Whistleblowing

Debate between Stephen Kerr and Philippa Whitford

Wednesday 3rd July 2019 Commons Chamber

[Stephen Kerr]

Whistleblowers are heroes, not villains—although sometimes there are villains in their stories—and they should be treated with respect and listened to. Sometimes they are looking for no more than validation of what they have brought to the attention of the authorities. Whether they should have a financial award, or whatever, is a side issue; the real issue is how they are perceived and responded to.

[Dr Whitford]

The hon. Gentleman raises financial rewards. Does he think they might make the personal situation for a whistleblower within a workplace worse, because it would be easy to ascribe their actions to their seeking a financial benefit as opposed to genuine altruism?

[Stephen Kerr]

I completely understand, and am sympathetic to, that point. We need to work together to establish this independent office of the whistleblower. Sometimes whistleblowers pay such a heavy price in terms of the financial consequences that flow from their actions that perhaps there is a case for compensation, but I have not made up my mind. We have to hear more evidence and have a wider discussion in Parliament about these issues. It is absolutely clear, however, that whistleblowers need somewhere safe to go, and to be supported and have their cases properly advocated in the face of power, authority and bureaucracy.

I mentioned the problem of blacklisting. One person told us how he had been blacklisted for speaking up. He had reported criminal activity to the employer. Instead of dealing with the issue, the employer dealt with the person who had spoken up in the first place and coerced them to stay silent. It is bad enough to have something criminal going on within one’s business, but then to cover it up, and contrive to force those who are willing to speak up for the reputation of the organisation or business to leave, is clearly unacceptable, and then to seek to blacklist them so that they cannot work in a profession in which they have trained and acquired qualifications is truly shameful.

The complex legal framework surrounding whistle- blowing covers too few people. It is complex and legalistic. Many of the whistleblowers whom we met were not recognised as whistleblowers by the law. The tests that are necessary to stop people abusing whistleblowing are too stringent and do not recognise complexity. One employee brought up issues of racism at work and the flouting of HR rules. The employer, instead of recognising the whistleblowing, tried to diagnose a mental health issue, sending the employee on medical leave. The company-appointed psychologist then broke confidentiality to speak to the managers of the business. Although regulators confirmed that the employee had a point, they were dismissed and have received no justice.

Whistleblowers can be dragged through the courts, with mounting costs and unending hassles. For many, their cases have consumed their lives. It may be thought that the best advice such a person could be given would be “Move on and forget it”, but that is not justice; it is unjust. While it might be said to have been good and well-intentioned advice, is that really the way in which we in this place want the affairs of our country—economic, and relating to public service—to be dealt with? I really do not think so.

However, it is equally important not to limit the definition of whistleblowers to employees. As I said earlier, and as was mentioned by the right hon. Member for North Norfolk, many categories of people should have the protection to which whistleblowers are legally entitled. We must ensure that, when they blow the whistle, they are given proper protection under the law—and the law is too vague in this regard.

When an individual faces the full force of a corporate or public sector legal department, it is a complete mismatch. Public corporations should be mandated to disclose legal costs to shareholders in such cases, and the same should be true of public authorities. They should have to make clear and transparent the costs of fighting whistleblowers that will be borne by the taxpayer. Some of the estimates of the costs that have been incurred by public services are absolutely mind-blowing and wholly disproportionate.

One brave whistleblower in Scotland had evidence of HR malpractice. It should have been a simple grievance dealt by the organisation, which should have been pleased to receive the feedback from that person. Instead, the person and their family, who also worked there, were victimised. They cannot afford legal representation, and will have to argue their own case at a tribunal against a public sector legal department with an expansive budget.

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[Dr Whitford]

I thank the hon. and gallant Gentleman for his intervention. As a medic myself, it is clear that we are advised by the General Medical Council, the Royal College of Nursing and various official bodies that we must speak up—that we have a duty to speak up. However, the landscape we look at is littered with broken careers and often broken people.

The problem is that whistleblowers think they are protected because they have heard about whistleblower protection, but it simply does not exist. The right hon. Member for North Norfolk talked about “brave people” speaking up. People should not have to be brave to raise concerns. If all people see is others ahead of them who have been driven and hounded out of their career, and who have maybe ended up with mental health issues or worse, then that is a big, black, threatening cloud—keep your mouth shut, keep your nose clean, walk by on the other side. The problem is that that results in more suffering and more death.

