Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 15th July 2014 Commons Chamber

[Jane Ellison]

I am sure that, like me, the hon. Lady welcomes the news this morning that food price inflation is at an annual rate of 0%, so food prices are at the same level as last year. On the issue that she raises, that is exactly why programmes such as Change4Life are important. It is also important that we see other measures across government. The school food plan is important for its emphasis on nutrition, as are free school meals and the Healthy Start programme. The Government are doing lots of things to try to make it easier for less well-off families to eat healthily.

[Andrew Selous (South West Bedfordshire) (Con)]

Will the Minister applaud the work of Colin Kaye in my constituency, who, on his own farm, is producing cheap, good quality food to help reduce the cost of food so that people can eat more healthily and have lower food bills?

[Jane Ellison]

That sounds like a fantastic local initiative, and I thank my hon. Friend for highlighting it. Taken together with our advice and support for families on how to use healthy food to make healthy meals, initiatives such as that are to be applauded.

--- Later in debate ---

[Mr Jeremy Hunt]

NICE has taken the sensible decision to issue its guidance. It does so independently, but we are not making it mandatory on the advice of the chief nursing officer and many other chief nurses across the country for the simple reason that if we have a mandatory minimum, that can become the maximum that trusts invest in and many wards need more than 1:8. That is why NICE’s guidance was so important today.

[Andrew Selous (South West Bedfordshire) (Con)]

T5. The Chavasse report on improving care for members of the armed services and veterans builds on the improvements that we have already made and has been welcomed by the Department of Health and indeed the Ministry of Defence. We owe it to our armed services to carry on making improvements to their care, so will the Minister encourage NHS England to look favourably on its recommendations?

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

My hon. Friend is right to highlight the importance of the Chavasse report. Its focus on improving care for veterans is warmly welcomed. There is a lot that we can work with to deliver better care and build on the specialist care centres already in place for veterans who have lost limbs and need prosthetic services and to provide additional support for veterans with mental health problems.

Patient Safety

Andrew Selous Excerpts

Tuesday 24th June 2014 Commons Chamber

[Mr Hunt]

I very much agree with my hon. Friend, and he will know that one of the things we have introduced this year is the duty of candour, which makes it a legal requirement for trusts to be honest with patients and their families when harm or avoidable death has occurred. He is absolutely right that we have to tackle this, and he will also know that when trusts are open and transparent, relatives are less likely to sue, because they recognise the good will and spirit involved.

[Andrew Selous (South West Bedfordshire) (Con)]

Will the Secretary of State join me in commending the initiative of Bedfordshire clinical commissioning group, under the excellent leadership of Dunstable GP Dr Paul Hassan, which has instituted unannounced checks on the wards of local hospitals by local GPs?

[Mr Hunt]

I do commend that, and it is excellent to see CCGs taking responsibility, because they control the NHS budgets. I think that is an excellent initiative, and I hope that other CCGs follow suit.

Care Homes

Andrew Selous Excerpts

Thursday 1st May 2014 Commons Chamber

[Andrew Selous (South West Bedfordshire) (Con)]

Yet again, it has taken undercover reporting by the BBC and covert recording by families to shine a spotlight on these appalling abuses. Given that people with dementia, in particular, cannot tell their own story—in some recent cases, that has involved their being slapped—should not the CQC not only make unannounced visits, but seriously consider undercover work to record these terrible abuses?

[Norman Lamb]

I agree with my hon. Friend. I have spoken to the chair of the CQC, David Prior, specifically about this matter. It is looking at both the use of hidden cameras in appropriate circumstances and at mystery shopping—going into care homes, finding out what is going on and getting a real picture, rather than things perhaps being hidden away from view when a named inspector turns up. All these mechanisms have to be used. We have to be prepared to do these things to ensure that people in very vulnerable situations, particularly people with dementia, are cared for with dignity.

