Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) Regulations 2020

Graham Stringer Excerpts

Monday 14th September 2020 General Committees

[The Minister for Patient Safety, Mental Health and Suicide Prevention (Ms Nadine Dorries)]

I beg to move,

That the Committee has considered the Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) Regulations 2020 (S.I. 2020, No. 791).

It is a pleasure to serve under your chairmanship, Mr Twigg. The regulations were made by the Secretary of State on 23 July and came into force on 24 July. We introduced the regulations to make it mandatory to wear face coverings in some indoor settings in England, such as shops, supermarkets and indoor transport hubs. The regulations are exceptional measures that have been brought forward to mitigate the unprecedented impact of the covid-19 pandemic, and they comply with all the Government’s obligations in relation to human rights.

[Graham Stringer (Blackley and Broughton) (Lab)]

I am grateful to the Minister for giving way so early in the debate. My intervention is relevant to the first point that she made. Paragraph 3.1 of the explanatory memorandum says that the order was laid on 23 July “by reason of urgency”. What was the urgency at that time, when this matter had been under debate for at least three months?

[Ms Dorries]

I will look further into what the urgency was, but I imagine that the evidence that we were getting at the time was that face coverings could prevent people who might be asymptomatic from spreading or contracting the virus. Any measure that can stop an increase in the incidence of coronavirus would have been deemed necessary to halt coronavirus, to stop it increasing in the community and to save lives. I will come back to the hon. Gentleman with further information on that.

The regulations are exceptional measures that have been brought forward to mitigate the unprecedented impact of the covid-19 pandemic, and they comply with all the Government’s obligations in relation to human rights. Above all, the regulations can help to save lives. I urge the Committee to approve the regulations, so that we may continue to use these powers to save lives. The regulations are a necessary response to the seriousness of the situation and the imminent threat to public health that is posed by the spread of covid-19, which is why they were brought into effect under the emergency procedure approved by Parliament for such measures.

It is important that the Committee is able to scrutinise the regulations through this debate. Further amendments were made to the regulations to extend the requirement to wear a face covering to a wider list of indoor settings that are now open to members of the public. Those amendments will be debated at a later date. This debate will therefore focus only on the regulations as they were originally made in July. This country has been, and still is, engaged in a national effort to beat the coronavirus, thanks to the hard work and sacrifice of the British people. Guided by the science, this progress has allowed us to cautiously ease lockdown restrictions, allowing sections of the economy, such as the retail and hospitality sector, to reopen.

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[Graham Stringer]

I am grateful to the Minister, who is as ever being generous. I think she is reading directly from the explanatory memorandum. I wonder if she would be good enough to point the Committee to the evidence she is referring to.

[Ms Dorries]

I will come to explain that a little further in my speech, but we take the evidence on face coverings from a variety of sources: not only the Scientific Advisory Group for Emergencies but the behavioural insights team at the Department of Health and the New and Emerging Respiratory Virus Threats Advisory Group.

When the retail sector reopened and footfall increased, we wanted to enhance protections for members of the public and ensure we were taking the necessary steps to build on the progress we continued to make in reducing the transmission of the virus. That is why we have made it mandatory to wear face coverings in indoor places such as shops, supermarkets and enclosed shopping centres. Similar measures have been adopted in Scotland and Northern Ireland and internationally in countries such as France, Germany and Spain, to name just a few.

I will now outline what the regulations do and set out the policies and processes underlying their development, implementation, monitoring and review. As I have said, the regulations introduced a requirement on members of the public to wear a face covering in relevant places such as a shop, supermarket, enclosed shopping centre and indoor transport hub unless they are exempt or have reasonable excuse not to. The regulations do not apply to employees working in those settings. The wearing of any protective clothing or personal protective equipment by the workforce is a matter for employers following a risk assessment and is part of their health and safety responsibilities. Definitions of shops and transport hubs are included in the regulations, as well as a list of premises that are excluded and where a face covering is not mandatory: for example, restaurants and bars.

The list of settings included reflected the premises that were open to the public at the time of making the regulations. As more settings reopened to members of the public, the regulations were amended to include additional indoor settings and provide more clarity to members of the public on where face coverings must be worn. Those amendments will be debated in due course.

Guidance on gov.uk describes a face covering as a covering of any type covering the wearer’s nose and mouth. People should make or buy their own. Guidance has been published online on how to make and wear a face covering. We are asking people not to use medical-grade PPE as that should be reserved for health and care workers. However, someone wearing PPE would be compliant with the regulations.

While the Government expect the vast majority of people to comply with the rules, as they have done throughout the pandemic, the regulations give powers to the police and Transport for London officers to ensure the requirements to wear a face covering. This could include denying entry to the relevant place and/or directing members of the public to wear a face covering. The police will use the usual four Es approach: explaining engaging and encouraging—and enforcing only as a last resort. In the event that a person fails to comply with a direction from a police officer or a Transport for London officer, a police constable is able to remove the member of the public from the relevant place.

The regulations also include powers for police constables, police community support officers or a TfL officer in relation to the relevant transport hub, to issue a fixed penalty notice to anyone over the age of 18 who is in breach of the law. At the time of making the regulations, that was a fixed penalty of £100, reduced to £50 if paid within 14 days of the notice being issued. Since making the regulations, we have made amendments to the penalty structure, with increased fines for repeat offenders. That is in line with the enforcement provisions in other coronavirus regulations. Parliament will have the opportunity to debate that amendment at a later date.

Although we want as many people as possible to wear a face covering, we recognise that some people are not able to wear one, for a variety of reasons. The regulations exempt children under the age of 11, employees or officials acting in the course of their employment in these premises, and emergency responders. There is no general exception on health or disability grounds. To reiterate, we recognise that, for some, wearing a face covering is not possible or would cause distress or difficulty, and there are certain situations in which wearing a face covering is not practical or reasonable.

The regulations provide a non-exhaustive list of circumstances that constitute a reasonable excuse, pursuant to regulation 3(1), for not complying with the legal requirement to wear a face covering in a relevant place. Such circumstances include where a person is unable to put on or wear a face covering because of physical or mental illness or impairment, or disability; where a face covering needs to be removed for communication through lip reading; where a person needs to remove their face covering because it is reasonably necessary to eat or drink; or where a person is required to remove a face covering for identification purposes. There is comprehensive guidance on what might constitute a reasonable excuse, including circumstances that are not expressly included in the regulations—for example, when a person is speaking to or providing assistance to someone who relies on facial expressions to communicate, or where a person needs to remove a face covering to exercise.

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[Graham Stringer]

It is a genuine pleasure to see you in the Chair this evening, Mr Twigg. This is first time I have served under your chairmanship, and I look forward to doing so on many further occasions.

There are a number of things I would like to say about this statutory instrument. Some relate to process, some to science and some are political. On the process, the Minister, for whom I have every respect, made the point that these regulations last for only 12 months, which is absolutely right. However, the downside is that when regulations last for only 12 months, no regulatory impact assessment is required. A regulatory impact assessment would of course have answered some of the questions asked by the right hon. Member for Elmet and Rothwell, as well as by my right hon. Friend the Member for North Durham, my hon. Friend the Member for Warwick and Leamington and my hon. Friend the shadow Minister. That is to be regretted, but it is part of a bigger lack of scrutiny, which I will come to in a minute.

First, I want to make a very general point. I do not envy the Secretary of State for Health and Social Care, any Health Minister, or, indeed, any Minister from other parts of the Government who has to deal with these issues. They are really difficult. People have died. It is difficult to know what to do. When Ministers and the public pray in aid science—of course science should be looked at—I think people sometimes misunderstand its capabilities. If someone wanted to find the escape velocity of a rocket to leave the earth’s gravitational pull, they should go to an astrophysicist, who would give the exact figures. If they are given the weight of the rocket, they will be able to say the force required to reach that velocity, because physics in that sense is an exact science.

The science surrounding this pandemic is not exact and cannot be exact, partly because it is a new virus and people do not know anything. I suspect it will surprise members of the Committee to know that, as far as I am aware, in real situations or in laboratories, no experiments have taken place on covid-19. We are relying on experiments on other germs, bugs, viruses and bacteria, and on other kinds of experiments.

