Maternity Safety Strategy

Victoria Prentis Excerpts

Tuesday 28th November 2017 Commons Chamber

[Mr Hunt]

I will look into that very carefully. I am satisfied that there is strong new leadership at the Pennine trust and that it is being turned around, but it has told me about some of the cases to which the hon. Gentleman refers. They are of very great concern, and we absolutely must do everything we can to give answers to bereaved families.

[Victoria Prentis (Banbury) (Con)]

As a bereaved parent, but also as a lawyer who has conducted many inquests, I ask the Secretary of State to consider two points. The first is the fact that not many families will need an inquest to determine what went wrong during the birth of their child. Secondly, will he commit to the training of special coroners, just as we have in military inquests, to ensure that those who deal with these very sad cases are the best equipped people to do so? Finally, on behalf of the all-party group on baby loss, may I thank him for today’s announcement and encourage him in his work to make maternity care kinder, safer and closer to home—and may I encourage him to save Horton General Hospital?

[Mr Hunt]

First, may I apologise to my hon. Friend, because I should have mentioned her in my statement as someone who has spoken very passionately and movingly on this topic in the House? I will take away her point about specialist coroners, because we are now going to have specialist investigators, which we have never had before. I would make one other point. I hope she does not think I am doing down her former profession, but really when people go to the law, we have failed. If we get this right—if we can be more open, honest and transparent with families earlier on—it will, I hope, mean many fewer legal cases, although I am sure that the lawyers will always find work elsewhere.

Mental Health Units (Use of Force) Bill

Victoria Prentis Excerpts

2nd reading: House of Commons
Friday 3rd November 2017 Commons Chamber

[Victoria Prentis (Banbury) (Con)]

I am most grateful to have been called first, Mr Speaker, out of the smorgasbord of choice available to you.

It gives me genuine pleasure to rise to support the Bill and to be the first to congratulate the hon. Member for Croydon North (Mr Reed) on his hard work. The Bill stems from great tragedy, but it is always good to see a piece of constituency casework come to fruition and get as far as the Floor of the House. I have enormous respect for the hon. Gentleman, and the all the work he has done with people across the House and outside to get this far. I wish him all the best.

[Wera Hobhouse]

Is it not also time to pay tribute to my right hon. Friend the Member for North Norfolk (Norman Lamb), who as Health Minister introduced the “Positive and Safe” guidelines, a two-year programme with funding to end the deliberate use of face-down restraint in all health and care settings? Unfortunately, those guidelines have not always been followed.

[Victoria Prentis]

I thank the hon. Lady for her intervention. It is very important in these cases to congratulate Members from across the House and to work together on cross-party lines to achieve the consensus needed, so we support those in our communities who need laws like this to keep them safe.

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

May I add my voice to my hon. Friend’s in congratulating the promoter of the Bill on not just bringing it to the House but gathering a consensus? Does she, like me, welcome the fact that he is willing to look at constructive suggestions in Committee to ensure the Bill is in a proper and fit state?

[Victoria Prentis]

I thank my hon. Friend for his intervention. We have begun to understand and talk about mental health only very recently. As we do so, we learn both from those patients who have suffered tragedies and those who have had better experiences with law enforcement agencies. It is important that we learn and listen as the debate progresses. Issues may well come up in Committee that nobody has given a moment’s thought to. A constituent will have a story to tell and we can learn from it as we go forward.

From my own constituency casework, I know that for those at the point of crisis the use of restraint can be both humiliating and traumatising. I discussed this issue with the Causeway Carers, a great organisation comprised largely of parents and other family members of victims with very severe mental health problems. They meet in Bicester once a month. Many have first-hand experience of sectioning and restraint, which they shared with me. That was a great privilege and I do not feel able to share any of those stories with the House today. From what we have heard about Seni, we can all imagine the sort of stories that are taking place even on the high street in Bicester from time to time, often at night. They are also taking place in all our communities. They are not isolated stories, and none of us can feel that we are untouched by them.

These families are suffering enormously because they are dealing with a very ill family member, often a child, and restraint is added to that dreadful suffering that they already have to cope with. I recognise that the use of police cells in England as places of safety under the Mental Health Act 1983 is declining, and that more cases than ever are now referred to health-based places of safety, which is real progress. We should also welcome the significant reduction in the number of deaths in, or following, police custody since 20 years ago. I imagine that this reflects improved training, guidance and practices in a number of areas, most significantly in suicide prevention. My background is as a lawyer for the Prison Service, and it strikes me that this is in sharp contrast to the dramatic and worrying rise in suicide rates recorded in the last 20 years in prisons.

[Clive Lewis (Norwich South) (Lab)]

We are being consensual across the House, and I would like to retain that spirit, but would also make the point that one of the linking factors in terms of both prisons and mental health is funding for the institutions. Staff and service users at the Norfolk and Suffolk mental health trust, which is in special measures, are concerned that a reduction in the number of staff—nurses and doctors—over the past five years means they have less ability to watch and monitor patients, so it is more likely that those patients are using medication, and that means restraint is more likely to be used, so we end up with the situation that the Lewis family were in. Will the hon. Lady comment on that?

[Victoria Prentis]

Rather than get too party political, I think it is appropriate to talk about other difficulties that have led to reductions in staffing in real terms in the Prison Service, because we on this side of the House can give lots of facts and figures about how much more is being spent. The difficulty that I know about personally now in my Banbury constituency is in recruiting and retraining staff—not with the money to pay for them, but with finding the right people. I pay tribute to all who choose to work in the very difficult mental health sphere, with patients who suffer from dreadful illnesses; the House should pay tribute to the work they do day in, day out with people who are often very difficult to deal with while they are ill.

One matter on which I am sure we can agree is the importance of reducing further the number of black, Asian and minority ethnic people detained for mental health reasons in police cells. The figures are disproportionately high. It simply cannot be right that black people are four times more likely to be detained under the 1983 Act than white people. The hon. Member for Croydon North mentioned the Angiolini review and the importance of standardised data recording. I apologise for again referring to my Prison Service experience, as the mental health system is completely different from the criminal justice system, but there are themes that run through the way BAME people are treated in both systems which we increasingly find utterly unacceptable.

[Victoria Atkins (Louth and Horncastle) (Con)]

I pay tribute to the hon. Member for Croydon North (Mr Reed) for bringing the Bill to the House. Does my hon. Friend join me in welcoming clauses 8 and 9 requiring mental health units to record the relevant characteristics of the patient on every occasion in which force is used, and to submit an annual report to the Secretary of State, so that health units and also the Secretary of State can review and understand where there are patterns of behaviour?

[Victoria Prentis]

I could not agree more. The provision of statistics and retention of figures and then the crunching of them is vital. It might not sound exciting, but it is the only way to deal with the big problem of racial imbalance in both the mental health and the criminal justice system. It sounds absurd to say that figures are what will push through action on racial imbalances, but I truly believe that facts and figures—such as those provided recently in the report on the Prison Service, where we learned that 277 black women are in prison for every 100 white women—will help achieve that. Such figures are unacceptable on any level. The more we can talk about such figures, backed up by good evidence, the better. A civilised society cannot put up with such things.

I have strayed far from my brief. I am proud that the Government have committed to addressing the disproportionately high rates of BAME people detained for mental health reasons, and I am proud of the work the Government have done generally on mental health.

We all know that the 1983 Act is outdated, and it will be reformed to make it fit for the modern era. In October 2017, the Prime Minister announced a comprehensive review of the Act, with a planned end date for the report of autumn 2018. I am pleased that the review is being led by Professor Simon Wessely, former president of the Royal College of Psychiatrists. I worked closely with him in my previous role. We were working on a case concerning the pardoning of first world war prisoners who had been shot for cowardice, and he was able to recreate their mental health states from the limited records we had available and give invaluable evidence to the court. He is a great man and I am sure he is the right person to lead this review. He has said that he expects some of the solutions to the difficulties in the mental health system to lie in practice, leadership and culture, as well as in potential legislative change.

I have been encouraged by the work on mental health in my constituency, including in the veterans support group. It meets at Behind the Wire in Heyford Park, next to my constituency office, about once a month. It is a former military establishment and the veterans who access it feel very comfortable in that environment. It is well known that veterans as a group are more prone to experience mental health issues. This particular group offers drop-ins for veterans living in the local area so they can meet organisations including the Support, Empower, Advocate, Promote service, Help for Heroes, the Royal British Legion, Veterans UK and Rethink Mental Illness, which the hon. Member for Croydon North mentioned, and which does a great deal of good work across the country.

I have other local organisations who are doing great things in supporting my constituents, including Restore in Banbury, which I was also lucky enough to meet recently. I visited the local branch of Mind in September, which has contacted me in recent days urging me to support the Bill. Its letter said that

“the proposals in this Bill are crucial to protecting people experiencing a mental health crisis...With your support this Bill would lead to better training for staff, better data, improving transparency and highlighting problem areas”.

