Support for Life-shortening Conditions

Gregory Campbell Excerpts

Tuesday 7th June 2016 Westminster Hall

[Stuart Andrew]

My hon. Friend is right. I saw great advances throughout my time in the hospice movement. When I first joined Hope House, the life expectancy of the children who suffered from Duchenne muscular dystrophy was usually no longer than 18 or 19. By the time I had finished my career in the hospice movement, some were living into their late 20s and possible even their early 30s. Transition is incredibly important for them, because often the style of care provided is geared more towards the older generation than to young people.

Transition is incredibly important and centres such as Martin House, which I worked for, understand that. It built Whitby Lodge, a dedicated unit for teenagers and young people, which has state-of-the-art equipment designed to enable social interaction through things such as a mini nightclub—something that we all take for granted. As well as caring for children and young people in the hospices, members of the care team supported the family in their home. Even after a child has died, help is provided in the form of bereavement care for family members.

Transitioning to other services can sometimes present real difficulties. From dealing with new agencies and professionals, to transitioning to a completely different plan, the result can create quite severe gaps in service provision. The impact is, frankly, quite shocking, with 36% of families breaking down, 64% of mothers and 24% of fathers having to give up work entirely, and nearly 70% of siblings being bullied or feeling isolated at school.

All that can create a cocktail of problems that leads families into poverty. Therefore, at all times, it is vital that locally available, community-led children’s palliative care is at the heart of the service provision. These kinds of services are, thankfully, easier to find than they once were due to local offers and organisations such as Together for Short Lives, which provide directories of available services. That is just one example of how provision has changed since I began working in the hospice movement.

I will never forget seeing families, drained and exhausted, arriving straight from work or school on a Friday, the colour drained from their faces with no fight in them, dragging bulky equipment around in their car, when all they wanted to do was what we all like to do—go out for a simple meal on a Friday night. Great palliative care allows those families to have short respite breaks, the importance of which really cannot be overstated, because it provides support to everyone in the family. With the number of children and young people with life-shortening conditions increasing, it is becoming harder for the Government, the NHS and local councils to budget enough to meet those families’ needs, given that the number of people with such conditions is not being monitored, as the hon. Member for Torfaen (Nick Thomas-Symonds) mentioned. The complex care that such families need from multiple agencies and professionals is not joined up enough, and families have to fight with their last ounce of strength to get the services they need. I therefore ask my right hon. Friend the Minister what can be done to ensure that the number and needs of children and young people with life-shortening conditions are more accurately monitored.

Funding for voluntary sector providers of children’s palliative care is not being provided fairly or sustainably. It is limited to medical elements of care and does not include crucial non-clinical elements such as short breaks and bereavement support. Together for Short Lives expects to publish soon the results of a series of freedom of information requests it has made to clinical commissioning groups and local authorities. Those results will show the extent to which different elements of care are being commissioned, and I hope that colleagues from across the country will use those data to see how their own constituents’ care is performing.

Before that, I ask the Minister whether he can set long-term plans for funding children’s palliative care fairly, sustainably and in a way that reflects the growing demand for such services. Additionally, will he work with his colleagues to write to CCGs and local authorities to make it clear what their responsibilities are in commissioning palliative care? Local authorities have a duty to provide short breaks for disabled children. However, they are cutting funding for short breaks at a time when demand from seriously ill children is increasing. The Government and local authorities, of course, face a difficult situation in balancing budgets, and I fully understand the need for that to happen, but at the spending review the Government gave councils the ability to raise more money for adult social care through council tax. Children’s social care was left out and I struggle to understand why, so I would appreciate it if he expanded on that. Additionally, will he hold local authorities to greater account for the money they spend on short breaks for disabled children and ask them what action they are taking to secure access to such breaks?

As I have mentioned, without access to specialist adapted vehicles, which many families need and many of which I saw, families are unable to transport their seriously ill babies and young children to and from hospital. That often traps those babies and young children at home or in a hospital bed, preventing them from enjoying the things that we all take for granted. Children under three with life-shortening conditions are not currently eligible for the mobility component of disability living allowance, so will the Minister work with his colleagues in the Department for Work and Pensions to change the eligibility criteria so that nought to three-year-old children with life-shortening conditions, whose lives will end without heavy and bulky medical equipment, can have access to such important vehicles?

[Mr Gregory Campbell (East Londonderry) (DUP)]

Does the hon. Gentleman agree that that single gesture would do more to transform the lives of many families than all the recommendations and assurances that we all want to give those families?

[Stuart Andrew]

I certainly agree. As I mentioned earlier, it was staggering to see the smallest child come with so much equipment to keep them alive. Larger vehicles enable such families to do the things that every family likes to do, for example to go out for the day. The lack of such a vehicle often creates more isolation for the siblings I mentioned a moment ago.

Care Homes: England

Gregory Campbell Excerpts

Wednesday 13th January 2016 Westminster Hall

[Peter Kyle]

I will always be generous with my time for the hon. Lady because, early in this debate, we have found common ground. Later in my speech, I will call for assessment of exactly those areas. We need to understand how the funding changes and the new mechanisms are impacting on the ground and geographically across the country. We must make sure that any revenues generated, particularly in these times of restraint, are going to the parts of the country that need it most. My hon. Friend the Member for Redcar (Anna Turley) made the point well from the Opposition Benches. In this case, the support promised by the Government will simply not end up where it is needed most.

Secondly, on the better care fund, Ministers have belatedly recognised some of the flaws in simply relying on a precept to generate the extra funds needed for social care. There is simply not enough revenue being generated in poorer areas. The Government have said they will take that into account and use a formula for allocating extra funds for these areas taken from the better care fund. That was announced less than a month ago and we wait to see exactly how the details will operate in practice. There are murky areas and a lot of detail is coming. We must make sure we know exactly how this will impact providers in the front line.

Care England, a leading representative body for the independent care services, has already voiced its concern. It doubts whether the funding will get to the care homes that need it most. It is more likely that it will be used on other unfunded projects across the social care budget. It is worth remembering that the initial funding for the better care fund was not new money; it was funding to assist health services which was re-allocated to local authorities. I want to give the Minister the opportunity today to confirm whether the £1.5 billion is new money, or is again taken from existing health service budgets.

Local authorities will not see any of this money, whether new or recycled, until 2017-18 and even then it will be only £105 million. It could be too little, too late to prevent parts of our care home sector catering for the most vulnerable people in our society collapsing or withdrawing from the market and focusing on self-funding residents. Initial better care fund plans have been signed off by local authorities and NHS England. It would be great if an evaluation was conducted into how the funding to date has helped to support residential care homes, if at all.

