Nurse Training

Debate between Richard Drax and Jim Shannon

Wednesday 5th September 2018 Commons Chamber

[Richard Drax (South Dorset) (Con)]

It is a great privilege to be drawn for one of these end-of-day Adjournment debates, as they give Back Benchers such as me the opportunity to debate a subject dear to their heart. Tonight’s topic is fairly dry, but it is very important. I hope the House and those watching will forgive me if I plough into a lot of detail, because the detail is important on this issue. I welcome the Minister, for whom I have a high regard, to his place. Another advantage of these debates is that the poor Minister has to sit there and listen to me, and there is nothing he can do—he cannot escape. So I hope my words will fall on receptive ears.

This debate follows a recent public meeting on Portland hospital in my constituency; the beds at the island’s much-loved community hospital have been closed, but more on that shortly. We have heard it before, and it needs to be said again: we are facing a desperate shortage of nurses. Health Education England believes there are 36,000 nursing vacancies in England, whereas the Open University says it is 38,000 and the Royal College of Nursing gives a figure of 40,000. That last figure equates to an 11% vacancy rate, with learning disability and mental health nursing the most affected, followed by community nursing. These gaps may be filled by bank or agency staff on a temporary basis, but Health Education England estimates that 1% remain permanently unfilled. The knock-on effect places nurses under “relentless pressures”, according to a report this January by the Select Committee on Health. It added that

“nurses felt their professional registrations were at risk because they were struggling to cope with demand.”

Meanwhile, any increase in nurse numbers is swallowed up by the demand for more of them. For example, although the number of new nursing positions created between 2012 and 2015 rose by 8.1%, the number of those who actually joined the profession increased by only 3.2%. What is the consequence? Well, obviously, costs rise. Temporary nursing staff are expensive, with NHS trusts paying an average of 61% more for every extra hour they worked compared with that paid for a newly qualified, full-time, registered nurse. A Freedom of Information Act request by the Open University in January revealed that, if the hours worked by temporary staff were instead covered by regular nurses, the NHS could save as much as £560 million a year. The independent health think-tank, the King’s Fund, revealed that on average NHS trusts were spending nearly 7% of their salary budgets on agency staff, with the figure rising to more than 25% in some cases. Dorset HealthCare, which covers my constituency, forecasts an overall spend of £4 million this year on agency staff alone. That is down from a staggering £12 million three years ago but still represents a significant share of the healthcare budget.

As I mentioned at the start, 18 beds were closed at Portland Community Hospital last month due to a lack of nursing staff.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for giving way: I sought his permission to intervene beforehand. He is outlining the shortage of nurses in his constituency, but there are nurse shortages in many other parts of the United Kingdom, including in Northern Ireland, which has a shortfall of some 1,800 in nurse numbers. Does he agree that the training of nurses must be a priority for trusts and the Department of Health and Social Care? Part of the way to attract new nurses is to show how we value our current nurses through decent pay and working conditions. It is important to ensure that nurses are regarded highly for the work that they do—and paid accordingly.

[Richard Drax]

I do not disagree with anything that the hon. Gentleman has just said, and I will come on to his points a little later in my speech. Of course all nursing staff should be appreciated and paid properly. One of the issues, as I shall describe in a minute, is the work environment, which is one of the factors leading to fewer nurses—or insufficient numbers—entering the profession.

Before the intervention, I was talking about my community hospital in Portland, where almost half of all nursing positions were unfilled this summer. Agency staff, costing as much as £58 per hour—and £135 per hour on bank holidays—were still hard to find. The trust’s chief executive, Ron Shields, for whom I have enormous respect, decided he could no longer safely keep the beds open. So, despite the understandable protestations from islanders who wish to keep their frail and elderly relatives close by, the beds were migrated to a hospital in Weymouth, where the nursing staff available can be consolidated. I suspect that that situation is not uncommon across the rest of the country.

The crux of the matter is the recruitment and retention of nurses. Recruitment depends mainly on training new nurses for the future. The numbers required are traditionally set by Health Education England, which then commissions the nursing places from further education and training establishments, including colleges, universities and the Open University. Standards are set and approved by the Nursing & Midwifery Council, ensuring uniformity across providers. Those establishments, in turn, invite applications, for registered nurses, nursing associates, nursing apprenticeships and Nurse First.

The first role requires a degree, the second a prior healthcare qualification, the third is a joint initiative between individual health trusts and further education establishments and the fourth is a new initiative for high-flying graduates and follows the lines of Teach First. The three-year degree option remains the main route into nursing. While many, including me, dispute the need for a degree, the Nursing & Midwifery Council says that that is to misunderstand modern nursing. Registered nurses are now an “officer class”, according to Geraldine Walters, the NMC’s director of educational standards, with much of the work for degree-level nursing now highly technical and demanding. In some cases, registered nurse prescribers replace doctors and indeed even run their own primary care clinics in London.

So far the nursing associates programme has been a success. In December 2017, 2,000 nursing associates were in training. This year, it is hoped that figure will be 5,000, rising to 7,500 in 2019. The Nursing & Midwifery Council is clear that more recruitment and widened access into nursing training are essential, as is the diversity of training provision.  The Open University, for example, provides for those who, for a variety of reasons, would not gain access to the profession via the traditional, campus-based route.

