Wednesday 16 May 2018
[Stewart Hosie in the Chair]
NHS 70th Anniversary
I beg to move,
That this House has considered the 70th anniversary of the NHS and public health.
It is a pleasure to serve under your chairmanship, Mr Hosie. The 70th anniversary of the NHS is an important time for the country, but it is also a special time for Blaenau Gwent. Aneurin Bevan, and the health service he created, was born and bred in Blaenau Gwent—in Tredegar. Since Nye’s death in the 1960s, Blaenau Gwent MPs have followed in the footsteps of a colossus. We in the borough are immensely proud and fiercely protective of his legacy. When he said he wanted to “Tredegar-ise” the NHS, he was basing his plans on the Tredegar Medical Aid Society, a mutual and an organisation established for all, supported and funded by the people of Tredegar, whether they be miners at the Ty Trist colliery, like my grandfather George, quarry workers at Trefil or nurses at the St James Hospital. If Bevan established an NHS for the 20th century, at this anniversary it is important that we ask ourselves what sort of NHS we need for the 21st century.
I should declare an interest as a biographer of Aneurin Bevan. Before my hon. Friend moves on to talk more generally about the future, does he agree that the decision to nationalise the hospitals, and the painstaking work that Bevan did in negotiations with the British Medical Association, mean that he truly is the architect of the national health service?
My hon. Friend has written a terrific biography of Aneurin Bevan. He absolutely captured what Nye did for us all.
On 5 July it will not be good enough just to celebrate the past, the history of this brilliant institution and its architect; we must also look to its future and the challenges it now faces. Many of those challenges have been created by eight years of Tory austerity, which has left our national health service underfunded, understaffed and underprepared. Labour would provide more doctors and nurses and provide a funding level to support the service for years to come. Other challenges cannot be put down to politics. The epidemics of old—diseases once fatal that we have almost eradicated—are being replaced with new health problems that are putting massive strains on our NHS. It is wonderful that people are now living longer, but that also means our population is an ageing one that needs support. As our society gets to grips with caring for our mental health, more people need access to these services than ever before.
Today I want to concentrate on another big challenge: rising levels of obesity, particularly among children. In this case, it is a challenge where an ounce of prevention can be better than a pound of cure. Back in Blaenau Gwent, surveys estimate that 70% of adults are overweight or obese and 11% are being treated for diabetes. Most troublingly, the latest figures from the child measurement programme reveal that last year 15% of four and five-year-olds in my constituency were classed as obese. We should all be worried by that trend, which is being replicated across our country.
My hon. Friend is making some important points. Does he agree that we should urge Ministers to take more of a lead in restricting junk food advertising and to provide extra money and the consequentials to the Welsh health service for such things as earlier intervention by GPs and practice nurses?
My hon. Friend makes an important point. As always, she is ahead of the game—I will come on to that point shortly.
Obesity is the second biggest preventable cause of cancer. Diabetes leads to significant complications, including, in extreme cases, amputation. The consequences for our society are massive. NHS England has said that around £16 billion a year is spent on the direct medical costs of diabetes and conditions related to being overweight or obese. That is more than the cost of delivering all our countries’ police and fire services combined. The Government cannot shirk their responsibility to tackle the issue head on. When the next chapter of their childhood obesity plan comes into effect, it needs an effective UK-wide public health drive. It needs to do more to deal with that priority. The 2015 Conservative manifesto pledge to clamp down on advertising unhealthy brands vanished into thin air by the time of the first childhood obesity plan.
It now looks like junk food ads may be banned from programmes where three quarters of the viewers are children. That is to be applauded. It is a good thing, but it fails to tackle the big primetime shows that families gather around the sofa for: shows such as “The X Factors” and the aptly named “Saturday Night Takeaway”. That is without mentioning, with the World cup on the horizon, the premium advertising space around sport. There is a real contradiction when fantastic displays of athletic prowess are bookended by burgers and packaged with pizzas.
Alongside others, Cancer Research UK is pushing for a 9 o’clock watershed for junk food adverts, and the Government must consider that proposal seriously. It is not only me who thinks that; the head of the NHS, Simon Stevens, thinks it would be a good way to tackle this scourge. He believes that even the likes of Facebook must be roped into any plans that limit junk food advertising. The Jamie Oliver Food Foundation suggests having mandatory training for GPs and health professionals to talk about weight in a helpful way and to refer patients to nutritional experts. Whatever the Government decide, they will need to be bold in the face of pressure from the industry heavyweights and their lobbying teams. When plans emerge from this Government, every organisation should be doing their bit.
I was pleased to see the Mayor of London, Sadiq Khan, take real steps to address junk food advertising last week with his announcement that such adverts are to be banned from the tube and bus networks. Almost 40% of London’s 10 and 11-year-olds are obese or overweight. The Mayor is taking a positive step to tackle what he has rightly called “a ticking time bomb”, and that must be supported. However, it is up to all public bodies, including devolved Administrations, councils and housing associations, to weigh in. Primary schools should promote walking every day to their pupils. It is about using soft power and nudge, as well as improved regulation to make legislative and cultural change.
The hon. Gentleman is talking about action to tackle childhood obesity and junk food adverts, and also about Jamie Oliver. He will perhaps be aware that Jamie Oliver met the First Minister of Scotland on Monday and welcomed and supported the Scottish Government’s plan to halve childhood obesity by 2030. Would he care to welcome that, as Jamie Oliver did?
I am pleased to welcome that support for a UK issue that we all need to work on.
With further support, we could achieve the healthy lifestyles that so many people want by using influence and our voices. I want to round this speech off with one initiative that I think deserves real backing. It will help our society get on track to healthier lifestyles. To return to Bevan, the initiative is about harnessing community support to deliver improved health for all. Dame Kelly Holmes teamed up with the NHS and parkrun last weekend to encourage people to “take care of yourself” in the build-up to a special parkrun for the NHS on 9 June. My local parkrun group is the Parc Bryn Bach running club, and I can report what a difference such initiatives can make. After a year of running every week, my blood pressure is down and I have tightened my belt a few notches.
I am grateful for the esprit de corps of my local running club. Parc Bryn Bach has Saturday parkruns, special Sunday sessions for parkrun juniors and is a backer of the brilliant NHS Couch to 5k scheme. Just a few Mondays ago, it had 150 people running through a wet, windy April evening to get their fitness up. Over three months, many of those local people will gain confidence and a level of fitness to help them change their lifestyle. The camaraderie and support on offer is fantastic, and that is what makes these schemes fun to join and easy to keep up. Unsurprisingly, the club membership has doubled in recent years, and the coaches and volunteers include many health professionals. They are a great team. I am pleased that the Welsh Labour Government have seen the value of that. Welsh Athletics is supporting clubs with regional Couch to 5k programmes.
I thank my hon. Friend for giving way and congratulate him on his passionate speech that marks this historic anniversary and the part that his constituency and the wider south Wales region played in the formation of the NHS. Does he agree that in order to tackle our modern health challenges it is important that we have further investment and that the UK Government match the Welsh Government’s passion and commitment to this most cherished national institution?
I join my hon. Friend in congratulating all those involved in parkrun. Will he join me in congratulating the volunteers who make parkrun possible in his constituency and in mine in Pontypool and Cwmbran, where I too have taken part in parkruns, but I have not quite reached my hon. Friend’s running level yet?
I thank my hon. Friend for supporting parkrun. Perhaps we should have a south Wales eastern region parkrun championship at some point in the coming months. He is absolutely right about volunteers and the running club supporters who are out there at 9 o’clock on a Saturday morning, or sometimes on a Sunday morning for the junior parkrun, in parks all across the country. They do a great job in all weather. It is brilliant to see. More than 30,000 runners took part in parkruns in Wales alone last year. It is that sort of activity with cross-body support and backing from our community role models that can make a big difference to making such schemes stick.
When Nye wanted to Tredegar-ise the national health service, he wanted a service built on community where we all bought in and all had a stake. In that spirit the public health challenges we face 70 years on should not be tackled alone. To truly take care of ourselves, we need a society that sets us up for success, a system that has our backs, a public service that recognises what needs to be changed and how to do it. The Government have a real chance to honour the anniversary of the national health service in the months ahead, not with pomp and ceremony, but with the sort of action that people will celebrate another 70 years from now.
It is a pleasure to serve under your chairmanship this morning, Mr Hosie. I congratulate the hon. Member for Blaenau Gwent (Nick Smith) on securing this important celebratory debate.
On 5 July this year we will mark 70 years of the NHS across the whole of the United Kingdom. Although now a devolved matter, the same core principle of safe, effective, person-centred care applies and it remains free at the point of delivery throughout the United Kingdom. I have no doubt that, no matter where we live on these islands, the NHS is the British institution most loved and valued by the public.
For the past seven decades, millions in the United Kingdom have known that they can rely on the NHS in their hour of need, to treat them when they are sick or injured and help them keep fit and healthy—most importantly, without discrimination. That principle has worked well for 70 years because of the dedication of generations of hard-working NHS staff. In this anniversary year, it is only right that we should thank all NHS staff, past and present, in Scotland and across the United Kingdom for their dedication and service. Mr Hosie, I should have declared an interest. I have two daughters who are nursing professionals in NHS Ayrshire and Arran.
This is indeed a time to reflect on the progress that the NHS has made since 1948 and consider what steps we should take over the next seven decades to ensure that the national health service continues to provide the best possible service to the British public, who very much rely on it.
In 1948, the newly created NHS was more concerned with childhood malnutrition than with obesity. Penicillin, discovered by Sir Alexander Fleming, physician and Nobel prize winner, who was born in Ayrshire in Scotland in 1881, was a relatively new and revolutionary treatment. Polio, tuberculosis and rickets were of major concern as opposed to dementia, the diabetes that was mentioned earlier, and the cancer conditions experienced today.
It is worth noting the progress that the NHS and society in general have made in recent years in recognising the need for improved mental health provision. Health is health, whether we categorise it as mental or physical. The UK Government’s introduction of parity between mental and physical health was a vital and important step forward, and I am glad that the Scottish Government have followed suit.
As our population ages—I fall into that category—and our society changes, the challenges that the NHS faces in health promotion and health and wellbeing will continue to evolve. We need an NHS that is adaptable and committed to embracing new technologies such as genomics wherever possible, and it must be well resourced to meet the increase in demand. I mentioned earlier the dedication of the staff, but it is crucial that there are enough skilled staff to meet today’s demanding and changing workload. Sadly, today’s national health service as a whole has vacancies and challenges in recruiting across the spectrum, whether nurses, allied health professionals or medics. There are too many gaps in the system, which has led to significant funds being paid on overtime and expensive agency nurses. We need to resolve the long-standing UK-wide conundrum of delayed discharges from acute care beds by ensuring that patients are cared for safely in the most appropriate, supported environment.
Over the past 70 years the NHS has been a great success based on a great principle. We are living longer and healthier lives as a result. May I commend the Labour Government who, 70 years ago, in the dark days of a post-war Britain, had the courage and foresight to create the national health service, and also successive Governments, including, dare I say, Conservative Governments, who have supported the service that we all continue to value so much?
If I were able to make a speech, which I cannot, I would talk about public health even before the health service. However, let me remind everyone that on the creation of the national health service, in January 1944, Henry Willink, a Conservative Minister in the coalition Government, held up the first White Paper that said, “national health service”.
I thank my hon. Friend for that intervention. I was being extremely kind today to my colleagues in the Labour party. The war prevented the launch at that time, but the general principle and the welcoming of a national health service has been good for the United Kingdom.
Finally, a line from a Robert Burns poem that was penned more than two centuries ago in 1780. It is four verses long but I will recite only one line. It is called, “Here’s to Thy Health”, and it reads as follows:
“I’ll count my health my greatest wealth
Sae lang as I’ll enjoy it”.
It is a pleasure to serve under your chairmanship this morning, Mr Hosie. I pay tribute to my hon. Friend the Member for Blaenau Gwent (Nick Smith) for securing this debate.
If we look back over almost a century, so much change has happened and so many developments have taken place, but one thing has remained constant: our world-leading, history-making and much loved national health service. Let us think about the founding principles of the national health service. It is comprehensive, universal and free at the point of delivery; millions of lives have been saved and millions of people treated and restored to good health; and it has tens of thousands of decent, hard-working and much-loved public sector workers.
As we approach the 70th birthday of the national health service, to those workers I say thank you for your compassion and sacrifices, for always going the extra mile and for standing firm in the wake of the millions of Tory cuts that we have seen since 2010 and the Scottish National party cuts in Holyrood since 2007. Decisions taken by politicians of all political parties have had an impact on our national health service. I was proud of the previous Labour Government’s record investment in our NHS. We delivered lower waiting times, faster operation times, a GP in local communities and vital investment in infrastructure and facilities. Sadly, it is not all good, and we cannot take our NHS, its workers or its mission for granted.
My local hospital, Monklands, serves many of my constituents in Coatbridge, Chryston and Bellshill. It is one of the busiest hospitals, and just a few months ago there were reports that it needed more than £30 million worth of repairs. There are leaks, and wards are closing. We will look at Monklands hospital. Sadly, on a personal note, one day when I was in Parliament my mother, who is 85 and has dementia, was sent home from Wishaw hospital in a taxi after waiting two hours, with no food and no toilet facilities. My father is 88 years old. They both saw the NHS born. They have been taxpayers all their lives. My father cannot understand why his wife, at her age and with her illness, was treated that way. All that in the 21st century. Thankfully, my mother is now back at her care home, and has settled down a little bit.
Sadly, thanks to the Scottish Government’s failure to invest, more than £3 million was spent on agency staff—that would have paid for more than 100 nurses. Across Lanarkshire in the year 2016-17, more than £10 million was spent on agency staff in three hospitals: Wishaw, Monklands and Hairmyres. To quote the leader of the Scottish Labour party—my leader—Richard Leonard, we need to stop these private companies
“sucking money out of the NHS”.
I do not want to sound too negative. I am proud of the NHS, and I am proud of its workers. I will work with anyone and everyone who wants to see it funded, supported, protected, defended and enhanced. That is why I am here: to defend and fight for public services, to champion public sector workers, and to fight for the right to a hospital bed, an appointment with a GP and an operation in good time.
As Bevan said in 1948, the national health service must meet everyone’s needs, be free at the point of delivery, and be based on clinical need, not the ability to pay. That is our mission; that is my focus. As we come together to acknowledge and celebrate the 70th anniversary of the foundation of the national health service, we must recommit ourselves to delivering that noble aim and objective. Happy birthday, NHS.
It is a great pleasure to serve under your chairmanship, Mr Hosie. Let me begin by reassuring the Minister that I am not going to give a list of all my medical complaints—I seem to have a tendency to do that at these debates. I will just say that they are very few in number. As one of the officers for the all-party parliamentary group for diabetes, I agree with what the hon. Member for Blaenau Gwent (Nick Smith) said about diabetes, and the way we need to tackle it by fighting obesity and waiting for the effects of that to come through.
If there were one birthday present that I would like to give the NHS, the Prime Minister has already given it: a long-term plan for the NHS and a multi-year funding settlement in support of it. That is very important for a number of reasons. We all know that the NHS has suffered its most challenging winter for many years. We also know, as Opposition Members have pointed out, that we are living in an ageing society. By 2020, there will be more 70-year-olds than there were five years earlier. I am not sure whether my hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant) and I will be in that category—I have not done the maths yet—but we will go there jointly and with good humour, I am sure. The number of over-85s will nearly double by 2035. We have to focus our services on dealing with the requirements of that group of people, who are living in a modern age where the NHS has introduced many improvements over the past few years.
For the NHS to plan and manage budgets effectively in the long term we need to move away from annual top-ups of its budget, and towards a sustainable long-term plan. Whatever plan we introduce, it has to be sustainable. We have the five year forward view as a basis on which to work towards that. I was very pleased that the Prime Minister announced to the Liaison Committee that the Government would introduce a long-term plan for the NHS and, most importantly, do so in conjunction with the leaders of the NHS, clinicians and health experts. We cannot introduce that long-term plan simply as politicians. I look forward to that with a great deal of anticipation.
We all know that care is not properly integrated—we have seen that in our constituencies—and we all know that we need to integrate health and social care more quickly than we can really manage. I fully support that process. All those things came up at a public meeting in my constituency just a few days ago. Somebody asked why we still fund the NHS on an annual basis, and I was able to point out that we are moving away from that system.
I will finish with this point: putting public health at the heart of what we are doing with the NHS is crucial. We cannot stand here and speak about the future of the NHS unless we put public health at the centre of everything we do. I recommend that course of action to the Minister.
Thank you, Mr Hosie, for chairing this morning’s important debate, and I thank my hon. Friend the Member for Blaenau Gwent (Nick Smith) for introducing it in the way that he did.
The incredible tributes that we have heard this past week to Dame Tessa Jowell have reminded us what a formidable politician she was, and how she centred her work around the important agenda of public health, backed up by the epidemiological evidence. We have had so many fantastic evidence-based reports, not least the work done by Michael Marmot in identifying the importance of the social determinants of our health outcomes. We know that various agendas meet around public health—social, economic, health and education agendas, and many more. That is why it is really important that we put our focus on the whole person and the impact that life has on people.
We have seen severe cuts, not least to our Sure Start centres, hundreds of which have closed. From the evidence that they produce, we know about the real impact that they have, particularly on our young people. Health visitors are an initiative that the Government took up in 2010, following Labour’s urging that we must increase the number of health visitors. That number has now fallen, from the 4,200 additional health visitors that David Cameron put right at the heart of his Government, back to the numbers before that Government. There is a real crisis among that vital workforce, with ever-increasing workloads.
We have had workforce cuts, financial cuts and service cuts in public health. Public health is about long-term outcomes, and when we are dealing with austerity and cuts, we are looking at having to support tomorrow, not the future. Public health has been a very poor relative in the austerity programme, and I can witness that in my city. In Acomb in York, since 2011 I have seen childhood obesity more than double among my community. I have also seen health checks cut; those are vital at the age of 40 to ensure that we put people’s health back on track.
Long-term contraception has been cut, and smoking cessation services demolished—unless, of course, people pay for them. We have seen a 90% fall in the number of people able to access smoking cessation services, in an area where the number of people who smoke is higher than the national average. Those are the real consequences of cuts. In York, the clinical commissioning group denies surgery to people who have a high body mass index or who smoke, yet the support services to help people change their lifestyle and behaviours are not there any more—a complete nonsense. That is why it is really important to put the focus back on public health.
Over the past week, I was most shocked by a letter I received about substance misuse services in York. York is now 148th out of 148 authorities when it comes to drug-related deaths of people in treatment and across the community as a whole. Most people will be shocked to hear that about York, but when I look at what our local council have done in absolutely slashing funding to those vital services, I am not really surprised—and, of course, the most severe cuts are still to come. What will that mean to the people in my community whose life chances are being taken away from them?
Across mental health services, the sustained lack of investment over such a long period is having a real impact on health outcomes. People have been hurt by cuts and hurt by political decisions. It need not be that way. We all know it is the most vulnerable, the poorest, the people who really need the state’s help who fall down when the state stands back.
We have heard so much about young people in the debate, for whom interventions are even lower than for older people. For people in their latter years, public health virtually does not feature. Yet, in the health service that Bevan created, everyone from cradle to grave could access the necessary good public health services. Such interventions save the NHS so much money—it is a no-brainer—so why cut those services? That question comes not just from me, but from directors of public health I meet regularly in my constituency, and across the board. They want to understand what will happen when the public health grant is withdrawn. I hope the Minister can reassure them today that he will ensure that they will receive the funding needed to sustain services into the future. They also want to know how the Department of Health and Social Care will work with directors of public health to ensure that their long-term goals for improving the community’s public health will be funded.
We need to look seriously at the workforce in public health, which has been decimated. We have to look at funding to sustain that for the future health of our nation. We need to look at outcomes, not just inputs. Let me take the child measurement programme as an example. It is a nonsense that we know now how obese children are, but we cannot afford the interventions to change the trajectory of those children’s lives. That means that the programme does not work. We need to examine how we change the life chances of so many people across the country.
I want to touch on the 70th birthday of the NHS, which is so important for so many of us, and draw the Minister’s attention to what we are doing in York. When I heard what his Department was rolling out, I thought it quite lacklustre—it lacked ambition—so I pulled together the health leaders in York to drive forward a public health initiative to mark the 70th birthday. It includes the clinical commissioning group, the acute trust, the mental health trust and the local authority. We are working together to launch in July, as part of that fantastic celebration, a whole programme intended to transform the health of our whole community.
