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Westminster Hall

Volume 690: debated on Tuesday 9 March 2021

Westminster Hall

Tuesday 9 March 2021

[Sir Christopher Chope in the Chair]

Covid-19 Vaccine: Take-up Rates in London

Virtual participation in proceedings commenced (Order, 25 February).

[NB: [V] denotes a Member participating virtually.]

Welcome to this version of Westminster Hall. May I thank all the people involved in facilitating this important development in our democracy? There have been some changes, which I will set out briefly. One is that we start five minutes earlier, so that we can finish this debate at five minutes to 11. I remind hon. Members participating, both physically and virtually, that they must arrive at the start of the debate and they are expected, under the instructions of the Deputy Speaker, to remain for the duration of the entire debate. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address. We ask that Members attending physically clean their spaces before using them and before leaving the room, so that those spaces can be used by others later. Without further ado, I call Andy Slaughter to move the motion.

I beg to move,

That this House has considered covid-19 vaccine take-up rates in London.

It is a great pleasure to be here in what I think is, from a Back-Bench point of view, the first of these virtual sessions in Westminster Hall, although it is also very good to be here physically, in the flesh, and to see the Minister and the shadow Minister, my hon. Friend the Member for Nottingham North (Alex Norris), here in the flesh as well. On the screen I can see, I think, nine Labour colleagues and even one Conservative who will take part in this debate, so that is a very good start, and what better subject than this to start the process off with?

There is a reason, which the Minister will be familiar with, why this issue has aroused a lot of interest among my colleagues. I need to say first that the Minister has been making himself available on a regular basis—sometimes almost daily—to answer our questions, which are often the same questions. That is a rather barbed compliment, because it implies, perhaps, that he has not answered them the first time they were asked. One thing that I would like to do today is to try to pin him down on just a few very important issues. I do thank him for his candour, his availability and, of course, for being here today—as I have pointed out to him, he is the only Vaccines Minister, so it would be difficult for him to delegate this one.

The second thanks that I would like to express is to everybody who is making vaccination work in London, and indeed across the country. Obviously I especially appreciate the work done in my own area of Hammersmith and Fulham by NHS staff, council staff and volunteers. It has been an absolutely exemplary effort, and I can testify to that personally, because I had my first jab two weeks ago and I cannot imagine a smoother, more reassuring and more professional service than the one I experienced at the time. I am told by the many constituents with whom I have been in contact that that is the experience across the board, so I can express nothing other than praise for the way in which the system is being rolled out.

Indeed, the success of the programme nationally, whereby I think we are at 22 million first doses and about 1 million second doses, is, again, an achievement. Obviously—I do not wish to state this in any adverse way—we are going to talk about the problems today. We are going to take for granted the successes and talk about the problems, because that is our job.

About one third of the population has had a first dose, and a very small percentage—less than 2%—has had a second dose. That is a matter of political and scientific choice, which most people would agree with, although it is not how some other countries have dealt with it. Nevertheless, it shows the size of the achievement and also the task ahead. If we have done a third, which might include some young people who are not getting the vaccine in the near future, there are two thirds to go—even my maths tells me that—and then there is the second dose as well. There is still a mountain to climb, but what gives me confidence is the fact that the NHS’s data and operation are better placed than perhaps any health service could be to deal with the problem. However, let us not gloss over the fact that this is taking the individual effort of millions of people across the country.

I shall go through some problems, but on another positive note, I had a very uplifting conversation with my local director of covid-19 response and recovery last night. She told me that the expectation, which I hope the Minister will be able to confirm, is that, first, from next week there will be a substantial increase in the amount of vaccine available nationally and locally. I think we are going from some 2 million doses a week to 4 million. I do not know whether that is true, so perhaps the Minister will be able to confirm that.

Secondly, that will allow the centres that are dispensing the vaccine to expand. One problem so far has been a lack of vaccine at some of the GP-run primary care network centres, with major centres in many places not opening at all. I hope that the Minister, if his information is this granular, will be able to confirm that the Hammersmith mass vaccination centre based at the Novotel hotel in the centre of Hammersmith, which was due to open on 8 February, will open next week and that other centres will open this month in north-west London.

My third point, which relates to a local initiative, is on the issue of vaccine hesitancy. Next Monday we start a local programme to contact every person who we know has either declined or not been contacted and is in one of the priority groups. We will go through the process of contact, persuasion or whatever else is necessary to ensure that we catch up on what are not terribly good figures at the moment. I will come back to that at the end, because one thing we are looking for there is perhaps support from the Government in carrying out that programme, which is a really good programme. I have been told all about it, and I compliment the local council on setting that up and using the Hammersmith and Fulham community aid network—H&F CAN—which has been helping people shield and helping people in need over the past year.

We have been asking for data for many weeks. I can see the Minister’s dilemma, because if he gives us national data, we ask for regional; if he gives us regional, we ask for integrated care systems; if we get ICS, we ask for clinical commissioning group; if we get CCG, we ask for Medical Science Liaison Association; if he gives us medical support officer, we ask for postcode—so he might think it is a slippery slope. In a darker moment, he might have concluded that it is better to give us nothing at all. I will contradict that view by saying that it is better to say, “There is a story to tell here.” I do not think that anybody will take a view other than one that will help the process go ahead. It is important to have more granular data, at least down to ward level, so that we can see what is happening in our constituencies and we can take action to deal with it.

On the issue of supply, it appears that—I say “appears” because I spend a lot of time on this and it is difficult to do the sleuthing work—in the initial roll-out at the beginning of the year, London was being left behind, and then there was a correction and more vaccines came into London, and in the past few weeks we have had something of a dearth—a drought—of vaccines nationally. If one looks at the daily figures, one sees that by the end of last year they were at around 600,000 doses a day. For the past week or so they have been between 200,000 to 400,000 a day, which is a significant change. I hope that we will see the figures go up again.

In a way, there is a bit of “bald men arguing over a comb” here, because colleagues in other regions will say, “Hang on, you are not taking our vaccines to London, are you?” I do not know whether they are saying that in your part of the world, Sir Christopher, but I have heard it said. The reality is that we all need to vaccinate all our populations. The question is one of overall supply. It would have helped had we known the situation more clearly at an earlier stage.

There is also the push and pull factor. Some privileged institutions, such as the hospital hubs, are able to order from what supplies there are and obtain those. There may be some logic to that, in the sense that they are principally—not exclusively—vaccinating NHS staff, who clearly are a priority, but it does mean that the local GP-run PCN hubs are reliant simply on what is delivered to them; they have very little control over that. They may have very little notice of what is being delivered. It got to the state last week where, between Monday and Friday, not one of the five dispensing outlets in my constituency had any vaccine delivered. Unless there was some left over still within its shelf life, no vaccination was going on.

That was an extreme example, but if I look at those GP hubs, during the course of this year, the best of them—where I had my jab—has operated for about 25 days, so less than half the time. When I say “operated”, I mean at a significant level of, say, more than 400 vaccinations a day, and that was for only 25 days. But for the other two hubs in the borough, including the one at White City, which is the most deprived area in my constituency and the one where vaccination rates are giving us most concern, the number of days has been in single figures since the beginning of the year. In that area, significant vaccination has been going on for fewer than 10 days. That is of great concern.