I will come back to the science, but the biggest point, on which I think I am in agreement with the right hon. Member for Elmet and Rothwell, is that there should be much more scrutiny of this legislation. I recently read the Lords Hansard from when the Coronavirus Act 2020 was passed. In that debate, phrases were used such as, “It would normally be anathema to a democratic Parliament to pass these regulations,” and, “Unprecedented powers are being given to the Government.”

The Minister in the Lords gave all the assurances one would have expected him to give: at the appropriate time, when these wide and extensive powers were used, there would be proper parliamentary scrutiny. It is not just about this SI—there have been many such statutory instruments laid and used, in terms of levels of fines and what is and is not against the law, that have yet to receive parliamentary scrutiny. We have been back here for some time. That is a breach of trust, given that all the parties gave the Government support for the Coronavirus Act 2020.

To go back to the science, one problem Ministers have is that most of them do not have a scientific background and, therefore, have not challenged the scientific advice, which cannot be that precise. In early April, the deputy chief medical officer said that masks should not be worn and that they even have a negative effect. I can understand why Ministers followed that. A few days later, on 16 April, the Secretary of State for Transport said that wearing masks would have a negative effect. In the next month, masks were introduced on transport and now we have them in shops and all sorts of places. Challenging the advice and asking for its source in the first place might have led Ministers to reach different decisions earlier, and even to different decisions leading to this SI.

Most of the evidence on masks has come from experiments with mannequins, which are difficult to do, conducted in laboratory settings, not real settings, so when the Government’s scientific adviser and other scientists say that there is no evidence that masks work, they are right, partly because no experiments have been done on this virus. Also, in the experiments and work that have been done we have not had the scientific gold standard of being able to test one experiment against a double-blind experiment.

That is part of the science background. The Government now come along and said that there is some evidence to suggest that, when used correctly, face coverings might have some benefit in reducing the likelihood of getting the virus, but common sense and the non-covid experiments tell us that. The Government advise putting a scarf over one’s face or getting a mask, which is actually not in line with the World Health Organisation’s recommendations. Following experiments conducted not on the virus but by firing laser beams at masks in Australia, published in the Thorax journal, the World Health Organisation recommended that three-layer masks are better than two-layer masks. The Welsh Government have followed that recommendation of having three layers. Our Government say that two is probably okay, but people can do anything they want. Having moved from saying that masks were of no use to saying they are now of some use, they are not using the best scientific advice, which the Welsh Government are using, to advise on which masks should be worn. I think that is a mistake. We have to go one way or the other. It is understandable that Ministers do not always challenge the advice.

When I asked what the latest evidence was, I expected the Minister to say that there was a large meta-study done by Professor Melinda Mills of the Leverhulme Centre in Oxford. It was not fundamental research, but the study looked across the board at all the papers that had been done and found that 120 countries were advising on masks, so we would have been massively out of step not to follow the advice. I realise that the original advice was not in accordance with that, but the Government could probably have moved earlier and more effectively, with parliamentary scrutiny, to the conclusion that they have reached. The Lancet, which has criticised the Government’s tardiness and slowness on this matter, and could have argued with Professor Van-Tam and any of the other advisers, has pointed out that lack of evidence does not mean the evidence is not there. They could quite easily have challenged those things.

Finally, on the point that my right hon. Friend the Member for North Durham made, I was at a meeting at the weekend with leaders of local authorities and some of the Greater Manchester MPs and there was no support from anybody for the Government’s proposals on marshals. Will the Minister guarantee to the Committee that untrained marshals will not be given enforcement powers that would normally lie with well-trained public health officials or the police? The last thing we want is busybody marshals upsetting members of the public by being over-officious. The confusion of the Government’s messages in this and other areas has meant that many members of the public, particularly younger people, have lost trust in the Government’s message and are no longer following it. What would make that situation worse was if we had untrained marshals throwing their weight about and upsetting the public so that there was even less support for what might well be necessary regulations.

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[Ms Dorries]

No, because every policy dealing with covid has to be based on evidence and scientific facts. We have always followed the science and we are still doing that today.

[Graham Stringer]

Is the Minister saying that the advice given to the Welsh Government was different from that given to the United Kingdom Government, dealing with England in this case? Secondly, we on the Science and Technology Committee have had all the scientific advisers before us on a number of occasions and they have been clear that they lay the evidence before Ministers and they may give advice, but, in the final analysis, it is for Ministers to take the decision, which may differ from the detail of the advice, or the advice may have to be interpreted. They are clear that it is not their decision. Does she agree with that?

[Ms Dorries]

On the hon. Member’s point about who advises the Welsh Government, I have no idea. I would imagine it is their chief medical officer. On whether the scientists take the decision about whether people wear masks, no, they do not. That is not their responsibility. Their responsibility is to evaluate and assimilate evidence and provide us with that evidence.

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[Ms Dorries]

I want to be absolutely clear myself before I give a response, so I will come back to the hon. Member on that in the morning.

[Graham Stringer]

I want to make a point similar to the one I made in the Minister’s opening contribution. What was the evidence, when was it given to Ministers, and what meant we had to wait until recess before the decision was taken? That is key to me. I am sure that if she was in opposition, she would be making exactly the same point.

[Ms Dorries]

We know each other too well.

I want to ensure that what I give the hon. Gentleman is an absolutely accurate statement; therefore, I will give it to him in the morning in writing.

I will stick to the substance of the issues that were raised. On the comments about transport police, the British Transport police outside London have the authority and they use their four Es: engagement, encouragement—

Adult Social Care in Shropshire: Government Funding

Graham Stringer Excerpts

Wednesday 22nd January 2020 Westminster Hall

[Daniel Kawczynski]

I will give way for the last time, very quickly.

[Graham Stringer (in the Chair)]

Order. In half-hour debates on the Adjournment, people who speak have to have the permission of the proposer and of the Minister, and it is not good form to come in after the proposer has started speaking. I ask the proposer and the Minister whether Bill Wiggin has had permission to intervene.

[Bill Wiggin]

I am happy to withdraw my intervention, Mr Stringer.

E-cigarettes

Graham Stringer Excerpts

Thursday 31st October 2019 Westminster Hall

[Graham Stringer (Blackley and Broughton) (Lab)]

I put on record my thanks to the right hon. Gentleman for his time chairing the Select Committee on Science and Technology. It has been an interesting period, in which we have gone into great detail—effectively, I think—on many subjects. I was annoyed that NHS England, which has the time to put out often crass and obvious statements on health, did not have the time to come and give us advice on e-cigarettes, the use of which, as he says, is one way get people to stop smoking.

[Norman Lamb]

I thank the hon. Gentleman for that. I will call him my hon. Friend, because I am demob-happy and I do not care about the normal rules. It has been a great pleasure to work with him on the Committee. I share his concern. Given that the Government’s own tobacco control plan describes tobacco as

“the deadliest commercially available product in England”,

one would have hoped that the body that runs the NHS in England would show a strong commitment to confronting that clear risk. Despite it being very clear from all the available evidence that vaping is significantly less harmful than smoking, I none the less absolutely encourage continued research in this area. We should always be alert to anything that indicates a potential risk; that is exactly what our Committee recommends.

E-cigarettes are not only less harmful than smoking, but appear to be an effective tool for stopping smoking, as the hon. Gentleman made clear. A study published earlier this year in the New England Journal of Medicine randomly assigned adults attending UK NHS stop smoking services either nicotine replacement products of their choice, including product combinations, for up to three months, or an e-cigarette starter pack. That study of 886 participants found that the one-year abstinence rate was 18% in the e-cigarette group, compared with 9.9% in the nicotine replacement group. That is a significant difference, and we need to make sure that we act on that difference now that we have knowledge of the effectiveness of e-cigarettes as a stop smoking tool.

Results from a 2019 survey carried out by YouGov for Action on Smoking and Health—ASH—found that

“the three main reasons for vaping remain as an aid to quitting (22%)…preventing relapse (16%) and to save money (14%)”,

because people who vape spend much less money than people who smoke. That demonstrates that users perceive e-cigarettes as a stop smoking tool. E-cigarettes are therefore likely to help the Government to meet their ambition, announced in the prevention Green Paper, for England to be smoke-free by 2030. None the less, I accept that further research is needed on the effectiveness of e-cigarettes as a stop smoking tool. Will the Government or one of their agencies request further independent research on the effectiveness of e-cigarettes as a stop smoking tool?

