Lower Limb Wound Care

Debate between Ann Clwyd and Jim Shannon

Tuesday 23rd July 2019 Commons Chamber

[Ann Clwyd (Cynon Valley) (Lab)]

As you know, Madam Deputy Speaker, I do not normally sit when I speak in this place, but half an hour ago I was in a hospital bed on the 12th floor of St Thomas’s when I heard that this debate was coming early, rather than later. There was a big rush to get me here, and there are very good doctors and nurses in the Gallery who helped me to get here, because I thought it was tremendously important to speak. I had secured this debate, for which I am very grateful, and I particularly wanted to talk on this subject. I was pleased to get it before the recess, and I was not going to miss it for anything. After we finish, I shall be returning, I hope, to the 12th floor of St Thomas’s and to very good care.

The subject of this debate was brought to my attention by Lord Hunt, our colleague in the House of Lords, where they had a debate not long ago about what plans the Government have to develop a strategy for improving the standards of wound care in the NHS. As somebody who needs wound care right at this moment, I know what a big subject it is. I did not know before—I was totally ignorant—but I have discovered what a challenging subject it is for so many people.

As a patient myself, I can talk about the subject with some feeling. I have to say that it is the most painful thing I have ever come across, and I had no idea that people suffered this kind of pain. A week ago, when I had to be taken to a local hospital in Merthyr Tydfil, I was asked by an ambulance driver what level of pain I was in, on a scale of one to 10, and I said, “Nine.” I do not usually exaggerate; it was that painful. I am grateful to everybody who has helped me, and I want to make sure that the service develops and people get all the help they need in such circumstances.

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. Member for Cynon Valley (Ann Clwyd) on securing the debate. She often features in Adjournment debates in this House. We are very pleased to see her in her place, and we thank her for all that she does. Does she agree that many people fear that the NHS neglects leg ulcers and the required treatment is not being given? The latest statistics, according to Dr Adderley’s speech at the Health Service Journal patient safety congress, show that leg ulcers account for 40% of chronic wounds but only 7% of the chronic wounds that are treated. There is quite clearly an anomaly.

[Ann Clwyd]

I am grateful to the hon. Gentleman for making my speech for me. I am sure we will be in total agreement as my speech develops.

Some interesting points were made during the debate in the other place, including the point that wound care is a massive challenge to the NHS, but it currently lacks priority, investment and direction. I want to push the Government, if they need pushing, on the need for urgent action and the development of a strategy across care providers to improve the standard of wound care.

A staggering 2 million patients are treated for wounds every year, at a cost of more than £5 billion and rising. While 60% of all wounds heal within a year, a huge resource has to be committed to managing untreated wounds. The NHS response is very variable. Healing takes far too long; diagnosis is not good enough; and inadequate commissioning of services by clinical commissioning groups compounds the problem, with under-trained staff and a lack of suitable dressings and bandages.

There has also been a very worrying drop in the number of district nurses, whose role in ensuring safe and effective wound care in the community is crucial. I was shocked when I talked to a friend in Cardiff about the problem of putting on surgical stockings, and her experience highlights the need for district nurses. My friend had had a serious operation, and she could not bend to pull on the stockings. I asked her what she did, because she is a widow who lives on her own. She said, “I go out in the street and ask somebody to help me.” I am sure that people are very ready to help, but no one should be in that situation. I think we would all agree that the drop in the number of district nurses is very worrying.

I am told that, ideally, 70% of venous leg ulcerations should heal within 12 to 16 weeks, and 98% in 24 weeks. In reality, however, research shows that healing rates at six months have been reported as low as 9%, with infection rates as high as 58%. Patients suffer, and the cost of not healing wounds swiftly and effectively can lead to more serious health problems, such as sepsis, which is often the result of an infected injury. We also know that foot ulcers on diabetics can unfortunately lead to amputations if they are not dealt with properly.

In the other place they talked about the Bradford study, and there is a very good summary of it in the House of Lords Library. It underlines the importance of evidence-based care, with nearly one third of patients interviewed in the study failing to receive an accurate diagnosis for their wound. As the study puts it:

“Wound care should be seen as a specialist segment of healthcare that requires clinicians with specialist training to diagnose and manage…There is no doubt that better diagnosis and treatment and effective prevention of wound complications would help minimise treatment costs”.

We learn most of all from our own experience. My experience is that when I first developed a farthing-sized spot on my leg, I did not know what it was. I asked my chiropodist, who looked at it a few times and said, “I think you had better go and see your GP.” I went to see my GP—a very good GP—who did not know what it was either. Eventually, I was referred to a skin specialist—this is some weeks ago, now—who looked at it and said, “I don’t know what it is, but why don’t you try putting Vaseline on it?” Now, I do not think the experts up there in the Gallery would think that that was a very good idea, but I did put Vaseline on it and I do not know whether that did me any harm or not. You do worry a lot when something like that happens, whether you have knocked your leg or injured yourself in some other way, and you wonder what on earth it could be.

I think that maybe diagnosis is difficult, but rapid diagnosis is absolutely essential. I am sure the Government would agree that we need to get to grips with a nationally driven strategy. Without it, patients will receive worse care for their injuries and the financial burden on other parts of the NHS will continue to increase, because patients develop chronic wounds or catch an infection that could lead to life-threatening illness.

During the course of my journey, I have met many interesting people. For instance, I did not know there was an all-party group on vascular and venous disease. I just happened to see it in the all-party notices the day after I had been in St Thomas’s. I rang up the chair, the hon. Member for St Ives (Derek Thomas), and asked him if I could come along to a meeting. He said that I was welcome to. I went along and, apart from the chair, I think I was the only MP there. There was a fascinating mixture of people, who were all involved in this problem in some way.

