Draft Blood Safety and Quality (Amendment) (EU Exit) Regulations 2019

Jeremy Lefroy Excerpts

Wednesday 19th December 2018 General Committees

[Jeremy Lefroy (Stafford) (Con)]

The hon. Member for Central Ayrshire made both the points I intended to make. Very briefly, the situation of Gibraltar as a third country strikes me as very odd. On the obligation for the maintenance of communication of serious adverse events, although I understand that it should no longer be an obligation, it should still have to happen. It is absolutely vital that that takes place. Will the Minister say how he intends to ensure that it will?

Finally, I refer to something that I often speak about in the context of the very sad case of our leaving the European Union: the importance of maintaining research across borders of blood diseases and all kinds of health problems we are tackling, because they know no borders. We have to continue and strengthen that. Could the Minister briefly comment on that in the context of these draft regulations?

Mental Capacity (Amendment) Bill [Lords]

Jeremy Lefroy Excerpts

2nd reading: House of Commons & Money resolution: House of Commons & Programme motion: House of Commons & Ways and Means resolution: House of Commons
Tuesday 18th December 2018 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

I speak as a member of the Joint Committee on Human Rights. We looked at this whole issue generally in our report in June, and we looked more specifically at the Bill in October, so I declare that interest. Article 5 of the European convention on human rights sets out the right to liberty and security. It says that no one shall be deprived of their liberty

“save…in accordance with a procedure determined by law”.

That essential safeguard applies to all those who are deprived of their liberty, not just people in the criminal justice system, and so it should. The previous system involved the deprivation of liberty safeguards, which were criticised by the House of Lords Committee on the Mental Capacity Act 2005. The Committee found that

“far from being used to protect individuals and their rights, they are sometimes used to oppress individuals, and to force upon them decisions made by others without reference to the wishes and feelings of the person concerned.”

So reform is most definitely needed.

The only guidance that the Mental Capacity Act 2005 gives to the courts is that

“references to deprivation of a person’s liberty have the same meaning as in Article 5(1) of the Human Rights Convention.”

The Supreme Court, as has been mentioned, has defined deprivation of liberty in an “acid test” that covers all those who are under “continuous supervision and control” and “not free to leave”, regardless of their condition or contentment. It was logical of the Supreme Court to do that, but it has none the less meant that hundreds of thousands of people who were not previously considered as being deprived of their liberty may now be so considered, and 125,630 people have been unlawfully deprived of their liberty between 2017 and 2018.

Just as importantly, this definition causes real anguish to many people and their families. We heard evidence from parents whose children are now considered to be deprived of liberty, despite being content and cared for in their own home by devoted family members. I shall give the House a couple of examples. Mark Neary told us that his son Stephen was

“very much king of his castle in his own place. He requires 24/7 support, which is either me or a member of the support team. It was decided last week that Stephen is being deprived of his liberty in his own home on the basis that, first, he is not free to leave, because you need support workers to go with him when he goes to the shop or goes swimming, and secondly, that he is under constant supervision.”

Graham Enderby told us that we had

“gone so overboard after this judgment it is ridiculous”.

Keeping to the current definition will mean that any system of authorisation would have to be either extraordinarily expensive or minimal. As we said in our second report on this issue,

“a scheme which applies too widely will be so light touch as to reduce protection for those who truly need it.”

For those reasons, the Committee recommended that Parliament use this opportunity to give the courts guidance about an article 5-compliant definition of liberty that will ensure that the safeguards are focused on those who need them. We noted two possible ways in which that might be tackled. The first was to focus on whether the deprivation of liberty was the result of an underlying condition, or whether it was caused by continuous supervision and control. The alternative was to revisit the whole notion of valid consent. Those who lack mental capacity cannot, by definition, give legal consent, but as we have heard, in practice it is possible in many cases to tell whether a person is content with his or her support.

We were disappointed, when the Bill was introduced, that the Government had not tackled that issue. We were also disappointed that the scheme that was initially proposed did not have sufficient safeguards for people who were going to be the subject of the new liberty protection scheme. However, I am pleased to see that the Government have listened, and that during the Bill’s passage through the House of Lords it has been amended to make it explicit that there is a duty to consult the cared-for person about their care arrangements. There were many other amendments that I do not have time to go into now. I am also pleased that the Government have now undertaken to bring forward an article 5-compliant definition of liberty, and we look forward to that extremely important step.

