Tuesday 26 April 2016
[Sir Alan Meale in the Chair]
Fixed Odds Betting Terminals
I beg to move,
That this House has considered fixed-odds betting terminals.
Fixed odds betting terminals are a big issue, and a big crowd of hon. and right. hon Members are here to speak about them. There is a lot of concern in the House about the issue. There are probably some hon. Members here today—perhaps not so many—who will not be speaking with the same level of concern as me, but Opposition Members intend to take the issue further in their speeches today.
Fixed odds betting terminals are touch-screen roulette machines found in betting shops across the whole United Kingdom. Gamblers can play casino-style games with a maximum stake of £100, which can be wagered every 20 seconds. That is a possible total of £300 a minute. We have more than 35,000 fixed odds betting terminals in the United Kingdom’s bookmakers. FOBTs are disproportionately found in the poorer parts of the United Kingdom and generate some £1.7 billion of revenue for bookmakers. Campaigners have labelled the machines the crack cocaine of gambling, and that is what they are. The issue is of great importance.
Bookmakers have a powerful lobby and powerful friends. They have kept arguing that we need more evidence, despite the obvious case for regulation, in order to protect their huge profits made at the expense of the vulnerable. We are here to speak for the vulnerable, for legislative change and for better protection.
The hon. Gentleman is bringing forward the debate with his characteristic compassion. Does he agree that it is a matter of social justice that we address this issue? Those affected are not just those who are addicted, but their families, and in particular their children. It is primarily for them that many of us are here today.
As always, I thank the hon. Lady for her intervention—she is an hon. Friend, too. She speaks with heart and compassion, and she speaks for me as much as everyone else here.
Our Prime Minister told Parliament more than 12 months ago that FOBTs are a serious issue, and that he would act as soon as there was more evidence. Since then, two tragic cases of suicide have been linked to the machines, and there are numerous reports of the terrible impact they are having on the most vulnerable, but the Government are yet to act. The Minister is here to respond to the debate, and we look forward to hearing the ideas that he will put forward in response to what we have to say. There is no place for £100-a-spin games on the high street in bookmakers that have little or no supervision. There is a simple answer to protect the vulnerable, as the hon. Lady said, and that is to reduce the stake.
While a lot of us have worries about what is going on in betting shops, does the hon. Gentleman agree that we do not know enough about the people who gamble at home on their phones and on the internet? There is no control over that at all, and they are being equally affected.
The hon. Gentleman is absolutely right. We have many concerns. Today’s debate is fixed primarily on the fixed odds betting terminals, but I accept that control is needed elsewhere.
The lack of regulation of FOBTs has meant that they have clustered in areas of high social deprivation. They can prey on the young and vulnerable. There is strong evidence that the high stakes on FOBTs in the low-supervision environment of a bookmaker have led to increased problem gambling. Recent Responsible Gambling Trust research on FOBTs showed that 37% of players exhibited signs of problematic gambling. At stakes of more than £13.40 a spin, that rose to 80% of players exhibiting problem gambling behaviour. One third of problem gamblers calling the national problem gambling helpline cited FOBTs as their issue. Let us be clear that the debate is about fixed odds betting terminals and the blight they cause on society.
The hon. Lady is absolutely right. There is evidence of that, and I will give examples shortly. I am sure others will, too. Whenever there is misuse and a dirty laundering system, that has to be addressed.
More than half the UK population plays the national lottery, and they lost £7.2 billion last year. That compares with the less than 4% of the population who play FOBTs, who lost £1.6 billion. The unemployed are twice as likely to play the machines as someone in work. The demographic that bookmakers target with FOBTs are also the least likely to have access to bank accounts, debit cards and credit, and thus have restricted access to remote gambling sites. Bookmakers and the gambling associations are clearly targeting those who are vulnerable to start with, but who are perhaps in some difficulties with money, too.
Bookmakers are using the cover of account-based play, which was instigated by the Government, to provide cash top-up cards that facilitate access to their online sites; the hon. Member for Alyn and Deeside (Mark Tami) mentioned such sites in his intervention. The gambling lobby says that we need more evidence, but it is clear that the evidence is out there. It is comprehensive, and it consistently lines up on the right side of the argument: we need to protect the vulnerable and enact regulation. I hope that, arising from this debate, we will have a chance to enact regulation that will filter out from this House to the whole United Kingdom, including Scotland and Northern Ireland.
FOBTs are useful for money laundering, as the hon. Member for North Down (Lady Hermon) said. The machines have a few filters, but the money launderers know them and work within the limits. Supervision is low and closed circuit television is poor, so it is a safe way to money launder. Low-level drug dealers clean cash in case they are pulled over by the police. Generally, they are younger lads with smaller amounts of cash. In one West Yorkshire case, the police uncovered £18,000 of FOBT tickets being held by one drug dealer. The machines are used for underworld criminal activities by those whose thoughts are nothing but criminal and outside the law.
Using the proceeds of crime to fund a gambling addiction, or cleaning the cash obtained from a crime, is common. The most common use of FOBTs since they landed on the high street is for getting rid of dyed notes obtained during robberies on armoured vans, cash machines and so on. The notes are sprayed with an irremovable dye that is an immediate alert as to their origins. They are therefore not exchangeable. However, they are still identified as legitimate currency by note accepters on gaming machines. The machine with the highest cash transaction capability and ticket pay-out facility would be the preferred option for laundering, and that is the fixed odds betting terminal.
The bookies and the suppliers adapted the software controlling ticket pay-outs to identify where less than 40% of the cash put in is wagered—that is where people either put cash in a FOBT and then print a ticket straight out, or stake a minimal amount of the total cash inserted—so that staff are alerted when people cash those tickets. Launderers have adapted to that by using minimal-risk wagering. The bookies are now making it easier for criminals by allowing them to put cash winnings on to a pre-paid credit card. They are not just hiding the cash, but making it electronic. Never ever think that the criminals and evildoers have not got ideas as to how to get around the law, how to work it to their advantage and how to launder some of that dirty money.
Following on from weaknesses in money laundering policies at Ladbrokes in 2013, Paddy Power was recently the subject of a high-profile money laundering investigation. That investigation resulted in the Gambling Commission reprimanding Paddy Power and imposing a £280,000 penalty; there were also serious failures in social responsibility. The Government are considering including betting shops in the European Union’s fourth money laundering directive. That would require the identification of customers transacting over £1,500 in a 24-hour period. The bookmakers are lobbying to be excluded from that, despite recommendations that they should be included first being made in 2001 in the Budd report.
The lack of FOBT regulation is a huge issue that cannot be ignored, and I am keen to ensure that the debate highlights it. Gambling the world over has evolved into a consistent structure, with the hardest gambling reserved to highly regulated venues such as casinos, where customers go with the knowledge and expectation of experiencing a harder gambling environment. Casinos have very high levels of player supervision and therefore protection. Players tend to be occasional visitors, and the casinos tend to be viewed as a destination leisure venue with more than just gambling on offer.
The Gambling Act 1968 put in place a regulatory permit for gambling. This set out that high-stakes gambling should take place in highly regulated and highly supervised environments such as casinos, and low-supervision environments should have lower stakes and require lower levels of supervision. Those principles were reaffirmed in the Gambling Act 2005 by Sir Alan Budd. Other countries follow this model. The UK is alone in offering very-high-stakes gambling of £100 on Britain’s high streets in the low-supervision, easily accessible environment of a bookmaker. Little or no monitoring and little or no supervision means vulnerable people can be taken advantage of. The regulation of fixed odds betting terminals is out of kilter with the principles of gambling regulation. They offer very-high-stakes gambling in an unregulated environment.
The only material restriction is that bookmakers are allowed four fixed odds betting terminal machines per shop. The result of this is that bookmakers have opened multiple betting shop branches in close proximity. That is a concern. When we look at the streets of the United Kingdom of Great Britain and Northern Ireland, we sometimes wonder whether we are in a gambler’s paradise—if there is such a place—because betting shops seem to be prevalent everywhere.
The bookmaker Paddy Power has focused its branches in areas with high immigrant populations. We have seen a 43% increase nationally in the number of betting shops located in town centres.
I seek a lesser number in the shops, and fewer shops as well. We agree on many things, but we do not agree on this topic. The opinion that I express will win: ComRes did a survey of MPs seeking their opinion, and of the MPs who responded, seven out of 10 want FOBTs regulated. They want a reduction in the number of machines and shops. It was quite clear. If a private Member’s Bill is brought before the House—some in this Chamber are of a mind to do that—we can tackle the problem.
I thank the hon. Lady for that; it is one of my concluding points. I know that other Members are of the same opinion. Yes, the maximum stake should be lowered; then we could manage the issue, so that people are not deprived.
The regulation of FOBTs is out of kilter, as I have said. The only material restriction is the four machines per shop. We have seen an increase nationally in the number of betting shops in town centres, and last year the Government stepped in and imposed a £50 staking threshold on fixed odds betting terminals, above which players are required to identify themselves to staff or sign up for a loyalty card. The objective of this measure is to help players stay in control. I suggest that that has not happened. The measure is non-evidence-based and the Department for Culture, Media and Sport failed to quantify what impact it would have on players other than the £17 million reduction—1%—in bookmaker revenue from the machines. Secondary research based on the British gambling prevalence survey 2010 estimates that up to 40% of B2 revenue comes from at-risk and pathologically addicted players—higher than all other combined gambling activities—so the Government predicted very little impact. There is also evidence that bookmakers are using the player registration as a mechanism to market FOBTs further.
An evaluation of the DCMS assessment of the £50 measure so far, carried out by Landman Economics, highlighted issues with the quality of the data provided by the bookmakers; it also noted that DCMS could not assess changes in staking, mentioned the absence of a pilot scheme so that the measure could be evaluated better, and noted that the evaluation omitted key questions that it is important to consider when looking at the success or failure of the £50 regulations. For example, the question why fixed odds betting terminal machine players might wish to remain anonymous is not discussed. Despite the Government measure, players are still able to stake up to £100 per spin, and it appears that bookmakers are using the change as an opportunity to further market products to vulnerable gamblers. Even £50 is still materially out of kilter in the normal gambling world.
I congratulate the hon. Gentleman on securing this important debate. Does he agree that the issue is also about making sure that players can make a genuinely informed choice? If a sign was required to be displayed that said, “A machine of this type made on average £825 a week in profit for its owners in 2012”, would people be inclined to gamble on it? In short, it would be a bet not worth having.
Absolutely. I thank the hon. Gentleman for his wise words.
I am conscious that many people want to speak, Sir Alan. I gave you an undertaking that I would not speak for too long, but I want to set the scene, and then I will give other Members an opportunity to participate.
The Government must take urgent action to regulate fixed odds betting terminals and reduce the stake that can be gambled from £100. The hon. Member for North Ayrshire and Arran (Patricia Gibson) referred to £2; I think that many in this House would be happy with that. This is the only way effectively to tackle the growing problems that these machines are inflicting on our communities and on those who can least afford it. The Minister responsible for gambling has said that the Government want to reduce the stake for FOBTs, so let us hear what the reduction will be. A substantially lower stake would bring fixed odds betting terminals into line with machines in other low-supervision environments such as adult gaming centres and bingo halls.
The Gambling Commission has said that if staking levels were being set now, it would advise against the £100 stake on a precautionary basis. The previous Government said that a lower stake would bring adequate public protection. The Government should take this opportunity to control the gaming machines and the stakes and reduce significantly the numbers of shops and machines on the high street. The evidence is out there and is clear: the bookies are in the wrong. They are on the wrong side of the argument, and it is our job to put it right.
I want to say one quick thing in relation to Scotland, as hon. Members from Scotland are here. The Bill in Scotland gives some control to the Scottish Parliament, but if we were to bring forward a private Member’s Bill in this House to legislate for change, this debate today would be the first stage in that process. If that happens, that will filter its way out to Scotland and to Northern Ireland as well. We in this House today have the opportunity at least to start the first stage of that process. I believe that many in this House—seven out of 10 MPs—wish for that to happen.
Eleven people have put their name down to speak in this debate. The subject is popular—or, depending on your perspective, unpopular. Many people want to speak. I will have to call the Front-Bench speakers at about 10.30 am, so that means approximately four minutes each for everyone else. Since Jim started the debate, people who have put their name down to speak have been bobbing up and down. That is unfair of them, because they can make their points in their four minutes. Perhaps Members will restrict themselves. Those who have not been able to write in to put their name down to speak can intervene to make their points. I ask speakers to be fair to one another, and to restrict their contributions to four minutes or under.
I would like to endorse that, Sir Alan.
I pay tribute to the hon. Member for Strangford (Jim Shannon) for securing the debate. May I declare my registered interests? I have received hospitality from bookmakers and racing; along with your good self, Sir Alan, I am joint chairman of the all-party group on racing and bloodstock; and I have the Cheltenham racecourse in my constituency.
It is from the horse-racing point of view that I come to this debate, because bookmakers very largely finance horse-racing through the betting levy and through media rights. If we lose too many bookmakers we will lose horse-racing, there is absolutely no question about that. There are two very good racecourses in Northern Ireland, which I have visited a number of times. We also see the spectacle of the grand national, the Derby, Royal Ascot and, in my own constituency, the Cheltenham gold cup.
The hon. Gentleman is beginning to make an interesting point about the connection between the old type of bookmakers, with sports betting and horse-racing, and the prevalence of high street bookmakers, but will he accept that there is clustering? He argues that doing away with bookmakers will affect the horse-racing industry, but does he not see a line of bookmakers all next to each other one side of the road, and another line on the opposite side of the road? There is a clustering effect.
I will come to that in a moment, but I just wanted to establish where I am coming from on this issue. There is a link between bookmaking and horse-racing, and if we lose one, without doubt we will lose the other. I want that to be very clear. There are far fewer betting shops than there used to be. We hear about the proliferation of bookmaking shops, but there are something like half the number there used to be. It is important to recognise that, while certainly acknowledging the issues raised by the hon. Member for Strangford.
You have asked us to take very little time each, Sir Alan, and I am happy to comply with that. I hope that the Government will continue with their evidence-based approach. I am not convinced that there has been an increase in the number of problem gamblers. There are people with addictive natures who will be addicted to something, whether that is alcohol, drugs or gambling, but we are discussing only one form of gambling, and many other forms are available.
Any Member could use their mobile phone to empty their entire bank account into a betting account and lose all that money within a minute or two. I mention that to draw attention to whether it would be fair to place restrictions on one kind of gambling when so many other forms are available, including the national lottery. I have linked horse-racing to bookmaking, and I also want to link the national lottery to the many good causes it supports. Billions of pounds have been spent on good causes thanks to the national lottery. I have some news for Members: that money is taken not from the millions of pounds that are won but from the money that people lose on the national lottery each and every week.
I hope we can get a measure of proportion into this debate. The Government should take seriously the important points and concerns raised by the hon. Member for Strangford, but I ask them to continue with their evidence-based approach and to remember that the great sport of horse-racing depends on the actions taken by my right hon. Friend the Minister and the Government.
The hon. Gentleman is of course the Chair of the Northern Ireland Affairs Committee, of which I am very proud to be a member. He chairs us well.
The hon. Gentleman has called for an evidence-based approach to be taken before the Government do anything, and he mentioned race courses in Northern Ireland. Can he produce any shred of evidence that those who go to the horse-racing in Northern Ireland, or anywhere in the United Kingdom, are the same people who play on fixed odds betting terminals? Where is the evidence for that connection?
That is not quite the point I was making. The situation is a lot worse now, but five years ago PricewaterhouseCoopers produced a report that said that up to 95 shops in Northern Ireland, which represents around 30% of the total there, would close if fixed odds betting terminals were banned. The hon. Lady is not calling for them to be banned, but that shows the scale of the problem. Some 975 jobs would be lost, costing £18 million per annum throughout Northern Ireland. The knock-on effect for the betting industry and therefore for horse-racing would be huge, because it is the machines that tend to keep the shops going. I am sorry that I did not explain that earlier, but that is my point. Fixed odds betting terminals are far rarer in Northern Ireland, where there are fewer than two per shop, than in Great Britain, where the number is nearer to four, so I am not convinced that the problem is greater in Northern Ireland. That does not mean that there is no problem, but if there is one I do not think it is of the same scale.
Sir Alan, you have indicated to me that I should draw my remarks to a close, so I repeat to the Government: please continue to take an evidence-based approach, and please remember that the sport of horse-racing depends on bookmaking.
It is a pleasure to serve under your chairmanship, Sir Alan. I declare an interest as the newly elected chair of the all-party group on fixed odds betting terminals. I congratulate the hon. Member for Strangford (Jim Shannon) on securing the debate. I know that my hon. Friend the Member for Hyndburn (Graham Jones) was also very keen for it to take place.
Huge amounts are being lost in fixed odds betting machines by those who can least afford it. In 2014-15, gamblers lost £2 million in my constituency alone. There are 20 licensed betting shops in the area, which means that that £2 million was lost on 80 FOBTs in Swansea alone—£25,000 on each machine. As many Members will point out, there are 35,000 FOBTs located in bookmakers throughout the UK, on which gamblers can play casino-style games with a £100 maximum stake every 20 seconds—that is £300 a minute. We know that there is a link with problem gambling: four out of five FOBT gamblers exhibit problem gambling behaviour at stakes in excess of £13 a spin, compared with one in five at stakes of £2 and under.
Not only do FOBTs provide hard, high-stakes gambling on British high streets, but many bookmakers have only one member of staff on duty. Bookmakers’ shops often suffer high levels of crime and violence, and a single member of staff is expected to manage the premises, supervise the gambling, memorise scores of faces to enforce a self-exclusion scheme, and carry on their other duties. It is ludicrous.
Does the hon. Lady agree that the difference between where gambling was 15 years ago and where it is now is that there used to be a pause for reflection between, for example, greyhound races and horse races? Gamblers would think about whether they were going to continue to spend their money. With fixed odds betting terminals, there is no pause for reflection, which tends to be where problem gambling comes in.
FOBTs have been called the “crack cocaine of gambling”, and what the hon. Gentleman says reinforces that idea. Betting shop staff are not in a position to intervene when punters, as they like to be called, exhibit signs of problem gambling. They have no training to deal with it. Every year, 7,000 FOBTs are smashed up by irate customers and there are 10,000 calls to the police, despite the fact that bookmakers discourage staff from reporting such crimes.
As was mentioned earlier, FOBTs are used for money laundering. I recently asked the Treasury to look into the problem. The machines have few filters and the money launderers know how to work within the limits. Supervision is low and CCTV is poor, so it is a safe environment—a haven—for money launderers. Regulations were introduced last year to require players to open an account in a bookmaker if they want to stake more than £50. In my experience, that opens people up to receiving advertising and tempting texts and emails encouraging them back into the bookmakers to spend money that they do not have. Some people get around the stake limit by gambling between £40 and £50, while others use two machines simultaneously.
Before FOBTs were introduced, bookmakers were a relatively benign part of the social fabric. In fact, I would say they were welcome—everybody liked a flutter on a Saturday afternoon. Since the introduction of FOBTs, bookmakers have become a major problem, with rising crime levels. The introduction of FOBTs is the only variable that has changed. The ComRes survey that has been mentioned showed that seven out of 10 MPs from all parties agree with me and others that FOBTs are a dangerous pastime.
The Government are due to launch their triennial review, so now is the time to look carefully at the damage that these machines are doing. The Gambling Commission has said that, if the stake were being set now, it would advise against £100 as a precautionary measure and would advocate a £2 level. There is a wealth of evidence about the harm that these machines cause. There have even been two tragic suicides: Ryan Myers from Liverpool and Lee Murphy from Aberdeenshire took their own lives as a consequence of their addiction to these dreadful machines.
Bookmakers argue that reducing the stakes would have an economic impact. A report by NERA Economic Consulting assessed the claims of shop closures and job losses. It concluded that
“cutting the stake on these machines would reduce the numbers of bookmakers by about 800, primarily where the clusters have developed”—
there are often four or five bookmakers in a close-knit area—with
“just 5 to 10 per cent fewer shops than before the introduction of B2 machines in 2000.”
Moreover, it found that the move
“would create a net positive 2,000 high street jobs as money returned to the more labour-intensive and productive high street shops.”
Limiting the stakes would benefit traditional horse-racing, as money would return to over-the-counter betting and bookies would return to their traditional role as a valued part of the high street. The horse-racing industry would also benefit from an increased levy. It would be a win-win: a win for the high street and a win for the bookies as they returned to being bookmakers. There would be reduced harm, fewer deaths and more jobs. I ask the Government to look at these machines and to take Members’ thoughts on board.
As the hon. Member for Strangford (Jim Shannon) rightly pointed out, the size of the stake—up to £100—and the very short cycle make FOBTs a particularly aggressive form of gambling that encourages fast repeat visits. FOBTs now account for almost half of betting shops’ turnover in the UK as a whole. Given that shops are limited to only four terminals per site, the way to make more from that money spinner is to open additional branches. The result has been that betting shops have proliferated, particularly in the Chinatown area of my constituency. Local authorities are hamstrung by the “aim to permit” guidance under which they review premises’ licence applications for betting shops.
The Soho Society and the London Chinatown Chinese Association have become increasingly alarmed. Betting shops have been pushing for later opening hours and more branches to target people—particularly members of the Chinese community in my constituency, who work until the early hours in the area’s busy restaurant scene. Many of those people are particularly vulnerable to becoming problem gamblers.
Some 12 months ago, the Government accepted that FOBTs are a serious cause for concern and said that more evidence would be gathered on their negative effects. Unfortunately, there is still no sign of a definitive review. Several key questions need to be answered. Should £100 stake gaming machines be allowed in ambient gambling environments such as betting shops? Do those machines exacerbate problem gambling in betting shops? Would cutting the stake protect those who are vulnerable?
The regulator has a statutory duty to act to protect the vulnerable. It has suggested that a precautionary approach could be applied to reduce the stake. Campaigners against FOBTs want the maximum to be reduced from £100 to £2, in line with all other category B machines. I support that suggestion.
Gambling the world over has evolved within a fairly sensible, consistent structure. The hardest gambling is reserved to highly regulated venues such as casinos—my constituency has many—to which customers go with the expectation of experiencing a much harder gambling environment. Casinos have very high levels of player supervision and protection. Players tend to be occasional visitors, and casinos tend to be viewed as destination leisure venues that have more than just gambling on offer.
The Gaming Act 1968 put in place a regulatory pyramid. At the top, harder gambling was reserved to more strictly regulated venues. The lowest level of supervision was for soft gambling at seaside arcades, for example. The middle tier—the general, high street, ambient gambling, which we are discussing today—was expected to be fairly soft gambling with lower levels of player supervision. It is not, in my view, suitable for the kind of hard FOBT games that we see today.
B2 gaming machines are totally inappropriate for high streets across the country at the current level of stake. Until their advent, bookmakers had few issues with crime and attacks on staff. Since their introduction, police call-outs to gambling premises have rocketed, as frustrated users carry out damage to machines.
I understand that the instinct of this Government—a Conservative Government—is not to give in to nanny state urges. I make that sort of argument fairly regularly. However, it seems odd that at the self-same time as we are imposing a sugar tax and ever more draconian measures against smokers, we are allowing these high-stake gambling machines to proliferate in a loosely regulated environment. I ask the Minister to work with responsible operators in the gambling industry, of whom there are very many, to reduce the FOBT stake.
I am pleased to have the opportunity to speak today. I thank the hon. Member for Strangford (Jim Shannon) for securing the debate. I consider myself lucky to represent one of the best race courses in the country—Haydock Park—and I endorse the point made by the hon. Member for Tewkesbury (Mr Robertson) about bookies’ contribution to the survival and success of horse-racing.
There are 14 betting shops in my constituency, which employ 67 people. They contribute hundreds of thousands of pounds in business rates and tax and a total of more than £1.3 million to the local economy. Those jobs and that money are important.
