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House of Commons Hansard
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Invisible Disabilities and Accessibility Challenges
05 June 2019
Volume 661

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I beg to move,

That this House has considered invisible disabilities and accessibility challenges.

I thank the Backbench Business Committee for granting this debate, my hon. Friend the Member for Newport West (Ruth Jones) for co-sponsoring the application, and the right hon. and hon. Members who will take part. I also thank the Minister who is responding; I was extremely grateful that, along with other colleagues, he spared the time yesterday to attend the roundtable discussion on this issue. We are all keen to look into this matter more closely over the coming months. I hope the Minister will agree that the roundtable was a constructive, illuminating and at times exciting discussion in which we were able to preview the new accessibility signage that reflects all disabilities, whether visible or invisible.

Before discussing the new signage and the wider campaign to improve our understanding of invisible disabilities, I want to reflect briefly on the progress that we have made as a society when it comes to people with all disabilities. The landmark legislation that I, as a Labour Member of Parliament, am particularly proud of, is the Equality Act 2010: a historic amalgamation of rights, placed under one statute, in the final days of the last Labour Government. The Act enshrined all the protections in one place for all disabled people in this country—a benchmark for our future direction of travel.

Many pieces of legislation start with an inspirational story involving an inspirational campaigner acting as a catalyst for change. One such campaigner is the reason why I stand here today to speak on this issue. Before I came into politics and before I considered standing to represent East Lothian as Member of Parliament—even before Brexit started, believe it or not—I had the honour of being a teacher at Prestonpans Primary School. I had the great pleasure of teaching hundreds of children over the years. I truly take pride in every young person I had the privilege to teach.

One person, who has already achieved so much in her short life and is now my constituent is Grace Warnock. Grace is a passionate, articulate, intelligent and creative young person, who is determined to change the hearts and minds of people around her. She is resolute in her mission to remind everyone that not all disabilities are visible. Grace suffers from Crohn’s disease—a condition that many hon. Members will be aware of. Those with Crohn’s need more than most to use accessible toilet facilities, sometimes at very short notice. When Grace tried to use an accessible toilet some years ago, she was accosted, heckled and abused. She was targeted because Crohn’s is not a visible illness. I would not blame any young person who, after experiencing such an incident, kept their head down, possibly even avoiding accessible toilets and facilities.

Grace felt embarrassed. She was upset, but she was also determined to do something about it, so she created a toilet sign that strikes a powerful chord—one that asks people to have a heart and to consider the range of disabilities that exists. This sign, first displayed in her primary school, has spread across Scotland and is changing perceptions along the way. It is empowering people like Grace, who may feel unable to do so, to use accessible facilities, which is a great testament to Grace’s work and to her mum, Judith. The next step is to take forward the energy, the enthusiasm and the ideas of Grace’s campaign and to put forward new signage that can be a British and international standard.

That brings me to the work of another inspirational woman, Lucy Richards. Lucy is the creative director of StudioLR, and she wants to use design to take on some of society’s big challenges and to make a positive impact on people’s lives. Lucy specialises in inclusive design, creations that are simple for people to understand. Working with people with dementia and in partnership with Life Changes Trust, an incredible charity based in Scotland, she has designed a new set of everyday symbols that help people find their way around. She was inspired by Grace’s campaign, and her work includes a new symbol for people with any disability. There is a need for a sign that is easily understandable to all.

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I am sure that my hon. Friend, like me, has been contacted on many occasions by blind constituents, who have great difficulty finding their way around obstacles on the pavement. He also mentions toilets, and there is now a big shortage of toilets in the towns of this country, which may well be down to local government cuts. The Government should be looking at those two issues.

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My hon. Friend anticipates, as he so often wisely does, where my speech is going on street furniture and people with sight problems, and on the availability of toilets and facilities generally across the United Kingdom.

Yesterday I was delighted to meet the British Standards Institution, which supports the establishment of inclusive signage. Understandably, the process of standardisation is rigorous, and it is fair to say that it perhaps does not lend itself to political timetables. I am under no illusion. This is a long-term project, and there are a number of barriers that stand in the way.

Of course, because of parliamentary convention, I cannot explicitly show hon. Members the symbol. However, I am happy to preview the design after the debate. The “any disability” symbol depicts a range of disabilities, both visible and invisible, and it can be accompanied by text saying, “For people with any disability.” This is a profoundly important message that strikes at the heart of the campaign.

The nucleus of the campaign that Grace started those years ago is about changing the perception of what disability looks like. It strikes at the heart of how we define a disability. There are 13.3 million disabled people in the UK—21% of the population. If we examine the figures more closely, they reveal that 25% of those who are disabled report a mental health impairment and a further 18% have other non-visible conditions, yet I worry that what it means to be disabled is still not properly understood.

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The hon. Gentleman is making an excellent speech on such an important issue. As chair of the all-party parliamentary group on disability, I was approached before this debate by a number of individuals who would like me to point out that those with an autistic spectrum disorder are often overlooked or badly understood by members of the public, and such disorders are certainly not noted as a disability because they are not visible. As I know because my husband suffered a head injury while serving in the Army, head injuries can cause cognitive processing difficulties, and so on, that are not obvious. This signage is great work, and it will aid understanding of the whole range of disabilities and impairments.

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The hon. Lady raises a most profound and important point: people’s understanding of disability is influenced more by their personal experience than by what society brings together as to what it is to be disabled.

The figures show that those with non-visible disabilities suffer an unfair double attack. What sits at the heart of Grace’s campaign about having a heart and of what we hope to achieve here today and in the future is making that playing field more level and fairer. I worry about a misunderstanding of what amounts to “a disability”. Crohn’s and Colitis UK, which is leading the way in trying to change perceptions about this issue, has undertaken a huge amount of research, which shows that 93% of people think that if they challenge someone who looks healthy for using an accessible toilet, they are “standing up” for the “rights of disabled people” or doing this because the situation is not “fair” on others. One noticeable aspect of this debate is that I do not think many of the people who took part in that survey answered maliciously; they genuinely feel they are doing the right thing by pointing out to someone they do not think is disabled that they are doing the wrong thing. Their first thought is, “I want to stand up for people who are marginalised in society, those who rightly deserve full accessibility rights”. This instinctive reaction to what people believe a disability “looks like” needs to be challenged.

It is worth noting that the false perceptions of what constitutes a disability have a profound effect on the individual’s mental health. In preparing for this debate, I have been made aware of some incredibly upsetting cases of abuse directed at disabled people who have been queueing for accessible toilets or trying to use a parking bay. Further research by Crohn’s and Colitis UK shows that two thirds of people with Crohn’s or colitis have experienced an accident while they have been queuing to use a toilet, and they have, in turn, received abuse for that. Almost half say that they will change their attitude to social spaces such as restaurants because of their condition. That is just wrong, in this society; it is a damning picture of the everyday experience that disabled people suffer.

I was struck recently by an article on the impact of invisible illnesses by how hurtful people’s perceptions are. The piece noted what just an everyday misconception associated with a disability can do. We are talking about the idea, “You can’t be sick because you look so well.” There is a misconceived image of what it looks like to have one of these illnesses, and things start with a tiny casual gesture or throwaway line but then quickly evolve into something far more pernicious.

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My hon. Friend is making a powerful speech. Dementia is one of those invisible cognitive impairments. I chair the all-party group on dementia, which has just conducted an inquiry on dementia as a disability. As a society, we still face issues on access to blue badges and on attitudes and how people relate to those with dementia. I am very grateful to him for his speech today.

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I am grateful for that intervention. The Minister will find that one of my requests at the end may make reference to that point.

Let me follow up on what has been said about those who suffer acquired brain injury, as there are many instances where people feel that the person in front of them is drunk and has not suffered an injury. People who have fatigue syndromes are accused of laziness when they ask for a seat. In employment, people with these invisible conditions are often disproportionately discriminated against. Those with neurological conditions such as autism will struggle in a conventional workplace setting, but this is to miss the great opportunity and strength that people with autism can offer in the workplace.

I was interested to hear yesterday from leading charities about the impact of signage, particularly in respect of conditions that affect the functioning of the brain. Signage that vulnerable people can understand works for everybody and will go a long way towards allowing people, particularly those with dementia, to become and to feel more integrated in society. It is such small changes that go a long way towards changing the lives of significant numbers of people.

I stress that I do not want this debate, nor the introduction of new signage, to dilute the need to reform and rearrange the built environment for those who suffer from a physical disability. Wheelchair users and those with mobility challenges face huge obstacles in our society, and this is in no way an attempt to split the two groups. In fact, it is an attempt to bring them together. Whether it is the creation of more accessible homes, the altering of transport infrastructure or the forcing of private companies to improve their surroundings, it is all helpful.

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I remember that when I was trained as a dementia friend I was shocked to be informed that sometimes if a person with dementia comes across a dark rug on the floor, they get absolutely petrified because they think it is a hole. When we make public places, we have to realise that we need to be careful when we put down a dark rug or piece of carpet or whatever, because it might look like a hole to someone with dementia, and they are sometimes terrified.

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That powerful intervention shows that those people who are not suffering from dementia or do not feel that they have a disability need to think about the simple things to make the world and the community accessible to everybody in society.

