Covid-19: PPE Procurement

Sarah Owen Excerpts

Thursday 24th November 2022 Commons Chamber

[Neil O’Brien]

The hon. Gentleman always makes constructive suggestions, and today is no exception. He knows that we have an ongoing inquiry into the lessons that can be learned and a dialogue with the Health and Social Care Committee about many of these issues. Given its heritage, Northern Ireland was an important supplier of textiles and PPE equipment. Inevitably, given the global balance of production, a lot of items did come from China, as he says, but as part of the lessons learned, we should be thinking about domestic supply.

[Sarah Owen (Luton North) (Lab)]

We have all seen the shameful Guardian front page this morning, but the front page that sticks in my mind is the one showing nurses in bin bags—not PPE on the frontline, but bin bags. This was at a time when Luton Borough Council was facing another cut of £11 million. People are struggling, so why are this Government not lifting a finger to get our money back? They could start by releasing the records after the mediation process.

[Neil O’Brien]

The hon. Lady’s question takes us back to that extraordinary moment when we had a huge crisis of PPE, and we were desperate and doing every conceivable thing we could to get the PPE that those nurses needed; that is what I have been referring to in my answers this morning. It is just not true that the Government are not lifting a finger to get the money back. We have a process, and there is a substantial team in the Department working on it right now.

Oral Answers to Questions

Sarah Owen Excerpts

Tuesday 19th July 2022 Commons Chamber

[James Morris]

That sounds like a very distressing constituency case. Obviously we are investing lots of money in research across the whole cancer spectrum, and I would be happy to meet my hon. Friend to discuss the issue he raises.

[Sarah Owen (Luton North) (Lab)]

Unprotected exposure to the sun can leave someone vulnerable to skin cancer, but as my constituent Tina, who suffers with melanoma, knows, the sun is not the only risk factor for skin cancer—sunbeds continue to be used all year round at very high risk. Does the Minister agree that it is time we took the dangers of sunbeds seriously? Does he support Melanoma UK’s campaign to ban the use of sunbeds, and if not, why not?

Access to GP Services and NHS Dentistry

Sarah Owen Excerpts

Tuesday 21st June 2022 Commons Chamber

[Imran Hussain (Bradford East) (Lab)]

For many people living in Bradford, being unable to get an appointment with their GP for days or weeks, or being unable to see an NHS dentist at all, is one of the most depressing issues they face—if not the most depressing. Although such a scandal in our healthcare system is of course unacceptable anywhere, the harm that it is causing in Bradford, where we face especially stark health inequalities and where people are dying a decade earlier and facing a higher rate of preventable diseases, is particularly damaging.

It seems that the Government either do not understand or just do not care. Earlier, the Secretary of State opened for the Government. According to him, we have had record levels of investment, the Government are now planning many initiatives, and any concerns were entirely a result of the two years of covid. Of course, everybody in this Chamber would accept that the NHS, GPs, dentists and all the health services faced pressures during covid. I do not think anyone is denying that. The Secretary of State said to the shadow Minister, “You supported us during that period”. Of course we did. We were a responsible Opposition and of course we ensured that any pressures during a very difficult period could be alleviated. But to say that the issues have suddenly resulted from that period is simply untrue, and Ministers know that it is untrue.

The second assertion—those who were in the Chamber will recall that I pressed the Secretary of State about his record investment in the NHS—was that of course there was record investment, but let us look at that investment. Let me go to my district, to Bradford, and see the record investment that Ministers and the Secretary of State want to boast about. Frankly, they live in some parallel universe, because we do not see the effect that they come here and tell us about. In Bradford, one of the most deprived districts—more than 50% of the deprivation in my constituency is in all the top 10 deprivation indices—child poverty is now at a record high because of those on the Government Benches. Nearly 50% of children in my constituency today live in poverty because of the draconian, ideological cuts made by this Government over the past decade. I have said this in the Chamber many times: people who live in the inner cities are likely to live 10 years less than if they live in the leafy suburbs, which are far more affluent and, frankly, get more investment.

What does the record investment that the Secretary of State and Ministers tell us about equate to in Bradford terms? They tell us that, on average, we will get £4 per patient more than the rest of the country, even though we have the levels of deprivation, poverty and health inequalities that I have gone through. But actually the situation is worse, because even that £4 of investment that they tell us we are getting is fudged figures and smoke figures, because in real terms, if inflation was to be counted, we are getting £3 million less than we had before this Government came to power. On average, we have more than 2,800 patients per GP, whereas the national average is 2,100 patients per GP. If anywhere should be seeing this record investment, it should be in places such as Bradford, but are we seeing it? How does that equate? The hon. Member for St Albans (Daisy Cooper), who is no longer in her place, talked about the stark reality on the ground. This is why I say that Ministers are living in a parallel universe, because the stark reality on the ground is not as they see it. Most people simply cannot get GP appointments. People start ringing first thing in the morning and are on hold for hours on end. Many people will then have to wait until the next day. Getting through to a GP practice on the phone takes days on end.

[Sarah Owen (Luton North) (Lab)]

When the Minister comes to her feet, I am sure she will say that X number of people have been able to access a GP, but have they been able to access their own GP? We have heard time and time again from health professionals how important continuity of care is. Does my hon. Friend agree that this is not just about seeing any old GP—it is about someone seeing their own GP?

[Imran Hussain]

I absolutely agree with my hon. Friend, who makes the point that I was coming on to raise. Her Luton constituency is not dissimilar to mine. With a single GP having 2,800 patients, it is obvious why those patients are not getting to see their GP. I could spend a long time in this Chamber going through constituency cases that I have recently dealt with. Indeed, I have done that in the past and those cases are on the record. Let me cite just one case today. An elderly lady in her 90s had to go to hospital and was then told to go to see her GP. Her son tried day after day to make a simple GP appointment for her. She had multiple health needs. My office had to intervene and even we were unable to secure a GP appointment for her. People are having to go through this ping-pong of not getting a GP appointment and then going to A&E as they have nowhere else to turn.

