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Westminster Hall
Tuesday 24 November 2015
[Mr Philip Hollobone in the Chair]
World Prematurity Day
9.30 am
Chris Heaton-Harris (Daventry) (Con): I beg to move,
That this House has considered World Prematurity Day.
It is a pleasure to serve under your chairmanship, Mr Hollobone. This subject does not get enough attention in this place, or indeed in the media. In the previous Parliament—in a Westminster Hall debate and elsewhere—I raised the subject of stillbirth, as I have a very good friend who suffered possibly one of the worst stillbirth events that I have ever heard of. I asked lots of questions in this place on that subject, including at Prime Minister’s questions, because I truly believe that we need to raise awareness of these matters. I worked very closely with Sands and with a charity called Bliss, whose strapline is,
“for babies born too soon, too small, too sick”.
Those organisations really care passionately about neonatal issues.
Nick Thomas-Symonds (Torfaen) (Lab): It is a pleasure to serve under your chairmanship, Mr Hollobone. I warmly congratulate the hon. Gentleman on securing this very important debate. I have received a number of emails about the debate, including from a constituent, Samantha Evans, whose son Dylan was born in the 27th week of pregnancy. Across the emails I have had, there is a wonderful sense of how great the care provided by the NHS to premature babies is. I absolutely praise that, but suggest that perhaps in policy development in future, it might be useful to look at what support can be provided to the parents of premature babies.
Chris Heaton-Harris: I thank the hon. Gentleman for his intervention. He is absolutely right, and I will come on to that later. I, too, have had a lot of contact from my constituents on this issue. In fact, at my very first surgery—or advice centre—as a Member of Parliament back in 2010, a lady called Catherine Allcott came in, and it is through her that I got involved with the charity Bliss. I asked whether she would mind if I read out a couple of paragraphs about what happened to her and why this issue is so important to so many parents such as her and her husband, Nigel. She very kindly agreed, so to set the scene for Members, I will read out Catherine and Nigel’s story.
Their twins, Luke and Grace, were born in the early hours of the morning of 4 May 2006, at 26 weeks’ gestation. The twins’ premature birth caused serious health problems, including brain bleeds, suspected meningitis, necrotising enterocolitis and heart problems. Although Grace is now a happy, healthy child, sadly, Luke died nearly four months after being born. Catherine tells me:
“One of the things we found hardest to deal with at that time was the fact that there was often only one nurse in the NICU”—
the neonatal intensive care unit—
“usually to three or four babies.”
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She was on the unit so much because of the issues she was experiencing and because she felt so uneasy about that situation, and that is why she has been involved ever since.
“When I was there sometimes I would have to help the nurse on duty by running into the next room to fetch help. I often wondered what happened when I wasn’t there. When the nurses would tell me not to spend so much time on the unit, what was I to do? Tell them I didn’t trust them with so many babies to look after?”
“As a committed campaigner for high quality neonatal care I am saddened to think that in ten years very little has changed in terms of staffing units safely and effectively. How many babies have died or now endure life changing illnesses because there simply weren’t enough nurses to care for them appropriately, and what cost is that to the NHS?”
Catherine’s story is really significant. She took me on to the Gosset ward—the neonatal ward—in Northampton general hospital. I was told by a junior doctor who works there that it has all completely changed; it has been refitted and is a much nicer space. There is no doubting the passion and the care that the staff on the ward give, but equally, there is no doubting the pressure that they are under and the fact that we can help to improve the conditions for them.
World Prematurity Day takes place on 17 November every year—we have just missed it, but this was the closest time to World Prematurity Day that I could get for the debate. The day is aimed at raising awareness of the issues facing premature babies. It is co-ordinated by a global coalition of charities and groups, including Bliss, each year.
The global statistics are quite astonishing: 15 million babies are born prematurely worldwide each year—that is 29 babies every minute, and one in 10 of all babies born—and in the UK, that equates to nearly 60,000 babies born prematurely each year. Bliss estimates that 113 babies who need specialist care to help them survive and thrive are born every year to parents living in my constituency. About 61 of those babies are born prematurely, at under 37 weeks’ gestation. Those born at under 32 weeks’ gestation are considered very pre-term. Those babies are born before they are fully developed and often spend the longest time in neonatal care.
Obviously, most premature births have no clear cause, whereas others are induced due to medical necessity. There is evidence that risk factors for premature birth include smoking, drinking alcohol, substance abuse, low or high maternal age, infection, high blood pressure and multiple births. There is lots of research—although we could always do more on this subject—showing that socio-economic factors also have an impact.
I want to underline the fact that prematurity is a global issue, which is why we have World Prematurity Day. It is the world’s biggest cause of death for young children. Of the 15 million babies that are born prematurely worldwide each year, more than 1 million do not survive. We are fortunate in the UK to have the resources to care for all babies born prematurely, but there is a long way to go before babies and their parents are given the best possible chance.
Julian Knight (Solihull) (Con):
I congratulate my hon. Friend on securing this important debate and on his unstinting work for the families of those who are
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facing the challenges of a premature birth. Often, one of the most acute problems facing families in that situation is meeting the costs of constant hospital visits. Will he join me in calling on all hospital trusts across the country to follow the Government’s guidelines on hospital parking charges, which would see concessions and even free parking for families of babies who often stay in hospital for months on end?
Chris Heaton-Harris: I concur with my hon. Friend on that matter. I have heard many a story about that. I have also visited the John Radcliffe hospital to see its neonatal unit and talked to parents. In Northampton general hospital’s case, there is a way for someone to get their parking charge back, although actually, if they are the parent of a premature child who is not doing very well, the last thing they think about is where they are going to park and how they are going to pay for the ticket. The grandparent of a baby born prematurely who is not very well does not think about the parking charge when they go in, but it is one of their worries when they leave. We need to do better on that issue and spread some of the best practice that exists in the NHS when it comes to parking charges. Those charges seem like a minor element in the scheme of things, but they are such a big deal to parents, grandparents, friends and family—the support mechanism that builds around a family when a baby is born prematurely and especially when a baby is born unwell. My hon. Friend is completely correct to raise that issue.
As I said, we have a long way to go before all babies born too soon have the best possible chance of survival and of living a good-quality life. The UK mortality rate for babies is quite high for a western European country. I have previously raised in this place an article in The Lancet, going back probably five years now, saying that we ranked 33rd of the 35 top western countries in stillbirth mortality rates. We were in a very poor place, and I struggle with the massive regional variation across our country. I would like to think that we have best practice that spreads across the NHS, but there will always be somewhere that has a number of staff sick and where there is pressure on a unit. However, there should not be a massive regional variation. The Lancet article said that stillbirth was a third more likely in the east midlands than in the south-west, so there are significant issues to deal with. Surely that rate should be equal across the piece.
If the UK could match the mortality rates achieved in Sweden and Norway, for example, the lives of at least 1,000 babies could be saved every year. One thousand babies—that is such a significant statistic. I have met parents of stillborn children and know what they have gone through. Some 1,000 babies each year could be saved with best staffing and better equipment, although the issue is not so much about resources. It is about spreading throughout the whole NHS the best practice that I have seen in various hospitals up and down the country. Concerns about variation in care were highlighted in this year’s Bliss baby report, which found that two thirds of neonatal units do not have enough nurses and two thirds do not have enough medical staff to meet Government standards for safe, high-quality care.
We must talk about this significant issue and raise awareness of it. I sat on the Public Accounts Committee
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for five years and raised it there when we had the chief maternity officer in front of us, because we should talk about such issues whenever we get the opportunity. I know that those working in the NHS get it—I have spoken to all sorts of people from the top to the bottom of the NHS, and they obviously all care passionately for the parents and want the best outcome for their babies—but we have a long way to go to improve the care available to mothers, fathers and their babies. We need to raise the matter at every opportunity, and when I did so in the Public Accounts Committee the chief maternity officer took me to one side afterwards and said, “We are really working hard on this. This is an issue that we know we can do better on. The Government have announced a strategy to reduce infant mortality by, I believe, 50% by 2030. That is obviously welcome and recognises that we could and should be doing better.
I want to raise a few points about the 2015 baby report by Bliss, which has done so much work in this area. I know that plenty of other charities do fantastic work, but Bliss is one of the biggest, and I have worked closely with it through my constituents, the Allcotts. I very much respect its work. The report, entitled “Hanging in the balance”, found that funding shortfalls, national skills shortages and problems with training and recruitment are leaving many neonatal units without the staff they need to meet Government and NHS standards for safe, high-quality care. It states that 64% of neonatal units do not have enough nurses to meet national standards of safe staffing levels; two thirds do not have enough specialist nurses; two thirds do not have the medical staff they need to meet national standards; and 41% have no access to a trained mental health worker—one of my hon. Friends will raise that point, so I will not go into it in detail—leaving parents and staff without the vital support they need to help them cope.
I emphasise that it is not only parents who need help. When I went to the John Radcliffe hospital, I unfortunately went on a morning when three babies had died the night before. None could have been helped, but although the staff are professional people who know exactly what they are doing and the situation they are working in—they have a huge passion for their role, deliver a huge amount of care and become attached to families in a big way—it was palpable that the unit was feeling down that morning. In fact, I felt that I was getting in the way, so I left as soon as I could. It is not just parents who need trained mental health workers available to them; the staff also need them to help them cope in such situations.
There are insufficient funding accounts for three quarters of nursing shortfallsin neonatal units, and 72% of units struggle with at least one aspect of nurse training and development. From all the time I have been involved with the matter, especially when seen through the glasses that I have put on as Daventry’s MP and from standing beside Catherine Allcott on Gosset ward at Northampton general hospital, I know that attracting people to go into this area of nursing is quite a job. Those who go into it find it remarkably rewarding, but it is also a remarkably tough role. That is one reason why vacancies in this field of nursing specialism have historically been high, and we must address that. The rewards are massive, but occasionally there are unbelievably bad days at work.
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We should have a whole host of ambitions nationally. I want to be able to look my constituents, Catherine and Nigel, in the eye and say that I have done everything I possibly can to ensure that what happened to them does not happen to anyone else.
Mr Gregory Campbell (East Londonderry) (DUP): I congratulate the hon. Gentleman on securing this debate. He is talking about improvements nationally, and I hope that we all concur. Does he agree that the Government should ensure that international best practice and improving statistics in several countries are closely investigated and, where possible, replicated?
Chris Heaton-Harris: I thank the hon. Gentleman for his intervention, and he is absolutely right. Statistics regularly prove that we are not doing as well as our Scandinavian colleagues, and we should look at that. I know that we are doing so—a lot of work is going on in the Department of Health and elsewhere to see where we can improve.
I really want to be able to say to my friends who suffered from a full-term stillbirth that the care available to parents in similar situations is much better than it was for them. I said in my 2010 speech that the mother of the full-term stillborn baby was told at the beginning of a weekend that her baby had passed away, but she was sent away because an anaesthetist was not available, so she had to come back on the Monday to have the baby delivered.
I do not deny that there will always be stillborn and premature babies, but what matters is how we look after the parents and how neonatal units look after the babies. I am absolutely sure that in this Chamber and this Parliament, and across society, we all want to deliver the best possible care in those situations.
Mr Philip Hollobone (in the Chair): The format in Westminster Hall is that we have the Back-Bench speeches and then, no later than 10.30 am because we are due to finish at 11, we will have the first of the Front-Bench speeches, from the Scottish National party, and then hear from the official Opposition and from the Minister, but if we get to the Front-Bench speeches before that, so be it.
9.50 am
Mr Steve Reed (Croydon North) (Lab): I offer warm congratulations to the hon. Member for Daventry (Chris Heaton-Harris) on securing the debate. This is a very important issue, but, as he made clear, it does not get the attention that it deserves. It is right and proper that it is being raised in Westminster Hall today, so close to World Prematurity Day.
I want to refer to a campaign that is based in Croydon North, the constituency that I represent, and that is calling for better support for the parents of premature babies. Called The Smallest Things, it was set up in 2014 by Catriona Ogilvy after her two gorgeous little boys, Samuel and Jack Smith, were born prematurely. She and her husband, Mike, were delighted to be parents. They were excited and full of joy as one would expect, but their lives were turned upside down because of the needs of their children and the fact that they did not feel that they were adequately prepared or supported to provide the care and love that their children needed.