We have an obligation under article 19 of the UN convention on the rights of persons with disabilities. We should continue to lead by example. Will the Minister update the House on the work the Government are doing to ensure that the UK continues to meet its international obligations? In particular, how are the Government ensuring that those with invisible disabilities face no barriers to their day-to-day lives? How can we make sure that they can live their lives without facing abuse?

I call on the Minister to support the campaign for an easily understandable disability sign and, crucially, for there to be a standardised version of this sign that truly represents people with a wide range of visible and invisible disabilities. Once we have accepted the layout and design of a new accessible sign, we can start to progress the campaign and to consider how it can be rolled out. On that point, will the Minister consult colleagues across Government to explore the possibility of implementing such signage on our blue badge parking and disability railcards? People with a range of invisible disabilities are entitled to hold those passes. It would be a symbolic and practical change to the lives of those with such conditions if Government literature reflected the use of the new sign. I would be grateful if the Minister would agree to one further meeting with me and colleagues to discuss how we can move the matter forward.

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I am sorry to interrupt my hon. Friend’s excellent speech. He made the point about people not recognising disability, but there are problems even when it is recognised. Tanni Grey-Thompson is a very well-known former athlete who uses a wheelchair, and she suffered terrible embarrassment on a train because of failure to access a disabled toilet. Even when someone is well known, that often does not help them if the facilities are not made available when they should be.

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Absolutely, and that is why the call for a new sign is a small request in a big argument that requires society to change its view and stop seeing people with disabilities and instead see disabled people.

I thank Lucy Richards for the work she has put into creating the new signage, and I am grateful for the support of everyone who attended yesterday’s roundtable, including my hon. Friends the Members for Newport West (Ruth Jones) and for Rhondda (Chris Bryant), the right hon. Member for Broxtowe (Anna Soubry) and the hon. Member for Ayr, Carrick and Cumnock (Bill Grant). I am also grateful for the work of the Life Changes Trust, Innovations in Dementia, Dr Gordon Hayward and Rob Turpin of the British Standards Institution. I also thank my constituent Grace for the incredible work that she has put into the campaign.

In conclusion, although we must keep ensuring that our built-up environment is fit for purpose for everyone who uses it, environmental changes go hand in hand with changing social perceptions and meeting the holistic range of accessibility challenges that individuals in our community face. I hope that hon. and right hon. Members will use this time today to note the value of changing perceptions about invisible disabilities.

This debate is about far more than just accessible signage, but symbols matter because societal attitudes reflect the way that they are interpreted. Until we start a national conversation on how we change and adapt accessibility signs to reflect any and all disabilities, we will continue to marginalise disabled people across the UK. That goes against Grace’s fundamental reason for starting this campaign: she wants society and people to have a heart.

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It is truly an honour to follow the hon. Member for East Lothian (Martin Whitfield) in this debate. I congratulate him on his excellent speech and thank him and the hon. Member for Newport West (Ruth Jones) for bringing forward this important debate this afternoon.

Reading the original application to the Backbench Business Committee, I was struck by the campaign from the hon. Gentleman’s constituent Grace Warnock. Members across the whole House should be grateful for the work that she has done to raise awareness of the challenges that she and, indeed, very many of our own constituents face on a daily basis.

Although it is an enormous time after the actual event, may I welcome the hon. Member for Newport West to this House? I served with her predecessor on various Committees and cross-party groups and was proud to be one of the very few Tories that he never verbally slaughtered in the Chamber, presumably because we mischievously used to gang up on the then Chairman of the Committee on which we both served just for a giggle. He will be much missed in this place, but I am in no doubt that she will very quickly find her own way in this incredible madhouse.

I will not pretend that I am an expert on disability, hidden or otherwise. I am, however, very proud to be the independent chair of Medway Council’s physical disability partnership board—a role that I have had for some time. I have learned a phenomenal amount about the challenges that those with physical disabilities face—something that I as an able-bodied individual would never ordinarily appreciate. The right hon. Member for Cynon Valley (Ann Clwyd), who is no longer in her place, was quite right to mention some of the challenges that exist, such as being able to find suitable toilets, which is something that Baroness Grey-Thompson experienced.

I recall hearing a story while serving on the partnership board that may make Members laugh because it is amusing—apart from to those to whom it is relevant. A blind constituent of mine got on a bus and asked the driver to tell her when she was at her stop, to which the driver replied, “Well, can’t the dog tell you?” That just shows how we as a society still have so much to learn about physical disabilities, and even more to learn about hidden disabilities. In my time as chair of the partnership board, I have got to understand other disabilities or health conditions better, but I am always willing to accept that I need to learn so much more.

One of my great pleasures in life is whiling away time shopping, yet so many places are desperately inaccessible to those with hidden disabilities. I am pleased that, across my constituency and slightly beyond its borders, greater efforts are being made to support better accessibility for those with varying disabilities. The Pentagon shopping centre in Chatham, for example, has Sound-Out Sunday on the first Sunday of every month. It is not until it is explained that it seems like a complete no brainer. The centre minimises ambient noise, including turning off music and hand dryers, as well as having a chill-out zone, should people need to take a break from the crowds. Bluewater, which is a major retail outlet in north Kent, beyond my constituency, is permanently introducing services, including weekly quiet hours, sensory toy bags and hidden disability lanyards that allow staff to proactively offer assistance.

My young son’s soft play centre of choice, Adventure Kidz in Aylesford, offers special educational needs and autism friendly sessions so that there is inclusivity even at the earliest stage in life. My son does not have autism, but he does not like hand dryers. He gets incredibly upset by them, so we find it difficult to take him into a public toilet. I therefore just have that tiny insight into what it must be like for those who do have autism to find themselves really quite unsettled by noise. Anything that public places can do to reduce that impact and that disturbance, particularly for young children with autism, is incredibly important and very welcome.

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The hon. Lady’s speech is very enlightening about many of the things we could be doing. Following on from the comments by the hon. Member for East Lothian (Martin Whitfield), does she think that one of the issues we have to overcome with invisible disabilities is not only our own ignorance of what they might be, but people’s reticence to come forward because they fear that their invisible disability might be rejected as a disability?

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I absolutely agree. I always think that one of the main advantages of being Members of Parliament is that we get exposure to issues that, ordinarily, members of the public do not. We get to learn things and to discover issues and conditions that ordinarily pass the vast majority of members of the public by. The more we can do to educate and inform people about these issues, the better. My hon. Friend the Member for Orpington (Joseph Johnson) mentioned what he had learned as a dementia friend. Like the hon. Member for Oldham East and Saddleworth (Debbie Abrahams), I was previously—before ministerial life—a co-chair of the all-party group on dementia. What we learn in this place about dementia is incredible, and we need to get that across to everyone.

As the chair of the partnership board, I have learned things about disabilities that I would never have come across. Some of that is just about basic education and information. Unless someone has a family member who is affected, or they themselves have a disability—physical, visible, intellectual or hidden—they do not necessarily know about these things, and they certainly do not understand them. I have tried in my speech not to use the word “understand”, because I do not think I would ever fully understand these things; I could only appreciate the challenges that people face.

It will be no surprise to anybody in the House that one of my other great pleasures in life is watching and participating in sport. I want briefly to give a nod to the amazing Special Olympics team and their sponsors—especially Coca-Cola, which has partnered them since 1978. Special Olympics is by far the largest disability sports organisation in the world, with a strapline of transforming people’s lives through sport. Our competitors, who do not receive any regular funding from central Government—much to my disappointment, but not due to a lack of effort—are quite possibly the happiest, smiliest, most appreciative group of people you will ever meet in your life. I would like to mention the phenomenal work of my hon. Friend the Member for Daventry (Chris Heaton-Harris), who has supported Special Olympics for many years.

Special Olympics GB notes that 200 babies are born with an intellectual disability every week. Eight out of 10 of them will be bullied and all will be socially excluded. Sport dramatically enhances the psychological, physical and social wellbeing of every athlete, as well as having a positive impact on family members, who often face increased isolation and mental health deterioration.

Team GB has just returned from this year’s world games in Abu Dhabi with 169 medals, 61 of which were gold. What an amazing achievement, but what a shame it was barely mentioned. For the competitors, the world games would have been a life-enhancing moment, and I for one am trying to get some of the medal winners to come to my constituency, to go round some of my local schools and especially to meet those who share similar challenges—who knows, those athletes might even inspire them into sport in one way or another.

Sport England has been enormously helpful in recent years, and it now provides much-needed funds to get more people with physical, hidden and intellectual disabilities active. We know that those with disabilities are twice as likely to be inactive as able-bodied people. Sport England has also provided funds to Special Olympics to engage more volunteers and to support the delivery of competitions, to help it develop its commercial opportunities. However, I firmly believe we should be doing more as a state to support the Special Olympics organisation and its competitors.

When the Minister held this brief before, and I was still in my old post, we spoke of what more we could to support Special Olympics. I would be grateful if he agreed to resume that discussion with this now humble Back Bencher and others who might have an interest. There is a real appetite for the future world games to be held here, and I see no reason why we should not support that bid in the way we did for the Olympics and the Paralympics. Imagine how brilliant it would be for our athletes who have a variety of different disabilities to compete in front of home crowds as we welcome several thousand athletes from 170 countries around the world.

