Steve Barclay
MP for North East Cambridgeshire · Conservative · United Kingdom
“I speak to my brief exchange earlier with the Minister. As the previous speaker, the hon. Member for Harpenden and Berkhamsted, said, the draft regulations are fairly benign and very welcome to help people who are struggling with their bills.”
“The issue is not the lack of will; the issue is the alignment between procurement, regulation and clinical leadership, particularly in the colleges, as well as the ability to scale innovation—it is not about having more ministerial pilots.”
“Just to localise it to my own constituency, the Cambridgeshire and Peterborough ICB alone paid out £14 million in redundancies last year. It merged with a number of other ICBs to form the Central East ICB, yet we know hear from the Government that it should align with metro mayors, which means going back to exactly what it was before: the…”
“My right hon. Friend is absolutely right: the Government are spending millions of pounds and there is no plan. The measure was announced without working that out, it came as a surprise to many within the system, and it has had a chilling effect on many decisions. That is not isolated.”
“I rise to speak to clause 1 on the abolition of NHS England and clause 6 on promoting innovation. What characterises the first of those is an announcement without any clear plan. That is what has driven the cost and confusion that a number of Members across the House have spoken about.”
“All this is around 18 months on from the actual announcement. The confusion seems to extend to the Government themselves, because they seem unable to answer pretty straightforward written parliamentary questions. Given the time limit, I will give just a few examples.”
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“Lady also mentioned funding, which I will come on to specifically. The trust has had additional funding, but on the challenges set out by colleagues from across the House, the trust is undertaking a demand and capacity review that will determine the level of additional resourcing required. That will inform the commissioning for 2018-19. Of course, it will have taken note of the concerns raised. The hon. Member for Great Grimsby (Melanie Onn), who is no longer in her place, raised a point about whether there are peaks of demand linked to drug and alcohol-related calls. I am happy to pick that up as a specific action and investigate that further. As so often when we debate matters of health, my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) brought a much-valued practical experience to the debate.”
“My understanding is that revalidation can be done by call handlers where they are clinically trained, but not where they are not. Even where they are clinically trained, it cannot be done if the initial 111 call is either a life-and-death call—a category 1 or category 2 call—or where the initial assessment has been done by someone from 111 who is clinically trained. There is a framework there, but I am happy to have a further conversation with the hon. Lady if she has areas of specific concern about how that guidance is operated. She will be aware that, in any event, only 12% of NHS 111 calls are referred to ambulance trusts, so the 12% is a subset initially; within that, there is a subset of those who are clinically assessed and what power there is. I am, however, very happy to have a further conversation. The hon.”
“I will be happy to, Mr Davies. As I was setting out before the votes, a number of key measures have been announced. I will elaborate on those further, but, before I do, I will address some of the points raised by colleagues across the House in this constructive and well-supported debate. The hon. Member for High Peak very reasonably opened her remarks by putting some of the challenges in the context of the good work being done. She cited in particular the case of her constituents, Vinnie and Jo, which illustrates the fantastic work done alongside some of the challenges that we will come on to. She also mentioned specific issues faced in terms of geography and low population density. The hon. Lady mentioned empowerment of 999 call staff as a specific issue.”
“It is worth reminding the House that the pay band that applies to paramedic staff has been increased from band 5 to band 6, so there has been a recognition in the system of the importance of paramedics, alongside an increase—around 30% since 2010—in the number of paramedics. However, we recognise that there is also an increasing demand, and that this service has been under considerable pressure.”
“I know that is an issue that many police and crime commissioners have also identified, and many within the fire service are keen to ensure that we have a better join-up between the blue-light services. The hon. Member for Lincoln (Karen Lee) raised the issue of hospital handovers. I assure her that daily reviews are currently being undertaken by NHS England and NHS Improvement. Greater transparency and targeted assistance are being provided, and there are also specific initiatives linked to individual hospitals, particularly including the hospital-ambulance liaison officers. The hon. Lady also mentioned pay.”
“Gentleman, knowing my views on Brexit, that for all the talk of some of the challenges of Brexit, the opportunities of Brexit should not be missed. I share his desire on that. There is also the geography point—whether it is the way services elsewhere have been reconfigured or the extent to which there are, for example, centres of excellence to which his constituents are being taken. Is the issue the formal geography or how the operating protocols within that geography have evolved? That, again, is a perfectly valid point and one we can look at on a case-by-case basis. I know my hon. Friend the Member for Boston and Skegness has championed a number of these issues over a period of time. He raised how we can get the ambulance service working together with the other emergency services.”
