House of Commons
Tuesday 26 January 2016
The House met at half-past Eleven o’clock
[Mr Speaker in the Chair]
Oral Answers to Questions
The Secretary of State was asked—
Our prison system needs reform, and, in particular, we need to give governors greater freedoms to innovate to find better ways of rehabilitating offenders.
In December, the outgoing chief inspector of prisons said that he was concerned about Islamic extremism in prisons. In some prisons, including in Long Lartin in my constituency, the Muslim population is as high as 40% of inmates. What additional powers or support are the Government giving to tackle religious extremism?
My hon. Friend makes an important point. Radicalisation in prison is a genuine danger not just in England, but across the European Union. That is why we have charged a former prison governor, Ian Acheson, with reviewing how we handle not just the security concerns, but the dangerous spread of peer-to-peer radicalisation in our prisons. It is also the case that, in appointing a new chief inspector to follow on from the excellent work of Nick Hardwick, the experience of Peter Clarke in this particular area will count very much in his favour.
I welcome the steps that have been taken to tackle radicalisation in prisons, but the problem exists once people come outside prisons. In a previous report of the Home Affairs Committee, we talked about the need to monitor people when they come outside. Will the Secretary of State ensure that there remains that connection with the Home Office, so that those who have had lessons or initiatives to do with counter-radicalisation are able to continue with them when they get outside?
Absolutely. I make it my business to talk regularly to the Home Secretary about this issue, as we share the concerns of the right hon. Gentleman. I also know that the Under-Secretary of State for Justice, my hon. Friend the Member for South West Bedfordshire (Andrew Selous) and the Minister for Security, my right hon. Friend the Member for South Holland and The Deepings (Mr Hayes) meet regularly to ensure that we do everything possible to monitor the matter. Across the House, there is a recognition that we must deal not only with violent extremism, but with extremism itself. Those who seek to radicalise and to inject the poison of Islamism into the minds of young men need to be countered every step of the way.
We are determined to help eliminate the budget deficit and deliver better justice, which is why we are cutting 15% from the Ministry of Justice budget over the spending review, but finding £1.3 billion to overhaul the prison estate so that we drive down reoffending and ensure that my hon. Friend’s constituents get better value for money and better bang for their buck out of the justice system.
The Ministry of Justice has faced spending cuts as deep, or deeper, than any other Department in Whitehall, and yet, despite the occasional criticism and row, I am not sure whether the public has noted any discernible reduction in the service provided by the Department. Will my hon. Friend summon in the Secretaries of State for Health, Work and Pensions, International Development and Defence and give them a verbal tongue lashing about how we can emulate the private sector and create more wealth, goods, enterprise, deregulation and lower taxation and still provide better services?
I thank my hon. Friend for his insightful remarks. As a former Public Accounts Committee Chairman, he will appreciate that we have already slimmed back-office by £600 million so that we can extend rehabilitation to the 45,000 offenders on short sentences, where we have some of the highest reoffending. Now we are cutting the admin budget by 50%, but investing £700 million to modernise our courts. It shows that, whether we are talking about delays at courts or the offenders passing through them, we can drive efficiencies and deliver a more effective system.
Given the Secretary of State’s U-turns on things such as the criminal court charge and the ban on books being sent to prisoners, may I gently suggest that a good way of saving money would be to avoid such mistakes in the first place and listen to the Labour party?
With great respect to the hon. Gentleman, given the litany of mistakes, errors and systemic failings that we have had to clear up over the past five years and will continue to do over the next five years, we might just reject that particular piece of counsel.
One important area in which both service can be enhanced and value for money achieved is through greater efficiency both in the courts estate and the courts system. Is my hon. Friend satisfied that the Ministry has sufficient in-house capacity to deal adequately with major issues such as court restructuring, where negotiations have to take place at high commercial contractual levels, or will he bring in outside expertise where necessary?
My hon. Friend is absolutely right. I have already explained some of the back-office savings that we are making not only to deliver better value to the taxpayer but to find the savings to reinvest. He is right to say that, where we need to engage with the private sector—or the voluntary sector for that matter—to take advantage of their ingenuity and innovation, we will do so.
Figures released yesterday by the Department show that more Ministry of Justice staff received bonuses last year than the previous year, and that the average size of bonus increased by more than 7%. Considering that the whole public sector has had a 1% pay rise cap, is this not a case of one rule for one and a different rule for another?
No. I am afraid that that is not fair or reasonable to any of our hard-working public servants. There are strict rules and parameters on bonuses within the 1% pay cap and the guidance on that, but it is important, notwithstanding the savings that we have to make, especially in bureaucracy, back office and head- quarters, that we recognise outstanding performance.
My hon. Friend is absolutely right that we need a balanced approach to access to justice. I will answer some specific questions about the military claims later, but he is right to say that we need to look at the rules on legal aid, and that is what we are already doing and will continue to pursue.
Talking of value for money, how much has the miscalculation of divorce settlements cost so far? The 2,200 closed cases will require specialist legal advice and negotiation to correct. Who is going to pay for that—the taxpayer or the people his Department has so badly let down? On the back of it, the legal press has dubbed the Under-Secretary of State for Justice, the hon. Member for North West Cambridgeshire (Mr Vara), the Minister for cock-ups. We disapprove of this scapegoating. Does not the whole ministerial team deserve that title?
Women’s Prison Estate
Our announcement of the closure of Holloway prison signals a new beginning in the way we treat female offenders. It reflects our commitment to hold women in environments that better meet their specific needs and support their rehabilitation, helping them towards better lives on release.
Foston Hall is now a resettlement prison, so it is much better placed to support inmates throughout their time in prison and back out into the community. My hon. Friend will know that many female offenders have complex needs, which is why we have introduced a personality disorder pathway and a centralised case management system for female offenders. We have also ensured that family engagement workers are in place at all public sector women’s prisons, including Foston Hall.
The Minister might know that New Hall women’s prison is quite close to my Huddersfield constituency. Does she agree that often literacy issues stop women getting back into society and leading a good life? Also, many people—women particularly—are on the autistic spectrum, but are never tested. Could more attention be paid to special educational needs in women’s prisons so that we can help women more?
The hon. Gentleman makes an excellent point, and we will certainly take it into consideration. I visited New Hall prison towards the tail end of last year and had a look at some of the excellent work that it is doing to help women offenders both with literacy and numeracy and with their various other complex needs.
My hon. Friend will be aware, as will her colleagues, of the work of RAPT—the Rehabilitation for Addicted Prisoners Trust. She may not know that it began its work in Downview prison in my constituency when it was a category C/D male resettlement prison. That work had to come to an end when it was re-roled as a female prison back in 1999-2000. Now that the Minister is moving women prisoners to Downview, will she make sure that RAPT can restart its work as the prison reopens?
On the advice of organisations such as Families Outside, the Scottish Government have been trialling community sentencing for women serving sentences of six months or less, in order to reduce reoffending. Given that early indications suggest that that is working, will the Minister commit to looking at rolling it out across the whole United Kingdom?
I am keen to look at the Scottish model and see what progress has been made. I am also keen to intervene earlier in women’s offending journey to make sure that the right wrap-around services are put in place to try and divert as many people as possible away from ending up in prison, because we know that every woman in prison represents a potentially broken family and children potentially taken into care.
Given that the Minister is usually such a great champion of gender equality, may I suggest that instead of trying to turn the women’s prison estate into some kind of holiday camp, she makes sure that if a woman commits an offence, she is treated in exactly the same way as a man, and that female prisoners are treated in the same way as male prisoners? It is still the case that for every single category of offence, a man is more likely to be sent to prison than a woman. Why is a female offender who commits burglary any better than a male offender who commits the same offence?
I fear we may have been down this road before with my hon. Friend. I take on board his comments. Sentencing is a matter for the judiciary, but I will always defend my strongly-held belief that equality of outcome is what we are looking for in the female prison estate. At present, female prisoners are much more likely to have many complex needs and are far less likely to gain employment once they leave prison. I am seeking to tackle that.
Psychoactive Substances (Prisons)
Quite rightly, we do not tolerate drugs in our prisons and we are bringing forward tough new measures, including the new legislation on psychoactive substances, which will make possession in a prison a criminal offence, unlike the position in the rest of the country.
I congratulate the Minister on spearheading that new legislative tool, but if the scale of harm demonstrated by a significant increase in ambulance attendances and suicides were happening in other places where there is a duty of care—hospitals, children’s homes or schools—would we not have what is needed, which is a root and branch review of how best to tackle supply and demand for drugs in prisons?
We must make sure that these drugs do not get into our prisons. Psychoactive substances and drugs have been in our prisons for some time. Following a request not only from the prisons Minister, but from prison officers as well as prisoners around the country, we made sure that possession was a criminal offence. We need measures such as new sniffer dogs, which can sniff out such products, and they are in training. We must eradicate these drugs from our prisons.
