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Motion made, and Question put forthwith, pursuant to Standing Order No. 52(1)(a) (Money resolutions and ways and means resolutions in connection with Bills),
That, for the purposes of any Act resulting from the Civil Partnership Bill [Lords], it is expedient to authorise
(1) the payment out of money provided by Parliament of
(a) any expenditure incurred under or by virtue of the Act by a person holding office under Her Majesty or by a government department, and
(b) any increase attributable to the Act in the sums payable under any other Act out of money so provided, and
(2) the payment out of the Consolidated Fund of any increase attributable to the Act in the sums payable under any other Act out of that Fund.[Jim Fitzpatrick.]
Motion made, and Question put forthwith, pursuant to Orders [28 June 2001 and 6 November 2003],
That the programme Order of 11th October 2004 in relation to the Mental Capacity Bill be amended by the substitution in paragraph 2 (time for conclusion of proceedings in Standing Committee) for the words '28th October' of the words '4th November'.[Jim Fitzpatrick.]
Question agreed to.
Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),
Question agreed to.
That, for the purposes of their approval under section 5 of the European Communities (Amendment) Act 1993, the Government's assessment as set out in the Budget 2004 shall be treated as if it were an instrument subject to the provisions of Standing Order No. 118 (Standing Committees on Delegated Legislation).[Jim Fitzpatrick.]
Tim Loughton (East Worthing and Shoreham) (Con): I seek the leave of the House to present a petition brought to Westminster today by my constituents, Ray and Jane McCabe, and signed by more than 23,000 people in my constituency and beyond in West Sussex, on the first anniversary of the death of their daughter, 21-year-old Natalie McCabe, who was killed in a tragic traffic accident exactly a year ago, together with a second passenger, Vicky Browne. A third young girl was maimed for life. The petition marks the first anniversary of their death at the hands of a driver who had no licence to drive, was not taxed or insured, was exceeding the speed limit excessively, and was well over the drink-drive limit.
The petitioners therefore request that the House of Commons pass legislation to increase penalties for driving offences; to introduce a system requiring the display of a valid driving licence and insurance documents on the windscreen of each vehicle; and to create a separate category of offenceto carry a similar penalty to that incurred by causing death by dangerous drivingfor crimes committed by drivers without a licence who maim or kill.
And the Petitioners remain, etc.
Unlike eating and shelter, which are elemental requirements for the survival of an individual, reproduction is a primal requirement for the continuation of our species. If we as a species do not reproduce, we do not continue. It is also a powerfully personal issue. When things go well, it is the highlight of a life. When things do not go well, however, there is a great impact on a life. Within reason, we as a society should do what we can to maximise the number of times that things go right, and to minimise the number of times that they go wrong.
Ectopic pregnancy is one of the things that can go wrong. It occurs when the fertilised egg becomes caught either in the fallopian tubes or outside the reproductive system altogether. As it continues to divide and grow, it then bursts in the place where it is, leading to internal bleeding. If not caught, that internal bleeding can lead to death.
Around 10,000 women a year suffer an ectopic pregnancy. Around 10 die each year, and it is on the increase. Its impact is not just on the women who die and their families, but on those who survive when the ectopic pregnancy is not caught in time, who can suffer an emotional and traumatic time. They lose not only a potential child, but almost lose their life. The impact on the person of such an event is massive. There is a huge impact on their family, some of whom never get over it. There is a huge impact on the national health service, too, which need not happen.
Who is at risk of an ectopic pregnancy? Any sexually active woman of child- bearing age is at risk. An ectopic pregnancy is more likely if one has had pelvic inflammatory disease, endometriosis, any previous abdominal surgery, which does not have to be gynaecological surgery but could be having one's appendix out at a young age, if one has had a coil fitted, if one is on the progesterone-only contraceptive pill the mini-pillwhich is a little controversial in medical circles, or if one has chlamydia. The official view is that around half of all ectopic pregnancies are caused by chlamydia, although there are arguments in the medical profession about that. It is significant, however.
Looking back at the categories of women whom I mentioned, a huge proportion of the female population at any given time may have suffered from such conditions or may have used methods of contraception that might put them at greater risk.
