House of Commons
Wednesday 21 February 2018
The House met at half-past Eleven o’clock
[Mr Speaker in the Chair]
Oral Answers to Questions
Cabinet Office and Chancellor of the Duchy of Lancaster
The Minister for the Cabinet Office and Chancellor of the Duchy of Lancaster was asked—
Parliamentary and Local Elections
Last December, we published our democratic engagement plan, setting out our current evidence on under-registered groups, our plans for deepening our understanding of engagement barriers and a commitment to tackling them. This year we are already delivering a number of projects focusing on young people and linked to the suffrage centenary celebrations.
The electoral roll would be a good place to start a strategy like that. The Government are perfectly good at finding us when they want our tax, yet an estimated 6 million people—predominantly younger urban voters, particularly those in ethnic minorities—are missing from the electoral roll. Everyone who is on Government registers through the benefit system, the tax system and the health system should be on the electoral roll. The boundary changes based on this flawed register are an undemocratic sham, so why are the Government working to make it more difficult to vote, rather than addressing this national scandal?
Order. That was too long.
I do not think that the hon. Gentleman was listening to my answer. We are not trying to make it more difficult to register to vote. We have set out a full plan about making it easier to do so for the groups who need it most. I take this opportunity to make it absolutely clear that we have a number of record highs on our register. Since the introduction of individual electoral registration in 2014, more than 30 million people have registered to vote. Ahead of the general election last year, a record number of additional applications to register were submitted. The electoral register has reached a record level of 46.8 million electors, and we should be proud of that.
The Minister may be interested to know that the turnout in my constituency of Glasgow North East at the last election was 53%, which was well below the national average. It also happens to be an area with some of the lowest incomes and highest unemployment in the country. Research has shown that low-income workers and long-term unemployed people report lower levels of political knowledge and participation in political activities than those from other occupational backgrounds. Given that they are also less likely to be on the electoral register—
Order. Sit down. What I want is a single-sentence question. Forgive me, but these prepared screeds are too long, and they are not fair to colleagues—a single sentence, and then sit down.
Given that these low-income groups are less likely to be on the electoral register, what is the Minister planning to do to actively engage with them and get them on the electoral register?
As I say, a range of things are set out in the democratic engagement plan. I look forward to working further with the hon. Gentleman and people across parties in this House and outside it to ensure that all those who are eligible to vote do so.
Will the Minister confirm how she is ensuring that survivors of domestic violence can participate in our elections?
My hon. Friend is absolutely right to raise that very important point. We should be proud that, only last night in the House of Commons, we saw hon. Members, cross party, supporting ways to make it easier for survivors of domestic abuse to be on the register. That is something that we should be proud of in this centenary year.
Does my hon. Friend agree that one way of increasing participation is through a clear and trusted voting system? Will the Government perhaps look at how they can roll out first past the post in more English elections?
My hon. Friend reminds us that in the 2017 Conservative manifesto, there was the commitment to maintain first past the post as the way that we vote in this country and to roll it out to additional elections. I look forward to speaking further to him about that.
It is clear that disabled people are under-represented in our democracy and our politics, but in 2015, the Minister’s Government abolished the access to elected office fund, which supported many disabled people in meeting the extra costs in standing for office. How can the Government claim to be making democracy more accessible when these financial barriers are put in their place?
The piece of evidence that I am working on at the moment relates to a call for evidence that came back from work on how to make voting in elections more accessible for those with disabilities. It is important to note that we are talking about a range of disabilities, and not just those that may be visible. That is something I am keen to focus on in my work. Indeed, I look forward to working further with the hon. Lady on ensuring that people with any disability feel able not only to participate in elections as candidates, but crucially, to register to vote.
Is it not right that, despite the concerns raised, individual electoral registration has both increased the roll and helped to reduce fraud?
That is absolutely correct. According to a 2016 report from the Electoral Commission, both completeness and accuracy have risen, and we should aim to keep it that way.
Given the Government’s determination to end freedom of movement to and from this country, might this now be an appropriate time to embrace the principle that everyone legally resident in this country should have a say in its governance? Would the Minister therefore consider introducing proposals to allow those born in other countries who decide to stay and make this country their home after Brexit the right to vote and to welcome them to our democracy?
I am considering this point—a number of points need to be taken into account as we complete an orderly exit from the EU—but the broader point is that if somebody has citizenship in this country they have the right to vote, which we think is correct.
The Government stated in their manifesto a commitment to maintaining the voting age at 18. We therefore have no plans to lower the voting age in elections. We continue to believe that the voting age should remain aligned with the age of majority at 18. This is the point at which many other key rights and obligations are acquired and is in line with international comparators.
With growing support for votes at 16 on the Government’s own Benches, including from two former Education Secretaries, the right hon. Members for Putney (Justine Greening) and for Loughborough (Nicky Morgan), is not the right honourable George Osborne right when he says that the Government do not have a majority to stop this anymore and might as well get on and embrace it and get the credit?
The responsible thing for the Government to do is to stand by not just the policy we stood on in the recent general election but what we believe to be right, and it is right that the age of majority at 18 is the age at which every man and woman in this country acquires the full rights and responsibilities of adult citizenship.
If 16 and 17-year-olds are too childish and irresponsible to vote in local or Westminster elections, should that not also apply to their ability to vote in Conservative leadership elections?
We are talking here about electing the Parliament and the Government of the country, and although some 16 and 17-year-olds exercise and demonstrate enormous responsibilities, it is also the case that we make a general protection in our law for 16 and 17-year-olds—for example, through the criminal justice system. That is another way we recognise that 18 is, on average, the right point to make that judgment.
Last week, my local authority, Rochdale Borough Council, approved a motion supporting votes at 16 that received cross-party support. When will the Minister drag himself into the 21st century and get in line with the progressive and forward-thinking councillors representing the borough of Rochdale?
I am always genuinely interested to hear what is happening in Rochdale Council, but I draw the hon. Lady’s attention to the fact that 26 of our 27 EU partners, as well as Canada, Australia, New Zealand and the United States, all have a voting age that begins at 18. I do not think that those countries can fairly be said to be not in the 21st century.
May I encourage my right hon. Friend to follow the wise example of the last Labour Government, who, though they were in office for 13 years and made many radical constitutional changes, none the less did not bring forward proposals to reduce the voting age to 16—for very good reasons?
My hon. Friend is spot on, and not only that, but the last Labour Government took a deliberate decision to increase from 16 to 18 the age at which somebody could buy cigarettes and knives and use a sunbed.
I agree very much with everything my right hon. Friend is saying. Is not the answer to look at all the laws pertaining to the age of majority and actually have laws that make sense? As he identifies, someone is not deemed old enough to use a sunbed at 17; can get married at 16 with their parents’ permission but cannot go out and buy a drink to celebrate; and cannot drive a car until they are 17. The law is all over the place and needs a proper review. Is that not the way forward?
My right hon. Friend makes an interesting and valid point. I would add, of course, that we make specific protections in our law in respect of criminal justice and the asylum system, recognising that people under 18 need special protection.
During a debate in 2015, the hon. Member for Norwich North (Chloe Smith), said:
“I am one of those who believes that we should allow voting at 16”.—[Official Report, 17 November 2015; Vol. 602, c. 572.]
Since then, a range of senior Conservatives have outlined their support, including the former Chancellor, who said that the Conservative party risked
“being on the wrong side of history”
if it refused to back the measure. Does the Minister agree with his colleague and will does he support votes at 16?
I stand by the manifesto on which I stood in 2017, and, as has been made clear this morning, by the position that the Labour party took for the 13 years during which it was last in government.
We are working hard to ensure that United Kingdom producers of steel have the best possible chance of competing for and winning contracts. I believe that the Government’s changes in procurement guidelines make that opportunity greater for UK producers, including those in Corby.
As my right hon. Friend is well aware, we produce brilliant-quality steel tubes in Corby. What positive difference does he believe those public-sector procurement rules are making to our steel industry, and will he join me in promoting the use of British steel at every opportunity?
I am happy to join my hon. Friend in his tribute to the steelworkers of Corby, and the steel industry in the United Kingdom more generally. The guidelines that we have introduced mean that purchasing authorities must take account of the wider social and economic benefits that UK producers can bring, so that contracts are not awarded on the basis of cost alone. Moreover, every public authority is now required to incorporate relevant social and economic criteria in all major construction and infrastructure projects.
When will the Government fulfil their commitment in procurement policy note 11/16 to publish the performance of each Department?