The National Offender Management Service has revealed that the amount of alcohol found in prisons in England and Wales has almost trebled since the Government took office. Will the Minister explain what urgent steps he is taking to address this serious problem?
One of the ways we can deal with that is by making sure that individual governors have full control within their prisons so that they can work with their staff to make sure that not only drugs, but alcohol, which is not supposed to be in our prisons, is not there. Much of that alcohol is brewed within the prisons and we need to work hard to make sure that we eradicate that.
The Prison Service works very hard to try and make sure that we eradicate as many drugs as possible. The new legislation will help. We know that assaults on prison officers and inmates by people taking psychoactive substances have been prevalent and are a blight on our prisons. With the new legislation we will have powers that we did not have before.
There have been recent reports of prison officers falling ill after inhaling inmates’ legal highs. The Minister says that new legislation is being introduced, but how will we deal with the problem when present governors are retiring and leaving? We need a culture from the top to implement measures within the Prison Service. How will the Government effect that?
One of the ways in which we can improve the situation for prison officers is by listening to them. They categorically asked for the ban. At the moment such substances are legal, but they will be banned once the Psychoactive Substances Bill receives Royal Assent, so from April possession in prisons will be a criminal offence. That is what prisoner officers asked for, and that is what we have given them.
Access to Justice
We are committed to ensuring that our justice system delivers faster and fairer justice for all our citizens. Reform of our courts and tribunals will bring quicker and fairer access to justice and create a justice system that reflects the way people use services today. We have also ensured that legal aid remains available for the highest priority cases, for example where people’s life or liberty is at stake, where they face the loss of their home, in cases of domestic violence, or where children might be taken into care.
The result, as the Lord Chief Justice extraordinarily reported two weeks ago, is that:
“Our system of justice has become unaffordable to most”.
Two constituents were sacked unfairly. One went to tribunal but was unable to afford legal representation and therefore lost. The other immediately gave up. With justice now available to only the well-off, does the Minister have any serious proposals to open up access to justice to ordinary people?
I am grateful to the right hon. Gentleman for raising the issue of employment tribunals, because it allows me to say that this Government’s aim is to ensure that people do not have to go to court or tribunal in the first place, and therefore do not have to incur the legal expenses or experience the stress. In the case of employment tribunals—he might not be aware of this—the ACAS early conciliation service, which is free, was used by 83,000 people in its first 12 months. I very much hope that when constituents bring problems to his surgery in future, he will point them towards that free service.
The Law Society describes access to justice as being
“on the verge of a crisis”.
Funding for civil cases has fallen by 62% since civil legal aid was cut. Will the Minister carry out a full review to understand the equality impact of the changes in civil legal aid?
Some of the people who would struggle the most to pay court fees are those affected by family breakdown, often in chaotic families. Will my hon. Friend update the House on what plans he has to simplify and reduce costs to access child arrangements orders, and will that include any further statutory rights for grandparents?
We learnt this week that a district judge is suing the Ministry of Justice, blowing the whistle on the rising number of death threats and the increasingly violent claimants that our judges are having to deal with day in, day out. Given that that comes so soon after the Lord Chief Justice’s warning that judges face a rising number of challenging and emotionally charged cases, what action is the Minister taking to address these claims, or is this just another admission that his party’s failed austerity policies have made our courts more dangerous, both for judges and for victims?
Prisons’ Engagement with Employers
Providing prisoners with vocational skills and employment opportunities is an important factor in preventing reoffending. The Employers Forum for Reducing Reoffending brings together employers who are willing to employ offenders, and we are working with the Department for Work and Pensions to increase the involvement of more businesses. Community rehabilitation companies also have an important role to play in helping ex-offenders find employment.
I am grateful to my hon. Friend for that encouraging answer. I am sure he would agree with me that it is beholden on as many employers as possible to offer training in prisons, so that when prisoners leave prison they are ready for employment and equipped with the required skills. I invite him to welcome the work that Cleansheet does in our prison estate, particularly in Guys Marsh in my constituency. I have seen it at first hand and it really gets people ready for work.
I thank my hon. Friend very much for his interest in this important area and am delighted to praise the work of Cleansheet and so many other organisations that try to get prisoners into work. A number of companies—Timpson, Halfords, the Clink restaurants, the Census Data Group, Aramark and many others I could mention—are rising to the challenge. We want many more to join them.
My hon. Friend is absolutely right. We have the hard evidence: if a prisoner leaves prison and goes into work, they are less likely to reoffend. We know that reoffending costs between £9 billion and £13 billion a year and creates many more victims. We can avoid that by getting more prisoners into work.
My hon. Friend will know that access to the skills likely to be required in the working environment is key. I welcome what he said about the employers’ forum, but will he say what more the Government will do to get more employers to recognise the potential of providing those skills and of the opportunity to employ ex-offenders on release?
As a London Member, my hon. Friend may have noted that a week or so ago the Mayor of London pointed out that when employers hire ex-offenders, they report above-average commitment and loyalty; the issue is not only an important part of social responsibility, but very good business sense. London is leading the way in this area, with more joined up work between local enterprise partnerships getting extra skills funding into prisons. I want to see what is happening in London spread across the whole of England and Wales.
I do indeed. The hon. Gentleman is right to pursue this matter. Recently, I have come across the issue of insurers imposing a blanket stipulation that employers should have no ex-offenders on their premises. I am not only the prisons Minister but a former chartered insurer; shortly, I will be having a meeting with the Association of British Insurers to challenge it on that issue and see whether that is really necessary. As a former underwriter myself, I suspect that it is probably not.
This morning, the Minister has talked about employment on release from prisons. Education and skills are crucial to an offender’s chance of making something of themselves and getting a job on release. However, the Minister has admitted, in an answer to a question from my hon. Friend the Member for Hammersmith (Andy Slaughter), that Prison Service anti-riot squads were drafted in on 339 occasions in the year to 9 December 2015—an increase of 52% on the previous year. Does the Minister accept that prison overcrowding, coupled with his Government’s cuts in resources, has led to a prison estate that is not fit for educational purpose?
First, let me warmly congratulate the hon. Lady on her new position; I look forward to debating these important issues with her in the months to come. She is absolutely right to raise the issue of education, which is a crucial part of helping get offenders into work. The Government’s whole prison reform programme is front and centre of part of the answer to try to deal with the issues of violence and disorder that she has identified: more purposeful work, better education, better outcomes, better ordered prisons.
19. Hampshire’s community rehabilitation company plays a vital role in connecting prisons and offenders with local employers across the Havant constituency. Will the Minister join me in congratulating it on its work and in encouraging more employers to consider employing ex-offenders, including through job fairs run by Members of this House? (903256)
I certainly will. I warmly congratulate my hon. Friend not only on organising a jobs fair in his constituency—a very practical way in which to help our constituents find work—but on realising that it needs to be equally open to ex-offenders. He is leading the way, and I hope others will follow. I wish him well with his enterprise.
Order. Before I call the hon. Member for Barrow and Furness (John Woodcock), I remind the House that the Crown Prosecution Service is reconsidering this case and a second inquest is awaited. Right hon. and hon. Members should take account of that in carefully framing their remarks on the matter.
The death of Poppi Worthington is deeply, deeply distressing and very tragic. I offer my deepest sympathies to those who loved her and those who cared for her. I am unable to comment on the decisions of the previous coroner, but I note that the new Cumbria senior coroner took steps to hold a fresh inquest as soon as he was appointed. As the Under-Secretary of State for the Home Department, my hon. Friend the Member for Staffordshire Moorlands (Karen Bradley), rightly said last week,
“there is nothing more important than keeping children safe.”—[Official Report, 20 January 2016; Vol. 604, c. 1419.]
That is why the Government have given child sexual abuse the status of a national threat in the strategic policing requirement.
I thank the Minister for that answer, and the Lord Chancellor for his swift reply to my letter, which I received this morning. Our community wants accountability and wants to see improvements in services that have so tragically failed in these circumstances. So will the Minister make it clear that there is no reason why the serious case review into Poppi Worthington’s death and the Independent Police Complaints Commission’s report need be delayed pending the second inquest being carried out?
The hon. Gentleman is absolutely right to stand up for his constituency and fight for the truth in this way. I completely agree with him that a second inquest should be conducted as soon as possible. Both the IPCC report and the serious case review are of course independent of Government and decide their own timescales. However, I can confirm that neither is required to wait upon the coroner.
Probation Service Workers
Community rehabilitation companies are responsible for supporting any of their staff at risk of redundancy, in line with employment law. We encourage them to follow good industry practice and the ACAS guidelines. We are working closely with community rehabilitation companies to make sure that they fulfil their contractual commitments to maintain service delivery, reduce reoffending, protect the public, and deliver value for money to the taxpayer.