It therefore gives me great pleasure not only to support the hon. Member for Croydon North, but to stand up for those of my constituents who have asked me to attend this debate and to speak in it.

As a former civil servant, I cannot emphasise enough how important it is that we have a joined-up approach across Departments. It is very much not just a matter for the Department of Health; the Ministry of Justice is also involved. I speak to it frequently about mental health and prisoners and the use of restraint in the criminal justice system, and I hope that the Minister will reaffirm the importance of cross-governmental co-operation, including work with NHS England, on the delivery of reforms to detention.

Healthcare in Oxfordshire

Victoria Prentis Excerpts

Tuesday 17th October 2017 Westminster Hall

[Victoria Prentis (Banbury) (Con)]

It is a pleasure to serve under your chairmanship, Sir Roger. I made my first speech about the Horton General Hospital when I was seven. I apologise that many people in this Chamber will have heard it before, but I do not know that you have had that pleasure, so with your permission, I will carry on.

Let us remember what we are talking about. The Horton is not a community hospital. It has been a pleasure to listen to colleagues talk about their community hospitals; we have heard about Wantage and Abingdon, and one rarely meets my hon. Friend the Member for Henley (John Howell) without hearing him mention the Townlands, of which he is very proud. I love community hospitals too; my mother helped run Brackley Cottage Hospital for most of my childhood and until recently, and I think that the marvellous hospital in Bicester still has untapped potential. However, the Horton General Hospital, which I will talk about, is quite different.

The Horton has hundreds of beds and treats about 39,000 people in accident and emergency every year—nearly one third of Oxfordshire’s A&E attendances. What happens at the Horton affects all my colleagues, due to the knock-on effects of closure. Our surgeons are among the top five in the UK for neck and femur operations. It is not a community hospital; it is a fully functioning, very busy district general.

We feel beleaguered. For more than 40 years, the John Radcliffe Hospital has viewed us as a smaller and less academic sibling that can be treated with contempt when staffing is short. In 2008—this is not ancient history; it is nine years ago—the Independent Reconfiguration Panel was asked to consider the last proposed downgrade of paediatrics, obstetrics and gynaecology and the special care baby unit. It conducted, as I hope it will again, a full five-month review and made five excellent recommendations, which I will read once more.

The first recommendation was:

“The IRP considers that the Horton Hospital has an important role for the future in providing local hospital-based care to people in the north of Oxfordshire and surrounding areas. However, it will need to change to ensure its services remain appropriate, safe and sustainable.”

On the proposed downgrades, it said:

“The IRP does not consider that they will provide an accessible or improved service to the people of north Oxfordshire and surrounding areas.”

Other recommendations were:

“The PCT should carry out further work with the Oxford Radcliffe Hospitals NHS Trust to set out the arrangements and investment necessary to retain and develop services at the Horton Hospital. Patients, the public and other stakeholders should be fully involved in this work… The PCT must develop a clear vision for children’s and maternity services within an explicit strategy for services for north Oxfordshire as a whole… The ORH must do more to develop clinically integrated practice across the Horton, John Radcliffe and Churchill sites as well as developing wider clinical networks with other hospitals, primary care and the independent sector.”

I am afraid that none of that happened. The recommendations were made nine years ago, but none of them were followed. The only things that changed were that the traffic got worse and the population of the area grew. Our district council, I am proud to say, tops the leader board for house building.

Less than 10 years later, we now have no obstetrics or SCBU. They went in the blink of an eye, without any real attempt to address recruitment issues or work with us to do so, although we offered and offered. Locally, we remain deeply unhappy and frightened. Patients in the later stages of labour are travelling for up to two hours, and emergency gynaecological operations take place in a portakabin in the Radcliffe car park. We have heard stories locally—in fact, they are all people talk about—of babies born in lay-bys and in the back of ambulances. The data that show statistics of complete births—defined by when the placenta has been delivered—tell a different story; they do not register the reality of people’s experience.

I pay tribute to what my hon. Friend the Member for Witney (Robert Courts) said about Google Maps. Locally, the impression is that the CCG and the trust massage the figures and use them when it suits their argument. I conducted a travel survey of nearly 400 people on their real-life experiences of how long it takes to get from our area to the John Radcliffe Hospital in Oxford. Sadly, those data were not taken on board in any of the CCG’s reports, although the data set was bigger and better than the CCG’s. The CCG provided real data only when we had harangued, pestered and begged it to do so.

I will not go on about how worried I am; I will focus on what we can do to put the situation right. It is true, as all hon. Members have said, that local health providers do not talk to one another. Health Education England’s decision to remove training accreditation for middle-grade obstetricians was the straw that broke the camel’s back for recruitment, yet it remains aloof and makes decisions in a vacuum. Its recent decision to remove accreditation from certain grades of anaesthetists puts all the acute services provided by the Horton at risk. The dean did not communicate that decision to decision makers at the trust or the CCG; I had to tell them at a meeting in August. I do not think that that is an acceptable way to run a healthcare system.

The trust usually tells the CCG what to do. When it does not agree, there is stalemate. The trust, the clinicians and everyone else locally know that the A&E at the Horton cannot possibly be shut, because the knock-on effects on the rest of Oxfordshire and the surrounding counties would be catastrophic. The CCG, however, is determined to press ahead with its consultation that suggests otherwise. Owing to this impasse, we have ended up with a split consultation that means nothing to any of us. Patients’ needs appear to be an afterthought. South Central Ambulance Service, which bears the brunt of the transfers, is carried along as a consultee with no voice at the table when decisions are taken.

One of the main complaints is that local health decision makers do not listen to us. Our latest consultation report described the “universal concerns” of more than 10,000 people from my area who responded to our consultation. I cannot overemphasise the strength of local feeling. We all feel the same: all the elected representatives, of whatever party; a great campaigning group, Keep the Horton General; and even the local churches, which are praying for sense in the clinical commissioning group’s decision making. [Interruption.] My right hon. Friend the Member for Wantage (Mr Vaizey) laughs, but I am afraid it is impossible to overstate how essential our local hospital is to people in our area. He may think it is funny, but we do not.

[Mr Vaizey]

For the record, I am laughing because I have never heard of a church praying for sense from a clinical commissioning group. That highlights the parlous state that we find ourselves in.

--- Later in debate ---

[Victoria Prentis]

Quite.

At our last meeting, the trust’s chief executive told me that my fears about the Horton were “irrational”, but those fears are shared by the IRP—at least they were nine years ago, and I hope they still are—and by about 170,000 people who are served by the Horton. Rather than try to answer my questions, the chief executive simply dismissed them. I do not think that that is an acceptable way to behave.

We still do not know whether a father can transfer with a labouring mother from the midwife-led unit at the Horton. If not, how on earth is he supposed to get to north Oxford while she gives birth? We still do not know—although I have asked more often than I care to remember—whether the static ambulance will be stationed permanently at the Horton while all this is sorted out. As we have heard from all hon. Members, the CCG and the trust do not communicate with us elected representatives or with the general public, and often not even with each other. It has been left to me to organise public meetings locally. NHS Improvement was absolutely appalled when I showed it the pile of unanswered letters that I had written to the CCG and the trust. Hon. Members beyond the county boundary whose constituents use the Horton are completely overlooked.

Local health services may well be devolved to commissioners and providers, but if this is devolution, Minister, it is not working. The chief executive and the clinical lead of the CCG are leaving before the end of the year. I cannot pretend that I am unhappy about that—I have hardly been uncritical of how the CCG runs its affairs—but I have to say that I am not optimistic that the necessary changes will be made. The new clinical lead, whose appointment was announced yesterday, will be the former maternity lead. Although I will work with her, and I hope very much that she will engage with the issues we face, I am not optimistic. The CCG is hellbent on continuing the split consultation, despite various judicial reviews—I can tell it that there will be more to come, if necessary—and three referrals to the IRP, which presumably will not have changed its mind since nine years ago, particularly given the unprecedented growth in the town. Whoever takes on the CCG job is inheriting a poisoned chalice.

I am not going to give up, and nor are the constituents I represent. After all, I do not think that Banbury elected a bereaved mother with a passion for maternal safety, 20 years’ experience of judicial review and a 15-year background of voluntary work for the trust by accident. In 2008, local GPs were pivotal in the fight to save the Horton, but this time, poor leadership and an ever increasing workload—particularly given the town’s growth—have prevented them from being the vocal force that they once were. However, I have found allies in NHS Improvement, which has been investigating the trust, and in the Care Quality Commission, which can prosecute. I look forward to working further with those allies.

If help with recruitment is the answer, we need the Department to step in. Salary supplements for trainee GPs are really welcome, not just for rural or coastal areas but for market towns that face unprecedented growth. The catchment is predicted to increase from 170,000 to 207,000. We really need obstetricians. The district council has made sensible suggestions for developing and improving the Horton site; I just wish the CCG and the trust would look at them. They were included in the response to the consultation—I also made a very extensive response—but when I mentioned them at the last meeting in August, none of this had registered with the decision makers. I do wonder about the depth and quality of the work they do.

