Foetal Valproate Spectrum Disorder: Fatalities
Caroline Nokes Excerpts(1 year, 4 months ago)
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Caroline Nokes (Romsey and Southampton North) (Con)
I start by expressing my thanks to Mr Speaker for granting this Adjournment debate. It is not the first time we have debated the issue of foetal valproate spectrum disorder in this House or in Westminster Hall, but this time we have added fatalities to the title of the debate. It is stark, and deliberately so, because this year for the first time a coroner has listed it as a contributing factor to a death.
Jake Aldcroft was just 21 when he died in April this year after an infection triggered by problems with his kidneys. The coroner listed foetal valproate syndrome as a contributing factor to his death because of the physical damage done to Jake as an exposed baby, which meant that his bowel and bladder did not work properly and he relied on urostomy and colostomy bags. He had also suffered brain swelling that needed a drain. Jake did not experience pain in the normal way, which would have triggered the alarm sooner. That meant that when he arrived at hospital he collapsed and deteriorated quickly. His mum, Sharon Aldcroft, has been clear that she was never warned about the dangers of valproate when she took it while pregnant with Jake, who was diagnosed with FVSD as a baby.
Christian Wakeford (Bury South) (Lab)
I thank the right hon. Lady for raising this important topic. The fact that the warnings are still not being displayed on pharmacy prescriptions is truly shocking and needs to be corrected. Does she agree that if there is one clear message we can send from this House, it is that doctors and chemists need to be doing what they should be doing and warning any patient of the risks of this drug?
Caroline Nokes
Of course, the hon. Gentleman is right. One of the serious issues to do with sodium valproate has been the lack of warning and information provided to women of child-bearing age.
I have highlighted Jake’s case, with the permission of his mum, because it gives a stark description of some of the very severe problems FVSD can cause for affected babies, and because, as far as I know, it is the first time that it has been listed as a contributory factor to a death. But the horror for many families is that they have to do everything they can to avoid infection and to manage really complex and difficult conditions because they know that, like Jake, their children are vulnerable and could, ultimately, also lose their lives to this totally avoidable syndrome.
Jim Shannon (Strangford) (DUP)
I congratulate the right hon. Lady. She takes part in many of the same debates as me, when we often stand together, and we stand together in this one as well. Does she not agree that the fact that up to 20,000 births have been affected by the drug means that we have waited an awfully long time to react to the dangers in pregnancy? That is the terrible lesson that so many have suffered, and it reinforces the fact that we must act on the side of caution and, what is more, admit our mistakes and appropriately compensate those living with the effects of that negligence.
Caroline Nokes
I thank the hon. Member for that intervention. I remember being in this Chamber when a predecessor of my hon. Friend the Minister made a full apology in line with the recommendations of the Cumberlege report. Unfortunately, not all of that report’s recommendations have been implemented for some issues, which I will move on to shortly.
I know that I do not have to rehearse this with the Minister because she has been there—and indeed in Westminster Hall—when we have debated this issue before. There have been many debates, statements and urgent questions on this issue and on the related matters of vaginal mesh and hormone pregnancy testing, but this is the first time the syndrome has been found by a coroner to have contributed to a young person’s death—a child’s death.
As the Minister will know, foetal anti-convulsant syndrome is a serious condition in which a baby suffers physical and/or developmental disability from his or her mother taking sodium valproate. Those disabilities can vary and will include minor and major malformations ranging from deformities just of fingers and toes to major physical disabilities such as spina bifida, malformed limbs, skull and facial malformations and malformations of the internal organs.
Christian Wakeford
I thank the right hon. Lady for giving way a second time. We have also recently heard that foetal valproate syndrome can be passed down the generations, so the very unfortunate victim of that awful illness can pass it on to their children as well. Although that has been confirmed only recently, we need to ensure that people are warned about the knock-on effects. Up until probably a couple of weeks ago, no one really knew about that.
Caroline Nokes
The hon. Gentleman makes an important point. The illness can continue down the generations, and that is not yet well understood but it is causing real fear for the families who have been affected so far.
Additionally, problems can include learning disabilities, autism spectrum disorder, delayed walking and talking, speech and language difficulties, and memory problems. It is a long list, and it has now been listed as directly attributing to the death of a young person.
Way back in 2018, the Government commissioned the independent medicines and medical devices review, chaired by the noble Baroness Cumberlege, and its “First Do No Harm” report was published in 2020. That excellent piece of work had nine significant recommendations, some of which have been implemented, some of which have not—or not effectively. As the noble Baroness pointed out, many thousands of women of child-bearing age who suffer from epilepsy are still being prescribed sodium valproate.
Since 2018, when the pregnancy prevention programme was introduced, only 7,900 women are believed to have switched from valproate, which means that today approximately 20,000 women taking valproate are at risk of becoming pregnant. Information from the Medicines and Healthcare products Regulatory Agency indicates that of those 20,000 women, roughly one in three will have a pregnancy. That means that about 400 pregnant women a year have been exposed to valproate and that, of those 400 pregnancies, about one in two will have a child affected to some extent by foetal valproate syndrome.
Cat Smith (Lancaster and Fleetwood) (Lab)
I congratulate the right hon. Member on securing this debate on such an important issue. She is touching on the issue of women currently taking sodium valproate when they are of child-bearing age and the number of pregnancies we are still seeing. While more needs to be done with GPs to ensure that these women understand the risks and that there are pregnancy prevention plans, does she agree that it is important to say that any women listening to our debate this evening should keep taking their medication until they have had that conversation with a GP, because sodium valproate is also a lifesaving drug?
Caroline Nokes
The hon. Lady is absolutely right, and I will come on to say that none of us is advocating that valproate be banned.
Caroline Nokes
I will go on to say how important valproate is and how it is imperative that women keep taking the medication, but they need to do so in collaboration with their GP and in discussion with consultants —they need to do so being aware of the risks.