There is the potential for 900 probation officers to be made compulsorily redundant within just three CRCs in the very near future. These are the people who stood by the Government at the time of the transitional period into privatisation. They should not be penalised; they should be praised. Will the Minister guarantee that these professionals receive full voluntary redundancy terms and will not be booted out? They provide a very valuable service in the role provided by these private companies on the cheap.
I repeat what I said just now—we will make sure that the community rehabilitation companies comply with employment law as they are supposed to do. We closely monitor their performance in line with the contracts that they have signed. Last year, 195 extra probation officers became qualified, and we had 750 new probation officers in training. That is the largest intake of newly qualified probation officers for some considerable period.
Youth Custody Provision
Our system of youth justice does need reform. Although youth offending is down, recidivism rates are high, and the care of young offenders in custody is not good enough. I know that concerns across this House can only have been heightened following the “Panorama” investigation into events at the Medway secure training centre. That is why today, in a written statement, I have appointed an independent improvement board to investigate what has happened at Medway and to ensure that the capability of G4S, the Youth Justice Board and other organisations to meet appropriate standards is sufficient.
The roll-out of the new minimising and managing physical restraint system has been delayed for a year. In 2013-14, there were almost 3,000 assault incidents in the children’s secure estate—a 7% increase on 2012-13, even though the number of children in custody had fallen by 20%. What is the Secretary of State doing to address this rising number of incidents and to ensure that a new, safer system is implemented?
The hon. Gentleman rightly draws attention to the fact that there has been a reduction in the number of young people in the youth estate. However, as the number has reduced, so those who remain tend to be those who have been arrested for the most violent crimes and who pose the greatest difficulties for those who have to care for them and keep them in custody. It is vital to ensure that when restraint is applied, it is done so in a way that minimises risks to young people, but also ensures that safety can be restored. One of the purposes of Charlie Taylor’s review of youth justice is to make sure that the workforce is appropriately trained to restrain young people in their own interests and those of others.
I recently visited Swanwick Lodge, a secure home for 10 to 17-year-olds in my constituency. Its work focuses on tackling the root causes that have led to those young people’s loss of liberty with education, substance misuse therapies and early intervention. Will my right hon. Friend describe what other measures are in place to tackle youth rehabilitation and reduce reoffending?
Before my hon. Friend came into the House, she did a great deal of work to help disadvantaged children achieve better educational outcomes. She will know as well as anyone in the House that some of the children who end up in trouble with the criminal justice system have grown up in homes where love has been absent or fleeting, and where no one has cared enough to tell those young people the difference between right and wrong. The work being conducted by the Education Secretary to improve our child protection system and the work being led by the Communities and Local Government Secretary to tackle the problems of troubled families are integral to ensuring that we reduce the number of young people who fall into crime.
It was obvious to those who watched the “Panorama” programme that the G4S workforce was under-qualified, under-trained and under pressure not to report incidents that should have been reported, because of the threat to G4S’s profits. Is it not now time that we recognised that the most difficult and vulnerable children in our system should not be looked after by a profit-driven organisation, but by properly trained and publicly accountable staff?
I do not doubt for a moment the hon. Lady’s sincerity in caring about these young people. The allegations about what happened in Medway were of course terrible. It is also important, however, to take on board the fact that private sector organisations, including G4S, are responsible for the care of young offenders, not least at Parc in Bridgend, and have been doing an exemplary job in other areas. It is quite wrong to draw conclusions about the private sector or the public sector. What matters is getting outcomes right for children. We should not, on the back of human misery, try to carry forward a narrow ideological argument.
Will my right hon. Friend join me in congratulating the distinguished former soldier General Sir Rupert Smith on taking on the airborne initiative at the young offenders institution on Portland? Does he agree that getting appropriate young offenders out on to the moors for five testing days is an excellent scheme that demands our support?
I could not agree more with my hon. Friend. I have to say that the capacity of cadet forces and military involvement to turn around the lives of young men who find themselves in trouble has been attested to over the years. Everything that we can do to support the Education Secretary in extending the work of cadet forces or to support General Sir Rupert Smith, a man who is a hero in my eyes, in helping to rescue the lives of young people we should do.
The allegations in the “Panorama” programme on 11 January about Medway secure training centre were truly appalling. I am glad that the Secretary of State has listened to the chief inspector of prisons and to us, and will appoint an independent improvement board. I also note that the director of Medway has just resigned.
The three STCs in England—Medway, Oakhill and Rainsbrook—are run by G4S. Following a damning inspection report last year, the Rainsbrook contract was taken away from G4S. This has nothing to do with ideology, but on the basis of the evidence before us, will the Government now take away G4S’s Medway contract and ensure that G4S is not awarded any future contracts?
The hon. Gentleman is absolutely right: it is because the allegations are so serious that we have to investigate them properly. The independent improvement board will both investigate what went on and ensure that children are safe. When any organisation fails in the delivery of public services, as G4S did at Rainsbrook, we will take steps to remove the contract, and a new organisation has been given that contract. Of course, if G4S has failed in this regard, then we will take all steps necessary to keep children safe.
Safety in Prisons
Violence in prisons has increased in recent years. The nature of the offenders who are currently in custody and the widespread availability of novel psychoactive substances have contributed to prisons becoming less safe. There is no simple single solution that will improve safety in prisons, but we are making progress. We are trialling the use of body-worn cameras and training sniffer dogs to detect NPS, but ultimately the only way to reduce violence is to give governors the tools to more effectively reform and rehabilitate prisoners.
One threat to safety inside and outside prisons is the ability of inmates to access mobile phones. On Friday, a serving prisoner at Rochester prison was sentenced to 12 years for arranging the supply of reactivated firearms via a mobile phone from his prison cell. Random checks are only so good and prison officers do their best, but I think it is time to cut off the head of the snake and go for mobile phone jamming devices.
We already employ a number of measures. We have body orifice scanning chairs, metal detecting wands, signal detectors and blockers, and specially trained dogs. My hon. Friend is right that we need to refocus and redouble our efforts in this area, particularly in respect of the use of blockers and detectors. I assure him that the Secretary of State and I are fully engaged in this area.
The safety of young people in our prison estate was, as we have heard, called into question by the “Panorama” programme about Medway secure training centre. What assurances can be provided that the safety of young people across the prison estate, not just in Medway, is being prioritised?
My hon. Friend will have heard the answer that the Secretary of State gave to a previous question on this issue. I will not repeat that, save to say that we take this issue extremely seriously. That is why the Secretary of State commissioned Charlie Taylor, the former chief executive of the National College for Teaching and Leadership, to conduct a review of youth justice and youth custody across the piece. That will have not only safety at its heart, but improved outcomes for young people in custody.
There are occasions in custody when, for the safety of the young person and others, we have to use restraint. The chief inspector has acknowledged that the new process of minimising and managing physical restraint is an improvement, but that is the case only if it is used properly and appropriately, and not if it is abused. We are very mindful of that.
The report by the outgoing chief inspector of prisons quoted a member of staff at HMP Wormwood Scrubs as saying that one cell was so unsafe,
“I wouldn’t keep a dog in there.”
I know that you can’t teach an old dog new tricks, but will the Minister tell us what is being done to deal with the Tory prisons crisis?
I hope that the hon. Lady would be fair enough to recognise that this Government have accepted that much of our prison estate is simply not good enough. It is too old, it is inappropriate and we cannot provide the education or work that we need to provide. That is why the Chancellor has provided £1.3 billion to build nine new prisons, in addition to the new prison that we are building in north Wales, the new house blocks that we have delivered and the two further house blocks that we are going to deliver. We want a fit-for-purpose estate where we can rehabilitate people properly.
European Convention on Human Rights
I have met many of our international partners, from the Council of Europe Commissioner for Human Rights, Nils Muižnieks, to the United Nations High Commissioner for Human Rights, Prince Zeid. The Secretary of State for Justice has met many others, including Secretary-General Jagland of the Council of Europe. Those meetings are important opportunities to reinforce Britain’s proud tradition of promoting freedom and discuss how the Government intend to strengthen it both at home and abroad.
I am sure that if it was just the Labour party saying, “Don’t scrap the human rights act,” the Minister could roll with it, but when the Minister met Prince Zeid, did Prince Zeid say that the Government’s proposals would be
“damaging for victims and contrary to the country’s commendable history of global and regional engagement”
“many other states may gleefully follow suit”?
Is it not important that we listen to the United Nations?