There was somebody who runs a leg clinic, who had a lot of stories to tell. In fact, she sent me a whole pile of patient stories—there is not time to read them out today, but they are very interesting. I realised how difficult it is for patients to get the right diagnosis and the right treatment. I took a list of all the people—they are mainly consultants—and I know that some people in St Thomas’s would have come along if they had known of the existence of such a group. It introduced me to the Lindsay Leg Club Foundation, which is run by Ellie Lindsay OBE, who is the president. There are leg clubs in many towns and cities around the country. She was very encouraging—I say that as somebody who was a bit afraid when they realised what they had. She rang me up several times, and her patient stories were fascinating.

NHS Complaints System: Wales

Debate between Ann Clwyd and Jim Shannon

Wednesday 4th July 2018 Commons Chamber

[Ann Clwyd]

The normal is less than six; it was 8.7 on Owen’s admission, and eight days later it was 10.6.

Doctors will tell us that they do not just look at the results of blood tests; they also look at the patient. In Owen’s case, they failed to look at the blood tests and they failed to look at the patient. Members will no doubt be surprised to hear that although Owen’s inflammatory markers had increased during his second week in hospital, this was not recorded in his clinical notes. The tests that noted the increase in CRP and the neutrophil count were done on the Friday. That was four days before his death from hospital-acquired pneumonia. No one saw the results. No one saw Owen. No doctor saw him on Saturday. No doctor saw him on Sunday. By Monday, it was too late. I think it is reasonable to assume that if Owen had received effective antibiotics when his inflammatory markers were increasing, he would have stood a fighting chance and would have survived that infection.

I continue to be shocked by the way the hospital board has dealt with my concerns. Members might have heard of so-called independent reports. There was nothing independent about this particular report. All the members were employees of the Cardiff and Vale University Health Board. The chair was the deputy nursing director, Mandy Rayani. The board’s investigation failed to comment on the medical deficiencies that I have mentioned, but it very quickly acknowledged my “adverse perception” of what happened.

Most of my claims of poor care were denied. Of the 31 concerns that I raised, 21 were rejected. This was despite the fact that a few weeks after my husband’s death, Health Inspectorate Wales, the body that inspects Welsh hospitals, visited the ward where my husband had been a patient. While it was inspecting the ward, it noticed that senior nurses went off for their lunch leaving patients who needed assistance to eat without any help, that some patients were found without buzzers to call for assistance, and that individual care plans were not in place for the patients, yet my concerns were dismissed as my “adverse perception” by the deputy director of nursing, Mandy Rayani, in UHW’s so-called independent report.

I remain unhappy with the attitude of the health board. When Owen died, the chief executive was Adam Cairns. He has now left the country and is working in the middle east. When he left, I took my complaint up with other executives and I have found—as I did when I was writing my report for the Government on hospital complaints—that the culture of deny, delay and defend has continued.

I wrote to Maria Battle, the chair of the health board. I wanted to know why no one had spotted the abnormal blood results. I wanted to know why Owen’s low grade temperature did not appear to be of concern to anyone. The first meeting was postponed. We eventually met on 2 August last year. Despite my PA telephoning the board to ask for a copy of its response a week earlier, my medical colleague and I were not allowed to see the report until we arrived in the building for our meeting. I was astonished to hear Ruth Walker, the senior nurse, saying that she had taken it upon herself not to release the report prior to the meeting. I would have expected such a decision to be made by Maria Battle as chair of the board, by Dr Graham Shortland, the medical director, given that the matters mainly related to medical care, or by Dr Sharon Hopkins, who at that time was the acting chief executive.

I believe that the decision of the board to refuse to release this document beforehand reflects its dismissive, insulting and gratuitous attitude to members of the public and to the families of loved ones. It reflects the overall cover-up mentality that is all-pervasive in this health board.

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. Lady on securing this debate and on the very personal and poignant way in which she has told the story of her husband’s last few days in hospital. Has she at any stage considered referred this matter to the medical ombudsperson and asking them to investigate her complaint? Hopefully, they would come up with an answer that would satisfy her and perhaps give the Minister a way of taking this forward.

[Ann Clwyd]

I am grateful for that kind intervention, and I can assure the hon. Gentleman that I have been down all the official routes.

At the meeting, I soon discovered that it was impossible to get straight answers to my straightforward questions. Ruth Walker, for example, said that the problems of Owen’s care have been addressed by the introduction of the EWS—early warning signs—system. When my medical colleague pointed out to her that all the nursing notes were entered in the EWS format, she could not come up with an explanation. I was also astonished that Dr Shortland was unable to give a straight answer when asked about the arrangements for weekend medical cover. The board members were prepared to hide behind another independent report, but the report was incomplete, failing to comment on Owen’s continuing low grade fever, the rise in his white blood cells, the rise in his C-reactive protein count, the failure of an effective handover process between medical staff and why no doctor saw Owen during his two weekends in hospital.

I have always been a strong supporter of our national health service. I can be proud of representing Cynon Valley, a constituency that is both geographically and philosophically close to the community that bred Aneurin Bevan. It was the community that formed Bevans’ views on the need for an effective health service that is free at the point of need and where the quality of care is not influenced by one’s ability to pay.

Long before becoming a politician, I was on the Welsh Hospital Board from 1970 to 1974 with people such as Arianwen Bevan-Norris, who was Aneurin Bevan’s sister, and Archie Lush, his agent, and I know what they would be saying to me today: “Carry on. Keep on going.” They would not have accepted these kinds of answers. I was also the only Welsh member of the royal commission on the national health service, which met for three years from 1976 to 1979. We made many recommendations at the time, but they were unfortunately not acted upon. If they had been, I am sure that some of today’s problems would have been avoided.

