Thursday 27 October 2016
[Mr Peter Bone in the Chair]
[Relevant documents: Second Report from the Defence Committee of Session 2015-16, Shifting the goalposts? Defence expenditure and the 2% pledge, HC 494, and the Government response, HC 465.]
I beg to move,
That this House has considered the Second Report from the Defence Committee of Session 2015-16, Shifting the goalposts? Defence expenditure and the 2% pledge, HC 494, and the Government response, HC 465.
It is a privilege to present the findings of our report entitled “Shifting the goalposts? Defence expenditure and the 2% pledge” to the public once again—it was published some time ago. I doubt whether anybody two or three years ago would have registered the significance of the term “2% of GDP” in connection with defence, because it was only relatively recently that the prospect of Britain’s falling below the NATO recommended minimum expenditure on defence for the first time came to the public’s attention. For many years, we spent a great deal of money on defence. The purpose of the report is to track the history of that expenditure to check the extent to which we are continuing to meet the NATO minimum and to see whether there has been any financial jiggery-pokery to enable us to do so.
In a nutshell, we found that no rules have been broken. The Government’s figures and methodology conform to the NATO guidelines. It is true that, on the basis of including such things as armed forces pensions, which were not previously included but are allowed to be included, the Government will reach the 2% minimum. I use the word “minimum” advisedly, because that is what it is. It is not a target, but the minimum expected of each NATO country to contribute as a proportion of their gross domestic product to their defence. One could argue that it remains a target for countries that have never managed to reach it, but for those of us who have always exceeded it, often by very large amounts, it remains a floor, not a target, let alone a ceiling.
I know it is frowned upon to use props in debates in any Chamber, but the sheet of paper I have is so vivid that, even at a considerable distance and through the lens of a television camera, it is easy to read. The bar graph shows a consistent and steady decline in the percentage of GDP spent on defence since the mid-1950s. In the mid-1950s, we spent more than 7% of GDP on defence. In about 1963-64, that downward-falling graph crossed the upward-rising graph of what we spent as a proportion of GDP on welfare. Far from spending more on defence than on welfare, as we did until about 1963, we spend six times on welfare what we spend on defence. In the mid-1980s, we were spending roughly the same amount on defence, education and health. Since then, the descending graphs for defence expenditure and the rising graph for education and health have similarly crossed over, and we have declined closer to the 2% minimum. We now spend almost four times on health and about two and a half times on education what we spend on defence.
I am interested in the chart that my right hon. Friend is describing, which appears as a corrigendum to our report. More interesting than the three Departments he mentions is the fact that, during that period, spending on overseas aid increased by a significant amount while spending on defence declined. Is that not a significant correlation?
It is significant, and it is indeed included on the chart. The only reason why I did not mention it is that, in comparison with the total spent on the other high-spending Departments, it is a relatively small proportion of our GDP. However, my hon. Friend is absolutely right because, such has been the decline in defence, our commitment to spend 0.7% on international development now amounts to one third of the total that we spend on defence, which comes in just above the 2% minimum.
When we called the report “Shifting the goalposts?”, we put a question mark at the end because we did not wish to prejudge it. There are two ways in which the Government could be said to have shifted the goalposts: first, by including things they are not allowed to include—we absolved them of that—and, secondly, by including things that they are allowed to include but never included in the past, which would mean that we are not comparing like with like in terms of our previous methods of calculating UK defence expenditure. The Defence Committee inquiry found that the NATO minimum would not have been fulfilled if UK accounting practices had not been modified, albeit in ways that are permitted by the NATO guidelines.
Is the right hon. Gentleman aware that some of the money that is counted in the 0.7% official development assistance is also counted towards the 2%? I might take issue with some of his line of argument, but it sounds like he is arguing that that double counting should not be double counted.
We did not find a hard and fast case of double counting, but we noticed in the past that there are items of expenditure that are highly relevant to defence and security that could fairly and usefully be catered for by the international development funds. Given that the 0.7% is protected, and given that one sometimes hears stories of the Department for International Development struggling to find creative ways of spending the money it has to dispose of, there is an opportunity, particularly in relation to soft power, to use elements of the international development money for measures that add to our security.
Of course, this is a rather crude measure, because gross domestic product can vary. If this country’s gross domestic product goes down but we spend the same amount on defence, it might appear that we are doing more when we are doing nothing of the sort. Similarly, when the value of the pound changes, as has happened in the short term following the Brexit decision, we see the effect on what we are able to buy for the money we have available for defence when we purchase big-ticket items such as the P-8 maritime patrol aircraft from the Americans, although a considerable amount of that purchase will find its way to the British defence industry. What I am driving at is that perhaps we ought to be talking not about shifting the goalposts, but trying to move the benchmark.
We should be reminding people that, in the 1980s—the last time we faced a significant threat from the east in Europe in the second and closing phase of the cold war—we regularly spent between 4.5% and 5.1% of GDP on defence. The similarity lies not only in the international situation. In the 1980s, we simultaneously faced a very significant terrorist threat in the form of Irish republican terrorism. We now face a similar threat in the form of fundamentalist Islamist terrorism.
It therefore seems appropriate to note that and, in the week that we were told that the first of the successor submarines for the nuclear deterrent will be named HMS Dreadnought, to remember a previous HMS Dreadnought, the battleship that changed the whole nature of sea power as far as capital ships were concerned in the years approaching the first world war. A famous naval arms race was going on between this country and Germany and, around 1909, there was a great deal of controversy that the German navy was drawing level with the grand fleet of the British Royal Navy in terms of dreadnought battleships. A public campaign was mounted, encapsulated by the phrase of the Unionist politician George Wyndham:
“We want eight and we won’t wait!”
My view, which I believe is shared by at least some other members of the Defence Committee, is that a new benchmark is perhaps needed for the percentage of GPD to be spent on defence: “We want three to keep us free!” In reality, if we go on at the 2% level, we are in danger of finding ourselves incapable of meeting the threats that face us today and will continue to face us in future.
Yes, the threshold is important for a whole number of reasons, and we want to look at the overall level and get that focus of Government, but it is not the most important thing. The right hon. Gentleman might be about to come to this point, but we ought to be pressing the Government on what capability we are getting as a consequence in terms not only of materiel, but of manpower, and experienced manpower in particular.
The right hon. Gentleman is absolutely spot on, and of course that is what underlies my remarks about the fact that the figures are only, at best, the crudest guides. Nevertheless, they give us some sort of measure of comparison. Spending a certain amount of money on defence—or, should we say, investing it in defence—is not a sufficient condition for the reason that the vice-chairman of the Committee has just explained. It is, however, a necessary condition: if we do not spend enough, we cannot possibly have the potential. If we have enough to spend, we can consider how to ensure that we spend it in the most efficient and productive ways.
At this point, I pay tribute to the staff who help the Defence Committee to prepare our reports and, in particular, to one member of staff, Dr Megan Edwards, who did all the background research for the appendices to the report. They show, on as near as it is humanly possible to express the same terms, how much we have spent every year since 1955-56 up to the present day. That sort of original research work is of lasting value, because it sets into context the minuscule efforts that we make these days in comparison with the efforts that we had to make in the past. The reason that I single out Dr Edwards is that today is her last day working as a specialist member of the staff of the Defence Committee—our loss will be the Cabinet Office’s gain, and we wish her well in her new post and congratulate her on it.
Another aspect of the financial calculations that causes particular concern is the constant emphasis on efficiency savings. The most recent tranche of efficiency savings that the Government required from the Ministry of Defence was, I believe, some £0.5 billion, just before the 2015 strategic defence and security review. Some estimates put the aggregated total of efficiency saving requirements in recent years at something in excess of £1 billion, carried forward year on year. Theoretically, savings are ploughed back into the MOD. In practice, I understand from people who know about such things, it is hard to track that money, to apply those notional savings in concrete terms and to see where exactly the savings have gone in terms of new capacity.
A few days ago, on 18 October, that matter came up during a hearing on the Ministry of Defence’s annual report and accounts for 2015-16. The Defence Committee was interviewing Mr Stephen Lovegrove, the new permanent secretary at the MOD; Lieutenant General Mark Poffley, Deputy Chief of the Defence Staff for military capability; and Ms Louise Tulett, director general of finance at the MOD. They made an impressive trio of witnesses.
At one point, it was put to the witnesses that, of the almost £26 billion of equipment commitments that came out of the SDSR, almost a quarter really was new money, nearly £11 billion was so-called headroom or contingency, which is understood to be used up at appropriate points in the programmes, but the rest of it was in fact efficiency savings. It is therefore understandable if we feel a bit worried that what seems on paper to be a substantial commitment to spending large sums of money is, in a significant respect, notional, because it is dependent on the redistribution of money that the MOD already has but is supposed to spend more efficiently in some way or another.
May we forbear on the nomenclature of the civil service—the so-called efficiency savings? Efficiency, as I understand it, is when we are running a payroll office and using 100 people, but we bring in new equipment and only employ 50 as a result, while keeping outputs the same. Efficiency is when people find new and improved ways of undertaking their work. Everything else is cuts. We should be clear that many of the things we are discussing are not efficiency savings but cuts, and we should describe them as such.
The right hon. Gentleman perfectly exhibits the cross-party basis on which we try to find agreement on such matters in Committee, and the extent to which we succeed in doing so. He is of course absolutely right.
I do not intend to speak much longer, because it is excellent to see so many would-be contributors to this short debate, but I will first refer to the question that was put to Mr Lovegrove. We asked, basically, when the point will arrive at which an organisation can truthfully say, “We are just about as efficient as can be and, indeed, any further ‘savings’ that we make must amount to cutting into the bone, having already cut through the flesh.” The permanent secretary’s response was as follows:
“There may be a moment at which that happens. It is not on the horizon right now. There are certainly efficiency savings that we can get at in the Department, and our focus is on doing that and seeing whether or not we can go even further. It is only at that point that we would start engaging in the kinds of conversations that you suggest.”
With the greatest respect to the permanent secretary, who as I say made a good impression and was a credible witness in our examination of the annual report and accounts, we hear time and again from within the armed forces the same underlying fear: that we are in danger of creating a hollow force, which may have exquisite equipment—perhaps not enough so-called platforms, but exquisite nevertheless—but not enough people to man it.
The trouble is that short-term cuts—I beg your pardon; efficiency savings—can lead to long-term problems. That applies in particular to training. With the carriers coming on stream, the big frigate programme having to get under way and the new F-35 joint strike fighters taking over the maritime air role from the sadly missed Harriers, which will have filled too long a gap in our naval capabilities, now is the time when we should inject maximum effort into training. Yet we find ourselves in a position—perhaps for reasons of morale or under-investment, or perhaps because insufficient emphasis is being placed on defence in our national priorities—of struggling to recruit and retain the people we need even as we cut the size of the armed forces.
The Government have not broken any rules, but they have scraped over the line by the narrowest of margins. There is no guarantee that we will not dip below the 2% figure. People usually come up with the response, “Just remember that we are the second highest spender on defence in NATO.” I remember that sort of argument from back in the 1980s, when people who wanted us to spend less on defence—we were spending quite a lot in those days; between 4.5% and 5%—said, “Why should we spend this amount on defence when Germany and so many other European countries spend so much less than we do?” The answer, as the author of a short and pithy letter to The Times pointed out, was that the countries that we were being compared with were all on our side. We have to judge our defence expenditure by what our potential adversaries spend and what defence and attack capability they get for the money that they invest.
We do not want to engage in a race to the bottom. We do not want to preen ourselves on doing a good job because people on our own side are spending even less than we are. Our percentage expenditure on defence is lower than it has ever been—even on the new calculation, it is 0.1% lower than it was in the previous financial year. Something has gone wrong with our scale of national priorities, and the purpose of the Committee’s report is to draw attention to that, in the hope that the Government will renew their emphasis on their first duty: to keep our nation safe.
I will not delay everyone for long. Although the Committee found that the Government’s accounting criteria fell firmly within the NATO guidelines, we also found that those criteria had been amended to include several significant items that had not previously been included when the UK calculated its defence expenditure. That is the nub of the issue that we must address. The Committee is concerned that the inclusion of such items, which were critical in attaining the 2%, could undermine the promises in the SDSR of new money for defence.
During our inquiry, there was considerable discussion of the 2% as an indicator of Britain’s political willingness. Witnesses said that
“2% is good politically”
and not to meet the 2%
“would have been damaging to our reputation politically.”
The 2% was said to have
“a…powerful symbolic meaning”.
The UK has made great play of that 2% as demonstrating its commitment to collective defence in NATO, but the inclusion of items that had not previously been included, such as pensions, has not gone unnoticed—with considerable contempt—across the alliance. As well as being a member of the Defence Committee, I represent the UK on the NATO Parliamentary Assembly, and I have found that other countries, when talking about their expenditure and accepting that it does not reach 2%, take great delight in pointing out that their figures do not include pensions, as they have no wish to use creative accounting to bolster their spending. That is divisive within NATO and damages our credibility and capability to defend our shores and those of our allies.
Our report highlighted that 2% should be a minimum, not a target, and certainly should not be seen as an indicator of capability or capacity, or give a false glow of competency and readiness. The report also urged the Government to provide a calculation of what defence expenditure would be if we left out the new items such as pensions and used the same items as we had under the 2010 accounting rules. We still await those figures.
A perfect storm is building of cuts to personnel, cuts to training, problems in procurement and gaps in capability. With the 2%, there is a disparity between our procurement aspirations and their affordability—and our capacity to deal with major defence equipment deficiencies, such as the engines for the Type 45 destroyers and the delays in replacing the Type 23 frigates and logistics supply ships. I have a major concern in particular about the Royal Navy’s capacity and capability. If we went back to realistic accounting, perhaps we would be able to deal with those issues.
I do not want to take too much time, because I know that colleagues want to speak, but I must emphasise that in our report, the Committee expressed concern that the UK must not become a hollow force. Sadly, despite the great commitment and bravery of our personnel and their amazing “make do and mend” ingenuity, I fear that we are hiding our vulnerability behind the cardboard shield of 2%.