Abortion (Disability)

Andrew Selous Excerpts

Wednesday 9th April 2014 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

I thank you, Madam Deputy Speaker, for this opportunity to speak on a sensitive subject. Few would disagree that Britain is a friendlier place for disabled people than it was a few decades ago—better, that is, unless we are talking about a disabled baby in the womb. The contrast between the way we see disabled people before and after birth could barely be starker. A disabled unborn child has effectively no rights up to birth. Many people are shocked to learn that he or she can be aborted right up to birth—as many as 16 weeks beyond the 24-week threshold for able-bodied babies. But the moment after birth, a whole panoply of rights and support suddenly comes into play for the disabled child. I know that from personal experience, and here declare an interest. My own son, Sam, was born with a club foot, one of the defects for which an abortion up to birth can be obtained. Yet within minutes of his birth, the hospital telephoned its specialist in treating club feet, who was on leave at the time and who rushed in within two hours to begin manipulating Sam’s foot.

[Andrew Selous (South West Bedfordshire) (Con)]

On the issue of abortions up to birth, does my hon. Friend share my belief that where the disability may be relatively minor—a cleft palate or something such as that—the public would be very concerned to learn that these were allowed literally right up to birth?

[Fiona Bruce]

Indeed I do, and I thank my hon. Friend for that intervention. Although there are not many such abortions, there are still some taking place for treatable and relatively minor defects, such as a club foot. My son had physiotherapy every day for the first year of his life. He wore a calliper in his early years and he had two operations until into his teens, but now one would never know, unless one was a specialist, that he had been born with a foot defect. Yesterday, Sam was 21, and in the past few days has heard that he has been admitted to Oxford university. It is hard to think that such a treatable disability could have deprived him of life, and he is far from alone. I believe that the footballer, Steven Gerrard, was born with a club foot.

We have allowed a completely inconsistent and contradictory approach to disability to develop in this country with reference to the born and unborn child, and for that reason I am asking the Minister to review the application of this legislation. To clarify, the Abortion Act 1967 was amended in 1990 to provide for abortion up to, and during, birth where there is “substantial risk” of “serious handicap”—often called ground E abortions. But neither of those terms have statutory definitions. Instead, what constitutes “substantial risk” or “serious handicap” is left to doctors to decide, with differing outcomes across the country, and that difference can mean life or death to an unborn child. Professor Gordon Stirrat gives an example of a couple seeking abortion because of a cleft palate at 34 weeks, where there was a significant difference between doctors who refused an abortion under ground E and other doctors who interpreted the law as covering the couple’s situation.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 1st April 2014 Commons Chamber

The Secretary of State was asked—

[Andrew Selous (South West Bedfordshire) (Con)]

1. What steps he is taking to improve compassionate care in the NHS.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The Government have made it a key priority to restore a culture of compassionate care throughout our NHS. Ten thousand nurses and midwives will have taken part in a new leadership programme that champions patient-focused compassionate care. Pilots are testing whether all nurses should spend time on the wards prior to a nursing degree.

[Andrew Selous]

Will the Secretary of State join me in congratulating NHS staff, who are shifting the priorities of the NHS culture towards compassionate care and away from a tick-box culture? Does he agree with Robert Francis, who says that compassionate care very often saves money?

[Mr Hunt]

My hon. Friend is absolutely right. Last week I was in one of the safest hospitals in the world, Virginia Mason hospital in Seattle, which has cut litigation claims by three quarters since it introduced safer care. We have fantastic hospitals in this country too, such as Salford Royal. The truth is that safer care is better value for money: it means that more money can be spent on the front line, not on litigation.

Adult Autism Strategy

Andrew Selous Excerpts

Wednesday 5th March 2014 Westminster Hall

[Jim Shannon]

I thank the hon. Lady for her valuable contribution. Yes, I agree; I think all hon. and right hon. Members would. Churches have intervened to help in a number of complex cases in my constituency. What is not complex for us is complex for people with autism. There is a clear role to be played in that regard. Only 15% of adults with autism are in full-time employment; again, that results from some of the issues that they suffer from, including epilepsy, sleep disturbance and mental health problems. Many out there are trying to help and assist.

