Health Service Medical Supplies (Costs) Bill

Justin Madders Excerpts

2nd reading: House of Commons & Programme motion: House of Commons
Monday 24th October 2016 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I thank the Secretary of State for outlining the overarching principles of this Bill, which, as we have heard, seek to allow the NHS to better control the cost of medicines and to close some of the loopholes, which have been the subject of blatant abuses in recent years.

I also thank the Minister of State for taking the time to meet me and other hon. Members last week to set out what the Government were seeking to achieve with this Bill. I only hope that this increased appetite for state intervention in the market that we have on display will spread more widely across Government. As my hon. Friend the Member for Wolverhampton South West (Rob Marris) said, this kind of approach used to be called Marxist, anti-business interventionism. I never thought that I would say this, but, having heard what the Secretary of State said today, I believe that he is now a fully fledged Corbynista.

In all seriousness, it is clear that the market is not serving the patient or the taxpayer as well as it could. As we have heard, expenditure on medicines is a significant and growing proportion of the NHS budget, standing at £15.2 billion in England in 2015-16, an increase of more than 20% since 2010-11. One can only imagine where we would be now if the whole of the NHS had seen such an increase during the same period.

The incredible advances in science that we have seen in recent decades, often led by companies here in Britain, mean that people in this country are living longer, healthier lives than ever before. Although we celebrate that, it is also right that we work hard to secure value for money for the NHS to ensure that as many patients as possible can benefit from medical advances.

[Keith Vaz (Leicester East) (Lab)]

May I declare an interest as a type 2 diabetic and chair of the all-party diabetes group? Ten per cent. of the expenditure of the NHS budget is on dealing with diabetes and complications related to it. Does my hon. Friend agree that there may well be a desire to prescribe more medicines, which will cost more, rather than providing diabetics with a structured education which, if appropriately used, can bring down the cost of diabetes to the health service? It is not just about pills.

--- Later in debate ---

[Justin Madders]

I thank my right hon. Friend for his intervention and pay tribute to him for his great work on diabetes. It is a matter that he consistently raises in the House, and he is right to do so. Of course he is right that there are many ways in which the diabetes bill can be tackled, and some of the shocking statistics that I have seen on the level of take-up of education courses is something on which we can do much better.

We support the broad aims of the Bill and of what the Government are trying to achieve, but we have a number of concerns, which I hope the Minister will address when this debate is drawn to a close, both about what is in the Bill and about the Government’s policies more widely on access to treatments.

Historically, the technical mechanisms used by the NHS to control expenditure on medicine have not set the public’s imagination alight, but in June we were all appalled to read reports that a small number of companies were exploiting loopholes to hike up the cost of medicines. In the past few years, we have also seen headline after headline about one effective treatment or another being denied to patients in desperate need on the basis of cost. I will address each of those issues after briefly touching on the Government’s proposal to harmonise the statutory and voluntary schemes for price control and on the new reporting requirements.

As we have heard, there are currently two schemes for controlling pricing: the voluntary scheme, the pharmaceutical price regulation scheme, which applies to the vast majority of suppliers; and the statutory scheme, which, in 2014 covered around 6% of branded medicine sales in the UK.

The voluntary PPRS scheme is based on companies making payments back to the Department of Health based on their sales of branded medicines to the NHS. By contrast, the statutory scheme operates on the basis of a cut to the published prices of branded medicines. These different approaches appear to have produced different results. Since 2014, the statutory scheme has delivered significantly lower savings than those of the PPRS, partly as a result of companies either switching individual products or switching wholesale into the statutory scheme, which is one reason why we have seen a significant reduction in the level of the rebate. Therefore, we support the rationale behind aligning the two schemes, which will create a more level playing field between companies and also give us a better chance of delivering greater savings to the taxpayer.

However, as we have heard, this Bill extends beyond closely aligning the two schemes and adds a new provision, giving the Secretary of State the power to require all medicines manufacturers and suppliers to provide information relating to prices.

[Mark Tami (Alyn and Deeside) (Lab)]

My hon. Friend will know—I am sure that we all know this—that there is a difference between the list price that is advertised and the price that the NHS actually pays. That is a very important point, and we have to be very careful that, in gaining all this information, we do actually bring down the cost for the NHS. Those companies may well charge other people higher amounts, and we need to put that in context.

[Justin Madders]

My hon. Friend is absolutely right. That is one reason why we must tread carefully, and hear what regulations the Government produce for consultation.

Some of the measures did not form part of the initial consultation, and there is a feeling that they have been added to the Bill at the last minute. Given the damaging cuts to the community pharmacy sector that were announced only last week, there is an anxiety about what costs could be created by any additional administrative burden.

[Sue Hayman (Workington) (Lab)]

Does my hon. Friend agree that pharmacists often know their patients much better than over-stretched GPs do? They can also advise on the prescription of appropriate cheaper drugs. Does he also agree that, instead of putting further pressure on the pharmacy sector, the Minister should be supporting it to reduce the burden on GPs and to help the NHS save money?

[Justin Madders]

My hon. Friend is absolutely right. There was real concern about the announcement last week. From the surveys that have been taken, we know that approximately one in four people who currently use the pharmacist would go to their GP if they were unable to seek advice from the pharmacy. We know the pressure that GP surgeries, and indeed the NHS, are under. We will have to watch carefully the impact of these proposals, which I hope will not be as serious as a number of Members fear.

The impact assessment does not offer many clues. It states that the additional costs that could be incurred

“have not been quantified, as their magnitude will not be known until after consultation on subsequent regulations.”

We need to tread carefully. The Secretary of State is asking us to give him new powers before setting out exactly how he will use them. That is a far from perfect state of affairs. I hope that we will get some further clarity when the Bill reaches Committee.

[Mark Field]

The hon. Gentleman has been fair in his broad analysis of the problems that we face between the statutory and voluntary schemes. It is a salutary lesson that whenever a statutory scheme is put in place, it can easily be gamed by anyone in the industry. Is he encouraged by the fact that the Association of the British Pharmaceutical Industry supports the Government’s proposal and wants to work with the Secretary of State so that we can, hopefully, reach an agreement that will work for the future, rather than a draconian recommendation being issued by Richmond House?

[Justin Madders]

I agree that it is important that we keep the dialogue open with industry. We are proud of what the pharmaceutical industry can deliver for this country. It is a world leader and we certainly do not want to throw the baby out with the bathwater.

The Government will be aware that concern has been expressed by the medical technology sector that medical supplies are to be brought within the scope of a regime designed ostensibly to tackle a problem in the pharmaceutical industry. The medical technology sector has expressed concern that the Bill’s measures will put additional burdens on that sector and could lead to higher costs overall for the NHS. We welcome the assurances given by the Secretary of State today that the 99% of businesses in this industry that are small or medium-sized will not be unduly troubled by onerous additional reporting requirements. We hope to discuss that in further detail.

The former Minister for Life Sciences reported in February 2016 that the estimated income in England from PPRS payments in 2016-17 would be £518 million. That is considerably less than the amount received in 2015, at a time when the overall drugs bill is increasing, so that tells us that the scheme is not going according to plan. The Government have stated that the measures would save the health service around £90 million a year, so let us consider what has been going on and whether this Bill can address the issues that have arisen.

One of the benefits we have heard about is that the Bill will help to close the loophole that I referred to earlier which has led to extortionate prices being charged for a number of generic medicines. This occurs, as we heard, when a small number of companies purchase off-patent drugs for which there are no competitor products or there is a dominant supplier. They then remove the brand name, which takes the drugs out of the current pricing controls, allowing the companies to hike up the costs by many hundreds or even thousands of per cent. It is clear that some of these companies have made this strategy a key part of their business model.

In the past few months we have seen this House expose some of the worst excesses of capitalism, from Mike Ashley and his employment practices at Sports Direct, to Philip Green, but there should be a special category of obloquy for those who make themselves extremely wealthy by using loopholes in the law to prey on the sick and vulnerable and to extract obscene profits from our health service. An investigation in The Times highlighted how a small number of companies including Amdipharm, Mercury, Auden Mckenzie and Atnahs raised the cost of medicines by £262 million a year through this practice.

When a US pharmaceutical company hiked the price of HIV medication, people across the world were united in their condemnation, but it is less well known that at the same time the price of over 200 medicines more than doubled in this country, with 32 rising by more than 1,000% and in one case, as we heard, an unbelievable increase of 12,500%. An indication of how central to the business plan of some companies this practice has become can be found just by looking at their websites. The company Amdipharm boasts that it was sold to a private equity company for £367 million and talks of acquiring and commercialising niche generic medicines. Another of these companies, Concordia International, which now owns both Amdipharm and Mercury, is quite open about the fact that it

“specializes in the acquisition, licensing and development of off-patent prescription medicines, which may be niche, hard-to-make products.”

This may sound like a noble pursuit, but we know that it can in fact be code for establishing and then abusing a dominant market position to the detriment of vulnerable patients and the taxpayer.

[Rob Marris]

My hon. Friend speaks of the abuse of a dominant market position, and this Bill extends the powers of the Secretary of State effectively to confiscate profits, rather than acting through taxation. Does my hon. Friend agree that the same approach may be worth considering in the case of a company such as Google? It has 85% of the world mobile phone market for Android operating systems, and people use Google for 85% of the searches carried out in the United Kingdom. That is a dominant market position and there are questions about the tax paid by Google. Perhaps profit confiscation might be considered.