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The babies were cared for at the special care baby unit at Croydon university hospital. I had the opportunity to visit that unit with representatives from Bliss, about which the hon. Gentleman spoke. It is a fantastic unit, and I think that it is typical of many across the country. The quality of the care that is given at those special units is fantastic, but when someone walks into one even as a visitor, let alone as a parent, they are overwhelmed by an incredibly emotional feeling, because what they see is wires, tubes, boxes with portholes and bleeping machines and then those tiny little babies, vulnerable and needy, with all that paraphernalia around them. When we talk to the parents there, they are so delighted and relieved to have that support, but also so terrified and traumatised by what their little newborn baby is having to go through. At a time when they are desperate to hold that child and give them the physical love that they need, they cannot touch the child because of the intensity of the care that is being provided. That is incredibly difficult for parents, but we should pay tribute to all the staff who work in those extraordinary and wonderful live-saving units.
However, although the medical care is fantastic, the support for parents is, frankly, inadequate. The Smallest Things campaign is calling for maternity leave to be extended for mothers of premature babies. That is the primary purpose of the campaign and the point to which I hope the Minister will respond. The campaign organised an online petition that secured 10,000 signatures. Many comments that were made, but I will read out just one, which was put on the petition by a mother talking about her experience. She said:
“We had a baby born 11 weeks early and it crippled us. I lost my job because of the time I had taken off. We racked up huge debts on credit cards and 9 months on”
“still struggling immensely to keep a roof over our heads.”
No parent should be put in that position when they have the stress of a little baby struggling for their life at the same time. As a society, we owe better care to parents in that situation.
There are five reasons why The Smallest Things campaign is calling for maternity leave to be extended and they are as follows: financial; bonding with the child; the child’s development; the mother’s mental health; and employment. I will quickly run through each of those issues. On average, the parents of a premature baby spend an additional £2,255 in the course of the hospital stay, but very little financial support is available to parents in those circumstances. They cannot, for instance, apply for disability living allowance, and there is little flexibility to take additional paid leave from work. Therefore, many parents of premature babies, particularly if they are not earning a great deal of money in any case, are pushed into very difficult financial circumstances and even into debt, which is not a problem that parents in that situation should be forced to live with.
The second reason is about bonding between parent and child. A child can spend months in a neonatal unit and, in those circumstances, it can be near impossible for the parent to spend as much time with the child as they would if they were able to take the child home, but the physical bonding between mother and child is critical to the future healthy development of that child and can continue having impacts even in later life. Extended maternity leave would allow mothers to make up for the
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loss of that very important physical bonding once the child is no longer enclosed in the way that is necessary in a neonatal unit.
The third point is about development. Premature babies have different development patterns from babies born on their due date, so parents returning to work, perhaps after six months’ maternity leave, may well know that their child has reached the development stage only of a three-month-old. They go back to work worrying that their child has not had the support that they needed to reach the stage of development that they should have reached. Often, that can slow down the child’s development for years afterwards. Added to that is the fact that the child’s physical development is often slowed down. That can lead to much more frequent and regular visits to hospital during the first few years of a child’s life. All of that places further demands on the parents and, if they are working, on the employers to give the parents time off. Where employers refuse to do that, we need more flexibility to be permitted under law. The Government need to make that change, as some employers will not or are not able to do that themselves.
The fourth point is about maternal mental health. There is a huge risk of depression for mothers of premature babies. That arises from the anxiety and stress that they experience in having a child who has to struggle for their life for such a long period in their very early and very formative years. The additional financial pressures to which I have referred can add to that stress. Many mothers, struggling in incredibly difficult circumstances to cope, experience mental ill health, but they may not have been alerted to the signs of that and therefore do not seek treatment early enough. That is damaging not only to the mother but to the whole family, and can be damaging to the child.
The fifth point to which the campaign refers is employment. A planned return to employment can be disrupted by a premature birth. Often, a mother who originally planned to return after six months cannot, which can put people in extremely difficult financial circumstances. We need greater flexibility around periods of paid maternity leave for parents of babies who are born too soon.
The name of the campaign, The Smallest Things, comes from a quote from “Winnie-the-Pooh” by A. A. Milne:
“‘Sometimes,’ said Pooh, ‘the smallest things take up the most room in your heart.’”
It is time for these smallest things to take up more room in the Government’s heart as well. Maternity and paternity support for parents of babies born too soon is currently inadequate. I hope that the Minister will address the need for greater financial support for parents in those circumstances, better provision for paid parental leave and better support for the mental health issues that arise among parents whose babies come into the world too soon.
9.58 am
Victoria Prentis (Banbury) (Con):
It is a pleasure to serve under your chairmanship, Mr Hollobone, although it is not a great pleasure to listen to the debate. The quality, of course, is excellent, but the subject matter
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is so sad. I am very grateful to my hon. Friend the Member for Daventry (Chris Heaton-Harris) for organising the debate.
It is fair to say that when our son died because he was born prematurely 15 years ago, the focus was, rightly, on the medical situation. I was extremely unwell with pre-eclampsia and HELLP syndrome, which is a leading cause of maternal death worldwide; I am now the patron of the charity in this country. Bliss has reported, and others will speak, about funding and skills shortages in neonatal units. My own experience is that skilled staff worked hard and did all they could for us medically. More could and probably should have been done to create memories. I have spoken and corresponded with my hon. Friend the Minister about that and hope that his excellent work on it will bear fruit. The Minister for family justice is also doing great work for the families of babies who die to ensure best practice during the cremation and burial process.
Today, I want to focus on the other medical services that can make such a difference to premature babies and their families in the long term. This is an issue of growing importance. Just as the elderly are living longer, the very young are surviving in cases where even a few years ago, they would not have done. That is, obviously, good news but, just as with the very old, prematurity presents its own challenges.
First, I turn to mental health, which my friend the hon. Member for Croydon North (Mr Reed) has mentioned. According to Bliss, 40% of mothers of premature babies are affected by postnatal depression soon after birth, compared with 5% to 10% of mothers generally. For those whose babies die, I suggest that 100% need access to counselling, for both the father and the mother, and possibly for siblings and grandparents as well. It is not acceptable that on 41% of neonatal units, parents have no access to a trained mental health worker and on 30% of neonatal units, parents have no access to any psychological support at all. Not only is allowing mental health problems to go untreated needlessly cruel, but it has wider implications.
The Prime Minister made it clear how important family is to him in a speech last year, when he said that
“for those of us who want to strengthen and improve society, there is no better way than strengthening families and strengthening the relationships on which families are built.”
Sadly, however, a very large number—so large a number I am not even going to mention it—of marriages and relationships break up under the strain of a bereavement or the birth of a very sick baby, and more must be done to face that problem head-on.
Stephen Hammond (Wimbledon) (Con): I am on a Bill Committee upstairs, but I wanted to come down to this important debate. I raised some issues about summer-born children in a debate recently. Does my hon. Friend agree that in the long term, unless a family’s wishes about delaying the start of education are recognised, and unless that is embedded in the code by the Department for Education, significant problems will be experienced not only by the premature child but by the family?
Victoria Prentis: I agree, not least because I am the mother of a daughter who was born on 28 August. Although she was not premature, I am very aware of the difficulties that prematurity carries with it throughout the lives of children who are born too early.
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Julian Knight: My hon. Friend touched on the question of divorce following the sad death of an infant. I wonder whether she would like to reflect on the need for more marriage guidance and support structures for those who face that awful situation, and more widely on how working towards a seven-day NHS will help to alleviate many of the problems that come about with premature birth.
Victoria Prentis: Turning first to the difficulties in relationships, it is true, as I have found out personally and with great difficulty, that fathers and mothers grieve differently. The interface between two very unhappy people can be, as I know from personal experience, very difficult indeed to manage. I am fortunate that my husband and I had been married for a long time before our son died, and we were able to hold it together. We also come from very stable families who were able to provide us with a great deal of support, as was the Church. It is an enormously difficult area for people, however. On the seven-day NHS, yes, it is always terrifying to look at the units at weekends with lower numbers of staff on duty, and to wonder how those people are coping.
I return to poor mental health. It is important to focus not only on the parents but on the babies. From my work with the Parent-Infant Partnership UK, I know that long-term difficulties emerge from a lack of bonding between depressed parents and their children. The sad by-line “two is too late” is substantially true. If prematurity is not to have a multi-generational impact, early action must be taken quickly.
There are simple, practical solutions that would ease the strain on families. My hon. Friend the Member for Gillingham and Rainham (Rehman Chishti) has been working hard to ensure that more beds are provided in mental health mother and baby units nationwide. We heard, at an excellent lecture that my hon. Friend hosted last week in this place, from a psychiatrist who admits women from Cornwall to his unit in Birmingham. Travelling puts additional burdens on families under strain. Probably 50 or 60 more beds are needed nationwide to meet the commitments we have made to give mental health parity of esteem.
Other associated health professionals need to be in at the off, working with premature babies and their families. Professionals such as physiotherapists, occupational therapists, dieticians and speech and language therapists form a vital part of the care that premature babies need. Such care can have an enormous effect on development and quality of life. I will give the example of a child who is well known to me—a little boy born very prematurely to well-informed parents, who were not told about the importance of physiotherapy to his development. That must be seen in the context of the fact that 20% of premature babies have a cerebral palsy diagnosis. That little boy is now 10, and, rather than playing football with his friends, he has had a punishing sequence of operations and casts on his legs. His parents were told at their last appointment that physiotherapy from babyhood might have alleviated the need for all that. According to Bliss, 43% of neonatal units had no access to an occupational therapist, even via referral to another service, and 12% of units had no access to a speech and language therapist. As ever, early intervention saves trauma, time and money.
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The Government have wisely seen the need for co-ordinated care for the elderly, with named GPs and someone in charge of the entire patient experience. So often, we speak of the need for a joined-up approach to end-of-life care. Only a few weeks ago, the Minister responded to a debate on palliative care and spoke of the importance of integration between sectors. We are making great progress on that front; the Economist Intelligence Unit recently reported that we have the best palliative care in terms of access to services and the quality of those services. Perhaps the time has come to look at the needs of premature babies and their families as a whole and to do some joined-up thinking to ensure our neonatal care is also the best in the world.
10.7 am
Jim Shannon (Strangford) (DUP): It is a pleasure to be involved in this debate. I commend the hon. Member for Daventry (Chris Heaton-Harris) on bringing the matter to Westminster Hall for consideration and giving us all a chance to participate. Looking back, one of the greatest joys we have all had—I hope we have all had it—is the birth of our own children. Those special occasions are full of joy at the birth of a new child.
I was present when my three children were born, and I did not feel any pain at all; my wife experienced all the pain. The only pain I felt was when she grabbed my hand and would not let go, and the blood circulation got very tight. The births of the grandchildren were all great occasions as well. In this debate, we are hearing about those who did not have the same sort of experience, and I want to add some thoughts about that.
The World Health Organisation promotes World Prematurity Day to raise awareness of the one in 10 babies worldwide who are born prematurely. World Prematurity Day was just last week, so it is not too late to remember it. We are not just talking about babies who are born prematurely and die prematurely; I want to concentrate my remarks on those who are born prematurely and survive.
In addition to the risk they face to their lives, infants who are born early are prone to serious long-term health problems including heart defects, lung disorders and neurological conditions such as cerebral palsy, which the hon. Member for Banbury (Victoria Prentis) referred to. They may reach developmental milestones later than other children do, and they may struggle at school. Premature birth may lead to all those things, and it may mean that some people do not have the privilege of having children.
In 2013, there were 51,000 pre-term births—around 7% of live births—in England and Wales. We have had a couple of Adjournment debates in the Chamber in the last while. On both those occasions, very personal stories were told that resonated with all present. We have similar problems in Northern Ireland; the matter is devolved, but the figures are the same. We can be under no illusions—this issue is a problem not only in third-world countries, but in our country, and it remains an issue that needs to be addressed in the United Kingdom of Great Britain and Northern Ireland.
Of the 15 million babies born prematurely worldwide each year, around 1 million die from complications due to their prematurity. More than three quarters of those babies could be saved through better access to quality
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care and medicines for the mother and the baby, so something can be done. It is important that we try to address those issues.
Complications of pre-term births are the leading cause of death among children under five years of age. Earlier I made a point about the medical conditions sometimes present in those who are born prematurely. Without the appropriate treatment, those who survive often face lifelong disabilities including learning, visual and hearing problems, and their quality of life is greatly affected. Fortunately the United Kingdom has relatively world-class healthcare. Indeed, we are more prepared and more able than many to deal with such complications, but that does not mean that more cannot be done to address this important issue.