I have a meeting with businesses to talk about how employers can change the life chances of people who work for them. We are meeting faith and community groups to talk to them about people that they engage with. We are going to have a touring pop-up event across the city over the NHS birthday to provide advice, health checks and services, and simple programmes, because we do not have a lot of money. I know from Health questions that the Minister will meet with me, as the Secretary of State said, to talk about this initiative. We are going to have health walks at lunchtimes. We are going to have basic tests to understand health measures, as well as advice, information, encouragement and the promotion of better understanding, looking at diet, exercise, behaviour and the choices that people made. We are determined to touch the thousands of lives of people in York on this 70th birthday, because we want to celebrate the future with everyone.
We know that so many people are being failed, and the most vulnerable are being failed the most, but we can change things around. Public health does not actually cost a lot of money compared with acute services. So, I trust that from today, we will take the spirit of Nye Bevan and ensure that we invest in the very people who will depend on our NHS in the future.
It is a pleasure to serve under your chairmanship, Mr Hosie. I am grateful to the hon. Member for Blaenau Gwent (Nick Smith) for securing this important debate. I wish the NHS a very happy birthday. I cannot understand—I get angry—when I hear politicians on the other side of the Atlantic rubbishing the NHS as a service. It is one of the greatest achievements of this country and, as has been said, credit is due to Clement Attlee’s Government for doing what they did.
Being born when I was, and being brought up in the Highlands, as a child I was part of the nascent NHS service. My late father told me what it was like before I was born. He spoke of the inequalities—how, if someone did not have enough money, their life would be shorter, because they could not pay for the doctor. That is how unfair it was. The NHS is about fairness, and that is why it is such a great achievement for this country.
I extol the virtues of the staff. Through my wife’s illness, I know how dedicated the neurosurgery team in Aberdeen Royal Infirmary is, and how fantastic the nurses were at a critical time in my wife’s life. She recovered, thank God. If there are angels on this earth, they wear nurses’ and doctors’ uniforms, believe you me.
The issue for Scottish Members is that the NHS is of course devolved, but I want to touch on something I mentioned in the summer when I questioned the Prime Minister. Within my vast and scattered constituency, we face really big challenges owing to remoteness and distance. There was a story in the national press recently about a mother who lived in Wick who had to make a 520-mile round trip to Livingston to give birth. That was due to an accidental coincidence of unavailability of services more locally. I do not want to give the staff a hard time—staff morale is crucial—and, for the record, I am not getting at the staff, but the fact that it happened should worry us all.
What we see in remote parts of Scotland, including my own constituency, is that there seems to be an impression that our network of local hospitals is not being used to the maximum it could be, in terms of treating people locally. I believe it is an issue of funding, which other hon. Members have also highlighted. What bothers me about what I think is happening in my constituency is that it seems to be taking us rather worryingly near to the sort of inequalities that my father spoke of. In other words, a person who lives in a very remote area of Caithness or Sutherland might not get the same deal as someone who lives in Glasgow, Edinburgh or Aberdeen, because it is harder to access services. That is the challenge for the Scottish Government, and for us all. Surely to goodness a person should not be disadvantaged because of where they live. That is what lay behind the Beveridge report, which in a way was influential on Nye Bevan bringing into being the NHS: the idea that no matter who someone was, or where they lived, they had an equal right to the service.
I do not know the answer. Health is devolved to Scotland, which I accept. It is rightly the property of Members of the Scottish Parliament and Ministers in the Scottish Government, who I am sure do their level best, but if there is a perception in Westminster that one part of the UK—it may be Wales, Northern Ireland or Scotland—is perhaps not functioning quite as it should, and on something as fundamental to our lives as the NHS, at the very least there has to be a conversation between UK Ministers and Scottish Government Ministers to say, “Is it going okay for you? Is there something we could do better? Is there something that can be co-ordinated better throughout the UK to make sure that whether someone lives in Scotland, Wales, England or Northern Ireland, they have the same access to health services?”
I give notice that this is an issue to which I will return, while of course always recognising the difficulty of the fact that health is a devolved matter and there are therefore limits on what I can say. I do not intend to be silent on the issue.
It is a pleasure to serve under your chairmanship, Mr Hosie. As my hon. Friend the Member for Blaenau Gwent (Nick Smith) said, the antecedents of the NHS are to be found in Tredegar and in the Beveridge report, which preceded it. Disease was one of Beveridge’s five great evils. Infectious diseases such as polio, diphtheria and tuberculosis caused people to die in their early and mid-50s on average. The need for a sufficient and healthy labour force to rebuild the economy necessitated combating those diseases, which also caused a high rate of infant mortality. The need for a better, longer-living workforce drove much of what Beveridge looked at.
There was in fact a good deal of state funding provision before 1948 to cope with the devastation of disease, but what Bevan did, against tremendous opposition within the service and politically, was to centralise the system, nationalise hospital provision, create standards across the country and, crucially, give people the assurance that they would always be seen and treated, based on their need, not their ability to pay.
The health service was built on a tripartite structure of hospital, GP and community services. In return for good terms and conditions, clinical freedom and autonomy in the system, the doctors finally agreed and the NHS was born. It was a wonderful achievement, but it was also a wonderful compromise. Over the past 70 years, the tensions in that compromise—the local versus the national, the role of clinical autonomy, priorities and the quality of the service—have regularly surfaced. There are always crises—astonishingly, every year there is a winter.
We now treat 1 million people every 36 hours, and employ nearly 2 million people. We are very grateful for everything they do, and we celebrate them today on this 70th year. However, the challenges are different today, and the service should therefore be different in the next 70 years. This anniversary is an opportunity to celebrate the achievement, revisit the compromise and set a course that is as resilient for the next 70 years. The diseases that are with us today—cancer, and cardiovascular, respiratory and liver disease—are very different. Depending on a person’s social class, dietary risks, tobacco and obesity are the biggest contributors to early death and disability. Alcohol and drug misuse, and lack of physical activity, are also key. We are finally starting to appreciate the impact of mental health and social isolation on physical health.
Life expectancy has increased, but the prevalence of people living with one or more limiting long-term illnesses has changed the picture of healthcare demand, and that requires the system to change. In Bristol, women live an average of 64 years in good health, but a further 19 years in poor health. For men, the figures are 63 and 15 years, but that average masks a huge range in social class. Several areas of my Bristol South constituency are in the bottom 5% in England for male life expectancy. In 2010 the Marmot review told us that such health inequalities cost us approximately £36 billion to £40 billion in lost taxes and costs in welfare and to the NHS—that is a huge amount of money. We must prevent and manage life-limiting diseases and address the silent misery of families who support and cope with people living with them.
Accountability is a major issue for the service in the next 70 years. We need to start treating patients and the public as assets to the health service, not as nuisances. We need somehow to introduce democratic accountability into decision making. The complex fragmentation of the health service makes it wholly unclear where responsibility, and hence accountability, lies. From the bottom up, hundreds of bodies are involved. The 200-odd clinical commissioning groups are members’ clubs with no element of either direct or representative democracy, and they are plagued with conflicts of interest. At the top, there is not just the Department and Ministers, but a raft of arm’s length bodies, which Members of Parliament find it impossible to navigate. I worked in the system for a CCG, and I still find it really difficult—it is an absolute mess.
One reason for the mess is the disaster of the Health and Social Care Act 2012, but the NHS has been poor on accountability since the early centralisation. It has always been fragmented in a way that makes accountability harder, and it has always seen itself as separate from the rest of the local system, which has democratic accountability. That is a problem. It has always been riven by powerful vested interests that distort the general accountability. That is a key part of Bevan’s compromise, and I think we need to revisit it.
Presented with a well-made case that is supported by, dare I say it, experts or informed leaders, the public will make difficult decisions. I know local politics can make things difficult when tough issues such as service changes are necessary, but excluding people does not make that any easier. Making a hard case to local people and their MPs is challenging work, but if that does not happen decisions gain no legitimacy. We can keep the “N” in the NHS, but we need to give local people far more control to make it more resilient for the next 70 years.
It looks like we are going that way. We have heard about the experience in Scotland, and this is also a devolved matter in Wales. Very interesting things are happening in Manchester, but we need a much better debate about what local looks like. We must recognise that the key issues for now are the money and the workforce. Technology gives us huge opportunities, including on some of the workforce issues.
I want to finish by talking about leadership. I joined the health service as a manager in the late 1980s, and I am very proud of the role that managers play in the services. General management, which was introduced in the 1980s, has few friends, partly because it was associated with the Thatcher era of reforms, and partly because it threatens clinical autonomy and freedom, which were fundamental to Bevan’s compromise. We should use this anniversary to celebrate managers and leadership in the NHS. We need good clinical and non-clinical managers to make the changes we want to see, deliver the efficiencies we need and keep making the system safer. I hope that they can also help leaders make the NHS more open and accountable. We need that for the next 70 years.
It is a sincere and genuine pleasure to serve under your chairmanship, Mr Hosie. I pay tribute to the hon. Member for Blaenau Gwent (Nick Smith) for securing this debate and for his thorough and measured speech. He talked about the challenges we face in the NHS, about austerity—obviously, across these isles, we all face the challenge of dealing with austerity constraints—and about obesity. I mentioned earlier that on Monday, Jamie Oliver met the First Minister of Scotland, Nicola Sturgeon, here in London. He backed the Scottish Government’s target to halve childhood obesity rates by 2030 with a new healthy weight and diet plan, which is due to be published this summer. It will include action to restrict promotions that advertise junk food, including multi-buy deals on unhealthy products.
The hon. Gentleman mentioned the fantastic parkrun, which is one of the best lifestyle movements—if you will pardon the pun, Mr Hosie—that we have. It is free, run by volunteers and accessible. It is 5 km—anyone of any ability can manage that. This morning, I managed to get some miles in the bank before this debate, alongside my Scottish National party running club colleagues. The hon. Gentleman is more than welcome to join us any time he wishes. The invitation is open to all: we are ecumenical.
The hon. Member for Ayr, Carrick and Cumnock (Bill Grant) gave us a very good history lesson about how far the NHS has come. He was very comradely in his cross-party acknowledgment that Labour founded the NHS, and rightly so. In his comradeliness, he neglected to mention any of the NHS measures in Scotland, which are no doubt helped in no small part by the intervention and support of his daughters. It is right that we pay tribute to NHS workers. The NHS in Scotland is the best performing in the UK.
My constituency neighbour, the hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney), perhaps missed the tone a wee bit, but I understand his anxiety. He talked about Monklands Hospital, which is in my constituency. Of course, the SNP Scottish Government have committed funding to build a new Monklands Hospital. We are all aware of the challenges previous Scottish Governments faced with the accident and emergency service at Monklands Hospital. There was potential for a downgrade, but the hospital’s future is secure and we are going to get a new service. The hon. Gentleman talked about funding, and of course the NHS in Scotland is supported by record funding levels. However, the hon. Gentleman is right that, like all NHS services, we are not without our challenges in Scotland. In that regard, I hope that he pursues the case that he mentioned, involving his mother. It is right that where there are problems they are called out and we learn from them.
The hon. Member for Henley (John Howell) talked about the need for a long-term plan for the NHS. We all agree with that. He also talked about care not being properly integrated, but in Scotland we have legislated to integrate health and social care, so we are further down the road to seeing it realised. He was right to mention that public health must be central—we must all remember that, and remind ourselves of it.
The hon. Member for York Central (Rachael Maskell) was right to pay tribute to Dame Tessa Jowell, who personified dignity, passion and eruditeness in her final months of campaigning on health issues. We all pay tribute to her work and pass on our sincere condolences to her family.
The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) gave a very measured speech based on experience and personal testimony. He is right that the NHS is fundamentally about fairness, and he was right to pay tribute to our NHS staff, as we should all do—it should be something to unify us all. He talked about rurality and distance, and I benefit from experience in that regard because I am originally from Orkney, so I well appreciate the challenges of local service delivery, which are not too dissimilar from the ones that he faces in his constituency. I know, however, that the Scottish Government are aware of that and that the door is open to him should he seek to make representations or come up with ideas.
The hon. Gentleman also spoke about the potential for UK conversations, but as I have said, the Scottish health service is performing well according to any number of measures. The issues and conversations that we are having are about funding, and about breaking the austerity stranglehold that affects all our local public services. Perhaps he will join us in continuing to challenge UK Ministers to end austerity.
The hon. Member for Bristol South (Karin Smyth), too, gave a very good speech based on experience. She spoke about the new challenges that we face and how they have changed over time. She mentioned obesity, as I have, and alcohol abuse. The Scottish Government have intervened to legislate for and bring in, after much challenge, a minimum unit price for alcohol in Scotland. UK Ministers are following developments to see how progress is made. When discussing NHS staff, it is right to mention frontline staff—our nurses and doctors—but we should also mention the decision makers, leaders and management level. I have a good working relationship with my local decision makers and managers, and the hon. Lady was right to mention them.
I want to touch a wee bit on my personal experience of the NHS. In many ways, it has shaped where I am, and I am personally indebted to it. First, when I was a young boy, not that much older than my son is now, I pulled a kettle of boiling water down on myself. The scars are still there on my arm and chest, a physical reminder of what happened. Had it not been for swift and expert intervention at the time I would not have the full use of my right arm, so I am personally indebted to the staff in Kirkwall and Aberdeen for what they did for me.
Those who know me and my slightly accident-prone nature will be surprised to learn that my next major intervention from the NHS was not for 20 years, when I dislocated my knee running on a running track, ending what little there was of my athletics career. However, it could have been far worse. Had it not been for the swift intervention of the surgeon at Ninewells Hospital, John Dearing, who operated within the week, because of the nerve damage I sustained when I dislocated my knee I would not have the full range of mobility in my legs that I have now. As I have said, I can still run, and play football and rugby equally badly, but I would not have been able to had it not been for his swift and timely intervention, so I am very grateful.
I am sure that many of us in the House are indebted to the NHS in one area that we have not really talked about, other than the hon. Member for Caithness, Sutherland and Easter Ross. I am certainly grateful to the NHS for the wonderful experience of the birth of my two children. Sometimes we take such services for granted, in particular when we hear about the experience of friends in America, for example. Anecdotally, if we make an analogy with the recent delivery of the royal baby in the Lindo wing, American patients could travel first-class the whole way to the Lindo wing for the same price that it would cost to have their baby delivered in America. We should all remind ourselves of how fortunate we are in many regards in this country.
I know that we do not all have positive experiences when we interact with the NHS. I deal with complaints about the NHS, just as any MP, any Member of the Scottish Parliament up the road, or any colleagues of the hon. Member for Blaenau Gwent in Wales do. However, as I mull over developments in my area, such as the new Monklands Hospital, and the medical advances that have been made over the past 70 years, we should be incredibly proud of our NHS and protect its integrity with every political and moral fibre available to us. I thank all those who work in our NHS, past and present, in Scotland and across these isles, and I wish the institution that we are so proud of a very happy 70th birthday.
Mr Hosie, it is a pleasure to serve under your chairmanship this morning in this very important debate.
I start by thanking my hon. Friend the Member for Blaenau Gwent (Nick Smith) for securing the debate and for his excellent speech. He is rightly proud of his roots in his wonderful constituency and the connection that it holds with Nye Bevan and the founding of the NHS. I am sure that he and his constituents will enjoy the 70th anniversary celebrations, and I look forward to hearing all about them.
I would also like to thank the other hon. Members who spoke this morning for their thoughtful contributions to the debate—the hon. Members for Ayr, Carrick and Cumnock (Bill Grant), for Henley (John Howell), for Caithness, Sutherland and Easter Ross (Jamie Stone) and for Airdrie and Shotts (Neil Gray), who speaks for the Scottish National party, and my hon. Friends the Members for Coatbridge, Chryston and Bellshill (Hugh Gaffney), for York Central (Rachael Maskell) and for Bristol South (Karin Smyth).
This is the first speech that I am giving on the 70th birthday celebrations of the NHS, and it is a genuine honour and privilege to be able to do so here today as the shadow Minister for public health. On 5 July, 70 years ago, the Health Secretary, Aneurin Bevan, was handed the keys to Park Hospital in Manchester, now known as Trafford General Hospital, and launched our national health service. I have my own little photocopied memento of a leaflet distributed before that launch—I wish I had a better copy, but I treasure this one. It says:
“Your new National Health Service begins on 5th July. What is it? How do you get it?
It will provide you with all medical, dental, and nursing care. Everyone—rich or poor, man, woman or child—can use it or any part of it.”
It went on to say:
“But it is not a ‘charity’. You are all paying for it, mainly as taxpayers, and it will relieve your money worries in time of illness.”
The crux of it for our citizens was that they would no longer have to make that awful decision—the choice between debt or, in some unfortunate cases, death. Everyone would now receive healthcare publicly provided and free at the point of use.
I have got my own family anecdote which, as we have the time, I am going to share with you all this morning. I am sure we have all got these family anecdotes. Mine involves my Aunty Ella and my mam. My Aunty Ella was born before the start of world war two and my mam was born in 1945—so you can see straightaway that there is going to be a great anecdote here.
Now, I do not know why—they must just have been unlucky—but in both of their childhoods they suffered from pneumonia. Pre the NHS, when it was my Aunty Ella who had pneumonia, my nana had to go to the doctor’s surgery every morning, where he would hold out his hand, and into his hand she would place a coin—a shilling or whatever. Then she would hold out her hand and into her hand he would place a tablet—obviously, penicillin or some form of medicine. Then she would go home and give it to my Aunty Ella. This went on nearly a week.
My nana was very poor, working class, and she says that in those days, in order to get the money to get that tablet, she would pay a visit to the pawn shop on her way, and pawn whatever was valuable to her at that moment. It tended to be sheets, or a son’s suit or her husband’s suit. She did that in order to get the tablet.
Now fast forward to when my mam, who was born in ’45, got pneumonia, after the health service came in in ’48. My nana did not have to pawn anything; she did not have to go to the doctor’s surgery at all, because a district nurse knocked on the door every day and went upstairs to where my mam was lying in bed with pneumonia, gave her an injection and left. No pawning of sheets, no handing over of money, no stress—that was the difference. Therefore, all of us—I do believe that it is all of us—are committed to those founding principles. We on the Opposition side of the House especially, will continue to fight against the privatisation of our NHS for those reasons.
To quote a phrase often falsely attributed, I now understand, to Bevan, but one I repeat because it rings true no matter who said it:
“The NHS will last as long as there are folk with the faith to fight for it.”
I am pleased to say that 70 years on, there are still plenty of people with the faith left to fight for it. I hope that we will all—though maybe not us personally—be celebrating our NHS for 70 years more, and 70 years after that, and so on. It changed the lives of people then and it is still changing the lives of people today.
Bevan had huge ambitions, but he never would have imagined all those years ago the successes we have had in medicine because of the development of the NHS. I will talk about a few of them now. In 1952, Francis Crick, a British scientist, and James Watson, an American student, made one of the most important scientific breakthroughs of the 20th century, when they discovered the molecular structure of DNA. The discovery helped revolutionise medical treatments in the NHS and elsewhere, improving prevention and treatment of disease. For example, we know now that a BRCA gene mutation can cause a number of cancers in both men and women, who now have the option to have preventive surgery in order to reduce their risk of developing cancer.
In 1954, Sir Richard Doll, a British scientist, published a study in The British Medical Journal co-written with Sir Austin Bradford Hill, which established the link between smoking and lung cancer. That very important study has since led to increased smoking cessation policies from successive Governments, including the ban on smoking in public spaces by the Labour Government in 2006 and the current Government’s—and the Minister’s—tobacco control plan. Smoking prevalence is decreasing across the country, and I am pleased to say that smoking rates in the north-east are declining faster than the national average, thanks in no small part to support from programmes such as Fresh North East, which has seen around 165,000 people quit smoking since 2005.
In 1958, vaccinations for polio and diphtheria were launched, to reduce deaths from both diseases. I am pleased to say both those terrible diseases have now been eradicated from the UK. Others, such as TB and MMR vaccinations, have now become a key part of NHS prevention work. We were in this Chamber just two weeks ago debating the extension of the HPV vaccination to boys after its successful roll-out to girls in order to prevent cancers caused by that virus. Bevan could never have imagined such developments—or maybe he did, such was his vision.
In 1960, doctors at the Royal Infirmary of Edinburgh completed the UK’s first kidney transplant, using a set of 49-year-old twins. Incidentally—perhaps it was the pneumonia—my Aunty Ella, who I have mentioned once already, went on to have kidney failure; and just a decade after the first transplant in Edinburgh, she became one of the first to receive a kidney transplant in Newcastle Freeman Hospital. That helped her live long enough not only to see her own children grow up, but to see her first grandchildren born. In 1968, a team of 18 doctors and nurses at the National Heart Hospital in London, led by surgeon Donald Ross, carried out the first heart transplant in this country. There are now more than 50,000 people living with a functioning transplant thanks to organ donation and transplantation in the UK, giving them more time to spend and treasure with their families.