According to the MHRA’s chief safety officer, around three babies are being born every month having been exposed to valproate in pregnancy, although The Sunday Times has estimated the numbers to be double that, at six per month. I pay particular tribute to The Sunday Times, which has worked alongside families and campaigners, such as the Independent Fetal Anti-Convulsant Trust, or INFACT, to make sure that this scandal does not get brushed to one side and forgotten about.
As the hon. Member for Bury South (Christian Wakeford) indicated, new information suggests that valproate will affect their children too. Those mothers who already feel a sense of guilt that their medication has harmed their children now live in fear that it will impact their grandchildren too. Put simply, it is a health disaster that is not going to go away.
Alongside other Members, I recognise the importance of sodium valproate as a drug to control epilepsy. It is crucial for some patients where other drugs have proven ineffective. At no point have I, or the APPG that I co-chair with the hon. Member for Lancaster and Fleetwood (Cat Smith), or INFACT called for it to be withdrawn, but the controls have to be more effective. We have to do better with the pregnancy prevention programme, and we have to do better at providing the necessary information to women of child-bearing age.
The pregnancy prevention programme is just not working adequately. Information to women is not getting through. Drugs are still being dispensed in plain packaging, without the required warning notices. Many women are still highlighting through the media, through campaign groups and to their Members of Parliament that they were not warned, that they have become pregnant and then, only at that point, have they been told of the possible danger to their baby and advised to have an abortion. First-time mums excited at finding they are pregnant are advised to have an abortion. I know that the Minister, my hon. Friend the Member for Lewes (Maria Caulfield), will find that abhorrent.
There are drugs for other conditions where I have seen far more radical and determined pregnancy prevention programmes. I have previously identified Roaccutane, where women prescribed it have to have long-acting contraception and produce a negative pregnancy test before they can collect a monthly prescription, not to mention sit with a consultant and go through a very detailed explanation of foetal abnormalities and be given a form to sign stating they will have a termination if they get pregnant. That might sound draconian in the case of valproate, but it would at least mean that every woman prescribed the drug would have had the risks spelled out very clearly.
For thousands of families, the damage has been done. At this point, I pay tribute to Emma Murphy and Janet Williams of the INFACT campaign group, who are the women who have kept up the pressure on Government. They are the ones who have kept digging for information on what was known by the authorities and how long ago. They are the ones who persuaded my right hon. Friend the Chancellor of the Exchequer, when he was Chair of the Health and Social Care Committee, to launch an inquiry into the use of sodium valproate, which The Sunday Times has described as a scandal bigger than thalidomide. Why is it a scandal bigger than thalidomide? Because it is still happening. Those babies are still being born to parents who have simply not had the level of warning and practical prevention measures that they need.
That brings me to redress and recommendation 4 of “First Do No Harm”. I know that successive Ministers have decided that redress should come via the courts and medical negligence claims, but I would like us all to reflect a little on that and the added strain it puts on families already caring for a disabled child or, in some cases, children—children who we now know can have their death caused by foetal valproate syndrome.
We know that the costs of caring for a disabled child are high. We know that in this cost of living crisis the energy costs for any family living with a disabled child will be higher. We know that in terms of physical effort and mental anxiety it is simply harder to look after a disabled child. We also know, unequivocally, that the dangers of valproate were known the best part of 50 years ago, so it is especially tough and insensitive to suggest to those same families that redress should be via a courts system that is itself under immense strain and subject to delays.
The noble Baroness recommended in her review not only that an independent redress agency be set up, but that there be separate schemes for the three medicines or devices covered. Specifically, recommendation 4 states:
“Separate schemes should be set up for each intervention—HPTs, valproate and pelvic mesh—to meet the cost of providing additional care and support to those who have experienced avoidable harm and are eligible to claim.”
To my mind, the specific relevance here is around the additional care needed, which we all acknowledge, and the bare fact of avoidable harm.
I have three asks of the Minister, and I look forward to her response. The first is for an acknowledgement that sodium valproate has contributed to a death. A young person has died avoidably, and we need the Government to reflect on the very serious conditions that too many babies were exposed to the risk of. What additional controls does she think should be put in place in the light of the knowledge that valproate has caused a young man to lose his life?
Secondly, the pregnancy prevention programme needs to be more effective. Some 200 babies are at risk every year. Is the Minister satisfied that the programme is adequately effective and that the information is properly communicated to women of child-bearing age? If not, what more is she planning to do?
Finally, we need redress. Back in 2019, the disability equality charity Scope reported that a family with disabled children faces average extra costs of £581 a month. That was three years ago. Fuel inflation and food price inflation have increased since then, and the stark reality is that families with disabled children are struggling. These children were, in the words of the “First Do No Harm” report, “avoidably harmed”. It is no sort of redress to suggest that those struggling families resort to the courts.
My suggestion to the Minister, who I believe is dedicated to her job, works extremely hard and can be very persuasive, is the following.
Christian Wakeford
I thank the right hon. Member for giving way a third time. As we know, both Emma and Janet have unfortunately been blacklisted by the Department of Health and Social Care, so if I could be so bold as to suggest another recommendation, it would be that they are never blacklisted again, to ensure that their voices are listened to, and the voices of those children and mothers are constantly heard.
Caroline Nokes
The hon. Gentleman makes an important point, but I am absolutely confident that the Minister will be very pleased to meet both Janet and Emma. I look forward to her agreeing to do so from the Dispatch Box.
My final point to the Minister is this: the Chancellor of the Exchequer, when he was Chair of the Health and Social Care Committee, was incredibly active on this issue. He launched the inquiry when he was still the Chair. His successor, my hon. Friend the Member for Winchester (Steve Brine), is equally committed and is continuing with the inquiry, and both Janet Williams and Emma Murphy will give evidence to the Committee next week. I would like the Minister to use her powers of persuasion and ability to convince the Chancellor of the Exchequer that he needs to keep going on this issue. He is now in a position where he could put in place the finances to allow a redress scheme to be set up. I urge her to persuade him to do just that.