“We are looking at how we assess the return on investment between the cost of ambulances and emergency admissions and what that investment might do if it were put into a more preventative role—care homes, for example. On the specific matter of Sports Direct, which I was not aware of, the hon. Gentleman makes a valid point, which I will be keen to look at with officials—where there are peaks of demand, what is driving those peaks and how to mitigate them. He also mentioned the issue of privatisation from 2009. We are looking at how we take a more holistic view across a landscape and how mutual support from different parts of the system can provide assistance to that. It will not surprise the hon.”
“If we take the average length of stay from 40 to 35, that is the equivalent of 5,000 hospital beds, each at £100,000 per year. We can see how there is an interplay between what we are debating with the ambulance services and the wider Lincolnshire health economy, which is a specific point. I am happy to have further discussions with him on that. The hon. Member for Bassetlaw (John Mann) raised three points about the report on the disproportionate calls, which were pertinent to a conversation I had just this morning about spikes in care homes and what action might be taken. For example, to what extent can we improve GP access into specific care homes in Lincolnshire through Skype, as one of the mitigations of ambulance demand?”
“My right hon. Friend makes a pertinent point. As he mentioned, he is my constituency neighbour and I am very aware of the specific challenges posed by the geography and the road network in Lincolnshire. I am happy to take that specific point forward. It will not surprise him that I have already zeroed in on some of the challenges in Lincolnshire, particularly around United Lincolnshire and Northern Lincolnshire and Goole, how that interplays across the spectrum of primary care, how the patient pathway goes through, the various blockages in the system and how we look at that in a more systemic way. That issue interplays with a much wider debate, outside the scope of this one, but to give my right hon. Friend one statistic, 43% of beds are occupied by 5% of patients.”
“We recognise that the trust has challenges, and I am very happy to work with the hon. Lady and other colleagues as we move forward to address those. In addition to the increase in pay bands and the increase in numbers, an active plan is under way to tackle some of the challenges we have heard about today, which I hope gives some comfort to the hon. Lady.”
“In terms of the service nationally, a number of actions have been taken. Under Sir Bruce Keogh’s review of the NHS urgent and emergency care system, ambulance services are being transformed into mobile treatment centres, making much greater use of “hear and treat”, which is treating patients over the phone, and “see and treat”, which is treating and discharging patients on the scene. While we have heard of some of the challenges faced by the trust, it is also worth placing on the record that it is one of the best-performing trusts for “hear and treat”, and treats and discharges more than three in 10 patients either on the phone or on scene. There are areas of good practice that, for balance, it is only fair to recognise. I will conclude, to allow the hon. Member for High Peak time to speak.”
“I think most people who observed my questioning during my four years on the Public Accounts Committee will know that organograms and looking at where investment is and how streamlined structures are is extremely important to me. At the same time, it is important that one does not make a false saving in driving down some of the management costs, so that procurement, IT investment and consultancy spend, for example—some of the big ticket expenditure—is not effectively managed and escalates. There is a balance to be struck between having good leadership of trusts and, as my hon. Friend alludes to, not drifting into areas where additional hires are created in the back office as opposed to services on the frontline, where I think Members from across the House want to see them.”
“Finally, I have spoken with colleagues at the Ministry of Justice and confirm to the House that they intend to investigate the issues arising from this report in respect of HMP Liverpool specifically and the prison estate more generally. All organisations and individuals make mistakes. Where this is used as an opportunity to learn and improve, we will do all we can to provide support. Where, however, there is any kind of cover-up or a blinkered denial of what has happened, Members of this House and the victims of that wrongdoing have a right to expect accountability. The hon. Member for West Lancashire has done the NHS a great service. I will place a copy of the Kirkup review in the House of Commons Library. The Government are acting in full on the findings of the report.”