Gavin Newlands (Paisley and Renfrewshire North) (SNP): I praise the hon. Member for Daventry (Chris Heaton-Harris) for securing this important debate. My first child was born more than six weeks premature as a result of an emergency caesarean in the Southern general hospital in Glasgow. Luckily, Emma is now a healthy nine-year-old—touch wood—but, as has been mentioned, not all parents are as lucky. I have friends who have experienced the horrendous strain of a stillbirth. Putting aside party politics, does the hon. Member for Strangford (Jim Shannon) agree with me that special care baby units should be insulated from the cost pressures on NHS hospitals and trusts, no matter what those pressures are?
Jim Shannon: I thank the hon. Gentleman for the personal story that he told us, as others have today. The Minister will address that issue and mention how best he can do that. I would like to see that measure in place; we probably all would. The Minister is the man with the responsibility, so let him earn his money and give us the answer that we need to hear.
I welcome the Health Secretary’s announcement that his new ambition is to reduce the rate of stillbirths and neonatal and maternal deaths in England by 50% by 2030. He has set a goal to be achieved, which indicates a commitment to try to address those issues. Although the Minister will be the one to respond today, the man in charge at the top has indicated that he wants it to happen.
Worryingly, Christine Carson, the clinical practice programme director of the National Institute for Health and Care Excellence, has said:
“Despite medical advances, rates of premature birth have remained constant over the last 10 years.”
There is a clear issue to be addressed. The hon. Member for Daventry is right that although there seems to be a commitment to change and to doing it better, we have not seen much evidence of that—at least not through the statistics.
“An early labour—one that occurs before the pregnancy reaches 37 weeks—can pose numerous health risks to the baby, and these risks increase the earlier that child is born.”
I commend, as others have, the work of many charities. I would say to the hon. Member for Banbury that, in the worst of circumstances, it is always good to have faith and the support of the Church. Perhaps the shadow Minister and the Minister will comment on the importance
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of faith groups and churches, and of the availability of church ministers to offer emotional and perhaps even physical support at a time when families need it most. That is personally important to me, and I know that it is for others.
“Although more premature babies are surviving, rates of disability among these children remain largely unchanged. The way to tackle this is to provide consistent and high-quality care to prevent early labour”.
If we can do that, we can prevent disabilities and long-term health conditions. We cannot take our eye off the ball when it comes to this issue. It is not good enough that for a decade premature birth rates have been stagnating, rather than improving with advancements in medical science. One of the best ways to promote equality is to give each and every child the best possible start in life with the most equal opportunities possible.
NICE and the World Health Organisation, among others, have produced guidelines on how best to address the problem. We have to recognise that we are short on funds at the moment but some of those recommendations provide good guidance on how best to move forward and how to make inexpensive, cost-effective changes to help to improve outcomes.
I think it was said in the news this morning that the Health Minister is going to raise some more money for the NHS—that is probably in England. Will the Minister give some indication of what that money will be focused on? Maybe it will be focused on A&E or on direct care. Is it possible that some of that funding could go towards this issue?
Some of the recommendations of NICE and the WHO include:
“When to offer progesterone…or a cervical ‘stitch’…to prevent or delay the onset of preterm labour; How to diagnose if a woman’s waters have broken prematurely before labour has begun and which antibiotics to offer to avoid infection; Which drugs will help to delay labour and to whom they should be offered; When to safely clamp and cut a premature baby’s umbilical cord.”
Those four recommendations and thoughts from NICE and the WHO are simple, yet effective measures that could make a real difference in addressing the issue.
I thank the hon. Member for Daventry again for bringing the issue to the House for consideration, and I thank all Members who have contributed. We can and should come together and get the right approaches to improve outcomes for prematurely born children in a way that is compatible with the current state of the Treasury. I look forward to the replies of the shadow Minister and the Minister, but I apologise in advance as I have to go to the Defence Committee at quarter to 11, so I have to be away at about 20 to 11.
10.16 am
Will Quince (Colchester) (Con): I congratulate my hon. Friend the Member for Daventry (Chris Heaton-Harris) on securing this incredibly important debate. I will start by picking up on some of the points made by the hon. Member for Strangford (Jim Shannon) that focused on mortality, because our prematurity rates are a national scandal. He is absolutely right when he says that they have stagnated for about a decade. We have one of the worst records in the western world; I believe we are positioned 33 out of 35 countries. That is totally unacceptable considering we have one of the best health services in the world. It is a scandal.
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When we talk about statistics and about being 33rd out of 35, we forget that we are actually talking about babies—more than 5,000 babies a year. More than 5,000 families go through the absolute tragedy of stillbirth or neonatal death. I very much welcome the fact that the Government now have a focus on the matter. Statistically, the third biggest cause of stillbirth and neonatal death is prematurity, and that is poignant to this debate.
The Government have recently made an announcement on stillbirth and neonatal death, as the hon. Member for Strangford rightly pointed out, with an ambition to reduce rates by 20% by the end of this Parliament and by half by 2030. That is a huge number—more than 2,000 babies who will be saved and 2,000 families who will not have to go through this most traumatic and awful experience. My wife and I have been through a full-term stillbirth, and it is a traumatic experience. As a Government, we should do anything we can to avoid those tragedies. I am glad that there is that renewed focus. That is key— it is the driver to ensure that we have the training and the best possible equipment.
Looking at the whole NHS, some of our hospitals have the best maternity units and are doing the best work anywhere in the world—second to none. Sadly, that is not consistent across the country. The situation is patchy. That is something that I very much hope the Minister will address as part of this programme. We must ensure that we have the later-pregnancy monitoring equipment that can save lives and, more importantly, the training so that midwives know what to spot and have the confidence to stand by what they believe in terms of diagnoses.
There is also the question of what we do when things do not go well; of course, as my hon. Friend the Member for Daventry suggested, we cannot avoid stillbirths or neonatal deaths. We can reduce the numbers, and the Government have measures in place to do so, but, sadly and tragically, there will always be stillbirths and neonatal deaths. I secured an Adjournment debate a few weeks ago in which I said that we must have the right procedures, processes and facilities to ensure that those who go through a stillbirth or neonatal death, particularly the parents, have a support network.
My hon. Friend the Member for Banbury (Victoria Prentis) talked about gynaecology counsellors and bereavement-trained midwives, and it is important that we have such facilities providing support in every maternity unit in the country. She rightly said that a huge number of marriages fail because of a stillbirth or neonatal death—I think the figure is a staggering 90%, which is enormous; I know the huge pressure that it put on my family and my relationship with my wife. I can entirely see how relationships can be broken up by that hugely traumatic experience. When I talk about the NHS, I know that we have the best facilities in the world, but we have to ensure that those facilities are available across the country. I am talking about specialist suites, bereavement-trained midwives, specialist nurses and psychological support, which is also important.
I am conscious of the time, but I will pick up on two other points. My hon. Friend the Member for Solihull (Julian Knight) mentioned hospital car parking, which was almost flippantly talked about, but it is hugely important. We forget that not everyone can afford to pay the £20 or £30 a week that some hospitals are
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charging. My hospital in Colchester has a reduced rate of £10 a week, I believe, but for some people even £10 a week is a huge amount of money. It is not only the parents but the families, the grandparents and the carers who are paying, so it is important that hospitals follow the guidance to ensure that hospital parking is affordable—or, even better, free so that families who are going through the most traumatic experience of their lives are not worrying about money. That is really important.
The hon. Member for Croydon North (Mr Reed) touched on an interesting point about the pressure on parents from prematurity and from having to go to the hospital. The mother is likely to be in hospital on an ongoing basis, but we forget about the importance of the father’s role. A father gets only two weeks’ paternity leave, after which he will be going back to work and either thinking all day about his premature child and then racing up to the hospital to try to squeeze in time with the baby in the morning and evening, or putting his job at risk by taking that time off, regardless of the consequences. Government guidance on the importance of employers understanding and recognising the pressures of prematurity on families is important.
I am conscious of the time, so I will conclude by saying that we have one chance to get this right. I welcome the steps that the Government are taking. When they announced their ambition to reduce by half the number of stillbirths and neonatal deaths the week before last, it was my proudest moment in the six months since I was elected to this place. I welcome those steps, but we need to go further and ensure that people have the facilities, the processes and the places to go to as they go through this incredibly traumatic experience. We must also make sure that stillbirths and neonatal deaths are as rare as possible. I welcome this debate, and I congratulate my hon. Friend the Member for Daventry on securing it. This is an incredibly important issue that we can all get behind and support.
Mr Philip Hollobone (in the Chair): If the Front Benchers can keep their speeches to 10 minutes, and if the Minister can conclude his remarks just after 10.55 am, Mr Heaton-Harris will have three minutes in which to offer us a pithy summary of the debate and I will have 30 seconds to put the motion to the House. We will then have achieved everything we set out to achieve today.
10.24 am
Neil Gray (Airdrie and Shotts) (SNP): It is a pleasure to serve under your chairmanship, Mr Hollobone. I pay tribute to the hon. Member for Daventry (Chris Heaton-Harris) and congratulate him on securing the debate. I am delighted to make a small contribution on behalf of the Scottish National party.
The hon. Gentleman started by saying that the House does not give enough attention to this issue, so again I pay tribute to him for securing the debate and for his dedication to this issue over a number of years. He delivered an excellent speech, citing examples and stories to highlight the issue. I was incredibly touched by his personal example from Catherine and Nigel. I put on record my sympathy for the loss of Luke—what an incredibly touching and harrowing story. As a father, I find it impossible to comprehend how difficult that time must be, not only for Catherine and Nigel, or for any of
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the other parents we have heard about today, but for all those who have experienced pre-term birth, whether or not their child has survived. It is an incredibly traumatising time for all those parents.
The hon. Gentleman said that if we were to match the pre-term survival rate of Sweden, we would save 1,000 babies a year in the UK, which would save 1,000 families from tragedy, so I hope the Minister will look at that. I absolutely agree that we must ensure that stillbirths and pre-term babies are as few as possible and that parents are properly supported. On one of his visits to his local hospital, the hon. Gentleman learned that three babies had passed away the night before. We cannot imagine the pain felt by the families, but as he said, we must also recognise and pay tribute to the work of our NHS staff, who will share that pain and trauma. I take this opportunity to pay tribute to those staff, who do an incredible job for all of us. I sincerely congratulate the hon. Gentleman on doing a great service to his constituents and friends.
The hon. Member for Croydon North (Mr Reed), in another good speech, cited the excellent unit at Croydon university hospital, which he visited with Bliss. He said that the families were delighted to receive excellent NHS support but were also terrified and traumatised by not being able to hold their babies—babies who had survived but required extra help—because they were so fragile. When a child is suffering, it is the most natural maternal and paternal thing for their parents to want to hold them. The difficulty experienced by those parents cannot be comprehended, and we must ensure that the necessary emotional and practical help and support is in place. The hon. Gentleman gave the example of the family of an 11-week pre-term baby being forced into debt, which is an absolute tragedy that must be sorted out. I hope the Minister will touch on that in his contribution.
The hon. Member for Banbury (Victoria Prentis) brought her personal experiences to the debate in a very touching way. She cited some excellent but harrowing statistics that are difficult for us to understand. Some 40% of mothers of children born pre-term experience mental health problems, compared with 5% to 10% of mothers of children born at full term. That takes us back to the support required by parents of premature babies. It is absolutely right that extra support should be available for all parents if their baby passes away, but we must also consider the support that is available to parents whose children survive. She also mentioned the link between pre-term babies and cerebral palsy, which my family has experienced. She is right to draw attention to that, because it needs wider consideration. I thank her for her contribution.
The hon. Member for Strangford (Jim Shannon) made a typically reasoned and measured contribution, touching on the long-term health problems to which surviving pre-term babies are susceptible. That point was in tune with many of the other contributions made today. He mentioned one statistic that startled me: three quarters of the 1 million babies around the world who, tragically, die after pre-term birth could have survived with adequate care and support. We must address that not just here in the UK but internationally. Surely we could consider it in our aid budget.