Emotions can run high when we talk about fixed odds betting terminals. I have seen—no doubt, like other hon. Members—the devastation that addiction, whether to alcohol, tobacco, drugs or gambling, can cause. One of my very good friends, a man widely known in sporting and media circles in Ireland—the Armagh Gaelic footballer Oisín McConville—has written and spoken extensively about his struggles with gambling. The problem has a disastrous effect on those who suffer from it or are in close proximity to it. I ask hon. Members to believe me when I say that I know.
I knew problem gamblers when I worked in a bookies at the age of 14. Before the internet, cashing-in, betting exchanges and FOBTs, we took people’s money over the counter and stamped their docket. Bookies did not open on a Sunday, and there was no champions league football, no in-play betting, very limited evening racing and no FOBTs.
The reality for those who have developed a problem is that people now have a multitude of gambling opportunities, including online gambling, spread betting, casinos, the lottery or betting shops. The vast majority of people can control their gambling and view it as a leisure pursuit. That is demonstrated by the fact that problem gambling levels in the UK have remained constant for the past 30 years at about 0.5% of the adult population.
A veritable litany of academic research and evidence shows that problem gambling is not limited to one product or type of gambling. Many experts conclude that problem gambling is a complex issue. Focusing on one element of gambling alone will not give a better prediction of problem gambling or decrease the rates of gambling-related harm. I therefore ask that we look at the wider problems of gambling and, as ever, focus on the evidence and facts.
The hon. Gentleman is talking about the range of gambling options that exist. Problem gamblers are attracted to all of them. Does he recognise that many firms provide all of them? As he seems to be saying, those firms depend on FOBTs; otherwise they would go out of business.
I am very clear that there should be no carte blanche for any part of the gambling or gaming industry. Regulation is important. Let us look at access to gambling and the amount that people can wager, and let us find ways of protecting those who are susceptible to developing a problem, but let us do it fairly and in the interest of good public policy.
Let us ensure that those with gambling addictions get the help and support they need to overcome their problems. We must ensure that the industry meets its obligations in that regard. Let us also acknowledge that having a flutter is a treasured and enjoyable national pastime, and that the vast majority of the millions of people who have a bet do so occasionally and in moderation—me included.
It is, as always, a pleasure to serve under your chairmanship this morning, Sir Alan.
Fixed odds betting terminals are entirely legal. Some claim that people become addicted to gambling but, unfortunately for those who advance the argument, that is simply not supported by the evidence. There is no objective evidence from gambling prevalence surveys or Government health surveys that the level of problem gambling in this country is rising. The inconvenient truth is that the level of problem gambling has remained constant at about 0.5% of the population for the past 13 years. Crucially, that level has not increased since the terminals were first introduced.
The FOBTs are already heavily regulated. Every aspect of their operation is controlled: they must be licensed; the maximum stake is controlled by Government; and the maximum pay-out is controlled. The fact is that gambling is available in many forms. There is no control over how much anyone may stake, say, on a five-furlong flat race, which is over in less than a minute. There is no control over how many scratchcards a 16-year-old may buy.
The hon. Gentleman seems to be making a principled argument that we should not even have a £100 limit on FOBTs. He is asking why we should we have that—if someone can bet £1,000, or £10,000, on a horse race, or can walk into a casino and put x amount on whatever, what is the point in having a £100 maximum stake on a FOBT? Clearly, his argument is to remove the maximum stake and for people to have the freedom to stake as much as they want.
The fact is that very few people bet £100 a stake—only about one in 100 customers even stake over £50. The average stake on a machine is £5.13.
As I was saying, there is no control over how many games of bingo someone may play, and there is no control over how much people may spend on betting on their mobile phone. Betting shops, arguably, are the safest place to gamble responsibly.
I have some sympathy with the nanny state argument. As my hon. Friend knows, we have had discussions about that in many different areas of public policy. Does he not recognise, however, that there is an element of responsibility here? Without doubt, no self-respecting newsagent would be selling dozens and dozens of scratchcards to a 16-year-old; the newsagent would take responsibility there and then. A lot of things are regulated, but in this sort of area the Government need to find a balance. As I said in my contribution, it seems to me that what is happening in many of our betting shops should be regulated at a higher level than might be expected for a seaside arcade.
In answer to the point about scratchcards, there is nothing to stop people going into 10 different shops and buying as many scratchcards as they want. I am not suggesting that they would buy them all from the same shop.
I will make two final points. First, it is generally accepted, and it has been mentioned in the debate this morning, that the FOBT machines make a profit of about £1,000 a week—the figure given earlier was a little more than £800 a week. Given that the shops are open for about 90 hours a week, on average, that works out at a profit of about £11 an hour. So the question that those who want to control the machines further must answer is, do they think that such a level of hourly profit is fair? If not, what hourly rate do they think is fair?
Secondly, it is argued that the FOBTs are used for money laundering. That argument has been advanced again this morning. Unfortunately, however, it has been advanced by exactly the same people who argue that people are losing £300 a minute on the machines. Which is it? Are people losing £300 a minute, in which case that is not a good way to launder money, or are the machines being used for money-laundering purposes? Clearly, they cannot both be true.
We should protect the freedom of the individuals who want an occasional flutter, and allow them to do so.
It is a pleasure to serve under your chairmanship, Sir Alan.
As a member of the newly formed APG on fixed odds betting terminals, I am pleased that the hon. Member for Strangford (Jim Shannon) secured this important debate. I also thank my hon. Friend the Member for Swansea East (Carolyn Harris) for forming the APG, and I congratulate her on being elected as its chair.
I am pleased with my local council, Rochdale, which neighbours the constituency of the hon. Member for Bury North (Mr Nuttall). I was interested to hear what he had to say about problem gambling in Bury, because it is certainly not supported by his local newspaper, The Bury Times, which has highlighted the problems caused by FOBTs in Bury. Last September, however, my local authority, Rochdale Council, formally supported the campaign to have the maximum FOBT stake reduced from £100 to £2.
In the Metropolitan Borough of Rochdale, which encompasses my constituency and the Rochdale constituency, 140 FOBTs are estimated to be spread across 35 betting shops. The amount spent on the machines locally is staggering. According to data compiled by the Campaign for Fairer Gambling, residents of the borough gambled up to £152 million on FOBTs in 2013, which equates to £721 by every man, woman and child in the population—excluding residents aged under 18, who legally are not supposed to be gambling, that is nearly £950 per adult resident. By comparison with the 2012 figures, the research also seems to indicate that the local problem is getting worse. Between 2012 and 2013, the amount spent per resident increased by 112%, representing a massive drain on a borough facing significant challenges.
The gambling industry has introduced a range of voluntary measures to protect gamblers, such as gamblers being able to self-exclude themselves from betting premises, or the introduction of personal limits on the amount of money to be gambled during a single session. Given the vulnerable nature of those who tend to use FOBTs on a frequent basis, however, an approach that is more robust than self-regulation would be preferable.
On local licensing obligations, the Gambling Act 2005 requires local licensing authorities to “aim to permit” gambling, subject to licences complying with three licensing objectives: keeping crime out of gambling; ensuring that gambling is fair and open; and protecting children and vulnerable people. As a consequence, betting shops are required to obtain a licence from their local authority. FOBTs were previously restricted to the highly regulated casino environment but, as we have heard, they are now permitted in betting shops. For that reason, the licensing section of local councils has a role to play in ensuring that local betting shops comply with the relevant legislation.
I am pleased that Rochdale Council voted formally to support the campaign, and I believe that to be the action of a responsible council. I hope that others will follow suit.
It is a pleasure to serve under your chairmanship, Sir Alan.
I congratulate the hon. Member for Strangford (Jim Shannon) on securing the debate. Many of us have probably applied for a similar debate, and for a Glasgow Member the issue is particularly pertinent. In 2014, The Evening Times of Glasgow found that the city had the highest proliferation of FOBTs—puggies, as they are known colloquially—at one for every 2,458 adults, with losses of £30 million per year. Only Liverpool came anywhere close to matching the Glasgow figure. It is not a statistic that I am proud of.
In my constituency the number of betting shops is particularly high, and they are in a concentrated area. It has been suggested that the disproportionate impact of fixed odds betting terminals on poorer and more vulnerable communities is due to the massive overprovision of bookmakers in such areas. Some streets in the east end of Glasgow have as many as four bookmakers on them, within a few hundred yards of each other, and with multiple FOBT units in each shop. In parts of my constituency, the high street is dominated by fast food shops, payday loan shops and bookmakers, and their proximity to each other is no coincidence.
Areas with a higher density of gambling machines are therefore more likely to be poorer areas, with lower than average economic activity and more people in lower-paid jobs, which means that the machines have a higher impact on people in those communities. I might have taken this incorrectly, but I take issue with the idea that people in such areas have more addictive personalities than those in more affluent areas. This is about proliferation, availability, the absence of hope, and the desire for control. Gambling has a massive impact on the lives and families of problem gamblers, often leaving families in debt, desperate, and more dependent on council and Government services. A report by Glasgow City Council on the impact of FOBTs found significant evidence of clustering of betting shops on many local high streets and other retail centres in Glasgow. Despite a period of unprecedented growth in online gambling, the number of betting shops has remained consistent and floor space continues to increase.
On the points made by the hon. Member for Tewkesbury (Mr Robertson), the idea that the poor pay in betting shops so that the more affluent can go horse-racing does not seem to me a reason to urge caution on the Government about taking action.
That was an interpretational issue, then. I am glad to have my interpretation corrected, because what I said was what came across to me, and perhaps to others in the Chamber.
Evidence from the Scottish health survey suggests that as many as one in 20 betting shop customers may be problem gamblers. The addictive nature of the machines can and does devastate the lives of many people, especially those from poorer communities. The Government need to step in and do more to help those struggling with addiction, and they need to seek out preventive measures.
What is of most concern is the fact that many of the most popular games on fixed odds betting terminals are categorised as B2 casino content and are not subject to the same restrictions on stakes and prizes as traditional slot machine games. With vulnerable people already at risk, the Government must take action and reconsider the B2 classification.
I am fascinated by the hon. Lady’s argument. She is a former member of the Scottish National party—I do not know whether she is still a member. The point was made to the Smith commission that Scotland wanted full devolution of powers over FOBTs, yet the party tabled no amendments to the Scotland Bill on the issue. It said nothing about it, and not one Scottish MP spoke about the matter during the passage of the Bill. For the SNP to criticise the Government is simply duplicitous.
I admit that I find myself extremely disappointed that the hon. Gentleman makes a political point on an issue of great importance for people across the UK. Amendments were tabled on fixed odds betting terminals, but unfortunately, because of the constriction on the time given to the Bill, they could not be brought forward.
No, I am sorry. There is a more important point to be made about the impact of fixed odds betting terminals on vulnerable communities, and I will thank the hon. Gentleman to sit down so that others can get to speak.
I urge the Government to consider the evidence from communities such as mine, and to take action to stop fixed odds betting terminals blighting people in vulnerable and disadvantaged communities.
It is a pleasure to serve under your chairmanship, Sir Alan. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this important debate. I want to mention my membership of the newly established all-party group.
There is no doubt that fixed odds betting terminals are causing concern, and indeed misery, across the country. Many people believe that they are having a negative impact on society, and there is a widespread view that the maximum stake of £100 is far too high. No other country in the developed world has £100-stake machines other than in highly supervised casino environments. Addiction to these high-stakes machines is blighting people’s lives. It is of huge concern to me when I read reports that the number of betting shops is twice as high in the poorest areas of the UK. In Wales, more than £60 million vanished into fixed odds betting terminals last year, and there are 50 of them in the communities that I represent.
I have heard it said several times that fixed odds betting terminals are the crack cocaine of gambling, and that view has come from those engaged in support and counselling services—the very people who witness at first hand the misery caused, and who deal with the consequences of gambling addiction. There has been a significant rise in the amount of money gambled in fixed odds betting terminals in recent years, from £1.3 billion in 2010-11 to £1.6 billion in 2013-14, according to the Gambling Commission. That is not a light-hearted flutter. Punters are able to stake £300 per minute, or £18,000 an hour, and huge losses are quickly racked up. Gambling is a major cause of indebtedness, and commentators have indicated that betting on FOBTs alone equates to £675 for every Welsh adult each year.
It is time for the Government to commit themselves to tackling the issue seriously, and to reduce the maximum stake on the terminals. The starting point can be the review of stakes and prizes, which I believe is long overdue. The Government have stalled so far, and they must now signal that they are committed to taking action. There also is concern in many communities about betting shops clustering together on the high street, as we have heard. Many councils across England and Wales have called for the highest stake on fixed odds betting terminals to be cut to £2. They also want more local power to tackle some of the issues involved, as current planning and gambling laws are failing to protect our towns and high streets. I support that call from local government, as I believe that councils have the most awareness of the issues being created in their areas and should have more of a role in dealing with them, in partnership with communities.
Last year the Welsh Assembly passed a motion noting that
“the growth in online gambling and fixed odds betting terminals has turned gambling in the UK into a multi-billion pound industry”,
and urging the Welsh Government to
“engage with the UK Government to discuss the devolution of greater powers”
to tackle the issue.
Fixed odds betting terminals have allowed betting shops to introduce low staffing by pushing the money on to machines, so there is little or no interaction with anyone behind the counter. Figures show an increase in the number of times police have been called to betting shops over the past few years. We have all heard about individuals who easily become addicted, and about those who have lost their jobs and homes, and in some cases their families, as a result. I am sure that many hon. Members have read case studies in which people have testified clearly that the introduction of fixed odds betting terminals was a major factor in their addiction.
The consequence of doing nothing is unthinkable. The Government need to take decisive action, and I look forward to hearing today the Minister’s clear commitment outlining what the Government intend to do about the situation.
It is a pleasure to serve under your chairmanship today, Sir Alan. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this important debate and setting out an extremely detailed position. I declare an interest, having worked in addiction services as a psychologist for a number of years.
It is true that gambling has been a problem in society for many years. However, problem gamblers have told me that the fact that it is possible to gamble at all hours of the day and night exacerbates their difficulties. The description of fixed odds betting terminals as the crack cocaine of gambling has already been referred to. Patients have described addiction to those machines to me: the loss of large sums of money—hundreds of pounds in an instant—and the insufferable pain that relapses of such magnitude cause to families and children, who can become impoverished because of debt and instability.
Gambling, like many other addictions, also causes people to engage in behaviour that they might not otherwise. Those who have had periods of problem gambling have spoken about stealing from society and from their families to support their habit. That has an impact on social services and the criminal justice system. The machines we are discussing are among the most addictive set-ups, because they involve repetitive behaviour, random reward and very high stakes, so problem gamblers are soon chasing their tail and trying to recoup money they have lost. The availability of the machines, virtually on the high street, is a cause for grave concern. People who are vulnerable to gambling addiction describe seeing them everywhere, finding it difficult to abstain, and relapsing even if they pop out to the shops for bread and milk.
I would argue that debt causes depression and mental health problems, and we have heard that at worst it can cause suicide. Those issues have an impact on the health service. Other types of gambling have been mentioned, such as the national lottery, but I have had discourse with patients who have stated that betting on the lottery is not as addictive, because they have to wait some time to get the result. The issue with these machines is their instantaneous and repetitive nature.
I will not speak for too long, because I wish everyone to be able to speak. I have significant concerns about the availability of these machines, the number of them in shops and the number of shops that have them, the level of the stakes and the level of supervision of vulnerable individuals. I ask the Minister to look at that.
I cannot give way, because I want others to have the chance to speak.
I support a responsible gambling industry. We all like to have a flutter occasionally or pop into a casino on a night out—very occasionally, I add—but I urge the Minister to act. We need a balance. Vulnerable individuals are being gravely affected by these machines, and we need to address that through independent research and by developing safe and responsible policy.
It is a pleasure to serve under your chairmanship, Sir Alan. May I thank the hon. Member for Strangford (Jim Shannon) for securing the debate and my hon. Friend the Member for Swansea East (Carolyn Harris) for leading the all-party group on this important issue?
A lot of ground has been covered in the debate, and I will not repeat other Members’ points. There is a pattern of bookmakers clustering in towns with high levels of deprivation. I speak from the perspective of Oldham, which the Office for National Statistics recently announced as the most deprived town in England. We see massive clustering there of not only bookmakers but payday loan shops, logbook loan shops and pawnbrokers. There is a cycle of people hoping they are going to win, losing and then pawning gold or something from their house to get more money, which they feed back into the machines.
I do not accept at all that the arguments on this issue are conflicted. It is true that these machines are being used for money laundering. In fact, during the course of this debate, constituents have sent me messages on Twitter in which they name bookmakers in Oldham that are quite open about the fact that these terminals are used for money laundering. Let’s face it, if someone wants to find a way of cleaning money, losing 10% of it through one of these machines is not a bad transactional cost.
The poorest in society are paying the price. In 2014, Oldhamers fed £29 million into 100 terminals, losing an estimated £5.5 million. That is money from the pockets of the people who can least afford it. I believe in people being able to make adult choices about these things, but we have seen that the bookmakers cannot be trusted to monitor and support people who have problems. I will give one example. In Chadderton precinct, I can be stood at the door of one Ladbrokes—a bookmakers that has four fixed odds betting terminals, which is the maximum it is allowed—and you, Sir Alan, can be stood as close as we are now, at the other Ladbrokes across the precinct, which has the same number of terminals. Bookmakers know the rules and will seek a way around them. Any sense that we can trust bookmakers, which are there to make money, to look after people who are falling into trouble and have problems is wrong. I do not trust them one bit.
We need proper and fair regulation that strikes a balance between treating people like adults and letting them make a conscious decision to spend the money they earn however they choose, and ensuring there are proper restrictions where bookmakers are taking liberties. I do not believe that the Local Government Association and the 100-odd local authorities that are supporting the proposals made under the fantastic leadership of Newham Council are wrong. They know their communities, and they are asking for more Government action and local accountability and support. That is the least we can do to address this very real modern problem.
I was delighted recently to be elected the vice-chair of the new all-party parliamentary group on FOBTs. I too congratulate the hon. Member for Strangford (Jim Shannon) on securing this debate. He has said it all, and there have been many excellent contributions, so I will be incredibly brief.
Against the background of what many hon. Members have said, the degree of lax regulation of FOBTs is extraordinary. Two pounds is deemed the correct stake for machines in arcades and bingo halls—environments that have far higher levels of supervision than bookies. High-stakes gambling should take place only in highly supervised and regulated environments such as casinos. Our lax approach to FOBTs makes no sense, and it sticks out like a sore thumb compared with the equivalent regulations that apply in other European countries.
The Government promised to review stakes and prizes, but to date, they have failed to do so. The longer they prevaricate on this, the greater the damage that will be done to individuals, families, communities and, indeed, our economy. It is time for the Government to get their act together. I look forward to working with hon. Members across the House and with colleagues in the new all-party parliamentary group to ensure that that happens.
It is a pleasure to serve under your chairmanship, Sir Alan. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this debate. We have witnessed today the common agreement among most in this Chamber that there is a particular problem with fixed odds betting terminals, which leads those who are vulnerable and seduced by the promise of easy money into all sorts of difficulty.
In my constituency and the neighbouring constituency, there are 135 FOBTs in bookmakers, where gamblers racked up losses of more than £5 million in the year to 2015. Those are two constituencies with some of the deepest pockets of poverty and deprivation in the entire United Kingdom, and they host 37 betting shops. That spend of more than £5 million is set to increase, and campaigners have expressed deep concern.
This problem affects some of the most vulnerable people in communities right across Scotland and the United Kingdom. People who struggle with gambling are drawn in by the glamour, the glitter and the promise of easy wins for the hollow thrill that these machines offer. They promise so much and deliver so little. We have heard today that vulnerable players are gambling as much as £100 in 20 seconds. Who can afford to sustain such losses without facing huge difficulties? It is no wonder that FOBTs are called the crack cocaine of the gambling world.
So far, the approach of the gambling industry has been about self-exclusion, but we know that that does not work. Research has shown there were around 22,000 self-exclusions in 2012-13, but more than two thirds of those who self-excluded cancelled the exclusion after the minimum period expired. As the hon. Member for Congleton (Fiona Bruce) has pointed out, this is an issue of social justice. It is clear that the particular danger of these machines is that so much money can be lost so quickly. We cannot continue to stand aside and watch this problem develop. The casino industry has said in evidence to the Scottish Parliament that these machines are a hard form of gambling and are completely unsuitable, as we have heard today, for the unsupervised environment of a bookmakers shop.
We know that more research needs to be done to inform policy. We need play to be safe and enjoyable. The Responsible Gambling Trust has said there should be further studies so that we can target problem gamblers using informed research. It is time the Government looked at the recommendations from the Responsible Gambling Trust on these machines.
We have heard today about inconvenient truths, and I would like to point out one such truth. We have all seen areas—usually ones with socially disadvantaged communities—that have bookie after bookie on each street corner. Despite what the hon. Member for Tewkesbury (Mr Robertson) said, 55 of the most deprived boroughs in the United Kingdom have more than twice as many betting shops as those in the most affluent areas. That is an inconvenient truth. Too many local authorities feel powerless to stop that clustering, and the Scottish Government have taken action to tackle the issue through planning policy.
The betting industry has claimed that reducing the maximum stake from £100 to £2 would put betting shops at risk. It is a little known fact that like the hon. Member for St Helens North (Conor McGinn), I, too, once worked for betting shops—for two high street betting shops to put myself through university, working in just about every bookmakers in and around Glasgow. I can tell hon. Members categorically that there were no FOBTs at that time and that profitability for bookmakers was never an issue. There are now about four terminals in each shop.
I want to make a very important point. There has been an attempt to make political points in this debate, which is utterly inappropriate, but they have been raised and therefore must be answered. It was suggested that the Scottish National party did not table any amendments to the Scotland Bill with regard to these machines. I can tell the hon. Member for Hyndburn (Graham Jones), who made that point, that that is utterly untrue. Perhaps he was so busy working with his Tory allies against more powers for Scotland that he missed it. The SNP tabled an amendment on 4 November 2015 to clause 45 on page 47 and it was not accepted. It is true that some power has been devolved under the Scotland Act 2016, but what the Scottish Government are not able to do with the powers is retrospectively re-examine the licences for the number of betting terminals that are already available. The way that the powers have been devolved will create confusion because there will, in effect, be a two-tier system.
We know that these machines are an issue. We know that we need to tackle it, and I ask the Minister—if one thing comes out of today’s debate—to seriously consider making the maximum stake £2 so that people can gamble with much more safety and responsibility, and so that they are less open to being preyed upon by these machines and mistaken about the riches that they offer.
It is a pleasure to take part in this debate under your chairmanship, Sir Alan, and I start by congratulating the hon. Member for Strangford (Jim Shannon) on securing it; it is important and has certainly attracted a lot of support on both sides of the House.
I get a feeling of déjà vu when I come to these debates, particularly when I read the briefings from the Association of British Bookmakers—I think I could have written the opening sentence of the one I have here before I even received it. It says:
“There is no objective evidence from either past British Gambling Prevalence surveys or Government Health surveys that problem gambling levels in the UK are rising.”
We ask the question, “Is there a problem with FOBT machines?”, and we get an answer to a completely different question. This has got to stop. That sort of propaganda does the industry no service whatsoever, and it is not fooling anyone.
No, I will not, because of the time. I have argued consistently that if we are going to move ahead with any restrictions on FOBTs, we need to do so on the basis of evidence. People are calling for a £2 stake, but there is no evidence that that will be any safer than the existing stake.
However, in terms of the issues confronting us—as many hon. Members have said today—this is about location more than anything else. It is about the proximity of these machines to people who may be vulnerable to developing a gambling habit and to falling foul of their propensity to gamble too much by going into a betting shop and losing more money than they can afford to. There is no denying that a high proportion of these machines are in proximity to socially deprived communities, and a disproportionate amount of the money gambled in them comes from people on low incomes.
