Paediatric First Aid

Mark Hunter Excerpts

Monday 15th December 2014 Westminster Hall

[Mark Hunter (Cheadle) (LD)]

I beg to move,

That this House has considered the e-petition relating to the Millie’s Trust campaign to train all nursery nurses in paediatric first aid.

Mr Chope, it is a great pleasure to conduct this debate under your chairmanship. It is a sombre subject that we are addressing this afternoon, and it is a difficult address for me to give, knowing the circumstances, and the family, Joanne and Dan Thompson, who are here with us today to listen to our proceedings. In parts, it might also be a difficult debate for Members to listen to.

Tragically, Millie Thompson passed away aged just nine months after a choking incident at a nursery school in my constituency of Cheadle. Following Millie’s tragic death in October 2012, her parents, Dan and Joanne Thompson, set up a charity called Millie’s Trust, as a legacy in Millie’s memory. I am delighted that they are able to be here today to witness our debate.

This Backbench Business debate is the next step for the Thompsons’ campaign, which has one simple aim: that all nursery and pre-school staff receive paediatric first aid training.

[Robert Flello (Stoke-on-Trent South) (Lab)]

I am grateful to the hon. Gentleman for securing this debate, and I am particularly grateful to the family, who are with us today. However, it is almost amazing that this requirement is not already law and on the statute books. The fact that there so many Members here from across the House should perhaps send a message to the Minister: “Let’s get this on the statute books really quickly.”

[Mark Hunter]

I thank the hon. Gentleman for his contribution and I could not agree with him more. I am delighted that so many hon. Members from across the spectrum in the House of Commons have been able to find time to be here today, when I know that—as ever in this place—there are plenty of other important issues being debated at the same time.

Millie Thompson was just nine months old when her parents, Joanne and Dan, left her in the care of a nursery in Cheadle Hulme. Her parents had done what every parent does when placing a child in an educational establishment, and as far as they were concerned they had chosen the very best place for their daughter because the establishment had an outstanding Ofsted rating in early 2012.

Millie Thompson passed away on just her third day at nursery. The Thompsons received a phone call stating that Millie was having problems breathing and when Millie’s mum arrived at hospital, sadly Millie had already passed away. Millie had choked on her lunch, which consisted of food that she had been competent at eating for several months previously, which added further to her parents’ distress.

On further investigation by the police, a few things became apparent. The nursery had used various first aid companies for their training, many of which no longer exist. Furthermore, the majority of staff were trained in first aid at work, which of course is not the same as paediatric first aid. However, two members of staff were trained in paediatric first aid, but we will see later why I believe that that was not effective enough and why we would like a change in legislation.

Millie was not given full choking treatment from any member of staff; she received only the bare minimum of treatment, which consisted of a few slaps to the back. Sadly, Millie’s parents have had to view CCTV coverage from outside the nursery on that tragic day, which showed many people running around, including the supervisor and the two members of staff who were trained in paediatric first aid.

[Mark Tami (Alyn and Deeside) (Lab)]

The hon. Gentleman is making a very moving case. Does he agree that it is surprising, bearing in mind all the other requirements and regulation around child care, that this requirement is not just part and parcel of it? As my hon. Friend the Member for Stoke-on-Trent South (Robert Flello) suggested, most of us would have assumed before this incident was highlighted that that was the case, and that trained people would be there and able to see the signs if such a tragedy was happening.

[Mark Hunter]

I thank the hon. Gentleman for his contribution and, yes, I totally agree. As the previous intervention by the hon. Member for Stoke-on-Trent South (Robert Flello) also suggested, most parents—I am a parent myself, although my children are now grown up—would assume when they are taking their children to a nursery that has all the relevant certification and regulation that the staff there will be adequately trained, and I intend to emphasise that point later.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I used to chair the Children, Schools and Families Committee and I remember pushing Ofsted on this issue; I also represent Huddersfield where the National Day Nurseries Association is based. This case has been a wake-up call to everyone that paediatric care in an emergency is totally different from first aid and needs specific training. I hope that this positive intervention from parents who are grieving—they are being positive and doing something about this issue—is an example to all of us to make these changes quickly.

[Mark Hunter]

I thank the hon. Gentleman for his intervention. Again, I could not agree more. I think that everybody, once they have focused on the issue, starts to appreciate that there is a significant difference between having a general qualification in first aid and having a qualification in paediatric first aid, which by the very nature of the fact that it involves dealing with small children—in this case, Millie was only nine months old—is rather more specialist. However, parents would naturally assume—I think we all would—that if they are placing their child in a nursery, the nursery would be covered.