“Thirdly, I have asked the Department to review the effectiveness of sanctions where records go missing in a trust, or where records appear to have been destroyed. Fourthly, I have asked the Department for advice on what disciplinary action could be taken against individuals in relation to the findings of this report. Clearly due process needs to be followed, but it is important that we address a revolving door culture that has existed in parts of the NHS, where individuals move to other NHS bodies, often facilitated by those who are tasked with regulating them. Fifthly, I will ask NHS Improvement and NHS England to clarify the circumstances under which roles were found or facilitated for individuals identified in the report as bearing some responsibility for the issues at the trust.”
“I believe that review will need to address the operation and purpose of the fit and proper test, including but not limited to: where an individual moves to the NHS in another part of the United Kingdom; where they leave but subsequently provide healthcare services to the NHS from another healthcare role, such as with a charity or a healthcare company; where differing levels of professional regulation apply, such as a chief executive who is a clinician compared to one who is a non-clinician; where there is a failure to co-operate with a review of this nature and what the consequences of that should be; and reviewing the effectiveness of such investigations themselves when they are conducted. I will be pleased to hear the views of the hon. Member for West Lancashire, and those of the Health Committee, on these issues.”
“I will ensure copies of that response are shared with the Health Committee. Secondly, one recommendation is specifically for the Department of Health and Social Care, as set out in paragraph 6.5 on page 64. This relates to a review of CQC’s fit and proper person test. I intend to discuss the terms of that review with the hon. Member for West Lancashire and will appoint someone to undertake that review within the coming days.”
“It would appear from the report that while the former chief executive, Ms Cuthel, is now able to see that there were failures in clinical governance, she does not have as strong a sense of her own responsibility as one might expect. I understand that she is no longer employed in the NHS in England, but she does continue to hold a role working with the NHS in Wales. In response to this report, the Government intend to take a number of actions. First, the Government accept the recommendations in full. While this was a report commissioned by NHS Improvement, I will write to all the organisations named in the recommendations set out at section six of the report, asking them to confirm what steps they will take to implement the recommendations, or to set out their reasons for not doing so.”
“All but one of the board of the Liverpool trust shirked their legal and moral responsibility to be candid about the organisation they governed. In large, complex organisations, responsibility and accountability are always distributed to some degree. It is the case that the higher up in an organisation someone is, the greater their degree of responsibility. In this case those individuals were Bernie Cuthel as chief executive and Frances Molloy as chair. It is clear from reading the report that they each must take a significant share of the responsibility for these failures. Hon. Members will, I am sure, have noted the conclusion to the clinical governance section of the report, which highlights the responsibility of the former chief executive of the trust for the system of clinical governance and its failures.”
“Alongside this, we have put in place a number of measures to create a wider culture of learning and improvement. The Secretary of State has offered a great deal of personal leadership in helping to create this culture, including the establishment of an independent chief inspector for hospitals, whom I met yesterday and spoke with again this morning, and the recent introduction of measures to support trusts to learn from deaths and to improve patient safety. I am sure I am not alone in finding it astonishing that Dr Kirkup found there was a “small minority of individuals who refused to co-operate” with the review. I wholeheartedly agree with his view that “it remains the duty of all NHS staff to assist as fully as they are able with investigations and reviews that are directed toward improving future services”.”
“That was accompanied by many of the hallmarks of an organisation that has lost sight of its purpose. As Dr Kirkup states, “the evidence that we heard and saw amply confirmed the existence of a bullying culture within the Trust, focused almost entirely on achieving Foundation Trust status. Inadequate staffing levels, poor staff morale and appalling HR practice went unheeded. This was the end result of inexperienced leadership that was not capable of rising to the challenges presented by the Trust.” Following the Mid Staffordshire report, Dr Kirkup recognises that steps have been taken to introduce independent, clinically-led inspection by the Care Quality Commission. The Government have also introduced the special measures regime within NHS Improvement.”
“This represented a cut in resources of approximately 22%. We were surprised that such an ambitious financial reduction was not scrutinised more closely—by both commissioners and regulators.” There is a direct line from the decision to pursue foundation trust status in that reckless manner to the harm experienced by patients. Indeed, an earlier report by solicitors Capsticks reported in March 2016 that the interim chief executive who took over from Bernie Cuthel found in her first week that “there was an underspending by £3 million on district nursing. These teams were devastated because they weren’t allowed to recruit, some of them down to 50%”. This is a district nursing service in which Dr Kirkup reports that patients were experiencing severe pressure sores, up to what is clinically called grade 3.”