There are two aspects to this issue: business and industry, which is represented most commonly by the finance sector; and public services, which are most commonly represented by the NHS. Those two sectors—finance and the NHS—probably generate the biggest number of scandals and whistleblowing cases, and therefore specific treatment is required in those industries to invite whistleblowers to come forward and protect them.

While there is UK-wide regulation of finance, health services are devolved. The four health services are struggling with this and working to improve whistleblowing. After the Mid Staffs scandal, Sir Robert Francis highlighted that in Mid Staffs—indeed, this was an issue in some of the later scandals—there was an obsession with becoming a foundation trust. The hon. Member for Stirling (Stephen Kerr) and others have talked about why people cover things up. Whether it is a high-profile business or a public service that has been corporatised, there is a drive to remain shiny and perfect on the outside, instead of admitting a problem and trying to fix it.

Having produced his report, Sir Robert Francis set up the “freedom to speak up” guardians in hospitals and the national guardian. In Scotland, the local person in health boards—we do not have trusts—is a specific non-executive director who is a whistleblowing champion. The advantages of a non-executive director is that they are on the board, with a clear and loud voice, and they are not an employee, but they are part of the system. The “freedom to speak up” guardians are employed by the trust, so they are operational—they are a person to go to—but they are also an employee. There are issues at the trust and health board level with how the guardians or champions themselves are protected. Perhaps we need not only an independent national office but an independent system. In the NHS, that might be people who are taking responsibility for safety or healthcare services information. Unfortunately the legislation on that is in the Brexit long grass, but I hope it will eventually come forward.

There is a national guardian in England, but it does not have statutory powers. Scotland has set up an Independent National Whistleblowing Officer, who is basically the public services ombudsman. They are completely separate—they are outside the system—and they have statutory powers, which is important. A reporting and advice line was set up back in 2013, so that if people were afraid to report locally or were not getting anywhere, they could report to that phoneline.

[Stephen Kerr]

The hon. Lady makes a good point about what is happening in Scotland now, but it is worth mentioning the evidence that my APPG received from Police Scotland and NHS Scotland. For example, the lessons that NHS Scotland has learned in Inverness are being taken on board by public authorities in Scotland. The size of our country allows us to do things a bit more quickly and deftly, but undoubtedly the lessons of the past are being learned and implemented, and I applaud NHS Scotland and Police Scotland for that.

[Dr Whitford]

So small is beautiful after all—that is excellent. The evidence is there; it has been there for years. The problem is that action has not been taken.

The Independent National Whistleblowing Officer has already developed, published and is consulting on standards. The standards will look at bullying and harassment—an issue that has come out in NHS Highland—and patient safety issues, and they can empower reporting and review. They include primary care and social care. They include not only trainees like Dr Chris Day, who was appallingly treated, but students and volunteers. No one should be limiting and excluding the person who saw bad and dangerous behaviour from coming forward and doing something about it.

Every health board will have to report on the actions they have taken to remedy the findings of an investigation. Health boards must investigate and record how they investigated. They must record the action they took, and they must show any improvements that they developed from that investigation. Statistical analysis will be part of an annual report by the board every year, which will look for themes, trends and patterns. This is—and I welcome the fact that the hon. Gentleman recognises it—an attempt to make this work by having an independent office.

The results of a survey of health and social care staff in Scotland—and they are health and social care staff now—showed that two thirds felt they would have the confidence to speak up and raise a concern. That is contrary to the fact, as Members have said, that approximately a quarter of staff in England would have the confidence to speak up. As a doctor, I would like to see the figure an awful lot closer to 100%.

The Independent National Whistleblowing Officer will have among their statutory powers the ability to take disciplinary procedures against anyone who victimises a whistleblower. That is also critical because, at the moment, as we have heard, the whistleblower suffers, and the person who caused the suffering does not.

Regardless of how the different nations of the UK are trying to tackle whistleblowing issues within their own public services, particularly their NHS, we need to deal here with the financial and other UK regulation systems. In particular, the Public Interest Disclosure Act is the overarching legislation for whistleblowing, covering all sectors. It was actually 21 years old yesterday. It was a private Member’s Bill, so perhaps it did not really have the scrutiny it should have had. It was groundbreaking at the time, but the UK is now well behind the pack, including countries such as Ireland, and, frankly, it needs to catch up. As has been highlighted by the hon. Member for Ellesmere Port and Neston (Justin Madders), it does not protect the whistleblower; it only allows them to go to an employment tribunal after they have suffered huge detriment, with only a 3% success rate, and the tribunal is often used to create more damage and victimisation.

