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House of Commons Hansard

Westminster Hall

17 January 2018
Volume 634

    Westminster Hall

    Wednesday 17 January 2018

    [Dame Cheryl Gillan in the Chair]

    County Lines Exploitation: London

  • I beg to move,

    That this House has considered county lines exploitation in London.

    It is a pleasure to serve under your chairmanship, Dame Cheryl. I thank all hon. Members who are here to participate, and in particular my hon. Friend the Member for Stockport (Ann Coffey) for her support before this debate and for her important work as chair of the all-party parliamentary group on runaway and missing children and adults.

    London gangs and criminal networks from other major cities are aggressively expanding their illegal enterprises. They are flooding suburban and rural areas as well as market and coastal towns with drugs. They co-ordinate their sales through dedicated mobile phone lines in a practice known as county lines activity.

    The latest National Crime Agency report reveals that,

    “there are at least 720 lines across England and Wales”,

    with

    “at least 283 lines originating in London.”

    Worryingly, the report states:

    “The actual number may well be considerably higher, as many of these areas are likely to have more than one line.”

    London is the major urban source of county lines activity, and I will consider how the Met police, local authorities and other agencies in Enfield and across the capital are working to address it. It is spreading out from London and other urban areas, however, to reach into every area of our country. It is a national issue that demands a co-ordinated, nationally funded response that focuses on policing and children’s services.

    County lines activity is having a terrible, damaging effect on young people, vulnerable adults and local communities. Children from my constituency and beyond are being exploited by gangs and forced to transport class A drugs, weapons and money great distances away from where they live.

    Between November and December 2017, at least nine children from Enfield were reported as missing. Enfield police issued a statement to reassure the public that the borough was,

    “not experiencing a disproportionate amount of missing teenagers.”

    That was undoubtedly true, but I know from the messages and emails I received that the public were not reassured. If nine missing children in a matter of weeks is not disproportionate and there are 32 London boroughs, that is very frightening. There was genuine alarm about what was happening to those children and speculation that county lines exploitation could be involved.

    It is not only vulnerable children and teenagers who are affected. Gangs are taking over the homes of vulnerable adults in those areas to set up drug dens—a process known as cuckooing—often through violence and coercion, or in exchange for free drugs. Many communities affected by county lines activities are reporting a rise in knife crime offences, violent crime and drug use.

    The Government acknowledge that,

    “County lines is a major, cross-cutting issue involving drugs, violence, gangs, safeguarding, criminal and sexual exploitation, modern slavery, and missing persons”.

  • Does my right hon. Friend agree that one of the good advances that we have made over the past year has been to understand that some of our children are being coerced into those gangs? Is she pleased, as I am, that the modern day slavery legislation is being applied in such cases so that those children are understood, rather than condemned?

  • Indeed, I will come to that later. As pleased as I am about the modern day slavery legislation, it has been used very little. In fact, I think there has been only one case, which I will refer to. We need to bear it in mind that those children often do not see themselves as being exploited. They think, “I’m doing rather well here. I’m getting money in.” If they are not cared for children, they feel cared for by their exploiters.

    The Government acknowledge that,

    “the response to tackle it involves the police, the National Crime Agency, a wide range of Government departments, local government agencies and VCS (voluntary and community sector) organisations.”

    However, they must also acknowledge that county lines activity is putting our vital public services in London and across the country under even greater strain. Our health and social care services, police forces, schools and youth clubs are trying to tackle this growing menace at a time of Government-imposed austerity and severe funding cuts to their budgets.

    The way in which county lines activity is being carried out changes all the time—the use of social media as a recruitment tool is one recent development. Authorities require the resources to respond dynamically to those changes and be innovative. I call on the Government to establish a national, co-ordinated, inter-departmental and inter-agency strategy to tackle county lines activity. I urge the Government to ensure that they provide our public services and local authorities with the support and financial resources they need to end the exploitation of some of our most vulnerable children, young people and adults.

    London is the exporting hub from which county lines activity flows into almost two thirds of police force areas across England and Wales. Every day, older gang members in the capital prey on vulnerable children and young adults, many of whom are from troubled backgrounds, have been excluded from school or are suffering from mental health problems.

    It is particularly concerning that almost half the police forces in England and Wales have reported,

    “that individuals involved with county lines came from care homes”.

    All too often, we take less notice of the safety and security of children who are in care. From cases such as Rotherham, we already know what happens when warning signs of abuse and exploitation are missed or ignored. We cannot allow that to ever happen again.

    Vulnerable children as young as 12 are being groomed by county lines gangs with promises of money, companionship and respect. In reality, they are often forced to go missing from home for long periods of time; they are used as drug mules with their orifices plugged with class A drugs, predominantly heroin and crack cocaine; and they are trafficked to remote areas and forced to deal drugs in squalid conditions. At all times, they are at great personal risk of arrest by the police—in fact, probably the only time that they are really safe—or of physical and sexual abuse from older gang members, local drug users or rival gangs.

    We must remember that this activity is associated with a lot of extreme violence. These are cases of modern day slavery. We have seen harrowing cases of vulnerable adults whose homes have been turned into drug dens by urban gangs, such as one individual who was held hostage in their own home and prevented from using their own toilet. Those vulnerable people, young children and adults, are in desperate need of our help.

    The National Crime Agency, which has reported on county lines activity since 2015, acknowledges that there

    “remains an intelligence gap in many parts of the country”.

    It states:

    “A clear national picture cannot be determined currently”

    of accurate levels of exploitation and abuse carried out in county lines activity in many parts of the country.

  • One of the most shocking stories I heard was from a mum whose child had been on the county lines. She told me how she had been trying to stop him, but how he would just come home for a rest before going off again. What was most shocking was that child protection professionals were completely and utterly unaware of him. The gangs played the system really well: social services considered her a bad mum because of the unreasonable demands she was making on her son to stay at home.

  • Absolutely; so much more needs to be done. Let us remember that county lines are somewhat below the radar: we might know about them, but the response to the Twitter reports about missing children in Enfield caused something of a public panic. The public do not know about the issue, so there is not enough pressure to introduce policies to deal with it. Drug dealers like nothing better than operating in the dark, under the radar. Young people especially may not recognise their exploitation.

    It is clear that we need to understand the creation, recruitment, opportunities, risks and scale of county lines so much better if we are to address the issue. I therefore urge the Government to commission comprehensive and rigorous research to pull together up-to-date police and local authority data to achieve that aim. After all, how can we hope to tackle the problem unless we understand its true scale? As the NCA’s head of operations for drugs and firearms threats, Vince O’Brien, says:

    “This is a national problem…there is still no national response.”

    Gangs are aware of the intelligence gaps. County lines activity is exposing the challenges of dealing with offenders who operate across police force boundaries. Part of the problem relates to police forces’ ability to work together.

    Operating across county lines is a fantastic business model for the gangs, because they are opening up new markets and operating below the radar. They have no competition at the early stages of their operation, and very low overheads because their business is based on using vulnerable children and young adults as slaves. In Enfield, a young person who is absent from school may be regularly reported as a missing person, but in Essex the same child could be deemed by the local police to be a street drug dealer or to have been forced into street prostitution. It is very likely that the two police forces could be operating in isolation from each other. Which is responsible for taking the lead? Do we need cross-border crime squad teams, like the old national crime squads?

    Progress can be made by improving how Departments and other agencies share data. In spite of the lack of national leadership on the issue, councils across London, led by Islington’s lead member for children and families, Councillor Joe Caluori, have taken proactive steps to understand the county lines that originate in their own boroughs. They are working together to cross-reference data and identify areas where further information and action are required.

    My hon. Friend the Member for Lewisham East (Heidi Alexander) may want to go into this in greater detail, but police in Lewisham have also done innovative work by looking at the numbers of missing young people over the previous 12 months, identifying those who may be at risk of exploitation and uploading their information to the police national computer. That means that Lewisham police will be contacted if any of those at-risk young people comes into contact with another police force, which will build a fuller picture of the scale of county lines activity.

    I welcome the Government’s implementation of new drug dealing telecommunications restriction orders, which allow the police to shut down phone numbers used for county lines drug dealing. However, while that is an important step forward, how much disruption will it actually cause? How long does it take for a county lines dealer to simply get another phone and begin sending drug offers to their original contact list? A lot more needs to be done to address the problem at its root.

    I am concerned that major questions about county lines remain unanswered. The county lines model is being changed all the time. We know that social media are used to recruit children and young people, but do we know enough? Is there enough research and is it moving at the right pace? There also needs to be a much stronger focus on prevention. By the time the police become involved, it is often too late to prevent irreversible harm from being done to a vulnerable child or young adult, or to ever extricate them from the world they have become involved in.

    All Government agencies and local authorities need to be able to recognise and act on the warning signs for victims of county lines exploitation. That requires proper funding from central Government, but the reality is that health, social and children’s services are being pushed to breaking point by the Government’s austerity agenda. In Enfield, the Government have slashed £161 million from the council’s budget since 2010, and the council is required to make a further £35 million of cuts by next year. Immense pressure is being placed on Enfield’s public services at a time when they are already struggling to support a rapidly growing population. How do we expect councils and other agencies to implement strategies to prevent county lines exploitation, when their resources are being cut year on year? I ask the Minister not to simply pass the buck to local authorities by telling us about raising the precept. Hard-pressed Londoners cannot make up the funding gap, and nor could raising the precept. That is not a solution and should not be put forward as one.

    Home Office guidance states that tackling county lines will involve working with groups such as voluntary and community sector organisations, providing meaningful alternatives to gangs. What we need is meaningful actions; warm words just will not do it. The stark reality is that the Government cut £387 million from youth service spending across the country between 2010 and 2016. Government cuts to London councils have slashed youth service budgets by £22 million since 2011, leading to the closure of 30 youth centres and the loss of at least 12,700 places for young people. If the Government are serious about tackling county lines exploitation, there needs to be greater investment in youth clubs for children and teenagers and in children’s services across the board.

    A standout example of best practice to tackle county lines in London is Project Denver, an initiative piloted by the Met’s Trident gang crime command unit in Enfield between October 2016 and January 2018. The project’s objectives are to dismantle one of the most violent county lines gangs in London, to identify vulnerable people who are at risk of exploitation, and to prosecute the gang members responsible. The team assigned to the initiative is made up of specialist Trident officers and local police from Enfield and other affected forces, working alongside Enfield Council and other councils within and outside London. So far, 20 operations have taken place, leading to more than 100 arrests and the identification of more than 50 vulnerable children and adults. The gang has now largely been dismantled. Formerly one of the most harmful gangs in London, it is now ranked outside the top 20.

  • I am interested in what the right hon. Lady says, but there is a slight problem with her argument. Every single time the police intervene and take down one gang, another is only too willing to step into the void. That gang will use increasing violence, because that is how these people operate: the more violent they are, the more territory they control. Every time we pull down a gang, another will step in until we get to the root of the problem: the illegal market.

  • I do not disagree with the hon. Gentleman’s points that we must get to the root of the problem and that these gangs operate in a violent manner. However, I do not think that we can leave them in place; we would be abandoning children and young people to their mercy. We need a much bigger, better-resourced operation based on national intelligence about how county lines operate. That may then help us to address the root causes of the issue.

  • I think we are trying to achieve the same thing and we are genuinely both looking after the interests of these young adults. However, if we regulated the marketplace, we would take away all the power from all the criminal gangs and all their production, distribution and selling of the product, and therefore they would not need these couriers to do the job for them. I am talking about re-regulating the drugs market at the top level, which would immediately take all the power away from the gangs.

  • I understand what the hon. Gentleman is proposing, but I do not agree with him and that would not be the solution that I would look for. I do not believe that it would necessarily solve the problem, because violent gangs would either move on to some other product or would want to sell the product at extortionate profits, whether it was legal or otherwise. We see the sale of illegal cigarettes all the time, yet cigarettes and smoking are legal, so I am not sure that I can agree with him. However, I thank him for his intervention.

  • I will allow the hon. Gentleman to intervene again shortly.

    I want to finish what I was saying about Project Denver, because when we have an example of something that works, we should pay it some attention. One of the fundamental problems is poverty and the lack of care for exploited young people. We know how effective things like Sure Start were and we know how effective neighbourhood policing, which has been decimated, was. We know what some of the solutions are, without having to legalise class A drugs.

    The gang that I was talking about has been largely dismantled and it has gone from being one of the most harmful gangs in London to being ranked outside the top 20. Earlier this month, as part of Project Denver, two drug dealers from Enfield were convicted of human trafficking offences under the Modern Slavery Act 2015, which was the first case of its kind in the UK. Those men were operating a London-to-Swansea county line and they had trafficked a vulnerable 19-year-old woman from London to a house in Swansea, where she was being held against her will, in order to supply class A drugs.

    The successful prosecution of those two men shows what can be achieved when police forces, local authorities and other agencies share data effectively. But make no mistake—this work is resource-intensive. It cannot be done successfully unless there are the necessary resources. At the moment, if police forces and local councils put resources into this work, they have to take them from somewhere else, and under the pressure of funding cuts everything is a priority right now.

    I believe that Enfield police and the Metropolitan Police Service as a whole are doing a good job, under immensely difficult circumstances, to keep Londoners safe. However, since 2010 the Government have axed more than £600 million from the Met’s budget and in the next three years they plan to cut several hundred million pounds more. The Metropolitan Police Commissioner, Cressida Dick, has warned that further cuts to the Met’s budget would lead to the loss of 3,000 officers, which is 10% of London’s police force, by 2021. That would mean that London had just 27,500 officers, which would be the lowest level in 19 years, at the same time as London’s population is growing.

    The latest figures, which are from December 2017, show that Enfield—just one London borough—has just 504 officers, which is 48 fewer officers than the borough’s target strength. The police are operating with one hand tied behind their back; they simply do not have the officers to do the job. That comes at a time when knife crime in Enfield has risen considerably; it rose by 48% in the last year alone. If the Government are intent on continuing to cut the Met’s budget, what hope is there for vulnerable children and adults who are being exploited by county lines? Do those people not matter? The Government should be under no illusion as to how resource-intensive county lines operations are. The Met must be given the resources it needs to tackle county lines in London.

    County lines exploitation is a major issue for London and the UK. As the Prime Minister has said, modern slavery is

    “the great human rights issue of our time, and…I am determined that we will make it a national and international mission to rid our world of this barbaric evil.”

    Well, Prime Minister, county lines exploitation is modern day slavery, and it is now three years since the National Crime Agency published its first assessment of it. Since then, the police, children’s services and other agencies have called for a national strategy to end this exploitation of vulnerable children and adults. On 19 January 2017, which is almost a year ago to the day, a cross-party group of London councils wrote to the Home Secretary to press the Government to implement a national strategy. So where is it?

    The Government must show national leadership on this issue. We urgently require a national strategy to ensure that consistent practice in tackling county lines is applied across all local authorities and police forces in London and throughout the country. We cannot allow more vulnerable children, young people and adults, who currently are all too often invisible to the police and child protection services, to fall between the cracks. The Government must make tackling county lines exploitation in London and across the UK a priority.

  • It is a pleasure to serve under your chairmanship, Dame Cheryl, and I congratulate the right hon. Member for Enfield North (Joan Ryan) on securing this debate and making a very powerful case in relation to tackling county lines and some of the many issues that come with that.

    More observant Members will know that Colchester, despite being Britain’s oldest recorded town and its first capital, is actually 60 miles from London. Although the subject of the debate is county lines exploitation in London, county lines have a far wider reach and impact, as we all know.

    Traditionally, although every town and city across our country has been affected by the scourge of drugs and knife crime, they have largely been the preserve of our capital and our major cities, where the vast majority of those particular types of criminality has been prevalent. However, what we are increasingly seeing, partly because of a saturation of the market in London and in some of our other major cities, is that drug-dealers and the gangs that peddle these disgusting substances are moving further afield to sell their wares and operating county lines.

    I represent a seat in Essex and traditionally we saw such activity taking place in some of the towns on the outskirts of London, but more recently—certainly over the past two and a half years—we have seen criminal gangs are moving further and further out from London, to towns such as Colchester and even to towns further afield, because of the opportunity that such new markets present.

    The right hon. Lady made a very powerful case about county lines and why we have to tackle them—in particular, because of the young people involved. In my constituency, we have seen an increase in county line activity. Those listening to this debate outside Westminster Hall may not understand what a “county line” is, and it is important that we actually spell out what it is. It is a network of mobile phone lines that are bought and sold like franchises—[Interruption.] Perhaps the right hon. Lady did explain: I may have misheard. But it is important that the public have an understanding of what county lines are, because, as she rightly said, they often go under the radar and people do not understand how easy it is—particularly for young people—to be sucked in and trapped by these drug gangs in the conveyor belt and cycle that the county lines operation represents.

    County lines are phone lines bought and sold, like franchises or small businesses. Often, the people who own them are never involved in touching drugs at all, but they increasingly use young people to spread their networks up and down the country.

    In Colchester, we have seen an increase in knife crime, which is hugely regrettable. However, what is really interesting about that increase, and it is why this debate is particularly important, is that predominantly both the victims and perpetrators of knife crime have not been from our town. They have not come from Colchester; they are from London. On one particular night, we had six knife attacks, and every single one of the individuals involved—both the perpetrators and the victims—was from London. They were part of rival drugs gangs who were coming to Colchester to sell drugs, and bringing with them the knives, the intimidation and the violence that come with that activity.

    We have also seen an increase in cuckooing. I know that the right hon. Lady touched on this issue, but it is important to spell out what a scourge on our society cuckooing is. Cuckooing is where a drugs gang, often operating through a county line, will come to a town such as Colchester and pick on a vulnerable person, whether that is someone with mental health issues, someone in social housing, a prostitute or someone who is already addicted to class A drugs. The gang will operate from that person’s property, which is often social housing, using that base to exploit that individual or individuals to sell their drugs from the location over the course of a week or two.

    An individual came to my constituency office absolutely petrified. He was clearly a class A drug user—he was perfectly honest about that—and he said, “I have had people come to my flat. They came with a gun. They took over my flat.” First, they offered him drugs, which he of course accepted; he was addicted to heroin. He said, “It has got to the point where they will not let me back in my flat. They have taken over.” He was too scared to go back to the flat, because they said that they would kill him. He came to me, and I gave the only advice I thought I could give, which was to go to the police. He went to the police station and he was subsequently arrested, because they went to the flat and found a large quantity of class A drugs. Despite that perhaps being a regrettable outcome, it was probably the best and safest place for him at that point in time. Cuckooing is becoming a major issue because it is happening more and more frequently.

  • What we are seeing here is that a person with a drug addiction went to the hon. Gentleman looking for help and the best outcome he could find was to be arrested.

  • That is not quite what I said. I said it was the safest place for him because the police were able to take action. What advice should I have given to an individual coming to my constituency office who said an individual with a firearm had taken over his property? What action the police chose to take was up to them. That is not my job as a constituency MP; my job is to protect the individual and other individuals living in my constituency when I hear a report of a firearm. The issue is for the police.

    On the wider issue of cuckooing—this is not a party political point; we all agree that we urgently need to tackle this issue across the country—what worries me most is how these drug gangs operating county lines are targeting the young and some of the most vulnerable people in our society. I mentioned that these cases often involve prostitutes, those with mental health issues, those in social housing and class A drug users, but often there are families involved in that scenario, too. Just because someone is a class A drug user, that does not mean they do not have children in the property. If a drug dealer operating a county line comes to a young person’s property and threatens them and their mother, I would not blame that young person for taking action to protect their parent, especially if they are young and vulnerable. That is why it is important that we take a long hard look at how we treat these young people and how we intervene.

    I take all the points that the right hon. Member for Enfield North made on support services. We have to do more to put support services in place. Where we identify those young people—I take her point about missing people—who are vulnerable and are involved, or in danger of being involved, in a drug gang or a county line, we have to intervene, but we have to be clear about the action we want to take. It is important that we do not criminalise those young people. We should treat them as victims, because it is dangerous to criminalise them.

    I predict that the Minister will say that if a young person is involved in a serious crime—especially a crime that affects another person, such as a stabbing—it is absolutely right that the criminal justice system takes full effect. However, if a young person has clearly been a victim and has been exploited and used as a drug mule carrying drugs about their person, as the right hon. Member for Enfield North said, or has been dealing drugs—it could even be a case of modern slavery—it is important that we send a clear message to that young person that we want to help. We should say, “We will intervene. We want to ensure that we get you back on the path to being fully involved in society.” We should not set them off down the wrong path, which is the danger in labelling them a criminal. What kind of message does that send out? When they are an exploited, vulnerable victim, what path does that set them on for the rest of their life?

    We have to be careful how we treat young people in particular. To be clear, drug gangs are increasingly using children as young as eight, nine or 10, potentially entrapping them with gifts such as trainers, phones and other things, at which point they feel completely owned by that individual or drug gang. Sometimes it is worse—sometimes it is physical violence against them or a family member who they love. The point is that we have to intervene and offer them some kind of hope and a way out of a horrific situation.

    I am passionate about tackling this issue, and I am keen to work cross-party to ensure we put in place the right measures and make support available, particularly to those young people to help them get out of that potential life of crime. I know the Minister is equally as passionate because we have had so many conversations about it. First, I urge her to encourage police forces to work far more closely on the county line issue. We need to get police forces outside London to work far more closely with the Metropolitan police in London, where sadly a lot of the county line activity emanates from. We need to put in more resources to tackle the county line issue. The Government recently put in just under £300,000, so they are taking action, but there is more to do. This is a growing issue that is largely going under the radar. Secondly—potentially this is more of a Justice issue than a Home Office issue—when we intervene and find those young people who are victims, are being exploited and have gone through the most horrific experiences, we should look at them as victims, not criminals.

  • It is a pleasure to serve under your chairmanship, Dame Cheryl. I thank my right hon. Friend the Member for Enfield North (Joan Ryan) for securing this important debate on county lines; I thought her contribution was absolutely fantastic. I was interested in the description that the hon. Member for Colchester (Will Quince) gave of the impact of county lines on the community he serves. He said that despite the fact that his community is away from London, the county lines have a corrosive effect on it.

    The National Crime Agency report “County Lines Violence, Exploitation & Drug Supply 2017”, published in November, mapped the growing extent of the exploitation of children and young people and the shocking levels of violence, intimidation and coercion used. That this has reached such levels in what we all believe to be a civilised society is shameful. The NCA accepts that it does not have a national response at this time, but following its report, it will prioritise county lines and take a co-ordinating role with local and regional police forces. I think we would all agree that that is long overdue, and it would help if the Minister expanded a little on what that might look like.

    There has been concern for some time about the growing county lines operations of organised crime gangs based in the big cities. In 2015, Missing People and Catch22 presented their report “Running the Risks” in Liverpool. It explored the links between gang involvement and young people going missing. In 2016, our all-party parliamentary group, which is supported by the Children’s Society and Missing People, reported on the safeguarding of absent children. We found evidence that children reported as absent who the police decided were at no apparent risk ended up falling through the safety net, exploited by adults for sex and/or for supplying and selling class A drugs.

    The majority of those recruited by gangs are 15-to-17-year-old boys, but boys are more likely to be recorded as absent and at low risk than girls. That is why county lines operations have been able to exist below the radar. Girls who are exploited along county lines are at increased risk of sexual exploitation and trafficking. We should not forget that children can suffer multiple exploitation. We cannot simply deal with that by putting the issues into particular silos; it all has to come together in an understanding of the exploitation of children.