It was just outside the constituency of the hon. Member for Bridgend (Mrs Moon) that Her Majesty’s Government first committed two or three years ago to the 2% target—or the 2% figure; I will come back to the target in a moment. I would be ungracious if I did not start by saying that I warmly welcomed that that was the case. Until then, through five years of coalition government, that had not been the case. It probably would not be the case—dare I say, without being too party political—if we had a Labour Government; people would seek to find savings from defence to spend on schools and hospitals. The first thing that we ought to say is that thank goodness we have that 2%. I am glad that the previous Prime Minister made that firm and rather surprising commitment at the Wales summit.
The trouble is that under Labour Governments we always have wars and things so we have to keep spending up—that is the difficulty. However, the right hon. Gentleman is absolutely correct. I am not suggesting that the Labour party made cuts in previous years, but, from listening to some of the speeches produced by the current leader of the Labour party, it would be perfectly reasonable to expect that significant defence cuts would be made were Labour to be in power today.
Before the right hon. Gentleman leaps in to enter into a party political discussion of the matter, the purpose of the debate is not to have a party political pop across the Chamber—and of course I would not wish to tread unreasonably on the Opposition’s personal grief on this subject.
On a point of order, Mr Bone. As we are having a debate on defence, it is perfectly proper for the hon. Gentleman, who is normally much better behaved in the Defence Committee, to make partisan points. What I think is improper and verging on being out of order is then not giving way for a response, because I for one do not believe in unilateral disarmament either in the Chamber or in our defence policy.
No, if the right hon. Gentleman will forgive me. We have a short debate and I have one or two things to say. I do not want to go on too long, but too many interventions of that kind will simply delay the proceedings. He knows perfectly well, because he and I are close friends—
I have the strongest respect—[Laughter.] Allow me to finish the sentence. I have the strongest respect for the strength of commitment by Labour members of the House of Commons Defence Committee to the defence of the realm. Perhaps the right hon. Gentleman is right in saying that I have been a little ungracious in talking about some other parts of his party’s approach to defence because I know the members of the Labour party on the Defence Committee are strongly committed to that.
May I thank the hon. Gentleman, my friend from the Committee, for giving way? I point out that in fact he cannot point to any Labour party policy. The policy of the party is decided at our party conference, as indeed is our commitment to Trident. In the previous Parliament, when decisions were being put off on Trident, there was an overwhelming majority in the Labour party to support the Labour party policy of renewal of Trident. It is the same for the defence budget.
I am most grateful and greatly reassured by the right hon. Gentleman’s commitment both to Trident and to an increase in defence spending. I look forward to that vision being repeated by the hon. Member for Leeds North East (Fabian Hamilton) when he replies to the debate from the Front Bench. It is good news to know that that is what Labour thinks.
In all events, the debate is not about which party will spend more on defence. I think perhaps we should move away from that parti pris squabble and move on to discuss the report in front of us, which is a very well worded, calculated and researched paper. The first thing I would say, however, is that the Ministry of Defence’s accounts are second only to the Schleswig-Holstein question in being completely and utterly incomprehensible. I think there is nobody alive today who fully understands the MOD accounts, so the one or two accountants in the Department are well able to move figures around and fiddle with them in such a way that no normal human being can understand or follow.
Indeed, much of the language used is equally incomprehensible. For example, in paragraph 14 of the Government’s reply they are talking about the £11.2 billion of efficiency savings—we asked where they would find that. It lays out a few efficiency savings first and then says:
“A further £2 billion will be delivered through the reprioritisation of existing funding.”
They will save £2 billion through the reprioritisation of existing funding. They then go on to say that £2.1 billion that will come in from the joint security fund will in fact allow cuts in the ordinary defence spending. Therefore, that is not extra money coming in from the joint security fund at all; that is merely replacing moneys that otherwise were to be cut. There are many other examples of precisely the same thing.
Without a PhD in such matters it is simply impossible to understand exactly how the MOD accounts work and I am slightly concerned that the Government’s response tends not to try to clarify matters but to make them even more complicated than before. That makes comparators extremely difficult. It is very difficult indeed to compare our spending today with what we spent in the past. My right hon. Friend the Member for New Forest East (Dr Lewis) touched on this: it is perfectly true that when I was born in 1954 we were spending something like 7.8%—if I remember rightly from the charts in the report—and today we spend about 2%. Therefore, the cut has been gigantic. However, comparing what we were spending then with what we spend today is extraordinarily difficult because of the accounting procedures.
It is unclear whether things like urgent operational requirements, or several other things that occurred in the past, are included, not least because, as the MOD said in its reply, it keeps its accounts only for seven years. Therefore, if we ask officials about any financial matter before seven years ago, they do not know. They are unable to give answers on what happened in the 1950s, 1960s and 1970s because they do not keep the accounts. It seems to me simply bizarre that a Government Department should not keep accounts in perpetuity—it ought to be able to give an answer on what Government spending on defence was at the time of Waterloo if we asked the question sensibly. To say that it does not know for more than seven years ago is simply extraordinary. We therefore do not know how our spending today compares with previously because of that rule and we cannot compare our spending with other NATO countries for the same reason: it is all lost in the shrouds of mystery and antiquity.
My right hon. Friend made the extremely important point that 2% is all very well, but it is not a target and it is not even a floor—it is absolutely the minimum. In terms of the rhetoric, the Government appear as if they are claiming, “Haven’t we done well? We have achieved 2%.” No, never in the history of British defence before have we ever had to spend only 2% of GDP. Actually, that is the lowest figure we have ever been at. Moreover, if we were to listen to the previous Chancellor of the Exchequer and we were to face quite a significant recession post-Brexit—I personally do not believe that will occur, but he said so plainly—2% of GDP would presumably mean a significant cut in the pounds spent on defence. Therefore, the 2% figure is, to some degree at least, misleading. What we need to know is that this year we are spending £35 billion or thereabouts on defence and that that will increase every year irrespective of what happens to the economy.
The opposite applies as well. Supposing the economy were to grow at some fantastic rate thanks to Brexit—let us imagine that we see 2%, 3% or 4% growth—does that really mean that we will spend billions and billions of pounds more on defence than we have currently programmed to do? If so, how on earth will we find things to spend the money on? I am not certain that the 2% figure necessarily allows for sensible comparators with other Departments or that it is quite the right way to judge it.
We need to know how much the Government will spend and, as my right hon. Friend and the hon. Member for Bridgend said, not only how they will spend it but what they will spend it on. What we need to know is what we can do in defence terms—how many ships, tanks, soldiers and sailors and all the other things we need, such as cyber, will we have in the future? The 2% figure does not necessarily tell us that. It is a question of capabilities and not necessarily of money.
While I very much welcome the Government’s commitment to the 2%, which is certainly a step in the right direction, that by no means reassures me that we as a nation are ready to face the appalling threats we now face. Russia is a bigger threat to us today than it has been since the cold war, the middle east is in complete turmoil and much of the rest of the world is a disaster area and we are struggling to maintain a level of spending that we have never before seen.
It seems to me that we are in danger of failing in our primary responsibility of defending the realm by allowing ourselves to be fooled by a piece of camouflage: “Aren’t we being great? We are spending 2% of GDP”. Are we able to defend the realm? I suggest that we may well not be.
Thank you, Mr Bone. I will try to be as brief as possible because I also hope to catch the Chair’s eye in the next debate— I have half a speech to give because at first I thought there would be one debate.
Of all the Government’s commitments, we can point at and quantify two—2% of gross national income on defence and 0.7% on aid—and the others go up and down. The right hon. Member for New Forest East (Dr Lewis) appeared to imply that somehow that was a bad thing and that spending more on welfare than defence, showing compassion to the most vulnerable and needy in our society and providing that social security safety net of which we all ought to be so proud, was somehow at odds with finding the money we need to spend on the defence of the realm.
The right hon. Gentleman also spoke of investment, which I think is also quite important when considering the international aid budget. I would argue that spending money on international aid is an investment in our security and in our enlightened self-interest—helping to build a more stable and secure world by lifting people out of poverty and helping them get the food and education that they need.
It is particularly interesting that the 0.7% target, which admittedly was agreed some time ago, was based on a calculation of what was needed to meet the globally agreed goals for poverty eradication, including ending hunger, access to education and so on. I am not entirely clear where the 2% target came from. Is it a needs-based assessment of what NATO countries ought to be spending in order to effectively defend themselves or, as the report seems to say, a political target—an arbitrary amount? I think that has serious implications.
Even if we are meeting the 2% target, the key point I make is that there is a serious risk of conflation between those two targets. This might be a point of agreement: by definition, the double counting of money that is spent on aid and money that is spent on defence means the total amount of money being spent on each of those is less than it ought to be. That might be permitted under OECD rules, and sometimes there might be a good reason, but both the people who support the aid budget, like I do, and people who support the minimum defence spending target are effectively being short-changed by the Government’s practices in this regard.
There is also the question of what the 2% is actually spent on. I was in Westminster Hall not that long ago and was told that money could not be found for the Type 26 frigates, yet there seems to be a blank cheque for weapons of mass destruction on the Clyde. I have spent a lot of time in Westminster Hall this week discussing the Chagos islands and Libya, as has the Labour Front-Bench spokesperson, the hon. Member for Leeds North East (Fabian Hamilton). We heard a worrying amount of language that sounded an awful lot like old-style projection of power and a frankly old-style colonialist mind-set that belongs in the past. If the Government insist on setting these targets for defence spending and want to spend that, fine, but please spend it on what we need, such as modern counter-terrorism or conventional forces in places such as Fort George near Inverness, which is where I grew up. Do not conflate that spending with aid and do not waste it on weapons of mass destruction.
It is a pleasure to serve under your chairmanship, Mr Bone. I commend the Chair of the Defence Committee on the leadership he has shown in bringing the Committee together, as is obvious from our work. While there may have been a wee bit of spat today, the fact is we all work together because we all share the same goals. It is good to be able to tell people outside of the Chamber that we were able to work together on behalf of our service personnel. It is always wonderful to be able to do that.
As a member of the Defence Committee, this is an issue I feel strongly about, and other hon. Members have strongly expressed themselves as well. The evidence that came before the Committee was incredibly persuasive, and I believe the Government have issued their conclusive response since April 2016. The crux of the matter is clear. I have a direct quote from the press release for the report, which I agree with. It says that
“the Government has achieved its 2% commitment to defence spending in the last year only through what appears to be creative (albeit permissible) accounting.”
That is the fact of the case. The hon. Member for North Wiltshire (Mr Gray), who spoke very clearly, outlined that. We are all saying together that there has been creative accounting and that, while the figures may show that the percentage has been met, it is not where we wanted it to be. That is the clear issue and what we are about.
I am a straight man. If I can do something for someone, I will tell them and then do it. If I cannot do something, I will tell them that it cannot be done, and together we can work to find an alternative plan. We do that in the House, in the advice centre back home, in the constituency office and in life in general. I understand that Government bodies cannot always achieve miracles and that people cannot do everything I would like them to do, but this is life. By the same token, if someone says they can and will do something, I expect it to be done. That is the fact of it, and that is what the debate is about.
When the Government made the pledge, I was among the first to stand up and congratulate them on taking this step to ensure that our armed forces were at full strength in all aspects. Why, because of creative accounting, has the pledge not been met in real terms? Why have I seen so much evidence that the 2% pledge has not been fulfilled? Today, along with other members of the Committee, I am holding the Minister and the Government to account on the reasoning behind the failure simply to do what they committed themselves to do with the statements they made a long time ago.
The Government’s commitment to not fall below the NATO-recommended minimum defence spending of 2% of GDP for the rest of the current Parliament was not simply a message to our armed forces that they will not be sent out without adequate equipment, training and intelligence. It also sent an important message to our partners and potential adversaries that we are a force to be reckoned with and that we will continue to improve and enhance our defence with an appropriate budget. As other hon. Members have said, we have to respond adequately and strongly to threats, and send a message that defence and our ability to take up arms if necessary is a Government priority. That message has been diluted and clouded by rhetoric, and has not amounted to much in reality.
It is unclear what accounts have been included in the definitive defence budget, both now and in the past. The Ministry of Defence has been unable to provide a robust dataset that identifies which years the costs of operations or the purchase of urgent operational requirements were included in the calculations it submits to NATO. Such inclusions are allowed by NATO, but the lack of clarity confuses anyone’s ability to make year-on-year comparisons of the defence budgets. The MOD must be secretive—that is the very nature of it—but there is no need for shading in that respect, unless it is because the Government hope to get away with not doing what they said they would do. If that is not the case, it could easily be cleared up and rectified with a clear, simple and transparent spreadsheet. That has not been done. I am sure the Minister will respond to that when the time comes.
In accounts provided by the MOD for 2010 and 2015, the new inclusions of the 2015 accounting strategy are difficult to identify. The new inclusions should be outlined and shown from which Department each was previously funded, such as war pensions, intelligence gathering and all of the other things that may be found in the budget for the first time that have suddenly been introduced as part of the 2%. Hon. Members will understand why the Defence Committee is concerned; others who are not on the Committee have expressed concerns as well. My mother often talked of “robbing Peter to pay Paul”. That is what appears to have happened. We have enlarged one defence budget by doing away with others. In the end, Peter and Paul have the same combined amount as they did before. It really is hard to understand how it all works.
As I said in March 2015, my concern is not and never has been about the pennies. My concern is about provision and whether we have in place what we need to actually do the job we want. That was mentioned by the hon. Member for Glasgow North (Patrick Grady), who spoke before me. Is there enough? I do not believe there is enough spending, and the report backs up the fact that that has not changed. My first concern is not having the adequate manpower or provision to step in and offer adequate aid to buttress against further pressures in the areas in which we are involved, which is in the wider context of heightened security tensions across Europe and the middle east and across the Atlantic.