That may be corrected by the sheer volume that is coming through. It is essential that we get enough vaccine for the PCNs, the major centres, and for the pharmacy and hospital centres if they are to continue to operate. I hope that the Minister will be able to confirm what I think is the strategy now, which is that the major centres—in my case, say, 1,500 doses a day, which is very significant—will be dealing with the new cohorts, so the younger people coming into the system now and also possibly some second doses. That is what we think is going to happen.

There is a certain sense in that, because the process of going to a major centre involves getting a letter and making an appointment, and it may involve some travel. It is more suitable for people who are more mobile and may have a car or something of that nature to get them where they are going.

The PCNs are going to give some of the second doses, but I suspect they are going to scale down a little, because GPs obviously have other work to do—I am going to ask the Minister about this. The problem is that we are neglecting an important group of people in groups 1 to 4 who missed out on the vaccine and who now need to be the target for ensuring that we get our vaccination rates up. It is pretty clear that the PCNs are the best vehicle for delivering that.

I do not want to go on for too long as I know many colleagues want to get in, but the last and most important point for us at the moment is how we deal with the issue that is variously called vaccine resistance or vaccine hesitancy, but is simply a problem for the NHS, the Government and all of us working to resolve it. We need local solutions as well as national resources. There has been a lack of data in relation to these matters. The evidence for that is the reliance that so many colleagues have placed on Sky News’s analysis of the data on the NHS website. I am not sure that is where we should be going as our first port of call, although they did a good job, because for the first time, over a week ago, we were able to see figures by ward. Knowing the different characteristics of our wards, we were able to see how things were going within the constituency.

In my constituency—I feel the pattern is true across the rest of London—the more prosperous areas, the less ethnically diverse areas and the less deprived areas were already at 100% for the older cohort of the population. Poorer areas, such as those in Shepherd’s Bush, White City and West Kensington, were below 75%. That is a very significant difference. It is replicated across London, and north-west London is one of the most difficult areas. As of last Friday, it was the only integrated care system area in England that was below 80% for those over the age of 65. All the London ICSs are down at the bottom, but north-west London is slightly further down.

We talk about 80% and 75% as worrying and significant, but when one adds in deprivation, by looking at the most deprived 10% of the population, and ethnicity, because certain ethnic groups are being vaccinated at a much lower rate, often below 50%, then that should be ringing alarm bells in Whitehall. It is certainly ringing them locally. We have not cracked this nut. I seek a response from the Minister on that point.

We know what is needed: time, money and personnel to ensure that those contacts are made. The problem is that phone calls are made that are not answered once, twice or three times, or someone may express a reservation about the question, and either there is not time to deal with it, as that is not the way the system is set up, or the caller is not expert enough to deal with it. A lot of it is about trusted people—that is very important— and places, and places that are accessible.

All of those are important, but so is having people who can answer the questions that are asked. If they cannot answer questions such as, “How do you know that the vaccine will be safe in 5 years’ time?” or, “How will it protect someone with my medical condition?”, or dispel fears and rumours such as, “I have heard this about the vaccine from somebody I trust,” it is almost worse than not having made the approach at all, because they end up reinforcing the problem.

We think we have cracked that. I have been looking at the hesitancy programme that Hammersmith has set up, and I think it is good. I pay tribute to the staff doing it. It will be labour intensive and will cost money. The Minister knows my beef on that. When the £23 million of so-called community champions money was made available at the end of January, quite rightly, and handed out to some 60 local authority areas across the country, those that had the lowest take-up rates at that time essentially did not get any money—Westminster, Kensington and Chelsea, Hammersmith, and Newham. Some did, but it seemed to be a bit of a lottery. I think seven London boroughs got sums ranging between £40,000 and £750,000. I do not think we need help in knowing what to do, but we do need some resource of that kind. I understand that there is a little resource coming in through the NHS: £100,000 per ICS. However, that really only goes down to £10,000 per CCG. Looking at areas we have the most data on, where there are particular problems, it would be useful to add to that resource now.

I think I have gone on long enough—you are probably not the man to ask, Sir Christopher—but I think I have had enough questions for the Minister to be able to remember and answer them all. This is special pleading for London, in a way, because London has suffered. We can conjecture the reasons for that. They are complicated. We have talked about deprivation, we have talked about ethnicity, but there are other factors in London we all know about. We know about them through canvassing and elections; we know about them through electoral registration; we will know about them this month through trying to fill in census forms.

London has a disproportionate number of people who are isolated, for all sorts of reasons. They may not have financial resources, or they may not have a mobile phone, or have credit on their mobile phone. They may live in a room in a multi-occupancy house which has no doorbell or other means of reaching them. They may have mental health problems. They may simply live alone and have become isolated from the community around them.

We are actually very good at contacting those people if we have the time and the money to do so; we do it through electoral registration, and we are also doing it with the census. However, we do need that prioritisation and I hope that the Minister will understand that, and will be able to respond in kind.

I congratulate my hon. Friend the Member for Hammersmith (Andy Slaughter) on introducing this very welcome and extremely timely debate. He has set out the arguments very comprehensively and I shall endeavour not to repeat too many of the key points.

I will repeat, and I am sure that everyone speaking this morning will also repeat, our grateful thanks to NHS and public health staff who are working so hard to deliver this vaccine. It has been a national success story; there is no doubt of that whatever. It is an extraordinary logistical achievement, of which the NHS can be extremely proud. I had my vaccine on Saturday at St Charles’ Hospital and it was an extraordinary, professional operation; swift and effective. I think everyone should be very proud of what they have done.

Of course, that does not mean that that we should not be able to focus on some of the outstanding questions that arise regarding the delivery of the vaccine in London. As has been stated, London as a city, as a region, is not achieving the same figures as other parts of the country, which should be a cause for concern. My particular concern is my own borough, my own constituency area, Westminster North. It is apparently the second-worst performing borough in the country with just 69% coverage of 65-plus. City of London and Westminster South are also performing very poorly.

This does matter very greatly, for reasons we all understand. It matters in terms of individuals and in terms of the public health of the borough, but I would also suggest to the Minister that it is a particular concern because the central London economy is so critical to our national economic revival. Therefore, being confident that we have good coverage in central London seems, to me, to have a significance even over and above the pure public health considerations.

I want to focus on two particular themes, the first of which I am afraid is going back to the question of data. For the reasons that my hon. Friend the Member for Hammersmith has outlined, inner London generally has a highly complex set of population characteristics. We need to understand the particularity of those circumstances to be effective in delivering to those populations. While it is useful, indeed, to have the national and regional—north-west London, in my instance—and some of the borough data, we need to be able to look at local data, understand it and know that it is accurate.

I have yet to see the information that is provided to the directors of public health. As of this point, the middle of March, nearly three months into the vaccination programme, it has not yet been shared with me. The fact that it has not been shared with me by my local authority reflects its concerns that the data is not accurate. The Minister will have heard, no doubt, from many other people, that there is a concern that building up from the basis of the local data to a larger picture and then expanding it out to a national picture will give different results, and people will start looking at variations in that data and asking questions about it. I understand that point and can see that it is indeed difficult to get those statistics all squared off. On the other hand, I am absolutely clear that unless we understand the difference between what is in happening in, for example, the Mozart estate area in the Queens Park ward, and in Belgravia and Knightsbridge, we will not get a proper understanding of where the priorities should be.

