Wednesday 18 October 2017
[Albert Owen in the Chair]
Surgical Mesh Implants
Before I call Emma Hardy to move the motion, I must tell hon. Members that the list of speakers is over-subscribed. I ask those who wish to speak and are on the list not to make long interventions, which eat into other hon. Members’ time. I may also have to impose a time limit of four minutes for other speakers after Emma Hardy.
I beg to move,
That this House has considered the risks of surgical mesh implants.
It is an honour to serve under your chairmanship, Mr Owen. Many hon. Members present have been contacted by constituents affected by mesh surgery, which is a medical procedure used to treat incontinence and prolapse in women. The surgery, which usually takes less than half an hour, involves inserting a plastic mesh into the vagina to support the bladder, womb or bowel. It can also be used to treat rectal prolapses in both men and women. This debate is crucial, as it gives me and other colleagues the opportunity to be the voice for all those men and women who have been affected. Each individual story fits into the wider national and international narrative. This debate is our opportunity to call on the Government to do something about it and help to end the suffering of thousands of men and women in this country.
The issue of surgical mesh implants was first brought to my attention when I was visited by a constituent. She was advised in her 30s to have the mesh fitted, after suffering incontinence following the birth of twins and a hysterectomy. Its impact on her quality of life is devastating. She cannot walk very far now, she is unable to work, she is in constant pain and suffering, she is unable to partake in sports and she is having problems sleeping.
A constituent of mine has recently contacted me. She has just had a lengthy and painful surgery, but for years she was told that hers was an isolated case and there was no problem. This is a national scandal and needs to be treated in that way.
I will go on to talk about some of the problems with people recognising the symptoms later, so I thank my hon. Friend for that.
Since calling for the debate, my inbox has filled up with emails from men and women across the country telling me their horrific stories of having mesh implanted. I will read one of them, which I received just this week:
“Please help me I feel desperate. Who can I turn to to get relief from the terrible irritation and pain I am experiencing. My husband is very worried about my health mentally and bodily, because I keep telling him the quality of my life is dreadful.”
To hear the stories of the women who have suffered complications following their surgery is extremely distressing. Women tell us that they were informed that the surgery would be a quick fix for their bladder problems, that they would be able to continue to have active lifestyles and that their incontinence would be corrected after the 20-minute operation. Women in their 30s, 40s and 50s tell us that they struggle to walk, have lost their sex lives and suffer from horrendous pain day in, day out. Some even suffer from post-traumatic stress disorder following the horrific impact that the mesh has had on their quality of life.
I congratulate my hon. Friend on securing this hugely important and timely debate. One of my constituents contacted me, and in her words:
“I’ve suffered pain, I’ve soiled myself, suffered depression and sepsis. My employment contract as a store manager will be terminated in the next few weeks due to ill health.
My life has changed dramatically but others shouldn’t have to suffer the same fate. It really is unacceptable that we are in 2017 and this is allowed to happen.”
I have no doubt that my hon. Friend will agree.
I absolutely agree with that. Sadly, that is also reflected in many of the emails I have read this week. I have no doubt that many women also suffer in silence, either too worried or too embarrassed to see their MPs, or completely unaware that their symptoms are replicated in other women who have had the mesh fitted.
I pay tribute to the hon. Lady for giving national recognition to this important issue. Does she agree with what my constituent said to me: that it is shocking that something so agonising has not had the public recognition it deserves?
Absolutely; that is a really important point. The BBC programme “Inside Out West” that aired just this Monday evening highlighted some of the problems with rectopexy, which is a form of rectal mesh, and the investigation a local trust is carrying out on the surgeon, Mr Dixon. I understand that one of the allegations it is looking into is that girls as young as 17 and 18 have had rectopexy.
On that point and the case that is being investigated in Bristol, I understand from my constituent that NHS England will set up 17 regional teams to look at this. Does my hon. Friend agree that that cannot be done on a local, ad hoc basis? There needs to be national co-ordination on this.
I absolutely agree with that. That hospital would neither confirm nor deny that those young girls had been operated on. For background information, all the colorectal surgeons who the programme spoke to said that the young women should have been offered other avenues before surgery. The programme also highlighted the extremely concerning practice of one surgeon attaching part of the rectal mesh to the soft tissue on the wall of the vagina. The shocking reason for subjecting women to this was explained by one consultant, who stated that if the rectopexy mesh is fitted in that way, the surgeon can charge for vaginal repairs as well as for fitting the mesh. Some of the patients being operated on were not aware of where the mesh was being attached, which raises serious questions about the warnings patients are given.
We must remember that it is not only women affected by this issue; men and women are suffering from chronic pain after having mesh surgery for hernias, using the same material—usually polypropylene plastic—used in vaginal mesh surgery. Research shows that between 10% and 15% of people who have had hernia mesh surgery suffer from chronic pain and complications after surgery. However, as with vaginal mesh surgery, not enough information is available to understand the extent of the risks of surgery.
Thankfully, there are organisations that help those affected to tell their stories. The Sling the Mesh campaign has done an incredible job in highlighting the problems, but there must be a wider effort from the Government to inform members of the public that this is an issue and to encourage them to speak out if they experience problems. Thousands of people have had the procedure over the past two decades without knowing what would happen if their body rejected the plastic mesh or if the mesh harmed their internal organs, leading to many people wanting the mesh removed. However, mesh removal is not a simple solution.
My constituent Alison had a mesh put in too tight. She was in appalling pain and had to travel all the way from Cumbria to Manchester to get treatment. Now she has had it partially removed, she is in a worse state than ever and has to go back to Manchester again. Does my hon. Friend agree that something has to be done to help people with removal?
I absolutely and completely agree. One consultant has written to explain the problems with mesh removal, stating:
“Once stuck the mesh is never fully removed and failure of implanting means that mesh will fuse, erode, stick and adhere to organs, nerves and blood vessels—creating life long…injuries.”
She argues that patients were never clearly told of the risks of mesh fused to organs. She stated further that the
“mesh weave that is stuck will become a perfect breeding ground for bacteria”,
and unless it is completely removed, the patient will remain continually infected and fatigued forever.
I apologise, Mr Owen, for arriving a little late. I know that the hon. Lady is talking about consultant surgeons, but does she agree with my constituent, Karen, who has corresponded with me to say that there is also a lack of awareness among the general practice community? The procedures are taking place and are deemed to be a success, but these other problems then present themselves and GPs are just not aware of the causal link and how to diagnose it.
Absolutely; I will talk about that later. One of the women who wrote to me this week explained that her surgeon was worried about trying to remove a small piece of mesh from the heart of her vital organs, near her bowel and bladder, which he could not actually see by visual examination, ultrasound or X-ray. She explained that, since having the mesh fitted five and a half years ago, it has prevented her body from healing, causing ongoing problems ever since.
This is not an effort to scaremonger. For most, the surgery is successful, but we have estimates from the Medicines and Healthcare Products Regulatory Agency that about 1% to 3% of women suffer complications. A recent report in the scientific journal Nature showed evidence of about 10% of women suffering complications after surgery, and another research study estimates that the figure could be 15% to 20% or even higher.
I thank the hon. Lady for calling this incredibly important debate. My constituent Nancy contacted me recently. She had a mesh implant fitted seven years ago, and her life and that of her family have been turned upside down. She is in constant, crippling pain. She needs tramadol, and when the tramadol has not worked, she has been in hospital for four days on morphine. Does the hon. Lady agree that this devastation for women and their families is absolutely intolerable and must never be allowed to happen again?
I completely agree. Sadly, that example is reflected across the whole UK. The Department of Health says that in the past 10 years 136,000 women in England were treated with mesh implants for urinary incontinence and organ prolapse, but it is only recently that NHS England has brought in guidelines that require surgeons to inform patients of the possible risks, and even now we do not have accurate information about just how many women are suffering complications after mesh implants. We know that mesh is the subject of international scrutiny, with legal cases in countries around the world, including Australia, Belgium, Canada, Israel, Italy, the Netherlands, the USA and Venezuela.
Many mesh implants have been fitted at private hospitals rather than NHS hospitals, and we know from the recent case of convicted breast surgeon Ian Paterson that in those circumstances private hospitals deny liability for private surgeons carrying out operations on their premises. Does my hon. Friend agree that that loophole, allowing private healthcare companies to operate under different rules from the NHS, should be looked into and amended?
We should be looking into that. I thank my hon. Friend for making that excellent point.
Recently in America, a woman was awarded damages of $57 million in relation to mesh implant surgery, and more than 800 women are currently taking legal action in the UK. Yet so far the Government have sat on the fence on this issue, acknowledging in answers to parliamentary questions from the hon. Member for East Renfrewshire (Paul Masterton) and my hon. Friends the Members for Bristol South (Karin Smyth) and for Ellesmere Port and Neston (Justin Madders) that it is a problem, but completely failing to create a robust system to ensure that all complications are accurately recorded.
The surgeon Robert Bendavid has argued for longer studies on the women who have had mesh fitted, because in short-term studies the data are not capturing the level of risk. Many of the women who have written to Sling the Mesh have reported difficulties three years after having the mesh fitted. The Department does not even have accurate data to show just how many mesh removals have taken place as a result of surgery complications. We must have a proper framework for building an evidence base to determine exactly how widespread this problem is.
The guidelines from the National Institute for Health and Care Excellence do not provide any information on mesh-removal surgery procedures. I accept the argument for clinical freedom for surgeons and that there are difficulties in testing objects that go into our bodies, but that makes the case for thorough and effective follow-up even more important. There is an ethical duty for surgeons to write and record where there have been complications, so will the Minister commit today to ensuring that all mesh procedures are properly recorded? Will she commit to the mandatory reporting of all complications, and will she commit to raising awareness of this condition?
Raising awareness is not just about raising awareness among the general public. Women are telling us that they are going back to their doctors and surgeons after surgery and being met with blank faces when they describe the complications that they are experiencing. It seems that without adequate research and awareness of the risks of mesh surgery, patients are not receiving the support and aftercare that they need. Although we welcome the resource guide that has been developed to provide GPs with more information about the risks of transvaginal mesh implants, more must be done to encourage dialogue on this issue between GPs and their patients.
Building an evidence base is not the only issue. Many people, most notably the Sling the Mesh campaign, have raised concerns about the fact that previous reviews, especially in England, of surgical mesh have focused solely on the procedural failures of mesh surgery and not looked into the safety of the product itself. That is in line with the findings of a report issued by the EU’s Scientific Committee on Emerging and Newly Identified Health Risks, which said that when assessing the risk associated with mesh application, it is important to consider the overall surface area of material used, the product design and the properties of the material used.
I completely agree with my hon. Friend the Member for Pontypridd (Owen Smith), the chair of the all-party parliamentary group on surgical mesh implants—he was of great help to me in preparing this speech—when he says that the fact that many companies have already taken their mesh product off the market should tell us that something is not right with these devices. We have to go to the core of the issue and investigate the fundamental safety of the products. Will the Minister commit to doing all she can to ensure that any future reviews of mesh products look at product safety as well as procedural issues?
I congratulate the hon. Lady on securing the debate. Does she agree that the Health and Social Care (Safety and Quality) Act 2015 —legislation passed by this House two years ago—is relevant? It says:
“The Secretary of State must by regulations impose requirements that the Secretary of State considers necessary to secure that services provided in the carrying on of regulated activities cause no avoidable harm to the persons for whom the services are provided.”
I absolutely agree and thank the hon. Gentleman for raising that.
Currently in the UK, there are about 100 types of vaginal mesh implants. Carl Heneghan, professor of evidence-based medicine at the University of Oxford, has raised concerns about the evidence that mesh manufacturers need to provide before their products are approved and made available on the NHS. It is extremely worrying that the Pelvic Floor Society, which is associated with the surgeon Mr Dixon and was set up as a world expert group, is partly sponsored by mesh manufacturers. The BBC spoke to the Pelvic Floor Society on camera during the “Inside Out West” documentary and was told that it had discovered complications only in 2014. However, minutes of a joint meeting of the southern, midland and northern groups of the Pelvic Floor Society in October 2012 say:
“We need to ensure that all individuals are appropriately consented for the risks of mesh placement; Long term Shrinkage, Mesh erosion, Mesh failure. We need to have a prospective registry for”
laparoscopic ventral mesh. Why, if the industry knew about these problems in 2012, are they only coming to light now? That is further proof that the Government must do something about this.
One thing that could be done is to follow the recommendations of the all-party parliamentary group and bring forward publication of the NICE guidelines on mesh for stress-related urinary incontinence. Currently, NICE says that it plans to publish revised guidelines in 2019, but we think that is too long to wait. We want NICE to urgently prioritise them. Mesh as a first-line treatment for incontinence and prolapse should be suspended until the NICE guidelines are revisited.
In May this year, the Scottish Cabinet Secretary for Health and Sport, Shona Robison, confirmed that the Scottish Government had suspended the treatment for people with pelvic organ prolapse. Until we have a proper understanding of just how many women are suffering from mesh injury, we think the surgery should be suspended, but in all cases, not just for pelvic organ prolapse.
Professor Carl Heneghan says that some of the devices used in mesh treatment have not been clinically tested or trialled and that the number of people affected by mesh injury means that this could be one of the biggest medical scandals of our time. Suzy Elneil, consultant urologist at University College London, has also warned about the number of women affected by mesh injury. She is one of the few qualified surgeons in the UK who can remove mesh once it has been fitted and she tells me that she sees about 15 women a week who are suffering following mesh surgery. Consultant gynaecologist Dr Wael Agur from the University of Glasgow was once an advocate of mesh surgery, but has changed his mind since seeing at first hand the evidence of mesh risks. He agrees that there is significant under-reporting of mesh complications and says that, as a result, the MHRA has only a fraction of the knowledge of adverse events associated with mesh.
I apologise for arriving late to the debate, Mr Owen. I congratulate the hon. Lady on holding this important debate. The point that she makes about long-term complications is just as important as that about the short-term complications. My constituent developed fibromyalgia as a result of the complications arising from her mesh surgery for stress urinary incontinence. Does the hon. Lady agree that long-term conditions such as that must be taken into account?
Absolutely. Studies need to go far beyond the two years.
I am delighted that Labour has called for a public inquiry into the use of mesh. As my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) rightly said, it is extremely worrying that mesh surgery has been introduced so widely, with so little evidence and with limited trials to support it.
I call on the Government to do four things. First, they must commit to a full retrospective and mandatory audit of all interventions that involved mesh, followed by a full public inquiry. Secondly, they must suspend prolapse and incontinence mesh operations while the audit is being carried out. Thirdly, they must bring the NICE guidelines for mesh in stress-related urinary incontinence forward from 2019 to 2018. Fourthly, they must raise awareness among the general public and GPs.
Mesh implants have affected thousands of people all over the country. For some, the consequences of operations will be life-changing and devastating. A Government commitment to taking these actions will not undo the suffering and pain that these people have endured, but would go a long way to making sure that nothing like this happens again.
It is an honour to serve under your chairmanship, Mr Owen. As co-chair of the all-party group, I am delighted to speak in this debate; I thank the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) for securing it.
As MP for a Scottish constituency, I will focus on the situation in Scotland, where the devastating effects of mesh surgery were first brought to our attention by the campaign group Scottish Mesh Survivors, which is made up of women and their families whose lives have been ruined by the procedure. The group is led by my constituent, Elaine Holmes, who brought the issue to the Scottish Parliament’s Public Petitions Committee in May 2014. Through the group’s efforts, a request to suspend the surgery was announced by the then Scottish Cabinet Secretary for Health and an independent review group was established.
Scotland had an opportunity to lead the way, but, to my deepest regret, it has lost the initiative. The independent review group’s final report, which was published in March this year, has rightly been termed a whitewash. It refused to recommend a ban on transvaginal mesh implants; an entire chapter with key evidence highlighting the dangers of mesh was omitted; recommendations were weighted in favour of mesh, at the expense of safer non-mesh alternatives; and the review group’s chair was replaced late in the process. Patient representatives were excluded from meetings over 10 months and ultimately resigned from the review group, alongside a consultant physician, branding the report “not in our name”.
Disappointingly, the Scottish Government elected to accept the review group’s recommendations in full. As a result, Scottish Mesh Survivors has been forced to go back to the drawing board and is once again pursuing justice through the Scottish Parliament’s Public Petitions Committee.
One of the most common arguments against reclassification is that the evidence to support such a move is not there. I disagree. I stand shoulder to shoulder with women like Elaine and the numerous other mesh-injured women who have rightly proclaimed, “We are the evidence,”; with women like Lorna Farrell, another constituent who has suffered devastating injuries from the procedure; with women like Leslie McGlinchey, a mum of two who was not even 30 when she had the operation and now spends a huge amount of time in a wheelchair. Leslie frequently has to explain to her two little girls why mummy keeps falling over. She was told that a 20-minute operation would change her life. Well, they weren’t wrong. Women who have lost their careers, their husbands, their homes, their dignity and their lives; who are forced to spend day after day and night after night in agony; who are left with little option but to make use of wheelchairs and walking aids just to get by—they are the evidence.
It is increasingly clear that when women are fully informed of the potentially life-altering consequences of mesh surgery, they reject the procedure outright. Dr Wael Agur, the consultant physician who resigned from the independent review group, spoke at a recent petition hearing on the subject in the Scottish Parliament. He informed the meeting that, out of 22 women who had made use of his health board’s shared decision-making tool to assess whether mesh was right for them, only one indicated that she was in favour of the procedure, and it was later discovered that she had not read the leaflet properly.
The Scottish Conservatives, led on this issue by my colleague Jackson Carlaw MSP, have been at the forefront of the debate in Scotland since the scandal first erupted, working closely with Scottish Labour, which is led on the issue by Neil Findlay MSP. We have stood firmly behind the women whose lives have been devastated by mesh. I urge party colleagues south of the border to be alive to the issue, to act now while they have the opportunity, and—please—to suspend this procedure. If they are not convinced that there is enough evidence, they should suspend the procedure while they gather the evidence.
Mesh is rapidly becoming one of the great global health scandals. I implore all hon. Members to do what we can to protect women from this potentially devastating procedure and to ensure that our nation becomes an example to others of how to achieve justice for all those who have been broken by mesh.
This is an important debate for me and for so many hon. Members because of what our constituents are telling us. I pay tribute to my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) for giving voice, with great eloquence and passion, to an issue that so many of us feel strongly about. We have wanted a debate in this House for a long time, and I am pleased that she secured it.
My hon. Friend spoke for the women, many of whom are in the Gallery watching the debate, who want and need us to amplify their voice. One of the most heart-rending things for them has been the sense that they have not been listened to and their voice has not been heard. Our job is to listen and to be as brave as them by speaking in this debate and amplifying their voice. This topic has not had the coverage that it deserves, because it is complex, clinical and disputed. It is difficult to see a way through the clinical evidence and feel that we, as non-clinicians, can make sensible remarks without scaremongering, but we need to be brave and engage intellectually to try to understand it.
In truth, the story is quite simple. Since 2000, these products have been diligently marketed by the devices industry as a quick fix—an easy solution to stress-related incontinence or other problems for young women who want to maintain active lifestyles post-childbirth by doing exercise and other ordinary things that we take for granted. The products, which had not been widely used by the clinical world, became used all over the world. Approximately 130,000 women in the UK have had devices implanted.
The regulators and the clinical guidelines said that the risk was between 1% and 3%. However, behind those statistics, the reality has emerged that for a significant number of women—not the majority, but a significant minority—the devices have resulted in chronic, life-changing adverse effects such as sexual dysfunction, loss of mobility, and inability to work. Those effects ought to be taken seriously by us and by the medical fraternity. Instead, they have been dismissed and, worse still, women have been patronised by being told that their problems were unique, which is not the case.
There are questions to address, and the Minister needs to come up with some answers—I know that she is engaging seriously with this debate. If a medicine marketed to deal with incontinence led in one out of 10 cases to sexual dysfunction or the inability to walk or work, it would not be on the market. Surely she agrees that that is how we need to look at it. In Health questions last week, I think she said that the NICE guidelines are expected in 2018—next year. That is not what NICE is saying. Will she clarify whether the guidelines are coming forward to next year, as she implied? I am not sure whether she simply misspoke.
Finally, will the Minister ensure that, as the Government’s representative, she listens to the women who have been mis-sold these devices and lied to about the relative risk? They now feel that they are being listened to at last, but they need their Government to listen and to take action. Guidelines should be brought forward and mesh should be suspended until we know what the real risks are.
I commend the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) for securing this vital debate.
I knew nothing about surgical mesh until I was elected in 2015. Since then, women who have written to me or sat opposite me in my surgery have introduced me to their experience: a world of untold suffering, misery, distress and anxiety, which could and should have been avoided. I can add little to the debate other than to describe the experience of ladies in west Cornwall. A constituent in Helston writes:
“Before mesh, I was a vibrant and active woman, positively contributing to my community and society. Mesh has ruined my life with devastating life-altering consequences. Life is now marked by overwhelming daily challenges to my physical, psychological, social, occupational, and financial health and wellbeing. I am unable to work which adds to the financial stress. I am primarily housebound and not able to participate in the lives of family and friends, which I find most heartbreaking. I have three beautiful granddaughters…who live in…Germany. It has been a year since I have been able to visit and look into their curiously beautiful eyes.
I have a Masters Degree in Psychology which has helped me to cope with the devastating life-altering limitations and overwhelming daily challenges of living with significant mesh complications. The pain, discouragement, depression and anxiety is overwhelming every day, and excruciating on others, which is why I have also sought the support of occupational therapists, health psychologists and mental health professionals.”
Another constituent of mine states that the Food and Drug Administration in the USA has issued strict guidelines for mesh use and that in the USA a warning is given to patients about the potential dangers. She had a mesh implant to correct a pelvic prolapse and was told by her doctor that her quality of life would be significantly better, but it has not been. Her retirement has been ruined. She used to walk miles every day with her dogs but now struggles to walk due to pain and feels she might have to go into a wheelchair, as even the shortest walk around the house causes excruciating pain.
