Mental Health Support: Frontline Staff

Nadine Dorries Excerpts

Thursday 8th October 2020 Westminster Hall

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

I echo the sentiments of the hon. Member for Tooting (Dr Allin-Khan): it is an absolute pleasure to see you in the Chair, Ms McDonagh. I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for securing the debate. I have heard her speak many times in Westminster Hall, including when I have been in the Chair. She always speaks with passion, particularly on this subject, and she always bring her experience as a consultant psychologist. We are the better and the richer for it.

The onset of the covid-19 pandemic in March was the beginning of a hugely challenging time for all our frontline staff, who have so brilliantly supported our essential frontline workers. I echo everything that has been said in praise of our frontline workers. They have been beyond exceptional—beyond words. I spoke to some of them this week. When they were going into work in March and April, every day it got a bit worse. Every day they had no idea what they would face that day, but they did it, sometimes working 12 hours without a break. Those staff in ICU went on a hugely emotional journey with their patients. As we know, the pathology of covid once someone is in ICU changes very rapidly. That took some getting used to for the staff who were nursing those patients—one moment they thought they were doing fine, and the next their condition fell off a cliff. That was hugely challenging emotionally for the staff who were nursing those patients.

I endorse everything that has been said in the debate, and I give my thanks and praise to staff. They worked long hours doing emotional and draining work, which is why it was important to ensure that support was put in place. We know that staff resilience has been tested to the nth degree, and the Government recognised early on that this would be a difficult situation and that we had to prioritise the mental health of the staff who were working in those very challenging conditions—not just staff in ICU and in hospitals, but staff who were working in care homes and social workers, too. That is why, at the beginning of covid-19, we commissioned NHS England and NHS Improvement to develop a comprehensive package of emotional, psychological and practical support for NHS workers. We ensured that the same offer was in place for all social care staff and their colleagues in the NHS, wherever possible.

Throughout the pandemic, NHS and social care workers have been able to access a dedicated and confidential staff support line operated by Samaritans, which is open from 7 am to 11 pm. It is there for people if they have had a tough day, if they feel worried or overwhelmed about what they are facing at work, or if they have a lot on their mind that they need to talk through. Trained advisers are available and can help with signposting to further services, or they can simply listen in confidence. A text helpline runs parallel to the phoneline and is open 24/7 to all NHS workers, social workers and care staff. A separate bereavement helpline has also been established by Hospice UK; it is manned by a team of fully qualified and trained bereavement specialists. So we had one-to-one care, the helpline, the text service and the Hospice UK bereavement line available for frontline staff.

Alongside the helplines, workers were given free access to a range of mental health and wellbeing apps, including Daylight, Sleepio and SilverCloud, and there have been over 150,000 downloads of these apps by key workers. For NHS workers, virtual staff common rooms have been established in partnership with NHS Practitioner Health. It has given staff the opportunity to reflect, share experiences and find ways to cope with how covid-19 is affecting their life at home and at work. Line managers have also been given the tools that they need to effectively support their teams through covid-19. For example, mental health conversation training has helped to equip NHS managers, supervisors and those with caring responsibilities for NHS staff to confidentially hold local, supportive and compassionate mental health and wellbeing conversations.



In addition to everything we have done through the NHS and the Department of Health and Social Care to provide a complete safety net and blanket of support around our NHS staff, the trusts went further. There are amazing stories of what some trust managers put in place straight away for their staff, including making space in the hospital where staff could go and download, and talk about their day; putting in place a practice of buddying up with another NHS worker; and putting into practice the process of staff not just finishing shifts and giving a handover report, as they used to, but then having a coffee session afterwards to debrief and go through what had happened that day. NHS trust managers also need to be praised for the huge package of care that they put in place for their staff, going over and above what the NHS supplied. NHS England and NHS Improvement also launched a new framework that enables employers to buy in additional occupational health and support for their staff.

Additionally, in partnership with the trusts, chief social workers published guidance for social workers and social care professionals, which can be accessed via Skills for Care. It explains the need to support the emotional wellbeing of employees during and after the pandemic, what managers can do to support that and what social care professionals should do to support themselves. To support our frontline workers more widely, NHS mental health services have remained open for business throughout the pandemic; no mental health services closed or ceased to look after patients during the pandemic.

In fact, during the pandemic we were able to accelerate parts of the long-term plan. For instance, 24-hour mental health crisis helplines opened across our trusts throughout the pandemic. Every one has been established and every one is now open. They have not been open long enough for us to gather data on how many people have used them and how they have been accessed, but I have heard anecdotally from ambulance support services, who are aware that the helplines are being used, that they know the helplines are working because there are fewer call-outs for mental health crisis.

To increase support throughout the covid-19 pandemic, we provided £5 million to national and local mental health charities, through MIND and the mental health consortia. On 22 May, the Chancellor announced a further £4.2 million for mental health charities as part of the Government’s UK-wide £750 million package of support for the voluntary sector. These additional moneys for mental health charities will support adults and children, including frontline and key workers. However, we still have to go further. We continue to learn from our experience during covid-19.

On 18 September, we published, “Adult Social Care—our COVID-19 Winter Plan 2020/21”, for adult social care settings outside the range of support we are making available, to ensure we support the workforce throughout the winter. A tough winter is coming, so as well as everything we have put in place, we need to go further to ensure that those services continue to be provided throughout the winter and that we have well-established support for our frontline workers.

As part of what we are doing throughout the winter, the NHS is in the process of setting up a first wave of staff mental health hubs, which will provide proactive outreach and engagement; overcome barriers to seeking help for frontline staff; build capacity in local employer organisations or teams; provide rapid clinical assessment; and provide care co-ordination and supported onward referral to deliver rapid access to mental health treatment. These hubs will be particularly useful and successful because we can focus mental health services into the infrastructure of the hubs. That will be of huge additional benefit, along with everything else that we have been providing to frontline staff. We are committed to providing essential mental health support to our frontline workers as they continue their work in response to the covid-19 pandemic. Ensuring that the health and adult social care sectors are well staffed with colleagues, to look after patients and prevent the pressures from becoming too great, is an absolute top priority for the Government.

The hon. Member for East Kilbride, Strathaven and Lesmahagow asked a question about clinical negligence claims against staff. There is a clinical negligence scheme for trusts that provides indemnity cover for all staff. I knew that was in place, because I signed it off at the beginning of the pandemic; I just could not remember what it was called. No staff member or frontline worker needs to worry. This is, I believe—I will be corrected if I am wrong—aside from what is provided by the Medical Defence Union and what normally applies. This package, which I believe came about as part of the emergency coronavirus regulations, is available to all staff, and all staff are covered.

We are committed to continuing to provide services to staff. If I went through every trust and listed every measure and initiative that has been put in place to support staff, I would be here for quite a long time. As well as the helplines, the apps, the one-to-one psychological care sessions provided to frontline staff, the trust support, the download rooms, the buddying up and the coffee debriefs, additional trust-by-trust measures have been put in place. As we know, staff were also provided with free meals. A huge package went in, and rightly so. This was not just a job during the recent pandemic, and it will not be in the future.

The hon. Member for East Kilbride, Strathaven and Lesmahagow mentioned post-traumatic stress disorder. We are going into a difficult winter, so I made inquiries this week as to what evidence we have about the rise in mental health issues that she spoke about, and other things. At the moment, we are seeing that the pandemic has had an impact on those with pre-existing mental health issues, as we would expect. Somebody who already suffers from bipolar, schizophrenia or a medically diagnosed mental illness will have found the pandemic challenging, and they will still find it challenging. The same is true for people with eating disorders—I think the hon. Lady has spoken about this—which I regard as the most serious of all mental health issues, because they are linked with morbidity. One in five people with eating disorders dies, and that is the highest morbidity rate of all mental illnesses. There is support here. That is why we have provided funding to increase the capacity to deal with those who have eating disorders and who need quick access to someone they can talk to.

We know that those with pre-existing mental health conditions are going to suffer. It is really important that we unpack wellbeing from mental health. There is some very unhelpful dialogue taking place that does not help people at all. We may see in the newspapers or hear people saying that suicide rates are going up, but they are not. We have no evidence of that; in fact, the recorded suicide rate from April to June was down. That could be for a variety of reasons, and we will not know what the true rate is until next year. However, we know that writing and talking in such a way has an impact out there, and that is why we ask the media to be careful about how they discuss suicides. We all need to be careful about how we talk about mental health. As for whether there is going to be a tsunami of mental health problems, I asked the clinical lead director of NHS England about that yesterday, and there is no evidence of that either.

We know that the other group of people who will be impacted are the frontline workers who have gone through the pandemic. As we know, post-traumatic stress disorder takes a long time to manifest, so those people may not even be presenting. We are expecting a problem, but it has not manifested itself yet. I do not have to tell a clinical psychologist how long it can take for the impact to fall out, but apparently it can be some time. We have prepared for that and we expect to see it in the future, but it has not happened yet.

I say that we should unpack wellbeing and mental health because a lot of what people are experiencing now—anxiety, apprehension, fear of the unknown and fear of covid—is a wellbeing issue, and it is normal to feel like that. Nobody ever goes into an adverse situation without experiencing such emotions. It is okay, and very normal, to feel anxious and fearful in an adverse and quite frightening situation, and people will develop their resilience. We want people—particularly frontline workers and students—to reach out and talk to their friends and their family, and to use the support networks that they would normally use to get through a difficult situation.

The problem arises if those feelings persist over a long period, and if that happens, we then urge people to seek help. However, we are not at that point, and we are not seeing that manifest yet in referrals or people seeking help. What we know is that people are going through a phase of anxiety. We therefore launched Every Mind Matters, because we need to provide people with the tools to get themselves through a difficult situation of anxiety and fear. Every Mind Matters launched for adults and, on 8 September, for children. It is now launching for students, too, alongside Student Minds.

Interestingly, when we talk about mental health, there is almost no such illness that cannot be helped in some way, and no experience of wellbeing that cannot be assisted, but people need the tools. They need improving access to psychological therapies services, 70% of which are available online, and tools to get them through such difficult situations. Those tools are available on Every Mind Matters, which I believe has had 2 million downloads for adults. They are there to help people get through. It is amazing that people do not know what they should do—I did not, until I looked into this—and how they should help themselves to get through a difficult situation now.

I caution everyone that we need to be careful about the language we use, such as “falling off a cliff edge”, or the “tsunami” of mental health issues. According to the clinical lead at the NHS yesterday, there is no evidence to support any of that yet. Hundreds of surveys are going on, some of which are showing that some people’s mental health has been improved—some people are enjoying working from home and do not ever want to go back to doing the commute, which they now realise was making them feel pretty miserable. They are welcoming the social change that has occurred. It is not at all a case of one size fits all, and that is why we need to be careful.

Hopefully, we are prepared, particularly when it comes to frontline workers. The services that they require have been put in place, after consultation with frontline workers, and we will have even more ready as we move forward into the winter.

Oral Answers to Questions

Nadine Dorries Excerpts

Tuesday 6th October 2020 Commons Chamber

[Abena Oppong-Asare (Erith and Thamesmead) (Lab)]

What recent discussions he has had with the Secretary of State for Education on allocating additional resources for mental health support in schools.

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

We are working closely with the Department for Education to support children and young people’s mental health, and we remain committed to implementing the proposals in the children and young people’s mental health Green Paper putting mental health support teams in schools and colleges, otherwise known as trailblazer schemes.

[Abena Oppong-Asare]

Schoolchildren have had their education interrupted. They have been separated from their friends and face continual threats to their daily lives. The Government knew schools were to return. Why did they not put adequate measures to provide mental health provision in schools for students and teachers?

[Ms Dorries]

I am afraid I have to say that, actually, the opposite is the case. We have just completed the wellbeing for education return “train the trainer” scheme. The trainers have been trained by the Anna Freud Centre and are ready to go out into schools across the country. It was always the position that schools should be open and the best place for children to receive help and support, for exactly the reasons that the hon. Member described: separation from their routine and their friends, and school being a place of safety.

Train the trainer has now completed. The Under-Secretary of State for Education, my hon. Friend the Member for Chelmsford (Vicky Ford), and I worked hard on that over the summer to ensure that the £8 million was there and the training was in place, ready to provide mental health and wellbeing support to children when they return to school. I am pleased to say that the last “train the trainer” scheme happened last week, and those involved are now ready to move into schools across the country.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

It has been six months of uncertainty for our country’s children and their parents, with schooling cancelled, the exam results fiasco and now students trapped in uncertainty in their university accommodation. Despite the Education Secretary recognising that there was a serious impact on young people’s mental health, yet again it seems that the Government have no plan. Children and young people are being failed. When will the Minister finally address the pending mental health crisis in our schools, colleges and universities?

[Ms Dorries]

I just do not recognise the picture that the hon. Lady has presented. We are investing at least £2.3 billion in mental health support and mental health provision. That investment translates to 345,000 children and young people who will be able to access mental health support via NHS-funded health services and school-based mental health support teams. Spending on children and young people’s mental health services is growing faster than the overall spend on mental health, which itself is growing faster than the overall NHS budget. Children and young people’s mental health is our priority, and we are showing that by investing in it. The picture that she paints is, I am afraid, completely not the case.

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

What recent assessment he has made of the effectiveness of the NHS Test and Trace service.

--- Later in debate ---

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

As I said in an answer to the hon. Member for Tooting (Dr Allin-Khan), we are committed to spending on children and young people’s mental health services, which is growing faster than the overall spend on mental health, and the overall spending itself is growing faster than the NHS budget.

[Ian Lavery [V]]

See, Hear, Respond, a new service managed by Barnardo’s in response to covid-19, to provide early intervention support for families and children in crisis, has received more than 11,000 referrals since June. The majority of children and young people referred need support for their mental health and wellbeing. What early intervention measures have been introduced? Are they enough? Does the Minister agree that early intervention measures are key to tackling the increase in children and young people’s mental health and wellbeing needs?

[Ms Dorries]

I could not agree with the hon. Gentleman more. The Government’s £8 million Wellbeing for Education Return programme, which is to support staff to respond to the emotional, mental health and wellbeing pressures that some children have experienced during the pandemic, is in place. As I have said, the last train the trainer session took place last week and those trainers are ready to go into primary schools to assist both teachers and parents to recognise when children display early signs of emotional distress or mental health issues as a result of the pandemic. I have been working closely with the Under-Secretary of State for Education, my hon. Friend the Member for Chelmsford (Vicky Ford), to ensure that this programme is in place to address exactly the needs that he has highlighted.

[Mr Alistair Carmichael (Orkney and Shetland) (LD)]

What steps he is taking to support people with long covid.

NHS Hysteroscopy Treatment

Nadine Dorries Excerpts

Thursday 24th September 2020 Commons Chamber

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

Wow. That was certainly a moving Adjournment speech. I thank the hon. Member, who knows she has my respect. We have been here together for many years, and I have to say that I am truly moved—more than moved—by the accounts of Rebecca, Vidya and Alison. Those stories are incredibly impactful because we know they are real and because, as women, we understand exactly what they are relaying in their experiences in a way that—I am sorry—chaps just do not.

The hon. Member referred to being here eight times. I think I have some good news for her in my response, and that is because she has brought this issue back here eight times. What I am about to say is in no small part due to her persistence. We all know that, in this place, very little happens overnight. The only way we achieve change is by doggedly continuing to push until something happens. I think she will be pleased with what I am about to tell her, but there is also something we will need her and the campaign to do to continue the momentum.

I thank the hon. Member for her continued campaigning, and I am delighted to respond to the debate. A hysteroscopy can be an essential tool in the diagnosis and treatment of conditions. What she referred to in, I think, Rebecca’s experience was a biopsy that is taken to look at tissues, for various reasons. Hysteroscopies are most important in investigating unexplained and distressing problems—they are a timely diagnosis tool—and can be used as a process for dilation and curettage. There are many reasons why women need them.

I am almost loth to read out these words—the hon. Member can tell I am going off script here—but the answer always is, “It’s a very quick procedure, it takes 10 to 15 minutes. If someone is in pain, 15 minutes is a very long time. Who would want to be in labour for 15 minutes? It is a long, long time.

I am almost tempted to say, “Shall we put our hands up to show who in here has been through a hysteroscopy?”, but maybe it is not appropriate for me to say that. I think we all can understand what the experiences are like. Patient experience is significantly varied, so there will be patients who say they did not feel anything and there will be patients who have stories such as those of the people the hon. Member has spoken to.

The NHS does not collect data on the number of women who experience pain— surprise, surprise—during hysteroscopy. However, I am aware that the Campaign Against Painful Hysteroscopy estimates that between 5% and 25% of hysteroscopy patients have reported pain, and 25% is a considerable number. It is essential that women who are offered a hysteroscopy are given the information that they need to make that informed decision, which must include information about potential pain, options for pain management and alternative procedures that are available, such as a general anaesthetic.

I will address the points the hon. Member made regarding whether women are being offered appropriate pain relief and her concern that the national tariff—I completely agree with her here—creates an incentive for hysteroscopies to be carried out as an out-patient, without appropriate pain relief for those 25% of women. I will talk about three components to ensuring that women receive the care they deserve: evidence-based clinical guidelines, embedding the patient voice and monitoring implementation.

To minimise pain and promote best practice in hysteroscopy, it is essential that clinicians have access to guidelines. The Royal College of Obstetricians and Gynaecologists currently has a guideline, produced in 2011, which provides clinicians with evidence-based information regarding out-patient hysteroscopy. The guideline has an explicit focus on minimising pain and optimising the woman’s experience. It makes specific recommendations on practices that help to reduce pain.

