4.27 pm
Damian Collins (Folkestone and Hythe) (Con): It was a pleasure to listen to the speech by the right hon. Member for Lagan Valley (Mr Donaldson) and I commend him for the work he has done. I am sure that he would agree that the stated desire of the Prime Minister and the Taoiseach Enda Kenny to visit a war grave together during the run-up to the centenary is an excellent way of marking the fact that Irishmen, both Unionist and nationalist, fought together for a good cause in the first world war and we should not forget that.
The first world war has captured the imagination of the public. It might have passed from living memory, but people’s desire to find out about it, to walk in the footsteps of the soldiers by visiting the battlefields and to gain an insight into what it must have been like is as keen now as it has probably been in living memory. Perhaps that is because we want to challenge ourselves. In the same circumstances, would we be as brave as people were then?
Throughout the debate, people have mentioned the “Blackadder” version of history and asked whether we are too cynical now as a nation to make the sacrifices that people did then. Through the course of the first world war centenary years we will remember the sacrifices of those who gave their lives and of those who served, both on the front line and to support the people on the front line. It is a reminder of the incredible sacrifices people make and the incredible endurance people have in extreme circumstances. People rise to that challenge generation after generation and it is right that we should remember the sacrifices of the first world war, which were on such an enormous scale.
I remember reading the remarks of my predecessor, Philip Sassoon, who was an MP during the first world war. He felt that the battles at places such as Waterloo
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seemed Lilliputian compared with Neuve Chapelle, as it was such a totally different experience from anything anyone had seen before.
I want to mention the Step Short project in my constituency, of which I am chairman. I thank the Under-Secretary of State for Defence, my hon. Friend the Member for South West Wiltshire (Dr Murrison), who has been to Folkestone to visit the project and see what we are planning: to tell a local story based on rediscovering the role the town played during the war. Folkestone was the major port of embarkation for troops to and from the trenches of the western front. It is estimated that 10 million servicemen came through the town during the war and our major project is to create a memorial arch over the route that they marched down to the ships in the harbour waiting to take them to France. The arch will commemorate not just those who lost their lives and for whom that journey was their last on home soil but everyone who served in the war—soldiers, nurses, people in the supply chains, everyone who was part of the national contribution to the first world war. I hope that people will come and experience what Folkestone has to offer and see the arch, which we will unveil on 4 August next year as our commemoration of the centenary of the outbreak of the war.
I also thank the National Army museum, which will bring an exhibition to Folkestone that will run from June next year for 10 months. It will help tell the story of the home front and the journey to war. Many stories will be rediscovered as part of the first world war centenary.
Another local story I will touch on is that of Walter Tull, whose story was rediscovered by the Dover war memorial project. He was the first black soldier to be commissioned in the British Army, as well as having been the first black professional footballer to play in an outfield position in the professional football leagues. Many such stories will be rediscovered.
Another Folkestone story that is important to us is the role that the town played in accommodating tens of thousands of refugees from Belgium in the first weeks of the war. We gave succour and comfort to people who had been dispossessed of their homes. That is an incredible story of the war, and we will discover more such stories as we go through.
In his poem “Aftermath”, Siegfried Sassoon said:
“Have you forgotten yet?
For the world’s events have rumbled on since those gagged days.”
Next year we have a chance to demonstrate that we have not forgotten.
4.31 pm
Mark Lazarowicz (Edinburgh North and Leith) (Lab/Co-op):
On the morning of 22 May 1915, 227 people were killed in what is still Britain’s worst rail disaster when a troop train and two other passenger trains collided at Quintinshill near Gretna. Almost all those who died were men from the Leith Battalion of the Royal Scots, who were killed before even reaching the battlefields of Gallipoli that they were heading for on their first posting after training. The vast majority of those who were killed were obviously from Edinburgh and Leith. Of course, in the time before and after
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hundreds more from the community of Edinburgh died in various battlefields and at sea, but the impact of that rail disaster, because it had such a dramatic effect on one day on people who did not even get to Gallipoli, where they had been expecting to fight, was both dramatic and traumatic.
The disaster is now remembered every year on its anniversary at a war memorial in a cemetery in the centre of my constituency. At one of those commemorations a few years ago I met a grandchild, the great-grandchildren and the great-great-grandchildren of a victim of that disaster who were pleased that the local community was now remembering their ancestor. I am glad to say that the Quintinshill disaster is recognised by both the UK and Scottish Governments as one of the Scottish national events to be remembered in the commemorations of world war one. It reminds us that the way in which the war impacted on individuals and communities was not just at the front and at sea but in places a long way from the battlefield and in ways that we do not always appreciate.
The bodies of those who died in that disaster were brought back to the Drill hall in Leith. That building is now the Out of the Blue centre, a successful arts and cultural centre. Appropriately, in that very building a couple of months ago, I was privileged to take part in the launch of one of the community projects funded by the Heritage Lottery Fund. It was a project organised by the Disability History Scotland group, which aims to look at how the experience of disability caused directly or indirectly by world war one had consequences for families and communities, for social policy, disability groups and disability rights campaigns for generations until now.
That is again a reminder of how the consequences of war extend far beyond its original participants in all sorts of ways and down the decades. Besides the project that I mentioned, I know that others in my community have sought, and I hope received, funding from the HLF. I have encouraged them to do so and I hope that the publicity about today’s debate will encourage other groups to come forward with projects for their community.