The House will understand my sorrow at the loss of Owen. It is heartbreaking to find that the people whom we appoint to safeguard our services, and who benefit from a significant income and a highly respected position in our society, are unable to address the failings of their organisation, engaging instead in obfuscation and half-truths. The cover-up mentality has to stop. We all make mistakes, but we should be ready to admit them.

My case is not unusual. I have previously told the House of the thousands of letters I received from people from all over the country when I was producing a report for the Government on complaints in England. I knew that the NHS did not treat its complainants well, but I did not expect to be here still looking for answers nearly six years later. In the past, Mr Speaker has allowed me to read out letters that I have received, and more than 4,500 people have written to me about NHS complaints, 500 of which related to the University Hospital of Wales. I am sorry to say that two of my close friends have since died at the same hospital, and complaints have been made about their treatment as well.

In the introduction to the shocking report on Gosport War Memorial Hospital, which was published a few weeks ago, Bishop James Jones of Liverpool said that

“what has to be recognised by those who head up our public institutions is how difficult it is for ordinary people to challenge the closing of ranks of those who hold power. It is a lonely place, seeking answers to questions that others wish you were not asking.”

I will continue to ask those questions on behalf of my family and of the many others who are grieving and who have not had answers.

International Human Rights Day

Debate between Ann Clwyd and Jim Shannon

Wednesday 20th December 2017 Westminster Hall

[Ann Clwyd (Cynon Valley) (Lab)]

I beg to move,

That this House has considered International Human Rights Day and the UK’s role in promoting human rights.

It is a pleasure to serve under your chairmanship, Ms Dorries. I am very pleased to have been given a Westminster Hall debate this year to mark International Human Rights Day, which was on Sunday 10 December, and to discuss the UK’s role in promoting human rights, including on the international stage.

Highlighting the fundamental importance of international and universal human rights to each and every one of us in the UK and abroad, and of the UK remaining a human rights champion on the international stage, is still vital. The international human rights framework, much of which emerged out of the destruction and the depravity of the second world war, with millions killed, destruction and despair widespread and those deemed undesirable led to the gas chambers, is under considerable threat. Authoritarian regimes the world over are trampling over hard-won rights such as freedom of expression, assembly and association, the rule of law and judicial independence, the right not to be arbitrarily detained or tortured, and even the right to life itself.

[Jim Shannon (Strangford) (DUP)]

I thank the right hon. Lady for bringing this debate to Westminster Hall. Unfortunately, half an hour is not enough, but that is by the way. Does she share my share my concerns that, according to the Pew Research Centre, approximately four out of every five people on this planet live in countries where their right to freedom of religion or belief is significantly and violently restricted?

[Ann Clwyd]

Yes indeed, and I thank the hon. Gentleman, who is always about on these issues, and is very often heard in the Chamber.

Principles, processes and people are unfortunately viewed as expendable if that is justified by the needs of the ruling elite: national security, state unity, the fight against terrorism and/or the quest for greater development or prosperity. That is increasingly apparent in a growing number of countries, such as Russia, Egypt, Turkey, Bahrain, Ethiopia, Cambodia, Burma, North Korea and Venezuela. Of course, that list is not exhaustive; I could go on and on, unfortunately, as I have not even mentioned those countries being ravaged by violent conflict.

International Human Rights Day

Debate between Ann Clwyd and Jim Shannon

Tuesday 13th December 2016 Commons Chamber

[Ann Clwyd (Cynon Valley) (Lab)]

Before I start my speech on International Human Rights Day, I would like to a quote a tweet that has just been received from Matthew Rycroft, our excellent UN ambassador in New York. He says:

“For every barrel bomb dropped

For every chemical weapon deployed

For every bullet fired on innocents

There will be accountability.”

I am sure the Minister will support that, because throughout the war in Syria and Aleppo we have constantly asked questions about who is collecting evidence.

I apologise for my croak. I will have a drink of lemonade every so often and see whether I can get through my speech.

I am here to mark International Human Rights Day, which was on Saturday 10 December. I will provide a brief overview of the countries and issues of the most concern. The fact is that although most countries have signed and ratified the main international human rights conventions, many people in the world—far too many—continue to be the victims of serious and systematic human rights violations such as torture, extra-judicial killings, arbitrary detention, disappearance, slavery and overt discrimination. State officials, who are meant to serve their fellow citizens, often use their powers to terrorise and subjugate them, whether in the name of national security or counter-terrorism; to uphold a kleptocratic regime in which they have a vested interest, because they are tainted by society’s prejudices; or even just because they can get away with it.

Sadly, human rights are too often referred to in a disparaging or dismissive way in the UK. I believe that disregard may stem at least in part from complacency, misunderstanding and possibly even incredulity. It is all too easy to take rights for granted when, by and large, we benefit from them, although of course I am aware that we are all far from perfect, have deficiencies that need to be addressed and must remain vigilant to ensure that our rights are not eroded. It can be challenging to imagine the real suffering endured by the many millions who have their rights violated, and it can be distressing to believe that people can still treat others with such disdain and cruelty. However, as most of us here know, terrible things happen every day, everywhere. Many of us have had the privilege and honour of meeting victims of human rights violations all over the world, who have given us detailed testimony and whose courage and dignity are simply astounding.

I am concerned that, post-Brexit, we are heading for even more challenging times. I fear that we will become so consumed by “Project UK” that, whether deliberately or inadvertently, the importance of the international human rights framework and the promotion and protection of universal values throughout the world will be downgraded at the expense of more short-term prosperity and security considerations. In addition, I fear that the UK leaving the EU could make it more difficult, not less, to speak out and act when serious and systematic violations occur. In the first instance, we are bound to have less leverage acting on our own, and in the second, how often will the UK put its head above the parapet on its own? I would be grateful if the Minister reassured me on those points.

