13/12/2016 House of Commons

tax advantages but also provided in many cases a simplified regulatory

environment, which is very attractive to businesses. I think

there experience commends them. Order, statement the Secretary of

State for Health. Secretary Jeremy Hunt.

Mr Speaker, on the 12th of April this year I asked the sea QC to

conduct an investigation into lessons that needed to be learned

following the tragic death of Connor sparrowhawk in 2013 at seven health

NHS Trust. I want to start by paying tribute to his family, particularly

his mother, Sara Ryan, but her persistent and determined

campaigning for a proper investigation into what happened.

The lessons of mid-Staffs, Morecambe Bay and other injustices like

Hillsborough is that when families speak out, we must listen. In this

case, thanks to Doctor Ryan's efforts, many improvements will be

made for the care of people to learning disabilities, many lives

saved. I asked the CQC to look at what happened in that NHS Foundation

Trust and assess more broadly lessons for the NHS as a whole.

Their findings make sobering reading. Amongst other things, the

report said that families and carers often have a poor experience of

mortality investigations. Sometimes not treated with kindness, respect

and sensitivity, can feel their involvement is tokenistic and often

question the independence of the reports.

The NHS does not prioritise learning from death and Mrs countless

opportunities to learn and improve. There is no single framework which

sets out our local NHS organisations should identify, analyse and learn

from depths of patients in their care or who have recently been in

their car. As a result, there is inconsistency. Some NHS trusts get

some elements of mortality reporting right, but not one gets all elements

right. In particular, the leaders of NHS organisations, their doctors,

nurses and other staff, simply do not have access to the full picture

of how many patients die in their care, which deaths were preventable

and what needs to be learned. I would like to thank Professor Sir

Mike Richards and his CQC colleagues for an extremely thoughtful and

thorough report. I am accepting all their recommendations. So from March

the next year, the boards of all NHS trusts and foundations trusts will

be required to collect a range of specified information on deaths that

were potentially avoidable and serious incidents and consider what

lessons need to be learned on a regular basis -- from March the 31st

next year. This includes estimates of how many deaths could have been

prevented in their own organisation and an assessment of why this might

vary, positively or negatively, from the national average, based on

methodology adapted by the Royal College of physicians from work done

by Professor Nick Blacker Doctor Helen Hogan. We will require trusts

to publish that information quarterly in accordance with

regulations I will lay before the house so that patients and the

public can see when and where progress is being made. Alongside

that data they will publish evidence of learning in action that is

happening as a consequence of that information. They will feed the

information back to NHS improvement at a national levels of the whole

NHS can learn. All trusts will be asked to identify a board level

leader as patient safety directed to take responsibility for this agenda

and ensure it is prioritise and resourced within their organisation.

This person is likely to be the medical director. They will be asked

to appoint a nonexecutive director to take oversight of progress. We

will ensure that investigations of deaths that may be the result

problems in care are more thorough and genuinely involve families and

carers. More broadly, instead of the

patchwork approach we currently have, all trusts will be asked to

follow a standardised national framework for identifying

potentially avoidable deaths, reviewing the care provided and

learning from the stakes. I've asked the NHS National quality

board, which include senior clinicians from all national NHS

organisations, to draw a guidance on reviewing and learning from the care

provided to people who died, in consultation with the new chief

investigator health care safety. These guidelines will be published

before the end of March next year for implementation by all trusts in

the year starting next April. We will also work with the National

quality board to insure that much greater support is offered to

bereaved families in the future. Because the report highlighted those

issues around support to families, health education England will be

asked to review the training for all doctors and nurses in respect to

both engaging with patients and families after a tragedy and,

equally importantly, maintaining their own mental health and

resilience in extremely challenging situations.

Finally, because the report identified particular concerns about

the treatment of people with learning disabilities, we'll take

tee further actions. In acute trusts we will ask for particular priority

to begin them to identifying patients with a mental health

problem or learning disability, to make sure that their care response

to their particular needs. At that particular trouble is taken over any

mortality investigations to ensure wrong assumptions are not made about

the inevitability of death. We will also ensure that the NHS reviews

have learned from all depths of people with learning disabilities in

all settings, learning disabilities mortality review programme will

provide support to both families and local NHS areas to enable reporting

an independent standardised review of all learning disability depths

between the ages of four 274. We will ensure there is coverage in all

regions the end of next year and full national roll-out by 2019. As

the programme develops, it will all be transferred to the avoidable

national mortality programme. I have asked another programme to provide

annual reports to the Department of Health on its findings and how best

to take forward learnings across the NHS. From next year, we will then

become the first country in the world to publish data on avoidable

deaths at a hospital by hospital level. I want to address the issue

of how we ensure data published about avoidable deaths is accurate,

fairer and meaningful and ensure that the process of publication

rewards openness and honesty. Of course we will be working closely

with the CQC, NHS improvement in senior NHS doctors and nurses to get

this right, but I want to make clear to the House that I will not set a

target for reducing reported avoidable deaths, nor do I believe

it would be valid to compare numbers between hospitals, because the data

depends on clinical views which may change all vary. I also, and this

may surprise in the number of reported avoidable deaths, and this

is likely to be because hospitals get better at spotting and reporting

them down because Carey is deteriorating. We should also

remember that when there is a tragedy in the NHS, there is always

a second victim, namely the doctor or nurse involved, who invariably

suffers huge anguish. Let us today also give credit to all NHS front

line staff for the changes already taking place to improve patient

safety. The number of people, for example, experiencing the four main

hospital harms is down by a third since November 2012, Cedar freights

have halved since 2010, as have MRSA, we have thousands more

hospital nurses and is France's report, they are at record numbers.

There is a new health care safety investigations Branch to provide

speedy, no blame inquiries into avoidable harm and death modelled on

a successful system operated in the airline industry for many years, and

a consultation this week on legislation to create a safe space

for NHS staff to talk openly about how to improve the safety of care

for patients without having to worry about litigation or professional

consequences. The culture of the NHS is changing

following a number of tragedies but this report shows there is much

progress to be made on collecting information about deaths and

analysis of the results. Only by implementing its recommendations in

full will we honour the memory of him and I commend this statement to

the House. Can I thank the Secretary of State

for advanced sight of his statement and the CQC for the report. Any

death is a tragedy for families but when that death could have been

prevented and was the fault of a system that was meant to care for

our loved ones then the trauma is all the more difficult to cope with.

The circumstances of his death was shocking and I like the Secretary of

State paid tribute to his family who fought so hard for justice and so

that other families don't have to go through what they went through.

Connor Sparrowhawk's stepfather told Radio 5 live that when a loved one

dies in care knowing how and why they died is the very least a family

should be able to expect. We agree. The findings of the CQC are a

wake-up call. Relatives of investigations, reasonable questions

gone unanswered, grieving families made to feel like "A pain in the

neck" or feeling they would be better dealt with at a "Supermarket

checkout". This is unacceptable, shameful and has to change. We

strongly welcome the recommendation of the national framework and the

specific measures the Secretary of State outlined today. Can I assure

the Secretary of State we will work with him in the Care Quality

Commission to support the establishment of such a framework in

a timely fashion. Families and patients should not be forgotten in

this process. Will the Secretary of State pledge that families and

carers will be equal partners in developing the Government's plans

for the CQC's plans. This Dummett does the Secretary of State agree

that those who work in the NHS show extraordinary compassion, goodwill

and professionalism? And does he accept that when something

tragically and sadly goes wrong it can often be the result of a number

of into playing systemic failures and therefore a national framework

will provide welcome standards in guidance across the service? Does

the Secretary of State recalled that the national patient safety agency

was responsible for monitoring patient safety incidents including

medication and prescribing errors in the NHS before it was scrapped under

the 2012 Health and Social Care Act? Will he acknowledge in retrospect

that the scrapping of that was perhaps a mistake? For a national

framework such as this to succeed and the proposed measures he has

outlined to succeed investment will be necessary. Can he confirm whether

hospitals and trusts will receive the extra funding to carry out the

additional requirements the CQC has recommended today? Mr Speaker, more

generally hospitals across England are suffering chronic staff

shortages leaving doctors and nurses overstretched and struggling to do

basic tasks. Will recall Sir Robert Francis QC for safe nurse staffing

levels to be published by Nice, however this guidance has been

blocked. Will the Secretary of State connected Nice publishing safe

staffing levels as recommended by the Francis Report? The Secretary of

State is aware of the wider pressures on the service. Will he

acknowledged that the cuts to social care and failure to provide social

care with extra investment in the Autumn Statement two weeks ago are

leaving hospitals dangerously overstretched with patients at risk

of harm? The Secretary of State will also be aware of the pressures on

the mental health provision. Over the weekend we saw reports of bed

shortages in England being such that seriously ill patients with eating

disorders are having to travel hundreds of miles for treatment?