The hon. Gentleman is also right to say that tribute must be paid to the Thompsons; after such a terribly tragic experience, they have made something positive through Millie’s Trust, which is creating a legacy in Millie’s memory. I will say more about that legacy later.

I will go back to the point I was making about the CCTV coverage. Millie’s parents have stated that it was obvious from that footage that when Millie was being taken out to the ambulance she was “like a rag doll” and they believe that at that point she should have been receiving CPR.

[Andrew Gwynne (Denton and Reddish) (Lab)]

I am grateful to the hon. Gentleman for giving way, and of course he is right to highlight these issues here in the Palace of Westminster today. However, this tragic incident not only highlights the failures in the nursery system—that is, the lack of paediatric first aid training—but the fact that until recently the ambulance services were not compelled to have the appropriate paediatric equipment in their ambulances. If one good thing has come out of the Millie’s Trust campaign, it is that the North West Ambulance Service has now pledged to ensure that all its ambulances have the appropriate paediatric equipment.

[Mark Hunter]

Again, I thank the hon. Gentleman for his intervention and he is absolutely right. I will come on to the point about how the North West Ambulance Service has responded to this case in the positive way that he has indicated.

On the day in question, Millie was being fed by the supervisor of the nursery, who had worked in child care for some 20 years; she was an experienced person. Yet, when this tragic incident happened, Millie received no treatment from the supervisor, because she was not trained in paediatric first aid. Instead, she handed Millie to another member of staff.

After Millie had received the slaps to her back, she was left in the arms of someone who was trained in first aid at work, not paediatric first aid. That should not have been the case. Sadly, of the two paediatric first-aiders at the nursery, one chose not to be involved and went to look after the other children while the second administered the back slaps and then left the building, through the nursery grounds, and went to the main road to wait for the ambulance. This should never have happened. The paediatric-trained first-aider should not have left Millie’s side until the paramedics arrived.

I will outline the treatment that Millie should have received and what should have happened at that point in time. Millie, as I said, received a few back slaps and was then held in a non-paediatric-trained first aider’s arms for around 10 minutes. On arrival, the paramedics immediately began standard choking treatment for a baby. By this point, it was tragically too late and Millie’s heart had stopped beating.

In a statement from the nursery, it was stated that one of the untrained staff members finger-swept Millie’s mouth, which all guidelines and all paediatric first aid courses state is the wrong thing to do. The treatment for a choking baby, as outlined on the NHS Choices website, is as follows:

“A baby who is choking will be distressed and may be unable to cry, cough or breathe.

Lie the baby face down along your forearm or thigh, with their head low. Support their head.

Give up to five firm slaps to the baby’s back between the shoulder blades with the heel of your hand. (The heel is between the palm of your hand and your wrist.)

Stop after each slap to check if the blockage has cleared. Look inside the baby’s mouth and remove any obvious blockage. Do not poke your fingers into the baby’s mouth unless you can see and reach the blockage. You may push it further in.

If the airway is still blocked, give up to five chest thrusts.

Stop after each thrust to check if the blockage has cleared.

If the baby’s airway is still blocked after three cycles of back slaps and chest thrusts, you should: dial 999 for an ambulance immediately. Do not leave the baby—take him or her with you to the phone; continue with the cycles of back slaps and chest thrusts until help arrives.

In babies under one year old”—

remember that Millie was under one year old—

“chest thrusts are used in an emergency to clear a blockage from their airway. Important: do not use abdominal thrusts with babies under one year old.

Lie the baby along your forearm on their back, with their head low. Support their back and head.

Give up to five chest thrusts. Using two fingers, push inwards and upwards (towards the head) against the baby’s breastbone, one finger’s breadth below the nipple line.

Check if the blockage has cleared after each thrust, by looking inside the baby’s mouth and removing any obvious blockage.”

Again,

“Do not poke your fingers into the baby’s mouth unless you can see and reach the blockage as you may push it further in.”

This is standard choking advice and every paediatric first aid course teaches these guidelines, which means that the staff involved that day should have given a statement as I just stated it.

[Alistair Burt (North East Bedfordshire) (Con)]

We are all moved by the hon. Gentleman’s description of what has happened, and impressed that he has put on the record exactly what should be done. I am the grandfather of a seven-year-old child, and we all go through these agonies about what we would do. Has he made any estimate of the amount of time and difficulty there would be in incorporating this work in a straightforward, standard course for paediatric care workers, so that we can see just how little time would need to be spent to make sure that all those working in nurseries have that sort of information available to them, and have practice doing what he has stated needs to be done, should there be a choking incident involving a baby?