We hear the figures about the numbers of betting shops and all the rest of it, but it is clear that the trend in betting shops is for more money to come from B2 machines than from over-the-counter betting on horse-racing, dog-racing or football, as more of that sort of betting moves online. The growth in the gross gambling yield from machines has more than covered the decline in over-the-counter betting, with a combined gambling yield in 2014-15 of £3.74 billion, which is higher than in any previous year recorded by the Gambling Commission. The yield from the machines has been higher than that of over-the-counter betting every year since 2011-12 and now represents 54.2% of the combined gross gambling yield. The number of premises has been in decline since March 2014: there were 299 fewer premises on 30 September 2015 than on 31 March 2014. However, the number of B2 machines has increased year on year since records began in 2008-09 and has now reached 34,500.
We have a growing problem in our communities, given the proximity of FOBTs to locations where, I think, they do not belong. Anyone who has been to discuss these machines with me knows I loathe them. I do not think they belong in our high streets, but they are an unintended consequence of the Gambling Act 2005, and they are now there. Many businesses are predicated on the machines being there and if they were to be removed, people would lose their jobs and livelihoods, which is why we must move forward on the basis of evidence.
We are told that there is no problem, or that the problem lies elsewhere, or perhaps that the problem is not getting any worse, so we should not do anything about it—or a combination of all those arguments. However, the number of people in treatment, according to GamCare, is up by 39%, and the number of people who present problems as a result of playing FOBT roulette machines represent 26% of those who are in contact with GamCare. The number of calls from people addicted to FOBTs has gone up by 50% over the last five years.
I accept that there is a growing problem online. For the first time ever, the current figures show that the number of people presenting problems to GamCare from gambling online has increased over the number of people who are presenting problems from machine-related abuse. However, that can be explained by the increase in the number of people who are contacting GamCare and does not show a reduction in the problems from FOBTs. It shows an overall increase of people who are presenting with problems, and we have to address that issue going forward.
The Gambling Commission wrote to the Secretary of State in March 2015 about the conclusions of research carried out by the Responsible Gambling Trust and NatCen Social Research. It was based on people who gamble from accounts, because they can be tracked and their gambling behaviour can be followed. There were some interesting factors: 37% of the number of people who have loyalty cards or gambling accounts said that at some time, they had a problem with machine gambling—so a very high proportion are presenting with a problem.
The Gambling Commission says that the betting industry needs to increase the number of people who have accounts, so that detailed research can be carried out on what is going on with these machines. In the letter, it states:
“Consequently, we recommend encouraging operators to promote account-based play with the aim of increasing uptake significantly. If they succeed, playing anonymously might itself become a useful indicator of risk. If operators fail to make sufficient progress with promoting account-based play, then the case for making it mandatory would need very serious consideration.”
Will the Minister therefore consider, in his next discussions with the betting industry, whether that should be made mandatory? If we are not making any progress, we are just not finding out what the problem is. We have the technology. We can do it and we need to make more progress in this area.
I say to the betting industry, “Make this move before it is forced on you, or you will lose the machines completely.” I think that the time is coming when action on these machines will be forced on the gambling industry. If there is not a problem, let us have the data and the account-based play, so that we can demonstrate that there is no harm.
The time has come to apply the precautionary principle. The betting industry says there is no evidence to prove that the machines are harmful, but there is no evidence to prove that they are not, so we should apply the precautionary principle that if it cannot be proved that they are not harmful, let us remove them until there is proof that they are not. It is time to act. The data are available to the Minister so let us move towards account-based playing of the machines and ensure that we satisfy ourselves that it is safe to have them on our high streets. Otherwise, they should be removed.
In conclusion, I want to ask the Minister a few questions. The Government are carrying out a review of the £50 stake, which is why the triennial review has been delayed. When will the former be concluded and when will the triennial review of stakes and prizes start? What steps is he taking to investigate money laundering—several hon. Members highlighted that this morning—and whether there is a money laundering problem?
There is concern about late-night betting and the fact that stakes on these machines tend to increase late at night. Should we review the opening hours and the rules that allow live racing from Hong Kong to be played and betting shops to stay open even later so that more people can play these machines? Should we mandate account-based play on these machines? Will the Minister support giving local authorities, once and for all, the powers they are demanding so they can control the proliferation of betting shops in our communities?
It is a pleasure to serve under your chairmanship, Sir Alan. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this debate and on his passionate and thoughtful speech, which I think we all appreciated.
We have had a good, constructive and measured debate. All hon. Members who spoke took a balanced approach, and I am grateful for their informed and helpful contributions to this important debate. I appreciate that gambling is a devolved matter for Northern Ireland, so I shall concentrate on Great Britain.
I start by restating that the Government recognise the concerns around subcategory B2 gaming machines, or fixed odds betting terminals, as they are more commonly known. I assure the hon Gentleman and all hon. Members here that the Government take the issue seriously and keep it firmly under review. I appreciate the matters that have been raised and share the concerns that the hon. Gentleman highlighted. I have listened carefully to the comments made and take note of the strong views that have been expressed.
I congratulate the hon. Member for Swansea East (Carolyn Harris) on being elected to the chair of the new all-party parliamentary group on fixed odds betting terminals. I welcome its establishment and look forward to hearing from her and her group. Perhaps we can chat later about issues that we cannot cover here. I wish the group well in its work. This is a good opportunity to say that the Government are listening and looking at the whole issue, and will make strong recommendations in due course.
I cannot give way because I have so little time.
The Government are consistent in their approach to gambling legislation. Any changes in the industry must go hand in hand with enhanced player protection and a genuine commitment to social responsibility. We recognise public concern about the increased visibility of gambling and its potential harm, particularly as regards B2 gaming machines. That is why the Government introduced measures in April 2015 to end unsupervised high-stake play on those machines and gave more powers to local communities, requiring planning applications for new betting shops to be submitted to local authorities. That was a positive move to allow local authorities to make decisions in their area. The industry and the Gambling Commission introduced additional measures to further the social responsibility agenda at this time, and I will touch on that shortly.
The Government subsequently conducted an evaluation of the regulations on B2 gaming machines, which was published earlier this year. In summary, there has been a significant reduction in the number of stakes above £50 and there are indications that, as a result of these regulations, players on B2 gaming machines may now be making a more conscious choice to control their playing behaviour. In addition, the regulations led to an increase in the use of verified accounts, so the number of people able to track their play through an account and make more informed decisions as a result has increased. Although that is a positive step in the right direction, it is prudent to think carefully about what further player protection measures might be appropriate, particularly in relation to B2 gaming machines.
The coalition Government concluded the last triennial review of stakes and prizes in October 2013. They noted in their public response that the reintroduction of a triennial review system was appropriate and anticipated that the next formal review would conclude by 2016. We are aware that there is an expectation of a review this year, and we will set out our views on a review of the stakes and prizes on gaming machines in due course.
It is important to note the role of the Gambling Commission and the industry in the social responsibility agenda. The Association of British Bookmakers, the trade body representing the vast majority of high street bookmakers, introduced new measures for its members in 2014 under its code on social responsibility, which was further updated in 2015. We have made it clear to the industry that although these measures are welcome, they must be independently evaluated and built on to ensure they are fit for purpose.
The Gambling Commission updated its social responsibility provisions in its revised licence conditions and codes of practice, which were introduced in May 2015. This included requirements that customers of B2 gaming machines make an active choice on whether to set time and monetary limits to help them to control their play.
There is little time left, but I want to highlight the issues of money laundering and crime, particularly money laundering through B2 gaming machines. Crime in the gambling sector is obviously worrying, and we and the Gambling Commission are looking closely at the issue. I assure the hon. Member for Strangford and other hon. Members that the Government take the issue of money laundering in gambling very seriously indeed.
The Gambling Commission already requires operators to take measures to prevent money laundering through its licence conditions and codes of practice, and it will shortly announce its conclusions following a consultation on proposed regulatory changes to strengthen the fight against crime linked to gambling. In addition, the Treasury is planning to consult shortly on the EU’s fourth directive on money laundering, which will seek evidence about the extent of risk in certain sectors, including gambling, of money laundering practices. The combination of these measures represents the Government’s continued focus on preventing crime in gambling, including money laundering.
Time is extremely short, but I re-emphasise the fact that the Government recognise the concerns expressed. I welcome the constructive comments of the hon. Member for Eltham (Clive Efford), but time does not allow me to answer all his questions, so I will write to him with my answers. I am grateful for his constructive contribution to the debate. Much has been done, but much more needs to be done. We will certainly look at the matter carefully and monitor it to ensure there is protection and social responsibility, which, as the debate has highlighted, are so important in the gambling industry.
I thank the Minister, the shadow Minister and right hon. and hon. Members for their significant contributions. A significant proportion—higher than for any other product—of users of fixed odds betting terminals are problematic gamblers, and that has come out of this debate. Fixed odds betting terminals are the crack cocaine of gambling. They are totally addictive, destroy lives and focus on the vulnerable. What must we do? We must reduce the number of machines from four per shop to one, and we must reduce the maximum stake from £100 to £2. We must remove the table game content from fixed odds betting terminals, because the pace of the games is faster than in real casinos. We must reduce the spend frequency from 20 seconds to 60. Those are some of the things we can do.
I welcome the new all-party group on fixed odds betting terminals, and I thank hon. Members for their contributions. The Minister can be sure that Members here will return to look for change through legislation.
Motion lapsed (Standing Order No. 10(6)).
Lewy Body Dementia
I beg to move,
That this House has considered awareness and recognition of dementia with Lewy bodies.
It is a pleasure to have secured this debate, under your chairmanship, Sir Alan, on dementia with Lewy bodies, or DLB as it is known, and as I will refer to it henceforth. May I start by congratulating the Minister on his very significant achievement on Sunday in completing the London marathon? Well done to him for the moneys that he raised for his charities. In the same vein, it is with some pride that I declare that I was recently appointed an ambassador for the Lewy Body Society, a charity whose mission is to raise awareness of DLB among the general public and educate those in the medical profession and decision-making positions about all aspects of the disease, as well as to support and fund research into it. For 10 years, the LBS has raised awareness, provided support and information, and funded research into DLB, which is the second most frequent cause of age-related neurodegenerative dementia. I am delighted that some of those involved in the campaign are in Parliament today.
It might be helpful if I say a little about DLB. Lewy bodies are abnormal aggregates of protein that develop inside nerve cells in Parkinson’s disease, DLB and some other disorders. They were first discovered by Dr Frederick Lewy as far back as 1912, but incredibly, despite that, DLB was virtually unknown until the late 1980s, when advances in techniques made it possible to identify Lewy bodies under a microscope.
Every case of DLB is as individual as the person living with it. Different people show different combinations of symptoms. At present, a diagnosis of DLB can be confirmed only by autopsy, but a careful clinical evaluation of the patient and their symptoms can in many cases form the basis for making a reasonably confident lifetime diagnosis. There are also technological advances in imaging and research into biomarkers that it is hoped will result in earlier and more accurate diagnoses.
The central symptom of DLB is dementia, which is defined as progressive mental decline that is serious enough to interfere with normal daily activities such as eating, washing, dressing, cooking, shopping and managing finances. Significant memory loss may not develop until later. There may also be problems with executive function in respect of attention, problem solving and spatial awareness. This can easily be mistaken for Alzheimer’s disease.
Additional symptoms that may lead to a diagnosis of probable DLB are, first, disturbances in REM—rapid eye movement—sleep. The impact of that on a family carer is terrible. The carer is unable to sleep themselves and therefore becomes unable to support the person with DLB. REM sleep is the deep sleep in which people dream. A certain amount of good, REM sleep is necessary for people to function efficiently. DLB sufferers may talk in their sleep or act out their dreams. Sometimes that is so marked that the sufferer falls off the bed.
Secondly, there is severe sensitivity to neuroleptic drugs. Sometimes people with DLB are prescribed neuroleptic—antipsychotic—drugs to help with their symptoms. That should be done only by someone experienced in the illness, as many of those drugs can be extremely harmful or even fatal to people with DLB. That problem has been recorded.
Despite the importance of correct diagnosis and treatment of DLB, the disease is often not recognised, identified or diagnosed.
I thank the hon. Gentleman for bringing a very important issue to the House. The week before last, I had a debate in this Chamber on dementia and Alzheimer’s disease, which a number of hon. Members attended. Dementia has the potential to be the defining condition of this age. Does he think that there should be more research and more partnerships between parts of Government, between universities and between businesses to find a cure for this disease? By finding a cure, we will help to ensure that diagnosis happens earlier, as it should.
The hon. Gentleman, whom I would feel comfortable referring to as my hon. Friend, makes the point with his usual eloquence, and I could not agree more. I will say a little more later about some of the research being done.
Dementia is not just about memory. The supportive symptoms of DLB are fainting, falls, problems with swallowing and continence, delusions, depression and hallucinations, including hearing, smelling or feeling things. Some people have benign or pleasant hallucinations of, for example, children or animals. A sense of the presence of someone who is not there is common in many patients. Other sufferers see frightening and disturbing things and may react to them by displaying challenging behaviours that prove very difficult for the family to manage.
More than 700,000 people in the UK have dementia. That number is projected to rise to 1 million by 2021 unless significant advances are made; indeed, the figure is expected to double in the next 20 years. As the hon. Gentleman said, the issue now touches the lives of virtually every family in the United Kingdom. It is a big issue for the NHS, but also for all local authorities and, indeed, all public services. In the UK, approximately 100,000 people are thought to suffer from DLB. At least 5% of people aged 85 or older are thought to suffer from this little known, but not uncommon, and devastating disease.
It is important to note that diagnosis rates of dementia across the country are low and incredibly varied. In the UK, less than half of people living with dementia are diagnosed, let alone differentiations being made between the types of dementia.
I thank the hon. Gentleman for bringing this important debate to the House today. He says that diagnosis rates across the country are patchy, but will he acknowledge that there has been good progress in general with dementia diagnosis, and that there is increasing awareness through dementia-friendly communities and so on? There is, however, a poor understanding of this type of dementia, and it is vital that we move ahead in informing the public and clinicians about not only dementia, but the various types of dementia.
I thank the hon. Gentleman for his intervention. I agree with him and will come later to some of the issues that he raises. I come to this debate in a spirit of co-operation, recognising the good work that has been done, and looking at how we can work effectively together to continue and develop it.
It surprised me that officially there are no data on the diagnosis of DLB. There is, however, an ongoing National Institute for Health Research-funded study examining diagnosis rates of DLB in the NHS. Current findings indicate that the rates are more than 50% lower than expected, with considerable variation, again, between services. I am sure that the Minister will agree that early and accurate diagnosis is of great importance and can allow more people to have as good a quality of life as possible for as long as possible.
As always, it is the human experience of the disease that expresses fully its awfulness and tragedy. My constituent Jacqui Cannon, who is chief executive of the Lewy Body Society, told me:
“In 2007 my darling dad was diagnosed with dementia with Lewy bodies. My father had been behaving increasingly strangely for a few months and I took him to the doctors. He was fortunate that he had a GP who was responsible for GP training in Greater Manchester and who made an immediate diagnosis. He was then referred to an old age consultant, he had an appointment almost immediately due to the ability to be able to pay as a private patient. The diagnosis was confirmed. The GP used him as a case study at a GP conference to put emphasis on the importance on patient centered care. My father had other underlying health issues and the consultant liaised very closely with his other doctors. This does not happen for everyone.
Knowing what I now know; my father had all the hallmark symptoms of DLB. He had hallucinations, he was totally muddled and could not distinguish between what was on the television and what was actually going on around...We struggled to care for my father at home. I was taking over from my mother when I finished working full time…for a major…company. He was very well cared for in a local EMI unit The caring doesn’t stop at this point and I visited every day after work and missed one day in 2 years, often only arriving home at 9:00pm each day. I did a google search and The Lewy Body Society appeared, I have been involved since that point.”
One of the charity’s founders, Ashley Bayston, said:
“In 2005 my precious mother was diagnosed with dementia with Lewy bodies. She had been behaving increasingly strangely for 5 years during which my father took her to dozens of doctors before, at my father’s suggestion, neurologist 26 made a diagnosis of DLB. I have heard this story so many times in the past decade. The carer, frustrated by the doctors’ prevarication and inability to admit they don’t know, does extensive search and ends up suggesting the diagnosis.”
Ashley also uses that phrase:
“Knowing what I now know, my mother had all the hallmark symptoms of DLB. She had terrifying hallucinations, she was totally muddled”,
and she says that her mother could not tell the difference between reality and illusion. She continues:
“One time she told me that she had seen me on the telly the night before and liked my outfit. She often thought that there was a cat in the house. Years before she had lost her sense of smell and at the start of her illness suffered from severe…hypotension and constipation. By the time my mother was diagnosed she was in the final stages of DLB. Totally bedridden and helpless and in and out of consciousness. Fortunately my father was able to keep her at home tended round the clock by angel nurses who treated her with the love and respect they would give their own mothers. This is very unscientific but I do believe that it was love that kept my mother alive after the doctors wrote her off. My parents had been married for 67 years when Mum died.”
There are, however, some grounds for optimism. It should be a source of pride that the United Kingdom has played a significant role in the recognition and management of the disorder. Newcastle University is a centre of excellence in the field and the UK is a major force in understanding the disorder. Indeed, Professor Ian McKeith from Newcastle, who is internationally recognised as the world’s leading expert in DLB, is the founding president of the Lewy Body Society. That is important because the society’s objective is to bring support and expertise over and above what is offered elsewhere. Additionally, the existence of an organisation dedicated solely to DLB validates those affected by the disease and gives them a sense of community. It is difficult for people to understand this complex and frightening disease unless they have experienced its effects.
Thirty years ago, the concept of DLB simply did not exist. People with the disorder were misdiagnosed and mismanaged to the severe detriment of all concerned. However, the situation has improved significantly. Many patients are now recognised as having the condition early and accurately, and receive appropriate treatment and care, but as always, and particularly in this case, much more needs to be done.
In the previous Parliament, the Prime Minister released “Prime Minister’s challenge on dementia 2020”, a five-year plan to improve dementia care and the understanding of dementia in England. The document set out the welcome ambition for England to be
“the best country in the world for dementia care and support and for people with dementia, their carers and families to live; and…the best place in the world to undertake research into dementia and other neurodegenerative diseases.”
The progress made is welcome; the £150 million Dementia Research Institute is set to be up and running by 2020. It is also welcome that more NHS and care staff have had specialist training in the development of dementia, but we are still a long way from getting to grips with the serious issue of DLB, which has often been neglected.
The National Institute for Health Research has supported some DLB research, including the DIAMOND-Lewy study on diagnostic rates and management, run jointly by the University of Cambridge and Newcastle University. However, despite the increase in funding and commitments from the Government, funding for research into DLB has been limited, and although the National Institute for Health and Care Excellence issues guidance and guidelines about the management of dementia, and the Royal College of Nursing has done much to raise practitioner awareness, there are few specific provisions for DLB. The lack of funding available and the lack of guidance around DLB remains a concern.
The fact that DLB is not mentioned once in the entire 2020 dementia strategy means that there is a lack of funding available for the disease. The Lewy Body Society, for example, currently receives no funding from central Government. As a first step, will the Minister consider updating “Prime Minister’s challenge on dementia 2020” so that it specifically mentions DLB? Will he also incorporate plans to fund and help sufferers of DLB in the overall strategy? That would mean that the Department of Health could establish training programmes about DLB for GPs and other healthcare professionals. The NHS could then promote the message that, like cancer, dementia is a spectrum of diseases; that would make it easier to diagnose. It would also mean that research could be placed on a sustainable national footing and draw on existing expertise and experience. Recognition of DLB in the strategy will help awareness and lead to better treatment for those who suffer from it, because the more people who know, the fewer people who suffer.
The announcement that I was to become an ambassador for the Lewy Body Society received some media attention, and I received a phone call from my cousin, Patrick McGinn, whose father, my great-uncle Basil, had died some months previously. Like most of our extended family, I thought that Basil had Alzheimer’s or dementia, or was going senile or whatever particular euphemism we had occasion to use when we spoke about him. In fact, Basil had dementia with Lewy bodies. My own family has been touched by the awfulness and tragedy of the disease, and I did not know it. How many others are in a similar position, either suffering from DLB or caring for someone with it? For them and for my uncle Basil, I ask the Government for recognition to aid increased awareness of dementia with Lewy bodies, so that we can begin to help the many people affected by it.
It is a pleasure to serve under your chairmanship, Sir Alan. I congratulate the hon. Member for St Helens North (Conor McGinn) on securing the debate and raising the important issue of awareness and recognition of dementia with Lewy bodies. I thank him for his kind personal remarks about my weekend activities, when I ran the London marathon. He is probably unaware that the Chair and I also have a sporting connection. Many years ago, we took part in a charity penalty shoot-out between English and Scottish MPs at Ibrox stadium in front of 50,000 people. That is not the normal size of crowd that the Chair or I play football before, but we enjoyed the occasion immensely. A sporting connection runs through us all.
I congratulate the hon. Member for St Helens North on his recent appointment as ambassador for the Lewy Body Society, and on the way in which he has raised the debate and brought the issue to the Chamber. As always, I thank colleagues in the House who show an interest. I thank the hon. Members for Strangford (Jim Shannon) and for Foyle (Mark Durkan) as well as my hon. Friend the Member for Vale of Clwyd (Dr Davies) for their attendance.
I agree with the hon. Member for St Helens North about Lewy body dementia touching many families. My wife’s uncle has recently been diagnosed, and I would like to thank her and all the other members of the family who are caring for her uncle as well as the staff at the care home and social services, who have also been involved. That brings home that dementia and its variants is something that many families can expect to experience. The debate is therefore timely and raises issues that are important to all of us.
The hon. Gentleman set out well some of the symptoms of DLB and issues relating to diagnosis. I cannot better that; I will not describe the symptoms because he did that extremely well. Diagnosis can be difficult. A GP can do some simple checks to see whether there is a chance that someone could have dementia and then refer them to a memory clinic or other specialist clinic if necessary. At the clinic, the person will be asked about symptoms and have a physical check-up and memory test, and they may also have blood tests and brain scans. The results of those checks and tests will give the doctor a good idea as to whether the symptoms are caused by dementia with Lewy bodies, another type of dementia or something else entirely. It is complex and, as the hon. Gentleman said, it is reckoned that perhaps 4% of all recorded dementia may be accounted for as DLB, but it may in fact account for 10% of all cases because it tends to be mistakenly diagnosed as another condition.
That brings up the question of research, which I will turn to before more general remarks about our approach to dementia generally because the hon. Gentleman raised that as a matter of some importance. The 2020 challenge sets out the aspiration to see research funding in dementia double by 2025 and relates to funding from all sources, including industry and charity. Through initiatives including Dementias Platform UK, the Dementia Research Institute, Join Dementia Research, the international drug discovery fund and the accelerated access review, we are creating a highly attractive environment for industry investment, including new targets for drug development. We also anticipate that greater public awareness achieved through the 2020 challenge and charity campaigns will lead to increased philanthropic donation to research charities.
On how particular funding is determined and which research projects are selected, funding panels made up of academic researchers, subject experts and patient and public advisers advise on decisions as to which projects should be funded within NIHR funding programmes, within the remit of each programme, determined by quality. On DLB specifically, as the hon. Gentleman said, the National Institute for Health Research funds the NIHR Newcastle biomedical research unit in Lewy body dementia, which is part of the NIHR dementia translational research collaboration, TRCD. However, other biomedical research units and centres that make up TRCD also do research in the area, including the NIHR Maudsley biomedical research unit. That accelerates the translation of dementia research from basic science to early-phase clinical trials, focusing on the three common late-onset dementias—Alzheimer’s, vascular and Lewy body dementia—and on fronto-temporal dementia with motor neurone disease.
