Southern Health NHS Foundation Trust

Debate between Baroness Blackwood of North Oxford and Andrew Smith

Wednesday 8th June 2016 Westminster Hall

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate the hon. Member for Fareham (Suella Fernandes) on securing this vital debate and on her work with the all-party group on Hampshire and Isle of Wight. Everything that has come out or been dragged out since the tragically avoidable death of Connor Sparrowhawk, “Laughing Boy”, has highlighted the severe failings of Southern Health and the wider questions they raise about the treatment of learning-disabled people in the NHS. The facts that have emerged are awful beyond belief and are a shocking indictment of the leadership of the Southern Health trust and the appalling neglect of the most basic care needs and human rights of learning-disabled people.

As the hon. Lady said, we all owe enormous thanks to the courage and determination of Connor’s mother, Sara Ryan, and her family, as well as the other families of those who have died and suffered. Without them, there was a real risk that the hideous truth of neglect at Southern Health might not have been fully exposed. Connor’s family and other families have been let down so badly and shamefully by Southern Health, which did not share information that the family had a right to. The family were treated as the enemy at Connor’s inquest and did not even receive an apology until Southern Health was directly pressed to give one. Even today, as Sara went for mediation with Southern Health on her human rights case, it had not released background papers, as it was supposed to have done.

The Mazars report happened only because of the determination and persistence of Connor’s family. As we have heard, the failings it exposed were shocking beyond belief and have been confirmed by the CQC reports. It is important to remember some of the hideous statistics that the hon. Lady quoted; we should remember that each one is a human life. Of 10,306 deaths, 722 were categorised as unexpected, of which only 272, or 37%, were investigated as a critical incident. A lower proportion—30%—of deaths in adult mental services were investigated. Appallingly, less than 1% of deaths in learning disability services were investigated. Liaison with families was appalling, with 64% of investigations not involving the family.

I will quote what the My Life, My Choice charity from my constituency said in a letter yesterday to the new chair of Southern Health. It is a charity of learning-disabled people, for learning-disabled people. This is how things look from the perspective of people with learning disabilities. It said:

“You suggested that the Mazars report was not very important, or not true. We think it is a very important report. Our members are very worried about people with learning disabilities dying, and their deaths not being properly looked into. We know from Connor’s case that the truth is not always told, so investigations need to happen. Our members are scared because people with learning disabilities do not get the same standard of healthcare as everybody else. The Mazars report told us that if we die, our deaths will not be taken seriously.”

Someone has to take responsibility for what happened. To the families and to the public, it is unbelievable that the chief executive and medical director of Southern Health are still in post. We all understand that due process has to be followed, but nearly three years on from Connor’s death, we must ask: how long will it take before those responsible are properly held to account? That is important not just to atone for a wrong; it is crucial because of the signal it sends to others responsible for the care of learning-disabled and other vulnerable patients. It is crucial in re-establishing public confidence that those leading the provision of care are responsible and are held responsible for their actions.

I look forward to the Minister’s response to this debate. With Sara Ryan I met the Secretary of State, and I have talked and corresponded with the Minister. I know that they too are both concerned to see matters put right at the trust, and to apply the lessons more generally in the healthcare system.

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

The right hon. Gentleman is making a powerful speech. His point that no one, no matter how vulnerable, should feel fear when they go into our health services is something that should give us all pause for thought in this Chamber. But it is not only about accountability in this case; it is also about making sure that those who are watching us as we go through the process know that an independent, verifiable process will be put in place so that nothing like this can ever happen again, not only at Southern Health but throughout our mental health services.

[Mr Smith]

I very much agree with the hon. Lady, my neighbour and friend, on that important point. I look forward to the Minister’s response as to what the independent oversight will be to ensure security in future.

It will be helpful if the Minister can update us on progress in relation both to the Southern Health trust and to wider concerns in the NHS, and if he can say when he expects the CQC to publish its opinion on the trust’s response to its warning notice, with the possibility of enforcement action being taken. Will he also say when he expects the Government to be in a position to make a definitive statement on the action they will take on the conclusion of the Care Quality Commission’s wider investigation into deaths throughout the NHS? It is an enormously important issue to get right.

We all have to learn from these appalling events. We have to apply the lessons and put in place procedures and the culture so that learning-disabled people and others receive the care, treatment and respect that they deserve, and so that they can be confident that they will get that. An NHS that truly fulfils its duty of care, in which Southern Health so lamentably failed, is the only thing that can come close to a fitting memorial for Connor Sparrowhawk.

