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Westminster Hall

Monday 15 December 2014

[Mr Christopher Chope in the Chair]

Backbench Business

Paediatric First Aid

4.30 pm

Mark Hunter (Cheadle) (LD): I beg to move,

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

Mr Chope, it is a great pleasure to conduct this debate under your chairmanship. It is a sombre subject that we are addressing this afternoon, and it is a difficult address for me to give, knowing the circumstances, and the family, Joanne and Dan Thompson, who are here with us today to listen to our proceedings. In parts, it might also be a difficult debate for Members to listen to.

Tragically, Millie Thompson passed away aged just nine months after a choking incident at a nursery school in my constituency of Cheadle. Following Millie’s tragic death in October 2012, her parents, Dan and Joanne Thompson, set up a charity called Millie’s Trust, as a legacy in Millie’s memory. I am delighted that they are able to be here today to witness our debate.

This Backbench Business debate is the next step for the Thompsons’ campaign, which has one simple aim: that all nursery and pre-school staff receive paediatric first aid training.

Robert Flello (Stoke-on-Trent South) (Lab): I am grateful to the hon. Gentleman for securing this debate, and I am particularly grateful to the family, who are with us today. However, it is almost amazing that this requirement is not already law and on the statute books. The fact that there so many Members here from across the House should perhaps send a message to the Minister: “Let’s get this on the statute books really quickly.”

Mark Hunter: I thank the hon. Gentleman for his contribution and I could not agree with him more. I am delighted that so many hon. Members from across the spectrum in the House of Commons have been able to find time to be here today, when I know that—as ever in this place—there are plenty of other important issues being debated at the same time.

Millie Thompson was just nine months old when her parents, Joanne and Dan, left her in the care of a nursery in Cheadle Hulme. Her parents had done what every parent does when placing a child in an educational establishment, and as far as they were concerned they had chosen the very best place for their daughter because the establishment had an outstanding Ofsted rating in early 2012.

Millie Thompson passed away on just her third day at nursery. The Thompsons received a phone call stating that Millie was having problems breathing and when Millie’s mum arrived at hospital, sadly Millie had already passed away. Millie had choked on her lunch, which

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consisted of food that she had been competent at eating for several months previously, which added further to her parents’ distress.

On further investigation by the police, a few things became apparent. The nursery had used various first aid companies for their training, many of which no longer exist. Furthermore, the majority of staff were trained in first aid at work, which of course is not the same as paediatric first aid. However, two members of staff were trained in paediatric first aid, but we will see later why I believe that that was not effective enough and why we would like a change in legislation.

Millie was not given full choking treatment from any member of staff; she received only the bare minimum of treatment, which consisted of a few slaps to the back. Sadly, Millie’s parents have had to view CCTV coverage from outside the nursery on that tragic day, which showed many people running around, including the supervisor and the two members of staff who were trained in paediatric first aid.

Mark Tami (Alyn and Deeside) (Lab): The hon. Gentleman is making a very moving case. Does he agree that it is surprising, bearing in mind all the other requirements and regulation around child care, that this requirement is not just part and parcel of it? As my hon. Friend the Member for Stoke-on-Trent South (Robert Flello) suggested, most of us would have assumed before this incident was highlighted that that was the case, and that trained people would be there and able to see the signs if such a tragedy was happening.

Mark Hunter: I thank the hon. Gentleman for his contribution and, yes, I totally agree. As the previous intervention by the hon. Member for Stoke-on-Trent South (Robert Flello) also suggested, most parents—I am a parent myself, although my children are now grown up—would assume when they are taking their children to a nursery that has all the relevant certification and regulation that the staff there will be adequately trained, and I intend to emphasise that point later.

Mr Barry Sheerman (Huddersfield) (Lab/Co-op): I used to chair the Children, Schools and Families Committee and I remember pushing Ofsted on this issue; I also represent Huddersfield where the National Day Nurseries Association is based. This case has been a wake-up call to everyone that paediatric care in an emergency is totally different from first aid and needs specific training. I hope that this positive intervention from parents who are grieving—they are being positive and doing something about this issue—is an example to all of us to make these changes quickly.

Mark Hunter: I thank the hon. Gentleman for his intervention. Again, I could not agree more. I think that everybody, once they have focused on the issue, starts to appreciate that there is a significant difference between having a general qualification in first aid and having a qualification in paediatric first aid, which by the very nature of the fact that it involves dealing with small children—in this case, Millie was only nine months old—is rather more specialist. However, parents would naturally assume—I think we all would—that if they are placing their child in a nursery, the nursery would be covered.

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The hon. Gentleman is also right to say that tribute must be paid to the Thompsons; after such a terribly tragic experience, they have made something positive through Millie’s Trust, which is creating a legacy in Millie’s memory. I will say more about that legacy later.

I will go back to the point I was making about the CCTV coverage. Millie’s parents have stated that it was obvious from that footage that when Millie was being taken out to the ambulance she was “like a rag doll” and they believe that at that point she should have been receiving CPR.

Andrew Gwynne (Denton and Reddish) (Lab): I am grateful to the hon. Gentleman for giving way, and of course he is right to highlight these issues here in the Palace of Westminster today. However, this tragic incident not only highlights the failures in the nursery system—that is, the lack of paediatric first aid training—but the fact that until recently the ambulance services were not compelled to have the appropriate paediatric equipment in their ambulances. If one good thing has come out of the Millie’s Trust campaign, it is that the North West Ambulance Service has now pledged to ensure that all its ambulances have the appropriate paediatric equipment.

Mark Hunter: Again, I thank the hon. Gentleman for his intervention and he is absolutely right. I will come on to the point about how the North West Ambulance Service has responded to this case in the positive way that he has indicated.