[Mark Hunter]

I welcome the right hon. Gentleman’s intervention. The Millie’s Trust campaign has done an awful lot of work in this regard and is satisfied, I think, as most hon. Members who have considered the issue would be, that this can be done at no great cost. We hope that the Minister will make it clear that the Government are serious about their intention to address the subject. As other hon. Members have already said, with the benefit of hindsight, there is a loophole in the regulation that needs to be addressed urgently.

[Ann Coffey (Stockport) (Lab)]

I congratulate the hon. Gentleman on securing this very important debate and congratulate Millie’s Trust on its campaigning work on this issue. Was any member of staff on the premises that day trained in paediatric first aid? If there was, what happened?

[Mark Hunter]

Yes, there was. I mentioned just a few moments ago that, of the two paediatric first-aiders who were at the school at the time, one chose not to be involved, by going to look after the other children in the nursery, while the second member of staff with a qualification did carry out the back slaps, but then left the baby and went via the nursery grounds on to the main road to wait for the ambulance to arrive. So the child was actually left without the continual support of somebody qualified in paediatric first aid, which of course the guidelines clearly stipulate.

[Ann Coffey]

Would not the member of staff trained in paediatric first aid have appreciated the seriousness of the situation?

[Mark Hunter]

The only answer I can give is that one would like to think so. I think any parent would have assumed that to be the case. However, I will come on to that and to what the coroner said in this regard as well.

[Andrew Bingham (High Peak) (Con)]

I commend my hon. Friend for bringing this debate to the Chamber. It is a truly tragic story. Does he agree that, although this is always a serious issue, as more couples go back to work and ever more people are using child care, the gravity of this situation increases? One child lost is one too many, but with more people using child care they require more reassurance.

[Mark Hunter]

I could not agree more. That is one reason why it is long overdue for the Government to take this issue seriously and why they should make provision for a change in the regulations that will require this to happen in future. Hon. Members will be shocked to hear that in some respects the capacity of the regulations to help in a situation such as this has, in my view, been reduced; they have been weakened rather than strengthened. I am sure that that is the result of the law of unintended consequences, but that is what has happened and it will be a cause of great concern to all of us.

[Dr Liam Fox (North Somerset) (Con)]

I was a divisional surgeon with St John Ambulance and I also lectured in emergency medicine. The hon. Gentleman makes a good, specific case about what happens in nurseries, but very many more people are parents than nursery workers. Does it not seem absurd that, at the beginning of the 21st century, we spend so much money both on the National Health Service and on education, yet future parents can go through both systems without ever learning some of the most basic life-saving skills, which are readily available—they would not dream of not teaching their children to swim—but are not taught nearly widely enough in our society?

[Mark Hunter]

The right hon. Gentleman makes a pertinent point. In fact, Millie’s Trust—the legacy set up in the child’s memory—provides paediatric first aid training free of charge to interested parents. As hon. Members can imagine, a great number of interested parents have been stepping up, wanting to take advantage of that. The training courses are also provided at cost to commercial organisations, such as nurseries. Again, as hon. Members can imagine, as a consequence of this case and other tragic cases there has been a great deal of interest in that. However, it is pertinent to say that parents themselves might also want to make themselves aware of the correct practices and procedures, should such unfortunate circumstances come about.

[Andrew Stephenson (Pendle) (Con)]

I congratulate my hon. Friend on securing this important debate, and congratulate Millie’s Trust on highlighting awareness of this issue. I met a member of the family at Little Blossoms nursery in Barrowford in my constituency at a fund-raiser for Millie’s Trust. I echo what my right hon. Friend the Member for North Somerset (Dr Fox) has said. When I was talking to people and raising money for Millie’s Trust, it was providing people with the free pocket face shields that can be put on a key ring. Those of us who are qualified and trained in delivering CPR always have a face shield on us in case we come across a choking incident that has developed into something where CPR needs to be given.

[Sir Bob Russell (Colchester) (LD)]

rose—

[Mark Hunter]

I give way to the chair of the all-party group on first aid.

[Sir Bob Russell]

I am grateful to my hon. Friend for securing this debate and for the manner in which he has spoken. I follow on from the previous two interventions. Sadly, I am a parent who has walked this way, albeit at a different age and in different circumstances. We need to reinforce the need for first aid right across society. In each occupation and discipline, account needs to be taken of the specialist medical needs. First aid in schools, which I have been banging on about ever since I became a Member of Parliament, needs to be brought in, but the specialist needs of occupations need to be bolted on to that.

[Mark Hunter]

My hon. Friend’s contribution was, as ever, clear and concise. It gave a clear indication of his experience personally and as the chair of the all-party group on first aid.