The right hon. Gentleman is absolutely right that we should listen to all our international partners. I can tell him that Prince Zeid did not say that to me at all. When we have those meetings, they are a good opportunity to discuss the reality of our plans for reform. I made it clear that our forthcoming Bill of Rights proposals are based on staying within the convention. I explained the kind of abuses that we want to be rid of under the Human Rights Act and some of the challenges that successive Governments have had with the Strasbourg Court. That allows us to contrast our common-sense reforms with some of the baseless scaremongering coming from some of our critics.
But the UN special rapporteur on torture, Mr Juan Mendez, has warned that the Government’s plot to replace the Human Rights Act with a Tory Bill of Rights is “dangerous, pernicious” and would set
“a very bad example to the rest of the world”.
Is he not right?
Since when was it the practice of foreign legal and other entities to decide the views of this Parliament, and to traduce its sovereignty and the electoral mandate we have to introduce a British Bill of Rights? It is a tragedy that the European convention on human rights, which was founded by British jurists, has been distorted by perverse decisions such as trying to give an axe murderer the vote, which we have rejected. Is it not time that we got on with our manifesto commitment to a British Bill of Rights?
My hon. Friend is absolutely right and makes his point in his characteristically powerful way. I would point out that the Labour Government had problems with how the Strasbourg Court operated. They did not implement prisoner voting—I do not remember the right hon. Member for Delyn (Mr Hanson) calling for it to be implemented when he was a Minister—and nor did they implement the Abu Qatada judgment.
Will the Minister confirm that human rights have been part of our law in this country under the common law for many years, and that they will continue to be so after the repeal of the Human Rights Act, perhaps in a more modern and codified way?
My hon. Friend is absolutely right. We have a long tradition and pedigree of respecting human rights, dating back to Magna Carta and before that. We protected human rights in this country before the European convention, and certainly before Labour’s Human Rights Act. We shall continue to do so proudly in the years ahead.
The Minister is yet to issue his consultation on the repeal of the Human Rights Act and its replacement with a British Bill of Rights, but it is eight weeks until the Scottish Parliament is dissolved and goes into purdah—it is the same with Northern Ireland and Wales. Will he give an absolute guarantee that he will not squash out Scotland, Northern Ireland and Wales from this important consultation by issuing his proposal before, or worse still during, the election purdah period? Will he give that absolute guarantee?
There will be no squashing out of any of the devolved Administrations. We are already in detailed soundings. When we come to our consultation, there will be full consultation with all the devolved Administrations. There are clear rules and Cabinet Office guidance on purdah, and we will be mindful of them.
When Nils Muižnieks, the Council of Europe Commissioner for Human Rights, visited the United Kingdom last week, he said that the repeatedly delayed launch of the consultation on the repeal of the Human Rights Act is
“creating an atmosphere of anxiety and concern in civil society and within the devolved administrations”.
Will the Minister tell us exactly when the consultation will be published?
As the hon. and learned Lady knows, I met Nils Muižnieks last week to talk through these issues, and there is absolutely no cause for anxiety. We will introduce proposals for full consultation in the near future—those proposals are going well—and she will hear more shortly.
The commissioner also said:
“My impression is that the debate over the HRA in Westminster is not a true reflection of concerns outside England”.
Does the Minister appreciate that the impact on the devolved Administrations of an attempt to repeal the Human Rights Act would likely provoke a constitutional crisis?
The hon. and learned Lady is absolutely right that the debate within the Westminster bubble, particularly the shrill scaremongering, is not reflective of wider public opinion outside the House, which is clearly and consistently in favour of a Bill of Rights to replace the Human Rights Act, including, she will note, in Scotland.
I want fewer women in the criminal justice system, which is why, in partnership with the Government Equalities Office, we have made £200,000 of grant funding available, to add to the £1 million already invested to support local pilots for female offenders. This is where multiple agencies work together and intervene earlier to help address the complex reasons why women offend and assist them in turning their lives around.
Does the Minister agree that more needs to be done to steer vulnerable women away from crime and reoffending? I am aware that the Department is looking at this as part of a whole-system approach, but will she update the House on how it is progressing and what more is being done to tackle the issue?
Yes, the whole-system approach I have outlined demonstrates our commitment to divert as many women as possible away from custody by addressing the causes of offending, which left unchecked often spiral into prison sentences, family breakdown and children in care. That is why we will announce the successful bids for the pilot later this week.
T1. If he will make a statement on his departmental responsibilities. (903224)
I have already had occasion in the House to offer my thanks and gratitude to Nick Hardwick, the outgoing chief inspector of prisons, and to Paul Wilson, the outgoing chief inspector of probation. Their expertise will not be lost to the criminal justice system, however, because, as I am delighted to announce today, I will be appointing Nick Hardwick as the new chair of the Parole Board. He will succeed the current chair, Sir David Calvert-Smith, who is due to leave at the end of March. I thank him for his service.
The courts Minister, my hon. Friend the Member for North West Cambridgeshire (Mr Vara), will know that last year I wrote a report on former service personnel in the criminal justice system that recommended, among other things, training for members of the Bar, solicitors and judges to deal with this cohort—albeit a small cohort—of offenders. What steps is my right hon. Friend taking to ensure that court staff—those actually employed in the courts—receive appropriate training to deal with these individuals?
My hon. and learned Friend, who is a distinguished veteran as well as an outstanding silk, makes an important point. He produced an excellent report on offenders who have been in the armed forces. Court staff are trained to deal with the specific needs of veterans, and we are aware that there are particular needs, which might relate to post-traumatic stress disorder and associated mental health concerns, to which court staff need to be sensitive.
I commend the Secretary of State for his appointment of Nick Hardwick to the Parole Board. I am sure he will be just as forensic there as in his current role.
Exactly a year ago, my right hon. Friend the Member for Tooting (Sadiq Khan), with his usual prescience, said that the new criminal legal aid contracts were
“making a pig’s ear of access to justice”
and should be abandoned. Will the Secretary of State confirm the press reports that he is about to do just that?
I thank the hon. Gentleman for his praise for Nick Hardwick. I believe he is the right person to discharge this role precisely because he has spoken without fear or favour and has been an honest critic who has followed where the evidence has led him. I am sure he will appreciate the bipartisan support for his appointment.
We have had to reduce the spend on criminal legal aid to deal with the deficit we inherited from the last Government, but this country still maintains more generous legal aid than any other comparable jurisdiction.
An hour ago at the Justice Select Committee, the Master of the Rolls described the fee increases affecting civil litigants of small businesses as a desperate way of carrying on based on hopeless research. He laughed when asked by the hon. Member for Cheltenham (Alex Chalk) if anything in the Government’s argument stood up to scrutiny.
I can hear, borne like music upon the zephyrs, words from my hon. Friend the Member for Cheltenham (Alex Chalk) suggesting that, for once, the hon. Gentleman may be misinformed about what precisely happened in the Select Committee. But putting that entirely to one side, one of the biggest barriers to justice, as the Master of the Rolls and others have pointed out, is costs. Action needs to be taken to reduce costs in civil justice. It is not enough simply to say that the taxpayer must shoulder the burden. We need reform of our legal system to make access to justice easier for all.
T2. I know that my hon. Friend regards access to justice as a clear priority. With that in mind, and given the large area of north-east Cheshire that will be without easy access to a court under the proposals in the current consultation, can he tell the House what progress is being made in considering the Macclesfield proposal for a single, combined Macclesfield justice centre? (903225)
I thank my hon. Friend for the meeting we had and for the justice centre report that he and his constituent presented to me. He will be aware that we are giving serious consideration to that report and, indeed, to the 2,000-plus submissions made in the consultation, to which we will respond soon.
T3. Women’s Aid published a report last week entitled “Nineteen Child Homicides”. It tells the story of 19 children and two mothers killed by known perpetrators of domestic abuse in circumstances related to unsafe child contact. How will the Department work with Women’s Aid and others to ensure that no further avoidable child deaths take place where perpetrators of domestic abuse have been allowed contact through the family court? (903226)
We take concerns about child safety extraordinarily seriously, and I know that my colleague the Minister responsible for family law has been in touch with charities that work in this sphere in the past. We will make sure that we pay close attention to that report.
T6. Does my hon. Friend share my anger and that of my constituent Carol Valentine, whose son Simon was tragically killed while serving his country in Afghanistan, at law firms such as Leigh Day, which are heavily involved in actions against veterans and serving members of our armed forces? What action can the Government take to close down this industry, which is causing so much unnecessary distress to our armed forces and their families? (903229)
We do share my hon. Friend’s concerns. He will be aware of the Prime Minister’s announcement on Friday. The professionalism of our armed forces is second to none, but we cannot have returning troops hounded by ambulance-chasing lawyers pursuing spurious claims. The Justice Secretary has asked me to chair a working group with the Minister for the Armed Forces to look at all aspects of this—no win, no fee; legal aid rules; time limits for claims; and disciplinary sanctions against law firms found to be abusing the system—so that we prevent any malicious or parasitic litigation from being taken against our brave armed forces.