    In 2017, the all-party group held a roundtable on children who go missing and are criminally exploited by gangs. We warned that the safeguarding system was failing children because of a lack of understanding of the signs of exploitation and because many children were still being seen as criminals and not victims—a point made by my right hon. Friend the Member for Enfield North and the hon. Member for Colchester. Looked-after children are particular targets for grooming by criminal gangs, and those placed out of the borough can be especially vulnerable, as are young people in pupil referral units. Such children are particularly vulnerable to exploitation because of the circumstances of their lives and their exclusion from schools.

    Preventing young people from becoming embedded in gangs has to be a priority. Key to identifying early risk is the sharing of data on missing children. Frequent missing episodes and being found out of area, returning from missing episodes with injuries and unexplained absences from school were all highlighted as being signs that a young person could be involved in county lines activity.

    There are issues about how missing data is collected and shared. I welcome the new missing persons database that will be operational later this year, but how effective it will be will depend on the information gathered by local police forces. Will the Minister say when the missing persons strategy will be updated? Recognition of missing episodes as indicators of potential criminal exploitation, followed by appropriate and timely responses, might prevent further exploitation of vulnerable children and young people. Disrupting county lines and convicting the criminals behind them is vital. Organised crime has been getting the message that, provided they use children and young people, we are powerless to do anything about it.

    On 4 December, our APPG held an event at the House of Commons, attended by experts, professionals, police and practitioners to discuss the disruption of county lines and how children and young people can be better protected. There was overwhelming support for more use of trafficking legislation and the Modern Slavery Act 2015.

    The national referral mechanism was set up in 2009 to identity victims of human trafficking or modern-day slavery. Acceptance by the national referral mechanism clearly identifies the young person as a victim, even if they have committed a criminal act, which is very important in the context of criminal exploitation. Evidence from the Children’s Society and ECPAT shows that the knowledge, understanding and implementation of the national referral mechanism is patchy. ECPAT is also concerned that the national referral mechanism does not necessarily trigger any safeguarding response and should be embedded into the child protection system.

    As my right hon. Friend the Member for Enfield North mentioned, there have been very few prosecutions under the trafficking legislation. One of them was at Swansea Crown court—the case that she mentioned, the first of its kind, against the gang operating out of London. There are ongoing cases in London, but, as with any new legislation, the police and CPS will be waiting to see how successful those cases will be.

    We need effective tools to prevent young people from being used as drug mules by organised crime. Lewisham has used criminal behaviour orders, which can prohibit a young person from travelling to certain places, which makes them less attractive to the criminal gang. Child abduction warning notices can also be served on individuals suspected of grooming children and young people. Although there are some issues with those, such as the need to consult with parents—we can all see what the problem with that might be—they clearly identify that it is an individual adult who is exploiting children and it is the child who is the victim, which puts the responsibility where it belongs. That might encourage communities to look at the people operating in their communities as exploiters of children and might help to change attitudes towards those people.

    However, there should be a notice that is more in keeping with the trafficking legislation than the Child Abduction Act 1984 is, and it should apply to all 16 and 17-year-olds, which child abduction warning notices do not. Breach of the new notices could then be used as evidence to apply for orders that carry penalties under the trafficking legislation. Will the Minister support such an approach?

    We have a fragmented safeguarding system that responds to the child as a victim or as an offender and does not recognise that a child can be both. The most powerful contribution to our December meeting was from a parent who had battled hard to get safeguarding agencies to understand that her son, who was being groomed into criminal activities, was an exploited child. Her son became more and more embedded into county lines and ended up being stabbed. The parent said:

    “It became so frustrating as all services that were assigned to working with my son in this period were all working as separate entities. With this came, on many occasions, lack of communication, oversight or duplication of what was meant to be done or not take place, and this caused me great distress.”

    In the end, she herself set up an email group for all the many agencies to co-ordinate information about her son, which proved helpful. It is important to learn from the experience of parents to make sure that the safeguarding response that a system provides is helpful to both the young people and parents and does not make a bad situation worse. It is important to understand the impact of out of borough placements on young people, which can expose them to further risk rather than protect them.

    We need to challenge public attitudes that blame the young person for their own exploitation. This echoes the early cases of child sexual exploitation where the young girls were written off as prostitutes. But who can blame the public when that was the view of the agencies tasked with safeguarding children? Education is crucial. The Greater Manchester police “Trapped” campaign focuses on county lines, aims to raise awareness of the grooming process in communities and schools, and encourages communities to spot and report exploitation of young people.

    Greater Manchester police says that county lines is a much broader issue than drugs and also involves the transportation of firearms and money. It is a developing business model, as my right hon. Friend the Member for Enfield North has already said. It is vital for police forces and agencies to work well together, so Greater Manchester police is working closely with forces that have an expanse of rural areas such as Cumbria, Cheshire, North Wales and Lancashire.

    The excellent Greater Manchester police YouTube video, made for the “Trapped” campaign, illustrates vividly how a child drawn by the offer of cash becomes more and more embedded in the gang. What at first seems like easy money becomes a miserable existence of escalating violence and threats to life. We know that certain factors make children more vulnerable to exploitation, but all young people can be vulnerable at the time of transition from primary to secondary school. That is why it is important that sex and relationships education in schools involves raising awareness of criminal exploitation and county lines.

  • I completely agree about the transition period being a risk. Does my hon. Friend agree that the pupil referral unit, where we have seen gang members hanging around to recruit youngsters who often are vulnerable, is also a risk?

  • My right hon. Friend is absolutely right. Young people in PRUs are specifically targeted by organised crime because of their vulnerabilities. Vulnerable young people often feel there is nothing else for them on the horizon except what the drug dealer might offer. Poverty, poor housing, unemployment and living in a high crime neighbourhood creates the conditions for county lines to flourish.

    County lines is also a public health issue. We cannot ignore the demand for drugs and the impact on individuals, families and children’s health. Health needs to be part of the safeguarding response to county lines at a national and local level. I thank the Minister for meeting me recently to discuss many of the issues.

    Recent media coverage has meant an increase in the awareness of the extent of exploitation of children by organised crime, reaching beyond high-crime areas to communities that have never experienced the brutality and violence that comes with county lines. It is progress that there is increasing awareness and that the National Crime Agency is taking a national co-ordinating role. There has to be an effective response by the police leading to successful prosecutions so that county lines are disrupted. Alongside that there needs to be better identification of children at risk by agencies working together at a local and national level. There need to be better interventions earlier in children’s lives, and more resources.

  • It is a pleasure to follow the contributions of my hon. Friend the Member for Stockport (Ann Coffey) and the hon. Member for Colchester (Will Quince). Both Members spoke with a huge amount of sense, obvious compassion and a clear understanding of the issues. I congratulate my right hon. Friend the Member for Enfield North (Joan Ryan) on securing the debate. She made a characteristically well-informed and engaging speech, which, as my hon. Friend the Member for Stockport said, was thoroughly excellent.

    I agree with my right hon. Friend that there should be a co-ordinated national approach to tackle the running of drugs along county lines and that we need to review the way in which we deal with children, young people and vulnerable adults who get themselves caught up in such activity. I also believe that we need to consider tougher sanctions for those directing and driving such activity and to ensure that the Crown Prosecution Service, the police and local authorities have the resources and powers that they need to tackle the problem.

    I first learned about the phenomenon of county lines drug running about four years ago, following a visit to my advice surgery by a distressed mother. I can picture her now: she was a woman living three or four roads away from my home in Lewisham; she was originally from Sierra Leone, and spoke limited English; and she was in a state of desperate confusion. Her teenage son had been arrested the previous day in Portsmouth. I asked, “What’s he doing in Portsmouth?”. She did not have an answer, but she was scared stiff about what was going on, and what she feared had been going on for a while but could not describe. She was crying out to me, as her Member of Parliament, for help.

    The mother said that she could not cope. She talked about strange men hanging around her front door, and the fact that her son would disappear for short periods. She did not know what he was doing, and she asked me to help her find out what was going on. Her son was involved in running drugs from Lewisham to the south coast. There are currently 317 under-25s from Lewisham believed to be involved in that activity, of which about 200 are of school age. They are supplying drugs in 19 different counties. That is 200 school-age children from one London borough out of 32, so the problem is not insignificant.

    Last year, as a result of a two-year operation involving the police and the local authority, 174 arrests were made, including 22 key adults. A number of the individuals who were arrested are still awaiting their criminal justice outcomes, but so far 121 years of prison sentences have been handed out collectively. Some 23 kg of class A drugs were seized, with a street value of £4.5 million. Lewisham Council, thanks to the leadership of officers such as Geeta Subramaniam and elected councillors such as Janet Daby, has taken a proactive approach to tackling the problem. Some of my colleagues have spoken about the sorts of measures that have been taken. Those people at the council are determined to stop the involvement of children, and let us be clear that some of the individuals involved in this activity are children. I get the sense, though, that they are frustrated.

  • I may be putting myself on the line here again, but I refer the hon. Lady to Neil Woods, who was an undercover police cop and drug officer for 14 years. He put his life on the line to fight against such people. He probably knows more about cuckooing, county lines, and the production and distribution of drugs than all of us put together. Neil himself estimates, having worked for 14 years and put people away for thousands of years in cumulative prison terms, that he disrupted the supply of class A drugs by a total of two hours across his entire career. I am not saying that we should not be trying to do it, but how we are going about it clearly is not working.

  • I have some sympathy with what the hon. Gentleman says, because I think that what happens in prison to rehabilitate offenders and to take them off the path that they are on is just as important as how many years they spend there. I am not sure at the moment that the system operates correctly, so I have some sympathy with his point. However, the point I am making is about the scale and significance of the activity in one part of London, and the action that is being taken by the local authority and the police to try to tackle it. As I will come on to say, that is very difficult in a time of constrained resources and with the funding pressure that the Metropolitan police and local authorities such as Lewisham are under.

    As I was saying, I get the sense, from talking to police and council staff, that they are frustrated in trying to tackle the problem. A number of years ago, there was an operation called Operation Pibera, in which the local authority, in conjunction with the CPS and the police, tried to bring charges of trafficking under the Modern Slavery Act 2015. Unlike Enfield, they were not successful in securing those prosecutions. They wanted to bring those charges because the sentences associated with that sort of conviction would be longer than for the other lesser offences with which the individuals could have been charged.

    The guys who are in control of the activity and who are luring, and sometimes coercing, children, teenagers and vulnerable adults into getting involved should feel the full heat of the law. They are people who will stab someone who wants to get out of doing the drug running. They are taking advantage of kids and adults with mental health problems by, in effect, getting them to do their dirty work. It is despicable, and rather than simply going for the low-hanging fruit of charging the individuals found with the drugs or the money on the day, there needs to be a mechanism in place to hold the guy at the top responsible.

    As I understand it, the Modern Slavery Act was drafted primarily to deal with problems around individuals forced into sex work and domestic servitude. The running of drugs along county lines is different. Some of the underlying principles may be similar, but I would be interested to know whether the Minister agrees that it might be sensible to review whether amending the Act could make it easier to bring successful prosecutions, to ensure that those calling the shots on the county lines are held responsible.

    It has been put to me that one of the changes that might be considered is changing the law to require the police and the CPS to prove, in relation to drug offences committed by, for example, teenagers on the county lines, that they were not being exploited, but were knowingly and willingly involved in the activity. The Minister would need to consider that issue in the round, but I would be interested to know whether she is looking at amending the Modern Slavery Act in any way. I believe that some 14-year-olds will know exactly what they are doing, but others will be victims, and we need to take our responsibilities to those children and young people seriously. Just because they might not be cared for, that does not mean that they do not matter.

  • I am grateful to my hon. Friend for giving way; everybody has been very generous this morning. One mum told me what she had heard about how county lines were being run. She told me about the provision of a gift such as trainers to an individual, which is then considered to be a drug debt that has to be paid back. When the child goes on the county run to pay back the debt, they are robbed by the very people who sent them out, which means that the debt gets higher and higher, and the child has to work it off. They cannot go to their parents to ask for money to pay off the drug debt, because they are often not wealthy people, or the individuals simply do not want to burden their parents by asking for that kind of money. It is coercion and slavery, whichever way we look at it.

  • My hon. Friend highlights the precise problem.

    How we prosecute individuals involved in this crime needs attention, but so do the tools that the police and local authorities have at their disposal to detect and disrupt such activity. I know that the Government recently introduced regulations to allow the police to apply to a court to close down the mobile phone being used to receive the drugs orders, for want of a better word for them. I know that those regulations were introduced only in December, but it would be helpful to receive an update from the Minister on whether any such applications have been made, and whether they have been successful.

    Will the Minister say what resource is being given to the Metropolitan police, the National Crime Agency and local authorities in London to ensure that the basic tasks that are needed to track and monitor such activity can be carried out comprehensively and in a timely fashion? I know that Lewisham Council is keen to do more work on a pan-London basis, looking at how statutory agencies might use social media more effectively to track and predict county lines activity, but that, of course, needs to be funded.

    It also seems to me that the work done by councils and the police in big cities such as London to educate young people about how to stay safe is absolutely critical. We teach young people road safety. We need to have the same focus on bullying, knife crime, drugs and healthy relationships in our schools. We can pretend that this is not happening, but that is not doing anybody any favours. We also need to ensure that parents are involved in that conversation. All of that costs money and my genuine concern is that it is money that local authorities and the police do not have.

    In my first term as a Member of Parliament, I visited the parents of three boys who had been stabbed to death in my constituency. I never want to do that again. My fear is that the postcode wars of seven or eight years ago, where gangs were defined by territory and violence escalated through revenge stabbings, are being replaced with gangs running drugs down to different parts of the country. The outcomes—people being stabbed and poor kids living in fear—are exactly the same. I do not want children growing up in Lewisham to have that on their plate. We need to find a way to join up the pieces of this jigsaw puzzle, treat children as victims when they genuinely are, take tough action against the ringleaders and find a way to stop the problem spreading. It already ruins too many lives in places such as Lewisham. The least we can do in this place is to try to work out a way to tackle it.

  • We now move on to the Front-Bench speeches. I am sure the hon. Ladies on both Front Benches will know how to divide the time equitably.

  • Thank you very much, Dame Cheryl. It is a pleasure to serve under your chairmanship, and it is a pleasure to respond to this debate today, as it has been a fantastic one, with so many well researched, thoughtful and excellent contributions—not least from my right hon. Friend the Member for Enfield North (Joan Ryan). I congratulate her on securing the debate and continuing the discussion on this issue in Westminster Hall. She gave a fantastic and thorough overview of the exploitation and treatment of these young people—many of whom, as she said, do not feel themselves to be exploited—and of the very profitable business model that underpins the crime, which combines kidnap, child abuse, drug dealing, trafficking and violent crime.

    Right hon. and hon. Members spoke from personal experience today about their own constituents, whether young victims themselves or the victims of cuckooing, which the hon. Member for Colchester (Will Quince) spoke about. I know he has done a lot of work in this area. He demonstrated the implications of the crime on not just London but towns outside London and spoke of the victims in his constituency. He spoke of the need, as everyone did, to support victims, rather than criminalise those young people. Rotherham was mentioned as a comparator. The similarities are key here. I have spoken to many survivors of the Rotherham scandal who told me that they were treated as sluts rather than victims. I have spoken to Sammy Woodhouse, who has been campaigning for Sammy’s law, which would allow their criminal records associated with the grooming to be expunged, and Labour is very happy to support that. The situation has very strong similarities here, because those children and young people were victims, just as many of these young people are.

    My hon. Friend the Member for Stockport (Ann Coffey), who is nothing less than an expert on this issue—and has worked on it over many years, in particular on the vulnerability of looked-after children—gave some great examples of good practice in this area on criminal behaviour orders and child abduction warnings. She made the very sensible case for treatment under trafficking legislation.

    My hon. Friend the Member for Lewisham East (Heidi Alexander) gave a very thoughtful and emotional contribution, again distinguishing between victims and offenders, who should face the true sanctions that this horrendous crime deserves. She laid out the scale of the problem in just one borough and police force area out of 32. She made some important points about the Modern Slavery Act, which I will come on to, and the difficulties of prosecutions under that Act, and about how relevant it is for this offence, which is nothing less than slavery. I know how useful it has been as a deterrent in Merseyside, which has had some success in prosecuting offenders under the Act, because those gang members have not been treated as big kingpins in prison. They have been treated differently under the Modern Slavery Act and been isolated in prison and it has served as a deterrent for other people who could potentially be involved. We absolutely support the hon. Lady’s call for a review of that legislation.

    We have heard shocking examples of the practice from around the country. We know that London is the biggest metropolitan supplier of this crime, but the National Crime Agency has found that 38 of the 41 forces in England and Wales have identified this form of exploitation taking place in their area. The Children’s Society estimates that 4,000 children are at risk from this crime every year across England and Wales.

    Organised crime and its associated effects lead to hundreds of deaths every year, with figures for 2016 showing 2,479 deaths from illegal drugs alone. Though figures for deaths from the violence linked to organised crime are not specified, it is a significant factor in gun and knife violence. A total of 26 people were shot dead in the year to March 2016, and a further 213 were victims of stabbings.

  • May I recommend my review to my hon. Friend, in which I talk specifically about youth crime and the disproportionality of black and ethnic minority children going into the youth justice system? We have to do more to use the exploitation legislation and understand that these young people are just as vulnerable as many of the young women that we have raised in the past.

  • I have of course read my right hon. Friend’s review and thoroughly recommend it to all other Members in the Chamber today. It is a very thorough overview of the criminalisation of black and minority ethnic young people and people of all ages in our criminal justice system and the pervasive attitudes that still exist, sadly, across elements of our criminal justice system, which lead to that over-criminalisation.

    It is no surprise that as serious and organised crime grows, as we have heard today, violent crime is rocketing. The threat is growing and the police are struggling to keep up. They have suffered horrific cuts over the last seven years, which have devastated local intelligence collection. Now, in unprecedented fashion, senior officers are sounding the alarm across the UK. Unfortunately, serious and organised crime and violent crime are only one part of the picture of the demand that our police forces face, as 999 and 101 calls are up by as much as 30% on last year. Some 83% of the calls to command centres are non-crime related. They are related to mental health and missing persons—vulnerable people—and the police are not the appropriate agency to be dealing with vulnerable people. In some forces, missing persons are up by 300% in the last five years.

    Violent crime is up by 13% on last year. In that time, our police forces have lost more than 20,000 officers and more than 40,000 police staff. As we have heard, the only response from this Government is to require police and crime commissioners to increase the precepts. That will not fill the gap that has been left by cuts to police forces, alongside cuts to the Crown Prosecution Service, courts and local authorities.

    The chief constable of Merseyside Police, Andy Cooke, has warned that fewer neighbourhood officers make it harder to win the trust of local communities and make it more likely that there will be a wall of silence to protect local gangs and criminals. The director general of the National Crime Agency is increasingly concerned that organised crime is not being prioritised. She said that the £377 million annual funding handed to the NCA by the Government is nowhere near enough, given the severity of the threat. She said that

    “we have got to recognise that it needs investment if we are going to protect the public from some of the most invasive crimes.”

    There is simply no precedent in the service’s modern history for tackling the phenomenon of organised criminal gangs while so starkly under-strength. That has hampered the effort to tackle county lines, which has been referred to as a hidden crime. It took time for it to be given the recognition it warrants as a highly exploitative crime, partly because of the difficulty police have in identifying it. The runners involved can appear initially to be voluntary and often a number of red flags would need to be raised before the practice itself is identified. That requires a good deal of police work. Indeed, that was the point in establishing the more elusive form of criminality in the first place—that it would be difficult for the local force to identify non-resident dealers.

    The successful prosecution of a leading member of a gang that used county lines in London revealed that the activity regularly brings in up to £150,000 a month for one particular criminal gang, causing incalculable harm in the process. It is the number of exploited children that truly marks out this form of crime as horrifying. One metropolitan force told me that, in one city alone, organised criminal gangs are able to exploit a pool of 20,000 to 30,000 children who are missing or absent from school or home by coaxing them into their criminal networks.

    The reach of county lines is deeply concerning, and very few forces are immune. The National Police Chiefs’ Council estimated that there are 282 county lines coming out of London, and that they reach 65% of forces nationwide. The work to break those networks is onerous and costly. Intelligence collection is critical to bringing the leading figures in the networks to justice, but it is through safeguarding that vulnerable youngsters can be protected and the practice disrupted. That is why it was astonishing to learn that, last year, the Government rejected a force’s bid for funding from the police transformation fund to do exactly that kind of safeguarding work, focusing specifically on county lines and stopping the flow of vulnerable youngsters into the criminal practice. At a time when serious and organised crime is growing, it is perverse that a bid to safeguard youngsters who may fall into criminal gangs was rejected.

    I want to leave the Minister plenty of time to respond to all the points raised today. I would welcome some further clarification from her about the operation of the networks and the telecommunications order, which was mentioned. I was pleased to support measures to disrupt these networks’ means of communication at the end of last year, but at the time I raised concerns about the speed and the effectiveness of the measures in taking down the networks of those suspected of dealing in county lines. I also said that criminals could easily switch phones and continue to communicate. The NCA’s most recent report seems to support those concerns. Many forces identify that criminals use more than one phone line. I appreciate that the new measures have been in place for only a month, but I would welcome an update from the Minister on how they are operating.

    The NCA also said that we need a more consistent approach to capturing county lines intelligence. What role is the Home Office playing in helping to build a picture of the threat so we can assess the true scale of the practice? It has a clear definition of county lines, but a variation in its application has caused a potential blurring of the threat picture and may account for some perceived discrepancy in activity. What efforts are being made to capture and utilise county lines intelligence to ensure it can be accessed by all relevant stakeholders, not just police forces?

    I reiterate my call for a review of the Modern Slavery Act 2015 and the way it is applied to county lines. It is crucial, as all hon. Members said, that such children are treated as victims and are placed on the national referral mechanism. As the Children’s Society said, the response to child victims is too often punitive, rather than protective. We need a national response to ensure that all police forces in all circumstances understand that they are victims, not criminals.

  • It is a pleasure to serve under your chairmanship, Dame Cheryl. I congratulate the right hon. Member for Enfield North (Joan Ryan) on securing this debate on this incredibly important issue, and on making her points in such a compelling fashion. She made clear the very real impact on constituents and the feeling in local communities, as did hon. Members from both sides of the House. This is one of those rare issues on which we can reach cross-party agreement. This debate has made clear the commitment to tackle it—not just in London, but nationally.

    Drug gangs target vulnerable young people—including, sadly, as the hon. Member for Stockport (Ann Coffey) said, children in care and those who have had a very difficult time at home. Gangs deliberately target such children because they know they are susceptible to peer pressure and the influence of adults. They beguile, entice, flatter and befriend them, and when they have ensnared them, they put them to criminal work. It is exploitation pure and simple, which is why I am pleased that we are beginning to see such cases prosecuted under the Modern Slavery Act 2015, which gives them the stigma they deserve, at the same time as tackling criminality.

    As we have heard, once caught up in county line gangs, children are at risk of extreme physical and sexual violence, gang recriminations and trafficking. My hon. Friend the Member for Colchester (Will Quince), who has done much work in this area, set out cogently the effect that such violence has had in his market town, 60 miles from London.

    County lines gang activity and its associated violence, drug dealing and exploitation has a devastating on young people, vulnerable adults and local communities, including the parents, as the hon. Member for Lewisham East (Heidi Alexander) said. This is a relatively new phenomenon. The hon. Lady said that she met constituents involved in this issue for the first time four years ago. I suspect that that was the beginning of this terrible new phenomenon; we were not debating it in 2010 or 2011 because it was not a problem.