I am told that the RCOG is now developing a second edition of those guidelines to ensure that the recommendations are based on the most up-to-date and robust evidence base. It is being developed jointly with the British Society for Gynaecological Endoscopy, and patient groups are represented on RCOG’s guidelines committee and the development group. Furthermore, a statement from the British Society for Gynaecological Endoscopy, which was published on RCOG’s website in 2018, also emphasises the importance of offering women from the outset the choice of having the procedure performed as a day-case procedure under general or regional anaesthetic as an alternative to an out-patient setting.

Alongside clinical guidance, I note the importance of patients’ voices, which are critical at every stage of the treatment pathway. Decisions on any treatment, including out-patient hysteroscopy with its benefits and risks, should always be discussed as part of the shared decision making between the clinician and patient. I understand that since the last parliamentary debate on this subject in December 2018, the NHS website, as the hon. Member noted, has been updated. I thank her for pointing it out and enabling that to happen. The website has been updated and RCOG has published a patient information leaflet regarding the procedure.

NHS England recommends that, as part of good practice, the Royal College of Obstetricians and Gynaecologists’ patient information leaflet, published in 2018, is provided to patients in advance, to assist with obtaining informed consent for the procedure. I imagine by that they mean that it is sent out with the appointment for the procedure or handed out at the clinic.

The patient information leaflet contains a lot of helpful information for patients. It explains what the procedure is and what is involved, what the patient should do beforehand and the questions they should ask health care professionals, the risks and alternatives, after-effects and what will happen following the procedure. The leaflet also recommends that patients take pain relief one to two hours before the procedure. After a hysteroscopy, I encourage any woman to read these valuable resources, along with the additional resources provided by their clinician. First, before the procedure, women must be able to speak to their doctor or nurse about what to expect and about pain relief options, including local or general anaesthetic, but, as we know and as the Cumberlege report has recently shown us, women’s voices are very often not listened to.

[Ms Brown]

I just point out that Rebecca turned up last week to an appointment, and there was no information. She did not even know that she was having a hysteroscopy. That was last week.

[Ms Dorries]

That is distressing to hear.

Women should also be advised that the procedure can be stopped at any time— but, although they are aware of that, that is an incredibly difficult decision to make. When we are in pain, we do not think rationally. It is important to put this on the record as women must be informed of their rights and have their voices heard. Finally, after the procedure, if the woman believes that there have been issues with the treatment that should be raised with the trust.

I want to talk about progress. NHS England advises that progress is being made through the implementation of clinical guidance. Within that, commissioners, and providers should advise service user feedback to be monitored to identify where the guidance is not being followed. As the hon. Member may be aware, women’s health is a personal priority of mine, and I have been looking at improving the experiences of women in the healthcare system since I arrived in the Department. As I recently set out in my statement to the House on the Independent Medicines and Medical Devices Safety Review, we cannot accept the status quo whereby it takes women so long to have their voices heard and for their concerns to be taken seriously. Whether we are talking about the Shipman or Paterson inquiries or the Cumberlege review or another maternity incident, it is sobering to reflect on the amount of inquiries that we have taking place that are about women-only issues. As I work with the team to evaluate every recommendation and every aspect of the Cumberlege review, I want to assure the hon. Member and the House that it remains an absolute priority of mine to tackle these issues.

I understand that the hon. Member has ongoing concerns with the best practice tariff. The aim of the best practice tariff is to encourage procedures in an out-patient setting where clinically appropriate. Out-patient procedures provide the patient with a quicker recovery, as well as allowing them to recuperate at home. I understand that NHS England and NHS Improvement will shortly be engaging with the sector on policy proposals for the 2021-22 national tariff. The tariff engagement document due for October publication will lay out NHS England and NHS Improvement’s initial proposals for the 2021-22 national tariff and will be followed by a statutory consultation. I understand, drawing on the momentum created by changes in the payments system this year due to covid-19, NHS England and NHS Improvement expect to propose an accelerated shift towards the use of a blended payment approach. This proposal would include the majority of services providing hysteroscopy. Blended payment would not differentiate between in-patient and out-patient procedures and, as such, the out-patient procedure’s best practice tariff would no longer be necessary. NHS England and NHS Improvement are currently planning to propose the removal of the best practice tariff from April 2021.

I hope the hon. Member will be pleased to hear this update, and I encourage her and patient groups to comment and contribute to NHS England and NHS Improvement’s proposals both in the tariff engagement document and the subsequent statutory consultation. I myself will be contributing to that consultation.

Once again, I thank the hon. Member for raising this important matter for discussion. She raised the issue of what was the women’s taskforce. I am not aware of any work that has taken place so far on hysteroscopies, but I will look into that. What I will say is that we have established something called the women’s health agenda, which has met this year. Sadly, it had to be stopped because of covid. We are already looking at restarting that agenda now and hysteroscopies will very definitely be on the table, as with all women’s procedures, when we are discussing the women’s health agenda. I really feel strongly that there is more we can do to ensure that we empower women to talk about their health, and I hope that we enjoy better outcomes as a result. Women are not listened to. They are not listened to in so many areas within health as a whole, and we have to change that. We have to ensure that a woman’s voice is heard throughout all the settings in the NHS.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I have heard this debate before, and I am very, very glad to hear that progress is being made. Fifteen minutes is the time that the Minister took to speak, not two minutes. [Interruption.] No, I am not criticising the Minister. I am pointing out that being in pain for the whole of the Minister’s speech would not have been amusing.

[Ms Dorries]

Some people may.

[Madam Deputy Speaker]

We were not in pain for that time.

Question put and agreed to.

Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) (Amendment) Regulations 2020 Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) (Amendment) (No. 2) Regulations 2020 Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place and on Public Transport) (England) (Amendment) Regulations 2020

Nadine Dorries Excerpts

Monday 21st September 2020 General Committees

[The Chair]

Before I call the Minister, I remind Members that we are applying social distancing, so I would be grateful if you sat in the places indicated. If you have speaking notes that you want to supply to Hansard, please do not send hard copies but email them to [e-mail].

[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) (Amendment) Regulations 2020 (S.I. 2020, No.839).

[The Chair]

With this it will be convenient to consider the Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) (Amendment) (No. 2) Regulations 2020 (S.I. 2020 No. 882) and the Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place and on Public Transport) (England) (Amendment) Regulations 2020 (S.I. 2020 No. 906).

[Ms Dorries]

It is a pleasure to serve under your chairmanship, Mr Efford. These regulations amend the Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) Regulations 2020, which will henceforth be referred to as the face covering regulations.

The face covering regulations came into force on 24 July and made it mandatory for people to wear face coverings in some indoor settings, such as some shops, supermarkets and indoor transport hubs in England. The original face covering regulations were debated and approved by members of the Committee on 14 September. This debate will therefore not focus on the content of the original set of regulations but will deal with the subsequent amendments.

Amendments were made to face covering regulations on 8 August, 22 August and 28 August to extend the requirement to wear a face covering to a wider list of indoor settings, to make clear that certain persons are exempt and to change the penalty structure for these regulations. I urge the Committee to approve these amending statutory instruments so that we may continue to use these powers to enhance protections for those visiting indoor spaces and minimise the risk of spreading the infection.

Amendments to the face covering regulations were necessary to ensure that this legislation tracked with the easement of lockdown restrictions and the reopening of further indoor premises, in order to offer the maximum protection to members of the public. These regulations are a necessary response to the serious and imminent threat to public health posed by the spread of coronavirus —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 these amending regulations through this debate, which is taking place within the statutory 28 sitting days of the regulations coming into force.

This country has been and is still engaged in a national effort to beat the coronavirus, thanks to the hard work and sacrifice of the British people. Informed 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 open. Colleagues will be aware that we introduced the original face covering regulations to coincide with the easement of some restrictions, to give members of the public greater confidence to visit public indoor spaces and to enhance protection for those working in these settings, as explained by the Secretary of State when he addressed Parliament on 14 July and announced these measures.

As I mentioned earlier, the face covering regulations, as originally made, were debated and approved by the Committee last week. The Government have continually reviewed and refined advice on face coverings. Prior to the face covering regulations coming into force, the Government had already been advising the wearing of face coverings in enclosed spaces where people might find it difficult to maintain social distance and might come into contact with others whom they would not usually meet.

Furthermore, face coverings have been mandatory on public transport in England since 15 June. Although face coverings are not a substitute for social distancing and good hand hygiene, the scientific evidence suggests that, when used correctly, they may have some benefit in reducing the likelihood of those with the infection, particularly if they are asymptomatic, passing it on to others.

On 31 July, my right hon. Friend the Prime Minister announced that the Government would mandate the use of face coverings in further indoor settings such as museums and galleries, cinemas, places of worship and other indoor settings outlined in the Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) (Amendment) Regulations 2020—SI 2020, No. 839—and supporting guidance. That was done to reflect the easement of further restrictions as more places were reopening to the public. Footfall in those places was increasing, and face coverings can offer additional protection measures to those visiting such spaces.

Subsequent amendments to the regulations offer additional clarity on exemptions and reasonable excuses and update the penalty structure to discourage non-compliance and to deter repeat offending. I will outline the purpose of each amending instrument to the face coverings regulations and then set out the policies and processes underlying their development, implementation, monitoring and review.

The amending regulations that came into force on 8 August increase the scope of the face coverings regulations by widening the number of premises where face coverings must be worn, reflecting the easement of some lockdown restrictions and the fact that more people would be visiting those places. The amendments include additional indoor places and remove some of the exemptions from the definition of a shop. The result of the amendment is that members of the public must wear face coverings in indoor places such as museums, galleries, cinemas, places of worship, beauty salons and other spaces, unless they are exempt or have a reasonable excuse not to do so. More information on the settings covered can be found in the regulations’ explanatory documents and supporting guidance. No amendment was made to the persons exempt from the face coverings regulations, to the list of reasonable excuses or to any other legislation in force. However, some minor typographical amendments were made to the regulations—for example, renumbering the schedules for clarity.

The second set of amending regulations came into force on 22 August and included further premises brought into the scope of the face coverings regulations—namely, casinos, members’ clubs, social clubs and conference centres. To ensure that there is no doubt that the face coverings regulations only cover indoor premises, the amending regulations also update the definition of “relevant places” to make it explicit that face coverings are required only in indoor premises.

These amending regulations also remove certain exemptions from the definition of a shop that are listed in schedule 2—for example, premises for indoor sports and leisure activities. Consequently, these regulations introduced an exemption for elite sportspersons, the coach of an elite sportsperson, referees, professional dancers and professional choreographers, from the requirement to wear a face covering where they are acting in the course of their employment, training or undertaking a competition at relevant places that are in the scope of the regulations. In addition, given that the face coverings regulations were amended to include indoor places of worship as a result of SI 2020 No. 839, these amending regulations insert an additional exemption into regulation 3 to exempt pupils under the age of 19 at a religious school from the need to wear a face covering when undertaking education or training within a place of worship as part of the curriculum of a religious school.

The amending regulations that came into force on 28 August amended the penalty structure, to discourage non-compliance and to deter repeat offending. The original face coverings regulations stipulated that a penalty notice of £100 could be issued to someone over the age of 18 who was in breach of those regulations and that that would be halved to £50 if paid within 14 days. The amending regulations insert a laddering fine structure into the face coverings regulations, so that the fine payable for the second and subsequent breaches of those regulations, or of the Health Protection (Coronavirus, Wearing of Face Coverings on Public Transport) (England) Regulations 2020, doubles for each occasion, up to a maximum of £3,200, with no discount for early payment from the second fine. That is in line with enforcement provisions in other coronavirus regulations. The amendment does not make any change to those who have powers to enforce the policy.

Although the vast majority of people have complied with rules throughout the pandemic, and enforcement measures remain a last resort, these amendments will further deter non-compliance and tackle those who repeatedly breach the requirement to wear a face covering. It is important that we all continue to play our part in reducing the risk of transmitting the infection as we visit indoor places.

I would like to be absolutely clear that, 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 amending regulations do not remove or make changes to the list of exemptions or reasonable excuses beyond those additions I have already described.

The face covering regulations include a review clause, requiring a review of the need for the requirements, as amended, at six months. A sunset clause is included so that face covering regulations expire 12 months after the day they came into force. We will continue to monitor the impact and effectiveness of this policy in the weeks and months ahead, and we will develop our approach to enforcement and to communicating the policy as necessary.

I am grateful to all hon. Members for their continued engagement in this challenging process and in scrutiny of the regulations. We will, of course, reflect on the issues in the debate to come. I commend the regulations to the Committee.

[The Chair]

I remind the Committee that we are debating all three motions.

--- Later in debate ---

[Mr Jones]

I will not challenge you, Mr Efford, and I welcome you to the Chair today. We had a debate last week about enforcement and who could and could not enforce the regulations. The Minister promised to write to us last week with a long list of individuals, but we have still not got it.

[Ms Dorries]

I did.

[Mr Jones]

Well, I am sorry but I have not received it, and I do not think my hon. Friend the Member for Ellesmere Port and Neston has, either. The list would include people who could be designated by the Secretary of State. He could designate, for example, marshals, but I shall leave it there.

In terms of these regulations, my hon. Friend points out a growing trend with this Government: they seize emergency powers. We in Opposition support them because we saw back in March that clear action needed to be taken, but there has been no give and take in terms of trying to involve the Opposition or even Parliament in how the regulations are implemented.

My hon. Friend raises a very good point about the way in which the regulations have been introduced, because it raises a broader issue here. For these regulations to be effective, they have to have public buy-in. We are elected to this place to represent our constituents. We have seen over the past few weeks the utter confusion there is now about what people can and cannot do—added to that is the announcement of just half an hour ago. When the Secretary of State introduced the lockdown regulations for the north-east last week, he excluded any reference to childcare, so my inbox and that of everyone else in the north-east was inundated with people questioning whether they could take their grandchildren to school. I am glad to see that sense has been arrived at this afternoon and the clarification has been made, but that is one example, and these regulations will lead to more confusion, as I shall illustrate.

Again, these regulations have not been well thought through. First, we discussed last week how a relevant place is defined. The first regulation extends the number of places where a face mask is needed in what is deemed a relevant place. Before, it was shops, supermarkets, shopping centres, banks and post offices, but not included were restaurants that could provide table service to customers, bars, pubs or areas of a shop or shopping centre that provided for the consumption of food and drink, and seating areas in coffee shops, supermarkets, cafés and food courts. We discussed whether seating areas in transport hubs were covered, and I got clarification on that from the Minister this week.

The relevant places are then extended to include indoor places of worship, crematoria, burial ground chapels, museums, galleries, cinemas, public libraries, public spaces in hotels such as lobby areas of hotels, and community centres. I will come back to the issue of clubs in a minute. To me, this is not very clear. Many hotel lobbies, for example, have seating areas where people perhaps just want to sit and wait to be checked in, but many hotels have seating areas where someone can order a sandwich or a drink or another type of refreshment, so are those areas excluded? Occasionally, for example, I walk into the Radisson Blu hotel or the Royal County hotel in Durham and ask for a sandwich at the reception, and it is delivered to me as I sit in the reception area. Am I then exempt from wearing a face mask or not?

I will come on to community centres, and I am sure hon. Members will know of similar situations to mine. I have a number of very good community centres in my constituency that provide food, but not regularly. They have seating areas for luncheon clubs and various catered events. Under the definition in the regulations, the community centres should be excluded on the basis that they have seating areas and provide food. Do they actually have to provide food at that time? Are we saying that if they are providing food, people there do not have to wear face masks, or that if they are not providing food, people do have to wear face masks? Those are things that will be very confusing to local organisations. It would be interesting to know how that actually works.

Another issue is the definition of a place of worship. That is pretty simple in that a place of worship is a church, a synagogue, a mosque and so on, but increasing numbers of churches do not actually have fixed buildings. They meet in people’s houses as community churches. I have a number in my constituency, and I am sure that there are some in London as well. Are they covered under the rule of six? I imagine that there would be more than six people in those congregations. Are those houses covered as places of worship? For those individuals, that is what they are. We might not recognise them as traditional places of worship, but for their congregations, they are. Will those congregations have to wear face masks in the houses where they hold their services?

I take the point made by my hon. Friend the Member for Ellesmere Port and Neston about social clubs. Many of them were struggling before the pandemic as it was. Their membership tends to be elderly, so a lot of people will not be going to the clubs. They are no different from pubs, in my opinion—except that, importantly, the regulation around them is more strict because they know exactly who goes in, and there are disciplinary proceedings if things happen. Putting them at a disadvantage is wrong.

I now come to the question of wearing face coverings in nail bars, beauty and hair salons, barbers, tattoo and piercing parlours, massage parlours, storage and distribution centres, auction houses, spas, funeral directors, veterinary surgeons and so on. Based on these regulations, if the hon. Member for Aldershot goes into his barber or his hairdresser to have his locks coiffured, he will have to wear a face mask. I am aware that many women, as well as men—the hon. Gentleman included—have their hair washed when they go to their barber or salon. I am sure that the hon. Gentleman goes to a salon rather than a barber. Does the person have to wear the face mask while they are actually having their hair washed? That creates some very difficult problems, does it not?