More recently, a lady came to see me in my surgery and talked about her experience. She had undergone an operation where a surgical mesh was used. After complications, she underwent a second procedure, during which the mesh was accidentally compromised, and she now suffers recurrent uterine prolapse. The surgeon has written to her, explaining the damage caused during the surgery, and has stressed the need for urgent further intervention, but she has been told that she cannot have surgery until May 2018. Until my intervention, she did not expect to hear back from the hospital until December at the earliest.
Further stories have emerged, including that of a constituent whose mesh eroded through her bladder and vagina. The mesh had been inserted in 2008 for stress urinary incontinence. At the time her complications emerged, there were only two surgeons in England who specialised in removing such mesh. One was in Oxford and one in London, both of which are a long way from west Cornwall.
Finally, another constituent of mine had transobturator tape, or TVTO, inserted five years ago to treat stress urinary incontinence. The device immediately caused her pelvic pain. Within six months, she suffered complete saddle anaesthesia with associated bladder, bowel and sexual dysfunction. The mesh was removed after two years but my constituent’s chronic pain continues, due to nerve damage.
For those ladies, little can be done to put right years of discomfort, distress and indignity. What they want is for the Department of Health to allow the use of mesh only in the most serious of cases, where no other option is available. A husband of a patient whose suffering continues following her surgical mesh implant writes:
“Our ultimate desire and goal is to see a complete ban on surgical mesh procedures so other women need not suffer the same appalling life-altering complications.”
I pay tribute to my constituents who have lived with this harm and who are willing to face up to the indignity of talking about their experiences, so that others do not suffer a repeat.
First, I congratulate the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on bringing a major issue to the fore. I say “major”, not because there are necessarily millions of people involved—the final number of women who have been affected is not yet known—but because the impact that this issue has had on the lives of the people who have been affected by it is major and heart-breaking, and it deserves attention and action from this place.
I have received a large number of emails from Northern Irish people outlining their horrific experiences and some of the ladies affected are in the Gallery today. It would seem that in an attempt to access a cheaper form of surgery, we are putting some people at risk of horrific complications. It is clear that this surgery must be used only after the full extent of the dangers is outlined and fully understood by women, and once they accept that this option comes with a massive warning.
One of my constituents contacted me about this issue. She has not worked for two years and she will have an operation very shortly. In the short time that I have in which to speak, I will say that another woman—she is not from my constituency, but from the constituency of my party leader—contacted me and outlined her case. Her experiences are clearly similar to those of other women who have been affected:
“Listed are just a few of what I have and am still enduring since the surgeon inserted this foreign object into my body: Constant agonising pain, as if I was being cut inside… Inability to bend over without crying out in agonising pain… Constant urine and bladder infections… Inability to carry out my duties associated with my occupation… Inability to enjoy any social life whatsoever”.
She is also unable to have intimate relations with her husband, which she says has been “detrimental to my marriage”. She is also suffering:
“Depression and extreme low self esteem… Sweating profusely… Inability to walk or exercise due to chronic pain and fatigue… Severe agonising pain passing urine… Visits to A&E with agonising pains in my groin, legs and pelvic area... Visits to out of hours doctors and many visits to my GP practice”.
She says she has had:
“Regular phone calls and visits to the continence nurses to find my bladder was not emptying properly and each time told my urine sample showed up infection and blood. My family as a unit have been affected also, as they too feel my stress and pressure that I have and am under due to no one helping or believing me.”
This is a lady who is wearing what amounts to—I say this with respect—adult nappies, and I for one am not prepared to ignore her story.
There are some 250 members of the Meshed Up Northern Ireland support group and their pleas are very clear. There are no options in Northern Ireland for the surgery that is necessary. All those ladies who have had mesh implants must come across the water for surgery. Some have had operations; some are about to have an operation.
My party is very concerned about that situation and, for the record, we are asking for the best possible information, including better data for women considering this procedure; an improved and more holistic approach to caring for these women; updating of clinical guidance and standards; increased awareness among GPs of post-operative problems, with better access to follow-up clinical expertise for those women with problems; and a more complete picture of the level and seriousness of the complications. There must be standardised information for patients and a more consistent consent process, so that when women are asked about these operations they understand what they mean and the implications, because they have not been told—at least my constituents were never told—about the implications and had no idea what the operation meant. We are asking for specialist centres with multidisciplinary teams to advise on and treat complications and post-operative problems; a minimum workload of cases for surgeons carrying out relevant procedures; and further ongoing research into mesh procedures and adverse effects.
All those things would be best considered within an inquiry. That is what I am asking for today, that is what my constituents are asking for, and that is what all the sufferers from this problem in Northern Ireland are asking for.
I sincerely congratulate the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing this debate, and it is a pleasure to serve under your chairmanship, Mr Owen.
I, too, have applied for debates on this subject in the House, so this debate is welcomed by all parties. Like other colleagues, I am pleased that this issue is being discussed so openly, and it is absolutely vital that Ministers listen to the UK-wide concerns that are being raised. I have heard from Eastleigh constituents who have shared simply horrific accounts of the long-term difficulties that they have experienced as a result of having had a mesh implant, so I am very pleased to contribute to this debate.
I was also contacted via Facebook by a long-term friend who wanted to tell me her story after having her third child, and to link me into the Sling the Mesh group, which, as we know, is an ever-growing group, with more than 3,500 women involved with it. After an operation three weeks earlier, my friend had to self-catheterise. It was simply hideous. She said:
“It would seem that health professionals do not want to quite hear the truth or tell the truth about the complications of mesh or the TVTO surgery”,
which she had had. She felt that because the condition was so embarrassing, it was just being under-reported.
After a woman has had a baby, especially her first, she always listens to the professionals. Pain and suffering after a birth are not unusual, but two or three years after giving birth many women are in pain, with incontinence, with an impact on family life, with no sex life, and with no opportunity to play sport or to enjoy time with their children down at the park, or to enjoy time as a family and have time with their partner. Too many women are simply being ignored, post-pregnancy and through the long-term impact, as we have heard. GPs seemingly do not have a full understanding of this matter.
Let us be in no doubt: in some cases, but not the majority, this option is perhaps appropriate for women, but it must be carried out by trained surgeons. However, one more woman suffering in the way that many of our constituents have suffered is one woman too many. We have heard such stories today. So today I urge us to look at all those women who have been so dramatically affected by the long-term impact of trusting the advice of their surgeon. We must make sure that if anyone has a mesh implant put in, they really understand the impact.
I will give one further example that I have been informed about, which is the case of a lady in my local area who had surgical mesh implanted five years ago. Further treatment is ongoing; she has had multiple complications and operations. Her case has also been raised with me by her father, who has spelled out the heartbreak of seeing his daughter in so much pain.
I call on the Minister to ask the Medicines and Healthcare Products Regulatory Agency to work further with the mesh working group to ensure that all those who use mesh know that it is the right treatment for them and fully understand all the issues and concerns that exist about mesh. Nobody should come away from this debate unaware of the warnings and complications. There is no doubt that if someone is suffering, mesh could be a good option for them. However, professionals should ensure that it is the right course for them.
I finish by strongly urging the Minister to act on this worrying, UK-wide concern. Let us not be afraid to end the suffering and let us be prepared to make sure that no further harm is caused by this issue. We should also be bold, because women’s health matters and family lives are simply being blighted.
It is a pleasure to serve under your excellent chairmanship, Mr Owen. I congratulate my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing this important debate. I pay tribute to my hon. Friend the Member for Pontypridd (Owen Smith) for taking the lead on this important issue and for establishing the all-party parliamentary group on surgical mesh implants, of which I am proud to be an officer.
When one in 15 women fitted with the most common type of mesh will require surgery to extract it, it is clear that the issue needs to be addressed nationally. The figures are staggering and the situation is like Russian roulette. Mesh is resulting in women being unable to walk, go to work, go about their everyday lives or enjoy a fulfilling sex life. More than 800 women in the UK are taking legal action against the manufacturers of the product, so it is clear that the problem is not just going to go away.
The NHS tells us that insufficient reporting and under-published data are contributing to the problem. A basic requirement should be a register of women who have had the implants, so that we can truly assess the potential impact. Regulators around the world have been demanding more testing to ensure that the mesh is as effective for treating prolapses as it is for other conditions. We cannot just sit on the fence; the problem is ongoing. We cannot just sit around waiting for the guidance to be published, whether that is next year or not. With so many people affected, there must be an immediate inquiry. We cannot wait—too many women are experiencing severe pain and discomfort because of these products. Now is the time for the Government to carry out a full audit, establish a register and look to find a way to eliminate the damage and destruction to women’s lives that the mesh has caused. Now is the time to sling the mesh.
I congratulate the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing this important debate. In the brief time available, I would like to touch on the issues of how we allowed this situation to continue to for so long, consent, clinical quality and governance, including in the private sector, and what we should be doing going forward.
First, I pay tribute to the many women who have been courageous in coming forward and discussing intensely painful and personal experiences, not only with myself but with other Members. I would like to quote one, who said:
“I am in so much pain at times that I just give up on the day…The pain never goes, it just varies in intensity.”
We have heard numerous examples of how these devices are deeply impacting on people’s lives with life-changing symptoms. In many cases, those symptoms were not life-changing before the procedure. Many women have delayed symptoms or were unaware that they had these devices inserted in the first place. Women have told me that they did not consent to these devices being inserted and were not informed of the risks. A fundamental principle of consent is that unless the consent is informed, it is not consent at all.
It is very difficult for women to be properly advised of the complications when we have such poor data, and that goes to the heart of the scandal. The clinical trials of these products were inadequate. We know now that variations in the type of mesh lead to a greater or lesser risk of complications in the first place, yet these products were varied and introduced and marketed aggressively without adequate clinical trials, and that is why there has been such a long delay before action has finally been taken. I hope the Minister will address that in her remarks, because if clinical trials are not a fundamental condition for the introduction of new devices, we will see this situation with other devices.
Another concern is the way that such procedures are used. We saw variation in the techniques with which these devices were introduced. We must have an absolute guarantee that there will be proper clinical trials, just as we would expect for the introduction of medicines.
Does the hon. Lady agree that if the companies failed to introduce proper clinical trials at the outset, they should now be queueing up to ask these women to come forward so that they can look at the specific cases where the devices have failed? They should be begging these women to come forward.
The hon. Gentleman raises an important point, but many women were not even informed that they had the devices in the first place. Other Members have touched on the fact that because the complications can be late in arising and because of the inadequacy of recording, it is very difficult for women to come forward.
In the brief time available, I would like to mention the yellow card scheme—I will add links on my social media later—which enables women to self-report complications. However, if someone does not know they have had the device fitted they will not report those complications. There is work to raise awareness among GPs of the possibility that symptoms that women present with are related to mesh, to ensure that those women are referred. I welcome the specialist centres that have been set up to treat women who have been so adversely affected by mesh, but if mesh is inserted in the first place, it should absolutely be done in specialist centres.
I do not agree that we should ban mesh, because for some women the symptoms of stress urinary incontinence or prolapse can be life-altering. We should retain it as an option where alternative procedures may create worse outcomes or worse complications, but there must be adequate consultation with women about the risks so that they can weigh them up. I agree with Members who have said they hope that NICE can prioritise the development of more detailed guidance, so that we may have it as soon as possible.
A fundamental absence of data is at the heart of the issue. There has been cavalier practice, and we cannot allow that to continue. The women who have been affected deserve an apology and recognition of the extent of the problem and the delays in recognising and dealing with it. I welcome the findings of the mesh oversight group report, which describes pragmatic and practical recommendations, but clear failings have been allowed to continue for so long. At the heart of those failings is the inadequacy of clinical trials, recording and consent. Finally, we know that the devices are regulated by the European Union. I hope the Minister will comment on how the Government propose to take this issue forward after we leave the European Union. At the heart of it is the need to ensure that the safety of women is prioritised at all times.
First, I congratulate my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing this important debate. I also pay tribute to the incredible work of my hon. Friend the Member for Pontypridd (Owen Smith), whose campaign has ensured that those women affected by mesh implants have a voice and are being listened to. They may receive some reassurance from the fact that we are debating the issue today.
I have a constituent who is suffering from the consequences of a failed mesh implant. She met me recently and explained the debilitating and life-changing effects it is having on her quality of life. She told me of her experiences of the failed procedure, which left her barely able to walk, and bedridden for three months. She spoke of the pressure that put on her family, with her children left to care for her and her husband unable to work overtime due to childcare commitments. It has prevented her children from having friends over, stopped family holidays and left her disconnected from her community, being unable to walk or drive without excruciating pain. The financial burden and personal impact on her family has been immense. She described the effect on her mental health. She has uncontrollable mood swings, angry outbursts and frustration at not being able to care for her young family. She now faces many more procedures and many more months of pain before she can even dare to think about her future.
There are many more women like my constituent, as we have heard today, and I pay tribute to the bravery of these women who have come forward to demand that they be heard and that their stories are told and acted upon; but these are the women we know about. Alarmingly, many are not aware that post-operative issues may be a direct result of the implants. The worrying narrative emerging is that many women who have had the implants and have since experienced problems are only now finding out about the complications that mesh can cause. Women who have had the procedure should be contacted directly and made aware of the issues we are debating here today.
Women who have suffered such debilitating effects deserve a full inquiry to determine how it could have happened and what steps will be taken to ensure such a situation never happens again. I therefore agree with the APPG’s recommendation to suspend the procedures pending a NICE guideline review to protect the health and wellbeing of more women.
I hope this debate will ensure that the Government listen to the women affected by the implants. I hope they will confirm their commitment to investigate the situation fully and take urgent action to prevent other women going through some of the horrific ordeals we have heard about today.
I pay tribute to the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) for securing this debate. I did not know about the subject until a constituent came to see me on Friday. The stories in the Chamber today from all parts of the realm—from Northern Ireland, Wales, Scotland and England—with every Member of Parliament telling a similar tale, show that this is the tip of the iceberg and that there are many hundreds, if not thousands, of women out there who could be struggling. Of course, they may not know yet that they will have a problem, because we do not have the data.
My constituent who came to see me is incredibly brave. She could not make herself at all comfortable during my surgery, but leant forward with her hands on the table. She could not sit, could not stand straight and could not bend over. As the consultation went on, she was sweating more and more with pain. It is all very well having sweeping statements about ruined sex lives and constant pain, but what does that mean? My constituent, who is only 47 years old, was more concerned about my embarrassment as she told me her story than she was about herself. A lot of women do not want to embarrass us, but we are the postmen for relaying stories back to Government.
My constituent said that during sex four years after the operation her husband ended up with a cut and bleeding penis. Further surgery has taken place and intercourse is now completely impossible. This lady had had a loving and physical relationship with her husband, and after further surgery now has no sexual stimulation at all. Indeed, she told me that any clitoral stimulation had immediately become a huge abdominal pain. She has also been diagnosed with a low level of infection. There is a shocking statistic: research has shown that 83.6% of implants have been found to have vaginal bacteria on them. That is an important statistic because the Medical Devices Regulations 2002 state that before a medical device can be placed on the market, the manufacturer must ensure that the device meets essential requirements, which include sterility and minimising the risks of contamination.
My constituent was a physiotherapist and had led a very active life. She can now barely get through a day. She was not told about the risks of the operation. Her prolapse was not serious enough to demand such an operation, but she was told, “We can sort that out.” It was not until 2013 that she was told she had a vaginal extrusion. Even then she was told by the surgeon, “Don’t worry; you truly have a designer vagina now,” which showed a complete lack of sympathy and understanding that is scandalous.
We are debating the issue and showing that the scandal has moved forward. I did a lot of work on the thalidomide campaign and I thought this was the next thalidomide scandal. That is how Sky News described it this morning in recognition of how serious this matter is. As my hon. Friend the Member for Totnes (Dr Wollaston) has said, there may be areas where the procedure can be used, but at a minimum the situation warrants a suspension of use at this stage, as has happened in the United States and in Scotland. My constituent is a generous woman. She said, “I don’t expect you to understand this quickly, but please raise my voice today in Parliament.”
Suspension and study of the data is vital; otherwise, we could be creating the biggest scandal in years in the NHS.
Thank you, Mr Owen, for chairing this debate. I congratulate my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing this important Westminster Hall debate on International Menopause Day.
Women are always reluctant to speak out about the personal and intimate medical issues that they experience. Sadly, they are highlighted only when things go wrong. Two women in my constituency have spoken out about their experiences, but I urge all women who have suffered as a result of a mesh implant to get in touch with their MP, because we know there are many other cases. As we have heard, there are women suffering whom we do not know about.
Recently I met a constituent of about my age whose life has been devastated. She had a mesh fitted in December 2011 and knew immediately that something was wrong. She could hardly move her right leg. She had pain all across her lower abdomen and back and in the right side of her groin. She had infections in the operation sites and was given three lots of antibiotics. Three weeks later the consultant said that she had mesh exposure. She was admitted on 3 February for what she thought was a removal, but it turned out to be for steroid injections, which did not alleviate the pain.
She was then sent for internal physiotherapy. I imagine that was very painful. She has also received physio on her back because of back pain. She saw numerous consultants and had many scans. Eventually, after bursting into tears during a physio session because of the pain she was in, she ended up seeing another consultant, who decided she should be admitted to remove the mesh. The operation was in August 2012 and she was pain-free for about a year after, but then it started again. She had constant pain in the groin, back, and across the lower abdomen, and she went back and forth to the doctor in the familiar scenario that we are hearing about today. It was even thought she might have bladder cancer, but all the scans were clear and still she was in constant pain.
My constituent was under the impression that the mesh had been removed, so when they were all scratching their heads and saying they did not understand why she was in pain, she was told she should try and manage it better. Understandably, she did not know where to turn. Eventually she saw a different consultant who asked her what she could feel inside, and she said it was the mesh. It turned out they had only cut the mesh in half. It was still there—no wonder she was in so much pain. Again, she went in for removal in August 2015. Unable to pass urine for three weeks, she had to self-catheterise at home.
About nine weeks later she started to feel as though she was getting on her feet again and was relatively pain-free for about a year, but it flared up again. She had another round of video urodynamics done, which was not pleasant. She was told that the corner pieces of the mesh were still there and it was too risky to remove them. After a recent flare-up with severe inflammation, she was sent for an urgent scan. Having spent the past six years in constant pain and discomfort, she does not have a partner because so much time is taken up looking after herself and her son and working.
During a visit to the consultant this year he asked what she wanted him to do. She said, “I came to be under your care because I was incontinent. I am still under your care six years later, still incontinent, and in pain as well now, so you tell me what you are going to do.” We must realise these women need help. As the MP for Gower, I have talked about my constituent and the plight of mesh-injured women. Many women do not like to discuss this topic and they do not want to complain. We cannot wait until 2019 for NICE to bring out guidance. I echo the words of the shadow Minister for Public Health, my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), by asking the Government to hold a public inquiry into the numbers of women adversely affected.
It is a pleasure to serve under your chairmanship, Mr Owen. I congratulate my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing the debate and on her powerful speech. I also congratulate my hon. Friend the Member for Pontypridd (Owen Smith) on raising the issue and on forming the APPG to raise the profile of an issue that I confess I knew virtually nothing about until quite recently. I congratulate the many Members who have made powerful speeches explaining the experiences of women in their constituencies.
As I have said, I knew nothing about this issue, but its seriousness was brought home to me when a constituent came to see me. He had had an inguinal hernia repair that developed complications because of the mesh used in the procedure. It left him in agony; he described it as like having a metal plate wedged in his lower abdomen. Eventually, he had to have corrective surgery, but it did not resolve the chronic pain that he suffers. That points to one of the unique aspects of this problem, which is the difficulty of removing the mesh and correcting the initial surgery. He had the mesh removed, but he is still in constant pain. I think that is partly due to the fact that the expertise in removing mesh implants is not really there.
That is an important, well-made point. The failure of the procedure that my constituent went through has changed his life. He was previously a runner, cyclist and mountain-climber—a very active man. He now struggles to get around. When he came to see me, he had to stand throughout our meeting because of the pain that he is in. He is now suffering with a chronic condition as a result of the failed procedure.
My constituent has been in contact with a number of other men—and is aware of many others—who are in this difficult situation. He asked me to ask the Minister two questions. First, how many men have gone through this procedure and had it fail? Secondly, will the scope of any future NHS investigations be widened to include men as well as women? I do not want to downplay the seriousness of the issue for women, which has been clearly explained by a number of Members today, but any investigation needs to take the experience of men into account.
As it happens, my constituent underwent his procedure in a private hospital, which points to three wider issues that he asked me to raise. First, there is a lack of clarity—as we have already heard—about the roles and responsibilities within private hospitals and between hospitals, surgeons and others involved in the process. Secondly, there is no mandatory reporting of chronic pain incidents following unsuccessful operations; that clearly needs to be addressed.
Thirdly, there is a three-year limit to medical negligence claims, which has had an impact on my constituent and possibly others as well. My constituent had his operation just under three years ago, but he has been managing his agonising pain and chronic condition for the last two years and has not really been able to think about whether there is a medical negligence claim. He does not really have time now to lodge one within the three-year limit. I would be interested to hear the Minister say something on those matters.
I conclude by supporting the other points that have been made by hon. Members about the prioritisation of this issue by the National Institute for Health and Care Excellence and the need for a full public inquiry.
I am grateful to the hon. Gentleman. I want to thank all Back-Bench Members for their co-operation with their interventions and speeches, and for taking such a serious tone on this matter. We will now hear from the Front-Bench spokespersons.
It is a pleasure to serve under your chairmanship, Mr Owen. I will be as brief as I can, because we are all very keen to hear from the Minister.