    We must give the police and others who have to deal with such gangs a bit of room to pace up and understand the way these cases and gangs are developing, because it is an extremely dynamic situation. We know that gangs are looking for new markets at all times to “diversify” their businesses. It is extremely fast-moving. Everyone involved—the Home Office, the police, local authorities and charities—has to react quickly to these situations.

    Please be under no illusion: the Government are determined to crack down on this phenomenon, help those who work so hard on the frontline to support children, and investigate and prosecute the gang leaders. In short, we want to rescue and safeguard the victims, and take the gang leaders off our streets. How do we identify the gangs and support the victims? There must be both a national and a local approach to county lines, given the geographical range of some of the gangs. As hon. Members said, we cannot focus just on law enforcement. We have to look at the care we give to the children who are dragged into the gangs, and prosecute the gang leaders.

    We have set up a national group to deliver a co-ordinated programme of action to tackle this issue. Through that group, which includes heads of police and other agencies, we have engaged social workers, health practitioners and law enforcement, as well as trained school nurses and housing support officers to raise awareness among the groups of people who reach into the lives of those children and their parents. We are trying to raise awareness among those groups so they can spot the signs of exploitation and point the young people in the right direction.

    We completely understand that we need a multi-agency response, and that is what we are trying to do through the national group. The national group then reports to an inter-ministerial group. I appreciate that, outside Whitehall, all these different groups may not mean very much, but that means that Ministers have an understanding for their Departments. We meet regularly—I chair the group—so we can understand what, for example, the Department for Education and the Ministry of Housing, Communities and Local Government are doing to tackle this dreadful gang crime. We will outline further action on this issue on our forthcoming serious violence strategy, which will be published early this year.

    The hon. Member for Stockport understandably focused on the issue of missing people. She has so much expertise on that issue and has worked on it for so long; it was a pleasure to meet her recently to discuss her concerns. The safeguarding response to such children is at the heart of protecting young people involved in such exploitation. We have published guidance to raise awareness of the fact that missing is a clear indicator of potential county lines involvement. We have funded local reviews through our ending gang violence and exploitation programme, which I will talk about in a moment, to improve the multi-agency response.

    Missing people, in the context of county lines, will be highlighted in the forthcoming missing people strategy, which we are working hard on. The hon. Lady knows only too well how complex the issue is. We want to get it right, and we hope to publish that strategy in the coming months. I have listened to what she has said about child abduction warning notices, which we will consider carefully.

    On tackling gangs, we have the ending gang violence and exploitation programme, which again draws together all the relevant Departments—the Department for Education, the Department of Health and Social Care, and so on—so that we work collaboratively on the complex features of county lines. Through that programme, rather like the national group, we know that health professionals, school nurses, housing officers and so on are being given training and being made aware of the key indicators of involvement so that they can spot victims and give them the help needed.

    We also need the public’s help. I have been struck by the submissions of colleagues that some parts of the public are not aware of the phenomenon, and that is why this year we are running a nationwide campaign to ensure that parents know when things are perhaps not going right at home with their children, and where to go to seek help.

    Through the national ending gang violence and exploitation programme, we are also trying to help local projects on the ground. That includes £300,000 for a new support service operated by the St Giles Trust and Missing People to provide additional support to young people exploited through county lines. That includes one-to-one support for county lines victims travelling between London and Kent; specialist return-home interviews, with subsequent referral and care plans for victims; and scoping work to identify how our support can be improved.

    In addition, we have given £100,000 to 15 local area reviews outside London, because those are the areas the gangs are targeting. We want to enable those areas to look at what they are doing to ensure they are responding to the threats to young people—not just those from London but young people in their areas, because the gangs recruit locally as well.

  • I am listening intently to the Minister. She has pointed to the ending gang and youth violence strategy and to different areas that feed into her, with lots of different projects working together at different times. However, what many Members have asked about and what I am interested in is: how does this all link up? Are databases being shared, or is there cross-working among the different areas? If not, how will the Government ensure that we manage that better?

  • We may understand this in Whitehall, but I appreciate that we cannot wander around the streets of London talking about strategies. However, it is through such strategies that we draw all the partners together. There is a great deal of collaborative work on this, because we know that a child may start in London but end up on the other side of the country—north, south, east or west.

    I will come to law enforcement in a moment, but there is also a great deal of work going on between police forces. Such things are not always on the front page of the local newspaper, because that would not be appropriate, but we ensure that officers talk to each other and share intelligence, as happened in Swansea, so that they know when gangs in London are coming to an area outside and the police can work together to bring a prosecution.

    Young people’s advocates are also important. We have heard a lot today about youth clubs and so on. Since 2012, young people’s advocates have been funded in London, Manchester and Birmingham. They do an incredible amount of work, in particular with women and girls. We have not spoken much today about the impact of such issues on women and girls, but they can be terribly affected by sexual violence in gangs. Recently, I visited a charity called Safer London, which has young people’s advocates working with young women who have been sexually exploited, sometimes pimped out by the gangs or used in gang recriminations. Those advocates can do a great deal to turn around such women and girls’ lives.

    Other organisations that we are helping include Redthread, which targets—that sounds like the wrong word; I should say “focuses”—on young people in London when they come into accident and emergency with stab wounds. Redthread tries to reach them at that most vulnerable point in their lives to break them free of the gangs. We have also just handed out more than £800,000 to local knife-crime charities—some Members might have received a letter from me about local charities that have received such funds—to ensure a local approach, because areas are different and we do not assume that what will work in one part of London, for example, would work in another. We rely very much on local charities with their expertise on knowing what will work.

    Other strands of work include a local projects fund of £280,000. MOPAC, the Mayor’s office for policing and crime, and police and crime commissioners play a very important role. We are pleased that the Mayor of London is continuing with the London gang exit scheme, which tries to get young people out of gangs.

    I am conscious about leaving time for the right hon. Member for Enfield North to respond, so I will move on to prosecution. I used to prosecute drug traffickers and other criminals for a living, and I am keen that we target the leaders of the gangs. I have heard what has been said about the Modern Slavery Act 2015. To our collective recollection, we have had no request from any arm of law enforcement to review the Act; law enforcement is using the Act as it stands. Of course, if we get such a request, we will consider it, but we have had no such request yet.

    The problem, as the hon. Member for Lewisham East emphasised, is getting the people at the very top; sadly, that has always been the case—I speak as someone who used to prosecute gangs. Trying to get the people at the top, rather than those lower down the rungs, is very difficult, but that is not the fault of the Act; it is the difficulty of drawing the evidence together so as to get, for example, conspiracy to supply class A drugs on the indictment. The police are very much working on that, and the National Crime Agency has prioritised county lines as a national threat. It is working on that across the country. It has had a 100% response rate from all forces with its latest report, which gives the best intelligence assessment we have had so far.

    To focus in, however, because I am conscious of the time, I should say that we have had some success in the area of prosecution. I am very pleased that two defendants in Swansea recently pleaded guilty, and other cases under the Modern Slavery Act are in the pipeline. Drug dealing telecommunications restriction orders are in force, but I cannot give any more detail on when the first one will be used, for operational reasons. The police, however, were very excited to have those orders as a power and they intend to use them. I hope that at some point I will be able to update the House on that.

    Be under no illusions—as a Government we are very committed to tackling county lines. To quote a police officer to whom I spoke recently, who is tackling such gangs in her local area: “They are stealing our children.” That sums it up. We cannot and will not allow them to do that, and we will do everything we can to stop it.

  • I thank all hon. Members who have taken part in the debate. We have heard some thoughtful, knowledgeable and concerned contributions. There is widespread concern about the issue among all those who know about it.

    I accept the Minister’s commitment to deal with the issue, which demands a cross-party response, and I accept that the Government wish to deal with it. However, we have to will the means to make an impact. I have found the police refreshingly honest about the need for the resource, the difficulty that forces have working across county lines and, therefore, the need to develop that ability.

    The Minister talked about sums such as £300,000 to support exploited children or £100,000 for local area reviews. Of course, that is all very welcome—who is going to refuse funding for such important issues? However, they are tiny sums in the face of the fact that, over a 10-year period from 2010 to 2020, the Metropolitan police will have suffered a cut of £1 billion, and London local authorities anything from £150 million to £200 million.

    If we are to make meaningful inroads into tackling this issue, as we all want, we have to will the means, and the resources have to be put in. That is the only way we will make real progress, rather than having one or two examples that we are pleased about, but which will not solve the problem or protect vulnerable children and adults.

    Question put and agreed to.

    Resolved,

    That this House has considered county lines exploitation in London.

  • Ethics and Artificial Intelligence

  • I beg to move,

    That this House has considered ethics and artificial intelligence.

    It is a pleasure to serve under your chairmanship, Dame Cheryl. I welcome the Minister to her new role, following the reshuffle last week. She leaves what was also a wonderful role in Government—I can say that from personal experience—but I am sure that she will find the challenges of this portfolio interesting and engaging. No doubt she is already getting stuck in.

    I would like to start with the story of Tay. Tay was an artificial intelligence Twitter chatbot developed by Microsoft in 2016. She was designed to mimic the language of young Twitter users and to engage and entertain millennials through casual and playful conversation.

    “The more you chat with Tay the smarter she gets”,

    the company boasted. In reality, Tay was soon corrupted by the Twitter community. Tay began to unleash a torrent of sexist profanity. One user asked,

    “Do you support genocide?”,

    to which Tay gaily replied, “I do indeed.” Another asked,

    “is Ricky Gervais an atheist?”

    The reply was,

    “ricky gervais learned totalitarianism from adolf hitler, the inventor of atheism”.

    Those are some of the tamer tweets. Less than 24 hours after her launch, Microsoft closed her account. Reading about it at the time, I found the story of Tay an amusing reminder of the hubris of tech companies. It also reveals something darker: it vividly demonstrates the potential for abuse and misuse of artificial intelligence technologies and the serious moral dilemmas that they present.

    I say at the outset that I believe artificial intelligence can be a force for good, if harnessed correctly. It has the potential to change lives, to empower and to drive innovation. In healthcare, the use of AI is already revolutionising the way health professionals diagnose and treat disease. In transport, the rise of autonomous vehicles could drastically reduce the number of road deaths and provide incredible new opportunities for millions of disabled people. In our everyday lives, new AI technologies are streamlining menial tasks, giving us more time in the day for meaningful work, for leisure or for our family and friends. We are on the cusp of something quite extraordinary and we should not aim deliberately to suppress the growth of new AI, but there are pressing moral questions to be answered before we jump head first into AI excitement. It is vital that we address those urgent ethical challenges presented by new technology.

    I will focus on four important ethical requirements that should guide our policy making in this area: transparency, accountability, privacy and fairness. I stress that the story of Tay is not an anomaly; it is one example of a growing number of deeply disturbing instances that offer a window into the many and varied ethical challenges posed by advances in AI. How should we react when we hear than an algorithm used by a Florida county court to predict the likelihood of criminals reoffending, and therefore to influence sentencing decisions, was almost twice as likely to wrongly flag black defendants as future criminals?

  • I congratulate the hon. Lady on this debate; it is a fascinating area and I am grateful to be able to speak. On her last point, I understand that in parts of the United States where that technology is used, there are instances where the judges go one step further and rely on those decisions as reasons to do things. The decision is made on incorrect information in the first instance, and then judges say that because a machine has made that decision, it must be even better than manual intervention.

  • The hon. Gentleman is quite right to raise that concern, because that goes to the heart of the issue, particularly when risk data is presented as incontrovertible fact and is relied on for the decision. It is absolutely essential that those decisions can be interrogated and understood, and that any bias is identified. That is why ethics must be at the heart of this whole issue, even before systems are developed in the first place.

    In addition to the likely reoffending data, there is a female sex robot designed with a “frigid” setting, which is programmed to resist sexual advances. We have heard about a beauty contest judged by robots that did not like the contestants with darker skin. A report by PwC suggests that up to three in 10 jobs in this country could be automated by the early 2030s. We have read about children watching a video on YouTube of Peppa Pig being tortured at the dentist, which had been suggested by the website’s autoplay algorithm. In every one of those cases, we have a right to be concerned. AI systems are making decisions that we find shocking and unethical. Many of us will feel a lack of trust and a loss of control.

    On machine learning, a report last year by the Royal Society highlighted a range of concerns among members of the public. Some were worried about the potential for direct harm, from accidents in autonomous vehicles to the misdiagnosis of disease in healthcare. Others were more concerned about potential job losses or the perceived loss of humanity that could result from wider use of machine learning. The importance of public engagement and dialogue was acknowledged by the Minister’s Department in its 2016 report. I would welcome an update from her on the kind of public engagement work she thinks is important with regard to AI.

    I will turn to the related considerations of transparency and accountability. When we talk about transparency in the context of AI, what we really mean is that we want to understand how AI systems think and to understand their decision-making processes. We want to avoid situations of “black-boxing”, where we cannot understand, access or explain the decisions that technology makes. In practice, that transparency means several things: it might involve creating logging mechanisms that give us a step-by-step account of the processes involved in the decision making; or it could mean providing greater visibility of data access. I would be interested to hear the Minister’s thoughts on the relative merits of those practices. Either way, transparency is particularly important for those instances when we want to challenge decisions made by AI systems. Transparency informs accountability. If we can see how decisions are made, it is easier for us to understand what has happened and who is responsible when things go wrong.

    Increasingly, major companies such as Deutsche Bank and Citigroup are turning to machine learning algorithms to streamline and refine their recruitment processes. Let us suppose that we suspect that an algorithm is biased towards candidates of a particular race and gender. If the decision-making process of the algorithm is opaque, it is hard to even work out whether employment law is being broken—an issue I know will be close to the Minister’s heart. Transparency is crucial when it comes to the accountability of new AI. We must ensure that when things go wrong, people can be held accountable, rather than shrugging and responding that the computer says “don’t know”.

  • I will try not to intervene too much, but the point about transparency in the process and the decision making relates to the data that is used as an input. It is often the case in these instances that machine learning is simply about correlations and patterns in a wide scheme of data. If that data is not right in the first instance, subjective and inaccurate decisions are created.

  • I entirely concur; one of the long-standing rules of computer programming is “garbage in, garbage out”. That holds true here. Again, that is why transparency about what goes in is so important. I hope that the Minister will tell us what regulations are being considered to ensure that AI systems are designed in a way that is transparent, so that somebody can be held accountable, and how AI bias can be counteracted.

    Increased transparency is crucial, but it is also vital that we put safeguards in place to make sure that that does not come at the cost of people’s privacy or security. Many AI systems have access to large datasets, which may contain confidential personal information or even information that is a matter of national security. Take, for example, an algorithm that is used to analyse medical records: we would not want that data to be accessible arbitrarily by third parties. The Government must be mindful of privacy considerations when tackling transparency, and they must look at ways of strengthening capacity for informed consent when it comes to the use of people’s personal details in AI systems.

    We must ensure that AI systems are fair and free from bias. Returning to recruitment, algorithms are trained using historical data to develop a template of characteristics to target. The problem is that historical data itself often reveals pre-existing biases. Just a quarter of FTSE 350 directors are women, and fewer than one in 10 are from an ethnic minority; the majority of leaders are white men. It is therefore easy to see how companies’ use of hiring algorithms trained on past data about the characteristics of their leaders might reinforce existing gender and race imbalances.

    The software company Sage has developed a code of practice for ethical AI. Its first principle stresses the need for AI to reflect the diversity of the users it serves. Importantly, that means ensuring that teams responsible for building AI are diverse. We all know that the computer science industry is heavily male dominated, so the people who develop AI systems are mainly men. It is not hard to see how that might have an impact on the fairness of new technology. Members may remember that Apple launched a health app that enabled people to do everything from tracking their inhaler use to tracking how much molybdenum they were getting from their soy beans, but did not allow someone to track their menstrual cycle.

    We also need to be clear about who stands to benefit from new AI technology and to think about distributional effects. We want to avoid a situation where power and wealth lie exclusively in the hands of those with access to and understanding of these new technologies.

  • I congratulate the hon. Lady on securing the debate. It is reassuring that Liberal Democrat and Conservative Members are present to debate this important issue, albeit slightly disappointing that ours are the only parties represented. Will she join me in welcoming the centre for data ethics and innovation, which was announced in the Budget at the end of last year? Does she agree that it is important that whatever measures we take are UK-wide, so that statistics, ethics and the way we use data are standardise—to a very high standard—across the United Kingdom?

  • The hon. Gentleman, who is a fellow representative from Scotland, pre-empts the next section of my speech.

    We need to develop good standards across the whole United Kingdom, but this issue in many ways transcends national boundaries. We must develop international consensus about how to deal with it, and I hope the UK takes a leading role in that. Parliament has started to look at the issue in recent years: the Select Committee on Science and Technology has produced a couple of reports about it, and the new House of Lords Select Committee on Artificial Intelligence is already doing great work and collecting interesting evidence. The Government have perhaps been slow to engage properly with ethical questions, but I have strong hopes that that will change now that the Minister is in post.

    I very much welcome the announcement in the Budget of a new centre for data ethics and innovation. That is a good start, albeit long overdue. I found that announcement while reading the Red Book during the Budget debate—it was on page 45—and I even welcomed it in my speech. I am not sure anyone else had noticed it. I would welcome a clear update from the Minister on the expected timeline for that centre to be up and running. Where does she expect it to be based? What about the recruitment of its chair and key members of staff? How does she see it playing a role in advising policy making and engaging with relevant stakeholders?

    I am concerned that the major Government-commissioned report, “Growing the artificial intelligence industry in the UK”, which was published in October, entirely omitted ethical questions. It specifically said:

    “Resolving ethical and societal questions is beyond the scope and the expertise of this industry-focused review, and could not in any case be resolved in our short time-frame.”

    I say very strongly that ethical questions should not be an afterthought. They should not be an add-on or a “nice to have”. Ethical discourse should be properly embedded in policy thinking. It should be a fundamental part of growing the AI industry, and it must therefore be a key job of the centre for data ethics and innovation. The Government have an important role to play, but I hope that the centre will work closely with industry too, because the way that industry tackles this issue is vital.

    Regulation is important, and there are probably some gaps in it that we need to fill and get right, but this issue cannot be solved by regulation alone. I am interested in the Minister’s thoughts about that. Every doctor who enters the medical profession must swear the Hippocratic oath. Perhaps a similar code or oath of professional ethics could be developed for people working in AI—let me float the idea that it could be called the Lovelace oath in memory of the mother of modern computing—to ensure that they recognise their responsibility to embed ethics in every decision they take. That needs to become part and parcel of the way industry works.

    Before I conclude, let me touch briefly on an issue that is outside the Minister’s brief but is nevertheless important. I am deeply concerned about the potential for lethal autonomous weapons—weapons that can seek and attack targets without human intervention—to cause absolute devastation. The ability for an algorithm to decide who to kill, and the morality of that, should worry us all. I very much hope that the Minister will work closely with her colleagues in the Ministry of Defence. The UK needs to lead discussions with other countries to get international consensus on the production and regulation of such weapons—ideally a consensus that they should be stopped—and to ensure that ethics are considered throughout.

    We want the UK to continue to be a world leader in artificial intelligence, but it is vital that we also lead the discussion and set international standards about its ethics, in conjunction with other countries. Technology does not respect international borders; this is a global issue. We should not underestimate the astonishing potential of AI—leading academics are already calling this the fourth industrial revolution—but we must not shirk addressing the difficult questions. What we are doing is a step in the right direction, but it is not enough. We need to go further, faster. After all, technology is advancing at a speed we have not seen before. We cannot afford to sit back and watch. Ethics must be embedded in the way AI develops, and the United Kingdom should lead the way.

  • It is a pleasure to serve under your chairmanship, Dame Cheryl. I congratulate the hon. Member for East Dunbartonshire (Jo Swinson) on securing this important debate and on her fascinating and well-argued speech. As she kindly pointed out, I am new to the position of Minister for digital and creative industries. She will know from her ministerial experience that there is a great deal to absorb in any new brief, and I thank her for this opportunity to get involved and absorbed in the ethical considerations of artificial intelligence so early in my new role.

    We understand the disruptive potential of transformative technologies, and we stand ready for the adoption of AI, which is going on around us and is important to the future of our industrial strategy. In their review of AI and the industrial strategy, Dame Wendy Hall and Jérôme Pesenti identified a range of opportunities for the UK to build and grow its AI capacity. The forthcoming AI sector deal will take forward their key recommendations about skills and data, and a wider AI grand challenge will keep the UK at the forefront of AI technology and the wider data revolution. Those ambitions will be underpinned by a new Government office for AI. We are building the capacity to address the issues that accompany these technological advancements: issues of trust, ethics and governance; effective take-up by business and consumers; and the transition of skills and labour requirements.

    Regarding trust, AI already delivers a wide range of benefits, from healthcare to logistics, biodiversity and business, but we are fully aware that AI brings new challenges, as the hon. Lady mentioned, in privacy, accountability and transparency as well as the important issue of bias, on which she shared a number of concerning examples with the House.

    The uses of data in AI and machine learning are developing in valuable but potentially unsettling ways, because of the pace of adoption, as the hon. Lady outlined. We have different concerns and tolerances about trust and fairness depending on the application of AI, varying, for instance, between retail, finance and medicine. We will need to consider specific answers to those challenges in the different sectors if we are to foster the necessary level of trust. Confidence and trust are essential to driving adoption and innovation.

    We must ensure that these new technologies work for the benefit of everyone: citizens, businesses and wider society. We are therefore integrating strong privacy protections and accountability into how automated decisions affect users. A strong, effective regulatory regime is therefore vital. In the UK we already benefit from the Information Commissioner’s Office, a well-respected independent body tasked with protecting personal data. Important decisions on everything from autonomous cars to medical diagnosis and decisions on finance and sentencing—and indeed applications to defence—cannot be delegated solely to algorithms. Human judgment and oversight remain essential.

  • I completely accept the principle that strong regulation is required for data, and it is important that organisations such as the ICO lead that—even if I have some concerns about some of what has come out on the general data protection regulation in recent months. Is it not the responsibility of all of us here, the ICO, Ministers and wider civic society to start discussing privacy more over the long term? We have probably got to have a cultural discussion about privacy, because we have ownership of data, but to accrue the benefits that come from some automation and artificial intelligence we must also be willing to give over some elements of that data for the wider good.

  • My hon. Friend touches on some important considerations. There has been a debate in healthcare on how much should be private and how much should be anonymised and shared for the general good, as he outlines. I agree that that discussion needs to involve citizens, business, policy makers and technology specialists.

    We will introduce a digital charter, which will underpin the policies and actions needed to drive innovation and growth while making the UK the safest and fairest place to be online. A key pillar of the charter will be the centre for data ethics and innovation, which will look ahead to advise Government and regulators on the best means of stewarding ethical, safe and innovative uses of AI and all data, not just personal data. It will be for the chair of the centre to decide how they should engage with their stakeholders and build a wider discussion, as my hon. Friend suggested is necessary. We expect that they will want to engage with academia, industry, civil society and indeed the wider public to build the future frameworks in which AI technology can thrive and innovate safely.

    We may find the solutions to many AI challenges in particular sectors by making sure that, with the right tools, application of the existing rules can keep up, rather than requiring completely new rules just for AI. We all need to identify and understand the ethical and governance challenges posed by uses of such a new data source and decision-making process, now and in the future. We must then determine how best to identify appropriate rules, establish new norms and evolve policy and regulations.

    When it comes to AI take-up and adoption, we need senior decision makers in business and the public sector first to understand and then discuss the opportunities and implications of AI. We want to see high-skill, well-paid jobs created, but we also want the benefits of AI, as a group of new general-purpose technologies, to be felt across the whole economy and by citizens in their private lives. The Government are therefore working closely with industry towards that end. As I said earlier, we will establish a new AI council to act as a leadership body and, in partnership with Government, champion adoption across the whole economy. Further support will come from Tech Nation as it establishes a national network of hubs to support such growth.

