Clinical Waste Incineration

John Howell Excerpts

Tuesday 16th October 2018 Commons Chamber

[Stephen Barclay]

My hon. Friend is absolutely right that the issues we have experienced with the supplier have not affected the NHS’s ability to maintain its service. That has been our key objective throughout, and that continues to be the case.

[John Howell (Henley) (Con)]

Will the Minister confirm that, after the NHS trusts had terminated their contracts with HES, a new contract was given almost immediately?

[Stephen Barclay]

My hon. Friend is absolutely right. One of the key issues was to have alternative provision in place as quickly as possible so that we were not in the situation of waste being stored on site beyond the absolute minimum. It is a tribute to officials in the Department and in the NHS, the Department for Environment, Food and Rural Affairs and elsewhere that a quite complex set of legal arrangements has been mobilised in such a short period to ensure that services are maintained.

Management of NHS Property

John Howell Excerpts

Wednesday 4th July 2018 Westminster Hall

[John Howell (Henley) (Con)]

Will the hon. Lady join me in condemning how the parking company Smart Parking operates its fines system at the Townlands Hospital in Henley? It is a monstrous way of dealing with people; intimidating them when they are at their most vulnerable.

[Karin Smyth]

I cannot comment on the specific company, but trying to understand accountability and how systems work is frustrating for local people. Many of us are trying to make sense of it.

The estate was an afterthought for the coalition Government and their disastrous Health and Social Care Act 2012—the Lansley Act. Their laissez-faire approach, which bordered on contempt, has saddled communities across the country with burdens and consequences ever since. The current Government recognised that in their response to the Naylor review, stating:

“The structural changes in recent years have distracted attention away from the importance of the estate as an enabler of high quality care, and the NHS has lost valuable expertise and knowledge in strategic estates planning, development and management.”

As we are developing the 10-year plan to transform our NHS into a more community-based, joined-up system, the function of the community and primary care estate as an enabler of service transformation becomes more critical. Although the Government said in response to Naylor that they want to incentivise local action, in practice there are no mechanisms to do so. My focus is therefore on the local roles of two national bodies: NHS Property Services and Community Health Partnerships.

The Lansley Act nationalised health centres, GP premises and, in my constituency, the South Bristol Community Hospital overnight. When the Government realised that no one was responsible for property managed by primary care trusts—mainly GP premises and health centres in poorer areas—they set up NHS Property Services, which became the landlord and asset manager on behalf of the Secretary of State. Community Health Partnerships took over the primary care trusts’ 20% control of local infrastructure finance trusts—LIFT companies—which were public-private partnerships for new GP premises and community-based services, such as South Bristol Community Hospital.

A key part of the LIFT incentive was that the companies made a profit and from that a dividend was returned to all shareholders, including the primary care trust. The Lansley Act passed that 20% local share to the Secretary of State. That LIFT company is still operating, as others are across the country. Bristol Infracare LIFT paid dividends totalling £823,000 last year and £2,344,000 in 2016. Community Health Partnerships received 40% of that, but 20% should have been retained in the Bristol health economy. In the last two years, that amounts to £633,400 in Bristol alone, and that is replicated across the country. I am here today with a simple message for the Secretary of State, via the Minister: I want control of this asset to be given back to the local health economy, and I want our money back.

The closer one looks at the labyrinthine structures that govern NHS properties, the more it seems that the opaque and impenetrable way in which these companies operate is not accidental. They appear to be purposefully disenfranchising and disempowering local people. Whatever the merits of the Lansley Act—I contend that there are not many—it was supposed to drive devolution, liberation and accountability.

Child Migration Programmes (Child Abuse)

John Howell Excerpts

Tuesday 3rd July 2018 Westminster Hall

[Lisa Nandy (Wigan) (Lab)]

I beg to move,

That this House has considered child abuse in the child migration programmes.