In 1988, breast cancer screening was introduced, offering mammograms to women over 50. We have now increased the number of women who are eligible for breast screening. That helps with early diagnosis and survival rates, which are now at 78% for 10 years or more—excellent figures. None of this would have happened if it were not for our NHS and the everyday heroes that work within it. The NHS is the UK’s largest employer, with over 1.5 million staff from all over the world and more than 350 different careers. Those people are kind, caring and passionate about their patients. They just want to get on and do their job, but sadly, they are finding this more and more difficult, with funding cuts and thousands of unfilled vacancies, when more and more is expected of them.
We on the Opposition side of the House do not take our NHS or the workforce for granted, and neither should the Government. It has to be said that for the last eight years, the NHS has been in crisis. We have ever-growing waiting lists, patients waiting on trolleys in overcrowded hospitals, and people being told not to go to A&E unless it is an absolute emergency. Earlier this year, the Prime Minister announced a funding plan to mark the 70th anniversary of the NHS. I hope the Minister will inform the House how much of that funding will go to improving and establishing public health services. There is a huge funding gap within the NHS, but with the right public health services we can help people to live healthier lives and support them in their endeavour to do so, which, in turn, will save money.
It is estimated by the King’s Fund that since local authorities became responsible for public health budgets in 2015, on a like-for-like basis, public health spending has fallen by 5.2%. That follows a £200 million in-year cut to public health spending in 2015-16 and there are further real-term cuts to come, averaging 3.9% each year between 2016-17 and 2020-21. On the ground, that means cuts to spending on tackling drug misuse in adults—cut by more than £22 million compared with just last year—and smoking cessation services—cut by almost £16 million. Spending to tackle obesity has also fallen, by 18.5% between 2015-16 and 2016-17, again with further cuts in the pipeline in the years to come. These are vital services for local communities, which would benefit their health and life expectancy, but sadly, they continue to be cut due to lack of funding.
As my hon. Friend the Member for Blaenau Gwent said in his excellent opening speech, an ounce of prevention is better than a pound of cure—a line that I will certainly be stealing for future speeches—and that is why, 70 years on, we must focus on public health initiatives. That is why I am so pleased that he made today’s debate about public health, rather than its just being on the 70th anniversary generally. Not only can such initiatives help people live healthier lives, but they will save the NHS—and, in turn, the Treasury—money. I think the technical term for that is a no-brainer.
In closing, I will return to Bevan’s wise words. He said:
“No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”
This Government have the means to make people in this country some of the healthiest in the world. I hope that they will take those means and ensure that vital public health services are provided to society to do just that.
My hon. Friend is making an excellent speech, as usual. Does she agree that one of the issues with devolution, and some of the experimentation we have seen, is the separation of knowledge between the health service and providers of our public services, particularly in England? We can learn from the experience that has been gained, particularly in Wales, where there is much more integration between those areas, and transfer the learning about public health that has come into local authorities, so that they understand the need to work better with local health services.
Absolutely. That point had not been covered, so I am pleased that my hon. Friend has made it. There is best practice in Wales, and even in Scotland—we are always hearing in these debates about some of the wonderful things going on in Scotland, aren’t we, Minister? We should learn from where there is best practice. Where good things are happening, that knowledge should be spread across the NHS, especially if it will lead to better public health and, in turn, save money.
I was just coming to the end of my contribution. I just wanted to say that we want to go on to see more successes, such as the ones I listed earlier, over the next 70 years. I am sure we will. With medical technology and science the way they are, we probably cannot even imagine the sorts of advances that we will see. I hope those will all be within the publicly funded national health service that we are all so proud of, for many years to come.
What an interesting debate. I echo the view of the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), that it is a privilege to be in this position at this time in the NHS’s history. I feel like I know her Aunty Ella personally—what a lovely family anecdote that was. That real example was a good reminder of what the NHS has brought to families.
I congratulate the hon. Member for Blaenau Gwent (Nick Smith) on securing the debate. Those who know me know that I certainly share his passion for this topic. Winchester cannot claim ownership of Mr Bevan, but Florence Nightingale established a hospital in my city on the hill—the Royal Hampshire County Hospital, which is much loved and is still there doing great things. It has very committed and caring staff. The hon. Member for Bristol South (Karin Smyth) said that the NHS was a great achievement but that there were also a number of compromises. If I may say so, she was very astute to put it that way. As many Members have said, we live with that achievement but there are many compromises.
The NHS is of course 70 years old this year. Much has changed in our society and our health since 1948. Our health needs are very different, and we have better drugs and diagnostic tools. When the NHS was born, life expectancy was 66 for men and 71 for women; today it is 79 and 83 respectively. That is incredible. In 1948 there were more than 34 deaths for every 1,000 live births; today there are just five, although that is still too many.
I will start where every Health Minister should, by thanking our NHS staff for all they do, day in, day out, to make our NHS something that we are incredibly proud of. There was a great awards event this week in London, at which the Duke of Cambridge spoke, which showcased so many wonderful examples. Indeed, Mr Bevan would be amazed at the work that goes on today across the NHS.
We want to use the NHS70 moment to reflect on the last 70 years of patient care, to celebrate the innovations in the NHS, to raise awareness of the many ways we can support the system and, probably most importantly, to promote the public’s role in the future of the NHS and the importance of taking care of our own health and using the NHS wisely—and, yes, accountability, which the hon. Member for Bristol South wisely raised. I am giving her a lot of credit. [Interruption.] “Keep going,” she says.
So much of this debate is about our changing society, but the NHS has consistently been a universal service that is free at the point of need. That will continue. However, as several Members said, we are facing many different challenges from those we faced back in the ’40s, such as the prevalence of type 2 diabetes, which my hon. Friend the Member for Henley (John Howell) mentioned. He sits on the all-party parliamentary group on diabetes. I was bitterly disappointed that he did not give us any of his medical updates, but I know that those will come another time. In fact, we heard a couple of medical examples from the SNP spokesman, the hon. Member for Airdrie and Shotts (Neil Gray). The rising prevalence of type 2 diabetes is a great challenge for us, as is cancer. Both can be reduced if we tackle obesity and encourage more people to lead healthier lifestyles, so that is where I will focus.
The Government take the public health challenge we face incredibly seriously. We have responded by putting prevention at the heart of public policy making. We have taken quite stringent steps. As the shadow Minister said, we are a global leader on tobacco control. We were the first country in Europe to introduce legislation to bring in plain packaging for cigarettes, off the back of the smoking ban in public places. She rightly mentioned Fresh North East, which is a very good example—it is in many ways the apple of my eye in this policy area. I hope at some point, if the arithmetic in this place ever allows, to go and see it for myself. I will let her know if I do—perhaps we can do that together. In April we introduced the soft drinks industry levy, which is a big public health measure. In recent years we have vaccinated more than 1 million infants against meningitis and an additional 2 million children against flu.
We have run award-winning public health campaigns, including Be Clear on Cancer, which I am very invested in, and Act FAST, the public health stroke campaign. They all sit with the inheritance of the landmark Don’t Die of Ignorance campaign about the AIDS challenge we faced in the late 1980s—I am surprised that was not mentioned. That campaign still makes the hair on the back of the neck stand up, does it not? It was an incredibly impactful and powerful piece of work that came out of the public health movement.
I want to cover a lot of things, but let me return to diabetes, which is a major challenge. Preventing diabetes is a huge priority for the Government. According to Diabetes UK, which I saw just last week, about 5 million people in our country are currently at high risk of developing type 2 diabetes. If the current trend persists, one in three people will be obese by 2034 and one in 10 will develop type 2 diabetes. Some of the risk factors for type 2 diabetes, such as poor diet and a sedentary lifestyle, which can lead to obesity, can be changed. We know that 61.4% of adults are either overweight or obese; and 26% of adults and 20% of children aged 10 to 11 are obese. The obesity crisis has been decades in the making, and tackling it is a real challenge. It will not be turned around overnight, and no one pretends that it can be. That is why tackling obesity is absolutely a Government priority. I will come back to that point in a moment.
I mentioned the NHS diabetes prevention programme, which is aimed at providing people aged 40 to 60 who are at risk of diabetes with personalised help with healthy eating and lifestyle, and bespoke physical activity. So far, as I said at Health questions last week, more than 170,000 people have been referred to that programme. Those who are referred get tailored, personalised help, and that is really making an impact.
I thank the hon. Gentleman for that point. I touched on child obesity, which is one of the top public health challenges, if not the top challenge, for this generation. Overweight and obesity-related ill health is estimated to cost the NHS in England about £5.1 billion each year. The estimated total cost to society is between £27 billion and £46 billion per year. Our child obesity plan, which was published back in 2016, is informed by the latest evidence and research in the area. At its heart is a desire to change the nature of the food that children eat and make it easier for families to make healthier choices. Since we published the plan, real progress has been made on sugar production. Since the introduction of the soft drinks industry levy, which I mentioned, sugar has been drastically reduced in around half of all soft drinks products that fall under the levy. I recognise the daily mile, which was rightly raised by the hon. Gentleman, which he said started in Scotland. It is in England as well, though not as much as I would like to see it—we have an ambition for it to do much better.
Many Members mentioned child obesity, and we have always been clear that the child obesity strategy is the start of a conversation and not the final word—we call it chapter 1 for a reason. We continue to monitor the progress we have made since the publication of the strategy a couple of years ago, and if further measures are needed we will take them.
Let me touch on physical activity, which the hon. Member for Blaenau Gwent rightly spoke about. People know that being active is good for their health and they want to do more, but the truth is that many of us are simply not active enough to benefit our health. Only 66% of men and 58% of women in England meet the chief medical officer’s recommendation to be active for at least 150 minutes a week. Children are no better, with only 23% of boys and 20% of girls being active for at least 60 minutes a day. As we get older, we become less active. It is recommended that we do muscle strengthening and balance exercises on at least two days a week, but the most recent health survey shows that only 1% of the adult population in England meet that guideline.
Why is that important? We are facing an ageing population and there is good evidence that being active reduces the chance of falls, depression and dementia by up to 30%. That will help people stay healthy and independent for longer, and we need that to happen if the NHS is to be sustainable for its next 70 years. People need to understand why being active is important and have a clear understanding of how much activity they should do and the impact that can have on their health. I was pleased to hear parkruns mentioned by a number of Members, including the hon. Member for Blaenau Gwent, because they are incredibly important. I have them in my constituency at the River Park leisure centre.
It is vital that we acknowledge the importance of good mental health, which was mentioned a couple of times in the debate. Everybody’s mental health is on a point on the spectrum and, as my hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant) said, mental health is just the other side of the coin of physical health. Good mental health is so important to leading positive and productive lives and to the NHS. This is Mental Health Awareness Week, but really every day should be a mental health awareness day. Mental health is a key priority for the Secretary of State and the Prime Minister, which is why last December we published the Green Paper on children and young people’s mental health, backed by more than £300 million of funding to improve access to services and, crucially, mental health support in schools.
Just yesterday I was at the Maudsley Hospital in London, looking at the incredible work it has done in bringing us to a smoke-free NHS. We identified mental health in-patients as a key target in the tobacco control plan. I saw the important work being done, which I would recommend to any Members who think they could inspire their local areas to follow that lead.
My hon. Friend the Member for Ayr, Carrick and Cumnock was dead right to mention delayed transfers of care—delayed discharges—which are a key component and in many ways the magic key to the NHS. It is also always nice to hear Robert Burns quoted in the Chamber, but I am sorry that he did not sing it—maybe next time.
I understand why the hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) made the speech he did. He certainly put down a marker for the Scottish Government, who govern his constituents.
I thank my hon. Friend the Member for Henley for mentioning the long-term economic plan—I have not said that for a while—and the multi-year funding plan that the Prime Minister talked about at the Liaison Committee. He is dead right. That is exactly what we should be doing, and it is exactly what we will do.
As always, the hon. Member for York Central (Rachael Maskell) spoke from the heart about health matters. She mentioned the integrated public health plan for her city, which sounds great. Local application of what is good for local areas is right, and I look forward to hearing more about her local area when we meet.
The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) raised questions about the devolution settlement. Of course, we talk across England and the devolved nations, but the settled will of this Parliament and of the people in this country is that we have a devolution settlement. Devolution can bring difference, and that can be good or bad. Yes, we do talk and share best practice, and I know that NHS England and Public Health England talk to their counterparts in the devolved nations all the time.
On good and bad difference—this is not political knockabout; it is just some facts—it would be remiss of me, as a Conservative Health Minister, not to put on the record that since 2010 we have increased NHS spending each and every year, even as we have had to take some very difficult financial decisions, given the state of the public finances we inherited. The NHS now has £14 billion more to spend on caring for people than it did in 2010. To give that some context, over the past five years funding for the NHS increased in Wales by 7.2%, in Scotland by 11.5%, and in England by 17.3%. I say that not to make a political point; it is a simple fact that should be put on the record.
Let me take this opportunity once again to congratulate the hon. Member for Blaenau Gwent on introducing this timely and important debate. As we have seen, the challenges that the NHS faces are radically different from those it faced in 1948. The debate has shown us why we, the Government, the NHS and the people we all represent, wherever they live in this United Kingdom, are all part of the solution to the deep and significant public health challenges we face as a nation. They are also all part of the inheritance of that health service that we are all so proud of.
In the short time available I have tried to show how seriously the Government and the NHS take those challenges. We must use all the opportunities we have at our disposal and that long-term health economic plan—I like saying that—to address the big public health challenges facing our nation. Only through the combined efforts of the Government, the NHS and the people in our country who are taking responsibility for their own healthcare, as technology increasingly allows them to do, which was another good point made in the debate, can we truly tackle the public health challenges we face and make sure that the NHS does not just survive for another 70 years—we are not interested in that—but thrives and goes from strength to strength, being a preventive health service as much as a treatment health service. That will truly honour Nye Bevan and everyone else involved in its establishment back in the ’40s.
I thank my comrades and other colleagues for their contributions. I agree with the Minister that it was good to hear a Rabbie Burns poem emphasising good health. My hon. Friend the Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) praised health service workers, and I was pleased to hear that his mum is better and at home now.
My hon. Friend the Member for York Central (Rachael Maskell) emphasised the enormous contribution that Tessa Jowell made to her career. I too would like to support and emphasise that. From the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) we heard about the huge difficulties of getting healthcare on the Scottish islands before 1948. He supported the then Attlee Government’s legislative jewel in the crown: the establishment of the NHS. I thank him for that.
My hon. Friend the Member for Bristol South (Karin Smyth) emphasised the importance of William Beveridge and the thinking he did to address the five “giant evils” in 1942. That was important for our Labour Government after the second world war. I was pleased to hear from the hon. Member for Airdrie and Shotts (Neil Gray) about the Scottish Government’s plans to halve child obesity. I support that, and of course it should be done everywhere. I was also pleased to hear that our parliamentary running group is getting stronger weekly.
I was glad to hear the Minister emphasise the importance of addressing child obesity, but we really must do better. I will not accept his political barbs about the NHS across our country. I remind him that Churchill and the Conservatives voted against the establishment of the NHS in 1948, and that crucial fact is never forgotten—certainly not in my constituency. I want to praise Nye and the people of my constituency for helping to establish the national health service. We on the Opposition side will guard it with every muscle in our bodies.
Question put and agreed to.
That this House has considered the 70th anniversary of the NHS and public health.
I beg to move,
That this House has considered access to reproductive rights around the world.
It is a pleasure to serve under your chairmanship, Mr Hosie, in a debate that should concern everybody in the country who is committed to equality. Abortion lies at the heart of equality for women, and men and women can never truly be equal until they have equal control over their own bodies. Abortion is the most common procedure that women of reproductive age undergo, and one in three women in Britain under the age of 45 have an abortion in their lifetime. In truth, those of us committed to equality and to ensuring that women are able to make choices about their own bodies can never be too vigilant, or think that the law in this country, let alone around the world, brings us equality and human rights. That is because there are continued attacks on that basic freedom for women, and that is what the debate is about.
I have seen and read the Minister’s words, and he knows that I am a fan of his persuasive abilities. However, I want to test whether the Government will learn the lesson of the suffragette movement, which is that it is deeds not words that matter, especially when it comes to equality. The Government must not simply say that they are committed to ensuring that women have the right to decide their own sexual and reproductive health; it matters that they act, including in response to any threats to that right.
There is a big variation around the world in access to abortion. Although 98% of countries permit abortion to save the life of a woman, only 62% allow it to preserve a woman’s mental health, and 63% to preserve a woman’s physical health. Only 27% of countries provide abortion on request. There has been some progress. For example, in recent years there has been a heated national debate in Bolivia when it was discovered that women were being turned in by their healthcare providers. A 16-year-old girl who arrived at hospital haemorrhaging was later apprehended and accused by hospital staff of having had an abortion. New legislation in Bolivia now allows abortion in the first eight weeks of pregnancy for a broad range of circumstances.
Canada decriminalised abortion in 1988. As a result, not only is Canada’s abortion rate lower than in the United Kingdom, but it enjoys the world’s lowest rate of maternal mortality from abortion. Abortion is legal in many parts of South Asia, including India, Nepal and Bangladesh, although it is not always accessible. In some African countries, for example, South Africa and Ethiopia, abortion is permissible and reasonably accessible.
First and foremost, we should listen to African women, and they are consistently clear that they would like control over their own bodies. Being forced to continue an unwanted pregnancy is no freedom or liberation at all.
For every country where there is progress, we also see the tightening grip of the anti-choice movement. Let us not call it “pro-life”; there is nothing pro-life about forcing a woman to continue an unwanted pregnancy. In Europe—our own continent—Poland now has some of the strictest rules on abortion in the world, and abortion is allowed only if the pregnancy is the result of rape or incest, if the woman’s life is in danger, or in cases of severe or fatal foetal abnormality. Consequently, 80,000 Polish women a year go abroad or seek illegal abortions at home.
America now has a President who says that women should be “punished” if they have an abortion, and a Vice-President who believes that women who have a miscarriage should report it and hold a funeral. One Governor signed a law that states that it is illegal to have an abortion once a foetal heartbeat has been detected. Given that heartbeats can be detected as early as six weeks into a pregnancy—sometimes before a women even realises she is pregnant—that is no freedom or liberation at all.
In El Salvador, abortion is illegal with no exceptions, and that horrendous ban violates the basic human rights of women in that country. At least 23 women and girls remain in prison as a result of the abortion ban, and one woman, Teodora del Carmen Vasquez, walked out of prison a few weeks ago after more than a decade of imprisonment. She was marked as a criminal because she began bleeding and suffered a stillbirth. She was sentenced to 30 years for aggravated homicide, and released only after the Supreme Court ruled that there was not enough evidence to show that she had killed her baby. Abortion may be permitted in Rwanda, but Rwandan police unjustly arrest and imprison hundreds of women on abortion-related charges—such women make up 25% of the female prison population.
The number of maternal deaths resulting from illegal abortions represents the truth: banning abortion does not stop abortion; it simply makes it unsafe. In Africa, a quarter of all those who have an unsafe abortion are adolescent girls. Indeed, about half of the 20,000 Nigerian women who die from unsafe abortions each year are adolescents. It is insulting to suggest that African women do not deserve the rights that we would fight for in our country and around the world. Africa shows us how vital international aid is, as is the job that the Minister is intended to do. Abortion is relatively legal in Zambia, but only 16% of women have access to abortion facilities—in Zambia’s Central Province, there is just one medical doctor for more than 110,000 patients.
Closer to home we see the impact of restrictions on access to healthcare services for women. In the Republic of Ireland, the Protection of Life during Pregnancy Act 2013 imposed an almost total criminalisation of abortion. Ireland is one of a few countries in Europe with such highly restrictive abortion laws. The Irish constitution currently affords equal rights to the life of a foetus and to the life of a woman. However, the 18,000 women from Ireland who have travelled to the UK since 2012 reflect the fact that stopping access to abortion does not stop abortion, it just puts people at risk, including—increasingly—at risk from taking pills they have bought online. At the end of this week the Irish will go to the polls. I plead for dignity, for compassion in a crisis, and to ensure that every Irish person can care for their own at home, that there will be a yes vote.
But who are we to lecture? We should not forget how we treat women in our own backyard, particularly in Northern Ireland, which has some of the harshest laws and punishments in Europe for women who undergo an abortion. A woman with an unwanted pregnancy in Northern Ireland must either travel to the mainland or procure abortion pills online. Since the Government agreed to fund those abortions on the NHS, more than 700 women have travelled to England or Scotland from Northern Ireland. However, those are the women who are able to travel and get away from family commitments, who are not in a coercive relationship, and who have their travel documents. Little wonder that the United Nations condemned the United Kingdom for its treatment of Northern Irish women, which it called cruel, degrading and inhuman.