A lot of the key points have been extremely well made by all the Members who have spoken. I particularly congratulate the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing the debate and opening it for us. I also want to pay tribute to the chair of the all-party parliamentary group, the hon. Member for Pontypridd (Owen Smith), for the work that he has done.
Like many Members, the issue was brought to my attention by a constituent and the very powerful and emotional meeting held in one of the Committee Rooms before the formal founding of the APPG, where we heard testimony from a range of constituents and campaigners. Many of those testimonies have been echoed and repeated today, notably, but not exclusively, by the hon. Members for St Ives (Derek Thomas), for Gower (Tonia Antoniazzi), for Strangford (Jim Shannon), for Elmet and Rothwell (Alec Shelbrooke) and for Manchester, Withington (Jeff Smith). They are painful enough to listen to—we saw the reactions of Members in the room as we heard those testimonies—so how much more painful and traumatic it must be for people to have to live in those terrible situations.
The hon. Member for East Renfrewshire (Paul Masterton) raised the situation in Scotland, and I want to dwell on that for a moment. He must be one of the first opposition politicians—as he is in Scotland—ever to say the words, “I am disappointed that the results of the independent review were implemented in full.” Normally, Governments get criticised for not implementing the outcomes of an independent review.
In 2014, the Scottish Government requested a suspension in the use of vaginal medical mesh by the NHS in Scotland. In 2015, the Cabinet Secretary for Health apologised to women who had been left in severe pain by these operations. Since that suspension was introduced, the use of mesh has fallen dramatically. Between 2009 and 2016, the number of women receiving mesh surgery in Scotland has fallen from 2,267 to 135.
I understand from what was said by the hon. Member for Totnes (Dr Wollaston), who probably knows far more about these issues than many of us in the room, that it would be very difficult to get that figure right down to zero, because there may be occasions when the surgery is appropriate. However, it has to be under very specific conditions and absolutely with the fully informed consent of which she spoke. That comes out clearly in “The Scottish Independent Review of the Use, Safety and Efficacy of Transvaginal Mesh Implants in the Treatment of Stress Urinary Incontinence and Pelvic Organ Prolapse in Women”.
The hon. Member for East Renfrewshire is right to say that transabdominal mesh is not yet under suspension, but that remains, and should remain, under constant review by the chief medical officer in Scotland. All the evidence that was submitted to the review are available on the website, along with the different drafts. It is important that we make it clear that the evidence has been fully published, and that the recommendations were made independently by the review and have been accepted in full by the chief medical officer in Scotland, who has been clear that the requested suspension of the use of mesh implants should remain in place until she is satisfied that the recommendations have been implemented.
An oversight group will oversee the recommendations and will be expected to put the patient at the heart of everything it does. Professor Alison Britton has been asked to examine the review process itself, to listen to and take on board some of the concerns that the hon. Gentleman raised. I would be interested to hear from the Minister what discussions she has had with colleagues in Scotland about what lessons can be learned from some of the questions that have been asked there.
The Scottish Government have no power to ban the use of mesh, because the matter remains reserved to the Westminster Parliament and, in particular, to the Medicines and Healthcare Products Regulatory Agency. The Sling the Mesh campaign, as we have heard from a number of Members, has asked for some clarity from the MHRA and a stronger, more stringent system of auditing the efficacy of mesh and other medical practices.
One of the most important things that has come through clearly in the debate is the collection and analysis of data, so that a full picture of the situation can be brought up. We have heard so many times of individual cases where people are told, “This is just you; this is an isolated case,” when it very clearly is not. The evidence has to be gathered, and full investigations have to take place and continue.
There is a clear expectation that the MHRA must continue to review the use of medical mesh implants. That should include considering all available evidence and taking lessons from the use of such implants further afield, such as in the United States and Europe. That is important to ensure not only that the best healthcare options are provided, but that women can be confident that the services they have received have been shown to be effective under robust and effective clinical trials—an important point, which was stressed by the hon. Member for Totnes. One of the key things I have learned from this debate is the difference between the testing regime for medicines and the testing regime for implants and other medical devices. There is clearly a cross-party consensus on that, and I hope the APPG will continue to look at the issue.
I welcome the conclusions and recommendations of the Scottish and English reviews of the use of this procedure. We must ensure that surgical mesh implants are used only after all other appropriate alternatives have been exhausted and, crucially, only when women give their fully informed consent.
Once again, I pay tribute to the campaigners for their bravery and courage and for bringing this issue to our attention. I hope it is not a totally inappropriate comparison, but this reminds me of the Women Against State Pension Inequality campaign, during which individual, isolated cases started to snowball, and the issue got on to the agenda. That campaign for justice made progress and is now being heard loud and clear. There is a parallel with this campaign, although it is not exactly the same. I hope the Government listen. We have to thank those campaigners for the small and belated progress that has been made. They will rightly hold us to account to ensure we make progress.
It is a pleasure to serve under your chairmanship, Mr Owen. I thank my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) for securing this very important debate and for her excellent contribution. The Opposition fully support her four asks of the Government.
I commend all other speakers for their thoughtful and passionate contributions, and I thank their constituents who allowed their experiences to be shared with us. I especially want to thank Kath Sansom, who leads the Sling the Mesh campaign, for all her hard work in uniting the women affected by vaginal mesh implants and for raising awareness of the tragic impact that mesh implants have had on so many lives. I also thank other hon. Members who have spoken out about this issue for such a long time—in particular, my hon. Friend the Member for Pontypridd (Owen Smith), who spoke with such knowledge and passion. It was vital that he took part in this debate, and I thank him for everything he has done on the issue.
The experiences we have heard about today are incredibly distressing. I have the utmost sympathy for those suffering because of mesh implants. We are here to stand up for those women, and we seek answers and Government action on their behalf.
Let us start at the beginning, when women are told that the best course of action is to have a mesh implant. They are told that the procedure is quick and cheap, but, as we have heard, the low financial cost of the implants is far outweighed by the huge human cost to those women for the rest of their lives.
The NHS and the MHRA say that the risk of complications is low, at 1% to 3%, but a report by nine leading medics put the risk much higher, at 15%. If leading bodies and medical professionals cannot agree, how can patients be expected to make informed decisions? Health professionals are supposed to outline clearly and explicitly the risks of any operation that a patient is asked to undergo to ensure they can weigh up the risks and benefits for themselves.
As we have heard, the mesh implants are made of the same material as some drinks bottles. They can shrink, twist and curl at the edges. The material can degrade, cut through internal tissues, poke through the vaginal wall and stick to organs, causing pain, incontinence, urinary infections and a loss of sex life. Marriages have been destroyed and people have been left unable to walk, work or even to pick up their young children. Knowing those risks, how many in this Chamber would consent to a mesh implant? It is time to take women’s health and wellbeing seriously. They need to be listened to. Their voices need to be heard and their concerns believed so we can put right this injustice and prevent it from going on any longer.
Since this debate was announced, I have been inundated with emails and tweets telling harrowing stories of how women have been affected by vaginal mesh implants. I am sure everyone in the Chamber has received the same sort of emails. Just last night—very late in the day—I received an email from Sling the Mesh with an attachment containing 210 emails out of the 400 it received following the Minister’s answer to my question during Health questions last week, when she said there is not enough evidence to ban the mesh. Those emails are packed with evidence, and I am very happy to pass them on to the Minister. They all detail how the implants have been life-changing, but unfortunately not for the better.
Julie has had to give up her job as a paramedic, and is now trapped in a world of pain and medication. Kath has lost her passion for mountain biking because it is now impossible to get on the bike. Suzi says that her pain consumes her every day.
Another woman, Tina, also shared her experiences. For four years, she went to her GP and accident and emergency several times with excruciating pain, and was sent from pillar to post. She was told that the pain was due to irritable bowel syndrome, painful bladder syndrome and a slipped disc, and that the mesh implant was absolutely not the problem. After four years of searching for answers, she went private and spoke to a surgeon who finally believed her pleas about her pain and partially removed the mesh. She says that her recovery has been successful and she is no longer in pain, which is excellent, but four years is such a long time to lose. We know that many, many women are unable to go private to end their trauma, but they should not have to do so.
After this debate, there is a lobby of mesh-injured women, which I encourage the Minister to attend. We will be joined by Dr Robert Bendavid, who has flown in overnight from Canada. That shows that this really is a worldwide scandal. Many countries, including our own, are just waking up to the horrors of vaginal mesh. In Australia the Senate is holding an inquiry, and in the US vaginal mesh has been considered a high-risk device for nearly a decade. As we heard, vaginal mesh has been suspended in Scotland since 2014, yet across the border the Government have rejected a ban in England and have failed to empathise with the approximately 8,000 women who have been admitted to hospital with a mesh complication. That is not surprising, considering that just 1,000 mesh admissions have been reported to the MHRA as a mesh-related issue. Surgeons are clearly reluctant to report that mesh is the issue, which lets their patients down and distresses them further.
Our next concern is what the Government are going to do to support women who have had to leave because of the effect of vaginal mesh. Most GPs do not attribute the pain to the mesh, so it is very difficult for those women to claim personal independence payments, disability living allowance or any other benefits. They have to rely on their families’ finances, which is incredibly frustrating and distressing to the victims, especially those whose families are unable to support them. We must also consider the women who are suffering in silence and have not come forward yet because of the intimate nature of the issue. After hearing of the experiences of others, some women may be embarrassed or just too scared to come forward for fear of being dismissed as a hysterical woman.
At Health questions last week, the Minister said that a NICE update on vaginal mesh implants is expected at the beginning of next year—my hon. Friend the Member for Pontypridd also mentioned that—but that is too little, too late for the approximately 200 women who will get a vaginal mesh implant on the NHS between now and then and the thousands of women who have already been affected. One of my constituents reached out to me to say that she is worried because she is due to have that surgery soon, and she asked for my advice. Obviously, we cannot give medical advice, so I told her to watch this debate and speak to a surgeon. If there is a chance that a car or an aircraft could cause harm, it would be immediately recalled while the problem was investigated. Why does the precautionary principle not also apply when the health and wellbeing of thousands of women is in jeopardy?
Last week, the Minister said there was not enough evidence to warrant asking the MHRA to reclassify these procedures, but there was so little evidence to justify beginning them in the first place. What exactly is she waiting for? Given what we have heard today, I hope she will recognise the urgent need for action on this issue and justice for those women. I hope she will take these calls back to the Department of Health and ensure that no more women are subject to the risks of vaginal mesh implants. That is why the Opposition are calling for an urgent public inquiry into the number of women adversely affected by vaginal mesh implants and into why the safety of so many women was disregarded. We urge NHS England and NICE to act immediately to update the guidance and suspend the use of vaginal mesh today. It is our duty to ensure that the failings are understood and corrected so that they never happen again. That should be a matter of urgency for the Minister and the Government, and I trust she will respond positively to these calls.
It is a pleasure to serve under your chairmanship, Mr Owen. I thank the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) for securing this debate and shining a light on a condition that is very distressing for far too many women. Clearly this is not where we would like to be.
Obviously, many hon. Members would like an immediate ban on mesh products. From my perspective, the issue is not with the product but with clinical practice. That is what is going wrong. That is where we need to be much clearer, ensuring that women are treated properly by their clinicians, given proper advice and risk assessments, and given the opportunity to report any complications and the ability to complain and challenge. The Government also need to ensure that all clinicians have the most up-to-date and appropriate advice.
The focus of this debate is the women who are suffering. The most important thing we can do—my priority—is to ensure that they get the support, care and treatment they need to alleviate a debilitating condition.
With regard to the evidence, we expect to produce the NICE guidelines before the end of 2017. We will bring them forward as soon as possible. I am sure that hon. Members will want to review those guidelines, to see whether they are satisfied that they have moved forward.
The advice I have received from the MHRA is that mesh is still the best product for treating stress incontinence, but the evidence regarding prolapse is more mixed. I can give that advice to hon. Members today, but we await the NICE guidelines before the end of the year.
The women are the most important aspect of this debate. We should be focusing on them. We must make sure that they are fully supported to make informed decisions about the surgery, and I have heard from many hon. Members that in many cases they were not. This is a risky process and, as my hon. Friend the Member for Totnes (Dr Wollaston), the Chair of the Health Committee, said, many women have benefited from this surgery but there is a risk to it, and those risks were not properly communicated to allow women to make an informed choice. That is not acceptable and we must make sure that does not happen in the future.
To do all of that, we are working with patients, NHS England and the MHRA, to come together with the mesh oversight group. The most recent report was published in July and its recommendations are being implemented. The updated guidelines will be published before the end of 2017. It is important that regulators ensure that advice and guidance keep up with developments in clinical technology and practice. We will constantly review evidence as it comes in to keep advice and guidance up to date.
A number of hon. Members mentioned that there have been no clinical trials for these devices, and I agree that we need to continue to draw on emerging evidence. There have been a number of research studies which have directly informed the guidelines issued by the regulators and led them to reach their conclusions, on which I have just advised the House.
It is still important that we listen to the concerns of women, and I encourage all hon. Members who speak to their constituents suffering with the consequences, to make sure that they report those complaints through the MHRA yellow card scheme, so that we can build a body of evidence about where things have gone wrong.
Will the Minister make a specific inquiry to the MHRA about the evidence of bacterial infection on the product, which flies in the face of its advice that the product must have sterility in order to be implanted? There seems to be a contradiction in the MHRA’s advice as to how it should be licensing products.
I hesitate to give a full answer, but the advice I have received is that over the years these products have been reviewed and there are clinical standards for the size of the mesh. I will write to my hon. Friend in more detail, because I am not an expert in that.
The hon. Member for Kingston upon Hull West and Hessle calls for a public inquiry. I think it is more important that we get the treatment that is needed, but I encourage everybody to report their cases through the yellow card scheme.
I am horrified to hear from my hon. Friend the Member for Totnes that many women did not know they were having the device fitted in the first place. That general issue indicates some arrogance of the medical profession towards women. The stories I have heard from colleagues, about how their constituents have been treated by their GPs when they have gone for treatment, are indicative of that. Women tend to suffer in silence. Quite often that means they are not the best at championing themselves. That is clearly unacceptable. This issue has been considered by the mesh oversight group, and it has been clear that improvements are needed to ensure informed consent.
I give my hon. Friend that assurance. To be frank, the same standards of consent and regulation apply in the private sector as in the public sector. A number of colleagues mentioned issues in the private sector, but there is no excuse; it is equally regulated by the Care Quality Commission and the General Medical Council, so the same standards apply.
I am not sure that there is a loophole. Surgeons are required to demonstrate their clinical competence as part of their regular revalidation, whether they work in the private or the public sector. Concerned patients may contact the GMC, just as they would do in an NHS trust. In addition, surgeons will be inspected by the CQC and their procedure examined to ensure that it meets standards. I cannot see that there would be any difference, but if the hon. Lady would like to bring to me a specific example, I would be delighted to look into it for her.
Clinicians working in private hospitals are under the same ethical obligations to ensure that treatment is based on consent, that complications are addressed and that information is shared with regulators as appropriate. Private hospitals are subject to CQC registration and must abide by those fundamental standards.
I am very short of time, but I suspect that we will come back to this matter, particularly after the NICE guidelines are published later this year. The most important thing we can do is make sure that the women have access to the support that they need, and that GPs know what to look for in order to give them that support, and I am always open to hearing representations from colleagues on this issue.
I thank everyone who has attended and spoken. I had hoped that my summary would be a little more positive. I am sorry, but the Minister’s response is simply not good enough—at all. I am extremely disappointed. I completely disagree with her: it is about not only the procedure, but the product. I hope that the weight of evidence from all the women involved—all the women who have emailed, all the constituents and all the people who have contacted Sling the Mesh—will be enough to show the Minister that this is more than just procedural; this is about the product.
I also disagree that this is the best treatment for women with urinary incontinence, and I urge the Minister to please look again. I urge men and women around the country to send letters and explain this to the Minister, so that hopefully the weight of emails and letters coming to her doorstep will show that this needs to be looked at again.
I thank all the brave women and men who have raised this issue. I want to reassure them that I will continue to be their voice, and so will the other members of the APPG. My hon. Friend the Member for Pontypridd (Owen Smith) has campaigned tirelessly on this issue. We will not let those people down. We will keep pushing until we get a much more satisfactory response to all the problems they have been suffering.
Question put and agreed to.
That this House has considered the risks of surgical mesh implants.
Social Security Support for Kinship Carers
I beg to move,
That this House has considered social security support for kinship carers.
It is a pleasure to serve under your chairmanship, Mr Owen. There are about 200,000 kinship carers in the UK, three quarters of whom live in poverty. By taking in their relatives’ children they save the state tens of thousands of pounds in care costs and keep families together, often in tragic circumstances. Research suggests that children living in kinship care also have better outcomes than children fostered by non-relatives.
According to a report by the University of Bristol,
“Children in kinship care are more likely to have better mental health and behavioural outcomes due to the stability of placements and they are also more likely to preserve their identities through family and community ties.”
Yet although foster carers receive extra support from the state for their efforts, kinship carers are often denied even the bare minimum. According to the Family Rights Group, the majority have to give up work completely or temporarily to look after the children they take in. As a consequence, kinship carers have been disproportionately affected by the benefit cap. They are more likely to be unfairly sanctioned, because of the lack of joined-up working in the state system. For example, their appointments at the jobcentre might be scheduled at the same time as their meetings with a social worker—if they are lucky enough to get a social worker—none of which they are allowed to miss or move.
I congratulate my hon. Friend on securing a debate on this important issue. She makes an excellent case for the needs of kinship carers. Does she agree that we need to look more generally at the extraordinary contribution that carers make every single day to our society and our economy?
My hon. Friend makes an excellent point. Indeed, this morning I was contacted by a constituent who has previously been to my office for assistance and who wanted to raise the issue of carers more generally. Her daughter had a brain injury at birth, and 24 years later she is still caring for her. She was keen to ensure that I understood the financial, social and emotional impact of taking on the responsibility of caring for another family member. We must always remember that many people around the country do excellent work in caring for their relatives, and their friends and neighbours in some instances. Too often we forget them and they are an overlooked group in our communities.
Due to reductions in funding to local councils, local authority allowances for carers have been cut. Although foster carers can receive fast-tracked support from social workers or child mental health services, kinship carers usually are left to get with on with it themselves. With regards to the support that does exist for kinship carers, a survey by the Family Rights Group and the Kinship Care Alliance found that 80% of carers do not know enough about the legal options and support that are available to them.
I congratulate my hon. Friend on securing this debate. She talks about kinship carers not understanding some of the benefits available to them. One of the difficulties that kinship carers face is that often they are grandparents, who would never not take in their grandchildren. However, lots of them have retired so they are not financially ready to take on young children again. I have cases in my constituency where grandparents face having to take equity from their properties to support the grandchildren who are now, in effect, their children. Does she agree that the Government lack understanding of what kinship caring is about? There is a real lack of understanding and support, particularly for older generations of people—grandparents—who are looking after children.
Certainly, there is a huge amount of expectation on families to ensure that children are cared for in a family setting. The state should be aware of those people and the support that they deserve should be available. Too often, kinship care arrangements are informal, unofficial and under the radar. Sometimes parents are in a crisis situation, some simply cannot cope and in more extreme cases there may be death in the family, and that burden falls on the wider family circle.
Older people who perhaps have retired are caring for members of their family for a second time—in my experience, it is often not the first time that they have done so. They may have looked after their children or other family members in their time, and then face doing that again in their retirement years, which they may have been looking forward to enjoying, free from the responsibility of the school run. Children are incredibly tiring and we tend to forget too easily the burden that is placed on people.
There is a huge amount that I would like the Government to do, not least to address the points that my hon. Friends highlighted in their interventions, to recognise the enormous value of kinship carers and to provide them with the support that they need. However, I want to focus on two measures that the Chancellor could adopt in his Budget next month at very little cost that would have a huge effect on younger carers today. The Minister may already have read the recommendations in the October 2015 Family Rights Group and Kinship Care Alliance report, but if she has not, will she do so? If she feels that my two measures do not go far enough and she would like to do even more, those recommendations would be well worth a read.
In September, I raised the case of my constituent Alyssa at Prime Minister’s questions. Alyssa took responsibility for raising her three younger siblings when their mother passed away four years ago. She was only 18 when she took on the care of her sisters and brother, which is an enormous responsibility for someone of such tender years who is just about to start out on their life journey themselves. She did an absolutely brilliant job, despite the numerous daunting challenges that she faced. She had to work to clear her mum’s debts while looking after her family. Her eldest sister is now in her second year of university, and Alyssa has just started a family of her own with her partner, which is wonderful news.
However, because Alyssa cared for her siblings, she is being denied the Sure Start maternity grant and child tax credits. She is missing out on up to about £3,000 a year in total. When the Government restricted the Sure Start maternity grant to a family’s first child, they reasoned that families could reuse the equipment that the grant helps to purchase, such as prams, toys and clothes. I do not think that Ministers really considered that some carers take children into their care after infancy, so they never had clothes, prams or bottles to begin with.
It seems to me that Alyssa’s case is an anomaly in policy—an unintended consequence of the one-child limit on Sure Start and the two-child limit on child tax credits—but she is not a one-off. Another constituent contacted me recently to say that his wife had taken on her sister’s two children a few years ago after she passed away. He and his wife are now expecting their first child, and they, too, will not be entitled to tax credits for their own child. If they had already claimed tax credits for a child of their own and had later put in a claim for her nieces, that would have been accepted and all the children would have been eligible for tax credits. The Government included an exemption for kinship carers in the Welfare Reform Act 2012, but I just do not think that they realised that the exemption did not cover all cases.