Thank you, Mr Hollobone, for allowing me to shine a spotlight on what I can only describe as a state-sponsored system of child abuse. The former Prime Minister, Gordon Brown, said recently that it was

“bigger in scale, bigger in geographical spread and bigger in the length of time that it went on undetected”

than possibly any other national sex abuse scandal in our history.

For five decades from the 1920s until the 1970s, more than 130,000 children were sent into care overseas in countries including Australia and what was then Southern Rhodesia. Charities, churches and the UK Government participated in the scheme, known as the child migration programmes.

Many of those children were physically and sexually abused. Children as young as 12 were subjected to backbreaking work. Many were psychologically tortured. Some of those children were as young as three years old. They were separated from parents and siblings and many were wrongly told that their families were dead. Children reported being abused in institutions in England before they were then abused again in institutions in the countries that they were migrated to. They were abused by staff, by visitors and by other children. Some were also abused in transit. I will briefly share two of their stories. It is impossible to understand the full horror of this period in our history without hearing some of what happened. I apologise in advance, because it is extremely distressing.

Marcelle O’Brien was only four years old when she was migrated to Australia by Fairbridge. She was bullied. She was locked in cupboards. She was mentally abused. She was sexually assaulted and repeatedly raped by a succession of men. Like so many others, she continued to live with the horror of what had happened until well into adulthood, suffering mental breakdown and periods of manic depression. It was only when she found the Child Migrants Trust that she felt able to talk about what had happened.

Michael O’Donoghue recounted his horrific experiences at the hands of Christian Brothers in Clontarf in Western Australia. He was beaten. He was raped. He endured electric shock treatment. Along with 15 other children, he was forced to watch their pet horse murdered in front of them on what was known as “special punishment day”—one of a series of regular collective punishment days that those children had to endure.

What has since emerged is how many warnings were overlooked, ignored and covered up. For decades, successive Governments ignored those warnings and continued to send children to harm.

[John Howell (Henley) (Con)]

The hon. Lady is telling some very powerful stories. Has she come across the Lanzarote convention, which was produced by the Council of Europe and signed by the British Government in March, and is she aware of the work the Council of Europe has been doing to highlight the problem of child abuse among refugees? I think that would help her case enormously.

[Lisa Nandy]

I am very grateful to the hon. Gentleman for attending this debate and for raising that point. One of the reasons why it was important for me to bring this issue to the House for the first time for a full debate is that many Members have a strong interest in this area and in pursuing justice for the affected families. It is important that those suggestions are heard, and I hope the Minister has heard them.

Like Marcelle O’Brien, many of those who survived that horrendous period are still living with the consequences. Four years ago, the Prime Minister—then the Home Secretary—commissioned an independent inquiry into child sexual abuse. MPs from various parties, including me, welcomed that decision. The inquiry’s first full report is on this subject, and it is damning.

--- Later in debate ---

[John Howell (Henley) (Con)]

Thank you, Mr Hollobone. Am I sufficiently loud for you?

[Mr Philip Hollobone (in the Chair)]

indicated assent.

[John Howell]

Great. Let me keep it at that level and say what a pleasure it is to serve under your chairmanship, Mr Hollobone.

I wanted to pick up on my intervention, which the hon. Member for Wigan (Lisa Nandy) kindly took, and to raise an issue that has troubled us greatly at the Council of Europe. We are members of the Council of Europe and we shall still be so after Brexit. It is an important body. The convention that I mentioned is the convention on the protection of children against sexual exploitation and sexual abuse, which is known colloquially as the Lanzarote convention.

The convention is important because the one thing that it requires above all is the criminalisation of sexual offences against children. It requires countries that have signed it to ensure that they have in law the necessary criminalisation of such sexual offences. It applies to Europe and to states beyond Europe. Its purpose is to protect child victims and to ensure that perpetrators are prosecuted. Those two things go together well. Forty-seven members of the Council of Europe have signed the convention—there are only 47 members of the Council of Europe, so all members have signed it—and 44 have ratified it. I think we ratified it in March this year.