I hope that we shall be able to do that later this year. According to the most recent information that I have, Government Departments are committed to following the guidelines, but we are carrying out checks to ensure that that is being followed through to the spirit as well as the letter.
Severfield, in Lostock at the heart of my constituency, produces architecturally significant steel structures such as the 2012 Olympic stadium and the ArcelorMittal Orbit sculpture. Will my right hon. Friend do all that he can to ensure that Government procurement buys beautiful, buys British, and buys from Bolton?
We want both public and private sector customers to buy British steel whenever possible. The Government have published a pipeline of future public procurement in which steel is needed, so that British producers can plan to bid to take part in the process.
The Government are committed to ethical procurement. The Public Services (Social Value) Act 2012 requires commissioners to consider the social benefits of their approaches to procurement, and the industrial strategy requires Departments to consider wider social and economic factors in the design of major Government contracts.
Another recent report has commented on the link between ultra-processed food and cancer, rising levels of obesity, and the fact that only one in four adults is eating five a day. What more can the Government do through their public procurement processes to encourage healthy, sustainable eating, and to source it from British producers?
The hon. Lady has raised an important point. As I have said, the Public Services (Social Value) Act 2012 enables procurers to take those wider factors into account. We are also encouraging the adoption of a so-called balanced scorecard approach whereby, in the process of procurement, we consider those wider factors. We have rolled that out for all contracts worth more than £10 million, and have extended it to the Crown Commercial Service framework for facilities management.
What additional flexibility in public procurement will be yielded by Brexit?
One of the advantages of Brexit is that it will provide a wide range of opportunities to tailor our procurement rules to the needs of this country. Once we have left Europe, we will be considering exactly those measures.
What certainty does the Minister have that there is no direct or indirect gender discrimination anywhere in the Government’s supply chain?
In October last year, the Government produced a code of conduct relating to Government procurement which covered precisely those points.
Government Procurement: SMEs
Small businesses are the backbone of our economy and we are committed to supporting them in securing public sector contracts. Our aspiration remains to spend a third of our procurement spend with them by the end of 2022.
I thank my right hon. Friend for his answer. Does he agree that individual Government Departments have crucial roles to play in promoting the use of small businesses in Government procurement, in order to deliver greater diversity in the firms that are awarded Government contracts?
I completely agree. We are working with Departments through the Crown Commercial Service to develop detailed SME action plans Department by Department, with every Department putting in place both a ministerial lead and a senior official with a role to champion small businesses. The figures so far show that more than half of Government Departments have increased the proportion they now spend on SMEs.
When we start the major work on this building, which will be a massive multibillion-pound infrastructure project, will the Government ensure that small businesses all around the country get contracts, not just the big corporations?
I certainly hope that that will be the case, and I believe our guidelines and approach to different Government Departments will encourage small business to secure those opportunities, but it will also be a matter for the Commons Commission.
Voter ID Pilots
The Cabinet Office is working in close partnership with all piloting local authorities to ensure that each pilot has a tailored and comprehensive awareness-raising campaign that encourages eligible voters to bring ID to the polling station.
Research by the Royal National Institute of Blind People has found that the polling cards in the Government pilot are still inaccessible for blind and partially sighted people, and are often mistaken for junk mail. Can the Government guarantee that restrictive ID requirements will not disenfranchise disabled voters?
That is an extremely good point, and it is exactly the kind of thing I was referring to in my earlier answer regarding the call for evidence on how those with disabilities might in some ways be disempowered from using the registration and voting system. In this case, I would expect the piloting local authorities to look carefully at the issue in their own work, and I will undertake to do so as well from the point of view of the Cabinet Office.
What guarantees can the Minister give people who do not currently have the necessary ID to go and vote in the upcoming elections that they will be able to have access to the photographic ID that is needed without incurring personal cost?
The local authorities involved in the pilots are ensuring that nobody will be left behind in the way the hon. Gentleman might fear. They will provide ID if a voter does not have it, in the format of, for example, barcoded poll cards or letters that are relevant on the day. Those kinds of issues remind us why it is important to do pilots to test things out
The award-winning elections team in Swindon will deliver one of those pilots. Does the Minister agree that it is staggering that Labour opposes a change that is no different from collecting a parcel from the post office?
That is absolutely right. Anybody who might oppose these measures should think very, very carefully. We already ask that people prove who they are when they go to collect a parcel, rent a home, buy a home, rent a car, or travel; it is normal to use ID in everyday life.
One short sentence only; Bob Blackman.
Given that voter ID is required in Northern Ireland, will my hon. Friend roll this out across the country as quickly as possible so that all elections are free and fair?
Thank you; splendid.
I will look closely at the results of the pilots to evaluate whether it is possible to go further with them. My priority is to do what we can to stamp out electoral fraud. Fraud is not a victimless crime; to have your vote abused is to have it stolen, and that is what I am looking at.
In the context of these trials forcing people to show ID to vote, in the context of individual electoral registration resulting in 2 million people falling off the electoral register, and now it seems in the context of proposals to make postal votes harder to obtain, why is it that every change the Government bring in makes it harder for people to vote? Why are they scared of people voting?
The hon. Gentleman is blowing this out of all proportion. Let us not forget that we already use ID to register to vote. What we are talking about here is proving that the person who is voting is the person who registered. Let me return to an earlier answer and say that individual electoral registration has increased the accuracy and completeness of the register. I think that the hon. Gentleman is misunderstanding his own point.
I was pleased to be able to announce that Mr Justice Langstaff will serve as chair for the independent inquiry into the infected blood scandal. He is a highly experienced judge who I am confident will conduct a thorough inquiry. Over the coming weeks, he will be talking to those affected to set comprehensive terms of reference, and the Government will provide him with all the support he needs. [Interruption.]
Order. There is far too much noise in the Chamber. The Minister’s answer could hardly be heard. Let us hear the voice of Amber Valley. I call Mr Nigel Mills.
I thank the Minister for his answer. What plans does he have to use the events marking the centenary of women’s suffrage to encourage greater democratic participation?
During this centenary year, we will host the first national democracy week. We have established a council to help to deliver a unified programme of events up and down the country that will focus on those who are underrepresented on the electoral roll, and a package of education-themed events to inspire young people and women through the story of suffrage and our democracy.
Any such death is a tragedy. The Government have established an inter-ministerial group to drive forward our objective of halving rough sleeping by 2022 and eliminating it altogether by 2027. I am playing an active part in that work.
The Government are committed to moving activities away from London and the south-east. There is a presumption that all new non-departmental public bodies should be outside London, so we have created Government hubs across the UK, including in Edinburgh and Glasgow. My hon. Friend makes a marvellous case for having more such opportunities in Scotland.
I completely understand the importance of Dounreay to the hon. Gentleman’s constituency. The Government’s industrial strategy is all about trying to ensure that every part of the United Kingdom benefits from the new industrial opportunities now open to us, and my right hon. Friend the Business Secretary will be working with the Scottish Government to ensure that it delivers for Caithness and Sutherland.
My hon. Friend makes an important point. Small businesses are the engine of our economy, and we are committed to supporting them in public procurement. That is why we have already streamlined our procurement processes to assist small businesses by, for example, abolishing complex questionnaires. Specifically in relation to too much bureaucracy, businesses can report such practices to the mystery shopper service.
Work on clause 11 has been going on for a long time, to deliver on our commitment to table amendments during proceedings in the House of Lords—with the agreement of the Scottish and Welsh Governments if humanly possible.
Yes, I intend to speak on the Government’s behalf during the Bill’s Second Reading on Friday. The proposal is an important Conservative manifesto commitment, but I hope that it will also command cross-party support.
My colleagues in Edinburgh will be voting today to scrap the public sector pay cap and give a 3% pay rise to those earning under £36,000. When will public sector workers in England see a similar rise?
Public sector workers are among the most talented and hard-working people in our society, and they should be fairly rewarded. In respect of the Cabinet Office, the Chancellor’s Budget statement confirmed that we are moving away from the 1% average public sector pay award, and proposals will be issued later this year.
I wish my right hon. Friend every success in his forthcoming meeting with the Scottish and Welsh Governments this week. Will he bear in mind that he is being compromising and open, and will he invite them to be the same?
My hon. Friend is right to point to the importance of all parts of the United Kingdom working together to deliver an orderly, smooth Brexit. We want to work in partnership with the Scottish and Welsh Governments to deliver a big increase in the powers devolved to their Parliaments and Governments.
I welcome the Minister’s announcement about the appointment of Sir Brian Langstaff as the judge for the public inquiry into contaminated blood, but will he reassure the House that the inquiry will have a families-first approach, that an outward-facing secretariat will support all those affected, and that meetings will be held around the regions and nations of this country?