I am grateful because I did ask the Health Secretary about Bradford and urgent treatment centres, and he did favourably say that he would arrange a meeting with the Minister for Health, the hon. Member for Charnwood (Edward Argar), who joins us now, at precisely the right time. I look forward to that meeting because that is a way through and I am grateful for that offer. But the reality remains that the Government’s promise—or the points the Secretary of State made earlier today—is not apparent on the streets. People continue to suffer, they cannot get GP appointments and they have nowhere else to turn. That point has been made eloquently by a number of Members.

At least, after days and weeks of trying, people are able to get an appointment with a GP. Many Members have talking about issues with joining an NHS dentist. There is more chance of finding gold bricks on the street, or of finding the parallel universe that Government Ministers live in, than there is of getting on to the list of an NHS dentist. People simply cannot get NHS dentists, and we have heard accounts today of how they are being forced to carry out DIY operations at home, without anaesthetic or any medical care—I have come across such cases in my own constituency—because they have no other option. Frankly, as the fifth largest and richest economy in the world, it is shameful that people are having to resort to DIY treatment at home. Again, that is happening on this Government’s watch.

I have been in this place since 2015, and every time we have a debate about NHS dentists or GPs, Tory Members refer back to the Labour Government of 12 years ago. I remember that when I was growing up, under a Thatcher Government, GP practices were back-to-back houses on terraced rows without adequate facilities. The last Labour Government brought in record investment, gave us state-of-the-art health centres, and reduced health inequalities and child poverty. That was all under a Labour Government, but Tory Members cannot pretend that the Labour Government of 12 years ago are somehow responsible for the issues we face today. The Whips are not in their place, but I say to the Tory Whips, “Please do your Members justice and remove that line from the long-standing script you have for them”, because it is becoming embarrassing when Tory Members stand up and say, “12 years ago, there was a Labour Government, so it must be all their fault.” They can use that line for a year or two, but unfortunately, in nobody’s world can they use it for 12 years. Tory Members need to start understanding that.

Can we expect any more from this Government? This is a Government who believe people choose to be poor—they have said so in this very House and on TV. This is a Government who believe people should work extra hours and do more, and that those who are forced into poverty are not forced, but have chosen poverty. The reality is that this is a Government who could not care less about people in Bradford who continue to suffer. [Interruption.] The Minister chunters from the Front Bench; she will have time to address those points when she responds.

Children’s Mental Health

Sarah Owen Excerpts

Tuesday 8th February 2022 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)]

I hear your words loud and clear, Madam Deputy Speaker.

I am grateful to Opposition Members for providing the opportunity to debate the very important issue of children and young people’s mental health on the Floor of the House in Children’s Mental Health Week. As my hon. Friend the Member for Eddisbury (Edward Timpson) stated, this is such an important issue and I hope that we can use this debate to find common ground. I pay tribute to his work on this extremely important issue.

This year’s theme is “Growing Together” and I know that the past two years have been tough for many young people and their families. While some young people may have seen their mental wellbeing improve during lockdown, for many others, the disruption to their home lives and education has caused difficulties. We must support them to grow emotionally and find ways to help one another to grow.

We recognise that both the health and care and education sectors continue to face challenges caused by covid-related issues. I thank all staff across all sectors for their ongoing dedication to supporting children and young people in this vital period and for the support for their families, too.

Children and young people’s mental health and wellbeing are a priority, as is face-to-face education, so that children and young people feel supported in their education and on track with their learning and wider development. Around 12,000 schools and colleges across the country benefited from £17 million to improve mental health and wellbeing support in schools and colleges. I want to be clear that children and young people are not alone on this journey and that the onus is not on them to catch up; it is something that the whole school and whole education system is looking to achieve together, and it is our priority to support them to do so.

The Government are delivering record levels of investment in mental health services, but that was not always the case. Through the 2016 “The Five Year Forward View for Mental Health”, we now have a solid foundation on which we can build the necessary levels of care and support, but we know that we need to be more ambitious. That is why we published the Green Paper on transforming children and young people’s mental health provision in 2017 and the NHS long-term plan in 2019. Together, they set out a clear vision for ensuring that children and young people who need mental health support can get it when they need it.

The NHS long-term plan is backed by an additional £2.3 billion a year for mental health services by 2023-24. That will mean that an additional 345,000 children and young people will be able to access support.

[Sarah Owen (Luton North) (Lab)]

Will the Minister give way?

[Maggie Throup]

I will make progress because we are short of time and I want to give plenty of time for Back Benchers to contribute.

More than 420,000 children and young people were treated through NHS-commissioned mental health community services in 2020-21, which was almost 100,000 more than three years ago. The NHS children and young people’s mental health workforce has seen growth of 40% from 11,000 whole-time equivalents in 2019 to 15,486 whole-time equivalents in 2021.

Early intervention and mental wellbeing support in schools and colleges can prevent poor mental wellbeing from developing into mental illness. We remain committed to the proposals set out in the Green Paper to roll out mental health support teams based in schools and colleges and staffed by mental health professionals. There are now more than 280 teams set up or in training, with 183 of those teams operational and ready to support young people in around 3,000 schools and colleges. I am really pleased that we have been able to accelerate that programme to meet our original target a year early and then reach around 35% of pupils through 399 mental health support teams by 2023.