Black Maternal Health Awareness Week 2022
Caroline Nokes Excerpts(1 year, 6 months ago)
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Caroline Nokes
That is a terrible omission. It is a pleasure to serve under your chairmanship, Mr Gray. I thank the hon. Member for Streatham (Bell Ribeiro-Addy) for leading this debate on a crucial issue.
The Women and Equalities Committee has twice held one-off evidence sessions—although there is a slight conundrum in twice having one-off sessions—looking at black maternal health. It has taken evidence from campaign groups, such as Five X More, and experts in obstetrics and gynaecology, yet the picture does not change. Looking at the evidence, we have known that there is a disparity in the health outcomes for black mothers since the early 2000s. For 20 years, we have known that there is a problem, yet still it continues. It has been a huge privilege for me to serve on panels alongside people such as Clo and Tinuke from Five X More, who have done so much incredible campaigning to highlight the issue, as has the hon. Member for Streatham. It is crucial that we begin to see progress; we cannot, 12 months or 10 years down the line, continue to have the same debate.
Raising awareness in Parliament is vital, but what we actually need is Government action. The hon. Member for Streatham made a slight dig about Government reshuffles. I am delighted to see the Minister in her place; this is an issue on which we have engaged before and she takes it seriously. I hope that the Secretary of State for Health will himself grasp the issue, and ensure that we drive it forward to see progress.
We have heard that one of the challenges is data, and the lack of specific data being collected on maternal health outcomes for black and Asian women. I pay tribute to Five X More, which carried out its own experiences survey that included 2,000 women—a huge number—reporting their experiences and findings. The thing that really hits home for me is the repeated use of the phrases, “I didn’t feel listened to,” “We weren’t listened to,” and, “What I was experiencing was being ignored.”
I am loth to say that we sometimes have very gendered healthcare, but look at the evidence. Look at the fact that when there is medical research, it is almost exclusively carried out on men; look at the fact that drug trials are carried out on men; look at the fact that some of the highest backlogs as we come out of the pandemic are in health conditions predominantly affecting women. Whether it is in cardiac, obstetrics or another sphere of medicine, too often the experience is, “I didn’t think they were listening to me.” I am sure every Member hears that from their constituents, and that has been my experience as a constituency MP. I hear from my constituents that, specifically in the area of maternity, “I wasn’t listened to. Nobody paid attention. It was my body, and I knew something was wrong.”
Only last week, I received an email from a constituent who had lost his daughter-in-law moments after she gave birth. He was with his son, helping to bring up a baby and pursue a complaints procedure against the hospital in question. Throughout his email, he kept making the point that they had not been listened to. His daughter-in-law had been a midwife, and even she was not listened to.
Talking to black and particularly Muslim women—I should declare an interest as chair of the all-party parliamentary group on Muslim women—they feel that their voices are doubly ignored, and that there is that intersectionality. Whenever I talk to journalists about intersectionality, they look at me and say, “Please don’t use that word. Nobody understands that word.” It is imperative that we all understand that word. You will be discriminated against if you are a woman, and you will be discriminated against if you are a woman from a black, Asian or other minority ethnic group; when the two come together, as we find in maternity units in particular, women’s voices are not heard or listened to.
When we talk to the Royal College of Obstetricians and Gynaecologists, as the hon. Member for Streatham has done, it calls for specific targets for black maternal health outcomes, and it is right to do so. Although it may be a small number as a percentage of births every year, it is still a significant number. The loss of one mother is one too many.
Jim Shannon
It is always a pleasure to listen to the right hon. Lady; she brings lots of wisdom and knowledge to these debates. Ministers in other debates we have had in Westminster Hall, in different positions in the Department of Health and Social Care, have always spoken about the issue of data. The hon. Lady is outlining examples of where data could be used to formulate a Government and ministerial response. Does she agree that the Government really need to grasp the data issue? They can then prioritise their strategy to respond.
Caroline Nokes
I thank the hon. Gentleman for his intervention. I did not think he would be entirely able to resist speaking in the debate. He is right: policies must be data-driven and evidenced, but the evidence is there and has been for many years. We are augmenting and adding to that body of evidence the whole time.
I will not be entirely negative, because we have some great opportunities. I was pleased to see Dame Lesley Regan appointed women’s health ambassador earlier this year. I welcome, reinforce, champion and offer anything I can to help the women’s health strategy. Finally, we have one of those, and I pay tribute to the Minister who was instrumental in getting that published. What we now need from the strategy is outcomes. That has to be the focus. What is happening to drive outcomes, and to ensure that the disparities we know exist are recognised, acted on and reduced? Our goal has to be to reduce that horrendous figure of four times as many maternal deaths for black women. We have to improve the outcomes for black babies, so that there is not, as I think the hon. Member for Streatham said, a more than 100% likelihood of stillbirth—
Caroline Nokes
Increased risk. The hon. Lady is absolutely right to highlight that as an imperative. We must ensure that we reduce the inequity, of which there are many drivers. She was with me when the Women and Equalities Committee took evidence from Professor Sir Michael Marmot, who talks so compellingly about health inequalities and their drivers.
I will not say that there is anything wrong with black women’s bodies—there is not—but we have to look at housing conditions, air quality and the areas where they live. Air quality is a significant driver of poor health outcomes. We have to look at what we are doing around smoking cessation, which is good for not just black women, but all women. We have to look at obesity, which is, again, a crucial factor for all women.
I look forward to seeing, in the remainder of this Parliament, focused and determined action around obesity, smoking cessation and air quality. There are targets on all those things, but—how can I put this gently?—there has been a little backsliding on some of them. Targets have been pushed into the dim and distant future, and there is less commitment around drives to reduce obesity and smoking, which are incredible drivers of poor health outcomes across the population. We should double down on our commitment to those targets.
I hope that in due course—I get fed up of saying “in due course”, which is a standard ministerial answer—to see a White Paper on health disparities. It is imperative that we get that done, and that the women’s health strategy is seen as a driver to ensure that we improve outcomes. First and foremost, I reiterate the calls from the hon. Member for Streatham for targets. I am never a great fan of targets if they are just there for the collection of targets, but if they work, and we see that in many instances they do, we should have them.