Another ceremony that has recently been revived is at the war memorial at Newhaven village in my constituency, a fishing village in the past and a very small fishing community now. It takes place every year at the war memorial attached to the local school. It brings together the wider community and the young people at the school to remember what their forefathers fought for in the first world war. It is an opportunity to remind young people of what happened at that time and to look, as many colleagues have said, at reconciliation and work for peace so that future generations will not have to go through what so many went through in the first world war.
4.34 pm
Graham Evans (Weaver Vale) (Con): Thank you, Madam Deputy Speaker, for giving me this opportunity. I shall make a brief contribution.
I was born on Remembrance day and I have always attended Remembrance day services—those cold November mornings, the leaves falling on the ground, the sound of Elgar’s “Nimrod” and the stories of my grandparents. That may explain my long-standing interest in military history. I believe that the only way we can shape a better future is by understanding and honouring those who have fallen for this country.
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I have been struck by the respect and solemnity with which the public regard Remembrance day and have been raising money for poppies across my constituency over the past few weekends, as have many hon. Members. I ran the London marathon earlier this year, raising money for the Royal British Legion. I pay tribute to my constituents. We are raising money for the Todger Jones VC bronze statue. Todger Jones was a Cheshire Regiment lad who won his Victoria Cross at Morval on the Somme in 1916.
War is an inescapable truth and to leave any conflict saying that it is the last would be either naive or wilfully misleading, but what we can do is recognise the importance of what is done, ensure that the skills and requirements protect the armed forces as much as possible, and remember those who have made such sacrifices in our country’s name. That is why I am so proud to speak today and take part in the commemoration service across Weaver Vale this weekend. Those who have fought for Britain may be gone, but they are always in our thoughts and in our memories.
We pay tribute to Tommy Atkins—Tommy Atkins, like Todger Jones and my grandfather, who, being a Manchester lad, wanted to join up in 1914 but was not old enough. The recruiting sergeant knew that he was not old enough so, along with his mates who were under age, he hot-footed it to Manchester Piccadilly station, got on the west coast line down to London Euston and joined up at the first recruiting office, which just happened to be the Middlesex Regiment. I make that same journey every Monday morning down to this place and I never fail to remember those brave Tommy Atkins from all parts of the country who made the ultimate sacrifice.
4.37 pm
Mr William Cash (Stone) (Con): On Saturday, in common with many other Members of Parliament and millions of people throughout this country, we will commemorate and remember those who died in the first and the second world wars. In particular, in my constituency we commemorate the North and the South Staffordshire Regiments with their VCs and those who did not attain great gallantry medals but who fought the battles, fought the war, saved this country and saved our democracy.
I pay tribute to the Royal Irish Rifles because, as has already been mentioned, it is remarkable that despite all the troubles between us and those who live in the southern part of Ireland, so many people are now touched by the fact that we are coming together. We commemorate people who fought—people like Vincent Cullen—because they were loyal, they were real and they were brave. They fought with our people and we should never forget them.
Finally, I should like to put it on record that Doug Lakey, who came here this afternoon and was the only person in the Special Gallery, as far as I know, was with my father on the day he was killed in the second world war. He is a constituent of the Under-Secretary of State for Defence, my hon. Friend the Member for South West Wiltshire (Dr Murrison), and I thought he would like to know that. Doug Lakey is 93 now. He has had a fantastic day and it has been a wonderful occasion for me to be able to have him here for the first time in the House of Commons.
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4.38 pm
Dr Julian Lewis (New Forest East) (Con): Madam Deputy Speaker, I am very grateful for your permission to contribute to this debate, particularly as the first ever televised session of the Intelligence and Security Committee meeting today prevented me from attending by far the greater part of the debate. I shall just make a few very brief remarks and hope that I am not unwittingly repeating things that others have already raised.
We all have our different methods by which we have been in contact with or affected by the first world war. Mine dates back to my days as a schoolboy, when I became friendly with a veteran of the Royal Navy, Mr Leslie Horton, who served from 1915 to 1945 in just about every variety of royal naval ship. He served on the destroyer HMS Landrail in the first world war, for example, and the S-class submarine HMS Seadog in the second world war. The force of character and personality of all those people who have been through these vicissitudes, ordeals and dangers cannot help but transmit itself to people of a younger generation.
In the brief time available I want to make one point for the Minister to consider in his reply. It will not come as a surprise to him, because we have discussed it privately previously. I want to be certain that when, in the course of commemorating the events of the first world war, we focus on particular spikes in the history of that catastrophic conflict, we do not end up focusing solely on those events that marked terrible mistakes and defeats. It is a reality that the generalship behind the battle of the Somme was sadly lacking—some would say it was grossly negligent. It is a fact that the mistakes made at the battle of the Somme were repeated at the battle of Passchendaele, but it is also a fact that by the time we got to 8 August 1918, the lessons of those disastrous earlier offences had been learnt, however belatedly. The battle of Amiens, which hardly anyone has heard of by comparison with the earlier battles, was a stupendous victory for which our forces gain too little credit.