Covid-19 Update

Sarah Owen Excerpts

Monday 29th November 2021 Commons Chamber

[Sajid Javid]

I thank my right hon. Friend for his support. The UK has been supporting a new vaccines programme largely thanks to his efforts when he was in my position. That work continues. If it is necessary to procure new vaccines that we believe are safe and effective and will help with the new variant, we will do so.

[Sarah Owen (Luton North) (Lab)]

Gordon Brown said yesterday that the chief medical officer urgently needs to teach the Prime Minister “some basic medical facts”, and I would say that that could probably be extended to some of those on the Government Back Benches as well, meaning that we are not going to stop the threat of variants—

--- Later in debate ---

[Mr Speaker]

Order. Mr Shelbrooke, I thought you might have been going on the NATO delegation, and I do not want to hear that you have missed out on it.

[Sarah Owen]

We are not going to stop the threat of variants derailing our progress until we vaccinate the world. Our country has enough vaccine to give at least three doses to everybody, yet of the 100 million doses that were pledged by the Prime Minister to the world’s poorest, less than 10% have actually been delivered. Can the Secretary of State tell us if the PM will meet his ambition to help vaccinate the world by the end of 2021, or is that yet another broken promise with catastrophic consequences?

[Sajid Javid]

I said earlier that, out of the 100 million commitment that the UK has made to international donations, over 20 million have already gone and been delivered, and another 10 million are about to go.

Covid-19 Vaccinations

Sarah Owen Excerpts

Thursday 4th November 2021 Commons Chamber

[Maggie Throup]

I reassure my hon. Friend that we always look at ways to make it easier for people to get their booster, as well as for people to get their first and second jabs and their flu jab. We are always open to looking at opening up further opportunities.

[Sarah Owen (Luton North) (Lab)]

The Minister said earlier that she will not take any lessons from Labour on this issue but, given we have one of the highest death rates in Europe, perhaps she should.

I want to talk about one of the most vulnerable groups of people who have been left unprotected throughout this pandemic. One in six of the most critically ill covid patients in the UK are unvaccinated pregnant women. What are the Government doing to protect pregnant women now and throughout the ongoing pandemic?

[Maggie Throup]

The hon. Lady makes a very good point. I find it really concerning that one in six people in hospital with covid are unvaccinated pregnant women and it is an issue that I wholeheartedly want to address. I encourage every lady who is either looking to become or is pregnant to talk to their midwife and their GP and get reassurance that vaccines are safe for that cohort of ladies. The best thing they can do is to protect themselves and their babies.

Health and Care Bill (Twenty First sitting)

Sarah Owen Excerpts

Committee stage
Thursday 28th October 2021 Public Bill Committees

[Edward Argar]

The new clause would require ICBs to provide specialist domestic violence and abuse training, support and referral programmes to all GPs, with the aim of strengthening the health response to domestic abuse and improving links between the NHS and voluntary sector support for victims. We have concerns about the new clause, which is why we cannot accept it, but I hope that I can set out to the shadow Minister my reasoning.

Domestic abuse, as we discussed yesterday when considering another proposed new clause, is a terrible crime, and it can have a devastating impact on victims and survivors. It is also important that we remember that children are often just as much victims as the victims themselves, through the experiences that they have of domestic abuse and domestic violence. The Government are clear that there is absolutely no excuse for abuse. Tackling domestic abuse and supporting victims, survivors and their children is a key priority for Government, now more than ever.

The Domestic Abuse Act 2021 and the forthcoming domestic abuse strategy will help to provide a whole-system approach to protect and support victims and their children. The measures in the 2021 Act seek to promote awareness by introducing a statutory definition of domestic abuse, and to recognise children, as I alluded to, as victims in their own right, in order to protect and support both, tackle perpetrators, transform the justice response, and drive consistency and better performance in the response to domestic abuse.

The 2021 Act also sets out the convening of local domestic abuse partnership boards, with healthcare representation. We recognise the key role that healthcare services play within a whole-system approach to tackling domestic violence. Healthcare services must identify signs of risk and harm, enable victims and survivors to come forward, and provide timely integrated care and support. We know how important it is that statutory agencies and professionals properly understand and react to domestic abuse. However, I hope that I can reassure the Committee that placing in the Bill a formal duty on ICBs to ensure that specialist domestic violence and abuse training, support and referral programmes are universally available to all GPs is not necessary.

General practice is delivered by multidisciplinary teams, rather than just GPs, and existing Care Quality Commission registration requirements include a review of practices’ safeguarding processes. In addition, NHSEI’s ICS people guidance sets an expectation that ICBs will foster learning and continuing professional development. Going further, the Bill, in proposed new section 14Z41 of the National Health Service Act 2006, imposes a duty that each ICB

“must, in exercising its functions, have regard to the need to promote education and training for the persons mentioned in section 1F(1)”

of the 2006 Act.

[Sarah Owen (Luton North) (Lab)]

Again, I break the convention that Whips do not speak, because this issue is close to my heart. I listened carefully to the discussions yesterday, and to what the shadow Minister, my hon. Friend the Member for Nottingham North, and the Minister have said on the new clause, but if we looked at domestic abuse as a disease or virus, given the fact that it kills women, it kills people in their homes, and has mental and economic impacts that affect people’s overall health, we would certainly ensure that GPs were trained on it. Why can we not do the same thing with domestic abuse?

[Edward Argar]

I am grateful to the hon. Lady. In part, the reason is because this is sadly not a well drafted new clause. It is very narrowly drafted to GPs, not recognising the multidisciplinary nature of how healthcare is delivered in GP practices. I suspect that we all have correspondence from constituents—whether happy or unhappy—going to doctor associates, practice nurses and others. That is one of my key concerns, but let me articulate a little more what is already being done. I see where she is coming from. As I mentioned yesterday, I was the Minister with responsibility for victims of domestic violence, and of crime in general, when I was in the Ministry of Justice, so it is something that I am very familiar with. It is about raising awareness not just with GPs, but within the police and a range of agencies. My challenge, just before she intervened, was partly about the way the new clause is drawn, but let me articulate a little further our views on it. I am keen to do so before the business possibly collapses early in the House, and we have to adjourn in order that I can respond to the Adjournment debate.

