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House of Commons

Friday 20 November 2015

The House met at half-past Nine o’clock


[Mr Speaker in the Chair]

Compulsory Emergency First Aid Education (State-funded Secondary Schools) Bill

Second Reading

9.34 am

Teresa Pearce (Erith and Thamesmead) (Lab): I beg to move, That the Bill be now read a Second time.

I thank all the Members present for giving up their time in their constituencies. I look forward to hearing their speeches. There are other private Members’ Bills to follow mine, and I hope that we can make progress so that we can debate the second Bill on the Order Paper, which is promoted by my hon. Friend the Member for Nottingham South (Lilian Greenwood).

Being chosen by ballot to introduce a private Member’s Bill represents a fantastic opportunity, but it also brings an enormous feeling of responsibility. I wanted to make sure I chose a cause that could make a real difference, not just to my constituents in Erith and Thamesmead but to people across the country. I cannot think of a better reason for promoting a Bill than to contribute to saving lives. Making emergency first aid education compulsory in secondary schools would do exactly that.

Let us imagine a generation of children learning how to react in an emergency—knowing what to do, embracing such a responsibility and potentially making the difference between life and death. Think of the sense of pride and responsibility those children would have, knowing that they had stepped up and really made a difference to somebody. I am very glad to lead this debate today and to champion this important legislation.

What does the Bill propose? What it proposes is simple, straightforward and common sense. It would make sure that emergency first aid education is compulsory in all state-funded secondary schools. It would be the responsibility of the Secretary of State to make provision for exactly how to do that. The Bill would make sure, for the very first time, that the vast majority of children had the opportunity to learn these vital skills. The campaign has been called Every Child a Lifesaver because every child has the untapped potential to save a life.

As things stand, independent groups—swimming clubs, scout and guide troops, St John Ambulance, the British Red Cross and the British Heart Foundation—all play an amazing role in teaching life-saving skills to young people. Their work has been fantastic and has undoubtedly saved lives, but the number of children learning the skills is just not high enough. Less than a quarter of schools teach their pupils first aid. That means that the vast majority of children going through school never

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learn these vital skills. Unfortunately, the chances are that someone who attends a state-funded school will leave with a clutch of good qualifications, but without the life-saving skills to know what to do in an emergency.

Mr Christopher Chope (Christchurch) (Con): I am grateful to the hon. Lady for introducing the Bill so that we can discuss the issues. Do all schools in her constituency teach first aid, and if not, what is she doing to try to persuade them so to do?

Teresa Pearce: Very few schools in my constituency teach first aid. We have a very active local St John Ambulance and scouts and guides groups, but only children who are lucky enough to go to those groups get such a provision. I do not want a postcode lottery; I want every child to have the same chance in life to learn these skills.

Mr Nigel Evans (Ribble Valley) (Con): Does the hon. Lady agree that most youngsters going through school are learning skills for life, but that this is a case of their learning skills for life or death? If they are taught such skills at a very young age they not only will carry those skills with them throughout their lives—they could help to deal with an emergency or an accident anywhere they were—but, as in many cases of youngsters learning, will start to teach their parents and other relatives. Even that flow of information can be very valuable.

Teresa Pearce: I could not agree more. I will come on to that point later.

The shortfall in skills has a real effect in the real world. Last year’s figures show that, in London alone, paramedics attended more than 10,000 out-of-hospital cardiac arrests, but only in a quarter of those incidents did a member of the public attempt to step in and carry out cardiopulmonary resuscitation.

Mrs Sheryll Murray (South East Cornwall) (Con): The hon. Lady talks about cardiac arrests, but her Bill mentions only first aid. There is a big difference between first aid and CPR.

Teresa Pearce: The hon. Lady is exactly right; there is a big difference. CPR is part of first aid, but it is not the only thing.

Mrs Murray: When I was a doctor’s receptionist, I took a first aid course that lasted three years. I was also shown how to use the defibrillator, which was self-explanatory. The two things are completely different.

Teresa Pearce: I understand what the hon. Lady is saying, but the Bill does list the things that will come under first aid and CPR training. It includes putting people in the recovery position, defibrillation and CPR. I have taken advice from the British Red Cross, St John Ambulance and the British Heart Foundation, and I trust what they have told me.

In only a quarter of the cases of cardiac arrest I mentioned did a member of the public attempt CPR. That is not because people do not care; it is because they are worried that they do not have the right skills or that their intervention might make things worse, not better. That is not only a bad thing for the person who

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needs attention; it is bad for the bystander who might go through the rest of their life worrying about whether they could have done something to save that person’s life, especially if it was a family member.

If we want to save more lives, the number of people learning life-saving skills needs to be higher and people need to feel more confident that they can intervene in a helpful way. The Royal College of Surgeons of Edinburgh says that the Bill would massively increase the number of children who have the chance to learn life-saving skills. It believes that more lives could be saved in that way. The Resuscitation Council of the UK says that about 270 children die every year of cardiac arrest at school and that four out of five cardiac arrests happen outside hospital. It asks what better way there is to improve that situation than to teach schoolchildren the simple skills that might save a life.

We must remember that CPR can be taught in as little as 30 minutes. We are not talking about the need for extensive, complicated training. CPR can be taught straightforwardly and schoolchildren can learn it easily.

At the launch of the campaign for this private Member’s Bill, which was kindly hosted by the hon. Member for Waveney (Peter Aldous), I had the privilege to be joined by Beth Chesney-Evans. Her son, Guy, died seven years ago when his heart stopped beating while he was riding his motorbike. He was 17. Guy’s friends did not move him, for fear of causing more harm, even though he had no other physical injuries. They had not been taught first aid or CPR and could do no more than sit with him and hold his hand while they waited for the ambulance. His mother believes that he would have had the best chance of survival if one of them had known what to do. She does not blame his friends at all. In fact, she feels bad about how difficult it has been for them to cope with the trauma of losing their friend and feeling so helpless.

When Beth talked at the launch, it resonated deeply with me, because it was hearing stories such as hers that convinced me of the need to make sure that the next generation of children grows up with the skills to help in emergencies. We have to act today to start a process that will transform passive bystanders into active potential life savers. The Bill does not expect the impossible to become possible. All of us in the Chamber know that not everyone can survive a serious accident or medical emergency and that not every intervention is successful. However, we can give people the absolute best chance of surviving by equipping people with the skills needed to keep them alive until the paramedics turn up.

The statistics on survival rates are telling. When someone has a cardiac arrest, every minute without CPR and defibrillation reduces the chance of survival by 10%. Every minute counts. Surely, therefore, we have to ensure that people nearby take action straight away to help keep people alive. That means increasing the number of people who know what to do in such an emergency. When CPR can be taught in as little as half an hour, do we have any excuse not to teach it to as many children as possible?

Will Quince (Colchester) (Con): Countries such as Norway teach CPR routinely. How many lives does the hon. Lady estimate could be saved on an annual basis if we did the same?

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Teresa Pearce: The hon. Gentleman must have read my speech, because it mentions Norway in the next sentence. I do not know the exact number of lives that could be saved, but 95% of Norway’s population is trained in first aid and in Germany the figure is 80%. Their survival rates are much higher. Unfortunately, in this country, only 5% to 10% of people have the same training.

When I chose emergency first aid education as the topic of my private Member’s Bill, I knew that any proposal for a new law would have to be realistic, so I listened to all the objections that had been made when other people had raised the issue. I also listened to teachers and tried to respect the extensive demands on their time by allowing schools flexibility in how they make provision. I believe that my proposals meet those requirements. My daughter is a teacher, and through speaking to her I understand the pressures that many teachers feel they are under. If this Bill made things harder for teachers, I would not be promoting it. The Bill allows real flexibility for schools in how they teach emergency first aid.

Caroline Nokes (Romsey and Southampton North) (Con): I congratulate the hon. Lady on promoting this Bill. The Mountbatten school in Romsey in my constituency held a mass CPR lesson, with more than 100 pupils in the school hall learning CPR together. Does the hon. Lady agree that it is important to have flexibility, so that schools are given freedom to decide how they deliver first aid education? Lessons for very large groups can be successful.

Teresa Pearce: I agree with the hon. Lady, and that is why the Bill gives flexibility to schools regarding how and where first aid is taught. Some schools have suggested that it could be done during PE lessons or as part of personal, social health and economic education. Some have suggested teaching first aid during assemblies, or jointly with other schools. Some will use first aid-trained teachers, and others want to use external providers or online resources. It is up to head teachers and governors to decide how it is delivered.

Mr David Nuttall (Bury North) (Con): What the hon. Lady says seems slightly to contradict what might be inferred from the words that she seeks to insert into the Education Act 2002, which state:

“For the purposes of this Part, EFAE shall comprise formal lessons to equip pupils with age-appropriate skills”.

That does not quite tally with the impression that she seeks to give the House.

Teresa Pearce: “Formal lessons” means within a school setting. Informal lessons are when people are taught at home, for example. In this case there is no testing and none of the things that one would imagine would be part of formal lessons. However, if the hon. Gentleman is concerned about this issue, and if the Bill goes into Committee, I would be happy to suggest that he serves on it, and if he wished to table an amendment I would be more than happy to work with him on that.

Skills can be taught quickly and easily so as not to overburden schools. Importantly, no assessment or attainment targets will be set, and it will be up to headteachers and governors to determine how lessons

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will be delivered. I am happy that the Parent-Teacher Association is backing the Bill, as that indicates the range and depth of support for these proposals. It is also a measure of support from those who matter most, because 95% of parents and 84% of secondary school teachers agree that such skills should be taught as part of the school curriculum.

Beyond the process of learning these skills, the Bill could have other benefits. The International Red Cross believes that

“First aid is not just about techniques. It is an act of humanity”

and therefore a key responsibility of citizenship. Teaching these skills will also help to create the next generation of good, caring citizens—it will teach character. The Red Cross is surely right about that. Empowering young people with the ability to act and potentially save a life can transform how they feel about themselves and improve their self-esteem. It could also encourage more people to become paramedics and explore the possibility of careers that they would not have otherwise considered. I want the Bill to contribute to an increase in the uptake of such careers.

Philip Davies (Shipley) (Con): Given that in the hon. Lady’s view first aid education is such an obvious thing to do, and given that it will cause no disruption or hassle at all to school life, and that it will make such a big difference to so many people’s lives, why are schools in her constituency not already teaching first aid when they are perfectly free to do so?

Teresa Pearce: I am afraid I cannot answer for every school in my constituency any more than I can answer for every school in the hon. Gentleman’s constituency. I say only that teachers, parents and children want this Bill, so why should we as parliamentarians not provide it?

Clive Efford (Eltham) (Lab): Is the answer to the question from the hon. Member for Shipley (Philip Davies) that MPs do not run schools or decide policy within them? For example, I suspect that not every school in his constituency is campaigning to come out of Europe. Does that mean that he is failing in some way as an MP?

Philip Davies: I would not be so sure!

Teresa Pearce: I thank my hon. Friend for his intervention. The Bill is consistent with other ideas that the Government have been happy to support in the past. Earlier this year the coalition Government passed the Social Action, Responsibility and Heroism Act 2015, which attempted to redraw the relationship between bystanders and people suffering from medical emergencies. Bystanders should not be intimidated by emergencies. They should not fear the consequences if they intervene sincerely, but do not manage to save a life. My Bill mutually supports that Act. It makes it more likely that bystanders will have the confidence to take action based on the teaching they will have received at school.

Stopping emergency situations from becoming worse could save the NHS money on later treatment. Providing emergency first aid skills might instil in the next generation a more responsible, confident approach to their own medical issues and perhaps reduce the current tendency

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to attend A & E for all sorts of minor problems that could be dealt with at home or by a GP. The Royal College of Nursing, with its membership of 430,000, is the voice of nursing across the UK. It supports the Bill, arguing that increasing first aid knowledge and skills in future generations will save lives and equip children with skills and confidence—skills they will carry through their lives.

