James Murray
MP for Ealing North · Labour (Co-op) · United Kingdom
“I wonder whether any other Members might say that they have the most pubs in their constituency, or whether the hon. Lady has done her research. [Interruption.] I hear her saying that hers are the best pubs, a claim that even more Members may challenge in the Chamber. Although the hon.”
“The hon. Gentleman has some cheek, given the number of pubs that closed when his party was in government. The Labour party is making sure that the business rates system is set right for the future.”
“I think the hon. Gentleman’s point is that the price of fuel is linked to international events, which, as I said earlier, I very much agree with. That is why it is important that we de-escalate the situation in the strait of Hormuz, which is the best way to bring down the cost of fuel.”
“I know my hon. Friend is a great champion of pubs in her constituency. In fact, she has brought together people for her pub politics events, including at the Willy Wicket, the Beaufort Arms, the Baileys Court Inn—which I have been to—and the White Lion, where people come to talk about issues that matter to them.”
“I thank the hon. Gentleman for talking about the Station House in his constituency; I am sure we all have pubs in our own neighbourhoods that we feel are at the heart of the local communities that we represent. The 20% business rates cut that we announced was a down payment on further reform.”
“I agree with the hon. Lady about the importance of providing breathing space for families, which is a priority for us as a Government, and she mentioned her plans. I have set out what we have done since the general election to reduce fuel prices by 11p per litre compared with what they would have been otherwise.”
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“There is no single lever we can pull, no single change we need to make; we need to ensure that, from top to bottom, maternity services are overhauled in order to be fit for the future.”
“I thank the hon. Lady for her comments. She speaks about funding, which is of course a very important part of the response that we need to have to the failings in maternity care. We are investing £25 million, as I am sure she is aware, in tackling the causes of maternal death, to enhance bereavement facilities and to improve triage facilities, as well as £145 million through the estates safety fund to address safety risks in the maternity and neonatal estate. For me, this is not just about funding; this is also about culture, exactly as she says. When there is a culture of mothers and midwives not being listened to, and of the board, in this case, commissioning reviews and then ignoring them, that is where the problem lies. That is what we need to change.”
“I thank my hon. Friend for her comments and questions. As well as thanking the families for what they have done to drive the report forward, she also thanked Donna Ockenden for her critical work in producing this report, and to those thanks I add my own. My hon. Friend asks about the timetable for action. The national taskforce, which I chair, will draw together all the national recommendations, all the recommendations from Donna Ockenden’s report, the recommendations from Baroness Amos’s report, and any other report on failures in maternity services, and the taskforce will report by the end of the year. That will be the timetable for us ensuring that there is a comprehensive plan of action. I know from my conversations with families that some have wanted a public inquiry and others have had different views.”
“We must ensure that the entire system is structured in the right way to provide that accountability and to drive change and action, and I will put under careful consideration his suggestion about how that might be achieved.”
“I sincerely thank the right hon. Gentleman for his comments. I have a great deal of respect for him, as he knows, so I very much appreciate him making his suggestions in that manner. Let me add to what he said about Jack and Sarah Hawkins, who I met last week in Nottingham. Their sheer determination to push for accountability and justice is incredibly humbling. The right hon. Gentleman mentions the importance of clinical accountability, which gets to the core of how to drive change in the NHS—as he knows, and as I now know, that is not always possible through central control, or by instructions being sent out from the Department of Health and Social Care or NHS England.”
“My hon. Friend raises the important issue of compelling witnesses to give evidence. Although many members of staff contributed towards Donna Ockenden’s review, I found the fact that so many senior leaders did not shocking, and I think it is unacceptable. We will change that by ensuring that the duty of candour, which is due to come in under the Hillsborough law once that is in place, will apply to future maternity reviews, including those taking place in Leeds and Sussex. As I said a few moments ago, there are different views among different families about whether they do or do not want a public inquiry, but I am not taking any options off the table.”
“I thank the right hon. Gentleman for his remarks. The story he told was of yet another horrific and harrowing experience that a family has gone through in this scandal. He asked whether we want to prioritise a focus on regular and high-quality training across the country, and I think it is essential to ensure that such training is in place. Although I do not want to prejudge the action plan that the taskforce I am chairing will produce, I cannot imagine a world where training is not a key part of that. Having seen the report, and spoken to families and to Donna Ockenden, my strong feeling is that no single action will transform the system on its own, and that we need a comprehensive plan from every angle to truly transform maternity services across the country.”