We should have time-limited targets, so that in maybe three years we can look and say, “Nothing has changed.” Looking at the data and the evidence from campaign groups, I see that over 20 years, nothing has changed. I do not want to be here in 20 years’ time giving the same speech on this important issue, feeling that nothing has changed. I look forward to the Minister’s comments, and reiterate my congratulations to the hon. Member for Streatham on calling for today’s debate.
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
It is a pleasure to serve under your chairmanship, Mr Gray. I thank the hon. Member for Streatham (Bell Ribeiro-Addy) for securing this debate. As she highlighted, we had a similar debate recently. I hope that my comments reassure her that we are taking action and making progress in this area.
I take the issue of maternal disparities very seriously; that is why when I was in post previously I set up the maternity disparities taskforce, which has brought together a range of specialists and campaigners. We have heard from groups such as Five X More and the Muslim Women’s Network to hear their views on what is going wrong right now, what systems we need to put in place to improve outcomes and also the experiences of black women in maternity services.
The data shows the disparities in black maternal health. We have heard about them clearly this morning, and I do not think anyone is in any disagreement about the scale of the problem we are facing. As the hon. Member for Streatham said, it is harrowing to hear those figures. The MBRRACE annual surveillance report shows that women of black ethnicity are four times more likely to die from pregnancy and birth compared with white women. I do not think there is a dispute about that; we fully acknowledge it and we want to reverse that trend as quickly as possible.
Caroline Nokes
I want to make a quick point about MBRRACE and the data. Data collection remains tricky, with some hospitals not reporting women’s deaths—not necessarily maternal deaths—until up to 500 days after they have happened. Then there is a delay with the medical records and notes, which might indicate the reasons for that. What reassurance can the Minister give that she will work to reduce those times?
Maria Caulfield
My right hon. Friend is absolutely right. Although Five X More does its surveys about the experience of women, the data on outcomes is very delayed. When we put measures in place, we cannot see the difference they make until the data comes through, roughly 18 months to two years later, as my right hon. Friend said. That lag does not help us determine whether the measures we are putting in place are actually making a difference. Getting that on track is a key priority for me so that we can accurately measure what is happening.
From the data that we do have, The Lancet series in April last year found that black women have an increased relative risk of 40% of miscarriage compared with white women, and the stillbirth rate in England for black babies is 6.3 per 1,000 births, compared with 3.2 per 1,000 births for white women. That is completely unacceptable, and as the hon. Member for Streatham said, we cannot come back here, debate after debate, without seeing those figures move. One potential cause for optimism is that we do not have up-to-date data on the benefits of the interventions that we have put in place, so it might be better than we think. However, we absolutely need that data, not only to measure what is happening, but to know whether we are heading in the right direction if we set targets in the future.
To reassure Members, I want to clarify the point about not setting a target because the problem is too small. I do not agree that the problem is too small; it is a significant problem. Even if it is affecting one or two women, it is a significant problem, so that is not a reason not to set a target. As the hon. Member for Putney (Fleur Anderson) pointed out, there are multiple factors in why black women often face poorer outcomes in pregnancy and birth, and for their babies. It is a mix of personal, social, economic and environmental factors. Air quality, which the hon. Member touched on, also has an impact on overall health. The maternity disparities taskforce found that being in a lower socioeconomic group has a significant effect on maternal outcomes, and black and ethnic women are often in those groups and so face a double whammy in terms of their likely outcomes.
We cannot just fix this in isolation at the Department of Health and Social Care. That is why I am pleased that in my role for women’s health—I am also the Minister for Women, across the board—I can bring in other Departments, because we need to take a cross-Government approach to this issue. Whether it is the Department for Environment, Food and Rural Affairs on air quality, the Department for Levelling Up, Housing and Communities on housing, or the Department for Work and Pensions on employment, we need to work together so that all the factors affecting black maternal health are addressed in tandem to address this issue.
We know from a health perspective that pregnant black women are more likely to suffer from some chronic diseases that will affect their maternity outcomes, and in particular cause poorer mental health. There are health initiatives that we can put in place to ensure that we improve the outcomes for black women, but that cannot be done in isolation from the other factors that also negatively affect them.
Given the risks that such conditions pose in pregnancy, there is a need for safe personalised care for black women and women from ethnic backgrounds, because the needs of women from each and every community are so different. Just nationally introducing blanket systems will not address some of the problems; there is no one single solution that will improve the statistics and improve the outcomes for women.
The issue is not just the outcomes from maternity services. As we heard from the hon. Member for Streatham, the Five X More survey also reflects the general experience by black women of the healthcare system. Although black women are often at a more difficult point to start with, when they engage with health services they often have a very negative experience. We have seen that in the recent publication of the East Kent maternity report and in the Ockenden maternity review, which highlighted that there is racial discrimination present in some parts of the maternity services.
We cannot allow that to continue, because if we want black women to come and engage with services and to come forward when they have concerns, if they feel that they are not being listened to or if they raise concerns and they are dismissed, why would we be surprised when they do not engage with services in the future? Regarding the East Kent report in particular, I will look at the calls for action on how we improve black women’s experience of the healthcare system and considering how we can address those issues as urgently as possible.
When we consider the actions that we are putting in place, and I will touch on some of the ones that have already started, I am very much a supporter of Professor Marmot’s idea of proportionate universalism, whereby we introduce good services across the country but then we target those people who are most in need; in the case of black maternal health, that is clearly women from the black community. We need to go to them rather than expecting them to come to the health service: we have a universal offer, but ensure that it is targeted specifically at those who do not experience the best outcomes.
On targets, as my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) touched on earlier, we have an issue with data collection across the board in health services, including in maternity services. Black women often experience the worst outcomes, although some of the data that we are seeing is from 2020. For some of the initiatives that we have put in place in the last year or 18 months, we are not yet seeing the benefit of those initiatives in terms of outcomes. I am being very candid here: we have not got a handle on what is making a difference, or on which parts of the country are doing well—as was acknowledged by the hon. Member for Bolton South East (Yasmin Qureshi), the shadow Minister, there are some very good practices in place—and which parts of the country are still not supporting women in the way that women want.