Of course commemoration is about reconciliation, but we must not blind ourselves to the fact that those battles took place not on the territory of a country that did the invading, but by definition on the territory of countries that had been invaded. It should be a matter of pride for the people of this country that we fought on the right side in the first world war. Indeed, the failure to draw the right lessons from what happened at the end of the war had the consequence that after the second world war we were determined there would have to be unconditional surrender—so that next time nobody could argue, as they had done after 1918, that they had not really been defeated. Let us of course reach out the hand of friendship and remember the terrible mistakes made, but let us remember the victories, too, and the justice of the cause for which British soldiers, sailors and airmen fought and died.
4.43 pm
Andrew Griffiths (Burton) (Con): Thank you, Madam Deputy Speaker, for calling me at the end of the debate; I was in a Committee meeting and so was unable to contribute earlier.
Burton can take the credit for having been home to the most decorated non-commissioned soldier of the first world war, William Coltman, who won not only
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the Victoria Cross but the distinguished conduct medal and bar and the military medal. He won those amazing medals as a pacifist. He was a stretcher bearer because his religious beliefs prevented him from fighting, but he was a brave men. He is a man that Burton is very proud of.
I speak as a patron of the Victoria Cross Trust. As has been mentioned, there are hundreds of graves of heroes across the country, including VC winners, that are not tended by the Commonwealth War Graves Commission because those brave servicemen died after they had been decommissioned and when they were no longer in the Army. It is a terrible shame for our country. In my opinion it is a national disgrace that the graves of those men who did such great acts of bravery and valour on behalf of this country and democracy are not tended. We see these crumbling gravestones and overgrown memorials to such brave men, and it is time that we looked at what we can do about them.
The Victoria Cross Trust is a charity that was established by a gentleman called Gary Stapleton. With no public money, he and his band of volunteers have restored very many graves, up and down the country, of VC heroes. It is time that we looked at what we could do as a Government to try to support them. They do not ask for huge amounts of Government funding, but I am sure there must be ways we can help. This is the big society in action—people going out in the community, raising money to restore the graves of some of the bravest men of this country. We should commend them and do all we can to support them.
4.45 pm
Clive Efford (Eltham) (Lab): This has been a very fitting and moving debate. I always feel that the House is at its best on such occasions. I cannot, in the time available, do credit to all the speeches. We heard from the right hon. Member for Lagan Valley (Mr Donaldson), the hon. Member for Broadland (Mr Simpson), my hon. Friend the Member for Hyndburn (Graham Jones), the hon. Member for Wolverhampton South West (Paul Uppal), my hon. Friend the Member for Caerphilly (Wayne David), the hon. Member for Colchester (Sir Bob Russell), my hon. Friend the Member for Bridgend (Mrs Moon), the hon. Member for Banbury (Sir Tony Baldry), my hon. Friend the Member for Rhondda (Chris Bryant), the hon. Member for Bournemouth East (Mr Ellwood), my hon. Friend the Member for Islington North (Jeremy Corbyn), the hon. Members for Lancaster and Fleetwood (Eric Ollerenshaw) and for Plymouth, Sutton and Devonport (Oliver Colvile), my hon. Friend the Member for North Durham (Mr Jones), the hon. Member for Folkestone and Hythe (Damian Collins), my hon. Friend the Member for Edinburgh North and Leith (Mark Lazarowicz), and the hon. Members for Weaver Vale (Graham Evans), for Stone (Mr Cash), for New Forest East (Dr Lewis), and for Burton (Andrew Griffiths). All I can say is that it is an honour to have taken part in this debate with them.
How we should approach this commemoration is symbolised by Harry Patch’s insistence that German and British veterans should carry his coffin. For the past 20 years, long before I became a Member of Parliament, I have been attending the remembrance service in Eltham.
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Over the years, it has become a much more diverse affair. In fact, the people who attend nowadays represent the diversity of the armed forces who took part in the first world war more than they ever have in previous years. It is a real community event with everyone coming together. More recently, we have been happy to welcome a large contingent of the Gurkha community, and it is a pleasure to see how their presence is warmly welcomed by the entire community. British Future’s publication about the first world war refers to
“the graves…of Christians, Jews, Muslims, Sikhs and Hindus lying side by side, just as”
“had fought side by side”.
It is often at these times in the field of human conflict that humanity shows its greatest attributes. Whether it is the brotherhood of those diverse cultures or the symbolic events that took place in no man’s land at Christmas 1914, there is more in human nature that binds us than divides us. When Harry Patch sadly passed away in 2009, we lost one of the last direct connections with the British soldiers who fought so bravely in that war. Our generation will be the last to have had direct contact with these soldiers. We must therefore reflect on how the 150th anniversary might be remembered.
When this Chamber suffered a direct hit from a German bomb during the second world war, Winston Churchill instructed that some of the rubble from the bomb damage be incorporated in the renovated Chamber of the House of Commons to remind us not only of the fortitude of those who fought in that war but the damage and harm that was inevitably caused by wars. So this Chamber itself, in a way, has a form of remembrance. That is a reminder that we, as politicians, must exhaust every political and diplomatic avenue before we ever consider sending our armed forces into harm’s way. War is a breakdown of the political process and, as such, can only be the last resort in any conflict.