Since 2002, the Open University has offered a four-year registered nurse degree apprenticeship in addition to the straightforward apprenticeship. This is aimed specifically at existing healthcare support workers who welcome the chance to earn while they learn. So far, it has trained more than 1,000 applicants as registered nurses, with 940 more currently on the programme in England. One huge benefit to the scheme is that participating trusts seem better able to retain the nurses they have trained. Compare this with the 24% drop-out rate for student nurses on the degree course. As the NHS is the nation’s biggest contributor to the 5% apprenticeship levy, it would be odd for it not to participate.

The loss of the bursary scheme has been keenly felt, with the Royal College of Nursing saying that it is a serious own goal. It was a support package including tuition fees, a non-means-tested maintenance grant, a means-tested bursary itself, and other elements designed to help students with placement, travel and childcare costs. It was overwhelmingly popular, attracting more applicants than there were places. It was replaced by the student loan scheme, requiring students to borrow money to pay for their training.

The problem is that nursing is a vocational training and does not cater for school leavers unsuited to the profession. Significantly, following the removal of the bursary, the number of applications for nursing through UCAS has fallen by a third since March 2016. Although the Department of Health and Social Care says that there are 52,000 nurses in training—more than ever before—the number of those accepted on to courses is still down by 9.3% in England. That threatens the pipeline of new nursing talent and, at the very least, should and could have been anticipated. Much-needed mature applicants, many with care experience, are also deterred by the burden of debt and loss of earnings, and Ms Walters told me that these are exactly the people the profession needs. Mature applicants also tend to choose careers in specialist areas worst hit by the staffing crisis, such as learning disability and mental health.

New figures from UCAS show that applications for nursing degrees and from mature students are down by 33% and 42% respectively since March 2016. As the latter group are the very people who would be grateful for any support given, and probably remain in the organisation until retirement, Mr Shields suggests that trusts should provide some form of financial support in the absence of bursaries. A recent survey by the Open University showed the effect of the loss of the bursary on recruitment. Only 30% of nurses asked said they would have been willing to self-fund or partially self-fund their initial nursing education. In addition, more than half of those surveyed believed that applications would continue to fall.

Attracting nurses back into the NHS after they have left is another crucial focus for recruitment. The return to practice campaign, run by the Nursing & Midwifery Council, which provides refresher training and a re-entry route back into the NHS, has already recruited almost 2,500 former nurses and is currently registering another 1,800. However, as the Health Committee report states,

“too little attention has been given to retaining the existing nursing workforce, and more nurses are now leaving their professional register than are joining it.”

The Committee cites many causes, including workload pressures, an inability to meet patient expectations, concerns about providing adequate care, poor access to continuing professional development, poor organisational culture, pay restraint and budget cuts. The impact of Brexit was another reason, although—interestingly—briefings from the Library show that overall EU staff numbers in the NHS have, in fact, fractionally risen since the referendum, with numbers of EU nurses falling by just 0.3%.

Another issue is the current pensions arrangements. Senior and experienced staff who might want to work beyond 55 are leaving because their pensions reduce in value if they stay on. Mr Shields has recently lost two senior and valued members of his team, and believes the Government must look at this urgently.

A partial solution to increase nurse numbers is to recruit from abroad, including Commonwealth countries. However, this was, until recently, severely limited by immigration rules, which were wisely relaxed in June after an intervention by the Home Secretary.

In December 2017, Health Education England published its draft health and care workforce strategy for England to 2027. “Facing the Facts, Shaping the Future” anticipates a significant shortfall in nursing numbers due to an increase in the number of posts needed. The Health Committee has emphasised that future projections of demand for nurses should be based on demographics rather than on affordability alone. A final workforce strategy is expected from Health Education England at any minute. Perhaps the Minister can enlighten us, as it was expected, as I understand it, at the end of July.

Finally, I thank all those who work in our NHS for the wonderful job they do, not least the fantastic teams in South Dorset.

Primates as Pets

Debate between Richard Drax and Jim Shannon

Monday 24th April 2017 Commons Chamber

[Richard Drax (South Dorset) (Con)]

It is a pleasure to be here to see off another day, Mr Deputy Speaker. At the outset, I wish to thank Dr Alison Cronin, the director of Monkey World, the international primate rescue centre in my constituency, which assists Governments around the world to stop the smuggling, abuse and neglect of primates. Her time and input into this debate have been invaluable.

It seems barely credible in this age of enlightened animal welfare provisions and animal rights, but it is still entirely legal for someone to walk into a pet shop and buy any one of 66 species of monkey as easily as they can buy a goldfish in a plastic bag. These monkeys—all types of marmoset, tamarin and squirrel monkey—are snatched away from their families as infants and sold in birdcages for well over £1,000 each. There are no licensing demands or special regulations for their care. The pages of Loot, for example, are full of advertisements for these animals. A brief search of the internet shows that it is awash with monkeys for sale, supplements for their diet and advice on looking after them. According to Dr Cronin, at least half these advertisements are scams. Many demand large amounts of money up front for vet checks and transportation, all too often for non-existent monkeys.

