Thursday 5 March 2020
[Steve McCabe in the Chair]
Post Office and Horizon Software
I beg to move,
That this House has considered the Criminal Cases Review Commission’s process for review of convictions relating to the Post Office and Horizon accounting system.
It is a great pleasure to serve under your chairmanship, Mr McCabe, and a privilege to have secured this debate. Following the completion of the litigation process, I am sure it will be the first of many on different aspects of this miscarriage of justice.
I pay tribute to those who have fought the corner of postmasters affected by the Horizon IT system over many years, particularly Lord Arbuthnot of Edrom and my hon. Friend the Member for North West Leicestershire (Andrew Bridgen). I also pay tribute to the right hon. Member for North Durham (Mr Jones) for his sterling work, my hon. Friend the Member for Woking (Mr Lord), who has worked so hard on the terrible case of Seema Misra, and many other Members across the House who have long campaigned on this issue.
I pay a particularly special tribute to those Post Office workers and campaigners who have had to overcome the myriad obstacles and hurdles that have been put in their way over the years. I am humbled by their fortitude and dignity, as they have continually—indeed, stoically—endured much in many ways, as their quest for justice goes on.
I have not come to Westminster Hall today to level criticism at the Post Office, nor to set out the background to the successful group litigation against the Post Office. I have no need to do so because the honourable Mr Justice Fraser, who I am sure will eventually go down in history as the next Lord Denning, has already comprehensively done so in his very fine judgments, particularly that handed down on 16 December 2019. I will, however, draw attention to the way in which the Post Office embarked on what appears to any outside observer to have been a war of attrition against its former employees throughout the litigation process, repeatedly appealing every decision, seeking to recuse the judge, and appealing the judgments that were handed down. That war of attrition ground down the claimants and forced them into a settlement, most of which will go towards meeting their legal fees.
My hon. Friend makes a valid point about the settlement. The case was supposed to be settled through a process of mediation. The settlement came to more than £57 million. Does she not think that it is outrageous that most of that sum is going to lawyers, which brings into disrepute the whole process of mediation—and I say that as a mediator myself? It is outrageous that mediation can charge so much for what was a fairly straightforward operation.
I am grateful to my hon. Friend for making that vital point. Many of the postmasters thought that the £57 million would go to them, as was announced in the press. However, after the legal costs have been paid, it is unlikely that sufficient moneys will be left over to compensate even those from whom the Post Office extracted money when their tills did not balance. Even that money may not be refunded, never mind the costs for the actual losses suffered by postmasters. There will be nothing at all left for actual compensation.
I am sure the hon. Lady will agree that this whole episode has had far-reaching consequences for those affected by it. She will also be aware that the Select Committee on Business, Energy and Industrial Strategy Committee is going to hold an inquiry. Does she share my view that there needs to be more than that? We need a full and comprehensive public inquiry, to ensure that this kind of shambles, which has cost so many people so much, never happens again.
I am sure the hon. Lady will agree that this business—the Post Office—was effectively wholly owned by the Government. None of us should argue about whether lawyers should be paid for bringing litigation on behalf of these victims, but should not the Government themselves step in to ensure that all of that money—all of those lawyers’ fees—is paid by the Government?
The hon. Gentleman makes a very important point, and it is absolutely right that those sub-postmasters who paid money they did not owe to the Post Office—simply on the basis of their tills not balancing, which was due to a flaw in the Horizon IT system—should be fully compensated for those losses, not to mention those they then suffered as consequence.
Actually, Fujitsu has a role to play in this process as well, because the judge made clear in his judgment that he doubted the veracity of some of the information he was given, and he subsequently made a referral to the Director of Public Prosecutions to query that information. There is a separate debate to be had on that issue, which we could have at a later stage.
May I praise my hon. Friend for her campaign against this miscarriage of justice? I and many other MPs are here in Westminster Hall today on behalf of our constituents. I am here on behalf of just three of the victims of this scandal: Gillian and Graham Howard, and Maria Lockwood. There are other victims across the country. Will my hon. Friend continue to work with me and other MPs so that we get justice and full redress for the victims of this miscarriage of justice?
I thank my hon. Friend for his intervention, and he is absolutely right that it is now down to us as parliamentarians to put right this miscarriage of justice. I am grateful for the support of many MPs from all parties, but I am also grateful, as I said earlier, for the incredible campaigning work that was done long before I came to this place.
I will make just one more point before I move on to the main issues I want to raise. I will put on the record that the judge handed down findings that confirmed that bugs, errors and defects did indeed exist in the Horizon IT accounting system, and that these defects had caused financial discrepancies, for which postmasters were held accountable. That is a very important finding and I am pleased to place it on the record.
The purpose of this debate, now that the litigation is complete, is to highlight the need to find a mechanism that will allow those Post Office workers affected by this scandal to put the nightmare behind them and move forward with their lives. Of course, until convictions are quashed and criminal records expunged, it is very hard to see how they can possibly do that.
So many of these decent people were pillars of their communities, working in a respected role in what was once a respected institution. They speak of the way that the wrongful allegations of theft and fraud, and their wrongful imprisonment, affected their reputations in their community, causing a deep sense of stigma, social isolation and shame for themselves and their families. For some of them, that was too much to bear.
I thank the hon. Lady for bringing this matter to Westminster Hall for us all to comment on, and so we can support her, too, as always. Does she agree that, since our courts have found that the Horizon system was unreliable, it follows that the convictions that relied on the Horizon data may also be unreliable? The argument that the interests of justice cannot be met unless we review convictions based on this flawed system is, therefore, understandable. The judgment, however, did not deal with the question of convictions, so there is still work to do to address that.
The hon. Gentleman is absolutely right, and I thank him for his intervention, because we are just at the beginning. We now have the opportunity, as parliamentarians, to start work. This matter is no longer sub judice—we can talk about it—and it is fantastic that there is a groundswell of support from right across both Houses.
My hon. Friend and neighbour is making a very powerful case on behalf of all the victims, including my constituent, Rubbina Shaheen, who is one of three or four postmistresses who got into severe difficulties as a result of this error on the part of Fujitsu. She was convicted in 2010 and spent 12 months in jail. Her life was destroyed and she and her husband lost their home. What does my hon. Friend think we can do to try to hold to account those who are responsible and provide some justice for our constituents?
My right hon. Friend and neighbour is absolutely right, and I am glad he has had the opportunity to raise that distressing case. There is a great deal we can do to correct this miscarriage of justice. This debate is just the beginning. I have had very constructive conversations with members of the Ministry of Justice team. Overturning the convictions is one element, but we must have a mechanism to hold to account those who were responsible, who at some point in this saga were fully aware that the Horizon system was flawed. I am delighted that the BEIS Committee will, I hope, invite many of those responsible to give evidence.
I congratulate the hon. Lady on securing this debate and on the work she has done. My constituent Karl Reid describes himself as one of the lucky ones because he was not jailed or convicted, but he did lose £50,000 and two businesses. He felt that he had to move out of the area where he used to have those businesses because of the associated shame and concern. Does she agree that, although it is a priority to get the convictions overturned, the consequences of the scandal go so much broader, to people such as Karl Reid? He describes himself as lucky, but I would not describe him as lucky, and I am sure the hon. Lady would not, either.
The hon. Lady is right and I fully endorse what she says. One direct benefit of the settlement and the conclusion of the litigation is that, as the representatives of postmasters who have been so grotesquely wronged, we now have the opportunity to correct that. I am thankful that the day has come.
I say to all those postmasters affected by this injustice that this debate is just the beginning. The Prime Minister has promised to get to the bottom of what happened, and I understand from what I heard at Prime Minister’s questions last week that he has agreed to an independent inquiry. Regrettably, in my experience, those responsible will have long since retired before any such inquiry even gets under way, but it is in any event a welcome first step.
What is hugely to be welcomed—I think all sub-postmasters affected will welcome this—is that next week the BEIS Committee will begin holding its inquiry and taking evidence. My constituent, Tracy Felstead, will be giving evidence next Tuesday. She is perhaps one of the most tragic cases, having only been a young 18-year-old girl in her first job straight out of school, delighted to be going to work for the Post Office. She ended up in Holloway Prison for six months and is still struggling to come to terms with the reality of what happened to her. The BEIS Committee inquiry is a fantastic opportunity for all the issues of the Horizon accounting system to be explored, in-depth and in public, and that is very important. The hon. Member for Leeds West (Rachel Reeves) is a very thorough Chair, and she will hold those responsible to account through her Committee. I know that all of us here today will welcome that.
I thank the hon. Lady for bringing this debate. I certainly welcome the BEIS Committee inquiry into the issue. Although justice and compensation are entirely appropriate, does she agree that no amount of compensation will restore the dignity that was lost by so many or repair the damage done to people’s physical and mental health by this long-standing scandal?
The hon. Gentleman is absolutely right: no amount of money will ever compensate those affected. We need to help them get their lives back on track, and there are various ways we can do that. Having a sense that justice has been done is incredibly important, even if it is not possible to fully compensate for the losses suffered.
My constituent Pamela Lock had 80 hours of community service and, like many others, was sacked from the Post Office, but she continues to have a successful shop and bakery. We all understand that the financial pay-out will not be enough for the people affected and does not cover the losses, but the hon. Member said this debate is just the beginning. If this is the beginning, what hope can we give to victims of this travesty in terms of the timescale they have to work in?
The hon. Lady is right to raise that point, because many of these people have been suffering for many years. My constituent was one of the very first victims of this miscarriage of justice, with the event happening to her in 2000, so Members can imagine how she has suffered throughout that period. Indeed, her family have suffered, too.
I will move on to the question of how we get to the review of these convictions. A group litigation order was approved by the president of the Queen’s bench division, so it follows that a group remedy is possible when there are clearly common themes. One such common theme must surely be that convictions were achieved on the basis of the Horizon IT evidence, which Justice Fraser has ruled, as I said earlier, to be not “remotely robust” and prone to errors.
Dialogue with the Criminal Cases Review Commission has been helpful, and I am confident that it realises that the case is exceptional and should be treated as such, and that it will carefully consider all the common themes that would enable a referral to the Court of Appeal to be grouped. I very much hope that the CCRC continues with that mindset. I understand from my discussions with representatives of the Post Office that it would prefer each case to be treated separately. They have said that the Post Office will insist that those who pleaded guilty to false accounting should be excluded from the process. However, it seems to me that that should not be a matter for the Post Office to involve itself in. Should the cases be referred by the CCRC to the Court of Appeal, the Post Office will be a respondent. It would be wholly wrong for the Post Office to be involved in any decisions around the mechanisms for the quashing of the convictions, given that the convictions are of people whom it sought to prosecute.
One of the representatives of the Post Office said to me that he doubts many cases will be referred to the Court of Appeal and that those that do are unlikely to succeed. It seems to me that rather than learning the lessons and moving forward, as the Post Office suggests it has, it is in fact still intent on protecting the interests of the institution at all costs. That is hugely damaging to the Post Office. We love the Post Office. We support the Post Office and we want it to thrive, but to continue with that mindset, which Justice Fraser referred to as “institutional obstinacy”, is not only damaging to the Post Office brand and reputation, but adds insult to injury for those who have suffered as a direct consequence of its failure to see the world as round.
I have huge admiration for the Minister, who I know is a man of enormous integrity with an inquiring mind. He will, I have no doubt, read around the subject in depth, and I wish him well in his new role as Minister for the Post Office. With a new Minister in post, a new Government in office and a fine judgment from Justice Fraser, we have an opportunity to get justice done. I look forward to hearing what the Minister has to say about how Government can help postmasters overturn wrongful convictions in a timely manner. I urge him to work with the excellent Minister for miscarriages of justice, my hon. Friend the Member for Cheltenham (Alex Chalk), to see how Government can help to support the CCRC in these unique circumstances and ensure that the Post Office and its management stay well out of these decisions.
As well as encouraging the Minister to see whether there is a way to overturn these wrongful convictions, does the hon. Lady agree that he should see if there is a way that people such as my constituent, who suffered losses of more than £100,000 and was forced to sell his business, are rightfully compensated? When I heard the size of the award, I was so pleased for all my constituents, but the majority of it seems to have gone on legal fees. My constituent tells me that he will receive hardly any of the £100,000 he lost, not to mention compensation. Does the hon. Lady think that the Government should seek to ensure that the majority of the award goes to the victims?
The hon. Lady makes an important point. It is unbelievable that the announcement was made by the Post Office on 11 December, when we all know what we were doing on 12 December. It was supposed to be part of a confidentiality agreement, and the Post Office announced that £57 million was to be paid to sub-postmasters when that was of course not the case. That is further evidence of the way in which the Post Office has conducted itself throughout the process. It is not acceptable to mislead in that way. The judge said almost the same thing regarding some of the evidence that was put before him. I therefore fully agree that that was a shameful part of this saga, although the whole saga is deeply shameful.
I invite the Minister to consider the many very real conflicts of interest. I will not outline them all, but I will put on record that his Department owns the equity in the Post Office, provides up to £1 billion in debt funding, approves the board, monitors performance, and provides annual grants. Last year’s grant was £50 million. I will say no more on that, but I will give him a list of the conflicts of interest, which also include personnel, at a later date. In a modern business environment, we need to be alert to the fact that such conflicts do not prevent justice from being done.