Brain Tumours

Debate between Baroness Blackwood of North Oxford and Andrew Smith

Monday 18th April 2016 Westminster Hall

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

I am humbled to speak after hearing so many moving personal stories. I am here because of Skye. Skye was five when he tragically died in August 2014, not from the medulloblastoma that he was diagnosed with but from the severe side effects of his treatment—the Milan protocol. We now know that a number of other children also developed similar side effects, and the Milan protocol has now been withdrawn. Skye’s mother, Sally, is here in the Gallery today and since his death his family have shown extraordinary courage, raising awareness of, and funding for, childhood brain tumours and setting up the charity Blue Skye Thinking to support research so that all children diagnosed with brain tumours have a better chance of survival. However, Skye’s story illustrates that, although much is working in childhood cancer treatment, some key areas are in need of urgent improvement.

[Mr Andrew Smith (Oxford East) (Lab)]

As the hon. Lady knows, I lost my dear wife, Val, to secondary tumours and it is a year to the day since she started to have palliative care. I very much share what the hon. Lady said about Skye’s case. Does she agree that, more generally, there is a cruel paradox? Progress is being made in treating other cancers but, because of the blood-brain barrier, that increases the number of people who survive to get a brain tumour. That is a further compelling argument for more research.

[Nicola Blackwood]

The right hon. Gentleman, and friend, has made an important point and I hope the Minister will respond to it. However, we should note at this stage that the overall story of childhood cancer over the last 30 years is positive. Eight in 10 children with cancer survive five years or more, compared with just three in 10 during the 1960s. We should congratulate the Government on that because it is clear that the work and funding we put into fighting cancer is money well spent. As we have heard, unlike most cancers, brain tumours are on the rise and research is underfunded, and because the money spent on cancer is effective, we must put that right.

I want to focus on childhood cancers, for obvious reasons. Despite causing more than a third of childhood cancer deaths, brain tumours receive only 6% of childhood cancer funding. Childhood cancers account for less than 1% of cancer diagnoses in the UK and of that 700 children are diagnosed with a brain tumour every year. It is the most common form of cancer affecting children and the most lethal, killing 160 children every year.

We must consider childhood cancer funding in its own right because children’s cancers are biologically very different from adult cancers and to treat them effectively requires specifically tailored research and treatment. The effect of the funding shortage, ethical challenges and small cohorts mean that 50% of childhood cancers are part of a clinical trial and the remainder are treated using standard treatment guidelines such as the Milan protocol. There are risks with that approach.

As we have heard, cancer treatment is a brutal regime and can cause long-term disability. That is particularly true of childhood brain tumour survivors, 60% of whom are left with life-altering disability. In a few cases like Skye’s, these effects can be fatal.

Student Visas

Debate between Baroness Blackwood of North Oxford and Andrew Smith

Thursday 6th June 2013 Commons Chamber

[Mr Smith]

The problem is that not enough is being done to encourage it to thrive. As was pointed out earlier, Universities UK takes issue with some of the figures, but however we characterise them the current position is pretty flat. For a global market that is expanding so quickly, it simply is not good enough.



Of course the closure of visa factories masquerading as colleges is a good thing, not least because of the impact on applicants, as my hon. Friend the Member for Islington North (Jeremy Corbyn) pointed out. They damage the reputation of UK education as well as undermine legitimate immigration control, but it is important to understand that the way the Government and UKBA have gone about their wider changes have hit legitimate universities and colleges that are an enormously important source of intellectual capital, jobs and prosperity, both now and for the future, that is worth tens of billions of pounds.

The hon. Member for Thurrock (Jackie Doyle-Price) mentioned Oxford university. Its briefing for this debate points out:

“The cumulative and frequent changes to Tier 4 policy guidance over the last few years have created increased anxiety amongst our current and prospective student body especially when some of the rule changes were applied retrospectively.”

It goes on to say:

“We have received feedback and comments from prospective students and institutions overseas about the numerous UKBA rule changes over the last few years that indicate it may be a determining factor in students choosing to study elsewhere.”

The Government have to understand that those damaging effects have an impact at a time of intense international competition, in particular for the highest calibre of undergraduates, post-graduates and researchers. The funding shortfall for postgraduates, especially compared with the United States, makes it an increasing challenge to recruit and retain the best. Oxford university makes it clear that it supports the recommendations of the Select Committee reports referred to in the motion.