Had I realised that I would have more time, I would have prepared something celebrating some of the excellent work that goes on in my constituency, in this House and beyond on having a better understanding of dementia. The hon. Member for Oldham East and Saddleworth has been doing a fantastic job in that regard. Locally, we have a dementia alliance that is trying to work with all partners to ensure that we have proper dementia-friendly communities. We have an ambition to make this place dementia-friendly, but we still have a very long way to go with that. We could start by getting rid of all the black strips and black rugs in this place.

Bradfields Academy is one of my favourite schools in my constituency. I am an honorary member of its school council. It is a special educational needs school. It has children there with extremely challenging disabilities, yet it is one of the calmest and kindest schools that I go to in my constituency.

I pay tribute to Kent Autism Trust, which is doing some brilliant work with local people and local employers to get a better understanding of autism and how we can support people with autism into the workplace and in our communities.

I would like to make special mention of those who support people with Parkinson’s disease. As the hon. Member for East Lothian said, some people assume that people with Parkinson’s are drunk. It is one of those conditions where people think that some sort of inebriation has been involved because of their reactions. We still have a long way to go in getting a better understanding of that.

I pay tribute to the work that the Government are doing with Changing Places. I recently listened to an incredibly powerful and emotive phone-in on a local radio station about the challenges that people still face in just going into their own communities, particularly town centres, and finding it very difficult to find places to use the toilet.

Some debates in this House really influence and inspire Members to do more for their constituents, and so far this has definitely been one of them. I am genuinely inspired by the hon. Gentleman’s constituent Grace. I will take away much of what I have learned today and consider what more I can do, in addition to the work I do on physical disabilities, to support those with hidden disabilities in my own constituency and beyond.

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I thank my hon. Friend the Member for East Lothian (Martin Whitfield) for instigating this debate, which I am delighted to be able to co-sponsor.

The whole point of the development of a new sign—Grace’s sign—is to be welcomed as a physical reminder that not all disabilities are visible, but also as a general encouragement to us all to not take people at face value. We need to have compassion and care for one another, as this sign reminds us. As a physiotherapist, I was well used to treating patients with disabilities that were visible because of, say, a plaster cast, crutches or a wheelchair. These are outward signs that the individual needs to be given extra consideration in a number of ways. We are all very used to seeing someone with a visual impairment using a white stick or a guide dog, and hopefully we react appropriately. This is perfectly normal.

In my previous role as a physiotherapist, I spent some time working with stroke patients, and it was my goal to help them to walk independently without the use of a stick. But my patients would often tell me that they wanted to keep the stick, even though they could walk independently, because other people knew that it signified that they may need additional time or space when walking. Certainly, in crowded areas, my patients valued the stick as an outward reminder to others that they needed to be treated with just a bit more care. So it is with people who may have invisible additional needs or disabilities.

My hon. Friend explained the origin of the planned new sign, so I do not need to repeat that, but there are others who have other invisible disabilities such as learning difficulties. I have worked with some fantastic children, young adults and adults who have learning difficulties. They do not want our sympathy; there is no need—they are getting on with their lives very well, thank you. What they need is our empathy and understanding. They may require extra help when accessing toilet facilities or a parking space for the family car close to the shops. These people look perfectly normal, whatever “normal” may be. They can walk, but some days they may not want to walk for whatever reason. Those are times when Grace’s sign would explain to the ordinary person that they need the extra space or help to ensure that they can get on with their lives.

Many people with mental health issues struggle to access public amenities at times. Their condition may fluctuate greatly, and that group of people would also benefit from Grace’s sign, to remind others that sometimes they need extra time or space when they are out and about.

I have been contacted by Jonathan Kingsley from Muscular Dystrophy UK, who reminded me that although some people with one of the 60 types of this muscle-wasting disease may be able to walk, they cannot walk far. Their ability to walk may fluctuate on a day-to-day basis, so they need to be able to park close to amenities. People with muscular dystrophy may not use a stick or wheelchair, but they cannot walk far and may require assistance when using public toilets. Again, Grace’s sign would remind the general public that people do not use disabled parking spaces or toilets unless they need to.

Sometimes people just need reminding to stop and think. They are not necessarily being unkind. Indeed, they may think they are protecting the person with genuine additional needs and stopping people using facilities inappropriately. They genuinely want to help people with disabilities, but they need to be gently reminded that not all disabilities are visible.

I hope that Members now have a better awareness of the nature of invisible disabilities. I call on the Minister to ensure that we work together on a cross-party basis to get this sign developed and implemented, perhaps at some pilot sites to start with. Ultimately, we need a sign that is universally recognised, to help the general public to better understand invisible disabilities and thus ensure that our society becomes more considerate and compassionate to all its members.

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It is a pleasure to follow the hon. Member for Newport West (Ruth Jones). I thank her and the hon. Member for East Lothian (Martin Whitfield) for securing this very important debate.

People are often quick to form perceptions and slow to establish facts. For example, the young person not rising to give their elder a seat may in reality have a life-changing condition that genuinely prevents them from affording such a courtesy. Bowel and bladder cancer patients or persons with inflammatory bowel conditions may have undergone major surgery and be living with a stoma and discreetly concealed bag. The complexities of emptying and changing the bag in a sterile environment are difficult enough out in the community, without persons giving them the evil eye or, worse still, berating them for using an accessible toilet. Those with chronic obstructive pulmonary disease may not be at the stage of carrying an oxygen cylinder around with them, but they may nevertheless be unable to use a downstairs or upstairs toilet, opting for the accessible toilet on their level.

In 2017, the BBC’s “Newsbeat” ran an article on new signage appearing on accessible—formerly disabled—toilets, which read simply, “Not every disability is visible.” That is a fact; not every disability is visible. At that time, Tottenham Hotspur were reported to be the first football club to feature a revised sign on their accessible toilets. Two years later, I have not observed many such signs bearing that important additional information. Charities such as Crohn’s and Colitis UK are lending their support to have the more informative signs fitted. That would not be an immense cost to many organisations in the United Kingdom and it would be a kindly thing to do for those who need a bit of extra help.

“Can’t wait!” toilet cards have been available for some time to those with incontinence. When discreetly exhibited, the card confirms to others that the holder has a medical condition and needs to use the toilet urgently. That may mean using the accessible toilet, if the other toilets are occupied or there are queues. Those who daily face the fears and stresses associated with their conditions’ symptoms and side effects from treatment should not have to face the potential additional burden of confrontation from ill-informed and often wicked, thoughtless protagonists who believe that they know better.

There is a wider issue: the availability of public toilets in general. Such facilities are on the decline throughout the UK due to financial cuts, inappropriate use by substance abusers or needless vandalism. I have had constituents contacting my office to express concern that they are becoming not quite housebound, but limited in the activities they are able to undertake outwith their homes as a result of the closure of public toilets. Their confidence is affected and there is a risk of social isolation evolving. I think that the closure of toilets is something that applies throughout the UK. We do not really realise that there are invisible victims of these closures. I was a councillor for 10 years and, yes, I too carry the burden of responsibility for being part of the closure programme in South Ayrshire.

Groups such as Inclusion Scotland work to achieve positive changes to policy and practice so that disabled people are fully included throughout all Scottish society, as they should be, as equal citizens. The Disability Rights Commission seeks to ensure that people are aware of their rights. The Government have undoubtedly enhanced legal protection under the Equality Act 2010, which was mentioned earlier. They have expanded their disability sector champions scheme, continue to roll-out their Disability Confident scheme, have announced their inclusive transport strategy and are consulting on a change to English building regulations relative to Changing Places toilets for those with profound disabilities.

However, at a time of concerns over social isolation, for those with the illnesses I have touched on, it is the basic quality of everyday life that must be our immediate focus. Will the theory of the Government policies address the real and practical issues of not being, as people say, caught short, or of having to face the indignity of being refused the use of a facility or challenged in doing so, as it was so eloquently put by the hon. Member for East Lothian?

For the most part, I believe it is the able-bodied across the United Kingdom who require to be re-educated. We must as a Government be proactive in putting the message out there. I ask the Minister to consider how the Government could facilitate such important improvements for those living with invisible disabilities. As has been said, improved signage would be a start and it is low cost. The Government could work together with devolved Governments, local authorities, recognised charities and transport groups to ensure, where possible, that toilet facilities are provided and are accessible to all.

If I may, I will take a moment not to berate bus companies, which give a good service, but to point out that there are terminuses—a point of departure and a point of arrival—where there is no toilet facility. I will simply name Ayr bus station, but I am sure there are such bus stations throughout the length and breadth of the United Kingdom. Is it not important for people to have access to a toilet on boarding the bus and that on their arrival they can be confident of finding access to an accessible toilet? I ask local transport groups, such as the Strathclyde Partnership for Transport, to ensure that this goes on and I plead with bus station operators to go—dare I say it?—the extra mile for their customers.

For the wider community, I have a simple thought: be kind and thoughtful towards accessible toilet users as they may have invisible disabilities and accessibility challenges.