I turn to specifics. I know that there was a very good debate this afternoon on Aleppo. Unfortunately I was in the Foreign Affairs Committee at the time, where we were debating, among other things, arms exports from our own country and how we continue to police them. There can be no doubt that Syria has long been a repressive state with a virtual absence of outlets for non-violent dissent.

I remember going to Syria some time ago, on behalf of the Inter-Parliamentary Union committee on the human rights of parliamentarians, to visit two imprisoned Syrian MPs. Let us say that I was left in no doubt during my visit about the Syrian Government’s utter lack of respect for their human rights obligations, and for the fundamental political rights of their citizens. Understandably, the people of Syria became tired of being subjugated and tried to break free. The Government instituted a brutal crackdown, from which a civil war followed, resulting in mass atrocities, carried out in the main by the Syrian and Russian Governments, although they are not the only perpetrators. Schools and hospitals have been deliberately targeted; thousands have been detained and tortured; hundreds of thousands have been killed; and millions have been forced to flee their homes.

Earlier this year, the Office of the UN High Commissioner for Human Rights concluded in a report that the Assad regime had killed so many detainees in Syria that it had committed the crime against humanity of extermination. More recently, in late November, the UN under-secretary general for humanitarian affairs, our former colleague and former UK MP Stephen O’Brien, said that residents of Aleppo were at risk of extermination. I fear that the news we hear tonight gives us no cause for optimism.

This is a complex conflict with many different actors with differing agendas, but let us not forget that it started because the Syrian people wanted their fundamental rights to be respected. Let us not forget either that no Syrian civilian should be deliberately targeted in the fighting or starved to death in besieged areas of the country. Given that we aired many of those issues earlier today, I will not elaborate further except to ask the UK Government yet again to let us know how they will work with their partners in the international community as a matter of extreme urgency to get the vulnerable—the children, the elderly and the injured, and doctors and nurses—out and get aid in, particularly to besieged areas, and to protect those left behind, particularly to prevent and avoid mass executions.

Yemen is another complex conflict in which mass atrocities are being committed by all sides, including as a result of Saudi-led coalition air strikes. Earlier this year, the UN High Commissioner for Human Rights accused the Saudi-led coalition of causing twice as many civilian casualties as all the other forces fighting in Yemen. Since the breakdown of peace talks in early August, the fighting has intensified and continues to take an unacceptable toll on civilians, as we have seen on television recently, so why does the UK continue to sell arms to Saudi Arabia for use in the conflict in Yemen? I do not want to hear the standard responses, which include that the UK has one of the world’s most robust arms exports licensing committees. Obviously in this case, it is either not robust enough or it is not being properly applied.

Countries in which the human rights situation is a serious concern are Turkey, Egypt, Ethiopia, Eritrea, Bahrain, Iran, Saudi Arabia, Democratic Republic of the Congo, South Sudan, Sudan, North Korea and Burma.

[Jim Shannon (Strangford) (DUP)]

I commend the right hon. Lady for her indomitable spirit and for speaking out for human rights. Does she agree that, some 98 years after the 1948 convention was passed, throughout the world there is persecution of those with Christian and other religious beliefs on a level and with a significance that has never before happened? Does she agree that hon. Members must do everything we can to protect the most basic human right—the right to life and freedom, and the right to have a religious belief, whatever it may be? Does she also agree that we should use any and every possibility to exert influence in the world? This debate is an example of doing just that.

[Ann Clwyd]

I am grateful to the hon. Gentleman for raising that issue. Over the past 30 years, from among my friends in Iraq, I have seen minorities having to flee from where they live. My oldest Iraqi friend is a Mandaean; there are very few of them left in Iraq now. The last conference I went to in Kurdistan, held by the former President of Iraq, was called to discuss how to protect minorities. Sadly, of course, the persecution of minorities is happening in many countries in the world, but at least we are, I hope, having some influence in Iraq.

I am aware that we cannot do everything, but conversely that does not mean we should not be doing more. First, we should be more vocal and confident in defence of human rights in UK foreign policy. I know that the UK Government, particularly the Foreign and Commonwealth Office, raise human rights concerns with foreign Governments, but I contend that more needs to be done to convince state-sanctioned human rights violators that abuses are counterproductive, particularly in the longer term, because fair and tolerant societies are more prosperous and stable and because ultimately violators may be held to account and have to pay for their crimes. The UK must also promote a universal rights agenda, and not tout human rights as British values, which simply plays into the hands of those dictators positioning themselves as protectors against western infiltration and domination. Everyone is entitled to fundamental rights by virtue of our common humanity, no matter who they are or where they come from.

Secondly, we need to push back a lot harder against the worrying spread of the adoption of legislation that seeks to clamp down on civil society and non-governmental organisation activity by restricting freedoms of speech, assembly and association, and/or by imposing unduly burdensome administrative requirements. Civil society and NGO representatives, such as lawyers, journalists and human rights defenders, are vital to checking the abuse of power, promoting good governance, monitoring compliance with international human rights standards and obtaining justice.

--- Later in debate ---

[Ann Clwyd]

I totally agree, of course, with my hon. Friend. One of my concerns is that, with the increased emphasis on trade, human rights is moving to the bottom of the pile; they are certainly lower down the pecking order of concerns than they have been for many years.

Civil society and NGO representatives, such as lawyers, journalists and human rights defenders, are vital to checking the abuse of power, promoting good governance, monitoring compliance with international human rights standards and obtaining justice. It is not surprising, then, that they are resisted, obstructed and persecuted by those who intend to exercise their authority for personal advantage. The UK and the wider international community must continue and do more to support these courageous activists and to challenge such destructive legislation.

I would like to draw attention to Amnesty International UK’s Write for Rights campaign, which this year features cases from, among other places, China, Iran, Egypt, Malawi and the UK. Last weekend, I had the pleasure to co-host with Mr Speaker and Amnesty International UK a parliamentary reception to encourage MPs and peers to take action in support of those whose fundamental rights are at risk of being violated. It means so much to those receiving messages of solidarity; it keeps their hopes alive for a better future. A letter to the authorities can also spur them into action; when they know that the eyes of the world are watching, they may be moved to do the right thing.

