dangers of alcohol, smoking, vitamin deficiency and obesity, both during and after pregnancy, as a matter of course and not just as an optional extra, because those are the biggest causes of preventable perinatal death.

The Lullaby Trust and Bliss do wonderful work together and are helping my own local authority in Medway, which has multiple areas of deprivation, to identify risk and support professionals targeting intervention. This is essential. The statistics speak for themselves. The cross-party report published recently by colleagues, entitled “1001 Critical Days”, found that 26% of babies in the UK are estimated to be living within complex family situations, which can heighten the risks for a baby’s well-being, and that drug and alcohol problems affect more than 109,000 babies. Targeting resources at higher-risk families, parents and babies will help to reduce SIDS. It is essential to ensure that support and information are there for those who have premature babies, have babies young, or who are living in complex situations.

Furthermore, if we are really going to tackle infant mortality and reduce our embarrassingly high rates, we need to support, encourage and promote breastfeeding and improve access to “Healthy Start” vitamins, which are currently only accessible via named chemists. These should be available at all chemists. Investment should be made in both universal and targeted services, as recommended by the Healthy Child Programme. Where targeting has not made an impact—for example, vitamin D supplementation—universal approaches should be considered if they are also cost-effective. We need to highlight the message that this is not an optional extra, but is vital to ensuring foetal welfare.

We must improve awareness of smoking cessation services and the harm caused to unborn children by smoking. Similarly, we need to ensure that people understand the dangers of smoking for those who have been born. We must also do more to discourage binge drinking during pregnancy. I was shocked to learn that 18% of women still binge drink—that is, drink more than six units in one session—while pregnant, often leading to foetal alcohol syndrome.

I know I have not covered everything in this debate, but I hope it is a useful start. I thank the Royal College of Paediatrics and Child Health, Tommy’s, Sands, Kent Sands, Bliss, the Lullaby Trust, Abigail’s Footsteps, Together for Short Lives, the National Childbirth Trust, the Women’s Institutes and Bounty for their briefing materials in advance of this debate. I thank, in particular, the mothers and fathers I have met who have spoken movingly about their own personal tragic experience.

The Prime Minister said he wants to make sure that Britain is the best place to end life. Today, I am calling for us to work together to make Britain the best place to start life and give every expectant mother all the support they deserve. I look forward to the Minister’s response and the contributions of other Members, and thank them for taking the time to be here this afternoon to discuss this important issue.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Davies. Like others who have spoken today, I congratulate my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) on securing a debate on a sensitive issue that it is incredibly vital that our nation makes more progress on. I apologise that the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), whose portfolio covers this policy, is not here to respond, but I undertake to report back to him and to refer him to colleagues if I am unable to respond to anything today.

The death of a baby, whether during pregnancy or following birth, is of course a tragedy. Colleagues have eloquently described the devastating impact on families of losing a baby to stillbirth or during the first year of life. Although stillbirth is now at its lowest recorded rate in England since the definition changed in 1993, a study published in The Lancet in 2011 ranked the UK 33rd worldwide on stillbirths, below a great many other high-income countries. As has been said, being in that place in the league table is not a record we can be proud of. We are making progress, which I will describe, but as everyone accepts we clearly need to do more and to be in a better place. Similarly, infant mortality rates are at historic low levels, but still higher than the European Union average.

Although the stillbirth rate has decreased dramatically over the past 50 years, until recently it had not declined significantly since the 1990s. My hon. Friend referred to that sense of stalled progress. Thus, the rate for England and Wales in 1993, when the current definition was introduced, was 5.7 stillbirths per 1,000 total births. By 1999 the rate had fallen to 5.3, but 12 years later, in 2011, it had not really changed, at 5.2. It is encouraging that the rate has now started to fall. The rate for 2012 was 4.8 stillbirths per 1,000 total births, which is the lowest rate recorded in England since the definition changed. Although that is a statistically significant fall, which we all welcome, we recognise that the decline in stillbirths in the UK has not kept pace with that in other comparable countries. My hon. Friend also demonstrated that across the UK we do not necessarily have even rates of progress. The decline in the infant mortality rate has been more encouraging, that in England falling from 5.2 to four deaths per 1,000 live births between 2002 and 2012, although that remains higher than the EU average, as I said.

Such reductions are welcome, but the rates in England are still high and there is considerable scope for future reduction. That is why we have a wide range of initiatives in place that will help to reduce stillbirth and infant mortality rates, and tackle health inequalities. The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), and others, were right to refer to the relevance of this issue. It remains a source of concern that we sit where we do in international league tables.

What can be done to reduce the number of stillbirths? As colleagues have said, stillbirth has many causes, some of which are known and some not. That is one of the challenges: we are so used to identifying exactly what a problem is, what we need to do and the resources necessary to tackle it; but here we are in slightly strange terrain, in that we know some things but not enough. The known causes include lifestyle issues such as smoking and obesity; medical causes affecting the woman, baby or placenta; demographics; and the safety and effectiveness of the maternity care given.