Our report highlights the issue of what the NHS does on smoking cessation. Cancer Research UK recently pointed out that primary care clinicians face barriers to discussing e-cigarettes with patients who smoke; one in three clinicians is unsure whether e-cigarettes are safe enough to recommend. Given the death toll from smoking, it is extraordinary that it appears that clinicians are unaware of the clear advice from Public Health England in that regard.

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[Norman Lamb]

I suspect that the right hon. Gentleman knows better than I do, but I note the point that he makes. My view, based on the evidence that the Committee heard, is that the action taken by India is not based on evidence and is likely to result in more people dying of lung cancer. I think that is shameful.

I encourage all right hon. and hon. Members to read the helpful and comprehensive reply that we received from Public Health England on these issues and others, and which we have published so that anyone can delve into the detail. I am reassured that Public Health England is in “close dialogue” with a range of international partners, and I agree with Public Health England when it says:

“It is no exaggeration to say that inflating fears about e-cigarettes could cost lives.”

Incidentally, I have concerns about the attitude at the World Health Organisation, which does not take the same evidence-based approach, as far as I can see, as this country has done. Again, that has implications through the potential loss of life for millions of people across the globe.

It seems to me that people often conflate the fact that we do not have all the long-term evidence on vaping impact with an assertion that that should lead us to conclude that we should not be recommending vaping as an alternative to smoking. Frankly, that is stupid as a public policy approach, because we know that smoking is killing—I think—more than 70,000 people in England every year, and all the evidence so far shows that nothing like that is happening from vaping. According to Public Health England, it is 95% less dangerous than smoking. Therefore, the clear public health advice has to be that vaping is an appropriate way to help people give up smoking. Of course, the best thing of all is not to vape and not to smoke, but if that is not possible for someone, the clear public health advice needs to be that vaping is better than smoking.

Will the Minister set out what contact the Government —she or other Ministers—have had with other countries on international approaches to e-cigarettes? In particular, what are they doing at the World Health Organisation to encourage a more enlightened approach? What assessment have the Government made of the effects of those international approaches on public perception of e-cigarettes in the UK? What steps will the Minister take to ensure that this misinformation on e-cigarettes is challenged?

[Graham Stringer]

It is not only the World Health Organisation that is not using evidence for its advice, but the EU. The EU’s directive on the size of the bowls used and the amount of substance put in is not based on evidence. It is likely to mean that those people getting a nicotine kick—much less dangerous than cigarettes—will not find the products satisfactory and will go back to smoking.

[Norman Lamb]

I share the hon. Gentleman’s concern about the directive and the proscriptive rules relating to vaping, which do not appear to be sufficiently evidence-based.

E-cigarettes are positive in helping current smokers to stop smoking, and they are significantly less harmful than smoking conventional cigarettes. Yes, there are unknowns about long-term risks, and we need to maintain research on e-cigarettes, but doing nothing is not an option when people’s wellbeing and lives are at risk. I look forward to the contributions of other right hon. and hon. Members, and to the Minister’s reply.

Eurotunnel: Payment

Graham Stringer Excerpts

Monday 4th March 2019 Commons Chamber

[Matt Hancock]

Yes, I would be very happy to talk to my hon. Friend about that business.

[Graham Stringer (Blackley and Broughton) (Lab)]

This expenditure is only necessary because of the sheer incompetence of the Secretary of State for Transport. I have sat and listened to him in this Chamber and listened to him in the Transport Committee, and after every fiasco his defence is that it has not cost the Exchequer any money. The fact is that this has cost the Exchequer £33 million. Has he not run out of runway and should he not resign?

[Matt Hancock]

No, the decision to settle this case in order to provide for the unhindered supply of medicines, which I am sure that, like me, the hon. Gentleman, agrees is important, was the correct judgment and the correct decision, because we need to make sure that we keep people safe.

Leaving the EU: NHS

Graham Stringer Excerpts

Thursday 22nd March 2018 Westminster Hall

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I thank my right hon. Friend for bringing this debate to the Chamber today. As many Members will know, my predecessor Baroness Tessa Jowell is campaigning, in the face of the cancer that she is dealing with, for greater international research and access to dynamic trials and new treatments for patients suffering from brain tumours. Does my right hon. Friend agree that Brexit puts at risk exactly that kind of international collaboration—that access to data sharing and to international scientific research—that patients suffering from brain tumours and many other conditions need to see move forward, not backwards? This is a grave threat from Brexit.

[Graham Stringer (in the Chair)]

Before I call Ben Bradshaw, let me say that we have sufficient time, given the number of people who want to speak, but may I please ask that interventions are to the point and brief?

[Mr Bradshaw]

I absolutely agree with my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes). I will develop that argument in more detail in a moment.

Our Committee also recognised that the Government have ruled out, so far, continued membership of the customs union and the single market. In the absence of a change of mind from the Government, the Committee concluded that the least damaging Brexit for our NHS will be for us to keep the closest possible regulatory alignment with the rest of the EU in the long term. A majority of the Committee would probably have liked our recommendations to be stronger on that and to include keeping open the option of an European economic area-type relationship in the long term. However, as Committee members we recognised that it is much more powerful for a Select Committee to agree a unanimous report, which ours is, rather than to disagree on a contested one.

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[David Tredinnick (Bosworth) (Con)]

It is a pleasure to serve under your chairmanship, Mr Stringer. It is also a pleasure to see the Chair of the Health Committee, my hon. Friend the Member for Totnes (Dr Wollaston). When my right honourable Friend, then the Member for Charnwood, Stephen Dorrell, stood down, I had the pleasure to chair that Committee, which I served on during the 2015 Parliament, and it was a great disappointment when I stood against my hon. Friend and she won. I will not tell hon. Members about how close the contest was, other than that she won handsomely and has chaired the Committee very well.

This is a sombre day: the anniversary of the death of members of the public and of PC Keith Palmer not very far from here. On that day I was too close for comfort; I will not forget it. I reflected then, and I reflect now, that luck plays a part in life. We are all lucky to be here today.

I want to focus on a section of this important report and on the Government’s response. I see the Minister in his place. He took over from my hon. Friend the Member for Ludlow (Mr Dunne), who was my Whip for a while. I want to focus on the future staffing requirements and on delays and cost.

The report states:

“The Government’s plan for our post-Brexit should…ensure that health and social care providers can retain and recruit the brightest and best from all part of the globe”.

On healthcare, we have to think beyond the European Union when we address Brexit, and I congratulate the right hon. Member for Exeter (Mr Bradshaw) on securing the debate and on his introductory speech.

The Committee reported:

“The Government must acknowledge the need for the system for recruiting staff to the NHS, social care and research post-Brexit to be streamlined to reduce both delays and cost.”

The Government’s response states:

“We are also boosting the domestic supply of staff through expanding training places and nursing and other areas.”

We have to focus on other areas. The thrust of my remarks is that if we are going to solve the ever-increasing problems of demand in the health service generally and have a better service post-Brexit, we have to broaden the base of practitioners; we have to look beyond doctors and nurses.

As part of that, we have to pay attention to regulation. The Committee addressed that under recommendation 10, which states:

“Attention needs to be paid to the balance between patient safety as served by regulatory rules which may restrict access to the profession... Regulation should not evolve into unnecessary bureaucratic barriers that inhibit the flow of skilled clinicians into the NHS.”

What we need to do post-Brexit is get more skilled people—health practitioners other than doctors and nurses—who adhere to properly regulated registers, into the health service, to reduce the demand on the doctors, nurses and other hard-pressed professionals who work there.

I refer my hon. Friend the Minister to the recent report by the Professional Standards Authority and the Royal Society for Public Health. The PSA regulates 31 occupations, including acupuncturists, holistic therapists, hypnotherapists and clinical technologists, as well as the Society of Homeopaths, the UK Council for Psychotherapy and many others. One of its key recommendations was that its 80,000 regulated practitioners should have the authority to make direct NHS referrals in appropriate cases, thereby reducing the administrative burden on GP surgeries.

