Organ Donation (Deemed Consent) Bill

Will Quince Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Friday 26th October 2018 Commons Chamber

[Will Quince (Colchester) (Con)]

My hon. Friend rightly references the very important toolkit, which will be useful in sharing information about this new policy with our constituents, but does she agree that for it truly to work we need to educate people about why the Bill is so vital?

[Vicky Ford]

I thank my other fellow Essex MP for his excellent point. Essex MPs get things done, as do we all.

I try to think about what has worked in other countries, and it is clear from other countries that an opt-out system makes a difference. As my hon. Friend points out, however, it must go hand-in-hand with information systems and improving the resources available to our excellent health service staff. That is key to ensuring best practice. In countries that have introduced an opt-out system as part of a wider package of measures, it is associated with an increase in the number of donations and lives saved.

I support the soft opt-out system, as it is called, under which family members can say that they do not want their love one’s organs used for donation. It is important that family members have that choice. I have been struck listening to family members who have made that difficult decision after losing a loved one—we just heard the beautiful example of the young lady whose heart went to Max—talk about how much pride and hope it has given them to find out that their loss has resulted in many other lives being saved. That said, it is important, where family members feel strongly that a loved one’s organs should not be used, that they have the option of that soft opt-out.

Having said all that, I believe that with a clear and detailed communications strategy following the introduction of the system, and with investment in the right health structures to give our outstanding NHS workers the resources they need, the Bill will make the world a much better place for many of our constituents. Thank you Mr Deputy Speaker, for making sure we all came here today to pass these Bills.

Baby Loss Awareness Week

Will Quince Excerpts

Tuesday 9th October 2018 Commons Chamber

[Will Quince (Colchester) (Con)]

It is a pleasure to follow the hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney); I am pleased to say that his is one of the Scottish constituencies that I do not have a problem pronouncing. I should also like to thank all the previous speakers, particularly the hon. Member for Ceredigion (Ben Lake). He and the hon. Member for Coatbridge, Chryston and Bellshill have shown the importance of hearing men’s voices in the Baby Loss Awareness Week debate. I particularly want to thank the Backbench Business Committee for allowing the time for this debate, and my hon. Friend the Member for Eddisbury (Antoinette Sandbach), the co-chair of the all-party parliamentary group, for securing this important debate for the third year running.

In November 2015, when I was a relatively newly elected MP, I remember coming back after the recess and putting in for an end-of-day Adjournment debate. Based on my own experience, I thought we should have a debate on bereavement care in maternity units. Little did I think that we would have made such progress in just over three years. We now have the all-party parliamentary group, and we are in our third year of marking Baby Loss Awareness Week here in Parliament. That demonstrates the power of this place when we put aside the squabbling and party political differences and work together with a clear aim. It is clear that we are united and speak with one voice when we say that we are committed to reducing stillbirths and neonatal deaths—I include miscarriage in that description. We are also committed to ensuring that we have world-class bereavement care right across our world-class NHS for those who go through the huge personal tragedy of losing a child.

This is a particularly important and poignant week for me and my family, because it is four years ago this week that we lost our son, Robert. We will be marking his birthday on Friday, when he would have been four years old. On Sunday, my two daughters and I picked out the birthday cake that we will be sharing. Sadly, we are just one of the families who are going through this experience week in and week out, up and down our country.

We should not underestimate the importance of talking about baby loss. This is why debates such as these are so important and powerful. Totally wrongly, baby loss is a massively taboo subject. We have made huge efforts over the past three and a half years to try to break the silence and the taboo by working with charities, organisations and health professionals, but the taboo still exists. It exists because we do not like talking about death, full stop, and particularly about the death of children or babies. It is important that we talk about it, however, because that little baby was a huge part of somebody’s life. It is part of their story and their journey, and to ignore it can cause irreparable issues.

We must use the power of Parliament to break that taboo and talk about the issue, rather than crossing the street and avoiding someone who has suffered a stillbirth, miscarriage or neonatal death. We should talk to them about it. We should ask about their child and refer to them by their name, because people do want to talk. If they do not want to talk, they will tell us. It is really important that they should not be ignored.

[Richard Graham (Gloucester) (Con)]

I am so impressed by the work of the all-party parliamentary group. I rang my sister, who lost a baby a long time ago, to ask her what she would say if she were here. She asked me to encourage hon. Members to ensure that two things are available in hospitals. First, there should be someone practical to give advice on issues such as burials. The second, more important, thing was to have someone who can give emotional support to people who are in a moment of crisis and panic, and she felt strongly that in today’s era such services should be multi-faith and no faith. The chaplain’s offices in our Gloucestershire Royal Hospital can do that.

I should also like to mention a male constituent of mine who said that there had been a lot of support for his wife when they lost a child, but there had been no male support group. What does my hon. Friend think of those suggestions?

--- Later in debate ---

[Will Quince]

I thank my hon. Friend for raising those very good points, which are entirely valid. His points about support, both in hospital and post-hospital, and about the support available to fathers, are very important and I shall come on to them in a moment.

Just before we move on to the debate proper, I want to talk a bit about my right hon. Friend the Member for South West Surrey (Mr Hunt), because we have not had a chance since his elevation to the position of Foreign Secretary to praise him for the work he did on these matters when he was Health Secretary. From the beginning, we also felt supported by Ben Gummer—I think I am allowed to call him that now, as he is the former Member for Ipswich; he encouraged us to set up the all-party parliamentary group. However, the former Health and Social Care Secretary, now Foreign Secretary, could not have been more supportive, and we felt from the very beginning that we were pushing against an open door. He knew that the issue needed to be addressed, and he threw the full weight of the Department behind it. I thank him on the behalf of the APPG, and I know that all the charities feel the same way. He was hugely supportive and continues to be so.

We produced a video for Baby Loss Awareness Week, which is live now, and my right hon. Friend features in it, showing how passionate he is about tackling this issue. I also want to say how much the rest of the APPG and I are looking forward to working with the new Secretary of State for Health and Social Care, my right hon. Friend the Member for West Suffolk (Matt Hancock), who has already reached out to me and other members of the APPG, as have his special advisers, to continue that work, which they recognise is important.

Several colleagues have already referenced the hugely important work done by charities up and down the country. That includes both big charities such as Sands, which is marking its 40th anniversary this year, the Lullaby Trust, the Mariposa Trust, Tamba and so many others and small charities that provide support locally. The support that they provide to parents at the most difficult time in their lives is so valuable, and I thank everyone who works in and volunteers for those charities.

[Lilian Greenwood]

The hon. Gentleman is making a powerful contribution, as he always does, and I congratulate him and all the members of the APPG on their work. Will he join me in congratulating a local Nottinghamshire charity called Forever Stars? Not only is it doing fantastic work supporting parents who have lost a child, but it has managed to raise £300,000 to create two new bereavement suites at the two Nottingham hospitals over the past year. I know that that has already been touched on in the debate, but it makes such a difference to parents who have experienced the loss of a child when they have somewhere suitable to be with their baby and deal with the aftermath of a terrible situation.

[Will Quince]

I thank the hon. Lady for her intervention. I will absolutely thank and pay tribute to that charity. In so many cases, bereaved parents want to do something to make a difference and to provide a legacy for or mark the life of their child, however short, and raising money to support our NHS or to provide support for bereaved parents is hugely worth while. If I heard the hon. Lady right, an incredible £300,000 was raised: I pay tribute to the work that parents across the country do to raise such sums, which support the NHS in providing world-class facilities. I will discuss this further in a bit, but although we do have world-class facilities and bereavement suites some of our hospitals do not have them, which is an issue in and of itself.

I have thanked charities, but it is also important to thank the clinicians and support staff within the NHS who work so hard in this area. They really are heroes, and their work is incredible. Midwives do an incredible job, because although they are so often there at the best time in someone’s life—when a child is born—they are sometimes sadly also there at the very worst time in someone’s life. Their ability to, in effect, wear both hats and provide that caring, compassionate, empathetic support is a credit to them. We really do have world-class staff in our NHS.

I also thank all the clinicians who are working so hard on the national bereavement care pathway. Numerous colleagues have mentioned it already, and it is important to reference the progress made so far. I do not want this to be a back-patting debate, because I will move on to some areas where the Government could do more, but we have achieved quite a lot in just over three years. The first, and probably most significant, achievement was the Government’s commitment to reduce stillbirth and neonatal death by 20% by 2020 and by half by 2025. I note that that target has been moved forward—I think the target three years ago was 2030—thanks to the work of the Secretary of State for Health and Social Care, Health Ministers and clinicians. Having spoken to the Department and to clinicians up and down the country, I understand that those targets are realistic and achievable and that we are on track to achieve them, which is quite incredible.