Other major NIHR investments include improving the diagnosis and management of neurodegenerative dementia of Lewy body type in the NHS DIAMOND-Lewy study, which the hon. Gentleman mentioned. The chief investigator, to whom we pay tribute, is Professor John O’Brien of the University of Newcastle. Funding for that major programme of work is just over £1.9 million, which lasts from January 2014 to December 2018, and it is expected to result in an increase in the number of dementia with Lewy bodies cases diagnosed and to improve their care considerably.
We are very keen to see NIHR research programmes and to fund high quality proposals in dementia where those are within remit. In terms of future spending, there will be announcements on the Dementia Research Institute in due course about competition for membership. The content of the scientific programme will depend partly on the composition and directorship of the DRI, which is to be determined by competition, but I will ensure that the hon. Gentleman’s specific pleas in relation to DLB are passed through into the process and go to the Minister who is primarily responsible.
Let me say a little about further recognition of dementia into which this fits, because that is important. The hon. Gentleman was gracious enough to recognise that this issue continues to be of the highest priority for the Government. It is not a party matter in any way, as he made clear. In 2015, the Prime Minister set out his vision for dementia over the next five years, with his challenge on dementia 2020. The implementation plan, which was published last month, sets out the actions that partners—including those across health and care—will take to ensure that those commitments are delivered.
An accurate diagnosis of dementia is key to helping people live well with the condition. As my hon. Friend the Member for Vale of Clwyd said, more people now receive a diagnosis of dementia than ever before and it is reassuring to know that in the constituency of the hon. Member for St Helens North, 87.9% of people with dementia have received a diagnosis, which is significantly above the national average. I commend and praise the relentless efforts of those providing care and support to people with dementia. Again, he set out a moving case in relation to that.
In the context of the Prime Minister’s commitment in challenge on dementia 2020, which is very welcome, he has committed to roll out a national standard for tailored packages of post-diagnosis support. Will the Minister commit to ensuring that, when that standard emerges, it will be articulate enough to address DLB specifically?
It would be best for me to take specific requests on DLB back to the Department. I will write to hon. Members who have taken part in the debate with a response to that in due course. I hear and understand the hon. Gentleman’s point, but let me reflect and come back.
I return to those who are looking after people. The families and carers and the hundreds and thousands of health and social care staff who work tirelessly to deliver high quality, compassionate, personalised care always require and deserve a mention in any discussion of dementia and those involved.
The work we have done to improve diagnosis rates has meant that more people than ever can access the advice, care and support they need to help them, their carers and families live well with the condition. We now need to focus our efforts on reducing local variation in diagnosis rates and the care and support that people require. The diagnosis is only the start. We also need to ensure that every person diagnosed with dementia, and their carers, receive meaningful care following their diagnosis. To be clear, the needs of the person with dementia, their family and carers, should be at the heart of everything we do. We therefore want to see more consistent provision of innovative and high-quality dementia care delivered in a way that is personalised and appropriate to the specific needs of the individual. I have been fortunate enough to see at first hand some of the high- quality dementia care provided across the country and have been impressed with the culturally sensitive care and support, catering for a diverse range of dementia needs.
We also want people across England to have a greater understanding of dementia and what they can do to make a real difference to people living with the condition. I am pleased to say that there are now more than 1.5 million dementia friends in England and the Alzheimer’s Society is working to deliver an additional 3 million by 2020. I am grateful to the representative who talked to me and gave me some basic advice to help me become a dementia friend. In St Helens North there are reckoned to be over 6,500 dementia friends. Furthermore, local work such as that undertaken by the Dementia Action Alliance, the Life Story Network and National Museums Liverpool in neighbouring cities is helping support people, their families and their carers live well with dementia in their local communities.
I thank the hon. Gentleman for raising the nature of the debate and for being so specific, mentioning the work of the Lewy Body Society. I note that when he was appointed as an ambassador to it, he was quoted as wanting
“a commitment from the Department of Health to ensure that recognition for DLB is an integral part of strategies to tackle dementia.”
I assure him that we want everyone diagnosed with dementia to receive meaningful care following their diagnosis, and that very much includes those with dementia with Lewy bodies.
The fact that the hon. Gentleman has taken the trouble to raise the issue for debate, that he did so in the way in which he did and that he paid tribute to those who work in this area has done an immense amount just in this debate to raise the profile of Lewy body dementia and to secure commitment and recognition from the Department.
As a result of the debate, I will write to the hon. Gentleman with some answers to the specific questions he asked. I thank him for the way in which he did that and I hope that, through what we have said this morning, our commitment to dementia—to those suffering from it, to those who care for them and to all those involved in its research and treatment—has been made clear. This is a Parliament-wide commitment, which we all share. I am pleased to have had the chance to answer the debate.
Motion lapsed (Standing Order No. 10(6)).
Antibiotics: Research and Development
[Mr Nigel Evans in the Chair]
I beg to move,
That this House has considered incentivising research and development of new antibiotics.
It is a pleasure to serve under your chairmanship for the first time in this hall, Mr Evans. I am delighted to have secured the opportunity once again to introduce a debate on the increasingly urgent issue of antibiotic resistance. I first debated this issue back in October 2014, when I discussed the wide-ranging causes of antimicrobial resistance—AMR—and our urgent need to address the problem head-on.
Today, I will focus on the most pressing elements of the issue: the need to incentivise more research and development of new antibiotics so that we have new drugs coming on stream to meet our future needs. Before I discuss the development of a new funding model for antibiotics, I will briefly explain exactly why AMR is such a pressing issue. This is far from being a problem only for the future; it came as a shock when, before my last debate, doctors in my constituency told me that patients were already experiencing the devastating effects of AMR. Across the country, we are seeing an increasing number of patients in intensive care units who have resistant infections, meaning that there is no effective treatment available. Antimicrobial-resistant infections already kill some 50,000 people every year across Europe and north America, but sadly the reality of AMR today is nothing compared with the nightmarish scenario of the future. The initial paper of Lord O’Neill’s AMR review concluded that
“a continued rise in resistance by 2050 would lead to 10 million people dying every year”.
That is more than the number of people who will die of cancer, and it is double the number of people who will die of cholera, diabetes, diarrhoea, measles, tetanus and road traffic accidents combined. Some might say that AMR is the biggest threat to mankind.
We have also been warned that the secondary health effects of AMR could result in a return to the dark ages of medicine. Our national health service and other modern health systems across the world rely heavily on antibiotics. When surgery is undertaken, for example, patients are given antibiotics to reduce the risk of infection. In a world in which antibiotics do not work, surgery will become far more dangerous. Many routine procedures, such as hip operations, will become too risky for many elderly patients, depriving them of their mobility and their active lives. Cancer treatments such as chemotherapy supress patients’ immune systems, making them more susceptible to infections. Without effective antibiotics to prevent those infections, such life-saving treatment could no longer be an option. As Jeremy Farrar, a director of the Wellcome Trust, said:
“We are sleepwalking back into a time where something as simple as a grazed knee…will start to claim lives.”
Thankfully, medical opinion is, in the vast majority of cases, that the looming global crisis can be avoided if we take action, but it must be taken sooner rather than later. It is encouraging that there have been numerous positive developments since this topic was last debated in Westminster Hall. The £20-million Fleming fund was announced in March 2015, and it will support the delivery of action plans for AMR laboratory surveillance across the world, with a particular focus on low-income countries. Just before the 2015 general election, I was delighted that the Conservative party manifesto said:
“Antibiotic resistance is a major health risk so we will continue to lead the global fight against it, taking forward the recommendations of the independent review launched by the Prime Minister”.
I promise that that will be my last reference to party politics, because this issue has the support and attention of every party in this House. AMR is such a huge issue that it transcends party politics.
I thank the hon. Gentleman for securing this debate on an important subject. Before he completely passes on from party politics—I agree that this issue cuts across all party politics—does he agree that the nature of antibiotics, and the fact that we want to use them as little as possible when they are discovered or invented, drives against the free market system, in which new products and services are used as much as possible? For that reason, the Government and the public sector must take action, because to be effective, antibiotics should be used not as much as possible but as little as possible.
I take the point raised by the hon. Member for Newcastle upon Tyne Central (Chi Onwurah), with which my hon. Friend the Member for York Outer (Julian Sturdy) has just agreed. This is also about having the right diagnostic tests to ensure that people who need antibiotics receive them while ensuring that they are no longer handed out like sweets.
My hon. Friend is right. Later in my speech, I will discuss the model of how antibiotics are used across the country. It is chilling how antibiotics are used in different parts of the country. Testing to find out resistance to certain antibiotics is also important before any antibiotics needed are used. It is not just a matter of how we bring new antibiotics to market, which can take 15 years; it is also about how we protect our existing armoury of antibiotics to buy us time for those new antibiotics to reach the market.
The £1 billion Ross fund was announced by the Chancellor in the spending review of November 2015. Some £350 million will be spent fighting AMR by strengthening surveillance of drug resistance and laboratory capacity in developing countries, and by delivering the new global AMR innovation fund with China. In January 2016, at the World Economic Forum in Davos, 85 major pharmaceutical and biotech companies agreed to the declaration on combating antibiotic resistance, which demonstrates the industry’s willingness to take up the challenge. Earlier this month, the Chancellor addressed the issue once again by highlighting the importance of AMR at the International Monetary Fund in Washington DC. He confirmed what the industry has long been telling us: that the reimbursement models for antibiotics are broken. I entirely agree that a global overhaul is required, and I will focus on that issue today.
Lord O’Neill has also backed proposals to change the way we develop new antibiotics for the marketplace. We all look forward to the AMR review publishing its final set of recommendations in the months ahead, and the Minister might be able to give us a firmer timescale for that review. In my previous debate on antibiotic resistance, I raised the key issues at stake in the growing challenge of this continuing problem. We know that using antibiotics inappropriately increases resistance and the risk associated with routine treatments. In the last debate on the subject, I mentioned that in India, many prescriptions are purchased over the counter to treat a wide variety of unsuitable illnesses, often with no professional diagnosis. Such practices compound the problem. However, it is greatly encouraging that many countries around the world have now woken up to the impending disaster that we could face if we simply do nothing.
As a consequence, things are starting to move forward, which must be seen as positive. However, the central challenge of getting new antibiotics on stream remains. As the Chancellor said earlier this month and as we have heard, the current funding model is no longer fit for purpose. The O’Neill report makes it clear that it typically takes about 15 years for an antibiotic to go from the initial research stage to final delivery to the marketplace. For that to happen, a large amount of money is required up front to fund the project, at a stage when the company has absolutely no idea whether the drug will succeed. Astonishingly, only about 2% of products, or one in 50 proposed new antibiotics, successfully make it to the marketplace. In the vast majority of cases, large sums of money are invested with no financial return whatever.
Although to a certain extent that is true of the manufacture of all new drugs, the problem is far worse for antibiotics. Conditions such as cancer or diabetes often closely follow demographic trends, so new drugs are also used as the medication of choice for cancer or diabetes, as they are more effective than the older prescriptions. In the case of antibiotics, however, generic products can treat infections as well as new drugs for far less money, except where there is resistance. Furthermore, in the attempt to slow the development of resistance, new antibiotics are often held back and are prescribed only when everything else has failed. That is the right thing to do. The market for new antibiotics is therefore limited to a small section of patients, as new drugs are used only when existing drugs are no longer effective. They will be required as a first-line treatment only many years after their introduction, by which time their exclusive patents have often expired.
That may explain why so many pharmaceutical companies have, sadly, exited the market over the years. Of the 20 pharmaceutical companies that were the main suppliers of new antibiotics back in the 1990s, only four remain. Furthermore, only five new classes of antibiotics have been discovered in the last 15 years. Sadly, some companies are waiting for resistance to rise before they even explore the viability of investing in a new product, which is clearly not in the best interest of patient health and wellbeing, or of the future of health care as we know it. Under the current funding model, the profitability of any new drug depends entirely on how many units are sold. As discussed, that is not suitable for the development of new antibiotics. Incentivising the increased use of antibiotics only increases resistance in patients, which can have devastating consequences.
The O’Neill review therefore proposes the creation of a more predictable marketplace that will sustain commercial investment in antibiotic research and development. A key proposal that has the full support of many pharmaceutical companies is for profitability to be de-linked from volume of sales for new antibiotics. That would guarantee developers an acceptable return on their investment when they produce a new antibiotic that fulfils an unmet clinical need. That is especially important when volume would not be sufficient to make the product commercially viable, despite its value to the NHS. A de-linked model also has the added benefit of eliminating any incentive to oversell antibiotics needlessly as cure-all miracle drugs, which, sadly, still occurs.
Before being elected as a Member of this House, as many know, I was a farmer—a farmer who produces food, not a pharma who is part of the prescription sector—so I do not pretend to know exactly what model is right for our national health service. However, it seems to me that an insurance-based approach that shares financial risk is certainly worth the Government’s consideration. Providing developers of the most important antibiotics with a fixed fee would remove the current financial uncertainty from the marketplace. It would also limit financial uncertainty for the NHS: if there were an outbreak of an infection requiring the antibiotic, the costs would be capped at an agreeable level.
I understand that AstraZeneca and the Association of the British Pharmaceutical Industry have been working closely with the Department of Health to develop such a model. We must continue to encourage innovation while doing what we can to remove the financial uncertainty of developing key new antibiotics. At the same time, it is essential that any new funding model provides the best possible value to the taxpayer. There should be no additional support in areas that are already adequately supported by the marketplace.
I thank the hon. Gentleman for being generous in giving way a second time, and for making an excellent summary of the case. Although the state—the national health service—should share the risk, does that not mean that it should also share the benefits and returns? As the economist Mariana Mazzucato sets out in “The Entrepreneurial State”, where the state invests, particularly in services such as this one, there should perhaps be a return to us as well, so that the upside as well as the downside is shared.
I do not disagree at all. There must be a return, in the first place, for the companies looking to develop drugs, or they will not come forward. Delivering new antibiotics must be viable. At the same time, it is absolutely right that if the Government, the NHS or, ultimately, the taxpayer invests in those drugs, they also must see the benefit and the return. When we talk about risk, we are talking about shared risk, and if we are talking about shared risk, we should be talking about shared return.
I hope to receive the Minister’s undertaking that he will continue to work closely with companies such as AstraZeneca and with the Association of the British Pharmaceutical Industry to develop a model that supports innovation and removes financial uncertainty. The industry has asked for a clear timetable of action on the development of a new funding model, as it is essential that we turn our positive words into meaningful change.
However, it is worth saying that pharmaceutical companies do not have a monopoly on innovation, and they alone cannot solve the colossal problem of AMR. Within our rich medical marketplace across the country, there are a range of other organisations that are well positioned to offer invaluable assistance in this exciting area of discovery. In fact, the O’Neill review makes it clear that the research and development of antibiotics must be opened up, offering new opportunities for small and medium-sized enterprises, academic research teams and not-for-profit entities to compete with established players in the market.
I am proud to say that one such charity is based in my constituency: Antibiotic Research UK, or ANTRUK, is the first charity in the world set up to tackle the challenge of the scarcity of new antibiotics to treat resistant bacterial infections. Some of the country’s leading scientific and clinical experts form part of this team, and they all share the same concern about the slow progress made in combating AMR, as well as a passion for taking practical steps to take up the challenge.
The charity has three key missions: first, to develop a new antibiotic therapy by the early 2020s; secondly, to educate both practitioners and the public alike about the threat of AMR; and thirdly, to provide support to patients with antibiotic-resistant infection. In less than two years, ANTRUK has raised over £400,000, and it is working towards a programme of developing antibiotic resistance breakers. This technique reverses the resistance and extends the life of existing antibiotics. ANTRUK believes that is the best hope of finding a way of breaking AMR in the short term. Basically, it is a way of buying us more time to develop new antibiotic drugs.
Charities such as ANTRUK are ideally placed to work with both the Government and large pharmaceutical companies in finding a solution to AMR. However, to maximise its effectiveness, ANTRUK needs our support. Despite being a new player in the industry, it is already demonstrating the innovative ways in which it can help to inform public policy on AMR, an issue touched on earlier in an intervention.
In co-operation with an analytic database company, ANTRUK has published a heat map of England that shows how the number of antibiotic prescriptions varies across the country. I am happy to show this map to interested Members. The results are absolutely fascinating. The research demonstrates that the number of antibiotic prescriptions being given is rising at an alarming rate in some of the most hard-pressed areas of England. The key findings are that there is a widening gap in antibiotic prescription. For example, doctors in London prescribe 20% less antibiotics than doctors in the north, and doctors in the most hard-pressed coastal towns in Lincolnshire, Norfolk and Essex are prescribing the most. In Clacton-on-Sea, the number of antibiotic prescriptions by doctors is almost double the national average. Furthermore, doctors prescribe almost 60% more antibiotics in December than they do in August. At first glance, that might not seem surprising, but many illnesses treated by antibiotics are not seasonal in nature. Is this another example of the potential misuse of antibiotics? On a positive note, it appears that the number of prescriptions peaked at 3.4 million in 2012 and has since dropped by more than 5%.
Such research is absolutely vital in the fight against AMR. It demonstrates how charities can complement the vital work of Government and the large pharmaceutical companies. Consequently, I would be most grateful to the Minister if he would agree to meet me and a delegation from ANTRUK to discuss how the Government can assist it with its mission to combat AMR. A key request is for a relatively small amount of funding from the £12 billion foreign aid budget to assist ANTRUK’s work, which could have a revolutionary impact across the world, particularly in developing countries.
I have already had one such meeting with the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), who has responsibility for public health, along with my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake), who is also my neighbour. Sadly, he could not attend today’s debate. That meeting proved to be immensely helpful, and I hope that the Minister will agree that charities, and not just the large pharmaceutical companies, have a key role to play in the fight against AMR.
Ultimately, antibiotics are often woefully undervalued, in the sense that their price often bears no resemblance to their overall value to society. Since Dame Sally Davies published her report on the threat of AMR back in 2013, there has been an unprecedented focus on the need to change how we tackle the threat of resistance. However, this concern and the widespread discussion of the topic need to be translated into action if we are to tackle the problem head-on.
Antibiotics are the fire department of our health service, and they need a better funding model. We do not pay our firefighters only when they put out a fire; nor do we think that it is a poor return on our investment when they are not in action. Instead, we ensure that we have a well-funded fire service in place at all times, to protect us in our hour of need. It is a service that we all take for granted, and exactly the same is true of our use of antibiotics.
It is probably fair to say that whoever discovers the cure for cancer will go down in history, but the pioneer who prevents a return to the dark ages of medicine through a new antibiotic discovery will probably be forgotten. Nevertheless, the clock is now ticking, and producing positive noises without taking action is simply not an option. I hope the Minister will agree to publish a clear timetable on reforming the antibiotic funding model, and I also ask him to meet me and representatives of ANTRUK, who I know have so much to offer in furthering the process of making our next great discoveries.
I hope that the Minister will work with Departments across Government to give due consideration to the idea of allowing a greater proportion of our generous foreign aid budget to be used in this vital area of study. We have the potential to be world leaders in this field. I have heard, as other Members probably have, reports that Sweden is exploring options for changing its funding model. We must not let Sweden steal a march on us.
It was British innovation that ushered in the golden era of medical discovery. Without action, we risk squandering that legacy for future generations, who may not have the benefit of antibiotics as we know them today. It is absolutely right that global action is required to solve what is ultimately a global problem, as drug-resistant bacteria do not recognise national boundaries. We have the opportunity to safeguard the future of medicine as we know it. To achieve that goal, we must both set the standard and rise to the challenge, and hopefully the rest of the world will follow us.
Did I see four people standing just now? Good. I intend to call those making the winding-up speeches from 3.30 pm. If everybody else could keep to about seven minutes for their speeches, that would mean everybody would get a fair share of time.
It is a pleasure to see you in the Chair, Mr Evans, and I certainly hope to follow your request without any difficulty; I do not expect to speak for too long.
I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this debate and on his comprehensive introductory speech. As a former firefighter myself, I had to chuckle a little bit about his fire analogy. Also, in the main Chamber now, new clause 20 of the Policing and Crime Bill, which deals with the role of the fire brigade under police and crime commissioners, is being debated. So there is a little bit of continuity between the two Chambers in that regard.
I also speak as a member of the all-party group on global tuberculosis and because my previous constituency of Poplar and Canning Town had the highest TB rate in the UK and one of the highest TB rates in the world, despite being situated in central London. I congratulate Barts Health NHS Trust, which includes the Royal London hospital, as well as the local authorities of Tower Hamlets and Newham, on the work that they have done in tackling that problem and the efforts that they are making to address these issues.
I am very grateful to Dan Sharp, the policy adviser for the all-party group on global TB, for the briefing that he has sent me; I will quote from it extensively. The first quote is from Dr Margaret Chan, the director general of the World Health Organisation:
“antimicrobial resistance is a crisis that must be managed with the utmost urgency. As the world enters the ambitious new era of sustainable development, we cannot allow hard-won gains for health to be eroded by the failure of our mainstay medicines.”
The report goes on to congratulate the Government on the lead they have taken, as referred to by the hon. Gentleman. It states:
“The UK Government prioritised tackling drug-resistance within its aid strategy, published last November, and created the related Ross Fund. In addition, it brought the issue to the attention of the international community by commissioning the independent Review on AMR in 2014”,
as mentioned by the hon. Gentleman. The report continues:
“The Ross Fund is a commitment to spend £1 billion over the next five years on research and development...including £315 million to fight AMR.”
As the hon. Gentleman mentioned, the Prime Minister appointed Lord O’Neill to lead a review, and its recommendations are expected next month. The Chancellor highlighted the issue of AMR in a speech to the IMF. He said:
“Unless we take global action, antimicrobial resistance will become an even greater threat to mankind than cancer is”.
TB, as we know, is the leading infectious killer. It kills 1.5 million people in a single year—4,000 every day—and is the biggest killer of people with HIV. I met Dr Chan in Brazil in November last year at the UN World Health Organisation second world summit on road crashes; road crashes kill 1.25 million people a year. The Government are committed to sustainable development goals 3.6 and 11.2. It is to their credit that they are leading on TB also.
The number of cases of drug-resistant TB is increasing, with nearly 500,000 new cases last year, and almost 200,000 deaths. Multi-drug-resistant TB already accounts for one third of the 700,000 annual deaths from AMR. The all-party group produced a report last year entitled “The price of a pandemic: Counting the cost of MDR-TB”, which called for several measures: a pooled research development challenge fund to support innovative approaches such as the Médecins sans Frontières 3P proposal to incentivise the pharmaceutical sector, as mentioned by the hon. Gentleman; and investment in basic research to address key gaps that remain in our fundamental understanding of the biology of the TB bacterium.
I have questions for the Minister. When will funding provided through the Ross fund be allocated? Investment in TB diagnostics, drugs and vaccines through the fund is critical, as he knows. Which Department is ultimately responsible for the commitments pledged through the Ross fund, given that the remit is cross-departmental? I assume from the Minister’s presence here today that his Department will lead.
The Government recognise the serious threat posed by TB within the frame of AMR. In addition to the Ross fund, the Government’s aid strategy included the creation of a global challenges fund. Will that be used to address AMR? Can the Minister provide further details on that? Finally, what discussions have the Government had with pharmaceutical companies on addressing the challenge of AMR? I note the request by the hon. Member for York Outer to lead a delegation of pharmaceutical companies that he is associated with. What does the Minister say about that?
The Government have provided a positive lead on this matter, and more information will be reassuring. I look forward to hearing the Minister’s comments and those of the shadow Minister, my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders), and of the Scottish National party spokesperson, the hon. Member for Glasgow North West (Carol Monaghan), in response to contributions to the debate.
