Tuesday 16 July 2019
[Mr Clive Betts in the Chair]
I beg to move,
That this House has considered defence spending.
It is a pleasure to lead this important debate on defence spending, and to serve under your chairmanship, Mr Betts. I thank the Backbench Business Committee for granting us time to discuss the funding of our nation’s defence at a time when our world is more unstable than ever and detractors wish the western liberal way of life and our values harm.
It is rare for us to be able to discuss money in this place. Today, we must consider what value we place on our nation’s defence, how the huge sums of money allocated to it are used, the interconnectivity of the Foreign Office’s assessment of global instability, our world-class military tacticians’ understanding of how we can protect our citizens and allies, and what we need to have in place to do so. We need to understand why projecting our cultural and economic values and ethos, and promoting Britain’s and our allies’ economic stability and prosperity, is vital.
The question is: is a percentage figure the way to judge whether we are investing enough? We need to look ourselves in the eye and ask why there is so little appetite among politicians to invest properly in defence spending. The issue is simply not in our postbags. The NHS is now in receipt of a huge extra budget of £20 billion a year by 2024. The Prime Minister agreed to such an enormous increase because it was clear from the hundreds of colleagues who spoke up on the matter that their constituents had too much unmet need and that resources needed to be increased. We needed to address old age—that great success story of the NHS—and mental ill health, because we want a healthy and happy population, and we now realise that it makes economic sense. In wishing to improve the lives of our constituents, the Government assessed that a step change in funding was required.
Defence, on the other hand, does not feature in our postbags. Commanding officers are not allowed to talk to MPs about the problems they are experiencing, including a lack of investment in the sites that they manage and resources to support their serving personnel, who have no choice about their location and environment. There is no mechanism to share concerns about kit provision or whether we will be able to sustain a long conflict. Due to secrecy or national security, the politicians who should be speaking up about whether more investment in defence is needed have too few facts to assess the reality of the situation.
I congratulate the hon. Lady on securing the debate. Does she agree that this is about not just how much money is spent, but where it is spent? The national picture is one thing, but there are huge regional disparities in defence spending. For example, it is just £60 per head in Yorkshire, compared with more than £900 in the south-west. That obviously has a huge impact on the jobs that are supported in the defence industry.
I thank the hon. Lady for that point. It is important to look at how we spend that investment for UK prosperity. The hon. Member for Plymouth, Sutton and Devonport (Luke Pollard) is nodding—he is thrilled that the south-west is doing particularly well out of the regional disparities. I agree that we need to think about how the funding is allocated.
In the busy life of a constituency MP, it is often too easy to assume that all must be well in our defence investment. Surely no Government would fail to meet their first duty of governing—to protect their people. When budgetary constraints are imposed, our military leaders cannot talk directly to MPs to tell them whether funding is getting to the frontline or into the investment paths that they need to deliver what we ask of them.
I congratulate the hon. Lady on securing the debate. I want to make a technical point about defence spend. We can spend now to save later, but I draw a distinction between capital spend and revenue spend. Everything I have looked at on defence spending in my short two years here suggests that the Ministry of Defence is not being very clever. Going down the capital route, rather than the revenue route, would be much more efficient in the longer term.
The hon. Gentleman pre-empts some of what I am going to talk about. He is absolutely right.
Our doctors and nurses tell us directly and bluntly if the funding systems for the NHS are not working properly so we can do something about it and advocate for them. However, that is not an option for our defence chiefs, so it is hard for us to know whether their resources would be sustainable and resilient if there were a major crisis. The question is not only whether enough funding is going into our defences but whether we are spending it correctly—a narrative that ran successfully after the strategic defence and security review in 2010, when the country was in dire financial straits and the former Member for Whitney had the unenviable challenge of trying to put it back on to a stable financial footing. SDSR ’10 declared—conveniently, perhaps, to match the financial crisis—that the Ministry of Defence, like other Departments, had to find efficiencies. There is no question but that that was the right thing to do.
First, I resent the use of the word “efficiencies”. Basically, that is Treasury speak for cuts, and it would not face up to that. Secondly, the hon. Lady is clearly under a misapprehension: the country was on a very steady path to reducing the deficit. Owing to the crash-and-burn tactics of Mr George Osborne, we went into a recession, which lessened the revenue coming in, deepened the crisis and worsened the deficit.
As ever, the right hon. Gentleman is a great defender of his party’s financial position. I would not choose to pick a fight with him, because he is a staunch defender of all matters defence.
I agree with my right hon. Friend the Member for Warley (John Spellar) on the use of the word “efficiency”. It is a fact—there is no reason to hide from it—that the Conservatives in the coalition Government cut the defence budget by 16%.
I thank the right hon. Gentleman for his comments.
The challenge is that the premise of SDSR ’10 was not just financial; it was that there was no longer an existential threat to the UK. It said that Russia was no longer a nation that we had to watch and fear. That has turned out to be a false premise, if it was ever anything other than an excuse to reduce defence spending. We were told that, owing to the sudden outbreak of global neighbourliness, we could return our Army from Germany. The freedom to move safely around international waters was assured because the middle east had become stable and unthreatening to the 20% of the UK’s energy requirements that travels by sea through the strait of Hormuz, so a reduction in the size of the ageing fleet was a perfectly sensible idea. Global airspace was going to be full of fluffy clouds and rays of sunshine, so there would be less need to patrol the skies or deliver force from the air to those who wish our allies harm, and we could reduce the number of airframes we would need. All that has, perhaps not surprisingly, turned out to be a false premise.
The Government seemed to make a conscious choice conveniently to forget that new equipment, recruitment and high-tech training takes time and money if we are to maintain our military advantage by having the best and most advanced equipment with the best-trained men and women in the world. I am afraid that SDSR ’10 was allowed to set out that false premise due to financial pressures. There was a realignment, as those in post realised that the position that was set out was not right. The work done for SDSR ’15 started to assess more honestly the instabilities across the globe and their risks to UK safety and prosperity, but the cash needed did not follow that strategic assessment.
It is a pleasure to see the Minister for the Armed Forces in his place; it is not him whom I challenge, but our Treasury Ministers. The pertinent question is, after setting out what was eventually understood to be required to meet minimum security risks in SDSR ’15, why have we not funded it properly to get the outputs that we know we need? We must be able to look our constituents in the eye and promise them that we can defend them. This is about not just the level of GDP that we use to invest in a larger force, but whether we are meeting future need.
In SDSR ’10, the MOD declared that we should reduce RAF aircraft numbers substantially while pushing forward with the aircraft carrier class of warship, but by SDSR ’15, those decisions had evidently proved incompatible, given that we need to increase aircraft numbers once again. We need to think holistically about transformation—the time it takes, the training requirements to achieve it and the best value-for-money methodology for doing it. As the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) said, that is the invest-to-save model, and the Treasury needs to help the Department. Short-term decisions for annualised cash-flow rules simply do not work for our defence programme and produce an output that meets our defence needs or our value-for-money rules.
The hon. Lady is making an excellent speech, and I congratulate her on securing this debate. Her point about through-life costs is very powerful. Does she agree that there should be more scrutiny—possibly independent—of the increase to the overall cost of projects caused by changes early in the cycle? I am, of course, thinking of the decision to delay the vote on renewing the deterrent submarines, which has added a significant amount of risk and cost to the project. Many of us said that to the Government at the time, but there was no ability to assess independently what the increased costs would be.
The hon. Gentleman’s point is well made. I will refer to submarines later. We need to challenge the Department continually on whether Committees such as the Defence Committee and the Public Accounts Committee, on which I sit, have the tools to look pre-emptively at the risks of those sorts of decisions.
There is also a mantra that technology is changing how we do everything and that it will, as if by magic, solve all challenges. It is implied that it will make everything cheaper, and that we can stop doing things the old way because there will be a whizzy, less manpower-hungry solution. Although it is true that world-leading UK defence businesses are creating extraordinary cutting-edge kit, that is not the only tool for solving our defence challenges. From Florence Nightingale and her medical advances to Alan Turing, the urgent need to gain advantage over the enemy has always brought out the brilliance of our citizens’ inventive genes. Defence has always been at the forefront of innovation because defence in action stretches human ingenuity under the insane pressures of war.
I congratulate the hon. Lady on her excellent speech. However, for industry to be able to respond, there needs to be an industry. That requires the British armed forces and the Treasury to put orders into British factories and British yards, rather than applying a model of international competition that takes no account of the prosperity agenda and no account of the long-term sustainability of the defence industry and its ability to innovate.
That question of sovereignty and the prosperity agenda—the third pillar of defence’s remit—is one we need to continue to challenge. As a Brexiteer, I am happy to say that I think we will have more authority to speak in how we choose to do that—
That’s not true.
Well, that is my opinion. Leaving the EU will give us more flexibility to bring the various parties together and will enable UK businesses, which are world leading, to make their case as effectively as possible.
The hon. Lady should not allow herself to be misled by Treasury-speak. In both European regulations and the Treasury Green Book, the Ministry of Defence has all the tools it needs to support British industry. The problem is a lack of will. It does not help to blame the EU. The problems are in Whitehall, not in Brussels.
I thank the right hon. Gentleman. The Minister will have heard his perspective.
One of the key issues for defence is its people, who are flexible, selfless, uncomplaining and serve willingly—indeed, alongside the Minister, who puts his life on the line to serve his country. Equipment changes constantly—if it did not, we would still be sending our Navy to sea under sail—but the quality of our people is always critical. We spend more than a third of our defence budget on people. I say that that is an investment, since they are highly trained and we invest in their training throughout their careers, in a way almost no other employer does. However, we classify them as a cost, so departmental behaviour fails to look after them—our human capital—as assets.
We would not fail to repaint a warship—clearly, that would make her less seaworthy or less capable of dealing with the scars of battle—yet we are perfectly content to fail to invest in the personnel who serve, by not looking after their families and by failing to demonstrate what the armed forces covenant should mean: that if someone has served or is serving, this country genuinely thinks they and their family should not suffer disadvantage. It is imperative that we change the financial models the MOD is allowed to use so that our human capital can be classified as an asset. Service chiefs cannot determine how to reward their personnel, because they are not allowed to use their budgets freely to maximise the benefit to their people and their service. For small change—in both senses of the word—the behavioural changes achieved by flexibility would be substantial and immediate.
I believe the reason change is not happening is that the Department and the Treasury fail to understand the nature of military preparedness, and do not seem to question our resilience if we need to put our military under pressure. Although we put kit that is small, plentiful, cheap and speedy to resource on to the soldier, we put highly skilled men and women, who take years to train, into equipment in the Royal Navy and the RAF that takes years to build. A modern warship or fast jet cannot be whipped up in a few months. It is at the mercy of international supply chains, the risks of which, as the right hon. Member for Warley (John Spellar) mentioned, perhaps are not properly understood.
Importantly, that equipment would take a long time to replace if lost. Although bullets for small arms can be produced at speed if necessary, the missiles sustaining our warships and Air Force cannot be churned through a production line at speed if they are suddenly required. Training a submarine commanding officer or fast jet pilot takes years of investment—it takes time. Too often, it feels like the Department’s financial models simply refuse to acknowledge that and fail to understand the human capital investment that is being made, leaving us with huge risk from poorly assessed decisions.
We must consider the key tenets of successful defence and assess whether we are investing enough to sustain them. The first is deterrence. Deterrence works. Nuclear is the ultimate deterrent, but we must never forget that conventional deterrence has greater utility and that strong power generates respect. Let us consider for a moment our nuclear deterrent in its 50th year in our Royal Navy. Our continuous at-sea deterrent is an extraordinary feat. I always refer to it as our best weapon of peace, because the threat of nuclear war has ensured that we have had no more global wars. Humanity understands genuine existential threat, and the CASD is the embodiment of the UK and USA’s global policing, which reminds any rogue state why using a nuclear weapon would be a bad decision. But do we invest properly in our submarine service?
The hon. Gentleman shakes his head violently. I have talked about the CASD repeatedly in the House since I was elected in 2015. It strikes me as bizarre that the long-term nature of that critical weapon of peace is stuck in a funding framework that stubbornly refuses to allow long-term planning and flexible funding. All credit to the former Secretary of State for Defence, my right hon. Friend the Member for South Staffordshire (Gavin Williamson), for persuading the Treasury last year to bring forward £600 million of funding—not additional funding but simply to reduce future financial risk—to assist in making efficient decisions to move the Dreadnought programme forward a little more effectively. Deferred cost is always increased cost. I speak as an accountant who has done this many times.
The money the hon. Lady refers to was already in the contingency budget. Does she agree that the delay under the coalition Government in making a decision to build the Dreadnought class of submarines not only delayed the programme but added cost to it?
I agree completely. Deferred cost will always be increased cost in such big projects. We need more financial flexibility to get better value for money. Why did we have to battle so hard last year to get the Treasury to move on that £600 million? Why is the Treasury not doing its long-term cash-flow thinking in a rational way? If we are going to keep the CASD—there is overwhelming support for that across the House and the nation—it would make financial sense to allow a multi-year rolling financial commitment so Ministers can make rational decisions.
The hon. Lady is making a superb case. Is there not a case for going so far as to make good on the commitments, which have been made at various points of the successor programme but then conveniently forgotten when there have been changes of personnel, to properly insulate the programme and remove it from the conventional defence budget? That would allow it to be managed as a proper long-term national endeavour capital commitment, rather than being subject to the in-year in and out of defence spending on other programmes.
I completely agree. Both I and the hon. Gentleman have pushed that campaign. I would not dare to suggest that I want another general election in a hurry, but we attempted to put that in the Conservative manifesto at the last election to bring about a change. I will continue to do that as and when the appropriate moment arises.
The hon. Gentleman is absolutely right: the MOD is not like any other Department of State. It has these 20-year programmes, which should be funded in a different way—a more intelligent and stable way. We need to get the Treasury to hear us and realise that the financial models need to be separate so that, exactly as he says, those programmes are treated as national endeavours. In the same way we funded Crossrail through a separate fund so it could roll forward as effectively as possible, despite the often challenging technical issues as we create state-of-the-art kit, we should give those working on these programmes the best financial framework to work within.
The hon. Lady is making a very effective case for multi-year spending and the need to reappraise entirely the Green Book principles. Does she agree that, in this instance, the restrictions on multi-year spending for programmes—particularly the Type 26—put at risk our sovereign capabilities, such as the electric motors factory in Rugby, which manufactures critical components for anti-submarine frigates? That may have been lost had the MOD not responded. We cannot continue to fight a war of attrition; we need a strategic approach.
I completely agree. We must continue to hammer home the importance of sovereign capability and work with industry to build opportunities. I say again, despite the criticism of the right hon. Member for Warley, that there will be opportunities once we have left the European Union to think more coherently than we have before—I think we have chosen not to do that—and for us parliamentarians to challenge the system more aggressively on the question of what sovereign capability should look like in the long term. Getting our shipbuilding strategy right will be critical to ensuring that we have throughput of work and know that, if we get into times of crisis, we have the supply chain we need within our borders.
Some time ago in her speech, the hon. Lady mentioned the Army covenant. I am sure she agrees it is vital that the covenant is implemented in full to servicemen and women in Northern Ireland. Doing so may cost a little more money, but the benefit to those people suffering from post-traumatic stress and mental health issues far outstretches that.
I absolutely agree. In my role as chairman of the all-party parliamentary group on the armed forces covenant, I have spent some time in Northern Ireland, where we have some real challenges at the grassroots level—not the political level—to try to help those who need day-to-day support to look after themselves. I have met some extraordinary women and extraordinary wives—I take the opportunity to say they are extraordinary—who are looking after very damaged former soldiers, some of whom are the hon. Gentleman’s constituents. They deserve all credit.
The world is not a safer place, and while the nature of warfare may be changing, at the end of the day we need to be able to reach wherever the threat is, bearing in mind that, as my son always reminds me, five sevenths of the globe are covered in water. Ships are therefore a critical tool, and our shipbuilding strategy must reflect the importance we play as a United Kingdom, and a critical part of NATO.
The key point is that presence is influence, and with influence come positive outcomes. We cannot do deterrence if we are not there. We saw that demonstrated in stark images on our TV screens last week when HMS Montrose in the strait of Hormuz assured the safe passage of a BP tanker, protecting it from the insurgent threat of Iranian military attack. If Montrose had not been there, I dread to think what might have happened. Freedom of navigation around the world’s seas and oceans is critical to our economy: 95% of all our imports come by sea, and it is NATO’s navies that keep the sea lanes open for commercial traffic. We would all be very cross indeed and notice quickly if Felixstowe or Dover were shut down by enemy attack. In the same way, just because we cannot see the huge areas of oceans from which our goods and energy are being brought to us, that does not mean we should forget that we need to police those waters, too.
What the hon. Lady is saying about the Royal Navy is music to my ears. I look forward to participating in the armed forces scheme next year.
The F-35 is a splendid aircraft that I fully support us buying from the Americans, but the bitter fact is that, as we all know, we will never own all the intellectual property of that aircraft. We will never know exactly how it works because of security aspects. Why should the Americans tell us? That is one reason why keeping manufacture here in the British Isles as much as we can is crucial. Only if we make it, or do so in partnership with others, will we know everything there is to know, with that information being secure.
The hon. Gentleman’s point is well made.
The question today is defence spending. Let me therefore share with the House the assessment the Public Accounts Committee made of the latest equipment plan:
“In May 2018 we reported that the Ministry of Defence…did not have enough money to buy and support the equipment it needs.”
Bear in mind that buying is 50% and supporting is 50%. Our report continued:
“the Department has made little progress, continuing to delay the difficult decisions needed to make the Equipment Plan…affordable, particularly around which programmes to stop, delay or scale back. It now estimates a most likely affordability gap…of £7 billion across its Plan… It also estimates that the gap could widen to £14.8 billion, but even this looks to be unlikely and overly optimistic. The escalating and continuing affordability issues have led to short-term decision making which has only worsened the longer-term affordability risks.”
We continue to watch that on the Public Accounts Committee, but the sense of anxiety just builds as we keep seeing a lack of change in policy frameworks. Instability across the globe is increasing, so if we do not build the equipment we need to achieve our SDSR ’15 goals, let alone what those in SDSR ’20 might look like, we will simply not be able to meet politicians’ requirements.
Politics is about making choices and we need to think carefully about this one. Our military will always offer their political masters choices and solutions as required, but they may have to bend themselves out of shape with collateral damage, gaps and risks elsewhere in order to do so. I do not believe that we can expect them to do so if we, the politicians, do not give them the funds they need to meet at least the SDSR ’15 asks. If we do not show confidence in our military personnel with, in the scheme of things, a very small amount of cash investment in human capital, which is utterly vital to success in warfare, we will continue to lose too many people who have been willing to commit their lives to defending us and our families.
We must not leave our armed forces with the impossible decision of robbing Peter to pay Paul. Short-term decisions on finances can have long-term implications on recruitment, retention and equipment capability and availability. Defence is an insurance policy, so if we get our deterrence right, it stops wars and attacks on us or our allies. That is success, but it costs to achieve that, and it is invisible. No soldiers on our TV screens battling in the desert does not mean that we are not maintaining a global presence to deter those who would wish us and our allies harm. Military personnel are defending us and our way of life invisibly 24 hours a day.
We all have house insurance not because we expect our homes to burn down, but because a roof over our family’s head is so important that we plan to protect ourselves just in case. Our armed forces are our nation’s “just in case.” I worry about how our political leaders sleep soundly at night thinking that we have only a budget insurance policy and hoping that we will never have to claim on it. The budget is large at £40 billion a year, but, without the right decisions and an acceptance that that is not quite enough for what is needed to keep us all safe, the shortfall in funding and financial frameworks leaves us horribly exposed to unknown threats.
We must bring the defence budget up at least to the point where the political ambitions set out in our own SDSRs are matched by the funding for our military experts to deliver those for us. To do that, I estimate we need an increase of some £4 billion a year to the budget and, equally importantly, flexibility to fund long-term projects intelligently for best value and speediest output. It cannot be right that we allow our military personnel to be put at greater risk than they need to be by failing to invest properly in our Army, Navy and Air Force.
I do not mind if the Treasury wants to invest more because it is morally the right thing to do to ensure we can protect our people, our trade and our allies, or simply because it is the right financial method to make better use of taxpayers’ money over the long term to get real value for money. If the financial models set out in the Green Book do not deliver that, we should change them so that they do.
We are in charge of our country’s destiny and we can set the framework to maximise the positive outcomes for this great nation of ours, which is respected around the world for its military prowess and its people. I thank the Minister for his loyal support of our armed forces, and I hope that the Treasury is listening.
Order. There are slightly more speakers than we had anticipated, so I will introduce a time limit of three minutes to try to get everyone in. We may have a squeeze at the end if people do not follow that.
There is one thing the Conservative party is, and that is consistent. Its Members call for more defence expenditure while in opposition, and when they come into power they cut defence expenditure. In 2010, defence was not immune from austerity and the budget was cut by 16%. The smokescreen the Government put up—that they had inherited a £38 billion black hole in the defence budget—was complete and utter nonsense.
Will the right hon. Gentleman give way?
No, I will let others make their speeches.
Ministers kept repeating that claim. I kept asking them about it, but never got an explanation. I think it came from a National Audit Office report from 2009 that said that if the equipment budget was flat over the next 10 years, that might get us to £36 billion; if it rose with inflation, it would be about £6 billion in the defence capital budget. The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) was talking about the two budgets conflated.
We then saw slash and burn, with stupid decisions such as the scrapping of Nimrod and the Harriers, vicious cuts made to people’s pay, and redundancies. That led us to a situation where we have an Army that, at 82,000 personnel, is the smallest it has ever been. No one has yet explained to me how that figure was set.
We are told that the defence budget is rising, but the foundations are shaky. If we look at the 2015 SDSR, we see a huge amount of it is based on billions of pounds of efficiencies that have not yet been and cannot be met. To return to the claim that Labour somehow left a £38 billion black hole, if the situation was so terrible, it is strange that two years in, the right hon. Member for Runnymede and Weybridge (Mr Hammond) eliminated it overnight.
In defence, we need honesty. There is a degree of consensus across the House on the support needed for members of our armed forces and for defence. What we need now is an honest stocktake, looking at our commitments and what we want to do in the world, and ensuring that, as the hon. Member for Berwick-upon-Tweed (Anne-Marie Trevelyan) said, we fund not just the capital side—equipment is important—but the people. I hear all the time that we can do more with more sophisticated equipment, but as any military technician will say, mass and people are still important. We must invest in them over the long term.
The hon. Gentleman can have an extra minute, because the Front-Bench spokespeople have agreed to take only five minutes, so hon. Members have four minutes each.
I always liked the Minister; he is very good.
Investment in people does not just mean balancing the in-year budget, which I suspect is what has happened. How was money taken straight out of the defence budget in 2010? It happened in two ways: by taking equipment out, as the Government did by putting a wrecking ball through the Nimrod and Harrier programmes; and by slowing the recruitment pipeline. That will lead to problems in future years as people develop and we find that we have capability gaps, not in equipment but in people’s skills, which are important.
Regarding the Conservative party’s commitment to defence expenditure, let us hope that the promises made by the two contenders to become the next Prime Minister hold water. I will support any Government who want to increase spending and, more important, invest in the people we rely on every single day for our peace and security.
In the four minutes available, I propose to make two points. First, I congratulate my hon. Friend the Member for Berwick-upon-Tweed (Anne-Marie Trevelyan) on a masterly introduction to the debate. Her timing could have been better—to secure a debate so close to the arrival of a new Prime Minister is perhaps chancing her arm. Nevertheless, if we are to get the issue in the news, we need to link it to that, so I will quote the responses of the two remaining candidates in the race to be the next Prime Minister to my letter of 26 June, which asked about their defence policies.
On 2 July, my right hon. Friend the Member for Uxbridge and South Ruislip (Boris Johnson), the former Foreign Secretary, replied:
“The armed forces have done some exceptional work of late in attempting to live within an increasingly stretched budgetary environment. I can give you an absolute commitment to fund defence fully. I believe Military spending should be dictated by the threats we face—and, it is clear that these threats have multiplied in both scale and complexity in recent years. I guarantee, of course, that we will exceed the minimum 2% NATO spending target and the Defence Budget will continue to grow at a minimum of 0.5% annually.”