What is worrying is that chlamydia is on the increase. In February 2002, I was able to introduce a debate in the House on sexually transmitted infections, which are often referred to nowadays as sexually shared infectionsafter all, it takes two to tangoas a result of
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the dramatic rise in the number of such infections. It is a matter of concern that the level of infections is still increasing.
At the time of the debate, I was promised that there was a Government commitment to extend the national chlamydia screening programme. The screening had initially been piloted in just two placesPortsmouth and the Wirral. It was extended to a further 10 sites in 2002 at a cost of about £1.5 million a year. Two years ago, the Department of Health estimated a cost to the nation of £50 million a year as a result of pelvic inflammatory disease, ectopic pregnancy and infertility as a result of chlamydia. Those costs, I suggest, are likely to increase, particularly as women with infertility problems are now to be offered a cycle of in vitro fertilisation treatment on the national health service. If conditions such as chlamydia continue to increase, infertility will also increase.
As I have suggested, some think that these figures are an underestimate. Compared with this country, there has been a massive campaign in Sweden in the past 15 years to educate and screen the population. Chlamydia in Sweden is now rarethe rate has declined from 15 per cent. to some 3 per cent.and ectopic pregnancies have reduced at all ages, most markedly in women under 30.
Almost two and a half years ago, I called for a national screening programme for chlamydia, but it has not happened. Since then, the rate of infection has increased, and the number of women suffering ectopic pregnancies has increased. That is not to say that nothing at all has happened. Diagnosis has improved and the death rate is not increasing, although the number of ectopic pregnancies is.
I was pleased to read in the September issue of Men's Health Forum magazine about work carried out by the Men's Health Forum in partnership with Telford and Wrekin primary care trust and six local employers. Testing kits were made available in men's workplace lavatories, which could then be sent to Princess Royal hospital in Telford. The men were notified of the results by phone, post or e-mail, and if they tested positive, they could pick up antibiotics from a pharmacy without a prescription. I was also pleased to note that the scheme has been extended to include another local factory, a military base, a local college and some youth centres.
The importance of this work is shown in a study of young soldiers in Edinburgh undertaken last year. Some 10 per cent. of the men had chlamydia, and some 88 per cent. of those with the infection had no symptoms and no reason, therefore, to seek medical attention. A leading consultant in sexual health says that one would expect to find the same proportion of hidden infection in any group of young men tested, or, indeed, in any group of men who had recently changed sexual partners. That gives us some idea of how widespread the infection is, and how urgently we need the screening campaign.
If my hon. Friend the Minister is unable to announce tonight the nationwide roll-out of the national screening programme, I hope that he will at least be able to indicate further progress towards it. I urge him to encourage the Department of Health to expedite the programme if at all possible.
The Minister may not be aware that some of the sexual health services that were keen to implement the chlamydia screening programme have been prevented
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from applying for money by their primary care trusts. That is because the Department of Health provides the first year's pump-priming money and covers costs for years 2 and 3, but then requires the PCT to pick up the full cost. The sexual health clinic in Bristol, which is widely acknowledged as one of the leading centres for chlamydia research in Britain, submitted a bid for the most recent tranche of funds in 2003, only to have it withdrawn by its PCT on the ground that the PCT could not afford to pick up the cost in 200607. That decision surely beggars belief, given that Bristol's sexual health service problems were highlighted by my colleagues on the Health Select Committee in last year's report to the House. Does the Minister have any suggestions as to how PCTs can be encouraged to support, and given incentives to support, local health services in accessing the screening campaign, instead of obstructing them?
Whatever the cause of ectopic pregnancies, there is a more important change in the way in which services are delivered that could reduce the damage caused by them. As I said, ectopic pregnancy is a life-threatening condition that is on the increase. It has an impact on future fertility, and the emotional and physical trauma experienced is significant. But it is not only screening for chlamydia that can have a massive impact in terms of reducing the number of ectopic pregnancies, and we do not always have to look overseas for best practice. Some hospitals in the UK have established early pregnancy units. Any woman who might be pregnant is scanned to make sure that she does not have an ectopic pregnancy, and the provision of good ultrasound services and blood tests increases the accuracy of diagnosis. If early diagnosis can be achieved and the appropriate facilities provided, less invasive surgery or no surgery at all can be used to manage the condition. That will ultimately reduce the cost to the health service, the unnecessary suffering and the trauma to the woman, and will increase the chance of her future fertility. Medical advisers to the Ectopic Pregnancy Trust are already operating in that way. They have already made the changes necessary to reduce ectopic pregnancy.