I am encouraged by discussions with Ministers and across parties. There is a clear will in Parliament to move forward and see justice done. Whatever obstacles the Post Office continues to put in the way, I hope it senses the appetite in Parliament and hears the voice of the judge in this case. The Post Office needs to stop putting obstacles in the way of justice; it is doing the organisation no favours whatever.
I am sure the Minister will agree that the Post Office has had the opportunity to be part of the solution over and over again, and that that time has passed. Given all its actions throughout, including the mediation process back in 2015 that it simply cancelled—it did not like what the forensic accountants were saying, and it fired them—the Post Office has had its opportunity to be part of the solution. Its behaviour in the litigation suggests that it has no interest whatever in finding a solution for postmasters; its interests lie in preserving the institution no matter what.
I hope we can all ensure that the Post Office does not stand in the way of the work of the CCRC or the Court of Appeal. I put on record my thanks to the campaign group, which has done amazing work against the odds, and to the Chairman of Ways and Means, who allowed this debate. I know that many others wanted to be granted a debate on this subject, and I am grateful that I was given the opportunity. It is we, in this place, who must now find a solution to this grotesque injustice—a miscarriage of justice of immense proportions—and we must do so whatever the obstacles, come what may.
It is always a pleasure to serve under your chairmanship, Mr McCabe. I congratulate the hon. Member for Telford (Lucy Allan) on securing this incredibly important debate, and thank her for the work that she has been doing to expose the Post Office’s utterly despicable behaviour in the entire proceedings, from the very outset when people were prosecuted.
Prior to my election to the House, I practised criminal law from my local chambers in Hull, prosecuting and defending. Prior to that, I worked for a firm of solicitors in Hull, the Max Gold Partnership. I think it was in 2006 that I met a sub-postmaster who was implicated in these proceedings. Janet Skinner was prosecuted by the Post Office for theft. During the short proceedings, the prosecution offered her the opportunity to plead guilty to false accounting, which she did. She was sentenced accordingly by Hull Crown court, and received a custodial sentence of nine months in prison.
Janet Skinner had a son, Matthew, who was 14 and clearly busy with his studies in preparation for various exams that were coming down the track. Her daughter, Toni, who was 17, was in the middle of examinations at the time. It was an incredible shock to Janet Skinner. I remember her instructions to me quite well. I have had the opportunity to speak with her subsequently; indeed, I spoke to her yesterday evening. When I think back, with the benefit of hindsight, I find it chilling and it makes my blood run cold. The prosecuting authority offered the opportunity to plead to a lesser offence, yet according to Janet’s instructions to me, she was effectively led to commit the offence of false accounting.
It is a bit like being locked in a burning building, speaking to the emergency services, being advised to smash a window to get out and then, weeks or months later, being prosecuted for the offence of criminal damage. It is utterly deplorable. Lawyers watching the debate will say that that is not a perfect analogy because there is an inbuilt defence to criminal damage, which is reasonable excuse. That does not exist for section 17 of the Theft Act 1968, which provides for the offence of false accounting. It really is utterly deplorable. Janet Skinner and others contacted the Post Office to say, “We have problems with the system. The books are not balancing. What’s going on?”. The Post Office should have investigated the IT system, rather than rushing to interview and investigate, and threatening to interview people whether they liked it or not.
The contract between the sub-postmaster and the Post Office was unbelievable. I did not know this then, but the contract said that sub-postmasters were not allowed legal representation in those initial proceedings. Therefore, their only possible representation was through the National Federation of SubPostmasters, which happens to be completely owned and financed by Post Office Ltd. That is almost like a solicitor representing a client in a police station regarding criminal proceedings for serious offences—there are more serious offences, but this is dishonesty; this is where reputational damage can be caused, and people cannot live with the consequences of the charges—while working for the Crown Prosecution Service. It is utterly deplorable, and I honestly do not think that I have heard of anything as bad for a very long time.
Does my hon. Friend agree that the real difficulty in tackling such wrongful convictions will involve those who pleaded guilty? Our legal system does not provide a simple way of overturning convictions when there has been a guilty plea, and for good reasons. In this case, however, there may be reasons for that to be looked at. That will be the thorniest problem for the Minister.
My hon. Friend is spot on. There are major problems in that regard, though I am very hopeful. However, I do not want to interfere with the Criminal Cases Review Commission and the hearing that is bound to come for those individuals whose convictions will be considered by the Court of Appeal.
I suppose my point is that Janet Skinner should never have been prosecuted in the first place. She should never have been led, off the record, to falsely account. When her system was not balancing at the end of the day, she rang the Post Office to say, “What do I do?”. Off the record, the Post Office said, “Well, just make something up.” There is never a paper trail of that advice being given.
Although I will hopefully make my speech in a little while, I will first make a point that the Chamber might appreciate, based on sub-postmasters’ evidence to me about how they got into the position of being forced to admit guilt due to false accounting. The system did not balance when they came to close down at the end of the day. They knew they had not done anything wrong, so they looked for the fault and checked the stock for a compensating error, by which time the helpline to the Post Office was closed. Under the contract that those sub-postmasters had signed—a very onerous contract that was slanted in favour of the Post Office—they could not open their post office the following morning unless they closed off the books that night. That left them thinking, “It will be all right in the morning; I will find the fault tomorrow.” In that moment of closing off, they were guilty of false accounting—something that was held over them all the way through the process with the Post Office.
From a legal perspective, false accounting is not a strict liability offence, so there is an opportunity to defend against that allegation. However, the hon. Gentleman is absolutely right to say that those sub-postmasters were put into a position where they could do nothing but make those false accounts. That is why I think this is the most disgusting example of predatory capitalism that I have ever come across. I say that because Post Office Ltd, along with Fujitsu, invested £1 billion in that IT system. I suspect that senior people within Post Office Ltd were desperate to maintain the reputation of the Post Office, but also, sadly, to maintain their own reputation as senior people within that business. I think people misled from the very outset.
I have read many judgments, both while practising in criminal cases and since that time, and I have never read a judgment as damning as that of Mr Justice Fraser. For that, I pay huge tribute to him. I do not know Mr Justice Fraser, but I know that his practice was technical—in the areas of engineering and technology—and it is clear from his understanding and grasp of that case that he knew exactly what was happening. I think that evidence given in that hearing was tantamount to perverting the course of justice, which I suspect is why Mr Justice Fraser has referred the matter to the Director of Public Prosecutions, Max Hill QC, for him to consider. Honestly, this is utterly deplorable.
Of course, people will say, “Those victims can rely on civil litigation to bring an action for malicious prosecution,” but what sub-postmaster has £50,000, £60,000 or £70,000 spare when their careers have been ruined and every penny they had amassed in savings has gone to pay off the Post Office—money that they did not actually owe?
The hon. Gentleman is making a powerful point based on his experience of the law, but I ask him to comment on the corporate governance aspect. He has touched on corporate responsibility; does he not, as I do, find this utterly astonishing given the volume of similar allegations being made right across the country? It is not as though this were isolated to a geographic area or particular type of sub-postmaster; it was happening right across the country. Any corporate directorship or management scheme worth its salt would have identified that there was a fundamental problem and sought to find the root cause of it, rather than immediately reach for their solicitors’ letters.
The right hon. Gentleman is absolutely right: alarm bells must have been ringing. I am not saying that my legal advice at the time was bad advice; I think it was perfectly good, considering the weight of the evidence and the instructions I was receiving. However, somewhere in the Post Office, someone must have been saying, “Hang on a minute. We get maybe two or three allegations of wrongdoing per month or year”—I do not know what the figures might be—“but all of a sudden, we have 550 thieving, dishonest sub-postmasters who have never had so much as a parking ticket in their lives,” as Janet Skinner said to me. It is utterly deplorable.
For me, the alarm bell rang in 2015 when “Panorama” did its documentary, which was chilling. My blood ran cold, because I had to remind myself what advice I had given and check with myself whether everything had been absolutely right in that regard. Since I have been involved with this matter, I have been contacted by a sub-postmaster who got the opportunity to not be prosecuted by paying the Post Office back; he had to sell his house to do so. He has made the important point that the only people he could turn to were those in the National Federation of SubPostmasters.
That sub-postmaster agreed to do an interview in a spare bedroom of his own home. He says in his email that he was shocked to witness the investigating officer, when speaking with the NFSP representative, telling him to “fucking shut up”. At the time, he thought for that reason that the NFSP representative was on his side, but he now thinks that it was all a scam—that the representative was pretending to be interested, to be befriending him, and to be representing him in that interview.
Thank you, Mr McCabe; I will finish now. That sub-postmaster is now wondering whether what he experienced was all part of the scam. Given what has now been found in these proceedings, I wonder that as well.
People have to be compensated properly. Lawyers must be paid. This was an incredibly costly litigation—a David and Goliath situation in which people needed to make representations in proceedings before courts. The Government must step in immediately, pay the legal costs on behalf of those victims, and get them the money they so desperately deserve.
It is a pleasure to serve under your chairmanship, Mr McCabe, and I congratulate my hon. Friend the Member for Telford (Lucy Allan) on securing the debate. I will keep my offering reasonably brief, because I hope to speak in greater detail during the Backbench Business debate on Thursday 19 March.
It is worth reminding Members present of the points I made in this very Chamber during a debate in December 2014. They are credible evidence that the Post Office knew about the flaws in the Horizon system throughout the whole time it was prosecuting sub-postmasters, and that it tried to suppress evidence and the investigation that we, as a group of MPs with the help of Second Sight, were running into the activities and efficacy of the Horizon system. They illustrate why these convictions are unsafe and should be quashed.
This whole issue first came to my attention because of the plight of one of my constituents, a Mr Michael Rudkin, who for 15 years was a sub-postmaster. He had served as the most senior member on the national executive of the NFSP and as chairman of the federation’s negotiating committee, where he was responsible for negotiating with Post Office Ltd and Royal Mail Group. He is an experienced sub-postmaster who was very much on the side of the sub-postmasters. I will share his experience, because he was well aware of problems in the Horizon system.
Mr Rudkin’s story really starts on Tuesday 19 August 2008. In his official capacity as a negotiator on behalf of the sub-postmasters, he was invited to a meeting at the Fujitsu and Post Office Ltd offices in Bracknell to discuss problems with the Horizon system. When Mr Rudkin gave me this evidence, I had no doubt that he was telling the truth—he was an honest man—and a Fujitsu whistleblower has since come forward to confirm everything he said.
On his arrival that Tuesday morning, my constituent signed the visitors’ book in reception and waited for his chaperone, a Mr Martin Rolfe. Mr Rolfe took him to the second or third floor, and they entered a suite where Mr Rudkin recognised Horizon equipment on display on the benches. There was only one other person in the room, a male of approximately 30 to 35 years old, who was reluctant to engage in conversation when he realised that Mr Rudkin was a representative of the sub-postmasters. Mr Rolfe asked Mr Rudkin to follow him through a number of pass-protected security doors and down some stairs. They went down to the ground floor and entered the boiler room. Mr Rudkin states that a number of men dressed in casual office wear were standing around the doorway. They became very uncomfortable about Mr Rudkin’s presence and left.
Having entered the boiler room, Mr Rudkin instantly recognised two Horizon terminals. There were data on both screens, and an operative was sitting in front of one of them, on which the pure feed for the Horizon system came into the building. Mr Rudkin asked if what he could see were real-time data available on the system. Mr Rolfe said, “Yes. I can actually alter a bureau de change figure to demonstrate that this is live.” He was going to alter a figure on a sub-postmaster’s computer remotely. Mr Rolfe then laughed and said, “I’ll have to put it back. Otherwise, the sub-postmaster’s account will be short tonight.”
The Post Office, throughout its prosecutions, relied on what it stated in court and in evidence to the panel of MPs six or seven years ago, that there was no remote access from its headquarters to individual sub-postmasters’ computers. The moment that we established that, years ago, every single one of those convictions was unsafe and the Post Office knew it.
Mr Rudkin obviously raised his concern in 2008. He had been told the same as everyone else, that no one could access the computers remotely and any shortfall was therefore bound to be down to the sub-postmaster. When they realised who he was, he was escorted from the building very quickly. He was taken to reception and told to leave.
Mysteriously, and ominously, the next day, Wednesday 20 August 2008, a Post Office Ltd auditor, a gentleman Mr Rudkin knew, Paul Fields, arrived at Mr Rudkin’s sub-post office in Ibstock in my constituency. He proceeded to tell Mr Rudkin that his branch had a loss of £44,000—a loss that he knew existed before he had even looked at the system on Mr Rudkin’s computer.
Mr Rudkin was absolved of all knowledge of the loss by Post Office Ltd, but he was ordered to pay the money back. He paid it at a rate of £1,000 a month from his salary. As we have heard, the sub-postmaster is completely liable under the contract for all losses. As he points out, why would someone steal money from themselves when they know that they will have to pay it back?
After Mr Rudkin had paid £13,000 back to Post Office Ltd, the Post Office started proceedings against his wife for false accounting. We have heard it all before. It also applied for a confiscation order on his property and had his bank account frozen under the Proceeds of Crime Act 2002. Mr Rudkin has since cleared all his debts to Post Office Ltd, but in the process, he has lost his business, his reputation, his position as a magistrate, some property and his good name, and he has been unable to work since. His wife was prosecuted and had to complete community service having been warned that she could face a prison sentence unless she pleaded guilty.
