Paediatric First Aid

Sam Gyimah Excerpts

Monday 15th December 2014 Westminster Hall

[The Parliamentary Under-Secretary of State for Education (Mr Sam Gyimah)]

I start by offering my deepest sympathies to Mr and Mrs Thompson for the tragic death of their daughter, Millie, in October 2012. I would also like to say how much I admire the worthwhile work that the Thompsons are doing through Millie’s Trust in their daughter’s memory, providing first aid courses free of charge for people who are pregnant or have children under 12 months, and providing two-day courses for a charge to nurseries. Those are all incredible feats in a very short period of time, and I congratulate them on that. It is no accident that Joanne Thompson won the Lorraine Kelly inspirational woman of the year award.

This debate has come about following Millie’s tragic death and because of the impact of Mr and Mrs Thompson’s e-petition, which has gained more than 102,000 signatures, to have it made law that everyone working in a nursery must be trained in paediatric first aid. I congratulate the hon. Member for Cheadle (Mark Hunter) on securing today’s debate on this important matter. I also thank all the hon. Members who have spoken here today. I have listened to their contributions and I agree that Millie’s death is a wake-up call for all of us. I hope during the course of my speech to address the points that have been raised so far.

As many hon. Members have said today, we can all agree that all young children deserve the highest possible level of safety and care. As a new father myself, with an eight-month-old son who is about to start nursery, I know that I want the nursery that I choose for my son to have an exemplary safety record, so that I can be reassured that he will have the best possible care. That is because the safety and welfare of children in all settings, whether in social care, schools or early years provision, is paramount.

What do we want to achieve? We want to ensure that there are confident, capable paediatric first-aiders in all nurseries, taking responsibility and responding quickly in an emergency. What are we doing to deliver that? The statutory framework for the early years foundation stage sets the standards for learning, development and care for children from birth to age five. All nurseries must meet these standards to ensure that children learn and develop well and are kept healthy and safe.

In the light of Millie’s case, we have strengthened the early years foundation stage requirements. From this September, the early years foundation stage has made it even clearer that nurseries must always have staff available who are trained in paediatric first aid. Beyond that, we added to the paediatric first aid requirement that nurseries

“should take into account the number of children, staff and layout of premises to ensure that a paediatric first aider”

is “available at all times” and

“able to respond to emergencies quickly.”

In other words, if a nursery is operating over three floors, with children on each floor, it is not acceptable for it to say that it only has one first aider, because it is operating on three floors.

[Sir Bob Russell]

Bearing in mind what my hon. Friend the Member for Cheadle said, will the Minister state whether training in those first aid requirements are being given by people who are qualified first aid trainers and not just people who say they are qualified first aid trainers?

--- Later in debate ---

[Mr Gyimah]

I thank the hon. Gentleman for that important intervention. I know that he has a lot of experience in these matters, which brings me on to one of the points that has been raised in this debate. It has been said that the regulations have been watered down since September. That is simply not the case. We have strengthened the regulations by saying that providers must take account, as I have said, of the number of children, the staff and the layout. Although we have removed the local authority approval, we replaced that with a requirement to meet the course content for British Red Cross and St John Ambulance, so based on good practice of those with expertise.

[Ann Coffey]

The Minister seems to be saying that he is not prepared to ensure that all staff working in a nursery have training in paediatric first aid. Two staff in this nursery were trained. Does he think that the nursery had trained enough staff in paediatric first aid? If he does not think that is so, why will he not bring in regulations to ensure that the number of paediatric staff that he thinks are suitable to be trained in a nursery are trained?

[Mr Gyimah]

That is a very good intervention. I am developing my case, but as I said at the outset, it is obvious that we need two things. We need enough staff trained in paediatric first aid, but also, importantly, we need to ensure that they are confident and capable of acting in an emergency, rather than panicking and not dealing with it. We do not want it to be the case in an emergency that there are a number of people who have a first aid certificate but it is not clear who is the point person who is capable and competent to deal with that kind of situation.

[Ann Coffey]

As the Minister will be aware, the campaign that Millie’s Trust is running is aimed at ensuring that every member of staff in a nursery is trained in paediatric first aid, because it believes, rightly, that that will protect children in all situations. The Minister has not answered my question; I have heard a lot of good intentions from him, but I return to the question that I asked him. If he does not think that it was sufficient, in the nursery in this case, to have only two members of staff trained in paediatric first aid, why will he not regulate to ensure that all members of staff working in a nursery are trained in paediatric first aid?