Lisa from Grimsby took care of her 18-month-old nephew five years ago. He was diagnosed with global developmental delay—autism—and has an extra Y chromosome. His mother’s mental health issues meant that she was unable to meet his care needs, which only increased as he got older, so Lisa and her husband eventually both gave up work to look after him. That is another example of the financial hardship that kinship carers often face. When they had a child of their own this year, they were denied the the Sure Start maternity grant. Unfortunately, it is all too tempting for Governments to take kinship carers for granted, allowing them to make enormous sacrifices and raise children who are not their own, without offering them the support they need and deserve.
It is unknown how many carers are or will be affected by these policies, because the Government do not measure that. However, a survey by the Family Rights Group suggests that 25% of kinship carers have both their birth children and kin children living with them, and about one in five—up to 40,000—carers has three or more children living with them. As the two-child and one-child limits are not applied retrospectively, a small fraction of that number will be affected by this issue.
The number will be growing every year, but we are talking about a small amount in cost terms to extend the exemptions for kinship carers to those who have children of their own after taking kin children into their care. That small cost would be of huge benefit to kinship carers, like those in my constituency who are sacrificing a massive amount to do the right thing and give children a loving home within their family.
I am calling on the Government to ensure that kinship carers are eligible for child tax credits and the Sure Start maternity grant when they have children of their own. I asked the Prime Minister about Alyssa’s case on 13 September and she asked me to write to her about it. I sent her a letter that day, and I sent another letter with more information on 3 October after Alyssa’s appeal for the maternity grant was rejected, but as I mentioned before, I still have not received a reply. I hope the Minister will be much more forthcoming in how she plans to deal with these anomalies in the law so that kinship carers are no longer penalised for the amazing work they do.
It is a great pleasure to serve under your chairmanship, Mr Owen. I congratulate the hon. Member for Great Grimsby (Melanie Onn) on securing this important debate on social security support for kinship carers. She has raised a number of important issues and I am glad that she has taken the opportunity to highlight the invaluable work that kinship carers do. They truly are the unsung heroes, stepping in and offering care to children when they most need it.
Let me start by assuring the hon. Lady that the Government acknowledge the immense value of care given by kinship carers, be they family or friends looking after children whose parents are unable to provide the necessary care themselves, or non-parent carers supporting children who would otherwise be in local authority care. As she said, they save the public purse an awful lot of money; but more than that, the value of the stability and care that they give is probably immeasurable. A number of the issues she raised in passing, as well as the Family Rights Group and Kinship Care Alliance report that she referred to, cover a multitude of Departments. I will take a closer look at that report and recommend it to my colleagues from across different Departments.
I am grateful that the hon. Lady raised the specific issues of some of her constituents and others. Those individuals, through the selfless gesture that they make, play such a vital role in ensuring that children are raised in a caring family: an environment that gives them the stability they need to grow and develop. As a society, we owe them a massive debt of gratitude. In particular, she raised the story of her constituent, Alyssa, who raised three of her siblings from a very young age, and I understand that she gave up her own studies to do that. She has clearly done a remarkable job, given that one is now making her own way through university. She should be the subject of all our praise and thanks for that enormous act of self-sacrifice at such a young age—it must have been terrifying for her.
The Government work to ensure that the role of kinship carers is recognised and supported by ensuring access to the same support as parents within the benefits system in relation to child benefit, universal credit, child tax credits and other means-tested benefits. I am sure the hon. Lady will understand that the benefits administered by the Department for Work and Pensions are designed to try to suit the majority of claimants and cannot always be tailored to every individual circumstance, as that would introduce difficult and often subjective decisions into what are intended to be simple, streamlined schemes. However, I assure her that the Government recognise that there are times when the rules may not seem to have the flexibility that one would want, and this is clearly one of those times.
The hon. Lady has raised a number of important issues. This is something I will look more closely at and, as with all our policies, the Department will continue to keep the policy under review.
With regard to the Sure Start maternity grant, payment is restricted to just the one child under 16 in the family. We believe it is important to focus support where it is needed most. That is why we took that decision. The expenses related to the first child—buying all the necessary paraphernalia that come with a baby—are usually greater than those for subsequent children. That means that kinship carers of children under the age of 16 who then have their first baby are usually not eligible for the grant for that baby. However, as the hon. Lady rightly said, the circumstances of kinship carers vary, and it is not possible to legislate for every specific circumstance. As she highlighted, sometimes children taken into kinship care are not infants and did not come with all the necessary baby bits and bobs. That is why I take on board very much what she said and am happy to look at the issues she raised to do with that specific circumstance.
The hon. Lady also raised the Government’s policy to limit tax credits to two children. I would like quickly to touch on the rationale for the policy to provide support for a maximum of two children, as that might help to explain its impact on kinship carers as well as other claimants. As we know, a benefits structure that adjusts automatically to family size is not fair on families supporting themselves solely through work, who do not usually see their incomes rise when they have more children. We know that households need to think carefully about whether they are financially prepared to support an additional child without relying on income-related benefits. The Government’s view is that providing support to a maximum of two children or qualifying young persons in universal credit and child tax credit will ensure fairness between claimants on the one hand and, on the other, those taxpayers who support themselves solely through work. We believe that all children should be treated equally, and the decision to have more children should be taken based on whether the claimant can afford to support additional children.
However, I must stress that the Government recognise that some parents and carers are not able to make choices about the number of children in their family, and kinship carers often step up to the plate unexpectedly. That is why we have developed a number of exceptions for third and subsequent children to the maximum support on entitlement. One of those exceptions applies to parents who already have two children in their household and make the selfless decision to take on the responsibility of kinship care for children who would otherwise be at risk of entering the care system.
Claimants will still be entitled to an additional amount for any disabled children, regardless of the total number of children in the household. It is also worth noting that tax-free childcare is available to households where all parents are earning at least the equivalent of 16 hours at the national minimum wage per week. Households can receive support for any number of eligible children from age zero to 12, or to age 17 where the child is disabled. Child benefit will continue to be paid regardless of family size, as that is the basis of the Government’s contribution towards the cost of bringing up a child.
I reassure the hon. Lady that the Government recognise the pivotal role played by kinship carers. Our welfare policies are designed to ensure fairness between families supporting themselves solely through work and those on income-related benefits and to support those most in need. She has raised a number of important issues and the Department will give the policies discussed today and their impact on kinship carers every consideration.
Question put and agreed to.
Taxes on Small Businesses
[Ms Nadine Dorries in the Chair]
I beg to move,
That this House has considered the effect of taxes on small businesses.
It is a pleasure to serve under your chairmanship, Ms Dorries. I am grateful for the opportunity to raise this issue, which affects small businesses in west Cornwall and the Isles of Scilly, in the constituency of St Ives.
Some 87% of business enterprises in my west Cornwall constituency are classed as microbusinesses, meaning that they employ fewer than 10 people. In fact, 99% of all businesses in my constituency are small and medium-sized enterprises, employing fewer than 250 workers. Those small, locally run businesses provide the lion’s share of jobs and are the drivers of our local economy. If that is true in St Ives, it will be true elsewhere in the country, which is why understanding how the tax system helps or hinders small business is so important and why I am pleased to raise the issue today. It is also why I have dedicated a considerable amount of time since being elected in 2015 to meeting small businesses and understanding the issues facing them. In fact, I had a small business of my own until my election in 2015.
I know that this Conservative Government recognise the considerable contribution of small businesses, and I acknowledge and appreciate the work that has been done to address the tax burden and support small employers. Many of the 3 million jobs created since 2010 are within small businesses, which is, in part, a credit to Government policy. I recognise that there is no shortage of priorities for the Government and that navigating our way out of the EU will be time-consuming, to say the least. Despite that and—dare I say it—because of it, if there was ever a time to radically address the way businesses are taxed, it is now. While reform will be a challenge, it will undoubtedly yield benefits for our economy by improving productivity, driving wage growth, boosting full-time employment and spreading wealth across all corners of Great Britain, which is a particular concern and interest of people in the far west of Cornwall.
Time does not permit us to consider every aspect of business taxation, and I am not gifted with the brain that is needed fully to understand the complexities of the issue. However, I wish to cover three tax-related issues that stand out to me as clear opportunities for the Government to remove barriers for small business and demonstrate an understanding and recognition of the life of a small business owner.
The first issue is the VAT threshold. Small business owners in coastal communities such as Cornwall and the Isles of Scilly choose to curtail their business to duck under the VAT threshold of £85,000. That is not necessarily about tax avoidance, but more a desire to avoid another level of administration. One business owner on Scilly contacted me because the gallery she runs is set to cross the VAT threshold. She will then have to raise prices by 20% to break even. Since only one of the gallery’s 30 artists is VAT-registered, being able to claim back VAT would not compensate for that change. The gallery must either take the leap and accept that burden or close for the rest of the season.
The effect of the stifling VAT threshold in my constituency is reduced activity during shoulder and winter months, reduced employment opportunities, reduced Government tax income, depressed town centre activity and greater pressure on the hospitality sector during peak season. A guest house owner wanting to avoid registering for VAT may also choose to close early, reducing the availability of beds for visitors and removing altogether the potential spend of the visitor within the wider community.
I raise that issue now because leaving the EU presents an opportunity for the Treasury to consider raising the threshold to, for the sake of argument, £120,000. The Isles of Scilly would be a great place to look at if the Treasury wanted to assess the possible impacts and implications of such a change. The Government may find that it is a cost-neutral proposal.
Another benefit of that proposal is the potential to create greater job opportunities and encourage fresh blood into the tourism sector. That is particularly relevant in Cornwall, Scilly and other rural areas across the UK that struggle to retain young people. I am not suggesting that the proposal would address the skills gap entirely in remote and rural areas, but it would be a step in the right direction.
I assure the Minister and everyone here today that the need to address the VAT threshold in coastal communities is regularly brought to my attention by business owners. I am interested to hear if the Minister is minded to consider such a proposal and possibly a pilot in the constituency of St Ives.
This is a very complex matter. I was doing some research on it and found that 59% of homes now own a tablet, 71% of UK adults have a smartphone and 97% of small and medium-sized businesses have access to online services. I make a plea to the Minister on behalf of craftspeople—people who know nothing about computers but everything about their hands. The person who has a computer in their house is probably a 13-year-old—
If the hon. Gentleman is happy to wait, I will be pleased to address that issue later.
I will move on to business rates, which have been quite a contentious and well-documented issue in recent months. There is no doubt in my mind that if the Treasury were inventing a taxation system from scratch today, the current business rate system would not feature in its proposals. The Government should scrap the current system of business rates and develop a fresh solution, injecting fairness into the tax system for small businesses and taking into account the growth of online shopping and supermarket home delivery services.
Structurally, there are many things wrong with business rates. The tax bears little or no relation to the success or activity of a business. The method used to calculate it is arbitrary. Colleagues will be aware that rates are calculated by multiplying the rateable value, based on the assumed rental value of the property, by a multiplier set by Government. Almost in recognition of that, and in an attempt to spare small businesses the business rate burden, the 2010 Conservative-led coalition and the two successive Conservative Governments have sought to address the problems associated with business rates. As a result, some businesses are eligible for rate relief, with many paying no rates at all. Others, for reasons that are beyond the understanding of most lay people, find they are charged 100% business rates, with many in my constituency experiencing considerable increases following the revaluations earlier this year.
The owner of a small independent delicatessen in Helston, where rents are relatively lower, approached me for help in March. Her current rateable value stands at an extortionate £17,750 per year. To rub salt into the wound, her rates are calculated as £149 per square metre, which is the second highest on the street. A chain bakery operating next door pays just £101 per square metre—32% less—and a national clothing chain on the other side of the street pays just £66 per square metre, which is over 56% less. If she enjoyed the same rate per square metre, she would be liable for no rates whatsoever. Because of her business rate charge, she is not sure that she can afford to stay in business.
The current business rate calculations unfairly discriminate even between businesses in the same part of the high street and do not enable businesses to operate on a level playing field. The great tragedy is that that example is not unique. There are similar cases of an independent photography shop in Penzance and a car paint-spraying business that is run by two youngsters who find that their business rate charge bears no comparison to similar units on the same industrial estate. In both instances, there is little hope for the businesses unless the Government act quickly.
Furthermore, in this age of online shopping and supermarket home delivery services, there are businesses essential to the health of the high street that find competing in today’s world nigh on impossible, despite their so-called privileged position on the high street. Historically, a place on the high street gave an advantage to the shop owner, and consequently the business rate levy reflected that. The ability of supermarkets to provide a delivery service direct to the door has undermined that advantage, and in many cases, despite the modern reach of supermarkets as a result of home delivery services, the supermarket pays relatively less in business rates than the high street shopkeeper. In fact, in St Ives, business rates for some supermarkets reduced this April.
To add insult to injury, rents in St Ives town are being pushed up by the perceived popularity of this iconic place. This year, because rate charges relate to rental values, independent business owners have seen their business rate charge rocket. Traditional retailers, such as bakers, butchers and grocers, face the risk of closing after decades of trading. High street chains move in, and ironically the very thing that drives visitors to St Ives is being lost, partly because of what I believe is a flawed business rate system.
Could it be that the cost of running a high street business, including a business rate charge, means that a greengrocer can no longer compete with a supermarket 20 miles away, now that it can deliver groceries to the family living in the flat above? Surely a modern-day business tax should recognise such changes in consumer behaviour. Furthermore, business rate charges take no account of external factors such as high parking charges, poor upkeep of the local area, closure of local public toilets, or a downturn in the economy, most of which have been experienced in Cornwall in recent years.
I have worked hard with a number of business owners who have found the business rate system profoundly challenging. That group includes a local pub owner, who came to the trade recently, full of enthusiasm. The pub employs 14 locals and is a focal point for the community. A rate review means that the pub now faces a 280% increase in business rates, which equates to an extra £13,000 a year. I recognise that the Government have done some work, and Cornwall Council is also doing some work, to help with that, but the fact remains that that rural pub owner’s rates have increased by 280%. As rural pubs close around us and communities are losing their rural services, issues such as this are hardly encouraging to new entrants.
Another major drawback is that business rates hinder aspiration. Should a small business benefiting from full rate relief wish to take on a second property, expanding both the business and the workforce, it will lose its rate relief and pay rates on both the new and the existing outlet. That step change discourages growth and innovation, and stifles all the benefits that growth brings, including job opportunities, staff training and career progression. That is hardly the intention of what I believe is a small business-friendly Conservative Government.
Before moving on, I want to stress the potentially unique role that traditional independent retailers such as bakers, butchers and grocers have in looking out for vulnerable people in the community—for example, the elderly. That is reason indeed to consider the potentially devastating impact of an outdated business rate system.
Finally, I would like to address the Government’s Making Tax Digital plan. I am in favour of moving across to digital tax reporting and I recognise the Government’s ambition to move to a fully digital tax system during the next few years. Will the Minister ensure that SMEs, including sole traders, have easy access to reliable software and training? Have the Government considered that for some businesses, a transition to digital-only tax will present a further serious administrative and financial burden? Strange as it may seem, there are still significant numbers of traders who are not naturally acquainted with online activity. I am reluctant to single out individuals, but I have met a number of sole traders who are not tech savvy, and the idea of making tax digital fills them with dread.
At present, I can see that there may be a benefit to Her Majesty’s Revenue and Customs in making tax digital, and I know that the Government are making allowances for areas of poor digital connectivity and plan to exempt some on very low self-employed incomes. Can the Minister please ensure that those exceptions are properly supported by accurate data, so that those who are not yet in a position to take part in the brave new world of digital tax reporting will not be unfairly penalised or discriminated against?
In conclusion, I believe that the Government could send a clear message that Brexit does not mean that important domestic priorities are being left on the back burner. The Government can do that by ensuring that small business growth is not stifled by out-of-date and grossly unfair tax systems. Taxation must promote growth so that, as a nation and within our communities, we can maximise all the benefits that a vibrant economy brings. As changes in consumer behaviour and better digital services lead consumers to gravitate towards online shopping and supermarket home delivery, we must ensure that the Government have a fair system of taxation and make changes to unlock the potential of our country’s entrepreneurial small businesses.
The Government must recognise that the negative impact of business rates and the profit hit from VAT registration often go hand in hand. Both taxes kick in at the crucial point when an enterprise is on the cusp of growing to a size at which it can be of useful benefit to the local economy and community. Will the Government please consider scrapping business rates once and for all, in favour of a tax that reflects the economic activity of all businesses concerned? Will the Government explore opportunities to raise the VAT threshold in coastal and rural tourist areas, and will the Government continue to listen carefully to those who recognise the move towards digital tax reporting but ask that we approach it with caution and understanding?
It is a pleasure to serve under your chairmanship, Ms Dorries. I am grateful to my hon. Friend the Member for St Ives (Derek Thomas) for bringing this matter to the House’s attention. It is an incredibly important subject.
Like a number of hon. Members in the Chamber today, I came to the House having run a business. Not only was I involved in running businesses, but more importantly, I grew up—indeed, spent most of my life from the age of four—involved to a greater or lesser extent in a family business. Having seen a business founded and run from a kitchen table and known that the roof above your head was on the line when the cash flow was short or times were difficult gives you a respect for small business people and entrepreneurs that never leaves you. That helped to forge my politics and make me a Conservative, because it is the Conservative party that has always respected small business and sought to use what levers we have, including the tax system, to incentivise small business people and entrepreneurs, to reward enterprise and to focus enterprise on the things that really matter, not just for them but for the benefit of everyone—the whole of society. I am talking about innovation, research, development and building a vibrant economy that works for everyone.
I want to talk about a few of the tax changes that have been made since the Government first came to power in 2010, which I know, from the small businesses that I speak to in my constituency, and from talking to the businesses that I have been involved in and even my own family business, have made a huge difference. There are the obvious ones to the headline taxes that we have made such a big issue of over the years. I am thinking of the reduction in corporation tax, which has fallen to 19% and will fall again to 17%. That is an incredibly important, landmark reduction in taxes that affects, of course, big businesses and corporations, but also small businesses that prosper—the directors, founders and shareholders want to see a reward for their hard work. That tax would go up under Labour. The Labour party’s manifesto, or the small print of it at least, said that the small profits tax—for those below £300,000—would rise to 21% in 2020-21.
Capital gains tax is another tax that we have reduced. We increased it initially, at the beginning of the coalition Government, and then accepted that we had made a mistake and brought it down again. We have not brought it to as low a level as applied under the last Labour Government, but we have brought it down, which benefits businesses of all kinds. I would be very concerned if a change in Government led to its rising again.
However, taxes that get far less publicity in the main political debate are perhaps my priority. I am talking about those that, in the long term, benefit innovation, investment and research and development. The most obvious one that I have seen succeed is the research and development tax credit. That tax credit enables businesses large and small to claim back against profits, following the latest development, an extra 130% of their qualifying costs. That was on top of the 100% that we had had in the past, meaning a 230% tax credit for research and development by a business. In fact, there is a tax credit even if there is a loss by that business. That is incredibly generously defined and implemented by the Treasury, particularly for small businesses. Businesses involved in manufacturing—like the business that I have been involved in, through my family, for many years—with a high research and development capability, can usually see tax bills as low as 10%. In fact, it is unusual for a business like that—an SME manufacturing business—to have a tax bill above 10%. That is incredibly important because those are the businesses that, across the House, we care about and want to succeed in this country.
The patent box regime introduced by the last Chancellor of the Exchequer for corporation tax relief is incredibly important. It has led to tax reductions for all businesses that develop new products in manufacturing, software and other areas, and has been generously defined so that SMEs can access it and benefit from it without needing the finest lawyers or tax accountants. The innovative businesses that we want to prosper in our constituencies would struggle to pay more than 10% tax as a result of corporation tax, R and D tax credits and the patent box regime. I am concerned that a future Labour Government would abolish those incredibly important reliefs. Will the shadow Minister, the hon. Member for Bootle (Peter Dowd), comment on the Labour party’s position on the reliefs that businesses the length and breadth of the country rely on?
Entrepreneurs’ relief has increased the lifetime limit on gains for entrepreneurs, which I think was £1 million when we came into government, to £10 million—a lot of money to almost anyone, and certainly to people in my Nottinghamshire constituency. Entrepreneurs of any scale can use that relief to ensure that their lifetime’s hard work—the business that they have built up—can be used for their pension or passed on to the next generation. Someone who owns a business, whether it is a highly successful tech business worth tens of millions or a florist’s in Newark that they have devoted their entire life to, can be sure that when they sell it, they will gain the benefit. Enterprise and hard work have their reward. Above all, the entrepreneurs we care about most in society—the ones who do not take out the profits but reinvest them in their business—can have the confidence that they will be able to use that business in retirement as their pension or nest egg. I ask the shadow Minister what the Labour party intends to do about that relief.
For seven years, we have worked hard to close loopholes that were exploited by private equity and others to direct those funds to people that none of us in this House would want them to go to. We want to ensure that genuine entrepreneurs have the confidence not to take out money from their business, which they could easily do when it becomes successful, but to continue to reinvest it and to ensure that that business succeeds. Reinvestment involves employing more people, expanding, creating new opportunities and driving the economy forward. We should be proud of entrepreneurs’ relief and promote it to entrepreneurs, whatever the size of their business, in our constituency.
Although we have cut corporation tax to the lowest level imposed in any major developed economy, the level of business property taxes is still among the highest in the OECD, as we heard from my hon. Friend the Member for St Ives. I agree with him about the effect of business property taxes, not just on the obvious business owners, such as shopkeepers in the small market towns of Newark and Southwell, but on start-ups; on businesses that need a workshop or retail outlet before they build a presence online; on offices; on manufacturers who want factory space; and on businesses making their first expansion by purchasing new sites and renting new premises. Those businesses suffer most from this, and the Treasury should do further work to understand how we can move into the 21st century. Business is going online and we need a level playing field.