The hon. Lady will understand that Sir Brian, as the independent chair, will ultimately determine such matters, but I was struck when I met him by his determination both to listen to the views of the families who have been worst affected by the tragedy and to ensure that those views are fully taken into account.
The Prime Minister was asked—
This morning I had meetings with ministerial colleagues and others. In addition to my duties in this House, I shall have further such meetings later today.
On Monday, children and parents at St Mary’s Catholic Primary School in Chiswick told me of their concerns about air pollution affecting children’s health. This morning, the High Court ruled that the Government’s air quality plan is unlawful. What does the Prime Minister feel is worse: losing for the third time in the High Court, or 40,000 unnecessary deaths and the impact on children’s health of the UK’s unsustainable air quality?
The issue the hon. Lady has raised about air quality is important, and that is why we have been taking action to improve air quality. I say to her that I do not think that the way she has described the Court’s decision this morning properly reflects the Court’s decision. Let me just explain to the House that we welcome the fact that the Court dismissed the complaint relating to five cities with major air quality problems and found that we are taking appropriate action. It agreed that the modelling we used to support the 2017 air quality plan is sound. It has asked us to go further in areas with less severe air quality problems where we thought a pragmatic approach was appropriate; we will now formalise that. But actually, on two of the three counts, the Court found in the Government’s favour.
My hon. Friend raises an important issue, and he is right to speak up for his constituents in relation to this matter. He is also right, because this Government have been keen to ensure that police are out there, not in back-office jobs. More money is going to policing—[Interruption.]
Order. Please, the questions and answers must be heard, and I make no apology for repeating that the discussions here at Prime Minister’s questions should bear some resemblance to what the House is saying in relation to culture. We have recently had a report on harassment. Let us try to behave properly in these sessions. That means listening to the answers and listening to the questions. Both sides of the House have got to try to wake up to the reality that huge numbers of people outside this place—I could not care less about the Press Gallery—disapprove of this sort of behaviour. On both sides, stop it.
Thank you, Mr Speaker. The funding settlement for next year provides extra money for policing, which means that West Midlands police will receive an increase of £9.5 million. Of course, as my hon. Friend the Member for Walsall North (Eddie Hughes) says, it is up to the West Midlands police and crime commissioner—a Labour commissioner—to decide how he spends that money, but I know that police forces can be more effective and productive, and I am sure my hon. Friend will make his case very strongly to the Labour commissioner.
Yesterday the Brexit Secretary assured the country that Brexit will not plunge Britain
“into a Mad Max-style world borrowed from dystopian fiction.”
Does the Prime Minister not feel that the Brexit Secretary could set the bar just a little bit higher?
As the right hon. Gentleman knows, we are very clear that we are going to ensure that, when we leave the European Union, we are able to take back control of our borders, our money and our laws. The only fiction in relation to Brexit and the European Union is the Labour party’s Front Bench, who cannot even agree with themselves on what their policy is.
One of the Prime Minister’s former Brexit Ministers in the other place warned her that Britain will be walking a “gangplank into thin air” if she does not decide what she actually wants on leaving the European Union.
In his speech, the Brexit Secretary also said that fears about a deregulatory “race to the bottom” were “based on nothing”. Why, then, did his own Department’s exit analysis state that there could be opportunities for Britain in deregulating areas such as environment and employment law?
The right hon. Gentleman talks about what we actually want to achieve when we leave the European Union. I will tell him what we want to achieve: we want to ensure that this is a country that can negotiate free trade deals around the rest of the world; we want to ensure that we have a good trade agreement with the European Union, and that is what we will be starting to negotiate; and we want to ensure that we have a good security partnership with the European Union, as I set out in detail in my speech in Munich last week. But we also want to ensure that this country takes the opportunities that will be open to us outside the European Union to boost our economy and to ensure that we develop the economy of the future and jobs for the future—more high-paid, high-skilled jobs for the people in this country. We are putting the people first.
In December, the Foreign Secretary and the Environment Secretary were briefing that the working time directive would be scrapped. The CBI and the unions are very clear that they are not looking for a bonfire of regulations—quite the opposite. The only party that wants to scrap workers’ regulations and protections is the party opposite.
In her Lancaster House speech a year ago, the Prime Minister clearly stated:
“I also want tariff-free trade with Europe”.
Now, a year on, she has downgraded that aim to “as tariff-free as possible”. Businesses and workers want tariff-free access to protect jobs, so why have the Government abandoned that for “as tariff-free as possible”?
I have to say to the right hon. Gentleman that the Government have not abandoned their negotiating position in relation to this; we will be ensuring that we get that good, comprehensive trade agreement—new economic partnership—with the European Union. He also mentions workers’ rights. I have been clear since I became Prime Minister that this Government will not only protect workers’ rights, but enhance them. Let us just look at the Conservatives’ record in government. Which Government took action on zero-hours contracts? It was a Conservative Government, not Labour. Which Government got Matthew Taylor to report on the new economy, so that we ensure workers get the highest rights? It was a Conservative Government, not Labour. Which Government are ensuring that workers’ voices are heard on the boards of companies? It is a Conservative Government, not Labour.
I do not know whether the Prime Minister has had a chance to read The Daily Telegraph today, but 62 of her Back Benchers want a bonfire of regulations and to destroy workers’ rights in this country. When the Government’s EU exit analysis was published, the Brexit Minister, the Under-Secretary of State for Exiting the European Union, the hon. Member for Worcester (Mr Walker), said:
“It does not consider our desired outcome”—[Official Report, 31 January 2018; Vol. 635, c. 835.]
Will the Prime Minister take this opportunity now to tell the House and the country: what is the Government’s desired outcome?
I am very happy to: a bespoke economic partnership.
Okay. So, given that the Prime Minister ruled out any form of customs union post-Brexit, can she explain how she expects then to avoid a hard border with Northern Ireland?
The right hon. Gentleman and others have asked this question previously. I have already pointed out in this Chamber that the Government published papers last summer that showed how we can deliver exactly that—no hard border between Northern Ireland and the Republic of Ireland, and a bespoke economic partnership with the European Union.
The Foreign Secretary recently made a speech about Brexit and found time to mention carrots, spam, V-signs, stag parties and a plague of boils. There was not one mention of Northern Ireland in his speech. We are halfway through—[Interruption.]
The hon. Member for Morecambe and Lunesdale (David Morris) must calm himself. It is not good for your health. It is only Wednesday, man—you have the rest of the week to get through. I am trying to help you. You should appreciate my kindness.
We are halfway through the six speeches we were told would set out the Government’s negotiating position. So far, all we have had is waffle and empty rhetoric. Businesses need to know. People want to know. Even the Prime Minister’s Back Benchers are demanding to know, but it is not clear from today’s exchanges. This Government are not on the road to Brexit—they are on the road to nowhere.
I think I have mentioned to the right hon. Gentleman before that his job is actually to ask a question, but I am perfectly happy to respond to the points he made. He said that we have not set out any detail. May I suggest to him that he needs to think very carefully about the security partnership that we want with the European Union when we have left? I set out in my speech in Munich last week exactly what we want that security partnership to cover, because we believe in ensuring that we are maintaining the security and safety of people here in the UK, but also in Europe. We are unconditionally committed to the safety and security of Europe. But may I congratulate him, because normally he stands up every week and asks me to sign a blank cheque? I know he likes Czechs, but really that is terribly depressing.
My hon. Friend has raised a very important point. It is absolutely crucial—of course we want to ensure this—that people who are driving are actually fit to drive. I know that the sympathies of not just my hon. Friend but the whole House will be with Evelyn’s family and friends. The current driving licence system is designed to balance road safety with the needs of the individual. All drivers must inform the DVLA if they have a medical condition that might affect their driving and should discuss any of their concerns with their own medical professionals. We take this issue very seriously and are committed to ensuring that those who are granted a driving licence are fit to drive.
At least 194 people have been killed in the past 48 hours in Eastern Ghouta. Will the Prime Minister tell the House what discussions her Government have had with UN colleagues since Sunday on the enforcement of the existing UN resolutions that call for an end to sieges of civilian areas and attacks on civilians?