Will the Secretary of State considered this, what does the

Secretary of State make of this and does he consider it safe and

sustainable? Can ask the Secretary of State about the heartbreaking

case of the death of the baby Olivia Dixon. The Secretary of State

ordered an investigation but I understand from the family that 16

months down the line the investigation has not yet started.

Could the Right Honourable gentleman provide the House with an update? In

conclusion the CQC called for the report to be a national priority for

those involved in delivering safe care to review the findings and

publish a full report. We absolutely agree. Action is needed, we welcome

recommendations and stand ready to work with the government to ensure

the issues are no longer ignored. I'd like to thank the Shadow Health

Secretary for the constructive nature of his comments and he is

absolutely right to do that because this is an issue that can unite

people on all sides of the House and in fairness tragedies happen in the

NHS when both sides of the House are responsible for it. We all have a

responsibility to work to do better than we are doing at the moment, and

in particular I want to tell him how much I agree with him with his

comments that front-line doctors and nurses work incredibly hard and we

need to get away from a blame culture when these tragedies happen.

It is the blame culture that is the root cause of why we are not

learning from the problems that are happening in the way that we should

because people are worried about what will happen to them personally

if they speak out and we have seen this with a number of tragedies.

That's why what we are trying to do with this national framework is move

away from a blame culture. Of course, people have to be held

accountable if there is gross negligence, if people do totally

irresponsible things then there must be no hiding place and that is what

families rightly insist upon, proper accountability. The vast majority of

the time, people are just trying to do their jobs as best they can come

and as he rightly says it is often a systemic problem that can be solved

with systemic changes. That is the culture of investigation that we can

see work so successfully in the airline industry and other

industries we are trying to implement. I will absolutely assure

him and families and carers that they will be equal partners as we

develop the new national guidance. I think that was one of the most

shocking things about the CQC report. I am sure it was a great

surprise to many people in the NHS how excluded many families felt and

we clearly have to do better in that respect. We do have different

structures in place. He talked about the National patient safety agency.

I paid credit to Sir Liam Donaldson who was Chief Medical Officer under

the last Labour government and was a great champion of patient safety but

we have different structures, the new CQC inspection regime, the

health care safety investigation Branch, which I think are given

equal, if not greater priority to patient safety. -- giving. With

respect to the issues of funding he talked about, this is an issue we

discussed on many occasions and I think he is acknowledging it with

his facial expressions. The point I would make because I think we have

had a good exchange and I don't want to get into the particular politics

of NHS funding. The point I would make is this is a win-win because

avoidable harm and death is incredibly expensive for the NHS.

The time it takes to do investigations when things go wrong

is utterly exhausting for the doctors, nurses, managers involved

and they would much rather be doing front-line care. Preventing these

things happening in the future is the best possible way of freeing up

time for people on the front line. I will take away what he has said

about the Elizabeth Dixon case and find out what is happening on that

review. Let me finish by saying that I think the real lesson of today is

that every family, every doctor and every nurse has a simple aim when a

tragedy happens. It's not a money, it's to make sure that lessons are

learned openly and transparently so that history doesn't repeat itself

and that is really what today is about and that is why we will

continue our mission to make NHS care the safest and highest quality

in the world. Maria Jenkins.

Thank you, Mr Speaker. The Secretary of State did answer what I was going

to say but I will just say, as chairman of the safety APG jig, the

publication of avoidable death figures is welcome news and I would

like to support what you said about creating a culture where clinicians

and other staff feel safe. It is important so they can speak up about

failure. It is important to deliver high quality but also safer and

better value services the NHS aspires to.

I'd like to thank her. She does a huge amount of work on patient

safety. Not least because of sadness in her own families experiences

which creates particular passion in this respect. This is absolutely

about creating a just culture. There are inspiring people who lost his

son at Morecambe Bay who talks more eloquently about the need to get

this done. Parts of the culture is justice for future people who use

the NHS to whom we have a responsibility to learn the lessons

and make sure that mistakes are not repeated. One of the really

important things we need to get right from today is to make sure

there is a national way where something that goes wrong in one

place, the lessons can be conveyed right the way across the NHS as

quickly as possible. Doctor Philippa Whitford. Thank you, Mr Speaker, I

welcome this statement and I remember of discussion of this case.

The majority of people who come to hospital and dying hospital will be

simply too ill for us to save but we mustn't be nihilistic about just

imagining that applies to everybody. Particularly, the failure here was

people with learning difficulties and mental health needs who were

somehow just set aside and not looked at. I welcome the idea of a

safety board, and I think there will be lots of things that can be

learned and shared in that. I will slightly pick the Secretary of State

up in that the Scottish patient safety programme which is a national

programme has been running since the beginning of 2008 and part of that

was to break down all of the barriers very much like in the

airline business using first name terms, making it everybody's

business, making even the cleaner in the theatre feel they can point out

they think a mistake is going to be made. But when something happens

having those adverse reviews, and certainly in my hospital we also

reviewed near misses and that's something I would commend, when what

might have happened would have been serious, there should be a review.

Certainly in the 1's I've been involved in, family have been

involved repeatedly and I think that is really important. I welcome also

the idea of a safe place for whistle-blowers. Can I just say that

people who have raised issues in the past and have been appallingly

treated by the NHS still stand there as a terrible example to people who

currently work in the NHS. So there does need to be some ability to go

back to these old cases and actually do justice to people who have ended

up losing their careers by trying to raise patient safety issues.

I thank her for her contribution and I recognise the progress made in the

Scottish patient safety programme, and particularly the inspirational

leadership of Jason Leach who has done a fantastic job in Scotland and

some very pioneering work. I think she makes some good points. Just in

reverse order, the point about whistle-blowers is one that I asked

Sir Robert Francis to look at in his second report and he concluded that

it would be very difficult, if not impossible to go back over historic

cases because of the reason that the courts pronounced, and it's very

difficult to create a fair process in which legal judgments have

already been made but I take on board what she says and I don't

think that means we can't learn from what has happened from previous

cases and they are very powerful voices. She is absolutely right

about near misses and that is something we will be including as

part of the learning from mistakes ambition. She is most right of all

on the issue with Donegal people with learning disabilities. The

problem we have here is deciding when a death was expected and

unexpected. About half of us die in hospitals, and as she rightly says

the majority of those are expected deaths. -- on the issue with

learning disabilities. But making the decision that that person would

have died anyway is a prejudice that we have to tackle and it is a

prejudice that Connor Sparrowhawk's mother talks about extremely

powerfully, and that's why we have to make sure this isn't just about

lessons for the whole NHS but particularly do better for people

with learning disabilities. Mr Speaker, as chair of the all-party

group on learning disability, can I say to the Secretary of State, the

most chilling phrase I think in the four word in this report was where

Mike Richards and his team found that the level of acceptance and

sense of inevitability when people with a learning disability or mental

illness die early is too common. Will the Secretary of State put on

the record what might Richard says in this report, that there can be no

tolerance for the deaths of people with learning disabilities and

treating them with any less importance than any other patient in

the National Health Service? I am happy to put that on the record

and say that those words have the Government's old hearted support. I

would like to credit him for his work leading the APPG. Mutch the

Government's wholehearted support. The reason I commissioned this

report was that one year ago we had a reported to what happened at

Southern Health, they said that only 19% of unexpected deaths were

investigated, falling to 1% for people with learning disabilities.

That cannot be acceptable and that is why it is so important we act on

today's report. I seek the indulgence of the house

while I raise a personal issue, this Thursday I should have been

attending the inquest into my Father's death, which I anticipate

will conclude was avoidable. I have been notified in our ago that one of

the key witnesses will not be attending because the hospital had

incorrect contact details for him, he was a local and unaware that the

inquest was taking place, so it has been cancelled for the second time.

Could the Secretary of State tell us whether the report has looked into

the aspect of locum doctors and the pressure... The failure to learn

lessons because so many people in the health service and A in

particular are only coming to that hospital on a one-off occasion, and

that is part of the cause of the sort of defensiveness within the

system? Burst of all, I am sure the whole

House will join me into offering condolences to him about what

happened to his father -- first of all.