All these lower taxes for businesses are in the debit column, but there are some items in the credit column. The introduction of the national living wage means that small businesses must pay their staff more and make pension contributions. There are enhanced benefits; most recently, the Government announced extra bereavement leave. All these policies have almost universal support in this House. I support them all. Most small business owners want their workers to be treated well, paid the living wage, and so on. However, the policies have put pressure on small businesses, particularly in constituencies such as Newark that have high numbers of catering businesses and small retailers.
There is a fine balance between the pressures that important social changes have brought to our small businesses, and the policies that this Government have introduced, and that we support. If we want to ensure that the living wage continues to rise and working people are better supported, we need low taxes on the other side—corporation tax, capital gains tax, entrepreneurs’ relief, the patent box regime. We need the balance to work in favour of entrepreneurs and risk-takers—the businessmen and businesswomen of this country. That is why we should be deeply concerned about a Labour Government, who would not only follow our lead on social reform and treating workers as they should be treated, but risk diminishing and undermining the tax reforms and reductions that small businesses have come to rely on. That would put the enterprising people of all our constituencies at great risk. Enterprise should have its reward. I believe the Conservative party will always provide that reward for the hard-working constituents we represent.
It is a pleasure to serve under your chairmanship, Ms Dorries. I welcome the chance to speak in this important debate, which I congratulate my hon. Friend the Member for St Ives (Derek Thomas) on securing. I declare at the outset my chairmanship of the all-party group on small and micro business, and my practice at the Bar, both of which have a clear bearing on the debate. I also refer hon. Members to my entry on the Register of Members’ Financial Interests.
There is no doubt that small businesses are the drivers of our economy—the agile, risk-taking job creators. It is no exaggeration to say that they are the very fabric of our society. That is never clearer than when I walk around my constituency of Witney and west Oxfordshire and see many hundreds of brilliant examples of small businesses that have started from scratch in small premises. As my hon. Friend the Member for Newark (Robert Jenrick) says, many of them start around a kitchen table. I recently launched the West Oxfordshire Business Awards, at which I saw some fantastic examples of such businesses. They make the importance of small business crystal clear.
It is essential that we continue to work towards a low-tax economy. I entirely concur with my hon. Friend about this Conservative Government’s attitude to support for small businesses and the low-tax economy they have fostered. I thank them for it. There is no doubt that the burdens of taxation on small businesses are significant: it is estimated that they spend about £3,600 per year and three hours per month on administering the tax burden and complying with its obligations. It is incumbent on us to reduce those obligations to as limited a level as realistically possible. The chief culprits are VAT, corporation tax, income tax and PAYE.
Making Tax Digital is a key plank of the Government’s agenda. I freely confess that when I practised at the Bar before being elected to Parliament, I did not hugely look forward to filling in my annual tax return or my quarterly VAT return, so I was not wildly enthusiastic about the prospect of doing either more frequently. Setting aside that immediate reaction, once the system has bedded in and people have got used to it, it will clearly make it easier in the long run for small businesses and microbusinesses—as well as sole traders like me—to do tax returns online and more frequently, rather than in a massive chunk at the end of the year.
I welcome Making Tax Digital, and I think its benefits need to be explained to all businesses, but I ask the Government to ensure that complying with it is not an onerous burden for small businesses. Chief among my concerns are training and software. I make a plea that the software be fully tested before digital taxation is rolled out, so that it works smoothly and unintentional difficulties are not introduced. I also applaud the amended timetable that was laid out in July; I think it was the Minister who is here today who did that. Clearly the Government have listened to some of the concerns that have been expressed by small businesses and that amendment will assist them greatly.
I welcome the national living wage and the start of auto-enrolment for pensions. Those measures have done so much under this Conservative Government to help the lowest paid in our society and to ensure that people have planned for a successful, safe and financially secure retirement; they are much to the Government’s credit. However, there is an impact upon small businesses, especially those with lower margins and those for whom the staff costs—childcare, social care and so on—are particularly high.
I ask the Government and the Minister just to consider whether they might be able to support employers further by looking at increasing the employment allowance, simply because that is something that companies tend to use to put into investment in technology, hiring more staff or raising wages. The small business community would welcome such an increase.
It would not be right for me to make a speech in this debate without mentioning business rates, which of course are a major concern to many small businesses. Again, when I walk around my constituency—including the streets of Witney, Burford and Chipping Norton—and see the wonderful small businesses that are so unique, I am reminded how important it is that we never reach a situation in which we have identikit high streets and essentially the same chains populating towns.
I thank the Government for having listened to the concerns expressed earlier this year with regard to the discretionary relief fund—the £300 million that was produced and given to local authorities. I pay tribute to my council, West Oxfordshire District Council, which is well on its way to distributing the help that has been given by central Government to local Government. I would like to make it quite clear at this stage that there is good evidence in Witney that that help has made a real difference and saved some businesses that might otherwise have been unable to cope. So, as I say, I thank the Government for that.
However, I have some concerns about the administration that is involved in any business rates system, particularly with regard to the valuation office. A constituent has been locked for four years in an unresolved dispute over the valuation of their property. The layers of bureaucracy, which are confusing enough for those of us who regularly deal with these matters on a casework basis, are particularly challenging for small businesses. I would like to see a quicker and more efficient appeal process for the purposes of business rates valuation.
I will just say a few words about the online environment, which I know the Government are working on. An incredible world exists for us now. When we are sitting here having made our speeches, we can order things online—all sorts of products from all over the world. Gone are the days of needing to visit another country to get their products; we can get their products brought here to us. That is extraordinary but there is a real issue when small businesses, such as those I have referred to, that are trading from brick and mortar premises are up against large companies that are not paying the same business rates because of their obvious lack of such a physical presence. It is very difficult to compete against those companies, and likewise against the larger multinationals or nationals who can more easily absorb the costs, the bureaucracy and of course the taxation that is involved. I know that the Government are aware of that and that they are doing something about it; I simply flag it as something that is very important for small businesses.
We must also remember that there is an element of choice for consumers, and that it is incumbent upon all of us to spread the word among our constituents about the brilliant small businesses that we have in our local area. In my constituency there is a great local bookshop in Woodstock. Well, if we want to have that shop, or the florist in Witney, we need to go in there and buy things, and not buy everything from Amazon. Those shops need to be there and we need to support them and actively make that choice. And let us not forget what such shops can give, because there is the real customer service—the care and dedication—that one gets from businesses that their owners really feel about, when they have set them up from their own kitchen table and grown and sustained them through their own blood, sweat and labour.
I will conclude by saying that as we leave the European Union we have an extraordinary opportunity to make Britain the most business-friendly environment in the world—the best place to start the small businesses that really are the lifeblood of our local economies. I am entirely confident that that British entrepreneurial spirit will ensure that we continue to thrive outside the European Union and make the most of those global opportunities that are there for the taking.
However, we all need to continue to ensure that we have the business-friendly environment that encourages and unlocks the talent that we have, which means a low-tax and low-regulation environment, to make sure that our local businesses not only continue to survive but continue to thrive. I know that is the case under this Conservative Government, and I applaud all activities in that regard and in that direction.
Thank you, Ms Dorries, for calling me to speak in this debate and, indeed, for your generosity in doing so after I was a couple of minutes late in arriving.
I congratulate my hon. Friend the Member for St Ives (Derek Thomas) on bringing this matter forward for debate. I took great interest in his comments about business rates. I cannot say a great deal about business rates, because they are a devolved matter in Wales and it would not be appropriate for me to speak about their effect in Wales here in Westminster. However, I must say that the dramatic changes in terms of revaluation really have put the most horrendous pressure on some of the most important businesses in my constituency.
The one issue that I will raise today is VAT on tourism. It is not a new issue; it has been discussed many times before. However, I want to make sure that it stays on the Treasury’s to-do list, so I have come along to this debate to talk about the impact of that tax on small business.
In Montgomeryshire, and I am sure in most rural areas of Britain, tourism is a massively important industry and a hugely important part of the local economy. Very often, the competition to an area such as my constituency is from overseas. In a lot of overseas countries, which people can choose to go to for their holidays or to visit for a day or a week, the level of VAT is much lower than it is here. The differences might be measured in relatively small amounts of money, but the point is that it is competition and other countries can advertise by saying that they have a lower level of VAT than Britain. The impact of our level of VAT is negative and it is particularly damaging to rural areas that depend on tourism.
As for my constituency, a lot of people know about Powis castle, Lake Vyrnwy and the Lake Vyrnwy hotel, which is a huge attraction, as well as the Montgomeryshire canal and the Welshpool to Llanfair light railway. Those things are why people come and very often they are the reason people come to Montgomeryshire to set up all sorts of businesses. The point that I am making is that tourism is massively important to my constituency, and I am sure that the same is true of every other rural part of Britain.
As I have said, the issue of VAT on tourism, which is at 20% in Britain, has been under discussion for many years and addressing it has been very much part of the work of the all-party group on the tourism and hospitality industry in Wales. Lowering it is one of our major campaigns and has been for a long time. The ambition is to make certain that VAT on tourism is not forgotten. Addressing this issue needs to be part of the Treasury’s considerations.
It would be very enjoyable for me if the Minister stood up today and said that in the Budget in November, the Chancellor will say that he is contemplating a cut in VAT on tourism, but I am not absolutely sure that that will happen. However, it is important that we keep this issue as a consideration for the future. I know it is not a straightforward issue, and that there may well be administrative costs and that we could be accused of having different levels of VAT. We need to know what the benefit to businesses would be of lowering VAT on tourism. Instinctively, we believe there will be a benefit when the competition is lower, but we need to know what that benefit might be.
What I am asking for more than anything else is that the Treasury keeps this issue under consideration, and that we have a proper understanding of and a continuing inquiry into what the benefits of any VAT cut would be, because as we leave the European Union, the freedom to take decisions relating to VAT will change things; it will give us a lot more freedom. Something that I would like to do as a celebration of our leaving the European Union and the ensuing freedom that we will have to vary our VAT is to announce that we are either removing or greatly reducing VAT on tourism in Britain. The economic benefits of doing so would be huge and I hope that it is something the Treasury will keep under consideration.
It is a pleasure to be called so early in the debate this afternoon, Ms Dorries. I thank the hon. Member for St Ives (Derek Thomas) for securing such an important debate. He spoke passionately about constituency interests and local businesses that are affected.
The hon. Member for Newark (Robert Jenrick) presented his personal experience of tax on SMEs and talked about the importance of supporting innovation and enterprise, which I will talk about a little. The hon. Member for Witney (Robert Courts) talked about what he saw as the opportunities presented by Brexit. I do not necessarily share his optimism for the next couple of years, but we will see what happens. Time will tell on that one. As far as I am concerned, it is important to reinforce that Brexit is a real threat to small business, and we should do everything we can to avoid a hard Brexit. I know from speaking to trade organisations across the UK that their members are genuinely worried about what Brexit—or, even worse, a no-deal Brexit—will mean for their small businesses.
The Scottish Government recognise the importance of SMEs and are taking action to support them with initiatives such as the £500-million Scottish growth scheme to target high-growth, innovative and export-focused SMEs, which will clearly need as much support as they can get after March 2019. In June the Scottish Government announced the first tranche of the Scottish growth scheme, aiming to stimulate more than £200 million of investment to help small businesses grow, and they will make a further investment this year. Alongside additional private sector investment, we expect that to provide more than £100 million to innovative, high-growth companies. Scottish Government funding for new business research and development projects is also increasing, with an additional £45 million being invested over the next three years.
Various Members have mentioned VAT on tourism. The hon. Members for St Ives, for Montgomeryshire (Glyn Davies) and for Strangford (Jim Shannon), who has left the Chamber, mentioned the tourist tax. I have just come from the Royal National Mòd, which is being held this year in Lochaber around the Fort William area. The area is the outdoor capital of the UK, and definitely of Scotland. The area is poised and ready for expansion. The opportunities for tourism are unique. Ben Nevis is on its doorstep and there are all sorts of activities available from white-water rafting to low and high-level walking. One issue that crops up time and again is VAT on tourism. If that could be brought into line with other EU countries, we could see much greater investment and real expansion in the area.
Business rates were mentioned by most Members. The Scottish Government’s small business scheme has removed the rates burden entirely from 100,000 premises across Scotland and we will urgently take forward the Barclay review recommendations on non-domestic rates. More than half of our rateable properties are paying nothing this year, and more than 70% of Scottish properties are paying the same or less in 2017-18 than they did last year. That is making a difference to small businesses across Scotland. Additionally, all rate payers in Scotland have the right of appeal against the independent assessor’s determination of rateable value, which is free to do in Scotland, unlike in the rest of the UK.
We believe a simplified tax code would pave the way for a significant boost in tax yield. The UK has one of the most complex tax codes, which is often guilty of creating an uneven playing field for our businesses and workers, as well as creating loopholes that disproportionately aid and assist the wealthy and powerful. The hon. Member for Witney talked about the amount of time that had to be spent on completing tax returns, which is a big issue for small businesses.
We broadly support the transition to digital taxation, but we have a series of concerns regarding its implementation, particularly for small businesses and specifically around the impact of digital taxation on low technologically advanced businesses, businesses in rural areas with restricted access to the internet, and small businesses generally that perhaps do not have the skills required to deal with it.
As we face Brexit and the challenges that that will pose for our small business community, the UK Government must do more to support small businesses, which are the backbone of our economy, and I urge the Minister to look seriously at the issue of VAT on tourism that has been raised by several Members this afternoon.
It is a pleasure to serve under your stewardship today, Ms Dorries. I thank the hon. Member for St Ives (Derek Thomas) for initiating this important debate. We all recognise that small businesses are the backbone of our economy. Most of us have a family member involved in a small business. They might work for or own a small business, or they might be a partner in a small business, so I would not like people to get the idea that the Labour party is distanced from small business. We are not; we are right in the heart of the small business community. The question is whether the Government have neglected the needs of small business in favour, for example, of tax breaks to big business that has failed to stimulate investment and create the high-skilled, well-paid jobs that the country needs. We have record employment but, as I have said in the past, the issue is not just about the quantity of jobs but the quality. I do not demean the number of jobs that have been created, but there has to be a balance.
Under the Conservatives, productivity trails behind our international rivals and British businesses are struggling to recruit the skilled workers they need. The Government have failed to invest in the infrastructure that businesses depend on and have presided over what amounts to a skills crisis. The approach we have seen from Ministers on business rates revaluation is only one example of the chaos at the heart of the Government. Their approach to business rates revaluation has created a huge and destabilising burden for many businesses, with many facing a substantial and unfair increase, which other Members have alluded to. Discretionary funds are helpful, but they do not solve the underlying problem. All that is in advance of the issue that the continued uncertainty around the Government’s approach to Brexit negotiations is creating in the UK business community, whether small or large.
Such uncertainty has led many businesses to delay investing in their people or capital, which is having the unintended effect of undermining the economy’s long-term prospects. No wonder optimism among small firms and businesses has tumbled to its lowest level in the wake of the referendum and the unprecedented political and economic uncertainty that we face. What we do about it is a different matter, but that is what we face, and that is the environment that people and small businesses operate in.
According to the Federation of Small Businesses’ small business index, a majority of small and medium-sized businesses report that operating costs have risen compared with the same period last year. Labour costs are up, taxation is up and rent is up, and all are frequently mentioned as problems. On top of that, the Government are out of kilter—I will go no further than that—in relation to Making Tax Digital. Stakeholders, including tax experts and accountants—we have discussed this previously—have queried the Government’s implementation date as well as the added cost that will be passed on to small and medium-sized businesses. I take the point made by the hon. Member who said, “You get used to it,” but to be fair, at what point do you have to get used to it?
What we might call the U-turn, or about-face, that the Government made during the summer, under the Minister’s auspices, scaling back plans for Making Tax Digital, was welcome. It pushed back the implementation date to 2019, ensuring an exemption for small businesses below the VAT threshold, and ensuring that businesses do not have to submit quarterly tax returns just yet. I do not criticise that; it is welcome. However, despite that volte-face there is still, in our opinion and that of many others, an impact on small businesses; an example is the unrealistic 2019 implementation date for Making Tax Digital for VAT. That date would mean that SMEs were expected to deal with the added costs and complications of digitalising their tax returns at the same time as having to deal with the added costs of Britain’s leaving the European Union. The hon. Member for Montgomeryshire (Glyn Davies) thinks that is a good thing and he is entitled to his opinion, but that is not necessarily everyone’s view.
There is also huge uncertainty over whether businesses and HMRC will be ready to implement Making Tax Digital by 2019, and we must take that into account. Perhaps the Government’s implementation timetable has more to do with the lacuna in the public finances. I do not know; I pose the question. According to HMRC, Making Tax Digital will raise £2.1 billion for the Treasury, although the Minister may tell me that that is not the correct figure. That money has probably already been spent; whether it is raised is a different kettle of fish. That is another factor for small businesses to take into account.
The truth is that the Conservatives are not the only party for small businesses. In fact, one could argue that in the past few years they have rewarded larger companies with tax cuts at the expense of SMEs. As to tax avoidance, over the past month we have seen the same story play out, first with eBay and then Amazon. We have heard about small stores in villages having to compete in the face of non-collection of huge amounts of tax from the likes of Amazon, which avoid their fair share of tax or run rings around HMRC. That affects small businesses because they pick up the tab.
I have been listening with growing disbelief to the hon. Gentleman’s running commentary of doom on our approach to business. He mentioned tax avoidance, but does he recognise that since 2010 we have, through our measures against avoidance, evasion and non-compliance, brought in £160 billion? We have reduced the tax gap—the amount of tax that should have been collected but has not—to 6.5% of tax. That exceeds any year when his party were in government.
I am pleased that the Minister has brought that to my attention. I bring to his attention Labour’s tax enforcement programme, as well as our manifesto, “Funding Britain’s Future”, and our industrial strategy. I am sure that the Minister has read those avidly and will no doubt revisit them.
SMEs find it increasingly difficult to operate around the tricky and ever-changing tax law while HMRC has been directed to crack down hard on them. The likes of Martin McTague, policy director at the Federation of Small Businesses, recently accused HMRC of going for the soft underbelly by tackling SMEs over tax avoidance and evasion rather than showing the same energy in confronting larger companies, and arguably, by underfunding and not resourcing appropriately.
Will the hon. Gentleman answer the point that I made in my remarks about why the Labour manifesto included an increase in corporation tax for small businesses? If it cares about small businesses rather than large ones, why increase business profits tax for them?
I suggest that the hon. Gentleman reads the totality of the document, about the whole environment in which small businesses would operate. It is not a question of one element, but the total environment. That is the point I am trying to get across. It is not one specific thing, such as tax for small or large businesses, but the complete environment in which businesses must operate that we must consider. The current environment is not the most conducive to business for SMEs, in my humble opinion. That is my view; Members may agree with it or not.
We are committed to putting small and medium-sized businesses at the heart of our economic policy. We value them.
To pursue the point a little further, I understand that the Labour party’s policies are to put up the corporation tax rate to 26%, whereas we are going down to 17%. The difference is a huge gulf—a huge additional tax burden on British businesses. Has the hon. Gentleman’s party conducted any analysis of the impact that that huge hike in taxation is likely to have on jobs, wealth creation, taxes and our ability to fund our public services?
The hon. Gentleman, from a sedentary position, asks for the answer. We are here for the Government to defend their record, not for a defence of what Labour’s record will be. [Interruption.] It is okay for Members to laugh, but the bottom line is that the economy is in chaos. Only yesterday the OECD effectively said that the Government should rethink their position on corporation tax. That is not coming from me; it comes from our partners elsewhere.
We want to support small and medium-sized enterprises. I have made the point that it is ridiculous to suggest that they are somehow a foreign land to the Labour party. The country needs, and we have set out, proper investment in the economy and skills and increased productivity. We believe that small businesses can play a part in investment, in a rise in productivity and in helping with skills shortages; but in turn it is our responsibility to help them. I am not sure that they are getting the support they need.
It is a pleasure to serve under your chairmanship, Ms Dorries. I thank my hon. Friend the Member for St Ives (Derek Thomas) for securing this excellent debate. I recognise the extraordinary passion with which he has always prosecuted the argument for the importance of small business, not least in St Ives. As a fellow west country Member of Parliament, I am grateful for all that he has done to fly that flag over the years.
I have sat with growing incredulity as the shadow Minister, the hon. Member for Bootle (Peter Dowd), for whom I have a lot of personal respect, has set out Labour’s stall as the party for business. Apparently it is not the Conservatives, a number of whose Members are here for this important debate, who are the party for business, but the Labour party, represented just by the shadow Minister, who of course needs to be here, unlike his absent colleagues who chose not to be. I think that says a great deal. The hon. Gentleman referred to the chaos presided over by the Government. I am afraid I simply do not recognise that suggestion. The economy has been growing for the past four years. We have more people in employment than at any time in our history, we have the lowest level of unemployment since 1975 and we have slashed the deficit by three quarters. That is not the hallmark of a Government who are in economic chaos.
To move on to the question in hand—the importance of small businesses, and particularly taxation of small businesses—I want first to recognise the huge contribution that they make to the economy. I thought my hon. Friend the Member for Newark (Robert Jenrick) quite movingly described his early years when, sitting at the family table, he realised that every pound mattered. I think the expression he used was that the roof of the house was at risk, in some sense. I recognise, having had a similar background and watched my parents and family go through a similar experience, and having created a business myself and done the same, that we owe a huge debt to the 5 million small business people who do what they do day in, day out, and who often worry about it greatly.
Small businesses are delivering. Small businesses are generating 48% of private sector employment. About a third of private sector turnover comes by way of small businesses. The benefits are not just there for those involved in small businesses; they are there for us all and for society. Small businesses pay the taxes that in turn pay for public services, for the doctors, nurses and paramedics and for the army, police, fire services and so on—all the things that are the hallmark of a civilised society. We owe them a very large debt.