On 8 July, the current Foreign Secretary replied:
“In this leadership campaign, I have given more attention to defence spending than any other candidate. I have pledged to increase the defence budget to 2.5 per cent of GDP over five years. I have argued that additional funds would need to be”—
made available, I think he means—
“for new capabilities and not simply plugging gaps in existing plans. Were I to become Prime Minister, I would consider the path of further increases in spending once the 2.5 per cent had been achieved.”
That is their position.
Will the right hon. Gentleman give way?
I had better not, because of time pressure.
Secondly, to coincide with the debate, the Defence Committee has updated its April 2016 report, “Shifting the Goalposts? Defence Expenditure and the 2% pledge”, in which we set defence spending in context. We showed that, while we spent similar amounts on education, defence and health in the mid-1980s, we now spend 2.5 times more on education than defence, and 4 times more on health.
Our latest report, which was published today—HC 2527, for those who are interested—has recalculated the figures for the last few years and brought them up to date. It shows that, in the last three years, we have spent 2.1% on defence, if we calculate it from NATO’s point of view and bring in extra things such as war pensions, which never used to count towards the total. If we exclude them, the new report shows that our like-for-like defence spending is only 1.8%. Is that credible in an age when the profile of the threats we face includes an adversarial Russia and the revival of a terrorist threat in the form of Islamist terrorism? When we compare it with the 1980s, when we regularly spent 4.5% compared with 1.8%, or 5% compared with 2.1%, we can see the shortfall.
Slightly unusually, if an hon. Member takes an intervention, I will not add on time, because that would push somebody else out at the end and they would not be able to speak.
It is good that the hon. Member for Berwick-upon-Tweed (Anne-Marie Trevelyan), who I call a friend, has secured the debate. We disagree on nearly everything except defence, so it is a good place to be.
As Devonport’s MP, I talk a lot about defence and defence spending—and rightly so, because it is the country’s largest naval base. It is home to the Type 23s with tails, which are soon to be replaced like for like by the new Type 26s; our amphibious capabilities, Albion and Bulwark, although sadly we lost the HMS Ocean due to Conservative cuts earlier in this Parliament; and the basing for the fantastic and underappreciated flag officer sea training arrangements. In Babcock, we have a refit capability that is second to none around the world; it is currently refitting HMS Vanguard and our hunter-killer class.
Devonport is also where we tie up old nuclear submarines; there are 13 awaiting spending to ensure their safe and sustainable recycling. That is why a defence spending debate is important, because those nuclear submarines—those big expensive tickets—frequently drop off the bottom of the priority list. They get left and tied up not only in Devonport but in Rosyth. That is why we need to get our defence spending level right.
The argument that I and the hon. Members for Berwick-upon-Tweed and for Dunfermline and West Fife (Douglas Chapman), who represents Rosyth, have made is that we should use a different funding mechanism to support the recycling of those submarines. We know that the defence budget does not have enough pennies in it and that there will always be a greater priority than recycling old nuclear submarines. Our cross-party argument is that, instead of putting pressure on the Minister, who already has many demands on his time and on the pennies in his budget, the civil clean-up programme that is cleaning up our civil nuclear power stations should be extended to those nuclear submarines.
We have to find a way to recycle those submarines. If we wait for the Ministry of Defence’s budget to provide the funds, I fear that we will wait as long again as we already have—many decades. The first submarine was tied up before I was born; we cannot wait that long again for it to be done sustainably. That is why we need to look at the issue carefully.
I agree with the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) on the need to value the whole-life costing and to invest to save. That is certainly what we need to do with our submarine programme and our future capabilities in naval warfare in terms of the basing arrangements.
I look forward to meeting the Under-Secretary of State for Defence, the right hon. Member for Bournemouth East (Mr Ellwood), to talk about the refit of the Stonehouse barracks as an interim measure. It is not right that when at home, not on operations, our Royal Marines are being asked to reside in blocks without hot water or decent heating. That is not acceptable to Plymouth, which is a military city that is proud of its Royal Marines, and it should not be acceptable to any hon. Member. I hope we can put cross-party pressure on Ministers.
We could go into the line-item spending on defence, but we need to start from the top. What are we trying to do with defence? Where is our strategy for it? The 2010 and 2015 strategic defence and security reviews were fronts for cuts; all hon. Members present know that, because we are the defence-focused MPs from every party. They were excuses for cuts and did not portray a decent strategic analysis of where we are as a nation or the threats against us. The hon. Member for Berwick-upon-Tweed was polite in her description of the 2010 SDSR, but we need a proper review that looks at the real threats that face us and that has a properly funded plan to address them, including long-term industrial strategies for combat air, naval procurement, autonomous marine and autonomous aerial. There is a lot to get right, and we should start with a decent strategy that enables us to look at it properly.
I congratulate my hon. Friend the Member for Berwick-upon-Tweed (Anne-Marie Trevelyan) on securing this debate and introducing it with such brio. I am delighted to see how many colleagues are present to debate these important matters.
On the defence budget, I was reassured to hear from the Chair of the Defence Committee, my right hon. Friend the Member for New Forest East (Dr Lewis), that my right hon. Friend the Member for Uxbridge and South Ruislip (Boris Johnson), who is most likely to win the leadership election, told that Committee
“I can give you an absolute commitment to fund defence fully.”
In the nicest possible way, we should bank that and endeavour to hold him to it if and when he becomes our Prime Minister.
Having been a Defence Minister—I have great respect for the Minister, as he knows—I have always believed that there is a kind of asymmetric conversation between the Ministry of Defence and the Treasury. I will exaggerate slightly for effect, but it essentially goes as follows.
The MOD view is, “Those people over the road don’t know what they’re doing. They don’t understand us. They don’t realise the relentless operational pressure that we have been under for 20 years, or the pressure on our people. They ask us to scrimp and save at every possible opportunity to make false economies that are injurious to the defence of the realm.”
The Treasury view goes something like this: “Those people across the road don’t know what they’re doing. They have £36 billion a year. They don’t manage it very well or control their contractors properly, and waste a vast amount of it on procurement programmes that go way over budget and come in years late. All they ever do is bleat like children for more money so that they can waste it on more procurement programmes that go wrong.”
Those are the asymmetric views, and the truth probably lies somewhere in the middle. If we are to deal effectively with the defence of this country, rather than that adversarial relationship, which is how I have seen it happen for so long, we have to get those two Departments to work together positively for the benefit of our country and its defence. In fairness, the MOD does have to be better at managing its budget. Some contracts are shocking and the MOD has been deficient in holding contractors to account. The military flying training system is a disaster, partly because of the unavailability of Hawk, and on that, BAE Systems needs to look to its laurels.
The Defence Infrastructure Organisation is not the most efficient part of the Ministry of Defence—the maintenance contract with Amey is awful. The other day, the DIO told the Public Accounts Committee that there was a 64% satisfaction rate, but there is not. In the armed forces continuous attitude survey, the satisfaction rate is actually 32%, which is an appalling statistic. The A400M has been an absolute procurement disaster—it is known as “the dog” by the crews that operate it at RAF Brize Norton—at a cost of £2.6 billion for aircraft with an appalling reliability rating, bad engines and gearbox, and an inability to deliver paratroops. Finally, as the Minister knows, it would be unlike me not to mention my great friends “Crapita,” whose army recruitment contract is utterly hopeless. While the number of applications goes up, the number of people joining goes down.
There is a way through this: whoever they may be, the next Defence Secretary and the next Chancellor—I wish our outgoing Chancellor the very best of luck in his posting in outer Mongolia—need to work together for the benefit of this country’s defence.
It is always a pleasure to speak in these debates. I congratulate the hon. Member for Berwick-upon-Tweed (Anne-Marie Trevelyan) on setting the scene, and thank all right hon. and hon. Members who have contributed.
Like others in this Chamber, I am massively concerned about defence spending, as every hon. Member in this place should be. We are known as a world leader, and for that to be in any way meaningful, it must follow that our defence is top class and that the men and women who wear the uniform of this great country—the United Kingdom of Great Britain and Northern Ireland—are irrefutably the best in the world. The very clear fact is that we do not do as well by them as they do by us.
We sit at the NATO target of 2% GDP for defence, but I cannot quite figure out why that figure means that we are doing okay. Some have outlined to me that while the paper trail can look like 2% GDP, the reality is very different. The Chair of the Defence Committee, the right hon. Member for New Forest East (Dr Lewis), mentioned the figure of 1.8%, which would not be in order.
Does my hon. Friend agree that when looking at historical defence expenditure, the UK’s defence spending as a percentage of GDP has been reduced by more than 50% over the last 40 years? That is a real indictment of Governments of all types and descriptions. We need to do better by our armed forces.
I would adhere to and agree with my hon. Friend’s figures.
The obligations on our armed forces are incredible. From war zones to giving aid in peace zones and every area in between, such as simply helping Commonwealth nations to do the right thing on the world stage, as we often do, our men and women are the first on the scene doing the best job, but we stretch our resources in every operation or every time we lend a hand. I put on the record that some of the other NATO countries need to make an effort to meet their obligations. Latvia, Estonia and Lithuania have met theirs, but where is Germany on its NATO contribution?
All that heaps pressure on the everyday running of the forces, on their recruitment processes, and on the training for the next generation. I am not stuck on a figure for military spending, although I would aim high, and while I understand that a bottomless budget is impossible, an adequate one is not—it is essential.
Between 2018-19 and 2019-20, defence spending is planned to increase by an annual average of 1.4% in real terms. Defence spending in 2019-20 is planned to be £1 billion more in real terms than in 2016-17. That is good news, but if that is the figure we are aiming for, will it do the business? Is it enough to ensure that our armed forces personnel have the right equipment at the right time for the battle, the right training for the situation and the right support for when the fighting is done?
At present, what I am hearing is that we simply are not there. Recruitment officials cannot afford to run high-end campaigns to attract the next generation. We do not have the funding to give new recruits the appropriate training in different situations to ensure that they are as prepared as possible. On the frontline, we are certainly lacking in top of the range and fit-for-purpose equipment.
On recruitment, the armed forces have always recruited highly in Northern Ireland, and I understand that the campaign there is going well. Will the Minister give some idea of the recruitment figures? I commend the gallant Minister for his service and for his commitment and interest. I know that when he responds, we will get a reply that we will be happy with. Are we sourcing as much equipment as possible from our own shores to support local industry? Will the Minister ensure that everyone across the United Kingdom of Great Britain and Northern Ireland benefits? We also need funding to address the mental health of veterans of all ages.
Our Navy, Air Force and Army are simply the best. We need to do better by them and that is why I support the calls for an increase in defence spending above and beyond the schedule and the target.
I congratulate my hon. Friend the Member for Berwick-upon-Tweed (Anne-Marie Trevelyan) on securing the debate. As someone who represents RNAS Culdrose in my constituency, I cannot stress enough that base’s value to our local area, to our community and to the skills and opportunities afforded to our young people and those who work there.
My hon. Friend was right to challenge us to understand the full value of defence, both of the realm and of UK plc. I do not want to repeat what has already been said, but I will touch briefly on the issue of recruitment and retention of armed forces personnel, starting with where they live and work.
I have seen for myself the standard of accommodation that we expect our armed forces personnel to live in. If we value them as we say we do, and if we want them to join and stay in the armed forces, we must find the money to improve where they live. I challenge the Minister to challenge Government on how serious they are about the climate change emergency, because the Committee on Climate Change clearly recommended an improvement of our accommodation. It is right that we challenge the Government to fund quickly the improvement and retrofitting of armed forces accommodation. That would not come out of the defence budget, but would meet our national and international commitments. Is the Minister prepared to challenge the Government on their commitment to improving the living accommodation of our servicemen and women and their families?
On the working environment, one does not have to go to many bases—I have been to a few—to see that real investment is needed in the places that our armed forces work. There has been a multimillion-pound investment in RNAS Culdrose—it is an amazing piece of work but it has taken us an extremely long time to get there. We used to have hangars that had not been useable for some time. I am pleased to see the work going on there, but I recognise that more is needed there and elsewhere. That is not an easy thing to do when also trying to provide the right kind of kit—the technical expression for our carriers and so on—but it is right that wherever our armed forces are based and work, we give them the safest and best working environment possible.
I will touch on one other area briefly. The armed forces community, as defined in the armed forces covenant, includes regular personnel, reservists and veterans, but not the merchant navy or the Royal Fleet Auxiliary Service. That is relevant to my constituency. The merchant navy is not the armed forces, but it is tough on the children. Mums and dads can be away for the entire school holidays, which will be the case for some of my constituents this summer. They can be caught up in aggressive and intimidating situations around the globe, in particular with attacks by pirates and other rogue individuals elsewhere on the planet. As a result, schools in my constituency have to handle difficult situations. That is not about defence spending, but I would like the Minister to consider whether modern-day threats and the modern-day role of the merchant navy justify including the merchant navy—such as those of my constituents who serve—in the armed forces covenant.
Thank you, Mr Betts, for calling me to speak. It is a pleasure to do so in this debate, which was ably introduced by the hon. Member for Berwick-upon-Tweed (Anne- Marie Trevelyan).
The figures are stark. Certainly in my lifetime, over the past 30 years, the defence budget has halved as a percentage of GDP. During the austerity programme in the UK over the past decade alone, it has in effect been cut by a quarter. Furthermore, looping in additional spending items such as pensions, as alluded to previously, is fanciful in the extreme as a way to save us from embarrassment by padding out the defence budget. It is certainly not reflected in operational capability, which is at the core of what the budget should be a measure of. Nor was I particularly enamoured of the claims by the possible successors to the Prime Minister of their commitment to defence spending. Even the most extravagant proposal will only return defence spending to the level under the previous Labour Government when they left office in 2010, at 2.5% of GDP. That is not a dramatic transformation of the defence budget, because even then defence faced significant resourcing challenges.
One of the biggest aspects of defence expenditure—and the measures applied to it by the Treasury—to have a deleterious effect on operational capability is multi-use and generational spending, as alluded to by the hon. Lady. That was a critical part of Sir John Parker’s report which, unfortunately, did not make it into the final national shipbuilding strategy—I wonder why. The critical piece of advice, or observation, on the failure of existing capital programmes was to do with the lack of an assured capital budget, as well as a lack of a grip on design trade-offs at an early stage in the programme. Crucially, the advice was not incorporated into the national shipbuilding strategy, and that will lead to significant increases in programme inefficiency.
The Ministry of Defence itself has calculated that an increase of 1% in the delay to programme time leads to a 0.38% increase in programme cost. Why then, for the sake of balancing the budget in year, was the Type 26 frigate programme’s drumbeat increased from 18 months to 24 months—a 33% increase? By my calculations, that leads to a baseline increase of 7% in the overall programme cost over that time. That does not include the fact that it also militated against investment in the capital infrastructure that would have delivered an upper-quartile shipbuilding industry in the UK—“upper quartile” refers to being benchmarked against other shipyards around the world. Getting our processes and methods correct—world-class—was militated against by the need to balance in-year budgets. That acted further against increased efficiency, throughput and, ultimately, combat effectiveness, and against the increased size of the Royal Navy.
That is the ultimate absurdity in the vicious cycle perpetuated by the existing funding model. That is why I welcome the Labour party’s commitment to tear up the Green Book, because it is thoroughly unfit for purpose when it comes to major defence equipment programmes. We therefore need a thorough review of how we ensure assured capital budgets for major defence procurement programmes. I hope that the Minister will allude to how the Type 26 programme’s increase from 18 to 24 months is an effective use of public money.
Also, why are this Government not invested in the upper-quartile shipbuilding facilities necessary to further maximum benefit to this country from the Type 26 programme? We have already seen its huge export success. Furthermore, the Australians and Canadians are investing in upper-quartile facilities, but the UK is not. That is a sad indictment of a failure of the investment cycle in UK defence procurement. The Government need to get a grip on that and to sort it out quickly. Moreover, Sir John Parker’s report is not reflected in the national shipbuilding strategy, and I encourage the Minister to consider that critical and glaring omission, and to incorporate it into revisions of the national shipbuilding strategy to ensure that we maximise the impact of our defence budget on operational capability.
It is a pleasure to serve under your chairmanship, Mr Betts. I join with others in paying tribute to my hon. Friend the Member for Berwick-upon-Tweed (Anne-Marie Trevelyan) not only for securing this debate but for her consistent championing of our armed forces.
It is worth putting the debate in the context of our international alliances. This year, NATO celebrated its 70th birthday. Despite discussion about its long-term future, I think that future looks bright. Since the 2004 Wales summit, non-US spending among the other member states has increased by $87 billion, and the UK’s record of consistently meeting the 2% target—although there is debate about that, which I understand—is symbolically and politically important.
NATO faces some real challenges. The UK’s spending commitments are therefore more important than ever. Given the geopolitical situation, it is no accident that Latvia, Lithuania and Estonia have been among those most keen to see their defence expenditure meet the 2% target that has already been met by the UK and US. Furthermore, as we leave the EU, 80% of NATO forces will be contributed by non-EU members. Given Brexit, however, our commitment to co-operate with our European allies must remain a key element of our strategic direction and spending.
Despite all the successes achieved as a result of British defence spending—whether our strong record of meeting our NATO target, the fact that we are the only country to meet both that target and the 0.7% on aid, or the Government’s increased support for our cyber-capabilities announced in last year’s Budget—we need to address the real financial strains faced by our armed forces, as we have rightly heard about. The Public Accounts Committee has identified a £7 billion funding gap in Ministry of Defence expenditure, which could double over the next 10 years. As hon. Members also know, the nature of defence procurement can often lead to a Catch-22, in which piecemeal spending on capital projects can cause delays and consequent increases in expenditure.
When the new Prime Minister, whomever it might be, gets his feet under the table, a real priority will be to make a clear-eyed and long-term assessment of those capital projects, with a commitment to increased defence spending. I was pleased to hear the potential new Prime Minister’s words in that respect.
As the Defence Secretary said recently, however, the value of our defence industries, supply chains and armed forces goes beyond what we think of as specifically military activities. UK defence spending provides employment right across the country, not least in my constituency. The £293 million contract signed between the MOD and Leonardo helicopters in Yeovil was welcomed across the south of my constituency, not just by Leonardo employees but by those whose companies are part of the supply chain. Beyond the purely economic, the Defence Secretary was right to highlight the role that our armed forces play in increasing social mobility, binding communities together and exemplifying those real values which they are called on to defend.
The three objectives set out in SDR ’15 remain of paramount importance: protecting our influence; projecting our global influence; and promoting our prosperity. As we take stock of whatever Brexit resolution is achieved in future, it is vital that it does not undercut either our commitment to the security frameworks that have guaranteed peace on our continent, or Britain’s ability to project its power in defence of our values and interests.
It is a real pleasure to serve under your chairmanship, Mr Betts.
I congratulate my hon. Friend the Member for Berwick-upon-Tweed (Anne-Marie Trevelyan) on securing this timely and important debate, and on her enthusiasm and support for and her commitment to our armed forces and veterans. That is fantastic.
I must respond to the remarks of the right hon. Member for North Durham (Mr Jones), whom I consider a friend, on how when Conservatives come into office we have to make some pretty tough decisions. The reason for that is very simple: every single Labour Government in history leave a mess to clear up, and we cannot defend our country if we are broke. As we regain our status as a sovereign, self-governing country—[Interruption.] I did not interrupt the hon. Gentleman, so I ask for the same respect.
It is important that the UK is both a credible partner and a reliable ally. That means that the UK has to remain a tier 1 military power. We must retain a global reach and, if necessary, a sustainable level of effort either as a coalition partner or unilaterally. To achieve that, we must be able to field top-of-the-range equipment that can go up against any near peer competitor. We must not return to the situation when we deployed troops to Iraq and Afghanistan, where our forces were nicknamed “the borrowers” because we did not have adequate funding from HM Government to deploy and protect our people on those operations. We must also understand the threats that emanate from non-state actors or terrorists who seek to undermine our way of life and denigrate our resilience by attacking our critical national infrastructure in a cyber-attack. All that requires investment and a sustainable defence budget.
In the time I have left I will focus on the benefits of defence spending to our economy. The Royal United Services Institute estimates that for every £1 spent by Government on orders in the UK defence sector, well over a third—36%—is returned to the Treasury via taxation. The UK defence industrial sector is one of the world’s strongest, with an annual turnover of £22 billion, and it supports 260,000 jobs, many of which are highly skilled and well paid. I am proud to represent a constituency that is home to many of our world-class defence manufacturers, as well as the Ministry of Defence’s defence acquisition service at Abbey Wood, which employs roughly 8,000 people.
I am passionate about social mobility and apprenticeships. The Ministry of Defence is the largest provider of apprenticeships in the country; it has enrolled 53,000 civil service and armed forces apprentices since April 2015. Over 90% of military non-commissioned personnel now gain an apprenticeship as part of their trade training and first assignment. In 2018 the UK defence sector employed 4,400 apprentices. They are crucial to develop and continue our sovereign defence capability, and to develop the skills of our military personnel so that when they go back to civilian life after their service, they have the electronic and cyber skills and all the things they could need in future. As I said, 250,000 jobs are supported, so there is a huge argument for having a sustainable, properly funded MOD when we get to the comprehensive spending review.
Most of us would agree that we should, at least, maintain our minimum commitment of 2% of GDP: most would argue it should be nearer 3% to sustain what we are trying to do on a global stage and to continue our global reach. For social mobility, apprenticeships are a vital route to provide engineers and scientists, of which we are already short, and to give employees the necessary skills for our country for the future.
It is an honour to serve under your chairmanship, Mr Betts. I congratulate my hon. Friend the Member for Berwick-upon-Tweed (Anne-Marie Trevelyan) on her passionate advocacy on all occasions and on the very valuable and insightful points that she made.
In the 1990s, we saw a supposed peace dividend. I suggest that was illusory then and, in the face of a revanchist Russia, is folly now. We live in a world of great power threats, where there are diversifying, multiple non-state actor threats, too. It is right that we invest properly in our armed forces.
We tend always to have this debate in the context of kit. I welcome the fact, as the Minister will probably remind us in due course, that we are due to see two new aircraft carriers coming on stream, and the F-35s too. Of course, we need enough to make sure that we can operate both carriers, but that may be a point for another day. I welcome the Poseidons coming on stream; the first British-marked example flew only last week. I very much value that, but we must not just see all those as expensive baubles that are signature-tick projects to show we are investing in defence. We need a holistic approach to our armed forces.
I am grateful that my hon. Friend mentioned deterrence—she is quite right—but she will realise, as I am sure most hon. Members do, that we need layered defence deterrents for them to work at all. It is no good simply relying on the nuclear deterrent, because that is devalued hugely if there are not the layers to support it. What we have done in the past is simply to salami-slice the defence budget—chop a programme here and a capability there, in order to make ends meet. That simply will not do. We need a strategic assessment of the threats we face and what kind of power we want to be: do we want to be a full-spectrum tier 1 power? If we do, we need to fund our forces appropriately for the threats we wish them to defend against.
We have to see the value of the kit beyond just the capability it provides. I always refer to the glory of the 1960s aviation industry in this country—multiple companies producing wonderful multiple aircraft—but that world simply does not exist anymore. We could buy cheap, capable kit off the shelf from the Americans. That is one philosophical approach we might take, although I do not think we should and I doubt many of us do, because we would lose our sovereign capability and investment in industry.
We have to accept, therefore, that if we want sovereign capability, it requires the Government to invest not just in money but in strategy. In the past, we have taken neither approach; we have bought a bit of kit; we have invested in some kit; we have built some kit ourselves; we have collaborated in other kit, but with no overall holistic approach. My view is unequivocal: we should have that sovereign capability for reasons of national defence and because it employs hundreds if not thousands of people in our industries. We are very good at it, and it provides the skills that our young people would like, but it requires Government investment in planning.