“I thank my hon. Friend for her comments and I welcome her support for our decision to ensure the duty of candour introduced by the Hillsborough law will apply to future maternity reviews, such as those due to happen in relation to Leeds and Sussex. In terms of the process of what happens next and the implementation of the changes that we know need to happen, I reassure her that the national taskforce that I chair will produce, by the end of this year, a comprehensive plan of action that will be based on a consideration of all the recommendations that apply nationally in Donna Ockenden’s review, as well as the recommendations from Baroness Amos’s review and any other reviews that have issued recommendations on the subject too.”
“We need to find the best route to deliver that for them, because that is, above all, the most important thing. However, I reassure him, as I have reassured other hon. Members, that for me no options should be off the table.”
“I thank the right hon. Gentleman for his comments and for telling us some of the story of Thomas and his son, Aubrey. On the need for action, I intend the taskforce that I chair, which will consider all the recommendations from Donna Ockenden’s report and other investigations into failures in maternity services, to produce a comprehensive action plan by the end of this year. That will ensure, as I said earlier, that these recommendations do not sit on shelves gathering dust and that they are put into action. I take on board his points about a public inquiry. I know that his views are shared by some of the families, but I am conscious that other families have different views on this matter. What unites them all is a desire for action, accountability and justice.”
“I agree with her wholeheartedly that this moment and this process that we are now going into must be a catalyst for change.”
“I thank my hon. Friend for her comments about the role of the families in fighting for justice. She is absolutely right that the recommendations of the Ockenden report, Baroness Amos’s report, which is due shortly, and other reviews and inquiries into maternity services must not simply end up on the shelf gathering dust. That is why the process that I have spoken about today, whereby the national taskforce that I chair will produce a comprehensive action plan by the end of the year, is so important. That will give us the right forum to develop a plan across all aspects and from all angles on this horrific scandal, including the inequalities faced by different families from different backgrounds that my hon. Friend alluded to.”
“The hon. Gentleman makes an important point about regulators and our regulatory system. The report exposes how completely unacceptable it is that regulators have protected their own and what a serious matter that is. We need to ensure that the regulators are doing their job properly, that they have the right mandate to do so and that they have the right instructions about driving up performance in trusts across the country, because otherwise we run the risk of being in a situation in the future where we are again confronted with what he accurately described as shame.”
“Let me repeat what I said earlier about my humble admiration for Jack and Sarah Hawkins and their campaign for justice over baby Harriet. My hon. Friend is absolutely right to refer to the failings as systemic. This is not a handful of cases or problems; this truly is a problem that affects the entire system. The culture and the systems that are in place have let people down, and that is why our response must be so comprehensive. My hon. Friend mentions the input of families into the taskforce and his constituent Ashley Harper, who raised that matter. I am very happy to discuss with him after this statement how we can ensure that the taskforce represents the views of all families.”
“As I said earlier, although more than 800 members of staff contributed towards the review, I was appalled at the number of senior clinicians who did not agree to take part. That is why it is so important that we change the law—applying the duty of candour through the Hillsborough law to ensure that this can never happen again.”
“The right hon. Gentleman raises an important part of the dynamic that has been exposed through Donna Ockenden’s review: people not feeling able to challenge what is happening—feeling that they are being intimidated or forced to stay silent—even when they want to raise issues of great importance. We must ensure that the right structures and culture are in place not only so that women and their families can raise their concerns, but so that staff, midwives and others working in maternity and neonatal services have the confidence to raise their concerns through whatever mechanism is most appropriate in the circumstances. They must have confidence in the mechanism to raise their concerns. The right hon. Gentleman spoke about clinicians who refused to take part in Donna Ockenden’s review in Nottingham.”
“That is an important first step, but this must be a watershed moment that does not rely simply on one action or a small handful of actions. There must be a comprehensive plan to tackle this issue from every angle and to ensure that we have the systemic change that so many Members today have said is crucial.”
“My hon. Friend asks about the immediate actions that the Government are taking in response to Donna Ockenden’s review. For me, above all else—above all the shocking, harrowing detail—the review highlights the fact that women simply were not listened to. That comes up time and again. I know that it comes up in other aspects of healthcare as well, but it came up so strongly in this report and underlined so many of the shocking failures that have occurred. As a first step, extending Martha’s rule to all maternity services across the country means that when women or their family members are concerned that they are not getting the treatment or care they need, they can get a second opinion—an urgent, independent review.”
“The hon. Lady makes an important point about the fatigue, weariness and exhaustion of families at so many recommendations being made and accepted but not put into action. To pick up on the point made earlier by the Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), we must now break that cycle to ensure that the recommendations do not simply get accepted and sit on a shelf gathering dust, but that they feed into the plan of action, which will then produce the change that we need to see. As the hon. Member for Canterbury (Rosie Duffield) said, the change must be nationwide. Although we are today rightly talking about what happened in Nottingham, we know that it is far from the only place where such failures in maternity and neonatal services have been seen.”