I went my local barbers a few weeks ago, where I had a disposable gown put on me. To be fair to them, they were good at making sure that people socially distanced, and hygiene was very good. If we are asking people to wear a face mask when they go to a salon, including when they have their hair washed, that will be very difficult.

[Ms Dorries]

indicated dissent.

[Mr Jones]

The Minister says no, and I am sure that the hon. Member for Aldershot has a different view. Asking a person to wear a face mask when they have their hair washed will cause difficulty, because they will then be sitting in a salon with a damp or wet face mask on. What is the science as to how effective a face mask is if it is wet? I am not a scientist, and we do not have here my hon. Friend the Member for Blackley and Broughton (Graham Stringer), who last week actually went into the science of the way in which face masks work. Clearly, some of the more robust ones might stand up to that use. The one that I have with me may well do—I think it was washed yesterday by Mrs J—but I am sure, Mr Efford, that by the end of your salon appointment some of the more disposable ones would be floating around in the handbasin. Again, the issue is just the confusion that the measure causes.

The other issue is about fines. Clearly, No. 10’s strategy over the weekend was to sound tough on fines: “We are going to start fining people. If people don’t follow the rules, they are going to get fined.” [Interruption.] Does the Minister want to intervene?

[Ms Dorries]

indicated dissent.

[Mr Jones]

Was it wind?

The problem is that what No. 10 was saying might sound tough, but, as my hon. Friend the Member for Ellesmere Port and Neston said, how many people have actually been fined? The problem with these types of regulations is that they are confusing to people, so people are not going to be very clear about how they will be enforced. This does come down to enforcement—we had this discussion last week. I have no problem with a police officer or someone else—I think it was a community support officer under the regulations last week—giving out fixed penalty fines if they think that right. We asked for a definition last week of a TfL official, for example; they are not identified. We also asked another question, because in the regulations there is a long list of people and then there is a catch-all provision whereby it could be anyone whom the Secretary of State designates to give those fines. That is why my hon. Friend and I raised the issue about marshals. I do not want to go down that path and upset you in any way, Mr Efford, but if the Secretary of State actually gave local authority marshals the power to issue fines, I would find that very uncomfortable; I am quite happy if people have had training in dealing with these situations. We were offered a list last week, but I am still waiting for it.

This does matter, because we are now extending the regulations to other areas. I come now to my closing remarks, which are about the entire Government approach to this area. We are supposed to be seeing now a super-duper new communications centre at No. 10, but frankly, there is confusion outside the House and these provisions will add to it. The unintended consequences of some of the regulations that have been brought in lead to that confusion, and it is made worse by some Ministers who try to act tough in the way in which they put things over. It is important that we be able to communicate the position, and I do not think we can, with the way these provisions are structured. The Government have been remiss. We should have had more opportunities for debate. I am glad to now hear from Conservative Back Benchers the arguments for why we need more scrutiny of these things in Parliament, which would allow us, as representatives of the people, to have a say before they actually come forward.

[Ms Dorries]

There were an extensive number of questions from the hon. Member for Ellesmere Port and Neston, but if he does not mind, I will first answer the questions from the hon. Member for North Durham.

[Mr Jones]

Right honourable.

[Ms Dorries]

Absolutely. I do apologise: he is right honourable—he will be “Sir” soon.

On face masks for hair washing, salon owners have a responsibility to their staff and themselves and to their customers to keep everyone safe. I hope that my hon. Friend the Member for Aldershot will not mind my saying that I am not quite as follicly challenged, and I had my own hair washed at the hairdressers two weeks ago and I wore my own mask. I will admit that the ties that went behind my ears got slightly damp, but there were no masks floating in sinks or anything like the other extravagant descriptions that the right hon. Member for North Durham provided us with about a day in the hairdressers. There were no problems whatever. I have yet to see anybody not wearing a mask walk into a hairdresser’s salon without their being given a mask by the staff there. It would be extraordinary if somebody had an appointment at a hairdresser’s salon and just walked in without wearing a mask. So, the answer is, “No—that is not a problem at all”.

[Mr Jones]

I accept the point the Minister is making, but until now there was no indication that people actually needed to wear a face mask. She talks about her own experience, but how, for example, would a hairdresser cut the hair of the hon. Member for Aldershot, or shave it round the sides, if he had a face mask on? Does that not make it very difficult?

[Ms Dorries]

The tie on a face mask is close to the skin; it is not worn in the hair. It is worn like a hearing aid—around the skin.

[Mr Jones]

Depends how long the hair is.

--- Later in debate ---

[Ms Dorries]

I literally cannot go into the ins and outs of a hairdresser’s means and ways of cutting somebody’s hair, Mr Efford; all I will say is that we have had no complaints.

The right hon. Gentleman raised the issue of worship in homes—the answer is a very blunt no. Houses are not covered. He also mentioned hotels and hotel foyers. Again, if there is a bar or a café inside the hotel, or wherever one may be, then one is allowed not to wear a mask.

[Mr Jones]

Does the actual bar or food service area have to be open to allow people not to wear face masks?

[Ms Dorries]

I will ask for an answer on that one. I would imagine that if it were in an environment where food was normally served in a hotel, it would not have to be open, although I will wait for a definite answer.

However, I would challenge the right hon. Gentleman—and I will answer a question asked by him and the hon. Member for Ellesmere Port and Neston during this debate about the figure of 96% of people wearing masks. That figure came from the Office for National Statistics. It was not a case of what the right hon. Gentleman suggested, but with the ONS—people were actually just answering a survey. All the people here have been going around shops and hairdressers, and it is hard to go anywhere in a public space and find anyone who is not wearing a mask. However, I have asked for an answer about whether a bar has to be open, and I will ensure that the right hon. Gentleman receives it.

As for community centres—[Interruption.] Sorry, I thought the right hon. Gentleman mentioned social clubs.

[Mr Jones]

No, I just mentioned community centres. Many community centres have facilities for providing food, but do not provide it on some days, for example. On the days when they do not serve food, will people have to wear face masks, or will people be exempt only when they are actually serving food?

[Ms Dorries]

Again, a community centre will be run by people who are responsible, and have responsibility for their staff and the people in the community centre. Any community centre would have a policy that people should wear masks. But again, I will get back to the right hon. Gentleman on that particular point.

[Mr Jones]

If a luncheon club is going on and the Minister is saying that people have to wear face masks, it gets down to the point about leaving it to the actual local people to decide. That is not the regulation. It needs clarifying, so they can say, “Fine. If we’re providing food, then people don’t need to. Clearly, if we don’t, or have some other event on and food is not included, then they may have to comply.”

[Ms Dorries]

As I said, Mr Efford, I will revert to the right hon. Gentleman with an answer to that particular point.

On the substantive points raised by the hon. Member for Ellesmere Port and Neston, he raised one overarching question a couple of times in his speech, namely why, if we made the guidance on 11 May, we did not introduce it officially until after that date. That is for two reasons. First, the science on wearing masks was evolving, and evidence was coming in from China, Lombardy and other places where masks were being worn, or not, and where studies were taking place on the efficacy of masks in prohibiting the spread of the virus.

Secondly, at the same time, we began to ease restrictions, and as we eased the restrictions we saw an increase in footfall. It was necessary to bring in the regulations because we were easing the restrictions, and the public were coming out on to the streets and into the areas where we were doing so. However, as I have said before, we have seen huge compliance from the public.

The right hon. Member for North Durham did not mention that I was incredibly generous in engaging with him last week on the points that he made about covid marshals. They are out—I was hoping for a nod from the Chair—

[Mr Jones]

rose—

[Ms Dorries]

I will not take any more interventions, and we will now move on. Covid marshals will be subject to their own SI shortly, but this Committee is about three SIs on face coverings. I will keep to the point of face coverings, which is what I am here to address. I am not here to debate an SI on covid marshals.

I have set out why we felt it necessary to do as we did after the guidance. We were also receiving information that people were happy with wearing face coverings, and, from public compliance and people wanting to keep themselves safe, it was obviously the right thing to do at that time.

[Justin Madders]

The Minister is absolutely right to say that she has been generous in taking interventions, both today and on previous occasions. I want to try to understand what she has said about the delay. She has talked about the science evolving, and of course we accept that. However, virtually all retail was open by mid-June, and yet the regulations did not come in until 24 July. I am trying to understand why there was such a delay between those two dates.

[Ms Dorries]

I revert to the substantive point: we were constantly easing regulations at the same time as we had issues to do with Leicester. We had areas in the country where rates were rising at the same time as we had national easement. It is very complex, but at the time it was felt that the public had complied and were wearing masks to go into shops and public places. However, we felt it was important, as footfall increased and we had spikes in other parts of the country, that we introduce guidance nationally for people to wear masks.

I will answer some of the shorter points that the hon. Gentleman raised. He asked me how many people had received FPNs: it is eight to date. I am not aware of what fines were charged, and whether they were on the ladder or went up to the full amount, but eight FPNs have issued so far. I was also asked why we are not legislating for handwashing.

[Mr Jones]

Will the Minister give way?

--- Later in debate ---

[Ms Dorries]

No. It is incredibly difficult to legislate for people to wash their hands. However, given how compliant and how willing the public have been to wear face coverings—we only have to see how many people are carrying hand sanitisers, and how responsible and conscientious the public have been—I am not sure there will ever be any need to legislate for handwashing. That would be an incredibly difficult piece of legislation, and I am sure the hon. Member for Ellesmere Port and Neston agrees that that is not where we want to go.

The hon. Gentleman brought up the question of staff in various areas. I go back to my previous answer to the right hon. Member for North Durham: it is not compulsory for shop or supermarket staff to wear face coverings, although we strongly recommend that employers consider their obligations, where appropriate and where mitigations are not in place. It is also important to mention that the list of where to wear face coverings and where the exemptions apply is not exhaustive; it is something that is reviewed almost daily. We listen to representations from Members on both sides of the House, and from organisations and individuals, about where they think the exemptions should apply, and what else should be included in the list. This is a constantly moving feast. The fact that we are here today is not the end of it—the process will continue. Businesses are already subject to legal obligations to protect their staff, so a safe working environment is what we expect of everywhere where staff are employed and where members of the public come on to the premises.

The hon. Member for Ellesmere Port and Neston mentioned face coverings in schools. I will mention universities as well; I know that his son has gone back to university this week. The Department for Education has updated its guidance recently on wearing face coverings in schools, following, as I am sure the hon. Gentleman is aware, the World Health Organisation’s statement about children over the age of 12. However, the Government’s absolute priority is to get children back to school and keep them in school.

The Department’s guidance sets out that face coverings should be worn by staff, by visitors and by pupils when moving around the school. They should be worn in further and higher education settings indoors, such as in corridors and communal areas where social distancing cannot be maintained. However, as we discussed last week, obviously that does not apply when people are eating, because it is difficult to eat with a mask on—it is not practical. Schools are not included in the regulations before the Committee, with the exception of an exemption for pupils of religious schools receiving educational provision in a place of worship.

It is important that university students can start the new term and the campuses can remain open. Again, education is an absolute priority, and it is also an important thing for students’ mental health and wellbeing. It is important that these things are done safely and we have been working closely with universities, and the sector, to help them to prepare for their intake of students, which, as Members know, is staggered from the beginning of September to almost the end of October, depending on where the university is, and which years are going back there.

Universities have introduced a number of measures such as staggered term times and staggered returns. There have been some assertive information notices across universities, such as “Don’t kill your nan”, and requirements about where students should wear face coverings. We have helped universities to make campuses safe by reiterating the face covering message throughout to students, including where they should wear them. Again, there is an impression that students will completely disregard all the social distancing regulations. I am not saying that they will be perfect, but universities have stepped up to the plate and are doing their bit. I am not sure which universities are providing disposable face coverings, but I think that the message about what students should be doing will be put out strongly to them.

The Government’s aim, with all the regulations and all that we are doing about face coverings, is to achieve as high a compliance rate as possible. We are incredibly impressed with the public’s response and the compliance so far.

[Justin Madders]

Will the Minister say a little about the distinctions between pubs and social clubs? As I and my right hon. Friend the Member for North Durham have explained, that is an important issue for our constituencies, and we want to understand that distinction.

[Ms Dorries]

I believe that social clubs were part of the original discussion. I shall find out why they were not included. I cannot guarantee that I will be able to write to the hon. Gentleman about that tomorrow, as before, but I apologise and I shall get back to him and provide an answer.

The Government have always been clear that the highest priority in managing this national crisis is protecting our public and saving lives. Face coverings and public compliance in wearing them is a part of that endeavour. I am satisfied that the additional premises included in the amending regulations are necessary, reasonable and proportionate. The amending regulations offer further clarity for members of the public on where they should wear a face covering, exempt further categories of person and update the penalty structure to maximise compliance with the policy. Our guidance has consistently set out to the public that, to protect themselves, they must continue to follow social distancing measures, wash hands regularly, adhere to the isolation guidance and wear face coverings where appropriate. The current guidance from the Government states that people should also wear a face covering in enclosed public spaces, where social distancing is more difficult to maintain and where people might come into contact with others whom they do not normally meet.

Today has provided an opportunity for the Government to hear people’s concerns through the contributions made during the debate. Parliamentary scrutiny is a vital part of the regulation-making process, and I am pleased to have been able to set out the content of the regulations to the Committee. I hope that the Committee has found the debate informative and that it will join me in supporting these amending regulations.

Question put and agreed to.

Resolved,

That the Committee has considered the Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) (Amendment) Regulations 2020 (S.I. 2020, No. 839).

The Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) (Amendment) (No. 2) Regulations 2020

Resolved,

That the Committee has considered the Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) (Amendment) (No. 2) Regulations 2020 (S.I. 2020, No. 882).—(Nadine Dorries.)

The Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place and on Public Transport) (England) (Amendment) Regulations 2020

Resolved,

That the Committee has considered the Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place and on Public Transport) (England) (Amendment) Regulations 2020 (S.I. 2020, No. 906).—(Nadine Dorries.)

Health Protection (Coronavirus, Restrictions) (Leicester) (No. 2) Regulations 2020 Health Protection (Coronavirus, Restrictions) (Leicester) (No. 2) (Amendment) Regulations 2020

Nadine Dorries Excerpts

Monday 21st 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, Restrictions) (Leicester) (No. 2) Regulations 2020 (S.I. 2020, No. 824).

[The Chair]

With this it will be convenient to consider the Health Protection (Coronavirus, Restrictions) (Leicester) (No. 2) (Amendment) Regulations 2020 (S.I. 2020, No. 875).

[Ms Dorries]

It is a pleasure to serve under your chairmanship, Mrs Murray. The regulations came into force on 3 August and 19 August respectively. On each occasion, my right hon. Friend the Secretary of State for Health and Social Care announced that the latest epidemiological data allowed a relaxation of some of the measures imposed on those living and working within the protected area of Leicester.

The regulations were preceded by the Health Protection (Coronavirus, Restrictions) (Leicester) Regulations 2020, brought into force on 3 July, which imposed the first interventions in Leicester and the surrounding wards. They required the closure of all non-essential businesses, restricted indoor gatherings to no more than two people and outdoor gatherings to no more than six people from different households, and prohibited residents from staying away from their homes and visitors from staying within the protected area. They were debated by the House on 29 July.

Since those measures were introduced, and by the first review date, the number of positive cases in Leicester decreased and the rapid increases prior to the lockdown were arrested. It was clear that our co-ordinated national and local effort, particularly by the people of Leicester, was working. Amendments to those regulations came into force on Saturday 18 July, removing the boroughs of Blaby and Charnwood from the protected area. Then, on 24 July, a further amendment to the regulations allowed specific businesses and out-of-school childcare and educational establishments to reopen in Leicester. The amendments that came into force on 1 August removed Oadby and Wigston from the protected area.

The first of the regulations that we are debating today repealed the previous Leicester regulations. That is why we are not debating statutory instruments 2020 No. 754, No. 787 or No. 823, which have all been revoked. I hope that that summary sets the context of the present set of regulations. Given the urgency of the situation in Leicester, we used the emergency procedure to make them as soon as we could. They give effect to the decision set out by my right hon. Friend of State responding to the latest epidemiological evidence and local insights.

It is as important to remove restrictions as soon as possible as it is to impose them when transmission rates are unacceptably high, so that the people whom the restrictions impact hardest are not subject to them for any longer than necessary. The Health Protection (Coronavirus, Restrictions) (Leicester) (No. 2) Regulations 2020 allowed more businesses to reopen across the city of Leicester. Residents were allowed to stay overnight away from their homes, and the restrictions on how many people gather in homes or outdoors were replaced by a restriction preventing different households from meeting up with each other in homes and gardens.

At that stage, the only businesses that remained closed were those where the transmission risk remained unacceptably high in the light of the incidence rates of coronavirus in Leicester—for example, nightclubs and casinos; nail bars, salons, spas, tattoo parlours and skin piercing services; sports venues such as indoor ice skating rinks, swimming pools, bowling alleys, and fitness and dance studios; outdoor swimming pools; conference centres and exhibition halls. There were various exemptions to the list—for example, to let blood donations take place at those locations, and for elite sportspersons and professional dancers to continue training.

The revised restriction on household gatherings in private homes was also subject to several exceptions to mitigate the impact of the measure. For example, those who were part of a support bubble arrangement were allowed to continue to meet, a person could attend a birth or visit someone who was dying, and gatherings necessary for work, education, childcare or charitable work could take place. Gatherings were also permitted in emergencies, to avoid injury or illness, or to escape risk of harm, to move to a new house, and to provide caring assistance to a vulnerable person.