My local authority has told me that part of its anxiety is that there is a variance between the use of the Office for National Statistics data and the national immunisation management system data, which has led to a significant national population variant of, I believe, as high as 5 million. As my hon. Friend outlined, there is good reason to believe that the percentage variance will be greater in central London than anywhere else in the country. We have seen that in terms of the census and the population figures. I had a debate on the 2001 census because of my concerns about accurate recording of population. However, it is unclear to me, from discussions with people working in the local health service, what population denominators are being used locally. It is unclear who is using what data, and as a consequence it is unclear whether such local data as exists is even remotely accurate.

The question is: does that matter? I would say that it does, because if we are spending time trying to find people who are simply not present, to raise the vaccination rate, for good reasons, we are wasting time and effort on them, whereas at the same time—both phenomena are, I think, true simultaneously—there are wards, estates and communities in my constituency, as there will be in others, where we are failing to make contact with people who need to be contacted, because they are extremely hard-to-reach populations. My hon. Friend outlined some of the reasons for that. There is a high relative proportion of single people who will not necessarily have ties to communities, and links so that we can use the normal channels of communication. There is a high proportion of people with mental health problems, again, often living singly. There is the largest private rented sector in the country, with a high degree of population churn, which means that when talking to someone it is often unclear whether they are the same person who was living there six months before. Unless and until we can be sure of the granular data and understand the baseline population statistics on which it is based, we have a problem.

A secondary data problem concerns ethnicity and understanding some of the issues around both the take-up of the vaccine and vaccine reluctance, which are different components. The issue is that, in central London, we have the largest Arabic-speaking populations, a very diverse set of communities, but these are being recorded under “ethnic—other”, and therefore it is difficult for us to be able to focus in on those communities, which are important, in terms of delivery.

I have written to the Minister with some of these questions, but even since I wrote to him there has been new information from the local authority and from the clinical commissioning groups that raise questions for me about the data. We need to know whether the population that we are chasing is there, whether we are chasing hard-to-reach people or whether we need to focus in on people who have vaccine reluctance. I was told last week—

Order. I am sorry, but if the hon. Lady were participating physically, I would by now have been staring her down, because a lot more people wish to participate in the debate. I hope that she will bring her remarks to a swift close so that I can call the next speaker.

Many apologies. I will conclude on that. I have concerns about the data and the investment in support for reaching hard-to-reach populations, and I hope the Minister will address those. My sincere apologies.

It is a pleasure to serve under your chairmanship once again, Sir Christopher, albeit for the first time virtually. I congratulate the hon. Member for Hammersmith (Andy Slaughter) on securing the debate, which is important for all Londoners. It is a pleasure to follow the hon. Member for Westminster North (Ms Buck).

In the London Borough of Harrow, we have had an outstanding performance on vaccination rates. We received congratulations from the Secretary of State for Health and Social Care on that performance, and I put on the record my appreciation and thanks to the fantastic team—both from the NHS and the volunteers—who made this possible. To set it in context, more than 70,000 people in Harrow have had their first vaccination, out of an adult population of just under 200,000, which is a remarkable performance, at the Hive centre, which opened in December, and at Byron Hall and Tithe Farm, which opened in January. To get to this stage so quickly has been remarkably good.

That has to be set against the fact that Harrow is the most ethnically diverse borough in London. Others have a higher number of different sections of population, but we literally have someone from every country on the planet and various different communities, so it is a direct challenge to reach all those different communities and to encourage them to come forward to get their vaccinations. This fantastic effort also has to be set against the position that, at the beginning of the pandemic, Northwick Park Hospital came very close to being overwhelmed by the number of covid cases. Sadly, we have had a very high death rate, and at one stage Harrow had the highest covid transmission rate in London, so achieving this vaccination rate has been vital.

More than 35,000 people have had their first vaccination at the Hive since the middle of December, and the Prime Minister visited the site to see at first hand the excellent work that is being done. However, we are experiencing problems, and I will relay some of those for the Minister. There is reluctance among the Afro-Caribbean, Bangladeshi and Pakistani communities, who are hard to reach. There have been real difficulties in getting them to come forward; there is a reluctance to have the vaccine. Among the white British, Irish and Indian population, there have been no such problems—they have come forward in their droves to receive their vaccinations, which is good news.

The supply problems are really serious. To give the Minister an example—I hope he will be able to answer this—the capacity at each of our vaccination centres is roughly 860 doses a day, yet this week, our centres will only receive 400 doses. That is less than half a day’s work, so the lack of supply is holding us back from achieving even faster vaccination rates.

The real problem that emanates from that is that we are having particular difficulties in contacting younger people who have underlying health conditions. They are among the most reluctant to come forward, because of the myths and legends about what the vaccine does to people’s bodies. I am pleased that we now have a myth-buster to combat this unfortunate propaganda, which is spreading very widely among different communities. An excellent video has also been put together by different community leaders, coming together irrespective of race, religion, colour or creed to say why it is important that people have the vaccination, to encourage people to do so, and to try to combat some of this insidious propaganda.

Also on the issue of vaccine supply, my centres complain that they get notified only a day in advance of the vaccine arriving, which of course means that it is very difficult to schedule people in to get their vaccinations. Can we have a better plan for supply of vaccine, which is vitally important? Equally, allowing flexibility to GPs undertaking vaccinations at GP surgeries would help considerably. It would reach those harder-to-reach groups, because people trust their GPs in the way that they do not necessarily trust going to a large vaccination centre.

I will end my remarks by saying that in Harrow, certainly, we have achieved remarkably well, but we can do better provided that we get the supply, that we have better notice, and that the facilities continue to arrive. At the end of April, two of our mass vaccination centres will close, and there will be the potential for complete chaos when we come to the second doses, because everyone will be invited to attend one centre in Harrow to get their second dose. I predict that is going to be quite chaotic, so I would ask that we look at potentially keeping those centres open for a further period to ensure that every adult gets their opportunity for at least the first dose by the end of July, as per the plan that the Minister has.

Thank you, Sir Christopher, and I look forward to listening to what other colleagues have to say.

As there are still eight more speakers and we start the wind-ups at 10.33, I am afraid that I now have to impose a four-minute maximum time limit.

We are now in the second year of coronavirus, and we have all experienced highs and lows throughout this period. At the beginning, we were told that this is a great leveller, given that Prince Charles and the Prime Minister had it. Rather than the “we are all in it together” narrative, it is maybe more fair to say that we are all in the same storm, but in different boats. Nowhere have we seen that differential impact more clearly than in the vaccine roll-out in London.

We all remember the pictures of the memorably named William Shakespeare having his jab early in December, but it took a good 10 days for the vaccine to reach the magnificent gothic splendour of Ealing town hall, and sadly the supply in London has lagged behind other parts of the country. It has been a magnificent effort. We have all seen the brilliant statistic that a third of the population have been done, but again, there is room for improvement here. We remember the highs and lows—the 50,000 fatalities figure came just before the miracle of the vaccine at Christmas that has given everyone hope—but that maxim of differential impact is one we have to look at.

There are two things that will take us to the other side of this: vaccine uptake among the population and the hesitancy that people talk about, and supply. London has nudging 10 million people—some 12% of the population. My own borough has 360,000 people. Initially, we had the town hall, then we had a second venue in Southall— in the west of the borough. Both those were closed last week. The latter did a record 1,200, I think, before shutting its doors until further notice. There has been a magnificent effort from volunteers and NHS staff, and everyone was poised. I have heard nothing but praise about the efficiency of the operation, but then they were all stood down.