[Justin Madders]

My hon. Friend tempts me a little way outside my brief. I note, though, that our health service is entering into partnerships with Google, so I hope that questions are being asked by Ministers about the taxation arrangements.

We know that the vast majority of the generics sector is well controlled by competition and delivers value for money to the taxpayer, and we welcome the extension of pricing controls where competition has failed. Is the Minister confident, however, that the steps taken in the Bill are adequate? We have seen, as my hon. Friend the Member for Wolverhampton South West mentioned, how adept international companies can be at moving figures around to avoid taxation, and we clearly want to ensure that the system that we develop is not vulnerable to the gaming that we have seen elsewhere. I do not think for a minute that given the vast sums of money at stake, the companies will just shrug their shoulders and take the hit if they can avoid it.

I was more than a little concerned when I read a section about this Bill in a Concordia investor presentation, which said that in the past the Department of Health

“would seek informal negotiations with manufacturers where it believed there were pricing issues. We believe this step will remain.”

The notion of informal talks with officials brings up uncomfortable memories of the sweetheart deals between multinationals and Her Majesty’s Revenue and Customs. Although I am happy for chains of communication to be open with such companies, can the Minister reassure us that in all cases prices will be regulated through a transparent, formal process and not through behind-the-scenes talks?

[Steve McCabe]

Where the advertising budgets of pharmaceutical companies dwarf their R&D budgets, is there not an argument for the Government to look again at the tax position of those companies, as well as at the price of their products?

[Justin Madders]

We will not get very far with this Government on corporation tax. They have been going in a direction that we would not have chosen. They have decided on the measures in the Bill as the best way to control prices and we will see how they get on. Will the Minister confirm that if it becomes clear in a few years that we have opened up another set of loopholes, we can expect the Department to take the lead and to be proactive in its investigations, rather than relying on a team of journalists to expose the problem?

We know that in Scotland the rebate that has been generated has been used to create a dedicated fund to give patients access to new medicines. Will the Minister consider investigating similar models and ensuring that the benefits of the scheme are used for the purpose of improving our frankly poor record in allowing patients to benefit from new medicines? We accept that there will always be challenges in matching funding to new drugs, but there is at least a degree of logic in allowing savings made in the drugs bill to be reinvested to enable new products to reach patients more quickly.

We welcome today’s report by the Accelerated Access Review, which sets out an ambitious plan that could see patients accessing new lifesaving treatments up to four years sooner. We hope the Minister will take this opportunity to give financial backing to the aims of the review by committing to using future rebates from the pharmaceutical sector to improve access to treatments. I ask the Government to seriously consider this, as there are growing concerns about access to new drugs and treatments in this country, and particularly about the widening gulf between the UK’s record on developing new drugs and the ability of the NHS to ensure that all patients benefit sufficiently.

The “International Comparisons of Health Technology Assessment” report published in August by Breast Cancer Now and Prostate Cancer UK shows that NHS cancer patients in the UK are missing out on innovative treatments that are being made available in some comparable countries of similar wealth. This is at the same time as a number of medicines have been delisted by the Cancer Drugs Fund after it overspent its budget, and the failure to extend this scheme to innovative treatments as well as medication. There was a report in The BMJ in July entitled “A pill too hard to swallow: how the NHS is limiting access to high priced drugs”. It came to similar conclusions when looking at new antiviral drugs that held out a real prospect of eliminating hepatitis C but which were very expensive.

[Mark Tami]

Does my hon. Friend agree that we have to be careful not to discourage drug companies from doing research, particularly into those rarer illnesses, because they would not see a financial return?

[Justin Madders]

My hon. Friend is absolutely right. We must be careful of the law of unintended consequences with this piece of legislation. Commercial decisions will be taken on investment if the return is not sufficiently high, so we have to get the balance right between encouraging investment and getting value for money for the taxpayer.

The BMJ report showed how NHS England, having been unable to budget for broad access to the drugs I mentioned, sought to alter the outcome of the National Institute for Health and Care Excellence process and, when it failed, defied NICE’s authority by rationing access to those drugs. There was also widespread controversy over attempts by NHS England to avoid funding anti-HIV pre-exposure prophylaxis by passing on responsibility to local authorities at the same time as cutting the public health budget allocated to councils. If we are to strive to create a level playing field for drugs companies, we should look to do the same for patients and their ability to access treatments.

Labour established NICE to speed up the introduction of clinically proven and cost-effective new medicines and procedures. An order was made by Parliament in 2001 to mandate the funding of healthcare interventions approved by NICE through its technical appraisal process. They were intended to be available to patients three months after publication of the appraisal. However, subsequent orders have chipped away at that, culminating in the current consultation by NICE and NHS England, which will again potentially delay or deny access to important treatments. Therefore, as well as looking at ring-fencing the payments received under this scheme, will the Minister look more widely at access to medicines? Successive studies have demonstrated that there is relatively low take-up of new medicines by the UK compared with other high-income countries. Not only does that let patients down, but it could impact on the future of the pharmaceutical industry in the UK, particularly given the sector’s concerns about the relatively small value of sales in the UK, compared with other countries, and given the uncertainty surrounding the future of the European Medicines Agency following our decision to leave the European Union.

I am sure Ministers are aware of the concerns that have been raised about that and of the need to ensure that the country is still seen as a leader in the research sector. The Prime Minster has said:

“It is hard to think of an industry of greater strategic importance to Britain than its pharmaceutical industry”,

and the Opposition agree, but we cannot be complacent about the state of UK pharma, particularly as investment decisions are often made by parent companies based in other parts of the world. I hope the Minister will take seriously the interrelationship between decisions about access to treatments and the future of pharmaceutical research and development in the UK, particularly when we know that other countries across Europe are using the current uncertainty as a result of Brexit to eye up opportunities to steal a march on our own industry.

To conclude, the Opposition support the broad aims of the Bill and what the Government seek to achieve in terms of better controlling the cost of medicines. In Committee, we will seek to explore in more detail the new information powers and the details of the impact of those new powers on the supply chain. We will also continue to hold the Government to account and ensure that patients are able to access the best available treatments without any unnecessary delay.

Baby Loss

Justin Madders Excerpts

Thursday 13th October 2016 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I congratulate the hon. Members for Eddisbury (Antoinette Sandbach) and for Colchester (Will Quince) on securing this debate, and I pay tribute to their courage in speaking so movingly about the incredibly difficult circumstances that they, sadly, have experienced personally. It is a great tribute to their character that they responded to such tragic experiences by seeking to do all they can to help others. We have heard from many Members how their constituents have done the same, following their own personal tragedies. I commend the work of the Members who comprise the all-party parliamentary group on baby loss, which has made an important and valuable contribution, addressing both the prevention of baby loss and the importance of offering the best possible care to parents when this happens.

This is the first time that we have discussed baby loss in the Chamber, but the third occasion on which I have responded to a debate on the subject over the past year. Each occasion has shown the House at its absolute best. I would like to take a few minutes to go through some of the compelling contributions.

The hon. Member for Eddisbury talked about the lack of recognition of how miscarriages can increase feelings of loneliness and isolation. I was sorry to hear about the lack of understanding that some people have faced when they have been contacted having suffered a miscarriage. I know from my own experience that there is a propensity to put miscarriage down as “just one of those things”, as we have heard several times today. The hon. Lady made very powerful comments that most parents just want to make sure that whatever has happened does not happen again. There is a recognition—a number of Members spoke about this—that parents sometimes do not feel that they get the answers they need.

It is disappointing to hear the statistic that the hon. Lady revealed that 25% of maternity hospitals do not have bereavement suites. Time and again today, we have heard Members welcome the provision of these suites in maternity units. I know from those I have visited up and down the country what a valuable contribution they make. They are often built following local fundraising and are often born from tragic circumstances. They always seem to receive significant input from parents who have suffered bereavements. I hope we are all agreed that we should aim to get a bereavement suite in every maternity unit.

As the hon. Lady said, one hour of bereavement training for midwives is clearly not enough, and the issue of training and support featured in several contributions. She is also right, however, that there is plenty of good practice out there, which we should disseminate across the country. Her comments about a bereavement pathway were important, and I am pleased to hear that Sands has been asked to look into it. I hope we will hear some good news about developments in that respect.

The hon. Member for Colchester spoke from personal experience with great passion and knowledge about what he believes needs to be done. He is absolutely right that no one who suffers a bereavement should have to go back on to a maternity ward. A number of Members made that point. He was right, too, to say that this is a far bigger issue than just ensuring that we have bereavement suites everywhere. We need to do much more work to understand why there are such disparities in occurrences across the regions and across different ethnic groups. His point that a mother can sense when something is not right was a powerful one. We should always stress how important it is to seek medical advice if there is any scintilla of doubt. The hon. Gentleman was right, too, that every stillbirth and every neonatal death is something that we should learn from. We need consistency right across the bereavement pathway and right across the NHS.

I wish the hon. Gentleman success with his private Member’s Bill, the Parental Bereavement Leave (Statutory Entitlement) Bill. We know that the odds of such legislation succeeding are not great, but perhaps today’s comments and the no doubt eloquent case he will make in support of the Bill will persuade the Government to bring forward legislation of their own.

My hon. Friend the Member for Heywood and Middleton (Liz McInnes) spoke with her customary experience of the health service. She gave examples of some of the best practice in her constituency, but also spoke of the struggle of one of her constituents, Jane, who had been trying to obtain answers following the death of her daughter Niamh, and referred to the gaps in support throughout the country.