I congratulate the hon. Member for Telford (Lucy Allan) on her effective and efficient introduction to the debate. All parts of the United Kingdom have been affected by this utterly disgraceful scandal. Postmasters up and down the country and across in Northern Ireland have been affected. Whether our constituencies are rural or have large towns, all hon. Members know how important central post office services are to our constituents. Post offices take on an even more significant role when banks withdraw from our constituencies, so the reputation of the people in the post office is so important.
My uncle was a postmaster in Dundonald. Although, thankfully, he was not caught up in this situation, he often talked about how the system caused many people in the post office to work under an atmosphere of fear in case it did not tally and was not right. They saw what was happening to colleagues of sound reputation and how their lives were being destroyed by what was going on. The injustice done to more than 500 postmasters is all the more duplicitous given how central post offices and the standing of the workers in them are to our community.
After the judgment was made in December, my constituent Mr Graham came to me to outline the problems that he has gone through. I will not recite the details, as the hon. Member for North West Leicestershire (Andrew Bridgen) has eloquently put on record one specific example, and we have heard other examples of individuals.
I salute the fortitude of the campaigners. One can imagine people putting their heads down and saying, “Let’s just hope this goes away,” but they have stood up and fought, because they have suffered a personal injustice that means that they want the matter to be put right. Their reputations have been ruined and their family’s lives have been completely disrupted, yet they have faced the injustice.
Is the hon. Gentleman aware that the Post Office was given prosecution powers, which meant that the prosecutions it brought did not have to go through the Crown Prosecution Service for review, as normal prosecutions would? It abused those powers, as far as I am concerned.
The hon. Member for Telford made it absolutely clear that the Post Office and the authorities should hang their heads in shame about how they acted.
Before I became a Member of Parliament, I worked on a campaign with the Criminal Cases Review Commission. It was a murder conviction of four individuals called Latimer, Allen, Bell and Hegan. I had to try to find fresh factors or new evidence that would overcome a very high standard to persuade the commission to send that case to the High Court for a retrial. I found that the statements had been wrongly written, which sufficed to get the case back to court. Ultimately, three of those murder convictions were overturned on that basis.
In this case, the Post Office admitted in court that it had got it wrong. A letter from the former Minister for Small Business, Consumers and Corporate Responsibility, the hon. Member for Rochester and Strood (Kelly Tolhurst), states that the Post Office had not only “got things wrong” but “apologised” for its actions to all the postmasters. A statement from the most senior lord justice says that what the Post Office has done
“amounts to the 21st century equivalent of maintaining that the earth is flat”,
and that the Post Office has completely ignored reality.
According to my reading of the Criminal Cases Review Commission process, those statements alone show that there are fresh factors on the table and new evidence that was not available before. Those cases should be expedited and brought to the courts without delay. There should be a fast-track process for those people so that they can get justice at last, have their day in court, have their reputations restored to them, have some semblance of normality and have the right to say, “We were not wrong. We have faced an injustice and it must now be put right.” The earlier that happens, the better, because the fresh factors and new evidence are there and should be raised.
As the Minister knows, there is a double injustice in this case. On the one hand, the postmasters thought that they had won through the mediation process and were handed a secret solution or compensation package. But on the other hand, when it was within a hand’s grasp, like Lady Macbeth, it disappeared in front of them when they went to take it. It was no longer there. It is an atrocious set of circumstances where the lawyers have been allowed to win and the postmasters have faced a double injustice and will not get their compensation.
Some people have said that it is up to the Government to pay, but I leave that to the Government. It is up to the Post Office to pay. The Post Office put that injustice on my constituent—on our constituents. Someone is responsible here. The Government could step in and hold the line until the matter is resolved, but ultimately the Post Office should be made to pay.
The hon. Member and I are on the same page. This has got to be sorted out and a payment has got to be made. Ultimately, the right person and the right corporation have to be held responsible and accountable for their actions. If individuals have done even some of the things that the hon. Member for North West Leicestershire recounted to the House on behalf of his constituent—my goodness! Four or five people in the basement of that room should be taken to court and held accountable for their actions. We need to face this issue honestly and openly.
I call on the Government to have some transparency. Let the public be the judge and jury. Let us set out with transparency the amount of money that was supposed to be paid, and who is getting what of that money. If it means shaming certain people for walking away with their pockets stuffed full because they represented a case—they are entitled to their payments, but postmasters get absolutely zilch in some circumstances—that should be exposed. I hope it is exposed. I call on the Minister to ensure that we have that transparency, because of what has now happened.
I thank my hon. Friend the Member for Telford (Lucy Allan) for bringing this debate forward. I declare that I was a sub-postmaster for two post offices before I became an MP. I have resigned as a director of the company that runs those post offices. I have no interests anymore and none of the staff I employed were affected by this issue. My only interest is that of my constituents who are affected.
I wonder if anyone else in this room has been a sub-postmaster. It is important because, having done the job, although admittedly not every day, I have used the Horizon system. I have heard about and seen at first hand the experience of making up the losses, and I thoroughly empathise with the utterly awful situation that hundreds of innocent victims have found themselves in.
Many of the individuals who worked tirelessly running post offices were as honest and trustworthy as the day is long. They have had their careers and livelihoods wrecked. Indeed, as we have heard, people have been made bankrupt because of a flawed system that accused them of theft. As we all here agree, that is a true miscarriage of justice. People have lost their life savings; even worse than that, young women have been jailed and have struggled to rebuild their lives because of a criminal record.
I have constituents in North Norfolk who have gone through such a trauma. Their story will be similar to more than 500 other cases, each as harrowing and as appalling. I do not want to reveal the names of my constituents because they still struggle to talk about these issues.
Accused of stealing thousands, suspended from their role and then charged, one of my constituents found themselves in the Crown court and was offered a deal to plead guilty to false accounting to enable the theft charges to be dropped. Why would they accept that? This lady was a grandmother and she told me that she was not prepared to look her grandchildren in the eye and say that granny was going to jail. That is not right—we all know that. In my constituent’s case, the amount was reduced to £12,000. Interest and legal costs of a further £9,000 meant a debt of £21,000. That is lower than some of the costs we have heard about, but we should just imagine being levelled with £21,000 to pay, when it is not our fault.
I appreciate the experience that my hon. Friend brings to this debate. Through our investigations years ago, we discovered that the Horizon system had a suspense account in it. It was a flawless system, yet it had a suspense account, where unallocated funds ended up throughout the whole system. The surplus—and it was a surplus—ran to hundreds of thousands of pounds a year, and after three years it was returned to the profit and loss account.
To date, my constituent has had no money back, like many others. They have had no indication of when the money is coming back and we are sceptical about how much they will get back.
Financial compensation is just one issue. The mental strain and loss of earnings should also be taken extremely seriously. There is the humiliation of walking down the street and being accused of stealing, having done nothing wrong. We are a fair society and it is our responsibility to ensure that those people are paid back in full.
I totally agree that the £58 million that was put to one side will no doubt be hoovered up by lawyers. What will be left for the real victims? That is not right. The Government must intervene and force the Post Office to make good the losses that those postmasters have suffered, in full. The board of the Post Office is accountable for this fiasco. Action must be taken against it. The issue is most definitely worthy of a public inquiry to uncover the extent of the wrongdoing that has occurred. We need transparency and a fair analysis.
As far as I am concerned, the Post Office knew that Horizon had bugs, errors and defects. It was told about that and chose to ignore it. Multiple accounts of losses should ring alarm bells in any organisation, but the Post Office was more concerned with its reputation and so individuals were accused of stealing, false accounting and fraud. Their names have to be cleared. The criminal records of those jailed must be overturned.
My constituents, who cannot bring themselves to talk about this, still feel the shame of being accused and nothing will repair the damage of losing their livelihood. However, I want to say, from my personal experience of being a sub-postmaster, that the post office is an invaluable place on our dwindling high streets. It is a hub for people to go to that offers incredible services. Post office workers do an incredible job. It is hard; there are many transactions to master. They do a superb job. The people accused should be properly recompensed, supported and entirely vindicated.
It is a pleasure to serve under your chairmanship, Mr McCabe. I thank the hon. Member for North Norfolk (Duncan Baker), whose personal experience is welcome in today’s debate. I thank the hon. Member for Telford (Lucy Allan) for securing the debate. She outlined the background and history to this long, complex and shameful episode, presided over by the Post Office and a Government who I believe have so far sidestepped responsibility for the hundreds of lives ruined by this scandal.
From the outset of the Post Office introducing the Horizon computer system, sub-postmasters were reporting problems. Instead of the Post Office listening to them, it took the draconian approach of terminating contracts, hounding sub-postmasters out of their businesses and pursuing prosecutions. As we have heard this afternoon, the results were charges of theft and fraud, reputational damage, loss of homes, bankruptcy, loss of life savings and, for some, the loss of their freedom. It took until December last year, when there was a judgment, for the Post Office to admit that it “made mistakes” and “got things wrong”. This was more than mistakes and getting things wrong; it ruined people’s lives.
It is an utter insult to tell my constituents who have suffered this injustice that it was simply a mistake. The Post Office’s mistakes cost Kevin Carter, who ran one of our local post offices with his wife, absolutely everything. His wife Julie noticed discrepancies in Horizon from the outset. She frequently reported concerns, but they fell on deaf ears. Being decent people, they began to use their own money to balance the books.
After continually raising concerns over several years, and with shortfalls increasing, Julie was invited to an informal disciplinary meeting. The Post Office demanded she pay back the unaccounted moneys and accused her of fraud. After remortgaging their home, Kevin and Julie were forced to pay the Post Office a total of £75,000. Julie suffers from multiple sclerosis, and the situation exacerbated her condition. She and Kevin had worked hard. They had a lovely home and employed 14 staff. Their lives have now completely changed for the worse. Kevin and Julie, like many others, never gave up. They joined the Justice for Subpostmasters Alliance, and an exhausted Kevin recently told me, “Quite simply, we’ve lost our family home. We’ve lost everything.” It literally cannot get worse than that.
Another constituent, Dionne Andre, bought two post offices in South Shields. After noticing discrepancies, and being a decent, honest person, she too started using her own money to try to put things right. Accused of fraud after the Post Office lost a recording of a disciplinary meeting with her, she was told, “Pay up, or we’re sending you to prison.” Dionne paid £70,000, but she was never told by the Post Office whether it had dropped the fraud case against her, so she continued to live in constant fear of being arrested. She was then told by the Post Office that she had to resign. She was forced to sell her business at a £50,000 loss and the Post Office prevented her from selling her second business, for which she had paid a quarter of a million pounds. She lost absolutely everything. Dionne is now in her 40s, but she had a promising future back in her early 30s. She told me that her working life has now gone, and it has taken years for her to try to build it back up.
Anyone who has ever had to fight for justice over a number of years, in order to clear their name when they are losing everything, will know that it can take its toll, physically and mentally. The reputational damage and utter shame, for something that they know they were not responsible for, will stay with them forever. I think we can all agree that mud always sticks, yet the people responsible are doing just fine. That is why nothing less than an independent, judge-led inquiry into this miscarriage of justice will do.
After legal costs, the damages payouts awarded will amount to only about £10 million for 550 people. In short, they are never going to get back the money they lost. For those wrongly convicted, their criminal record remains. Although some of these cases are being reviewed, they should all be reviewed. It is not good enough for successive Ministers to wash their hands and repeat the mantra that the Post Office operates as a commercial independent business and they have no day-to-day control over it. Given that it is a state-owned private company, the Government have a statutory duty to be involved in the Post Office—a duty that they have abdicated.
In the other place, the Under-Secretary of State for Business, Energy and Industrial Strategy, Lord Callanan, recently admitted that the Government were passive in their duties on the board of the Post Office. Why did they allow the Post Office to spend phenomenal sums of money on persecuting innocent people in the courts? Why did they not speak up for sub-postmasters? More importantly, who is the Government’s representative? Surely the Government should pay up for the legal costs incurred, or at least put pressure on the Post Office to do so.
The Post Office’s sheer obstinance and obfuscation has been left unchallenged by the Government. It has been left to former sub-postmasters in the depths of despair to organise and fight for justice, but justice is still being denied. Their financial recompense is pitiful, and the lack of accountability and action against those responsible is completely woeful. The Government need to take culpability and stop abdicating their responsibility for those who are being denied justice. Given that this is not a new issue, I sincerely hope that the Minister has come prepared and can furnish us with some hope and positivity—for a change.
It is a pleasure to serve under your chairmanship, Mr McCabe, and I congratulate the hon. Member for Telford (Lucy Allan) on securing this important debate. I want to make it clear that the CCRC applies only to England and Wales, and the Scottish equivalent, the Scottish CCRC, has not received any applications for review but does not rule out the possibility. I will not mention all the speakers who have taken part in the debate. I will try to get through my speech as quickly as I can, so that we can give the Opposition spokesperson and the Minister more time.
The Scottish National party has called for a full independent inquiry into the Horizon system, because justice must be done. I have lost count of the number of times I have taken part in Westminster Hall debates on various aspects of the Post Office, including how Horizon has affected sub-postmasters and post office staff. The Post Office and the National Federation of SubPostmasters have not acquitted themselves well over the issue of the Horizon accounting system—I do not normally use sarcasm in this place, but that is a sarcastic remark.