We are working with NHS England, the Office for National Statistics, MBRRACE-UK and the National Neonatal Research Database, because there are also multiple sources of data. We need to pull all the data together and get it as close to real-time data as we can, so that when we introduce interventions and measures we can know whether they work.
As part of the maternity disparities taskforce, I am also keen to make sure that we include black women more in the national patient survey, because the shadow Minister was quite right that we had over 100,000 responses to the women’s health strategy but only a small percentage of those responses came from black and ethnic minority women. That illustrates the problem that we are talking about—that black women do not feel represented, or do not feel engaged with the process. So we have to change things and work is being done to address that situation.
We are introducing some measures. First, we have set guidance that each local maternity system is now working in partnership with women and their families and their local areas to draw up equity and equality action plans. For each local maternity system’s local area, there has to be a plan in place about how to improve the outcomes for women. The plans are agreed by the local maternity systems and the new integrated care boards, which were set up in the summer. They were published last week, so I encourage hon. Members to look at their local action plans to see what they are putting forward and to challenge them if they feel that they are not meeting local community needs. That is why they are done on a local basis: what is appropriate in my constituency of Lewes may be different to what is needed in Streatham, Putney, Leicester East, or Romsey and Southampton North. It is really important that we look at those action plans to make sure that they address the problems that we are concerned about. Every plan is being reviewed by NHS England, which will identify areas of good practice and the support that is needed to drive them forward.
In addition, we have also commissioned 14 maternal medicine networks covering the whole of England, which will ensure that women have access to specialist management. We know that black women are more at risk of high blood pressure, diabetes and sickle cell anaemia and yet many of those risk factors for their pregnancy and birth are not dealt with or managed. The maternal medicines network will bring in specialists so that, at an early stage of their pregnancy, those women can access those specialists to help them manage their pregnancy. They will also be offered pre-conception advice for further pregnancies. We have never done that before. We are targeting the risk factors of black women, and all women who are at risk, to make sure that they get the medical support and advice that they need during and after their pregnancy.
The Department also launched the £7.6 million health and wellbeing fund last year, which is supporting 19 projects throughout England to try to generate best practice guidelines that we can introduce to help reduce disparities. These projects include supporting expectant young black fathers in child development and providing perinatal mental health support for black mothers. If we can get some evidence-based best practice, we can look to roll that out across the country in the coming months and years. There is a lot of work going on.
I will touch on the issue of racial discrimination. It is clearly unacceptable that black, Asian and ethnic minority women feel that the health service is not accessible or not responsive to their needs. There is education and training for NHS staff on health disparities to eliminate bias and racism in obstetrics and gynaecology. The Royal College of Obstetricians and Gynaecologists’ race equality taskforce has developed e-learning cultural competencies. They now form part of the colleges’ members continuing professional development. The Nursing and Midwifery Council is also looking at how to promote and embed equality and respect in professional practice, so that they can create an environment where everyone feels that they can access the services they need. We will obviously continue to look at this with the maternity disparities taskforce, which is bringing in campaigners, experts and professionals to try to drive momentum on this issue.
Data is the key. I can give a commitment here that has been highlighted already. We need that data. We cannot be working with data that is two years old to see if we are making a difference because, if we are, we will not know about it for two years and will not be able to roll out good practice in other parts of the country. In my brief as the Minister for Women, I am aiming to bring that across other Departments as well.
I hope I have reassured hon. and right hon. Members in today’s debate that I am committed to continuing the work to tackle the disparities in outcomes to ensure that everyone has the opportunity to live a long and happy life. I am happy to work with the APPG on black maternal health, which is chaired by the hon. Member for Streatham, because it is only by working together to identify good practice and raising it when things are not working well that we can eliminate the disparity: it is unacceptable that black women are four times more likely to die during pregnancy simply because they are black women.
International Women’s Day
Caroline Nokes Excerpts(4 years, 2 months ago)
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Caroline Nokes (Romsey and Southampton North) (Con)
It is a pleasure to have the opportunity to speak in this debate.
I also thank the Leader of the House for granting Government time for this debate. We are, of course, in quite interesting times. This debate is normally granted by the Backbench Business Committee, but I found myself with no Committee to which to apply for time for this debate, so I appreciate the efforts of my right hon. Friend to find this time today. I extend my thanks to the hon. Members for Canterbury (Rosie Duffield) and for Birmingham, Yardley (Jess Phillips), who joined me in advocating for having this debate at the right time.
It is also a pleasure to follow the shadow Minister, the hon. Member for Brent Central (Dawn Butler). She spoke about intersectionality, and my first contribution in any public forum as, at that time, Chair-elect of the Women and Equalities Committee was at a meeting hosted by the Fawcett Society on how discrimination against women is exacerbated for women from a black or minority ethnic background and for women with a disability. The one point the hon. Lady did not mention is that discrimination is also exacerbated by age. Older women are, of course, among the most invisible in society.
We will hear many powerful contributions to this debate, perhaps particularly from the hon. Member for Birmingham, Yardley. She will again make a powerful, moving and, frankly, horrific contribution. Each year, on International Women’s Day, we reflect again on those women who have been a victim of their partner’s violence during the previous 12 months. It is appalling, and I want the numbers to go down. I want there to be a year when she can stand and celebrate International Women’s Day without a single name to read out. We are not there yet. Indeed, we are a long way from it, and perhaps we will never get there, but we have to keep moving forward with important measures like the Domestic Abuse Bill, which we must pass in this Parliament.
I remember being in the Chamber when the Bill was debated last year, and I remember the frustration that a general election came along and the Bill did not make progress. We have no excuses this time.