I very much welcome the shipbuilding and combat air strategies but, as has been referred to, we need plans for a number of other things, including autonomous capability, helicopters, transport tankers, carriers and training—there are probably others. Above all, we need the Treasury to recognise the value of defence and not the cost. I see that when representing RAF Brize Norton. It is difficult to expect bright young people to serve if they cannot get a hot shower in the middle of winter, or if they see that their accommodation is nowhere near as good as what their friends have in the private sector. Those bright young men and women do have options.
I will just make a plug with the Minister for the REEMA sites at RAF Brize Norton, which need redevelopment—I know it is not his fault. We have brownfield sites there. It is having an effect on west Oxfordshire’s housing stock and on the young men and women who serve at RAF Brize Norton. I appreciate that is not the Minister’s fault but the Treasury’s. The Treasury must see the value, not the cost. It needs to revalue the Green Book and see defence not as a cash drain but a net gain to the UK economy.
I thank my hon. Friend the Member for Berwick-upon-Tweed (Anne-Marie Trevelyan) for securing this important and most interesting debate.
It is crucial that the UK has robust and reliable combined armed forces that are well trained, properly equipped and ready to respond as required to keep our nation and its people safe and secure. That is ever more important as the threats to our nation evolve in intensity, intertwined with ongoing scientific and technological advances. Hopefully, the modernising defence programme launched in January 2018 is taking account of those somewhat fast-moving developments.
Having worked in the emergency services, I appreciate that our armed forces personnel are going into situations that others are escaping from. Added to that, they will engage in conflicts where the norms on law, order and safety no longer apply. The Government must consider their duty of care to armed forces personnel prior to, during and after committal; no doubt, their health and wellbeing underpins any successful mission. Armed forces personnel may be called on to put their lives on the line to protect us from harm, and we need to afford them the best protection available. That certainly will mean spending more money on personal protective equipment or military equipment. Surely, it is preferable for all involved to spend money by choice than to be decreed by a court to pay compensation, which has an impact on the morale of our service personnel and those wishing to join.
The Government have taken much needed and welcome measures, as has been mentioned, to improve housing provision for armed forces personnel, increased allowances and tax reliefs, and facilitated access to rehabilitation centres. However, I hope they will not rest on their laurels, but continue to review that important aspect of defence spending as part of a continuous improvement programme. We heard earlier that there is much more to be done on housing for our service personnel.
Our involvement is further afield, too. As was the case with our forebears in the two world wars, our armed forces may be called upon to assist in defence partnerships with other nations. I hope—like many others, I am sure—that responding in anger will seldom be required in future, but with that will come a greater focus on peacekeeping assistance throughout the world and the opportunity for the armed forces to bring their unique skills to bear on local civil contingencies. That said, for our children and grandchildren, cyber-space may be the war zone of the not too distant future.
Let us be clear: funding for our armed forces depends on a strong economy, which only the Conservative Government can fund; not the fairy tale finances that we hear about from other quarters. UK defence spending over the last five years has been stable at around £36 billion in real terms, increasing this year to around £38 billion. Minister, is that really enough?
Despite the future of RM Condor in my constituency and jobs across Scotland being secured by the UK Government, does my hon. Friend recognise that we have not seen a firm commitment from the SNP that they would still be secure in an independent Scotland?
I recognise that there has been little or no comment about defence for Scotland from the SNP, but I welcome the investment in Scotland by the Ministry of Defence, not least in my hon. Friend’s constituency.
Finally, in relation to the defence transformation budget of £160 million ring-fenced from the defence budget, I would be grateful to know if the Minister expects the stated possibility of a further £340 million to be raised as part of the spending review.
Our regular servicemen and women, in addition to the reservists who balance a civilian life with commitment to the armed forces, are talented people from a diverse range of backgrounds. They deserve our fullest support. That means investment in our armed forces and those who serve in them.
We now come to the contributions from the Front Benches. Please do not exceed the guideline of six minutes, as that allows a minute for the mover to wind up.
It is always good to see you in the Chair, Mr Betts. I sincerely congratulate the hon. Member for Berwick-upon-Tweed (Anne-Marie Trevelyan) on securing the debate and the fine way in which she opened it.
The hon. Lady invited us to consider the issue of defence spending in its purest sense. How does one fund a public service, the most critical public service that the Government can fund and preside over? In her opening remarks, she urged us to consider not just the sum of money spent on defence but how that money is spent across the Department. As we say in Scotland, there has been a fair kick of the ball on that issue here today, but we again find ourselves with the Defence Minister—it is always good to see him on the Front Bench—and not with a Treasury Minister. For those who are new to defence debates, although most of us here are regulars, that is something we have yet to use our collective ingenuity to achieve.
When considering defence spending, in my mind there are three clear elements that the process should contain. The first is to analyse the threat picture. It has been mentioned this morning that it is increasingly complex, fast-changing and differing day to day, hour to hour. There is then a decision to be made on the capability that is required in order to meet the threats that we face. The third step is to fund, fund and fund that necessary capability.
There is an entirely legitimate political debate to be had—indeed, the public would expect no less—over how well served we are by the current set-up. It is a debate about which Members here today, certainly those in my party, have tried to encourage some thinking outside the box. At the moment, we have a Department that is constantly chasing its tail and is ill-served by political posturing, some of which regrettably has been on display here this morning; there are warring political factions in the governing political party and Government Departments are set off against each other.
Indeed, the right hon. Member for Rayleigh and Wickford (Mr Francois) said that the Treasury does not understand the Ministry of Defence. I will come back to that, but he said something even more revealing: he asked us to go to the bank with a promise from the right hon. Member for Uxbridge and South Ruislip (Boris Johnson), the likely next Prime Minister, that he would fund defence fully. Well, he is hardly going to say he will fund defence partially. The right hon. Member for Rayleigh and Wickford might run to the bank, but we need detail, and we have not had that from either of the prospective Prime Ministers, despite the warm words.
If we go back to the first step in how I see devising how much is spent and how it is spent, we need a greater, more robust and more sophisticated discussion in the House about the threat picture that we face. When we get on to how we fund the capabilities required, we need a shift to multi-year defence agreements—something I raise in just about every debate we have.
There have been interesting and subtle shifts in the language used, particularly by Conservative Members when they talk about multi-year arrangements. I have asked previously if the Government are looking at bringing in proper multi-year defence agreements, similar to the model used in Denmark, for example. The previous Minister for Defence Procurement, the hon. Member for Aberconwy (Guto Bebb), said that was being looked at; the current Minister for Defence Procurement says that is being looked at. I ask the Minister, when can Parliament expect to hear some more detail? I think that would lead to the end of tin-eared design and outcomes, such as the closure of the Royal Navy base in Rosyth, which is the only Royal Navy base in the north-east of these islands.
I disagree vehemently with other Members about nuclear weapons; look at how they have done nothing but haemorrhage money as though it were going out of fashion. That is before we get to other issues, such as submarine decommissioning, that I know the hon. Member for Berwick-upon-Tweed has an interest in. We would have an end to National Audit Office reports, detailing a black hole of up to £15 billion in the equipment plan.
People are the greatest asset the Ministry of Defence has; they are the real deterrent. When she opened the debate, the hon. Member for Berwick-upon-Tweed adumbrated the need for a long-standing SNP policy—perhaps she did not mean to—of having an armed forces representative body to better represent those in the armed forces, veterans and their families, and so get better outcomes for them. It is often said that defence does not win votes, but it can certainly lose them. I fear that collectively this House is getting that wrong.
Last, I encourage Members to read an excellent academic paper called “Military Strategy of Small States: Responding to External Shocks of the 21st Century” before they come to the next defence debate. It is written by three Swedish academics, and it is about the relationship between the threat picture, the money that is spent and the political discussion, which needs to be more sophisticated in this place.
It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate the hon. Member for Berwick-upon-Tweed (Anne-Marie Trevelyan) on securing this important debate and on setting out the case. She highlighted the fact that defence does not feature in our postbags, as we are all aware, and as a result it does not get the focus it needs. She also talked about the conscious choice by Government in recent years to reduce Government spending on defence, which, as she said, was based on a false premise.
There were some excellent contributions to the debate, from my right hon. Friend the Member for North Durham (Mr Jones), the right hon. Members for New Forest East (Dr Lewis) and for Rayleigh and Wickford (Mr Francois), my hon. Friends the Members for Plymouth, Sutton and Devonport (Luke Pollard) and for Glasgow North East (Mr Sweeney), as well as the hon. Members for Strangford (Jim Shannon), for St Ives (Derek Thomas), for Somerton and Frome (David Warburton), for Filton and Bradley Stoke (Jack Lopresti), for Witney (Robert Courts) and for Ayr, Carrick and Cumnock (Bill Grant). One point of consensus that all the speakers highlighted in different ways was the need to increase defence spending.
Labour is committed to spending at least 2% of GDP on defence, in line with our NATO commitments. The last Labour Government consistently spent well above the 2% figure. Sadly, since then we have seen a sharp fall in the real-terms value of the defence budget. Independent analysis by the House of Commons Library has shown that defence spending in the last financial year was £9.3 billion lower in real terms than when Labour left office.
The debate is ongoing on the appropriate level of defence spending, with both candidates for the Conservative leadership adding their thoughts. That is particularly galling when both of them have consistently voted for budgets that have slashed defence spending to what it is today.
In his haste to criticise the leadership candidates for their commitments to increase defence spending, can the hon. Gentleman point to a single speech where the Leader of the Labour party—not its defence spokesman—has indicated that he wishes to increase defence spending?
I was not attacking the comments of the candidates for the Conservative party—they are welcome. I was saying that it is galling that they voted for cuts. The Leader of the Opposition has highlighted, as did the last Labour party manifesto, our commitment to a 2% minimum for defence spending, in line with the NATO commitment. He has also said that we cannot do defence on the cheap. He is as committed as our party to spending on defence.
Added to the squeeze on defence spending is the fact that the MOD’s purchasing power has suffered from the fall in the value of sterling after the Brexit vote. Of course, what matters is not just what is spent, but how it is spent. As we debated last Thursday in this Chamber, we need to use the defence pound to support UK prosperity and to back UK defence workers. Labour wants more MOD defence contracts to be awarded here in the UK, and we would like to start with UK-only competition for the fleet solid support ships. As my right hon. Friend the Member for Warley (John Spellar) highlighted, that is a matter of political will. Not only is it vital that we support the UK defence industry to retain our sovereign capability; we also know that investing in the UK leads to additional revenue coming back to the Exchequer in taxation, higher national insurance contributions and lower social security payments—not to mention the value of apprenticeships and spending in the wider economy.
We know from reports by Oxford Economics that the UK defence industry has an output multiplier of 2.3, which means that a £100 million investment in the UK industry generates some £230 million to the UK economy. Its reports have also highlighted the fact that each additional job created in the manufacturing element of the defence industry results in a further 1.8 jobs being created in the wider economy. I am sure that the Minister will want to convey that message to the Treasury. Of course, sufficient levels of defence spending depend on an economy that is growing, so I hope that the Minister will join the Opposition in opposing a harmful no-deal Brexit, which would be damaging to our GDP and would therefore threaten all Government spending, including spending on defence.
I thank all the Front Benchers for co-operating in reducing the time they take on their speeches.
It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate my hon. Friend the Member for Berwick-upon-Tweed (Anne-Marie Trevelyan) on introducing the debate. There can be few in Parliament so passionate about the armed forces and I am not surprised that it is she who called the debate. It has been highly constructive and has demonstrated a gratifying commitment to the defence sector on both sides of the House. We should start on a note of agreement: clearly everyone in the Chamber wants the defence budget to continue to rise, and that is gratifying. It is tempting to pick up on another point where we all agree—that it is the Treasury that is the enemy; but I cannot possibly say that. With a reshuffle coming next week, I do not want to limit my options too far. They are already pretty narrow, so let us not go further.
I doubt it.
As has been said, the first duty of any Government is the safety and security of the British people at home and abroad. I am proud that the Government have delivered on their NATO pledge to spend at least 2% of GDP on defence. They will be spending more than £186 billion on equipment and equipment support between 2018 and 2028. Aside from ensuring that our armed forces have the latest and best capability, our investment of around £19 billion a year underpins a world- class British industry, providing direct employment for 115,000 people and nearly 400,000 more across the wider supply chains. That substantial and sustained investment is not only vital to our national capability and prosperity and to supporting economic growth. It is also vital to our ability to counter the rising threats that menace us and all NATO members, including a resurgent and increasingly assertive Russia, and extremist terrorism across the world.
This year NATO celebrates 70 years as the foundation of our mutual security. The UK is one of very few NATO members that meet both their core spending guidelines by spending 2% of GDP on defence, of which 20% goes on major equipment and associated research and development. Defence spending in many NATO states is still too low, and although our allies are making progress on burden sharing, they must do more. The increase mirrors rising defence spending across the world, which makes it vital that the UK maintains its position as a leading player on the world stage.
The upcoming spending review is an opportunity to reprioritise our national investments across defence, ensuring that we can meet whatever the future may throw at us in an era of intensifying threats. The Department has done a great deal to drive out inefficiencies in defence, and there is more to be done, but we must also invest in new capabilities and in transforming the way defence operates, so that we can continue to defend the UK and project our influence.
First, we must mobilise defence to meet rising threats. The international situation is darkening. The rules-based order that has kept the peace for so long is under constant pressure and the external threats that confront us increasingly come from multiple directions. Despite the coalition’s success in degrading the power of Daesh, the threat of terrorism is still with us, while malign cyber-warfare and proxy warfare are rapidly changing the face of conflict. The nation’s approach to future spending decisions must reflect those new realities.
Secondly, we have to modernise and innovate—to embrace new technologies to ensure we have a competitive edge over our adversaries and to identify opportunities to sustainably reduce our cost base, which will require some up-front investment. The Department is investing about £800 million through the defence innovation fund to keep us ahead of the curve, and ring-fencing £160 million of its budget this year for the new transformation fund. Thirdly, on efficiencies, defence has to transform the way it does business by liberating new industry thinking and tackling the behaviours and practices that have racked up excessive costs in the past. That means tackling the mindset of short-term decision making that leads to poor value for money. We must invest in technology now for long-term savings.
I want to answer a couple of points raised in the debate. The MOD does not collate defence expenditure figures for regions, but the average spend per person in the UK was £290 in 2017-18, and the MOD spends some £19 billion a year supporting 115,000 jobs. That means that one in every 220 jobs in the UK is in defence. On the accusation that there have been cuts under the present Government, since 2014 defence spending has increased year on year and we now spend £39 billion—rising to £40 billion by 2020. [Interruption.] I would also say to the right hon. Member for North Durham (Mr Jones), having served in Afghanistan in 2006, that the sort of commitment that we had, with so many of our troops serving on operations overseas in Iraq and Afghanistan, made for an environment very different from today’s. With the different threats we face at any one time, it is sometimes difficult to compare like with like. Our relationship with strategic suppliers in the UK defence and security sector is vital. The armed forces support an industrial base in the UK providing employment to about half a million people.
I was delighted that many Members raised the issue of mental health in the debate. In the autumn Budget the Chancellor announced £10 million to support veterans’ mental health and wellbeing needs, and in January the armed forces covenant fund opened a £3 million funding programme to fund innovations and improvements to veterans’ community centres. We are considering investing more in veterans’ mental health. Accommodation is another key issue for many service personnel. We are looking closely at the new accommodation model, which is aimed at giving choice to service personnel. Equally, on pay, the Armed Forces Pay Review Body has recently presented its latest findings, to which the Government will respond in due course.
I end on a note of consensus again. I am delighted that in this Chamber at least we are committed to armed forces personnel, and to a rising defence budget.
I thank all colleagues and the Minister for their continuing commitment to the armed forces and for speaking out so that those who have no voice of their own know that many of us in the House understand the incredibly difficult role they play in our defence. As my hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant) said, they run towards danger as most of us are running away from it. It is extraordinary that there are people willing to do that—as he did as a fireman—in defence of our nation, security and children. The issue is not a percentage figure; it is about making sure we can meet the operational requirements, whatever problems arise.
As ever, I thank the Minister for his support and his willingness humbly to agree that it is the Treasury we need to continue to fight. We will find a way, as the hon. Member for Glasgow South (Stewart Malcolm McDonald) said, to bring the Treasury to us to listen to the arguments. I think we all agree that funding for defence is not like funding for any public service Department and we must find new, more effective ways to spend taxpayers’ money.
Question put and agreed to.
That this House has considered defence spending.
Public Health Funding: Enfield
I beg to move,
That this House has considered public health spending in Enfield.
It is a pleasure to serve under your chairmanship, Mr Betts.
I requested this debate to highlight some of the harsh realities stemming from the Government’s decision to slash the public health grant to our community, and to draw attention to the fact that the ongoing uncertainty around long-term funding is prompting a crisis in public health. Our council’s ability to deliver a range of public health services aimed at preventing disease, prolonging life and promoting good health is being seriously affected.
The Government’s national health service long-term plan may have put prevention at the heart of its policy but, to quote David Finch, senior fellow at the Health Foundation:
“The sustained cuts to the public health grant clearly run counter to these aims. The public health grant is not a nice-to-have. Without urgent reinvestment, we will continue to see a direct impact on people’s long-term health”.
Last month, the Health and Social Care Committee said that cuts to public health services were a “false economy”. Cancer Research UK and more than 80 other organisations have come together to call on the Government to provide a sustainable solution for public health. Ministers must take immediate and positive action to increase investment in public health, to reduce health inequalities and to support our health and social care system.
I will take this opportunity to pay tribute to the work of the Enfield Over 50s Forum and its president, Monty Meth, who is sitting in the Public Gallery today with many of the forum’s members. Their typically dogged campaign to highlight the cuts to Enfield’s public health grant and the disparity in per-person funding between our borough and other councils in London has forced this issue to the top of our community’s agenda.
The Minister should be well aware of the forum’s work on this matter, given the number of letters that its members have written to her and her Department in recent weeks and months—although, sadly, their letters have not received a considerate ministerial response. Instead, they have received a reply from the Department’s correspondence unit that, to put it mildly, leaves a lot to be desired.
One constituent with impeccable manners, who forwarded me a copy of the letter he received, described the response as “baloney.” Another resident labelled the reply “meaningless” and “full of Whitehall gobbledygook”, and it is hard to disagree with that analysis when they are treated to phrases such as:
“The formula is designed to generate target allocation shares of a funding envelope”.
Does my right hon. Friend agree that, because the baseline funding has been set from 2013, it takes no account of changes in the population of Enfield to do with age, poverty and other factors that might hugely affect the funding that Enfield actually deserves right now?
My hon. Friend is absolutely right; that is a key factor in this whole scenario.
On the kinds of responses that constituents are receiving, surely responses from Government Departments to citizens raising legitimate concerns on important issues should seek to clarify and not to cloud matters? I do not raise this point as an attack on civil servants, but to urge the Minister—and it is her responsibility—to provide some clear and full responses to the concerns I raise today on behalf of the Enfield Over 50s Forum and our whole community in Enfield.
Given that the population in London boroughs—including Enfield, as my hon. Friend has said—is growing twice as fast as in the rest of the country, the pressure on already strained public health resources is only set to intensify over the coming years. Enfield has some of the most poverty-stricken and deprived wards in the country, and we all know that poverty and poor health are inextricably linked.
According to a recent report by the Child Poverty Action Group, our borough is one of the 20 local authorities in the UK with the highest levels of child poverty after housing costs are taken into account. There are almost 40,000 children in poverty, or four in 10 children in the borough. Obesity rates for children in reception class are higher than the average in London and in England, and more than four in 10 year 6 children in Enfield are either overweight or obese, the eighth highest rate of all London boroughs.
However, it is not just children affected by serious public health issues in Enfield, but adults and the elderly too. Our rates of diabetes are higher than the London and England average. Cancer Research UK recently revealed that being overweight is a bigger cause of bowel, kidney, ovarian and liver cancer than smoking. More than six in 10 adults in Enfield are overweight or obese, a significantly higher rate than in London in general. Our bowel cancer screening rates for people aged 60 to 74—one of the best ways to diagnose bowel cancer earlier—are only just over 50%. That is lower than the average in England and far lower than the rate of 75% of eligible people taking part recommended by Cancer UK.
One of the most pressing issues facing our community and our country at the moment is the impact of serious violence and knife crime. I held a packed community meeting on Saturday on this issue, talking about how to keep our young people and our streets safe. Earlier this year, Enfield had the highest rate of serious youth violence in the capital. In 2018 alone, North Middlesex Hospital had to deal with the consequences of 1,457 assaults, including stabbings and gunshot wounds.
To protect staff and patients on site and reassure the local community of their continued safety whenever they visit the hospital, North Middlesex increased its security spend by an additional £149,000 and had to hire two additional overnight security guards in its busy accident and emergency department, at a cost of £3,000 per week. North Middlesex Hospital should not have to use its already stretched budget to address a situation that is not of its making. Every penny that is spent on these interventions is money that is diverted away from essential patient care.
Both the Government and the Mayor of London want to tackle the knife crime crisis with a public health response. That is an important and welcome initiative, but if the Home Secretary is going to implement a legal duty on the police, councils and the NHS to share information and intelligence, then those bodies will need the resources to make it effective.
The public health system is already at crisis point. We require a public health budget that addresses the desperate needs of our community in the immediate and long term. But where is the support from the Government? The Prime Minister has declared that austerity is over, so where are the resources to reverse the cuts suffered by our public health services?
When the NHS long-term plan was launched the Prime Minister said:
“We also know we need to…support prevention and public health, both for the benefits they bring in themselves and to relieve pressure on NHS care.”
In 2018, the then Health Secretary, the right hon. Member for South West Surrey (Mr Hunt), told the House that
“there cannot be a transformation of the NHS without a proper emphasis on public health.”—[Official Report, 18 June 2018; Vol. 643, c. 61.]
The current Health Secretary has said that prevention is one of the three pillars of his stated priorities. He also said:
“Each year, we are spending £97 billion of public money on treating disease and only £8 billion preventing it across the UK—that’s an imbalance in urgent need of correction.”
What urgency has he shown to fix this imbalance? That statement was made more than eight months ago.
While parts of it were leaked to the press over the weekend, we still await the formal publication of the Government’s Green Paper on public health and the future of funding. Analysis by the Health Foundation shows that the public health grant is now £850 million lower in real terms than the initial allocations in 2015-16. Last month, the Health Foundation and the King’s Fund stated:
“With the Spending Review likely to be delayed, key funding decisions will be postponed and as a result, the grant will face a further real-terms cut of £50 million in 2020/21 under provisional plans…With population growth factored in, £1 billion will be needed to restore funding to 2015/16 levels.”
Enfield is one of the communities to really bear the brunt of these savage cuts. Our borough’s grant is the 9th lowest in London, at £48 per head of population, compared with the London average of £71—a gap of £23—and we are getting £2 less per person this year than last year. In total, we are receiving £440,000 less from the public health grant this year than in 2018.
In addition, Enfield is one of five London boroughs that make up the NHS’ north central London sustainability and transformation partnership, which has pledged to reduce health inequalities for its 1.5 million residents. Haringey, Camden and Islington receive £70, £99 and £104 per head respectively for public health funding. I recognise that these boroughs also have considerable public health needs, but I do not understand how the disparity in public health funding between boroughs in the same area can be so large. There is then the Royal Borough of Kensington and Chelsea, which is allocated £130 per person for public health—almost three times more per head than Enfield. Where is the evidence that Kensington and Chelsea’s public health needs are almost three times worse than Enfield’s?
It is not as if Enfield Council can step in and plug some of the gaping holes in public health funding. Up to 2018-19, the core funding the council received from the Government to provide vital services was slashed by an average of £800 per household. Ongoing Government cuts and increased demand on services mean that the council has to find another £18 million of savings this year and then £12 million more the next. Austerity is clearly not over in Enfield. The cuts will continue to bite for the foreseeable future unless the Government do something about it.
What I find so frustrating is that the extent of these cuts to our public health system, and to local government, are so short-sighted; they have immediate and long-term adverse consequences. In April, when I asked the Minister for her assessment of the correlation between the levels of public health funding allocated to Enfield and the effectiveness of the provision of public health services in our borough, the response I received was:
“We have made no specific assessment of any relationship between funding…and the effectiveness of services in Enfield.”