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I congratulate my hon. Friend the Member for East Lothian (Martin Whitfield) on securing this debate. It is an important issue. It is a shame that the Chamber is so empty again because every Member of this place will have constituents who have hidden disabilities. I also congratulate my hon. Friend the Member for Newport West (Ruth Jones) on her speech. She clearly has some relevant experience that she is bringing to this place.

I am pleased to be able to take part in the debate because I believe that the issue of hidden disabilities can have an immense impact on individuals’ lives. It is something we do not speak about enough in the Chamber. As some hon. Members may know from my contribution in a Westminster Hall earlier this year, my wife has an invisible condition—fibromyalgia—so I am well aware of how some of these conditions can be very hard to deal with. She can look perfectly okay on the outside, but she is really suffering on the inside. Fatigue can wipe out fibromyalgia sufferers for days at a time, and the pain experienced can vary from aching muscles and painful joints to extreme tenderness all over. There are cognitive challenges too, such as brain fog, insomnia and disturbed sleep. In fact, there are so many symptoms, it is not possible to list them all here. Just as with many of the conditions we have heard about today, the outside world cannot see that there is any issue at all.

My wife, like many others, has tried to find ways to manage her condition. She has to pace herself, plan ahead and make adjustments to keep her symptoms under control. That is the only way in which she can manage her condition. She does not always succeed—it still catches her out. It is incredibly frustrating and tough to know how best to help and improve things, which is why I, along with others, have called for greater awareness of the condition by the medical profession and employers so that fibromyalgia sufferers are not disadvantaged by more than their symptoms, and so that they have support out there in the world.

In common with many people with invisible, long-term and fluctuating conditions, what matters most to people with fibromyalgia is how their condition is treated and supported. Much more research is needed on the condition and how it begins. We need consistent treatment pathways and better training for medical professionals to recognise those symptoms and recommend treatment. There is a huge need for services to be put in place to support and enable people with invisible conditions to live their lives as fully as possible.

I should like to discuss the barriers that people with invisible conditions face in their everyday life, beginning with getting back to work. I recently spoke in a Westminster Hall debate on another invisible condition, arthritis. An estimated 16,000 people in my constituency live with back pain. Another 4,000 and 8,000 people respectively are estimated to live with hip and knee conditions. Those are just some of the estimated 17.8 million people who live with arthritis or related conditions across the country. About half of them live with pain every day. That is a staggering number of people coping in their everyday lives, while people around them are blissfully unaware of their suffering. Just because we cannot see their pain does not mean that it should be ignored or written off as just how it is.

As with fibromyalgia, the problems that people with arthritic conditions face are exacerbated by the fact that they can fluctuate in severity, leaving them unsure how well they will be able to cope from day to day. That can make it difficult to hold down a regular job, but that should not be used as cover for discrimination. Many people with arthritis want to work and can do so if the right support is in place. Such help is available through the Access to Work scheme, but that is not working as well as it should, as various arthritis charities have said. They are also calling for the Government to commission research on the meaning of “reasonable adjustments”, and for support to be put in place to help people who challenge employers who do not act on Access to Work recommendations. Employers, as we know, are obliged to make reasonable adjustments but, if someone is in work and not a member of a trade union, who will argue the case for them?

There was a Westminster Hall debate yesterday on trade union access to workplaces My hon. Friend the Member for Warrington South (Faisal Rashid) has introduced a private Member’s Bill on the issue, as some well-known employers have actively sought to prevent trade unions from accessing workplaces by banning visits or by manipulating shift patterns to prevent opportunities for engagement. It is important that we do as much as we can to ensure that people have access to trade unions at work so that they can be adequately represented. Rights are only as good as our ability to enforce them.

To return to employment opportunities for people with invisible conditions, on a practical level, how easy is it for them to raise issues associated with their condition at a job interview, or when they begin work? It is a difficult conversation to have because, although discrimination is unlawful, that does not mean that it does not happen or that it is not a difficult subject to raise at the beginning of an employment relationship. If an employer refuses to make adjustments, how realistic is it to expect people to take them to tribunal, especially without support, and what reassurance can we give them that if they raise those issues and put their head above the parapet it will not rebound negatively on them?

I want to say a few words about the challenges of employment for people with autism. In a recent survey of over 2,000 autistic adults, just over half of respondents said that they had told their current or most recent employer that they were autistic, but just under a third had not. For people with autism, busy workplaces can be socially overwhelming, or they can overload them with too much information from noisy conversation, bright lights or other sensory stimuli. Many of these barriers can be overcome quickly, easily and cheaply through increased understanding. We recently had some training here in Parliament on autism awareness—I certainly found it valuable. We can also make simple adaptations to the environment. Sadly, at the moment the National Autistic Society reports that about a third of its respondents said that support or adjustments made by their current or most recent employer, both in relation to sensory needs and to autism generally, were poor or very poor. We need to ensure that access to work is working effectively for autistic people and that specialist support is available throughout the country.

What about those with invisible conditions who are not well enough to work? We have talked about this issue many times, but my constituents’ experience of work capability assessments has not been good. Many decisions are overturned at tribunal and it seems to me that the system does not learn from its mistakes. A constituent of mine with two conditions I have already mentioned, arthritis and fibromyalgia, was assessed five times in eight years. At each assessment she was found fit to work. On each occasion she appealed and on each occasion she won the appeal. How can the process be wrong so many times? How can that waste of public money on five separate occasions be justified when the final decision has been the same every time? What does that say about the Government’s approach to people with long-term conditions? How many times does someone actually have to prove that they are not fit to work before it is accepted?

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My hon. Friend is making a very powerful speech, particularly in relation to the work capability assessment. Is he aware that sanctions are more likely for people with invisible health conditions? This is a real issue that needs to be addressed.

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I thank my hon. Friend for her intervention. From my experience in the constituency, those with mental health issues in particular sometimes have real difficulty engaging in the process. That does, very unfairly, lead to sanctions.

Some constituents have raised concerns about the speed at which assessments are carried out and the fact that assessors do not listen to the answers given. Others have had their request for a home assessment refused, despite medical evidence being provided that they are necessary. I am thinking, in particular, of one of my constituents who has an invisible condition but was refused a home assessment. That condition was agoraphobia. Surely the need for a home assessment in those circumstances was obvious? People who enter the system deserve compassion, respect and support. They should not be made to feel that they are on trial because they are ill. I am afraid that that is the experience of so many people who come to see me about the assessments.

I want to say a few words on accessible toilets. I recently met a constituent who has a stoma, which, as I am sure Members are aware, is where the bowel is diverted through the abdomen so that bodily waste can be collected in a stoma bag. Stoma surgery is often used to treat a number of invisible illnesses, including cancer, Crohn’s disease, colitis and diverticulitis. People of all ages are affected and have additional needs—for example, when using a toilet. But, as their condition is hidden, they often, as we have heard, face prejudice. There are no accurate figures on the number of people with stomas in the UK, but estimates range from 120,000 to 150,000. A lifestyle survey by Colostomy UK in 2016 of over 1,300 people with stomas found that 19% had experienced discrimination, either in the workplace, in public or elsewhere, and 30% of respondents had been challenged or criticised for using an accessible toilet. A constituent I met last week is actively campaigning in my local area, raising awareness of the needs of people with stomas. This has included encouraging local businesses and organisations to change the signage, so that accessible toilets are able to reflect the hidden nature of conditions. We have accessible toilets here in Parliament, which have signs to remind us that not every disability is visible. I see no reason every disabled toilet could not have accessible toilet signage along the same lines.

People with a stoma have additional needs when using the toilet, which can make even a simple day trip to the shops or the supermarket extremely stressful. A few easy-to-implement changes to accessible toilets would make a huge difference to people living with a stoma: ensuring that every toilet has a hook on the door to hang clothing, handbags and luggage while changing stoma bags; a shelf to spread out the items they need; a mirror to allow users to see their stoma while changing; and a disposal bin in every cubicle to avoid embarrassment for men and women having to dispose of their stoma bag in public view. I do not see why those changes cannot be implemented across the whole country.

Many people have conditions or disabilities that affect their everyday lives and they are disadvantaged by barriers in society and in the workplace. It is incumbent on all of us to do what we can to remove barriers that restrict opportunities and choices for people with disabilities, invisible or otherwise. We need to ensure that no one is held back because of these conditions, not just because we know that fairer societies are better for us all, but because everyone deserves to be treated with dignity and respect.

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It is a pleasure to follow the hon. Member for Ellesmere Port and Neston (Justin Madders). I thank the hon. Member for East Lothian (Martin Whitfield) for securing this really important debate and for giving us the opportunity to discuss the issues that are faced by and raised by our constituents, who have disabilities both visible and invisible, which can be a barrier to their independence.

One barrier to independence should not be travel. The disability charity, Scope, in its report, “Independent. Confident. Connected.” found that 40% of disabled people often experience issues or difficulties when travelling by train in the UK, but there has been progress in transport accessibility in recent years, driven in no small part by the Equality Act 2010. However, I would like to touch on a number of issues that disabled or impaired residents of Cheadle still face. These issues remain a real concern and I would like to see them addressed.

