Draft Mental Health Bill

Marsha De Cordova Excerpts

Monday 27th June 2022 Commons Chamber

[Sajid Javid]

I agree with my hon. Friend. The reforms that we have set out today in this draft Bill mean that, in the absence of a mental health condition, learning disability and autism will no longer be a reason for people to be detained in a mental health hospital after an initial period of assessment. I would be happy to meet him and his APPG.

[Marsha De Cordova (Battersea) (Lab)]

I am disappointed that, yet again, the Department has not produced all the papers for me in large print; it has produced all the papers in standard print. I hope the Secretary of State will take that away and ensure I receive my papers as soon as possible.

I am sure the Secretary of State will share my disappointment that, in England, 24% of all children’s mental health referrals are closed before the child receives any support. In my Adjournment debate last week, I highlighted the importance of children’s mental health services and trauma support and care, so will he reassure the House and me that he will do everything in his power to make sure children receive timely mental health support?

[Sajid Javid]

Of course the hon. Lady should get the Bill and any other documentation she needs in large print, and I am sorry that she has not. I will take that up. I apologise to her, and she makes a very important point.

Support for children, even before the pandemic, was rightly a priority. Funding will increase to record levels by 2023, with an additional £2.3 billion in total so that an additional 345,000 children and young people can be seen. We put in an additional £79 million during the pandemic, and we will set out in our new 10-year mental health strategy exactly how we will do more.

Battersea Funfair Disaster: Child Trauma Support Services

Marsha De Cordova Excerpts

Tuesday 21st June 2022 Commons Chamber

[Marsha De Cordova (Battersea) (Lab)]

This year is the 50th anniversary of the Battersea funfair disaster. I want to start by remembering the victims, their families, and the survivors. I also want to pay tribute to and thank two of the survivors, Hilary Wynter and Liz Haigh-Reeve, for their tireless campaigning to have the tragedy recognised and remembered.

The Big Dipper rollercoaster was the main attraction of the Battersea Park funfair which opened as part of the festival of Britain. Tragically, on 30 May 1972, a carriage of the rollercoaster broke loose and plummeted backwards through a barrier killing five children—Alison Comerford, Thomas Harmer, Shirley Nash, Debora Robertson and David Sait—and leaving 13 injured. The disaster is one of the deadliest rollercoaster crashes in history. However, it has largely been forgotten and there has been no justice for the victims, their families and the survivors.

To mark the anniversary of the disaster, I attended a special memorial ceremony together with families and survivors in Battersea Park where a plaque was unveiled and a tree was planted. That is the first step to creating a new legacy and a permanent memorial.

There is another silent tragedy associated with the incident, on which I will focus the rest of my speech. It is something that I am determined to change. Survivors have spoken about the devastating impact that childhood mental trauma has had on their lives. As one told me,

“bones are mended, physical injuries fixed, but the dreadful damage to our mental health goes untreated.”

Damage from trauma is not necessarily skin deep: some wounds penetrate through to our minds, leaving lasting damage that can be just as debilitating. Although the funfair and the big dipper are long gone, some of the survivors of the disaster still struggle to go to Battersea Park, and have been unable to shake off their horrific memories of that incident. I am sure many survivors of other tragedies, such as Hillsborough, the Manchester Arena terrorist attack and the Grenfell Tower fire, have been through similar experiences.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady on securing this debate on childhood trauma support services. I would mention helpfully to her, and probably to the Minister as well, that we in Northern Ireland have faced 30 years of a terrorism campaign during which many young children, women and men have lost their lives. Such trauma can last way beyond the time that it happened. Does the hon. Lady agree that some discussions with the responsible Minister in Northern Ireland might be helpful when it comes to devising a policy and a strategy to address trauma and child mental issues, which I know she wishes to see?

[Marsha De Cordova]

The hon. Gentleman is right: we can all learn, and it would be useful for the Minister to say whether she would like to meet Ministers in Northern Ireland to look at what works well.

Childhood trauma can have a lifelong effect, and can have lasting consequences for a child or young person’s development, including psychological, behavioural and emotional problems. Those problems can occur into and throughout adulthood, presenting related challenges in many aspects of that person’s life. According to the UK Trauma Council, childhood trauma refers to the ways in which some events and experiences are so extreme that they overwhelm a child’s ability to cope. Many different experiences can lead to such trauma: for example, physical or sexual abuse can be traumatic for children. One-time events like the tragedies I have mentioned can take a psychological toll on children as well. Ongoing stress such as the effects of the pandemic can also be traumatic for a child, even if it just feels like everyday life to an adult.