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My hon. Friend the Member for Paisley and Renfrewshire North (Gavin Newlands) made a passionate personal plea to the Minister in an intervention, and I hope that the Minister will respond. Finally, the hon. Member for Colchester (Will Quince) also brought his personal experience to the debate in a touching manner; he made a great speech. He is absolutely right: it is a national scandal that we have one of the worst pre-term mortality rates in the western world. He reminded us that when we talk about that mortality, we are talking about babies. Hopefully that brings the issue home to all of us. He also recognised the difficulties experienced by employees, and the fact that employers must take better cognisance of the fact that their employees in that situation will need extra support. I hope that the Minister will take note of that too, and refer back to it when he sums up.
The World Health Organisation promotes World Prematurity Day to raise awareness of the one in 10 babies worldwide who are born prematurely—that is, before the 37th week of pregnancy. It is the leading cause of death in newborn babies and the second most common cause of death in children under five. According to Bliss, a charity that supports families with premature babies and helps raise funds for adequate hospital equipment, 15 million babies worldwide are born prematurely every year, or 29 every minute, and 1 million of those will not survive. In the UK, 60,000 babies are born prematurely every year, which is one in 13.
A motion has been lodged in the Scottish Parliament commemorating world prematurity day and congratulating Sarah Brown on launching a new £1.5 million study on improving educational outcomes and life chances for premature babies. The study is called the Theirworld Edinburgh birth cohort. It was launched last week at the University of Edinburgh, and it will involve researchers at the university following 400 newborns from birth to adulthood, collecting biological samples and brain scans as well as information about socioeconomic status and educational attainment. There is a lot of work going on in Scotland at the moment that I would have loved to mention if there had been slightly more time.
From a local perspective, my constituency is served by the maternity and neonatal unit at Wishaw general hospital. In 2013, there were 5,988 births, 426 of them premature. Some 13% of those premature babies were born weighing less than 1,500 grams. Wishaw general hospital has had its problems in the past, but I am proud to say that NHS Lanarkshire is the only health board in Scotland to have received nominations for the Royal College of Midwives’ annual midwifery awards, which are coming up in March. My local health board has been shortlisted in two categories: the better births award, for which Maureen McSherry and Carole Burns have been nominated for their post-delivery debriefing, and the Pregnacare award for maternity support worker of the year, for which my constituent Leigh-Ann Johnstone from Airdrie has been nominated.
Earlier this year, NHS Lanarkshire implemented Scotland’s first heart rate observation system. Equipment has been installed in Wishaw general hospital to monitor the heart rate of premature and sick babies. It provides early warning of irregularities and can indicate the development of infection, a leading cause of death in vulnerable babies. I again pay tribute to the hon. Member for Daventry for securing this debate, and I thank everyone for their contributions.
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10.34 am
Justin Madders (Ellesmere Port and Neston) (Lab): It is an honour to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Daventry (Chris Heaton-Harris) on securing the debate and on how he introduced the subject, which, as he rightly said, does not receive enough attention in the House or in the media. Hon. Members from all parties have made excellent and sometimes very moving contributions to this debate; I am pleased to have the opportunity to respond on behalf of the Opposition.
World Prematurity Day on 17 November gives us the opportunity to raise awareness of premature birth and concerns involving pre-term babies and their families. The landscape is ever changing; advances in medicine mean that many more babies survive than ever before, and many survive at very young ages that even a few years ago would have seemed impossible. We should warmly welcome those advances, while acknowledging the extra demands that they bring. We should also use this debate as an opportunity to take stock of the progress that we have made in improving outcomes for premature babies and, more importantly, to focus on the challenges that we face and what more we can do to ensure that progress continues.
This issue is extremely significant, and I am pleased to see it receiving attention and a good turnout by Members. As the hon. Member for Daventry said in his opening remarks, an estimated 15 million babies around the world are born prematurely each year, and pre-term birth problems remain the leading cause of death among children under five, responsible for nearly 1 million deaths in 2013 alone. The World Health Organisation estimates that if everyone had access to the same kinds of intervention that we in the developed world enjoy, three quarters of those babies could be saved. This country has a proud cross-party tradition of supporting international development, and I hope that world prematurity day will provide a catalyst for us to redouble our efforts to support programmes to improve outcomes worldwide.
Turning to matters closer to home, in 2013 more than 50,000 babies were born prematurely in England and Wales, meaning that tens of thousands of families faced one of the most terrifying and physically and emotionally exhausting experiences imaginable. I recently spoke to one of my constituents about the issue, and I wanted to share her story with the House, as I am sure that it will be familiar to many who have, sadly, faced the same issues. She told me:
“My twins were born nine weeks prematurely, and seeing your tiny poorly babies hooked up to machines and wires, having to watch while your baby’s heart has stopped and seeing them helped back to life, praying the machine will pick up a rhythm again, isn’t something that I would wish on my worst enemy.”
I am sure that some Members will recognise the intensity of that statement. She goes on to say:
“All we want is for all premature babies to be looked after and given the best chance possible, with the best medical care available to help them to survive”.
Who can disagree with that? I am pleased to say that my constituent’s twins are now four years old, fit and healthy and attending a local primary school, which by coincidence I visited last Friday.
We have made significant progress on increasing the number of premature children who go on to live full lives. Mortality rates have improved year on year, falling
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by 15.5% between 2006 and 2012. Thousands of people are alive now who would simply not have survived in previous decades. That is the impact of the progress that we have made in recent times, and particularly of advances in treating the most premature babies. We should be rightly proud of that.
However, there is no room for complacency. I am sure that hon. Members share my concern about the recent report by the charity Bliss, which has already been highlighted, particularly by the hon. Member for Daventry. The report, “Hanging in the balance”, argues that neonatal services are “stretched to breaking point” and states that two thirds of neonatal intensive care units do not have enough doctors and nurses, with 2,140 more nurses needed to fill the gap. It also identifies a shortage in junior doctors, a situation that could worsen if the Government do not reverse their current antagonistic stance toward the profession.
The Bliss report goes on to state that more than 850 babies were transferred between hospitals last year because there was not enough space or staff at the units where they were. More than 100 of those babies were ventilated. Such transfers are unnecessary and risky. Frankly, at such a time, the family has quite enough stress already, so I hope that we can work to reduce the number of transfers needed in future.
A report by the Royal College of Midwives states that more than 40% of wards became so busy last year that they were forced to close their doors. The average unit closed its doors on five occasions, with some closing more than 20 times. That situation cannot be allowed to continue. One key issue is training. Trusts currently face the Catch-22 situation of having insufficient qualified staff to cover for nurses on training, while the lack of training contributes to the shortage of qualified staff.
It is clear that a co-ordinated approach is required from the Government, the NHS and local managers to tackle the issue. We welcome the announcement by the Secretary of State on 13 November of extra investment in high-tech digital equipment and training, but we question just how far £4 million will go, particularly when we consider that the shortfall in nurses has almost doubled in the last five years, while during the same period the proportion of nurses with specialist qualifications has fallen by 19%. I would welcome any comments from the Minister about when we can expect that investment to come on stream, and what impact he expects it to have on the number of staff available in our overstretched neonatal units.
However, the biggest issue is without doubt a lack of adequate funding for neonatal services across the board. We welcome the work being done by NHS England and its partners to review the payment model for neonatal services and the priority being given to this area in next year’s NHS plans. I hope that the Minister will be able to reassure us that that will result in the increases in funding that are required to provide the right level of care for premature babies. I also hope that he can reassure us that we will be able to provide that care in the right place, with the number of transfers being minimised as far as possible.
As I set out earlier, there has been a huge amount of progress in reducing the rates of stillbirths and infant deaths. Sadly, however, we know that there is further work to do. The national confidential inquiry, which was led by the University of Leicester, found that more
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than 60% of stillbirths might have been avoided with better care. As the hon. Member for Daventry said, Britain is currently ranked 33rd out of 35 countries in the developed world for stillbirth rates. As the hon. Member for Colchester (Will Quince) said, that is a national scandal, and there is an urgent need for improvement. He also quite rightly pointed out the massive regional variations that exist. Those variations should be avoidable, and they inform us that best practice should be disseminated further so that improvements can be made across the board.
We welcome the Secretary of State’s declaration of his ambition to reduce the rate of stillbirths and neonatal and maternal deaths in England by 50% by 2030. However, as the hon. Member for Strangford (Jim Shannon) pointed out, the rate of stillbirths has remained stable for the last 10 years and 2030 is clearly a long way off, so we hope that some of the issues can be tackled in the much shorter term. I would welcome any comments from the Minister about what progress is expected within the next five years.
I will return to the experience of my constituent for a moment. In addition to telling me about the obvious pain that she experienced during the time that her babies were in hospital, she went on to express to me something that appears, sadly, to be common among mothers of premature children—a sense of guilt for not being able to carry their children until full term. My hon. Friend the Member for Torfaen (Nick Thomas-Symonds) quite rightly raised the issue of parental health, as did the hon. Member for Banbury (Victoria Prentis), and we have heard that up to 40% of mothers of premature babies are affected by postnatal depression soon after birth. So it is not just the premature babies who need the care; it is the parents as well. That is why it is so concerning that a third of neonatal units have no overnight accommodation, 41% have no access to a trained mental health worker and 30% are unable to offer psychological support.
My hon. Friend the Member for Croydon North (Mr Reed) highlighted the challenges set out in the campaign The Smallest Things, including the financial, emotional and developmental challenges that premature births create, and the impact that those challenges can have on the mental health of parents. Interestingly, he also touched on the need for greater flexibility in maternity and paternity leave. Although we have legislation on such leave, it is a fact that working mothers still face considerable workplace discrimination, and from what my hon. Friend said it seems that those problems are exacerbated when a mother is dealing with a premature birth. I hope we will see some recognition of that issue by the Minister.
I also hope that the Minister can confirm to us what steps he will take to expand access to mental health services in neonatal units. We should also point out that services have been stretched, so a significant allocation of resources is required if progress is to continue to be made.
We will continue to hold the Government to account to ensure that the vision of England as one of the safest places in the world to have a baby becomes a reality, and while the Government continue to make progress they will have our support.
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10.43 am
The Parliamentary Under-Secretary of State for Health (Ben Gummer): It is a great pleasure to answer another debate on neonatal care. It demonstrates that there is a real head of steam behind this important issue. I cannot comment with any experience on the number of debates on this issue that there were in the previous Parliament, but it is clear that there is now a critical mass of Members in this House, and interest in all parties, to try to do something to improve neonatal care, whether that is for babies who are born prematurely or at term.
First, I add my tribute and thanks to those given by the shadow Ministers and spokesmen, the hon. Members for Ellesmere Port and Neston (Justin Madders) and for Airdrie and Shotts (Neil Gray), for the personal stories told by Members, and I will state on the record that I think the whole House is grateful to them for their personal bravery in explaining what has happened to them, and to other Members who have told the stories of their constituents.
It was with such a story that my hon. Friend the Member for Daventry (Chris Heaton-Harris) began his speech, discussing the account of Catherine and Nigel Allcott, and their son and daughter. He reminded us, as did many hon. Members later, that we can speak about statistics and percentages but what we are actually dealing with are newborn people, little ones and “the smallest things”, who deserve the greatest protection and care that we can possibly give, because they could not be more vulnerable.
In a 2014 study, The Lancet estimated that there were 5.5 million newborn deaths in the world every year and it is that stupefyingly large number that we are addressing today in discussing World Prematurity Day. I know that many speeches were addressed to the domestic situation, but I am very grateful to the shadow Minister, the hon. Member for Ellesmere Port and Neston, for pointing out that we have an international obligation in this regard, and I will certainly talk to my counterpart in the Department for International Development about the areas that our aid spending are being focused on in terms of healthcare and neonatal support, to see if we are doing all we can to try to spread the best practice in this country and Europe to those parts of the world that are beginning their journey in creating a universal healthcare system for their populations.
With that in mind, I turn to the current situation in the United Kingdom. In this country we have some of the finest neonatal care in the world, but what has been apparent in the speeches given today—accurately reflecting the facts—is that we have far too much variability. That is the principal reason why we are at the bottom of the pack in terms of developed countries when measuring rates of stillbirth, which is by means of proxy for the way that we look after premature babies. So I will outline what the Government plan to do about that situation, because it significantly touches—indeed, it does not just touch but covers—the ground that those campaigning to improve care for premature babies have so rightly highlighted, and the Bliss report is an important contribution to that work.