I think the Minister can now see that there is cross-party support for this kind of independent evaluation into how funding mechanisms are impacting on front-line care provision. It could act as a best practice guide for authorities going forward, even when the extra resources the Government referred to become available. Will the Minister commit to this evaluation covering the impact of funding on the sector? Both Government and Opposition Members would find that helpful.

The majority of media coverage of the sector has been about the state of big providers, such as Four Seasons Health Care and HC-One, and speculation about their future viability. It is important to realise that the 10 largest providers account for about only 25% of the market, the rest being much smaller, independent providers. In my constituency there is a small family home, Wilbury rest home. Last year I sat down with the owner, Graham Dean, shortly after the Chancellor’s announcement on the living wage. Graham is the second generation of his family to run the home and, remarkably, he was born in it. Listening to him and other local independent care home managers talking with kindness, compassion and outright professionalism about the people they care for day in and day out has left a deep impression on me. They provide the kind of loving, caring environment that every human being deserves into their old age.

There are countless homes like that dotted around the country, but they are being pushed to the limit. Indeed, a survey from the National Care Association shows that almost a quarter of providers could exit the market altogether. That would be a tragedy for residents and society, and a crisis for the Government.

Another issue that is putting pressure on the sector is the national shortage of nurses, which has resulted in the increased use of agency nurses. In some cases that costs double the amount for permanent staff. To the Government’s credit, they have recognised that there is an issue and have been working with the care sector and with the Government’s skills body to develop a new training scheme to create a career ladder into caring professions. Sadly, that project was axed last December, just weeks before it was due to be launched. I understand from written answers that I have received that that was not a decision taken by the Department of Health. As a member of the Select Committee on Business, Innovation and Skills, I am happy to take up this cause with the relevant Ministers in that Department if the Minister feels that would be helpful. I would like to aid his work and I hope that his officials have already been doing much work behind the scenes to fight for its reinstatement.

As I move to my closing remarks, I would appreciate some reassurance from the Minister that the Government have a plan—dare I say it, a plan B—that is ready to be implemented should the worst-case scenario predicted by ResPublica and other respected think-tanks in the health sector come to pass. Do the Government have in place a robust contingency plan should the statutorily funded care home sector collapse, resulting in the nightmare scenario of 37,000 older people becoming homeless?

When Southern Cross Healthcare went bust in 2011, there were just enough resources from other providers in the sector to take over. Due to the current state of the industry, no private provider has the capacity to respond to a shortfall of 37,000 beds.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Gentleman on securing this debate. He is outlining the scenario that might lie ahead if the Government do not increase their intervention. Does he agree that, for the first time in history, the UK is reaching a stage where, in addition to senior citizens being dependent on care they receive in care homes, some of their sons and daughters are of such an age that they, too, are senior citizens, so the level of dependence is even greater?

[Peter Kyle]

I am extremely grateful for that intervention. I had not considered that and I will take it on board. I am grateful to the hon. Gentleman for pointing it out and putting it on the record.

It may not be a Southern Cross that fails first. In fact, it is most likely to be the smaller, independent providers in areas that are most dependent on local authority placements. Can the Minister reassure us that his Department and local government have the capacity to respond to any piecemeal closures that are likely to occur?

World Prematurity Day

Gregory Campbell Excerpts

Tuesday 24th November 2015 Westminster Hall

[Chris Heaton-Harris]

I concur with my hon. Friend on that matter. I have heard many a story about that. I have also visited the John Radcliffe hospital to see its neonatal unit and talked to parents. In Northampton general hospital’s case, there is a way for someone to get their parking charge back, although actually, if they are the parent of a premature child who is not doing very well, the last thing they think about is where they are going to park and how they are going to pay for the ticket. The grandparent of a baby born prematurely who is not very well does not think about the parking charge when they go in, but it is one of their worries when they leave. We need to do better on that issue and spread some of the best practice that exists in the NHS when it comes to parking charges. Those charges seem like a minor element in the scheme of things, but they are such a big deal to parents, grandparents, friends and family—the support mechanism that builds around a family when a baby is born prematurely and especially when a baby is born unwell. My hon. Friend is completely correct to raise that issue.

As I said, we have a long way to go before all babies born too soon have the best possible chance of survival and of living a good-quality life. The UK mortality rate for babies is quite high for a western European country. I have previously raised in this place an article in The Lancet, going back probably five years now, saying that we ranked 33rd of the 35 top western countries in stillbirth mortality rates. We were in a very poor place, and I struggle with the massive regional variation across our country. I would like to think that we have best practice that spreads across the NHS, but there will always be somewhere that has a number of staff sick and where there is pressure on a unit. However, there should not be a massive regional variation. The Lancet article said that stillbirth was a third more likely in the east midlands than in the south-west, so there are significant issues to deal with. Surely that rate should be equal across the piece.

If the UK could match the mortality rates achieved in Sweden and Norway, for example, the lives of at least 1,000 babies could be saved every year. One thousand babies—that is such a significant statistic. I have met parents of stillborn children and know what they have gone through. Some 1,000 babies each year could be saved with best staffing and better equipment, although the issue is not so much about resources. It is about spreading throughout the whole NHS the best practice that I have seen in various hospitals up and down the country. Concerns about variation in care were highlighted in this year’s Bliss baby report, which found that two thirds of neonatal units do not have enough nurses and two thirds do not have enough medical staff to meet Government standards for safe, high-quality care.

We must talk about this significant issue and raise awareness of it. I sat on the Public Accounts Committee for five years and raised it there when we had the chief maternity officer in front of us, because we should talk about such issues whenever we get the opportunity. I know that those working in the NHS get it—I have spoken to all sorts of people from the top to the bottom of the NHS, and they obviously all care passionately for the parents and want the best outcome for their babies—but we have a long way to go to improve the care available to mothers, fathers and their babies. We need to raise the matter at every opportunity, and when I did so in the Public Accounts Committee the chief maternity officer took me to one side afterwards and said, “We are really working hard on this. This is an issue that we know we can do better on. The Government have announced a strategy to reduce infant mortality by, I believe, 50% by 2030. That is obviously welcome and recognises that we could and should be doing better.