The right hon. Gentleman raises an important issue. We are appalled by the escalation of air strikes in Eastern Ghouta and deeply concerned by reports of the ongoing deliberate targeting of civilians and civilian infrastructure, in blatant violation of international humanitarian and human rights law. We, as the United Kingdom Government, certainly call on the regime and its backers to cease this campaign of violence. They should respect international humanitarian law, protect civilians, and allow rapid and unfettered humanitarian access. There is concern that something like 700 people who need medical evacuation are being refused that evacuation by the regime. We will continue to work with the UN and the UN Geneva-led process. The UN envoy has our full support for his work to try to bring an end to this by finding a political solution for Syria.
I thank the Prime Minister for that answer. The bombing is relentless. Doctors on the ground are treating pregnant women and babies who have lost limbs. It is estimated that well over 100 children have been killed since Sunday. The UN has issued desperate pleas calling for political intervention. It has stated:
“No words will do justice to the children killed, their mothers, their fathers and their loved ones”.
Will the Prime Minister show leadership and join me in calling for an urgent meeting of the UN Security Council to address the horrific genocide that is unfolding in Syria?
The United Nations has called on Governments around the world to call out the action that has been taken and to be ready to stand up against that action. That is exactly what this Government are doing. We will talk to our UN colleagues to ensure that the best possible approach can be taken in relation to these issues, but it is not just about the Syrian Government; it is about the backers of the Syrian Government as well. We call on all their backers, including Russia, to ensure that the violence stops, and that those people who are need of help are given that help.
I am sure that my hon. Friend is aware that the competition will be open and fair. I cannot comment on individual bids, but I am sure that he will make his voice heard. It is right that from autumn 2019 we will issue new blue and gold passports, which have always been the UK’s colours of choice for our passports. It is absolutely right that after we leave the European Union, we return to deciding the colour of passports that we want, not that the European Union wants.
Our thoughts are with Claire following the terrible tragedy that she has been through. We recognise that we need to provide support for the victims of domestic violence. As the hon. Lady suggested in her question, there are many aspects to this issue. Before my right hon. Friend the Home Secretary brings forward legislation, she will be issuing a consultation, because we want to ensure that we listen to all those who have been affected so that we deal with all aspects of this particular issue. The Government are committed to working not only to support the victims of domestic violence, but to ensure that we end violence against women and girls.
I am very happy to join my hon. Friend in congratulating those many carers who are looking after people with dementia, and also volunteers who provide services for people with dementia and their carers. We are working with partners across the health system to ensure that more people with dementia than ever before receive a diagnosis, as well as to raise awareness, to ensure that people get an earlier diagnosis, and to provide the care and support that is needed. I am also pleased to say that there are now 2.3 million dementia friends across the country, and that we are doubling spending on dementia research. I will also ensure that members of the Cabinet are given the dementia friends training.
It is good to see the hon. Lady back in the House.
As I said to my hon. Friend the Member for Walsall North (Eddie Hughes), we are providing extra funding for police forces—[Hon. Members: “No, you’re not.”] It is no good Labour Members shaking their heads and saying that, because we are providing extra funding for police forces, and it is of course up to police and crime commissioners to decide how that money is spent.
I am happy to welcome—as I am sure that you are, Mr Speaker—the fact that we have been joined in the Public Gallery by a delegation of French Members of Parliament.
My hon. Friend raises a very important point about EU citizens living in the United Kingdom. They have made a huge contribution to our country, which is why we want them and their families to stay. I am absolutely clear that EU citizens living lawfully in the UK today will be able to stay. On the process of applying for settled status, I can assure him that it will not cost more than that of a British passport. EU citizens will have a period of two years in which to apply. The system will be a digital, streamlined and user-friendly, and will ensure that the process is as simple and easy for people as possible.
The hon. Gentleman raises an important point. As he may know, there are two ways in which those rehabilitation services will be commissioned. NHS England commissions specialised neurological rehabilitation centres for complex brain injury, and it does so at a national level. More routine rehabilitation is commissioned locally, although NHS England sets guidelines for commissioners to support delivery, including for brain injury. The hon. Gentleman raises an important point, and I will ask the Health Secretary to respond to him and the specific question that he asks.
May I tell the Prime Minister how welcome the Policing Minister’s response to yesterday’s urgent question was, as he said that he would help Alfie Dingley to find a way through regulations to access the medicinal cannabis that he needs? Will the Prime Minister ensure not only that the Minister’s words go beyond the popular view of, “I’m from the Government; I’m here to help,” but that we join the majority of states of the European Union and the United States, as well as British public opinion and all colleagues who raised questions yesterday, so that we give British citizens the earliest possible access to the potential benefits of medicines derived from cannabis through a proper evidence-based process? Will she ensure that the United Kingdom is on the front foot in licensing all medical investigations that need to be done to get us these benefits?
I know that the sympathies of Members across the House are with Alfie and his family as he undergoes treatment. We recognise that people with chronic pain and debilitating illnesses will always look to alleviate their symptoms, but if we are going to permit medicines to be used, we first need to ensure that they have been through the most rigorous testing and that we apply the most rigorous standards. We believe that cannabis should be subjected to the same regulations that apply to all medicines in the United Kingdom.
Order. Forgive me; I was struggling to hear. Just before I ask the Prime Minister to respond, I need an assurance from the hon. Gentleman that he is not suggesting that the presence of a Member of Parliament was bought. If he is suggesting that, it is straightforwardly out of order. Is that what the hon. Gentleman is saying?
Mr Speaker, I was referring to a story that was in the newspapers.
I am afraid that that is not good enough. Forgive me—I have to make instant judgments. If the Prime Minister wishes to issue some sort of response, she is free to do so, but she is under no obligation. No? Then I call Andrew Bridgen.
Twice in the last four weeks, the Equality and Human Rights Commission has had cause to write to the Labour party regarding breaches of equality law. Does the Prime Minister agree that equality law must be applied equally, and that it exists to protect all groups equally?
I am happy to agree with my hon. Friend on that point. I was in opposition when the Equality Act 2010 went through Parliament, and we supported that Act. It is there to ensure—exactly as he says—that people are treated equally.
Order. Let us just be absolutely clear about this. This question, like every question, will be heard. The hon. Lady will not be shouted down and that is the end of the matter, so if some foolish person is seeking to do so, examine your behaviour and stop it.
Thank you, Mr Speaker.
The CEO of the Nuclear Industry Association points out that if medical isotopes that are used to treat cancer are delayed in reaching the UK, they could be deemed useless on arrival because of their short half-life. Will the Prime Minister explain how she plans to prevent delays to cancer treatment that would be caused by her pursuit of a hard Brexit?
The hon. Lady is wrong on two counts. First, we are pursuing a Brexit that will enable us to have an economic partnership that sees freedom of trade across the borders with the European Union. But it is also the case, as we have made clear previously, that the availability of medical radioisotopes will not be impacted by the UK’s exit from Euratom. The import or export of these radioisotopes is not subject to any Euratom licensing requirements, so our ability to import medical isotopes from Europe and the rest of the world will not be affected by our withdrawal from Euratom.
May I thank the Prime Minister for taking a personal interest by meeting myself and other colleagues from across the House to discuss getting justice for the Primodos victims? These people went to their GPs in good faith and were given a drug that resulted in the loss of babies’ lives, abortions and the birth of disfigured young people. Does the Prime Minister have any good news for the victims of Primodos so that we can put an end to this terrible situation?
I was very pleased to meet my right hon. Friend and, indeed, my hon. Friend the Member for Eastleigh (Mims Davies) to discuss this issue. I recognise that the lives of many individuals have been affected by this. There are very powerful stories of these individuals. I know this has been a concern across the whole House. The concerns raised by campaign groups about not just Primodos, but issues such as vaginal mesh and sodium valproate, have highlighted that there is an issue with our regulatory and healthcare system, and we are determined to address it. I have been clear that we need to do better. I was very struck by the powerful stories I heard. We need to see a faster, more understanding response when patients raise concerns. If my right hon. Friend can be a little patient, my right hon. Friend the Secretary of State for Health will be making a statement to the House this afternoon to set out his plans for a review of these issues.
Over the years, under both Labour and Conservative Governments, building regulations and enforcement have obviously been looked at, and the arrangements in relation to enforcement were in fact changed by the last Labour Government. What we did immediately following the appalling fire at Grenfell Tower was to ensure that all those involved—local authorities and others—worked with their fire authorities to inspect towers and look at the cladding. There are issues about not just the cladding, because this is also about how it is affixed to buildings. Action was taken by local fire authorities in the areas where they thought that was necessary, which was why in Camden, for example, people had to leave their tower block while action was taken. My right hon. Friend the Housing Secretary has put in place a review of the regulations. It was urgently put in place, and action is being taken as a result of that review.