We are all keen to encourage people out of cars and on to public transport. It is really important that public transport recognises invisible and visible disabilities and makes the accommodations that need to be made for people to travel. Cheadle Hulme in my constituency is an important station on the rail corridor from Stoke-on-Trent and Crewe to Manchester Piccadilly, and it is well used by commuters travelling to and from my constituency for work or leisure. The construction and completion of lifts and a footbridge with funding from the Access for All programme is very much welcome, but several wheelchair users have encountered issues with the station’s disabled access and particularly the lift, which is active only until quarter to 9 in the evening, even though trains continue beyond that time. That is an important issue for people who have disabilities. Because of it, one constituent had to get off at Stockport station and get a taxi to Cheadle Hulme, which is a journey of four miles. Another—this was a really terrible experience for him—had to carry his disabled daughter and luggage down the station stairs because the lift cannot be in use 24 hours a day, as it relies on the station being manned.

I recognise that all transport companies, such as Northern, seek to address these issues and provide help for those who need assistance, but that help is often not well known about by passengers or the service is not consistent enough to adapt to the needs of disabled people. I am pleased, however, that Northern is actively looking at how to address this issue and is undertaking a pilot at another station using technology so that lifts can be monitored remotely. It is important to know that there are ways to address all these issues. Whether a person has a visible or invisible impairment or need, these issues can be addressed.

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The hon. Lady’s point is entirely valid, because Northern has proposed to remove guards from trains. That makes the accessibility problem even more difficult, particularly given the number of unstaffed stations on the Northern network.

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I thank the hon. Gentleman for that intervention. I agree that we need to make sure that we have the right safety measures in place on all our trains, but my point is about the accessibility when people arrive at stations and the issues that they may have if a lift is not working. Clearly, we would not want a person to have to carry their disabled child up and down stairs.

Seven thousand people in the UK rely on an assistance dog to help with practical tasks and to go about their daily lives. For many people, the first and only visible sign of their invisible illness is their dog. I recently discussed this issue with Lynne from my constituency and I was distressed to hear the effect it has had on her. She was refused access to a taxi because the driver did not want the dog in her car. She suffers from regular epileptic seizures. She looks no different from any other person, but she is accompanied by her assistance dog, who can detect when she is about to have a seizure. I was amazed to hear that humans emit a specific odour that some dogs can recognise, which means they can warn their owner of an oncoming seizure, sometimes a significant period in advance, to allow them to find a safe place and get the assistance they need. My constituent was left waiting in the pouring rain for 30 minutes for another taxi after being refused passage. The taxi would not accept her assistance dog as a passenger. She reports that sometimes taxis arrive, see her dog and move on or refuse to pick her up.

Businesses such as private hire taxi firms are a vital transport service for people suffering with physical or mental conditions—they enable them to get about—and they need to be made aware of the legislation protecting people with assistance dogs. It is a concern that not enough licensing authorities require drivers to complete disability awareness and equality training, and this should include people who have disabilities that are visible and those that are not.

I am encouraged that in response to the task and finish group report, which investigated the issue, Ministers have stated that they intend to include new guidance for licensing authorities. Under the Equality Act 2010, taxi and minicab drivers cannot refuse a booking on the grounds that someone has an assistance dog accompanying them. I appreciate that in some circumstances they may not be able to have dogs as passengers in their cars—for example, if they are allergic—but that is why the legislation allows for drivers to carry certificates of exemption.

Customers must be aware of this, however, when booking a taxi so that they are not left literally out in the cold. I would like all taxi drivers to complete disability awareness and equality training so that they know they should report discrimination. We also need to take action against drivers who discriminate against disabled passengers so that experiences such as those of my constituent do not continue. This is not about forcing new regulations on business; it is about reinforcing current legislation to protect disabled people.

Like epilepsy, bowel disease is also an invisible illness. While someone may appear to look okay on the outside, they might suffer from an invisible illness such as Crohn’s or colitis and might urgently need to use a toilet when out and about.

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I know I have just arrived in the debate, but I would like to pick up the hon. Lady’s point about Crohn’s and colitis. A close member of my family was diagnosed a few years ago with colitis, and their struggle to find public toilets and amenities and have it recognised has been a huge challenge. Does she agree that we need to raise awareness of those invisible diseases?

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The hon. Lady knows from her own family experience how important this is and how seriously we need to address it. People who suffer from illnesses such as Crohn’s and colitis might urgently need to use the toilet when out and about, and we need to ensure they can and that they are accessible. It is a major anxiety for people that stops them or prevents them from going out and about. Sometimes people have to think long and hard about their journey because of the impact it might have if they need to use a toilet urgently. That is why the roll-out of accessibility signage is so important. It needs to be addressed and people need to be made aware of it. I would like this to be a bigger issue that is taken on board by more and more shops, retailers and restaurants.

A “Can’t Wait!” card is available to people with hidden illnesses—bowel disease, and so on—that they can show to staff at restaurants and shops without having to give a long explanation about their condition. In many cases, people find this embarrassing to talk about to strangers. That is the whole point of doing something about it. Some retailers are part of the “Can’t Wait!” card scheme and recognise it, but a lot of independent businesses do not, and the wider knowledge and encouragement of such schemes is needed, alongside the roll-out of more accessible signage. I would be grateful if the Minister informed the House in his closing remarks what more the Department can do to encourage businesses to recognise these schemes. Whether or not someone is disabled, their ability to go about their daily life without hindrance is a right, and one that we must ensure is respected.

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It is a pleasure to speak in this debate. I am grateful to each and every one of the Members on both sides of the House who have spoken so far, but I am particularly grateful to the hon. Member for East Lothian (Martin Whitfield) for initiating this Back-Bench business debate. While—sadly—there is not much in the way of business going on in the House, I think it absolutely right that a debate of such importance take place on the Floor of the House rather than in Westminster Hall, as is so often the case.

I also thank the hon. Member for East Lothian for his passionate words about Grace and her mum Judith, and their campaign in respect of Grace’s son. In too many cases, younger and younger people are experiencing disability. The fact that across Scotland a sign can be seen saying “Not all disabilities are visible” is encouraging to many people who now feel that their disabilities are recognised.

I am grateful for the opportunity to speak up for many of my constituents who face hardship, extra costs and discrimination owing to invisible disabilities or illnesses. It is extremely important for us to recognise in this place that invisible disabilities can have a powerful impact on people’s lives and livelihoods. I think that that has been recognised throughout today’s debate, but we need to ensure that such conditions are fully recognised and respected in everyday society and the workplace. As we heard from the hon. Member for Chatham and Aylesford (Tracey Crouch), celebrating disability in sport is just one example of the ways in which we can ensure that society as a whole recognises the abilities that many people have, while also having a disability. The way in which society views disabilities such as dementia, Parkinson’s and autism often contributes greatly to people’s experiences of disability, and can also be stressful for the parents of young children.

There are many misconceptions about what a disabled person is “supposed” to look like, but many disabilities do not present themselves in an obvious physical way. That includes physical health conditions and neurological and mental health issues. My hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) told us that her own husband had suffered a head injury. That is another disability that is not seen every day, and I commend my hon. Friend for sharing her experience with the House.

Recently, in this place, I have been making the case that invisible conditions such as fibromyalgia and arthritis do not receive the recognition, the attention or the levels of support that they deserve. The Minister is probably tired of hearing the same voices arguing the case, but I think that Government Departments could do more to recognise not just fibromyalgia and arthritis but all the illnesses, diseases and symptoms that are not currently recognised within the departmental framework.

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I congratulate the hon. Member for East Lothian (Martin Whitfield) on initiating the debate.

ME is another of the invisible conditions that are not receiving enough recognition. I understand that the Minister and I are to meet in an couple of weeks to discuss this very issue, but does my hon. Friend agree that such invisible conditions are often not recognised in work capability assessments? Some sort of indicator would be helpful in those circumstances.

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I wholeheartedly agree with my hon. Friend. As the Minister knows, I have highlighted that issue time and again during Westminster Hall debates in relation to ME, fibromyalgia, arthritis and other lesser-known illnesses. The hon. Member for Ellesmere Port and Neston (Justin Madders) gave his own personal account, speaking passionately, on behalf of his wife, about fibromyalgia.

What has not been covered so far today, although I assumed that we might hear about it at some point, is the fact that conditions such as anxiety and depression are also deeply misunderstood, although they are often as disabling as a physical illness. Those invisible illnesses exemplify the way in which conditions without obvious symptoms can escape the untrained eye while wreaking havoc on people’s lives, but that, too, has not been recognised by the Department for Work and Pensions.

Anxiety and depression are not easy conditions to talk about, and many men suffer quietly with symptoms because they are too afraid to speak up. I think it incumbent on everyone in the House to speak up themselves, and to ensure that people know that it is okay to ask for help. That is because, sadly, the stigma that still exists around too many illnesses can make it very distressing to have to explain and justify the additional needs to loved ones or family members, never mind employers. I know from personal experience of losing a loved one to mental ill health that it is essential that these people have the recognition and support that they deserve, because I would hate to see more people lose their lives unnecessarily.

I have also recently tried to highlight how the cuts to disability benefits by this Government are making it more difficult for disabled people to live independently and with dignity. I see the Minister roll his eyes and I appreciate that he is just one of many Ministers who have taken on this departmental responsibility and I have every sympathy as he has a large ship to steer in the right direction, but the fact of the matter is that the DWP has failed to recognise many of the disabilities today, and if we are going to sit in this House and debate the subject it is only right that we address concerns about things that reside in Government Departments.

