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The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I begin by congratulating my hon. Friend the Member for Reading, East (Jane Griffiths) on securing today's debate on an important and harrowing subject. I very much appreciate the valuable work that she has undertaken, both as co-founder and now as chairperson of the Ectopic Pregnancy Trust. I also very much appreciate the work carried out by the trust itself in raising awareness of ectopic pregnancies among women of child-bearing age, the medical profession and the general public. I am also grateful to my hon. Friend for sharing her personal experience with the House.

Approximately one in 100 pregnancies is ectopic, sometimes known as tubal. As has been noted, this is a dangerous and potentially life-threatening complication, for which early diagnosis and treatment are essential. I am sure that all hon. Members have the greatest sympathy for all the women who experience this devastating condition and have to cope with the consequences. They have to deal not only with a threat to their own life, but also with the loss of a baby.

Diagnosing an ectopic pregnancy presents particular challenges, as its symptoms present very early in pregnancy, often before the woman affected realises that she is pregnant and usually before she has sought any antenatal care. So, at this point, I should say two things clearly. First, even one avoidable death from an ectopic or tubal pregnancy is one too many, but secondly—and thankfully—a woman is now very unlikely to die from an ectopic or tubal pregnancy.

Successive reports of the Confidential Enquiries into Maternal Deaths in the United Kingdom have highlighted delays in the diagnosis of ectopic pregnancy, sometimes with fatal results. So it is important that the possibility of ectopic pregnancy is considered for any women of child-bearing age presenting with abdominal pain, and that a pregnancy test—and, if possible, an ultrasound scan—is undertaken as a matter of urgency. My hon. Friend the Member for Reading, East was fortunate in having a doctor who understood that.

The most recent CEMD report covered the three-year period from 1997 to 1999, and identified 13 deaths from ectopic pregnancy in the United Kingdom. It found that a majority of the women who died from ruptured tubal pregnancies and who were known to have sought medical help before death had symptoms suggestive of gastrointestinal or urinary tract disease. The report
 
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identified a clear need to highlight the atypical clinical presentation of women with tubal pregnancies to undergraduate medical and nursing students, and to postgraduate trainees in relevant specialties. Those included primary care, emergency medicine, general surgery and obstetrics and gynaecology.

Without the CEMD reports for the UK, which are funded by the Department of Health, it would have been impossible for us to understand why women are still dying as a result of ectopic pregnancies, or from other causes. In February 2001, the chief medical officer reminded all doctors in England of the CEMD's detailed advice. Following the CEMD report, we asked the Royal College of Obstetricians and Gynaecologists to produce guidelines on the best way to manage a woman diagnosed with ectopic pregnancy. These were first produced in 1997 and have recently been updated. They have been distributed to all members and fellows of the college and are freely available on the college website.

It is encouraging that many hospitals have established early pregnancy units to allow for rapid assessment. However, I recognise that that is not the case everywhere. The maternity standard of the national service framework for children, young people and maternity services, which was published on 15 September, highlights the clear need to enable equitable access to rapid and skilled care for women currently unable to access those services. The maternity standard asks primary care trusts and maternity care providers to ensure that every woman who is experiencing problems in early pregnancy has access to an early pregnancy unit; that every pregnant woman whose unborn baby is found to have a possible problem has access to high-quality, appropriate services in an environment sensitive to her, and her partner's, needs; that as a minimum, early pregnancy units have access to high-quality ultrasound equipment and suitable expertise, other methods of assessment and therapeutic expertise, and provide a suitable environment for worried or distressed mothers and their partners; and that diagnostic guidelines are circulated to all health professionals likely to be consulted by a woman who may have an ectopic pregnancy. I hope that my hon. Friend will accept that, with the help of the national service framework, we are making progress in the direction that she set out.

In discussing our efforts to tackle ectopic pregnancy, it is also important to say something about what we are doing to reduce the numbers of people infected with Chlamydia, which my hon. Friend also highlighted in her comments. Chlamydia is the most common sexually transmitted infection in this country. It often causes no symptoms, but if left untreated can lead to pelvic inflammatory disease—the single most preventable cause of infertility—and ectopic pregnancy.

As part of the implementation of the Government's national strategy for sexual health and HIV, the Department of Health is rolling out a chlamydia screening programme across the country. England is the first European country to have such a nationally organised programme and I am pleased to report that, after just two years, it already covers more than a quarter of PCTs in England. We forecast that full coverage will be achieved by 2008–09. I appreciate that my hon. Friend and many other people would like to see the programme available across the whole country
 
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immediately, but all screening programmes require time and commitment to implement successfully. Advice from the National Screening Committee is that it has taken at least five years to implement similar programmes successfully, and that our phased approach to rolling out the programme is the right one.

We have also invested funding to enable laboratories to switch to the more reliable and non-invasive type of chlamydia test. Last year, the chief medical officer publicly announced, in response to the Health Committee's report on sexual health, that £8 million would be allocated for 2004–05 to enable the improved test to be available in at least one laboratory in each strategic health authority. That money has now been allocated to those areas where it is needed.

Recently published data from the Health Protection Agency show a 9 per cent. increase in chlamydia between 2002 and 2003. It is encouraging to note, however, that the rate of increase for chlamydia, as with a number of other sexually transmitted infections, has slowed. I was interested to hear about the Telford programme, which—as my hon. Friend describes it—sounds very promising. However, there is no room for complacency and we agree with the Health Protection Agency that the numbers of sexually transmitted infections being diagnosed in sexual health clinics is still a cause for concern. We shall continue to tackle that in several ways. Those include investment in clinics to improve capacity and raising awareness of the risks of
 
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chlamydia and other infections through national campaigns, such as "The Sex Lottery" and the teenage pregnancy campaign.

Voluntary organisations, such as the Ectopic Pregnancy Trust, also have an important role to play. I am pleased that the Department of Health has, in the past, been able to support the Ectopic Pregnancy Trust with grant aid towards its core costs and its chlamydia and ectopic pregnancy project. I hear what my hon. Friend says about continued funding. The mechanism by which we fund voluntary organisations is the so-called section 64 grant. Of course if the trust were to put in a bid for further section 64 funding, it would be considered, although my hon. Friend will understand that I am not in a position to make any promises tonight.

I hope that my hon. Friend will accept that the Government recognise the need to ensure that facilities are available to enable women suffering from an ectopic pregnancy to be accurately diagnosed and treated, and that the maternity standard of the children's national service framework, in particular, will bring real benefits to all pregnant women. It gives us a real opportunity to drive up the quality of care offered to pregnant women, including those who have an ectopic pregnancy. I shall ensure that my hon. Friend's comments are carefully considered by all the officials involved in planning those services. I assure her that we shall reflect deeply on what she has told us about a very important subject on which further action is required.

Question put and agreed to.


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