NHS Whistleblowers

Justin Madders Excerpts

Wednesday 18th July 2018 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is, as always, a pleasure to serve under your chairmanship, Mr Davies.

I congratulate the hon. Member for Central Ayrshire (Dr Whitford) on securing the debate and on her powerful and knowledgeable contribution. As always, she drew on her many years of experience in the national health service. She listed a series of scandals in the NHS and raised themes common to them all. They lasted too long, and too often those who blew the whistle paid a high personal price for their actions. She raised the real risk of clinicians finding themselves with potential conflicts of interest, which requires further thought, and rightly highlighted the fact that the current legislation does not create an obligation to investigate the original complaint—it is primarily concerned with protection after the event.

In his analysis, the hon. Member for Stirling (Stephen Kerr) suggested that PIDA was intended to be a deterrent but that, given the way it has operated, it is not that at all because whistleblowers are still being punished. Both he and the hon. Lady pointed out the woeful success rates in employment tribunals, which should give us all pause for thought about whether the legislation is fit for purpose. The hon. Member for Stirling talked about how litigation can sometimes be a war of attrition and employers can be very defensive at times, and how at the bottom of all this is an individual—sometimes a highly skilled individual—whose talent has been wasted and lost because they have blown the whistle.

My hon. Friend the Member for Hartlepool (Mike Hill) spoke with great passion and no little knowledge of some of the experiences of those who have blown the whistle. He was right that some employers have not embraced the spirit of the legislation; in fact, they contrive policies to run contrary to what we are trying to achieve here. Having met many of the staff in the NHS, I know they care deeply about the work they do and they want to do the best by their patients. That is why it is so important that we provide an environment where they are able to raise their concerns about things they may be worried are going wrong, without fear of repercussion or unfavourable treatment. They must also be confident, once they have raised those concerns, that action will be taken.

However, despite some notable advances in the protections available in recent years, it remains the case that even the best run organisations, with the most comprehensive policies in place, can still feel very daunting for individuals who want or need to blow the whistle. I know from my many years working as an employment lawyer—although not one who lined his pockets in this particular area—that it is extremely difficult for an employee to raise those issues. As we have heard already, the consequences of doing that can be hugely damaging. They can face anything from being shunned by their colleagues to summary dismissal on spurious charges, and the impacts of the kinds of things they deal with can last much longer than the period of employment to which we are referring.

In that respect, it was deeply concerning to read in the Francis report about staff who were on the brink of suicide because of the treatment they had received after speaking out. One of the few criticisms on the record of the NHS is the fact that many promising careers have lain in tatters as a result of ineffective protections under this legislation, while other people have spent years languishing in the legal system, with the taxpayer racking up tens of thousands in legal fees in the process.

Of course, while protecting whistleblowers is vital across all professions, it should be pointed out that NHS staff also have a professional duty to raise concerns. The NHS England and NHS Improvement policy states:

“If in doubt, please raise it. Don’t wait for proof… It doesn’t matter if you turn out to be mistaken as long as you are genuinely troubled.”

We cannot say that enough; I just wish it was easier to see that delivered in practice.

The Minister recently brought forward regulations to provide some additional protections for the present and future employment prospects of whistleblowers, which we welcomed. I raised a number of concerns during that debate and the Minister was good enough to write to me afterwards setting out some of the responses. However, one issue that I do not think we have got to the bottom of was protections for other workers who support whistleblowers. There is a worrying gap in the existing legislation. It is easy to envisage circumstances, particularly in the health service, where two or more employees might have an issue of concern that they jointly notice, but only one of them, in law, can make that protected disclosure.

When I raised that point to the Minister, her response made clear that the only remedy available to such associated parties would be to register a grievance under their employer’s grievance policy. That is a very worrying omission from existing legislation and I ask the Minister to consider whether she will look at that again, as well as at the many points that have been raised about the deficiencies of the existing legislation.

Another lacuna in the existing law was exposed much more prominently by Dr Chris Day. On 10 January 2014, Dr Day made a protected disclosure about critically low staffing ratios during a night shift on an intensive care unit at the Queen Elizabeth hospital in Woolwich. Unfortunately, the trust and Health Education England decided not to act on his concerns and terminated his contract, based on what Dr Day believes were false allegations, thereby stalling his progress to consultant.

Sadly—like many whistleblowers, as we have heard today—rather than having his rights protected by his employer, Dr Day was instead forced to defend them via legal redress at an employment tribunal. This is because Health Education England contended that

“even if the facts alleged by Dr Day were true, HEE could not be liable in law for any acts causing him detriment.”

That was significant because, while not acting directly as the employer, HEE recruits doctors in training, supplies them to various trusts and appraises them. The result was a wholly unnecessary and extremely lengthy legal battle, whereby Health Education England, which is a body of the Minister’s Department, effectively sought to move around 54,000 doctors out of whistleblowing protection. Despite the clear principles at stake, the Government consistently refused to become involved in the case to prevent the costly and embarrassing outcome that we have now arrived at.

In September 2017, in a written parliamentary question, I asked about the cost to the NHS of defending the legal action brought by Dr Day. I was told that the total legal fees incurred by Health Education England stood at over £100,000, while Lewisham and Greenwich NHS Trust had incurred costs of £30,000. In May this year, Health Education England was ordered to pay Dr Day’s solicitors’ legal costs of £55,000 after it backed down and accepted that it should be considered an employer after all.

After four years and more than £200,000 of taxpayers’ money spent, Health Education England has accepted its responsibility and made a statement that I consider frankly astonishing:

“Having never wished to do anything other than facilitate whistleblowing for doctors in training, HEE is happy to be considered as a second employer for these purposes if it removes a potential barrier for junior doctors raising concerns.”

I ask the Minister to explain why this situation was allowed to go on for so long, when the case was refuted not on the basis of the facts, but on a technicality that flies in the face of everything we have tried to achieve today.

[Dr Whitford]

As in the case of Dr Day, the issue of poor staffing levels or rota gaps is a common incidence for people blowing the whistle because they feel it is unsafe. Scotland has just passed a safe staffing law, and I wonder whether, as with Datix and other systems, we need staffing level reporting to be seen not as whistleblowing but as something that should be done routinely. Whistleblowing would then start to become a smaller and smaller part of what staff might feel they had to do.

[Justin Madders]

That is an important point; we should see reporting issues such as staffing levels as something that would not be such a big deal. As is happening in Scotland, the safe levels should be ingrained not only into law, but into the culture of the workplace.

In conclusion, I repeat the same point that I made when the recent statutory instrument was discussed: that we now have a two-tier whistleblowing system, which provides some NHS employees with a greater level of protection than others working in the health and social care sector—social care workers, construction workers or anyone else who does not happen to work within those particular areas. Social care in particular is an issue. Public Concern at Work found that more than half of whistleblowers also reported some kind of victimisation, with 23% saying they had been dismissed after raising concerns. I ask the Minister, who is of course also responsible for social care, whether she considers that a satisfactory state of affairs.

Whistleblowers should be not just protected, but celebrated for the role that they play in defending the safety of others. Nobody making such a disclosure should do so in fear, wherever they work, nor should they face the risk of having their livelihood taken away. We owe it them to ensure that those protections are as effective as they can be.