Rachael Maskell (York Central) (Lab/Co-op): I thank my hon. Friend for bringing forward the Bill which, it is estimated, would save about 5,000 lives a year. It should surely proceed on that basis alone. Will the Bill not also encourage workplaces to introduce first aid training, which will save even more lives?

Teresa Pearce: I agree. Schools are workplaces, too. If children are trained in first aid, who knows what could happen in a school. They could step forward and maybe even save their teacher.

The Bill has attracted cross-party support from colleagues. I see hon. Members from all parties sitting in the Chamber this morning. I thank them for their support, some of which has been immense. I am truly grateful. I look forward to hearing contributions from their own perspective. I know there is a deep well of support for the principles underpinning the Bill.

In the course of the campaign so far, I have received incredibly generous and useful support from a range of people and organisations. I would like to emphasise my thanks to the British Red Cross, the British Heart Foundation and St John Ambulance. I place on record my true gratitude to my staff, who have been living and breathing this for the past month. I would also like to pay tribute to, and acknowledge the efforts of, Julie Hilling, the former Member for Bolton West. She no longer sits in this place, but she pursued the same aim with integrity and verve. She passed me the baton. Today, I hope we move another step nearer to the finishing line.

Wes Streeting (Ilford North) (Lab): I am really grateful to my hon. Friend for giving way and for bringing forward the Bill, which has widespread support in my constituency. What can she do to reassure my constituents that her vital Bill will not be talked out by some of the troublemakers on the Government Benches, as other Bills that they support have been on recent Fridays?

Teresa Pearce: I have faith in the goodness of this Chamber. I believe Members will do what is best for their constituents. I am very hopeful for my Bill.

I know many Members care very deeply about making sure every child has access to first aid education. No one here wants to think of their own son or daughter, or any loved one, facing an emergency situation and having no idea what to do to help. I want to make sure that does not happen to anyone. I want to make sure that we create a generation of caring responsible young people who take the initiative and always act to help where they can. I want to save the NHS money and encourage new paramedics, and I want to scrap the unfair postcode lottery in the teaching of skills.

People say a lot about private Members’ Bills and they say a lot about politics, not all of which is positive, but today we have an opportunity, no matter which

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party we belong to and no matter where we come from, to do something that can only have a positive impact on the society we represent. Parliament at its best puts party politics aside, acts in the interest of the public and reflects the will of the people. Some 95% of parents back the Bill. I would like to think that in future those of us here today can look back on what we did and be proud, as we see a generation of life savers step out and step up to help friends and strangers in a great time of need.

9.54 am

Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con): I have remained in Westminster today, rather than heading back to my constituency, to support the Bill promoted by the hon. Member for Erith and Thamesmead (Teresa Pearce). I believe that it has the potential to have a genuinely positive impact by ensuring all secondary schools in England provide young people with the opportunity to learn emergency first aid skills, and to gain the confidence to know what to do in an emergency. Ultimately, it can help to save lives.

The case for teaching first aid to all young people is unassailable. Every year in the UK, tens of thousands of medical emergencies result in death, injury and disability. Less than one in 10 people survive an out-of-hospital cardiac arrest, whereas in countries where CPR is taught in school, that survival rate is more than double. We are talking about real people’s lives being saved thanks to education and a population with the confidence to act and intervene in a crisis. It is rare in Parliament that an MP has the opportunity to vote on a crucial issue that could touch the lives of any or all of us. The Bill is not about burdening young people with the pressure to deliver first aid, but by imparting such knowledge through our schools, it has the power to kick-start a culture change among future generations. It could empower all of us to become more confident and better able to step in to help someone when they need it.

Mrs Sheryll Murray: I think all Members agree it is good to teach first aid in schools, but where would it fit into the curriculum? Would something be dropped? Who would pay for it? Has my hon. Friend thought about that? It is the compulsory element that concerns me.

Mrs Trevelyan: I see the education coming from local groups, such as St John Ambulance, supporting local schools through their own fundraising.

I was taught first aid as a girl guide, and I have had cause three times in my life—twice at the scene of a car crash—to help to save lives by applying basic but vital principles to injured people.

Valerie Vaz (Walsall South) (Lab): First aid could be taught as part of personal, social, health and economic education, but does the hon. Lady agree that, given the events of 7/7 and 13/11, it is now more important than ever to make sure the whole country knows how to cope in an emergency and can do its civic duty to save lives?

Mrs Trevelyan: I agree absolutely. My knowledge of first aid, which I was taught when I was 12, has stuck with and empowered me throughout my life, and I have

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had need to use it. My first aid education helped me and my fellow girl guides to prepare for life by developing our character and resilience to take on unexpected emergencies with a strength of purpose and enough knowledge to help others, but there are also broader health considerations and areas in which greater first aid knowledge could be of benefit. We all know that our accident and emergency departments are under increasing pressure to treat people.

Will Quince: We often talk about the cost of doing something, but we rarely talk about the cost of not doing something. Does my hon. Friend agree that there might be considerable savings to the NHS by taking this preventive measure?

Mrs Trevelyan: I absolutely agree: our A & E departments are under enormous pressure. Although the Bill is not a panacea, evidence suggests that greater knowledge of first aid can help to reduce the number of unnecessary visits to A & E and reduce the pressure on our paramedics.

Empowering people with quick and simple skills and the basic medical understanding to save lives is so profoundly important that it deserves a place in the school day. Some schools already do an excellent job of teaching these essential life skills, with the support of charities such as St John Ambulance, for instance. The Government have already mandated that all schools must provide swimming instruction, either in key stage 1 or key stage 2, to ensure that every pupil can swim competently, confidently and proficiently, and perform safe self-rescue in different water-based situations. This Department for Education rule is for the purpose of saving lives. How much more of that goal might be achieved over the life of every child taught basic life-saving skills such as CPR, how to stem the flow of blood from a wound and how the recovery position can stop someone choking to death?

In my constituency, the St John Ambulance cadets in Alnwick learn first aid in their weekly meetings, and then go into their local schools, where invited, to share their knowledge. It is a wonderful example of teamwork and local knowledge sharing among peer groups that is helping children in my constituency to become life savers. However, despite widespread support for the idea of first aid education, only one in four secondary schools are taking it on. It is a very limited spread of life-saving skills.

The Bill is not about imposing even more targets on schools and teachers. Schools and headteachers would have the flexibility to decide when and how to impart these core skills—whether in morning assemblies, as my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) suggested, or as part of PHSE, physical education or biology. There are any number of places where this could be brought into the curriculum. It will not require teachers to have any prior medical knowledge, and neither will it take up a huge degree of the school timetable. As has been said, CPR can be taught in as little as 30 minutes—a small investment in a child’s school year for a huge reward, not just for the children and their families, but for the whole community as they grow up and become resilient members of our country.

These skills are quick and easy to teach and learn. The British Heart Foundation, the British Red Cross, St John Ambulance, for which I do a lot of work, and

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other organisations provide free resources for schools, so there is no cost implication for schools attached to this excellent Bill. There is cross-party backing for it, and I know many colleagues will, like me, have been inundated with messages of support from constituents.

Mr Nuttall: Is my hon. Friend suggesting that a 30-minute lesson will be all that is required to meet the imposition of the Bill?

Mrs Trevelyan: I think 30 minutes, where presently children are given no indication that life-saving skills can be understood, would be valuable. It is the confidence in the child that is important—confidence that they can be part of a life-saving situation. It could be an annual subject, but there are any number of ways to achieve this. The St John Ambulance programme is broad and flexible for when it goes into schools to support children better to understand what life-saving skills can mean and how they can carry them out when faced with a challenge.

I do not believe that this is a controversial issue and it should not be viewed as political; it will touch each and every one of us. I therefore urge all my fellow MPs to join me in support of the Bill to give every child the opportunity to be a life saver.

10.1 am

Alex Cunningham (Stockton North) (Lab): I congratulate my hon. Friend the Member for Erith and Thamesmead (Teresa Pearce) on securing the time for this debate. I would like to make a relatively brief contribution in support of the Bill.

I was a personal first aider, and I believe I still carry some of the skills with me today. I joined St John Ambulance—not for first aid skills, but because we used to go to the motor racing every other week! I remember now how important acquiring those skills was, and I have carried them through my life. Media stories down the years have shown how young people have saved lives just by having a little bit of knowledge. We know that boy scouts, girl guides, Boys’ Brigade members and all manner of young people have, with training, been able to accomplish that. So we could be saving so many more lives if we gave more young people the necessary skills.

In February 2015, a report on PSHE and sex and relationships education by the Education Committee, of which I was a member, recommended that PSHE should be made a statutory subject, but that schools should retain a little flexibility over what is taught as part of it. With a little encouragement, first aid training and CPR could be included. This Bill does exactly that. It provides for emergency first aid education to be a compulsory part of the national curriculum at key stages 3 and 4. It also provides for academies, which do not have to follow the national curriculum, to be required to teach EFAE at those key stages. To impart those skills, it does not take half an hour a week for three years; it takes an hour a week for about three or four weeks.

We have already heard that current survival rates from out-of-hospital cardiac arrests in the UK are extremely low.

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Mrs Sheryll Murray: Does the hon. Gentleman agree—he has mentioned his St John Ambulance background—that work towards first aid certificates lasts for three years, as does CPR training, and that things change within three years? Is he suggesting that schools continue to renew these certificates?

Alex Cunningham: I most certainly am. I believe that all young people should have updated training as they grow up—as should we all. Would it not be a great thing if we Members of Parliament led the way and did our first aid certificates? Perhaps, Mr Speaker, you could arrange through the House for some form of training to be imparted to MPs so that we can lead by example in our constituencies.

Of the 30,000 people who have out-of-hospital cardiac arrests in the UK each year, fewer than one in 10 survive. In countries such as Norway, where CPR is taught in all schools, survival rates are up to three times higher. That is why I support the Bill, and why I have championed the British Heart Foundation’s campaigns to make CPR training available in schools, workplaces and community groups, including the call push rescue kit mission and European Restart a Heart day on 16 October 2015. St Michael’s Catholic academy, Northfield school and sports college, and Red House school in my constituency have all acquired a CPR kit award. I want to see those skills used and I want to encourage other schools to follow their example.

There are tens of thousands of medical emergencies every year in the United Kingdom, resulting in deaths, injuries and disabilities. For instance, 250,000 people suffer burn injuries of varying severity each year, and 175,000 of them attend emergency departments. Too many of us, however, do not know how to help someone who is having a cardiac arrest, choking, bleeding, or having an asthma attack or seizure. In the case of cardiac arrest, about 75% of people would not feel confident about performing CPR. Bystander CPR doubles survival rates, but is attempted in only 20% to 30% of cases. Lack of knowledge, fear of causing harm and failure to recognise cardiac arrest are all factors.

The Bill will give young people the skills and confidence to know what to do. It could help a young person to save a life. Giving young people the opportunity to learn simple first aid skills need not impose a burden on the school day, as the skills are quick and easy to teach and learn. As we have heard, the British Heart Foundation estimates that ensuring that all school leavers are trained in CPR could save 5,000 lives every year. The foundation has campaigned tirelessly to improve survival rates, and is aiming to create a nation of life savers to ensure that every young person leaves secondary school knowing how to perform CPR. We should stand by the British Heart Foundation, and stand by our young people. We should support this Bill.

10.6 am

Dr Tania Mathias (Twickenham) (Con): I congratulate the hon. Member for Erith and Thamesmead (Teresa Pearce) on the Bill. It is an important measure, and I support it, but I believe that it could go much further.