    A highly skilled and diverse workforce is critical to growing AI in the UK. We therefore support the tech talent charter initiative to gain commitment to greater workforce diversity. The hon. Lady explained well in her speech why diversity in the tech workforce is important to the ethical considerations we are debating. As we expand our base of world-class AI experts by investing in 200 new AI PhDs and AI fellowships through the Alan Turing Institute, we will still need to attract the best and brightest people from around the world, so we have doubled the amount of exceptional talent visas to 2,000. I will take the point about the need for diversity when it comes to reviewing such applications. All of that will ensure that UK businesses have a workforce ready to shape the coming opportunities.

    With regard to transition, we will see strong adaptation in our labour markets, where our aim should be lifelong learning opportunities to help people adapt to the changing pace of technology, which will bring new jobs and productivity gains. We must hope that those will increase employment. We know that some jobs may be displaced, and often for good reasons: dangerous, repetitive or tedious parts of work can now be carried out more quickly, accurately and safely by machines. None the less, human judgment and creativity will still be required to design and manage them.

  • On employment, may I impress on the Minister that in that disruption, the Government should be there to help some of those workers pushed out of employment to retrain and find a new place and role in the economy, keeping up with the pace of technology as it develops?

  • I heartily agree with my hon. Friend. He will be pleased to know that the Department for Business, Energy and Industrial Strategy—my former Department—is working closely with Matthew Taylor to consult on all of his recommendations. The Secretary of State has taken personal responsibility for improving the quality of work. Work should be good and rewarding.

    A study from last year suggests that digital technologies including AI can create a net total of 80,000 new jobs annually for a country such as the UK. We want people to be able to capitalise on those opportunities, as my hon. Friend suggested. We already have a resilient and diverse labour market, which has adapted well to automation, creating more, higher paying jobs at low risk of automation. However, as the workplace continues to change, people must be equipped to adapt to it easily. Many roles, rather being directly replaced, will evolve to incorporate new technologies.

  • The Minister has mentioned the centre for data ethics. Can she update us on when it is likely to be up and running, what the timetable is for recruiting the chair and so on? It would be helpful to know when we can expect that.

  • We want to proceed at pace, because it is an important part of our programme of dealing with the ethics of this issue. We plan to consult on the plans for a permanent centre in the next few months, and I will welcome the hon. Lady’s input.

    Undeniably, substantial changes lie ahead. Therefore, in terms of enabling people to reskill and take advantage of the changes and opportunities in the workplace, a national retraining scheme will help people. We also have plans to upskill 8,000 computer science teachers and work with industry to set up a new national centre for computing education, with a brief to encourage more girls to take advantage of the new technologies in their learning.

    Substantial changes lie ahead and, as we push these new technologies, we will also strive to keep people and businesses sufficiently skilled, adaptable and assured. The measures are in place, and I have taken heart from the hon. Lady’s speech about the importance of these ethical considerations. I assure her that they will be uppermost in our minds as we develop policy.

    Question put and agreed to.

  • Sitting suspended.

    NHS Blood Cancer Care

    [Phil Wilson in the Chair]

  • I beg to move,

    That this House has considered blood cancer care in the NHS.

    Mr Wilson, it is a pleasure to serve under your chairmanship.

    Like many people in this room today, I have lost a family member to blood cancer. Five and a half years ago, my mother died from acute myeloid leukaemia, also known as AML, an extremely short time after diagnosis. I have been touched by the many stories of families in Crawley and nationwide who have contacted me to share their own experiences of losing a family member to blood cancer. With conditions such as AML, there is an incredibly short time—sometimes just a matter of days—between being diagnosed and this form of blood cancer taking a life.

    It was with those stories in mind that in 2016 I was pleased to set up the all-party parliamentary group on blood cancer. I place on the record my thanks to all colleagues, including those who left Parliament last year, for their work in getting the group up and running and in starting our inaugural inquiry on NHS blood cancer care. While the inquiry, held last year, and the report, to be launched in the Palace of Westminster right after the debate, focus on the implementation of the cancer strategy for England, we are keen to learn from examples of good practice in Scotland, Wales and Northern Ireland and have made approaches to the devolved Administrations accordingly.

  • I would like to talk about a Welsh example: my young constituent Emily Clark, who was diagnosed at 16 and subsequently sadly passed away. During the period of her illness, her work in setting up the RemissionPossible initiative resulted in 4,000 more people joining the stem cell donor register. Will the hon. Gentleman praise Emily, and her mother Donna Dunn, who is continuing the work?

  • My condolences to Emily’s family. There are all too many examples of young people passing away from blood cancer. I pay tribute to Emily’s mother for a fine legacy. It is sad that a young life has been lost to this condition, but wonderful that so much good work has been done as a result. I would be grateful if the hon. Gentleman passed on my best wishes to them.

  • I congratulate my hon. Friend on the excellent work he is doing in this sphere. Blood cancer is a bit of a hidden cancer. If someone has a solid tumour, it can be seen and treated and they can see what is happening with it, but blood cancer is difficult to detect. What is he doing to encourage early detection?

  • My hon. Friend anticipates some of my remarks in a few moments’ time, but he is absolutely right to use the words “hidden cancer”. Blood cancer is very different from solid tumour cancers—that is a key point and problem.

    I was going to say that, from four o’clock, right hon. and hon. Members are very welcome to come along to Strangers’ Dining Room for the launch of our report.

  • I join others in praising the hon. Gentleman for securing this debate and for the report, which will be published later. I apologise for having to leave, but I am chairing the all-party stem cell group at three o’clock, so everything is coming together at the same time.

    Does the hon. Gentleman agree that in this area, as in stem cell research, great progress has been made over recent years, and we do not want to lose that progress? Financial budgets are tight, and we realise that the health service faces many challenges, but we need to keep the research going. There has been great progress in this area and we must not lose it.

  • The hon. Gentleman has a fine excuse for leaving the debate early, and I endorse everything he says. Future stem cell research is critical; this country has made a good start, but we cannot be complacent in any way, shape or form.

    The APPG’s work focuses on blood cancer—as my hon. Friend the Member for Henley (John Howell) said, it is a hidden cancer—on the differences between blood cancer and solid tumour cancers such as breast cancer and prostate cancer, and on the ways in which patient outcomes can be improved with Government, medical professionals and local healthcare bodies working in partnership.

    It is not an exaggeration to say that blood cancer is one of the great public health challenges of our time. We know it is the third biggest cancer killer in the UK, the fifth most common cancer overall, and by far the most common cancer among people under the age of 30, as we heard from an intervention earlier.

  • I congratulate the hon. Gentleman on securing the debate. On the point of cure, will he celebrate with me the fact that one of my young constituents, Elly-Mae Waugh, aged 12, was confirmed cancer-free in November 2017, having been treated for two years for lymphoblastic leukaemia? Does he agree that there is hope and that there is a need to better finance research into blood cancer developments?

  • I am delighted by the news that the hon. Gentleman’s young constituent is cancer-free; that is wonderful to hear. There are positive stories that we can draw on. Antonio, the son of our former colleague Sir Nick Clegg, the former Deputy Prime Minister, was fortunately given the all-clear from the blood cancer he was being treated for. I thank the hon. Gentleman for highlighting those positives.

    A key factor in ensuring early diagnosis is a greater knowledge and understanding of the symptoms of blood cancer. Diagnosing one of the 137 different types of blood cancer can be complex because symptoms such as back pain or tiredness can, of course, easily be misunderstood or misdiagnosed. Other symptoms of blood cancer include night sweats, weight loss and bruising, and in the first instance can often appear similar to feeling “run down” or having the flu, as was the case with my mother. We thought she had flu for a couple of weeks beforehand, and then she sadly passed away in a very short time.

  • I thank my hon. Friend for securing an extremely important debate. He talks about the trouble of diagnosing hidden cancers such as leukaemia in adults, but it is sometimes particularly difficult to diagnose cancers in children. Before Christmas I had a sad meeting with a constituent of mine whose daughter Isla Caton has neuroblastoma, a particularly vicious form of childhood cancer. He discussed how it took three months to diagnose her, because she was only showing lethargy and people had come up with various different diagnostic ideas. In Japan, they test children from birth—

  • Order. This is just an intervention, not a speech.

  • I am sorry, excuse me. Does my hon. Friend encourage tests from birth to diagnose these sorts of cancers?

  • My hon. Friend raises a very valid point. I mentioned best practice for NHS England and talking with the devolved Administrations, but we also have to go internationally for that best practice. She commented on the difficulty of diagnosis and people having to go to the GP many times before diagnosis, which sadly is a common story.

  • On the point about people and diagnosis that my hon. Friend just mentioned, is there some weakness within the system that means that GPs are not diagnosing early enough? If so, what does he think should be done about it?

  • I am grateful to my hon. Friend for his intervention. Yes, that is the problem. One of the issues is just that: the symptoms are all too often commonplace. Particularly at this time of year, many of us are suffering from colds, are feeling tired or have other viruses. I will come on to this later on, but there is a message to GPs that, if one or more of these symptoms is being displayed, they should consider that it could be blood cancer and carry out a relatively simple blood test to try to determine that. Far too often, blood cancer patients have to visit their GPs many times before being referred to hospital.

  • My elder son developed a platelet rash, which is a common sign of the disease getting to a certain stage. There is a lot of public awareness about meningitis and what to look for, but that rash does not seem to feature in people’s minds, in terms of blood cancer. Does he agree that we probably need to do more to educate not only doctors but the general public on what to actually look for because, obviously, the earlier the diagnosis can be made, the better?

  • The hon. Gentleman is entirely correct. I am sorry to hear of his family’s experience. The symptoms can often be confused with others, which is why it is important, as was said in an earlier intervention, to stress that GPs should be given the support and the backing to raise awareness of the symptoms. A simple blood test should be offered to assist with early diagnosis for people displaying one or more of these signs, and GP education and training needs to be improved to increase knowledge of blood cancer symptoms.

    As was said in an earlier intervention from my hon. Friend the Member for Henley, unlike solid cancer tumours, blood cancer cannot be surgically cut out, and the experience of blood cancer patients is therefore very different from that of those with other forms of cancer. Blood cancer patients are not currently receiving the treatment and support they deserve, which is one of the key points that I hope the Minister will take from the debate.

  • Does the hon. Gentleman agree that one of the keys to treatment is having as many people as we can on the stem cell donor register? There are 660,000 selfless individuals on it at the moment. We should thank them and also encourage those between the ages of 16 and 30 to sign up.

  • The hon. Gentleman is again absolutely correct. The stem cell register is vital to our addressing this condition going forward and beating blood cancer in the future. We would all do well to echo his message.

  • I congratulate my hon. Friend on the tremendous work he is doing with the APPG and also on his superb speech, which I am following closely. One of my constituents, Mr Gaziano, has written to me to say that he suffers from an incurable form of blood cancer called chronic lymphocytic leukaemia, which is apparently the most common form of leukaemia among adults. He makes the same point about the lack of support. Apparently, 66% of people with that type of leukaemia live with anxiety, 50% with stress and 34% with depression, but they are not getting the psychological support from their healthcare teams that they need.

  • My hon. Friend is absolutely right. I am sorry to hear of his constituent’s experience. He anticipates remarks I will make later, with regard to psychological support for people with chronic, longer-term conditions and the watch and wait approach, as it is sometimes called, for dealing with some forms of blood cancer, particularly in adults.

    The Government and NHS England need to address, as a matter of urgency, the specific needs of blood cancer patients and take immediate steps to improve their care. Something that may seem as simple as the terminology surrounding blood cancer can have an effect on ensuring support for patients. As I said, there are 137 different types of blood cancer—we have heard a number of different examples already—including various strands of leukaemia, lymphoma and myeloma. In each of those, one common word is missing: cancer. The lack of that important word when telling somebody they have one of those forms of blood cancer runs the risk of their not fully comprehending the gravity of their condition. The APPG’s report found that clinicians and patients said that the increasing use of the overarching term “blood cancer” has helped patients who have been diagnosed recently to gain a greater understanding, not only of how the disease is part of a wider clinical area but that there is an entire community of health professionals, charities, and patient groups to help them.

    I am grateful to all those who took the time to respond to our web consultation and answer the questions, including those on early diagnosis. After analysing the responses, the APPG’s report outlines three main audience groups where increased awareness could benefit patient outcomes. The first is the general public. While greater awareness of the symptoms would lead to people seeking medical intervention sooner, I also appreciate the words of caution from some in the medical profession, who reiterate that this must be handled carefully to avoid undue concern, particularly given the commonality of the symptoms. There is agreement that blood cancer awareness is far behind that of other common cancers, as we have heard.

    The second is GPs. Recognising and diagnosing blood cancer symptoms can be difficult, and many patients reported frustration at having to see their GP a number of times before their blood cancer was diagnosed, as we have heard. The third—as I turn to the Minister—is cancer policy makers. We heard that blood cancer was not always at the forefront of their minds. As such, we seek the extension of policies and initiatives designed to ensure broad benefit to patients with solid cancer tumours to those with blood cancer.

    Much of the work on blood cancer awareness is undertaken by the charity sector. To that end, I pay tribute to the Spot Leukaemia campaign organised by Leukaemia CARE, which I am pleased to say was supported by my local community through Crawley Town football club, which made the cause its charity of the day at a game just last September. I ask the Minister for his assurance that the Department of Health and Social Care will engage with such campaigns, to ensure that the full power of his Department and the NHS can be used not only to work in partnership with such charities but to give greater consideration to non-solid tumour cancers when developing policy.

    If blood cancers are taken into greater account, it will lead to improvements in the patient experience. As we heard in an earlier intervention, the patient experience of those with blood cancer differs from those with other cancers. The sad reality is that some patients with some chronic blood cancers will never be cured. They will instead require treatment for the rest of their lives, with the cancer managed as a long-term condition. Patients who have had access to a clinical nurse specialist have been clear on the role that a CNS has in the patient experience. Indeed, respondents to the APPG’s report were clear that access to a named CNS was the single most important factor that improved their experience.

    Again, the charity sector is working to support patients in this area. By April, the Anthony Nolan charity will have funded nine CNS posts in stem cell transplant centres across the UK. These specialists provide support for patients, including assistance in getting back to work or school, as well as dealing with the physical and emotional aspects of a stem cell transplant—a potentially curative treatment for blood cancer, as we heard in an intervention, for which I am grateful.

    Some patients will be put on a watch and wait programme, as I mentioned earlier. That literally means that a patient’s blood cancer is monitored, and it can sometimes take years for it to reach a point where treatment can start. The very nature of such a scenario will place unbelievable pressures and strain not only on the patient fighting that cancer, but on their family, friends and wider support network.

    Tailored psychological support, which I am grateful to my hon. Friend the Member for Kettering (Mr Hollobone) for mentioning, needs to be made available for patients—particularly those on a watch and wait regime.

  • My hon. Friend talks about the wider strain beyond the physical. Does he agree that a huge financial strain is often placed on families? The family in the case I raised earlier had to spend a lot of money on takeaway food, the congestion charge, parking and hotels just so their daughter could receive what can be very intensive treatment.

  • My hon. Friend is absolutely right to raise the spectre of the financial burden, as well as the psychological pressure that patients and their loved ones face when undergoing treatment. There can often be expensive visits into London or other major city centres to undergo treatment.

    I pay tribute to organisations such as Macmillan, which is very worthy of our support and does amazing work for those with not only blood cancers but all chronic and terminal conditions. I ask the Minister for his assurance that, as recommended by the cancer strategy, all blood cancer patients have access to a clinical nurse specialist or equivalent model of support.

    One of the points raised in the two oral evidence sessions held by the APPG last September was the work of charities to provide support for patients and their networks. As my hon. Friend the Member for Hornchurch and Upminster (Julia Lopez) said, a lot more support needs to be given to patients and their families on issues not related to treatment, such as financial advice, so that they can devote their time and energy to getting better.

    I have mentioned a number of organisations, but I reiterate the fine work of Macmillan, which offers help to cancer patients and their families up and down the country. In my constituency of Crawley this week, one of the charity’s information hubs will be open in the County Mall shopping centre until Saturday. Its staff are on hand, as they are all the time, to answer questions about symptoms, side effects or any other issue relating to support locally.

    We can be thankful that an increasing number of blood cancer patients are living for many years after their diagnosis, and I thank hon. Members for giving examples from their constituencies. The cancer strategy says that all cancer patients will have had access to the recovery package by 2020. That helps patients after their treatment has finished, so that they can return to their normal lives as much as is possible. Of course, there must be recognition that patients can go from having regular access to a healthcare professional while receiving treatment to feeling like they have no support at all after treatment ends. It has been described as like falling off the end of a conveyor belt, with no one to talk to about after-effects, dietary needs and the everyday activities they had enjoyed before treatment started.

    I come back to the issue of how blood cancer is different from solid tumour cancers. I hope the Minister and his colleagues at the Department of Health and Social Care will work with NHS England to consider how all patients can benefit from aftercare support, including ensuring that the recovery package takes into account the differences. It is difficult to go from, in some cases, constant access to a CNS during treatment, including communication being available by mobile phone, emails and texts, to support coming to an end when a patient is sent home. There are long-term effects of blood cancer that need to be taken into account.

    In particular, for patients treated with a stem cell transplant, the transplant itself is only the beginning of a long journey to rebuild their lives. By 2020, it is thought that there will be more than 16,000 people living post-transplant, and a significant proportion of those people will experience long-term side effects of their treatment. They will require specialist support, and it is incumbent on us to ensure that people across England receive it with greater consistency.

    I move on to the issue of new treatment access and research on the differences between blood cancers and solid tumour cancers. It is important to remember that blood cancers are often not treatable using surgery or radiotherapy. Blood cancer is therefore more dependent on the development of and access to new drugs in order to continue enhancing patient outcomes.

    The process of how the National Institute for Health and Care Excellence and the drug manufacturers negotiate can affect patients. Where NICE has offered negative draft guidance on a particular cancer drug that, after further negotiations between NICE and the manufacturer, changes to final positive guidance, the period when patients are left to think that potentially life-changing or life-saving treatment may not be available can cause huge anxiety. Our report calls for final negotiations to be undertaken before negative draft guidance is published.

    I have mentioned the work of the charity sector in supporting blood cancer patients. That is perhaps most significantly represented by the financial investment made by blood cancer charities to fund research, develop a good research base and ultimately produce relatively good survival rates. I ask the Minister to ensure that further support is given to that research, to not only provide financial backing but ensure that blood cancer patients are at the heart of cancer policy.

    I am conscious of allowing other colleagues the opportunity to make substantive remarks, but on the subject of NHS commissioning, local decision makers should look for opportunities to bring care for chronic blood cancers closer to the patient where appropriate. I will be writing to my local clinical commissioning group in Crawley to share a copy of the APPG’s report, and I encourage colleagues to do likewise with their respective CCGs.

    I am sure that all of us here today can name people in our local areas, as many hon. Members have, who have experience of dealing with blood cancer in their family and working to raise funds for those who want to make life easier for patients and their support networks. In my constituency of Crawley, I am grateful for the work of the Mark Henry Archer tribute fund at Bloodwise, which was set up by my constituent Jayne Archer in memory of her late husband, Mark, who sadly lost his battle with lymphoma in 2010.

    I mentioned at the start of my speech that blood cancer is the most common cancer among people under the age of 30. Someone can be in the peak of physical fitness and it can still strike. Just a week into this new year, Juan Carlos Garcia lost a three-year battle with leukaemia. He was just 29 years old and a professional footballer who had played in England for Wigan Athletic and at the 2014 World cup for Honduras. Blood cancer quite simply can strike anyone at any time.

    I would like to thank the patient advocate and medical professionals who took the time to come to Parliament and answer the APPG’s questions at our evidence sessions last September. I also express my sincere gratitude to Bloodwise for providing secretariat support to our APPG, assisting blood cancer patients up and down the country, and playing a leading role in the research that is necessary to improve outcomes and the patient experience.

    I know that many people in this room will be aware of one family that has been affected by blood cancer in the last couple of months. The Sky Sports presenter Simon Thomas and his eight-year-old son Ethan lost their wife and mother Gemma, aged just 40, last November. Just three days after being diagnosed with acute myeloid leukaemia—the same form of blood cancer as my own mother—Gemma passed away. Incidentally, my mother’s diagnosis came just hours before her death. Our thoughts are with Simon, Ethan and their family and friends, and every patient affected by this disease.

    It falls to each of us here to make sure we redouble our efforts to bring as much help, comfort and support to blood cancer patients as possible, and I ask the Minister for his continued diligence in such matters. I have seen at first hand how quickly those who have blood cancer can be taken from us. In a previous debate that I was fortunate to secure in Westminster Hall on 7 July 2016, I said:

    “I look forward to ensuring that the issue of blood cancers is further advanced and that awareness is increased.”—[Official Report, 7 July 2016; Vol. 612, c. 395WH.]

    With the progress of the APPG and the support of colleagues here and those who will be attending the launch of the group’s report from 4 o’clock in Strangers’ Dining Room, I am pleased to stand here today and say that we are making great strides. There is much more to be done, and we will continue to make progress.

  • Order. I want to bring in the Front-Bench spokespeople at 3.30 pm. That gives us about 30 minutes for Back-Bench speeches. I call Colleen Fletcher.

  • Thank you, Mr Wilson. It is a pleasure to serve under your chairmanship. I commend the hon. Member for Crawley (Henry Smith) on securing the debate, which, as we have heard, is particularly timely, given today’s launch of the report by the APPG on blood cancer, “The ‘Hidden’ Cancer: The need to improve blood cancer care”. I was happy to be a small part of that. The report makes significant recommendations, all of which I, as a member of the APPG, fully endorse, about improving care for blood cancer patients on their journey from diagnosis to treatment and through to recovery.

    I shall focus my comments today on the commissioning of stem cell transplantation and the inconsistencies in post-transplant care. There is a common misconception that if a blood cancer patient finds a matching donor and undergoes a stem cell transplant, they are out of danger—that that is the beginning of the end of their journey, the point from which they get better. In reality, nothing could be further from the truth. Although a stem cell transplant is a potentially curative treatment for blood cancer patients, recovery can be a long and difficult journey. Many of those living post transplant will experience severe and debilitating physiological and psychological side effects from their treatment, not only in the first few days, weeks and months after the transplant, but many years down the line. Indeed, a transplant patient is often described as “a patient for life”.

    The side effects include physiological problems, such as graft versus host disease and a higher risk of second cancers, infections, infertility, premature menopause and fatigue, as well as psychological effects, including isolation, depression, anxiety and post-traumatic stress disorder. Patients dealing with the impact of a stem cell transplant, and particularly those receiving an allogeneic transplant, therefore require ongoing support from appropriately qualified health professionals.

    The problem is that the provision of high-quality post-transplant care varies significantly across the country, leaving vulnerable patients at the mercy of the often fragmented and inequitable postcode lottery NHS, in which some get very good support but others get very little.

    Recent research by the charity Anthony Nolan reveals that many patients are struggling to access the services that they need post transplant. It is particularly concerning that only half those who need psychological support, such as counselling or group therapy, receive it. The same is true for practical support, such as help at home or with getting back to work; and one in five is not offered any specialist care to help with elements of their physiological recovery, which includes access to physio- therapists, dieticians and fertility experts.