To move on for a moment to the current guidelines, the Department for Education published its new statutory framework for the early years foundation stage in March. It became effective in September. Paragraph 3.25 of section 3, which is on the safeguarding and welfare requirements of early years providers, states:

“At least one person who has a current paediatric first aid certificate must be on the premises and available at all times when children are present, and must accompany children on outings. Childminders, and any assistant who might be in sole charge of the children for any period of time, must hold a current paediatric first aid certificate. Paediatric first aid training must be relevant for workers caring for young children and where relevant, babies. Providers should take into account the number of children, staff and layout of premises to ensure that a paediatric first aider is able to respond to emergencies quickly.”

What the Thompsons, Millie’s Trust supporters, I and countless other Members are asking is: why stop at one person? Does that not leave a nursery open to the possibility of another such tragedy? What happens if the first-aider is off ill, called away or panics?

[Mr Marcus Jones (Nuneaton) (Con)]

Children’s day nurseries are places where all sorts of bugs go round. Often the level of sickness absence is a lot higher than in other places of work. Is it not right, therefore, that more people are trained so that if paediatric first-aiders are absent because of sickness, someone else can take up the reins?

[Mark Hunter]

That is indeed the case I am advocating, so I can only agree with the hon. Gentleman’s comment. If the trained first-aider is off ill or has been called away urgently or even, dare I say, panics when presented with a choking child, who is able, under the current guidelines, to step in and provide the assistance that could save a child’s life? Furthermore, I am concerned that the Department is heading in the wrong direction on this issue. The new update to the framework, which came into effect in September, has placed the onus on the child care facility to decide how many staff need to be trained. It is now up to the individual organisation; there is no national regulation on that. No ratio on first-aiders to children on site has been given or suggested by the Department. That is a weaker position than we had previously, when the framework clarified that

“first aid training must be local authority approved and be relevant for workers caring for young children”.

On first aid training providers, it is my view and that of the campaign that straightforward guidelines should be in place on who can administer paediatric first aid training and to what level. Many child care providers do not realise that a nursery using a first aid training company that is not regulated must carry out its own due diligence. Would it not be best if everyone obtained a regulated first aid qualification accredited by an Ofqual-recognised awarding organisation, so that we can make it easier for parents to have confidence when placing their loved ones in the care of others?

[Sarah Newton (Truro and Falmouth) (Con)]

The hon. Gentleman is making an important and powerful case. Does he agree that as part of that training, it is essential that people are given opportunities to practise on dummies? As we might have seen with that qualified person in the nursery, sometimes people faced with these situations, without having practised on dummies, panic.

[Mark Hunter]

The hon. Lady is absolutely right. She raises an issue that I hope to address in the rest of my speech. I am sure that we would all agree that parents should be able to walk into a nursery and see “Level 3 Paediatric First Aid” on a certificate and be satisfied that the nursery has followed platinum-standard guidelines. I will move on to why that is particularly relevant, as a couple of Members mentioned earlier.

[Kevin Brennan (Cardiff West) (Lab)]

A few moments ago, the hon. Gentleman said that the current guidelines had in effect watered down the previous position. Has he been able to ascertain from Ministers before the debate why that is the case? What is the thinking behind that dilution of the position when this terrible tragedy occurred?

[Mark Hunter]

The short answer to the hon. Gentleman’s question is no, we have not been able to ascertain that, but I hope the Minister will address that in his response.

[Mr Sheerman]

The hon. Gentleman is absolutely right about regulation, but regulation will not do everything—it never will. What I discern in the tragic circumstances of Millie’s death is panic. I believe that people were running around and did not know what to do. I am sure that Millie’s parents, being so passionate, have already thought of this, but what we need are not Baker days, but Millie’s days, where every three months there is training for all the staff. That training will trickle down fast if the culture is changed, and then there will not be the panic that we saw.

[Mark Hunter]

The hon. Gentleman is absolutely right. He was one of the Members who referred to the rising number of children in nursery schools, which is why this debate is particularly pertinent and topical. More and more people are looking to avail themselves of the opportunity to place their children in nurseries. The Department for Education’s child care and early years providers survey in 2013, which was published in September, revealed that the number of registered places in full day care settings rose by 10% between 2011 and 2013. Due to the introduction of funded provision for disadvantaged two-years-olds, there was a whacking 72% increase between 2011 and 2013 in the number of two-year-olds attending sessional settings in the 30% most deprived areas. This debate is on a huge issue that potentially affects an awful lot of people.