Health and Social Care (National Data Guardian) Bill

Justin Madders Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Friday 6th July 2018 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I congratulate the hon. Member for Wellingborough (Mr Bone) on his success in making progress on this Bill in pretty quick time—as he candidly said, quicker than some other private Members’ Bills, which may well be down to the Government’s view on the merits of particular Bills. As the hon. Gentleman said, there are other Bills that we would like to see make progress, but that is not to detract from the merits of this one.

As I said when we last debated the Bill, the Opposition welcome the decision to put the National Data Guardian for Health and Social Care on a statutory footing. As we know, the use of data has the potential to improve every aspect of the NHS, from transforming the way in which we diagnose illnesses such as cancer to improving the patient experience by ensuring that every clinician at every stage has the complete picture. We know from experience that the use of data in the NHS can be controversial at times, and patients sometimes raise concerns. Those concerns are not unfounded.

Official figures show that more than 100,000 patients were caught up in NHS data blunders in 2016-17. The number of serious data incidents has doubled in a year and they are now occurring at a frequency of one every three weeks. It emerged last year that NHS Shared Business Services had failed to deliver just under 709,000 letters from hospitals to GP surgeries, with the correspondence being left in an unknown warehouse. Such examples show the importance of an effective, modern data protection system with robust safeguards, which is central to securing public trust and confidence in the NHS.

[Scott Mann (North Cornwall) (Con)]

The hon. Gentleman might or might not be aware, but in Cornwall we have a higher proportion of cases of glaucoma than any other place in the country, and we know no reason why. Does he agree that sharing information on that could help us to understand why some of these complex conditions occur? Does he also agree that when the Data Guardian is in place, they might be able to look at and break down the data to work out why some of these conditions exist?

[Justin Madders]

The hon. Gentleman is absolutely right that there are many variations in conditions and, indeed, outcomes throughout the whole country. The importance of data in establishing patterns cannot be understated.

[Chris Philp]

The British Heart Foundation recently said of the research environment that “too much” of its researchers’ time

“is taken up with unnecessary red tape and bureaucracy. The weight of this form-filling is slowing down vital discoveries”.

Does the hon. Gentleman share my hope that putting this role on a statutory footing will help to address such concerns?

[Justin Madders]

Whenever we speak to anyone in the NHS, particularly GPs, they express concern about form filling, but it is important that due processes are followed and that there is a clear audit line. I am sure that the hon. Gentleman can have a word with the Minister about what practical steps can be taken to deal with some of the British Heart Foundation’s concerns.

We support the establishment of a statute-backed Data Guardian because it is one way to improve confidence in the way data is used. As I said in Committee, we are concerned that the Bill does not include an absolute obligation for data controllers to act on advice—only to have regard to it—and there appears to be no requirement for organisations to state proactively how they have dealt with such advice. Responses to question 5 of the Government’s consultation were overwhelmingly supportive of such a provision. In that question, the Government proposed that

“organisations holding health and care data which could be used to identify individuals should be required to publish all materials demonstrating how they have responded to advice from the National Data Guardian.”

In their response to the consultation, the Government said:

“Responses were supportive of the proposal that the national data guardian should be given formal advice giving powers.”

That would certainly provide reassurances that the National Data Guardian will have real authority and act as an independent voice for patients. Without statutory backing, it is foreseeable that the National Data Guardian’s authority and independence could be undermined. Without a requirement for organisations that receive advice to provide evidence of their response, it could be difficult to be sure that the National Data Guardian is effective in doing the important job required by the Bill.

I am sure that Members will recognise that the requirement for a body to have regard to advice does not always mean that the body acts on that advice. We know that how clinical commissioning groups interpret the guidance of the National Institute for Health and Care Excellence leads to some variations in the way in which treatments are dispensed and that advice does seem to be ignored with impunity by CCGs.

I know that the hon. Member for Wellingborough does not see the need for additional powers to be handed to the guardian and does not want to see effectively a regulator, which is the road that my proposals may be taking us down, but it is important that, when the Minister responds, she gives us some indication as to what yardstick she proposes will be used to ensure that the concerns that I have set out will be effectively judged by the guardian.

In conclusion, although I have set out some concerns, we are not intending to oppose the Bill as it is currently drafted today.

Healthcare on English Islands

Justin Madders Excerpts

Wednesday 27th June 2018 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is, as always, a pleasure to serve under your chairmanship, Mr Hanson. I congratulate the hon. Member for Isle of Wight (Mr Seely) on securing the debate and on his very knowledgeable presentation of his constituents’ concerns and views. It is clear that health services on the Isle of Wight face challenges that, as he eloquently set out, are unique and require a tailored approach. However, there are similarities between the experiences that he reported and people’s experiences with health services throughout England.

When we think of the geography of England, there can be too little appreciation of the fact that England covers just five eighths of Great Britain, and includes more than 100 islands. Those islands are an intrinsic part of our nation, as you will know, Mr Hanson. Not too far from both our constituencies is Hilbre Island, which, although it has no resident population, is an important part of our area’s history and culture. Like Hilbre, the vast majority of islands do not have a permanent population. Most of those that do are connected to the mainland by road—examples are Canvey Island in Essex and Portsea Island in Hampshire—and, as a result, their healthcare services are very integrated with those of the surrounding areas.

As we have heard, however, there are islands, including the Isle of Wight, the Isles of Scilly and Holy Island, that are accessible only by sea and air, and they do not benefit from such ease of access. That poses serious challenges, particularly for the smaller islands, especially in emergencies, which of course cannot be planned for.

Before discussing the points made by the hon. Gentleman about the Isle of Wight, I will touch on the situation on some of the other islands in England. Many do not have their own medical facilities providing emergency care, because of their smaller populations. With the exception of the Isle of Wight, all our islands are served by NHS organisations based on the mainland. For those with road access, ambulances from the mainland can reach patients without undue difficulty. However, those without access have had to develop local approaches to providing support. Much of that support comes from volunteer community first responders, who reach patients before an ambulance can arrive to provide first aid.

On behalf of the Opposition, I pay tribute to all those who give their time to such services. They provide a vital lifeline in their communities. We do not speak enough about the role that volunteers play in our health service. I have seen for myself during a stint at my local ambulance station how volunteer responders can play an important role in assisting paid professionals. On that occasion, it was in a rural location, but the principles about access and timely intervention also apply there.

I understand that last year a volunteer first responder group was launched on Holy Island, which as we all know is inaccessible at high tide. Supported by the North East Ambulance Service, the group plays an extremely valuable role. There are similar groups across many of our islands.

In the time that I have served on the Front Bench, I have been privileged to visit several air ambulance services. They, too, play an extremely valuable role in providing urgent care in isolated areas. Again, much is down to efforts by volunteers and to fundraising, as they are of course charities. There was a reception at Parliament yesterday for the various regional air ambulances, and I was very pleased to see a great many parliamentarians attend to show their support. It is concerning to consider what the position would be for our island communities if those volunteer organisations were not involved.