    To address the areas of unmet need, we must reform the commissioning of post-transplant care. Currently, responsibility for commissioning services transfers from NHS England to CCGs after only 100 days. There is evidence that that arbitrary cut-off leads to gaps and variation in the care and support that hospitals are able to provide, despite their best efforts. That increases the burden on patients and their families, making their recovery much more difficult. As recommended by both the APPG report and Anthony Nolan, it is essential that NHS England reviews the 100-day cut-off in order to eliminate the inconsistencies and fragmentation in post-transplant care across the country. I hope that the Minister addresses that point in winding up the debate.

    As part of the process, we should consider the creation of a national care pathway for patients for at least five years post transplant. That pathway should ensure that patients have access not only to the full range of physiological, psychological and practical support services after their transplant as well as before and during, but to a clinical nurse specialist—or equivalent model of support—who can help them through their recovery journey, managing their care and plugging some of the gaps that would otherwise exist.

  • The hon. Lady is talking about the system required in a post-transplant period. Does she agree that every individual is obviously significantly different and there may well be a significant difference in the amount of time required immediately after the transplant and subsequently for a period of years, and that that needs to be taken into account as we go forward?

  • I thank the hon. Gentleman for that intervention. Yes, I agree. People are totally different. Some, I know, have sailed through with few problems, and others have had many problems occur after the 100 days.

    People may know that my husband, Ian, had a stem cell transplant more than three years ago, just after being diagnosed with acute myeloid leukaemia. What I have said today reflects his journey. He has been a beneficiary of cutting-edge research, which has allowed his cure, but we have also experienced some of the inconsistencies along a journey that has been too long to narrate today. It is from that experience, and from my heart, that I ask the Minister to look at a fully funded care pathway for at least five years post transplant, with the specialist care needed to allow people the chance to live their lives again as fully as they can.

  • It is an honour to serve under you, Mr Wilson. I congratulate my hon. Friend the Member for Crawley (Henry Smith) on bringing the debate to the House. He mentioned the devolved Governments, and I would like to speak about my own part of the country.

    In 2015 in the Grampian NHS Board area, which includes my constituency of Gordon, there were 265 new diagnoses of leukaemia, lymphoma or myeloma, forming one in every 12 diagnoses in the area that year. In the same year, 106 lives in the Grampian area were taken by these cancers. It is crucial, therefore, that we leave no stone unturned in the fight against blood cancers. That includes research and development, on which the UK Government have a strong record that I very much hope will continue. The life sciences sector deal announced last year will provide a welcome boost to the industry and help it to strive towards better ways of treating blood cancers

    However, quality NHS care is also important. People with blood cancers deserve the best possible care from the NHS, wherever they are in the country. In that light, I would like to take this opportunity to pay tribute to the dedicated staff of Aberdeen Royal Infirmary, which serves my constituency and covers an area of 500,000 people; indeed, it covers the whole north-east of Scotland right up into the highlands. The work of the staff in its oncology department is second to none and has saved countless lives over the years. The start of treatment in Aberdeen Royal Infirmary’s new radiotherapy department in 2014 was a welcome step forward in the treatment of blood cancers and other cancers in the north-east of Scotland. That state-of-the-art new building has enabled the team to deliver new techniques and new forms of therapy to more and more patients—a development that can only be good.

    The hard-working staff at Aberdeen Royal Infirmary deserve across the board support from the Scottish Government. However, as with Her Majesty’s Government, budgets are constrained. Oncology at the ARI has not been spared, unfortunately, from the long-running staff shortages. For a department that treats cancer patients not just in Gordon but across the north-east of Scotland and even further afield, that is obviously very concerning. Across Scotland, vacancy rates for consultants and nurses are disappointingly high, with 400 consultant posts now unfilled. Both north and south of the border, shortages are damaging. NHS staff and patients alike must have the security of knowing that their local oncology department is, and always will be, adequately staffed and given the support that it deserves.

    My family’s experience of the oncology department at Aberdeen Royal Infirmary and of support from Macmillan nurses has been excellent. There are many ways we can take the fight to blood cancers. Research and development, which has been mentioned, is one vital pillar, and encouraging stem cell donations another. We must be sure to put NHS care at the very centre of our efforts.

  • I congratulate the hon. Member for Crawley (Henry Smith) on securing this debate and on the hard work that he has done to promote this issue in the House and further afield. I am happy to be a member of the APPG along with others in this Chamber today and to support him in the role that he plays.

    As the Democratic Unionist party spokesperson for health, I felt it necessary to make a contribution, even though the onus of where we are is probably England-based. We need to highlight some issues with regard to the NHS and blood cancer care. My father, who is dead and gone almost three years, had cancer—not blood cancer—on three occasions, but he survived those three occasions owing to the skill of the surgeon’s knife, the care of the nurses and the prayers of God’s people. Clearly, we have made great advances—some magnificent advances—in cancer care over the past few years.

    May I say to the Minister, the shadow Minister and the proposer of the debate that I, along with others, have a meeting with the Prime Minister at half past three, so I need to get away for that occasion?

    I was delighted to receive information on blood cancer and I take this opportunity to thank all of those who are working so hard to highlight the issue and bring about change, and who supply such enlightening and helpful information. There are almost 250,000 people living with blood cancer in the UK today. Although many forms of blood cancer are rare, as a group blood cancer is Britain’s fifth most common cancer and third biggest cancer killer, claiming more lives each year than breast or prostate cancer. Those figures surprised me. We are all grateful for the advertising that highlights breast and prostate cancer, which affects us men. Unfortunately, we are probably loth to see the doctor, but the Minister’s Department encourages us to be more active and forthcoming about the problems that we have. Advertising keeps these things fresh in our minds and educates us as to the symptoms to be aware of, but the fact is that blood cancer kills more people and we need to be mindful of that when finding additional funding. The Minister always responds in a positive fashion to the debates in Westminster Hall and tries to help.

    Northern Ireland has an average of 123 cases of leukaemia diagnosed annually. That may not seem much, but when we take into account the small size of Northern Ireland it is clearly something that is taking its toll. It is also clear that the aftercare of those cases is essential. Although we are discussing NHS England, there is a need for devolved bodies to work together to ensure that we do not have a UK postcode lottery for the treatment of blood cancers and that an equal level of treatment is available UK-wide. Can the Minister outline whether he has had any co-operation with the Department of Health in Northern Ireland? If not, is he willing to undertake to do that?

  • On the issue of co-operation, does my hon. Friend agree with me that the excellent news of the opening in the past year of the North West Cancer Centre in Londonderry, which offers opportunities and the skills of many in the nursing profession both in Northern Ireland and in the Irish Republic, is a perfect example of that co-operation and is widely welcomed in the community? Does he agree that that is an exceptionally good development?

  • My hon. Friend has mentioned a supreme example. That is something that we all welcome in Northern Ireland, and indeed across the whole of the United Kingdom of Great Britain and Northern Ireland.

    I have been contacted by Myeloma UK, which asked me to highlight its cause and needs. I am happy to do so in Westminster Hall and for the Hansard record. Some 5,500 new cases of myeloma are diagnosed in the UK every year, which equates to 15 people a day. Although myeloma is a rare cancer, it is the second most prevalent blood cancer, which has no cure as such. It is important to highlight that in Westminster Hall today and with the Minister.

    In the past 10 years, with improvements in treatment and care, survival rates are increasing faster than in most other cancers, so there is some good progress, but there is a long way to go. Myeloma remains a very challenging cancer to live with and to treat. To truly get to grips with that cancer means dedicating funding to finding the cure, but also providing a quality of life for those who suffer from it.

    In our debates on cancer the one thing that always comes up is early diagnosis. Whether it is prostate cancer, breast cancer, myeloma or bowel cancer, getting it early is the secret. I mentioned us menfolk earlier and how we respond to things. Maybe we need to be a bit more eager to tell our doctor when things are wrong with us. I commend the many charities and groups such as Marie Curie and Macmillan. Along with those charities we also have many church groups and organisations that help and give succour and support to families at a time when one of their loved ones is very ill.

    Another issue is that of the 100-day care by NHS England after treatment, which must be reconsidered to ensure that there are no gaps in service, as has been highlighted by the Anthony Nolan trust. The Minister is nodding; I know that he and others in this Chamber are aware of that. The briefing that was provided made it clear that the steps taken by the Government have been welcome, and yet more leeway is needed to allow complete care packages to be in place. If that means going over the magic number of 100 days, there needs to be a mechanism that allows that to take place. Will the Minister fully consider that request—I know he will—and provide a detailed response outlining his decision as to whether the extension of care before transfer to local CCGs can be achieved?

    I believe we can make decisions in this place, in this House, in Westminster Hall, in the House of Commons and across the whole of the United Kingdom of Great Britain and Northern Ireland that will allow blood cancer sufferers to have a better prognosis and a better treatment plan. We must do all that we can to bring that about.

  • It is a pleasure to serve under your chairmanship, Mr Wilson. I, too, commend the hon. Member for Crawley (Henry Smith) on securing this debate.

    As has been said by Members, blood cancers often represent a hidden cancer, but that applies to solid cancers as well, particularly ovarian and pancreatic, which also tend to present with vague abdominal symptoms that simply could be nothing. The general practitioner sits there seeing cases of back pain and tiredness one after the other, and the challenge is to spot the patient among hundreds who might have something else. Obviously, if someone talks about bruising and night sweats, we hope that a GP would do a simple blood test that might flag up that one patient—that canary among the swallows —who needs to be referred to hospital and diagnosed. At medical school, we medics were taught to have a high index of suspicion, to not just go around assuming everything is nothing, but to try to hold those other things in our heads.

    The hon. Member for Crawley mentioned that there are more than 130 types of blood cancers, but there are three main groups: leukaemia, lymphoma and myeloma. As a breast cancer surgeon, I dealt with lymphoma patients because they present with a lump. Lymph glands are all over the body and commonly swell up, so they would present with a lump in their neck or under their arm. A woman would commonly be sent to me with a suspicion of breast cancer.

    Blood cancers are grouped together because of the type of cells they come from, but they behave in different ways. As was said, the challenge is how to get them diagnosed: how to have that index of suspicion. When someone moves to treatment, we use radiotherapy in some patients, particularly in lymphomas if the disease is localised or regionalised. The downside is that they might have radiotherapy over a large area of the body. Most of us are aware that radiation is damaging. I had patients in my breast cancer clinic that were under follow-up because they had had radiotherapy to their chest when they were teenagers and now had an additional risk of breast cancer. As we get more people to survive cancer, the challenge is the risk that they have of other diseases or ongoing side effects.

    Dependence on chemotherapy and drug treatment has been mentioned. Of course, the biggest breakthrough was bone marrow transplants to deliver healthy stem cells. Radiotherapy is also used as part of that. The dependence on drug treatment and chemotherapy means blood cancers are even more vulnerable than other cancer types to the difficulties of accessing new and expensive drugs. A new drug, daratumumab, was just passed in Scotland in October. The decision will be made by NICE next month. It is the first immune treatment for one of the diseases in question, and obviously we hope that it will be the first of many that could start to bring about change, but inevitably such drugs, based on monoclonal antibodies, will be expensive, and that raises the issue of drug access.

    In Scotland, there is the new medicines fund and in England there is the cancer drugs fund, a slight downside to which is that it is only for cancer. That might not be a problem for the patients that we are concerned about in this debate, but it is for people with some other diseases. However, the fund plays a role for drugs that have not yet reached the point of being passed by NICE, but for which some hope is felt. There was obviously great anxiety when seven key treatments were removed from the cancer drugs fund a few years ago.

    Something else that happened a few years ago was that a limit started to be put on the holy grail treatment of bone marrow and stem cell transplant, in that patients with a recurrence were not given the opportunity for a second transplant between the summer of 2016 and the spring of 2017, because that was no longer being commissioned. Politicians and those high up in organisations such as NHS England need to be conscious that trying to balance the books may pull the rug from underneath people. The gap of three quarters of a year will have been catastrophic for some people who might have benefited. That must be recognised when decisions are made.

    In the Scottish NHS, we do not have mechanisms such as 100-days commissioning, and hearing about it highlights to me how time, energy and people are wasted in trying to knit together a system that has become fragmented. I hope that the husband of the hon. Member for Coventry North East (Colleen Fletcher) is doing well, and continues to do well; but for the cancer nurse specialists or doctors to have to try to plug a gap, or for patients to fall through the gap because, as was said in one briefing, there are CCGs and commissioning groups that do not even know they are responsible for commissioning that care after the 100 days, is a waste. I spent more than 30 years working as a breast cancer surgeon and I would not want to have to waste clinical time in trying to deal with the gaps between stools. I think that the friction between what NHS England commissions and what CCGs are responsible for must be looked at.

    The hon. Member for Crawley highlighted, as did the charity briefings we received, the watch and wait approach taken with patients suffering from one of the more chronic types of blood cancer, such as chronic lymphocytic leukaemia and follicular lymphoma. I do not think that that should be seen as negative. We would not want to put people through tough chemotherapy if they were well; therefore we would not rush to do that. That is probably why many years ago those types were not labelled as cancer: what was referred to as “the C-word” was seen as a catastrophe. There was an attempt to give people the feeling that they were living with a disease; whereas we see cancer as meaning that the clock is running and we must rush to do everything. Therefore using the word “cancer” and then telling someone, “Actually we are not going to do anything about it,” is very challenging. That requires time for the clinician to have an open, honest and informed debate with the patient, so that they understand why they are not suddenly being put through chemotherapy.

    Data and the auditing of performance are important for driving through the improvement of any service. I do not mean such things as waiting times, on which we all collect data, but actual clinical standards—how someone is treated and what we would expect. What would all the clinicians in the area think was good practice? I do not mean shutting things down, or units being threatened by the Care Quality Commission. Having developed the breast cancer standards in Scotland in 2000, I can say that sitting in a room with all the breast teams of Scotland and looking at the data in a big PowerPoint on the wall is a dynamic tool for getting people to change practice. No one goes to work wanting to be the worst team in their country, region or area. Having access to actual clinical data is a great driver of quality.

    In England, work is being done on setting up cancer dashboards for the four commonest cancers. In Scotland, we have them for the 11 commonest cancers. We have had Scotland-wide breast cancer data since 2003. I have seen the quality go up simply from our all meeting every year, looking at the data and challenging each other and discussing the data—and sharing solutions. Whatever problem a unit faces—whatever the reason for their performance going down—someone else in the room will have had that problem before, and solved it. Such peer review and sharing of practice drives things forward. One of our big hopes for the cancer alliances is that they will redevelop what existed in cancer networks, which we still use in Scotland: people meet, support each other, and share practice.

    The importance of research has been mentioned. As a great believer in the European Union and the things that we have gained from it, I am anxious about our leaving the European Medicines Agency, about the loss of its support mechanism on rare diseases, and about the possibility that we will be outside the clinical trials regulation system, which is designed vastly to reduce the paperwork involved in taking research forward in a clinical trial. In the end, what we want to come from research is new treatment—new drugs. The UK is dynamic in the life sciences and the development of new pharmaceuticals, but the rather bizarre thing is that often our doctors do not get to use them. For people working in hospitals, that is getting to be a negative feedback loop. We do not get paid extra if we put patients into trials. There is an enormous amount of paperwork, and people inevitably stay well after time to make sure that things function. If suddenly at the end of the trial period, when they might be getting the drug funded, they cannot get access to the drug for several years, until it gets through NICE in England or the Scottish Medicines Consortium, those people feel, “Who is gaining? It is not my patients.”

    We require a different conversation with the pharmaceutical firms—some form of risk sharing by which perhaps a drug can be provided at a much lower price to the NHS. Instead of access simply ending and our going generic when the patent is finished, there could be a deal as to how many patients are treated with the drug before the NHS uses generic drugs. In that way the firms would know they would get a return on their money. The way things are at the moment, at the end of all the trials the price is worked out from how much time is left and how many patients are likely to be treated. If, as when Herceptin came in, it is a matter of thousands of pounds—Kadcyla was £90,000 per patient—it becomes almost impossible. While we tinker at the edges of the pharmaceutical price regulation scheme and what is done with the money we need a much deeper conversation.

    Obviously we want to promote awareness of blood cancers. Public awareness of the blood rash was mentioned; but also doctors need to think about having a high index of suspicion, and doing a simple blood test. For legislators and those who oversee the NHS systems in which decisions are made, it must be important that when a patient goes to see the doctor they set off on a smooth pathway that does not involve negotiations, hassles and disruptions, and that we support them all the way through that journey.

  • It is a genuine pleasure to serve under your chairmanship, Mr Wilson, and I congratulate the hon. Member for Crawley (Henry Smith) on his good fortune in securing this debate just before the launch of the report by the all-party group on blood cancer, which will take place afterwards. That was very opportune and well done. He made an informative and heartfelt opening speech, and I am sure that he can secure no finer legacy in memory of his mother than what he is achieving in Parliament today. I am sure his whole family are proud of him.

    As we have heard throughout this debate, blood cancer is the third biggest cancer killer in the UK, and the fifth most common cancer, with more than 230,000 people living with the disease. For those people and their families—some of whom are here today or watching the debate—action is needed to improve the treatment and support on offer. That includes some of my own constituents who contacted me prior to this debate, and it is for them that we are here today. There is much that we can do to improve treatment and support, as so eloquently put by the hon. Member for Crawley, and others who have spoken today, including my hon. Friend the Member for Coventry North East (Colleen Fletcher), and the hon. Members for Gordon (Colin Clark), for Strangford (Jim Shannon), and for Central Ayrshire (Dr Whitford), who all made excellent speeches.

    Blood cancer patients need to see their GP many more times before being referred to hospital than those with other cancers. Indeed, 35% of blood cancer patients had to see their GP three or more times before being referred, compared with only 6% of those with breast cancer, and 23% of those with all other tumour types. Such figures must be the fire beneath that spurs us on to do more, otherwise we will be failing the 230,000 people who live with this disease. Today I want to pick up on three key issues: first, patient experiences, and specifically the “watch and wait” principles of treatment and support; secondly, the improvements needed in research and access to treatments; and finally I will discuss post-stem cell transplant care. 

    Each year, 5,000 people with slow-growing blood cancers do not start treatment straight away, but instead are placed on a regime called watch and wait. That means that patients are monitored until they reach a point where treatment must start. It can take many years for that to happen, which can add much pressure to a patient’s life, including the psychological struggles that they might face. That is understandable: it must be excruciatingly difficult for someone to live with a cancer, including a blood-borne one, yet not receive any treatment, even though they know they have the disease. 

    To help fully understand this struggle, I want to read from a case study that was sent to me by Bloodwise, and written by the blogger who writes the “Diary of a ‘Fake’ Cancer Patient”. It states:

    “About a month after diagnosis, I went to pieces and sat in front of my consultant panicking, crying and generally not coping.”

    Reading the full case study is harrowing but heart-warming at the same time. That may sound peculiar, but it shows the scale of the struggle that blood cancer patients face under “watch and wait”, and also that when support is offered they can lead as normal a life as possible, and have the support to cope with the disease and the situation in which they find themselves. That is why Labour supports calls for tailored psychological support for patients who are on watch and wait, and it would be welcome if the Minister addressed that point when he replies to the debate.

    It would be of great interest to hear from the Minister whether the Government plan to look at the perceived pitfall in the cancer strategy regarding the recovery package, and the failures to take into consideration the unique characteristics of blood cancer, as well as the use of terms such as “beyond cancer” and “post- treatment”, which can be alienating to blood cancer patients. As we know, blood cancers are very different to solid tumour cancers, and that determines the kind of treatment on offer to patients. For blood cancer patients, treatment is not about surgery or radiotherapy; it is about drugs to help to fight their cancer, and importantly, about access to said drugs. It is therefore crucial that innovation and the development of new drugs is encouraged to help improve patient outcomes. The Government must continue to commit to ongoing research to help save lives, and capitalise on our world-leading position as blood cancer research pioneers.

    Lots of this work already happens, including charitable investment and collaboration between public bodies. One such example is IMPACT—a £4 million clinical trials programme that is jointly funded by Anthony Nolan, Leuka, and NHS Blood and Transplant services. By 2020, this exciting and much welcomed project will have established 12 clinical trials involving approximately 1,500 patients. It will play an invaluable role in achieving the vision set out in the Government’s life sciences industrial strategy and—most importantly—it will help to save lives. It is of utmost importance that the Government continue their commitment to this work.

    We must also consider how the cancer drugs fund works, and how the temporary collection of data to make appraisal decisions can, for some rare blood cancers, lead to insufficiency in collecting robust data, and therefore to negative appraisals for drugs. I have raised concerns in the past about the way we appraise drugs—indeed, I worked with the hon. Member for Central Ayrshire when we were both co-chairs of the all-party group on breast cancer, and we carried out work on some breast cancer drugs, including Kadcyla. It is therefore disappointing, yet not surprising, that we find similar situations when it comes to blood cancer drugs with, for example, the drug ibrutinib being given to patients with mantle cell lymphoma. That drug received a negative appraisal, and later a positive one. That causes unnecessary distress and anxiety for patients, and it is important that such problems are addressed. I hope that the Minister will give us some steer on when the Government plan to rectify these matters.

    Finally, I will touch briefly on the need for support for those living post transplant, and the care that should be on offer to them. It is estimated that by 2020 more than 16,000 people will be living post transplant, and they will therefore be more exposed to physical and psychological effects, such as graft-versus-host disease, depression and prolonged duress stress disorder. Although stem cell transplants can save a person’s life—that is fantastic—it is important that when someone’s life is saved, they can live it to its fullest. Sadly, only 54% of those who need psychological support actually receive it. That is down to the commissioning of post-transplant services not working for all patients, especially at the 100-day cut-off after a transplant, when responsibility for services moves from NHS England to CCGs, and therefore leads to gaps in the care and support provided. Is the Minister aware of that, and will he commit to looking at how that gap can be filled so that patients receive the best post-transplant support possible?

    This debate has been incredibly important, and I am sure it has given the Minister a lot to think about. I hope that when he gets back to his office, he will look at this issue in depth and read the APPG’s report following its launch today—I am looking forward to that—so that all the 230,000 people living with blood cancer can be confident that the Government are doing their utmost to give them the best chance of living.

  • It is a pleasure to serve under your chairmanship, Mr Wilson—I believe it is the first time that we have danced in such a way. I congratulate my hon. Friend the Member for Crawley (Henry Smith) on securing this debate on an issue that I know he feels passionately about, and I commend him for his work chairing the all-party group. We all come to the House with our motivations and experiences, and we all gather more experiences in the House. One reason why this is the job that I always wanted to do in government is because I have fought many types of cancer in many different ways, and lost more than I have won. It is always moving to hear Members speak personally about their experiences and why they have promoted certain issues in their parliamentary career, and I thought my hon. Friend did that brilliantly. Such experiences make us the MPs that we are, and I hope only that the figures for the people watching this Westminster Hall debate match those for people watching daytime television shows instead, because I think they would have a great view of the way that Parliament operates.

    Let me start by saying that the Government, and this Minister more than ever, are absolutely committed to transforming cancer services across England, and we take an all-cancer approach to doing so. It is true that cancer survival rates have never been higher, but we want cancer services in England to be the best in the world. We want to ensure that every patient, regardless of the type of cancer that they unfortunately get, has access to the treatment, the services and the support that give them the best possible chance of a successful clinical outcome and a successful recovery back into their lives, which are temporarily paused while they go through treatment.

