Transport: Cheshire

Debate between George Howarth and Justin Madders

Wednesday 5th June 2019 Westminster Hall

[Justin Madders]

I agree, and London seems to do better than the rest of the country in terms of per-head transport investment, too.

None of the crossings in Northern Ireland is tolled, none in Scotland is tolled and, as we have heard, London is equally blessed. In fact, more than 90% of tidal crossings in this country are toll free. The argument that tolls harm economic growth seems to be accepted everywhere, except on the River Mersey.

As I said, the tolls on the Mersey tunnels have always been with us. They are not popular, but they have always been part of life. However, an unconscionable decision earlier this year by the Liverpool city region metro Mayor has made them far less acceptable. Regular tunnel users can apply for a fast tag, which gives a discount on the normal fees. From 1 April this year, the fee for those who live in the Merseyside area was reduced from £1.20 to £1, but the fee for those outside the Merseyside area was increased by a whopping 50%, from £1.20 to £1.80. That decision was made with little notice, no consultation and complete disregard for the economic impact on those living outside Merseyside.

Although my constituency is in Cheshire, we are very much in the hinterland of Merseyside—the number of Liverpool shirts I saw over the weekend is testament to that. We are less than 10 miles from Liverpool city centre, and our economic, cultural and family connections mean that people travel there daily. When my constituents ask me whether it is right that they have to pay nearly twice as much as someone who lives just down the road from them to go to work or visit their elderly mother, I tell them, “No, it isn’t.” It is discrimination by postcode, and it is not something I believe anyone who wants fairness in this country can support.

To be fair to the metro Mayor, he would like to be able to get rid of tolls altogether. I am happy to work with him and anyone else who wants to join me on that campaign, but that is a longer-term aim. In the short term, he has defended his decision robustly. He rightly points out that the Liverpool city region has experienced the largest Government funding cuts anywhere in the country, and that the people he represents cannot be expected to shoulder the burden of austerity. His conclusion is that he cannot have non-city region residents’ travel being subsidised. I understand what he says, but he is simply wrong about subsidy.

The Mersey tunnels, for which I understand the tolls are the third highest of their type in the whole country, are operated under the Mersey Tunnels Act 2004, which permits any operating surplus to be used by the transport authority to achieve public transport policies in its local transport plan. In 2017-18, the surplus from operating the tunnels was £16.7 million, so my constituents, far from asking for a subsidy, clearly subsidise the rest of the Merseytravel operation—indeed, all tunnel users do. Given that level of surplus, the decision to increase the costs for my constituents by 50% cannot be said to be critical to Merseytravel’s operations. There is no room for doubt about that. It feels much more like racketeering.

One might argue that the surplus is used to provide good public transport services across Merseyside and beyond, which of course benefits my constituents, albeit to a lesser degree than Merseyside residents. However, a closer look at rail fares suggests that when my constituents use cross-border Merseyrail services, they are again subject to indefensible price differences. For example, a day return from Eastham Rake on the Merseyrail line—the first stop in Merseyside when travelling from Cheshire—to Liverpool is £1.50 cheaper than a day return from Little Sutton. That is 25% extra for just two stops down the line. Although Capenhurst station is not in my constituency, it is used by many of my constituents and it is also just two stops down from Eastham Rake, but a day return to Liverpool from Capenhurst costs more than £3 extra.

It feels like the residents of Cheshire are seen as a soft touch—a cash cow. Sadly, I feel there is a bit of reverse snobbery here, the implication being that people who live in Cheshire are a bit better off, so they can afford to pay more. That just is not the case for the majority of people. My constituency has some pockets of wealth, but it also has some of the most deprived wards in the country. Some of the examples constituents have given me of the hardship they have suffered demonstrate that they are not people with loads of spare cash floating about, waiting to be squeezed until the pips squeak.

[Mr George Howarth (Knowsley) (Lab)]

My hon. Friend is making a powerful case. Although he feels his constituents are discriminated against, does he accept that the same applies to people from Knowsley, parts of Liverpool and St Helens, for whom there is no public transport option that makes sense? They have only one option: the Mersey Gateway. In some cases, it costs them £20 a week extra to travel to and from work in his constituency or that of my hon. Friend the Member for Weaver Vale (Mike Amesbury). Surely that is not acceptable.