Let me take the opportunity to highlight the case of dual British-Iranian national, Nazanin Zaghari-Ratcliffe, who has been detained in Iran since April. The legal process to which Nazanin has been subjected has been so flawed that it is nonsensical to make reference to it, or to the outcome of any such process. Kamal Foroughi is another dual national who has been imprisoned on spurious charges on the basis once again of a highly deficient process. These are arbitrary detentions. Indeed, I would go further and say that these individuals are, in effect, being held hostage. I therefore ask the Government publicly and unequivocally to call for their release.

As for specific country situations, it is important to mention the current plight of Government critics and the Kurds in Turkey. I know that the Turkish Government have had to deal with a savage coup attempt this summer, but I fear that their current repressive response will serve only further to alienate large swathes of the population and result in further bloodshed. Thousands of alleged coup sympathisers are in jail, and tens thousands of them, including soldiers, judges and teachers are being forced out of their jobs. According to the latest annual survey compiled by the Committee to Protect Journalists, Turkey is currently the top jailer of journalists in the world. In a two-month period, the Turkish Government, led by President Erdogan, detained more than 100 journalists and closed down at least 100 news outlets. As of 1 December, at least 81 journalists were in detention in Turkey.

Although the crackdown against journalists has been exacerbated by the coup, media freedom was already under siege earlier in 2016. As the Committee to Protect Journalists points out, authorities are arresting, harassing and expelling journalists and shutting down or taking over news outlets. In a report in December, Amnesty International highlighted that an estimated half a million people are being forced out of their homes in the south-east of Turkey as a result of a brutal crackdown by the Turkish authorities over the past year, which might amount to collective punishment.

To compound the situation, the targeting of Kurdish opposition voices, including leaders and MPs of the opposition HDP party who have been arrested and detained following the coup attempt, has meant that NGOs providing vital support for poor and displaced people have now been shut down. Displaced residents have rejected Government claims that the ongoing curfew and house demolitions are being done in the interests of security, given that the clashes finished over eight months ago. Instead, they are seen as a calculated plan to redevelop their neighbourhoods and resettle them elsewhere.

I would like to take this opportunity to relay my concerns about Egypt. Since 2013, when al-Sisi led the military overthrow of President Morsi, the authorities have prosecuted and jailed thousands for peaceful opposition to the Government. Under al- Sisi, a wide range of activities protected under the Egyptian constitution and international law have been interpreted as threats to national security. In the CPJ report, Egypt is ranked third in the world in terms of the number of jailed journalists.

Human Rights Watch has also highlighted the possible introduction of an NGO law, which would effectively prohibit independent NGOs in the country, by subjecting their work and funding to control by Government authorities, including powerful security agencies.

[Jim Shannon]

We all know of the horrific recent attack on a Coptic church in Cairo. Islamic terrorists attacked people because of their religious beliefs. Does the right hon. Lady join me and others in this House in supporting the Egyptian Government’s efforts to contain ISIS terrorists in Egypt?

[Ann Clwyd]

I agree that it was a dreadful attack, and we deplore any attacks on people because of their religion.

Human Rights Watch has also highlighted the possible introduction of an NGO law, which would effectively prohibit independent NGOs in the country in question, by subjecting their work and funding to control by Government authorities, including powerful security agencies.

There are also continuing concerns about Eritrea.

Humanitarian Situation (Iraq)

Debate between Ann Clwyd and Jim Shannon

Wednesday 9th July 2014 Westminster Hall

[Ann Clwyd (Cynon Valley) (Lab)]

It is a pleasure to be here under your chairmanship, Dr McCrea. I am grateful for the debate, because it is timely, and I am glad that the Minister is present.

I care very much about Iraq. I have been involved with it since the late 1970s, when I met some Iraqi students who had left Basra and Baghdad for Cardiff. They opened my eyes to the brutality of the regime of Saddam Hussein and I campaigned against its abuses—first through an organisation called CADRI, the Campaign against Repression and for Democratic Rights in Iraq. Many Members of this House were members, as well as exiled Iraqis such as Hoshyar Zebari, who is now the Foreign Minister of Iraq, and Latif Rashid, a former water Minister.

In the late 1990s, I was involved in setting up an organisation called INDICT, which campaigned for Saddam and other leading members of the regime to be prosecuted for war crimes, crimes against humanity and genocide through an international tribunal set up by the United Nations. Later, we campaigned for prosecutions to take place in individual countries that had an international jurisdiction with respect to war crimes and crimes against humanity, but that did not happen, despite our best efforts. I went to many countries and we interviewed many Iraqis in exile, but only one country almost went through with the process, and that was Belgium. At the last minute, however, the Belgian Parliament changed the rules of the game.

The evidence collected by INDICT of the crimes that had taken place and of the direct involvement of certain members of the regime was subsequently used in the war crimes trials in Baghdad, some of the sessions of which I attended. Over a number of years, as the special envoy on human rights in Iraq for both Tony Blair and my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown), I went to Iraq about 26 times in all, and at times when it was quite difficult, but I have many friends there. The idea was to help the Iraqis after 30 years of a brutal regime; we tried to explain the niceties of human rights and what they meant in practice.

I still have friends in Iraq. I was last there 18 months ago, when there was a stand-off between the peshmerga of the Kurdish regional Government in Kirkuk and Mr Maliki’s Iraqi forces. They did not actually clash, but it was certainly a stand-off.