The Minister might say that each of those examples is due to separate policy decisions in those countries, but I want to sound the alarm and call attention to the fact that that might not be the case. Increasingly, around the world, far-right organisations and extreme religious groups are co-ordinating and funding anti-abortion and anti-choice campaigns. We in this House are used to debating the impact of foreign countries interfering in our democracy—perhaps in referendums—and we should be alive to the fact that those foreign organisations and countries are interfering in a woman’s basic right to choose. The real “The Handmaid’s Tale” is now unfolding.
In 2013, American and European campaigners met in this capital city to plan their campaign. It is called Restoring the Natural Order: an Agenda for Europe, and it seeks to overturn basic laws on human rights related to sexuality and reproduction. Since that meeting, we have seen the impact of those organisations, and the funding they have provided. We have seen how they produced results in Poland with the ban on abortion, and with bans on equal marriage in several central European countries and action on LGBT rights. We have seen how they have targeted international aid in the UK, Europe and America.
In 2013-14 the European Citizens Initiative, One of Us, called on the European Commission to propose legislation that would ensure that EU funds could not be used to fund abortion. It garnered 1.7 million signatures, and although the EU rejected that petition, given the impact it would have on women’s healthcare, that was by no means a one-off. Such rhetoric is coming back.
I very much agree with my hon. Friend and commend her comments. Does she think that now is the moment for the Government to give enthusiastic backing to the SheDecides movement that has emerged since the decision by the American President, Donald Trump, to reimpose the global gag rule? In the light of her comments about anti-abortion campaigners coming together, that would be a powerful signal of Britain’s opposition to that movement.
I absolutely agree with my hon. Friend and am extremely proud of the work that he did in government when the global gag rule was first introduced, standing up to what it represented as well as putting our money where our mouth is. We should recognise that the global gag rule under the present President is far worse than the original one. It states that no US funds will go to any organisation that provides for women to be referred for abortion, or advocates doing so. The policy may be called “protecting life in global health assistance”, but it is clear that it is leading to an increase in maternal deaths. Trump has expanded the rule that was in force under previous Republican Presidents to cover all US health assistance funds, whereas previously it was only about family planning.
Marie Stopes International estimates that its loss of US funding will result, between 2017 and 2020, in 6.5 million unintended pregnancies, 2.1 million unsafe abortions and 21,000 maternal deaths, let alone the impact on access to reproductive healthcare, including work on HIV, gender-based violence and sexually transmitted diseases. We can already see the impact. In Botswana, the prevalence of HIV is among the highest in the world at 18.5% of the general population. The Botswana Family Welfare Association provided a range of healthcare and family planning services, and 60% of its funding has been threatened, because America is—or was—the largest funder of overseas healthcare. In Swaziland, family planning, antenatal and post-natal services and treatment for sexually transmitted diseases are key services from the Family Life Association of Swaziland, and there has been a clear impact. US support accounted for 25% of its annual funding. That is why there is now a massive funding gap that needs to be filled.
I am sure that the Minister will tell us about a summit to be held in this country in June promoting the idea that abortion is part of the services that we provide around the world, but we have not, as a country, put our money where our mouth is. We have not put money into the SheDecides fund. That matters. It does not matter if we are funding other services: our approach matters because of what the global gag rule represents, what a co-ordinated attack on a woman’s basic right to choose means, and what that says about the world, and our commitment to equality. That is why it matters whether we contribute. It is about solidarity. It is also about saying that there should be no shame in seeking an abortion. I hope we would all want women to be safe, and abortion to be legal, and rare—but we do not want women to suffer in silence or to be oppressed as the network in question would want. That network brings together President Trump and his supporters, and Russian oligarchs, in funding organisations that claim to promote family values—but only the ones that they choose.
In Poland, the “stop abortion law” was drafted by ultra-conservative lawyers from an organisation called Ordo Iuris. Agenda Europe, an organisation that started here, in our country, was able to attract senior members of the Polish Government, including the Deputy Minister for Foreign Affairs, Konrad Szymański, and the Polish Vice-Minister for Foreign Affairs, Aleksander Stępkowski, who was also president of Ordo Iuris. The same groups are now active in Ireland, in the referendum. It is little wonder that Google and Facebook have been so concerned about the impact of foreign organisations on the fairness of the Irish referendum that they have stopped all foreign-funded advertising about the Irish referendum on their platforms. Agenda Europe summits gather a veritable “Who’s Who” of anti-choice and anti-LGBT movements around the world, such as the architects of the Croatian traditional marriage referendum, the citizens’ initiative on traditional marriage in Romania, HazteOir in Spain, which has sought abortion restrictions, and the French organization Les Survivants, which claims that everyone in French society shares a collective trauma, potentially, because of the experience of abortion. The organisation even developed a Pokémon app where the aim of the game is to save Pikachu from abortionists.
Such rhetoric and funding are clearly having an impact on our democracies and on women; they are having an effect. Indeed, Agenda Europe has targeted the Council of Europe. It would be useful to know who it works with in this country, because it is not transparent about it. If the Minister recognises the danger of the rhetoric and of a lack of solidarity over women’s basic rights, will he investigate the links between organisations such as the Society for the Protection of Unborn Children, Christian Action Research and Education, which funds an all-party parliamentary group in this place, and Agenda Europe? Those groups do not just mobilise and target politicians; they also spread lies such as abortion causes breast cancer, and claim that Planned Parenthood is involved in the illegal selling of foetal tissue. In developing countries, they spread rumours that the west is trying to impose western women’s human rights. Internationally, they have promoted and supported the intimidation of women seeking abortions, as has happened in this country with pickets outside abortion clinics.
There have been such protests at 42 clinics already. As my hon. Friend the Member for Ealing Central and Acton (Dr Huq), who has done sterling work on the issue, has pointed out, that is not protest in the usual sense. The protesters are not seeking to change the law. They want to harass and target women who have come to a difficult decision and who seek access to lawful healthcare. Indeed, when the former Home Secretary, the right hon. Member for Hastings and Rye (Amber Rudd), reviewed the matter last year, she said that it was
“completely unacceptable that anyone should feel harassed or intimidated”
for exercising the legal right in question. Less than two weeks ago such protesters took part in a “march for life” through the capital city. I note that there are links with our political organisations. One person at the London meeting was Oliver Hylton, the asset manager for a UK Conservative party donor, Sir Michael Hintze. The new Conservative party vice-chair has called for a reduction in the time limit for abortion, arguing that we need to debate the issue. That is a classic tactic set out in the Agenda Europe campaign bible. That is despite evidence that 92% of abortions are carried out at less than 13 weeks’ gestation in this country.
In addition, women are being criminalised for obtaining abortion pills, reflecting how our legislation and legislation around the world is cripplingly out of date: 5,650 women from the Republic of Ireland and Northern Ireland accessed pills online, to create an abortion, from Women on Web. Twenty-six per cent. were aged between 30 and 34. The majority were mothers. They were women making their own choice about how their own body should be treated. Without legal access to the pills, they risk problems. There is currently a judicial review in Northern Ireland of the case of a 15-year-old girl, whose mother procured abortion pills for her online. The girl’s case was referred to social services as she was in an abusive relationship, and somehow the GP notes were turned over to the police. Even with a suspended sentence, that young girl will have a criminal conviction. This country must not leave her in that situation. We must act to protect young women around the world making choices about their bodies. Women deserve access to what is a basic healthcare procedure, and do not deserve to be shamed for making choices about their bodies. They deserve our trust, and do not deserve to have to fight for their rights every day against a shadowy organisation involving the collusion of religious and far-right groups. They deserve a Government who will stand up to that network and stand with them.
Will the Minister investigate whether any of his ministerial colleagues have met representatives of Agenda Europe, whether in a parliamentary or political capacity? Did they, for example, take part in the decision to give Life money from the tampon tax? Have Foreign Office ministers met Agenda Europe in their lobbying work in Europe? What action is the UK taking to assist Polish women who now face one of the most restrictive regimes in the world, or to fight for the rights of women in El Salvador? Will the Government change their mind and commit to putting money into the SheDecides fund to send a strong message that those who seek to make men and women unequal will not be tolerated? Will they ensure that the laws governing access to abortion in Northern Ireland fully comply with international human rights law, including the decriminalising of abortion? Will they act to give the idea of buffer zones legal status in the UK, and promote it elsewhere? To put it simply, I trust women and we are asking whether the Government do.
It is a pleasure, as always, to serve under your chairmanship, Mr Hosie. I thank the hon. Member for Walthamstow (Stella Creasy) for what she has said today and for her work in this area over a long period of time. I want to say at the outset that I am not sure that I or the Government are the targets of what she has been saying. She spoke about a variety of things in relation to campaigning, and set out a variety of attitudes with which the Government entirely agree. We are not in league with those who put a different case on abortion. Our abortion policy is clear and, as I will set out, it is clear in relation to other parts of the world. It is forward-looking. It is fully in favour of access to vital services. It is not a reluctant policy; it is a policy we advocate and are clear about.
A number of the matters that the hon. Lady raised are not within my remit, either in the Foreign and Commonwealth Office or in the Department for International Development, so let me start with as much agreement as possible with the general sense of where she was coming from, while making it clear that some of the issues she wishes to tackle do not fall within my ministerial remit. It might be helpful if I first set out what we do, and the money we put in, to support women right across the world to have access to safe abortion. If she is not aware of that, it will help her and her colleagues; being aware, it is something she can champion as part of her advocacy. That she has a Government and a country that want to do what I am setting out will, I hope, form part of her argument.
Every woman, regardless of where she lives, possesses the same reproductive rights. Every woman has the right to make decisions about her own body. Every woman has the right to decide whether, when, and how many children to have. Every woman has the right to make decisions that affect her own life. But the reality is that not all women are able to exercise those rights. That is why this Government, through the Department for International Development, are working tirelessly to be a loud and strong voice for access to sexual and reproductive health and rights services. We are working to enable women and girls to have sexual and reproductive choices, to avoid unwanted sexual contact, injury and infection, to make informed decisions about childbearing, and to face fewer risks in the course of pregnancy and childbirth.
The UK is the world’s largest donor to the United Nations Population Fund and the second-largest donor for family planning. Access to voluntary family planning information, services and supplies is fundamental to women’s and girls’ empowerment. It means they can avoid a life of early, multiple and frequently dangerous pregnancies and births, and instead complete their education and fulfil their potential. That is why we have driven global investment and innovation in family planning through major summits in London in 2012 and 2017. We have committed to spending an average of £225 million a year on family planning over the next five years, enabling nearly 20 million people to use contraception, preventing 6 million unwanted pregnancies and so preventing more than 3 million abortions, many of which would be unsafe.
The UK has a proud record of putting women’s and girls’ rights at the centre of its international development policy. Addressing gender inequality and empowering women and girls underpins all our work to promote sexual and reproductive health and rights. My right hon. Friend the Secretary of State for International Development recently launched the new “DFID Strategic Vision for Gender Equality”, which is a call to action to all our development partners to step up and act to address gender inequality in all its forms. Sexual and reproductive health and rights is one of five foundational areas in the new vision. We believe, and the evidence tells us, that that vision will work to transform the lives of women and girls, and we will continue to lead on and invest in it.
I am proud that the UK is leading the way on this. Leadership means not shying away from issues such as access to safe abortion, where the evidence shows that access to safe services saves women’s lives. We are clear that access to safe abortion is a crucial element in the full range of comprehensive sexual and reproductive health and rights services. That is not a reluctant position, but a position that firmly focuses on rights, on saving lives and on amplifying women’s voices where some seek to deny them their voice and their rights. Our policy position paper sets out that approach in full.
Does the Minister recognise that by not being part of the SheDecides fund and by not putting some of the money he is talking about into working with other nations to send a clear message that those who seek to defund women’s rights and family planning organisations because of their objections to abortion, the Government are acting in a counterproductive way? The message that sends is that the people spreading an anti-abortion message, such as Agenda Europe—I hope he will check whether his Department has met with organisations involved in Agenda Europe—are winning. By putting the money he is talking about into the SheDecides fund, we could send a strong message about whose side we are really on. That should be women, because we trust them.
I do not think there is any message that we are not. I am pointing out the work we are doing. The hon. Lady called for deeds—not words or association with movements just for the sake of it and for the symbolism, but what we are actually doing. I will look at SheDecides. The position, as I think she knows, is that my hon. Friend the Member for Penrith and The Border (Rory Stewart), then a Minister in the Department, went to the launch of SheDecides. We support the objectives of SheDecides. We are putting support into a whole range of services. I understand the symbolism and the point she makes. I will look at that and see whether there is more to be done than simply supporting and putting money into what SheDecides does. If an attachment to SheDecides makes a difference, that may be something that my right hon. Friend the Secretary of State and I will want to do.
I urge the hon. Lady not to take our decision not to be formally involved in that, but to support that work, to mean that all the other work we are doing either does not matter or is not important enough. That is dancing on the head of a pin. It degrades all the work that all our colleagues are doing all over the world to defend women’s rights, promote women’s services and promote access to safe abortion, just because we are not doing one thing that she would like us to do. I am not sure I want to go down that route. I would rather defend what we do and how positive and forward-looking it is.
I do not think that anybody on the Opposition side questions the investment that the Government are making through the Department for International Development—I welcome that. The concern is that the Government have not had the courage to stand up to the American President over his reintroduction of the global gag rule and to show solidarity with all the other countries that have challenged him and are seeking to galvanise even greater investment in access to reproductive services, to plug the gap that the American decision on the global gag rule has left.
I take the point. Again, our work concentrates on advocating for the best services, and on getting individual states and people within those states to understand the purpose and importance of access to safe abortion. Being involved with political movements is a different question. We are keen to ensure that the work we do supports the policies behind something such as SheDecides, which is what we are doing.
SheDecides is an international aid initiative. It is a cross-country initiative by Governments in response to that political movement. Indeed, the point of this debate is to sound the alarm about that political movement around the world, whether it is interfering in the Irish referendum or in international aid. By not standing up to it, we are by default encouraging that political movement as it becomes stronger and therefore women are more oppressed by it.
I have already given a commitment to go back and look at the engagement with SheDecides. I will make it quite clear: we support the overarching principles of SheDecides; a Minister attended the launch; we work with all partners who are promoting universal access to sexual and reproductive health and rights; and we think that it is most sustainable to demonstrate our commitment to those issues through long-term, sustained support for sexual and reproductive health and rights. We face the consequences of US policy not just in this area, but in others. The response we have delivered so far is to put investment and support into the work that is done, and to say, “This is the best answer to those who wish to close it down.”
I take the point that the hon. Lady and colleagues have challenged me on in relation to the SheDecides movement, but I ask her not to be completely distracted by that. Our deeds in supporting and promoting services, the £1.25 billion that we are putting into this work through our support for family planning services, and the work we are doing in a variety of other areas—I can set them out in a letter to the hon. Lady, as we are running short of time—demonstrate our commitment to what is done.
I take the point about the political movement. I have no knowledge of or connection with the other movement she speaks about—I have never met Europe Now, or whoever they are. I am not aware of any contact in the Department, but I will check. But I would not want us to be pinned on this question in this debate, in which the hon. Lady has spoken about things that I believe in and I want to see. She has spoken about things that the Government are doing and delivering, and she seeks to pin me on one particular part of it, a political policy in relation to a particular movement that we already support and attended the launch of. In all fairness, she is trying to find a very small area of difference between us.
Housing and Access to Legal Aid
[Mrs Anne Main in the Chair]
I beg to move,
That this House has considered housing and access to legal aid.
It is a pleasure to serve under your chairmanship for the first time, Mrs Main. Before I start, I want to thank the House of Commons Library, which provided me with advice and information for the debate, and the Ealing law centre.
Having been an elected councillor for 25 years before coming to this place, I know how important good-quality, early professional help is in preventing so many issues, but particularly homelessness, indebtedness and other related problems. I also know how important early advice is in preventing problems from escalating, which causes stress to families and costs to the public purse. The sooner and the earlier, the better and the cheaper.
Legal aid for housing advice was withdrawn by the Government between 2012 and 2013. At that time, we saw problems that were already there begin to escalate. More and more people were having problems trying to keep their home and to keep it safe and warm. Demand for social housing was increasing but there was an acute shortage, owing to the right to buy and the ending of Government funding for new council and other social rent housing.
Related to that was the escalation of private sector rents beyond the means of average wage earners, let alone those on low and minimum wages. In my constituency, private sector rents are three to four times those of council rents. There is also the related use of one-term tenancies, as landlords can afford to gain possession of a home and then rent it to someone else who is able to pay a higher rent in the inflated west London housing market. The escalation of zero-hours work and low-paid self-employment also affects the ability of many people on low incomes to pay their rents, while for many people, some of whom are working and some of whom are not, cuts and changes to many benefits and tax credits mean that there is less to live on. Finally, the draconian universal credit rules were introduced, which—apart from providing less to live on than legacy benefits—expect claimants to wait for five weeks with no money at all. In my constituency, five weeks of rent for a family can be anything up to £2,000.
It is therefore hardly surprising that more people need more help with housing and debt, or that landlords can get away with providing more substandard private sector housing, where repairs need catching early before they make homes dangerous. MPs and councillors offer advice, but too often it is left to underfunded organisations and their many advisers, who might not be legally qualified, to help; they might be willing and able, but one often needs legally qualified people, even at an early advice stage.
I congratulate my hon. Friend on securing this important debate. Does she agree that there has been a serious decline in the number of providers of housing legal aid? In my area of Barnsley there are only two, which is simply insufficient. It leaves those most in need isolated and often without the help they need.
I congratulate the hon. Lady on securing the debate. North-west Wales has only one provider of housing legal aid for a population of more than 300,000 people. Travel has already been mentioned, but we should also note that a single provider might not have the capacity to deal with the needs of all its potential clients, and may well have to put people on lists based on their needs. Some people who need urgent help might not be reached. Secondly, that single provider may also—[Interruption.]
My hon. Friend is absolutely right. The cuts to local authorities and other parts of the public sector have affected the voluntary sector, which has so often been the alternative provider of professional, consistent, good-quality advice and support to people who need it.
There is currently no law centre in my area. When I was a lead member on Hounslow Council in 2010, we increased the funding for the citizens advice bureau, but demand for the local CAB escalated well beyond that. The philanthropic centres and foundations—the Big Lottery Fund and so on—are often left to pick up the pieces, but pressures on their funding are getting greater. Overall, less good-quality professional help and advice is available in the sector, and I urge the Government to address that as part of their review, which I will move on to in a moment.
As I was saying, MPs and councillors are not professional legal advisers. At best we should signpost and provide basic advice, but we do not have the capacity or skills to provide the detailed advice that people need, even at the early stages of problems arising. I will give a couple of examples that Vicky Fewkes of the Ealing law centre provided me with. They concern people who much of the time were not eligible for housing legal aid. In all cases, the welfare and benefits work that was done was under grant funding, not legal aid.
First, a constituent was in substantial rent arrears due to universal credit issues. Her tenancy was jointly in her name and that of her partner. However, she had been abused by her partner, which led to their separating and her partner moving out. Universal credit would not pay her full rent due to the tenancy being in both names. She was given time to transfer the tenancy into her name and resolve the universal credit issues. The adviser worked with her and managed to resolve the matter, and to retrieve about £5,000 in universal credit housing payments. She kept her home—at substantial cost to the public sector, of course. That case was not funded through legal aid, but I believe it should have been.
In another example, a constituent was in arrears of more than £2,500 following the stoppage of her employment and support allowance and housing benefit. She had four children, aged between 11 and 19, and she suffered from depression, anxiety and physical problems. Her housing benefit had been cancelled due to the required information not being supplied. The caseworker worked with her and her husband to claim backdated housing benefit. The caseworker liaised with the council and worked with the husband to answer all the council’s questions and provide the required evidence. The hearings were adjourned until the ESA and housing benefit issues could be resolved. The ESA decision was appealed and overturned, meaning that she eventually got a backdated ESA payment and £4,000 in housing benefit being paid into her rent account, meaning that she kept her home. She was a council tenant. If she had been a private sector tenant, that landlord would not have waited for her income situation to be resolved.
Vicky says of the crisis navigator role at the Ealing law centre:
“The Crisis Navigator is part of a Big Lottery funded Help through Crisis Project. This work is essential and is not being funded by Legal Aid as it stands at the moment. A lot of problems arise from insecure work (variable hours/zero contracts). These then impact benefits and rent arrears as a result. If clients are evicted if they are housed by local authorities, then the temp accommodation rent is so high and Housing Benefit is being paid for this.”