It has been an honour to take part in this debate. In particular, I pay tribute to the work of the Under-Secretary of State for Defence, the hon. Member for South West Wiltshire (Dr Murrison), and what he has done to bring us to this point. I also pay tribute to the Commonwealth War Graves Commission, to the Imperial War Museum, to the BBC for what it has planned over the next four years, and to all the countries of the Commonwealth that will be doing so much to help us to mark this important event in our collective history.
Forty-one million British people lived through the first world war while what was described as the flower of British youth went off to fight. Nine million soldiers lost their lives and 16 million people died overall. For them, we must be a nation at our best when commemorating these events. We must lay the foundations for future generations to go on learning the lessons of just how devastating war can be. If we can achieve that, we will have achieved something that is worthy of those whom we aim to remember.
4.50 pm
The Parliamentary Under-Secretary of State for Culture, Media and Sport (Mrs Helen Grant):
I thank all Members who have taken part in this very important debate and
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I am sorry that there is so little time to respond fully to all the important issues and moving stories that have been mentioned.
More than anything else, the Government want engagement with this commemoration. Almost every one of us has discoveries to make about the first world war and our various personal links to it. The issue is important to me: as the mother of a Royal Marine Commando, I understand and appreciate the courage, tenacity and skill of our armed forces. I also understand the pride and anxiety that families feel when those they love go away to serve.
Today’s speeches and interventions by Members stemmed, understandably, from their own interest in the time and their genuine concerns for how war is commemorated. I sensed considerable consensus in the Chamber this afternoon.
The shadow Minister, the hon. Member for Barnsley Central (Dan Jarvis), and the hon. Member for Colchester (Sir Bob Russell) and others raised the issue of the tone of the commemoration. I absolutely agree with them that this is not a celebration; it is a commemoration. There are no surviving veterans from the first world war, but it is up to us to pay respect and to ensure that future generations do not forget and that there will be no triumphalism or jingoism.
My hon. Friend the Member for Banbury (Sir Tony Baldry), the hon. Members for Bridgend (Mrs Moon) and for Islington North (Jeremy Corbyn), the right hon. Member for Lagan Valley (Mr Donaldson) and my hon. Friend the Member for Folkestone and Hythe (Damian Collins) spoke about the importance of war memorials and the various plans for research, restoration and having these important structures listed. Those are exactly the sorts of projects that the Government programme is designed to support and I wish those concerned every success.
On the issue raised right at the end by my hon. Friend the Member for New Forest East (Dr Lewis), when my hon. Friend the Under-Secretary of State for Defence opened the debate he mentioned the battle of Amiens, which was a victory. I think my hon. Friend the Member for New Forest East may have missed that reference.
The role of women has been raised by several Members and it will certainly be commemorated. Women played an essential role in the war. We need to recognise the huge impact that the war had on women, their place in society, the suffragette movement and employment.
My hon. Friend the Member for Broadland (Mr Simpson) and others spoke about the importance of engaging with our young people. One of our key objectives for the centenary is to engage with them by making connections between young people today and young people who fought and died a century ago. Our battlefield visit programme will connect young people with battlefields and, I hope, offer them a special experience that they can share with their classmates.
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It was humbling to hear about the Barnsley Pals, and about the Accrington Pals from the hon. Member for Hyndburn (Graham Jones), and about the valiant Todger Jones, William Coltman and Tommy Atkins. It was also moving to hear from my hon. Friend the Member for Wolverhampton South West (Paul Uppal) about the bravery of the Sikh regiments, and from my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) about the importance of diversity. I reassure Members that this commemoration will help us mark such contributions. It will also make future generations aware of the history of the war so that we can continue to learn from the lessons of the past.
It is clear from what has been said today that many Members have already encouraged their constituents to become involved, and I thank them very much for their efforts. If Members have not already done so, I ask them to tell those in their area about what is being planned and encourage them to find their own links to the first world war, a conflict that, though it took place 100 years ago, remains deeply ingrained in the fabric of our society, our churchyards, our memorials and our heritage buildings, and in the hearts of our families.
Although our Government commemoration is proudly led by the Government, the spirit is rightly owned by all of the people of this country. I hope that what we have said this afternoon has assured Members from all parties that we are working hard to make sure that the UK’s first world war centenary commemoration will be solemnly, respectfully and properly remembered.
That this House has considered commemoration of the First World War.
Petition
Redevelopment of the old Royal Ordnance Factory site (Puriton, Somerset)
4.55 pm
Mr Ian Liddell-Grainger (Bridgwater and West Somerset) (Con): I am presenting a petition of 1,298 signatures from the Bridgwater and West Somerset constituency.
The Petition of residents of Puriton, Somerset,
Declares that the Petitioners believe that the proposed redevelopment of the old Royal Ordnance Factory site is unacceptable on grounds of air pollution, noise, village access, visual impact and the overall character of the development.
The Petitioners therefore request that the House of Commons take note of the plans in advance of consideration by the local planning authority.
And the Petitioners remain, etc.
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Group B Streptococcus (Newborn Babies)
Motion made, and Question proposed, That this House do now adjourn.—(Claire Perry.)