[Justin Madders]

My right hon. Friend is absolutely right. I will talk about the Mersey Gateway later, because we have another very difficult situation there.

As my right hon. Friend says, many people have no option but to cross the Mersey to get to work. Many of those people work in public sector organisations such as the police and the NHS, and have not had a real pay rise for almost a decade. They often work shifts. The only way they can get to work is with their own transport, because public transport does not operate on the routes or at the times they need to get to work.

For example, an Ellesmere Port resident works as a physiotherapist specialising in treating head and neck cancer patients from across the north-west at Aintree Hospital. She pays at least £400 more per year than Wirral residents to get to work. What about the band 5 staff nurse who recently began working at the Royal Liverpool Hospital and, due to her shift times, has to drive from Ellesmere Port to Liverpool? She says she finds it financially crippling to pay tunnel tolls and car park fees. She also makes the point that colleagues who live down the road from her on the Wirral and in Liverpool can pay the lower toll, but they have better public transport options anyway.

We know how hard it is for the NHS to recruit and retain staff, particularly nurses, but this policy seems to be forcing them out. One nurse told me that

“the individual cost of the Toll fees on my current wage may force me to leave my nursing post at the Royal Liverpool NHS Foundation trust and seek employment elsewhere. I find my situation ironic due the desperate need for nursing staff at the hospital but am being forced out by unfair and discriminatory postcode politics.”

I could not have put it better myself. Then there are the people who have to travel across the Mersey at both crossings to get treatment at more specialist healthcare services, such as Broadgreen and Alder Hey. Why should people with the most serious conditions be treated in that way?

I have been given dozens of examples of people who use the tunnels for work and who are thinking of taking their talents elsewhere. Ultimately, this is an economically damaging policy. There are also those who go to visit their family, including elderly relatives. I have a constituent who travels over the Mersey nearly every day to care for her 80-year-old mum, who has dementia. She saves the council a fortune in social care costs, but her contribution does not appear to carry any weight. There are others, including the British Sign Language interpreter, the paramedics, the teachers and the Leahurst veterinary school students. None of those people have been considered, because there has been no assessment of the impact of the decision.

Those are just some examples of the hardship faced by my constituents and others who have no choice but to cross the Mersey—hardship the metro Mayor actually appears to recognise. Last year, he said:

“The introduction of additional tolls has proven to be a significant imposition to many from lower socio-economic groups, who are already struggling to make ends meet.”

He was talking about the Mersey Gateway tolls, but it could just as easily have been the Mersey tunnels tolls. I agree, and his argument applies to both crossings. I also agree with him when he said:

“The economic wellbeing of our city region is a joint responsibility between the combined authority and Government.”

I ask the Minister to set out what he will do to ensure that my constituents no longer face these rip-off charges.

If the Minister does not think it is the Government’s responsibility to ensure citizens of this country do not face postcode discrimination, he must agree that they do have responsibility for promises made by members of the Government. I refer specifically to the former Chancellor of the Exchequer, George Osborne, who made promises about the Mersey Gateway that have not materialised. In a tweet on 23 April 2015 he said:

“Confirm we’ll extend free bridge tolls to residents of Cheshire W & Chester + Warrington”.

One of my constituents was understandably a little sceptical about that comment, so he emailed the Conservative party candidate for Ellesmere Port and Neston in the 2015 election, who responded in unequivocal terms:

“If we get a majority it’s a firm commitment and applies to all of Cheshire West Council including us. I’ve been involved in making the case to the Chancellor and he’s listened and acted.”

As we know, the Conservatives did win a majority, but the promise was reneged on. As my constituent said, it was a clear and simple promise on which they have totally failed to deliver in any way whatever.

While we are on the subject, I draw the Minister’s attention to a statement by the then Chancellor during the 2015 election regarding Mersey tunnel fees. He said:

“They will definitely be cut. I think we might be able to go further. I’m quite optimistic that we might be able to go further and abolish them altogether”.

Please, Minister, do not say in responding that this is for local operators to determine. When the Chancellor of the day makes clear statements—promises, no less—it is incumbent on the Government to deliver them. The reputation of this place has had a real shaking in recent times, and no wonder when unambiguous, incontestable promises are made just before an election and jettisoned without a second thought. It destroys the very essence of what politics should be about—honesty and integrity—and replaces it with cynicism and callous disrespect for the public.