I want to raise a few points about the 2015 baby report by Bliss, which has done so much work in this area. I know that plenty of other charities do fantastic work, but Bliss is one of the biggest, and I have worked closely with it through my constituents, the Allcotts. I very much respect its work. The report, entitled “Hanging in the balance”, found that funding shortfalls, national skills shortages and problems with training and recruitment are leaving many neonatal units without the staff they need to meet Government and NHS standards for safe, high-quality care. It states that 64% of neonatal units do not have enough nurses to meet national standards of safe staffing levels; two thirds do not have enough specialist nurses; two thirds do not have the medical staff they need to meet national standards; and 41% have no access to a trained mental health worker—one of my hon. Friends will raise that point, so I will not go into it in detail—leaving parents and staff without the vital support they need to help them cope.

I emphasise that it is not only parents who need help. When I went to the John Radcliffe hospital, I unfortunately went on a morning when three babies had died the night before. None could have been helped, but although the staff are professional people who know exactly what they are doing and the situation they are working in—they have a huge passion for their role, deliver a huge amount of care and become attached to families in a big way—it was palpable that the unit was feeling down that morning. In fact, I felt that I was getting in the way, so I left as soon as I could. It is not just parents who need trained mental health workers available to them; the staff also need them to help them cope in such situations.

There are insufficient funding accounts for three quarters of nursing shortfalls in neonatal units, and 72% of units struggle with at least one aspect of nurse training and development. From all the time I have been involved with the matter, especially when seen through the glasses that I have put on as Daventry’s MP and from standing beside Catherine Allcott on Gosset ward at Northampton general hospital, I know that attracting people to go into this area of nursing is quite a job. Those who go into it find it remarkably rewarding, but it is also a remarkably tough role. That is one reason why vacancies in this field of nursing specialism have historically been high, and we must address that. The rewards are massive, but occasionally there are unbelievably bad days at work.

We should have a whole host of ambitions nationally. I want to be able to look my constituents, Catherine and Nigel, in the eye and say that I have done everything I possibly can to ensure that what happened to them does not happen to anyone else.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Gentleman on securing this debate. He is talking about improvements nationally, and I hope that we all concur. Does he agree that the Government should ensure that international best practice and improving statistics in several countries are closely investigated and, where possible, replicated?

[Chris Heaton-Harris]

I thank the hon. Gentleman for his intervention, and he is absolutely right. Statistics regularly prove that we are not doing as well as our Scandinavian colleagues, and we should look at that. I know that we are doing so—a lot of work is going on in the Department of Health and elsewhere to see where we can improve.

I really want to be able to say to my friends who suffered from a full-term stillbirth that the care available to parents in similar situations is much better than it was for them. I said in my 2010 speech that the mother of the full-term stillborn baby was told at the beginning of a weekend that her baby had passed away, but she was sent away because an anaesthetist was not available, so she had to come back on the Monday to have the baby delivered.

I do not deny that there will always be stillborn and premature babies, but what matters is how we look after the parents and how neonatal units look after the babies. I am absolutely sure that in this Chamber and this Parliament, and across society, we all want to deliver the best possible care in those situations.

Women Entrepreneurs

Gregory Campbell Excerpts

Wednesday 18th March 2015 Westminster Hall

[Jim Shannon]

I thank my hon. Friend for that intervention. His business expertise is good for this Chamber and for the House. He will not mind my saying this, but a part of his success is his wife. I mean that genuinely. My hon. Friend and his wife have a business partnership and they both work equally hard. The success of that business is due to the efforts of both of them. He and I know that, and his wife knows that as well.

When women take it upon themselves to launch businesses, often it is to beat the high cost of child care. Perhaps the Minister will address that issue. Child care costs are a big factor in whether ladies are able to start their businesses and move forward.

It is always good to give an example. A retired lady comes to my office. She does craft work and makes bits and bobs to help to raise money for orphan projects in Africa. I am amazed at her ingenuity at times. For example—my colleagues will know this—I am apt to give out business cards. As Members will know, they come in wee plastic boxes. Given the amount of business cards that I have given out over the past five years—and long before that—there are a lot of those wee plastic boxes. She has turned those wee boxes into memory boxes and she fills them with little cards with a poem on them or a thought for the day. She does that for her Elim church mission to raise money for Africa. She has used her skills as an entrepreneur and her skills in crafts to create a business of sorts. If that did not come under charitable purposes, I have every certainty that she could make enough money to live on with all the crafts and things that she sells. That is what an entrepreneur does—that is what it is all about—and that is a lovely example of what can happen.

[Mr Gregory Campbell (East Londonderry) (DUP)]

Does my hon. Friend agree that whenever there is a successful woman locally in business, quite often she is perceived and projected in the local press as achieving success against the odds in an uphill struggle? It is almost a perception that the woman is not a natural fit within a particular system, rather than giving encouragement that this is an automatic thing. It ought to be a natural phenomenon, rather than something that is the exception. It should become the rule and the norm.

[Jim Shannon]

My hon. Friend is absolutely right. It should not be something that happens against the norm, but naturally. We welcome every business start-up, and we want to ensure that women do not feel out of place by starting a business.

The reign of the internet is now allowing more women to use their skills in a way that will benefit them. It is not simply men who are now suiting themselves with their working hours and flexible dot.com businesses. One need only look at Facebook to see how people use that medium to display their abilities. We can have anything personalised and sent almost overnight by those who choose to make the best of their time on the internet. There are many possibilities and opportunities. This is entrepreneurship at its best.

I recently met a man and a woman who own a few clothing shops in my constituency and in the neighbouring constituency. They realised that the potential for online shopping was within their grasp and expanded to include that. A business that had a turnover of £3,000 in its first few months will this year have a turnover of £1 million in online sales. That gives us an idea of the possibilities that there are. We had a meeting this week with the Department of Enterprise, Trade and Investment, and we want DETI and BT to ensure that better broadband is available for shops to make the work a lot easier. The fact is that those people saw an opportunity and took it, and we need to encourage more women—and men—to take such opportunities.

In Northern Ireland, the average age for a female entrepreneur is late 30s. The hon. Member for Feltham and Heston referred to that figure in her introduction, but anyone of any age can be an entrepreneur. Opportunities should be there earlier. Many women work part time while setting up a business, which gives them the chance to develop their business idea, while reducing the financial risk that may be involved. Others work flexible hours in their new business to allow them to look after a home or to fulfil other commitments while getting their business off the ground. Sometimes women have to care for elderly parents or their partners or children. We need to help people who have caring responsibilities.