I ought to give a Northern Ireland perspective, because we have done good, helpful work there, health being a devolved matter. The Minister is aware of that good work because he has visited a number of times. Perhaps he might comment on that in his response.

The Northern Ireland Assembly put in place the Autism Act (Northern Ireland) 2011, which is the most comprehensive autism and single disability legislation in the whole of Europe. The need to do something was recognised at an early stage, as was the fact that the power was there to do it within the devolved Administration, and that was done. It is the first legislation in Northern Ireland requiring by law all Departments to plan and work together on the delivery of the strategy. The cross-governmental attitude that the right hon. Member for Chesham and Amersham requested is there. My hon. Friend the Member for East Londonderry (Mr Campbell) and the hon. Member for Stretford and Urmston (Kate Green), who both intervened on me, have confirmed that that should happen. Departments worked together on the delivery of a strategy. No cross-Department barriers are allowed at all. When we say “comprehensive”, we mean it. I am delighted that the debate is calling for such a strategy.

Autism Northern Ireland was at the centre of the campaign for the Autism Act (Northern Ireland) with its grass-roots campaign. There was no money or external lobby company—just hard work, and determination to make it happen and to gain support from all parties, which was forthcoming. It had autism ambassadors—health and education party spokespersons—to build up expertise on issues of concern. It also formed a partnership with Autism Cymru, which was already working with the Welsh Government on implementing a Wales autism strategy. That was the foundation of the Celtic Nations Autism Partnership—Celtic as in “keltic”, and certainly not “seltic”. No offence to any Celtic supporters who might be here, of course. That is a partnership with the autism societies of Scotland and the Republic of Ireland, which has led to initiatives in the USA. The CNAP and Members of the Legislative Assembly visited the US Congress and the European Parliament.

When we say that the approach is comprehensive, we are talking about looking across Europe and the world; examples were considered and discussions took place. That led to the Autism Act (Northern Ireland). A partnership was initiated with Autism-Europe and MEPs to develop a comprehensive and well-thought-out European autism strategy.

In 2012, I highlighted the difference between the Autism Act (Northern Ireland) and the English Autism Act 2009: the Northern Ireland Act is equality-driven and lifelong-focused. Perhaps the Minister will indicate whether the Government are trying to achieve in England the equality and lifelong focus that we have in Northern Ireland through the Autism Act (Northern Ireland) 2011. That Act amends our disability discrimination legislation, too, to include those with social communication disabilities such as autism. That supersedes the Great Britain Equality Acts, which only give recognition and guidance in primary legislation. That is significantly different from how we did it back home, where we have attempted to address adult autism.

I again thank the right hon. Member for Chesham and Amersham for securing the debate. She, like me and everyone else in the Chamber, sees the gaps in the strategy and the need to enhance provision by including an adult strategy. I have raised today the cases of a young girl and a young adult male. The strain on families grows greater with time as the child becomes an adult and more difficult to handle. The legislation should be amended to provide more state help.

[Andrew Selous (South West Bedfordshire) (Con)]

I apologise for not being here earlier, but I was unable to get out of a meeting. One of my constituents contacted me to say that now that her daughter is 20, none of the professionals dealing with her daughter will speak to the mother. Does the hon. Gentleman think that we should make changes, so that with the young person’s permission, if they are over 18 and want their parents involved, all the different organisations work with the parents, who are there for their autistic children as they get older?

[Jim Shannon]

I agree entirely with that most helpful intervention. In my experience as an elected representative, that is exactly what people want. We should help whenever we can. The Minister for Health, Social Services and Public Safety in Northern Ireland has been anxious to collaborate with the Department of Health on what is working well in Northern Ireland. I have great respect for the Minister of State, Department of Health, but perhaps things could work better. There are examples of good work on the mainland. I looked through the background notes this morning before the debate, and one thing that caught my eye is that there is a specialist autism unit at South Devon college called the LODGE—Learning Opportunity for Development and Guided Education—which has been shortlisted at a national award ceremony in recognition of the education it provides to young adults with autism. There are many good examples of how Departments can do better for young adults with autism, and we should be trying to make that happen.