Although not all breeders are unscrupulous, the public and the primates need to be protected. It is a fact that most buyers are well meaning, wanting only an entertaining and lovable pet that can be fed on scraps from the table, but the truth is that almost no domestic owner is equipped to look after primates properly. When, months after buying one of these tiny creatures, they call for help because their monkey is lying on the floor of the cage crying, it is far too late. Most south American monkeys—all 66 species for sale come from there—are extremely sensitive to a lack of vitamin D, and the lack of sunlight in a British birdcage deprives them of this crucial nutrient, as we might expect. Without it, they can, almost overnight, develop rickets. Although, with the right treatment in expert hands, rickets can be reversed, the agonising skeletal damage is permanent. Even without rickets, a marmoset frequently becomes aggressive and/or withdrawn, as its unnatural confinement takes hold, with it starved of its natural habitat and unable to mix socially with other monkeys.

[Jim Shannon (Strangford) (DUP)]

It is always a pleasure to listen to anything the hon. Gentleman has to say. He and I agree on many things, the first of which is that we need to be out of Europe. However, in this instance, does he think that we should follow the lead of the 15 European countries that have banned keeping primates as pets, because they have shown the way? I think that he and I agree on that, too.

[Richard Drax]

It is always a pleasure to be in the same place as the hon. Gentleman, as we are in this debate. I will come on to address that point and a possible solution, which the Minister has heard before, having kindly agreed to me myself and Dr Cronin.

As I was saying, there is no doubt that these monkeys are suffering. Let us compare the circumstances in a cage in someone’s kitchen with what happens in the wild, where marmosets pair-bond for life and bring up extended, exuberant families, and every monkey participates in caring for the younger ones. They are never alone and they live for 15 years. Tragically, barely weaned infants are handed over by unscrupulous breeders who rely partly for their profits on the fact that marmosets almost always bear twins, after a gestation period of about four months. The males are sold on, while the females are kept for breeding. They may survive physically, but their captivity is nothing short of torture. Remember, these are primates: they share more than 90% of their DNA with their human cousins—us. That proportion rises to approximately 98.6% for chimps and bonobos, which are our closest relatives on the evolutionary tree, according to the Smithsonian Institution. Such treatment of chimps and bonobos would be considered immoral; indeed, there are laws to protect them.

Almost exactly a year ago, Dr Cronin and I, along with the former Genesis front man Peter Gabriel, delivered a petition bearing 110,000 signatures to Downing Street. The UK primate pet trade petition asked the Government to change the law so that all monkeys would be guaranteed a standard of care, as is already mandatory in zoos and wildlife parks. The Minister kindly said that he would put forward a law for a regulatory system that would ensure appropriate care. Since then, regrettably, we have heard nothing. That is understandable, given all the recent political upheavals—I know that my hon. Friend the Minister has been extremely busy—but according to the Department for Environment, Food and Rural Affairs code of practice working group, the number of primates kept as pets in the UK is thought to be between 1,200 and 5,000.

Dr Cronin says she has seen an “exponential explosion” in the British monkey pet trade, with ever-growing numbers of monkeys needing rescuing. In the past 30 years, Monkey World in Dorset has rescued 106 pet-trade monkeys. Of those, 53 have been rescued since 2012, in an accelerating catastrophe caused mainly, Dr Cronin suspects, by social media. Many rescued primates come from decent, well-meaning but inexperienced owners who were duped into thinking they had bought pets that were easy to look after. In a recent police raid, Dr Cronin was asked to rescue a tiny infant marmoset that was freezing to death in a bird cage in a darkened city flat. She says that that is proof that the Animal Welfare Act 2006 is simply not working.

The 2006 Act was passed to cover the care and welfare of all animals—domestic and wild. Under it, DEFRA published a code of practice for the welfare of privately kept non-human primates in 2010, which explained, among other things, that it was inappropriate to keep these animals alone in domestic settings for the purposes of companionship or personal interest. In March 2016, DEFRA announced that it planned to review the code of practice and would make recommendations for any changes to the code within a year. However, the Commons Library has been unable to find any information on the result of the review or any plans or proposals. Dr Cronin says that although the Animal Welfare Act can be enforced, it does not enforce the conditions in which primates should be kept. Instead, it is most often used to prosecute cruelty or neglect cases after the fact.

Five different laws cover the care of any one monkey in this country. The Zoo Licensing Act 1981 has the strongest laws governing species-specific care, and applies to any parks that are open to the public. Under that Act, some 200 Government inspectors on a constant inspection regime apply extremely rigorous standards covering animal welfare, health and hygiene, safety, ethics and other areas.

Under British law, primates are divided into two classifications. Non-dangerous primates, which can be bought and sold without any form of checking or regulation, make up the 66 species that I mentioned earlier. The rest are classified as dangerous, as specified under the Dangerous Wild Animals Act 1976, which focuses on protecting owners, not the animals, and fails to acknowledge any duty of care for them. Interestingly, smaller monkeys were declassified on the basis of the size and shape of their canine teeth.

Thirdly, the pet shop licence laws of 1951 and 1983 cover pet shops that sell primates. Fourthly, the Performing Animals (Regulation) Act 1925 and its 2012 regulations cover circus animals, while fifthly the Animals (Scientific Procedures) Act 1986 covers animals in laboratories. Dr Cronin believes it is not logical that the same monkey could be subject to all the above laws to a greater or lesser degree, particularly as none seems to work properly. For example, she says that Monkey World’s most chronic problem is with the legal trade in primates as pets in the United Kingdom.