I and other members of the Defence Committee have expressed concerns before about the numbers of reservists and how we get those numbers up. How do we deliver that? How do we retain our regulars? How do we ensure that our service personnel are adequately trained and equipped, and that we have the frigates and ships to fulfil the Royal Navy’s roles? Sometimes Members who are not here or not on the Defence Committee may not know what those roles are. Do we have an RAF that can carry out its responsibilities, from as far away as the Falklands to the piracy in the horn of Africa? Can we be effective in the middle east? We need to be, and we need to have the money in place to do that.
We face threats of both an internal and existential nature, which we need to be prepared to meet. Those threats stretch the capacity of our defence capabilities, first, to maintain the standard of assistance in areas in which we are involved and, secondly, to meet the prospect of further demands. That is what we have to do: meet those further demands.
Those concerns have been shown to be truth over the past 18 months, as we have become involved in more and not fewer situations that require, if not a presence, then intelligence and preparation. We cannot stretch ourselves to such a limit that we are no longer able to protect our citizens, or commit to and deliver our responsibilities, wherever in the world they may be.
As I stood then for at least a 2% of GDP spend, I stand today. We will not be pacified with pie charts and graphs, as the Chair of the Defence Committee presented it to us at an earlier stage, or columns of this or that. We need an honest and open account, and that is not what we have received.
I am conscious that other Members wish to speak, so I will conclude. I say to the Government: do the right thing. Be a Government who stand by their word. Do not seek to pull the wool over the eyes of the Defence Committee or anybody else outside it, when our national security and the lives of men and women are at stake. Our men and women whom we are very proud to see serving and honouring the pledge they have made to defend all these shores and all our interests deserve no less, and their service demands that we cease the disservice that has been done. The Government should simply do what they said they would do by delivering on the 2% and ensuring it is a real 2%. At this time, I do not believe it is.
It is a pleasure to speak under your chairmanship, Mr Bone. It is always a challenge to follow my informed colleagues in these debates, so I apologise for any repetition.
The first duty of any Government is the defence of the realm and security of their citizens, so I welcome this opportunity to discuss the Government’s ongoing defence commitments. We are living through a period of global turmoil and national uncertainty. Though Britain is preparing to exit the European Union, we must remain an outward-looking nation, committed to fulfilling our role in the world and supporting the efforts for peace and international stability across the globe.
The threats to that peace are many and varied: an emboldened Russian Federation, continuing instability in the middle east, a Europe struggling to come to terms with the historic migrant crisis, ever-adapting terror networks, and modern technology that expands the potential threats to our country and that has revolutionised the theatre of war. In these uncertain times, it is more important than ever that the UK is committed to maintaining a military that is capable of dealing with whatever threats the future may hold and that meets the capacity and capability needs identified by the strategic defence and security review. That can be achieved only by ensuring sufficient year-on-year funding to maintain and expand our armed forces capability. That is why I and my colleagues on the Defence Committee welcome the Government’s continued commitment to the 2% pledge on defence spending, to ensure our NATO compliance. That commitment sends an important message to our allies in NATO and beyond that the UK remains committed to fulfilling our role in the world, and to defending and supporting our friends, wherever and whenever that need arises.
As we have heard, the UK has the largest defence budget in the EU, the second largest in NATO and the fifth largest in the world, but money alone will not solve these issues. I hope that the 2% pledge is a commitment to maintaining our military strength in the long term. It is important that we do not simply take the figure of 2% as an arbitrary one or as the final word on Britain’s spending and procurement in the years ahead. In charting the future of the UK’s military capacity, we must always endeavour to work from first principles. What is required to keep our country safe?
In our Committee’s report, we raised a number of initial points in response to the Government’s spending plans. We noted that while the Government met their 2% commitment to defence spending last year, they did so with the aid of what appeared to be a measure of creative accounting, albeit creative accounting that was accepted by NATO, as was outlined by the Chair of the Committee, the right hon. Member for New Forest East (Dr Lewis). By revising the criteria by which defence expenditure is calculated, the predicted Government spend for 2015-16 rises from £36.8 billion, or 1.97% of GDP, to £39 billion, equivalent to 2.08%. That was achieved by including expenditure from other funds, such as the conflict, stability and security fund, which is controlled jointly by the MOD and the Department for International Development.
I have no doubt that the Government’s commitment to defence spending and recognition of the challenges our country faces is sincere. However, our troops deserve more than financial wizardry. I hope that, in future years, the Government work to ensure that the necessary resources are put into defence, and ensure that we are spending a minimum of 2% annually in real terms, so that we have sufficient resources to fund our capabilities as well as to invest in our future.
I also welcome the Government’s commitment to maintaining the size of our armed forces, with plans to grow the size of the Royal Navy to 30,600 in 2025—an increase of 400 personnel and an uplift of 1,600 over the position initially laid out by the previous Government in 2010. However, as we have discussed today, with the planned retirement of HMS Ocean, even those numbers are insufficient to fully man our current capabilities. I have significant concerns about proposed cuts to our Royal Marines in terms of absolute numbers, which I hope our Committee will continue to investigate.
Considering the ongoing active deployments of our RAF forces, plans to expand the strength of RAF regular personnel to a baseline of 31,750 are welcome. However, with the imminent arrival of not enough F-35s, we will have to review that number. I remain sceptical of the Government’s suggestion that an integrated Army of 112,000 personnel is sufficient to deliver the Army’s contribution to joint force 2025, but time will tell, and I am sure we will revisit that.
There is much in the Government’s response to our report that is welcome, but I wish to stress the importance of ensuring that capacity is met and that our defence spending is sufficient to meet our needs, even when that may necessitate a spending increase over and above the 2%, which, despite what the hon. Member for North Wiltshire (Mr Gray) said, many Members on the Labour Benches would support. We must understand that the 2% pledge represents a minimum annual spend, and we should never seek to curtail or compromise our military capacity in order to stay within that amount. Our report stated that
“the Government must be clear that 2% is a minimum—not a target—and be prepared to increase defence expenditure further, in order to reflect the increasing threats faced by both the UK and our Allies.”
We must also take into account the UK’s situation in the wake of the EU referendum and the role that the current uncertainty may play in our economic outlook. With the additional financial and geopolitical challenges that Brexit may pose in the short to medium term, it is vital that the Government recognise those concerns and act to ensure that our military remains on solid financial and operational ground in the years ahead. A report from the Resolution Foundation suggested that the economic upheaval thrown up by uncertainty around Brexit could cost the UK economy up to £84 billion over the next five years, which would have a significant impact on the 2%. The real value of the Government’s 2% pledge ebbs and flows with the country’s economic fortunes. As outlined by the hon. Member for North Wiltshire, the commensurate drop in GDP resulting from that would be reflected in a drop in the value of the 2% set aside for annual defence expenditure, which could have a devastating effect on our capability, especially if the 2% comes to be seen as a spending cap rather than a minimum.
A further concern is the declining value of sterling and the impact that it may have on overseas procurement. One particular issue is the purchase of military equipment bought in US dollars, at prices that could greatly exceed initial estimates. For instance, the MOD recently announced the purchase of nine P-8A Poseidon maritime patrol aircraft from Boeing via a foreign military sale. The predicted cost, including training, infrastructure and the necessary support at RAF Lossiemouth, was recently estimated to be £3 billion over the next decade. However, with the pound slumping to its lowest value against the dollar in some time, the initial costs of purchase could greatly exceed initial predictions unless appropriate—
I apologise for interrupting, but as former Ministers in the room and the Chair of the Defence Committee will know, these sorts of contract are offset, and predictions are put in—the Treasury has that capability. If we build a road project, we put in the project cost and the inflation cost. That risk is built into the project, which former Ministers in the Chamber know.
And the Apache. There are significant concerns about British manufacturing capabilities within the current procurement programme.
As the UK comes to terms with our future outside the European Union, it is more important than ever that we maintain a strong independent military presence. I believe the Government recognise that. I again welcome their response to the Defence Committee’s report and their ongoing commitment to supporting a robust UK military. I for one believe these issues to be above party politics.
It is a pleasure to serve under your chairmanship, Mr Bone.
I was going to talk about the 2% pledge, but many of the points I was going to make have been covered today and were extensively covered in the report, so I will confine my remarks to chapter 4 of the report: “UK defence: what can we afford”. It considers that question in the context of the 2% pledge.
In paragraph 75, the Ministry of Defence is quoted as saying that the SDSR would
“determine priorities for investment to ensure that the UK has a full suite of capabilities with which to respond to defence and security threats”.
Indeed, page 67 of the “National Security Strategy and Strategic Defence and Security Review” document of last year identifies the three tiers of domestic and overseas risks we face, grading them as tier 1, 2 or 3
“based on a judgement of the combination of both likelihood and impact.”
Taking that at face value, the National Security Council has identified terrorism, international military conflict, cyber, public health, major natural hazards and instability overseas as the tier 1 threats facing the UK.
With that exercise having been undertaken, one would have thought the resources would follow the perceived threats and their perceived likelihood, but that does not seem to be the approach followed by the Ministry of Defence. For example, it is extremely concerning that the Government seem to be hellbent on pursuing their ideological obsession with a new generation of nuclear weapons, which its proponents argue are to deter an attack using chemical, biological or nuclear weapons—a tier 2 threat according to the National Security Council risk assessment.
Meanwhile, the Government have delayed commissioning and building the promised Type 26 frigates on the Clyde, which my hon. Friend the Member for Glasgow North (Patrick Grady) mentioned. Those are essential to address tier 1 threats—international military conflict and instability overseas.
I am in favour of fulfilling the promise made in 2013 to have 13 ships built on the Clyde. If the hon. Gentleman goes to the Ministry of Defence website he will see that its description of those ships’ role includes a whole range of things in addition to protecting the nuclear deterrent.
We wait to see whether the national shipbuilding strategy, which is due by 23 November, sees an end to the disgraceful delay in commissioning those ships on the Clyde. We wait to see whether there is a guarantee that the five multi-purpose frigates will be built on the Clyde, or whether they will be commissioned to be built overseas. Based on the answers to those questions, we will evaluate the long-term prospects for the Clyde yards, which provide vital capability infrastructure, enabling the UK to address tier 1 threats set out in its own national security strategy and SDSR.
Originally, of course, the Government promised that 13 Type 26 frigates would be built on the Clyde, but they revised that substantially to eight, with five general purpose frigates to make up the shortfall. In paragraph 90 of the report, the Committee correctly identifies the risk:
“Should…the ‘concept study’ to investigate the potential for a new class of lighter, flexible general purpose frigate be unsuccessful, we wish to be informed at the earliest opportunity of the MoD’s contingency plans to deliver the extra ships to satisfy the total originally promised.”
The Government’s response to these concerns merely indicates a willingness to keep the Committee informed, and we must hope that there will be no further backtracking on the general purpose frigates. Further, we await confirmation that they will be built on the Clyde. Should that not occur, as well as being a betrayal of the skilled workers employed at those shipyards, it will threaten the yards’ capacity to deliver complex warships in the future and undermine the UK’s ability to meet the challenges identified in the national security strategy and SDSR.
The report also identifies clear concerns among the witnesses the Committee questioned about the MOD’s ability to maintain the size of the armed forces at the levels envisaged in the SDSR, which several speakers touched on today. Those concerns were voiced more than six months before the EU referendum and the economic impact of that vote. Should the decision of the UK as a whole to leave the EU result in an adverse economic impact on the UK, as seems likely given its impact in the months since the vote, there will be further pressure on the UK’s ability to deliver expensive military capability and manpower in future.
In particular, the collapse in the value of the pound may have a serious impact on the affordability of imported military systems, of which we have many and plan many. Spending 2% of a significantly smaller pot will have serious implications for the delivery of ships and planes and the maintenance of manpower, particularly if, as seems inevitable, the costs of vastly expensive programmes such as the successor nuclear weapon submarines spiral.
I thank the Defence Committee for its work in this area—it does an excellent job looking at this policy. I am very happy to have had the opportunity to speak today.
It is a pleasure to speak under your chairmanship, Mr Bone.
This debate is about what sort of country we see ourselves as being. I have always seen the UK as a force for good, and I mean that not just in military terms but in our humanitarian role in the world and how we have defended liberal democracy over the decades. The issue is not just the 2% pledge, but whether we have the capability to achieve what we set out to do as a military nation. In 2013, the UK’s GDP was £1.6 trillion, with a defence budget of £37 billion, or 2.3% of GDP. In 2014, our GDP was £1.7 trillion and the defence budget was 2.17% of GDP. At the same time as the budget has fallen significantly over that period, Russia’s defence budget went up by 21% last year alone. That is what we must consider.
I do not think the Russians want to enter into a war with the west, but times are uncertain. Russia might be a declining power, but insecure powers, like insecure people, may lash out, and that country also has nuclear weapons. I read in The Times at the beginning of this week that Russia has just unveiled a new sort of intercontinental ballistic missile. We know that it has put nuclear weapons into Kaliningrad, and we know what it does in Syria. We definitely know what it did in Ukraine. Russia is flexing its muscles, and we must be prepared for that.
General Sir Richard Shirreff said in his evidence to the Committee that even if all NATO’s member states put 2% of their GDP into the defence of the west, he was sceptical about whether that would be enough to see off the threat from countries such as Russia. We must realise that many of the military conflicts and issues around the world are asymmetrical, and there are all sorts of issues such as cyber and terrorism. Russia is one nation that we could find ourselves in conflict with.
China’s defence budget is well over $200 billion. The rest of that region’s defence budget put together is only $45 billion. A figure I came across at the beginning of the week is that there are more than 100,000 UN peacekeepers around the world in 16 locations, many of them in Africa. The world situation is very turbulent. Are we in a position to defend ourselves?
Sir Richard Barrons said in The Daily Telegraph on 17 September that the UK’s armed forces are withered. I do not want to talk down our armed forces and the brave men and women who serve in them, but this man knows what he is talking about, so he should be listened to. He referred in the Financial Times to Britain’s ability to defend itself from aerial attacks and said:
“UK air defence now consists of the”
working Type 45 destroyers,
“enough ground-based air defence to protect roughly Whitehall only, and RAF fast jets. Neither the UK homeland nor a deployed force—let alone both concurrently— could be protected from a concerted Russian air effort.”