Aside from the Isle of Wight, the Isles of Scilly are our most populous islands that can be accessed only by air or sea. Despite five of those islands being inhabited, there is just one minor injuries unit, at St Mary’s, so the island is hugely reliant on the five ambulance all-terrain vehicles that serve the island. Many non-emergency procedures have to take place on the mainland because of the need to access specialised treatment for conditions. The cost of accessing that treatment is usually met by the patient, when they are not in receipt of qualifying benefits. That can cause problems for a number of individuals.

As the hon. Member for Isle of Wight said, for those who live on the Isles of Scilly, a £5 concessionary fare on the Skybus to the mainland is available, but that covers the cost of the journey only from St Mary’s to Land’s End; there is the additional cost of the remainder of the journey. However, that is still a better situation than the hon. Gentleman’s constituents enjoy—or not, as the case may be. It was perfectly reasonable for him to raise that anomaly, which he described as an inequitable situation. He was also right to raise the issue of families travelling to the mainland. It is important that those faced with an extended stay in hospital have the support of family and friends.

The hon. Member for Isle of Wight set out three main arguments to show that his constituents are in a different position. He believes that the Isle of Wight is underfunded generally when it comes to health services. He made the point that it is the only English island separated from the mainland by sea that is without any kind of subsidy for patient travel. He also expressed a desire to integrate public services, particularly health and social care. He raised a point about the extra cost of providing public services on the Island, because of reduced capacity; that was no surprise to hon. Members. He said that services such as A&E and maternity are needed on the Island, because it is not possible to travel to the mainland in every emergency. He set out very well how that sometimes creates diseconomies of scale, and problems that require more working with mainland providers.

The hon. Gentleman made comparisons with the funding increases for other CCGs in recent years. He expressed a desire for his constituency to become a national leader in integrating local services. He will be aware that up and down the country there are a great many plans at various stages of development. It is clear that many communities are heading in the direction of greater integration between health and social care. On that point, I would be grateful if the Minister could indicate in his response whether he believes there is any need for legislation to bolster this development, particularly in terms of safeguards around governance and standards.

Earlier this year, the Labour party conducted a coastal communities consultation, which extended to the islands. The issues we have discussed this morning are exactly the kind of things that a future Labour Government would be keen to look at. We have heard that the Isle of Wight is a unique island in our nation, with such a large population being dependent on ferries to get to the mainland. As the hon. Member for Isle of Wight set out, the Island’s unique status has led to a unique response, in terms of the configuration of health services. The Isle of Wight NHS Trust is the only integrated acute, community, mental health and ambulance healthcare provider in England. The hon. Gentleman wants to increase integration further. As we also heard, in addition to the geographical challenges, there are demographic issues on the Isle of Wight. Its proportion of residents aged 80-plus is above the national average. That has an additional impact on health and social care costs. The proportion of patients with dementia is double the national average.

In response to some of the unique challenges the Island is facing, a service reconfiguration is being planned through the Hampshire and Isle of Wight sustainability and transformation partnership. That involves 89% of current hospital-based care remaining on the Island, with 11% of more complex and specialist treatments being provided on the mainland. It is clear that the hon. Gentleman would like as many of those treatments as possible to be dealt with directly on the Island, and for his constituents not to have to travel to the mainland to access them. I appreciate that that will not always be achievable, but I seek the Minister’s assurances that he will consider the measures that can be put in place to support those patients who will have to travel, and will often be in a vulnerable condition as a result of that. Will he confirm that the changes proposed are based on clinical, rather than financial, priorities? Will he also confirm that proposals will not lead to a reduction in the overall number of beds on the Isle of Wight? The STP document states:

“There would be no change in capacity at St Mary’s until actual changes in activity are put in place”.

That suggests that there may be some reduction in bed numbers.

The Isle of Wight NHS Trust was again rated inadequate by the Care Quality Commission as recently as April, and it remains in special measures. No fewer than 233 incidents were reported in which the NHS was found to be failing to meet its obligations to residents of the Island. I would be grateful if the Minister said what he is doing to improve the trust’s performance. The report recognised that there were some improvements, although those can never come quickly enough.

Finally, while many of the challenges facing our health service on the islands are unique, there are also many similarities in the challenges we face. One of those similarities is in the financial pressures trusts are facing as a result of the longest and most sustained period of financial constraint the NHS has ever faced. As a result of that, performance has deteriorated. Take the example of the four-hour A&E target, which the Secretary of State described as being critical for safe care. In 2010-11, 99% of patients were seen within four hours on the Isle of Wight, whereas today that figure has fallen to 88%. Some 22% of Isle of Wight cancer patients wait more than two months for treatment, which, again, represents a significant deterioration. That is not uncommon within other parts of the NHS.

The financial challenges faced by the Isle of Wight NHS Trust are deeply concerning, as the hon. Member for Isle of Wight set out, and I believe that they can be directly traced to years of austerity. As we have heard, the trust and the CCG will end the year in a significant deficit. The trust is having to take out more than £1.5 million in loans each month, which will have to be repaid. We have heard reference to the additional funding announcements made by the Prime Minister last week. We should acknowledge that those funding announcements, if they are delivered on, will represent nothing more than a standstill position, rather than an improvement on the current situation. It has also been confirmed that social care, capital spending and public health are excluded from that announcement.

In conclusion, I thank the hon. Member for Isle of Wight for the impressive way he set out the issues facing his constituents, and the unique challenges that face those on the Isle of Wight and our other islands. Giving the NHS the funding that it needs is at the core of all that.

Draft Nursing and Midwifery (Amendment) Order 2018

Justin Madders Excerpts

Wednesday 20th June 2018 General Committees

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Evans. As the Minister said, the draft order amends the Nursing and Midwifery Order 2001 to provide the Nursing and Midwifery Council with the necessary legal powers to regulate the nursing associate profession. Committee members will be relieved to hear that the Opposition do not oppose the draft order. We understand the importance of bringing nursing associates under the auspices of the NMC as soon as possible.

As we heard, the nursing associate role was create in response to the “Shape of Caring” review in 2015 as a defined care role to act as a bridge between unregulated healthcare assistants and the registered nursing workforce. Now that the role has been created, we agree with the Royal College of Nursing, which stated in its response to the Government’s consultation on these provisions that

“there must be absolute clarity that the nursing associate…is not a separate profession, but a new role within the nursing family that works under the delegation of the Registered Nurse”.

It went on to ask for “urgent guidance” to be published on “the precise relationship between” nurse associates and registered nurses

“in terms of delegation and accountability”.

Although bringing both roles under the same regulatory umbrella is a step in the right direction, will the Minister confirm whether we can expect such guidance to be issued? It is particularly important to try to achieve clarity and consistency given the varied roles that associates are taking during the implementation phase, not least for their benefit and for patient safety.

Let me turn to the amendments to the 2001 order, in particular the appointment of nursing associates to relevant panels. It is worth noting that the discretion afforded to the NMC for practitioners is slightly wider than it is currently for nurses and midwives. I presume that is to take account of the initial paucity of nursing associates with relevant experience to sit on panels. The NMC hopes that sufficient associates will emerge in due course to take a more active role in the process. Does the Minister intend to keep an eye on that, to ensure that in time these roles will always be judged by relevant peers?