However, it is important to note that even if we achieve the target of reducing stillbirth and neonatal death by 50%, that still means that around 2,000 or 2,500 babies are dying in the UK every single year and that a similar number of families will be going through a horrific personal tragedy, so we must ensure that we have world-class support. That is why the national care bereavement pathway, which I think it is fair to say was a concept initially drawn up based on the APPG’s work with charities, is game changing. The pathway is game changing, because what we had and continue to have across our NHS is world-class bereavement care, but it can be found only in pockets. It is not consistent across the NHS.

A particular hospital trust may have one or perhaps even two specialist bereavement suites and one, two or maybe more specialist bereavement-trained midwives or gynaecological counsellors, and all sorts of charities may be supporting bereaved parents within that hospital trust. In other hospitals, however, there may be no bereavement suite and perhaps just one or even no specialist bereavement-trained midwives or gynaecological counsellors. That is an issue, so a national bereavement care pathway that provides consistent, compassionate, empathetic care and support across our NHS, whichever hospital one visits, is so important.

[Antoinette Sandbach]

I congratulate my hon. Friend on that point. However, even where world-class care is not available, that can change, and the Medway NHS Foundation Trust is a great example of that. It received a negative inspection report, but it completely turned the situation around and now has absolutely first-class facilities. World-class care is achievable when hospital managers and NHS trusts are absolutely committed to delivering it.

[Will Quince]

My hon. Friend is absolutely right. The core purpose of the national bereavement care pathway is to show what good care looks like so that it can be rolled out across our NHS. My hon. Friend is right that we can do that by having bereavement suites and trained gynaecological counsellors and midwives, and we are seeing it. The pathway has now been launched in 32 sites, and I must again praise the Government for their initial funding, which supported the establishment of the principle and the pilots, and then the further funding for the roll-out into more sites.

I echo the comments made by my hon. Friends the Members for Eddisbury and for Banbury (Victoria Prentis) about further funding to roll out the pathway to ensure that it reaches the entire NHS nationwide, but 77% of professionals at the pilot sites who were aware of the pathway agree that bereavement care improved in the trust during the trial, and some 95% of parents interviewed agreed that the hospital was a caring and supportive environment. We therefore know that the pathway is making a difference and will work, which is why the Government have been so supportive. We just want to ensure that it is rolled out. The roll-out has deliberately happened in stages because ensuring that it is effective and embedded is just as important as the initial implementation.

Others have mentioned the Parental Bereavement (Leave and Pay) Act 2018, which is an incredible and ground-breaking piece of legislation. It is the first time that workers have had such a right, and it is one of the best rights in this area in the world. I pay tribute to my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) for so ably and passionately steering the legislation through the House of Commons and then ensuring its passage through the House of Lords and beyond. It is game changing, because it means that, from 2020, parents who lose a child up to the age of 18 will be entitled to two weeks’ paid leave. That is particularly important in relation to this baby loss debate, because it means that parents who lose a child to stillbirth will also be entitled to those two weeks.

For a mother, those extra two weeks may not be a huge change because mothers are entitled to their full maternity leave, but for a father it is game changing. Instead of two weeks’ paternity leave, he will get four weeks, because he will get the additional two weeks of paid leave. The Act will make a huge difference to fathers up and down the country who go through the awful experience of a stillbirth.

I said earlier that this was not a back-patting debate. Far, far more needs to be done. Earlier we had reference to bereavement suites. It is essential that we have bereavement suites in every hospital up and down the country. It is not acceptable that any parent should have to suffer a stillbirth or neonatal death in a maternity unit where they can hear happy families, crying babies and people with balloons and teddies—all the joy of that. People who are going through this most traumatic of experiences need somewhere quiet for reflection, to grieve and to spend time with their baby in peace. We know that we can provide this because NHS trusts up and down the country are providing bereavement suites. In Colchester we were lucky to have use of the Rosemary suite, and I am not quite sure what we would have done without it.

So we have to ensure, Minister, that we have a bereavement suite in every hospital away from the main maternity unit. Ideally, I would like another room to be available, because you cannot book in. You do not know when exactly you are going to have a baby—these things do come on, as my wife and I found out with our second, who was born at home, unexpectedly. It was also a pretty traumatic experience, but it ended well. The point is that people do not know and they cannot book suites out. They can just turn up at hospital. If, sadly, the suite is already being used, another room should be available. It might not have the full facilities of a bereavement suite, but it is important to have that room.

As was mentioned earlier, cold cots are also important. Not all parents will want to spend time with their child, but those who want to should be able to spend as much as they need after the birth, and for that cold cots are important.

As I mentioned earlier, it is important that bereavement-trained midwives or gynaecological counsellors are available in every hospital—not part time but full time, and available for parents when they need them. Let us not forget that many stillbirths and neonatal deaths are sudden and unexpected. It is a hugely traumatic experience and people need support immediately. A trained individual is so important. However, there is merit in ensuring that bereavement training is a module in the midwifery course so that every midwife is trained to an extent, because sadly we know that they will come across stillbirth and neonatal death in their career.

The other thing is to ensure that there is learning from every miscarriage and stillbirth. We still do not really understand why 50% of stillbirths happen. I will come on to it, but research is so important. I have already mentioned embedding the national bereavement care pathway.

I want to touch on the new pregnancy loss review, because it has not been mentioned so far. One of its heads is Zoe Clark-Coates of the Mariposa Trust. We often talk about stillbirth and neonatal death, but we do not talk enough about miscarriage and we still do not really know the true numbers of miscarriages. Colleagues in the Chamber have spoken emotively in previous debates about their experience of losing a child at less than 24 weeks. They said that their loss was not recognised in any way because it was classed as a miscarriage, not a stillbirth, even though they gave birth. This is why the pregnancy loss review is so important.

I echo the comments made by my hon. Friend the Member for Banbury about post-mortems. Too often, people are scared to have the conversation about a post-mortem. It is a difficult subject; I would not want to approach parents who have just lost a child and ask if they would consider a post-mortem. But it is so important that that question is asked, because post-mortems will enable us to start to understand why stillbirths happen. So changing cultures within NHS trusts to ensure that that question is asked as a matter of course is important. The parents can say no, but if they are not offered the opportunity, they may look back and say, “My child’s life could have made a difference to future children.”

I would like to see the national bereavement care pathway and bereavement support more widely included as part of the matrix and assessment regime for the Care Quality Commission. We do not put enough emphasis on bereavement and the support that parents are given. I would also like to see support for subsequent pregnancies. There is pretty good support in many NHS trusts at the point at which someone suffers a loss, but what about subsequent pregnancies? Often the mother and the father will be thinking every single day up until the 12-week scan, every single day up until the 20-week scan, “Is this going to happen again?” But at that point often no support is available unless they reach out. The support network is patchy across the country.

My hon. Friend the Member for Gloucester (Richard Graham) spoke about fathers, and he was absolutely right to do so. As I said at the beginning of the debate, it is important that men take part in it. So often, men bottle things up. They think they have to be the tough guy and hold it all in to support the family. I did it, and I have spoken to other fathers, so I know that it is a common reaction. Men are often treated like the spare part. That is by accident, not design. The chaplain or midwife will often be talking to the mother—understandably—but the father has just witnessed the woman they love give birth to a child they love and have now lost. They have been through the experience too. They are often the ones who will have to go off and tell family members, register the death and make arrangements for the funeral. So it is important to ensure that fathers have all the necessary support available to them, and it is one area that the NHS needs to get much better at.

It is important that we have more research into baby loss. The taboo nature of this issue means that charities that specialise in it—even the bigger ones such as Sands, the Lullaby Trust, the Mariposa Trust and others—do not get the financial support that other charities do. I implore people up and down the country to support baby loss charities, because they can fund vital research, which will lead to fewer babies dying.

Lastly, I want to touch on another passion of mine. We talk about 15 babies dying every single day in the UK. Every single one is a tragedy. But 7,175 die every single day worldwide. Every day 830 mothers die from preventable causes related to pregnancy, and 99% of them are in developing countries. So let us be passionate about reducing stillbirth and neonatal death here in the UK, but let us be equally passionate about tackling this issue worldwide. I am a big champion of UK aid because I know that it makes a difference around the world. UK aid is not sold, especially by some of the right-wing media, but it is so important in tackling issues such as this. I do not think that there is one person in this country who would say that spending money on reducing the number of deaths of babies is not money well spent. If we were to get the newborn mortality rate of every country down to the average of high-income countries such as our own, or even better below it, that would save 16 million lives a year.

UK aid is already making a huge difference to this issue. In 2015-16, something like £124 million was spent on maternal and neonatal health. That is equivalent to about 15% of aid spending. The Department for International Development is supporting programmes in about 16 countries, focusing on maternal and neonatal health. I recently made a visit with Unicef to Ethiopia, a country that has a high prevalence of baby loss. Although the number of deaths of children aged between one month and five years has dramatically fallen in recent decades, newborn death remains a massive issue. Think of the difference we can make worldwide if we can share some of the learnings from this country and others in the western world by using UK aid and support from clinicians in this country. Let me give an example of that.

