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House of Commons Hansard
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Westminster Hall
26 June 2018
Volume 643

Westminster Hall

Tuesday 26 June 2018

[Mr Laurence Robertson in the Chair]

Phenylketonuria: Treatment and Support

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Given the number of Members who will seek to catch my eye, I am imposing a four-minute time limit on Back-Bench speeches.

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I beg to move,

That this House has considered access to treatment, support and innovative new medicines for phenylketonuria patients.

It is a pleasure to serve under your chairmanship in this important debate, Mr Robertson. It is just over 12 months since I was elected Member of Parliament for Blaydon, and only a few days less than that since I first heard of phenylketonuria—commonly known as PKU, which is easier to pronounce. One of my constituents, Barbara McGovern, had called at my office and spoken to a member of my staff about whether I would attend an event in Westminster on 28 June. Barbara’s son Archie has PKU, and she described his condition and some of the restrictions that he has to cope with every day. Her explanation of what PKU means, and her determination to get the best for her son, impressed my staff, who made sure that I attended the reception to learn more about the condition. Barbara and her husband David, and Archie, have travelled from the north-east to listen to the debate, and I welcome them.

Since that first encounter, I have been lucky enough to be introduced to the officers of the National Society for Phenylketonuria, and have had the chance to work with them and its other members to raise the profile of PKU, get people to understand it and its effects, and press for access to treatment and support. I will give a few of the many names that I could mention. Kate Learoyd and Caroline Graham both have children with PKU, and they have dedicated much of their time to talking to Members about the condition and the need for action for people who live with PKU. Professor Anita MacDonald OBE, of Birmingham Children’s Hospital, also does much to raise awareness of the condition and goes above and beyond in advising families affected by PKU on diet.

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I commend my hon. Friend on securing the debate and on her leadership of the all-party parliamentary group on phenylketonuria. There are lots of health-related campaigns for more resources, new treatments and drugs. Many have plenty of resources and are funded by major pharmaceutical companies, which hire expensive lobbyists and all the rest of it. The remarkable thing about Kate Learoyd and Caroline Graham is that they are parents of children with the condition, and their campaign is entirely voluntary. They have to fit it around their family and other commitments, which makes their work all the more remarkable.

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My hon. Friend is absolutely right, and of course there are many others working hard in the NSPKU.

PKU is a rare inherited disorder, affecting about one in 10,000 babies. Most people are familiar with the pinprick test that newborn babies are given; that is how the condition is picked up. It is one of a series of tests given. People with PKU are unable to break down the amino acid phenylalanine, which is found in proteins. They must have a diet very restricted in protein to prevent problems. If the condition is not properly controlled, it can lead to severe neurological and brain damage, as well as to behavioural problems. Untreated PKU causes profound, irreversible intellectual disability, seizures and behavioural problems. As the damage is not reversible, early diagnosis and early consistent treatment are vital.

I say that the condition can be treated by diet; that sounds easy, but it is not. Imagine, as a child or young person, trying to cope without all the foods that most children and adults take for granted. When we think of food that is high in protein, we probably think of meat, but that is the straightforward bit. All meats are on the red list, and so is fish. Everyday bread is too high in protein, so people with PKU must have special bread without protein, much of which must be baked at home using a specially prescribed flour.

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Having learned about the disease and issues connected with it, I think that the hon. Lady is right to argue for better treatment, but I am struck by the peculiar and intense pressures that PKU puts on parents and carers. Does she agree that we should explore ways to support them in coping with those pressures?

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I agree. There is incredible strain on parents—and of course on people with the disease, but we must not forget about the parents.

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I commend both my hon. Friend for securing the debate, and the many parents and families who work to raise the issue. She is right to highlight how challenging the condition can be for children, particularly in adolescence. A constituent told me that her daughter asked whether, for her 18th birthday, she could eat a pizza in a restaurant—seemingly a normal activity for a teenager, but a clear challenge for such children, who want to fit in with their peers.

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My hon. Friend is right, and I want to touch on that issue.

As well as having to have bread specially baked with prescribed flour, people with PKU can have no cheese, eggs or dairy products. Even some vegetables, such as cauliflower, are problematic, and so are potatoes, so there can be no chips or crisps. The daily intake of food needs to be monitored constantly. Imagine how that must be for a child at school who just wants to join in with classmates, or for young people who want to go out and socialise with friends—perhaps to go for a pizza, as my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) mentioned—and get on with their life. Everything must be measured and calculated to make sure that the appropriate level of protein for the child or adult with PKU is not exceeded.

Let us not forget that the condition is lifelong, and adults, too, must restrict their intake of protein. On top of all that I have described, both children and adults must take a protein supplement. I and other MPs have had the chance to try it, courtesy of our friends at the NSPKU, and it is not a pleasant experience. That puts additional pressure on parents, who often struggle to get their children to take the supplements, which they really need, three times a day. Making sure a child has the right diet, including when parents are not around to control it, and trying to make food interesting, often by starting from scratch with basic low-protein foods, is a minefield.

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I congratulate the hon. Lady on securing the debate and on her work for the all-party group. A constituent shared with me some experiences similar to the ones that she has outlined. They are heartbreaking, and other Members who have constituents with PKU will share that feeling. Does the hon. Lady agree that alongside the medicinal treatments that might be available, it is important to raise awareness, through debates such as this one, and through Thursday’s “diet for a day”, in order to help provide and incentivise more support for parents who are supporting their children with PKU?

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I agree; it is important to look at the question in the round.

Many parents find that they need to give up work or reduce their hours to maintain their child’s diet and keep them healthy. At the end of last year, the NSPKU produced a booklet and video, “Patient Voices: Listening to the experience of people living with PKU”, which clearly and movingly sets out the practical and psychological impact of the condition on individuals.

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I congratulate my hon. Friend on getting the time for a debate on the issue; not enough is known about it. It strikes me, as I listen to her, that a child with PKU is a prisoner of their body, in a way, and so are their parents, because of the regimented way they must deal with the child’s needs. Does she agree?

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I most certainly agree that it places an incredible strain on parents, who must live with that all the time. I recommend the “Patient Voices” booklet and video to anyone who has not already seen them.

In this debate, I will highlight very specific concerns about treatment and support for PKU. The first is the issue of access to a drug treatment, sapropterin, which is thankfully more commonly known as Kuvan. Although it is available in 25 countries across Europe, and was licensed for marketing over 10 years ago in the European Union, Kuvan is not available to people with PKU in the UK.

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I congratulate the hon. Lady on this important debate. She makes a hugely important point about the licensing of Kuvan. The European Medicines Agency licensed the drug in 2008, and 10 years on we have buck-passing between the National Institute for Health and Care Excellence, the Department of Health and Social Care and NHS England. It is deeply concerning. I am representing two children with PKU—I am sure there are many more—in my constituency. I got a letter back from NICE just a few weeks ago that said that the condition and the treatments for PKU are

“the subject of a NHS England commissioning policy…not covered by any existing NICE guidance.”

It went on to pass the buck back to NHS England. Does the hon. Lady agree that it is time for the buck-passing to stop, and for the treatment to be licensed?

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I absolutely agree. I hope that one of the good things that will come out of this debate will be that the buck stops being passed, and the assessment gets done as quickly as possible. It is so important for people to have access to this drug; we need that to be sorted.

There is evidence that for a significant proportion of people with PKU—about 25% —this drug can significantly improve their condition. It does not cure it, but it does make it much easier to deal with the dietary issues, which have such an impact on the way people live their lives. Despite the drug having been around for so long, NHS England has only recently considered it for the management of PKU. The drug has now been referred to NICE for assessment and technology appraisal. The APPG on PKU recently heard from NICE about the process, but there is concern about the timescales and how the benefits of the treatment will be assessed. Understandably, there is huge frustration on the part of the PKU community that there are children and adults who could be benefiting from Kuvan now, and there is substantial evidence to support its benefits.

There is a particular issue about prescribing Kuvan for pregnant women with PKU, who can understandably find it hugely difficult to control their diet, and who fear the effect of any problems on their unborn child. While there is a 2013 commissioning policy in place that allows Kuvan to be prescribed to some pregnant women, it can be difficult for women to be prescribed it in a timely way.

Some people, some of whom are in this room, have had access to Kuvan through individual funding requests, or on a trial basis. Those people have found real benefits from the drug. My constituent Archie, who is here, started on the treatment earlier this year. Archie tells me he has benefited from having Kuvan, not just because his diet is now much less restricted and he is able to do what many of his school mates do, but because it has improved his energy and his life. As his mum Barbara said to me, “If we had been coming here before the treatment, we would have been bringing our own special breakfast for Archie to eat in the hotel, and would have had to watch everything he ate very carefully. It has made a real difference.” I hope that the Minister will be able to assure us that the assessment of Kuvan will be done very quickly, and that it will be available to the people it can help.

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I congratulate the hon. Lady on securing this important debate. Kuvan, the brand name for sapropterin, is clearly deeply beneficial for about 20% to 30% of sufferers. I met the manufacturers last week, and they told me they had written to NHS England twice to ask for meetings to discuss price, but they are still waiting for a response. Will she join me in urging the Minister to use all his best offices to ensure that that meeting and the price negotiation can go ahead?

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I certainly do join the hon. Lady in that wish. I too have met BioMarin, which says it is prepared to negotiate significantly on the price, but we need to get in there and ensure that it happens quickly.

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I congratulate my hon. Friend not only on securing this debate, but on the knowledgeable and passionate way in which she is putting the case. Does she agree that this is an example of the way that we in this country are very bad at dealing with rare conditions and potential therapies or treatments for them? Does she believe that, while this needs to be hurried up, the whole process needs to be streamlined and sped up?

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I certainly agree with my right hon. Friend. It has become clear, as we have looked into the issue, that there is a very complex way of assessing drugs. Clearly, we want to get the process right, but there needs to be a rigorous look at that process, not just for Kuvan, but for other treatments for rare diseases. PKU perhaps falls between the cracks, because it is not quite rare enough to be in that group, but it is still very rare, and will be pushed to the back of the queue if it goes into a more general group.

For those whom Kuvan will not help, and who still need to manage their diet carefully, there is another issue that must be addressed: access to low-protein foods, which help to maintain the diet. Individuals may be advised through their dietician and their specialist centre that they need a particular level of foodstuff supplies, such as the low-protein flour I mentioned, which I am told can be used in many ways to try to make the diet more palatable. General practitioners, however, may not have a complete understanding of the condition or the dietary needs, and may feel that patients are just trying to get food on the cheap, and they may limit or deny prescriptions for those foodstuffs. They may feel that they are like gluten-free foods, which can be bought at supermarkets.

The fact is that those foods and supplements cannot be bought; they are available only on prescription, and the absence of them creates a real injury to those affected. It is not just that they are not there; it is actually damaging if they are not available. It would be good if the Minister could address how we can ensure that GPs prescribe the specialist foodstuffs that form part of the treatment that those with PKU need, and how we can close the gap between the specialist services, clinical commissioning groups and GPs.

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I add my congratulations to the hon. Lady. Does she agree that there should be clear guidance, so that GPs or CCGs that are thinking about stopping prescribing that stuff can be told quickly and clearly that that is the wrong thing to do, and that there is no other way of getting this bread, and so that if one of them is foolish enough to go down that line, there can be a quick resolution?

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I thank the hon. Gentleman for that comment, and I agree. Last week at the APPG meeting, we heard some terrible stories; over the years, people have felt as if they were asking for a favour in asking for those goods. They are not; the goods are absolutely essential, and they cannot be bought over the counter. We must do something about that. We need to square that circle.

Finally, for the 75% who will not benefit from Kuvan, it is important that new, innovative treatments are developed and assessed quickly, so that more people can benefit from treatments that enable them to live well and safely with the condition.

To conclude, it is important that we listen to individuals and families who are living with PKU day in and day out. It is time that this condition was acknowledged, and that we addressed the need for effective treatment. I hope that the Minister can give us positive news that will move us forward in helping those with PKU.

This Thursday, on National PKU Awareness Day, I and many other hon. Members in this room and across the House will undertake the PKU “diet for a day” challenge. We will restrict our protein intake to 10 grams a day, avoid all those things we normally eat without thinking, such as that piece of toast in the morning or Rice Krispies with real milk rather than coconut milk, and drink tea or coffee without milk. We know that we will not really face those restrictions day in, day out, or the relentless grind of getting the diet right to stay well, but we hope that it will help raise public awareness of PKU, and help to bring about change.

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Like other hon. Members, I wanted to speak in the debate because PKU affects a family in my constituency. I will not go over what PKU or Kuvan are. The hon. Member for Blaydon (Liz Twist) did an excellent job of that, and I congratulate her on her work as chair of the APPG in bringing this issue to wider attention across the House.

Scotland has a higher prevalence of PKU than other parts of the UK, which makes the attitude of the Scottish Medicines Consortium so disappointing. It has a poor record of approving treatments for very rare diseases, and I understand from conversations with the NSPKU that the current application for PKU is not going particularly well. The decision is due next week on 3 July, and there is real concern that it will not be approved, even for high-risk groups such as pregnant women. The hon. Member for Blaydon mentioned that there is currently a pretty poor Kuvan policy for pregnant women in England. It may be poor, but at least it is a policy; we do not even have that north of the border.

Pregnancies for women with PKU are extremely high risk. We have a slightly odd fail-first approach in this country, which can lead to serious defects and lifelong disabilities for children if they survive the pregnancy. The cost to the NHS of treating those disabilities over the life of the child is significantly more expensive than the cost of Kuvan for the mother during pregnancy. We have an odd approach to cost-effectiveness when looking at medicines in this country that I think we need to reassess. That is not only true for Kuvan—we have seen it when talking about Orkambi and for various other issues.

I completely agree with the decision of the NSPKU to apply for Kuvan to be placed in the ultra-orphan stream due to the rareness of the condition and the Scottish gene variant. I was disappointed to hear of the Scottish Government’s lack of engagement with the NSPKU, so I ask Scottish National party Members present to do something about that. While I appreciate that there is a distinction between the Scottish Government and the SMC, the Scottish Health Secretary could step up a little bit there.

As a Scot from Greater Glasgow, I was of course drinking Irn-Bru when I met the NSPKU in Portcullis House. That led to quite an interesting discussion, because Irn-Bru could previously be given to young adults with PKU as a kind of treat and something to make them feel normal, but then we introduced the sugar tax. The recipe for Irn-Bru changed overnight and they could no longer drink it. It suddenly became toxic. This is one situation in which a very well-meaning policy, such as the sugar tax, had unintended consequences.

Members may have been in touch with their diabetic constituents after the recipe for Lucozade changed and suddenly they could not drink something that had been safe for them. Unless someone has very good eyesight, it is hard to read on the can that the recipe has changed. We also have the odd situation in Scotland where, depending on the shop, someone can buy old recipe Irn-Bru or new recipe Irn-Bru. They have to check very carefully. I do not think that we do a good job of looking at the potential unintended consequences of changes in health policy for special interest groups.

I was struck in our discussions when it was put to me that, in 12 years’ time, my now four-year-old daughter will be going out and I will worry about her drinking alcohol or smoking, so imagine being the parent of a child with PKU and worrying about them going to a friend’s house and eating a bag of crisps. The difference in terms of the strain and pressure is huge. For the family in my constituency, the parents of 10-year-old Katie and 20-month-old Harry said to me:

“Having PKU is a constant shadow that hangs over the family. Everywhere you go you are surrounded by food they…can’t eat...Katie’s 10 and wishes she could eat what her friends can, or even a little bit of it, but is aware”—

even at age 10—

“of the implications of brain damage if she doesn’t stick to her diet... Kuvan might not work for her, but if it did it would be life changing…It’s really sad knowing that our one year old has all this ahead of him.”

We can and should do more to get Kuvan out there.

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It is a pleasure to serve under your chairmanship, Mr Robertson. I must admit that I had not heard of PKU before my election to the House, let alone of some of the medical terms, which I still cannot pronounce. I think that the same is true for many across our country. In fact, after hearing that it meant a fault with enzymes, leading to an inability to break down the amino acid phenylalanine—PHE—I was not much the wiser.

However, after hearing my constituent Holly Mae’s story and what the condition meant for her everyday life and tasting the various concoctions that replace typical meals for PKU patients, I was left in no doubt as to the potential debilitating impact of the disease. That is why I will begin with the impact on everyday life and what that means in practice for people with PKU.

As has been mentioned, people with PKU have to eat a diet with virtually no protein, meaning that they must take chemical supplements to avoid malnutrition. The briefing I was sent by the excellent NSPKU describes the protein replacements as “unpalatable”. I have tasted those replacements and can assure hon. Members that the NSPKU is being polite; they are absolutely rank. However, they do not just taste disgusting. They form part of an incredibly prescriptive and restrictive diet that not only consumes a huge amount of time—approximately 19 hours a week—but makes living a normal life difficult and social activities intolerably difficult.

Hollie Mae’s mum, Tara, says they hardly ever eat out. When they do, they have to bring separate food. It is the same at friends’ houses. It is inevitably a difficult diet to manage, and because no young person likes to stand out as different, PKU makes sensitivity and insecurity around food and eating particularly pernicious among its teenage victims. These young people just want to live normal, happy lives, but PKU often exacerbates teenagers’ vulnerability to eating disorders and so also becomes a mental health issue. I therefore urge the Minister to do all he can to improve access to psychological support for people with PKU. Clearly, the pressure of PKU and the diet it necessitates puts patients in immense difficulty and can be overwhelming.

We have just celebrated national Carers Week, and it is important to consider the burden that falls on families too, as we have heard. Half of parents stop working or reduce their hours to accommodate the extra work of caring for a child with PKU. What is more, the burden inevitably falls on women, with 81% of respondents to an NSPKU survey saying that it was the mothers who did most of the PKU-related work. I pay tribute to Tara and all the other parents and families who care for those with PKU. However, they do not want warm words, they need action.

I hope the Minister agrees that the opportunity to offer those with PKU and their families hope of a better life cannot be missed. There are practical things that can be done. I suggest that that means meeting with the manufacturers of a tablet can make a massive difference. It means making life a little bit easier for families and PKU patients by fixing the fragmented service on offer and smoothing and simplifying the chain from specialist metabolic clinic to GP to pharmacist to courier, complications in which constantly cause grief for patients. It definitely means ending the exclusion of PKU treatments from the prescription charge exemption.

The fact that PKU is a rare disease should not mean that it deserves any less of our attention. On behalf of my constituents and Hollie Mae, I urge the Minister to implement these changes.

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It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate the hon. Member for Blaydon (Liz Twist) on securing the debate and on championing so well the cause of PKU patients and their families and carers.

It is also appropriate to highlight the pioneering work of my hon. Friend the Member for Spelthorne (Kwasi Kwarteng). In an Adjournment debate on 1 December 2011, he highlighted his constituent’s problems in obtaining a Kuvan prescription. He successfully secured a prescription for his constituent, but it is most unfortunate, as we have heard, that six and a half years later we are no further forward in making this drug, which has the proven potential to change many people’s lives, more widely available.

Finley Walsh lives in Lowestoft with his parents, Michelle and David. He is two and half years old and he was born with PKU—a genetic condition that will be with him for his whole life. All Finley’s foods have to be weighed, using a calculation that takes account of the amount of protein in the food. His parents have to take weekly heel-prick blood tests, which are sent to Addenbrooke’s hospital in Cambridge for analysis. The results are then sent to the Norfolk and Norwich Hospital, where dieticians phone through the results that enable Michelle and David to prepare Finley’s food intake for the coming week. That is a critical, delicate and often worrying process for them. It is vital to get Finley’s protein levels right; if they go too high, there is a real risk of brain damage.

The challenges that the family face daily are immense and place a real strain on them. Quite often, the blood test results do not come through on time and must be chased up. At present, they have had no feedback for two weeks. Food must be ordered on prescription to enhance Finley’s diet. Products such as those from Violife and Hooba are not only expensive but, quite often, not immediately and readily available. At present, there is also the worry that Finley was due to have a review with his specialist in May and that appointment has yet to take place.

Children with PKU suffer patchy care and support, which depends on where they live. That could be addressed by setting up specialised metabolic centres with an experienced metabolic physician and dietician. Psychological support should also be available in the centres to assist children if they experience learning difficulties and to ensure that they receive an education that enables them to realise their full potential. The centres could also administer prescriptions for PKU foods and dietary supplements so as to provide a more efficient service and to overcome the problems that the Walshes are experiencing.

On Thursday I, too, will take part in the PKU diet for a day challenge. In no way does that replicate the real experiences of people such as Finley, but I hope that together, we in this Chamber and around the House can highlight the need for modern treatments and better care for those who face such an enormous challenge daily.

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Like other hon. Members, I had never heard of this condition until I was contacted by a constituent, Kirsty Thornton from Dudley. She is the reason why I am taking part in the debate. To hear how the condition had affected her was very moving, and as a result of meeting her, I met Kate Learoyd and Caroline Graham, to whom I paid tribute earlier. I want to mention one other person at the outset. Professor Anita MacDonald OBE, who is with us today, is the brilliant head of a dedicated team of dieticians caring for children with rare inherited metabolic disorders at the Birmingham Children’s Hospital. I want to tell the Minister that Kate Learoyd, Caroline Graham and Anita MacDonald are here today. I hope that, at the conclusion of the debate, he might find a moment to say hello to them and arrange to meet them properly and at length subsequently.

It is deeply moving to hear how families manage this condition, particularly for toddlers, who cannot understand why they are not allowed to eat the same food as their siblings or have the same food as their friends at a birthday party. One parent has said of their child:

“She resents the fact that her family can eat normally and she can’t. At mealtimes, she will go into a depression. Often she will ask to eat the crumbs of normal bread off our plates or we catch her licking our plates. It is awful to see.”

It is very distressing to hear how a simple mistake can have huge ramifications, affecting a young person’s concentration and even their mental health and then their ability to study or to work. One young person said:

“When I have high phe levels I slur my words, struggle with balance, lose my train of thought and stop speaking...I am hit with such fatigue that I lose sight of what it is like to feel awake.”

I would therefore like to encourage the Minister and the Opposition spokesperson, my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), to join us on the PKU diet challenge this Thursday—indeed, I hope that as many hon. Members as possible will take part—to highlight the difficulty of adhering to the strict rules that people with this condition have to follow. We have to do this properly and stick to the rules. We have to check all the ingredients, as we heard earlier, weigh foods properly and keep a tally throughout the day of the amount of protein that we have eaten. Most of all, as we have just heard, we have to remember that we are doing it only for a day and not a lifetime, like the constituents on whose behalf we are speaking today.

I want to ask the Minister three other questions before I conclude. First, as he has heard, we are calling for an examination of the failure to use Kuvan in the UK. That treatment can transform people’s lives. It has been licensed for almost 10 years and is used in lots of other countries in the EU. We would like the Minister to take personal charge of this matter and work out what can be done to sort out provision of it in the UK, too.

Secondly—we have raised this issue in respect of other conditions and other drugs—will he look at the appraisal rules for new treatments for PKU? This is a very rare disease, but it has a wide impact outside direct health costs. It is not a criticism of NICE or the Minister or Government, but the fact is that these are conditions and treatments that NICE was not really designed to deal with. How can the appraisal system be altered to work for conditions such as this?

Finally, will the Minister work with the NSPKU to review the provision of treatment to patients, including basic dietary treatments? How can that be made consistent across the country? It is not the case at the moment. That is a very urgent thing that it should be possible to sort out without too much difficulty.

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Thank you, Mr Robertson, for the opportunity to speak in this important debate. I add my congratulations to the hon. Member for Blaydon (Liz Twist) on securing it. I speak as a chair of the all-party parliamentary group on rare, genetic and undiagnosed conditions, but also on behalf of my constituent Cait, and other constituents who suffer from PKU. I was very honoured to lead an Adjournment debate on this condition in March. I will not repeat everything that I said then, but I want to add some points.

PKU is a very rare condition, affecting about one in 10,000 people, but it is not ultra-rare, and that is part of the problem. Living with PKU is extraordinarily challenging, but for the 20% to 30% of sufferers who react positively to the drug sapropterin, there is a glimmer of hope. That is only about 150 children in the UK, and about 350 people in total, but for them, sapropterin is life-changing. Sapropterin is available in Austria, Belgium, Bulgaria, the Czech Republic, Denmark, Estonia, France, Germany, Hungary, Italy, Latvia, Lithuania, Luxembourg, the Netherlands, Norway, Portugal, Romania, Russia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and Ukraine, as well as in the United States. However, except for a small number of people—truly exceptional cases—and women during pregnancy, it is not available in England on the NHS, and that must change. It should be available for all those who would benefit, not just those who cannot stick to the diet. Those who do stick to the diet should not be excluded for good behaviour.