The right hon. Member for Mid Sussex (Sir Nicholas Soames) talked about Group B Strep, which, he said, is one of the most common causes of infection. He told us that one baby a day develops it. That is a shocking statistic, given that, as we know, the infection is largely preventable. The right hon. Gentleman also mentioned childhood strokes and the courage of his constituent Emily. I look forward to hearing the Minister’s response to what he said.

The hon. Member for North Ayrshire and Arran (Patricia Gibson) has her own personal experience. She very bravely told us about Kenneth, who would have been seven on Saturday. She rightly made the point that people often do not know what to say in such circumstances, and end up saying nothing at all. We hope that the more Members talk about these issues, the less often such situations will arise. The hon. Lady also said that the response that she had received that it was “just one of those things” was not good enough. She talked about the culture of secrecy and the pulling down of shutters, which cannot possibly help bereaved parents who are looking for answers.

My hon. Friend the Member for Kingston upon Hull North (Diana Johnson) raised an important issue about her constituent’s son William, whose ashes had been scattered without the constituent’s acknowledge. She talked about her campaign to get Hull council to conduct an independent inquiry into what is apparently a widespread practice in Hull. The campaign was initially successful, and my hon. Friend is right to be furious about the U-turn that has now taken place, with no consultation or warning. We certainly support her campaign to have the inquiry reinstated, and I hope that the Minister will agree to look into the matter and make representations to the Secretary of State for Justice.

The hon. Member for Banbury (Victoria Prentis) spoke, very bravely, about her personal experiences. She observed that we often hear that the nature of the public’s interaction with many public services means that people must tell their story again and again. She stressed the importance of relationship counselling, or, at the very least, an evaluation of how bereavement affects relationships. She also spoke with great knowledge about the importance of getting cremation right. I was pleased to hear that a working group is now looking into that.

The hon. Member for Gower (Byron Davies) said that awareness was the key to tackling this issue. He spoke with great sincerity about the fact that he and his wife had felt that they could not speak about their own loss, such was the stigma surrounding it. He rightly said that the medical advice that they were given at the time to “keep trying” was simply not acceptable.

The right hon. Member for Broxtowe (Anna Soubry) talked about her constituents’ daughter Emily, who was stillborn, and their subsequent discovery that there was no bereavement suite. She said that it was almost cruel for bereaved parents to have to be in close proximity to those who had experienced successful births, and I think we can all understand that sentiment.

The hon. Member for Congleton (Fiona Bruce) highlighted the experience of her constituents, and the lack of joined-up communication in dealings with bereaved parents. She gave some disturbing statistics from a miscarriage survey which found that four out of five women received no aftercare at all. I think it is clear to all of us, given what we have heard today, how important it is for that support to be provided as often as possible.

The hon. Member for East Worthing and Shoreham (Tim Loughton) spoke with great knowledge of this subject. He mentioned the shocking statistic that 68% of local authorities do not commission bereavement support, and presented a volley of other statistics revealing a lack of access to mental health support across the board. As he said, this is not something that just fades away; ongoing support is needed for parents. He paid tribute to the many charities that provide such support, but rightly said that people should not have to rely on charities to receive it. He also drew attention to his own private Member’s Bill, and to the legal absurdity of the classification of births before 24 weeks. He made, I think, a compelling case for a change in the law.

Finally, let me pay tribute to the outstanding contribution from my hon. Friend the Member for Lewisham, Deptford (Vicky Foxcroft), who showed incredible courage in telling us about her daughter Veronica. We could all feel the pain that she must have felt every day for the last 23 years, and we all admire her bravery in talking about her experience. I am sure that Veronica would be as proud of her mum as we all are today.

As we have heard, this debate coincides with baby loss awareness week, which provides an opportunity for bereaved parents, their families and their friends across the world to unite and commemorate their babies’ lives. I echo the tributes that have been paid to the many charities that do so much to support families through what is possibly the most challenging time that they will ever face. I do not think that any Member can be in any doubt about how difficult it is, having heard the moving speeches that have been made today. I know that the hon. Member for Colchester did not want to single out particular charities, but I shall name four. Sands, Bliss, the Miscarriage Association and Antenatal Results and Choices all do excellent work.

It is a demonstration of the importance of this issue that in baby loss awareness week—as in every week—we know that more than 100 families will experience one of the biggest tragedies of their lives. An average of 15 stillbirths occur each and every day. We have heard from Members that stillbirth is often a taboo subject that many find difficult to discuss. I think we are beginning to change that, but we owe it to all those families to address the issue, and I know that today’s debate is a valuable part of the process. The loss of 100 lives a week in any circumstances is a tragedy, and if it were happening in a particular industry, there would no doubt be calls for action to be taken. That is why the words of the Members who have spoken today about their personal experiences are as important as they are brave.

I followed with great interest Monday’s baby loss debate on Twitter, and I commend the hon. Members for Eddisbury and Colchester for their innovation in facilitating it. The debate offered members of the public from all over the country an opportunity to share their views about this issue, and I want to put on record my thanks to everyone who took part. Twitter and social media generally have gained a bit of a reputation over the last few years for being unforgiving and cruel domains, but Monday's debate showed how that arena can be harnessed to bring about genuinely thoughtful and meaningful engagement with the public.

One of the key themes that emerged from the debate was the fact that this country offers some of the best neonatal care in the world, along with some exemplary psychological and bereavement support services. However, it also made clear that—as we have heard from many Members today and in the past—it does not offer that excellent care equally in every area. There is a great deal of variation across the country, which is why, much to our shame, our rates of stillbirth are unacceptable in comparison with those of similar countries. There has been an enormous amount of progress in reducing the rates of stillbirths and infant deaths in the last century, but it has sadly stalled in recent years. Indeed, according to The Lancet, the annual rate of stillbirth reduction in the UK has been slower than those in the vast majority of high-income countries. Our annual rate of reduction has been 1.4%, compared with 6.8% in the Netherlands. I think we would all agree that that is not an acceptable level of progress, and variability may well be one of the key reasons for it.

We welcome the Government’s commitment to reducing the rate of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or soon after birth by 20% by the end of this Parliament, and by 50% by 2030. During the debate that took place in June, the former Minister, the hon. Member for Mid Norfolk (George Freeman), confirmed that the first annual report on progress towards meeting those targets was due to be published this autumn. I should be grateful if the Minister would tell us whether that is still the Government’s intention, and when we can expect to see the report.

If we are to see a reduction in the number of avoidable deaths, another key priority, which is linked to the variability of care, is to ensure that there are safe staffing levels in neonatal units. According to the “Bliss baby report 2015: hanging in the balance”, 64% of neonatal units do not have enough nurses to meet national standards, and 70% of neonatal intensive care units regularly look after more babies than is considered safe. Given the strong evidence of a link between staffing levels and babies’ mortality, I ask the Minister to set out what steps the Government are taking to address that. We shall simply not be able to achieve the Government’s laudable ambitions if we cannot provide safe staffing levels in neonatal units.

Another issue that was raised during the debate in June was the investigation of stillbirths. At present, coroners do not have the jurisdiction to investigate the deaths of children who are stillborn to try to understand exactly why the deaths occurred and to inform best practice. As we have heard from many Members today, parents simply want to know what went wrong and whether it will happen again. Members of all parties were encouraged when the previous Minister undertook to discuss expanding the remit of coroners with his counterpart in the Ministry of Justice. I should be grateful if the Minister could tell us how those discussions have gone.

Let me end my speech by focusing on the families who so sadly experience bereavement, and the care and support that is offered to them afterwards. This is another area in which, sadly, there is a great deal of variability, with some families receiving the levels of support and care that we would expect while others have had shocking experiences such as those about which we have heard today. I should be grateful if the Minister could outline the steps that he will take to realise the Government’s commitments on parity of esteem for mental health in neonatal care. No one who has suffered the trauma of losing their baby should be left to suffer alone.

Members in all parts of the House have spoken very bravely and with great passion about their personal experiences. I hope that, following the debate, we shall be able to move forward, continue to break down the taboos, and ensure that every family to whom this happens receives the very best care, both medically and in terms of bereavement support. Families experiencing the very worst of times deserve a system that offers them the very best.

Hormone Pregnancy Tests

Justin Madders Excerpts

Thursday 13th October 2016 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I congratulate my hon. Friend the Member for Bolton South East (Yasmin Qureshi) and the hon. Member for Livingston (Hannah Bardell) on securing this debate, and I welcome the well-informed and passionate nature of the contributions that we have heard from across the House. I take this opportunity to pay tribute to Marie Lyon, chair of the Association for Children Damaged by Hormone Pregnancy Tests, who has never given up in her fight to ensure that parents like her get to the bottom of exactly what happened to their children and why.

I also pay tribute to the all-party parliamentary group on oral hormone pregnancy tests, ably chaired by my hon. Friend the Member for Bolton South East, which has offered the campaigners a huge amount of support. It was its campaigning, alongside the Association for Children Damaged by Hormone Pregnancy Tests, that led to the expert working panel group being set up.

There are serious concerns about the process that clearly need to be addressed. We welcome the fact that the former Minister for Life Sciences has sought to set up an independent investigation into the issues. Unfortunately, as we have heard, there appears to be a divergence between the type of process that the Minister sought to establish and the way it is currently operating. I will address that point later in my remarks.