We are very concerned about the sexual abuse of child migrants. If the hon. Lady looks at the Council of Europe website, she will see a huge raft of discussions and papers that have been produced on this subject, which will contribute strongly to her case. We have approached this from a human rights position, trying to protect the human rights of the children involved. The Council of Europe is the premier human rights organisation in Europe. What came out of the production of the convention was that this should be a political priority in every country that has signed and ratified the convention.

I leave that as an explanation of my earlier intervention on the hon. Lady and of how this may help. It is also an indication to the Minister of how we are activity pursuing a line, in association with our Council of Europe colleagues, of taking this matter further.

Oral Answers to Questions

John Howell Excerpts

Tuesday 19th June 2018 Commons Chamber

[Caroline Dinenage]

We are aware of concerns in the sector with regard to sleep-ins and we are looking very carefully at the options. We have been developing the evidence base very carefully. We have been engaging with the European Commission, the sector and other Government Departments.

[John Howell (Henley) (Con)]

Oxford Health NHS Foundation Trust recently won a bid under the Beyond Places of Safety scheme to put in place IT support for users of learning disability services. Is that not a very useful way of taking forward such projects?

[Caroline Dinenage]

My hon. Friend makes an excellent point. It is vital that when we look at how to move forward with both our health and social care services, we are able to capture all the latest technology to ensure that we improve the experience for all our service users.

NHS 70th Anniversary

John Howell Excerpts

Wednesday 16th May 2018 Westminster Hall

[John Howell (Henley) (Con)]

It is a great pleasure to serve under your chairmanship, Mr Hosie. Let me begin by reassuring the Minister that I am not going to give a list of all my medical complaints—I seem to have a tendency to do that at these debates. I will just say that they are very few in number. As one of the officers for the all-party parliamentary group for diabetes, I agree with what the hon. Member for Blaenau Gwent (Nick Smith) said about diabetes, and the way we need to tackle it by fighting obesity and waiting for the effects of that to come through.

If there were one birthday present that I would like to give the NHS, the Prime Minister has already given it: a long-term plan for the NHS and a multi-year funding settlement in support of it. That is very important for a number of reasons. We all know that the NHS has suffered its most challenging winter for many years. We also know, as Opposition Members have pointed out, that we are living in an ageing society. By 2020, there will be more 70-year-olds than there were five years earlier. I am not sure whether my hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant) and I will be in that category—I have not done the maths yet—but we will go there jointly and with good humour, I am sure. The number of over-85s will nearly double by 2035. We have to focus our services on dealing with the requirements of that group of people, who are living in a modern age where the NHS has introduced many improvements over the past few years.

For the NHS to plan and manage budgets effectively in the long term we need to move away from annual top-ups of its budget, and towards a sustainable long-term plan. Whatever plan we introduce, it has to be sustainable. We have the five year forward view as a basis on which to work towards that. I was very pleased that the Prime Minister announced to the Liaison Committee that the Government would introduce a long-term plan for the NHS and, most importantly, do so in conjunction with the leaders of the NHS, clinicians and health experts. We cannot introduce that long-term plan simply as politicians. I look forward to that with a great deal of anticipation.

We all know that care is not properly integrated—we have seen that in our constituencies—and we all know that we need to integrate health and social care more quickly than we can really manage. I fully support that process. All those things came up at a public meeting in my constituency just a few days ago. Somebody asked why we still fund the NHS on an annual basis, and I was able to point out that we are moving away from that system.

I will finish with this point: putting public health at the heart of what we are doing with the NHS is crucial. We cannot stand here and speak about the future of the NHS unless we put public health at the centre of everything we do. I recommend that course of action to the Minister.