Really? Maybe this type of assessment is required so that her Department can gain a better understanding of the public health situation in Enfield, as well as in other communities across the country. Will the Minister resolve to look again at this issue?
Given the pressing public health issues in Enfield I have outlined today, is the Minister willing to commit, at the very least, to reinstating the £440,000 cut in public health funding suffered by our borough this year? Does the Minister accept the need to increase the level of public health funding allocated to our borough to at least the London average each year? And does the Minister agree that Enfield urgently needs its public health system to be put on a sustainable footing? More widely, I want to hear from the Minister about the future of public health funding. Can she provide any indication of when the Green Paper will be released? Can we hold out any hope that the calls from the Health Foundation and the King’s Fund to reverse the £1 billion a year cut to public health funding will be acted upon?
There is a lack of clarity on the Government’s previously announced plans to phase out the public health grant to local authorities by 2021 and to instead fund public health through the proposed 75% business rates retention scheme. Cancer Research UK says that the continued uncertainty around the public health funding formula means it remains concerned about the potential negative implications of business rates on local service delivery. There is no point in Ministers extolling the virtues of a robust public health system if, in reality, all they do is weaken the prevention agenda by slashing funding for services. The success of the Government’s NHS long-term plan will be built on the foundations of improvements to public health, but these foundations will crumble, and the investment in the NHS’ long-term future will be undermined, if the Government fail to increase investment and make prevention a top priority.
Finally, I return to the work of the Enfield Over 50s Forum. Reading one of its recent newsletters, I was struck by this succinct but perfect encapsulation of why achieving fairer funding for public health in Enfield is so important:
“Improving public health is not just an over 50s issue. It concerns every single body and soul in the borough—toddlers, teenagers, every family with young children. This is one case when we are really all in this together.”
I look forward to the Minister’s response.
It is a pleasure to serve under your chairmanship, Mr Betts. I thank the right hon. Member for Enfield North (Joan Ryan) for raising this issue. She is a great champion for her constituency, as is the hon. Member for Enfield, Southgate (Bambos Charalambous) for his.
I reassure the right hon. Lady that the Government are fully committed to improving public health. We want to place prevention at the heart of our health and social care system, because that is the only way to make the NHS sustainable in the long term. That is challenging, as we all know. We need to tackle the root causes of poor health, not only the symptoms. The population of our country is growing. As both the right hon. Lady and the hon. Gentleman pointed out, growth in London boroughs is particularly acute and has been rapid over the six years since the formula was put in place, and we recognise the demand on the NHS, social care and other public services. My right hon. Friend the Secretary of State for Health and Social Care and the Prime Minister are aware of the great gaps in life expectancy in London boroughs and across the country. We also know that lots of diseases that people die from nowadays are preventable, which is why we want to put prevention at the heart of what we do. The Prime Minister’s ambition is to extend healthy life expectancy by five years by 2035 and to reduce the gap between the richest and the poorest. We have made great strides in many areas.
Childhood obesity is an international problem, but we are being ambitious on it, as well as on air quality and tobacco. All these measures have the potential to make a real difference to people’s health and wellbeing. We have reduced sugar in fizzy drinks by 11%, we have cut average calories per portion by 6% through the soft drinks levy, and by 2020 the NHS diabetes prevention programme will support 100,000 people at risk of diabetes across England each year. On screening, the right hon. Lady will be aware that Professor Sir Mike Richards is undertaking a screening review at the moment, so issues such as those she raises about bowel screening will be brought up. That review will report later in the year.
The Green Paper is coming up and I hope that that will take us even further. We need action across local government, central Government and the NHS. Of course, the over-50s group to which the right hon. Lady has referred is an important part of that, because only through everybody working together will we be able to tackle the determinants of health and be far more successful at improving and protecting health outcomes.
To move specifically to public health and where it sits now, we gave back to councils responsibility for public health in 2013. That was important. They recognise what is relevant for their communities and are uniquely placed to use the full range of their activity—levers such as planning, transport, housing and the local economy—to promote better health.
I realise that there is not a great deal of time today, but the Minister says that the funding given to Enfield Council is relevant to its needs. Is she saying that the funding that it has been given is adequate to cover the public health requirements in Enfield?
I will move on to the specific issue of the funding formula, how it came into being and how it might change. Of course public health is a question of the investment that national Government put in and how local authorities spend it, but there is a lot of innovation. I applaud Enfield Council and all local authorities for what they have done, because different authorities have used it in different ways. They are adopting innovative approaches. They are renegotiating contracts that perhaps had been untouched for years before the 2013 transfer. I will address funding later in my remarks. Councils are adopting new service models that have the potential to reach communities that have often been left out by traditional service delivery models.
I recognise that in the last spending review, there were difficult decisions to be made to ensure the sustainability of public finances, but over the five-year period, £16 billion has been available to local government for use on public health, including £3 billion for the current financial year.
The right hon. Lady raised a very important issue about the distribution of funding for local authority public health activity. I recognise the pressures that she has referred to specifically in relation to Enfield. When responsibility for local health functions moved from the NHS to local government in 2013, funding for relevant services was transferred to individual local authorities. That was based on historical local spend for the NHS, and the process revealed huge variation across the country. The funding for Enfield is based on what the NHS had been spending there up until 2013.
The Government are now carefully considering how to allocate public health funding in a more needs-based way, rather than continuing to allocate funding based on NHS historical spend. We recognise that Enfield’s per capita funding breakdown is different from that of other London boroughs, but a per capita basis is not actually a meaningful way of comparing allocations or the best way of determining funding. That is precisely because it takes no account of different levels of need and it disregards significant variables that have a major influence on the need for public health interventions. An example is the age profile of a local authority’s population. We will look carefully during the next spending review at future funding arrangements and the best way to allocate funding to each local authority.
On the letters from the Enfield Borough Over 50s Forum, if the right hon. Lady would like to distil those messages into a letter to me, I will happily respond to her and she can make that response available to her constituents.
A future funding formula needs to take account of need. There should not be the current differentiation. Kensington and Chelsea receives £82 per person more in funding than Enfield. It cannot be right that two boroughs that are about 8 miles apart have such a variance in funding. Will a future funding formula take more account of local needs?
As I have said, the Department is looking at the funding formula. The hon. Gentleman says that the boroughs are only 8 miles apart, but we know that in areas that are very close together, life expectancy and, importantly, the length of time a person lives in good health can vary hugely. That is why we need to look very carefully at all the factors before the new formula is created. That will be assessed in the next spending review in the light of all the available evidence.
I am committed to working closely with local government, and with other partners and colleagues, to build on the achievements of the last six years. We need to act on a local, national and global level to meet the public health needs of the present and to rise to the public health challenges of the future.
Question put and agreed to.
Children and Mental Health Services
[Mark Pritchard in the Chair]
I beg to move,
That this House has considered children and mental health services.
It is a great pleasure to serve under your chairmanship, Mr Pritchard. We could not be in better hands. It is a delight to have the Minister here. I know she comes to this issue with great personal interest and a commitment to deliver for all our constituents. It is fantastic to see so many right hon. and hon. Members from across the House here to take part in the debate. That is testament to the interest in this place and the concern across the country about mental health, particularly that of children.
I praise the Government for what they have done to date. When it comes to mental health, there is no doubt that this Government get it, making it a priority like no other. They have tackled the stigma of mental health and put in much-needed resources, but although they have done great work, like Oliver, we would all say, “Please, Minister, can we have some more?” because although we are getting on board with the issues, and royals, TV stars, politicians, and people from sport and all spheres talking about mental health, the problem is snowballing, getting bigger and bigger. Such are the pressures and stresses placed on our children’s mental health that this is an ever-increasing problem, which demands our attention, resources and commitment as a Government.
One in eight five-to-19-year-olds—12.5%, or 1.25 million children across the country—have a mental health difficulty, according to the Government’s own survey of November 2018, “Mental Health of Children and Young People in England”. The Local Government Association says that children’s services are seeing more than 560 cases of mental health issues every day. Some 75% of adult mental health illnesses begin before the individual turns 18 and over 50% start before the age of 14. Some 23% of the population are affected by mental health difficulties at some point each year. The economic and social costs of mental illness in England total £105 billion.
I congratulate the hon. Gentleman on securing the debate. About 10 or 11 years ago I introduced a Bill that would have provided a specialist to a cluster of schools, to help teachers to identify children with health and mental health problems. Does he agree that the Government should think about that? Secondly, and most important, employers do not recognise the problems young people have with mental health when they start out in industry, nor do they recognise adult mental health problems. Does he agree that more could be done in that area?
I could not agree more with the hon. Gentleman. It is a pity that more people did not share his foresight, so that we could have acted sooner. We are laying the foundations for mental health problems in adulthood. Childhood mental health has a lifelong impact, so it is important that we do not waste a moment. Rates of depression and anxiety among teenagers have increased by 70% in the last 25 years.
I thank the hon. Gentleman for securing this important debate. My constituent Elodie Fleet, who is now 18 years old, experienced anxiety, which came to a head at the age of 13. She wanted to see the school counsellor, but her needs were not deemed to be urgent enough because “she hadn’t tried to hang herself or taken a blade to her wrists.” I hope the Minister will say how we can get more counsellors in our schools to deal with people such as Elodie, because she is not alone.
The hon. Lady makes a powerful point. It is true that her constituent is not alone. When I publicised this debate on my Facebook page, I was amazed by the number of parents who got in touch. I was overwhelmed by parents who have either battled through and managed to get to the other side, or are in the midst of fighting to keep their children alive, safe and well. As a parent, I realise what a scary thought that is.
To reiterate that point, does the hon. Gentleman agree that this is a state of emergency? In my constituency, the parents of a 12-year-old boy are being advised that there is a 72-week wait for their son to get help, even though there is a risk of serious self-harm.
I agree that we are in a crisis. The Government are putting record amounts of money in, but the hon. Lady is absolutely right to say that that is an unacceptable wait. I will discuss waiting times later in my speech. Any parent would be terrified at the thought of that long wait and their child being further harmed by it.
The statistics the hon. Gentleman is outlining are horrific. Some years ago figures were released showing that across the whole of the United Kingdom, over 10,000 young people under the age of 10 were manic depressives. That is a horrendous figure. Such a situation puts horrendous pressure on parents and carers.
I have spoken about my own mental health challenges and my battle with depression and anxiety. As an adult it was very difficult to cope with, but for a small child it must be an incredibly hard to have to deal with.
On the social and economic effect, does my hon. Friend agree that we need a more joined-up approach across Departments? Earlier this year, I met chief superintendent Paul Hepworth of West Yorkshire police, who is a fantastic guy. He mentioned that nationally there is a lack of forensic beds for children with severe mental health issues. He told me the story of a young girl who was in police custody with a severe illness; she was suicidal, self-harming and violent towards others. Does my hon. Friend agree that the Government must address this issue, to offer safe space and support for people in dire risk?
I point my hon. Friend to some of the work done in my area by Matthew Ellis, the Staffordshire police and crime commissioner, and the work done by the Prime Minister when she was Home Secretary on how we treat mental health in our police stations. That is very important, but it is even more important for vulnerable young children. She makes a valid point. I will canter through some more points before taking more interventions.
The Government’s own survey shows that one in four children with a mental health disorder are seen by a mental health specialist and over 400,000 children are receiving no assistance at all. The NHS is managing to see only a fraction of the young people who have problems. My hon. Friend talks about cross-departmental working. I am delighted that the Minister is here, because she has done a huge deal to bang heads together and make this a priority. It involves the NHS, local government, the police and so many different areas, which we need to bring together.
The Children’s Commissioner’s analysis of NHS figures from 2017-18 shows that 325,000 children were treated by community services, while another 5,000 are in hospital—less than 3% of the population. Around £700 million is spent on child and adolescent mental health services and eating disorder support. By comparison, services for adults received 15 times more, despite the fact that children represent 20% of the population. While it is important that we are putting money into mental health services, we are turning it on its head. We need to put more money into children’s services, not only because there is such a great demand, but because if we can nip problems in the bud by making that early intervention, we can avoid those services being needed later in life.
I congratulate my hon. Friend on securing the debate; he is making some very good points. As he recognises, CAMHS are the Cinderella services of the Cinderella service—mental health is still woefully underfunded in comparison with many other parts of the NHS. Does he also recognise that CAMHS recruitment is a real challenge? The August 2019 fill rates for higher trainees in the UK stand at only 63% for those entering CAMHS specialist training and at only 23% for learning disabilities, which means that almost 80% of new posts in learning disabilities for new trainees will be unfilled. Does he agree that that is a key issue for the Government to address if they want to improve CAMHS provision?
I absolutely agree with my hon. Friend, whom I congratulate on his work in our NHS; I am grateful that he does such a great job on mental health work in the community. He raises the very important point that it is all very well wanting to deliver these services and putting the money in place, but if we do not have the staff to deliver on the ground, we will always be running to catch up.
The hon. Gentleman is giving an excellent speech. In York, we have seen a 26% increase in referrals into CAMHS over the past five years. As a result of such high demand, one referral in four is turned away from the service, including children who are self-harming and have experienced abuse. Surely we need to focus on investment in the workforce, as well as on funding.
The hon. Lady is absolutely right, and we must not underestimate the immense added stress and pressure for families whose child is self-harming. She makes a very good point.
I congratulate my hon. Friend on securing this important debate. May I follow up on the point made by my colleague the hon. Member for York Central (Rachael Maskell) about the figures for York? Are not parents under huge stress because of these referral figures? In York, CAMHS referral times are peaking and troughing, which has a lot to do with not getting the resources needed. Sometimes referral times are down to six months, but at other times they are longer than 12 months, which has a huge impact on the children involved. It also means that schools are having to take action and exclude young people before they can get the treatment they need.
My hon. Friend is absolutely right, not only about the impact on schools—I will say more later about what we can do in schools—but about the pressure on CAMHS and the massive importance of getting children seen as soon as possible. Just imagine if one of us were having a mental health episode and were told that we could see someone in 12 months who would then refer us for treatment. CAMHS are not the doctors or the psychiatrists who see the patient. They are not the help; they are the doorkeepers to getting help—the triage, as it were. Even when someone gets through the CAMHS door and jumps over the very high bar for getting treatment, it could be many months before they receive it.
It is a great challenge. I know that the Government take it seriously; their 2017 Green Paper “Transforming Children and Young People’s Mental Health Provision” outlined their ambitious new plans for delivering mental health support in schools, and the announcement this week of the mental health services trailblazers is a welcome part of that strategy. I am delighted that my area, Burton, is to be in the second phase of those trailblazers, which I genuinely believe will make a difference. However, figures from the Children’s Society suggest there has been little expansion in the provision available in schools since 2015, so we are starting from a low base. In particular, the figures point to a worrying lack of awareness among parents about the counselling offered in their children’s schools: just under a third are not aware of what is available at all.
I am pleased that the Government have announced that every school, college and alternative provision across England will be offered training as part of the £9.3 million mental health services and schools and colleges link. However, even though my area is one of the trailblazers, priority access to mental health training for schools and colleges will not be available in my constituency until next year. It is clearly needed now. There are so many MPs, constituencies and constituents who want access, so how can we roll it on quicker? To use my “Oliver!” analogy again—
My hon. Friend is making an excellent speech. May I ask him to reflect for a minute on the particular issues for rural communities, including the distances? The lack of broadband means that the opportunities for dealing with those distances are missed. It seems to me—perhaps we will hear more from the Minister about this—that the Government could use technology more effectively in rural areas. We will certainly not get the help we need in time otherwise. My schools will not be getting help under the new scheme any time soon—we are not even one of the pilots. My teachers are very concerned that they will have more burdens, rather than an added resource.
My hon. Friend, who is always a champion for rural communities, makes an important point about rural isolation. We have known for a long time about the mental health challenges of farmers and rural communities, but it is all the more difficult for young people who are isolated from their friends. We talk about the social media pressure on young people with Facebook, Twitter and so on, but it is even more difficult for kids in isolated rural communities, because they are even more separated. That social media connection is often their only chance to talk to their friends.
My hon. Friend is making one of the best speeches that I have heard in this Chamber for some time, and is going into granular detail to make his case. In the medical workforce, the numbers of mental health nurses have fallen nationally over the past decade, and we know that there are challenges with CAMHS and LD recruitment. We cannot deliver mental health care without bodies on the ground. Unless we get the workforce challenge right, it will just be rhetoric. We need to start turning rhetoric into reality by recruiting the right number of staff on the ground to deliver high-quality mental health care.
My hon. Friend is absolutely right. It is about not just the psychiatrists and the doctors, but the mental health nurses out in the community. I have witnessed their great work at first hand, so I know just how important they are.
The extensive roll-out—as the Government rightly claim it to be—over the five-year pilot is great, but it will address just 20% to 25% of the country’s need. So many young people will miss out on support until at least 2023 or perhaps even later. The mental health training for schools and colleges announced in the past week is fantastic, but under the NHS long-term plan, an extra £2.3 billion is due to be put into mental health services by 2023-24. That is a lot of money, and I want us to make sure that as much of it goes into children’s mental health services as is humanly possible. If we spend it wisely, it can have a double-whammy effect.
Does the hon. Gentleman agree about the importance of bereavement counselling for children with mental health issues? As shadow Police Minister, one of the most common factors that I see among young offenders is a close family bereavement in their childhood, yet so many children languish on waiting lists for bereavement counselling. Indeed, I had a young constituent who waited for bereavement counselling for three years. Unfortunately, his life was taken by another teenager. That just shows the absolute importance of getting in there and delivering that mental health care.
The hon. Lady is absolutely right. Trauma in young people’s lives is often the trigger, whether it is sexual abuse, domestic abuse, violence perpetrated by other young people, or bereavement. All those triggers set off a train of deterioration in young people’s mental health that is often lifelong. It is so important that they get the access they need.
Several hon. Members have mentioned waiting times for CAMHS. I have certainly found that my constituents cannot get on Facebook quick enough to tell me about their CAMHS experiences. I do not want to denigrate CAMHS, which have great people doing great work; the problem is that there are just not enough of them and they are under too much pressure. As the hon. Member for York Central (Rachael Maskell) noted, CAMHS are turning away nearly a quarter of children who are referred to them. In 2017-18, they turned away 24.2%, meaning that at least 55,800 children were not accepted for treatment. Of those who were referred, the average waiting time was 34 days for an initial assessment and 60 days for treatment—significantly longer than the four-week standard set out in the Government’s Green Paper. We can all point to examples of much longer waiting times in our constituencies.
One constituent contacted me to say that her son had been self-harming for years. It took them months to get an appointment with CAMHS, and when the appointment happened, her son suffered a meltdown. That is not unusual, due to the pressures that those appointments put on young people. Because he is 15, their GP cannot prescribe anything for him. My constituent has had to watch her son throughout the night to make sure he does not do any permanent damage to himself. Another parent told me how her daughter was discharged from CAMHS, with it saying there was nothing more it could do to help with her anxiety.
Young people have told mental health charity Mind—I am very lucky to have Burton and District Mind in my constituency, which does a great job—that the wait for support is one of the most difficult issues they face. They say that sometimes, they find that their mental health deteriorates while they are waiting; the wait actually makes it worse. In England as a whole, half of those accepted for treatment during 2017-18 were still waiting for treatment at the year’s end. That proportion was lower in my area, east Staffordshire, where it was just over one third. However, that is still a substantial figure.
A school counsellor from my constituency contacted me to say that the waiting lists for referrals to child services outside of school can be months long. She believes that when it is established that a child needs help, a counselling session needs to happen within 48 hours. She goes on to say that too much red tape is preventing children from getting the help they need. I think we all recognise, as the Government have done, that support in school, delivered in a way that is accessible to young people—they feel comfortable asking for it, and know of other young people who have accessed it—is a real help.
One parent told me that she decided to fight to get her son’s care commissioned outside of the county they lived in because of her disappointment with the support she had received. She says that early intervention is key, and that there have been too many endless reports and not enough action has been taken. Another parent in my constituency said that she took her daughter to the GP two years ago. She was referred to That Place in Burton, which is a fantastic facility; she took her for assessment, only to be told that her daughter was not old enough to be accepted. Yet another constituent told me that after a referral for her daughter, aged nine, it took three years for them to see a psychiatrist. That kind of wait is difficult, and all the time, the young people are getting worse.
There is also a problem with the transition from childhood to adulthood. According to the British Psychological Society, about one in six 17 to 19-year olds have a mental health disorder; according to the Children’s Society, 16 to 17-year-olds are the biggest service users of mental health services. However, young people often face barriers to accessing support, and end up falling through the cracks of adult and children’s services as they transition. Some young people who are discharged from children and young people’s mental health services at 18 find it can be very difficult to get a referral to adult mental health services at all, and can end up completely isolated. In some circumstances, young people are not accepted into either children and young people’s or adult mental health services, due to them falling between the gaps.
Again and again, I hear that CAMHS discharges young people on their 18th birthday, and that there is no provision at all for them. The challenges those young people are facing do not magically disappear when they become adults. Just last Friday, I met with a constituent who was getting ready to leave CAMHS and had been left to organise her future on her own. She was not automatically transferred to adult services, and had to organise a private therapist in order to get the ongoing treatment that she needs.
One of my constituents sums the problem up better than I could:
“All the time the kids are getting no support, becoming suicidal, becoming adults with even more complex issues, families are breaking up because of the pressure, parents quitting work to do the job of education/social care/health, and all of this causes more and worse financial pressure later on. No one sees the bigger picture because they can’t afford to. No one sees long term because that’s too expensive. Early interventions are crucial but they aren’t funded. We will reap the whirlwind then wring our hands and say ‘how could we have prevented this’”.
That is absolutely pertinent.
The Government have set a five-year forward view for mental health, which is for one in three children and adolescents with a mental health disorder to access NHS mental health community services by 2020-21. In the new long-term plan, they have set a target that 100% of children and young people who need specialist care will be able to access it by 2028-29. However, that is so far down the track.
I totally agree with my hon. Friend: it is so far down the track. Does it not further concern him that in that same 10-year plan, the NHS talks about “parity of esteem”, but that is in 10 years’ time, and it is very unclear what will be done about the timelines for getting there? As my hon. Friend has said, 10 years is much too long to solve the problems we have today.
My hon. Friend is absolutely right. During that time, babies become children, children become adults, and the problem gets worse and worse. I do not deny the Government’s commitment and determination in this, but it is just not happening quickly enough.
The other thing we need to bear in mind is that, although we have heard about CAMHS and the pressures on the workforce, a huge number of brilliant voluntary sector organisations are also delivering these services. I am very lucky to have in my constituency an organisation called Youth Emotional Support Services, which delivers in schools in Uttoxeter, as well as Burton and District Mind. There are so many great organisations. However, even in my own patch, I have heard that a tendering process is currently going on in which the bar is so high, the requirements so difficult and the boxes to tick so numerous that third sector organisations simply feel unable to compete. The challenge is that the tender to provide the facilities goes to a private company, and the experience, dedication and benefits of those voluntary sector organisations are lost.
I was staggered to learn that some of the children’s mental health charities operating in my constituency are providing 85p of frontline services for every pound they receive. That is tremendous value, representing help for young people, and few businesses could get anywhere near matching that. However, the tender process that we go through makes it impossible for voluntary sector organisations to compete. I hope the Minister will look into that; I will be raising with her my particular issue in Staffordshire.
I think the Minister recognises that in this place, we are simply voicing the real concerns and fears of parents up and down the country. Like a snowball coming down a hill, young people’s mental health is under greater pressure than ever before, and as a result they are self-harming, committing suicide, or getting themselves into a situation in which they will, in future years, suffer from greater mental health disorders, addiction, and so many other long-term problems. I hope that the Minister will go away feeling that she has great support across this House for her campaign to get even more resources and focus on mental health services, particularly for children, because quite frankly our children’s lives depend on it.
I do not propose to enforce a formal time limit of four minutes, but I ask colleagues to be mindful of the number of people who wish to contribute to the debate.