Many diagnosed with disability and a persistent long-term health condition can be empowered and enabled to seek the support they require to live a fulfilling and long life, but the reality is that there are higher costs to living with a disability. Many are unable to work, and the difficulties they face in navigating the welfare system can be seen in all our casework. Whether the Minister is willing to acknowledge that is another matter, but it is a simple fact that if we went to any case officer in any constituency we would hear the same problems. Disabled people face overall higher costs than non-disabled people, and the cuts to their income can be devastating because they often do not have savings; they do not have a fall-back. Many do not have a support system, so what does the Minister propose they do if the last people they can turn to are this state and this Government and they are not getting the support they need? The bottom line is that shaking our head and saying it is not the case is simply not good enough. We perhaps only hear the worst of cases, but if we are just hearing some of the worst cases I dread to think how many other people do not come to us, do not know how to be advocates for themselves, and do not know how to get the support they need. I dread to think how they experience the DWP service.

Where there is a gap that is supposed to be plugged by benefits such as the personal independence payment, people instead face the blatant discrimination of a disability assessment. Is it really right that someone should face a panel of people and a medical practitioner to prove an already diagnosed medical condition? Is it really necessary when they have a diagnosed medical condition to then further prove that medical condition to other health practitioners who are often not as qualified as those who made the original diagnosis?

The system is not working for people who need help, and that is because of the ideology of this austerity-driven Government. They are ultimately cutting on the backs of the poor. In 2016 the Government introduced regulations which specifically excluded people with psychological conditions from receiving higher points in PIP assessments. I appreciate that that was not under the Minister’s stewardship, but consecutive Ministers who have had responsibility for this area have failed to address these systemic issues.

It took a defeat in the courts for the DWP to overturn this practice. Is it right that public money should be spent trying to defend the indefensible? That demonstrates the direction of the Government, their perspective on disabled people, and their contempt for their additional needs. The DWP looks at the needs of disabled people at arms’ length, with assessments contracted to a private company.

While I appreciate that some of the assessors are highly skilled medical professionals who have the empathy required to work in a clinical setting, this is not always the case. Numerous constituents have complained to me of assessors who did not understand their illness and who could not imagine how difficult life is on a bad day with fibromyalgia or depression. They were simply not listened to, and the report they received simply did not reflect their experience of the assessment. Assessors are simply not trained in spotting these illnesses, and that is reflected in the points awarded in their assessment reports. The result is that people in genuine need either have to put up and shut up or they challenge the outcome through a gruelling mandatory reconsideration and appeals process. The very fact that the outcomes are often overturned at that stage implies that there is a systemic problem with the system. This is a flawed system that needs to be reviewed urgently, and I urge the Minister to take that action.

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My hon. Friend is making an excellent point about PIP assessments. Epilepsy Scotland says that 77% of those who appealed when they lost out on their PIP won on appeal. The DWP denied PIP to over 53% of people living with epilepsy who had previously had DLA, so this absolutely bears out my hon. Friend’s point that those with particular conditions such as epilepsy are not being well served by the system.

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I wholeheartedly agree. Fundamentally, this is all I want the Minister to take home today. I genuinely want us to be able to work cross-party across the House to get this right, because this is not simply about levelling this at the Government. We all have a responsibility to make the system work better.

As the Minister knows, I am a member of the Women and Equalities Committee, and we have consistently argued that more can be done to support disabled people. I think he would agree that there is always more that we could do within the built environment to support those with a disability. It is often not the disability itself that disabling; it is the built environment and the structures within society that disable the individual.

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Is it not the case that the Scottish Government had the opportunity to recreate a Scottish social security system? The hon. Lady has spent some time berating the current system, yet the opportunity was gifted to the Scottish Government, as it should have been, through devolution.

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The hon. Gentleman knows fine well that there is a Scottish social security service, and the approval ratings and general success of the implementation of that system provide evidence that where this is done correctly and with an ethos of integrity and respect, it works far better than an interrogative system that implies that people must prove that they are disabled. Frankly, I would expect more from the hon. Gentleman, who often makes the case in this House that it is the responsibility of the Scottish Government and Scottish taxpayers to mitigate this Conservative Government’s austerity measures. He knows that that is an inconceivable and ridiculous notion.

Once more, I call on the Government to define specifically what “reasonable adjustments” are, because too many employers are unable to provide the level of support required because “reasonable adjustments” have not been exactly defined. For that matter, the Equality Act 2010 is often not being enforced, particularly across Government Departments and in outside bodies that are accountable to the Government. There is more that the Minister can do to ensure that the Equality Act works for people and that the definition of “reasonable adjustments” is clear so that employers can support people.

We need to have a shift in the way we look at disability in this country. We should commend the companies and employers who are making the changes needed to help disabled people to continue into work, but we also need to ensure that the people who require welfare support are actually receiving it and not being excluded owing to processes that are not fit for purpose. The Minister has heard me make these asks several times, and I know that he is probably tired of hearing me make them, but I urge him to speak to his colleagues across the Departments —specifically, given his remit, to the Department for Work and Pensions—and to champion reforms with those disabilities in mind. If the true measure of a society can be found in how it treats its weakest members, right now we are coming up short. So, before yet another reshuffle and yet another Prime Minister, I urge this Minister to make a lasting impact and improve the lives of disabled people.

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This has been a fantastic, high-quality debate. It is a shame that the attendance was a bit—[Interruption.] Yes, it is quality over quantity, which is what we tend to find at the moment. Perhaps other things are going on and focusing minds elsewhere. I would like to begin by thanking my hon. Friends the Members for East Lothian (Martin Whitfield) and for Newport West (Ruth Jones) for securing the debate and for their excellent and passionate opening speeches. They both mentioned Grace and her “have a heart” campaign. That is a fantastic example of a lived experience-led campaign, and they are often the most powerful and successful. I join my hon. Friends in commending Grace and her campaign, which I wish widespread success.

At this juncture, I also want to mention the Changing Places campaign, which I have been involved with in my constituency on behalf of a constituent whose son has spina bifida. I was shocked to find out how few facilities there are across my constituency; no doubt the same applies to all constituencies.

I thank all hon. Members who have taken part today, including the hon. Members for Chatham and Aylesford (Tracey Crouch) and for Ayr, Carrick and Cumnock (Bill Grant)—[Interruption.] I am going to crucify all these constituency names with my Geordie accent. I also thank my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders)—I just about managed that one—and the hon. Member for Cheadle (Mary Robinson), as well as the hon. Member for Lanark and Hamilton East (Angela Crawley), who spoke for the SNP. I thank them all for their excellent speeches.

Members may have noticed that I am not a Department for Work and Pensions shadow Minister—I am shadow Public Health Minister—but I am happy to be closing this debate on behalf of my hon. Friend the Member for Battersea (Marsha De Cordova). I do chair the all-party parliamentary group on dyslexia and other specific learning difficulties. Those are also, of course, invisible disabilities; I shall come back to that aspect later.

As we have heard, in the last census, one in five people in the UK reported having a disability or limiting long-term health condition. The vast majority of disabled people have hidden impairments not immediately obvious to others—neurodiversity, Crohn’s disease, colitis, dementia, arthritis, or mental distress and energy impairment conditions such as myalgic encephalomyelitis, or ME, and chronic fatigue syndrome, to name but a few.

According to Scope, nearly half the British public are not aware that they even know someone who has a disability. People with invisible impairments face attitudinal barriers in every part of their lives, from accessing public toilets to using disabled parking bays, but I will concentrate mainly on education, access to social security and employment.

People with invisible disabilities often face significant exclusion and stigma in education. For example, the lack of awareness of autism in schools affects autistic students at every level. As a result, fewer than half of children and young people on the autism spectrum say that they are happy in education. SEND provisions are woefully inadequate and have been devastated by brutal cuts to our schools and sixth forms, worth £2 billion per year.

What assessment has the Minister made of the impact funding cuts have on children with autism and their ability to stay in mainstream schools? The issue is about accessibility and access to the curriculum. Autistic children are sometimes forced to wait for more than a year for the SEND support that they need, and just one in 10 parents is satisfied by the education, health and care plan for their child. As I know, children with dyslexia and other specific learning difficulties experience that, too: my son is severely dyslexic, and as I mentioned earlier, I am the chair of the APPG on dyslexia and other specific learning difficulties.

Earlier this year, our group released a report entitled “The Human Cost of Dyslexia—the emotional and psychological impact of poorly supported dyslexia”. It outlined the ways in which missed or poorly supported dyslexia during education has made such children feel stupid, unvalued by society, guilty—as if the problem was their fault—and disinterested in education. The implications can lead to under-achievement at every level of education, in careers and work life thereafter and, at the extreme end, to disengagement from society. That is reflected in the fact that there are proportionately more people with dyslexia in the criminal justice system than among the general population. The same can be said for a number of SEND conditions.