Education (Student Support)

John Howell Excerpts

Wednesday 9th May 2018 Commons Chamber

[Stephen Barclay]

I absolutely recognise that the apprenticeship route will take four years, but the Government have given a clear commitment to that and that is backed up by significant—[Interruption.] The UCAS figures are embargoed, so I do not have the latest figure. The point is that it is a four-year programme and it will take time to roll out, but it is backed by significant funding: the NHS is contributing £200 million to the apprenticeship levy. That is a signal of this Government’s commitment. The Minister for Apprenticeships and Skills is here, championing the apprenticeship route, as are other Members through the Select Committees. It is a shame that some Opposition Members are not reflecting on the benefits offered by apprenticeships as an alternative route into the nursing profession that will deliver more nurses. That should be welcomed.

[John Howell (Henley) (Con)]

I think my hon. Friend the Minister has forgotten that the Minister for Education, my right hon. Friend the Member for Bognor Regis and Littlehampton (Nick Gibb), is also here, which reinforces the point that the starting point for promoting nursing is at school. Does my hon. Friend agree?

[Stephen Barclay]

I do agree with my hon. Friend. Indeed we have three Ministers from the Department for Education here, which again shows the Government’s joined-up approach. The NHS, as the employer of 1.5 million people, is a standard setter that can provide leadership in the apprenticeships market and looks at doing so not just for nursing apprenticeships, but across a range of apprenticeship routes. The Minister for Apprenticeships and Skills, who is a former Minister in the Department of Health, understands that issue extremely well.

Learning Disabilities Mortality Review

John Howell Excerpts

Tuesday 8th May 2018 Commons Chamber

[Caroline Dinenage]

It is not about that. This is about inquiring into the deaths of people who have died in our care. Despite all the really difficult decisions we have had to make to deal with the financial challenges this country faced, which the hon. Lady’s party will be well aware of, we have made progress on this issue in terms of transforming care and the healthcare checks on people with learning disabilities, and this very report on the learning from deaths programme proves how absolutely committed we are to ensuring that not one single one of those deaths goes unrecognised or uninvestigated.

[John Howell (Henley) (Con)]

Surely the quicker integration of the NHS with social care across the board will help to solve some of these problems. Does the Minister agree with that?

[Caroline Dinenage]

Yes, my hon. Friend is absolutely right. The integration of health and social care services is absolutely vital, and that is why we are so delighted that we have renamed the Department as the Department of Health and Social Care. That has to be more than just a title; it has to be a statement of intent.

HPV Vaccination for Boys

John Howell Excerpts

Wednesday 2nd May 2018 Westminster Hall

[Sir Roger Gale]

My hon. Friend the Minister indicates that he knows the problem only too well. My hon. Friend the Member for Finchley and Golders Green has done a significant amount of work in achieving the provision of human papillomavirus vaccine for gay men—a small but significant step in the direction in which I hope we may travel further this morning.

Until a relatively few weeks ago, I knew very little about this issue. I concede that entirely. Unlike one of my colleagues who was here in this Chamber yesterday morning while I was in the Chair listening to the debate, who had a relative who had died of bowel cancer, I have no personal experience. However, when I met Professor Nutting and Peter Baker, I was astonished at the speed with which they convinced me of the argument—and I am not a pushover when it comes to spending taxpayers’ money. I think it is a no-brainer, and I hope to persuade my hon. Friend the Minister, and others, on this cause.

The human papillomavirus causes, among other things, cervical cancer, throat cancer, anal and penile cancers, and cancer of the back of the tongue. The virus is carried by about 80% of the population, which means somebody in this room is a carrier; it is not uncommon. I would like everybody to take that on board. Go on the tube in the morning and there will be dozens of people carrying the virus—most of it dormant, and a lot of it non-malignant. It is contracted in sexually active youth and, for men, usually in their teens or 20s.

The point is that it is a slow-burn issue. Its effects are not experienced overnight. A condition contracted as a teenager or at university may not rear its head for 30 years. We are talking about men now in their 50s and 60s, who some of the eminent people sitting behind me in the Public Gallery are treating, waiting that length of time without realising that they have anything wrong with them at all, because there is no screening process for men, unlike the screening process for cervical cancer.