I have tabled questions about whether Ministers have considered the report, and to date I have not had a positive response. I am sure that that is an oversight. However, I want to point out to my hon. Friend, and perhaps to the Chair of the Health Committee, my hon. Friend the Member for Totnes, that Harry Cayton, who chairs the PSA, is not happy that the report has effectively been ignored. For years we have been told that better regulation is necessary before additional practitioners can be given the opportunity to practise in the health service. As soon as better regulation appears, that seems to be of no consequence. The report was produced by not just the PSA but the RSPH. Where else do we go? The work has been done, and I should like to hear from the Minister about the important work on regulation done by the PSA.

I want to refer to two parliamentary reports. In 2000 the House of Lords produced a report on complementary and alternative medicine and set out to categorise a wide diaspora of services that were available in that field. It came up with a classification, and it is important that I run through it. In the top rank were five categories of what were known then as complementary and alternative medical practitioners. The report said they had to be considered independently in relation to the question whether they should be included in mainstream healthcare. The five were osteopaths, chiropractors, acupuncturists, herbal medicine practitioners and homeopaths. I shall run briefly through those in relation to their appropriateness for use in the health service.

I had the honour to serve in the 1987 Parliament, and at that time the mantra was, “The osteopaths are out of control.” It was all about one or two miscreants and why they needed regulation. Some of us organised a private Member’s Bill, and I served on the Committee that resulted, in the 1992 Parliament, when John Major was Prime Minister, in the Act of Parliament that regulates osteopathy—the Osteopaths Act 1993. Osteopaths are now regulated by Act of Parliament. Not only that, but they have brought the different colleges of osteopathy together so that they are regulated by one body.

Secondly, there are the chiropractors, who are also back manipulators. We got another private Member’s Bill through the House. That became the Chiropractic Act 1994. The chiropractors came together—the McTimoney chiropractors and the others—and were bound together under one regulatory body. They are regulated by Act of Parliament.

Before I go on to the third discipline, my hon. Friend the Minister should be aware that the number of people taking hours off work for lower back pain is the highest for all complaints. He would do well to make better use of chiropractors and osteopaths in the new landscape post-Brexit. That is something we have ignored, and now we are freed from the European connection, or will be—although we will obviously have links—we should look at it.

The third discipline that the noble Lords referred to was acupuncture, which is regulated by the PSA, and the fourth is herbal medicines, which has different forms of self-regulation. In the 2010 to 2015 Parliament, I was asked by my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), then Under-Secretary of State at the Department of Health, to work with Professor David Walker on a report on herbal medicine. We met as a Select Committee meets, for the best part of a year, to produce a report that recommended further improvement in regulation. That is something we need to return to.

The last discipline referred to was homeopathic medicine. Homeopathy is the most controversial of all the treatments I have described, but has had huge support in the House. In the 2006-07 Session, Rudi Vis, a former Labour MP, whose constituency I forget, put down an early-day motion in support of six NHS homeopathic hospitals. That was remarkable for two reasons. First, it attracted over 200 signatures, or one third of the House. Secondly, it was signed by the Secretary of State—not the former Secretary of State, but my hon. Friend the Minister’s boss. He signed it—here is his name on the motion. He is sympathetic to homeopathy. His problem is that he has been sandbagged by people such as the chief medical officer, who knows nothing about it. That is a major problem.

The early-day motion said:

“That this House welcomes the positive contribution made to the health of the nation by the NHS homeopathic hospitals; notes that some six million people use complementary treatments each year; believes that complementary medicine has the potential to offer clinically-effective and cost-effective solutions to common health problems faced by NHS patients”.

In subsequent Parliaments, other motions were tabled, and there was a change in approach—not by members of the public, but by a tiny, vociferous anti group outside the House, which launched attacks on Members who signed the motion. I took that to the Speaker as a breach of privilege. There was a motion backing homeopathy in—

[Graham Stringer (in the Chair)]

Order. I have been listening carefully to the hon. Gentleman; he has referred his remarks back to the impact on the NHS of leaving the EU, but I think he is drifting a little. Does he think he could bring those remarks back to the subject before us?

[David Tredinnick]

I certainly can, Mr Stringer. I would be glad to. We served together on the Science and Technology Committee in the 2010 to 2015 Parliament, and you know my interest in this.

I will draw this all together with what is now a very important report. I have referred to the Lords report and said that there has been some doubt about complementary medicine. The reason the Government need to look at this post Brexit is the publication last week in The BMJ of a report entitled “Do NHS GP surgeries employing GPs additionally trained in integrative or complementary medicine have lower antibiotic prescribing rates?” More than 7,000 practices were surveyed—I will end on this point, Mr Stringer—and the report shows that there are statistically significant differences between the patient populations of surgeries employing integrated medicine and those of conventional GP surgeries. It is a properly formed report, and I suggest to the Minister that such treatments can reduce the cost and prescribing not only of antibiotics—we know that Dame Sally Davies published a book called “The Drugs Don’t Work”—but of other drugs.

In the post-Brexit landscape, the Minister has to look at a wider field. To ensure I stay in order, Mr Stringer, I turn to a question I asked the Secretary of State this week:

“Does my right hon. Friend agree that leaving the EU will be a good opportunity to build links with other countries’ medical systems, particularly those of the Chinese, who have, for instance, integrated Chinese medicine and western medicine to reduce the demand for antibiotics?”

The Secretary of State replied:

“My hon. Friend is right to draw attention to antimicrobial resistance because China is one of the big countries that can make a difference on that, and yes, we have had lots of discussion with Chinese Health Ministers about how we can work together on that.”—[Official Report, 20 March 2018; Vol. 368, c. 149.]

As a representative of Leicestershire, I found that significant, because Leicester’s hospitals have signed a memorandum of understanding with China—with a Nantong University-affiliated hospital—which expands a deal they already have to ensure greater research and training collaboration across the international medical community.

I have used Chinese medicine for years. I have no doubt that, post Brexit, when we have a better opportunity to strike deals and are no longer being hampered by the European Union’s restriction, we can bring those practices here. It would be good to set up a trial. Also, the Minister should look at the Indian Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy—AYUSH—which I will be visiting in September, to see how that wider base reduces healthcare costs in India.

When I was Chair of the Health Committee for a short time, I managed to get out a report on long-term care and conditions. About 15 million people in the UK have long-term conditions, which involve polypharmacy, or lots of drugs, and polymorbidity, or lots of problems. Many complementary therapies are effective in that context. That is another reason the Minister should look at them.

On Monday, the Secretary of State announced five new medical schools. Is the Minister aware of the time medical schools spend teaching the disciplines I have been discussing? In a five-year course, it is one hour. No wonder many doctors are reticent about such referrals, given that they do not understand the subject. Let us have a wider base of learning in the new medical schools so we have a better service in the future.

I have spent a long time in this House—30 years—and I have pretty much stuck to this subject right the way through. I think we are at a turning point with the report I have referred to, published in The BMJ, in which 7,000 practices are analysed. It blows out of the water the argument that there is no evidence. There jolly well is evidence, and if the Minister will only look at it, he can improve the quality of the post-Brexit health service, get better value for money, and bring people who have studied for years and who are out in the cold into the service. If he does that, we will have a much better situation than we have now.

Maternity Safety Strategy

Graham Stringer Excerpts

Tuesday 28th November 2017 Commons Chamber

[Mr Hunt]

I can absolutely confirm that. This follows a very interesting discussion on that topic we both had at lunch. My hon. Friend is right that the key is early intervention. Also, we know that continuity of carer makes a very big difference. If, well ahead of labour, people can meet the midwives who will be delivering their child, that can help reassure people and lead to safer births.

[Graham Stringer (Blackley and Broughton) (Lab)]

This is a very welcome statement. The Secretary of State will know of the very disturbing cases over the past few years in the Pennine health trust. Will he make space within the legislation for retrospective investigations where there have been a number of cases, as in the Pennine trust?

[Mr Hunt]

I will look into that very carefully. I am satisfied that there is strong new leadership at the Pennine trust and that it is being turned around, but it has told me about some of the cases to which the hon. Gentleman refers. They are of very great concern, and we absolutely must do everything we can to give answers to bereaved families.

Pennine Acute Hospitals NHS Trust

Graham Stringer Excerpts

Tuesday 17th January 2017 Westminster Hall

[Graham Stringer (Blackley and Broughton) (Lab)]

I beg to move,

That this House has considered the future of the Pennine Acute Hospitals NHS Trust.