Section 1F of the 2006 Act defines a wide group of people, covering persons who are employed, or who are considering becoming employed, in an activity that involves or is connected with the provision of services as part of the health service in England. That duty on ICBs would already cover general practitioners, but it goes wider. I appreciate that the new clause goes beyond training, so I will also discuss the support and referral elements that the hon. Member for Nottingham North talked about.

The NHS provides care and support to victims of domestic abuse through a range of healthcare services. This response is centred around ensuring that healthcare professionals are trained to spot the signs of domestic abuse and those at risk; to make safe and sensitive enquiry of the issue; to know where to refer people to get further support, and to know when and how to share information appropriately with colleagues and other organisations.

All NHS staff must undertake annual mandatory safeguarding training, which includes focus on domestic abuse. NHS England, NHS Improvement and Health Education England are reviewing mandatory safeguarding training for all health professionals to ensure that they are fully equipped with the key skills, knowledge and principles to protect all citizens. The Government published an online domestic abuse resource for health professionals and have developed a number of training modules with the Institute of Health Professionals, the Royal College of Nursing and the Royal College of General Practitioners.

From 2018 to 2020, the Department managed £2 million of funding for the domestic abuse pathfinder programme, which created a model health response for survivors of domestic violence and abuse in acute, community and mental health services. The pathfinder toolkit was published in 2020 as the result of emerging promising practice at our pilot sites, coupled with the expertise of the pathfinder consortium of specialist domestic abuse organisations, to encourage best practice across the health system. Pathfinder has given us a model for our response to domestic abuse in healthcare. It is a model for integrated, joined-up and trauma-informed care and support, with healthcare settings and the voluntary sector working together.

As the shadow Minister mentioned, the Department of Health and Social Care has also funded the IRIS programme, to which I pay tribute. IRIS is a training, referral and advocacy model to support clinicians in better supporting patients who are affected by domestic violence and abuse, and to increase the awareness of domestic violence and abuse within general practice. IRIS is recognised by the DHSC as good practice, and via the National Institute for Health Research we funded a study that demonstrated the effectiveness of the IRIS programme at scale. I am delighted to note that the study won the 2020 Royal College of General Practitioners research paper of the year award.

I am proud that the Government have championed the building of that evidence base. I believe that it would not be best or appropriate, however, for the legislation to require local health and care systems to adopt specific programmes. Indeed, such detailed requirements would reduce local health and care partners’ flexibility to meet the needs of their local populations or to engage with particular local organisations and expertise in delivering their programmes.

Beyond ICBs, I see a huge opportunity for integrated care partnerships to support improved services for victims of domestic abuse, sexual violence and other forms of harm, through better partnership working and joint planning of services. The Government have also developed a cross-Government strategy for tackling violence against women and girls, and will develop a cross-Government domestic abuse strategy.

As committed to in the tackling violence against women and girls strategy, the DHSC will continue to work closely with NHS England and NHS Improvement to promote evidence-based approaches to tackling violence and abuse through guidance and engagement with the new system.

Baby Loss Awareness Week

Sarah Owen Excerpts

Thursday 23rd September 2021 Commons Chamber

[Nickie Aiken (Cities of London and Westminster) (Con)]

I thank my dear friend, my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory), for having the bravery we have seen here today, but also for how, throughout her time in this place, she has fought and campaigned very bravely for those who have experienced the loss that she has experienced. I think we see this place at its very best when we come together, put politics aside and discuss the issues that are so important and affect so many thousands of families across our country. I also pay tribute to the former Minister for patient safety, suicide prevention and mental health, my right hon. Friend the Member for Mid Bedfordshire (Ms Dorries), who has certainly put campaigning for women’s health at the front of her Government’s priorities.

I, too, have experienced baby loss, and I remember it as if it was yesterday. It was my first pregnancy with my husband and, sadly, at eight weeks it did not continue. It is something that stays with me even today; this is the first time I have actually spoken about it publicly. However, I was very fortunate in that, within five months, I was pregnant again and I had my rainbow baby. Until Mrs Johnson, the Prime Minister’s wife, used that term I had never heard of a rainbow baby, but it is a fantastic term because it is about the positiveness that can come after the dreadful experience of losing a baby. My rainbow baby is now 17 years of age, in her last year of school and about to begin her life adventure.

It was not until I had my miscarriage that I realised that one in four pregnancies can be lost in this country, usually early—before 12 weeks. More than this, estimates from St Mary’s Hospital in Paddington in my constituency suggest that there are about a quarter of a million miscarriages every year in the UK, and about 11,000 emergency admissions for ectopic pregnancies, which always, sadly, result in pregnancy loss.

I think the theme of wellbeing for the forthcoming Baby Loss Awareness Week this year is so important. On this, I am very proud to highlight the work of the brilliant maternity wards at St Mary’s Hospital, which were the first in London to receive an outstanding rating from the Care Quality Commission. I invite the Minister to join me on a future visit to see their work at first hand, with, I hope, my hon. Friend the Member for Truro and Falmouth.

I note that patients from St Mary’s, which is part of the Imperial College Healthcare NHS Trust, have been taking part in a new study showing that one in six women experience long-term post-traumatic stress following baby loss.