Unfortunately, the issues faced by people with invisible disabilities during childhood do not disappear but actually worsen in adulthood. The employment gap between disabled people and non-disabled people is 30.1 percentage points and has remained just above 30 percentage points for the past decade. This is something that the last Labour Government were trying to tackle. We had the Valuing People Now partnership boards—before he had to dash to a meeting, my hon. Friend the Member for Gateshead (Ian Mearns) told me that he chaired the successful board in Gateshead—but, sadly, the coalition Government scrapped them in 2012. Three years later, in 2015, the Government pledged to halve the disability employment gap to 15 percentage points. [Interruption.] The Minister is getting frustrated.

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Does the hon. Lady not welcome the fact that just short of 1 million more disabled people were in work in the past five years alone and that for the first time ever, which I emphasise, more than half of disabled people are now in work? We have made significant progress. There is much, much more to do, but we are in a significantly better position than we were in 2010.

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I am sure the Minister will be making all those points in his contribution.

The Government pledged to halve the disabled employment gap to 15 percentage points in 2015, but the 2017 Conservative manifesto set a new target to get an extra 1 million disabled people into work by 2027, which is a much downgraded commitment. If that is not the case, will the Minister please clarify the Government’s target and update us on the progress on closing the employment gap? The National Audit Office released a damning report concluding that the DWP lacks any clear measures to support disabled people into work. [Interruption.] It is about accessibility. I cannot see how it is not about this debate.

What will the Government do to ensure that clear measures are put in place to support disabled people, including those with invisible disabilities, into work? A recent TUC survey found that more than two thirds of respondents say there is more stigma for disabled people when their impairment cannot be seen by others in the workplace.

For example, people with autism often face significant stigma and difficulty in work. According to the National Autistic Society, just 16% of autistic adults are in full-time employment, compared with 80% of non-disabled people who are in work in the UK. The vast majority of autistic people face a hostile environment in the labour market, and there is an appalling lack of understanding of autism among jobcentre staff, disability employment advisers and some employers. The same goes for the police and the criminal justice system, which can lead to autistic people being wrongfully arrested when their only crime is being autistic. What will the Government do to ensure better understanding of autism across society?

The Government’s Disability Confident scheme lacks any credible performance measures to ensure that employers support disabled people into work, and it is possible to reach level 3 accreditation without actually employing a single disabled person. Is that something the Government will review?

People with fibromyalgia, which as we have heard is an invisible disability affecting up to 1 million people in the UK, also fall victim to barriers in the labour market. Under this Government, fibromyalgia sufferers face a lack of proper understanding of their condition, as we heard from my hon. Friend the Member for Ellesmere Port and Neston, as well as a lack of vital in-work support. Only 63% of people with musculoskeletal conditions are in work, with many forced out of work by the difficulties of daily life due to their invisible disability.

The Access to Work scheme could play a vital part in ensuring that employers provide valuable reasonable adjustments in the workplace for people with invisible disabilities. However, a survey conducted by Versus Arthritis found that just 59% of respondents with conditions such as fibromyalgia and only 41% of employers are aware of the scheme. What steps can the Minister take to ensure that employers are aware of the scheme and to encourage take-up?

As we have heard during the debate, assessments for PIP, employment and support allowance and universal credit are failing people with invisible impairments such as mental health problems and mental distress. The Time to Change campaign has reported that 90% of people with mental distress have experienced stigma, including in employment and in accessing social security support. The current assessment framework fundamentally discriminates against people with mental distress, and I am sure that we will all have constituents who have experienced this and felt overwhelmed by the process. The process begins with an arduous written assessment, which is 34 pages long in the case of PIP. That is followed by the collation of medical evidence, which can involve travelling extensively, liaising with different health services and facing huge expense. Finally, there is an often invalidating and often humiliating face-to-face assessment.

In 2013, an upper tribunal panel said that the design of the work capability assessment substantially disadvantaged mental health claimants, as it relied upon the self-reporting of a disability. In 2017, the Government changed the eligibility criteria for the PIP mobility component, to exclude certain people undertaking journeys who are facing “overwhelming psychological distress”. These changes, which were ruled to be unlawfully discriminatory by a High Court and which will take years to complete, prove, once again, the DWP’s shocking disregard for people with mental distress. Some 220,000 people are owed back payments by the DWP, but thus far the Government have only reviewed 10% of cases. When does the Minister expect to have reviewed all these cases?

It is clear from this debate that people with invisible disabilities face stigma in all areas of their lives. That is due not only to the chronic lack of knowledge and awareness of invisible disabilities across society, but to the Government’s cruel loopholes that discriminate against people with invisible disabilities. I hope that the Minister will take on board everything he has heard today. I know he probably is not happy with what he has heard from me, but there we are.

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It is a real pleasure to respond to this proactive and constructive debate. Until the last two, the majority of speakers stuck to the spirit of this incredibly important subject, and I know that people worked incredibly hard to get this vital debate secured through the Backbench Business Committee. First, I say to the hon. Member for East Lothian (Martin Whitfield), “Yes, yes and yes.” How about that? There are not many debates in which a Minister can just totally and whole- heartedly agree.

I had a stroke of luck, because on Saturday a Red Box was dispatched to my house. We knew this debate was coming up, so a 3,500-word draft speech was prepared and there was a lot of briefing on what subjects would be covered. I thought that the best thing to do was to pop the kettle on, have a cup of tea and look at something else first. As I did so, I found an invitation to a meeting of the all-party group on this very subject on Tuesday. As a matter of luck, I was therefore able to attend a brilliant meeting to discuss exactly what would be coming forward. I had further luck, as the various areas of priority for us were then connected to three further meetings I had later in the week, prior to this debate, and I will be covering all those in a little more detail.

There is a huge amount of respect for the hon. Gentleman, who has built a brilliant reputation in this area for a long time, both in his role before he came to the House and in the House. He is widely respected and he is right to recognise the progress that has been made since the Equality Act 2010. I pay tribute to the Labour party for its work in that area. Our Government has rightly continued, as I am sure all future Governments will, to work with stakeholders to build on that incredibly important step, which does make a real difference.

The hon. Gentleman is right to highlight that we need to improve awareness. He talked about how 93% of people who challenge feel that they are doing the right thing because they want to stand up for those who are marginalised in society, and I am acutely aware of that point. This was summed up by an incident I saw where someone with a disabled autistic daughter parked in a disabled parking space, with a blue badge, yet received abuse.

It was not a one-off—I am sure it happens all over the place. On that stat—93% of people would challenge someone—they probably feel that they are doing the right thing, but because of the lack of awareness and the additional challenges of hidden disabilities, society is creating awkwardness and putting people off and that is affecting people’s lives.

I shall come shortly to Grace, the inspiration, but first let me whizz through some of the excellent speeches and respond to them directly. My hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) has done brilliant work, both in her constituency with the partnership board and in her former role as everybody’s favourite sports Minister. When I was previously a disability Minister, we worked together carefully to push organisations such as the Premier League, which was, to its credit, very proactive. Richard Scudamore, the departing chief executive, took a personal interest in improving disability access in premier league stadiums. I could not have asked for more support from the sports Minister in that policy area.

My hon. Friend was absolutely right to highlight the importance of the Special Olympics. The point that I really picked up on was just how happy people are—in all the visits in my 19 years as an MP, a Minister and a councillor, nothing has come close to the joy that I saw when I went to a learning disability netball session. I literally thought that the young adults were going to explode with excitement. I am glad that my hon. Friend also took the time to highlight the work of my hon. Friend the Member for Daventry (Chris Heaton-Harris), who has done a huge amount in this policy area.

The hon. Member for Newport West (Ruth Jones) has made a good impression since her recent arrival in the House, from which we are all benefiting. This is the second debate to which she has contributed and I have responded. She brings real-life experience in this area, particularly in respect of strokes, and it was really important to highlight that. She reminds us how important it is that we do this because some people will need extra time and space. That is crucial.

My hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant) led a brilliant Westminster Hall debate just a few weeks ago and carried on today in the same form. Not every disability is visible. He was right to highlight that there is not an immense cost to making a real difference in this policy area. That came through in many speeches, and I will cover it in more detail later.

Through the direct experiences of his wife, the hon. Member for Ellesmere Port and Neston (Justin Madders) raised some incredibly important points about access to work and sanctions. He has raised them before in other debates and he always raises them in a constructive manner. I want to try to keep to the spirit of the debate, so I offer him a personal meeting so that we can explore the issues in more detail and do them justice.

My hon. Friend the Member for Cheadle (Mary Robinson) was absolutely right to highlight the challenges in respect of public transport, an area on which she has worked tirelessly. She also raised the issue of assistance dogs, on which British Guide Dogs has been one of the best and most visible campaigning charities, particularly in respect of the misunderstanding of what taxi drivers should or should not do and how we can tighten things up through licensing. My hon. Friend was also right to highlight the brilliance of medical dogs that can smell certain conditions—it is the equivalent of detecting one particle in a swimming pool, which is absolutely amazing. What a difference we can also make in the retail environment, which I will cover a little later.