Yesterday, after months of ignoring evidence from a wide range of stakeholders, the SNP agreed to pause its plans to merge British Transport police into Police Scotland. Does the Prime Minister agree that, during that pause, the Scottish Government must look at all options for the future of BTP when it is devolved from this Parliament, to ensure that we get the best possible deal, rather than the failed integration plans that are already struggling in Scotland?
That is of course an important point. We as the UK Government are committed to delivering the Smith commission in full. As part of that, we are devolving powers over the British Transport police to the Scottish Government, but the No. 1 priority must be the safety of the public as they travel, so we will work with the Scottish Government to make sure there is a smooth transfer of the British Transport police to their responsibility. Whether or not the British Transport police is merged with Police Scotland is, of course, a matter for the Scottish Government.
Order. Mr Wishart, calm yourself. You are supposed to be setting an example to some of your colleagues. You aspire to be a statesman, one century or another.
Mr Speaker, I am tempted to say that the hon. Gentleman is a right example, but there we are.
It is a matter for the Scottish Government as to what they choose to do, but I urge them to ensure they are putting the safety and security of people who are travelling first when they make that decision.
The hon. Gentleman is perfectly right to ask me questions about things for which I am responsible, and I have the right, as I did previously, to comment on issues that we are taking up with the Scottish Government.
I say to the hon. Gentleman that I will be the judge of what is in order, and he will accept the ruling. The Prime Minister was in order, and that is again the end of it. Somebody has to decide, and I have done so.
Thank you, Mr Speaker. What we are doing in relation to jobcentre services is ensuring that there will be no decrease in the level of services that jobcentres offer people in Scotland. In fact, we are going to increase the number of work coaches across the country, to provide more support to the people who need it. Those plans are designed to retain the skills and experience of the DWP workforce across the country and to ensure that we not just protect but enhance the service offered to people.
Will the Prime Minister tell the international aid sector that, despite the abuses that have come to light recently, this Government are committed to helping the most vulnerable and poorest people around the world, but the sector really does need to get its act in order?
This Government maintain their commitment to helping the most vulnerable people around the world, and we maintain our commitment to our international development budget, but we want to work with organisations that meet the high standards that we expect. The behaviour of Oxfam staff in Haiti was quite frankly horrific and far below those standards.
I am pleased to say that my right hon. Friend the International Development Secretary has taken immediate action by demanding assurances from all our charitable partners here and abroad about their safeguarding and protection policies by the end of the month. Next month, DFID and the Charity Commission will hold an urgent safeguarding summit, where they will bring together UK international development charities with regulators and experts, to look at the possibility of an accreditation scheme that can be used for aid workers and taken into the international arena later in the year. It is absolutely crucial that we continue our support through aid for those who are most vulnerable, but they also deserve to be treated with the same high standards that we would expect to be treated ourselves.
I say to the hon. Lady that I am not going to comment on the individual case. The Home Office looks at the circumstances of individuals. There are rules—immigration rules—in place and the Home Office will make decisions accordingly.
The whole House will be well aware of the excellent work done by the Holocaust Educational Trust, particularly the brilliant Lessons from Auschwitz project. However, at the moment, the Polish constitutional court is considering a draft law that would make it illegal to refer to “Polish death camps” and to the role of Polish citizens during the holocaust. Will my right hon. Friend take this up with her counterpart in Poland to ensure that families of victims and survivors’ words are heard—that history cannot be rewritten?
I say to my hon. Friend that I understand the Government have already raised this issue with the Poles. What we should be doing is ensuring that nobody forgets the holocaust—nobody forgets the horrific inhumanity to man that was shown through the actions taken by the Nazis in the holocaust. The Holocaust Educational Trust does very important work. The education centre and memorial that is going to be placed here at Westminster will be a long-standing memorial to people, and will also do the important job of educating people about the past to ensure that we never see such horrific crimes being committed again.
I say to the hon. Gentleman that a lot of work has been done on what proceeds of crime can be spent on. He will have noted that the Home Secretary has heard the question he has raised, and I will ensure that the particular issue he has raised is looked into.
Three months ago, I raised the case of a constituent distressed by the relationship between his 17-year-old daughter and her much older driving instructor. This week, the Driver and Vehicle Standards Agency announced that a consensual sexual relationship between an approved driving instructor and a 16 or 17-year-old pupil would now be considered an exploitation of their position of trust, and any instructor involved will likely be struck off the approved driving instructor register. May I thank the Prime Minister for her response, and the DVSA for its action? Does she agree that this sets a strong example, and will she ask the Department for Education to consider adding driving instructors and other coaches to its list of those formally covered in law by a position of trust?
May I thank my hon. Friend for raising what was an appalling case? But from that, as he said, has come a change in attitude from the DVLA, which I hope will be of benefit to others who could have been put in that very difficult and appalling situation. I will certainly ask the Department for Education to look at the point he has raised.
In Sheffield, the council’s £11.1 million projected current overspend on children’s services is the highest in Yorkshire and the Humber and the second highest in England. This is clearly in correlation with the £350 million of cuts since 2010. What does the Prime Minister say to children who need these vital council services, but may not be able to access them because the Tories continue to cut council budgets so savagely?
As I pointed out earlier in response to other questions, we are ensuring, as we have done over the settlement period, that local authorities do have more money to deal with some of the particularly difficult issues that they have to deal with at a local level. We do want to see and ensure that children are given the best possible start in life, but it is completely wrong to suggest that decisions taken at local level are all the responsibility of this Government.
It is clear from academics, dog behaviourists, charities and trainers that electrocuting dogs does not help to train them, but risks creating more detrimental long-term consequences for their welfare. I thank all colleagues who came along to my event yesterday to sign up to the pledge to ban shock collars. Does my right hon. Friend agree that, as dogs are man’s best friend, it is time we showed some of that loyalty and friendship in return by banning the use, distribution and sale of these barbaric devices?
I thank my hon. Friend for raising that issue. I know he has been campaigning long and hard on it. We made it clear in the updated statutory code of practice for the welfare of dogs that positive training should be used and that any training that involves pain, injury or distress would breach the Animal Welfare Act 2006. I understand that my hon. Friend will be meeting the Environment Secretary to discuss the matter further.
The deputy president of the National Farmers Union said that losing full access to the European single market could be absolutely disastrous for British agriculture. Does the Prime Minister agree with her?
My position remains exactly as it has always been. We are going to negotiate a new economic partnership with the European Union. I assure the hon. Lady that the interests of agriculture will be one of the considerations we take into account when we make sure that we are still able to have a good trade arrangement with the European Union, as well as improved trade arrangements with the rest of the world.
On a point of order, Mr Speaker. It relates to Prime Minister’s questions.
I will give the hon. Lady the benefit of the doubt. Points of order are supposed to come after statements. She says it appertains to the exchanges we have just had. I hope it does and that it is not just a prolongation of the argument. Let us hear it.
Thank you so much, Mr Speaker. My question to the Prime Minister referred to the ruling of the High Court today. In the ruling handed down in the High Court this morning, Mr Justice Garnham declared the Government’s failure to require action from 45 local authorities with illegal levels of air pollution in their area to be unlawful. In her response, the Prime Minister—
Order. Forgive me, but the words that immediately spring to mind in this context are “second bite of the cherry”. I am afraid a Member is entitled only to one bite of the cherry. If the hon. Lady feels very aggrieved, she can always write to me about the matter. I am not sure I should exhort her to do so—doubtless a missive will be winging its way to me ere long—but I do not think we can detain the Chamber now. The hon. Lady had a good bash earlier and we will leave it there for the moment.
Medicines and Medical Devices Safety Review
With permission, Mr Speaker, I would like to make a statement setting out the action the Government are taking to address public concerns regarding the safety of medicines and medical devices used by the NHS.
On Friday, I will host campaigners, clinicians and safety experts from across the world as part of the world patient safety, science and technology summit, which is being held for the first time outside the United States here in London. As part of that, we will release a landmark report on the extent of medication errors in modern healthcare systems, as well as the NHS’s plan to tackle them. Alongside those in the report, there are three areas of potential medication error that I wish to update the House on today where serious concerns have been raised by patients and their families.
The first is Primodos, a hormone-based pregnancy test, which is claimed to have led to miscarriages and birth defects during the 1960s and ’70s and was prescribed to more than 1.5 million women before it was withdrawn from use in 1978, partly due to more modern pregnancy tests becoming available. The second is sodium valproate, an effective anti-epilepsy drug, which has been definitively linked to autism and learning disabilities in children when taken during pregnancy. Campaigners have suggested up to 20,000 children may be affected. The third is vaginal mesh implants, often used in surgical interventions to address complications after childbirth, which have been linked to crippling, life-changing side effects.