One of the biggest causes of newborn death in Ethiopia is sepsis, which is relatively rare in the UK because we have high levels of hygiene and sanitation. UK aid water projects will make a huge difference on that, but we can do far more. At one neonatal unit there, the scrubs and clogs I was asked to put on were dirtier than the clothes I was wearing, which was a little worrying. There was a baby in there with sepsis, and I spoke to the doctor, who was a general practitioner, not a specialist in gynaecology or an obstetrician. There is a real need for some specialism and specialist training there. I asked, “Where is the hand wash? Where is your alcohol rub? This is commonplace. You can’t go about 10 feet along a hospital corridor in the UK without finding an alcohol rub dispenser.” He replied, “Ah, yes, I’ve got some of this” and he reached into a bottom drawer, underneath a load of stuff, and pulled it out. This is exactly the sort of intervention, on cleanliness, hygiene and sanitation, that we in the UK can share with countries around the world and that can make a difference. So I invite the Minister, and I will also be pushing the Secretary of State for International Development on this, to have a little more focus on tackling infant mortality, stillbirth and neonatal death on a global scale.

I have probably spoken for long enough, but I just want to say that this is a hugely important subject. We in the all-party group will continue our work, and I wish to thank all Members here from across the House, the Government and Members from all parties for their ongoing support.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

I thank Mr Speaker for granting this debate and the Backbench Business Committee for selecting the subject. I thank the hon. Member for Eddisbury (Antoinette Sandbach), who as always set the scene on a subject about which she is very passionate and knowledgeable, with her personal story. I thank all the right hon. and hon. Members who have made incredible contributions, every one of them straight from the heart. They have certainly set the scene for a very serious debate in which we acknowledge what has happened. The hon. Member for Colchester (Will Quince) put forward ideas that he thought would be helpful. Everyone did that, to be fair, but he did so especially.

I will never begin to speak in a debate of this variety without first expressing my sincere sympathies to all those who have been affected by the loss of their baby, at whatever stage. My thoughts are with those people today, and I pray that the God of peace and comfort will be their strength. Baby loss is an extremely painful topic, but it is one that is being spoken of more and more. Such debates enable some of the pain and hurt to be talked about, and that can only be a good thing. We must thank charities such as Saying Goodbye for raising the topic and saying that it is okay to speak out, remember and reflect. Whatever way a person deals with their pain is okay, as long as they know that they are not alone. Such debates allow us to express the message, “You are not alone.” The Members present who speak in these debates reflect the opinions of our constituents outside the Chamber, about whom we talk.

As I have said in previous debates, my mother suffered several miscarriages, as did my sister and a member of my staff—in fact, the member of staff who helps me to prepare my speaking notes. For me and for all of us in the Chamber, this is a matter that is very close to our hearts. The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) spoke of the miscarriages that his mum had between his birth and that of his younger brother. That is probably very real to me, as well. As we spoke about my staff member’s workload for the coming week, we realised that it was Baby Loss Awareness Week. Might I suggest that if a debate ever came at the right time, this one did? We discussed how during the last two weeks of September, we had heard of six couples who live in my constituency who had suffered miscarriages. That is six children lost; six expectations never to be fulfilled; six homes filled with sadness; six women who felt empty; six partners who felt so helpless; and countless loved ones who simply had no words. Those six people were known to all of us very personally, and the fact that one in four pregnancies ends in miscarriage has never felt so real.

In the past eight months, I have known three ladies, who are also constituents of mine, who have carried their babies for the full nine months only to have them for just two hours. I can well remember my wife, Sandra, informing me that she was pregnant with our first son, Jamie. Like every parent, I had never felt such joy. I planned for our future and imagined what he would look like. I did not check whether the baby was a boy or a girl as I have always liked the element of chance. I just hoped that whatever sex the child was, they would be accepted. To be truthful, I did ask for three boys and I got three boys—I am not sure how that worked. As I held my child, I realised that the expectation could never meet the reality of having a child in my arms. I also remember very well holding my first grandchild, Katie—I know that there are other Members here who are grandparents as well. Katie is now nine years old. I remember when Del Boy, the character on TV, took Damian in his arms and he looked at him in wonder, and there was I at the Ulster Hospital in Dundonald. I said, “Next year, Katie, we will be millionaires.” Of course, we were not millionaires, but we were in a way as we had our grandchild. Such was the joy that we felt. Therefore, when I think of those families who have lost that hope for their future, my heart simply aches. Through my constituents, I have stared into the face of pure sadness and emptiness, and I would have given anything to change the outcome. That was never going to be in my power, or in the power of anybody in this Chamber, but, having spoken to many women, one theme is clear: they cannot forget their loss and they do not want others to forget it either.

I know that my parliamentary aide will not mind me saying that she lost her first baby abroad while on a church mission trip. She returned a few years later with her family—she now has two wee girls—and planted a tree with a simple plaque in remembrance of the wee child who had died. This simple act of remembrance, while not addressing her grief, helped her to move forward, as she knew that that tree would grow and be a testament to the life that began but could not flourish and grow. This is a desire that is reflected in the events that are organised to celebrate the short lives of babies. Women no longer feel that they must and should grieve in silence. The taboo that existed in my mother’s generation that kept women silent in their grief has gone now. One look on social media will reveal messages that say no more than a date, or a number of dates, and that is proof that it is good for some women to acknowledge and commemorate their loss. Balloon releases and services of remembrance indicate that those who grieve want to see their loss acknowledged.

There are, of course, other women who wish to grieve in silence and that is their right, and I absolutely respect that. Some pain can never find a voice. We may never know the people around us who have gone through baby loss—I am sure that a trawl of families of staff members in this place would show us all to be connected in some way to a loss of child—but what we must know is that there is a way in which we can remember and pay tribute to those lives, those hopes and those dreams that have been lost.

I want to take a brief moment to think about the fathers. This is something that my aide mentioned to me and that others have referred to as well. Fathers suffer emotional loss—not the physical emotional loss—and have to watch their loved one going through the physical and emotional trauma of loss and they need to be remembered as well. It is their loss as well and they have a right to grieve, and that should be said in this place, too. Others have also referred to grandparents and other family connections. There must be support available for the whole family, and I feel that this is lacking. I have heard it said that the leaflet that is handed to a mother when she miscarries does not help. It is often not read or thought about. A follow-up phone call offering help and advice may go a long way to dealing with the pain and the fear, and I am grateful to the charities that fill that breach when perhaps, with great respect, the NHS does not.

What words do I have for those who have lost babies?

[Will Quince]

I distinctly remember the intervention that the hon. Gentleman made in that speech back in November 2015 when he raised the importance of the hospital chaplain and the huge comfort that they give to families. Does he agree that the point he made then is as valid today as it was three years ago?

[Jim Shannon]

Absolutely, and I thank the hon. Gentleman for his intervention and for reminding us of that debate. Like many others in this Chamber, I am a man of faith who feels that it is important to have a chaplain available—to have someone to share one’s grief and hard times. The intervention that he mentions was right along those lines. I felt that it was so important to have that help at that time, just when one needed it the most. I thank him for his intervention and for his salient reminder.

Mental Health Units (Use of Force) Bill

Will Quince Excerpts

Report stage: House of Commons
Friday 15th June 2018 Commons Chamber

[Philip Davies]

I do not believe the hon. Lady has been present throughout the debate; had she been, she would have appreciated that we all support the Bill. The hon. Member for Croydon North supports the Bill in its current form, but it has become apparent during the debate that he actually agrees that it would be improved by the inclusion of amendments 11 and 12. It is a question not of whether we support the Bill—we all support it—but of whether we get a Bill that is fit for purpose, and if we pass the best possible Bill. The point is that once these provisions have passed through the House, that will be it: the Bill will move off the House’s agenda, and we will not have another chance to do the great things that the hon. Gentleman is trying to achieve. We have to get it right this time, because otherwise the opportunity will pass. Those two absolutely key bits of training to prevent what happened to Mr Lewis from happening to other people need to be provided for in the Bill. To be perfectly honest, it is blindingly obvious to anybody that they need to be in the Bill.

[Will Quince (Colchester) (Con)]

Are we not in danger of allowing the perfect to be the enemy of the good?

[Philip Davies]

On that basis, my hon. Friend is basically saying, “Let’s get a Bill with a nice title, with any old nice-sounding provisions in it, and bang it on to the statute book without any scrutiny whatsoever.” The whole point of Report is to try to improve Bills. I am still confident that people will decide that what I am saying is sensible, because the amendments are sensible improvements to the Bill. It is not my fault that the Government cannot carry out their decision making in time. To address the point raised by the hon. Member for Croydon Central (Sarah Jones), the whole point of requiring amendments to be tabled by Tuesday evening prior to their being debated on Friday is to give people time to consider them.

National Bereavement Care Pathway

Will Quince Excerpts

Tuesday 24th April 2018 Commons Chamber

[Will Quince (Colchester) (Con)]

It is a pleasure to lead this debate this evening, and may I thank the Minister for being here to respond?