[Mr Gyimah]

The hon. Lady makes a very passionate point. As I said, I will develop my case further. What I am saying is that the requirement of the EYFS means that nurseries must think carefully about whether they have enough trained staff. That is about more than ensuring that they have enough trained staff to cover leave or staff sickness. We know that, in some instances, the speed at which a trained first-aider can attend to a child who needs help can be crucial in ensuring a good outcome for the child. We are already seeing how the new requirement is being delivered on by many nurseries, which are taking into account staff turnover, holidays and sickness.

The hon. Member for Cheadle mentioned the House of Commons nursery, which advertises that all its staff have first aid certificates. In fact, many nurseries continue to do that as a point of differentiation between them and other nurseries, so I would say that the strengthening of the EYFS is having an effect on the market. We are putting lots of other things in place to strengthen that even further.

[Nic Dakin (Scunthorpe) (Lab)]

I apologise for joining the debate late: I was in a statutory instrument Committee. I have been listening carefully to the debate and the Minister’s responses. The more I listen, the more I wonder what the reason is for not having everyone trained to the extent that the e-petition asks for. As the Minister explains things more, he seems to be confirming my growing feeling that that would probably be the best way forward. Will he spell out why the Government are reluctant to go down that route?

[Mr Gyimah]

We want to create a situation in which we have competent people dealing with this kind of incident. On its own, a first aid certificate, which means that someone can tick the box to say that they have a first aid certificate, does not mean that that individual will be able to deliver first aid as and when an incident happens. As the hon. Member for Colchester (Sir Bob Russell) mentioned, in the case of one of the people who had a first aid certificate in this instance, their certificate had expired. If someone gets a first aid certificate, they have to renew it every three years.

I want to ensure that we do not end up legislating and having a tick-box culture, thinking that that in itself has addressed the problem, when there are a number of other things that we can do, as I will explain if hon. Members allow me to develop my points further. I am referring to work that we are doing with the National Day Nurseries Association to help nurseries to understand what it means to have capable and competent staff and how they can respond in an emergency. I believe that that is far more important than a tick-box approach to dealing with this kind of situation.

[Mark Hunter]

I thank the Minister for taking another intervention. With respect, I do not think that anyone here today has been arguing for a tick-box culture and, if I may say so, I do not think that that phrase is particularly helpful to the consensus that has emerged during the debate.

I want to follow up the intervention from the hon. Member for Stockport (Ann Coffey). The Minister referred to the changes to legislation. The fact of the matter is that it rests with individual organisations, individual nurseries, to decide what is and is not sufficient. The Minister says that if a nursery is operating over three floors rather than one floor, that is a different consideration. But as long as it remains the decision of the individual establishment, there will be inconsistencies.

Certain establishments—better-funded ones, with much more money—will no doubt ensure, as some already do, that every relevant member of staff has paediatric first aid training, but until it becomes necessary for all relevant staff to have that training, there will always be some nurseries, some of these businesses, that choose not to have every relevant member of staff trained. That is the core of the problem. The Minister needs to provide some clarity on why, apparently, the Government do not think that that would be a logical way forward. It would remove any uncertainty.

[Mr Gyimah]

I thank the hon. Gentleman for that intervention. He used Ireland as an example in his speech and, in the light of the intervention that he has made, I will refer to the Irish example. The Irish are actually moving towards the framework that we have in this country with the early years foundation stage. In response to a parliamentary question, they have said explicitly:

“The final draft will include a requirement that early years services have a person trained in first aid for children available at all times.”

The solution that we are adopting, which can best be described as one that allows nurseries to use their professional judgment in appointing the right staff to this vital role, is not as anomalous as the hon. Gentleman describes. I have said before and I will say again that not everyone who works in a nursery will be ideally suited to being a first-aider. Nurseries should ensure that their first-aiders have the confidence and the reliability to cope with an emergency, and I believe that the EYFS achieves that. At this stage, I do not feel that we need to amend those requirements further. I do, however, want to remain fully informed of the effects that those changes are having on the ground, and I know that the Department for Education plans to undertake a review of them next year.

I also know that the Thompsons were concerned that some nurseries might not know how to interpret the strengthened requirements. I am pleased that in direct response to the Millie’s Trust campaign, the Department for Education will issue in February new guidance for nurseries, setting out clearly what the expectations are and how nurseries can deliver on them effectively. I have asked the National Day Nurseries Association to help with that guidance. It will be identifying a number of nurseries delivering exemplary paediatric first aid practices, including methods used to ensure sufficiency of first aid-qualified staff, and providing case studies and videos to ensure that nurseries are absolutely clear on what the PFA requirements mean and how they should work in practice.