We know that the pandemic has had a huge negative impact on children and young people’s mental health and wellbeing. The Children’s Commissioner’s Big Ask survey found that one in five children was not happy with their mental health, and that figure rose to two in five for some groups. Childhood trauma does not have to involve experiences that are directly related to the child: for instance, watching a loved one endure major issues can be extremely traumatic, as has been highlighted by the impact of the cost of living crisis on children’s mental health. According to the Childhood Trust’s latest report, 47% of children surveyed felt stressed, 21% of parents said that their children smiled less, and most concerningly, 9% of parents claimed that their children had started self-harming. The results of that report should worry us all, as all those types of trauma will affect children’s development and wellbeing.

The Government need to invest in mental health services to ensure that children who experience trauma today do not face the same painful ordeal that survivors of the Battersea funfair disaster have gone through over the past 50 years. Spending on children’s mental health remains behind investment in adult mental health services. It is worrying that children and young people’s mental health services are among the most under-resourced and that the quality of care varies between different parts of the country. A BBC freedom of information request revealed that 20% of children are waiting more than 12 weeks to be seen for mental health support. That is why I was pleased to secure this debate on better provisions for children’s mental health services and childhood trauma.

The Government need to correct the historical underinvestment in children and young people’s mental health and the postcode lottery of services and support provision. To do that, they must create a comprehensive child mental health strategy, and childhood trauma services must be prioritised as part of that. The UK Trauma Council has called for the Government to invest in the development and delivery of specialist trauma provision so that children and young people have access to the support that they need. It also called on the Government to equip all professionals who work with children and young people with the skills and capacity to support those who have experienced trauma.

Labour has already set out its plan on tackling the mental health crisis, which includes giving adequate funding to mental health services. We have also committed to radically expanding the mental health workforce, including, crucially, investment in children’s mental health that includes putting open-access mental health hubs for children and young people in every community and ensuring that a full-time mental health professional is in every secondary school and a part-time professional is in every primary school.

Labour’s focus on early intervention is so important, because it can prevent the ongoing effects of trauma into adulthood. It would ensure that children are properly supported and resolve problems before they escalate. I will therefore ask the Minister about the Government’s plan for children’s mental health services and, specifically, childhood trauma care. When will her Government introduce a comprehensive child mental health strategy that includes prioritising trauma and investment in the development and delivery of evidence-based trauma service provision? How are they ensuring that children’s mental health services are a high priority in the NHS? That includes increased investment.

The Government have made £139 million available to support children and young people’s mental health in the community, but we need to see more investment. How are the Government working with professionals in contact points including in schools and the third sector so that children can access support when problems emerge?

Much work also needs be done to ensure that every child and young person gets the support that they need for their mental health and wellbeing. We need to step up as a society and be more ambitious in our call for better support for children and young people’s mental health. More funding and resources will be an investment in our children’s future. It is time for the Government to act and listen to the voices of children and young people, especially those suffering from trauma. If we do not act now, when will we?

[The Minister for Care and Mental Health (Gillian Keegan)]

I congratulate the hon. Member for Battersea (Marsha De Cordova) on securing the debate. I must admit that I was not aware of the tragic events that unfolded 50 years ago, on 30 May 1972, and I am sure that others were not, either, so it is fantastic that she secured the debate to remind us all. However, I discussed it with my husband when I got home last night. At the time, he was a 10-year-old boy growing up in London. He was very much aware of what happened and he vividly remembers it. What should have been a happy day in Battersea Park, on the bank of the River Thames, resulted in five children losing their lives and a further 13 being injured, and it shocked many more. I very much hope that the survivors’ campaign for a permanent memorial in Battersea Park is ultimately successful, so that that terrible event is never forgotten—maybe that is the plaque the hon. Lady referred to, or maybe there is something else that they are still campaigning for.

Undoubtedly, many affected by the Battersea funfair disaster will have suffered from what we now call post-traumatic stress disorder, but let us not forget that PTSD was not even added to the International Classification of Diseases until the ’80s, and guidance from the National Institute for Health and Care Excellence was not published until 2005. Events have taught us that people affected by any traumatic incident must be able to access timely mental health support when and if needed, but I am not sure there was the same understanding all those years ago.

Luckily, PTSD can be successfully treated even when it develops many years after a traumatic event. The treatment depends on the severity of symptoms and how soon they occur after the traumatic event. The hon. Lady reports that survivors of the tragedy remain concerned that mental health support for children who have suffered trauma has not changed much since 1972. I too would be very concerned if that was the case, but I must respectfully disagree with that assessment.

If a child has witnessed or experienced a traumatic event, it is quite natural for them to be stressed, upset or frightened. That should not usually last beyond four weeks, but if it does, it may indicate post-traumatic stress disorder and it is then important to seek help via their GP. There are now some really effective treatments, including cognitive behavioural therapy, for children and young people who are experiencing the effects of trauma.

To respond to the hon. Lady’s specific question, NHS England and NHS Improvement have issued guidance on responding to the needs of people affected by incidents and emergencies, which stresses that plans for incidents and emergencies must provide psychosocial and mental health care for people affected, since early intervention for people at risk of developing mental health problems may reduce their severity and chronicity and, ultimately, related costs.