It is a pleasure to serve under your chairmanship, Mr Evans. Like my hon. Friend the Member for York Outer (Julian Sturdy), I have also held a debate—an Adjournment debate—on the subject of AMR to look at the use of antibiotics in primary care. The UK, as we all know, is the envy of the world when it comes to research and development into new drugs and new drug technology. Antibiotics have been widely used to treat infections for more than 60 years. Without doubt they have saved many millions of lives, as my hon. Friend said. I doubt whether there is any hon. Member who has not taken antibiotics at some time in their life. It is extensive use that has created the problem that we have today.
Although new infectious diseases have been discovered nearly every year over the past 30 years, very few new antibiotics have been developed in that time. This means that the existing pool of antibiotics are used to treat more and more infections. My hon. Friend the Member for York Outer has eloquently outlined the problems in developing new antibiotics, but one of the consequences of their widespread availability and the relatively low cost of the current antibiotics is the extensive inappropriate prescribing of the drugs for conditions on which they will have no effect. That adds to the increasing resistance to these life-saving drugs.
In preparing for the debate today, I found out that treatment-resistant bacteria are responsible for approximately 25,000 deaths across Europe each year—similar to the number of deaths from road accidents. The “National Risk Register of Civil Emergencies” estimates that a widespread outbreak of a bacterial blood infection could affect 200,000 people in the UK, and if this could not be treated effectively with our existing drugs, approximately 40% of those affected could die: 80,000 people.
There is an urgent need for action to slow the spread of antimicrobial resistance. My hon. Friend the Member for York Outer referred to buying time to allow for the development of new antibiotics to catch up with need. I talked about the number of deaths due to road traffic accidents. We have seen widespread campaigns for road safety, and we need more campaigns to highlight the dangers of the overuse of antibiotics.
In the UK, 74% of antibiotics are prescribed in a primary care setting, and a staggering 97% of patients who ask for antibiotics are prescribed them whether they need them or not. Studies have shown that antibiotic resistance rates are strongly related to use in primary care. They have also shown that more than half of the antibiotics used in primary care are for respiratory tract infections, most of which are either viral in nature or self-limiting.
As this debate indicates, one method of tackling antimicrobial resistance is by incentivising research and the development of new antimicrobials. My hon. Friend made an excellent case for that. That obviously takes time and a huge amount of financial investment. We should also look at the role that diagnostics can play. Diagnostic tests can often be carried out rapidly, giving results in minutes. This allows immediate diagnosis and treatment choices. Such tests also prevent the need for over-prescribing and ensure that patients have the right drugs at the right time.
A couple of years ago, the chief medical officer described the threat of antimicrobial resistance as being
“just as important and deadly as climate change and international terrorism.”
On that basis, and taking all the evidence into consideration, it is vital that the Government do whatever they can to tackle this major threat. If I may be so bold, I will suggest to the Minister that in addition to measures such as incentivising research and development of new antimicrobials, the Government should consider improving access to diagnostic tests in primary care, and focusing research and development funding on diagnostics as well as on drug development.
It is a pleasure to be called to speak to speak in this debate, Mr Evans. I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this debate on an increasingly important issue that we are more aware of today than ever before. He set out a comprehensive scene, which has been most helpful. He covered many of the issues involved, which will probably take away from other contributions, but he added to the debate, and that is the important thing.
The discovery of antibiotics revolutionised healthcare, allowing for the effective treatment of illnesses, including TB, that had previously been commonplace and frequently deadly. The hon. Member for Poplar and Limehouse (Jim Fitzpatrick) referred to the increase in TB in his constituency, which I am aware of because of events that have taken place here in Westminster. The incidence of TB in the United Kingdom has risen sharply in certain areas, and there is a tie-in between how we address TB and HIV. It is important that we look at the bigger picture.
Pathogens have evolved to resist new drugs. Resistance has increasingly become a problem as the pace at which new antibiotics are discovered has slowed and antibiotic use, including misuse and overuse, has risen. Antimicrobial resistance presents arguably the most serious threat to global health security and is threatening to undo major gains in the control of infectious diseases. If it is left unaddressed, 300 million people will die prematurely because of AMR by 2050 and the world’s GDP will be 2% to 3.5% lower. This year, the World Health Organisation and the G20 are considering AMR, providing the UK Government with an opportunity to build on the leadership they have shown to date. The UK Government prioritised tackling drug resistance in their aid strategy published last November. They also created the related Ross fund, which they are to be congratulated on. In addition, they brought the issue to the attention of the international community by commissioning the independent review on AMR in 2014.
The Ross fund is a commitment to spend £1 billion over the next five years on research and development on infectious disease, including £315 million to fight AMR. It is jointly administered by the Department of Health and the Department for International Development. Will the Minister give us some indication of how those Departments are working together to achieve the goals set? Commitments under the Ross fund are yet to be detailed. The all-party group played an instrumental role in securing the Conservative party’s manifesto pledge to create the fund. Given the urgency of tackling the TB epidemic, it is important that TB is prioritised within the Ross fund. Will the Minister tell us— I am sure he will—how that will happen? Although the Government’s steps are welcome, we must ask when the funding provided through the Ross fund will be allocated, because many of us are keen to see that happen. The hon. Member for York Outer also asked that question. Investment in TB diagnostics, drugs and vaccines through the fund is critical, and we need to see where the money is being spent and what the feedback is.
TB is the world’s leading infectious killer, killing some 1.5 million people every year, or 4,000 every day. TB is the biggest killer of people with HIV, as I mentioned earlier with reference to London. As the only drug-resistant infections spread through the air, multi-drug-resistant and extensively drug-resistant TB pose a serious threat to global health security. When we think about what is happening in London with TB and HIV, we should also think about what is happening in other parts of the world, where greater numbers are affected and there could be even more deaths.
Multi-drug-resistant TB—MDR-TB—is resistant to certain drugs. It can take more than 4,000 pills over a period of six months to cure someone with TB, and the drugs are often associated with severe side effects that can make treatment unbearable. As a result, patients often do not finish treatment, which increases the likelihood of drug resistance. I do not know whether any research is happening into how to make the drugs more palatable, if that is possible.
As well as treatment failure, inferior treatment and infection with resistant strains are drivers of MDR-TB. The number of cases of drug-resistant TB is increasing. There were nearly half a million new cases of MDR-TB last year and almost 200,000 deaths. One quarter of MDR-TB cases are in the WHO European region. MDR-TB requires patients to take a course of drugs over an 18 to 24-month period, including eight months of daily intravenous injections. That would be quite hard for anybody. Fewer than half of people who start treatment successfully complete the course due to the unbearable side effects, which can include permanent deafness. We have to be aware of not only what is done to treat people medically but the side effects.
The treatment of MDR-TB can cost 450 times the amount usually required to treat TB. In the UK, treatment of MDR-TB costs about £70,000, which is quite a lot of money, but if it addresses the issue, it has to be done. Due to stigma, lack of access to services and poor understanding, 3 million people—more than a third of those who fall ill with TB each year—fail to be diagnosed. MDR-TB already accounts for one third of the 700,000 annual deaths from AMR, and if it is left unaddressed, an additional 2.59 million people will die each year from the disease by 2050. It is imperative that TB is included in the AMR review’s recommendations to be published this year and considered in any international negotiations that follow. The G20 and the WHO will consider AMR this year.
I will finish with one more point—I am conscious of the suggested time for speeches, Mr Evans, but it is important that Members hear this. Although there may be a natural inclination to focus on the impact of increasing resistance to antibiotics on people, there is great work happening within the livestock industry, and particularly the poultry industry. The British Poultry Council has managed to achieve some encouraging results with its antibiotic stewardship scheme. It is the first UK livestock industry to pioneer a data collection mechanism to record antibiotic usage, which covers 90% of production across the chicken, turkey and duck sectors. It is important to record that since the scheme began monitoring overall use, it has demonstrated an encouraging downward trend. Between 2012 and 2015 production increased by 5%, with UK poultry meat accounting for 44% of total UK meat production. The total quantity of antibiotics used by scheme members in the same period decreased by 44%. In 2012, the scheme introduced a voluntary ban on the use of third and fourth-generation cephalosporins and a commitment to reduce the use of fluoroquinolone antibiotics. In 2016, the scheme made a further commitment not to use colistin.
Those encouraging results within the poultry industry should be recognised and encouraged, but as we have seen, when it comes to antibiotics for people, we need to wake up to the issue sooner rather than later. We need the Government to commit to delivering on the Ross fund and to continuing to look for further ways in which they can help address this issue.
It is a pleasure to serve under your chairmanship, Mr Evans. I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this debate on an issue he has long championed. I became interested in the issue having listened to presentations by clinicians and scientists in my constituency. They made it absolutely clear that incentivising research into and the development of new antibiotics is essential not only for our generation but for future generations. Antimicrobial resistance and its consequences are happening now. The World Health Organisation has cautioned:
“A post-antibiotic era—in which common infections and minor injuries can kill—far from being an apocalyptic fantasy, is instead a very real possibility for the 21st Century.”
Last year, antimicrobial resistance was added to the Cabinet Office’s national risk register for civil emergencies. The Government rightly warned that without effective antibiotics, even minor surgery and routine operations could become high-risk procedures.
Long lead times for developing new medicines and the relatively low commercial returns on investments have unsurprisingly hampered investment in antibiotic development. In 2014, the Select Committee on Science and Technology highlighted the fact that only 22 new antibiotics have been launched since 2000. The Association of the British Pharmaceutical Industry—I thank it for its help in preparing for this debate—points out that whereas 18 large pharmaceutical companies were actively involved in antimicrobial research and development in the 1990s, that number had fallen to four by 2010.
To ensure that new antibiotics are developed, it seems that we need a new reimbursement system, as other Members have said. Unless the environment for companies to invest in antibiotic development becomes more attractive, the problem will continue to grow. Looking at the wider field of the development of new drugs, I fear that some indicators suggest we may be going in the wrong direction. In 2010, 6% of international clinical trials were based in the UK, but the figure now stands at a mere 2%.
There are a wide range of suggestions for what we might do, including altering the regulatory framework to incentivise innovation and developing new economic models, perhaps through innovative pricing and reimbursement mechanisms to incentivise more investment in researching new antimicrobials. There may be possibilities through the emergence of what is termed venture philanthropy, which is an exciting development for some of the big research charities.
It has to be said, however, that if there is not enough money in the system as a whole, it is hard to see a way forward. Some caution that whatever the accelerated access review brings, chronic funding shortages will continue to hamper innovation. If we add to that the changes in capital allowances that make other countries more attractive and the uncertainty over the replacement of the political fix known as the cancer drug fund, it is easy to become pessimistic.
The industry needs to think hard about the future. As the independent O’Neill review said:
“Big pharma…needs to look beyond short-term assessments of profit and loss, and act with ‘enlightened self-interest’ in tackling AMR, recognising that it has a long term commercial imperative to having effective antibiotics, as well as a moral one.”
The fact remains that the Government must position the UK as the most compelling global location to develop new treatments. Methods for doing that might include committing to, and funding, a reimbursed early access to medicines scheme; and ensuring that there are sufficient funds to continue funding some of the important schemes focused on innovation, such as the biomedical catalyst. Indeed, the World Health Organisation recommends that policy makers can help to tackle antimicrobial resistance by rewarding innovation and the development of new treatment options. A global innovation fund was one of the preliminary recommendations of the O’Neill review, and we await the final recommendations, which are due to be published this summer.
In addition to incentivising research and the development of new antibiotics to tackle antimicrobial resistance, as we have heard, the Government must focus on preventing the inappropriate prescription of antibiotics, which is causing resistance to spread. The Science and Technology Committee has said that the Government
“needs to set clear responsibilities at all levels of the NHS and veterinary medicine to achieve better stewardship of the antimicrobial drugs vital in modern medicine.”
Indeed, the National Institute for Health and Care Excellence has warned that more than 20% of prescriptions issued for antibiotics are likely to be unnecessary. That is about 10 million prescriptions.
Another problem that is contributing to growing antimicrobial resistance is the use of antibiotics in livestock production. Other European countries have already set targets for reducing the use of antibiotics in farming, but the UK Government have not. Considering that farm animals account for almost two thirds of antibiotics used in Europe, and about 40% of those used in the UK, it is hard to overestimate the significance of that in the increasing problem.
Antimicrobial resistance is a grave threat that is only going to grow and intensify. The Government must act now to tackle the barriers to the development of new antibiotics and make the environment for researching and developing new drugs less challenging. The alternative, to go back to a world without antibiotics where almost half of people in this country died of infection, must be avoided at all costs.
It is a pleasure to serve under your chairmanship, Mr Evans. I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this important debate on an issue that is not well enough known or understood.
Tackling the over-consumption of antibiotics is one of the greatest health challenges of this generation. Alexander Fleming warned in 1945 that micro-organisms could develop resistance to antibiotics. Unfortunately his prediction proved to be correct. A report published by the World Health Organisation in 2014 said antibiotic resistance was now “a global threat”. The hon. Member for Strangford (Jim Shannon) described that threat to global security as being on a par with other, better-known threats. The US Centres for Disease Control have pointed to the emergence of “nightmare bacteria”, and Professor Dame Sally Davies has evoked parallels with the apocalypse. The hon. Member for York Outer mentioned that antimicrobial resistance is estimated to kill more than 700,000 people globally every year—a horrifying figure to us all, I think.
A number of hon. Members, including the hon. Members for Erewash (Maggie Throup) and for Cambridge (Daniel Zeichner), discussed the inappropriate prescription of antibiotics. The picture in Scotland reflects that in the rest of the UK. In 2014, 55,000 people—1% of the population—were taking antibiotics at any one time, and in up to 50% of cases, they were for conditions that would have got better without them.
Resistance is a natural biological phenomenon, but it is increased and accelerated by various factors, such as the misuse of medicines, poor infection control and global trade and travel. That is a particular concern with antibiotics. Many of the medical advances of recent years, such as organ transplantation and chemotherapy, need antibiotics to prevent and treat the bacterial infections that can be caused by the treatment. Without effective antibiotics, even minor surgery and routine operations could become high-risk procedures. The hon. Member for York Outer talked about a grazed knee becoming a serious condition, and I have personal experience of that, because a small cut to my knee did not respond to antibiotics, and I ended up in a serious situation, needing an operation and fairly strong antibiotics to save my leg. The situation we are talking about is a real one, and a major threat.
Inaction could mean the loss of effective antibiotics, which could undermine our ability to fight infectious diseases. The hon. Members for Poplar and Limehouse (Jim Fitzpatrick) and for Strangford both talked about TB, and the hon. Member for Poplar and Limehouse spoke of the high rates in his previous constituency. As he said, it is a devastating disease, causing 1.5 million deaths worldwide every year. Of most concern are the cases of drug-resistant TB that hon. Members have highlighted.
Action is needed at local, national and global level to improve the knowledge and understanding of antimicrobial resistance, to steward the effectiveness of existing treatments, and to stimulate the development of new antibiotics, diagnostics and therapies. The Scottish Government are taking the issue seriously. In March they announced a £4.2 million research grant to investigate the prevention and control of healthcare-associated infections, and to research new ways to use existing antibiotics more effectively and efficiently. The hon. Member for Strangford spoke about the use of antibiotics in farming and mentioned that some advances had been made in reducing their use. That is certainly positive and praiseworthy.
I welcome the UK Government’s focus on AMR, including the establishment of the independent review led by Lord O’Neill to explore the surrounding economic issues, and I look forward to seeing the review, which I hope will be published next month. It is important to acknowledge that we are simultaneously dealing with a health problem and an economic problem. The Association of the British Pharmaceutical Industry has argued that it would like a clear set of actions to be taken on developing new economic models, in particular through innovative pricing, and reimbursement mechanisms incentivising more investment in the search for new antibiotics.
There are many challenges in the current antibiotic funding landscape. The hon. Member for York Outer talked about the timescale for getting new treatments to market. I think that we would all agree that 15 years is far too long, in both economic and healthcare terms. The expected returns and associated risk with antimicrobials mean that they are not competitive with other therapeutic areas. New, innovative antibiotics often have a low price, as society expects generic antibiotics for treating large numbers of patients to be economical. The hon. Member for York Outer also talked about a fixed price for antibiotics, and perhaps that could be investigated further. The hon. Member for Cambridge talked about the drop in the number of trials of new drugs in the UK. We must ask what the reason for that is. Why cannot trials be carried out in the UK? We must look at the funding for that. I would like the UK to accelerate its leading role in developing solutions to incentivise the development and management of new antibiotics; that would promote investment in antibiotics as well as their appropriate use, and reduce the risks for both the payer and the investor.
Total antibiotic prescribing, measured using daily doses, continues to increase. The Scottish Government have been encouraging everyone to play their part by reducing the unnecessary use of antibiotics, raising awareness, and pledging to be an antibiotic guardian. That campaign aims to increase knowledge of antibiotic prescribing and resistance. It has reached more than 12,000 individuals in the first six months. Those were predominantly healthcare professionals, but everyone can pledge to become an antibiotic guardian at www.antibioticguardian.com. I did it earlier today, and I hope that many hon. Members will do so, too.
The hon. Member for Erewash discussed future public engagement work and how we raise awareness of antibiotic resistance. It is essential that we educate people about when and why antibiotics are needed. That should include helping patients to understand the duration of illness and alternative treatments for common viral infections, such as colds and flu, that do not require antibiotics.
In November 2015, Scotland’s Cabinet Secretary for Health, Wellbeing and Sport, Shona Robison, said that the rise of drug-resistant infections must be tackled around the world. She marked European Antibiotic Awareness Day by pledging to be an antibiotic guardian. The Scottish Antimicrobial Prescribing Group and UK partners have launched their target. Is the Minister willing to sign up to be an antibiotic guardian? When does he plan to launch his public awareness campaign?
It is a pleasure to serve under your chairmanship, Mr Evans. I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this extremely important debate, and on the knowledgeable and measured way in which he introduced it. I also commend his ongoing efforts to bring antibiotic resistance to the House’s attention since his election in 2010. As he said, he secured a Westminster Hall debate in October 2014 in which he called for co-ordinated action to be taken to tackle this issue. Today’s debate offers a valuable opportunity to take stock of progress since then, and to redouble our efforts to ensure that the right conditions are created to incentivise the development of the next generation of antibiotics.
The hon. Gentleman rightly said that something as minor as a grazed knee could claim lives. It is difficult to comprehend how that could happen, but there is a real risk that incidents of that sort will become commonplace in future. He cited the staggering statistic that of the 20 pharmaceutical companies that were originally developing antibiotics, only four are now in operation. He highlighted the tension between the need to encourage innovation and the financial uncertainty in this area of research. He also gave some interesting facts about regional variance in antibiotic prescription, about which I would like to learn more after the debate.
It was a pleasure, as always, to hear from my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick). He discussed tuberculosis from the perspective of both a member of the all-party group on global tuberculosis and the representative of a constituency that historically had severe problems with TB. He highlighted the increasing incidence of drug-resistant TB, and raised important questions that I look forward to hearing the Minister answer.
The hon. Member for Erewash (Maggie Throup) discussed the obstacles to the development of new antibiotics and the issue of inappropriate prescribing. She made a fair analogy with road deaths, as did my hon. Friend the Member for Poplar and Limehouse. The hon. Member for Strangford (Jim Shannon) made a valuable contribution. He was right to acknowledge and encourage the political leadership that is needed on this issue. He also made an important point about the side effects from treatments.
It was good to hear from my hon. Friend the Member for Cambridge (Daniel Zeichner), who brought a great deal of knowledge from his constituency and revealed the alarming statistic that the UK has gone from having 6% of the world’s clinical trials in 2010 to just 2% today. He echoed Jim O’Neill’s comments about pharmaceutical companies needing to look beyond the short term; I think we would all agree that that is an important challenge that we face. He also stated clearly that he believes that more should be done to encourage research and development in this country. We have been a leader for many years, and it would be a real shame if that position was under threat.
The debate is timely, as the Government-commissioned review on antimicrobial resistance is due to report next month. I pay tribute to the huge amount of work that Jim O’Neill and his team have undertaken. I hope that the conclusions of the review will lead to the far-reaching changes that we know are necessary, both in this country and around the world. Antibiotic resistance has been described by the World Health Organisation as the
“single greatest challenge in infectious diseases today, threatening rich and poor countries alike.”
The hon. Member for York Outer referred to the future as a nightmare scenario, and the WHO has also said that if we fail to act on antimicrobial resistance, by 2050 an additional 10 million lives will be lost each year to drug-resistant strains of malaria, HIV, TB and certain bacterial infections, at a cost to the world economy of $100 trillion.
As Dame Sally Davies set out in the foreword to the “UK Five Year Antimicrobial Resistance Strategy 2013-2018”:
“The harsh reality is that infections are increasingly developing that cannot be treated. The rapid spread of multi-drug resistant (MDR) bacteria means that we could be close to reaching a point where we may not be able to prevent or treat everyday infections or diseases.”
Despite that, so far, drug-resistant bacteria have not had anything near sufficient attention in terms of medical research.
It is easy to forget that it was less than 100 years ago that Alexander Fleming discovered penicillin after a piece of mould contaminated a petri dish at St Mary’s hospital, and it was not until the 1940s that the true era of antibiotics began. Despite an exponential increase in the use of antibiotics and an increasing awareness of the threat posed by antimicrobial resistance, since the year 2000 just five new classes of antibiotics have been discovered, most of which are ineffective against a number of resistant strains of bacteria, including Gram-negative bacteria.
We need to take a wide variety of steps to get to grips with the problem, including, of course, looking at how we address the long-term decline of the pipeline for new antibiotics through incentivising research and development, which I will come to shortly. We must also improve our focus on disease prevention, improving surveillance over drug resistance and tackling unnecessary antibiotic consumption. I will briefly address each of those matters in turn.
First, disease prevention, particularly in hospitals and care environments, is vital if we are to tackle antimicrobial resistance. Around 300,000 people a year get an infection while being cared for by the NHS in England—that is one in every 16 people treated by the NHS. As the Royal Society for Public Health said,
“it is alarming that the very place you would expect public health to be a high priority remains a breeding ground for life threatening infections.”
Despite improvements in recent years, the rate of healthcare-acquired infection in England has remained stubbornly high, while checks on compliance with hand hygiene best practice can only be described as inadequate. On 13 January, hand hygiene was the subject of a Westminster Hall debate, to which I responded on behalf of the Opposition. Will the Minister set out what additional steps have been taken since then to improve hygiene in all care settings? There is still a lot we can do to deny superbugs such as MRSA the opportunity to spread.
Secondly, we need to tackle surveillance blind spots in all parts of the world. As Jim O’Neill made clear,
“if we can’t measure the growing problem of drug resistance, we can’t manage it.”
We know that the technology exists to combine rapid diagnostics with data sharing, but we need to build consensus on precisely how that will take place. I would welcome any comments from the Minister on the steps being taken to improve surveillance, both in the NHS and internationally.
Thirdly, as the Science and Technology Committee found in July 2014, there is an urgent need to tackle unnecessary antibiotic consumption in healthcare and in farming, which is one of the key causes of antibiotic resistance. The Chair of the Select Committee at the time, Andrew Miller—my predecessor as MP for Ellesmere Port and Neston—called on the Government to take
“decisive and urgent action to prevent antibiotics from being given to people and animals who do not need them.”
Nearly two years on from that report, there is little evidence that such decisive and urgent action has taken place, or that all the Committee’s recommendations have been implemented. When the Minister responds, will he update us on what steps have been taken to reduce the unnecessary use of antibiotics? Although at the time of the report the Committee welcomed the launch of the O’Neill review by the Prime Minister, it cautioned against using that as an excuse or a reason to delay any progress. I hope the Minister will assure us that that has not happened.