On reducing the risk of stillbirth, an important first step is to raise the issue’s profile, so that people are aware that it needs to be dealt with and is not simply one of those things to be accepted and about which little can be done. It is not acceptable to have one of the worst stillbirth rates in comparison with similar countries. We have therefore included stillbirth and neonatal mortality as an area of improvement for the NHS in its outcomes framework. We have identified it as an area in which we need to do much better.

A range of research has been conducted that demonstrates that women who access antenatal care late have poorer outcomes. Early access to antenatal care is therefore pivotal to improving health and well-being outcomes for women and their babies. In line with the guidelines of the National Institute for Health and Care Excellence, women should have an assessment of their health and social care needs, risks and choices as early as possible in pregnancy. That enables midwives to provide pregnant women with important lifestyle messages —for example, about diet, exercise, smoking and drinking —and to identify any pre-existing conditions that might require additional support. I will say more about public health later, but I can only share in the alarm expressed by Members at some rates of drinking—quite heavy drinking—during pregnancy, for example. According to the national statistics on that, there is great variation between local authorities. I will touch later on one of the reasons why we think public health sits so well within local authorities, which are in a position to tackle that regional variation.

The Department and NHS England are working with a number of key partners, including the stillbirth charity Sands, Public Health England, the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists, to take forward a stillbirth prevention work programme. The programme covers a range of initiatives, including raising awareness of the known risk factors among pregnant women and health professionals. That will ensure that women receive consistent advice on how to minimise the risk of stillbirth—including the importance of healthy eating and the other lifestyle issues that have been raised—are aware of foetal movement and what is normal for their baby, and know where to go for help if they suspect there is a problem. It is important that each stillbirth is investigated and lessons are learned. We are therefore working with NHS England to explore how standardised perinatal death reviews could be introduced.

Growth-restricted babies are up to eight times more likely to be stillborn than non-growth-restricted babies. My hon. Friend the Member for Chatham and Aylesford is aware of the encouraging results we have achieved in reducing the stillbirth rate in the three regions where uptake of the Perinatal Institute’s growth assessment protocol training package—the GAP programme—was most prevalent. Following discussions with the Perinatal Institute, NHS England is encouraging uptake of the programme across the NHS in England. More than 75% of trusts in England have already signed up for that training.

[Tracey Crouch]

Will the Minister elaborate slightly on that training? Given the example of my constituent whose son, Henry, was stillborn at 38 weeks but had not grown for 16 weeks, the measurement tools currently available to midwives are clearly simplistic and some more sophisticated technology for measurement could well be of use. Will she elaborate on whether the new system is using more sophisticated technology? That is one reason why having an extra scan could help with early intervention, by identifying any growth problems sooner.

[Jane Ellison]

My hon. Friend has asked an extremely good question. I hope she will allow me to reply after the debate—I do not have an answer readily to hand, as the subject is not in my policy portfolio. I will come back to her on that, because it is a good question.

Although we know some of the risk factors for stillbirths, other causes are unknown, and it is important that we gain a greater understanding of those. The NHS National Institute for Health Research funds a range of research relating to causes, risk factors and prevention of stillbirth and neonatal death. Both the NIHR Cambridge and the NIHR Imperial biomedical research centres have ongoing research programmes on women’s health, including research relevant to the prevention of stillbirth and neonatal death.

In addition, the NIHR health technology assessment is funding three significant trials. The first is a £6 million trial of an intelligent system to support decision making in the management of labour using the cardiotocogram, or CTG. The second is a £1.4 million trial of nicotine replacement therapy in pregnancy, led by the university of Nottingham. The third is a £1.2 million trial of physical activity as an aid to smoking cessation during pregnancy, led by St George’s, university of London.

My hon. Friend referred to the Tommy’s stillbirth research centre at the university of Manchester, which is conducting innovative research that focuses on the unborn baby’s life support machine—the placenta. It has opened the Manchester placenta clinic, which combines specialised antenatal care for pregnancies affected by foetal growth restriction with front-line research into why the condition occurs and how it might be treated. The Government also fund MBRRACE-UK, or Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the United Kingdom, which is continuing the national Confidential Enquiry into Maternal Deaths and national surveillance of late foetal losses, stillbirths and infant deaths.

I turn now to bereavement support and counselling, which were quite rightly raised during the debate. It is obviously important that women who have suffered a miscarriage, stillbirth or neonatal death receive evidence-based care, in an appropriate location, which supports both their physical health and their emotional well-being. In December 2012, NICE published clinical guidance that offers evidence-based advice on the diagnosis and management of ectopic pregnancy and miscarriage in early pregnancy—that is, up to 13 completed weeks of pregnancy.

