Health and Social Care (Safety and Quality)

Fiona Bruce (Congleton) (Con): May I begin by congratulating my hon. Friend the Member for Stafford (Jeremy Lefroy) on his Bill, which, if implemented, has the potential to provide significant improvements right across this country to the treatment and care of patients requiring medical assistance? Indeed, the improvements proposed by the Bill would have an immediate and real impact.

The national health service is an institution of which the whole nation can be proud. It serves our society with outstanding professionalism and admirable compassion. However, as a few specific, terrible instances have shown, there is room for improvement.

I salute my hon. Friend’s tireless work to do everything possible to ensure that this country never again experiences tragedies of the type reported from Mid Staffordshire hospital. Indeed, my hon. Friend’s constituents have cause to be extraordinarily proud of him as their elected representative and of the thoughtful, tireless and effective work he has done on their behalf in response to the issues raised at Mid Staffordshire hospital. I do not believe that any other Member could have worked harder for their constituents in this connection. He has raised their concerns in this House countless times.

The Bill is another carefully considered and utterly compassionate response—so characteristic of my hon. Friend—to those events. It is a focused, effective and, above all, practical proposal. It has one overriding focus: patient care. It deserves to be fully supported in its passage through the House. Its proposals are specific, 

7 Nov 2014 : Column 1088

realistic and immediately applicable. It will bring about real changes in the lives of real people right across the country at their weakest and most vulnerable moments.

As I have said, particular situations hit the headlines. Although they were extreme, the House must remember that they are part of a wider national picture. We must use the lessons to inform future policy, and the Bill does just that. It is all about patients and their care, and about promoting consistency across the country so that all patients are cared for safely, and are seen to be cared for safely, to an accepted and understood standard. The NHS is an institution that the British people own, fund and use, and it is right for us to be concerned about public confidence in the quality and safety of the care it provides.

I understand the concerns of those who say that the NHS cannot be run on the basis of public opinion—I will speak about that when I come to clause 5—but that does not negate the fact that public confidence in the NHS is an essential concern, not an optional extra. Indeed, an NHS or local hospital that loses the confidence of the public will quickly cease to be able to serve effectively the community for which it is designed.

The first purpose of the Bill is to set in stone the priority of patient safety in NHS standards not just as a power but as a duty of the Care Quality Commission, as my hon. Friend has said. We have learned from the Francis report that patient safety is not an optional extra; it is essential and should be at the heart of good health care. The recognition of every single person’s dignity and value has characterised the proud history of the NHS and must always remain central to its practice, no matter what pressures it comes under on a wider scale.

The priority of safety in the work of the CQC will help to enshrine the dignity of individuals in a system that must inevitably focus on what is efficient in the wider structural picture. Putting safety first will ensure that it is not lost within bureaucracy and procedures. The nature of the NHS clearly means that health care professionals are always under all sorts of pressures to decide how they can most effectively allocate their resources of time, expertise and treatments.

Clause 1 will be a buttress to the rights and dignity of each and every individual within the larger picture. It will make sure that safety is one of the key non-negotiable factors that guide professionals and institutions as they make decisions. The clause acknowledges that there is no such thing as risk-free health care, and it allows for a certain margin when those providing the service cannot reasonably avoid risk. The responsibility that the clause will permanently place on health care professionals, institutions and those assessing the CQC should ensure that the recent tragedies in patient care are far less likely to happen in future. Ideally, no one in the House would want them to happen and to be reported again.

The second aim of the Bill relates to transparency and the integration of health care. A more integrated health care system must surely be a better system. It would promote shared expertise, shared learning and greater safeguards. The care provided for patients should reflect the fact that disconnected and fragmented health care is weak health care. These provisions will aid heath care professionals with regard to not just safety, but good practice across the board. I hope that it will simplify, rather than—as some fear—make more complex, 

7 Nov 2014 : Column 1089

the system of health care provision for patients. A consistent patient identifier and wider information sharing should create clearer channels for the integration of health and social care for individuals. This is the way of the future, particularly given the needs of our increasingly elderly population. I applaud my hon. Friend for those practical proposals.