Some concerns remain, however. We must consider whether people should be able to give advance consent to care arrangements. I understand the Government’s position is that advance consent could date from many years before care was put in place, that people may “give up” their human rights in long-stay settings, and that people could feel pressurised into making advance consent arrangements when they did not wish to do so. We understand those concerns, but they can be mitigated with sufficient safeguards to enhance the personal autonomy of cared-for persons. I also remain concerned that the right to advocacy is not robust enough. The provision of advocacy is essential for ensuring that cared-for persons can exercise their right to challenge authorisations, and article 5 guarantees everyone the right to challenge their deprivation of liberty before a court. I am pleased that amendments strengthening the right to advocacy were made in the Lords, but they may not go far enough.

This important Bill needs careful and thorough consideration, so I fully support the recommendation that the Bill’s Committee stage be extended.

Oral Answers to Questions

Jeremy Lefroy Excerpts

Tuesday 27th November 2018 Commons Chamber

[Stephen Hammond]

The NHS faces a challenging winter, but it has been planning throughout the year for this winter. It has been supported by an extra £420 million to redevelop A&Es, improve emergency care and help patients get home quicker. Those plans, more directly, include reducing the extended hospital stays we saw last year, increasing access to GP appointments and increasing the volume of cases that can be treated by emergency dentists.

[Jeremy Lefroy (Stafford) (Con)]

Last week I visited the A&E at County Hospital, Stafford, which achieved 95.8% on the four-hour target in the week beginning 22 October and has consistently achieved over 95% for the past few months. Will the Minister come to Stafford to see what a great job it is doing, and to see how we can use County Hospital more and bring more services into it?

[Stephen Hammond]

My hon. Friend has always been an assiduous advocate for his constituents and their concerns. He is right to make that case today. He is also right that, thanks to the hard-working staff in his hospital and across the country, the four-hour target continues to be met for nearly nine out of 10 patients. I will be delighted to come to Stafford.

Budget Resolutions

Jeremy Lefroy Excerpts

Tuesday 30th October 2018 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

Our country faces some immense challenges and this Budget—from a fine Chancellor, who I hope stays for many more Budgets—does good work in tackling a number of them, but there are several others that I want to address and that some colleagues have touched on.

The first challenge to which the Chancellor and the Prime Minister have risen is the need to fund healthcare properly. A number of Members across the House have regularly made the case for an increase of about £20 billion a year to bring our spending in line with German or French levels, and this is happening. But I agree with the point made yesterday by the hon. Member for Bassetlaw (John Mann)—that is, that we need to pay for this. It should not just come from additional borrowing, and we should continue to look at using hypothecated or other forms of revenue, particularly when it comes to social care.

A second challenge that the Chancellor has met—as, indeed, have employers up and down the country—is the need to increase and maintain employment, and to reduce unemployment to the lowest level in decades. The unemployment rate has fallen from 8% to 4%. In many constituencies, including mine, it has fallen much further than that, but every person out of work is still one too many. It is also welcome that on the whole jobs are gradually becoming better paid.

The third area in which the challenge is being met is defence and our global role, particularly in international development. The UK is one of the only major countries in the world—if not the only one—to maintain both the 2% defence commitment under NATO and the 0.7% official development assistance, and I welcome that. In difficult times, we can be proud that the UK will meet our international commitments as well as the commitments to our own people on safety and security.

Now, what about the challenges? The big and immediate one is clearly exiting the EU. It is absolutely essential that we reach a deal. I am a member of the Exiting the European Union Committee, and the more I hear of the consequences of no deal, the more apparent it is just how damaging it would be to the EU and to the UK. The Chancellor recognises this, and I sincerely hope that he does not have to come to the House with his alternative Budget. But this is not just about exiting the EU; it is about the future of the economy.

My hon. Friends the Members for Mid Norfolk (George Freeman) and for The Cotswolds (Sir Geoffrey Clifton-Brown) have mentioned the challenges we face and the future opportunities. The right hon. Member for Birmingham, Hodge Hill (Liam Byrne) and I recently produced a book on the future of work, looking at countries around the world that are meeting these challenges, including South Korea, Singapore and Argentina. Lots of people across the country are trying to meet these challenges, but they also exist globally.

