Criminal Justice Bill

Debate between John McDonnell and Peter Dowd

Report stage
Wednesday 15th May 2024 Commons Chamber

[John McDonnell (Hayes and Harlington) (Lab)]

My hon. Friend the Member for Birmingham, Yardley (Jess Phillips) said that it was uncertain whether this legislation would ever reach the statute book, because of the time available to us in the run-up to the general election. I hope that some of the measures to be dealt with on day 2 of consideration of the Bill do not get on to the statute book. However, across the House today, there has been an interesting setting of the agenda for the next stage of the debate on the Bill in the Lords and perhaps for the period after the general election. Perhaps an incoming Labour Government will have to deal with those issues as well. They reflect a number of concerns that we deal with as constituency MPs.

I congratulate the hon. Member for Gloucester (Richard Graham) on tabling his amendments on spiking. It is an issue that affects many of our constituents. I hope that the Government will respond positively and work through the detail. Perhaps we can have something in the Lords that overcomes some of the Government’s concerns about it. I agree that using the expression “spiking” is important, so that people know that we are dealing with it.

[Peter Dowd]

I welcome the amendments tabled by the hon. Member for Gloucester (Richard Graham). It is important to indicate that my hon. Friend the Member for Bradford South (Judith Cummins) was also involved in supporting amendments on this matter. I welcome the cross-party agreement on this issue.

[John McDonnell]

The Bill Committee itself also worked hard to try to reach consensus on some of the issues.

The right hon. Member for Chingford and Woodford Green (Sir Iain Duncan Smith) is not in his place, but cuckooing has become a critical issue in some of our constituencies, where the most vulnerable people have their accommodation taken over by drug dealers and feel intimidated. Often, they are the most vulnerable, with special educational needs or mental health problems. It is a relatively new issue that has come to light in some of our constituencies, and it needs to be addressed.

On the amendments tabled by my hon. Friend the Member for Bootle (Peter Dowd), in a dignified way he did not go into the detail of individual incidents, but there have been cases in my constituency. We had three youngsters—one aged 17 and two aged 16—killed by a hit-and-run driver. The drunk driver was eventually caught. The issue was not just that they broke the law but that they did not stick around to help in any way, or even report the incident so that emergency vehicles could get there more quickly to assist those who had been harmed.

The two issues I want to draw attention to are the ones whose campaigns I have been involved in. First, my hon. Friend the Member for Liverpool, Riverside (Kim Johnson) tabled new clause 28 on joint enterprise. I think we are all getting long in the tooth on this one. We have been campaigning for years—for decades—for some clarity in the law, so that it does not operate as a dragnet that draws people in. In some instances, we have had cases where the individual drawn in was not at the scene of the crime or was distant from the scene of the crime, yet they have been prosecuted for serious crimes, often murder. For that reason, the significant contribution of new clause 28 reflects discussions and debates within legal circles but also in the courts themselves. It is a simple amendment that would bring some justice to many cases where people have, unfortunately, experienced what I believe is a miscarriage of justice.

Secondly, the hon. Member for Carshalton and Wallington (Elliot Colburn), who is not in his place at the moment, raised the more effective use of the law to tackle hate crime. I convened a meeting of disability groups a few weeks ago. There is a wave of hate crime against disabled people at the moment, on a scale that we have not seen for a number of years. We have had incidents not just of abuse in the streets, but even people being pulled out of their wheelchairs. I do not want to be party political here, but I have to say that statements by some individual Ministers about lifestyle choices and benefits and so on have not helped. In fact, it has directed some hate crime towards people with disabilities. We need to recognise that that happens—we should not sweep it under the carpet—so we should have an effective legal response to it. New clause 32, tabled by the hon. Member, is an effective way of ensuring the message goes out there to people that hate crime is a serious offence and that if they commit it they will be prosecuted and the sanction will be effective and serious. I hope that the Government will accede to new clause 32, but if he does put it to a vote I shall certainly be voting for it.

I want to raise another issue, prisons overseas, that I just find preposterous, to be frank. The hon. and learned Member for Bromley and Chislehurst (Sir Robert Neill), the Chair of the Justice Committee, referred to it and I agree with him. I tend to think it is a stunt. I do not see it as a practical way of dealing with the overcrowding problems in our prisons. We should deal with them in exactly the way the Justice Committee has been saying for a number of years: send fewer people to prison, in particular those for whom prison is inappropriate—those with mental health problems, drug problems and so on. If we do send people to prison, build appropriate prisons so that we can maintain them but, more important, rehabilitate them.

This flies in the face of all we know about rehabilitation and everything we have learnt over the years. I declare an interest as an honorary life member of the Prison Officers Association. Everything we know from the professionals involved—probation officers, prison officers and others working within the system—is that to rehabilitate people one of the best things we can do is, first, make sure they have access to their families. It is their families who urge them to behave, rehabilitate and come out as quickly as possible. Secondly, we can ensure they have full access to training and education to rehabilitate. Thirdly, we can ensure that they have proper legal advice, so they know the situation they are in and come to terms with it, and understand the law as it applies to them.