Let us also recognise that the damaging impact of Government policy has not been confined to universities and university students. Indeed, the effects have been even more serious for independent colleges, whose educational and economic contribution rarely gets the credit it deserves, and seems to be totally ignored by this Government. It is deeply ironic that a Government with an ideological obsession about liberating schools for home students from state control are hammering private colleges that support thousands of jobs and billions of pounds of overseas earnings.

[Nicola Blackwood]

As a fellow Oxford MP, the right hon. Gentleman will know that I share some of his concerns about student reforms, but it is important that the debate continues with factual information. The 22% figure quoted by my hon. Friend the Member for Thurrock (Jackie Doyle-Price) is based on data from the Higher Education Statistics Agency, and is used in both the Universities UK and Million+ briefings. The points that he was just making are important, because the falls we have seen are in the FE college and private college sectors. The main concerns from the university have been about the frequent changes to student visas, which are much more of a difficulty for both students and the university. Perhaps he might like to comment on those issues, as they are the main challenges that are actually faced by the university’s students.

[Mr Smith]

I will take those comments as warm and strong support for the points I have made about the damage the changes to the visa regime have done.

The Government are denying independent colleges a level playing field and disadvantaging them in a number of respects. These include: the 2011 two-year cap on international student numbers; all the uncertainties of the twice-yearly Highly Trusted Sponsor renewal application; the denial of part-time work for students either in term time or holidays; student exclusion from the new post-study work schemes for PhD and MBA graduates; and the fact that unlike university students, PhD students at independent colleges are not exempt from Tier 4’s five-year time limit, so they cannot do a first degree in the UK before their PhD.

It is little surprising that international student enrolments on higher education courses at independent colleges fell by over 70% between 2011 and 2012, with a fall of 46% in college sector visas for the year ending March 2013. This has destroyed tens—possibly hundreds—of college businesses, cost thousands of jobs and resulted in a loss of income to the families accommodating students and to the local businesses and communities within which they spend their money.

I strongly support the motion. I hope that the Government will listen to the Select Committees that have come to the same view and take international students out of the migrations statistics used to steer UK immigration policy. I hope that Ministers will remove the unfair penalties imposed on independent colleges, work in partnership with them to develop longer-term, highly trusted accreditation and promote the contribution these colleges make. I also urge them more generally to think further and positively about how to encourage, not discourage, overseas students at all levels who want to come here, as those students invigorate universities and other education institutions and generate lots of overseas earnings, jobs and economic demand, which people here desperately need. Doing so would rebuild Britain’s reputation in the world as somewhere that welcomes international students and researchers and recognises their enormous potential contribution to our culture and economy—which, let us remember, is to the benefit of us all.

Flood Insurance

Debate between Baroness Blackwood of North Oxford and Andrew Smith

Tuesday 26th March 2013 Commons Chamber

[Nicola Blackwood]

I agree that infrastructure is vital. I believe deeply that many of the problems we face today stem from an inherited legacy of bad planning.

[Mr Andrew Smith]

rose—

[Nicola Blackwood]

My right hon. Friend—ish—the right hon. Member for Oxford East (Mr Smith) knows how difficult it can be to get accountability and solutions for constituents when responsibility falls between the Environment Agency, local authorities and Thames Water, and he might want to comment on that point.

[Mr Smith]

I am grateful to my hon. Friend-ish for giving way.

Flood waters are no respecters of constituency boundaries and we work closely on these issues. On planning, does the hon. Lady agree that, given that successive Governments and councils of all complexions have allowed so much development on the floodplain, it is perfectly proper for the state to pick up some of the responsibility by participating in insurance schemes, such as “Flood Re”, which are the only way to protect our constituents from unaffordable premiums?

[Nicola Blackwood]

Clearly, it is vital that flood insurance continues to be widely available and affordable, a point I will come to in a moment. Although there is frustration about the responsibility of different agencies working together to respond to constituents, the emergency response to flood events locally since 2007 has improved dramatically, and there have been positive developments on flood defences in Kidlington and Oxford.

However, none of that addresses the long-term strategic challenges we face, and insurance has to be at the top of that list. That is why, with all the other urgent flooding priorities that we have heard about, we have to focus on the 30 June deadline. That date dominates the lives of far too many of my constituents. They fear that they will suddenly become uninsurable, breach their mortgage conditions and have unsellable properties. While I appreciate that negotiations with the Association of British Insurers have been complex and that there is no easy solution, especially with the current fiscal situation, it is not as if we did not see this coming—it has been coming since the statement of principles was agreed in 2002.