Thank you for calling me early, Mr Pritchard; it is a pleasure to serve under you. I apologise to the hon. Member for Burton (Andrew Griffiths) for arriving late. I was in the main Chamber for the domestic abuse statement, which unfortunately ran over a little. I commend him and those who made interventions on what I heard them say. I am sure that throughout this debate we will be given shocking examples of how this is truly a nationwide crisis. Any Government of any hue must, as a first step, be honest about the scale of the problem and how much is being stored up for future generations, as was said eloquently by the hon. Gentleman.
I will give the Minister and the Chamber a couple of the many examples I have received from constituents who have got in touch. Drew is a nine-year-old boy whose mother contacted us in March last year in a desperate state. On a weekly basis, Drew talked about killing himself; he would regularly go so far as to put a rope around his neck. Obviously, they were seeking urgent medical help for Drew.
Fifteen months later, Drew had his first appointment with CAMHS. That was 15 months when that child was at risk and that family was going through something—it is really hard for parents to imagine their child in distress, desperately reaching out for help and just being put on an interminable waiting list. Drew’s mum is left wondering how best to house her family. Her benefits have been reduced because of the bedroom tax. The need for Drew to have a separate room is not acknowledged, despite the fact that he is aggressive and sometimes violent towards his sibling. His mum is now forced to confront the prospect of Drew sharing a bedroom with her. That is deeply inappropriate and a sign of a system that is broken locally.
Another example is a child who was deemed to be a clear suicide risk. A significant amount of resource was placed into multidisciplinary team meetings for the child, but in meeting after meeting, for whatever reason, CAMHS did not show. The process to provide appropriate help for that child could not go ahead and deeply scarce resources were being burned up. It was only after the intervention of our team that we managed to bring CAMHS to the table.
Professionals want to do things. No one goes into this field wanting to do the wrong thing; they go into it to help, but the resources are not there and often the system is inefficiently resourced. I briefly pay tribute to the work of the local commissioning group, which as of last week has put in some resource for mental health professionals to work across schools, but it does not come close to the level needed. I beg the Minister to listen and to do what she can to get the Government to act.
It is a pleasure to serve under your chairmanship, Mr Pritchard. I congratulate my hon. Friend the Member for Burton (Andrew Griffiths) on securing this debate. I concur very much with all that he said in his opening speech.
Because we have only a small amount of time, I want to address one specific issue that has been brought to my attention. We all agree that we have a growing challenge with mental health conditions among young people across the country. It is right to acknowledge that the Government recognise that and are acting. We are grateful in Cornwall that, as I speak, a residential unit for children with mental health conditions is being built, after many years of not having a residential unit and our children having to be sent all over the country to be cared for. That unit will be open soon, which is very welcome.
I am particularly concerned about the amount of pressure we are putting on our schoolteachers when it comes to caring for children with mental health conditions. We are expecting more and more of teachers in that regard when it is not their role or responsibility. I am concerned about the impact that is having on our teachers.
I am also concerned about another aspect of education, which is authorised absence. I know that is not the Minister’s direct responsibility, but I hope she will take the remarks on board and feed them back to the Department for Education. Many parents are coming to me saying that they are struggling to get the school to support them as a family when they need to take their children out of school because of mental health concerns and conditions, including to attend appointments with CAMHS or other organisations.
In one case, the school was refusing to recognise absence from a particular child who was suffering from a mental health condition until that condition had been formally diagnosed by CAMHS. As we have heard today, it can take many months—I have heard it is up to 18 months—to get a diagnosis from CAMHS. The school was sending warning letters home to the parents about the amount of time the child was having away from school and threatening to take legal action against them. All that was doing was exacerbating the problem and putting more pressure, more stress and more distress on the family at an already difficult time.
Through the Minister, I appeal to the Department for Education that we need our teachers, and our headteachers in particular, to be more understanding and more compassionate. They are being driven by a heavy-handed approach from Ofsted in meeting attendance targets. It seems that those targets, above all else, are the most important thing for schools. No recognition or allowance is given for the real challenges many families face when they have a child who is suffering with mental health conditions and is therefore unable to attend school regularly. They are being put under huge pressure.
Many children are aware of what is going on, and I am concerned that they are encouraged to bury the issue and go to school because they do not want the pressure put on their parents, rather than opening up and getting the help and support they need. We need to ensure that schools work with parents and families when they have a child facing these issues. They should not add to the problems or the pressure that the family is under. I ask the Minister to take that on board. We can do better in getting schools to recognise the concerns and conditions that many families find themselves facing and in working with families, rather than exacerbating the problem.
It is a pleasure to serve under your chairmanship, Mr Pritchard. I applaud the hon. Member for Burton (Andrew Griffiths) for securing this debate. Children and young people’s mental health is incredibly important. I appreciate the contributions of other Members. I have similar situations of children suffering in my constituency, but I will not repeat them.
I want to focus on three issues that are important to the mental health of our young people. First, I want to raise the issue of young people’s mental health within our judicial system, which I spoke about in this Chamber only a few months ago when I highlighted how young people with mental health issues had been forgotten in the Government’s response to the Justice Committee’s report on the disclosure of youth criminal records. I emphasise that when we look at the Government’s funding plans for young people’s mental health—they are welcome, but could stand to go further—we should not forget the vulnerable young people who have been taken out of mainstream schools and placed under the care of the UK’s judicial system. Many of those young people may not understand why they are there, and they are placed under stress and pressure that even we as adults would struggle to cope with. We must ensure that does not lead to the degradation or further degradation of their mental health, which may damage their chances of rehabilitation.
Secondly, I want to raise the issue of personal, social, health and economic education—also known as PSHE, and formally known as citizenship—for those young people still within our education system. Frankly, the provision is woefully inadequate for the issues it is trying to tackle. There is little to no guidance from central Government, and how the provision is conceived and delivered is almost completely up to the school. That has produced an almost laughable system where each school can have a completely different interpretation of the curriculum and its requirements. One school might require just 15 minutes a week during form time, yet 30 minutes down the road, another school might give an hour’s lesson once a week.
Within that time, teachers are expected to cover everything from mental health to how mortgages work, to sexuality, to how Government and this place works, all with little to no guidance. Many schools simply do not provide the time required to tackle the subjects properly. The lesson material is often put together by a teacher who happens to have the time or by a third-party company that knows little to nothing about it. Neither of them may have the necessary subject matter expertise. I call on the Government to get to grips with the issue and make PSHE a statutory subject with guidelines on the content of the subject area, so that the situation does not essentially amount to, “It’s up to you.” There should be a key focus on mental health, which is too important to have such vague guidelines.
Finally, I want to touch upon the subject of loot boxes in video games. For those who do not know, loot boxes are a mechanic in video games that require someone to pay money to get a box or a pack. Within the box, they might get a piece of very good equipment, a rare boost or a character that will give them an edge when playing online against other people, or they might get something that is rubbish. If they already have it, it is virtually useless to them. To put it in plain English, loot boxes or “surprise mechanics” are essentially gambling. The mechanics also have no impact on the age rating for a game, meaning that young people of all age ranges can be exposed to what are basically gambling mechanics.
I am not someone who believes that video games are bad for young people and rot their brains, as some would put it, but such gambling can have a negative effect on young people’s mental health and cause addiction. There is a reason why we have age restrictions for fruit machines and gambling websites. Even then, we can see the negative effect on adults. I therefore call on the Government to follow the lead of countries such as Belgium and step in to deal with gambling mechanics and their impact on the mental health of our children.
It is a pleasure to serve under your chairmanship, Mr Pritchard. One in nine young people aged between five and 15 has a diagnosable mental health condition, so I thank my hon. Friend the Member for Burton (Andrew Griffiths) for securing this vital debate. The issue becomes more pressing as figures suggest that those children are twice as likely to carry mental illness into adulthood. However, the Government are taking some action and have invested £1.4 billion to improve specialist services for mental health, but we are playing catch-up.
Pressures on the younger generation are at a new high with the advent of social media. There is a constant pressure to keep up on platforms such as Instagram, Snapchat and Facebook, which is compounded when we look at their exposure to image and celebrity culture. Although social media can be a power for good, it is clear that such platforms can have a detrimental impact on children’s mental health. We have already had some truly devastating cases, such as that of Molly Russell, whose suicide sparked this important conversation nationally. I welcome the current review by the chief medical officer, Dame Sally Davies, who is assessing the impacts that social media has on a child’s mental health.
Another mental health condition on the rise, especially in young people, is eating disorders. I recently met a constituent, Lizzie Speller, here in Parliament, with the charity Beat UK, which supports people with eating disorders. Lizzie spent several years fighting anorexia. She overcame her long battle and got the help that she needed. It is fantastic that four fifths of young people with eating disorders now receive treatment within one week. Lizzie is doing a lot to help others. She has set up Mental Health Mates walks, a Chichester community group that has a monthly city walk. My husband and I joined them earlier this year. It is an opportunity to meet and talk about things that concern people. The role of Beat is important in spreading the network across the country.
Another Beat ambassador is my goddaughter’s sister, Isabella Tee, who worked hard to overcome anorexia as a teenager and now works to support others at York University. Schools have a vital role in offering support and spotting the signs when people need help. Many schools in my constituency—Chichester High School and Bourne Community College, to name just two—have done a lot to support mental health in schools and have trained mental health first aiders and pupil mental health ambassadors. On the ground, visible services are exactly what we need, and I look forward to seeing the impact of the new mental health support team pilot in my area, as the Coastal West Sussex CCG is taking part in the first wave.
Getting to grips with mental health is important, as the consequences of not doing so are unimaginable. On 17 July 2017, one of my constituents, Jo Marsden, had her life turned upside down when her 20-year-old son, Ned, took his life at Witley station. Ned had been excluded from school earlier in his life, and over the years had withdrawn from his family and friends. His mental health issues were well masked and not identified at school or later when his doctor tried to identify signs. I have met Jo several times now, and she is an inspiring woman. She has created Ned’s Fund, which offers vocational courses to young people who drop out of school. She said:
“My dream is to help as many children as I can by funding vocational training. I’m not a fairy godmother but nothing would bring me greater happiness.”
The impact of suicide on a young person is truly devastating, as my family knows from personal experience because my young cousin, Sallie Gibson, took her life some years ago.
People across Chichester continually come together to improve each other’s lives. Tackling mental health issues needs a comprehensive approach where, in every part of a young person’s life, someone is available to give a much needed helping hand.
I thank the hon. Member for Burton (Andrew Griffiths) for securing this debate. It is important because the simple way to change attitudes around mental health in this country is to talk about it. The more we do it in Parliament, the better. I pay tribute to all those, including charities such as Rethink Mental Illness, that have made a real step change in the way that we consider mental health in this country. I also give credit to the Minister. She obviously does not know what will happen next week with the change in Prime Minster, but she has been a great champion for mental health in not only doing the work that she does, but caring about it. Sometimes we get a Minster who simply goes through the motions, but this Minister cares deeply about the subject and has made a real difference.
The point about finance is important in mental health. That point has been made over the years not only in respect of adult services, but in respect of children’s services, and it has been made again today. Having the proper workforce is also important. I do not want to relegate those two issues because they are very important in this debate, but the other thing that often does not get spoken about is having a proper pathway into a service, which is a mess at the moment, partly as a result of reorganisations in the health service. We have also had cuts to local authorities and they can no longer afford to fund voluntary sector organisations. Sure Start centres have been cut, and the cuts are having an impact on people’s access to services.
I pay tribute to CAMHS. They get a bad name, but they are trying their best in the impossible job that we give them. We have to try and turn down the pipeline of people going into CAMHS services. The only way we can do that is if we have a proper triage system before going into CAMHS, so that people know whether they can get help elsewhere. We often over-medicalise mental health conditions. The Tees, Esk and Wear Valleys mental health trust in my area has a good pilot that pays for a psychiatrist to sit in a GP’s surgery so that a mental health professional can triage cases as they come in. I do not want to criticise GPs, but they are not mental health professionals. They should have a mental health professional who can triage the cases that need to go through to CAMHS or other adult mental health services and then they can try to help the others.
We need a local network of support organisations, whether it is the voluntary sector, as the hon. Member for Burton rightly pointed out, or others that do fantastic work. He put his finger on the issue of how we tender for mental health services. I am sorry, but the ones that I speak to in County Durham have contracts that are too big and they do not have the capacity to take them on, but they do valuable work in the community. In some cases, it is a way of taking pressure off the pipeline going into CAMHS and adult mental services. Parents want to know where to go, so we need signposts and pathways so that people do not wait 12 months or longer to get into CAMHS, thinking that will somehow answer their questions.
I thank the right hon. Gentleman for giving way and for his great speech. Does he agree that one of the reasons why they tender in that way is because they want to have a uniform approach across the whole country? In reality, if someone wants access to a service, people understand the local charity and are much more aware of it, and more likely to go to it for that very reason.
I do agree. In my experience the best local examples of mental health support are what is being done by local charities, most of which, frankly, run on a shoestring. They do not ask for huge amounts of money. I think it would be cost-effective for the taxpayer if we directed services into that, but we need that joined-up system. If we do not have it, we can pour as much money as we like into the system and it will not work.
I want to mention one last thing—students’ mental health, which is being highlighted in universities. Will the Minister contact Northumbria University, which is doing innovative work on using new technology to track students and highlight those who are vulnerable? I saw it a few weeks ago on a visit to the university. It is a new model, which could have implications nationally, and I think it is worth looking at. I will finish by just saying, let us keep on talking about this subject.
I thank the hon. Member for Burton (Andrew Griffiths) for obtaining this important debate. I imagine that not a single Member of the House would diminish the importance or severity of this issue. We all want every child to get the best possible start in life, but that is an empty commitment if we do not make sure that the right level of support and help is available for children who suffer from mental health conditions, just as we would for children with physical injuries. We would never allow a child with a broken leg to suffer alone, without professional treatment. Nor should we fail to provide a child suffering from depression or anxiety with the support they urgently need. In the past, the issue has not been given the priority it clearly deserves, so I am glad that finally a consensus is starting to build around the importance of improving mental health services for children and young people.
Despite the acknowledgement of how much needs to be done, the Government have failed to act decisively on the issue. Identifying a problem is all well and good. What we need is real leadership, concrete solutions and properly funded services. At present they are failing on all three fronts. Not enough has been done to address the inadequacy of funding for services or to reduce the number of children who do not have access to mental health support at all.
The Government’s children’s services early intervention grant has been reduced by almost £600 million since 2013. It is projected to decrease by another £100 million by 2020. Children’s services now face a funding gap of £3 billion by 2025. That underfunding is taking place in the context of a rising demand for children’s mental health services. Underfunding leads to a vicious cycle, as the support necessary for good mental health—provided through services such as housing, education and family support—is gradually cut away. When those resources are unavailable, early intervention becomes impossible and mental health problems are left to fester and deteriorate, until finally they require urgent medical intervention. Children are not suffering from more mental health problems at random: the conditions for mental ill health are being created by austerity.
That is why I support the recommendations of the Local Government Association’s “Councils Can” paper, which calls for the empowerment of local government to lead communities and improve young people’s mental health and wellbeing. The point about signposting pathways and helping charities is important. Properly funded housing, education and family support services need to be given priority to ensure the wellbeing of children and young people. Councils are uniquely placed to do that. That is why they need to be properly funded and at the heart of our efforts to address the issue.
Inequality is also a huge issue in the delivery of mental health services for children and young people. Research this year from the mental health charity Mind found that vulnerable people in some regions struggle with little more than half the NHS funding of those in the best-resourced areas. For example, in Surrey Heartlands health and care partnership, the average annual spend on mental health services per head of population is just under £125, but in South Yorkshire and Bassetlaw sustainability and transformation partnership the figure is over £220. The Government need to act as soon as possible. The crisis is absolutely huge.
It is a pleasure to serve under your chairmanship, Mr Pritchard. I congratulate the hon. Member for Burton (Andrew Griffiths) on obtaining the debate and on his excellent speech, which I almost wholly agree with.
I carried out a constituency survey on mental health services for young people and the responses showed that my constituents are worried and concerned and feel that the situation is getting worse. Of the top issues when we analysed the results, No. 1 was long waiting times, No. 2 was that people get care only after self-harming, and No. 3 was that the police were having to intervene to protect at-risk young people. The young people were coming to the notice of the services far too late. For example, a parent said they had had to visit the GP three times and it was only after their child self-harmed that they were referred to CAMHS. Another, speaking of her daughter, said:
“Her future has been robbed by mental illness and the NHS didn’t have the staff or resources to make a difference when it counted.”
The hon. Member for Burton and others have clearly outlined the need for more funding. If the Minister needs ammunition to help her with her arguments in the spending review, just think of the cost to the nation of not adequately funding early intervention and CAMHS before things reach crisis level for young people.
I want briefly to discuss early intervention in schools. Universal services—in education, family and youth services, as well as voluntary services—are a vital part of early intervention, identifying at-risk children and signposting them towards dedicated services. That is why we need fully funded universal as well as specialist services. However, cuts to Sure Start centres, youth services and school funding mean a loss of welfare support and other forms of support. The people in those services are the ones who pick up issues, give support and make referrals. That is why austerity in the context of mental health is not just an issue affecting CAMHS; it is about all those services. My local authority, the London Borough of Hounslow, has lost 40% of its total income through a cut of more than 80% in Government grants. That has meant that it has had to cut direct and commissioned services. Now we can see that cut after cut has a detrimental impact not just on young people’s life chances but on their physical and mental health.
Schools are a vital part of early intervention, as other Members have said. When we discuss the role of education in relation to mental health, we need to remind everyone that our schools are facing a funding crisis. They have had to implement a real-terms funding cut of 9% since 2010. In further education it is worse. FE colleges are losing an average of 20% in funding. That is certainly happening at my local FE college. It affects their ability to support young people in crisis. Teachers and school staff are already overworked, and welfare and teaching support have had to be cut. Often teachers can spot problems, but they are not trained to treat mental health issues. In addition, because of the nature of teacher training, there is often no space for teachers to learn about neurodiversity—dyslexia, dyspraxia, autism, ADHD and so on. It takes even teachers a while to recognise what the problems are. That in itself causes mental health problems. Even when they do identify at-risk students and refer them, those students face long waiting times.
We are lucky in Hounslow. We have been successful in getting £820,000 in grant funding for specialist mental health staff based in hub schools, which is good. It is one of 25 pilots. However, that is not enough and I am afraid I do not agree with the Government when they say they are spending a record amount in this area. There have been so many cuts that I believe a lot less is being spent than was funded under the Labour Government.
It is a pleasure to serve under your chairmanship, Mr Pritchard. I congratulate the hon. Member for Burton (Andrew Griffiths) on securing this important debate, and my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), who secured a debate on the issue in the main Chamber last week.
Good mental health is important to us all, especially in childhood and adolescence. If mental health problems in childhood and adolescence are not properly treated, they can continue into adult life. It is not a problem for just one part of the country. It is truly a national crisis. I appreciate that much of the debate will focus on children’s mental health services in England, but I want to highlight the situation in Scotland. The number of young people in Scotland who took their own lives increased by 50% last year—I repeat: there has been a 50% increase in suicides among young children in Scotland. We are losing young people, who have so much to offer, but who find themselves suffering in silence. It is a national tragedy across the UK. The Scottish Government pledged to reduce the number of suicides in Scotland by 20% by 2022. If that pledge is to be met, there needs to be some serious action to improve mental health support for children and young people in Scotland.
The children and young people’s mental health taskforce made a series of recommendations, including joint working between the Scottish Government and local government, to reform the way that mental health support is provided. I urge the Scottish Government to enact those recommendations in full. I back the call of the Scottish Children’s Services Coalition for an increase in investment in specialist mental health services, and I hope that the Scottish Government respond positively.
Investment alone is not the answer, however; we need to tackle the underlying causes of mental health issues among children and young people. Some 60% of young people in Scotland say that the pressure to succeed has led them to feel overwhelmed or unable to cope. One in five young people say that they are ashamed of the way they look. Others have experienced mental health issues as a result of their school environment.
We have to look for new ways to support the mental wellbeing of children and young people, which is why I welcome the “Give Youth A Chance” petition, started by the families of three young men who took their lives in Lanarkshire. The petition calls for suicide prevention and mental health support programmes to become mandatory in schools across England and perhaps the UK. That would be a positive step to ensure that the mental health support needed by children and young people was more readily accessible.
The state of children and young people’s mental health services is a national crisis. They are being let down across the UK by inadequate funding for specialist services and growing waiting lists. It is time for the Scottish Government and the UK Government to listen.
I congratulate the hon. Member for Burton (Andrew Griffiths) on securing the debate.
It is a tough time for children to be children. When I was a child, which was not yesterday, I went to school, came home and did my chores, then went out to play with the rest of the children. We did not have much, but it was all we knew. That is not the case now. Children are under so much pressure to have the best gear, go to the right places and look and behave a certain way. There is no closing the door at night to get away from the pressure; social media follows them everywhere.
I was horrified, but not surprised, to read that one in 10 schoolchildren in Northern Ireland has a diagnosable mental illness, and that 35,000 children had been treated by child and adolescent mental health services in 2018. The Northern Ireland Affairs Committee has just done an inquiry on education and health that reinforced those figures. Indeed, I have had parents in my office whose child is on the waiting list for the CAMHS team and who cannot get on it, and there are many more who should be on the list and are not, so the real number must be well above 35,000.
Schools find themselves on the frontline of dealing with day-to-day anxiety and trying to help, but it is not enough. An article quotes Dr Phil Anderson, a consultant psychiatrist in CAHMS with the Belfast Health and Social Care Trust, who says:
“The research shows there has been an increase in the emotional difficulties in children, a 50% increase since 2004.”
That is an absolutely horrendous figure. He continues:
“There are various reasons given for this. One is social media and the rise of cyber bullying and screen time. Some people have said it’s as a result of rising economic inequality and, of course, academic pressures.”
We do not have the tools to deal with that, but our young people are crying out for help.
A young lady in my constituency, Katie Graden Spence, who recently shadowed me in this place, has been open about her struggle with anxiety and mental health. She published a poetry anthology, “Searching for freedom”, which paints the scene of emotion in many young people. Katie was a finalist in a prestigious category of the Pramerica Spirit of Community awards in recognition of her poetry and fundraising for Action Mental Health, as well as her work to outline her proposals on peer-led mentoring in schools to the Department for Education and the all-party parliamentary group on mental health. She is inspirational and inspired. She is fighting those battles for herself and for others her age whom we are failing. We must ask ourselves about that.
I am thankful to the hon. Member for Burton for raising the issue, but I will be more thankful to learn how we are going to radically change how we deal with children’s mental health in the UK. Children are struggling. They need us to do more. I look forward to hearing how we will put funding in the right places and guarantee controls on social media to prevent cyber bullying and trolling, to ensure that young people know that they are loved and important, and that they matter in their home, their community and here in this place.
It is a pleasure to serve under your chairmanship, Mr Pritchard. I thank the hon. Member for Burton (Andrew Griffiths) for securing this extraordinary debate, in which there have been many contributions from both sides of the House and many interventions, which shows that the issue is a high priority in our constituencies. It is important that the subject was brought to this Chamber. His speech was detailed, extensive and passionate. I congratulate him on being an assiduous representative of his constituents.
We have heard about the main issues; I will not go through them all again but point some out. Workforce is obviously a problem, as are training, access to services, prevention, treatment, trauma and eating disorders. We have also heard about social media and how technology can be helpful in signposting people, but can also undermine mental health in young people, so appropriate safeguards must be put in place.
We have heard constituency cases from across the United Kingdom. The Office for National Statistics shows that the highest rate of suicide is in north-east England and Wales, but all Governments across the United Kingdom need to make tackling suicide a priority. I thank the Minister, who has been working hard on it and has made significant progress. The problem is, however, that we had such a long way to go that we are not yet where we want or need to be.