[Sarah Owen (Luton North) (Lab)]

I congratulate the hon. Member on having a rainbow baby, as I do myself. We know that the road to pregnancy is not always smooth, and the numbers she has just highlighted show how frequently this happens. Is it not now time that we reviewed the cruel requirement for three miscarriages or baby losses before medical intervention is offered to families?

[Nickie Aiken]

I thank the hon. Member for her intervention, and I think it is clear from the debate today that there needs to be more support for women and their partners when they experience miscarriage. I will never forget, when I became pregnant with my daughter, how terrified I was of going for the 12-week scan, because my first experience had been one of baby loss and I had been told at that scan that the baby was not viable. I think I would have benefited from some counselling and some support when I was going for that scan for the second baby.

--- Later in debate ---

[Maria Caulfield]

My right hon. Friend is right that there has to be a whole family, cross-departmental approach, which I hope we can take forward.

The partners of expectant new mothers also face the stigma that many hon. Members have mentioned this afternoon, and I hope we can improve the situation by offering a range of help, such as peer support, behavioural couples therapy sessions and other family and parental interventions. I will focus on that.

This year, unlike in our previous debates on Baby Loss Awareness Week, we have to consider covid. This year, more than most, has been particularly difficult for those facing the loss of a baby. The covid pandemic means measures have been put in place to protect healthcare workers, patients and the general public, and it has been particularly difficult for those who have suffered baby loss during this period.

Specifically on preventing maternal death and morbidity due to covid, recent findings from a national perinatal study show that of 742 women admitted to hospital since vaccination data has been collected, four had received a single vaccine dose and none had received both doses. This means that more than 99% of pregnant women admitted to hospital with symptomatic covid-19 are unvaccinated, and one message I want to get across today is that it is hugely important that mothers and their families are vaccinated to improve their safety.

[Sarah Owen]

We have been pushing the Joint Committee on Vaccination and Immunisation to make sure that pregnant women are a priority group. Will the Minister give a commitment today that pregnant women will be a priority group in any booster programme?

[Maria Caulfield]

I take the hon. Lady’s point. There was a lot of misinformation earlier in the year that made pregnant women reluctant to come forward, and there is a lot of work we can do to improve that communication.

Health and Care Bill (Ninth sitting)

Sarah Owen Excerpts

Committee stage
Tuesday 21st September 2021 Public Bill Committees

HEE’s “Framework 15” will help to ensure that we have the right numbers, skills, values and behaviours to deliver world-leading clinical services and continued high standards of patient care. For the first time ever, the framework will include registered professionals working in social care, such as nurses and occupational therapists, as I have mentioned. That will require close working with partners and stakeholders from all levels and sectors, so that we can build a shared set of assumptions and common goals to provide that clear shared framework within which more detailed workforce plans can be developed and delivered nationally and locally, resulting in better care and better work for all.

[Sarah Owen (Luton North) (Lab)]

I know it is not the done thing for Whips to contribute to debates, but because I have been a care worker, this part of the Bill is close to home for me. I wanted to touch on the word that the Minister used when he spoke about “assumptions” about workforce planning. Does he agree that actual independence takes away the need for Ministers to make assumptions, and that is why the amendment is important? Otherwise, Ministers are in danger of marking their own homework when it comes to whether they have met the workforce projections that they say they have met.

[Edward Argar]

The hon. Lady alludes to it not being normal form for a Whip to intervene, but her contribution is, as ever, extremely valuable in this context—particularly given the work that she did before she became a Member of this House—and I am grateful to her. My counterpoint would be that we need to be cautious about a separation of projections and planning from the reality of day-to-day delivery. The system, as envisaged, will bring together an actual knowledge of what is going on on the ground with those projections and data delivery.

I suspect that I will not convince the hon. Lady, but I recognise and acknowledge the expertise that she brings to the area. Back in my days as a councillor, I was a cabinet member for adult social care and saw at first hand the amazing work done by care professionals and by volunteers in the care sector. Notwithstanding any political disagreements we might have, I pay tribute to her for that.

Finally, regarding the consultation requirements in amendments 94 and 41, I assure the Committee that consultation already happens throughout the workforce planning and delivery process. To give a recent example of such engagement, HEE completed a call for evidence as part of its refreshed “Framework 15”. That call for evidence closed on 6 September and received responses from a wide variety of bodies. Between October and April of next year, engagement and consultation will continue through various events led by HEE. I am sure that as I assume my new responsibilities, I will occasionally be questioned on those by the shadow Minister, either across the Dispatch Box or in written questions and letters, as is his wont and, indeed, his right.

At local level, ICBs will be under various workforce-related responsibilities and obligations, as I have set out. As part of that work, we can expect ICBs to work with local stakeholders in their area. We expect all this stakeholder consultation to continue, but we want engagement to be flexible, in keeping with one of the principles—the permissive principle—behind the Bill.

Let me turn to the issue of safe staffing. Amendment 42 would significantly amend our proposed workforce accountability report so that it would have to cover an assessment by the Secretary of State of safe staffing levels for the health service in England and whether those were being met. The effect of the amendment in reality would be to require the Secretary of State to make such an assessment but, in so doing, risk detracting from the responsibility of clinical and other leaders at local level for ensuring safe staffing, reflecting their expertise and local knowledge, supported by guidance and regulated by the Care Quality Commission. We do not support the amendment as drafted, for various reasons.

First, there is no single ratio or formula that can calculate the answer to what represents safe staffing in a particular context, and therefore against which the Secretary of State could make an objective assessment. It will, as we have seen over the past year and a half, differ across and within an organisation. Reaching the right mix, for the right circumstances and the right clinical outcomes, requires the use of evidence-based tools, the exercise of professional judgment and a multi-professional approach. Consequently, in England, we think that the responsibility for staffing levels should remain with clinical and other leaders at local level, responding to local needs, utilising their expertise, supported by guidelines from national bodies and professional organisations, and all overseen and regulated by the CQC.