It is an honour to follow the hon. Member for Makerfield (Yvonne Fovargue), who was right about funding for 16 to 18-year-olds. The years from 16 to 18 are a critical time, and funding dropping off at that stage poses some severe challenges to colleges and schools.

[Mr Jim Cunningham]

Like me, the hon. Gentleman is a west midlands MP, and knows that the west midlands economy is very important to the country. I am not sure whether the Government have clarified whether there will be more money for further education. Further education is the backbone of things such as apprenticeships, and we need more apprenticeships. Does the hon. Gentleman agree that we should be focusing on this important area?

[Jeremy Lefroy]

Indeed, and I think I just mentioned that. In my constituency, Newcastle-under-Lyme College and Stafford College do excellent work, as does South Staffordshire College, but they are underfunded, particularly at that level.

A further challenge is balancing the Budget. The OBR report refers to the Chancellor in terms of St Augustine, as it describes the Budget as Augustinian—“make me chaste, but not yet.” I believe that it is nearly 20 years since the UK has run a Budget surplus, and we are now pushing that back by a further two years. This is not the way to go. We have to look carefully at how we can return to a balanced Budget or a surplus, which can only come from growth, more efficiency or allowing tax rates to rise—we have some of the lowest revenues as a percentage of GDP in the G7—but that has not happened this time. If we are to maintain a sound fiscal policy, it will have to happen soon. The country needs to build up assets in better times to meet the challenges of hard times, and one of those assets is a surplus Budget and a reducing deficit.

Local government finance has been mentioned today. This is a great challenge because I believe, as do pretty much all colleagues in this House, in the importance of devolution and making decisions locally. However, the Government are placing more and more pressures on local government, without giving it the means to deal with them. Local authorities, including Staffordshire, have done excellent work to reduce spending while maintaining services over the last eight years. That cannot go on. Local government has reached the bottom. I welcome the additional money, but we need to see more, particularly in terms of loosening up the requirements for referendums.

The right hon. Member for Enfield North (Joan Ryan) rightly said that the Office for Budget Responsibility report talked about the low savings rate and rising personal debt. That incredibly important area has not been focused on, and I am extremely concerned about it. We need to help households rebuild their balance sheets. People cannot always look to Government to support them in times of difficulty. Personal assets are vital, and I urge the Chancellor to look at ways of encouraging saving, difficult though that is—including efficient lifetime savings accounts that people can draw on in times of difficulty, financial education in schools and further support for credit unions.

We have the biggest current account deficit in the G7—from memory, it is about 3.8%. That is down from 5.1%, but it is still too much. We are too dependent on resources from other countries, and we need to build up our network of foreign assets, from which we receive income. At the same time, we need to reduce our balance of trade deficit.

Finally, we have the challenge of supporting people on the lowest incomes who are long-term sick or disabled. At a time when many people in this country are seeing their incomes continue to rise and are living in prosperity, which I welcome, we need to meet the needs of those who suffer from disability, sickness or low income. I welcome the changes to universal credit, but it still does not work for everyone. I welcome the additional money, but we have to make sure that nobody loses out in the transfer to universal credit, most particularly disabled people. Others, including my hon. Friend the Member for South Cambridgeshire (Heidi Allen) and the right hon. Member for Birkenhead (Frank Field) yesterday, have spoken about how that could be done.

This Budget is a chance to tackle long-term challenges in difficult circumstances, with the coming exit from the EU. The Chancellor has seized the chance to address some of those areas, on which I congratulate him. I believe that, but for this challenge of exiting the EU, he would have tackled other areas, too, but the challenges that remain cannot be put off for ever.

Childhood Obesity Strategy: Chapter 2

Jeremy Lefroy Excerpts

Monday 25th June 2018 Commons Chamber

[Steve Brine]

Yes, that is part of the strategy, in so much as we want local authorities to be involved, and upper tier authorities in England are all now public health authorities in their own right. There is absolutely no reason why sports clubs, which are plentiful in all of our constituencies, should not be a key part of the active lives agenda. Not just children need to do more activity in our country; all of us do.

[Jeremy Lefroy (Stafford) (Con)]

I thank the Minister for the inclusion of both physical exercise and diet in this. Of course physical exercise is vital for mental health as well as physical health. Is the ambition to halve childhood obesity by 2030 ambitious enough, given that this is such an important issue for the future of not only the children, but our health service?