I turn to our continuing problems with the Mersey Gateway, to which my right hon. Friend the Member for Knowsley (Mr Howarth) referred. According to the local campaign group, hundreds of thousands of fines have been issued, and so far about 7,500 penalties have been appealed to the Traffic Penalty Tribunal, which I understand have all been allowed. If that is correct, it must surely encourage the Minister to make enquiries about what on earth is going on. I urge him to look into how these fines are arising. It is clear there are regular issues with people seeing the signs and paying in time. It is far from clear when people have to pay by and how they should pay. Why does it have to always be online?

Trade Union Access to Workplaces

Debate between George Howarth and Justin Madders

Tuesday 4th June 2019 Westminster Hall

[Justin Madders]

Yes. We have a lot of potentially dangerous industries in our area. The ones I tend to deal with have been around for a long time. They all have long-standing recognition agreements with trade unions, and excellent safety records as a result. It is a learning process, not an adversarial process, particularly in health and safety.

Some companies ought to take a leaf out of those employers’ books and learn how to treat and to deal with employee representatives in a much more reasonable and engaging way. A number of employers behave despicably, adding to employees’ fears about victimisation, which leaves many individuals not wanting their employers to know that they belong to a trade union. How sad is that? How damning is it that some companies are so vindictive to their staff that their employees will not tell them that they belong to a trade union?

Only last week I met a constituent who told me what it was like in his workplace, where unions are not welcome, where arbitrary decisions are made about who is retained and who is let go, and where all the workers are too worried to put their head above the parapet. I hope to discuss my concerns with the company in due course, but does it really need a Member of Parliament to remind an employer of how to treat its staff? If a trade union official was allowed access to the site, they would be able to do that, and in the end everybody would benefit—the workers and the company. At the moment they are locked out, which is simply not good enough. It is shocking that these kinds of things still take place in the 21st century.

What is the point of someone having the right to join a trade union if they cannot exercise that right because an employer refuses to engage? What is the point of their being a trade union member if they cannot be represented? I have lost count of the number of times companies have lied to employees about their right to be accompanied by trade union reps at disciplinary or grievance hearings by saying that, because the company does not recognise a particular trade union, those unions do not have the right to attend the hearings. The Government should clamp down on that.

We have a culture of weak employment rights, greedy corporations and a Government that obstruct trade unions. We need to get away from that and towards a period of renewal and rebuilding of one of the pillars of a decent society: job security. Without job security, people have no security. How can they plan for their future, for a home or for their family if the labour market is so cut-throat, so insecure and so parasitic that they are always just one step away from disaster? The stabilising force of trade unions is a vital component of a decent society.

“Rights” is not a dirty word. Rights are not only about individual dignity and respect in the workplace; they give people a stake in society, when they know that if they do a good job and their employer runs the business well, they will be rewarded. We need an economy —and a country—where everyone has a stake in its prosperity, but to do that we must have a system that values the security and sustainability of a job itself as much as the principle of job creation. Good employers want to work with unions, and in an ideal world all employers would be able to do so without the need for the legislation that we have talked about.

[Mr George Howarth (Knowsley) (Lab)]

My hon. Friend mentions insecure employment. Does he agree that while those on short-term or rolling contracts are among the least organised of the workforce in the United Kingdom, they actually need to be members of a trade union probably more than any other group of workers?

[Justin Madders]

My right hon. Friend is absolutely right. We have seen an explosion of insecure employment in this country in recent years. We wonder why people are so fed up with the way this country is run. People have no security and do not know what they are doing from one day to the next. Let us not forget that until someone has two years of continuous employment somewhere, they have no employment rights whatsoever. What kind of country is that? We do not really want to live in a place where people have no protection until they have been somewhere for two years. Their whole life could change in that period. We absolutely need more support at an earlier stage for people who live in these precarious times.

This is not only about improving workplace rights, but about sending a message to employers that we need to move to a much more stable system, and we need the Government to bring forward legislation to encourage that. A good example is New Zealand’s Employment Relations Amendment Act, which has already had a positive impact on the workforce, restoring protections and strengthening the rights of workers without causing disruption to business. Just as importantly, it has changed people’s attitudes towards their right to represent themselves. I think the people of this country deserve the same. It is a shame that there are absolutely zero Members on the Tory Back Benches. That tells us absolutely everything that we need to know about the priority that the Conservative party places on this issue. In these circumstances, the idea that it could rebrand itself as the party of the worker is a joke.