On the day in question, Millie was being fed by the supervisor of the nursery, who had worked in child care for some 20 years; she was an experienced person. Yet, when this tragic incident happened, Millie received no treatment from the supervisor, because she was not trained in paediatric first aid. Instead, she handed Millie to another member of staff.

After Millie had received the slaps to her back, she was left in the arms of someone who was trained in first aid at work, not paediatric first aid. That should not have been the case. Sadly, of the two paediatric first-aiders at the nursery, one chose not to be involved and went to look after the other children while the second administered the back slaps and then left the building, through the nursery grounds, and went to the main road to wait for the ambulance. This should never have happened. The paediatric-trained first-aider should not have left Millie’s side until the paramedics arrived.

I will outline the treatment that Millie should have received and what should have happened at that point in time. Millie, as I said, received a few back slaps and was then held in a non-paediatric-trained first aider’s arms for around 10 minutes. On arrival, the paramedics immediately began standard choking treatment for a baby. By this point, it was tragically too late and Millie’s heart had stopped beating.

In a statement from the nursery, it was stated that one of the untrained staff members finger-swept Millie’s mouth, which all guidelines and all paediatric first aid courses state is the wrong thing to do. The treatment for a choking baby, as outlined on the NHS Choices website, is as follows:

“A baby who is choking will be distressed and may be unable to cry, cough or breathe.

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Lie the baby face down along your forearm or thigh, with their head low. Support their head.

Give up to five firm slaps to the baby’s back between the shoulder blades with the heel of your hand. (The heel is between the palm of your hand and your wrist.)

Stop after each slap to check if the blockage has cleared. Look inside the baby’s mouth and remove any obvious blockage. Do not poke your fingers into the baby’s mouth unless you can see and reach the blockage. You may push it further in.

If the airway is still blocked, give up to five chest thrusts.

Stop after each thrust to check if the blockage has cleared.

If the baby’s airway is still blocked after three cycles of back slaps and chest thrusts, you should: dial 999 for an ambulance immediately. Do not leave the baby—take him or her with you to the phone; continue with the cycles of back slaps and chest thrusts until help arrives.

In babies under one year old”—

remember that Millie was under one year old—

“chest thrusts are used in an emergency to clear a blockage from their airway. Important: do not use abdominal thrusts with babies under one year old.

Lie the baby along your forearm on their back, with their head low. Support their back and head.

Give up to five chest thrusts. Using two fingers, push inwards and upwards (towards the head) against the baby’s breastbone, one finger’s breadth below the nipple line.

Check if the blockage has cleared after each thrust, by looking inside the baby’s mouth and removing any obvious blockage.”

Again,

“Do not poke your fingers into the baby’s mouth unless you can see and reach the blockage as you may push it further in.”

This is standard choking advice and every paediatric first aid course teaches these guidelines, which means that the staff involved that day should have given a statement as I just stated it.

Alistair Burt (North East Bedfordshire) (Con): We are all moved by the hon. Gentleman’s description of what has happened, and impressed that he has put on the record exactly what should be done. I am the grandfather of a seven-year-old child, and we all go through these agonies about what we would do. Has he made any estimate of the amount of time and difficulty there would be in incorporating this work in a straightforward, standard course for paediatric care workers, so that we can see just how little time would need to be spent to make sure that all those working in nurseries have that sort of information available to them, and have practice doing what he has stated needs to be done, should there be a choking incident involving a baby?

Mark Hunter: I welcome the right hon. Gentleman’s intervention. The Millie’s Trust campaign has done an awful lot of work in this regard and is satisfied, I think, as most hon. Members who have considered the issue would be, that this can be done at no great cost. We hope that the Minister will make it clear that the Government are serious about their intention to address the subject. As other hon. Members have already said, with the benefit of hindsight, there is a loophole in the regulation that needs to be addressed urgently.

Ann Coffey (Stockport) (Lab): I congratulate the hon. Gentleman on securing this very important debate and congratulate Millie’s Trust on its campaigning work

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on this issue. Was any member of staff on the premises that day trained in paediatric first aid? If there was, what happened?

Mark Hunter: Yes, there was. I mentioned just a few moments ago that, of the two paediatric first-aiders who were at the school at the time, one chose not to be involved, by going to look after the other children in the nursery, while the second member of staff with a qualification did carry out the back slaps, but then left the baby and went via the nursery grounds on to the main road to wait for the ambulance to arrive. So the child was actually left without the continual support of somebody qualified in paediatric first aid, which of course the guidelines clearly stipulate.

Ann Coffey: Would not the member of staff trained in paediatric first aid have appreciated the seriousness of the situation?

Mark Hunter: The only answer I can give is that one would like to think so. I think any parent would have assumed that to be the case. However, I will come on to that and to what the coroner said in this regard as well.

Andrew Bingham (High Peak) (Con): I commend my hon. Friend for bringing this debate to the Chamber. It is a truly tragic story. Does he agree that, although this is always a serious issue, as more couples go back to work and ever more people are using child care, the gravity of this situation increases? One child lost is one too many, but with more people using child care they require more reassurance.

Mark Hunter: I could not agree more. That is one reason why it is long overdue for the Government to take this issue seriously and why they should make provision for a change in the regulations that will require this to happen in future. Hon. Members will be shocked to hear that in some respects the capacity of the regulations to help in a situation such as this has, in my view, been reduced; they have been weakened rather than strengthened. I am sure that that is the result of the law of unintended consequences, but that is what has happened and it will be a cause of great concern to all of us.