I spoke yesterday to two people, Jamie Rae and Stephen Bergman—both sufferers, and both in their mid-50s—who described their experiences to me. I will not go into too much of the gory detail. I heard again this morning of another experience: somebody’s colleague, himself an eminent surgeon, who had throat cancer and suffered many months out of work, which was a loss to the health service, damage to his family and, of course, the treatment. The treatment involves chemotherapy and radiotherapy; it may involve a tracheostomy; and it inevitably damages the saliva glands in the mouth, leaving the patient who survives with permanent dryness, considerable pain and ongoing discomfort. As I have indicated, there is also the social damage. Both Jamie Rae and Stephen Bergman described to me in graphic detail the processes they have been through and the discomfort—I use that word very modestly indeed—they have experienced. They described themselves as the lucky ones, because both those gentlemen have come through it relatively unharmed, but of course there are many others who do not.

The HPV vaccine has been available to adolescent girls since 2008. A pubescent girl of 12 or 13 is offered the opportunity to be vaccinated in school. The parents, quite properly, have a right to refuse that vaccine. Just in case anybody has any doubt, I am aware that there are a small number of cases where parents believe that things have gone wrong and that children have suffered as a result of the vaccination. That is medically unproven, but we have to recognise that the parents believe it. Parental choice is vital, and in the case of pubescent girls there is parental choice.

The process ties in directly with the Department of Health and Social Care’s cancer strategy, which of course is about prevention. The Department has done significant work on preventing or seeking to prevent other prominent cancers. Lung cancer is the obvious one, and the anti-smoking campaign is highly relevant in this context. Melanoma is another; something that people of a certain age, such as myself, probably did not bother with at all has suddenly become prominent as the realisation of the damage that the sun’s rays can do to the skin and the cancers that can arise from that has dawned on the population. Any responsible parent or grandparent now takes the trouble to ensure that their children have appropriate sunscreens at all times when enjoying the sun. HPV vaccine falls directly into that category. It is usable for prevention and, used properly, it works. That is proven. As I said, this has been available to adolescent girls since 2008.

We now come to the hard bit of the argument, because up until now I think everybody would probably agree that we are on a winner in using HPV vaccine, but of course there is the question of cost and efficacy. The argument has been deployed that herd immunity, to use the colloquial phrase, will mean it is not necessary to vaccinate boys, because if we eliminate the infection in girls, boys will not catch it from the girls. That is nice in theory, but wrong in practice.

I am told by those who know better than I do that the average young male has at least 10 sexual partners. The Minister might find that surprising; I did myself, but it is so. It depends whom we believe, but in the United Kingdom the vaccine has an uptake of between 70% and 83%, although in some parts of the country it is as low as 50%. A young man embarking on an exciting night out with his girlfriend therefore has a very high risk of contracting HPV from a girl who has not been vaccinated, and that is just in the UK. We overlay on that the foreign travel that many young people are now happily able to enjoy. Sometimes, with sun, sea and sand goes sex, and the risk of exposure to HPV in those circumstances can be even greater. Therefore, the idea that herd immunity will in time address the problem is fallacious, and this is where I have to accuse those who are responsible for taking the decisions—that is not the Minister—of short-termism.

I can see the attraction of the argument that extending vaccination would not be cost-effective and that herd immunity is coming downstream. Yes, the cases coming through now are historical, in the sense that the disease was contracted 20 or 30 years ago, so well before any immunisation. If we want to save money and damage health at the same time, that is quite a good way of going about it. I am seeking to persuade the Minister of the real value of having the courage—he is not lacking in courage—to take a long-term decision now.