The regulations include provisions that make it a criminal offence to breach any of the restrictions or requirements. As with the national regulations, those who breach the provisions may be issued with a fixed penalty notice fining them £100, or £50 if paid within 14 days, with repeated breaches attracting increasingly greater amounts. Offenders may also be fined following conviction.

On 19 August, the regulations were amended, considering the more stable incidence of the virus of 70 per 100,000 people. My right hon. Friend the Secretary of State agreed that it was safe to allow more businesses to reopen in accordance with covid-secure guidance, but not to relax the restriction on households meeting one another in private homes. From that date, nail bars, hair salons, tanning booths, spas, beauty salons, massage parlours, tattoo parlours, body and skin piercing businesses, and outdoor swimming pools could reopen. We also published guidance for people living in Leicester, to help them to understand what they can and cannot do under the restrictions. That was updated each time there was a change.

Concern about the outbreak in Leicester has been significant. Engagement with local leaders has been extensive, repeated and productive throughout the period. I thank the local authorities, the local resilience forum, Public Health England, the Joint Biosecurity Centre and the local director of public health, to whom I have spoken a number of times and to whom we refer repeatedly. Ivan Browne of Leicester City Council, who has done an amazing job, is the director of public health.

On each occasion, the decision to take action was driven not by one number but by a judgment about the overall situation. When we imposed the first lot of restrictions at the beginning of July, however, one number stood out: the seven-day infection rate, which in Leicester was 135 cases per 100,000, which I know the Opposition Front Bencher, the hon. Member for Leicester West, understands fully is an extremely high rate—three times higher than in the next highest area at that time. On the clinical front, admissions to hospitals were between six and 10 per day in Leicester, rather than one per day in other hospital trusts. Actions had already been taken to protect people in Leicester, including increases in testing and public health capacity. We hoped that those interventions and the work of the local public health teams would get the infection rate down without us having to take more drastic action but, sadly, that was not to be.

As required by the regulations, we have reviewed the situation at least once every 14 days since then, and we revised the geographical extent and the nature of the restrictions as and when it was safe to do so. We also published guidance for people living in Leicester, to help them to understand what they can and cannot do under the restrictions. I emphasise that point again. I think the hon. Lady would agree that the guidance and information produced have been extensive, thanks to people such as Ivan Browne.

We always knew that the path out of lockdown would not be entirely smooth. It was always likely that infections would rise in particular areas or workplaces, and we would need to be able to respond quickly and flexibly to such outbreaks. As the Committee has heard, the protected area covered by the regulations is due to be extended from tomorrow to include the Borough of Oadby and Wigston. Unfortunately, following a drop in the incidence rate in that area earlier this summer, rates have now risen to an unacceptably high level. We decided that restrictions on households meeting each other in their homes need to be put in place. As I said, there are ongoing reviews of the Leicester regulations. The next review is due on or before 25 September. We will of course make public the outcome of that review in due course.

I am grateful to all Members for their continued engagement in this challenging process and for their scrutiny of the regulations. In particular, I thank people in the protected area in Leicestershire, who have responded well to the measures put in place. It is thanks to their continued efforts that we were able to reopen non-essential retail, childcare and educational establishments. We hope to ease measures further if the improvements continue. I commend the regulations to the Committee.

--- Later in debate ---

[Ms Dorries]

I thank the hon. Lady for her impassioned speech. Nobody would ever doubt her commitment to Leicester. As a Minister who has now been responsible for restrictions being put in place in a number of areas across the country, I know how upsetting that is for everybody and especially MPs, who really care about their constituencies and the lives of their constituents. It is distressing. The hon. Member for Leicester West raised many points today. I will hopefully address all of them and will do so as best I can. She did go out of scope in bringing up testing and tracing, but I will, with the tolerance of the Chair, address some of those points.

First, I thank hon. Members for being here today for what is an important debate. The restrictions that we have debated today are necessary in these unprecedented times, and they are important for three reasons, the first and foremost of which is to protect the people of Leicester and the surrounding areas from this terrible, dreadful virus. The lockdown that we have had to impose has been difficult, but I think that the people of Leicester recognise that letting the virus spread unchecked would be far worse.

Secondly, the restrictions are important because they protect those of us who do not live in Leicester. As a result of these ongoing restrictions, there is less risk of the unacceptably high infection rates in that city spreading elsewhere. We should recognise that the restrictions and difficulties faced by the people of Leicester will benefit the whole country.

Thirdly, the restrictions show our absolute determination to respond to the outbreak of the virus in a focused and effective way. We are learning from what has happened in Leicester as we work with local authorities and others in order to respond to future localised outbreaks. We have seen that recently in parts of the north-west and north-east of England, as well as in the midlands.

I am pleased that, since 3 July, when the original restrictions came into force, the area of Leicestershire subject to the restrictions has been reduced and we have been able gradually to allow businesses to reopen and residents to meet up with each other. That recognises the reductions in the incidence rate and shows that Leicester is on the path to realigning with the rest of England’s measures. The next review will take place this Friday, 25 September.

I would like now to deal with some of the points that the hon. Member for Leicester West raised. She spoke about the issue of gardens and asked why people could not go into back gardens. My hon. Friend the Minister responsible for social care was absolutely right in her answer previously. It is because not all homes have access to gardens without going through houses, and winter is coming—to quote a far better phrase from a better source than me. Winter is indeed coming and people will not be so inclined to stay in the gardens and not go into the houses. We do not want people not to be able to mix in their gardens. We want families to be together. We want people to mix. But as always, we are guided by the science.

I am sure that the hon. Lady heard the announcement by the chief medical officer and the chief scientific adviser today. If we said, “Can people mix in gardens; can they do that?”, and they said that it was safe to allow them to do so, we would. We want people and families to be in contact. It is heartbreaking that families are not. But I am afraid it is as it is. We cannot make one rule for families who have direct access to a garden and another rule for families who do not. That just is not fair.

I will mention businesses in a moment; I will deal now with the test-and-trace aspect that the hon. Lady mentioned and the testing. I have to say—with your forbearance, Mrs Murray—that we have one of the best testing rates in the world; it is equivalent to at least one test for every five people in the country, outpacing Germany, Spain and France. I never miss an opportunity to say that at the moment, because we are one of the best testers out there. We had the capacity for over 250,000 antigen tests on 18 September, from just 2,000 a day in March, and over 2 million testing kits are delivered to almost 9,000 care homes—I will not go on with the rest of the list, Mrs Murray, because I know that you would pull me up.

On test and trace, where do I start? We have reached 86.6% of people who have been contacted; that is over 13,000 positive people who have been reached via contacting. This system did not start on day one; it was not up to speed on day one. We agree with that. The virus blindsided us—for want of a better word—but we are in a much better place now with test and trace, and I have to thank Baroness Harding for her extraordinary efforts.

Grants are now in place for businesses that are required to shut due to the new measures. They can claim up to £1,500 per property every three weeks, because we recognise the impact of localised restrictions on local businesses. That is why we allowed the opening of non-essential retail as soon as the data showed that it was safe to do so. Leicester businesses have access to a large number of support schemes that are in place to help businesses through what is a very difficult time. They include discretionary grants, tax breaks and more. The only way to protect our people and economy is to prevent a second wave of the virus, which is why measures such as those that we have taken in Leicester are necessary and proportionate.

The hon. Lady spoke about shielding. As incidence rates are starting to fall, we continue to review the position. People who are clinically extremely vulnerable and living in the city have been advised to continue to shield. That advice is being reviewed as part of the wider reviews of the measures, and it will be changed as soon as it is safe to do so. Support for shielding has been extended to allow the advice to be followed.

The hon. Lady made a point about communications and having information about the lockdown in Leicester—the words communicated to people. She spoke about coming on to the MP engagement call, and she said that the decision was suddenly arrived at and no one knew. I have to correct her. We had discussions with the Mayor of Leicester, Ivan Browne, and with Mike Sandees from the county side of Oadby and Wigston, who has provided two mobile testing centres in Oadby and Wigston and done a fantastic job. Everybody in Leicester wants this nightmare to end. I know, because I was involved in the calls and meetings. We had the Mayor of Leicester, the leaders of both the county council and Leicester City Council, the chief executives of both the county council and the city council, the directors of health from both councils, and the chief constable. Almost all the people who were responsible for the implementation of the local management outbreak plan were in discussions about the reviews and what was happening in Leicester all the way along.

As the hon. Lady knows, we cannot manage what happens in 10 Acacia Avenue in Leicester from Westminster. That is why we introduced local managements outbreak plans across the country. Every local authority stepped up to the plate. They did their bit, and we provided them with £400 million-worth of funding to do it. Leicester has received a considerable sum of money.

As I am sure the hon. Lady is aware, we have also now introduced consensus meetings, where hon. Members can discuss the incidence rates in their constituencies with their directors of public health and their chief executives. The meetings are normally held on Tuesday afternoons for representation to JBC—joint biodiversity centre—Silver on a Wednesday, and we take the decisions in JBC Gold on a Thursday. The Secretary of State introduced that four or five weeks ago so that MPs can be actively involved in the decisions that are taken in their local areas.

I urge the hon. Lady to be part of the consensus meetings with those individuals on a Tuesday afternoon. If she thinks that some wards should not be in lockdown, or that parts of the regulations should be relaxed, she can make those representations. If they are not listened to by her local authority, she can come to the Ministers at the Department of Health and Social Care and give us the evidence and data to show why she thinks that the wrong path is being taken in Leicester and why she thinks that the local authority is locking down or suggesting the imposition of restrictions where they should not be doing so. I urge her to do that. We do not make any decisions in the Department of Health and Social Care without full consultation with everybody on the ground, particularly those who are responsible for designing and delivering the local outbreak management plan.

Let me conclude by recording on behalf of the Government our thanks to all the people of Leicester, particularly the NHS and care workers in the city. They put themselves on the frontline on a daily basis with their ongoing hard work to keep our vital services running and to save lives throughout this crisis.

Question put and agreed to.

Resolved,

That the Committee has considered the Health Protection (Coronavirus, Restrictions) (Leicester) (No. 2) Regulations 2020 (S.I. 2020, No. 824).

HEALTH PROTECTION (CORONAVIRUS, RESTRICTIONS) (LEICESTER) (NO. 2) (AMENDMENT) REGULATIONS 2020

Resolved,

That the Committee has considered the Health Protection (Coronavirus, Restrictions) (Leicester) (No. 2) (Amendment) Regulations 2020 (S.I. 2020, No. 875).—(Ms Dorries.)

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

Nadine Dorries 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.

[Alec Shelbrooke (Elmet and Rothwell) (Con)]

I am grateful to my hon. Friend; she is being very generous with her time.

I want to return to my hon. Friend’s comment about the regulations being debated in the House at a later time. Is she saying that we will eventually debate them in the House? I will support the regulations, so she need not worry. We are where we are, but there is a lot of debate about whether face coverings are necessary, and it needs to take place on the Floor of the House. Is the intention that the regulations will be debated on the Floor of the House?

[Ms Dorries]

These regulations are up for debate every six months anyway, because they are only temporary. Even at that point, they would be up for debate. I cannot tell my right hon. Friend when they will come before the House, but they certainly will do at some stage, particularly as we have an obligation in law to bring them to the House for debate.

To coincide with the easement of some restrictions, we introduced the regulations to give members of the public the confidence to visit public indoor spaces safely, and to enhance protections for people working in such settings. This was explained by the Secretary of State when he addressed Parliament on 14 July and announced the measures.

There has been support for the policy in the retail sector. For example, the chief executive of the British Retail Consortium said that, together with other social distancing measures, face coverings can make shoppers feel even more confident about returning to the high street. Additionally, the chair of the Federation of Small Businesses said:

“As mandatory face coverings are introduced, small firms know that they have a part to play in the nation’s recovery both physically and financially, and I’m sure this will be welcomed by them.”

Therefore, we are confident that this was the right step to take.

The Government have continually reviewed and refined their advice on face coverings, led by the latest scientific evidence. Prior to the regulations, the Government were already advising the wearing of face coverings in enclosed spaces where people might find it difficult to maintain social distance and might come into contact with others they would not usually meet. Furthermore, face coverings have been mandatory on public transport in England since 15 June. While face coverings are not a substitute for social distancing and good hand hygiene, the scientific evidence suggests that, when used correctly, face coverings may have some benefit in reducing the likelihood of those with the infection passing it on to others, particularly if they are asymptomatic.

[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.

[Alec Shelbrooke]

I just want to build on that point. My hon. Friend will be well aware that I myself have impaired hearing. It is incredible, but what I have discovered is that you may think that you can hear someone, but unless you can see their lips moving, you cannot hear them. And that is in the normal context—I can hear everything perfectly well in this room right now, but if it is a busy area, I cannot. I am therefore grateful to my hon. Friend for making that clarification. I think that there should perhaps be a little more emphasis, for the understanding of people outside the House, that actually even those of us who are not registered deaf or anything like that do rely on seeing lip movement to hear people in a crowded room.

[Ms Dorries]

Having known my right hon. Friend for some years now, I of course do know that, and my own mother is almost totally deaf. It is incredibly distressing, particularly for the elderly who are deaf and can no longer hear/see what people are saying to them. I take on board my right hon. Friend’s point about deafness and face coverings. Taking all that into account, and even with my own personal life experience of how it affects people, I am still absolutely supportive of the fact that, on the basis of scientific evidence and recommendations to us, this is a necessary move, one that we have to undertake, to stop the increase of the virus within communities.

We have been working with stakeholders to ensure that staff are aware of the exemptions in place and that some people will not be able to wear a face covering. We are also clear that people do not need to prove that they are exempt from, or have a reasonable excuse regarding, the requirement to wear a face covering, and they should not be challenged about that. These regulations have been supported by a communications campaign explaining where face coverings are mandatory—I take my right hon. Friend’s point; that may need to be ramped up—how to wear one safely and encouraging understanding and awareness of those who may not be able to wear a face covering. We have set out the full details of this policy in our guidance.

As expected, reports indicate widespread compliance with the requirement to wear a face covering in relevant indoor settings, and surveys suggest that there is significant public support. The Office for National Statistics public survey showed that, in the period from 29 July to 4 September, at least 96% of adults in England had worn a face covering when shopping. The figure has remained consistently high. However, we should not expect participation to reach 100%, as there will always be those people who are exempt or have valid reasons why they should not be wearing a face covering.

Included in the regulations is a review clause requiring a review of the need for the requirements imposed by the regulations at six months—to answer the question about that. A sunset clause is included, so the regulations will expire at the end of 12 months after the day they come into force.

We will continue to monitor the impact and effectiveness of the policy in the weeks and months ahead, and we will develop our approach of enforcement and communicating the policy as necessary. I am grateful to all hon. Members for their continued engagement in this challenging process and in the scrutiny of the regulations. We will of course reflect on the debate to come. I commend the regulations to the Committee.

--- Later in debate ---

[Ms Dorries]

On the point about covid marshals and data protection, we will get back to my right hon. Friend. A number of points have been made in a holistic and wide-ranging way by different people, and I will try to answer the specifics as much as I can. If I do not cover them all, hon. Members can shout at me; we will certainly ensure that they receive answers by tomorrow.

I will first address some of the wider points about lip reading, because there is some kind of misinterpretation of this. Somebody who has a disability, including deafness, does not have to wear a mask, nor does the person assisting someone. If a deaf person goes up to somebody in a shop and asks for help, the shop worker can remove their mask to provide assistance if they are told, “I can only lip read.” The assistant helping somebody with a disability or helping somebody to find their way—whatever need they have—can remove their mask. I wanted to make that clear.

Reference has been made to the fact that people are not wearing masks in pubs and restaurants, but they are socially distancing. There are hand sanitisers when people enter. As pubs and restaurants are keeping their staff safe, they are being very careful about how their clientele use their premises. I want to reiterate a point that I made in my opening speech: 96% of people wear masks.

On the question of why this took so long and the scientific evidence—a question that has been raised in a number of ways—we as politicians did not decide that it was now time for people to start wearing masks. That information comes to the Government and to politicians via a number of filters. It comes from SAGE. It then goes to the chief medical officer, the deputy chief medical officers—Jenny Harries and Jonathan Van-Tam—and, I think, Professor Stringer, our chief scientific officer. We then take the advice from the Behavioural Insights Team; we take the advice that we are given by the scientists.

The Welsh Government have been mentioned. They have their own chief medical officer and their own advisers. They take their advice; they are devolved. We do not tell them when people in Wales should start wearing masks, and they do not tell us. We have our own established scientific body of advice. We do not say to SAGE, “We don’t like your advice today. We’ll go and take it from somewhere else.” We are consistently advised by SAGE and by NERVTAG. When they tell us that the evidence now is such that people should start wearing masks because there will be some benefits, we will take it. In fact, people were wearing masks before we brought in the legislation. The public had already made their mind up, whether they had the scientific evidence or not, that they would start wearing masks, and indeed they were.

That is where we add. As politicians, we do not say, “Do you know what? It is time for everyone to start wearing masks.” We do not have the authority, the scientific background or the evidence—

[Mr Jones]

Yes, you do.

[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.

[Mr Jones]

Personally, I have no problem with wearing masks; neither, I think, do the public—

[Ms Dorries]

I would never have guessed.

[Mr Jones]

I am sorry if the Minister wants to be flippant, but it is my job to look at the legislation and scrutinise it. She said that 96% have no problems with it. I never believe in putting forward legislation if there is no need.