In general, psychological support can be accessed four to six weeks after the event for those who are exhibiting signs of needing professional help, as per NICE guidelines. Those who require urgent support may be referred to services sooner than that, and it is important to ensure that messaging about support services is appropriate. Not all people need psychological support, and many recover over the course of time without specific interventions, but it is still important that such people continue to look after their health and wellbeing after a traumatic incident. That includes getting enough rest, eating well, returning to their routine and staying connected with others.

[Marsha De Cordova]

I just want to ask about the support that is available via NHS England and ensuring that it is available, as the Minister says, within a four to six week period. Can she assure me that that is actually happening? Is there any evidence base to ensure that children who experience trauma or post-traumatic stress disorder are getting that support in a timely fashion?

[Gillian Keegan]

Yes, and of course we always try to ensure that, as the targets we put in are worked throughout the system, those targets are met. That is why we measure those things. Maybe it would be helpful to the hon. Lady if I gave some recent examples. In the wake of the Manchester Arena terrorist attack, which sadly affected many children and young people, the Greater Manchester Resilience Hub was set up to provide a central point for mental health advice for those directly affected, including children and emergency responders. The hub worked with other agencies to develop packages of care.

In response to the tragic fire at Grenfell Tower, more than £10 million has been spent on treating the mental health of those affected. In the year after the fire, 2,674 adults and 463 children were screened for symptoms of post-traumatic stress disorder, and the St Charles Centre for Health and Wellbeing was opened up so that those affected could be treated in dedicated therapy suites. I hope the hon. Lady will recognise that we have seen a dramatic change in both attitudes towards mental health since the days of the Battersea disaster, and the NHS services available to support people with their mental health.

Oral Answers to Questions

Marsha De Cordova Excerpts

Tuesday 14th June 2022 Commons Chamber

[Sajid Javid]

My right hon. Friend is absolutely correct, and that is why that is one of our biggest priorities. As well as asking the NHS to come up for the first time with a 15-year, long-term workforce strategy, we are also recruiting at a record rate, with more doctors and nurses working for the NHS than ever before.

[Marsha De Cordova (Battersea) (Lab)]

Demand for eye care services is at an all-time high, with more than 632,000 people waiting on the NHS waiting lists for ophthalmology treatments. Delays to diagnosis and treatment could lead to a loss of sight, as well as stress and anxiety for patients. Given the stark figures, it is vital that we invest in eye health, such as through the national eye care recovery and transformation programme, which, worryingly, is due to end this year. Does the Secretary of State agree that it is essential that funding for this programme is retained so that he can bring down waiting lists and ensure good-quality eye care?

[Sajid Javid]

The hon. Lady is right to talk about the importance of eye care services. That is why we are putting record investment into dealing with those covid backlogs. As she rightly points out, many of those are in eye care and ophthalmic facilities and surgeries. That record investment is going in, and we will keep it under review to make sure it is leading to the outcome that we all want to see.

Health Inequalities: Office for Health Improvement and Disparities

Marsha De Cordova Excerpts

Wednesday 26th January 2022 Westminster Hall

[Peter Dowd]

I am pleased that my hon. Friend asked that question, because it is one that has been asked many times, and I am sure the Minister will cover it—it is one of the questions I have as well.

The UK vaping industry said:

“It is absolutely critical that the new Office for Health Improvement and Disparities continues the pragmatic approach of Public Health England in recognising the role of vaping in tackling inequalities. It is essential that the institutional knowledge of PHE is not lost in the establishment of the OHID”

It is important that that is factored into these debates.

The House of Commons Library referred to the debate on health inequalities versus disparities. Jabeer Butt of the Race Equalities Foundation has welcomed the institution of the OHID and the possibility of working alongside it, but he said:

“With the establishment of OHID, we can’t help but wonder why the language used by the Health and Social Care Secretary talks about ‘health disparities’, compared to Professor Chris Whitty, who describes ‘health inequalities in the Government announcement.”

This is not just about semantics. It is important that we recognise that it is about not just disparities but health inequalities as well.

[Marsha De Cordova (Battersea) (Lab)]

I commend my hon. Friend on his speech. He touched on a really important point: that the Government talk about disparities when they should talk about inequalities. To truly tackle health inequalities, we need to look at social factors, such as housing, racism and air pollution, and socioeconomic factors. Does he agree that, to tackle all of those inequalities, the OHID will need to look in the round at all those issues and seek a cross-governmental role to deliver on the Department of Health and Social Care’s aims?

[Peter Dowd]

My hon. Friend is spot on. That is a key point that we want to tease out today: cross-departmental working.

As with many other health issues, the devil is in the detail. Only by looking into the granularity of the issues can a real understanding of the levels of inequality and disparity be established. I do not have time for more significant references to the organisations concerned, but it really was important for me to get down to the detail of the information that they provided. I will give the documents to the Minister for her perusal in due course.