I know that the Horton has a future as a provider of acute services. I am sorry to use the language of war, but I welcome the sight of my hon. Friend the Member for Witney defending my right flank, as he so often does. Ever since he was elected, he has been a real ally and friend in this fight. We in Banbury are most grateful to him for all his work and for securing this debate. I also welcome the support of my right hon. Friend the Member for South Northamptonshire (Andrea Leadsom) and my right hon. and learned Friend the Member for Kenilworth and Southam (Jeremy Wright), who are both in Cabinet this morning but will be interested in this debate. They both feel as we do about our hospital in Banbury. My hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi) was present earlier; his district council has been a great ally, has brought one of the judicial reviews, and continues to support us—even though, as far as I can tell, it is not consulted about anything by the Oxfordshire CCG. I really feel that we are beleaguered, so it is lovely to see hon. Members appearing like battalions, with patients and GPs in their wake, to support all of us who use the Horton General Hospital.

We are not irrational, but we are passionate. We want a reasoned and evidence-based conversation about the future. We are very, very determined, so I am afraid everyone in this Chamber will have to listen to this speech many, many more times.

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Roger. I begin by thanking the hon. Member for Witney (Robert Courts) for securing a debate on this important subject. It gives us an opportunity to discuss a subject that I would suggest goes beyond Oxfordshire.

Forgive me if I am not as familiar with the healthcare scene in Oxfordshire as many of the hon. Members who have spoken today, but I have listened closely and what they have described resonates with similar situations across the country. I applaud their commitment and dedication on behalf of their constituents, which, by the sound of things, are quite justifiable. It is clear from what hon. Members have said that the people of Oxfordshire seem to be very unhappy about the proposals, and my research shows me that perhaps they have good reason to be.

The proposed changes will mean less hospital beds; changes to acute stroke services; changes to care at the Horton General Hospital, as the hon. Member for Banbury (Victoria Prentis) has just explained to us in great detail; changes to critical care; changes to maternity services; and changes to the special baby care services. I gather that there has been lots of vociferous opposition to these proposals on the ground, which has been reflected in hon. Members’ comments today. I understand that local people have said in a petition that they believe these proposed changes will lead to poor services, a cheaper service, overcrowding and long waits. I particularly noted what a local A&E doctor said about the process way back in August:

“This is just awful. Working in A&E is particularly difficult, and has been all year. We often have significant nursing and medical rota gaps, and long waiting times. Despite it being August, every shift has patients on trolleys in the corridor, with the time waiting for a bed over 12 hours…We are not coping”.

I also note that there is a proposal to reduce the number of hospital beds in the first instance by 110 further beds. Clearly, no one is listening to the NHS staff there in Oxfordshire.

Oxford City Council has also expressed its concerns and has quite rightly commented on the lack of a workforce plan. Interestingly, however, it also said that it understands the position that the clinical commissioning group finds itself in. We have heard a lot of criticisms of the CCG this morning and it has obviously been remiss in its consultation process. However, the council says it understands that the CCG is up against national policy.

That point is very important, because what we have heard this morning is not only a problem that affects Oxfordshire. The hon. Member for Witney spoke about his constituency being one of the few that still has snow. My constituency, too, still has snow—lots of it—and we also have in common a great dissatisfaction with the health services that we are receiving, particularly as we look forward, or maybe dread, the introduction of the sustainability and transformation plans.

At this stage, we have a national health service, and the changes that we have heard about this morning are Oxfordshire’s response as part of the STP group that takes into account Buckinghamshire, Oxfordshire and west Berkshire. The STP ordered by Government is one of the 44 they have ordered. In total, those STPs will look to save the NHS £22 billion and the share of the savings that have to be made by Oxfordshire, Buckinghamshire and west Berkshire is £480 million. That, I would suggest, is at the root of the changes.

[Victoria Prentis]

I accept that I could not possibly expect the hon. Lady, coming from Burnley as she does, to have the encyclopaedic knowledge of Oxfordshire health services that, sadly, we Oxfordshire MPs have to, but the changes to the Horton General Hospital apparently stem from recruitment—the inability to recruit obstetricians—and not a lack of money. Indeed, the changes started when the STP was just a twinkle in someone’s eye, so the situation is slightly more nuanced.

[Julie Cooper]

I note the hon. Lady’s points, and there is another issue we could talk about. Our NHS has a crisis on three fronts—a funding crisis, a workforce crisis and a systemic crisis—and I think that is what we are looking at today: some of the systemic problems.

Going forward, £480 million has to be saved. This is not something that the CCG has decided to do, and it does not matter how transparent the consultation is—it sounds like it needs to up its game on that—because it still has to make its share of that saving.

As for the national health service, I note with absolute horror that, when it comes to the percentage of GDP that we spend on our NHS, we are well down the league—indeed, we are close to the bottom—compared with nations that we would expect to be up there with. We are behind France, Germany, Canada, Switzerland, Denmark, Belgium, New Zealand, Portugal and Japan—I do not have time to list them all, but we are well down the list.

The hon. Member for Henley (John Howell) quite rightly mentioned the issue of beds and how it is not really a bad issue—people ought to receive care at home where possible. I totally support that; the problem is that the cart is being put before the horse. The care, including social care, is not there in the first instance to allow us to reduce hospital beds and provide the excellent care in the community that we all want to see. When it comes to the number of hospital beds per head of population, we are again close to the bottom of the league.

For obvious reasons, healthcare in the modern NHS is delivered in a different way. In all comparable nations, the number of hospital beds has reduced, but nowhere near to the extent that it has been reduced in England. I particularly note with horror the reduction in maternity beds and mental health beds. There has been a lot of talk about standing up for the mentally ill, but beds in mental health care have actually been reduced by over 90%. That is very worrying when we all see that the necessary care is not there in the community. In fact, Oxfordshire County Council has said it is worried that there would be no impact assessment of some of the proposed changes. How was the community going to cope? Were the services in place in the community to provide support when, for example, hospital beds were removed? The council was not convinced that that was the case.

So, we are bottom of the league on spending as a percentage of GDP and close to the bottom—we are just bumping along the bottom—on hospital beds.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a pleasure to speak under your chairmanship, Sir Roger. I congratulate my hon. Friend the Member for Witney (Robert Courts) on securing the debate and on the manner in which he spoke. I share the admiration of my right hon. Friend the Member for Wantage (Mr Vaizey) of the forensic skills he has brought here from a former life, and I feel somewhat fortunate that I am sitting on the same side of the Chamber as he is.

We have heard many powerful contributions about the strength of feeling in Oxfordshire from its many impressive elected representatives, and about how a large number of the service changes that are under consideration in the county have suffered from a lack of engagement, with the clinical commissioning group in particular failing to explain to local residents the purpose of and the objectives behind the changes. I take that on board, as something that needs to improve, and I will come back to it at the end of my remarks.

It is very clear, from the Government and the Department of Health, through the NHS leadership, that all proposed service changes should be based on clear evidence that they will deliver better outcomes for patients. That is at the heart of why service change is proposed. We have made an explicit commitment to the public that all proposed service changes should meet four tests. Just to rehearse them, they are that they should have support from GP commissioners, be based on clinical evidence, consider patient choice and, most specifically for the purposes of this debate, demonstrate public and patient engagement. In the case of the service change proposals that have been made thus far in Oxfordshire, when they are capable of coming to us for determination, for ministerial decision making on appeal, my colleague the Secretary of State and I are placed in some difficulty, because we need to remain impartial and consider the issues on their merits. I am sure that my hon. Friend the Member for Witney and other colleagues will therefore appreciate that I am unable to offer opinions on the merits of the proposals from the two transformation consultations, whether actual or anticipated.

We recognise that Oxfordshire, like many areas across England, faces unprecedented demand for its services. We are all aware of the growing number of older people, many of whom are living with more complex, chronic conditions, partially thanks to the success of the NHS in keeping people going for longer, but we have also heard from a number of colleagues that Oxfordshire faces particular population pressures, with welcome increases in house building planned for the coming decades. In addition, as my hon. Friend the Member for Banbury (Victoria Prentis) said when she intervened on the Opposition spokesman, the hon. Member for Burnley (Julie Cooper), there are particular challenges in recruiting high-quality NHS staff into many of our facilities, not just in rural and coastal areas but across the country. We accept that, and are looking to increase the numbers of medical and nursing staff being trained. There was an unprecedented 25% increase in doctors in training, announced last year by the Secretary of State, and earlier this month a record increase of 25% in the number of nurses in training was announced for the next two years. Those are all reasons why the Oxfordshire transformation programme has been reviewing the model of care to ensure that future health service provision in the county is clinically and financially sustainable.