It is a pleasure to serve under your chairmanship, Mr Streeter. We have a delicate path to tread in this debate. Over the past 10 years, there has undoubtedly been a scandalous failure of care within this NHS trust. It has been well documented; I will come to that in the middle of my comments. There has been a failure in the structure of the trust, a failure of management and, in individual cases, failure by clinicians, and people have suffered and died because of those failures.

That discussion and debate needs to be aired, while ensuring—this is the delicate balance—a solid and credible future for the hospitals in the trust, and particularly North Manchester general hospital in my constituency. The vast majority of clinicians, staff and employees in the trust are committed to the good care of patients, want the best for those patients and devote their careers and time to giving it to them. There is a delicate balance to be struck: I do not want any criticism of the trust to undermine morale further, but we have a responsibility to debate the issues. This is not about the present general debate on NHS cuts or the impact of the Health and Social Care Act 2012; it is specifically about the structures of the Pennine trust and some of its failures, and what we should do to secure its future.

Almost exactly 10 years ago, on 24 January 2006, I sponsored another debate on the Pennine Acute Hospitals NHS Trust; it can be found in Hansard at column 372WH. Shockingly, when I read that debate, I found that it covered almost exactly the same points that I believe we will discuss in this one. On the day of that debate, the front page of The Times highlighted misdiagnoses, with serious consequences, by the radiology teams at North Manchester general hospital, as well as at Trafford general hospital, which is not part of the Pennine trust. At the time, Professor George Alberti and Dr Joan Durose had written a report on the Pennine trust, which had been going for only three years, having been set up on 1 April 2002. The report found low staff morale, poor communications and poor administration, which is almost exactly what the Care Quality Commission’s current report found. The human resources director and medical director of the trust had already left, and after the 2006 debate, the chair and chief executive left.

We hoped for a better future and improvement through Professor Alberti’s 25 recommendations, but today we find that the chief executive of the trust has gone elsewhere and the current director of operations is on gardening leave. We are almost back where we were 10 years ago. In the meantime, there have been numerous warning signs that things have been going terribly wrong. One question on which I shall focus is why, even with all those red lights flashing all over the place for 10 years, with dire consequences for patients, the national organisation of the NHS and, more recently, the clinical commissioning groups did not notice them and sort out the situation.

The first strong warning sign that things were wrong came in a report from Channel 4’s “Dispatches” on 11 April 2011. “Dispatches” sent secret cameras into North Manchester and Royal Oldham hospitals in the Pennine trust, and found very poor care, amounting almost to low-level torture of some patients, who were shown not getting what they asked for. It was a terrible situation. At the time, I took up the case, and I am told that staff were disciplined.

[Liz McInnes (Heywood and Middleton) (Lab)]

Is my hon. Friend aware that the nurse who was dismissed as a result of “Dispatches” took her case to a tribunal, which instructed the trust to give her back her job?

[Graham Stringer]

I was not aware of that. There are obviously many technical details about the disciplinary situation of which I am not aware. However, I saw the programme, and the patients in that situation were undoubtedly treated appallingly. One cannot resile from what one sees directly.

[Liz McInnes]

I caution my hon. Friend against reading too much into the “Dispatches” programme. The tribunal overruled the trust. The reporters spent six months in the trust and managed to find two incidents, which they broadcast. When the case was heard by a tribunal, it ruled that the nurse in question should not have been dismissed.

[Graham Stringer]

As I just said to my hon. Friend, I will not go into the details, but I probably know more than she does about the situation from the patients’ side, because a relative was affected. I have no doubt that those patients were treated appallingly. I cannot comment on the details of personnel issues, but I can comment on the fact that patients have been badly treated. Given the technicalities of the situation and having watched the programme, I find it worrying that although one or two cases were found after six months, the nurses were re-employed.

After “Dispatches”, the CQC report found scandalous failings within the trust. It found that the safety and wellbeing of patients were inadequate, and that the trust’s responsiveness and effectiveness needed improving, but that the care of patients was good. That report was very worrying; the trust would have been put in special measures, if a new team had not already been put in place to deal with the situation.

As I say, the CQC report found that the care of patients was good, but within a very short time—and after excellent investigative work by Jennifer Williams of the Manchester Evening News and other journalists—an internal report on maternity care was made public, showing that the care provided by some individuals was very poor indeed.

It is worth reading out for the record an extract from that internal report, because we have now had a 13-year period of failure. It is also worth remarking that both that internal report and the CQC report relied on nothing but internal statements by the trust’s staff. A paragraph from the internal report really contradicts the CQC report, as it states:

“Staff attitude has been a feature of a significant number of incidents, from the most basic reports of staff relationship breakdowns, resulting in women and their families exposed to unacceptable situations, to an embedded culture of not responding to the needs of vulnerable women”.

The report went on to say of one woman that

“in one incident it is clear that the failure of the team to identify her increasing deterioration and hypoxia attributed her behaviour to mental health issues. Failure to respond to deterioration over a period of days resulted in her death from catastrophic haemorrhage.”

That means that, according to internal sources, the situation was actually worse than had been thought.

The report continued:

“A further example of staff attitude and culture has been experienced recently when a woman gave birth to her baby just before the legal age of viability (22 weeks and 6 days)…whilst no resuscitation would be offered to an infant of this gestation, compassionate care is essential. However, when the baby was born alive and went on to live for almost two hours, the staff members involved in the care did not find a quiet place to sit with her to nurse her as she died but instead placed her in a Moses basket and left her in the sluice room to die alone.”

That is inhuman treatment.

These failings are the failings of individuals, of management, who failed to sort things out, and of the structure of the Pennine trust itself. I could list a whole series of other cases. In fact, late last night I was contacted by constituents I know about another case. I do not know the details of that case, but my constituents wanted me to take it up, as they strongly believed that a misdiagnosis meant that proper therapeutic care had not been provided. So problems in the Pennine trust continue.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

My hon. Friend is making a very powerful speech and I share his absolute horror at some of the reports of the standard of care that some patients have received. Like me, he was at a meeting with staff last month, who also expressed their concerns about the quality of care being provided.

I am trying to understand something. Is my hon. Friend saying that this poor care, as set out in the CQC report and other reports, is endemic and is found right across the Pennine Acute Hospitals NHS Trust? Also, does he recognise that the new leadership is playing an important role and that the site leadership teams will have an important role in turning this situation around?

[Graham Stringer]

What I am saying is that there have been failures from the very beginning of this trust, in that it has four hospitals that were jealous of each other. That caused administrative problems, which means the trust has never worked well, and there is also a structural problem. Secondly, there have been failures of management to deal with those issues of individual failure to care.

I have enormous confidence in Sir David Dalton and the team who are taking over the Pennine trust. Sir David’s record of developing Salford Royal hospital is exemplary, and I hope that he can do the same with North Manchester general hospital and the other hospitals within Pennine.

As my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) said, along with my hon. Friend the Member for Heywood and Middleton (Liz McInnes) we met the trade unions in Pennine just before Christmas and, like the vast majority of the staff, they were committed to improving healthcare in the trust. Like my hon. Friend the Member for Oldham East and Saddleworth, I made the point that one has to acknowledge failures to ensure that there is improvement. One cannot just say that, just because so many staff are committed, that is good enough for the future. One also has to recognise the failure of the local clinical commissioning groups to deal with the problems, the fact that the board of the trust seems to have been paralysed and the fact that NHS Improvement has not dealt with the trust’s problems.

I have listed some of the cases that have caused public concern. One cannot put a financial cost on those cases, but if one reads the internal report on maternity care, one sees that the amount of money spent on compensation in the year 2014-15 was £58 million. I repeat— £58 million. Nearly £20 million went on three cases, which means that just over £6 million was spent on each one. In those cases, the people involved took legal action and at the end of the process were awarded that sum to look after severely handicapped patients.

There is no question but that, as I just said to my hon. Friend the Member for Oldham East and Saddleworth, Sir David Dalton has put in place a team who are committed to taking North Manchester general hospital out of Pennine and putting right what was a structural mistake.