The whistleblowers I have been working with have asked for an independent, free-standing public interest protection Act—not part of employment law, but free-standing—that should do a few things. It must ensure investigation of the concern, because the concern often disappears in all the fighting. The whistleblower should be protected from the point at which they raise their concern. It should cover all those who would be in a situation to report, including trainees or non-workers. It should prohibit detriment, and there should be the ability for civil wrong or criminal offence actions to be taken.

This requires an independent agency or body, and it should also cover regulators. This is not just about the FCA or the FRC, because the Care Quality Commission is in the frame for Whorlton Hall, in that it did a report that described it as not having a problem when people had actually raised issues. If we take the heat out of whistleblowing and make reporting normal, as we have done with Datix systems in the NHS—making this not whistleblowing, but just part of normal duties—then we can change this. Whistleblowers must be valued. In the NHS, it is a matter of patient safety, and that is critical.

Immigration

Debate between Stephen Kerr and Philippa Whitford

Wednesday 26th June 2019 Commons Chamber

[Stephen Kerr]

Thank you, Mr Deputy Speaker.

The truth is that this debate is a great opportunity to talk about the positive side of immigration: to talk about how people have come from all over the world to make their home here in the United Kingdom and in Scotland in particular, and how they make an invaluable contribution to our communities and our economy. But the SNP never miss an opportunity to miss an opportunity.

Luckily, Government Members have heard already how immigration policy can be run at a UK level to take account of the local and sectoral issues throughout our economy. I would like to add my voice to those genuinely speaking up for Scotland, rather than casting around for more grievance and more excuses to talk about constitutional politics. Simply transferring responsibility for Scotland’s immigration to Holyrood, as the SNP proposes, entirely misses the point of how a UK-wide approach will ensure a positive environment to attract the very people our economy needs.

We cannot afford to have different systems operating in the United Kingdom, where people must be able to move freely around. I referred earlier to the various hugely influential voices in Scotland on this issue—the director of CBI Scotland, Tracy Black, the Food and Drink Federation Scotland, the Scottish Chambers of Commerce and NFU Scotland—who are saying that we should use Scotland’s influence to lead a UK-wide system that meets our needs. That is exactly what I am trying to do by making this contribution.

The proposals for a future immigration policy, however, as laid out in the White Paper, will cause real damage to the UK economy and must be changed. The truth is that the diverse needs within Scotland need to be accommodated within a flexible policy framework based on reality, rather than on an academic theory. Scotland’s needs for an immigration policy are the same as those in any other part of the UK. In our fishing communities in the north-east of Scotland, we find similar issues to those in communities in the south-west of England. In our industrial heartlands in central Scotland, we find the same issues as in the west midlands of England. In places such as Stirling, with its rural agricultural base and tourist attractions, we find the same issues as in Yorkshire, Lancashire, Cornwall and many other parts of England.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The hon. Gentleman says that there are no differences, except that England has developed an immigration issue because of population growth. The problem is that Scotland has a set population, with a diminishing working-age population. He quotes directors and business, but what about NHS Scotland? We need more people.

NHS Whistleblowers

Debate between Stephen Kerr and Philippa Whitford

Wednesday 18th July 2018 Westminster Hall

[Dr Whitford]

I thank the hon. Gentleman for his intervention. I hope that this is just the first little step towards putting the matter on the agenda. The tragedies at Gosport brought the whole issue back. A nurse had come forward years and years ago, and could have saved hundreds of lives had she been listened to. Not being listened to is almost the least that can happen to a whistleblower, in that often they suffer detriment or reprisals and even lose their jobs.

The one change that Sir Robert Francis suggested to PIDA that has been made in England and Scotland is redress for discrimination regarding new employment—that is, applying for a new post within the NHS. Work is under way to introduce that in Wales as well. However, the main Act remains as it was. The first key weakness of PIDA is that it does not ensure an investigation of the whistleblower’s concern. Given the risks they take when they come forward, the detriment they may face, and the months or years of tribunals or other stages, it is crucial that the concern that made them step forward is not either overshadowed or completely ignored. I think that is their biggest frustration.