I understand that NICE sometimes has a very challenging time in considering whether to approve drugs that can be very expensive, but sapropterin does not fall into that category. In my Adjournment debate, I pointed out that when the broader economic benefits of prescribing PKU are compared with the costs of not doing so, the pure financial calculation alone suggests that it may even be financially beneficial to the public purse to prescribe the drug. Furthermore, as I stated back in March, BioMarin, the manufacturer, told me that it was willing to make a substantial reduction in the price. During that debate, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), suggested that a patient should go down the individual funding request route, but I understand that only one child has ever managed to receive the drug by that route. It simply does not work for the patients who need it.

I have written to the Under-Secretary of State for Health in the House of Lords a couple of times and I am grateful for his responses, but in his latest response, he suggests, in relation to the approval process, that the drug has now been prioritised for potential guidance development through NICE’s technology appraisal programme. Both patient stakeholders and the manufacturer are really concerned that that could lead to even more delays. BioMarin tells me that it has written twice to NHS England, offering to meet to discuss price. It wants to negotiate on price; it wants to make a generous offer, but its letters have apparently not been responded to. The decision needs to be made. It should not need 21 Members of Parliament standing here in Westminster Hall to get this drug for 150 children.

Looking at the broader picture, there is a fundamental problem with NICE’s commissioning programme. It works well for common conditions, and the highly specialised technologies process seems to work well for ultra-rare conditions, but conditions such as PKU fall through the gap. We need to find a way to get modern, personalised, specialist medicines to those who need them, where their condition is rare, but not unique.

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It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the hon. Member for Blaydon (Liz Twist) for securing this important debate and for her cogent argument. I am here on behalf of Mark Edwards of Llanegryn, Tywyn in Gwynedd. We have heard much about the impact on families and children, but the most effective thing I can do is talk about how Mark, as an adult, deals with this condition; how he manages from day to day; and what would make a difference to the quality of his life and the lives of others living with PKU.

Mark first contacted me about the sugar tax, which I had blithely thought to be a good thing. The sugar-sweetened drinks issue sums up how people with PKU struggle to strike the excruciatingly difficult balance between a medically essential specialist diet and fitting in with society’s rigid norms about food and drink.

Our social lives revolve around food and drink, from children’s tea parties to teenagers’ fast-food binges to adults’ restaurant dates. I have been told time and again how difficult it is for people with PKU to cope with the stigma of being “difficult” and “different”, especially over something as integral to our lives as food. If they cannot enjoy cake, jelly, burgers and chips, at least they can enjoy a fizzy drink—Irn-Bru or whatever the brand—like everyone else. Now, however, it costs more, because aspartame is on the red list. People with PKU are being taxed on one of the few social drink and food experiences that they are able to share with everybody else, simply because of their condition.

Mark is keen to stress how much he appreciates Wales’ policy on universal free prescriptions, which allows him to receive the special food and medical dietary supplements that he needs through Tywyn health centre’s dispensary, when he needs them and for free. That means that people with PKU in Wales have a much better arrangement, he said, than those in England. None the less, Mark still faces public prejudice towards his invisible condition. He has had to explain to people that he is not “freeloading on food”, as though it were a matter of lifestyle choice, and not medical necessity.

A number of us in this Chamber have committed to the PKU “diet for a day” on Thursday. A great number of people in Wales have also done so, and they deserve a shout out. They are: Alex Jones of Cambrian News; Janet Davis, the supervisor of Brighter Foods, where Mark works; school friends Carys Hughes and Nicci Hughes; and Tywyn solicitor Andre Bright, who has committed to keeping to the diet for a week. He deserves respect, even if a week is nothing compared to what the families face. I am only brave and organised enough to do it for a day; I apologise. We are doing this in solidarity with PKU families, but we also know that this in no way fully reflects or replicates the reality of their lives. Most of us will do this by being fussy and awkward—I anticipate living off aubergine for a day—but we are only doing it for one day. We will not face this fraught, potentially toxic relationship with food, and the stigma associated with it, every day of our lives.

PKU affects every aspect of one’s life. Controlling the condition by diet alone causes immense strain, and any possible medical intervention will make an immense difference to the quality of people’s lives. Wales is alert to England’s NICE guidelines, and I urge the Minister to do all he can to press NICE to move ahead, so that his Department can recommend Kuvan. I also urge that other drugs, such as Pegvaliase, be considered. I ask the Government to consider the health implications of the wider use of aspartame, which is associated with the sugar tax, and the way that it affects a number of other health conditions as well. Diolch yn fawr.

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It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate the hon. Member for Blaydon (Liz Twist) on bringing this debate. I also congratulate the hon. Member for Chelmsford (Vicky Ford) on her work in the past and on bringing her Adjournment debate to the House, which I supported.

I am the Democratic Unionist party health spokesperson, so it is important to be heard on this issue, which grossly affects people in Northern Ireland, as well as in the Republic of Ireland. Not many people know this, as Michael Caine always says, but there is a higher per capita prevalence of PKU in Northern Ireland than in the rest of the UK. In fact, one in 4,000 people in Northern Ireland has this condition, compared to one in 12,000 in England.

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Given the higher incidence in Northern Ireland, but also instances across the United Kingdom, does my hon. Friend agree that that it is imperative for the Minister, and all health Departments across the UK under the devolution settlement, to ensure that the best possible treatment and support is given to PKU sufferers and their families?

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My hon. Friend is absolutely right. We always look to the Minister for support on these issues, and he is always very forthcoming, so we look to him again with that in mind. It is clear that this condition affects my constituents and those of everyone else who is speaking today.

PKU is usually diagnosed shortly after birth by the heel test. Many women can tell us that when the heel prick is done and they hear their child crying in the hands of the midwife, their automatic reaction is to reach out and grab the child. That test is so important at a very early stage. For those families who receive a diagnosis of PKU, however, the pain begins when they realise just what that means.

People with PKU have a faulty version of the enzyme that breaks down the amino acid phenylalanine, a component of protein. Untreated, it can cause brain damage when it builds up in the blood and brain. Untreated PKU causes profound and irreversible intellectual disability, seizures and behavioural problems. The damage is not reversible, so early diagnosis and early consistent treatment is vital. That is why, in 1969, we added this test to the routine blood test at birth. Some people here were not born then; I was just a young child.

The only treatment for PKU that is currently funded by the NHS is a very restrictive diet. I am a type 2 diabetic, so I understand a wee bit what it means to be careful with what I eat. I know that if I had a wee bit of honey with my toast this morning, I probably should not have done, but by and large I know what I have to do, and what I can and cannot eat. For those with PKU it is much more difficult, and the restriction is great. Most sources of protein are removed from the diet to prevent brain damage.

I want to give a few quotes from the parents of PKU sufferers, so that we can understand a bit better the life lived by those with this disorder. One parent said:

“The low protein prescription breads and pastas give her stomach ache—another reason she refuses to eat them.”

A parent whose daughter has PKU said:

“My daughter struggles with drink supplements as they all upset her tummy so she has to take 50 tablets per day.”

Another parent said:

“PKU causes arguments between us. My husband and I have suffered with stress, we argue about the management of her diet. I had hoped after 12 years things would get easier but this diet is met with anger, frustration, resistance and annoyance all aimed at me.”

The hon. Member for Dudley North (Ian Austin) already referred to the following case, but it is worth repeating simply because of its importance. One parent said that her daughter cannot normally eat, adding,

“she will ask to eat crumbs of normal bread off our plates or we catch her licking our plates.”

That is the impact PKU has on some children and their families. That is why parents throughout the UK are demanding that more be done. We look to the Minister to see if more can be done through his office. If there is something to help these people, we must make it available. We all know what must be made available: Kuvan. We all know what it can do. One young girl took a one-month trial of Kuvan and could eat a normal vegetarian diet. She had more energy, her mood lifted, her nightmares stopped and she could do ordinary activities at home and at school. What a difference it made to the child’s quality of life, and that of the entire family!

I have read that the cost of Kuvan is on average £14,535 for a child and £43,597 for an adult, based on list pricing. The pharmaceutical company BioMarin has publicly stated its willingness to offer substantial discounts in a deal with the NHS. I am asking the Minister, as other Members have done, to broker that deal, and enter into meaningful discussions on providing the medication, as the High Court ruling has said that we should. I urge the Minister to instruct his Department to find a way of making this available, rather than simply checking a box.

In conclusion, I ask that no parent be forced into this situation when there is something available to prevent it. I stand with the PKU sufferers of Strangford, Northern Ireland and the whole of the United Kingdom of Great Britain and Northern Ireland.

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I commend the fantastic work of my hon. Friend the Member for Blaydon (Liz Twist) and the National Society for Phenylketonuria, who have worked incredibly hard to raise awareness of PKU in Parliament in the past few months.

Until I met with representatives from the NSPKU a few months ago, I knew very little about PKU, like many other hon. Members. Since, I have learned a huge amount about it, and it has become clear that this devastating disease requires action. It affects one in 10,000 people across the UK. Although it is rare, an estimated 3,000 individuals in England alone live with it and could benefit from increased awareness and improved treatment of it.

As we have heard, the only treatment of PKU available on the NHS is a severely restrictive diet. Patient voices from the NSPKU illustrate how much of a daily struggle that diet is. It often leads to eating disorders and unhealthy relationships with food. It forces patients into social exclusion and is a great burden on their carers, who often also report psychological distress and strained family relationships. Studies show that half of parents will stop work or reduce their hours to accommodate the extra work needed to take care of a child with PKU.

I am grateful to my constituents, who shared with me the story of life with their five-year-old daughter who has PKU. Their openness helped me to understand what that life is like, and the difficulties their daughter faces daily, especially when she is unable to eat the same meals as other children at school.

The fragmented nature of NHS services provided to PKU patients often leads to confusion and mistakes in the chain. The inconsistent quality of those services has made the system needlessly complex and has added to the patients’ burden. There have been multiple reports of clinical commissioning groups restricting funding for PKU dietary products. The variable quality of even the most basic treatment is simply not good enough.

Beyond dietary treatments, a drug called Kuvan has been developed, as has been mentioned. It can treat up to 25% of PKU patients and allow them to eat substantially more natural proteins, which fundamentally improves their quality of life. Despite having been licensed in the USA since 2007 and the EU since 2008, and being used in almost every EU country as a routine treatment for PKU, it is unavailable for the vast majority of patients in the UK.

Of course, Kuvan comes with a price tag, but as we approach the 70th birthday of our treasured NHS, we must allow it to uphold its fundamental principle of providing healthcare on the basis of need.

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It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate my hon. Friend the Member for Blaydon (Liz Twist) on securing this important debate. I will speak on behalf of my 11-year-old constituent, Olivia, and describe a bit of her struggle. I congratulate her parents on fighting so hard for her, because the stress on families is incredible. We have heard from many hon. Members about the impact that PKU can have on the whole family and just how isolating it is. The National Society for Phenylketonuria is helping us as parliamentarians to get to grips with the issues.

We have heard how restrictive the diet is. My hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell), who is no longer in her place, talked about going to a pizza restaurant at the age of 18. Olivia is 11, but she is allowed only 8 grams of protein a day. She was fortunate enough to participate in the one-month trial of Kuvan, and she was found to be a responder. Her protein tolerance increased from 8g to 27g. On Kuvan, she had safe, low blood results and ate healthy, natural, normal vegetarian food. She could have baked beans at school on a Friday with a normal-sized portion of chips, just like her friends. It filled her plate—and her, instead of leaving her hungry. Her teachers commented on how bright and focused she was in lessons. Ironically, they asked, “What did she have for breakfast today?”. Olivia loves life, and, during that month on Kuvan, it showed, just as it does for everyone else.

As many hon. Members have pointed out, it seems anomalous that a drug that is licensed in the US and the EU is still so difficult to obtain for our constituents. NHS England has handed the draft policy on commissioning Kuvan to NICE for review, but no date has been set. I press the Minister for a date, because it is absurd that Kuvan has been prescribed for years as a routine treatment in the rest of the developed world.

For Olivia, the waiting is taking its toll. She has frequent and severe migraines that cause vision disturbance, light, sound and taste sensitivity, vomiting and gastroparesis. During such times, she loses her PKU supplement and exchanges food, which takes her off diet for the duration of the migraine. They are difficult times for the whole family. Her illness and temporarily altered sense of taste mean she cannot drink the supplement and wants the normal food she prefers. How could anyone refuse a sick child because the food contains too much protein? She can be off diet for 60 hours.

Last year, Olivia was also diagnosed with moderate to severe scoliosis—a curved spine—for which she has to wear a back brace for 23 hours a day until she is 16 years old. It is uncomfortable, painful, and often prevents sleep. Her consultant said that spinal fusion surgery would likely be advised, but PKU is likely to result in low bone density, especially among girls. Olivia had a scan that showed that her bone density was abnormally low and getting worse.

Nothing more can be done dietetically; the amino acid supplement contains the correct levels of calcium, vitamin D, vitamin K and potassium, but it does not contain whole protein, which plays a major role in bone density. By definition, the diet goes to great lengths to avoid whole proteins, and that is one of the consequences. Olivia may therefore never be able to have the spinal fusion surgery that she needs, because her bones are not strong enough to take the screws and rods that would need to be drilled and fixed to her spine. Kuvan would at least allow her to eat more whole natural protein. Would that not be better for her, and everyone else who has been mentioned? The only access route to Kuvan remains an individual funding request. I hope that the Minister will consider that issue in his response.

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It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate my hon. Friend the Member for Blaydon (Liz Twist) on securing this important debate. We have heard some heartrending accounts from hon. Members about the impact of PKU on their constituents.

My constituent, Denise Clayton, whose family I have known for 30 years, has lived with PKU for nearly 70 years, so she was born long before any real screening programme was in place. Consequently, she did not receive the required treatment, and the treatment she did receive was too little, too late to avoid neurotoxicity. Her family have done everything they could to support Denise. A few weeks ago, I spoke to her father, Norman, who recounted some of the traumas and difficulties that they experienced down the years. His view was that nothing could be done for Denise, but it seems that a treatment is now available.

I join hon. Members in their pleas with the Minister to use his good offices to ensure that the new life-changing drug Kuvan is made available so that the sufferers of PKU in the UK—like sufferers in other countries—can obtain the benefits of it and lead something approaching a normal life. Let us remember that we live in a wealthy nation; we are the sixth-biggest economy in the world.

PKU is a very rare condition that affects only a very few people in total across the country. The cost of the drug would be minimal in comparison to the life-changing impact it could bring about for young people—our fellow citizens. I plead with the Minister to listen to the impassioned pleas we have heard from Members today. He should use his good offices to ensure that the drug is made available so that we can change the lives of so many young people in our country who are suffering from this terrible condition.

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We now come to the wind-ups. I would like to leave two minutes for the mover of the motion to wind up at the end.

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It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate the hon. Member for Blaydon (Liz Twist) on securing time for this important debate and on her comprehensive and detailed summary of the issue. I am also grateful for the NSPKU briefing she kindly sent round to colleagues in advance of the debate. I must admit I had been in touch with Library specialists before I received the briefing to find out the pronunciation. The hon. Lady sensibly told us how to pronounce it. I will refer to it as PKU for the rest of the debate, despite my hatred of acronyms. It is fair to say that without that guidance, I would have been mispronouncing it.

I welcome the NSPKU members who are here to watch the debate. In preparation for the debate, I found out just how awful the condition is. I am grateful to all Members who have taken part and shared their constituent cases, which have helped highlight how truly horrendous the situation is. For my part, I am aware of no cases in my constituency, but as health is a devolved matter, they would more likely go to Scottish Parliament counterparts.

We have heard that PKU is a rare inherited disorder sufferers of which are unable to break down the amino acid phenylalanine. It is a truly horrific condition, and it is worth putting on record that there is currently no cure. Left untreated, it can cause serious damage to the brain and nervous system, which can lead to learning disabilities and other symptoms. As has been pointed out, the condition affects about one in 10,000 babies in the UK. As the hon. Member for East Renfrewshire (Paul Masterton) mentioned, the situation is worse in Scotland. The stats I have seen suggest that the condition affects one in every 8,000 babies in Scotland, which represents about six or seven cases a year.

Early intervention is vital. Without it, irreversible damage can occur. The Scottish Government take the condition seriously, which is why at around five days old, babies are offered newborn blood spot screening to check whether they have PKU or a number of other conditions. If PKU is confirmed, treatment will be given straight away to reduce the risk of serious complications. If the right treatment is followed, babies with PKU are well in early life and do not develop symptoms. It can be managed with a low protein diet, but as has been pointed out by many speakers today, that is far from an easy option.

We have heard much about access to new treatments such as sapropterin, also known as Kuvan, which is available in 25 countries and has been licensed in the EU since 2008. In May this year, Scotland’s Health Secretary Shona Robison wrote to the Health and Sport Committee to provide a further update on the Scottish Government’s progress in delivering the recommendations from the review of access to new medicines. She confirmed that the pharmaceutical company BioMarin has made a submission to the Scottish Medicines Consortium for sapropterin or Kuvan to be used for the treatment of PKU. The SMC will publish its advice within the next few weeks. Let us hope that we can see progress in the matter as a consequence of the Montgomery review and the definitions of new processes for ultra-orphan drugs.

Decisions made by the Scottish Medicines Consortium are independent of Ministers and the Scottish Parliament, and it is worth remembering that our involvement in that process can be limited, but I would be happy to offer my support to the hon. Member for East Renfrewshire to do any joint working we can to bring pressure to bear, as the drug would be very beneficial for sufferers. The Scottish Government do not intervene in SMC processes, but they have sought to consider with all parties how issues identified in previous submissions could be resolved in new applications to achieve a best-value deal for NHS Scotland.

The Scottish Government have significantly increased access to new medicines in recent years. Between 2011 and 2013, the combined SMC acceptance rate for orphan cancer medicines was 48%. Between 2014 and 2016, the rate was 75% for ultra-orphan, orphan and end-of-life medicines. There are some positives that we can look at in that process. A responsible funding model is key, however. The Scottish Government are actively examining an improved negotiating function that seeks to ensure that the NHS in Scotland pays the same effective price for medicines as in the rest of the UK.

I thank everyone who has taken part. My sympathies go to anyone who is living with the condition. I would be interested in supporting the diet for a day challenge. My diet needs serious improvement at a range of levels, but I would be up for putting in the effort.

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It is a pleasure to serve under your chairmanship, Mr Robertson. I thank my hon. Friend the Member for Blaydon (Liz Twist) for securing this important debate, for her excellent speech and for all her campaigning on the issue. I also thank all the Members who have spoken this morning. There has been a good number. I thank the hon. Member for East Renfrewshire (Paul Masterton), my hon. Friend the Member for Portsmouth South (Stephen Morgan), the hon. Member for Waveney (Peter Aldous), my hon. Friend the Member for Dudley North (Ian Austin), the hon. Member for Chelmsford (Vicky Ford), the hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts), the hon. Member for Strangford (Jim Shannon), my hon. Friends the Members for Warrington South (Faisal Rashid), for Hornsey and Wood Green (Catherine West) and for Derby North (Chris Williamson) and the hon. Member for Linlithgow and East Falkirk (Martyn Day) for their excellent contributions to this important debate.

I also thank the all-party parliamentary group on phenylketonuria, which is more commonly known as PKU. I understand the group was only recently set up by my hon. Friend the Member for Blaydon and others. It is already providing an invaluable forum for PKU to be discussed. Finally, I thank the National Society for PKU for the help and support it provides to sufferers of PKU, for its sponsorship of medical research into PKU and for the work it does with medical professionals in the UK. Just last week, it held a particularly informative event in Parliament sponsored by my hon. Friend. I attended it, and I know it will have been helpful in spreading awareness of this extremely serious disease. I found it very useful, and I know other Members did, too.

I had not heard of PKU. It is a rare metabolic disease that causes an inability to break down the amino acid phenylalanine, which can then build up in the blood and brain. Left untreated, PKU causes severe intellectual disability, seizures and behavioural problems. Damage caused by the disease is, tragically, irreversible. That makes early diagnosis and treatment essential. The only treatment available on the NHS for PKU is an extremely restrictive diet. A PKU diet involves avoiding most forms of protein, and taking a special protein replacement—as we have heard, it does not taste as good as what it replaces—to avoid malnutrition. I would like to briefly highlight a number of the problems with the treatment.

First, it is extremely restrictive. Only a small number of foods can be eaten without severe limitation. It is easy to think that almost all food allergies and requirements are catered for in the modern supermarket these days, but with PKU that is not the case. Some of the necessary food replacements are only available by prescription. For some sufferers, the nature of the diet can have a detrimental impact on their social lives, particularly for younger people, as we have heard from a number of Members. Sadly, a high number of PKU patients also suffer from eating disorders and other mental health problems because of it. The NSPKU recommends that all people with PKU should automatically have follow-up appointments with an integrated specialist metabolic physical dietician, along with support from a psychologist and support worker. Is that something the Minister agrees with? Are the Government looking into providing that kind of support?

The second problem with the current available treatment is that it places a huge amount of pressure on those who care for children with PKU. In order to administer the necessary diet, a significant amount of measuring and preparation is required. As we heard at the event last week, dietary care takes on average 19 hours a week according to a recent study.

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Is the shadow Minister aware that nearly 60% of mothers who care for their children with PKU have some kind of other psychological stress associated with this type of lifestyle?

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I was not aware of that fact, but it is hardly surprising when we realise how complicated the diet is. As the child grows, the calculations have to be changed. As we know, children’s sizes change every week, so it is a constant battle to try to get it right, and it is not surprising that that figure is so high.

As the consequences of a child with PKU consuming the wrong type of food are so severe, it is easy to see how much stress a carer can go through in ensuring not only that they are preparing the right food but that a child follows the diet, particularly when away from home, as we have heard, or in school. With that in mind, I want to know whether the Minister believes that patient-centred care should be extended to school support, psychological support and counselling in order to relieve some of the pressure on carers.

When we consider the fact that the consequences of failing to adhere to the necessary diet are so extreme, one would imagine that all treatments that could improve outcomes would be available. Sadly, as we have heard, that is not the case. As has already been discussed this morning, a non-dietary treatment for PKU does exist, and yet it is not available to patients here in England. Kuvan is a licensed medicine that comes in the form of a simple tablet. In some 20% to 30% of people with PKU, taking Kuvan considerably increases the amount of protein that they can eat each day while maintaining a safe phenylalanine level. Indeed, some patients are able to stop or decrease the use of specially manufactured prescription foods while taking the drug. For those people, having access to Kuvan would literally change their lives and in some cases it would allow them to come off their restricted diet.

Unfortunately, the treatment is not currently commissioned by the NHS, except in a very small number of cases and for women during pregnancy. That is despite its having been licensed in the USA since 2007 and in the EU since 2008. It is used by thousands of patients across Europe and around the world. We heard the full list from the hon. Member for Chelmsford, but I will simply mention such countries as Ukraine, Estonia and Turkey by way of example. Many patients who suffer from PKU will rightly ask why, if the treatment is available there, it is not here?

Although Kuvan is available to women during pregnancy, it can be difficult to get hold of. Tragically, some women with PKU avoid having children altogether owing to fear of the risks to the foetus associated with high levels of phenylalanine. I understand that NHS England has recently referred Kuvan to NICE after it went through its internal clinical panel. Can the Minister explain why there has been such a delay in commissioning Kuvan, and when we can expect it to be available to all patients? Indeed, I understand that it was under the appraisal process in NHS England for seven years.

Access to Kuvan is not the only PKU treatment that has been impeded by the structure of the NHS. For sufferers of PKU, there is a significant risk of variable outcomes and health inequalities, something that is exacerbated by access to special protein replacements and manufactured low protein foods. Many PKU patients have reported difficulties in accessing the prescriptions they rely on, and some clinical commissioning groups have been found to actively restrict funding for PKU products. Has the Minister had any conversations with Public Health England and the CCGs to ensure that people with PKU have easy access to prescription-only foods and amino acid supplements?

As a parent who watched her children have the heel prick test as babies, I had no idea how important that test was. I had not heard of PKU back then and I thought the test was just a little test in which they check the hips and prick the heel. I can only imagine how it must feel to be the one out of 10,000 parents who receive a life-changing diagnosis for their child, only to find out that their life and the health of their child will be harder than it needs to be because of what can only be described as rationing by their CCG and NHS England.

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Does my hon. Friend the shadow Minister agree with me that it is a disgrace that it takes a court case to get the NHS, NICE and all the other bodies to respond, even when they have heard about the difficult times that families have? Does she agree that a family should not have to take the Government to court to get the treatment that their child needs?