I am keen to assist and work with the right hon. Member for Chesham and Amersham to ensure that adequate legislation is introduced to make changes that will greatly affect the lives of those with autism and their carers. Never forget the carers, who also need support. They love their children, but they need help, because things are not simple. They want their child to have the best future possible, which does not include an institution. How will we deal with ageing parents? I know that I am not the only one who is aware of ageing parents. What will happen to these children and young adults when their parents pass away? They may no longer be able to look after their children and young adults alone. The answer is clear: they need support, and we must put it in place. Hopefully today is a first step towards providing that support to families across the United Kingdom of Great Britain and Northern Ireland. I support the right hon. Lady and her proposal.

Cancer Priorities

Andrew Selous Excerpts

Thursday 13th February 2014 Commons Chamber

[Andrew Selous (South West Bedfordshire) (Con)]

It is a privilege to speak in the debate, and I should like to start by congratulating my hon. Friend the Member for Basildon and Billericay (Mr Baron) on his work chairing the all-party group and on his excellent speech, in which he covered the whole area of cancer care. We are all grateful to him.

I am speaking today in my capacity as the chair of the all-party parliamentary group on brain tumours. I have not held the post for long and, like many MPs, I came to the issue through one of my constituents, an inspirational lady called Nicole Witts. She was diagnosed with a brain tumour many years ago, and she contacted me a few years ago and explained the effect that it had had on her life. She talked about the massive need for increased research funding for brain tumours and asked me to become the patron of her local charity, which raises funds for such research. I gladly agreed to do so, and I have been hugely inspired and impressed by all that she has done. It is she who caused me to become the chair of the APPG and to make this speech today.

I did not know a great deal about brain tumours before I met Nicole, and this has been quite a sharp learning curve for me. Brain tumours are among the very few conditions that are becoming more prevalent than they were a few decades ago. They are much more common now than they were in 1970. Cancer patients are reporting a worse experience in the NHS for brain tumours than for any other cancer. Unfortunately, 58% of men and women diagnosed with a brain cancer die within a year, compared with 5% of people with breast cancer, 35% of people with leukaemia and 7% of people with prostate cancer. There are also considerable regional variations in incidence, ranging from 108 per million in London to 145 per million in the south-west. Brain cancer is the chief cause of cancer deaths in children, in the under-25s and in the under-35s. The consequence of brain tumours striking so young is that the average tumour is responsible for over 20 years of life lost in the average patient, making it the most lethal cancer by that measure.

Let us look at the funding that brain tumour charities receive. I think that Members will be quite surprised by how low it is. The National Cancer Research Institute consistently devotes less than 1% of its research spending to brain tumours. Between 2002 and 2012, the figure was 0.8%, and in 2012 itself the figure was only 0.78%. There was an average of 6.9 deaths among the under-45s for every £1 million spent on research for all cancers as a whole, but the corresponding figure for brain tumours was 82.5 deaths, and more than £7,700 was spent on research for every death from leukaemia, whereas just £1,400 was spent for every death from a brain tumour.

Between 2002 and 2012, breast cancer research received £352 million of funding, leukaemia research received £291 million, prostate cancer research received £149 million, cervical cancer research received £47 million and, right at the bottom, brain tumour research received only £35 million, less than 10% of what breast cancer research received. As hon. Members can appreciate, brain tumour research funding is very much the poor relation. That is a particular problem because, unlike with many other cancers, brain tumour research does not benefit from general research, for a number of clinical reasons: brain tumours are very different from other types of cancer; the blood-brain barrier presents particular difficulties for researchers; and there are more than 120 different types of brain tumour, which makes research much more difficult. The conclusion to draw is that it is only through giving directly to brain tumour charities and funding laboratory-based research that all types of brain tumours—adult, paediatric, low-grade, benign, high-grade and malignant—will be cured.