How do we solve this problem? The Royal Society for the Prevention of Cruelty to Animals, the British Veterinary Association and the Born Free Foundation all advocate an outright ban on the ownership and trading of primates. However, Dr Cronin believes that such a move is neither realistic nor necessary. She suggests that we need a practical solution to ensure that these small primates are kept appropriately—I agree with her. Marmosets, tamarins and squirrel monkeys need to be registered under the Dangerous Wild Animals Act 1976. Alternatively, a register of primates that are kept as pets could be implemented, like the one for dangerous dogs, as suggested by the Minister himself at a meeting with Dr Cronin and me last June.

Additionally, the Zoo Licensing Act 1981, policed by local authorities, could be imposed on licensed private owners, pet shops, breeders and dealers. If required, the existing large national team of professional zoo inspectors could then be used to assess applications. Extending this existing standard of care to the pet trade would prevent the sale of individual monkeys over the counter, or on the internet, to those who simply do not understand what they are taking on. It seems to me and Dr Cronin, as well as many others, that the best solution is to require private owners to meet the standards imposed on zoos and game parks. Were those standards applied, I am sure we would all agree that no domestic user could possibly meet them, so keeping a monkey in one’s home, garage or anywhere else would be impossible. I humbly ask the Minister to please consider changing the existing laws, as he suggested last year, to make sure that all primates sold in Britain are properly protected, as they surely deserve to be.

European Union (Notification of Withdrawal) Bill

Debate between Richard Drax and Jim Shannon

Tuesday 31st January 2017 Commons Chamber

[Richard Drax]

I want to pick up on a point made by my hon. Friend the Member for Stroud (Neil Carmichael), whom I respect and who is no longer in his place. He used the analogy of someone checking that they had a parachute before jumping out of a plane. I believe that the reason we are leaving the aeroplane—whether we check the parachute or not—is that it is on fire. The EU as it now stands—the political experiment that was put in place—is over. It is finished, and the people of Europe are beginning to realise that. The British people have led the way, and others are now seeing the light. I hope that where the United Kingdom leads, others will follow.

I hope for a peaceful and ordered change for Europe, which we all love. We love Europe, and we want to remain friends and allies with it. If we look back in history, I think we will find that Britain has been the best ally that certain countries in Europe could ever have hoped to have. The future for us in this country and our European allies will be sound. I have used the example of Airbus on many occasions, and I will use it again tonight. The fuselages are built in Germany and France, and the wings are built in Wales and Bristol. It is a fantastic European enterprise, and I cannot imagine any sane, sensible politician or bureaucrat wanting to get in the way of all those thousands of jobs. I believe that, over the next two years, the EU will come to us. It will see the pragmatism of having a future with us that involves sensible trade and friendship resulting in the prosperity and wealth of us all. In fact, I have no doubt about that whatever.

Many Members have talked about their fear of what we will do when we become our own country again and when we take control of our destiny, which we have not had for 40 years.

[Jim Shannon (Strangford) (DUP)]

Does the hon. Gentleman accept that there should be no veto from any region of the United Kingdom over the democratically expressed opinion that all of the United Kingdom of Great Britain and Northern Ireland should leave? Does he also agree that article 50 should be invoked by 31 March and that no region should say no to that?

[Richard Drax]

I agree with my hon. Friend. That is why we are here tonight, and it is what the vote will be about tomorrow. We are all going to vote to trigger article 50. We will then have at least two years of negotiations to find out exactly where we are going to be. Who knows, that might take even longer, but I have every confidence in our Government and in our Prime Minister, who could not have been clearer about the direction in which this country is going. She has said that no deal is better than a bad deal, and I entirely endorse that view. If we have to fall back on WTO rules, so be it, but I am convinced that common sense and pragmatism will ensure, over the next two years, that that will not happen.

Prison Officer Safety

Debate between Richard Drax and Jim Shannon

Wednesday 16th November 2016 Commons Chamber

[Richard Drax (South Dorset) (Con)]

What a pleasure it is to be here under your command, Madam Deputy Speaker. This debate on prison officer safety is rather well timed given what has been on our TV screens and in our newspapers. Before I start, I want to thank all those who work in the Prison Service—prison officers, managers, governors—and the numerous organisations, both charitable and voluntary, that support the service to ensure that prisoners have a chance to rehabilitate and that we are kept safe. We owe them a huge debt. I also praise the prison officers who serve at The Verne immigration centre, which was a prison until quite recently and is now under the auspices of the Home Office.

I welcome the Secretary of State’s recent announcement about the recruitment of 2,500 more prison officers by the end of 2018 and her aim for every offender to have a dedicated prison officer providing regular one-to-one support. More officers will certainly help to deter attacks on them, which have risen worryingly over recent years. In the 12 months to June 2016, there were nearly 6,000 assaults on staff—up 43% on the previous year. Of those, 700 assaults—an increase of 20% on the previous year—were regarded as serious and required hospital treatment. A recruitment drive is most welcome, as I have said, but the problem of retaining staff remains. In 2015, of the 2,250 officers who were recruited, only 440 were retained. We must remember that there are 7,000 fewer officers now than in 2010, when the prison population was about 2,500 lower.

The recent action by prison officers, which I do not support, was driven by a genuine concern for their safety—I am certain of that. We must take note of that. If we do not, not only we will fail to recruit sufficient new officers, but the exercise will be a complete waste of money as they all leave. Understaffing is the root cause of their discontent. Savings have understandably been made in the public sector, and I have voted for such savings on many occasions, so I do not condemn the Government for making the savings necessary for us to learn to live within our means. However, if we make savings, we must note the consequences and act if they are unintentional and serious. My next point refers to the prison estate in general, not to the young offender institution in my constituency, which is excellently led by James Lucas, a former soldier with whom I do a lot of business. The increased workload, lower morale, poor leadership in some cases, a higher retirement age—more on that in a minute—and an increased risk of being assaulted have all contributed to the problems we see today. Frankly, who can blame the officers?