As I have said, the NHS is a unique institution with a unique connection to the public. Public confidence is not an optional extra, but to achieve it requires transparency. I am sure that many health care professionals in the NHS will welcome greater transparency. The overwhelming majority of those who work in the NHS do an outstanding job, of which they—and we—can be proud.

The British Medical Association has certain concerns about the NHS number being used as a universal identifier, so I am pleased to highlight the fact that the Bill does not require any particular identifier to be used. The Bill seeks to promote the principle and merit of having an identifier, but which identifier is to be used can be left to the discretion of the Secretary of State, who I am sure will consult interested parties.

Provisions for sharing information in the Bill are also important. They will facilitate better health care treatment for every individual across all areas of their treatment, allow professionals to do a better job, and allow patients to know with confidence that those looking after them are fully informed about their care requirements before they provide treatment. Currently, patients cannot be sure that their medical and care history and priorities are being shared between professionals responsible for their care. My hon. Friend has cited cases where that has caused problems, which is no doubt typical of many.

Care must be taken to ensure that information is shared in a responsible way that upholds the privacy of the individual—that is critical. Questions of who information is shared with and how consent is assumed or obtained from patients are important, and there will be the opportunity to discuss such matters further in Committee. As the Bill rightly points out, patient data should not be shared where that is not appropriate, or in an unsafe manner—for example, where a person’s medical record contains confidential information about another person. Critically, the sharing of information must always be in the best interests of that person’s care and treatment. The Bill would not require the sharing of identifiable information for purposes other than direct care. As Dame Fiona Caldicott said:

“For too long, people have hidden behind the obscurity of the Data Protection Act or alleged rules of information governance in order to avoid taking decisions that benefit the patient. Personal data must be protected lawfully, but common sense and compassion must prevail.”

The third and final aim of the Bill is to ensure that the various health care regulators, including the Professional Standards Authority when making decisions on cases of conduct or misconduct, have consistent overall objectives in mind: the maintenance of public safety, public confidence in the relevant profession, and proper professional standards of conduct on the part of health care professionals. The proposals have not sprung up in a vacuum; they are consistent with recommendations in the Law Commission’s report, “Regulation of Health 

7 Nov 2014 : Column 1090

and Social Care Professionals”. It noted with concern the inconsistencies in the way different professional regulators assess individual fitness to practise. The relevant section of the Bill, recommended by experts, should ensure fewer examples of poor practice, and that it is properly addressed. Everyone—practitioners and regulators —should know the primary principles by which professional performance in the health care system is to be judged.

I understand that some professionals, and the BMA, are concerned that the link to public confidence could lead to an inappropriate link between volatile public opinion and the decision of regulators. Those are reasoned concerns but they underestimate the capacity of regulators to make appropriately sound judgments against set benchmarks. The legal position already requires attention to be paid to public confidence. The Law Commission’s report stated that

“the concern is that in cases of clinical misconduct or deficient professional performance they—”

that is the regulators, and for the benefit of the House I will elaborate a little on what “the regulators” means, because it is an extensive group of organisations—

“are more likely to look at whether the instances of clinical misconduct or performance are remediable than to fully consider all of the factors, including public confidence in the profession.”

The Bill addresses that concern.

Concerns that this will lead to inappropriate links between regulation and public opinion, perhaps especially as it relates to so-called scare stories in the press, should prove unfounded. Far from it: the Bill should encourage greater clarity and rigour in the grave task of regulators in assessing professional standards and promoting best practice. The impact of the Bill in this regard should not be underestimated. The extensive list of regulators—the bodies that regulate health and care professionals in the UK and will be affected positively by the Bill—includes: the General Chiropractic Council, the General Dental Council, the General Medical Council, the General Optical Council, the General Osteopathic Council, the Health and Care Professions Council, the Nursing and Midwifery Council and the General Pharmaceutical Council.

Jeremy Lefroy: I am most grateful to my hon. Friend for taking on the role of enunciating all the regulatory bodies. Does she agree that we would be wrong to downplay the great common sense of the British people when talking about public confidence? Public confidence in health care professionals, by any objective reasonable measure, is at a very high level and we do not just need to look at press headlines for that. Does she agree that, when it comes down to it, the British people have a huge amount of common sense and the profession should not be afraid of public opinion? It is very much on its side.