If we are not going to hit the deadline, we need to be clear and transparent with constituents about what will happen between then and any future deal. Until now, the line has been not to undermine negotiations by giving a running commentary on them. That is not unreasonable and had an agreement been reached in time, I think that all would have been forgiven, but people need to know now how to protect themselves. Ministers have been clear about their priorities, which are to ensure that flood insurance remains widely available, affordable and fiscally sustainable. Nobody is going to argue with any of those principles, but they will not help householders to work out how to plan for their financial future.

I therefore ask the Minister the following questions. On the stroke of midnight on 30 June, will we have a free market or will we have some kind of interim extension of the statement of principles? If it is the latter, have there been any discussions about what form it will take? If the Government are going to let the free market emerge in the interim, will Ministers let it be genuinely uncontrolled, with all the pricing risks that holds, or are they considering regulation? If so, what kind of regulation, and how and when? On “Flood Re”, the current cross-subsidy is £8. Yesterday the ABI told me that the proposed levy would also come to £8, but it would have to be formalised as a tax. However, the National Flood Forum brief estimates the levy at £13. What assessment have the Government made of the levy and what mechanism would they need to regulate it? Finally, what measures are being considered to incentivise flood defence investment on a personal, local and national level? That is the only responsible way to manage flood risk on an ongoing basis.

I accept that it takes two to tango. I met the ABI yesterday and I made those points, but I am afraid that today it is the Minister’s turn. My constituents deserve to know whether their homes will be insured in July and on what terms. They deserve at least that measure of certainty, even though they live in a flood-risk zone.

Child Sexual Exploitation

Debate between Baroness Blackwood of North Oxford and Andrew Smith

Tuesday 13th November 2012 Commons Chamber

[Nicola Blackwood]

I thank my hon. Friend for that intervention. I am by no means an expert on the details of the Waterhouse inquiry. I understand that the report is very lengthy, so I have great respect for anyone who has read it in its entirety. However, I do think those who commented with such certainty would have been wise to have made sure they knew the details before making sweeping statements.

No one takes allegations of child sexual abuse more seriously than I do, but those who attempted to start a vigilante crusade of trial by Twitter were, however pure their motives, certainly not acting in the interests of the victims. At best they clouded the debate and the real issues that affect victims, and at worst they risked undermining prosecutions so that victims might be denied the very justice they deserved. Frankly, I cannot think of any more irresponsible kind of politics or journalism than that. Today’s debate should not be about allegations or rumours; it should be about how we can get better support and justice for victims.

I am daily haunted by the knowledge of what happened to those girls minutes from my home. I cannot refer to any details for fear of prejudicing the case, but that is why I am here now. It is why I called for, and secured, a Home Affairs Committee inquiry into localised grooming, and since May we have been hearing about where the system has failed, such as in Rochdale, and about the reality of the ways in which victims experience child sexual exploitation. Repeatedly I have been told that victims initially do not see themselves as victims and, in a cruel irony, even when they do they struggle to gain credibility from the very agencies meant to protect them.

[Mr Andrew Smith (Oxford East) (Lab)]

I commend the hon. Lady and colleagues for securing this enormously important debate, and of course I share her horror and concern at the events in Oxford. Do reports such as ChildLine’s excellent “Caught In A Trap” not scream out that these young people need to have confidence that there is somebody they can go and talk to? Do we not need a pervasive national campaign saying that it is okay to talk about it, coupled with suitably trained teachers, social workers and others to whom young people can go with confidence?

[Nicola Blackwood]

I thank the right hon. Gentleman for his comment. As we are both Oxford Members, we have shared the difficulty of realising that a thing such as this could happen in Oxford. I agree with him on the importance of victims feeling that there is somewhere they can go and that they will be believed when they go there, but it is important that, first, victims realise that that is exactly what they are—victims. One problem is that many victims are slowly lured into exploitation by someone posing as a boyfriend and are then kept under control by threats. They are encouraged to commit petty offences, drink, take drugs and play truant. During that process, their relationship with their school, their family and their carers increasingly deteriorates and they become seen as disruptive and a bad influence, with the police and social services perhaps considering them to be petty criminals who are making “bad choices”. In that context, their relationship with their real family deteriorates ever more and their relationship with and dependence on exploiters, whom they see as their real family, becomes ever more entrenched, with threats, violence and intimidation commonplace.

Flood Defences

Debate between Baroness Blackwood of North Oxford and Andrew Smith

Tuesday 21st February 2012 Westminster Hall

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

It is a pleasure to serve under your chairmanship, Mr Dobbin.