I touched on the pension age and the necessity for prison officers to work until 68, which does affect their safety. Let me explain. I witnessed a demonstration laid on by prison officers of how to remove a troublesome prisoner—on this occasion, actually a prison officer—from his cell. The officers were equipped with all the necessary protective gear and they went in to remove this troublesome fellow. He did not react violently. He simply stood in his cell, not co-operating and using his weight and strength not to move. Those three beefy officers eventually got the man out, but it took them an awfully long time. I am 58 and in reasonably good nick, but I am not so sure that I would be able to drag someone out of a prison cell in 10 years’ time, particularly if they were behaving violently or were under the influence of drugs, as they often are. I ask the Minister to respond to this particular point about the physical demands on a prison officer when they get to the age of 60 and above.

I have also seen pictures of riots, which were taken on the body cameras that the Government are introducing—again, I entirely commend what they are trying to do—to ensure that evidence can be gathered. In addition, the cameras are a deterrent, because the prisoners who might offend know that they are being filmed and therefore that they will be found guilty if caught. I have faced crowds in Northern Ireland, but I was always surrounded by guardsmen armed to the teeth. In one particular riot, I think one prison officer had a shield, but the rest were caught out at quite short notice. Two of them were female prison officers, and they were facing a baying crowd of thugs, who were really geared up and were looking for that moment of weakness. Had those prison officers shown that weakness, I am convinced that 10 to 15 of the prisoners would have pounced, and those prison officers would have been seriously hurt.

[Jim Shannon (Strangford) (DUP)]

I sought the hon. Gentleman’s permission to intervene before this debate, Madam Deputy Speaker.

The £1.3 billion investment that the Government have offered over the next five years is good news, but there is a short-term issue to take care of, which the hon. Gentleman has outlined very well. Does he agree that, when it comes to discussions on safety, they must take place with counterparts in Northern Ireland, and that those who have experience of how to deal with difficult cases across the prison system in Northern Ireland over some 30 to 40 years could help, as there is a lot of knowledge that could be used for the betterment of the service in Northern Ireland? I make that point as a careful and gentle suggestion to the Minister.

[Richard Drax]

I absolutely agree with the hon. Gentleman. Like anything in life, those who are trying to achieve something turn to those who have experienced it. They listen to their experiences and, if they are wise and if the advice is good, they will adopt it. Perhaps the Minister will respond on that particular point.

I pay tribute to the officers who faced this baying crowd. They stood their ground and maintained control of the prison. As it happened, the most thuggish of the men, who was bouncing up and down on the wire netting that was there to prevent people from falling, actually fell off the end of the netting and damaged his ankle. It was extraordinary. At the point that the ring leader went down, calm returned almost instantly. It just shows how little things have to be affected in a prison before these very brave men and women are faced with some very unpleasant experiences. I have a question for the Minister. Can the Government—I would be very grateful for an answer to this—bring prison officers under the same retirement age as the uniformed services to reflect the occasional physical testing characteristics of the job?

There is no doubt that the presence of drugs in prison is contributing to attacks on officers. I welcome the Secretary of State’s assurance that dealing with drugs is high on her agenda. Spice is the modern curse in prison. It fuels violence against officers because of its mind and behaviour altering effects. Worse, it exacerbates existing mental health issues, personality disorders and behavioural issues, causing unpredictable bouts of violence. This point was picked up by the report of the Independent Monitoring Boards for the year to March 2015. Under problems, it says:

“The widespread and apparently un-checkable presence of so-called ‘legal highs’ or ‘Spice’ on the wings. This is leading to trading, debt, bullying of more vulnerable prisoners and their families, criminal networking and gang activity, violence and unpredictable behaviour among prisoners.”

That of course has a knock-on effect on those who are guarding them. Dogs are one solution, but in my constituency the young offender institution has only one dog, and, as we all know, much as we love them they cannot work seven days a week. They have to be rested. More dogs may be a solution. Perhaps the Minister can expand on that. I believe someone mentioned that the number of dogs would be increased.

Spice is endemic and is seemingly brought into prisons via drones and social visits, thrown over prison walls, brought in by new or returning prisoners and, apparently, by soaking letters in it. As I said, drugs lead to bullying and debt, increasing the risk to both prisoners and officers.

Another way of improving safety for officers is to hold more regular searches. As I understand it—perhaps the Minister can help me—they used to happen once a month or thereabouts. Searches are more irregular now because in order to search one cell, officers have to shut down a whole wing, and they do not necessarily have the resources to hand when that needs to be done. A lockdown of an entire wing in one prison recently revealed a range of illegal goods.

More officers would reduce the need to lock prisoners in their cells for longer than is necessary. The report from Winchester prison today underscores that point. Taking part in purposeful activity would counteract the inevitable resentment that builds up behind a locked cell door. A fairly treated prisoner—I am not all flowery on this, but I believe that prisoners should be treated fairly—is less likely to resort to violence.