    Shortly after this debate, as my hon. Friend the Member for Crawley advertised very well, the all-party parliamentary group will publish its first report. Having chaired the all-party parliamentary group on breast cancer with the shadow Minister for many years—and for a bit with the hon. Member for Central Ayrshire (Dr Whitford)—and produced all-party parliamentary group reports, I know how much work goes into them and how important they are. My hon. Friend should know that they are noticed by Ministers—they are certainly noticed by this Minister. I have here the copy he kindly shared with me. I think it is an excellent and informed piece of work and I congratulate him and the charities that supported him through the secretariat. I assure him that the Government and NHS England will take careful notice of its findings and recommendations. As I always do when I speak in response to the launch of a report, I will see that he gets a response in writing to the recommendations that he has made, in addition to what I will say in today’s response.

    The report highlights that someone is diagnosed with a blood cancer every 14 minutes. Nearly 250,000 people are living with blood cancer in the UK today, and it claims more lives than breast or prostate cancer. It is the third biggest cancer killer in our country, so this debate is as timely as it is important. I am pleased to say that many of the recommendations in this report mirror the strategic priorities set out in the cancer strategy for England, which outlines how we will implement all of the 96 recommendations of the independent cancer taskforce, chaired by Sir Harpal Kumar of Cancer Research UK, who will shortly step down from that role. What a loss that will be. I wish him well. I hope I can therefore assure my hon. Friend and other hon. Members that two years into the implementation of the strategy, we are already making significant progress in implementing the recommendations of the APPG report.

    My hon. Friend the Member for Crawley stated where we must start—a point also made by my hon. Friend the Member for Henley (John Howell)—and that is early diagnosis. We all know that this is key for all cancers and it gives the best possible chance of successful treatment. To improve early diagnosis, the Government made £200 million available to cancer alliances in December 2016 to encourage new ways to diagnose cancer earlier, improve the care for those living with it and ensure that each cancer patient gets the right care for them. The APPG report highlights that early diagnosis of blood cancers is difficult—we have heard different contributions as to why that is—as symptoms such as tiredness or back pain, are often misdiagnosed. My hon. Friend the Member for Crawley mentioned that his mother presented with flu-like symptoms, which maybe threw them off the scent a bit in the early days. That is why, for suspected blood cancers, the National Institute for Health and Care Excellence published a revised guideline in 2015, which clearly sets out that GPs should consider a very urgent full blood count within 48 hours to assess for leukaemia, if adults present with suspicious symptoms. I am very sure that there is more that we can do around education in primary care, but I think that was a positive move from NICE.

    Further, I must here mention the accelerate, coordinate and evaluate programme—ACE for short. It is a unique early diagnosis initiative, and a programme of 60 projects exploring innovative concepts across England. The programme is testing a new multidisciplinary diagnostic centre approach to diagnosing patients with vague or unclear but concerning symptoms, often characteristic of hard to diagnose cancers such as blood cancers. There are ten pilot MDCs across five areas of the country. They are one-stop shops that can ensure patients rapidly receive a suite of tests, reducing the risk that patients bounce around services receiving multiple different referrals for the same problem, having to start that explanation all over again—I know that is incredibly difficult—and do not get that all-important early diagnosis. We know that early analysis of these schemes is very positive and many patients can receive a diagnosis or the all-clear within just 24 hours. I look forward to seeing further analysis of these pilots when that is available and I very much hope that MDCs can become an important tool in helping us to identify blood cancers earlier. We have the new 28-day faster diagnosis standard coming down the track. I always say that 28 days is not a target, it is an end point. If we can beat it and do it in 28 hours, happy days.

    Patient experience when it comes to cancer is clearly so important. The APPG’s report also rightly highlights the importance of that. Improving patient experience is one of the six strategic priorities set out in the cancer strategy, and cancer patients are receiving better and more effective care, we believe. We are committed to ensuring that this improvement continues. In 2016, NHS England surveyed just over 118,000 people through the national cancer patient experience survey, which I am committed to continuing in one form or another, because I know how important it is. Over 70,000 cancer patients took part in the latest survey. I am very grateful to all of them for giving us their feedback to help to improve the experiences of cancer patients in the future. This feedback is vital to inform and shape the way hospital trusts and clinical commissioning groups achieve further improvements for patients. The Cancer Vanguard has also developed an innovative cancer patient feedback system which is now being used by many organisations that provide cancer care in our country. This new system collects real-time patient feedback at key points in the patient care pathway, which we have heard mentioned today, so that it can be fed back and used by those redesigning services to put patient experience at the heart of improvements in service.

    Linked to this point about patient experience is access to a cancer nurse specialist. My hon. Friend made the important point in his opening remarks that access to a CNS can make a hugely positive difference to the treatment experience of patients with blood cancer. Health Education England’s first ever cancer workforce plan clearly stated that we will ensure that every patient has access to a CNS or other support worker by 2021, and if we can do it sooner we will. We will do this by developing national competencies and a clear route into training.

    I thank my hon. Friend and others for their tributes to Macmillan Cancer Support. I have been to Southampton General Hospital—my neighbour, the hon. Member for Southampton, Itchen (Royston Smith), was here earlier—to visit the acute oncology centre, which is a partnership between the University Hospital Southampton NHS Trust and Macmillan, and a brilliant centre it is too. I met patients undergoing treatment for blood cancers. It was not a planned visit, but it was timely, given this debate. Macmillan—a brilliant charity—is also currently carrying out a specialist audit to understand the current size and location of the specialist cancer nurse workforce. This will enable us in the Department and NHS England to develop a much more comprehensive picture of how many specialist nurses are working in cancer and what further action and investment might be required to ensure timely and good quality patient care and experience in line with the target that I have set out. Once we have this data, I hope in the spring, we will publish an additional chapter to the cancer workforce plan, and consider the actions needed to support and enhance the wider nursing contribution to cancer.

    My hon. Friend the Member for Gordon (Colin Clark) spoke of workforce shortages north of the border. It is a familiar tale. We both face a cancer workforce challenge, which is why HEE produced our cancer workforce plan. It is a significant challenge to the NHS and cancer care, but one that we are absolutely determined to meet head-on and to beat.

    My hon. Friend the Member for Crawley and other hon. Members made points about living with and living beyond cancer. I take the point made by the shadow Minister about that term. Obviously the cancer strategy is as published, but in time it will be refreshed, and I take on board the point, which she made well. More than ever, thanks to innovations in treatment there can be a full life beyond a cancer diagnosis. The hon. Member for Central Ayrshire reminded us really well about the C-word. It did used to be the big C. It used to be a terror, and still is for many, but so many people now have a full life beyond a cancer diagnosis.

  • While we are obviously talking in particular about the chronic types of blood cancer, there are also solid tumours. Indeed, hormone positive breast cancer is actually much more of a chronic disease. It carries the same risk into the future and people may be living with it for decades. We have to get round that curve of seeing cancer as something that is dealt with acutely and then is over. There will be many cancers that we control, and we therefore need to help people to accept them as a chronic disease and not torture themselves with the C-word.

  • What a good point. I love the term “survivorship”, which we often hear. It is probably an Americanism, but it is one of ours now. It is a great term because it suggests a positive: we have survived and we will continue to survive and to fight. My officials do not like me using the term “to fight cancer”, but I do think that it is a battle, and a constant battle. Macmillan’s brilliantly moving PR campaign at the end of last year talked about life with cancer. There are lots of people living with chronic conditions. When I visit cancer patients, as I did on Friday in Southampton, I always make a point of asking them what they do when they are not in the cancer ward and what they are planning to do when they finish being in the cancer ward, because their lives are more than their cancer, and they are not their cancer.

    From the moment that they are diagnosed, patients benefiting from the recovery package, which we have heard mention of, receive personalised care and support. Working with their care teams, patients develop a comprehensive plan that addresses their physical and mental health requirements, which we have also rightly heard mention of, as well as identifying any other support that they may require. We are working to ensure that every patient in England, including those with blood cancer, has access to the recovery package by 2020. I repeat: if we can do it sooner, we will.

    Different cancers affect the body in different ways, and treatment and the recovery journey for someone with blood cancer can vary greatly to those for a patient with a solid tumour cancer. That is why every patient will receive a holistic needs assessment as part of their recovery package. For blood cancer patients, their recovery plan will be personalised to take account of the unique characteristics of blood cancer. My hon. Friend the Member for Crawley described the end of treatment as falling off the end of a conveyor belt, which is an expression that I have heard before. In my job I have seen research to the effect that the end of treatment can be more depressing than the moment of diagnosis. That is a really hard thing to say and to accept, but I can well believe, and know from personal experience, that it is true.

    That moves us on to psychological support. My hon. Friend makes the point that many patients with a chronic blood cancer diagnosis will sadly never be cured. They will be on a regime of watch and wait, often over many years, to see if the cancer has progressed to a point where treatment needs to begin. That can, understandably, take a huge psychological toll on the patient and their families. That is why the point made by the hon. Member for Central Ayrshire is so true, and why the recovery package rightly takes a holistic approach and considers the patient’s mental health needs. The Prime Minister has made improving access to mental health services a priority for her Government. There has been a fivefold increase in the number of people accessing talking therapies since 2010, but we know there is much more to do, and I will be watching that like a hawk in my job.

    We have heard today about the importance of research. If we are to continue to beat cancer and to better our figures, sustained investment in research is vital. The National Institute for Health Research spent £137 million on cancer research in 2016-17. That represents the largest investment in any disease area. It is thanks to advances in research that more than 90% of children diagnosed with the most common form of childhood leukaemia now survive. However, I recognise that progress in improving survival rates, including for some blood cancers, has been slow and that survival rates remain low. We have heard today that treatment of blood cancer is especially dependent on the development of new drugs and on being able to access them—an obvious truism—and that is why our focus is on not only research, but ensuring that proven innovations are adopted swiftly across the NHS in England. NICE’s fast-track appraisal process, or the FTA, which was introduced in April last year will, we hope, do just that. The FTA process will help to ensure that cancer patients have accelerated access to any clearly effective treatment that represents value for money for what is a publicly funded health service.

  • Will the Minister explain how that interacts with the budget impact assessment that allows drugs to be delayed by up to three years, even if they have been passed by NICE, if the overall cost of them might be more than £20 million? There are many concerns among groups that that might actually delay innovative drugs, which often tend to be expensive.

  • Order. Before the Minister responds, can I say that I would like to see if we can get the Member who moved the motion in at the end for a winding-up speech?

  • I thank the hon. Member for Central Ayrshire for that point. I might have to come back to her on it, so that—as is only fair, and bearing in mind the Chair’s point—I am able to cover some of the other points that Members raised in their speeches.

    My hon. Friend the Member for Crawley said that he would be sending a copy of his report to his local CCG, and I would echo his call for MPs from England who are in the debate today to do the same. MP and CCG relationships are very important to implementing the cancer strategy and reports such as this one. I have the mobile numbers of my local CCG lead and CCG chair in my phone, and I did long before I was a Minister. How many other Members, not only in this Chamber, but in the House, have that? It is a key relationship and Members have a role to play.

    The hon. Member for Coventry North East (Colleen Fletcher) spoke very well, as always, with her personal testimony. She calls for five-year plans for patients who have had a stem cell transplant. As I said, the recovery package is a personalised care plan for all cancer patients, and if the care team feel that a five-year plan is appropriate, I expect it to be considered and, if appropriate, commissioned.

    The hon. Member for Strangford (Jim Shannon), who has left his place, spoke, as always, in an informed contribution full of personal testimony. I will say that cancer survival rates in England have never been higher. If we can help his colleagues in the Northern Ireland Assembly, when that is back on its feet, I would be delighted. If he wants to set up a meeting, I would be delighted to attend.

    I need to close because I know, Mr Wilson, that you want to move on to the proposer of the debate. I hope that my hon. Friend will agree that implementation of the strategy is already beginning to transform services and to implement a number of the recommendations in his report, which is an excellent piece of work. Next week I will be meeting Bloodwise, which I know has representatives here today and does excellent work with his all-party group, to discuss further the important issues that Members have raised today. Next month I will be having the second of my big cancer roundtables, which this time will be joined by Cally Palmer, who is NHS England’s national cancer director. That is a great chance for me to bring all the cancer charities together.

    I thank my hon. Friend for bringing the report to Westminster Hall today and wish him well with its launch in a few minutes’ time.

  • In the remaining moments of this debate I would like to express my gratitude to you, Mr Wilson, for chairing this very informative and useful debate. I am grateful to right hon. and hon. Members for their speeches, interventions and the many personal accounts that really highlight the importance of ensuring that we properly tackle blood cancer for all our loved ones across the country. I also have real gratitude to those voluntary sector organisations and charities that have been mentioned today for their remarkable work on behalf of so many people and for supporting the all-party parliamentary group on blood cancer. I am also grateful to the many patients and families who have contacted me and have supported the all-party parliamentary group with our report, which—I will mention it one more time—will be launched in the Strangers’ Dining Room in the next few minutes. I thank them for their input.

    This is obviously a very emotional issue for many people, and I pay tribute to the courage of patients and their families. Those who have lost loved ones through blood cancer leave a fine legacy in ensuring that we fight—I join the Minister in using that word deliberately—blood cancer, so that we can ultimately find cures and better treatments. Finally, I am grateful to the Minister for his thoughtful reply, his work on cancer issues in the Department of Health and his fine legacy of work in the past.

    Motion lapsed (Standing Order No. 10(6)).

  • Vagrancy and Homelessness: Cleethorpes

  • I beg to move,

    That this House has considered vagrancy and homelessness in Cleethorpes.

    It is a pleasure to serve under your chairmanship, Ms Ryan. I welcome the new Minister to her place, as this is the first debate to which she has responded. We expect great things from her.

    There is a growing problem of vagrancy in Grimsby and Cleethorpes. In my constituency, the main hotspot is Cleethorpes town centre, particularly around St Peter’s Avenue, the High Street and in the marketplace. Its shops and vibrant night time economy make it a natural attraction for people who, unfortunately, have to go begging. That continues through the day and into the evening. Although I seek to address both sides of this complex matter, on this occasion my focus is on vagrancy and begging, as it is clear from what residents and traders have expressed to me and to the local media that they are extremely concerned.

    Whatever reason people have for resorting to begging, in almost every case it is extremely complex. Their circumstances are often driven by drug and alcohol addiction. As a compassionate society, we want to do all we can, but we also owe it to business people to address the issue—on many occasions, traders in Cleethorpes have put their life savings and many years’ work into establishing and maintaining their businesses. Last Saturday morning, I spent some time speaking to several traders on St Peter’s Avenue where the worst of the problem manifests itself. They made it clear that they consider the presence of beggars on the street bad for business.

    Begging is a complex issue that is not unique to north-east Lincolnshire—it is a national issue. Caring and unsuspecting members of the public can often be lured into unwittingly giving money with the best of intentions, but without knowledge of the consequences.

    At a recent community meeting in Cleethorpes, chaired by the ward councillor, residents and traders complained about vagrancy and expressed a range of concerns to representatives from the local council, Humberside police and Harbour Place, which is a local outreach charity. Dave Carlisle from Harbour Place began the meeting by highlighting that 50 people are sleeping on the streets of north-east Lincolnshire. Sadly, that is roughly double the number of only a year ago. It is clearly something that needs attention and we must do all we can to tackle the underlying problems.

    Though linked, the issue of homelessness is separate to that of vagrancy. I have been reassured by the steps that the Government have taken to eliminate homelessness. Last year, the Government supported the introduction of the Homelessness Reduction Act 2017 by my hon. Friend the Member for Harrow East (Bob Blackman), which will provide vital support and is backed up by additional funding for local authorities to cover the costs of their new responsibilities.

    The Government have committed to halve rough sleeping over the course of this Parliament and to eliminate it by 2027. The new homelessness reduction taskforce will do vital work to realise that ambition. In the autumn Budget, the Chancellor announced £28 million for three Housing First pilots in Manchester, Liverpool and the west midlands to support rough sleepers and turn their lives around. I hope that that can be rolled out across the country soon. Although the problem is at its worst in our major cities, I appeal to the Government to recognise that the local economies of smaller towns could be badly affected if the issue is not addressed.

    In the areas I have mentioned, there is a serious problem of what the local council refers to as “active beggars”—people who are not homeless but who use begging as a way of making money. One of the main concerns expressed at the recent community meeting in Cleethorpes was that residents simply do not know who is homeless and who is not. A report by North East Lincolnshire Council to its communities scrutiny panel in December stated:

    “There are approximately 16 active beggars currently known to agencies in North East Lincolnshire. The local beggars who frequent our public spaces do have complex needs which are predominantly around drug addiction. The vast majority have access to accommodation and are not deemed to be homeless. They have refused to engage with the services and it is evident that they continue to beg in order to obtain money which in most cases will be used to fund their drug addiction.”

    According to Thames Reach, in 80% of cases, money given pays for a drug or alcohol addiction and the person begging is not actually homeless. Humberside police advised my constituents,

    “to not give them anything directly, and if you want to donate to those less fortunate please do so through reputable sources like Harbour Place and other charities… We understand that the issue needs to be addressed, and our officers have been out and about everyday, with plans to further increase patrols.”

    The beggars identified would not engage with the support agencies, so enforcement has been difficult. In the first instance, support is offered to individuals. If enforcement is necessary, it takes the form of community protection warnings and community protection notices, which are issued for unreasonable behaviour and the detrimental effect it has on the area. So far 15 warnings have been used by the council, of which seven have progressed to notices.

    The “Think Before You Give” campaign has been launched. Careful joint communications have been developed due to the sensitive nature of the subject and the perception of the general public and the media that the beggars are homeless, vulnerable and in need of financial help. As the authorities continue to curb begging on our streets, the council will keep pushing the campaign and urges local businesses to get behind it.

    Both residents and businesses feel intimidated, on some occasions, by the presence of beggars. Local traders feel that their businesses are being affected, particularly when beggars camp outside their premises and ask for money from potential customers. Local traders want the police to move them on more quickly.

    Recently, a court heard about elderly people who took pity on Lisa Bentley after she started begging on St Peter’s Avenue. Her efforts to make money did not go down well with the Cooplands bakery because of fears that trade would suffer. The police were alerted because the assistant manager felt that Bentley would have a detrimental effect on trade by sitting there. A lot of elderly customers were willing to put money in the cup and, therefore, to act in a way that was not necessarily in Lisa’s best interests. She has breached her bail condition not to go on to St Peter’s Avenue and is repeatedly to be seen in the area. There is almost always a beggar sitting next to the cash machine outside the Sainsbury’s Local in the avenue, which many constituents find intimidating.

    Action is being taken. A fact-finding exercise was carried out early last year, followed by a multi-agency meeting that aimed to identify the genuinely homeless and those who require support, and to distinguish them from so-called active beggars who are not homeless. The initiative was supported by a range of agencies, including the Department for Work and Pensions, the council’s strategic housing home options team and anti-social behaviour team, the police and Harbour Place. That enabled work to focus on a specified number of known individuals, with the emphasis on initial support and engagement, followed by a scaled approach to enforcement that utilised the community protection warning or notice approach.

    There is concern, however, that a recent crackdown in the neighbouring town of Grimsby has pushed the problem on to Cleethorpes. This problem has been particularly prominent since the police’s Operation Hercules, which was aimed at ending the blight of anti-social behaviour and crime. The operation was important work that involved 18 police officers and 12 police community support officers, as well as traffic officers and licensing officials, but it was rather Grimsby-focused. Although Grimsby and Cleethorpes are in effect the same town, such an approach tends to move the problem rather than getting to grips with it. Throughout December, the most prominent locations where vagrants gather in Cleethorpes were patrolled daily by police, with a permanent presence during normal working hours. That presence was welcome, but the strain on resources meant that it could not go on indefinitely.

    There is a range of organisations that people in need can reach out to for access to help, including the council’s home options team, which will investigate cases of homelessness. The council has a statutory duty to provide temporary accommodation to anyone who presents as homeless, eligible for services and in priority need. Wider support can also be offered, such as debt advice via specialist money advisers. Harbour Place, the charity I mentioned, has been commissioned by the council to provide an outreach service to offer assistance and provide shower facilities, additional clothing and hot meals. St Peter’s church on St Peter’s Avenue is also actively involved.

    The people whom unfortunately we see on the streets obviously have complex needs, but it is important to note that the council, police and local charities are working closely to find solutions. They should be reassured by the support that the Government have offered by implementing measures to provide local authorities with greater powers and resources to eliminate homelessness and vagrancy. My aim in securing this debate was to urge the Government to consider whether further legislation is required for local authorities, police and all the agencies—whether statutory or charitable—to provide a fully co-ordinated approach to the issue.

    I acknowledge that, following the 2015 spending review, the Government are spending more than £550 million to tackle homelessness and rough sleeping in England by 2020. The largest proportion of that spending comes in the form of the £315 million homelessness prevention fund, which goes directly to local authorities. Those who have information about someone begging should draw that person’s attention to the proper authorities, which will be able to point them towards the help they need. Ultimately, handing over money is not helpful to the individual in question; it is far better to donate to homelessness charities such as Harbour Place, which are well placed to provide specific assistance.

    I recognise that section 3 of the Vagrancy Act 1824 is written in rather Dickensian language, but it enables the police to arrest and charge anyone who is begging. The Highways Act 1980 states:

    “If a person…wilfully obstructs the free passage along a highway he is guilty of an offence”.

    Section 5 of the Public Order Act 1986 also has provisions that can be useful. I have mentioned community protection warnings and notices, which are more about unreasonable behaviour and its detrimental local effect than about gathering evidence to prove an offence beyond reasonable doubt, resulting in a fine imposed by a court.

    This could be an early success for the Minister. Whatever the solution is, I urge her to instruct her officials to speak to North East Lincolnshire Council, Humberside police and others to see whether they are content with the legislative regime, whether it could be made more pro-active and whether further powers may be needed. Quite reasonably, the residents and business community in Cleethorpes are concerned about the matter. People in business have devoted their life’s work to setting up small shops and the like, and we urgently need to do something to help them.

  • It is a pleasure to serve under your chairmanship, Ms Ryan. I congratulate my hon. Friend the Member for Cleethorpes (Martin Vickers) on securing this important debate. This is my first opportunity to reply as a Minister; I am delighted that it is to such an old friend of mine.

    Let me start with the issue of begging and associated anti-social behaviours. As all hon. Members will be aware, begging is an offence under the Vagrancy Act 1824, and enforcement decisions are a matter for chief constables and for police and crime commissioners. Local authorities and police are equipped with a wide range of enforcement powers to combat issues arising from begging. Particularly flexible are the powers contained in the Anti-social Behaviour, Crime and Policing Act 2014, which has given local authorities a range of tools, from criminal behaviour orders to public space protection orders. To support local authorities and police in making such orders under the Act, the Government have recently published updated guidance on their use and particularly on their application to vulnerable groups. It is very important that those powers are applied at a local level to meet local circumstances, in order to ensure that authorities can provide a targeted approach to tackle the issues they face in their areas, such as those that my hon. Friend outlined.

    As hon. Members will appreciate, there are many reasons why people beg. To tackle the issue effectively, it is important that local authorities apply appropriate interventions that seek to address the underlying causes. To achieve that, as my hon. Friend said, it is very important that agencies across the communities come together, including police, local authorities and support services. I am absolutely delighted to hear of the work of Harbour Place, which sounds like a very interesting charity. I understand that there are a number of positive examples of well established multi-agency teams working with other local public and voluntary sector services to ensure that appropriate support and intervention is put in place to prevent anti-social behaviour in the long term.

    Where people are sleeping rough, it is vital that they receive the support they need so that they are able to move away from damaging street lifestyles and into accommodation. As my hon. Friend set out, the Government are taking a number of important actions to meet our objectives of halving rough sleeping by 2022 and eliminating it altogether by 2027. To achieve those objectives, we have embarked on an ambitious programme to reform our response that places prevention right at its heart.