We expect maternity care providers and commissioners to give due regard to NICE guidance and to ensure that there are comprehensive, culturally sensitive services and facilities for the management and support of families who have experienced a miscarriage, stillbirth or neonatal death. Skilled staff should of course be available to support parents. I take on board entirely the point that that picture might sometimes be inconsistent. Clearly, we have to work towards greater consistency. As I often say when we have debates such as this, it can only be a good thing that Parliament continues to demonstrate its great interest in this area, as we can demonstrate to those who provide and plan our health services in which Parliament has shown a particular interest. Today’s debate provides another opportunity for us to do that.

In May 2012, the then Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), pledged that women who have suffered a miscarriage would get more support from the NHS. Over the past two years, the Department has awarded £35 million in capital funding to improve NHS birthing environments, including facilities for bereaved parents.

My hon. Friend the Member for Chatham and Aylesford raised the issue of scans. There are currently no plans to introduce routine scans in the third trimester of pregnancy to monitor foetal growth and development. I recognise that there is a challenge to that policy. The UK national screening committee advises Ministers and the NHS in all four countries of the UK about all aspects of screening policy, and supports implementation. It uses evidence based on research, pilot programmes and economic evaluation, and assesses the evidence for programmes against a set of internationally recognised criteria. If stakeholder organisations, individuals or Members feel that there is enough evidence published in peer-reviewed journals to consider screening for a condition in the third trimester of pregnancy, they can submit a policy proposal to the national screening committee. That might well be something that my hon. Friend wishes to consider.

I turn briefly to the subject of the registration of stillbirths. I say briefly, because I know that the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, is meeting my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) in early April to discuss his ten-minute rule Bill on the registration of stillbirth. That Bill aims to amend the Births and Deaths Registration Act 1953 to provide that parents may register the death of a child stillborn before the threshold of 24 weeks’ gestation. That Act, as amended by the Still-birth (Definition) Act 1992, provides for the registration of all babies stillborn after 24 weeks’ gestation. When a baby is stillborn, the doctor or midwife who attended the delivery or who examined the baby’s body after birth gives the parents a medical certificate certifying the stillbirth.

Although some parents are very distressed that they cannot legally register the birth of a baby born before 24 weeks who did not breathe or show any signs of life, others would be distressed at the possibility of having to do so. Getting the right balance between those conflicting wishes is challenging, but the existing system, whereby hospitals can issue local commemorative certificates—my hon. Friend the Member for East Worthing and Shoreham alluded to those in his remarks—for those parents who want them goes some way to addressing the issue. I know that he will have more questions and challenges for my hon. Friend the Member for Central Suffolk and North Ipswich, and will want to discuss those at that meeting in April. I recognise that he has signalled his intention to take the matter forward.

Although infant mortality rates are at an historically low level, health inequalities remain and often reflect inequalities by socio-economic group, ethnicity, geographical area and age. There is a threefold difference in infant deaths rates between professional groups and manual groups. Mothers born in the Caribbean, west Africa, Pakistan and Bangladesh have rates between one and a half times and twice the national average. The greatest numbers of infant deaths and the highest rates are to be found in the most deprived parts of big cities such as Birmingham and Bradford. Young mothers under 20 have the highest risk of infant mortality—almost 60% higher than that for mothers aged 20 to 39, with young lone mothers at even greater risk. That is a terrible catalogue of loss, for the families concerned, for their communities and for the nation as a whole.

There has, however, been some progress in reducing those inequalities in recent years. The difference in the infant mortality rate between the routine and manual group, for example, and the population as a whole has narrowed from 18% in 2002-04 to 9% in 2009-11. We are looking to build on that progress, and that is why we have made reducing these inequalities a priority for the whole of the new health system, working with PHE and NHS England, and backed that up with new legal duties on access to and outcomes from services.

Professor Sir Michael Marmot has been referred to during the debate. He said in his post-2010 health inequalities review that there is a social gradient in health, whereby the lower a person’s social position is, the worse his or her health will be. He recommended that action should be proportionate to the level of disadvantage, including on his first priority of giving every child the best start in life, with which none of us would disagree.

On a practical note, we are strengthening the health visitor service, which Members were right to highlight. We are conscious that it is an important pledge and crucial to infant health and early child development. We are increasing the number of health visitors by 50%—4,200—by 2015. We are also doubling—by 1,600—the number of places on the family nurse partnership programme, which supports vulnerable young mothers over the same time scale. Sure Start children’s services also have a role to play.

The family nurse partnership has an exceptional record of successful intervention, particularly in the lives of young and vulnerable mothers. It has supported many thousands of them throughout the country through pregnancy and birth, and sustained the life chances of the child and the mother. I will quote a nice comment from one of the young women who were helped by this service. She said of her family nurse:

“Margaret doesn’t tell me what to do but helps me make good decisions about my baby, my life and how to be a great mum. I’m excited about my future and seeing my baby grow up. My partner and I became engaged last October and next year I start university”.