I thank the British Psychological Society and the Paediatric Psychology Network UK for sending me their updates and views. They pointed out the problem with access to child and adolescent mental health services and that the services continue to be run on medical models, so if a young person presents with suicidal thoughts or behaviours, unless they have a concomitant mental disorder such as depression or an eating disorder, they do not always gain access to the treatment part of CAMHS. That is wrong, because not every young person will be medically classified as having a disorder, but may need access to coping skills, treatments, counselling and perhaps family therapy. They may have social issues, rather than a condition that requires a medical diagnosis, but they still need access to crisis care to prevent suicide.
That has been brought home to me in the last couple of weeks, as we have suffered our own tragedy in East Kilbride. Ryan Coleman, a young man with his whole life ahead of him, took his own life. This weekend, I am going to a tribute event to mark his life and what he had accomplished in such a short space of time, and to support his family and friends. Families should not have to go through such tragedies, however, and Parliament must do more.
I thank the Trust Jack Foundation in Stonehouse, which has set up young people’s services to bridge the gap and make sure that something happens between a referral to CAMHS and being seen by CAMHS. It gives young people access to support from other young people who experience mental health issues and to support-based activities and therapies. Again, that came out of a personal tragedy—the loss of Jack—which his mother, a wonderful woman, has turned into a positive thing for other children across the area. I cannot thank her enough.
Transitions are important; we need to focus on the transition from child to adult mental health services, and services in colleges and universities. Will the Minister think about the children who have lost a parent serving in the armed forces, and update me on that? A couple of weeks ago, I went to an event with the armed forces parliamentary scheme where I found out that there is a lot of work going on in the US to support young people who lose a parent in service, but there is no much support, treatment and access to services in the UK. Obviously, children who lose a parent serving in the armed forces also lose their home and support network. They have to make dramatic adjustments, and for young people, that is a critical time.
Governments across the United Kingdom are trying their best to improve services, but we have a very long way to go. I want to help everybody in Westminster and the other Governments to achieve the progress we need.
It is a pleasure to serve under your chairmanship, Mr Pritchard. I congratulate the hon. Member for Burton (Andrew Griffiths) on securing this important debate. I thank hon. Members on both sides of the House who have contributed some extremely moving testimony from their own lives and their experience as constituency MPs. I will refer to some of their contributions during my speech.
Fundamentally, children’s mental health services are in crisis because the funding is inadequate and prevention has been cut at a time when the pressures on children are higher than they have ever been. Difficulties in childhood, such as growing up in poverty or experiencing neglect, abuse or childhood bereavement, which my hon. Friend the Member for Sheffield, Heeley (Louise Haigh) spoke about, can have a huge impact on a child’s mental health. There are also new pressures that affect all children, which many of us did not experience, such as the increase in exams and tests at school and the rise of social media, which has created new forms of bullying and has put new pressure on children in relation to their self-image and how they feel about their bodies.
I want to explore the issue of childhood trauma a little more, because it plays an important role in developing higher incidence of childhood mental ill health. There are three high-risk factors that indicate that a newborn baby’s life chances will be dramatically reduced: having a parent who is addicted to drugs or alcohol, having a parent with severe mental ill health, or witnessing a parent being subjected to domestic violence. Any one of those three factors creates a significant risk for the child, but shockingly 16,000 babies are born every year in this country to parents with all three of those risk factors.
Without intervention and support, those children have very little chance in life. They will become the young people committing knife crime. They will end up in the care system. They will fill our prisons, as my hon. Friend the Member for St Helens South and Whiston (Ms Rimmer) pointed out. They will end up living on the streets, develop mental ill health and die younger. My hon. Friend the Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) pointed out the alarming increase in the rate of suicides.
One in three mental health conditions relates directly to adverse childhood experiences. A study by Safelives shows that more than half of children who witness domestic violence develop behavioural problems and have difficulty forming relationships later in life. Their fragile young minds are deeply traumatised by seeing their mother beaten up by a violent and abusive partner in their home, which should be a safe space in which to grow up. Professionals do not always recognise that the problem underlying what they may term “difficult behaviour” may be mental ill health caused by traumatic experiences in earlier childhood. Professionals who work with children are not routinely trained in how trauma can affect behaviour, so the child does not get the help they really need. We need services to get dramatically better at identifying when challenging behaviour comes from trauma so we can treat the problem at source, rather than continuing to fail the child, who had precious little chance from the moment they were born.
Mental ill health affects not only the most vulnerable young people, of course. As we have heard, one in eight children experiences mental ill health, yet the recent NHS mental health prevalence survey found that only one in four young people with a mental disorder is seen by a mental health specialist. My right hon. Friend the Member for North Durham (Mr Jones) is right to call for better access to care. As my hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury) said, on average it can take three visits to a GP before a child is referred for specialist assessment. They then have to wait an average of six months for treatment to start. Of course, there are far worse waiting periods. My hon. Friend the Member for Ashfield (Gloria De Piero) spoke about a 72-week wait, and my hon. Friend the Member for Barrow and Furness (John Woodcock) spoke about a young man, Drew, waiting 15 months for a CAMHS assessment. In that time, the child’s mental health condition gets worse. It is a very long time for the child, with very serious implications for the rest of their lives.
Many more severe mental health problems could be avoided if we invested more in early help and prevention. We know it works, but the cross-party Local Government Association points out that children’s services face a £3 billion funding shortfall, to which my hon. Friend the Member for Warrington South (Faisal Rashid) referred. That means that the lack of early intervention work is now reaching an absolute crisis point. This country is failing some of the most vulnerable children in our society and then blaming them for our failure to provide the help that they needed. Thousands of young people did not have a chance from the moment they were born.
I have the highest regard for the Minister from our previous interactions on related issues. I know that she is deeply committed to these issues, so I hope she will act on what she has heard today. I have some questions of my own to ask before she responds. Will she ring-fence NHS mental health budgets and require that they be spent on mental health services, rather than being reallocated elsewhere, as we are currently seeing? Will she invest in prevention and early help, rather than waiting for mental health problems that develop early in a child’s life to turn into crises as they grow up? Will she ensure that children’s services professionals are trained to recognise trauma and provide appropriate care that meets the child’s needs, rather than blaming them for behaviours that have arisen because of the trauma that they have experienced? Will she make sure babies born to parents with the highest risk factors get the support they need from the moment they are born, rather than allowing their lives to be written off and wasted? I hope very much that we will hear positive responses from the Minister, because no country that loves its children can keep treating them like this.
I thank all hon. Members who have contributed to this afternoon’s debate, which has given me a lot to think about and a lot to address. I pay particular tribute to my hon. Friend the Member for Burton (Andrew Griffiths), who gave an excellent exposition of the challenges before us. I welcome the contributions of all Members. We have covered a lot of content, and I will do my best to address all the points that have been made—there are a hell of a lot.
As the right hon. Member for North Durham (Mr Jones) said, for a long time we have not talked about mental health enough. It has been a taboo subject, and these issues have been left to fester. As a consequence, mental health has been a Cinderella among public services. People with mental ill health have suffered discrimination at the hands of the state in many ways.
We have identified that children’s mental health services have been underfunded for generations, and we will have to fix that—of that there is no doubt. Unfortunately, that takes more than a magic wand. It requires investment and all commissioners to step up to the plate. It requires good partnership working between NHS organisations, local authorities, schools and everyone involved in the system. It is, frankly, a massive culture change, but we need to deliver it. We have heard examples this afternoon of individual children who are being failed by poor service. Frankly, that is the state’s failure, and we are all duty-bound to put it right.
I am grateful that hon. Members have given me these examples, challenging though they are, because they are a helpful reminder to the system that these are individual people. People like Drew should not have to wait 15 months for an appointment. The hon. Member for Barrow and Furness (John Woodcock), the hon. Member for Westmorland and Lonsdale (Tim Farron) and I have talked about the challenges in Cumbria. In terms of delivering the transformation and improvement we are aiming for, we are seeing a real lack of consistency in the speed and quality of services as they are rolled out. Again, that is a challenge for us as a system. In my contacts with NHS England, I am keen to ensure that we get more uniformity in provision.
In answer to the point the hon. Member for Croydon North (Mr Reed) made about ring-fencing funding for mental health services, NHS England will challenge CCGs very directly about how much money they spend on mental health services. We are very clear that they should spend more than the increase in their budgets. Although we have always rejected the suggestion of a ring fence on the basis that they can often be seen as a ceiling, which we do not want, there is now room for some very challenging comments. We really need to start thinking about whether what we have in place is delivering the outcomes that we in this Chamber and we as a society ought to be able to expect.
There is so much to cover that I am sure I will miss something, but there are some points that I really want to emphasise. The right hon. Member for North Durham talked about the role of the voluntary sector. That was music to my ears. I have said repeatedly that good support for people with mental ill health does not necessarily have to be medical—in fact, the wrap-around service that can be provided by just company and comfort is far better delivered by organisations in the voluntary sector, but it is part of our health offering. I am very challenging in telling CCGs and commissioners that they should be thinking about commissioning services from the voluntary sector. Taxpayer funding should deliver the outcomes we want, and the voluntary sector can do that better and cheaper than we can by medicalising the problem. I cannot emphasise that enough.
On delivering more efficient pathways, clearly, the ability to triage people to services that are not medical, are more fleet of foot and can react more immediately provides an opportunity for early intervention that will deliver the better outcomes we want for people.
Looking particularly at individual groups, we heard reference to people with neurodiverse conditions—people with ADHD, ASD and dyslexia. Often, those things go undiagnosed. We need to ensure that, in schools, those people are not just treated as difficult but signposted to places where they might get additional help. We know that earlier diagnosis of those conditions can be the difference between developing mental ill health and not, so we must do better on that. Obviously, the next wave of delivering a transformation for children will involve continuing our pressure on the need to deliver a better mental health service for children, but key to that for me is getting earlier diagnosis of autism and ADHD.
I am not shy about articulating the benefit of that for society; early diagnosis is not just for the benefit of those children, although of course they deserve the best services. We heard about the impact of trauma, and everyone who mentioned it was absolutely right. We have no excuse for failing those people and not putting support around them when they need it. Not only do they deserve that, but by doing so, we win as a society. As I said, those people end up in the care system at best and in prison at worst. Our prisons are full of people who have been failed by the state because we did not give them that hand up when we needed to. We must grasp this issue, and I am not shy about raising that challenge. Yes, it is good value for money—I am sure I speak for all hon. Members when I say that I would rather spend more on health than on prisons, thank you very much. We must ensure that we support people when they need it and recognise the impact of trauma.
Hon. Members will be aware of the work that my right hon. Friend the Member for South Northamptonshire (Andrea Leadsom) led when she was in Government on the support given to people in the first 1,001 days of life. She has a debate on that subject in the main Chamber later this afternoon—in fact, she is speaking now. I am sure she will echo some of the points the hon. Member for Croydon North made. We can see the children who are at risk. The state has every opportunity to support those people and, frankly, we should be a lot more assertive in doing so. As I said, those individuals will benefit, society will benefit and, of course, the taxpayer will benefit because we will not be spending money on failure.
The hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) spoke movingly about the increase in suicide among young people. Collectively across Government, we need a better understanding of the pressures facing young people, which seem to be a lot more acute than they were when I was growing up. Bluntly, I used to play at “Charlie’s Angels”; I did not expect to look like them. That might seem a trite thing to say, but body image puts massive pressure on our young people.
We used to think that kids would be safer in their bedrooms than if they went out to play on their bikes. That is no longer true, because the way people are routed through content when tackling social media leaves them very much at risk. Although we can celebrate the revelations and opportunities that the internet and social media have given our young people, they bring with them risks, and we need to be a lot more on top of those. I am glad to say that I am now in regular dialogue with those companies. To be fair, they are stepping up to the plate at this stage, but that is not to say that we should not consider legislation where we can see that that would bring value in protecting young people.
Obviously, we have made commitments to increase funding. We will continue to do that, because we need to ensure that we meet the unmet need that was alluded to. As I say, money spent early is money spent wisely and money spent less, so we must absolutely continue to do that. The value of early intervention is totally unarguable when expenditure on acute service is so much costlier.
Waiting times were mentioned, and I will take that away. We need to get a much better handle on areas with particularly long waiting times. We have set targets. Some 80% of young people with urgent cases are seen within a week. Again, this comes back to the extent to which we triage services. The really important thing about early intervention and getting support to children at an early stage is our proposals for mental health support teams to work directly with schools—my hon. Friend the Member for Burton alluded to the project starting in his constituency. Those teams will be able to equip the schools themselves with more material and support to help them embed mental wellbeing throughout the curriculum, but they will also be the place for additional support and the place where services are referred.
I thank all hon. Members who contributed to the debate. We are on it, but I would be the first to admit that we still have a long way to go to deliver mental health services for children that we can all be proud of.
At a time when the public look in on this place often with derision and sometimes with desperation about how we behave, this debate has shown Parliament at its best. There was lots of consensus, lots of cases were mentioned in a heartfelt way, and we heard lots of determination to make a difference. I think we all recognise that these issues involve young people in a desperate state and parents who are equally desperate about the future of those children. If we can come together and deliver the early intervention and support mechanisms that can make such a difference later in life, we can literally save the lives of those young people. I thank everybody who contributed to this really positive debate. I hope it is just a springboard for us to go further and ensure we deliver for all those young people across the country.
Question put and agreed to.
That this House has considered children and mental health services.
No Deal: Agriculture Tariffs
[Mr Philip Hollobone in the Chair]
I beg to move,
That this House has considered a proposed tariff schedule for agricultural products in the event that the UK leaves the EU without a deal.
Diolch yn fawr iawn, Mr Hollobone. It is a pleasure to serve under your chairmanship once again.
On 13 March this year, the British Government published their temporary tariff regime for a no-deal Brexit. At the time, the announcement gained little political attention as it was the policy of the period to avoid no deal at all costs. One of the greatest failures of the current Prime Minister is her use of the phrase,
“No deal is better than a bad deal”.
She fell into a bear trap set by the extremists in her own party. When the British Government switched strategy in summer 2018 to warn explicitly about the dangers of no deal as a means of gaining parliamentary support for her deal, it was too late. The infamous phrase had legitimised the totally reckless policy of a no-deal Brexit.
With the Prime Minister’s demise, the leadership election for the Conservative party has been dominated by the question of who can puff out their chest the most on Brexit. The debate has occurred in a parallel universe, far divorced from political realities. However, one conclusion we can safely assume is that it seems inevitable that no deal will become a viable option for the next Prime Minister, so all aspects of British Government policy in relation to a kamikaze Brexit deserve greater scrutiny.
A key aspect of a no-deal situation is that, on 1 November, if the likely next Prime Minister sticks to his Halloween promise, the British Government will have to introduce an independent tariff schedule for goods entering the newly formed UK customs area. A major consequence of leaving the EU with no deal is that the territories of the British state will no longer inhabit the safe harbour of the EU customs union.
I could have concentrated on a whole range of goods that will be impacted, but I want specifically to debate agricultural products for two reasons. First, Carmarthenshire is a proud agricultural county, and therefore leaving the EU customs union will have a disproportionate impact on the communities I serve. Secondly, tariffs on agricultural products are traditionally far higher than on other goods. That is especially true of the European Union, the destination for the vast majority of Welsh produce.
As part of the EU customs union, Welsh farmers are protected by those high tariffs, which has enabled our food producers to develop high-quality goods with unhindered access to the most lucrative and largest market in the world. The agricultural industry faces not only the loss of unfettered free access to its main export market in Europe; the new tariff schedule and its accompanying quotas offer precious little protection for the domestic market from being flooded by lower standard food products from around the world. That double hit would be too much for many farmers in my constituency and beyond. I cannot emphasise the dangers to the industry enough.
Both farming unions in Wales agree. John Mercer, Director of NFU Cymru, said:
“It is absolutely clear that a no deal scenario will be catastrophic for Welsh and indeed British agriculture. A scenario where Welsh farmers have to operate under the ‘no deal’ default of WTO tariffs will have devastating effects and will severely threaten the livelihoods and business of Welsh farmers.”
I am delighted to report that Mr Dafydd Jarrett from NFU Cymru is watching our proceedings.
Glyn Roberts of the Farmers’ Union of Wales said:
“It says it all that the prospect of a hard Brexit means a rich and highly developed state is stockpiling food and hoping to use an exemption to WTO rules on the Irish border which would more normally be applied in cases of war or famine. Yet this situation is not compulsory; this is a crisis which in fact we can easily avoid by acting in the best interests of our four nations; by withdrawing Article 50 and telling people honestly why Brexit must take place over a safe and realistic timetable.”
In July 2018, the British Government lodged proposed schedules with the World Trade Organisation setting out the most favoured nation tariffs that would apply to imports to the UK after Brexit. Subsequently, in March 2019, the British Government set out proposed temporary tariffs to apply in the event of a no-deal scenario, which would see zero tariffs applied to 87% of imports measured by value for up to a year in a temporary regime, while consultation and review on a permanent tariff regime takes place.
I am pleased that the British Government have exercised at least a degree of sensitivity in their treatment of the sheep sector, recognising the need to maintain tariff protection for lamb in the event of no deal by maintaining the full WTO tariff of 48% on lamb imports. However, what they give with one hand, they take away with the other. Tariff rate quotas will allow lower or zero tariffs to be applied up to a certain level of imports on some products. We know, for example, that New Zealand will continue to enjoy significant tariff-free access to the UK market for 110,000 tonnes of lamb annually. One of our principal competitors in the lamb sector will therefore enjoy more generous tariff-free access to our market.
I was involved in some of that work and the development of that schedule as a Minister. The existing New Zealand tariff rate quota would be split in half, giving it less access to the UK market than previously. Is the hon. Gentleman aware that, in any event, in recent years New Zealand has used only about 70% to 75% of its current rate quota because it cannot compete with lamb produced in the north-west and south-west of this country even before it reaches that ceiling?
I recognise the former Minister’s expertise in the matter. We will have to wait and see what farmers have to say about that. I invite him to attend the Royal Welsh show next week and make that point. I am sure he would receive a welcome response to his comments.
The new Brexit date of 31 October will coincide with very high numbers of finished lambs coming on to the UK market.
Will my hon. Friend take this opportunity to invite Ministers not just to the Royal Welsh show next week but to Balla Mart, which will be held on 31 October, when perhaps 800,000 small-body lambs will come to market at a time of considerable pressure on prices?
I welcome my right hon. Friend’s intervention, because it takes me to my next point. If we are locked out of European markets, there is no way in which domestic consumption could pick up the slack. Additionally, the final quarter of the year sees the sale of light lambs from Wales, which are traditionally destined for export. There is no way in which they could be redirected into domestic consumption. Economists previously assumed that the loss of the EU market would depress UK farm-gate prices by 30%.
I am grateful to the hon. Gentleman for being so generous. The added threat of tariffs, as he suggests, is that British supermarkets will think they have farmers over a barrel because of the loss, in effect, of our export markets. Does he agree that Ministers ought to take action now and increase the powers of the Groceries Code Adjudicator to ensure that supermarkets cannot exploit the situation?
I am grateful for that valid intervention. Those are the remedial measures that the British Government should be looking at urgently to protect our domestic farm producers. We are all aware of the imbalance there has been in the supply chain over many years, with, as he said, producers under the barrel of the supermarkets. The situation may well be exacerbated by what comes in the following months.
To return to my point, economists believe that farm-gate prices will fall by 30%. With an additional 800,000 lambs on the domestic market at the end of October, farm-gate prices will come under additional pressure. I therefore call on the British Government to commit, on top of the measure mentioned by the hon. Member for Westmorland and Lonsdale (Tim Farron), to additional funds for Wales to be able to implement contingency plans should the worst happen and we find there is unsellable surplus on the domestic market. There would be a disproportionate impact on Welsh agriculture.
In other sectors, the British Government have elected partially or completely to dismantle tariff walls on most products. Tariff rates of 45% for beef, 0% for eggs and 22% for poultry meat will apply for imports into the UK from the EU and the rest of the world, while our exports of those products to the EU will face tariffs of 84%, 19%, and 48% respectively. In the dairy sector, only certain products—such as cheddar with a 7% tariff and butter with a 15% tariff—will be afforded some degree of protection, with the EU applying tariffs of 57% and 48% respectively on those products.
I am grateful to my hon. Friend for his time. Does he agree with Dairy UK’s analysis that the toxic combination of WTO tariffs on exports aggravated by zero tariffs on imports will cause a massive shock to raw milk prices? That will affect big dairy sector employers such as farmer-owned South Caernarfon Creameries.
That was another valid intervention. The hit will not be just to core producers, but along the supply chain to some of the producer and production capacity as well.
Commodities such as skimmed milk powder, yogurt, whey, cream and liquid milk will not be protected by any tariffs. If farmers in Northern Ireland cannot send their liquid milk into the Irish Republic for processing and export, there will also be the problem of a major oversupply of liquid milk on the domestic market.
In my constituency we have Lakeland Dairies, which has two factories in Northern Ireland and two factories in the Republic of Ireland. Michael Hanley is the chief executive officer of that firm. He says that whether or not there is a Brexit deal, life will go on. In other words, the movement of milk across the border, either way, in liquid or powder form, will still take place. We need to be aware of what some businesses are saying. That comes straight from a firm in my constituency.
I appreciate the hon. Gentleman’s expertise; he is a farmer himself, I believe. However, if there is a no-deal Brexit, the European Union will have to protect its customs and market territory under all circumstances; otherwise, it would undermine the essence of the customs union and the single market.
Owing to our inability to discriminate between countries under WTO rules, the tariffs that we apply to the EU27 in the case of no deal will be the same as those we apply to countries with which we do not have a trade deal. At the moment, that is basically the rest of the world, apart from the Faroe Islands and a few other territories. That would mean that South American beef, which is currently subject to the EU’s common external tariff of 84%, would, in the event of a no-deal Brexit, be able to enter the UK subject to a 45% tariff and out-compete our domestic producers.
Many classes of imported product will be produced to standards that are currently illegal in the UK, and that will undermine our high domestic standards. As an unintended consequence, it will also hinder our ability to trade with our biggest market, which prides itself on high standards. The fact that the UK could be on the cusp of leaving behind a trade policy based on almost half a century of EU membership and swapping it for a trade policy based on WTO tariffs and protection for a handful of products is, to say the least, deeply concerning.
All that, and I have not even begun to countenance the north of Ireland. The UK temporary import tariffs are set to apply to products exported from Ireland to the British mainland but not to goods crossing from Ireland into Northern Ireland. Although protecting the integrity of the Good Friday agreement must be a priority, that fantasy solution has been branded useless by the unions, as it flies in the face of WTO and EU rules.
On another point often used by the British state to defend its tariff schedules, although I recognise the importance of ensuring that food prices do not rise in the immediate aftermath of no deal, the second-order effects of a no-deal Brexit on the economy could well lead to the cost of living sky-rocketing, rendering that argument null and void. Surely, ruling out no deal in the first place is the best way of achieving food price stability and food supply. If the next Prime Minister insists on keeping the myth of no deal alive, I would urge him to prioritise revisiting the proposed tariff schedules, with a view to ensuring that protections are maintained rather than eroded or removed completely.
From a wider strategic perspective, what proponents of no deal do not admit is that the strategy is essentially a negotiating tactic. I do not think that even the mad caps of the Tory European Research Group want to base the British state’s trading relationship with the EU on the North Korean, Venezuelan, Cuban, Belarusian and Kazakhstani model. They believe that threatening no deal will secure favourable terms from the European Union. That has not been the case to date and is highly unlikely to change in the autumn, owing to the simple fact that the European Union holds all the cards in the negotiations.
I do not think our inability to secure such terms is down to insufficient effort by previous UK negotiators. The strategy is the international trade equivalent, as one expert put it, of placing a gun to our own head and telling our opponent that we will pull the trigger unless they concede. In that case, they are likely to say, “Go ahead.” The reality is that, far from being intransigent, I am amazed by the patience of our European friends as Westminster goes through a full-scale political nervous breakdown.
The strategy, however, has developed. Some in the Conservative party now believe that the crisis of a no-deal situation, which will face the British state on 1 November, is the best way to secure favourable terms in future negotiations, as opposed to doing things in a managed, grown-up way. It is a game of risk, in other words. Those advocating no deal are prepared to throw all their chips in the air in the hope that they fall on the right roulette numbers. Personally, when dealing with people’s jobs and living standards, I prefer a more strategic and nuanced approach.