Before the pandemic, growth in life expectancy had stalled for the most deprived in England. Between 2014 and 2019, people in the least deprived areas saw their life expectancy grow significantly, but there were no significant changes for people in the most deprived areas. For women in the most deprived areas of England, life expectancy fell between 2010 and 2019—a stark fact. The pandemic unambiguously exposed and exacerbated inequalities that have existed in our society for far too long, as many hon. Members will have seen first hand in their constituencies. The pandemic has widened gaps that were already too big to begin with, and once again it is the most vulnerable who have borne the brunt.

We know from the Sir Michael Marmot’s “Build Back Fairer” report that mortality rates for covid in the first wave mirrored mortality rates for other causes. In order words, the causes of health inequalities more widely were similar to the underlying drivers of covid-19 deaths among certain groups. It has been estimated that working-age adults in England’s poorest areas were almost four times more likely to die from covid than those in the wealthiest areas—another stark figure. Now, with the backlog, analysis of waiting list data shows that people living in the most deprived areas are nearly twice as likely to wait more than a year for treatment compared to those living in the least deprived areas. That cannot be right.

Before the pandemic, through the pandemic and now as we emerge, we hope, from the worst of the omicron variant—it is clear that there is a deep-rooted inequality in our society that causes huge inequality in health. The gap in life expectancy is startling. People in my constituency live on average 12 years less than people in Southport—just at the other end of the borough. Those are stark differences in healthy life expectancy—how many years a person spends in good health. Before covid, it was estimated that people in the richest communities in England could expect to live in good health for up to two decades more than the poorest. In Bootle, according to Nomis at the Office for National Statistics, 42% of people who are economically inactive are long-term sick, compared to the national average of 24%.

However, statistics get us only so far. A recent paper from the Royal College of Physicians brings to life the reality of health inequalities. One hospital clinician saw a patient who was extremely malnourished and dehydrated. The patient had been regularly missing meals so she could feed her teenage son. When she first became unwell, she did not call the GP, because she was unable to afford to pay someone to look after her son, and was frightened that he would be taken into care if she had to go to hospital for a long time. She was eventually admitted to hospital with sepsis. There are other stories in the paper of people who missed hospital appointments because they could not afford public transport, people who do not have the kitchen facilities to cook food and someone who was hospitalised because their asthma was aggravated by mould in their flat that the landlord refused to fix.

As we all know, 40 years ago, Sir Douglas Black, a former president of the Royal College of Physicians, was asked by the Department of Health and Social Security to lead an expert committee looking into health and inequality. That now famous Black report was unequivocal and said that while overall health had improved since the introduction of the welfare state, there were widespread health inequalities, the main cause of which were economic inequalities.

In his foreword to the report, the then Secretary of State said:

“the influences at work in explaining the relative health experience of different parts of our society are many and interrelated.”

That is as true today as it was then. It might seem that health inequality is a matter for the Department of Health and Social Care and the NHS but, as other hon. Members have said, health and social care services can only try to cure the ailments created by the environments people live in.

Research by the University of York linked austerity measures with the deaths of almost 60,000 more people than would be expected in the four years following their introduction. The money a person has will change the decisions they make about their health. It is the difference between having a healthy meal and having a meal at all, or between choosing to pay for the journey to the GP for an ongoing cough or choosing not to.

Housing affects health too. Last year, Shelter found that poor housing was harming the health of a fifth of renters. Our society benefits some people and deprives others, and those structural inequalities drive many of the health inequalities in black, Asian and other minority ethnic groups. We have to address that if we want to tackle this issue.

If we are to prevent ill health in the first place, we need to take action on issues such as how much money people have, poor housing, food quality, communities, place, employment, racism and discrimination, transport, and air pollution. That is why many organisations and coalitions, including the 200 members of the Inequalities in Health Alliance, which is convened by the Royal College of Physicians, have made calls for a cross-Government strategy to reduce health inequalities.

Tackling health inequality requires a considered and co-ordinated approach across myriad factors. Last year, the Government signalled that they recognise the need to look beyond the Department of Health and Social Care and the NHS and to take action on the issues that cause ill health. When the Secretary of State announced the Office for Health Improvement and Disparities in October last year, we were promised a new cross-Government agenda that would look to track the wider determinants of health and reduce disparities. The Health Promotion Taskforce was established.

These are potentially encouraging signs, but I am concerned that we are yet to hear the detail of what the OHID will do to reduce health inequalities. Will the Health Promotion Taskforce have a remit to take action outside the Department of Health and Social Care? When will we see a strategy on reducing health inequalities, so that we know what the Government’s ambition is in this area and we can track progress? Will the Government commit to developing a cross-Government strategy to reduce health inequalities?