Secondly, the amendment would require the formulation of safe staffing levels against which the NHS workforce could be assessed. I fear that that would be a retrograde step, as it would inhibit the development of the more productive skill mixes that are needed for a more innovative and flexible workforce for the future. That new workforce is crucial to successful implementation of the new models of integrated care that the Bill is intended to support.

The specific wording of the amendment is incredibly broad and would require the Secretary of State to assess safe staffing levels across all healthcare settings, across the whole of England, for all medical and clinical staff. Such a duty would be burdensome not only for the national system but, potentially, locally—for local clinical leaders. It would move us away from that local accountability and expertise.

I assure the Committee that we will continue to engage with stakeholders and hon. Members, including my right hon. Friend the Member for Kingswood, to look closely at this area. I want to reassure Members, including Opposition Members, that we have heard their concerns and the views that they have expressed in relation to workforce in today’s debate and reflecting the evidence of witnesses. I am grateful, as ever, for the tone in which the shadow Minister has raised his concerns and put his points. We will carefully consider these issues and continue to ensure, and to reflect on ensuring, that we work to address them through the Department’s wider work on workforce.

Let me just say, before concluding, that while we were doing the changeover between clauses, I did a very quick check and I believe I was correct in my answer to the shadow Minister that no applications were currently pending for foundation trusts. I wanted to clarify that it turns out I was right—I suspect he thinks he was right in his assumption as well.

For the reasons that I have set out, I encourage hon. Members not to push these amendments to a Division but to continue engaging with me and other Ministers.

Reducing Baby Loss

Sarah Owen Excerpts

Tuesday 20th July 2021 Westminster Hall

[Sarah Owen (Luton North) (Lab)]

It is a pleasure to serve under your chairship, Mr Gray. It is an honour to follow my hon. Friend the Member for Liverpool, West Derby (Ian Byrne), who spoke wholeheartedly on behalf of his constituents. I thank the hon. Member for Truro and Falmouth (Cherilyn Mackrory) for her courage and compassion, and for her campaigning throughout. She is an inspiration to so many women out there.

The last time we debated this subject, although it was in Westminster Hall, as opposed to here, we had a very emotional debate on baby loss. It was Parliament at its best. MPs from across the House brought their life experiences—and, yes, painful experiences—to benefit the people we seek to serve. That is Parliament at its best.

This has been a painful year for many women and families. We have heard from constituents who were forced to receive bad news apart, were unable to grieve losses together or were even unable to hug a friend or a loved one they saw in pain. Those of us who have experienced baby loss and miscarriages know the pain and anxiety that appointments and scans can cause. I remember breaking down into bits at just the first appointment. It was just a question-and-answer session with a midwife during my second pregnancy, but it can be a horribly anxiety-provoking, triggering experience to go back to a place you have received bad news in the past, let alone doing that during a pandemic. Many women this year have been robbed of the joys of pregnancy.

Although I have had two pregnancies that ended in miscarriage, I now speak from the fortunate position of having a beautiful rainbow baby, which is the term used for a baby following miscarriage or baby loss. That is a very different experience from before. I do not know how others have the strength to speak out while they are still on that journey or without their rainbow. I know I would struggle; you are truly inspirational.

It is because of that shared experience that I am especially proud of the teams at Luton and Dunstable University Hospital, who recognise the pain and stress this has caused. I thank the team at Luton and Dunstable for working with me and families to accommodate visitors at scans and appointments as soon as possible. I appreciate that they are under huge stress and pressure during the pandemic, but the difference they make to families is priceless. Thank you to the sonographers, the early pregnancy units, the admin staff, the midwives, the GPs and the consultants who have helped women through this difficult year. You have gone above and beyond—thank you.

To fast-forward to just a few weeks ago, I met some of the brilliant midwife team at the L and D to talk about the changes and the challenges of the future. One is always staffing. They are doing wonders, but to limit the burnout that this pandemic has caused, we need to ensure that we not only retain midwives but recruit adequate numbers. NHS staff have experienced increased stress and pressure, which would test even the toughest of heroes. Hospitals could delay some procedures and surgeries, but as one midwife told me, people do not stop having babies.

We know how important continuity of care is to the health of both mother and baby, so it would be great to get an update from the Minister on where we are on the target to improve continuity of care for women, especially for black and Asian mothers, for whom the maternal health outcomes have been particularly poor. We have heard that stillbirths have doubled for black women, and Asian women are more than 1.6 times as likely to experience stillbirth.

I hope the Minister takes a serious look at the proposals in the report of the Health and Social Care Committee, on which I sit. The Committee heard evidence from a range of parents, grieving families and health experts. I hope the Minister takes a serious look at the recommendations and takes steps to implement them. One of the crucial recommendations is about having adequate levels of staffing. How many midwife vacancies are currently unfilled? How many do we need to train and retain in position to meet future challenges and targets on providing continuity of care to all mothers?

To focus quickly on the pandemic, we know the devastating impact that covid can have on pregnant women. The Royal College of Obstetricians and Gynaecologists released shocking statistics relating to pregnant women and covid. One in 10 pregnant women admitted to hospital with covid symptoms needed intensive care. More than 100 pregnant women have been admitted to hospital with covid-19 in the past two weeks. No pregnant women who have received both doses of the vaccination have been hospitalised since vaccination programmes began. Those are startling statistics.