Kate Green (Stretford and Urmston) (Lab)
I congratulate the right hon. Lady on her speech. She is right to highlight the appalling incidence of domestic abuse still disproportionately suffered by women. Does she agree that that underlies much of women’s offending behaviour? Will she join me in asking the Government to clearly link their domestic abuse strategy with their female offender strategy so that women who end up in the penal system as a result of having been a victim of abuse have their needs properly addressed in the criminal justice system?
Caroline Nokes
The hon. Lady is, of course, right to point out the link between domestic abuse and women too often ending up in the penal system. I am somewhat surprised and disappointed that the hon. Member for St Albans (Daisy Cooper) is not here, because she has frequently raised with me the issue of women in the justice system and what more we have to do to assist them and to avoid them ending up there in the first place.
This debate is a chance to look backwards as well as forwards, and to consider whether the previous 12 months have been good for women. I have supported, promoted and, indeed, celebrated measures in this House but, as Charles Dickens might have said, they have been the best of times and the worst of times. It is odd for somebody from Southampton to quote a man from Portsmouth—those who are not from the south coast will not understand what I mean—but it accurately sums up the progress we have made and the setbacks there have been.
I vividly remember when the Domestic Abuse Bill was first introduced, when we heard the fantastic, powerful and horrendous contribution from the hon. Member for Canterbury. I also remember the powerful contribution from my hon. Friend the Member for Wyre Forest (Mark Garnier)—I was sitting directly behind him, and it will forever be seared in my mind—about Natalie Connolly and the horrendous defence we see used increasingly often in domestic abuse and murder trials that rough sex is something women victims enjoy. There should be no place for such a defence.
Last year we did see the introduction of stalking protection orders, which are designed to protect the victims of stalking, the vast majority of whom are women. The crime survey for England and Wales estimates that 4.9 million adults in England and Wales have experienced stalking or harassment in their lifetime, and women are twice as likely to experience stalking, with mixed-race women and those aged 20 to 24 at greatest risk.
The law was changed last year so that upskirting offenders can be arrested and sent to prison. Some of us felt that legislation was unduly delayed, and, of course, there were some interesting lingerie-led protests.
My right hon. Friend the former Member for Richmond Park, now a noble lord, secured a strengthening of the law on female genital mutilation. I know my right hon. Friend the Prime Minister cares deeply about the issue, and I am pleased to hear the Minister for Women and Equalities mention it today. As Immigration Minister, I worked hard to keep out of this country people who advocated FGM. I was appalled when I heard the deployment of the phrase, “It is only a little bit of cutting.” No, it is child abuse, it is illegal and there should be no place in this country for people who are the proponents of FGM.
Outside the world of politics, we saw last October the first all-female spacewalk, and last month Christina Koch returned from the longest single spaceflight by a woman. She spent 328 days in space, an incredible period, and she is one of those fabulous role models that we have for young women everywhere. Dina Asher-Smith, in Doha, scooped silver in the 100 metres, gold in the 200 metres and silver in the relay, becoming the first Brit to win three medals at a major championship, Simone Biles continued being one of the greatest women athletes ever, racking up medal after medal at the world gymnastics championships in Stuttgart, and Jade Jones added her first world taekwondo title to her double Olympic gold. Of course there are those who cannot bear to watch female athletes and make offensive comparisons. To them I say that I would like to see them compete with Sarah Storey, who achieved her 35th world para-cycling title.
On pay, there have been some triumphs, although I would argue that they are not wins—they are merely fairness. Samira Ahmed won her case against the BBC in January this year, but we all know there is a long way to go. Gender pay gap reporting has shone a light on disparity, but we know that some Departments have gone backwards and the disparity is greater today than it was this time last year. Perhaps when the Whip—my hon. Friend the Member for Lewes (Maria Caulfield)—responds, she will be able to give us an assurance that my right hon. Friend the Secretary of State is absolutely committed to closing the gender pay gap. In this place, we have done better—
Ms Harriet Harman (Camberwell and Peckham) (Lab)
I absolutely agree with everything that the right hon. Lady is saying in her speech, and I congratulate her on becoming Chair of the Women and Equalities Committee. Will she meet me so that we can plot together to use the forthcoming employment Bill as an opportunity to bring in new tougher laws to narrow the gender pay gap? Although in law it is illegal, the yawning pay gap persists. We can use that Bill to toughen up the law. Shall we work together on that?
Caroline Nokes
I believe the right hon. and learned Lady, the Mother of the House, is working on a number of issues on which she and I would find common ground. I am always delighted to meet her to work out how we can continue to do better. The Women and Equalities Committee has only met for the first time this week, but it has a number of priorities it wishes to look at. One of my contentions was that the gender pay gap should be a recurrent issue that we revisit annually, giving Ministers the opportunity to come before the Committee to explain to us how the Government have been making progress, or perhaps otherwise, on closing that yawning gap.
As I was saying, in this place we have done better. The Secretary of State and the shadow Minister both mentioned that there are now more women MPs than ever before; 34% of all MPs are women, and that is a great deal better than the situation was in 2010 when I arrived. I recall that when I joined the House, my right hon. Friend the Member for Basingstoke (Mrs Miller) pointed out to me that when she came in here in 2005 there had been only 17 Conservative women MPs. There was a massive jump in 2010. From last year’s election, this Parliament did do better, but on this side of the House we are still a long way short of 50%. I cannot help but mourn the departure of people such as Amber Rudd, Claire Perry O’Neill, Caroline Spelman, Baroness Morgan, Justine Greening, Anne Milton, Margot James, Sarah Newton and Seema Kennedy, many of whom came in at the same election as me in 2010. But I am delighted to see new Members here, and I know that in time they will rise to the dizzy heights that those female colleagues whom I mentioned rose to. I know that they will come to love this place, be promoted and contribute a great deal.