That is typical of a young life that has been turned round by effective intervention at a critical moment—not just the mother’s life but, critically, the life of her child also. We are delighted to support the family nurse partnership and to see it grow.

As expected, reference was made to midwives. It is vital to have the appropriate number of trained midwives available in the NHS. Since May 2010, the number has increased at twice the rate of the number of births. There are now 1,500 more midwives than in May 2010, and more than 5,000 in training who are due to qualify in the next three years. Obviously, Health Education England has been given a mandate by the Government in this area, but I completely accept the point about consistency of midwife care and support. That very good point was well made, and I will ensure that it is made to the NHS.

--- Later in debate ---

[Tracey Crouch]

I am delighted to hear that there are 5,000 midwives in the training programme. Are they receiving dedicated bereavement training?

[Jane Ellison]

Again, if my hon. Friend will forgive me, I will respond to that question after the debate. I would not want to get the answer wrong.

We have touched throughout the debate on public health, which sits within my portfolio. National action must be complemented by local action. I mentioned the extraordinary range of indicators that I see regularly on issues such as drinking in pregnancy. It makes the case for why the transfer of responsibility for public health from the NHS to local government is sensible. We have backed that with £5.4 billion over two years, and a public health outcomes framework that focuses on health inequalities and key indicators in infant mortality such as low birth weight, which is associated with prematurity and is a significant cause of infant mortality and poor infant and child health.

Some of that local action is already being taken. My home city of Bradford has an excellent record in addressing infant mortality, despite having some of the worst outcomes. It established the Born in Bradford project, a long-term cohort study of 14,000 pregnant women and their children to improve understanding of health and sickness in babies and children, tracking their health throughout pregnancy and childhood into adult life.

In Salford, which is closer to home for the shadow Minister, the city council’s health improvement service offers activities to support new mums and children, including breastfeeding, weaning, exercise and socialising, and it is working to improve MMR vaccine uptake among black and minority ethnic and other groups, where uptake remains low despite our good national statistics.

In Birmingham, pregnancy outreach workers employed by the social enterprise, Gateway family services, tackle health inequalities in infant mortality by bridging the gap between women who need support and the agencies that provide it. Those are three illustrations of some of the imaginative projects that are under way. I hope we will see more and more local government adopting best national practice and responding to the particular challenges in their areas. Some of the contrasts are stark, and local government, which knows its communities well, is well placed to respond to them.

My hon. Friend the Member for Chatham and Aylesford referred to cot deaths. We have made reducing infant mortality an area of improvement for the NHS. Comprehensive advice to parents about reducing the risk of cot death is available on the NHS Choices website, which includes a wealth of other advice. In 2012, the NHS launched the Start4Life information service for parents. They can receive regular e-mails, videos and texts about pregnancy and the first eight months of their baby’s life. It is a free digital service to provide quality-assured advice at the right moments for parents, who can sign up online for it.

The Department has also included advice about the risk of sudden infant death in the Healthy Child Programme, which is the universal programme for all children from the start of life and includes preventive services for children with additional risks. Obviously, anything more we can do to highlight the available advice and support would be valuable, and Parliament has a great role to play in that regard, as do MPs in their constituencies, and local government. The advice is there, but the challenge is always to ensure that it gets to vulnerable groups, and accessing advice across a whole range of health information is difficult.

I thank my hon. Friend for securing this debate, and other Members for their contributions. It further raises the profile of this vital issue of stillbirth and infant death. I assure the House that the Department is working collaboratively with partners, including charities such as Sands and Bliss, the royal colleges and others on a range of initiatives to help to reduce the number of tragic deaths. The Department is always open to new ideas and to working with partners throughout the health sector. We welcome these debates and the opportunity to engage further in any way that Members believe will help us to move forward in this vital area of policy for all our constituents.

G8 Summit on Dementia

Tracey Crouch Excerpts

Thursday 28th November 2013 Commons Chamber

[Tracey Crouch (Chatham and Aylesford) (Con)]

I beg to move,

That this House has considered the G8 summit on dementia.

It is a pleasure to see you in the Chair, Madam Deputy Speaker; this is the first opportunity I have had to give you my warm congratulations on your election.

I am incredibly grateful for the support of the right hon. Members for Salford and Eccles (Hazel Blears) and for Sutton and Cheam (Paul Burstow), and others, for helping to secure this debate. I thank the Backbench Business Committee for allowing Members time to contribute—albeit briefly—to a debate on what many believe is one of the most important issues facing our health and social care system in the future. I shall keep my opening comments as brief as possible, as I know that others wish to speak, but it is important to congratulate the Prime Minister on using the opportunity of hosting the G8 summit on 11 December to focus on international efforts to prevent, delay and effectively treat dementia. The debate will allow parliamentarians an opportunity to shape discussions at the summit, following on from wider and commendable consultation with the public. Collaboration, which is at the heart of the conference, is the basis of my contribution to the debate.