These issues are worrying for me and, I believe, for the other people in this Chamber and the Defence Committee.
Is 2% enough? When other things, such as pensions and so on, are included, and there is creative accounting, do the Government really mean 2%? We must sit down and think whether it is enough. Efficiencies are brilliant and fantastic. We all agree with that, but the one thing we must do is to protect this country. We must have a serious look at whether 2% is what we should be paying.
We have two brilliant aircraft carriers that will come into service in a little while, but have we got enough ships to defend them? Have we got the submarines to defend them? Have we got the skills to man them? We need to look at that. If we are to punch above our weight, let us ensure that we can actually do that. We just have to be honest with ourselves. Is 2% enough? Is the 2% actually 2%? Should the figure be higher? We need to hear from the Minister on that.
It is always a pleasure to serve under your chairmanship, Mr Bone. I thank the right hon. Member for New Forest East (Dr Lewis) for his input this afternoon and for his chairmanship of the Defence Committee. I associate the Scottish National party with his comments about the excellence of the Committee staff.
In preparing for today’s debate, I not only read the report and the Government response, but looked back over my notes from last year of the evidence that the Committee took. It speaks well of the quality of the witnesses to the inquiry that much of what they said is now coming to pass. I will touch on some of that evidence today.
This is obviously a vast subject that really deserves a day’s debate in the House. However, time pressures will restrict me to only dipping into some of the issues raised in the report. Those are the decidedly squidgy nature of what 2% means; the pressure that that will inevitably put on future procurement projects; and the overwhelming feeling that the Government are confusing “preserving the shop window”, which is typified by the pledge, with actual hard-headed strategic thinking that links in to capability. The focus on inputs has simply provided a useful smokescreen for a distinct lack of usable outputs in our defence capability.
The report is unequivocal that although 2% may act as a useful benchmark and a statement of intent, we should not kid ourselves that it means anything more than the MOD wants it to mean, because, quite simply, using previous measures of defence spending will bring us below the desired figure. Shifting the goalposts means bringing into that figure a whole range of spending priorities, from pensions right through to Trident, that would not have been included before. That has conspired with a whole range of other restraints and ring fences in a way that will see the MOD increasingly tie itself in knots.
Let us take pay restraint, for example. Central to future budgets of the Department is a commitment to ensuring that any rise in the pay of personnel does not exceed 1%. Any upwards movement on salaries would, given the nature of such a target, mean less money for other projects. As inflation rises in post-Brexit Britain, so our dedicated and selfless armed forces personnel will face a pay “crunch”, as Dr Robin Niblett of Chatham House foresaw in his evidence to the Committee last October.
In that regard, although giving hard-pressed personnel a pay rise will be out of the question, the one part of the 2% that there will be no problem with is funding the weapons of mass destruction. I and my colleagues have been relentless in asking the Government to address that anomaly. In fact, if the SNP Defence team could be renamed, I am sure that we would be called HMS Relentless, because we know that every penny spent on Trident is a penny less spent on conventional defence, and that also mean fewer pennies for the salaries of serving personnel.
The right hon. Member for New Forest East suggested that we should move to “three to be free”. I think that a great campaign would be to go for “nil to save on the bill”. Perhaps the Minister can comment on that.
As the Member for Dunfermline and West Fife, I am sad to say that every penny spent on Trident also means less money to support the stunning Queen Elizabeth-class carriers being built in my constituency. Those amazing vessels deserve and require a host of capabilities around them, but in the Government response to the report, we do not get much idea of how they will be paid for. Other hon. Members have alluded to the Type 26s, for example. Whether we are talking about the F-35B joint strike fighters that will fly from the carriers or the Type 26s that will protect them, it seems that in putting forward their pledge, the Government may have caught themselves in a trap of their own making. Of course, as the Great British pound continues to fall in value against the dollar, each of the planned 138 F-35s becomes that bit more expensive, even allowing for what the Minister alluded to earlier. Every day that passes without a timetable being given for the Type 26 programme means that the hard work of my constituents in ensuring that the carriers are delivered on time and on budget is being undermined. I hope that, along with addressing the other substantial points from the report today, the Minister will take the time to let us see what his Department plans to do to ensure that those projects are not adversely affected by the plummeting pound.
Ultimately, the problem is that the 2% pledge should not be confused with a strategy—a charge made by many witnesses in their evidence to the Committee and most forcefully by Professor Julian Lindley-French. The problem is well illuminated in the recent document leaked to the Financial Times, in which General Sir Richard Barrons critiqued the Ministry of Defence for its focus on “preserving the shop window” over its most basic national security duties. The 2% pledge obviously sits very nicely in that shop window.
Also in the shop window sit projects such as Trident, which the Government hope will boost our international prestige and look good in a press release, but which bear no relation to the threats that this country faces and are taking a terrible toll on real, usable procurement projects and, indeed, our armed forces personnel. As we float off into the uncertain waters of Brexit Britain, I would hope that at the very least we could have some form of real stability in our national defence, but as the report shows, as it is with Brexit, so it is with defence—there are more questions than answers.
It is always a pleasure to serve under your chairmanship, Mr Bone. I add my voice to those congratulating the right hon. Member for New Forest East (Dr Lewis) on securing this important debate. As we have heard from other hon. Members, he has been an excellent chair of the Defence Committee. I congratulate him and his Committee on their report “Shifting the goalposts? Defence expenditure and the 2% pledge”.
I thank all hon. Members who have taken part in the debate, but particularly my hon. Friends the Members for Stirling (Steven Paterson), for Dunfermline and West Fife (Douglas Chapman) and for Glasgow North (Patrick Grady). [Interruption.] And the hon. Member for North Wiltshire (Mr Gray) of course, although I will have to caveat that by saying that I agreed with much of what my hon. Friends said and, as the hon. Gentleman will not be too upset to discover, I did not agree with a great deal of what he had to say.
What has been confirmed to us today is that the 2% target was created to redress the balance between the defence budgets of the United Kingdom, the other European NATO members and the United States. It has been correctly pointed out that it does not necessarily follow that achieving the 2% target will deliver the defence capabilities required by the UK. The Defence Committee was very aware of the limitations of the arbitrary 2% figure in delivering capability. It may well, as has often been stated in this debate, have a powerful symbolic meaning in the context of the perceived commitment of the UK to our NATO allies. As the report says, it
“sends an important message to all the UK’s partners and potential adversaries.”
However, as I am sure the right hon. Member for New Forest East would agree, that is a far cry from saying that we are getting this right. Committing a minimum percentage of GDP to defence may well send the desired message, but—as my hon. Friend the Member for Stirling said—it does not adequately protect us from the threats that we ourselves have identified. I need not remind hon. Members of the words of General Sir Richard Barrons just last month. He said that the UK armed forces had lost much of their ability to fight a conventional war and accused the MOD of sidestepping “profoundly difficult” strategic challenges. He also said that there is
“no military plan to defend the UK in a conventional conflict.”
Let us be clear: that is because we have made in this country the political choice to go down a nuclear route at the expense of a conventional route. That will have massive consequences for what we can do now and in future. Do not just take my word for it. Just last year, when General Sir Richard Shirreff spoke at the Defence Committee, he said one either goes
“down the line of a nuclear capability at the expense of conventional capability, or conventional capability at the expense of nuclear.”
As a result of our decisions, our vital conventional defence capability has been sacrificed on the altar of this Government’s obsession with nuclear weapons. As my hon. Friends the Members for Glasgow North and for Stirling said, the most notable casualty of that is the Type 26 programme, which has been cut, delayed, cut again and further delayed while the Ministry of Defence struggles to find the money to cut the first steel on the Type 26 frigates. Lord West, a former First Sea Lord, said:
“Because of pressures…our numbers have declined. Not only is that a problem for our defence capability and the security of our nation and our people; it is a problem for our shipbuilding and our defence industries.”
The lesson we have learned from this Government is that there will always be money for nuclear weapons and that it will always come at the expense of our conventional defence. How much longer will the workers on the Clyde have to wait to start work on the Type 26 programme? How much longer does the Ministry of Defence believe it can eke out the ageing Type 23 fleet? Those frigates were supposed to have been taken out of commission by 2023, but that is now virtually impossible to see happening. The Type 26 frigates are badly needed by the Navy and are a vital part of our conventional capability; however, they are being sacrificed because of this Government’s obsession with nuclear weapons.
I thank the hon. Gentleman—he might even be a friend—for giving way. I repeat: a primary role of the Type 26 global combat ship is to preserve our independent nuclear deterrent. Frankly, if we really go down that road, perhaps we do not need the Type 26. If the Scottish National party were in power, it would get rid of our independent nuclear deterrent, make us really vulnerable and get rid of the Type 26 frigates while it was at it.
I appreciate the hon. Gentleman’s repetition and think that my hon. Friend the Member for Stirling adequately answered him previously. There is much more to the Type 26 frigates than simply protecting the deterrent. The workers on the Clyde were initially promised 13, which has subsequently been cut to eight. All we are asking the Government to do is honour their commitment and fulfil their promise to the workers on the Clyde.
Whatever the Government’s method of calculating defence expenditure, we have grave concerns about their strategic choices and the effects those are having on the UK’s defensive posture. As the hon. Member for Bridgend (Mrs Moon) and the hon. Member for North Wiltshire said, the MOD’s creative accountancy and ability to hide a multitude of sins in a fog of statistics is the stuff of legend. Let us be absolutely clear, as Professor Phillips O’Brien at St Andrews University said recently, defence
“cuts have fallen disproportionately on the guts of British defence: the army and logistics.”
The Army is smaller than it has been for centuries while the Government throw obscene amounts of money at Trident.
As my hon. Friend the Member for Dunfermline and West Fife said, although 2% may act as a useful benchmark and a statement of intent, let us not kid ourselves that it means anything more than what the MOD wants it to mean. As we have heard on numerous occasions this afternoon, if we take previous measures of defence spending, it brings us well below the desired figure. Only by adding a whole range of spending priorities, from pensions to Trident, can we achieve that 2%. In many ways, that renders “2%” meaningless—it becomes a totem rather than any meaningful gauge of how we defend this country. The Government have thrown everything into the pot, including the kitchen sink—indeed, we probably could claim against the kitchen sink—in order to play what has become a rather crude numbers game.
On this side of the House, we have said many times that the Select Committee’s report noted that meeting the minimum NATO spending targets does not mean that defence is adequately resourced. That is very clearly the case under this Government and previous ones. Their sums do not add up, and we believe that their decisions have been highly detrimental to the armed forces and to this country’s conventional capabilities.
In his opening statement, the right hon. Member for New Forest East said that there had been no jiggery-pokery by the MOD, but I am sure he would agree that there is, indeed, a strong whiff of jiggery-pokery in reaching the 2% target. The Government have had to rely on childish tricks, including conflating international development and defence spending, to reach this target. They have ignored numerous requests from the Committee to come clean and to explain where that money has been re-accounted for.
In conclusion, this debate has shown that the 2% figure is pretty meaningless; it is a totem and is merely symbolic. The debate is now about what we should be doing with the real money we have, rather than posturing with percentages. It is about the amount of money we have and what we do with it, not whether it is 1%, 2%, 3% or—in the opinion of the hon. Member for North Wiltshire—4%. We can do better if we allocate it properly, which means allocating it to our conventional defences and not pouring it down the black hole that is Trident.
It is a pleasure, as always, to serve under your chairmanship, Mr Bone. We have had an extraordinary debate this afternoon here in Westminster Hall. I want to add my congratulations from the Opposition Front Bench position to the right hon. Member for New Forest East (Dr Lewis), who chairs the Defence Committee, and to all the members and staff of his Committee, on producing an excellent report. So far, nine right hon. and hon. Members have spoken about it, plus two Front-Bench spokespersons, and the Minister will speak in a few minutes.
The Chairman of the Committee made it clear at the beginning that what we spend as a percentage of our gross domestic product on defence has radically altered since I was born in 1955, a year after the hon. Member for North Wiltshire (Mr Gray). [Interruption.] Yes, I appreciate he looks considerably younger than I do. When we were born in the ’50s, it was just 10 years after the most momentous world war and the destruction of so many lives and properties throughout this country and the world. Our entire country was effectively one armed force to defend ourselves from the aggression we faced at the time. It was logical, therefore, that we should have scaled down the percentage that we spent. However, one of the themes that has come through clearly during the debate this afternoon, is that it is not about the crude percentage, but about how we spend it and the value for money we get. Speaker after speaker has made that point and I am sure the Minister will underline it when he sums up at the end.
We have heard some very good contributions. My hon. Friend the Member for Bridgend (Mrs Moon) is well known for her hard work on the Defence Committee and for her knowledge of defence. She questioned, yet again, the criteria of the calculation that was amended so that the Government were assisted in reaching that 2%. As many other right hon. and hon. Members have mentioned, including pensions is perhaps a slightly dodgy calculation when trying to make up that 2%. I would welcome the Minister’s view on the inclusion of pensions in the overall percentage. My hon. Friend made the point that the UK’s credibility is being damaged by the way in which we make up the 2% that NATO demands.
We heard a very good contribution, as always, from that expert on the Government side, the hon. Member for North Wiltshire. I have known him for many years and have worked on many campaigns with him—we share that in common. He made the point that we cannot compare the percentage spent in 1954 with the percentage spent today because the world is a totally different place. He also made a very important point about accounts: why are they not kept for more than seven years? I find that surprising. Surely the different accounts must be in the records of this place in Hansard from when estimates have been debated and discussed in the decades since 1954.
The hon. Member for Strangford (Jim Shannon), as always, made his contribution to a debate—it seems that every debate I take part in he is there, making important points. He said that the MOD was unable to provide a robust dataset and that, as his mother used to say, it was robbing Peter to pay Paul.
[Andrew Rosindell in the Chair]
I pay tribute to my hon. Friend the Member for Stoke-on-Trent North (Ruth Smeeth), who made a thoughtful and well written contribution to the debate. We are the fifth largest defence spender in the world, but it is really important that 2% does not remain a maximum of what we spend to keep the realm safe. She said that we need to spend what is required. We on the Labour Front Bench agree.