According to the Association of British Insurers, Oxford West and Abingdon is the constituency with the 49th highest flood risk in the UK, with more than 2,000 homes and businesses at significant risk of flooding. That assessment excludes risks associated with surface flooding caused by heavy rainfall. Despite the high level of local flood risk, the Oxford flood risk management scheme received such a low cost-benefit analysis that even under the new “all or part or none” funding provisions, it will be necessary to find non-Department for Environment, Food and Rural Affairs funding for 92% of the project, or approximately £127 million of the £133 million project. At the same time, in Abingdon, where nearly 500 homes and businesses were flooded badly in 2007, neither of the flood storage proposals for the River Stert or the River Ock reached even that level of cost-benefit threshold: they were rejected outright as “not economically viable”.

Those decisions have been disappointing to many, especially those whose homes and families are at risk of flooding, but everyone understands that we are in a time of austerity and that the money must go where it will do the most good—that is fair. Having said that, we heard just before the recess the good news that there would be a lot of weir work going on: Osney weirs A and B and Godstow weir B will receive funding. Design and appraisal work for raised flood defences at Lower Wolvercote, and the Farm road scheme in Abingdon in partnership with the Vale of White Horse district council, will go ahead. This last project’s bid for £40,000 in funding was rejected in December. I am pleased that the Environment Agency has had a change of heart on its viability.

I began this debate by outlining at some length the flood context in my constituency, and will come on to discuss the key issue—funding the replacement for Northmoor weir from flood defence funding—for two reasons. The first is to make the Minister appreciate fully that for far too many people in my constituency, the spending of flood defence money is not a bureaucratic issue to do with balance sheets. Hundreds of people were made homeless for months in 2007, losing prized possessions, mementos and even pets to the floods. Those memories are still raw. Given the current economic situation, we have had to cut flood defence funding by 6%. I need to be able to assure those constituents that, even where money cannot be spent locally, the Government are spending, transparently and accountably, each and every penny of available flood defence funding in the best possible way. Anything less than that is unacceptable.

Secondly, I am not taking issue with flood funding provision in other parts of my constituency today. My concern, and that of my constituents, is the Environment Agency’s programme to replace all paddle and rymer weirs on health and safety grounds and, in particular, the replacement of the Northmoor weir in the village of Appleton in my constituency. My constituents in Appleton and elsewhere have opposed the idea since before my election. Indeed, my first meeting with the Environment Agency and local residents on the subject dates back to before I was elected in 2010. The Minister knows the background only too well following our extensive correspondence, but for the sake of colleagues, I will outline the salient points.

Northmoor weir, like all paddle and rymer weirs, is manually operated by lock-keepers who pull the paddles and rymers out of the weir system to adjust the water levels. The weir has been operating in that way for more than 200 years. Northmoor weir was extensively refurbished in 1995 and given a 40 to 60-year lifespan. Between 2008 and 2010, however, the Environment Agency decided to conduct extensive health and safety tests on the weirs. It is unclear why it suddenly decided to do so, given that the relevant legislation dates back to 1992, before the refurbishment of Northmoor weir, and given that there is no record of a serious injury, which might reasonably be supposed to have triggered such a response.

The report, by HJ Consultants, was of the opinion that it was only a matter of time before there was a major injury on the paddle and rymer weir. That is despite the fact that the only injuries recorded under the safety, health and environmental reporting and management system since 2000 are strains, sprains and splinters. Even before the introduction of that system, the assessor could only record one brain haemorrhage, in 1991, that may or may not be attributed to the pulling of a paddle and, before the introduction of safety harnesses, an incident in which a lock-keeper at Blakes weir fell in. I assume that safety harnesses have now addressed that situation.

The consultant found that the loads at the weir exceeded the levels recommended by the Health and Safety Executive, but found no evidence that that had caused any significant problem in more than two centuries of use, even though the consultant found that there had been no regular programme of health and safety training offered to lock-keepers, with one lock-keeper last receiving manual handling training more than seven years ago. Just think how many fewer sprains and splinters there might have been if regular training had been provided during that time, and if there was a work pattern that provided a formal break for lock-keepers in the morning, as recommended on page five.

Should the Minister think I am being a little hard on lock-keepers, here is what one of them wrote to the Prime Minister on the issue:

“My work over the years included the operation of both Paddle and Rymer and more modern weirs, and I can say that, with proper training, care and safety precautions, there was very little danger involved. Any equipment can be worked dangerously. The worst scenario was the possibility of misjudging the placing of a rymer or a paddle in the flowing water: one had the choice between trying to save it or losing it through the weir! It was not a very hard choice! Also, it was not actually lost, and would float around in the vicinity until retrieved later.”