The cost of immunising every adolescent boy within the relevant range in the UK is estimated to be, at the top end—this includes the purchase of the vaccine, which of course has to be negotiated by the health service, and its application—about £22 million a year. That is a lot of money, but in health service terms it is almost a bagatelle. Set against that, I am told by those with real experience, some of whom are sitting behind me in the Public Gallery, that there are about 2,000 patients a year—men in their 50s and 60s—who have developed throat, penile or anal cancers. The cost of treating those is about £21 million a year. Of course, that takes no account of the social costs and the other damage that can be done. In the case described to me this morning, of a surgeon who was taken out of play for a considerable time, the cost of treatment—of a replacement jaw, as well as the chemotherapy, radiotherapy, hospitalisation and everything else that goes with it—is looking like being somewhere between £50,000 and £100,000, and that is just one case.

[John Howell (Henley) (Con)]

My hon. Friend mentions the 2,000 people. Does he have an estimate of the total number of people who might be spared the effects of the virus if the actions that he proposes are taken?

[Sir Roger Gale]

I am afraid that I do not. The figure that I have is 2,000 people a year, so one has to assume that it is that—but it is growing.

The reason the condition is becoming more prominent, not less, is the change in sexual attitudes from the 1960s onwards, when practices that were previously unacceptable became acceptable. Oral sex, for example, became relatively commonplace. We can therefore expect, certainly within the next 10, 15 or 20 years, a significant rise in the number of cases. The discussion has to be about what happens after that and whether the herd immunity actually works. I am arguing that it will not, for the reasons I have given.

I have talked about the slow burn, the 20 or 30-year wait, and the costs to the health service, on which the view seems to be, “Okay, fine. Let’s kick that into the long grass. It’s not our problem.” There will be 15 Ministers between the present one, sadly, and the time when people are developing diseases. However, the condition of genital warts, which is also caused by HPV, takes only three, four or five years to incubate, and the cost of that annually is £50 million, so do the maths. The economics of this are unassailable, and on those grounds I defy anyone to challenge my argument. The argument comes down to herd immunity. Will vaccinating girls do the job or not? I have made it clear that I believe it will not, and I think that the time has come for the Department to take a further long, hard look at the issue.

Up to now, the Joint Committee on Vaccination and Immunisation has indubitably taken a short-term approach to this: “Does it work? Well, yes, the vaccine works. Is it worth it? Well, not if we are vaccinating girls. Let’s see what happens—kick it down the line and save £20 million a year today,” even if that means that in 10, 15 or 20 years’ time we will be spending not £20 million but £200 million a year, which will be in addition to all the social costs. I understand that the JCVI will meet in the first week of June. We were promised that a decision on extending vaccination would be taken in 2015. That was deferred until 2017 and has now been deferred without a date being set for the final result.

Before I conclude with a request to the Minister, I want to say this. Chris Curtis, chairman of The Swallows head and neck cancer charity, sent me a video this morning. It was compelling, because he has been a sufferer himself and he described his own circumstances. I want to say something to the JCVI, to each and every member of that august body, who are of course medically qualified in a way that I am not. What I want to say on behalf of all the people who have been treated and have approached me is what Chris Curtis said at the end of his video. Friends, when you are thinking of kicking this into the long grass because it is not going to affect many people for a very long time and we do not have to concern ourselves with tomorrow, remember what Chris Curtis said, very starkly: “Tomorrow comes very quickly.”

I will not ask the Minister to second-guess the JCVI—that would not be right. I do not believe that this is his decision to make, in the sense that I suspect he is little more medically qualified than I am. Neither of us has the expertise to make this judgment. Will he please convey that sense of urgency about tomorrow to the JCVI, with the firm and genuine request that he wants them to take a long-term view, and to make the decision on the balance of long-term cost, not savings tomorrow?

--- Later in debate ---

[John Howell (Henley) (Con)]

It is a pleasure to serve under your chairmanship, Sir Henry. There is not much more that I can add to the presentations that have been made by my colleagues, but I want to make a couple of points. First, this is not simply about the sexual relationships of gay people. It affects all of us. My colleagues made that point firmly, but we need to make it again. Secondly, this virus is horrible. It is a disgraceful virus—to anthropomorphise a virus. We have heard the descriptions of the cancers that are induced by it.