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I absolutely agree. It is shocking. I want to end by saying to all the campaigners here and across the country that I hope we have shown in this debate today that we are listening. All their campaigning has not been in vain. It has led to us having an amazing champion in my hon. Friend the Member for Blaydon, and it has led to this well-attended debate today. The Minister has heard all the powerful speeches. He is a compassionate man, so they cannot fail to have had an impact on him. I look forward to his response. This is his opportunity to give hope to thousands of people. Let us hope that he does so.

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No pressure, then. I will try to give some hope.

Thank you, Mr Robertson, for chairing our debate. I also thank the hon. Member for Blaydon (Liz Twist) for introducing the debate with such humanity. She speaks so well and passionately on this subject. We also heard from my hon. Friend the Member for East Renfrewshire (Paul Masterton), who mentioned the Irn-Bru issue. The Treasury has a policy on the sugar tax, which is part of our child obesity plan. We published the update on that yesterday. The policy long predates me. This subject has not been raised with me before, but we cannot let the bad be the enemy of the good. Taking sugar out of fizzy drinks is a good thing for society, but the unintended consequences of that need to be addressed, and he is right to raise it.

We also heard from the hon. Gentleman from my own county, the hon. Member for Portsmouth South (Stephen Morgan), from the hon. Members for Dudley North (Ian Austin), for Warrington South (Faisal Rashid), for Hornsey and Wood Green (Catherine West), forDerby North (Chris Williamson), and from my hon. Friend the Member for Waveney (Peter Aldous), who always speaks so passionately, from the hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts), and, as always, the hon. Member for Strangford (Jim Shannon), all of whom—I think everybody—touched on the subject of Kuvan. Many touched on the dietary aspect and everybody gave personal examples of constituents. I hope to address all of those subjects.

I congratulate the hon. Member for Blaydon (Liz Twist) and the all-party group on the work that they do. When I was a Back Bencher I was involved in many all-party groups, including the APPG on breast cancer with the hon. Member for Washington and Sunderland (Mrs Hodgson), who speaks for the Opposition. So much of the good work of this place goes on in APPGs. I hope that the public watching inside and outside today can see that.

The House debated PKU and Kuvan in March this year, led by my hon. Friend the Member for Chelmsford (Vicky Ford), who spoke well again today. I was not able to attend that debate in person back in March, so I am grateful to have the opportunity today to hear the issues around PKU and access to treatments. I have learnt a lot today, as I did in my reading ahead of today. The importance of rare diseases, of which PKU is one, is of course recognised by us and by policy makers and healthcare service providers in the UK and internationally, and rightly so. One in 17 of us will suffer from a rare disease at some point in our lives.

With the number of known rare diseases steadily growing as our diagnostic tools improve, the Government remain focused on and dedicated to improving the lives of those living with a rare condition. That was reinforced in the Prime Minister’s words last Monday at the Royal Free. I was fortunate to be there when she set out a vision for the long-term plan for the NHS, underpinned by increased funding for the service. She said the UK had an opportunity,

“to lead the world in the use of data and technology to prevent illness, not just treat it; to diagnose conditions before symptoms occur, and to deliver personalised treatment”,

informed by our own data, including our genetic make-up. I will say more about that in a moment.

Early and accurate diagnosis of rare conditions is essential for the best outcome for patients with rare diseases such as PKU. We know that without early treatment the outlook for those born with the condition is very poor, as the Scottish National party spokesperson, the hon. Member for Linlithgow and East Falkirk (Martyn Day), and the Opposition spokesperson, the hon. Member for Washington and Sunderland West, said.

With early treatment, however, the outlook can be good, which is why, as a number of speakers have said, screening has such a vital role to play. I have two children, and equally watched the pin heel prick with trepidation—little did I know what it could have found. I had no idea what they were doing—I was in that daze—let alone what it could have found, so I have great compassion for people in that moment.

The current newborn screening programme in the UK is based on the blood spot test—the heel prick test that we have referred to—and screens for nine rare but serious conditions, including PKU. With that early diagnosis, treatment can start straight away. For patients with the condition, that treatment includes a special diet and regular blood tests. We have heard so many incredible examples today.

We have heard how severely limiting a protein-restricted diet is and how difficult it must be for any patient to stick to, but particularly for young children. Those of us with young children can really feel that. Children with PKU, as has been said, cannot eat most of the foods that we all take for granted, such as meats, fish, milk and treats such as chocolate—everything in moderation—and that is just to name a few.

I stand here as a Minister, but also as a constituency MP. I, too, had not heard of PKU until constituents brought the condition to me. I recently met with one of my constituents, Sarah, who was a doctor and, like many people, as we have heard, had to give up her job to look after her children. Her three-year-old daughter, who is a beautiful little girl, lives with the condition. I heard first-hand of much of the daily strain that it puts on her daughter and the family. My constituent, like many carers, cares for the child full time—preparing the meals, calculating ingredients and going to doctor appointments—and has had to give up her career. As the hon. Member for Blaydon said in her introduction, when we say that the condition can be treated by diet it sounds quite easy. However, in an email last night my constituent said to me,

“If she goes off ‘the diet’, she will suffer permanent and irreversible brain damage.”

If my seven-year-old boy goes off diet and drinks a fizzy drink we certainly suffer the consequences, but it usually lasts for only an hour. I have a great understanding from today’s debate about that.

I understand that even in adulthood, as the hon. Member for Dwyfor Meirionnydd said, PKU can cause harrowing symptoms that make any attempt at a normal life and contributing to society very difficult and sometimes impossible. The availability of specially formulated low-protein foods and nutritional supplements through the NHS is therefore vital. Since its development in the ’50s, it has saved the lives of and improved outcomes for many patients.

I cannot deny that PKU is not on the list of medical conditions in England that are exempt from prescription charges. As such, only the usual age-related pre-paid certificate exemptions apply to such patients. That is the current situation, but everything can be challenged and can change. As I said at the start, the power of all-party groups is incredible, and perhaps that is something that the all-party group may wish to look at and campaign on.

An awful lot of information is available. My constituent Sarah is also the editor of the National Society for Phenylketonuria’s magazine. She sent me the summer 2018 edition last night, which I read overnight. It was a really interesting read, and I might touch on a couple of things in it before I close. That magazine and its website contain all sorts of information on foodstuffs, advertisements for foodstuffs, products and recipes—and yes, avocado does keep coming up.

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Will the Minister give way?

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I will briefly, but then that will be it, because I know hon. Members want to hear from me, as the Minister. We have heard from Back Benchers.

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As the Minister knows, there have been five applications for an individual funding request. Two of those were allowed and one, which I mentioned earlier in the debate, had to go to the High Court. The judge declared that the decision that had been made was irrational and unlawful. Will the Minister not just speak about the dietary supplements, which we can all find out from Google, but about what he is doing to push these requests? Specifically, what is he doing on behalf of Olivia, aged 11, whose mother is here today, who would like to know whether he will personally support her application for Kuvan?

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I was going to come on to talk about Kuvan; obviously, I stopped to listen to the hon. Lady’s intervention. No, I will not personally support an individual request. That would not be appropriate for a Minister at the Dispatch Box. That is not how our system works, but if she wishes to write to me with the specific example then of course I will see that she gets a reply. That should be handled through the right processes. I know that the processes for individual funding request applications are sometimes torturous, and I am sure that we could do them better.

Let us touch on Kuvan, which everybody has raised. It is one treatment option that has been found to lower blood phenylalanine levels in some patients with mild or moderate PKU. We know that the drug is effective in a small number of patients, depending on their genetic make-up, and is more likely to benefit those with milder forms of the condition. If patients respond to treatment, it is likely that they will still need to continue with some form of dietary restrictions—everyone understands that.

As we have heard, Kuvan is not currently routinely commissioned for use in children and adults. That is due to the lack of evidence of its effectiveness on nutritional status and cognitive development at the time the policy was developed in 2015. NHS England does, however, have a commissioning policy for PKU patients with the most urgent clinical need—namely, pregnant women, as we have heard.

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Will the Minister give way?

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No, I will not. Although the decision taken by NHS England was not to commission Kuvan routinely, the system has the flexibility to review that decision if new evidence emerges. As the House heard during the debate in March, NHS England received a preliminary policy proposal for the use of Kuvan in the management of PKU for adults and children, because new evidence has now been published to support its use. Kuvan was subsequently referred to the National Institute for Health and Care Excellence for assessment through its topic selection process—the process through which NICE prioritises topics for appraisal in its technology appraisal or highly specialised technology programme.

The NICE process is important. It is independent of Ministers and provides a standardised, governed procedure to ensure that NICE addresses topics that are important to the patient population, carers, professionals and commissioners and, similarly, helps to make the best use of NHS resources. To update the House on progress, Kuvan has progressed through the first stage of the topic selection, and NICE is currently considering whether the drug should proceed to the draft scope creation stage. We are expecting that decision to be taken in the autumn. I will press NICE, along with the relevant Minister in the Department—the Under-Secretary who sits in the other place—to bring that to a conclusion as swiftly as possible.

People have asked today for me to personally get involved in access to Kuvan. NICE’s process is important and sits independently of Ministers. It would be a very strange situation if Ministers were able to sit in the Department of Health and, like a Roman emperor, give a thumbs up or thumbs down. I do not think that any Minister in this Government or previous Governments would want to be in that inappropriate position. As I said, we expect the decision to be taken in the autumn and we will press for that to be brought to a conclusion as soon as possible.

I will give the hon. Member for Blaydon time to wind up the debate, but there are other promising treatments on the horizon. NICE is currently considering pegvaliase, an enzyme substitution therapy indicated for adults, through its topic selection process, and recently consulted stakeholders on its suitability for the technology appraisal. I can update the House that a scoping workshop on this topic is scheduled to take place tomorrow, 27 June.

Finally, the hon. Member for Chelmsford said that there had not been a response on BioMarin. She mentioned that point to me last night, and I am worried to hear it. As I said, Kuvan is currently going through the independent NICE assessment. If the topic goes ahead, there will be many opportunities for BioMarin to engage in commercial discussions, as per NICE’s usual process. BioMarin and NHS England are already in discussions about a number of other drugs, so it has the opportunity to raise the issue. However, it seems to me that NHS England could at least communicate better, because no answer sounds like a bad answer. I will take that away from the debate and ensure that it happens ASAP.

I know you want me to stop, Mr Robertson, and let the hon. Member for Blaydon close the debate, so I will do that.

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What can I say in less than one and a half minutes? I thank all hon. Members who have taken part today. I thank the hon. Members for East Renfrewshire (Paul Masterton), my hon. Friend the Member for Portsmouth South (Stephen Morgan), the hon. Member for Waveney (Peter Aldous), my hon. Friend the Member for Dudley North (Ian Austin), the hon. Members for Chelmsford (Vicky Ford), for Dwyfor Meirionnydd (Liz Saville Roberts) and for Strangford (Jim Shannon), my hon. Friends the Members for Warrington South (Faisal Rashid), for Hornsey and Wood Green (Catherine West) and for Derby North (Chris Williamson), the hon. Member for Linlithgow and East Falkirk (Martyn Day), my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) and the Minister for his reply.

I am rather disappointed that we did not have a bit more promising news on the future of Kuvan, but we will be back; we will ensure that the Minister hears from us again, and we will continue our campaign. Finally, I thank all the families who are here today to show how strongly people feel about the issue. I thank everyone for attending. The issue will not go away. We will be back and will keep pushing this agenda.

Question put and agreed to.

Resolved,

That this House has considered access to treatment, support and innovative new medicines for phenylketonuria patients.

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Would hon. Members leaving please do so quietly? Thank you. We have another debate.

North Wales Police and Nicholas Churton

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I beg to move,

That this House has considered North Wales Police, probation and the murder of Nicholas Churton.

It is a pleasure to be here, and to address you in the chair, Mr Robertson. I always hesitate to bring up individual cases in the House, but this extremely serious case involved the death of one of my constituents. I hesitated to raise the matter because it brings grief and sad memories to his family, but I have notified them of the debate, and I think there are profound matters of public interest in the case that need to be raised.

The primary responsibility of our criminal justice system is to keep people safe, and this case highlights where it did not do so. I will ask questions about why that happened, who was responsible and how we will respond to serious failures in the system in future.

My constituent Nicholas Churton was 67 when he was brutally murdered in his own home in the middle of Wrexham in March 2017. He was murdered by Jordan Davidson, who had a long history of offending, and was, at the time, on licence and serving a sentence of three years for burglary. While still in prison, Davidson received a further 12-month prison sentence for possession of a knife in prison. He was released in December 2016 on licence. Following Davidson’s release, Nicholas Churton complained on a number of occasions to the police about Davidson’s conduct. According to the prosecuting barrister at his trial, Davidson knew that.

In March 2017, just four months after being released on licence, Davidson was arrested for another offence of possession of a knife. None the less, he was released by the police in Wrexham on bail, without having a court appearance. Within three days of his release by the police, Davidson went on a spree, committing serious offences, which culminated in Mr Churton’s murder in his own home in a hammer attack. Davidson’s trial was for not only murder, but four offences of assault and two of robbery, as well as offences of aggravated burglary, attempted robbery, burglary and aggravated vehicle taking.

Davidson pleaded guilty to Mr Churton’s murder and many of the other offences. The offences were so serious that the Attorney General appealed against the tariff imposed by the judge on the ground that it was too lenient. The Court of Appeal agreed with that appeal and increased the sentence.

I am grateful to local journalist Jez Hemming of the Daily Post in north Wales for highlighting the facts of this dreadful case, which were revealed in court. As the Member of Parliament for the constituency where the dreadful incidents occurred, I contacted North Wales police and asked for a private briefing. The chief constable told me that that was not possible because the Independent Office for Police Conduct had started an inquiry into the case to address why the police had not adequately responded to Mr Churton’s complaints about Mr Davidson before the attack. I made it clear that I was very concerned about the extraordinary decision to release Davidson from police custody when he was arrested for possession of an offensive weapon, and asked why that had happened despite Davidson’s long criminal history. I also wanted to understand the role of the community rehabilitation company and the probation services that were dealing with the prisoner on licence, to ensure that adequate systems are in place to protect my constituents. Despite that, the police would not meet me.

That approach is unacceptable and disrespectful of the role of a local Member of Parliament. The police and crime commissioner in north Wales will not meet individual constituents to discuss their cases, unlike Members of Parliament. It is quite clear that the advent of the office of the police and crime commissioner has diminished the accountability of the chief constable to MPs in north Wales. The chief constable has a much more distant relationship with MPs than they did when I was first elected.

Given the Attorney General’s involvement in the appeal and my continued concern about not being properly informed about the facts of the case, I wrote to the Attorney General and pointed out the detail of the case and its seriousness. I am grateful for the response that I received from the Home Office. Following my intervention, the Independent Office for Police Conduct announced a second inquiry, into the decision to release Davidson on police bail. Until I intervened, that matter was not the subject of such an inquiry. I am glad that it is now, but I am not certain that the matter would have been investigated if I had not intervened.

I am pleased to say that, unlike the police, the probation service, which is also involved in the matter, agreed to meet me privately to discuss my concerns about the supervision of those on licence from custody. I fully understand that there are limitations on the information that can be disclosed to a Member of Parliament, but given the appalling set of circumstances that led to the offences, it is entirely appropriate that the MP should be closely involved in ensuring that his or her constituents are safe.

Of course, the set of incidents and the situation with the probation system and the police have a political context that it is important to raise. Since 2010, we have had large reductions in the numbers of police officers on the streets of Wrexham, in common with everywhere else in the UK, which necessarily means that individual police officers are under more pressure in providing a police service. That is a political decision that the Government made, for which they need to be held accountable.

Further, in 2014 and 2015, the Government introduced major structural changes in the probation system. That included changes to who delivered probation services and what was delivered as part of probation, which is clearly relevant to the supervision of prisoners on licence. The reforms were known as Transforming Rehabilitation, and sought to extend statutory rehabilitation to offenders serving custodial sentences of less than 12 months; to introduce nationwide “through the gate” resettlement services for those leaving prison; to open up the market to new rehabilitation providers to get the best out of the public, voluntary and private sectors; to introduce new payment incentives for market providers to focus relentlessly on reforming offenders; to split the delivery of probation services between the national probation service for offenders at high risk of harm and community rehabilitation companies for low and medium-risk offenders; and to reduce offending.

Like many others, I was deeply concerned at the time about the impact that this huge set of reforms would have. I was very aware that they were introduced without additional resources, despite the fact that a group of prisoners on short prison sentences and people who had been released from prison who would not have received supervision previously were expected to receive it under the new system. I was particularly concerned about how we would determine which individuals would be supervised, and which body would do it. Jordan Davidson—the murderer in this case, who had a long criminal history and had been given a relatively short sentence—was one such individual.

The more I look at this case, the more I think that the reforms contributed to the failure of supervision that led to Jordan Davidson’s release on bail and on licence after the serious offence of possession of an offensive weapon, to the subsequent assaults he carried out, and to the death of my constituent, Nicholas Churton.

Last week, after I applied for this debate, the Justice Committee published its excellent report, “Transforming Rehabilitation”, which looked at the probation reforms and was compiled without knowledge of this case. It said:

“We are unconvinced that splitting offenders by risk was the right way to split the probation system. Splitting the system in such a way does not recognise that the risk of harm an individual poses can change over time.”

It continued:

“The splitting of probation services between the National Probation Service and Community Rehabilitation Companies has complicated the delivery of probation services and created a ‘two-tier’ system. Although we heard about joint working going on at a local and national level, problems in the relationship remain.”

Crucially—this is very relevant to this case—it said:

“We are concerned that problems remain regarding data sharing across the criminal justice system.”

I believe that Jordan Davidson’s case highlights many of those issues.

Why did the police not share data about a man who had offensive weapon convictions and a long history of offending, and had been the subject of complaints by Nicholas Churton in the recent past? When Davidson was arrested for another offensive weapon offence, why was he released without even a court appearance? What system was in operation for the supervision of offenders that all allowed all this to happen? No single person is responsible for the system, but the then Secretary of State for Justice was a vocal proponent of the change, and proudly made it clear at the time that the system was put in place for ideological reasons. It has now been heavily criticised by the all-party Select Committee and many others.

The appalling case of Nicholas Churton is a real example of the deficiencies of the system created by the then Secretary of State, for which he needs to take personal responsibility. It is disgraceful that, in such a serious case, North Wales police failed to respond adequately to legitimate concerns that I, the elected Member of Parliament for Wrexham, expressed. The confusion in the probation system is exacerbated by the confusion in lines of responsibility created by the office of the police and crime commissioner, who, as far as I am aware, has taken no action in this case.

In short, the situation is a mess, and there have been appalling consequences. We need clear answers, and the then Secretary of State, the police and the bodies tasked with probation and protecting the public must accept responsibility. Only in that way can the public be confident that such a dreadful case will not happen again.

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It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the hon. Member for Wrexham (Ian C. Lucas) for securing this debate and for setting out the terrible facts of this very sad case. The Attorney General referred it to the Court of Appeal because of the inadequacy of the initial sentence. The Court of Appeal’s judgment makes for very stark, sobering reading. I extend my sincere condolences to the family of Mr Churton, who was the victim of the most horrendous attack in his home. He was clearly targeted by Davidson because he was elderly and vulnerable, and he was unable to defend himself against Davidson’s ferocity. Davidson is now rightly serving a life sentence with a tariff of 30 years for his wicked murder of Mr Churton.

The hon. Gentleman raised a number of issues and made a political link to this case, with which I am afraid I do not agree. I am going to break down those issues. As Jordan Davidson was subject to statutory probation supervision at the time, the Wales community rehabilitation company had to complete a serious further offence review, which identified a number of areas where the practice of those responsible for monitoring Mr Davidson fell below the expected standards. Indeed, there were significant failings. Her Majesty’s Prison and Probation Service is now overseeing the CRC’s implementation of the improvement actions from that review. Senior officials from the CRC met members of Mr Churton’s family in March and shared with them the victim summary report, which was based on the review.

My hon. Friend the Minister of State, Ministry of Justice will consider the Justice Committee’s recommendations carefully and will respond in due course. This was a significant programme of reform. For instance, an additional 40,000 people who would not previously have been monitored now receive support and supervision upon release. Fewer people reoffend, and there have been some innovative and impressive programmes. Of course, the Ministry of Justice accepts that there have been challenges, and that CRC services need to improve. It is currently in discussions with the providers and will consider all possible options to ensure improvement is delivered.

That is, of course, of no comfort to Mr Churton’s family. I am pleased that the local probation service met them. I imagine they will take little comfort from looking at this after such a traumatic event in their lives, but I hope they found some resolution in that meeting with the probation service.

The hon. Gentleman also raised the issue of the police, and I understand that he is concerned about North Wales police’s lack of engagement with him. To my mind, one of the most important responsibilities of the police and police and crime commissioners is to connect with local residents and answer their concerns, and to ask questions of their chief constable when they have concerns about how the force is delivering policing locally. Police and crime commissioners were introduced to make the police accountable to the population they serve. I urge the hon. Gentleman to press the police and crime commissioner further and insist that he discusses this case with him, because it is obviously so important to the hon. Gentleman and his constituents.

As the hon. Gentleman is aware, there are two Independent Office for Police Conduct investigations into North Wales police’s involvement. I am not in a position to comment on them while they are ongoing, but I am sure that when those reports are handed down, the policing Minister will be pleased to discuss them with the hon. Gentleman to see what further improvements can be made.

The hon. Gentleman raised the issue of funding. I wish that we did not have to view policing just through the prism of funding, but that seems to be the only line of debate on policing that Opposition Members wish to pursue. I am conscious that I am constrained by the fact that there are two live IOPC investigations. He described funding as a political decision; I must remind him why that decision had to be made. I would not have raised funding in this context, but he has done, so I am obliged to put it on record that the reason those hard decisions had to be made was the economic mess in which we found ourselves when the last Labour Government left office.

We are very conscious of the pressures that the police have been under in the last few years, which is precisely why the then Home Secretary protected spending in 2015, and why it has been protected since then. This year, my right hon. Friend the Minister for Policing and the Fire Service has spoken to every constabulary in the country. With the help of police and crime commissioners, we have secured an extra £460 million of funding for police forces.

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I am sorry that the Minister takes exception to me raising funding. I do not accept her description of the position in 2010; in 2010, the Conservative Government reduced policing funding for 2010 to 2015 on the basis that the policies that they were pursuing would eliminate our budget deficit by 2015. That policy failed, but none the less we suffered the imposition of cuts between 2010 and 2016. It is fair to individual police officers to point out in a debate such as this where I have made criticisms that they are under more pressure now than they were in 2010. That is a fact.

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I wonder whether the hon. Gentleman, as the good constituency MP that I know he is, has raised with the local police and crime commissioner the fact that as of March 2017, the police and crime commissioner had held-back reserves equivalent to 24.1% of funding for the local police force, or £34.4 million in savings. The hon. Gentleman talks about political decisions; presumably it is a political decision by the police and crime commissioner not to spend that money on frontline policing.

I am very conscious of the gravity of this case; frankly, there are times when the public want us just to get on with it and sort things out, rather than have these back and forth arguments about funding. The fact is that we have protected spending and it is now increasing this year by £460 million. Any police and crime commissioner or chief constable who wants to spend that money on frontline policing however they see fit for their local area will have our support. That is their decision.

Data sharing sadly is a point raised not just in this context but in other cases, where there are serious incidents of violence and it emerges that various agencies involved in the run-up to an incident did not share information in the way that we would wish. To declare the fact that agencies can and should share information for safeguarding purposes, we amended the Data Protection Act to include a statement to that effect. I hope that will provide reassurance to those agencies that hold information—not just the police but social services, the medical profession and others. That may help to safeguard children or vulnerable adults. I hope that amendment to the Act will give them comfort, enable them to do that and create a culture in which agencies realise that in certain circumstances, they are allowed to share information where it may help to keep people safe. I hope that change will reassure the hon. Gentleman and Mr Churton’s family for the future.

I want to praise the actions of two police officers in North Wales. During Mr Davidson’s tirade of crime in the aftermath of the murder, police constables Rhys Rushby and David Hall arrested Mr Davidson and were very badly injured in the process. They were extraordinarily brave, selfless and devoted to their duty. I was very pleased to hear that their bravery has been recognised not just by their own force but in their nomination for a national police bravery award. I give them my thanks and wish them the best of luck in that ceremony. This is just one example of the daily dangers faced by our police officers. We must thank them for facing them

I thank the hon. Gentleman for securing this debate. He is an assiduous constituency MP; we have met to discuss other issues relating to behaviour in and around his constituency. He has raised this important issue because he wants to ensure that the thoughts of the Churton family are heard and, just as importantly, that actions are taken by the agencies involved to ensure that these terrible mistakes are not repeated. I thank him for his contribution.

Question put and agreed to.

Sitting suspended.