Before addressing the specifics, it is important to set out the global perspective. Dementia affects more than 35 million people worldwide and is now considered to be one of the greatest global health challenges of our time. It is estimated that, by 2050, more than 150 million people will suffer from dementia.

Hon. Members will have seen the devastating human cost of dementia if not in their families, then in their constituencies. We know of the suffering of those with the condition and those who become carers for their loved ones. However, we perhaps do not so obviously see the huge economic effects of dementia, the worldwide cost of which is estimated to be about £400 billion, which is the equivalent of 1% of world gross domestic product. Without urgent action, that figure will increase in line with the number of people who are anticipated to get dementia, which is why global collaboration is essential. The more we can do together globally, the better the outcomes we can secure nationally.

[Mr Simon Burns (Chelmsford) (Con)]

My hon. Friend makes an extremely important point. Does she accept, however, that it is equally important to do more on seeking diagnoses? About 350,000 people in this country are undiagnosed and go without the help and support that those who have been diagnosed receive.

[Tracey Crouch]

I agree entirely with my hon. Friend. The all-party group on dementia recently produced a report on diagnosis. Shockingly, only about 42% of people get diagnosed, which leaves a massive diagnosis gap. The earlier people are diagnosed, the better their treatment and pathways.

[Andrew Miller (Ellesmere Port and Neston) (Lab)]

I congratulate the hon. Lady on introducing the debate. I hope she will hear later some of the evidence that the Science and Technology Committee has taken on variant Creutzfeldt-Jakob disease, and of the important work of the Medical Research Council prion unit, which could lead to exciting new possibilities for the treatment and diagnosis of people with all sorts of dementia. Does she agree that it is important to maintain such research programmes?

[Tracey Crouch]

I agree entirely with the hon. Gentleman, and I will hear more later of the initiatives his Committee is examining. The importance of research is very much the basis of my speech.

Hon. Members may talk about many aspects of dementia, but I shall address four, the first of which is investment. The statistics are gloomy, but there is a good-news story underlying the negative numbers: people are living longer and people can live well with dementia. We need to capitalise on best practice and ensure that we maximise people’s ability to maintain long-term well-being, despite their debilitating condition. Although we do not have a cure for dementia, we have come on leaps and bounds in recent years. A cure is hopefully no longer a lifetime away, but to ensure that we make that cure happen, we need to take action.

Dementia costs the UK economy £23 billion a year, which is more than cancer, stroke or heart disease, but the annual research spend on dementia is about £51 million. The research spend on cancer is £521 million —10 times more—yet dementia costs society much more than cancer annually. I therefore welcome the increase in investment in dementia research through the Government’s themed initiatives, which has resulted in Government investment more than doubling over four years. However, the investment comes from a low base and represents less than 1% of the overall science budget.

[Zac Goldsmith (Richmond Park) (Con)]

I congratulate my hon. Friend on securing this important debate. It is widely believed—it has recently been widely reported in scientific journals, including by scientists who will take part in the G8 meeting—that up to half of all Alzheimer’s cases can be attributed to modifiable and therefore preventable risk factors. If that is the case, and there seems to a general consensus along those lines, does she share my disappointment that, as far as I can see, none of the additional £22 million allocated for dementia research has been spent on prevention research?

[Tracey Crouch]

I am sure that the Minister will have heard the good point that my hon. Friend makes. I would like to concentrate on the fact that there has been an increase in investment for research. There are various reasons why we need research, and I am sure the Minister will address my hon. Friend’s comments in his response.

[Huw Irranca-Davies (Ogmore) (Lab)]

The hon. Lady rightly talks about the low investment base from which we are starting on dementia research and prevention. One way to make limited resources go further is to co-ordinate properly and better across the regions and nations of the UK. There is good work going on in Wales, but that is also from a low base.

[Tracey Crouch]

I agree entirely with the hon. Gentleman. We need greater co-operation and collaboration across the world, and if that is needed across the world, we certainly need it at home.

We should recognise that the USA is committed to spending $550 million on dementia research, which is a reflection of the importance of the condition to its society. To be frank, however, the combined investment by the USA and the UK is small fry compared with the investment in research by the pharmaceutical industry. Any collaboration needs to include the global pharma leaders to ensure that they are financing research, bringing together their world-leading scientists and helping to achieve the breakthrough in the prevention and treatment of dementia that we all want. One of the most important outcomes I would like from the G8 summit is a long-term commitment to double investment in research to provide stable and predictable funding so that we can get closer to finding a cure and improved care.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Does the hon. Lady agree that part of the problem is the fact that we use the term “dementia” as if it is just one thing? There are many dementias and we must not focus just on Alzheimer’s. We must be aware of frontotemporal dementias, which affect younger people in particular, and ensure there is funding for research into that.

[Tracey Crouch]

I agree entirely. This is something that blights many conditions, including cancer. We talk about cancer investment, but there is little or no research funding for some cancers. Mesothelioma is a classic example, about which there is a debate on Monday.