I am sorry, but the Minister is wrong in what she just said. It is down to politicians to make the ultimate decision. I have been a Minister, and there are occasions when advice can be ignored—that is a political decision. It is no good hiding behind the scientists, which is what the Government have done all the way through the crisis.

[Ms Dorries]

This is the decision. That is what we are here debating—the decision to introduce the wearing of face coverings in public places. We have taken the decision; that is what we are doing right now.

I was asked why we were so slow to react to the wearing of face masks. It is because, to come here and introduce legislation, we needed evidence that wearing face masks works. As I think the hon. Member for Blackley and Broughton said, this is a new virus—globally, not just for the UK—and all over the world countries have taken their own decisions on the basis of whatever evidence they could gather over a short period and in a short timeframe. We have now got to the point where we believe the evidence is such that wearing a mask will provide protection even if the wearer is asymptomatic, not showing symptoms of coronavirus and not coughing. Therefore, we are introducing the regulations.

[Justin Madders]

I am grateful to the Minister for giving way. I appreciate that these things do take some time, but it is the case, is it not, that recommendations were made on 11 May about the wearing of face coverings, but they did not become law until 24 July? What is the reason for that long delay?

[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—

[Mr Jones]

Are the British Transport police covered by this legislation, because there is no reference in it to them?

[Ms Dorries]

Again, I will clarify that. They might not be in these regulations, but this is about not just Transport for London, but British Transport police across the UK.

On the point about people eating in cafeterias in transport hubs, of course people cannot eat through a mask. When people are purchasing food, or are sitting at a table eating and drinking, they obviously do not have to wear a mask.

[Mr Jones]

I am sorry, but that is not what the regulations say. It is in the definition of what a transport hub is. I will read it again:

“In these Regulations, “transport hub” means any…premises used as a station, terminal, port or other similar premises from or to which a public transport service operates, but does not include…an area which is not open to the public;…an area where seating or tables are made available for the consumption of food and drink”.

Surely a transport hub that has tables for food and drink is not classed as a transport hub under the definition in the regulations.

--- Later in debate ---

[Ms Dorries]

Areas that are open to the public, where people are purchasing food, drink or refreshments, do not require the wearing of a mask. Again, I will clarify the wording to the right hon. Gentleman in writing, but that is the advice that I have been given. It beggars belief that anybody could consume food or drink while wearing a mask, but I will ensure that I clarify that information to him.

[Anthony Browne (South Cambridgeshire) (Con)]

On reading this, I think it is very clear. If I dare say so, the right hon. Member for North Durham is misunderstanding what the Government policy is. Areas where there is food and drink in a transport hub are excluded from these regulations, so people do not have to wear a mask there them. I think it is really quite straightforward.

[Ms Dorries]

They are exempt.

The shadow Minister raised the issue of regulation 3(2)(c), which is intended to capture contractors working on site, medical practices, and those who are best placed to advise about their own medical practices—both people working in the medical practices and patients.

I would like to thank hon. Members. If there are any points that require a more detailed response, we will ensure—

[Several hon. Members rose—]

[Ms Dorries]

I give way to Mr Jones.

[Mr Jones]

I am old-fashioned. I thought that in Committee we are referred to by constituency, not by name. I have been here too long. Could we have the Secretary of State’s list of the other people who can issue fixed-penalty fines?

[Ms Dorries]

I have already asked for that.

[Matt Western]

The Minister is being very generous in giving way. In response to her honest offer, I am sure everyone would welcome urgent clarification about the role of covid marshals and the powers that they will have. Clearly, they are referred to under regulation 7(11)(d). Quite how they will be funded and what the powers are is a separate issue. The emphasis that the Prime Minister and the Government are giving to the new covid marshals seems disproportionate to the reality of what will happen on the street. I do not believe that the authorities will actually be able to deliver that, and they will rely on the police.

[Ms Dorries]

It was an honest offer, and I will ensure that the hon. Gentleman receives that information.

[Justin Madders]

I thank the Minister for giving way, and I promise that I will not intervene again.

What we have heard today from various Members is clear evidence of why it is important that regulations are debated before they become law. There is a whole series of questions in relation to covid marshals, in particular, and their powers and training and the data protection requirements that we are not able to answer. The point has been made by several Members that it is really important for public buy-in to the concept of those marshals that the powers are clear and they have democratic consent because they have been transparently debated, so can the Minister make a commitment today that any new powers given to marshals, whoever they end up being, will be debated in this House before they become law?

[Ms Dorries]

No, I cannot; I apologise. I will obtain the list of those who have the authority and ensure that the hon. Member for Warwick and Leamington has that tomorrow. The hon. Member for Ellesmere Port and Neston, I am sure, was trying his hand when he asked his question. He did so knowing very well that that is not something that I can commit to.

[Mr Jones]

The reason why the Minister cannot do so is that this measure gives carte blanche to the Secretary of State to give those powers to anybody.

[Ms Dorries]

In this new world of coronavirus and covid-19, we as a Government have to have the right to respond, both urgently and in the case of an emergency, when we need to keep the public safe and to save lives. We have to retain the ability to do that.

The hon. Member for Ellesmere Port and Neston raised one other point that I would like to address. He talked about universities and further education and face coverings. Actually, this has been really interesting, because many universities are very enthusiastic about developing their own policies. They are keen to get their students back in. They are keen to get up and running in a way that is as “back to normal” as it can be in the context of social distancing, and the wearing of a face mask is something that many universities have themselves required. They have done their own messaging to students. I have seen some of this. “Don’t kill your nan” was quite extreme; that was at one university in my own home city. Universities have very much taken on board the fact that they want to keep their campuses safe, and they are launching their own campaigns.

[Matt Western]

I echo those points. For example, the University of Warwick has done a terrific job in terms of its preparation on campus and is doing its very best to ensure safety among the community off campus. However, this then comes back to what is beyond their remit and what actually happens in communities such as Durham, probably, or Warwick and Leamington—my community—where students quite rightly will be back for the new term; some will be starting and will be there for the first time, and they will be out, in among the population. That is why these sorts of enforcement measures are so important.

[Ms Dorries]

The measures that we are taking to ensure the wearing of face masks in public places are to ensure that we try to contain the virus as much as we can, in the light of the fact that of course students do move from their university. They travel back home at the weekend. They move back into the community. They will be in student houses. Their community mixes. They have house parties, as they do. These are the kinds of thing that we are trying to prevent with the regulations that we are bringing in, so that those students can keep attending university and keep learning. The universities have taken responsibility for what happens on campus; we have taken responsibility for what happens off campus via the rule of six, the new legislation that we have introduced as of today, and via the measures such as the one that we are debating today on the wearing of face coverings. Keeping everybody safe is the only objective of anything that the Government are doing in terms of the legislation that they are introducing. None of this is political. It is about keeping people safe. That is the bottom line with everything we introduce in terms of regulations and any measures to do with coronavirus and covid-19.

I thank hon. Members for their contributions to this important debate. They have been many and interesting, and we will respond to those that I have not been able to answer. The Government have always been clear that their highest priority in managing this national crisis is protecting our public and saving lives. I am satisfied that the requirements imposed by the regulations and the enforcement powers given to police and Transport for London are reasonable and proportionate, with regulations specifying appropriate exemptions and reasonable excuses.

Our guidance has consistently set out to the public that to protect themselves, they must continue to follow the social distancing measures, wash their hands regularly and adhere to the isolation guidance. The current guidance from Government states that people should also wear a face covering in enclosed public spaces where social distancing is more difficult to maintain and where people may come into contact with others that they do not normally meet.

The debate today has provided an opportunity for the Government to hear hon. Members’ concerns through the contributions made during the debate. Parliamentary scrutiny is obviously vital as part of the regulation-making process.

I would just like to correct the point that I made to my right hon. Friend the Member for Elmet and Rothwell earlier. It is not necessary for this regulation to be debated in six months; it will be reviewed in six months, but will fall anyway 12 months after 24 July, when the regulations were made. I hope that the Committee has found this debate informative and that it will join me in supporting the regulations.

Question put and agreed to.

Resolved,

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).

Oral Answers to Questions

Nadine Dorries Excerpts

Tuesday 1st September 2020 Commons Chamber

[Daniel Zeichner (Cambridge) (Lab)]

What recent assessment he has made of the availability of covid-19 testing for GPs required to attend care homes.

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

GPs with symptoms can be tested through the self-referral portal. In addition, we are launching pilots in Northamptonshire, Peterborough and Cambridgeshire to provide regular covid-19 testing for professionals who visit care homes regularly and provide services within 1 metre of residents.

[Daniel Zeichner]

That is all in the future, of course. I was talking to GPs in Cambridge last week, and they told me about the difficulty they have with getting tested before going into care homes. Indeed, one of them told me she had to pretend to be a care worker to get a test. That cannot be right after all this time, can it?

[Ms Dorries]

As I said, the pilots are now being launched in Peterborough and Cambridgeshire to provide regular covid-19 testing for professionals, and I think that problem has probably been resolved.

[Yasmin Qureshi (Bolton South East) (Lab)]

What steps he is taking to implement the recommendations in the July 2020 Independent Medicines and Medical Devices Safety Review report.

[Yasmin Qureshi [V]]

The Minister is aware that the Cumberlege review has clearly set out Government failure, with Primodos not being withdrawn and thousands of babies being born with severe deformities. Does she think it is acceptable to cite legal action, which has no bearing on the report’s findings, to continue to delay justice for the families? Will she meet me and the all-party parliamentary group to discuss a road map to implement the recommendations for all the three causes without further delay?

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

We welcomed the Cumberlege report and we are looking into the recommendations made, but the hon. Lady knows that, as a result of live litigation, I am not able to comment further.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

What recent assessment he has made of the adequacy of Government guidance for people unable to wear face coverings due to medical or other reasons.

Patient Safety Incidents and Deaths: Liverpool Community Health NHS Trust

Nadine Dorries Excerpts

Thursday 16th July 2020 Written Statements

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

Following questions raised about the management of the Liverpool Community Health NHS Trust an independent review chaired by Dr Bill Kirkup CBE was established. The review report, published on 8 February 2018, found that there were significant failings in the trust from November 2010 to December 2014.

It is important that these failings are investigated, and lessons learnt to improve services. In response to these serious patient safety incidents described in the report the Secretary of State for Health and Social Care commissioned Dr Bill Kirkup to conduct an independent investigation into patient safety incidents at the trust.

These terms of reference cover patient safety incidents that occurred in the same period as the initial independent review addressed, namely November 2010 to December 2014.

This independent investigation is being conducted over three stages. Stage 1, which identified individual serious patient safety incidents that had not been reported or adequately investigated by the trust, and stage 2, an examination of a series of historic mortality reviews.

We are now entering stage 3, which will fully investigate those individual serious patient safety incidents identified from the previous stages to determine the scale of deaths and patient harm and identify local and national learning.

The work of the independent investigation panel is expected to complete by the end of 2021 and arrangements will be made for publication of its report to Parliament.

A copy of the terms of reference will be deposited in the Libraries of both Houses.

[HCWS376]

Health Protection (Coronavirus, Restrictions) (Leicester) Regulations 2020

Nadine Dorries Excerpts

Thursday 16th July 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, Restrictions) (Leicester) Regulations 2020 (S.I., 2020, No.685)

It is a great pleasure to serve under your chairmanship, Sir Christopher. I have sat in your Chair many times over the past 10 years, but this is the first time I have been here in my role as a Minister, so now I know how it feels.

The regulations were made on 3 July and came into effect the following day. They have not yet been formally cleared by the Joint Committee on Statutory Instruments. This debate has been listed as quickly as possible to address Parliament’s concerns about delays between making regulations and scheduling debates. The regulations were necessary to give effect to the announcement made a few days earlier on 29 June by my right hon. Friend the Secretary of State for Health and Social Care that targeted measures needed to be taken to tackle the outbreak of coronavirus in Leicester.

The concern about the outbreak in Leicester was significant and was shared by local leaders, including the local authorities and the local resilience forum; by national organisations, including Public Health England; by the local directors of public health, Ivan Browne at Leicester City Council and Mike Sandys at Leicestershire County Council; and by the Joint Biosecurity Centre, Ministers and the chief medical officer.

Of course, the decision to take action was not driven by one number. It was a judgment about the overall situation, but some of the figures we had in front of us when the targeted lockdown was imposed bear repeating, because they are stark. At that stage, the seven-day infection rate in Leicester was 135 cases per 100,000 people, which was three times higher than the next highest area. Admissions to hospital were between six and 10 per day in Leicester, rather than around the one per day at other trusts.

Action had already been taken to protect people in Leicester by deploying mobile testing units and providing extra capacity at the regional test site. Extra public health capacity had been deployed to boost the local team. Additional financial support was provided to the local authorities to provide business grants, including £70 million to Leicester City Council. We hoped that the interventions and the work of the local public health teams would get the infection rate down without our having to take more drastic action.

By the end of June, however, it was clear that the high rate of infection was continuing. The cross-Government covid-19 operations committee, chaired by the Prime Minister, therefore decided on 29 June to take further measures to tackle the outbreak. The Secretary of State set out the measures in his statement.

Most of the measures taken did not require legislation. We increased testing capacity further: there are now 10 mobile test units deployed across the city, a regional test site and three local test sites. Four of the mobile units operate on a hyper-local basis, enabling teams of NHS and council volunteers to go door to door across the communities with the highest positivity rates.

We also gave additional funding to the two upper-tier local authorities involved. In addition to the £70 million, Leicester City Council was provided with approximately £2.5 million, and Leicestershire County Council approximately £2.3 million—that is £4.8 million between the two upper-tier authorities. That enabled them to enhance communications, including in locally relevant languages. Public messages on the virus in Leicester were translated into 12 different languages, and a wide range of locally relevant formats were used to communicate those messages, including various social media platforms, posters, and videos by GPs who speak different languages and by Ivan Browne, the local director of public health. Messages were also broadcast from local radio stations in different languages as well as through community leaders and volunteers on the ground.

We also concluded, however, in discussion with the local team, that the restrictions in Leicester would need to be tightened, even as the restrictions were being eased elsewhere in the country. People in Leicester were advised to stay at home as much as they could. We recommended against all but essential travel to, from and within Leicester. Shielding measures could not be relaxed, as they were in the rest of the country the following week. Schools in Leicester would close, except for vulnerable children and children of critical workers.

It would not be proportionate or practicable to ban travel altogether, but we concluded that it was necessary and proportionate for people living in Leicester not to be allowed to stay overnight away from home without a reasonable excuse. It was not safe to allow the easing of social contact measures, including those on gatherings, that the rest of the country benefited from on 4 July.

We also concluded that non-essential retail in Leicester would have to close again. We recognise how difficult and disappointing that was for citizens and businesses in Leicester, but it was the only way we could bring the outbreak in the city under control. We must keep people in Leicester, as elsewhere in the country, safe from this terrible virus.

I shall now move on to the regulations themselves. Given the concern about the situation in Leicester, we used the emergency procedure to make the present set of regulations as soon as we could. They give effect to the decisions set out by my right hon. Friend the Secretary of State. In particular, they require the closure of non-essential retail; limit overnight stays away from the place where individuals live, or a linked household, without reasonable excuse; restrict gatherings to six or fewer outdoors and to no more than two indoors; and enable households containing only one adult, or one adult and one or more people under the age of 18, to link with another household.

The people of Leicester have responded well to these restrictions over the past two weeks, and I would like to thank them for that—as, I am sure, everybody would—and to recognise the impact that they are having on their daily lives. We are required to review the regulations every two weeks, and we will announce the outcomes of the first review shortly.

Coronavirus is the biggest challenge that the UK has faced in decades. The resilience and fortitude of the British people in complying with the national lockdown that we introduced in March has been a true national effort and something of which we can all be proud. It is of course welcome that we have been able to start easing the national restrictions in line with our road map. That reflects the continued decline in the daily death rates and the downgrade in our covid alert level from level 4 to level 3.

We always knew, however, that the path out of lockdown would not be entirely smooth. It was always likely that infections would rise in particular areas or workplaces, and we knew that we would need to be able to respond quickly and flexibly to those outbreaks. We are now working with local authorities, and at national level, to ensure that we have the data and analytical capability to spot potential outbreaks quickly. We have, and will continue to develop, a range of tools and powers that will allow us to respond effectively and proportionately.

We will be saying more in the coming days about our plans for responding to local lockdowns and the powers that will be available. The Leicester lockdown has demonstrated our willingness and ability to take action where we need to. We will of course use the experience of the lockdown in Leicester to inform and help us to develop our responses to any future local outbreaks.

I shall now talk through what the Leicester regulations are designed to achieve. I will not go into detail about the national regulations that sit alongside them, because they are being debated in another Committee Room along the corridor. In general, these regulations return Leicester to where the national lockdown was in the first half of June, before non-essential retail could be opened.

Part 1 of schedule 1 to the regulations lists the postcode districts covered by the regulations. In discussion with the directors of public health at Leicester City Council and Leicestershire County Council, it was agreed that the restricted area for the purpose of a lockdown needed to go beyond the boundaries of Leicester City Council into a number of suburbs of Leicester to the south, west and north of the city that are the responsibility of the county council. The boundary makes sense geographically, as can be seen from the map that was widely circulated, but the simplest and most certain way to describe the areas covered by the restrictions was to list all the affected postcodes. This means that people and businesses could be in no doubt about whether they were covered by the restrictions.