Gaza: Humanitarian Situation

[Ian Paisley in the Chair]

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It is extremely stifling in here today. If hon. Members wish to remove their jackets, I will permit that, given the heat. I know we will probably generate more heat and light during the debate. This is also a highly subscribed debate, so I ask people to bear that in mind when they make their introductory remarks. I will try to get everyone in, if possible, but quite a lot of Members wish to speak. I will try to accommodate everyone; if we can keep interventions to a minimum, that will help.

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I beg to move,

That this House has considered the humanitarian situation in Gaza.

It is a pleasure to serve under your chairmanship for the first time, Mr Paisley. This is a DFID debate rather than a Foreign and Commonwealth Office debate, and I am glad that the Minister of State, Department for International Development, the right hon. Member for North East Bedfordshire (Alistair Burt) is present to bring his expertise to bear.

The situation for Gaza and its 1.7 million residents is appalling and inhumane, but before I turn to some of the specific concerns of the many in Gaza and the wider Palestinian community, I will briefly comment on the events of the past few months. Many hon. Members will be aware that there have been multiple protests along the border with Israel as part of the “Great March of Return”. The start marked the 70th anniversary of the exodus of as many as 750,000 Palestinians, many of whom were driven from their homes during the creation of the state of Israel in 1948. According to Medical Aid for Palestinians, approximately 14,600 people have been injured by Israeli forces, and 55% of those were hospitalised. Tragically, 118 Palestinians were killed, including 14 children. Elsewhere, including in the west bank, a further 17 Palestinians were killed during the same period, including five reportedly shot at the fence or after crossing into Israel.

In particular, I pay tribute to Razan al-Najjar, a 21-year-old volunteer for a medical team helping wounded protesters, who was shot dead near Khan Younis. Razan was fatally shot in the neck while clearly wearing a medical staff uniform. That is a war crime, as the Palestinian Health Minister, Dr Jawad Awwad, has said. Razan was brave and inspirational, and will be remembered as such, but it is our responsibility as politicians in the UK Parliament to try to ensure that those responsible are held to account for her death. Dr Andy Ferguson, who is MAP’s director of programmes and was present at Gaza’s largest hospital, Al-Shifa, on Monday 14 May, said the following about what he witnessed:

“Any hospital in the UK would be utterly overwhelmed by such a massive influx of injuries as we saw in Gaza. Amid dwindling supplies of medicines and equipment and Gaza’s chronic electricity shortages, hospitals in Gaza were in crisis even before the protests began. It is testimony to the motivation and skills of medical teams in Gaza that, despite this, hospitals were able to keep receiving, triaging, referring and treating patients—both the newly-wounded and the hospital’s standard patient workload.”

Although it is apparent that some protesters may have engaged in some form of violence, that does not justify the use of live ammunition. International law is clear: firearms can only be used to protect against an imminent threat of death or serious injury. In some instances, Israeli forces appear to have committed wilful killings, constituting war crimes.

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My hon. Friend will recall that I asked the Minister a question —I think it was about a fortnight ago—about an inquiry into what had been happening there. That was to go to the United Nations, but when it got to the UN, the British Government sat on their hands. What does my hon. Friend think about that?

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I am grateful for that intervention and I am pleased that the Minister is here. He has some responsibilities and I hope we will have some answers. We need to have an inquiry and to hold those responsible to account, because Israeli forces were using not only live ammunition, but high-velocity weapons in particular, causing absolute maximum harm. Another issue of concern is that the UK Government have approved more than £490 million-worth of arms exports to Israel since 2014.

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According to the latest figures from the UN, since 30 March this year, 135 Palestinians, including children, have been killed and thousands injured, half of them seriously, as a result of live ammunition. Does my hon. Friend agree with Amnesty International, which has renewed its call on Governments worldwide to impose a comprehensive arms embargo on Israel following the country’s extreme response to the mass demonstrations along the fence separating the Gaza strip from Israel?

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I agree with my hon. Friend. It is about not just the sale of high-powered rifles but the type of ammunition that is being used, all of which has been licensed. The licences include categories of arms and arms components such as sniper rifles, assault rifles, surveillance and armed drones, and grenade launchers. As yet, the use of UK-manufactured weapons in the current atrocities has yet to be verified, but US-supplied weapons of the same type are clearly being used by Israeli forces to kill and maim Palestinians.

The export controls under which our Government operate clearly state that export licences should not be approved if there is a clear risk that the weapons might be used in violation of international law or for internal repression. From the Government’s own figures, it is hard to see how current sales of military and security equipment to Israel are not in breach of those obligations, which comes back to my hon. Friend’s point. The Israeli Government must rein in the military to prevent the further loss of life and serious injuries, and the UK Government must immediately suspend all their current arms sales to Israel and support international efforts to set up a comprehensive arms embargo that applies to Israel, Hamas and other armed Palestinian groups.

The UN Human Rights Council has condemned

“the disproportionate and indiscriminate use of force by the Israeli occupying forces against Palestinian civilians,”

and called for the urgent establishment of an “international commission of inquiry” to investigate the killing of Palestinians during the protests. In my opinion, it shames the UK Government that the UK abstained on the vote, objecting to the omission of references to Hamas and its role in the violence. The UK has, however, separately called for a full and independent inquiry. Indeed, the Minister told the House:

“Our abstention must not be misconstrued. The UK fully supports, and recognises the need for an independent and transparent investigation into the events that have taken place in recent weeks, including the extent to which Israeli security forces’ rules of engagement are in line with international law and the role Hamas played in events…The death toll alone warrants such a comprehensive inquiry.”—[Official Report, 21 May 2018; Vol. 641, c. 579.]

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It would be extremely useful to see the rules of engagement issued to the Israel Defence Forces; I wonder whether anyone has a copy of them.

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The hon. Gentleman makes a valid point. However, certain principles apply in relation to the use of lethal force. It is clear that the Israeli security forces’ response has been completely disproportionate, as demonstrated by the death toll and the huge number of Palestinians with gunshot wounds, many of whom are in a very serious condition and will have permanently disabling injuries as a result.

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I congratulate the hon. Gentleman on securing the debate. Is he aware of the high committee of the “Great March of Return”, which includes Hamas, posting on Facebook a request that people bring a knife or gun to the protests? Does he agree that it is a distortion of the truth to ignore the role of Hamas in this violence?

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I condemn violence and I condemn those who advocate it on all sides. I have seen some appalling quotes from prominent Israeli politicians that are equally worthy of condemnation, so I condemn Hamas and I condemn those responsible on the Israeli side.

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The last time we debated this in the Chamber, I asked the Minister if we had any statistics on Palestinians being arrested, but he was unable to give them. Those statistics would indicate whether the Israeli forces’ approach to the protest was one of “shoot to kill” or of arresting the protestors. Does my hon. Friend agree that that should be looked into?

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I know that my hon. Friend has visited the west bank and has seen some of the actions of the Israeli security forces. Perhaps the Minister will respond to that. The UK must press for an independent inquiry and ensure that its abstention at the Human Rights Council does not send the message that grave violations of international humanitarian law will be tolerated.

In 2012, the UN warned that Gaza would be unliveable by 2020. In July 2017, the then UN co-ordinator for humanitarian aid and development activities, Robert Piper, revised that projection, saying that

“that unlivability threshold has been passed quite a long time ago.”

I share that view. Chronic needs and injustices must be addressed now. Many right hon. and hon. Members present have actually seen the conditions there with their own eyes. The people of Gaza cannot wait for a successful peace process. The blockade must be lifted and the suffering relieved.

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My hon. Friend will be aware that the former Conservative Prime Minister described Gaza as the world’s biggest open-air prison. That narrative has changed, as has the policy of the Government, who seem increasingly apologetic about the Israeli Government’s actions. I welcome the Government’s reference to an international inquiry, but they are shirking responsibility given our history in that country and region. I call on the Minister and his Department to work in the spirit he has always shown and make sure that the Prime Minister and the Foreign Secretary start to show some leadership on this issue, rather than ducking and diving, as has happened over the past few years.

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I absolutely agree. I hope that we will hear some positive responses from the Minister. Until Israel ensures effective and independent investigations that result in the criminal prosecutions of those responsible, the International Criminal Court must open a formal investigation into these killings and serious injuries as possible war crimes and ensure that the perpetrators are brought to justice.

The debate relates to the work of DFID, and the protests, attacks and deaths merely shadow a wider issue, which is that many Palestinians live a miserable life because of the Gaza blockade. It has now been 11 years since the closure of Gaza, which was intensified by Israel’s imposition of a land, sea and air blockade.

Despite Israel’s removal of its settlements in Gaza in 2005, it retains effective control over both the territory and its population. It therefore remains the occupying power, with all the humanitarian and legal responsibilities resulting from the fourth Geneva convention, including for the Gaza population’s access to adequate healthcare, the provision of medical supplies and the functioning of medical establishments. Hospitals in Gaza are suffering a drastic deficit in medical disposable equipment and vital drugs. The World Health Organisation warned that the health system in Gaza is

“on the brink of collapse”,

with more than 40% of essential medicines completely depleted, as well as shortages of electricity and fuel for generators.

Permit approval is needed from Israel for patients seeking urgent treatment outside Gaza. Last year saw the lowest rate of permit approvals for Palestinian patients since records began, causing the avoidable tragedy of the deaths of at least 54 people after the denial or delay of their permits.

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My hon. Friend is making a powerful and informed speech, and I congratulate him on securing this important debate. He is absolutely right to say that healthcare is on the brink of closure, but so are other vital services, such as energy, schools and sewage management. Despite humanitarian efforts over 11 years, the situation has worsened year on year. Will he ask the Minister to set out what concrete steps he will take to end this illegal blockade?

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Precisely. I am grateful for that contribution, and I hope that the Minister will respond positively and give us some good news about the potential for progress on a lasting settlement and relief for the hardship of those people.

Gaza’s unemployment rate is almost 50%, which is the world’s highest, while 97% of households lack access to clean drinking water. There has been a threefold increase of diarrhoea among under-threes, and in contrast to the global improvement in infant mortality the rate in Gaza has actually stagnated for a decade. Mains electricity is available for only four or five hours a day—less under certain circumstances—which undermines vital services and severely inhibits people’s everyday lives and wellbeing. Some 109 million litres of waste water is released into the sea every day, and almost the whole of the Gaza coastline is contaminated.

I know that the Minister shares my concerns, but we need to do more. We need to step up to the plate for the Gazans. We cannot allow the desperate situation of these innocent people to continue. Taking no action will be counterproductive. It will simply strengthen the position of those who advocate extremism. We need to hear a stronger voice from the UK in the international community.

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The hon. Gentleman is making important points about the desperate humanitarian conditions faced by Gazans. However, unless he is willing to mention that the disruption to energy supplies for Gazans has much to do with the ongoing dispute between Hamas in Gaza and the Palestinian Authority in the west bank, that the Rafah crossing is hardly ever opened to allow humanitarian supplies in from Egypt, or that Hamas runs Gaza with an iron fist and is guilty of numerous accounts of misappropriating aid, we will not get the balanced discussion that this important issue needs.

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We need an understanding of the situation and the appalling hardships faced. Let us not forget that Israel has obligations under international law and under the fourth Geneva convention. It must honour those commitments, and if it does not the international community must take action.

On our roles and responsibilities, I have seen at first hand the vital work of the United Nations Relief and Works Agency and the Office for the Co-ordination of Humanitarian Affairs. I hope that the Minister gives us something positive in his comments today, because we need to ensure that those organisations are properly funded. I believe that we must consider sanctions against Israel if international law continues to be flouted. Most importantly, we need to ensure that the blockade is lifted and Gazans are allowed to travel, trade and have access to healthcare. If we do not do everything in our power, and the Government do not do everything in their power to achieve peace, the blood of many more people will be on our hands.

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Order. Before I call Sir Nicholas Soames, I ask hon. Members to restrict themselves to as few interventions as possible or no interventions—I know it is impossible to order that. It will mean that everyone gets a chance to speak, but after Sir Nicholas speaks, I will be cutting the time available to each Member to, potentially, two minutes, depending on interventions. I want to get it to three minutes each, but that will be up to you.

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It is a great pleasure to serve under your chairmanship, Mr Paisley. I congratulate the hon. Member for Easington (Grahame Morris) on securing this very timely and important debate. I wish to make only a brief contribution.

I speak today as a long-standing member of the Conservative Middle East Council and, now, its president, and as someone who has travelled extensively in the middle east for many years. At the beginning of my speech, I want to make it clear that I believe absolutely in Israel and I believe without qualification in the statehood of Palestine. I want to see a secure Israel alongside a viable and independent Palestine. However, I want today to express my deep concern about the truly appalling humanitarian conditions in the west bank and most particularly in Gaza.

In the 35 years that I have been a Member of Parliament, I have taken a very close interest in the middle east, with all its endless shifting alliances, problems and disasters, and it has always seemed to me quite unbelievable that a nation such as Israel—a nation that is cultured, sophisticated and democratic, that has triumphed over so much and whose people have, down the centuries, suffered so dreadfully—should even consider tolerating the grotesque situation that pertains in Gaza and the serious harm, desperate squalor and cruelty that the people there live with. It is immoral and contrary to all humanitarian norms. Israel acts with seeming impunity, imposing what is in effect a collective punishment on Gaza. Israeli actions against the Palestinians are legally and morally wrong and must be condemned, but more importantly, they must be put right. It is not enough just to express concern and to go on expressing concern. I say to my right hon. Friend the Minister, who is indeed my friend and who has a deep and profound understanding of the middle east, that I look to him for something stronger.

A democratic, sophisticated Israel should know much better than to do what it is doing at the moment, not only in its recent violent behaviour towards the Palestinians —the position was very well expressed by the hon. Member for Easington—but as it continues to expropriate, absolutely illegally and against all advice from all its friends and its opponents, land for settlements.

This year is the 70th anniversary of what Palestinians refer to as the Nakba, the terrible catastrophe that befell them, in which most of Palestine’s Arab population fled or were driven from their homes during Israel’s creation in 1948. Since 2007, an illegal Israeli-imposed blockade and three major wars have wreaked havoc on Gaza’s economy, its infrastructure and, above all, its people. Unemployment in Gaza stands at 43%; 39% of Gaza’s 2 million Palestinians live in abject poverty, with 80% dependent on international food aid for their very survival. If that is not enough, 97% of Gaza’s entire water supply is contaminated by sewage and seawater. According to the United Nations, on top of all that are hopelessly inadequate health services. Essentially, the Gaza strip has been made uninhabitable and unliveable.

It is clear that the ongoing split between Fatah and Hamas has paralysed Palestinian politics, made it much harder to make any progress, and rendered very difficult reconstruction efforts in Gaza. However, the House should express today our unqualified and unreserved anger and our shock that Gaza should be kept as it is, with a devastated economy and desperate humanitarian needs.

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Will the right hon. Gentleman give way?

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I will not, if the hon. Lady will forgive me, because I am coming to the end of my speech and many hon. Members want to speak.

I know many Israelis and many Jews in this country who are deeply, abidingly, desperately ashamed of their country’s behaviour—that wonderful, extraordinary country’s behaviour—in this respect, and we should not in the House let this moment pass without most strongly condemning such dreadful and barbaric behaviour.

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It is a pleasure to speak in the debate, and I congratulate my hon. Friend the Member for Easington (Grahame Morris) on securing it. It is also a pleasure to be under your chairmanship, Mr Paisley.

Last week, Jamie McGoldrick, the director of the Office for the Co-ordination of Humanitarian Affairs, spoke to the Britain-Palestine all-party parliamentary group here. A very experienced UN diplomat, he took over recently, and he gave us a horrific picture of both the current and the long-term situation in Gaza. As has been said, there is very little electricity or clean water. There are appalling levels of unemployment, poverty and reliance on aid. One statistic that he gave stuck in my mind. It was that 1,700 people were shot in one day. It is not just the 135 people who have been killed but the thousands of people who have been injured recently. We are talking about really quite unimaginable figures. Nearly 15,000 people have been injured, and the injuries of a large number of those—4,000—related to live ammunition. This is firing into largely unarmed crowds of people who do not pose a threat to the state of Israel.

We can go back 200 or 100 years to events in our own history, such as Peterloo and Amritsar, in which the military engaged in attacking civilian populations. The idea that that is happening now in a country that says it is a democracy and is an ally of this country is just horrific. I am waiting to hear the condemnation that we should hear on this, because it relates to an illegal occupation that has gone on for 60 years. What has happened over the last 25 years—long before Hamas came on the scene—is the separation of Gaza from the west bank so that a Palestinian state becomes impossible. It is no longer possible to travel, not just for health reasons but for any reason at all, out of Gaza. In effect, the people of Gaza are being told, “You are sealed off. You will continue to be occupied. You will be subjugated and humiliated, but you will no longer have the right, just as people in East Jerusalem do not have the right, to travel to the west bank.” This is the fracturing of Palestinian integrity and society in a way that is clearly deliberate.

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Will my hon. Friend give way?

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I will give way—no, having looked at Mr Paisley, I will not; that was a stern shake of the head.

I end by asking this one question. Tomorrow Omar Shakir, a director of Human Rights Watch, will appear before an Israeli court. Can the Minister deal with the question of whether there will be British attendance there from the consulate or the embassy? It is important that voices in Israel speaking up against what is happening are defended and supported, because otherwise the truth simply does not get out. I ask the Government to do their bit, not just in condemning, but in supporting those who are trying to make a difference to the lives of people in Gaza.

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It is a pleasure to serve under your chairmanship, Mr Paisley. I congratulate the hon. Member for Easington (Grahame Morris) on securing the debate, although I am saddened that this contribution is on a fraught and hostile topic that concerns many of my Jewish constituents in Southport. I draw hon. Members’ attention to my entry in the Register of Members’ Financial Interests. I recently made a trip to Israel and the west bank with a number of colleagues—a trip that I will refer to.

Last Wednesday, a rocket exploded outside a nursery in southern Israel. No children were hurt, but the rocket was one of 45 fired from the Gaza strip that day. In recent weeks, dozens of balloons and kites with explosives attached to them have floated into Israel. One landed on a children’s trampoline. Fortunately, no children were hurt. We rarely hear about violence emanating from the west bank or the deprivation there. I ask hon. Members to consider why. What is the difference between the two territories? The answer is simple. Whereas the Palestinian Authority want to create a lasting peace, the regime that controls Gaza wants to wage war against the Jewish people. Such hatred informs its decisions, which worsen the lives of ordinary Gazans.

Even more worrying is the anti-Semitism of Hamas. If we want to understand the humanitarian situation in Gaza, we need to appreciate the importance of the hatred that drives Hamas to launch bombs attached to balloons in the direction of innocent children. Since its foundation, Hamas has promoted the sort of perverse anti-Semitic stereotypes that some in our own country now believe. Its original charter accused the Jews of controlling Governments and triggering wars between them. It asserted that the Jewish people needed to be broken and their dream of a Jewish state destroyed. Even its revised charter denies Israel’s right to exist.

Such unrelenting hatred causes obvious concern in Israel, but it creates only misery for Gaza. It is the reason why Hamas hides its weapons in the homes of innocent people; why it fires rockets from unprotected schools and hospitals; and why it channels tens of millions of dollars of international aid into maintaining a network of tunnels that terrorise Israel. This year I had the opportunity to see one of those tunnels. Only by seeing it can a person comprehend the true scale of the terror infrastructure that Hamas has created. It is nothing like what many anti-Semitic commentators would have us believe. The tunnels are not built to assist those who might be fleeing. They are the product of sophisticated technical engineering, built with the purpose of supporting Hamas in achieving a prescribed outcome. Concrete slabs support the walls and ceilings of the passageways, many of which have electric wiring and lighting.

It is right that we concern ourselves with the ongoing humanitarian crisis in Gaza, yet I ask hon. Members to keep in mind what continues to make the humanitarian situation in Gaza unfavourable. Is it a lack of support by the international community? No. Is it the chronic shortage of humanitarian funding? No. It is the anti-Semitic hatred of Hamas that keeps Gaza in its current pitiful state.

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It is a pleasure to serve under your chairmanship, Mr Paisley. I want to associate myself with what was said by my hon. Friend the Member for Hammersmith (Andy Slaughter). The hon. Member for Southport (Damien Moore) talked about seeing Gaza for ourselves. I have recently been to Israel and to the Palestinian territories. Seeing it for ourselves is important; it is what makes us turn up at 2.30 in the afternoon in Westminster to speak about these things. It is important that we all see it for ourselves. I appeal to the Minister to try to ensure that arrangements are made for Members of this House to go to Gaza, so that we can have proper oversight of British funding around Gaza and the humanitarian crisis. My hon. Friend the Member for Liverpool, Walton (Dan Carden) and I asked to visit Gaza as delegates, and were told in no uncertain terms that it would be almost impossible. That does not fill me with hope that the system is fair, especially given all the points raised in the opening remarks. It worries me when we stop being able to see.

My hon. Friend the Member for Hammersmith raised the case of Omar Shakir from Human Rights Watch. It appears that there is a closing down of dialogue, which is aimed at silencing human rights voices in the west bank and Gaza. The only way in which we can exert power to try to change that is through the use of our missions in the region. I urge Ministers to seek support on the case regarding Omar Shakir’s deportation, and to urge the missions to attend tomorrow’s court case in Jerusalem. Something must be done, so that we are not left guessing about the propaganda and the different groups. Let us call a spade a spade. We are all associated with different groups that have different feelings and ideologies on this issue, but we can put all that aside. I watched myself and the people I travelled with put some of our preconceived ideas aside when faced with the reality. I ask the Minister to try to make sure that we can go into Gaza and see it for ourselves.

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It is a pleasure to serve under your chairmanship, Mr Paisley. I congratulate the hon. Member for Easington (Grahame Morris) on securing this very important debate.

The humanitarian situation in Gaza is severe and extremely difficult, and I am pleased we are having this debate. I want to focus first on the good work that is being done. We often think the problems are insurmountable and ignore the really serious efforts to improve the situation. Israel has doubled the amount of water it provides to Gaza to relieve the water crisis that Gazans face. Furthermore, Israeli healthcare and charitable bodies continue to provide their services to Palestinians. Some 6,000 children have been examined in the weekly cardiology clinic run by Save a Child’s Heart in the city of Holon. Each day, around 700 trucks of supplies of medication, food and building materials enter Gaza through the Kerem Shalom crossing. In total, 10 million tonnes of construction material have been delivered to Gaza since 2014. Those are all positive signs.

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I appreciate the hon. Gentleman’s giving way. The World Health Organisation has stated that in Gaza, there is only a month’s supply of half of the items needed for essential medicines, and of a third of essential disposables. Does he find that acceptable?

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These things are extremely difficult and it is not up to me to say whether that is acceptable. I will simply highlight what I think is happening to some of the resources directed towards Gaza.

As I said, there are positive signs, but clearly they have not alleviated the very serious humanitarian situation in Gaza. It could be said that Israel can and should do more, but when we ask why it does not do more, we come across the root cause of the Gazan humanitarian catastrophe. Hamas won in the 2006 Palestinian legislative election, and emboldened by that, it militarily seized the Gaza strip in 2007. Since then, Hamas has been the undeniable root cause of the suffering and devastation in Gaza. It is committed to the destruction of the state of Israel, aided and abetted by its Iranian paymasters. It antagonises the situation by being a bad, unhelpful and corrupt Administration.

The reconstruction material that Israel sends through the Kerem Shalom humanitarian crossing is frequently misappropriated to build terror tunnels. In 2016, it emerged that $36 million had been diverted from the international relief group World Vision directly into Hamas’s coffers. Additionally, 369 Palestinians are alleged to have abused their medical permits to seek treatment in Israel, using them instead to plan and prepare terrorist atrocities. In such circumstances, given the rampant maladministration and deception that Hamas oversees, the Israeli and international aid efforts are amazing and optimistic. It is a credit to all involved that they continue to do the right thing, despite the real risk that their good intentions will be subverted for evil ends. Hamas is not just a corrupt administrator; it is a genuine threat to the security of Israel and the wider region.

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It is a pleasure to serve under your chairmanship, Mr Paisley. I congratulate my hon. Friend the Member for Easington (Grahame Morris) on securing this important debate and on his excellent speech.

Following the killings of Palestinians protesting on the “Great March of Return”, a senior UN official rightly described the humanitarian situation in Gaza as a

“crisis on top of a catastrophe”.

And it is a long-running catastrophe.

The illegal blockade of Gaza is entering its 12th year. That is more than a decade of occupying forces violently locking nearly 2 million people in one of the most densely populated areas in the world, in what David Cameron described as an “open-air prison”. It is more than a decade of Palestinians being terrorised by an Israeli army that still effectively occupies Gaza, with Israel retaining control over Gaza’s borders, air space, sea space and public utilities. It is more than a decade of the Israeli army making frequent and devastating military interventions in Gaza, and it is more than a decade of its control being used to suffocate Gaza.