I also meet people from the Iraqi Parliament regularly at the Inter-Parliamentary Union; I always look out for them and we spend some time together. The women in particular need to be commended for their bravery. I will not name anyone, but one woman doctor is a Member of Parliament and she has stayed in Baghdad the whole time. She still practises as a doctor, but she is also active as a politician. Since the start of the recent conflict, she has been sending me messages regularly about their concerns in Iraq. I pay tribute to the bravery of such politicians, because it cannot be easy always to be surrounded by about 30 bodyguards—each MP has about that number, which illustrates how dangerous and difficult the situation is.

Since January this year, the surge in violence between armed groups and Government forces has resulted in an estimated 1.2 million internally displaced people in central and northern Iraq and an estimated 1.5 million people in need of humanitarian assistance, according to the UN.

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. Lady on bringing the issue to us for consideration. The Christians in Iraq are under particularly serious pressure. They are centred around Mosul and the plains of Nineveh, but the takeover by ISIS has had a detrimental impact on them and they are threatened, because of their religious views, with crucifixion, beheadings, bomb attacks, beatings and loss of property. Does she agree that we must always ensure that religious persecution stops and that religious freedom wins?

[Ann Clwyd]

Certainly. In fact, the last time I was in the Kurdish area, about 18 months ago, I went to a conference of all minority religions—there are not only Christians, as I am sure the hon. Gentleman knows, but many other religious groups as well. The conference was supposed to bring them all together. I also met various groups individually, some of which wanted to set up territories of their own, although I think that they have been persuaded that that is not a good idea. We need to ensure safety for all the minorities of Iraq.

The attention of the world is focused on the terrorist group called the Islamic State of Iraq and the Levant, known as ISIS or ISIL. Inside Iraq, however, the group is only one part of a larger revolt that has been years in the making. Although there is some co-ordination between ISIL and other Sunni groups fighting in northern Iraq, ISIL is only part of the revolt. Anger against Nouri al-Maliki and the behaviour of the Iraqi Government has been building for almost eight years.

The Maliki Government reneged on their promises to build an inclusive Government with the Sunnis and went after moderate Sunni leaders as soon as American troops left. It is regrettable that the Iraqi Parliament has had to adjourn again until the middle of August. It did convene, but has adjourned because it could not agree on the election of a new Speaker.

Iraqi army and police crackdowns over the past year in cities—including Falluja and Madain—have been part of the escalating Sunni-Shi’a tit-for-tat violence that has plagued Iraq for over a year. In one incident in April 2013, dozens of Sunnis were killed by Iraqi security forces in the town of Hawijah during what had been a peaceful protest. As a former US official in Iraq, Ali Khedery, wrote in the Washington Post on 3 July, the US policy during the crucial years following the 2008 Sunni awakening was to place its faith in Maliki to build an inclusive system rather than supporting other political actors.

The international community should support a process in which all political stakeholders could be brought together to review the political process and devise a whole new formula for the sharing of power and resources in Iraq. More specifically, it should step in and play a role in helping solve the real problems in Iraq by encouraging a unity Government. In the end, the involvement of other countries, particularly those supporting only one side or the other in the conflict, can only destabilise the region further.

Managing Risk in the NHS

Debate between Ann Clwyd and Jim Shannon

Wednesday 17th July 2013 Commons Chamber

[Ann Clwyd (Cynon Valley) (Lab)]

As on six previous occasions, I shall read from testimony showing a lack of care and compassion from the 2,500 people who sent letters and e-mails to me.

The family of an 89-year-old patient wrote:

“During our daily visits, we had to locate a cup from the kitchen on the ward in order to give her some fluid. She never had a drink of any sort within reach. This resulted in severe dehydration, which was apparent by her sunken eyes, dry, scaly skin, fatigue and her unquenchable thirst when we provided her with drinks. The staff informed us that she was not eating but we found she would eat any food we brought in for her. Whilst in bed the staff neglected to move her on a regular basis and this resulted in circulatory problems and ultimately necrosis of both feet. She also developed many infections…the wound on one heel was so advanced that the bone was visible.”

A man whose son suffered further brain damage due to lack of care said:

“He was left lying in his own urine, faeces, etc. He was left without fluids for over 12 hours then he had a huge seizure. The doctor would turn up at 5 o’clock stating ‘What’s the plan for today?’ when the day was clearly over…I witnessed nurses allowing drugs and feed to go to the floor…the floor was in such a state my feet were sticking to it. You can’t blame the cleaners for MRSA!”

A woman writes about her father’s death in hospital:

“I used the term ‘conveyer belt to death’ at the time we lost our beloved dad. On that chaotic Friday afternoon, when all the Consultants and senior staff are dashing off for an early week end finish, a poor young doctor was pushed into our path by one of these Consultants from the palliative team and uttered the immortal words that will stay with me—“Is Tuesday OK?”…I only twigged later that night that that was the date to cancel any care and pull the plug.”

A woman writes of her father’s experience in hospital:

“I’ve tried to find out what he’s eating and how much but no one seems to know and the nursing staff just tell me they have too many plates to clear to remember who was eating what. My Dad is wasting away in front of my eyes and they just keep telling me they’re too busy to help. My Dad is 76 and he has always been fit and well but I’m fearful now that he will never come home from hospital alive.”

Another woman wrote:

“Having continually pushed for the best care available during his time there, it seemed that complaining wouldn’t make any difference, other than making me relive every humiliation, discomfort, stupidity and indifference…My father spent a month in hospital, and he said it was worse than his experiences in the Second World War…We watched one man fading away, naked apart from a soiled nappy, in full view of visiting families.”