Will the Minister set out how the Office for Health Improvement and Disparities will reduce health inequalities? Will he tell us about the work of the Health Promotion Taskforce and how often it meets? What engagement has the OHID had with Government Departments to date, since it was formally established on 1 October 2021? Importantly, will the Minister set out how the OHID will work with integrated care systems and support them to address health inequalities in their areas? I hope he can answer some of those questions.

When the Labour Government first asked Professor Marmot to review health inequalities in 2008, Gordon Brown said:

“The health inequalities we are talking about are not only unjust, condemning millions of men, women and children to avoidable ill-health. They also limit the development and the prosperity of communities, whole nations and even continents.”

He was absolutely right.

This Government were elected on a platform of levelling up, but while covid-19 caused a decrease in life expectancies for most countries between 2019 and 2020, the UK’s life expectancy has fallen below where it was in 2010. The UK was one of only two countries where that happened, the other being the United States.

In 1980, the Government responded to the Black report by saying:

“you might be right about the solution, but it’s going to cost too much.”

After two years of living with the pandemic, which, of course, has hit the most deprived the hardest, it is clear that the real cost lies in not supporting those who need that support most. Only Government can create the conditions for better health by improving the factors that lead to ill health in the first place. I hope the Minister can set out what the Office for Health Improvement and Disparities can do to achieve the aim of reducing inequality, and can confirm that the Government intend to tackle the wider determinants of health, which drive so much of the health inequality that we see.

Point of Order

Marsha De Cordova Excerpts

Monday 13th December 2021 Commons Chamber

[Marsha De Cordova (Battersea) (Lab)]

On a point of order, Mr Deputy Speaker, may I seek your advice? I have been trying to chase my papers for tomorrow’s debate on the statutory instruments, which have not been produced in large print for me. My office and the Vote Office have been chasing the Department of Health and Social Care, and we are not getting a response. I was wondering whether you could advise me on how I can get my papers, so that I can read them in readiness for tomorrow.

[The Secretary of State for Health and Social Care (Sajid Javid)]

Further to that point of order, Mr Deputy Speaker, I would like to reply to the hon. Lady. I have heard very clearly what she has had to say, and I will get back to the Department right now and chase that up immediately.

Sickle Cell Treatment

Marsha De Cordova Excerpts

Wednesday 8th December 2021 Westminster Hall

[Mr McFadden]

I quite agree with my hon. Friend, and our report goes into many recommendations that could improve care. Indeed, it is a call to action; it is a call to arms. Following Evan’s death, the deaths of others and the many near misses involving sickle cell patients, we wanted the report to set out the changes that are needed to stop this story from repeating itself over and over again.

Sickle cell affects about 15,000 people in the UK, with many more carrying a trait. Patients with the condition experience periodic crises—bouts of intense, severe pain that sometimes require hospitalisation. The crises are treated with strong pain relief, and sometimes blood transfusions, and over time they can result in organ damage, an increased risk of stroke, other associated conditions and even early death. It is therefore common among sickle cell patients to have to go to hospital regularly, to present at A&E and to be admitted on to wards. This is an important point. For sickle cell patients, contact with the healthcare system or admission to hospital is not a one-off; it is a lifelong part of living with the condition.

To prepare our report, we took evidence in three oral evidence sessions in June this year. We heard from patients, clinicians and policy makers. We heard from Evan Smith’s parents, Betty and Charles, who spoke with so much dignity about the loss of their son and their determination to make sure that other families do not have to go through what they have been through. We received over 100 written submissions and, taken together, this is the most comprehensive report on sickle cell care that the APPG has ever produced.

[Marsha De Cordova (Battersea) (Lab)]

I congratulate my right hon. Friend on his leadership on and commitment to this issue. The report that his APPG has produced has shone a light on some of the challenges faced by people living with sickle cell—whether it is around some of the negative attitudes, the lack of awareness and understanding, or, most importantly, patient care. Does he agree that tackling this issue and the multiple health inequalities that exist will require significant investment and resource from the Government, and an acknowledgement of the structural racism that exists within the health setting?

[Mr McFadden]

My hon. Friend makes some very strong points, and I will discuss some of them, including the question of race.

Since the report’s publication, I have continued to receive emails from sickle cell patients all around the country that confirm the report’s findings, and I want to put on the record my gratitude to each and every person who has taken the trouble to write to me, whether it was just after the report was published or in advance of today’s debate.

Let me set out the main findings of the report for the House. Let us begin with a positive: we found a good level of trust among sickle cell patients in the specialist haematology departments of hospitals that look after them on a long-term basis. We found clinicians passionately committed to better treatment and honest enough to tell us when that good treatment was not there. We found that where there is a good level of understanding and knowledge, sickle cell patients are generally well treated and well looked after, but we also found a huge gulf between the good level of confidence and trust in the specialist parts of the system, and treatment in the more generalised parts of the system—specifically A&E and general wards.