The Minister joined me to meet my constituent Ernest Boateng who lost his wife Mary more than a year ago, shortly after she contracted covid-19 and gave birth. Ernest has shown amazing strength after losing Mary to look after his two beautiful children. His campaign to see pregnant women prioritised for vaccination is inspirational and one I wholeheartedly support, as do the facts. Yet, throughout this year, and despite protestations from Ernest and MPs such as my hon. Friend the Member for Walthamstow (Stella Creasy) and others, the Government have failed to prioritise pregnant women for vaccination, relying on the Joint Committee on Vaccination and Immunisation recommendations. I feel the figures now show that that should change. I ask the Minister to commit that, should boosters be needed in future, pregnant women will be some of the first to receive them, and that alongside that there will be an education and information programme targeted at pregnant women.

Before we get to that stage, there is the issue about which my hon. Friend the Member for Sheffield, Hallam (Olivia Blake) has spoken so passionately from the heart: the ludicrously cruel requirement that women should suffer three losses before support is given specifically for miscarriage and baby loss. Let that sink in. In 2021, we are asking women to go through such a physical, emotional and painful loss three times before they qualify for extra tests, or even early pregnancy support in future pregnancies. How can that be right?

I was lucky to receive extra help and access to some of those tests, but only because a consultant was kind enough to count the losses that I had in the number of babies, rather than pregnancies. I am currently working with a constituent in a similar situation. I am pleased to say that she is now accessing the support she needs, but that should be the norm; it should not be extraordinary. Why are we making women and families go through such pain before they even get a simple blood test? It is cruel beyond belief.

To summarise my points: first, we should make pregnant women a priority for covid-19 vaccines and ensure that they are prioritised for any subsequent boosters. Secondly, we need to recruit, retain and reward midwives to ensure that we have adequate numbers, while being honest about the scale of the challenge ahead of us. That leads on to point three about continuity of care. We need to see continuity of care, prioritising those who are most in need, particularly black mothers, who are four times more likely to die during childbirth.

We must implement the recommendations in the Health and Social Care Committee report. Many of my colleagues on the Committee would have joined today’s debate, but that Committee is sitting at the same time. I pass on their apologies, knowing their strength of feeling and that we are united on those recommendations. Finally, we must end the requirement of three losses before intervention and support is given to women. Pregnancy can be a painful journey for far too many women. Let us listen to women, end that cruel requirement and support women through their joys and their losses, and so improve the statistics on baby loss and miscarriage for good.

--- Later in debate ---

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

It is a great pleasure to serve under your chairmanship, Mr Gray, and a huge pleasure to respond to my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory). Many tributes have been paid to her bravery, courage and compassion and to how inspirational she is on this issue. I echo all that and thank her for securing this debate today on an incredibly important issue.

This debate has an hour and a half. If we had half a day, it still would not be enough. I have 10 minutes and a huge amount of information to respond to. I will not be able to respond to all the questions and issues raised in those few minutes. The hon. Member for Nottingham South (Lilian Greenwood) and I have a call very soon and we will discuss Nottingham in detail during it.

I want to start by saying that the UK is one of the safest countries in the world to give birth. We are safer than Canada, the United States, France and New Zealand. I could go on listing how safe we are. We have made good progress. I want to start with that context. We have made really good progress in improving maternity safety over the past few years. The original ambition was to halve the 2010 rates of stillbirths, neonatal and maternal deaths, and brain injuries in babies occurring during or soon after birth by 2030. We updated that ambition in 2017 to bring forward that date to 2025 and to include an additional ambition to reduce the rate of pre-term births from 8% to 6%.

In relation to stillbirths, we are making solid progress towards meeting that ambition. Since 2010, the stillbirth rate has fallen from 5.1 stillbirths per 1,000 births to 3.7, which equates to a 25% reduction in the stillbirth rate. That places us firmly ahead of our target to meet the 2020 ambition for a 20% decrease, and that means there are now at least 750 fewer stillbirths each year.

Similar progress has been made on reducing the number of neonatal deaths. According to the ONS, there has been a 29% reduction in the neonatal mortality rate for babies born over 24 weeks of gestational age of viability. I am particularly proud of that progress and acknowledge that progress on reducing the maternal mortality rate, the brain injury rate and the pre-term birth rate has been slower. However, according to a bespoke definition developed by clinicians at the request of the Department of Health and Social Care, the overall rate of brain injuries occurring during or soon after birth has fallen to 4.2% per 1,000 births in 2019 from 4.7% per 1,000 in 2014. Although that progress is slower, we are still seeing a reduction.

Because of that slower reduction, on 4 July I announced £2 million of funding to support a new programme to reduce brain injuries in babies. The first phase of the programme is being led by the Royal College of Obstetricians and Gynaecologists, the RCM and the Healthcare Improvement Studies Institute at the University of Cambridge. It aims to develop clinical consensus on the best practices for monitoring and responding to babies’ wellbeing during labour—the progress of the baby during labour has been mentioned a number of times—and in managing complications with the baby’s positioning, specifically when a baby’s head is impacted in the mother’s pelvis during a caesarean section.

Funding for the second phase of the work, beginning later this year, will begin to implement and evaluate this new approach to inform how we can roll it out nationally. On pre-term births, recent ONS provisional data shows the percentage of all pre-term live births decreased for the second year in a row, from 7.8% to 7.5%.

Although we have had a reduction in maternal deaths, there is still more work needed to address the underlying causes of why mothers die in or shortly after childbirth. In the 2016 to 2018 data, 217 women died during or up to six weeks after pregnancy. That represents a 9% reduction in the maternal mortality rate against the 2009 to 2011 baseline, but we obviously need more up-to-date data on that. Some 58% of the deaths were due to indirect causes, such as cardiac disease and neurological conditions. This means that we need to look not only at what maternity services can do during the 40 weeks or less they may care for a woman while she is pregnant, but also at a lifetime approach—supporting women to be in the best health before pregnancy.