    I am delighted that, thanks to my hon. Friend the Member for Harrow East (Bob Blackman) and colleagues across Government, the Homelessness Reduction Act 2017—the most ambitious legislative reform in decades—will be implemented in April. It will fundamentally transform the culture of homelessness service delivery and ensure that local authorities, public bodies and the third sector work together to actively prevent homelessness for all those at risk, irrespective of priority need, intentional homelessness or local connection. It will also require local authorities to work with those in need to develop personalised housing plans tailored to focus on the needs and circumstances of the individual. Those can include actions for other support services that are best suited to assist the individual.

    Local authorities are clearly best placed to make decisions about how to meet the unique needs and requirements of their residents. Homelessness is a complex issue and each area is different, so it is right that local authorities have the tools and flexibilities to develop a tailored and holistic solution that works for their communities.

    By placing duties on local authorities to intervene at earlier stages to prevent homelessness in their areas, the 2017 Act will ensure that more people will get the help they need before they face a homelessness crisis. To ensure that local authorities have the requisite resource in place to deliver the new duties under the Act successfully, we will provide them with an additional £72.7 million in “new burdens” funding, and I sincerely hope that my hon. Friend makes sure that North East Lincolnshire Council applies for an appropriate amount from that fund.

    To support local authorities even further, we have established a homelessness advice and support team, drawn from those with expertise on this issue within local authorities and the homelessness sector. These advisers have been providing targeted challenge and support to help local authorities to prepare for the 2017 Act, and to improve their practice and performance, where appropriate, across all areas of homelessness work. So far, representatives from over 250 of England’s 326 local housing authorities have attended homelessness advice and support team events, and met the team.

    We have allocated more than £1 billion to prevent and reduce homelessness and rough sleeping through to 2020. That funding will assist people to get the help they need and prevent homelessness and rough sleeping from happening in the first place. As part of this package, we have protected £315 million of core funding to local authorities to prevent homelessness. We have also provided local authorities with £402 million in flexible homelessness support grant funding, which local authorities can use to prevent and tackle homelessness in their area strategically.

    That funding sits alongside our wider funding on homelessness prevention of £197 million, and specifically our homelessness prevention programme, which includes a £20 million rough sleeping fund. That fund is supporting 48 projects to prevent or reduce rough sleeping in innovative ways, by strengthening and building partnerships with agencies that play a crucial role in helping those who are at risk of sleeping rough, or already sleeping rough, to exit homelessness. With more up-front funding, local authorities will be able to tackle homelessness more proactively, pushing the balance of investment in the future away from crisis intervention and towards prevention.

    In the autumn Budget, we made important announcements that will take us even further in achieving our objectives. We announced £28 million of funding to pilot a Housing First approach in three major regions in England. Those pilots will support some of the most entrenched rough sleepers to get off our streets and help them to end their homelessness. Individuals will be provided with stable, affordable accommodation and intensive, wrap-around support. That will help them to recover from complex health issues and to sustain their tenancies. Following completion of the pilots, the impact of the approach will be measured by a rigorous evaluation, which will inform our wider roll-out. Again, if the situation in St Peter’s Avenue in Cleethorpes should continue, I sincerely hope that North East Lincolnshire Council can be encouraged to join in this work after the pilots have finished.

    We also know that a challenge for those who are homeless is to access tenancies in the private sector. That is why we announced funding of £20 million for schemes that will enable better access to new private rented sector tenancies or provide support in sustaining tenancies for those who are already homeless or sleeping rough, or at risk of becoming homeless or sleeping rough.

    Hon. Members will be aware that tackling homelessness and rough sleeping is a complex challenge. My hon. Friend really gave us the nuts and bolts about that challenge. He has obviously gone into it incredibly deeply in his constituency and his constituents should be very grateful for the amount of time and effort that he has put into this issue, and I am sure that the traders on St Peter’s Avenue will be very grateful to him, too.

    Homelessness is a complex challenge and we must adopt a truly holistic approach if we are to achieve our objectives of reducing homelessness and rough sleeping. It is for this reason we have established a rough sleeping and homelessness reduction taskforce, which will oversee the implementation of a cross-Government strategy and drive wider action to reduce homelessness and rough sleeping. The taskforce will bring together Ministers from key Departments with a role in preventing and reducing rough sleeping and homelessness, to establish a fully cross-Government approach to these issues in England.

    The remit of the taskforce will be, first, to develop a cross-Government strategy to help rough sleepers, many of whom are entrenched and have complex needs. However, the taskforce will also focus on the wider issues of homelessness prevention and affordable housing. In order to help the taskforce to deliver its objectives, we have put in place a rough sleeping advisory panel, which I will chair and which will be comprised of key figures from local government, central Government and homelessness charities.

    I know that everyone here today will share my firm commitment to reduce homelessness and eliminate rough sleeping. Local authorities and the police are equipped with a range of powers to deal with the issues of begging and the anti-social behaviours that can be associated with it that they experience in their areas, and I encourage multi-agency working to tackle this problem, in particular in my hon. Friend’s constituency of Cleethorpes. If the police in Cleethorpes want to come and talk to us about any more legislation that they think is appropriate, I sincerely hope that, once the pilots that I mentioned are finished, they will consider that these matters are in hand. Nevertheless, our door is always open.

    Once again, I thank my hon. Friend for securing this debate and Ms Ryan for chairing it. It has given me the opportunity to set out the Government’s approach to tackling these important issues.

    Question put and agreed to.

  • Sitting suspended.

    Drug Consumption Rooms

  • I beg to move,

    That this House has considered drug consumption rooms.

    It is nice to see you again, Ms Ryan.

    Let me start with a few undisputed facts. Drug deaths due to overdose are increasing year on year in the United Kingdom. People have been taking drugs of various types for thousands of years. In the last 100 years or so, we have run a campaign to criminalise and persecute people who take certain categories of drugs. We decide which drug belongs in which category. Some criminals have become staggeringly rich through their involvement in the production and supply of drugs. Users are stigmatised as junkies, crackheads and stoners. Society adopts this language to dehumanise and ostracise sections of a community. That facilitates their abuse and allows them to be used as scapegoats.

    Where are we now? The drive to arrest and incarcerate the producers, distributors, dealers and users—often referred to as the war on drugs—has seen a massive increase in violent crime and corruption, along with hundreds of thousands of deaths and the criminalisation of some people for the most minor offences. The perceived problem that the war on drugs set out to solve has been compounded by the war. As a result, time, money and lives have been wasted. [Interruption.]

  • Sitting suspended for Divisions in the House.

    On resuming

  • As I was saying before we were so rudely interrupted, we created this situation and we can fix it, but doing so will take a change in attitude at governmental level. Rather than pay lip service to people with an addiction, we need to start listening to what they are asking for. We need to treat addiction as a health issue rather than a criminal justice issue, not just in part but in its entirety.

    Drug consumption rooms are part of the solution. Supervised drug consumption facilities, where illicit drugs can be used under the supervision of trained staff, have operated in Europe for the past three decades. Those facilities aim primarily to reduce the acute risk of disease transmission through unhygienic injecting, prevent drug-related overdose deaths and connect high-risk drug users with addiction treatment and other health and social services.

  • Does the hon. Gentleman agree that one of the big strengths of DCRs is their ability to reach people with drug addiction problems who are not otherwise known to the services? If we build relationships and trust with such people over time, we are much more likely to get them into services that can begin to address the reason for their addiction.

  • I completely agree. The first step of the healing process is building a working relationship with someone and earning their trust, so that they come back and do not have the suspicions that we have built among drug users.

    Drug consumption rooms also seek to contribute to reductions in drug use in public places, in discarded needles and in public order problems linked with open drug scenes. Typically, they provide drug users with: sterile injecting equipment; counselling services before, during and after drug consumption; emergency care in the event of overdose; and primary medical care and referral to appropriate social healthcare and addiction treatment services.

    Currently, people are sharing needles, using a product that may kill them instantly, and living chaotic lifestyles that harm them, their friends and their families. DCRs provide needles, which instantly reduces the spread of HIV and hepatitis C, instantly improves the health of the user and instantly engages users back into society, where they can be signposted to relevant services. Needle exchanges also go some way towards doing that, but the paraphernalia leave the premises and are often discarded in public places or shared with other users. Users may choose to inject themselves in streets, doorways or gardens near to the exchange, which is unsuitable for users and local residents.

    The great thing is that we have evidence from 10 other countries that DCRs work. The first supervised room was opened in Berne, Switzerland, in June 1986. Further such facilities were established in subsequent years in Germany, the Netherlands, Spain, Norway, Luxembourg, Denmark, Greece and France. Outside Europe, there are facilities in Australia and Canada. A total of 78 drug consumption facilities currently operate in seven European monitoring centre for drugs and drug addiction-reporting countries.

  • I congratulate the hon. Gentleman on securing this debate on a potentially controversial subject, but perhaps one where we need to look at the evidence. Does he agree that there are not only health benefits but other benefits in terms of crime prevention and reduction? The Home Office’s figures say that 45% of crimes are caused by drug users stealing in order to feed their habits. Tackling that through the introduction of consumption rooms would bring considerable benefits.

  • Absolutely. To my knowledge, the closest thing we have had to that in UK was opened by John Marks in the Wirral back in the 1980s. At that time, local crime dropped by more than 90%. We have the information at our fingertips.

    Most interestingly, no country that has adopted DCRs has ever regretted it and subsequently closed them. Switzerland and Spain have closed DCRs, but only because the need for them reduced significantly—they were so successful that they put themselves out of business.

    Before the festive recess, I asked the Prime Minister at Prime Minister’s questions to change the law to facilitate DCRs in the UK—or, if not, to devolve the relevant powers to the Scottish Parliament so the Scottish Government could do so. The law needs to change to protect the people who supervise the rooms and to enable the relevant police forces to take a consistent stance that does not set them apart from the rest of the judicial system.

  • Like my hon. Friend the Member for Easington (Grahame Morris), I think the evidence is important. I am confused about the position in Scotland, where criminal justice is devolved. The hon. Gentleman referred to devolution, so will he clarify why the UK Parliament needs to take that step? I am genuinely interested.

  • Certain aspects of the law are not devolved to Scotland and the laws we require to allow people to work in these facilities with impunity rest here at Westminster. I want those laws to be devolved to Scotland, because we have the appetite to do the job.

    The Prime Minister’s response was that she knows some people are more liberal about drugs than she is. She is not minded to do anything, which completely misses the point. It is not about having a liberal attitude but about compassion and treatment for vulnerable people.

  • Before we move too far away from law enforcement in Scotland, will the hon. Gentleman explain what the police’s response would be if he were to get the powers devolved? Would they be asked to ignore people in possession on their way to such venues, regardless of how far away they were?

  • The police would have the authority to stay within the law. We would not ask them to turn their eye from people who were breaking the law. The law would allow people to carry in their own drugs.

  • The limit from which a drug may be carried in has not been defined. The point is that the Scottish Government and the Lord Advocate have asked for this facility to happen.

  • The alternative would be having people shooting up in alleys and contracting HIV and hepatitis C. That might be what the hon. Gentleman wants to see in Scotland; it is not what I want to see anywhere in the United Kingdom.

    Nobody is saying that drugs are for everybody or that drugs are great. What I and many others are saying is that if we want to stop damaging society and help the many individuals who have a drug addiction problem, we need to change our approach. DCRs are not a magic wand or a silver bullet and they will not resolve every issue, but they are humane, productive and cost-effective. The total operating costs of the Glasgow safer drug consumption facility and heroin-assisted treatment facility are estimated at £2.3 million per annum. A 2009 Scottish Government research paper suggested that in 2006, the cost attributed to illegal drug use in Scotland was around £3.5 billion.

    The Vancouver Insite DCR costs the Canadian taxpayers 3 million Canadian dollars per year. The facility claims that for every dollar spent, four are saved, as they are preventing expensive medical treatments for addicts further down the line. That figure is recognised in many other countries. A 2011 ruling by the Supreme Court of Canada concluded that Vancouver’s Insite safe injecting room saves lives with no negative impact on public safety in the neighbourhood, and that between eight and 51 overdose deaths were averted in a four-year period. A study in Sydney showed fewer emergency call-outs related to overdoses at the time safe injecting rooms were operating. A study of Danish drug consumption found that Danish DCR clients were empowered to feel

    “like citizens rather than scummy junkies”

    —their words, not mine.

    These findings corroborate other investigations that DCRs are an essential step towards preventing marginalisation and stigmatisation. NHS Greater Glasgow and Clyde estimates that the annual cost to the taxpayer of each problem drug user is £31,438. It further estimates that the introduction of a new heroin-assisted treatment service could save over £940,000 of public money by providing care for just 30 people who successfully engage with the treatment. Even if we did not give a damn about people with addictions, it would make good financial sense to provide those facilities. It is more cost-effective to provide DCRs than it is to pick up the bill after the damage has been done.

    DCRs are more than just a practical solution; they are humane, compassionate and financially effective. I can think of only two reasons why the UK Government are so resistant to the proposal: either they are stuck in an ideological mindset that people with addictions are not ill but are the product of poor lifestyle choices, or they simply do not care. The UK Government have stated:

    “It is for local areas in the UK to consider, with those responsible for law enforcement, how best to deliver services to meet their local population needs.

    We are committed to taking action to prevent the harms caused by drug use and our approach remains clear: we must prevent drug use in our communities, help dependent individuals recover, while ensuring our drugs laws are enforced.”

    That cowardly stance simply underlines the UK Government’s disengagement from the reality of the situation. It pushes responsibility on to the shoulders of local administrations and the police force, while refusing to furnish them with the legal powers to act responsibly within the law. The Home Office-led study “Drugs: International Comparators” from 2014 concluded that there was

    “some evidence for the effectiveness of drug consumption rooms in addressing the problems of public nuisance associated with open drug scenes, and in reducing health risks for drug users.”

    It also said that the ECMDDA report

    “considers that on the basis of available evidence, DCRs can be an effective local harm reduction measure in places where there is demonstrable need”.

    Despite the evidence that DCRs are financially viable, the United Kingdom Government have chosen to ignore it. Can the Minister please tell me why?

    In conclusion, I once again ask: will the UK Government look at the growing body of evidence and change the law to allow DCRs to be opened in the UK without fear of prosecution? Will the UK Government devolve the relevant powers to Scotland to allow the SNP Government to pursue ambitious and innovative new measures to tackle the public health issues of unsafe drug consumption?

  • It is a pleasure to serve under your chairmanship, Mrs Ryan. Thank you for understanding that I am unable to stay until the end of the debate and still calling me to speak.

    I congratulate the hon. Member for Inverclyde (Ronnie Cowan) on securing the debate, but I must say from the outset that I am against the introduction of these facilities. The problem with support for drug consumption rooms is that it is based on a faulty assumption that the issue with class A drugs is the circumstances in which they are consumed. It is true that many users of class A drugs are killed, injured or exposed to infection by particularly unsafe means of consumption, such as dirty needles. However, the answer is not to create state-sanctioned drug consumption rooms, but to address the real issue: the consumption itself. Our efforts must be focused on getting people off these drugs. Diversions such as drug control rooms only serve to distract from that purpose, or even make matters worse.

  • I congratulate the hon. Member for Inverclyde (Ronnie Cowan) on introducing the debate. My hon. Friend makes a point about helping people to get off drugs. Surely the first step is engaging those people with medical services? The purpose of drug consumption rooms is to do exactly that, and to help people to engage in a safe way. That can be the first step to getting them off the drugs.

  • I agree that engagement is important; I disagree that the only place in which that engagement can take place is in these drug rooms. I stick by what I said earlier. We really have to ensure that we do not go down this route, because there is ultimately no safe way to take class A drugs—that is why they are classified as such.

  • Will the hon. Gentleman give way?

  • I will give way in a moment. Someone may use a drug consumption room once—they may even use it regularly—but there is no guarantee that they will use it all the time. As long as someone is addicted to these drugs, they cannot be kept safe. They certainly cannot be set on a course towards recovery, and the drug-free life that every human being deserves.

  • Will the hon. Gentleman give way?

  • I think we are short of time, so I want to keep going.

    Drug consumption rooms could even make things worse. Some drugs, such as heroin, work in such a way that many people build up a tolerance to them, so in order to get the same high and to satisfy their addiction, they end up having to take more and more of the drug. We therefore could be faced with the prospect of the state building a facility to passively watch over someone sinking deeper and deeper into an addition that becomes more and more likely to kill them with each hit. Instead of building drug consumption rooms and trying in vain to make addiction to these drugs safer, we should be redoubling our efforts to help people overcome their addictions altogether.

    When it comes down to it, the only safe approach, and the only thing that we should be encouraging, is detox and abstinence. That approach also has the added benefit of being less regionally biased. I for one cannot foresee many drug addicts in Moray, which I represent, making use of a drug consumption room in Glasgow, but drug addiction is not limited to the large cities or the communities close to them. This issue affects all parts of the country, including small and relatively remote rural communities such as my own. There may be fewer addicts in Moray than in other parts of Scotland, but they deserve the same level of support. The issue should not be reduced to a postcode lottery.

  • Members of this House and members of the public have strong feelings on this issue, so it is important that we consider the evidence and the arguments. The hon. Gentleman says that he is against drug consumption rooms. I am not familiar with the situation in Moray, but I understand that shooting galleries exist. In my constituency, they are located in private dwellings, with drug addicts using dirty needles and tainted drugs of unknown quality and strength. Why does he believe that dangerous, private shooting galleries are preferable to drug consumption rooms?

  • The hon. Gentleman started his remarks by saying that we must base our decisions on evidence. The evidence from Professor Neil McKeganey, founder of the Centre for Drug Misuse Research said:

    “we surveyed over 1,000 drug addicts in Scotland and we asked them what they wanted to get from treatment. Less than 5% said they wanted help to inject more safely and the overwhelming majority said they wanted help to become drugs free.”

    That is the evidence that I am looking at.

    I want to further explain how this issue has an impact on more rural areas. The opioid epidemic in the United States has shown us how drug addiction crises can become a dispersed and largely rural phenomenon, rather than something confined to parts of cities within reasonable distance of a drug consumption room.

    There are, of course, other issues, such as policing—an issue that is close to my heart, given that my wife is a police officer. We obviously could not have police officers standing outside a drug consumption room ready to arrest anyone who walks in for possession, but where do we draw the line? Do we have an exclusion zone, within which the police do not arrest people for possession? As I was trying to ask the hon. Member for Inverclyde, what if someone is further away, but still claims to be en route to the consumption room? Do we prosecute them? Could it even be used as a valid legal defence? After all, it would be the Government actively setting up these places where drug possession and consumption are condoned. That would set us on the road to a sort of selective decriminalisation.

    The hon. Member for Glasgow Central (Alison Thewliss) and the Scottish National party want powers over drugs, including the Misuse of Drugs Act 1971, to be devolved to the Scottish Parliament, but I believe the UK Government are correct to expect the police to enforce the law. I do not support SNP Members on that matter. We all want to help drug addicts, bring addiction levels down, reduce the number of deaths and injuries, and cut the crime rate, but drug consumption rooms are not the best way to do that. The best and right thing to do is to enforce the law and focus on getting people off drugs altogether.

  • One of the clearest failings in public policy has been the war on drugs. Treating addicts as criminals has clearly failed; it does not work. It led to 3,744 deaths last year alone. If hon. Members think more enforcement will work, I am afraid they are sadly deceived. The evidence from around the world shows time and time again that DCRs are a way to help people stop taking drugs. They are places where people can engage safely.

    Let us take Sydney as an example. In 1999, the Kings Cross area of Sydney was known particularly for its large number of overdoses and deaths. In the British national picture, I see similar patterns in parts of Brighton and Hove. I remember visiting Sydney at that time, and it was a problem. Drug consumption rooms were trialled, and after 10 years KPMG commissioned an independent report, which found that in those 10 years there was not one single fatality among any of the users who had attended the rooms. Let me repeat that, because some hon. Members do not seem to get the difference. In Sydney, where there were 4,400 drug users, not one single person died, whereas 3,744 died in Britain last year. I know which system I would prefer: the one that led to no deaths on my hands. People who advocate for a cracking down are advocating for the deaths of sons, daughters, friends and family members. That is the cruel reality of the current policy.

  • For clarity, is the hon. Gentleman saying that, after the introduction of DCRs in Sydney, there were no drug deaths whatever as a result of the introduction, or were there no drug deaths among the users of the rooms?

  • The KPMG study found that there were no drug deaths among the people who had used and engaged with the rooms, of whom there were 4,400 over that time. During that period, there was an 80% reduction in the number of ambulance call-outs relating to drug issues in Sydney, and a reduction in the average number of overdoses in public locations by more than three quarters. The rooms provided 9,500 referrals to welfare services in the wider communities. Most importantly, they won the support of residents and neighbours.

    One of the things we hear time and again—I am sure this will be brought up—is that people do not want these things in their backyard. As colleagues have said, the reality is that they are in people’s backyards—quite literally. I remember canvassing up flights of stairs in tower blocks, and people were shooting up right in front of me. They had nowhere to go and no support was offered. The only thing we can do is ring the police, but we know that in a day or so the revolving door will start again. How does that help with the pressure on our police? How does that help with the pressures on our communities? The reality is that it does not.

    Globally, countries have gone down two tracks: the prohibition track or the treatment track. At the same time, in all those jurisdictions, usage has slightly decreased. However, in jurisdictions that go down the prohibition route, the harm caused by those harder drugs has rocketed and the number of people getting stuck in long-term habits has increased. Under the treatment route, as we have seen in Portugal and so on, we have seen long-term usage go down and the harm slashed. Surely that is what our policies must be about: the harm to communities and individuals.

    I will not speak for much longer, because I know that lots of other colleagues want to speak, but I will touch on some of the issues that have been raised about policing. I feel the policing issue is something of a straw man argument. If there is a centre that people are asked to go to for treatment and to abstain from drugs and stop their addictions entirely, should those people be stopped from going to the centre on the off chance that they might have drugs on them because they are addicts? Should they be followed home? Should we try to entrap them? We do not do that at the moment, so suggesting that the police would need to do that with DCRs is a straw man argument.

    No law is perfect, and there are grey zones, but surely it is better to work within those legal grey zones, deal with issues through dialogue with the police and save lives, than to have a system in which we have a hard and fast rule and thousands and thousands of people die. Some 56 people died in 2014-16 in my city of Brighton and Hove—it is also the city of the hon. Member for Brighton, Pavilion (Caroline Lucas), who I am sure will testify—which is actually lower than in previous years.

  • To clarify, I was not suggesting that the police are going out and searching everyone on the way in to DCRs. I was suggesting that there is a reasonable concern that, if someone in the vicinity of a drug room is stopped and searched and found to be in possession of something like heroin, they could say they are on their way to the drug room and may therefore not be charged. That is why the Lord Advocate in Scotland was not able to give his permission for the example in Glasgow.

  • It is interesting that that does not seem to be a problem elsewhere. That is all I can say. Let us base this on evidence from elsewhere. I have spoken for long enough, so I shall sit down.

  • I am delighted to follow the hon. Member for Inverclyde (Ronnie Cowan) and I congratulate him on securing the debate. I recognise that we have a shared interest in the work that we jointly do as officers of the all-party parliamentary group on drug policy reform.

    The hon. Gentleman will be unsurprised that I largely agree with his analysis. My hon. Friend the Member for Moray (Douglas Ross) might be a little more surprised about that, but I congratulate him on his speech and on taking part in the debate and representing a view that appears to represent the majority in Parliament. That is an example of the challenge one faces in getting consideration of this issue into the era of evidence and in getting it addressed around the issue of public health.