I never entered politics with the intention of becoming a baby loss awareness campaigner. As with so many in this field, the loss of a child—my son in 2014—brought about my interest and desire to bring about change. And being a Member of this House, gives every one of us the platform to make a difference. It can be a small change that affects just one of our constituents, or it can be something larger that affects everyone in the UK. I am proud that through my role in this House I have been able to play even just a small part in the development and roll-out of the national bereavement care pathway, which is something that will make a difference to tens of thousands of bereaved parents and families up and down the country.

Before I move on to the pathway itself, I want to pay tribute to you, Mr Speaker. You have been hugely supportive of our baby loss awareness campaigning efforts in this place, and I know I speak for all members of the all-party group on baby loss when I say a heart- felt thank you.

Launched last year at 11 sites across England, the pathway has been developed by a number of baby loss charities, royal colleges and professional organisations with the support of the Department of Health and Social Care and the APPG. It is designed to improve the quality of bereavement care experienced by parents and families at all stages of pregnancy and baby loss up to 12 months. The pathway provides a practical framework for all those healthcare and other professionals involved and has been informed and led by the views of bereaved parents at every stage of its development. Parents have stressed the importance of sensitive and consistent care, of making informed choices, of privacy, of not having to repeat their stories to different members of staff and of having opportunities to create memories and spend time with their babies. As one bereaved parent put it:

“Parents don’t need protecting; they just need the chance to be parents, provide their child with dignity and create memories.”

Each year in the UK, thousands of parents and wider families sadly go through the devastating experience of losing a child. While we cannot take away that devastation and grief, good care can make a devastating experience feel more manageable, while poor-quality or insensitively delivered care can compound and exacerbate pain.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on his hard work in this area—we are all greatly moved—and he is right to thank you, Mr Speaker, for all you have done. The combination of both your efforts is highly regarded in the House. Does the hon. Gentleman agree that, with three babies a week being stillborn or dying in the first four weeks of life in a nation as small as Northern Ireland, those suffering this heartbreak must be supported, which is why the care pathway is essential?

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[Will Quince]

My hon. Friend is absolutely right, and I thank him for the support he has given to the APPG since its formation. He is right that just one stillbirth or neonatal death is one too many, and while we should rightly campaign for reductions—we have ambitious targets in that regard—it is absolutely right to ensure that even if we hit those targets, as I will come to later, we make sure we have world-class bereavement care for those parents and families who sadly suffer the loss of a child. Through the pathway, we can work to ensure that they receive the best-quality bereavement care that the NHS can deliver.

Bereavement care has been a priority for the APPG for two reasons. First, there is sadly an inconsistency in the quality and standard of bereavement care across the country. Every parent and family who suffer the loss of a child should receive the same high-quality bereavement care no matter where they live, yet that is not the case at the moment. A report from Sands in 2016 found that only 46% of trusts with maternity units provided mandatory bereavement care training for maternity unit staff. Further, of those who did provide the training, 86% provided their staff with just one hour or less of training each year.

A separate report by Bliss in 2015 on neonatal units found that 41% of units had no access to trained mental health workers and that while some units had dedicated bereavement facilities, many relied on normal accommodation or quiet rooms. That is very important. In the case of 50% of bereaved mothers, care after their baby had died was considered poor enough to have affected their psychosocial wellbeing and any plans that they might have for a future baby. We should therefore be ensuring that parents who suffer the loss of a child receive the best possible care wherever they are in the country, and that is exactly what the bereavement care pathway does.

The second reason, however, is that 15 babies sadly die every single day before, during, or shortly after birth. This takes me to the point made by the hon. Member for Strangford (Jim Shannon). Even given the Government’s ambitious target of a 50% reduction in stillbirth and infant death by 2025, there will still be tens of thousands of stillbirths and neonatal deaths, and tens of thousands of parents, grandparents and wider family members will still go through the tragedy of baby loss. While it is right that we work to reduce baby loss rates by, for instance, tackling smoking among pregnant women, we also need to ensure that there is high quality-care throughout the NHS for the parents who do, sadly, lose a child.

Last month, I had the opportunity to visit one of the first pathway pilot sites, established by Chelsea and Westminster and West Middlesex University hospitals, to see it in action. It was great to chat with staff and discuss what challenges they faced in implementing the pathway, and what benefits they had found for parents. My experience during that visit has been backed up by the recent early evaluation of the first phase of the pathway. Feedback from the pilot sites found that it had helped to raise the profile of bereavement care in hospitals—a vital change, now that that will be assessed as part of inspections by the Care Quality Commission—and that it had also encouraged different teams in hospitals and departments to work more closely together.

That independent report showed not only the need for the programme, but its obvious impact. For example, where bereavement midwives are in post, they are making a significant and positive difference in their trusts. However, more work is clearly needed to ensure that good practice is shared across hospital trusts, so that all staff who come into contact with bereaved parents are equipped and helped to deliver the high-quality care that we all want to see. The findings show the huge potential for improving bereavement care in pregnancy and baby loss, something that I, and the all-party parliamentary group, will continue to proudly support. It has also been useful for healthcare professionals to suggest ways in which the pathway can be refined, and, in particular, how it can be ensured that the documents and guidance that are issued are more practical in terms of implementation.

Last Monday, our APPG hosted a reception to mark the launch of the second wave of pathway sites. A further 21 trusts are now piloting the pathway, providing sites where bereaved parents will be able to experience better care.

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I congratulate the hon. Gentleman on securing the debate and on all the work that he has done in this field, including his work in the all-party group. Earlier, he gave the chilling statistic that 15 babies die each day in the United Kingdom. Of course we all know that the loss of a baby—the death of a child—is the last taboo. The irony is that, although the rolling out of bereavement pathway sites throughout the UK is welcome and much needed, it is because baby loss is so hard to discuss that it has taken us so long to reach this point.

[Will Quince]

The hon. Lady—and I will call her my hon. Friend—has made a very valid point, and I thank her for all her contributions to the formation and the continuing work of the APPG. She is right: there is a taboo surrounding baby loss, and we must break it. I remember the first debate about it that we held here, in November 2015, and the floods of e-mails and messages that we received from parents out there who were saying, “Thank heavens, someone is now talking about baby loss.” They had felt so enclosed, and unable to talk about it, to the extent that people would cross the street to avoid having to have that awkward conversation.

That is exactly why the pathway is so important. Although NHS professionals up and down our country are caring and compassionate to their very core, not everyone has experienced this kind of grief. It is important that the pathway is parent-led, because that enables parents to share the experience of what they went through, how they were feeling, and how things could possibly improve in the future. I encourage the hon. Lady to continue her work in the APPG and continue to participate in debates like this, because that shows the country as a whole that we are willing, ready and able to talk about baby loss, and will not stop talking about it until as have addressed some of these big issues.

[Jim Shannon]

The hon. Gentleman is being gracious in giving way—I thank him for that. One of my staff members had two miscarriages, and the loss for her was immense. What sustained her through that time of grief, which he knows about himself, was the support of family, friends and all of us associated with her, but probably more than anything else her faith and her Christian beliefs. Does he agree that it is critical that that is part of the pathway?

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[Will Quince]

I thank the hon. Gentleman for his further intervention. He raises a good point, because hospital chaplains provide amazing support for those who have gone through this horrific experience. Whether someone is of a religion or of none, there is an important role for the calm, comforting voice and listening ear of a chaplain, who can sit with them and give them the time that NHS professionals are not always able to give in a busy, hustling and bustling maternity or neonatal department.

[Victoria Prentis (Banbury) (Con)]

My hon. Friend is being generous in giving way. Does he agree that the baby loss services that we have organised, particularly last year, have helped many couples across the UK come to terms with their grief? We had a fantastic one at St Mary’s church in Banbury and a fabulous one downstairs in the Crypt here. Whether or not people are of faith, those services enable them to demonstrate their grief in a public place, which is very helpful.

[Will Quince]

I thank my hon. Friend for that intervention and for the considerable work that she has put into both the formation and the ongoing work of the all-party group. She makes a really good point. Those services are not always religious, although most of them tend to be in some way, shape or form, and they are hugely important and comforting to families. I know that she has organised several, and various charities organise them too. They are about not just the religious element but people being able to come together and pay their respects to the children they have lost. They bring about a community and show people that they are not alone and that there are others who have gone through the same or very similar experiences. Long-lasting friendships often flow from them. I remember a service that I attended with my wife—I think it was the year after we lost our son. There was a lady there in her 80s who still came to the service every year to remember the child she lost in her late teens. That shows that the experience stays with people forever, and that these services are really important.

With the evidence showing that the pathway is making a really big difference in improving the quality of bereavement care in the hospital trusts in which it is being piloted, the aim is to roll it out across the country in October. As I said at the beginning, 11 sites launched last October and a further 21 last week, and a nationwide launch in October is very much the ambition. Sands established the project on behalf of the core pathway group, entirely thanks to £50,000 of funding from the Department of Health and Social Care. I am extremely pleased to see my hon. Friend the Member for Ludlow (Mr Dunne), the former Care Quality Minister, in his place, because he did so much with the Secretary of State to help secure that funding.