The poverty rate is 40%, with 80% of the population dependent on foreign assistance. Just 20 years ago, Gaza’s water network provided safe drinking water to 98% of households. Now the figure is less than 4%. Today there are just three to four hours of electricity a day in Gaza. In 2012 the UN warned that Gaza would be “unliveable” by 2020. That judgment was revised last summer: Gaza is already unliveable.

We could spend all day cataloguing the severity of the de-development of Gaza but throughout it must be remembered that the humanitarian catastrophe is human-made, perpetrated through military might and with international backing. Because it is human-made it can and must be unmade, but rather than seeking a political solution our Government facilitate the disaster. Just last year the Government approved more than £490 million-worth of weapons exports to Gaza, including sniper rifles like those used to kill Palestinian protesters in recent months. Since we know that the Israeli army’s military arsenal is crucial in the ongoing humanitarian catastrophe in Gaza, will the Government review the sale of arms to Israel?

The human-made disaster in Gaza can be unmade. Palestinians and Israelis can live in equality and peace, and on just terms, but it will require political courage to bring that about. I look forward to that day and pray it will be soon, when we have a Government who are willing.

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Since Hamas seized control of Gaza in 2007, the humanitarian situation has deteriorated drastically. Hamas does not use international aid for the benefit of its citizens, to build schools or hospitals. Instead it uses it to build sophisticated tunnels into Israel, with the intention of committing terror attacks.

It has gone relatively unreported, and has certainly not been mentioned in this debate, that Israel has facilitated the passage of well over 10 million tonnes of construction materials into Gaza since Operation Protective Edge in 2014. It has expanded and developed its Kerem Shalom goods crossing to increase its capacity to 800 trucks a day, which carry food, medical equipment, fuel, building materials and more. Yet on at least three occasions in recent weeks Hamas has set fire to the crossing and to the gas pipelines that serve the people of Gaza. It has refused and destroyed aid supplies, including the medicines whose severe shortage other Members have highlighted, when it has been realised that they came from Israel. That attitude is completely incomprehensible and only compounds the suffering of Gazans, who are living in the most horrifying situation.

Israel regularly allows Gazan patients to get treatment in Israel, and helps Gazan doctors and nurses to receive further medical training at Israeli hospitals. When I visited Tel Aviv I saw Israeli doctors at Save a Child’s Heart providing life-saving heart surgery to Palestinian children and training Palestinian doctors, who will return to Gaza where they will be able to perform the surgery themselves.

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My hon. Friend makes the point that Israeli hospitals treat citizens from Gaza. Is he aware that some of the people who have been treated have included senior Hamas operatives and members of their families, and their children?

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I thank my hon. Friend for that point, which is a good one. Senior officials in Hamas are always too ready to allow access to those high standards of healthcare in Israel, although they seek to block it for their own citizens.

The moments in that Tel Aviv hospital gave me hope that peace could be achieved, because Palestinians and Israelis worked together there as equals with mutual respect. When we debate the disastrous humanitarian situation in Gaza we cannot ignore the role of Hamas, as others have sought to do. What struck me when I was in the west bank and met the Palestinian chief negotiator was the fact that his overriding emotion was not frustration, anger or upset; instead there was a sense of despondency and guilt, because he keenly felt that the loss of the Gaza elections to Hamas in 2006, the battle of Gaza in 2007 and the political violence of 2009, when opponents of Hamas were tortured, shot and thrown off buildings, have created an insurmountable obstacle to peace and left the innocent people of Gaza at the mercy of an authoritarian militant jihadi regime.

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Will the hon. Gentleman give way?

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No, I am sorry but I do not have time.

It is important to note that the Palestinian Authority are not reconciled with Hamas. They cannot work with it or bring it to the table. They do not want Hamas to be in control of Gaza. They have sought to use financial measures to isolate it, and in the past couple of weeks President Abbas has really tried to increase pressure on the regime to transfer power over to Ramallah. Until Hamas renounces violence, seeks to work for peace and co-operates with the international community, the humanitarian situation in Gaza will only get worse.

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It is a pleasure to serve under your chairmanship for the first time, Mr Paisley. I congratulate my constituency neighbour, my hon. Friend the Member for Easington (Grahame Morris), on obtaining the debate, and associate myself with all his remarks. I also agree with every word that the right hon. Member for Mid Sussex (Sir Nicholas Soames) said.

I want to deal with a couple of issues that have not been mentioned in the debate. One concerns the truth. The debate is about the humanitarian situation in Gaza, not the politics of the region. We should remember that. It is about the men, women and children who live in an absolute hell hole. The media reporting this week of the visit by His Royal Highness the Duke of Cambridge has been inaccurate. I welcome his visit—it is a good one—but the media have been referring to the Palestinian territories, and not the occupied Palestinian territories. We should never forget that point, and the BBC needs to do better.

Another thing that has not been touched on today is the issue of permits. To get access to hospitals in Israel, the west bank or East Jerusalem, people need a permit to leave Gaza. I visited the west bank last year and the number of people refused permits was enormous. With the recent increase in violence on the border, after the “Great March of Return”, children are being refused permits to seek medical attention in better equipped hospitals outside Gaza. By any parameter—by any civilised metrics—children should not be refused medical treatment. They are not a security risk or political operatives, but children. We should remember that.

We are talking about the enormous suffering of people who live in Gaza—an area that is beautiful, if only it can be given the resources to succeed. I feel strongly that British parliamentarians have a huge responsibility to shine a light on what is happening there. That is what we are doing today. The Government have a responsibility to step up to the mark and do something. We need to stand tall and act on what is happening, and not allow it to continue. I look forward to hearing what the Minister will say to call out that unacceptable situation, and what meaningful, purposeful suggestions he will make for what can be done to address the humanitarian crisis in Gaza.

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It is a pleasure to serve under your chairmanship, Mr Paisley. I congratulate the hon. Member for Easington (Grahame Morris) on securing the debate, and draw attention to my entry in the Register of Members’ Financial Interests.

The humanitarian situation in Gaza is most worrying. The people of Gaza live in difficult circumstances, with high unemployment, particularly among the young. There are no real export markets to speak of, and GDP is at low levels. The territory suffers from intermittent blackouts, and access to water is deteriorating. However, it is important to note that for many years Israel has provided electricity to the people of Gaza, and it was the Palestinian Authority who last year put pressure on Israel to reduce the electricity supply temporarily, when they refused to continue paying for it.

The only way to end the humanitarian crisis is to improve the prospects and life opportunities of the people of Gaza. Israel has an important role to play in that. I particularly welcome reports today that Israel and Cyprus are working together to build a sea port to facilitate Gaza’s rehabilitation, while also ensuring that Hamas will not be able to exploit the port for smuggling weapons. Hamas has, for too long, taken humanitarian aid away from the most needy in Gaza, for the purpose of terrorism. I hope that with the support of the international community the sea port will be able to open up a new and more hopeful chapter for the people of Gaza.

Sadly, today’s debate is set against rising tensions along the Gaza-Israel border. The Hamas-orchestrated riot on the border and the highest levels of rocket fire into Israel in years have been a painful reminder of the volatility of the area. Less well known, however, are the new arson terror attacks being deployed in Gaza, which have devastated Israeli communities along the border. Almost 1,000 incendiary kites and helium balloons bearing inflammable materials and, occasionally, explosives have been launched from Gaza into Israel, causing more than 1,000 fires in Israeli communities.

Make no mistake: this new form of terrorism is led and co-ordinated by the Hamas terror group. It is inexpensive and straightforward. It must stop. The cycle of violence fundamentally highlights why Hamas must abide by the Quartet principles and immediately renounce violence against Israel.

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Order. Before I call Dr Rosena Allin-Khan, I inform Members that her speech will be the last three-minute speech. After that, the time limit will be two minutes.

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It is a pleasure to serve under your chairmanship again, Mr Paisley. I thank my hon. Friend the Member for Easington (Grahame Morris) for initiating this debate.

It has been heartbreaking to follow the ongoing situation in Gaza. Time after time, we have had the opportunity to ease people’s suffering around the world, yet in Gaza we have failed to do so. We are witnessing ongoing massacres and conflict. In the past three months alone, 135 Palestinians have been killed and almost 8,000 people have required hospital treatment. That is the largest loss of life in Gaza since 2014. Violence was directed at protestors, many of them children. The massacre on the border on 14 May was triggered by the opening of the US embassy in Jerusalem. On that tragic day alone, 52 Palestinians died. How, as an international community, can we allow our actions to lead to such a senseless loss of life? How can we welcome President Trump here next month, when his actions have led to the death of civilians and the slashing of funding for UN relief work for Palestinian refugees?

In my capacity as a humanitarian aid doctor, I worked with Palestinian refugees for three years, with the Red Cross and the humanitarian aid department of the European Commission. Through that work, I witnessed the aching and suffering of a marginalised population who have been repeatedly displaced, are without hope and are continually at the mercy of the international community. Gaza is suffering from a protracted health crisis, which is inhumane. To restrict access to healthcare for an already marginalised population is nothing short of disgraceful. Basic infrastructure such as healthcare, electricity and sanitation is not being developed in Gaza.

What makes Gazans less deserving than anyone else in the world who Britain, as an outward-looking country, fights for day in and day out? Why should parents continue to witness their children—children like ours—dying in their arms? We have a duty to ensure that we use the honourable power bestowed on us on the political stage to protect those at risk. Britain has always been an outward-looking country that does not shy away from the challenges that face us all. Our country’s response to this crisis goes to the essence of who we are as people. We must stand up and call out the human rights offences in Gaza when they are taking place. We have a duty. We cannot turn our backs on those in Gaza.

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It is a pleasure to serve under your chairmanship, Mr Paisley. I congratulate my hon. Friend the Member for Easington (Grahame Morris) on securing this important debate.

It is clear that the situation in Gaza represents a major humanitarian crisis, which is getting worse, not better, and which has dangerous consequences for the whole region. It makes the likelihood of a Palestinian state seem further away than ever.

Some 2 million souls are living in cramped urban conditions under a blockade by land, air and sea, as if they are in a prison. Some 1 million Palestinians are reliant on food aid. Just 10 years ago, that figure was 80,000. Ninety seven per cent. of households are without access to fresh running water. There are regular, frequent power blackouts. The reduced electricity supply puts strain on hospitals, as well as water and sanitation supply, with over 110,000 litres of raw waste or untreated water released into the Mediterranean sea every day. Six in 10 young people are unemployed. A Palestinian in Gaza is twice as likely to be unemployed as a Palestinian in the West Bank. That situation is simply unsustainable, so there is an immediate humanitarian need for aid.

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Does the hon. Gentleman agree that the US President’s slashing of UN aid to Gaza threatens to make the situation much worse? Will he join me in calling on the UK Government to put that case to the President when he is here on 13 July?

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I could not agree more with the hon. Lady and I hope the Minister will answer that point.

At the International Development Committee on 19 June, Rachel Evers, director of legal affairs at the United Nations Relief and Works Agency, gave shocking evidence about the pressures on the relief on the ground. I ask the Minister to address the important point about the impact of cuts to the UNRWA budget. Can more be done by the UK in the short term to ease the humanitarian crisis? We all know that the long-term solution will be a political one, pursued by calm heads with a genuine desire for peace—alas, I do not see too many of those in Washington and Jerusalem at present.

We should absolutely condemn the US moving its embassy to Jerusalem as a provocative and reckless act. But what of the medium term? Here the answer may be economic as much as political. The Israeli Government must relax their blockade and allow economic development. People in Gaza must be allowed to develop their own infrastructure and economy. Finally, I ask the Minister to share his views on economic development as a route to a better future for the Palestinians in Gaza. In conclusion, Gaza is collapsing. Its people are suffering. The world is watching. We must act now.

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It is a pleasure to serve under your chairmanship, Mr Paisley. I will concentrate my remarks on children, who have never had a say in this conflict, have never done anything to add to it and have committed no crime whatever except being born. They are suffering the most. I visited Gaza in 2012 and what I saw will stick with me for the rest of my life. I remember the people who were making the most of a very difficult situation. They were welcoming people, with aspirations for their children, as we have for ours, but above all, they wanted freedom.

I also remember the mothers showing me pictures of their children locked up in Israeli prisons after being sentenced—contrary to international law—by military courts. They could not visit their children, because the Israeli Government would not permit it. I also saw the fertile land and stunning beaches, but the land could not be fully exploited and the beaches were polluted because of the lack of sewage treatment. The potential for a vibrant nation was there, but people had little optimism that it could be achieved. It just gets worse.

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I want to make a brief comment about children. A 10-year-old child in Gaza will already have lived through three conflicts, with no end in sight. Already, Save the Children is reporting that children are facing huge mental health problems, bed-wetting and all sorts of issues.

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Indeed, that is the case. I wanted to address mental health, but I do not have sufficient time. I thoroughly believe that it is the responsibility of Governments and countries around the world to help those unable to help themselves, yet countries trying to help the Palestinians are restricted by the harsh regime imposed on the movement of goods and aid by the Israeli Government.

It is not just about aid but about development and a nation that can sustain itself. I know it is an old cliché: give a man a fish and you have fed him for a day; teach him to fish and you will feed him for a lifetime. It is about allowing people to develop and reach their potential. Although that does not do the Palestinian fisherman any good, as they are banned from their own fishing waters. It cannot possibly be right to have two nations living cheek by jowl, with one firmly in the 21st century, developing and thriving, while the other is left behind in poverty and need.

We have seen how the nations of the world react in times of disaster. We have seen countries devastated by famine, others ruined by catastrophic weather and refugees fleeing war zones across the world. They all have one thing in common. Other countries can get access to those people. We cannot get access to the people of Palestine. It is time that the nations of this world made it clear that they are prepared to tell Israel that they want and will have access to these marginalised people. That is not just my message. I attended an Eid festival event at Stockton Mosque on Friday and heard a series of speeches, most from young Muslim women, about the middle east, particularly Palestine. They want a peaceful world. They want to reach their potential, but that is also their wish for the children of Gaza.

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It is a pleasure to serve under your chairmanship, Mr Paisley. To improve the humanitarian situation in Gaza, what must happen is self-evident but, unfortunately, intractably difficult to achieve. There are steps that the UK Government can take to help. They must take the long-overdue action they know is required to improve the humanitarian situation.

There are three main things the UK can do. The first is to demand an end to the 11-year blockade of Gaza. Not only is the blockade illegal under international law—as has been mentioned, it is in contravention of the Geneva convention on human rights—but it is preventing the rebuilding of infrastructure, hospitals, schools, electricity supply and sewage systems. Indeed, the GDP in Gaza has halved in recent years. The blockade is highly restrictive to the work of local and international humanitarian organisations, not to mention the local economy and the ability of Gazans to support themselves. Humanitarian and development organisations are extremely limited in obtaining basic supplies, such as building materials for shelter and medical supplies, which undermines their ability to provide support and take a sustainable approach to development assistance. The restrictions need to be lifted and, until they are, I hope the Government will urge the Israeli authorities to go much further in easing them.

Secondly, the UK Government need to review their defence sales relationship with Israel. In response to a written question that I tabled earlier this month, the Minister said:

“The Government…have been keeping the situation in Israel under review. We have no information to suggest that UK supplied equipment has been used in contravention of the Consolidated EU and National Arms Export Licensing Criteria.”

However, as the Government’s review found that the UK had issued 12 licences for defence equipment that they believed were likely to have been used in the 2014 war, and as equipment sales have continued unabated ever since, serious questions remain as to whether the UK-made weapons supplied to Israel were used by the Israeli Government during the recent horrific violence in Gaza, and there needs to be a full investigation into that.

Thirdly, we must push for an independent investigation by the UN or the International Criminal Court into Israel’s use of live ammunition against civilians in Gaza, particularly during the recent protests for the Palestinian right to return. After 70 years of intractable conflict, the only sustainable future is a comprehensive peace deal based on a two-state solution of a secure Israel alongside a secure and viable Palestine. Sadly, that vision—

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Order. I call the first Front-Bench spokesperson, Joanna Cherry. I thank her for conceding some of her time to Back Benchers.

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It is a pleasure to serve under your chairmanship, Mr Paisley. I congratulate the hon. Member for Easington (Grahame Morris) on securing the debate and on making such an eloquent and heartfelt speech. It is always a pleasure to listen to him.

The hon. Gentleman spoke of the shocking number and nature of the casualties sustained by Palestinians in Gaza due to recent events. In particular, he spoke about the fatal shooting of the volunteer paramedic, Razan al-Najjar, despite the fact that she was clearly identified as a paramedic. He said that that was a war crime, and I endorse that. He stressed the importance of an independent investigation of that death and of all the other deaths that took place, and the importance of people being held to account.

The hon. Gentleman also spoke about the nature of the weapons and the ammunition used, and made the demand, which many hon. Members agree with, that until those matters are looked into properly, arms sales to Israel should be suspended. He spoke about the humanitarian conditions on the ground, which was taken up very eloquently by the right hon. Member for Mid Sussex (Sir Nicholas Soames).

Like me, and the Scottish National party, the right hon. Member for Mid Sussex supports a two-state solution, but recognises that that is becoming less likely because of the situation on the ground and the settlements in the occupied territories. In connection with that, I refer hon. Members to my entry in the Register of Members’ Financial Interests. In October 2016, I visited the Occupied Palestinian Territories with the Council for Arab-British Understanding and Human Appeal. It was sobering to see the size and nature of those settlements and the way in which they make the two-state solution unfeasible. I agree with his description of what is going on in Gaza as “collective punishment”, and he is also right that it is legally and morally wrong.

The hon. Member for Hammersmith (Andy Slaughter) has long worked on these matters. He spoke about a briefing by Jamie McGoldrick last week that several hon. Members present attended. Mr McGoldrick described the situation in Gaza as polarised and visceral—a crisis on top of an unfolding disaster, as the hon. Member for Battersea (Marsha De Cordova) said. He said that there would be no humanitarian solution without a political solution. I asked what his key asks were, and he said that we had to address the United Nations Relief and Works Agency shortfall; shore up the health sector in Gaza; and support education so there can be a depolarised place for children to spend time, rather than getting sucked into the conflict.

Mr McGoldrick also said that the parties to the conflict must exercise restraint, and that is the message that the UK Government must put to the Israeli Government. Of course, Hamas must exercise restraint, but democratic Government should speak to democratic Government, and we must tell the Israeli Government to exercise restraint too.

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Mr McGoldrick also indicated not just that there had been a lack of restraint but that the weaponry used against civilians was designed to cause maximum injury. In contrast to some of the bizarre things that we have heard from Government Members, there was no attempt to treat the injured, so even minor wounds are causing amputations and infections. I also refer to my entry in the Register of Members’ Financial Interests; I travelled to Palestine with Medical Aid for Palestinians last year.

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Mr McGoldrick made strong reference to the terrible injuries that have been sustained. He said that Gaza was running out of external fixators because people have suffered such terrible fractures from a bullet going into their foot and essentially exploding it, so that it does not even look like a foot any longer.

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Will the hon. and learned Lady give way?

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I had better make some progress, so that the Minister can respond.

Many issues have been raised today, and because of the lack of time, I will not go over them again in detail. The Minister is a good man, and he recognises the gravity of the situation. I would like the United Kingdom Government to have a stronger voice on this issue. Earlier, the hon. Member for Battersea referred to what David Cameron said years ago about Gaza being an open prison. We need that sort of language to be made real.

Last month, the Israeli ambassador visited Scotland, and my colleague, the Scottish Government’s Cabinet Secretary for Culture, Tourism and External Affairs, Fiona Hyslop, met him. She delivered a forceful message on the Scottish Government’s behalf that the 50 years of Palestinian oppression, the illegal occupation of the west bank, the illegal expansion of settlements and the illegal siege of Gaza must end, and that there must be genuine work in good faith towards a peaceful two-state solution. The Scottish National party also supports the UN Secretary-General’s call for an independent investigation following the recent massacre.

The Scottish Government have spoken decisively, but they do not have the foreign affairs competence of the British Government. I want to hear what the Minister will do. Will he give us a cast-iron guarantee that the United Kingdom Government will not shirk their responsibility and that they will join others in the international community in speaking out clearly on this matter?

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It is a pleasure to serve under your chairmanship, Mr Paisley. It gives me great pleasure to follow in the footsteps of distinguished hon. Members, especially my hon. Friend the Member for Easington (Grahame Morris), who has spent many years campaigning on this topic. I well remember when he played a vital role in securing a vote in the House of Commons to recognise the Palestinian state, but the UK Government still refuse to give that recognition. I am limited by time, and I want to give the Minister as much time as possible to answer all the questions that have been asked, but I will start by saying that, importantly, this is a different debate. It is about the humanitarian situation in Gaza. We want to know what the Government can do to alleviate some of that pain and suffering.

The right hon. Member for Mid Sussex (Sir Nicholas Soames) spoke strongly, with great experience and passion, and as president of the Conservative Middle East Council, about how what has taken place in Gaza is legally and morally wrong. He was very plain with his words and I am grateful to him for that.

My hon. Friend the Member for Hammersmith (Andy Slaughter) mentioned Jamie McGoldrick. We are all putting a lot of hope and faith into his role for the future of the conflict. My hon. Friend the Member for Birmingham, Yardley (Jess Phillips) and I travelled to the west bank together and had an emotional and educational visit. Many hon. Members have had similar trips. My hon. Friend the Member for Battersea (Marsha De Cordova) focused her contribution on the problems with the water and electricity supplies and the real humanitarian situation on the ground. My hon. Friend the Member for Sunderland Central (Julie Elliott) talked about the permits. I saw at first hand how children who were leaving Gaza to try to get medical assistance in the west bank had to travel with family friends or others, because they had to leave the country with someone who was over a certain age, so they could not be assisted by their parents.

This debate comes at a vital time for the Palestinian people. It is no exaggeration to say that their whole future in the Occupied Palestinian Territories is now under direct threat. If we do not act in Britain, Europe, the United States or the middle east, or through the United Nations, millions will suffer from continued violence, from a lack of the most basic public services and clean water, and from a shortage of places to live.

The Trump Administration substantially cut funding to the United Nations Relief and Works Agency. The EU has partially stepped up to the plate by announcing €3 million of new humanitarian aid to help civilians in Gaza in need of urgent assistance. In response, the UK decided to advance £28 million of agreed funding. Yesterday, the ad hoc committee for voluntary contributions to UNRWA met for the first time, and my reading is that the United Kingdom has donated a further $51 million, or £38.5 million. I welcome that contribution whole- heartedly. Will the Minister report back fully on yesterday’s meeting and what money will be targeted specifically at Gaza? We know that will be reliant on Israeli co-operation.

More than 120,000 people are still disconnected from public water networks, and 23% of Gaza is not connected to the sewerage system. Some 96% of the water from Gaza’s coastal aquifer is contaminated with nitrates and chlorides. Only a quarter of wells in Gaza meet World Health Organisation safety levels.

We are here today to offer advice to the British Government on what they can do economically, socially and politically to help the Palestinians in their hour of need. Last week, to mark the UN’s World Refugee Day, the leader of the Labour party visited two of the biggest Palestinian refugee camps in Jordan. This week, Prince William is visiting the Occupied Palestinian Territories in an important symbolic act aimed at showing that people in Britain do care about the plight of the Palestinians. What is the Minister doing to argue for better access to Gaza so that the international community, non-governmental organisations, charities and politicians here can visit, so that the crimes perpetrated on Gaza are not hidden behind blockade walls?

We have to begin by acknowledging that the humanitarian crisis is man-made. It is vital to resolve Gaza’s catastrophic lack of clean water and electricity, as well as its health system, which is hanging by a thread, and other life-threatening problems that experts say will make the strip uninhabitable in a matter of years. The utter desperation rife in the squalid, bombed-out settlements of Gaza has in recent weeks manifested itself in huge protests and an Israeli response that has shocked and appalled. As Members have said, we condemn any acts of terror by Hamas, just as we condemn the appalling actions of the Israeli Government.

Since the first protests on 30 March, the Israel Defence Forces have killed 135 Palestinians, including a young medic, 21-year-old Razan al-Najjar. Nearly 15,000 people have been injured, with 4,000 of those injuries caused by live ammunition. Sixteen children have been killed. Five Israelis have been injured. This puts further pressure on Gaza’s health system, which was anyway already on the brink of collapse, according to the World Health Organisation. I do not have the time to go into the details of those outrageous, disproportionate and illegal acts, which have been covered many times in previous debates and today. Instead, I will use my time to pin down some of the humanitarian situation and what DFID can do to improve the lives of these people in the most dire of situations.