To care for pregnant women with acute and chronic medical conditions, NHS England is rolling out maternal medicine networks to ensure that there is timely access at all stages of pregnancy. In the debate today, a number of people have mentioned staffing levels and workforce. We have recently announced £95 million towards increasing the workforce in maternity units—some 1,200 additional midwives and 100 additional consultant obstetricians. The figures have been calculated at trust level on the basis of birth rate, along with the RCOG. We have also given the RCOG £500,000 to develop a workforce tool for planning, so that we have as safe staffing levels as we can have on maternity units, when they are needed.

I am going to go on to the nitty-gritty of the problems that affect some of the outcomes that we are trying to negate during pregnancy. We know that obesity during pregnancy puts women at an increased risk of experiencing miscarriage, difficult deliveries, pre-term births and caesarean sections. I underline the importance of helping people to achieve and maintain a healthy weight in order to improve our nation’s health.

That is why we launched the obesity strategy in July 2020. The strategy sets out a campaign to reduce obesity, including measures to get the nation fit and healthy. We know that obesity has a huge impact on covid-19. According to the RCOG, the overall likelihood of a stillbirth in the UK is less than one in 200 births, but if a woman’s body mass index is over 30, the risk doubles to one in 100. According to Public Health England, 22.1% of women were obese in early pregnancy. If a woman’s BMI is higher than 25, that is associated with a range of additional risks, which I will not list now, but which include miscarriage.

On smoking, some 12.8% of women in the UK were smoking at the start of pregnancy and 10.4% of women were smoking at the time of delivery. With the new emphasis on public health post covid, I requested meetings with Public Health England to discuss how we once again emphasise the negative effects of smoking during pregnancy and the impact of obesity, particularly given the RCOG figures of the doubling of the risk of stillbirth for women with a BMI over 30.

[Sarah Owen]

I am sure it is not the Minister’s intention that the tone of the response, particularly in this section, feeds into the guilt that many women experience having suffered miscarriage or stillbirth. It feels as if the onus is being put on the woman—that the reason they have experienced this loss is entirely their fault. Perhaps, if we want to tackle the root causes of obesity and smoking and those reasons for baby loss, we would be tackling the root causes of deprivation, not necessarily focusing on personal responsibility in the way that the Minister has just outlined.

[Ms Dorries]

I could not agree more, but we are doing nobody any favours whatsoever if we do not inform women of the impact of smoking and obesity during pregnancy. Before covid—some time ago—Public Health England had a huge emphasis on the negative effects of smoking during pregnancy, and we think we need to focus once more on the fact that 12.8% of women are smoking at the beginning of pregnancy and 10.4% are smoking at the time of delivery, as part of this approach to continuing to reduce the number of stillbirths. To keep that trajectory moving, we have to discuss all the reasons why and all the health implications during pregnancy.

A number of Members mentioned the continuity of care programme. We are committed to reducing inequalities in health outcomes and experience of care. In September 2020, I established the maternity inequalities oversight forum to bring together experts from key stakeholders to consider and address the inequality for women and babies from different ethnic backgrounds and socioeconomic groups.

In response to a direct question from my hon. Friend the Member for Truro and Falmouth, we wanted to see all women placed on the continuity of care pathway by March 2022, but that will not be possible. We are therefore focusing on having 75% of black, black British, Asian and Asian British women on the continuity of care pathway by 2024. We will have 20% of all women on that pathway at the same time. The issue of training on continuity of care was brought up, and that is the important point. We can talk about continuity of care pathways, but it is about having the right training in place and ensuring that those midwives who have those women on that pathway and are caring for them are trained in the particular inequalities that my hon. Friend mentioned. That is why it will take us to 2024, but we will have 75% of those ethnic minority women on that pathway by that date.

A number of Members mentioned covid-19. It has caused a huge amount of disruption to our lives. As the hon. Member for Luton North (Sarah Owen) said, women have continued to have babies throughout that time. Maternity and neonatal services have worked hard to enable partners to be present during labour and birth. According to the latest information, all maternity partners are accompanying women to all antenatal scans and appointments in acute settings.

The hon. Member for Luton North also brought up vaccinations. She made the point that the Government need to ensure that all pregnant women are vaccinated. My daughter is 32 weeks pregnant, so no one has been more aware of that than me, but I am afraid that politicians do not make clinical decisions, and the Government are not the JCVI—the Joint Committee on Vaccination and Immunisation is completely independent. The committee decides who is vaccinated.

After constantly asking why pregnant women were not being prioritised and taking a glance at the make-up of the JCVI, however, I was shocked to discover that it is made up of 14 men and three women, so I am unsurprised at the JCVI not emphasising or prioritising pregnant women for vaccination. Again, that is a point I am making in the Department and in particular with the women’s health strategy. Perhaps all scientific committees that make decisions about women’s health should have a gender balance.

I want to reassure the hon. Member for Luton North that I am absolutely on to that and have been all the way through. I might just be beginning to get a bit of insight into why the JCVI has not prioritised pregnant women for vaccination. It is shameful that they were not; they should have been. She highlighted the data herself at the L&D hospital, which is one of my local hospitals, and I hope that the hospital will now begin—despite the constant requests and pressure from Government—to review its policies on pregnant women and vaccination.

I thank the Health and Social Care Committee and its independent expert panel for its inquiry into the safety of maternity services and evaluation of maternity commitments. The Department is considering the recommendations made in the report and will publish a full response in September.

In conclusion, I am absolutely proud of the progress that we are making on stillbirths, neonatal deaths and maternal deaths, but we have to do more. That will involve Public Health England, and that will involve looking at all the reasons why and all the targets that we have to beat so that we can reach those ambitions and reduce those figures.