My interest in this subject stems from something that happened to me when I was a junior doctor working abroad. A gentleman was unconscious and not breathing,

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and was surrounded by hundreds of people. A great crowd had built around him, but it became apparent that nothing was being done. Despite my—at the time—limited knowledge of the language of the country, I managed to get through the crowd and start the resuscitation procedure. Members of the crowd acquired a pick-up truck, and the gentleman was transferred to some hospital. I still do not know where the hospital was, or the gentleman’s name. He did not survive, but I believe that he could be alive today if someone in the crowd who had been standing close to him when he collapsed had known how to perform basic CPR.

Like my hon. Friend the Member for South East Cornwall (Mrs Murray), I am focusing on CPR rather than on first aid in general. I believe that schools should have the freedom to decide what is on the curriculum, but I make an exception for CPR. I have been doing some basic research in my constituency, because it surprised me to learn that only one in four schools provided first aid or CPR education. I am heartened by the fact that most of the schools in Twickenham that have responded to my inquiries already provide CPR education for their students: that is terrific. Well done Waldegrave and Lady Eleanor Holles! I am bigging up the girls, because my hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan) was a girl guide—just saying. However, other schools such as Teddington school provide CPR education, and I applaud the sea and air cadets in Twickenham, who are also learning how to carry out the procedure. I am strongly in favour of the Duke of Edinburgh awards; the bronze award involves first aid including CPR, which is absolutely brilliant.

I am very fortunate in Twickenham. However, as I have said, I think that the Bill should go further, because I think that first aid education is needed in the community per se.

Mrs Sheryll Murray: I acknowledge that my hon. Friend is probably far more experienced and qualified to speak about this subject than I am—although I was a doctor’s receptionist for 21 years—but does she think that the quality of provision might be reduced if it were made compulsory? Rather than what people doing what they need and want to do, they might be thinking, “We have to learn this”, while not actually paying any attention.

Dr Mathias: My hon. Friend makes a good point. I share her concerns, but I was converted when the British Heart Foundation visited the Commons and I saw its kit, which I have told all my schools is offered free—I thank St Richard Reynolds school, because it is taking that up. I was very impressed that the kit includes a DVD; a specialist trainer is not needed. The BHF showed us the models, including Resusci Annie. In half an hour, I was convinced—the BHF let me test the kit—that in that time one can teach good CPR that will be useful for a good samaritan or a passer-by. I share my hon. Friend’s concern, but I am convinced by the BHF campaign.

I want this to go further, however. In Twickenham, I am concerned not so much about the children, but about our community. I have said before in the House that someone should have CPR training if they get a

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driving licence. Also, every business that has a health and safety expert should arrange for the 30-minute training that the BHF provides.

I will purchase one of those kits and offer it free to businesses in Twickenham to see whether we can roll this out. I also believe that the national citizen service could include first aid in its programmes, because it is a brilliant scheme. Everywhere there is a defibrillator—and there are a few in the community—every business and institution within 100 metres should be given the opportunity to learn how to use it. Wherever there is a defibrillator inside a sports hall, it should be available—behind protected glass or whatever—when the hall is closed.

My concern is for CPR to be rolled out in all our communities. Yes, make it compulsory in schools, but we have to go beyond that. I commend the Bill.

10.12 am

Julie Cooper (Burnley) (Lab): I pay tribute to my hon. Friend the Member for Erith and Thamesmead (Teresa Pearce) for introducing this important Bill, which, if passed, will save the lives of many. I also pay tribute to the British Heart Foundation, which has campaigned tirelessly on the need for young people to be educated in emergency first aid in school and which undertakes great work every day to educate the public in how to lead a healthier and ultimately longer life.

The statistics speak for themselves. Every year, an estimated 60,000 out-of-hospital cardiac arrests occur. Ambulance staff reach 30,000 out of 60,000 people—only 50%. Anyone who knows anything about cardiac arrest knows that time is of the essence. With each passing minute, the chances of survival decrease by 10%. Current survival rates outside the hospital remain extremely poor, with The BMJ estimating that the rates vary between 2% and 12%. The vast majority of cardiac arrests happen in homes and in front of loved ones, so it is imperative that someone in the household knows CPR, particularly at a time when cuts mean that ambulance response times are on the rise.

In 2014, the number of red 1 emergency responses within eight minutes by the North West ambulance service dropped by 3.5%, and the number of red 2 emergency responses within eight minutes dropped by 5%. Some people simply cannot wait for an ambulance. Knowledge of CPR will be the difference between life and death. That is why I, and many of my constituents, wholeheartedly support making emergency first aid training part of the national curriculum. A recent British Heart Foundation poll found that 83% of people in Lancashire believe that children should leave school with this life-saving skill.

There are countless examples of the correlation between countries that have CPR as part of the national curriculum and rising survival rates in relation to out-of-hospital cardiac arrests. Norway is an example that has already been mentioned in the debate, and another is the city of Seattle in America. Seattle has one of the highest survival rates, which is attributed to its 30-year history of teaching CPR in physical education lessons in school. CPR can be taught in a short time and without teachers needing extensive medical knowledge. This time could be the difference between a student saving their mum’s, dad’s, best friend’s or even a stranger’s life and feeling powerless to act.

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Philip Davies: I understand that the hon. Lady is a former teacher. Why therefore does she not trust teachers to make these decisions and provide the first aid training in schools themselves, without the need for the Government to force them into it? Why cannot teachers be trusted to make these decisions for themselves?

Julie Cooper: As has been mentioned, there is patchwork provision across schools. I, as a teacher, think this is a good thing, as do the majority of teachers, but it is too important to leave to chance. Being able to save a life is as important as making sure every child can swim.

Wes Streeting: Which of these does my hon. Friend think would be more useful: compulsory first aid training that would save thousands of lives or introducing amorphous British values into the national curriculum with very little definition?

Julie Cooper: That needs no answer; it is absolutely clear. The provisions in this Bill will be a very important addition to the national curriculum, saving many lives. This training would no doubt feed into the ability of bystanders to use CPR in public settings outside of the home—this is a long-term investment for the country.

Our country’s bystander CPR rates are some of the lowest in Europe, with many Britons unable to diagnose cardiac arrest or other heart conditions. I believe that by making CPR and the use of defibrillators a key part of our national curriculum, we will create a whole generation ready to intervene and save the life of a stranger, joining Sweden and the Netherlands, which have some of the highest bystander CPR rates in Europe.

Mrs Sheryll Murray: Will the hon. Lady congratulate this Government on rolling out a programme to make defibrillators available in communities and in schools?

Julie Cooper: I am delighted to see the widespread and increased use of defibrillators around the country, and I would congratulate any Government who make that provision. That is the right thing to do, and we should do the right thing. I therefore hope the House will do the right thing today.

I have noticed that every London underground station now has a defibrillator. While I welcome that, I would like to see more in public spaces, including in my constituency of Burnley. I am sure that we can all agree on the sentiment that training students in CPR and emergency first aid is just the beginning when it comes to saving a life in a public space, but there needs to be a readily available defibrillator.

I will be supporting this Bill today, and I encourage all those assembled in this Chamber to do the same. How to save a life is, after all, the greatest lesson we can teach our children, and I hope that our schools will be required under the curriculum to teach that skill.

10.17 am

Michelle Donelan (Chippenham) (Con): May I also commend the hon. Member for Erith and Thamesmead (Teresa Pearce) for introducing this Bill?

Today’s debate is not really about whether we should overload the curriculum; it is about what the true objective of our education system is. What is the purpose of the

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curriculum in the first place? I urge Members to sit back and think about what that objective might be. Is it to produce meaningless statistics and grades, or to produce the citizens of tomorrow, to safeguard our children and give them the best shot at life? Every year, 150,000 people die when first aid could have made a difference and saved them.

The national curriculum officially creates a minimum expectation for the content of school curriculums. Are we really saying that ensuring that our young people have the confidence and skills to save lives is not a minimum expectation? More than 30,000 people have a cardiac arrest outside of hospital every year in the UK, but fewer than one in 10 survive. We have heard that lifesaving skills can be taught in personal, social, health and economic education; however, as we all know, PSHE is not compulsory. We also hear that schools should have the freedom to choose to teach it, yet only approximately 24% schools exercise that freedom. Are we really happy to send a message that saving lives is less important than maths, music, art or history? Seriously, what are we coming to—not as MPs but as people?

I welcome the current assistance from the Department for Education to help schools to buy defibrillators. As of last week, 787 schools had purchased one under the scheme, and it is my aim to ensure that every school in my constituency has one by the next election.

Mrs Sheryll Murray: Having seen a portable defibrillator, I know that they are very explicit and that they also allow an electrocardiogram to be carried out before CPR. Does my hon. Friend acknowledge that people can do a lot of harm by trying to administer CPR when it is not needed?

Michelle Donelan: I thank my hon. Friend for her intervention. Defibrillators are extremely easy to use. The problem that we have in this country is a lack of confidence surrounding their use, which is what the Bill is trying to correct.

I was delighted that, in this year’s Budget, £1 million was dedicated to buying defibrillators for use in public spaces and schools and for training, but what is the point of doing that if people do not have the confidence to use them? Recent surveys show that the primary reason that people are deterred from intervening in any first aid situation is a lack of confidence and knowledge. We also need to stop ignoring the industry experts. St John Ambulance, the British Red Cross and the British Heart Foundation have all campaigned for this change in the law for a number of years. Let us also consider the practicalities. As we have heard, this training would take up a very small amount of time in the school curriculum.

Craig Whittaker (Calder Valley) (Con): The hon. Member for Stockton North (Alex Cunningham) referred earlier to the report on PHSE that the Education Committee produced earlier this year. He did not mention, however, that the report stopped short of recommending an extension of the school day to accommodate putting this extra training on a statutory footing. Does my hon. Friend agree with the idea of extending the school day in order to make this vital addition to the curriculum?

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Michelle Donelan: I think we are straying off the topic of the Bill. We really would not need to extend the school day to fit this training in. As we have heard, it will take a very small amount of time each year.

I have already stated that this ability to save lives is as crucial as maths, English and science. Free packs are available from the British Heart Foundation, which would help to reduce costs. Many organisations in the charity sector have already promised to help to put this course in place. So this really is necessary, achievable and cost-effective. It is also the moral thing to do. There is no point in trying to enrich the lives of our young people through the education system unless we are also helping to prolong and save them too.

To be honest, the statistics speak for themselves. As I have said, 30,000 people have an out-of-hospital cardiac arrest each year, but only one in 10 survives. If more people knew how to do CPR or use a defibrillator, survival rates could increase to 50%. The survival rate in the UK is poor and highly variable, but today we have an opportunity to make a real difference. First aid is a true life skill, and the Bill aims to make every child a life saver. Ensuring that life-saving skills are taught in schools would instil in children how valuable life is and how important it is to be a good citizen. We must consider the wider ramifications of the Bill and its value for society.

All surveys indicate huge support from parents and young people, with some showing that up to 95% of parents support this training in secondary schools. Coupled with a host of case studies from around the world, this provides a strong argument for the Bill. Indeed, we are very much lagging behind other countries in this regard. In the USA, 36 states have passed legislation to ensure that youngsters learn emergency skills. It is also on the curriculum in France, Denmark and Norway, where survival rates have also increased.

I want all Members to think long and hard today about what our education system is really for. If they believe it is about creating citizens and building a strong society for tomorrow, they must support the Bill. Our voters have placed their trust in us as their representatives and we have a moral duty to ensure that every person is given the best shot at life, but investing in equipment is no good unless people have the confidence to use it. To conclude, I echo the words of Dr Andy Lockey of the Resuscitation Council when he said that teaching emergency life support skills in schools and in the community is

“a no brainer, it’s just common sense”.

10.24 am

Rachael Maskell (York Central) (Lab/Co-op): May I start by congratulating my hon. Friend the Member for Erith and Thamesmead (Teresa Pearce) on promoting this Bill, which will save so many lives? I am going to keep my comments brief because I am keen for it to have the opportunity to proceed.