[Steve Brine]

I think it is very ambitious. Our first plan was world-leading and I outlined some of the things it has achieved. I think this plan is ambitious enough at the moment. We say in the plan that it is chapter 2 and that there will be a chapter 3—and no doubt there will be.

NHS Long-Term Plan

Jeremy Lefroy Excerpts

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

This is, as the hon. Gentleman knows, a devolved matter, but I would say that England, Scotland, Wales and Northern Ireland are all on the same journey when it comes to the NHS. We are all moving to integrated out-of-hospital care built around the person and focused on prevention. In one respect, Northern Ireland has gone further faster than anywhere in the UK: I refer to the integration of the health and social care systems. There is plenty we can learn from them and they from us.

[Jeremy Lefroy (Stafford) (Con)]

I congratulate the Secretary of State on this very welcome announcement and reiterate what others have said about the importance of prevention and public health. Since this is a long-term settlement, may I ask him to ensure that the disparities between various parts of England are narrowed over the coming years? They are too great, with some getting £300 or £400 a year per person less than other areas. That is just too much of a difference.

[Mr Hunt]

I totally take on board what my hon. Friend says. I am happy to engage with him and with NHS England. As he knows, we have taken the politics out of that particular process by giving it to NHS England, which I think is the right thing to do. I know NHS England would be happy to engage with him on that.

Oral Answers to Questions

Jeremy Lefroy Excerpts

Tuesday 8th May 2018 Commons Chamber

[Steve Brine]

I talk to colleagues across Government all the time. The first round of the child obesity plan—it was maligned earlier—contained many good things, such as the sugary drinks tax. A couple of months ago we launched, with Public Health England, changes in relation to the nutrient profiling of foods marketed to children. That is positive for the hon. Lady’s constituents and for mine.

[Jeremy Lefroy (Stafford) (Con)]

Five years on from the Francis report, how does my right hon. Friend assess patient safety in the NHS?

[Mr Hunt]

There are still many things to tackle when it comes to patient safety, but I think the NHS has risen magnificently to the challenges in the report. There are nearly 45,000 more doctors and nurses across the system. Although there is more to be done, much credit should go to the NHS.

Patient Safety

Jeremy Lefroy Excerpts

Wednesday 28th March 2018 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Before I begin my speech, I draw the House’s attention to my entry in the Register of Members’ Financial Interests.

Doctors become doctors to help make people better. Patient safety and improving patient care are therefore at the forefront of every doctor’s practice. Indeed, when I went for my consultant interview, I was asked to give a presentation on how I would demonstrate to the trust board that paediatric services in that hospital were safe, and my answer, of course, was, “How safe?” As safe as going to a football match? As safe as travelling on the tube? As safe as flying in an aeroplane? Those activities are safe, but, like patient care, nothing is ever 100% safe. We need to ensure that care is as safe as it possibly can be, and that there are processes in place to learn from mistakes. No party has a monopoly on wanting to make the NHS as good as it can be, and all of us know that the increasing demand and complexity would make healthcare a challenge for any Government.

During my career, there have been significant improvements in patient safety, the most important of which is probably the establishment in 2009 of the Care Quality Commission, with its Ofsted-like reports. By 2017, it had inspected every trust, primary care and adult social care provider, and it continues to ensure they are meeting the highest standards. We now also have the regular revalidation of professionals, reflective practice and case reviews, as well as child death overview panels, which review in detail all unexpected child deaths. New maternity systems have been developed that have resulted in clear progress, as seen in the 20% fall in the stillbirth and neonatal mortality rate in England between 2003 and 2013.

[Jeremy Lefroy (Stafford) (Con)]

I congratulate my hon. Friend on securing this debate. Does she agree that the changes to and strengthening of the CQC’s remit through the Health and Social Care (Safety and Quality) Act 2015, a private Member’s Bill passed with all-party support, represent one step on the long road to ensuring that patient safety and quality care is at the top of the NHS’s agenda?

[Dr Johnson]

I congratulate my hon. Friend on passing that private Member’s Bill, which has undoubtedly saved many lives.

I am proud to work in a health service that, just last year, was rated the best and safest healthcare system in the world by the independent Commonwealth Fund think-tank. To err is human: we all make mistakes. The consequences of a doctor’s error, though, are potentially catastrophic. Doctors live with that responsibility and, as a doctor, I live in fear of making a mistake because I do not wish for anyone to suffer harm.