That is just one of many similar comments I have received from Thames lock-keepers. Nevertheless, it was on the basis of that health and safety report that the Environment Agency decided it was imperative to spend £2.6 million from the flood defence funds to replace Northmoor weir.

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate the hon. Lady on securing this important debate, which of course touches on matters that affect my constituency, too. Will she join me in congratulating the Oxford Flood Alliance for its work, and does she agree that the Environment Agency generally takes better decisions when it takes notice of what the OFA and local residents have to say? Even if the health and safety case was accepted, the Environment Agency should be funding the project not from flood prevention money, but from some other budget.

[Nicola Blackwood]

The right hon. Gentleman makes a very good point. The Oxford Flood Alliance has stated publicly, and to me personally, that it has significant reservations about the project.

The Environment Agency has stated that the project will improve the weir’s resilience and speed of operation. At a meeting of the Environment Agency, Northmoor and Appleton parish councillors and me in December, the EA acknowledged that there had never been any problem with the operation of the weir, even in times of flood. It is important to note that the project will not reduce flood risk. The EA specifically confirmed to me in writing, and at the meeting of December 2011, that the project will not reduce flood risk in any way, and that in any case—according to the EA—the number of properties affected directly by the operation of the weir amounts to five. That comes out at £500,000 per property, if we are counting. Nevertheless, the finance will still come from the flood defence budget.

According to the EA in December 2011, the project has such high priority that it would go ahead even if it cost £10 million. On hearing that extraordinary statement, I became uncomfortably well acquainted with the health and safety apparatus of Whitehall, as every good constituency MP should. On writing to the HSE, to ask whether such a position was reasonable, I was told:

“The EA has carried out an extensive risk assessment. The aim of the risk assessment is to help the EA identify reasonably practicable ways of reducing or controlling the risks of injury from operating the weirs. As part of this, the EA would need to consider costs and their likely effectiveness in reducing the risks.”

I have been astonished to learn, however, that EA policy is apparently not to conduct cost-benefit analyses for health and safety projects, even if they come from flood defence funding, a budget considered so precious that all flood defence proposals must be subjected to rigorous cost-benefit analysis. I was told by the EA in December that that was because the policy was to eliminate all risk.

Being joyfully unfamiliar with the health and safety world until then, I thought that cost-benefit analyses might not generally be conducted for health and safety. In fact, the Manual Handling Operations Regulations 1992, which are the relevant health and safety regulations, state:

“The extent of the employer’s duty to avoid manual handling or to reduce the risk of injury is determined by reference to what is ‘reasonably practicable’. This duty can be satisfied if the employer can show that the cost of any further preventive steps would be grossly disproportionate to the further benefit from their introduction.”

The concept of “so far as is reasonably practicable” was tested in case law as far back as 1949, in Edwards v. National Coal Board, which established that a computation must be made in which the quantum of risk is placed on one scale and the sacrifice, whether in money, time or trouble involved in the measures necessary to avert the risk, is placed on the other. If it be shown that there is gross disproportion between them, the risk being insignificant in relation to the sacrifice, the person upon whom the duty is laid has discharged the burden of proving that compliance was not reasonably practicable.

It is clear, therefore, that what is required by law is not to eliminate the risk, as I was informed, but to reduce the risk to what is reasonably practicable and to consider the cost of doing so. Any action in which the cost was grossly disproportionate would not be required by law, and the HSE expected the EA to have considered the cost. Indeed, freely available on the HSE website I found not one but two helpful documents that walked me through how to do a cost-benefit analysis for a health and safety project, one of which even had a user-friendly checklist. I am not a lawyer, though, so I asked to see the EA’s legal advice, to see if there were grounds for the multi-million-pound health and safety investment that I had failed to grasp. The EA, however, confirmed that before committing to the full replacement of nine paddle and rymer weirs as the only appropriate level of response to its legal responsibilities under health and safety legislation, it had taken no legal advice of any kind.

The picture is now fairly clear, but before closing, I will express one further concern that has arisen in discussions about EA plans for Northmoor weir. It is about the really poor standard of consultation and communication that has marked the process from the beginning. Appleton residents, who will bear the brunt of building disruption if the project goes ahead, found out about the project when there was an application for suspension of parking along the route to the weir. Understandably, that led to outrage in the village and a vigorous local campaign by the parish council and the Weir Action Group, but despite delaying the work for a year, ostensibly to consult with the local community, the only change that the EA has made to the project so far was the proposal for a change of access route, so that Appleton residents experience less disruption during the two years that the work will take.