Our key findings include the unacceptable variability of treatment, depending on where someone lives or who happens to be on duty at the time; patients having to battle for the pain relief to which they are entitled; and protocols on pain relief—for example, that it be administered within 30 minutes of arrival—being regularly and repeatedly ignored or not being implemented. Witnesses told us of waiting for hours in excruciating pain. Some clinicians spoke of adherence to the pain relief guidelines within their hospital being as low as just 20% or 30%. There is a lack of compliance with care plans that have been agreed for individual patients, including with the hospital where a patient has turned up, and people have been told, “That doesn’t apply here.”

We found a dangerous lack of communication between the general and specialist parts of the system. In Evan Smith’s case, he had been in the hospital for over two days before the haematology unit even knew he had been admitted. That finding was described as “shocking” by one haematologist who gave evidence to the group. Such delays can contribute to mistakes, with the most terrible consequences. As well as deaths, we heard about a number of near misses where care had gone badly wrong and the patient had still survived.

There is a lack of awareness of the condition and a lack of understanding about how to respond to a sickle cell crisis among some NHS staff. Everyone in the healthcare system knows the key symptoms of a heart attack or a stroke, and how to respond to them. With sickle cell, however, the patient experience is often one of being caught in a perpetual loop of trying to teach staff about what is happening to them and what treatment they need, often at the time that they are experiencing excruciating pain.

Covid-19 Update

Marsha De Cordova Excerpts

Monday 29th November 2021 Commons Chamber

[Sajid Javid]

I believe that right after my statement the Leader of the House will be making a statement about the debate and vote tomorrow.

On the severity, there are reports, as my hon. Friend has said, but it is early days and we are looking into them, talking with our South African friends and getting more details. It is worth pointing out the difference in age profile and demographics: in South Africa, people with covid are on average younger, and we are taking that into account as well.

[Marsha De Cordova (Battersea) (Lab)]

The Secretary of State set out the booster programme for the vaccines in his statement but has not mentioned what steps he will be taking to support those areas where take-up of the vaccine is still very low: what additional resources will be provided to those areas?

[Sajid Javid]

That is an important point and the hon. Lady is right to raise it. We estimate that 5 million people across the UK have not even taken up the offer of their first dose of the vaccine, putting themselves and their loved ones at great risk. A lot of work has been done over the past few months and it is bearing results: we are seeing ever more people coming forward, especially in the past few weeks. Indeed, many came forward this weekend, perhaps out of concern about the new variant. A lot of work is being done with community leaders, and there is an existing communications campaign but a new one will start imminently.

Black Maternal Healthcare and Mortality

Marsha De Cordova Excerpts

Monday 19th April 2021 Westminster Hall

[Marsha De Cordova (Battersea) (Lab)]

It is a pleasure to serve with you in the Chair, Sir Gary. I am grateful to my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) for leading the debate on behalf of the Petitions Committee. I also congratulate the formidable campaigners Tinuke and Clo, the founders of the Five X More campaign, who got the petition debate in Parliament today. The petition received more than 180,000 signatures. It is not before time that such a huge injustice is finally receiving the attention it deserves.

We have heard some powerful contributions from right hon. and hon. Members this evening, including my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman), the Chair of the Joint Committee on Human Rights. Just last year, the Committee published its report “Black People, Racism and Human Rights”, which contains shocking findings, particularly that the care that many black people receive is unequal to what is given to white people. I urge the Minister to accept all the recommendations of that report.

My hon. Friend the Member for Edmonton (Kate Osamor) highlighted, as others have done, the choice made in the report of the Commission on Race and Ethnic Disparities to sideline the institutional and structural racism that exists across society, but more so in the health service. My hon. Friend the Member for Streatham (Bell Ribeiro-Addy) made a powerful contribution sharing her lived experience. I thank her for doing so, but also for her tireless campaigning on the issue. She has been brave, and I thank her for that.

More importantly, my hon. Friend the Member for Vauxhall (Florence Eshalomi) highlighted some of the issues related to underlying health conditions in her own experience of being diagnosed with fibroids and also of being a sickle cell carrier. I also urge the Minister to listen to my hon. Friend the Member for Luton North (Sarah Owen), to give 20 minutes of her time to her and her constituent and to hear their experiences.

I also want to mention the contribution of my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes), who highlighted the fact that we need to focus more on issues relating to research. Unless we do the work, we will not move forward and bring an end to this crisis.

As we have heard, it is absolutely shameful that black women continue to be four times more likely to die in childbirth and pregnancy than white women. That inequality has existed for decades, with little action being taken to address it. [Interruption.]

[Sir Gary Streeter (in the Chair)]

Order. Does any Member present have to go to vote physically, or is everyone on a proxy vote? If everyone is happy, let us continue.