The Opposition support the proposed approach to education and training for nursing associates. However, as my hon. Friend the Member for Easington said, there are concerns about continuing professional development across the board. As we heard, Health Education England’s budget for workforce development has been slashed by 60% over the last two years, from £205 million to £83.49 million in 2017-18. We had an announcement about increased spending in the NHS this week, but I understand that there was nothing specifically for training. I know this is slightly outside the scope of the order, but I would be grateful for some clarity from the Minister on that.

There is also a worrying shortage of qualified registered nurses to supervise the training of nursing associates. We are certainly in favour of the approach but urge the Minister to step up the availability of continuing professional development to ensure adequate supervision and training.

[Mr Sheerman]

My hon. Friend pushed the Minister early in his remarks on whether the Royal College of Nursing was fully consulted and on board. What is his interpretation—is it on board and in favour of all this?

[Justin Madders]

It is fair to say it is on board the train. On whether it is fully behind this, it is a question of ensuring that it is done in the right way. I will go on to outline where its main concerns lie.

As the Minister will know, there is a question about substitution. I commend his ingenuity in claiming that the vacancy rate in the nursing profession is only 1%, which must be a record for the public sector. I am sure he will be talking to his ministerial colleagues about how he has managed to achieve that. There is clearly an issue with the level of money spent on agency and bank nurses in the NHS, so we must remind ourselves that the real figure is much higher.

As my hon. Friend the Member for Huddersfield said, there is anxiety about substitution, particularly in the context of the high vacancy rate we believe there is. The fact is, more nurses are leaving the profession than joining it, and there is also a demographic challenge in that one in three nurses are due to retire in the next decade. In that context, there is well-founded anxiety that nursing associates could be used as a substitute for registered nurses.

I appreciate what the Minister said about providing a bridge or a ladder between particular roles, but there may be concerns, as some trusts have acted in, shall we say, a quite remarkable or coincidental way. The Warrington hospital trust agreed to reduce the number of full-time equivalent nurses on its wards by 23.58, and at the same time created 24 new nursing associate roles. That seems quite a remarkable coincidence and shows why there will be legitimate questions about whether the order will continue to be fit for purpose if it turns out that nursing associates are taking on more of the nursing role.

[Grahame Morris]

My hon. Friend makes an important point. If nursing associates are going to be used to replace registered nurses, that is a huge concern. Everything that we have learned about some of the terrible things that have happened—including the announcement in today’s statement—shows that numbers are important, but so is the right skill mix. We have to ensure that we have an appropriately skilled nurse workforce to ensure that we deliver high standards of care in hospitals and social care settings.

[Justin Madders]

My hon. Friend is absolutely right. We need to keep a close eye on that. It is not fair on the professionals involved, and it is certainly not fair on patients, if people are asked to do things beyond their capacity or competence. The order would be a fool’s errand if we found that that became commonplace.

Was the Minister aware of the issue in Warrington, and has he made inquiries about any risks or trends in substitution? Does he intend to put safeguards in place to prevent it from becoming commonplace?

[Mr Sheerman]

Today of all days, with the vote that we will all be involved in shortly, someone should put on record the question of how far the order, which I have read carefully, applies to nursing associates coming from Spain. My chief executive at the Calderdale and Huddersfield trust said that at one stage, the hospital could not have been run without young Spanish nurses, although they are much diminished in quantity now. Under the present visa regulations, could those Spanish nurses come in as nursing associates to train here?

[Justin Madders]

I think my hon. Friend’s question is directed at the Minister, rather than me.

[Mr Sheerman]

I think I was being naughty.

[Justin Madders]

I repeat the question that my hon. Friend has posed. There is provision in the order to take account of European economic area nursing associates, I think, but my understanding is that there is not a uniform description or role that fits the narrative across the board. We are still developing that, so comparisons are not necessarily easy to make. I urge the Minister to look carefully at the guidance on delegation and accountability for both roles, so that the scope of practice reduces any risk that staff are carrying out activities and duties beyond their professional remit.

We do not oppose the order or what it seeks to achieve, but I would welcome some reassurance from the Minister on the issues that have been ventilated. The nursing associate role has the potential to make an important contribution to the NHS, but—this needs to be reinforced—it can never be a substitute for the role of a registered nurse. I appreciate what my hon. Friend the Member for Huddersfield has said, because the role will allow people to enter the profession or the nursing world without being saddled with the debts that the Government’s current policy commits them to. Of course, the Opposition are committed to reinstating the nursing bursary, which I hope will reverse the trend we have seen in the past couple of years of a downward trajectory in the number of applications and a narrowing of the groups that have applied, but I do not see that as inconsistent with what the Government are trying to achieve today.

--- Later in debate ---

[Stephen Barclay]

From memory, the fee is the same as for a nurse in the NMC, which is £120, although I am sure that my colleagues will correct me if my memory is misplaced on that. That is a flat rate applied by the NMC across the board.

The hon. Member for Huddersfield and the Opposition Front Bencher also raised the issue of overseas staff. This will be a new role, and the Prime Minister’s announcement on tier 2 visas applies to existing roles, such as doctors and nurses, whereas this role is not currently in place. However, the opening of the nursing associate part of the register will provide a new registration route for overseas nursing staff whose competence and qualifications fall short of those of a registered nurse, providing that they can demonstrate that they meet the same high standards expected of a nursing associate trained in England. Again, just as it is a ladder for his constituents, it is a pathway through which European staff could potentially enter the NHS. [Interruption.] My memory was correct: the NMC has consulted on applying a fee of £120.

The hon. Member for Ellesmere Port and Neston mentioned the guidance. The Department is working with arm’s length bodies, NHS Employers, healthcare environment inspectorates and the regulators—the NMC and the CQC—to develop guidance. That will obviously need to be in place before the first tranche of nursing associates come out of their training in January ’19. I also note his point on panels. It is a perfectly fair observation, and I take it on board.

[Justin Madders]

I think the fee is still out for consultation.

[Stephen Barclay]

It is.

--- Later in debate ---

[Justin Madders]

The figure is proposed to be set at the same rate as for a nurse. I understand that, once the NMC sets up this process, the costs will be broadly similar to those for a nurse, but the fact is that this role is designated to be on “Agenda for Change” band 4, whereas nurses are in band 5. Does the Minister agree that there is possibly an argument that the proposed fee should be slightly lower to reflect that?

[Stephen Barclay]

I see exactly the point that the hon. Gentleman raises. The NMC is consulting on that, and I think that consultation should be allowed to run its course, but I am sure that his points will have been heard by those undertaking it.

Agency spend was raised. Again, that is an area of considerable focus within the Department. It is part of the transformation that the Prime Minister signalled with the investment announced on Monday, and there is a lot of work on, for example, e-rostering and how to give staff greater predictability and flexibility, and how we can use technology to facilitate that, because that also has an impact on retention rates.

I hope I have addressed the hon. Gentleman’s points. I am grateful for his and the Opposition’s support for the new role. It is important that we increase the number of people able to access roles in the NHS, and this is a valuable pathway to enable that. I commend the draft order to the Committee.