My fear is that, if we depend on prisons in foreign countries, access to family will be limited—that is inevitable. There is no assurance that I can see that prisoners would receive appropriate training or rehabilitation. Access to legal advice within the UK system would inevitably be restricted. This therefore flies in the face of everything we know about how prisons should work, and it flies in the face of many of the things that the Government themselves say about how the system should operate to maintain safety but, at the same time, rehabilitation.

A number of amendments and new clauses have been tabled on the basis of professional advice from others. I urge the Government to accept that we should not send abroad prisoners who, within a limited period, will face potential release. I also think that prisoners who have been imprisoned for public protection should not be doubly harmed by being sent abroad, and that proper consideration should be given to inspection arrangements. I believe that it will be almost impossible to maintain an appropriate inspection arrangement for both prisons and escort services when they are located abroad, and that if it is maintained, it will be extremely expensive.

Podiatry Workforce and Patient Care

Debate between John McDonnell and Peter Dowd

Tuesday 20th June 2023 Westminster Hall

[Peter Dowd (in the Chair)]

I will call John McDonnell to move the motion, and I will then call the Minister to respond. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up.

[John McDonnell (Hayes and Harlington) (Lab)]

I beg to move,

That this House has considered the podiatry workforce and patient care.

The background to this debate is a meeting I had with a number of local podiatrists representing the Royal College of Podiatry, so let me thank them for the briefing that the royal college has sent me. I want to talk about the development of a workforce strategy for podiatry.

To explain for those who may take an interest in the debate, podiatrists are highly skilled healthcare professionals. They are trained to assess, diagnose, prevent, treat and rehabilitate complications of the foot and lower limbs. They manage foot, ankle and lower-limb musculoskeletal pain, and skin conditions of the legs and feet. They treat infection, and assess and manage lower-limb neurological and circulatory disorders. They are unique in working across conditions and across the life course, rather than on a disease of a specific area.

A podiatrist’s training and expertise extends across population groups to those who have multiple chronic, long-term conditions, which place a high burden on NHS resources. The conditions largely relate to diabetes, arthritis, obesity and cardiovascular disease. In addition to delivering wider public health messages in order to minimise isolation, promote physical activity and support weight-loss strategies and healthy lifestyle choices, podiatrists keep people mobile, in work and active throughout their life. They contribute to the wellbeing of our economy and workforce.

Podiatry is intrinsic to multiple care pathways too, and podiatrists liaise between community, residential, domiciliary, secondary care and primary care settings. They specialise in being flexible and responsive, ensuring focused patient care, irrespective of the clinical setting. Podiatrists are at the forefront of delivering innovation in integrated care. They deliver high-quality and timely care, as well as embracing safe and effective technologies that lead to improved patient outcomes.

The role of podiatrists in managing diabetic foot complications is key. They play a vital role in the prevention and management of diabetic foot complications, which, at the last estimate, cost the NHS in England £1 billion a year. In the three-year period from 2017-18 to 2019-20, there were over 190 minor and major amputations per week in England. Of the people affected, 79% will be confined to one room within a year, with 80% tragically dying within five years. That is a shocking outcome for patients, and it is even worse than the outcomes for the majority of cancers we seek to deal with.

The impact of lower-limb amputations on patients’ quality of life and chances of survival are shocking, so we must do everything we can to prevent diabetic foot complications. We have to act in a timely and targeted manner to ensure that people have the best possible chance of living long and fulfilled lives.

It is estimated that by 2025, 1.2 million people with diabetes in the UK will require regular podiatry appointments if they are to remain ulcer, infection and amputation free.

[John McDonnell]

What I have discovered on my journey of finding out about podiatry, which I knew very little about before I met podiatrists in my constituency, is that of course people need professional care, and that care needs to be properly funded. There are volunteers, but we should not have to rely solely on volunteers; we need professionals leading the way. Podiatrists are skilled and trained in the prevention and management of diabetes-related foot complications. That is why many of us believe that they must be at the heart of the NHS plan to eliminate unnecessary amputations and the consequent avoidable deaths.

As I said, the broader cost of diabetic foot ulcers to the NHS is more than £1 billion per year—the equivalent of just under 1% of the entire NHS budget. Effective and early intervention for diabetic foot complications prior to ulceration could save thousands of lives and millions of pounds each year.

The situation in my area in Hillingdon exemplifies what is happening elsewhere in the country, which the hon. Member for Strangford (Jim Shannon) has mentioned. Hillingdon’s community podiatry service is part of the Central and North West London NHS Foundation Trust. It is suffering from severe workforce issues, which is having a detrimental effect on the people delivering the service and those suffering from foot ulceration, infection and amputation.