The need to
“stimulate the development of new antibiotics, rapid diagnostics and novel therapies”
was one of the three strategic aims set out in the chief medical officer’s September 2013 report on the five-year antimicrobial resistance strategy. It was also one of the key recommendations of the Science and Technology Committee report. Although I welcome the renewed focus that today’s debate brings, I fear we are no closer to a solution than we were two and a half years ago. The barriers that existed to the development of new drugs have still not been addressed. I hope that today’s debate, and the final report of Jim O’Neill’s review, will provide the catalyst needed for meaningful action finally to be taken. As the hon. Member for York Outer said, a firm timetable from the Minister would be helpful.
The key issue is that in other medical fields, once a new drug is developed that significantly improves on previously available drugs, it quickly becomes the standard first choice for patients once it comes to market. However, as we have heard, a new antibiotic might not become the first choice until there was resistance to previous generations of drugs. Indeed, health officials logically seek to limit prescribing a new antibiotic drug, with the goal of delaying resistance for as long as possible. By the time that a new antibiotic becomes the standard line of care, many years or even decades are likely to have elapsed, bringing it near to or beyond the end of its patent life. If a company has spent tens of millions of pounds on its development, that would leave it unable to generate sufficient revenue and to come close to recouping its original investment. As the hon. Gentleman said, from that perspective, the system is certainly broken.
In the review, “Securing New Drugs for Future Generations: The Pipeline of Antibiotics”, Jim O’Neill suggests a number of interventions to tackle the systematic issues that prevent the development of new antibiotics. He says that those interventions, which require political leadership at a global level, have the potential radically to overhaul the antibiotics pipeline. Will the Minister assure us that the Government will do everything they can to secure an international consensus? We have been told by report after report over the past decade how important tackling antimicrobial resistance is. I am sure Members from all parties will agree that it is time we started to put those findings into action. If the Government do the right thing and take action, they will have our full support.
Members have talked about the challenges, which are on a par with climate change, global terrorism and various other apocalyptic scenarios. It is a sad fact that generally our constituents talk about these issues only when they become everyday concerns. If that happens with antimicrobial resistance, we will have failed. We are all committed to ensuring that that does not happen; we certainly have a duty to do so.
It is a great pleasure to serve under your chairmanship, Mr Evans. I believe we are expecting a vote, so my speech may be interrupted. I shall crack on, awaiting the bell.
I congratulate my hon. Friend the Member for York Outer (Julian Sturdy) on securing the debate and on the tenacity with which he has raised this issue in the House in recent years. It is a great opportunity to have this debate today, when so much is going on this week in London on international health leadership. My hon. Friend’s speech and the informed and constructive comments that he and others have made highlight how seriously this issue is taken throughout the House. Last Monday we had more than 60 Members of Parliament in this Chamber. The fact that we have a dozen today does not suggest that there is any less interest; many Members are tied up in other debates. I know that Members from all parties are concerned about this issue.
The debate is timely, because it coincides with a two-day international summit on antimicrobial resistance convened by the Wellcome Trust in London, which brings together a global gathering of scientists and policy makers to explore key areas for action. I thank the Wellcome Trust and pay tribute to it for its leadership. In so many areas of public policy, it has put its money and expertise to work for us. I also pay tribute to Jim O’Neill and his team, as others have done, for their work on the issue.
I will set out the context of the debate, as a number of other hon. Members have done. Antibiotics play a crucial role not just in human health but in animal health and welfare—my hon. Friend is a doughty campaigner for agricultural causes—and so are of great strategic interest in the wider field of biosecurity. We have seen the impact of diseases in domestic and agricultural poultry and in some of our tree species, and we are trying to view this issue in the wider global context of biosecurity from infectious diseases.
There have been some marvellous steps forward in addressing the use of antibiotics on poultry, as I indicated in my speech. Many people are trying to move that forward. If we take steps forward with poultry and other animals, we can transfer that work to humans too.
The hon. Gentleman makes an excellent point. As ever, Belfast University and the Northern Ireland life sciences cluster are doing good work in agriculture and in the medical space.
For the reasons that I outlined, the growth of resistance presents a genuine strategic global threat, which, as hon. Members from throughout the House have gratifyingly acknowledged, the Government have taken a strategic grip of. Globally, some 700,000 people will die this year because of antimicrobial resistance. In Europe, the healthcare and societal costs of resistance are estimated to be of the order of €1.5 billion per annum. That translates into a verifiable and measurable cost to the NHS of £180 million, but it may well be an awful lot more. Meanwhile, we face an antibiotic discovery void. The golden age of discovery ended in the 1980s. We have had very few new antibiotics since then and no new class since 1987.
I had a 15-year career in the sector and spent one chunk of it starting, financing and managing a small anti-infectives company that was spun out of Hammersmith and Imperial College and used some phenomenally powerful technology to look at the genetics of how microbes reproduce. We spent a lot of money on some elegant science, but we did not produce a new anti-infective. The truth is that these bugs are very difficult targets in biomedicine. It is difficult to go after the cell wall of Gram-positive and Gram-negative bacteria. Their ability to reproduce and develop resistance to drugs—they are moving targets, as it were—makes it particularly difficult to design effective drugs for them.
The good news—if I may put it that way—is that we can do things that will make and are making a real difference. The chief medical officer outlined the scale of the issue and its implications for public health in her 2013 annual report. She called for urgent action at a national and international level. The UK responded by publishing our five-year antimicrobial resistance strategy, the core aims of which were to improve understanding of resistance, to ensure that existing medicines remain effective and to stimulate the development of new antibiotics, diagnostics and therapies. Three years on, we have made considerable progress. We have put the building blocks for success in place, including better data, guidance and a strengthened framework—
Sitting suspended for Divisions in the House.
[Mr Philip Hollobone in the Chair]
I leave Mr Evans for five minutes and he transforms into you, Mr Hollobone. I am grateful for the opportunity to serve under your chairmanship.
We are three years into our strategy and we have put building blocks in place, including better data and guidance and a strengthened framework for antimicrobial stewardship. I want to highlight one or two areas of progress. The first is surveillance. The UK has one of the most comprehensive surveillance systems in the world. We collect baseline data from which antibiotic prescribing and trends in antibiotic resistance can be monitored, and we are continuing to improve those data so that we can identify problems early and take action.
Alongside that, we have published outcome measures against which the UK will assess progress, and we have produced a range of tools and guidance to support best practice on antibiotic stewardship. We have introduced incentives for the NHS to improve the prescribing of antibiotics and the quality of data, which will be supported and enhanced by a set of AMR indicators that will provide NHS teams with local data on infections, resistance rates and prescribing, so they can set their own ambitions to take action and drive improvement locally.
Of course, it is simply not possible to look at the challenge presented by AMR without examining it from a global perspective. AMR is a global problem and no one country can tackle it alone. The UK has played and continues to play a major part, if not the major part, in raising awareness and pushing forward international commitment and action, as several colleagues throughout the House have acknowledged. We sponsored the World Health Organisation’s 2015 global action plan on AMR, we created the £265 million Fleming fund specifically to help poorer countries tackle drug resistance, and we are promoting work on AMR through the G7, the G20 and the United Nations.
The other, perhaps obvious point to make is that there is no single solution to antimicrobial resistance. We must prevent infection, conserve the antibiotics we have, develop new diagnostics and promote the development of new drugs. The UK’s strategic approach rests on those pillars, and they resonate across the world.
I turn briefly to the Jim O’Neill review. It is widely recognised that the systems on which drug discovery and development currently depend cannot and will not deliver the new antibiotics the world needs. Hon. Members have made that point clearly. That is why my right hon. Friend the Prime Minister established the independent review. It has run for two years and has made a comprehensive and highly informed assessment of the AMR challenge. Hon. Members will have seen some of the authoritative and readable papers the review team has published, setting out its thinking on a number of key areas, stimulating debate here and globally, and paving the way for the final report, which we all await and which is due to be published next month.
Not surprisingly, research and development has received much attention from Lord O’Neill’s team. It featured particularly in their paper on AMR and the antibiotic pipeline, which appeared in May 2015. That paper argued for the establishment of a global payer fund and an innovation fund to boost funding for blue-sky research into antibiotic drugs and diagnostics. Elsewhere in their publications, the review team identify some of the neglected areas of research that they believe such a fund could help address.
The Government’s response to the review team’s work will rightly follow the publication of its final report, which we eagerly anticipate. In line with our manifesto commitment to take forward the review team’s recommendations, that response will be positive, ambitious and timely, building on what we have already achieved. We do not intend to delay in a sector that needs urgent action.
One reason why the review team published their series of thematic papers was to stimulate international debate. The value of that approach was made very clear when the President of China came to the UK in the autumn, which led to agreement on a joint UK-China innovation fund modelled on the very proposal that Lord O’Neill set out. We have committed £50 million to that fund and are now in discussion with the Chinese on how it can be taken forward. We hope at the end of it not only to have increased financial collaboration in antimicrobial research and development, but to have brought together the best research teams from industry and academia in the search for practical solutions.
The review explored how the disincentive to antibiotic research and development presented by the absence of a viable commercial market could be tackled. Hon. Members will know that, as I have painfully experienced in the industry, there is an irony in the anti-infectives field. If a new class of anti-infectives is developed, they will tend to be used as a last line of defence, so the level of usage is quite low and patent protection is often not as significant as is required or justified by other drug discoveries. The fundamentals are not the same with anti-infective drug discovery, which is one reason why the standard model does not work as well as in other areas.
The Government are convinced of the need to look again at how we fund antibiotic development, based on Lord O’Neill’s groundbreaking work. It seems clear from that work and other studies that a global solution will be needed, although I cannot, of course, pre-empt what Lord O’Neill will recommend.
Inevitably, global solutions take some time to come to fruition, and for that reason my officials have had meetings with a number of pharmaceutical companies, including AstraZeneca, to discuss alternative approaches to reimbursement. They include the insurance model and a number of others that have been widely discussed. Progress is being made and the discussions are continuing. We do not intend to allow the potential delay in global discussions to get in the way of this country taking all the steps it can to facilitate our leadership in this space.
Meanwhile, Government investment in antimicrobial-related research here in the UK continues to grow. The Medical Research Council funds an AMR research funders forum, which we established to co-ordinate research across different funding bodies. The forum has set up a number of AMR-themed research programmes, and its members have together allocated some £36 million to them. Themes include resistant bacteria and how they interact with their hosts, and projects to speed up the development of therapies and diagnostics. At the applied end of the spectrum, the National Institute for Health Research is funding health protection research units at Oxford and at Imperial College. An NIHR research call has led to the allocation of around £15 million in support of some 16 projects.
I want to reinforce the point made by my hon. Friend the Member for York Outer and others about the important role of charities—not just the Wellcome Trust, which leads, but in the sector in general. In my reform of the life science space, I have made a clear offer to charities to come to the top table as we set out the policy and reform landscape. Medical research charities in the UK now invest £1.4 billion in research every year, which puts them at the top table alongside the biggest pharma companies. I am determined to ensure that they have a voice in policy setting to reflect their increasing voice in the research landscape. We are especially fortunate in this country to have the Wellcome Trust, whose work this week is timely.
My hon. Friend referred to the Antibiotic Research UK charity, which has been set up in his constituency. It is very encouraging to hear about that initiative and its work and ambition. He has had meetings about it with the Minister with responsibility for public health, my hon. Friend the Member for Battersea (Jane Ellison), and with the Prime Minister, and is being typically diligent in ensuring that its existence and profile are raised. He knows that I cannot pre-empt the outcome of the O’Neill report, but it is incredibly encouraging to see a charity coming forward in this space. We look forward to continuing to work with that charity and others in our response to the O’Neill report.
Antibiotic Research UK is, understandably, enthusiastic about what it has to offer. My hon. Friend the Member for York Outer and other hon. Members will understand that the NIHR does not award research money by particular therapeutic area. There are good reasons for that, which I will not go into in the few moments I have left. We fund the infrastructure and are open to research bids, and I encourage that charity and others to put bids together in conjunction with industry. We stand ready to support them. I have no doubt that when we respond to the O’Neill report we will look at how we can do more to encourage and support those bids.
In the time remaining, I want to deal with some of the questions that have been asked. My hon. Friend asked whether I would meet Antibiotic Research UK. I would be delighted to do that. It would probably be sensible to do so with my hon. Friend the public health Minister after publication of the O’Neill report, but I am happy to meet them before that.
My hon. Friend made a point about the foreign aid budget. He and other observers will have noticed that in the autumn statement we announced yet more funding from the prosperity fund to go into global public health. Whether in relation to vaccines or anti-infectives, we are determined to ensure that our international development spend addresses global public health issues, and we are harnessing UK science to that end.
My hon. Friend made a point about Sweden. We are trying to strike a balance between global leadership and supporting global collaboration. My position on that, as on wider EU affairs, is that I am ambitious for the UK life sciences sector, ambitious for life sciences in Europe and ambitious for the European single market in a global race for investment. We need every collaboration network we can get.
My hon. Friend the Member for Erewash (Maggie Throup) mentioned diagnostics, and she was absolutely right. She brings to the debate her experience and professional background. Diagnostics are key, and there is some very exciting work in that field. It is fair to say that the diagnostics sector is probably ahead of the therapeutic sector on this one.
The hon. Member for Poplar and Limehouse (Jim Fitzpatrick) asked about the Ross fund, as did a number of other hon. Members. It is good to hear the level of support for the fund, which is aimed at developing, testing and delivering a range of new products, including vaccines, drugs and diagnostics, to help combat the most serious infections in low-income countries. My right hon. Friend the Chancellor of the Exchequer announced the Ross fund with added detail in January, with a portfolio of projects and programmes led by DFID and the Department of Health. The hon. Gentleman asked which Department is responsible for that, and I can confirm that it is the Department of Health through the health research budget and portfolio, for which I am responsible.
Time is against me, but I want to deal with the point made by the hon. Member for Cambridge (Daniel Zeichner) about clinical trials. As a result of an awful lot of hard work across the Department, led by the chief medical officer and the NIHR, we are turning the corner on trials—we got recruitment to trials in the NIHR clinical trials network up from 200,000 to 600,000 last year. We are starting to see an increase in the number of first-in-human trials globally, which is an indicator of cutting-edge clinical science, and we have reduced the rate of time to first patient recruitment. We are never complacent—there is more to do—but we are turning the corner on global trial recruitment.
I believe that 2016 is set to be a critical year for the AMR challenge. The O’Neill report is shortly to land, as is my accelerated access review. We have secured a historic science budget for capital and revenue and a series of initiatives in global public health. We are well placed to convene and pull together that international leadership and ensure that British science is leading in what is ultimately, and needs to be, a global endeavour. I look forward to Lord O’Neill’s report and to working with colleagues across Government to implement it as speedily as we can to ensure that the momentum is maintained. I want this country to lead in what must ultimately be a global effort to find models to ensure that we bring all our science to bear to generate new diagnostics and new treatments. We must prevent the appalling situation, which a number of us have discussed today, of antimicrobial resistance becoming one of the great scourges of the 21st century.
I thank the Minister for his comments. He is absolutely right to say that 2016 is a crucial year. There have been many detailed and thoughtful contributions this afternoon, especially about the devastating impact of TB and drug resistance. I want to finish by going back to the firefighter analysis, just to please the hon. Member for Poplar and Limehouse (Jim Fitzpatrick). If we have a chip pan fire, we put it out to prevent a house fire. Antibiotics put out the chip pan fire by preventing the spread of infection, but they also go on to prevent a house fire, because without them we would have widespread outbreaks of infection. Without antibiotics, we could have widespread outbreaks running right across the country, uncontrolled, like wildfires. As many hon. Members have said, a world without antibiotics is a very—
Motion lapsed (Standing Order No. 10(6)).
I beg to move,
That this House has considered quiet cities.
I am grateful for the opportunity to speak on this topic; I believe this debate is a parliamentary first, certainly in the UK. There has been much debate in this place and outside, and within the legislative process in this place and outside, on green cities and smart cities in recent years. I am delighted that the Minister will answer the debate on behalf of the Government, though I am not sure whether he is delighted. He has clearly drawn the short straw today, but he has, I think, an appreciation of the aesthetics of politics.
In Shropshire, we do not have large cities—in fact, we do not have a city, and I hope that we will not have a city—but we do have slow towns. We have in the county the slow town of Ludlow, just a few miles from my Shropshire constituency. However, there has been very little public discourse or political dialogue about quiet cities—making our cities and towns quieter, and in so doing, improving the quality of life for millions of city dwellers.
Noise pollution in UK cities is becoming a greater problem, and loud cities do have an impact on the quality of life of millions of people. They also have an impact on our health. A scientific report by Chalmers University of Technology in Sweden suggests that prolonged exposure to high noise levels can be associated with elevated blood pressure; an increased heart rate; sleep deprivation; in extremis, hearing loss; tinnitus; cardiovascular disease; and cognitive impairment. The US Centres for Disease Control and Prevention estimate that 20 million US citizens struggle with tinnitus at some point in their lives. A 2011 report by the World Health Organisation concluded that noise pollution is a direct threat to public health. Further symptoms of exposure to noise pollution include constriction of blood vessels, unhealthy tightening of muscles, and increased anxiety and stress.
What can be done? According to the World Health Organisation, national Governments, local authorities and urban planners can take some relatively low-cost action. In the case of the United Kingdom or England, that could involve Highways England and local highways authorities and agencies procuring better low noise emission road surfaces; quieter pavements; designing cities to encourage more safe use of bikes and pedestrian areas—I recognise and am glad that the Government are doing a lot in that area—encouraging the building of noise buffers when new environments are being built, which would involve landscaping and tree planting to alleviate noise; ensuring that all new public transport systems are as quiet as possible; and Government and local authorities asking, “Does this new bus or train service reduce noise in this particular city; does it make a difference?” For example, in relation to the train operating companies, let us take the Virgin Pendolino train, which I know the Minister literally takes, as do I. People will notice the difference between the Virgin Voyager train and the Virgin Pendolino. Modern technology can make a difference; making the right choice can make a difference.
Many of the WHO recommendations complement the Government’s targets on climate change, but the right to some respite from constant noise needs to be a central feature of Government policy—part of their strategy—not a by-product or consequence of another Government policy.
My own observations are these. The Government should work with motor manufacturers to encourage all cars and vehicles to have linings that stop the doors making a noise when they are slammed shut. A simple rubber lining would make a huge difference; metal on metal makes noise. Slamming doors are even an issue in the House of Commons. Where the doors are lined, they close quietly; where they are not lined, they slam and create noise pollution.
Emergency vehicles should reduce the use of their very loud sirens after midnight. The blue flashing lights are enough to alert people to their presence in the dark. Of course discretion should be allowed. That is an issue even when walking down the streets here in Westminster. The ambulances are going out to save lives; we respect that and recognise it, and they have to get through heavy traffic. But some of the sirens are so ear-piercing compared with those of other emergency vehicles. Ambulances do seem, anecdotally, to be far louder than police vehicles. Perhaps there is a reason for that, but do the sirens need to be used after midnight when the blue lights can be seen? That is a public debate I think we should have, because it does impact on people’s lives in cities and towns up and down the country.
Perhaps we should put polite notices on public transport systems. We cannot compel people to do things, but we can encourage people, through polite notices, to set their phones to vibrate or silent, as I know you do from time to time, Mr Hollobone, when you are in the Chair. I hope that we all have our phones on silent or vibrate at the moment.
There needs to be a national conversation about how to make the country—our cities and towns—quieter. We could even use polite notices about loud conversations on telephones, which I am sure have been an irritant to us all. I confess that I probably have had such conversations myself. I should do so less, and now that I have made this speech, I probably will. [Interruption.] I have proved my point, because the phone of one of the officials has just gone off. Although it is a nice tune and not an irritant, it should be on vibrate or silent. The point is that noise pollution has an impact on and makes a difference to our lives every day.
What about urban design? The concept of green buildings and skyscrapers has been around for some time. We need to encourage that more. Many years ago, a friend of mine whom I have not seen for some time—Dr Kenneth Yeang, a Malaysian-based, but Cheltenham College and Cambridge-educated green skyscraper architect—was one of the originators of green design, by which natural air cooling, instead of costly and noisy air conditioning units, is built into the building.
Space should be designed with sound in mind, so that we reduce noise pollution. Utility companies should be made to replace manhole covers in a way that does not increase noise. Loose-fitting metal covers crack or clank every time a vehicle goes over them. As hon. Members walk down the street tonight, they might hear that same noise. Imagine being an office worker or somebody living nearby, hearing that clank every few seconds on a busy road. Very low-cost, simple measures can be put in place. These problems are a noise nightmare for many local residents and office workers in this city, and in many towns and cities around the country.
A social survey by the City of London assessed that general attitudes to noise suggested that alarms and aircraft noise are the two most common causes of noise complaints. I will not comment on aircraft noise today, as that has been done many times in this place and, no doubt, will be done again. I do not want to be drawn into the third runway debate. Nevertheless, the Government can work with the security trade bodies to seek out ways of countering noise pollution from alarms. They can also recognise and work with what aircraft manufacturers are doing do reduce noise from aircraft.
The Government—the Department for Business, Innovation and Skills and other Departments—could work with car manufacturers to encourage the increased production of low-noise tyres, and the Department for Transport and the Department for Communities and Local Government could do more to work towards procuring silent road surfaces. I pay tribute to the Transport Secretary, who has done a lot in that area, but I hope the Government can do more. The silent road surface that covers some parts of the M54 in Shropshire has made a real difference to the quality of life of my constituents and those transiting through the constituency—both those inside and outside vehicles. Let us move towards that nationally, and make a national difference, not just a local one.
The Government could get London black cabs to convert to quieter vehicle models. I believe that that is in the Mayor of London’s strategy. I live in London as well as in Shropshire, and there is a big difference between a London black cab going by, accelerating, puffing out lots of diesel and making a noise, and the cars of the much criticised Uber drivers. I am not here to promote Uber, but most Uber drivers drive electric vehicles that are greener, cleaner and quieter. When they accelerate off, they can hardly be heard. They are making a difference. The cab trade in London generally needs to work towards using more environmentally friendly and quieter vehicles. That is the point of the debate.
Another example is the London Duck Tours. Has anyone seen the London Duck? It is a converted military vehicle that is so noisy and polluting. Throw on top of that the microphone of the person talking about the delights of central London, and it makes a real disruption to the lives of residents not only of central London in SW1, but of SE1, down in Vauxhall. Such things can be changed. It would not be of huge cost, but it would be of great benefit to many people.
A website that I read stated:
“Motorcycle owners value the loud revving noise produced by their engines: this noise is part of what completes the experience of riding vehicles.”
Does the hon. Gentleman agree that that sort of inconsiderate and selfish behaviour does not do sensible motorcyclists any good?
I have ridden a motorbike and I like riding motorbikes, albeit mostly abroad rather than here, although I have friends that ride motorbikes here. Modifications that make motorbikes or other motor vehicles noisier is inconsiderate, but as long as those motorcycles abide by the environmental guidelines and the manufacturer’s model, I do not have an issue with that. I am conscious of the time, so I will have to speed up.
City and town planners should noise map their cities in more detail, creating anti-noise or counter-noise policies. There should be more enforcement by local councils, DCLG and other Government Departments. The national planning policy framework should include a requirement for new home builders to factor noise abatement into their designs—for example, no wooden floors in apartment blocks unless they are on the ground floor. People walk on wooden floors without carpets and it hugely stresses people in apartment blocks.
We should introduce a quiet homes standard and a single national acoustic standard across all new home building, and encourage the Royal Institute of British Architects, working with the Institute of Acoustics, to include training modules on acoustic design in all architect training courses. Certainly all public buildings should meet a minimum noise requirement, especially schools and hospitals where, perhaps, noise pollution creates the most anxiety and disruption. Public buildings should also seek to work towards a quiet mark—the international eco-award scheme for excellence in designing quiet buildings and products.