Fiona Bruce: I entirely agree. In saying what I have said, I in no way want to denigrate my hon. Friend’s intervention. I absolutely agree with him.

In closing, let me repeat my support for this profound and potentially far-reaching Bill. If passed, it would influence the life of every citizen in this country. Let me repeat my support for the excellent work my hon. Friend has done in bringing it to the House, and in working to drive up standards in the NHS, both locally in his constituency and nationally, and protect people 

7 Nov 2014 : Column 1091

across the country from a repetition of the sad and tragic events documented at Mid Staffordshire. The Bill will strengthen relationships between patients and health care professionals, and between the NHS and the public in general. It will help to lift confidence in the NHS even further. Most of all, it will help to ensure that every person who relies on the NHS in their most vulnerable moments will be safer wherever they live and whatever their condition. For that reason, I commend my hon. Friend’s Bill to the House.

Abortion (Sex Selection)

Fiona Bruce (Congleton) (Con): I beg to move,

That leave be given to bring in a Bill to clarify the law relating to abortion on the basis of sex-selection; and for connected purposes.

Sex-selective abortions are happening in the UK, and there is widespread confusion over the law, which is why this Bill is needed. The Bill is extremely straightforward, merely clarifying that nothing in section 1 of the Abortion Act 1967 allows a pregnancy to be terminated on the grounds of the sex of the unborn child. It is a shame that this clarification is needed. Successive Health Ministers and even the Prime Minister have been very clear on the matter. They state that abortion for reasons of gender alone is illegal. The Prime Minister has described the practice as “simply appalling”. But these Ministers are being ignored. The British Pregnancy Advisory Service, which performs around 60,000 abortions a year, flatly disagrees with them. Even today, it is advising women, in one of its leaflets and on its website, that abortion for reasons of foetal sex is not illegal, because the law is “silent on the matter”.

The British Medical Association holds yet another interpretation. It argues that there may be cases where having a child of a particular gender may be

“a legal and ethical justification for an abortion”

on the grounds that the sex of the child may severely affect the pregnant woman’s mental health. I wish to address that point. Some say that the sex of the unborn child can be a legitimate ground for an abortion where a woman is being threatened with abuse if she carries the baby to term. Those who make that argument perhaps fail to realise that, in such tragic cases, it is not the sex of the child that is the ground for the abortion but the threat of abuse, which may constitute a physical or mental risk. I find it deplorable that anyone would be satisfied to provide a sex-selective abortion to a woman who, after she has had it, is then sent back to an abusive partner. What needs to be addressed in those dire circumstances is the abuse itself. Those women need help, and that is one aim of the Bill.

The BMA represents every doctor who permits or performs an abortion and BPAS is the UK’s biggest abortion provider. We cannot sit idly by as it contradicts Ministers over a practice that the Government state is illegal. Urgent clarification from this House is needed.

The main motivation for the Bill, which is more than merely a desire to achieve a consistent policy line on this issue, is that we know that sex-selective abortions are happening in the UK and little is being done to stop them. We know that because a growing number of courageous women are speaking out about their experiences. Here is the story of Rupinder, which is not her real name, told by Jeena International, which works with UK women who have sex-selective abortions.

“Rupinder decided to abort her third child as she was expecting a girl. She was the eldest of six girls and she recalls that each time her mother went to hospital how disappointed everyone was when each time it was a girl. This experience traumatised and consumed her so much that the thought of giving birth to a girl meant disappointment, betrayal and lowered status within the 

4 Nov 2014 : Column 678

family and the community. Rupinder made a painful decision to abort which she now regrets as she felt that she had no other choice.”

Then there is the experience of Uraj—also not her real name—which might help to persuade those who doubt that son-preference is a problem in this country.

“During a routine ultra-sound scan Uraj’s husband asked what the sex of the baby was and was told a girl. During the drive home, there was pin drop silence in the car. When they arrived home, Uraj started to prepare the evening meal in the kitchen, trying to silence her daughter at the same time as she was crying. She knew her husband was not happy and was angry that she was expecting another girl. She remembers him repeatedly punching and kicking her in the stomach and passing out. When she regained consciousness her husband had walked out and he sent her divorce papers a couple of months later.”