There are concerns about whether the courts take assaults on prison officers as seriously as they take assaults on police officers, despite the fact that, as I understand it, both have equal standing and protection under the law when on duty. In early 2015 a joint protocol was published on the appropriate handling of crimes in prisons, but the issue remains a very real one. Will the Minister review the range of sentences handed down to prisoners who assault prison officers? Anyone who assaults a prison officer or any other public servant in uniform should face an automatic custodial sentence. A strong deterrent and message is needed, and a tougher stance should be taken by the courts. Anything that the Government can do to assist me and other colleagues in the House, and certainly prison officers, would be helpful.

Let me highlight that point with two brief examples. In the first case, a prisoner who was due to be released the next day “potted” a female prison officer. “Potting”—if there is anyone in the Gallery, I apologise for being so crude—involves urine and excrement being thrown over an officer. It is disgusting, demeaning and outrageous. That prisoner was released the next day, when he was arrested for assault, fined £200 and given a suspended sentence. That is farcical. In another case, another female officer was “potted” and the prisoner received a mere 21 extra days on his sentence. That officer was then goaded and teased by the prisoner when she returned to work. Again, that is unacceptable. Perhaps because “potting” causes no physical damage, the courts tend to be more lenient, but the effect on officers who have been subjected to such disgusting humiliation is traumatic, and offenders should be dealt with harshly. I would be grateful if the Minister commented on that.

The prison population is becoming more violent, with the number of those sentenced for violent offences rising by 30% in the past 10 years. Officers are clearly struggling to cope on many occasions, and their concerns have been expressed in a number of ways to me personally and by taking the action which I did not agree with, but which many of us understand. A survey of Prison Officer Association members in 2014 found that the demands of the job are particularly high and support from managers is low. I am not commenting, as I said, on any prisons in my constituency, but we had a saying in the Army that there are no bad soldiers, only bad officers. I suspect that that is true in every walk of life and I am sure it applies in the case of prison staff.

I do not know whether the Minister is prepared to comment on what control is kept over managers and governors to ensure that prisons are managed properly. Let me give a tiny example from a prison I visited some time ago. I said to one of the prison officers, “I’m sure the manager comes round every day with his board and pencil and says, ‘Bob, good morning. It’s your wife’s birthday. Happy birthday to her. Your little son is 10 today. How marvellous. I hope you have a very nice day. If there are any problems, do come and see me.’” This officer’s jaw hit the floor, and he said, “I don’t think so, Richard. That is not exactly how it works.” As it happened, he had not seen his governor for some time. That is a tiny example, and I do not know, but I would say that the governor was not in touch with the men and women he was commanding.

The warning signs are therefore clear, and we would be irresponsible to ignore them. In my humble view, the line that used to exist between prison officer and prisoner has become increasingly blurred. The forgotten army, which is how I often refer to prison officers, needs our support, and we owe them and all who work in our prisons our thanks and a duty of care.

Ambulance Waiting Times

Debate between Richard Drax and Jim Shannon

Monday 17th October 2016 Commons Chamber

[Richard Drax (South Dorset) (Con)]

It is a pleasure to address the Chamber under your chairmanship, Madam Deputy Speaker. It is also a pleasure to see in his place my hon. Friend the Minister of State, Department of Health, who is a very able Minister.

My speech is not an attack on the Government per se. It is my job as the MP for South Dorset to stand up and speak for people without fear or favour. In my six years as MP, I have seen the ambulance service increasingly struggle, and I hope that any information that I impart will lead to the improvement of the service.

I pay tribute to the men and women of the ambulance service, whose professionalism, dedication and selflessness have saved countless lives. People’s ability to dial 999 in an emergency in the expectation of receiving urgent and expert medical help has long been one of the NHS’s treasures. Now, it is the ambulance service itself that is facing an emergency. In the year to May 2016, ambulance response times hit a record low. Not a single one of the 10 ambulance trusts in England met the target of reaching 75% of incidents within eight minutes. Worryingly, the current national average for a response within eight minutes is 68%. This trend has grown over the past four years, which is the period for which the Government have published response figures.

Ambulance control rooms across the country are buckling under the twin strains of increased demand and dwindling resources. The increased demand is undeniable. Last year set a new record, with 10.8 million ambulance call-outs in 12 months—a staggering number. The London control room alone now fields 5,000 calls for ambulances every single day.

The numbers show that emergency calls for ambulances have risen by 6% year on year for 10 years. This has not been helped by the fact that people are finding it harder to see their GP, meaning that they fall back on A&E. Although we can debate the causes, the fact remains that there are simply not enough vehicles, paramedics and clinicians to cope with the increase in workload. At the same time, the resources available have been cut or frozen. Six of the 10 English ambulance service trusts are currently in deficit, having overspent their budget, despite making efficiencies. East Midlands Ambulance Service NHS Trust alone had a £12 million deficit last year.

In my constituency, efficiency savings have directly affected the South Western Ambulance Service NHS Foundation Trust, which I shall refer to from now on as the trust. An ambulance call-out in the trust now costs 2.5% less than last year. The trust covers Bath and north-east Somerset, Bristol, Cornwall and the Isles of Scilly, Devon, Dorset, Gloucestershire and South Gloucestershire, Somerset, Swindon and Wiltshire—a huge predominantly rural land mass covering 20% of England. I highlight the trust’s area of responsibility because it is the most rural of all the ambulance trusts and the area is one of the most sparsely populated, which means longer distances, higher fuel costs, patients who are harder to locate and hospitals that are more spread out. This means that ambulances need to be parked at intervals across the region, as I see all the time.