When we talk about job creation, wealth creation and taxation, it is important to recognise that it is not government that does those things, but it is government that sets the environment. The Government can pull the levers that make it easier, or sometimes get in the way and make it more difficult to achieve particular outcomes. I would like to focus on some of the things we are doing.
First, outside the tax sphere, we have the British Business Bank, which has facilitated £9.2 billion in finance. Lending through the bank was up 24% on the previous year. We are channelling money into commerce. We have the StartUp loans programme, from which 50,000 entrepreneurs have benefited, and those are individuals who typically cannot go to family for the funding required. It is small amounts of money, but they have the get-up-and-go and the desire to make something happen in the business environment. We have the enterprise finance guarantee scheme, which has driven £2.9 billion of investment in business to date. Most of those guaranteed loans—I think they average a little over £100,000 each—are going into the small business community.
We have done a huge amount on the tax front. Many Members have raised some of the issues in the debate this afternoon. Corporation tax was 28% when we came into office in 2010. It is now down at 19%, and we made a manifesto commitment for it to head down to 17% by 2020-21. That is a huge drop in taxation. For those who are self-employed and unincorporated, the personal allowance has risen dramatically since 2010 to £11,500. It is heading further up to £12,500, taking 3 million to 4 million people out of tax altogether. Once again, that is us assisting those in business not operating through a corporate or company structure.
The employment allowance was mentioned. It is an allowance of £3,000 for anyone employing somebody. If someone has four workers on the national living wage, which my hon. Friend the Member for Witney (Robert Courts) rightly lauded, they would be paying just £30 in national insurance. That is huge assistance for the smallest companies and for generating jobs.
Entrepreneurs’ relief has been much spoken about. It increases the lifetime allowance to £10 million so that the capital gains tax for entrepreneurs when they sell shares in their businesses is just 10%, rather than 20% or potentially 28%. The new state pension has not been mentioned. It started in 2016 and benefits the self-employed to the tune of £1,900 a year.
We are making a number of important changes that support business, but I want to turn specifically to a few of the contributions to this afternoon’s debate. My hon. Friend the Member for Newark shared his personal experiences with us, for which we are grateful. He talked about the high importance of low taxation, tax support for research and development, the patent box and entrepreneurs’ relief.
My hon. Friend the Member for Witney is passionate about business. I was interested to hear about his West Oxfordshire Business Awards, which he has done a great deal to promote and encourage. He welcomed the new timetable for Making Tax Digital, which is an example of our listening to the business community. He welcomed the employment allowance and suggested we increase it. I will take that as a Budget representation from him. I noted his comments about appeals and the valuation office. If he would like to meet me or write to me—not so much about the specific case he raises, because it would not be appropriate for me to get involved in that—about the principles that that case throws light on, I would be interested to take that up on his behalf.
My hon. Friend the Member for Montgomeryshire (Glyn Davies) raised the importance of VAT and its interconnection with tourism. He is right, and once we have left the European Union we will have greater latitude to make changes there. It is probably a big debate for another time, but I understand the points he made so strongly.
The hon. Member for Glasgow North West (Carol Monaghan) highlighted the uncertainties of Brexit and the difficulties it might cause. We were in a metaphorical sense around the same side of the table on that debate, because I campaigned to remain, but I say to her that the British people have taken their decision. It is beholden on us all to be positive and upbeat and to seize the opportunities. We need to look for the bright sky and not dwell on any lingering doubts that we might have. I say to her that ironically, one of the great opportunities will be for us to take control of some of those tax areas, such as VAT, as we go forward after leaving the European Union.
The hon. Lady raised the issue of Making Tax Digital and its accessibility in rural areas where broadband might not be as available as in other areas. There are provisions in the Finance Bill that I am taking through the House to ensure that those who are genuinely digitally excluded will be able to provide their information in a non-digital form.
I turn now to the specific points that my hon. Friend the Member for St Ives raised. The Government recognise that accounting for VAT can be a burden on small businesses. That is why we maintain the highest VAT registration threshold in Europe, which increased to £85,000 in April 2017. That keeps more than 3 million of the smallest businesses out of VAT and costs the Exchequer around £2 billion a year. The case for change has been regularly reviewed over the years, and views on the threshold are divided. While some businesses have argued that a higher threshold would reduce administrative burdens, others contend that a lower threshold would provide a fairer competitive environment, and that the current threshold incentivises some businesses just below the threshold to limit their recorded turnover and creates unfair competition between businesses operating above and below the threshold. The Government have therefore asked the Office of Tax Simplification to consider the registration threshold as part of its current review of VAT. The final report is due to be published in early November and we look forward to hearing its recommendations.
I recognise my hon. Friend’s concerns about the fairness of business rates, but the Government do not believe there is a case to scrap the system entirely. The objective of business rates is to raise revenue to pay for key local services. The Government concluded a fundamental review of business rates at Budget 2016 and the consensus was to maintain them as a property tax. Respondents agreed that property-based taxes were easy to collect, difficult to avoid and had a clear link with local authority spending.
Some evidence was provided that suggested that changes were taking place in the use of property. A number of hon. Members highlighted the shift away from bricks-and-mortar retailing towards greater online retailing. However, the overall picture was of changing patterns of use within different sectors, rather than a decline in property use overall. Although increased internet shopping might lead some larger retailers to rationalise their portfolio of physical property, some Members pointed out that that has led to increased demand for retail warehouses, and that new, more leisure-orientated businesses are now occupying traditional retail space on many high streets.
None the less, the Government recognise that business rates represent a high fixed cost for small businesses. That is why, in the 2016 Budget, the then Chancellor introduced an £8.9 billion package of measures providing support for all rate payers. That package included making the 100% small business rate relief permanent and raising the thresholds from April 2017. As a result, 600,000 of the smallest businesses will not pay business rates again. It also included raising the rateable value threshold for the standard multiplier to £51,000 from April 2017, taking a quarter of a million properties, including some high-street shops, out of the higher rate of business rates. All rate payers will also benefit from the switch in indexation from the retail prices index to the main measure of inflation. That represents a cut every year worth £1.1 billion by 2022.
Some small businesses are also eligible for rural rate relief, as has been mentioned. We are looking to revalue properties more frequently, and plan to look more broadly at the way in which we address the perceived unfairness of companies that operate in bricks and mortar being effectively treated differently from those that do not.
Finally, I turn briefly to Making Tax Digital, which represents a major step towards the Government’s objective of helping businesses to get their tax right first time. It is, however, a big change, and although it has received broad support, some stakeholders have voiced concern about the scale and pace of change. The Government have listened carefully to those concerns. In July, I announced significant changes to the scope and timetable for Making Tax Digital.
Businesses will not now be mandated to join Making Tax Digital until April 2019, and then only to meet their VAT obligations. Businesses with turnover below the VAT threshold will be able to choose whether to take part. The scope of MTD will not be widened before the changes are shown to work, and not before 2020 at the earliest. No business will have to file VAT returns more frequently than it does currently. Approximately 3 million small businesses that would have been mandated will have the flexibility of joining MTD at their own pace. I am confident that many businesses will recognise the benefits of a streamlined digital experience and will choose to do so.
Once again, I thank everyone for taking part in this important debate, particularly my hon. Friend the Member for St Ives. It has given us the opportunity to demonstrate the Government’s commitment to backing business wholeheartedly, as we will do going forward.
Unquestionably, since 2010 the Government have taken action to support small businesses and stimulate local economic growth. I am glad that the debate has provided an opportunity to remind the House of those measures. I am also glad that we have been able to discuss the introduction of positive employee support, such as the national living wage and auto-enrolment.
We are united in our desire to ensure that Great Britain remains open for business. Our desire is to make Great Britain a great place to run businesses, which is why my plea, on behalf of rural areas that are largely populated by small businesses, is to reform how we tax them. I thank everyone who took part in the debate. I apologise to the shadow Minister for what seemed to be quite an uncomfortable experience for him.
As we have heard, the business rate charge is hurting many independent small businesses. It is time to install some fairness into business taxation. I maintain that a tax system that reflects the activity of the business, rather than the building from which it operates, has to be fairer.
Question put and agreed to.
That this House has considered the effect of taxes on small businesses.
Capital Funding: New Hospital in Harlow
[Mr George Howarth in the Chair]
I beg to move,
That this House has considered capital funding for a new hospital in Harlow.
It is a pleasure to serve under your chairmanship, Mr Howarth, and I am grateful to Mr Speaker for allowing this debate. The Princess Alexandra Hospital was completed in 1966 to provide acute hospital and specialist services for around 350,000 people living in Harlow and the surrounding areas. Alongside others, I have been working hard for Harlow residents to improve healthcare services, so that they are fit for the 21st century. I have worked to secure extra funding and more doctors and nurses for our hospital, and the new leadership team work tirelessly to do everything possible to improve performance.
However, only so much can be done at the hospital as it stands. The infrastructure is deteriorating. The accident and emergency services are overstretched and staff retention remains a serious problem. It is for these reasons that I am putting forward the case for capital funding for a new health campus in Harlow, bringing together accident and emergency services, GP provision, social care, physiotherapy and a new ambulance hub—bringing healthcare in Harlow into the 21st century.
The Princess Alexandra Hospital is in special measures. It was judged as inadequate overall by the Care Quality Commission in 2016. It is important to note, however, that maternity and gynaecology were rated outstanding at the inspection. Day in, day out, a huge amount of remarkable work is done by the hospital leadership, the hospital’s chief executive Lance McCarthy, and above all the doctors, nurses and auxiliary staff, to provide the very best care they can.
I take this opportunity to thank and praise the health trade unions, led by people such as Councillor Tony Durcan from the nurses’ union, and Councillor Waida Forman and Daniella Pritchard from Unison, whose only aim, whatever our occasional political differences, is to improve the quality of hospital care and the services for their members. Much of this improvement work has been noted by the CQC. Its report, however, outlined various remaining concerns, from staff shortages to deteriorating mortuary fridges, some of which were no longer fit for purpose and were ordered to be repaired during the inspection.
This leads me to my first and most pressing concern. The Princess Alexandra Hospital is not fit for purpose. It is unable to provide healthcare fit for the 21st century and Harlow and the wider area. According to the CQC report in 2016:
“The environment was one of the top risks for the trust. The estate was aged and in need of repairs costing tens of millions”.
Much of the hospital is original and therefore over 50 years old. It has exceeded its useful life and much of the infrastructure is in a state of permanent decline. In addition to the original hospital built in the 1960s, a number of temporary structures have been added, many of which have now surpassed their 10 to 15-year lifespan. That creates a complicated design, with urgent care spread across the site.
A 2013 survey rated 56% of the hospital’s estate as unacceptable or below for its quality and physical condition, which puts the capacity of the hospital to care for those in need at serious risk. That becomes strikingly clear when we read and hear reports of sewage and rainwater flowing into the operating theatres.
The doctors, nurses, management team and support staff at the Princess Alexandra Hospital work so hard, every single day, but their working lives are made so much harder by the hospital’s deteriorating facilities. In addition to the ageing infrastructure, the services are under increasing pressure to provide care to residents in Harlow and the surrounding area. Changes to other local facilities have placed additional pressures on the trust’s capacity, resulting in occupancy levels running higher than 96%. That means that the Princess Alexandra is not only fundamental to the health and wellbeing of the growing Harlow population, but to a wider area, including parts of Hertfordshire and Epping Forest—it is very good to have my hon. Friend the Member for Hertford and Stortford (Mr Prisk) in the Chamber to ensure we get good health services in our area.
I congratulate my right hon. Friend and parliamentary neighbour on securing this important debate. Does he agree with me that in my constituency and his, ever since the previous Labour Government scrapped their plans for a new hospital at Hatfield, there has been a sense locally that somehow our area has been ignored for capital investment, and that is why his proposal is so sensible?
As usual, my hon. Friend makes a powerful point. I will come on to how changes in nearby hospitals have had a significant effect on the Princess Alexandra Hospital.
The emergency department in particular suffers. As the CQC reported last year:
“Long waits in the emergency department and capacity issues in the wards meant that patients were not always seen in a timely manner, with many patients in the emergency department breaching four hour and 12-hour targets.”
As I understand it, we have the highest A&E use of any hospital in England. The department struggles to deliver the national four-hour standard, achieving 72% for 2016-17. Having said that, the A&E department saw 10,628 more people in less than four hours last year than it did in 2009-10. This improvement is astonishing when considered against the changes to the nearby emergency departments and with attendance rates at the Princess Alexandra Hospital being 10% higher than the national average, at around 200 to 300 visitors per day.
Chase Farm Hospital near Enfield became an urgent care centre in 2013. The same happened at the Queen Elizabeth II Hospital near Welwyn Garden City in 2014. Urgent care centres only deal with minor injuries, while the Princess Alexandra Hospital deals with those plus major injuries, including life-threatening chest pains and head injuries. All major injuries and illnesses have been dispersed to surrounding emergency departments, and attendance at the Princess Alexandra Hospital has risen consistently.
My right hon. Friend is making an excellent and passionate speech about the needs of his community—a new town, just like mine. He is setting out the problems of decaying infrastructure against a backdrop of increasing population. Does he agree that, as new town MPs, we should be championing our hospitals at all times? They are the centre of our communities and cement our identity. Hospitals are something people are deeply attached to and they form so much of what the town is, whether it is the Princess Alexandra or the Princess Royal in Telford.
My hon. Friend has set up the all-party parliamentary group on new towns, of which she is the chair and I am pleased to be vice-chairman. We set it up because we have many of the same problems. Our towns were built at the same time and we have the same issues, whether it is to do with our hospitals or regenerating housing and our high streets. I thank her for the work she does on this and the way she represents her new town and her constituents in Telford.
As I was about to say, the hospital secured £1.95 million of emergency department capital funding in April this year, allowing significant building works to support the department’s work, including the expansion of the medical assessments base. That is coupled with an A&E-focused recruitment drive to take advantage of the new facilities.
That leads me on to staff recruitment and retention. While Harlow hospital now has 27 more doctors and 35 more nurses than in 2010, the vacancy rate in recruitment is a perpetual worry. The nurse vacancy rate for September stood at 25%. Staff vacancy rates were picked up in the CQC report in 2016, in which inspectors found that
“staff shortages meant that wards were struggling to cope with the numbers of patients and that staff were moved from one ward to cover staff shortages on others.”
The proximity of Princess Alexandra Hospital to London plays a major role and, although pay weighting is a factor, I have been told by the hospital leadership and Harlow Council’s chief executive, Malcolm Morley, who is in Parliament today, that career development is significant. Princess Alexandra Hospital must compete with Barts and University College Hospital in specialist training and career development. The retention support programme established career clinics and clear career pathways, but there is only so much that the hospital can do to compete with the huge investment and facilities at London hospitals. Harlow needs to be able recruit and retain staff. Recruitment is related partly to the future of the hospital itself and partly to the staff’s ability to develop their careers in Harlow. Of course, both factors relate to the hospital’s infrastructure.
I have tried to make sure that our NHS in Harlow is a top priority for the Government, and I have had many meetings with the Health Secretary and the hospitals Minister. I am pleased to say that they have visited our hospital a number of times, most recently in May, when the Health Secretary visited the Princess Alexandra Hospital to speak to the hospital leadership team about Harlow’s case for a new hospital. He spoke of
“the exciting proposals which are coming together to invest capital in upgrading these facilities, including the option of a brand new hospital.”
He also stated:
“These proposals are at an early stage but upgrading services on this important site will be a priority for a Conservative government”.
Following capital funding announcements for sustainability and transformation partnerships in July, I was informed that
“Princess Alexandra Hospital is still a real priority”
for the Department of Health
“and work is ongoing to take it forward”,
and that the Government are “on hand” to carry on helping to get the Princess Alexandra bid together. Given that the Health Secretary said that Princess Alexandra Hospital is a priority case, will the Minister say what the current budget is for capital funding and how it will be allocated to new hospitals, such as Harlow?
In autumn 2016, the Secretary of State requested that the PAH board, the local clinical commissioning group and local authority partners progress a strategic outline case. After considering a number of options,
“the SOC concluded that a new hospital on a green field site, potentially as part of a broader health campus, to be the most affordable solution for the local system”—
note the expression “most affordable”—
“and the solution that would deliver most benefit to our population.”
The health campus would bring together all the services required to ensure that healthcare in Harlow is fit for the 21st century: emergency and GP services, physio, social care, a new ambulance hub, a centre for nursing and healthcare training.
Having recently met the chief executive of the East of England Ambulance Service, I know that there has been a significant increase in the number of calls from critical patients who need a fast response. Harlow has four new ambulances but the development of a top-class ambulance hub would allow huge improvements in that area. The health campus could also act as a centre for degree apprenticeships in nursing and healthcare, bringing specialist training to the eastern region. It could build on strong links between the Princess Alexandra Hospital and Harlow College and capitalise on the new Anglia Ruskin MedTech innovation centre at the Harlow enterprise zone.
The health campus proposal has been supported by West Essex CCG, the East and North Hertfordshire CCG and the Hertfordshire and West Essex STP, which brings together 13 local bodies and hospital trusts. A joint letter has been signed by more than 10 councils, including Harlow Council, Epping Forest District Council, Essex County Council and the Greater London Authority.
Despite recognition from local authorities and Ministers alike, some NHS England officials—I stress the word “some”—suggest that a refurbishment would be more fitting than the development of a brand-new hospital, due to capital funding constraints. That solution is the equivalent of an Elastoplast—a short-term option that will do nothing to solve real, long-term problems.
Given the support from the Government and key organisations, we need to be sure that plans for a new hospital are not obstructed. Will the Minister give an assurance that NHS England and NHS Improvement will work positively with public, private and voluntary sector partners to progress the plans? A rapid strategic solution is needed, rather than a short-term fix.
The cost of the new campus model would be between £280 million and £490 million, depending on the type and preferred method of funding. The hospital leadership is looking at all the options to maximise public sector investment and bring together the public, private and voluntary sectors. Private investment will not involve any kind of private finance initiative contract. Instead, the leadership will focus on how the private sector works with the NHS and how the development can generate revenue flows through social care, for example. The development also raises the potential development of housing as a source of income and private investment. These are decisions for the future. When the PAH leadership looks at private investment, it will consider supported housing and similar options.
Moreover, Public Health England’s move to Harlow will create a world-class health science hub. Without exaggeration, once Public Health England has completed its move, Harlow will be the health science capital of the world, Atlanta aside. We must ensure that the Princess Alexandra Hospital is an important partner that benefits from and adds to that success. The creation of a health campus is vital not only for Harlow but for the surrounding area. The infrastructure of the campus would be fundamental to the vitality of the community and the economy of the entire region that the Princess Alexandra serves.
I have visited the Princess Alexandra Hospital many times. I defy the Minister to find more professional and dedicated staff, doctors and nurses. They work day and night to look after the people of Harlow and the surrounding area. I have seen the incredible work in A&E, intensive care and the maternity and children’s units. That is why I know that PAH staff are second to none. However, their professionalism and hard work will go to waste unless our hospital is fit for purpose. I know that the Secretary of State recognises that, given his numerous visits to the hospital and what he has said since. I know that the Minister himself recognises that, given his visit to the hospital this time last year. I know that all the key local authorities, neighbouring MPs and trusts are supportive. I urge the Minister to do everything possible to ensure that Harlow has a hospital that is fit for the 21st century.
Before I call Mark Prisk, he needs to be aware that adequate time must be allowed for the Minister to respond. If he does not appear to be finishing his speech in a timely manner, as I am sure he will, I will intervene to bring in the Minister.
Thank you for your guidance, Mr Howarth. I will do my best—the best a politician ever can do—to be brief.
First, may I say a huge congratulations to my parliamentary neighbour, my right hon. Friend the Member for Harlow (Robert Halfon)? He and I have worked together on a number of projects. I want to make the point to the Minister that this issue is of real concern to many of us, not just in Harlow, important though that is, but in east Hertfordshire. I mentioned the problems in years past in Welwyn Hatfield. There is genuine concern that our area as a whole has been denuded of capital investment. Given its growing population, which I will come to, that cannot continue. Importantly, there is a partnership in Harlow and its neighbouring areas among the health services, local government and communities.
My right hon. Friend is absolutely right to point out that the current buildings and facilities are ageing and inadequate. Although there are clearly practical operational challenges around the recent CQC report, it underlines a point that his speech brought out really well: given their state, the buildings and facilities are frankly no longer fit for purpose. We have all recognised that for some years, and I hope that the Department will recognise it too, in respect of both immediate and longer-term capital.
My right hon. Friend rightly pointed out that some have said, “Well, let’s tart it up—let’s refurbish the existing buildings.” I speak partly as a chartered surveyor. I have been around those buildings on many occasions and spoken to patients and staff. It is clear to me that, on that very constrained site, refurbishment is not practical. Indeed, it could prove very poor value for money for the Minister.
Let me come to my third and final point, which is to look ahead. My right hon. Friend rightly pointed out that this is an opportunity, but I say to the Minister that we have a rapidly growing population. Indeed, the elderly population is growing even more rapidly. In my constituency, the growth in the population of those aged 65 and over is three times greater than that of the rest. I therefore ask him to think about the present and to support the changes as strongly as he can.
It is a pleasure to serve under your chairmanship, Mr Howarth. You have chaired the debate admirably in allowing my hon. Friend the Member for Hertford and Stortford (Mr Prisk) to get in to support my right hon. Friend the Member for Harlow (Robert Halfon) in his excellent speech, which was both concise and heartfelt.
I visited the hospital with my right hon. Friend a year ago, shortly after the trust went into special measures. I share his view about the commitment of the staff, which was evident to us on that occasion, at a time when, it would be fair to say, there was a state of some unease, the trust having just gone into a special measures regime. In part, we were there to reassure them that it could be a learning process from which they could improve the services offered to their patients, notwithstanding the challenges presented by the consequences of the CQC report.