There are old divides between the inner city and the leafy suburbs, but my seat has both: Ealing is known as “queen of the suburbs”, but there are wards of deprivation in Acton, where there has been no vaccination centre; it is a bit of a vaccination black spot. I hope the Minister will help me to address that issue. Acton is big enough to have a tube or rail station with every compass point on several different lines—Central, District, and Piccadilly—but there is no vaccination centre. Given the characteristics of its population, the Acton-shaped hole makes the issue even more urgent.

As a whole, London—our nation’s capital—sometimes seems to have experienced this over-promising, and this moonshot rhetoric. Not that long ago, we were promised 24-hour vaccinations in the capital. That was being said in January. The experience of our centres last week was far from that.

We are waiting for the second dose and hopefully there will be a big surge, but it concerns me that there seems to be a bit of anti-London rhetoric from the Government at times. That stretches to the fact that we have a towns fund with new bungs bringing in prosperity and opportunity—but not in London, which has been completely excluded in favour of red wall locations. I would caution the Government not to let that apply to vaccination supply. London is not immune from deprivation, poor housing and overcrowding: I have those in my wards in Acton. Localised need should drive allocation, not centralised supply.

Order. I am sorry to interrupt, but you have gone beyond your time limit. I do not know whether it is because you cannot see the clock. My job is to try to ensure that everybody is able to speak. I call Feryal Clark.

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank my hon. Friend the Member for Hammersmith (Andy Slaughter) for securing the debate. I start by paying tribute to the amazing NHS workers at North Middlesex University Hospital and at Chase Farm Hospital, as well as all the NHS workers in Enfield and the public health team at Enfield Council, who are working day and night to make the vaccine roll-out a success.

The vaccine roll-out programme that began in early January across the nation is nothing short of amazing, thanks to the great work by our NHS. I congratulate the Minister on the work he has done. Right from the start, however, as my hon. Friend the Member for Hammersmith set out, there have been concerns with the roll-out in London, and those concerns have been raised by London MPs from day one.

It transpired initially that the vaccine supply to London was inadequate in comparison with other regions, and that the set-up of delivery centres across London was limited and done too slowly to come on board. We knew that the pandemic had highlighted the inequality in our communities and we knew about the pockets of deprivation—the areas with high covid rates and poor healthcare provision: we have been raising those issues over the past twelve months of the pandemic.

It took a very long time for the NHS to be allowed to share the vaccine update data with us MPs. When the Government finally gave clinical commissioning groups permission to share that data, it became abundantly clear that those areas and communities that we had been raising—in Enfield, the communities that had suffered the worst of the pandemic—were also those with the lowest vaccine uptake.

I have raised this matter at many meetings with NHS colleagues and with the Minister. There are many barriers. The issue is not just about vaccine hesitancy, as is constantly repeated; there is an expectation that an 80-year-old Kurdish woman will book an appointment over the internet, but that is just not going to happen. The digital divide in the eastern part of Enfield North constituency, where the uptake of the vaccine by over-65s is just above 50%, is a real issue. There needs to be an easier booking mechanism for areas with a digital divide, as well as for the elderly, who are not very tech-savvy.

The wards in my constituency with the highest covid rates and poor primary care provision do not have vaccine centres nearby. The nearest vaccine centre for constituents in those wards is two bus rides away, which is just not acceptable. Where the need is greatest, the provision is low. In the most affluent areas of my constituency, where there is good primary care provision and many vaccine centres, the uptake is more than 80%, and 40-year-olds are now being called for their vaccines.

Finally, 16,000 people across Enfield—predominantly in the eastern part—are not registered with a GP. There is no clarity on how those constituents will access vaccines. I would be really grateful if the Minister set out the plan for people who are not registered with a GP. Will the Minister also clarify what is meant by the term “hesitancy”, as there is real confusion on that? Does it mean people who reject the vaccine outright, saying, “I do not want this,” or does it mean people with whom no contact has been made after three contact attempts? It is really important that we get some clarity on that.

I thank my hon. Friend the Member for Hammersmith (Andy Slaughter) for securing this debate. What we are seeing is a tale of two cities, but within one constituency in my case. We know from the excellent work of Professor Marmot that the decade of neglecting to address health inequalities, which are writ large under the covid pandemic, is really showing itself in the vaccination strategy.

I thank Dr Maimaris from Haringey Council, who is the head of public health, and Dr Peter Christian of Dukes Avenue practice, who is leading on the GP side. He told me last Friday that one of his colleagues in Wood Green made 30 phone calls, and that of those only one person was keen to take up the vaccine offer. That is the kind of hesitancy that we are seeing. In my constituency, someone who catches the 41 bus from Wood Green to Hornsey Rise sees their life expectancy rise by years and years, so that by the time they get to Highgate, they will be living 15 to 20 years longer than the average person in Wood Green—that is common across many of our London constituencies.

We have been working hard with Christian churches, with Rabbi David Mason in Muswell Hill, and with the Imam in Wightman Road mosque, where I will be at the weekend to push for many more people to take up the vaccine. We really need to understand the granular detail of the levelling-up debate in the national context. It is not just about levelling-up between the north and south of England, but levelling-up within our constituencies. North Middlesex University Hospital and Whittington Hospital have done a wonderful job during the pandemic. I pay tribute to their staff, and call for them to be correctly remunerated. I hope that the Government will review their position on the 1% pay offer, which is just a disgrace.

This is not just about the level of vaccine on offer. We know, for example, that in the Fortis Green and Crouch End wards in my constituency, 99% of eligible people have had the vaccine. That number falls to 74% in Wood Green. Office for National Statistics data up to February 2021 showed that fewer than 50%—some 49%—of black or black British adults said that they were likely to have the jab. We must have high-quality conversations between GPs and their patients to tackle that. We also know from the OpenSAFELY analysis that 60% of black people aged 70 or over had been vaccinated, compared with 75% of south Asians and 90% of white people. Nowhere is that clearer than in my constituency.

What we need to do is to address health inequalities in the wider sense. We need to consider the impact of overcrowded housing, educational attainment, the high incidence of violent crime and all the indicators of inequality, and address them. We cannot have another decade of neglect and unequal distribution. We are a wealthy country; we are simply not spending public funds in the right way to address long-term health inequalities. If anything has shown that, it is this vaccination strategy, which shows it in all its detail.

It is a pleasure to join this very important debate, Sir Christopher, and I congratulate my hon. Friend the Member for Hammersmith (Andy Slaughter) on securing it.

The speed of the roll-out of the vaccination programme is a great source of hope for all of us. Those of us who have lost loved ones are particularly grateful to the NHS, to the scientists and to so many people who have come together to produce this vaccine, because we all know how important it is to protect our constituents, and our friends and family.

Locally, I pay tribute to my local authority, which has set up a helpline that is proactively contacting people who have not been vaccinated, and addressing and answering their questions. Government resources will make a big difference to other local authorities to help support that effort, and we need that back-up from Ministers.

I also thank the Royal London Hospital, Queen Mary University, GPs’ surgeries, the London Muslim Centre and other partners who have been helping with the vaccination effort in my constituency. Many people will be aware that in the first wave Tower Hamlets had the fourth-highest age-standardised death rate in the country. Although we are a young population, relatively speaking, there are huge health inequalities and huge issues with deprivation, severe overcrowding, intergenerational households and many other factors that, as other colleagues have said, make inner London extremely vulnerable to this pandemic.