Regulation 2 requires the Secretary of State to review the need for restrictions and requirements by 18 July—this coming Saturday—and thereafter at least once every 14 days, if necessary. In any case, under regulation 12, the regulations will expire six months after they commenced on 4 July, if they are not amended or revoked before then.

Regulations 3 and 4 set out the requirements on non-essential retailers to close. The types of business that need to close are set out in schedule 3. In line with the national regulations on closure of non-essential retail, there are some detailed provisions to clarify how these regulations will operate in particular circumstances, and some necessary exceptions. The requirements will be familiar to businesses from the national lockdown.

Regulation 5 sets out the restrictions on movement. The restrictions prevent people living in the protected area from staying overnight away from their home without a reasonable excuse. They can stay in a linked household. A non-exhaustive list of reasonable excuses is specified. For example, it would be reasonable to stay overnight in order to attend a funeral of a close family member, for work purposes, or to attend a birth.

Regulation 6 restricts gatherings of more than six people outdoors, or of two or more people indoors. There are some necessary exceptions to the restrictions on gatherings—for example, if the person is attending a funeral, or if the gathering is reasonably necessary for work or educational purposes.

Regulation 7 sets out the implications of the lockdown in Leicester for linked households. Households in Leicester may be linked with households outside Leicester.

Regulations 8 to 10 set out how the provisions will be enforced. As with the national regulations, there is the possibility of fixed penalty notices. We have published guidance for people living in Leicester, to help them understand what they can and cannot do under the restrictions.

As I said earlier, we will be saying more in the coming days about the outcome of the initial review of the Leicester regulations, and whether the impact of the lockdown so far allows us to ease them. We will also be saying more about how we plan to deal with future localised outbreaks. I am grateful to all Members for their continued engagement with this challenging process, and their scrutiny of the regulations. We will, of course, reflect on this debate as we consider our response to any future local outbreaks. I commend the regulations to the Committee.

--- Later in debate ---

[Ms Dorries]

I thank the hon. Lady for her—as always—reasonable, intelligent and impassioned response. Some of her points were much wider than the scope of the regulations, so I cannot respond to them, but I will try to respond as well as I can to her substantive points about Leicester.

I want to correct a number of the hon. Lady’s points. We both know whom we are talking about: Ivan Browne, the local director of public health in Leicester, who has done a fantastic job. However, he does not need to wait a week for anything; in fact, as a result of the Joint Biosecurity Centre, all local authorities have daily access to all the data relating to their area. Ivan has an authentication code with which he can log on each day to find out the daily data. No one has to wait a week for anything; if that were the case, we would be in a difficult situation with regards to the epidemiology of the virus.

I do not believe that any announcement was made—this is another one of the hon. Lady’s points—about extending Leicester’s lockdown. I am not aware of the article that she mentioned, but there have been no statements on extending the lockdown. She asked me when an announcement will be made—will it be today or on Saturday? All I can say is that the decisions regarding Leicester will be made very shortly.

The hon. Lady asked whether the decision to lockdown Leicester was based on the R rate or the number of infections. Actually, the decision to lockdown Leicester was based on a number of factors They include not just the positivity rate and the R rate—the transmission rate—but the way people live their lives in Leicester and where they travel to and from. I have never been to Market Harborough, but it has been mentioned to me numerous times in the past two weeks that people have been travelling from Leicester to Market Harborough during lockdown. Lots of considerations were pulled into the decision-making process.

I first spoke to Ivan—I believe it was before the lockdown took place—when we were aware that there was a spike and that the rates were rising, and he named a number of his concerns about households, living conditions, working conditions and the movement of people across Leicester. The hospital is on the far west side of Leicester, but one of the areas most affected is in the east, so Ivan was concerned about travel across the city. There were a number of considerations, and the same issues will be considered when easing the lockdown in Leicester. It will not be down to one issue, but a number of issues. We are advised on those issues on the ground in Leicester. It is not a decision that is just taken in Whitehall; it is taken with local leaders, the local director of public health, Public Health England via the Joint Biosecurity Centre, and the chief medical officer. There is a huge number of considerations and people who have input into the decision

On funding, we have assisted 9 million people across the UK with furlough, and the furlough scheme will continue until October, so people will not be out of pocket in terms of salary. Very few would say that the Government are not being generous in their provision to compensate people under threat of losing their livelihoods, businesses or jobs during the epidemic. We stepped up to the plate, and we have supported people throughout so far. The people of Leicester are no different in that consideration, and they will continue to be supported.

The hon. Lady also mentioned the boundaries. I make the point that the Mayor of Leicester set the boundary himself. He drew the map, and I was at the meeting at which he explained where he had put the boundaries and why he had drawn the map as he had, along with Nick Rushton, the leader of Leicestershire County Council. Overnight, between them, with their officials, they drew the boundary plan; we approved it the next day, on the basis of their recommendation. They recommended, “This is where we think the boundary should fall”, and we approved it. The hon. Lady made issue of the postcodes, areas and local geography, but it was the Mayor of Leicester who decided where the lockdown boundaries should fall. If I have missed any other points, I am happy to speak to the hon. Lady afterwards, but this is all very fast moving.

On finance, we have made £4.8 million available, including for the management of the local outbreak plan and support for local businesses. The funding is there for Leicester. We will continue to review Leicester and any area that goes into lockdown as we move forward.

I felt the passion in the hon. Lady’s voice when she was talking about Leicester, as I have in the voices of many people who have spoken about it. It is as though some people feel upset and almost embarrassed that Leicester has gone into lockdown, but 153 councils across the country have put in place local management outbreak plans. We have put £300 million into supporting those plans and helping every area—every upper-tier authority, which has responsibility for public health management—to be ready for when an outbreak occurs anywhere. Leicester is not the first and it may not be the last—living with coronavirus will be part of our lives.

In my opening speech, I said that we will learn from Leicester and what has happened there. I do not think that we were too slow in what we did. We worked with the data, which was made available, and I have a timeline of when that was available. It does not concur with the hon. Lady’s timeline: on 11 June, the new local dashboards went live and the authentication code was provided to local directors of Public Health England, not just in Leicester, but across the UK; and Leicester accessed its dashboard on 19 June.

Even before we began the enhanced testing—with discussions taking place on the ground a considerable time before that—we were aware at the Joint Biosecurity Centre, as the data was coming in, that a problem was arising. We analysed the data daily, and we could see that a problem was coming in Leicester. Public Health England worked with Leicester long before we announced the lockdown. On 19 June, Leicester used its authentication code to access the Joint Biosecurity Centre to get hold of its data.

I take on board the hon. Lady’s points about ethnicity and named households. That is being considered by the JBC. Obviously, a number of considerations have to be gone into to release that information and data. That is for authorities far higher than here. However, I take on board what she said, and she is not the only person to make the point; the Mayor of Manchester made similar ones. The issues are being discussed.

In conclusion, I thank Members for taking part in the Committee. I emphasise that some of the hon. Lady’s questions will be answered shortly—she will be relieved to hear that. The restrictions we debated today are necessary, and they are important for three reasons: first and most important, to protect the people of Leicester and the surrounding area from this terrible virus. The lockdown we have had to impose has been difficult, but I think that people in Leicester recognise that letting the virus spread unchecked would have been far worse for their continued livelihoods, businesses and future.

Secondly, the restrictions are important because they protect those of us who do not live in Leicester. As a result of the lockdown, few people will travel out of or to Leicester, and that greatly reduces the risk of transmission and of the high infection rates in the city spreading elsewhere. We should recognise that the restrictions and difficulties faced by the people of Leicester will benefit the whole country.

Thirdly, the restrictions show our absolute determination to respond to outbreaks of the virus in a focused and effective way. As I said, we will learn from what has happened in Leicester as we work with local authorities and others to develop our response to any future localised outbreaks. We will say more about that in the coming days.

I am grateful to the hon. Lady for her contribution today. I will conclude by placing on the record on behalf of the Government my thanks to the people of Leicester and particularly the NHS and care workers in Leicester—indeed, all key workers across the city—for their ongoing hard work to keep our vital services running and to save lives throughout this difficult crisis.

Question put and agreed to.

Resolved,

That the Committee has considered the Health Protection (Coronavirus, Restrictions) (Leicester) Regulations 2020 (S.I., 2020, No. 685).

Independent Medicines and Medical Devices Safety Review

Nadine Dorries Excerpts

Thursday 9th July 2020 Commons Chamber

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

With permission, Mr Deputy Speaker, I would like to make a statement about the independent medicines and medical devices review. This review was announced by my right hon. Friend the Member for South West Surrey (Jeremy Hunt) in February 2018, in response to public concern about the safety of medicines and medical devices used by the NHS. It focused on three areas. The first is Primodos, a hormone-based pregnancy test that is claimed to have led to miscarriages and birth defects during the 1960s and ’70s. It was prescribed to more than 1.5 million women before it was withdrawn from use in 1978. The second is sodium valproate, an anti-epilepsy drug that has been definitively linked to autism and learning disabilities in children when taken during pregnancy. The third is the vaginal mesh implants used in the treatment of pelvic organ prolapse and stress urinary incontinence, which have been linked to crippling, life-changing side-effects.

Baroness Cumberlege was asked to conduct a review into what happened in each of those three cases, including whether the processes that were followed were sufficient when patients’ concerns were raised. She was also asked to make some recommendations for the future, such as: how to consider the right balance between the criteria or threshold for a legitimate concern; how best to support patients where there might not be a scientific basis for their complaint, but where they have still suffered; how we can enhance the existing patient safety landscape; and how we can be more open to the insights that close attention to patient experience can bring.

The report has now been published, and a copy has been deposited in the Library of the House. It makes for harrowing reading. Every page makes clear the pain and suffering that has been felt by so many patients and their families. As Baroness Cumberlege herself said, they suffered “avoidable harm”. She said that she had listened to the heart-wrenching stories of acute suffering, of families fractured, of children harmed and so much more.

On behalf of the health and care sector, I would like to make an apology to those women, their children and their families for the time the system took to listen and respond. I would also like to thank every single person who has contributed to the review. I know that some of them wanted to be here in the House today. They felt as though their voices would never be heard, but now they have been, and their brave testimony will help patients in the future. I have watched and read some of their testimonies. They left me shocked, but also incredibly angry and most of all determined to make the changes that are needed to protect women in the future. It is right and proper that the victims were the first people to see this report. As a Government, we have now received its findings and, as hon. Members will understand, we are taking time to absorb them before we respond. That is the least that the report deserves. We will update the House at the very earliest opportunity.

I would like to thank Baroness Cumberlege, who has carried out her work with thoroughness and compassion. She has worked tirelessly to ensure that patients and their families have been heard, and I would like to pay tribute to her and her team. I know that the patients’ stories that they have heard have been harrowing and, at times, frankly beyond belief. She has done us all a great service by highlighting them, along with the suffering of so many women and their families. I know that there will be strong feelings across the House about the report, and that hon. Members will be eager to hear a fuller response. However, it is imperative for the sake of those who have suffered so greatly that we give the review the full consideration that is absolutely deserves.

It is clear, as I am sure the whole House will concur, that the response to these issues from those in positions of authority has not always been good enough. The task now is to establish a quicker and more compassionate way to address issues of patient harm when they arise. We must ensure that the system as a whole is vigilant in spotting safety concerns, and that we rapidly get to grips with the concerns identified by the report. We must make sure that different voices are invited to the table and that patients and their families have a clear pathway to get their answers and a resolution. The issues tackled in this report are, from one perspective, complex—matters of regulation, clinical decision making and scientific judgment—but there is one simple core theme that runs through all of this, and it goes to the heart of our work on patient safety. It comprises just two words: listening and humility. So much of the frustration and anger from patients and families stem from what they see as an unwillingness to listen—for us to listen and for them to be heard. We need to make listening a much stronger part of clinical practice and to make the relationship between patients and clinicians a true and equal partnership.

While the review has been progressing, the Government and the NHS have taken a number of steps relating to the concerns it has raised. However, there is always more that we can do, and it is clear that change is needed. We owe it to the victims and their families to get this right. I commend this statement to the House.

[Alex Norris (Nottingham North) (Lab/Co-op)]

I am grateful to the Minister for coming to make this statement today and for providing advance sight of it.

“Ignored”, “belittled”, “derided”, “gaslit”—those who have campaigned to highlight the harm caused by Primodos, sodium valproate and pelvic mesh have been called every name under the sun, but today they are one thing alone: proven right. I thank the noble Baroness Cumberlege for overseeing a piece of work that will make a huge difference to so many people, both today and in the future. It is hard to read, but it is vital that we do, and that we understand it and learn from it. It is really important to note that campaigners have universally said how well the review team treated them.

The review’s report thoroughly investigates what happened in respect of each of the three areas that I mentioned. Although, on the surface, they are separate, they have an awful lot in common, not least that they were all taken and used by women, and in two cases, pregnant women. This is clearly no coincidence and I was glad to see that the Minister referenced that the healthcare system must do better to protect women, because these cases reek of misogyny from top to bottom— and ageism and ableism as well. They also share the reaction of the healthcare system, which, according to the report, failed to monitor the use of these medicines and medical devices, then failed to identify and acknowledge that things had gone wrong, and then failed to work in a joined-up fashion to improve. The healthcare system failed to protect these people. As the review says, it has taken the act of having a review to shine a light on these systemic failings. I share with everybody else the love affair that we, as a nation, have with our health system, but we cannot be blind to its faults, and it is time that we act on them.

We would not be here without the campaigners. Without their tireless activism—for many decades in some cases—this would have been ignored. I want to take the opportunity to highlight a few of the groups that have done such tremendous work. That is a dangerous game, I know, and I can only apologise to those whom I do not have time to mention. Marie Lyon has led the way in bringing to attention the damage that hormone pregnancy tests, including Primodos tablets, can do. This report has finally proven her to have been right all along, stating that opportunities were missed to remove them from the market. She is right, too, that the Department for Work and Pensions has mugged campaigners over the condition insight report. I hope the Minister will commit to righting that wrong, too. Janet Williams and Emma Murphy, who founded the Independent Fetal Anti-Convulsant Trust—In-FACT—have fought so long to be believed and for action to be taken regarding sodium valproate, the risks associated with which far too many expectant mothers were unaware of. Kath Sansom, who founded Sling the Mesh, has provided so much support for so many people living in incredible pain because of pelvic mesh. This is a sombre day for those people, but I hope that they can take some satisfaction that their efforts have paid off in this way.

I would not often say this, but this is a day for parliamentarians, too. It was not clinicians or regulators who brought this to the surface. It was right hon. and hon. Members who listened to and believed campaigners and fought for them, too. Again, there are too many to name, but I will mention my hon. Friends the Members for Bolton South East (Yasmin Qureshi), for Kingston upon Hull West and Hessle (Emma Hardy), for Lancaster and Fleetwood (Cat Smith), the right hon. Member for Elmet and Rothwell (Alec Shelbrooke), my hon. Friend the Member for Blaydon (Liz Twist) and my predecessor as shadow Public Health Minister, my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson).

There is not time for me to cover all the recommendations, but I want to highlight a few. Recommendation 1 calls for a fulsome apology. It was right that the Minister did that, and it will be greatly appreciated. Recommendation 3 of the report calls for a new independent redress agency for those harmed by medicines and medical devices, to create a new way of delivering redress in the future.  It suggests that manufacturers and the state could share the costs. I would be interested in the Minister’s reflections on that. When does she think that could be implemented by?

Recommendation 4 suggests separate schemes for each intervention—HPTs, valproate and pelvic mesh—to meet the cost of providing additional care and support to all those who have experienced avoidable harm. That is the ethical responsibility of the state and manufacturers. Will the Minister today commit to that recommendation —to providing some redress for those who have suffered avoidable psychological, physical and neurodevelopmental harm? Will she commit, critically, to work on that with these people? For too long, they have had things done to them and they are owed the opportunity to shape their futures.

On recommendation 6, regarding the Medicines and Healthcare Products Regulatory Agency, I said at every stage of the Medicines and Medical Devices Bill that the timing for that Bill was challenging, although that was inevitable as we had to get on with it, because the report would have profound implications for the MHRA—and, boy, does it. I would like the Minister to commit to amendments in the other place to make sure that the MHRA regulatory regime is as strong as possible.

Finally, and absolutely critically, recommendation 9 calls for the immediate creation of a taskforce to implement the recommendations. Will the Minister commit to that? It was right for her to say that she needed time for reflection, but I would be keen to have a definition of how long she feels the Government will need to reflect.

This is a sombre moment. It is incredibly hard to read the report, but it is vital that we do so. Campaigners and those affected have got justice today; now they need action. We will not let the report gather dust on a shelf. We will be fighting every day to get the recommendations implemented and to meet the needs and the expectations of those who have fought for so long.

[Ms Dorries]

That was a long list of asks. I am sure the hon. Gentleman appreciates that we received the report yesterday, and it is a detailed, in-depth and complex report. He is pushing on an open door, with almost everything he asks—patients absolutely have to be at the heart of this. The report is titled, “First Do No Harm”. Our response has to be to do good. We are listening; I am in listening mode. I have listened to what he has said. I will listen to what everybody here has to say today, and to what all the groups have to say, to the details of the report. We will take it away.