My hon. Friend the Member for Sedgefield (Phil Wilson) spoke well, as always, being very knowledgeable in these things and being an active member of the Committee. He pointed to the threat from Russia. In my previous role in the foreign affairs team, I was responsible for our connections with NATO, where I went in June. We heard over and over again, from officials in Brussels and in the Supreme Headquarters Allied Powers Europe in Mons, about the increasing threat from Russia as it flexes its muscles in the world, shows us what it is made of, making up for the deficiencies of the President of that country in internal and domestic policy with aggressive foreign policy. It is very clear that that is what dictators look to divert attention.
In bringing my remarks to a conclusion, Mr Bone—[Interruption.] Sorry, Mr Rosindell. Thank you for pointing that out, Minister. In trying to bring together the points that have been made this afternoon, I make it absolutely clear that Labour’s position is to remain an active, important and strategic member of NATO and to keep our defence spending as we need it to be to defend the realm.
Everyone in the armed forces knows the damage that was done during the last Parliament when our defence spending dipped well below that 2%. Many are questioning, as we have this afternoon, what is now included in the calculation that puts us artificially over that 2% to 2.08%. It has not necessarily been achieved as a result of increases in actual defence spending on our armed forces and on the equipment that they need; it has been done by showing and including other expenditures, such as some of the money spent within the Department for International Development. I would welcome the Minister’s comments on that.
As my colleagues have pointed out, the Labour Government comfortably met that 2% target each year. In fact, the lowest percentage of GDP spent in the 13 years that Labour was in power was 2.4%, so the next Labour Government are certainly committed to spending that NATO minimum. [Interruption.] Sorry, did the Minister want me to give way?
Well, that is the calculation that I have been given by my researchers.
As I said, we have the fifth largest defence budget in the world. I am glad to say that defence spending will increase by £5 billion up to 2020-21. That is welcome, but like any competent business purchasing supplies or the resources necessary to make it work, we have to ensure that we get the best possible value for what we buy, and that, as the Chair of the Committee pointed out, we put money into our personnel with adequate, proper and decent training. We all know that without that training, our forces cannot work as a collective whole and cannot work as effectively as possible.
I believe that only Estonia, Turkey, Greece and France spend 2% of GDP or more on defence. There has been anxiety in Washington about the fall in the UK’s defence budget. In the Financial Times recently, the right hon. Member for West Dorset (Sir Oliver Letwin), the former head of policy at No. 10 Downing Street, was reported as saying:
“If we need to get to 2 per cent of GDP, there is a question of whether you can increase overall spending by counting funding of the intelligence agencies as defence spending”.
I would welcome the Minister’s response to that.
The Opposition Front-Bench team believes, like the Government and I think every Member of this Parliament, that the defence of the realm is the No. 1 priority of the Government of the day. We need to spend what is necessary to keep the population of this country safe, but we need to spend it wisely and well.
I will conclude by returning to the remarks that were made by my friend and colleague, my hon. Friend the Member for Sedgefield. He said that even if all the NATO countries put 2% of their GDP into defence, it would not be enough to protect us from our enemies. There are 100,000 UN peacekeepers in 16 countries because the world is in such turbulence at the moment, so the question I leave the Minister with is this: is 2% of GDP sufficient?
It is a pleasure to serve under your chairmanship, Mr Rosindell—I hope I get your name right; I got told off last time, so I will try hard.
This has been a very interesting debate on such an important day—the day that the national poppy appeal is launched, when we remember those who gave so much for us. What a perfect time for this debate to take place. It is my first debate as Minister for the Armed Forces in the Ministry of Defence.
I completely agree with the Committee in asking whether 2% is enough. Could we spend more? I am sure we could, but 2% is a NATO guideline. Would it not be great, as the hon. Member for Bridgend (Mrs Moon) indicated, if the other NATO countries also stepped up to the plate and spent 2% of their GDP on defence?
What great news it was today that our GDP has increased, even though scaremongers, including the BBC and others, said that the economy was in a dive after Brexit. It has gone in the opposite direction, which will mean there is more money to be spent. No Defence Minister would stand up and say, “No, we wouldn’t like to have more money,” and anybody who did would not be telling the truth. However, we have to live within our means and make sure that what we get is spent correctly, which is the crux of today’s debate.
Let us get Trident over and done with first. If we want to be a member of NATO, we have to be under a nuclear umbrella. If we do not want that, we do not stay in NATO. If we took the Scottish National party’s position, not only would we lose thousands of jobs on the Clyde, but we could not really be part of NATO. That debate has been had before. We debated the nuclear deterrent in the House, when the House—not the Conservative party or this Government—made the decision on the future nuclear deterrent by a huge majority. That was the message to the rest of the world and to NATO.
Does the Minister accept, though, that the Scottish Parliament, the Scottish Government, the SNP, the Labour party, the Greens, the Scottish Trades Union Congress, the Scottish churches and great swathes of Scottish civic society have all said no to Trident? Should that voice not be respected?
Perhaps the referendum in Scotland, when the Scottish people decided to stay part of the United Kingdom and under the rule and sovereignty of this Parliament, is another important decision that needs to be taken into account. The percentage of GDP in the Scottish economy from defence spending is huge, and the SNP really have to take that on board in what they say about the future of defence.
No, I have given the hon. Gentleman an opportunity to intervene and he has had plenty of time.
We have to spend the money correctly. Comparisons are really difficult. My right hon. Friend the Member for New Forest East, the Chair of the Committee, touched on that point in saying that trying to compare like with like is very difficult. National service was still in place when the hon. Member for Leeds North East (Fabian Hamilton) and my hon. Friend the Member for North Wiltshire (Mr Gray) were born, which has been alluded to. When I joined the Army in 1974, I was in the British Army of the Rhine in Germany with the 3rd Armoured Division. We had almost no fuel and almost no ammunition and we hardly ever left the military transport park. We just did not have the money. We sat there knowing full well that we were a deterrent. The boys and girls who were serving at that time were very brave—all the armed forces were brave—but we knew that the money was not being spent correctly. As a young soldier, I could see it then and we have seen it through various Governments that have been in power.
How do we spend the money as well as possible? We get the right kit to deal with the threats, but the threat changes. Most of us thought the cold war was over. We thought we could look at the threats from other parts of the world and apply our defence accordingly. In the past couple of months we have had to look back to the old foe. We saw their fleet sailing through the English channel, probably as a sign of what they could do. We saw black smoke coming out of the top of the aircraft carrier—she could not have gone a knot faster if she had tried because she is so old and decrepit—but she represents a threat. Could they have gone round the north, as they have done before? In fact, the weather was very bad off the west coast at the time, but probably they were sending a message. Our boys and girls in our armed forces shadowed her man for man as she came through. I know that because I was on a frigate in the channel while the aircraft carrier was coming through.
We have to be careful with these defence reports. We are genuinely trying to do the best for our armed forces and make sure they have the right equipment. We must show we are behind them and not undermining them. It is a very thin line.
I have responsibilities as the Ops Minister. Everybody thinks we are home from Afghanistan and Iraq, but we have ops in nearly 39 countries where our armed forces are serving us today. I do not think we have paid enough tribute to those boys and girls—our servicemen and women who are out there on our behalf—during this debate. I know it was touched on in some Members’ speeches, but mostly it was not, and that is a real disappointment because the forces pick up on what we say in this House and see where their support is.
Are we hollowed out? I do not think so; I would not be able to do this job if I thought that was the case. We will continue to fight the Treasury to make sure we have as much as we possibly can. It is enormously difficult to compare what happened in 1956 with what happened in 1974 when I joined the Army. The package we offer our armed forces is absolutely important. The issue is not just about recruitment, but about retention, which I will come to in a moment.
(East Renfrewshire) (SNP): There is genuine support for the armed forces, but when working out what we have to spend, it is difficult to have confidence in the figures we have been given. For the seventh year in a row the Ministry of Defence accounts have been qualified because they cannot meet international accounting requirements. A resolution of that would go a long way to supporting the appropriate spend in the areas that need it. It would also give confidence to our service personnel.
I am in my seventh Department in six years and I have struggled to understand the accounts in most of them. That does not make it right—I fully accept that. From my point of view and that of my fellow Ministers, when we are looking at what we can and cannot do around the world and at home in defence of the realm, it is difficult, but at the end of the day, NATO set the 2% so that the rest of the NATO countries would come on board.
The question has been asked whether the international aid budget, which is 0.7% of GDP, should be linked to the MOD budget. Some of us have been in this place a long time. Although I was not elected such a long time ago, I remember a huge argument going on between DFID and Defence when Clare Short was the excellent DFID Secretary of State over helicopters during the flooding in Bangladesh—I may be wrong, but I think it was in Bangladesh. A massive delay took place while they argued about money. Is that the sort of situation that we want to be in today? If our Navy or our armed forces are operating in a humanitarian area, it is right that we help, but should that come from my budget or from DFID’s? We need to work much more closely together.
I will not be able to answer all the questions in the time I have been given, but the crux of the matter is that we are all, no matter what party we are from, pushing for the same thing. We want to respect our armed forces and give them the kit and equipment they need. We will disagree on certain aspects. We disagreed on Trident, which was debated in the House. We will continue the debate, but the House has made a decision and we are pressing ahead. I am really pleased that Her Majesty’s Opposition has committed to 2% of GDP on defence. That is the first time we have heard that. We have had a commitment for this Parliament going forward and I am really pleased that the Labour party has bitten the bullet, for want of a better description, and committed to doing that. I hope the hon. Member for Leeds North East (Fabian Hamilton) has not got into trouble over it, but I will write to him to confirm the commitment when this debate is over. It is a very important message from this House as we go forward.
I felt the report was helpful. As it says, we have not broken any rules. Along with my fellow Ministers, I will spend the money in the best way we possibly can to make sure we continue to have the best armed forces in the world and that they have the kit and equipment they require.
I thank everybody who has contributed to the debate. We have had an excellent turnout for a quiet Thursday afternoon. The fact that so many people have given up their afternoon to take part in this debate and made such strong contributions, both from the Back and from the Front Benches of the respective parties, is a matter for congratulations. I think we all agree that adequate funds are a necessary condition, but not a sufficient condition for wise defence expenditure. The question that came up again and again was whether 2% is enough. We heard it from the hon. Member for Sedgefield (Phil Wilson) and from the Front-Bench spokesman for the Labour party, the hon. Member for Leeds North East (Fabian Hamilton).
I started off by referring to the “we want eight” crisis of 1909, of which Winston Churchill wryly noted:
“The Admiralty had demanded six ships; the economists offered four; and we finally compromised on eight.”
Perhaps in the context of this debate we might end up by saying that I want three to keep us free in terms of percentages. My hon. Friend the Member for North Wiltshire (Mr Gray) wants four or the Government should be shown the door. Maybe we can compromise and, like the Bee Gees, say, “We want five for stayin’ alive.”
Question put and agreed to.
That this House has considered the Second Report from the Defence Committee of Session 2015-16, Shifting the goalposts? Defence expenditure and the 2% pledge, HC 494, and the Government response, HC 465.
[Relevant documents: Fourth Report from the Defence Committee of Session 2015-16, An acceptable risk? The use of Lariam for military personnel, HC 567, and the Government response, HC 648.]
I beg to move,
That this House has considered the Fourth Report from the Defence Committee of Session 2015-16, An acceptable risk? The use of Lariam for military personnel, HC 567, and the Government response, HC 648.
Before I turn to the overview of the report and the conclusions of the Select Committee on Defence, I want to put on record our thanks to those who gave us the impetus to investigate the issue and contributed their knowledge and their time. I apologise if I leave anyone out. Our thanks go to Trixie Foster and the retired Colonel Andrew Marriott for their persistence in raising the issue and co-ordinating a detailed submission; to defence correspondents who took the matter up; and to Forces TV whose work brought in more evidence. I thank the Library for its research and our Clerks, who do a magnificent job, as well as the witnesses who appeared at our three evidence sessions, including from the drug’s manufacturer, Roche.
I would also like to put on record my personal thanks to the Committee for agreeing to pursue the issue for the sake of the approximately 25% to 35% of personnel who have taken Lariam who have been directly affected. The Committee was determined to ensure that the Ministry of Defence would examine the damage to lives and the failure of the duty of care, and to make the necessary recommendations to protect our armed forces personnel in the future.
Lariam is one of several antimalarial drugs that the MOD uses to protect military personnel against malaria. None of the alternatives is without its problems, but Lariam has been the subject of concern for a long time. The inquiry set out to establish a clear picture of the impact of its use in the UK armed forces. I think it is fair to say that the Committee was shocked and surprised by what we found. I will leave others to go into details, as it is my role to give an overview of our principal conclusions and recommendations.
From the evidence we received from individuals and the statistics that the MOD provided, we were shocked that Lariam is still being used so often despite the well-known problems. We were told by the drug’s manufacturer that the MOD accounts for one fifth of all its UK sales. At a minimum, 17,368 personnel were prescribed the drug between 2007 and 2015. There may well be more, but one of our findings was the haphazard nature of MOD medical record keeping. Note to the Minister: it was particularly unhelpful when the MOD published its first 10-page statistical bulletin on Lariam on the day we took evidence from the Minister.
The MOD receives advice from the Advisory Committee on Malarial Prevention alongside the advice from the manufacturer. Roche is clear in its guidance that every individual who is prescribed Lariam should undergo an assessment with a medical professional to identify any contra-indications that might make them more susceptible to side effects. We questioned whether the ACMP’s advice was appropriate. It was clear to us that the general advice that it offered was not tailored to the specific needs and circumstances of the military. It fell short and put military personnel at risk. We concluded that the MOD should work with the ACMP to develop specific guidelines, similar to the US so-called “Yellow Book”.
If I am perfectly honest, no. I think that the medical care that is offered continues to fall short, but I hope that the Committee will be able to address the issue again in future and ask for further updates. Of course, we have the opportunity to hear from the Minister today what further progress has been made.