The Act most certainly does not protect whistleblowers. It describes itself as protecting whistleblowers from detriment, intimidation and reprisals, but PIDA can be used only for litigation after the detriment. Once someone has lost their job they can take their employer to an employment tribunal and attempt to have redress. The problem at that point is that the whistleblower has to prove that it was their disclosure—their coming forward and speaking up—that drove the loss of their job. Of course, employers will find all sorts of other excuses, such as, “Oh, they didn’t get on with their colleagues,” or, “They were a trouble maker,” or, “They were late for work.”

The success rate of litigation under PIDA is 3%, which is appalling, and shows how utterly weak the law is. Whistleblowers suffer further detriment while going through litigation. They know that they may face being landed with the costs. They may face bankruptcy, and stress that could go on for extended periods. Furthermore, between 2013 and 2017, people had to pay for employment tribunals. That, of course, closed that avenue off to many whistleblowers.

I make the simple case that we need a new public interest disclosure law. It should not sit inside employment law. It should not be a tweak to what we have now. We should recognise that the Public Interest Disclosure Act covers all sectors. The NHS may be one of the most common sectors to have whistleblowers, but the Act covers finance, research and business. We need a specific law.

It must be utterly clear that such disclosures are in the public interest, and that is where I disagree with the hon. Member for Stirling (Stephen Kerr), who may speak later. I do not agree with paying bounties to those who would disclose. Whether or not it creates a conflict of interest, it certainly gives the impression of doing so. It is utterly important, in the defence and protection of whistleblowers, that they can show that the only reason they have come forward is to protect patients or whoever the consumer is in their service.

[Stephen Kerr (Stirling) (Con)]

Just for clarity, I am not advocating bounties. It is one of the options to be looked at, but there are reservations about it, which I know the hon. Lady shares.

European Union (Withdrawal) Bill

Debate between Stephen Kerr and Philippa Whitford

Report stage: First Day: House of Commons
Tuesday 16th January 2018 Commons Chamber

[Stephen Kerr]

That is brave talk, but the facts of the matter are that Conservative Members are seeking to co-operate with the devolved Administrations so that there can be a unanimous approach to the legislative consent motion.

[Dr Whitford]

Does the hon. Gentleman not see that the way to achieve UK frameworks and to respect devolution would be to have all four Governments around the table as equals? We should not have this place handing things down from on high.

[Stephen Kerr]

I do not recognise that description of what has been going on. In fact, as lately as October, the UK Government and the devolved Administrations set out the principles by which such an agreement as I am describing would be achieved. I do believe that an agreement is necessary for us to be able to see that clause 11 is fit for purpose. It is a very important part of the passage of this Bill. We have to respect the devolved settlement, and an appropriately amended clause 11, which is subject to the negotiation and agreement of the devolved Administrations, is how to proceed.

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[Stephen Kerr]

I am going to disappoint the hon. Gentleman—I will come on to that last point. What I believe should exist in clause 11 is the subject matter of the agreement that is reached between the UK Government and the devolved Administrations, in terms of UK frameworks in particular. We all accept that it is necessary that there are UK frameworks.

[Dr Whitford]

When I was referring to having all four Governments around the table, I was talking not about negotiating clause 11, but about how to set up frameworks for fishing, food or the environment. Those things should be decided together and not just decided here.

[Stephen Kerr]

My hon. Friend the Member for Harwich and North Essex (Mr Jenkin), the Chair of the Public Administration and Constitutional Affairs Committee, is not in his place now, but he dealt with that matter in his speech. I must say that I find myself in complete agreement with his sentiment and that of the Committee’s recent report, which is that, since we arrived at the position we are at with devolved Government in the United Kingdom, there has been a lack of appropriate machinery for our Governments to work together. There is a lack of appropriate constitutionally agreed machinery for even Parliaments to talk to each other. That must be addressed.

Space Industry Bill [Lords]

Debate between Stephen Kerr and Philippa Whitford

2nd reading: House of Commons
Monday 15th January 2018 Commons Chamber

[Stephen Kerr]

I am the better for that intervention, but I am now worried about what else I will say. I am grateful for the fact that the hon. Lady, who is a physics teacher, is in the Chamber today to provide that illuminating insight. I hope that we can agree that 25,020 mph is very fast, but such speeds are difficult for us to assess with our 70 mph motorways, which make it difficult to imagine a speed 357 times faster. Even the HS2 line, operating at 250 mph, pales into insignificance. I am obviously deploying parliamentary understatement when I say that we are dealing with something out of the ordinary as a means of transport.