I wonder whether the Minister has listened to “File on 4” on BBC Radio 4. The harrowing effect on victims of the now discredited Horizon system, and the evidence of the Second Sight forensic accountants, is truly appalling. Post Office Ltd knew there was remote access to the system but denied that that was the case. Second Sight told Post Office Ltd of its concerns, but they were ignored. It is no wonder that the whole situation spiralled out of control. The honourable Justice Fraser, who presided at the recent trial, clarified that the Government own the Post Office:
“I would also add that Post Office Ltd, the corporate Defendant in these proceedings, is ultimately owned by the Government, admittedly through a corporate chain and a Government Department. It therefore either is, or shares a large number of features with, a public body. That is not to say that its decisions are subject (for example) to judicial review (and that point was not argued at all, so I am not expressing any view) but it cannot be seen as entirely private and wholly commercial.”
At every turn, successive Tory Governments have refused to deal with concerns about Post Office Ltd. In one debate, the then Minister told me—I am paraphrasing—that everything was fine because Post Office Ltd was now making a profit. As the hon. Member for Telford mentioned, the Prime Minister appeared to commit to a full independent inquiry at Prime Minister’s questions last week. On Monday, however, Computer Weekly contacted No. 10 to ask explicitly whether the Prime Minister had committed to a full public inquiry and whether it would be judge-led. No. 10’s response makes it clear that a decision has not been made:
“We take the Post Office’s relationship with its postmasters very seriously and closely monitored the situation during the legal proceedings. The Post Office, under its new CEO, has since accepted it got things wrong, apologised and has said it aims to re-establish a positive relationship with postmasters. The Department for Business, Energy and Industrial Strategy is working actively with the Post Office on this matter and will hold them to account on their progress. We are also looking into what more needs to be done.”
That does not appear to be what the Prime Minister said in the Chamber, and I would like the Minister to address that.
Post Office Ltd has spent millions trying to defend itself in the Horizon cases and caused untold damage to many innocent people, who paid up to prevent prosecution. Some 56 cases are in the hands of the CCRC, which will start to consider them this month. It is likely that the appeals will be successful, which could allow applicants to recover damages.
The hands-off approach taken by Tory Governments to Post Office Ltd could end up costing taxpayers even more millions of pounds. Indeed it should, because the Government should look to support the victims of the scandal, who should not be out of pocket for the financial harm they have suffered.
I see them as being as much victims of the Horizon scandal as any person who was taken to court, and they should be financially compensated. This is a national scandal, and the biggest involving IT in the public domain so far.
At the heart of the issue is the UK Government’s laissez-faire attitude. They refuse time and again to intervene despite being the special shareholder. The UK Government must take action to ensure that it does not happen again and that sub-postmasters and post office staff are supported and financially compensated. The UK Government can no longer sit on their hands. They must launch an independent investigation and ensure that such miscarriages of justice never happen again.
It is a pleasure to serve under your chairpersonship, Mr McCabe. I thank the hon. Member for Telford (Lucy Allan) for securing this important debate.
This extremely serious matter has raised worrying questions about the management and governance structures of Post Office Ltd and the way in which the Government oversee it as a public body. I pay tribute to the many sub-postmasters who have endured the harsh realities of this national scandal. Among them is Alan Bates, who has spearheaded the litigation that ultimately saw sub-postmasters get some of the vindication they deserved. Like Mr Bates, I know that the successful litigation was the first step towards achieving justice. I also pay tribute to journalist Nick Wallis, who has followed the case from the beginning and has been a passionate champion for the sub-postmasters’ cause over many years.
This debate relates specifically to the review of criminal cases, so I am disappointed that the Ministry of Justice is not responding to it. Will the Minister explain why it is a BEIS representative who is responding, when the topic of the debate was intended to fall under the brief of the Ministry of Justice?
The wrongful conviction of sub-postmasters has had an impact on the lives of far too many individuals and their families. People have lost their livelihoods, had their businesses stolen from them and, in many cases, been ostracised from their communities. For those affected, that has been a living nightmare.
One young woman began her career as a sub-postmaster at the age of 18, but after prosecution and conviction she has faced unemployment and financial ruin at a time when her adult life and independence should have begun. Another sub-postmaster whose life was turned upside down was bankrupted by legal fees and shunned by the community he had so diligently served. His neighbours would not speak to him, and his daughter was spat at on the bus to school. In one of the most tragic examples, one sub-postmaster took their own life, such was the shame, anxiety and stress that the Post Office’s heavy-handed pursuit of them brought on. Sub-postmasters who were implicated in Horizon’s IT failures have been wrongly labelled as criminals, had their lives turned upside down and, in some cases, faced decades of debt and social disgrace.
On 11 December, while we were all busy with our election campaigns, the sub-postmasters’ fight for justice took a huge step forward. The Post Office agreed to pay a £58 million settlement to the 557 sub-postmasters who brought court action against it. Mr Justice Fraser noted in his ruling that the Post Office felt entitled to treat sub-postmasters
“in capricious or arbitrary ways which would not be unfamiliar to a mid-Victorian factory-owner.”
That falls far below the standards we would expect from one of Britain’s most recognisable and trusted institutions. Mr Justice Fraser also raised concerns about the structure of accountability within the Post Office, stating that it appeared
“to conduct itself as though it is answerable only to itself.”
That was evident in the way in which the Post Office handled its litigation; it was noted that the Post Office pursued the trial with the resources and effort of a blue-chip tech company.
It is worth remembering that litigation was brought to address the errors of a Government-owned company, which was ultimately found at fault for the vicious pursuit and prosecution of hundreds of sub-postmasters. The Post Office is a Government-owned company. A civil servant sits on the board and its only shareholder is the Secretary of State for Business, Energy and Industrial Strategy, so more should have been done to address the scandal before it was allowed to fester to this extent.
In the light of the number of wrongful convictions, a group expungement of the criminal records of those convicted seems the most suitable way forward. Unfortunately, the Post Office has resisted that idea and would prefer each sub-postmaster to bring their own legal action to overturn their conviction. That is completely outrageous. People who have lived for many years through the scandal and lost everything, including their savings and reputations, are now being asked to go back to court to give their own evidence, despite Mr Justice Fraser’s finding that the Horizon computer system by Fujitsu was at fault. The Post Office was alerted to those faults many years ago, so it should not have any illusions about the system’s effectiveness.
It is striking that the Post Office seems to have learned nothing from the unnecessary prosecutions of 557 hard-working sub-postmasters or from the huge amount of anger expressed by judges, parliamentarians and the public. Instead, it forges ahead as though it has done nothing wrong. I urge the Minister to work with colleagues in the Ministry of Justice to move towards overturning, quickly and fairly, the convictions of the sub-postmasters affected by Horizon.
Serious questions need to be answered about the relationship between the company and the Government. The Government have been content to parrot the Post Office’s line throughout the process, claiming that the December settlement was the end of the matter. Nothing could be further from the truth for the people who are still fighting for justice.
My hon. Friend, who chairs the all-party parliamentary group on post offices and has long been an advocate on this issue, is making a powerful case. Does she agree that, although the scandal is outrageous and should never have happened, the Government and Select Committee investigations need to follow the money? People lost their livelihoods to pay that money back, so where did it go? Where was the shortfall? Somewhere, there are bulks of money that obviously went to the Post Office, which should use it to pay the legal fees as part of the compensation.
My hon. Friend makes a key point. People have paid money, so where is it? That must be at the heart of any investigation.
Unfortunately, fundamental corporate change within the Post Office seems a long way off, given the close relationship between both current and previous Post Office officials and the Government. The Post Office is being allowed to mark its own homework, meaning that a culture of denial is likely to persist. Could the Minister explain why Paula Vennells, the former chief executive of the Post Office, whom Judge Fraser noted was practising
“the 21st-century equivalent of maintaining the earth is flat”,
serves in the Cabinet Office?
The management and governance of the Post Office were severely criticised by the judges, so I raised the issue with the previous Minister. Will the new Minister call for a full review of the governance and management and of the relationship between the two? Furthermore, will he look closely at the way in which the National Federation of Sub-Postmasters, which is fully paid and resourced by the Post Office, has acted throughout the affair?
It is important that the taxpayer is not left to foot the bill for mistakes made by management. In December 2019, BEIS paid the Post Office £50 million as a network subsidy payment to cover the operating costs for the network. Will the Minister assure us that not a penny of that public money will be used to fund the December 2019 settlement or any future litigation?
The consistent failings of the Post Office, spanning more than two decades, have caused immeasurable damage to hundreds of lives. Only now is the full picture beginning to emerge. I welcome the commitment from the Prime Minister for a full public inquiry into the issue. I have already written to ask him to confirm that that is the case, and to give me timescales. Unsurprisingly, I have not received a letter back to that effect.
The convictions we have discussed today, however, must be dealt with as a matter of urgency. The Post Office and the Government must wake up and use every influence to ensure that the seriousness of the situation is realised. I hope this debate is one step in helping to move this process along. We must secure an independent, judge-led inquiry to quash the convictions, to pay up what the convicted have lost and, most of all, to clear the names of those hard-working decent people.
It is a pleasure to serve under your chairmanship, Mr McCabe.
I congratulate my hon. Friend the Member for Telford (Lucy Allan) on securing this important debate about the Criminal Cases Review Commission’s review of the convictions. As we heard, there has been a lot of human cost to what has happened over the past few years, and as the new Post Office Minister, I will dedicate my time to ensuring that we can see this through, keeping the Post Office on its toes, so that we come to a proper conclusion that means something to the postmasters who have suffered in the past. We also want to give confidence to the postmasters of the future about their ability to work in the network.
I am responding to the debate, rather than a Justice Minister, because, as I suspected, the debate has widened beyond the CCRC part of the situation. I hope to respond more fully to those wider points.
The hon. Member for Gower (Tonia Antoniazzi) asked what hope we can give to the victims about timescales. That will obviously depend on the complexity of each case so, yes, although we want to get this dealt with as soon as possible—it has without doubt been going on a long time—just having a tick-box approach would not be fair on those postmasters or give the answers that we need to move forward.
I will come back to my hon. Friend’s point in a little more detail, but the way in which our legal system works means that, at the moment, we cannot do that. The CCRC can analyse the cases that come before it as a group, and it still needs to do a lot of forensic accounting, but the Court of Appeal can only deal with each case individually. The legal structures that we have at the moment prevent just one single hearing with a view to taking on board all the people who have gone through this process.
I thank the hon. Lady for making that point. I was going to cover it because, as she said, ordinarily those who had pleaded guilty would not be able to do that in the system. The whole point about the CCRC system is that we can allow those people who were found guilty to have their cases reviewed—among the cases that went through, 46 people did indeed plead guilty. I can assure her about that.
Clearly, a lot of the speech I have in front of me talks about the post office network and how important it is for this country and our communities but, begging the House’s forbearance, we do not need me to cover that. We all know what a great job that post offices do for our communities and, therefore, what a great job postmasters do for our communities, so I will stick to the questions that have been asked and where we will go.
The Post Office has accepted that it got things wrong—it clearly did, and we have heard that in stark measure today. I am pleased that on 11 December we had a comprehensive resolution to the litigation, following several days of challenging and ultimately successful mediation, but there is an ongoing process. Some Members talked about the settlement, and clearly a number of people who had shortfalls in the past were not part of that group litigation, so there will be an ongoing process that the Post Office will announce shortly. I hope that some of the other cases will be able to be raised in that.
We heard about the financial and emotional suffering that impacted postmasters over so many years. Settling the long-running litigation, therefore, is so important. The Government will challenge the Post Office and its new chief executive proactively. I will ensure that happens.
I will not just at the minute, because I want to make some progress.
I spoke to Nick Read, the new CEO, and what I found refreshing about that conversation was that this guy had been chief executive of Nisa, the association of independent supermarkets, so he already gets the relationship, the fact that he is working with people who own individual independent shops. They were self-employed people, so that relationship is similar in some ways to the Post Office relationship with sub-postmasters. Rather than treating them as de facto employees, he understands the nature of their micro-businesses within the wider network.
Given that the Minister had an opportunity to speak to the new chief executive, I wonder whether the Minister and indeed the new chief executive of Post Office Ltd support an independent, judge-led inquiry. The Government need to support that, as does the Post Office.
I will not for now, because I must give my hon. Friend the Member for Telford a minute at the end.
I do not want to step on the toes of the CCRC’s investigation or of the things that are happening at the moment. Clearly, however, we need to ensure that lessons are learned. Over the coming days, we will look to see what more we can do.
I want to cover the CCRC cases specifically. The litigation that concluded with a judgment on 16 December last year only resolved the civil case—it cannot deal with criminal matters. Claimants with convictions are therefore seeking to have those convictions overturned by going through a process with the CCRC, which has the power to refer cases to the Court of Appeal. The independent CCRC plays a vital and valuable role in maintaining confidence in the criminal justice system. It is important to pay tribute to it for its process. The key role of the commission is to investigate cases in which people have been convicted and have unsuccessfully appealed, but believe that they have been wrongly convicted or incorrectly sentenced.