Protecting the Palestinians is an international obligation —let us be clear about that, too. In fact, it is the international community’s collective responsibility as states party to the fourth Geneva convention to provide protection to Palestinians in the occupied territories. The British Government should not be ordering their diplomats to vote against or abstain on resolutions that uphold international law.

I will move on to some questions that I hope the Minister will be able to answer. Currently the Government do not disaggregate between their DFID spending for Gaza and that for the west bank. Will he consider reviewing that approach, so that our development work in Gaza, which is clearly a separate and defined area under blockade, can be more readily reviewed by this House? At present, the movement and access restrictions imposed by Israel significantly constrain the health system in Gaza. Access to treatment is impeded by the inability to import medical equipment, and administrative constraints are placed on people seeking medical attention outside Gaza. What progress has the Minister made in talks with the Israeli Government on expediting medical permits for those who require treatment outside Gaza?

The UK is supporting water and sanitation needs through £1.9 million-worth of support to UNICEF and £1.5 million to the International Committee of the Red Cross, helping support patients in 11 hospitals in Gaza. Will the Minister tell us more about those projects? Are those the only Gaza-specific aid contributions made by the UK Government to Gaza, outside obviously of their contributions to UNRWA, which supports 1.3 million people in Gaza? If I am allowed a crude calculation, if the population of Gaza is near enough 2 million, that money works out at just £1.70 a person in Gaza over one year. That funding finishes in September 2018. Will the Minister tell us when we will hear about future years’ funding?

In answer to written question 144778 in May, the Minister said he is reviewing how the UK can best support the health system in Gaza. What does that review involve and when will he report to the House? If elected, Labour will recognise the state of Palestine immediately. The Minister has been asked before why his Government do not recognise Palestine right now. If not now, when? He often talks with great empathy about the polarisation and worsening of the situation between Israel and Palestine. The reality of this Government’s actions is that they are providing very good critiques of the situation, but are failing to act robustly when they should be upholding international law. They should be taking action, not simply offering words.

On America, we often hear the Minister take a different line from that of US counterparts. That is of course welcome, but this Government must have the courage to tell President Trump that he is wrong. What is the Minister doing to work with other European and global partners so that all the UK’s eggs are not in the Trump basket and we are not reliant on the peace plan of Jared Kushner?

Finally, in his response to a House of Commons debate on 15 May on violence at the Gaza border, the Minister said:

“we are supportive of that independent, transparent investigation.”—[Official Report, 15 May 2018; Vol. 641, c. 139.]

When the UN Human Rights Council resolved to set up a commission of inquiry to undertake precisely that investigation, the UK failed to join 29 partner countries and abstained in the vote. We are still waiting for an explanation of that decision.

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It is a pleasure to serve under your chairmanship, Mr Paisley. I begin by once again thanking the hon. Member for Easington (Grahame Morris) for securing the debate. His long-standing commitment to and passion for the Palestinian people is well known and appreciated by many. The conviction with which he speaks is noted.

There have been a number of powerful speeches on all sides. The hon. Member for Liverpool, Walton (Dan Carden) went through them, and I do not intend to add to that. It is impossible to pick out all the speeches, but I commend my right hon. Friend the Member for Mid Sussex (Sir Nicholas Soames). He spoke about his admiration for the state of Israel and his worry about where Israel policy has gone in relation to Gaza and the humanitarian concerns. I am sure he spoke for many in expressing not only the interest that the House has in the future security and existence of the state of Israel, but the worry, because of the humanitarian situation we have all described, about policy in terms of Gaza.

It is difficult to approach the issue in a new way, but I will say something towards the end about that, if I may. To begin, I would like to concentrate on the humanitarian issues. As so many Members have spoken and so much has been said, it is impossible to cover everything, so I hope colleagues will bear with me.

Last month, I visited Gaza again. I say to the hon. Member for Birmingham, Yardley (Jess Phillips) that we will do what we can to assist Members of Parliament in going, because there is nothing like seeing things on both sides, but it must be for Israel to decide in terms of security. We are all subject to being cautious about that. While I was there, I once again saw the extreme humanitarian difficulties that the people of Gaza now face. As Members have noted over the course of the debate, people there are living without enough fresh water, with only four hours of power a day, with some of the highest youth unemployment rates in the world and, perhaps most importantly, with diminishing hope for their own or their children’s futures.

I will pick out a few key parts of the humanitarian system. Without additional support, the health system is unable to cope with the high casualty rates from the demonstrations. Between 30 March and 12 June, 14,605 people were injured and a further 135 died. Between 30 March and 3 June, two health workers were killed and 328 were injured, including by live ammunition and tear gas. An estimated 80,000 additional non-trauma patients have had limited access to emergency healthcare services. Shortages of medicines are chronic in Gaza. An estimated 1.2 million Gaza residents have no access to running water. A lack of adequate sanitation facilities poses a serious health risk. Approximately 1.45 million people in the Gaza strip are at risk of contracting waterborne diseases from the consumption of unsafe water. Gaza has three main sources of electricity supply: Israel, Egypt and the Gaza power plant. The most stable of those sources is from Israel, which supplies 120 MW of electricity through 10 feeder lines, but those are unstable, as we know.

[Mark Pritchard in the Chair]

The food and nutrition situation remains difficult. An estimated 1.6 million people do not have reliable access to nutritious food in Gaza and are judged to be food-insecure. As I will say later, someone doing an objective assessment of whether the policies in relation to Gaza are working would come to the answer, “No”.

Before I come on to the politics, colleagues rightly want to know what we are trying to do. There are three key issues: first, the need to alleviate the urgent humanitarian need; secondly, the need to unlock the barriers to an improved quality of life for Gazans through economic development; and thirdly, the need to work with international partners to secure political agreements that will ease movement and access restrictions to Gaza.

The Department for International Development is stepping up its support to alleviate humanitarian need. When I was in Gaza I announced £1.5 million for the International Committee of the Red Cross appeal. The hon. Member for Liverpool, Walton asked for a little more information. That money will help 11 hospitals. I went to the al-Quds hospital in Gaza city, which was spotless. I met some of the doctors involved in treating patients there and some of the patients. Our work will help some of those 11 hospitals and their patients with the restocking of surgical equipment and medicines and with providing physical rehabilitation.

We are also committing an extra £2 million to UNICEF to address urgent water and sanitation needs. That will help Gazans to have access to clean water to drink, cook and bathe. Our support will provide more than 1,000 roof water tanks for families to help them store scarce water, drinking water tanks, and chemicals to treat water in 280 wells and 38 desalination plants, making water safe for human use.

Colleagues have mentioned access. We value the role of the UN in co-ordinating humanitarian worker access and in supporting the safe reconstruction of Gaza. The UK is committed to an extension of support for the UN access and co-ordination unit, which works to ensure humanitarian access for UN and non-governmental organisation workers.

The UN Relief and Works Agency plays a vital role in providing basic services. We are, of course, concerned about the lack of finance for Gaza, particularly as a result of the United States’ decision to reconsider its financial commitment. UNRWA will struggle to survive unless we can find a way around this. Accordingly, I have announced £28.5 million, which I committed at the UNRWA pledging conference in Rome. Yesterday, at the UN Security Council, we pledged a further £10 million, making the £38.5 million that the hon. Member for Liverpool, Walton mentioned. That is money being brought forward to give to UNRWA now to help it to meet the shortfall. I hope that that is appropriate.

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Is that new money, or is it bringing money forward?

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It is money brought forward, so of course we will have to consider what will happen in future years. However, the immediate need for UNRWA is money now, which is why we have done what we have done. The hon. Gentleman’s question is perfectly appropriate, and that is our answer.

That deals with the immediate term. On the slightly longer term, we are looking hard at what we can do on a new economic development package, designed to lift the standard of living in Gaza by increasing trade and job creation, enabling greater movement and access for people and goods, and enhancing the supply of electricity and clean water.

We are also looking at the proposals of Nikolai Mladenov, the UN special representative, that I mentioned the last time I spoke. They are being confirmed in the next month, but I anticipate that they will include measures to catalyse the Gazan economy and ameliorate the energy and water situation. We are very committed to supporting the special representative’s plans. That will deal more effectively with medium and long-term needs.

I will now move off the script, to the worry of my officials. In trying to find something new to say about a situation with which we are all familiar, I thought of this. As I said earlier, if someone looked objectively at Gaza, they would say—whatever party they were from—that whatever is being devised by way of policy just is not working. Israel has put pressure on Hamas for 12 years or so in order to effect political change in Gaza. It has clearly not worked. Hamas is still there. Rockets are still being fired. People on the border areas are still under threat, in Sderot and other such places.

Equally, Israel has not crumbled and is not at risk from Hamas. Hamas has achieved nothing politically and has damaged the people it purports to represent. The Palestinian Authority have had no success in dealing with Gaza. Attempts at reconciliation should be encouraged and should go forward. Those who live in Gaza have seen no evidence of the success of polices purportedly put forward in their defence, including politically, to give them a right to protest against the state of Israel. The same applies to protecting those in Israel from a terrorist organisation that is clearly hell-bent on killing them if it gets the chance.

I suspect it will come as little surprise if I tell colleagues that there is much truth in everything they have said. I do not agree with everything that has been said, but if hon. Members look at one another’s speeches, they will see that there is no great contradiction. Colleagues are talking about two sides of the same coin. It is true that Hamas was involved in exploiting—

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indicated dissent.

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The hon. Gentleman shakes his head, but this is the point. If colleagues only listen to their own side of the argument, we get—

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Will the Minister give way?

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No, I will not. The hon. Gentleman should just listen for a moment. We get nowhere if we listen to only one side of the argument. It is no more effective to talk about Hamas’s rule in Gaza and blame everything on Hamas than it is to blame everything on Israel and not understand the context of the political discussion and what is going on. My point is that none of that helps the people of Gaza. If that is what we want to do, we have to do something new.

I am saying very clearly that I do not think that the policies in relation to Gaza are working; I think they are failing. There is now greater recognition in the state of Israel that those policies are not working. A search on the internet for “Israel in talks with Hamas” will produce an article from 9 May this year titled, “Western country said to be brokering Israel-Hamas talks on long-term ceasefire”; an article from Haaretz on 6 June titled, “Israel Has to Talk to Hamas. Otherwise, It’s War”; and an article from 6 June, again from Haaretz, titled, “Israeli Army Believes Hamas Willing to Negotiate Deal”.

The only extraordinary thing in politics is that we assume that these two different sides will go on forever. This must not go on. The people of Gaza are not being served, and we would all be amazed by who talks to whom. The truth is that there has been a comprehensive, international and partisan failure for the people of Gaza, and this debate, like previous ones, has made it very clear. If the United Kingdom is to have an impact, we first have to say very clearly that these policies have not worked, and stress the urgent need for a political settlement and for immediate attention to be given to humanitarian aid in Gaza. We also have to be very clear that those who exploit the situation politically, whether it is non-state groups or state groups, also have to bear their responsibility. We get nowhere unless we understand that.

Now I will, of course, give the Floor to the hon. Member for Easington.

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I simply wanted to say very briefly that it is not two sides of the same coin. We are dealing here with an asymmetrical situation where we have an oppressor and an oppressed. To present it as two sides of the same coin is wilful misrepresentation of the situation.

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No, it is not. I entirely accept that it has an asymmetric element to it, with regard to Israel and Hamas, but that is a description. It gets us nowhere, because unless the two sides are engaged in finding an answer there will not be one. That is why it is interesting that people are starting to talk to people.

What worries me is that the PA, who for years have accepted the state of Israel, have been non-violent and co-operated in relation to security, must not be left out of ultimate settlement talks. It cannot all depend on Hamas and what it has been able to achieve over the years with its policy of destruction towards the state of Israel.

Colleagues have accurately described what is happening is Gaza, but my point is simply that, in trying to get something done, believing that only one side or the other has the answer is not, in my view and that of the United Kingdom Government, sufficient. We have to do more and call out everyone, saying, “Actually, the policy is failing, so everyone needs to provide something new.” Perhaps the settlement proposals from the envoys of the President of the United States may start that, but unless we each accept that there is some truth in what the other says, we will not get very far.

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I thank everyone who has participated in the debate from both sides. There has been great interest, with contributions and interventions. I thank the Minister for his response, and the Front-Bench representatives of the Scottish National party and my own party for their responses.

I urge the Minister to do all he can to seek to resolve the problem and bring relief to the people of Gaza. I say to Government Members: please do not mistake our empathy for the suffering of the people of Gaza with support for Hamas. It does not make us anti-Semitic or anti-Israel; it makes us human.

Question put and agreed to.

Resolved,

That this House has considered the humanitarian situation in Gaza.

Sitting suspended for Divisions in the House.

Fentanyl: Sentencing

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I beg to move,

That this House has considered sentences for supplying Fentanyl.

I am delighted to have secured this debate on the evils of fentanyl. It all came about because of a tragedy that took place one morning in 2016, when every parent’s worst nightmare came true for a family in my constituency. Graeme Fraser was getting ready to walk his dog. He went to ask his son if he wanted to join him. On entering his son’s bedroom, he found his son’s body on the bed, pale, rigid and lifeless. Robert Fraser was just 18 years old. Beside Robert’s body, on a book cover, was a clear plastic bag containing white powder. The police did not know what it was. Only several weeks later did tests identify it as a substance called fentanyl.

Robert was one of the first people in Britain to be killed by this dangerous and incredibly toxic drug. Since that day, at least 120 deaths in this country have been attributed to fentanyl, and since that day I have been working with Robert’s family to raise awareness, to try to save other young lives and prevent other parents going through what Michelle and Graeme have gone through. I am delighted that Michelle, Robert’s mother, is here in the public gallery today.

Ultimately, we are fighting for tougher jail terms for people who are caught supplying fentanyl. We are calling it Robert’s law, in memory of Robert, and I will explain why it is so incredibly important. Fentanyl is a class A drug, yet it is vastly more dangerous than any other substance in that category. Kent’s top drug detective told me that it was more like a poison. It is extremely powerful—50 times stronger than heroin.

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Does my hon. Friend agree that due to its intense potency, when fentanyl is cut with heroin and cocaine those drugs become far more addictive? Fentanyl is therefore ideal for drug dealers, because it is very addictive and their clients become very dependent.

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I thank my hon. Friend for making that point. He is absolutely right. He is a true champion of his constituency, and he will recall that his own constituent, Jed Spooner, who was just 27 years old, died on 2 December 2017 from fentanyl in Clacton. It is an appalling drug and a real, evil poison, 50 times stronger than heroin. It is a synthetic opioid, often produced in China, smuggled out in shipping containers and sold domestically on the dark web. Over in America, fentanyl has claimed 20,000 lives.

Those numbers are remarkable, not because they are so large and rising so quickly but because our top police people at the National Crime Agency say they have seen no evidence that drug users are demanding fentanyl. It is not a drug that people are craving for and demanding at all. Robert did not demand it. He was no drug addict. He would get together with friends at weekends and experiment; I would not recommend that young people do that, but we all know that they do, and what happened to Robert could happen to any of our kids.

Other fentanyl deaths have involved even greater deception. In the north-east of England, only last year, heroin suppliers began secretly mixing fentanyl with their usual supplies to increase profits, exactly as my hon. Friend pointed out. There has been a surge in overdoses in the region. In Teesside, at least six people have died. Again, the National Crime Agency said that it has seen no evidence of users demanding fentanyl-laced heroin.

Why do dealers get involved in it? The answer is simple: it is cheap and versatile. It is a great cutting agent, it is difficult to detect and it has extreme potency, which means that drug users believe they have consumed a pure, powerful and strong substance, yet for the supplier it is a fraction of the cost. For most drugs, supply is dictated by demand—people will always supply them because there is so much to gain from doing so —but fentanyl is not being demanded. It is a choice, which until now has been tipped one way by the desire for profit on the part of drug pushers and dealers, not by users seeking that toxic and dangerous substance. Given the lack of demand for fentanyl, its obvious dangers and its capacity to kill, dealers should be punished more harshly for supplying it. Today, they know that they will not be, which is why I am making the case for updating our justice system.

Some will argue that a whole new class should be created for fentanyl, but I do not think that would be the right thing to do. That would send the wrong message about other class A drugs, which are incredibly harmful. Michelle and I want the existing sentencing guidelines to be strengthened. Right now, they mention drugs such as cannabis, heroin and all the rest of it, but they do not mention fentanyl. The result is that we do not send a strong enough message to drug dealers. One recently convicted supplier was handed a jail term of just 18 months, despite the fact that his batch of fentanyl was directly linked to a death. That shows that the existing guidance is not strong enough. Until it is, drug dealers across our country will not be sent a strong enough message. They do not think our justice system will punish them fully for the level of misery they inflict.

Some people will say that tougher sentencing does not work. Again, I disagree. Let us look at gun control. Two decades ago, we introduced legislation to stop Britain heading down the American route of rampant gun ownership. Ten years later, the Violent Crime Reduction Act 2006 went even further and introduced still tougher sentences. Today, Britain has one of the lowest rates of gun homicide in the world. We have a history of looking across the Atlantic, taking note of alarming trends, and taking action to stop them gathering pace here. Over there, they know things are already very serious, and a number of states have started bringing in second-degree murder charges against fentanyl dealers. Let us do what we did with guns. Let us look at the fentanyl problems in America, look at the growing numbers here and take action now before it is too late.

I believe that a good start would be to place any quantity of fentanyl in the top of our sentencing categories of harm. After all, a quantity of fentanyl the size of a grain of sugar can be fatal. High or extreme potency should be added to the list of aggravating factors. Purity is already on the list. In terms of danger and capacity to kill, potency is far more significant than purity. The measure that I suggest would increase minimum jail terms from three years to six. After accounting for aggravating factors, most fentanyl suppliers would be looking at a minimum of 10 years behind bars. That is the kind of strong message we want to send to dealers who think nothing of taking the lives of our kids.

I can see that there are arguments against this campaign. People will say, “The war on drugs is lost”—the usual defeatism. They will say, “We can never win the war on drugs. We can never stop drug addicts putting dangerous substances in their bodies. We can never stop dealers trying to make a buck off the back of them.” I say that the war on drugs is not lost. We must fight back. The number of drug deaths in Kent—the county of my constituency—has doubled in the past three years. In Canterbury, two young men recently lost their lives because of fentanyl.

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Last year, some 60 deaths were recorded, and that number has now doubled. In comparison with the number of deaths caused by the misuse of many other drugs, that is relatively small. Is it not right that we get on top of this now and nip it in the bud before it spreads even further?

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I completely agree, which is why yesterday’s huge step forward on the road to Robert’s law is so welcome, with the Sentencing Council setting out new guidance called “Sentencing of drug offences involving newer and less common drugs”, which specifically related to synthetic opioids. I hope that the Minister will tell us more about the action being taken by the Ministry of Justice, the Crown Prosecution Service and the Sentencing Council. This is a trend that we must reverse. Drugs rain devastation on our families, friends and communities; they drag our young people into gangs and violent crime and they kill those closest to us.

I want to take you back to the day that Robert died. His mother Michelle, who is sitting in the Public Gallery, was with a friend in Primark that morning when her phone rang. Graeme told her the news and she collapsed to the shop floor, screaming. Her life has not been the same since. I will finish with her words, because her situation could all too easily become anyone else’s in this room. She says:

“Robert was not an addict. He made a bad choice. This poison is costing lives and sitting back, hiding, hoping it will all go away is not an option. My son’s memory is worth so much more — and so is our children’s future. If we bring in Robert’s Law, we will save lives. And it means my son mattered. That can by my boy’s legacy.”

I hope that my hon. Friend the Member for South Thanet (Craig Mackinlay) is able to take a few minutes in the time remaining to make a short speech about the campaign against this evil drug that he has been fighting alongside me for some years.

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It is a pleasure to serve under your chairmanship, Mr Pritchard. It is very good to support my hon. Friend the Member for Dover (Charlie Elphicke). I led a Westminster Hall debate on 22 November last year on the human and financial costs of drug addiction. The real trigger for that debate was the rise in fentanyl. My hon. Friend gave the figure of 20,000 deaths in the US, but the figures that I found suggest that to be more in the region of 50,000 to 60,000 in 2016. Fentanyl is becoming a real killer drug in the US. As we are very aware, it is a manmade opioid mimic. To put that figure into context, 60,000 deaths represents the entire rate of attrition and death of the entire 20 years of the Vietnam war, but that is happening each and every year in the US.

Ohio has had a particular problem, where deaths rose 33% in 2016 alone, with a death rate of 4,050. That is people across the whole social spectrum out of a population of 12 million in Ohio. To put that in relation to the size of the UK, that would represent 22,000 deaths. Thankfully, we are nowhere near that, at about 2,500 drug deaths in the UK.

My worry is that what starts in the US often crosses the Atlantic to us. I do not want to see what happened to Michelle and Robert happen again. Rehabilitation is important, because for every £1 that we invest in rehabilitation, £2.50 is saved. In that debate of 22 November, I called for fentanyl to become a category AA drug, with a higher sentence to go with it. Current sentencing guidelines are that 5 kg or more of a class A drug would bear a maximum of only 16 years in prison, whereas attempted murder, which is what supplying fentanyl actually is, carries up to 35 years. I am very pleased to support my hon. Friend and the family in every way that I can.

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It is a great privilege to serve under your chairmanship, Mr Pritchard. I begin by paying tribute to the hon. Member for Dover (Charlie Elphicke), and my hon. Friends the Members for South Thanet (Craig Mackinlay), and for Clacton (Giles Watling), for their leadership on this issue.

Fentanyl is a very serious and pressing threat in three distinct ways. First, as the hon. Member for Dover pointed out, it has an unusual potency; it can be 50, 100 or, in some chemical forms, close to 10,000 times more powerful than heroin. A tiny fragment of this artificially produced drug can be far more powerful than heroin.

Secondly, there are the chemical effects of the drug. It is much more dangerous, gram for gram, than heroin because of its effects on the respiratory system. Artificial opioids bind themselves to receptors in the brain and have an effect on its ability to distinguish between its oxygen and carbon dioxide intakes. Confusing the receptors in the brain can lead to respiratory depressions, so that one effectively stops breathing.

The final reason why we need to be worried about the drug is that we can already see the scale of the problem it causes in the US, as my hon. Friend the Member for South Thanet pointed out eloquently. In the UK, it represents a tragic element in a larger swathe of overdoses. It accounts for a few per cent. of the people dying from overdoses in the UK. In the US, fentanyl and other fentanyl-like substances account for nearly a third of such deaths, and the figure is climbing. As my hon. Friend pointed out, tens of thousands of deaths in the United States are taking place through fentanyl.

How do we deal with that? Here I pay tribute to the hon. Member for Dover. His leadership and championing have led to two important changes in relation to the Crown Prosecution Service and the sentencing guidelines of the Sentencing Council—changes that I can honestly say would not have happened as rapidly had it not been for his work.

The first change made thanks to the hon. Gentleman’s championing is that the Crown Prosecution Service has specified that prosecutors dealing with cases involving Fentanyl need to take into account the potency of the drug. They are encouraged to bring expert witnesses into the courtroom to explain how the drug operates, and that a tiny quantity can have the potency of a larger quantity of heroin or cocaine. The second, perhaps more important, thing that happened is that the Sentencing Council yesterday published its new guidelines. You will understand, Mr Pritchard, that it was absolutely no coincidence that that happened the day before the hon. Gentleman’s debate. The guidelines state:

“Since publication of the Drug Offences guideline, there has been an increase in the number of cases before the courts involving newer drugs, such as synthetic opioids”—

in other words, fentanyl—

“which may have much higher potency and potential to cause harm than more common drugs. Where these newer drugs are covered by the guideline but not specifically listed in the section on assessment of harm, the approach to assessing harm in these cases should be as with all cases of controlled drugs not explicitly mentioned in the guidelines.”

This is the key point:

“Sentencers should expect to be provided with expert evidence to assist in determining the potency of the particular drug and in equating the quantity in the case with the quantities set out in the guidelines in terms of the harm caused.”

Then there is a box entitled “Example—supplying or offering to supply a controlled drug”, which says:

“If the quantity of the drug would cause as much harm as 5kg of heroin, the offence would be in the most serious category.”

Why is that important? Drug offences are listed by category, from 4 to 1. Category 4 would be 5 grams of heroin; the top category would be 5 kg. The guidelines will move expert witnesses to state that fentanyl is in the top category of class A drugs for prosecution. That will be vital in deterring people from supplying and importing the drug, but it is just the beginning of what will happen. The tragic death of Robert has led to a significant campaign, led by Roberts’ family and the hon. Gentleman, that has already changed the guidelines for the Crown Prosecution Service and the Sentencing Council.