“This is a problem that goes very deep; it is systemic, cultural and deeply embedded, and a comprehensive plan will be required to change that.”
“I thank my hon. Friend for her comments, and for talking about the shocking situation with her daughter’s baby that she managed to avert. She spoke about the inequalities, the racism and the fact of women being silenced, all of which come through very strongly in Donna Ockenden’s report. As I have explained, the taskforce I chair will now consider the full set of recommendations from that report, as well as the recommendations from Baroness Amos’s national review and other reviews and inquiries into what has happened in maternity services. That taskforce will produce a comprehensive plan of action that will cover the whole range of actions that need to be taken, because we know it will take more than one action, or even a small handful of actions, to transform maternity services and make them as they should be.”
“While the conversation we are having today is of course about the failures in Nottingham, we know that most women will receive high-quality care, and the majority of the NHS workforce do an important job supporting them. We should make sure that is acknowledged in this difficult conversation. However, one of the changes we want to make immediately is extending Martha’s rule to maternity services right across the country, because we know it is something we can do now. Martha’s rule is a mechanism that has worked well in other parts of the NHS, and it will mean that when women and their families feel they are not being listened to, they will have a way to get an urgent, independent review of the care they are receiving.”
“I thank the hon. Gentleman for his remarks, and for his tone and approach in encouraging cross-party working—he is absolutely right that that will be essential for making progress on this most important issue. I will consider the important point he has made about the Ministry of Justice and its remit in relation to what we have seen in mortuary services. As I said earlier, in a report full of shocking revelations, that inhumanity and lack of dignity left me truly aghast; it is almost unbelievable that it could have happened. The hon. Gentleman also raises an important point about women and their families across the country using maternity services.”
“I thank my hon. Friend for his question. I was personally inspired by meeting Ryan’s mum Sarah when I visited Nottingham last week—she told me about Ryan, and showed such incredible strength and courage in advocating for the forgotten children in Nottingham. I can reassure my hon. Friend and the whole House that I will do everything in my power to support children with acquired brain injuries. We are working on an acquired brain injury plan at the moment, and I am also working with the Department for Education and NHS England on ambitious reforms to the special educational needs and disabilities system, including on the future direction of EHCPs.”
“I thank the hon. Gentleman for drawing my attention to that report. We will certainly ensure that any reports containing relevant recommendations are considered as part of the taskforce’s work, because one of the changes that I want to make sure we achieve is to not have so many different reports with hundreds of recommendations that then do not become a plan of action. That is a cycle we are seeking to break through the taskforce’s work by producing a plan of action by the end of the year.”
“My hon. Friend is absolutely right to point to regulatory failure, which has been drawn out very strongly by Donna Ockenden’s report. For me, what is completely unacceptable is that in their response to what has happened in Nottingham, they have sought to protect their own. That is something we must change, because it is only through effective regulation that we can have true accountability, and it is only through true accountability that we can get action and change.”
“I thank the hon. Lady for welcoming our decision about applying the duty of candour to future maternity reviews and inquiries, including those in Sussex and Leeds. We have always been clear that the Public Office (Accountability) Bill—the Hillsborough law—is an important priority for this Government. As soon as it is in law, we will ensure that the duty of candour is applied. Our commitment today is to ensure that NHS staff, current or past, cannot refuse to take part in what the lead investigator wants in future inquiries.”
“I commend my hon. Friend on mentioning his constituent, Louise Thompson, who is campaigning on this important issue. He mentioned the impact of racism, discrimination and inequality in maternity services and their failures—all raised powerfully by Donna Ockenden’s report today. As I said earlier, the action plan, which the taskforce will be producing, will be published by the end of this year. We are determined to break that cycle where recommendations get accepted and then get left on the shelf to gather dust. We want an action plan that can be implemented. We want to make sure that delivery is set out and is progressed by the Secretary of State and the Department. That is a key part of the accountability in making sure that the delivery plan is put into action.”
“I thank the hon. Lady for expressing how she feels angry and upset. I think that that feeling is shared by all of us in the House today. The publication of Donna Ockenden’s report today has exposed the lifelong suffering of those families. The details of the action plan will be published by the end of the year, because we want to make sure that recommendations are not simply accepted and then not implemented. The recommendations must go into the taskforce, and the taskforce must produce that clear action plan, which we can then implement, and people can see us doing so. That is the way to break the cycle of recommendations that do not get implemented and to make progress towards the justice, accountability and change that I understand from families is so important to them.”