It is worth reflecting on another point that was made in the Westminster Hall debate about 10 years ago, which is about why the Pennine trust was created. It was not created for good medical reasons. There was a public reason, which was given at the time by Billy Egerton, the then chair of the North Manchester health trust—I think that was what it was called. He said that he thought that if North Manchester general hospital had remained separate from the trust, it would have been prey to the predatory instincts of Manchester Royal infirmary and the major central hospitals in Manchester. First, I do not think that was a good idea—there could have been co-operation—and secondly, there were a number of chief executives in the trust who were retiring, which meant that three chief executives could be paid off and one chief executive found. Those three chief executives who were paid off came back and did consultancy work for the NHS. Unfortunately, that is the way that the NHS has dealt with problems. It has spent money, and wasted money.

The proposals for devolution will help to deal with the problem. The national structures have not worked. Having the combined authority, encompassing the 10 local authorities, taking decisions and examining these issues, with North Manchester general hospital being within the Manchester hospital schemes, is not a guarantee of success, but I generally believe that when decisions are taken closer to what is happening on the ground, they are more likely to be correct decisions than if they are left to a national body, which has clearly failed in this situation.

[Mr Ivan Lewis (Bury South) (Lab)]

I congratulate my hon. Friend on securing this incredibly important debate and on his years of attempting to highlight the dreadful failure of leadership—not of frontline staff, who do a remarkable job—in the trust. We have to hope that the future is better, but being dependent on the leadership of one individual in the long term is not always the best way to turn around an organisation.

In the light of my hon. Friend’s comments about local decision making, does he believe that at a time when accident and emergency at North Manchester general is under such tremendous pressure, it makes sense for Bury CCG to press ahead with its proposal to close the Prestwich walk-in centre? At a time when patients are being told not to go to accident and emergency services, it seems absolutely bonkers to close a walk-in centre that is so well used.

[Mr Gary Streeter (in the Chair)]

Order. Interventions should be brief.

[Graham Stringer]

I agree with my hon. Friend about the closure of walk-in centres. There has always been a conflict of interest between GPs getting patients through their surgeries and walk-in centres. At a time when there is stress across the whole Greater Manchester NHS—indeed, across the NHS in the whole country—to increase that pressure by closing walk-in centres seems—my hon. Friend says “bonkers”, but I would use slightly tamer language—perverse.

I will finish with some questions for the Minister. Part of the plans that Sir David Dalton and his team have in place, which involve separate management teams for the three major hospitals—putting Rochdale in with Bury—will require investment in the short term in 24 new beds for intermediate care and hopefully, in the medium term, the demolition of more than half of North Manchester general, which is a 19th-century workhouse, to turn it into a completely modern hospital. What will help staff morale most is a commitment to the future of the hospital on that site, dealing with a community with some of the country’s worst mortality and morbidity statistics. The Minister might not be briefed on this because it happened relatively recently, but the paediatric audiology unit has failed its accreditation assessment. If he does not know about that—I would not necessarily expect him to—will he write to tell me what the response will be and whether paediatric audiology will continue on the site?

On 13 December 2016, in a statement on the NHS deaths review, the Secretary of State, while recognising the difficulty in doing so, committed to trying to understand which of the highlighted cases were avoidable deaths and which were not. It is important for both the families and the public to know which of them could have been avoided and which were, unfortunately, the kind of unavoidable hospital death that takes place when someone is very sick. Was it a mistake to remove 31 medical beds from the hospital just over 12 months ago? As a result, the number of people being admitted into North Manchester general is lower, because there simply are not enough beds. What is happening to the people who otherwise would have been admitted?

Those are the detailed questions. The real question for the future is whether the Minister will give a long-term commitment to the hospital and to its moving into the Manchester hospital system. Given the statistics showing that men from north Manchester are likely to have lives that are six years shorter than those of men in the rest of the country, and that women’s lives are likely to be about 4.4 years shorter, is there a commitment to quality care and investment in the hospital for the future, to ensure that those rather damning statistics are changed?

[Several hon. Members rose—]

--- Later in debate ---

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Streeter. I am an ex-employee of Pennine acute. I worked for Pennine acute and its predecessor trust from 1987 for 27 years before I was elected to this place. I come to this debate very much from the Pennine acute staff point of view and our experiences of working there.

We have always worked against a background of change. Ever since I started work in the NHS, I cannot remember a time when there was not a new scheme coming up. It was always couched in the same language and everything was going to be different under the latest proposals. That has been my experience of working for the NHS in a 33-year career. There was always a new scheme on the horizon that promised the earth. We would try to give it a go and work with the new system, but systems were never given time to bed in. Just as we were getting used to a different way of working, a new system would come along promising the earth and everything was going to be wonderful under the new system. We all wondered what was so wrong with the old system that we had been told would be so good and solve all our problems. That, in a nutshell, is my experience as a member of staff working in the NHS.

Listening to the views of my hon. Friend the Member for Blackley and Broughton (Graham Stringer) and the hon. Member for Bury North (Mr Nuttall) was very interesting. They have been MPs in the area for a long time. My hon. Friend the Member for Blackley and Broughton said that Pennine acute was formed from four trusts that were jealous of each other, but I feel that is a misinterpretation. He was partially right in quoting Bill Egerton: the trust was formed because North Manchester general was worried about being swallowed up by Central Manchester. That was a fear shared by the staff as well, because none of the four hospitals that form the Pennine Acute Hospitals NHS Trust are teaching hospitals. There was a real concern among the staff that North Manchester general, a local hospital, might be swallowed up by teaching hospitals in central Manchester and disappear. Patients were also concerned that their local hospital would disappear. The trust treats a disadvantaged area, as has already been highlighted. The fact that life expectancy is low in that region is more to do with the quality of life rather than the standard of hospital care there.

Pennine acute was formed in 2002 from a merger of four existing trusts that I think merged to support each other. It was very much a banding together of four non-teaching hospitals that wanted to work together and make a success of Pennine acute. Obviously, any change is difficult, and the merger was a major change, but when Pennine was formed there was a real spirit to make it work. It was one of the biggest trusts in the country with 10,000 staff.

[Graham Stringer]

I am glad my hon. Friend agrees with me about the reason for the formation. Does she recall that within three years of the formation of the trust the consultants and the unions had an unprecedented vote of no confidence in the management? All the different hospital sites believed they were going to be closed at the expense of another site. Within three years the formation was not working.

[Liz McInnes]

I was coming to that point because my hon. Friend referred to the chief executive leaving. I inferred from his speech that that was as a result of a debate my hon. Friend had held in Parliament, but the chief executive left because the doctors had a vote of no confidence. The trade unions similarly expressed concern about the way in which the trust was being managed, but, as I recall, the trade unions did not have a vote of no confidence. Unless my memory is not serving me well, I do not recall the trade unions voting on that. I was heavily involved in the trade unions and I have no recollection of our having a vote of no confidence. That came purely from the doctors, who were concerned about the direction the trust was going in. It was as a result of that vote that Chris Appleby resigned from the trust. I was heavily involved in trade union activities as I was a workplace rep for Unite the union while I worked at the trust.

I want to highlight the issues involved in constant reorganisation and relocation. With the single hospital service proposal and with Healthier Together, we have two proposals running concurrently now, both of which seem to have different aims with different groups of hospitals working together. Healthier Together relies on the four Pennine acute hospitals working together and the single hospital service review, commissioned last year, proposes that North Manchester general should now work with Central Manchester and South Manchester. To add to the background of the constant confusion of reorganisations, we now have two different schemes that do not seek the same outcomes. I am sure everybody can understand how confusing and worrying such uncertainty is for the staff.

During the formation of Pennine acute, as a union rep I dealt with many staff who struggled with suddenly being told that their job was moving to another site and that they would be expected to relocate. Very little attention seemed to be paid to staff’s caring responsibilities. I dealt with several staff with disabilities, who had real issues about suddenly being told their job at North Manchester general no longer existed and that they were now expected to get themselves to Oldham at the same time in the morning, even though they had an extra six or seven miles to travel. There were real issues in dealing with staff and relocation in a sensitive manner. Such issues lead to uncertainty for staff and also make Pennine acute look an unattractive place to work.