As we have heard, hundreds, if not thousands, of families have been affected by this issue and have suffered not only debilitating physical conditions but, in some cases, sadly, premature death. Alongside that, they have experienced a sense of injustice and the pain of more than 40 years of questions being left unanswered. My hon. Friend the Member for Bolton South East, in setting out the history so well, made the crucial point that the victims should be at the heart of the process. The testimony she gave on their behalf clearly showed that that is not currently the case.

My hon. Friend the Member for Makerfield (Yvonne Fovargue) spoke about her constituent Marie Lyon, who is on the panel, and gave the specific example of her being required to read 36 files in two weeks, which she cannot talk to anyone about. That is a patently absurd way to go about this business, and a stark example of what is going wrong.

The hon. Member for Livingston (Hannah Bardell) spoke forcefully about her legitimate concerns about the impartiality of the working group and, disappointingly, a lack of any substantive response when those concerns were raised.

We also heard from my hon. Friends the Members for Stalybridge and Hyde (Jonathan Reynolds), for Garston and Halewood (Maria Eagle)—she made a particularly powerful speech—for Bootle (Peter Dowd), for Heywood and Middleton (Liz McInnes), for Feltham and Heston (Seema Malhotra) and for Wolverhampton North East (Emma Reynolds), and from the hon. Member for North East Somerset (Mr Rees-Mogg). Time prevents me from going into much detail, but all those Members spoke passionately on behalf of their constituents and clearly identified the issues that we need to address in the current process.

As we now know, from the late 1960s warnings began to emerge about adverse reactions to the drug Primodos, including birth defects and miscarriage. A wide range of studies prompting warnings continued, and by the early 1970s it was declared that Primodos should not be used as a pregnancy test. However, despite this and a warning issued in 1975 by the Committee on Safety of Medicines about an association between hormone pregnancy tests and an increased incidence of congenital abnormalities, Primodos continued to be provided to women until its withdrawal from the market by Schering in 1978. In 1977 there were still, unbelievably, 7,038 prescriptions of Primodos to pregnant women.

That really is the crux of the issue: the delay between warnings emerging and any action being taken to stop the drug being offered to women. As we have heard today, steps were taken in Sweden, Finland, Germany, the USA, Australia and Ireland up to five years before any warnings were issued in the UK. It was that delay that led to thousands more women taking the drug than would have done so had it been withdrawn from the market when the warnings became clear in 1970. It is a scandal that families are still waiting for answers about why that was allowed to happen. There is a duty on all of us to ensure that is put right.

When the issue was last debated, in October 2014, the families were very pleased when the previous Minister for Life Sciences agreed to set up what he termed

“an independent panel of inquiry”

and committed to

“the release of all information that is held by the Department”.

He also promised that the committee would be comprised of “independent members” and that he would ensure that

“the association is properly represented and has a chance to give evidence.”

Finally, he stated that he wanted to

“shed light on the issue and bring the all-important closure in an era of transparency, so that lessons can be learned and this never happens again.”—[Official Report, 23 October 2014; Vol. 586, c. 1139-1143.]

As I said earlier, the Opposition welcomed the establishment of that process and the assurances offered by the Minister at the time. However, as we have heard today, there is now a gaping chasm between those assurances and the current process. I therefore hope that following this debate the Minister will take some urgent steps to ensure that the families, who have already been through so much, can regain confidence in the process.

With regard to independence, we have already heard that the selection process for members of the panel can at best be described as opaque. Serious concerns have been raised about conflicts of interest, and they need to be answered. Can the Minister tell us whether he is absolutely satisfied with the transparency arrangements for the selection process and with the independence of the panel? With regard to the promise to release all information, it is vital that the panel, in addition to being provided with absolutely every piece of relevant evidence, is afforded sufficient time to consider it. The evidence must also be presented in an accessible format, as is good practice in a process of this nature. Is the Minister satisfied with the way the information is being presented to members of the panel, and can he now confirm that every piece of information held by the Department has in fact been released?

In terms of the association being properly represented, we have heard that just one member of the association is entitled to attend meetings as an observer and that they have been required to sign a confidentiality clause. I understand that the clause applies both during and after the inquiry, and not only to the panel’s discussions but to the documents that are presented. How can that person raise concerns about the process if they are prevented from talking about it? Can the Minister explain why such a high level of secrecy is being applied to a process, the primary purpose of which was originally to

“bring the all-important closure in an era of transparency”?—[Official Report, 23 October 2014; Vol. 586, c. 1143.]

Justice must not only be done but be seen to be done, and there is a danger that this inquiry is failing properly to serve the people it was set up for. Given the public interest and the cost of this process, the Minister simply must address these issues now if the inquiry is to bring closure and the correct lessons are to be learned. Can he see how some of these issues will look if the families and victims of this scandal do not get the correct answers? Does he not agree that we owe them a process that is fair and transparent and, most importantly, that has their trust and confidence? Victims and their families have fought for 40 years to get answers, and during that time they have experienced grief, anger, a sense of injustice and, sadly, in some cases, even guilt, but despite all that their determination has never waned.

I am incredibly proud that, after 30 years, justice was finally served for three of my constituents and 93 other people who were tragically killed when they attended a football match at Hillsborough. That justice was achieved only because the families refused to give up, and, as the Minister will no doubt be aware, the families of the children harmed and killed by hormone pregnancy tests will not give up either. Why should the injustice that those people have suffered be compounded by further injustice and the sham of an inquiry that is patently not fit for purpose? Transparency, impartiality and completeness are not unreasonable demands; they are the basic ingredients for justice to be done. So, I ask the Minister, please to listen to the words he has heard today and act on them.

European Medicines Agency

Justin Madders Excerpts

Wednesday 12th October 2016 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr McCabe. I congratulate my hon. Friend the Member for Cambridge (Daniel Zeichner) on securing this important debate and on the powerful and knowledgeable way that he made his case today. I share his disappointment that this matter is not being responded to by the Department for Exiting the European Union, but I understand that there are competing interests today. However, I hope that the Minister will undertake to raise the issues set out today with his colleagues in the Department and will answer some of the questions posed today.

I know that my hon. Friend the Member for Cambridge was and remains a passionate advocate for both the European Union and his constituency, and today he has channelled his disappointment at our impending departure from the EU into a well argued case to support key industries in his constituency. He spoke about the local interest that he has in this issue. The Cambridge biomedical campus is one of the most significant sites for medical research not only in this country, but anywhere in the world. Like him, I represent a constituency with an interest in the science and research sector, which could take on even more significance with the proposed Cheshire science corridor, which has the potential to create more than 15,000 new jobs by 2030, around a third of which could be in my constituency. Of course, I do not have to tell the Minister about that because the science corridor benefits Warrington as well as Ellesmere Port. Even before projects such as the Cheshire science corridor come to fruition, the north-west, as we have heard, is already one of the leading regions in the country for the pharmaceutical industry, employing about 18% of the total national workforce.

As my hon. Friend the Member for Cambridge said, the industry is a massive part of our country’s economy, with a turnover of more than £60 billion a year and exports worth around half of that. In 2014, it invested £4 billion in research and development: more than any other sector. It also employs some 220,000 people. I have set out those facts to paint a clearer picture of what is at stake in today’s debate and why it is so important that we begin to offer some clarity about what our plans are, not only for the future of the European Medicines Agency, but for pharmaceutical research, development and regulation more widely. I believe that the importance of the issue is reflected in the number of Members attending the debate, even though the bigger picture on our exit from the European Union is being debated in the main Chamber now.

I appreciate the tone that the hon. Member for Strangford (Jim Shannon) adopted. I think that he was saying that, wherever we came from pre-referendum, and whatever our views on the European Union, the vast majority of Members now want to ensure that our departure happens on the best possible terms. I regret the mischaracterisation of Members who request greater scrutiny and debate on the terms of exit as being involved in a Machiavellian plot to undo the referendum result. What Members are asking for is scrutiny, transparency and accountability on what is surely the most important issue that the country has faced in a generation.

My hon. Friend the Member for Heywood and Middleton (Liz McInnes) spoke from great personal experience. She was right to use the word “isolation”. We want to avoid becoming separate from the rest of the world in such an important area. She gave specific examples of the benefits of pan-European research on diseases such as cancer. The hon. Member for Linlithgow and East Falkirk (Martyn Day) raised important concerns about delays in approval, and the potential loss, on leaving the EU, of our involvement in pharmaceutical trials. He mentioned the concerns of the Japanese Government about the siting of their European bases in London. That echoes concerns that they have raised about other sectors.

The hon. Member for Central Ayrshire (Dr Whitford) clearly set out the fact that the EMA is not a body that tells us what we should do, which is how much of the European landscape is portrayed. It is part of a collaborative exercise across 28 nations, which have been making real progress. She also set out the financial benefits that this country has received from membership, and highlighted the important point about the difficulty that some smaller British companies may face in exporting their innovations, if we do not get the terms of exit right.

We all remember the famous promise, which several hon. Members have referred to, that the Brexit vote would mean £350 million a week being spent on the NHS. It is fair to say that it is accepted that that figure does not stand up and was misleading, but, as the hon. Member for Central Ayrshire eloquently pointed out, I suspect very few people who voted leave would have appreciated the threat that leaving means to jobs in the science and research sector and to speedy access to new medicines.