In the second wave, we saw that the spread of the virus caused more deaths, which is why it is vital that we get to those who have not yet been vaccinated and those who have underlying health conditions by increasing the supply of the AstraZeneca vaccine, and that we get to those who did not take up the vaccine when they were offered it, for a number of complicated reasons, as other colleagues have mentioned. In some cases, it is about reticence, but it is also about practicalities and about deprivation. It is not just ethnic minority communities who are affected, although we have seen big differentials; it is also those from white disadvantaged backgrounds and from working-class backgrounds who have been disproportionately affected, both in terms of death rates and in lower take-up of vaccines.

What we need to do now is make sure that the vaccines are in the right places. The centralised hubs are, of course, useful and important, but it is also vital that we get vaccines to local GP surgeries. As I have said to the Minister time and again, it is vital that we get more vaccines to pharmacies and that pop-up clinics get up and running. The ones that we have are very good and very helpful, but the unpredictability of supply, the inability to plan and the lack of local flexibility are all leading to sub-optimal outcomes, when we could have better outcomes.

So today I call on the Minister, once again, to get the vaccines to the local providers and to provide local authorities with additional support, so that they can do the chasing, as is the case in my local authority. What we have seen is that when GPs are responsible for getting vulnerable patients, including homebound patients, vaccinated in my borough, 95% of those patients have been vaccinated. So this is not rocket science; we can address the gaps.

I am grateful to the Minister for the work that he has done so far and I appreciate that in him we have a listening ear. I hope that he listens to the arguments that have been made—not just by Members in my party, but by Members in his own: we have to get the supplies in. Going forward, as other colleagues have pointed out, we also need to address some of the deeper underlying conditions and to make sure that people’s vulnerabilities are addressed.

There is one final issue. Ramadan is coming, so we are in a race against time to vaccinate vulnerable constituents from the Muslim community in our city, because if we do not vaccinate them there will be even greater risks. So I hope the Minister will address that point, as well as the importance of getting more supplies into London—

It is a pleasure to serve under your chairmanship, Sir Christopher. I congratulate my hon. Friend the Member for Hammersmith (Andy Slaughter) on securing this very important debate, to enable us, as London MPs, to speak about the situation now, which can be rectified. I add my thanks to all the scientists, NHS managers and fixers, vaccinators and volunteers who have made the roll-out of the vaccine programme so far so swift and such a success.

To defeat this pandemic in the UK, we have to defeat it in London—there is no getting away from that—but the vaccination rate is lower here, as colleagues have said. In my area of south-west London, the CCG has provided the first dose to 389,000 people, which is 26% of the population, but some local authorities around England have a rate of over 50%. Areas such as Rother, West Devon and North Norfolk have much higher vaccination rates, so it is not just an issue of supply, although supply is an issue in my area. We have two vaccination centres and they are not open today. We do hope to see that surge.

In January, a promise was made to open a vaccination centre in Queen Mary’s hospital in Roehampton. It will not surprise the Minister that I am going to talk about Roehampton today, as I have raised the subject many times. The vaccination centre there has been built but not opened. There is no vaccination centre in Roehampton, but there have been spikes of covid infection there. It is an area of high deprivation; as my hon. Friend the Member for Hornsey and Wood Green (Catherine West) said, this is a tale of two cities.

There are not good transport links from Roehampton. The primary care network is keen to support vaccination but there is no vaccination centre. The rates at the moment are because a huge amount of transport has been organised, relying on voluntary organisations, to make minibus trips to Putney. That cannot go on for the long term; we need a long-term solution for Roehampton, which is an area of highest need.

The Minister knows Roehampton well because he was a Putney councillor for many years. I know that last week he met Dr Hasan from the Alton Practice, who is a shining example of someone passionate about the health inequalities in Roehampton and the need to address them. She is very concerned about vaccine hesitancy in young people. As the vaccine roll-out goes on, the vaccine hesitancy we see will only increase.

In Roehampton there are higher levels of black and ethnic minority populations, isolation and overcrowding. All those mean that having a trusted vaccination centre nearby that can be attended around shifts—for a care worker, for example—is so important. Otherwise, we risk baking in those existing health inequalities for the long term, which will go alongside all the other inequalities felt by the population in Roehampton. They are throwing up their arms and saying, “We don’t get other things, so we are not getting a vaccination centre.” That is not acceptable.

We are not arguing for more in London; we are arguing for our fair share. We are not arguing for more in particular areas; we are just arguing for every area to have its fair share. We must anticipate, see the problems that are already developing and nip them in the bud right now and address them. I hope I will hear from the Minister that we will have a vaccination centre in Roehampton and that those areas being left behind will be identified and addressed.

May I begin by making it clear that I am not here to raise criticism for criticism’s sake? I am here because I understand how imperative it is that the vaccine programme is successful. Although I welcome the scale of the programme and the number of vaccinations delivered, I am extremely concerned about the vaccination take-up in my constituency, and the inconceivable decision to open the two new vaccination centres miles away from the NHS declared low take-up wards of concern.

Let me briefly explain the geography. The borough of Merton is split in two: Mitcham and Morden, and Wimbledon. Merton’s inequalities in health are stark, with an eight-year difference in life expectancy between parts of Mitcham and parts of Wimbledon. The Minister will be aware of Tudor Hart’s inverse care law—that the areas in the greatest health are then statistically more likely to receive better health services.

Look no further than Merton. When the state-of-the-art Nelson health centre was opened in one of the wealthiest, richest wards of Wimbledon, Mitcham received the “Wilson portacabin”. When lateral flow testing was introduced at community pharmacies, they were opened everywhere but Mitcham. When a decision was made to relocate acute hospital services—guess what? The proposals moved them miles further away from the most deprived areas, with the statistically worst health. While many of these decisions are baked into decades of inequality, the location of a vaccination centre is a decision for here and now.

Here is the state of play: there are two centres in Merton; one in Wimbledon and one in Mitcham. However, take-up of the vaccine across the borough has varied significantly and, as ever, the devil is in the detail. Merton has 25 middle and lower layer super output areas. Of the 12 with the highest vaccination take-up rates, 11 are in Wimbledon. In all 12 Wimbledon areas, over 93% of over-70s have received their first dose. Compare that with Mitcham and Morden, where seven of the 13 areas are still below 90%, and Mitcham West, where the vaccination take-up was just 81%. That means that one in five residents have been offered, but not accepted, the vaccine.

I recognise the breadth of factors as to why this could be, and that accessibility of the vaccination centre is only one. However, it is a significant one, particularly given that, of the two new large-scale vaccination centres that are set to open in Merton, both are in Wimbledon—two centres, miles away from the wards with the lowest take-up areas, which also have statistically lower levels of car ownership. Are we not supposed to be breaking down barriers, rather than throwing up even more?

I am not calling for Wimbledon to lose their services, but the Minister must surely see the absurdity of this decision.

I will have to limit the last two speakers to three minutes each. If they have not seen it, there should be a countdown clock at the top of their screens to help them keep to the time limit.

It is a pleasure to serve under your chairmanship, Sir Christopher. I congratulate my hon. Friend the Member for Hammersmith (Andy Slaughter) on securing this important debate.