[Ann Coffey]

Despite what the Minister is saying, we could still have a situation in which a nursery, under his example, had decided that having two staff trained in paediatric first aid was sufficient—and a child died. That clearly shows that the way to protect children is not to rely on nurseries exercising their professional judgment, but to make it mandatory that all staff be trained in paediatric first aid. Otherwise, at some time in the future, there will be another inquest because a nursery has exercised its professional judgment. Sadly, for the child who might die in the future, that is not enough. Surely the Minister can accept that the way forward has to be making it mandatory for all staff in nurseries to have first aid training. We cannot leave this matter just to the professional judgment of individual nurseries.

[Mr Gyimah]

The hon. Lady makes another very passionate intervention. Of course we want to ensure that the requirements in the EYFS are being delivered on in every nursery. As she rightly points out, we do not want just to leave that to the nursery’s professional judgment on its own. We should remember that Ofsted regulates and inspects all early years provision. Before a nursery can open, Ofsted checks that it meets all the registration requirements, including those for first aid. It also inspects all nurseries on how they meet the EYFS requirements, including those for paediatric first aid.

If a nursery fails to meet the requirements on first aid, that will impact on Ofsted’s inspection judgment; as anyone who has looked at the nursery market will know, nurseries crave a good judgment from Ofsted because it is a point of differentiation in the market. Ofsted’s judgment is therefore really important. If the nursery does not meet the requirements on first aid, Ofsted will respond with appropriate steps. That may include giving the nursery a short time to meet the requirements. Where necessary, Ofsted can take enforcement action.

[Mr Graham Brady in the Chair]

To ensure we have consistency of practice in the sector, I would like to hear from professional bodies and training providers about how they support nurseries in providing paediatric first aid. I would be delighted to discuss the guidance further when I meet Mr and Mrs Thompson later today. The guidance will be published next year, and I very much want to have their input and involvement.

[Annette Brooke (Mid Dorset and North Poole) (LD)]

I apologise for not being here for the whole debate. I welcome the inclusion of the requirements in the Ofsted inspection, but will the Minister tell us how frequently our nurseries are inspected? My understanding is that an outstanding one, which would have been judged on previous criteria, might not be inspected for several years. In taking the approach that he is, does the Minister consider that time is on his side?

[Mr Gyimah]

That is a good question. There is an Ofsted inspection cycle for every nursery, but there is also a cycle for the first aid certificate. If someone has a certificate, it will expire after three years, and they will then have to go back and do a two-day course to have it refreshed. I am counselling against believing that the acquisition of a certificate alone will prevent such awful tragedies from happening again. What will prevent them from happening again is nurseries knowing what best practice is and implementing it, rather than just saying, “Our staff have the certificate, so we are covered.” That is what I want to avoid.

[Richard Graham]

In a sense, there are two slightly different issues. I think the hon. Member for Stockport (Ann Coffey) was close to implying that, had everyone received paediatric training in the nursery where Millie, very sadly, died, these events would not have happened, but I am not sure that any of us here today is in a position to make that judgment. However, on the wider point, many of us feel that future tragedies would be much less likely if everybody did receive paediatric training, so will the Minister respond to the call for a review, which the coroner, in effect, made?

[Mr Gyimah]

I can commit to a review next year of how the requirements have been strengthened and how they are bedding down in the nursery sector. I welcome my hon. Friend’s intervention. None of us can say what would happen if there was another situation on the ground, but we do have the coroner’s response, and I can commit to a review.

[Mark Hunter]

Further to that intervention, does the Minister agree with this statement from St John Ambulance:

“Ensuring that every adult working in a child facing role has appropriate paediatric first aid training would decrease the delay in responding to a first aid emergency, and increase the quality of care”?

If he does, is that not somewhat inconsistent with his previous response?

[Mr Gyimah]

It is a powerful point. To restate my argument, not everyone with a certificate is necessarily the right person to deal with an emergency. We can argue that the likelihood of not having the right person on hand is reduced if everyone has that certificate, but we want to have a situation where nurseries follow recognised best practice, rather than to mandate it just so that everyone can say, “I have the certificate, and that is it.” We obviously value what St John Ambulance does, which is why the EYFS requires nurseries to use its training or British Red Cross training.

[Richard Graham]

The Minister has helpfully confirmed that the national review will go ahead, as the coroner wanted. To avoid any doubt, will he confirm that it will include consideration of moves to make it mandatory for everybody working in nurseries to receive paediatric training?

[Mr Gyimah]

My hon. Friend is fast bringing me to the end of my speech—I was going to address that right at the end. Yes, when we have a national review, we will look at making this mandatory.