I was walking down the street one day when I saw a crowd of people. As most of us would be, I was curious, but I walked by, not knowing why they were gathered. Something drew me back into that crowd and, as I looked beyond, I saw a woman lying on the ground. There were 40 to 50 people in that crowd, with two people attending to the woman, tidying her skirt and

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arranging her legs. The thing they did not do was check whether or not she was breathing—she was not; her heart had stopped. Not one person knew what to do. Nobody had called an ambulance—they did not even have the confidence to do that. I gave that instruction and then started CPR.

Mrs Sheryll Murray: The hon. Lady has administered CPR, as have I. I administered it, along with my late husband, to a next-door neighbour. Keeping the CPR going until an ambulance arrives is a really tough thing. Does she think an 11-year-old would be physically able to do that?

Rachael Maskell: I thank the hon. Lady for her comments. I would just like to finish my story and then I will answer her point. I administered CPR and had to keep going for some time before an ambulance was able to get to the scene and its crew were able to step in and take over. We are talking about changing a nation by giving it the confidence to administer CPR, so other people will be able to assist in that process.

Dr Mathias: When I asked the British Heart Foundation at what age it felt CPR could be taught, its answer was from the age of 10, although it does depend on the strength of the child. It thinks that every 11-year-old could do it. Part of the training is about swapping round if there are other good samaritans who know CPR, in order to maintain that physicality. Does the hon. Lady agree?

Rachael Maskell: I thank the hon. Lady for her intervention —clearly we know what we are talking about, and I totally agree with what she has just highlighted.

The reality of that or any other situation is that if people have the skills, they can administer them. The Bill is not just about CPR; it is also about dealing with bleeding or choking, situations we may come across at any point. As one of those bystanders, you would feel totally helpless, knowing that you could have saved the neighbour, the friend or the relative—we might even be talking about someone saving you. That is why I urge hon. Members to allow this Bill to go forward.

Philip Davies: In a previous speech in Parliament, the hon. Lady talked about how teachers must also have more of a say. She said:

“They cannot be told how important their professionalism is in one breath and then not be trusted to make the best decisions for children in the next.”—[Official Report, 22 June 2015; Vol. 597, c. 678.]

How does her support for a compulsory measure, whether teachers like it or not, fit in with what she said previously about how we should trust them as professionals?

Rachael Maskell: I thank the hon. Gentleman for making that point, because I can tell him that 84% of secondary teachers support the Bill. Clearly, teachers want these provisions to be brought in, so this is in line with my previous statements in the House.

Whatever the medical condition, we know that it is only the start of a journey for a patient, who then will go on to use wider NHS services. Having worked in intensive care for 20 years, I know the cost of that time

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delay; individuals could have hypoxic brain injury or other such conditions as a result, which would place real strain on not only the services, but the family and the life of the individual. For that reason, it is vital to ensure that the Bill has a safe passage to its next stage.

As I have said, I will keep my comments brief. What we are seeing today is the start of a journey towards us being a nation of life savers, which is what I hope the Bill will achieve in time. I urge the Minister to allow this Bill to continue to the Committee stage.

10.29 am

Peter Aldous (Waveney) (Con): I congratulate the hon. Member for Erith and Thamesmead (Teresa Pearce) on the enthusiasm and determination with which she has promoted this Bill. I speak as chairman of the all-party group on first aid, which has received cross-party support in promoting this Bill. As we have heard, the Bill is supported by St John Ambulance, the Red Cross, the British Heart Foundation and the Royal College of Nursing.

This is a short and straightforward Bill, which, if passed, will have far-reaching benefits for individuals, families and society as a whole. I will briefly outline the reasons why the Bill should be supported. First, it will save lives. At the APPG meeting on 16 September, I met Samantha Hobbs and her parents. When she was 14, Samantha saved her mother’s life. She said:

“It is horrible to think what could have happened if I had not known CPR.”

In those countries where CPR is taught in schools, survival rates are more than double those of the UK. If we could match our survival rates with those of Norway we could save 5,000 lives each year.

Mr Nuttall: Samantha Hobbs is the very brave young lady who was mentioned in a standard letter that was sent to me—to be fair, it is the same letter that I received from several constituents. Having met this very courageous young lady, can my hon. Friend explain where she learned her skills?

Peter Aldous: I do not have the precise answer to that. From what I understand, it was through her membership of St John Ambulance. I would not want to be quoted on that, but that is my understanding.

As well as having obvious benefits for the recipients of first aid, acquiring such skills can change the lives of young people. It can build confidence, unleash hidden talents and skills, and it can set people on a path that might lead to a career as a paramedic.

Secondly, for young people, knowing how to look after those around them can play a huge part in achieving independence and helping them when they move away from home. For young people who may be vulnerable, who may live in deprivation or who may be at risk of exclusion, acquiring such skills can be a real benefit and a positive life-changing experience.

Thirdly, ensuring that young people acquire such skills can have significant benefits for society as a whole. It encourages people to get involved in their communities, brings those communities together and builds social capital.

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Mr Chope: My hon. Friend talks about ensuring that young people acquire such skills, but the Bill does not do that. It says that the skills can be taught, but there is no system of testing, assessing or judging attainment.

Peter Aldous: We can get a little bit too obsessed with continuous testing. Having been on one such course—in the previous Parliament, the APPG did organise such a course—I can say that it is far better to acquire the skills at a young age. It was slightly comical to watch some of us attempting to carry out these skills, but if we can acquire the knowledge at a young age, it will remain with us forever.

Mrs Sheryll Murray rose

Dr Mathias rose

Peter Aldous: I will give way to my hon. Friend the Member for South East Cornwall (Mrs Murray) first.

Mrs Murray: My hon. Friend might like to know that, over the 21 years that I worked at Cawsand surgery, I did CPR training every three years. The advice changed over that period, which is why people need to update their certification every three years.

Peter Aldous: I thank my hon. Friend for that advice. I agree with her, but once a person acquires basic knowledge, it can stay with them for the remainder of their life.

Dr Mathias rose

Peter Aldous: I see that there is a doctor in the House; I look to her to take this forward.

Dr Mathias: Does my hon. Friend agree that one of the best tests of CPR training is that experiential feeling? Members who attended the British Heart Foundation showcase will know that, after training, a person knows the pressure required on Resusci Annie. The test is whether people use “Nellie the Elephant”, “Stayin’ Alive”— everybody listening will know what I am talking about—or have Vinnie Jones in their mind.

Peter Aldous: I agree wholeheartedly with my hon. Friend. The measures could save money. Funds for public services are, we hear, in short supply. The NHS faces significant pressures; why not relieve some of them? If, as a society, we all had a simple knowledge of first aid, it would provide some relief to accident and emergency units, and the people doing great work in them, and they could get on with the work they want to do.

Mr Nuttall: My hon. Friend raised the question of cost, which has hardly been touched on. As he states that the measures will save money, he must have made some assessment of how much they will cost.

Peter Aldous: First—this is the embodiment of the big society—organisations such as St John Ambulance and the British Heart Foundation are prepared to take the financial strain on this; it is important to remember that.

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Alex Cunningham: Let us get down to basics: this is about time versus lives—a few hours a year in schools to impart basic knowledge that could save 5,000 lives a year. Does my hon. Friend agree, as chair of the all-party group on first aid?

Peter Aldous: I agree wholeheartedly with my hon. Friend. Thirty-six US states, Germany, France and several Scandinavian countries have compulsory first aid education on the curriculum. If we did in this country, it would bring significant benefits. Today, I should be with members of Waveney youth council on its youth breakout day. When I explained to them why I would not be with them, I sought their views on the Bill, although the situation in Waveney schools appears to be better than it is across the country as a whole. I received a very clear message: “Go for it.” In that context, I urge the House to give the Bill a Second Reading.

10.37 am

Liz McInnes (Heywood and Middleton) (Lab): I am delighted to be able to speak in this debate. I thank my hon. Friend the Member for Erith and Thamesmead (Teresa Pearce) for making first aid education in schools the subject of her private Member’s Bill. It is a really important subject that I have become very aware of over the years. I remember the problems we sometimes had, when I was an NHS worker in a busy pathology department, in getting members of staff to come forward to train as first aiders in the workplace. It is surprising that, in an NHS setting, we had difficulty getting volunteers. If we were all taught first aid as children in school, it would normalise the subject, and make first aid far more accepted as a life skill; it would then be a far less daunting prospect as an adult.

As a local councillor, I trained in the use of public access defibrillators, and I know only too well how essential it is to have trained members of the public available should there be an emergency and a need to put the defibrillator to use. Teaching first aid in schools would make it far less a matter of lucky chance that a trained first aider was in the vicinity of an emergency. When all our children are trained first aiders, it will give the victim of an arrest or another medical emergency a much better chance of receiving life-saving emergency first aid.

In my constituency, Heywood and Middleton, first responders and the North West ambulance service have done and are doing a great job getting defibrillators installed around the borough of Rochdale. Getting the equipment is one thing, but without trained members of the public who feel confident using them, the defibrillators are mere wall decoration. They are easy to use—I can vouch for that. Once one opens them up, one is talked through the procedure by a reassuring voice, but the key thing is confidence to use them.

The Bill is not just about defibrillators. It aims to ensure that more people have the skills and the confidence to act if they witness a range of medical emergencies, such as choking, bleeding, an asthma attack or a seizure, or a cardiac arrest when a defibrillator is not readily available. By teaching our children first aid skills at a young age and making CPR part of the national curriculum, we can instil that confidence and ensure that surviving a cardiac arrest becomes far less a matter

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of chance and good luck. The national curriculum framework is clear that every state-funded school should teach subjects that promote

“the spiritual, moral, cultural, mental and physical development of pupils at the school and of society”

and prepare

“pupils at the school for the opportunities, responsibilities and experiences of later life”.

First aid education amply fulfils both those criteria. It can easily be incorporated into many areas of the curriculum, as has been mentioned—for example, PSHE, citizenship, sports education and PE.

I pay tribute to Siddal Moor sports college in my constituency, which teaches first aid in year 10 as part of a health and social care course. Such teaching should, however, be wider—every child should have access to first aid training. Support for the mandatory teaching of first aid comes from countries such as Denmark, where CPR training became compulsory in 2005 for all schoolchildren over 11 years of age. In the following six years, the provision of CPR by members of the public more than doubled and survival from out-of-hospital cardiac arrest tripled.

I would like to pay tribute to voluntary groups such as cadets, the scout and guide movements, St John Ambulance, the British Heart Foundation and many others who do a great job of teaching first aid skills. But 60% of children have had no first aid training whatever, and only 24% of schools currently offer first aid training. Without this becoming mandatory, we will still have a large section of young people who do not have the skills to potentially save lives. If we approve this Bill, we will be going a long way towards improving the safety and survival of everyone in our society. None of us knows when we might need the skills of a trained first aider.

10.43 am

Robert Jenrick (Newark) (Con): I congratulate the hon. Member for Erith and Thamesmead (Teresa Pearce) on bringing forward the Bill for consideration. She has done not just the House but the whole country a service by increasing our awareness of the issue.

I saw how important first aid is just over a year ago when I was standing with 600 of my constituents outside the parish church in Newark for the Newark Remembrance Sunday parade and an 82-year-old Army veteran had a severe heart attack two paces behind me. Six hundred of my constituents and I stood feeling pretty helpless at not being able to support him. Fortunately, a number of people there had had first aid training, and an off-duty firefighter stepped in, with others from Newark Community First Aid, to support the veteran and re-start his heart with CPR. That gentleman was centre-stage at our Remembrance Sunday parade a couple of weeks ago. That experience, which left me feeling helpless, led me to do a proper first aid course in the intervening 12 months provided by our local community first aid group in Newark. As a parent of three young children, I think it only appropriate that all parents should be equipped with basic training, so that we are never in the terrible position of feeling like a helpless bystander.