I put on record my thanks to everyone who is working to deliver the vaccination roll-out in Dulwich and West Norwood, from the scientists who have worked to deliver safe and effective vaccines at such a rapid speed, the nurses, doctors and public health teams who have organised the delivery to the volunteers who have made vaccination centres such welcoming, joyful places.

The vaccination programme is our great hope at the end of this difficult year of coronavirus, but it is as true locally as it is globally that none of us is safe until all of us are safe. Coronavirus has already shown itself to be a disease of inequality, thriving on pre-existing ill health, low paid occupations and overcrowded housing, and affecting people from black, Asian and minority ethnic communities much more severely.

Previous studies of flu vaccination uptakes have identified ethnicity and deprivation as factors correlating negatively with take-up. It was entirely predictable that the inequalities of covid-19 could be further exacerbated by vaccine hesitancy within communities and occupations that were already at a high risk of serious illness and death. That is what we now see. Last week, more than a quarter of over-80s in Lambeth and Southwark had still not received their first jab, and while 80% of white residents over 65 have now been vaccinated, the rate among African and Caribbean residents was below 45%.

The reasons for hesitancy are complex, but they are not mysterious: well-documented examples of appalling, unethical medical experimentation have led to understandable fear and mistrust in some communities; mild side effects of a jab, which might require a day off work, are a deterrent if there is no guaranteed sick pay; the structural racism that some communities have encountered has eroded their trust in institutions, including the NHS, and peer-to-peer communication of anti-vax misinformation on WhatsApp and Facebook is very potent. All those factors and more may lead people to be hesitant to come forward to take the vaccine.

Addressing people’s deep-seated fears and concerns requires time and resources. I pay tribute to some of the very effective work being done at a local level in Lambeth and Southwark to address vaccine hesitancy, including the leadership being shown by black and Asian councillors. Those efforts are driving up vaccination rates week by week, but our councils urgently need more resources to deliver that work. When the Government recently invited a select list of councils to bid for additional funding to address vaccine hesitancy, Lambeth and Southwark were not on the list. This is, frankly, inexplicable.

The vaccination programme is rightly being celebrated across the country, but it will not have been a complete success as long as disparities remain in the vaccination rate between different communities according to race, income or occupation. If that is allowed to persist, covid-19 will become a disease of inequality to an even greater extent, with some communities enjoying protection, while those in others still fall ill and die. That is not a reality that we can possibly accept, so I urge the Government to take this issue much more seriously and fund our councils properly to combat vaccine hesitancy.

The truth is that the vaccine roll-out has not worked as well as it might for the vulnerable of London. In West Ham, it has been about age. We are one of the youngest areas in Europe and we have had the highest excess deaths. The numbers in the highest-priority groups, especially the over-70s and 80s, are low; consequently, our areas were allocated vaccine supplies at a level far below what could have been delivered. We have had disproportionately large numbers with clinical vulnerabilities—illness linked to higher levels of deprivation—but they were in the top four priority groups, so clinicians have only just started to vaccinate them.

Sky News found that Newham had the highest excess deaths in the UK between March and mid-January. Some 15 of the top 20 areas for excess deaths are in London. Local clinicians have constantly called for the flexibility to vaccinate younger people with clinical vulnerabilities, and I know that Ministers will remember that I have echoed those calls. However, I am not here just to complain, because I am very grateful that Ministers and officials have listened, and I am hopeful that London CCGs will be given greater flexibility to deliver second jabs. More than anything, we have to focus on the role of deprivation, because it is the major barrier to speedy vaccinations.

GP data is limited in areas such as mine because people move, from one short private rental to another, over and again, and so many are in temporary accommodation. Those in poverty and insecure work are less likely to be able to keep their phone contracts and hang on to the same number, which makes it hard when so many vaccine appointments are organised by text. People do not have access to broadband or mobile data, and the consequences are clear.

For the affluent group in DQ5, uptake has been 60%. For the most deprived group, DQ1, it has been just 37%, and it drops at each step, from DQ5 to DQ1. We must find better ways to address this, because we are letting down the vulnerable and it is hindering our collective ability to fight this virus. I would therefore like to hear more from the Minister today about how we will tackle this.

But I do not want to finish without heaping massive praise on our NHS locally—our fantastic local GPs, our local public health teams and all our volunteers. I genuinely cannot thank them enough. They are working together with such tenacity and extraordinary commitment, and I thank them from the bottom of my heart.

It is a pleasure to serve under your chairship, Sir Christopher, and it is a pleasure, too, to be back doing Westminster Hall. These debates are a crucial way of airing important topics. I am grateful to the staff for the clearly extraordinary efforts they have made to make this happen. Facing a wall of pictures of one’s colleagues in this way is possibly the closest I will get to being on “Saturday Night Takeaway”, so I am grateful for that, too.

I congratulate my hon. Friend the Member for Hammersmith (Andy Slaughter) on securing this debate and his leadership of it. His argument was very much based around three themes: data, supply and the impact on take-up in diverse and poorer communities. It is remarkable that all the contributions that followed basically fitted within that framework. It is clear that this is a strongly held view and a commonly shared experience in London, so I hope the Minister will address the points raised. I was particularly interested in what my hon. Friend said about the catch-up point and using local authorities to contact those who have chosen not to take up their vaccine yet, or who have been unable to do so, and encourage them to do so. I know that, as a former leader of a council, he shares my enthusiasm for the ability of local authorities to cut through and connect with their constituents. That is a very good model and is certainly one that has succeeded for us in Nottingham.

Just to pick up briefly on some of the things colleagues have said, my hon. Friend the Member for Westminster North (Ms Buck) made the point about granular data, and as my hon. Friend the Member for Hammersmith says, we always want more data, but it is for a purpose. I think it is really clear that we need granular data about the vaccine because, as my hon. Friend the Member for Ealing Central and Acton (Dr Huq) said, we started off thinking this would be a great leveller, but actually in terms of both covid deaths and vaccine take-up, we know that it is not a great leveller and the experiences are not common to everyone.

That chimes very much with the point that my hon. Friend the Member for Hornsey and Wood Green (Catherine West) made about the tale of two cities, which is a very elegant way of explaining it. Similarly, my hon. Friends the Members for Bethnal Green and Bow (Rushanara Ali), for Putney (Fleur Anderson) and for West Ham (Ms Brown) all talked about the inequalities that exist within London, and that difference between inner and outer London. We have to match our policy response to that. In that spirit, the point that the hon. Member for Harrow East (Bob Blackman) made about different ethnic minorities and not grouping them collectively, which I will talk about in a second, was very interesting, too.

The critical point that my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) made about access was so well put. It can be easy to say, “Hang on a minute, we just know that in certain groups of the population take-up is lower and that is kind of how it is.” But, as the care law she mentioned says, if that is then overlaid with access and where facilities are, we are baking in and causing that conclusion ourselves. Again, I hope that is something that can be addressed.

All colleagues were at pains to talk about good news, and I think that is right. It is wonderful that over 22 million people have now had at least one dose. That is about one in three of all of us in the UK, and about 40% of the adult population. People are getting those first doses at a rate of about 300,000 a day, which is a real success and an extraordinary effort by all involved. I am grateful to the Minister for his leadership and for his constant availability to me and to all colleagues, and, of course, to the staff who have delivered this. It is working; we are seeing a decline in hospitalisations and cases. Of course, lockdown is a significant part of that, but the vaccination effect is a major part. It is wonderful news and provides that light at the end of the tunnel.