The CCRC received 57 applications, all of which are being reviewed—the first 20 in 2015 and the most recent 22 following the settlement in the civil case in December 2019. A small number of those applicants pleaded guilty at the magistrates court and, normally, they would have no ordinary route of appeal, but the CCRC provides a way to ensure that we can go through those cases. The CCRC has a team of three case review managers working on the cases, supported by a group leader, a commissioner and other advisory staff. They have obtained and are reviewing thousands of pages of material from the Post Office and other public bodies, and expert forensic accountants have been instructed, with the substantial task of examining transaction data from a sample branch.
I fear that the Minister does not get it. He is still parroting exactly what has been said by previous Ministers to me. If this had happened to him, and he had lost everything and had his reputation done, he would want an independent judge-led inquiry. In this Chamber, we have all made it very clear that that must be the outcome.
I am grateful for the hon. Lady’s intervention, but she used up a lot of my time. Specifically, we are talking about the CCRC. I want to ensure that I leave my hon. Friend the Member for Telford some seconds at the end. I will continue to look at that. We will continue to ensure that sub-postmasters can feel that they will have justice, recompense and the confidence to move forward.
I thank everyone who has participated in the debate. I am truly grateful for the level of support and passion that we have heard across the House and across the country. We have to recognise that this was a unique set of circumstances that deserves a unique remedy. There is no point hiding behind the CCRC not having a mechanism; we must give the CCRC a mechanism—we must invent a mechanism to deal with this, because it is so unique. People have suffered, and they will go on suffering if we do not do something about it. I urge the Minister, please reread Justice Fraser’s judgment—
Motion lapsed (Standing Order No. 10(6)).
Eating Disorders Awareness Week
[Andrew Rosindell in the Chair]
I beg to move,
That this House has considered Eating Disorders Awareness Week 2020.
It is a pleasure to serve with you in the Chair, Mr Rosindell. May I say how glad I am to have secured this debate during Eating Disorders Awareness Week? I am glad that we have the opportunity to talk about how people acquire eating disorders and how they can, or should, be able to get the help they need.
Let me place on record my thanks to all the people and organisations who helped me to prepare for this debate. It is a long list, so I hope hon. Members will bear with me, because they deserve to be highlighted: Sandie Atkinson from Diabetics with Eating Disorders, Beat Eating Disorders, the Royal College of Psychiatrists, the British Psychoanalytic Council, the Musicians’ Union, Equity the acting union, the British Dietetic Association, Professor Khalida Ismail of King’s College, London, Hope Virgo of the Dump the Scales campaign, the Priory Group, the House of Commons Library, which has produced a really good briefing, as always, the Parliamentary and Health Service Ombudsman, which has also provided a briefing, and Julia Tyson.
Some 1.25 million people are living with an eating disorder, 10% of whom suffer with anorexia nervosa, and 40% with bulimia; the remainder suffer from other forms such as binge eating. Research shows that the earlier the treatment is accessed, the better the chance of recovery. The figures show that 50% recover and 30% experience some improvement. Worryingly, however, 20% remain in a chronic condition. The most common age of onset is 15 to 25, although there is growing evidence that older people are affected as well.
I want to touch on three areas: first, diabulimia, which is a form of eating disorder that many may be unaware of; secondly, the interplay between the entertainment industry and social media, and the impact they have on people’s sense of their own appearance; and thirdly, treatment.
Diabulimia is a form of eating disorder that affects thousands of people with type 1 diabetes. We cannot give an accurate figure, because of how incidents are recorded—it will show up as an eating disorder but not necessarily for somebody who has diabetes. Simply by withholding insulin, type 1 diabetics are able to attain rapid weight loss. There are, however, serious physical health consequences, and it can be fatal. I will not say too much on this topic, although I will return briefly to it later, other than that the right hon. Member for Maidenhead (Mrs May) has agreed to co-chair an inquiry into this matter with me, which we hope to commence later in the year. The right hon. Lady and I intend that the inquiry will raise awareness of diabulimia and look at evidence of what practical steps can be taken to improve the treatments available.
The relationship between the entertainment industry and eating disorders is complex but real. It has been described as a vicious circle, whereby some musicians and actors are put under pressure to look a certain way. In many well-documented cases they subject themselves to eating habits that, as they see it, enable them to achieve that appearance. However, that is not without consequence for their mental and physical wellbeing.
Let me explain what I mean. The actress and Equity activist Jean Rogers has drawn my attention to the work of Dr Sara Reimers of Royal Holloway, University of London, on aesthetic labour, which is defined as
“the employment of workers with desired corporeal dispositions”
“employers intentionally use the embodied attributes and capacities of employees as a source of competitive advantage.”
That work formed the basis of the “Making an Appearance” research she conducted with the Equity women’s committee.
Maureen Beattie, the president of Equity, has given an account of her own eating disorder as an actress, which she struggled with from the age of 14 to 30. She said:
“When I was at drama school I found the mixed messages I received very confusing—on the one hand I was told I was a big, fat lump of a girl and on the other hand was always cast in leading lady roles which required elegance and charm and attractiveness. There was a lot of pressure on me to lose weight, but the more the staff (and my parents who were both in the entertainment industry) lectured me about my weight the more I needed to eat. I ate so much I sometimes felt like I had been drugged. I realise now I was protecting myself”.
She says that the pressure of acting contributes to eating disorders:
“The feeling of being an object to be pushed and pulled and commented on and criticised and laughed at by the public is very real to many people.”
Recently, on “Desert Island Discs”, Melanie Chisholm, the former Spice Girl Mel C, said:
“I was described as the plain one at the back…I ended up making myself really ill. I was anorexic for a few years. I was exercising obsessively, and I ended up being incredibly depressed. I was in denial.”
After being diagnosed, she described going from anorexia
“to having a binge-eating disorder”.
Tellingly, she concluded that her
“appearance began to change, which was the biggest fear”.
In the documentary “Miss Americana”, the hugely successful international singer Taylor Swift talked about how, as an 18-year-old, she was portrayed on the cover of a magazine. She said:
“The headline was ‘Pregnant at 18?’ and it was because I had worn something that made my lower stomach look not flat. So, I just registered that as a punishment”.
Consequently, she said of her performances that she
“thought I was supposed to feel like I was going to pass out at the end of a show, or in the middle of it”.
It is not only young women who are affected by eating disorders—the singer Sam Smith has talked about starving for weeks to prepare for photoshoots.
A 2016 Credos survey of 1,000 boys aged between eight and 18—“Picture of Health?”—found that 55% would consider changing their diet to look better. Interestingly, the survey also found that respondents felt under pressure from other factors to look good, with 68% citing friends, 58% social media, 53% advertising, and 49% celebrities.
Another disturbing aspect is how a performer’s body shape is changed digitally. Victoria Hesketh, who performs under the name Little Boots, has drawn attention to the use of photoshopping to alter the appearance of artists, citing the case of the singer Meghan Trainor, herself a campaigner on the misuse of body image, whose 2016 video “Me Too” had been digitally manipulated to reduce her waist size without her express consent. Ms Hesketh commented in an article in The Independent:
“This stuff is nothing new, but I’m not sure if people really realise the extent to which image manipulation really matters, especially in pop music videos and even more so with female artists.”
“I remember a music video director once telling me”—
this is really shocking—
“‘You should have seen Beyoncé’s ass before we got in the edit’.”
Let us think about the implications of what the editor in those circumstance thought was his responsibility. It is quite frightening.
In 2011, as part of their “Pretty as a picture” project, Jo Rigby and the advertising think-tank Credos commissioned Panelbase to conduct an online survey of 1,000 girls and young women aged between 10 and 21. Since that time, the fashion industry has become significantly more sensitive about body shape for models, which is to be welcomed. The survey found that 53% of young women took
“inspiration from adverts for their appearance”,
and that 37% wanted to
“look like models they see in adverts”,
even though 85% of them
“recognise that...images in advertising have been altered using airbrushing.”
Worryingly, about half of the young women involved admitted:
“Seeing adverts using thin models makes me want to diet/lose weight/feel more conscious of the way I look.”
On the issue of social media, Girlguiding UK’s “Girls’ Attitudes Survey 2019” concluded:
“Girls and young women say they’re aware of the difference between real life and what they see represented online and in the media. Almost half of girls regularly remind themselves that social media is not a real reflection of others’ lives. One solution may be making sure airbrushed pictures are always labelled as such, with over half of girls agreeing to this. Nearly half of girls agreed there should be a more diverse range of people on screen too.”
My point in citing those examples is to make a connection between what we see and the reality of young people trying to emulate the stars that they see as role models, which I described earlier as being a vicious circle.
Another pressure turbocharges this phenomenon—namely, the way in which social media can serve as a means of shaming people about their appearance. I confess that I find that to be an ethical minefield. In an open society, we rightly defend the principle of freedom of speech, but when that freedom normalises abuse and shaming, the platforms and the individuals who use them surely have to take responsibility for what is said and the potential consequences. What might seem a bit of fun can very easily have devastating consequences when it targets people in such a way as to drive them towards eating disorders.
In last week’s New Statesman, Amelia Tait wrote about personal responsibility for those who engage with social media. She stated:
“It’s not up to algorithms to change our behaviour, it’s up to us. We have to stop celebrating cruelty with our clicks, and instead make a conscious effort to reward people who are kind to others or people who call out poor behaviour when they see it.”
Social media platforms need to recognise how they can profoundly affect people’s mental health and behaviour. Either they accept that responsibility or, sooner rather than later, they will have to be regulated to do so. We all have an important role to play through the language we use. When we say things such as, “You need to grow a thicker layer of skin”, or “Get a grip”, that is not helpful. The effort required to tackle an eating disorder of any description is profound and massive. Simply telling people to “get a grip” does no good at all.
I said earlier that I am indebted to the charity Beat, among others, for its help in preparing for this debate. Its key policy suggestions are based on the current treatment available for adults, treatment for young people, medical training and research funding. My constituent Emily helps raise funds for Beat and has organised sponsored walks with her family and friends, which I have been pleased to support and I am probably healthier for having taken part.
Beat has pointed out:
“Adults with eating disorders in England face a postcode lottery”
in trying to access treatment. Only 26% of adult patients commenced treatment at a specialist service within four weeks of being referred. The average wait is nine weeks. In some clinical commissioning groups, adults are first referred to a non-specialist health service or to a panel for approval before being referred to a specialist service. That inevitably creates delays, which in some cases can have tragic consequences.
Beat and the Royal College of Psychiatrists suggest that a funded access waiting time standard should be introduced for all adults with eating disorders in England. An access and waiting time standard has already been introduced for the treatment of young people with eating disorders. By 2020-21, it is hoped that 95% of children and young people will commence treatment approved by the National Institute for Health and Care Excellence within one week of referral for urgent cases and within four weeks for less urgent ones. The most up-to-date information across clinical commissioning groups, however, shows that the rate for meeting the urgent referral target varies between 22% at worst and 100% at best. Beat is calling for the access and waiting time standard for children and young people with an eating disorder to be met in every area across England.
A further concern raised by Beat is that eating disorders are not sufficiently covered during medical training. On average, medical schools spend less than two hours teaching about eating disorders. One in five provide no training at all, and many do not even include a question on eating disorders in their final exams. As one fourth-year medical student put it:
“We don’t get any clinical skills experience.”
For those reasons, Beat recommends:
“Eating disorders are appropriately taught and assessed at all medical schools”,
and that all junior doctors in the UK
“gain...clinical experience during their foundation training.”
The Royal College of Psychiatrists has called on the Government to double the number of medical school places in order to provide the specialists needed to help people with eating disorders. I echo that call.
Beat’s final point relates to research funding. Given that the broader category of mental health accounts for 23% of NHS activity in 2018-19, 10% of the Department of Health’s research funding goes to mental health research, with just 0.09% devoted to eating disorders. That amounts to 96p per sufferer, compared with £228 per person spent on vital cancer research that has led to survival rates for cancer doubling over the past 40 years. I mention that not to suggest that too much money is being spent on cancer research, but because it shows that if more money is put into research, results follow. Beat is calling for a “significant increase” in funding for research into eating disorders.
Hope Virgo of the Dump the Scales campaign last week launched the z-cards campaign, a guidance resource for those with eating disorders and those supporting them. It has the timely and important aim
“to raise awareness of eating disorders”
“an educational piece for all frontline staff.”
Dump the Scales is asking the Government to recommit to NICE guidance 1.2.8:
“Do not use single measures such as BMI or duration of illness to determine whether to offer treatment for an eating disorder.”
The Royal College of Psychiatrists makes the same point. Hope Virgo is also calling for support for the roll-out of the z-card, training for GPs on eating disorders, and the development of a meaningful way of measuring the implementation of the guidelines, together with an annual implementation review.
I want to deal with the question of the best form of treatment for eating disorders. I have spoken to many people who have experienced them, and some believe that long-term residential treatment, sometimes including cognitive behavioural therapy, has been beneficial. There is, however, no consensus about cognitive behavioural therapy. Some experienced psychiatric specialists argue that although it may be a short-term way of dealing with the immediate problem it is not necessarily a long-term solution, in that it does not address the underlying cause of the disorder. I do not intend to draw any conclusions on that difference of professional opinion because, frankly, I do not feel equipped to do so, but I will refer back to the matter shortly. Some treatments at private healthcare facilities have been cited as having a positive effect on people’s eating disorders. However, such treatment can be very expensive and is usually beyond the means of most sufferers and their families.