No one blames the Department of Health for those misleading claims. Indeed, I know from my own parliamentary questions that Ministers sought legal advice about the use of the NHS logo by the leave campaign. However, we are entitled to ask for more from Ministers on the near total absence of work to prepare for the possibility of a leave vote. For example, on 11 July, I asked the Secretary of State what assessment he had made

“of the potential effect on workforce numbers in the NHS of the UK withdrawing from the EU.”

I was told that no such assessment had taken place. On 6 September I asked what discussions the Secretary of State had had with the Home Secretary

“on the immigration status of NHS employees from other EU countries when the UK leaves the EU.”

I was told only that arrangements were being made for a meeting to take place at some point in the future. A similarly disappointing response from the Government on the issue was pointed out by my hon. Friend the Member for Cambridge, who noted that when asked about the future physical location of the EMA the Minister responded that it was “too early to speculate”.

We are not asking the Government to speculate; speculation is happening whether we like it or not. We are asking them to set out some concrete and substantive detail on what they plan to do. We have heard many times from the Prime Minister the words “Brexit means Brexit”, and that she is not prepared to give a running commentary. But investment decisions are being made right now, and if we cannot begin to provide some certainty we shall quickly find out that the UK and, in particular, places such as Cambridge and Cheshire will miss out on investment. It is about time we got some clarity on the Government’s position.

The first and most obvious point is the location of the EMA. We have already heard that countries from around the world are queueing up to offer it a new home. Having heard the benefits that it brings we can understand why they are forming an orderly queue. I know that the Minister does not want to speculate on what will happen, but will he at least set out whether, as part of the negotiations, he will take steps to try to retain the EMA headquarters in London, if that is possible? Will he also provide clarity about what steps the Government will take, if the EMA does relocate, to safeguard the headquarters of major international pharmaceutical and life sciences companies?

Beyond the future location of the EMA, there are wider issues about how medicines will be regulated in future, which could not only have an impact on investment but affect how quickly new medicines reach UK patients. Various hon. Members have mentioned that. Will we be able to safeguard the UK’s position as one of the leading locations for clinical trials in Europe? Clearly, a lot of Members feel passionately about that. Will the Government guarantee that the UK will continue to adhere to the EU regulatory framework on the authorisation and conduct of clinical trials? What assurances can the Minister give us that retaining access to the centralised marketing authorisation procedure will be a key part of our Brexit negotiations? Will the Government seek to negotiate continued access for UK research institutions to the innovative medicines initiative and other EU-funded research and collaboration programmes?

If the UK is left in the position of developing a separate regulatory framework from the EU, not only will that make it a much less attractive place in which to develop, manufacture and launch new products; it could also signify the end of accelerated access to treatments for patients in the UK, putting us to the back of the queue when new medicines are developed. Patients in Australia and Canada, where medicines are licensed nationally, have a comparative delay of six to 12 months before new medicines come to market. For people with rare conditions that could mean the difference between life and death.

European co-operation also provides some key benefits in terms of patient safety. One example is the European Centre for Disease Prevention and Control, which assists in our response to communicable diseases and pandemics. Another is the co-operation that reduces the risk of falsified medicines reaching UK patients. Can the Minister confirm that we will seek to continue to co-operate with our neighbours on those crucial issues?

What assessment has been made of the impact of the EMA’s leaving on the Medicines and Healthcare Products Regulatory Agency? As the hon. Member for Strangford said, work from the EMA is a substantial source of income for the MHRA, accounting for up to a third of its income. What provision has the Department made for the potential shortfall, particularly if the MHRA will have more responsibilities in future? As the hon. Member for Central Ayrshire said, in any scenario, it is likely that the MHRA will require further investment. What provision has been made for that?

This has been a wide-ranging and well informed debate. While we recognise that the issue does not begin and end with the physical location of the EMA and the 900 staff based there, there are at the heart of it, as my hon. Friend the Member for Heywood and Middleton said, 900 people—highly skilled and able to take their talents probably anywhere in the world—who face a future that is a vacuum. They will all have families and plans, and it is unrealistic to expect them to put their lives on hold for two or three years while things are sorted out.

I appreciate the Government’s reluctance to be drawn into making substantial commitments on the issues, but we run risks with respect to decisions about investment, future co-operation and, indeed, staff retention, if we do not begin to make our position clear. I hope that, when the Minister gets to his feet, we shall begin to get some certainty about the Government’s intentions as to seeking regulatory co-operation and, most importantly, safeguarding future investment in the sectors that we have heard about today.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Dunne]

My right hon. Friend managed to include several questions in his impressive supplementary. I can confirm that much of the waste that took place in the years he cited—2002 to 2007—related to projects of the previous Labour Government that they themselves then cancelled, such as the IT project. I can also confirm that savings generated in the NHS are kept in the NHS. Lord Carter, whose report I referred to earlier, has identified £5 billion of efficiency savings, which we hope to deliver during this Parliament.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

There is a distinction to be drawn between realistic efficiency targets and systematic underfunding. Only last month, Simon Stevens told the Public Accounts Committee that for three of the next five years

“we did not get what we originally asked for”.

Chris Hopson, chief executive of NHS Providers, also said last month that

“we’ve got a huge gap coming… it’s the chairs and chief executives on the front line…who are saying they cannot make this add up any longer.”

On funding, the Government keep saying that the NHS is getting all that it has asked for; those actually running the NHS say something quite different. Who is right?

NHS Sustainability and Transformation Plans

Justin Madders Excerpts

Wednesday 14th September 2016 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

This has been a high-quality and interesting debate. I welcome the Minister of State, Department of Health, the hon. Member for Ludlow (Mr Dunne), to his new role. As he is new to the role, I will forgive him for not knowing precisely how many trusts ended last year in deficit—it is 80%, by the way. As my hon. Friend the Member for Lewisham East (Heidi Alexander) said, that is the context in which we are discussing the plans, which means that the public will rightly be cynical about them, particularly if they are presented with a final plan. The Minister underplayed their development a little when he said that they were simply ideas. If that is all they are, let us see them.

We have heard contributions from the hon. Members for Bosworth (David Tredinnick), for Central Ayrshire (Dr Whitford) and for Totnes (Dr Wollaston); my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown); my hon. Friend the Member for Dewsbury (Paula Sherriff); the hon. Members for Spelthorne (Kwasi Kwarteng), for Bedford (Richard Fuller) and for Faversham and Mid Kent (Helen Whately); my hon. Friend the Member for Bootle (Peter Dowd); the hon. Member for Lewes (Maria Caulfield); my hon. Friend the Member for Hammersmith (Andy Slaughter); the hon. Member for North Dorset (Simon Hoare); my hon. Friend the Member for Newcastle-under-Lyme (Paul Farrelly); the hon. Member for Eddisbury (Antoinette Sandbach); my hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury); the hon. Member for Stafford (Jeremy Lefroy); my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley); the hon. Member for Bath (Ben Howlett); and my hon. Friends the Members for Wirral West (Margaret Greenwood), for South Shields (Mrs Lewell-Buck) and for Heywood and Middleton (Liz McInnes). I am sorry that I am unable to refer more to hon. Members’ contributions because of the time pressures.

Let us get down to the brass tacks. This is another reorganisation of the NHS, only this time it is being done behind closed doors. It is not just a reorganisation but an admission, as if we did not already know it, that the Government got the last one wrong. The Opposition do not need persuading that there is a benefit to more localised strategic oversight of the NHS and the health sector. We know that because we opposed the Government’s decision to scrap strategic health authorities as part of the 2012 Act.Unlike the strategic health authorities they are now trying to replace, there is no statutory basis for STPs and there is no scrutiny or transparency at all. Despite this, they are being asked to go further than any body has ever had to in the entire history of the NHS in terms of the cuts they are being asked to make. These cuts are being cooked up behind closed doors. This is happening without the involvement of patients, carers, clinicians, trade unions and staff. Consultation with the public does not mean presenting them with a completed plan as a fait accompli and asking them whether they support it. It means involving them from day one. The bigger the change, the better it is to start early with that consultation.

In my area, what has been published about the Cheshire and Merseyside plan states that it

“will require our hospitals to be reconfigured, consolidated with less sites and clinicians and consultants.”

Yes, that means fewer hospitals, fewer doctors and fewer nurses. No wonder the Government do not want to talk about it. Many Members, including the Chair of the Health Committee, have talked about the importance of consultation. We know from history that if an attempt is made significantly to alter local health services without engaging with the public and establishing local support at an early stage, it will fail. That is not just my view. This is what the Secretary of State himself said:

“the success of STPs will depend on having an open, engaging, and iterative process that involves patients, carers, citizens, clinicians, local community partners, parliamentarians, the independent and voluntary sectors, and local government”.

That just has not happened so far.

Not only are the public locked out of contributing to this process, they cannot even find out what is happening. I submitted freedom of information requests to NHS England and the 44 STPs, asking for copies of the plans submitted in June. The deadline for replies is tomorrow and so far not one has been provided to me. Many have simply refused to provide me with the plans, using the exemption that they are “intended for future publication.” When I asked the Minister when the June plans would be made available, I was surprised to read in his response that

“The June submissions were a ‘checkpoint’ and will not be published.”

We have STPs saying one thing and Ministers saying something else about whether the plans will be even published. No wonder people are concerned about what is in them.

Is this not the nub of the matter? Plans about fundamental changes to local health services have been sitting on the Secretary of State’s desk since June, but he will not release them. Surely in the interests of transparency they should be made publicly available now. There is nothing wrong in principle with the idea of local partners working collaboratively to transform health services, but there is everything wrong with doing so without transparency, public involvement or clear lines of accountability.