Obviously, if the weir goes ahead regardless of every objection I have put forward today, it is clearly preferable that the works route is not directly through the village, but the local objections, and the objections from some on the far side of the river and from others at risk of flooding in the rest of my constituency, are not simply about a works route. They are about the whole justification of the project, and its funding from the flood defence budget. To characterise them as anything else is simply inaccurate and misleading.

Other concerns about the quality of consultation have come to me from owners of nearby land considered for use in possible access routes. One wrote to me to say:

“At no time has the EA been in direct contact with us (or any of the relevant landowners I believe). I first heard of the whole project in February 2010—the proposed start date for the project then was 1 April 2010! I was then rung by a neighbouring farmer to warn me that the Contractors for the EA were going to come and survey our land but…the Contractors…had been unable to find out who owned our land and had contacted him for our telephone number. I phoned the contractors who paid me a visit prior to doing the survey. They were perfectly pleasant but I think as shocked as I was that the EA had not been in contact with me. The survey was duly done but we have never received any information or follow up from either the Contractors or the EA since”.

I am afraid that that example is not isolated. Failure to follow up meetings, to contact individuals or to communicate more widely have been hallmarks of the project so far.

The EA accepted in the December 2011 meeting that there had been significant such failures, but that does not seem to have stopped it, as is evident from a letter from the chairman of the board of the Environment Agency—briefed, I assume, by his officials—to the Minister. The letter claims that I believed that the £2.6 million being spent on the weir should be transferred to other local flood defence schemes. The Minister must know that I have never made that suggestion, and nor would I.

I said that when other flood defence schemes locally were being turned down, it was difficult to justify spending £2.6 million on health and safety, which is what it is. I said that flood defence money must be allocated on the grounds of greatest need, wherever that might be. I fully accept that, and my constituents fully accept that, but I am unable to assure my constituents that that is what is happening in this case, because the necessary due diligence on the project was never done. I said that when every flood defence proposal that is granted funding is first tested to destruction by EA cost-benefit analysis models, it is incomprehensible that in this case the EA is willing to spend millions of flood defence money with no cost-benefit analysis of any kind, with no legal advice of any kind and with no analysis of alternatives that would work for Northmoor weir specifically.

I ask the Minister, therefore, to ensure that the EA suspends the project until there has been a full and transparent cost-benefit analysis. On Wednesday, I discussed the project with the Prime Minister, as the MP for the other side of the weir, so I know that he has also written to the Minister asking for that to be done. The Prime Minister is also concerned that we should be able to defend our flood defence spending fully to the public. We will not be able to do so, however, until there is also sound legal advice that this multi-million pound health and safety investment is reasonably practicable, and not grossly disproportionate, and, most sensible of all, until we have a genuine Northmoor-specific study to see if there are more proportionate options that will meet the EA’s genuine health and safety obligations.

My constituents face flood risk daily, but they are not asking for preferential treatment or for funding of projects that do not meet the cost-benefit thresholds set by DEFRA. All they want to know is that flood defence money is being spent on genuine flood defence projects, and that every single penny of that budget can be transparently accounted for. All they want is a fair playing field.

Medical Students

Debate between Baroness Blackwood of North Oxford and Andrew Smith

Tuesday 3rd May 2011 Westminster Hall

[Mr Andrew Smith (Oxford East) (Lab)]

It is a pleasure to have this debate under your chairmanship, Ms Dorries. I am very pleased to have the opportunity to raise some key issues about the funding of medical students. Aspects of the upheaval in higher education funding are, of course, important both for the recruitment of doctors and the availability of opportunities to study for the medical profession. They are of particular concern in my constituency, which is home to 1,000 undergraduates and 1,300 postgraduates in medical sciences. I am grateful for the briefing that I have received on the matter from the British Medical Association and the Oxford university medical sciences division, as well as for the concerns that constituents have raised with me on these issues.

At a time when higher education as a whole faces the challenges and dangers of the 80% cut in university teaching support and the trebling of fees, concerns about the costs of and access to medical education are all the greater. The length and intensity of medical courses both add to the cost to students and limit their opportunity to supplement their income through paid work.