I support the aims of the Bill. Given our ageing population and the fact that my community is relatively isolated—ambulances can take an hour to get to many

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villages, and in some horrific cases, far longer—it is important that more and more people are fully trained in first aid, particular in CPR.

Sir Greg Knight (East Yorkshire) (Con): My hon. Friend has just said that he supports the aims of the Bill. Will he clarify his position? Does he actually support the Bill?

Robert Jenrick: I thank my right hon. Friend; I was coming to that. Like many private Members’ Bills, this Bill is challenging: our instincts tell us to support it, but on closer examination, particularly after having talked to the people on the ground who would have to implement it, our heads tell us that there may be better ways to address the issue. I shall come to that in a moment.

A constituent of mine, Mrs Harriet Smith of Southwell, emailed me after my hon. Friend the Member for Shipley (Philip Davies) had made his speech last week. She asked me to request his permission to market it as a cure for insomnia, although she added that admittedly he was right in almost every respect.

I want to emphasise that first aid is incredibly important, and that is recognised in my constituency. In my local experience, awareness of first aid and training is increasing. The Newark Community First Aid project, founded almost 10 years ago, has trained thousands of my constituents on a voluntary basis. Individuals of all ages take part, including the young; I agree with my hon. Friends that 11, 12 and 13-year-olds can and do take the training. Thousands of young people are now fully trained members of our community and are there to help should emergencies arise. The Prime Minister met the founders of the Newark Community First Aid project a year ago to praise it as one of the leading groups in the country to have seen non-compulsory training really take off in a community.

Mr Nuttall: Does my hon. Friend share the concern that those valuable groups might suffer if first aid became compulsory in schools?

Robert Jenrick: That is certainly a concern. In the experience of those groups—I shall come to the experience of some of my local schools—a compulsory element has diminished the training. When young people are asked whether they want to do the training on a voluntary basis, more have come forward and done it in the spirit that it really deserves.

A huge number of groups offer first aid training on a voluntary basis: the scouts, the girl guides and the sea cadets, for example. Workers at our district council of Newark and Sherwood are mostly fully trained, while the University of the Third Age in Newark and Southwell has trained hundreds of people in large groups very effectively. Many rural parish councils are purchasing or being donated defibrillators, which are often placed in redundant telephone boxes and other rural locations and marketplaces. A Chinese restaurant that I am due to open with my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke) in a couple of weeks’ time is the latest example. Many parish councils are training or providing in their village halls a community voluntary opportunity to learn how to do CPR when the defibrillator is installed. I have been to a couple of

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those voluntary community events, and they are great—people really enjoy them and the community gets behind them.

Workplace schemes are also taking off; we have seen them in a number of employers, large and small, in my constituency. Generally, again, they are voluntary rather than compulsory and are done during lunch hours—sometimes during working hours—or after work. They are popular and worth while. That work is ongoing, and I do not want to it to be diminished. I want it to be encouraged by the Government, and I hope, if nothing else, that this Bill, whether it succeeds or not, will push it forward.

However, we have to ask ourselves whether enacting this Bill is the right answer. In answering that question I have done something that I have not heard every Member say they have done, which is to ask for the views of the headteachers in my constituency. I am all in favour of opinion polls, and I do not dispute the veracity of those that have been mentioned, but nothing is better than a face-to-face conversation with one’s local headteacher. In my constituency, I have five highly respected and competent headteachers of secondary schools whose views I want to share with the House.

Dr Mathias: I think that lots of MPs present, including me, have contacted their schools. I did that research because this Bill was coming to the House, and the good thing in my constituency is that most of the schools are already doing CPR training.

Robert Jenrick: I appreciate that. I did say that not every Member had done it. I would be interested to hear the remarks of those who have spoken to their local headteachers about their views.

I have spoken to my local headteachers, or most of them. Four out of the five I spoke to support the principle of the Bill and want to see more first aid training, particularly CPR. Three out of the five already do quite a lot of this activity to differing degrees. However, none of them was in favour of its being compulsory. I do not say that with any pleasure, in speaking against this Bill, but those are the facts. The highly competent and respected headteachers with whom I work are not in favour of this Bill. That needs to be said, alongside the statistics that we have heard, which are clearly less precise than the conversations with our own headteachers.

One of my headteachers, from Southwell Minster school in Nottinghamshire, said that the school already has quite a significant first aid programme. It takes place as part of extra-curricular activities, and sometimes in PSHE and biology classes, and through some of its sports clubs. He does not think that a headteacher such as himself who is taking this issue seriously and working with valuable local community groups needs to be told that it is a compulsory element of the national curriculum. He and his teachers are behind the idea already, and he is doing what he thinks is appropriate for his local community. He is also concerned that while schools such as his might take the issue very seriously and do a good job, the national curriculum can sometimes lead to a tick-box exercise, whereby some will take the requirement seriously, but quality will vary dramatically across the country.

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The Bill, in its effort to provide maximum flexibility, which is entirely understandable and logical, opens up the possibility that some schools, such as Toot Hill in my constituency, will have a superb programme that we would all be proud of, while others might provide 30 minutes of training every now and again, leaving quality in doubt. Toot Hill, an outstanding academy in Bingham outside Nottingham, provides a range of first aid training on a voluntary basis. It offers it to its prefects as part of the prefect programme, so it is a reward. It also offers it on a voluntary basis to all its year 8 and 9 students. The training is extremely popular but it is not made compulsory.

Mr Nuttall: My hon. Friend makes the very interesting point that the training is seen as a reward rather than something to be endured, as I fear it would be regarded if it became a compulsory lesson.

Robert Jenrick: I do think there is a lesson to be learned there.

On the news this morning I heard cited a school in Sutton Coldfield that has built a very strong alliance with St John Ambulance. The school offers training on a voluntary basis to all its year 9 students. It has found that when training is compulsory, students are often less excited about it, as we can all remember from our own schooldays, but that because it is voluntary almost all students choose to take it up. If I were a headteacher, I would offer the programme to students on a voluntary basis and hope that almost all of them took it up.

Mrs Sheryll Murray: Did my hon. Friend’s headteachers make any comment about whether Ofsted would get involved and whether it would be yet another tick-box exercise whereby they would need to comply with an Ofsted inspection?

Robert Jenrick: Yes, two of them specifically raised the issue of tick-box exercises and asked how, if the requirement were in the national curriculum, it would be measured and whether Ofsted would become involved. If not, what would it mean? Some schools would be exemplars that provide superb quality training and work with great local groups such as Newark Community First Aid or St John Ambulance, and others would do much more modest training—an online exercise or whatever that is considered to be the bare minimum. That might be because they are not interested or, more likely, because they do not have the time or the resources. Others might feel that it is more appropriate to concentrate on academic outcomes because they are struggling to educate children with particular needs.

Philip Davies: Does my hon. Friend agree that in order for the training to be a meaningful compulsory part of the curriculum, it would need to be subject to an Ofsted inspection to make sure that it was being done properly, because otherwise there would be nothing to say whether schools were carrying it out, and that therefore it would be another part of a school inspection that I am sure schools could well do without?

Robert Jenrick: If we believe in the principle of training in first aid for young people, or indeed people of any age, we want to ensure quality, and quality is

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clearly very variable. If we provide maximum flexibility so that a school can take it very seriously or not seriously at all, then the whole scheme could be jeopardised.

I want to refer Members to my local group, Newark Community First Aid, and what it considers to be high quality. In its training it uses qualified doctors, nurses and extremely experienced first aiders. Its minimum course lasts two and half hours and has to be re-done regularly. Its preferred course lasts four hours. If we want good-quality training, some minimum standards are involved. I do not want thousands of young people to believe that they have had high-quality first aid or CPR training when they have had a half-hour video presentation—although I am sure that would be better than nothing—rather than having gone to one of these superb local community groups and spent a whole afternoon or day being trained.

Alex Cunningham: The hon. Gentleman has talked about headteachers being opposed to compulsory training in schools. Which schools in his constituency have said that they are not prepared to spend a few hours a year in order to save thousands of lives?

Robert Jenrick: All the schools I spoke to are trying in their own way to provide training, doing what they believe is appropriate and working with local groups. However, the point remains that none of them wants it to be a compulsory part of the national curriculum, believes that that is the appropriate and best way of furthering the cause, or, given their awareness of young people, believes that forcing them is the best way of inspiring and motivating them to do it, to take it seriously, and to really believe in it.

Other headteachers raised with me the point that many other important issues could persuasively be suggested for the national curriculum, such as PHSE, biology—

Will Quince: Why does my hon. Friend think that headteachers are out of sync with the 84% of teaching staff who hold a completely opposite view?

Robert Jenrick: I do not know. I have spoken only to my headteachers, as well as a range of other teachers. With great respect to my hon. Friend, it appears that he is relying on an opinion poll. I have spoken to my headteachers and to 10 other secondary school teachers in my constituency, and that, to me, as a constituency MP, is the best way of gauging the opinion of my constituents.

Many other issues could be put on the national curriculum. There have been recent campaigns in my constituency on several such issues, including road safety, respect for women, violence and knife crime, all of which are important. I suspect, as a parent, that first aid and CPR training should be very high on that list, if not at the top. However, there clearly has to be a limit on what can be in the national curriculum, and there are many competing demands on that time.

Sir Greg Knight: Does my hon. Friend think that it might be useful if a mechanism were in place for teachers to share best practice on this issue?

Robert Jenrick: Yes, I do. That is extremely important. In fact, many of the headteachers in my constituency work together on these issues. The headteacher of Toot

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Hill school in Bingham is very aware of what is happening at various Nottingham schools, and some across the border in Leicestershire. I would like to see much more of that. There is an important role for our local community groups as well.

Proceedings interrupted (Standing Order No. 11(4)).

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Junior Doctors Contract

11 am

Heidi Alexander (Lewisham East) (Lab) (Urgent Question): To ask the Secretary of State for Health if he will make a statement on the negotiations for a new junior doctors contract.

The Minister for Community and Social Care (Alistair Burt): Three years ago, negotiations began between the British Medical Association, NHS Employers and the Department of Health. They were based on a common view that the current contract—agreed in 2000, when junior doctors were working very long hours—was outdated and needed reform. Between December 2012 and October 2014, extensive and patient negotiations took place, with an agreed target date for implementation of August 2015.

The negotiations were abruptly terminated by the BMA’s unilateral withdrawal from them, without warning, in October 2014. That led to the independent and expert Doctors and Dentists Review Body being asked to take evidence on reform of the contract from all parties, including the BMA, and to make recommendations. That happened because of the unwillingness of the BMA to agree sensible changes to the contract, and allowed an independent expert body to recommend a way forward.

The DDRB report on the junior doctors contract, with 23 recommendations, was published in July. The Secretary of State then invited the BMA to participate in negotiations based on those independent recommendations. Unfortunately, the junior doctors committee of the BMA maintained its refusal to negotiate, even though the negotiations would be on the basis of an independent report to which it had had an input. Both the Secretary of State and NHS Employers have repeatedly invited the BMA to participate in negotiations. It was made clear that there was a great deal to agree on based on the DDRB recommendations.

We deeply regret that the BMA chose the path of confrontation, rather than negotiation. While we continued to try to persuade it to develop a new contract with us, it instead chose to campaign against the independent DDRB’s recommendations, including by issuing a calculator, which it subsequently withdrew, suggesting—wholly falsely—that junior doctors would lose 30% of their pay. Instead, the BMA issued demands, including a right of veto on any contract change. In effect, it asked us to ignore the DDRB’s recommendations, the heads of terms agreed back in 2013, and to start again.

Given the BMA’s refusal to engage and its wholly misleading statements about the impact of a new contract, NHS Employers issued a contract offer to junior doctors earlier this month. This offer has safety at its heart and strong contractual safeguards to ensure that no doctor is required to work more than 48 hours a week on average, and it gives junior doctors the right to a work review when they believe hours are being exceeded. It reduces the maximum hours that a doctor can work in any week from 91 to 72 hours. It pays doctors an 11% higher basic pay rate, according to the hours that they work, including additional payments for unsocial hours.