Alongside our findings about the ACMP, we looked at whether Lariam was appropriate to where personnel were sent and the work that they do. The Minister and the Surgeon General told us that geographical location was a consideration in prescribing Lariam. By contrast, other witnesses made it clear that there is nowhere where Lariam should be the preferred drug, particularly given that there is increasing resistance to it and there are alternatives available. Geography aside, and linked to our earlier concerns about the ACMP advice, we sought to clarify whether Lariam, given the known side effects, was appropriate at all in a military setting. A military deployment is a world away from a tourist sightseeing or sitting by a pool. The physical and mental strain of being deployed in stressful situations does not need to be exacerbated by the severe side effects that Lariam can induce.
Dr Nevin gave evidence of an alarming potential negative impact on military performance and operations. There were cases of service personnel experiencing
“episodes of panic resulting in abnormal behaviour”
and incidents of servicemen becoming confused and being found “wandering aimlessly”. There were incidents of tension and anger, episodes of severe mental and physical exhaustion and nausea, lapses of concentration and episodes of short-term memory loss, ill temper, dangerous driving, confusion and suicide ideation. That is a grim picture of medically induced problems for military personnel on deployment.
We explored whether other nations gave Lariam to their armed forces. Our research uncovered a mixed picture, but a tendency towards either no longer using Lariam at all or using it only as a drug of last resort. That all added weight to our recommendation that greater clarity is needed in determining when to use Lariam, and that attention should be paid to whether it is appropriate for military personnel.
At the heart of our inquiry was the question whether the MOD was fulfilling its duty of care by following the clear guidance on prescribing Lariam. Did every individual undergo the Roche-required individual medical assessment prior to deployment? Was it realistic to think that the MOD could ensure that that happened, particularly for a large-scale, short-notice deployment? Alarmingly, there was evidence that individual assessments were not happening. Lariam was included in pre-deployment kit; it was handed out on parade; or the MOD relied on an assessment of medical records only for prescription. We felt that that was a fundamental failure in duty of care. We concluded that, aside from the need to consider the practicalities of arranging assessments, prescribing Lariam should only ever be a last resort bounded by strict conditions. Linked to that, we uncovered concerns about non-reporting of contra-indications; military personnel appeared unwilling to admit to conditions such as a previous history of depression, because of fear of a negative impact on their career. That underlines even further the need for individual assessments.
Several witnesses reported that personnel were so concerned by the reputation of Lariam that they discarded their medication and were potentially left with no antimalarial protection at all. That came even from the very top. I believe Lord Dannatt has announced that he refused to take Lariam and would throw it away. We were deeply disturbed by that and recommended that the MOD should monitor compliance rates.
We most certainly did; but that also shows the inertia in the Ministry of Defence. We heard from many personnel—either individually or as a Committee—at different ranks within the MOD. The matter was not something that was not known about, but it was not being tackled or recognised as a major problem for serving personnel.
Finally, and most tragically, we heard from many individuals who suffered severe long-term effects from taking Lariam. Long after leaving the military, they are still suffering such things as mental trauma, vivid dreams and suicide ideation. That is totally unacceptable. We sought to establish what support was on offer for them from the MOD as it became clear that arrangements were somewhat fragmented. We recommended the establishment of a single point of contact, which we felt was particularly important for veterans, some of whom have experienced mental health problems for years.
Having seen what happened in the previous debate, when the vice-chair of the Committee could not be called to speak owing to time restrictions, I shall now leave it to my colleagues to expand further on the report and evidence. We look forward to hearing from the Minister that further progress has been made.
I, too, want to thank the Defence Committee Clerks, who did a terrific job. We were presented with a wide range of evidence, some of which was reasonably scientific, and we certainly needed their help. I also pay tribute to our many witnesses, one of whom flew in from America to give us evidence.
The report has been an important one for the Committee. In the first 18 months following the 2015 general election we have produced three reports on the duty of care and how we look after people. It is an interesting time in politics, and there are diverse views on defence on either side of the party divide and in the SNP; that is great, but we have a duty to hold the Government to account. That is where Select Committees can come into their own, and we have had some success. The report speaks to the soft side of looking after people and why it is important.
Having served and so on, I know that the interesting side of the military is going on operations and all the things that come with that—shiny stuff, bombs and all the rest of it—but what we fail to get in this country is the importance to combat power of looking after people. I certainly would not hold the United States up as a bastion of getting everything right, but we have seen its forces go through a process so that they understand the whole force concept. They do not just talk about it doctrinally or write about it at staff college. They actually impose a whole force concept whereby looking after families, housing, accommodation, health, wellbeing and so on contributes to fighting power. The US has seen those rewards. We are slow to that game, but we are beginning to get there and we are making real strides, particularly under the current Minister.
In the challenging time we are going through with Brexit, which absolutely presents opportunities as well, it is important that we do not drop the ball on defence issues. As everyone will recognise, we have come out of a particularly tense time on operations. We must maintain our focus, as my right hon. Friend the Minister for the Armed Forces alluded to in the previous debate. People read and watch what happens in this place, and it means something to them, so I am pleased that we are having this debate.
Lariam can be quite a complex issue, but it comes down to one clear thing. There is a drug that is clearly very effective at fighting malaria, which is a killer—we should not lose sight of the fact that malaria still kills a lot of people worldwide—but any manufacturer will say that the drug should be used within the guidelines. Unfortunately, for one reason or another, we did not use it within those guidelines, and people were affected.
The matter can be viewed as being a bit niche. When I first brought it to the attention of the Ministry of Defence in August last year, I was treated as though it were a personal campaign of mine. I have never taken the stuff, so I have never experienced any of the effects at all, but the issue is not niche to those who have been affected. We are now doing so much better in this place when it comes to the problems caused by Lariam, as we are on other mental health matters. However, it is simply not good enough to understand it just because it happens to us, our family or someone close to us. We have to take these things seriously, and we must take responsibility.
The hon. and gallant Gentleman has been identified as being closer to the issue than most. Do his former colleagues in the services believe that things have improved or changed? Is there any evidence of more support being given to our armed forces who have been subjected to the drug over many years, and are there signs of improvement in the support they get?
It would be hard for me to say, at the moment, whether there has been a shift. From the information I have been receiving, I understand that work has been done and it will take a little while to get the granular picture of that support. We have been given assurances that the report has changed things for people who are suffering.
We have to be mature and accept that, as an employer and a Government, we have asked young men and women to take medication to protect them from a disease in areas where we are asking them to operate, and we have not done so correctly. I welcome the fact that the report realises that. It is not in keeping with how we normally look after people. I know that, having served, I have come to this place on a bit of a mission, and that I get slightly carried away, as I did the other night, about how we look after people. However, one of the strengths of the military, including the Army, is that we do look after people. That pastoral care very much contributes to what we do, but the way in which we have looked after those who have taken this drug has been out of keeping with that.
I thank my very good friend for giving way. I am slightly concerned by the third condition for prescribing Lariam, whereby the danger of the drug is explained to the soldier, sailor, airman or airwoman, and then the decision is down to them. In my experience, a lot of soldiers will say, “For goodness’ sake, tell me whether I should take it or not. Why do you give me that decision?” That condition worries me, because I think that most soldiers will say, “You tell me what I should take. I am not the judge of that.”
I thank my hon. Friend, loosely speaking, for raising that point. He gets to the crux of the problem. Essentially in the military, we go on medical advice. None of us are scientists or doctors. If we get into the real detail of the issue, it is on that point that we get to the nub of what has gone wrong.
Does the hon. Gentleman agree that the problem was that there was no medical advice? Often, a sergeant major would just walk down the ranks, saying, “Take these.” There was no assessment—nothing. It was just, “This is what we have in the stores. You take it.” There were no warnings about the side effects or about reporting them. That was, and remains, the failure.
I absolutely agree that the single point of failure was that we had a drug that, like any drug—even paracetamol or Anadin—should be used within the guidelines set down by the manufacturer, but instead of people being given it carefully, in a medical fashion, with individual risk assessments as stipulated by Roche, Lariam was just handed out on parade. Clearly, that is not the way to do business. The hon. Lady is right. I am glad that we have identified that practice, and I believe that we have put a stop to it. That is a good thing to have come out of the report.
We now need to ensure that we look after those who come forward. There are conversations about compensation and things like that—I understand that that is the way of the world—but that is never the intent behind inquiries such as this. I am interested in looking after those who are going through the process. We must get those who come forward some sort of treatment. We must provide some point of contact that is not just known by me, other MPs and those within Main Building. Everybody should know where they can go to get help if they feel they have been affected, and we need to show them a clear pathway.
Ultimately, we need to pay people an interest and accept that something has gone wrong. There is a slight issue within the Department—I know that everybody, including the Minister, knows this—with accepting evidence of a problem. If I have seen that in my experience as a lowly Member of Parliament, I can only imagine what it is like for families who have an issue with the Ministry of Defence to come forward. I bring that point to people’s attention and ask that we never ignore evidence of problems. We all know what soldiers are like. They are fantastic people, although if they are not moaning, something is not right, but we need to be slightly smarter and understand what they are saying so that we can identify problems before they become as big a problem as Lariam.
I am loth to interrupt the hon. Gentleman when he is in such impressive flow, but I would suggest that the chain of command is a problem. Although soldiers may moan to one another—the hon. Gentleman will have more experience of that than I do—they are unlikely, at any point, to want to challenge. When soldiers are brave enough to say that there is a problem, that should be our priority and we should listen to them.
The hon. Lady is right. That is a generic function of leadership, not one that is particular to this cause. Having that intimate relationship with our soldiers, or with those under our command, is something we work hard on at a junior level. At a senior level, it is desired. Whether the time is taken to do that is another matter. Across the military, we need to foster an environment where it is okay for a conversation to go both ways so that we can get on top of such problems.
I know that more Members want to speak, so I will finish soon. We need to change our view on having a softer side in the Ministry of Defence and understand how important it is to look after people. Whether we reconfigure what we do, or look into having a Minister for defence people or whatever as a No. 2 in the MOD, we need to bump that change up the priority list. I thank the Defence Committee and its Chair for letting us look into the issue. People talk about Parliament being so remote—that essentially, we just turn oxygen into carbon dioxide and no one really cares—but I hope that the people who have been affected by the issue see that Parliament does work for them and can take some comfort from that.
It is a great privilege to speak under your chairmanship, Mr Rosindell. I congratulate the Defence Committee, under the excellent chairmanship of my right hon. Friend the Member for New Forest East (Dr Lewis), and all previous speakers in this debate.
I declare an interest as chair of the all-party parliamentary group on malaria and neglected tropical diseases and as a trustee of the Liverpool School of Tropical Medicine. I have a large MOD base in my constituency, MOD Stafford, which has three signals regiments and the RAF’s tactical supply wing. Many members of those units spend quite a lot of time on deployment in countries where malaria is a problem.
Malaria, as my hon. Friend the Member for Plymouth, Moor View (Johnny Mercer) said, is a killer. It used to kill well over 1 million people a year, but thankfully that figure is now down to 438,000 a year, according to the World Health Organisation in 2015. I hope the figure is still falling, but it is an awful lot of people. I have had friends die from malaria, which is a serious disease.
It is absolutely right that the Ministry of Defence should take every precaution to protect its personnel from the depredations of malaria, but the question, of course, is how to do it. I had experience of Lariam when I lived in a tropical country. I took it when I was diagnosed with malaria—I took it not as a prophylactic but as a curative—and they were four of the worst days of my life, and not because of the malaria. Lariam produces extraordinary dreams that leave those who take it completely debilitated. The next time I had malaria—I have had malaria four times—I took a different drug, artemether, and the experience was quite different. Within 12 hours I was back on my feet, back at work and able to continue. The side effects were almost zero.
We are talking about Lariam as prophylaxis, but several alternatives are mentioned in the report. There is Malarone, which for many years was quite expensive, but it is a lot cheaper now that it is off patent—that is the one I use whenever I go to tropical countries. There is doxycycline, which is effective and cheap, and of course chloroquine and proguanil, which have been used for decades. Those two drugs have some side effects, particularly proguanil, which can cause mouth ulcers if taken over an extended period—proguanil is also an ingredient of Malarone.
On the curative side there is Lariam, but artemisinin-based combination therapies are also incredibly effective and are the recommended curative drugs for malaria across the world—I will talk about those in my conclusion.
The Committee’s recommendations for using Lariam are spot on. First, the MOD should find out whether service personnel are unable to tolerate alternatives. Secondly, individual risk assessments should be conducted and, thirdly, the patient should be aware of alternatives. I am delighted that the Committee has come up with those recommendations, which are all absolutely right, but they need to be put into effect. I am delighted to hear that the Ministry of Defence has taken the report seriously.
I finish by issuing a warning. We think that we have come a long way with both prophylactic and curative drugs against malaria, and that is indeed the case. All the research funding over the past decade and a half has partially resulted in halving the number of deaths, although a substantial part of that is also due to the use of mosquito nets. Has the Committee looked at how many service personnel are provided with insecticide-treated mosquito nets? A recent study by Oxford University found that almost two thirds of the reduction in deaths from malaria since 2000 is the result of insecticide-treated bed nets, not the improved drugs.
Be that as it may, it is vital that research into improved drugs continues because, unfortunately, we are beginning to see resistance to the artemisinin-based combination therapies—ACTs are the best drugs available at the moment—in south-east Asia, particularly on the Myanmar-Thai border. The worry is that resistance to all the previous effective antimalarials, first chloroquine and then sulfadoxine-pyrimethamine, started in that same area. The fact that resistance to ACTs is starting there gives us great cause for concern. The Department for International Development is putting a lot of effort into research on that subject, which I welcome, but it is important that we continue to focus research on antimalarials both as prophylaxis and as curative.
I am grateful for the opportunity to speak in this debate, and I thank my hon. and right hon. Friends on the Defence Committee for their excellent work, which I hope results in better treatment for our servicemen and women across the world.