I welcome the new Minister, the hon. Member for Warrington South (David Mowat), to the Government Front Bench. When he responds to the debate, will he commit to dropping the secrecy and listen to the concerns of clinicians and patients, and ask each area to make their plans publicly available immediately? Will he clarify his role in the plans? When responding to a point made by the right hon. Member for North Norfolk (Norman Lamb), he said that plans will not go ahead if they do not deliver for mental health. However, the Minister of State, in response to a written answer, said:

“The reconfiguration of services…is clinically led and a matter for the local National Health Service.”

So which is it? Who will get the final say? Will it be the Government or will it be the local STPs?

What we have seen so far is a process that has failed to engage with just about every stakeholder imaginable, but even those who have been invited to attend the meetings are beginning to lose faith in the process. Council leaders and officers are queueing up to express their concerns. We heard from my hon. Friend the Member for Bootle about how his council leader’s concerns were dismissed. The Conservative leader of Kent County Council, Paul Carter, said:

“In Kent and Medway, NHS England is doing everything it can to keep local government out of it.”

Izzi Seccombe, Conservative leader of Warwickshire County Council, said that local government was being

“left out in the cold and not involved in the integration agenda.”

If STPs are the answer, can the Minister tell us why even council leaders from his own party are finding themselves totally disengaged from this process?

Many Members, including my hon. Friend the Member for Lewisham East and the hon. Members for Central Ayrshire and for Totnes, made the point that much of the money set aside for transformation has been spent on deficits, so let us not pretend that STPs are a panacea. Do not take my word for it; listen to what NHS providers are warning:

“We must be realistic about what STPs can achieve…and what they can deliver in terms of the £23 billion efficiencies required. It should not be overestimated.”

Nigel Edwards, of the Nuffield Trust think-tank, says:

“I’ve been visiting a lot of STPs and nobody I’ve spoken to is confident they can reduce the financial gap.”

Given the warnings we have already heard, will the Government seriously engage with the health service on the challenges they face, or will they continue to insist on impossible targets and unrealistic timetables?

I am sure the response will be the same one that we hear time and again: that the Government are investing £10 billion more in the NHS. We know, however, that that is an illusion. The Health Committee has confirmed that they are in fact delivering less than half of that, while at the same time chronically underfunding social care. The NHS has just had its biggest deficit in history under the stewardship of this Government, but the Secretary of State is not simply trying to convince us that he will maintain services at their current level, he is telling us that he will somehow do more.

The Government are in denial. It seems that virtually every day somebody is warning us that the NHS is on the brink of collapse. Only this weekend, the chief executive of NHS Providers said that

“we face a stark choice of investing the resources required to keep up with demand or watching the NHS slowly deteriorate”.

The Society for Acute Medicine has warned us that the NHS could experience “pockets of meltdown”. In the real world, not one serious commentator or senior NHS manager—not one—believes the NHS can deliver the services that it currently does, function safely, improve quality, move to 24/7 working and be financially sustainable. Let us end this charade; let us open up the debate and get to the truth about the damage being caused to the NHS by this Government. I commend this motion to the House.

Capsticks Report and NHS Whistleblowing

Justin Madders Excerpts

Wednesday 13th July 2016 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Main. I start by paying tribute to my hon. Friend the Member for West Lancashire (Rosie Cooper), who has ploughed what has at times been a very lonely furrow on this issue. She has shown incredible tenacity in pursuing the matter over a number of years. What makes this all the more remarkable is that, despite all of the inspection regimes and safeguards in place, the only reason we are debating this is because she had the courage and the determination to pursue these issues. She made a powerful and lengthy contribution today; I do not use that adjective in a critical way, but to highlight that there is so much that needs to be considered. The debate is certainly not going to be the end of the story. My contribution will perhaps not be as lengthy as on other occasions as I would like to give the Minister as much time as possible to set out how he intends to take matters forward.

At the heart of this is a random occurrence—my hon. Friend attending the trust in question as a result of her father being a patient there—and one can only wonder whether anything would have been done about the situation had she not attended, and had the brave staff on the ward not approached her after that. We heard from her about a whole catalogue of incidents, any of which in isolation ought to have raised alarm bells. When she spoke of the picture across the board, the number of grievances, some taking years to resolved, the suspensions that seem to be used as a punishment rather than the neutral act they are meant to be and the number of complaints of bullying and harassment it is clear that a wider pattern was there. In the words of the report:

“Non-Executive Directors took reassurance too easily and failed to provide sufficient scrutiny and challenge across a number of key areas. They collectively represented a series of missed opportunities to intervene.”

It should be said that there were also repeated failures by the executive directors to be open and transparent with the wider board, which included them not divulging details of a serious assault carried out on a staff member and keeping from the board the results of a staff survey that said 96% of respondents believed bullying was a problem to some degree within the trust. Will the Minister address whether he considers there needs to be more training or support for non-executive directors, so they at least know when they are not getting the whole picture? I also wonder whether there ought to be a requirement for at least one employee representative on each board so that, if there is a culture like this, there is a greater chance of it being revealed. What steps are being taken to prevent those non-executive directors who were involved in this from serving in a similar capacity in future?

The position of the executive directors deserves much sharper criticism, particularly when, as my hon. Friend pointed out, many of the senior people involved have found themselves in employment elsewhere in the NHS, and she quite rightly asked where the individual accountability is. Staff spending their last few days stood at a shredding machine is the sort of thing that goes on in multinational companies that have been cooking the books. It is not what should be happening in an open, transparent and accountable public body. It seems that the human resources team were used as a tool to enforce management’s will rather than to ensure the rules were applied fairly and consistently across the board. It is little wonder in those circumstances that staff did not feel confident that they could raise concerns freely.

I am sure we will talk about the duty of candour, but will the Minister give us assurances that this sort of situation will not happen again? Policies and good intentions can only take us so far, particularly when a culture develops that positively attacks those that raise concerns so that everyone is too frightened to raise those concerns in the first place. In my experience I have seen far too many times people who have legitimate concerns about a practice at their place of work but who do not have the confidence to raise those issues without fear of reprisal. A policy is only as good as the people entrusted to honour it and that is down to the people at the top. They set the tone and they have a duty to ensure that every person who raises a legitimate concern is protected. It only takes one bad experience or one failure to act in good faith on a concern raised and the entire system falls into disrepute.

I am sure that nobody goes into public service with the intention of creating such a culture of fear but it is clear that good intentions can be diverted by other influences and pressures. In this case, the central conclusion in the report, which needs more careful consideration, is that when the trust made the decision to go for foundation status what happened was an

“accompanying focus to reduce costs, which resulted in enormous pressures on many front line services and the emergence of a culture of bullying and harassment of staff at various levels within the organisation and the delivery to some patients of poor and in some cases sub-standard care.”

The report also said:

“For many of these concerns, it is hard to come to any other conclusion than that they were managed in the way they were in order to ensure the Trust application for NHS foundation trust status remained on track.”

That is pretty damning.

Aside from the financial pressures faced, we know that other pressures on staff are not going away, with significant numbers reporting work-related stress. We know that vacancy rates and rota gaps still remain unacceptably high and there are serious problems with staff morale across a whole range of services. I pay tribute to all NHS staff who are working hard in very trying circumstances, but we should also be realistic about the challenges they face. The staff at the trust have been key to delivering the improvements we have already seen, and the latest CQC report recognises that there have been improvements, which is not only a credit to those staff but also to the new leadership team.

It is fair to say that there is clearly still some way to go. For example, the performance of paediatric speech therapy service was worse than at the last inspection to the extent that the trust had to suspend the waiting list for a year. It was also noted that, despite some improvements, too many patients are developing serious pressure ulcers, which is something that ought to be eradicated altogether. Inspectors also highlighted “significant improvements” in the culture of the organisation and praised the trust for the measures it has introduced to keep staff safe, which is clearly one of the biggest and most important changes that was needed.

Whether that change in culture is permanent can only be tested by events, but we should reinforce at every opportunity the importance of speaking out with confidence. In that regard, it appears the future of the national whistleblowing helpline is still being considered. I would like to see the local guardians as complimentary to, rather than a replacement for, the national helpline. I would be grateful if the Minister will address whether any decision has yet been taken on the future of that national helpline.

In conclusion, I add my voice to the calls made by my hon. Friend the Member for West Lancashire for an independent clinical review into patient harm associated with the leadership failings at the trust. We also need an investigation into the adequacy of the actions taken at the same time by NHS Improvement, NHS England, the clinical commissioning groups and their predecessor organisations. Only then can we move into a position from which we can confidently say this is something that will never happen again.

NHS Spending

Justin Madders Excerpts

Wednesday 6th July 2016 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

In what has been a hugely significant day in a monumentally significant fortnight, we have been discussing issues that are also of huge significance, but I fear that the contributions will be lost amid the historic nature of the events are currently engulfing this place and the whole country.

Let me turn now to the contributions to this debate. The hon. Member for Central Ayrshire (Dr Whitford) rightly highlighted the uncertainty now facing our staff who have come from the EU. There is also a very real fear that agency costs will go through the roof as a result of the decision that has been made.

My right hon. Friend the Member for Enfield North (Joan Ryan) spoke with graphic clarity about the problems that a lack of funding has caused the health services in her own constituency. She also pointed to the promises to protect local services that have not been honoured. She talked about the scandal of junior doctors left unsupervised in the North Middlesex hospital A&E. I know that she has a debate in Westminster Hall on that issue next week, and I am sure that some of the matters that have been raised today will get a further examination then.