Of course our first thoughts are with the individuals and families whose lives have been turned upside down by these issues. Many people have endured, and continue to endure, severe complications and tremendous pain, distress and ill health, alongside a strong sense that their concerns have not reached a satisfactory resolution. I pay particular tribute to those who have responded to such experiences not just with understandable anger, but with resolute determination to campaign for change on behalf of others. Many of them have met Ministers and Members to share their concerns, and I thank everyone who has written or spoken to me personally to raise these concerns on behalf of their constituents.
We must acknowledge that the response to these issues from those in positions of authority has not always been good enough. Sometimes the reaction has felt too focused on defending the status quo, rather than addressing the needs of patients, and as a result patients and their families have spent too long feeling that they were not being listened to, making the agony of a complex medical situation even worse, so today, in addition to practical steps for each of the three cases, I am setting out plans to establish a fairer, quicker and more compassionate way to address issues when they arise, bringing different voices to the table from the start and giving individuals and their families a clear path to answers and resolution.
Immediate action is being taken in each of the three cases. On Primodos. I have asked my ministerial colleague Lord O’Shaughnessy to drive forward, and where possible accelerate, the recommendations of the expert working group, further strengthening our systems for monitoring the safety of medicines in pregnancy. That will include offering the families of the Association for Children Damaged by Hormone Pregnancy Tests a full and up-to-date genetic clinical evaluation; better information for pregnant women and their families; better training and support for obstetricians; better evidence around dosing recommendations; making electronic yellow card reporting available directly to clinicians at the point of care; and stronger and more joined-up messages on safety.
The issue of valproate extends beyond the UK. The outcome of the EU review, expected in March, will strengthen our regulatory position. In preparation, we have tasked system leaders with delivering a rapid, co-ordinated response. Directly responding to calls from patients, we are introducing a new warning symbol on valproate packaging; updating National Institute for Health and Care Excellence guidance on valproate; pushing for valproate to be contraindicated for women of childbearing potential not using effective contraception; strengthening alerts across all GP systems and community pharmacy systems; and, for those women for whom valproate is an effective treatment, offering stronger and more tailored advice on risks and contraception.
On vaginal mesh. I asked the chief medical officer for advice in the light of calls for a full ban. She has been clear that clinical experts here and abroad agree that, when used appropriately, many women gain benefit from this intervention, hence a full ban is not the right answer in the light of the current evidence available. However, this is not to minimise the suffering many women have experienced, which is why today I can announce that we will be publishing a retrospective audit to investigate the links between patient-level data to explore outcomes, and investing £1.1 million to develop a comprehensive database for vaginal mesh to improve clinical practice and identify issues.
Those actions will improve the way the regulators and the NHS deal with issues related to vaginal mesh and valproate, as well as improve monitoring of the safety of medicines in pregnancy, but the fact that it has taken so long to surface these issues raises much bigger questions. It is an essential principle of patient safety that the regulatory environment gives sufficient voice to legitimate concerns reported by patients, families and campaigners, works alongside them and responds in a rapid, open and compassionate way to resolve issues when these are raised. My view is that that did not happen in the way I would expect in these three cases.
To do better in the future, we need to ensure that patient voices are bought to the table as systematically and consistently as other voices in the system, so today I have asked Baroness Julia Cumberlege to conduct a review into what happened in each of these three cases, including whether the processes pursued to date have been sufficient and satisfactory, and to make recommendations on what should happen in future. She will assess, first, the robustness and speed the of processes followed by the relevant authorities and clinical bodies to ensure that appropriate processes were followed when safety concerns were raised; secondly, whether the regulators and NHS bodies did enough to engage with those affected to ensure their concerns were escalated and acted upon; thirdly, whether there has been sufficient co-ordination between relevant bodies and the groups raising concerns; and fourthly, whether we need an independent system to decide what further action may be required either in these cases or in the future. This is because one of the judgments to be made is whether, when there has been widespread harm, there needs to be a fuller, or even statutory, public inquiry. Baroness Cumberlege will make recommendations on the right process to make sure that justice is done and to maintain public confidence that such decisions have been taken fairly.
Although I am deliberately leaving the terms of this model open for Baroness Cumberlege, I have asked that she consider how we strike the right balance on the criteria or threshold for a “legitimate concern”; how best to support patients where there might not be a scientific or legitimate concern, but they still have suffered harm; how we can be more open to the insights that close attention to patient experience can bring, including whether a patients’ champion could help to act as a point of contact for people or families raising legitimate concerns, ensuring that these are heard and responded to; and how any new entity interacts with existing bodies including NHS Resolution, the Healthcare Safety Investigation Branch and the ombudsman. Recognising that this is an issue that many hon. Members have been concerned about, I have asked Baroness Cumberlege to meet relevant all-party parliamentary groups and campaign groups early in the review process.
We are rightly proud of the NHS and all it has achieved and will achieve in the future. Much of this has been built on the strong connections between scientific discovery and medical progress, but innovation requires safeguards, including a culture of learning to protect against the unintended consequences of new technologies and treatments, and a clear focus on the experience and treatment of patients and their families affected by these consequences. From Mid Staffs to Morecambe Bay to Southern Health, patients and their families have had to spend too much time and energy trying to access, lobby and influence NHS leaders and Ministers to get a hearing for their concerns. The stress and frustration of campaigning, sometimes in the face of closed ranks and a defensive system, has added insult to injury for too many families. We need to establish a fairer and quicker way to resolve such concerns when they arise in the future.
It must be said that our regulatory system is, in many ways, world-leading, but it too needs to adapt to a changing environment and to draw intelligently on multiple sources of feedback to protect the safety of patients. Today’s announcement will build a system that listens, hears and acts with speed, compassion and proportionality, strengthening the commitment to patient safety, which is at the heart of this Government’s and this House’s priorities for our health and care system. I commend this statement to the House.
I thank the Secretary of State for the advance copy of his statement. I welcome the tone of his remarks and generally welcome his commitment to a review of medical device safety, although I note that the 2017 Labour manifesto called for an inquiry into medical devices and product licensing and regulation. Today’s announcement is an acknowledgement that there are major problems, going back decades, to do with safety and lack of proper scrutiny and research.
In debate and Committee, Members in all parts of the House have offered moving testimonies about the devastating impact of mesh, Primodos and sodium valproate on the lives of thousands of women and children in our constituencies. I wish to put on the record my thanks and tribute to all the campaigners and the MPs from across the House, but especially those who have worked so hard with the all-party groups, including my hon. Friends the Members for Pontypridd (Owen Smith) and for Bolton South East (Yasmin Qureshi), and the right hon. Member for North Norfolk (Norman Lamb), who have all spent many years campaigning for justice on these issues.
We have heard how mesh implants have left women in permanent pain, unable to walk, unable to work. This is an ongoing public health scandal, and we hope the Government will do much more to support those who are affected. Mesh has been suspended in Scotland and banned in other countries around the world. I understand that mesh has been paused for use in cases of prolapse. Will the Secretary of State consider fully suspending mesh use while the review is carried out?
On Primodos, the Secretary of State indicated that the Department will drive forward and “accelerate” the recommendations of the expert working group, but does he accept that that report was met with concern on both sides of the House? Indeed, campaigners branded it a whitewash.
I am grateful to the Secretary of State for including sodium valproate. My constituent, Emma Friedmann, took sodium valproate during and after her pregnancy, leaving her son, Andrew, with severe autism along with hearing and sight problems. Andrew, who is now 18, needs round-the-clock, full-time care. Emma, like thousands of others affected, was never fully informed of the risks of taking sodium valproate during pregnancy. Last year, a charity survey found that almost one fifth of women who are taking the drug still do not know the risks that the medicine can pose during pregnancy. I welcome the Government’s efforts to raise awareness of the dangers of sodium valproate, but will the Secretary of State tell us whether the review will look at the guidelines for clinicians who prescribe it to women of childbearing age?
We offer the review our support, but note that it falls short of the calls for a full public inquiry, which campaigners have been demanding. Will the Secretary of State give the House an absolute reassurance that the review will gain access to medicine regulation files held in the National Archives, access to any valuable evidence cited in unsuccessful legal actions and access to documents and information held by pharmaceutical companies and that all such material will be made public?