[Mr Philip Dunne (Ludlow) (Con)]

I hesitate to rise after that generous tribute, but may I say that I am absolutely convinced that without the work of my hon. Friend and his colleagues in the all-party group, we in the Department would not have given this issue the prominence that it has achieved under their leadership? In particular, I wish to mention the role that Sands has played in driving this agenda forward. I pay tribute to that organisation and all the bereaved parents that it represents, and I congratulate my hon. Friend on securing yet another debate on this topic.

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[Will Quince]

I thank my hon. Friend for his kind words. He makes a good point about the charities involved. One of the great strengths of the all-party group is that we have been able to bring together about 40 baby loss charities, and that number grows at every meeting. This is one reason why we have been so successful. Some of the charities are big, including Sands, Bliss and the Lullaby Trust, while others are very small, including those that make teddy bears or knit little items of clothing for their local neonatal units. We are bringing all those charities together with one common purpose: to reduce baby loss and ensure that we have world-class bereavement care. This is what has genuinely made the difference. When politicians work with the charitable sector, the Government, bereaved parents, clinicians and medical professionals, that is when we can really make a difference, and I genuinely believe that this is a prime example of that happening.

This is also a good juncture to pass on my sincere thanks to the Secretary of State for Health and Social Care. He could not have been more supportive of the formation of the all-party group or of our work, and I have always felt that, with him, we were pushing at an open door at every turn. I know that that feeling will be echoed by other members of the group. Every time we have tried to move the agenda forward, the Secretary of State has been willing to listen and to act, and I thank him for that.

We are also most grateful for the Department’s financial support, in the form of £50,000, to help to launch the national bereavement care pathway. However—this is the big “however”—that funding was exhausted last year. Since then, Sands has continued to support the project, covering the costs of staff, partnership, documentation production, website development and all the engagement activity that supports it. To ensure that the pathway is embedded across England by 2020, in line with commitments on improved patient safety, maternity services and bereavement care, the project has to be suitably resourced. Sands has approached the Department of Health and Social Care asking for support to cover the core costs of the pathway. It has formally requested further funding for the current financial year and the next.

There is overwhelming political, parental and professional support for the pathway. I do not want to put the Minister on the spot, but I ask the Government to commit to provide Sands with additional funding for the roll-out of the pathway, which is so important. This will mirror the commitment given by the Scottish Government, who are funding the roll-out in Scotland. More widely, the Department of Health and Social Care should look to put in place the resources needed to ensure that staff are given the training and facilities that they need to make this a success and to give bereaved parents the best possible care. The loss of a child is something that affects tens of thousands of parents every year. The Government can rightly be proud of the progress made, the ambitious targets set and the plans put in place to reduce baby loss. By committing to funding the pathway roll-out across England, the Government can ensure that families who suffer the loss of a baby receive consistent, sensitive, world-class bereavement care right across our NHS.

NHS Staff Pay

Will Quince Excerpts

Wednesday 21st March 2018 Commons Chamber

[Mr Hunt]

The hon. Lady is right to draw attention to that problem. We have certainly stopped doing any new PFI deals of the disastrous kind that lead to the consequences she talks about. We have given some relief to a number of hospitals in that area, but I will look again at her local hospital, because it is clearly totally unacceptable if that is happening.

[Will Quince (Colchester) (Con)]

Colchester General Hospital has recently come out of special measures, and the staff there have worked so hard to turn our hospital around, so I welcome wholeheartedly this announcement of extra money, which means that our staff will get a well-deserved pay rise. I will always champion our hospital, however, so will my right hon. Friend commit to continuing to invest in our hospital and its people? In particular, will he look at the accident and emergency department?

[Mr Hunt]

I will happily do that. The hon. Gentleman has championed his hospital, which has been on a rollercoaster journey during his time in this House but which has now turned a corner. The staff have worked incredibly hard to improve safety standards for patients, but I know that, like many places, they would like more investment in their A&E, and I will certainly look at it.

Maternity Safety Strategy

Will Quince Excerpts

Tuesday 28th November 2017 Commons Chamber

[Mr Hunt]

Through the hon. Lady, I express my thanks to Jack and Sarah for bravely telling their story this morning in the media, which was incredibly moving and touched a lot of hearts. With respect to allowing inquests into full-term stillbirths, our objective is to move as quickly as any legislative vehicle allows. If I am able to work closely with my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) to do that, that is exactly what I want to do.

[Will Quince (Colchester) (Con)]

I very much welcome the Secretary of State’s statement and congratulate him on it. Does he agree that the vast majority of grieving parents, if not all, not only want to know why, but want to know that their child’s life, however short, will have had meaning by ensuring that we learn lessons from them not as a statistic, but as a baby? That is why the independent investigation unit is so important. We must learn the lessons not just in one trust, but across the whole NHS and spread that learning to ensure that as few people as possible go through this emotional personal tragedy.

[Mr Hunt]

My hon. Friend is absolutely right. As he knows, because he has spoken so movingly on this subject many times, there is absolutely nothing we can do to make up for the searing loss of losing a loved one—a baby. It is the worst thing any parent can go through. We can at least give them the commitment that we will learn. If we are honest, we do not do so at the moment, because we sometimes wait 10 years for a court case to be settled, and even then it is not always clear to me that the lessons of what happened are properly learned around the system. This statement is an attempt to change that.

Mental Health Units (Use of Force) Bill

Will Quince Excerpts

2nd reading: House of Commons
Friday 3rd November 2017 Commons Chamber

[James Heappey]

The hon. Gentleman is absolutely right. It is great on days like today when the House is in such violent agreement. The cameras really are a great addition for our police forces. They give transparency for those who want to complain about perceived unfair treatment. But they also give a protection as important as the stab vest, by reassuring police officers that they will have a video record of what they did.

[Will Quince (Colchester) (Con)]

I accept points from both sides of the House on body-worn cameras. The Bill makes it clear that the officer has to turn the device on as soon as practically possible from the point at which they are called. Does my hon. Friend think that it would be more practical to say that that should be at the point they attend the mental health unit, not the point at which they take the call? Is not that a little too onerous for the officers? I am just posing the question.

[James Heappey]

From discussions with local police constables and with the police commander, it seems that police officers have an instinct for when they are going into certain types of situation. One would imagine that if an officer were on the custody desk and heard that something required their intervention, they would obviously flick on their camera as a matter of drill while they were going down to the cell or wherever something was happening. That is assuming what we were just discussing—that it should be standard practice that somebody in those circumstances is always fully kitted out.

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[Will Quince (Colchester) (Con)]

I add my congratulations to the hon. Member for Croydon North (Mr Reed), who is not in his place, on introducing the Bill and on the emotive and heartbreaking story that he shared with the House.

The Bill is an important part of a wider issue. We need to improve our approach to mental health. Without question, mental ill health carries a stigma and a taboo, and Members from both sides have played a huge role in tackling that. One of my passions is campaigning on baby loss, which has a similar stigma and taboo attached to it. We do not talk enough about it, and that has led many people to stay silent. If we are to tackle the stigma and taboo, we have to raise these issues as much as possible and ensure that people feel able to talk about them openly. There is no greater place to do so than on the Floor of the House of Commons Chamber.

The Mental Health Act has remained unchanged since it was first published in 1983, and many consider it to be no longer fit for purpose. As a comparison, when the legislation was introduced, the Diagnostic and Statistical Manual of Mental Disorders, which is known as the DSM, existed in its third edition. Since then, it has undergone multiple revisions, and it is now in its fifth edition. The research into mental health conditions and our understanding of them have developed, particularly over the last three and a half decades, but our legislation has not changed. That is not good enough.

The Bill is one important step among many towards ensuring that people with mental health conditions are treated appropriately. I want to make it clear that there will be circumstances in which restraint is required in mental health units. That is, sadly, inevitable. Staff in such units have an incredibly challenging job. We would all agree, however, that restraint should be the last resort, not the first. I pay tribute to Mind, which launched its campaign in 2011 to reduce the use of restraint in healthcare settings. It has made fantastic progress so far.

In 2014, the coalition Government published guidance in this area following investigations into abuses at Winterbourne View hospital and a report published by Mind, which found that restrictive interventions were not being used as a last resort. The guidance made it clear that staff must use such actions only if they represent the least restrictive option for meeting the immediate need. The guidance also made it clear that staff must not deliberately restrict people in such a way as to impact on their airway, breathing or circulation. That includes face-down restraint on any surface, not just on the floor.