Dr Liam Fox (North Somerset) (Con): I was a divisional surgeon with St John Ambulance and I also lectured in emergency medicine. The hon. Gentleman makes a good, specific case about what happens in nurseries, but very many more people are parents than nursery workers. Does it not seem absurd that, at the beginning of the 21st century, we spend so much money both on the National Health Service and on education, yet future parents can go through both systems without ever learning some of the most basic life-saving skills, which are readily available—they would not dream of not teaching their children to swim—but are not taught nearly widely enough in our society?

Mark Hunter: The right hon. Gentleman makes a pertinent point. In fact, Millie’s Trust—the legacy set up in the child’s memory—provides paediatric first aid training free of charge to interested parents. As hon. Members can imagine, a great number of interested parents have been stepping up, wanting to take advantage of that. The training courses are also provided at cost to

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commercial organisations, such as nurseries. Again, as hon. Members can imagine, as a consequence of this case and other tragic cases there has been a great deal of interest in that. However, it is pertinent to say that parents themselves might also want to make themselves aware of the correct practices and procedures, should such unfortunate circumstances come about.

Andrew Stephenson (Pendle) (Con): I congratulate my hon. Friend on securing this important debate, and congratulate Millie’s Trust on highlighting awareness of this issue. I met a member of the family at Little Blossoms nursery in Barrowford in my constituency at a fund-raiser for Millie’s Trust. I echo what my right hon. Friend the Member for North Somerset (Dr Fox) has said. When I was talking to people and raising money for Millie’s Trust, it was providing people with the free pocket face shields that can be put on a key ring. Those of us who are qualified and trained in delivering CPR always have a face shield on us in case we come across a choking incident that has developed into something where CPR needs to be given.

Sir Bob Russell (Colchester) (LD) rose—

Mark Hunter: I give way to the chair of the all-party group on first aid.

Sir Bob Russell: I am grateful to my hon. Friend for securing this debate and for the manner in which he has spoken. I follow on from the previous two interventions. Sadly, I am a parent who has walked this way, albeit at a different age and in different circumstances. We need to reinforce the need for first aid right across society. In each occupation and discipline, account needs to be taken of the specialist medical needs. First aid in schools, which I have been banging on about ever since I became a Member of Parliament, needs to be brought in, but the specialist needs of occupations need to be bolted on to that.

Mark Hunter: My hon. Friend’s contribution was, as ever, clear and concise. It gave a clear indication of his experience personally and as the chair of the all-party group on first aid.

To move on for a moment to the current guidelines, the Department for Education published its new statutory framework for the early years foundation stage in March. It became effective in September. Paragraph 3.25 of section 3, which is on the safeguarding and welfare requirements of early years providers, states:

“At least one person who has a current paediatric first aid certificate must be on the premises and available at all times when children are present, and must accompany children on outings. Childminders, and any assistant who might be in sole charge of the children for any period of time, must hold a current paediatric first aid certificate. Paediatric first aid training must be relevant for workers caring for young children and where relevant, babies. Providers should take into account the number of children, staff and layout of premises to ensure that a paediatric first aider is able to respond to emergencies quickly.”

What the Thompsons, Millie’s Trust supporters, I and countless other Members are asking is: why stop at one person? Does that not leave a nursery open to the possibility of another such tragedy? What happens if the first-aider is off ill, called away or panics?

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Mr Marcus Jones (Nuneaton) (Con): Children’s day nurseries are places where all sorts of bugs go round. Often the level of sickness absence is a lot higher than in other places of work. Is it not right, therefore, that more people are trained so that if paediatric first-aiders are absent because of sickness, someone else can take up the reins?

Mark Hunter: That is indeed the case I am advocating, so I can only agree with the hon. Gentleman’s comment. If the trained first-aider is off ill or has been called away urgently or even, dare I say, panics when presented with a choking child, who is able, under the current guidelines, to step in and provide the assistance that could save a child’s life? Furthermore, I am concerned that the Department is heading in the wrong direction on this issue. The new update to the framework, which came into effect in September, has placed the onus on the child care facility to decide how many staff need to be trained. It is now up to the individual organisation; there is no national regulation on that. No ratio on first-aiders to children on site has been given or suggested by the Department. That is a weaker position than we had previously, when the framework clarified that

“first aid training must be local authority approved and be relevant for workers caring for young children”.

On first aid training providers, it is my view and that of the campaign that straightforward guidelines should be in place on who can administer paediatric first aid training and to what level. Many child care providers do not realise that a nursery using a first aid training company that is not regulated must carry out its own due diligence. Would it not be best if everyone obtained a regulated first aid qualification accredited by an Ofqual-recognised awarding organisation, so that we can make it easier for parents to have confidence when placing their loved ones in the care of others?

Sarah Newton (Truro and Falmouth) (Con): The hon. Gentleman is making an important and powerful case. Does he agree that as part of that training, it is essential that people are given opportunities to practise on dummies? As we might have seen with that qualified person in the nursery, sometimes people faced with these situations, without having practised on dummies, panic.

Mark Hunter: The hon. Lady is absolutely right. She raises an issue that I hope to address in the rest of my speech. I am sure that we would all agree that parents should be able to walk into a nursery and see “Level 3 Paediatric First Aid” on a certificate and be satisfied that the nursery has followed platinum-standard guidelines. I will move on to why that is particularly relevant, as a couple of Members mentioned earlier.

Kevin Brennan (Cardiff West) (Lab): A few moments ago, the hon. Gentleman said that the current guidelines had in effect watered down the previous position. Has he been able to ascertain from Ministers before the debate why that is the case? What is the thinking behind that dilution of the position when this terrible tragedy occurred?

Mark Hunter: The short answer to the hon. Gentleman’s question is no, we have not been able to ascertain that, but I hope the Minister will address that in his response.