Let us examine the experience of people living with brain tumours. I am indebted to the Brain Tumour Charity for its report on that just before Christmas, just as I am to Brain Tumour Research for its excellent report last July on the research issue. When we examine people’s experiences of care, we find that we clearly need to make improvements to make sure that they have the best possible quality of life before and after diagnosis. We know that 38% of people living with a brain tumour visited their GP more than five times before being diagnosed. We know that communication between health care professionals, and people living with a brain tumour and their carers, very much needs to be improved. The Brain Tumour Charity has made a number of recommendations in that area: it wants professionals to recognise and respond to the signs and symptoms of brain tumours more quickly; it wants data collected on the quality of care in different areas up and down the country, so that we can see who is doing well and who is not; and it wants to ensure that written information about treatment options is given to people, along with proper signposting to sources of expert help.

I also wish to highlight the importance of clinical nurse specialists, which was mentioned by the hon. Member for Ashton-under-Lyne (David Heyes). We know from the 2013 cancer patient experience survey that there is a huge difference in the quality of care experienced by patients when a clinical nurse specialist is present. When a clinical nurse specialist was present 74% of patients were given easy-to-understand written information about the type of cancer they had, whereas fewer than half of patients—only 49%—received it when no such specialist was present. Some 87% of patients were given a choice of different types of treatment—that is pretty important—with a specialist, whereas only 67% were given it when no such specialist was present. If we look at those patients who were given information about support and self-help groups—a really important area—86% got that with a clinical nurse specialist and only just over half, 51%, when there was not one present.

For those patients who were eligible for free prescriptions, 78% were informed of that when there was a clinical nurse specialist present and only 55% when there was not. Prescriptions are expensive, so that can make a big difference. Similarly, with information on financial help and benefits to which patients might be entitled, 58%, who had a clinical nurse specialist were told what they could claim, and only 25% were told when there was not one present. I think the Minister will agree that those are pretty huge variations in the quality of care. I absolutely agree with what my hon. Friend the Member for Basildon and Billericay said about the importance of early diagnosis.

The final matter I want to raise is the excellent campaign run by HeadSmart, which has produced information cards. I know that the Minister is aware of them. I pay huge tribute to the Brain Tumour Charity and to others who are absolutely determined to get these cards into schools across our country. I have written to every colleague in the House—I hope you got the e-mail as well, Mr Deputy Speaker—telling them about how we can do that, and have provided a sample letter that we can all send to our head teachers. I suggest that colleagues write to their local authorities as well. It is so easy to get these cards. HeadSmart provides them, so local authorities and schools do not have to pay anything. The cards provide the warning symptoms that we need to look out for in pre-school children, children aged five to 11 and young people between the ages of 12 to 18. Symptoms include persistent recurring vomiting, recurrent headaches, balance and co-ordination problems, abnormal eye movements, blurred or double vision, behavioural changes and fits and seizures. They are all on the card, which will fit in a purse or wallet.

My challenge to Members here today and to those who read this debate is to get these cards out to their schools, and to our young people. We know the vast difference that early diagnosis can make; it could literally be the difference between life and death. This is something practical that we can all do as a result of this debate, and I ask all colleagues to try to do it.

Children and Families Bill

Andrew Selous Excerpts

Monday 10th February 2014 Commons Chamber

[Ian Paisley]

Let me take one of the facts raised by Labour tonight. According to tobacco consumption rates in the United Kingdom, 22% of people smoke in the Liverpool district, but according to the statistic put in front of us tonight, 25% of all children are subject to being in front of smokers. The number of people smoking is, therefore, higher than the Government statistics show. We need more clarity on the stats being put about by Members on both sides of the House. Labour and Government Front Benchers should wait, as they said they would in November, for the outcome of the Cyril Chantler independent review. If we wait for the gathering of evidence that we can all accept, we will be in a much stronger position to make the decision we are making tonight.

I am also concerned about the plain packaging measures, which will decimate an industry. There is not sufficient evidence to show that they will do what everyone wants them to do, which is to stop people smoking. A pound store I visited sells boxes for people to put their fags in. It is even possible to get ones that say “Vote Labour” or “Vote Conservative” on them. Believe you me, Mr Deputy Speaker: whenever cigarettes are sold in the future under this provision, these boxes will be given out freely by certain companies because they will take away the one warning that we do know is important, which is that smoking kills. Tonight we are putting in place an opportunity for people to cover cigarettes with no warning whatsoever.