Sandie Atkinson of Diabetics with Eating Disorders has said that there is still a desperate need to make insulin omission for weight loss, also known as diabulimia, a diagnosable condition. DWED supports the use of “type 1 eating disordered”, or T1ED, as an umbrella term for all disordered eating occurring in type 1 diabetes. The diagnosis would include subcategories for anorexia, bulimia and diabulimia, as insulin omission can occur separately or alongside other eating disorder symptoms.
I have a number of questions I want to address to the Minister, although I do not necessarily expect answers to all of them today. First, will she give careful consideration to the suggestions that DWED, Beat, and Dump the Scales have made about eating disorders, and will she undertake to respond in some form of written statement when she has had the opportunity to look at them more carefully? Secondly, will she undertake a review of the long-term effectiveness of cognitive behavioural therapy to assess its efficacy for treating eating disorders? Thirdly, will she undertake to meet representative bodies of the entertainment industry, Equity and the Musicians’ Union, to discuss the relationship between the promotion of a certain type of body image and the way in which it can affect young people? Finally, will she hold a similar meeting with social media providers to discuss what more they should do to prevent their platforms from enabling abusive behaviour, which shames some young people into acquiring eating disorders?
I hope we can agree that the issue of eating disorders is in need of urgent attention, not least because of the serious implications it has for the health and wellbeing of so many people and their families.
It is a great pleasure to follow my right hon. Friend the Member for Knowsley (Sir George Howarth). I call him my right hon. Friend because I have been working with him on diabulimia. He has huge expertise in the area and I am rather new to the field. I shall be brief.
We are all occasionally touched by surgery cases we get, and about 10 months ago a couple came to see me whose daughter had recently taken her life after a long battle with diabulimia. It is terribly distressing to talk to parents who have lost a child to suicide, and perhaps even more so given the terrible background to that suicide—although all suicides are to be mourned equally. The Minister has been fantastic. I have been in correspondence with her about the case, and about diabulimia.
For the record, I shall give a quick overview of what led to the tragedy of a young woman aged 27, who was a teacher, taking her own life. She had suffered with eating disorders for a number of years and was diagnosed with type 1 diabetes. As her parents said, she became giddy with joy. This is not a normal reaction when someone is diagnosed with diabetes. She was giddy with joy because she realised that as a sufferer of diabetes, she could suppress her weight through insulin abuse. In her parents’ words, the prescribing of insulin weaponised her eating disorder.
The concern that I and the young woman’s parents have, which I have raised with the Minister, is that too many healthcare professionals are unsighted in this area. When they prescribe insulin to an adolescent female or young woman, they are not alive to the risk that there may be an undiagnosed or undeclared eating disorder, or an underlying risk of an eating disorder, and that what is actually happening is that someone with a severe condition, or a propensity to a severe condition, is being handed a toxic substance that might save their life in one way but lead to the loss of it in another. There is a need for really strong background discussions with young women and girls when they are diagnosed with type 1 diabetes about their mental wellbeing and whether there is any danger of an eating disorder being present.
I have taken the case up with the Minister and I pay tribute to her. She is aware that the NHS is currently piloting services joining up treatment for diabetes and for eating disorders in London and on the south coast. Our most recent correspondence was last summer and I hope that, if not today, at some stage the Government will be able to update the House as to the success of the pilots and whether they will lead to a wider roll-out.
As the Minister said in her letter, the pilots will provide a valuable insight into the impact insulin prescribing has on individuals at risk of developing eating disorders, and they are an important step forward in recognising and treating diabulimia and minimising its devastating impact on patients and their families. That is exactly what we want to hear from the Department of Health, and I congratulate it on recognising the scale of the problem. The Minister went on to say that raising awareness among health professionals and alerting them to the risk associated with insulin and eating disorders is one of the Government’s priorities.
The debate is hugely timely. I hope that further measures will emerge from it across the NHS—across GP and mental health surgeries—that contribute to ensuring that no families have to lose a child in the way my constituents did.
I thank the right hon. Member for Knowsley (Sir George Howarth) for bringing the debate forward. I am pleased to participate in it. I, too, have had constituents who have had eating disorders over the years, so this is an opportunity to highlight those issues and look to the Minister for a positive response—no doubt we will get one. It is good to follow the hon. Member for Broxbourne (Sir Charles Walker), and I thank him for his contribution. Until the right hon. Member for Knowsley told me about it some time ago, I was not aware of the issue of eating disorders among people with diabetes.
It is good to have the opportunity to speak about eating disorders, which are serious mental illnesses that deserve to be dealt with in that vein. My interest in the issue came from sitting with a friend of mine—a father who was at his wits’ end trying to get his daughter, who was suffering from an eating disorder, the help she needed. That was way back when I first came here, between 2010 and 2012. He did not give up. Neither did I—and neither did the Minister responsible for health back in Northern Ireland or the Health Minister here. It was a combination of both that brought about the success that we had hoped for. The Minister in Northern Ireland managed to make changes to how things were approached there. The result of that was that we—not me, but the Minister at the time—made legislative changes and changes to the provision of in-patient care specifically for those suffering from eating disorders.
That story is very poignant. I will not mention any names, but that young lady had severe eating disorders. Unfortunately, she had hidden much of it from her parents, whom I knew extremely well; they both were in an occupation that I had a particular interest in. They had approached the Department of Health back home but had not really got the response they wanted, so I met Edwin Poots, who was Health Minister at that time. Ultimately, through our contact with him and the Health Minister here, we were able to get that young lady over from Northern Ireland, where there did not seem to be anything in place to help, to St Thomas’s Hospital just across the way from where we are now. Ultimately, the medical care it was able to offer saved that young girl’s life. It is as simple, as graphic and as honest as that. I would like to put on the record my thanks to the Minister at that time and to St Thomas’s for giving that family the treatment and help they needed.
The wonderful thing about that story—again, I will mention no names—is that that young girl is now married. She is still one of my constituents, as indeed are her mum and dad, and she has two young children. I had not seen her for a few years, but before the election I knocked her door. She came to the door looking extremely well, and she reminded me of that story. I wanted to tell it today to add to the interactions described by the hon. Member for Broxbourne and the right hon. Member for Knowsley. Things can be changed if the right measures are in place to make that happen.
I asked the Minister back in January how many people were recorded as having had eating disorders over the past five years. The answer was not straightforward. That moves us to the crux of the issue: the differing diagnostic processes. The Minister’s response read:
“The following tables show the number of people referred to specialist secondary mental health services with a primary diagnosis of eating disorders from 2014/15 to 2015/16, and the number of people referred to specialist secondary mental health services with a primary reason for referral of eating disorders from 2016/17 to 2018/19.”
The figure was 4,513 in 2014-15 and 3,895 in 2015-16. The source for those two years is the NHS Digital mental health and learning disabilities dataset. In 2016-17, the figure jumped to 11,207, and in 2017-18 it increased to 18,224. In 2018-19, there was a massive jump of more than 4,000, to 22,336.
The Minister’s answer continued:
“There are two matters to consider when looking at the MHSDS data:
Diagnosis recording is known to be low. Of the people in contact with these services on 31 October 2018, for example, a diagnosis was recorded for only 22.3% of people. Therefore, the number of people with a primary reason for referral of ‘eating disorders’ for 2016/17, 2017/18 and 2018/19 is provided, rather a count of people diagnosed with an eating disorder.”
That probably means that in 2014-15 and 2015-16 a large number of people had similar problems but were not referred. That is what the Minister acknowledged in her response. If we have a problem even counting how many people have a disorder, how on earth do we find them the help they need?
The charities that work with those struggling with their eating are a little clearer about how they work things out. The right hon. Member for Knowsley referred to Beat—I thank both it and the Library for the information they sent us—which estimates that there are some 1.25 million people in the UK with an eating disorder. That is not in any way reflected in the Government’s figure of 22,000. If it is anywhere near the truth, Beat’s figure cannot be ignored.
“The most common age of onset is 15-25 years old, during a developmentally sensitive time. Anorexia has the highest mortality rate of any mental illness, and the mortality rates of the other eating disorders are also high. People with eating disorders typically develop severe physical health problems and overall quality of life has been estimated to be as low as in symptomatic coronary heart disease or severe depression.”
That demonstrates the magnitude and severity of the issue. Beat continued:
“Without early intervention, many become unable to participate in education or employment.”
Some 1.25 million people in the UK currently live with an eating disorder, while 10% of people affected by an eating disorder suffer from anorexia and 40% suffer from bulimia. The rest of sufferers, including those with binge eating disorders, fall into the “other specified feeding or eating disorders” category. There are some very complex examples of those problems.
Research suggests that the earlier treatment is sought, the better the sufferer’s chance of recovery. That is the case with almost every disease: early diagnosis always helps to address something early, solve problems and raise awareness. Some 50% of eating disorder sufferers go on to recover. That is encouraging, but it tells us that 50% continue to have problems. Only 30% improve, and 20% remain in a chronic condition; many continue to suffer way beyond their alarming early conditions. Those high figures highlight the serious issues with the availability of holistic treatment.
I wholeheartedly support the Dump the Scales campaign, which would bin the GP regulations enforcing a minimum weight or BMI before a diagnosis can be given. Indeed, I support calls for GP retraining on this issue. I am very respectful of our GPs, who are wonderful people. They do great work, but sometimes we need a better understanding of eating disorders. We should not insist on certain categories in relation to eating disorders or insist that people get on the scales. I think it is important to address that.
I am a type 2 diabetic. Whenever I go down to the doctor, he weighs me and refers to my BMI, and he tells me whether I am on the right or wrong side of it. Thank goodness, this last while I have been on the right side of it. I try to keep careful control of what I eat and how much I eat.
When a parent, a carer or a sufferer themselves realises that all is not okay with their mindset towards food, palming them off with a little leaflet or a referral—I mean this respectfully—to yoga classes, as sometimes happens, is not enough. I am not saying that yoga is not good to do—I have never done it and have no knowledge of it—but to say that that is a way to solve someone’s eating disorder is a wee bit crass, to say the least. We must get on with early diagnosis and intervention, rather than effectively saying to people, “You aren’t skinny enough yet to merit help,” because they are.
The starting point must be the first realisation that there is a problem. When the parents of the young girl I mentioned earlier realised that their daughter had a problem, they addressed it early on. A doctor has never asked me to be tired for six months before checking the iron in my blood. He carries out a test to ensure that nothing is wrong. We start at the beginning and do not waste six months to see what it is. Why must we wait until someone is dangerously underweight before we offer them help when, in some cases, that is just too late?
I am fortunate to have two granddaughters who are extremely beautiful, not like their grandfather—and they will be glad to hear that; they have their grandmother’s and mother’s good looks—but never do I want them not to see what I see when I look at them. If, God forbid, there was a problem, I would want to know that the NHS had not simply the finance but, more importantly, the understanding of how and when to intervene. That is not simply when the scales show the correct small number.
It is a pleasure to serve under your chairmanship, Mr Rosindell. I thank the right hon. Member for Knowsley (Sir George Howarth) for introducing the debate, particularly in Eating Disorders Awareness Week, on such an important issue that is often overlooked because it is hidden. He was fastidious in detailing so many of the crucial aspects of eating disorders and how our popular culture impacts on so many. I think it will go on to affect more young people as it grows under the social media stresses and pressures put on them.
I was thinking back to when I first started to think about appearances, which was probably when I was in my mid-teens, but my daughter, aged 11, is already looking on Instagram and so aware of how she looks and how many friends she has on social media. Those are not what I would call actual friendships, but these days it is all about social perception, and the pressures and stresses we put on young people through social media, which remains largely unregulated, are astronomical. We are creating a mental health catastrophe that is coming down the line for our young people. It will impact on men, who are not immune, but it impacts significantly on young women. I see that in young children of primary school age: my daughter and her friends very much relate to pictures of one another online and how they look. A societal image of perfectionism is being created that is very unhealthy for people’s mental health.
Eating Disorders Awareness Week is running this month, raising awareness of a disorder that, as has been said, affects 1.25 million people across the UK. When I worked as a psychologist in mental health services, I was aware how even then it was not a key focus in our training. Mental health professionals could benefit from much more in-depth training in eating disorders. When I was at Glasgow University, we benefited from the psychologist who came to train us having a specialist interest in the area. He is long retired and I do not know if anyone has taken his place, but training was very much dependent on individuals who had developed specialist expertise coming and lending that expertise, because those in training may not meet or have clinical experience of treating people with eating disorders unless they go on to do a specialist placement. Many of the professionals we are bringing through across the United Kingdom will not necessarily feel that they have sufficient expertise to treat eating disorders. We need to address that, particularly because, as has been said, it is not the kind of difficulty where people often come forward and say, “I have an eating disorder.” Clinicians, trying to form a picture on presentation of someone who might come with a diagnosis of depression or trauma, may notice a larger clinical picture not in the referral, but they require that expertise to pick up those symptoms early on. We know that earlier intervention creates a much better outcome for those with these conditions.
The other important issue I want to bring up is the Dump the Scales campaign, which I looked at while other hon. Members were talking. There may be more obvious signs of weight loss in individuals who present with anorexia, but those with bulimia are often bingeing and then purging, so there may not be noticeable weight loss. Such disorders can become extremely chronic before anyone picks up the symptoms. Certainly, one symptom of the disorders is denial and attributing difficulties elsewhere.