Question put and agreed to.

Resolved,

That the Committee has considered the draft Nursing and Midwifery (Amendment) Order 2018.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 19th June 2018 Commons Chamber

[Mr Hunt]

I visited the hospital not too long ago and was able to see for myself some of the estate issues the hon. Lady talks about. I can assure her that need is a fundamental criterion when we look at allocating capital funding.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

The Secretary of State knows that he has presided over a crisis in capital funding, with a £5.5 billion estimated maintenance backlog, £1 billion of which is classified as urgent. Yesterday’s statement hopefully goes some way to addressing that, although it was far from clear whether capital funding was included in that announcement. Can the Secretary of State confirm today whether any cash generated by the sale of NHS property under the Naylor review is in addition to the money announced yesterday?

[Mr Hunt]

Yes, I can.

Mental Health Units (Use of Force) Bill

Justin Madders Excerpts

Report stage: House of Commons
Friday 15th June 2018 Commons Chamber

[Jackie Doyle-Price]

That issue did come up in Committee. Although I appreciate the spirit with which the right hon. Gentleman makes that inquiry, we would not want to make a particular arrangement for one set of NHS data over another. Clearly, we need to explore this issue to make sure that there is some annual return on how this Bill operates when it becomes an Act.

I could say so much more, Mr Deputy Speaker, but I will not. Everybody in this House is very clear that they want this Bill to make progress. I appreciate that I cannot keep all Members happy all the time, but I do hope that I have been able to assure my hon. Friends the Members for Shipley and for Christchurch on how we will take forward their representations and that I can persuade them not to push their amendments to a vote.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

May I start by congratulating my hon. Friend the Member for Croydon North (Mr Reed) on progressing this extremely important Bill to this stage? I had the pleasure of speaking to it on Second Reading back in November. I am sure that the past seven months have felt pretty long to him, particularly as there were delays outside his control with the money resolution, and I am sure that that feeling was present again at times this morning. I hope that his diligence and persistence will pay off. We all know how much it will mean to see this Bill finally enshrined in statute. Nothing can demonstrate better the positive impact that a constituency MP can have in such circumstances, where there are clearly shortcomings in the current law, which we hope to put right.

I congratulate all hon. Members who have contributed so positively to the progress of the Bill, and the Minister on her constructive approach. I also echo the tributes paid to the Lewis family for the dignified and helpful way in which they have assisted in shaping this legislation. It has been evident from contributions that hon. Members have made during the passage of the Bill just how united we all are in our determination to do something to ensure that the tragic case of Seni is not repeated.

It is shocking to hear that, according to the Independent Advisory Panel on Deaths in Custody, 46 mental health patients died following restraint between 2000 and 2014. Victims of restraint in these circumstances have said that face-down restraint by groups of men adds to the trauma that in many cases led to their mental illness in the first place. As well as bias towards women, there is evidence to suggest that members of the BAME community are disproportionately more likely to experience restraint, so we strongly support the Bill, which we hope will reduce the use of force and address the unconscious bias currently reported in the system, by increasing transparency, evidence, accountability and justice.

In terms of transparency, data is not currently collected consistently, so it can be hard to collate accurate data on how often restraint is used and on how restraint is used disproportionately against certain demographics. We hope that the Bill will create a level of uniformity that is currently missing. Recording how and why restraint is used, who it is used on and what steps were taken to avoid its use will inject much needed transparency and consistently into the system. We will then be in a much stronger position to tackle the issues of unconscious bias or overuse of restraint to which hon. Members have referred throughout the passage of the Bill.

We need to ensure that if tragedies of this nature occur again, they are independently investigated and that justice is not only done, but seen to be done. As my hon. Friend the Member for Croydon North has set out, new clause 1 would make it compulsory for an independent investigation to be carried out whenever a death occurs in a mental health unit. He set out the thinking behind the new clause very well. The Minister set out why it is not something that she can take on board, but she did give a clear view of some of the safeguards that will be needed regarding independence, particularly when it comes to potential conflicts of interest or, as she said, appearances of conflicts of interest. She was clear and strong about the need for the ownership and involvement of the families in any investigation. That is of paramount importance. I look forward to hearing whether my hon. Friend considers that a satisfactory response.

In conclusion, the Bill is a step towards a model of care, rather than one of containment. Of course, it does not have everything that we would want, but it is an important step in the right direction that will support patients, their families and emergency service workers. I commend my hon. Friend the Member for Croydon North on his hard work in reaching this stage and look forward to Seni’s Bill becoming Seni’s law.

[Richard Benyon (Newbury) (Con)]

On a point of order, Mr Deputy Speaker. I seek your advice, because I have heard conflicting views. It is quite clear that we are not going to get to my Armed Forces (Statute of Limitations) Bill today. Would I be right that, if I were to not move it today and were to go to the Public Bill Office to seek another date, we would then have a better chance of having a debate? Many Members on both sides of the House want to debate the Bill, and there are 250 veterans in Parliament Square who particularly want the matter aired on the Floor of the House. I seek your advice on the best way to make that happen.

Health and Social Care (National Data Guardian) Bill

Justin Madders Excerpts

Committee Debate: 1st sitting: House of Commons
Wednesday 6th June 2018 Public Bill Committees

[Mr Bone]

I agree, but what we are not doing today is creating a regulator; I would not be likely to propose a Bill to create a regulator. The Data Guardian already exists and it is not a regulator—I specifically said that in my opening remarks. Although it is probably true that regulators do that, that is not what I expect to happen with the National Data Guardian.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure, as always, to serve under your chairmanship, Dame Cheryl. I congratulate the hon. Member for Wellingborough on his notable success in getting the Bill to this stage, and I thank him for his candour during the debate on the money resolution and for his acknowledgment of his good fortune in getting the Bill to this stage ahead of others.

As I mentioned when we debated the money resolution of the Bill, Labour Members welcome the decision to put the National Data Guardian for Health and Social Care on a statutory footing. On that basis, we agree with the thrust of the Bill. I am sure that colleagues will be relieved that I do not intend to speak for too long, but I have one or two comments and observations about clause 1—and about clause 2, which we will discuss a little later. I hope that the Minister will be able to respond to the points made by the hon. Member for Wellingborough, some of which I was going to make anyway.

I mentioned when the money resolution was debated that although the use of data has the potential to improve our health services and treatments beyond recognition, we know from past experience that use of data in the NHS and in wider society can prove controversial and carries high levels of suspicion among patients. We hope that the establishment of the Data Guardian on a statutory footing can give patients confidence that their medical information will be treated in the correct manner. I note from the comments of the hon. Member for Wellingborough that there seems to be an omission from clause 1 as it stands, as there does not seem to be an opportunity for the National Data Guardian to give advice to the Secretary of State himself, although he considers that duty to be covered elsewhere and that such as an addition would be superfluous.

There seems to be a discrepancy that leaves the Data Guardian in an inferior position to either the existing Confidentiality Advisory Group or the Health Research Authority. I would be grateful to know if that was the intention of the legislation. The power to appoint the Data Guardian rests entirely with the Secretary of State, seemingly without any qualification. Is it envisaged that the Health Committee might get an opportunity to comment on such appointments? Recent appointments in the health sector have proven controversial, so it would be appropriate for the Select Committee to comment.