My hon. Friend the Member for Witney began his remarks by referring to the closure of the Deer Park medical practice in Witney. I will not go into the full history, but he acknowledged that the closure took place in March this year. In the previous December, a judicial review had been requested and, as my hon. Friend pointed out, this was the first time in recent years that such a thing had happened to a primary care facility. The judge who heard the case refused permission to bring it for judicial review, and it was therefore passed to the independent review panel in March of this year. The panel concluded that the referral was not suitable for full review because further local action could address the issues raised.

The Secretary of State considered and accepted the recommendations—some of which my hon. Friend the Member for Witney read out—and the Oxfordshire CCG is now working to address them. Foremost among the recommendations was that all former patients of Deer Park medical practice should be registered at an alternative practice as soon as possible. My understanding is that, of the 4,400 patients who were registered with the practice, more than 4,000 had been reregistered, as of mid-September, and that the CCG is acting to encourage the remaining 400 patients to register at one of the three other GP practices in and around Witney, whose lists remain open so that patients can register at a practice of their choice, as long as they live within its catchment area. I believe that a further letter will be sent out to all those remaining patients, to encourage them to register with another GP.

The second key recommendation, which my hon. Friend the Member for Witney also referred to, was that a primary care framework be developed to provide direction for a sustainable GP service in Witney and the surrounding area. That is at the crux of his concern about the way in which the CCG engages. I happen to have a copy of its locality place-based plan for primary care, and I note that the consultation on how primary care services should be developed for west Oxfordshire opened last week. I strongly encourage my hon. Friend to engage with the CCG and to encourage his residents to do so, so that it learns from the lessons of the Deer Park lack of consultation and, in devising services for the future, fully takes into account local residents’ concerns. I believe that the consultation period is six weeks and is due to conclude at the end of November. A common theme in colleagues’ contributions today has been that lack of engagement, as they see it, with the local CCG.

My hon. Friend the Member for Banbury raised again today her historic championing of the cause of Horton General, which clearly goes beyond primary care into secondary care. She gave us another history lesson. She has been campaigning on this issue since she was seven years old, and I think she could probably trump any Member who wanted to stand up and say that they had been consistently campaigning on any issue since a young age. Having said that, I suspect that one or two older Members have been campaigning on the same issues for longer, but certainly not from such a young age.

My hon. Friend referred to the temporary suspension last October of the obstetric-led service in the Horton because of the difficulties in recruiting doctors and midwives. It has temporarily become a midwife-led unit. As she also pointed out, at a public board meeting this August, the CCG accepted recommendations following consultation. [Interruption.] She may regard that as inadequate, but there has been some consultation. Those recommendations include one to centralise Oxfordshire’s obstetric facilities in the John Radcliffe Hospital and one to make the midwife-led unit at Horton General a permanent establishment. As she has pointed out, that decision is subject to judicial review and referral to the Secretary of State, so no action will be taken to make that recommendation permanent until the referral process has run its course.

My hon. Friend has referred to a number of the challenges posed for local residents and for pregnant women in labour in getting access to Horton General. I have taken note of the comments made by her and other Members on the reliance on Google Maps to determine travel times. I understand that the CCG has undertaken an extensive travel survey. If a mother is in labour and is in an ambulance, she has the benefit of the blue light service to get through the traffic. That can mean a more rapid journey time than ordinary residents would expect or experience.

[Victoria Prentis]

I am so grateful to the Minister for giving way and for the comments he is making. Most people who go to hospital while in the later stages of labour to have a baby are not in an ambulance. The ambulance times relate only to transfers from the midwife-led unit to the Radcliffe. Although a significant number of the people who give birth in the MLU have to transfer during or immediately after labour—we are told that it is up to 40%—that is nothing compared with the vast majority of women, who travel in a private car, if they are lucky enough to have one.

[Mr Dunne]

Indeed, I recognise that. If we are moving to an obstetric-led service at the John Radcliffe, any mother who is high-risk or is expected to give birth will have time to travel in good order, rather than in an emergency. I accept that emergency transfers do take place from midwife-led units during the course of labour.

I have heard the criticism about the overall transformation programme for Oxfordshire being divided into two phases. At this point, we are where we are. The first phase has come to a conclusion, and we are entering the second phase. I recognise some of the criticisms that it is hard to comprehend a coherent system without seeing it all laid out together.

Baby Loss Awareness Week

Victoria Prentis Excerpts

Tuesday 10th October 2017 Commons Chamber

[Victoria Prentis (Banbury) (Con)]

Thank you for calling me, Mr Deputy Speaker, although I have to say it is not a pleasure to speak in today’s debate. It is absolute torture for many of the speakers who have chosen to share their experiences with the House. It is, however, a pleasure to follow the extremely knowledgeable speech, as ever, of the hon. Member for Central Ayrshire (Dr Whitford). It is so good to hear the good news from Scotland about the real developments that have come from investigation into what happens when things go wrong.

I am most grateful to business managers—even if I am quite close to some of them—for allocating time during Baby Loss Awareness Week, and to all those who organised the extension of today’s sitting. It is a testament to the way the House has changed. I am grateful that you, Mr Deputy Speaker, have chosen to be in the Chair after your traumatic experiences last year listening to us. We are most grateful to all those who have enabled this debate.

It is fair to say that maternal safety keeps me awake at night. Issues with the maternity unit at Horton General Hospital in my constituency sadly continue. It is good to see my hon. Friend the Member for Witney (Robert Courts) in his place. I do not know what keeps him awake at night. Indeed, I do not know whether he is kept awake at night. If he is, I suspect his young son probably has something to do with it, but I also know that he worries as much as I do about the future of the unit. The uncertainty goes on. My hon. Friend, other campaigners and I are not giving in. I remain convinced that the current situation is unsafe. Significant numbers of transfers are taking place during labour. Babies have been born at the side of the road and in ambulances. Mothers and their babies are not getting the sort of care that is safe, kind and close to home, which is what everybody in the Chamber wills them to get.

Out of this morass sadly comes some dreadful casework. I have noticed that when something goes wrong, the shutters come down in the health service. Hospitals are on the defensive from the beginning and legal teams are called in. In one of the saddest cases I have had to deal with over the past year, Oxford University Hospitals NHS Foundation Trust responded by saying that it would not meet me or the family in question without legal representation. My attempts to ensure that there was a full and external review of the case by MBRRACE-UK, for example, were stalled for months. This is simply not acceptable. Families, along with most of us, are motivated by a burning desire to ensure that what happened to us will not happen again. They are not interested in compensation except where that is necessary for looking after a desperately sick child. They are motivated by change in practice.

Sir Charles Pollard, the former chief constable of Thames Valley police, has been working tirelessly on producing restorative solutions in the justice sector—that is my background—and increasingly in the health sector, where the needs of all parties, including families, doctors and staff, are crucial. Constructive conversations can be had in carefully controlled environments. I think, particularly after having a lengthy conversation with my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), that it is important to find a new language. We do not want to apportion blame to anyone in any way, unlike in the justice sector. Finding a new language would be good for families and for staff, who are often traumatised by a loss on their watch.

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

There have been some exceptional speeches on this sensitive issue. I am not sure whether my hon. Friend is aware that my private Member’s Bill—the Civil Partnerships, Marriages and Deaths (Registration Etc.) Bill—includes a clause to give coroners the power to investigate late-term stillbirths. Extraordinarily, that is currently not available to them. Many parents who have gone through difficult stillbirths where the circumstances are unclear would like an independent assessment of what went wrong so that everybody can learn from the situation. I am sure my hon. Friend will support that.

[Victoria Prentis]

I will most certainly support that.

The hon. Member for North Ayrshire and Arran (Patricia Gibson) made an excellent speech in which she mentioned inquests and fatal accident inquiries. I do not know why so many of us involved in this debate are lawyers; it is very strange. These are, of course, very sensitive legal issues. We are talking about when a person becomes a person—things that we have not spoken about in places such as Parliament or the courts, and perhaps should have done, over the years. We have allowed a body of law to grow up that does not fit current requirements. Even though restorative solutions are great, inquests may also be appropriate and may also act restoratively. They do not have to be legalistic. They can be inquisitive, which is why inquests came into being. Inquests and, in Scotland, fatal accidents inquiries, have an important part to play in preventing stillbirths and neonatal deaths.

Today is World Mental Health Day, so it is particularly appropriate that we are talking about the bereavement care pathway in Baby Loss Awareness Week. As we have heard from other hon. Members, the pathway is very good in places but variable in others. We are making progress but we need to do more to ensure consistency, and I know the Minister is on top of this. The Care Quality Commission does not currently ask sufficiently in-depth questions about the quality of bereavement care on offer, but I am encouraged by the constructive conversations I have had with it on behalf of the all-party parliamentary group on baby loss recently and am hopeful that we will have real progress to report this time next year.