I continue in the spirit of the coalition Government by paying tribute, as my friend the hon. Member for Bath (Wera Hobhouse) has done—she is currently looking at her phone on the other side of the Chamber, and I cannot attract her attention—to the right hon. Member for North Norfolk (Norman Lamb) for the work that he did as a Minister. I know that this is an issue that he cares deeply about. I know that the right hon. Gentleman is not in the Chamber at the moment, but I certainly want to put that on the record—the hon. Lady still has not realised that I am complimenting her colleague—because he did a huge amount of work in this area.

Later in 2015, the Mental Health Act 1983 code of practice was revised, and NICE updated its guidance on violence and aggression, both of which put the emphasis on prevention and advised against the use of prone restraints. What all this recognised is that the solution is not to blame the staff, but to give them the skills and confidence to deal with some incredibly challenging situations.

In September, I visited the Lakes mental health unit in Colchester to see at first hand what a mental health unit is like. I initially had a brief meeting with senior managers, including Sally Morris, the chief executive of the Essex Partnership University NHS Foundation Trust—the names of NHS trusts always seem to be a bit of a mouthful—which manages the Lakes unit in my constituency. I was then given a tour of Ardleigh ward and Gosfield ward, and we discussed many issues. Restraint was not one of the issues we discussed, but following the debate on this extremely important Bill—the hon. Member for Croydon North, who introduced it, is now in his place—I will definitely be asking questions about the use of restraint in that unit.

I support what the Bill is seeking to achieve on training, especially as set out in clause 5(1). In many ways, it strikes me as remarkable that frontline staff would not already be given such programmes, but this is a good way of ensuring that staff, particularly new staff, are aware of best practice and guidance on the use of force. I suggest, however, that the Committee looks at whether the provision should be wider than just induction, so that existing members of staff are also given this training. In any workplace environment, it is incredibly important for people to be given refreshers to ensure that training remains fresh and at the front of their mind.

Another area I want to touch on is the mandating of body cameras for any police officer who attends a mental health unit. A number of colleagues have already raised this issue, but I want to focus on one particular area. It is important to mention from the outset that the use of body-worn cameras is ultimately a decision for local police and crime commissioners. Police forces are at different stages in this process: some are just investing now; and others are looking at new equipment, because they have used body-worn cameras for some time and are now in the second phase of procurement.

I suggest—I mentioned this in an intervention on my hon. Friend the Member for Wells (James Heappey)—that clause 13(2)(a) is perhaps a little too eager in expecting officers to turn on their cameras. It states:

“The police officer must ensure that his or her body camera is recording…from as soon as reasonably practicable after the officer receives the request to attend the mental health unit”.

That might be looked at in Committee, because the focus should perhaps be on ensuring that there is a recording of their attending the mental health unit, rather than from the point at which they get such a request.

[Kevin Foster]

My hon. Friend is making some very interesting points. Does he agree that the presumption is that an officer who is on duty and using a body-worn camera should have it switched on? Only when an officer has a specific reason to turn it off—for example, when dealing with a vulnerable witness who is uncomfortable talking while the camera is on—should it be switched off.

[Will Quince]

My hon. Friend raises a very good point. I come back to what I said earlier about body-worn cameras, which is that police forces are at different stages in the evolution of these pieces of kit. Their cameras have different battery lives and different download capabilities—some recordings take several hours to download, but more modern functionality means that that can be done quite quickly—so it depends where police forces are with their procurement and how long they have had the equipment. I totally agree with him, however, that the presumption is that this piece of equipment should be on, and that is and should certainly be standard practice for newer cameras.

[Mrs Murray]

My hon. Friend mentions a point I was about to raise. A battery could expire or there could be a software glitch, so maybe the clause needs to be tweaked in Committee. I wonder whether the hon. Member for Croydon North will consider that carefully if the Bill reaches the Committee stage.

[Will Quince]

My hon. Friend raises a very good point. I think we are all largely in agreement about the use of body-worn cameras, and I think we all think they are an excellent evolution in policing that protects both the public and police officers. I hope the hon. Member for Croydon North does consider that carefully in Committee, working with senior police officers who use the equipment on the ground to work out how the proposed legislation should be worded to ensure it is exactly right on this point.

Essex police works in partnership with the NHS in a county-wide street triage programme that helps to provide the best possible care to people with mental health issues. This trailblazing idea works brilliantly and I will come on to mention some of the statistics relating to it. Four street triage cars, staffed by trained officers and mental health professionals from the South Essex Partnership University NHS Foundation Trust and the North Essex Partnership NHS Foundation Trust, are available to Essex police. They operate seven days a week, from between 10 am and 2 am, and are based in Harlow, Colchester, Basildon and Rochford. Officers and mental health professionals attend incidents across the county if an individual is thought to be suffering a mental health crisis and is in urgent need of support or an intervention. The person is assessed by the officers and the mental health professional, who then gets them the assistance they need if it is appropriate to do so.

The programme follows the success of a four-month pilot that ran three nights a week. During that time, 269 individuals were assessed, of whom 11 were required to be detained under the Mental Health Act 1983. Others were referred to the appropriate services and given guidance from the mental health professional who was present. This initiative has been funded by the police and crime commissioner. The scheme has proved instrumental in reducing, by nearly a quarter, the number of people across Essex detained unnecessarily by the police under section 136 of the Mental Health Act 1983. It has also ensured that those with acute vulnerability are given the care and support they need.

In summary, I very much welcome the Bill. It will ensure that staff working in mental health units are given the training that will enable them to give patients the best possible level of care; training that I believe, having met staff at The Lakes mental health unit, they want to receive. There are a couple of areas in the Bill that need tweaking—I would be very happy to work with the hon. Member for Croydon North in Committee—but nothing should stop it from being given a Second Reading. I will be supporting the Bill.

Tobacco Control Plan

Will Quince Excerpts

Thursday 19th October 2017 Commons Chamber

[Will Quince (Colchester) (Con)]

I rise to speak primarily as the co-chair of the all-party parliamentary group on baby loss. I apologise to some extent if I appear a little like a broken record on this subject, but in many respects I do not apologise because we have so much work to do in this area. I want to focus, if I may, on smoking in pregnancy. My hon. Friend the Member for Chippenham (Michelle Donelan) has eloquently put some of these points already, but I want to go into somewhat more detail.

The Prime Minister spoke of the burning injustice that sees the poorest in this country die on average nine years earlier than the richest. It is essential for the tobacco control plan significantly to reduce the health inequality between richest and poorest in Britain. Those who earn £10,000 a year are twice as likely to smoke as those who earn £40,000. As the Minister knows, we have massive issues with regard to smoking in pregnancy and regional variation: 2% in Richmond, 2.2% in Wokingham, and 2.4 % in Hammersmith; yet 26.6% in Blackpool, 24.4% in South Tyneside, and 24.1% in north-east Lincolnshire. Women in routine and manual jobs are almost three times more likely to smoke during pregnancy than those in managerial and professional roles. Teenage mothers are six times more likely than those over 35 to smoke throughout their pregnancy.

I applaud the success of the 2011 to 2015 tobacco control plan. As my hon. Friend the Member for Harrow East (Bob Blackman) pointed out, we exceeded the ambitions in the plan and reduced the adult smoking rate from 20.1% to 15.5%. I also applaud the Minister’s ambition to reduce the rate of adult smoking from 15.5% to 12% or less by 2022, and I further welcome the ambition to reduce the prevalence of smoking in pregnancy from 10.7% to 6% or less, notwithstanding my earlier point about regional variation.

To be clear, this is absolutely not about criticising or demonising women who smoke during pregnancy. Tobacco, as Members have already pointed out, is highly addictive and it can be incredibly difficult to stop smoking. In relation to stillbirth and neonatal death, the Government have set some really ambitious targets: to reduce the rate by 20% by 2020, and to cut it in half by 2030. In order to achieve that, we have to be clear about the fact that the biggest modifiable risk factor for those issues is smoking in pregnancy. I have raised these statistics in the House before, and I make no apology for reiterating them today. One in five stillbirths is associated with smoking, and women who smoke are 27% more likely to have a miscarriage. Their risk of having a stillbirth is a third higher than that of non-smokers. Mothers who smoke are more likely to have pre-term births and babies who are small for their gestational age.

Then we have second-hand smoke. Maternal exposure to second-hand smoke during pregnancy is an independent risk factor for premature birth and low birth weight, but only one in four men make any changes to their smoking habits when their partner is pregnant. The number of sudden infant deaths could be reduced by more than 30% if children were not exposed to second-hand smoke. The Royal College of Physicians has estimated that 20% of pregnant women are exposed to second-hand smoke throughout their pregnancy, increasing the risk of many poor birth outcomes. If every pregnancy were smoke-free tomorrow, there would be around 5,000 fewer miscarriages, 300 fewer perinatal deaths and 2,200 fewer premature births each year.