I do not have the detailed information that the hon. Lady has asked for, but if she will allow me, I will write to her with the details.
I understand my hon. Friend’s proper interest in this subject. As the threat evolves, we evolve our response. I can tell her that we are strengthening the training for new prison officers to ensure that they are able to tackle criminal activity in whatever form it takes within prisons. As the Secretary of State said earlier, he has asked the Department to review its approach to dealing with Islamist extremism in prisons, and we await that report shortly.
T5. It is worth repeating the damning indictment of this Government given by the Lord Chief Justice just two weeks ago:“Our system of justice has become unaffordable to most”.Will the Secretary of State take heed of those comments and also follow the Scottish National party lead by committing to the abolition of tribunal fees? (903228)
I take very seriously everything that the Lord Chief Justice says, and that is why I am delighted to be able to work with him on a programme of courts reform, which should make access to justice swifter, more certain and cheaper. Of course it is important that we learn from different jurisdictions, but even as we look to Scotland from time to time to see what we can learn from the development of the law there, it is also important that from time to time those charged with what happens in Scottish courts should look at the tradition of English justice, which, as a Scotsman myself, I would have to acknowledge has certain superior elements.
T9. Does the Minister agree that improving the mental health of prisoners should be a top priority and specifically that when a prisoner is released from prison with a known mental health condition, there should be close liaison between the prison authorities, local GPs and local health services to put a care plan in place? (903232)
My hon. Friend is absolutely right, and I pay tribute to his long interest and great expertise in this particular issue. He will probably know that local commissioning groups in England and local health boards in Wales are responsible for services in the community. NHS healthcare staff in prisons are responsible there. It is their job to make sure that services provided in the prison are followed through in the community. We go to great efforts to make sure that happens.
T7. Will the Secretary of State meet his colleague the Immigration Minister to explain that the Minister’s Bill, which would allow migrant families to be evicted without even a court order, is contrary to the rule of law and the right to a fair hearing, and must be urgently reconsidered? (903230)
I enjoy meeting both the Home Secretary and the Immigration Minister, and this Government would never do anything that was contrary to the rule of law, but we must ensure that we safeguard our borders. It is an issue of profound public concern that immigration across the European Union is not being effectively controlled. Our Home Secretary is in the lead in taking the measures necessary to keep our borders secure. I would have thought it would be in the interests of every citizen of the United Kingdom to stand behind her in that fight.
T10. Further to the question asked by my hon. Friend the Member for North Warwickshire (Craig Tracey), does my hon. Friend agree that people in this House will find it despicable that two firms and possibly more are actively seeking—soliciting, in fact—people in Iraq to make spurious and bogus claims against our servicemen overseas? Will he reject reports in newspapers that we still intend to give legal aid to these appalling claims? (903233)
My hon. Friend will have heard my earlier remarks. I am concerned about the way in which the system operates. It is important to say that there is accountability for any wrongdoing, but that does not mean giving lawyers a licence to harass our armed forces. We will look at every angle, including the point about legal aid that he made, as well as no win, no fee, and, of course, disciplinary powers against lawyers who try to abuse the system.
In 2012, the Minister’s own Department spent £1.7 million refurbishing St Helens courthouse to accommodate civil and criminal proceedings in the same building, declaring that it was efficient and logical. Are we to assume therefore that considering the closure of the same courthouse just four years later is illogical and inefficient, or would the Minister like to rule that out today?
Following the question from my hon. Friend the Member for Halesowen and Rowley Regis (James Morris), what steps are being taken to ensure that all prisoners with mental health issues are dealt with safely, appropriately and compassionately?
I am glad that my hon. Friend has raised this issue again. Whenever a prisoner comes into prison, they immediately have a full health assessment. That health practitioner has the ability to refer on to the prison’s in-reach mental health services. Furthermore, through our liaison and diversion services, we now have either learning disability or mental health nurses available at police stations and in courts, so we can start the mental health treatment right at the beginning of the journey into the criminal justice system.
I hope that the Secretary of State, who takes a keen interest in this issue, will meet me and Brake to discuss my Criminal Driving (Justice for Victims) Bill. May I gently point out that the consultation on this started on 6 May 2014 —a very long time ago, and we are not expecting to hear anything back from the right hon. Gentleman until later this year?
I am grateful to the hon. Gentleman for the persistent and effective way in which he has continued to campaign for a change in the law. We had the opportunity to meet MPs from many parties to discuss the case for change. There was widespread agreement that change was needed, but no agreement about precisely what change. We will get back to him in due course.
Given the significant rate of reoffending, would it not be better to focus on improving rehabilitation rather than simply on incarceration, especially in relation to short-term prison sentences?
My hon. Friend makes a powerful point. Few know more about what happens in our courts than he does as a result of his work as a barrister. Yes, it is important to put an emphasis on rehabilitation, but it is also important that we give all our citizens the security of knowing that those people who pose a real threat to us are incapacitated behind bars and receiving the punishment they deserve for the most heinous crimes.
Last week the Public Accounts Committee heard from the chief executive of the Infrastructure and Projects Authority. He was asked what three projects kept him awake and worried him most, and the courts programme was one of them. We can add that to the list: to the tagging and translation services fiascos, and the concern that has been expressed about the big probation and prison programmes. Does the Secretary of State fear that his Department cannot cope with all this change?
The Secretary of State made his name in the Department for Education as someone who would take on vested interests, but he has gone native in record time as Secretary of State for Justice. That includes hanging on every word that is said by the Howard League for Penal Reform—the NUT of the justice system—and reappointing Nick Hardwick. When will he get back his mojo and put the victims of crime at the heart of what he is doing? Come back Ken Clarke, all is forgiven!
I am not sure that Labour Members would agree with the suggestion that I have become a sandal-wearing, muesli-munching, vegan vaguester. I think that they would probably say that I am the same red-in-tooth-and-claw blue Tory that I have always been. It is because I am a Conservative that I believe in the rule of law as the foundation stone of our civilisation; it is because I am a Conservative that I believe that evil must be punished; but it is also because I am a Conservative, and a Christian, that I believe in redemption, and I think that the purpose of our prison system and our criminal law is to keep people safe by making people better.
On 4 November, the Prime Minister agreed to meet my constituent Tina Trowhill to discuss the baby ashes scandal. My constituent had already had a very helpful meeting with the Under-Secretary of State, and I wonder whether she will now help me to secure the meeting to which the Prime Minister agreed. May I enlist her support?
We are very clear about the fact that what happened at Emstrey—and, sadly, at other crematoriums in England and Wales—must never happen again. In December, as the hon. Lady will know, we launched a consultation which will end in March. However, I shall be more than happy to make that representation on her behalf.
Thank you, Mr Speaker. I greatly appreciate that.
The Minister will be aware of the strength of representations from Torbay about the proposal to close Torquay magistrates court. What progress is being made in the consideration of that proposal, and in the making of a decision to keep justice local in the bay?
William Mead: 111 Helpline
This tragic case concerns the death of a one-year-old boy, William Mead, on 14 December 2014 in Cornwall. While any health organisation will inevitably suffer some tragedies, the issues raised in this case have significant implications for the rest of the NHS, from which I am determined that we should learn. First, however, I want to offer my sincere condolences to the family of William Mead. I have met William’s mother, Melissa, who spoke incredibly movingly about the loss of her son. Quite simply, we let her, her family and William down in the worst possible way through serious failings in the NHS care that was offered, and I want to apologise to them, on behalf of the Government and the NHS, for what happened. I also want to thank them for their support for, and co-operation with, the investigation that has now been completed. Today NHS England published the results of that investigation—a root cause analysis of what had happened. The recommendations are far-reaching, with national implications.
The report concludes that there were four areas of missed opportunity on the part of the local health services, where a different course of action should have been taken. They include primary care and general practice appointments made by William's family, out-of-hours telephone conversations with their GP, and the NHS 111 service. Although the report concluded that they did not constitute direct serious failings on the part of the individuals involved, if different action had been taken at those points, William would probably have survived.
Across those different parts of the NHS, a major failing was that in the last six to eight weeks of William’s life, the underlying pathology, including pneumonia and chest infection, was not properly recognised and treated. The report cites potential factors such as a lack of understanding of sepsis, particularly in children; pressure on GPs to reduce antibiotic prescribing and acute hospital referrals; and, although this was not raised by the GPs involved, the report also refers to the potential pressure of workload.
There were specific recommendations in relation to NHS 111 which should be treated as a national, not a local, issue. Call advisers are trained not to deviate from their script, but the report says that they need to be trained to appreciate when there is a need to probe further, how to recognise a complex call and when to call in clinical advice earlier. It also cites limited sensitivity in the algorithms used by call-handlers to red-flag signs relating to sepsis.