The biggest problem that this country faces on tobacco is the illicit trade: 25% of all cigarettes smoked in the United Kingdom tonight will have been smuggled by criminals. We as a House should do something, on a united basis, to wipe out such criminal empires, instead of making it easy for them by giving them plain cigarette packages that are simpler to print, smuggle and get into the hands of children. That should be our real cause and health concern.

[Andrew Selous (South West Bedfordshire) (Con)]

I rise to support Lords amendment 125 for the very simple reason that children have no choice about getting into a car. Every day, up and down this country, children are told to get into a car by their parents or guardians; they have no choice. I think that we should operate on the basis of the “Do no harm” principle. The facts are clear: 165,000 incidents of childhood disease are caused every year by passive smoking. Not all car journeys are short: a close family member of mine was made to get into a car and to travel many hours to go on holiday while a pipe was smoked in the car. Despite protests, that pipe continued to be smoked.

On enforcement, many laws are not properly enforced—like all hon. Members, I want full enforcement—but is anyone saying that we should abandon the law against driving while holding a mobile to one’s ear because it is not always properly enforced? I have written to my police force to ask how many convictions they have had for people holding a phone to their ear.

Yes, in a perfect world we would change this situation through education, and of course we should refrain from banning things unless we have to, but the fact is that too many children—an estimated 185,000 every day—have to put up with it. Against their will—they have no choice—they are told to get into a small metal unit. We are here to speak up for those who have no voice, which is why I am proud to support the measure tonight.

[Alex Cunningham (Stockton North) (Lab)]

I quote:

“I would ban smoking in cars where children are present. I would do that for the protection of children. I believe in protecting children. I would see it as a child welfare issue.”

Those were precisely my feelings when I introduced the Smoking in Private Vehicles Bill under the ten-minute rule exactly 964 days ago. I did so after a briefing from the British Lung Foundation, with which I have been proud to work ever since. My thoughts have not changed in the two and a half years since, and I am delighted that the day has come when hon. Members have the opportunity for a decisive vote to make life healthier for half a million children. Although I share the sentiment and could hardly have put it better myself, the words I started with are not mine; they date from February this year and are those of the then public health Minister, the hon. Member for Broxtowe (Anna Soubry).

In Committee in the other place, an amendment was tabled and supported by all political parties, with eight peers speaking in favour of the ban. Such is the cross-party nature of the measure. This will be the fourth time that Members of this House have asked for a definitive vote on the issue. After my ten-minute rule Bill failed to get a Second Reading, the noble Lord Ribeiro’s private Member’s Bill won support in the other place but failed to make progress in the Commons. In this Chamber, we tried to amend this Bill, but we failed again. Now, after sustained pressure from a cross-party group of Back Benchers and Lords, four measures are proposed in the Bill—including powers to bring in standardised packaging of cigarettes and to prevent smoking in cars with children present—and I welcome them all.

It is not just parliamentarians who support such a ban—quite the opposite. The changes are backed by many professional bodies and research groups. I have been delighted to work closely with other organisations, as well as the British Lung Foundation. The list is too long to name every person and organisation, but it includes Cancer Research UK, Action on Smoking and Health, the British Medical Association, the British Heart Foundation and Fresh, our own campaigning organisation that has done so much in north-east England. We must not forget the royal colleges and the 700 health professionals, who have already been mentioned.

Facts, figures and statistics in abundance have highlighted the appalling dangers of passive smoking, particularly to children and young people, and specifically in relation to smoking in vehicles. A plethora of studies have returned the same results: smoking in a vehicle significantly increases children’s exposure to harmful toxins and particulates. Numerous surveys and opinion polls have consistently shown that the public support such recommendations. I have no doubt that my fellow Members will draw attention to them as the debate progresses.