It is the need for speed that necessitates this Bill, not in the physical sense that I have been discussing, but in the legislative sense. Prescriptive legislation that annotates all aspects of regulation is doomed to fail in the fast-moving and changing world in which we live, especially in this fast-moving industry. I made similar comments about the need to move quickly to keep up with the times in the context of the Automated and Electric Vehicles Bill and data protection legislation.

[Dr Whitford]

I totally accept the point that we need flexibility to keep up with innovation, but do the hon. Gentleman and his colleagues recognise that the industry is anxious because it cannot see draft regulations a mere two years before the Government would like to see launches?

[Stephen Kerr]

I thank the hon. Lady for her intervention, and I agree. It is important to establish a framework in which policy is laid out so that, as mentioned in her excellent speech, investors can have some view of the future and there can be certainty for investment decisions. Going back to what I was saying about the other Bills, it is important that legislation keeps up with the rate of change, and technological change in particular.

Several Members have mentioned the vital importance of spaceports and their location and the opportunity for this country to have satellite launch facilities within its borders instead of sending satellites abroad, and that issue has been well discussed throughout the debate. It is frequently pointed that the United Kingdom has some attractive geographic advantages when it comes to launch facilities. If someone is intent on launching satellites into polar orbit, launching them over an ocean at a good angle is what they are looking for, and Scotland has a good number of ideal locations for vertically launching satellites into polar orbit.

A space race is going on, but it is not the same as the space race of the past; this race is about establishing new spaceports. The competition is not just between locations in the United Kingdom—I totally subscribe to the view that there should be as many spaceports as demand requires—but between the United Kingdom and other northern European countries. This Bill allows the possibility of the UK getting into this game early, getting head and staying ahead.

Madam Deputy Speaker, you will not be surprised to hear me say that Scotland is indeed the ideal location for spaceports, and its candidate locations are competing to become Britain’s first spaceport. In a really good speech, my hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant) spelled out the advantages of Prestwick, as did the hon. Member for Central Ayrshire (Dr Whitford), and one of the attractive features of the Prestwick proposal, apart from the geographic and meteorological advantages, is the community and cross-party unity on the matter. I cannot think of a more inspirational happening for the young people of the west of Scotland than the announcement of the building of a spaceport in Ayrshire—right on the doorstep of the vast majority of Scotland’s population.

I belong to the generation where the word space immediately conjures up the three-word phrase “the final frontier”, which has been referred to several times, but we are talking about something far more real than the science fiction and television series of my boyhood. As an eight-year-old boy in 1969, I remember watching in wonder at the flickering black and white images on our family television as the astronauts of Apollo 11, Neil Armstrong and Buzz Aldrin—names that will live forever in the history of mankind—stepped out of the lunar module and on to the lunar surface, famously taking that

“one small step for a man, one giant leap for mankind.”

It was an exciting time and the possibilities of space exploration seemed limitless, and every young mind in the country was seized with the excitement of that possibility.

Sadly, before I had even reached my first year at secondary school, manned flight to the moon, which was such an exciting prospect, had lost the attention of the vast majority of people. It is sad to say that the only time in recent memory that the British public really embraced, in a popular way, the concept of space exploration was Christmas day 2003, when Colin Pillinger and his team attempted to land Beagle 2 on the surface of Mars, as I am sure we all remember. Perhaps in the best traditions of noble first endeavours, it did not quite come off. Colin sadly passed away without knowing that he had come very near to achieving the objective of the mission.

I am most excited about this Bill, this subject matter and what it does to fire the imaginations of our young people.

NHS Winter Crisis

Debate between Stephen Kerr and Philippa Whitford

Wednesday 10th January 2018 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Like others across the House, I thank all staff in all four UK systems, who, as the Secretary of State has said, have gone above and beyond the call of duty to focus on their patients, and I do not think any debate we have in here is intended to upset or insult any of them.