NHS Winter Crisis

Jeremy Lefroy Excerpts

Wednesday 10th January 2018 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

It is an honour to follow the hon. Member for York Central (Rachael Maskell). I entirely agree with her about being very careful before the NHS sells off property or land for non-health uses. There is a reason why our health facilities are in the places they are, and they could be better used for things like intermediate care.

I had the honour of visiting County Hospital in Stafford on Christmas day, and I saw the wonderful care being provided there. County Hospital is of course the Stafford hospital, which went through the Francis inquiries and the trust’s special administration. I just want to pay tribute to the staff there, who have done an amazing job in bringing the hospital up to the standard it is now at. We want more services put back into that great place, but it is an example of what can happen when people get behind change, and when the patient and safety are put at the heart of care.

I also visited Royal Stoke on new year’s day. The hon. Members for Newcastle-under-Lyme (Paul Farrelly) and for Stoke-on-Trent North (Ruth Smeeth) have already mentioned the huge pressures that the hospital has been under during the past few weeks, and I would not deny that. I saw for myself the trolleys in the corridor and the real pressure under which the staff were working, but I have to say that the care I saw there was exemplary in those conditions. As the hon. Member for Newcastle-under-Lyme mentioned, some serious issues have to be tackled, not least the fact that Stoke, and to some extent Staffordshire, are systemically underfunded, as we can see from the figures. I will write to the Secretary of State about that in due course.

I want to bring some figures to the House’s attention. They are not the most recent figures, but they are from an international health organisation—I think it was the World Health Organisation—three or four years ago, when it asked patients in a number of developed countries whether they could get proper access to good healthcare. The UK performed best: only 4% said that they could not get good access to reasonable healthcare. In Germany, the figure for those who said they could not do so was 15%, and in France it was 18%. When we consider the challenges we face and the needs for the future—I absolutely agree with much of what has been said in this debate—we must not forget how our national health service performs and how it is an egalitarian service, providing access to people of all backgrounds across all our communities.

I fully agree with what has been said by Members on both sides of the House—by the hon. Member for Leicester West (Liz Kendall) and by my hon. Friend the Member for South West Wiltshire (Dr Murrison)—about the fact that we need a 10-year cross-party approach and that we need it urgently and quickly. The Green Paper on social care is a start, but the approach must be more extensive. I urge the Secretary of State and his new team, as well as the Minister on the Front Bench today—the Under-Secretary of State for Health, my hon. Friend the Member for Winchester (Steve Brine)—who has done a great job over the past few months, to consider widening the Green Paper to cover health and social care, especially now that the Department is an integrated one. “Social Care” should not just be stuck on the end of its name.

Finally, I pay great tribute to all those who continue to work day in, day out to provide some of the best healthcare in the world. It can be better, and we must make sure that it is.

Social Care

Jeremy Lefroy Excerpts

Thursday 7th December 2017 Commons Chamber

[Jackie Doyle-Price]

I welcome part of the hon. Gentleman’s comments. He is right: one reason we are at this stage is that the absence of long-term security means that some of these issues are crystallising rather more quickly than they ought to. We have made more money available to local authorities, but clearly they, more than any others, are desperate for a solution. It is incumbent on us all to hold a constructive discussion about the solutions to this issue. I am well aware of the challenges. The hon. Gentleman highlighted the CMA report, and it contains a lot that, frankly, did not surprise me. In the new year we will be bringing forward a response that deals with some of the issues raised.

[Jeremy Lefroy (Stafford) (Con)]

I thank my hon. Friend for her statement, and I encourage her—as others have done—to engage with the whole House on an issue that so many Members care deeply about. As the hon. Member for Sheffield South East (Mr Betts) said, it is important to recognise the crises that exist now in certain areas of the country. We must engage for the long-term on a cross-party basis, but also on the crises now, including in my county of Staffordshire.

[Jackie Doyle-Price]

I do not disagree with much of what my hon. Friend says. Colleagues are talking about a crisis, but local authorities and the care sector have been put under a lot of pressure this year getting ready for winter, and they have stepped up to the plate. I pay tribute to everybody who works in that sector. They work incredibly hard and with real care. The work they do is not putting us in crisis but delivering great care outcomes for many people.