What is being asked for is not so much money as training for accident and emergency staff and for obstetrics and gynaecology staff. It is about the way services are organised and about making A and E staff aware of ectopic pregnancy. It is about midwives and nurses being able to refer women who possibly exhibit ectopic pregnancy symptoms to early pregnancy units for an early scan. In many areas, though, that is not possible and it has to be done via a GP. We must accept that midwives are the lead professionals for healthy women and are ideally placed to make referrals. Woman who are perhaps pregnant or at the very least those who exhibit early pregnancy problems should have easy unrestricted access to early pregnancy units across the UK. That will result in a reduced number of hospital admissions.
Where GPs are involved, it is important that they are aware of problems in early pregnancies and have the necessary equipment to deal with them. For example, one of the medical advisers to the Ectopic Pregnancy Trust lectures to GPs across the country on the diagnosis of pelvic pain in women. Two years ago, at a course in Oxford, he found that half of the GPs worked
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in practices that refused to stock pregnancy testing kits on the grounds that they were too expensive and they were not being reimbursed for the cost. It costs approximately £1 for each test. The medical adviser was astonished to find that those GPs simply referred to hospital all women with pelvic pain that was viewed as severe enough by the doctor.
Those are precisely the circumstances under which women with ectopic pregnancies and mild pain could be missedand could die. More recently, that adviser found fewer GPs with that attitude, but they still number around 5 to 10 per cent. of the total. Is it possible to ensure that primary care trusts insist that all general practices have pregnancy testing kits, and that GPs have adequate training in the diagnosis of pelvic pain in women to ensure that ectopic pregnancies will not be missed?
I have talked about the importance of chlamydia, screening programmes and the organisational changes that I believe are necessary. One thing that I ask is that the Department of Health meets the senior medical staff already running best practice to learn about what can be done to reduce the numbers of ectopic pregnancies, so that discussions can be held on the theme.
Having said at the start of my speech that I was involved in establishing the Ectopic Pregnancy Trust, I make no apology for ending my speech by talking a little about its work. The Ectopic Pregnancy Trust is the only organisation in the UK that focuses on this relatively common condition that affects around one in 80 pregnancies. Over the last five years, the trust has provided information and support to tens of thousands of women in the UK through a dedicated helpline and website, which receives 50,000 visits per month yet receives no formal funding.
It is very welcome that the Department of Health funded the initial start-up costs and sponsored the information leaflet on chlamydia and the link with ectopic pregnancy, though both those grants have now ceased and much of what we achieve is through the trust's fundraising activities and the good will of volunteers and supporters.
This debate is of particular importance to me. Twelve years ago I had an ectopic pregnancy, and had it not been for my brilliant GP, Dr. Asghar, in diagnosing it, I would not be here now. I had thought that I might be pregnant, but I waited to do a test until after celebrating my birthday over the weekend. On the Monday, I did a test and found that I was pregnant. On the Tuesday, I went to the doctor who said that he would arrange a scan for me as early as possible. He mentioned the possibility of an ectopic pregnancy, which meant nothing to me at the time.
At the weekend I began to feel very ill. Eventually, my then 10-year-old son called out my doctor and my son accompanied me to the hospital, hearing it said that I could die if not operated on very quickly. Confirming the foresight of my doctor, it was discovered that I had an ectopic pregnancy and I had a major operation. A nurse told me that I would have been dead if I had not had the operation within two or three hours. I was off work for several weeks, and received counselling for several months. I recovered fully, but what happened is still with me, as it is with every woman who goes through
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that. I do not want anyone else to go through what I went through, or anyone else's family to go through what mine went through.
It is very important that we do all that we can to ensure that no one else goes through the experience that I have described and to arrive at a position when no ectopic pregnancies occur, or almost none. That is achievable. With not a lot of money, but a lot of will, my hon. Friend the Minister can make a major difference to the lives of many women and families. I look forward to his reply.
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