The Government and NHS England accept these recommendations, which will be implemented as soon as possible. New commissioning standards issued in October 2015 require commissioners to create more functionally integrated 111 and GP out-of-hours services, and Sir Bruce Keogh’s ongoing urgent and emergency care review will simplify the way in which the public interacts with the NHS for urgent care needs.
Most of all, we must recognise that our understanding of sepsis across the NHS is totally inadequate. This condition claims around 35,000 lives every year, including those of around 1,000 children. I would like to acknowledge and thank my hon. Friend the Member for Truro and Falmouth (Sarah Newton), who—as well as being the constituency MP of the Mead family—has worked tirelessly to raise awareness of sepsis and worked closely with UK Sepsis Trust to reduce the number of avoidable deaths from sepsis. In January last year I announced a package of measures to help to improve the diagnosis of sepsis in hospitals and GP surgeries, and significant efforts are being made to improve awareness of the condition among doctors and the public, but the tragic death of William Mead reminds us there is much more to be done.
No one who watched the courageous interviews that Melissa Mead gave this morning could fail to be moved by this tragic case. I pay tribute to Melissa and her husband Paul, who have fought to know the truth about their son’s death and who are now campaigning to raise awareness and improve the care of sepsis. It is right that we should express our sorrow at what has happened, and the Health Secretary was right to apologise on behalf of the NHS. They key now is to ensure that the right lessons are learned and that action is taken. As the Secretary of State noted, the report found a catalogue of failures that contributed to William’s death, including four missed opportunities when a different course of action should have been taken. I want to press the Health Secretary on those areas.
First, the report states that William saw GPs six times in the months leading up to his death, but that none spotted the seriousness of the chest infection that cost him his life. Ministers were warned about poor sepsis care back in September 2013, when an ombudsman’s report highlighted
“shortcomings in initial assessment and delay in emergency treatment which led to missed opportunities to save lives.”
Will the Secretary of State tell us what action was taken following that report? Why was it only in December 2015, more than two years later, that NHS England finally published an action plan to support NHS staff in recognising and treating sepsis?
Secondly, the report found that the NHS 111 helpline failed to respond adequately to Melissa’s call. It concluded that if a doctor or nurse had taken her call, they would probably have seen the need for urgent action. The replacement of NHS Direct, which was predominantly a nurse-led service, with NHS 111 means the service relies on call-handlers who receive as little as six weeks’ training. So when will the Health Secretary review the training call-handlers receive, and will he consider increasing the number of clinically trained staff available to respond to calls?
The report says the computer programme that call-handlers are using did not cover some of the symptoms of sepsis, including a drop in body temperature from very high to low. Does the Health Secretary have confidence that the 111 service is fit to diagnose patients with complex, life-threatening problems who may not always fit the computer algorithm call-handlers have to rely on?
Finally, may I ask the Secretary of State what he is doing to raise awareness of the symptoms of sepsis so that treatment can begin as quickly as possible? I know this is an issue that Melissa and Paul feel particularly strongly about and we owe it to them to implement the recommendations of the NHS England report and do all we can to ensure the failures in this tragic case are never, ever repeated.
I hope I can reassure the shadow Health Secretary on all the points she raised.
First, there has been a sustained effort across the NHS since September 2013 to improve the standard of safety in the care we offer in our hospitals. An entirely new inspection system was set up that year. It has now nearly completed inspections of every hospital, and it has caused a sea change in the attitudes towards patient safety. Sepsis is one of the areas that is looked at. In particular it is incredibly important that when signs of sepsis are identified in A&E departments the right antibiotic treatment is started within 60 minutes. That is not happening everywhere, but we need to raise awareness urgently to make that happen, and that inspection regime is helping to focus minds on that.
On top of that—I will come to the issues around 111, and I agree that there are some important things that need to be addressed—a year ago I announced an important package to raise awareness of sepsis. It covers the different parts of the NHS. For example, in hospitals a big package on spotting it quickly has been followed from December 2015, with NHS England publishing the cross-system sepsis programme board report, which is looking at how to improve identification of sepsis across the care pathway.
The hon. Lady is right to raise the issue of faster identification by GPs. That is why, in January 2015, I announced that we will be developing an audit tool for GPs, because it is difficult to identify sepsis even for trained clinicians, and we need to give GPs the help and support to do that. We are also talking to Public Health England about a public awareness campaign, because it is not just clinicians in the NHS, but it is also members of the public and particularly parents of young children, who need to be aware of some of those tell-tale signs.
So a lot is happening, but the root cause of the issue is understanding by clinicians on the frontline of this horrible disease, and it does take some time to develop that greater understanding that everyone accepts we need. I can reassure the hon. Lady, however, that there is a total focus in the NHS now on reducing the number of avoidable deaths from sepsis and other causes, and that is something the NHS and everyone who works in it are totally committed to.
With respect to 111, there are some things that we can, and must, do quickly in response to this report, but there is a more fundamental change that we need in 111 as well. One thing we can do quickly is look at the algorithms used by the call-handlers to make sure they are sensitive to the red-flag signs of sepsis. That is a very important thing that needs to happen. NHS 111 has in some ways been a victim of its own success: it is taking three times more calls than were being taken by NHS Direct just three years ago—12 million calls a year as opposed to 4 million—and nearly nine of out 10 of those calls are being answered within 60 seconds.
When it comes to the identification of diseases such sepsis, we need to do better and to look urgently at the algorithm followed by the call-handlers. Fundamentally, when we look at the totality of what the Mead family suffered, we will see that there is a confusion in the public’s mind about what exactly we do when we have an urgent care need, and the NHS needs to address that. For example, if we have a child with a high temperature, we might not know whether they need Calpol or serious clinical attention.
The issue is that there are too many choices, and that we cannot always get through quickly to the help that we need. We must improve the simplicity of the system, so that when a person gets through to 111, they are not asked a barrage of questions, some of which seem quite meaningless, and they get to the point more quickly and are referred to clinical care more quickly. We must simplify the options so that people know what to do, and that is happening as part of the urgent emergency care review. It is a big priority, and this tragic case will make us accelerate that process even faster.
I join colleagues from across the House in sending deepest condolences to William’s parents. I welcome the Secretary of State’s response that he will put into action the recommendation from today’s report. May I draw out one aspect that has not been touched on so far, which is the comment in the report that out-of-hours services did not have access to William’s clinical records, and that had they been able to do so they would have seen how many times a doctor had been consulted, and that that would have been a clear red flag? Will he reassure me that that matter will be addressed across the NHS, so that all services have access to patients’ clinical records—of course with their consent?
My hon. Friend is absolutely right. There is so much in this report, but we must not let some very important recommendation slip under the carpet, and that is one of them. We have a commitment to a paperless NHS, which involves the proper sharing of electronic medical records across the system. We have also instructed clinical commissioning groups to integrate the commissioning of out-of-hours care with the commissioning of their 111 services to ensure that those are joined up. It is a big IT project, and we are making progress. Two thirds of A&E departments can now access GP medical records, but she is absolutely right to say that it is a priority.
Like others, I add my condolences to the family. It is hard to imagine anything worse for a family to face. Like many deaths in the NHS, it is always sad to look back and see that it was a catalogue of missed opportunities and errors. One thing I should like to pick up on is the fact that young children are very hard to assess. It is quite hard for a doctor to assess them when they are actually seeing them; they can be running round one minute and then keeling over half an hour later. It is particularly hard to pick up clues about their health over the phone. When NHS Direct services were started throughout the UK, they were based in local out-of-hours GP centres, which meant that the nurse could just pass the phone and say, “Can you come and chat, because I am not sure.” We had rules in our local one that if a young child was involved, they got a visit from our mobile service. Instead of such cases being put through call centres, I hope that the Secretary of State will agree in this review to have some dissemination back to a local system, so that these cases can be accelerated easily to a clinician.
I agree with the broad thrust of the hon. Lady’s remarks. Of course she speaks with the authority of an experienced clinician herself. In this case, the tragedy was that there was actually a doctor who spoke to the Mead family on the night before William died, and he did not spot the symptoms. It is not simply a question of access to a doctor, but ensuring that doctors have the training necessary. However, as she says, dealing with cases such as this can be very difficult. The doctor’s view on that occasion was that, because the child was sleeping peacefully, it was fine to leave him until morning when, tragically, it was too late. Other doctors would say that that is a mistake that could easily have been made by anyone, which is why the report is right to say that it is about not individual blame, but a better understanding of the risks of sepsis. She is right in what she says. As we are trying to join up the services that we offer to the public, it is a good principle to have one number that we dial when we need advice on a condition that is not life-threatening or a matter for a routine appointment with a GP, and 111 is an easy number to remember. However, we need to ensure that there is faster access to clinicians when that would count, and that those clinicians can see people’s medical records so that they can properly assess the situation.