My hon. Friend the Member for Daventry and many other hon. Members have pointed to the announcement a couple of weeks ago by the Secretary of State that we wish to see the rates of stillbirth, neonatal death and
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maternal death reduce by 20% by 2020, and by 50%, or by half, by 2030. Within that target, we include a reduction in brain injury for babies.
It is worth pointing out that many of the contributory factors to stillbirth and to brain injury are the same for prematurity, which, in the round, are public health measures. They have not been covered much in this debate but I would like to raise them, because it is very important that we also understand the obligations of parents, to ensure that we can bring down the rates of prematurity and stillbirth.
We still have too many mothers in this country smoking. We know that smoking is a significant contribution to prematurity. If we were to improve the variability of smoking rates across the country, which is actually quite shocking, we would do much to reduce rates of stillbirth. In looking at the smoking rates across the country, it is quite interesting that there is not just a simple binary division between areas of affluence and areas of deprivation. There are some areas of significant deprivation where local public health partners have made considerable strides in reducing smoking rates compared with areas that are quite close by. Likewise, obese pregnant women are much more likely to experience miscarriage or pre-term birth than those women who are in the normal body mass index range.
Therefore, we have significant public health challenges ahead of us in reducing obesity, smoking, drinking and substance abuse, and if we are able to achieve those reductions in partnership with parents across the country we will have made the biggest stride that we can towards reducing rates of prematurity, ensuring that those babies that are born premature are as healthy as they can be and reducing rates of stillbirth, whether premature or term.
I wish to turn to the University of Leicester study and the “Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries in the UK”—or MBRRACE-UK—report that was published last week, which was touched on by the hon. Member for Ellesmere Port and Neston. The study highlights the challenge ahead regarding the care of neonates across the country. The figures are arresting. In half of all the cases highlighted, at least one aspect of antenatal care that could have had an impact on whether the baby was born alive could have been improved. In a third of cases, there were significant problems with bereavement care and in a quarter there were major issues with one or more aspects of intrapartum care.
For me, perhaps the most troubling statistic in the report is that in only a quarter of all the stillbirths it looked at was there an internal case review. We are not improving our position as quickly as we could because we are not reviewing cases in enough instances—we should be reviewing 100% of them—and we are not spreading the knowledge of the reviews across the system. That is one reason why the Secretary of State is so keen to turn the NHS into a learning organisation. Until we get the NHS to do well something that it currently does badly—spreading learning from places that have had a problem, a tragedy, and from those that have made significant strides—we will not make improvements. I refer hon. Members to the experience of St George’s hospital in Tooting, where they have undergone that journey in the past few years, just through dogged clinical persistence, and have been able to change the outcomes for children attending the maternity unit.
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I was interested in the remarks made by the hon. Member for Croydon North (Mr Reed) on support for parents, and I shall certainly take his valid point about maternity leave—to which my hon. Friend the Member for Colchester (Will Quince) added comments about paternity leave—to my colleagues in the Department for Work and Pensions. I would hope that all employers—not that they will know about or watch this debate—would have the consideration to behave properly with parents of a premature child. The hon. Gentleman’s point about the need to reflect the development of a baby who has been born prematurely in maternity pay arrangements is interesting and important. I shall certainly take his comments back to colleagues but I can make no promises about what we can do.
The hon. Gentleman also talked about mothers’ mental health, which is something that the Government put a lot of emphasis on in the previous Parliament. We know about the importance of investing in perinatal mental health and that it pays significant dividends if done successfully. That is why we announced in March that we will invest an additional £75 million in it over this Parliament. The services, as provided, are not sufficiently good and we need to do much to improve them.
I hope that many of the instances that hon. Members have mentioned of the lack of support for parents with a premature child who is either living or has died and the lack of counselling for both mother and father—along with the important points made by my hon. Friend the Member for Daventry about marriage counselling and the powerful ones made by my hon. Friend the Member for Banbury (Victoria Prentis) about the difficulty of maintaining a marriage through a premature or stillbirth—can be addressed through the additional money. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who is now in his place, was critical in securing that funding in March.
Various hon. Members also made important points about parking charges and travelling. I hope that NHS England’s 2014 neonatal critical care services review and service specifications will lead, in the next few years, to ensuring that we have more comprehensive neonatal cover. There will be instances when that is not possible—we cannot predict every occasion on which there will be stress on a maternity service—but I hope that the services specifications will come to correct that in the next few years. Hospitals should follow the Department of Health guidance on parking, which contains specific recommendations to ensure that people who have to park for long periods are catered for.
I know that hon. Members raised additional issues that I have not been able to cover in this fascinating debate but I shall ensure that they are responded to afterwards. I thank all hon. Members for their interesting and personal accounts regarding this important subject.
10.55 am
Chris Heaton-Harris:
May I thank, through you Mr Hollobone, the Backbench Business Committee for allowing me and the House the time to discuss this important issue? I thank the hon. Member for Croydon North (Mr Reed), my hon. Friend the Member for Banbury (Victoria Prentis), the hon. Member for Strangford (Jim Shannon) and my hon. Friend the Member for Colchester (Will Quince) for their contributions, and also the Front-Bench spokespeople for the consensual
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and cross-party basis on which they made their speeches, which is the basis from which we should attack issues about premature babies.
Many important issues have been raised, including mental health care and the acknowledgement of the Government’s ambition to halve the rate of stillbirths and neonatal and maternal deaths by 2030. The Royal College of Paediatrics and Child Health issues an annual national neonatal audit programme report, and the 2014 report came forward with some interesting points, some of which we have talked about today. Sometimes, unfortunately, in Britain in 2014 we were still missing development checks for premature babies, and that is raised in the report. It also mentions something I find shocking, which we have all talked about in our speeches today. We are doing better, and we are focused on the ambition of doing the best we can for parents with a premature baby, but one in 10 families is still not recorded as having a consultation with a senior member of the neonatal team within 24 hours of their baby’s admission. It is unbelievable that that can happen when the parents are at their most stressed and worried.
I thank the Minister for his reply and thank everyone who has taken part. I thank Bliss and other charities for their work in this area, and I especially thank my constituents Catherine and Nigel for their magnificent work in trying to ensure that no one else goes through what they had to go through.
That this House has considered World Prematurity Day.
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Children of Alcoholics
10.58 am
Liam Byrne (Birmingham, Hodge Hill) (Lab): I beg to move,
That this House has considered support for children of alcoholics.
It is a privilege to serve under your chairmanship, Mr Hollobone. I am glad to see the Minister for Children and Families, the hon. Member for Crewe and Nantwich (Edward Timpson) in his place. The matter we are about to debate is something I know he will care deeply about, and I very much look forward to working with him over the months—and, I hope, years—to come, to implement many of the things that I will talk about. I think he will embrace wholeheartedly what I call for, and I look forward to turning some of the ideas that we will debate into action.
I have done some difficult jobs in politics with my right hon. and hon. Friends, but in many ways this is the hardest speech I will have made in my 11 years in the House: it will be the first time I have talked publicly about being the child of an alcoholic. My dad was an amazing individual. He was warm and charismatic. He was the son of Irish immigrants. He dragged himself into grammar school and into university. He was a great idealist who devoted his life to public service. His warmth, charisma and idealism inspired me to join the Labour party when I was 15, and it was his example that inspired me to get stuck into politics—to do my bit to try to make our country a bit better.
My dad battled with an addiction to alcohol for most of his adult life. When he lost the woman whom he loved so passionately—my mother—at the age of 52 to pancreatic cancer, it knocked him over the edge. I know from first-hand experience the damage and harm that come to families living with an alcoholic. I know what that sense of guilt and shame feels like. I know about the kind of co-dependency that builds up in families as different members of the family do what they can to support each other. In my case, it was a co-dependency with my mum, who I talked to about my dad’s drinking from the age of seven or eight. I know all too well the feeling that most children of alcoholics have as they wrestle with why they cannot fix things or make things better. I know what it feels like to worry constantly about whether your parent is okay. You worry about whether they are on a floor and whether they are eating. I know what it is like to be at a bedside in an intensive care unit, having been told that your parent has maybe a one in 10 chance of surviving. I know the agony of constantly asking yourself whether there was more you could have done to help stop that drinking. I know that there are no answers to those questions.
I know what it feels like to feel second best. “Second Best” was the title of a great book written by Calum Best, the son of George Best, the footballer. Calum has done a great deal over the past few years to highlight the plight of children of alcoholics and to explain what the emotional turmoil feels like. I also know that if anything, I had it easy. Ultimately, I had a loving home. So many children of alcoholics have it an awful lot worse than I did, and many of them are here with us today in the House.
Children of alcoholics are five times more likely to develop an eating disorder. They are something like three times more likely to attempt suicide. They are
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three to four times more likely to become alcoholics themselves, and that is what happened to my dad. He, too, was the child of an alcoholic. In the months since my dad’s death just before the election campaign started, it has been a struggle to decide whether to speak up and speak out. I have been inspired by such people as my right hon. Friend the Member for Don Valley (Caroline Flint) to take the plunge.
For me, the challenge was the programming that comes with the fourth commandment, which is for people to honour their mum and dad. I struggled with whether I would be dishonouring my dad’s memory by bringing this issue into the public domain and talking about it. I suppose I concluded that I had to honour the boy who became a man who became my dad, because there was no help for him when he was growing up as the child of an alcoholic. If I want to change things for children in the future, I have to play my part by speaking up.
The final trigger for speaking up was the loss of a great friend to this House, Charles Kennedy. When I read a lot of the media coverage about his death, so much was riddled through with the old clichés about how Charles was a man who battled with demons. Charles was not battling with demons; he was battling with a disease—alcoholism. The sooner we start talking about alcoholism as a disease and the sooner we get rid of the taboos, the stigma and the shame, the easier we will make it for hazardous drinkers in this country to get the help they need to quit or to cut down.
The scale of alcohol harm is profound. It is estimated to cost our country something like £21 billion a year. It costs the national health service something like £3.5 billion a year, and there are something like 1 million accident and emergency admissions related to alcohol harm each year. I have accompanied people on a couple of those admissions myself in the past few years. When we look at different parts of the country, we can see how the problem is getting worse. Figures from the House of Commons Library that I am publishing today show that the number of A&E admissions due to alcohol harm is rising in two thirds of local authority areas. The problem is not going away; it is snowballing and getting worse. As a country, we have to decide not only how we will break the silence around the disease, but how we will break the cycle of alcoholism cascading down the generations.
I would like to offer a few thoughts today, based on my conversations with friends in the House. I thank in particular the host of organisations that have had the good grace to listen to me bleat on about this issue over the past few months. Some of the charities have helped me try to build an integrated picture of my path. In particular, I give enormous thanks to Hilary Henriques of the National Association for Children of Alcoholics. It was through her doors that I walked about a month and a half after my dad died. NACOA was magnificent. It helped me see clearly for the first time that I was not on my own and that my dad’s drinking was not my fault, and that, frankly, there was little I could have done to change things for him. NACOA celebrates its 25th anniversary this year. It is a small group that is run on a shoestring, and it has helped more than 200,000 children in our country over the past few years with the same kind of advice that it gave me earlier this summer.
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Additionally, I thank Sir Ian Gilmore at the Royal College of Surgeons; the British Medical Association; the Children’s Commissioner, Anne Longfield; Alcohol Concern; Adfam; Turning Point; and the Institute of Alcohol Studies for the advice that they have given. I do not want to offer the Minister some kind of manifesto that is perfect in all its design; I want to start a conversation, which I hope he will engage with in the months and years to come. Last night, I asked Members of this House and the other place whether they would be interested in joining an all-party group for children of alcoholics, and I have been overwhelmed by the response and moved by the personal stories that colleagues have shared. I hope that the group can work together with a number of other all-party groups—we have the chair of one here this morning—that have done such a magnificent job to champion solutions to the curse of alcohol harm.
Let me offer the Minister a few points to get the debate going. Above all, I want the Government to do more to support extraordinary helplines such as NACOA, which make such an enormous difference. As a former Minister with responsibility for children’s health, I know that there is a challenge when it comes to specialised commissioning for children’s services. There is never enough of a problem in any one part of the country to create a critical mass of demand, so we have to find ways in which local authorities can work together to put in place specialised commissioning. Crucially, however, we need to support charities such as NACOA, which is making so much difference to so many people.