In my area, west London, housing benefit caps are well below the rent even for poor-quality private sector housing. Finally, Vicky says:
“It really would make sense to provide benefits support at an early stage.”
The Legal Aid, Sentencing and Punishment of Offenders Act 2012, which I will refer to as LASPO, made fundamental changes to eligibility for legal aid. Under LASPO, applicants must pass three basic tests. The case must be within the scope of the legal aid scheme; there is a financial means test to pass; and there is a merits test, looking at the applicant’s chance of success in the case and a cost-benefit analysis of providing legal aid funding. Matters that are included in the scope of legal aid are homelessness; allocations; accommodation for asylum seekers; repossession of a rented home, but only when the loss of the home is imminent and the landlord has sought an order for possession; lawful and unlawful eviction from the home; injunctions relating to harassment; antisocial behaviour cases in the county court; disrepair, but only when there is a serious risk of harm to the health or safety of the occupiers; and judicial review. Areas that are no longer eligible for legal aid under LASPO are rent and mortgage arrears that may ultimately result in possession proceedings; early stage disputes between landlords and tenants—
My hon. Friend mentioned early legal advice. Of course, one recommendation from the Bach commission is that early legal advice can help to save money in the long run. The Law Society estimates that the cost of early legal advice on housing benefit claims would be £1.7 million to £2 million each year, but the costs through avoidable evictions are often far greater for individuals, councils and the NHS. Will—
Absolutely. My hon. Friend anticipates what I will come on to in a minute.
Not only are early-stage disputes between landlords and tenants no longer eligible for legal aid, but housing benefit advice is no longer eligible. That is particularly worrying because of the many changes to the benefits system, to which I have referred. As I said, when people transfer to universal credit, there is no payment for up to five weeks. That is a lot of money and a lot of heartache, particularly for tenants in the private sector whose landlords are not prepared to wait until things are resolved. However, the situation is worrying even for housing association or council tenants. I try to reassure them by saying, “Don’t worry. The council will not evict you on this basis.” However, it is still stress and worry that people do not need, and many people go and borrow money, which they can ill afford to repay, from friends, relatives and payday lenders. It causes massive problems.
Since LASPO was introduced in 2012-13, there has been a 58% fall in legal help for housing cases in England and Wales; the number has gone from just over 85,000 per annum to just over 35,500 per annum. As we have mentioned, LASPO has caused a critical decline in the number of housing legal aid providers, from 646 in the year before LASPO to 427. The Law Society found in July 2016 that one third of legal aid areas have just one solicitor providing specialised housing advice through legal aid. Areas such as Surrey, Shropshire and Suffolk had no legal aid provider specialising in housing. That is shocking.
A review of LASPO in respect of legal aid for housing advice and aid is urgently needed, but I want to focus now on the area raised by my hon. Friend the Member for Lewisham West and Penge (Ellie Reeves)—early legal advice. Without early legal advice, a problem can escalate, which costs the tenant stress and possibly the loss of their home. That causes knock-on costs for the public purse, poor health, homelessness and debt. I have met several families in my surgery and in my work as an MP outside the surgery who did not seek early advice. They left their home when the landlord asked them to; they did not wait for the court order, let alone the bailiffs. As a result, they were deemed intentionally homeless, so the housing department was able to discharge its duty to house them. How many people know the ins and outs of housing law sufficiently to know what I know, which is, “Wait until the bailiffs arrive”? Most people want to do the right thing. They are scared by their landlords. They think that they can sofa-surf for a while and sort something out. Reality is not like that, particularly in the very high-cost areas of west London that I represent.
As I said, if people are deemed intentionally homeless, the housing department is able to discharge its duty to house them. If they have children, then under the Children Act 1989 social services, quite rightly, have to find them a home. That is yet more work and costs for already overstretched social workers, who are not housing specialists, and it means that social services are competing for the small amount of private sector accommodation from which the housing department is seeking temporary accommodation. And there are all those people who come to live and work in London, who are also looking for accommodation.
Under LASPO, legal advice is not available for disrepair until it affects the tenant’s health, or for possible eviction unless a possession notice has been granted. In November 2017, the Law Society called for legal aid to be reintroduced for early advice in respect of family and housing law, saying:
“Everyone knows that if you catch a problem early, you’re more likely to stop it getting worse.”
The Law Society research showed that, on average, one in four people who received early professional legal advice had resolved their problem within three to four months, but for those who did not get any legal advice, it was not until nine months after the issue first occurred that one in four had resolved their issue, and those getting no early advice were 20% less likely on average to have their problem resolved.
The Law Society, in making its report, was not angling for more work for its members—in fact, probably the opposite, as it recognises that legal problems, like so much in life, are easier and cheaper to deal with early on. The Law Society estimates that restoring housing benefit advice to the legal aid system could be done for about £2 million a year. That is based on the cost of pre-LASPO advice in relation to housing benefits. It also suggests that restoration of early advice on mortgage arrears, which is now outside the legal aid remit, could prevent escalation of arrears and further costs of possession proceedings and, by the way, reduce some of the additional costs arising from legal aid cuts.
I am really pleased that in April, the Labour party announced its new policy to restore legal advice in all housing cases. That came from one of the recommendations of the justice commission chaired by Lord Bach, which was established by my right hon. Friend the Member for Islington North (Jeremy Corbyn) when he became leader of the Labour party; it was one of the first things he did in that role. The Bach report estimates that restoring legal advice funded by legal aid could help up to 50,000 households a year to enforce their housing rights.
By responding to Labour’s announcement and starting to provide funding for early professional legal advice for housing matters, the Government would really be making a difference to many people in our constituencies. That would almost certainly mean a lower volume of cases going to court, as they could be resolved earlier. Wider benefits and savings would include avoiding health issues caused by significant disrepair; not having to pay housing benefit for high-cost temporary housing; fewer people becoming homeless; and fewer leaving rent arrears and mortgage debts unaddressed.
Everyone should have the right to a safe and decent home, so I ask the Government to take the opportunity presented by the review of LASPO announced last October to recommend returning to the legal aid scheme the ability to obtain legal advice for housing matters, and to have a fundamental review of legal aid as it applies to housing issues. I look hopefully at the answer that the Minister gave my hon. Friend the Member for Sheffield Central (Paul Blomfield) on 23 January this year on this very issue.
It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate the hon. Member for Brentford and Isleworth (Ruth Cadbury) on bringing this issue forward. It is a pity that there are not more hon. Members here, but there are debates in the other Chamber and I suspect that is where most are.
We live in a time when there are more breakdowns in the home. The family home no longer has the nuclear family. This sad breakdown has life-changing aspects for the children. It also puts more pressure on housing, as more houses are needed. The necessity of legal support is a by-product of that. The hon. Lady outlined the issues we experience every day in our constituency offices, dealing with those going through a family break-up. The Relationships Foundation, in a report which I hope others have had a chance to look at, calculates that the annual cost of family breakdown has risen to an all-time high of £51 billion. That gives us an idea of the financial cost involved in the breakdown of couples and their lives. That figure—up from £37 billion 10 years ago—takes into account the cost to the taxpayer of families splitting up across areas including tax, benefits, housing, health, social care, civil and criminal justice, and education.
A BBC poll from the week before Christmas found that one in 10 of 16 to 25-year-olds had spent at least one month sofa-surfing, and it has been said that up to 60% of youth homelessness is down to family breakdowns. We want to address the issue of legal aid, and we would also address some of the issues of homelessness by doing so. Every one of us is concerned about homelessness. We cannot not be concerned, if we look at what is happening in our constituencies and further afield. Almost half of 15-year-olds do not live with both parents, which is double the OECD average. We also have one of the highest percentages of lone parents in Europe. These stats show not only the extent of relationship breakdowns, but the impact of those breakdowns upon housing in particular, and why we need to focus, as the hon. Lady said, on how we address those issues.
Family breakdown has put a lot more pressure on so many aspects of life. Further, with this amount of separation and difficulty, people need access to sound advice; moreover, they need help. This is about giving the right help at the right time to those who need it. It is up to us to ensure that there are mechanisms in place to provide the help and support that is needed for people to live their lives.
I do not watch much TV, but I do get the chance when I get home at about 11 o’clock or 12 o’clock at night, when “Can’t Pay? We'll Take it Away!” is on. That programme shows people in the most desperate circumstances. In some of those cases, the people have brought it upon themselves, but in many cases people find themselves in difficulties because they do not understand the legal system. They do not understand what the power of eviction means when the enforcement officers come to change the locks on the doors or ask them to leave. There are some important things to address there.
We need to put on the record our thanks to some of those charitable groups that step in to help those who are homeless and who have problems. There are many good people out there from church groups and community groups—all round good people, who do charitable work. I have had men in my office who have made personal mistakes. I am nobody’s judge in this world—far from it—and I never will be, but sometimes things happen and relationships break down. That is the nature of where we are. I can, however, do one thing, and that is to help that person. Those people have had to leave their family home and they have no idea of what to do next. They do not know what the Northern Ireland Housing Executive or housing associations are in Northern Ireland. They do not know how to change their tax code, address the issue of benefits and many other things. That all adds to the stress of the marriage breakdown. People have no idea of the help that should be received and often end up paying over the odds for sub-standard housing, which they feel they are unable to fight against and change.
The beauty of legal aid is that it allows people to understand the bare minimum they can expect of a landlord or a housing body. I have seen the look of fear on the faces of people who come to me. I have to refer them on for legal advice, as the hon. Lady mentioned, because I am not legally qualified. When they ask me about a legal matter, I have to say, “I do not have the capacity or ability to respond to that, but I can point you in the direction of someone who can.” It is our job to point them in the direction of someone who can give them legal advice.
Over the years, I have been fortunate to have a good relationship with the solicitors in the main town of Newtownards, where I have my advice centre. I can often phone up and ask them—without any charge— “What advice would you give to someone in these circumstances?” That is a rudimentary thing. They say, “Well, I suggest you do this, that and the other.” There are many people out there who would like to help. It would not be legally correct for me to give them advice. When I know that someone does not have the money for legal advice, I make phone calls to the solicitors that I know in town.
Legal aid is a way of enabling those who work, but cannot afford a legal battle to know their rights and, more importantly, to have access to justice. We have to have access to justice to help the people in the greatest need. The Independent recently produced an article, which I will quote for Hansard:
“Households earning more than £2,657 a month before tax are excluded from legal aid, while many that earn substantially less than this are only eligible for partial financial help…Some of those who qualify for legal aid but are not on state benefits still have to make a contribution towards the cost—at a level which is often far beyond their means.”
That is what I see in my office and, I believe, other hon. Members see in their offices and in their contact with their constituents.
Although I disagree with legal aid funds being used for multimillion-pound test cases—I do not want to see that money going there—which has become all too common, I firmly believe that legal aid access must be expanded to those who work but who still live hand-to-mouth. Let me back that up with some figures. It has been stated that 60% of families living in poverty in Britain have at least one member of the family working. They work to live and cannot afford the luxury of legal advice. As the hon. Member for Coventry South (Mr Cunningham) said, many of the people who come to me have a low wage and are unable to afford legal aid. They are in a grey area that, unfortunately, precludes them from seeking legal advice. It is also telling that of that 60%, the majority live in private rented accommodation and therefore may need access to legal advice, and yet are precluded from that as well.
I look to the Minister for some help, ever mindful of this debate. I presume the shadow Minister’s contribution will be close to what we are all saying. We look to the Minister for a response. We need to look again at the perameters of legal aid and stop those who use public money to fund their personal agenda, while still allowing those who are being treated unfairly, yet cannot afford to pay the price of justice, to access legal aid, especially in the realm of housing.
It is good to see you in the Chair, Mrs Main. I congratulate the hon. Member for Brentford and Isleworth (Ruth Cadbury) on securing this debate. It is one in a series of debates we have had in Westminster Hall on access to justice and legal aid more generally. That is essential, as we keep pressure on the Government during their internal review of the operation of LASPO.
From the outset, the hon. Lady identified the clear importance of early advice and the benefits that can bring in avoiding the escalation of difficulties and challenges into outright crises, and also in terms of cost. She put the debate in the appropriate context of a crazy housing market, austerity and cuts, challenges posed by universal credit and the complexity of housing law. All of that means that good and early advice is absolutely essential, but unfortunately it is becoming increasingly difficult to access. I join the hon. Member for Strangford (Jim Shannon) in paying tribute to those who are doing immense charitable work to support homeless people who have fallen foul of the challenges identified. They are overworked and under-appreciated. As he recognised, the key is to deliver advice that can prevent homelessness in the first place.
In my view and the view of my party, LASPO was a disastrous piece of legislation based on the utterly ill-conceived idea that taking whole swathes of civil law outside the scope of legal aid would be key to cutting costs, but would have no impact on access to justice. From the Justice Committee to the National Audit Office, from the Public Accounts Committee to the Lord Chief Justice, from the legal profession to third sector organisations, nobody has a good word to say about the changes introduced by that Act. The Justice Committee found that LASPO had unambiguously failed in three of its four stated goals: targeting legal aid towards those who need it most; delivering better overall value for money; and discouraging unnecessary and adversarial litigation. In relation to the fourth target, the Committee stated that,
“while it had made significant savings in the cost of the scheme, the Ministry had harmed access to justice for some litigants”.
Housing is an area of law that highlights many of the Committee’s points. Although a handful of housing law elements remain in the scope of legal aid, the absence of funding for early legal advice illustrates everything that is wrong about LASPO. Allowing legal aid for those who are about to lose their house but not those who are in rent arrears or struggling with housing benefit, is frankly absurd. It does not target legal aid at those who need it most. It provides legal aid to exactly the same people, but only after the crisis has become full-blown and perhaps impossible to resolve, instead of in its early stages when resolution would have been much easier. Nor does it deliver better value for money, because to fund someone defending eviction proceedings in court is clearly significantly more expensive than giving a small amount of advice earlier in the process. Self-evidently, it does not help to discourage adversarial litigation, except in the sense that some tenants will simply not manage to challenge rogue landlords, which I will come back to later. The Justice Committee pretty much says that in express terms, stating:
“The Ministry’s efforts to target legal aid at those who most need it have suffered from the weakness that they have often been aimed at the point after a crisis has already developed, such as in housing repossession cases, rather than being preventive.”
As regards cost savings, it would be interesting to see a detailed analysis of the impact of removing many elements of housing law from the scope of legal aid. We should include in that not only the extent to which costs are moved from the provision of early legal advice to defending evictions in court and other such crisis procedures, but the financial impact on other services such as those relating to homelessness, housing, social work and health.
Instead of achieving the goals set for it, LASPO has left advice deserts, as was highlighted in several interventions. One third of legal aid areas have been left with just one specialist housing solicitor to provide legally aided advice, and some areas have none at all. The overall number of providers is down by a third, and it is actually a surprise that it has not fallen further, given the 58% fall in the number of legal help matters started for housing since LASPO was introduced. In 2016-17, there were almost 50,000 fewer cases than before the Act came into force, and that is a year in which exceptional case funding for housing and land law reached a record high of seven successful applications out of 48.
We need to ask who benefits from the system. In this area of law, it can only be those rogue landlords who breach tenants’ rights and who will increasingly be left unchallenged. LASPO can only have encouraged a culture where a lack of access to easy legal redress leads to more problems with rogue landlords across England and Wales. According to the Law Society, advice on housing benefits, rent arrears and other housing issues could be restored for as little as £2 million. It is an absolute no-brainer. The Government do not need to wait for any review to get on with that.
None of that is to deny the pressures that the Government face in terms of spending and ensuring that the legal aid budget is sustainable. However, my party does not believe that taking vast swathes of important legal advice outwith the scope of legal aid is the answer; in fact it can be utterly counter-productive, as this debate has shown.
That is why, in government in Scotland, we have continued to fund a legal aid system that is comprehensive in scope, including housing law, and generous in its eligibility criteria. The Scottish Government are considering the recommendations of the independent report that they commissioned to ensure that the system is made sustainable for the future, not through crazy cuts to the scope of legal aid, but through innovation, enhancing fairness and flexibility.
LASPO should be scrapped by the UK Government and they should go back to the drawing board. That is almost certainly what any independent report would tell them. If the Government’s internal review merely seeks to tinker around the edges, it will be seen and called out as the whitewash that that would undoubtedly represent. As I have said, there is no need to wait. The case for comprehensive legal aid for housing issues is overwhelming.
It is a pleasure to serve under your chairship, Mrs Main. I congratulate my hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury) on securing this important debate. I confess that I feel a heavy sense of déjà vu standing opposite the Minister once again: it is another week and yet another debate on the devastating impact of the Government’s cuts to legal aid. This time the issue is housing.
Most of us expect the right to a decent home that does not suck in two thirds of our income each month, that does not give us health problems and that does not endanger our safety. For too many people across the country, however, that expectation is simply not a reality anymore. We have a housing crisis in this country. Home ownership among young adults has collapsed. The Institute for Fiscal Studies reports that the chance of someone owning their own home has halved over the past 20 years. The number of council houses is at a record low. The Government have overseen the lowest rate of house building since the 1920s, which pushes more and more people to spend years in the private sector, but they have not made it safer or more secure to be a tenant; they have made it much harder.
Because of the cuts in the Legal Aid, Sentencing and Punishment of Offenders Act 2012, it is now more difficult to challenge a rogue landlord, to obtain compensation for damages to health and property because of poor living conditions, or to access basic advice that could prevent someone from losing their home down the line. New figures that we have uncovered show that 4,815 fewer people a year are being granted civil legal aid for representation on housing matters, including faulty repairs and poor maintenance of a property by landlords, as well as more serious issues such as possession of a home or where a tenant’s health or welfare is at serious risk. That is a drop of one third over the past five years—close to 5,000 more people a year are being denied the right to challenge poor living conditions and unfair treatment. Does the Minister recognise that there is a crisis in access to legal aid for housing issues?
The Government have set the bar so high for legal aid that housing lawyers warn that it is
“very difficult for a tenant to obtain funding in order to bring a claim against their landlord.”
Legal aid is available in disrepair cases only where it can be proven that there is
“a serious risk of harm to the health or safety of the individual or a relevant member of the individual’s family”.
That bar means that a persistent cough that is likely being caused by mould or damp, or risk of accidental injury because of shoddy work, is often not enough to qualify for legal aid. If someone develops serious health problems as a result of poor living conditions that landlords refuse to sort out, the Government have taken away the legal aid to obtain compensation.
Ministers might argue that for the most serious cases, legal aid may still be available through the exceptional case funding scheme, but only 13 cases have been approved for exceptional funding since the legal aid changes were introduced—out of 211 applications. The truth is that people are simply being denied access to justice and have nowhere else to turn. It is the same old story of a two-tiered system; justice in this country is available only to those who have the money to pay for it.
That is not just the case for taking a claim to court. Many housing issues can and should be resolved at an earlier stage by people getting the right advice about their rights, but the Government’s cuts to housing legal aid included the removal of early legal advice. The effect is that tenants must now wait for a minor damp problem to have a serious effect on their family’s health before they can challenge a bad landlord and force repairs to be made. Rather than resolving a dispute with a landlord early with good legal advice, tenants face the point of being made homeless before they have access to legal aid. Since the introduction of LASPO, the number of cases of legal advice for housing has more than halved. It is not just housing cases; overall, the total number of legal advice cases has fallen by three quarters, which means that more than 400,000 fewer people are getting housing advice. That is not just bad for tenants; it is short-sighted policy making that will ultimately cost the country more.
The vice-president of the Law Society, Christina Blacklaws, has said:
“The current situation is unsustainable. If early advice was available to those who need it, issues could be resolved before they worsen and become more costly for the individual – and the public purse.”
The charity Citizens Advice estimates that every £1 of legal aid spent on housing advice has the potential to save £2.34 to the public purse. Lack of support to resolve a case early means potentially far more costly court proceedings down the line.
It is not just by helping to avoid court that early advice benefits the public purse. Social problems such as homelessness and debt, and health problems that come with not sorting out housing issues early, are a ticking time bomb for the Government. At the end of last year the Law Society published research that found that a quarter of those who received early advice resolved their problems within three to four months, compared with an average of nine months for those who did not receive early advice. Those costs must be factored into any assessment of the savings realised from cuts to legal aid. Will the Government, as part of their review of legal aid, publish their own cost-benefit analysis of the wider impact of reducing early legal advice?
Labour Members agree with the President of the Supreme Court, Lady Justice Hale, who described the Government’s legal aid reforms as “a false economy”. That is why we have announced that a Labour Government will restore early legal advice in housing cases to prevent small problems escalating into big ones. The impact of the Government’s cuts is not only being felt in cases where legal aid has been removed. Even in cases where individuals should still be entitled to legal aid, such as risk of homelessness, tenants are finding that support is not available because lawyers in their area have had to close up shop.