“There are many more examples of poor care and its impact on both patients and staff in the report, but what compounds the shock is the lack of insight into those failings displayed by the organisation at the time. This was the very opposite of a culture of learning, with incidents under-reported or played down, warning signals ignored, and other priorities allowed to take the place of patient safety and care for the vulnerable. We have seen this sort of moral drift before, most obviously at Mid Staffordshire and Morecambe Bay. As with Mid Staffordshire, the management at Liverpool Community Health NHS Trust put far too much emphasis on achieving foundation trust status. The review states that, “the trust undertook an aggressive cost improvement plan, targeting a £30 million reduction over five years.”
“The report covers the period from the trust’s formation in November 2010 to December 2014, and it describes an organisation that was, “dysfunctional from the outset”. The consequences of that for patient care were in some cases appalling, and the report details a number of incidents of patient harm including pressure sores, falls leading to fractured hips, and five “never events” in the dental service—an incredibly high number for one organisation. The failings of the organisation were perhaps most starkly apparent in the services provided at Liverpool prison, where the trust failed to properly risk-assess patients, including for nutrition and hydration, and it did not effectively manage patients at high risk of suicide. The review also identified serious failings in medicine management at the prison.”
“As the report makes clear, her personal commitment to get to the truth on behalf of the victims of Liverpool Community Health NHS Trust, her personal courage in asking difficult questions of those in senior positions within the NHS, and the persistence and precision of her search for accountability, are all vindicated today. We in this House, and across the wider health and social care services, owe her a debt. I also thank Dr Kirkup and his team for this excellent report. As with his report on Morecambe Bay NHS Foundation Trust, it is a clear, forensic, and at times devastating account of failures in the care of Liverpool Community Trust by its management, its board, and its regulators.”
“With permission, Mr Speaker, I wish to make a statement on the independent review of Liverpool Community Health NHS Trust, which was conducted for NHS Improvement by Dr Bill Kirkup and published today. What happened to patients of Liverpool Community Health NHS Trust is, before anything else, a terrible personal tragedy for all families involved, and the report also makes clear the devastating impact on many frontline staff. On behalf of the Government I apologise to them, and I know that the whole House will want to extend our sympathies to every one of them. As Mr Speaker correctly identified, I wish to pay tribute to the hon. Member for West Lancashire (Rosie Cooper). The people of Merseyside know only too well the cost of attempting to silence the victims and campaigners for those seeking justice.”
“We share concerns, and I know the House as a whole wants us to get to the heart of them.”
“Turning to the other issues that the shadow Minister raised, we clearly need to ensure that due process is followed. I do not need to remind the House of the difficulties of any enforcement against for instance, Fred Goodwin in financial services or Sharon Shoesmith in child services. People rightly expect due process, and all hon. Members would ask for that. The victims will rightly ask, “How can the chief executive, with this catalogue of issues, move within the NHS rather than be fired?” I know that the hon. Member for West Lancashire (Rosie Cooper) has many concerns about that, as do the Health Committee and many other Members. I look forward to working with the hon. Member for Ellesmere Port and Neston (Justin Madders) in the spirit in which he raised these issues.”
“However, it remains to be explained why a trust could pay so many compromise agreements, for example, in response to so many staff disciplinary issues. I assume that many concerns were raised by trade unions locally, as no doubt the hon. Gentleman is aware. We must also consider the extent to which earlier reports, such as the Capsticks report, raised concerns that should have been addressed. That is why, in my statement, I signalled my desire to look at those issues and ensure that they are addressed by the fit and proper person test in particular. As he will be aware, though, that test pertains only to board-level appointments in the NHS, not to all roles. We will need to look at that scope, at the effectiveness of the investigation and particularly at the revolving door element of the problem, which he recognised.”
“I thank the shadow Minister for his questions and the manner in which he put them before the House. His first key question was to what extent measures are in place to address this sort of issue, should it arise again. Post Francis, and following Sir Bruce Keogh’s review of 14 trusts with high mortality rates, a new regime has been put in place. There is a new chief inspector of hospitals, Professor Ted Baker, and a specific regime involving NHS Improvement, which commissioned this report. NHS Improvement has a new chair, Dido Harding, a very senior figure from the business community. That regime has put 37 hospitals into special measures so far. The methodology that is used to alert regulators to areas of concern has also been revised. For example, far more importance is now placed on staff and patient surveys.”