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Mr Sheerman: The hon. Gentleman is absolutely right about regulation, but regulation will not do everything—it never will. What I discern in the tragic circumstances of Millie’s death is panic. I believe that people were running around and did not know what to do. I am sure that Millie’s parents, being so passionate, have already thought of this, but what we need are not Baker days, but Millie’s days, where every three months there is training for all the staff. That training will trickle down fast if the culture is changed, and then there will not be the panic that we saw.

Mark Hunter: The hon. Gentleman is absolutely right. He was one of the Members who referred to the rising number of children in nursery schools, which is why this debate is particularly pertinent and topical. More and more people are looking to avail themselves of the opportunity to place their children in nurseries. The Department for Education’s child care and early years providers survey in 2013, which was published in September, revealed that the number of registered places in full day care settings rose by 10% between 2011 and 2013. Due to the introduction of funded provision for disadvantaged two-years-olds, there was a whacking 72% increase between 2011 and 2013 in the number of two-year-olds attending sessional settings in the 30% most deprived areas. This debate is on a huge issue that potentially affects an awful lot of people.

As demand increases, supply rises to meet that demand. As new nursery places are provided, we have a duty to ensure that all children are safe and that all staff are well trained. None of us here will need reminding that children younger than one are extremely vulnerable and need constant care and attention. In the rush for nursery places and with the subsequent waiting lists, I firmly believe that parents are making an assumption that all nursery staff are adequately trained in how to provide the appropriate paediatric first aid, but we now know that that is sadly not always the case.

As an aside, hon. Members may be interested to know that I recently inquired about the provision of training here in Westminster, at Parliament’s nursery. The answer is that all relevant staff are trained in paediatric first aid. If it is good enough for the children of Members and House staff, it ought to be good enough for every child attending nursery anywhere in the country.

Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op): I am extremely grateful to the hon. Gentleman for securing the debate. As is evidenced by the attendance today, the campaign has generated huge interest—particularly, for understandable reasons, in Greater Manchester. I was aware of the case, but not of the policy background, which the hon. Gentleman has described. I simply want to indicate my support for the campaign and for the hon. Gentleman’s speech.

Mark Hunter: I thank the hon. Gentleman for his intervention. I am sure that everyone involved in the Millie’s Trust campaign will be heartened by the interest shown by hon. Members from right across the House, including the hon. Gentleman.

During the inquest into Millie Thompson’s death in December 2013, the coroner, John Pollard, said:

“It is of national importance that the legislation surrounding nurseries regarding paediatric first aid is reviewed.”

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He also recommended that the North West Ambulance Service review some of its policies, including what paediatric equipment each ambulance should carry. I am pleased to report that, since the inquest, it has successfully carried out that review. The coroner has said that the issue is of national importance and called for the policies around paediatric first aid treatment in nurseries to be reviewed, so I hope that the Minister will take that on board.

The North West Ambulance Service has gone further by introducing a minimum requirement list of paediatric equipment that every ambulance must now carry. The service’s urgent review and subsequent changes have ensured that any errors made in how it reacted to the 999 call regarding Millie Thompson will not be repeated. It has taken seriously what the coroner advised, and Millie’s death has had a positive outcome that will help other children in future. We acknowledge that the Department for Education deals with a wider remit than that of the North West Ambulance Service, but it is disappointing that we have seen action from the ambulance service on the coroner’s recommendations, but none as yet—although we live in hope—from the Government.

Following Millie’s tragic passing, the Thompsons decided to set up a charity to provide paediatric first aid training to anyone who wants to learn. They have successfully built what is now a national charity in just two years. It provides free training to parents and hugely discounted qualifications to anyone who needs paediatric first aid training, which is what Ofsted requests. Over the past two years, the charity has trained about 7,000 people, many of whom are nursery nurses. Millie’s Trust is a registered centre through Qualsafe, which is an Ofqual-recognised awarding body organisation.

Sir Bob Russell: I am grateful to my hon. Friend for allowing me to speak for a second time and for making that point. Millie’s Trust is a bona fide, regulated, registered charity. Did the coroner make any comment about the training competence of whoever trained the first aiders? I was alarmed when my hon. Friend said earlier that unregulated people may be out there providing first aid training; they may not be competent to do the job that they tell people they are able to do.

Mark Hunter: The coroner made a wide-ranging series of points in his response. I do not have his report to hand, but I am happy to ensure that my hon. Friend, as the chair of the all-party parliamentary group on first aid, gets to see a copy. It is fair to say that the coroner addressed the wider concerns and the relevance to any future measures that may need to be taken.

Sir Alan Meale (Mansfield) (Lab): I am grateful to the hon. Gentleman for securing the debate. Like the hon. Member for Colchester (Sir Bob Russell), I sadly lost a young member of my family in my earlier life, so I know what the experience is like.

I want to stress that the issue is not limited to England. People in Ireland are currently trying to get a Bill through that would do exactly what the hon. Gentleman is supporting here today. We must ensure, because of how we deal with education and health matters in this great nation of ours, that the same recommendations are made in Wales, Northern Ireland and Scotland.

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Mark Hunter: I thank the hon. Gentleman for his contribution. He is quite right. As I progress through my speech, I will be discussing the experience in Ireland and elsewhere. The Irish Government are indeed making moves towards ensuring that such regulations are in place. That is credit to the Thompsons, who, at the request of the Irish Government, have had two or three meetings with officials over there to see how that might best be done.

Millie’s parents have taken it upon themselves to use the success of the charity, combined with the recommendations of Mr Pollard, to start an awareness campaign about the current legislation. I turn to what the Thompsons and their campaign seek to achieve. The first thing to say is that they do not stand alone. Thousands of people from my Cheadle constituency, from Stockport, from Greater Manchester and from all around the UK have rallied to their side to sign their e-petition, which now has more than 102,000 signatures. For the benefit of hon. Members, I shall read out the petition:

“Following the death of Millie Thompson and the coroner’s suggestion in December 2013 that ALL nursery nurses should be trained, Millie’s parents are now campaigning to have it made law that everyone working in a nursery MUST be trained in Paediatric First Aid.