Achieving response times and meeting budget targets under such circumstances is a challenge. It is not just the increased demand and reduced resources that are creating the problems; the target culture does not help. Though well intended, targets can skew both priorities and outcomes. For example, to meet target times, a fast-response paramedic on a motorbike or in a car might be sent to a critical incident that would almost certainly require ambulance transportation to hospital. Those red-category incidents include life-threatening emergencies such as cardiac arrest, where survival depends on swift and specific action. Sending the wrong resource in such a case might well tick the target box on response times, but the eventual outcome might not be so satisfactory. For example, if responders reach a patient only one second short of the eight minutes, it is considered a success, even if that patient dies.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this matter to the House. In 2014-15, the Northern Ireland Ambulance Service met its eight-minute deadline in only 60% of cases. Such problems beset all of us across the United Kingdom—here on the mainland and in Northern Ireland. Does he agree that it may be time to share those experiences and also ideas about how we can make things better across the United Kingdom? If we can do that together, to see what improvements we can make, we will all benefit.

[Richard Drax]

I entirely concur. As I said at the start of my speech, I am not here to condemn the Government, because they have the most appalling situation to deal with, given rising costs and all the things we know about the health service. Yes, more integrated systems, which the Government are working on, are definitely part of this. As I will say at the end of my speech—perhaps I will say it now—we really ought to think about the whole NHS and how it is run, not just the ambulance service. We need to do that free of politicians, with expert advice being sought from non-politicians—those who know how the health system works, not least the clinicians—so that we can re-look at this whole situation. We have enough money, but we have not spent it particularly wisely in every case.

Let me just go back to my example—you might well have lost the thread, Madam Deputy Speaker—about the target times for red-category incidents. I was saying that if responders reach a patient only one second short of the eight-minute target, it is considered a success, even if that patient dies. Conversely, it is deemed a failure if a patient lives, but help has arrived just one second over the eight-minute response time. Worse, the trust is marked down for it.

Once at the hospital, ambulance crews face yet another target: they must hand over their patient to the emergency department within 15 minutes. Anything over 30 minutes incurs a fine, although it is not applied to all areas and is capped by the trust’s commissioners. Yet, handovers can be achieved only if there are available beds and bays in the emergency department, which in turn can free up space only by transferring patients to wards or into surgery. That flow—from ambulance to emergency department to ward and, hopefully, to home and recovery—simply is not happening, because beds are not being cleared. The so-called bed blockers—the chronically ill and often elderly patients—languish in hospital beds because there simply is nowhere else for them to go. Without enough community care outside the hospital to discharge them to safely, there is no alternative, and so if the wards are full—they often are—there is gridlock. Regrettably, we have all become accustomed to the sight of ambulances lined up outside the emergency department with their crews tending to their patients until they can be handed over. In August this year, ambulances delivered patients to the Royal Bournemouth hospital’s emergency department 650 times. The 30-minute handover target time was breached 91 times, and in eight cases patients waited for more than two hours.

It is perhaps not surprising that ambulance crews feel demotivated and demoralised, and A&E staff are equally under pressure. They are all attempting to do their best—everyone recognises that—but perhaps that is in a system that sets them up to fail. Unsurprisingly, the attrition rate in the ambulance service in England is running at 11% a year, leading to each ambulance service having to replace more than one in 10 of its call handlers, drivers, clinicians or paramedics. I am told that these invaluable, experienced professionals eventually buckle under the physical and emotional demands of their jobs, often leaving for the better hours, conditions and pay offered by GP surgeries and clinics. The retention of staff is notoriously difficult in A&E departments, too, for similar reasons. A recruitment crisis now faces the ambulance service and A&E departments. Yet, for these most dedicated and professional workers, without whom the NHS would grind to a halt, there is little light on the horizon. Instead, and extraordinarily, fines are imposed on the cash-strapped services employing them.

Hold-ups from ambulance to A&E represent a waste of precious resources; in the trust’s area, that amounts to a staggering 5,000 hours per month, and the south-west’s hospitals are by no means the worst performing in England. For that reason, the trust and the Yorkshire and west midlands ambulance services have been trialling a new response programme. The aim is to get the right resource to the right incident first time. Rather than sending a response vehicle to meet a target, more time is taken to identify the reason for the call-out. Something that is life-threatening, such as strokes and heart attacks, will inevitably need an ambulance transfer to hospital, whereas a less serious case can be dealt with by a paramedic. Members might have thought that that sounds like common sense, but it seems to me, and I think to many, that targets, in part, get in the way of common sense. Sheffield University will report on the results of the programme. Interestingly, Wales is already using the system, with a 75% success rate, and Scotland is starting trials now.

Inevitably, waiting times for ambulances are increasing as pressures mount. Regrettably, there are consequences for the patient and, of course, their family and friends. Less well known are the physical and verbal assaults on ambulance staff. In the trust’s area alone, those have doubled in 12 months—that situation is, I am told, untenable. Death threats have been made to control room staff, while physical injuries have included a broken jaw and a career-ending attack with a baseball bat. Often, drink and drugs are to blame; sometimes, mental health issues, pain, sheer anxiety and frustration make relatives and friends lash out. I am not, for one second, condoning that behaviour—in fact, I condemn it—but I am just trying to explain it. I have some experience of this with constituents who are devastated when they do not get the emergency response they expect—when we dial 999, we do indeed expect a speedy response.