In the meeting that we had with staff, they were very concerned about the maternity report that had been reported in the Manchester Evening News and the detrimental effect that it would have on staff who wanted to work there. At the meeting we heard from a representative from the Royal College of Midwives that a scheme had been put in place for improvements. The scheme is ongoing and midwives are now being recruited. There was an anomaly with the grade on which midwives were employed. They were being employed one band lower than they should have been, but that has been remedied. So there is an improvement plan in place and we need to be careful about extrapolating from dreadful incidents and saying that the whole of the trust is failing. I caution against that.

I have spoken about Healthier Together and the single hospital service running simultaneously, but seemingly both requiring different outcomes. The staff at Pennine are concerned about the single hospital service and the proposal that Central Manchester, South Manchester and Pennine acute should begin working together. Unfortunately, a lot of staff have been through it all before. They have been through the assurances that their jobs will be safe and that they will not have to move, but they have seen those promises eroded over time. Many are concerned about the prospect of having to journey right across central Manchester to go to work at Wythenshawe. That will be a lot of commuting for staff and they are very concerned about the proposal. The single hospital service review makes a virtue of staff being transferable—that is quoted in the document—and yet, at the moment, staff are being assured that they will not have to move.

On maternity care, the hon. Member for Bury North said that it is not a funding issue, but the appalling report on maternity services highlighted the lack of funding. In the past, there was a proposal to improve maternity services, called “Making It Better.” That was based on an annual birth rate of 3,500. The trust is now dealing with 10,000 births per year on the amount of funding that was settled on 3,500 births, so the funding issue obviously needs to be addressed.

The building stock at North Manchester is a real issue, as my hon. Friend the Member for Blackley and Broughton already mentioned. In my understanding, it was never a workhouse and has always been a hospital, but it was built to serve the workhouse that was built next door. The state of the building stock was always the reason that Pennine acute could not get foundation trust status.

CQC: NHS Deaths Review

Graham Stringer Excerpts

Tuesday 13th December 2016 Commons Chamber

[Mr Hunt]

My hon. Friend makes a very good point. We are making sure that all A&Es have liaison psychiatry services by the end of this Parliament. The critical issue is that someone with a severe mental health problem or learning disability who turns up in an A&E has special needs, and has bigger needs than the other patients there, but unless that is recognised early in the process, they are unlikely to get the care they need. If a tragedy then happens and they go on to die—as sadly happens sometimes—but the illness or disability is not known about, people do not realise that there are other potential issues. That is why the report is very clear that all acute trusts are required to know when patients have learning disabilities or mental health problems and to pay particular attention in any mortality investigations that happen regarding those patients.

[Graham Stringer (Blackley and Broughton) (Lab)]

The CQC has produced a grim report, and there was an even grimmer internal report on maternity services operated by Pennine Acute NHS Trust. Mothers and babies have died. I have put in parliamentary questions to the right hon. Gentleman and talked to the chief executive to try to find out which of those deaths were avoidable. I welcome today’s statement, but is it possible to be retrospective, so that the families of those people who have died in the Pennine maternity service can find out whether those deaths were preventable?

[Mr Hunt]

When the new guidelines are published, we need to investigate, as far as we possibly can, deaths that have already happened. I totally recognise the hon. Gentleman’s picture of Pennine and share his real worry about the standard of care in that trust. The positive thing is that under the leadership of Sir David Dalton—the chief executive of Salford Royal, which is one of the safest trusts in the NHS and a CQC outstanding trust—things are beginning to turn around. I have spoken to him about the situation at Pennine on many occasions. The hon. Gentleman is right to say that there is a lot of work to do there.

Alcohol Consumption Guidelines

Graham Stringer Excerpts

Tuesday 28th June 2016 Westminster Hall

[Byron Davies]

I am grateful for that intervention. I accept that we have to be very careful on that issue.

We should not be complacent. It is essential that public health advice keeps pace with advances in scientific understanding. Crucially, the communication of any guidance from the state must be seen to be above reproach and carry the confidence of industry and the public alike. However, I felt this debate was needed because I and several other hon. Members are concerned that the process by which the chief medical officer reaches their conclusion is flawed and has, in some ways, been hijacked by a group of campaigners with a clear anti-alcohol, total abstinence agenda.

Views are strongly held on this subject, which divides scientific opinion and the medical community. I recognise that that puts the CMO in a difficult position in making judgments about risk and in communicating sensible guidelines to consumers. We are bombarded with health advice from all quarters in this 24-hour social media age, and it is vital that anything published in an official capacity as advice from the Government’s chief medical officer is properly scrutinised and beyond reproach. I argue that the process that has been adopted, the clear conflicts of interest of the panel of so-called experts deployed to deliberate on these matters and the biased presentation of the findings have left a crisis of confidence in the new CMO guidelines among consumers, the media and industry. The Minister needs to address that in her response to the public consultation.

Let me deal with those points in turn. First, on the process adopted to undertake this review, the Department of Health guidance for expert group members states clearly:

“It is important to avoid any impression that expert group members are being influenced or appearing to be influenced by their private interests in the exercise of their public duties. All members therefore must declare any personal or business interests relevant to the work of the expert groups which may or may not be perceived by a reasonable member of the public to influence their judgment.”

Members of the guidelines development group set up to advise the CMO have been active policy advocates during the time in which the guidelines have been developed. Thanks to the investigative journalism of Sean O’Neill, chief reporter at The Times, it has come to light that an academic who played a key role in drawing up the controversial new safe drinking limits, Professor Gerard Hastings, did not even declare his links to the Institute of Alcohol Studies, a registered charity that receives most of its income from the Alliance House Foundation, which states that its aim is spreading the principle of total abstinence from alcoholic drinks. That is not quite putting Dracula in charge of a blood bank, but it is not far off.

Policy advocates such as Professor Hastings have taken strident campaigning positions. Many have a temperance or total abstinence axe to grind. They are clearly not neutral or, I argue, objective in their assessment of the costs and benefits of alcohol consumption. Indeed, the chief medical officer for England, when giving evidence to the House of Commons Science and Technology Committee on the proposed new alcohol guidelines, admitted that the experts

“found remarkably little evidence about the impact of guidelines, but we did not do them to have direct impact so much as to inform people and provide the basis for those conversations and for any campaigns that, for instance, Public Health England and others might run in the future.”

One member of the behavioural expert group, Dr Theresa Marteau, writing in the British Medical Journal, went further and stated that the new guidelines are

“unlikely to have a direct impact on drinking…but they may shift public discourse on alcohol and the policies that can reduce our consumption.”

Minutes from the guidelines development group meeting of 8 April 2015 state:

“It would be important to bear in mind that, while guidelines might have limited influence on behaviour, they could be influential as a basis for Government policies”.

There we have it. Never mind what consumers think about being told by the chief medical officer to think of cancer every time they hold a glass of wine or pour a can of beer, or that, as someone drinking a pint of beer a day, they are drinking more than they should. The not so well hidden agenda of the temperance activists is to influence Government policy to drive down alcohol consumption across the board. Wales has a strong Methodist and temperance tradition, which I respect, but I take issue with organisations such as the Institute of Alcohol Studies, which is funded directly by the temperance movement, helping to produce biased reports that are then given undue influence over the Government’s alcohol policy.

Having raised my concerns with the process adopted in undertaking the review, which I believe may have prejudiced the outcome and has certainly rendered the process lacking in credibility with consumers and the industry, I turn to the presentation of the review’s findings and, in particular, to the assertion that there is no safe level of alcohol consumption, the lowering of the recommended weekly levels for men in line with those for women, and the communication of risk. I believe that that assertion is at the heart of the flawed nature of the proposed guidelines and it is, in some respects, clearly deliberate on the part of campaigners. If the Government accept that there is no safe level of consumption, it becomes much easier to argue for more restrictions on alcohol availability,

[Graham Stringer (Blackley and Broughton) (Lab)]

I agree with the points the hon. Gentleman is making, specifically and generally. Does he agree that, not just on these guidelines but right across the board, Governments of all political colours have made a mistake in involving campaign groups and pretending that they are scientific experts? It is not just on alcohol, but in all sorts of other areas.

[Byron Davies]

I could not have put it better myself. I thank the hon. Gentleman for that intervention.