Oral Answers to Questions

Gregory Campbell Excerpts

Tuesday 13th January 2015 Commons Chamber

[Norman Lamb]

I have to say that I was not aware of the information provided by the hon. Gentleman. I should be happy for him to send me more information, but I make the general point that it is always important for us to base our decisions and expenditure on evidence.

[Mr Gregory Campbell (East Londonderry) (DUP)]

Would the Minister be prepared to discuss with his counterparts in the devolved regions the need to ensure that clear language is considered essential, and that best practice is replicated throughout the United Kingdom?

[Norman Lamb]

I am happy to make sure that we liaise properly with the devolved Administrations and it is important for officials on both sides to ensure that the language is as clear as possible across the United Kingdom.

Care Workers

Gregory Campbell Excerpts

Wednesday 5th November 2014 Westminster Hall

[Mr Gregory Campbell (East Londonderry) (DUP)]

Does my hon. Friend agree that there is sometimes a double whammy, in that the standard of care is put at risk because of the often condensed nature of a 15-minute visit, while that also puts stress and pressure on the care worker, because of the severe intensity of trying to ensure that they get there in time knowing that they have a very limited window? That is causing problems doubly, both for the carer and for those for whom they care.

[Jim Shannon]

I thank my hon. Friend and colleague for mentioning that. Every one of us will adhere to that and will have examples of that as well.

Care workers are responsible for looking after older people, including, as mentioned previously, the provision of dementia care and palliative care, and people with learning disabilities, in order to provide a full and independent life—it is important that we try to make their lives as normal as possible. My hon. Friend highlighted the issue of care workers rushing in for a 15-minute slot, in which they interact with the person verbally and help them physically, or whatever their duties may be. To do that and be out of the house in that time is, I would suggest, impossible.

Care workers also work alongside those with physical or mental health disabilities, as well as people who have acquired a brain injury and are working along the pathway to rehabilitation. On that matter, my brother Keith had a motorbike accident some 10 years ago. He had very serious brain injuries, but care workers gave him attention during their four visits a day. Without those care workers, it is clear that he would not be able to have a normal life at home—as much of a normal life as he could have—so again, everyone is aware of the work that care workers do and the difference that they make.

As was referred to earlier, dementia will affect one in six people over the age of 80. Some 750,000 people in the United Kingdom live with dementia, and having that disease does not always mean that someone goes to a care home. People can stay at home and have a good quality of life at home—that involves not only those who are at home, the family members, but those who call—and undoubtedly, that is due to the fantastic work and support of the care workers who enable men and women with the disease to enjoy an independent and rewarding lifestyle.

Hospice care can run for days, months or years. Most care is provided in people’s homes, but people also visit hospices for day therapy and stay as in-patients. Hospices provide expert care and support for 360,000 people—those are not just figures, they are people. They are individuals and their families, and that is a point I want to hit on as well. The care and support is based on the belief that everyone matters all the way through their life until the moment they die, and that no one should die in avoidable pain, suffering or emotional distress. Such care is very important, as Britain’s older population is set to rise sharply over the next few decades, with the number of people aged 85 and over expected to double in the next few years—some in this room may fit into that category, I suspect, and hope that they will have a good quality of life at that time as well.

Undoubtedly, the job of care workers is not an easy one, and we are deeply indebted to them—people have got to recognise that rather than miss it and not speak of it. However, in recent years, they have not always hit the headlines for the right reasons. Abuse is something that we take extremely seriously, but when we hear of it taking place in care and respite homes at the hands of care workers, who are employed to support and care for them, it is truly sickening. We have heard reports of physical, sexual and emotional abuse. Earlier this year, BBC 1’s “Panorama” did a story on some homes where residents were physically beaten, verbally abused and left in their own excrement for hours.

A Government initiative in England was set up in 2000 called “No Secrets”, aiming to set out the ways in which workers were expected to treat patients with dignity, respect and compassion, as well as ensuring that health and social care services work together effectively. It was a great initiative back in 2000, but given what has come to light in recent months, I feel—perhaps the Minister can respond to this point—that much more needs to be done to ensure that what was set out in the “No Secrets” initiative at that time works better.

The majority of care workers do fantastic work. They do their jobs because they are passionate about helping those who are in less fortunate positions than themselves. However, as with every job, there are those who take advantage, and we have to ensure that vulnerable patients are well looked after and that no abuse takes place. We all recognise the great work that care workers do. They are undoubtedly overworked and do a phenomenal job, and for many people, they are the only contact that they have with the world outside their door.

Antibiotic Resistance

Gregory Campbell Excerpts

Wednesday 15th October 2014 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairmanship, Mr Chope. It is always nice to speak on health issues in this hall. It is also nice to see the Minister in her place—we seem to be here regularly discussing health issues—and I look forward to her response.

First, I thank the hon. Member for York Outer (Julian Sturdy) for bringing this issue forward for discussion and for his introduction. The issue is of the utmost importance, and, despite the warnings about it, some people still want to bury their head in the sand like the ostrich—“If you put your head in the sand, the car won’t run you down.” Antibiotic resistance is a serious issue but, for some reason, some people—perhaps many people —are under the illusion that if we do not talk about it, it will not happen. However, it is happening right now, and we should all be extremely worried about it. That is why the debate is important. Indeed, the hon. Gentleman and the hon. Member for Inverclyde (Mr McKenzie) both mentioned the example of the grazed knee—in the past, it was not an issue, but it could be in the future, and people could end up dying from it.

Antibiotic resistance is the ability of a germ to prevent an antibiotic from working against it, and it is a global problem. It is also part of the reason why, in recent years, we have been warned over and over again to take antibiotics only when absolutely necessary. That is a serious issue, which we must address. Although we cannot become resistant to antibiotics themselves, because they are designed to target germs not cells, antibiotic resistance is a major health problem, and we already face the reality of having fewer choices of effective drugs with which to treat basic illnesses.

Some 70% of the world’s bacteria have developed resistance to antibiotics. Unfortunately, we are now in the position of considering drugs of last resort. Before we are at the stage when only one antibiotic is left that can do the business, we need to think ahead. Other Members have talked about the pharmaceutical industry and the development of new drugs, and that is important. The more a drug is used to treat germs, the more resistance they develop. For example, just a few years after penicillin was developed, resistance to it was found in Staphylococcus aureus, in the skin. After years of heavy use, several species of bacteria are now resistant to penicillin. However, the biggest problem facing us is the development of multi-resistant germs, which are resistant to a large range of antibiotics. As they begin to develop, effective treatments become difficult. In that respect, I declare an interest as a type 2 diabetic. Every year, I am eligible for a flu jab to help me combat colds and flu. Some years it does, but some years it does not—I am not quite sure why—but, again, that shows there is resistance to the jab used to deal with flu and the cold bugs out there.