I want to concentrate on the preventive powers of this vaccination for genital warts. There is a strong case for that. They may appear to be insignificant, but I do not believe that they are; they are much more widely distributed among the population than the cancers induced by the virus. My hon. Friends the Members for North Thanet (Sir Roger Gale) and for Worthing West (Sir Peter Bottomley) have made a compelling case for the immunisation of boys, which I fully support.

Autism

John Howell Excerpts

Thursday 29th March 2018 Commons Chamber

[Robert Halfon (Harlow) (Con)]

I am hugely grateful for the opportunity to speak in this important debate, and I again congratulate my right hon. Friend the Member for Chesham and Amersham (Dame Cheryl Gillan) on her work in this area. I particularly want to pay tribute to the work of organisations that support autistic people, such as PACT for Autism in my constituency of Harlow. It started off as a small charity, but has now become a national one, and it has done so much to educate me about autism and to support families with autistic children across my constituency and elsewhere.

Ensuring that all children are able to access supportive, high-quality education and post-16 opportunities is essential for their life chances and for enabling them to climb the education ladder of opportunity. Our Education Committee is currently holding an inquiry into alternative provision, and we are likely to do an inquiry in the future into the role of special needs in education.

Children in alternative provision are the most vulnerable children. Compared to their peers, they are seven times more likely to have a special educational need, 10 times more likely to have a recognised mental health problem and, as I said to my right hon. Friend earlier, four times more likely to be permanently excluded from school than any other child. We have a real problem with the number of exclusions in our country. We are excluding a classroom-plus—35 children—from school every day.

[John Howell (Henley) (Con)]

Is my right hon. Friend aware that schools deliberately exclude children with autism when they know that an Ofsted inspection is coming?

[Robert Halfon]

We have heard all sorts of stories about exclusions in schools, and I think there is a wild west of exclusions out there. This is why our Committee is looking into it and undertaking an inquiry, and we have heard what my hon. Friend has said.

--- Later in debate ---

[John Howell (Henley) (Con)]

It is a great pleasure to follow the hon. Member for Bristol West (Thangam Debbonaire) and all my other colleagues who have spoken on this matter. I congratulate my right hon. Friend the Member for Chesham and Amersham (Dame Cheryl Gillan). I am very pleased to support World Autism Awareness Week.

I have a constituency interest and a personal interest in this issue. The constituency has a large number of centres that provide support to those with autism. We also have a spectacular charity, Music for Autism. I was interested to hear the comments on the link between music and those with autism, which has been enormously helpful. I hope to come on to my personal interest in due course.

Young people and adults with autism are some of the most loyal and hardworking people I have ever come across. All they need is a chance, and that chance comes through early diagnosis. The more I have looked at this issue, the more I have become attached to the idea of one-stop shops for parents or guardians. Provision varies depending on where one is in the UK. I refer Members to the Department for Education report that covers that, by our former colleague Lee Scott.

On school exclusions, what has shocked me the most is that young people with autism face more exclusions than any other group. That is a frightening thing to take on board. It is perhaps not surprising when we have heard that some schools are excluding people when they know that Ofsted is coming—a disgraceful use of the system.

My personal interest is as an ambassador for a scheme that goes by the names of the Glyn Hopkin Foundation, the Sycamore Trust, and Space—Supporting People with Autism into Continued Employment. The charity does a lot of the work that hon. Members have been talking about the Government providing. It not only provides people who are fully ready for work; it provides advice to employers on how they should go about changing their own operations to make them autism friendly. What I have taken away from its work is a reminder that minor, easy adjustments to recruitment and the workplace can make a huge difference. I am currently trying to take a young person with autism into my office here in the House of Commons to work alongside me, initially for a few weeks on my first attempt. It is a great privilege to be involved in this area.

I will finish a little earlier for similar reasons to those given by the hon. Member for Bristol West, but I will say that the Department for Education has done great work over many years. This is not a question of funding, but attitude. It is a question of getting the attitude right in the Department to face this opportunity to make the most out of those with autism, so that they can better contribute to our society.