“I thank my hon. Friend for raising the important issues that she referred to in her remarks. I am happy to make sure that either me or a member of my ministerial team will meet her to discuss them in further detail.”
“One of those learnings that I am conscious of is how unacceptable it is that senior leaders refused to take part, for which I can see no justification whatever. I am pleased that, through the duty of candour that have we spoken about today, that will no longer be possible.”
“My hon. Friend speaks about his constituents whose experience might be relevant to some of the findings around mortuary services and their failings. I would be happy to ensure a meeting with either me or a member of my ministerial team. As I said earlier, the details of what happened in mortuaries leave me struggling for words, because of how dehumanising, disrespectful and abhorrent that was. I would be happy to make sure that his constituents’ points are picked up as part of that. On learning the lessons from the review in Nottingham and applying that to Leeds and Sussex, we are fortunate that Donna Ockenden will be leading those reviews, having just completed the review in Nottingham. She will be in a strong position to ensure that she goes into that with the learnings she has made from the current review.”
“Friend has said, this is not just a case of individual cases going wrong or individual members of staff making the wrong decision. It is endemic, and shows the incuriosity of leaders in maternity services about what is going on and what is going wrong in their services. It is a failure of regulators, it is systemic, and the response to it must step up accordingly.”
“I thank my hon. Friend for his comments, and for telling us what happened to his constituent. He asked about some of the wider changes that we are making in the NHS modernisation Bill. The aim is to bring the patient experience across the NHS into the heart of the new organisation that will arise from the merging of NHS England into the Department of Health and Social Care to ensure that the patient experience drives the decisions being taken about how NHS care is delivered, and is at the heart of what we do as a Department and a national health service. However, as the report makes clear, the level of failure in maternity and neonatal services is truly devastating. It demands a specific response, which is why the work of the taskforce will begin and it will report by the end of the year. As my hon.”
“My hon. Friend is right to emphasise quite how shocking it is that people in senior leadership positions refused to take part in Donna Ockenden’s review. I cannot understand how they could make that decision and think it acceptable. That is exactly why the law needs to change. It shows why the Hillsborough law is so important and why it was important to put it on the statute book, and also why it was important for us to decide now to apply that duty of candour to future reviews of the failures of maternity services so that never again can NHS staff, current or past, decide not to take part in the search for justice and accountability that it is so crucial for us to deliver.”
“I thank my hon. Friend for sharing with us his experience of brain injury in his own family, and for reminding us how some of the issues that we are discussing today touch the lives of many people in the House and across the country. We all have a responsibility to act on the basis of the recommendations of today’s report, and I assure my hon. Friend that those recommendations, along with those in Baroness Amos’s report, will enable the taskforce to produce a comprehensive action plan. A key element of that work—this concerns his direct point—will be ensuring that when people are at greater risk of harm, greater risk of being ignored, greater risk of being discriminated against, lied to or not being given the care that they need, that inequality will be addressed.”
“That is why it is so important that we develop our plan, which will have a nationwide impact, in order to finally tackle this challenge head-on and ensure that we deliver the maternity and neonatal services that women across the country need and deserve.”
“Although the report that we are discussing today deals with what has happened in Nottingham over the past 13 years, my hon. Friend is right to point out that it has not just happened in Nottingham and it has not just happened over the past 13 years. When I have spoken to people about this report, even today, so many have shared their own stories from many years ago in all different parts of the country. That reminds us that although the focus of the report is what has happened to the families in Nottingham, this issue affects families throughout the country, which is why, as my hon. Friend says, it is “all too familiar” to so many people when they hear what has happened.”
“She found that even clinicians working in the field were divided on the best way to support, treat and care for young people suffering from gender dysphoria. Where there is strong divergence of medical opinion on treatment, the two possible responses are either to continue with uncertainty—and with that, conflicting opinions and advice—or to undertake a trial. It is only by doing that that we can ensure that children with gender-related distress get the same access to and standards of care as everyone in the NHS.”
“What Dr Cass uncovered was shocking and scandalous, and she made a series of recommendations for how children can be better protected and supported. It was, in my mind, unquestionably wrong for children and young people to be routinely prescribed puberty blockers for gender dysphoria without any clear evidence on their benefits or risks. The situation then was out of control and so I fully supported the indefinite ban introduced by my predecessor, my right hon. Friend the Member for Ilford North (Wes Streeting), which followed the temporary ban brought in by the previous Government. In considering what to do next, Dr Cass identified that treatment for gender incongruence was “an area of remarkably weak evidence”.”