The BMA estimates that, under the present system, medical students graduate with some £37,000 of student debt. With all universities charging or set to charge £9,000 for medical studies under the new regime, the BMA estimates that that figure will go up to around £70,000. That does not count overdrafts, credit cards, professional loans or family borrowing. We do not need to exaggerate the impact of prospective debt on students’ choices to be concerned that debts of £70,000 or more might be a barrier to able people from poor—or, indeed, middling—backgrounds who are considering entering the medical profession.

My concern is about the funding position facing all medical students. However, on the challenge facing us on widening participation, there is likely to be a triple impact on entry to medical studies. The A-level admission grades are understandably particularly demanding and poorer students from schools serving poorer areas are less likely to achieve them, which clearly demands further action within the school system. The requirement of medical work experience is also likely to be harder to fulfil for school students from financially hard-pressed families or, indeed, from families with no connections to the medical profession. At the same time, the prospective length and costs of study are considerably higher and it seems plausible that those are also having an impact on the relatively low rates of admission to medical studies from poorer socio-economic groups.

Statistics on admissions show that the wider challenge of opening up access to higher education is certainly compounded in the case of medical studies. The BMA equal opportunities committee report published in October 2009 includes a review of UCAS data. It states:

“The proportion of acceptances to medical school coming from socio-economic class I (31%) was almost twice that of acceptances to all other degrees from class I (16 %). Just 15% of students accepted into medical school came from the four poorer socio-economic classes (grades IV to VII) compared with 24% of students accepted to all degrees.”

The BMA has also said:

“The percentage of students from lower income families is slowly improving across the higher education sector but the rate remains stagnant in medicine.”



In the light of all that and the Government’s stated commitment to widen access to higher education, I would like to ask the Minister what the Government’s specific proposals are to widen the pool of talent entering medicine and whether the Government, in bringing forward the higher education White Paper, will look at the likely special factors at work in relation to medicine? I have listed some of those.

Will the Government also consider the advice and support given to able students in school, the necessity and operation of the work experience requirement and the £75 cost of the UK clinical aptitude test used as part of the selection process? That test gives an early signal to students from poor backgrounds that studying medicine is an expensive undertaking.

An important part of overall support for medical students is the provision of bursaries. As the Minister will be aware, the future shape of those has been uncertain for some time. The previous Government consulted on options for change in 2009, and last month the present Government set out new options for reforming the system.

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

As I represent the other half of the Oxford university seat, the right hon. Gentleman will know that I share many of his concerns. In the light of his valid concerns about equal representation among medical students, does he agree that now is the crucial time to decide about the NHS bursary scheme, given that many students are deciding which courses to apply for?

[Mr Smith]

I am grateful to have the support of my colleague. I might describe her constituency as covering the other third of Oxford university. Her support on that point is very welcome. I was about to say that people are already asking what the situation will be, and obviously the sooner they can have certainty, the better.

The BMA has joined other bodies in consulting on the issue, and I understand there is some expectation that agreement will be reached. However, one big outstanding question is whether the new proposed bursary arrangements will cover tuition fees in the same way as they are covered now, with the Department of Health paying the fees for years 5 and 6 of an undergraduate course. If the bursary does not cover fees—it seems extraordinary that Ministers have not yet made the Government’s position on that clear—medical students would obviously face still higher costs and debt.

As my colleague and friend the hon. Member for Oxford West and Abingdon (Nicola Blackwood), whose constituency represents the other third of Oxford university, says, mounting urgency on that matter arises because would-be applicants worry about how the arrangements will work for 2012-13. I press the Minister to give an undertaking that tuition fees for medical students will be covered at least as well as they are now.

Equitable Life

Debate between Baroness Blackwood of North Oxford and Andrew Smith

Tuesday 20th July 2010 Westminster Hall

[Nicola Blackwood]

I agree entirely. A key concern during the general election campaign was the fear that the saving culture in this country, which for so long had been part of our economy, had been completely destroyed. We must do everything we can to avoid entrenching that destruction.

[Mr Andrew Smith (Oxford East) (Lab)]

The hon. Lady, who is my fellow Oxford Member, makes her case passionately and effectively. Is not the crucial point that we get a commitment to transparency and fairness, which is what EMAG has been calling for, and that it would therefore be helpful to hear from the Minister on how the coalition Government intend to change and enhance the remit that was given to Sir John Chadwick?

[Nicola Blackwood]

Transparency must clearly be at the heart of any process we now embark upon. As I have said, with trust at an all-time low, the only way we can ensure a process in which all partners can take part is by showing that we are not in some way trying to brush under the carpet some of the problems that the previous Government did.