Of course, the incredible grief that he and others feel when they lose a

family member is just compounded if you subsequently discover that the

death was avoidable. He raises a very important point. The CQC were

not in this report specifically looking at the issue of locum 's but

they have in many other reports are many other occasions talked about

the dangers of locum and agency staff for precisely the reason he

mentions. It is partly because people are not necessarily around at

the time you do an investigation because they have moved on and work

somewhere else, but it is partly because I believe, and I am sure we

all believe, you can give better care in a team of people who know

and trust each other. That is not possible if staff are... The

majority are temporary based, I think he makes a very important

point. Secretary of State, it is clear that

half of the medical negligence claims are in the field of

maternity. Does the Secretary of State agree with me that it is often

the fear of legal action that prevents people speaking out, and

how will that saves space be created that will not allow the lawyers to

intervene? Because very often the lawyers slow up the process and an

early admission of fault and a willingness to express that lessons

have been learned which provides so much comfort for families.

She has spoken many times about this the reality when the in the house.

In the case of maternity, if a baby is born with a brain injury, serious

brain injury, there will typically be a court case that lasts 11 years

and a settlement that will be around ?6 million. This is a family having

to cope with the shock of having a disabled child, which some families

say is kind of mourning process because was not the baby they

expected, but then they give their love to that child. We compound it

by making them go through a legal process of over a decade, it is

shocking and despicable that that happens, which is why we need to

find out a way to get them the financial support they need and make

sure they learn lessons more quickly, that is what this agenda is

all about. Can I pay tribute to the mother of

Connor Sparrowhawk, Sarah Ryan, who has fought tirelessly for justice

for those with learning disabilities. I will warn the

Secretary of State that I think she will take some convincing that

things were really change given all the resistance she has come up with.

Would he be willing to meet with her, if he has not already, to

discuss the plans going forward. One key issue not covered in the report

is the timeliness of investigations. A report nine months or read year

after the incident is often no good at all. The organisation has moved

on, people have forgotten what happened. Can I commend Mersey Care,

where they do a quick investigation within 48 hours, where the

information is current and people are shocked by what has happened,

and they seek to implement the lessons from every tragedy?

He was a big champion for people with learning disabilities when he

was in my ministerial team, I want to put that on record, particularly

over issues that Winterbourne View, which he brought to my attention and

did a huge amount of positive work on. I have met Sarah Ryan and spoke

to her again yesterday, I repeat what I said in my statement that I

think that without her campaigning we would not now be making huge

changes on a national level that we are making, and the other comments

he has said, I wholeheartedly agree with his well.

One of the findings from the review was that acute and community trusts

don't always record whether the patient has a mental health or

learning disability. What steps will be taken future, perhaps expansion

of the psychiatry services, to make sure there is proper join up and

real parity? He makes a very good point. We are

making sure that they all have liaison psychiatry services by the

end of this Parliament. The critical issue is that it's among the mental

health problem or learning disability, for example, at the

macro, they had special big and that the other patients. -- if someone

with a mental health problem or learning disability, for example,

turns up at A If a tragedy happens and they go on

to die, which happen sometimes, sadly, if that is not known then

people do not realise that there are potential other issues, which is why

the report is very clear that all future trusts are required to know

when they have patience with learning disabilities or mental

health problems and pay particular attention in any mortality

investigations that happen with those patients.

The CQC has produced a grim report, and there is an even grim internal

port, of the maternity services operated by the Pennine NHS Trust --

and even more grim internal report. Mothers and babies have died, I have

put in parliamentary questions and talk to the Chief Executive to try

to find out which of those deaths was avoidable. I welcome the

statement today, but is it possible to be retrospective so that the

families of those people who have died in the Pennine maternity

service can find out whether those deaths were preventable or not?

I think as far as we possibly can, we need to investigate deaths that

have already happened. When these new guidelines are published. I

totally recognise the picture he says about Pennine, I share his real

worry about the standard of caring that trust. I think the positive

thing is that under the leadership of Sir David Dalton, the Chief

Executive of Salford Royal, one of the safest trusts in the NHS, a CQC

outstanding trust, things are going well. I have spoken to David about

the situation at Pennine on many occasions and he is right to say

there is a lot of work to do. Many people will be shocked to hear

that some trusts don't even know how many inpatients have died in my car.

What will my right honourable friend say about what action should be

taken against boards and leaders who are negligent in this way?

He is absolutely right. Bought is, of course, now have a legal duty of

candour where they are obliged to tell patients the truth about what

has happened when something goes wrong -- boards, of course. But how

can they possibly do that if they do not properly record when they have

deaths or avoidable deaths. That is why this is a very significant

moment. From next year, on a quarterly basis, all trusts will be

showing how many avoidable deaths they have in their trust. That will

be compared to national benchmarks. That will be the way, I think, that

we start to make boards feel that this is a critical responsibility

they have. I welcome the learning disability

mortalities review, which the Secretary of State has announced.

What I would be keen to ensure is that that includes unexpected deaths

in the care settings other than the NHS. When I was first elected, long

Croft home, which purported to be a care home for learning disability,

was actually a torture chamber for people with learning disabilities.

-- Longcroft home. We have ended that type of thing, but we had to

make sure that whether there are unexplained deaths of people with

learning disabilities in other care settings, they are fully and best a

gated and feed into the review. She is absolutely right and I will

take away the issue of what the legal responsibilities are going to

be for people in adult social care settings. I think one of the things

that the report highlights, something I had not particularly

anticipated, was the problem that a number of people with learning

disabilities are cared for in multiple settings. If there is a

tragedy, the place the tragedy happens may not be the place

responsible for what went wrong, but often the place where they were

previously never finds out that they had even died, so one of the things

that Sir Mike Richards talks about is making sure that all care

providers are formed very promptly when something happens so that there

can be a multi-institution examination of what went wrong.

Thank you, Mr Speaker, and I welcome the statement from my right

honourable friend and the measures announced.

I have been supporting a family of a constituent who died unexpectedly in

hospital. At every step along the way, they had suffered with a wall

of silence, refusal by the trust to cooperate, the CQC have refused to

investigate, every step along the way they have been frustrated.

This has been made even more important by the fact that the son

of the disease is a doctor in the NHS and actually knows that there

has been badly handled processors -- the son of the deceased. All he

wants is for the NHS to learn from its mistakes. Can he undertake to

say what he will do about the number of unexplained deaths that have

taken place in the NHS over the past two years and whether any of those

cases can be examined by an appropriate authority?

I am very happy to look personally at the case that he talks about. I

think he talks about all patients and families who have suffered

tragedies in that the only thing people want is for lessons to be

learned. I think there is sometimes a more challenging issue which is

that staff do not feel empowered to speak out, they were real about the

consequences. What we see is that we have a number of trusts that have an

outstanding learning culture, really supportive of staff, but that is not

everywhere. One of the big lessons for today is to work out how to get

the positive culture spread across the NHS.

On December the 15th last year, I asked the Secretary of State whether

he was satisfied that families seeking truth and justice for the

deaths of their loved ones had to rely on pro bono lawyers for advice

and representation and crowd sourcing to get that legal advice.

He said that it should never come down to lawyers, but we all know

that it will, on occasion. I wonder if any of the recommendations from

the CQC will follow that eventuality?

It is difficult, because access to lawyers as a matter for the Ministry

of Justice. I am not trying to duck the issue but my responsibility and

what we are trying to do today is to try to make sure that families do

not feel they need to go to lawyers, because the NHS is open and

transparent enough. With the values of people in the NHS, that ought to

be achievable. I am happy to look at the individual case that she raises

and raise it with the Lord Chancellor.