Ambulance service staff are united in calling for a formal, ongoing public information campaign that tells the public not only when to call an ambulance but what to expect when one is called. With the number of calls continually outstripping the number of ambulances available, expectations need to be managed. I would be grateful if the Minister expanded a little on that when he answers. By way of example, in Dorset and across the whole trust area, 58%—nearly 60%—of 999 calls do not result in patients being sent to A&E at all, and 14% of callers are treated and advised over the phone.

Calls to make funding for ambulance services and A&E a special case chime with calls for increased social care provision to free up beds in hospitals so that a flow can be re-established. That is particularly important in Dorset and the south-west, where so many pensioners choose to live.

I would like to share some observations from Mrs Fiona Smith, who is the manager of Milton Court sheltered housing in Poole, which is not in my constituency. Her charges, who are all in their 80s and 90s, live independently and successfully in their own homes, with support services provided by the company. If they suffer heart attacks or strokes, the ambulance arrives within 10 minutes, she says, but if they fall down, the importance of the incident is downgraded by call handlers due to immense pressure from other incidents. Mrs Smith recently waited for more than four hours with a frail 96-year-old lady who remained lying on the floor with a broken hip because protocols would not allow staff to lift her. Mrs Smith is at pains to point out that she is not criticising the ambulance staff; she simply believes that there is insufficient funding and staff. Her advice to me and the Government, and to others, is that we need to get our priorities right.

I know there is no short-term solution to the picture I have painted, and I sympathise enormously with the Government’s plight. In the past, Governments of all colours have had this massive problem, which is growing as the population gets older and lives longer, and the cost of medical care rises. More joined-up care is one way forward, as the hon. Member for Strangford (Jim Shannon) suggested. I praise the clinical commissioning group in Dorset, which is working with all GPs and hospitals to try to ensure that a more joined-up care approach is working. I believe that that is happening across the country, and I am sure the Minister will expand on that. This is a vital way forward that will solve some of the problems.

Perhaps, as I hinted—I do not know whether the Minister can expand on this—we need to re-examine the whole NHS, rather than just picking on particular bits of it. Now and in the past, when politicians and Secretaries of State sometimes feel that that things need to be done—and they do—they unfortunately fail to look at the whole picture. This is not a criticism of our current Secretary of State, for whom I have high regard; I think he is doing an extremely good job in difficult circumstances. However, perhaps now is the time—as we see, to a certain extent, the writing on the wall and the warning signs flashing—for us to sit down and have another look at how the NHS is run. I leave that point with the Minister and his Department. I can only recommend that politicians are kept out of that debate until such time as ideas are put forward to us, because inevitably we would have to make the final decisions.

I end as I began by praising the staff of the ambulance service in the south-west, not least those who serve us in South Dorset and do a fantastic job. I have met many of them and cannot praise them enough. I now look to the Minister to expand on what I have said in the hope that there is some light at the end of the tunnel, and perhaps a little more money at the bottom of the bucket.

Rural Bus Services

Debate between Richard Drax and Jim Shannon

Tuesday 29th April 2014 Commons Chamber

[Richard Drax]

I thank my hon. Friend for his wise intervention and I agree with both the points he makes. However, although his efforts to provide some form of service are to be highly praised, such a service does not necessarily fit in with the right timings to get people to or from work, for example. In Wool, the Share and Care system has been set up mainly by retired people. Some 50 drivers provide a service, at a price of about 40p a mile, for those who are stuck at home and need to get to the doctor or to hospital, or to go shopping and do all the everyday things that people in rural communities need to do. That is, one could say, the community in action, which is to be applauded, but it is slightly regrettable that such a basic service as a rural community bus must be provided almost through charity. As I say, however, I applaud the initiative.

[Jim Shannon (Strangford) (DUP)]

In Northern Ireland the Rural Community Network scheme provides Government grant aid and assistance through the Northern Ireland Assembly to enable those who live in rural areas or are isolated, such as elderly or disabled people or those who do not have cars, to get transport to where they need to go, such as their GPs, doctors or shops, at a price they can afford. Perhaps the hon. Gentleman and the Minister will consider that scheme, which enables people in the countryside to access transport.

[Richard Drax]

I applaud the scheme in Northern Ireland. The Minister will no doubt have heard the hon. Gentleman’s point and perhaps he will comment on it.

Another pressure on rural bus services is the concessionary bus pass. Government statistics show that 30% of all bus journeys are now made using this pass. Free off-peak bus passes for pensioners are welcome, but they skew the economics of bus networks in rural areas. For example, in Dorset operators are dealing with record numbers of pass holders enjoying our stunning countryside and coastline. Up to 20 million people visit Dorset, many of them on buses. It is a tourist destination. The original idea of the pass was to ensure that bus companies are not better or worse off. However, reimbursement is paid on the basis that without concessionary journeys, fewer would have been made. Dare I say it, that is slightly illogical in a business sense, although any money is gratefully accepted. The rebate is about a third of the cost of a ticket, which clearly disadvantages the bus company and the local taxpayer. Inevitably, it means that operators are left struggling to fund services, not least in rural areas such as my constituency.

The Government recognise the value of the national network, and the “Green Light for Better Buses” agenda is intended to improve local bus services. Some, however, such as the Campaign for Better Transport, worry that 2014 may be the worst year yet for cuts to bus services.