As chair of the all-party group on sepsis, may I also pay tribute to the Mead family, who are now campaigning to ensure that no other child suffers in the same way as William? The Secretary of State has taken a great deal of interest in the UK Sepsis Trust and the work that it has been doing with the APPG. He will know that we are pressing for a campaign similar to the F.A.S.T campaign for strokes, as early diagnosis can save lives. Will he now consider very seriously funding such a campaign for sepsis, because there are thousands of deaths that could be prevented by a campaign that makes everyone aware of the signs of sepsis?
I am happy to undertake that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), will look urgently into whether such a campaign would be right. I can reassure my right hon. Friend that the package that we put together and announced last January did contain what most people felt was necessary, but we can always look at whether more needs to be done. I commend her for her campaigning on the issue of sepsis. On a more positive note, when the NHS has decided to tackle conditions such as MRSA and clostridium difficile, it has been very successful. In the past three years, the number of avoidable deaths from hospital-acquired harms—the four major ones—has nearly halved, so we can do this. We should be inspired by the successes that we have had to make sure that we are much, much better at tackling sepsis.
One reason why the number of calls to 111 has trebled is that people find it impossible to get to see their GP. As well as the shocking failings of this family’s GP, is it not the case that the Government were warned of the consequences of abolishing the popular and successful NHS Direct and of replacing it with a non-clinician led service? Will the Secretary of State look personally at the performance of 111 in the south-west, which has been bedevilled by failings ever since it was set up?
I gently say to the right hon. Gentleman that when 111 was set up it had the support of the Opposition. The shadow Health Secretary at the time looked at the risk register. The number of calls has increased dramatically partly because demand for NHS services has increased dramatically. That does not mean to say that there are not important things that need to be improved. We need to look honestly at what went wrong. The 111 service was one of the four areas where we should have done better. I am happy to look carefully at what is happening with 111 in the south-west. One improvement is that, in many areas, we are integrating the commissioning of 111 with the Ambulance Service, and that is something that happens in the south-west. On the whole, that has been a positive experience, but I know that there have been problems in the south-west, and I am happy to look further at them.
May I associate myself with those who have paid tribute and expressed condolences to the Mead family? Given the seriousness of this case, which we learned about today, what more can the Secretary of State do to reassure us about the clinical input and expert oversight of the NHS 111 service and its methods?
All 111 services have clinicians present at call centres, so it is about not the availability of clinicians, but the speed with which they are involved in cases where they can make a difference. It is also about the training of those clinicians so that they can recognise horrible infections such as sepsis quickly. It is a combination of things. The important thing here is that if we are to give the public confidence in a simpler system where they have a single point of contact—albeit a phone line or a website—they need to be confident that if they are not immediately speaking to someone who is clinically trained they will be put through to such a person if it is necessary. We have not earned that confidence yet, which is why it is so important that we learn lessons from what happened in this tragic case.
I was the Minister who set up NHS Direct, and one of the first cases that caused us to review the algorithms was a meningitis case. May I therefore say to the Secretary of State that just looking at the algorithms used by call-handlers will not be sufficient? It is clinically exceptionally difficult, and his review is too limited to address the problem.
I understand what the right hon. Lady is saying, and of course I would listen to her because of her experience, but I reassure her that that is not the only thing that we are doing; we are doing lots of other things. The report makes many recommendations, one of which is to look at the algorithms that the call-handlers use to make sure that they are more sensitive to some of the red-flag signs of sepsis, meningitis and other conditions. There are lots of other recommendations. They include earlier access to clinicians where appropriate, and recommendations on the training of clinicians in the out-of-hours service, the training of GPs and the training of people in hospitals. So we will be undertaking a much bigger body of work as a result of this review.
I welcome my right hon. Friend’s commitment to support CCGs to commission the 111 service and the out-of-hours service together where appropriate. He may be aware of some concerns in Norfolk about our out-of-hours service. What else is he doing to recruit, retain and support GPs in providing the round-the-clock care that people clearly need?
I have said before at this Dispatch Box that successive Governments of both parties have under-invested in general practice, and that is part of the reason why it takes too long for many people to get a GP appointment. It is why we have said that we want to have about 5,000 more doctors working in general practice by the end of this Parliament. That is an important part of what we want to do.
The other side is improving our offer to the public. When you have a child with a fever, and you are not sure, and it is the weekend, very often you have a choice between an out-of-hours GP appointment, a weekend appointment at your GP surgery, calling 111 or showing up at an A&E department. It is just confusing to know the right thing to do. If we are to improve standards of care, we need to standardise safety standards across the NHS, including for spotting potential sepsis cases, and that means a much simpler system.
My hon. Friend the Member for Lewisham East (Heidi Alexander), the shadow Secretary of State for Health, commented on the concerns expressed in the report about the quality and effectiveness of the tools at the disposal of call-handlers at the 111 service. How many other cases have been misdiagnosed by the 111 service?
We believe from the independent case note analysis that has been done across the NHS, not just for sepsis but for hospital deaths, that there are around 200 avoidable deaths every week. That is something we share with other health systems; it is not just an NHS phenomenon. It is why we are asking hospitals to publish their estimated avoidable death rates, and we are having an international summit on that next month.
We think there are about 12,000 avoidable deaths from sepsis every year, and that is as a result of a combination of different parts of the NHS—GP, hospital or the 111 system—not spotting the signs earlier. That is what we are determined to put right.
Looking across the NHS at how we ensure that learning and behaviour change, can the Secretary of State update the House on how the hospital payment system is changing to incentivise new diagnosis and better outcomes?
My hon. Friend is right to say that we are doing that for hospitals. When I talk about 200 avoidable deaths every week, that is hospital deaths, not deaths as a result of problems in the 111 service. It is much harder to quantify avoidable deaths outside hospital, but we are determined to do that, and we are going further and faster than any other country that I am aware of as part of our commitment to make the NHS the safest system anywhere in the world.
The Secretary of State said that the report was
“far-reaching, with national implications.”
I have to say that this should have been a statement, not an urgent question. The right hon. Gentleman did not answer the question about the number of misdiagnoses on the 111 system. He needs to give more detail. The report suggests that other deaths of young children may be associated with misdiagnosis by 111. How many other cases are under investigation?
No one could have done more than this Government to tackle the issue of avoidable deaths across the NHS. It is much harder to identify when a death was avoidable when it happens outside hospital. As part of our work on reducing the number of avoidable deaths in the wake of what happened at Mid Staffs, we are looking at how we could improve primary care generally. Our first priority is to reduce the number of avoidable deaths in hospital and to learn from reports such as this one when they point to improvements that need to be made in the 111 service.
I join in the condolences that have been expressed in the House. By way of tribute to Mr and Mrs Mead’s campaign to raise awareness of sepsis and its symptoms, I wonder whether each and every parent can take a small but practical step today and google the symptoms of sepsis so that we know when things are not right with our children and are better armed to tackle doctors when we are not getting the answer that we need. I did exactly that this morning after hearing Mrs Mead’s very moving interview on the radio.
I thank my hon. Friend for that important intervention. If we are going to deal with the 1,000 tragic sepsis deaths among children every year, it needs a sustained effort from all of us, not just the NHS. I will take away the action of looking at what Public Health England is doing to raise public awareness. The Minister for Public Health, my hon. Friend the Member for Battersea (Jane Ellison), will look at what health visitors can do to boost awareness of sepsis, but in the end we all have a responsibility to understand the symptoms better.
Last November, I contacted the Minister because the South East Coast Ambulance and 111 service carried out a trial that failed through poor governance, putting patients at risk. It turned out that the Department for Health heard about this only after Monitor contacted it. Is not his Department becoming reactive and simply not proactive enough to tackle these issues before they end up becoming statements and urgent questions in this House?
Not at all. I gently urge Opposition Members not to fall into the trap of trying to make political capital when tragedies such as this happen. In the wake of the Francis report on Mid Staffs, this Department has done more than any Government have ever done to improve the safety of care in the NHS. If you take the four most common harms—urinary tract infections, venous thromboembolisms, pressure ulcers and falls—the number of deaths in hospitals has fallen by 45% in the past three years. We are making sustained progress in improving the level of safety and care in the NHS, but we are never complacent, which is why are taking so seriously the report issued today.
This is a tragic case, and our thoughts today are with the Mead family. Reluctance to prescribe antibiotics due to the dangers of antimicrobial resistance played a key part in this tragedy. Does the Secretary of State agree that this is a significant global problem, and we need to commit significant investment to it?