As demand increases, supply rises to meet that demand. As new nursery places are provided, we have a duty to ensure that all children are safe and that all staff are well trained. None of us here will need reminding that children younger than one are extremely vulnerable and need constant care and attention. In the rush for nursery places and with the subsequent waiting lists, I firmly believe that parents are making an assumption that all nursery staff are adequately trained in how to provide the appropriate paediatric first aid, but we now know that that is sadly not always the case.

As an aside, hon. Members may be interested to know that I recently inquired about the provision of training here in Westminster, at Parliament’s nursery. The answer is that all relevant staff are trained in paediatric first aid. If it is good enough for the children of Members and House staff, it ought to be good enough for every child attending nursery anywhere in the country.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

I am extremely grateful to the hon. Gentleman for securing the debate. As is evidenced by the attendance today, the campaign has generated huge interest—particularly, for understandable reasons, in Greater Manchester. I was aware of the case, but not of the policy background, which the hon. Gentleman has described. I simply want to indicate my support for the campaign and for the hon. Gentleman’s speech.

[Mark Hunter]

I thank the hon. Gentleman for his intervention. I am sure that everyone involved in the Millie’s Trust campaign will be heartened by the interest shown by hon. Members from right across the House, including the hon. Gentleman.

During the inquest into Millie Thompson’s death in December 2013, the coroner, John Pollard, said:

“It is of national importance that the legislation surrounding nurseries regarding paediatric first aid is reviewed.”

He also recommended that the North West Ambulance Service review some of its policies, including what paediatric equipment each ambulance should carry. I am pleased to report that, since the inquest, it has successfully carried out that review. The coroner has said that the issue is of national importance and called for the policies around paediatric first aid treatment in nurseries to be reviewed, so I hope that the Minister will take that on board.

The North West Ambulance Service has gone further by introducing a minimum requirement list of paediatric equipment that every ambulance must now carry. The service’s urgent review and subsequent changes have ensured that any errors made in how it reacted to the 999 call regarding Millie Thompson will not be repeated. It has taken seriously what the coroner advised, and Millie’s death has had a positive outcome that will help other children in future. We acknowledge that the Department for Education deals with a wider remit than that of the North West Ambulance Service, but it is disappointing that we have seen action from the ambulance service on the coroner’s recommendations, but none as yet—although we live in hope—from the Government.

Following Millie’s tragic passing, the Thompsons decided to set up a charity to provide paediatric first aid training to anyone who wants to learn. They have successfully built what is now a national charity in just two years. It provides free training to parents and hugely discounted qualifications to anyone who needs paediatric first aid training, which is what Ofsted requests. Over the past two years, the charity has trained about 7,000 people, many of whom are nursery nurses. Millie’s Trust is a registered centre through Qualsafe, which is an Ofqual-recognised awarding body organisation.

[Sir Bob Russell]

I am grateful to my hon. Friend for allowing me to speak for a second time and for making that point. Millie’s Trust is a bona fide, regulated, registered charity. Did the coroner make any comment about the training competence of whoever trained the first aiders? I was alarmed when my hon. Friend said earlier that unregulated people may be out there providing first aid training; they may not be competent to do the job that they tell people they are able to do.

[Mark Hunter]

The coroner made a wide-ranging series of points in his response. I do not have his report to hand, but I am happy to ensure that my hon. Friend, as the chair of the all-party parliamentary group on first aid, gets to see a copy. It is fair to say that the coroner addressed the wider concerns and the relevance to any future measures that may need to be taken.

[Sir Alan Meale (Mansfield) (Lab)]

I am grateful to the hon. Gentleman for securing the debate. Like the hon. Member for Colchester (Sir Bob Russell), I sadly lost a young member of my family in my earlier life, so I know what the experience is like.

I want to stress that the issue is not limited to England. People in Ireland are currently trying to get a Bill through that would do exactly what the hon. Gentleman is supporting here today. We must ensure, because of how we deal with education and health matters in this great nation of ours, that the same recommendations are made in Wales, Northern Ireland and Scotland.

--- Later in debate ---

[Mark Hunter]

I thank the hon. Gentleman for his contribution. He is quite right. As I progress through my speech, I will be discussing the experience in Ireland and elsewhere. The Irish Government are indeed making moves towards ensuring that such regulations are in place. That is credit to the Thompsons, who, at the request of the Irish Government, have had two or three meetings with officials over there to see how that might best be done.

Millie’s parents have taken it upon themselves to use the success of the charity, combined with the recommendations of Mr Pollard, to start an awareness campaign about the current legislation. I turn to what the Thompsons and their campaign seek to achieve. The first thing to say is that they do not stand alone. Thousands of people from my Cheadle constituency, from Stockport, from Greater Manchester and from all around the UK have rallied to their side to sign their e-petition, which now has more than 102,000 signatures. For the benefit of hon. Members, I shall read out the petition:

“Following the death of Millie Thompson and the coroner’s suggestion in December 2013 that ALL nursery nurses should be trained, Millie’s parents are now campaigning to have it made law that everyone working in a nursery MUST be trained in Paediatric First Aid.