Please support and sign this petition in memory of Millie and for the future safety of your children.”

The campaign’s objectives are simple and straightforward, and I do not think that anyone here would demur from the idea that such important issues need addressing now.

Regarding the awareness campaign, it has become extremely apparent to Millie’s Trust that the majority of people, including parents and child care workers, do not know about the current legislation—just as Millie’s parents did not know about it until this tragedy struck them. Most parents presume that when they put their child in the care of a nursery, they are in the safest possible place. In fact, if disaster strikes in a situation such as Millie’s, the reality is that many staff would not know how to help a child who was choking, struggling to breathe or needing CPR. Is that really protecting our children as they should be protected? Is that really what parents should expect when they leave a child in someone’s care, often when paying high costs for the privilege?

Health and safety is up to date in every other aspect in the UK, so why has the simplest safety for children been forgotten about? Why has the legislation been allowed to fall so far behind modern times? If legislation was not there to be changed, we would still be placing children in cars without child seats and we would not be wearing seatbelts. It is time that this legislation was brought into the 21st century.

In June, the Thompsons and I met the Minister then responsible for this area, the Under-Secretary of State for Education, my hon. Friend for Crewe and Nantwich (Mr Timpson). We had a helpful meeting. The Minister listened to the Thompsons’ case and told us about the new requirements in the statutory framework that came into force in September. The Thompsons and I want the requirements to go further and we look forward to meeting the Minister who will reply today at the conclusion of the debate. I should report to hon. Members that the Minister has indicated his willingness so to do.

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I am struggling to understand the reticence about moving to a requirement for all nursery staff to be trained in paediatric first aid. Under the Thompsons, Millie’s Trust has been a revelation, providing paediatric first aid training as cheaply as possible and making it available to people whatever their financial situation. The Thompsons do not want any other parent to go through the tragedy that befell them. I sincerely hope that I will not do them a disservice by saying that if they can set up a charity and begin providing the necessary training to thousands so rapidly, why can the Government not do the same, or at least make it a legal requirement?

In England, there is no mandatory requirement for anyone on a child care course to achieve a qualification in a paediatric first aid course, whether a national vocational qualification or an award from the Council for Awards in Care, Health and Education. In the National Nursery Examination Board course that child carers took during the 1990s, first aid was a requirement. When the course became an NVQ or a CACHE award, that requirement was taken out. Will the Minister address that concern as well? At the meeting with the then Minister, my hon. Friend the Member for Crewe and Nantwich, the Thompsons asked him who made the decision to remove the first aid part of the course and why—a fairly simple and straightforward question. The Minister could not give an answer off the top of his head, and Mr and Mrs Thompson were told that his Department would research the matter and contact them with the findings. It saddens me to report that some six months later they are still waiting for an answer to that simple and straightforward question.

We are not asking the Government to fund the courses for nursery establishments. The majority of nurseries are private and are run as a business, for profit. We simply want the regulations changed to make it clear that, as a business, nurseries have to build paediatric first aid training for their staff into their annual business costs.

I want to touch briefly on precedents elsewhere. For example, in Australia the legislation includes regulation 136(3):

“The approved provider of a family day care service must ensure that each family day care educator and family day care educator assistant engaged by or registered with the service—

(a) holds a current approved first aid qualification; and

(b) has undertaken current approved anaphylaxis management training; and

(c) has undertaken current approved emergency asthma management training.”

Each family day care educator and educator assistant must hold all three qualifications.

Mr Sheerman: Does that cover childminders?

Mark Hunter: The hon. Gentleman asks his question from a sedentary position, but I believe so.

Mr Sheerman: I am sorry. A lot of children in this country are with childminders in small groups.

Mark Hunter: I am sure that we can check that out afterwards. I am happy to get back to the hon. Gentleman on that.

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In Minnesota, in the United States, in June 2010 at a child care centre a young girl called Hannah Kozita, aged only four, passed away after choking on a grape. Within a year, the state had seen fit to pass what is commonly referred to as Hannah’s law. One year after that tragedy, therefore, that particular state had introduced a new law including a new requirement from May 2011 for all teachers and assistant teachers in child care centres to have CPR training, including, specifically, CPR for children and infants. The law also required at least one trained staff member to be present whenever a child was on a school trip, and for training to be completed within 90 days of the law being passed. What is good enough for Minnesota, ought to be good enough for us in the UK.

The hon. Member for Mansfield (Sir Alan Meale) referred earlier to circumstances in Ireland. The Thompsons have been warmly received in the Republic of Ireland. They have made a number of visits there, at the request of the Irish Government, to talk about what ought to be done. Earlier this month, Millie’s Trust was invited to Ireland by Denis Naughten, TD, the Member for the Roscommon, South Leitrim constituency, following an earlier visit to Ireland in April. During their most recent visit, the Thompsons received vital support from Senator Jillian van Turnhout, who is also a successful children’s rights activist.

Mr and Mrs Thompson presented to TDs and Senators in Leinster house in Dublin to make them aware of the state of existing legislation. The Thompsons met with an extremely positive reaction. The TDs and Senators even received a mini-training session, which they all accepted was valuable knowledge, despite the small amount of time available. Following the presentation, a meeting was set up with Ireland’s Minister for Children, Dr James Reilly. I am pleased to report that the outcome of that meeting was also extremely positive. Dr Reilly was surprised to hear how Millie had received only “a few back slaps”. He went on to offer his own experience of watching a valuable member of his staff freezing when having to deal with working with a child in an injection scenario, even though she was extremely competent when dealing with adults. That goes back to the point made earlier by my hon. Friend the Member for Truro and Falmouth (Sarah Newton) about the understandable reaction of some to panic in such distressing circumstances.