Before the Minister starts blaming my side of the argument for keeping no deal alive by not voting for the Brexit deal, it is the case that the Brexit model and narrative in front of us today has shifted drastically towards a harder, more extreme Brexit. At the start of the process, directly after the EU referendum, a soft Brexit was perceived as staying within the framework of the EU single market and customs union, while a hard Brexit was widely perceived as Canada-plus. At the time, Plaid Cymru would have been content with the former. Indeed, we have voted for those options when they have been before the House. By now, the discourse of a soft Brexit looks more like Canada-plus, while a hard Brexit is widely accepted as being no deal. There is no way on earth that we could accept either of those options with a clear conscience.
The reality of the situation is clear: on day one of a no-deal Brexit the British state will have to negotiate a series of mini deals or face dire economic consequences. No deal is therefore a complete oxymoron. The European Union has said clearly that its priority before any meaningful negotiations would be settlement of the £39-billion divorce bill, citizens’ rights and the British border in Ireland. Considering the British Government will have to concede on those three issues no matter what they do, I am at a complete loss as to why anyone who supports Brexit voted against the withdrawal agreement.
Over the last year, the British Government have clearly outlined the dangers of a no-deal Brexit. On top of an economic recession equivalent to the great financial crash of 2008, highlights include troops on the street to deal with civil unrest; food shortages and higher prices as import supplies are disturbed, especially for fruit and vegetables; customs checks costing UK businesses £13 billion a year; no legal protections when buying products and services from EU countries, while UK courts no longer offer redress for consumers; flights from UK airports not receiving equal treatment when traveling to and landing at airports of countries who are members of the common aviation area; the Eurostar being disrupted until new arrangements are negotiated with each country along its routes; and fishing boats losing access to EU fishing waters, and being unable to land their catch at EU ports—and that is just what the British Government have chosen to share with us over the last few months.
Pascal Lamy, who should know a thing or two about such things as director general of the World Trade Organisation between 2005 and 2013, equates leaving the European Union single market and customs union and trading on WTO terms to leaving the first division and facing a double relegation to the third division. Aware of the potential backlash to such a reality, no-deal proponents now argue that the British state could seamlessly enact article XXIV of the general agreement on tariffs and trade to keep the current tariff schedule. That argument was shot down last week by the WTO’s current director general, who said:
“Article XXIV of the GATT is simply the provision of global trade law under which free trade agreements and customs unions are concluded… If there is no agreement, then Article XXIV would not apply, and the standard WTO terms would.”
In other words, as we now famously know, paragraph 5(c) of article XXIV of GATT states that it applies only if there is a deal—the direct opposite of what the no-deal apostles are arguing for.
For that reason, I have little doubt that, were the British Government to adopt no deal as its official policy, they would lose a vote of no confidence in this House. I for one am certainly committed to voting to bring down the British Government in order to defend the economic interests of my constituents. Diolch yn fawr iawn.
The debate can last until 4.30 pm. I will call the Minister at 4.20 pm. To speak for the next 90 seconds, I call James Cartlidge.
Thank you, Mr Hollobone; I will be very brief. I congratulate the hon. Member for Carmarthen East and Dinefwr (Jonathan Edwards) and thank him for allowing me to make a short point that is very important to me. I had a meeting with arable farmers in Shimpling in my constituency two Fridays ago. They are extremely worried about the prospect of no deal. Under the current proposal, we are suggesting nil tariffs on imported wheat and barley into the United Kingdom, while exports will be subject to an out-of-quota tariff of almost €100 per tonne, making their being unmarketable a serious prospect.
Obviously, there is no time to go into the potential impact of that. I am sure that the Minister, like me, does not want no deal, but were no deal to happen we must revisit the tariff schedule from the point of view of protecting arable farming. Otherwise, it could face a serious impact. In my view, we should respond with a reciprocal tariff to ensure that the breadbasket of England, just like our farmers in Wales, is on a level playing field with the rest of the world.
I congratulate the hon. Member for Carmarthen East and Dinefwr (Jonathan Edwards) on securing this debate on the proposed tariff schedule for agricultural products in the event of the UK leaving the EU without a deal.
I reiterate the position of the UK Government: leaving the EU with a deal remains our top priority. I hear the hon. Gentleman’s justification for not voting for the deal, but the deal that I voted for three times already this year represented a compromise between people such as him, who seem to think that being in the single market and customs union is the only way to deliver Brexit—in my view, it would be Brexit in name only and would not give us the freedom to negotiate free trade deals around the world—and others, who seem to want some sort of pure Brexit. I believe the compromise deal was a good deal. Had we voted for it, we would have left on 29 March and would now be in negotiations on the trade arrangements with the rest of the European Union.
I gently remind the hon. Gentleman that 52.5% of the people of Wales voted to leave the European Union. They will be frustrated that some parties in Wales have not voted to deliver on that. He said it was a narrow margin, but the majority for the 1997 devolution referendum was 50.3%, and he seemed very happy to stick with that.
That is something that has been raised on several occasions. Is the Minister aware that there was a further referendum on devolution in Wales in 2011, which saw the Welsh people over- whelmingly support granting further powers to the Welsh Government?
I understand that a win is a win, which is why the results of the initial referendum and the referendum on Britain’s continued membership of the European Union should be respected and delivered on by all parties in Parliament.
As a responsible Government, we have spent more than two years carrying out extensive preparations for all scenarios, including no deal. Nowhere has the preparation been more assiduous and detailed than in my own Department. As we heard, the Government announced on 13 March a temporary tariff regime that will apply for up to 12 months should the UK leave the EU without a deal. In developing the policy, we have sought to balance the five principles set by the Taxation (Cross-border Trade) Act 2018. The five principles include taking into consideration the interests of consumers, producers, external trade, productivity and competition.
We analysed a range of evidence, including information on average trade volumes, tariff data and Government modelling on tariffs in a no-deal scenario, supplemented with business stakeholder engagement. Under this policy, the majority of UK imports—87%—would be tariff free. However, tariffs will be in place for the remaining 13% of overall trade, to avoid significant adjustment costs for certain agricultural products, where tariffs help to provide support for UK producers against unfair trading practices such as dumping, and to maintain our trade commitments to developing countries.
We have not had tariffs on cereals to any extent for a number of years. Indeed, I believe the protections that we are introducing through tariffs on imported poultry meat will help protect the cereal industry, because the major customers of our cereal producers will be producers of poultry and other meat products, which we are protecting.
I declare an interest in this issue as the chair of the all-party parliamentary group on eggs, pigs and poultry, which has asked me to pose the following question. Does the Minister agree that it is absolutely essential that eggs and egg products are included in the tariff scheme, given that it is the most effective way to ensure that all UK egg producers can continue to make improvements and further welfare standards without the threat of being undermined by low-quality imports from third-world countries?
I hope I can to some extent reassure the hon. Gentleman on the issue of shell eggs, which is the major egg market. Supermarkets have made it clear that they would not seek to buy lower quality products, and that they will continue to sell only Lion mark products. I have heard representations on liquid and powdered egg, which might be a problem, and we will continue to listen to the industry.
The no-deal tariff policy has been carefully designed to mitigate price spikes should we apply the full EU most favoured nation rates to our trade with the EU, which will result in large tariffs and potentially price increases for both consumers and producers. I will give a few examples. Should we retain EU MFN tariffs, it will result in tariffs on pasta of over 20%, and 12% tariffs on basic foods such as potatoes, cabbage and lettuce.
The policy has been designed with the objective of minimising disruption in the agricultural sectors, and it aims to strike the right balance between exposing sectors to an unreasonable level of disruption and liberalising tariffs to maintain current supply chains and avoid an increase in consumer prices. A mixture of tariffs and duty-free quotas will therefore be used for beef, sheep meat, poultry, pig meat, butter and some cheeses. The aim is for their impact on production and consumption patterns to be broadly neutral. A point was made on lamb imports from New Zealand, which will be maintained at roughly the same levels. Lamb production is of course seasonal, and New Zealand production has always filled a gap in the UK market.
The export tariffs for UK farmers, including Cumbrian hill farmers, into the single market worry me the most. Would the Minister consider the potential for increasing the powers of the Groceries Code Adjudicator, so that it can prevent supermarkets from taking advantage of the loss of export markets by paying our farmers a pittance after 31 October, should we have no deal?
Well, I will now turn to the sheep meat market, which is my single biggest concern about a no-deal Brexit. Supermarkets will operate only within the market. There is an idea that supermarkets will drive prices down. Should we have an oversupply of lamb—we could well have, as lambs come on to the market in the autumn, around the time that we could leave the EU without a deal—it will put tremendous pressure on the market. We have already seen that lamb consumption is pretty inelastic in the UK, with a 4% year-on-year reduction. We will also have the big store markets, particularly in hill areas in places such as Wales and Scotland. Hill farms that cannot keep their sheep over the winter will bring lambs to market, which could be affected by the impact of a no-deal Brexit.
As I said, the largest economic risk to the sheep sector is limiting or halting the export of lamb to the EU. The sector is unique among UK agriculture in relying heavily on exports to balance supply—indeed, we are net importers of most products. UK lamb exports will face both tariff and non-tariff barriers in the event of a no-deal Brexit from the EU. UK exports were worth £365 million in 2018, with 97% destined for the EU. To export to the EU, the UK must be recognised as a third country. Even then, the imposition of EU MFN tariffs—around 50% in ad valorem terms—would reduce the competitiveness of UK lamb on EU markets and consequentially reduce our exports. Should the UK be listed as an approved third country, it will need to meet the EU’s additional requirements for third-country products of animal origin, including movement through a border inspection post, pre-notification of delivery, checks on marketing standards and export health certificates.
My boss, the Secretary of State, has said that he will support vulnerable sectors, should the price of sheep meat fall considerably. In the event that an aid scheme is deemed necessary, it is likely that we would use retained EU powers; hence the scheme would be exempt from state aid rules. As I said, UK lamb exports were worth £365 million in 2018, with most going to the EU.
In March, the British Government said it would have to undertake a mass culling programme of lambs and sheep in the event of no deal. Is that still the policy of the British Government, should they pursue no deal in November?
That is not the policy of the British Government. As I say, we are looking at emergency measures, and various figures have been bandied about. The president of the National Farmers Union suggested that the cost of supporting the sheep industry—probably a system involving a headage payment based on the ewes that farmers had already declared—would cost around £150 million. We understand its scale, and I am sure the Treasury will be able to consider that. As I say, we do not want a no-deal situation; we need to get a deal over the line. Whoever the Prime Minister is next week, the best way to minimise the impact on farmers—particularly sheep farmers—is to get us a better deal that is acceptable to Parliament. Every single hon. and right hon. Member of the House will need to examine their conscience and consider how they have voted this year in a way that did not deliver on Brexit.
It is important that we deliver on Brexit. Confidence is waning in our democratic systems, and the Brexit party did very well in the European elections. We have only ourselves in the House to blame for not delivering on Brexit, and sheep farmers will pay the greatest price. We will still get our salaries as MPs, but they will pay the price of our failing to secure an agreement.
In conclusion, I re-emphasise that leaving the EU with a deal remains the Government’s top priority, but the tariff policy has sought a balance between the impacts on consumers and producers in the event of no deal. We expect the impact on UK consumers as a whole to be broadly price neutral should these changes be transmitted to retail prices, and we will provide support for our most sensitive sectors.
Motion lapsed (Standing Order No. 10(6)).
Drug Treatment Services
I beg to move,
That this House has considered drug treatment services.
It is a pleasure to see you in the Chair, Mr Hollobone. This is a very timely debate, because today we learned shocking new figures for drug-related deaths in Scotland. There were 1,187 drug-related deaths last year, which is an increase of 27% on the previous year and the highest drug death rate in the EU. We await the 2018 figures for England and Wales without much hope for better news or an improvement.
Today also sees the launch of a new report called “Towards Sustainable Drug Treatment Services” by the research-led biotech company Camurus, which has done some extremely interesting research on the state of drug treatment services, including anonymised surveys of 22 directors of public health in England. I thank Camurus for sight of that report and thank those who have sent me briefings from other organisations, including the Hepatitis C Trust, Release, the Alcohol Health Alliance UK, the Local Government Association, Humankind and the Royal College of Psychiatrists. I will not be able to refer to all those briefings in this relatively short debate, but a couple of themes emerge from most if not all of them.
First, there is worry across the sector that the whole drug treatment services system is under pressure—some would say under threat. Since around 2012, Government cuts have squeezed treatment services so much that they are under strain and struggling to cope with demand. In 2010, the coalition Government inherited one of the best drug and alcohol treatment systems in the world, with over 250,000 people treated every year. Drug-related crime was decreasing, HIV and AIDS were under control, and tens of thousands were overcoming addiction through opiate substitution or abstinence-based programmes. The Labour Government prioritised that sector in the late 1990s as part of their social exclusion agenda, and raised treatment budgets from around £200 million per year in 1998 to more than £1 billion by 2003.
When the coalition Government’s austerity really began to hit public services, the hardest-hit area was local government. When local authorities became responsible for the funding and commissioning of drugs services under the Health and Social Care Act 2012, they were already struggling with the reduction of approximately 37% in central Government funding between 2010 and 2016. Between 2014 and 2019, net expenditure on adult drug and alcohol services decreased by 19% in real terms. In 2017, the Advisory Council on the Misuse of Drugs warned that local authority funding would prioritise mandated services over non-mandated services, such as drug services,
“particularly if service users are stigmatised or seen as undeserving.”
All the stakeholders who contacted me have expressed their dismay at the impact of the cuts in recent years. More than a third of the public health directors surveyed by Camurus believe they will be unable to keep up with demand for substance misuse services in the coming year.
I thank the hon. Gentleman for giving way and for bringing this important debate to Westminster Hall. The figures for Scotland are horrendous, but the figures for the United Kingdom, including Northern Ireland, also show a rise. Does he agree that the current system is not equipped to deal with the level of drug abuse and need for treatment, and that the waiting times for dedicated facilities leave people without support for too long, which inevitably leads them back to their coping methods and further addiction? Those facilities need to be upgraded and made more available.
I agree with the hon. Gentleman; not for nothing is the UK labelled the drug-death capital of Europe. That should worry us across the UK.
The second theme that emerged from the reports is the real worry about the future of services after 2020 if the ring-fenced public health grant for local authorities ends and funding moves to general local authority funding. A report by the Select Committee on Health and Social Care showed that public health budgets have been cut every year since 2013, with alcohol and drug treatment services facing the biggest cuts. Councils have reduced spending on adult drug misuse by an average of 27% since 2015-16, and almost one in five local authorities have cut budgets by 50% or more since then.
The highest cuts have been disproportionately concentrated in areas with high rates of drug-related deaths, according to the Camurus report. More than half of the directors of public health surveyed believe that the removal of ring-fenced public health grants will result in further cuts. Service providers are struggling to maintain their current offer, and have even less capacity to make additional outreach efforts that are needed, such as offering proactive early prevention measures or engaging under-represented groups and communities who come less into contact with available services.
I wish I had more time to talk about hepatitis C, which is a really important issue. Stuart Smith, the head of community services at the Hepatitis C Trust, said:
“I walk into many drug services around the country and it’s chaos. They’re being asked to do so much with so little resource. I’m not sure how many of them can even feasibly have it on their priority list to discuss hepatitis C with clients.”
Hepatitis C is a very harmful condition but it can be prevented and cured if we have the resources to do so.
This is another story of austerity hitting the services that are most needed by the most vulnerable in society, but—this is the third theme that emerges from the sector responses—it is also a story of false economies. Spending on the recovery and reintegration of people who struggle with drug and alcohol dependency is one of the smartest spend-to-save investments that a Government can make. Strong evidence suggests that properly funded drug treatment services help to drive reductions in drug deaths, crime, and rates of blood- borne viruses. Research that the Government themselves commissioned concluded that drug treatment can “substantially reduce” the social costs associated with drug misuse and dependence, with an estimated cost-benefit ratio of 2.5:1. Depending on the breadth of the definition of “social costs”, that ratio could be calculated far more favourably and take into account factors such as lower crime, fewer health problems, less benefit dependency, lower social services spending and so on. Public Health England estimates that for every £1 invested in drug treatment services, there is a £4 social return.
Drug treatment and harm reduction services are cost-effective and offer good value for money, so this is a classic example of funding reductions in one part of the public services leading to spending increases in another. To quote Ron Hogg, police and crime commissioner for Durham and Darlington, who in my view is one of our most progressive PCCs:
“As PCC, I have concerns regarding the future allocation of public health funding in Durham, via the Public Health Grant, and the knock-on effect for policing. I am fearful that I will face the triple whammy of a reduction in police funding, a further reduction due to changes in the funding formula, and the consequences of a decrease in public health funding. The consequences of these changes are likely to include a significant increase in crime in County Durham and Darlington.”
We know that half of acquisitive crime in the UK is directly related to drug dependency.
I am grateful that my hon. Friend has raised the issue of crime. Is he aware that crime prevention orders and drug and alcohol treatment orders attached to sentences have fallen? Drug treatment orders have fallen from 8,734 in 2014 to 4,889 in 2018, and alcohol treatment orders have also halved. People are not getting drug treatment orders as part of their sentence in the community, which leads to the same threats that my hon. Friend describes.
I thank my right hon. Friend for making that important point. Durham constabulary’s Checkpoint scheme, through which low and medium-level offenders with drug dependency are diverted into treatment rather than the criminal justice system, has reduced arrests by 11% and convictions by 9.7%, and has made a positive contribution in relation to participants’ drug use, physical and mental health, finances, accommodation status and relationships. There are benefits right across society when we send people into help and treatment, rather than into custody.
A number of stakeholders have identified that the lack of resources not only puts a strain on current treatments and activities, but stifles innovation in new ideas and treatments. That leads me to another key point, which is on our wider approach to drug treatment and policy. There are measures that we can take to reduce deaths and that would lead to less demand on drug treatment services, but the Government are either not encouraging or not permitting them. The most obvious is what many call drug consumption rooms, although I prefer the term overdose prevention centres, which are aimed at those with severe addictions. People will take their drugs—they have them in their possession, so they will inject them, and there is no way that we can stop them doing that—but rather than being left to inject their drugs in a bedsit or back alley, alone with an increased risk of overdose, they can go to one of the centres, where a nurse is on hand; they can use in a sterile clinical space with medical supervision, and naloxone on hand to reverse any overdose.
There are two great benefits to the centres. First, they save lives: no one dies of an overdose in such facilities. Secondly, they also have services for addicts to engage with. It might be the first time that addicts have come into contact with services, so they could be encouraged into other treatment options. At least 100 drug consumption rooms operate in at least 66 cities around the world, in 10 countries. In a number of European countries, such as in Spain, Germany and the Netherlands, supervised drug consumption has become an integrated part of services offered within drug treatment systems.
Police and crime commissioners and health professionals have been assessing the value of piloting such facilities in various areas, but the Government position is to block the pilots. Furthermore, the Government are unwilling to revisit the legislative framework, and so are insistent that we cannot make provision for the centres. However, according to the European Monitoring Centre for Drugs and Drug Addiction last year:
“There is no evidence to suggest that the availability of safer injecting facilities increases drug use or frequency of injecting”.
“These services facilitate rather than delay treatment entry and do not result in higher rates of local drug-related crime.”
Drug consumption rooms, overdose prevention centres or whatever we want to call them simply make sense, and it is very regrettable that the Government will not allow them to become part of our treatment landscape.
On the subject of innovative models of service delivery, I mention the Checkpoint scheme in Durham.
The hon. Gentleman is making some excellent points. Does not the thrust of his argument lead to the conclusion that, if one were to regulate and control but decriminalise more broadly, many of the social ills and medical problems might be reduced? Is it not time for a royal commission to look more broadly at the troubling social disease of drugs?
The hon. Gentleman makes an excellent point. I absolutely agree that we need regulation and control. Personally, I am not sure about royal commissions, because they tend to kick things into the long grass a bit, but perhaps a parliamentary commission or some other way of looking at the problem, trying to come to a consensus and taking the politics out of it—stop people weaponising drugs as a political issue—is the way forward. We need to look at that, because our system is not working. This is not a debate about wider drug policy but, clearly, that policy is not working, and it is resulting in the kind of problems that we face—addicts need the kind of drug treatment services that this debate is about.
I will try to be quick, because other people want to contribute to this short debate. On innovative models of service delivery, naloxone is a life-saving medication that can be used to reverse opioid overdose. However, coverage across England remains poor and the guidance is confusing. If we cannot convince the Government to increase funding for naloxone treatment by implementing a national naloxone programme, they should at least offer national support and guidance for local authorities and prisons. Finally, on drug safety testing, the Home Office refuses explicitly to sanction drug safety testing, which is a simple measure that could save lives and result in fewer people needing treated for drug harms.
We therefore need a refocus of our spending priorities. Funding constraints are curbing the effectiveness of proven treatment and harm reduction measures at the same time as we spend fortunes on drug law enforcement. In 2014-15, for example, an estimated £1.6 billion was spent on drug law enforcement, compared with only £541 million on drug treatment and harm reduction services over the same period. However, while we know that treatment services are cost-effective and save money, the Home Office’s own evaluation of its last drug strategy could not demonstrate value for money in drug law enforcement or enforcement-related activities.
The Government, unfortunately, are preoccupied with trying to stop people from taking drugs—something no one has managed to do in centuries of human behaviour—instead of focusing on harm reduction and treatment. Problematic drug users are stigmatised by our policies and treated as criminals, leaving them less likely to access the life-saving drug treatment services that they need, for fear of arrest. Meanwhile, the services that are available—as we heard earlier—have had their funding slashed and continue to be squeezed.
I need to conclude with some proposals. First, the one consistent message from all stakeholders who have been in touch and care about the issue is that we need to reverse the cuts to our struggling drug and alcohol treatment system. We need to reinvest in those services. The Camurus report released today states:
“The evidence shows that we are fast approaching a point at which we risk doing irreparable damage to our hard-won recovery system, leaving services unable to meet the scale of need that exists.”
The Government must therefore use the upcoming spending review to increase spending on drug treatment services. They need to provide local authorities with additional funding towards those services, without which the ability of services to meet demand will continue to decline.
Among other proposals I suggest the Government should consider guaranteeing the delivery of substance misuse services by making them a statutory, mandated service to end the ambiguity about their delivery and to underline importance of protecting budgets. The Government should also look at the commissioning regime—the consensus among many stakeholders is that it is not working and is too variable—to see whether it is fit for purpose. A 2017 report by the Advisory Council on the Misuse of Drugs asked whether the constant re-procurement of addiction services creates unnecessary instability in the system, resulting in poorer recovery outcomes, which is something I have seen on a small scale in the area of south Manchester I represent. Finally, we need to remove barriers to overdose prevention centres and drug safety testing to encourage faster use of heroin-assisted treatment. Such proposals can stop deaths and reduce the numbers going into treatment. We are looking at a public health emergency, and we need to act.
The shadow Health Secretary, my hon. Friend the Member for Leicester South (Jonathan Ashworth), has talked movingly about his experience of alcoholism in his family. He has promised that a future Labour Government will reverse the decline in the drug and alcohol treatment sector. I fully support him in that endeavour, but we cannot wait. We need the Government to act to safeguard our drug treatment services and, most importantly, to safeguard those who use them.
The debate can go on until 5.30 pm. I am obliged to call the Front Benchers from no later than seven minutes past five o’clock. The guideline limits are five minutes for the SNP, five minutes for Her Majesty’s Opposition and 10 minutes for the Minister, and Jeff Smith has two or three minutes at the end to sum up the debate. Five Back Benchers are seeking to contribute, so there will need to be a time limit, which is four minutes each, and then everyone will get in.
I congratulate the hon. Member for Manchester, Withington (Jeff Smith) on securing the debate. I agree with everything he said. I draw the attention of Members to my declaration of interest as a practising NHS psychiatrist and as someone who has worked in drug addiction, or drug treatment, services.