I want to focus on the arguments about enforcement and intrusion. It is important to remember that the police already have a number of duties with regard to private vehicles, and to recognise that the additional enforcement costs of a measure to outlaw smoking when children are present are minimal.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 26th November 2013 Commons Chamber

[Jane Ellison]

We are aware of those additional costs, and I know that my hon. Friend recently met my right hon. and noble Friend the Under-Secretary of State for Health. We are very conscious of those costs and of the difficult decisions. It is the subject of ongoing negotiation between the Welsh Government and NHS England.

[Andrew Selous (South West Bedfordshire) (Con)]

12. What lessons he has learnt from the findings of the report of Professor Timothy Briggs on improving the orthopaedic surgery published in September 2012, entitled “Getting it right first time”.

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

In 2012 Ministers welcomed the publication of the report and acknowledged that its recommendations could help build on improvements in orthopaedic care. I believe that my right hon. Friend the Secretary of State met Professor Briggs.

NHS England is now responsible for securing high-quality outcomes. Peter Kay, the national clinical director for musculoskeletal services, is also supportive of the report’s findings.

[Andrew Selous]

Growing numbers of orthopaedic consultants accept that collaboration across networks of hospitals could improve the quality of orthopaedic care, which frankly has not always been good enough in the past. Will my hon. Friend accept the recommendations of the “Getting it right first time” report?

[Jane Ellison]

We know that NHS England has welcomed Professor Briggs’ recommendations. They are contributing to a substantial body of work on orthopaedics, with the sole objective of improving outcomes for patients. I am sure that my hon. Friend will welcome the fact that this year for the first time data about surgical outcomes have been published at both hospital and consultant level, with the objective of driving up quality and supporting patient choice.

Group B Streptococcus (Newborn Babies)

Andrew Selous Excerpts

Thursday 7th November 2013 Commons Chamber

[Nadine Dorries]

Researchers stated:

“The most striking finding that has implications for clinical practice and policy is the low sensitivity of risk factor based screening, compared with PCR or culture tests in predicting maternal and neonatal GBS colonisation—”

[Andrew Selous (South West Bedfordshire) (Con)]

I warmly commend my hon. Friend on bringing the issue before the House. I have a constituent who lost a child as a result of it, so it is something that I take seriously. Is my hon. Friend pleased, as I am, to see that Public Health England is now adopting gold standard enriched culture testing in its eight regional laboratories? Does she welcome that as a small advance in this important area?

[Nadine Dorries]

I welcome my hon. Friend’s intervention, and I will go on to talk about the gold standard culture medium.

The researchers continued that the sensitivity of such screening was

“below that which we considered to be a minimally acceptable sensitivity for our study—which calls into question the validity of the current UK policy. Moreover, consistent with previous evidence of practice variation, the risk factor-based screening policy was poorly adhered to, with one-third of women with indications for IAP not treated.”

Despite those authors and numerous others recommending routine screening as cost-effective in the UK, the UK national screening committee continues to recommend the risk-based approach.

Most countries that have national strategies against GBS infection offer routine antenatal testing for GBS. Those countries have seen the incidence of early onset disease fall dramatically, such as by more than 80% in the US and Spain. That compares favourably with the result of the risk-based approach in the UK under which, as I have said, the number of infections has increased. If we know that the risk-based strategy we are adopting is not working because infections are beginning to increase, yet countries such as Spain are seeing an 80% reduction, should we not consider the cost-effectiveness of moving to a system that we know will reduce the number of poorly babies in our intensive care units that have GBS-induced meningitis and other complications?

Studies show that testing for GBS in late pregnancy, as well as offering tests to women found to carry GBS or who have other recognised risk factors, is more cost-effective than the current risk-based strategy. A risk-based strategy is poor at predicting women who will be carrying GBS in labour, and therefore women for whom antibiotics in labour would potentially prevent devastating infections in their newborn babies.

Recently published research shows that although women want to be informed about GBS and offered testing for it during pregnancy, that is not happening. At less than £12, the tests are not that expensive, and the antibiotic recommended during labour if a woman is found to carry GBS in pregnancy is cheap and cost-effective. It is penicillin, which is shown to be exceptionally safe, as well as being a narrow-spectrum drug that is unlikely to cause greater resistance later.