I want briefly to raise with Ministers the question of vaping and e-cigarettes. Although I appreciate, notwithstanding points already made by colleagues, that the jury is still out on these products to some extent, and although quitting outright is always the aim, these products must surely be better than smoking, especially for pregnant women. I encourage the Minister to work with the Treasury to investigate some kind of levy on the tobacco industry. Incidentally, the tobacco industry has huge investments in vaping and e-cigarettes; in fact, most of the biggest e-cigarette companies are owned by the major tobacco manufacturers.

[Vicky Foxcroft (Lewisham, Deptford) (Lab)]

Perhaps I should start by declaring an interest as an electronic cigarette smoker myself. I have seen at first hand the health benefits of moving from smoking to electronic cigarettes, including being able to run much further and feeling much healthier. A smoker who gives up for, say, six months will start to feel the same benefits. I encourage the hon. Gentleman to seek a lot more research in this area.

[Will Quince]

I thank my hon. Friend—I use that description intentionally—for that intervention, and I think she is absolutely right. Without wanting in any way to sound patronising, I applaud her for making the move from smoking cigarettes to using e-cigarettes. The evidence is out there to suggest that it is a great way to transition off smoking and off nicotine entirely. Far more research needs to be done in this area, and I hope that the Chancellor is looking at how we could, in the Budget, encourage tobacco manufacturers to provide these products for free to women who are struggling to give up smoking during pregnancy, in particular.

I would also like to touch on the important issue of carbon monoxide monitoring. Challenges remain for staff in implementing the NICE guidance, particularly in relation to carbon monoxide screening. NICE has recommended since 2010 that pregnant women be screened for exposure to carbon monoxide. The current tobacco control plan reiterates the importance of that and further commits to recording women’s carbon monoxide levels in the maternity services dataset. However, front-line staff do not universally have access to carbon monoxide monitors.

We know already that babies who are exposed to carbon monoxide are more likely to suffer birth defects, to be born prematurely and to have a low birth weight, so it is incredibly important that we look at this area. Carbon monoxide screening is one of the key elements in supporting women who smoke to access quit services. Properly embedded into services, screening can transform outcomes. The evidence from the north-east shows that following a comprehensive programme to train midwives, provide them with monitors and set up referral routes to local quit smoking services, smoking in pregnancy rates fell by nearly a third. We know that this absolutely works.

I stress to the Minister that carbon monoxide monitors are not an optional extra; they are an essential tool for midwives. We would never ask midwives to do their jobs without, for example, blood pressure monitors. In the same way, all midwives should have access to CO monitors. Part of the problem is that there is no consistent national approach to the provision of these vital pieces of equipment. Local decisions determine whether midwives and health visitors have access to them, so there is local variation.

I would also like to touch on training for health professionals. The smoking in pregnancy challenge group, a coalition of health and baby charities, produced a report in July examining the training needs of midwives and obstetricians in England. That report was launched at a joint event of the all-party group on baby loss and the all-party group on smoking and health. I co-chaired the event, and the Minister kindly attended and addressed the meeting. I do not need to remind the Minister of this, but the report found that although health professionals have generally received training about the harms of smoking in pregnancy, a majority have had no training in how to communicate those harms to women and support them effectively to access the treatment that is available. Health professionals say that, in the absence of training, they lack the confidence to engage in such conversations.

The report recommends that such training form a regular part of mandatory midwifery training and be embedded into obstetricians’ continuing professional development. Can the Minister outline the steps that are being taken to review and implement the findings of this report? Will consideration be given to extending the analysis undertaken by the smoking in pregnancy challenge group to look at training needs, involving key stakeholders such as other health professionals?

To conclude, I very much welcome the new tobacco control plan and the commitments that the Minister and the Government have made in this area. Is there more that we can do? Yes, of course, there is much more that we can do. I know that the Minister, the Secretary of State and the Minister of State, my hon. Friend the Member for Ludlow (Mr Dunne) are as passionate as I am about reducing our miscarriage, stillbirth and neonatal death rates.

I repeat, because it is really important, that this debate is not about demonising or criticising women who smoke during pregnancy. I fully appreciate how addictive smoking is; it is really hard to stop. Like my hon. Friends the Members for Chippenham and for Harrow East, I have seen my parents struggle. They have both been smoke-free for many years, and I am very proud of them, but it is incredibly difficult.

When it comes to pregnancy, we know that all parents want to give their baby the best possible start in life, so I thank the Minister for all the work that he and the Department have done so far. I ask him to keep a watchful eye on this issue and to be pragmatic in ensuring that the Government give anyone who is struggling to quit smoking the tools and the support that they need to help them to achieve that goal.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

I thank the hon. Member for Washington and Sunderland West (Mrs Hodgson), my ministerial shadow and my friend—she certainly is that.

I congratulate the right hon. Member for Rother Valley (Sir Kevin Barron) on securing this important debate. The Backbench Business Committee was an excellent innovation that arrived in this House at the same time as me—there is no correlation between those two things, I should point out—and debates such as this would not necessarily have happened without it. So well done to the right hon. Gentleman, and to all the Members who have participated. As the shadow Minister said, it is Stoptober, which is an excellent time to have this debate, but of course our passion to cut back on smoking rates is not confined to October.

Let me say a bit about the tobacco control plan and try to respond, as far as I can, to the points raised in the debate. My ministerial brief covers a wide area: public health, primary care, and cancer. That might appear to be a disparate agenda, but there is a plan. For me, all of my responsibilities come back to prevention and in particular how we prevent some of the major diseases; cancer is, of course, still the biggest preventable killer in our country, and the link to smoking is obvious and has been given by many Members. To give some obvious examples, our work to tackle the harmful use of alcohol, our strategy to tackle obesity and specifically childhood obesity, and our tobacco control plan are all about doing more to prevent ill health in our country, and above all cancer.

The TCP is not an end in itself; it is part of a plan. The shadow Minister kindly said that publishing it was down to me. At our very first health orals, she asked when it would be published, and I gave the answer that it would be published by the summer recess. She then shouted out, “Which summer recess?”, but the plan had been started and I wanted to get it right and to get it out. It is amazing what announcing things at oral questions will do to our officials. Anyway, we got it out, and I am very pleased with it.

The last TCP ran from 2011 to 2015 and was considered highly successful; I am grateful to the many Members from all parties for saying that. All the ambitions we set out in that plan were exceeded. We introduced a significant amount of legislation over the course of the plan, as did the Labour Government before then. There was the ban itself, then the ban on smoking in cars containing children, and then, last year, the introduction of standardised packaging, which is a first for Europe. The UK remains a world leader in tobacco control, and Governments of both parties have a proven track record in reducing harm caused by tobacco. The country has made a significant reduction in the prevalence of smoking over the past 25 years, from 27% in 1993 to just over 15% today. That is some achievement.

[Will Quince]

At the moment we have symbols on every bottle of alcohol sold in the UK. I appreciate that this is under EU rules, so other Government Departments would need to look at this, but could we consider having “no smoking while pregnant” symbols on all smoking products, rather than just one in six, as is the case at present?

[Steve Brine]

I will look at that point; as ever, my hon. Friend makes a pertinent point from the Back Benches—where I do not think he will be forever, I might add. [Interruption.] It is evidently not my decision.

I have given the relevant figures, and we are now considered by independent experts to have the best tobacco control measures in Europe. We published the new plan this year to build on that success, but there is no room for patting ourselves on the back in this game, and we still have a huge amount to do.

We still have 7.3 million smokers. That exerts a huge impact on our communities and our NHS. Tobacco use is the biggest contributor to cancer, accounting for more than one in four UK cancer deaths, and nearly a fifth of all cancer cases in this country. Research by the Independent Cancer Taskforce reported that up to two thirds of long-term smokers will die as a result of smoking if they do not quit. We have heard from a number of Members across the House about people whom they have loved and lost, and they are not statistics; they are people’s mothers and fathers, and sons and daughters, who have been lost to cancer. Cancer is not contracted through smoking alone, of course, although it accounts for a huge part of the cancer rate. We must remember that 200 people die every day due to smoking; I think every Member will join me in saying I want us to do better than that.

The plan sets our interim ambitions en route to that goal. Over the next five years we want to reduce the prevalence of adult smokers to 12%. In answer to my hon. Friend the Member for Harrow East (Bob Blackman), I would like to go lower than that, but that is the current figure in the plan. It is not necessarily an end-point, however, and it is not an end in itself. We should also remember the prevalence of 15-year-olds who regularly smoke. We want to get that down to 3%, and the prevalence of pregnant smokers—which so many Members have mentioned today—down to 6%. We want to reduce the burning injustice—a number of Members have used that term today— that sees some of the poorest in our society die on average nine years earlier than the richest, so we will focus, as the plan says, on people in routine and manual occupations.

We want to focus on other groups particularly affected by smoking, such as people with mental health conditions and those in prisons. The hon. Member for Stockton South (Dr Williams) rightly spoke about that being part of a wider poverty reduction programme. That has to be central to the plan, which is not just owned by the Department of Health and me. It is a cross-governmental plan and everything that we do should be part of that aim to reduce poverty. That is why the Prime Minister said what she did. I guess that the hon. Gentleman does not agree with everything she said, but surely he must agree with her words on the steps of Downing Street about poverty reduction.