Could the Secretary of State tell the Haas more about the health care

safety investigation Branch? How big will it be, who will head it, where

will it be based and how locally will it use its forensic detective

work to get to the nitty-gritty of these things that really cause

problems for hospitals? I am happy to do that. The best

example, in order to understand what we are trying to achieve, and this

relates to the right honourable member for North Norfolk and what

they said about the speed of the investigation, if you think of the

tragedy of the Croydon tram crash that happened recently, the Rail

Accident Investigation Branch produced and published a full

investigation into exactly what happened within one week of that

accident happening. That learning was able to be transmitted around

the whole trial industry. That is what we are looking for -- the whole

trial industry. We model the branch on what happens in the transport

industry and we are lucky that it has already been set up, but the

person heading it appears Keith Conrad, who headed up the Air

Accident Investigation Branch and knows exactly how these things

should happen. The CQC clearly identifies the need

for a changing culture, the Secretary of State has acknowledged

that in his remarks today a number of times. The NHS has to be less

defensive and more honest and open with families if there is to be that

genuine commitment to reflect and learn and make sure things are

different in the future. What does he think about the barriers to

ensuring that culture change takes place, what steps does he intend to

take to overcome them? I think there are a number of

barriers. One of them is time. Staff feel very pressured for time. And I

strongly argue that it is a false economy not to allow time for

lessons to be learned. Because actually tragedies when they happen

take up a huge amount of time as well so we have to make sure that we

do nonetheless have a management point of view and leadership point

of view making sure that doctors and nurses are time for reflective

learning as part of what they do. I think another one is the management

culture. I think if people feel the management of their trust isn't

open, and listening, they are more likely to be open and listening

themselves. -- is open. If they feel it is a hire and fire culture they

are less likely to take that approach. There are a number of

lessons. Thank you, Mr Speaker. Given the case at Torbay Hospital in

2010 and a Parliamentary health service ombudsman concluded that so

many mitigations into avoidable deaths were not fit for purpose, I

welcome the statement and the spirit of openness that will follow in

relation to issues that are extremely difficult. We are

ultimately all mortal. With the Secretary of State reassure me on

what ongoing monitoring there will be, while we will not have targets

among which is right, to ensure we can work with trusts proactively to

make sure the number of these incidents are reduced?

First of all, I have met the parents on a number of occasions and they

describe how when their son died all of the shutters came down, and I met

them only a few months after I became Health Secretary and it

engraved itself on my memory because it was so awful hearing. He raises a

rather incentive issue which I tried to talk about in my statement. I am

expecting as a result of these changes the number of reported

avoidable deaths to actually increase. I don't think it will

necessarily mean that patient care is suffering if that happens. We

have got to be very careful in this house and with our local newspapers

to say that if trusts start reporting increased reported

avoidable deaths that might mean they are having a more transparent

culture, they are being more open, even their standards about what is

expected and what is expected to start a change as they realise as

what they realise is an unexpected death there are things that could

have been done to prevent it. As members we have a duty to encourage

responsible reporting on this new openness and that will help staff in

turn. Thank you, Mr Speaker. I'd like to

pick up on a point that my honourable friend made. When a

constituent of mine spoke to me, an agency nurse, she was telling me she

was left in charge of a ward of 24 patients, fragile patients come on a

ward she didn't know very well, some with the norovirus with only two

health care professionals working with her. Given this, will the

Secretary of State commits to Nice publishing safe nursing staffing

levels as recommended by the Francis Report?

Nice has published its staffing levels for wards. But first of all,

I recognise the problem, and that was exactly what we were dealing

with in the Francis Report and we have 10,000 more full-time staff

now, nurses, on our hospital wards than we had three years ago so we

are making significant progress but there is still huge pressure in

hospital wards. I think we have now developed a new methodology which I

think more accurately makes sure that patients get the care they

need, whether it is a nurse for a health care assistant, or whoever in

the hospital and I'm happy to write to her and tell her what the

guidance is. I thank the Secretary of State for

his statement, the families of those who died played a vital role in

campaigning for transparency improvements. Will he join me in

commending the families for their work in the most distressing of

circumstances? I absolutely do and I know the family of David Hanks

campaigned very strongly on this matter. I think the key point here

about families is that often families are the people who know

best what happened to individuals when something went wrong because

they saw the carer at every single stage, whether it was in a care

home, in a hospital or in AGP's surgery the family is likely to have

seen everything so they can help to understand what might have gone

wrong and they are a positive force in process -- GP's surgery. I'm

pleased he took the time to praise campaigners in my constituency who

have done so much to help to breakdown this culture of secrecy

and cover-up which has afflicted to many of our trusts. He himself

deserves credit for his determination as well and I hope

this new tone that he has struck today it lasts and we do not go back

to some of the accusatory and thick ticked if Dominic -- vindictive tone

that we had in the last Parliament. Thank you, Mr Speaker, for your

indulgence. Can he say more about the tension there is between the

family's need for individual accountability and encouraging this

culture of openness where people can come forward? Yes. Two important

points, in fairness. I know he worked very closely with James, one

of his constituents. The tension between accountability and having a

learning culture is something we are now learning the right way through.

It essentially boils down to an understanding that in 98% of the

time a mistake will be because of a systems problem a structure, a

framework that didn't enable a doctor or a nurse to operate to the

best of their ability. 2%, 1%, maybe even less, there will be genuine

negligence from an individual that deserves full accountability. When

you understand it's like that you start to realise the first thing to

ask is what can be changed in the system? But if you uncover bad

behaviour by individuals, and there is 1.3 million people in the NHS so

obviously it is going to happen at some stage, then of course there

needs to be full accountability. In the tone of these exchanges, I want

to say something optimistic I believe the NHS can become the

safest, highest quality health service in the world. I believe the

party opposite would welcome that, and we would welcome it as our

commitment to high standards in public services. There is no country

in the world that is even considering what we have announced

today, which is asking hospitals to publish on a quarterly basis is

there a avoidable deaths. It is a very big step which happens in a

system built around public service. Mr Speaker, Kevin, the son of my

constituent Desmond Watts suffered from a very significant learning

difficulties and was neglected in a care home in the County leading to

his tragic death. This was completely avoidable. So Des has

never seen justice for Kevin but I know what he would want is for my

Right Honourable friend to consider whether it's possible to apply some

of the principles he has set out today into social care. I would join

the Right Honourable lady, the member for Slough, in encouraging

him to do that. My Right Honourable friend makes an important point and

I will have discussions with the minister responsible for social care

on what we can do in the social care field. I am optimistic we can do

something because with the new CQC inspection regime, if we make it

part of the inspection framework which has to happen with the consent

of the CQC, we can create a very strong incentive for adult social

care providers to do what we want and what is happening in the NHS.

Thank you, Mr Speaker. I would also like to raise the issue of the

appalling neglect in maternity care at Pennine acute. The report,

extremely damning report, only came to light following the persistence

of Jennifer Williams, a journalist on the Manchester Evening News, and

the bravery of a whistle-blower at the trust. I know the Secretary of

State will do what he can to protect whistle-blowers. But I would like to

ask, how will he enforce a no blame culture and culture of openness in a

trust like Pennine Acute, that appears to have actively tried to

suppress this extremely damning report?

Well, there should be no hiding place for managers who neglect their

legal responsibility, which is the duty of candour that we have passed

into law in 2014 in this place. That's the first point to make. I

think it is also important to be realistic about the ability to

impose a culture on organisations by ministerial diktats. But I think we

can get there because this is something the NHS staff themselves

want. The thing that is worrying about Pennine is you have Salford

Royal next door virtually which is one of the best hospitals in the

NHS, and the sort of learning and transition of what happened there

didn't even seem to penetrate a neighbouring hospital, so that's why

between hospitals we must get much better at sharing learning. Mark

Pawsey. I wonder if the Secretary of State could say something about how

the additional and extra information he has referred to that would be so

important for patient groups to judge rates of progress, about how

that will be made available. I'm happy to do that and we will lay it

down in regulations in this house that that information has to be

published for all trusts on a quarterly basis. But I do draw his

attention to what I said in the statement that I don't think it is

legitimate to compare the numbers in different trusts because different

trusts will have different levels of reporting and better trusts may have

higher reported avoidable deaths because they are better at picking

these things up. Derek Twigg. One of the recommendations says greater

parity is needed in reporting avoidable deaths. How will that

happen? -- clarity. This is a complex issue but important. People

with learning disabilities will be users of services of multiple

organisations. This is the guidance the National quality board are going

to put together before the end of March so that we can roll it out

across the whole of the NHS next year. Can I first of all welcomed

the Minister's statement and the Minister's comments. Would you join

me in saying those greeting people are not always treated with the

kindness and respect, that is not acceptable and those handling the

review into the death must have the compassion and empathy to deal with

families as that must be one of the qualifications for the job. I

absolutely endorse what the honourable gentleman says. The point

here is families and carers are part of the answer because they can help

us understand what went wrong so it is in all of our interest to treat

them with that kind of respect and dignity. Point of order, Mr Kevin

Jones. A fundamental part of our parliamentary democracy is the right

of constituents to raise concerns with their members of Parliament.