That is just the beginning. The next stage needs to be a very serious public education campaign, so that we do more than ensure strict guidelines against people supplying or importing this drug. Anyone thinking of using fentanyl should be aware of not only the danger to themselves, but the catastrophic damage that tiny quantities of the drug can cause to anyone in their home. In the United States, toddlers are being killed by this drug, because the tiny quantities, even on a small patch on the arm, can immediately choke and kill somebody as young as two. That needs to be apparent to the public. This debate in the House of Commons underscores that. I hope that what we have said in this debate will push that change through society.

I want to end by paying particular tribute to the hon. Gentleman for his extraordinary campaigning on the issue, which, as I said, brought about a change yesterday, driven entirely by this debate.

Question put and agreed to.

Leaving the EU: Upland Farming

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I beg to move,

That this House has considered the future of upland farming after the UK leaves the EU.

Dioch yn fawr iawn, Mr Pritchard. It is a pleasure to serve under your chairmanship and to lead this debate. I thank both the farming unions in Wales, NFU Cymru and the Farmers’ Union of Wales, for their help in preparing for this debate and for their overall contribution to supporting the farming industry in Wales and the wider rural economy.

Wales does not have a national animal in the way that New Zealand has the kiwi, Australia the kangaroo, Argentina the puma and South Africa the springbok. We have the splendid mythical Welsh dragon, of course, but if we were to have a living animal, a very strong case could be made for the sheep, or perhaps the ram. There are more than 10 million sheep in Wales, based on the latest annual survey, accounting for 33% of all UK sheep. That compares to a human population of around 3 million, accounting for only 5% of the UK population.

The reason for the huge number of sheep livestock in Wales is the terrain and climate of my country. Wales is very mountainous and, as we know, even more wet. Some 82% of Welsh lamb is utilised for agricultural purposes, an incredible figure when considering Welsh terrain, and 10% of UK agricultural land is in Wales. Agriculture contributes 400% more to direct employment in Wales than it does in the UK on average, if my reading of the British Government’s Brexit economic impact assessments is correct. With those statistics in mind, Welsh politicians should be extremely concerned about the likely impact of Brexit on this vital indigenous Welsh industry. We have far more to lose from a botched Brexit than other parts of the British state do.

The vast majority of farming land in Wales is designated a less favoured area. It is more suited to pasture than to arable farming. As a consequence, the Welsh farming model tends to be the traditional family farm based on livestock, rather than the crop-based farming that we tend to see in England.

In the late winter of 2010, before I was elected, I visited Mr Ian Rickman and his family at their Gurnos farm to undertake some work experience. Gurnos is high above the village of Bethlehem in the Tywi valley, near the Garn Goch. The Garn is one of the largest iron-age forts on the Brecon Beacons mountain range. It houses the monument to the late Gwynfor Evans, a national great, and the first Plaid Cymru MP elected to Westminster. He used to walk its slopes to gain solace and inspiration.

When I did my work experience, it was bitterly cold. The reality is that the only productive use of land at such altitudes is for sheep farming. After that experience, I gained a huge amount of respect for the sheep as an animal, but also for the families who endeavour to make a living out of hill farming. I assure you, Mr Pritchard, that there are far easier ways to make money and sustain a family. Let us remember that according to Welsh Government statistics, the average farm income in Wales is less than £30,000 a year.

These people, however, are from the land. Their families have worked the hills for generations upon generations, and have sustained a community, a culture, a language and a way of living that has lasted thousands of years. They have cultivated a natural landscape so beautiful that in 2017 “Lonely Planet” designated the north of my country one of the most essential places to visit in the world. As beautiful as the north is, I would of course say that Carmarthenshire is best, but the critical point I am endeavouring to make is that the beauty of our country, and everything that goes with it, is not just something that happens naturally. It is the result of the work of the agricultural community and its livestock. Without that, Wales would not be the special place that it is; nor would it have the impact that it has, economically and socially.

Had I more time, I would have elaborated on the economic and cultural importance of agriculture, and its benefits for tourism, other sectors of the Welsh economy, and the Welsh language. My good friend Councillor Cefin Campbell, who leads for the executive board of Carmarthenshire County Council on rural development, has identified working with the agricultural community and young farmers’ clubs as a key cog in his strategy for regenerating the economy and preserving the language in Wales.

I realise that other Members want to speak, and I am grateful for the support I received before the debate from those Members, so I will move on. Farmers are a tough bunch, used to operating in a climate of fluctuating incomes and rapid market changes for their produce. European agricultural support has been the one constant in keeping their businesses sustainable. The European market is by far the biggest external market for Welsh agricultural produce, especially lamb. I have to say to the Minister that there is a huge amount of anxiety and foreboding about the future. I have held many meetings with farmers and unions since the Brexit vote, and anxiety is increasing as we move on. If this debate achieves only one thing, I hope it is that we can collectively begin to reduce those anxieties in the agricultural community.

We have to concentrate on three main areas that are vital for the future of hill farming: devolution, agricultural support, and trade. If it is the ultimate decision of the British Government to leave key European frameworks such as the single market, new frameworks of the territories of the British state will have to be created in their place to govern internal trade. I am not opposed to the creation of such frameworks, if the British Government do decide to shoot the economy in the foot by leaving the single market. Following Welsh independence, I would want the Welsh economy to be within a larger trading bloc; cross-border economic co-operation is a very good thing.

The key divide between Plaid Cymru and our Unionist opponents is that we believe that any common framework should be built and regulated by the four Governments of the state in co-operation—in a partnership of equals. Any decisions should be made on a shared governance basis, by a properly constituted UK council of Ministers, with a robust decision-making and dispute resolution process. They, on the other hand, believe that these matters should be decided in Westminster, and Westminster alone. That risks Wales becoming a permanent rule taker—or, as the Foreign Secretary might say, a vassal country within the British state. That risks English-specific frameworks being imposed on Wales, to the detriment of hill farmers in my country.

Admittedly, our position in Wales has not been strengthened by the contemptible capitulation of our country’s Labour Government, who accepted the changes. As Professor Tim Lang said recently in an evidence session of the External Affairs Committee of the National Assembly, when it comes to Brexit, Welsh interests are now “steamrollable”. As I said during a Ministerial statement last week, the actions of the Welsh Government will go down as one of the biggest sell-outs in Welsh political history, and I can assure you, Mr Pritchard, that that is quite some achievement.

The 26 policy powers re-reserved by Westminster include vital agriculture-related policy areas such as agricultural support, fertiliser regulation, genetically modified organism cultivation, organic farming, zootech, animal health, animal welfare, food and feed safety, food labelling, public procurement, nutrition labelling, plant health and food geographical indicators. Welsh lamb holds EU-protected geographical indication status, of course, as does Welsh beef.

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I thank my hon. Friend—diolch yn fawr iawn. Would he agree that it is time for the red meat levy—on animals that were reared in Wales but slaughtered in England—to come back to Wales, so that Hybu Cig Cymru can do an effective job on marketing that meat?

Sitting suspended for a Division in the House.

On resuming

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My hon. Friend makes an important point. It has been a bone of contention for the Welsh farming community for far too long that when products go over the border to be slaughtered, the levy is collected in England and not returned to us for the proportion of our products.

Welsh meat has an EU protected geographical indication, which is a mark of its quality and a vital marketing tool. Indeed, Hybu Cig Cymru considers the PGI to be of enormous economic importance to the Welsh red meat industry as it identifies the origin and unique qualities of our lamb and beef. Hybu Cig Cymru estimates that 25% of the growth in Welsh lamb exports between 2003 and 2012 can be directly attributed to its PGI status.

The Welsh Labour Government have effectively handed control of the issue to Westminster, despite the warnings of farming representatives. Of course, that is a Westminster Government who insist that only the Union Jack can appear on our driving licences, despite honourable exceptions in Wales who insist on having the Welsh dragon on them.

Concerns are not limited to Wales. The chair of Food Standards Scotland, Ross Finnie, expressed his concern in a letter to the Scottish Parliament. On the power grab, he said:

“However, if those matters are reserved to the UK Government to determine, it will be difficult for Scottish stakeholders’ voices to be heard, or for the needs of businesses or consumers in Scotland to be given priority.”

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I thank the hon. Gentleman, my neighbour, for giving way. He mentioned the UK market framework, which most of the farmers in my constituency are pleased about. He also mentioned the Welsh Labour Government. The fear of farmers in my constituency is about that Government being in charge of farming—thank goodness that Westminster will be leading the way.

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I fear the hon. Gentleman is continually getting mixed up. Nobody opposes the creation of common frameworks should we decide to leave the EU internal market. The key question is where power over those frameworks resides. Our approach is that this is a multi-polar state, so the four Governments of the UK should have a joint say. His approach, confirmed today, is that such matters should be determined only in Westminster. A serious political divide separates us, and the people of Wales can cast their view on that at the next election.

The second major issue is agricultural support. Since the formation of the common agricultural policy, hill farmers have received direct support, which constitutes a significant element of farm incomes. In Wales, 80% of total farming income comes from CAP, and Wales, which has 5% of the UK population, gets 9.8% of CAP spend in the UK, which equates to nearly £300 million a year. CAP is a key part of the EU’s seven-year multiannual financial framework, which gives great certainty in support at a time when market prices for produce are volatile.

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Does the hon. Gentleman welcome the Government’s announcement that they will guarantee CAP payments until 2022? Since he mentioned Scotland, will he back the National Farmers Union Scotland, which supports the Government’s approach to have common frameworks but to allow the devolution of currently devolved agriculture matters to Scotland and elsewhere in the United Kingdom?

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I am afraid that the situation in Wales is not as good as for English farmers, who have certainty until 2022—[Interruption.] I am not aware of the situation in Scotland, because I am a Welsh Member of Parliament. I am sure the hon. Member for Ochil and South Perthshire (Luke Graham) will accept that. [Interruption.] The hon. Member for Perth and North Perthshire (Pete Wishart) may address those issues.

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Order. If Members want to make a contribution, they can intervene or speak. I ask those who intervene to be mindful that this is a very popular debate. I will impose a time limit once Mr Edwards ends his speech, and that is likely to be shorter if people keep intervening. I do not want to stop debate, but be mindful of other colleagues in the Chamber.

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I am grateful for your guidance, Mr Pritchard. I will return to the issue at hand, Welsh farming.

In Wales, the situation has been compounded by the decision of the Labour Government of my country to reduce direct payments to producers by 15% by moving money from pillar 1. However, the point remains that CAP payments offer a degree of stability. While previously, under CAP, farmers did not have to worry overtly about the impact of Westminster elections on the amount of agricultural support they would receive, they could easily now face a situation in which a new Westminster Government could radically alter agricultural support policy. As we see from the power grab, the Labour Government of my country have abdicated all responsibility.

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Will the hon. Gentleman give way?

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I will not give way. I will carry on, mindful of what the Chairman has said. While the British Government have promised to protect the current UK level of EU payments until 2022, the reality is that once we have left the EU, agricultural support will become an annual issue for the budget, or at the very best a three-year cycle under a future comprehensive spending review. There is no guarantee that current levels of funding for Wales will continue after March 2019.

We urgently need clarity for Welsh hill farmers, particularly about what the budget for agricultural support will be and how exactly it will be administered. Now that agricultural support has been re-reserved, I would be grateful if the Minister could outline how it will work for Welsh hill farmers. Will the Welsh share of agricultural support be based on our agricultural footprint, or do the British Government intend to distribute funds for Wales, Scotland and Northern Ireland based on Barnett consequentials?

During the referendum, the leave campaign argued that farmers would receive a dividend post-Brexit, because the UK would no longer have to make contributions to the EU budget. However, the reality is that there will be less money for Government investment post-Brexit, because the economy will slow and revenues will subsequently be less. Agriculture could find itself way down a long list of priorities for Westminster. Will the Minister outline what inter-governmental discussions have been held between the UK and the devolved Governments, and where exactly we are on getting clarity on the vital issue of agricultural support?

The third major issue is access to export markets. The European Union is a vital market for Welsh meat. Hill farmers inform me that approximately half of all their lambs are exported to the EU on a frictionless, zero-tariff basis, and 90% of all Welsh meat exports are destined for the EU. The EU is the largest global market for agricultural produce, and while the rest of the world is doing everything possible to get access to that market, the British Government are moving in the opposite direction. Preserving those markets is vital. It is sobering that some of the highest new tariffs are agricultural. The lowest that tariffs on lamb can be under WTO rules is 40%, and they are far higher if the product is frozen or processed in any way.

Admittedly, a comprehensive trade agreement with the EU could solve the problem, but while the British Government continue to maintain that no deal is an option, those of us who have concerns about the British Government’s negotiating strategy cannot be accused of scaremongering. We only have to look back to the chaos caused by foot and mouth. There was a collapse in market prices, a collapse in farm incomes and a host of other problems, all because farmers could not export to the EU. Impacts on upland farms were particularly acute. While such circumstances occurred due to a ban on exports rather than trade barriers, such impacts are worth bearing in mind when we consider the potential impacts of harder Brexit scenarios.

Now is the time to commit to maintaining tariff-free access to the UK’s largest trading bloc through our membership of the EU single market and customs union. That would ensure that our food producers could continue to export tariff free, that there would be no other barriers to trade and that already established, complex supply chains were not disrupted. The Farmers Union of Wales agrees. The president of the union, Glyn Roberts, said:

“Since the Referendum we have maintained that we should remain within the Single Market and Customs Union, and every day that passes brings more evidence supporting our view that at least in the short term, leaving these institutions would be a grave mistake.”

Our farmers are proud of the standard of their produce. They have some of the highest environmental and welfare standards in the world. If the British Government insist on dragging us out of the EU single market and customs union and pursuing free trade deals with third countries, it is vital that those standards are not compromised in any way, and that our markets are not opened up to substandard produce. It is essential that such matters are not regarded as exclusively within the remit of the UK Government and Parliament. As Hybu Cig Cymru chairman Kevin Roberts has said,

“Any future trade deal must take full account of the needs of the Welsh red meat sector.”

Ultimately, any future trade deal must be fully endorsed by the National Assembly, the Scottish Parliament and the Northern Ireland Assembly.

To close, agriculture, due to its complex supply chains and its prevalence in Welsh culture, is the backbone of the rural economy. It is vital, therefore, that the UK and Welsh Governments should do all they can to ensure its sustainability and success into the future. As the director of NFU Cymru, John Mercer, told me,

“Farmers were promised a bright and prosperous future after Brexit and it is now imperative that those political promises are upheld.”

Welsh hill farmers potentially face a perfect storm of hindered access to their main export markets and the opening up of the UK domestic food market to lower-standard food produce. Policy makers cannot afford to get it wrong. With the clock ticking, it is time for Ministers to start coming up with some answers.

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Order. I thank the attendants and technical team for their help in resolving a problem with some of the microphones earlier.

Given the popularity of the debate, I reluctantly have to impose a time limit of four minutes. That, of course, excludes the Front Benchers, who have five minutes, apart from the shadow Minister and the Minister, who have 10.

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It is a pleasure to serve under your chairmanship, Mr Pritchard. I congratulate the hon. Member for Carmarthen East and Dinefwr (Jonathan Edwards) on securing the debate. My interest in upland farming lies with Exmoor, and I am incredibly proud that about one third of the national park is in my constituency. For the record, the other two thirds are in the constituency of my parliamentary neighbour, my hon. Friend the Member for Bridgwater and West Somerset (Mr Liddell-Grainger).

Farming is an incredibly important part of the county’s economy. It is 13% of Devon’s GDP, by some measures. As well as producing food, upland farming adds value to rural economies in many ways through diversification. The retail, recreational and tourism industries are especially important. I am proud that many of the upland farmers on Exmoor are embracing that diversification, and proud of the work that they do to protect and enhance the unique upland landscape. However, I want to focus on the primary industry, if I may put it that way, of farming.

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Does the hon. Gentleman agree, furthermore, that diversification of the final product of upland farming, such as quality land and products, can enhance its economic future, particularly because of the image of an unspoiled environment, wind and rain and so on?

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Yes, that is absolutely right. There are about 70 million day visits a year to national parks in this country, because of the landscape. Quite apart from the farming that goes on there, stewardship by upland farmers contributes to the fact that so many people want to visit those areas.

The uplands are home to about 44% of England’s breeding ewes and 40% of its beef cows. I saw a small sample of what I am talking about on a recent visit to West Ilkerton farm at Barbrook, near Lynton on Exmoor. It is a family-run livestock farm whose farmers have not only embraced diversification and run a successful business in challenging areas, but are leading members of the Exmoor Hill Farming Network, which, along with the Exmoor National Park Authority, has been instrumental in producing a detailed document, “Exmoor’s Ambition”, seeking to engage the Government in discussions of how upland farming might be supported post-Brexit.

There is clearly considerable uncertainty for upland farmers now, and it is right that they should play their part in shaping future policy, so I am delighted that the Government are listening. I know they are, because three weeks ago the Secretary of State for Environment, Food and Rural Affairs was kind enough to make two visits over two days to Exmoor farms in my constituency, in which he took full account of what the document says about realising Exmoor’s ambition. The national park authority and the Exmoor Hill Farming Network have an idea for a pilot for a new approach, to be used after Brexit, to secure and enhance the many public benefits that rural landscapes and their farming businesses give their local economies.

“Exmoor’s Ambition” is about a simpler, more integrated and locally accountable policy that incentivises all the public benefits provided by the countryside. It would be delivered through a single scheme that has the concept of natural capital at its heart and is driven by results and evidence about what actually works. There are no better people to talk to about that than the upland farmers who have worked that landscape for many years.

The proposed scheme consists of two complementary measures: “good farming”, available to qualifying land-managing businesses, and “enhanced benefits”, which target specific outcomes. Importantly, those measures would be matched by the branding and promotion of goods to secure a premium income for their producers and the local economy. The post-Brexit outcomes that this programme seeks to achieve include tackling climate change, protecting the historical environment of the uplands, restoring damaged landscapes, rejuvenating hedgerows, improving river quality, enhancing public recreation, promoting local products and reducing flooding, which is incredibly important on Exmoor.

In the very limited time left to me, let me say this. These are uncertain times, as we approach Brexit. For upland farmers, such as those on Exmoor, the uncertainty is exacerbated by the inherent challenges to farming in that difficult landscape. I know that the Government are alive to those issues, and I look forward to hearing from the Minister about the support that upland agricultural communities, such as those on Exmoor, will have as the Brexit process moves forward.

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It is a pleasure to serve under your chairmanship, Mr Pritchard. I congratulate the hon. Member for Carmarthen East and Dinefwr (Jonathan Edwards) on securing this very important debate.

My constituency includes Teesdale, which is part of the north Pennines area of outstanding natural beauty. I represent 400 sheep farmers, most of whom are on the uplands. Teesdale is a unique natural environment. A couple of months ago, I got up at 4.30 am to see the black grouse lekking, and we had a tour of the area to see the fantastic bird life. There were lapwing, curlew, snipe, oyster catchers and partridges. There were also mad March hares boxing. The biodiversity is absolutely spectacular, but it is fragile. If we do not get a good post-Brexit solution for the farming community, those species could collapse in 20 years. If they do, we will not be able to bring them back.

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I must visit the lovely place that the hon. Lady is describing. Does she agree that some of the attributes she mentioned are down to the passion with which rural communities pursue their country sports in those areas?

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In Teesdale, we have achieved a balance between shooting and hill farming that the community is happy with.

From a farming perspective, the land is extremely marginal. Tenant farmers have an average annual income of about £14,000, which means that, when we change the subsidy regime, we need to bear in mind that their income cannot fall.

Three things matter. The first is the trade regime, about which I think I have asked the Minister 39 times since the Brexit referendum, and I have still have not had a proper answer. As the hon. Member for North Devon (Peter Heaton-Jones) has said, the EU is our biggest market, so we have to be able to continue to sell into Europe. That means staying in a customs union and maintaining the current regulatory standards so we have regulatory alignment. It also means that we do not want the Department for International Trade to negotiate a flood of cheap lamb imports from New Zealand and Australia. It is DEFRA’s responsibility to make it clear that that is a red line.

If we lose our domestic market and do not have our European markets, we will not be able to secure the environmental benefits we want, because farming must be sustainable as a business. One of my constituents has written to me to point out that other World Trade Organisation members have already made a formal complaint about the proposed EU-UK split on agricultural import quotas, so it will be interesting to hear what the Minister has in mind on that.

The second important thing is the support mechanisms, because we obviously do not want to see a cliff edge. A switch to public goods is fine in theory, but it will be fine in practice only if the amount of money paid is sufficient to keep farmers in business. I have already pointed out that people are on low incomes that they cannot afford to see cut; they need to see their incomes rise.

I am worried by the proposed cap on payments to individuals, which is aimed at the landed aristocracy. The only way that Ministers can avoid it is if they start paying tenant farmers directly without—this brings me to my third point—increasing Rural Payments Agency bureaucracy, which is a long-standing problem about which the Department is well aware. Obviously, we do not have a lot of scope for deregulation in the farming community, on animal identification and so forth, because we have to maintain our access to the European market.

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It is a pleasure to serve under your chairmanship, Mr Pritchard. I thank my parliamentary neighbour, the hon. Member for Carmarthen East and Dinefwr (Jonathan Edwards), for proposing the debate.

I think it is fair to say that my constituency is based on agriculture. It is a hill farm constituency that measures 85 miles by 45 miles, and upland hill farms are predominant throughout. Agriculture is the backbone of the constituency, but in GDP terms tourism is now in front of it. However, our tourism industry exists only because of the agriculture industry, and people forget that the two are intertwined, as are many other industries. The upland hill farmers support our vets, garages, shops and so on, so when we talk about upland farms we are also talking about communities.

Farmers in my constituency have many concerns, one of their main ones being—I have already touched on this—that the Welsh Government will take the lead on agriculture outside of a UK-wide framework. We need only consider the lack of a response to bovine tuberculosis in Wales. Only on Sunday I visited a farm that, sadly, after three generations of farming beef, has had to sell all its cattle. They went clear weeks before and have now, sadly, stopped beef farming.

Quarantine units at local shows are another issue. DEFRA has not introduced them in England, but they have been introduced in Wales. Local shows are the lifeblood of communities, yet those communities are being penalised. It is tragic, so thank goodness—we hope—that Westminster will take a sensible lead on that.

Three weeks ago the Secretary of State visited the beautiful valley near Painscastle in my constituency. As we came over one of the open common hills, I told him to look down the valley and tell me that it was not designed by an environmentalist based in a London or Cardiff office just two or 20 years ago. That valley is so beautiful because it was designed by farmers over the past 100, 200 and 300 years. Farmers are the best people to run our environment and they should be supported to do that.

I am delighted to say that the Secretary of State made it clear—as I am sure will the Minister again today—that environmental payments, or public payments for public goods, will continue under the “Health and Harmony” consultation. That consultation covers England, but we must not forget that Cardiff Bay has produced nothing to address looking after farmers or to consult them on their future in a post-Brexit world.

The Secretary of State spoke to many senior farmers in a barn from which he could not escape. He gave a very informative talk and answered all their questions on their concerns about the future. Even more importantly, after that visit I took him up the road to Rhosgoch—another village, next to Painscastle—where he met 40 representatives of local young farmers’ clubs whose futures depend on a post-Brexit agricultural world. My goodness, if hon. Members had seen and heard the positivity in that room, they would not be concerned about a post-Brexit agricultural world.

Ladies and gentlemen—[Interruption.] I am sorry, I meant to say “hon. Members”. I was on the stump there —I’ll sell something in a minute! We constantly hear negativity from politicians, academics and the press, but what we are hearing from the agricultural world, including the young agricultural world, is positivity, because of what the Westminster Government are doing and our future in a post-Brexit world. Europe sells more to us than we sell to it, and this country’s farmers have a very positive future.

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Rwy’n llongyfarch fy Nghyfaill anrhydeddus yr Aelod dros Ddwyrain Caerfyrddin a Dinefwr (Jonathan Edwards) ar sicrhau y ddadl hon. I congratulate my hon. Friend the Member for Carmarthen East and Dinefwr on securing this debate. Dwyfor Meirionnydd is eryri—mountainous and magnificent to the eye. It has been a man-made landscape for hundreds, if not thousands, of years. Livestock husbandry made much of the environment, and taking farmers and families out will unmake it.

Earlier this year, I held a series of events with agricultural societies and farmers unions, which included visits to upland farms in the Trawsfynydd, Abergeirw and Cwm Prysor communities of Meirionnydd. Time and again, I heard anxiety for the future and a real fear that the voices of upland farming and upland communities would be lost in the Brexit lobbying cacophony.