Despite the existence of such stories, there are still those who claim that there is no evidence for the practice. In response to these critics, Rani Bilkhu, the director of Jeena International, said:

“Saying that there is no evidence is tantamount to saying that these women are lying and that our organisation is making things up.”

It is hard to disagree with her, and it is crucial to note that Ms Bilkhu is referring to the brave few who have come forward in the hope that, in so doing, they will help to combat the practice. Their stories are only the tip of the iceberg. Another organisation, Karma Nirvana, which runs a crisis helpline for women in such situations, says:

“We believe the prevalence of sex-selective abortion in the UK is currently under-reported and this has been the case for many years. We have received, and continue to receive, calls from victims who are pressured to identify the gender of the child for the purposes of identifying if it is a girl. Victims express how they are then pressured by family members to abort the child and to give reasons other than sex selection and how they face abuse if they refuse to request this or abort.”

To those who argue that there is no evidence of sex-selective abortion in the UK, I pose a question: what reason do we have to doubt the word of these organisations? If the testimony of these women and those who work with them is not enough, consider the statement of the GP and former BPAS consultant, Dr Vincent Argent, who said he had “no doubt” that this was a problem in the UK and that there were

“an awful lot of covert sex-selective abortions going on.”

Indeed, I am told that some hospitals operate a policy of not telling the women the sex of their baby for fear that it will lead to a sex-selective abortion.

We can no longer ignore the fact that sex-selective abortion is a reality in the UK. Lest anyone think that this is an issue that applies only in certain communities, they should consider the tragic fact that the words “family balancing” are heard with increasing frequency and understanding across the country.

Thankfully, at the moment, countrywide analyses of birth data do not seem to show significant gender imbalances, but sex-selective abortion is clearly happening. Surely we cannot be saying that we will do nothing until the statistics show a national skewing in gender ratios, as in other countries. That would be wrong. How many more women must come forward before we take action? The time at which Government support should have been offered to women such as Rupinder and Uraj passed long ago, which is why I, and other colleagues, have brought this Bill to the House today.

4 Nov 2014 : Column 679

The Bill is sponsored by 11 female MPs from all parts of the House and supported by a large number of other MPs. Today, I wish to place on record my thanks to those MPs, including: the hon. Members for Stoke-on-Trent South (Robert Flello) and for Linlithgow and East Falkirk (Michael Connarty), my hon. Friends the Members for Rossendale and Darwen (Jake Berry), for Dover (Charlie Elphicke), for Salisbury (John Glen), for Enfield, Southgate (Mr Burrowes), for Stroud (Neil Carmichael), for Daventry (Chris Heaton-Harris), for Stafford (Jeremy Lefroy), for Wolverhampton South West (Paul Uppal), for Harrow East (Bob Blackman), for Sittingbourne and Sheppey (Gordon Henderson), for Tewkesbury (Mr Robertson), for Calder Valley (Craig Whittaker) and for Cleethorpes (Martin Vickers), the hon. Member for East Lothian (Fiona O'Donnell), my hon. Friends the Members for Gainsborough (Sir Edward Leigh) and for Pudsey (Stuart Andrew), and my right hon. Friends the Members for Chelmsford (Mr Burns) and for North Somerset (Dr Fox). All of them support this Bill and I sincerely thank them for that.

Clause 1 would send a clear signal that abortion for gender is not permissible under UK law, clearing up considerable confusion. Subsection (2) would make it clear that the clarification relates only to sex-selective abortions, therefore putting the Bill squarely in line with the Government’s interpretation of the Abortion Act. Clause 2 obliges the Secretary of State for Health to ensure that the law is being upheld. That will enable the Government to think about ways to help such women.

This month, for the first time, the UK has dropped out of the gender equality top 20. It is a further damning indictment of our commitment to female parity that we allow national institutions to contradict the Government on an illegal practice that predominantly affects girls. Even worse, we are choosing to ignore the evidence of women who have gone on the record and who have suffered under this appalling practice. This has gone on long enough. We must now act. As an editorial in The Independent said in January:

“Sex-selective abortion is barbaric and socially destructive.”

This Bill would be a step on the way to addressing this tragic and discriminatory practice and the first and most fundamental form of violence against women and girls. I commend it to the House.

Question put (Standing Order No. 23).

The House divided:

Ayes 181, Noes 1.