“From around 2009, the number of children and young people being referred for NHS support around their gender identity increased rapidly. Stories subsequently emerged of young people struggling after undergoing radical and permanent transition surgery at an early age, of children rushed into taking medication without adequate therapy beforehand, and of clinicians disregarding conditions such as neurodiversity and mental health issues. As such, there was rightly deep concern about the vulnerability of these children and young people, the care and treatments they were receiving, and the surge in referrals. And so, in 2020, NHS England commissioned the leading paediatrician, Dr Hilary Cass, to carry out a review into NHS gender identity services for under-18s.”
“I remind the shadow Minister that it was her party that commissioned the Cass review and accepted its findings, which included the Pathways trial. I have been clear to the House that this is a challenging area. I accept and welcome the scrutiny of Members, but I encourage us to keep in mind Dr Cass’s request to consider the issues sensitively and cautiously. She says: “Polarisation and stifling of debate do nothing to help the young people caught in the middle of a stormy social discourse, and in the long run will also hamper the research that is essential to finding the best way of supporting them to thrive.” I do not think that there is any question that a few years ago, children’s safety and wellbeing was not being protected when it came to gender incongruence.”
“I know what a sensitive, emotive and difficult issue this is. As I said in the House yesterday, I have myself struggled with the profound challenges this subject raises. We all, as adults, owe a duty of care to every child and young person in this country. That is a responsibility I bear, both as a citizen and as Health Secretary, with the utmost seriousness and sincerity. It is why, in all my deliberations on this matter, my consideration is to protect the safety and wellbeing of children and young people. Children’s healthcare must always be evidence-led, safe and effective. The way to ensure that is to follow expert clinical advice, which is what the Government are doing. Dr Hilary Cass, the clinician who I think has more respect in this space than any other, has spoken about the importance of this trial in recent days.”
“The hon. Gentleman’s question allows me to address that matter directly. The data-linkage study will not provide clear evidence of the risks and benefits of puberty-suppressing hormones, which is needed to guide future clinical practice for this cohort. The type of information that would be available in a linkage study is much more limited than the detailed information that the research team will collect about the relative benefits and harms of puberty-suppressing hormones when accessed alongside a holistic model of care.”
“I have responsibility for NHS England as Secretary of State for Health and Social Care, and I am setting out the protocol agreed in relation to this trial, as it is a subject that is arousing a lot of questions in the Chamber, which is fair. [ Interruption. ] I will come back to that point, if the hon. Member for Gordon and Buchan (Harriet Cross) allows me to make a little progress.”
“That is why Dr Cass recommended a trial to study the effects of puberty-suppressing hormones on young people’s physical, social and emotional wellbeing, and to establish how best to support children and young people suffering gender incongruence.”
“I will make a little progress, and then I will be open to more interventions. We need to be clear about who we are talking about. As Dr Cass said, the vast majority of children and young people who question their gender will resolve it without needing any support other than their friends and family. For many young people, questioning their identity, on many different fronts, is a normal part of growing up, and we should simply let them be. A small number of those young people, however, need greater support because of the level and longevity of discomfort that they feel, and that can often involve counselling or therapy. For a very small number of young people, it is possible—and I emphasise the word possible—that medical treatment would help improve their quality of life and mental health and reduce their gender-related distress.”
“What is important, however, and what I hope will set this Pathways trial in a wider context, is all the other work that is being done to study the incidence of gender incongruence and the responses to that among young people, which will go beyond the trial we are talking about to look at children and young people questioning their gender through talking to them, understanding their mental health and their approach to that. All that will happen alongside this trial, which is one part of a much wider study to understand how best to support young people who are facing these gender-related issues.”
“The hon. Gentleman raises an important question around how the clinical trial is designed. In this case, the young people involved in the trial, of whom there will be around 226, will be split into two groups; one half will have the puberty blockers from the start, the other half will receive them after a year. My understanding of this matter, having interrogated the detail carefully, is that a placebo would not be appropriate for this trial because the subject will be able to know the impacts of having the puberty blockers; they will be aware of whether they are having the medication.”
“I thank the right hon. Gentleman for the tone he took in asking an important question, which I am pleased to be able to respond to. The bar for getting on to this trial is set extremely high, with strict eligibility criteria: parental consent, alongside the young person themselves consenting or assenting; a diagnosis of gender incongruence for at least two years; and consent from both the NHS care team and a national multidisciplinary team, including a wide range of disciplines, to understand all aspects of a young person’s health, context and situation. The level of approvals and scrutiny that young people will have to go through to participate in the trial will, therefore, set the bar extremely high.”