4.56 pm
Nadine Dorries (Mid Bedfordshire) (Con): I am delighted and honoured to have secured this debate on group B streptococcus, which is also known as group B strep or GBS. GBS is the most common cause of serious infection in newborn babies. In the UK, it is the most common cause of meningitis in babies in their first weeks of life. With prompt and aggressive treatment, most sick babies will recover from GBS infection, but even with the best medical care, about 10% of them will die, and some of the survivors will suffer lifelong problems, including 50% of those who recover from GBS meningitis.
The subject was last raised in the House 10 years ago by my right hon. Friend the Member for Witney (Mr Cameron), who is now Prime Minister. There has been some progress but, given his current position, it would be encouraging if we could see more. I shall quote his words at the end of my speech.
The rate of confirmed cases of group B strep infection in newborn babies increased by almost 50% between 1991 and 2010. The true rate of infection, which includes cases that are not confirmed through the identification of the bacteria, but in which GBS is strongly suspected by clinicians, is likely to be several times higher. The issue is therefore not only serious, but one that is becoming more serious.
We have known for a long time that the key risk factor for a newborn baby in developing GBS is the mother carrying GBS at delivery. The UK guidelines state that if GBS has been detected during the current pregnancy from a swab or culture from a pregnant woman, she should be offered intravenous antibiotics in labour to minimise the risk of GBS developing in her newborn baby.
The UK’s risk-based strategy to reduce GBS infection in newborn babies was introduced by the Royal College of Obstetricians and Gynaecologists in 2003, but there is no evidence that it has appreciably reduced the incidence of this devastating infection. In 2003, there were 229 reported cases of GBS infection in babies aged nought to six days; in 2011, there were 281 cases. On that evidence alone, I suggest to the Minister that the risk-based strategy has failed demonstrably and that we need to consider new alternatives.
One UK case study found that 21% of women carried GBS, and that 22% had risk factors for GBS infection developing in their newborn baby and would therefore be offered intravenous antibiotics in labour. However, only 29% of women with risk factors actually carried GBS. Using risk factors alone means that a high proportion of women not carrying GBS will be offered intrapartum antibiotics, while many actually carrying it will not.
5 pm
Motion lapsed (Standing Order No. 9(3)).
Motion made, and Question proposed, That this House do now adjourn.—(Claire Perry.)
Nadine Dorries: Researchers stated:
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“The most striking finding that has implications for clinical practice and policy is the low sensitivity of risk factor based screening, compared with PCR or culture tests in predicting maternal and neonatal GBS colonisation—”
Andrew Selous (South West Bedfordshire) (Con): I warmly commend my hon. Friend on bringing the issue before the House. I have a constituent who lost a child as a result of it, so it is something that I take seriously. Is my hon. Friend pleased, as I am, to see that Public Health England is now adopting gold standard enriched culture testing in its eight regional laboratories? Does she welcome that as a small advance in this important area?
Nadine Dorries: I welcome my hon. Friend’s intervention, and I will go on to talk about the gold standard culture medium.
The researchers continued that the sensitivity of such screening was
“below that which we considered to be a minimally acceptable sensitivity for our study—which calls into question the validity of the current UK policy. Moreover, consistent with previous evidence of practice variation, the risk factor-based screening policy was poorly adhered to, with one-third of women with indications for IAP not treated.”
Despite those authors and numerous others recommending routine screening as cost-effective in the UK, the UK national screening committee continues to recommend the risk-based approach.
Most countries that have national strategies against GBS infection offer routine antenatal testing for GBS. Those countries have seen the incidence of early onset disease fall dramatically, such as by more than 80% in the US and Spain. That compares favourably with the result of the risk-based approach in the UK under which, as I have said, the number of infections has increased. If we know that the risk-based strategy we are adopting is not working because infections are beginning to increase, yet countries such as Spain are seeing an 80% reduction, should we not consider the cost-effectiveness of moving to a system that we know will reduce the number of poorly babies in our intensive care units that have GBS-induced meningitis and other complications?
Studies show that testing for GBS in late pregnancy, as well as offering tests to women found to carry GBS or who have other recognised risk factors, is more cost-effective than the current risk-based strategy. A risk-based strategy is poor at predicting women who will be carrying GBS in labour, and therefore women for whom antibiotics in labour would potentially prevent devastating infections in their newborn babies.
Recently published research shows that although women want to be informed about GBS and offered testing for it during pregnancy, that is not happening. At less than £12, the tests are not that expensive, and the antibiotic recommended during labour if a woman is found to carry GBS in pregnancy is cheap and cost-effective. It is penicillin, which is shown to be exceptionally safe, as well as being a narrow-spectrum drug that is unlikely to cause greater resistance later.
Most NHS pathology services currently use culture media that are general purpose and identify GBS in only about 60% of carriers. At the request of the chief medical officer, Dame Sally Davies, the enriched culture
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medium test that my hon. Friend mentioned will be made available throughout England from 1 January 2014. That will identify about 90% of carriers, and it is the gold standard for that purpose, under Public Health England’s regional laboratory standard operating procedure. The results of the GBS test are about 85% predictive of carriage status for up to five weeks. It should be used to identify GBS carriage wherever there is an indication. These sensitive tests have not previously been widely available within the NHS when requested by the health professionals and pregnant women.