Dump the Scales is important, because my understanding is that BMI has to be at a certain level for a referral. We need to move on from that in clinical practice and look much more widely. I have just looked up the criteria in ICD-10 and, while they may have moved on, there are a number of symptoms and BMI is one of them. That needs to be considered, because, as I said, the person is not likely to come with a presentation of eating disorders in the first place and then, if some of the clinical symptoms are so stark that they cannot be referred on to appropriate services so quickly, that creates another barrier to getting the treatment they so desperately need.
Family support is another matter that we often overlook but need to focus on. We really need to get family members on board in order to have holistic treatment, particularly for young people’s mental health. It would be helpful to know more about what is being done in relation to family systems therapy and family therapy.
I was trained in the cognitive behavioural therapy model when I was practising, but it was very much a formulation-based model. I do not think eight sessions of CBT would necessarily be effective for people who have a long-standing chronic illness or perhaps other underlying issues such as trauma that need to be resolved. We need a flexible system to ensure that a person’s care pathway is at the level of service they need for the chronicity of their difficulties.
It has not passed me by that it is International Women’s Day this week, so it is apt to have this debate on eating disorders awareness, which an issue that is likely to affect so many young people—overwhelmingly women, but also men—who face this social pressure.
I will finish with a few things that the Scottish Government are trying to do. This is an area where we should share best practice and have much collaboration across the UK, and I would like to see that and be part of it. It is excellent for the way forward that an all-party parliamentary group has been reconstituted.
Last year, the Scottish Government created an online peer support tool specifically for this issue to allow young people to pair with a trained volunteer, who had themselves recovered from an eating disorder. That is important because peer-to-peer support can be extremely helpful, particularly for young people. At certain stages in life we may speak to our parents more or less readily, depending upon our stage of development, and for adolescents, among whom a higher percentage of eating disorders initially develop, peer-to-peer support will provide an excellent starting point for treatment.
The website caredscotland.co.uk is an information platform for parents and carers. We must ensure that parents and carers, who are, most often, going to be the ones who pick up the initial signs, have awareness, as well as the support they need. It is vital that parents and carers have that support because dealing with an eating disorder can take an enormous emotional toll upon an entire family. We need to look at people’s mental health in a holistic manner.
We need to do much more, right across the United Kingdom, in relation to access to treatment for those who have eating disorders. We have come some way, but we need to raise more awareness at different levels within the system. GP training has been mentioned. We also need a public awareness campaign, because often peers or families pick up the initial symptoms, and medical training for psychiatrists and those working in mental health. From my own training, I do not think those professionals have the level of training necessary to treat people in primary mental health care, which is often where an eating disorder might be picked up initially before it is referred on to secondary community mental health teams.
I am thinking about the dangers of social media and how it affects children and young people. Could the dangers of social media be made clear at an early stage, perhaps at school? The perfect body, clothes, hair and everything become things everyone wants, whereas the reality of getting them is quite different. For instance, in some photographs, models’ six packs or their weight are actually changed digitally. Social media has a lot to answer for.
The hon. Gentleman is entirely correct. Social media often creates a false world that none of us can ever live up to. That is why I welcome the Government’s work on social media, which is looking at potential regulation and other issues in relation to the impact on mental health.
This is an excellent pivotal debate, but it is not the finishing point. It is most definitely the starting point for taking these issues forward on a cross-party basis. I look forward to working with everyone who has an interest in this field, to support progress for those who have eating disorders across the United Kingdom.
It is a pleasure to speak in this debate with you in the Chair, Mr Rosindell. I congratulate my right hon. Friend the Member for Knowsley (Sir George Howarth) on securing this important and timely debate, and for the excellent way he opened it, which was very helpful. It has been a compact debate, but he covered a wide range in what he said.
I welcome the contributions of the hon. Member for Broxbourne (Sir Charles Walker), particularly when he spoke about the moving case of his young constituent who took her own life, which is always sad to hear; the hon. Member for Strangford (Jim Shannon), and the SNP spokesperson, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron). I agree with her about using the debate today as a starting point. There is much that we should be talking about.
As we have heard, eating disorders are serious mental illnesses that affect too many people in this country. It is estimated that there are currently 1.25 million people in the UK with an eating disorder. It is a serious issue that we should be talking about, even more so because that is only an estimate as we do not have reliable data on the prevalence of eating disorders in the UK. The hon. Member for Strangford talked about that; it is an issue that we must take forward from the debate today. It is part of a broader problem with our data on mental health conditions, although we must acknowledge that some of it comes down to the stigmatisation of eating disorders.
Eating disorders can affect people of all ages, from instances among children as young as six years old, which should alarm us, to women in their seventies. Around three quarters of people with an eating disorder are women but, as we have heard in the debate, eating disorders also affect men. We need to be careful not to stereotype when we describe people affected by eating disorders because it can deter men and young men from seeking help.
Anorexia has the highest mortality rate among all psychiatric disorders because of the severe medical complications that it can cause, but all eating disorders have an impact on the daily life of people who live with them. It is vital that eating disorder services are there to support people when they need it. It is my belief that too often people with eating disorders are being let down by our NHS, and those of us who are interested in this must take that forward from here.
Someone with an eating disorder will currently wait an average of three and a half years before receiving treatment. Too often someone goes to their GP to ask for help, but simply does not get it, as we have heard. The eating disorder charity Beat, which we have all rightly mentioned in our speeches, found that nearly one in three people who seek a referral to an eating disorder service did not get one from the first GP to whom they spoke. These delays clearly go against the NICE guidance on ensuring prompt access to specialist services, and they come with an enormous emotional toll for the person involved. The hon. Member for Broxbourne talked about where that emotional toll can take somebody. Imagine having finally built up the confidence to go and ask for help only to be told, “You won’t get to see a specialist”.
Earlier this week, I spoke to people who are now recovering or recovered from eating disorders, who told me about their struggles to get support. I thank Beat for organising that meeting with MPs. One person was told by a doctor that she weighed too much to have treatment for an eating disorder, despite weighing only 38 kg, which is less than 6 stone. Let us imagine that weight. I also heard about a doctor praising over-exercising, as if that were a good thing. We heard from my right hon. Friend the Member for Knowsley that Mel C had the problem of obsessively exercising, which is another way people can seek to lose weight. Finally, a person was told that she needed to find the willpower just to eat. My right hon. Friend rightly criticised the attitude of underestimating the difficultly of the condition and the danger of the “just get a grip” attitude. We have to get over that and clearly it is even more damaging when it comes from clinicians.
People with bulimia have been denied treatment based on the frequency, or lack of frequency, of their bingeing and purging episodes. The continued focus on weight that we have talked about is particularly concerning as bulimia, along with other over-eating disorders, does not always lead to excessive weight loss. My right hon. Friend and the hon. Member for Strangford talked about Hope Virgo, the campaigner who leads the Dump the Scales campaign. That campaign tells us that clinicians are still using measures such as BMI to assess whether someone is eligible for eating disorder treatment, as I was told by the young person I met this week.
That is another instance where NICE guidelines are not being correctly followed, meaning people are being turned down for the support they should receive. Is someone who has been told they are ineligible for help after visiting their GP really going to go back and ask again and again, until they get the help they need? Or are they going to struggle with their eating disorder, potentially deteriorating to the point where they need to be admitted to hospital?
We should emphasise that the situation is not necessarily the result of medical professionals not caring about eating disorders, but a reflection of the fact that medical schools have less than two hours’ training on eating disorders across the average medical degree. In fact, one in five medical schools do not cover eating disorders at all and, where they are covered, the subject is not in the final exam, meaning students will give it a lower priority.
We see doctors who think people cannot have an eating disorder if they have a healthy BMI, family GPs who are not confident that they should make an urgent referral to a specialist service and many doctors who have never seen a patient with an eating disorder before. The Parliamentary and Health Service Ombudsman and the Public Administration and Constitutional Affairs Committee have both recognised this and call for all doctors to receive proper training on eating disorders. The General Medical Council has said that it will engage with medical schools on the lack of training, but that is a long way from guaranteeing that all newly-qualified doctors will have basic levels of knowledge on eating disorders.
Will the Minister act as a champion for improved training on eating disorders, so that patients can see a doctor who has a basic understanding of what an eating disorder is and of how important it is that a patient sees a specialist? That would be a first step in ensuring that the NHS gives people with eating disorders the support they need. I say a first step, because even when people can secure a referral to a specialist eating disorder service, there is no guarantee that they will then get the help they need.
Colleagues have brought a number of statistics into the debate. In 2017-18, an adult referred to a specialist eating disorder service could expect to have to wait an average of nine weeks to start treatment. That is clearly not good enough. In no other area of mental health would we accept a wait of more than two months to see a specialist. The Government seem to have accepted that in the case of children and young people, where we are finally seeing the introduction of waiting time targets, but waiting time targets for adult services are still being piloted. Can the Minister tell us why that is the case and when the Government will introduce waiting time targets for adult eating disorder services, to ensure that everyone can access timely support?
Simply setting targets will not solve this problem. I am afraid we are seeing that in services for children and young people where, despite some progress since the introduction of targets, people with eating disorders still face a postcode lottery up and down the country. In my constituency, 97% of young people referred to a specialist eating disorder service are seen within a month, but if they live just yards away, across the border in Wigan, the chances of their being seen in that timeframe fall to 66%. That is not good enough. We need all areas of the country to be given the resources they need to give people with eating disorders appropriate and timely support.
Sometimes the right support can mean the person with an eating disorder getting hospital treatment, but there are only 649 specialist in-patient beds for people with eating disorders in England, and just 249 of those are for children and young people. According to NHS data, the most common age for admission to hospital for eating disorders is 13 to 15. More than 4,400 children were admitted to hospital for eating disorder treatment last year.
When their local hospital does not have enough beds, children are being sent miles away from their families for special treatment, because the NHS does not have the resources to treat them closer to their homes. My right hon. Friend the Member for Knowsley also raised the issue of the use of private healthcare companies and private hospitals; too often, in the case of beds not being available, the NHS relies on private healthcare companies to deliver the services. My concern is that many of those services have been falling well below the standards expected. Some 28 privately-run mental health units have been rated as inadequate by the Care Quality Commission in the past three years. Vulnerable people with mental health conditions deserve much better.
Another issue worth mentioning is that the available treatment does not match the length of duration of adult eating disorders, even when a patient can have treatment. Two thirds of adult eating disorders last for three years or longer, but the current NICE-recommended adult out-patient therapies span only one year, or something like 20 to 40 sessions, 30% of which will be in-patient services. Fewer than 20% recover. There is a mismatch in the resources, there is a mismatch in the number of beds and there is a mismatch in the length of time that therapies last. If we catapult somebody out of a service before they are recovered, then clearly there will be a relapse. We need more research on that, and the NHS needs more mental health beds to cope with demand.
My final point is that services also need to be properly funded. The Minister will know that for too long we have seen money intended for mental health services diverted to meet other short-term financial concerns in the NHS. Given the pressure on NHS services now that we have the coronavirus to deal with, one can see that there will be even greater pressure not to spend money on mental health, but to spend it on other services.
Until mental health funding is both increased and ring-fenced, mental health services will remain a lower priority than patching up buildings, meeting demand for physical health services or even increasing services to deal with coronavirus. If we want to see eating disorder services improve, we must do everything we can to ensure that mental health services are properly funded, starting with increasing and then ring-fencing the funding.
It is a pleasure to serve under your chairmanship, Mr Rosindell. I congratulate the right hon. Member for Knowsley (Sir George Howarth) —my right hon. Friend, if I may call him that—on securing this important debate on eating disorders awareness during Eating Disorders Awareness Week.
This is a subject close to my heart; it is a subject that we talk about frequently over at the Department and it is on the desk. It is so important because, as I think the hon. Member for Worsley and Eccles South (Barbara Keeley) mentioned, the morbidity rates among young women suffering with eating disorders are the worst of any mental health issue. It is the most serious of all mental health issues that children and young people, and indeed adults, can suffer from. That is why it has such a high priority within the Department.
People with eating disorders often suffer in silence, but Eating Disorders Awareness Week brings this important issue out into the open and provides information and advice for those who seek help. I pay tribute to all those who are working hard to raise awareness of eating disorders, in particular the charity Beat, which hon. Members will know is supported by the Government and does so much to support young people through its helplines and support groups. I have met with Beat and I am incredibly impressed by the charity. It does incredibly good work.
We also have passionate and committed individual campaigners such as Hope Virgo, who has been mentioned a couple of times today. They are also doing much to raise the profile of eating disorders and to show people who are suffering from an eating disorder that, as hard as that is, it is possible to fight them and to get well.
As I have said, eating disorders are serious and life-threatening conditions; they can be devastating for those who are suffering, their family members and the people around them. That is why we want to ensure that people have access to the right mental health support in the right place and at the right time. Improving eating disorder services is a key priority for the Government, as I have said, and is a vital part of our work to improve mental health services. We know that the earlier an intervention is made and treatment provided, the greater the chance of recovery.
The waiting time figures for child eating disorder appointments in London show 97.1% of urgent cases being seen within one week and 92.8% of routine cases being seen within four. In my constituency, the figures are 78.6% and 78.3% in the same circumstances. Does my hon. Friend the Minister agree that, as part of our great levelling-up agenda for this country, the young people in my community in Rother Valley and across South Yorkshire deserve the same waiting times for eating disorder services as Londoners currently enjoy?