In conclusion, it is only through improved access to workplaces that unions will be able to inform individuals of their rights and, critically, ensure that those rights are enforced—people’s rights are only as good as their ability to enforce them. Only then will we see real changes and improvements to people’s working lives. It is my belief that it is the duty of the Government to be an enabler in that process, not an accomplice to those who would deny people those basic rights.

Infection Prevention and Control

Debate between George Howarth and Justin Madders

Tuesday 15th May 2018 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Howarth. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this extremely important debate and on his insightful contribution. He has a reputation for being one of the most prolific Members of this House, both here and in the main Chamber. He has pursued this issue assiduously during his time here, and his comments made clear his commitment to improving patient safety. His contribution was wide-ranging and fecund, and he highlighted the good timing of the debate, given that 5 May is World Hand Hygiene Day. There is a particular focus this year on sepsis, to which a number of hon. Members referred. We should reflect seriously on the staggering figures they mentioned: there are 30 million infections worldwide a year and 44,000 deaths in this country, and we could save between 5 million and 8 million lives a year through greater awareness and control. We all want to tackle sepsis very seriously.

The hon. Gentleman was right to say that there will not be any political disagreement today, as we all want the very best outcomes in this area. He was right that good progress has been made, particularly over a longer period, but it could be argued that we have plateaued. The infection rate remains too high. I am sure that we all agree that the figure of 6.4% across the NHS is far too high. He talked about the human and financial cost—he mentioned the figure of £1 billion. He made the fair point that this has downstream effects, as beds are occupied unnecessarily. It is always regrettable if any patient is in a bed because of something avoidable, particularly given that the number of beds across the NHS is at an historic low.

I was pleased to hear from the hon. Member for Morley and Outwood (Andrea Jenkyns). She has spoken on a number of occasions about this important subject, and she spoke again about the personal tragedy of her father’s death. She has been a consistent and vigorous campaigner on the issue since she came to this place. This is the first time I have heard in such detail the appalling circumstances surrounding her father’s death and the basic hygiene breaches that took place. I doubt that any member of the public, let alone any trained medical professional, would consider what happened there to be acceptable. That highlights the difficulties we sometimes face in tackling these issues.

The hon. Member for Amber Valley (Nigel Mills) made a considered and thoughtful speech about a wide range of issues. He referred to the World Health Organisation’s figures, which suggest that about half of the associated deaths in this country are preventable. He was right to say that in no other area would we be prepared not to tackle such a figure with great vigour. I agree with him that staff are not deliberately flouting hygiene standards, but the pressure of work sometimes means that standards slip. From the vacancy rates referred to by the Scottish National party spokesperson, the hon. Member for Central Ayrshire (Dr Whitford), and from regular staff surveys, we know how much pressure staff are under in the NHS. The hon. Member for Strangford highlighted accurately the difficulties with the existing audit processes and how they are not necessarily the best. He summarised perfectly the false comfort that we derive from the belief in 100% compliance rates. We know from what we have heard today that when audits are not taking place, compliance is considerably less than 100%.

The hon. Member for Moray (Douglas Ross) had clearly done a lot of important and excellent research to come up with all those statistics across a whole range of environments. He showed that there is no uniform picture in tackling infection control and suggested that the condition of the buildings might sometimes be an impediment to best practice. He rightly said that that is an area where many things can be learned from across the border, or indeed across the world—best practice should be disseminated.

The hon. Member for North East Derbyshire (Lee Rowley) talked about the need to reduce hospital admissions as one way of reducing infection rates. He mentioned anaemia in particular: apparently 4 million people have an iron deficiency and anaemia is the fourth most common cause of admission. He also mentioned sepsis and the possible gap in understanding or focus in the NHS, although we have heard today that a lot of awareness-raising is going on in that area.