I would like to end on a high. Petals opened its new bereavement counselling service in Banbury yesterday, in the Horton General Hospital, and I was very pleased to be there. It offers bereaved families six sessions per couple. That might not be enough, and it certainly might not be appropriate for mothers and fathers to be seen together, but the evidence shows that what it does is of very real value and that its outcomes are valuable and beneficial to the couples who use its service. Lots of charities do similar work, as is clear from our well-attended APPG meetings.

We might not enjoy these debates, but they have begun to change both perceptions and the law, and I am grateful to the Minister and the previous Member for Ipswich for all their work. I would like to finish by congratulating us all.

--- Later in debate ---

[Antoinette Sandbach (Eddisbury) (Con)]

It a pleasure to follow the hon. Member for Nottingham South (Lilian Greenwood). I know exactly how Jack and Sarah feel, because it was the burning desire to see change that motivated me and many others in the all-party parliamentary group on baby loss to work not only to reduce the number of neonatal deaths and stillbirths, but to consider how we can improve things for parents.

When we set up the APPG, saying that we wanted to achieve huge cuts in the number of families affected by all these issues and to put in place a bereavement care pathway seemed to be setting rather a large challenge. I pay enormous tribute not only to Members of this House—it has been a cross-party effort—but to parents and health professionals, who have risen to the challenge set by the APPG and the Department of Health. In a way, I can provide some comfort to a number of Members who have spoken today about miscarriage, for example, because the national bereavement care pathway, which was launched yesterday, in effect addresses loss from conception to up to one year post-birth. That is quite groundbreaking in a number of ways. Pilot schemes in 11 hospital trusts are developing specific pathways to address early miscarriage, late miscarriage and stillbirth, and for those in the very unfortunate situation of having to terminate because of foetal abnormality. I have been encouraged by the willingness of parents to come forward and talk about their experiences as part of the development of these pathways and to share their loss with medical professionals, including the Royal College of Obstetricians and Gynaecologists, and the Royal College of Midwives. There has absolutely been cross-working and buy-in for this change.

I am encouraged that the change is being supported by the Department of Health. Pilots are taking place so that lessons can be learned, with the outcome of those lessons applied before things are rolled out more widely and nationally. As somebody who sat in a room with white walls and a sofa that was not anything like a bereavement suite, I know at first hand, as do so many parents who have not been in such facilities, that when one visits a hospital such as Medway Maritime Hospital, which has the most extraordinary facilities, one can see that change is coming. The improvement and change in the past year has, to my mind, been something that I and many professionals did not imagine would happen as quickly as it has and in the way that it has.

I would absolutely support the hon. Member for Nottingham South if she proposed a ten-minute rule Bill to try to effect the change in coronial law that she spoke about. I myself will introduce a ten-minute rule Bill tomorrow on the regulation of foetal dopplers. I will expand on that point tomorrow, but the false reassurance they provide to parents can increase the risk of stillbirth. I know that my hon. Friend the Member for Colchester (Will Quince) put forward a Bill in the last Parliament that has now been taken up by my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake), and it is due to have its Second Reading on 20 October. There are therefore methods to effect change in this Parliament, and I know that the hon. Member for Nottingham South would find great support in the House for her constituents if she tried to effect the change that they propose. I know that I will be trying to get the Minister’s support tomorrow on the subject of foetal dopplers.

This is Parliament at its best. We are listening to constituents. We understand where there has been a failure in the system, and there is no doubt that the statistics show we need to make changes in this area. I am delighted that the Government have accepted that quickly and have therefore set ambitious targets. The chief executive of my local hospital, the Leighton Hospital, which has an award-winning maternity unit, was able to say to me that they had had 14 fewer deaths this year. That means 14 fewer families in my local areas going through the loss that so many in this House and outside it have seen. At the same time, I should say that the Countess of Chester Hospital is under investigation in relation to 15 baby deaths. There are concerns about care in relation to eight of them. So the perinatal mortality tool is crucial, as is the investigation of these incidents, in order that those lessons are learned, that good practice is shared and that professionals are honest with parents where something has gone wrong; they need to admit that and learn from it so that it does not affect other families. Let us get that open culture; the Health Secretary has talked openly about the need for no-fault investigation, and the need to learn from that culture is incredibly important. The hon. Member for Ellesmere Port and Neston (Justin Madders), who speaks for the Opposition on this matter, will know of the particular importance of that, because the Countess of Chester serves his area too and this directly affects all our constituents.

I say to the Minister that the huge progress that has been made is encouraging. The charities and colleges yesterday spoke about the great enthusiasm and drive that has come from working collaboratively together. If we can take that and use it, the progress we are starting to make can carry on. We can roll it out into the difficult areas. We know that they exist, so let me mention just two. First, we know that there are big issues in respect of minority ethnic groups that go beyond the hospital setting, often relating to factors in the environment. Those issues fall outside the Department of Health’s remit, but wider working will need to be done to examine how those factors can be addressed and whether or not public health issues arise in their regard.

The second area involves general practitioners. I sent out a freedom of information request to every clinical commissioning group in England, and less than 50% of them provide any form of bereavement counselling, whatever the death. So even not in relation to child loss, a lot of CCGs simply are not commissioning support in the community. Those CCGs have relied on provision from the acute sector, and the next piece of work from the all-party group will need to be on how we take the lessons learned from the acute sector into the primary care sector, because that will end up benefiting not just those who have lost a child, but those who have suffered a loss.

[Victoria Prentis]

The other sector that provides so much of the bereavement care, such as the service I helped open yesterday, is of course the charitable sector. Would my hon. Friend like to comment on whether CCGs should be encouraged to join that sector in funding bereavement counselling, such as that provided by Petals, in the future?

[Antoinette Sandbach]

My hon. Friend makes a good point, and she can probably guess that the reason for my freedom of information request was to put pressure on not only my local services, but services more widely. There is expertise out there that we can build on, but bereavement touches everybody and this Government’s focus on mental health gives us a real opportunity to approach death in a way that minimises its mental health impacts, which can be severe. We can roll out elsewhere the way in which the Department of Health is leading on baby loss and working together with the third sector. This year’s Baby Loss Awareness Week therefore perhaps has a message of hope that has not been present in the past two such debates we have had.

Oral Answers to Questions

Victoria Prentis Excerpts

Tuesday 4th July 2017 Commons Chamber

[Mr Hunt]

The hon. Gentleman is right to say that it is time we had more medical schools, given that health and social care will be one of the fastest-expanding areas of the economy in the coming years. I think the Prime Minister was absolutely right to say that there should be no scaremongering about important local plans that will improve services for patients.

[Victoria Prentis (Banbury) (Con)]

Will the Secretary of State reassure my constituents that the component parts of the NHS can communicate with each other sufficiently to ensure that decisions such as the one by a medical dean to remove accreditation for anaesthetic training will not lead to the closure of A&E departments in hospitals such as Houghton general, where my father was treated so well last Friday?

[Mr Speaker]

The hon. Lady’s father is a splendid fellow, and he is now in another place. [Laughter.] I was referring to another House of Parliament.

Health and Social Care

Victoria Prentis Excerpts

Monday 27th February 2017 Commons Chamber

[Dr Wollaston]

I absolutely agree with my hon. Friend and neighbour. As she will know, in our area, we are seeing not only the closure of four much-loved community hospitals, but, on top of those 44 beds lost from community hospitals, the local trust wanting to cut 32 acute beds, at a time when its bed occupancy is already running between 92% to 94%. Unless we have that double running and the communities can genuinely see the change, those plans will be seriously undermined. Too often, the NHS plans for hoped-for demand, rather than actual demand.

[Victoria Prentis (Banbury) (Con)]

I thank my hon. Friend for listening to me on a number of occasions when I have been worried about the situation in Horton general hospital. She has been kind enough to talk me through some options. One of the difficulties with the consultation process is that lay people—of whom I am one—are not given sufficient evidence to enable them fully to engage with the system and to have trust in the trusts that are seeking to engage them.

[Dr Wollaston]

My hon. Friend is absolutely right. It is important that the evidence is available not just to us, but to the local communities. There should also be a sense that consultations are a genuine process. As I have said, it is about the co-design of new services. Time and again, we have reports from the NHS that demonstrate that co-producing new services results in a much better service in the long run, so I thank her for her point.

We are talking about the cuts not only to the trusts, but to the clinical commissioning groups. What we are seeing now is that CCGs are being asked to hold back £800 million of their budgets to offset deficits in trusts. Again, this is about patient care that is being cut back. Alongside that, we have seen cuts to Public Health England and to Health Education England. The idea that we have an NHS that is on a sustainable footing is, I am afraid, simply not the case. I ask Ministers to be realistic about the current position, and I ask our Chancellor, in his forthcoming Budget, to address this matter by urgently giving a lifeline to social care, because that will benefit not just social care, but the NHS. In addition to announcing that lifeline, which I hope he can do by bringing forward the better care fund with new money rather than a transfer from the NHS, I hope that he will promise a genuine review of sustainable future funding covering both health and social care. I call on Members from across the House to agree that, rather than our having the usual confrontational debates, we should see this as a generational challenge that will face whichever party is in power over the coming years. We should all work together, for the benefit of our constituents, to produce a sustainable future for the NHS and social care.