My hon. Friend the Member for Copeland (Mr Reed), who, as my predecessor in this shadow role, has great knowledge of this area, spoke passionately about the challenges that his community faces in delivering an effective health economy. He is right to be concerned that the success regime could indeed turn out to be a Trojan horse.

My hon. Friend the Member for Burnley (Julie Cooper) gave a personal and troubling story about a recent case involving one of her constituents. I agree with the hon. Member for Aberdeen North (Kirsty Blackman) that all of us as politicians will have to work much harder to restore and retain trust in what we say. My hon. Friend the Member for Bristol South (Karin Smyth) spoke with the benefit of her own great experience of the NHS and her more recent experiences as a member of the Public Accounts Committee and the many critical reports it has written. I assure her that I have already considered many of them, so I trust I have her permission to watch the football later.

Finally, my hon. Friend the Member for Harrow West (Mr Thomas) spoke with great authority about the difficulties of his own local NHS trust. I think every Member who has spoken tonight has mentioned challenges in their own constituency, but more significant is the fact that every Member who has spoken tonight said that at least some of their constituents voted to leave the EU because they thought it would mean more money for the NHS.

Those are the Members who have spoken. Who have we not heard from? Where are the right hon. and hon. Members who have spent the last few months spearheading the campaign up and down the country claiming that there was £350 million a week just sitting there, ready to be spent on the NHS. Could it be that because it was a promise that could never be kept and should never have been made, we have seen a collective abrogation of responsibility by people who, frankly, should know better? Make no mistake: those who have associated themselves with such claims will be expected to account for their actions, but let us not allow those wild statements to distract us from the crisis in the NHS caused by this Government.

The challenges we already face in the finances, quality of care and the workforce put the NHS in a precarious position, but be in no doubt: those challenges were there before we voted to leave the EU. It has been clear for some time that the NHS does not have the resources needed to deliver the services that people expect. Only this week, we have heard where the Government’s priorities appear to be, with the Chancellor talking about reducing corporation tax yet again. Is it not interesting that we only hear such extra-parliamentary statements about tax cuts, and not about the extra investment that the NHS patently needs? Indeed, the Chancellor’s last big spending decision on the NHS was to cut £1.1 billion from this year’s capital budget, which came to light only after a study by the House of Commons Library—an approach about as far removed from parading impossible pledges on the side of a bus as I can imagine, but to my mind just as dishonourable.

As we know, the overall deficit in the NHS last year was a record £2.5 billion—a record deficit despite pledges from the Government that the investment needed would be front-loaded now to ensure that the NHS could implement the service transformation needed before the middle years of this Parliament, when the funding increases already announced for the NHS are microscopic. What will the NHS look like a few years down the line if the money that is supposed to be preparing us for the rocky road ahead will in fact be used to plug the black hole in finances left over from the last year? Surely, whatever the implications of the referendum result, the Government must recognise that their existing financial plan for the NHS needs comprehensive re-evaluation.

Only yesterday, we had a report from the Healthcare Financial Management Association that revealed that 22% of the NHS finance directors in hospitals and CCGs surveyed said that quality of care will worsen during this financial year. It does not end there: one in three finance directors fear that care will deteriorate in the next financial year. They warn that waiting times, access to services and the range of services offered are all likely to suffer because of the inadequate funding settlement. I know the Minister will try to reassure us that plans are in place to put the NHS back on an even keel, but I suggest that he listen to the 67% of CCG finance officers and 48% of trust finance directors who have said that there is a “high degree of risk” associated with achieving their organisation’s financial plans for this year.

In addition, only 16% of finance directors have expressed confidence that NHS organisations in their area will be able to deliver the changes required by their local sustainability and transformation plans. Along with the challenges they anticipate in delivering planned efficiencies, finance directors say that continued high spending on agency staff and inadequate funding of social care are pressures that are not going away. As my hon. Friend the Member for Bristol South mentioned, the Minister will be aware of what the Public Accounts Committee said: that the 4% annual efficiency targets imposed are

“unrealistic and have caused long-term damage”.

None of that will be news to the Minister. It is high time the Government acknowledged that within the current parameters, hard-working NHS staff are being set up to fail.

Across a whole range of indicators, the NHS is experiencing its worst performance since records began, but let me be clear: I do not for a second hold the people who work on the frontline in the NHS responsible for that. Indeed, it is only through their dedication that the health service keeps going, despite the best efforts of the Government to destroy staff morale. Be it the current generation of junior doctors alienated by botched contract discussions, the next generation of nurses deterred from entering the profession by tuition fees, or the thousands of EU nationals working in the NHS who fear for their future in this country, existing staff, who are at breaking point, see nothing from the Government that gives them confidence that the Government have a clue how to fix this mess.

Let us once and for all nail the myth propounded by Government Members that this Government have been generous in their funding for the NHS. The King’s Fund and the Health Foundation looked into this claim. Despite the oft-repeated mantra that this year’s funding increase is the sixth largest in the NHS’s history, they said:

“We find that…this year it is in fact the 28th largest funding increase since 1975”.

That is the truth. That is the cruel deception at the heart of the Government’s NHS plans.

NHS Providers, the organisation that represents NHS trusts, had this to say about the size of the deficit:

“the combination of increasing demand and the longest and deepest financial squeeze in NHS history is maxing out the health service”.

The fact is that the NHS is halfway through its most austere decade ever. It is getting a smaller increase this year than it got in any single year of the last Labour Government. Since the health service’s creation in 1948, NHS demand and costs have risen by 3.5% to 4% a year, and on average funding has kept pace. Now funding will rise, on average, by only 0.9% a year between 2010 and 2020. That is a quarter of the historical average, and well below what is needed to provide the same quality of service to a growing, older population.

I return to my opening remarks. It has been a seismic few weeks for this country. Politicians have been exposed as cavalier with the facts, cynical in their actions and irresponsible about the future of this country. Let us not allow that approach to continue to pollute our politics. Let us have the courage to be honest about the challenges that lie ahead. Let us stop the pretence that the NHS can continue to be the service that most of us want it to be within current Government spending limits.

Let us also be clear that the answer is not to emblazon buses with cheap slogans and then run away from those slogans at the first opportunity. Instead, the challenge for all of us in this place who want the next generation to enjoy the same access to the NHS that my generation has taken for granted is to provide a coherent, credible set of policies and then actually deliver them. On that measure, this Government have fundamentally failed. I therefore commend the motion to the House.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 5th July 2016 Commons Chamber

[Ben Gummer]

I welcome the hon. Lady to her seat. She fought a courageous campaign, and it is good to see her in the Chamber. She brings expertise to the House, which is also very welcome.

I agree with the first part of the hon. Lady’s question—the deficit at her local hospital is indeed partly caused by the excessive costs of agency nurses, and we are trying to put a cap on those costs—but I am afraid I disagree with the second part. I believe that changes in nurse bursaries will enable us to get more nurses and healthcare professionals into the NHS. There has been a similar development in the rest of the higher education sector, and I want to replicate that success in the NHS so that we can provide it with the workers that it requires.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I, too, am delighted to welcome my hon. Friend the Member for Tooting (Dr Allin-Khan) to her seat. Her recent experience on the front line of the NHS will be of great value, and we in the Labour party pride ourselves on listening to NHS staff. Let me also put on record my thanks to my hon. Friend the Member for Lewisham East (Heidi Alexander) for the excellent job that she did as shadow Secretary of State.

I must challenge the Minister again about the impact of this policy on mature students. According to an answer given to me by his colleague the Minister for Universities and Science, in 2010-11 there were 740,000 enrolments in higher education among people aged 21 or over. Let me ask a simple question: in 2014-15, after tuition fees trebled, was the number of enrolments among mature students higher or lower?

[Ben Gummer]

I echo the hon. Gentleman’s remarks about the hon. Member for Lewisham East (Heidi Alexander). She gave the House admirable assistance in challenging the Government, and I regret her loss from the Opposition Front Bench.

The latest figure from UCAS, for 2015, shows that the number of mature student applications has risen since the introduction of £9,000 tuition fees, but the hon. Gentleman is right to identify that factor as a challenge in relation to our new plans. That is why we asked open questions during the consultation, and I hope that, now that it has closed, we shall be able to respond to those questions to ensure that we can give the best possible assistance to mature students who want to become nurses.

[Justin Madders]

According to the universities Minister, the number of mature students enrolling in universities has fallen by 22%. If that were repeated in the health sector, what is already a staffing crisis would become a catastrophe. The Minister has said that an extra 10,000 training places will be created during the current Parliament, but everything I have heard from the Government suggests that that figure was plucked out of thin air. What is the baseline figure for the Minister’s claim—10,000 more places compared to when?

[Ben Gummer]

There will be 10,000 additional places over the five years from when the policy was announced last year, and that will give NHS organisations throughout the country the assistance that will enable them to bring down their agency costs. It is only through such bold initiatives that we can reform the NHS for the betterment of patient care throughout the country.