It is essential that research focuses on investment in infrastructure. Training and development for researchers is also crucial if we are to see swifter progress towards treatments and cures for dementia. However, it remains hard for an academic with a good idea to spin that off to a company, especially compared with the situation in America. The Government must do more to promote the commercialisation of research as these companies become a vital part of the ecosystem. Large companies and academia can then be partnered in the innovative collaborations that the Government seek.

Research on the provision of care is equally important. Four out of five people with dementia live at home. We want to keep it that way and to ensure that they can live there safely for as long as possible. Research comes in many different forms, including the identification of what works. We know that dementia costs the UK £23 billion, but arguably that money is not being spent properly or efficiently. Prevention is key. Avoiding unnecessary hospital admissions is vital to ensuring that funding is used effectively and, more importantly, makes a huge improvement in quality of life. Researching best practice in care is essential. An economic case developed by the Alzheimer’s Society estimated that if just 5% of admissions to residential care were delayed for one year as a result of dementia-friendly communities, there would be a net saving of £55 million a year across England, Wales and Northern Ireland.

There needs to be a change in the language we use when we talk about care. If we talk about weekly art lessons that are provided to help to improve cognitive function as therapy, rather than an activity, we could hope to see a change in attitude towards research and investment in this area. Many good ideas are having a positive impact in local communities. For example, Medway council, which covers part of my constituency, is promoting telecare as a means of supporting people with dementia, and there are lots of non-clinical treatments that could be further researched, such as the benefits of pets and petting animals for people with dementia, memory rooms and memory boxes. I have even heard of amazing innovative products such as wristbands that monitor someone’s usual actions so that they will detect if they have a fall. We need to consider all those things in the whole pod of research.

We should not forget to consider support for carers. Family carers of people with dementia save the economy £7 billion a year, but evidence shows that they struggle to do that, which can lead to avoidable crises in care, hospital admissions or early entry into care homes, all of which are very costly. The Dementia Action Alliance’s “Carers Call to Action” campaign, which I support, is calling for timely and tailored support for carers, whom I am sure we all agree are an important cog in the wheel of treating and providing for those with dementia.

On best practice, it is important that international collaboration includes the beneficial sharing of successes and failures. In utilising our resources, it is important that we do not duplicate unsuccessful investments and that we champion successful and effective progress. The summit should therefore ensure that all publicly funded dementia research data and results are made available, thereby allowing common factors in national research responses to be shared.

[Sir Roger Gale (North Thanet) (Con)]

Before my hon. Friend moves deeply into the main subject of the debate, which is the G8 summit, does she agree that we need much greater public understanding of, and support for, those who are caring for people with dementia and those with the condition, which can strike not just elderly people, but younger people? Some of us remember a former and much-loved Member of this House who, while still an MP, suffered from the disease. This is something that we have to ram home to people.

[Tracey Crouch]

I agree entirely with my hon. Friend. It is important to note that society has made much progress in the past 20 years and that dementia is not the taboo subject it perhaps used to be. We have changed how we think about it and now treat people with dementia much better, but we still need to get away from the idea of saying, “Nan’s gone a bit dotty.” We have to understand that something can be done about dementia and that proper care pathways exist to ensure that people can live well with it, and we have to support carers as best we can.

On the G8 summit, I turn to my final but no less important point: long-term strategies. The Prime Minister’s challenge on dementia for England has provided a welcome focus on the treatment and care of people living with dementia and the search for a cure, but there is a danger that the focus will be lost, especially as the initiative is not UK-wide but covers only England. Many countries have dementia strategies or brain bank initiatives, and the UK needs a new long-term strategy, because the current one is due to expire in 2014. I would be grateful if—not today but soon—the Minister could outline his plans to evaluate the national dementia strategy for England and tell the House when he will commit to a new strategy following the current strategy’s expiration next year. Notably, the US has a dementia strategy in place until 2025, which means that we could be left in the embarrassing situation of the UK Government leading the G8 in a discussion on dementia without a national long-term commitment comparable with that of many of their international partners.

In conclusion, it is fantastic that the UK Government, under the Prime Minister’s personal commitment, are using the G8 summit to champion a more collaborative approach to preventing, treating and curing dementia, but it is essential that the legacy of this summit goes further than the G8 and that the declaration and communiqué of the summit makes firm long-term commitments to the doubling of research funding, to sharing best practice, and to delivering an international ongoing collaboration on defeating this devastating disease, which affects so many people and their families.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. Several hon. Members have indicated that they wish to speak, but we have only one hour remaining, so I shall impose a limit of six minutes on Back-Bench speeches.

--- Later in debate ---

[Tracey Crouch]

We have had a fantastic debate, but I would expect nothing less, given that this is the second debate that we have had on dementia in the Chamber. Members’ contributions on the subject, which is important to our constituents, are always incredibly passionate and varied.