I believe I am correct in saying that across all Government payroll positions we are now just shy of 50:50. But—and it is a big but—has that percentage been reached by putting women on to the first rung, the unpaid payroll? If so, what on earth has that done to the gender pay gap in government, when 73% of the Cabinet are men and 45% of Parliamentary Private Secretary positions are filled by women who are not paid. So I think we have some things to celebrate and some that I simply cannot. I am saddened that the men in grey suits went after a woman Prime Minister—again. I am genuinely saddened that the Labour party looks unlikely to elect a woman leader—again—although I am the first to acknowledge that polls can be wrong. I wish every female candidate left in that race luck, and indeed those who are in the contest to become deputy leader. Having mentioned a string of Conservative colleagues who have left this House in the past 12 months, I should say that I also miss Luciana Berger, Ruth Smeeth and Angela Smith, to name just a very few. In this place, there has always been, and I hope there always will be, solidarity and sisterhood across the House. Some of the best advice I ever received in this place came from Joan Ruddock, way back in 2010, when I was a newbie and she was something of a grande dame of the Labour party. I refer to her as a grande dame as a term of affection, although I note that Quentin Letts now refers to me as a grande dame and I am not sure it is meant to be complimentary at all.
What we have certainly seen over the past year is an intensification of the harassment, bullying and torment of female politicians on social media. One of my local papers, the Andover Advertiser, asked me this week to provide some commentary ahead of International Women’s Day, and I found myself speaking of resilience. There are days when I hate the fact that I have to be as tough as I am. I always describe myself as having the hide of a rhinoceros, which is sometimes useful when dealing with constituents, particularly the ones who think it is okay to email me to tell me that I am a “tiresome underachieving woman”. I am sure they think they are getting somewhere with their comments, but I always prefer to laugh at them, envisaging a chap of a certain age, undoubtedly as red in the face as he is in the trousers, as he bangs his keyboard with venom. I joke, but it is not a laughing matter, and I know that I get off extremely lightly compared with the right hon. Member for Hackney North and Stoke Newington (Ms Abbott). For those new to the House, let me say that the “mute” and “block” buttons are your friends, and that by being here you achieve more every single day than your fiercest keyboard warrior critic ever will.
On press commentary, it was only last week that we had the celebration of 100 years of women journalists in the Press Gallery. Miss Marguerite Cody was the first woman ever to report from Parliament, but today there are still too few women who look down on us from the press seats. The faces we see are still predominantly male, some not in the first flush of youth, and for good reporting we need diverse reporting, even when we might find the commentary uncomfortable. I have no doubt that women do ask the toughest questions but also the fair ones. I use as an example the fact that no woman journalist has ever asked me what my dad thinks.
I turn to the role I now hold as Chair of the Women and Equalities Committee—what a great position and opportunity. My predecessor, my right hon. Friend the Member for Basingstoke, steered the Committee through its first five years, and I am very conscious that I have a difficult pair of shoes to fill. I suspect, however, that with size 8 feet I can more than manage it. She rightly mentioned the lack of statues of inspirational women in our country. There is no shortage of women role models, but there is a shortage of tributes to them through the arts and through culture. It is brilliant that in her constituency we now have a statue of Jane Austen, but I am struck by the fact that my constituency was the home of Florence Nightingale. She was a very modest woman who demanded that there should be no tribute to her when she died. Her grave is in the same village as I live in and it does not even have her name on it—it has her initials only. I look forward to going in a few months’ time to the unveiling of a stained glass window in Romsey abbey, which was deliberately moved away from the church in which she is buried but absolutely reflects the importance she had as a woman, as a scientist and, given the way she worked with government, as a politician—this was someone born 200 years ago.
Although the Women and Equalities Committee met in this Parliament for the first time yesterday, so it is still very fresh, there was no shortage of ideas. There was also a commitment to conclude in this Parliament some of the work started by the predecessor Committee in the last Parliament and curtailed because of the December election. We will in turn form our own priorities and set our own agenda, but some of that will be to return to the gender pay gap to benchmark progress. There is a serious job to do in scrutinising the performance of Government against their own objectives, and we will do that with determination and commitment.
Oral Answers to Questions
Caroline Nokes Excerpts(6 years, 6 months ago)
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Thelma Walker (Colne Valley) (Lab)
The Parliamentary Under-Secretary of State for the Cabinet Office (Caroline Nokes)
I thank the hon. Lady for her question. It is important that we look closely at the findings of the racial disparity audit that was released this week and work across the Government in every Department—including the Department for Work and Pensions and the Department for Education—to bring forward positive changes to address some of the very uncomfortable findings in the audit.
Chris Davies (Brecon and Radnorshire) (Con)
We have made incredible progress since women won the right to vote, and I am especially proud of my female colleagues and Ministers and, of course, our second female Prime Minister. What more will the Minister do to increase the number of women in Parliament?
Oral Answers to Questions
Caroline Nokes Excerpts(7 years, 1 month ago)
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Gavin Newlands (Paisley and Renfrewshire North) (SNP)
The Parliamentary Under-Secretary of State for Welfare Delivery (Caroline Nokes)
I would, of course, like to add my condolences to those already expressed by colleagues to the families of the victims of yesterday’s attack, and especially to the family of Keith Palmer.
I can assure the House that the Equality Act 2010 and the public sector equality duty, which incorporates a number of EU directives on equalities, will continue to apply once the UK has left the EU. Additionally, we continue to be signatories to the UN convention on the rights of persons with disabilities, which is binding in international law.
Alan Brown
I thank the Minister for her answer, but she will be aware that a lot of her Conservative colleagues are desperate to do away with many of the regulations. As we go forward post Brexit, will she guarantee that there will be no rush to deregulate and there will not be a reduction in the statutory protections available to disabled people?
Caroline Nokes
The hon. Gentleman mentions my colleagues, but I remind him that the Conservative party has a proud history of protecting disability rights. It was under a Conservative Government that we passed the Disability Discrimination Act 1995, which made it unlawful to discriminate against people in respect of their disabilities. The UK is a world leader in support for disabled people, and we are proud of the work that we do to support people with disabilities and health conditions, both in this country and abroad.
Gavin Newlands
There is already a lot of fear and anxiety as this Tory Government have substantially reduced disability support with the powers they already have. How then can we trust this Government’s word? Will the Minister set out exactly which of these rights will be safeguarded following Brexit?