Before the hon. Member for Ludlow (Mr Dunne) perhaps leaves the Chamber, I want to thank him for his service as a Minister of State for Health, whom I often met across the Chamber, but I also want to correct a comment he made in answer to my question on Monday. He claimed that the number of patients waiting longer than 12 hours in A&E in England was half the level of that in Scotland.

Naturally, I would have expected the Minister to know all the stats and what they mean: in England data are only published for the percentage of patients who meet, or do not meet, the four-hour target. There is no publication of data on eight hours or 12 hours. The clock restarts for patients who require admissions, and that is defined as from the decision to admit until they get a bed and is known as trolley waits. So 48,000 patients waited over four hours on a trolley after their four-hour wait in A&E to get a bed, and the 109 he was referring to had waited over 12 hours on a trolley for a bed after the four or five hours they had waited in A&E. Therefore, it was utterly incorrect to compare that with the Scottish data, where we have a single clock from when the patient starts right through until they get to where they need to go. I simply want to clarify that while the hon. Gentleman is in the Chamber.

[Stephen Kerr (Stirling) (Con)]

I know that comparing England and Scotland is one of the pastimes that Scottish National party Members like to engage in—it is a fascination for them—but the reality is that in my constituency of Stirling, served by the excellent NHS Forth Valley in Larbert, only 57% of patients were seen within four hours in the last week of last year because we have a flu epidemic in Scotland, as they do in England, and that should be acknowledged.

[Dr Whitford]

If the hon. Gentleman gives me a little longer, he will find that I intend to talk about the flu epidemic, but before he gets too celebratory he might want to wait until tomorrow when we will have comparable data, because while in Scotland the data are published every week, in England they are published only every month. I am glad, however, that we no longer wait six weeks after the end of a month, which is 10 weeks after the start of it, but get it a fortnight later. So that will be available tomorrow, and then he can compare hospital trusts in England with hospitals in Scotland to his heart’s content. I would have thought that, as someone who celebrates the United Kingdom, he might want to praise the fact that Scotland has led the entire UK since March 2015 on emergency admissions and A&E.

Having corrected that, all of us recognise that this is a particularly tough winter because there has been an outbreak of flu on top of a bad freeze. I point out to those who think the worst is past that the flu season lasts until March and at the moment this is an outbreak, not an epidemic, but it comes on top of underlying pressures, and across the four nations this has involved staff having to go above and beyond the call of duty.

Whether it was how Public Health England said it or how the media reacted to it, this business of stating in public that the flu vaccination does not work is unfortunate and irresponsible. The flu vaccination recipe is planned by the World Health Organisation at the beginning of each year. It will already be working on next year’s flu. It does not have a crystal ball and people who have what we in the medical profession call a retrospectoscope should recognise that that tool was not available at the time when the decisions were made. Producing vaccine is a biological process that takes months, so the decision is made in March for the northern hemisphere, and all the companies produce to that recipe. Headlines in Scotland implying that the Scottish Government popped down to Boots and took the wrong vaccine off the shelf are therefore facile, and that also encourages people not to bother.

We already have falling vaccination rates in childhood vaccination and in flu. We should be pointing out that multiple flu viruses are circulating. While all the talk in the media is of Australian flu, in Scotland that is about a quarter of the strains that are circulating.

One of the issues with flu is that it happens in cold weather, and in Scotland we get the coldest weather in the United Kingdom, so we have double the rate of flu that there is down here in England. We also had a worse freeze, and are continuing to have a worse freeze. So when the data come out tomorrow, I think we will see that Scotland will still lead the UK. We will not be performing to the level we want. We have not met the 95% target for emergency departments since August, but England has not met them since 2015 and, sadly, Wales has not met them since 2008. So this is a challenge across the board, but Scotland has been more resilient. I call on all MPs to encourage staff and other people to get a flu vaccination, because this will continue until March and it is still absolutely worth doing.

The Secretary of State often talks as if the problems in A&E are due to people who should not be there. If we talk to anyone who works in A&E, they will say that, by and large, that is not the case. With people getting fractured ankles and fractured wrists on the ice, A&Es will have been very busy with having people carted in and X-rayed, and what we call in Scotland getting a stookie put on before they go home. That is all going to take time, but anyone who works in A&E would say that the key issue is frail, sick people, often with multiple conditions, and whether they fractured their hip falling on the ice or have a respiratory problem secondary to flu, they need a bed and the issue in England is that there are not enough beds.