NHS and Social Care Funding

Victoria Prentis Excerpts

Wednesday 11th January 2017 Commons Chamber

[Dr Whitford]

The whole idea of STPs is to go back to areas. We simply have geographical health boards—the only layer we have—so we are not wasting huge amounts of money on having layers and layers, which could be integrated. For an STP to work it must make sense geographically, which might be a county or something bigger or smaller. I think that they should be put on a statutory footing. We have 211 CCGs. There will be an average of six CCGs for every STP, so that is a waste of layers, and it will be very difficult to integrate.

One of the biggest differences is that, in 2004, we got rid of the purchaser-provider split. In the past 25 years, there has been no evidence of any clinical benefit from the purchaser-provider split, the internal market or, as it now is, the external market. It is estimated that the costs of running that market are between £5 billion and £10 billion a year. That money does not actually go to healthcare, but on bidding, tendering, administration or profits. We cannot have an overnight change, but if we simply made a principled decision to work our way back to having the NHS as the main provider of public health treatment and to integrate care through the STPs, we could reach a point of sustainability.

As I said earlier, we must protect things such as community hospitals and community services and, indeed, invest in them. Our health board has rebuilt three cottage hospitals as modern hospitals, because that is where we should put an older person who is on their own and has a chest infection, who just needs a few days of antibiotics, TLC and decent feeding. We do not want them in big acute hospitals; we want them to be close to home. The danger is that under the STPs people will see community hospitals as easy to get rid of, but that is an efficiency saving only if it gets rid of inefficiency. If we slash and burn, we will end up spending more money in the end.

[Victoria Prentis (Banbury) (Con)]

Much of what the hon. Lady says is music to my ears as somebody who is campaigning to save their local general hospital. May we have the benefit of her views on the role of consultation with patients and the wider community when sustainability and transformation plans are being considered?

[Dr Whitford]

Public consultation is important, and not just in the way it has often been done in the past—“We’ve made a decision, it’s a fait accompli, and we’re coming and telling you about it.” Unfortunately, that is very much what we have heard about the STP process, partly because it has been so short and partly, I am afraid, because it is about budget-centred care, not patient-centred care. Areas have been given a number and told, “If you’re not reaching this number, don’t bother submitting your plan,” and they are working back from that. That will not achieve an efficient, integrated service, so the public must be involved.

Frontline clinicians must also be involved. They work in a service and know exactly what the bottlenecks are and exactly what horseshoe nail is missing and holding a service back. If we have clinician-led redesign, such as I was involved in for breast cancer in my health board 17 years ago, we can track a patient’s path. We can quickly imagine ourselves as a patient, see the bottlenecks and focus investment on them.

I read an article yesterday stating that three hospitals in Manchester have spent £6 million on management consultants to say, “Shut a ward, sack hundreds of people and jack up the parking charges.” I am sorry, but that was not good value for £2 million each.

Baby Loss

Victoria Prentis Excerpts

Thursday 13th October 2016 Commons Chamber

[Victoria Prentis (Banbury) (Con)]

What an honour it is to follow that speech by the hon. Member for Kingston upon Hull North (Diana Johnson). She and I have worked closely together over the last year on difficulties relating to infant cremations, and I very much listened with interest to what she had to say.

When my son died, I was told by our consultant that, one day, it would be possible to put my grief in a box and open the box only when it suited me. Obviously, at the time, I thought she was completely insane; now I realise it is possible to have an element of control over lifting the lid in public—although it is not one I have exercised particularly well today.

Over the years, I have talked about my experiences to raise money for charities, including mental health charities, and I have learned that nothing opens those wallets quicker than a few tears. I have also trained hundreds of midwives for Action on Pre-eclampsia; midwives are fairly used to emotional mothers, so the lid can be fully lifted with them around.

It is an honour to be vice-chair of the all-party group and to have been there at its conception one very late night in the Tea Room. We have well and truly lifted the lid this week in Parliament, which is an achievement in itself. However, just as importantly, we have succeeded in enlisting Health and MOJ Ministers—certainly to date—to our cause. The emotion of the Secretary of State for Health was obvious to all yesterday, and I was pleased to see him here earlier in the debate. The charitable fundraiser in me did wonder whether, next year, we should ask a well-known tissue manufacturer to sponsor baby loss awareness week in Parliament.

In brief, my story is that, following two miscarriages, I developed severe pre-eclampsia and HELLP—hemolysis, elevated liver enzymes and low platelet count—syndrome during my third pregnancy 16 years ago. My son died soon after he was born, and for some time it was not at all clear whether I would survive. To put that in context, my father was slipped from this place at a time of enormous difficulty for the Government, which shows that my condition was clearly very serious. I went on to have two more children, now aged 15 and 13.

With your permission, Mr Deputy Speaker, I would like to touch first on learning points from my own experience and then on some of the work the all-party group has done this year, and finally to make some general points about maternity care going forward.

The learning points from my own experience are out of date, but, sadly, not all of these things have been put right—in fact, most have not. Obviously, physical care comes first where maternal and baby death is a real possibility. However, someone needs to be tasked with the mental care of the whole family, because the death of a baby, as we have heard, leaves deep scars in so many of his or her relations. Memories, clothes and photos make a real difference later, however much they seem like fripperies at the time. Putting bereaved mothers in with live babies is simply not on, however ill they are. Explaining what is going on all the time is critical, and it may need to be done many times to different family members. Medical conditions have to be understood by those who are suffering.

Midwives, as my hon. Friend the Member for Eddisbury (Antoinette Sandbach) said, need considerably more than one hour of bereavement training. They also need training on how to have grown-up conversations on things such as lactation—conversations which were utterly lacking, in my experience. In fact, training all obstetric staff is important, as so many parents go on to have more children. GPs, who are often the first port of call, and other health workers, also need to be aware of the very long-term effects of baby loss.

It is difficult to go back to hospital with whatever condition in the future, let alone one to do with pregnancy. Where possible, parents should not have to tell and re-tell their story at every appointment. HELLP syndrome, which I suffered from, leads to multiple organ failure. I am not a doctor, and I do not really understand what is wrong with me, but if I go to the doctor with a minor condition, I have to go through the whole blinking story again. It would be easy to have a simple flag on my notes so that every time I have my blood pressure taken, for whatever reason, I do not have to re-tell everything.

Fathers, as my hon. Friend the Member for Colchester (Will Quince) mentioned, get ignored. We need proper evidence of the effects on relationships of babies dying. We have some evidence, which he touched on, but it is not broad enough or good enough. Let me read from an article about stillbirth in The Lancet this January:

“Fathers reported feeling unacknowledged as a legitimately grieving parent. The burden of these men keeping feelings to themselves increased the risk of chronic grief. Differences in the grieving process between parents can lead to incongruent grief, which was reported to cause serious relationship issues”.

The effects on grandparents should also be considered. My parents had to cope with the loss of their grandchild and the near loss of their daughter.

Access to mental health provision must be standardised, and good practice copied. According to Bliss, 40% of parents of premature babies need some mental health intervention. I would suggest that every one of those whose babies die needs at least an assessment. Relationship counselling should also be offered as part of an automatic deal, although I do not know at what stage that would be beneficial. At the very least, we need evidence on the effects of baby loss on relationships.

The all-party group is made up of individuals with different experiences and talents. My hon. Friend the Member for Colchester is excellent on parental leave. My hon. Friend the Member for Eddisbury knows more than all others about pathways of care. My role this year has, sadly, been dealing with the issue of infant cremations, not least because of a constituency case I had. I am aware that the Minister is not the Minister who should respond on infant cremation, but it is important that we have a cross-departmental and joined-up approach to the issue, and I would welcome it if he could intervene or at least speak to the MOJ about it.

[Bob Stewart (Beckenham) (Con)]

I have been horrified in listening to this debate. I have never lost a baby in my family, but I am horrified and upset. Surely for a mother who gives birth to a child, stillborn or not, that is her baby or the family’s baby, and surely she and the father should have absolute rights about what happens with the cremation and thereafter. I am absolutely horrified that they do not do so at the moment.

[Victoria Prentis]

I thank my hon. Friend for his helpful intervention.

We in the all-party group welcome the MOJ’s consultation and the subsequent response, which was published just before the summer. It seems that we are—I really hope we are—on the cusp of making some very important changes in this area. I ask that we push for these changes to happen speedily, because they are really important.

[The Minister of State, Department of Health (Mr Philip Dunne)]

I am very grateful to my hon. Friend for letting me intervene during her impressive and important speech. On the back of that comment, I want to inform the House that my colleague the Under-Secretary of State for Justice, my hon. Friend the Member for Bracknell (Dr Lee), announced last month the formation of a national cremation working group. It is now working with all interested parties, and it intends to take evidence from Members of the House. I strongly encourage all hon. Members with such an interest to participate.