“On the extent to which the culture was driving the problems, I refer to the remarks I made in my statement. According to the report, the interim chief executive went in and found a significant underspend—£3 million—in the district nursing budget, at the same time as there were significant vacancies and patient harm. That culture was driving the issue, and that culture is what we need to put an end to.”
“I am very happy to work with my hon. Friend on this. As she will be aware from reading the report, it is explicit that the finances were there for the existing service. That is stated at the outset of the report. What drove the problems was a wholly unrealistic attempt to seek foundation trust status, with a cost improvement plan that was simply undeliverable. There was a massive reduction, without any attempt to reconcile that with serious issues on staff levels and vacancies. As the report explicitly sets out, when staff raised those concerns, they were bullied, harassed and on occasion suspended without due cause. The culture has changed significantly, and measures have been put in place for how the regime involving NHS Improvement would address such issues and look at cost improvement plans.”
“NHS Improvement has set out a series of measures to ensure that trusts learn the lessons of Francis. Obviously the period covered by the report goes back as far as 2010, but it is important that the NHS learns from the issues that Dr Kirkup sets out.”
“Friend the Secretary of State has placed a huge amount of importance, and in which he has given a huge amount of leadership, is patient safety guardians and ensuring that there are people in trusts tasked specifically with giving voice to patients. One of the many sensible pieces of advice that my predecessor, my hon. Friend the Member for Ludlow (Mr Dunne), gave me was that when visiting a trust, I should have a one-on-one meeting with that individual, not only because of their status within the trust but to gather information from them. He did so assiduously on all his visits. The wider point is how, from a regulatory structure point of view, we can ensure that there are safeguards when there are cost improvement programmes and ask what visibility there is of them.”
“The hon. Gentleman raises a number of important points, but particularly regarding whistleblowers. That was one warning signal that clearly failed here. The regulations have been changed, as he will be aware. In the past, there was a culture in which compromise agreements were applied with gagging clauses attached. That prevented visibility of the compromise agreements. That is why I asked, on receipt of the report, why the compromise agreements that were paid were not escalated to the board, and indeed what sight, if any, regulators had of those compromise agreements. Clearly financial payments will have been made, so there should be an audit trail. The hon. Gentleman asked what changes had been made. An area on which my right hon.”
“My right hon. Friend raises an important point on the draft Bill and the consultation. I am not in a position to announce a date; that will be announced by business managers in the usual way. My right hon. Friend is right to allude to that Bill as one of a suite of measures following Sir Bruce Keogh’s review and the Francis report, which are all part of changing the culture. I acknowledge the importance of those measures, but I want to signal to the House today that Dr Kirkup’s report identifies remaining issues that need to be tackled. He has done us that service, and that is where I am keen that we focus as a Government.”
“It is clear that measures have been taken, and it is right that we recognise that much work has been done in the NHS to change the culture, to ensure that the warning signs are seen, and to ensure that something like this never happens again, but it is also clear that there are specific issues in the report to be responded to, and I very much share the desire of the hon. Member for West Lancashire that we do that.”
“Lady will use all the parliamentary tools to pursue this matter, including in her role as a senior member of the Health Committee. I am aware that other members of the Committee, such as the hon. Member for Liverpool, Wavertree (Luciana Berger), a former shadow Health Minister, will take a significant interest in this issue. I know that the Chair of the Health Committee will do so. I have regular discussions with her, and as we address the “fit and proper” test and other issues, I look forward to benefiting from the expertise on that Committee.”
“A number of steps are being taken, but the approach that underpins those is that although we must create a duty of candour, enabling people to learn from the mistakes that will happen in an organisation employing more than 5 million people, there should not be the sense that people can escape their responsibility by moving within the system. I have discussed that with people in the NHS, and I believe there is a wide recognition that the culture has changed significantly. But clearly, as we consider the issues that emerge from the Kirkup report, the House will need to see further reassurance. The hon. Lady asked how I and the Government will ensure that these issues are addressed, not covered up. First, no one doubts that the hon.”
“On the changes that have been put in place, I alluded to the CQC regime and the chief inspector and the methodology. I spoke to the chief inspector yesterday. Every hospital has now been visited, using that new methodology, and obviously that programme will start to accelerate and target as further work visits are done. The methodology used for that has also evolved to include staff surveys, for example. So a number of measures have been taken, and the special measures regime is also very much at the heart of that.”