We have been advised to follow some simple instructions to try to prevent germs from becoming immune to our medicines. The advice includes getting antibiotics only when absolutely necessary, and it falls to our GPs to know when that is. Other advice includes washing our hands regularly, finishing a course of antibiotics as advised and ensuring that antibiotics are taken only by the person they have been prescribed for. Finally—I hope the Minister can give us some indication of what is being done on this—GPs should not prescribe antibiotics for colds and flu, because they are caused by viruses, not bacteria. Sometimes GPs need to have a better focus on what is best. Do people always need an antibiotic, or do they need something different?

[Mr Gregory Campbell (East Londonderry) (DUP)]

Does my hon. Friend agree that we require an educational process—from the Government, to GPs, to pharmaceutical companies and to the wider public—to ensure that we do not face an Ebola-type position, where we are trying to play catch-up and the end result is many deaths?

[Jim Shannon]

I thank my hon. Friend for his intervention. As always, he succinctly puts the issue into perspective. We are all aware of Ebola, although we are not talking about it today. The question is how we resist such bacteria.

When it comes to viruses and bacteria, most of the pieces of advice I mentioned are simple enough for us to follow. However, the two most important, which involve access to drugs, relate to doctors, and my hon. Friend referred to that. Undoubtedly, we need to encourage greater awareness through media campaigns and posters in doctors’ surgeries, and by educating our children and young people. This is all about knowledge and awareness.

The findings from the World Health Organisation are quite disturbing. In May 2014, it warned that we should expect “many more deaths” because dishing out too many antibiotics

“will make even scratches deadly”.

That is the point many people are making. Over the years, antibiotics have been used properly to extend our lives, but now we are at grave risk of turning the clock back on medicine, with the World Health Organisation claiming that antibiotic resistance has the potential to be worse than the AIDS epidemic of the 1980s, which was responsible for 25 million deaths worldwide.

The importance of necessary prescriptions cannot be underestimated. In England last year, 41.7 million prescriptions were written out, up from 37.2 million in 2006. The World Health Organisation looked at data from 114 countries on seven major types of bacteria, and the results showed that we have reason to be most concerned about the bacteria that cause pneumonia, urinary tract infections, skin infections, diarrhoea and gonorrhoea—the hon. Member for Inverclyde referred to sexually transmitted diseases.

As people become infected by resistant superbugs, they are likely to need to remain in hospital for longer than would normally be required. That may also result in their being moved to intensive care. Both those things cost the NHS money, which is simply not an option in this economic climate.

Medicine is amazing, and we are blessed to have the NHS, which is so efficient and helpful. What has been achieved over the last 100 years is astounding. However, our generation has come to rely on tablets. We are all busy, and with work and families it is not always practical to take time off, but the convenience of taking a tablet to reduce our recovery time is beginning to have adverse effects. Unfortunately, while bacteria were getting smarter, we were loading ourselves up with antibiotics. If one did not work we got another one, and if that did not work we got yet another. Now bacteria are outsmarting us, and there are few new antibiotics in the pipeline.

Although we bear responsibility for our own health, and must ensure that when prescribed an antibiotic we take it properly, much of the responsibility lies with general practitioners. They must prescribe such drugs only when absolutely necessary, and they must prescribe broad-spectrum antibiotics suitably, making sure that the selection, dosage and duration are correct. That is a clear role for the GP to play. It is vital to review and renew our campaign to research and assess microbiological data, with the aim of preventing any more bacteria from becoming resistant to antibiotics. Perhaps in that way we will find a way to reverse their immunity, and ensure that the drugs that we are using are not those of last resort.

Melbourne Declaration on Diabetes

Gregory Campbell Excerpts

Wednesday 18th June 2014 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is always a pleasure to speak about diabetes. I am a type 2 diabetic, so the matter is important to me. I congratulate the hon. Member for Torbay (Mr Sanders) on securing the debate. I know of his passion for the subject, and it is always good to participate in a debate initiated by him. I hope that others will contribute and help him to pursue his ideas. I am fully behind the Melbourne declaration on diabetes. I am delighted at the attention the illness is receiving, and I look forward to great steps being taken to curb the effect of diabetes in our country and the world.

Many people have referred to diabetes as a ticking time bomb. We focus on many diseases, such as cancer and heart disease, in that way. Diabetes is a ticking time bomb because of the numbers of people who have it and do not know, or who will potentially be diabetic in the near future. I am sure that we are all very aware that it is estimated that there are 382 million people worldwide with diabetes, most of whom are aged between 40 and 59. Again, that middle-aged group is where the focus seems to be, and their number is expected to rise to 592 million by 2035. For one second, consider again that the figure will rise from 382 million to 592 million by 2035—another 200 million people will be diabetics by that time.

In 2013, diabetes caused 5.1 million deaths, which is one every six seconds. That is the magnitude of the issue of diabetes and what it is doing and has the potential to do. In world monetary terms, diabetes is taking up some $548 billion in health spending in 2013, right across the world. That is 11% of worldwide expenditure. Those figures get into what it means to be diabetic, and why the condition is a ticking time bomb not only for the United Kingdom, but for the world. The statistics are harrowing. It is an international problem. It is a disease that we are often too blasé about, and we must not let this dire situation continue. We must adequately assess the issue of diabetes and tackle the problem head-on.

I want to mention our colleague, Edwin Poots, the Minister for Health, Social Services and Public Safety in Northern Ireland. He has initiated a programme to bring in 400 insulin pumps to help type 1 diabetics and their families. He has also initiated training along with that, so that people who have the pumps are adequately trained in administering the insulin, and in helping the control of diabetes. Good things have been done in Northern Ireland, but good things have been done in England as well. As the Minister will know, I ask all the time about a strategy, not only regionally, but for the whole United Kingdom.

Obesity and diabetes-related illnesses combined cost the NHS an estimated £15 billion a year, and 80% of the available funding for diabetes is spent on treating preventable complications, because it is not diabetes that will eventually, to use strong terms, kill someone, but the complications. It can affect people’s kidneys, liver, circulation, heart and eyesight.