The hon. Gentleman asks how long; I am sure he appreciates that work needs to be done to formulate a response. The response will come as soon as possible, as soon as the work has been done. He is quite right about the role of women, which he referred to at the start of his comments. Whether it is Shipman or Paterson or maternity issues or the Cumberlege report, more often than not women are at the heart of these—for want of a better word—scandals. He is absolutely right and I feel very passionately about making sure we come back with a really positive and robust response to this report as soon as possible.

[Jeremy Hunt (South West Surrey) (Con)]

I thank the Minister for the compassion and the anger in her response. She is a fantastic champion of patient safety. I also thank the many hon. Members, including my right hon. Friends the Members for Hemel Hempstead (Sir Mike Penning) and for Elmet and Rothwell (Alec Shelbrooke), who persuaded me to commission the report. I, too, would like to thank the brave campaigners who have not stopped until they got justice. I particularly thank Baroness Cumberlege, Sir Cyril Chantler and their team, who did a painstaking amount of work to get to where we are today.

I commissioned this report because I knew that many lives had been ruined because we did not act quickly enough to deal with problems in these three areas, but the results are far more shocking and disturbing than I ever imagined at the time. Thousands of lives have been blighted by what went wrong in the most terrible way. Does the Minister agree that the central issue is not about the three areas alone, but about all medicines and devices where there is no one for patients and people who are suffering to go to with the confidence that they will be listened to? That is why the suggestion of a patient safety commissioner is so important. It is not a tsar or a quango; they would be a person who would listen to people whose voices were not heard. I hope the Government take that recommendation seriously.

Will my hon. Friend give a commitment that the Government will come back to this House before the end of September with their recommendations? We completely understand her tremendous commitment to patient safety, but does she agree that the gravity of this issue is such that it should be the Health Secretary, who made a very important apology yesterday, who comes back before the end of September and tells the House what the Government are going to do?

[Ms Dorries]

I pay tribute to my right hon. Friend, who commissioned the review in 2018. Thank goodness he did, because without it, these voices would still be struggling to be heard.

On my right hon. Friend’s question about the patient safety commissioner, as that is a recommendation, it will be considered, as will every other recommendation. It is important to mention that we have Aiden Fowler, whom my right hon. Friend appointed to NHS Improvement to take on the head of patient safety role on behalf of NHS England. That does not mean that we will not consider the recommendation thoroughly; we will do so.

Obviously, I cannot speak for the Secretary of State, but I am sure he is aware of my right hon. Friend’s comments. I cannot commit to coming back by the end of September; what I can give the House is my absolute assurance that I will chase this daily. The work commenced when the report became available to us, and a huge amount of work has been done overnight on assessing the recommendations made in the report. I or the Secretary of State will be back here as soon as possible with our recommendations.

[Hannah Bardell (Livingston) (SNP) [V]]

I thank the Minister for advance sight of her statement. Of course, her apology is very welcome.

“We have found that the healthcare system—in which I include the NHS, private providers, the regulators and professional bodies, pharmaceutical and device manufacturers, and policymakers—is disjointed, siloed, unresponsive and defensive.”

Those words in “First Do No Harm”, the report published yesterday on the Primodos, sodium valproate and pelvic mesh scandals, are a hugely powerful indication of the abject failings that must be addressed by the Government. Credit must go to Baroness Cumberlege and her team for all their work.

Yesterday was a landmark day for victims and survivors of those scandals, and we pay tribute to all the campaigners who fought so hard for so long, including Primodos campaigner Marie Lyon and my constituent Wilma Ord, whose daughter Kirsteen was affected by Primodos. Their fight must now be our fight.

Justice is not served until the recommendations are fully implemented. I understand the desire and the need to reflect on what is needed, but a full commitment to the implementation of all the recommendations is vital. In particular, will the Minister ensure that the taskforce to guide the recommendations is set up at speed and as soon as possible? Will she also commit to vigorous pressure being exerted on companies such as Bayer, which, to be frank, have got away with murder? They are responsible for Primodos and need to pay proper compensation to victims.

Will the Minister ensure that the recommendation of a patient safety commissioner is implemented and the post established as quickly as possible? In the words of Branwen Mann, a young person affected by sodium valproate,

“I know that the full harm done by sodium valproate is barely understood, or even recognised by anyone other than the family that live it.”

That cannot continue.

Finally, will the Minister ensure that the central patient identifiable database is created by collecting details on the implantation of all devices at the time of operation? So many patients affected by surgical mesh and other devices have never had their devices tracked or registered, which in the age of advanced technology is, I am sure she agrees, frankly ridiculous.

[Ms Dorries]

Again, that is a list of asks, and as I said in my reply to the hon. Member for Nottingham North (Alex Norris), we will take on board all the requests made and come back in time with a full report.

On the hon. Lady’s last ask, about the database, we have begun working with NHSX on establishing a database of those women who have had the vaginal mesh. We are looking at how those meshes can be safety removed, with their consent and with all the details explained to them. Getting that database together, both historically and moving forward, is work in progress. On the rest of the hon. Lady’s asks, we will be back with a full report, in which all of her points will have been considered.

[Mr Peter Bone (Wellingborough) (Con) [V]]

The three scandals we have heard about are terrible, but can I ask the excellent Minister about the future? I piloted through Parliament the Health and Social Care (National Data Guardian) Act 2020, which should allow us to get more data on problems that arise in the NHS. What further steps will the Minister take so that a future Minister does not have to come to the Dispatch Box to make a statement like the one she has just had to make?

[Ms Dorries]

In the Department of Health and Social Care, we work daily and continually on improving patient safety to make our NHS the safest healthcare system in the world. Procedures such as the national guardian scheme, which my hon. Friend mentioned, and others that have been put in place all work towards that goal. This report, as tragic and harrowing as the stories in it are, will go a long way towards enabling us to develop systems that enable the patient’s voice to be heard earlier.

That is the core issue. The thread that runs through is how long it takes somebody who has a complaint to have their voice heard and their complaint acted on. That is something that we need to resolve. If we can do that—if patients’ complaints can be heard and can be resolved as soon as they are raised—no Minister will, hopefully, ever have to come to the Dispatch Box in the future, because situations will have been dealt with effectively and promptly, and lessons will have been learned.

My hon. Friend will also be aware that we have introduced the Health Service Safety Investigations Body, and there are other measures that will help us to take the learning from incidents and move forward. Work therefore happens daily on improving patient safety and getting to the place he outlined, where a Minister will never have to come here and apologise again.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab) [V]]

I thank the Minister for her statement today. First, may I express my sincere gratitude to Baroness Cumberlege and the review team, who have shown such empathy and understanding to patients, their families and campaigners who have campaigned tirelessly on these issues for years? My mam is one of the thousands of patients who had her life and her health ruined because of this quick fix with a bit of tape. She was never warned of the damage that this plastic mesh could cause her body.

The review recommends setting up a network of specialist centres to provide comprehensive treatment, care and advice for those affected by implanted mesh, and that is to be welcomed. Does the Minister agree, however, that it would be abhorrent for any of those centres to be led by any of the surgeons who promoted mesh or put it into women, knowing it damaged them? For some women, it has caused the most unimaginable pain and life-changing damage.

[Ms Dorries]

I thank my hon. Friend—I do regard her as a friend because she is such a principled campaigner on issues such as this. I hope she does not mind my saying that I know that her mother gave evidence to the review and went along to one of the hearings. I thank her for that, because it was a very brave step to take. This is not an easy thing to talk about, so that was incredibly brave of her. We owe her for her bravery in coming forward, and I thank the hon. Lady for mentioning that.

I completely agree with the hon. Lady. I cannot comment on the specific point about individual doctors with expertise because work has to go forward on removals of meshes and on where we go in the future. However, on specialist centres—I think she is aware of this—NHS England is assessing bids from NHS providers to become specialist centres and to provide treatment for women with complications from mesh inserted for urinary incontinence and vaginal prolapse. Following the covid-19 pandemic, during which some of this work has unfortunately been halted, every effort is now being made to finalise the centres quickly. Stakeholders will be kept up to date with progress, but we do want to see more of that work.

[Sir Mike Penning (Hemel Hempstead) (Con)]

In October 2017, I stood in this very spot with the report in my hand, and it was a whitewash. It was disgusting to the victims—we have not heard that word yet today, but they are victims—of what has gone on in these three terrible cases. In particular, the Primodos victims were shown no compassion in the report and were in many ways blamed for what had happened to their children.

The new report is completely different. I apologise to my right hon. Friend the Member for South West Surrey (Jeremy Hunt), who was the Secretary of State, because I was critical of the three problems being put to Baroness Cumberlege in one inquiry; I thought it would be much better if each was looked at individually. I apologise to Baroness Cumberlege, because I said that to her as well as to the then Secretary of State, and I was wrong. This report is probably the best report on what has gone wrong inside the NHS that I have ever seen.

The NHS does wonderful things, but it gets things wrong. We all praise the NHS. We stood outside last weekend—I hope people did—and praised the NHS on its 72nd anniversary. But when it gets it wrong, it gets it seriously wrong. In 1967, it knew that Primodos was a danger: the company knew and the NHS knew. Young women went to their GP, and said, “I think I might be pregnant”. Very often, no prescription was issued. There were no warnings and no concept of what could happen to their foetus if they were pregnant. The drawer was opened and the tablets were given to them. Those tablets were given by the drug company to the GP, who in many cases did not even issue a prescription.

Today, we have the report, with nine recommendations, but how are we going to compensate those families? It is not just for the women, but for their families, including the men who have stood next to them, such as Marie Lyon’s husband, who has been with her all the way through. How are we going to compensate those who lost their baby, who were told to abort their baby or who had a stillbirth? How are we going to compensate and help those families when the loved ones, the mums and dads of the survivors—they have terrible disfigurements, and they did brilliantly well to give evidence for the report—are no longer with us and the survivors need such support afterwards? While we must make sure this never happens again, we must also make sure that we look after those families and that the drug companies pay for what they did to those families.

[Ms Dorries]

My right hon. Friend makes an impassioned and compassionate contribution, and he should be recognised for his long-term campaigning and his advocacy of the people he mentions who have suffered as a result of what has happened. I cannot comment on the individual points he has raised, particularly on Primodos, because there is legal action pending, but I hear everything he said and others will hear his comments too.

[Sir Edward Davey (Kingston and Surbiton) (LD)]

I thank Baroness Cumberlege profusely for her review’s welcome conclusions on Primodos, and I praise the Sky journalists who have worked on this, and Marie Lyon and all the other campaigners. However, can I tell the Minister that I see this just as the beginning of the end, because we have not yet got justice for the women involved or their adult children? We want to see the conclusions implemented as soon as possible, and we want to see compensation for the women and their adult children. But I also want to see criminal charges brought against the real perpetrators of this scandal for the cover-up, the suppression of the evidence of harm, and the marketing and sale of a drug that Schering and Bayer knew was dangerous and would result in miscarriages and birth defects. I am grateful for the way that the Minister has produced her statement today. Will she ensure that her Department, the Department for Work and Pensions and the rest of Government know that we will not stop campaigning until full justice is given to these women and their adult children?

[Ms Dorries]

I commend the right hon. Gentleman for his compassion and for his commitment to campaigning on this. I just have to repeat what I said in my previous answer. I have every—every—sympathy with every parent, mother and family who have been affected, but due to pending legal action I cannot make a statement.

[Alec Shelbrooke (Elmet and Rothwell) (Con)]

Today is a day of strongly mixed emotions—one of joy that we have such a comprehensive and thorough report recognising what many women and others have been through, and of course one of absolute sadness and anger that it ever had to come to this. I first raised the issue of sodium valproate in 2013 or 2104, and vaginal mesh in October 2017. I pay tribute to my right hon. Friend the Member for South West Surrey (Jeremy Hunt) for putting the inquiry in place, and to my hon. Friend the Minister for the way that she has handled today’s statement.

The Government, as my hon. Friend said, are now going to take note of what happened. I would like two particular areas to be looked at. First, we need to make sure that the complaints commissioner is thoroughly independent of the healthcare sector, because we cannot again ask people to mark their own homework. Secondly, there is the issue of powers of redress and ex gratia payments. One of my constituents has had to borrow tens of thousands of pounds to correct her mesh implant through private surgery. This operation was done and recommended by the NHS. If we can speedily get these recommendations in place and compensate women who have had to take on their own financial burden to correct this surgery caused by the NHS, that would be most welcome.

[Ms Dorries]

I thank my hon. Friend for his comments and for his campaigning. It is the campaigning of Members of this House on behalf of their constituents that has got us to the position where we are today. It demonstrates how this place works at its best when MPs represent their constituents in campaigning on issues such as this. On his specific question, I would like him to write to me, because I am not quite sure why, if the operation was undertaken by the NHS, his constituent had to pay tens of thousands of pounds. If he would like to write to me and let me know the details, I will give him a more detailed response.

[Cat Smith (Lancaster and Fleetwood) (Lab)]

As chair of the all-party parliamentary group on valproate and other anti-epileptic drugs in pregnancy, I would like to put on the record my and the group’s thanks to Baroness Cumberlege for her work on this. We welcome the report. I believe that its recommendations should be implemented in full as quickly as possible, because it is 268 pages about four decades of women being let down and lied to. When those women have campaigned for justice, Members of this House have told them that they are bored housewives and they are being hysterical. We cannot allow these women to be denied justice any longer. I would like to invite the Minister to join a meeting of our all-party group so that we can talk about the recommendations in more detail in a way that we cannot do on the Floor of the House.

[Ms Dorries]

I could not agree with the hon. Lady more. As I said earlier, whether it is Shipman, Paterson, Cumberlege or a maternity incident, women so often struggle to get their voices heard when they are at the heart of issues like this. I would be happy to talk to the all-party group, particularly on sodium valproate, where a huge amount of work is being done. We are seeing the number of users of sodium valproate in pregnancy declining, but there is more work to be done. I would be particularly interested in talking to the hon. Lady about how we get the message out about the dangers of sodium valproate, because there are women who suffer from epilepsy for whom sodium valproate is the only treatment that works effectively. That is the heart of the problem that we need to keep discussing and work through further. I am happy to meet and talk to her.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

The NHS collects a wealth of data in different clinical settings, but often computers and systems do not talk to one another; they are silent. What is on a GP’s computer may not be on a hospital computer or a health visitor’s computer, and this report highlights the critical need for registries and data that are systematically collected. Can the Minister assure me that another registry or dataset will not end up isolated and silenced, as many of the victims were before this report?

[Ms Dorries]

I thank my hon. Friend for that point. I had a thought while I was listening to him, which is that I did not mention Sir Cyril Chantler in my statement, the doctor who contributed hugely to the report, along with Baroness Cumberlege. I thank both of them. They worked as a team—even though it is the Cumberlege report, they worked together, and Sir Cyril deserves recognition and thanks for his work.

I agree with my hon. Friend. Because of the many reports a number of regulatory bodies have been established, but it is in their talking to each other and the bridges between them that we have problems. We recognise that this is a complex area. However, we have already gone beyond the development of the database. The Medicines and Medical Devices Bill was amended in the House, with cross-party support, to create a power to establish a medical devices information system. That will respond to Baroness Cumberlege’s recommendations in full, including ensuring that private providers that do not operate under the NHS contract can be required to provide data to that information system. NHS Digital is leading work with system partners and the devolved Administrations to ensure that this comprehensive database can be used to support clinicians and the MHRA. My hon. Friend is right to say that in the development of the database, all the organisations and regulatory bodies need to work together and support one another.

[Yasmin Qureshi (Bolton South East) (Lab) [V]]

As chair of the all-party parliamentary group on hormone pregnancy tests, I am proud to have campaigned with Marie Lyon for the Primodos families for almost a decade. I welcome the recommendations in the Cumberlege review, and I pay tribute to Baroness Cumberlege and her colleagues for their integrity and unflinching courage, but campaigners like Marie should not have had to give up their entire lives to pursue truth and justice. This is a scandal that should never have happened, and it is one of the greatest medical frauds of the 20th century. When I first raised this with Ministers in 2012, and several times with Prime Ministers since then, I was dismissed. I was met with constant denial, and doors were slammed shut at every turn. Can the Minister assure the House that enough is enough and that the Cumberlege review is a turning point for the Primodos families?

[Ms Dorries]

I thank the hon. Lady for her ardent campaigning on this issue. I can only say again that I have absolute sympathy with the families on whose behalf she has been campaigning, but once again I refer to my earlier answer: owing to pending legal action I cannot comment on Primodos.

[Laura Trott (Sevenoaks) (Con)]

This report was an incredibly difficult read, but what one of the things that stuck with me most is the guilt that so many mothers have felt for taking drugs that inadvertently harm their babies. I would like to echo what is said in the report: this was not your fault. Please can the Minister reassure all pregnant women across the country and the House that action has been taken to improve the monitoring of drugs used during pregnancy?

[Ms Dorries]

I thank my hon. Friend for her comment. She is absolutely right. The report is entitled “First Do No Harm”, and we here have to do some good in response to it. Work is being undertaken—the all-party group for valproate and other anti-epileptic drugs in pregnancy works incredibly hard. It is about getting information out there. For some women with epilepsy, sodium valproate is the only drug that works, and the pregnancy prevention programme works alongside this. As I have said, I cannot comment on Primodos, but work is ongoing. We have seen a decline in the number of pregnant epileptic women taking sodium valproate. That decline needs to be driven down even further, in tandem with the pregnancy prevention programme, but my hon Friend is absolutely right. I hope that nobody ever has to come to the Dispatch Box again to discuss a report such as the Cumberlege report and have to apologise for what happened, with the glaring inconsistences in treatment that has been provided to those women who have not received the information they should have received when taking those drugs.