If central Government and local government cannot move quickly towards having quiet buildings, perhaps we could have quiet policies. That could be done in quite a short space of time. Within some of those noisy public buildings, quiet policies could be implemented and achieved much more speedily and readily. I ask the Government to do more to work with organisations such as the Noise Abatement Society and Environmental Protection UK to help to reduce noise in towns and cities. The police should do more to take action against motorcyclists or vehicle drivers who increase noise by illegally modifying their vehicles. We need to update our environmental laws and the Noise Abatement Act 1960 to recognise new generators of noise pollution, with a defined schedule for offending and common noise pollutions in cities.
Noise, not sound, is an unnecessary form of negative energy—a negative vibrating energy that reaches our ears and causes a sensation of hearing through our nervous system. It is that direct kinetic energy that can, so significantly, have an impact on the quality of life of millions of people in the country. The national nervous system is being attacked every day. Silence matters, and the Government need to recognise that there is a huge difference between sound and noise. Noise is unwanted. Sound, such as that of nature, birdsong in the morning, or even church bells—although some people do not like bells—may be wanted. However, the illegal hooting of horns and overly loud emergency sirens create stress.
Calm matters. It is possible to work towards quieter cities, but unless there is an overall national strategy led and implemented by the Government, local councils and other public bodies, it might never happen. In our increasing technological advancements, let us not shut out silence, time to think and an alternative to noise. My call today is quite revolutionary—a vision for cultural and political change in the built environment of cities and towns—but I believe it would be almost universally popular. It would have a huge positive environmental impact and huge health benefits.
Change can come. My ambition is for London to become the quietest city in the world. It is a big vision, but a big city needs a big vision. With the Government leading, let us all work together towards quieter cities and quieter lives. The one sound that people want to hear in the city is the sound of silence.
It is a great privilege to serve under your chairmanship, Mr Hollobone. It is also a great privilege to respond to the speech by my hon. Friend the Member for The Wrekin (Mark Pritchard). I pay tribute to him for raising quiet cities, a striking and original subject that has not previously come across the Department for Environment, Food and Rural Affairs desk.
Quiet cities are interesting because, as recently as the 1960s, noise was not considered within Britain’s policy framework. In fact, a man called John Connell, an earlier incarnation of my hon. Friend, made it his personal campaign to put noise on the agenda. He led a great campaign, which began by addressing the issue of noisy dustbin lids. His big thing was to introduce rubber dustbin lids, instead of metal ones. His next revolutionary move was to introduce rubber milk bottle stands, so that people were not woken in the morning by the milk being put on their doorstep. He became interested in the issue of airport noise, and he was the first great champion of what is now known as the Boris island project—he tried to get the Japanese to buy into the estuary island. He succeeded in making the British Government and British law take noise more seriously. I am sure that my hon. Friend’s efforts, following that great tradition, will inspire us to look at quiet cities.
Although quiet cities have not previously been done in Britain, as my hon. Friend says, we have green cities, smart cities and slow towns. Yinchuan, in north-west China, is an example of a quiet city, as are Brisbane in Australia, and Hartford in Connecticut. Those places have tried to brand themselves around the idea of peace and silence, as has my hon. Friend. The website of Brisbane, Australia, for example, lists a series of things that are prohibited, all the way from A for air conditioners to R for refrigerators, with dogs sitting at D.
The Government are engaging with the idea, but it is a local authority lead. It is important that the idea of a smart city, a green city or, in this case, a quiet city is locally driven. It is about how an area brands itself and thinks about itself and what its values might be. Someone like my hon. Friend can inspire a city or a town to take that lead, and I know that he has been having conversations with the candidates for Mayor of London about how the idea could be part of the agenda for London. Our colleagues in the Department for Communities and Local Government have proposed coinciding the idea of pocket parks and green areas in cities with the idea of quiet areas, where there would be prohibitions on creating noise.
As the hon. Member for Bootle (Peter Dowd) suggested in his intervention on motorcycles, there are a number of difficult balances to be struck: one person’s noise is occasionally somebody else’s joy; one person’s noise may be somebody else’s music; one person’s noise may be somebody else’s supercar; and one person’s noise may be a vibrant city. We have to balance such things, and we have to get that balance right, which is why local leadership and local ideas will be important.
The Government have adopted a number of measures over the years to address noise, and I will tick off some of the issues that have been raised. On railway noise, there has been a massive rail grinding programme across the country, which is primarily for public safety and energy but is also significantly reducing the decibel levels created by trains. We have heard a little about laying new road surfaces, and we now have a £300 million programme, of which a significant proportion will be directed towards reducing noise and new highway roll-out. We have Euro 6 standards for engines, which will reduce the decibel levels created by individual engines. We have product standards, so when people go into a shop and buy, for example, a lawn mower, they will be able to see how many decibels that particular lawn mower emits. We have building regulations that have reduced the amount of noise emitted in the construction of hundreds of thousands of houses, as well as reducing the amount of noise heard by people inside by moving bedrooms away from the front and by installing triple glazing.
All of that reflects the common understanding in this room that noise matters. Why does noise matter? We put a value of approximately £6 billion to £7 billion a year on the damage done by noise to health and quality of life. That will remind hon. and right hon. Members of the kinds of calculations we do on air pollution, which causes some £14 billion or £15 billion a year of damage, but in fact noise is different from air pollution. Air pollution, as the hon. Member for Hackney North and Stoke Newington (Ms Abbott) has said in a previous debate, is a silent killer; people are often barely conscious of it.
Noise pollution causes significant health damage, largely driven by the effect on sleep and the stress that comes from loss of sleep. My father was severely deaf, and I was in a meeting this morning with a man who, through driving a vehicle in the 1960s, lost 70% of his hearing. He pointed out that the NHS spends £1,000 a year buying him new hearing aids. He sees three consultants a year, and the batteries of his hearing aids have to be replaced. His productivity in the workplace has been significantly affected by the fact that he cannot hear anything in meetings. The decision in the 1960s to save £500 by not putting a silencer on that vehicle has probably cost the public purse £20,000 or £30,000 over the life of that individual. There is not only a health impact; it is irritating, distracting, frustrating and infuriating to be disturbed by noise when tranquillity is at the core of what we care about.
We can talk in the abstract, but in my constituency the A5036, which leads down to the docks, is very loud. About half a dozen households on that road have been trying to get Highways England to provide acoustic amelioration. Will the Minister have a word with his colleagues in the Department for Transport and try to get Highways England to pull its finger out, if possible?
I would be delighted to set up a meeting with transport colleagues on that issue, which I thank the hon. Gentleman for raising. That issue is a microcosm of the issues that we are facing across the country, and there is often a difficult balance to be struck. We want infrastructure, we want roads, we want railways and we want planes, but all of our infrastructure, all of our communications and all of our industrial heritage are causing noise issues.
I realise that the Government and local councils cannot do everything. Local council finances are being pressed, and we know the reasons and the background, but we can encourage a change in behaviour by incentivising councils, and by rewarding new home builders by giving them recognition, such as a quiet mark or the environmental awards that they seek. Government Departments and local councils should be leading nationally on setting the standard for quiet mark awards. Does the Minister agree?
My hon. Friend is in tune with a whole movement. He will be aware of the Noise Abatement Society, which now runs the annual John Connell awards. I am proud to have participated in those awards for two years in a row. They are a fantastic initiative, doing exactly what my hon. Friend is pushing for. We can probably work with the Noise Abatement Society, which has a lot of innovative ideas, on taking the awards further.
We are also making a large £600 million investment in developing ultra-low emission, particularly electric, vehicles, which will make a revolutionary difference. In fact, one of the issues with electric vehicles, of which colleagues will be aware, is that some people feel that they may be becoming dangerously quiet as they move through the streets. Huge progress can be made on electric vehicles, and we have new funds available to lay quieter roads in future.
I finish with a tribute. Parliament, and Westminster Hall, is a peculiar place. It is often difficult to work out how to come up with and drive through inspiring new ideas, and I pay tribute to my hon. Friend for the novel idea of the quiet city. I encourage cities and towns across the country to think seriously about how different towns, ranging from Yinchuan to Hartford to Brisbane, have managed to create a culture around tranquillity, and the ways in which British towns and cities could take the lead in creating such a culture. In doing so, they would be accepting that from the very beginnings of human language, perhaps the most fundamental word—spiritually, emotionally and physically—has been the concept of peace.
Question put and agreed to.
Social Security (Equality)
I beg to move,
That this House has considered the effect of social security changes on equality.
It is a great pleasure to serve under your chairmanship, Mr Hollobone. When the benefits system was established, it had a couple of main aims: to provide a safety net for people in work if they lost their jobs, and to provide a springboard back into employment. Surely no one could argue with those aims; they both remain relevant today. To listen to Government rhetoric, hon. Members would be forgiven for thinking that all was fine and well, but there are two other principal aims of the system that I believe should also be considered. One is surely to give comfort and dignity to those who are unable to work for themselves, and the second is to use the levers of government to reduce inequality and make ours a more equal society.
I start by asking the Minister this: is it this Government’s view that it is their role to use the tax and benefits system to achieve a more equal and less extremely divided society? Taxation can be used to raise revenue and to nudge citizens’ behaviour—through, say, taxes on alcohol, tobacco or even sugary drinks—but also to level off the harshest divides by supporting those who cannot support themselves. For all this Government’s rhetoric, the UK is at best as unequal now as it was at the start of this decade, and according to the Institute for Fiscal Studies, it is likely to become more unequal towards the end of the decade. Perhaps that is acceptable to the Government. If the Minister concedes that equality is not a top priority, that is fine; we can accept his honesty and have a difference of opinion.
We have heard that the recent Budget will impact women most harshly, and there is still no fair transitional pension settlement for the 1950s women affected by pension changes. Young people are excluded from housing benefit and from the so-called national living wage—although, to be fair, as it is not actually a living wage, that is not much of an omission. Scandalously, state support for those affected by contaminated blood transfusions is being slashed. However, with your permission, Mr Hollobone, I will focus on the combined impact of changes to the benefits system on people with disabilities.
The Government have sought from the outset to justify cuts to benefits by demonising claimants, introducing a them-and-us atmosphere and creating a stark but false division between—in the Prime Minister’s words—shirkers and strivers. Or was it skivers and strivers? I cannot remember the exact words, but the sentiment is the same. Let me make it clear that I have absolutely no time for those who can work but do not, relying on everyone else’s work but not contributing themselves. They should be dealt with individually. However, those people are a tiny minority. Around 0.3% of the total benefits bill is spent on out-of-work benefits to those who could be working—the real shirkers or skivers—yet the Government have tarred all claimants with the same brush. I believe that they have done so deliberately, to make cuts to support for disabled people more palatable to the general public.
Nobody chooses to have a disability. Nobody chooses to have a long-term debilitating illness. I can guarantee that every single one of the people whom we are talking about would rather not be in the situation that they are in. People have disabilities for a variety of reasons, including genetic defects, pre-natal or ante-natal complications, serious illness and accidents. However, one common factor runs through all of those situations: blameless misfortune, or bad luck. It is surely the duty of the modern, compassionate state not to compound that bad luck, but to compensate for it.
Scope’s extra costs commission estimates that disabled people face average extra costs of £550 a month due to their disability. The personal independence payments system introduced to address those additional needs is failing. The extra costs are not being met, claimants are routinely being turned down, and 60% are being reinstated on appeal, but in the meantime, their worry and debt are growing exponentially.
This week I spoke to a constituent of mine, Kevin, whose wife has kidney failure and is on dialysis, as she has been for several years. It is unclear why she has kidney failure, though it could be linked to complications at the birth of her children. She receives dialysis in the morning, has something to eat and then goes to bed and sleeps until the next day. There is no possibility that she could hold down a job, and the support that she receives from the state is essential, yet when she applied for PIP after moving over from disability living allowance, she was turned down. My constituent is appealing the decision, which of course takes months. In the meantime, she and her family are being driven further into poverty, and probably into debt.
That brings me to my next main point. When PIP was introduced in the Welfare Reform Act 2012 to replace disability living allowance, we were told that it was to ensure that benefits were focused on those who needed them most. Indeed, the impact assessment for the 2012 Act said that under PIP, the number of claimants would fall by 500,000. I understand that it was designed to deliver a 20% cut to the total cost.
The Prime Minister expressed surprise and disappointment when the former Secretary of State, the right hon. Member for Chingford and Woodford Green (Mr Duncan Smith), resigned this year. Does my hon. Friend not think that if the former Secretary of State believed in what he was saying about disabled people being affected, it would have been more appropriate for him to have resigned when he introduced PIP to begin with?
That certainly would have prevented a lot of heartache and difficulties for those who have been affected. My hon. Friend, who sits on the Select Committee on Work and Pensions, is an expert in this area, so I will take his word for it.
On his recent appointment, the new Secretary of State immediately used the justification of focusing benefits on those who need them the most. I admit that even previous Labour Governments have used that as an excuse. However, I believe that it is a bogus argument, and a sham to give cover to further cuts. Why should a disabled person placed in the group of greatest need when PIP was first introduced suddenly be deemed not to be in the greatest need, just a couple of years later? Are the Government seriously suggesting that someone with a lifelong disability or chronic illness can be cured of that disability? Why is my constituent who is on dialysis with double kidney failure suddenly considered not to require PIP, when there has been no change in her condition and she has not yet received a transplant?
The situation does not only economic harm by forcing the vulnerable into even greater poverty, but psychological harm by increasing their stress, and their worry that their lives will be further impoverished by reductions. My constituent Lynda Hesketh, who is wheelchair-bound and who runs the Chester People Have Abilities group, describes to me her terror—that is her word—whenever a brown envelope drops through her letterbox; she worries that it is announcing a further cut to her support.
Of course, many people with disabilities want to work and are capable of doing so, but they face cultural or physical barriers. The Government have made some progress in helping disabled people into work, but the disability employment gap has nevertheless widened slightly in recent years.
Does my hon. Friend agree that having listened to the debate about quiet cities, we should listen to the quiet man, the former Secretary of State for Work and Pensions, who was scathing about the current Government’s policies in this developing area?
We should listen to him. As my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle) mentioned, it might have been more help if he had spoken up a little sooner, but none the less, better late than never. The advice that he gives is absolutely valid.
Of the 12 million people in the UK living with a disability, impairment or chronic illness, around 7 million are of working age. We know that 47% of working-age disabled people are in work, compared with almost 80% of working-age non-disabled people—a disability employment gap of more than 30%. That is important because it indicates not only the waste of the potential talent of disabled people who want to get into work but the fact that those forced off PIP and other benefits will have far less opportunity to make ends meet through their own efforts than through benefits. I welcome the Government’s determination to address those issues in the forthcoming White Paper, and I hope that the Minister might be able to give us a sneak preview today if at all possible.
I turn to employment and support allowance. The Government’s stated aim was to ensure that work became a way out of long-term illness and that benefits were focused on what a person can do as opposed to what they cannot do. That is all very laudable, of course, but again the reality was detached from the rhetoric. As the Work and Pensions Committee recognised, the focus on a return to work in such a short time was not appropriate for many claimants, and the work capability assessment failed to provide an accurate assessment of a claimant’s individual health-related employment barriers or distance from the labour market.
Through announcements by Lord Freud, the Government have now moved to make additional cash available to help disabled people return to work. That indicates that they accept that there was and remains a problem. Indeed, the Government’s intention to produce a White Paper, which I have just referred to and which is keenly if nervously awaited by disability charities and campaign groups, demonstrates that there is still a way to go.
Chester was one of the first areas to move to universal credit. We now hear that further cuts to the universal credit rate are likely to be coming down the line, to make up for the cost of the Government’s U-turn on tax credits. Such cuts will inevitably have a still further impact on those at the bottom of the pile. Indeed, from its inception, universal credit included the abolition of the severe disability premium of £61.85 a week, which was a massive and largely unpublicised cut in the benefit levels of the most severely disabled people, although, to be fair, it was mitigated by a degree of transitional protection for existing recipients. Consequently, many of the effects of the changes to universal credit are yet to be seen.
That brings me to my main point. With the combination of the changes to PIP, universal credit, ESA and other benefits, disabled people in particular are experiencing increasing insecurity and inequality. The effect on them and their friends and families is becoming tangible. We talk about the cutting of individual benefits, but when a combination of cuts falls on individuals or families, that has a greater effect. I therefore make one further request to the Minister, which is that the Government consider instituting a cumulative impact assessment to evaluate the overall combined consequences of the many different changes.
I will finish with two brief quotes. The first is somewhat truncated and is from July 2009:
“I do believe that you judge a society by the way it treats its most vulnerable… together we can create a society we are all…proud of.”
That was said by the then Leader of the Opposition, who is now our Prime Minister. Sadly, those pre-election words have come to nothing, as shown by my second quote, which is from Richard Atkinson, a disability rights adviser at DIAL House, which is Chester’s disability rights centre. He says:
“What we do know though, is that the barrage of cuts and their accompanying media offensive—orchestrated and encouraged by the government—have had a real effect on the security, self worth and confidence of millions of disabled people. Here at DIAL West Cheshire, we see people every day who have become frightened and apologetic about their disability. They say to us, ‘I’m not one of these scroungers but...’, and they are afraid of being judged, reassessed and found wanting. I myself have MS and can’t walk well—but can and do cycle albeit on a tricycle. As well as being apprehensive about being transferred from DLA to PIP, I have had to become inured to comments like, ‘Why’s he carrying a crutch if he can cycle—to get benefits!’”
It is time for Government rhetoric and philosophy to change, to create the caring society that the Prime Minister claimed he wanted to see. It is time to treat disabled people with a dignity not currently afforded to them either in the benefits system and the process for accessing benefits or in the wider cultural context in which they live and we operate. It is time to take away the sword of Damocles that is dangling above people who live every day with a disadvantage simply because they have been unlucky in life.
We now have until 6.14 pm. When we get to the Front-Bench speeches, the recommended time limits for an hour-long debate are five minutes for the Scottish National party, five minutes for the official Opposition and 10 minutes for the Minister.
It is a pleasure to serve under your chairmanship, Mr Hollobone.
I had not intended to speak in this debate, but unfortunately my hon. Friend the Member for Glasgow South West (Chris Stephens) was called away and he has left me a pile of unreadable notes here, which was his speech. So I am sorry that I will not be able to read what he wanted to say—
They could be in any language—I am not quite sure.
This opportunity to speak about the effect of social security changes on equality gives me the chance to mention something that I have mentioned several times before in the House, which is the impact on women of the proposed benefit changes, with particular reference to the two-child policy in tax credits and the rape clause that the Government have proposed. I have raised the two-child policy on several occasions; I am not sure whether I have yet raised it directly with the Under-Secretary of State for Disabled People, who is here today, but I am certainly yet to have an answer from the Government on it.
The two-child policy in tax credits perhaps sounds like a reasonable idea—people should not have unlimited access to benefits, and they should have the children that they can afford. However, that is not actually how life works or how families work. The policy does not really take into account the fact that someone may have had three or four children at a time when they could well afford them, but then real life gets in the way and they lose their job or their partner dies or takes ill. There is no means of recognising such a change in circumstances within the tax credit system. The system simply says that the benefit is calculated on the first two children somebody has, which, as I said, does not take into account how real life works.
With regard to equality, the policy does not take into account the impact that there might be on people of particular faith backgrounds, for whom larger families would be the norm. Those people may choose to have larger families because of their religious beliefs, and the policy has not been tested in that regard either. The Government have not done an impact assessment of the policy’s effect on people of a particular religion—be they Orthodox Jews, Catholics or Muslims—who may wish to have larger families for historical reasons. They have not taken that issue into account.
I also believe that the two-child policy does not take into account our obligations under the UN convention on the rights of the child, because it does not treat all children within a family equally. It says that the first two children in a family are somehow of greater value to the Government than the others. I believe that we should support all children within a family and make sure that each of them has enough to live on.
On the subject of the inequality of treatment under the two-child rule, does the hon. Lady note the contrast between what is happening on tax credits and the childcare element of universal credit, which are to be limited to two children, and what is happening on childcare allowances? The latter are to be paid for as tax allowances of up to £2,000 a year, or up to 20% of £10,000 costs. They will go to better-off families, will not be limited by a two-child rule and will be bankable allowances, unlike what people will get under the childcare element of universal credit.
I absolutely agree with the hon. Gentleman. There are a great many inconsistencies within the policy and a great many unanswered questions about it.
The rape clause puts particularly vulnerable women in an extremely difficult position, because the Government do not seem to realise that rape can happen within marriage as well as outside marriage. A woman may be in a relationship where she cannot tell the police about a rape, and no proof that she was raped can be found, but the Government somehow expect her to nip down to the benefit office and say, “Oh, this third child that I’d like to claim benefit for came about as the result of rape.” That is not something that many women would want to do, and I do not think that the issue has been fully thought through. There is also a problem if, as soon as the woman goes and claims that money, the man in the relationship, who has the power, knows that she has done so. Again, that will put her in a vulnerable position.
There is a similar situation with household payments under universal credit. The Government say that women can request split payments instead of the single household payment, but if a woman makes that request at her local Department for Work and Pensions office, the man will know it almost instantly, when the money that he is expecting does not come in. That woman will then have to suffer the consequences of that. Should she then leave that abusive relationship, if she has more than two children the tax credits system has no means of taking that into account. The system will not see that she could do with some extra support because she has left an abusive relationship. She may be in financial hardship, and she may have to put up with working extra hours or cutting her hours to look after her children. There are no means within the system to take into account that woman’s change of circumstances.
I appeal to the Government to consider the matter more carefully. It is an issue of inequality. Women are already not being treated equally under the system, and they are being further punished by the circumstances they are in. I urge the Government to take account of the religious aspects and the impact on women of their changes to benefit policy.
It is a pleasure to be called to speak in this debate, Mr Hollobone. First, I congratulate the hon. Member for City of Chester (Christian Matheson) on securing the debate. In Northern Ireland, we are shortly to come into the PIP system, and I will make some comments about that. It is always a pleasure to see the Minister and the shadow Minister in their places. I look forward to their comments.
When the new Secretary of State for Work and Pensions took over, he said that he wanted
“to start a new conversation with disabled people, their representatives”—
that is us in this room, councillors, Assembly Members, Members of the Scottish Parliament and so on—as well with healthcare professionals, who are the people who know best, and employers, in order to shape future policy. He also wanted
“to take time to reflect on how best we support and help transform people’s lives.”—[Official Report, 21 March 2016; Vol. 607, c. 1269.]
With that in mind, the conversation started a long time ago. The Minister knows the respect I have for him and I know he is interested in this matter, and I know that we will have a full and detailed response to our concerns. I honestly believe that his concerns are our concerns too.
Most of my comments will relate to my knowledge of the system and its shortcomings. It is unfortunate that in debates such as this we sometimes have to say what is wrong with the system, but the fact is that as elected representatives, people do not necessarily come to our advice centres and say, “You’ve done a great job. Have a nice day. How’s the football?” They come in to make their complaint. We have to put serious complaints to the Minister and make him aware of what is happening.
One concern that I have about the work capability assessment for ESA—I do not know how this happens—is that some of my constituents have to fill in ESA forms up to three times a year. My goodness me, how does the Department expect someone’s health to deteriorate or get better within four months? It is illogical. The assessment has to happen between three and six months before, so why does that happen? I stand to be corrected, but I am not aware of anyone who was receiving incapacity benefit in my constituency who was not turned down automatically when they were moved to ESA. I see that happening all the time. After being turned down automatically, they go to appeal and win it. There almost seems to be a presumption that individuals should not have been getting incapacity benefit and they certainly should not get ESA. I have to express that concern.