As I said, it becomes much easier to argue for more restrictions on alcohol availability, higher taxation of all alcohol regardless of strength, and more alarmist public health advertising to frighten people away from drinking. I am not a medic, but I have been around long enough to understand the old adages of “a little bit of what you fancy does you good” and “all things in moderation”—including international science. Indeed, looking into this further, I have discovered decades of evidence that shows the protective effects of low, moderate drinking.

Ealing Hospital

Graham Stringer Excerpts

Tuesday 3rd May 2016 Westminster Hall

[Several hon. Members rose—]

[Graham Stringer (in the Chair)]

Order. Before I call Dr Rupa Huq, I would like to explain the timetable for this hour-long debate. I would like to call the Opposition spokesperson at approximately 2.15 pm, and I expect him to take five minutes. Then the Minister can respond, leaving a minute or so for the proposer of the debate to reply. We seem to have plenty of time.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate my hon. Friend the Member for Ealing, Southall (Mr Sharma) on securing this extremely important debate and on the eloquent way he introduced it. He is widely known in this place for championing issues on behalf of his constituents; his contribution today will only further enhance that reputation. He presented a comprehensive picture of his constituency, rightly highlighting the scandal of health inequalities there and his concern about the implications for patient safety of the Government’s proposals. He cited staggering figures for the growth in elderly population in his area—not unique, but by no means to be ignored. He expressed his concern that the most vulnerable and those whose children have long-term conditions will have to travel further to access services, with possible negative implications for their economic situation. It is clear from what he said that he and his constituents have lost confidence in the process.

I draw attention to the contribution from my hon. Friend the Member for Ealing Central and Acton (Dr Huq). She is new to this place but is fast gaining a reputation as a Member who assiduously represents her constituents. She described the Government’s response as intransigent. If that is her experience, I am sure it is no reflection of the effort she has put in. She compared Ealing to the city of Leeds, and it is unthinkable that a city the size of Leeds would not have such fundamental health services as those being discussed today. She described what has been presented to us over the past few years as a bad deal all round. As an academic, she has based her comments on the evidence she has seen, not on opinion. She and my hon. Friend the Member for Ealing, Southall both expressed concern that Ealing hospital is on the way out. Those were not careless comments thrown about for political gain but genuine anxieties born out of what they see and hear.

My hon. Friend the Member for Hammersmith (Andy Slaughter) correctly said that the sooner the business plan for further implementation is available, the better. He identified the lack of information as a factor that has made the situation far more difficult than it could have been. As he says, where there is a vacuum, something will fill it. In this case, the vacuum has been filled by rumours—rumours so strong that two of my hon. Friends have felt compelled to raise them here today. He said that transparency will help; I certainly agree with that. I also agree that our concerns are no reflection on the hard work and valuable contribution that our NHS staff make each and every day.

More than 100,000 people have now signed the petition to express their concern about service downgrades and what they see as a real threat to the future of Ealing hospital. Their concerns relate to the “Shaping a healthier future” programme, which was launched in 2011 by a group of what were then 10 primary care trusts,

“to reshape hospital and out of hospital health and care services in North West London.”

Following the abolition of primary care trusts, the North West London Collaboration of Clinical Commissioning Groups has led the programme. It has proposed a number of extremely significant changes, including the downgrading of accident and emergency services at a number of hospitals.

In 2013, Ealing Council’s health overview and scrutiny committee referred the programme to the Secretary of State, who concluded that changes to NHS services in north-west London should proceed. In a statement, the Secretary of State said that five of the nine hospitals—Hillingdon, Northwick Park, West Middlesex, Chelsea and Westminster, and St Mary’s—would provide comprehensive, seven-day-a-week acute emergency care. He also stated that A&E departments at Ealing and Charing Cross hospitals would remain open, although with what—as my hon. Friend the Member for Ealing Central and Acton pointed out—he euphemistically called changes to the “shape or size” of services. Those changes have probably not turned out as people hoped. Changes were recommended to replace the A&E services of Hammersmith and Central Middlesex hospitals with urgent care centres, which were subsequently implemented in September 2014.

In 2013, it was decided that maternity services would be consolidated on to six hospital sites and maternity deliveries at Ealing hospital would cease. We have heard from my hon. Friends how significant that has been for their communities. The maternity unit at Ealing hospital was closed in July 2015. It has now been recommended that in-patient paediatric services should also be moved to maintain appropriate staffing levels. These changes have, understandably, caused great public concern, which in 2014 led to Brent, Ealing, Hounslow, and Hammersmith and Fulham Councils establishing an independent commission under Michael Mansfield QC to review the impact of the changes to the north-west London health economy and to assess the impact of planned changes.

On 2 December 2015, the commission published its final report, which was extremely critical of the “Shaping a healthier future” programme, finding that inadequate consultation had been undertaken and that departments had been shut without providing adequate alternative healthcare. Its recommendations included halting the SHF programme and that local authorities should consider a legal challenge. The Government’s response states that they are

“clear that reconfiguration of front line health services is a matter for the local NHS.”

It is clear from answers to parliamentary questions and a Westminster Hall debate on 24 March that both the CCGs and the Government do not accept the review’s findings.

The principle that decisions should be made locally by clinicians is sound, but there seems to be an issue about accountability in this case, as there is a clear feeling among the public and local politicians that their concerns are simply not being heard. Those who gave evidence to the commission were not fly-by-nights. Many were working on the front line of the services under discussion. Indeed, they are the local clinicians the Government say should be making the decisions. What recourse do clinicians, the public and patients have if they disagree so fundamentally with what is being done as we have seen here?

The most successful service reconfigurations are those where consultation is most effectively carried out and where support from clinicians at all levels, local politicians and, of course, members of the public is secured. It is no coincidence that when public concern is at its present level in Ealing and the surrounding communities, we tend not to see successful changes in provision.

Such was the frustration and concern about the changes that four local councils thought it necessary to use local taxpayers’ money to commission an independent report. As my hon. Friend the Member for Hammersmith said, the local authorities involved have behaved responsibly in commissioning this report. I do not believe there is any suggestion that they have behaved irresponsibly, so surely the Minister must acknowledge that taking this extraordinary step means that something must have happened that deserves further examination.

I turn to some of the recommendations in the independent report. Serious concerns have been raised about the consultation in 2012. There has been no significant further consultation since. Given that we are now four years on from that point and that the scheme has undergone considerable changes, as has the demographic make-up of the communities, it seems reasonable to consider a further period of consultation.

Concern was also expressed in the Mansfield commission’s report and here today about transparency, particularly in the business case on which the SHF scheme is based. I would welcome the Minister’s observations on both points, and if, like me, she is not satisfied that there has been sufficient public involvement, will she step in and ensure that that takes place before further downgrades or closures and that it is genuine consultation predicated on release of the full business case? Genuine consultation cannot take place if vital information is withheld. Transparency is the key to meaningful engagement.

The commission was asked to look at deteriorating standards in three local NHS trusts that were consistently failing to meet key targets, including that 95% of patients attending A&E must be seen, treated and admitted or discharged within four hours. The Minister will be aware that after six years of a Conservative Government, February’s figures are the worst on record for A&E waiting times. The most recent figures confirm that all three NHS trusts covering this area are failing to meet their targets.

In major A&E units, London North West Healthcare NHS Trust saw just 76% of patients within four hours and Imperial College Healthcare NHS Trust saw 69.1%. Does the Minister agree with the commission that the closures of Hammersmith and Central Middlesex A&E departments are responsible for these appalling figures, or is the Government’s overall record to blame?

Finally, the other key principle to which all service reconfigurations should adhere is that they should be based on clinical rather than financial need. They must represent what is in the best interests of the patients who access the services and not simply be a tool to balance budgets at any cost. In this case, because the Government have fundamentally lost control of NHS finances with 75% of trusts now in deficit, local people are understandably asking whether the serious financial hardship that the trusts face is forcing the CCGs to consider changes that they otherwise would not. Can the Minister assure us that no decision will be made in this case or any other on the basis of finance alone and that the interests of patients will remain the central focus at all times? It is clear that public confidence has been lost in this case, and it is simply not good enough for the Government to wash their hands of it. We urgently need an acknowledgement of those concerns and concrete plans to address them.

[Graham Stringer (in the Chair)]

To clarify, the debate, although it started early, will finish at 2.30 pm. Could the Minister leave a minute or two at the end for the proposer?