Today’s spotlight on London reveals a challenge for our capital, but also other similar communities. While the regional data is a little bit older—about 10 days’ old—in London just over 2 million doses have been delivered, which is about 29% of the adult population, so a significant drop from the 40% nationwide. My hon. Friend the Member for Hammersmith made it very clear that he did not want this to be special pleading. It is not special pleading; there is something different going on and therefore we must react in a different manner. That is true among boroughs, too. In Tower Hamlets, with the highest poverty rate in the capital, by my maths 16%—the BBC have it at 14%—of the adult population have had their first dose. In Newham it is 20% and this is the same across the capital. With Bromley, where there are some of the lowest rates of poverty, the percentage is close to 40% and in Richmond upon Thames the figure is about one in three.

London is not alone. Vaccination rates are lowest in urban areas in general, with Birmingham and Manchester also reporting lower take-up than the rest of England. These regional variations really matter and have a significant impact on local health systems. In London, the rate of decline in covid hospital patients is now the slowest in the country, with a weekly rate of decline of just 15% compared with twice that in the midlands, where I live, and nearly 40% in the south-west. That means more people in hospital suffering from covid but also less capacity for other treatments. I noted that in January, King’s College Hospital NHS Foundation Trust had to cancel all priority cancer operations—that is all those that need to be carried out within 28 days. I am keen to know what assessment Ministers have made of the impacts of such decisions and what plans there are to try to catch up.

Yesterday, YouGov released polling that might help pick away at some of the disparities. In the study, 19% of people who categorised themselves as black said they would not take a vaccine and 18% who said they were Pakistani said the same. That is compared with 6% of people who look like me or 5% who said they were Asian. Again, as the hon. Member for Harrow East demonstrated, that is a reminder of the limits of the term BAME as a collective, and that we should not lose the individual experiences of different communities by using that term. It should give us all cause for concern, because those groups who have said they are less likely to take the vaccine are also the groups who are most likely to have died from covid. That is a sobering paradox.

I know there is a lot of interest in this issue, so I would say for people who are watching, of course it is okay and it is natural to be hesitant about what you put into your body. However, we see all the misinformation that is circulated, whether on WhatsApp or online, and it is frustrating because much, if not all of it, has simple explanations. If someone watching today is unsure, I hope they will ask their doctor, their pharmacist, their Member of Parliament, or their faith leader—whoever they trust, please will they ask those questions?

With supplies set to double and, hopefully, able to tackle many of the supply issues that colleagues raised, we are at a crossroads. Will the inequalities widen or can we to use this moment to close them? I have a few questions that I hope the Minister will address this morning. What different steps are being taken to mop up segments of cohorts that the roll-out has moved past? What is being done to provide more local vaccination sites in communities that are being left behind? I am conscious that often, in politics—we all know this—sometimes we cannot change the message, but we can change the messenger. A community pharmacy, for example, is a trusted alternative in the heart of every community, on every high street, which can help reach a different group of people. How can we use those to try to close this gap? On a similar note, in Nottingham, we are using mosques as vaccination sites now. Are similar approaches being supported in the capital?

Before I conclude, I want to make a point about the staff delivering this tremendous vaccination programme. Their efforts have been incredible and are inching us out of this awful period, a day at a time. It is shameful that their reward for this is a real-terms pay cut and then to be told, as they were over the weekend by a Minister, that they are lucky to be getting anything at all.

Similarly, local authorities are playing a pivotal role in the logistics of the roll-out, as they did in resurrecting test and trace. Their reward is an even greater real-terms pay cut. As well as being a shoddy way to treat these people, this is also bad for the collective, as we seek to rebound from the impact of covid. Where do these healthcare assistants or leisure centre cleaners spend their money? It is in our local economies.

We have just finished a decade of disaster economics and all it did was lead to anaemic growth and an erosion of living standards that has weakened our communities, which has meant that the poorest communities were most vulnerable to covid. The Office for Budget Responsibility says that we have the same ahead of us again. It is crucial that we do not keep making the same mistakes. Simply put, those who clapped on their doorstep should not be voting to cut NHS pay this evening.

There is much to be pleased about with the vaccine roll-out, and it is giving the nation hope. However, we are seeing widening inequalities among already unequal groups. We must act now to tackle that.

It is a pleasure to serve under your chairmanship, Sir Christopher. It is truly wonderful to be back with Westminster Hall debates.

Before I respond to the various points made by hon. Members, I thank the hon. Member for Hammersmith (Andy Slaughter) for his collegiate way in highlighting some of the concerns and working together to address them, as well as for raising the issue of covid vaccinations in London, which is at the forefront of many Londoners’ minds.

It is worth reminding ourselves of where we were at the turn of the year, before the vaccine roll-out really gathered pace. In early January, we were seeing more than 50,000 new cases of covid and around 4,500 people admitted to hospital every day. Sadly, we were seeing more than 1,000 deaths every day. In London alone, there were more than 1,100 deaths a week. Each one of those deaths was of a grandmother or grandfather, mother or father, daughter or son, or in my case an uncle; each of them desperately missed by their families. We cannot prevent every death, but we are on the road to making sure that such tragedies are less commonplace.

Recent Public Health England data shows that levels of antibodies against covid-19 are highest in the over-80s, the first group to be vaccinated. It also tells us that a single dose of either the Oxford or the Pfizer vaccine delivers protection against severe infection in the over-70s, with a more than 80% reduction in hospitalisation. The vaccine is working and having a real impact, protecting the NHS, protecting individuals and putting us on the right track out of the pandemic.

I am pleased that enthusiasm for vaccination is still incredibly high and rising, in fact, week on week. When I took on this job, the percentage was in the late-70s in the adult population; now 94% say they would be willing to have the jab. I have read glowing words from people who have received the vaccine. In the constituency of the hon. Member for Hammersmith, there is Doris Sargeant, a 90-year-old former hairdresser, who was determined to get the vaccine to make sure she can see her family once lockdown is eased, or Jan Keith, for whom the vaccine means hope for reintegration into a better quality of life after almost a year of shielding alone. These stories are replicated many times across London and the rest of the country. I am determined that we will continue to hear more of these personal triumphs over the coming weeks and months of the roll-out.

On 22 February, the Prime Minister set out the new targets for the acceleration of the programme. We set an ambitious aim to offer all adults over 50 a first dose by mid-April and the rest of the adult population by the end of July. I reassure hon. Members that we are on track to meet those targets. Although day-to-day figures for vaccine supply vary and a few days are better than others, overall we are working towards accelerating the pace of the roll-out, as many hon. Members have indicated. We have some bumper weeks ahead, from the middle of this month, allowing us to ramp up vaccination during March.

I know that hon. Members have raised the issue of uptake rates in London and vaccine hesitancy. I am concerned about uptake in the BAME communities, which is why I spend a great deal of my time talking to community leaders about how we can reassure people about the safety and efficacy of the vaccine. On 13 February, we published our covid-19 vaccine uptake strategy, which aims to improve uptake across all communities. This was very much a strategy developed by our NHS, backed by the Department and local government.