My right hon. Friend is a consistent and persistent champion for his area and for this project, which has been in germination for some time. It is timely that he should bring it to the House’s attention; I will go on to explain why. I may not be able to satisfy him completely on the questions he has put to me, but I will do my best.
The Princess Alexandra Hospital faces many issues with its estate, as is evident to anyone who visits the site. My right hon. Friend has explained that it has an aged infrastructure and a strong reliance on temporary buildings—it has “sub-optimal clinical adjacencies”, which is the civil service phrase for bits of activity dotted around the place in an unco-ordinated way—much of which is in a fragile condition. There are also capacity challenges posed by the growing demand that he referred to from a combination of demographics and increases in housing, which are happening all around him. That is a shared picture recognised by the Department and the local NHS.
Any service change that might come to the Princess Alexandra Hospital is primarily a matter for the local health authorities. They recognise that and therefore have come up with various proposals. As my right hon. Friend would expect, any proposed changes that are pursued will be subject to the usual procedures and public consultation.
My right hon. Friend pointed out that the local NHS trust looked at five options for a potential redevelopment of the Princess Alexandra Hospital. The strategic case for change concluded that a new hospital on a greenfield site would be not only the most affordable solution but the one that would deliver the most benefit for the local population. West Essex CCG, as lead commissioner for services provided by the Princess Alexandra Hospital NHS Trust, supports that proposal.
Harlow is due to undergo significant economic and residential housing growth in the next 10 years. I am pleased that my right hon. Friend referred to the contribution that Public Health England will be making to that: it remains our ambition to create a world-class health life sciences facility in his constituency. I understand that as part of the potential development of some 10,000 homes in the Gilston area to the north of Harlow, there is the possibility of a new junction for the M11. That gives rise to potential greenfield sites and the opportunity for significant planning gain. That will be available to the local authority as it considers assisting with the financing of any scheme. That puts the proposition in a somewhat unusual light in relation to other competing claims for capital on the NHS.
Before I return to the central issue of capital raised by my right hon. Friend, I will touch on the special measures regime, which the hospital has been in since October last year, following a CQC report that rated the trust as “inadequate” overall. He identified the new management and since we visited, the trust has got a new improvement director in post. I think the new chair was in post when we visited, and he has recently recruited a new chief executive with whom he worked in a previous trust to drive through turnaround improvement. They are individuals in whom the Department has considerable confidence. It is good to hear that much of that improvement work is starting to come through.
A multidisciplinary transformation team called “quality first” has been established, which aims to drive through quality improvement and service reconfiguration across the hospital. Peer reviews are taking place on a two-weekly basis, which are being fed down to departments and wards within the hospital to drive improvement from the bedside. The most recent external peer review was conducted in June and helped to highlight areas of focus to assist the trust in its journey out of special measures status.
A consequence of that work is that there is now compliance at the trust with referral-to-treatment waiting times, which is not universal across the NHS at the moment—would that it were. It is also meeting cancer standards and ensuring that cancelled operations are rebooked within 28 days. That is positive concrete evidence of progress coming through the regime. There have also been improvements in critical care and end-of-life care since the CQC inspection. The trust has developed and launched a framework for a five-year plan, “Your future, our hospital,” and is currently preparing for its next CQC inspection, which will take place next month. We will all look at the outcome of that with great interest.
To return to the core question of capital, my right hon. Friend is right to identify the emergence of Department funding from which Harlow benefited: waves 1 and 2 of the current £100-million A&E pot. There is a bid in train for the final tranche of that funding. We will see whether or not that succeeds, but, certainly off the top of my head, I think Harlow has achieved more than any other trust in securing capital to help improve the situation in its emergency department.
More significantly, the trust has submitted additional capital bids to cover funding for other ancillary aspects of improving care in the hospital: a second maternity theatre, urgent estates infrastructure work and strategic estates transformation. All capital funding bids have to follow the same course as those of any other trust in the country. As a result, I am not in a position to confirm the trust’s prospects for success in this competitive round. The timeliness of the debate is that all STP areas have submitted bids for the next round of capital funding. I confirm that a proposal has gone in for Princess Alexandra. We await the Budget this autumn to see whether the Chancellor will allocate phase 2 capital for STP transformation. He indicated in March that he was intent to do so, so we are hopeful that that will occur. The extent to which there is capital available to support very significant projects will depend on how much is made available by the Treasury.
My right hon. Friend has rightly pointed out that this is a high priority for the region, for the county and clearly for the residents of Harlow. I wish him every success in advancing his cause—as he has done so admirably here today—when we see the allocation of that capital following the Budget later this year.
Question put and agreed to.
Women Released from Prison
I beg to move,
That this House has considered women released from prison.
It is a pleasure to serve under your chairmanship, Mr Howarth, as I am sure I have said many times. In the UK today, almost 4,000 women are in prison. Although many are serving long, extended sentences worthy of the horrendous crimes they have committed, more than 80% of convictions for women are for non-violent crimes, half of sentences being less than six months. The crimes most commonly committed by women are theft and handling of stolen goods. For many, those are a last resort—a desperate measure to feed a family or fund an addiction. When we consider the consequences of prison for such women, we should ask whether incarceration is the correct response.
After their sentences are served, women leaving prison face inordinate difficulties in readjusting to life. Homelessness is at the core of the problem; on release, six in 10 women do not have a home to go to. Without an address—permanent or temporary—safe and secure employment is near impossible. As a result, fewer than one in 10 women released from a prison sentence of less than 12 months manage to secure a positive employment outcome within a year. For those who struggle to find work, and often for those who find it, social security can be difficult to come by. Without a home, income or a family, the path to reconviction is clear; 45% of women are reconvicted within one year of leaving prison. Many women reoffend to fund a life outside prison, although many will do so aware that life can be easier inside prison.
Such problems for women should force the House to reconsider the use of custodial sentences for low-level crimes. Women—especially those with a history of social and financial difficulties—will often leave prison in a far worse situation than when they entered. Separated from their families, relationships may have broken down, and the resulting pressures can further an issue that was present before the sentence began. These women need help with the initial problem, and support from the state and society to identify and tackle it.
A prison sentence will not in itself reform a woman who only stole in the initial instance to feed her children, nor will it reform a woman with an addiction, be it to alcohol, drugs or gambling. Addiction is an illness, and the crimes committed to fund addictions are a symptom of that illness. Someone suffering from a physical medical condition will be offered treatment to ease their symptoms, but someone suffering from addiction is given a punishment.
I congratulate my hon. Friend on securing this welcome and important debate. Does he also agree that working with people suffering serious addiction issues is unlikely to be effective in the typically short sentences that women experience? A long period of time is needed to work with someone who has deep-seated problems.
My hon. Friend is absolutely right. This is part of the wider issue of whether a six-month custodial sentence is acceptable. I am not advocating that we should extend custodial sentences; it is about rehabilitation being part of that work, rather than a custodial sentence. In fact, she brings me on to my next point very well: a short prison sentence will not fix the problem. It is far more likely to be a catalyst for a downward spiral that will see these women yo-yo between addiction, committing crimes and short prison sentences for the rest of their life.
Ministers say these issues are not exclusive to women. However, decisions made in recent years have created a system that creates difficulties specific to women. The lack of women-only prisons primarily creates issues as it results in women facing sentences far from home. There are only 12 women’s prisons across England and Scotland, and none at all in either Wales or Northern Ireland; for Welsh women, the closest facility is in Gloucestershire. Staggeringly, some women in Scotland are placed in female units within male prisons—a trend that looks likely to be adopted across the whole of the UK in future—while women in Northern Ireland are detained in a male youth offenders centre.
At present, more than 17,000 children are separated from their mothers due to imprisonment, fewer than 10% of whom are being cared for by their fathers. Distance makes visiting difficult at best and impossible at worst, which has a harmful effect on the children’s welfare. Upon release, women may face further difficulties when a lack of local provision means they are again located 100 miles or more from their families. For some women and men, living in an approved property is a condition of their release on licence. These approved properties are single-sex establishments, and while there are 94 locations across England and Wales for men, including several in London, there are only six for women. They are in Bedford, Birmingham, Leeds, Liverpool, Preston and Reading; none of them are in London and, once again, none are in Wales.
Again women are forced to be away from everything familiar to them. They may be out of the physical prison building, but they are still prisoners of circumstance, separated from their families and communities and expected to reintegrate into a society that is unfamiliar to them. The Government should provide suitable facilities and sufficient support care for those vulnerable women on their release from prison. In my opinion, the Government are at present failing to do so.
In May 2017, a woman from London brought a case against the Secretary of State for Justice after she was forced to relocate to Bedford on her release from prison. She appealed on the grounds that the distribution of approved properties was unlawful sex discrimination against women. In a landmark ruling, the Supreme Court upheld her appeal and found that the Government were indeed discriminating against women on their release from prison. That was five months ago. Disappointingly, there was no response from the Government and no action was taken. It is my understanding that that is still the case today; perhaps the Minister will look at that specific point.
Women leaving prison will always face some difficulty in readjusting, but the complexities they face under this Government are not necessary. It is neither right nor inevitable that women, on their release from prison, should be left homeless and destitute. It is not right that they should be deprived of safe and secure employment, access to social security and support, and it is not right that, by virtue of the Government’s neglect of facilities, they are forced into communities hundreds of miles from their families. I hope that the Government will consider the difficulties faced by women leaving prison, and that they will act to ensure an easier transition from custody to society, free from homelessness, poverty and reconviction.
It is a great pleasure to contribute to the debate and to serve under your chairmanship, Mr Howarth. I am pleased that we are having the debate, as I have a long-standing interest in the experience of women in the penal system. I thank the many organisations that have supported me both for this debate and over a number of years, including Agenda, the Prison Reform Trust and the Howard League for Penal Reform, as well as Women in Prison, and which give us excellent briefings and information.
The title of this debate is about women leaving prison but, like my hon. Friend the Member for Ogmore (Chris Elmore), I will first talk about women going into prison. Alarmingly, the number of women in prison exceeded 4,000 for the first time in July 2017. As we know, the experience of women in prison is generally not a good one: 16 women died in custody in 2015-16 and there have been 18 suicides in 2016 and 2017 so far. That is 14 more than in the previous eight years put together. As we heard from my hon. Friend, many women who have a period in custody face losing their home and their children as a result of incarceration. We know that many also suffer mental health difficulties, which time in prison may exacerbate.
An increase in the number of women going into prison troubles me—especially to the extent that it reflects a perverse consequence of the Transforming Rehabilitation programme. I think it is a commonly understood problem that that programme is leading to a rise in the number of women being recalled to prison. The number of women recalled to custody following their release has increased by 68% since the end of 2014, according to analysis by the Prison Reform Trust. The number of those with a sentence of less than 12 months returned to custody after licence recall was 14.6 times higher in the first quarter of this year than in the first quarter of 2015. The numbers in the first quarter of 2017 were 220 women, compared with just 15 women two years before.
As my hon. Friend the Member for Ogmore said, despite the intentions of Transforming Rehabilitation to reduce reoffending, women are increasingly going round and round in a revolving door. We need to do better, both to keep women out of custody and to prevent them from returning to custody following release from a period in prison.
There may be a number of reasons for the high rate of recall, but one that alarms me is that the through-the-gate support that was envisaged to be provided by dedicated case managers in Transforming Rehabilitation is not yet properly in place. Nor are all community rehabilitation companies offering genuinely gender-specific programmes. My first question to the Minister is: will he review how Transforming Rehabilitation is working and the role of community rehabilitation companies in preparing women for and supporting them on release?
I am concerned that the Transforming Rehabilitation model means that the provision that should be in place for women completing custodial sentences is fragmented. The majority of women, most of whom commit less serious crimes, are likely to fall under the auspices of the community rehabilitation companies, with only a small number of women deemed high risk being supervised by the national probation service.
I understand the risk model that underpins Transforming Rehabilitation. I do not entirely agree with the model and am not convinced that it is viable, but I understand what the Government say it should look like. However, the number of women prisoners referred to the national probation service will be so infinitesimally small in the scheme of things that it is difficult to see how gender-sensitive models can be devised by the NPS for this very small group of very vulnerable women.
One suggestion I would like to put to the Minister is that all women leaving custody should be supervised by the CRCs, not the national probation service. Will he investigate that suggestion and make an assessment of the risk implications of doing so? Those risks could be mitigated, or indeed more than balanced out, by improving access to dedicated gender-sensitive support focused in the CRCs and available to all women.
I am sure the Minister will be well aware of the whole-system approach we have been trialling in Greater Manchester, where my constituency is. I very much commend that approach to him. The programme aims to embed integrated gender-responsive support services for women at three points in the criminal justice system—on arrest, sentencing and release from prison. Nine women’s centres in Greater Manchester provide support hubs for women referred via a range of routes. The services they offer are very much appreciated by the women who access them. I visited my own women’s centre and can absolutely vouch for how the women feel about them and the positive experience they have. They welcome the opportunity to be in a women-only safe space.
The 2015 evaluation of the whole-system approach carried out by Sheffield Hallam and Manchester Metropolitan universities found that service users had revealed a strong sense of despair, hopelessness and isolation prior to engaging with the support on offer at the women’s centre. Once they had that engagement, it gave them a sense of purpose and a structure to their day. It gave them aspirations for the future in terms of volunteering and employment opportunities and led to improvements in health and opportunities to re-engage with their children and families. The development of that positive sense of self is really necessary in improving wellbeing and reducing the isolation and lack of confidence that often lead women to offend and take them to a crisis point where criminal behaviour may result.
Particularly notable in the research and the service users’ own accounts was the fact that such intensive and tailored support was not available to them before their engagement with the women’s centres. Providing a more efficient service with less duplication and burden on statutory agencies was also reported to be a perceived benefit of the approach. Women’s centres were said to be places women could turn to and could be linked to other organisations in the community that could help them, which is important, given that the statutory agencies with which women are involved may not be aware of or not have time to make links with one another and offer all sources of support.
I of course acknowledge that the internal alliance between different statutory and voluntary agencies has improved the sharing of good practice and facilitated some of the pathways, but there are concerns. Some have expressed concerns that innovation will be squeezed out as the pathways become more standardised. Not all referral routes appear to be working fully effectively to refer women into the women’s centre provision. As I say, through-the-gate referrals have been particularly disappointing, perhaps because of the lack of dedicated through-the-gate case managers.
Women themselves may not know of or understand the support they could obtain from the women’s centres and be doubtful about it. When I visited Styal Prison recently, women peer mentors in the prison suggested that they should be able to liaise between the prison and women’s centres to encourage women coming up to completion of their custodial sentences to move on to use the women’s centre facilities.
However, the most crucial problem—it will come as no surprise to anybody in the room—is uncertainty about funding. Indeed, that applies to not only the whole-system approach in Greater Manchester, but women’s centres up and down the country.
May I make a suggestion to the Minister? I am not optimistic, but I keep suggesting this in the hope that one day a Minister will agree with me. I suggest, on the 10th anniversary of the seminal Corston report, which suggested that women should serve their sentences in community settings, that rather than money being put into new community prisons, which as far as I can tell are prisons in all but name, that money could be better directed at supporting women’s centres and rehabilitation programmes in the community. More women could be reached. They could be supported to remain at home, to care for their children and to work if they were able to do so. As we know, those are all important factors in reducing reoffending and costs to the public purse. Instead, precarious funding of community provision is exacerbated by cuts to other services, such as mental health services, and to the benefits on which women leaving prison will rely.
Housing is a particular issue. The Prison Reform Trust says that, as we have heard, 60% of women prisoners do not have homes to go to on release. I draw the Minister’s attention particularly to the following problem, which I heard about in Styal. A woman who had served a custodial sentence, who had a history of offending behaviour and addiction and had been treated as having made herself intentionally homeless by her housing authority before going into custody, was not able to point to the successful programme of rehabilitation that she had undertaken in prison in order to have her housing application treated differently on release. Would the Minister, with Department for Communities and Local Government colleagues, look into that?
I am conscious that you want me to move on, Mr Howarth, so I will make just two final points. The first is on universal credit, which we are debating in the main Chamber this afternoon. The prisons tell me that they cannot start a woman’s application for universal credit in advance of her release. That means that women often leave prison with just £47 to their name and a six-week wait. I hope the Minister will talk to his colleagues in the Department for Work and Pensions about whether it might be possible to start the application process for universal credit in the prison ahead of the release date.
Finally, I emphasise the importance of family contact, particularly contact with children, which we all know is also a very important factor in helping to reduce offending and reoffending. My final example on that is that on my recent visit to Styal, I met an EU national whose daughter was suffering very severe health problems, having just given birth. The grandmother was deemed low risk by the prison, no longer had her passport and, with a new grandchild, was very unlikely to abscond, yet she could not be granted a family resettlement visit, which would have enabled her to go to her daughter and provide the family with some support.
I hope the Minister will pick up some of the quite detailed but practical points that I have raised, because we all share the common goal of reducing the number of women in custody and helping them to be rehabilitated in the community.
It is a pleasure to serve under your chairmanship, Mr Howarth. I congratulate my hon. Friend the Member for Ogmore (Chris Elmore) on securing this important debate.
With nearly 50% of the women serving time in prison having experienced some form of abuse, be it physical, emotional or sexual, surely we should be putting more resources into supporting and counselling them than punishing them with prison sentences. Ten years ago, Baroness Corston published her “Review of Women with Particular Vulnerabilities in the Criminal Justice System”. In it, she talked about the very things that we are talking about here today: the chaos and disruption experienced by families; the disproportionate and inappropriate sentences that women face for minor non-violent offences; and the victims of violence, sexual abuse and childhood neglect who end up in prison because of lack of support.
At the time of writing her report, Baroness Corston called for a fundamental rethink. She addressed the need to consider the issues connected with women offenders before considering imprisonment as a serious option. When we read through the recommendations, we realise that the review could easily have been written 10 weeks rather than 10 years ago, because very little has changed. Women are still being imprisoned without consideration of whether that is the best solution and are still coming out of prison without the necessary support and facilitation to help them to reintegrate into the community.
In recent months, I have visited prisons and met too many women who have been appallingly let down by the welfare and judicial systems in this country—women who have been punished when they should have been supported. In my own city of Swansea, I spent two weeks during the summer recess talking to women who for whatever reason had served time in prison, and too many of those had suffered as a result of their time in prison. I heard harrowing stories that rendered me speechless; I desperately want to help these women. Yes, they committed crimes—they have never disputed that—but their punishment far outweighs the level of criminality. Prison sentences are harsh, but the subsequent loss of their home and, very often, their children is bitterly unfair.
Almost 4,000 women are in UK prisons, but only two are serving whole-life sentences: Rosemary West and Joanna Dennehy. For the vast majority of women in prison, there is life after prison, but there is a lack of support for them. The struggle they face on release is a grave concern. Housing is a huge problem: almost two thirds of women leaving prison will not have anywhere to live. Women released on the condition that they live in approved properties have the added difficulty of integrating into an unfamiliar community that is often hundreds of miles away from their family and loved ones.
Women who have served prison sentences often struggle to find work, and 90% are still unemployed a year after being released—a much higher figure than for men in the same position. All too often, money is tight and they find themselves reoffending because they cannot afford not to. I met a woman who had to sell her body to pay for a hotel room for the night. That should not be happening in modern society.
Too many women’s and children’s lives are being destroyed because of the judicial and rehabilitation system in this country. Women are sent to prison because there are no more suitable alternatives. When they are released—often after a very short time—they are homeless, unemployable and desperate ex-offenders with no support and little option but to reoffend to survive. These women need the Government to radically overhaul the support and the facilities available to aid their transition back into the community. They need help with housing, employment and social wellbeing to ensure that their lives do not become a vicious circle of reoffending, old mistakes and ruined futures.
I congratulate the hon. Member for Ogmore (Chris Elmore) on securing this debate and succinctly setting the scene. I congratulate the hon. Members for Stretford and Urmston (Kate Green) and for Swansea East (Carolyn Harris) on their contributions as well.
Many prison officers in my constituency have told me that things need to change in relation to women released from prison. The hon. Member for Ogmore referred to Northern Ireland, where ladies have a section in the dual prison for men and women. I understand that the Minister will talk specifically about England and Wales, and I will comment on the policies there.
The statistics about women in prison somewhat surprised me when I read them. The Library debate pack states:
“There were 6,442 women admitted to prison in England and Wales after receiving an immediate custodial sentence in 2016/17. 40% were admitted for Theft offences, 19% for Summary non-motoring offences and 10% for Miscellaneous crimes against society… Of the 6,495 women sentenced admissions to prison in England and Wales in 2016/17, 4,035 (62%) were there to serve a sentence of less than or equal to six months”.
The statistics add the facts to the case that hon. Members have already made, and that other hon. Members will make. The debate pack also states:
“Of the 6,669 women released from prison in England and Wales in 2016/17, 63% had been serving determinate sentences of less than or equal to 6 months… Between October 2014 and September 2015 around 84,277 women offenders were cautioned, received a non-custodial conviction at court or released from custody in England and Wales. Around 15,662 of these offenders committed a proven re-offence within a year. This gives an overall proven reoffending rate of 18.6%”.
That is less than the rate for men, which was almost 25% in 2014-15, but still indicates that something needs to be done differently. Other hon. Members have indicated in their constructive and helpful comments—we are not here to criticise, but to be constructive—some of the changes that they would like to be made.
I was interested to read the following in the debate pack:
“In September 2015 the National Offender Management Service (NOMS) published Better Outcomes for Women Offenders, its commissioning principles for women offenders.”
Those principles, which I agree with, are based on seven identified priority needs. The first is substance misuse, a malady and a difficulty that many people are subject to:
“Stabilise and address individual need, in particular address class A drug use, binge and chronic drinking.”