Our second query relates to public health commissioned through local authorities. Given the heavy use of data in public health, it is surprising that that does not seem to be covered by the Bill. Given all the public health activity undertaken by non-public bodies in recent years, I would welcome comments from the Minister and from the hon. Member for Wellingborough about whether the Bill is intended to cover health in the broader sense.

There is also a query about other forms of data that are more directly within the NHS, such as the cancer registry, which resides in Public Health England. It uses data collected by the NHS that could affect the direct care of patients. I would welcome confirmation of whether the Data Guardian is intended to cover that data, too.

The hon. Member for Wellingborough touched on clause 1 (6), which I would like to explore in a little more detail. Labour Members might have expected it to include an obligation for data controllers not only to have regard to advice, but to publish their response to that advice. That expectation is not unrealistic, given that the responses to question 5 of the Government’s consultation were overwhelmingly supportive of such a provision.

In question 5 of the consultation, the Government propose that

“organisations holding health and care data which could be used to identify individuals should be required to publish all materials demonstrating how they have responded to advice from the national data guardian.”

In their response to the consultation, the Government said:

“Responses were supportive of the proposal that the national data guardian should be given formal advice giving powers.”

That would certainly provide reassurances that the National Data Guardian will have real authority and act as an independent voice for patients, but without such statutory backing it is foreseeable that its independence and authority could be undermined. Without a requirement for organisations that receive advice to provide evidence of their response in a way that can be easily disseminated, there is no way we can be sure that the Data Guardian will be effective in doing the important job required by the Bill.

Members will recognise that the requirement for bodies to “have regard” to advice does not always mean that they take action in respect of that advice. An obvious example of that is, of course, the National Institute for Health and Care Excellence guidelines, which we know CCGs often ignore—seemingly with total impunity. I am sure Members do not want a repeat of that with this Bill, so I ask the hon. Gentleman and the Minister to respond on that point in a little more detail. I take the point that providing such responses might be burdensome on authorities controlling data, but I do not think that that cuts the mustard, given our concern about whether this measure will give the Data Guardian sufficient authority and teeth to deal with the issues under discussion.

My final point on clause 1 relates to data sharing and the lack of a positive obligation for bodies to provide that information. For the National Data Guardian to take a view on a particular data issue, it must first know that there is an issue on which to take a view—an unknown unknown, as we say. Could we have a published register of data sharing arrangements to which NHS bodies could sign up and submit a copy of their agreements? That would provide the Data Guardian with a single point of reference from which it could note any new agreements outwith the norm; that is exactly what the Government committed to doing with the current public service delivery data sharing codes of practice currently laid before Parliament.

There is a danger that the Data Guardian will become involved only after an issue has already reached the public’s attention, and possibly after an inappropriate use of data that might already have affected thousands of patients. A positive obligation to shared data arrangements with the Data Guardian might reduce the risk of such an eventuality. I look forward to hearing from the Minister and the hon. Gentleman on those points.

[The Chair]

For the sake of our protocols, I should say that I had arranged for the windows to be opened because it is rather warm in this Committee room, but I am perfectly happy if people wish to remove their jackets.

--- Later in debate ---

[Mr Bone]

I am grateful for the support from the Minister and the shadow Minister, and I wish to pick up on a couple of points. The appointment will be down to the Secretary of State, but I absolutely expect it to go to the Health and Social Care Committee—I think that is understood. A point was raised about advice and having written reports on what is being done, but the argument against that is that we want to see action. There is some confusion—the Data Guardian is not a regulator, and therefore that is not its role. All organisations are covered by a regulator and will take into account what the National Data Guardian says. That is why I do not think that such a provision would work.

[Justin Madders]

I understand what the hon. Gentleman is saying, but it was clear in the Government consultation, and the response to it, that there was an intention for the body to have a few more teeth. Why did that change course?

[Mr Bone]

The problem is that we could easily say that we need to have a regulator, but that is not what the Data Guardian does. We do not want to come along afterwards and say what has gone wrong; we want to get this right at the beginning and work with the different holders of data. It is a different approach. The comparison I think of is when I was involved with combating modern-day slavery. We now have a commissioner for that whose job is not to regulate but to expose and say what is going well or badly, and that helps. There could be pressure on an organisation—for instance, if it gets really bad publicity it will do something about it, but equally the commissioner will show where things are going well. We do not want to move towards a regulator or have lots of enforcement powers because that is totally different to what we have already established with Dame Fiona. Each hospital has a Caldicott guardian in it, so we are basically putting something that works on a statutory footing for the future.

I am pleased by the conversion of the hon. Member for Rhondda to concerns about cost, and I shall remind him of that if there is ever a Labour Government in future—

--- Later in debate ---

[Mr Bone]

We have dealt with the heart of the Bill in clause 1. The subsequent clauses, while important, are not so detailed.

The purpose of clause 2 is to define some of the important terms used in clause 1. For instance, subsection (3) defines “adult social care”. I would clarify that children’s social care data, as has already been mentioned, is not within the scope of the Bill. It is covered via a different legislative framework and that framework has safeguards in place to protect children’s social care data from inappropriate use.

I would also point out that clause 2(7) provides that “processing” has the same meaning as given in section 1(1) of the Data Protection Act 1998. That definition has been used as it is a broad definition that captures a whole range of activity involving data, including obtaining, holding, recording, using and sharing.

[Justin Madders]

I wish to raise a point on the exclusion of children’s data. I appreciate that hon. Members have referred to it already, but we are slightly concerned that although children’s data may be covered elsewhere, the guardian does not have any ability to write to bodies in that respect. It is perfectly reasonable for that to be included; indeed, I think it was included in the original Bill as drafted. We see it as a safety net, rather than an added complication.

[Jackie Doyle-Price]

I confirm that the Government support the clause. On the point about children, it is our interpretation that the provisions do not prevent the National Data Guardian from engaging constructively with the Department for Education on adult social care data and its interaction with or effect on children’s data. Clearly, this is something we will monitor, but, bearing in mind that the whole ethos behind the creation of the National Data Guardian is to spread good practice and make representations rather than regulations, the concern that the hon. Gentleman has expressed is important, but we do not think it will get in the way of sensible engagement.

--- Later in debate ---

[Jackie Doyle-Price]

In regard to application, the provisions extend to England and Wales but apply only to England. I have to confess that my knowledge of devolution arrangements is perhaps not as good as it should be, but our view is that the Bill applies only to England. Although the provisions could extend to England and Wales, it would be within the competence of the National Assembly for Wales to appoint a guardian and make such arrangements. That said, the National Data Guardian is an advisory role—it is not a reserved power under devolution arrangements—and as is common in the operation of the health systems in all four nations, I would expect that the advice and guidance given by the National Data Guardian would be heard and, when appropriate, acted on by the health services in the other nations.

[Justin Madders]

My understanding when preparing for the Committee was that it would apply to England only. I think that is what the Minister has confirmed. Certainly in my part of the world there is quite a lot of movement of patients both ways between England and Wales, because we are quite close to the Welsh border. Can the Minister explain what will happen to patient records in that situation?