The wife of a whistleblower wrote:

“My husband was a senior nurse who recorded what he considered to be gross ill treatment of patients to his senior Consultant…he was subjected to prolonged bullying campaigns and subjected to pseudo disciplinary procedures. He was supported by the RCN who managed to keep him in his job…To cut a long story short, after six years of abuse, stress and fear my husband suffered a major stroke while working at the hospital. He was later subjected to a vicious attack”

by the management

“at his back to work interview. He retired from the NHS on medical grounds. He was 46 years old. He lost the job he loved. The NHS lost a highly skilled super intelligent practical nurse who loved his patients and worked hard for them. His colleague who supported him lasted a bit longer but was also forced into retirement after her health was destroyed by bullying because she also witnessed and reported the abuse of patients”.

[Jim Shannon (Strangford) (DUP)]

The right hon. Lady is telling us some very compassionate and emotional stories. Does she feel that the voice of families, which she has illustrated very well, needs to be heard more by management and staff, and does she feel that the process should be improved to enable that to happen?

[Ann Clwyd]

Many people are afraid to complain. Some complain many years later, and some never do so at all. It must be made easier for people to complain.

Bradley Manning

Debate between Ann Clwyd and Jim Shannon

Monday 4th April 2011 Commons Chamber

[Ann Clwyd (Cynon Valley) (Lab)]

I am pleased to have the opportunity to debate this issue, because it is important that the case is raised here in the House of Commons. I want to talk about the treatment of Bradley Manning. An early-day motion on this subject—early-day motion1624—stands in my name and is currently supported by 37 right hon. and hon. Members, and I hope that others will add their names.

I wish to speak this evening in terms very similar terms to those of the early-day motion, which reads as follows:

“That this House expresses great concern at the treatment of Private First Class Bradley Manning, currently detained at the US Quantico Marine Base; notes the increasing level of interest and concern in the case in the UK and in particular in Wales; appeals to the US administration to ensure that his detention conditions are humane; and calls on the UK Government to raise the case with the US administration.”

That is what I want to expand on in this short debate. I want to explain why I am so concerned about Bradley Manning’s case and why others should be too, and I want to ask the Minister to undertake to raise the case with the US Administration.

Bradley Manning is the US soldier imprisoned at the US marine base at Quantico, Virginia. He is accused of being the person responsible for the leaking of the US Government information—about Iraq and about Afghanistan, and from US embassies around the world—that was released into the public domain through the website WikiLeaks. Bradley Manning is a serving member of the US armed forces and he is detained in a military prison. It is important for us to note that he has yet to be convicted of any offence—I am not sure whether there is a confirmed trial date, but I understand that it will not be until May or June.

Like me, the Minister will want to be careful about describing the actions of which Bradley Manning is accused, because we have yet to have Bradley’s account and he has still to have that account considered by a court. That is why I do not want us to get drawn into a discussion of the rights and wrongs of the WikiLeaks revelations. However, I would like to concentrate on the current conditions of detention for Bradley Manning. I have read the several accounts of Bradley’s treatment which have appeared in the press. Some very good accounts that have appeared in The Guardian have come from David Leigh, in particular, but the one that I paid most attention to was the one from Bradley himself. On 10 March, in an 11-page memorandum from Bradley Manning to the commanding officer of the Quantico marine base, issued through his lawyer, Bradley Manning described for us the conditions of his detention. This is what he said:

“Since 2 March 2011, I have been stripped of all my clothing at night. I have been told that the PCF commander intends on continuing this practice indefinitely. Initially, after surrendering my clothing to the brig guards, I had no choice but to lay naked in my cold jail cell until the following morning. The next morning I was told to get out of my bed for the morning duty brig supervisor (DBS) inspection. I was not given any of my clothing back. I got out of the bed and immediately started to shiver because of how cold it was in my cell. I walked towards the front of my cell with my hands covering my genitals. The guard told me to stand at parade rest, which required me to stand with my hands behind my back and my legs spaced shoulder width apart. I stood at ‘parade rest’ for about three minutes until the DBS arrived. Once the DBS arrived, everyone was called to attention. The DBS and the other guards walked past my cell. The DBS looked at me, paused for a moment, and then continued to the next detainee’s cell. I was incredibly embarrassed at having all these people stare at me naked. After the DBS completed his inspection, I was told to go and sit on my bed. About 10 minutes later I was given my clothes and allowed to get dressed…Under my current restrictions, in addition to being stripped at night, I am essentially held in solitary confinement. For 23 hours per day, I sit alone in my cell. The guards check on me every five minutes during the day by asking me if I am OK. I am required to respond in some affirmative manner.”

[Jim Shannon (Strangford) (DUP)]

Will the right hon. Lady give way?

[Ann Clwyd]

I have very little time, but yes, I will.

[Jim Shannon]

Is the right hon. Lady aware of when the trial will take place?

[Ann Clwyd]

No, I do not yet know that, but I think that it will be in a couple of months’ time.

Bradley Manning’s account continued:

“At night, if the guards cannot see me clearly, because I have a blanket over my head or I am curled up towards the wall, they will wake me in order to ensure that I am OK…I am prevented from exercising in my cell. If I attempt to do push-ups, sit-ups, or any other form of exercise I am forced to stop. Finally, I receive only one hour of exercise outside of my cell daily. My exercise is usually limited to me walking figures of eight in an empty room.”

We also learn from this memorandum, issued through his lawyer, that his treatment ignores the repeated recommendations of the Marine Corps’ own appointed psychiatrists. They repeatedly say that Bradley Manning’s detention status should be changed. That treatment serves no purpose other than to humiliate and degrade Bradley Manning. I regard it as cruel and unnecessary.

Bradley Manning calls his conditions “improper treatment” and “unlawful pre-trial punishment”. Human Rights Watch has called on the US Government to

“explain the precise reasons behind extremely restrictive and possibly punitive and degrading treatment that Army Private First Class Bradley Manning alleges he has received”.

Amnesty International has said:

“Manning is being subjected to cruel, inhuman and degrading treatment. This is particularly disturbing when one considers that he hasn’t even been brought to trial, let alone convicted of a crime”.