The right hon. Member for Salford and Eccles (Hazel Blears) put it much better than I could by saying that we must always remember that there is a person at the centre of the debate. When we talk about global economic figures, we are talking about how we can best help somebody who is suffering from this debilitating, devastating disease and their family who are there to support them.

The Minister has heard the passion of the Members who spoke today. They have demonstrated how important this issue is to our constituents, communities and society. They have also set out the economic factors. He should go back to his Department and think carefully about how the UK should take forward its dementia strategy, which is still not forthcoming beyond 2014. We must be clear that being a global leader on this issue is about not only holding a G8 summit, but practising what we are saying back at home. The Prime Minister has the support of the House in taking this matter to the G8 summit and we all wish him well as he does so.

Question put and agreed to.

Resolved,

That this House has considered the G8 summit on dementia.

Hospital Mortality Rates

Tracey Crouch Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

I think I have met most of them, but I have certainly met the General Medical Council and the Nursing and Midwifery Council, and I have talked to them about the reasons they are finding it difficult to remove doctors and nurses from their lists when there are questions about their poor performance.

[Tracey Crouch (Chatham and Aylesford) (Con)]

To complete the Medway Maritime hat trick, may I say I am very disappointed to hear from the Secretary of State that the hospital has gone into special measures? I have been assured that Sir Bruce Keogh’s recommendations are already being implemented, but will the Secretary of State say in what time frame he, and more importantly my constituents, should expect to see significant improvements at the Maritime?

[Mr Hunt]

We want these things to happen as quickly as possible, but all the hospitals Sir Bruce reviewed will be looked at again within the next year by the chief inspector of hospitals, Professor Sir Mike Richards, who starts work today, so we will be able to measure whether progress has been as swift as my hon. Friend and I would like.

Accountability and Transparency in the NHS

Tracey Crouch Excerpts

Thursday 14th March 2013 Commons Chamber

[Tracey Crouch (Chatham and Aylesford) (Con)]

I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie) on securing this very interesting debate, which has covered lots of issues to do with accountability and transparency, not only at Mid Staffordshire but throughout the entire country. It is clear from the speeches by the right hon. Member for Cynon Valley (Ann Clwyd) and my hon. Friend the Member for Wycombe (Steve Baker) that these concerns go beyond the appalling events at Mid Staffs. My own constituents need reassuring about their patient care, the quality of the information they are receiving and, unfortunately, the mortality rates at Medway Maritime hospital. Like other hospitals, it is now under investigation, and we await the outcome with interest.

It often takes a very long time for the truth about these matters to be completely uncovered. In the past, the quality of patient care has, in many respects, been secondary to the hospital meeting its targets. That is a shame, and it is part of the culture that we need to change. I do not want to believe that there is a culture of cover-up in the NHS. Like my hon. Friend the Member for Totnes (Dr Wollaston), I think that all those who work in the NHS—the nurses, the doctors and the consultants—do a brilliant job in delivering good quality care and the best patient outcomes. Unfortunately, that was not the case at Mid Staffs, and concerns about quality of care and mortality rates are spreading. As I have said, constituents are now concerned about the care they receive at the Medway Maritime hospital.

The trust is always incredibly good at responding to my questions, whether they be about what I consider to be the high use of the Liverpool care pathway at the hospital, constituent complaints, dementia care or specific patient services. However, I fundamentally believe that if a constituent has to involve an MP in a complaint, the system has failed. There is a growing perception that if someone complains, it is their fault and they are in the wrong, while the hospital paints itself as the victim of the complaint rather than the other way around. That is wrong.

The Medway Maritime hospital is under investigation for higher than expected hospital standardised mortality rates, and there is currently a specific outlier alert on septicaemia. Worryingly, this is not the first time this has happened. Discrepancies in coding were highlighted way back in 2008 with the discovery that 8% of deaths were being recorded as end-of-life care when the proportion should have been 37%. Adjusting the mortality index to exclude those deaths reduced the hospital’s score by more than a third. A clear manipulation and distortion of the information only served to damage the best outcomes and services for the patients. I hope that that will not happen again. However, as an outsider it appears to me that the complexity of coding is part of the problem with the lack of transparency.

A culture of bullying and its suppression within the NHS has been mentioned. The latest staff survey at the Medway Maritime hospital shows that there is still a perception that bullying is widespread. If we want to improve standards in patient care—which is a key aspiration for the newly restructured NHS—that has to be one of the most important issues to address. I welcome today’s announcement by the Secretary of State, but may I make a practical suggestion that was put to me by a GP this morning? One of the problems with the system for complaints is that they stay within the hospital—they go up to the management board and do not really go beyond it. Instead, complaints could be delivered on a quarterly basis to the new clinical commissioning groups, which would enable people outside the hospital structures to look at potential trends and patterns of poor quality, and at whether there are concerns about specific consultants. We could end up taking the responsibility from the hospital, having the outsider look in, and making more practical changes.