[Mr Gregory Campbell (East Londonderry) (DUP)]

While my hon. Friend is on the issue of the cost to the NHS and to all of us as taxpayers, does he agree that any additional resource that is deployed in early detection, and in trying to ensure greater awareness in communities across the UK, will vastly be outweighed by the savings, in terms of what the taxpayer would have to pay out otherwise? That has been outlined by both the hon. Member for Torbay (Mr Sanders) and by my hon. Friend.

[Jim Shannon]

I thank my hon. Friend and colleague for that comment. He is absolutely right, and I will come on to some issues that I feel the Government need to address early on. He is correct to say that vast savings will be made if there is early detection. The need for early detection was mentioned by the hon. Member for Torbay, and other Members will make the same comment.

Although it is great that money is available to treat this illness, we must not merely chase after it, putting a plaster on it after it has inflicted damage. That is clear. We need to ensure that money is spent not only on treating it, but on prevention methods—which makes me wonder whether my hon. Friend the Member for East Londonderry (Mr Campbell) was looking over my shoulder at my notes, because he made the next point that I was coming to. We cannot allow ourselves to accept the fact that 3.2 million people in the UK have been diagnosed with diabetes. Again, that is the magnitude of the problem. We must look to the causes and stamp them out at the root.

One thing that we can address is the preventive measures that need to be taken. We have talked many times in the House about the sugar content in food. The right hon. Member for Leicester East (Keith Vaz), who is not here today, introduced a measure, which I was happy to put my name to, addressing the issues of sugar in manufactured products that we eat. We need to take that issue forward, and in the future, I hope we will be in a position to take legislation on that subject through the House with the support of food manufacturers, so that we can address the issue of the food we eat. We do not need all the sugar or salt that is in food. There is a way of addressing issues outside the Chamber—issues that are outside Government control—but something needs to be done at a manufacturing level.

Our annual intake of sugar is 33.7 kg per capita. To put that in perspective, it is equivalent to eating nearly 34 average-sized bags of sugar each year. Imagine if the sugar was piled up on the table here; it would block my hon. Friend the Member for East Londonderry from sight completely. That is how much sugar we are all eating every year, and some people even eat more. Surely when discussing the Melbourne declaration on diabetes, the Government need to take another look at sugar levels in our food. What steps are the Government taking on diabetes prevention to ensure that the next generation is not blighted by diabetes in the way that this one is? Projections show that if current trends continue, in 2025, 5 million people in the UK will have diabetes. Again, the magnitude of the issue is clear, so what are the Government doing to ensure that that does not happen? What preventive measures are they putting in place to decrease that number?

The correlation between weight and diabetes has been made clear: 80% of people with type 2 diabetes are overweight or obese. The Government need to do more to increase education on the danger of being overweight or obese and tighten controls on how much sugar goes into our food. Those are all issues that I feel we need to take on board.

What is so frustrating is that up to 80% of type 2 diabetes could be delayed or prevented. I am not saying that in any judgmental way, because many in the Chamber will be aware that I am a type 2 diabetic, as I declared at the beginning of my speech. The truth of the matter is that I have to blame myself and my lifestyle choices for the onset of the disease. It was the Chinese carry-out five nights a week, with two bottles of Coke—not a good diet for anybody. That is the reason why I was almost 18 stone and had to lose weight very quickly. Aside from that, it was also a lifestyle with high levels of stress. When the two are combined, diabetes will knock on the door of nearly everybody, as most of us know.

While I am on the subject, many people can be diabetic even though they are not necessarily overweight. It can happen through them having a stressful lifestyle. How many others living the same lifestyle are not aware of the damage that they are doing to their bodies in the long term, and how can we do better in highlighting that? I have to take two Metformin tablets in the morning and two at night. That dosage could have to be increased; a doctor could come along, as he often does, and say “By the way, you just need a wee blood pressure tablet now to keep you right as well.” People wonder just how many tablets they will have to take before they reach the age of 65 and retire, if they are spared until that age.

What are the Government doing to diagnose diabetes early and treat it effectively, preventing or delaying the complications that cause so much human suffering, require costly treatment, and reduce life expectancy? Only one in 10 people who are newly diagnosed with diabetes are offered education on how to manage their condition, despite strong evidence that education is a cost-effective way of giving people the knowledge that they need to manage their condition. On managing diabetes, after someone is diagnosed as diabetic, what help is given to them to ensure that they manage that in a sensible way? I accept that the person also needs to acknowledge that they have to manage the condition. I remember Dr Mageean, my doctor, telling me when I was first diagnosed, “Jim, it is up to you what you do.” He was very clear and said, “You must manage this yourself,” but at the same time, I think we need a wee bit of help, perhaps from Government and from the health service in particular, just to ensure that we know what that all means for everyone involved.

It is estimated that in my small Province of Northern Ireland, 80,000 people have diabetes. That awful statistic worries me very much.

Type 1 Diabetes (Young People)

Gregory Campbell Excerpts

Wednesday 30th April 2014 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I thank the right hon. Member for Knowsley (Mr Howarth) for bringing this issue to our attention in Westminster Hall today. It is good to have a subject that we can all relate to and on which we can speak on behalf of our constituents. The right hon. Gentleman has knowledge of it on a very personal basis.

I was just sitting here and thinking about those deep sleeps that people get into—not that we often have them, Mr Havard. Young children who are diabetic are woken out of their sleep and will wonder what is happening to them. Someone—one of their parents—takes their hand, pricks their finger and checks their blood. That is the reality that many children in the UK face today, and many parents have the same reality because they have to wake them up during the night and have to set the alarm for that purpose. They have regularly to monitor and check their child’s blood sugar levels. It is surprising just how many children have to go through that every day.

The UK has the fifth highest rate in the world of children with type 1 diabetes. In Northern Ireland, there are 1,092 children with type 1 diabetes. The hon. Member for Cities of London and Westminster (Mark Field), who has just left the Chamber, referred to there being 400,000 diabetics in the United Kingdom. In Northern Ireland, we have almost 80,000; one fifth of the diabetics are in Northern Ireland.

[Mr Gregory Campbell]

When my hon. Friend refers to the high prevalence of diabetes in Northern Ireland, as well as across the UK, does he agree that need for greater emphasis on research, which has been repeatedly raised this morning, is a fundamental way to address the increasing problem? The UK, and the various regions thereof, must place greater emphasis on higher expenditure and greater research to ensure that future generations do not suffer in the same way as the present generation.