Baby Loss Awareness Week

Will Quince Excerpts

Tuesday 10th October 2017 Commons Chamber

[Will Quince (Colchester) (Con)]

It is a pleasure to follow the hon. Member for North Ayrshire and Arran (Patricia Gibson). I thank you, Mr Deputy Speaker, and the Leader of the House for going above and beyond to secure this important debate this week, as part of Baby Loss Awareness Week. It is particularly important that the debate should be held this week.

I did not come into politics to be a baby loss campaigner. Like several of my all-party group colleagues, tragic circumstances led me to campaign to bring about change on this issue. Those circumstances occurred three years ago this Thursday, which makes this week all the more poignant. We, as politicians, have the best job in the world, and I would challenge anyone who says that Back Benchers cannot get things done. Politicians do not always have the best reputations—some of that is deserved, and some less so—but I would refer any sceptics to the work of the all-party group on baby loss.

This place is amazing, and if we use it correctly on a cross-party basis we can achieve great things. We can get things done. We can bring about positive change that will make a difference and affect people’s lives. The all-party group was established, and exists, to reduce miscarriage, stillbirth and neonatal death, and to ensure that we have world-class bereavement care and support for those who suffer the tragedy of losing a child.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman, the hon. Member for North Ayrshire and Arran (Patricia Gibson) and those who will follow for their contributions in the Chamber. The hon. Gentleman is, like me, a person of faith. We are talking about losing small children or miscarrying; my mother miscarried a number of times, my sister miscarried and the young girl who works in my office miscarried on two occasions, and what sustained all of them was their faith. Does he agree that at such times, when people are in difficult circumstances, it is important that they have someone from a faith or religious background to call on? Does he also agree that it is important that hospitals have rooms where bereaved parents can spend time together, reflect and call on someone greater than us?

[Will Quince]

The hon. Gentleman makes some very good points, and he is absolutely right that bereavement suites play a very important role, as do hospital chaplains. I say that as a man of faith, but I know lots of people who have been through this tragic experience and who are not of faith. Nevertheless, the hospital chaplain came to talk to them—not about God, and not about religion—and sat there, listened, and allowed them to come to terms with the tragic event that had just happened. The chaplain gave them the time that they needed, and which medical professionals do not always have. It is a really important role, and chaplains are a credit to the NHS.

We now have some ambitious targets when it comes to tackling stillbirth and neonatal death. I applaud the Government for their commitment to bringing about a reduction in stillbirth and neonatal death of 20% by 2020— I recognise the Minister’s efforts to make us aware of the steps that will be taken to achieve that—and 50% by 2030. Those targets are very much to be welcomed. Even if we are to achieve those targets—let us be clear: it would be absolutely fantastic if we could achieve a 50% reduction in stillbirth and neonatal death by 2030—that statistic would still mean thousands of babies dying every year. Tens of thousands of parents—

--- Later in debate ---

[Will Quince]

The fact that we have some really ambitious targets is to be applauded, and I welcome the Minister’s update on the Government’s position on those targets. Even if we achieve a target of about 50%, however, that would mean that between 2,500 and 3,000 babies will still die every year. We must ensure that the parents, grandparents and wider family members have a support network. That is why the all-party group was established very much on the basis of bereavement care, and our focus very much remains on bereavement care.

[Ms Nusrat Ghani (Wealden) (Con)]

My hon. Friend mentioned support networks, and I want to draw attention to the Crowborough birthing unit in my constituency of Wealden. It does fantastic work with mums and dads, and siblings, to make sure everyone can go through the process either of having a healthy baby or, if they have such a tragedy, of losing a child.

[Will Quince]

My hon. Friend gives a great constituency example. Maternity units up and down this country have the most incredible provision and offer the most incredible compassion and care. In fact, we have some of the best provision in the world. Tragically, however, that is not replicated all across the country, and there is regional variation. I will come on to what we need to do to address that a little later.

To return to bereavement, the very first debate, which I led in this House back in November 2015, was about bereavement care. It specifically looked at bereavement suites in maternity units, and that was very much the focus. I am pleased to say that the theme of this Baby Loss Awareness Week is bereavement.

This week, we have seen something incredible, something truly groundbreaking—the result of over a year of work —which is the establishment of the national bereavement care pathway. The pathway has been developed by a number of charities and professional organisations, with the support of the Department of Health and the all-party group on baby loss. It has primarily been developed to improve the quality of bereavement care experienced by parents and families at all stages of pregnancy and, indeed, baby loss up to 12 months. The objective of the pathway is to ensure that all bereaved parents are offered equal, high-quality, individualised care that is safe and sensitive.

The national bereavement care pathway was launched yesterday in 11 pilot sites, and the plan is to roll it out nationwide over the next year. This has been an incredible exercise in collaborative working. I want to pay tribute to Sands, all the baby loss charities and organisations that have made an input, NHS trusts, the Department of Health and all the parents who have fed in their experiences. It is not easy for them to talk about their loss, and the evidence of all the parents who have talked about their tragic experience will improve care for very many others up and down the country. I also pay tribute to a former colleague, Ben Gummer, who, when he was the Minister with responsibility for care quality, pushed so hard for this and worked so hard to make it happen.

Yes, it is important that we push the Government to address the UK’s high stillbirth and neonatal death rate, but the support that we give bereaved parents is just as important, if not more so. We need to make sure that they have the support that enables them to have the time and the space in which to grieve. We know that going through this most traumatic of experiences can often lead to mental health issues—such as depression and post-traumatic stress disorder, about which there is growing evidence—whether they appear weeks, months or sometimes even years later. The number of couples that separate after losing a child is still very high, and that comes with huge social costs. Putting in place the right level of high-quality, consistent bereavement care is not just the right thing to do for parents; it should be part of our push to improve mental health care nationwide.

[Robert Jenrick (Newark) (Con)]

On the pathway for bereaved parents, may I raise a particular type of bereavement that is unusual but does, unfortunately, happen? On 4 August, my constituent Craig Renton went into hospital with his wife Heidi for her to have a caesarean. Sadly, she died during the caesarean, and although their baby was born, she also died 15 hours later. Within the space of 15 hours, the happy couple expecting the birth of their daughter were no more, and my constituent Craig, who came to see me, had lost both his wife and his first and only child. In such a situation, the bereavement care needs to be designed particularly carefully if it is to deal with two bereavements in one day.

[Will Quince]

My hon. Friend raises a most tragic case, and I know I speak for everybody in the House when we send our condolences to Craig in what must have been a hugely emotional and traumatic experience. My hon. Friend is absolutely right when he says that the point of the national bereavement care pathway is to ensure that care, although consistent, is individualised and patient-centred. That means that when there are unique sets of circumstances—I would say that was a unique set of circumstances—the care package and the bereavement support are unique to match them.

I could never, ever truly express my thanks to the nurses at the Rosemary suite, a specialist bereavement suite at Colchester General Hospital, for the care and support that my wife and I received just three years ago, but I want to ensure that every grieving parent receives the excellent, high-level support that we did. I truly believe that the new national bereavement care pathway is an important step to making that a reality. I am really proud to co-chair the all-party parliamentary group on baby loss and I know that the work that we are doing on a cross-party basis is really important and is changing lives up and down the country.

Finally, I want to send a message to bereaved parents up and down the country that together we will break the silence on baby loss.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

I want to make sure we all get equal time on this. Can I suggest that Members speak for up to eight minutes, so that everybody gets equal time? It is a very important day, it is a very emotional debate, and I want to make sure we get fairness right across the Chamber.

Oral Answers to Questions

Will Quince Excerpts

Tuesday 10th October 2017 Commons Chamber

[Jackie Doyle-Price]

I thank the hon. Lady for her question, and I know that she, through her role on the all-party parliamentary group for children who need palliative care, will continue to hold me to account on these commitments. We did look at the work undertaken by Together for Short Lives to improve end-of-life care for children, which does require special attention—she is quite right to raise that. NHS England recently co-hosted a policy summit with Together for Short Lives, and I will be meeting it next week to discuss that further. We are also engaging local sustainability and transformation partnerships to support planning for end-of-life care, and helping all trusts to develop and improve their services. This work is ongoing, but it remains a key priority.

[Will Quince (Colchester) (Con)]

When it comes to baby loss, the end of life can often be sudden and unexpected. In this Baby Loss Awareness Week, will the Minister join me in welcoming the launch of the national bereavement care pathway, and pay tribute to Sands, baby loss organisations and charities, the APPG and the former Care Quality Minister, Ben Gummer, who did so much to make it happen?

[Jackie Doyle-Price]

I am of course happy to join my hon. Friend in congratulating those organisations and thank him for all the work that he has done. The 11 pilots launched only last month are very much down to his work and that of hon. Members across the House, who have done so much over the past year to raise awareness of the issue.