Geraint Davies—Geraint Fedw Arian Uchaf of Rhyduchaf—is the chair of the Farmers’ Union of Wales in Meirionnydd. He has a lot to say about Brexit, but I will keep it simple. He tells me that in Wales, we need evidence of a long-term vision for rural communities as a whole, a sense that those communities matter, and an appreciation of their dependency on the rural economy. The single farm payment is spent in local shops and stores. Rural development programme money keeps local contractors in business. There is an interconnectivity to the agricultural economy that is as far-reaching and vulnerable to change as any environmental habitat.

Much is made of the payment for delivery of public goods. Farmers do not need to hear that that is a good thing—most agree—or that a way will be found to conform to World Trade Organisation requirements. They truly need to know not just whether but how a 100% level of public payments for public goods will work. I beg the Minister to respond to that. How will it conform with the WTO regulations?

In the same breath, if agriculture payments are to be used as environmental tools to deliver environmental benefits, we need clarity on the role of grazing livestock and how to manage grasslands to maintain habitats while symbiotically producing meat that inherently meets high-quality welfare standards.

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The hon. Lady is making a powerful speech. Many of the issues in my constituency that involve the farming community are exactly the same. In terms of the overall principles of future farming support, does she want a system that simply replicates the current common agricultural policy, that promotes efficient and productive farming, or that focuses on the marginal farms in our country, which I suspect we both have in our constituency? It is important to understand the driving force that she sees as being behind the future CAP.

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To speak frankly, I would like to see a system that does not result in the upland clearances of farmers. Farmers and their contribution are important to the wildlife, and we should consider the people and their role.

On the significance of grazing, it is important to have an awareness of the impact of under-grazing and over-grazing, local knowledge and the implicit co-operation of the Government, environmental officers and agriculturalists. It goes without saying that such awareness cannot be centrally managed from Westminster; it must be devolved.

Farmers in my constituency are being told to diversify and that they need to look at the sort of animals they produce. Surely, however, we need to acknowledge that only native mountain breeds are suitable for upland environments. It is simply not an option to diversify by crossing with lowland breeds, because large-carcase sheep simply cannot survive the winter, let alone fare well in such environments. At the same time, the small breeds that will flourish in mountain environments have their markets in Europe, and we are yet to find another market for them.

I take this opportunity to call on farmers to speak to each other and to speak out. The Brexit debate has been, and remains, toxic. People have been driven to one side or the other. Frankly, by now, it does not matter how someone voted in the referendum, but what happens now does matter. It is fast becoming clear that individual businesses and communities as a whole are at risk. Wales was sold Brexit on the back of unsubstantiated soundbites. Now is the time to come up with the substance of these promises or to come clean and admit that the risk to Welsh communities is a price Westminster is willing for us to pay.

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It is an honour to serve under your chairmanship, Mr Pritchard. I congratulate and thank the hon. Member for Carmarthen East and Dinefwr (Jonathan Edwards). Hill farming is of colossal importance to the United Kingdom it brings the public benefits of biodiversity and flood prevention, and economic benefits. In my constituency we have the Lake District national park, the Yorkshire Dales national park and South Lakeland, and the Lake District became a world heritage site just 12 months ago. The tourism economy of Cumbria is worth £3 billion a year and 60,000 jobs, all underpinned, as other hon. Members have said, by the work of our farmers to protect and maintain that landscape.

Why are most of our hill farmers involved in hill farming? It is about food production. Some 45% of UK lamb is produced in the uplands; 55% of the UK suckler herd is located in the uplands; and 35% of UK milk is produced in the uplands. Of course, straw and feed grown in the lowlands goes to feed animals in the uplands, so without hill farming, lowland farming would soon go. That should concern and bother us all.

Rightly, we are often concerned about fuel security, but we think too little about food security. Some 45% of the food we consume today is imported. Twenty years ago, that figure was more like 35%. It is a very worrying trend. The future for hill farming is vital. Providing a future for our uplands must be at the heart of the Government’s plan in the agriculture Bill that we look forward to in a few weeks’ time.

The ring-fencing and protecting of the common agricultural policy budget post Brexit of £3.8 billion until 2022 is important. I have heard some Government Members talk about that as a long-term commitment, but anyone who thinks four years in farming is long term understands nothing about farming. It does need to be a long-term commitment, and there needs to be a growing, not fixed, budget. The Government must take immediate action on existing payments.

Many hill farmers are coming to the end of their high-level stewardship and entry-level stewardship agreements. A friend of mine, a farmer in the Westmorland part of the Yorkshire dales, comes to the end of his HLS agreement in January 2019. He is not allowed to start an application or have a start date for a countryside stewardship scheme until January 2020, so he has to live for 12 months without a scheme of that kind. Even then, mid-tier countryside stewardship schemes offer little value, and higher tier schemes are frankly unfathomable and incredibly difficult to get through. Many farmers simply do not bother with them. Will the Minister ensure the continuation for hill farmers of HLS and ELS agreements until a new, better and bespoke scheme for the uplands can be introduced? I also suggest that the new scheme has monthly start dates, to ease the workload for the RPA and Natural England.

It looks like the one thing we are sure of in the agriculture Bill is that basic payments will not be part of it. Over the last 40-odd years, we have subsidised food in this country and we have never had a debate about whether we thought that was a good idea. But we can be certain that we will feel it when we stop subsidising food. We can welcome public goods being funded, but we should all take a step back and consider what that might mean for the upland farmer. If we over-commodify every single thing that they do, will we not be in a situation where we see the price of everything and the value of nothing?

I do not really have time to express my concern for the future of young people in hill farming; about how to create incentive schemes to get them in and to allow older farmers to retire with dignity to an affordable home, given the astonishing price of housing in rural areas such as mine. Every £1 invested in farming produces a £7 return. British farming begins in the hills. It has a future only if the uplands have a future.

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I thank the hon. Member for Carmarthen East and Dinefwr (Jonathan Edwards) for bringing this debate. I commend him for his passion for the security of sheep farmers and the industry not simply in his constituency but in the UK as a whole.

I declare an interest as a member of the Ulster Farmers Union, as a land owner and a former sheep farmer. The latest available data from 2014 shows some 33.7 million sheep and lambs in the UK, including some 16 million breeding ewes. A large percentage of those sheep can be found in upland and hill areas. In England, 41% of breeding sheep are found in less favoured area farms, and 53% of cattle and sheep holdings are in LFAs in Wales. Some 80% of the sheep population in Northern Ireland are within LFAs, and LFAs in Scotland are home to 91% of breeding ewes, so it is a very important sector for the whole of the United Kingdom of Great Britain and Northern Ireland.

Clearly, the hills and uplands are a vital part of a complex picture and require particular attention. Some 53% of the utilised agricultural area in the UK has been designated as less favoured. That is 5.3 million hectares in Scotland, 2.2 million in England, 1.53 million in Wales and 0.69 million in Northern Ireland. That land is perfect for the hard nature of the sheep industry, and would be inappropriate for any other farming use, so without that industry flourishing it would be unusable.

The National Sheep Association’s report on the complementary role of the sheep and upland and hill areas contains incredibly interesting information. I do not have the time to go through it, but I recommend those who have sheep farmers in their area to speak to them and gain a greater understanding of the challenges.

I recently read an article in the press back home that almost half a million lambs leave Northern Ireland for processing south of the border on an annual basis. We are under no illusions that Brexit could massively affect the sheep industry, along with almost every other industry in the UK. The facts are clear that everything that serves to make markets on mainland Europe less attractive indicates difficult times ahead for the sheep industry throughout the UK as a whole. I speak as a Brexiteer—one who supported, and still supports, leaving the EU. I am aware that the Brexit team is working hard to secure the ability for our cross-border sales to continue. Today’s debate will certainly serve as yet another reminder of the importance of the EU market to our sheep farmers in Northern Ireland, Wales and the rest of the UK.

I welcome the Prime Minister’s dedication to continue the subsidies in agriculture and I do not question that commitment, but I join others in asking for the details of that funding as soon as possible for sheep farmers who farm difficult lands and need to be secure in their hard work and industry. The hon. Member for Westmorland and Lonsdale (Tim Farron) mentioned a four-year plan for farmers. Farmers have a 10-year plan, a 20-year plan and a 30-year plan, not a four-year one. We need to know what is happening in the long term. The level of support is high in the last common agricultural policy reform package. That must continue if we are to allow our farming sector to thrive.

In Northern Ireland we are dependent on the less favoured areas for our sheep in particular and, to a lesser degree, cattle. That is very important to us in Northern Ireland, where we have a large agri-food sector and depend on exports. The sheep industry has the potential to do more, and that must be encouraged post-Brexit. I have every faith that the Department will continue to support the industry. I will work with the Department as it continues to facilitate the work of sheep farmers, as well as so many other farming industries that are reliant on subsidies to farm what we rely on so much in Northern Ireland and throughout the whole of the United Kingdom.

I fully support the case put forward by the hon. Member for Carmarthen East and Dinefwr and by other hon. Members who have spoken. I look forward to the Minister outlining how his Department will fully support our sheep farmers throughout the United Kingdom of Great Britain and Northern Ireland.

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I congratulate the hon. Member for Carmarthen East and Dinefwr (Jonathan Edwards) on securing this important debate. We are in the agricultural show season, when the public directly interface with our wonderful rural life and environment. I had the great pleasure of being at the Royal Highland show last week. I know the Secretary of State was there. I am not sure whether the Minister was there; he can let us know when he speaks. We saw the great interest in agricultural issues, and it was great for the Scottish Affairs Committee to come face to face with so many of our agricultural producers, growers and farmers at a roundtable.

Upland farmers are the backbone of the rural economy. Without their work, upland and highland constituencies such as mine would simply be abandoned. The value of hill farming and crofting cannot be measured by kilos of beef or lamb alone; they make a hugely significant contribution to thriving communities and flourishing environments. That contribution can be difficult to quantify. It is all about the maintenance of our upland environment, with all its iconic wildlife and landscapes. As we have heard, it is about the preservation of the social fabric in our more remote rural areas, and it is the cornerstone of both the local and national economies. But it is all in the margins, socially and, in particular, financially.

Without financial support payments, farming could simply disappear from large parts of Scotland. Less favoured areas make up 85% of farmland in Scotland, compared with 17% of farmland in England—and we make up more than a third of the landmass of the United Kingdom, so that is an awful lot of land. We are therefore a sector that is more dependent on support. Without it, so many places in Scotland would return to scrubland and weeds. That is now a real risk. Brexit uncertainty threatens to undermine confidence among all those involved in traditional hill farming. We need a post-Brexit package of co-ordinated policy measures to secure the long-term viability of hill and upland farming and crofting businesses.

The UK Government’s clueless Brexit has caused serious uncertainty about the economic viability of Scotland’s agricultural sector, given how valuable the EU is to the industry. Subsidy payments are immensely important to Scotland and account for about two thirds of total net farm income. Between 2014 and 2020, Scotland will receive €4.6 billion from the EU, which is equivalent to about £500 million per annum, representing 16.5% of the UK’s common agricultural policy allocation.

We do not know what will happen when things change. We have heard about plans for subsidies to somehow follow environmental improvements, or this vague suggestion of success. What we do know is that in 2022, payments as we currently understand them will come to a halt, and sectors such as upland farming will be disproportionately hit. We also have no idea how the devolved Administrations will be funded. We have heard talk of per-capita payments, or payments subject to the Barnett formula, but we have crunched the figures: the better outcome of the two would be the Barnett formula, but Scotland would still lose some £2 billion of CAP funding that would need to be replaced. That is because of Scotland’s higher concentration of farmers and crofters. We have no clue what the Government’s plans are, post 2022. Hopefully that will become more apparent in the agriculture Bill.

Meanwhile, in Scotland, we cannot wait. The Scottish Government have put in place a plan that will offset the worst of the chaotic cluelessness that underpins the UK Government’s approach to Brexit. We want to keep support in place beyond 2022, and the Scottish Government have announced a deal for Scottish farmers that would give them some sort of security until 2024. That five-year transition period would give a two-year period of stability in which we continue to adhere to EU rules, and a second phase of transition in which amendments could be made to payment schemes to simplify and improve issues around livestock inspections and farm mapping.

Scotland has the only plan in the UK to deal with the ravages of Brexit, but Scotland is not responsible for the UK’s Brexit. We did not vote for it and we did not want it. Indeed, this Government are doing all they can to lock us out of their plans. We heard from the hon. Member for Carmarthen East and Dinefwr about the plans for the power grab. Is it not unusual that all the powers that have been grabbed from Scotland and taken by the Westminster Government are on animal welfare or agriculture? The idea of trying to secure a UK single market is, for us, a creation of the UK superstate, administered centrally from Westminster, and the devolved Governments are to be locked out.

Finally, what about the EU convergence uplift payments that Scotland was supposed to get? All that money was earned in Scotland. We enabled the UK Government to qualify for a £190 million payment, yet Scotland has secured only £30 million of that back. When are we going to see that money? Agriculture and upland farming are vital to Scotland. We need to hear solid plans for what the Government will do as we leave the EU.

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I am delighted to serve under your chairmanship, Mr Pritchard. We have had a very interesting debate, and I congratulate the hon. Member for Carmarthen East and Dinefwr (Jonathan Edwards) on introducing it. It is vital that we tease out where we are going on these important matters. We have had contributions from my hon. Friend the Member for Bishop Auckland (Helen Goodman), and the hon. Members for North Devon (Peter Heaton-Jones), for Brecon and Radnorshire (Chris Davies), for Dwyfor Meirionnydd (Liz Saville Roberts), for Westmorland and Lonsdale (Tim Farron) and for Strangford (Jim Shannon), as well as from the Scottish National party spokesman, the hon. Member for Perth and North Perthshire (Pete Wishart).

I will keep my remarks very short, so that the Minister has plenty of time to respond. We have heard about the contribution that the uplands make to agriculture through lamb and beef, so I will not repeat those points. I want to look at some of the environmental issues, and I am indebted to the National Farmers Union, the Royal Society for the Protection of Birds, the National Trust, the Countryside Alliance, and Compassion in World Farming, which have all written to me about the debate.

If we look at the figures about the contribution that the uplands make to the environment, approximately one quarter of the total area of English and Welsh woodlands are in the uplands. The largest remaining tracts of semi-natural habitats in England and Wales are found in the uplands. The uplands are home to 53% of England’s and 40% of Wales’ sites of special scientific interest. The uplands are home to many rare animals and birds, as my hon. Friend the Member for Bishop Auckland made clear. They are the source of 70% of our drinking water. Last but not least, they are a store of 40% of England’s and 80% of Wales’ soil carbon. I could go on about the importance of the national parks, and how they put something in the order of £1.78 billion into England and about £205 million into Wales.

Given that contribution, which has shaped our natural environment, I ask the Minister what else we could ask from the farmers who look after the uplands. How could they work any harder to provide that public benefit and earn the money that they deserve? What could they do that they are not already doing?

In response to the hon. Member for Brecon and Radnorshire (Chris Davies), the idea that we will renegotiate the devolution settlement is somewhat ambitious and dangerous, because we have a clear relationship. This is a devolved responsibility. One of my Welsh colleagues could respond to the debate, because this is about Wales and Scotland, as well as England. These are devolved matters.

In conclusion, I ask the Minister to respond to those two points. What else could we expect these people to do? They already start at a huge deficit. Some argue it is £14,000, and some that it is as much as £16,000 or £17,000. What else could they do to earn more money? The second question is: how does this impact on the devolution settlement?

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It is a pleasure to serve under your chairmanship, Mr Pritchard. I congratulate the hon. Member for Carmarthen East and Dinefwr (Jonathan Edwards) on securing this important debate on upland farming after we leave the European Union.

The uplands have some of our most beautiful landscapes. Some 12% of land in England is in the upland areas, but it constitutes 75% of the world’s heather moorland. Some 70% of our upland areas are in national parks. The uplands are also home to important, vibrant rural communities. The hon. Member for Carmarthen East and Dinefwr discussed the position in Wales and the importance of the uplands to rural communities there, and I agree with him on that.

The truth is that future agriculture policy will be devolved. Wales, Scotland and Northern Ireland already have some, albeit limited, scope within EU schemes to design their own approaches; we have been clear that we want them to have as much freedom as possible to design schemes and approaches that work for their own agriculture. We want them to have more freedom than they have now under EU schemes.

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Might I put in a plea on behalf of Dartmoor farmers, whom I met recently? The one thing that matters most to them is that they are involved and consulted closely in designing whatever schemes come forward from Brexit. In that context, may I commend to the Minister the Dartmoor Farming Futures initiative? It is having conspicuous success in uniting farmers throughout the Dartmoor area in designing outcomes, including livestock numbers, and turning out and taking off dates. It is a model scheme. In considering how upland farming support should go forward, I urge him to look at that scheme closely.

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I can reassure my hon. and learned Friend that I have already looked at that scheme; I visited it two years ago. The Dartmoor Farming Futures project can show us the way, and it is something that we can learn from. It has been developed as a pilot, as a bit of a derogation from existing EU rules. As we think about future policies, we are keen to work out how we can tailor them to an individual area and focus more on outcomes, rather than processes and inputs.

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Further to the point made by my hon. and learned Friend the Member for Torridge and West Devon (Mr Cox), we are making a bespoke arrangement for the future. The Dartmoor scheme has huge amounts to recommend it, but in the meantime, many of our stewardship schemes will run out before we can set up the new schemes, so is it not a good idea to run the existing systems on for a couple of years, and pick up a bespoke arrangement when we are ready? Otherwise, many of these schemes will fall, and instead of getting more environmental benefits, we might get fewer. I am very concerned about that.

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I was going to come back to that. We will be absolutely certain that the existing countryside stewardship schemes will run on and be funded. Some of the agreements will outlive our membership of the European Union; they will continue to be funded until we have successor schemes in place.

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Will they run on even if they have run out?

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We will ensure that we have the new schemes in place by the time those agreements start to run out.

As I said, this area is devolved. It is recognised by everyone that there will be a need for some UK frameworks, particularly when it comes to delivering international obligations such as our obligations to the World Trade Organisation, which I will return to, but also in ensuring integrity in the UK single market. We are taking two approaches. There will be areas where things may be reserved—for instance, where they are directly attributable to international trade and international agreements that we have entered into. There will be others where we can construct frameworks through memorandums of understanding. There is already a lot of quite detailed work being done in that space.

The hon. Member for Carmarthen East and Dinefwr asked about our working with the Welsh Government. I reassure him that we are in regular dialogue with Ministers from across the devolved Administrations and that, at an official level, there has been incredibly close working on developing, for instance, the statutory instruments that we all need to bring forward in our various legislatures under the European Union (Withdrawal) Bill. There is a lot of close working on that. We have also done some quite detailed work on what future frameworks would look like, looking policy line by policy line at where we think a memorandum of understanding would work, what we think can be fully devolved and what we think should be reserved. That work is at an advanced stage.

We should be positive here. We can look forward to a future where we all have far more power. Under current schemes, we are told the minimum and maximum width of a hedge, what width a gateway is allowed to be, what types of crops someone can grow and whether they can claim that a cabbage is the same as a cauliflower or winter wheat is the same as spring wheat.

The hon. Member for Westmorland and Lonsdale (Tim Farron) raised the issue of the frustrations regarding countryside stewardship schemes. I agree with him. Farmers should be able to enrol on those schemes in any month of the year, but get this: we used to be able to do that, under the old schemes. The European Commission proposed that we change to a common commencement date for everyone. The UK opposed that vociferously, but the EU ignored us. As a result, we have an administrative nightmare, trying to put all these schemes in place on the same start date. We can leave all that behind and no longer fret about disallowance risks.

We had a consultation earlier this year on future agricultural policy, in particular as it relates to England. We have had over 44,000 responses. We are clear that there will be an agriculture Bill in this Session of Parliament, but we have also made a few other things clear. In our manifesto, we committed to keeping the budget the same in cash terms for the duration of this Parliament, out until 2022. We were clear in our manifesto that we would replace the common agricultural policy with the future funded scheme, to be rolled out thereafter.

We have also been clear that we think we can spend the money better, focusing it on the delivery of public goods and environmental outcomes, rather than on arbitrary payments based on how much land people own or control, which clearly makes no sense if we are seeking coherent policy. Finally, we have been clear that we recognise that there is quite a lot of dependency on the basic payment scheme and area-based payments. We will make changes gradually, over an agricultural transition period running for a number of years. We have invited suggestions on that in our consultation.

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Before the Minister moves away from discussing the funding arrangements, could he assure me that, in designing a future funding arrangement, the Government will look at ensuring there is a period of similar length—perhaps five or seven years? That gives certainty to farmers that a shorter period simply would not.

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There have been a number of representations about how long that period should be. Most people have suggested that somewhere in the region of five years or possibly a little bit more makes sense. As the Secretary of State has indicated for illustrative purposes, something in the ballpark of five years seems to make sense and seems to be where the consensus is.

We also recognise that we need to help businesses prepare during the transition. We recognise that we may need to take account of the less favoured area status of some areas, particularly the more financially vulnerable upland areas, and of the impact on those rural communities. We are certainly willing to do that, and we flagged the potential need for it in our consultation.

However, there is more than one way to approach this. We could continue with something similar to what we have now, but a number of organisations representing upland interests have actually said to me that they see great opportunities in the principles and the approach that we advocate. For instance, the Uplands Alliance told us that it was very keen to move to a system of payment for the delivery of public goods. It makes a powerful point, because at the moment the uplands, and particularly the moorlands, get less area payment because they are deemed to be disadvantaged areas on less productive land. That could not be more upside down.

In fact, they potentially have the opportunity to deliver more by way of public goods, in terms of public access, flood mitigation, carbon sequestration, peat bog restoration or improvements in water quality. There are many opportunities for the uplands to deliver those public goods, and several people are starting to say that, if we are serious about payment for the delivery of public goods, they see a vibrant, profitable model for upland farming.

We also set out, in an annexe attached to our consultation, ideas about the type or flavour of the options that we might offer. We have about 30 years of experience in various environmental land management schemes. For instance, even in the current schemes there are options for enclosed rough grazing, the management of moorland, the protection of native breeds and the shepherding supplement. We also have grants for stonewall protection, hedgerow restoration, the maintenance of weather-proof traditional farm buildings in remote locations and haymaking. There are many options within those existing schemes, and we have a lot of experience of making them work.

I will turn to some of the points made by hon. Members. The sheep sector is very important for Wales. There are 10 million sheep—around 30% of the UK total —and some 14,000 holdings with sheep, many of which are in disadvantaged areas. It will be for the Welsh Government to design a policy that works for their own farmers and their own circumstances. The hon. Member for Carmarthen East and Dinefwr mentioned how closely we are working with the Welsh Government. As I pointed out earlier, very detailed working is going on. The hon. Member for North Devon (Peter Heaton-Jones) highlighted some of the great work being done on Exmoor, and I very much agree with him. I visited the mires project, run by South West Water and other local partners on Exmoor, and some innovative policy thinking is going on there.

The hon. Member for Bishop Auckland (Helen Goodman) raised a number of issues relating to trade. I do not accept that we need a customs union, but we need a customs agreement. That is exactly what the Government seek—a comprehensive, bold free trade agreement with no tariffs and agreed customs arrangements. I do not agree that we need absolute uniformity on regulations. It is possible for us to recognise equivalence, since our starting point is that we are departing the single market; we are not a country with a very different regulatory tradition.

The hon. Lady also asked about the WTO. We believe that we should treat this as technical rectification, and we are working with the European Union to split our WTO schedules, both on tariff-rate quotas and aggregate market support, which is the ceiling on market support and subsidies that can be paid to farmers. Those will simply be divided based on historical use, which we do not believe will provide us with any problems.

Finally, on future trade deals with other countries, we have been crystal clear that we have standards and values that we will not abandon, and we will not abandon or compromise our standards in pursuit of a trade deal.

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Will the Minister confirm that, if the Government do not seek the endorsement of the Scottish Parliament, the National Assembly for Wales and the Northern Ireland Assembly on our trade policy, we will effectively have a situation in which those three constituent parts of the UK will have less power and influence over our trade policy than Wallonia has over trade policy at EU level?

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I do not really think that that is the case. At the moment, none of us have much influence over trade policy, because it is decided by the European Union. I know that my colleagues in the Department for International Trade are working closely with colleagues in the devolved Administrations to work out a sensible approach to our future trade agreements.

My hon. Friend the Member for Brecon and Radnorshire (Chris Davies) is passionate about farmers in his constituency and made the important point that we need to carry farmers with us on this journey. I agree that we cannot deliver the outcomes that we seek without the support of farmers to deliver them.

We have had a good and comprehensive debate covering many issues, with powerful contributions from Members from every single part of the UK. I believe that these are exciting times as we face the future. We should see this as an opportunity, not a threat.

Question put and agreed to.

Resolved,

That this House has considered the future of upland farming after the UK leaves the EU.

Sitting adjourned.