Another thing that comes to mind is the number of claimants with serious health conditions or disabilities who are found fit for work. I have one staff member who works full time on benefits cases. The role of the advice centre in my office has changed—its role was once about housing and planning, but now benefits are right up there next to those issues. I am sure that situation is replicated in the office of every Member. One problem is the number of people who are found fit for work or placed in the wrong ESA group due to deficiencies in the descriptors used or the assessment process. How can we do better on that?
The focus on returning to work within a relatively short period of time is not appropriate for many claimants. In England, 36% of all fit for work decisions in a given period were appealed against, and 52% of those appeals were won. We cannot ignore that fact. I make these points not to be aggressive or adversarial; I am trying to raise issues in a constructive fashion. There are deficiencies in the process, and other Members will no doubt speak about them.
As the Minister knows, this matter is devolved to Northern Ireland. The Northern Ireland Assembly has set aside £500 million for a further series of supplementary payments to carers, people suffering from ill health and families on low incomes. We have recognised that a number of issues have to be addressed. Will the Minister give his thoughts on that? Some 50,000 people in Northern Ireland receive the mobility component of the disability living allowance, and they are worried about the impact of PIP. Honestly, I sometimes wonder whether anyone sees the emotional effect that such things have on people. If they did, they would say, “The system needs to be changed.”
DLA will end in Northern Ireland on 20 June, and PIP will take over. The same contractor that looked after the system on the UK mainland will be taking over in Northern Ireland. I say this very respectfully, but we seek an assurance that the contractor is fit for purpose, fit to do the job in Northern Ireland and fit to do the job better. How will that company be monitored?
Families that include disabled people are more likely to be in receipt of state benefits than families with no disabled people. That fact should be recorded. The Government have announced further welfare measures that will affect disabled people, including a four-year freeze on most working-age benefits, changes to tax credits and universal credit and the abolition of the work-related activity component for new ESA claims from 2017. I am trying to be constructive, but can we have some assurance for those who are disabled? They are very worried about what will happen.
In Northern Ireland, more than 200,000 people receive disability living allowance. In a population of 1.8 million, that means that one in every nine people are receiving DLA. That compares to a figure of one in 20 on the UK mainland.
I know that the hon. Gentleman is entirely sincere in registering his concerns, but they are contradicted by the fact that his party voted in the Assembly for a legislative consent motion that endorsed all the clauses of the Welfare Reform and Work Act 2016 as originally tabled. He and his colleagues also voted down amendments to the Northern Ireland (Welfare Reform) Bill when we proposed them in the Chamber. Those amendments would have addressed exactly these issues.
I thank the hon. Gentleman for his intervention—at least, I think I thank him. We know how the system works. We have made some changes to the system in Northern Ireland and made some concessions. If we want to change it more, we have to pay for it. I am sure that he can tell us where the money would come from. We need to make those decisions as well, and in Northern Ireland, those decisions are made by those in government who are responsible. They must make decisions that do not run us into debt or extra problems. We agreed to that legislation because we cannot change everything that comes across from Westminster. The things we can change we do change—I will not comment on them now.
Kevin Doherty, the chief executive of Disability Action, has said that the growing number of people in receipt of DLA should be a sign to the Government that better services are needed. He stated:
“Disability Action would strongly recommend that the Government take heed of the rise in DLA recipients and continue to implement adequate and sustainable services that enhance the lives of disabled people.”
The number of people in receipt of DLA—or PIP, as it will be from 20 June—will continue to rise, and the number is greater in Northern Ireland than anywhere else in the United Kingdom. That cannot be ignored.
Some people have argued that people take advantage of the system, but from my experience, I can confirm that all those who come to my office needing help with DLA forms are genuine and deserving individuals, and DLA and PIP are intended for those people. I am honestly not aware of anyone who has come to my office who did not deserve support, and my staff work very hard to ensure that those who need it get it. I am ever mindful that we are nobody’s judge in this world. We are here to help anyone who comes to our offices, and we do that.
It is important to say that the Northern Ireland Assembly has set aside money out of its block grant, money that we all agreed to—or at least the parties with responsible minds in Government agreed to it—so that we could look after those hit by the bedroom tax or the spare room subsidy, which is completely discriminatory towards those most genuinely in need. Where did that money come from? The direct budget. We set that money aside because we are a responsible Government, which is why, looking forward to the elections on 5 May, the Democratic Unionist party can honestly say, with no fear of contradiction, that we are building a better future for everyone in Northern Ireland. We are doing that through responsible governance, paying our way and looking after the vulnerable, those on low incomes and in poverty, and the disabled. We are doing our best to ensure that they are looked after. I am sure that, when they respond, the Minister and shadow Minister will accept those points.
It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for City of Chester (Christian Matheson) for securing this important debate and congratulate him on having done so. I listened with a sense of admiration to the dignified way he made his case this afternoon. I know that he is a son of An t-Eilean Sgitheanach—for the non-Gaelic speakers, that means a son of the isle of Skye—and he very much conducts himself in the manner of a highland and island gentleman, if I can put it that way.
The hon. Gentleman discussed the use of taxation to create a more equal society, which is something with which the Scottish National party would very much agree. He asked the Minister whether he agrees; I must say that the evidence from the Government is that they certainly do not believe in the kind of things many of us do. My hon. Friend the Member for Glasgow Central (Alison Thewliss) has been fastidious in highlighting the rape clause. I think she did so on Budget day last year when it came up, and I congratulate her on how she has pursued that case. She also addressed the issue of support for all children.
The hon. Member for Strangford (Jim Shannon) spoke passionately about the failings of ESA and PIP and the percentage of people who have won their appeal. There are real questions for the Minister to answer there.
I thank the hon. Gentleman for that intervention and agree wholeheartedly with what he said. The Government must address not only the issue of those who are on benefits using food banks, but the fact that those in work are having to rely on them as well.
As the hon. Member for City of Chester said, it is noteworthy that the Resolution Foundation said last night that inequality in the UK has been falling recently but is projected to rise over the Parliament. That is a direct consequence of the Government’s policies. It is little wonder that the right hon. Member for Chingford and Woodford Green (Mr Duncan Smith) said, in the letter he sent to the Prime Minister to resign as Secretary of State for Work and Pensions:
“I hope as the government goes forward you can look again…at the balance of the cuts you have insisted upon and wonder if enough has been done to ensure ‘we are all in this together’.”
That is exactly the point. Social security should lift people out of poverty and give the disadvantaged equal opportunities. That is what the Opposition are asking for. Instead, the Government have created a system that breeds inequality and institutionalises unfairness. The relentless attacks on sick and disabled people show how callous the Tories have become. As we say in Scotland, we are fair scunnered at the policies of this Government.
I am glad that my friends in Northern Ireland use the same words. We use other words as well.
Families with disabled people are more likely to be in receipt of state benefits than families with no disabled people. In 2013-14, 83% of families in the UK with at least one disabled adult and no disabled children were in receipt of state support, and 38% claimed an income-related benefit. Almost 75% of families with a disabled child and no disabled adults received state support, and 37% received an income-related benefit. Some 46% of families with no disabled adults or children received state support, and 12% received an income-related benefit. We can see exactly how those who are looking after either disabled children or disabled adults rely on the state’s support; it is necessary.
It is little wonder that there is widespread fear among those in the disabled community about their vulnerability to an assault on social security, which often provides recipients with a level of dignity that the Government seem to want to undermine. The arbitrary £30-a-week cut to ESA is a regressive measure that is part of this Government’s continued attack on disabled people. The Government continue to peddle the line that such cuts will incentivise disabled people to work. That is a cruel and completely misjudged justification. A review conducted by the House of Lords in December 2015 found no evidence that such cuts will incentivise work, and surveys by the Disability News Service and Mencap show that cuts will force sick people backwards and further away from getting back to work. Social security should lift people out of poverty and give the disadvantaged equal opportunities. Instead, we are breeding inequality and unfairness.
The Resolution Foundation recently called universal credit
“a post-code lottery on steroids”
because it has continued to be cut while similar cuts to tax credits have been scrapped. Universal credit will now be less generous than the benefit that it replaces. Where someone is in the country will determine whether they are eligible for universal credit or the existing system.
As my hon. Friend the Member for Glasgow Central has said, women have been bearing the brunt of Tory welfare cuts, as they are twice as likely as men to rely on income from social security payments. Since 2010, £26 billion has been taken away from benefits, tax credits, pay and pensions, 85% of which has been taken from women’s incomes. That disgraces all of us.
Because of the time constraints, I will cut my remarks short, but I want to refer to the different agenda that we have in Scotland. The Scottish National party has pledged to restore housing benefits to 18 to 21-year-olds, giving back to Scotland’s young people what the Tories have taken away. That will protect 2,000 unemployed single people under 21. The SNP is also committed to treating disabled people with dignity and respect. Responsibility for disability benefits will be devolved to Scotland in 2018, and the SNP has pledged to chart a different course. The SNP’s compact with disabled people will treat everyone with fairness, respect and dignity. We will abolish the bedroom tax and increase carer’s allowance. We will continue the £52 million independent living fund, which was scrapped by the Tories. We will support disabled people into employment with a £20 million fund. We will maintain disability benefits when they are devolved to Scotland, not cut them. That is the difference that a caring Government who are on the side of the people will make. The Government in London must go back to the drawing board on social security to protect the disadvantaged and build a system based on equality, dignity and respect—all currently sadly lacking.
I sincerely congratulate my hon. Friend the Member for City of Chester (Christian Matheson) on securing the debate and his excellent contribution, and all Members on their contributions on such an important topic.
The hon. Member for Ross, Skye and Lochaber (Ian Blackford) mentioned the Resolution Foundation paper that was published yesterday. I used to work on inequality and there are a variety of ways of measuring it. He was probably talking about the Gini coefficient, which has been relatively flat over the past decade or so, but other data, such as those on the extremes of wealth in the top 1% compared with the bottom 1%, vary considerably. I will look at those data in a moment, but they show inequalities that hark back to the Victorian age. In fact, the International Monetary Fund has said that income inequality is
“the defining challenge of our time.”
In the UK, 40 years ago, 5% of income went to the highest 1% of earners; today, 15% does. But this issue is about not just income but wealth. If we think back a few weeks to when the Panama papers were published, they revealed the shocking extent to which the assets of the richest are kept in offshore tax havens, where tax is avoided and evaded. According to the Equality Trust, another good source of data, in the past year alone the wealth of the richest 1,000 households in the UK increased by more than £28.5 billion. Today, their combined wealth is more than that of 40% of the population, which is equivalent to 10.3 million families—so, the wealth of 1,000 families is equivalent to that of 10.3 million families. While the wealth of the richest 1% has increased by 21%, the poorest half of society saw their wealth increase by less than a third of that. I could go on, but I have set the context.
Looking over the past six years at the regressive Budgets of this Government and the previous coalition Government, we should not be surprised. As the Institute for Fiscal Studies has shown, last month’s Budget left people on low and middle incomes proportionately worse off as a result of tax and social security changes, which is what we are discussing today. Regressive economic policies that mean that the total tax burden falls predominantly on the poorest, combined with low levels of public spending, especially on social security, are key to establishing and perpetuating inequalities. In particular, those on low incomes, the sick and the disabled have been hammered by this Government.
Since the Welfare Reform Act 2012, according to analysis by Demos and Scope, 3.7 million sick and disabled people have had approximately £28 billion in social security support cut. That does not include the cuts that we have seen to social care, access to transport and support for disabled children in schools—right across the piece, disabled people have been hammered. The Welfare Reform and Work Act 2016, which has only just been given Royal Assent, will compound the effects of those cuts. The cut of £1,500 a year for people on ESA WRAG—the work-related activity group—and the UC equivalent who have not been found fit for work is an anathema.
There is clear evidence from the Extra Costs Commission, as we have heard, that sick and disabled people face additional costs—estimated at £500 a month—because of their condition. The effect of further cuts in support will be to plunge even more sick and disabled people into poverty. We know that 5 million sick and disabled people are already living in poverty; what we do not know is how many more will be pushed into poverty as a result of those measures, because the Government have not assessed that. It is shameful that the Government have not done so, or even looked at the implications for people’s condition.
I am sure that the Minister will respond by saying that the Act is about incentivising sick and disabled people into work, but again we have contradictory evidence from various reports. In connection with the disability employment gap, which remains stubbornly high, only 124 employers signed up to the Disability Confident campaign—
That is the latest figure from the website. Also, last year, fewer than 37,000 disabled people received support from Access to Work, out of the 1.3 million disabled people who are fit and able to work. Much, much more needs to be done. It does not stop there. Other cuts have included the bedroom tax, cuts to supported housing through the local housing allowance and the 1% cut in housing benefit—there has only been a reprieve for the next 12 months. I could also mention other cuts and policies such as sanctions. Those are all having and will continue to have an adverse effect on the sick and disabled.
This is the first time that the Minister and I have debated since the recent change in leadership at the Department. The new Secretary of State made sympathetic overtures in his statement to the House, and I welcome the Government’s U-turn on the cut to the personal independence payment proposed in last month’s Budget, but as the Channel 4 “Dispatches” programme a couple of weeks ago showed, the PIP assessment process is clearly not fit for purpose. According to a number of my constituents—if I have time, I would like to mention a couple of them—
Order. The hon. Lady does not have the time. She has already gone well over her five minutes. I know she only has a page and a half to go. If she wants to quickly go through that, that will be fine, but she will have to draw her remarks to a close pretty quickly.
Order. We are finishing at 6.14 pm. I have to work within the recommended time limits given to me by Mr Speaker. In an hour-long debate, the limit is five minutes for the SNP Front-Bench spokesperson, five minutes for the Opposition Front-Bench spokesperson and 10 minutes for the Minister. The hon. Lady has now had the same time as the SNP Front-Bench spokesperson, who went over. If she can draw her remarks quickly to a close, that will be fine.
I am grateful, Mr Hollobone, and will take your comments on board.
I would be grateful if the Minister could respond to the details I have sent him in writing regarding an inquiry to investigate the qualifications, training and behaviour of assessors; just how widespread the appalling behaviour we witnessed on that Channel 4 programme is; the validity and efficacy of the assessment tools—the Royal College of Psychiatrists was dismayed at the inappropriate standards and tools being used—particularly for people with chronic, fluctuating and mental health conditions; and the performance monitoring of contracts, not only in terms of activity levels but to ensure ethical standards of practice.
I have met many sick and disabled people since I was elected in 2011. Some are barely surviving and are hanging on by their fingertips. I genuinely fear for them. Of course, we know that many have not survived and have taken their own lives or just faded away.
Governing is about choices. The revenue lost to the Exchequer every year as a result of tax fraud is equivalent to what we spend on disabled people through DLA and PIP—£16 billion. If the Government truly believe in fairness and in addressing the real inequalities in this country, they need to reflect that in their policies. They need to clamp down on tax fraud and ensure that our most vulnerable in society are looked after properly, not plunged into poverty or worse. The Government should not just talk the talk, but walk the walk.
It is a pleasure to serve under your chairmanship, Mr Hollobone. I pay tribute to the hon. Member for City of Chester (Christian Matheson), who I know is widely respected in his local community. He is very passionate about this issue and raised a number of powerful points, as did many of the other hon. Members who contributed to what has been a good, constructive debate. In true tradition, I have not brought a pre-written speech but will do my best in 10 minutes to respond to as many of the points raised as possible.
I will start with PIP. A lot of the issues raised cut across many different Ministers’ areas, so I will spend the majority of my time on the areas for which I am responsible. PIP is my area. Time and time again, hon. Members say that life would have been better under DLA. The fact is that under DLA, 16% of claimants qualified for the highest rate of benefit. Under PIP, it is 22.5%. We are getting money to those who are most in need. That figure is even more stark if we look at things such as hidden impairments, including mental health issues. Under DLA, 22% of claimants with a mental health condition would expect to get the highest rate. Under PIP, that figure is 68%.
We continue to work with stakeholder groups and those with front-line expertise in order to continue improving the PIP assessments. It is fair to say that when PIP was introduced, Ministers were often in this Chamber explaining why things were not going right, but we have now been in a settled position for about a year. Currently, someone would be looking at an average of seven weeks to get an assessment, and 13 weeks end to end. That is widely respected as a settled and positive position. To put into context the extent of the improvement, there has been a three-quarter reduction since June 2014 in the time waiting for an assessment. Improvements are ongoing. I regularly meet with stakeholder groups and policy teams and am very much engaged with them.
Not unreasonably, Members have raised the issue of high appeal rates. That was one of the very first questions I asked when I became a Minister. On day one, I said, “Clearly there is something wrong, given the high appeal rates. Everybody down tools immediately and analyse what has gone wrong.” The vast majority of successful appeals, which account for only 2% of total claimants under PIP, are due to additional late submitted evidence, either written or oral.
When we send out a communication to tell somebody that they have not qualified for the level of benefit that they perhaps thought they were entitled to, we try to set out why very clearly. In some cases, those claimants realise that they have not submitted a piece of evidence. We then give them two further opportunities to submit that evidence: one is the mandatory reconsideration, and if they are still unhappy, there is the independent appeal process. We try to be as clear as we can be.
In a utopian world we would have a big supercomputer —a former Labour Government tried their best to deliver this; unfortunately, from our perspective, that did not work—and a claimant would phone and give their national insurance number, and we would have access to all of their medical records. We would not have to rely on late submitted evidence. We are trying to improve that; we have just announced that assessors will get an additional 10 working days to help claimants gather that evidence.
I also gently remind Members that, under the DLA, 70% of claimants were given an indefinite award. That sounds good, but the reality is that the condition of one in three claimants changes significantly within 12 months. If they are on an indefinite award, they may not necessarily pick up the phone and ask for a review. We were seeing more and more people staying on a lower rate of benefit indefinitely, because that is the point at which they entered, when in fact they were entitled to a higher rate. That is another reason why we are seeing the difference between the 16% and the 22.5%.
We all support the principle of halving the disability employment gap. Giving those with a disability the opportunity to work is good for them. On my visits with stakeholder groups—particularly with young ambassadors —I say, “You are the Minister for the day. What would you like to do?” Time and again they want the same opportunities that their friends take for granted. We are making progress: 152,000 more disabled people are in work in the last year, and 292,000 in the last two years. There is still a significant way to go.
We have secured additional funding for access to work, which helps about 36,500 people a year; we have funding to help a further 25,000 per year. That is the Government contributing to remove barriers to help people with disabilities into work. We are doing a lot of work at the moment on how we can promote the scheme, particularly to small and medium-sized enterprises that are often too busy to notice Government initiatives. I want to see a lot more business engagement, so that they understand the importance of this. We are keen to make sure that that money is well utilised. There are further opportunities. A lot of emphasis is going into providing jobcentre staff with additional training, particularly with things such as the hidden impairment toolkits, which the stakeholder groups are helping to design.
The hon. Member for City of Chester used the phrase “waste of talent”. That is absolutely spot on. Businesses that are struggling to fill skill gaps are missing out. I say this as somebody who benefited directly from employing disabled people in my former life, when I ran my own small business. The White Paper is a real opportunity to make some of those significant differences.
Many Members have raised concerns about the ESA work capability assessment. That is not directly my responsibility, but I understand the points raised. As it stands today, typically 1% of those on ESA will come off the benefit every month. That is the same for this Government as it was for the coalition Government, and the Labour Government who introduced it in the first place. There is no way of describing that as anything other than unacceptable, and the White Paper is a real opportunity for us to look at that. I was asked if I could give a sneak preview; I genuinely cannot.
We want to work with those stakeholders. The new Secretary of State has made it very clear that they will be at the heart of what we do. I personally know from my regular meetings with them that they have fantastic policy teams. There is no point in reinventing the wheel when often they have some very good, constructive ideas. The themes that we will be building around are those localised solutions, tailored to the individual, and recognising that everybody has their own unique challenges and opportunities.
From my perspective, we need to make sure that we do not forget that we need businesses to engage. It is one thing getting the individuals looking for work to play by the rules and engage in the different work programmes, but if there are not job opportunities at the end they will continue to loop through the system, attending yet another 12-week programme, during which their enthusiasm will further wane.
Many Members touched on universal credit. Again, I think there is accepted support for the principle. It is simplified—someone would have to be a nuclear physicist to navigate the current complex array of benefits that they might or might not be entitled to. We all know through our casework that individual constituents often miss out.
However, the area that most excites me is that for the first time ever, people will have a named coach. Time and again, people are frustrated that they have to go and explain their challenges to another person, which creates further frustration and reasons not to engage. That named coach will be there to provide support, helping people to navigate not only their opportunities to get into work, but other challenges that they might have—such as accessing child care, additional support and dealing with issues such as personal debt—and signposting them through to additional training. For the first time ever, that named coach will continue to support people when they go into work. If someone goes into their first job, perhaps on the national living wage, and keeps turning up and doing the right thing, the named coach might say, “Do you want me to speak to the supervisor to see if you can get promoted to other roles?”—doing things that we would often take for granted and helping people with opportunities.
We all quote different papers with figures that suit our argument, but the Office for Budget Responsibility has said that households will be £100 billion a year better off by 2020. We have introduced the national living wage. I know that some hon. Members will question—perhaps tongue in cheek—whether that is genuinely a national living wage, but we are anticipating it to be more than £9 by 2020. I seem to recall from my opponent’s election leaflets that he was advocating just over £8, so it is £1 higher than the Opposition proposed.
Rightly, we have been increasing the personal allowance. It will go up to £11,500 by April 2017 and will continue to rise to £12,500. We have legislated that it will then follow inflation. Living standards reached their highest ever level in 2015 after growing at their fastest rate in 14 years. Living standards have improved by 2.6% over the last year and employment has gone up by 2.4 million since the 2010 election.
I am very short of time, and I want to deal with a few more specific points that Members have raised.
I pay tribute to the hon. Member for Ross, Skye and Lochaber (Ian Blackford) because, although we may disagree on many of the points raised, he makes very clear alternative suggestions. It is one thing to criticise the Government but, to his credit, he sets out how his party would do things differently. I have always said that I will look very closely at what our friends in Scotland do. If something works there, we will be first in the queue.
The hon. Member for Glasgow Central (Alison Thewliss) made a very powerful point—and has done so consistently for a period of time—to do with rape. Lord Freud has said that he is going to look further at that, and I pay tribute to the hon. Lady for making powerful points in that area.
On the points made by hon. Members about women, I would say that tax-free childcare for working families— 30 hours a week of free childcare for three and four-year-olds—will make a significant difference. Two thirds of the 2.8 million people who have directly benefited from the national living wage are women, and, on the increased personal allowance, 59% of the people who have been taken out of paying any tax at all are women. These are key issues.
There is still much more to do. My door is always open to Members who have constructive suggestions and ideas on how we can make improvements. I want finally to pay tribute to the hon. Member for Strangford (Jim Shannon); he has often taken up that opportunity and those are the sorts of things that shape the way in which the Government are helping to support the most vulnerable in society.
I thank the Minister, the shadow Minister and all hon. Members for having taken part in the debate. I confirm to the hon. Member for Ross, Skye and Lochaber (Ian Blackford) that my grandfather was indeed from Skye, so I am a proud grandson, at least, of Skye.
I am grateful to the Minister for his response. My one concern, which I ask Members to dwell on as we close, is that the system does not take into account how real life works, as the hon. Member for Glasgow Central (Alison Thewliss) mentioned. The hon. Member for Strangford (Jim Shannon) talked about the fact that he sees nobody coming into his constituency surgeries or his constituency office who is somehow a bogus claimant. My hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) mentioned problems in the assessment procedures and qualifications for assessment.
In thanking the Minister for his response, I ask him to ensure that the reality on the ground matches the aspirations that he has set out in his speech today, and which, as hon. Members have mentioned, often does not match the hopes that Ministers have. I am grateful to you for your chairmanship, Mr Hollobone, and I am most grateful to hon. Members for their participation today.
Question put and agreed to.
That this House has considered the effect of social security changes on equality.