[Marsha De Cordova]

Last week I met campaigners, obstetricians, midwives and black, Asian and ethnic minority women with lived experience of maternal health complications. They were very clear that socioeconomic determinants such as income, housing and occupation and comorbidities only partially explain the inequalities affecting black maternal health. It is absolutely clear that structural racism is a driver of disparities in treatment, and it is a missed opportunity that the Commission on Race and Ethnic Disparities chose to sideline that important issue. I hope the Minister will choose to ignore and reject that view.

Black and Asian women, and their partners, regardless of their socioeconomic status, are not being listened to, not being respected and not being cared for. When they voice pain or concern during pregnancy or childbirth, they are branded as “aggressive” or “angry”, while dangerous stereotypes about “strong black women” mean that black women are often not offered the same treatment as white women.

It is outrageous that racist myths about black women having higher pain thresholds than other women continue to affect their treatment. Meanwhile, the lack of cultural competency in medical training means that complications experienced by black women are not spotted early enough. For example, black women have shared accounts of how their anaemia was not picked up soon enough because of the colour of their skin.

So I ask the Minister what action she is taking to tackle structural racism and to build trust in maternity services for black, Asian and ethnic minority mothers and their partners and for healthcare professionals, including midwives, as many have shared their experiences of occupational discrimination, as was highlighted in the Public Health England report last year. I would really like the Minister to address this issue. Additionally, cultural competency and unconscious bias training is an essential part of ending these inequalities, so will she commit to improving training in the health service and in medical schools?

We are all aware of the importance of data, which as we have heard is central to closing the maternal mortality gap. Many mothers and medical professionals have shared accounts of how pregnant women are recorded as being white if they do not disclose their ethnicity, meaning that it is difficult to track complications. Therefore, the recording of data is essential, so will the Minister commit to ensuring that all maternity services record the specific ethnicity of all mothers?

It is clear that fatalities are just the tip of the iceberg, with many women speaking of the near-misses and poor treatment they have experienced. I have heard from many medical professionals that data on near-misses could easily be made available, but it is not being. Will the Minister therefore commit to collecting and publishing data on maternal near-misses by ethnicity, and, if so, can she set a timeline for that commitment, with some clear milestones?

Midwives consider the continuity-of-care model as a way to help bridge some of these inequalities. A 2016 study found that women who see the same midwife throughout their pregnancy are 16% less likely to lose their baby. The NHS standard contract for 2019-20 stipulated that 35% of women will be booked on to a continuity-of-care pathway by March 2020. Can the Minister confirm whether that target was met? Can she also say what is being done to meet that target in the NHS long-term plan, which aims to provide continuity of care for 75% of black, Asian and ethnic minority women by 2024?

Before I close, I want to mention how the hostile environment is exacerbating this problem, as mentioned by my hon. Friends the Members for Erith and Thamesmead (Abena Oppong-Asare) and for Dulwich and West Norwood. Charging for maternity services and no recourse to public funds conditionality mean that many women are either becoming indebted as a result of their pregnancy or are turning away from health services all together for fear of being reported to the Home Office. Many women subject to charging are destitute and unable to pay, and three of the 209 women whose deaths were investigated in the 2019 MBRRACE-UK report were affected by charging for NHS maternity care. Does the Minister agree that charging women for maternity care is cruel and dangerous during this pandemic?

I want to make it clear that black maternal health and mortality is an avoidable inequality, and it is scandalous that the Government have not yet set a target to end this injustice in the NHS long-term plan, so will the Minister commit to doing so today? The NHS long-term plan sets many targets for other issues, so why not for black maternal health?

Let me be absolutely clear that a Labour Government would be committed to ending the crisis in black maternal health and mortality, and that the Government must take urgent action now. We need a national strategy to tackle health inequalities as a matter of urgency, which must include a target and a commitment to end the mortality gap between black, Asian and ethnic minority women and white women and to tackle structural racism once and for all, not deny its existence. We cannot afford for this not to be a priority.

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

I thank all Members of the House who have taken the time to attend and speak in today’s debate, and particularly the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) for having secured the debate. Along with everyone else, I also thank the co-founders of the Five X More campaign, Clo and Tinuke, for their incredible work. Their petition to Parliament has generated a huge amount of interest and support, and their work to improve maternity mortality rates and healthcare outcomes for black British women is inspiring and brings this deeply important issue the attention it deserves.

Every woman deserves to have safe care, to feel that her voice has been heard and to be an informed decision maker in her own care. The NHS is one of the safest places in the world to have a baby. Few women in the UK die during childbirth. Between 2016 and 2018, 217 out of 2.2 million women died during, or up to six weeks after, pregnancy from causes associated with their pregnancy. That equates to 9.7 maternal deaths per 100,000 pregnancies. We also know from the MBRRACE-UK maternal mortality reports that some of these deaths could have been prevented. Sadly, evidence shows that, currently, there remains a more than fourfold difference between maternal mortality rates among women from black ethnic backgrounds and among white women in England. There also remains an almost twofold difference between women from Asian ethnic backgrounds and white women. Those disparities are worrying and must be addressed, and I have heard all of the calls to do that today.