Please support and sign this petition in memory of Millie and for the future safety of your children.”

The campaign’s objectives are simple and straightforward, and I do not think that anyone here would demur from the idea that such important issues need addressing now.

Regarding the awareness campaign, it has become extremely apparent to Millie’s Trust that the majority of people, including parents and child care workers, do not know about the current legislation—just as Millie’s parents did not know about it until this tragedy struck them. Most parents presume that when they put their child in the care of a nursery, they are in the safest possible place. In fact, if disaster strikes in a situation such as Millie’s, the reality is that many staff would not know how to help a child who was choking, struggling to breathe or needing CPR. Is that really protecting our children as they should be protected? Is that really what parents should expect when they leave a child in someone’s care, often when paying high costs for the privilege?

Health and safety is up to date in every other aspect in the UK, so why has the simplest safety for children been forgotten about? Why has the legislation been allowed to fall so far behind modern times? If legislation was not there to be changed, we would still be placing children in cars without child seats and we would not be wearing seatbelts. It is time that this legislation was brought into the 21st century.

In June, the Thompsons and I met the Minister then responsible for this area, the Under-Secretary of State for Education, my hon. Friend for Crewe and Nantwich (Mr Timpson). We had a helpful meeting. The Minister listened to the Thompsons’ case and told us about the new requirements in the statutory framework that came into force in September. The Thompsons and I want the requirements to go further and we look forward to meeting the Minister who will reply today at the conclusion of the debate. I should report to hon. Members that the Minister has indicated his willingness so to do.

I am struggling to understand the reticence about moving to a requirement for all nursery staff to be trained in paediatric first aid. Under the Thompsons, Millie’s Trust has been a revelation, providing paediatric first aid training as cheaply as possible and making it available to people whatever their financial situation. The Thompsons do not want any other parent to go through the tragedy that befell them. I sincerely hope that I will not do them a disservice by saying that if they can set up a charity and begin providing the necessary training to thousands so rapidly, why can the Government not do the same, or at least make it a legal requirement?

In England, there is no mandatory requirement for anyone on a child care course to achieve a qualification in a paediatric first aid course, whether a national vocational qualification or an award from the Council for Awards in Care, Health and Education. In the National Nursery Examination Board course that child carers took during the 1990s, first aid was a requirement. When the course became an NVQ or a CACHE award, that requirement was taken out. Will the Minister address that concern as well? At the meeting with the then Minister, my hon. Friend the Member for Crewe and Nantwich, the Thompsons asked him who made the decision to remove the first aid part of the course and why—a fairly simple and straightforward question. The Minister could not give an answer off the top of his head, and Mr and Mrs Thompson were told that his Department would research the matter and contact them with the findings. It saddens me to report that some six months later they are still waiting for an answer to that simple and straightforward question.

We are not asking the Government to fund the courses for nursery establishments. The majority of nurseries are private and are run as a business, for profit. We simply want the regulations changed to make it clear that, as a business, nurseries have to build paediatric first aid training for their staff into their annual business costs.

I want to touch briefly on precedents elsewhere. For example, in Australia the legislation includes regulation 136(3):

“The approved provider of a family day care service must ensure that each family day care educator and family day care educator assistant engaged by or registered with the service—

(a) holds a current approved first aid qualification; and

(b) has undertaken current approved anaphylaxis management training; and

(c) has undertaken current approved emergency asthma management training.”

Each family day care educator and educator assistant must hold all three qualifications.

[Mr Sheerman]

Does that cover childminders?

[Mark Hunter]

The hon. Gentleman asks his question from a sedentary position, but I believe so.

[Mr Sheerman]

I am sorry. A lot of children in this country are with childminders in small groups.

[Mark Hunter]

I am sure that we can check that out afterwards. I am happy to get back to the hon. Gentleman on that.

In Minnesota, in the United States, in June 2010 at a child care centre a young girl called Hannah Kozita, aged only four, passed away after choking on a grape. Within a year, the state had seen fit to pass what is commonly referred to as Hannah’s law. One year after that tragedy, therefore, that particular state had introduced a new law including a new requirement from May 2011 for all teachers and assistant teachers in child care centres to have CPR training, including, specifically, CPR for children and infants. The law also required at least one trained staff member to be present whenever a child was on a school trip, and for training to be completed within 90 days of the law being passed. What is good enough for Minnesota, ought to be good enough for us in the UK.