I am grateful to my hon. Friend for raising that issue, which has not been raised so far this afternoon. He is right. We have a pressing global need—not just a UK need—to reduce the inappropriate prescribing of antibiotics. That is why training of clinicians is so important. In the case of sepsis, not only is the prescribing of antibiotics appropriate but it is essential and it is essential to do it quickly. We need to make sure that, as we train GPs to reduce their prescribing of antibiotics so that we do not develop the resistance to antibiotics that could be so disastrous for global health, they do not avoid prescribing them when they are absolutely essential.
The Health Secretary said that NHS 111 was a victim of its own success. I agree with what my right hon. Friend the Member for Exeter (Mr Bradshaw) said, which is that it is used because it is so difficult to see a doctor. On 2 January, the Hull Daily Mail reported that Hull Royal Infirmary was telling people not to come to A and E but to use services such as NHS 111. In the light of the findings of this investigation, which have national implications, does the Secretary of State agree that there should be more clinicians at NHS 111?
I do agree that we need more clinicians in primary care. We also need to invest in secondary care, which is why the hon. Lady has a new A&E centre opening in Hull, which I am sure she welcomes. We need more clinicians in primary care so that we can deal with these issues more quickly, before people need hospital care and to spot conditions such as sepsis. This Government are investing £10 billion in the NHS annually in real terms in order to step up the improvement in the services that we offer.
We will certainly look at whether we need to have more clinicians in 111. We do have clinicians available in 111. My own view is that it is the separation of the out-of-hours services and the 111 service that is at the heart of the problem that we are looking to deal with, but as part of the review we will look at the availability of clinicians in 111.
I, too, add my condolences to the Mead family. I can only imagine their anguish at having been told “not to worry” and that this was “nothing serious”. There was a catalogue of failures, not just with 111. Is consideration being given to the decision by GPs not to take William’s heart rate, as clearly should have happened? Is there in any sense a reluctance to refer young patients to the acute sector? If that is the case, advice to GPs needs to be changed.
I can reassure the hon. Gentleman that we are looking at all these things. As with the issue of the prescribing of antibiotics raised by my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake), of course we want GPs to avoid inappropriate referrals to secondary care, but it is vital that where a referral is needed, it happens. We see this not just in cases of sepsis, but in cases of cancer. It is vital that we get better at catching cancers earlier if there is to be a successful outcome to the treatment, so the hon. Gentleman is absolutely right. That will be looked at.
I commend the shadow Secretary of State on securing this urgent question. Earlier, the Secretary of State said that he felt that people had confidence in 111 because of the high call volumes, and that those had increased. I do not think that is the case. Confidence in 111 is shaky at best and this case could well shatter that confidence even further, unlike the confidence that we all felt in NHS Direct when we had young children. What is he going to do to make sure that as well as listening to the people whom he has mentioned already, he involves patients in determining what they need in 111 to give them back the confidence that we need them to have in order to avoid some of the pressure on the rest of the service?
The hon. Lady is right about the importance of involving patients when such tragedies occur, and I said in my response to the urgent question how grateful I was to the Mead family for their co-operation. One of the things the report identifies as important is earlier involvement and more listening to parents and families in such situations. I caution the hon. Lady against a blanket dismissal of the service offered by 111. There are many clinicians and call-handlers who work extremely hard and who deal with about a million calls a month, and the vast majority of those cases have satisfactory outcomes. But does that mean that there are not significant improvements that we need to make to that service? No, it does not. Of course there are things that need to be done better and we must learn the lessons from this terrible report.
My thoughts, too, are with the Mead family today. The diagnosis of conditions, including sepsis, must be carried out by those with the highest level of clinical skills. Triage by algorithms is unsafe. Can the 111 system be put back into the hands of highly trained clinicians, those trained to drill down in diagnosis, instead of non-qualified staff?
I think that is a misrepresentation of what happens with 111. There are clinicians in every 111 call centre. There are not physically enough doctors and nurses to have doctors and nurses answering every single call, and indeed the advice from the clinicians in the NHS responsible for the 111 service is that that would not be appropriate. If we are to do the triage that the hon. Lady talks about, what matters is that where a clinician needs to be involved, they are involved more quickly than happened in the current case. That is the lesson that this Government are determined to learn.
Points of Order
On a point of order, Mr Speaker. During Justice questions, I was alarmed to see the hon. Member for Cheltenham (Alex Chalk), who is in his place, dissenting from a quote I ascribed to him from the Justice Committee this morning. I now understand why: the quote was correct, but it was uttered by my right hon. Friend the Member for Delyn (Mr Hanson), not the hon. Member for Cheltenham. Having known and liked the hon. Gentleman for many years, I am anxious to correct that error, while noting that it shows his independence of thought that I could have credited him with the quote, and his magnanimity in trusting me to set the record straight.
On a point of order, Mr Speaker. I would be grateful for your advice on how we can determine the Government’s policy on a time-sensitive issue. Following the flooding in my constituency at the beginning of December, I wrote to the Prime Minister asking him to formally apply for funding from the European Union solidarity fund. Applications to this fund must be made within 12 weeks of flooding taking place. As it was time-sensitive, I also submitted a named-day written question to the Foreign and Commonwealth Office, asking if the FCO would make it its policy to apply for funding. On the last day before the House rose for Christmas, the Foreign Office replied that it would not be able to answer in time. On 20 January, however, I finally received an answer from the FCO, saying that that was not its responsibility and that the matter was one for the Department for Communities and Local Government. It took more than a month for the FCO to tell me that it was not its responsibility.
On the same day, 20 January, I received a letter from the Department for Environment, Food and Rural Affairs, saying that the Prime Minister had forwarded to it my original correspondence, but that it was not a matter for DEFRA. Why would the Prime Minister transfer my correspondence to a Department that does not have responsibility for the matter at hand? Since my original correspondence, six weeks have passed and my constituency and many parts of Cumbria are again flooding today. We are coming closer and closer to the deadline for applications to the European fund. If I was unkind, I would suggest that the behaviour of the Government appears to have been to delay my query until it was too late to apply for assistance. Can you advise me, please, how an individual Member of this House can scrutinise Government policy if the Government will not tell us what it is or if they do not have one?
I thank the hon. Gentleman for his point of order and for giving me notice of it. It appears that he has received a most unsatisfactory response from the Government to his written question and to his correspondence on a matter which is clearly of urgent interest to his constituents. Although it is for the Government to decide which Department has lead responsibility for a matter, it is clearly important to parliamentary scrutiny and to public accountability that the Government are clear and consistent on where responsibility lies. What the hon. Gentleman said will have been heard on the Treasury Bench and will, I trust, be conveyed to the relevant Ministers. If he wishes to pursue the specific matter of the unsatisfactory response to his parliamentary question, he may wish to write to the Chair of the Procedure Committee, the hon. Member for Broxbourne (Mr Walker), because his Committee monitors these important matters. I hope that that will serve the hon. Gentleman for now and be a useful guide to Members across the House.
On a point of order, Mr Speaker. This is a point of order about the rights of Back Benchers to be heard in this Chamber. You will know that some of us are very good attenders at business questions on Thursdays. Last Thursday, contributions from the Front Benches took 25 minutes. I know you are very generous and we carry on with our questions, but the predominance of all three Front Benches went on for a very long time, which squeezes the genuine Back Bencher. On the Labour Benches, we genuine Back Benchers are fighting for space all the time against the Front Benchers who are also Back Benchers part-time. Perhaps you could have a word. Also, I have never known such nasty, acrimonious jousting as there was between the two Front Benches last Thursday. It was not funny and it was not nice.
I note what the hon. Gentleman says about never having witnessed such unpleasantness in exchanges. I have never witnessed, in nearly 19 years in the House, the hon. Gentleman being squeezed by anybody; he almost invariably gets in. However, I take on board the very serious point he makes. Although I do not think that in the end Members are squeezed if they have the time to stay, because the record shows that I almost invariably let business questions run until everybody has had a chance to contribute, which was not always the practice in the past, I do accept that Members have time constraints and might have to go elsewhere to attend to other duties, including, of course, constituency and parliamentary duties. It is therefore important that they should not have to wait an excessive period of time.
My own view is similar to that of the hon. Gentleman. I think that the exchanges between the Front Benches do take too long, and they have recently started to take longer, not only on account of the involvement of the Scottish National party, which is a very legitimate and proper involvement, but because the exchanges between the Government and the official Opposition Front Benches are taking too long. Front Benchers have now been duly chided, and not just from the Chair, but, very importantly, by an hon. Member who will in May have had 37 years’ uninterrupted service in the House—namely, the hon. Gentleman. I hope that message will be duly heeded, starting this Thursday. I will have the point in mind as I hear the shadow Leader of the House and the Leader of the House. I hope that is helpful.