[Victoria Prentis]

I very much thank the Minister for that intervention. We in the all-party group were thrilled about the formation of that group.

In that contest, may I give the House a few more examples from the response of the MOJ that we feel are particularly important to take forward speedily? We hope that the MOJ will provide a statutory definition of ashes to make it clear that everything cremated with a baby, including personal items and clothing, must be recovered. We hope that the MOJ will amend cremation application forms to make explicit the applicant’s wishes in relation to ashes that are recovered. Crucially—I know this point is very important for many Members in the Chamber—we hope that the cremation of foetuses of fewer than 24 weeks’ gestation can be brought within the scope of the regulation, where parents wish that to happen. There is some positive news in this very sensitive area.

Moving on to the future of maternity services more generally, my overriding constituency concern at the moment is the future of the Horton general hospital. In fact, if I am honest, it occupies most of my waking moments, and my children complained during our summer holiday in August that I cannot formulate a sentence without the word “Horton” in it, which I fear is true. This summer, I found the lid repeatedly lifted on my own experiences, as we have real safety concerns about the downgrading of our obstetrics unit at the Horton general hospital.

Since last week, a midwife-led unit remains at the Horton general hospital, but all mothers who might—might, not necessarily will—need obstetric care, which is of course the majority of them, have to go under their own steam or be transferred as an emergency to the John Radcliffe hospital in Oxford. In a blue-light ambulance, that journey of between 22 and 27 miles, depending on the route taken, takes about 45 minutes. If my labouring mothers travel in their own car—of course, not all of them have one—the journey can easily take up to an hour and a half, depending on where they live and on the state of the Oxford traffic. The decision to downgrade the service was taken on safety grounds, as the trust had failed to recruit enough obstetricians, but I must say that I have severe safety concerns for the mothers and babies in our area. In 2008, an Independent Reconfiguration Panel report concluded that the distance was too far for our unit to be downgraded. As I see it, nothing has changed except that the Oxford traffic has worsened. I am keen, generally, that we start to be kinder to mothers during pregnancy and birth, and in my view, that does not mean encouraging them to labour in the back of the car on the A34.

We know that personal care leads to better outcomes. We need to take very careful note of Baroness Cumberlege’s recommendations in her “Better Births” report. She said that births should

“become safer, more personalised, kinder, professional and more family friendly”.

We must use the impetus of events such as this week to drive through her major recommendations.

Chief among these recommendations must be the recommendation for continuity not of care but of the carer, which has been shown to reduce premature deaths by 24%. Professor Lesley Regan, recently elected the first woman president of the Royal College of Obstetricians and Gynaecologists for 64 years, has done a plethora of well-evidenced research on miscarriage, demonstrating again and again that a system of reassurance and continuity, with weekly scans and meetings with a midwife, has reduced the rate of recurrent miscarriage by 80%. That figure of 80% is for women who have miscarried three or four times.

My hon. Friend the Member for Eddisbury mentioned the excellent work being done at Queen Charlotte’s as well. In this context, I am troubled that the sustainability and transformation plans might push us towards larger and larger units with less personal care. I may be wrong— I hope I am—and perhaps it is safer for such giant units to deliver the majority of babies, but I worry that in our case in Banbury decisions are being taken about my constituents without their views being considered and without real evidence of the risks involved.

Everyone in the House today is clearly committed to reducing baby loss, and I have never heard such emotion in a debate. We have evidenced-based research to show us how, in part, to do that. I refer the Minister very firmly to Baroness Cumberlege’s report. Yes, better bereavement care is important. Sadly, some babies will always die, as mine did, but let us really now make a commitment to reduce miscarriages and deaths from prematurity.

I need to be able to tell my constituents that they will not have to suffer as I did.

[Hon. Members]

Hear, hear.

--- Later in debate ---

[Fiona Bruce]

The hon. Lady makes an extremely good point. It is vital that we support women in appropriate settings for their situation. As other Members have mentioned, for women who have lost their babies inside the womb but need to go through labour, separate wards should be a priority. They might need to be in hospital for several days. To hear other women around them with their babies must be very distressing. Hospitals need to create better spaces for women at all stages in their pregnancies in such situations.

[Victoria Prentis]

With your permission Madam Deputy Speaker, I would like to share my own experience. As I told the House earlier, I was in hospital for a considerable time because I had been very ill. After I was in intensive care, I was put in a post-natal ward with people with babies. I was in a separate room, but I had to share the bathroom, the midwives and all the other staff, with mothers of live babies. I found it terribly difficult when nice people who had not been told, who were bringing me cups of tea, food and all sorts of care, repeatedly asked me where my baby was. That was so distressing.

[Fiona Bruce]

My heart goes out to my hon. Friend. The compounding of grief in that way is so unnecessary.

Families who have lost babies have spoken about the importance of acknowledging their child’s life. Unfortunately, this is an area where the law adds to distress. Under current UK law, a baby is effectively only considered a person at 24 weeks. This often means that that acknowledgement is not there as it could be. I have even heard of parents lying about the gestation period in order to try to obtain a birth certificate. Alongside other hon. Members, I appeal to Ministers to look again at this. As modern technologies improve, unborn babies are increasingly viable earlier than 24 weeks. The law should move not only with technology, but compassion. I ask Ministers to look at that, too.

There is one last point I would like to mention. It is very sensitive, but I feel I need to mention it. It is the taboo I mentioned earlier, but as one colleague said, if there is one thing we can do in this House it is break taboos. Parents can also suffer a deep sense of loss and bereavement when their longed-for child is not lost during pregnancy due to a miscarriage or stillborn, but due to a disability being diagnosed while their child is in the womb, leading them to have to make the often heart-rending decision to have a termination, sometimes late in pregnancy. There is little, if any, bereavement support or adequate counselling for such parents either before they make that decision or sometime after, yet they too have lost a much-loved child.

In 2013, the all-party pro-life group conducted a detailed, year-long inquiry into abortion on the grounds of disability. I have a copy here with me today. We were repeatedly told by witnesses about the lack of proper counselling and bereavement care for such parents should they want it, which many do. We were also told of some examples of very good practice. One parent told us that they had had a funeral service, which helped enormously. Another told of how they were able to bathe their child before the child was appropriately cared for following the termination. Other witnesses were amazed that this kind of care was available, because they had received none at all. One of our report’s key recommendations was that appropriate bereavement support and counselling should be available for all parents who want it in such situations, even if it is some time later.

I regret to say—I am following slightly in the footsteps of my right hon. Friend the Member for Mid Sussex (Sir Nicholas Soames) who spoke earlier about an uphill struggle—that I have had an uphill struggle in trying to gain the attention of the Department of Health on this issue. I thank hon. Members who have raised their losses in this debate. I hope now that the Department will consider it. Our report was issued in 2013. After the deeply moving Adjournment debate led by my hon. Friends the Members for Eddisbury and for Colchester, I spoke with the then Minister responding to that debate. We agreed that I would send the report to the Department of Health after the debate, which I did. Unfortunately, I received no reply. I sent a reminder some time later. Again, I received no reply. I hope that as a result of today’s debate, the Department of Health will take seriously the additional point that parents in this situation need the same kind of care and support as the others who have been spoken about in this debate today.

Land Registry

Victoria Prentis Excerpts

Thursday 30th June 2016 Commons Chamber

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I will be as brief as I can, speaking in this debate as the Chair of the Public Administration and Constitutional Affairs Committee—the successor to the Public Administration Select Committee, which considered the question of open data in the previous Parliament and produced a report on the matter.

What is the Land Registry? It is a part of our critical national infrastructure. It is an absolutely fundamental function of any civilised state. It is how disputes are resolved. In the most war-torn parts of the world, there is a land registry in every country—even for every town. It has been in the lexicon of military doctrine since the days of empire that when a town is taken, the land registry is taken first so that the disputes that arise between different factions and families after control has been taken can be resolved. The first building that the Black Watch took in Basra when the British Army went into southern Iraq was the land registry. That is how fundamental a land registry is to any civilised state.

[Victoria Prentis (Banbury) (Con)]

My hon. Friend and I share different views on the European Union, but I wonder whether he remembers the chaos that ensued when the former East Germany was unified with West Germany. There was no proper land registry for East Germany, making it difficult to ascertain who owned many houses in places such as Potsdam.

[Mr Jenkin]

That is exactly the point. The former communist state had destroyed the old records to create a new order.

I have no objection in principle to privatisation, which has been a successful means of transforming large parts of the former public sector. Even the Labour party would have absolutely no intention of returning large parts of what is now in the private sector to the public sector.