Does the Secretary of State agree that those affected must have trust and confidence in the review? Who will the noble baroness report to, and who will provide the secretariat to the review? I say this with no discourtesy to the Department or the Medicines and Healthcare Products Regulatory Agency, but does he agree that the review must be independent to avoid any sense of conflict of interest that has hampered previous inquiries? I understand the steer that he has given to the noble baroness on setting the terms of reference, but I press him to ensure that victims agree with the terms of reference to maintain trust and confidence in the review.
Is the Secretary of State now ruling out a full public inquiry, or is he saying to victims that they should wait for the review’s outcome? When can we expect it to report back to the House? More broadly, can he reassure us that the inquiry will have three separate strands that will look in depth at each issue to ensure that nothing gets watered down and lost?
In the broader context of Brexit, when profound uncertainty remains about medical and device regulation as we leave the European Medicines Agency, does the Secretary of State agree that the review must inform future regulatory mechanisms and take into account how we best co-operate with other national and international regulators post Brexit? What assurances can he offer the House that the medicines and devices that women use today—especially pregnant women—will not become the tragic and desperate scandals of the future?
On the treatment of the victims involved, the Secretary of State will know that many women have been denied access to legal aid to pursue compensation claims. Does he agree that women and children deserve full compensation and support? Is that not the Government’s responsibility? Will they establish a compensation fund, and what consideration has he given to compelling the pharmaceutical industry to support a compensation fund for those affected?
Finally, mesh, sodium valproate and Primodos have devastated the lives of hundreds of thousands of women and children. Is it not time that they were given a full apology? Surely, that is the very least they deserve.
I thank the hon. Gentleman for his considered response and for its tone. Like him, I thank all the all-party groups who have worked incredibly hard to raise this incredibly difficult issue. Let me go through the points that he raised; he asked detailed questions, which I want to give a proper answer to.
When it comes to mesh, no EU country has banned its use. In my understanding, Australia and New Zealand have not introduced a full ban. We have taken very clear advice. We obviously have a responsibility to all patients, and the medical advice from the chief medical officer is clear that some women benefit from mesh, if it is appropriately used, so we are following that advice. However, the review will look at all the processes around mesh. We will publish NICE guidelines on persistent pain and ventral meshes—it is also important to say that meshes are used in men as well as women—and we absolutely have to get this right.
I fully accept the point that the hon. Gentleman made on the concerns of many patients and families about the findings of the expert working group. He will know that this is a very difficult, hotly contested area. We are not proposing to revisit the science, but we are giving Baroness Cumberlege full freedom to look at what the expert working group did and to come to her own views. We are not excluding her from looking at what happened, even though we think that it is important to accept throughout that we have to follow the science at every stage to get this absolutely right. We will be going forward with some important recommendations of the expert working group regardless, such as the yellow-card system.
One thing that is clear is that when people, whether clinicians or patients, have an immediate concern about a medicine, there is no easy way to raise that quickly. If women are raising these concerns all over the country, we need to find that out very quickly at the centre, so that we can take action more quickly than happened in this case. We will also be offering genetic testing to families who have suffered, or who think that they have suffered, as a result of Primodos.
On valproate, we will issue guidelines to clinicians. We also want to make sure that there is greater awareness among patients. We are changing the NICE guidelines and the labelling. When it comes to valproate, we want to push for this to be a contra-indication for women of childbearing age who are not taking effective contraception, because it is so important to get this right.
The hon. Gentleman made very important points about the public inquiry. We are asking Baroness Cumberlege to give us her considered view on the appropriate way forward in this case, and that, of course, has implications for the issue of compensation. What I would say is that we have a problem in our system, in that there is no proper process for deciding what next steps are appropriate. Is it an investigation by the Department of Health and Social Care and NHS England, or do we need a full statutory public inquiry? We particularly want her to look at whether we should have an independent process to evaluate what happened. In my time, and in the hon. Gentleman’s time, we have been approached by a lot of people who want public inquiries, but it should not simply be about the strength of lobbying. There needs to be a process, because there may be people who do not have a loud voice, who are equally worthy of a public inquiry, but who do not get considered in our system at that moment. That would not be right.
Baroness Cumberlege will report to Ministers, not to the MHRA, and there will be full consultation with the families affected by the three issues over the terms of reference. That is absolutely the right thing to do.
The hon. Gentleman made a final very important point about how we regain the trust of families deeply scarred by these issues. We can do it in two ways: first, by being open and transparent in everything we do in this process so that they can see we want to get to the bottom of it as much as they do; and secondly by recognising the fundamental issue that in the past when we have assessed these clinical medical safety issues the voice of patients has not been as strong as it should have been. We have to put that right, and I know that everyone in the NHS, as in the House, is committed to doing so.
I welcome the Secretary of State’s statement and his ongoing focus on patient safety, which has added so much to the patient experience. I also welcome the fact that he is clearly representing the voice of patients when learning lessons. Many of those who, courageously, have come forward, including many of my own constituents, have been harmed in the private sector. Will he confirm that all patients, wherever they were treated, will be included within the review and that there will be a focus on clinical governance, not only in the NHS but in the private sector?
I can absolutely give that assurance. We are considering how to strengthen oversight, because a tragedy is a tragedy wherever it happens, and we should be demanding the highest standards of care throughout our healthcare system. We are particularly considering the issue of data sharing, because often clinicians operate in both the NHS and the private sector, and we want to make sure that we do not have two datasets but that we share data in a way that makes patients safer.
I thank the Secretary of State for advance sight of his statement, although I am sure that some of the women affected by these medicines or medical devices will be sceptical and might wonder whether the Government have not just announced a review of reviews, especially given the outrage among patients and the wider public over the review process and its outcomes in the past.
Medicines safety and licensing are reserved matters, and although we welcome the fact that the Government are not just doing nothing, it is disappointing that the review will not really consider the scientific evidence on Primodos, valproate and surgical mesh. Given the recent shambles over the Primodos expert working group, everyone needs confidence that this will not turn into a Government whitewash. How can patients be assured of the chair’s independence? Who will take a final decision on who advises the chair? Will those affected and those who took part in the initial reviews be able to participate? I am sure the Secretary of State is aware that Professor Alison Britton is already leading an independent review in Scotland of vaginal mesh. Will he and his officials seek to take advice and soundings from her findings and expertise in this process? Finally, having as much information and background as possible on women’s experiences is extremely important in getting justice and improving patient safety, so does the Secretary of State think that setting up a mechanism within his Department to collate extensive qualitative research for patients would be useful?
With respect to the hon. Gentleman, he is being a little uncharitable in describing this as a “review of reviews”. We have announced immediate action in each of these three cases—it will happen right away and will be of huge significance in the use of valproate, help for families who think they have suffered as a result of Primodos and the use of mesh. A lot of things are happening right away. These are complex issues, however, and if we are to step back and look at the systemic failures we think have happened, it is important that we ask what changes are needed. That is why we need someone of Baroness Cumberlege’s experience: she has a huge track record of campaigning on women’s issues; she was a Minister at the Department of Health for five years; and she did the “Better Births” review for NHS England in 2015. She is hugely experienced and passionate about patient safety and making sure that the patient voice is heard.
I welcome the review and the announcement of Baroness Cumberlege as its lead. I am sure the whole House will agree that she is, as the Secretary of State said, highly qualified and trusted. I pay tribute to the many hundreds of thousands of women who have suffered in silence and campaigned so effectively. As the Minister who surprised a few in announcing the Primodos working group, setting up the sodium valproate taskforce, with my right hon. Friend, and brokering the deal on the Saatchi Bill, I have seen the passion and the silent suffering with which so many women have had to live. He is absolutely right that for too long the medical establishment has tended to link arms and act very protectively when challenged, and we need to make sure that the patient voice is put right at the heart of this.
Will the Secretary of State agree with two points? First, does he agree that it is important that this does not become some legal witch hunt, but starts as a review of the evidence, the science and the clinical data in order to avoid future patient suffering? If it is couched in terms of legal liability, everyone will draw in and resist the sharing of evidence that is so key. Secondly, will he look at training? On mesh, the MHRA has licensed the device, but my understanding is that the problem is often with the training of clinicians in its installing. We need an intelligent healthcare system that uses everyday data to support patient safety.
I would like to put on the record my thanks to my hon. Friend for the work he did as a Minister in my Department that led to the setting up of the expert working group, which I think has taken this issue forward and which he championed. His experience of the life sciences industry was incredibly helpful. I take on board both his points. It is absolutely right that this needs to focus on patient safety and how we put in place processes that help people suffering now and avoid it happening in the future. His point about training is a very good one.