Hon. Members have already referred to the legal advice deserts, so I will not repeat those findings, but I will say that figures uncovered by the Bach commission on legal aid confirmed that, finding that the number of civil legal aid providers specialising in housing has declined by a third, from 681 to 449. What urgent action are the Government taking to reverse those trends to ensure that no area is left without a single legal advice provider?
The Government’s changes have made it simply not possible to operate for such a narrow category of cases, and the impact has been devastating. We are living through a time of high repossessions of homes and homelessness has risen by 78% since 2011. Yet at the same time there has been a steep decline in the number of challenges brought against eviction, according to figures from the Legal Action Group. Charities such as Shelter have warned that thousands of people a year are being made homeless because they cannot find lawyers to help them prevent eviction. The Government’s changes to legal aid have brought nothing but misery and pain since they were introduced. We have waited six years for the Government’s review into legal aid, but victims cannot wait any longer. I urge the Minister to heed the advice of the Law Society and legal professionals across the country and reinstate early advice for housing matters and take action now to prevent any more families being forced into destitution because of the lack of legal aid.
It is a pleasure to serve under your chairmanship, Mrs Main. I am grateful for the opportunity to respond to a debate on such an important issue. I congratulate the hon. Member for Brentford and Isleworth (Ruth Cadbury) on securing it. She is highly committed to this issue as she was a shadow Housing Minister. I offer my congratulations to her on completing the London marathon at the end of April, raising money for two causes, including the housing charity Shelter, which does excellent work.
The hon. Lady and the hon. Member for Strangford (Jim Shannon) mentioned the importance of the work that third parties do to support people in society, such as the work of the Law Centres Network and the CAB. There are many pro bono organisations put forward by the legal profession and, as the hon. Member for Strangford pointed out, church groups. I, too, would like to add my support for the work that they do.
I want to emphasise the importance of the legal aid system. The Ministry of Justice spends £1.6 billion a year on legal aid, one fifth of the Ministry’s overall budget, which is not an insubstantial sum. It is right that we spend a significant amount of money on legal aid, but there are not unlimited resources available to the Government, so it is right that we spend the money on the people who need it most: those who are the most vulnerable, those who face the most significant issues in their lives and those who have no alternative to legal support. Those principles are fair. It is right to recognise that this debate takes place in that context.
The hon. Member for Brentford and Isleworth suggested there is not enough legal aid support for legal advice. I will identify and correct some apprehensions about legal aid and housing. As many hon. Members have identified, legal aid for housing assistance is available. Legal aid, including early legal help, is available to help those who face homelessness to access accommodation and assistance. It is available to defend individuals who are being evicted from their home or having it repossessed; to ensure that homes are safe for habitation; and to obtain injunctions preventing harassment from landlords and others.
Legal aid is available for judicial review if a local authority subsequently fails to take action or those affected wish to challenge the conduct of the local authority. For example, if the rehousing proposed is not suitable, legal aid would be available to bring a challenge. It is available if there has been a significant breach of convention rights or abuse by someone in a position of power. Legal aid is also available to bring a damages claim. As I have mentioned, the Government have protected legal aid for those facing the most challenging situations in their lives, whether that is the threat of homelessness or dangerous conditions that pose a risk to the life, health or safety of their families.
I note what the Minister says about situations where legal aid is available, but does she not accept that, since the LASPO reforms, housing cases have fallen by 50%? That is a huge increase in the number of people not getting access to justice in housing cases. Does she agree that the review of LASPO should reverse that?
As the hon. Lady has identified, there is a review into the changes that were made. The Act aimed to cut legal aid, so availability was reduced in many areas. However, the fundamental principle behind the changes in the Act were to ensure that those who most needed help and could not get it from any other sources retained the ability to get legal aid. As I have mentioned, that is being reviewed.
I have identified the areas where we provide legal aid in housing, but we need to look at how it is provided. As the hon. Member for Brentford and Isleworth identified, it is important that we have early legal help. Last year, we spent nearly £100 million on early legal advice across all categories, including housing. Advice for housing is available through face-to-face meetings or through telephone advice. The telephone service offers services beyond that which can be provided at local centres face to face. For example, the telephone service can offer interpretation in more than 170 languages, including British sign language via webcam, which operates over the weekend. Last year, there were more than 20,000 instances of advice provided by that system. It allows individuals to access advice quickly and easily.
Legal aid is also available for representation at hearings. People can access representations from individuals already engaged in their case and giving them legal help. In addition, the housing possession court duty scheme is a vital service that offers on-the-day advice and advocacy at court to anyone facing possession proceedings. Individuals in danger of eviction or having their home repossessed can get free legal advice and representation on the day of their hearing, regardless of their financial circumstances.
The hon. Members for Ashfield (Gloria De Piero), for Barnsley East (Stephanie Peacock) and for Dwyfor Meirionnydd (Liz Saville Roberts) talked about gaps in advice, which they called advice deserts. We in the Ministry of Justice are committed to ensuring that everyone has sufficient advice to help, wherever they live. I should make it clear that the Legal Aid Agency regularly monitors market capability to ensure that there is adequate provision around the country, and moves quickly to ensure that face-to-face advice is available to prevent gaps appearing. Of the 134 housing and debt procurement areas for legal aid across England and Wales, all but one currently have provision. The Legal Aid Agency has recently secured provision for the remaining one and services will commence there shortly.
On the procurement of legal aid services, the Legal Aid Agency has recently re-tendered for new civil contracts to start in autumn 2018. The procurement includes contracts for both face-to-face advice and telephone advice for housing matters. I am pleased to say that the Legal Aid Agency received tenders from more than 1,700 organisations wishing to deliver face-to-face civil legal aid work. Those organisations submitted over 4,300 individual bids. Successful applicants for face-to-face contracts were notified in January. The new contract encourages providers to be flexible as to where and how advice can be delivered, including making better use of technology. A good level of response was received, with an overall increase in the number of providers wishing to do the work. In areas where an access gap is identified, the Legal Aid Agency will take steps to secure provision. In addition, to reflect the nature of today’s society, we have developed a user-friendly digital tool that makes it clear to people when legal aid is available to them. If someone is unsure which organisations offer legal aid in a given area, they can use the “find a legal aid adviser” tool on gov.uk to find the 10 nearest organisations to them that have a contract to offer advice and assistance through legal aid in that category of law.
A number of hon. Members raised issues that went wider than legal aid for housing. The hon. Member for Brentford and Isleworth spoke about welfare claims. We work closely with the Department for Work and Pensions to ensure that it gets decisions right first time and they do not end up in a tribunal. We are making changes using technology to improve the social security tribunals. The hon. Member for Strangford rightly identified the consequences of family breakdown. At the Ministry of Justice we are looking at ways to avoid the impact on families of conflict resulting from breakdown.
The hon. Member for Ashfield made some broad points about the Government’s record on housing and I should like to clarify the position. The Government have done a significant amount to improve the housing stock and to help first-time buyers and people who want to leave home. We have built 1 million homes since 2010. House building is at its highest level since the crash. We have abolished stamp duty for 80% of first-time buyers and brought in landmark legislation—the Homelessness Reduction Act 2017—to improve the life of people who have no home and sleep rough on the streets. Fewer than 3,000 local authority homes were built under Labour from 1997 to 2010. Since 2010, nearly 11,000 homes have been built.
Many hon. Members mentioned the LASPO review. The reforms in question were made under LASPO, and I have said that they were founded on the principle of ensuring that legal aid will continue to be available for the highest-priority cases. It is important that legal aid should be focused on those least able to pay for representation. The changes were subject to a significant amount of scrutiny in during the passage of the legislation through the House of Commons. They were debated extensively and amended before they were approved by Parliament.
As the Scottish National party spokesman, hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald), pointed out, we are in the process of a broader review of legal aid. Matters covered by the review will include housing advice changes and early legal advice. Given that there is an outstanding review, the debate is a valuable opportunity to listen to the many thoughtful points made by hon. Members. We are currently engaging with a wide range of stakeholders across the legal sector, individually and in consultative groups. The first round of consultative group meetings took place last month, and they were well received. We are keen to hear from as many interested parties as possible, to establish the impact of the changes.
As well as looking back over the record of LASPO and some previous decisions, it is crucial that we look forward to ensure that access to justice, to which legal aid makes a hugely valuable contribution, will be maintained and will meet the needs of a modern society. We are investing £1 billion to transform courts and tribunals and build on our world-renowned justice system, so that it will be more sensitive to victims, more modern—so that it works more efficiently and swiftly—and more accessible. As part of that we shall digitise our services to make them easier for the public to use. It is essential that we continue our work to ensure that legal aid is made available to the most vulnerable, as part of that wider approach to making the justice system fit for the 21st century.
I thank hon. Members who have taken part in the debate. The hon. Members for Strangford (Jim Shannon) and for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald) made valuable points supporting the gist of my reasons for bringing the debate. My hon. Friend the Member for Ashfield (Gloria De Piero), from the Opposition Front Bench, committed a Labour Government to addressing the issue of early legal advice on housing. I thank other hon. Members who are no longer in their places but who made valuable points, drawing on their experience in the House.
The debate is about a fundamental issue of access to justice. I felt that the Minister made positive points about the amount of money going into legal aid and early legal advice, and new initiatives to make such advice and support more accessible, but I am concerned that, when the situation is looked at from the ground, there are still massive gaps, and there is inadequate provision, given the level of need in the country’s housing crisis: £100 million for early advice does not go very far, because I assume that it would include translation costs, which the Minister mentioned, representation in court and so on. It is good to know that the existence of deserts of provision is being addressed, with one new contract being let, but that still does not deal with the number of people queuing for advice and being turned away because there is not adequate provision. Organisations and legal firms are also going under, or ending relevant work; those skills and that knowledge are being lost for lack of funding—funding that would be for people who would never be able to pay for legal advice and assistance.
The Minister asserted that a not insubstantial sum is being paid through legal aid for housing matters. As hon. Members have eloquently said in support of my arguments, that might be compared with the cost to the public purse of homelessness and the sort of disrepair that means people, including children, must go into hospital with severe asthma due to very bad damp in their accommodation. If people in those situations were able to obtain early legal advice landlords might be forced to address the issue before it became a health crisis. That is the cost to the public purse of homelessness—and there are social care, stress and mental health costs when families are in acute housing need.
The Minister talked about new housing. We have said time and again in the House that the level of funding for truly affordable social rented housing from the Government is nothing. What is being provided is coming from local authorities and housing associations, from other resources—capital that should be spent in other areas. It is the first time since the early 1920s that a UK Government have spent nothing on social rented housing. By the way, the Homelessness Reduction Act 2017 does not address street homelessness. It provides, without any resources, for additional local authority duties that may help to prevent homelessness. In itself it is no bad thing but it does not address the present crisis. I ask the Government, so that we may address, substantially, the fundamental issue of the lack of access to justice in housing, to reprovision early advice under legal aid, and carry out a serious review of all legal aid for housing issues.
Question put and agreed to.
That this House has considered housing and access to legal aid.
Violence and Harassment at Work
[David Hanson in the Chair]
I beg to move,
That this House has considered violence and harassment at work.
It is a pleasure to serve under your chairmanship, Mr Hanson, and to be able to lead this very timely debate. It is timely because in just 12 days’ time the Minister, and indeed the Government, will have a unique opportunity to act in support of the unbelievable courage of thousands—probably millions—of women across the globe who have spoken out as part of the #MeToo campaign about sexual harassment that they have endured at work.
Such women include Zelda Perkins, here in the UK, who spoke out against sexual harassment perpetrated by Harvey Weinstein. That took raw courage—something that the Women and Equalities Committee has seen in so many of the submissions to our current inquiries on sexual harassment. In just 12 days’ time, on 28 May, the International Labour Organisation will meet in Geneva to discuss a new possible global law: an ILO convention on ending violence and harassment in the world of work. The convention is an opportunity to move from #MeToo to #TimesUp, and to ensure that the world of workers is better protected.
As a member of the International Labour Organisation, the UK has not only a right to be there, but a right to support that important work, and to speak out and urge others to do the same. I hope that today’s debate will give the Minister, my hon. Friend the Member for North West Hampshire (Kit Malthouse), who is my neighbour, the opportunity to update the House on the Government’s position and progress on this important issue. The Government have an immensely proud record of acting globally to tackle violence perpetrated against women around the world. This is yet another opportunity to take forward that clearly articulated strategy to take action against the form of violence that affects more women than any other: violence and harassment at work.
I thank CARE International—the Co-operative for Assistance and Relief Everywhere—for its support in preparing for today’s debate, and I highlight the incredible work that team does and their professional insight into how we can address these issues. The Women and Equalities Committee first considered the issue of sexual harassment back in 2016, shortly after we were established, and around the same time that the International Labour Organisation started its work on a worldwide convention. The ILO should be applauded. When other organisations were, frankly, still in denial about the most prevalent form of violence against women, the ILO was doing the necessary preparatory work for this month’s meeting.
Here in the UK, the prevalence of sexual harassment is in no doubt. More than three quarters of respondents to the Equality and Human Rights Commission’s recent survey reported experiencing sexual harassment at work, and in 2016 research by the TUC and the Everyday Sexism Project found that more than half of women in the UK had experienced sexual harassment at work—a figure that rises to two thirds for young women in particular. Since our initial work, the Women and Equalities Committee, which I chair, has launched two further inquiries into these issues: one on sexual harassment of women and girls in public places, and one on sexual harassment in the workplace. Our initial work was on sexual harassment in schools.
Thanks to the tenacity of CARE International and other organisations, we also have evidence on how these issues affect women similarly around the world—those women who make the clothes we wear, grow the food we eat or build the gadgets we depend on. We must ensure that the #MeToo movement does not go down in history as simply a flash in the pan, but as a significant milestone for the whole world on our path towards equality. To do that, we need to keep the pressure up and ensure that abuse and harassment is never part of anyone’s job description, wherever they live in the world. The ILO conference gives us another opportunity to show real leadership, by tackling an issue that affects many millions of people in the UK and worldwide: violence and harassment at work.
It has been interesting to see in the ILO’s work that tackling violence and harassment is not only a moral imperative; there is a very strong business case for it as well. In the same way that many UK businesses advocated for the supply chain reporting requirements in the Modern Slavery Act 2015, because they wanted all businesses to operate on a level playing field and for no one to have an advantage by ignoring abuses of people’s rights, many businesses realised that a strong international convention on ending violence and harassment at work can help to ensure that the conditions in their factories, farms, pack houses and workshops within their supply chains are both decent and justifiable to the public.
The UK Fashion and Textile Association has already publicly supported the potential new ILO convention, and committed to working with the British Retail Consortium and others to promote the convention among its members. That is very important support. Businesses know that it is increasingly important to get human rights issues correct, and it was clear from the CBI’s response to the Committee’s recent inquiry into sexual harassment in the workplace that they understand that for the UK. I know that the CBI will support other employers’ associations taking an equally positive view, and I hope that it will continue to encourage others to see the merit in such a convention.
In addition, there has also been considerable research showing that harassment and violence at work has considerable costs for business. CARE International conducted research last year in Cambodian garment factories and found that more than 30% of the women who worked there had faced sexual harassment within the previous year while at work. Not only is that wholly despicable, but the research showed that such harassment directly leads to lower productivity, revenue loss and missed days of work, costing the industry many millions of pounds and dollars a year. Clearly, that cost gets added to the cost of the goods that end up in the shops.
What specifically are we asking the Minister—my hon. Friend and near neighbour—and his Department to do regarding the International Labour Conference? First, we want to see a convention, and we need to see it supported by a detailed recommendation. Only through that approach can we ensure that whatever is adopted will be legally and morally binding on many countries—including, of course, the UK.
Without the international legal status of a convention, we will frankly only be making a polite request to countries to improve how they tackle these issues. With a convention, countries have to be committed to taking steps to put in place an effective framework. They might drag their feet or attempt to ignore the problem, but a convention means that they have to answer on a regular basis to the International Labour Conference, and to the many millions of men and women in their own countries, whether via the workforce or the whole population in an election. If they are a country that exports to the UK, Europe or other nations, they can also be held to account by business and ultimately, and importantly, by our consumers.
It might appear to us in the UK that if there is a convention that addresses the issue in more formal workplaces, we will have dealt with the problem, but in many countries around the world only a tiny proportion of the workforce work in such formal workplaces. In India, for example, more than 80% of the female workforce are in the informal sector. In countries such as Nepal the figure rises to more than 95%. The convention needs to cover not only women who work in formal workplaces, but those who work outside those workplaces. I hope that the Minister can give some indication of the Government’s understanding of that necessity within the convention and say that they will be supporting that approach. In this country, an increasing number of workers are self-employed and I am sure that Members would not wish to see the mere lack of a traditional workplace used as an excuse to avoid responsibility for women being harassed by their de facto employers.
Similarly, we need a convention to be clear on the responsibility of companies down their international supply chains. That is an issue that the UK has a great deal of experience in driving through as a positive approach. The UK led on fighting modern slavery by making businesses aware of the importance of the supply chain in that approach. That is why I am hoping that when the Minister responds today he will be able to add some flavour of how the Government might be able to help other members of the International Labour Organisation to effectively put in place that sort of convention and give it maximum impact for women in their countries.
Even in the UK, where we have a relatively strong legal framework for dealing with harassment and violence, many women still suffer, so I ask the Minister to think about perhaps the one third of countries that have no such laws in place. Let us all be clear that a new convention can only be part of a much bigger picture for tackling the appalling treatment of people in the workplace. It is an essential part, but only part of an overall solution. We also need to see civil society and people in general challenge the norms that make it hard to speak out when one person suffers from, or sees, sexual harassment in the workplace. The #MeToo campaign has catalysed opinion and raised the issue to the top of not only the domestic agenda but the world agenda. The Minister and his Department have a real opportunity to take that catalyst for change and help turn it into lasting change for so many people around the world.
I mentioned CARE International research on the costs of harassment in Cambodia, but that has to be part of a wider campaign to help women understand what sexual harassment is and why they should no longer have to stand for it, and to help employers face up to and understand the problems it causes and how widespread it is. Our Select Committee heard evidence this morning from a number of different organisations that are working in the UK to try to make it clearer to people in the workplace what sexual harassment is. We have some of the best and most developed laws in the world on equality and employment protection. That the natural acceptance of sexual harassment is still part and parcel of the price of being employed in 2018 Britain is appalling. There is still a need for a great deal of work. How much greater are the issues in those countries that do not have those legal frameworks, do not have equality and human rights commissions, and do not have that very real sense of fairness and justice that we have in our country? It is an enormous issue and I am very pleased that the International Labour Organisation is so far ahead in finding a way of engaging Governments around the world in resolving this.
As parliamentarians, we all know that this year is an exceptionally important year for our Parliament, as the centenary of the introduction of women’s suffrage. Many of us were there when the statue of Millicent Fawcett was unveiled a couple of weeks ago—the first sculpture of a woman in Parliament Square. She is holding a banner that says, “Courage calls to courage everywhere”. It can never have been a better statement to make than as part of this debate today.
We need the Minister to call to courage everywhere when he or his officials attend the International Labour Conference at the end of this month, so that we can send a very strong message that the UK wants to protect women’s rights—not just here in the UK or when it comes to the campaigns that we are known for internationally, such as combating violence against women in areas of conflict or female genital mutilation, but also in ensuring that women no longer have to face violence and harassment in their work. We are expecting a truly effective global convention to emerge from the proceedings in Geneva that has the full weight of support from the UK Government behind it—not just from the Minister’s Department, but from the Foreign Office and beyond—and for this Government to continue to lead the way in extolling the rights of women to enjoy equality around the world, by ensuring that workplaces are safe for every woman, everywhere.
It is a great pleasure to serve in front of a fellow Liverpudlian, Mr Hanson, and, unusually, to appear in a debate where the majority of Members present are native Liverpudlians. It cannot happen that often, but perhaps it will happen more often in future. I also congratulate my neighbour and right hon. Friend the Member for Basingstoke (Mrs Miller) on securing this important debate, and on the leadership that she has shown on the issue recently. She has invested an enormous amount of political capital and energy into driving the agenda and pushing it up the political priority list; she is to be commended for that.
The Government take this matter extremely seriously. We welcome the inquiries by the Women and Equalities Committee into sexual harassment in the workplace and in public places, and the International Labour Organisation’s initiative on ending violence and harassment in the world of work. We all have a responsibility to bring an end to inequality and injustice and to do that, we must work together across gender, social, political and national divides.