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It reduces the number of consecutive nights that can be worked to four and of long days to five, ending the week of nights.

The hon. Member for Lewisham East (Heidi Alexander) has called for the parties to go to ACAS. The Secretary of State is not ruling out conciliation. We have always been willing to talk. The Government have repeatedly appealed to the BMA to return to the negotiating table, and that offer is still open. We believe that talks, not strikes, are best for patients and for junior doctors. The Secretary of State has said that talks can take place without preconditions, other than that an agreement should be within the pay envelope. However, the Government reserve the right to make changes to contracts if no progress is made on the issues preventing a truly seven-day NHS, as promised in the manifesto and endorsed by the British people at the last election.

It is regrettable that junior doctors have voted for industrial action, which will put patients at risk and see between 50,000 and 60,000 operations cancelled or delayed each day. I therefore call on the hon. Lady to join the Government in calling on the BMA, as it prepares for unprecedented strike action, to come back to the table for talks about the new contract for junior doctors. The Government remain firmly of the view that a strike by junior doctors is entirely avoidable, and we call on the BMA to do all it can to avert any action that risks harm to the patients we all serve.

Heidi Alexander: The fact that we are in this situation today, with 98% of junior doctors having voted to take significant industrial action for the first time in 40 years, makes me angry and sad. I say that because it did not have to be this way. The truth is that if we had had a little less posturing and a little more conversation from the Health Secretary, this whole sorry episode could have been avoided.

Does the Minister agree that, over the next week, everything that can be done should be done to stop the three days of planned industrial action? He said that the Health Secretary does not rule out going to ACAS, so why did the Secretary of State appear to dismiss the idea of independent mediation yesterday? Does that seemingly flippant rejection of the need for independent mediators to prevent industrial action not show a casual disregard for patient safety?

The way in which the Health Secretary has handled the negotiations has been appalling. Does the Minister understand that negotiation by press release is not the way to conduct discussions, nor any way to run the NHS? Does he understand that junior doctors are particularly angry about the way in which the Health Secretary has repeatedly conflated the reform of the junior doctors contract with seven-day services? Junior doctors already work weekends and they already work nights. For the record, not a single junior doctor I have met during the past few months would not drop everything to respond to a major terrorism incident. To suggest otherwise is to insult their professionalism.

The fundamental question hanging over Ministers this morning is this: why continue this fight? Hospitals are heading for a £2 billion deficit this year, mental health services are in crisis and the NHS is facing its most difficult winter in a generation, so why on earth

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are this Government picking a fight with the very people who keep our NHS running? There are nine days left before the first day of planned industrial action. Let me say very clearly to the Minister this morning: it is now time to talk.

Alistair Burt: I agree with the hon. Lady that we do not need to be in this situation. Absolutely. That is the whole point. The Secretary of State has kept his door open all the time. In seeking to conclude this, after starting negotiations three and a half years ago, the door remains open. It is for the BMA to come through it and say that it wants to continue the negotiations that it abruptly left more than a year ago.

Can and should everything be done to avert the strikes? Yes, it should. It would help if Labour Front Benchers made an unequivocal statement that they do not support strike action by doctors. I await to see whether that will be forthcoming. In the meantime, the Secretary of State has said that he is perfectly prepared to go to conciliation, but conciliation usually comes after a process of negotiations has broken down. The whole point is that the negotiations have not even kicked off again. The point is that the Secretary of State has offered such an opportunity, based on recommendations made by the independent Doctors and Dentists Review Body. That committee has made independent recommendations, including on the basis of information provided by the BMA.

For the hon. Lady to talk about a challenge to safety ill becomes the party that presided over Mid Staffs. The point is that, since he took office, the Secretary of State has, quite plainly and to everybody’s knowledge, made safety in the NHS his prime consideration. He wants a seven-day NHS to recognise the issues that have arisen at weekends. He has never said that junior doctors do not work at weekends. Of course they do—they carry the biggest burden of hospital work at weekends—but to make sure that the NHS is completely safe at weekends, as he intends, it is essential to spread out the burden and the junior doctors contract is part of that process. The hon. Lady said that it should be up to the Secretary of State to make the next move on the negotiations. I say to her that the door to negotiations is always open, as the Secretary of State has made clear.

The hon. Lady raised the issue of patient safety and the comments of Professor Sir Bruce Keogh, who is responsible for doctors in relation to emergencies. It is his role, as the national medical director, to ensure that everyone is safe. He wrote to the BMA yesterday and said:

“I would reiterate to both sides that I believe the best way to ensure patient safety is for the planned action not to take place. I would strongly urge you, even at this late stage, to come back to the negotiating table.”

He stated that

“patient safety is of paramount importance.”

Sir Bruce Keogh’s point in relation to an emergency situation was that although no one doubts for a second that, should there be an emergency in this capital like the one in Paris, every available doctor and member of medical staff would report for work, if it took place on the day of a strike when they were not already in the hospitals in the numbers required, it would take them time to get in. That was his concern about patient safety and it is a reasonable one.

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I say again that we await a suggestion from the hon. Lady that it is not right for junior doctors to take strike action and that she will support the Secretary of State in saying that it is time to return to negotiations. The Secretary of State has been patient and fair, and he is clear that this is about safety. Negotiations should be returned to as soon as possible, and it would help if everyone said so.

Dr Tania Mathias (Twickenham) (Con): For the record, I did not vote in the ballot. I urge the Minister and the BMA to return to the negotiating table, but without any preconditions. I applaud the new calculator on the Department of Health website, which is very helpful. I would be surprised if my colleagues and the people I know went on strike. I cannot imagine it. Therefore, there is an opportunity to negotiate and, if that does not succeed, to go to ACAS.

Alistair Burt: My hon. Friend believes, rightly, that there should be negotiations. The Secretary of State has said that. He has also said that conciliation is possible if the negotiations break down. There are no preconditions, beyond what the Secretary of State has said about his right to ensure that a manifesto commitment is delivered. My hon. Friend is right about the calculator. The initial calculator was misleading, which may have swayed some people over a period of time. She is also right to recognise, as the chief medical officer said yesterday—[Interruption.] Perhaps the hon. Member for Worsley and Eccles South (Barbara Keeley) will listen to the chief medical officer, if not to me. She said:

“I recognise the strong feeling of junior doctors and will always support them as the future of the NHS, but the severity of the action the BMA proposes is a step too far. I urge junior doctors to think about the patients that will suffer and I ask the union to reconsider its approach.”

That is a very sensible position that I think we would all endorse.

Yvonne Fovargue (Makerfield) (Lab): What evidence does the Minister have that reforming the junior doctors contract and having a seven-day NHS will make the NHS safer? Will he commit to publishing that evidence?

Alistair Burt: The evidence is there in what has been published about the details of the contract. It was published in the press because it was not possible to get it to the BMA as it was not negotiating. It includes an upper limit of working hours of 72 hours in a seven-day period, when it was previously 91; four consecutive night shifts instead of the current seven; five consecutive day shifts instead of the current 12; and greater flexibility over rosters. That is self-evidently safer than the existing system. One reason we are where we are is that the BMA and others recognise that the old contract does not deliver the safety that is necessary. Those sort of changes will make the contract safer. That is self-evident.

Mr Jacob Rees-Mogg (North East Somerset) (Con): I wonder whether my right hon. Friend saw the report in yesterday’s Daily Mail that said that under the Conduct of Employment Agencies and Employment Businesses Regulations 2003, it would be illegal to take on locums in place of striking doctors. Does he agree that if that is true, the law should be changed?

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Alistair Burt: The Department has not yet had a chance to examine that report, but I have seen it. This all goes to emphasise that we should not be where we are. This matter can be settled. The Secretary of State’s door has been open for negotiations all the time. There is no reason why the junior doctors committee should not walk through that door, begin negotiations and end the risk to patients that is involved in strike action.

Nic Dakin (Scunthorpe) (Lab): Why not just go straight to ACAS? From my constituents’ point of view, something has broken down and it needs fixing. Why not just get on with it?

Alistair Burt: Because of what happened the last time an independent body looked at this matter. After the negotiations broke down before, the Secretary of State sent the matter to an independent body, the Doctors and Dentists Review Body. The BMA took part in that and made its representations, but when the independent body reported, the BMA still did not do anything. Those recommendations form the basis on which negotiation can take place. If those negotiations are not successful, that is when conciliation can happen. That is exactly what the Secretary of State has offered. I hope the hon. Gentleman will support that and try to ensure that strike action does not take place.

Sir Peter Bottomley (Worthing West) (Con): It is quite clear that,

“Changes to contracts must be best for patients, fair for doctors and sustainable for the NHS.”

That, in effect, is what the Minister has been saying, but those words were said by Mark Porter of the BMA. If the problem is getting together to have discussions, may I suggest that instead of saying that the BMA should come to Ministers, Ministers announce that they are prepared to go to the BMA, discuss everything and hopefully come to a conclusion on everything? It seems to me that if the BMA has got itself stuck by proposing a strike that doctors do not want and that cannot be good for patients, the best thing is to say to it, “We will come and talk with you. Let’s get this settled.”

Alistair Burt: I thank my hon. Friend, but I do not think that the venue of direct negotiations is of any concern to the Secretary of State. What is important is that the body that represents junior hospital doctors should negotiate directly with the NHS, as has been on offer for some time, following the process that was going on for some three and a half years before it reached this state. My hon. Friend is right that direct negotiations should recommence immediately.

Sarah Champion (Rotherham) (Lab): The Minister quoted Sir Bruce Keogh. Will he tell us what Sir Bruce said about ACAS?

Alistair Burt: Let me see what Sir Bruce Keogh said. [Interruption.] I did not write the letter, so I will have to look through it. He said:

“I would reiterate to both sides that I believe the best way to ensure patient safety is for the planned action not to take place. I would strongly urge you, even at this late stage, to come back to the negotiating table.”

As far as conciliation is concerned, I have made it entirely clear that the Secretary of State has not ruled it out. I cannot see ACAS mentioned in the particular

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letter that I am looking at. Sir Bruce Keogh said that there must be direct negotiations between those who know most about the matter. The Secretary of State has said that if that does not work, he is open to conciliation.

The Secretary of State has reviewed the contract, published the terms and dealt with the BMA, which said first that it was a pay issue, then that it was a safety issue and then that it was an issue about imposition. At each stage, it has moved the goalposts, whereas the Secretary of State has been open about what he wishes to see. It is now up to the negotiations. We all want negotiations to happen because nobody wants to see the withdrawal of junior doctors’ work and, I suspect, neither do they.

Mr Christopher Chope (Christchurch) (Con): Is not the root problem that the NHS is a monopoly employer of junior doctors? If the veterinary profession can provide 24/7 care for sick animals, why cannot junior doctors provide the same for sick people?

Alistair Burt: As the House is well aware, the Commonwealth Fund said recently that the NHS was the best in the world. NHS staff, by implication, are the best in the world. They do an extraordinary job and junior hospital doctors do a fantastic job. Patient satisfaction is extremely high. We want that to continue. There is no reason to believe that NHS Employers, which is also calling for negotiations to continue and for the strike action not to take place, is not in full view of what staffing it needs to create an even safer health service. Its judgment is that the contract set out by the Secretary of State to be negotiated on provides the best basis for the employment of doctors in the health service.

Wes Streeting (Ilford North) (Lab): The Minister’s statements, even this morning, imply that people have been misled by the BMA. How is it conceivable that 15 heads of royal colleges and 98% of junior doctors have been so badly misled that this unprecedented strike action has been proposed? Instead of patronising people, why will he not accept that trust has broken down, cut out the middle man and go straight to ACAS, so that there can be proper negotiations and a resolution to the dispute? People do not trust the Government.