I welcome the Secretary of State’s statement, although would have been nice for the victims to have heard a little more about the legal aid and compensation issue. He was absolutely right to describe our regulatory framework as world leading. It is, of course, European and precautionary based. Will he dissociate himself from the Foreign Secretary’s comments last week in which he included medicines regulation in the list of those areas for which he favoured full regulatory divergence?
As the right hon. Gentleman knows—we have had these discussions at the Health Select Committee—this country makes an enormous contribution to medicines regulation across Europe, because of our extensive scientific base, and we very much hope that those links continue.
I welcome the review of the yellow card process. The first responsibility of the doctor is always to do no harm, and every doctor, when making any prescribing decision, always balances the potential improvement in patient care with the known risks. Sometimes, as more drugs are given to more people, rarer side effects will come through, and the improvements in the yellow card system will mean that those are identified earlier.
My other point is about Roaccutane. It is a drug given to treat acne but is known to be exceptionally toxic in pregnancy. I remember from my time working in dermatology that to get a prescription women had to attend monthly and have a negative pregnancy test before the next prescription was issued. I wonder whether that approach could be more widespread in the prescription of some of these drugs, which do provide some benefit but are known to be harmful.
My hon. Friend’s question demonstrates how useful it is to have people with medical experience in the House. To be honest, I am slightly overwhelmed by the detail in her question, but her broad point is absolutely right. The difficulty with the issues today is how much they affect women, particularly pregnant women. Through the review, we want to establish whether we are doing less well than we should on women’s health issues. Given that Baroness Cumberlege has done more campaigning on women’s health issues than pretty much anyone else in either House, I think she is the right person to take the review forward. My hon. Friend is absolutely right about strengthening the protections for pregnant women.
As the chair of the all-party group on oral hormone pregnancy tests, I am disappointed with the wording of today’s announcement. What happened with Primodos was a scandal similar to the Hillsborough, contaminated blood and sexual abuse scandals. Victims of Primodos and their families have waited 40 years for an answer to this grave historical injustice. It was a deliberate criminal cover-up by the statutory authorities of the day. The scientific evidence now shows a link between Primodos and deformities that was known to the drugs companies and our regulatory bodies 40 years ago. Will the Secretary of State ensure that the review—we want a full public inquiry—looks at the regulatory failures that took place 40 years ago? There was a systematic and deliberate cover-up, including the destruction of documents, by our health bodies as well as the drugs manufacturers. Primodos is, therefore, perhaps different from some of the other cases. We demand a proper inquiry and proper compensation and that the victims be put at the heart of the inquiry. They were completely ignored by the expert working group—that document was not worth the paper it was published on.
The hon. Lady and I may not agree on every part of my statement, but I thank her for her campaigning on this issue, and for the voice that she has given to thousands of women who believe that they have suffered badly as a result of Primodos. The things for which she has asked were not ruled out in the statement; in fact, what I have announced will create a process during which someone will look very carefully at the issue.
The hon. Lady has made some very serious allegations, and it is absolutely her right to do so as a Member of this House, but they differ from the conclusions reached by the expert working group. It is precisely because of that disagreement that we have asked Baroness Cumberlege to look carefully at the issue and form her own view of the right way forward. However, I assure the hon. Lady that regulatory failures are at the front of our minds, and we are absolutely determined to ensure that victims’ voices are heard.
I thank the Secretary of State for the compassionate tone that he has struck today, and for taking account of the years for which many campaigners, such as Janet Williams and Emma Murphy, have tried to make their voices heard, on valproate in particular. If, following the review, various medicines or medical devices are found to be unsafe—or, indeed, to have been taken unsafely—will there be legal consequences for the regulators who should have acted differently?
The simple answer to that question is yes: there are legal consequences for regulators who have failed. In that instance, it would be the responsibility of the Government, or of the drugs companies who failed in their responsibility to inform patients of the dangers of taking drugs. The priority is to establish the facts. Some of those are clear now, but some are not, and that is why I think that the review will help us.
Constituents of mine have been affected by both sodium valproate and Primodos. The Secretary of State has already heard the dismay expressed by my hon. Friend the Member for Bolton South East (Yasmin Qureshi) at the outcome of the review by the expert working group, but may I ask him another specific question? What he has announced today will not give a great amount of satisfaction to people, and confidence that his Department will take notice of Baroness Cumberlege’s review will be reduced by a written response that I received yesterday which stated that the Department had no plans to fund any independent scientific research on hormone pregnancy tests. We know that Dr Vargesson produced a report last week. Will the Secretary of State ensure that Baroness Cumberlege looks very carefully at this particular issue?
I can give the hon. Gentleman an absolute assurance that she will do so. In the case of valproate it is very clear what the next steps should be, because there is no dispute over the science. When there is controversy over the science—and I appreciate how distressing that is for the families involved—the first thing we must do is establish the truth of the situation, and that is why we have given Baroness Cumberlege a free hand to look at the whole issue.
I welcome the statement, which is consistent with my right hon. Friend’s track record of driving the NHS to stop causing harm to patients. May I ask him to continue to focus on encouraging, requiring and supporting all healthcare professionals to make the shift from a defensive to a learning mindset, so that they listen and learn not just from NHS experience, but from patients as well?
My hon. Friend, who has huge experience in healthcare, is right to say that at the heart of dealing with these very complex issues is the need for us to be careful not to inadvertently encourage a culture of defensive medicine. If doctors feel unable to be open about mistakes that may have happened because they are worried about legal consequences, we will not benefit from the learning that is so incredibly important, and one of the purposes of the review is to ensure that we support that open learning culture.
On behalf of my constituents whose families have suffered from the effects of Primodos, I thank the Secretary of State for taking a step in the right direction. He has announced that there will be another review with another remit. Can he reassure the House that one of the reviews will be able to investigate the cover-up over Primodos that we know has taken place for decades, and that if a crime has been committed, it will be dealt with?
I totally respect the right hon. Gentleman for airing his constituents’ concerns, but, as he will know from my answers to earlier questions, the difficulty in the case of Primodos—and this is incredibly distressing for the families involved—is that scientists do not agree about the issue, and as a result we do, unfortunately, find ourselves having to review what has happened. The review conducted by the expert working group was our first attempt. We are now giving Baroness Cumberlege a free hand to consider that and any other evidence that has come to light, and to draw her own conclusions.
Just an hour ago I met my constituent Carol Short and Emma Friedmann, a constituent of the hon. Member for Leicester South (Jonathan Ashworth), to discuss the next stage of the valproate campaign, but because of the statement, that meeting was adjourned. I am happy that they are now in the Chamber, and I am sure that they are pleased to hear about the review.
Is it possible to ensure that GPs are giving out the excellent advice that the Medicines and Healthcare products Regulatory Agency has put together? I am sorry to say that it seems that far too many are not, and there appear to be no regulatory sanctions to ensure that they do.
Order. I mean no discourtesy to the hon. Gentleman, but I hope that the people whom he mentioned are in fact in the Gallery rather than in the Chamber. That would be greatly reassuring to us, and quite possibly to them.
I can give my hon. Friend the assurance for which he has asked. We have announced today that we are improving the system of alerting both general practices and community pharmacies to ensure that the right advice is given and the right safeguards are in place, so that people who are pregnant or might become pregnant do not take a medicine that is very powerful and very effective in the right circumstances, but incredibly dangerous in the wrong ones.
I welcome the Secretary of State’s intention to look further at these very concerning issues, but I fear that his putting them all in one place means that he may not be giving sufficient attention to the Primodos issue, which is a scandal of very many years’ standing. I do not think that the recent report of the expert working group is the basis on which Baroness Cumberlege or anyone else should look further at the matter, because it was a complete whitewash, and the Secretary of State needs to acknowledge that. I think that if he were to do so, the people affected by Primodos over the last 40 years or more would feel much more confident that the process that he has described today might enable them to secure some resolution.
I understand why the hon. Lady has asked her question in the way that she has, but we set up the expert working group after a lot of very careful thought because we honestly wanted an answer. We are faced with circumstances in which scientists disagree, and in those circumstances it would not be right for me, as Secretary of State, to announce a different scientific view. I think that the right thing to do is to allow someone the time and space in which to look at the issues that the hon. Lady has raised, and that is what Baroness Cumberlege will do.
I have a constituent whose quality of life has been completely ruined by a surgical mesh implant. What reassurance can we have that the Cumberlege review will ensure that the voice of the patient is listened to much more quickly in future, so that when things go wrong, we limit the number of patients who suffer the type of harm that we have heard about this morning?