I want to ensure that we have a Minister with clear ownership of the problem. The responsibilities span not only the brief of the Minister here today but those of Department of Health Ministers, so I was glad that the Minister for Government Policy, the right hon. Member for West Dorset (Mr Letwin), told me that the Minister here today is in charge of co-ordinating the challenge. The Home Office took the lead on the alcohol strategy published in 2012. We need clear, visible ownership of who will provide and lead the support policy for children of alcoholics.
I want the Government to set out clearly a plan of action to support children of alcoholics. Having someone in charge of creating a solution is not good enough if we do not have a plan in place. As the Minister knows, the Government published their alcohol strategy in March 2012. It did not mention children, support for children or the challenge of children of alcoholics. Over the next few months we need the Minister to come up with a specific plan to provide support for the children of alcoholics. He might tell me that the forthcoming report, “Collateral Damage”, to be published in 2016, will be the framework for that. I look forward to hearing what he has to say.
Bill Esterson (Sefton Central) (Lab): I commend my right hon. Friend for the bravery he has shown this morning in his moving description of his own experiences and what happened to his dad. He is asking the Minister a list of things. As he mentioned, I chair the all-party group on foetal alcohol spectrum disorders. Will he include in his list of asks the children of alcoholic mothers who drink during pregnancy? We need the awareness and support that he has been talking about to be applied to that group as well.
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Liam Byrne: I congratulate my hon. Friend on the leadership that he has shown on that. Mothers who drink during pregnancy are absolutely included in the asks. I hope that the Government will accelerate the publication of advice for pregnant mums about what it is safe and not safe for expectant mothers to drink.
I want every public health director in England to make an estimate of how many children of alcoholics live locally. I want a local plan to make sure that hospitals, GPs and school nurses and teachers know how to identify the children of alcoholics and how to put help within their reach. The challenge with alcoholism as it relates to children is that it often falls between stools—between the public health director, the commissioning groups for children’s social care, the groups for adult social care, and primary care services. The children of alcoholics often sit in a hole in commissioning, which is why we need a specific plan of action locally.
I want the Government to publish a national league table of which councils are spending what on alcohol treatment, so that it becomes much easier for the public and parliamentarians to see where the problem is greatest. In that way we can challenge whether public health directors, councils and health and wellbeing boards have put in place the right provision for hazardous drinkers who are parents.
I want to make sure we have a public information campaign aimed at parents who are hazardous drinkers, so that they are clear about the damage they do to their children and how they can get help. What has been good about the way in which we talk about smoking is that we now aim our messaging at parents and help them understand the harm to children. Now that alcohol harm is the third biggest public health risk after obesity and smoking, it is time for a public health campaign on the same lines aimed at parents who are hazardous drinkers.
I want the Government to change the law, particularly the Children and Young Persons Act 1933, so that it would be illegal for under-16s to drink at home. Current legislation allows for drinking at home from the age of five, and I think that is the wrong message. I congratulate the coalition of alcohol charities that are preparing proposals on that front.
If the Scottish Government win their case for minimum alcohol pricing, I hope that the Government will look again at introducing that policy across the whole of England. Crucially, every charity and campaign group has said to me that we need far more research into the scale of the problem. The research that we have at the moment is patchy, and I think the Minister could do a great deal with a very small amount of money to make sure we have a good research base in place.
The 10 points that I have mentioned are a framework that parliamentarians can discuss over the weeks and months to come. I hope they are ideas that the Minister will be able to embrace wholeheartedly. If I were to pull out just my top three, however, the proposals would be as follows. First, we should equip front-line professionals to take proactive steps to identify the children of alcoholics and to make sure that they are equipped to advise and counsel children on where they can get help. For me it was absolutely crucial to understand that I was not alone as the child of an alcoholic, that my dad’s drinking was not my fault and that there was not much I could do about it. I want
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every child of an alcoholic in this country to know that they are not alone and that help, such as the NACOA helpline, is on hand.
My second priority would be the public information campaign. Many people have said to me that the Minister should take inspiration from the success of the public smoking campaigns, and we should gear up quite quickly a campaign aimed at hazardous drinkers who are parents.
Thirdly, we need to make sure that there is the right investment in treatment services up and down the land. We have made great progress over the past few years in putting in place the right budgets for drug treatment. By and large, we now know what works when it comes to alcohol treatment, but provision is patchy. The Minister will tell us that it is down to local authorities to ensure that the right treatment is in place, but right now, we as parliamentarians do not know whether the right treatment is in place. We need transparency so that we can get to grips with where budgets need to go up and where they need to go down.
What is shocking about some of the statistics that I am publishing this morning is that some local authority areas have seen 20%, 30% or 40% increases over the past few years in the number of A&E admissions due to alcohol harm. That tells us there are particular parts of the country where the problem is incredibly pronounced. Behind those statistics are children, which is why we need to know which local authorities are spending what so that we can campaign for better support.
Caroline Flint (Don Valley) (Lab): I am pleased that my right hon. Friend has secured the debate. Does he agree that, as was certainly the case with my mother, many alcoholics are functional? They often go to work and outwardly lead normal lives, so they do not present themselves at A&E and the problem is invisible to many people. We need to make sure that in the campaign, and in whatever the Minister responds with, we understand that this group of people is wider than the public perceive.
Liam Byrne: My right hon. Friend is absolutely right. Her intervention gives me the chance to say on the record how important her courage in speaking out some years ago was in persuading me that I could do it too. I very much follow in her footsteps.
Every child of an alcoholic has a different story. My right hon. Friend’s story is different from mine. Each of us in our own way and on our own journey learned that we could not really change things for our parents, but we sure as hell can change things for our children. That is what we have to do now as parliamentarians. We have to try to break the silence on this issue so that we can break the cycle of alcohol harm cascading down the generations. To normalise this conversation, we have to organise this conversation. We must sweep aside the stigma and the taboos. We must treat alcoholism as the disease that it is and make sure that help is within reach of those who need it. That is the only way we can help to heal so many lives up and down this country. It is a difference that I think we can make with practical steps over the months and years to come. I look forward to working with the Minister on putting some practical action into place.
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11.18 am
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con): It is a pleasure to serve under your chairmanship, Mr Hollobone. I want to put on the record my congratulations to the right hon. Member for Birmingham, Hodge Hill (Liam Byrne) on securing the debate and sharing some difficult personal experiences with the Chamber. That was not an easy thing to do—it is not an easy thing for anyone in public life. However, I hope that the conversation that he talked about opening will bring huge benefit to the lives of many children and improve the public health of our nation as a result.
In the brief time available to me, I want to outline and expand on a couple of the points that the right hon. Gentleman made. He is absolutely right that substance misuse—in this case, alcohol misuse—is an illness. Often there are links with anxiety, depression and people struggling with mental health problems. Yet our framework for tackling alcoholism in this country seems somewhat fragmented. I am sure that the Minister will want to pick up on that issue in his response. Local health services commission mental health services, and yet it is local authorities that have primary responsibility for tackling issues to do with substance misuse.
The two issues are so inherently intertwined that the support for both the people suffering from mental ill health and their families has to be co-ordinated and holistic, but it is difficult to understand how that can be achieved with a fragmented commissioning landscape. For me, that is at the heart of this dilemma—this challenge—and the right hon. Gentleman made the point very well. I look forward to hearing the Minister’s response, particularly on how we can better unify the services available for people who are alcoholics and their families.
11.20 am
The Minister for Children and Families (Edward Timpson): As ever, it is a pleasure to serve under your chairmanship, Mr Hollobone.
I congratulate the right hon. Member for Birmingham, Hodge Hill (Liam Byrne) on securing this important debate, and even more on the manner in which he introduced it and his courage in speaking out about his experience with his own family. It is a testament to him that his determination to give a voice to the many thousands of children who find themselves in a similar predicament has led to today’s debate—and, I am sure, to many conversations in the coming weeks and months. I read about his dad, Dermot, this morning. I listened to the right hon. Gentleman talking about his dad’s life and how he inspired him to enter the world of politics and make the world a better place. I also heard about the ongoing anguish that his father’s battle with alcoholism caused him, which will inevitably still affect him today. But there is no shame in that whatever—absolutely none.
I am really pleased that the right hon. Gentleman made the decision to speak up today and put on the record his desire to ensure that, from here on in, those children out there will feel more able to deal with the consequences of living in such a family environment. Even more important is his desire to prevent the problem from even happening in the first place. To that end, I look forward to working with him and the organisations
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that have helped him to prepare for this debate, so that we can take stock of both the progress that has been made and where there are shortcomings and a lack of understanding. There is sometimes a lack of encouragement to those out there who still feel very much unable to let others know of the suffering that they are having to deal with day after day.
Mr Gavin Shuker (Luton South) (Lab/Co-op): I salute the bravery of my right hon. Friend the Member for Birmingham, Hodge Hill (Liam Byrne) in introducing this debate. On the Minister’s point, will he ensure that all educational professionals have the appropriate training for when a child might disclose something to them? Many alcoholic parents are very concerned about losing their children, so will seek to involve them in the secret to try to prevent their child from being taken into care. The Minister is from the Department for Education, so will he look at whether all educational professionals are suitably trained for disclosure?
Edward Timpson: That is hugely important. It is not a surprise to me that one of the top three points that the right hon. Member for Birmingham, Hodge Hill wanted me to address was the fact that it is the professionals who interact with children daily who are best placed to try to spot the signs and act on them sooner rather than later. In that way, children who have nowhere else to turn will receive timely and sympathetic support, backed by the knowledge of that professional about what works and how they can help the child and their family to turn the corner—knowledge that has so often been lacking in the past.
I am conscious that I have only five minutes in which to address all the right hon. Gentleman’s extremely well-made points. We must base any response on the premise that every child has a right to grow up in a safe and secure environment. Parents play a crucial role in how their children develop and behave. Of course, parents should act as role models for their children, but we recognise that parental alcohol dependency is a disease that affects many parents. It can limit their parenting capacity, which can have serious consequences for their children.
Rather than read out the response that a Government Minister might normally give to this sort of debate, I shall discuss how my own experience reflects what the right hon. Gentleman said and why I, too, am determined to join him in trying to do more and to do right by the children who still have to live in such circumstances.
I grew up in a family who fostered many children, of whom a large proportion, including one of my adopted brothers, came from a home in which alcohol misuse had been a regular feature. We cannot underestimate the lifelong impact on such a child, who, whether for a short time or a much longer period of their childhood, has been trapped in a cycle. They learn behaviour that they find difficult to avoid later in life, which creates that cycle between generations, and they often witness violence and conflict and feel a sense of isolation. To try to unravel all that is a huge task for anyone. If we superimpose on to that the scale of the problem, irrespective of the progress that has been made on the public health agenda and reducing alcohol dependency, we will see that huge problems further down the line are being stored up for future generations.
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In both the private and public cases I dealt with in the family courts, alcohol was often a feature; as the right hon. Member for Don Valley (Caroline Flint) rightly said, it was sometimes a feature in families of whom the overriding public impression was that alcohol would not be at the heart of their problems. On the surface, these are functional families, but underneath there are serious issues that need to be addressed. To that end, notwithstanding that this is a complex issue that transcends the work of many Departments, the Government have a role, because there is commonality: a shared ambition to ensure that no child should be left behind in our determined efforts to try to tackle the problem.
I will look very carefully at the 10 points raised by the right hon. Member for Birmingham, Hodge Hill and undertake to talk to ministerial colleagues, particularly in the Department of Health, about how we raise public awareness of parental alcohol dependency in a similar way to how we have raised awareness on smoking. I am happy to meet the right hon. Gentleman, along with representatives from many of the excellent organisations that have come together to help him in both a personal and professional capacity to prepare for this debate, so that we can pull together our collective understanding of what is being done and where we continue to fall short.
Much of the work that we are doing on the social work reform agenda, and on how we equip teachers and other educational staff to understand the presentation of children from a family in which alcoholism is a problem, is going to be key to unlocking this taboo that sometimes remains. If we are honest, we all know of someone in our own family or immediate circle of friends, or certainly in our social network, for whom this is a feature in their lives.
We should not pretend that there is an easy way of trying to make changes happen, but, on the back of the right hon. Gentleman’s public push to galvanise the work already being done in many places around the country, we have a real opportunity to ensure that responses are more consistent and that we start to reduce some of the anomalies we see in different local authorities. As my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) said, there should be a much more joined up approach so that families who feel unsupported and children who feel lonely no longer have that as a central feature of their lives. We must use some of the innovation out there to ensure that the work we do in future really does make a difference.