The United Nations special rapporteur on torture, who I have spoken to in the House of Commons about the case, has officially raised his concerns with the US Administration and is awaiting a response.

We have not only those views but a view from inside the US Administration. Until recently, P. J. Crowley was the spokesman for the US State Department. He was a senior and well respected official and a career member of the US armed forces. Early in March he was forced to resign following comments he made about the treatment of Bradley Manning at a university seminar. He called the treatment of Bradley Manning “ridiculous”, “counterproductive” and “stupid”.

Since his resignation, P. J. Crowley has gone on to explain why he said what he did, including in a column in The Guardian last week. He says:

“As a public diplomat and (until recently) spokesman of the department of state, I was responsible for explaining the national security policy of the United States to the American people and populations abroad. I am also a retired military officer who has long believed that our civilian power must balance our military power. Part of our strength comes from international recognition that the United States practises what we preach.”

He goes on:

“Based on 30 years of government experience, if you have to explain why a guy is standing naked in the middle of a jail cell, you have a policy in need of urgent review.”

Finally, he says:

“So, when I was asked…I said the treatment of Private Manning, while well-intentioned, was ‘ridiculous’ and ‘counterproductive’ and, yes, ‘stupid’.

I stand by what I said.”

In the article and the interviews he has given, P. J. Crowley—a career US military and Government man—sets out why Bradley Manning’s case is important. It is important because of the message it sends to the rest of the world about what kind of treatment the United States thinks is acceptable for people in detention. As for us, it is important what we say—or what we do not say—because of the message that it sends about the kind of treatment we in the United Kingdom and in the UK Government think is acceptable. That matters in countries where human rights are not so well observed. People will pay attention in China, in Russia, in Libya, where we want to be on the side of those fighting for freedom from state repression, and most of all in Afghanistan. The image that Britain and the US have in the world matters to the UK and US service personnel fighting in Afghanistan.

I know that only too well from my experience in Iraq as special envoy on human rights over a seven-year period. In my view some of the greatest damage was caused to British and American efforts in Iraq when the stories of prisoner abuse emerged. It undermined our moral authority at a time when we needed to explain that we were fighting for a better future for Iraq, free from the torture and abuse suffered under the regime of Saddam Hussein. The United States and the UK, in the way we respond to US actions, need to preserve that moral authority if we are to have a positive impact on the world and lead by example.

So what am I asking the Minister to do? Let me address the issue of British nationality, because it seems to me to have been something of a red herring. I am not raising Bradley Manning’s case because he is a British national but because I believe his treatment is cruel and unnecessary and that we should say so. I am also chair of the all-party group on human rights and so I often raise human rights cases from around the world. They might be in Burma, Chechnya, East Timor, China, or, sadly, too many other places besides. I do not raise them because they involve British citizens, but because they involve human rights abuses or wrongdoing and because I am in politics because I want to do something to try to stop those things happening.

I want the British Government to raise Bradley Manning’s treatment with the US Administration because his treatment is cruel and unnecessary and we should be saying so. We cannot deny, however, that Bradley’s connection to the UK adds an additional dimension. Bradley’s mother, Susan, is Welsh and lives in Pembrokeshire. Bradley lived and went to school in Wales between the ages of 13 and 17. There is a great deal of interest in the UK, and in particular in Wales, in Bradley’s case and much of that is grounded in his close connection to the UK. Both London and Wrexham have seen protests against Bradley Manning’s treatment, and I pay tribute to those people in the UK who have raised his case.

Perhaps the Minister will take this opportunity to clarify, on the record, just what the position is with regard to British nationality. My understanding is that under the British Nationality Act 1981 anyone born outside the UK after 1 January 1983 who has a mother who is a UK citizen by birth is British by descent. Perhaps the Minister will assist us by confirming that that is the case. I am aware that Bradley Manning’s lawyer has issued a statement that Bradley is not asserting any kind of UK nationality. I know that, but from the point of view of British law, is it the case that Bradley Manning qualifies for British nationality?

I shall mention briefly the British aspect of the case, which concerns Bradley’s mother and family in Wales. I have met some of Bradley’s family—his aunt and uncle—and I am in contact with them. This will be an exceptionally hard time for Bradley Manning’s family, not just for his mother and family in Wales, but for his father and that side of his family in the United States. He is accused of the gravest of crimes which, according to some reports, can attract the death penalty, and there is intense media interest in Bradley, in anything to do with WikiLeaks and in the information that was revealed about the US Government.

Part of Bradley’s family live in Pembrokeshire and their son is in a military prison in Virginia in the US. They are being contacted by journalists, campaigners and politicians who are trying to raise the case. This is a difficult situation for any family to deal with. What kind of consular, official or other support could be made available to Bradley’s mother and family? When they visit Bradley in the US, for example, can they expect assistance from British embassy staff in the US? Can they receive advice and assistance in understanding the charges faced by their son, and perhaps advice, too, about the issue of British nationality?

I look forward to hearing what the Minister has to say. I hope that in his reply he does not say that we do not know what Bradley Manning’s conditions are. We have his own statement, backed by his lawyer, from which I read earlier. I am sure the Minister will not try to defend the harsh treatment that Bradley Manning is experiencing because of the gravity of the charges. That is beside the point. I hope the hon. Gentleman does not try to say that as he is not a British citizen, it is not appropriate to raise Bradley Manning’s case with the US Administration, because we raise cases with other countries all the time. I hope he will not fail to acknowledge that Bradley Manning’s having lived for a time in the UK, and given that his mother and that side of his family are British, creates an additional obligation on the Government to act in that family’s best interests.

I hope that the Minister can give two undertakings tonight—first, that the British Government will officially raise the case with the US Administration, and secondly, that the Government will consider what support they could provide to the British family of Bradley Manning as they try to do whatever they can to help Bradley.