As hon. Members have pointed out, if we do not address substance misuse in prison and follow up on it afterwards, we will not be doing anything to solve the problem or help.
The second identified priority need is mental health, which I have a particular interest in and have often spoken about in the House because it is so important:
“Expedite access to services that address mental health need, in particular anxiety and depression, personality disorder, post-traumatic stress disorder, and trauma.”
Many women in prison have needs that fall into those categories. We can try to assist them while they are doing their time, but where is the follow-up once they get out? Without it, anxiety, depression and other problems with personal circumstances will take over.
The third identified priority need is emotion management:
“Help women to build skills to control impulsive behaviour and destructive emotions.”
Again, we can give some help in prison, but we need the follow-up afterwards. Teaching anger management and self-control can help to change lives. It is not about dictating change, but helping people to create it within themselves.
The fourth identified priority need is a pro-social identity:
“Be positive towards, about, and around women, and encourage them to help and be positive towards others.”
If we always tell people off and do them down, they can never lift themselves up. It is important for society to give people who have made terrible mistakes and ended up in prison the chance to rebuild their lives.
The fifth identified priority need is being in control of daily life and having goals:
“Motivate women to believe that they belong and fit in to mainstream society, where they can work to achieve their goals.”
We need to encourage them, be positive and give them employment and training opportunities and a chance to be part of society and move forward.
The sixth identified priority need is to improve family contact:
“Help women to build healthy and supportive family relationships, especially with the children.”
The hon. Member for Stretford and Urmston also referred to family contact. Family can help people so much to cope with life.
The final priority need is to resettle and build social capital:
“Help women to find somewhere safe to live, to learn how to manage their money, access education, and improve their employability.”
All these things tie into giving people a second chance and making sure that they can be part of society. Sending people back where they lived before sometimes means sending them back to the same problems, so in some cases they may need to go somewhere different.
I look to the Minister for a positive response. I feel that we are missing the targets that we should be aiming for. How does he intend to address and implement the changes to help to rehabilitate offenders and secure family units with a mother at home who is aware of how she can do things differently, with plenty of the support that is so necessary?
It is an honour to serve under your chairmanship, Mr Howarth. I congratulate my hon. Friend the Member for Ogmore (Chris Elmore) on securing this important debate.
At Justice questions in September, the prisons Minister, the hon. Member for East Surrey (Mr Gyimah), told me that,
“the Government have a duty of care to everyone we hold in custody.”—[Official Report, 5 September 2017; Vol. 628, c. 21.]
I wholeheartedly agree. Yet the loss of 316 lives in our prison system last year, which my hon. Friend the Member for Stretford and Urmston (Kate Green) referred to, shows that too often that duty of care is not being met, and that our prisons are sometimes not fit for purpose.
Deaths in custody lead to the headlines when we talk about health and wellbeing in prisons, but when we read between the lines we discover a more startling picture of the fragile state of healthcare within the prison estate. Women in custody are five times more likely to have a mental health concern than women in the general population, 46% of them reporting having attempted suicide at some point. Also, in some prisons around half of healthcare appointments are being missed due to a lack of prisoner escorts.
Last week, in the main Chamber, I spoke of the difficulties of accessing services when someone has no fixed abode; the same can often be said of women leaving prison. At least four in 10 women leave the justice system having no accommodation arranged for their release, and having no accommodation often leaves these women facing difficulty in finding employment, a battle to gain local authority help and support, and even a struggle to do something as simple as to obtain a mobile phone.
I know from my experience as a GP that many women leaving custody find themselves alone and destitute, with no support networks in place. Due to the lack of transitional support, I myself have even had to resort to funding overnight accommodation for those left homeless upon release from prison, so that they do not have to risk their life by sleeping rough.
It does not have to be that way. Prisons literally present us with a captive audience and a host of opportunities to help people to transition back into society. If instead of locking up women as a punishment we invested in unlocking their potential, we would have more of these women out of custody long-term, we would have more mothers back with their children and—crucially—we would have more women contributing to our economy instead of contributing to the cost of the prison estate.
A prison system fit for purpose would ensure that we equip those in custody with the education and skills they need to get back on their feet and into employment; a prison system fit for purpose would provide better support on housing, linking those in custody with charities and other housing providers to keep them off the streets; and on healthcare, a prison system fit for purpose would ensure that prisoners’ health conditions are addressed, prevented, supported and brought under control, so that we would reduce the burden on our NHS in the longer term and have a healthier society.
We should not have to hear horror stories of women leaving prison with nothing more than a cheap sleeping bag and a list of problems that is larger than when they started their sentence. The challenge is not straightforward —we can all accept that—but tackling it requires a better joined-up approach from the Government and other partners. It cannot simply be an afterthought or something that we leave to charities alone to solve.
I urge the Minister to listen to these concerns and to work with his colleagues in Government to bring about the changes needed within our justice system, to ensure that women are better supported upon release from it.
It is a pleasure to serve under your chairmanship, Mr Howarth.
I congratulate the hon. Member for Ogmore (Chris Elmore) on obtaining this debate and on putting the issues so succinctly, especially highlighting the fact that we need to question whether incarceration is always the right response to female offenders, and indeed to all offenders. Clearly there are serious offenders who must be incarcerated, but for less serious crimes we need to consider alternative modes of disposal.
The hon. Member for Stretford and Urmston (Kate Green) spoke very strongly about the issues, based on her own hard work in and long experience of this area, and she spoke very movingly about the very real issue of deaths in custody and female suicides. She also spoke about the need to transform the way that we rehabilitate women, and about the need to address the issue of the funding that is required to do so. Topically, given today’s debate in the main Chamber, she also spoke about the need to address universal credit issues for women leaving the prison estate.
The hon. Member for Swansea East (Carolyn Harris) again emphasised the importance of resources for support and counselling, and raised the genuine issue of the homelessness of many women who leave our prisons across the United Kingdom. The hon. Member for Strangford (Jim Shannon) made the point that prison officers in his constituency who serve in the system see the need for reform, and the hon. Member for Stockton South (Dr Williams) emphasised the duty of care that is owed to these women, as well as the great importance of tackling mental health issues.
This is a devolved matter, and in Scotland we have faced similar challenges. The Scottish Government have worked to support the effective reintegration and rehabilitation of women released from prison. To do that, they put together the reducing reoffending change fund, which funds a number of services that provide mentoring support to women in the criminal justice system—in particular, to women leaving prison. They also looked closely at the issue of short custodial sentences, and there is now a presumption in Scots law against short custodial sentences for all prisoners. The idea is that it is easier to rehabilitate people if they do not serve a short custodial sentence. The Scottish Government are doing work in that area.
Let us be frank: Scotland has a serious problem with the number of people incarcerated. In 2015, women made up more than 5% of the prison population in Scotland. That is the second-highest female prison population in northern Europe. Only Spain has a higher female prison population. In response to that issue, a commission was set up under the former Lord Advocate of Scotland—my boss in another life—Dame Elish Angiolini, who looked into how to improve outcomes in Scotland for women in the criminal justice system. She published a report in 2012, which made many wide-ranging recommendations, including the establishment of community justice centres, which offer a one-stop support network for women, the introduction of nationwide mentoring services to support women’s compliance with court orders, and alternatives to remand—a disproportionate number of women end up on remand. She also recommended that the women’s prison—the main women’s facility in Scotland—be replaced with a small specialist prison for women serving long-term sentences and smaller units for women on shorter-term sentences. The Scottish Government have begun to implement those changes. We should pay tribute to the campaigners for penal reform and feminist groups that called for those changes over a long period and were able to influence the system in Scotland.
When we discussed the issue of prisons in England and Wales in the Chamber recently, I invited the Under-Secretary of State for Justice, the hon. Member for East Surrey (Mr Gyimah), to visit the prison system in Scotland to see the reforms we are carrying out there, and he very generously did so. I extend that invitation to the Minister. I am not saying the situation is perfect, but we have moved forward and taken the Angiolini report’s recommendations on board. Hon. Members have argued today that the UK Government should similarly take on board the Corston report’s recommendations.
The Scottish Government are also supporting rehabilitation services in the community. I would like to mention Willow, which services women in my constituency and across Edinburgh and the Lothians. It provides a range of services for women who are returning from prison to the Edinburgh or Midlothian area. It is a partnership between NHS Lothian, the City of Edinburgh Council and the Scottish Association for the Care and Resettlement of Offenders. It aims to improve the health, wellbeing and safety of women leaving prison, enhance their access to services and reduce their offending behaviour. It is an excellent facility—one of many that are springing up in Scotland. I am interested to hear from the Minister whether similar facilities will be funded by the sort of cross-government and local government partnerships that have been set up in Scotland.
It is a pleasure to serve under your chairmanship, Mr Howarth. I thank my hon. Friend the Member for Ogmore (Chris Elmore) for securing this very important debate. I understand that time is short, so I will get straight to the point.
After release, six out of 10 women have no home to return to, nine out of 10 women have no job, and one in two women sentenced to less than 12 months reoffends within a year. That is an appalling record, but, looking at the Government’s policies and decisions, it is clear why women released from prison are let down so badly.
The clearest of the policies affecting women after release is the privatisation of the probation system and the formation of community rehabilitation companies. CRCs have not simplified the provision of services and have done nothing more than reduce the effectiveness of the probation system in preventing reoffending. That has led them to be criticised, rightly, across the political spectrum, including by the Justice Secretary, as not fit for purpose.
The impact of CRCs is specifically felt by female offenders as probation has lost the vital one-to-one support that the Women in Prison campaign sees as crucial to reducing reoffending and securing better services and employment. Instead, the focus is on cheaper group work, which simply fails to provide the same benefits and leaves women without the tailored support that they need. However, rather than address the concerns raised about CRCs, the Government are rewarding failure by awarding them a further £277 million in funding. The decision to privatise probation has also meant an end to the ring-fenced funding for women offenders who leave prison, leaving provision dependent on local commissioning arrangements and creating a postcode lottery of post-release support.
Women are also being let down by the penal system before release, with a shameful lack of support in prisons, which makes it no easier to find homes or employment on the outside. Between prisons, there is significant variation in the quality of training courses, with many failing to offer wide-ranging vocational courses, and many that do nothing to overcome gender stereotypes. Many do not provide enough IT-related courses to teach skills that are vital to obtain employment in the 21st-century marketplace. That provision may be bad, but 70% of women in prison—those serving less than six months—have little to no access to courses at all, leaving them without enough support to find secure employment.
Although recent changes have led to all women’s prisons being labelled as resettlement prisons, progress on shifting the focus is slow and there is no overarching system to help offenders into employment. The housing support provided to offenders after release also varies dramatically between prisons. Although some women may have somewhere to go, the rules surrounding housing, the lack of provision and the absence of joined-up services mean that some do not. Some women may try to get into approved premises, but they are only available for specific offenders and are limited in number. Others may try to secure council housing, but there are shortages and specific criteria. More may attempt to find accommodation in the private rented sector, which is unaffordable, with landlords often unwilling to rent to ex-offenders. More worryingly, women who have suffered domestic or sexual violence may return to their abusive partners. The lack of support for housing is putting those women in grave danger.
What runs through the heart of the rules is a failure to take on board the Select Committee on Justice’s acceptance that women face very different hurdles from men. The Government are doing nothing to provide a distinct approach to the specific needs of female offenders, and are instead continuing with badly managed programmes that are often not fit for purpose in the first place, let alone fit to meet specific needs.
The Government say that they will produce a long-overdue strategy for female offenders. It must be specifically tailored to women’s needs, and not just be a rehash of existing policies with a female spin. It has to look seriously at whether prison is the right place for some women. The many cases in which women reoffend because of the appalling lack of support do not serve the best interests of women or of society.
I want to hear from the Minister what he is doing to ensure that women have access to a greater range of employment courses and that those serving short sentences have access to them, so that they can get a job; what he is doing with colleagues to overturn some of the ridiculous housing rules and biases against female offenders, so that after release they will have a roof over their head; why the follow-up report to the Corston report has been so damning; and what the Government are doing to fully implement the report’s recommendations to prevent women from reoffending. When will the Minister or his colleagues publish their strategy for female offenders? Crucially, what will that strategy entail? Can he assure me that it will look seriously at the range of sentencing options available for female offenders?
It is a pleasure to serve under your chairmanship, Mr Howarth. I congratulate the hon. Member for Ogmore (Chris Elmore) on securing a debate on such an important subject. He and many other speakers have made thoughtful and informative contributions and have raised several pertinent points that I will respond to.
I share many of the concerns that have been raised today. Female offenders are some of our most vulnerable members of society and often have complex needs. A significant number of the female prison population are indeed victims of difficult circumstances. They often face mental health issues, substance misuse problems, domestic abuse and homelessness. Those are all issues that need to be addressed during and on release from prison if we want to reduce reoffending and enable the women to have a chance to reintegrate back into their communities.
Our statistics show that almost half of women reoffend after leaving custody. That is not acceptable. I do, of course, recognise the concerns raised by the September 2016 Her Majesty’s inspectorate of probation thematic report on women’s services in the community. The report acknowledged that there were examples of excellent work, but that it was inconsistent. It was also encouraging that the majority of women interviewed felt that their involvement with probation services had helped reduce their likelihood of reoffending.
We accept that aspects of probation delivery, including through-the-gate services, are not meeting our expectations. As the Under-Secretary of State for Justice, my hon. Friend the Member for East Surrey (Mr Gyimah), made clear in July, we have already taken action to make changes to the contracts with community rehabilitation companies to better reflect the costs to providers of delivering core services. We are continuing to work with providers to explore further action that we might take to ensure that services protect the public, rehabilitate offenders and deliver the sentences of the court.
Her Majesty’s Prison and Probation Service contract management team has reviewed the compliance of CRCs against gender-specific contractual requirements. Although in general CRCs are adhering to their obligations, we are working with them to identify the necessary actions required to improve delivery and outcomes for women offenders. It is important, too, that women who are being supervised by the national probation service on licence have access to the interventions that will help build and sustain their rehabilitation. HM Prison and Probation Service is looking at the interventions provided to women in custody and in the community to identify any gaps or deficits, but also to ensure that staff maximise the use of interventions that are currently available.
The Transforming Rehabilitation reforms extended post-release supervision to some 40,000 offenders serving short custodial sentences, who previously received no support from probation on release. They also introduced through-the-gate services to help released offenders to resettle in the community. We know that, with the extension of supervision to offenders serving short custodial sentences, the number of recalls of women has increased.
Although it is important that a community order or post-custodial licence is properly enforced, we also need to support women to reduce unnecessary recall. We have therefore taken forward specific work to ensure we engage effectively with female offenders to improve compliance with an order or licence. This includes offering female offenders the option of a female offender manager if that suits their needs best; issuing a practice guidance document on working with women offenders to probation staff to help them to consider issues specific to female offenders; updating our instructions to probation staff on offender childcare to support access to childcare provision to facilitate engagement in supervision and specified activities, thus supporting female offenders to complete the requirements imposed upon them where childcare issues were previously a barrier; better supporting staff by providing additional guidance to inform their consideration of the thresholds to recall by, and, where viable, to make alternative decisions to improve engagement and compliance; and looking at how to best train prison and probation staff on how to most effectively engage with women and to work with them in a way that takes into account their previous experiences of trauma. Evidence indicates that if we do so, we are more likely to achieve effective outcomes and increase their compliance with their community order or post-custodial licence.
Concerns have been raised today about the sustainability of women’s centres. We recognise the important role that women’s centres can play in supporting female offenders, and those at risk of offending, to address their often complex needs and turn their lives around. We are investing £1 million in seed funding between 2016 and 2020 for local areas to develop new ways of working with female offenders by adopting a joined-up multi-agency approach and bringing together services at each stage of the criminal justice system. That model, often termed a whole-system approach, brings together local agencies and criminal justice—statutory and voluntary—to take a joined-up approach to providing the holistic, targeted support that a female offender needs, with shared investment and outcomes.
Women’s centres are at the heart of many of those models. The national probation service and CRCs are key partners, ensuring that female offenders receive targeted, wraparound support, both through the gate and in the community. I strongly believe that locally led services are more effective in addressing the needs of vulnerable women. The first whole-systems approach model in Greater Manchester has been fully operational since January 2015. The model includes police triage, a problem-solving court, and support alongside community orders and on release from prison. Although we cannot conclude that the model has had a direct impact, there has been a reduction in the number of adult women prosecuted, and in the number given custodial sentences in Greater Manchester in 2016. Learning from Greater Manchester and our other grant-funded areas will inform our future work.
There is considerable evidence of a link between a lack of stable accommodation and reoffending, with suitable accommodation playing an important part in enabling offenders to get a job or get into training, and to get registered with a GP. HMPPS has undertaken some initiatives to improve access to accommodation, such as expanding the bail accommodation and support services contract to offer accommodation to offenders on licence. We continue to work with all probation providers to ensure that offenders get the support that they need to find accommodation on release.
Accommodation is, however, a serious problem that requires a cross-departmental response. We are working with the Department for Communities and Local Government on a number of its housing priorities, including the implementation of the Homelessness Reduction Act 2017. Through the duty to refer, all prisons and probation providers will be subject to a new duty to refer someone they support who might be at risk of becoming homeless to the local housing authority.
I want to mention the work that we are doing to improve health outcomes. We are looking closely at what more we can do to improve support and continuity of care and treatment when someone leaves prison. One example is the change we made to allow prisoners to register with a GP prior to their release from prison, to facilitate a timelier transfer of information from prison to GP practices. That sounds like a simple change, but I know from my professional experience what a difference it can make.
The number of self-inflicted deaths is thankfully reducing, but six women still died in prison in the 12 months to June 2017. All deaths in custody are a tragedy, and I am acutely aware of the need to do more to meet the needs of women in our care. The incidence of self-harm is also still unacceptably high, and disproportionate compared with men. We are acting on the initial results from the Independent Advisory Panel on Deaths in Custody’s rapid information-gathering exercise on preventing the deaths of women in prison.
Action we have already taken includes making improvements to prison reception areas and first-night provision. We have also updated and improved the assessment, care in custody and teamwork process for supporting at-risk prisoners, and we have strengthened the suicide and self-harm training for staff, and for ACCT case managers. Juliet Lyon, the author of the report, also looked at what more could be done for women before their release from prison. She noted that the run-up to release could be particularly stressful as women consider all aspects of their life that have been on hold while they have been in prison. I met with Juliet only recently.
The hon. Member for Stretford and Urmston (Kate Green) always makes an informed contribution to these debates and I thank her for that. We have been reviewing and, as I have already said, have changed the contracts around CRC. The Department continues to assess the performance of probation, particularly for women because there have been difficulties. I met with DCLG this morning to discuss accommodation.
Regarding the points made by the hon. Member for Swansea East (Carolyn Harris), I fully recognise the complexity of the women involved and their needs. Every prisoner I have met has appeared vulnerable to me, whatever their crime. The hon. Lady said that there are two whole-life sentences, but there are a greater number of restricted prisoners in the country. It should be noted that more than 2,000 women currently held in custody are there for more than 12-month sentences, so there is no easy fix, and we need to maintain some perspective.
The hon. Member for Strangford (Jim Shannon) made reference to substance misuse and mental health care access. As a practising doctor, I am aware of that. Indeed, I am fully aware of the difficulties in seeking appropriate mental health care within prisons, continuity of care on leaving prison and access to appropriate substance misuse programmes. I have been doing my bit to go into bat for the Department on that with the Department of Health, which ultimately carries responsibility for those services.
The hon. and learned Member for Edinburgh South West (Joanna Cherry) kindly invited me to visit Scotland, but I am already going. I was going to go last week, but I am now going in December. I was very impressed by the presentation we had by people from the Scottish Parliament and Scottish civil service on the quite impressively bold approach on women’s justice that is being embarked upon in Scotland. I very much look forward to visiting.
Finally, in terms of the Government’s strategy for female offenders, one issue that was raised in the thematic report on women’s services by Her Majesty’s inspectorate of probation was the lack of a strategic focus on women. I am pleased to say that we have made progress. In April this year, Sonia Crozier was appointed executive director for probation and women. The creation of that role provides an excellent opportunity to focus on the needs of women in a more holistic way across prisons and the community. I am also leading the development of a female offender strategy, which I intend to publish later this year. This debate has been helpful in informing that work and highlighting what else we need to do to improve outcomes for women in the community and custody.
Thank you, Mr Howarth, for giving me the opportunity to respond. I start by thanking my hon. Friends the Members for Stretford and Urmston (Kate Green), for Stockton South (Dr Williams) and for Swansea East (Carolyn Harris) for their passionate contributions, which drew on their own experiences through casework and their work in the House through Women in Prison. I thank the hon. Member for Strangford (Jim Shannon) and the hon. and learned Member for Edinburgh South West (Joanna Cherry), who I appreciate is here in her role as a Front-Bench spokesperson.
There has been a reasonable amount of consensus. I am grateful to the Minister for acknowledging many of our legitimate concerns, responding in a constructive manner and setting out what the Government are doing. Maybe he could ask some other Ministers to respond in such a constructive manner in other Westminster Hall debates.
There are ongoing accommodation issues that seem to link to lots of other problems. I was glad to hear the Minister respond to that point. I was also glad to hear him acknowledge that there is a lot more to be done. It is nice that he is not suggesting that these things can all be resolved overnight, but I appeal to him to keep Members informed of the work that the Ministry of Justice is doing. I acknowledge that there is cross-departmental work to be done, so he cannot solve everything all the time.
The Minister mentioned suicide rates. There were 10 female suicides last year. The rate is higher than among men. All suicide is unacceptable, as he said, but we still face a real and deep-rooted issue of women being deeply and adversely affected by a prison system that is not working for them. I am glad that the Minister acknowledges that, but we need to do more, which I accept he sees too.
Question put and agreed to.
That this House has considered women released from prison.