The hon. Member for Mansfield (Sir Alan Meale) referred earlier to circumstances in Ireland. The Thompsons have been warmly received in the Republic of Ireland. They have made a number of visits there, at the request of the Irish Government, to talk about what ought to be done. Earlier this month, Millie’s Trust was invited to Ireland by Denis Naughten, TD, the Member for the Roscommon, South Leitrim constituency, following an earlier visit to Ireland in April. During their most recent visit, the Thompsons received vital support from Senator Jillian van Turnhout, who is also a successful children’s rights activist.

Mr and Mrs Thompson presented to TDs and Senators in Leinster house in Dublin to make them aware of the state of existing legislation. The Thompsons met with an extremely positive reaction. The TDs and Senators even received a mini-training session, which they all accepted was valuable knowledge, despite the small amount of time available. Following the presentation, a meeting was set up with Ireland’s Minister for Children, Dr James Reilly. I am pleased to report that the outcome of that meeting was also extremely positive. Dr Reilly was surprised to hear how Millie had received only “a few back slaps”. He went on to offer his own experience of watching a valuable member of his staff freezing when having to deal with working with a child in an injection scenario, even though she was extremely competent when dealing with adults. That goes back to the point made earlier by my hon. Friend the Member for Truro and Falmouth (Sarah Newton) about the understandable reaction of some to panic in such distressing circumstances.

Dr Reilly’s Department has since been in touch with Denis Naughten, TD, to ask Millie’s Trust to provide research information on legislation in other countries to see how it was worded when the law was updated. That Department has no problem with encompassing what Millie’s Trust is seeking to have done. That is extremely positive support as a consequence of the awareness that Millie’s Trust has created not only in the UK, but further afield.

In conclusion, I will revisit one or two key aspects of what I have said. The passing of Millie Thompson in a local nursery school was a tragic accident. The circumstances, choking, can happen to any infant at any mealtime in any child care provider or nursery school within the UK, or even at home. We can do nothing about such instances, but we can ensure that those responsible for responding are as well trained as possible.

The requirement for only one member of staff to be trained in paediatric first aid is simply not sufficient; it does not allow for illness, for large numbers of children or for the trained member of staff panicking when faced with a genuine emergency. My contention and that of the Thompsons and everyone behind Millie’s Trust is that the majority of parents assume that most pre-school staff will have paediatric first aid training. The best response to that mistake is to ensure that all staff are adequately trained.

The number of children in nursery schools is going up. We must ensure that they are all safe, not only the ones who go to the most diligent child care providers. More than 100,000 people have signed the Thompsons’ e-petition calling for the Government to introduce universal paediatric first aid training. Parents throughout the country want to see that change implemented. In Australia, in the state of Minnesota and, as looks increasingly likely, in the Republic of Ireland, the requirement for nursery staff to have paediatric first aid training is being implemented easily and straightforwardly. The UK must follow suit.

The last line of the Thompsons’ e-petition reads:

“Please support and sign this petition in memory of Millie and for the future safety of your children.”

That last part sums up our hope for the campaign in the future. It is not about concerns to do with new red tape, additional bureaucracy or even cost; it is about the future safety of all UK children, and it is about doing our utmost to ensure that a tragedy such as Millie’s death is never, I hope, repeated.

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[Mr Gyimah]

We want to create a situation in which we have competent people dealing with this kind of incident. On its own, a first aid certificate, which means that someone can tick the box to say that they have a first aid certificate, does not mean that that individual will be able to deliver first aid as and when an incident happens. As the hon. Member for Colchester (Sir Bob Russell) mentioned, in the case of one of the people who had a first aid certificate in this instance, their certificate had expired. If someone gets a first aid certificate, they have to renew it every three years.

I want to ensure that we do not end up legislating and having a tick-box culture, thinking that that in itself has addressed the problem, when there are a number of other things that we can do, as I will explain if hon. Members allow me to develop my points further. I am referring to work that we are doing with the National Day Nurseries Association to help nurseries to understand what it means to have capable and competent staff and how they can respond in an emergency. I believe that that is far more important than a tick-box approach to dealing with this kind of situation.

[Mark Hunter]

I thank the Minister for taking another intervention. With respect, I do not think that anyone here today has been arguing for a tick-box culture and, if I may say so, I do not think that that phrase is particularly helpful to the consensus that has emerged during the debate.

I want to follow up the intervention from the hon. Member for Stockport (Ann Coffey). The Minister referred to the changes to legislation. The fact of the matter is that it rests with individual organisations, individual nurseries, to decide what is and is not sufficient. The Minister says that if a nursery is operating over three floors rather than one floor, that is a different consideration. But as long as it remains the decision of the individual establishment, there will be inconsistencies.