I have some key questions for the Minister. Will he use this debate as an opportunity to make a statement welcoming the gold standard enriched culture medium test for group B strep carriage, which is being made available from January 2014 and which can be used to assess carrier state if there is an indication? From this point on, how does the Minister plan to reduce the incidence of GBS infection in newborn babies when the current risk-based strategy, introduced in 2003, has been shown not to be effective? Is there a target rate for GBS infection in newborn babies? I have always derided targets, but in this case setting a target for the reduction of GBS infections may be a way to introduce routine testing.
Will the Minister confirm that the audit of practice suggested by the UK national screening committee to establish how well the new guidance is being implemented at a national level will study the actual practice taking place in maternity units, rather than simply being an audit of policies without any check on whether they are being applied in practice, because we know that these policies are not being put into practice in maternity units? What is the time scale for the feedback and advice to trusts about how they can further improve their adherence to the RCOG and National Institute for Health and Care Excellence guidelines on the prevention of neonatal GBS disease? What provision is being made for telling pregnant women about the risk of GBS infection in their babies? What provision is being made to educate relevant health professionals about the prevention of GBS in newborn babies and the forthcoming availability of the gold standard ECM test? Do midwives and practitioners in maternity units even know that this gold standard test is being introduced in 2014?
UK guidelines recommend that when GBS carriage is found by chance during a pregnancy, it should trigger the offer of antibiotic prophylaxis in labour. Why should a woman with unknown GBS carriage status be denied the opportunity to find out if her baby is at risk?
I would like to pay tribute to the tireless work of Group B Strep Support, the charity and campaign group that has been working to raise awareness of this issue and reduce the death toll. I also have a constituent who has sadly lost a baby to GBS. The group has been a great help to me in preparing for this debate following a meeting with my constituent. Ten years ago, my right hon. Friend the Prime Minister said in his Adjournment debate:
“Group B Strep Support’s aim, which I support, is for the routine test to be offered to all pregnant women, with those who are found to have GBS at the 35 to 37-week stage being automatically offered intravenous antibiotics.”
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“I hope that the Minister will show great urgency over the issue”.—[Official Report, Date; Vol. 408, c. 267WH.]
My right hon. Friend supported the introduction of routine testing: I echo his sentiments exactly.
5.8 pm
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): I congratulate my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries) on securing this debate and raising this very important issue. The death of a baby is devastating for parents and their families. It is important that we do all we can to minimise the risk of such deaths. My hon. Friend has presented a strong case, but, as I shall set out later, it is equally important that we are guided in our decisions by professional, evidence-based advice to ensure that any action taken does not lead to potentially greater adverse outcomes or unintended consequences.
Group B streptococcus is one of many bacteria that can be present in the human body. It is estimated that about one pregnant woman in five in the UK carries GBS. Around the time of labour and birth, many babies come into contact with GBS and are colonised by the bacteria. Most are unaffected, but a small number can become infected.
If a baby develops group B strep less than seven days after birth, it is known as early-onset group B strep. Most babies who become infected develop symptoms within 12 hours of birth, and it is estimated that about one in 2,000 babies born in the UK develop early-onset group B strep, or about 404 babies a year—my hon. Friend made these points earlier. Most babies who become infected can be treated successfully and will make a full recovery, but even with the best medical care, one in 10 babies diagnosed with early-onset group B strep will unfortunately die.
The infection can also cause life-threatening complications, such as septicaemia, pneumonia and meningitis. One in five babies who survive the infection will be affected permanently. Early-onset group B strep can cause problems such as cerebral palsy, deafness, blindness and serious learning difficulties, and rarely can cause infection in the mother—for example, an infection in the womb or urinary tract, or more seriously an infection that spreads through the blood, causing symptoms to develop throughout the whole body.
It is worth reflecting on how the UK compares internationally on rates of group B strep. The reported rate per 1,000 births is 0.38 in the UK; in the USA, where there is testing, it is 0.41; in Spain, 0.39; in France, 0.75; in Portugal, 0.44; and in Norway, 0.46. Even in comparison with countries where there is routine group B strep screening at 35 to 37 weeks, therefore, the UK has relatively low levels of group B strep.
It is also worth setting out some of the general improvements in maternity care that are helping to reduce group B strep and improve the quality of care available to women. We all agree that women should receive high-quality and safe maternity services that deliver the best outcomes for them and their baby. Maternity services feature prominently in the key objectives set out in the first mandate between the Government and NHS England. As set out in the mandate, we want all women to have a named midwife responsible for
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ensuring she has personalised, one-to-one care. To help deliver that, there has been significant investment in the maternity work force. Since May 2010, the number of full-time equivalent midwives has increased by 6.5%—just under 1,500—and in addition there are currently in excess of 5,000 midwifery students in training. There has, therefore, been considerable investment in maternity services to ensure much more personalised care and, consequently, much safer care for women and their babies.
Nadine Dorries: For the reasons I highlighted, we know that the risk-based strategy is not working effectively. Does the Minister not agree that in countries that have routine testing the chances are greatly improved? He drew comparisons with the US, France and other countries, but we do not know what their figures would be if they were using our risk-based strategy. The fact is that they are routinely testing, so does he not agree that only if we were also routinely testing could we make a like-for-like comparison with other countries? Also, why specifically does the UK, a sophisticated country with sophisticated maternity services, not routinely test?