The service is currently failing to meet its timescales for seeing patients at high risk of developing a foot ulcer. What should be a team of 13 clinical podiatrists is now just 3.5 full-time equivalents and three support workers. The immediate concern is the pressure that puts on the staff who remain and the impact it has on the patients who need a minimum of weekly wound re-dressings to enable healing and prevent infection and life-changing amputation. The opportunities to prevent life-changing and life-threatening complications are minimised by the shortage of staff.

We also have concerns that support workers are being asked to triage and treat people beyond their scope of practice due to the staff shortage. That is not a criticism of them, but it is the reality. We should be filling the service with professionals who are fully trained to deal with the range of complications that they might come across. The workforce challenge facing podiatry is the real issue.

There is a need for focused recruitment. As I said, it is estimated that by 2025, 1.2 million people with diabetes in the UK will require regular podiatry appointments if they are to remain ulcer and amputation free. In the absence of that, there will be a greater risk of premature disability and death. There are currently just under 10,000 podiatrists registered with the Health and Care Professions Council. That is just one per 5,500 residents in England, and that number is due to decline as a result of demographics.

Following the removal of NHS bursaries for student podiatrists in 2016, the number of undergraduates studying podiatry has declined by 38%. Prior to that, the student bursary was set at £9,000 a year and it covered the cost of tuition for a year. In 2020, in a welcome move, the Government reintroduced student bursaries, but at £5,000. That has caused a slight improvement in recruitment to the profession, but it falls far short of ensuring the future of the podiatry workforce that will be required to deal with the oncoming wave of severe diabetic complications coming out of the pandemic.

Another issue is that the average age of podiatry students on graduation is 32. The majority of students are pursuing a second degree, and the need for a second student loan is having a damaging impact on universities’ ability to recruit undergraduates to train as podiatrists. By leaving it up to the market, we face the prospect of not training the workforce required to meet the needs of an ageing population.

The other issue raised with me is the limited career progression in NHS settings. Of the podiatrists currently qualified in England, approximately 40% work in the national health service. It is projected that many of those podiatrists not heading for retirement are likely to move to work in the private sector in the next five years. The reasons cited for that include lack of career development opportunities; repetitive workloads, with limited skill mix; and high demand and low capacity to meet it, leading to what people consider are unsafe staffing levels and to staff burnout.

Expansion of the podiatric workforce across primary, community and secondary services may address some but not all of those issues. Support for workforce growth is critical, but support for those already qualified to progress to advanced clinical practice and consultancy is also critical to workforce retention and ensuring adequate capability in senior clinical, leadership, education and research roles.

We need policy to ensure closer working across providers and the delivery of a foot health strategy. There is significant opportunity to expand the foot health workforce to include non-registered roles, supported by qualified, expert podiatrists. There is also opportunity to consider alternative workforce models that are inclusive of podiatrists working in private practice or the wider foot health workforce in the third and voluntary sectors, for example. A clear workforce strategy is desperately needed now. It needs to explicitly underpin how the foot health workforce is optimally configured, funded, implemented and trained and what the core outcomes of foot health services must be to meet the needs of our future population.

Currently, there is no workforce strategy, no clear statement of aim, and no standardised set of core outcome measures informed by public health or policy. Clear foot health policy is urgently needed to maximise all the benefits that podiatry can offer across an integrated care system, before the profession becomes—as we predict it will—unsustainable, with staffing levels even more unsafe and avoidable patient harms, amputations and deaths relating to lower-limb disease rising dramatically.

I therefore have three key asks. First, I ask the Government to reinstate the £9,000 bursary for student podiatrists. If podiatrists are to be able to support the millions of people who will require their expertise, the Government must reinstate the full podiatry student bursary of £9,000 a year. That is essential if the workforce is to be secured and expanded for future generations. In the absence of long-term funding confidence, allied health professions such as podiatry are unable to commit substantial and consistent investment towards maximising recruitment and retention, both of which will be crucial in securing the future viability of this vital profession.

My second ask is for national collection of podiatry vacancy rates and inclusion of podiatry in workforce planning. Publishing a national workforce plan that considers future need for allied health professionals such as podiatrists must be a priority for the Government. That plan must take into account current trends in recruitment and retention and, for future needs-based public health, comorbidities and their impact on disease prevalence. A national workforce plan will also act as a crucial evidence base for the allocation of long-term workforce funding.

My third ask is for the guidance on integrated care system membership to be strengthened to include allied health professionals. The absence of national guidance or recommendations regarding which organisations and individuals should be included in integrated care partnerships has resulted in a patchwork of involvement for allied health professionals, including podiatrists, in integrated care decision making. Without their meaningful engagement in those discussions, there is a danger that the invaluable contribution podiatrists can make to the delivery of care might simply be overlooked. Strengthened national guidance on the make-up of integrated care partnerships, to include representation of allied health professionals such as podiatrists, should be developed and implemented at the earliest opportunity.

I conclude by thanking the professionals who work in my constituency, as well as those who work nationally. I recognise the pressures they are under and the valiant way that they cope with them.

[Peter Dowd (in the Chair)]

I remind the Minister that the debate must conclude by 4.41 pm.