Sexual harassment can have a significant impact on those who are subjected to it. Nobody should be subjected to unwanted conduct of a sexual nature or be put in a compromising situation, and the law in the UK on harassment, sexual assault and rape is clear. Whether it is in the workplace, on the street, or part of domestic or sexual abuse, unwelcome advances that intimidate, degrade or humiliate are an abuse of power. The simple truth is that sexual harassment, in any situation, is unacceptable.
Workplace harassment is unlawful under the Equality Act 2010, which provides a remedy for harassment specifically in employment and other paid work, the provision of services, the exercise of public functions, the occupation, disposal or management of premises, education and associations such as private clubs. The Government believe that the criminal law also provides protection against violence and harassment for both men and women in the working environment and elsewhere. However, we keep the legislation under review to ensure it works as intended, and on all these matters we await with interest the outcome of the Select Committee inquiries.
On an international basis, we know that violence and harassment is a crucial barrier to women’s economic engagement and to gender equality worldwide. We know that if women had the same role in labour markets as men, up to an estimated $28 trillion, or 26%, could be added to global GDP in 2025—but we also know that it is not about the economic argument alone. Violence and harassment of women is an endemic human rights abuse, which prevents women from reaching their potential and living the life that they choose.
We have a responsibility to act as a global leader. We have strong laws on violence and harassment in the UK, but as my right hon. Friend said, many countries around the world do not have such protections. My right hon. Friend the Secretary of State for International Development has been clear that we should be proud to put British values on this issue at the centre of our international development work. She has launched a global call to action on gender equality and has put women’s economic empowerment at the heart of her Department’s economic development strategy.
We are working to tackle violence against women and girls around the world. Through our “What Works to Prevent Violence Against Women and Girls” programme, we are working in 12 countries across Africa and Asia to demonstrate the economic cost of violence and to understand the most effective approaches to prevention. The programme will reach up to 100,000 people worldwide. In Bangladesh, it involves working with textile workers to address violence against female garment workers in four factories in Dhaka. It provides workplace training to male and female workers to raise awareness and build skills, and works with managements to develop workplace politics and systems to address violence.
We are putting the economic empowerment of women and girls at the heart of the Department for International Development’s economic development strategy, which was launched earlier this year. It focuses on trade as an engine for poverty reduction and investment in sectors that can unlock growth. All our economic development work will tackle gender discrimination and will deliver safer, more secure work with higher returns for women. We are having a real impact: between 2011 and 2015, we helped 36.4 million women gain access to financial services and helped 3 million women to improve their land and property rights across the world.
My right hon. Friend the Member for Basingstoke rightly spoke about our stance at the ILO convention in Geneva later this year. The Government are committed to ending violence and harassment against workers worldwide. I assure her that we are fully engaged in discussions at the International Labour Organisation to develop measures that, if agreed, would provide an international legal framework in this area. My officials recently met CARE International, the CBI and the TUC to hear their views on the proposed measures. They will be attending the ILO conference in Geneva later this month for the first of two committee discussions on the proposed instrument.
The Government are already in a strong position to champion the need for international provision—particularly in the light of our leadership on modern slavery and gender-based violence initiatives. We recognise that there is a potential benefit in closing the gap in international law. In negotiating a new instrument, the UK will be looking for sufficient alignment with UK criminal and civil protections, on which the UK is already in a strong position. The definitions and scope of any instruments need to be reasonable and justifiable for all parties, and they must allow for practical implementation and enforcement. Our stance generally is constructive, and we are listening.
My hon. Friend the Minister is choosing his words very carefully in talking about the negotiations and discussions that will be going on towards the end of the month. He is talking about the development of an instrument, but in my remarks I clearly said it is important to have a convention, which would have far more weight than recommendations. Will the Government support a convention?
As I say, we are going to the conference with an open mind about what may come from it. We are generally supportive of the initiative on ending violence and harassment at work, which the ILO is undertaking. We need to be assured that what is produced is consistent with British practice and law, and is justifiable. Much of the devil of that work will be in the detail—particularly on some of the definitions. We definitely support an international push—we can assist it in ways other than just having an international initiative—to improve the situation of workers across the globe.
The UK is proud to be a global leader in efforts to eradicate violence against women and girls in all its forms, including through our leadership on efforts to eradicate modern slavery—one of the worst forms of abuse. I am proud that, in my time as deputy mayor for policing, I produced the first ever violence against women and girls strategy in a global capital city. That work was commended by the United Nations.
Everyone should be able to go to work without fear of violence or harassment, no matter who they are, where they work or what they do. The Government will continue to press for real progress through instruments such as the sustainable development framework and organisations such as the ILO, to help make this a reality worldwide.
Question put and agreed to.
I beg to move,
That this House has considered the mandatory fortification of flour with folic acid to prevent spina bifida and anencephaly.
I am delighted to serve under your chairmanship, Mr Hanson, in this important debate on the potential for the mandatory fortification of flour with folic acid to prevent neural tube defects. Every week in this country two children are born with a neural tube defect, most commonly spina bifida and anencephaly, and every day two pregnancies are terminated as a result of the diagnosis of such conditions in the womb.
The neural tube is the structure in the embryo that becomes the brain and the spinal cord. It should close between the 18th and 28th days after conception. Failure of the neural tube to close completely and properly leads to conditions such as spina bifida, affecting brain development, mobility, and bladder and bowel dysfunction—other right hon. and hon. Members have personal experience of that and will talk with great knowledge about it—and anencephaly, a fatal condition in which the brain does not develop.
In 1991 a seminal piece of research on prevention of neural tube defects for the vitamin study group of the Medical Research Council by Professor Sir Nicholas Wald showed conclusively that supplementing the diets of women with folic acid, a naturally occurring nutrient found in spinach, liver or Marmite, prior to conception and during the first trimester of pregnancy could reduce the incidence of NTDs by up to 70%. In response to the data, the Conservative Government at the time introduced new guidelines that recommended that all women should take supplements of folic acid prior to conception and during the first 12 weeks of pregnancy.
Eighty-one other countries around the world, however, including the United States, Brazil, Australia, South Africa, Nigeria, Indonesia, Argentina and Canada, took a far bolder position, mandating the fortification of flour and flour-based products in their countries with folic acid as a public health intervention for whole societies. They did so having recognised the data and the long-established fact that at least 40% of pregnancies are unplanned, so NTDs might develop in the womb often even before those women realise that they are pregnant.
The recommendation of voluntary supplementation in our country led to an initial increase in the number of women taking folic acid before conception. The proportion went up to 35% in 1999,but by 2012 it had started to fall back, to just 31%, with much lower numbers seen in the more deprived socioeconomic sectors of society and in black and minority ethnic communities. Among pregnant women aged less than 20, on average just 6% supplement their diet before conception.
In short, the position that we have taken in our country under successive Governments has led to increasing health inequalities, with poorer, more marginalised and younger women having greater risk of their children being born with spina bifida or other conditions. By contrast, in the United States, which in 1998 started mandatory fortification of rye and wheat flour, and in 2016 introduced a new programme to fortify corn flour so as to target the Hispanic population, we have seen a reduction in NTD pregnancies of almost 30%. In Canada, one study of the prevalence of NTDs showed a drop from 4.56 births per 1,000 to 0.76 per 1,000 after fortification. Had we in this country followed the same route as Canada or the US, we would have seen 2,000 fewer pregnancies with a neural tube defect between 1998 and 2012. That is a sobering thought for the advisory committee in the UK to consider.
In fact, the scientific evidence in the case for fortification is not really contested. That is why the Scientific Advisory Committee on Nutrition to this Government and previous ones—it used to be called COMA, the Committee on the Medical Aspects of Food Policy, but understandably changed its name—back in 2000 responded to the evidence and to the US move by recommending that our country should go down the route of mandatory fortification. SACN repeated that recommendation in 2006, in 2009 and in July of last year.
The most recent SACN report, surveying all the evidence available around the world about the benefits and the possible adverse consequences of folic acid fortification, stated:
“Conclusive evidence from randomised controlled trials…has shown that folic acid supplementation during the early stages of pregnancy can reduce the risk of the fetus developing neural tube defects”.
It goes on to maintain its view, expressed consistently by scores of scientific advisers to the committee over the years, that Britain should be fortifying our flour to prevent NTDs. The key question as far as I am concerned—not as a clinician or expert, but as someone who understands the value of evidence-based policy making—is this: why have this Government and previous Governments not acted on the advice and the evidence to take similar steps in our country?
The principal excuse offered by Ministers is that the evidence is mixed and that some studies have shown some possible risks associated with having higher levels of folic acid or folates in our bodies. In particular, two risks have been talked about: first, that higher levels of folates may mask vitamin B12 deficiencies in individuals, possibly leading to anaemia and neurological damage; and secondly, that higher doses of folic acid might run the risk of increasing the likelihood of certain cancers. As far as I can see, however, all the evidence and the science produced over the intervening 25 years have largely debunked such concerns.
The SACN has looked at all the evidence in last year’s review and previous ones and stated, on the issue of B12, that folic acid intakes up to 1 mg per day are not associated with neurological impairment in older people with low vitamin B12 status. The most recent SACN review stated that
“studies of folic acid supplementation and observational studies, indicate either no relationship with cognitive decline or a lower risk associated with higher folate status.”
It goes on to note:
“The prevalence of vitamin B12 deficiency with or without anaemia did not increase after mandatory fortification in the USA.”
Since the SACN provided that evidence, a further, critical study has been done by Professor Sir Nicholas Wald, who produced the original research suggesting the use of folic acid in flour, and Professor Sir Colin Blakemore, who is well known to right hon. and hon. Members. The study shows definitively that there is no evidential base for the suggestion of a maximum tolerable level for folic acid. The question of it masking vitamin B12 is therefore no longer taken seriously by the scientific community in our country or overseas as a reason for not introducing folic acid into flour.
On the potential connection between high folate levels and overall cancer risk, again I quote the SACN’s latest review:
“Findings from the different study types are inconsistent but overall do not suggest an adverse association. RCTs”—
randomised controlled trials—
“show no effect of folic acid supplementation on overall cancer risk. The MTHFR genetic studies suggest higher folate concentrations reduce overall cancer risk.”
Again, observed data from America, Canada and other societies do not show any adverse effects of increased cancer risk.
Support for the notion of mandatory fortification comes not just from our country or the SACN, but from a volume of organisations that I shall reference at some length: Shine, the brilliant spina bifida and hydrocephalus charity in this country; the Royal College of Obstetricians and Gynaecologists; the Royal College of Paediatrics and Child Health; the Royal College of Midwives; the British Maternal and Fetal Medicine Society; the Faculty of Sexual and Reproductive Healthcare; the British Dietetic Association; the Governments in Wales, Northern Ireland and Scotland, where only last year the Scottish Government said that they wished to introduce mandatory fortification but were unable to do so on a Scotland-only basis; the chief medical officers in England, Wales, Northern Ireland and Scotland; Public Health England; Public Health Wales; NHS Health Scotland; Health and Social Care in Northern Ireland; the Faculty of Public Health; the Food Standards Agency; Food Standards Scotland; Colin Blakemore; Nick Wald; Jeff Rooker; and me.
There are many people who think this is a very clear case where the evidence should lead to a policy change. Why do the Government not agree with their own advisers and with the overwhelming majority of scientific opinion? Why, in the light of the evidence, do they appear to have dragged their feet—not just this Government, but the previous Labour Government and, indeed, the Conservative Administration before that?
On 2 May, in response to a written question from my hon. Friend the Member for Coventry South (Mr Cunningham) on the case of mandatory fortification, the Minister said:
“No assessment has been made of potential merits of adding folic acid to flour on pregnant women or children.”
That seems to be slightly at odds with what I have been saying for the past 10 minutes—that there seems to be a lot of evidence in support of it. He went on to say that the recent SACN report, which was published in July 2017,
“made recommendations in respect of folate levels and developing foetuses. Ministers are currently considering the issue of mandatory fortification and will set out their position in due course.”
We find ourselves here because I am looking for the Minister to set out the Government’s position in due course. They have had a quarter of a century to mull over the position, in the light of the evidence. I know the Minister, who I have great regard for, is a man of action. I look forward to him setting out the Government’s case and getting on with it.
It is a pleasure to be here under your chairmanship, Mr Hanson. I congratulate the hon. Member for Pontypridd (Owen Smith) on securing this important debate and on the eloquent and cogent way that he set out the case for the fortification of flour with folic acid.
When the facts are set out and the evidence is adduced, it is a very compelling case. It is all the more surprising, when one hears the weighted evidence of the arguments in favour of it, that something has not yet been done in this country to ensure the mandatory fortification of flour with folic acid. The hon. Gentleman said that that has happened in many major countries across the world with vast populations. He mentioned Brazil, the United States and Canada; they are big countries with very strong regulatory regimes in which this practice has been carried out. Therefore, there have been multiple opportunities to have all the scientific evidence evaluated and to have all the upsides and downsides considered. It is very clear that the upsides are so massive that they require this country to follow suit. It is a shame that we are not yet in a position in this country to have mandatory fortification of flour.
It has been 27 years since the Medical Research Council published its research demonstrating that supplementing women’s diets with folic acid before the early stages of pregnancy reduced the chances of the pregnancy being affected by neural tube defects. That was in 1991. It was in 1990 that my son, Andrew, was born with spina bifida. Very soon after he was born, we became experts in the whole area of spina bifida: the reasons for it, how it develops and all the rest of it. Even back then, the great Professor Norman Nevin, who was an expert in the field in Belfast and did a lot of research, was a massive advocate for the mandatory fortification of flour, even before it was widely known about. He wanted to ensure that young parents who were planning to have children were better educated about the need to take folic acid and the general low levels of folates in the adult population and young people generally, because it was a massive problem and would store up big problems in future.
The reality is that as a result of not taking those measures, children are born with spina bifida or anencephaly. Children need not be born with those conditions if the parents have the right information and the mothers take folic acid at the appropriate time. The evidence shows, and it has been spelled out already, that it is too late once pregnancy has started. Many pregnancies are unplanned; many people even today, in 2018—never mind back in 1990 when my son was born—have no awareness of the need to take folic acid. They think it is something rather exotic—why on earth would they even consider such a thing? Even the name sounds a little strange.
People do not take the necessary steps and, as a result, children are born with severe disabilities. That presents great challenges to them, and often life-changing effects on their families. Often, as sadly was the case for my son, these children do not live a long life. Our boy died when he was eight years of age. In the process of his short but extremely rewarding and rich life, he underwent numerous procedures in hospital and numerous hospitalisations, sometimes lengthy. That had an impact on him, his family and his siblings.
The reality is that for all those children who are born with spina bifida and who live with it and are treated, many other children in the womb who are diagnosed with having a neural tube defect are never born. The hon. Member for Pontypridd and I recently hosted an excellent meeting in Portcullis House, which a lot of people attended. One of the things that came out of that was that, sadly, it appears that in this country we effectively deal with this problem simply by terminating foetuses that are diagnosed with a neural tube defect. That is how the vast bulk of these foetuses are treated.
It is a terrible thing that otherwise healthy babies and foetuses are in this situation as a result of a lack of action by society, successive Governments and by all of us, who have not done what other countries have done, which could be done at very little cost with no scientific downside, and which would reap enormous benefits for everybody. This is something that we need to take very seriously.
Over the years, my wife and I have done some work to try to educate people about the need to take folic acid. My wife, very bravely, did a number of television interviews when Andrew was alive. He even appeared on the television programmes. The process of education and telling people is not cutting through. It is not doing the job. It is not reaching the people it needs to reach at the time it needs to reach them, before they fall pregnant. We need to step up to the plate.
I will not repeat the scientific evidence, which has been laid out well by the hon. Gentleman and the groups that support this necessary move. There is a lack of understanding. People sometimes get nervous about the idea of adding things to food for public health purposes. I understand all that, but we already add things to flour and to water—we already make interventions where that is important and necessary. A lot of scientific evidence has been produced. I was struck that Professor Blakemore and the other experts who came to the event we held in Portcullis House said that, scientifically, absolutely nothing more needs to be proved or evaluated. All the evidence is there; we now require action on the basis of that evidence.
I simply add my voice to the plea for the Government to act on the advice of their own Scientific Advisory Committee on Nutrition and listen to the voices of all those who speak in favour of this measure. They should listen in particular to the voice of Shine which, as the hon. Gentleman rightly said, is a fantastic organisation that does tremendous work to help kids with spina bifida and hydrocephalus, and parents who have lost children. As I learned over those many years of intense engagement with clinicians and others, who often said, “Well, you tell us how Andrew’s feeling, because you know better,” parents do know. The Government need to listen to parents and potential parents—people who lost children in the womb or, totally understandably, felt unable to have a child with that condition.
This is a very important issue. It does not seem to me to be taken seriously enough, primarily because, relatively speaking, not a lot of children are born with spina bifida nowadays in the United Kingdom. As I said, I think that is partly because a lot of children with the condition are simply terminated in the womb. If it prevents even one or two children from being born with spina bifida who otherwise would have been born with the condition, this will have been a step well worth taking.
Order. I intend to call the Scottish National party spokesperson, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), at 5.10 pm. Three hon. Members wish to speak before that, so will they split the remaining time accordingly? I call Stuart C. McDonald.
It is a pleasure to serve under your chairmanship, Mr Hanson. I thank the hon. Member for Pontypridd (Owen Smith) for introducing this debate and for setting out the facts and the science so comprehensively. I entered the ballot to try to secure a debate on this topic, and I was unsuccessful in persuading the Leader of the House to allow a debate in Government time, so I am pleased that he came up trumps. I also thank both him and the right hon. Member for Belfast North (Nigel Dodds), who made an incredibly powerful speech, for hosting the recent Folic Acid Awareness Day event in conjunction with Shine. I was very sorry to miss that.
Both hon. Members mentioned Shine’s fantastic work, but let me mention another charity. I recently battled through the heat of the London marathon to raise funds for two charities, one of which was Spina Bifida Hydrocephalus Scotland. SBH Scotland is a fantastic charity based in Cumbernauld whose specialist staff work across Scotland and are committed to providing a lifetime of information, support and projects to all those affected by spina bifida, hydrocephalus and allied conditions. It, too, is a strong champion of mandatory fortification of flour with folic acid.
Like pretty much everyone else in the Chamber, I believe we are a long way past the point at which mandatory fortification became the right option. Intake of folic acid has been proven to reduce the number of pregnancies affected by neural tube defects, of which spina bifida is the most common. The Government themselves recommend that women who are planning a pregnancy or are within the first 12 weeks of their pregnancy should take a daily 400 microgram supplement of folic acid. However, only 31% of women take the correct dosage, and many do not begin until they are pregnant, when it is too late. We must keep in mind that 45% of pregnancies are unplanned—in those cases, there is no possibility to plan ahead. Overall, 75% of women of childbearing age across the UK are at increased risk of having a pregnancy affected by a neural tube defect due to having lower than the recommended level of folic acid.
There is no evidence to suggest that mandatory fortification would be anything other than beneficial, given that recent research, which the hon. Member for Pontypridd expertly set out, shows there is no longer a basis for setting an upper limit on folic acid intake. As we have heard, the argument is further strengthened by the experience in at least 81 countries, including the USA, Canada and Australia. Importantly, as I understand it, no country that has taken the step of mandating the fortification of flour has gone on to reverse it. It is clearly time for the UK to follow suit.
The issue is particularly pressing in Scotland, where proportionately more children are born with spina bifida than in other parts of the UK and folic acid levels are particularly low—lower than in the UK as a whole, which itself has low levels by international standards. As we have heard, the Scottish Government have supported compulsory fortification of flour for many years. Unfortunately, although power over the issue is devolved to Scotland, the advice from Food Standards Scotland is that realistically, given the way in which the flour and milling industries are structured, a response is better delivered UK-wide. That is what we unite to call for today.
The Holyrood Government, the Welsh Government, the Northern Ireland Department of Health, the Food Standards Agency, Public Health England, the British Medical Association, the Scientific Advisory Committee on Nutrition and all the royal colleges under the sun are on board. The science points overwhelmingly in favour of mandatory fortification, but surely, when we listen to the individuals and families affected by neural tube defects—spina bifida and allied conditions, of which the right hon. Member for Belfast North gave an example—that overwhelming case becomes undeniable. I hope that the Government listen to the science and to the families affected, and act quickly.
I congratulate my hon. Friend the Member for Pontypridd (Owen Smith) on securing this important debate and, as always, making an excellent case in favour of the fortification of flour and the science behind it. I also thank him and the right hon. Member for Belfast North (Nigel Dodds) for organising the recent event in Parliament with the charity Shine, among others. Shine has worked for many years alongside my constituents, the Walbyoffs, on whose behalf I speak.