Caroline Nokes
Our reforms to welfare are about making sure that we give more to those who need it most while encouraging those who can do so to get into work. That is why people with the most severe disabilities have had their payments increased and protected from the benefit cap and the benefits freeze.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Over 160 Members have signed a prayer against the new personal independence payment regulations. The period for praying against those regulations comes to an end on 3 April. A debate has been arranged in the other place next week, but to date the Government have refused to arrange a debate and vote on the Floor of this House. There is a huge democratic deficit, as the regulations will come into force under the negative procedure. Why are the Government refusing to hold a debate on the new PIP regulations in this House?
Caroline Nokes
As the hon. Lady will know, the usual channels decide when debates will be held in this place. It is not for me to give such a date today.
Fiona Mactaggart (Slough) (Lab)
The Parliamentary Under-Secretary of State for Welfare Delivery (Caroline Nokes)
The Welfare Reform and Work Act was scrutinised by both Houses and gained Royal Assent in March 2016. An impact assessment of the policy was published during the passage of the legislation. The policy strikes the right balance between protecting vulnerable people and encouraging families who receive benefits to make the same financial decisions as those who support themselves solely through work.
Fiona Mactaggart
The respected Women’s Budget Group calculates that these cuts will disproportionately affect Asian families, costing them £16,000 by the next general election compared with a cost of £13,000 for larger white families. Should not the Government have carried out a comprehensive equality assessment on this and other Budget measures, and taken action to end this disproportionate effect?
Caroline Nokes
As the right hon. Lady will have heard me say, the policy was available for scrutiny during the passage of the Bill. Since 2010, we have worked hard to make sure that families who are reliant on benefits make the same decisions as families in work. Our reforms are about encouraging more people into work.
Mr David Nuttall (Bury North) (Con)
For the very reason that my hon. Friend has just given—those on welfare benefits should have to make the same choice as those in work—will she reassure me that there will be no U-turn on this policy?
Caroline Nokes
As I have said, the reforms are aimed at helping working parents and they are removing barriers to work for ordinary men and women across the country. Ordinary working families rely on the Government to provide economic stability and we are starting from a position of strength. I assure my hon. Friend that we have looked at the regulations carefully, and we have taken this decision to restore fairness in the benefits systems.
Angela Crawley (Lanark and Hamilton East) (SNP)
May I, too, associate myself with the comments made by right hon. and hon. Members from across the House?
The Prime Minister wants to transform the way in which we think about domestic violence, and I am sure that the Minister supports her in those efforts, but does the Minister accept that that is completely undermined by introducing the rape clause without parliamentary scrutiny? Will she encourage her colleagues to scrap this pernicious tax?
Caroline Nokes
The hon. Lady will recall that there was a debate on this subject in Westminster Hall in October. I am aware that there have been repeated requests for further scrutiny and debate on this subject, and the usual channels have considered them.
Sarah Champion (Rotherham) (Lab)
I associate myself with the Minister’s comments about PC Keith Palmer. We will always owe a debt of gratitude to him and our hearts bleed for his family.
From 6 April, new mothers will not be able to claim tax credit or universal credit for their third child. What communications has the Minister had with women who are pregnant now to tell them that they face an unexpected drop in income because of this Government’s choices?
Caroline Nokes
Of course, the hon. Lady will know that no existing family will be a cost loser as a result of this policy. We consulted widely on the exceptions and how to implement them, and we have worked hard with Her Majesty’s Revenue and Customs to make sure that information is available to all staff who have to communicate the policy.
Lilian Greenwood (Nottingham South) (Lab)
The Parliamentary Under-Secretary of State for Welfare Delivery (Caroline Nokes)
The Government consulted on the exception in October 2016 and responded in January 2017, outlining the finalised policy. Since then, we have been developing guidance and working with stakeholders to plan for the delivery of this exception in the most sensitive and compassionate way possible.
Lilian Greenwood
The rape clause exception in the two-child limit on tax credits is not just unworkable, but inhumane. It betrays a fundamental misunderstanding of sexual violence and domestic abuse. Will the Minister act urgently and seek to persuade her colleagues in the Department for Work and Pensions to reconsider the proposal in order to protect women’s rights?
Caroline Nokes
We know that this issue is difficult and sensitive. The exception will use a third-party model, whereby women can request the exception through engaging with a third party, who will be a recognised healthcare professional. We are setting up procedures that are mindful of the sensitivities involved. Neither DWP nor HMRC staff will question the claimant about the incident, other than to take the claim.
Kerry McCarthy (Bristol East) (Lab)
The Parliamentary Under-Secretary of State for Welfare Delivery (Caroline Nokes)
Recent changes to the PIP regulations clarify the original criteria used to decide how much benefit claimants receive. This is not a policy change, nor is it intended to make new savings. It will not result in any claimants seeing a reduction in the amount of PIP previously awarded by the Department for Work and Pensions.
Kerry McCarthy
The Minister, in response to the Labour Front Bench, batted away suggestions that we need a full debate and vote on the Floor of the House on this issue, but given that the Government’s own equality impact assessment says that 164,000 people with debilitating mental health conditions will be affected, does she not think it is her job to go to the DWP and tell them we want a proper vote?
Caroline Nokes
Supporting people with mental illness is a priority, which is why we are spending more on mental health than ever before, and an estimated £11.4 billion this year. PIP does ensure parity between mental and physical conditions, and it achieves this by looking at the impact of conditions on an individual, not which conditions they have. As I have previously said, it is of course up to the usual channels to decide whether there will be further debate on the subject.
Mr Jim Cunningham (Coventry South) (Lab)
The Parliamentary Under-Secretary of State for Welfare Delivery (Caroline Nokes)
As the hon. Gentleman knows, there is a long-standing commitment to equalise the state pension ages of men and women, and we continue to look very closely at the state pension age in general. I am sure that the hon. Gentleman, like me, welcomes the increase in longevity. The Government have made big concessions with regard to cost—we have already committed more than £1.1 billion—and there will be no further concessions.