It is right that the first three speakers in this debate should be the hon. Member for Bridgend (Mrs Moon), who has campaigned on this subject for probably the longest time; my hon. and gallant Friend the Member for Plymouth, Moor View (Johnny Mercer), who is an outstanding campaigner on behalf of anything to do with the welfare of veterans and current service personnel; and my hon. Friend the Member for Stafford (Jeremy Lefroy), whose unparalleled experience of malaria—experience of an unfortunately all too personal nature as well as professional experience—we have just listened to with great attention.
My hon. Friend the Member for Stafford asked whether the Committee had considered the question of mosquito nets impregnated with insecticide, and the answer is no. We were focused entirely on Lariam and our concern that it was being prescribed inappropriately. We said that the prescription of a drug known to have what were described as “neuro-psychiatric side effects” and to cause “vestibular disorders” without face-to-face interviews showed a lamentable weakness in the MOD’s duty of care towards service personnel. We are grateful that the Minister, who has an outstanding record of military service, made an apology to present and former service personnel when he appeared before the Committee on behalf of the MOD in relation to those who believe that they were prescribed this drug without the necessary individual risk assessments.
This is a slightly unusual case because, for once, nobody is pointing a finger of accusation at the drug manufacturer. Roche appears to have behaved responsibly in this matter from the outset. It always gave the clearest possible instructions that this particular drug, though it could be effective in some cases, could have dangerous side effects and therefore absolutely should not be prescribed without a face-to-face assessment of each individual first. It was good to receive a letter from the manufacturer, despite the Committee’s report being so critical of the drug itself and despite the adverse publicity that the drug inevitably received, stating:
“Your report has made a major contribution to highlighting the correct use of Lariam in the armed forces.”
That shows the strength of the arguments in the report and reinforces the importance of the MOD following Roche’s guidelines for use.
The hon. Member for Bridgend mentioned several of the people who gave evidence to the Committee. I would like to mention Mrs Ellen Duncan, who gave evidence on behalf of her husband, Major-General Alastair Duncan. Alastair Duncan was awarded the Distinguished Service Order while in command of the First Prince of Wales’s Own Regiment of Yorkshire, or 1 PWO. In May 1993, he took the battalion to Bosnia-Herzegovina under the UN mandate during the Balkans conflict. The Daily Telegraph described what he did in the following terms:
“The hostilities had escalated into a three-cornered fight between the Bosnian-Serbs, the Bosnian-Croats and the Muslims. In this dangerous environment, at great risk to himself, Duncan sought out the commanders of the belligerents in an attempt to broker a truce. In June, he was instrumental in the rescue of 200 Croats who had sought sanctuary from a violent attack in a monastery at Guca Gora. The citation for the award to Duncan of the DSO paid tribute to his courage, resolution and inspired leadership which, it stated, had saved many lives and had helped 1 PWO to win an outstanding reputation.”
He was subsequently awarded the CBE for his work in Sierra Leone.
Major-General Duncan suffered from post-traumatic stress as a result of all that he had seen and done, but his wife was absolutely convinced that taking Lariam destroyed his mental stability. He was sectioned many times. Our report was published on 24 May 2016, and I was truly saddened to read in The Daily Telegraph that he had died on 24 July 2016. He was a year younger than I am. It is a case of someone at the highest end of the Army whose life was wrecked by the inappropriate prescription of the drug.
I will touch briefly on a number of the Committee’s recommendations and the Government’s response. As we have heard, the Committee recommended
“a single point of contact for all current and former Service personnel who have concerns about their experience of Lariam”,
and the Government announced that that would be done. I would like an update on that, as I have heard suggestions that the advice people get when they ring the relevant number is very basic indeed, even on a par with “Go and visit your GP.” If that is all they are getting, we still have some way to go on that recommendation. We also said that people should be offered an alternative to Lariam if they are concerned about the risks, that this should be explained to them and that a box should be ticked to show that it has. I believe that that is now happening.
One part of the Government’s response was strange. They have alleged that they need to keep Lariam on the books because there are certain geographical areas where no other drug will work. The report disputed the Government’s assertion that geography was a valid factor. We therefore asked the Ministry of Defence to set out which geographical areas, if any, it believed to be resistant to each antimalarial drug it uses, and give us any accompanying evidence to support that view.
The Government’s response was:
“The MOD relies on authoritative external advice on the global distribution of antimalarial resistance.”
They provided us with a link to guidance from Public Health England. That guidance, which is 109 pages long, includes a table where areas of malaria risk are listed alongside the recommended antimalarial drug for that area. The table shows a dozen countries or areas for which only chloroquine is recommended, but by contrast, we could see no instances where Lariam was the only recommended antimalarial drug in any single area. [Interruption.] I am interested to see my hon. Friend the Member for Stafford assent.
The report questioned the feasibility of providing face-to-face individual risk assessments before prescribing Lariam in the event of a significant deployment, so we asked the MOD to set out how it would be able to do so, alongside an estimation of how much time it would take to conduct face-to-face individual risk assessments at both company and battalion level. I will not go into all the details of the MOD’s response, but I found one aspect worrying. The MOD acknowledged that if the operational imperative meant that the timing of a deployment did not allow for specific face-to-face interviews,
“an appropriately trained and regulated healthcare professional will review individual electronic health records and confirm that there are no contraindications to the recommended anti-malaria drug. It is estimated that this will take up to five minutes per individual, or approximately eight hours for a company, or approximately 50 hours for a battalion.”
Can the Minister explain—or, if not, write to us—exactly what that means? Is it predicated on the fact that people will have had a face-to-face individual assessment at an earlier stage in their career? In that case, there might be some argument for it, but if it is meant to be a substitute for individual face-to-face assessments, I am sure the Chamber will agree that that would be wholly unacceptable.
Is not one of the problems with Lariam that if someone has had a mental illness before, they may be more vulnerable? A lot of servicemen and women would feel uncomfortable admitting that, would be unlikely to have told anyone within their chain of command and may well not have sought guidance, so the idea that the medication could be used even with those measures is almost impossible.
That is probably the single strongest point that one could make in the course of this entire debate. Particularly in the macho military environment—I use that term in a non-sexist way—people are unlikely to disclose mental troubles in their past, meaning that either they may take a drug that is inappropriate for them or they may throw it away, rendering themselves vulnerable to contracting malaria.
Did the Committee have any idea why there is such a particular emphasis on Lariam when other drugs are available, such as doxycycline or Malarone, that many of us take whenever we go to countries affected? The emphasis on Lariam seems to me extraordinary. I absolutely applaud my right hon. Friend’s point about the importance of encouraging Roche to continue its research in this area; we do not want it put off. Roche has been excellent in its clarity about what Lariam is about and what precautions need to be taken.
Other Committee members may correct me, but I have a feeling that we never quite got to the bottom of why the MOD is so fixated on that particular drug. What I am about to say is sheer speculation, but it could have something to do with the relative cost of different types of drug, or with concern about compensation claims. If the drug were given up completely, it might be easier to bring claims on that basis: “You don’t prescribe this drug at all now, so therefore you were wrong ever to have prescribed it.”
We sought to give the MOD a bit of wriggle room, for want of a better term, by saying that all we wanted it to do was designate Lariam as a drug of last resort. I do not see why it should not do that. It is obviously a drug of last resort, because the MOD accepts the fact that it should now be issued only under the most strictly defined conditions. What is that if not making it a drug of last resort? So why does the MOD not say so?
Similarly, there has been reluctance to acknowledge the experience of other countries. The MOD asserted that Lariam was
“considered by US CDC”—
the Centers for Disease Control and Prevention, which is the US equivalent of Public Health England—
“to be equally suitable (with an individual clinical assessment) as each of the other drugs”.
However, Dr Remington Nevin—one of the two doctors to whom we owe a great deal of gratitude for their consistent campaigning on this issue and for the evidence they brought to the Committee—described that as a “misinterpretation of CDC’s position”. The section entitled “Special Considerations for US Military Deployments” in chapter 8 of the CDC’s publication “Yellow Book” states:
“The military should be considered a special population with demographics, destinations, and needs that may differ from those of civilian travelers.”
In respect of the use of Lariam in other states’ armed forces, Dr Nevin argued that
“many of our Western allies have all but abandoned the use of the drug”,
and that the US and Australian military use it only for
“those rare service members who cannot tolerate…two safer and equally effective alternatives”.
That is why we made the point that Lariam should really be used only for such people, because we are not convinced that there is any geographical area where some other drug could not be used.
Dr Nevin also referred to the US Army Special Operations Command having taken the
“very wise step of banning it altogether”.
He said that the decision by the US military was made
“primarily on clinical grounds”
and was intended to
“decrease the risk of negative drug-related side-effects”.
The MOD’s response commits merely to updating the information held on the use by our allies of Lariam and other antimalarial drugs, including the extent to which Lariam is used and the circumstances in which it is supplied. It still does not appear to accept that its policy on Lariam is increasingly out of step with that of our allies.
We have made considerable progress by focusing on the terrible situation in which a drug designed for very specific issuing to very specific people after a very specific interview was doled out en masse as a routine prophylactic to our service personnel who were about to go to malaria-infested areas. That really was a scandal, and it would be another scandal if it ever happened again.
As always, it is a pleasure to serve under your chairmanship, Mr Rosindell. I thank Members for bearing with me; I know they will all get the chance to say their piece. I apologise to the Minister for having to leave. I have had to stand in at the last minute for my hon. Friend the Member for Caerphilly (Wayne David), who has been taken ill, and I need to catch a particular train to get back to my party meeting this evening.
Like my friend—I hope he does not mind my calling him that—the hon. Member for Stafford (Jeremy Lefroy), with whom I served on the International Development Committee for three years, I feel a personal connection to the subject of Lariam. Unlike him I have never had malaria, but had I contracted it I would no longer be standing here, because it is fatal to patients who have no spleen—mine was removed some 20 years ago. I really feel very concerned about malarial areas. The hon. Gentleman knows how difficult it is for people who do not have a spleen to go to them because of the risks involved. Even the prophylaxes that he mentioned are not 100% effective, so even places where there is a tiny risk of contracting malaria are too dangerous. The Foreign Office advises all its asplenic personnel not to visit those areas at all. His personal experience has informed us greatly about the effects of Lariam, and the fact that he has taken it himself and knows exactly what its side effects can be has brought the issue to life for many of us.
I also pay tribute to my hon. Friend the Member for Bridgend (Mrs Moon), because she has pursued and pursued this. I am so glad that the Chair of the Defence Committee, the right hon. Member for New Forest East (Dr Lewis), and the rest of the Committee agreed that the issue of Lariam was so important and wrote this splendid and well written report with all the evidence that they accumulated. I congratulate them and their staff on it.
I feel huge sympathy with the 25% to 35% of Army personnel who have been affected by taking Lariam. My hon. Friend the Member for Bridgend mentioned that geographical location was a consideration when prescribing Lariam, and the hon. Member for Stafford underlined that with his point about the resistance that is now growing in south-east Asia. My hon. Friend the Member for Bridgend also said something very important that is contained in the report: military deployment is very different from tourism. While it is unpleasant to suffer the side effects as a tourist, it is dangerous if not worse for military personnel who suffer them on military duties.
The biggest scandal of all that has been revealed in the contributions to this debate, many from former serving personnel such as the hon. Member for Plymouth, Moor View (Johnny Mercer), is that there seems to have been no duty of care from the Army. The right hon. Member for New Forest East said that just five minutes’ assessment may be sufficient to ensure that individual Army personnel have the right prescription and are not forced to take Lariam when it is wholly inappropriate for their needs.
My apologies for that. I obviously did not write my notes correctly. I am sorry if I misquoted the right hon. Gentleman.
As we discussed in the previous debate, we have a duty to ensure that people who put their lives on the line for the defence of this country, like hon. Members in this Chamber who have done so, do so in the knowledge that those who ask them to do it and who send them to dangerous places are looking after their interests.
We know that Lariam is the brand name of mefloquine and that it is used to treat malaria. It is most commonly administered as a prophylaxis, but the history of side effects, the evidence we have received and the evidence in the Defence Committee’s report make it clear that it is not necessarily the most appropriate prophylactic medication. I am glad we have made it clear that we do not blame the manufacturer, Roche, for the misuse of its drug. It is clearly an issue for the Army itself and we want the Army to get it right. That is why the Committee’s report was written in the first place. I myself have taken chloroquine and proguanil; I suffered some side effects, but nothing like those that have been recorded for Lariam.
We know that many countries’ military forces have used Lariam in the past, but that it is becoming increasingly uncommon because of its side effects. Some 17,000 British military personnel were prescribed Lariam between April 2007 and March 2015, and the reports of those side effects meant that many of them have discarded their Lariam tablets instead of using them. That makes them far more susceptible to malaria, which is extremely dangerous—as the hon. Member for Stafford said, it has killed 438,000 people in the last 12 months.
The summary of the Defence Committee report says:
“The evidence we received highlighted some severe examples of the possible side-effects of Lariam in a military setting. While they may be in the minority, we do not believe that the risk and severity of these side-effects are acceptable for our military personnel on operations overseas.”
When the Minister responds to the debate—I apologise that I will not be present to hear him—will he care to tell us about the handing out of Lariam to military personnel in future in the light of the report and the evidence contained within it?
In preparing for this debate, I sought the advice of a specialist—he has asked not to be named—who works at the London School of Hygiene & Tropical Medicine. His view was quite interesting. He made the point that Lariam is a cheaper medication than some antimalarials, and that it is very effective. That could be one reason why the MOD is maintaining its support for Lariam in the face of media controversy, the Defence Committee report and, of course, resistance from many military personnel. The specialist said that it is a good drug. He even gave it to his spouse when they went to west Africa a few years ago. He reported that she had had the most vivid and crazy dreams. Like most drugs, it is not good for some people, but it is good for others.
One thing in favour of Lariam is that it is administered once a week. Many other antimalarials are administered once a day. For someone in a military setting who is in a conflict situation, or who has been deployed in a remote area, it being a once-a-week drug will have a huge benefit for those administering it and those having to take it. A once-a-week dosage also increases the chances of compliance and of people actually taking the medication when they need to take it.