[Jackie Doyle-Price]

Clearly the Bill extends to England, but the purpose of the National Data Guardian is to give advice on the appropriate sharing of data and best practice. I should expect practitioners to have regard to the advice regardless of where they come from, because, notwithstanding the legal framework in which they operate, all health professionals want to behave in a responsible way. We expect the guidance of the National Data Guardian to be good practice. She has been giving advice without statutory powers to do so, and that advice has been respected; I think that that will continue. It is largely through an accident of the current structuring of the health service that the provisions are as they are. The principles under which the Data Guardian will give advice extend way beyond the geography of England.

NHS Outsourcing and Privatisation

Justin Madders Excerpts

Wednesday 23rd May 2018 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

This has been an interesting, passionate debate with many knowledgeable contributions. My hon. Friend the Member for Canterbury (Rosie Duffield) raised concerns about a new ALMO in her constituency and the impact on NHS staff working conditions, and I am sure that she will shine a light on that issue relentlessly. Like many Members, my hon. Friend the Member for Blaydon (Liz Twist) mentioned wholly owned subsidiaries, rightly highlighting the fact that the Treasury is turning a blind eye despite the fact that their creation represents a VAT loophole. That tells us everything we need to know about where the Government’s priorities lie. She mentioned NHS staff striking at the Wrightington, Wigan and Leigh NHS Foundation Trust because of their concerns about the impact that subsidiaries will have on their terms and conditions, and Labour Members send our solidarity and support. Government Members need to start listening to the staff.

My hon. Friend the Member for Stockton South (Dr Williams) gave a typically cerebral contribution. He was right that elements of privatisation encourage cherry-picking and a race to the bottom, and I look forward to hearing more from him on that. My hon. Friend the Member for Lincoln (Karen Lee) gave her frontline view of the problems in her constituency, speaking with real passion, and it would be wrong to characterise that first-hand experience as scaremongering. My hon. Friends the Members for Batley and Spen (Tracy Brabin) and for Bristol South (Karin Smyth) mentioned wholly owned companies. Both talked about the secrecy surrounding the plans—and Members sometimes wonder where conspiracy theories come from.

We also heard from my hon. Friends the Members for Kingston upon Hull West and Hessle (Emma Hardy), for York Central (Rachael Maskell), for Oxford East (Anneliese Dodds), for Birmingham, Edgbaston (Preet Kaur Gill), for Oldham East and Saddleworth (Debbie Abrahams), for Stockton North (Alex Cunningham) and for Coatbridge, Chryston and Bellshill (Hugh Gaffney). In fact, we heard from more than 20 Back Benchers today, so I do not have time to refer to every contribution, but some Members seem to have been in denial about the basic facts. Performance targets are being missed month after month, with A&E targets not forecast to be met until next year at the earliest and the 18-week treatment target seemingly dropped altogether. We have among the lowest number per head of doctors, nurses and hospital beds in the western world. We have a recruitment and retention crisis, with more than 100,000 vacancies across the NHS.

The biggest fact of all is that the NHS faces the harshest and most sustained financial squeeze in its 70-year history. Despite the squeeze, the amount of money being directed to the private sector has more than doubled. That is the NHS under the Tories: patients worse off while private companies cash in. We have heard countless examples of what is happening on the ground today and clear evidence about the damage caused by the wasteful, top-down reorganisation of the NHS created by the Health and Social Care Act 2012—damage predicted by just about everyone other than Conservative Members.

Conservative Members have known for years that the 2012 Act is not working, and even the Secretary of State was uncharacteristically coy today when he was given the opportunity to give his own opinion on it. After six years of disaster, we finally hear reports that parts of the Act will be overturned, but there has been no detail of what is proposed. Why are the media being informed of these plans instead of this House? If there is nothing to worry about, why will the Government not come clean? If Ministers are still formulating their proposals, let me offer them some advice: if they propose anything less than a properly funded, comprehensive, reintegrated public NHS that is free at the point of use, we will not support it and the public will not support it, either. If they will not give the NHS the funding it needs and end the toxic privatisation of the health service, we will. I commend the motion to the House.

Health and Social Care (National Data Guardian) Bill (Money)

Justin Madders Excerpts

Money resolution: House of Commons
Monday 21st May 2018 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

Thank you, Mr Deputy Speaker. I am sure that we can hang on for a couple more minutes before hearing the contribution of the hon. Member for Wellingborough (Mr Bone).

There is well-recorded Labour support for the Bill. The use of data has the potential to improve every aspect of the NHS by, for instance, transforming the way in which we diagnose illnesses such as cancer, and improving the patient experience by ensuring that every clinician at every stage has access to the complete picture. However, as we know from experience, the use of data in the NHS can be controversial, with high levels of suspicion among patients.

That suspicion is not unfounded. Official figures show that more than 100,000 patients were caught up in NHS data blunders in 2016-17. The number of serious data incidents has doubled in a year, and now, on average, there is one every three weeks. Last year it emerged that NHS Shared Business Services had failed to deliver just under 709,000 letters from hospitals to GPs’ surgeries, and that the correspondence had been left in an unknown warehouse. Those examples show the importance of effective, modern data protection laws with robust safeguards, which are central to securing the public’s trust and confidence in the use of personal information within the NHS. The establishment of a state-backed national data guardian for health and social care is one of the ways in which we can improve practice across the NHS and increase public confidence.

That said, the Government have fallen a long way short of their data aspirations. All hospitals and GPs were expected to be able to access GP records by 2014, and by 2015 patients were expected to be able to see all their own records online. We are some way from that, but the direction of travel is clear, which is why the Bill is so important.

The need for a data guardian is obvious, and we will support the motion, but it would be remiss of me not to mention that we are discussing a money resolution for the 94th Bill presented in the current Session. By an amazing coincidence, we have already heard extensively today from my hon. Friend the Member for Manchester, Gorton (Afzal Khan) about his Bill, which was the ninth to be presented but for which there has still been no money resolution. Do we know why that is?

It cannot be right for the Government to decide when to accept the will of the House, or whether to accept it at all. Money resolutions have historically been formalities, introduced as a matter of course after Second Readings, but now we see Ministers picking and choosing when to listen to the sovereign body of this country. The Government are defying the will of the House and overstretching their executive power in the service of their own electoral interests. Nothing in this debate will change that, but one day they will be sitting on these Benches again, and they may come to regret having played so fast and loose with Parliament.

Infection Prevention and Control

Justin Madders Excerpts

Tuesday 15th May 2018 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Howarth. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this extremely important debate and on his insightful contribution. He has a reputation for being one of the most prolific Members of this House, both here and in the main Chamber. He has pursued this issue assiduously during his time here, and his comments made clear his commitment to improving patient safety. His contribution was wide-ranging and fecund, and he highlighted the good timing of the debate, given that 5 May is World Hand Hygiene Day. There is a particular focus this year on sepsis, to which a number of hon. Members referred. We should reflect seriously on the staggering figures they mentioned: there are 30 million infections worldwide a year and 44,000 deaths in this country, and we could save between 5 million and 8 million lives a year through greater awareness and control. We all want to tackle sepsis very seriously.