Dr Poulter: I will come to those points a little later, but I will try to reassure my hon. Friend. Given that the majority of babies who die from group B strep are born prematurely, testing at 35 to 37 weeks would not benefit them. Tragically, they would have died in any case, so the screening test to prevent them from dying would not have been effective. I will say a little more about that later, if she will allow me to make some progress.
I pay tribute to my hon. Friend for raising this issue, because the first challenge is to raise general awareness of group B strep among the health care work force and women more generally. The Department of Health is working with the NHS, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the National Institute for Health Research health technology assessment team and the pharmaceutical industry to raise awareness of group B strep and reduce the impact of this terrible infection. The Royal College of Obstetricians and Gynaecologists has produced an information leaflet for women who are expecting a baby or planning to become pregnant, and this sets out information about group B strep infection in babies in the first week after birth and the current UK recommendations for preventing group B strep in newborn babies. In addition, information is also available on the NHS Choices website.
As hon. Friends will agree, the focus must be on preventing early-onset group B strep infection from occurring in the first place. The Royal College of Obstetricians and Gynaecologists published updated guidelines on prevention of early-onset group B strep infection in neonates in July 2012, which takes into account the latest evidence. It is important that services undertake local clinical audits to ensure the effective use of intrapartum antibiotic prophylaxis as recommended by the guidance. Following the publication of the revised guidance, the UK national screening committee suggested a formal audit of practice to establish how well the new guidance is being implemented at a national level.
The RCOG, in partnership, with the London School of Hygiene and Tropical Medicine, has now appointed a clinical research fellow to carry out a one-year audit
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across the UK, which will undertake a review to see how units have revised and updated their local protocols since 2006, using well-designed case studies to gather specific information about maternity unit policies by asking clinicians whether they would screen for group B strep and/or other intrapartum antibiotic prophylaxis in the circumstances described. It will also assess the extent to which current maternity information systems are able to provide data on whether women have had an antenatal culture for group B strep, whether women have been given intrapartum antibiotics and, if so, the antibiotics prescribed, the dose and duration and whether the women had particular risk factors such as intrapartum fever. The audit aims to provide feedback and advice to all participating trusts about how they could further improve their adherence to the RCOG guidelines on the prevention of neonatal group B strep disease.
Clinical audit is a tool that is incredibly valuable in improving the quality of patient care. It is something that trusts do very often on an ad hoc basis. The fact that we now have a national audit focused on group B strep disease will help to standardise practice across all maternity settings and improve the quality of care that is available, so that we can look at which women are more vulnerable and susceptible to developing group B strep and, therefore, reduce infection rates.
Nadine Dorries: That is encouraging news but again the focus is on women who are at risk of group B strep. I am advocating that all women should be tested for group B strep. I recommend that every pregnant woman I meet now buys a kit to test for group B strep. It is encouraging and positive to hear what my hon. Friend the Minister is saying but it is still focusing on the at-risk women, which is what the risk strategy does now. We need to move from that and away from the at-risk women. We need to move from 35 to 37 weeks and forward to full-term and routine testing of all women for group B strep.
Dr Poulter: I am hopeful that the audit by the RCOG nationally—something I discussed with the group B strep groups and the chief medical officer at a meeting this time last year to progress the work at a greater pace—will put us in a better position to understand in particular which women are at high risk, whether birth units are picking up on those women in a timely manner and how we can improve the situation throughout the country. In the past there has been quite a lot of variation in practice, broadly based on the RCOG guidelines, but it is important—knowing the devastating effects of this illness—that we put together a comprehensive audit tool that gathers data at a national level so we can spread good practice and good guidance throughout. If my hon. Friend will be patient I hope to address some of the broader issues about screening later.
Andrew Selous: Earlier, my hon. Friend said that some countries that screen have higher rates of group B strep than we do. Does he have any data—he could perhaps write to my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries) and myself—to show what the progression has been since testing was introduced in those countries? I think my hon. Friend the Member for Mid Bedfordshire said that it was falling in Spain but it would be interesting to see how it is moving following the introduction of widespread testing.
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Dr Poulter: I would be delighted to do so. It is important to consider the confounding factors that arise in any research. For example, there is some evidence of different rates of carriage of group B strep among different population groups. Also, the clinical treatment of the disease in hospitals—which is separate from the screening process—can vary from country to country. We have to set the data alongside other practices that take place at local level in order to interpret them in the right way. I would be delighted to write to my hon. Friends, and to any other hon. Members who are interested, with that broader general information.
I shall turn now to the question of routine screening for group B strep. The UK national screening committee advises Ministers and the national health service in all four countries on all aspects of screening policy, and supports implementation. At its meeting on 13 November 2012, the screening committee recommended that antenatal screening for group B strep carriage at 35 to 37 weeks should not be offered, as my hon. Friend the Member for Mid Bedfordshire has pointed out. That is the reason for the debate. The reasons given included the fact that the currently available screening tests cannot distinguish between women whose babies would be affected and those that would not. As a result, about 140,000 low-risk pregnant women would be offered antibiotics in labour following a positive screening test result. The overwhelming majority of those women would have a healthy baby without screening and treatment. In other words, a woman who had screened positive for group B strep at one point in her pregnancy might not necessarily be carrying it at the time of delivery, and up to 140,000 women a year could be given antibiotics during labour even though they did not need them.