[Barbara Keeley (Worsley and Eccles South) (Lab) [V]]

After decades of having their concerns dismissed and struggling to be heard, the victims of these scandals deserve both the apologies we have heard and ex gratia payments for the avoidable damage they suffered. Will the Minister confirm that it will be a priority to establish the independent redress agency recommended to help those affected by these scandals and a priority that the agency will be able to move quickly to provide the redress that the victims deserve? They have waited long enough.

[Ms Dorries]

Every recommendation in the report is a priority and everything will be given equal consideration. I hope that either I or the Secretary of State will be able to come back to the House as soon as possible after the report has been evaluated in full and make our own recommendations at that time.

[Chris Green (Bolton West) (Con)]

I thank my hon. Friend for her statement. Will she confirm that the Medicines and Medical Devices Bill incorporates steps to establish a database of medical devices, including information about device safety, which is a key part of the Cumberlege review? I wish to pay tribute to the many campaigners for their tireless work and, in particular, to my neighbour the hon. Member for Bolton South East (Yasmin Qureshi) for her work on Primodos.

[Ms Dorries]

I thank my hon. Friend for that. The Bill makes it clear that patient safety is paramount in any regulatory change on medicines and medical devices in the future. The Bill will allow us to implement a framework to continue to update and amend the Medical Devices Regulations 2002 and the Human Medicines Regulations 2012 to respond to patient safety concerns. It already explicitly set out provision of the medical device registers and information gateway, which will allow the Secretary of State or the Medicines and Healthcare products Regulatory Agency to disclose information about medical devices to the NHS family.

[Mr Tanmanjeet Singh Dhesi (Slough) (Lab)]

First, I wish to pay tribute to those amazing activists, including Members of this House, who have painstakingly and persistently fought for justice, struggling to get their voices heard. Although those campaigning for the truth about the side effects of Primodos, sodium valproate and pelvic mesh repairs have been vindicated by the findings of the Cumberlege review, it is too often the case that women’s health issues appear to be repeatedly dismissed and de-prioritised, sometimes with devastating long-term effects. What will the Minister be doing to get rid of this shameful health injustice?

[Ms Dorries]

I thank the hon. Gentleman for his question. I am here listening to everything that everybody has to say about this report. I am working with a team to evaluate every recommendation and every aspect of the report. I think I have answered twice, and I concur 100% with his opinion that so often we fail to listen to women’s voices and fail to take them seriously, and they live with the lifetime consequences of that.

We have a number of investigations taking place. When this Government, and in particular, the Department of Health and Social Care, hear that there has been what we consider to be an issue of concern anywhere affecting women we are not afraid to investigate thoroughly. The hon. Gentleman will know that we have mentioned a number of investigations recently. The NHS does amazing work, and we go out and clap for our carers, as we have done particularly in recent months. We have an amazing NHS, but we cannot say that problems do not occur and things do not happen, because they do. There has to be a quest for constant improvement and learning. In answer to his question, let me say that the only way we can improve is by learning. We have to learn from the Cumberlege report. We will need to learn from the Health Service Safety Investigations Body—from the investigations and the learning. We have to learn from the Care Quality Commission. Learning now needs to be something where we do not apportion blame.

If we continue to have a culture where we apportion blame to hospitals and to individuals, it will be difficult always—the barriers will always be there to learning. That is how I answer the hon. Gentleman’s question and how I give my commitment—to ensure that we do not apportion blame, but we do learn and we take those learnings, that we apply them and move forward.

[Dehenna Davison (Bishop Auckland) (Con)]

It has been really reassuring hearing so many Members pay tribute to those who have campaigned so tirelessly for this report to be done and contributed to the report. I would like to add my own personal tribute to Joanne Bylett from Bishop Auckland, who is personally affected by Primodos. Joanne and her daughter Natalie have been amazing in their campaigning efforts, and I just wanted to put that on record. Across my constituency, there have also been women affected by vaginal mesh implants. Will the Minister continue to work with the NHS and with women who have those implants to ensure that any removals are carried out with a full understanding of what that removal will entail?

[Ms Dorries]

My hon. Friend raises the important issue of informed consent, which has come very much to the fore recently, including how detailed consent needs to be and how much information people need to have. Of course we are working with those women and ensuring that they have every detail and every bit of information that they require before mesh is removed so that they know exactly what operation they are undergoing. That needs to be a template for moving forward. Informed consent needs to be what we move forward with in much more detail, so patients are fully aware of the risks and benefits of any surgical procedure they are undergoing.

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

One of the most disturbing aspects of Baroness Cumberlege’s report is the way that women have been dismissed when they report concerns and debilitating pain. This is a fundamental point in this entire scandal: as multiple studies have shown, there is an imbalance between the experiences of men and women in many areas of medicine, suggesting that a gender health gap does indeed exist, and often shows up in the misdiagnosis of women’s symptoms, while at other times it appears that their health concerns are just not taken as seriously. I have heard what the Minister said in response to earlier questions on this issue, but undoubtedly this is a systemic problem. Does she have any plans to review male bias across the NHS involving devolved Governments?

[Ms Dorries]

The hon. Lady is absolutely right in everything she said, and I completely agree with her, 100%. My team of officials and I, from the very first day that I arrived in the Department, have been looking at a women’s agenda and at the way that in so many areas of healthcare there does appear to be an unintentional bias. I am not saying that it is intentional and I would not particularly use the word “misogyny”, but there is an unintentional bias. It is proven by the amount of time it takes for women to have their voices heard and for their complaints to be taken seriously and yes, addressing that is absolutely a priority. The problems that women were subjected to and the prolonged pain they experienced simply because their voices were not being heard is something that we will have to address in our response. That bias against women must surely be obvious from the amount of inquiries that we are having about women-only issues, and I hope that highlighting that, bringing it here and not being afraid to ask for inquiries where we see that bias taking place, is like shining sunlight on it—to quote someone long before my time. It is only by opening up these issues, allowing a spotlight to be shone on them and not being afraid of what we find that we can go anywhere towards addressing this. We do it by establishing a blame-free culture, a bit like the airlines industry has in the HSSIB, where we look at incidents that have happened, do not blame anyone, and make sure clinicians, nurses and healthcare workers can reveal what has happened in an incident. By doing so, we can put the learnings in place to make sure that it does not happen again.

[Anne Marie Morris (Newton Abbot) (Con) [V]]

The report from Baroness Cumberlege is more than welcome. It demonstrates to me, and to many of us, that the key to getting this right is having the knowledge, because with knowledge we have power—the power to prevent something like this happening ever again. Only with that knowledge and that data can we ensure patient safety for the future, and safe innovation. In that regard, will the Minister consider going further than Cumberlege and the current medicine and medical devices legislation? We need a single database with all devices, not just those that are in vitro, and we do not need a web of connected databases; we need one. Also, we need this to be linked—we need information about devices and information about patient records connected, and those patient records must include primary and secondary care. I would like to see something that is truly integrated, internationally compatible and searchable, whether by universities, academics or the medical profession. I would like to see something that is state-of-the-art and internationally the best. To enable that, will the Minister create some form of protocol so that existing databases can in future be migrated into the master plan? At the moment, there is no plan for that. The concept is seen to be too difficult, but—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. I appreciate the importance of this statement, but please could we have shorter questions? I want to get everybody in and I think it is important that we do so.

[Ms Dorries]

Yes, we will look at that.

[Christine Jardine (Edinburgh West) (LD)]

Baroness Cumberlege’s report is not just welcome, but blunt, both in the way it talks about the specific problems with women patients treated by Primodos, sodium valproate and mesh, and the way it talks about the systemic and cultural problems that we have, which mean that this is not the first time that we have dealt with these issues in this place. Hopefully, it will be the last, but the report does say that there is nothing that leads them to believe that this is not happening with other medications and devices. I was in exactly the position of those women who were prescribed sodium valproate, but I was lucky. I had a female GP who spotted the danger and advised me, and I was given alternative medication—taken off it completely in fact—before I became pregnant. Can the Minister assure me that from today, we will take a much more positive approach, so that as well as the recommendations, we will have some kind of strategy—a cultural approach—to getting across how important it is that these issues are dealt with when women go to their GPs?

[Ms Dorries]

I will try to keep my answers shorter. The hon. Lady is absolutely right. The sodium valproate pregnancy prevention programme is running hand in hand with an information awareness programme. Many GPs are aware, but of course there is still a problem and it is something that we are addressing.

[Selaine Saxby (North Devon) (Con)]

My constituent Diane Surman’s daughter, Helen, was affected by the Primodos scandal, and I am delighted that their circumstances have finally been recognised for the injustice that they are. Will my hon. Friend assure me that the Government will do all they can to ensure that Bayer recognises its responsibilities, apologises and contributes towards the payments outlined in the report?

[Ms Dorries]

I cannot comment on Primodos due to pending legal action.

[Stephanie Peacock (Barnsley East) (Lab)]

For too long, female patients have had crippling pain dismissed as “women’s problems”. As the Minister said, women have been failed, so can I press her further on the recommendations of this report? Will the Government appoint a patient safety commissioner to ensure that women are taken seriously and that terrible mistakes like this do not happen again?

[Ms Dorries]

We will be considering all the recommendations and returning to the House with a full report as soon as possible.

[Fiona Bruce (Congleton) (Con)]

As vice-chair of the all-party group on valproate and other anti-epileptic drugs in pregnancy, I thank the Minister for her tone today. Does she agree that it is shocking that the Committee on Safety of Medicines as long ago as 1973—this is the predecessor of the MHRA—was clearly aware of the risks in pregnancy of the use of anticonvulsants? It said that they are liable to produce abnormalities. Over that period of time, 20,000 children could have been affected. There are families, such as those of Janet Williams and Emma Murphy, who have campaigned tirelessly—I pay tribute to them too on this issue—who now have to care for those children, potentially for their entire lives. Much more support is needed for those children from local authorities and health authorities. It has not been given until now as a result of the lack of recognition of the link between, and risks of, anticonvulsants in pregnancy and abnormalities. Will the Minister, when she meets us, focus on ensuring that that issue is taken forward so that more support can be provided?

[Ms Dorries]

I absolutely will. My hon. Friend highlights how long it takes for women’s voices to be heard—since 1973—and I will do as she asks.

[Chris Bryant (Rhondda) (Lab)]

May I add Owen Smith, my former constituency neighbour, to the list of those who campaigned vociferously, in particular on mesh? Medical innovation does save lives. I have sat next to a doctor who worked for many years in melanoma, and she said that, for nearly all of her career, when she met somebody with melanoma she basically had to manage their expectations of how long they were going to live. Now, because of medical innovation, she is able to save their lives, but she can do that only if the medication being provided is guaranteed as safe.

As I understand it, nearly all the clinical trials that were started at the beginning of this year in relation to cancer have been stopped. We need to get them started again so that people can be certain that they are safe. Is it not time that doctors, instead of writing to other doctors and copying the patients in, write to the patients and copy the doctors in, so that the patient is put in control of their own treatment?

[Ms Dorries]

The hon. Gentleman makes an interesting point about cancer trials. He may have heard the recent announcement that one of the Nightingale hospitals is to be used for processing cancer diagnoses. I believe that cancer treatments have started again, but I will come back to him with further information because this is not really in the scope of the report.

[Caroline Nokes (Romsey and Southampton North) (Con)]

We have heard a great deal about my hon. Friend’s agenda for women, and I hope that the Women and Equalities Committee will have a chance to scrutinise it at some point.

I remember first meeting Emma Murphy and Janet Williams to talk about sodium valproate back in 2014. The Minister is absolutely right to point out what a valuable treatment it is, but it has massive dangers for pregnant women. She spoke of the pregnancy prevention programme, but there are drugs out there, such as Roaccutane, for which people cannot get the next month’s prescription unless they take a pregnancy test. Will she consider going further than the advice in the information that is given out to doctors and women and ensure that it cannot be given to pregnant women?

[Ms Dorries]

That is an interesting proposal. My hon. Friend has spoken about Roaccutane several times in the House. She makes an interesting comparison, and we will go away and look at it.

[Jeff Smith (Manchester, Withington) (Lab)]

This report is vindication for the campaigners, but it will also provide relief for the McLellan family and the Pierce family, constituents of mine whose lives have been blighted for decades by the consequences of Primodos. I am particularly pleased that one of the recommendations is for an ex-gratia scheme for discretionary payments to the families for their costs, but I remind the House that many of the children are now in their late 40s or 50s and the mothers are generally in their 70s. They have suffered for too long already, so will the Minister commit to getting that redress for families as quickly as possible?

[Ms Dorries]

As the hon. Gentleman knows, that is not a commitment that I can make here at the Dispatch Box today, but we will return to this. All the report’s recommendations are being studied. It is a deep, comprehensive, two-and-a-half-year report, and it deserves thorough analysis and a proper response. It is not for me to come here and make recommendations the next day on the back of a huge report. We only saw it yesterday, and we need to evaluate it before we can come back with recommendations.

[Imran Ahmad Khan (Wakefield) (Con)]

This morning, I had a moving conversation with Julie Satari, a well-loved schoolmistress in Wakefield who underwent the mesh removal procedure. In addition to the significant cost, the nature of such procedures is tortuous, both physically and emotionally. Julie told me that she, along with many others she knows, cried yesterday as she read the Baroness’s report approvingly. Julie asks, “Will Her Majesty’s Government help wipe away their tears with immediate action, not promises for the future?”

[Ms Dorries]

As I have just said, this is a two-and-a-half-year report: it is complex. It is a deep dive into issues relating to Primodos, sodium valproate and vaginal mesh. There is absolutely no way that I could come to the Dispatch Box today and do what my hon. Friend asks. We need to evaluate the report properly to do it justice—to do those brave women who came forward justice. As I say, we will return to the House with our recommendations and an evaluation of the reportj in full.

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

I welcome the Minister’s statement and, indeed, the Cumberlege report itself. The concerns we hear throughout the Chamber are justified; we absolutely have to right the dreadful wrongs of these health scandals. I pay tribute to all those groups that have campaigned for justice for so long, because women’s health issues have appeared to be repeatedly dismissed and deprioritised. The review found that research on patient safety was neither prioritised nor funded. Can the Minister explain why historically that has often been the case, and whether and how she intends that to change in future?

[Ms Dorries]

Apologies, but I am not sure what the hon. Member means in terms of patient safety in the past. All I can say is that patient safety is an absolute priority. My ministerial titled changed recently to Minister for Patient Safety, Mental Health and Suicide Prevention—patient safety is the first consideration in my title. I am the Minister of State for Patient Safety. That is a demonstration of the Department’s absolute commitment to patient safety going forward. It is a high priority in the Department of Health and Social Care. Everything we do in terms of health—from HSSIB and the CQC to NHS Improvement—and a number of measures that we have put in place in recent years demonstrates that commitment to patient safety. We want to make the NHS the safest healthcare system in the world. We continue to strive to achieve that.

[Dr Kieran Mullan (Crewe and Nantwich) (Con)]

I welcome the report and its wide-ranging recommendations, particularly those focused on a medical-devices registry and the need to improve our post-market surveillance of drugs and treatments in this country. However, I urge caution in respect of the risk of creating new posts and bureaucracy when we already have an extensive number of organisations—including the CQC, the ombudsman and Healthwatch—and hospitals themselves have a responsibility to listen to complainants, whatever the cause of their complaint might be. In my time at the Patients Association, we ran a survey of complainants across a number of hospitals to compare and pick up those hospitals that were not as good at listening as others. Does the Minister agree that, if all healthcare providers had to survey their complainants and we could compare how well providers were listening to them, we might see improvement on the frontline for patients, in respect of all different causes of complaint?

[Ms Dorries]

My hon. Friend makes a really important point. It is a recurring theme—over and over again—that when patients complain, the first point of complaint is to the trust where they were treated, but that is often where the logjam is. A patient-safety campaigner told me recently that it was seven years before the chief executive of a trust would even acknowledge his complaint or meet him. That is where we see the logjam happening. I will take away my hon. Friend’s point and consider it, because it is a very important one.

[David Linden (Glasgow East) (SNP)]

Like the hon. Member for Lancaster and Fleetwood (Cat Smith), I wish to focus on the specific issue of sodium valproate. Given that it was a UK-wide review, what discussions is the Minister having with her counterparts in the Scottish Government to ensure that we find a systematic way to identify women who are at risk—say, by way of a patient register?

[Ms Dorries]

Health is devolved in Scotland, of course, but we constantly have conversations with our healthcare partners across all the devolved nations.

[Robbie Moore (Keighley) (Con)]

I welcome the statement and the report. My thoughts are with those individuals and families whose lives have been turned upside down by these issues. Will my hon. Friend work with the Medicines and Healthcare Products Regulatory Agency to ensure that patient safety is central to its work?

[Ms Dorries]

Absolutely. The MHRA itself is undergoing a culture change and an operational change and is itself looking into how it responds to patients and the way it considers patient safety as a priority. I am the Minister of State for Patient Safety. Making patient safety has to be one of our No. 1 criteria in the NHS. People who come into the NHS—who come into hospitals—have an absolute right to be confident and safe. All organisations in the healthcare structure need to do the same in that respect.

[Mr Deputy Speaker (Mr Nigel Evans)]

I thank the Minister for her statement and for answering all the questions on the call list.