The hon. Gentleman was right to say that there will not be any political disagreement today, as we all want the very best outcomes in this area. He was right that good progress has been made, particularly over a longer period, but it could be argued that we have plateaued. The infection rate remains too high. I am sure that we all agree that the figure of 6.4% across the NHS is far too high. He talked about the human and financial cost—he mentioned the figure of £1 billion. He made the fair point that this has downstream effects, as beds are occupied unnecessarily. It is always regrettable if any patient is in a bed because of something avoidable, particularly given that the number of beds across the NHS is at an historic low.

I was pleased to hear from the hon. Member for Morley and Outwood (Andrea Jenkyns). She has spoken on a number of occasions about this important subject, and she spoke again about the personal tragedy of her father’s death. She has been a consistent and vigorous campaigner on the issue since she came to this place. This is the first time I have heard in such detail the appalling circumstances surrounding her father’s death and the basic hygiene breaches that took place. I doubt that any member of the public, let alone any trained medical professional, would consider what happened there to be acceptable. That highlights the difficulties we sometimes face in tackling these issues.

The hon. Member for Amber Valley (Nigel Mills) made a considered and thoughtful speech about a wide range of issues. He referred to the World Health Organisation’s figures, which suggest that about half of the associated deaths in this country are preventable. He was right to say that in no other area would we be prepared not to tackle such a figure with great vigour. I agree with him that staff are not deliberately flouting hygiene standards, but the pressure of work sometimes means that standards slip. From the vacancy rates referred to by the Scottish National party spokesperson, the hon. Member for Central Ayrshire (Dr Whitford), and from regular staff surveys, we know how much pressure staff are under in the NHS. The hon. Member for Strangford highlighted accurately the difficulties with the existing audit processes and how they are not necessarily the best. He summarised perfectly the false comfort that we derive from the belief in 100% compliance rates. We know from what we have heard today that when audits are not taking place, compliance is considerably less than 100%.

The hon. Member for Moray (Douglas Ross) had clearly done a lot of important and excellent research to come up with all those statistics across a whole range of environments. He showed that there is no uniform picture in tackling infection control and suggested that the condition of the buildings might sometimes be an impediment to best practice. He rightly said that that is an area where many things can be learned from across the border, or indeed across the world—best practice should be disseminated.

The hon. Member for North East Derbyshire (Lee Rowley) talked about the need to reduce hospital admissions as one way of reducing infection rates. He mentioned anaemia in particular: apparently 4 million people have an iron deficiency and anaemia is the fourth most common cause of admission. He also mentioned sepsis and the possible gap in understanding or focus in the NHS, although we have heard today that a lot of awareness-raising is going on in that area.

It has been almost two and a half years since we last discussed this issue—January 2016—so today’s debate provides us with a useful opportunity to take stock of progress. We heard about a number of recent positive initiatives but, as the hon. Member for Strangford said, levels of healthcare-acquired infections remain stubbornly high, and in some cases they are increasing. Reductions in the rates of MRSA and C. diff are welcome, but the increase in MSSA and E. coli over the past five years is worrying. Furthermore, about one in every 16 patients will still acquire an infection while being cared for by the NHS in England, and every one of those infections requires additional NHS resources and, more importantly, leads to great patient discomfort and reduces patient safety.

According to the most recent figures from Public Health England, the fatality rate is 28.1% for MRSA cases, 19.7% for MSSA, 14.7% for E. coli and 15.1% for C. diff. We cannot overstate the seriousness of acquiring one of those infections. Furthermore, the Department of Health and Social Care reported recently that, sadly, E.coli infections led to the death of more than 5,500 patients in 2015, at an estimated cost to the NHS of £2.3 billion. The impact on patients and their families is devastating, while the growing threat of antimicrobial resistance adds to the significance of the issue.

In the US and Europe alone, antimicrobial-resistant infections are estimated to cause more than 50,000 deaths a year, and that figure is projected to increase significantly, as we have heard. A report by the World Health Organisation states that resistance is frequent among bacteria isolated in healthcare facilities, with antibiotic-resistant bacteria causing over half of all surgical site infections. We cannot overstate the importance of tackling the issue.

Healthcare of course carries inherent risks, and even if we were to take every possible preventative step, it would still be possible to acquire an infection. However, as I mentioned last time we discussed the matter, it has been estimated that about 30% of infections could be avoided by better application of existing knowledge and good practice. Much of that improvement could be realised through improved hand hygiene practices. Although we have known that for decades, the method of monitoring hand hygiene in hospitals remains outdated, inaccurate and, as we heard from the hon. Member for Morley and Outwood, flawed.

The monitoring method relies on direct observation by nurses, which leads to compliance rates being overstated and takes up hours of nursing time when staff on the wards are already overstretched. Staff naturally wash their hands much more frequently when being observed directly, which results in clearly overstated compliance rates of 90% to 100%. Academic research has found that typical compliance is actually between 18% and 40%. The international best practice to which the hon. Member for Strangford referred demonstrates that electronic monitoring of hand hygiene can decrease the risk of infection by 22%, which would not only save the NHS money, but save lives. We therefore welcomed the November 2016 commitment by the Secretary of State that staff hand hygiene indicators would be published for the first time by the end of 2017. However, as we heard, that deadline has elapsed and we seem to be no nearer to seeing implementation. Will the Minister tell us when we can expect to see the detail of that long-overdue improvement?

On 19 March, in a written response, the Minister mentioned that Public Health England had carried out some initial analysis with the available data, but that the data was incomplete, so it does not truly reflect hand gel usage. I accept that it might not provide an accurate representation of the NHS as a whole, but will the Minister set out what the analysis that he has received has found, and whether any of that information might be useful in the interim until the full dataset is available? Two ongoing pilots into the use of electronic monitoring technology within the NHS have also been mentioned. Has he made any assessment of those pilots? What plans do the Government have to look at universalising good practice, if it is shown to be as effective as early reports suggest?

As with any type of infection, healthcare-acquired infections can trigger sepsis, particularly in people who are already at risk—for example, those with chronic illnesses such as diabetes, or those who are immuno- compromised, such as those receiving chemotherapy. The majority of cases do not derive from a hospital setting, but with 150,000 cases a year and 44,000 deaths, many of them preventable, sepsis is a critical safety issue for the NHS. The challenge is to recognise it in its early stages, before multiple organ failure sets in, and to implement rapid treatment. If it is left untreated for hours, the chances of death increase rapidly. Sepsis in its early stages is often dismissed as something less serious, so I ask the Minister to advise us on what processes are in place to monitor patients at risk from sepsis. What steps will he take to ensure that treatment is started without delay?

In conclusion, around the world and in this country we spend vast sums of money on researching innovations to tackle illnesses and improve our welfare, but tackling hospital-acquired infections better would potentially put us in a position to prevent thousands of unnecessary deaths each year through the most basic of steps and the dissemination of best practice.

[Mr George Howarth (in the Chair)]

Before I call the Minister to respond to the debate, I remind him gently that it is customary to leave a short period at the end of the debate for the mover of the motion to wind up.