Dawna Knight, my constituent, raised with me the terrible treatment she

had from the hospital medical group following cosmetic surgery, and I

have raised her case on a number of occasions with ministers on the

floor of the House. Last week she and Lorna Kidd, a constituent of the

Right Honourable member for Ipswich, received solicitors' letters from

Schilling solicitors on behalf of the hospital group threatening them

with legal action if they would discuss their cases with a third

party, including their members of Parliament. I know the member for

Ipswich had already written to you concerning his constituent. Could I

ask you, Mr Speaker, to look at this case because this is fundamental to

the way we operate in terms of allowing our constituents to raise

their concerns with us. I'm grateful to the honourable gentleman for his

point of order and indeed for his courtesy in giving the advance

notice of it. I can also confirm I have received the letter to which

the honourable gentleman refers and it is a letter to which I shall be

replying in due course. Any attempt to impede an honourable member going

about his or her Parliamentary business is potentially a contempt.

In such circumstances I would ask the honourable member in the first

instance to write to me about this matter. I hope that that is helpful,

both to the honourable gentleman and more widely to the House. If there

are no further points of order, we come now to the Ten Minute Rule

Motion, Mr Gareth Thomas. Mr Speaker, I beg to move that leave be

given to bring in a build of the transfer of ownership of the Royal

Bank of Scotland to its customers and employees and for connected

purposes. Mr Speaker, taxpayers saved the Royal Bank of Scotland,

now in my opinion they should be allowed to own it. It should become

a people's bank which every taxpaying British citizens would

have the right to become a part owner of. The Royal building society

of Scotland would be a decisive break with the disastrous Fred

Goodwin era. Mr Speaker, there are new entrants to the banking market

and there have been many reforms to banking regulation. Many of which

have made a difference. But the structural problem in Britain's

banking market, a lack of competition between different types

of financial services institutions, is as bad now as it was in 2008 and

is arguably worse following the banking mergers that the crash

precipitated. The problems of 2008 can be traced back in part directly

to 1992 when the wave of building society demutualisation is began.

Whilst only ten of the 89 to that existed then demutualised, because

those ten were among the largest they represented around 70% of the

mutual sector's assets at the time. Before 1992 in the UK and still now

and the rest of Europe banking services are provided by financial

services providers with a range of different ownership structures and

therefore with different incentives and business ambitions.

After 1992, the gradual takeover of most of the big players in the

building society world led to a steady decline and deterioration in

competition in banking in the UK. Whilst many other countries had

serious problems in their banking sector, few others suffered as much

as the UK and, crucially, few others were so dominated by traditional

shareholder investor owned banks. Each of the last two governments

have been wrong, in my view, to leave in place what is effectively a

cartel of the major banks, with just one

building society challenging their dominance.

There have been persistent concerns about the level of competition in

and the structure of the banking market, which finally, I am pleased

to say, led to the Competition and Markets Authority being called in to

investigate. In August last year they publish their retail banking

market conclusions. For anyone tempted to think that banking is now

wholly reformed and properly functioning, the report makes

sobering reading. The CMA report describes the

personal banking market as being concentrated, but concentration

levels have increased since the crisis and the competition is not

working well. For lending to small and medium-size

businesses, the CMA knows that the four largest providers, RBS, Lloyds,

Barclays and HSBC, together had a combined market share of over 80%,

and new entrants had reduced their market share by just 1%.

They found there had been little product innovation in SME lending

and went on to note the adverse effects on competition and personal

banking, basic current accounts and SME lending caused by the

combination of persistent concentration in the market and the

very high barriers to entry and expansion for new lenders.

Almost 60% of banking staff working just two banking groups. In terms of

branch networks, almost 70% of banking branches are held by just

three banks. In 2014, of the top ten banking

groups by market share for personal current accounts, only two could

reasonably be described as mutual and only one had a market share of

5% or higher. What was striking about the remedies package advanced

by the CMA is that they did not consider reforms to the ownership

model of any of the major banks as a possible part of the solution. They

did discuss the idea of breaking up the big banks but, I repeat, did not

discuss changing the ownership model.

State ownership of RBS has steadied a sinking Titanic, but it has not

fundamentally changed that key structural weakness in British

banking, the lack of competition in British banking between different

types of financial services business. Full private ownership of

all the big banks, the stated aim of the last two governments, is only

likely to exacerbate the lack of competition. There has been

discussion about neutralising one of the banks, for some time the

co-operative tried, ultimately unsuccessfully, to consider the

re-neutralisation of Northern Rock. But now for slightly different

reasons, I suspect, we're willing to countenance that option. There has

been consistent support across all the main parties for reinvigorating

competition and choice in the banking sector. Firstly by fostering

more diversity and secondly by promoting mutuals. The case for

neutralising RBS rather than selling the rest of its shares at some

future point on the open market is partly to encourage that more

diverse group of big banking businesses, partly to enhance the

ritual mass of the mutual sector and partly to accelerate the practice of

RBS itself. And you held in, then of the Bank of England, has ordered

that a more mixed system of different corporate structures is

likely to produce a more stable financial system -- Andrew held

Dane. I am not making the case for

mutuals, per se, although I declare an interest as chair of the

all-party mutuals group. It is more the systemic advantages

of a mix of banks and mutuals that turning RBS into the Royal Building

Society of Scotland would deliver. Mutuals, though affected by the

downturn, were more stable than proprietary traditional banks. Given

the huge barriers to entry to setting up a new mutual of any

significant size in financial services and make sense to explore

the neutralising the mature business as well as concerning the existing

mutuals. There is an opportunity to consider an alternative to either

state or private ownership. No one thinks the Government will get its

money back from the share of RBS -- sale of RBS sales. The Office for

Budget Responsibility no longer factors in any sale of RBS shares in

this Parliament, and those sold resulted in a net loss of ?1 billion

to the taxpayer. A mutualising Asian of RBS would not mean that its debt

to the taxpayer can be returned to the taxpayer. An acid log for the

new royal building society of Scotland would be needed to make

sure that members, ie customers or employees, would benefit only from

their ongoing financial behaviour with the business. Membership of the

new society would not lead to a hand-out, said members would have no

incentive other than to see the business stick to its core

activities. The trade sale of RBS shares was to other financial

services players. If Goldman Sachs, Citigroup and Morgan Stanley are

allowed to continue that, it will simply reinforce ownership of the

big banks by the wealthiest in our country and beyond.

A Royal building society -- Royal Building Society would be the chance

to change culture fundamentally as one of Britain's biggest financial

players, and to inject some competitive energy and dynamism into

what is, to all intents and purposes, still a monopoly industry.

I begged to leave. The question is that the honourable

member have leave to bring in the bill. As many as are of that opinion

say aye. To the contrary no. The ayes have it, the ayes have it. Who

will prepare and bring in the Bill? Ryan Davies, Stella Creasy, Mark

Hendrick, Luciana Berger, my gates, Karen Buckley Christina Rees and, on

this issue, the excellent Steve Baker and myself.

Thank you. The mutualisation of the Royal Bank

of Scotland Bill. Second reading what day? The 24th of March 2000 and

17. Thank you. We now come to the

emergency debate on international action to protect civilians in

Aleppo and more widely across Syria. Mr Andrea Mitchell? -- Andrew.