Alistair Burt: I take the hon. Gentleman’s point. One example of why the Secretary of State believes that he is entitled to talk about misleading is that of the pay calculator that the BMA put on its website, which indicated that all doctors would suffer a 30% to 40% reduction in their salary, or something like that. The BMA was forced to take that calculator down when it realised that it did not reflect the truth. As we have seen, the Secretary of State has said that no doctor currently working legal hours will suffer a reduction in pay. There is an 11% pay increase on basic hours, and that is why he feels that there was an element of misleading. The hon. Gentleman is right about cutting out the middle man, which is why negotiations should restart. I am delighted that he supports that approach, and if that does not work, conciliation is there.

Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con): Does my right hon. Friend agree that the loss of some overtime pay currently earned by junior doctors who

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work more than 72 hours a week should be seen firmly in the context of the safety of patients being treated by exhausted medics, and the long-term health of our junior doctors?

Alistair Burt: My hon. Friend is right. One difficulty with this is getting through what has built up during the course of the dispute, and getting to the heart of this issue, which is shared by everyone. There is no doctor in the land who does not want to work in safe conditions or for their patients to be treated safely. There is no Member of Parliament who does not want safety to be at the heart of this, and no one from the royal colleges or in senior executive positions in the NHS wants to compromise on safety. That is why we need to cut the number of legal hours, and ensure that doctors cannot work the number of consecutive nights or long days that they can work currently. The contract was outdated and it needs to change, and that is why people should sit down together.

Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op): Members of the Public Accounts Committee hear repeated reports about the challenges of recruiting some of the very junior doctors who will go on strike. Not only is the Government’s game of brinkmanship causing problems with morale and patient safety, it could lead to a longer term crisis in the NHS as doctors choose not to work here. Will the Health Secretary just get on with it and get around the table? It is within his gift to get talks started again and avert this strike.

Alistair Burt: The hon. Lady speaks with great background knowledge on this issue. She is right to say that we should all just get on with it, but she is not right to say that it is within the Secretary of State’s gift—if it was, we would not be where we are. The Secretary of State wants a negotiation based on independent recommendations and on three and a half years of work, which is not an unreasonable position. The hon. Lady’s view that this issue should be settled in a way that means negotiations continue and the strike does not happen is correct.

Christopher Pincher (Tamworth) (Con): Does my right hon. Friend agree that, just as we would feel unsafe as passengers if we got on to an aeroplane that did not have a co-pilot—because not enough co-pilots work or are fit to work at the weekend—similarly we should feel unsafe because of the weekend effect in the NHS? Reasonable reform to fix that, agreed by the BMA, is necessary.

Alistair Burt: My hon. Friend makes a fair point. The current contract is simply not fair. It incentivises junior doctors to work long, unsafe hours, and around 500 doctors work outside legal limits at more than 91 hours a week. Safety has always been at the heart of the reasons for wanting to change the contract. People thought that the existing contract was unsafe as far back as 2008 when the BMA recognised that it did not do the job it was designed to do, and this issue has lasted from then to where we are today. One can reasonably ask what else the Secretary of State can do beyond publicising what he is doing, continuing to talk, keeping the door open, and wanting to ensure direct negotiations.

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Clive Lewis (Norwich South) (Lab): When the NHS is facing a winter crisis, why have the Government decided to pick a fight with the very people who will get it through that crisis?

Alistair Burt: The Secretary of State has not picked a fight. Three and a half years of negotiation on a new contract, publicising the offer, and being willing for negotiations—which he did not withdraw from—to restart, is a funny definition of picking a fight.

Tom Pursglove (Corby) (Con): I thank the Minister for coming to the House to set out the Government’s position, and I impress on him the concern felt by my constituents about this strike. Does he agree that our constituents expect everybody to get around the negotiating table to try to sort this out, and for Members of this House to advocate that approach? That is the responsible thing to do.

Alistair Burt: My hon. Friend is right. In any quarter there will be puzzlement about support for action that will withdraw the work of junior doctors from their patients. We estimate that between 50,000 and 60,000 elective pieces of work are done every day in the NHS, and such work will inevitably be put off if doctors are not available. Those numbers are individual patients who will not get the care that they are looking for, and that a doctor would want and expect to give. There must be something better than this stand-off, which is why we appeal to the BMA to take up the Secretary of State’s offer and come back to negotiations.

Anna Turley (Redcar) (Lab/Co-op): Given the crisis in morale in the NHS, have the Government estimated how many junior doctors might leave the NHS if they continue to impose this new contract on them?

Alistair Burt: No, I do not think it possible to make that sort of estimate or assessment, but the longer that doctors go on working under an unsafe contract that includes long hours, consecutive nights and long days, the more that will add to the pain and pressures of those working in the NHS. That is why a new contract with safer hours is a better option. Encouraging the BMA to return to negotiations and settle this issue, so that the threat of strike action is not hanging over us, is also important for morale.

Philip Davies (Shipley) (Con): Does my right hon. Friend agree that this strike action is completely irresponsible and that such action is never an acceptable substitute for the kind of negotiations offered by the Secretary of State? Will he guarantee that the Government will not give in to this strike action, as that would be a terrible precedent for the Government to set?

Alistair Burt: My hon. Friend reflects well the feelings of Chief Medical Officer Professor Dame Sally Davies, who urged junior doctors to think again because the severity of the proposed action is a step too far. I find it difficult to conceive of a circumstance in which I would support a medical practitioner withdrawing their labour, and I hope that anyone would think that such things should not happen. The Secretary of State is doing everything he can to make clear the terms of the contract, the safety principles on which it is based, and to deal

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with misleading information. Even at this stage, he urges the BMA to come back and sit round the negotiating table and—I repeat—he has not ruled out conciliation after that.

Andy Slaughter (Hammersmith) (Lab): I have hundreds of junior doctors in my constituency and I have spoken to many of them. They feel misled, but not by the BMA. Does the Minister understand that the anger that led to the 98% vote in favour of action is because junior doctors were told that they would get a pay rise, when many would get a pay cut? Disgracefully, they have been told that somehow they may be responsible for unnecessary deaths. The only way to restore trust now is independent arbitration. Will the Secretary of State agree to that without preconditions?

Alistair Burt: In an attempt to build on the opportunity of trust, after the BMA withdrew from negotiations last year, the work went to the independent Review Body on Doctors’ and Dentists’ Remuneration to urge an independent look at the issue and to get recommendations based on that independent review. When those recommendations appeared, the BMA still did not go into negotiations. That independent review has been sought, and the recommendations are there to talk about. When the hon. Gentleman spoke to junior doctors in his constituency—probably about misleading information that they may have had from the BMA—I hope he said clearly that he does not support strike action. It might be helpful if he told the House that that is what he said.

Mrs Sheryll Murray (South East Cornwall) (Con): Many of my constituents will want to know if the Secretary of State is satisfied with the reassurances given by the BMA, which has refused to confirm it will do what is necessary to ensure patients are not hurt if the strike takes place.

Alistair Burt: I am quite sure I can say to my hon. Friend that no one ever wants to see anyone hurt, but, if there is a withdrawal of labour, it is not possible to say that certain procedures to relieve the discomfort of existing patients will take place. That is obviously the point of the action and why no one wishes to see it happen. I repeat that no doctor wishes to put a patient in a situation of harm. No Minister wants to see that and none of us here does. This process has been going on for three and a half years; there has been reference to independent people, recommendations that the BMA played a part in making and an open offer always to come back to negotiations. That does not seem an unreasonable position for the Secretary of State to take. That is why it should be backed by everyone sitting in the House today.

Liz McInnes (Heywood and Middleton) (Lab): Negotiations have clearly reached an impasse, and winter pressures and a winter crisis in the NHS are looming. In the interests of patient safety, let us bring in ACAS. Talks have clearly stalled. If the Secretary of State is doing everything he can, will the Minister tell me where he is today?

Alistair Burt: The impasse was not created by the Secretary of State. The impasse was created by the BMA walking away from negotiations last year and not returning

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to negotiations after the recommendations of the independent body came through. That is not an impasse; that is one side deciding it does not want to take part. The Secretary of State’s response has been to say: keep the negotiations going, the door is always open.

The hon. Lady asks where the Secretary of State is today. He is working on the spending review plans for the support the NHS needs—a financial commitment the Labour party did not make at the general election. He is also working on contingency plans to make sure the NHS is safe if action takes place. I think that is pretty important work that he should be doing.

Mr David Nuttall (Bury North) (Con): As the Minister previously represented my constituency for 14 years, does my right hon. Friend agree that when the Government have guaranteed no junior doctor working within legal limits will see their pay cut and that none will be required to work longer hours, the hardworking residents of Bury, Ramsbottom and Tottington will find it difficult to understand why strike action has been voted for?

Alistair Burt: My hon. Friend puts it very well. The people of Bury, Tottington and Ramsbottom have long experience of very good health services provided by excellent family doctors, as well as through good secondary medical care, not just in their own constituency but around and about. They will find it surprising that, with the guarantees given by the Secretary of State and mentioned by my hon. Friend, anyone should be contemplating strike action. Equally, they will find it incomprehensible that anyone from any political party is giving that strike action any support.

Clive Efford (Eltham) (Lab): The Minister has just told us that the Secretary of State is across the road in his office and cannot be bothered to come here to account for an unprecedented strike by junior doctors in our national health service. That is an absolute disgrace! The Prime Minister has said that this is his miners’ strike. The doctors are prepared to go to arbitration. The public will know that if this strike goes ahead it will be because the Government will not go to arbitration. It will be the fault of the Secretary of State and the Prime Minister.

Alistair Burt: I think it is of primary importance for the Secretary of State to work on contingency plans this morning to make sure that we are all safe should there be a strike. That is the task he has been given by the action that has been taken. At the same time, he has repeated that he is open to negotiations to deal with the dispute. Rather than expressing anger, the hon. Gentleman should be expressing concern that a contract that makes an unsafe situation for doctors safer is not being backed more readily by those on the Opposition Front Bench, who should also be rejecting strike action.

Craig Whittaker (Calder Valley) (Con): One group that has not been mentioned by the shadow Secretary of State is, of course, the patients. They receive a poor level of service at weekends, sometimes, sadly, with dire consequences. Will the Minister and the Secretary of State pledge to stand resolute in their commitment to improve weekend care, which, as Sir Bruce Keogh has said, is both a moral and clinical cause?

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Alistair Burt: My hon. Friend gets to the heart of the matter. The clinical director of the NHS, Professor Sir Bruce Keogh, has said that the negotiations and the new contract are about safety and ensuring that a seven-day NHS is safe. They are about dealing with the issue of what happens at weekends, which is generally accepted to be a problem right across the medical world. The Secretary of State has put forward proposals to make people safer. They are backed by those in the NHS who are responsible for patient safety. The Secretary of State is perplexed, like everyone else, that the opportunity for negotiations is not being taken. That is what is needed to end the dispute. The Secretary of State has repeatedly made that clear.

Rachael Maskell (York Central) (Lab/Co-op): The Secretary Of State was here last year in relation to the rest of the NHS staff. First, the DDRB is an advisory body to government, not a mediator, whereas ACAS is a mediator. Secondly, the dispute has provided an opportunity for both sides to step back and explore the issue with a blank sheet of paper. Will the Minister take that opportunity by entering into ACAS talks to explore the grounds for moving the dispute forward?

Alistair Burt: The hon. Lady’s commitment to the health service is very clear from her background and everything else. I ask her to recognise that the 2008 contract is outdated and challenging. By 2012, we reached the stage where people had to negotiate around it because it was unsafe. After three and a half years, we have got to where we are. The idea that the process should start again is just unfeasible and very unfair on doctors working long hours who need to be relieved of that. She talks about the DDRB as a mediator. No, it is not a mediator, but it does provide the independent basis for the recommendations, which the BMA took part in, on which to negotiate. Anyone concerned with patient safety would say the time for direct negotiations to restart and take up the Secretary of State’s offer is now.