Certain establishments—better-funded ones, with much more money—will no doubt ensure, as some already do, that every relevant member of staff has paediatric first aid training, but until it becomes necessary for all relevant staff to have that training, there will always be some nurseries, some of these businesses, that choose not to have every relevant member of staff trained. That is the core of the problem. The Minister needs to provide some clarity on why, apparently, the Government do not think that that would be a logical way forward. It would remove any uncertainty.

[Mr Gyimah]

I thank the hon. Gentleman for that intervention. He used Ireland as an example in his speech and, in the light of the intervention that he has made, I will refer to the Irish example. The Irish are actually moving towards the framework that we have in this country with the early years foundation stage. In response to a parliamentary question, they have said explicitly:

“The final draft will include a requirement that early years services have a person trained in first aid for children available at all times.”

The solution that we are adopting, which can best be described as one that allows nurseries to use their professional judgment in appointing the right staff to this vital role, is not as anomalous as the hon. Gentleman describes. I have said before and I will say again that not everyone who works in a nursery will be ideally suited to being a first-aider. Nurseries should ensure that their first-aiders have the confidence and the reliability to cope with an emergency, and I believe that the EYFS achieves that. At this stage, I do not feel that we need to amend those requirements further. I do, however, want to remain fully informed of the effects that those changes are having on the ground, and I know that the Department for Education plans to undertake a review of them next year.

I also know that the Thompsons were concerned that some nurseries might not know how to interpret the strengthened requirements. I am pleased that in direct response to the Millie’s Trust campaign, the Department for Education will issue in February new guidance for nurseries, setting out clearly what the expectations are and how nurseries can deliver on them effectively. I have asked the National Day Nurseries Association to help with that guidance. It will be identifying a number of nurseries delivering exemplary paediatric first aid practices, including methods used to ensure sufficiency of first aid-qualified staff, and providing case studies and videos to ensure that nurseries are absolutely clear on what the PFA requirements mean and how they should work in practice.

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[Mark Hunter]

Further to that intervention, does the Minister agree with this statement from St John Ambulance:

“Ensuring that every adult working in a child facing role has appropriate paediatric first aid training would decrease the delay in responding to a first aid emergency, and increase the quality of care”?

If he does, is that not somewhat inconsistent with his previous response?

[Mr Gyimah]

It is a powerful point. To restate my argument, not everyone with a certificate is necessarily the right person to deal with an emergency. We can argue that the likelihood of not having the right person on hand is reduced if everyone has that certificate, but we want to have a situation where nurseries follow recognised best practice, rather than to mandate it just so that everyone can say, “I have the certificate, and that is it.” We obviously value what St John Ambulance does, which is why the EYFS requires nurseries to use its training or British Red Cross training.

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[Mark Hunter]

Yes, I would like to take the opportunity of summing up. To be candid, I find the Minister’s response a little disappointing. There seemed to me to be a fairly clear consensus—not only among the hon. Members who spoke, but also in the sources of information from which many of us quoted—that there is a need for something to be done.

No one is saying that the Government have deliberately neglected the situation or allowed it to happen; I am quite persuaded that the law of unintended consequences was involved. However there is clearly a problem, and as long as it is within the purview of individual establishments to take their own decisions about what is adequate and what is not and about whom they go to for the training—so that they need not be certified and accredited—there will still be doubt and uncertainty in the mind of many parents. A case has been made for a national framework.

[Mr Gyimah]

According to the EYFS, the content of the providers’ first aid courses should be from the British Red Cross and St John Ambulance, so that it is based on the good practice of those with expertise. The hon. Gentleman misquoted me on that.

[Mark Hunter]

The key point is this—I happen to have the St. John Ambulance note in front of me so I will refer to it again: St John Ambulance believes that every adult working in a child-facing role should have had training in paediatric first aid.

By highlighting the tragedy, and bringing it to the attention of parents throughout the country, we are giving the Government an opportunity to be seen to be listening and acting. It will not cost much money or need much legislative time to establish the safeguards, so that every parent taking their child to nursery will know that all relevant members of staff are adequately trained in paediatric first aid. It seems a simple, straightforward and relatively inexpensive request, and I am still baffled about why the Minister’s response has not been more optimistic and positive. I appreciate, however, that it will not be entirely down to him. I hope that we can explore the matter further in the private meeting to follow.

Question put and agreed to.

Resolved,

That this House has considered the e-petition relating to the Millie’s Trust campaign to train all nursery nurses in paediatric first aid.