I beg to move that this has has considered international action to

protect civilian -- protect civilians in Aleppo and Syria. The

honourable lady for Wirral South, with whom I co-chaired the friends

of Syria all-party Parliamentary group, joins me in thanking you for

granting this emergency debates. Both of us are concerned that on

occasions these sorts of motions can appear to be hand-wringing and to

focus on the concept that something must be done. We are very anxious

that today we encourage the Government to pursue all avenues and

options, as I know the British Government is extremely anxious to

do. The House will be particularly grateful to the Foreign Secretary

for himself responding to this debate. On the earlier occasion that

you granted an emergency debate on these matters, the Foreign Secretary

also return to the House and made his first major speech from the

dispatch box, and I believe it signifies the concern of Foreign

Office ministers about the tragedy that is Aleppo today. Mr Speaker,

there are three points that I wish to cover this afternoon. The first

is the current situation in Aleppo today. The second is specific

suggestions for the to consider, together with our allies. The third

is some observations on how this crisis could develop in 2017 and the

action the international community should take. So I started a position

today on the ground. We are able to monitor to some extent what is going

on through Twitter and social media, in particular the reports of the

mighty nations and its agencies and of the International Red Cross, they

are likely to be extremely accurate. They have reported over lunchtime

that there is clear evidence of civilians being executed and shot on

the spot. There are dead bodies in the street which cannot be reached

because of gunfire. In the last couple of hours we have heard there

are probably more than 100 children who are unaccompanied or separated

from their families who are trapped in a building under under heavy fire

in East Aleppo. Mr Speaker, we learn from independent sources that are

totally credible inside Aleppo that all the hospitals have been

deliberately destroyed by a barrel bombs and bunker busting bombs, and

that in case the people who were in those hospitals were not destroyed

by those munitions, cluster munitions, antipersonnel munitions,

have also been used. There are pop-up clinics in underground

locations. They are suffering Mike Maccagnan vision is with people

lying on the floor in pools of blood everywhere, doctors and nurses

wearing boots because there is so much blood on the floor. Casualties

move in and out as fast as they possibly can because there are grave

dangers to them from being in those locations. The ambulances of the

White helmets have been specifically targeted and there is no know fuel

available to them. The ten kilometre by ten climate zone which is the

centre of fighting in Aleppo is contracting, and it was probably

less than half our capacity. There are approximately 150,000 civilians

crammed into this area and very large numbers of children. There are

large numbers stranded in the open and looking for shelter. The only

food available is dates and bulgar wheat, water has run out, there is

no electricity, and last night people were flooding into this on

clay. There are, as I say, credible reports of executions and the

removal of groups of adult males. -- last night people were flooding into

this enclave. I thank him for giving way and he

paints a grim picture of the current situation in Aleppo. Two years ago I

travelled with the honourable member opposite to Srebrenica and we

visited an exhibition in Sarajevo of pictures from Srebrenica and Syria

and they were indistinguishable. When we hear about executions, the

disappearance of men and boys, do we not feel that we're running the risk

of this becoming the Srebrenica of our generation? He makes a point,

which I will come to directly. These terrified civilians in Aleppo

sophisticated, educated people from what was one of the great cities of

the world. With 2 million people, 6000 years old, treasured Islamic

civilisation and artefacts within it. A senior Aleppo resident,

terrified, said the following this morning. The human corridor needs to

happen. If the British Government is serious about fighting terror, they

can't ignore state terror. Doing so creates so many more enemies and if

they offer but empty words, nobody will ever believe them in the

future. Mr Speaker, this country along with

the entire international community, ten years ago embraced the

responsibility to protect, a doctrine that said that nation

states, great and small, with great fanfare, will not allow the strips

-- Srebrenica, Rwanda and other appalling events in Darfur to take

place again. This responsibility to protect was signed up to with great

fanfare and embraced by all of the international community, great and

small. Yet here we are today witnessing, complicit to what is

happening to tens of thousands of Syrians in Aleppo. Mr speaker,

that's the situation today, and I come to my second point, which is

specific actions I would like to put to the Government and which I know

they will wish to consider. The first of these is that there is an

urgent need for humanitarian teams to be deployed and given unfettered

access to Aleppo once government forces there are in control. It is

essential if we are to avoid the same circumstances as Srebrenica,

the precise point the honourable gentleman has just made. That, and

there is a very serious danger from the position I have described, that

such events are already taking place, that these teams are

deployed. We need to get immediately food, medicine and fuel and medical

services into East Aleppo. We also need to have independent

humanitarian eyes and ears on the ground to not only give confidence

to terrified civilians, who, as I remind the House, are caught out in

the opening temperatures which tonight are predicted to fall below

minus four degrees. But also they need be deployed to avoid possible

false allegations of breaches of international humanitarian law by

government forces and their military associates. It is not easy, Mr

Speaker, to see why Russia and Syria would wish to resist this, unless

they do not wish the world to know or see the actions they are now

taking in Aleppo. The second action, which I hope the Government will

evaluate and support, is to organise the evacuation to comparative safety

in United Nations buses and lorries under a white flag and in a

permissive environment the people who are wounded or who have been

caught up in this terrible catastrophe. It is clear that there

is the capacity from the United Nations with vehicles that are

available to move north up to the Costello Road and West to about how

Nirat Hanley on the border which Clare Short, form most distinguished

developer secretary in this house, and I, visited earlier this year.

There are hospitals and significant refugee facilities on the Syrian

side of the border. They are easily resupplied by the crossing. This

route out of the nightmare of eastern Aleppo by humanitarian

actors should be made available as fast as possible and Britain is in a

pivotal position at the United Nations to try and convene an

acceptance that this is the action that should be taken. We are hugely

respected on humanitarian matters at the United Nations. Matthew Rycroft,

the permanent secretary there, permanent member of the UN five on

the Security Council, is extremely effective in what he does. The

current national security adviser, the key United Nations operative for

many years, has great convening power. There are senior UK officials

at the United Nations, Steven O'Brien who worked with me at DFID,

plays a pivotal role. Mr Speaker, the British foreign service,

respected and admired around the world, supporting Staffan de Mistura

and Yannick Noah land, has a pivotal role to play in trying to convene

the consensus now urgently required. I'm grateful for to him for making a

powerful and important speech. Does he think the Syrian regime would

allow these necessary humanitarian interventions without counterattack?

I believe that if the Russians could be persuaded at this point that they

have nothing to lose from allowing international humanitarian actors

into a Aleppo then the Syrians would agree, and if they would not agree

the world must ask why it is they wish to hide from that sort of

humanitarian, purely humanitarian action. I'm grateful to him for

giving way and he's making an important point about the importance

of international pressure. He will have seen, as we all did, the

grotesque story on the front of the morning Star, suggesting what is

happening is a liberation of of Aleppo. While there is such

scandalous propaganda on behalf of Russia being put about within the

UK, isn't it even more important than the international pressure

opens up the eyes of everyone in the world to what is actually happening.

I confess to the honourable gentleman that the morning Star is

not on my morning reading list and in view of what he has just said I'm

most unlikely to add it. Would the Foreign Secretary, today that

Britain will use every sinew of this immensely impressive diplomatic

machine which I described, to secure a consensus for these two actions in

these last moments for Aleppo? I'm grateful to my Right Honourable

friend and sorry I cannot stay for the whole of the debate because of a

concurrent meeting of the Foreign Affairs Committee. While I agree

with him about the efforts to relieve the situation in Aleppo, a

year ago 20 nations sat around a table and produce an agreement about

the future of Syria, the international Syrian support group.

Does he agree that our efforts have also got to get back about the

politics of the whole international community into the same place on the

future of Syria? He is absolutely correct. Mr

Speaker, I come to my third and final point about the House wanting

to look to the future. What can we do about Democrats part of the

international community this catastrophe? After an unfortunate

sequence of events the international community has so far been completely

unable to help. The United Nations has been hobbled by Russian actions

using the veto they have been privileged to use the Security

Council to shield themselves from criticism and to stop international

action in respect of Syria. The curve Vian and plan originally put

forward by the UN was, in my view, tragically and wrongly rejected by

the American government. The Russians have in their turn been

shredding a rules -based system which will have cataclysmic effects

on international law and international humanitarian law and

international human rights. The Americans have been absent, and

crucially President Obama made it clear that were chemical weapons to

be used that would cross a redline and America would take action.

Chemical weapons were used and no action was taken by the Americans.

This house, in my view, was ill-advised to reject the former

Prime Minister's motion in August 2013 for British action to take

place, and I hope that the government will keep an open mind

about putting another resolution before the House as is necessary.

I'm extremely grateful to my Right Honourable friend for the powerful

case he's making and the leadership he has demonstrated on this issue

but would he concede that the motion in 2013 was not on a comprehensive

plan to bring peace and that if a motion is brought before this house

it should be a comprehensive UN backed plan to deliver peace and not

on such a narrow mission? Well, I certainly hope that if there is a

chance for Britain, with a pivotal role at the United Nations, to

support them if necessary with military action, a UN backed force

that Britain will very seriously consider it and such a proposition

will be put before the House of Commons. Mr Speaker, I was listing

the unfortunate coincidence of events which has hobbled the

international community. The fourth one is of course that the Arab

states of the region are irredeemably split on what should

happen now in Syria. And Europe has become dysfunctional, facing

inwards, and not looking outwards, focused on the symptoms of this

problem, the refugees, and not on the causes, and a resurgent Russia

is pursuing its interests. I say to the House that we should understand

Russia's interests and respect them, even as her actions are rightly

condemned and we confront them when they breach international

humanitarian law, as they have undoubtedly done in Aleppo. Mr

Speaker, there are only two ways in which this catastrophe will end.

There will either be a military victory, or there will be a

negotiation. There is not going to be a military victory. So at some

point there will be a negotiation and a ceasefire to enable bits of

the antagonistic foes to negotiate. When that time comes, Mr Speaker,

Britain has the experience, the connections, the funds and expertise

to assist. And the great powers must support that negotiation, however

difficult it is, and put pressure on the regional powers to do the same.