Most NHS pathology services currently use culture media that are general purpose and identify GBS in only about 60% of carriers. At the request of the chief medical officer, Dame Sally Davies, the enriched culture medium test that my hon. Friend mentioned will be made available throughout England from 1 January 2014. That will identify about 90% of carriers, and it is the gold standard for that purpose, under Public Health England’s regional laboratory standard operating procedure. The results of the GBS test are about 85% predictive of carriage status for up to five weeks. It should be used to identify GBS carriage wherever there is an indication. These sensitive tests have not previously been widely available within the NHS when requested by the health professionals and pregnant women.

I have some key questions for the Minister. Will he use this debate as an opportunity to make a statement welcoming the gold standard enriched culture medium test for group B strep carriage, which is being made available from January 2014 and which can be used to assess carrier state if there is an indication? From this point on, how does the Minister plan to reduce the incidence of GBS infection in newborn babies when the current risk-based strategy, introduced in 2003, has been shown not to be effective? Is there a target rate for GBS infection in newborn babies? I have always derided targets, but in this case setting a target for the reduction of GBS infections may be a way to introduce routine testing.

Will the Minister confirm that the audit of practice suggested by the UK national screening committee to establish how well the new guidance is being implemented at a national level will study the actual practice taking place in maternity units, rather than simply being an audit of policies without any check on whether they are being applied in practice, because we know that these policies are not being put into practice in maternity units? What is the time scale for the feedback and advice to trusts about how they can further improve their adherence to the RCOG and National Institute for Health and Care Excellence guidelines on the prevention of neonatal GBS disease? What provision is being made for telling pregnant women about the risk of GBS infection in their babies? What provision is being made to educate relevant health professionals about the prevention of GBS in newborn babies and the forthcoming availability of the gold standard ECM test? Do midwives and practitioners in maternity units even know that this gold standard test is being introduced in 2014?

UK guidelines recommend that when GBS carriage is found by chance during a pregnancy, it should trigger the offer of antibiotic prophylaxis in labour. Why should a woman with unknown GBS carriage status be denied the opportunity to find out if her baby is at risk?

I would like to pay tribute to the tireless work of Group B Strep Support, the charity and campaign group that has been working to raise awareness of this issue and reduce the death toll. I also have a constituent who has sadly lost a baby to GBS. The group has been a great help to me in preparing for this debate following a meeting with my constituent. Ten years ago, my right hon. Friend the Prime Minister said in his Adjournment debate:

“Group B Strep Support’s aim, which I support, is for the routine test to be offered to all pregnant women, with those who are found to have GBS at the 35 to 37-week stage being automatically offered intravenous antibiotics.”

He said to the then Minister:

“I hope that the Minister will show great urgency over the issue”.—[Official Report, Date; Vol. 408, c. 267WH.]

My right hon. Friend supported the introduction of routine testing: I echo his sentiments exactly.

--- Later in debate ---

[Dr Poulter]

I am hopeful that the audit by the RCOG nationally—something I discussed with the group B strep groups and the chief medical officer at a meeting this time last year to progress the work at a greater pace—will put us in a better position to understand in particular which women are at high risk, whether birth units are picking up on those women in a timely manner and how we can improve the situation throughout the country. In the past there has been quite a lot of variation in practice, broadly based on the RCOG guidelines, but it is important—knowing the devastating effects of this illness—that we put together a comprehensive audit tool that gathers data at a national level so we can spread good practice and good guidance throughout. If my hon. Friend will be patient I hope to address some of the broader issues about screening later.

[Andrew Selous]

Earlier, my hon. Friend said that some countries that screen have higher rates of group B strep than we do. Does he have any data—he could perhaps write to my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries) and myself—to show what the progression has been since testing was introduced in those countries? I think my hon. Friend the Member for Mid Bedfordshire said that it was falling in Spain but it would be interesting to see how it is moving following the introduction of widespread testing.