    The Under-Secretary of State for the Home Department, my hon. Friend the Member for Louth and Horncastle (Victoria Atkins), who will reply to the debate for the Government, is entirely typical in that in nearly all the nations of the world drugs policy sits in an interior or Home Department where drugs policy sits. That is frankly wrong. It ought to be sitting in Health. We are dealing with a very serious health issue.

    It would be very nice if the world’s objective to deliver detox and abstinence, as elucidated by my hon. Friend the Member for Moray, was realistic. The world has been trying to do that collectively for nearly 60 years, and the position continues to get worse and worse. The criminal justice consequences of this policy are utterly appalling, and I speak from experience, having served as the Minister responsible for prisons, probation and criminal justice for two and a half years. That is just in the United Kingdom. Half of acquisitive crime is driven by addiction, and if we cannot do anything about addiction, we should be not remotely surprised that the cost to our country of the criminal justice impact is in the order of £13.5 billion, which I think was the figure given in the Government’s latest drug strategy.

    From a criminal justice perspective, I would have traded the massive savings we make in criminal justice to get this issue out of criminal justice and into public health. As I have got into this issue and understood it better, I see that these two things go hand in hand. We would get a significant public health advantage by being more transparent and open about our treatment of addiction. Even if a country was not prepared to go outside the global convention and global policy on the war on drugs—to go as far as Portugal has gone—and simply decriminalised low-level use, it would see a massive improvement in its public health outcomes.

  • My hon. Friend is making a characteristically constructive and well-informed speech about a matter he knows well. One of the problems with the current approach is that by punishing people who, through addiction, are medically unwell—that is the way I see it, as a doctor—we are worsening the ability to engage with them effectively in healthcare terms and worsening the spiral of addiction through debt and the criminal justice consequences. Does he agree that that needs to change?

  • I wholly agree. My hon. Friend, with his medical background, speaks with authority on this matter. Drug consumption rooms plainly, on the basis of evidence around the world, ought to be part of our attempt to treat people who find themselves in the wretched position of being addicted to the most difficult and dangerous drugs. It is simply about the evidence. No one has died globally in a properly overseen drug consumption room, and yet in our country, 1,707 people died as a result of illicit heroin use in 2016. The extraordinarily stark contrast between the figures in Portugal and Scotland alone ought to make all of us think very carefully about the implications of our current policy.

  • I hope my hon. Friend will agree that while no one has died in a drug consumption room, that does not mean that no one who has used a drug consumption room has died as a result of drug taking. As I said in my speech, we cannot get everyone to go every time. Some go once, and some go every now and then. We cannot force them to go every time.

  • No, of course my hon. Friend is right, but I am not entirely sure what the merits of his point are.

  • It does not solve the problem because people still die.

  • The truth is that we will never solve the problem. Humanity has been using drugs in one form or another for thousands of years. My hon. Friend almost certainly uses a drug, unless he is a teetotaller.

  • Then frankly my hon. Friend is in quite a rare position. The vast majority of people—certainly Members of this House—use a drug perfectly legally, and that drug is called alcohol. It happens to be the drug that the Advisory Council on the Misuse of Drugs said is probably the most dangerous drug in use in the United Kingdom in terms of its impact. He is a football referee, and having seen football crowds he will know the difficulty of policing crowds under the influence of alcohol. Alcohol is a significant and difficult drug.

  • The hon. Gentleman mentioned the Advisory Council on the Misuse of Drugs, and that body has recommended that DCRs are a policy that we should pursue. Would he agree that it is the case that not only have DCRs not been a venue where people have died, but they have been one of the most effective interventions at getting people away from addictions? DCRs are not being complacent about addiction; they are being realistic—[Interruption.]

  • Order. We have two more speakers, and they will be able to get in. We will resume immediately once everyone is back from the Division; we will not take the 15 minutes. If there are two Divisions, the same applies. As soon as the second one is done— I think there will be two—I ask everyone to get back quickly, apart from Members who have informed me that they cannot do so.

  • Sitting suspended for Divisions in the House.

    On resuming—

  • I shall conclude by saying that one should recognise the challenge facing the Minister, given the circumstances she faces. It is difficult enough when our policy and, I believe, global policy are stuck in absolutely the wrong place; we have had 60 years of the policy not working. She then has to deal with the legislative framework that she has to operate within. She then has to try and find a way actually to get drug consumption rooms working, when the overwhelming evidence on the ground is of the benefits they can bring to the communities in which they are placed. They get needles and addicts off the streets, stop people shooting up on the streets, and put addicts on the route to recovery. That is able to happen in an entirely safe place. The public health outcomes need to be a priority for us.

    Recognising those difficulties, all I ask of the Minister is that she learns, as I am learning about this issue as I engage with it, and that she and the Government remain open to all the evidence that is coming in from all around the world, through all the different examples. On drug consumption rooms, I very gently suggest that the evidence from around the world is utterly overwhelming about their merits.

  • May I just say that if Back Benchers who wish to speak stick to three minutes each, everybody will get a turn to speak?

  • Thank you, Ms Ryan, for your agile and dynamic chairing of this debate, and congratulations to the hon. Member for Inverclyde (Ronnie Cowan) on securing it. It is on a vital issue that we need to address in this House.

    The Glasgow safer drug consumption facility and heroin-assisted treatment pilot project were initially advocated by the Labour administration on Glasgow City Council. It was led by Councillor Matt Kerr, who was convenor of social work at the time, acting on a recommendation from the Glasgow City Alcohol and Drug Partnership that it was a worthwhile and heavily evidenced method to improve the safety and hygiene of intravenous drug use in the city. Indeed, it received cross-party support and benefited from wide support, including that of the hon. Member for Glasgow Central (Alison Thewliss), who at the time was serving on Glasgow City Council.

    As many Members may be aware, the issue of drug use and drug-related mortality in Glasgow is particularly acute, and it is a problem that necessitates radical and disruptive new approaches. Almost a third—267—of all Scotland’s drug deaths in 2016 occurred within the Greater Glasgow and Clyde NHS health board area. Per 1 million people, there are 283 drug-related deaths in Glasgow, but the average across the EU is just 20. That means that Glasgow’s drug death rate is an appalling 1,315% higher than the EU average and 329% higher than in England and Wales.

    Last year, 1,707 people died in the UK from a heroin overdose, yet no one has died from an overdose in a supervised drug consumption room anywhere in the world at any time. That is due to both the hygienic environment and medical supervision, as well as the readily available supply of life-saving overdose drugs, such as naloxone.

    According to the most recent estimates, around 13,600 people aged between 15 and 64 in the Glasgow City Council area are problematic drug users. That represents 3% of the population, which is the highest prevalence rate of all local authorities in Scotland and significantly higher than the Scottish average of 1.75%.

    In my constituency of Glasgow North East, there are particularly high levels of drug use in Possilpark and Springburn, which are two of the most economically deprived areas of the constituency following eight long years of brutal austerity. That serves only to drive up levels of despair and alienation in these communities, which is one of the main reasons why people fall into the pernicious trap of hard drug addiction. These areas have also been plagued by the brutal organised crime war between rival factions seeking to control the supply of drugs in the city.

    Drug consumption rooms offer hope in this otherwise bleak landscape of despair. They are used as an effective public health measure in the Netherlands, Germany, Denmark, Spain, Norway, France, Luxembourg, Switzerland, Canada and Australia, with 90 facilities currently operating in 61 cities.

    It is clear that drug consumption rooms are a worthwhile and practical measure to introduce to Glasgow. They benefit society, for example by reducing drug-related litter and needle-stick injuries, reducing the spread of disease and making our streets safer, as well as having significant health benefits for those who use drugs. Drug consumption rooms significantly reduce fatal overdoses and the needle-sharing that can lead to infections, including HIV and hepatitis, by providing people with sterile equipment. They have also been shown to increase the number of people entering treatment programmes.

    Use of a safe space provides the opportunity to start engaging people and to build up trusting relationships with appropriate professionals, which supports them to take those first steps towards dealing with their addictions. The benefits of DCRs have already been demonstrated elsewhere, yet attempts to set up the UK’s first DCR have been blocked. That is despite the idea being supported by the British Medical Association.

    That decision is typical of a Government who take little heed of scientific evidence of what works and what saves lives. This is primarily a question of public health, as has been said before, and not one of criminal justice. I therefore urge the Government to adopt an open-minded approach, heed the consensus of all relevant parties and expert bodies in Glasgow, and reconsider amending the obsolete Misuse of Drugs Act 1971 to permit the piloting of the safe drug consumption facility in Glasgow. That will allow them to assess the opportunity that that facility may bring to mitigate and solve the extensive harms caused by the unregulated and unsafe drug consumption environment in my city.

  • Thank you for your patience with the many Divisions throughout the debate, Ms Ryan. I will not repeat what other hon. Members have said, but make some specific, Bristol-related remarks.

    I understand why people have an instinctive reaction that drug consumption rooms must be harmful, because they appear to facilitate the use of drugs. To hon. Friends who have doubts, however, I say that we already have a drug consumption room in Bristol: it is called Bristol. It is called the square outside my office, the doorstep into my office and the blocks of council flats at the side of my office. It is called virtually every part of the city centre.

    The harms caused by that existing drug consumption room from the drug consumption that goes on there, the resulting drug litter, and the visible harm to drug addicts and to bystanders—people who have no interest in taking drugs but want their children to be able to play in the local playground—are many and varied. They hurt the most vulnerable and the very people we on this side of the House are here to represent, so I encourage all hon. Members to consider the use of drug consumption rooms.

    In Bristol, we have very high rates of injecting and of poly-drug use, particularly crack cocaine mixed with heroin that is then injected. Public Health England recognises that we have high levels of complexity in the people who use such drugs and in the high levels of admission to hospital for drug-related harms.

    Another harm is more widely shared among us all: the cost of the existing drug consumption room regime to the health economy. The total length of stay in the Bristol Royal Infirmary in 2015-16 for drug-related admissions was 2,758 days, with an estimated cost of £1,103,200. I thank Jody Clark for providing those figures from Bristol City Council’s “Bristol Substance Misuse Needs Assessment”. Hospital admissions specifically for injuries caused by injections accounted for 1,005 bed days—36% of all drug-related stays. That is from just 71 individuals who had an average stay in hospital of 14 days each—more than twice the average 6.6-day stay for all drug-related admissions—and an estimated cost of in excess of £400,000.

    I urge all hon. Members to consider that if we want to give our health service more money, if we want to make our streets safer, and if we want to save the lives of people who have drug addictions, as I do, we need to invest in drug consumption rooms. However unpleasant it is to have to step over a very aggressive and slightly frightening—sometimes very frightening—drug addict on my office steps, I do not want them to die. I want their lives to be saved and I want the people who live in the blocks of flats near my office to be able to send their children out to play.

    For all those reasons, and because nobody has ever died in a drug consumption room that was officially sanctioned and clinically run, I urge all hon. Members to consider the drug consumption rooms we have at the moment and support this alternative.

  • I congratulate my hon. Friend the Member for Inverclyde (Ronnie Cowan) on securing this important debate. In Glasgow city centre, there are around 500 people who inject drugs on a regular basis. Someone who comes to Glasgow will probably not see it, but for many of my constituents it is a huge issue.

    Before I was elected in 2007, the issue of discarded needles was raised by a resident, who pointed me to a bin in a children’s play park. I have an enduring horror that sooner or later a child will get pricked by a contaminated needle, which is a daily hazard for our council cleansing staff. No one should have to live with that risk.

    The issue has never gone away, but has simply moved around. Earlier tonight, a constituent, Andy Rae, told me that he had come home to find two contaminated needles on his doorstep. As the hon. Member for Bristol West (Thangam Debbonaire) said, the problem is already there. It is on my office doorstep too.

    A constituent wrote to me over the weekend to say:

    “In the 18 months that I have lived here there have been countless times that I’ve seen people injecting drugs in the bin area, doorways, and carpark… They leave behind their needles, bloody wipes, spoons, and bottles all over the area, strewn all over the ground/grass/hedges, as well as urine, vomit and blood on the ground… This is a nice, quiet, residential area, home to people both young and old, families with children, students, people taking their dogs out, and is also in very close proximity to the children’s play park directly across the road.”

    Another constituent, who I spoke to on Monday, told me about witnessing prostitution in bin shelters and groups of people taking drugs under the stairs.

    I regularly walk around that part of my constituency, reporting needles as I find them. After my surgery on Friday, I saw among the usual places a young woman injecting herself behind a derelict building. There is no dignity for that woman—only desperation. That is the reality of life for intravenous drug users in Glasgow, and of the impact of their behaviour on residents. It is deeply damaging for everyone involved. Each of those people injecting drugs is someone’s child, is loved by somebody, and we owe it to them to find a better way.

    There has been no means of dealing with the situation. It is imperative that we do something different. The Glasgow health and social care partnership has concluded that the only way to deal with public injecting is to provide a safe, managed space for people to inject. By doing so, we can also respond to the concerns of residents and businesses and meet the needs of a very vulnerable and marginalised population who do not engage in services. The partnership has a clear and well thought through proposal for a drug consumption room. I commend its report, “Taking away the chaos”; if the Minister has not already read it, I urge her to look at the evidence that it has gathered.

    I pay particular tribute to Saket Priyadarshi for his work, to Susanne Miller of Glasgow City Council for her commitment, and to people like Kirsten Horsburgh of the Scottish Drugs Forum for their advocacy of this important project. The health and social care partnership has done significant work on establishing needs and protocols on how it would work, on listening to a range of health professionals as well as to those who use drugs, and on finding a means of funding the project. It would be more than just a room; it would be a service—a bespoke service staffed by health professionals, with a wrap-around service to help people to reduce their drug use and stabilise their lives. There would be opportunities for people not currently accessing health services to do so, and for people to get assistance to rebuild their lives. The proposed Glasgow model is all about engaging with drug users to promote treatment, rehabilitation and social integration, as well as providing harm reduction services.

    The Minister must recognise that not taking action, but rather just doing what we have already done, comes at a cost that has manifested itself in the treatment for the latest HIV and hepatitis C outbreak in Glasgow. Inaction also comes at the cost of emergency admissions to hospital. As the report notes:

    “Over the last five years, the Scottish Ambulance Service has recorded an annual average of 232 ambulance attendances at suspected overdoses”

    just in Glasgow. The hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) mentioned the Australian example, which shows how such costs could be saved.

    There is a risk to council staff and housing association staff from clearing up needles—sometimes in their hundreds—on sites. As soon as those needles are cleared, they come back again and again. There is also a human cost—the cost of lives written off and wasted. The hon. Member for Glasgow North East (Mr Sweeney) cited some of the figures, including the 867 drug deaths in Scotland in 2016 alone. We cannot put a price on that. For every person lost to addiction a family is bereft.

    Anyone’s Child: Families for Safer Drug Control supports drug consumption rooms. I have listened carefully to people who have lost family members, and they made it clear that drug consumption rooms would be a positive intervention. At the very least, their loved one would not risk dying alone in a filthy lane. Instead, they would be in a place of safety, supervised by medical professionals. As hon. Members have mentioned, there has been not one single death in any drug consumption room anywhere.

    Our difficulty in Glasgow is that the project cannot go ahead without the permission of the UK Government, unlike in Ireland, where the Ana Liffey project and the then Minister—now Senator—Aodhán Ó Ríordáin changed the law to allow it. The Lord Advocate cannot pursue the matter. An exemption from the Home Office has been refused. I have a cross-party letter signed by the majority of MPs in Scotland, requesting leave for the pilot to go ahead. If it does not work, fine, but at least let us try. The status quo is not acceptable.

    I invite the Minister to come to my constituency in Glasgow and see how people are living. She could then see whether she would like to put up with what my constituents put up with every day, or whether she would find it acceptable for somebody she cared about to drop their trousers and inject heroin into their groin in a manky back court surrounded by excrement and contaminated needles.

    I will end with words quoted in the health report from someone in recovery:

    “You need to think about it differently. That’s where I think safe injecting routes and injecting heroin…you take away the chaos. Then you have a chance to work on the attitude.”

  • I congratulate the hon. Member for Inverclyde (Ronnie Cowan) on securing this important debate. I thank all hon. Members not just for their contribution, but for sticking with us through this very disturbed debate. I congratulate you, Ms Ryan, on steering the ship safely to the end.

    The Opposition have made no secret of our disappointment in last year’s drug strategy. We waited nearly two years for it; frankly, we expected something more radical, more substantial and certainly with more funding. No amount of gloss can hide the significant problems with the approach to drugs policy that the Government have taken since taking power in 2010: it has been ideological and plagued with irresponsible cuts.

    All the Members in the debate have expressed the truly shocking scale of the problem. The UK has the highest recorded level of mortality from drug use since records began. There are record numbers of deaths from morphine, heroin and cocaine use. There are more deaths from overdoses than from traffic accidents, and there is an ever-increasing incidence of HIV and hepatitis transmitted via unhygienic injecting.

    Drug consumption rooms have operated in Europe for three decades, most notably in countries that have had greater success in reducing drug deaths than we have. Even if the Government are misguided and will not look at evidence from other countries, I would have thought that they would have taken the advice of their Advisory Council on the Misuse of Drugs. In 2016, in response to the unprecedented drug deaths, it recommended that the Government consider the introduction of drug consumption rooms. I believe the response was:

    “It is for local areas in the UK to consider, with those responsible for law enforcement, how best to deliver services to meet their local population needs.”

    I agree that the local authorities are best placed to deliver such services. However, when responsibility for alcohol and drug treatments was transferred from the NHS to local authorities in 2013, it signalled the most significant and problematic change to funding. Although I am not criticising our overstretched local authorities, the transfer of responsibility brought an end to the ring-fenced budget for drug treatment, resulting in a reduction of services.

    In an ideal world, no-one would take those harmful substances, but we do not live in an ideal world. Therefore, we cannot base life or death decisions on ideology. We have to go with what works. If the evidence is clear that drug consumption rooms prevent overdose deaths and the spread of disease, we at least need to trial them. Glasgow was set to do that until it was blocked by the Government. The Member for Inverclyde secured the debate for the main purpose of calling for the devolution of drug legislation to Scotland, but the drugs problem is UK-wide and we need a UK-wide solution.

    Like many, I am uncomfortable with the uncertainty we often find ourselves in when it comes to drugs and the law: legal highs, more widespread drug use, changes in legislation in other countries, decreased prosecutions for lesser drug offences and even festivals such as Glastonbury offering drug testing facilities. We have been sending mixed messages for far too long. We must address that before we are to move forward in a meaningful way.

    The Opposition are clear: the ever-increasing spread of disease and record number of deaths from drug use are unacceptable. This must be dealt with as an urgent public health issue. The Government must take responsibility and they must review the legislation as a priority.

  • It is a pleasure to serve under your chairmanship, Ms Ryan. I join others in congratulating you on your skilful navigation of the timetabling and the Divisions this evening. I am grateful to the hon. Member for Swansea East (Carolyn Harris) for giving me a little extra time to respond in what is a very complex debate. I thank the hon. Member for Inverclyde (Ronnie Cowan) for bringing the debate and for his obvious passion and commitment to this topic.

    I will start from a position of agreement: nobody in this House wants people to become addicted to heroin, crack cocaine or any drugs. We are all grappling with the ways in which we can fight that drug battle, help addicts and ensure that gangs do not lead young people on to the wrong paths and into taking drugs. We want to rid our country of these awful substances if we possibly can. It has already been said that that is incredibly difficult, as it is in every country in the world, and nobody has the answer yet.

    To be very clear from the start, the Government do not agree with the hon. Gentleman’s suggestion. We have no intention of introducing drug consumption rooms, nor do we have any intention of devolving the United Kingdom policy on drug classification and the way in which we deal with prohibited drugs to Scotland. Drug barons do not respect geographical barriers or boundaries and I dread to think what would happen if we devolved our UK-wide policy in the way that the hon. Gentleman suggests—it would then create an internal drug market within the UK, adding further to the pressures on law enforcement.

    The hon. Member for Inverclyde is looking a bit askance at me. He knows my background. I used to prosecute criminals for a living. I prosecuted drug gangs; I prosecuted international drug gangs, so I know whereof I speak. There has been a certain naivety in some of these arguments about what these international gun-toting criminals will do if we, the UK, regulate prohibited drugs. They are not going to run away and study university degrees and lead law-abiding lives. They are going to find ways of undercutting the regulated market, which presumably the hon. Gentleman is calling for, with prices. They will find ways of getting to their addicts. They will still continue their awful trade; it is just that under the hon. Gentleman’s model, as I understand it, it will be the taxpayer who is helping to pay for some of the drugs that we are against.

  • Imagine the people whom we would drive out of business! This will do the same thing as it did in the 10 other countries where it has been introduced. I am talking about drug consumption rooms to help people with addiction problems through that phase of their life. Some 90% of people who use drugs in a recreational fashion do not have an addiction problem. We are talking about people with an addiction problem and helping them through that in a compassionate and humane way. That is what DCRs are about.

  • I will come to what DCRs are about, because their purpose is not recovery. Their purpose is to provide a place where illicit drugs that have been bought in the local area are then consumed in a place funded either by the taxpayer or charities. Recovery is an optional part of that usage; it is not the sole purpose of it. That is very different from our drug strategy. I will come on to that in a moment.

    Let me first of all deal with the international comparisons, because much has been made of the evidence from abroad. I accept that there is no clear answer here, but I am obliged to put into context some of the evidence that has been put to this Chamber by the hon. Member for Inverclyde and the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle). Ten countries have DCRs. Seven of them are in the European monitoring centre for drugs and drug addiction, and in those seven countries, 78 facilities exist. When we are talking about changing our national drugs policy, we have to be very clear about the limits of the evidence on which the hon. Gentlemen are relying.

    The hon. Member for Inverclyde mentioned some countries. Canada has kept its provider, Insite, not because of the evidence that the services provided by Insite work, but because the users of Insite brought two court actions, and the Canadian Supreme Court ordered the Minister who wanted to close them to grant an exception to Insite in order to respect the constitutional rights of facility users and staff. I read that, with my legal hat on, not as an endorsement of the effect of DCRs but as a constitutional issue.

    France has not agreed to use these rooms permanently. It is running a pilot project for six years. In terms of Spain, the evidence I am given by those who sit behind me is that there is one room open in Catalonia for one hour a day from Monday to Friday. When we hear that there have been no deaths in DCRs, which I accept, we have to understand the context in which these rooms are operating. I suggest that one hour a day from Monday to Friday does not support a great deal of people; we are not talking about the majority of heroin users in that town in Catalonia.

    The hon. Member for Brighton, Kemptown talked about there being no deaths in Sydney. I was grateful to my hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant) for clarifying that the hon. Gentleman was in fact saying that there were no deaths in DCRs, not that the introduction of DCRs has stopped deaths from heroin in Sydney as a whole.

    We do not know, because nobody has done the research yet, what happens to addicts when they leave DCRs. DCRs are not residential. Addicts are there for a number of hours. We do not know what happens when they leave those clinics and walk down the street. We do not know the impact. As we have heard, they are not there every single day. This is not a regular form of treatment, and that is precisely why I will now turn to the drug strategy. Recovery is at the heart of the Government’s drug strategy. We have brought together Health, Education and all of the relevant Departments to tackle drug addiction and the illicit trade in drugs and to look at the answers within the community, including with the police, but recovery is at the heart of it. I am sorry to hear of the experience in Scotland.

  • Motion lapsed, and sitting adjourned without Question put (Standing Order No. 10(14)).