Dr Reilly’s Department has since been in touch with Denis Naughten, TD, to ask Millie’s Trust to provide research information on legislation in other countries to see how it was worded when the law was updated. That Department has no problem with encompassing what Millie’s Trust is seeking to have done. That is extremely positive support as a consequence of the awareness that Millie’s Trust has created not only in the UK, but further afield.

In conclusion, I will revisit one or two key aspects of what I have said. The passing of Millie Thompson in a local nursery school was a tragic accident. The circumstances, choking, can happen to any infant at any mealtime in any child care provider or nursery school within the UK, or even at home. We can do nothing about such instances, but we can ensure that those responsible for responding are as well trained as possible.

The requirement for only one member of staff to be trained in paediatric first aid is simply not sufficient; it does not allow for illness, for large numbers of children

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or for the trained member of staff panicking when faced with a genuine emergency. My contention and that of the Thompsons and everyone behind Millie’s Trust is that the majority of parents assume that most pre-school staff will have paediatric first aid training. The best response to that mistake is to ensure that all staff are adequately trained.

The number of children in nursery schools is going up. We must ensure that they are all safe, not only the ones who go to the most diligent child care providers. More than 100,000 people have signed the Thompsons’ e-petition calling for the Government to introduce universal paediatric first aid training. Parents throughout the country want to see that change implemented. In Australia, in the state of Minnesota and, as looks increasingly likely, in the Republic of Ireland, the requirement for nursery staff to have paediatric first aid training is being implemented easily and straightforwardly. The UK must follow suit.

The last line of the Thompsons’ e-petition reads:

“Please support and sign this petition in memory of Millie and for the future safety of your children.”

That last part sums up our hope for the campaign in the future. It is not about concerns to do with new red tape, additional bureaucracy or even cost; it is about the future safety of all UK children, and it is about doing our utmost to ensure that a tragedy such as Millie’s death is never, I hope, repeated.

5.20 pm

Sir Bob Russell (Colchester) (LD): I will be brief, because my hon. Friend the Member for Cheadle (Mark Hunter) has presented his case comprehensively; the interventions he took and his responses to them have dealt with virtually every aspect of the debate.

I will address the wider need for first aid. I was shocked to hear that the element of first aid required under the previous regulations for child care was withdrawn. We need an explanation of why, bearing in mind that many of us have been pushing for first aid to be made part of the national curriculum. I brought forward a Bill in the previous Parliament on that issue, and have raised it at regular intervals at Education questions; most recently, I raised it with the Secretary of State for Health when he made a statement on greater investment in the NHS a few weeks ago. A population trained in first aid would bring massive financial savings, and would save several thousand lives a year—think of those in need of attention after a heart attack or a road crash.

Today’s debate is specifically about young children and infants. We have heard a catalogue of things that went wrong. I pay tribute to Millie’s parents for the diligent way in which they have turned a personal tragedy into a hope that we can take things forward, so that no other parents—or grandparents, uncles, aunts or family friends—will experience such a tragedy in the future.

I repeat the point I made in an intervention: if we start with five-year-olds knowing about nose bleeds—both theirs and other people’s—by the time they leave school, they will be trained in life-saving techniques for the rest of their lives. On top of that, we then need to bolt on, occupation by occupation, the specific first aid requirements that each profession needs. Clearly we do not need to

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train someone in a car factory on how to deal with an infant who is choking, but a person working in a nursery needs to know all about dealing with whatever calamity might occur to a young person there.

One point my hon. Friend mentioned has caused me great concern. Until today I had simply assumed that people who taught first aid were qualified up to a required standard, meaning that they were registered and regulated to give first aid and first aid training. We know that St John Ambulance and the Red Cross are qualified first aid organisations, but I am aware of other organisations, companies, groups of friends or whoever, who come together to provide first aid cover at events at a much lower rate than those two charities. I do not know how qualified those people are.

That is a serious issue that the Government need to look at and investigate. Who is providing first aid at events and how qualified are those first-aiders? That is why I asked my hon. Friend whether the coroner had made any comment about who trained the two members of staff at the nursery who, on the day in question, fell short of what was required. I do not know this, but it may well be that they had not been fully trained by qualified trainers. That is a huge area that the Government need to look at, although it is probably more an issue for the Department of Health than for the Department for Education.

I congratulate my hon. Friend on securing this very moving debate. I thank hon. Members who have intervened. Specific thanks must go to Millie’s parents, who have devoted many months now to a campaign that has come quite quickly into the Houses of Parliament. We owe it to them to take the matter forward.

5.24 pm

Richard Graham (Gloucester) (Con): I pay tribute to my hon. Friend the Member for Cheadle (Mark Hunter)—not just for securing the debate, but for his calm and measured argument.

This debate marks yet another milestone in democracy. A while back, the tragic death of a nine-month-old child would not have led to a giant petition, signed by over 100,000 people, being considered by Parliament, with the chance perhaps to change the law. Although that would not have happened but for changes in parliamentary procedure, it is above all the result of the remarkable reaction and leadership shown by Millie’s parents, the Thompsons. Joanne is motivated by the purest motive that any of us parents could hope for—to make something positive out of profound tragedy, and light a candle in the darkness.

Although many of us can think of other recent examples of constituents campaigning successfully on issues dear to their hearts, today’s starting point must be to recognise both the very sad circumstances of Millie’s death and the positive reaction of Joanne and her husband afterwards in founding their charity. The heart of today’s debate is whether it should be mandatory in law for everyone working at nurseries to be given paediatric first aid training, or whether the law should stay where it was when the Childcare Act 2006 was brought in, under which it is mandatory that someone on the premises is trained, but not everyone.