That this House has considered support for children of alcoholics.
11.30 am
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Community and Voluntary Sector Funding
[Mrs Madeleine Moon in the Chair]
2.30 pm
Naz Shah (Bradford West) (Lab): I beg to move,
That this House has considered funding for the community and voluntary sector.
It is a pleasure to serve under your chairmanship, Mrs Moon. I welcome the presence of the Minister, who will respond to this debate.
Given the value that the charity, community and voluntary sector adds to the communities we represent and the incredible services that it provides to our constituents, such as mine in Bradford West, it is fitting that we debate this important issue as the sector faces difficult and economically challenging times and increasing user need. We are on the verge of another round of Government spending cuts, and in many places the cuts have already done irreparable damage to the community and voluntary sector. There have been many changes over the past five years to grants, commissioning and procurement for small, medium and large charities. Many should have offered a lifeline to vital projects in our constituencies in the face of austerity, but the reality is that they could not.
The previous and current Governments committed to reforming the voluntary and charitable sector and helping it to be buoyant at a time when it was most needed. The big society project translated to commitments made in this House, but in reality little progress was made in communities that saw funding falling, grants drying up, short-term procurement opportunities, increasing costs and plateauing revenue streams. We have seen projects and charities that provide innovative services and important community projects close and others struggle to stay afloat. By and large, the charity sector has tried to adapt to the challenging economic environment, but we should create a culture in which it can thrive and serve, because there are intangible and immeasurable benefits to the services it provides. I believe that all parties recognise that fact, but are the Government giving it due consideration?
On procurement, a recent study by the National Council for Voluntary Organisations on the financial sustainability of the sector showed that since 2009 there has been a £2.3 billion reduction in Government contracts, and that the sector faces a £4.6 billion annual shortfall by 2018-19 in the funding it needs to maintain its current level of service. The simple fact is that the need for charitable services is increasing, as demonstrated by a report published by the Charity Finance Group in December 2014, which showed that more than 70% of charities expect demand to increase. We have to recognise that, if we are to maintain the same level of services, we must take action now to ensure the long-term sustainability of the community and voluntary sector.
Dawn Butler (Brent Central) (Lab):
I congratulate my hon. Friend on securing the debate. On the issue of sustainability and the need for charities, I want to mention two charities in my constituency. First, given that this will be the coldest and longest winter in 40 years, the services that Energy Solutions provides to the community are essential. Secondly, although World AIDS
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Day is coming up on 1 December, the Community Health Action Trust has had its funding cut, which means that it can no longer serve the community and test people rapidly for HIV, which is on the increase among heterosexuals.
Mrs Madeleine Moon (in the Chair): Order. I ask that interventions are interventions, rather than mini-speeches.
Naz Shah: My hon. Friend the Member for Brent Central (Dawn Butler) makes a valid point. We are seeing that theme across the country.
The £2.3 billion reduction in Government funding is interesting. It will come through a number of streams, because the third sector has a symbiotic relationship with many Government-funded organisations, not least local councils, whose budgets have been decimated by austerity. However, the wider point is that the Government have been unable to build the third sector’s capacity to apply for more complicated contracts through increasingly complex and larger tendering processes.
Mr Jim Cunningham (Coventry South) (Lab): I congratulate my hon. Friend on securing this timely debate. The Government talked about a big society, but they really meant a smaller society. My hon. Friend touched on an important point. A lot of local authorities procure services from the voluntary sector—particularly from citizens advice bureaux, and I am sure from a lot of other organisations. In a time of austerity, people badly need those services. They cannot get legal aid any more for a whole range of issues. Does my hon. Friend agree that that is an injustice perpetrated on society?
Naz Shah: I absolutely agree. I will come on to talk more about the big society—or the failure to have a big society—and what should be done.
The coalition Government and this Government concretely demonstrated their commitment to tendering provisions for the VCS sector when they embraced the Public Services (Social Value) Act 2012. They have attempted—I use the term loosely—to reform public sector procurement to benefit VCS and social enterprise groups through their open public services approach. However, the reality on the ground is quite different. According to the National Audit Office, income from the Government to deliver contracts decreased by £1 billion in 2012. Its report shows that the biggest private sector contractors’ market share increased, and in 2012 charities lost almost £886 million in contracts, while the largest providers’ income grew by £551 million. That is unacceptable.
Those are not new statistics, and the problems are not new. There has been a lack of solid progress since the 2012 Act was enacted. The Government backtracked and kicked their commitment to transparent tendering into the long grass. They tender contracts that are far too large for the majority of VCS organisations to bid for; they put unrealistic timescales on the bidding process, which works in the favour of the larger private companies; and the calculations of cost value per unit still fail to consider the social value added by VCS organisations. Those issues are magnified by the financial pressure that all VCS organisations are under. Many have adapted and risen to the challenge of maintaining a similar level of service by innovating and raising finance elsewhere.
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The Government have failed to give due consideration to how charities can build the capacity that will give them the necessary skills to bid for contracts.
There has been a massive shift away from grant funding, which was more discretionary, to contract-based services, which are far more rigid. Without flexibility and financial stability, VCS organisations are unable to innovate—not in their front-line service, but in their capacity to bid for large contracts against private companies. I am extremely interested to hear how the Government will address that capacity shortfall to ensure that those who are doing the best, most valuable work are capable of applying for such contracts.
I used to issue health action zone grants. As a former NHS commissioner, I have seen at first hand how the voluntary and charitable sector developed, and how the Government strangled the ability of smaller organisations to thrive and meet the demand in their communities. Until recently I chaired a large mental health organisation, which, as a large organisation, was in a privileged position. We were able to ensure that we could survive. That is an example of the inequalities that are created by the Government’s stance on voluntary sector funding.
A further issue that must be addressed today is the Government’s longer-term strategy to devolve discretionary business rate exemptions for the VCS sector and charities. As the Minister is aware, there is currently an 80% mandatory business rate relief for charities, and the other 20% relief is provided at the discretion of local councils. Councils are already suffering incredible pressure on their budgets and are struggling to offer the full rate relief that is important to large and small VCS organisations. That 20% can be the difference between keeping services going and their having to close altogether. The situation made difficult by the uncertainty about the future of the rate relief and the expected full devolution of council tax control to councils.
It is essential that we give small charities all possible support so that they can continue to provide services to our constituents. It is imperative that the Government issue a long-term strategy on rate relief. Ideally, they should help councils to offer full rate relief to all charities for the foreseeable future. Given that more of the financial burden has fallen on councils in areas of higher deprivation, such as my constituency, it is not fair that yet again the Government are not supporting the communities that have the most need.
Recently, I was invited to address an event in my constituency organised by the Blenheim Project, which helped local women and their children who were made homeless and vulnerable due to domestic violence. I heard moving testimony and stories from those who had received invaluable support from the project and who, as a result of that help, managed to live not as victims but as active and productive citizens. Breaking the cycle of homelessness is the most cost-effective approach in the long term and has benefits for communities and for the economy as a whole. I heard from one woman who stayed in the project as a young child with her mother after they finally had to leave home. She continued to enjoy security at the project even though it had been taken away from her at home. That young women went to university and is now working and contributing to society. She is just one example from thousands of similar stories about the importance of receiving that much-needed support.
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However, the event was not held to celebrate the Blenheim Project moving forward or developing; it was to celebrate the project’s achievements upon its closure due to funding cuts. It was sad, because I know the value and appreciate the benefit that the project added to my constituency and community, reaching places and people that others could not. As someone whose life has been shaped immensely by the voluntary sector, both as a service user when facing difficulties in my own life and when I worked in it as an employee, I am devastated at the loss of the project’s beds. Let me be clear: one bed space literally means the difference between life and death for some women. Where I come from, one death is one too many.
The charity had 37 long years of hard work, supporting hundreds of women and providing exceptionally high-quality support to prevent women and children from becoming permanently homeless. It had proved itself successful, but could not find a sustainable financial platform despite offering a service that others could not, and for a modest sum when all its intangible benefits are considered. If it was not the definition of a public good that we in this House should protect at all costs, what is?
The pressures of the funding cuts brought about by the coalition Government’s austerity measures and increased by this Conservative Government cut to the heart of our communities. They disproportionately affect northern councils that have some of the poorest wards in the country. The funding cuts have propelled councils to rationalise and reconfigure services to meet demand and support vulnerable people, but the impact on service delivery continues to hit the most vulnerable indirectly, and initiatives such as the Blenheim Project are falling victim. The VCS is known to provide high-class services to people and communities who often get missed by mainstream services, but this Government believe that that does not carry a price tag, as we have seen from their so-called big society pronouncements in the past.
The changes in funding, which have required the development of new commissioning and VCS frameworks, have made it impossible for projects such as Blenheim to continue providing the quality support that they know women and children need. The new reality in funding and commissioning arrangements makes many successful small charities unsustainable. Small to medium-sized local charities face challenges due to the drive towards commissioning processes that seek to maximise outputs on the same resources. The tendency for bigger charities to drive down costs as loss leaders in the first instance makes the option of tendering for contracts unsustainable. Smaller charities do not have the resources to invest in future developments, never mind taking on projects as loss leaders as part of a wider strategy. In a statement, the Blenheim Project said:
“Due to pressures in funding Bradford Council can no longer support as many homeless people as before and have drastically reduced both the number of places they will fund and also the level of funding”,
which would no longer be adequate for the services that the project offered. In addition, the council took away the project’s ability
“to assess the needs and risks of the clients”
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Only a few hundred yards up the road from the Blenheim Project used to be another project, the Manningham Mills Community Association, which has also bitten the dust. Another community has been robbed of a vital resource due to funding cuts and belt tightening. For me, however, there is belt tightening and there is just strangling a community. What the Government are doing is a shameful indictment of how out of touch they are with the communities they are supposed to protect.
Chris Davies (Brecon and Radnorshire) (Con): The hon. Lady is making a generalisation—it sounds as though the whole of the third sector had disappeared. I met the Powys Association of Voluntary Organisations, my local third sector governing body, just last week at its annual general meeting. Everyone would like more money, but such organisations are striving to succeed and still doing an extremely valuable job. I regret the fact that the hon. Lady is making it sound like the third sector has vanished.
Naz Shah: I thank the hon. Gentleman for that comment. Although I agree that the third sector is doing a valuable job and is working hard, if one considers the Tory Government’s proposed £300 million-plus cuts to the Big Lottery Fund, which I will refer to later, that will put my comments in context.
In communities such as my constituency of Bradford West, where more than 26% of children are already living in poverty, the average weekly wage is more than £110 less than the national average. In another ward in my constituency is a specialist project catering for black and minority ethnic women fleeing violence, which would have soon closed due to pressures facing the local council were it not for the intervention of the Big Lottery Fund, the input of which in my community is literally life-changing. Across my great city there are many other examples of the axe falling heavily, and all of them have a few things in common. They are smaller VCS organisations, providing vital services and lifelines to those most in need of support and plugging the gaps where statutory services are not delivering strongly.
The Government are making it harder to secure grants and funding at a time when demand is increasing and capacity is already stretched to maintain current service levels. The top-heavy austerity measures and the slashing of Bradford council’s budgets by almost half by 2020 have led to a short-termist view, wholly created by the Conservative Government. Whereas councils were previously able to take long-term views on VCS funding, the parameters of that work have now been narrowly defined. The money available has been restricted to reduce costs, there has been a drive for efficiency and to obtain ever-increasing best value, and a reduction in unit costs has led to the likes of the Blenheim Project being placed in vulnerable positions. The situation is set to get significantly worse and have an impact on other areas of the VCS and charitable economy.
The Government fail to realise that much of local government, the NHS and the third sector operate in a symbiotic relationship, helping to create a robust mechanism to meet needs across the board. Taking out the third sector or reducing its ability to operate under financial strain will have an impact on the drive to reduce admissions, promote self-care and increase community capacity for
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home care and the promotion of health. We are only storing up problems for the future. Saving money in that way is a false economy.
Along with the provision that we have lost due to charities such as the Blenheim Project closing, the Bradford district has lost expertise and the ability to reach out to places and groups that need help. The project closed its doors at the end of September 2015 after 37 years of supporting hundreds of vulnerable, homeless women and children. As a result, Bradford has lost jobs and 17 rooms for vulnerable people, and wider community involvement and community development has ended. A successful church community project has closed, leading to the loss of valuable expertise that knew its community exceptionally well. There are many other such cases across Bradford, and the picture is repeated in constituencies across the country. It is not unique to Bradford West.