I do not intend to rehearse the discussion on the lack of, or reduction in, funding for the treatment of addiction services since the commissioning moved to local authorities, because that argument has been well established. The challenge we face is how to encourage more people to engage with addiction services and how to improve the quality of care available to those who are drug and alcohol-dependent. In my view—this is increasingly the consensus—commissioning by local authorities has probably been the single biggest failure of health legislation under our Government, and we need to revisit that if we want to improve the quality of care available to the patients we are looking after.
Between 2009-10 and 2016-17, the number of people with opiate addiction who access services has reduced by about 16%. Heroin deaths are on the rise; the number of people presenting with alcohol-related illness, pathology and morbidity is rising; and alcohol-related deaths are rising. Our current approach to additions is not working, which appears to be that the NHS will patch you up as best it can. We are not doing a good job of preventing people from appearing in A&E or in the acute hospital because the commissioning of addiction service is not right. While I do not believe that local authorities are in the right place to commission services, the lack of funding they receive has been a contributing factor.
There are five key challenges and problems with commissioning by local authorities. The first is the quality of patient care delivered. There is poor integration of services between the NHS and the providers that often are commissioned by the local authority, be they in the private sector or the charitable sector. Historically, NHS services have had a good integrated approach between physical healthcare and addictions care. NHS providers have a joined-up approach to treating people with hepatitis, HIV and other physical health problems, or older addicts who may need support for physical health needs, such as cardiac or respiratory problems they may develop as a result of their addictions, particularly if they smoke heroin. That does not happen when there is fragmented commissioning by private-sector providers and local authorities. That needs to change for the benefit of many patients.
Secondly, all private sector providers operate under their own IT systems that have no integration with the NHS whatsoever, so an NHS doctor does not know necessarily what care those private providers are giving. That is dangerous because there is no continuity of healthcare and it is fragmented, to the extent that one part of a supposed health system cannot see what is happening elsewhere.
I thank the hon. Member for Manchester, Withington (Jeff Smith) for securing this debate.
Figures released today show that in Scotland there are more than three deaths a day due to drug use. But who really cares? Who are those people who are dying? It is the homeless; the isolated; the good-for-nothing; the detritus of society. People who inject themselves with poisonous substances do it to themselves—nobody makes them do it. How often have we heard that justification? Nobody is saying it in this place, but we know some people are thinking it.
Through a lack of compassion, but primarily through a lack of understanding, society has created a sub-culture of marginalised people who are pushed to the fringes of our day-to-day consciousness. It has become far too easy to dismiss them, ignore them and exclude them from our cosy lives. Problematic drug users are not getting high for the kicks; they are self-medicating because the pain of everyday life is so great that without the drugs they could not live. The sickness is not the drug use—the pain started long before the addiction. Of the 10% of drug users who develop an addiction, the vast majority have been physically, psychologically or sexually abused. Mix that with financial and aspirational deprivation and it makes a powerful mix that it takes powerful drugs to supress. That is why the support services must be about homelessness, mental health, security, continuity, understanding and compassion—everything that counters the chaos.
When I visited drug consumption rooms in Barcelona, I was particularly struck by one facility: a health centre where people visit their GPs for everyday ailments, which is attached to a hospital that people can be referred to. One part of the health centre is for homeless people to visit and pick up clean clothes, have a shower and shave. Over time, the staff build up a relationship with the clientele and come to understand why they are homeless and what can be done. Another unit attached to the health centre is a drug consumption room; the staff there have exactly the same attitude as the staff in the health centre, the GP surgeries and the homelessness unit. They want to know, “What is your problem, and how can I help?”
That is a million miles away from the stigmatisation that is so common in the UK. The mindset of approaching problematic drug use as a health issue pays great dividends: it is cheaper than pursuing and incarcerating people for drug possession; it frees up the police to fight crime; and, most importantly, it works across the globe. It does not work for everyone; tragically, there will always be drug-related deaths, but as we look at the figures released today let us not forget that, thanks to the naloxone available in DCRs, there has never been a death due to overdose in any DCR anywhere in the world. When will the UK Government come to terms with that?
On the reform of drug laws, we probably have a lot in common, but today’s shocking figures show that the number of drug deaths in Scotland is not only three times the average of the rest of the United Kingdom, even though we are all under the same laws, but the highest in Europe. If the hon. Gentleman wants a health-based solution, will he explain what, after 12 years of SNP stewardship of our health service in Scotland, can be done? What should be done through the devolved and central Governments working together?
The policy is a Europe-wide one; it is proven that the methods used elsewhere in Europe have helped the situation.
Glasgow stands ready to pioneer a DCR. There is cross-party support from Glasgow Council, backing from the SNP Scottish Government, and NHS Greater Glasgow and Clyde is fully on board. What in the name of goodness is stopping the UK Government from joining us?
I congratulate the hon. Member for Manchester, Withington (Jeff Smith) on securing this debate and on speaking so well. Happily, much of what I intended to say I now do not need to, not that I would have time to say it anyway.
I congratulate my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter); he began to get into the systemic problems in this area, which is what I want to focus my remarks on. We have a systemic problem in the assessment of the rate of return on the investment in drug treatment services, particularly compared with the rate of return on investment in law enforcement in drug policy.
According to the Government’s own statistics, we are not getting a satisfactory return at all on drug law enforcement. That is why the police’s operational policy has been progressively to withdraw from doing nugatory work, leading to effective decriminalisation in many parts of the country, simply because that is not a sensible use of resources. It certainly is a sensible use of resources to try to repair the lives of drug addicts. The cuts under the necessity of austerity, and the systemic issue that my hon. Friend referred to in respect of local authorities taking responsibility, have meant that we are making a shocking value-for-money judgment in the application of public resources in this area.
It has to be down to the Minister—no one else can do it—to review how we invest public money for the public good. That is at the kernel of this debate. If we do not make changes, enforcement authorities will continue to progressively withdraw, because they simply will not waste the public money they have been given by running ineffective operations. The just-retired chief constable of Durham, Mike Barton, is a huge authority on that, and I urge the Minister to talk to her Home Office colleagues about his experience.
There is a very clear overlap between the application of the law to drug users and recovery. One then gets into the toxic situation of stigma around those users. There is also a public health budget administered by local authorities, which are under pressure to use those resources elsewhere. People who have used drugs that we have made illegal do not get automatic support in our society, yet they are just as much part of our society as anyone else.
If we do not invest resources properly, we will simply find that we carry the burden of the consequences of the damage that has been done to all those people. There is an infinitely better way to do things, and I urge the Minister to try her hand at effecting the system change that is needed to do things infinitely better.
It is an honour to serve under your chairmanship, Mr Hollobone. I congratulate my hon. Friend the Member for Manchester, Withington (Jeff Smith) on an excellent speech and on his commitment to tackle unswervingly the problems associated with drug and alcohol abuse.
I am pleased to speak as co-chair of the drugs, alcohol and justice cross-party parliamentary group that last week considered the Advisory Council on the Misuse of Drugs’ recent report, “Custody-Community Transitions”. The report is helpful in providing advice on how to reduce drug-related harms that happen when people move between custody and the community. I hope the Minister will agree to implement the report’s practical recommendations as soon as possible to ensure continuity of care.
Some simple changes could make a huge difference. For example, it suggests prisoners with complex needs should not be released on to the streets on Fridays. Given that last year only 12% of prisoners with drugs problems left prison with naloxone, which can reverse the effects of overdose, the report recommends that naloxone should be issued to all prisoners with drug problems on leaving custody.
We have record rates of drug-related deaths, yet drug treatment budgets have been slashed and services cut, as has already been said. I am sad to say that my region, the north-east, is the worst affected in England. Today we have heard that drug-related deaths in Scotland have gone up by a staggering 27%. We can only tackle these soaring statistics if substance misuse services are made mandatory and drug treatment budgets ring-fenced.
Instead of investing in harm reduction, we waste valuable resources on an unwinnable war on drugs, treating this as a criminal justice rather than a public health issue. We have excellent examples of a different approach being taken in the checkpoint scheme in County Durham and the Thames Valley diversion scheme. They show effective alternative solutions—not easy options, but positive ways of getting people out of trouble and into treatment. Another innovation to help drug users would be the introduction of drug-consumption rooms—effectively overdose prevention centres—which the Government stubbornly refuse to allow, despite conclusive evidence that they are of massive benefit.
In summary, I will quote Paul Townsley, chief executive of the charity Humankind:
“These challenging times provide an important opportunity to cement the evidence base of what our service users and our communities need, but to achieve this we will need stable funding and commissioning… Government has a duty to act now to ensure treatment services are accessible to all who need them. We call on Government to ensure that substance misuse treatment is a prescribed local public health activity.”
I can only concur.
Thank you for calling me to speak, Mr Hollobone. I congratulate my hon. Friend the Member for Manchester, Withington (Jeff Smith) on an excellent introduction to the debate and on the vital points he made.
Last week, one of my constituents, Chelsea Bruce, died of a drugs overdose. She was 16-years-old. She is another figure to add to the 1,187 deaths in Scotland in the last year. It is particularly poignant because this time last year I presented Chelsea with an award at her school, where I talked about the potential of the future and what young people could go off and do in the world. To think that that girl now lies dead for entirely preventable reasons sickens me. I wonder about the damage that has been caused to her family and the trauma that has been caused to her friends, who now live in a mixture of grief and fear of what drugs can do to them.
Chelsea might not have come to harm had she been able to have the pills tested, to have had a testing kit or to have sourced the pills from a supplier who had had them tested. There are now very high-strength MDMA pills in circulation. Sometimes it is not MDMA but other substances that mimic some of the effects of MDMA; that could have been a factor in Chelsea’s death. That is something we need to understand in this House and respond to with great urgency.
I have been following the campaign for drug policy reform closely since my election, and ensuring that a public health approach is at the heart of how we begin to properly tackle this devastating blight on our country is critical. I am personally convinced of the merits of decriminalisation of people who use drugs and minor drug possession for personal use, based on international examples, most notably in Portugal. I am pleased that the introduction of safe drug consumption facilities is Labour party policy and we will be campaigning to ensure that we go even further in our next manifesto.
However, I am alarmed at the lack of impetus to put in place practical policies now, which could save lives in my city where drug-related deaths have reached epidemic levels. They are now 1,000% higher than the European average; that is a public health emergency by any definition. While many are big on rhetoric, our public policy is years behind where it should be in addressing this appalling crisis of death and misery.
The Home Office and the Lord Advocate have been intransigent about the piloting of safe drug consumption in Glasgow. A model that has a worldwide track record of saving lives has been discussed. While the Home Office refuses to change the obsolete Misuse of Drugs Act 1971, the Lord Advocate, Scotland’s chief law officer, claims that a letter of comfort is insufficient to avoid possible prosecutions of NHS staff who might work in such a facility or those who would use it, unless the law is changed by the UK Government.
The chief executive of the Scottish Drugs Forum, David Liddell, believes that much more can be done to facilitate reform within current legislation. Last week, I suggested to the Scottish Affairs Committee that the Lord Advocate is being too risk averse and conservative in approach. I have now written to the Lord Advocate to challenge him on that point. It is certainly no good for Scottish Government Ministers and Glasgow City Council to abrogate their responsibility for this public health crisis by conveniently blaming Westminster, as unco-operative and unhelpful as it might be on this issue, when they have cut victim services in Glasgow by over a quarter in recent years, causing the closure of rehabilitation services and needle exchanges, as well as the end of central Government funding for the national naloxone programme.
While a heroin-assisted treatment pilot will launch in Glasgow later this year, it will be highly targeted and the thresholds for access will be difficult to reach for most of Glasgow’s problematic opiate and cocaine users, who are often polydrug users. That is why I have also asked for the Lord Advocate’s advice on an additional innovative model that could be adopted in Glasgow, a safe prescribing clinic, where instead of illicit drugs of an unknown purity being brought into the facility for use under clinical supervision— as in a drug consumption room—pharmaceutical diamorphine and cocaine can be prescribed freely for use in a supervised clinical environment. As well as bringing all the benefits of DCR, it removes the stranglehold that criminal gangs have over the drugs supply chain and removes the financial dependency that many people with drug problems face to feed their habit, and the crime that goes with it. Combine that with supervised drug facilities like the Loop in Bristol and WEDINOS in Wales, and we could be on to something that reduces harm.
Saving one life is one life that is worth it, and we should take urgent action now.
I am glad that the hon. Member for Manchester, Withington (Jeff Smith) secured this debate, because it is very timely for Glasgow and for Scotland more widely.
Let me start by saying that every single one of the 1,187 deaths last year is a tragedy—a tragedy for the families who lost a loved one and, as the hon. Member for Glasgow North East (Mr Sweeney) said, a tragedy because of the potential that was lost as a result of that person passing away. We should bear those people in mind whenever we talk about drugs policy.
Ideally, I want those people, who have an illness, to be able to get medical help as if they had any other illness. If they had cancer, we would not stigmatise the cancer drug that kept them well. That is what methadone does—it supports people and stabilises their lives.
I will not hear a word from the hon. Gentleman against that.
It is not stigmatisation; it is data led. We saw information today that more people die from the use of methadone. I am not asking the hon. Lady to cancel anything; I am asking whether she will join me in calling for a review. We need a review of all our drug laws across the board. She knows that I agree with her on many aspects of this policy. I seek a review, not to cancel out or stigmatise.
When the hon. Gentleman talks about methadone, the result is that he stigmatises it. That may not be his intention, but that is the result. He may have heard Kirsten Horsburgh from the Scottish Drugs Forum talking on “Good Morning Scotland” this morning about that being stigmatising for people. We need to get away from that stigma. We need to look towards treatment and harm reduction.
To that end, I and my SNP colleagues have argued for three years for a drug consumption room for Glasgow. That could go ahead as a pilot if the UK Government got out of the way and let us do it. It is three years since NHS Greater Glasgow and Clyde produced its “Taking away the chaos” report, the business case for that drug consumption room, which Saket Priyadarshi and his colleagues worked away on. That has been sitting there for three years. The UK Government are standing in the way of the life-saving intervention a drug consumption room would bring.
That drug consumption room would not save everybody—at the moment, it would be just for Glasgow—but it would make a huge difference to the people I know who inject in dirty bin sheds and back lanes and on waste ground yards from my office, time and again. It is the job of the rest of society to try to pick up the pieces of that—to pick up the discarded needles that are left behind. Those people would have the dignity of a drug consumption room within a few paces, where they could go to inject drugs, receive medical help and get support now, if the UK Government approved it. It is an absolute tragedy that that is not happening, and a huge source of frustration.
The hon. Member for Glasgow North East (Mr Sweeney) mentioned the Lord Advocate. The Lord Advocate is the Lord Advocate; we cannot intervene in the decisions that the chief legal officer takes on this. If he says that that is not within the law, that is his legal opinion. He is the chief legal officer, and that is his decision. It rests with the UK Government to make that change under the Misuse of Drugs Act 1971.
Will the hon. Lady give way?
I have already given way to the hon. Gentleman, and I am short of time.
The Misuse of Drugs Act is reserved. Where we have had powers in Scotland on alcohol, we brought in minimum unit pricing; on smoking, we brought in the end of smoking in public places. This is a medical intervention that we wish to pursue in order to save people’s lives. Glasgow, where it can, has applied for a heroin-assisted treatment programme; when that is up and running, it will be able to treat 60 people, but there are an estimated 400 to 500 people who inject publicly within Glasgow city centre alone. That medical heroin-assisted treatment programme is limited in size, scope and scale, because it is a treatment programme and people must be able to engage with that.
No doubt the programme will make a huge difference to those lives, but it almost goes without saying that if 394 people died in Glasgow last year, and it can only deal with 60 people at a time, it is not enough. It is clear that we need the entry level that drug consumption rooms will give, meaning that people can go in without any kind of barrier or stigma associated with seeking help, and are able to reach those treatment services. It needs to be an easy way for people to get in and get treatment within those services.
The Scottish Government are pursuing this. We are doing what we can. We have a new drugs taskforce, chaired by Professor Catriona Matheson from the University of Stirling, which is looking at all the things we do in the Scottish Government in the round and where improvements need to be made. Both I and the Scottish Government accept that improvements need to be made, but the UK Government also need to play their part.
I will mention organisations such as Turning Point Scotland in my constituency. They drive a van around as a needle exchange, but they know that as soon as they give that needle to somebody, that person is going around to the car park at the back, to inject in a dirty back lane. That is not good enough. Not one UK Government Minister has yet come to visit Glasgow to justify their position; I urge this Minister and any of her colleagues, whoever they may be, whenever the new Prime Minister eventually turns up, to come to Glasgow and tell me why this cannot be done.
It is a pleasure to serve under your chairmanship, Mr Hollobone.
I begin by thanking my hon. Friend the Member for Manchester, Withington (Jeff Smith) for bringing this debate on this very important subject. As we have already said, the debate is timely, as we hear today that 1,187 people died drug-related deaths in Scotland last year, an increase of 27%. I can say from personal experience of delivering services to drug users in a community pharmacy in my constituency that the problem is not confined to Scotland.
The problem is not new, but there is no doubt that cuts to budgets for addiction support services in recent years have made the situation worse. The cuts to public health budgets that have had an impact on this are downright irresponsible. There have been numerous calls over the years for us to take steps to address the problem, but instead, we prefer to speak about getting tougher in tackling the trade in illegal drugs. Meanwhile, police chiefs are on record as saying that there is no way that police will ever stop addicts buying from dealers, but still we continue to chase drug addicts like criminals.
While other countries move increasingly to a public health approach to drug use, the instinct in the UK is to criminalise addicts. It is worth noting that in Portugal, where drug use has been decriminalised, there has been a steep fall in the number of drug-related deaths and even in the number of drug users. It is time for an intelligent approach here in the UK, an approach that stops drug dealers preying on vulnerable addicts and that recognises that drug addicts are not alien beings, but people in our communities in need of help, not a criminal record.
Drug addicts have families and children who need and love them. My hon. Friend the Member for Glasgow North East (Mr Sweeney) spoke movingly of his constituent Chelsea, reminding us of the humanity in all this. In the first instance, addicts need support to stay alive, to safely manage their addiction, to overcome it and to recover their lives.
So what can the Government do? The Advisory Council on the Misuse of Drugs has clearly said that maintaining funding of drug treatment services is essential to preventing drug-related death and drug-driven crime in communities. It has also said that if resources are spread too thinly, the effectiveness of drug treatment will suffer, leading to drug-related deaths and drug-driven crime. As a first step, I hope the Minister can tell us that her Government will restore funding to addiction support services, but I also hope she will go much further and consider new ways of tackling the problem to save lives.
Both supervised consumption rooms and heroin-assisted treatments are possible ways to effect some positive changes. Supervised consumption rooms reduce the risk of disease transmission, prevent overdose and also present an opportunity to refer users to appropriate addiction services. Heroin-assisted treatment allows for the provision of pharmacological heroin to dependent individuals who have not responded to other treatments, and involves patients receiving heroin in a clinical setting from a doctor under strict controls.
That has many benefits. It reduces the use of street heroin, which can be of dubious quality and variable strength. It takes away the need for criminal drug dealers, who are preying on vulnerable people and profiting from their addictions. It gets addicts into treatment. It stops desperate addicts resorting to criminal activity to fund their addiction. It improves access to recovery services, HIV treatments and services to address adverse life circumstances. As the police remind us, it also stops drug-taking in open spaces in the community and protects the wider public from contact with used needles.
Both those services reduce pressure on other services in the NHS, police and justice systems, protect the wider public from contaminated needles and ultimately save public money. Cuts to those services are short-sighted in the extreme. Those initiatives are supported by the British Medical Association, and it is a fact that other countries are doing better than us because they have implemented those programmes.
I say to the Minister that we need urgent action. We need mandatory commissioning of drug and alcohol treatment services. We need to amend the Misuse of Drugs Act to enable an innovative, health-focused approach to tackling this problem. We need a Government with the courage and the compassion to act to save lives.
It is a pleasure to serve under your chairmanship, Mr Hollobone. I begin by sending my sympathies and those of the whole House to Chelsea’s family and friends. It is a reminder to us all of the seriousness of the subject we are discussing today. I also thank the hon. Member for Manchester, Withington (Jeff Smith) for securing this important debate.
Many of the hon. Members who have spoken are devoting their parliamentary lives to this issue, because they feel so strongly about it. They have raised questions that are a matter not only for me and my Department but for other ministerial colleagues, particularly those in the Home Office, and I will transmit the many challenges that have been set for me today to those colleagues.
We have made some progress in reducing drug dependency-related harms, but, as the hon. Gentleman pointed out, this is an ancient problem. We have made progress but we are not at all complacent, and events such as the death of a girl such as Chelsea remind us that there is much more to do. I have to work with other Government Departments, public health experts and local government to continue supporting people through recovery and to prevent them from ever taking up drugs in the first place.
We published a drugs strategy in July 2017 and it is being rolled out. We know about the serious health harms of drug use, including blood-borne viruses, overdose and death, which have been outlined in great detail by hon. Members. We know that the majority of people who need treatment for drug problems are also experiencing mental health issues. We know that drugs cost £10.7 billion a year in policing, healthcare and crime costs; it is estimated that drug-fuelled theft alone costs us £6 billion a year. There is both an economic case and a moral case for us all to act on this.
It is encouraging that drug use in England and Wales is lower now than it was a decade ago. In 2016-17, 8.5% of adults had used a drug in the past year, compared with 10.1% of adults in 2006-07. More adults are successfully leaving treatment than in 2009-10, and the average waiting time to access treatment is two days.
I will pick up on some of the points that hon. Members have made. On the drug-related death figures for Scotland, health is a devolved matter, but of course—[Interruption.] I am afraid I cannot hear what the hon. Member for Glasgow Central (Alison Thewliss) is saying.
The Misuse of Drugs Act is not devolved.
I will come on to that. However, health is a devolved matter. Any death is a tragedy, but the figures are really worrying. I understand that the Scottish Government have appointed Professor Catriona Matheson to head up a drug deaths taskforce, to look at the main causes of death and to examine how to save lives.
My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) raised the question where responsibility for public health should sit. Clearly, he thinks its sitting with local authorities is not right, but that is a broader question of public health commissioning that I do not know if we can get into here. However, he has a wealth of experience in this, and I will take away some of the points that he raised.
Does the Minister agree that, while we can argue about who should be responsible, as long as public health is the responsibility of local authorities, cutting their budgets is irresponsible?
I will come on to funding.
My hon. Friend the Member for Reigate (Crispin Blunt) takes great interest in this issue. He spoke about the legislative framework for drugs, which is a matter for the Home Office. As I said, I will talk to ministerial colleagues about that. The Government are putting together a formal response to the report on custody-community transitions, with input from many Departments, including the Department for Work and Pensions, the Ministry of Justice and the Home Office. I think we have until the end of the summer to issue that response.
Local authorities will want to increase the provision of naloxone to people who are not in treatment, perhaps through outreach workers, hostels or needle and syringe programmes. Public Health England is working alongside the National Police Chiefs’ Council and Her Majesty’s Prison and Probation Service and recently updated its advice and guidance on naloxone availability in prisons. The problem with drug testing kits is that not all of them are entirely accurate, which might give people false reassurance. More sophisticated testing has been available at some festivals in one pilot, but again this is a matter for the Home Office.
Hon. Members talked about the international evidence that drug consumption rooms can be effective at addressing public nuisance issues and health risks for users and for the wider public, but there is a risk that such facilities would be introduced at the expense of other more relevant, evidence-based drug services for local areas. There is currently no legal framework for the provision of drug consumption rooms, but we support a range of evidence-based approaches to reducing health-related harms. Again, we are committed to widening the availability of naloxone to prevent drug-related deaths. I acknowledge the strength of feeling on drug consumption rooms in the House.
This is a narrow point, but I invite the Minister to talk about overdose prevention facilities, rather than drug consumption rooms. One can understand the difference that might make to their reception in local communities; they are about preventing death.
I thank my right hon. Friend for that intervention.
Will the Minister give way?
Briefly, and then I must continue, because I want the hon. Member for Manchester, Withington to be able to make his concluding remarks.