Teaching has been mentioned. I am very appreciative of all that has been said about the provision of training for teachers, but actually I would not blame the teachers at all on this issue. I blame a number of local education authorities. It is currently very hit and miss as to whether a local education authority is autism friendly, and can cope and provide all the support services. There are many good examples, but I will not name them now.

[Dame Cheryl Gillan]

Does my hon. Friend agree that not only is it important that schools do not exclude a pupil with autism when the Ofsted inspectors are coming into the school, but that those Ofsted inspectors should be fully trained to understand autism? They could then inspect a real class in a real situation and see how the school handled it.

[John Howell]

My right hon. Friend makes a very good point. I expect Ofsted inspectors to be trained to ask the question, “Who has been excluded who has an autistic condition?” That should be fundamental to what an Ofsted inspector asks before beginning an examination. My criticism of local education authorities includes the fact that many do not pass on all the funding given to them by central Government. There is a great need for ring-fencing such funds so that LEAs can carry out what we are asking them to do.

Patient Safety

John Howell Excerpts

Wednesday 28th March 2018 Commons Chamber

[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.

[John Howell (Henley) (Con)]

My hon. Friend may have seen that the Medical Protection Society is asking for the bar to be lifted on criminal proceedings and for the General Medical Council to be shaken up a bit to improve its approach to dealing with this issue. Does she have any sympathy with that?

[Dr Johnson]

I will come on to that later, but I agree with my hon. Friend.

I have worked with at least two colleagues who made significant errors. Many lessons were learned and widely disseminated. Training was provided to stop recurrence, but neither doctor was prosecuted. Throughout my career it has been the case that, if a doctor does their best but makes a genuine error, they will not face criminal charges. Gross negligence manslaughter was seen to be an appropriate sanction for the doctor who refuses to see a patient, who turns up intoxicated or who deliberately does something wrong. That facilitates a no-blame or airline safety-style culture, promoted by the Secretary of State, in which errors are identified and continuous improvements are made.

Following the case of Dr Bawa-Garba, that safety culture and those improvements to patient care are now in jeopardy. Although she was newly back from maternity leave, had not received induction, was covering two people’s jobs, had inexperienced junior staff to supervise and had reduced consultant cover, a very busy unit and a broken IT results system to contend with, Dr Bawa-Garba was convicted of gross negligence manslaughter and, more recently, struck off the medical register by the GMC. Those events followed the very sad and tragic death of a little boy, which of course saddens all of us in this House and is something from which his family will never truly recover.

Whatever the rights and wrongs of this particular case, many professionals have seen sufficient ambiguity in the decision that Dr Bawa-Garba was criminally culpable that it has shaken their confidence that they understand the boundary between a genuine error of medical judgment and conduct so exceptionally bad that it amounts to criminal behaviour. It has, in the words of the chair of the Royal College of General Practitioners,

“shaken the entire medical community”.

Although the GMC is an independent organisation, the Government will be aware of concerns raised about its decision making on this case. Perhaps the most high-profile concern was raised earlier this month at the local medical committees conference, where GP leaders passed a vote of no confidence in the GMC. I would be grateful if the Minister elaborated on what the Government are doing in their work with the GMC to ensure it is executing its functions correctly and to restore medical and public confidence in it.

It is right that individuals are held accountable for their actions, but there is always a balance to be struck between accountability and blame. Where the balance is tipped towards blame, individuals become fearful and may attempt to cover their mistakes, preventing them and others from learning; the same errors will therefore be repeated. Since the case of Dr Bawa-Garba, many doctors have become fearful. That culture of fear means that some doctors are being advised to anonymise reflective practice and to avoid uploading those reflective practices on to their e-portfolio. They might unnecessarily escalate decisions previously undertaken themselves or refuse to do more than contracted. That cannot be good for patient safety.