However, let me address the points that have been raised by speakers today—many of which have been raised repeatedly—beginning with the right hon. and learned Member for Camberwell and Peckham (Ms Harman). We need to fundamentally understand why this issue occurs and why we have these disparities. The statistics tell only part of the story: the lived experiences of black women need to be understood, appreciated and heard for us to really gain an understanding of the full picture. I think it was the hon. Member for Liverpool, Riverside (Kim Johnson) who read out some of the reasons for these disparities that are given in the report. As we know, and as we could tell from that report and from the list that she read, which was just the tip of the iceberg, the reasons are incredibly complex.

That is why, last month, I announced that the Government are embarking on the first women’s health strategy for England. That strategy is, first and foremost, about listening to women’s voices. The call for evidence that launched on International Women’s Day seeks to understand women’s experience of the health and care system, and we have already seen an incredible response to it. Many thousands of women across the country have come forward to share their experiences through the online survey, which takes just a few minutes to complete, so I will unashamedly make another call in this debate for any woman who has not yet completed the online survey to do so.

However, women from black and other ethnic minority groups are under-represented in the responses we have received so far, and today’s debate has reiterated just how important it is to ensure that the health and care system is listening to women of all backgrounds. I encourage any woman listening to this debate, and in particular women from black and ethnic minority groups, to come forward and have their voice heard. By better understanding women’s experiences, we can ensure that the health system truly meets the needs of women as they should be met. The complaint that women’s voices are not heard—that women are not listened to and are spoken down to in the healthcare sector—is a common one across the board from women, and was highlighted in Baroness Cumberlege’s recent “First Do No Harm” report.

Disparities in maternal mortality rates among women from different ethnic groups have been well documented for many years. The numbers are just not acceptable, and the Government are committed to reducing those inequalities. The charity Five X More has campaigned to make the NHS commit to a target to reduce inequalities and close the current gap in maternal mortalities. There are considerable limitations on producing an England-level indicator of maternal mortality by ethnicity. Many Members raised that point. The fact is that maternal deaths are rare, even among women from black ethnic groups. Because of the very low numbers, even a large reduction in mortality rates for a particular ethnic group would not necessarily be attributable to a genuine improvement in the quality of care.

[Marsha De Cordova]

The issue is that there is a need for a target. When a target is set, work can take place towards a reduction. The Minister says it might be difficult to record the figures by ethnicity. Could she explain why it would be difficult?

[Ms Dorries]

I will go further and explain what we are hoping to do to make a difference. We know that for every woman who dies, 100 women have a severe pregnancy complication or a near miss. That has been mentioned a number of times. When that woman survives, she will often have long-term health problems. Disparities in the number of women experiencing a near miss also exist between women from different ethnic groups. Because near misses are more common than maternal deaths, we can investigate those disparities at local and regional level, to better understand the reasons for disparity, to assess local variation and to identify areas with less disparity and, hence, best practice.

Oral Answers to Questions

Marsha De Cordova Excerpts

Tuesday 28th January 2020 Commons Chamber

[Liz Twist (Blaydon) (Lab)]

2. What assessment he has made of trends in the level of unmet demand for adult social care.

[Marsha De Cordova (Battersea) (Lab)]

7. What assessment he has made of trends in the level of unmet demand for adult social care.

[The Minister for Care (Caroline Dinenage)]

The Government have enshrined in legislation through the Care Act 2014 a council’s statutory duty to meet eligible needs for adult social care. We have given councils access to up to £1.5 billion more dedicated funding for social care in 2020-21 to help them to meet this requirement.

[Caroline Dinenage]

As I have explained, the Care Act sets out the requirement that entitles individuals to a care needs assessment and sets a minimum national threshold at which care should be delivered. We have backed councils up by giving them access to £1.5 billion in additional funding in the next financial year. In the hon. Member’s constituency, that will equate to an additional £5.1 million from the new social care grant. This is something that the Government take very seriously.

[Marsha De Cordova]

According to the Institute for Fiscal Studies, more than 1.8 million older and disabled people are currently going without the support that they need to live independently. This crisis has come after the Conservative Government abolished the independent living fund and cut nearly £8 billion from adult social care budgets. In 2017, we were promised a Green Paper, but there has been nothing. Months ago, the Prime Minister stood on the steps of 10 Downing Street promising to “fix” social care, so when will the Government finally publish those plans?

[Caroline Dinenage]

We just do not recognise the figures that the hon. Lady is parroting. Public spending on adult social care in 2018-19 reached £17.9 billion in cash terms, which is the highest level on record. Since 2016-17, our sustained investment has enabled spending to increase by 7% over this period. But do not take it from me—the Local Government Association said last year:

“This is the biggest year-on-year real terms increase in spending power for local government in a decade and will allow councils to meet the rising cost and demand pressures they face in 2020/21.”