On the back of the evidence, concern was also expressed, understandably, about resistance to some of the antibiotics used to prevent early-onset group B strep, about the long-term effects on the newborn and about the potential for anaphylactic reactions in labour. Many of us will recall the report of the chief medical officer for England, in which she expressed particular concern about the risks posed by antibiotic resistance because of overuse. The use of antibiotics on that size of population could create a risk of resistance developing, which would have adverse consequences.
Nadine Dorries: I am interested in what the Minister has just said. As I mentioned in my speech, we are talking about a penicillin, a narrow-spectrum antibiotic. I know the Minister’s background, and he will know that GPs would prescribe it for a throat infection. This is a widely and commonly used antibiotic. Does he not think that these expressions of concern are over-egging the pudding slightly?
Dr Poulter:
In the report that the chief medical officer published earlier this year, she made the point graphically that the overuse of antibiotics among people who do not need them can lead to resistance developing in bacteria. We know from hospital super-bugs such as MRSA and VRSA that many other resistant strains of bacteria are developing. Part of the challenge is to see responsible prescribing adopted more broadly across the NHS, to ensure that antibiotics are being targeted at the people who will benefit directly from them. The chief medical officer’s concern is that the screening that
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my hon. Friend is proposing could lead to many tens of thousands of women being given antibiotics inappropriately at the time of delivery, because they were not carrying group B strep at the time, and that that could result in resistance developing. We already know about the devastating consequences of group B strep infection, and the development of further resistant strains could be an unintended consequence of such screening that none of us would want to see. We need to be mindful of that possibility, as I believe the national screening committee was when it made its recommendations.
The majority of babies who die from early-onset group B strep are premature and are, sadly, born too early to be helped by screening at 35 to 37 weeks. Data from 2001 show that, in that year, there were 39 deaths due to group B strep, of which 25 occurred prematurely—that is, before the 35th week of pregnancy, when any screening would have been carried out. Those deaths would therefore not have been prevented by a screening programme.
It has been estimated that up to 49,000 women carrying GBS at 35 to 37 weeks of pregnancy may no longer be carriers when receiving treatment during labour. Studies of the test suggest that between 13% and 40% of screen-positive women will no longer be carriers at the point of delivery. There is also a potentially detrimental impact on maternity services, increasing the medicalisation of labour, with the increase in hospital births and increases in the birth rate that we are seeing. We know that once there is one intervention in labour, it can lead to other interventions and a high rate of Caesarian section when it might not have been necessary in the first place. I am not saying that that would always be the case and absolutely not with GBS—far from it—but we know that when a woman enters a medicalised pathway in a maternity unit, it can often lead to interventions that might otherwise have been unnecessary and that are sometimes quite distressing for the woman during labour. This is particularly the case when many of the women potentially put on prophylaxis would no longer be carriers of GBS.
The advice from the UK national screening committee is consistent with that of the Royal College of Obstetricians and Gynaecologists and the National Institute for Health and Care Excellence. I believe we have talked through a number of the issues about why that recommendation was made.
In the brief time remaining, it would be worth mentioning some of the research that is going on. It is estimated that a vaccine for GBS is approximately five years away from development. First-stage trials have now been undertaken, and wider population-based studies for safety and efficacy are in place in high-prevalence areas such as South Africa. I am sure we would all agree that a vaccine would be a very effective solution to GBS, and I shall certainly do all I can to push and nudge to make sure that such a vaccine is brought forward in as safe and appropriate and as timely a manner as possible.
Nadine Dorries: Is the Minister informing us that that vaccine would be widely available? Let me ask him once more—after everything he has said today, for which I am incredibly grateful—why does he think countries like Spain, the United States and others have introduced routine testing when we still seem to be opposed to it?
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Dr Poulter: It is sometimes difficult to explain variations in clinical practice and the care of women during maternity services between different states or within regions of countries like Spain and to understand why they are different from what we have in this country. Here we have robust guidelines in place for trying to identify at-risk women and we are trying to tighten them through audit while we have low rates. I am not sure whether the same can always be said elsewhere in the world. That is why other countries might have wanted to introduce a cruder tool through a screening test to help them reduce their rates. As I have said, I will look further into this matter and write to my hon. Friends in order better to inform them.
Research and clinical audit are important. We want to make sure that we have a proper national audit programme to carry out and develop good and better practice guidelines for GBS. Looking forward to a vaccine, we hope that that will be a long-term answer to this devastating disease, not just for the UK but throughout the world. Prioritising other research studies is also important. At the moment, a study is being carried out by the maternal health and care policy research unit. It
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is looking at women with GBS sepsis, which will help us understand the physical impact that GBS has on women’s health. A second study looks at providing information at a national level on the numbers of women and babies affected by anaphylaxis due to antibiotic use in labour for GBS or presumed GBS infection. As I mentioned, one concern about a blanket prophylaxis would be the potential anaphylactic reaction that we know can occur when someone is allergic to penicillin or other antibiotics.
I thank my hon. Friend the Member for Mid Bedfordshire once again for raising this important issue. I hope I have been able to clarify some of the reasoning behind the national screening committee’s decisions. I will write to and engage further with my hon. Friend and others to reassure them again that the Government take this issue very seriously. Together, I know we will get to a better place so that fewer families are affected by this tragic illness.