[Jim Shannon]

I thank my hon. Friend for that contribution. He and other hon. Members have reiterated the need for research, including stem cell research, to enable us, I hope, to come up with a cure for diabetes. The prevalence of diabetes in Northern Ireland is now more than 4%. In addition to almost 80,000 people in Northern Ireland who have diabetes, some 10,000 have not yet been diagnosed. As an elected representative, I have had the opportunity to fight cases on behalf of parents who are under intense pressure because they have a type 1 diabetic child. In Northern Ireland, health is devolved. We have been able to speak to the Minister, Edwin Poots, and through his office and through the pressure that we and others have created, we have succeeded in getting the health service in Northern Ireland to provide 400 insulin pumps for type 1 diabetics. Getting the pumps is only one part of the story. The second part is to train people to use them, so the second stage of the process has been training parents how to do that. Good things have happened.

Diabetes has increased in Northern Ireland, but it has also increased worldwide. Type 1 and type 2 diabetes have increased by 33% in Northern Ireland, by 25% in England, by 20% in Wales and by 18% in Scotland, and some 24.5 children in every 100,000 aged 14 and under have diabetes. That shows the magnitude of the problem. The Minister is responsive and has a particular passion for health. He has attended, as have others in the Chamber, the type 1 diabetes events that have taken place here with young children. Those events have given us all a chance to see how important the issues are. We have far higher rates of diabetes in children than do Spain or France. In Northern Ireland, there are 1,092 children under the age of 17 with type 1 diabetes, and almost one in four of them experienced diabetic ketoacidosis before a diagnosis was made.

In my constituency, the number of diabetics has gone up by 30%, with 800 people becoming diabetic in the past seven years. I should have registered an interest at the beginning of my speech. I am a type 2 diabetic, and I am one of those 800 people who were diagnosed in the past seven years. In our small part of the United Kingdom, the total number of adults aged 17 and over who have diabetes and are registered with GPs is just shy of 76,000, and there are a further 1,092 under the age of 17. Diabetes UK Northern Ireland has launched a report that highlights the latest findings into diabetes in Northern Ireland, and I think it is important to put those figures on record. The Diabetes UK Northern Ireland national director Iain Foster said:

“The State of the Nation report is a timely and important piece of work which highlights, not only that Northern Ireland has seen the biggest rise in people being diagnosed with diabetes compared to the rest of the UK but that there is a real difficulty in collecting data as Northern Ireland is not included in the National Diabetes Audit. Our State of the Nation report gathers limited local information and we have found that there are now over 80,000 people living with diabetes in Northern Ireland.”

The official figure is just shy of 76,000, but the latest figures from Diabetes UK Northern Ireland indicated that more than 80,000 people are affected. Therefore, within the past five years, there has been a 33% increase in Northern Ireland in the number of people living with type 1 or type 2 diabetes. More than 100 new diagnoses are expected each year if the current trend continues, and 4% of the local population now has a diagnosis of diabetes.

I cannot emphasise enough that diabetes is a ticking time bomb, which has the potential not only to destroy lives, but to bankrupt the NHS. The financial cost of diabetes cannot be discounted. I agree with Iain Foster:

“It is not enough to shout from the side-lines: ‘something must be done’”—

we have been talking today about what must be done, and we want to see what will be done—

“so instead we have outlined ways in which we think the situation could be helped, for example, working to enable access to available treatments including insulin pumps for both adults and children and integrating diabetes clinical databases to create an accurate diabetes register.”

My hon. Friend the Member for Upper Bann (David Simpson) and the right hon. Member for Knowsley referred to education. It is so important, as hon. Members have said, for teachers, classroom assistants and staff in our schools to be aware of what it means to be a diabetic in school. In Northern Ireland, we have implemented a system of training for teachers and classroom assistants to ensure that they have the knowledge to deal with the condition.

In conclusion, I ask the Minister to outline what co-operation exists between regional assemblies to deliver a better strategy for the whole United Kingdom. He will be aware of the 10-year strategy that ended in 2013. I have asked on a number of occasions for a new strategy to be put in place, because it is important that all the regions of the United Kingdom of Great Britain and Northern Ireland work together to deal with the problem. To address the issue of the many children who suffer from diabetes, and many more who are predicted to be diagnosed, we must take action and take it now. I congratulate the right hon. Member for Knowsley on bringing the matter forward, and I urge the Minister to do more than simply talk about it. He must take action quickly, while there is still time to make safe this ticking time bomb.

Stillbirths and Infant Mortality

Gregory Campbell Excerpts

Wednesday 26th March 2014 Westminster Hall

[Tim Loughton]

It is horses for courses. I am glad to say that my maternity unit delivers well in excess of 3,000 babies a year. It is a centre of excellence, and the customer votes with her feet by choosing to go there from outside the area. My hon. Friend is absolutely right that the assessment of units must be primarily based on the quality and safety of care for mothers, but I fear we are straying slightly beyond stillbirths and infant mortality rates into the availability of maternity services and hospitals. You would not want us to go there, Mr Davies.

My hon. Friend also raises an interesting point about delivering services in the most appropriate way. There are certain constituencies of women and certain parts of the country where the problem is that much greater. To take one of the classifications, the infant mortality rate in the UK overall is 4.4 deaths per 1,000 live births, but the variations for mothers born outside the United Kingdom are worrying. For babies of mothers born in the Caribbean, the figure more than doubles to 9.6 deaths per 1,000 live births. For babies of mothers born in Pakistan, the rate is 7.6 deaths per 1,000 live births, and so on.

There are also regional variations, particularly for perinatal mortality overall. In the south-west, the figure is 4.7 deaths per 1,000 live births, but in the north-east it is 5.8 deaths per 1,000 live births—a 23% difference. Why are there those differences? We simply do not have enough research; we have not commissioned and are not doing enough research to find out why certain types of women and certain geographical locations are faring worse. Such research would enable us to focus, say, additional scans or support services, or whatever is required, to ensure that we make the best use of our NHS resources. My first call is for there to be rather better research across perinatal mortality.

[Mr Gregory Campbell (East Londonderry) (DUP)]

On geographical differences, we heard earlier about the improvement recently reported in Scotland. Does the hon. Gentleman agree that when Ministers from across the United Kingdom and beyond meet either at a joint ministerial council or at other levels, best practice, where it has been established, should be carefully researched and, where possible, implemented immediately?

[Tim Loughton]

I agree. My hon. Friend the Member for Bracknell (Dr Lee) gave the example of Scotland, where people have clearly examined the matter a bit further; they appear to be achieving more than people in other parts of the United Kingdom. We should be sharing that best practice, rather than being parochial and not sharing it beyond the United Kingdom, with or without Scotland after 18 September. That goes beyond sharing ministerial best practice on health issues; I would guess that not just health considerations but deprivation, housing and other local environmental factors are involved, too. More than just the Health Ministers of the respective parts of the United Kingdom need to be involved. If we compare deprivation with infant mortality rates, some signs certainly start to emerge.