Perhaps the hon. Members for Washington and Sunderland West (Mrs Hodgson) and for Lanark and Hamilton East (Angela Crawley) did not quite follow the spirit of the debate—that is one of the challenges when one arrives with a pre-written speech. I gently say to them that we are spending £55 billion a year on supporting those with long-term health conditions and disabilities. That is a record amount and is up £10 billion. Only 16% of DLA claimants had the highest rate of support, compared with 32% of those on PIP. Disability employment is at a record high: in respect of our target of 1 million by 2027, we are at 440,000 after two years. As I said in an intervention earlier, for the first time we have more disabled people in work than not in work. There is still more to do, though, specifically for people with autism in jobcentres. I am grateful for the work of Autism Alliance UK, which helped to create the autism toolkit. In the spirit of the debate, I am happy to meet both Members to discuss all those issues in detail, but will keep to the theme—

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Let me keep to the spirit of the debate.

This debate has happened because of Grace Warnock, a truly inspirational superstar who had a fantastic teacher, who can take some credit for starting this brilliant journey. She is an amazing young person dealing with the challenges of Crohn’s disease. She was targeted with abuse because of her hidden disability. Understandably, many people, including many of us, would have shied away. I am sure that, day in, day out, people are shying away, but she stood her ground and she has made a difference. We should all celebrate her courage. I am very proud that she was awarded the Prime Minister’s Points of Light award in 2018—the very least that we can collectively do to celebrate her brilliance. It is absolutely right that her energy, enthusiasm and ideas are used to drive us forward.

Sense sent us all a briefing in which it summed up why we should listen carefully to Grace. It said that many public facilities are not currently fully accessible. Many people have multiple complex and/or invisible disabilities and require greater support and accessibility in order to access the local community, but these facilities are often not provided. Change could include the invisible disability sign, greater Changing Places provisions, improved accessible public transport and greater staff awareness for people working in public places. Greater provision of such facilities would lead to better inclusion and help to improve attitudes towards disabled people. Every one of us in this place would agree with every word of that.

That brings me to the all-party group meeting that I attended only yesterday. It was fantastic to see such cross-party support and some really impressive individuals making a difference in an area which, as the hon. Member for East Lothian rightly highlighted, is complex. We all agree that we want Grace’s sign to be a stepping stone to improved signage that is internationally recognised but, as ever, it is not simple. Everything in the political environment takes a little bit longer than perhaps we would like. To get international recognition of a new symbol involves a process with various stages from the initial proposals, through to consensus building, public consultation and publication. It can take a number of years, but that does ensure that, when it is done, it is done properly and is of long standing.

In our country, the British Standards Institution, the UK national standards body, in effect audits and approves something before it is considered by the International Organization for Standardization. The APPG gave an update and a presentation on the work that is being done and I was thrilled that the BSI was fully involved and fully supportive. It is right to highlight those people, beyond the MPs on the APPG, who have done so much work. Lucy Richards, the designer, has taken on Grace’s idea to international stellar levels. I was incredibly impressed by that. Having run a marketing company, it gave me a warm glow to remember the joys of looking at designs. There has been support from Life Changes through Anna Buchan, who provided the funding needed to carry out that extensive work. I should also mention user experts such as Dr Gordon Hayward, Steve Milton and Robert Turpin from the BSI. We had all the movers and shakers making sure that this has been fully road tested, so that when we are ready to take it to the international standards organisation it will tick all of the boxes. I thank the hon. Member for Newport West (Ruth Jones), the right hon. Member for Broxtowe (Anna Soubry), the hon. Member for Rhondda (Chris Bryant) and my hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant), who were all present and supportive of that vital work. I will do everything that I can to support that going forward.

I did say that I was lucky with the other meetings that came up. This week, I met various sector champions who are helping to represent all of us to challenge those particular areas to do more and to highlight best practice. The first of those was retail sector champion Samantha Sen. Many of the speakers today have talked about the importance of getting it right in retail. That highlights the fact that this is a win, win. This is not just for those with hidden disabilities. If retailers can get it right, they can access the combined spending power of disabled people, which stands at £249 billion—those 13 million disabled people have considerable spending power.

Seventy-five per cent. of disabled people and their families have left a shop because of poor customer service. I do not believe that there is a single retailer who wakes up in the morning and says, “I want to turn away business.” I do not think that, on any of our visits, we have ever had a retailer saying, “I have too much business. Please do less.” I had the pleasure this morning of speaking at and opening the Retail Forum, at which many of the leading retailers and estate owners—including British Land and the Crown Estate—were present. They absolutely buy into this. They have a real appetite for sharing best practice. It is being channelled through the Purple Tuesday campaign, which many MPs support. On 12 November, we will have a genuine focus on this issue. When they set that up, they expected 70 retailers to be involved; it was actually over 700, and this year they expect it to be over 900. That is making a difference in retail and I commend all those retailers for being so engaged.

I also met Stephen Brookes, who is our transport sector champion. Many people will have worked with him on his brilliant work to tackle disability hate crime, which made a real difference to the Government’s way of going forward. He has real expertise; he initially started with the challenges on the Blackpool buses and spread out to rail and buses across the whole country. Part of the way through our conversation—this was amazing—I said I had been to an all-party parliamentary group that was beginning to look at how we can improve signage. I said, “One of the things I would like you to do is to meet the members of the APPG to give your expertise.” He said, “I have got something to show you. I have seen a sign that is amazing,” and he brought out the sign that had been presented at the all-party parliamentary group. He has confirmed that he would be delighted to support the APPG’s work. That will build on the Government’s new inclusive transport strategy to create a transport system that provides equal access for disabled people by 2030. That is a really important area, because disabled people should be able to travel confidently, easily and without extra cost.

Stephen Brookes reassured me that, over the last three years, there has been a complete shift, particularly with the rail companies and providers such as Network Rail. Any of their major improvements now have to go through their built environment access panel, for which there is a pan-disability group, to make sure they get things right for everyone and that they get them right at the beginning—it is a lot easier to do that then than it is to retrospectively fix things. I was encouraged that so many providers have understood the importance of this issue.

I also met Andrew Miller, who is our arts and culture sector champion. He, again, talked about the huge progress that is being made in our cultural venues and our live music venues. I pay tribute to Attitudes is Everything, one of my favourite charities, which makes live music venues accessible. When I was first a disability Minister, and I insisted on having a picture of Attitudes is Everything, my officials airbrushed out the pint glasses some of its members were enjoying as part of their evening entertainment, saying that that probably was not right for a ministerial wall. I got that corrected and the picture was put back in place.

I understand the importance of this issue, given that my first graduate job was as a nightclub manager. Interruption.] There are not many who could say that. [Interruption.] Mr Deputy Speaker has suggested that that was maybe because I liked dancing; actually, I was probably a manager because I was not very good at dancing. Andrew Miller and I talked in detail about what more all these venues, which an individual may visit only once or twice, could do. Many now put a lot of additional information up in advance on their websites so that users can check. What disabled users do not want to do is travel all the way to a venue and be left red faced when the facilities are not accessible.

I had a look at a website, which looked, in theory, like it was following good practice. It talked about free admission for carers or helpers; free loan of a wheelchair or motorised scooter; providing a personalised guiding scheme for unaccompanied disabled people, as long as it was booked in advance; subtitled video and large print being available; low-level counters; the induction loop system; and guide, hearing and assistance dogs being welcome. However, there was not a single point of contact, and probably the most important thing that any retailer or leisure provider can do is make it crystal clear that there is one. Those with disabilities do not fit into a neat box—everybody has their own unique challenges —and being able to talk things through and knowing where to go if there is a problem can make a real difference. It can also benefit facilities, which can then tap those 13 million customers with their £249 billion.

Finally, I met Huw Edwards, who is our physical activity and leisure sector champion. As my hon. Friend the Member for Chatham and Aylesford highlighted the importance of sport, I pay tribute to Sport England for doing lots more to focus on opportunities for those with disabilities, recognising the importance of sport and physical activity for disabled people through the Sporting Future strategy. I welcome the fact that we are seeing increases in activity. Again, there is still lots more to do, but it is right that we promote opportunities and share best practice. So many want to do more but need this information.

As I initially indicated with my triple yes, I am keen to do everything I can, as quickly as possible, to get this. I was blown away yesterday when I saw the designs and the right balance of the imagery, dealing with all the competing demands across the pan-disability spectrum and getting more detail with the words. I think this will make a real difference. As was said, not all things have to cost a huge amount of money. On this issue, everybody will do everything they can to make sure that Grace’s brave stand really does make a difference, not just in the UK but internationally.

It has been a real pleasure to take part in such a constructive and positive debate. Parliament is at its best today.

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It is right to say that we have seen Parliament at its best today. There are many distractions—shall we call them?—that take up political time. I know that Members from all parts of the House are doing other work today. Nevertheless, over 50 Members from across the whole House supported the application for this Backbench Business debate. It is right that the message should go out from here today that this is a cross-party ask and a cross-party right. I go back to the discussion about symbols: it is a symbol of how important this place feels our disabled community are, because they are an essential part of our society and we are stronger for them.

I thank all the Members who spoke and intervened. I finish with the words of the hon. Member for Ayr, Carrick and Cumnock (Bill Grant)—my hon. Friend— although not the ones he may think I will finish on. He said that this is the kind thing to do. As Grace said, it is about letting people have a heart about our whole society.

Question put and agreed to.

Resolved,

That this House has considered invisible disabilities and accessibility challenges.