[Kevin Brennan]

May I press the Minister on the nature of the review? Is he talking about an internal departmental review or about getting independent experts to look at the issue and come to a conclusion? Furthermore, on the timetable, he will be aware that we will be pressing up against all sorts of deadlines next year, if I can put it that way. The review will have to get under way quickly if he is to deliver on what he is promising the House, so when will it get under way?

[Mr Gyimah]

We have been looking at that since Mr and Mrs Thompson had their meeting with the Under-Secretary of State for Education, my hon. Friend the Member for Crewe and Nantwich (Mr Timpson). Once I have had a meeting with them, we will publish details of the nature of the national review, but that is not to say that the issue is not of great importance for us.

Let me turn to the points made by the hon. Member for Cardiff West (Kevin Brennan), who focused on whether we have watered down the regulations. I touched on the point about local authorities. I would also like to reassure him that, at the heart of the increase in the skills and qualifications of the early years work force, we have emphasised the importance of paediatric first aid, which is included in professional child care qualifications, although that might not necessarily lead to a certificate that can be renewed every three years.

Our standards for early years teacher status mean that all early years teachers will know how to establish and sustain a safe environment and employ practices that promote children’s health and safety. Our early years educator criteria, which the hon. Gentleman is intimately familiar with, mean that all early years educators will understand how to respond to accidents and emergency situations.

[Nic Dakin]

May I bring the Minister back briefly to the review? Can he give us a commitment to there being some independence and timeliness to that review?

[Mr Gyimah]

As I said, the review is of the utmost importance to us. I have committed to a review, and the Department will look at it as expeditiously as it can. Of course, independence is also important.

The Opposition spokesman asked for the previous Secretary of State’s response to the coroner’s report. I will write in due course to those who have spoken to provide them with the necessary information.

On the actions following the meeting with the Under-Secretary of State for Education, a letter was written to Mr and Mrs Thompson. We have also commissioned a good practice guide from the National Day Nurseries Association. On the removal of first aid requirements from qualifications, we will provide an answer in writing to Mr and Mrs Thompson and put it in the Library.

I hope that I have reassured hon. Members and Mr and Mrs Thompson that the Government recognise the importance of keeping children healthy and safe. We are focused on strengthening the EYFS. We will produce guidance and, in due course, a national review, which will include the question of mandatory training.

Paediatric first aid training is, and will remain, a statutory requirement for all nurseries and pre-schools. I hope that I have given the necessary assurance that the Government take the matter seriously and that we will work with Mr and Mrs Thompson to ensure that there will not be another awful tragedy such as the one they experienced.

[Mr Graham Brady (in the Chair)]

I do not know whether the hon. Member for Cheadle (Mark Hunter) wants to make a winding-up speech, but if he does I remind him that a Division in the House is expected at 13 minutes past 6.

[Mark Hunter]

Yes, I would like to take the opportunity of summing up. To be candid, I find the Minister’s response a little disappointing. There seemed to me to be a fairly clear consensus—not only among the hon. Members who spoke, but also in the sources of information from which many of us quoted—that there is a need for something to be done.

No one is saying that the Government have deliberately neglected the situation or allowed it to happen; I am quite persuaded that the law of unintended consequences was involved. However there is clearly a problem, and as long as it is within the purview of individual establishments to take their own decisions about what is adequate and what is not and about whom they go to for the training—so that they need not be certified and accredited—there will still be doubt and uncertainty in the mind of many parents. A case has been made for a national framework.

[Mr Gyimah]

According to the EYFS, the content of the providers’ first aid courses should be from the British Red Cross and St John Ambulance, so that it is based on the good practice of those with expertise. The hon. Gentleman misquoted me on that.

[Mark Hunter]

The key point is this—I happen to have the St. John Ambulance note in front of me so I will refer to it again: St John Ambulance believes that every adult working in a child-facing role should have had training in paediatric first aid.

By highlighting the tragedy, and bringing it to the attention of parents throughout the country, we are giving the Government an opportunity to be seen to be listening and acting. It will not cost much money or need much legislative time to establish the safeguards, so that every parent taking their child to nursery will know that all relevant members of staff are adequately trained in paediatric first aid. It seems a simple, straightforward and relatively inexpensive request, and I am still baffled about why the Minister’s response has not been more optimistic and positive. I appreciate, however, that it will not be entirely down to him. I hope that we can explore the matter further in the private meeting to follow.

Question put and agreed to.

Resolved,

That this House has considered the e-petition relating to the Millie’s Trust campaign to train all nursery nurses in paediatric first aid.