My hon. Friend the Member for Colchester (Sir Bob Russell) made a case for first aid training for every individual in the United Kingdom. He has a point: it is

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right that we should all go on a course. It is one of the best things I have ever done—I did so fairly recently, and no doubt far too late in life. However, that does not necessarily mean that to do so should be mandatory, thereby having rules, regulations and punishments attached to it—that people should be fined or there should be some other punishment for not going on a first aid course. I am not sure that today is the moment for a discussion of whether we should legislate that everybody should go on a course.

Sir Bob Russell: I should point out to my hon. Friend that I was not saying that there should be first aid training for every person, but that it should be part of the school curriculum. Clearly, over three generations everybody in the country would then be a trained first aider; others could—this is the example he has set himself—go voluntarily for training. However, if parents are entrusting their children to a nursery, it should be mandatory for the staff to have specific training for the needs of the role that they may be called upon to perform.

Richard Graham: My hon. Friend is right to differentiate between the two. The point I was going to make was that the fact that I went on a first aid course about two years ago does not necessarily make me that competent to attend to someone in a life-or-death situation today, let alone at some point in the future. Although it is a great idea that everybody at school should learn first aid, again, that will not necessarily make them competent to act in a life-or-death situation. As other hon. Members pointed out, the stress of that situation, the possibility of panic and the absence of recent and up-to-date experience of handling dummies and so on, will be crucial.

That brings me to the key points raised by my hon. Friend the Member for Cheadle. He rightly touched on the fact that the number of children in child care is rising and on the need for care for the most vulnerable—this point will be especially relevant to the Minister, whose son cannot be much older than Millie was at the time of her death in 2012. The case that has been made today for mandatory paediatric first aid training for everybody working in child care is therefore a powerful one. The coroner concluded that, first, the ambulance service should carry paediatric equipment for such a situation and, secondly, that there should be a national review.

Joanne and her campaign for Millie’s Trust have already achieved the first objective, which other ambulance services around the country may want to consider. I shall certainly write to my own ambulance service in Gloucester. The second objective is open for the Minister’s response, and I hope he will bear in mind the already remarkable achievement of the trust in having trained several thousand teachers for free. This is a fantastic objective, and the number of teachers who have already been trained is fantastic.

I do not know the precise cost of ensuring that every person in every nursery is trained, and I hope that it would not increase the cost of the child care provided to so many of our constituents around the country. I hope that it will be absorbed by the nursery as a necessary part of providing that trust in child care that all of us who are parents would expect.

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Today’s debate is an important step in recognising what an individual has done on behalf of her own child and her own family situation, but it has much wider applicability across the land to all of us who are parents and to everyone who puts their children, with trust, into a nursery school. My hon. Friend the Member for Cheadle made a strong case that is the stronger for having been measured and reasonable. I hope that the Minister—a reasonable man and a young father to boot—will be able to give us some reassurance about the national review as quickly as possible. I suspect that all of us here today hope that that review will lead to mandatory provision of paediatric first aid.

5.31 pm

Kevin Brennan (Cardiff West) (Lab): It is a pleasure, Mr Chope, to serve under your chairmanship. I am grateful for the opportunity to speak on behalf of Her Majesty’s Opposition in this debate, but I do not intend to speak at great length. There may be an interruption to our proceedings, and we want to hear the Minister’s response.

I commend the hon. Member for Cheadle (Mark Hunter) who introduced the debate in a calm and measured way. He told us about Millie Thompson and the tragic circumstances of her death, and outlined the aims of the subsequent campaign that her parents instigated. He said that despite that, the Government may have watered down some of the regulations since that campaign started. Before the conclusion of this debate, we need to hear whether that is the case and, if so, why. I commend the hon. Member for Cheadle on leading this debate in such a measured, calm, careful and considered way.

I thank the hon. Member for Colchester (Sir Bob Russell), who told us that he has had tragedy in his own family and therefore brings his own experience to the debate. My hon. Friend the Member for Mansfield (Sir Alan Meale) is no longer in his place, but he intervened earlier. I commend other hon. Members who have contributed, including the hon. Member for Gloucester (Richard Graham) who made a short speech emphasising that the hon. Member for Cheadle had made a strong case.

I am grateful for the opportunity to speak in the debate, and many others will be grateful that it is happening because more than 100,000 members of the public signed the petition that Millie Thompson’s parents started. It is absolutely right to take this opportunity to join in the tributes from other hon. Members to the tireless campaigning work undertaken by Joanne and Dan Thompson over the past two years since the tragic death of their nine-month-old daughter, Millie. Following their horrific loss, they have worked immensely hard to try to create something positive, launching Millie’s Trust last year to campaign for every nursery carer to be trained in paediatric first aid, and to provide courses to increase the number of nursery staff with first aid training. We should commend them on the practical training they have provided by setting up that trust.

The remarkable number of signatories that the parents’ petition has attracted demonstrates clearly that they have struck a chord with the public, and it is absolutely right that we consider carefully whether the current requirement for first aid training in nurseries is appropriate.

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What happened to Millie’s parents is something that every parent dreads: the sudden death of a perfectly healthy child whom they had dropped off at nursery on another ordinary working day. All of us who are parents can empathise with their sorrow and desire to understand what happened and why it happened to their daughter, but no one who has not experienced what they experienced can possibly understand the pain that they carry with them every day.