My final point is about potential cuts to the Big Lottery Fund. We have been hearing reports of a 30% reduction, with the money being used to cover a hole in the finances of the Department for Culture, Media and Sport equating to between £300 million and £320 million a year. If true, that will be devastating to VCS organisations across the entire country. I will use the example of my constituency to illustrate just how damaging the loss of 30% of grant money would be to small organisations, in particular small charitable projects. Since 2014, the fund has commissioned 466 projects in my constituency to the tune of £4.9 million, almost 90% of which were for under £10,000. It is an amazing array of projects, targeting some of the most vulnerable and the most in need. From that alone, we can see how a reduction in grant awards would decimate the small community projects that can have transformational impacts on people’s lives as they often concentrate on specific, niche needs. The Anah Project in Bradford is only there because of the Big Lottery Fund. Furthermore, as I said, we have seen changes to the awarding of grants, a lack of capacity in the VCS to apply for more complex funding and the loss of funding from struggling local councils. In all, plainly, the big society appears to be even more hollow than first feared.
Unlike the Government in their approach to communities such as mine in the north, the Big Lottery Fund does not discriminate. It gives out funding to individual projects, based solely on the value they add and, most importantly, on need. We could face a betrayal not only of the great work that individuals and organisations do in the community with lottery funding, but of the members of the public who elected this Government. Many will feel that the Government are overstepping the mark if they backtrack on the principle of the additionality of lottery money, which has been reiterated time and time again by successive Governments. The money is there for the community, not for this Government or any Government to plug holes in their funding.
I want assurances from the Government that they are considering the long-term implications of their decisions and the pressure that they are putting on the VCS. More has to be done to tackle the inequality in procurement and the manner in which contracts are decided if we hope to be able to retain some of the most valuable and innovative community engagement work across all sectors in the foreseeable future. Charities and voluntary organisations need to be able to plan their funding and
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projects on a longer-term basis. The Government not only have a responsibility to help build capacity in the third sector through investment, but they also need to give assurances on the unknown costs by making critical decisions, such as on council tax relief for charities. Ultimately, the Chancellor must not use the Big Lottery Fund to act as tape to cover up poor financial planning in central Government. As John Major said, lottery money is from the people for the people.
Mrs Madeleine Moon (in the Chair): Given the number of Members who have indicated their wish to speak in the debate, with the authority of the Chairman of Ways and Means I impose a time limit of six minutes on Back-Bench speeches.
2.51 pm
Michelle Donelan (Chippenham) (Con): Thank you, Mrs Moon.
I commend the hon. Member for Bradford West (Naz Shah) for the subject of the debate. I am extremely passionate about it because my constituency has some of the highest rates of volunteering in the country; more than 1,500 voluntary opportunities are being advertised there at the moment. Volunteering is deeply embedded in the fabric of the Wiltshire community. In fact, it is the very glue that binds it, filling the gaps left by the state. Voluntary organisations are essential for those two reasons and I welcome the Government’s support for the sector, although I encourage them to protect and support its work further.
Given a ballooning state, a huge deficit and an ageing population, the truth is that we will not be able to sustain the existing model and will be unable to continue providing all the levels of service that we have now. We will need to look to the voluntary sector for more and more, so it is imperative that we support and strengthen the industry today. In addition, as the hon. Lady said, charities save the state money in the long term.
For example, Wiltshire Mind, which is based in my constituency, receives no Government funding, but even the Avon and Wiltshire Mental Health Partnership NHS Trust acknowledges the charity’s vital work and how it reduces pressure on services. Alzheimers Support and the Alzheimer’s Society are prime examples of charities that achieve better outcomes than many state-run organisations, because they are specialised in their sector. Volunteer centres act as pivotal hubs, promoting and filling roles, and they often excel at rehabilitation of ex-offenders and back-to-work programmes.
As we all know, the recession has hit the voluntary sector hard; its total income has fallen in real terms every year since 2009-10. That is because of not only the reduction in Government spending, but the reduction in giving—an obvious symptom of recession. The National Council for Voluntary Organisations estimates that the rate of giving fell by around 10% during the recession, and it has still not recovered. Individuals are the voluntary sector’s single biggest source of income, hence the impact.
Funding is not the only issue, and that is the point that I want to labour. We also need to encourage volunteering, especially among the young and the elderly. In 2014-15 47% of adults in the country did some form of informal or formal volunteering. Informal volunteering is most prevalent among 26 to 34-year-olds and formal volunteering among the young—those of 25 and under. That means that a huge number of people in the retired
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sector with time and expertise who could get involved. Volunteering would also help some of them to ward off loneliness and other such attributes.
Martin John Docherty (West Dunbartonshire) (SNP): I recognise some of what the hon. Lady is saying, but does she recognise that such volunteering activity requires investment? It does not come for nothing.
Michelle Donelan: Exactly. I am trying to make that point and will continue to, but I am also saying that we can throw money at things, but it is not only a case of money—we must also promote the voluntary sector to ensure that we have the volunteers for tomorrow.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con): I completely agree with my hon. Friend. Carers’ organisations also recognise that the issue is not only about funding, but about the freely given caring provided day in, day out by carers to their families up and down the country.
Michelle Donelan: I agree. I am very much involved with the carers’ organisation in my constituency and I completely understand that point.
We need to go further to encourage and enable more people in long-term unemployment to go into volunteering schemes. We already do that, but we need to work more closely with volunteer centres to ensure that it happens more. There is a lot of concern about the loss of benefits to volunteers, so there is much work to do there.
We need to invest to encourage more young people to volunteer as well. Some fantastic work has already been done, such as that of the National Citizen Service. It is important today to focus not only on the negatives, but on the positives. Seventy-five thousand young people have changed their lives and got involved in their communities through the NCS. We should take note of the things that are working as well.
Anna Turley (Redcar) (Lab/Co-op): I share the hon. Lady’s positive view of the NCS and its good work with young people. At the same time we are seeing huge cuts to youth services across local authorities and the NCS works with a fairly small number of young people compared with the great majority who can access mainstream services. Does she not think that the cuts to local authorities also impact on young people’s preventive services?
Michelle Donelan: The cuts to youth services are for a totally different debate, because they are not purely about volunteering. There is a vast variety of youth services depending on the different areas and models involved. There is also the question of replacement: in many areas, including mine, the council has worked closely with the community to offer a replacement service that is the most cost-effective and efficient for the people using it.
In addition, the Government are providing funding for campaigns such as the national Step Up To Serve #iwill campaign, which aims to make social action part of the lives of as many 10 to 20-year-olds as possible. More remains to be done, however, and I am quite shocked that there is still no formal encouragement in
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respect of the value of getting volunteering into schools, through things such as voluntary placements. We have always had a system of work placements, but there has never been a system of voluntary placements as a formal mechanism in the UK. I have approached my local volunteer centre about the issue, and we are trying to do something with willing schools in my constituency.
We need to change the ethos and encourage more businesses to allow voluntary days, which would build on the Government’s initiative on that. There have been other great investments, which we should not fail to mention, such as Big Society Capital, tax relief for social investment, social impact bonds and £70 million for social investment in the investment and contract readiness fund.
Dawn Butler: In addition, business rate relief for charities is worth £1.7 billion. Does the hon. Lady not think that they should be excluded from the Government’s plans for rate relief? Those plans will hinder charities’ ability to provide services to the community.
Michelle Donelan: That is one thing we could look at, but it is not the only thing, as I shall get on to in the rest of my speech.
More needs to be done and it is time we looked at gift aid in particular. On average, the charity sector loses almost £1 billion a year from people not opting into gift aid. Perhaps we should not only promote it more as a mechanism, so that people understand it, but look at the logistics of having an opt-out instead for the working population. That might be one solution.
When compared with the state, charities are often far better placed to deliver services and value for money, as well as being far more knowledgeable about those services. The charities also provide specialised local knowledge and learning for volunteers. Young people can gain skills and a preparation for life and employment, while older volunteers can impart their own knowledge and reduce the training burden carried by charities. Charities may also reduce demand on the NHS as people stay active and healthier during volunteering. There are thousands of voluntary organisations in Wiltshire that bring in money from inside and outside the county in addition to Government funding.
While central Government may be able to replicate the functions of a local charity in part, that is not sustainable. That also does not take into account the unseen costs of not funding those charities, such as the loss of expert knowledge and the unquantifiable but large wider social benefit that community charities provide. I welcome the Government’s recent initiatives, but I urge them to go further. The reality is that we will need to rely more and more on the voluntary sector in coming years, so it is imperative that we support and promote it today.
3 pm
Susan Elan Jones (Clwyd South) (Lab): It is a great privilege to serve under your chairmanship, Mrs Moon. I am not sure whether this requires a declaration, but I am co-chair of the all-party parliamentary group on civil society and volunteering, which is administered by the National Council for Voluntary Organisations. I put that on the record; I might have got into trouble if I had not.
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Six minutes is not a lot of time to talk about this. As it was in 1601 that the Charitable Uses Act came to this House, we have been discussing charities and their development for the past 414 years. In England and Wales, we have got about 180,000 registered charities and there are probably as many again that are not registered. Charities have a combined income of £40.5 billion a year, similar to the figure for 2006. Of that, £13.3 billion is from Government sources, down £1.7 billion since 2010-11, and 83% is from contracts. Many of those points were made most eloquently by my hon. Friend the Member for Bradford West (Naz Shah), who spoke magnificently at the start of the debate.
Wherever we stand on the ideological spectrum, we all know that the public sector cuts will hit hard, so I will put in a plea for the charities’ old block grants. I know the history of contracts and the rest of it, but, as well as providing value in terms of simplicity for smaller charities, they also deal with capacity building. The core funding can and should be monitored. Indeed, when I was a manager of a small charity in London, I think I faced a lot more monitoring than Kids Company did for its multi-millions. That should be looked at, because it would enable those charities to develop and grow in funding and capacity.
It is right that controversies and indeed slightly dodgy fundraising practices are looked into, and it is right that we are considering those issues in the Charities (Protection and Social Investment) Bill. I, for one, will welcome the development of a fundraising preference service, but we know that charities need to raise money and always have needed to. We have seen that throughout our history, whether it was Dr Barnardo or those lesser known and less wealthy philanthropists such as those individuals and families who, in Victorian times, ensured that orphaned, destitute and illegitimate children became part of their family. They did not have the money or get the big plaques, but they were part of that bigger society.
To look to the new generation, I agree wholeheartedly with the hon. Member for Chippenham (Michelle Donelan) that we must look again at gift aid. I suspect that many of us make direct debits and the like and sign the little gift aid forms in the old-fashioned way. However, there is a new generation out there. Demos, in its “Introducing Generation Citizen” report in 2014, made the point that 13 to 19-year-olds have a real desire to help others through social action. Of course, many younger people do donations by text, so we need philanthropy for a modern age and a new generation of givers. Think, indeed, of Stephen Sutton and how crowdgiving led to more than £3 million for a charity in a year—that is a phenomenal legacy from a phenomenal life. Cancer Research UK’s no make-up selfies raised £2 million for charity and received more than 800,000 donations by text.
We know the history of gift aid and as a society we should be proud of how it has developed and increased, but surely it is time to look at making it automatic for text donation. The Government must look at that. We made the point in the Small Charitable Donations Act 2012—this is not for gift aid, but it is similar—that charities can automatically claim back on a gift from an unknown donor, so I hope that the Minister will look at that.
We are looking at our communities and discussing the charities and community organisations, which I think reflect the diverse aspects of Britain: the different
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societies; the wealthy philanthropists; the miners’ welfare organisations; the Churches and other faith groups; and a whole series of initiatives.
Let us not forget that the NHS did not start off as a national, state-sponsored health service; it actually began in small communities where people had ideas. When we talk about the divisions between voluntary sector and state and private sector, we forget that often a good idea is piloted in the voluntary sector and people think, “This is good. We will have a bit more of this and then we will do it locally or nationally.” At the heart of the debate, we need to look at funding and where clear problems are caused by the funding cuts, but we need to be innovative and pluralistic and celebrate that work. It is not that we want a big state; what we challenge the Government for is a much bigger society.