--- Later in debate ---

[Mr Hunt]

My hon. Friend is right to draw attention to that issue. We, too, are very proud of the progress we have made on mental health, with 1,400 more people accessing mental health services every day than six years ago, but there is a particular job to do with children and young people’s mental health, and we are putting £1.4 billion into that during the course of this Parliament—and there is a specific plan for the Manchester area, which I think will help my hon. Friend’s constituents.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It seems that almost every day there is another report about the deteriorating condition of NHS finances. Today we hear of a survey by the Healthcare Financial Management Association that said 67% of clinical commissioning group finance officers reported a high degree of risk in achieving their financial plan for the year, so does the Secretary of State now accept that the Government need to commit more funds to the NHS?

[Mr Hunt]

We have accepted that, which is why in our manifesto at the last election we were committed to putting £5.5 billion more into the NHS than was being promised by the hon. Gentleman’s party, but we have to live within the country’s financial envelope, because we know that without a strong economy we will not have a strong NHS. We will continue to make sure we get that balance right.

Stillbirth

Justin Madders Excerpts

Thursday 9th June 2016 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is an honour to serve under your chairmanship, Sir David. I congratulate the hon. Member for North Ayrshire and Arran (Patricia Gibson) on securing this extremely important debate and the compelling way that she introduced it. She is right that she is not alone in having gone through such a terrible experience, and she is certainly not alone in wanting to move this issue up the political agenda. I pay tribute to her for the courage that she has shown in retelling her experience. I do not think that any Member could fail to have been moved by her speech, and I am sure that many of those watching her contribution will, sadly, have recognised the personal tragedy, which was made more difficult by the defensive attitude of the health service. Many people have had such experiences—not just in this area but through many other failings in care in the health service. She made a compelling case for the extension of coroners’ powers to holding inquests on stillbirths. As we know from recent high-profile inquests, there is a need for a comprehensive review of that whole system.

Hon. Members from both sides have made excellent and sometimes very moving contributions. I draw particular attention to the contribution of the hon. Member for Henley (John Howell), who rightly raised the impact on parents’ mental health of such experiences and the loss that the whole family feels. Not only the mother and father, but little brothers or sisters and the wider family are impacted by such tragic events.

The hon. Member for East Renfrewshire (Kirsten Oswald) was right to highlight the need for prevention and how many parents experience a stillbirth and never get an adequate explanation of how that happened. I agree that only through continued targeted action will we drive the necessary progress. The hon. Member for Colchester (Will Quince) summed up the challenge very well when he said that we do not like talking about death in this country. I pay tribute to him for the great strength that he showed in talking about his experience. I am sure that he will be able to get many more Members to talk about this subject through his work on the APPG. The hon. Member for Livingston (Hannah Bardell) spoke with great sincerity about her constituents’ experience and the twin to twin transfusion syndrome process, and conveyed the incredible range of emotions that parents must go through in such situations, which are rare but none the less extremely difficult for those involved.

I welcome the debate, which, as we have heard, coincides with Sands awareness month. I add my voice to those of others who have already paid tribute to the enormously important work that that charity does. Sands awareness month gives us the opportunity to increase awareness of stillbirth and neonatal death and the devastating impact experienced when a baby dies before, during or after birth, which hon. Members have conveyed with great sincerity and courage.

In November, I was privileged to have the opportunity to respond for the Opposition in a debate marking World Prematurity Day. That debate was also difficult, and what we heard then from Members about stillbirths and neonatal deaths was equally compelling and challenging. We still face those challenges, and this is an opportunity to explore in further detail some of the issues that were raised in November and have been raised today and to scrutinise the progress that the Government have made in the six months since that debate.

As has been said already, although there has been enormous progress in the past century in tackling stillbirth and infant mortality rates, progress has more or less stalled in the past two decades, and the UK continues to perform significantly worse than many comparable nations on infant mortality rates and remains one of the poorest performing countries in the developed world for stillbirths. That is a clear sign that we are not doing well enough in providing neonatal care or tackling the underlying public health issues that contribute to premature births and stillbirth.

Research into babies stillborn from 28 weeks indicates that the UK has a stillbirth rate of 2.9 per 1,000 births —higher than Germany at 2.4; Poland at 2.3; the Netherlands at 1.8; and Denmark at 1.7. Members have said that this issue is not just about statistics, and it is about far more than that, but those statistics need to be laid out, because it is clear that we are not doing as well as we should be and progress is not as swift as in some other places in Europe. I think that all Members want to see that situation addressed. We welcome the Secretary of State’s ambition to reduce stillbirths and neonatal deaths by 50% by 2030, but 14 years is a long way off, so will the Minister give us some indication of what progress he expects to be made before that date? Will he also set out where he expects us to be by around 2020, by which time the Secretary of State has indicated that he expects there to have been a measurable reduction?

We welcome the announcement from 13 November of a £4 million investment in equipment and training and the establishment of a new system enabling staff to review and learn from every stillbirth and neonatal death. The Government have signalled their intention to review every one of those tragedies, and I would appreciate it if the Minister could update us on how close we are to reaching that target, and when he expects it to be met.

One of the key themes that has emerged today and in the debate we had last year is that we have some of the finest neonatal care in the world in this country, but that there is simply far too much variability between hospitals and regions. In my role as an Opposition spokesperson I have had the pleasure of visiting some excellent facilities, most recently those at Barnsley general hospital, where the commitment and attention to detail of the staff, based on listening to and valuing patients’ views, was particularly impressive. At this point, I think it is worth paying tribute to NHS staff who are tasked with helping families at their most difficult time for the sensitivity, understanding and professionalism that they show.

The hon. Member for Colchester raised the issue of bereavement suites being available in every maternity unit in this country. If we had the same quality of care that I saw in Barnsley throughout the country, that would be a real achievement. We need to see those units that currently offer the very best care spreading their expertise across the country, so that everyone can have the very best throughout their pregnancy. Attempts to achieve that have begun. In March, NHS England published new guidance, building on existing clinical guidance and best practice. It identified four key interventions, with the aim of meeting the Secretary of State’s ambition to halve the rate of stillbirths by 2020. Those key interventions are reducing smoking in pregnancy, enhancing detection of foetal growth restriction, improving awareness of foetal movement and improving foetal monitoring during labour.

It has been estimated that if no women smoked during pregnancy, 7.1% of stillbirths could be avoided, which would equate to around 230 additional babies surviving each year. Smoking and passive smoking increase the risk of infant mortality by an estimated 40%. However, despite those startling statistics, we have seen a significant cut in public health funding, leading to around 40% of local authorities cutting budgets for smoking cessation services. Only last week I saw two pregnant women smoking on the same day. While I appreciate that that is anecdotal, it nevertheless brought home to me that we are certainly not making the inroads that we should be into cutting smoking during pregnancy. As the hon. Member for Colchester said, one in 10 women still smoke during pregnancy, which is startling, given the huge amount of evidence about the risks of doing so. We clearly need to do more to get that message across. If the key interventions are to be effective, cuts to public health budgets will not help in achieving that aim.

I have no doubt that the other suggested interventions will also help us to drive down rates of infant mortality. However, as the Royal College of Nursing has pointed out, England remains 2,600 full-time midwives short of the number it needs. We simply must have the correct level of staffing if we are to successfully implement that guidance. There are also serious issues in the levels of other clinical staff in neonatal units. The report published last year by Bliss, “Hanging in the balance”, argues that neonatal services are “stretched to breaking point”. It also states that two thirds of neonatal intensive care units do not have enough doctors and nurses, with around 2,000 more nurses needed to fill that gap. A report by the Royal College of Midwives also stated that more than 40% of wards became so busy last year that they were forced to close their doors. The average unit closed its doors on five occasions, with some closing more than 20 times.

Worrying reports this week also suggest that staff shortages and increasing demands are impacting on the ability of midwives and maternity staff to provide care. A survey by the Royal College of Midwives found that 62% of midwives and maternity support workers felt dehydrated at work because they did not have time to have a drink; 79% did not take the breaks to which they were entitled; and 52% had witnessed an error, near miss or other incident in the past month. Given the impact of current staff shortages, I question the proposal to replace bursaries for nurses and midwives with student loans, as I believe that is a risk we cannot afford to take at this stage.

The Universities Minister has confirmed that, since the tripling of tuition fees in 2012, the number of student nurses over the age of 25 has plummeted. Given that the average age of nurses and midwives in training is over 25, I have serious concerns that, for all the good intentions we have at the moment, we will not have the resources and staff to deliver the improved outcomes we all want to see. Areas such as neonatal care, which are already stretched, need more support, and I therefore invite the Minister to reconsider the current policy.

I conclude by focusing on the families who experience bereavement when their baby dies during or after birth. It is difficult to contemplate what they go through when what should be a time of joy and celebration becomes a period of tragedy beyond measure. Again, I pay tribute to the compelling way hon. Members have expressed their experiences. They have certainly given us all an awful lot to consider. What has made many people’s experiences even more difficult is that speaking about the loss of a baby has, as many Members have said, traditionally been considered taboo. Families have often felt they have nowhere to turn for help, or even to talk about it. The fact that Members have had the courage to talk about it today will help us challenge that taboo, and along with Sands awareness month, we will be able to make progress in making sure that we can talk about these issues openly and give a voice to those who have experienced the personal tragedy of the death of a baby.

I hope the great sincerity and passion with which Members have spoken will lead to a redoubling of efforts, not only in terms of neonatal care and tackling public health issues but in ensuring that we listen to the experiences of people who have gone through this, so that families get the support they need at the point of such a personal tragedy. They deserve the best possible bereavement support from highly trained professionals, and we should do everything in our power to ensure they are offered nothing less than the very best.