The specialist I mentioned noted that the number of tests on the effects of Lariam on Army personnel were small and were not done in an adequately controlled situation. I do not know whether my hon. Friend the Member for Bridgend would agree with that, given the evidence taken by the Select Committee, but there needs to be far more testing. There needs to be a much greater database of evidence to prove conclusively that so many people will not tolerate Lariam and that it should perhaps be replaced by other drugs, depending on geolocation and the individual assessment of military personnel.
Is my hon. Friend aware that there have been episodes in which serving personnel have murdered individuals, and in which they have deliberately carried out inappropriate acts, all because they were under the influence of Lariam? That is part of the record that the Committee looked at.
Yes, I was aware of that, but I am not aware of the details. I have heard anecdotal evidence, but it is important to hear about the actual cases and evidence.
I know that other Members wish to speak, and of course the Minister must respond, so I shall conclude. Paragraph 97 in the conclusion of the Defence Committee report states:
“The Ministry of Defence has a duty of care to protect military personnel on operations overseas. It includes ensuring that they are adequately inoculated against disease. This will never be without the risk of detrimental side-effects, and we understand that the MoD must balance those risks against the health of our Armed Forces. However, in the case of malaria, we conclude that the MoD’s current policy has got that balance wrong.”
I hope the Minister addresses that point in his response.
It is a pleasure to serve under your chairmanship, Mr Rosindell. I shall be as brief as I can.
I have a couple of brief reflections of my own and from a constituent. I took Lariam prophylactically when I worked as a teacher in Malawi, and I certainly experienced what I later realised were its various side effects, including vivid dreams and a certain amount of paranoia. It was difficult to tell, though, because I had moved to a new context and was working in a stressful environment. It was not until some time afterwards that I started to realise that those side effects were the result of the Lariam kicking in. The hon. Member for Bridgend (Mrs Moon) was absolutely right to ask at the outset how much more difficult it must be for troops and service personnel, who are put into extremely pressurised situations, to try to deal with the consequences and side effects of these medicines.
I have heard from several individuals who have taken Lariam as part of their service. My colleague Feargal Dalton, a councillor for part of my area who also happens to be the husband of my hon. Friend the Member for Glasgow North West (Carol Monaghan), was a serviceman who served on Trident submarines and elsewhere. He described similar side effects which, fortunately for him, did not last after he stopped taking it. The point he made was that the drugs were prescribed and had to be taken under orders. If someone was to stop taking them, even if they were having side effects and making the person ill, they could be subject to military discipline. Many service personnel were put in a very difficult situation.
I was contacted by a constituent who was given Lariam while he was in Kenya for six weeks in the mid-’90s. Twenty years later, he continues to suffer from severe headaches and migraines, which are attributed to side effects of the drug. He has been given no compensation. He has also been told that the side effects are actually the result of post-traumatic stress disorder, but he has not been given any compensation for that either. The problems he faces are making it difficult for him to access work and, when he does, to maintain steady work. He has been told that his condition is not severe enough for him to be admitted to a treatment centre, despite his having approached various different charities. I wrote to the Secretary of State for Defence on 21 September but have not yet had a reply. I hope this debate will help to speed up the process.
There is clearly consensus in this debate. Lord Dannatt, who was quoted earlier, said:
“It is extraordinary that the MoD continues with this policy given the mounting evidence as to the harmful effects of Lariam.”
The Government have a duty of care to those who, like my constituent, have served in the armed forces. I call on the Government to implement the recommendations in the report and to provide the support needed by my constituent and many like him.
It is a pleasure to serve under your chairship, Mr Rosindell. I am aware that we are now very short of time, so I shall look for your guidance on when you want me to stop speaking so that the Minister can respond.
I thank the hon. Member for Bridgend (Mrs Moon) for opening the debate so thoughtfully, and the Defence Committee for its work. I endorse its recommendation that Lariam be retained for use by the Defence Medical Services, but it should be a drug of last resort, subject to the clear recommendations set out by the Committee. I would go further and suggest that those who are prescribed Lariam should be counselled about the potential side effects and the need to report them up the chain of command.
Once I had reviewed the Select Committee’s report, I was left wondering whether the level of debate and conflict on this issue was actually necessary—I shall try to return to that point at the end. I noticed from the departmental memorandum submitted to the Committee that the Ministry of Defence policy on preventing malaria is contained in a joint services leaflet called “Preventing Malaria in Military Populations”. I understand that the leaflet was made available to the Committee, but when I looked on the Government website, it was not there—it was released under a freedom of information request in 2013, so I was able to see it that way. The covering letter attached states that, in the interests of transparency, it should be published online. Had that happened and we had been able to see it, it would have been useful to a number of people. The sole reference in the leaflet to the use of Lariam and other antimalarial drugs is the statement:
“In the UK Armed Forces…policy is based on the guidelines at Footnote 1”,
which helpfully read:
“British National Formulary (BNF). BMJ Group and Pharmaceutical Press Extant Version”.
As we have heard from several Members in the debate, information on the use of Lariam is sorely lacking. The only direct reference to it in the guidance was regarding its use by divers and aircrew, who are not to use it. There is considerably less information than I would have expected from a document that is described to Members of this House as the Government’s policy on the use of antimalarial drugs. It is exactly as my hon. Friend the Member for Dunfermline and West Fife (Douglas Chapman) said.
Had the information been freely available, we would have seen a description of the briefing that is given to personnel receiving antimalarial drugs without an individual consultation. The only definitive items that have to be included in that consultation are dosage and frequency, and when to start and finish taking the drug. If that is the situation, advice levels clearly fall far short of what we would expect, as the right hon. Member for New Forest East (Dr Lewis) said. There was simply no indication that Lariam should be regarded as any different from other antimalarial drugs.
Will the Minister address whether the document was published online? Will he tell us more about the advice the Government are seeking from Public Health England’s Advisory Committee on Malaria Prevention? Will he commit to a wider consultation on the version of the guidance that is currently being prepared? I also wonder whether he will commit to review the procedures for sharing and consulting on policy documents, which are so vital to the welfare of our armed services personnel, as the hon. Member for Plymouth, Moor View (Johnny Mercer) told us.
The Government response looks too much like business as usual. The Committee’s report outlined the three stages when a risk assessment should be carried out: on completion of initial training; on being posted to a deployable role; and on receiving warning of possible deployment. Will the Minister clarify how the assessments will be made? Are they additional assessments, in which case how do we know what resources are needed to deliver them and are those resources in place?
As we heard from the hon. Member for Stafford (Jeremy Lefroy), the evidence provided by the Department in its response to the Committee reveals a significant difference in the nature of the side effects caused by Lariam and those caused by alternative drugs. We have heard significant detail about that difference today. As the right hon. Member for New Forest East said, the evidence that Lariam has such a clear link with adverse psychoactive effects suggests that the Committee’s recommendations about the use of the drug should be clearly heard by the Government, and it should simply be a drug of last resort.
It is a pleasure to serve under your chairmanship, Mr Rosindell.
We seem to have had something of a flurry of detailed questions towards the end of the debate, giving me little opportunity to address many of them in the nine minutes I have to respond to the debate. I will do my best, but at the start I simply commit to writing to any hon. Member whose question I do not manage to answer during that time.
Of course, I begin by taking this opportunity to thank the Defence Committee for its very thorough report on the use of mefloquine by service personnel, and I also thank the hon. Members who have spoken today, from the opening contribution by the hon. Member for Bridgend (Mrs Moon) onwards. I will address many of the points that were made as I go through, but on a specific point that she made, I absolutely regret the publication of the statistics on the day of the Committee hearing. However, she may not be aware that it is absolutely right that Ministers have no control over the collection or publication of statistics; it would be wrong if we did. So it was genuinely an unfortunate coincidence, and it would have been even worse if the statistics had been published the day afterwards.
I thank my hon. Friend the Member for Plymouth, Moor View (Johnny Mercer) for his passionate contribution, not least because every time he speaks in this House he seems to suggest that I should be promoted—so I thank him very much indeed. I also thank my hon. Friend the Member for Stafford (Jeremy Lefroy), who gave an incredibly incisive personal account; it really was very powerful. Of course, I also thank my right hon. Friend the Member for New Forest East (Dr Lewis), who asked a number of questions, which I will endeavour to answer during my response to the debate.
We had other good contributions from the hon. Members for Leeds North East (Fabian Hamilton), who has had to leave us, for Glasgow North (Patrick Grady), and for East Renfrewshire (Kirsten Oswald). I will endeavour to address all the points that they made in due course.
The Government have considered our conclusions carefully, and I will outline the positive steps that the Ministry of Defence is taking to address the Committee’s recommendations. Before I do so, I want to nail one issue that floated around towards the end of the debate—that Lariam is somehow the MOD’s drug of first choice, and that cost is a factor in its use. According to the “British National Formulary” of March 2015, Lariam, at £14.53 for an eight-week supply, is more expensive than Paludrine/Avloclor, less expensive than Malarone but more expensive than doxycycline. So cost is not a factor, and we would never prescribe on the basis of cost alone.
Equally, mefloquine currently constitutes only 1.2% of all the antimalarial tablets held by the MOD, and in terms of doses for a six-month deployment—of course, doses for different drugs are given at different rates—it accounts for just 14% of the stock. So 86% of our stock is not Lariam. That hardly represents a reliance on Lariam or evidence that it is being used as a drug of first choice.
Those figures give the current status, but I believe that the figures for the last eight years, which is as far as we go back, are similar. However, I am happy to write to the hon. Lady to give the exact figures. Of course, much of this debate is about how we move forward, as opposed to what we have done in the past, and I hope to demonstrate in my response over the next five and a half minutes that the steps we are taking are very positive.
It is important for me to state that we take the health and wellbeing of our personnel extremely seriously and acknowledge the duty of care to provide the best possible support to them. Malaria is a deadly disease, and we must protect our deployed personnel from it. The most effective way to do so is through the use of antimalarial drugs. However, as we have established, no antimalarial drug is 100% effective and risk-free. Indeed, all medications have the potential to cause side effects and adverse reactions in a small number of people. That is why the MOD needs to use a range of prevention drugs to protect our personnel and ensure that the treatment provided is the most effective for each individual. I should emphasise that despite tens of thousands of service personnel deploying to malaria-risk areas, no serviceman or woman has died from malaria resulting from an operational deployment since 1992, and cases of severe malaria are rare in the armed forces.
I turn to the two main recommendations of the Committee’s report. The first was that the MOD works with the Advisory Committee on Malaria Prevention to develop guidelines on mefloquine and other antimalarials, specifically regarding their use by military personnel. The MOD has always kept its malaria prevention policy under constant review, and I can confirm that a recently revised malaria prevention policy has been passed to the ACMP for its consideration.
The revised policy is based on three elements. In the first instance, at around the time when individuals complete initial training they will undergo a face-to-face consultation with a medical professional, to identify any adverse reactions to the five most commonly used antimalarial drugs. Secondly, after posting into a deployable role, armed forces personnel will undertake a generic face-to-face travel health risk assessment, again with a medical professional. Finally, once individuals are advised that they are likely to deploy, they will undertake a deployment-specific face-to-face travel health risk assessment.
The results of those assessments will be recorded in the patient’s electronic health record. Although the need for a risk assessment is not new—defence policy since 2004 has been clear on the requirement for such assessments—monitoring will now be better aided by an electronic records system. In answer to a question put by my right hon. Friend the Member for New Forest East, perhaps I can say that if the actions that he described need to be taken, in extremis, before an emergency deployment, they will be based on those three thorough, face-to-face, comprehensive interviews, as recorded in the electronic record.
On that point, I reiterate what I said when I gave evidence to the Committee. I recognise that anecdotal evidence submitted to the Committee suggests that, in a small number of cases, some people believe that their individual risk assessments did not take place in the past. I hope that the new system will prevent that situation from recurring. I encourage anyone who has concerns about the issue to come forward, in confidence, as there are established processes by which current and former members of the armed forces can be referred to medical staff to have such concerns investigated.
That leads me to the second main recommendation of the Committee’s report, namely that the MOD should establish a single point of contact for those who are worried about their experience of mefloquine. I am pleased to report that the mefloquine single point of contact has been set up and publicised widely through the chain of command, veterans’ organisations, military publications and GPs. As I sat here listening to the debate, I googled the advice about that single point of contact, and there it was on the gov.uk website. It was launched last month and is easily accessible. It is a confidential service for people to make contact by phone and email, and it is supported by other information on the Government website, as I have just said. Depending on their circumstances, individuals are directed to a range of information and services available to help them. That includes how service personnel and veterans can find out whether they have been prescribed mefloquine in the past. My right hon. Friend the Member for New Forest East has raised concerns about the quality of information being given on the helpline. I am more than happy to go and examine that, and I will write to the Committee with details as to exactly what advice is being given.
Again, I encourage anyone who is concerned about their experience of mefloquine and who has not yet gone to the single point of contact, including those who believe that their risk assessment did not take place, to contact the single point of contact or speak to their GP.
In addition to those two main recommendations, the MOD will conduct a prospective audit of returning travellers, to assess the impact of the new policy. That will be for any antimalarial drug that has been taken. The MOD will also continue to undertake post-deployment surveys, to enhance its understanding of compliance with the revised policy.
The Government informed the Committee that the MOD would undertake further research into the impact of the adverse effects of antimalarial drugs on the performance of military personnel. A research proposal is currently being considered by the MOD’s research ethics committee. The research will be in the form of a retrospective survey of soldiers deployed on exercise in Kenya who have been prescribed one of three antimalarial drugs. A questionnaire will seek information about risk assessments, individuals’ compliance with prescriptions, the incidence and prevalence of side effects of the drugs, and the impact of those side effects on functional effectiveness.
If there are any other questions, I will endeavour to write to hon. Members about them.
Question put and agreed to.
That this House has considered the Fourth Report from the Defence Committee of Session 2015-16, An acceptable risk? The use of Lariam for military personnel, HC 567, and the Government response, HC 648.