Greater transparency in the NHS is not just about honesty and accountability, but about better communication. As the most recent ombudsman report highlighted, the common pitfalls are also the result of equivocal language over care, the use of technical language and the failure of insincere apologies. We need to learn the lessons of the Francis report; patients from those families who use my local NHS services deserve nothing less.

Suicide Prevention

Tracey Crouch Excerpts

Wednesday 6th February 2013 Commons Chamber

[Dr William McCrea (South Antrim) (DUP)]

I beg to move,

That this House recognises that the number of suicides in the UK, particularly amongst young people, represents a major challenge for government and society; acknowledges the work that is taking place to address the issue; calls for even more urgency to be shown in seeking to reduce the rate of suicides; notes the danger posed in particular by websites which promote or give information about harmful behaviours such as suicide; and calls upon the Government to adequately resource and promote child and adolescent digital safety.

For years this subject has been swept under the carpet. I believe it deserves a mature and thoughtful debate. Suicide is a significant problem in our society. Its impact is often sudden and shocking. While we can to some degree prepare ourselves for the death, through ageing, of elderly parents or the loss of loved ones through chronic illness, suicide catches us by surprise. Often there is no warning and we are left with a feeling of utter bewilderment. We ask: was it preventable? Were there warning signs that we failed to recognise? Was it simply a cry for help that went wrong? All of those are questions to which we will, regrettably, never receive an answer.

It can be seen that suicide touches the lives of many people and is, in every case, a tragedy both for the life that has ended and for the family, friends and community left behind. We must always remember that each person who has been lost to suicide has been someone’s child, someone’s parent, brother, sister or friend. Their passing leaves a wound that does not easily heal, even with the passing of time. In addition, those bereaved by suicide have special needs and require special support, for bereavement by suicide is itself a risk factor for suicide.

We cannot afford to ignore or be complacent about the prevalence of suicide and self-harm in the United Kingdom. Preventing suicide presents a serious socio-economic issue, as well as a political challenge. It is a problem that we all have a duty to address. There is a great need to change public attitudes and to increase awareness and understanding about suicide as a major public health problem that is largely preventable. Globally, almost 1 million people die from suicide every year. In the past 45 years, suicide rates have increased by 60% worldwide. Suicide is one of the three leading causes of death among those aged 15 to 44 years in many countries. Although suicide rates have traditionally been highest among the male elderly, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of countries worldwide.

In 2011, 289 deaths by suicide were recorded in Northern Ireland, with the male suicide rate approximately three times greater than that of females.

[Tracey Crouch (Chatham and Aylesford) (Con)]

I congratulate the hon. Gentleman and his party on securing this important debate on the Floor of the House. He references male suicide. Does he not agree that one of the more worrying statistics is that people who have just come out of prison are at a very high risk of committing suicide in the first two weeks of their release? Does he not agree that we should make better use of community and health care pathways to ensure that we can prevent and protect people who are very vulnerable, such as those coming out of prison?

[Dr McCrea]

I agree wholeheartedly about the importance of those pathways. It is vital that every effort be made to ensure that persons at a vulnerable moment in their lives—this is what the hon. Lady was talking about—receive the best possible support. I will develop that point later.

--- Later in debate ---

[Norman Lamb]

I am very grateful to the hon. Lady for her intervention. Those representatives were not invited to the meeting, but let me make a clear commitment that we will work with the devolved Administrations. I mentioned that earlier and it is in all our interests that we tackle the problem together.

At that meeting, I urged the security companies, such as McAfee and Symantec, to work collaboratively with interest groups who were present, such as Samaritans and BeatBullying, and internet service providers to sign up to a concordat that would help to speed up the process for reporting harmful content and the blocking of harmful websites. They gave me positive assurances that they would explore such a concordat, and in turn we as a Government would be willing to facilitate and support such an initiative however we can.

The UK Council for Child Internet Safety is already making parental controls more accessible so that children can access less harmful content. The Under-Secretary of State for Education, my hon. Friend the Member for Crewe and Nantwich (Mr Timpson), who is the Minister responsible for children and families, will explain more about the work his Department has been doing when he sums up.

As I said at the outset, this is one of the issues that unite us all.

[Tracey Crouch]

I thank the Minister for giving way, as he has been very generous in doing so. We have heard that there are a host of reasons why people are driven to suicide, one of which is alcohol dependency. Is the suicide prevention strategy working alongside the alcohol strategy so that there is a holistic, joined-up approach to dealing with some of these complex issues?

[Norman Lamb]

Yes, very much so. I am grateful to my hon. Friend for her intervention. In each area in England, the health and wellbeing boards will be able to co-ordinate all that work. In considering their strategic needs assessments, they will be able to identify issues relating to suicide and alcohol and drug dependency.

I hope that I have satisfied the House that the Government take suicide extremely seriously indeed and that we are taking real action to help. I am grateful to the hon. Member for South Antrim for bringing the matter to the House’s attention.