It is essential that we provide, through our position at the UN, the

strongest possible diplomatic and strategic support to that process.

They will come a moment too, Mr Speaker, when President-elect Trump

and President Putin are able to discuss these matters. There are

indications, as is widely recognised, that the two men can do

business. I hope that the United States will lift their veto on Assad

being part of any negotiations. Assad is part of the problem and

therefore by definition part of the solution. And that Russia will use

its power to stop the conflict on the ground while both combined to

defeat Isil. Finally, I say to the Foreign Secretary, will he intensify

the efforts of his office to collect evidence, especially now, of

breaches of international humanitarian law and war crimes so

that individuals as well as states, no matter how long it takes, can be

held to account one-day for what they have done? The question is,

that this house has considered international action to protect

civilians in Aleppo and more widely across Syria. Emily Thornberry.

Thank you, Mr Speaker. May I congratulate the honourable member

for Sutton Coldfield and the member for the Wirral South for securing

this emergency debate. I would also like to compliment the Right

Honourable member for Sutton Coldfield for speaking with his

customary force and authority and the way in which he spoke out for

the people of Aleppo persistently. We on this side of the House will

always remember that it was he who took up Labour's fight to meet the

0.7% aid target after he became International Development Secretary

in 2010 and following the Chancellor's word yesterday, that

may be a fight we need to resume in coming years. I'm sure the Right

Honourable member will be on our side again. Mr Speaker, since our

last emergency debate on Aleppo just two months ago, every worst

prediction made that day has happened. We all warned that

grotesque war crimes being committed by Russia and the Assad regime would

only intensify, and so that proved. We all warned of the increasing

humanitarian crisis with thousands of civilians still trapped in Aleppo

desperately short of food, water, medical supplies and shelter. That

crisis has only got worse. Finally, we all warned that if nothing

changed, Eastern Aleppo would be destroyed by Christmas and that is

exactly what is coming to pass. Mr Speaker, it was depressing to read

in recent days the accounts of the talks that have taken place in

Washington said to have gone on for months about the technical options

for making airdrops of humanitarian supplies into Aleppo. The subject

raised recently in this house by my honourable friend the member for

Wirral South. According to the Guardian, the last meeting on the

subject of airdrops collapsed because of fears, and I quote, "That

by the time any airdrop took place there wouldn't be anyone left to

save." It was equally depressing and chastening to read the text said

yesterday by a doctor in East Aleppo described as his farewell message,

and he wrote "Remember there was once a city called Aleppo, that the

world erased from history." And while we have all condemned Russia

and Assad for their actions in Eastern Aleppo, and we must ensure

that one day they are held to account, while we equally condemn

Iran and the role they have played in this massacre, we must remember

the words of that doctor who did not just blame those directly

responsible for destroying his city, but for the world as a whole for

allowing that to happen. It was a global, collective failure. Every

bit as great command I agree with the Right Honourable member and my

Right Honourable friend behind me, every bit as great as Srebrenica.

The question, Mr Speaker, is what do we do now? This boils down in my

view to four points and I will go through them. First we must take

every diplomatic step to press in Russia and Iran to allow safe

passage from East Aleppo, not just for the remaining fighters and their

families, but for medical professionals, journalists and

others. Many of us may have watched the extremely moving inside Aleppo

films that Channel 4 have been showing. They are filmed by a young

mother, not a camerawoman and not a journalist. She is a young woman

dumb mother who is 25 and a citizen of Aleppo married to a doctor, and

his professional duties have kept them in the city even after all the

other civilians, or many of the other civilians, have fled. Is

difficult to imagine the terror they feel, because we have read the

messages for ourselves. We must take it clear to Russia and Iran that

those civilians must be given safe passage from the city, or be

protected if they remain. I've been told by a number of sources,

journalists, the United Nations and the Red Cross, that there is

currently a building, some call it the last remaining hospital, some

say it was simply a building that people had moved into in the last

few days. A building where there are hundreds of children, hundreds of

injured, 110 medical staff, and they are in this makeshift building and

they are trapped. There have been negotiations with the Russians and

Syrian government and the Russians have said that whilst the fighters

and their families will be allowed to leave, the so-called civilians

and activists will not. The activists, they are referring to,

medical staff. Why would it be that medical staff would not be allowed

to leave? They must remain in the city, according to the Russians, and

presumably face the shelling. Presumably they have a higher chance

of being massacred by the regime, or at the very least detained. How can

it be that men with guns can go out of his now Aleppo but men with

stethoscopes cannot? Perhaps I can offer my honourable

friend a reply to that, the men of guns have got a very high chance of

being killed in some future conflict but the citizen journalists and the

humanitarian doctors and nurses to which you refer, are credible

witnesses in any future criminal proceedings, and Russia and Syria

have every incentive to make sure that the evidence is never given to

the world. And I think the Right Honourable Lady makes a very

powerful point and it echoes what has been said earlier about the

importance of allowing aid workers and independent people into that

area in order to be witnesses. In order to witness what has been going

on. Mr Speaker, once the fighting in Aleppo has ended, and an end may

well come very soon, the question is, how do we get humanitarian

relief to the citizens still left in East Aleppo and those who have fled

elsewhere, particularly as has been stated as the temperatures begin to

Summit and the need for shelter and blankets becomes as great as the

need for food, water and medical supplies. As I have said, not only

that, but also the need for there to be witnesses to the aftermath. And

if Russia and Assad continue to block road convoys into the area,

then surely the government must buy an extent that we have reached the

point of last resort when the previous Foreign Secretary promised

that their drops would be used. If we fear that manned flights would be

too dangerous as I know, the honourable gentleman sitting next to

the Foreign Secretary does, then the government must consider using

unmanaged drones or GPS guided parachutes. Thank you Mr Speaker,

I'm really concerned about the idea, that we would send our aircraft,

into airspace that is contested, and is hostile. They fly low, they drop

aid as I know, very low, they can be taken out by ground fire, not just

missiles. May I suggest that all of those people that wish this to

happen, should sign their name, should perhaps travel on the RAF

aircraft that flies in, because it will be extremely dangerous. I think

that there is a live debate on that issue, but I also pray that there

are other solutions such as using unmanaged drones or GPS guided Ara

shoots, those parachutes can carry large amounts, much larger than an

unmanned drone. These are all proposals that we know that the

government is actively considering at the moment so I hope that the

Foreign Secretary will tell us today if airdrops are not the answer for

delivering humanitarian aid, then what is? Because inaction is simply

not an option. I thank my honourable friend for giving way and

congratulate those who have brought this debate today calls this morning

a UN spokesperson stated that there has been a complete meltdown of

humanity in Aleppo, if that does not mean we have not reached a point of

last resort, does she like me want to hear from the Foreign Secretary

what exactly would it be. I'm very grateful to the honourable lady and

I couldn't have put it better. Thirdly once Aleppo has fallen,

attention will some point .2 Raqqa and other cities where Daesh is

currently in control, civilians are trapped in those cities as well.