I will use my short contribution to give a voice to Paul and Liz, whose eldest daughter, Sara, lives with spina bifida. My hon. Friend for Pontypridd explained comprehensively how the conditions caused by a low level of folic acid during a mother’s pregnancy cause neural tube defects in an unborn child. Sara was diagnosed with the condition weeks before the birth of the family’s second child, Alis. Paul and Liz tell me that, had they known that earlier, Liz would have increased her dosage of folic acid during her pregnancy. Indeed, mums such as Liz would have benefited from the extra folic acid boost that would have come from the fortification of flour. The evidence suggests that, in as many as three out of four cases, that could be the difference between a baby being born with a neural tube defect and not.
Like many families across the country with a personal connection to the debate, Paul and Liz cannot understand why the UK has not introduced mandatory fortification of flour. Other food products, such as cereal, are fortified with folic acid; the rationale for excluding flour from fortification is unclear. There is clearly strong support for that among members of the medical profession. David Bailey, the chair of the BMA council in Wales, described mandatory fortification to prevent spina bifida as
“an important and cost effective public health measure.”
On behalf of Paul and Liz, I urge the Government to look at this sensible proposal carefully and to act. As the right hon. Member for Belfast North said, all the evidence is there; all that is needed is action. I hope that the Government listen to this debate.
I, too, congratulate the hon. Member for Pontypridd (Owen Smith) on bringing this debate to Westminster Hall. I congratulate him on presenting his case so well, as he did at the awareness day that some of us were able to get down to. As the Democratic Unionist party spokesperson for health, I am aware of this issue and very supportive of the fortification of flour.
All the speeches we have heard were tremendous. I commend my right hon. Friend the Member for Belfast North (Nigel Dodds) for telling a very personal story. Personal stories in these debates always carry substantial weight. His was a story that he and his wife have walked, and although we might have known something about this issue, we have heard a whole lot more. I commend him on that and assure him of our support. He knows that it has always been there for him, but on days when we tell personal stories we feel it a bit more.
When my parliamentary aide was pregnant, we got a surprise. In the mornings when she was under a little pressure, instead of shouts of “coffee” coming from her desk she would ask for water. By the time of her second baby, we all knew what “no coffee” meant—baby on board. You can imagine the apprehension I felt, Mr Hanson, on a Friday morning when I said to the staff in the office, “Girls, who’s for coffee?” If they said no, I knew they did not want coffee, but was there anything they wanted to tell me? That, however, is by the way. Why did my aide do that? It is simple: she told me, “Coffee makes the baby’s heart beat faster, so I need to stay away from it.” I wanted to make a contribution to the debate because she has lived through this.
Almost every mother I have ever known, as soon as they have that pregnancy test, has made changes to their lifestyle. They do it automatically, and in many cases right away, for the sake of the baby. They stop having alcohol and start on vitamins, reduce caffeine and increase their fruit and veg. By doing that, they naturally create—to use an Ulsterism—a better wee home for their child, which is what the mother is trying to achieve.
This is a personal story from my aide. They are told by the doctor to take folic acid, and of course they do, because it is important, but the problem is that ladies who have been on contraceptive pills find their folic acid store completely depleted. If they have not taken folic acid before pregnancy, it may be too late. With approximately 40% of UK pregnancies estimated to be unplanned, that is certainly an issue, so we look to the Minister for a good response. I mean this respectfully: larger ladies who have a higher body mass index should be taking more folic acid than the usual pregnancy dose. That is not talked about widely, but it is important to put on record how important folic acid is for anyone who is pregnant, and perhaps those showing signs more than others.
I read an excerpt from the NHS Choices website regarding flour and folic acid that made things very clear to me. It describes how a randomised controlled trial from 1991 first indicated that taking 4 mg of folic acid during pregnancy—10 times the current recommended dose—could prevent about 80% of neural tube defects. On the basis of that trial, it was concluded that such defects are due to a vitamin deficiency that needs correcting before pregnancy. However, it said that, despite campaigns, a study of nearly half a million women in England showed that less than a third took folic acid supplements before pregnancy. That tells me clearly that action is needed, and it is needed now.
On adding folic acid to flour, we have potentially been putting fluoride into water, and that has virtually no health benefits. That has only dental benefits, which are about lifestyle choice, and that is different from those suffering because they are not getting folic acid through their diet. It is great that this issue has been brought forward, and we should look to put folic acid into flour and ensure that everyone gets it, because there are no negative sides to that.
I wholeheartedly agree with my hon. Friend. We are already putting additives into many products we eat, to our benefit, and that is what we should be doing.
To return to taking folic acid supplements before pregnancy, of the half a million women in England surveyed, less than a third did so. The figures varied by age, with the highest use in women aged 35 to 39, of whom 38% took it before pregnancy, compared with only 13% of those aged 20 to 24 and 7% of those under 20. There was also a marked ethnic variation, with 35% of white women taking it compared with 20% of south Asian women and 18% of Afro-Caribbean women.
Just under two thirds of all women took supplements in early pregnancy, but the researchers say that that is already too late. The current strategy of encouraging women to take folic acid before pregnancy is inadequate and, in particular, putting younger women and minority groups at a disadvantage. People always talk about stats, but the fact of the matter is that they tell a story—and these stats tell a clear story. When women take folic acid before and during pregnancy, it makes a difference. However, there is clearly either no knowledge or not enough information about it. We look to the Minister and the Government to step forward and do what is right.
I would also like to mention that whenever people come to my office for benefit claims and I see what medication they are on, as we need to do—it must be the same for everybody’s offices—I find it surprising how many are, for different reasons, in receipt of folic acid. That is because folic acid helps to get their bodies back into kilter. That is important: folic acid has benefits not just for those who are pregnant but for those who are in ill health.
While I understand the Government’s reluctance to become a nanny state who enforce rather than guide, we should remember that flour fortification is not new. To white flour, the UK adds calcium, iron, thiamine and niacin to replace the nutrients stripped and discarded when the bran and germ are removed from the wheat grain. That was introduced after world war two to help improve the nation’s heath. We did it then for that purpose, so why in 2018 can we not do it for the purposes we are presenting to the House today? I do not agree with the nanny state argument. Sometimes, Governments have to take the initiative and do things that are important.
Today, milling is even more efficient at stripping the nourishing layers from the endosperm, which means that even less natural folate is left in white flour than there was when replacing other lost B vitamins was deemed necessary. There is, therefore, a greater need today for folic acid than there was in the past—even after world war two, when that was seen to be important.
I will conclude, because I am conscious of the timescale you gave us, Mr Hanson. The Government must consider this issue. I give my full support to the hon. Member for Pontypridd for bringing the debate forward, and to my right hon. Friend the Member for Belfast North and other speakers. We have all come here with the same message, in an attempt to highlight this issue to the Government. Anything we can do to bring healthy babies into this world should be done without any delay. This seems to be a cost-effective way of helping mothers and their babies from the earliest opportunity. I am fond of the Minister, and he knows that. I look to him for a substantial response—no pressure whatsoever—on what we have proposed, with reasons.
It is a pleasure to serve under your chairmanship, Mr Hanson, and to take part in this debate, which has been profound and poignant so far. I thank the hon. Member for Pontypridd (Owen Smith), who gave an extremely good, well-researched, evidence-based case for the fortification of flour with folic acid. There is scientific evidence, and when we know that we can do the right thing, there is no reason not to do so. His case was strong, clinically based and backed by the royal colleges and practitioners we should be listening to.
We heard that every week two children are born with spinal neural tube defects and that, as a result of potential defects, many terminations occur. As someone who has experienced a number of miscarriages in my life, there is nothing more horrendous than losing a baby: you question every single thing that you have done and everything that you could have done. If something like this could make a difference for those individuals who find themselves in that traumatic situation and do not seek terminations and for those who have unexplained miscarriages, we should be doing it.
There is absolutely no cost that can be put on losing a baby that you very much want to have. Often the tragedy of it is that it is unexplained. It is not until it has happened four times—another issue that we must address—that there is even any research into why it might have happened, or happened repeatedly. There are many individuals who may be or have been affected, who might not even know that a simple step such as this could have made the difference. That is certainly a step we must take.
As we have heard, the scientific basis is there. The countries that are leading now and protecting their populations by fortifying their flour with folic acid—I say again, such a simple step—have found no adverse consequences. Those countries have implemented the policy over a long period of time; they are looking at the health benefits and finding that any concerns about health costs were unfounded. The research is unequivocal in that regard and must be listened to.
As has been noted, the Scottish and Welsh Governments have both written to the UK Health Secretary, urging him to take action and introduce mandatory fortification of flour with folic acid on a UK-wide basis, because that is what is required. I am often in debates where there is little consensus across the four nations, but this seems to be one of those unique debates in which we are all saying, “This has to happen,” from across parties and across nations. There seems absolutely no logical reason for not taking this matter forward timeously, to protect families from the trauma of that unexplained miscarriage or of finding out that they have a baby who is very sick, and perhaps having to have a termination that they never wanted, or a difficult discussion regarding how to care for a young child who they want to see reach their full potential and want to give all the love in the world to, but who will have medical complications throughout their life.
I thank the right hon. Member for Belfast North (Nigel Dodds) for an extremely profound and personal account in memory of Andrew. We must pay heed to people’s personal accounts. That is what must guide policy. They are real people who are being affected; we are talking about families, and we must do the right thing. I also thank my hon. Friend the Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald), who has done a lot of fundraising in this regard—even running a marathon, which is something I commend him for doing, and unfortunately not something I will ever be able to do myself. The hon. Member for Strangford (Jim Shannon), who is a health spokesperson for his party, made a good speech and asked important questions of the Minister, and the hon. Member for Newport East (Jessica Morden) advocated excellently for her constituents. For once, we are singing from the same hymn sheet. These are small nudges that we can make—small changes that make such a great difference. I urge the Minister to act.
It is a pleasure to serve under your chairmanship, Mr Hanson; I think it is the first time I have had such a pleasure.
I thank my hon. Friend the Member for Pontypridd (Owen Smith) for securing the debate and for his eloquent speech. As always, he showed his knowledge and passion on this important topic. I also thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who speaks for the Scottish National party and mentioned that the Scottish Government have looked at this policy and, as I understand the situation, concluded that it was impossible to bring in fortified flour on a Scotland-only basis because of the fluid nature of the UK food industry and the very fluid nature of flour. I therefore think it is definitely time that the UK Government looked at this issue again.
I thank the right hon. Member for Belfast North (Nigel Dodds) for his brave and personal speech, and I thank my hon. Friend the Member for Newport East (Jessica Morden) and the hon. Members for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald) and for Strangford (Jim Shannon) for their excellent contributions to the debate. Finally, I add my thanks to my hon. Friend the Member for Redcar (Anna Turley), who raised this matter last week during Health and Social Care questions.
As we have heard, this issue has been on the table for decades now, and it is only right that it continues to be brought up at every possible opportunity. The UK Government continue their policy of voluntary folic acid supplementation for women of childbearing age, despite the evidence and the fact that the latest National Diet and Nutrition Survey states that 91% of women of childbearing age have a red blood cell folate level below the level estimated to lower the risk of NTDs. I therefore ask the Minister what he is doing to encourage women of childbearing age to take folic acid supplements. Additionally, what steps is his Department taking to ensure that women of childbearing age even know that they should take those supplements?
Incidentally, this was something that I was aware of when I was having my children 25 years ago. We think things have moved on, but my young researcher in my office said that she only found out about it when she was researching for this speech. So, the message is not out there—not everybody knows this information. The voluntary approach means that, more often than not, those who do not need the supplements will take them, whilst those most at risk will miss out. Young mothers and those from the most socioeconomically deprived areas are least likely to take supplements. What steps are the Government taking to ensure that these groups of women are included and reached?
I am sure that it will not come as a surprise to the Minister that as many as 40% of pregnancies are unplanned, and that means that many women will not have been taking supplements during the crucial phase, just before or just after conception. It therefore makes sense for flour to be fortified with folic acid, to ensure that women get the nutrients that they need in order to reduce the risk of NTDs. That already happens in over 80 countries worldwide, including the United States, Canada and Australia.
Currently, no countries in the European Union fortify their flour with folic acid. However, there is no legislation preventing any of them from doing so. Given the UK’s research on this matter, I believe that they are waiting for us to lead the way, and as we have heard, I believe Scotland is probably doing just that. Why are the Government not therefore taking the opportunity to lead the way and reduce NTDs, not only in the UK but, in turn, across Europe? I understand and sympathise with concerns about adverse effects that this may have on the population. However, there really is no evidence to suggest that from other countries that have fortified their flour with folic acid for many years.
I also note the response of the Parliamentary Under Secretary of State for Mental Health and Inequalities from Health and Social Care questions last week:
“We have advice that if the intake of folic acid exceeds given levels, that can also bring health problems”.—[Official Report, 8 May 2018; Vol. 640, c. 537.]
However, the modelling undertaken by Food Standards Scotland in 2017 indicated that fortification at the recommended levels, with a capping of voluntary fortification and supplements, can achieve the reductions in NTD risk without increasing the number of people consuming the upper recommended limit. Has the Minister made any assessment of that finding, and could he stipulate where his advice is from? Finally, has the Minister’s Department made any assessment in the last five years of the benefits of fortifying flour with folic acid?
From this afternoon’s debate it is clear that there are benefits to the mandatory fortification of flour with folic acid. I really do hope that the Minister will take all of this away with him today back to his Department and reconsider this policy—unless, of course, he is going to announce that he is going to fortify flour forthwith.
Thank you, Mr Hanson. Should that be the miller, Steve Brine? I like the notion from the shadow Minister that the European Union is waiting for us to lead. That is a new concept.
It is a pleasure to serve under your chairmanship for the first time, Mr Hanson. I congratulate the hon. Member for Pontypridd (Owen Smith) on securing the debate and I thank him for devoting it to an issue that I know he cares about. He works closely with Shine, which he mentioned and which was mentioned by others, and is based in his constituency. It does some fantastic work supporting people with spina bifida and anencephaly and their families. I have asked my officials to see if Shine will come in and see me as soon as possible. It is not a charity that I know, so I want to speak to and get to know its staff.
I hope I can reassure hon. Members a little bit—I suspect it will not be a lot—that the Government and those who provide us with expert independent advice are looking incredibly closely at all of this, as I will set out. I will say at the outset that I am sorry to disappoint the shadow Minister, but I cannot give the House an exclusive announcement today, I am afraid. However, I may be able to give some encouragement.
Part of the pregnancy advice currently provided to women is of course to take folic acid supplements. The consequences of folate deficiency in the general population are that pregnant women are at greater risk of giving birth to low birth-weight, premature babies with neural tube defects. Unless someone is pregnant or is thinking of having a baby, they should be able to get all the folate they need by eating a generally varied and balanced diet. Women who are trying to conceive, or who are likely to become pregnant, are advised to take a daily supplement of, we say, 400 micrograms of folic acid until the 12th week of pregnancy. They are also advised to increase their daily intake of folate by eating more folate-rich foods such as spinach and broccoli, which sounds lovely, and foods that are voluntarily fortified with folic acid such as, as has been said, a wide range of breakfast cereals.
As has been said by pretty much every Member who has spoken, around half of pregnancies are unplanned. Of those that are planned, it has been estimated that only half of all mothers take folic acid supplements or modify their diet to increase their folate intake. That is one of the main reasons behind the calls for mandatory fortification and is one of the reasons why the debate was called.
UK wheat flour is currently fortified with calcium, iron, niacin and thiamine in accordance with the Bread and Flour Regulations 1998—introduced under the last Labour Government—which apply in England, Scotland and Wales, with parallel regulations in Northern Ireland. This mandatory fortification is a domestic, not an EU, requirement and is done for public health reasons. It has the primary objective of restoring those nutrients lost during the milling process, with the exception of calcium, which is added in larger amounts than that lost.
To date, successive Governments have not considered that the mandatory fortification of flour with folic acid is the best way of protecting public health and have instead promoted the use of supplements as part of a wide range of pre and post-conception advice to women of childbearing age. That may be merely stating the obvious of where we have come from, but it does not necessarily need to mean where we are headed.
While it may appear straightforward to just add folic acid to the existing mandatory flour fortification measures, a problem that arises with the proposal to move from the current advice of taking a measured supplement is of how to ensure that women are able to assess their folate intake if getting it from foods made from flour instead. Women in the targeted age group may not eat the relevant products in sufficient quantities.
We also want to consider the population’s wider dietary advice, and to educate women to encourage them to achieve a greater folate intake by way of eating those folate-rich vegetables that I mentioned earlier, rather than relying on flour-containing foods, which may not be the best contributor to a balanced diet. It will be necessary to consider properly women’s consumption of all wheat flour-containing products to fully understand the impact of any mandatory fortification on diet and folate intake levels. Additionally, we are aware that the universal fortification of flour with folic acid may not be readily accepted by the general public, especially when the measure is intended to benefit only a specific section of the population.
The aforementioned Scientific Advisory Committee on Nutrition—SACN; it was indeed called COMA—is a committee of independent experts on nutrition that provides advice to Public Health England, for which I have ministerial responsibility, and other Government agencies and Departments across the UK. It has recently updated the evidence on folic acid in response to a request from Food Standards Scotland, which was prompted by Scottish Ministers expressing a desire to proceed unilaterally with the mandatory folic acid fortification of flour north of the border.
In its most recent July 2017 report, SACN saw no reason to change its previous recommendations, made in 2006 and 2009, for mandatory folic acid fortification, to improve the folate status of women most at risk of NTD-affected pregnancies, provided that this is accompanied by restrictions on voluntary dietary fortification with folic acid. Again, this emphasises the need to fully understand all the sources of folate intake by women, to ensure that their health is protected as well as to protect their unborn children. The Wald paper, which is a new scientific paper published on 31 January this year in Public Health Reviews, has again raised this issue. However, the paper suggests that there should be no upper limit on folate intake, which would remove some of SACN’s concerns.
The Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment—COT—is another independent scientific committee that provides advice to the Government on, among other things, the safe upper levels for vitamins and minerals. The Wald paper was brought to the attention of COT by its chairman, and COT agreed to take forward for further consideration the issue of tolerable upper limits for folate. COT discussed a scoping paper in March this year and will have its first detailed discussion in July to see whether Wald’s analysis of the data is correct and whether the original tolerable upper level recommendation is not appropriate. COT will then receive a second paper in September considering all of that and is hoping to be able to report its findings towards the end of this year.
I wanted to put that on the record because it is the advice I have been given, but I have to say that, frankly, I am the Minister, and that is not good enough for me. I want it sooner than that, so I have asked COT to come and see me by the end of this month to explain itself and to see whether we can move forward more quickly.
To conclude, I am moved by the testimonies given today. The right hon. Member for Belfast North (Nigel Dodds) is a gentleman and an excellent parliamentarian, and his speech about his son, Andrew, cannot have been an easy one to make. I thank him for putting those personal things on the record in the way he did. There are many issues to consider, but I wholeheartedly agree with the sentiment of the debate. I will do my utmost as the public health Minister, working with other colleagues across Government—this impacts on other Departments as well—to work through the issues to give the best effect to the aim of the debate as soon as we possibly can.
I thank the Minister for his response, but I have to say that I am disappointed by it. I am disappointed principally because I do not think he has taken the action that he could have on the basis of the evidence that has been presented both today and, more importantly, by the scientific community in our country and around the world over the past 25 years, as well as the lived experience of the 80-odd communities, societies and Governments around the world that have undertaken mandatory fortification with no evidence recorded in any studies of any of the potential adverse events in their populations that have been referred to in a few scientific papers.
The Minister concedes that the current process is not working because of low uptake of the advice and because so many pregnancies are unplanned. I am pleased that COT is looking at the Wald paper on tolerable upper limits and the evidence it presents that there is not one, because excess folic acid is excreted. However, I am intrigued to know—I will write to the Minister on this—whether COT has advised the Government not to introduce mandatory fortification and not to follow the advice from their other advisory body, SACN, formerly known as COMA. If it has not offered advice to that effect, I cannot understand where Ministers are getting the advice that tells them not to introduce mandatory fortification.
The only formal advice that Ministers have had from 2000 to 2017 is to do what all Members here and the scientific community have recommended and to get on with mandatory fortification. It is a mystery to me why the Government continue to suggest that there are serious scientific reasons for not doing it. I do not believe that the Government have illustrated that and I do not think that the Minister illustrated that today; unfortunately, I do not think successive Ministers in all Governments have illustrated that.
Today has been a missed opportunity. However, I leave the Minister under no illusion that we will continue to raise this issue and to push for mandatory fortification. I look forward to debating it with him again in the future.
Question put and agreed to.
That this House has considered the mandatory fortification of flour with folic acid to prevent spina bifida and anencephaly.