Last year there were 3,558 stillbirths; in 2011 there were 3,811 and in 2003 there were 3,612. The stillbirth level has remained persistently high for a long time. One in 200 pregnancies ends in stillbirth, but stillbirths are currently defined in law as being after 24 weeks of gestation, which still means that there are 15 times more stillbirths than cot deaths—the progress on cot deaths was alluded to earlier. The problem with the definition is that it masks the higher number of stillbirths that happen before the 24-week gestation qualification currently in legislation. If a woman gives birth to a stillborn child at 23 weeks and six days or earlier, the child counts not as a stillbirth but as another “miscarriage.”

That was the case for my constituent Hayley, who came to see me and was present when I presented my ten-minute rule Bill in January. She had been through the dual tragic experience of giving birth to a stillborn son at about 19-and-a-half weeks. She had to have her pregnancy induced, and she went through labour. She experienced all the pains and anguish of labour in a hospital for more than 24 hours before giving birth to her son. She and her partner, Frazer, held their son and took handprints and photographs. To all intents and purposes, their son had been born, but sadly born dead. In the eyes of the law, their son did not exist, because he had been born after less than 24 weeks. That child had no recognition in the eyes of the law. Some months afterwards, Hayley tragically went on to have a miscarriage after five or six weeks. Those two experiences were different—that is in no way to belittle the pain, anger and trauma of going through a miscarriage—but in the eyes of the law, they were identical: neither of those children was recognised as having been born.

That is what my Bill is all about. Since introducing it, I have been swamped by the experiences of women and families up and down the country. To take one example, a woman gave birth at about 21 weeks to twins. It might have been slightly more than 20 weeks—I forget now—but it was less than 24 weeks. One of the children was born just alive and lasted for a few hours. The other twin was born dead. As the first was born alive, albeit at less than 24 weeks, that child was recognised. The other twin, born dead, did not exist. How traumatic and cruel is that on the part of the state? Someone gave birth and had two dead children, but only one existed in the eyes of the law. That is why the law needs to change.

I will persist with the Bill well beyond the confines of this Session, when it will expire because of the constraints of this place, until I persuade the Government to take the issue on. It is about fairness and recognition for people who have had to go through trauma, anguish and pain unimaginable to those of us lucky enough to have had healthy, albeit slightly annoying, children. It is not acceptable for those who have lost a child before that child was ever able to breathe then to have the second blow of the state not recognising that child.

My Bill would amend the Births and Deaths Registration Act 1953, but not in a way that says that we should redefine the 24-week limit. I do not want to make it 23 weeks or 22 weeks; this has absolutely nothing to do with abortion thresholds and things like that. I want to make a differentiation between what are clearly miscarriages and instances of when women, to all intents and purposes, go through all the pains and experiences of giving birth to a child. The definition in my Bill of a “stillborn child” does not mean a child born dead from 24 weeks’ gestation onwards, but

“a child which has issued forth from its mother and which did not at any time breathe or show any other signs of life, following the recognised processes of labour including regular, painful uterine contractions resulting in progressive cervical effacement and dilation; and the expression ‘still-birth’ shall be construed accordingly.”

It is a bit technical and a bit physical, but it is a way of giving some comfort to mothers: if they gave birth to a stillborn child, it would be a birth. The Bill would say that they had had a child, that there had not been a miscarriage and that the state should recognise that.

We have not introduced the Bill to meddle with the abortion laws—it has nothing to do with that—and it is not intended to meddle with bereavement leave entitlements or benefit entitlements. The more enlightened employers of someone who has been through such an experience would give the employee some allowance on the time they need to get over the death. For them to receive some sort of closure and to give them the support and relief that they desperately need to be able to move on, the state needs to recognise what they have been through in giving birth to a stillborn child.

At the moment, a hospital or clinical practitioner can issue a certificate of birth. It has no status in law. It is of some comfort to some people, but it is certainly not sufficient comfort for many of our constituents. That is why I am putting forward the changes to the law. They are simple and do not involve a lot of cost, but they would offer huge support, relief and comfort for mothers and their partners who have been through these sorts of experience.

As well as wanting to change the law and calling for better research into why we appear to be so vulnerable to perinatal mortality and stillbirths, we need greater research and better guidance. I do, however, pay tribute to the existing guidance, particularly that issued by the Royal College of Obstetricians and Gynaecologists on recurrent first and second trimester miscarriage, and some of the best practice.

I echo the points that my hon. Friend the Member for Chatham and Aylesford made about foetal alcohol syndrome, which strays slightly beyond the confines of the debate. When I was a shadow Health Minister, I considered the issue. I visited children’s homes in Copenhagen that specialised in children born with foetal alcohol syndrome. In many cases, the child was born to parents from Greenland’s Inuit community, which has high alcoholism rates. A lot of research has been done on that in Denmark.

It is undeniable that a lot of our children are being damaged due to excessive drinking through pregnancy and that an awful lot of that is not being properly diagnosed. In my simple layman’s view, a lot of the symptoms have parallels with autism and the autism spectrum, and there may be links between autism and foetal alcohol syndrome.

The issue is very little researched in this country, but it potentially affects an awful lot of our children, and we need to do much more to identify it. More importantly, we need to give clear, stark, but accessible warnings to women about the practical perils of drinking irresponsibly at all stages during pregnancy. That is not to say that pregnant women must not drink at all, but we need to set out clearly what is and is not tolerable, just as we should for women who smoke during pregnancy.

To make a side point—a point I made during a debate on the Children and Families Bill—I cannot understand why the Government have set criminalising smoking in cars with children in them as a priority, yet have done nothing to criminalise, if that is the principle they want to follow, smoking for pregnant women whose foetuses are in rather more confined spaces than the back of a car. Smoking and drinking are highly damaging to children before and after they are born. People are irresponsible if they do that, and we need a much clearer and more pungent health message to mothers. We need to disseminate best practice better than we do now, whether that is from Scotland or other parts of the country that appear to have achieved some success in reducing some of these mortality rates.

This is a bigger public health crisis than we have given it credit for. I have met constituents and heard some tragic stories from around the country of families who have been through stillbirths and other perinatal mortalities. We need to take this issue much more seriously.