They will be just as vulnerable as civilians in Aleppo to bombardment

and the use of chemical weapons and the use of the man tearing effects

of any siege. So, I would ask the Foreign Secretary today to what

extent if at all will there be any cooperation with Russia, Iran or the

pro-government forces and if and when their attention turns to

fighting Daesh. I did the -- and if the answer is none, how will we stop

Raqqa and other cities becoming like Aleppo 's top yellow I'm very

grateful, she has referred to other cities in Syria. Isn't it clear that

the Assad regime and the Russians have focused all their resources on

destroying the East Aleppo and allowed Daesh to retake power

mirror. Doesn't this show what their real priorities are. In some ways

this will take me to my fourth and final point, the impending fall of

Aleppo must raise the question, which is what exactly is the

government 's current thinking in Syria. Across the country we are

seeing increasingly what the Foreign Secretary called moderate rebel

groups, either defeated by pro-Assad forces all signing truce agreements

with them. It has been claimed that more than 1000 such local truce

agreements are now in place. So the question is, does the government

believes that the Modric rebellion is still taking place or has any

chance of succeeding. And if not, what endgame is the government now

working towards? In September the Defence Select Committee published

its report on the government 's military strategy in Syria and they

came to the conclusion that the goal of creating a new leadership in

Syria, that was "Neither authoritarian and oppressive on the

one hand nor Islamist and extreme on the other" was too ambitious to be

achieved by military means alone. That remains in my view a wise

judgment and yet the government seems to be even further away than

they were in September from trying to square this particular circle. In

conclusion Mr Speaker, these are desperately dark and terrifying

hours for the people of Aleppo, and they are hours of shame for those

perpetuated this assault. And it should be deep sorrow for every

international stoush in an government who failed to stop it

happening. But even at this point, there are still things that we can

do, there are still important lessons to learn, and Thurston

important questions for the government to answer, about where we

go from here. I hope that from sexual take this opportunity to

answer some of those questions today. -- I hope that the Foreign

Secretary. We will begin with an eight minute limit on backbench

speeches. Mr Speaker can I first of all congratulate my right honourable

friend force up and call to full speed the with such passion and

compassion -- for speaking. Mr Speaker thank you for granting this

debate, it is good also to see my right honourable friend the Foreign

Secretary had to respond to it. Of course what we have heard already

moves us to tears, the tens of thousands of civilians trapped in

Aleppo, the reports today of residents being shot on sight, the

barbarous assault by the Syrian army, Iranians militias and Russian

airpower, as has been referred to, the morning Star describes it as a

liberation. I first of all, offer my support and gratitude to the

incredibly brave people who are risking their lives as doctors and

white helmet workers in that war zone. And I support everything that

has been said about what we need to do, to get aid into Aleppo, or to

provide some kind of ceasefire so that civilians can get out of

Aleppo. But I have the same as the Speaker, the whole concept of an

emergency debate suggest that somehow this tragedy has come upon

us out of the blue. And indeed it has almost natural element to it,

that is not the case. The Syrian Civil War has been waging since

2011. And therefore, it is something that we could have foreseen and done

something about. And I think that we are deceiving ourselves, I will give

way in a moment, but rarely make some progress, I think we are

deceiving ourselves in this Parliament, if we believe that we

have no responsibility for what has happened in Syria. The tragedy in

Aleppo did not come out of a vacuum, it was created by a vacuum, a vacuum

of western leadership, of American leadership, British leadership, I

take responsibility as someone who sat on the National Security Council

throughout those years. Parliament should take its responsibility

because of what it prevented being done. And there were multiple

opportunities to intervene. In 2012, David Petraeus, the head of the CIA

devised a plan for a much more aggressive intervention in Syria,

providing lethal support to what was then clearly a moderate opposition,

in the Syrian free army. That approach was rejected. We did, as a

country here in Britain, provide support for flak jackets, medical

kits and so on but it was clear throughout 2012 and 20 13th that

there was not a Parliamentary majority in this house for providing

lethal support to that opposition so that they could shoot down the

helicopters and aircraft, that they could fire back with sophisticated

weaponry. And of course, in 2013, this House of Commons took a

decision, not to back a government motion to authorise air strikes when

Assad used chemical weapons and broke a 100-year-old to boo that we

have established in the west that was survived the Second World War,

you do not use chemical weapons and crossed a web

-- red line that the president of the United States had established.

By happily give way. Does he think such lethal force would have

overcome, the Iranians, the Russians, Assad, does he think that

was a runnable war if you have provided more munitions? First of

all on the narrow point of August 2013, we were responding to the use

of chemical weapons, and providing air strikes as a demonstration that

that was completely unacceptable, that a red line had been crossed and

indeed that the West had established that red line. But of course once

this House of Commons took its decision, he did have an impact. I

believe it did have an impact on American politics. We can't have it

both ways, debate the issue on Syria and think that our decisions have no

impact on the rest of the world. I did think it caused a delay in the

ministration's actions, it did cause the Congress to get cold feet. This

is where I want to draw my remarks to a close, the last time that I

spoke from the backbenches was in 2003 on that side of the house, and

we were debating intervention in Iraq. And we all know, the price of

intervention. My political generation knows the price of

intervention. The incredibly brave servicemen and women who gave their

lives in Iraq and Afghanistan. That thousands of civilians who died in

those conflicts. The cost to taxpayers in this country, the chaos

that inevitably follows when there is intervention in a country. And of

course the division in our society and families and communities. But I

think we have come to a point where it is impossible to intervene

anywhere, that we lack the political will as the West to intervene. But I

have some hope out of this terrible charged in Syria, which is that we

are beginning to learn the price of not intervening. We did not

intervene in Syria, tens of thousands of people have been killed

as a result. Millions of refugees have been sent from their homes

across the world. We have allowed a terrorist state to emerge in the

form of Isis which we are now trying to defeat. Key allies like Lebanon

and Jordan are destabilised, refugee crisis has transformed the politics

of Europe, allowed fascism to rise in Eastern Europe, create extremist

parties in Western Europe, and Russia for the first time since

Henry Kissinger kicked them out of the Middle East in the 1970s, is

back as the decisive player in that region. That is the price of not

intervening. So let us have our debate, let us do everything we can

to help the civilians of Aleppo, let us hope that the new American

administration and Secretary of State work with the Russians to get

the ceasefire, but let us be clear now that if you don't shape the

world, you will be shaped by it. Alison McGovern. Thank you Mr

Speaker, and, I thank those members who have already made remarks.

It is an honour to speak after the member for Tatton. Samit times I

have vigorously opposed everything he put to us. Today I respect a very

thoughtful contribution and an important contribution he has just

made. Mr Speaker, I rise today with one purpose, and that is to persuade

the Foreign Secretary that if he chooses to listen to the member for

Sutton Coldfield and take the action suggested to him, he will do so with

wide support across the House. Mr Speaker, overnight we have seen

reports of the fresh hell that Aleppo has become. We hear this

message from the White Helmets stock 100,000 plus civilians are packed,

as the member for Sutton Coldfield said, in a tiny area. Bombing and

shelling is relentless, casualties unimaginable, bodies lie where they

fell. Last night we heard the final distress call. Today we decide

whether to answer. The situation in Syria is so dire, the need is so

urgent, that we must not waste further time in deliberation and

delay. It is as simple as this. Civilians in Syria cannot be left to

the mercy of Assad. Ban Ki-moon was very clear in his message yesterday,

we all have an obligation to protect civilians and abide by international

humanitarian and human rights law. He went on, this is particularly the

responsibility of the Syrian government and its allies. Mr

Speaker, like the Secretary General of the UN, what President Assad is

doing to the people of Aleppo we know and the government knows too. A

letter of condemnations sound by our Prime Minister described the

bombings of hospitals and children being gassed and describes these

actions as war crimes. These are strong words but strong words will

not rescue a single child whilst Assad continues to drop bombs on

their heads. The Prime Minister rightly condemns the Russians for

their refusal to engage in Syria's peace talks. But I say it is time

for our government to also rethink their efforts. As has been said, we

can now clearly see the consequences of our inaction. We have asked our

government to step forward with a strategy to protect civilians.

Without this we can see the consequences. So many bodies that

the White Helmets any longer count them let alone mount a rescue. Soak

our inaction now must become action, which is why 18 days ago when I

asked members of this house from all parties to sign a letter to the

Prime Minister in support of getting aid to the Syrians by air if

necessary as a last resort, I was surprised, though very glad that

within one day 100 members of this house had agreed to put their name

to such a request. Very quickly that number had been risen to over 200

and is now 221, if you count all parliamentarians. Labour,

Conservative, Liberal Democrat, Scottish Nationalists, SDLP, DUP,

Plaid Cymru, Krhin, Mr Speaker, who cares what party we are today. Human

beings are being slaughtered without mercy and I say, never mind party

policy, that is a sin against nature itself. So what the government do?

We know that Russia will continue to frustrate the UN process by using

their veto to protect Assad. Strongly worded letters from our

Prime Minister and others are worth nothing if we are not prepared to

back them up with actual action. First, Mr Speaker, we need to get

the vulnerable out of there, children, medics, injured and

disabled early Donaghy urgently need safe passage to somewhere with

shelter, food and basic medical facilities. Second as 221

parliamentarians are begging the Government, get aid in, by whatever

means we can come at the reality in front of our eyes is this. Even to

save a single life aid is required and we know it is there and even at

this late stage we must do what we can to get it to people. Third, we

have to protect those left behind. The Government must be pressing with

the full capacity of the British legal profession for UN monitoring,

or even just British monitoring of the atrocities now being committed.

If we offer Syrian civilians so very little, the least that we can do is

to promise, however long it takes, Assad will see justice. We have all

heard, Mr Speaker, the Government's usual lines, they say they are doing

all they can, they keep their options open and nothing is off the