Kit Malthouse (North West Hampshire) (Con): Will the Minister remind the House how many entirely avoidable deaths occur at the weekend every year, so that Members can reflect on where their primary concern should lie?

Alistair Burt: Medical studies have demonstrated that there are a number of extra deaths at weekends. The disputes about that are intense, but the medical profession recognises that the absence of facilities, the absence of consultant cover on the level it ought to be at, and the absence of diagnostic tests and other things, make entry into the health service at the weekend less secure than it would be at other times of the week. It is very important to change that. That is what the public voted for at the general election and that is what they expect the Secretary of State to deliver. That that should be held up by an industrial dispute, essentially by a union digging its feet in and not taking the opportunity to negotiate, is unfortunate and bad news for the patients my hon. Friend referred to.

Julie Cooper (Burnley) (Lab): Does the Minister accept that his insistence that junior doctors do not understand the conditions is deeply insulting to some of the most intelligent people in the country? Does he accept that

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this shabby and patronising treatment has led to a total breakdown in confidence in the Secretary of State, and that the only way forward is through ACAS, an independent body?

Alistair Burt: The Secretary of State has gone out of his way to seek to explain to doctors the basis of the contract, partly to deflect what was said about it originally by the BMA during the course of the industrial dispute. He will continue to do that. There is no doubt that we all value the work of junior doctors enormously and fully appreciate that they will be looking very hard at their conditions and everything else. Proper union representation is not delivered by a union that refuses to negotiate after three and a half years and after independent recommendations have been made. I urge the hon. Lady, who also has a valuable role in the NHS in relation to pharmacy and a deep interest in carers, to recognise what will happen for those 50,000 or 60,000 elective admissions that will not be able to take place, to think about those who will be involved and to continue to stress, as I know she will, that negotiations are the answer and that conciliation is available if they are not successful.

Mr Philip Hollobone (Kettering) (Con): My constituents appreciate and value the work of junior doctors but are worried about the threat of strike action and its potential impact on patient treatment, and really would not want strike action to take place. For the benefit of my constituents, will the Minister tell the House what a typical junior doctor gets paid, whether that is likely to go up or down as a result of the contract and whether that typical junior doctor is likely to work more or fewer hours?

Alistair Burt: As we all know, the pay of a junior doctor varies. As the Secretary of State has made clear, there will be an 11% increase in basic pay; antisocial hours will still be covered; junior doctors will work fewer hours to ensure greater safety; and there will be more cover at the weekends to ensure that the burden junior doctors bear is more equally shared.

Alex Cunningham (Stockton North) (Lab): As my hon. Friends have said, the absent Secretary of State

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has lost the confidence of almost everybody in the NHS, to the point that consultants, nurses and others support junior doctors in their fight against him. Morale is at an all-time low and the deficit runs into billions. How will Ministers get the NHS out of this very dark hole?

Alistair Burt: First, we will avoid the language of “fight” and the sense that this has become an industrial dispute, although there are elements of one, given how the BMA has behaved over the negotiations. As far as the public are concerned, however, this is not an industrial dispute: it concerns them very deeply. They appreciate and value their doctors, they want to have their treatment and they want to be safe. People must talk. The BMA, which withdrew arbitrarily from the negotiations, needs to take up the Secretary of State’s offer and start talking. We all know that ultimately this will be ended by talking. Whether that happens today or after 1 December is entirely up to the BMA. I repeat that the Secretary of State is right to be spending this morning dealing with the potential consequences of the action suggested, and I still wait to hear from any Opposition Member that they reject strike action by doctors.

Robert Jenrick (Newark) (Con): When I was a lawyer, I was involved in a number of arbitrations and mediations. Does my right hon. Friend agree that it is highly unusual to go straight to arbitration or to ACAS if there have not been normal negotiations? In this case, as with all other negotiations, the best practice is for the parties to get around the table, and, if that fails, then to go to ACAS, but not to waste time in the interim.

Alistair Burt: My hon. Friend is absolutely right. As the Secretary of State has also made clear, we need to restart the negotiations, which are based on independent recommendations that the BMA looked for and took part in. As he says, the normal procedure is that, if the negotiations do not work, conciliation is available, as the Secretary of State has said. However, we cannot say negotiations have broken down if they are not taking place. I am sure that everyone in the Chamber wants the negotiations to continue and will urge junior doctors in their constituencies to recommend that the BMA restarts them immediately so that we can move this forward and end the threat of strikes that no one wants.

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Transpeople (Prisons)

11.44 am

Cat Smith (Lancaster and Fleetwood) (Lab) (Urgent Question): To ask the Secretary of State for Justice if he will make a statement on trans prisoners.

The Parliamentary Under-Secretary of State for Justice (Andrew Selous): I begin by offering my sincere condolences to the family and friends of Vicky Thompson. Her death, like all others in custody, is a tragedy, and we are totally committed to reducing the number of deaths in prison. Each one is investigated by the independent prisons and probation ombudsman and is the subject of a coroner’s inquest. We believe that Vicky Thompson was being looked after in accordance with the relevant procedures, but that is now a matter for the ombudsman and coroner. While their investigations are ongoing, it would be wholly inappropriate for me to comment on the circumstances of her death.

I would also like to mark the fact that today, 20 November, is designated as transgender day of remembrance and to reflect on the violence still suffered by members of the trans community.

On the specific issue of transpeople in prison, prison service instruction 7/2011 sets out the National Offender Management Service’s policy on the care and management of prisoners who live, or propose to live, in the gender other than the one assigned at birth. Prisoners are normally placed according to their legally recognised gender, which means either the gender on their birth certificate or the gender on their gender recognition certificate. However, the guidelines allow some room for discretion, and senior prison staff will review the circumstances of every case in consultation with medical and other experts in order to protect the physical and emotional wellbeing of the person concerned, along with the safety and wellbeing of other prisoners.

While the most appropriate long-term location for a transgender prisoner will be considered in accordance with the procedures outlined above, the usual practice is for them to be held in a supportive environment, away from the main regime of the prison and protected from risk of harm by other prisoners. The risk-assessed daily regime will be structured to give the prisoner exercise and recreation and some measure of planned, supervised contact with other trusted prisoners. Where relevant, clothing and toiletries are provided to enable the prisoner to present in their acquired gender, consistent with the arrangements set out in the prison instruction.

More generally, prisoners who are transitioning are entitled to live in the gender they seek to acquire. Prisons must produce a management care plan outlining how the individual will be managed safely and decently within the prison environment, with oversight from psychologists, healthcare professionals and prison staff. A review of the current policy began earlier this year, and revised policy guidance will be issued to reflect NOMS’ responsibilities to transgender offenders in the community, as well as in custody. The intention is to implement the guidance in due course.

The management and care of transpeople in prison is a complex issue, and the review is using the expertise developed by NOMS practitioners, as well as engaging with relevant stakeholders, including those from the

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trans community, to ensure that we provide prison staff with the best possible guidance. The Government are committed to tackling all forms of discrimination and the underlying cultural attitudes that underpin inequality, so that everyone, regardless of gender, race or background, is given the opportunity they deserve.

I can also announce to the House that Kate Lampard has been appointed interim chair of the independent advisory panel on deaths in custody. She is a former barrister previously appointed by the Secretary of State for Health to provide independent oversight of the NHS investigation into Jimmy Savile and by Serco to lead the Yarl’s Wood investigation.

Cat Smith: Thank you, Mr Speaker, for granting the urgent question, on this, trans memorial day, which, as I am sure you know, given your interest in the matter, is when we remember all those who have lost their lives because of prejudice and persecution of the trans community, on which issue the shadow Women and Equality team is working closely with the shadow Justice team. I am grateful for their support. It is unfortunate that the Secretary of State could not be here, but I would like to thank the Minister for the tone of his response. On behalf of the Labour party, I want to put on the record our sincere condolences to the family, boyfriend and friends of Vicky Thompson, who died on 13 November in HMP Leeds.

On 3 November, I raised on the Floor of the House the issue of Tara Hudson, a young trans woman placed in a men’s prison. It is a tragedy that, within three weeks of that date, we are once again discussing the issue of trans prisoners.

Statistics released last month by the Ministry of Justice show that 186 people took their own lives in prisons in England and Wales in the 12 months to the end of September 2015. That equates to one prisoner taking their own life every four days. Will the Minister confirm that tackling the issue of suicides in prisons is a serious priority for his Department? With the number of prisoners who have died in prison having risen to the highest level for a decade, it must be right for the Government to take action and assess what steps should be taken to address the problem.

The safety in custody statistical bulletin also revealed that the number of self-injury incidents reported in prisons in England and Wales rose by 21% in the 12 months to the end of June 2015. At a time when the prison population is increasing with overcrowding in cells on the rise, and the number of individuals coming forward for gender reassignment surgery is also increasing, placement of transgender prisoners on the prison estate is likely only to increase. The Minister has already touched on the issue, but will he confirm whether the National Offender Management Service will begin to record the number of transpeople who are in custody in prisons, and will he commit himself to making those figures public?

Earlier this week, the Justice Secretary confirmed in a letter to the Justice Select Committee that he had nominated a preferred candidate for the role of Her Majesty’s chief inspector of prisons. Will the Minister confirm that whoever is ultimately appointed will make tackling the rise in prison suicides a top priority? Will he agree to meet the Opposition Front-Bench team and leading trans awareness organisations to discuss the issue?

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Prison understaffing is a serious problem. Will the Minister confirm that the spending review will not lead to more cuts from the MOJ staffing budget and that adequate transgender and equality training will be offered to all MOJ staff who need it? I welcome the fact that the Minister has confirmed that his Department is reviewing these matters, but will he go further and publish the terms of the review so that the House and the public can be reassured that the issue is being assessed with the seriousness that it deserves?

Finally, does the Minister believe that the policy guidelines on placing transgender prisoners in the estate are adequate? If so, does he think that the guidelines are being applied consistently and appropriately?

Andrew Selous: I shall do my best to respond to all the points that the shadow Minister has raised. I must correct one figure: she said that there were 186 suicides, but that figure is likely to include natural-cause deaths as well. She will know that we have an increasingly elderly population in prison, which accounts for part of that rise. Of course, even one self-inflicted death in prison is one too many. I want to assure her and the House of the seriousness with which the Secretary of State, I, and the whole of NOMS take the issue.

Let me repeat that we are currently reviewing prison service instruction 7/2011. I hope that the hon. Lady will be reassured by the fact that members of the trans community are involved in the process. I stress that rehabilitation is at the heart of what we do in prisons, so it is hugely in our interest to have every prisoner in an environment where they have the best chance to rehabilitate. We need to be mindful of the safety of trans prisoners, and of all prisoners, and of our wider legal obligations. I repeat that rehabilitation is at the heart of everything we are trying to do within our prisons.

The hon. Lady mentioned overcrowding and prison officer numbers. Our sustained recruitment campaign for prison officers is bearing fruit in a significant net increase in prison officers, as I told the House at the last Justice questions. We continue to recruit prison officers, which will make it easier to deal with a number of the issues that the hon. Lady raised.

The hon. Lady asked if she could come and see me. My door is always open to Members, and I would be more than happy to meet her on this issue. I repeat that decency for everyone we have care of in custody is at the heart of what NOMS does. I recently visited Leeds prison, where the tragic event took place. I have every confidence in the governor, Steve Robson, of whom we can all be proud. He is a decent, humane man, who I am sure will have tried very hard to do the right thing.

On self-inflicted deaths in prisons generally, we are taking a number of actions because of the seriousness with which we take the issue. We are reviewing the assessment, care in custody and teamwork process, and we hope to implement improvements to it early in the new year. We have put additional resource into our safer custody work, which deals with these issues, and we have held a number of national learning days, run jointly with the Samaritans, who are expert in this area, and I attended one of those days myself.

Several hon. Members rose