“I thank the hon. Lady for those comments. As I said, I have asked NHS Improvement and NHS England to clarify the circumstances under which roles were found or facilitated for individuals identified in the report as bearing some responsibility for the issues at the trust. I await the answer to that central question, which the hon. Lady posed. On the sense of cover-up, the Secretary of State has provided leadership in bringing about the culture change on patient safety. Following the awful situation in Mid Staffordshire, it was recognised across the House that changes needed to be made on patient safety, and I think the NHS itself has recognised that. NHS Improvement has new leadership, who commissioned the Kirkup report themselves.”
“I spoke to colleagues in the MOJ yesterday about the issue that my right hon. and learned Friend raised in the first part of his question. I agree with him that the standards of care for those in prison should be the same as those in the NHS more widely. As he will know, NHS England took over commissioning for healthcare services in prisons in 2013; that is one of the changes that have been made. He will also know that Dr Kirkup’s report drew attention to local factors, including a personal conflict of interests that goes to the heart of the relationship between the trust and the prison. However, he is absolutely right to allude to some wider issues from which we need to learn.”
“Only one member of the board co-operated with the review, from which we can deduce that all the rest did not. Given that I am relatively new to the Department, it would probably be wise for me to seek clarification on the extent to which individuals should be named, but I am happy to confirm that the chair of the board did not co-operate.”
“My hon. Friend is absolutely right. That is why we are increasing the number of doctors we train by 25%. We are also looking into how we can increase the number of clinicians in leadership positions in trusts, and how we can reduce variance. That is one of the key issues. The NHS has some brilliant leaders, but the variance between trusts is far too wide.”
“I am happy to reassure the hon. Gentleman, but he has raised an important point. The question of people moving within the United Kingdom is not the only issue; another potential issue is the question of people moving to a charity or a private company that is providing services for the NHS, or taking up other roles in the healthcare landscape.”
“I referred earlier to my desire to work on these issues with members of the Health Committee, who include my hon. Friend, and I shall be happy to look into the points that he has raised. The previous statement was about the culture in the House of Commons. I think that what goes to the heart of my hon. Friend’s question and the matters that we are discussing is that issue of culture, and the need for the culture in pockets of the NHS to change. My right hon. Friend the Secretary of State has done a great deal to bring about such change, particularly in respect of patient safety, but I shall be happy to work with my hon. Friend to take that further.”
“My hon. Friend is right: although 37 trusts have gone into special measures, a significant number have not just moved out of special measures, but moved from “room for improvement” to “good”. That is relevant to a much wider challenge in the NHS, whether it involves procurement, workforce planning, or mentoring for junior doctors. I met the family of a junior doctor last week to discuss mentoring and support, particularly for those in their first year out of medical college. Trusts have shown leadership on a number of issues, and I think that the special measures regime has shown the scope to spread that best practice much more widely across the system.”
“My hon. Friend is right. I think that at the heart of Dr Kirkup’s findings was the conclusion that what drove these events was not money—and he made that point specifically in relation to the finance for the initial services—but the desire to seek foundation trust status, which led to a wholly unrealistic cost improvement plan and an unwillingness to address the issues that arose as a consequence.”
“My hon. Friend is right. Professor Ted Baker, the chief inspector of hospitals, has drawn attention one of Dr Kirkup’s findings, which is that the CQC is now in a much better position to challenge and fine those responsible for unsafe care and poor standards. That also reflects the excellent work that Professor Baker and his team have been doing to ensure that inspections become much more rigorous in identifying issues such as those that we have been discussing today.”
“My hon. Friend is right to allude to the importance of learning lessons, especially given that there are many vulnerable people in prisons, and given the risks that accrue as a result. Yesterday I spoke to the Under-Secretary of State for Justice, my hon. Friend the Member for Bracknell (Dr Lee), who is responsible for offender management issues, and the Prisons Minister, my hon. Friend the Member for Penrith and The Border (Rory Stewart), visited Liverpool prison last week. I know that they have both taken a great interest in the report, and that they will take any further action that is needed.”
“I should be happy to discuss any such future opportunities with Dr Kirkup. His excellent report builds on the work that he did at Morecambe, and I think there is a huge amount for us to take forward from its findings.”