I thank my hon. Friend for that intervention. I will go on to talk about waiting times, but he is absolutely right. It is a trial that we have rolled out to ensure that, across the country, anybody who presents with a serious first instance eating disorder is seen within one week and routine cases are seen with specialist help within four weeks.[Official Report, 19 March 2020, Vol. 673, c. 12MC.] That has been rolled out and tested across the country by NHS England, and I am incredibly impressed at some of the statistics that I am hearing; I thank the hon. Member for Worsley and Eccles South for citing her own constituency.
This is a trial and, as we know, everybody has yet to meet the standards; that is the responsibility also of the clinical commissioning groups, because this is quite complicated.[Official Report, 19 March 2020, Vol. 673, c. 12MC.] I will go on to talk about that, but I am actually impressed even with those statistics, considering what it was like before. I am pleased to hear the figures that my hon. Friend the Member for Rother Valley (Alexander Stafford) quotes for his constituency, but they do have to be, to quote a phrase, “levelled up” along with everywhere else.
We know that the earlier an intervention is made and treatment provided, the more successful it is. One of the services in our mental health profile, which is not focused on eating disorders but which I am particularly impressed with, is the trailblazer schemes that we have rolling out into schools. Staff working on the schemes can pick up young people’s eating disorders at the very first signs. Outcomes are promising if they intervene at that very first stage, because the pattern of behaviour does not become established or embedded. They can intervene very early on.
On the point from my hon. Friend the Member for Rother Valley, we set up the first standard to improve access to eating disorder services for children and young people to ensure that, by the end of 2021, 95% of all children and young people with an eating disorder will receive treatment within one week for urgent cases, and within four weeks for routine cases. We are on track to meet that commitment, and figures I have seen today suggest that we may be on track to meet it early, which would be fantastic.
The number of people seeking treatment for eating disorders is sadly rising—or maybe it is a good thing, because people are not so stigmatised, are aware that help is there and are seeking it. However, that rise makes even more encouraging the corresponding increase in the number of patients who actually receive the care that they need. In-patient treatment should be a last resort, which is why in 2014 the Government announced a £150-million investment to expand community-based eating disorder care. We are making good on that promise, and as a result, 70 dedicated new or extended community services are now open or in development.
Indeed, I visited one myself and met the amazing staff who work there—it takes incredible skills to work with people who suffer from eating disorders—and some of the sufferers, and saw that work taking place. People who go into these units are usually there for quite a while; it takes some time to work through this. However, the outcomes looked incredibly promising, particularly for the young women I spoke to. The fact that we have 70 of those dedicated units open now, or about to open, across the country is an incredible step forward in addressing this problem.
That has led to sufferers receiving swift access to treatment within the community, because it is important that they receive treatment near to where they live, close to their families, schools and friends, and that their treatment causes as little disruption to their lives as possible. By improving care in the community, we can improve outcomes and recovery, reduce rates of relapse and prevent eating disorders continuing into adulthood, which is really important.
I thank the Minister for giving way; there is nothing more aggravating than somebody coming very late to a debate, but I have been in the International Women’s Day debate all afternoon. On relapse or eating disorders continuing into adulthood, does she agree that we have made massive strides forward in treatment for young people, but that there remains a problem of transition when sufferers turn 18? For those who develop an eating disorder slightly after their teenage years, or even well into adulthood, there is still a challenge in accessing services for those not eligible for children’s services.
My right hon. Friend makes an important point. That is why we invested £2.3 billion in mental health services, which, as I always say, is more than half the entire prison estate budget. We are focusing on young people and young women in this debate, but funding for mental health services is growing faster than the overall NHS budget. That funding and the development of community services is there to pick up exactly the cases she cites.
No mental health service, other than the very extreme, is better delivered in a hospital than in the community, whether for children, young people or adults. Despite that investment in community mental health services, our challenge is unprecedented, and our challenge is about workforce—it is about attracting people to work in this arena and to help us develop the community services that we need to provide treatment for adults and young people. That is the challenge we have taken on, and it is a challenge that we are meeting and moving forward with. It is our ambition and my absolute hope that children, young people and adults, regardless of their age—this illness is severe, whether in adults or children and young people—receive the treatment they require, when they require it.
Absolutely, and the Green Paper, which I am sure the hon. Gentleman will be aware of, references the mental health of young people in schools. However, it is also about the trailblazer schemes, peer support workers and other people who go into schools who specialise in how to identify this and pick it up. Teachers have a huge job, and I think if we were to say that they needed to pick up when someone is suffering from an eating disorder, they would probably throw their hands up, because it requires specialised training. It is a skill, and it takes careful handling when identifying someone who is suffering from an eating disorder. So yes, of course we work across Departments, but it is those specialised and trained mental health workers in schools who will pick this up.
We have a few moments left, so I refer the Minister back to the point I raised about relapse. We are largely talking about adults, and there is a mismatch between the average duration of an adult eating disorder—a large number of patients have severe and enduring illnesses—and the shortness of the therapies that they get. Professor Janet Treasure told me that a solution could be to increase the knowledge and skills of patients with those long, enduring conditions and their carers, so that they can self-manage the illness in parallel with clinical care. She is working on a pilot of that. I do not know if the Minister has heard about that, but I wanted to raise it as something that we ought to give attention to.
That is incredibly interesting. I had not heard about it, but I am sure that my officials will take note of it. We have an open door for anything that we can identify that helps us in targeting and providing services. We are looking for solutions to the problem. As I said, the money is there. Claire Murdoch, who I mention in almost every debate, and Professor Tim Kendall are rolling out mental health services across the country via NHS England. They have probably heard of it and are probably looking at it, but I am sure that we will take note and check if that is the case.
Although eating disorders are commonly first experienced by people when they are young, they can continue into adulthood. Following a report on how NHS eating disorder services were failing patients, NHS England convened a working group with Health Education England, the Department of Health and Social Care and other partners, which goes to the point that my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) made. We are working in collaboration to address the report’s recommendations and to take them into account when planning for improvements to adult eating disorder services. Work is in progress on that.
We are continuing the investment in mental health services through the NHS long-term plan, as I think most people know. The £2.3 billion is with NHS England, which has a long-term plan to deliver on mental health and is moving at incredible pace. Even today, although it is not relevant to the debate, it announced the opening of gambling clinics across the UK. Community services are being rolled out across the UK so that people in mental health crises do not end up in casualty. It is an incredibly impressive roll-out of mental health services across the UK, including for eating disorders.[Official Report, 5 March 2020, Vol. 673, c. 12MC.]
That long-term plan will give an additional 345,000 children access to mental health support; 380,000 adults access to psychological therapies; and 370,000 adults access to better support for severe mental illness by 2023-24. It commits to the delivery of eating disorder waiting time standards, which I have already spoken about, and I hope that we will reach those before the end of next year. The plan has also committed to the design and roll-out of a new integrated model of adult community mental health care.
To increase further the number of people seeking treatment for their eating disorder, the Government recognise that raising awareness and reducing stigma are incredibly important. Here I should come on to a few of the points made by the right hon. Member for Knowsley. I shall go through them backwards, because that will be more positive in terms of affirmative answers. He mentioned social media providers, their role in body image and the impact that they have on young women. My right hon. Friend the Secretary of State for Health and Social Care has already—this happened recently—held a roundtable with social media providers. It was an incredibly positive meeting, but that is something that needs to continue, because when it comes to social media interactors, providers and platforms need to be aware of the impact that their forums have on young women, so we are continuing that dialogue with them and, I hope, are continuing to push that point.
The right hon. Gentleman made a point about the entertainment industry and its relationship and responsibilities with regard to body image. I announced two weeks ago that I am holding a roundtable with the entertainment industry. That was as a result of the death of Caroline Flack, who took her own life. For me, that was a watershed moment. It is time for the entertainment industry to be aware that it does not have a duty of care only to the people who they take on a contract to work with them. This is not just about sudden fame and reputation loss. The industry has a wider responsibility in relation to images that it projects and how it projects them, because young women and, indeed, many people absolutely are influenced by what they see—their perceived role models—through the lens of television or the cinema. The entertainment industry definitely has a responsibility, so in response to the right hon. Gentleman’s question, I can say that I have already put that in train.
In relation to a review of the long-term effectiveness of CBT, I defer to the expertise and knowledge of our friend from the Scottish National party, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who made the point that short-term CBT may not be as effective, in terms of how it is delivered, for such long-term conditions. It may be part of the treatment, but as we know, when it comes to eating disorders, treatment is very prolonged in some cases. I am sure that CBT has a definite role, but it should not be seen in isolation. Management of eating disorders takes the input of physicians and psychologists—people who are expert in managing these conditions and working in this field. Therefore I would say yes, but not in isolation.
I thank the Minister for making that point. I think that there should very much be a formulation-driven treatment plan whereby all the issues that the person presents with are taken on board, and different aspects may require different parts of treatment. I do not think that often happens currently, particularly where people present to primary care services and perhaps do not get the specialist services that they need, but I hope the work that is being done will streamline that for the majority of people in the future.
I am sure that Claire Murdoch and Tim Kendall at NHS England are all over that and very aware of that. A streamlining approach to treatment is about getting people seen within the first week. If people are first seen within the first week when they present with their first crisis, that is the time when greater intervention can happen and when that treatment plan can be designed and put in place and there can be that entire care pathway through. I will not say that I think that that would shorten the illness, because I do not know. The hon. Lady probably knows more than I do, but I would think that an effective treatment plan with CBT and everything that is involved in that would provide a better outcome than piecemeal interventions along the way.
The right hon. Gentleman’s first point was careful consideration of Beat and so on. I am a huge admirer of Beat. It provides an incredible service. Its helpline deals with 30,000 people a year, I think, if I am not mistaken—it is a few weeks since I saw Beat. The support service that it provides, particularly to young women who are looking for someone to talk to and advice and help, is second to none. We are absolute supporters of Beat.
Let me just go on to the point made by my hon. Friend the Member for Broxbourne (Sir Charles Walker) about diabulimia. It is also of course the point that the right hon. Member for Knowsley raised repeatedly. We are absolutely committed to ensuring that people with diabulimia receive the treatment that they need. That is why NHS England announced in February 2019 the piloting of services. The services are being piloted on the south coast and in London, and NHS England will evaluate and monitor the pilots and take the learning from them. I will raise what the results show, if the results are through yet from the pilots, and what learning there has been and how it will apply across the UK.[Official Report, 19 March 2020, Vol. 673, c. 13MC.] I am sure that the officials will take a note, and when I have had that meeting, I will report back to the right hon. Gentleman and let him know exactly what the findings are and where we are going on that. The group that we are talking about is very small, but it is at the extreme end and requires very serious consideration.
I think that those are all the points that were raised and that I need to answer.
Absolutely. On training for GPs, I take the hon. Lady’s point exactly. The NICE guidelines are incredibly clear, in terms of the Hope Virgo campaign and taking BMI, weight and other things into consideration. The NICE guidelines are clear, and it is up to the clinical commissioning groups to ensure that GPs and others do not take weight as a consideration. Tim Kendall is all over this and is working on it. We want GPs and others to abide by what are already very strict NICE guidelines. We have the guidelines; we just need the medical profession to implement them, but I had an idea when the hon. Lady asked her question. We are talking about training for GPs with the General Medical Council and we will continue to hold conversations about that, and I am sure that NHS England is doing exactly the same thing, but there are quicker ways to get information through to GPs.
When I was a nurse and I was training, it was the Nursing Times that informed us, on a weekly basis, of what was new in treatments and operative procedures. For GPs, it is Pulse and other magazines that they receive. I think that there might be a quicker way into GPs’ surgeries to alert them to the fact that the NICE guidelines are not being applied by GPs or by clinical commissioning groups. I think that there may be more inventive ways around that. Yes, training GPs absolutely is important; it is important to include this issue in the GP training programme, but in terms of getting a message through to GPs now, I think that we need to look at a more innovative way of doing that.
On money being diverted and ring-fenced, I think that the hon. Lady knows that the money from the £2.3 billion that goes to the CCGs is ring-fenced for mental health services only. They are not allowed to siphon it off and use it for anything else. We have our own queries as to whether some are doing that, and I know that NHS England, because I raised this with it the last time I met it, is doing an evaluation of clinical commissioning groups and having a look and checking that that money, which is ring-fenced, is spent only on—
It is always a pleasure to talk to the Minister. I start by thanking everybody who took part in the debate. The hon. Member for Broxbourne (Sir Charles Walker) spoke movingly on behalf of his constituents. As he knows, I have met them. They are a formidable couple who are trying to turn their grief into something positive, and I applaud them for that.
The right hon. Member for Romsey and Southampton North (Caroline Nokes) has been, along with me, ploughing this somewhat lonely furrow over many years. It is always a pleasure to have her as a combatant in the battle that we have been conducting. As ever, we saw the compassion of the hon. Member for Strangford (Jim Shannon), which is legendary—in this Chamber and elsewhere and certainly in his own constituency. The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who spoke for the SNP, made a very helpful contribution, as did my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), who spoke from the Labour Front Bench. I will take the Minister up on her invitation. I am very grateful to everybody for contributing to the debate.
Motion lapsed, and sitting adjourned without Question put (Standing Order No. 10(14)).