It has been almost two and a half years since we last discussed this issue—January 2016—so today’s debate provides us with a useful opportunity to take stock of progress. We heard about a number of recent positive initiatives but, as the hon. Member for Strangford said, levels of healthcare-acquired infections remain stubbornly high, and in some cases they are increasing. Reductions in the rates of MRSA and C. diff are welcome, but the increase in MSSA and E. coli over the past five years is worrying. Furthermore, about one in every 16 patients will still acquire an infection while being cared for by the NHS in England, and every one of those infections requires additional NHS resources and, more importantly, leads to great patient discomfort and reduces patient safety.

According to the most recent figures from Public Health England, the fatality rate is 28.1% for MRSA cases, 19.7% for MSSA, 14.7% for E. coli and 15.1% for C. diff. We cannot overstate the seriousness of acquiring one of those infections. Furthermore, the Department of Health and Social Care reported recently that, sadly, E.coli infections led to the death of more than 5,500 patients in 2015, at an estimated cost to the NHS of £2.3 billion. The impact on patients and their families is devastating, while the growing threat of antimicrobial resistance adds to the significance of the issue.

In the US and Europe alone, antimicrobial-resistant infections are estimated to cause more than 50,000 deaths a year, and that figure is projected to increase significantly, as we have heard. A report by the World Health Organisation states that resistance is frequent among bacteria isolated in healthcare facilities, with antibiotic-resistant bacteria causing over half of all surgical site infections. We cannot overstate the importance of tackling the issue.

Healthcare of course carries inherent risks, and even if we were to take every possible preventative step, it would still be possible to acquire an infection. However, as I mentioned last time we discussed the matter, it has been estimated that about 30% of infections could be avoided by better application of existing knowledge and good practice. Much of that improvement could be realised through improved hand hygiene practices. Although we have known that for decades, the method of monitoring hand hygiene in hospitals remains outdated, inaccurate and, as we heard from the hon. Member for Morley and Outwood, flawed.

The monitoring method relies on direct observation by nurses, which leads to compliance rates being overstated and takes up hours of nursing time when staff on the wards are already overstretched. Staff naturally wash their hands much more frequently when being observed directly, which results in clearly overstated compliance rates of 90% to 100%. Academic research has found that typical compliance is actually between 18% and 40%. The international best practice to which the hon. Member for Strangford referred demonstrates that electronic monitoring of hand hygiene can decrease the risk of infection by 22%, which would not only save the NHS money, but save lives. We therefore welcomed the November 2016 commitment by the Secretary of State that staff hand hygiene indicators would be published for the first time by the end of 2017. However, as we heard, that deadline has elapsed and we seem to be no nearer to seeing implementation. Will the Minister tell us when we can expect to see the detail of that long-overdue improvement?

On 19 March, in a written response, the Minister mentioned that Public Health England had carried out some initial analysis with the available data, but that the data was incomplete, so it does not truly reflect hand gel usage. I accept that it might not provide an accurate representation of the NHS as a whole, but will the Minister set out what the analysis that he has received has found, and whether any of that information might be useful in the interim until the full dataset is available? Two ongoing pilots into the use of electronic monitoring technology within the NHS have also been mentioned. Has he made any assessment of those pilots? What plans do the Government have to look at universalising good practice, if it is shown to be as effective as early reports suggest?

As with any type of infection, healthcare-acquired infections can trigger sepsis, particularly in people who are already at risk—for example, those with chronic illnesses such as diabetes, or those who are immuno- compromised, such as those receiving chemotherapy. The majority of cases do not derive from a hospital setting, but with 150,000 cases a year and 44,000 deaths, many of them preventable, sepsis is a critical safety issue for the NHS. The challenge is to recognise it in its early stages, before multiple organ failure sets in, and to implement rapid treatment. If it is left untreated for hours, the chances of death increase rapidly. Sepsis in its early stages is often dismissed as something less serious, so I ask the Minister to advise us on what processes are in place to monitor patients at risk from sepsis. What steps will he take to ensure that treatment is started without delay?

In conclusion, around the world and in this country we spend vast sums of money on researching innovations to tackle illnesses and improve our welfare, but tackling hospital-acquired infections better would potentially put us in a position to prevent thousands of unnecessary deaths each year through the most basic of steps and the dissemination of best practice.

[Mr George Howarth (in the Chair)]

Before I call the Minister to respond to the debate, I remind him gently that it is customary to leave a short period at the end of the debate for the mover of the motion to wind up.