As we heard, Millie died after choking on mashed shepherd’s pie during her third day attending a nursery in Cheadle Hulme in October 2013. It is important to note, as hon. Members have done, what the coroner said about the case. He was concerned enough by what he heard during the inquest to raise serious questions about whether regulations on first aid training for nursery staff were set at the right level, and furthermore took the unusual step of announcing publicly that he would be writing to the then Secretary of State for Education, the right hon. Member for Surrey Heath (Michael Gove), to urge a move to first aid training for all nursery staff. The coroner described that

“as a matter of national importance”.

The hon. Member for Cheadle highlighted that.

The paediatric first aid certificate of the member of the nursery staff immediately to hand when Millie began choking had expired. Recognising the seriousness of the situation, they called for help from the staff member on duty with up-to-date training. Technically, the nursery was at that time, fulfilling its duty to ensure that at least one staff member trained in first aid was on duty. After looking at the circumstances of the case, the coroner’s verdict was death by misadventure, and the question arose of whether having that single member of staff available—we have heard more details from the hon. Member for Cheadle about what happened—was sufficient. As has been asked, what would happen if they were elsewhere in the building or engaged in a task that it would be dangerous for them to abandon immediately with other children in the nursery’s care? In serious medical situations involving the youngest children, any delay can mean the difference between life and death. We can genuinely understand the coroner’s concern regarding the regulations on first aid training and why he was moved to take the action that he did in writing to the Secretary of State.

Opposition Members and, I am sure, all hon. Members, are firm believers in securing high quality, affordable, flexible child care. We believe that at the heart of that mission is a continual drive to improve the standards and standing of child care staff. We are fortunate, as a nation, to have many highly-skilled, dedicated and hard-working people working on the front line in nurseries, children’s centres and as childminders. There is a real desire among the best practitioners for improved training, including ongoing retraining throughout an individual’s career in child care. They know that that route will lead to better care for children, as well as eventually improving pay and conditions for child care staff. As we move towards a child care sector where higher standards of training and professional development become the norm, improving the standard and quantity of staff trained in paediatric first aid must be at the heart of that.

The Minister may tell us that immediately to demand that every staff member must be fully trained would bring difficulties for the sector—it will be interesting to

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hear his response—but it is certainly right that that should be the goal. In larger child care settings in particular the requirement for a single first aid-trained staff member may not be sufficient. Rising professional standards in the child care sector ought to pave the way for parents and regulators to expect more in terms of the skills and training of staff. In this particular case, tougher regulations may not have made a difference, but the tireless work of Millie’s parents since her death has opened a serious and vital debate about whether the regulations that we have now are sufficient.

Everyone here today wants to do everything possible to prevent further tragedies of the sort that Joanne and Dan Thompson have suffered. To help us judge what is being done, we need to hear the Minister’s answers to a number of different points. Will he tell us what the previous Secretary of State’s response was to the coroner’s letter following the inquest and in what terms he responded to the coroner? I am sure the House would be very interested to know how he responded to that call from the coroner.

I have the Government’s response to the e-petition here, and it is quite brief and light in detail—I know that is often the case in the way that such things are set out. However, I and the rest of the House would be grateful if the Minister could tell us whether there is any kind of ongoing review of the suitability of required levels of paediatric first aid training in child care settings, and if so, what form that review is taking.

The Minister’s colleague, the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson), met Millie’s parents back in June. Further to what the hon. Member for Cheadle said, will this Minister tell us more about what actions arose as a result of that meeting? What follow-up actions were taken by the Department after that meeting? What were the new requirements that, as the hon. Gentleman mentioned, had been explained to the parents during the course of that meeting, and in particular, why have they not received an answer, as he reported, about who made the decision to remove the first aid requirements? If the Minister is not able to provide that answer directly to us here and now, will he commit on record today to providing it to the House in the very near future by writing to those Members present and to the Thompsons, and will he place a copy of that response in the House of Commons Library, so that it is available for all to see?

We would all like to know why, as the hon. Gentleman indicated, there has apparently been a watering-down of the regulations in this area since this terrible tragedy occurred. Does the Minister accept that that is the case? If not, will he explain why he does not accept that what has happened since constitutes a watering-down, and if he does accept that the regulations have been watered down since these tragic events, will he explain to the House why that has happened? What is the thinking behind it and what is he going to do about it, in the light of the strength of feeling that has been expressed across the House today and given the campaign that the Thompsons have launched and the e-petition with more than 100,000 signatures that has prompted today’s debate? I look forward very much to hearing the answers to those questions and to the issues raised by other hon. and right hon. Members during the course of this debate.

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5.44 pm

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

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

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

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

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

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

is “available at all times” and

“able to respond to emergencies quickly.”

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

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

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

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

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

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

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

The hon. Member for Cheadle mentioned the House of Commons nursery, which advertises that all its staff have first aid certificates. In fact, many nurseries continue to do that as a point of differentiation between them and other nurseries, so I would say that the strengthening

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of the EYFS is having an effect on the market. We are putting lots of other things in place to strengthen that even further.

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

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

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

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

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

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

Mr Gyimah: I thank the hon. Gentleman for that intervention. He used Ireland as an example in his speech and, in the light of the intervention that he has

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made, I will refer to the Irish example. The Irish are actually moving towards the framework that we have in this country with the early years foundation stage. In response to a parliamentary question, they have said explicitly:

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

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

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

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

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

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

[Mr Graham Brady in the Chair]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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intimately familiar with, mean that all early years educators will understand how to respond to accidents and emergency situations.

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

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

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

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

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

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

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

6.10 pm

Mark Hunter: Yes, I would like to take the opportunity of summing up. To be candid, I find the Minister’s response a little disappointing. There seemed to me to be a fairly clear consensus—not only among the

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hon. Members who spoke, but also in the sources of information from which many of us quoted—that there is a need for something to be done.

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

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

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

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

Question put and agreed to.

Resolved,

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

6.13 pm

Sitting adjourned.