Transforming the Land Registry into a modern, digitally-based service is crucial for making it more efficient and responsive to user needs. So far the digital transformation has been extremely slow. I have three main concerns about the present proposal. I hasten to add that I am speaking on my own behalf; this is not an agreed statement by my Committee. The Land Registry must continue to operate as an essential public service, the future owner of a privatised Land Registry must be committed to providing long-term stability, and the final deal, if there is one, must fulfil the Government’s own stated objectives for the use of open data.

In a submission to the Government’s consultation, I recommended that the quality of service provided to the public by the Land Registry must be prioritised above realising capital gains or transferring risk from the Government’s balance sheet. The primary concern must be to ensure that an accurate record of land use and ownership is maintained in public hands. The Land Registry’s core services should be protected from any real-terms price increases, and their quality must not suffer as a result of any transfer of operations to the private sector. The Land Registry is, and will remain, part of our critical national infrastructure. Its protection is crucial, and any public-private model or privatisation model must put in place safeguards to prevent the service being disrupted in the event of bankruptcy or commercial failure of any kind.

Our report in 2014 was based on evidence from leading figures in the world of data management and statistics, as well as from Ministers. Although the Committee did not look in detail at the privatisation of the Land Registry, we did look into the future use of the Government’s major datasets, of which the Land Registry is one. The final report made several recommendations for the use of Government data. In particular, we stressed the need to ensure that datasets are easy to access, easy to read and free to use.

On the specific subject of the Land Registry, the Committee concluded:

“A radical new approach is needed to the funding of Government open data. Charging for some data may occasionally be appropriate, but this should become the exception rather than the rule. A modest part of the cost to the public of statutory registrations should be earmarked for ensuring that the resultant data . . . can become open data.”

Data held by the Land Registry are one such example. If this model is adopted by the Government, they must not allow a new privatised entity to expect to make money from the selling of those data. The expectation must be that the data will be freely available.

In public policy terms, it is important to understand the value of open data to the economy as a whole. Research commissioned by the Open Data Institute found that public sector open data will provide more economic value every year, equivalent to as much as 0.5% of GDP, than data that users have to pay for. For example, we all use the Postcode Address File. That has been privatised, but what makes it of such value to us is that we can get on a website and get it free. How outrageous it would be if we had to pay for that.

Unfortunately, when the Royal Mail was sold, we transferred those data to the private sector and now big businesses have to pay to use those data. The result is that new forms of open source data will be created, which will gradually take over from the Postcode Address File. By transferring those data into the private sector as we have, we have undermined their value and created a cost to the productive sector of the economy for accessing them. In our conclusions, we stated that the sale of the Postcode Address File was the wrong decision. We concluded that such an asset should have been kept in public ownership, where it would be a national asset, free for businesses and individuals to use for the benefit of the wider economy.

If the Land Registry is privatised, the land register itself—the actual data—must stay in public ownership. It is crucial that the Government preserve for themselves a substantial degree of policy flexibility with regard to any agreement made with a privatised organisation, and if they decide that the public interest is best served by a change in data policy, they must remain free to effect this and to do so without excessive cost.

I am deeply concerned that the future owner of a privatised Land Registry must be committed to long-term stability and continuity. That depends on the character of the operator, if there is to be a private sector operator. The operator should understand that it may derive profit only from some kind of long-term yield for a long-term contract with the Government and be prepared to invest in the organisation to achieve this aim. An investor with a more venture capital-style approach, aiming to make a capital gain out of the development of the business and then on-sale, would be a completely inappropriate form of ownership.

Ambulatory Care

Victoria Prentis Excerpts

Wednesday 27th April 2016 Westminster Hall

[John Howell (Henley) (Con)]

I beg to move,

That this House has considered the use of ambulatory care.

I will start by referring to the NHS England publication that prompted me to call for the debate. NHS England has recently published a multi-agency quick guide and supporting information to support local health and social care systems to reduce the time that people spend in hospital. It acknowledges that people’s physical and mental ability and independence can decline in a hospital bed. For people aged 80 and over, 10 days in hospital equates to 10 years of muscle wasting. The report therefore recommends that people should seek to make decisions about their long-term care outside hospital and preferably in their own home or in a bed where their true long-term needs are understood.

The report was prepared not by the Government, but by the emergency care improvement programme of NHS England. It adds to the overwhelming clinical evidence that this approach is by far the best way of proceeding. The report goes on to say that care at home enables people to live independently and well in their preferred environment for longer. It contains checklists of questions for patients and commissioners to achieve that situation.

I am immensely encouraged by that, as it is on that basis that the number of beds has been worked out at Townlands hospital in Henley and the answer of up to 14 initially has been reached. Those beds are to be associated with the hospital, but in the care home at the side of the hospital. It is reassuring to know that we are at the forefront of current thinking and action. This approach is supported by organisations such as the Alzheimer’s Society and clinicians throughout the NHS. It is the right way to proceed and in the best interests of the whole community.

Before I continue, I should probably say what ambulatory care is, besides what I have just described. Ambulatory care is medical care provided on an out-patient basis. It includes diagnosis, observation, consultation, treatment, intervention and rehabilitation services. This care can include advanced medical technology and procedures, the costs of which should not be underestimated. Under this new care model, outlined in the NHS five year forward view, GP group practices would expand and include nurses, community health services and, in particular, social workers. Those practices would shift the majority of out-patient consultations and ambulatory care to out-of-hospital settings.

Let us consider the effects of hospitalisation. For many older persons, hospitalisation results in functional decline despite cure or repair of the condition that took them into hospital in the first place. Hospitalisation can result in complications unrelated to the problem that caused admission or to its specific treatment, for reasons that are explainable and avoidable. Age is often associated with a number of functional changes—which I am sure you and I, Mr Owen, have no experience of at this stage in our lives—including reductions in muscle strength and aerobic capacity; diminished pulmonary ventilation; altered sensory confidence, appetite and thirst; and a tendency towards urinary incontinence, which I am not saying any of us suffer from.

Hospitalisation and bed rest superimpose factors such as enforced immobilisation, reduction of plasma volume, accelerated bone loss, increased closing volumes and sensory deprivation. Any of those factors may thrust vulnerable older persons into a state of irreversible functional decline, so hospitalisation is a major risk for them. I am talking particularly about the very old. For many, hospitalisation is followed by an often irreversible decline in functional status and a change in quality and style of life.

A recent US study showed that of 60 functionally independent individuals aged 75 or older who were admitted to hospital from their home for acute illness, 75% were no longer independent on discharge. That included 15% who were discharged to nursing homes.

[Victoria Prentis (Banbury) (Con)]

By intervening, I am not of course in any way suggesting that my hon. Friend needs to take the weight off his feet after that sad list of symptoms. He is rightly concentrating on the needs and degeneration of older people who go into hospital, but does he agree that ambulatory care is also important for younger people? In our local general hospital, the Horton, there is a marvellous new children’s out-patient service, which is used by both his constituents and mine. Does he agree that that is a centrally important part of the offer of that hospital, which provides acute in-patient care as well as the out-patient care on the side?

[John Howell]

I thank my hon. Friend for allowing me to have a rest and to make the most of that time—as I get older, I need that. I do agree with her; she makes a very valid point. I am concentrating on older people because traditionally that is where the population who have used the hospital in Henley have come from. I think that in the past year only one was under 55. But as I said, my hon. Friend makes a very valid point.

In many cases, the decline that people experience cannot be attributed to the progression of the acute problem for which they were hospitalised in the first place. An example is pneumonia. Even if the disease is cured in a few days or, indeed, if a hip fracture repair is technically perfect and uncomplicated, the patient may never return to the same functional status as they had before they went into hospital.

According to the US study, between 30% and 60% of patients with hip fractures are discharged from the hospital to nursing homes; 20% to 30% of those persons are still residing in nursing homes one year later. Only 20% of one large group of patients returned to their pre-operative functional level after a hip fracture repair.

Many hospitalised patients have difficulty implementing their habitual strategies to avoid incontinence. The environment is unfamiliar. The path to the toilet may not be clear. The high bed may be intimidating. The bed rail becomes an absolute barrier, and the various “tethers”, such as intravenous lines, nasal oxygen lines and catheters, become restraining harnesses. About 40% to 50% of hospitalised persons over the age of 65 are incontinent within a few days of hospitalisation. A high percentage of hospitalised older persons discharged to nursing homes never return to their homes or community. In one study, 55% of persons over the age of 65 who entered nursing homes remained for more than a year. Many of the others were discharged to other hospitals or long-term care facilities, or simply died. The outcome for many hospitalised elders is loss of home and, ultimately, loss of place.

It is most important that relationships among physicians, nurses and other health professionals reflect the interdisciplinary nature of the whole of this process. In particular, I am a great enthusiast for the integration of the NHS with social care. That needs to move ahead very quickly to give the clinicians the responsibility for commissioning the social care that is required. Maintaining wellness and independence in the community prevents conditions deteriorating and therefore results in better health outcomes. Emergency hospital admissions are distressing.