The plan takes a local community-led approach, with support from the Government, NHS England and local authorities to co-ordinate and enable action. It includes engagement at local level, using trusted voices, sharing examples of what is known to work well in nearby areas and encouraging community-led efforts to address vaccine disinformation. We are absolutely committed to providing advice and information at every possible opportunity to support those getting the vaccine and anyone who might have questions about the vaccination process.

The community champions scheme, which was mentioned earlier, councils and voluntary organisations will deliver a wide range of measures to protect those most at risk. They are building trust, communicating accurate health information and ultimately helping to save lives. This will include developing new networks of trusted local champions where they do not already exist.

The funding is specifically targeted at areas with plans to reach groups such as older people, disabled people and people from ethnic minority backgrounds. According to the latest evidence, these individuals are more likely to suffer long-term impacts, as we have heard from colleagues, and poor outcomes from covid-19. We have put £23 million to work on this in 16 local areas.

Hon. Members have raised the issue of how vaccine supplies are managed in London at a local level. I want to reassure hon. Members that our supply and scheduled deliveries of vaccine will fully support the vaccination of priority groups 1 to 9, which the Joint Committee on Vaccination and Immunisation set, by mid-April. The UK has secured access to eight different possible vaccines across four different vaccine types, reflecting our strategy to ensure that we not only deliver the vaccines now but future-proof any vaccination programme—a booster or annual vaccination programme—in years to come.

Parts of the country have made significant progress, as we have heard, and gone faster than the average. We are putting more supply into areas, and I reassure colleagues that we will do more. The NHS is doing brilliantly to deliver the amount of supply we have. London vaccine allocations are now managed at a London regional level. Prioritisation is based on the uptake data; where the vaccine is most needed and which delivery methods are used are decided at a system level. We have heard about pop-up sites. Roving models are also used to take the vaccine to the under-served communities that we have heard so much about. Colleagues have been very supportive. We have an MPs’ toolkit to support the vaccination effort in their areas, which has done incredibly well.

Before I finish, I want to address some of the more specific points raised by the hon. Member for Hammersmith and others. The hon. Member raised the issue of the Novotel opening next week. I can confirm that it will open next week as a vaccination centre. There are 200 sites across London now vaccinating. I know that some people have issues about travel, but I know also that Age UK, for example, and some other brilliant charities have come forward to offer free travel for the over-50s to get them to vaccination sites.

The hon. Member for Westminster North (Ms Buck) raised a specific point about confusion between ONS data and NIMS data. I will just point out to her that, on occasion, there is double counting. ONS data is purely age based, and at-risk people or the workforce in care homes will be double counted in that data. The NIMS data is more accurate, but, for the sake of full transparency, the NHS has made both datasets available.

My hon. Friend the Member for Harrow East (Bob Blackman) raised the specific issue of vaccine supply. I can reassure him that we are about to see a massive step change in vaccine supply to his constituency. Of course, we need to make sure that we do not make a mistake, as he quite rightly warned us, with second doses. I can assure him of that, and I will take another look at his point about the mass vax centre closures.

The hon. Member for Ealing Central and Acton (Dr Huq) raised a number of specific issues about Acton town, which I will take up with her.

The hon. Member for Enfield North (Feryal Clark) talked about unregistered people. They can actually register at any GP practice, because we have amended the contracts to allow GPs to take on more people who are unregistered, including those who are undocumented, who have the ability to be vaccinated, because we want everyone to be protected.

The hon. Member for Hornsey and Wood Green (Catherine West), again, raised a number of issues about health inequalities. A standing agenda item in our daily ops meetings in the deployment programme is about health inequalities, and the strategy that I mentioned earlier, which we launched on 13 February, is very much part of that.

The hon. Member for Bethnal Green and Bow (Rushanara Ali) raised a very important issue about Ramadan and the use of mosques. I was at the Brent mosque last week to see how brilliantly it was doing by really getting into the community. I remind colleagues that Dr Habib Naqvi has said that the contents of the vaccines are halal and it would not invalidate a person’s fast if they were to be vaccinated in Ramadan.

The hon. Member for Hammersmith needs to close the debate, so I will end with a quotation from the director of public health for Newham Council that sums up the collaboration and partnership. He last week said:

“Over 50000 in Newham now vaccinated! Long way to go but real progress. All 60+ can book online + this week popup clinics at

Sri Murugan Temple

Minhaj Ul Quran

Ramgarhia Centre

Redeemed Christian Church of God

East Ham leisure centre

& homeless clinic - real partnership”.

That is what we are doing; that is what I am determined to deliver for those communities; no one will be left behind. I am grateful to colleagues for this very important debate.

Thank you, Sir Christopher, for your stewardship of our proceedings this morning. I am grateful to colleagues from north, south, east and west London for speaking on behalf of their unique constituencies but also identifying some common problems; to the shadow Minister, who has shown, as always, the support and solidarity that London MPs can expect from northern colleagues; and to the Minister himself. The Minister will be able to judge whether he has satisfied us on every point raised today by how many people turn up to his Friday briefing this week.

If there is one takeaway for the Minister from this debate, it is the need, in the laudable rush to hit overall targets, not to forget those left behind. That could be people of certain ethnicities. I draw his attention to the Royal College of Nursing’s work on this issue, which shows that even among nursing staff there is a disparity between different ethnicities. There are also those who fall through the net. I have a 68-year-old constituent who, because of her good health for 20 years, lost her NHS number and now is told that she has to wait eight weeks before she can get the vaccine. There are people who simply fall through the net, and it is partly our job to ensure that that does not happen.

On the hesitancy issue, I ask the Minister to look at the work that we are doing in Hammersmith and in north-west London. It is really good stuff. It is good practice that perhaps can be reflected elsewhere. He might even, after having seen it, want to go away and fund it.

Question put and agreed to.


That this House has considered covid-19 vaccine take-up rates in London.

The sitting will be suspended until 11 o’clock. May I ask those who have participated in this excellent debate to leave as quickly as possible?

Sitting suspended.

UK Video Games Industry: Contribution of Leamington Spa

I beg to move,

That this House has considered the contribution of Leamington Spa to the creation of the UK video games industry.

It is a pleasure to serve under your chairmanship this morning, Sir Christopher. If I were to say “Freddie Starr Ate My Hamster”, those of a particular vintage might recall that headline in a certain newspaper, but if I were to mention the title “Rock Star Ate My Hamster”, they might be forgiven for not knowing what I referred to. However, that was one of the first video games produced in the area of Leamington Spa. It is perhaps one of the least known games that emanated from a particular business that I want to talk about, along with the wider sector.

I do not know, Sir Christopher, if you are a seasoned video games player, but even if you are not, you may have heard of some of our global success stories, such as “Forza Horizon”, “Dirt Rally”, “Sonic Dash” or “The Division 2”. The UK games industry contributes a huge £2.8 billion to the UK economy. It comprises 50,000 full-time equivalent jobs, generating over £900 million in tax revenue. It comprises eight major hubs across the UK, as well as a huge number of cottage businesses around the country.

Those hubs include London, Birmingham, Manchester, Dundee, Slough and Leamington Spa—or should I say Leamington Spa, Slough, Dundee, Manchester, Birmingham and London? Because while the UK is one of the global centres for the video games industry, it is Leamington Spa—or should I say Silicon Spa?—that is the motor of the sector here in the UK. A simple glance at the gross valued added of the industry across those towns and cities, and a look at their relative populations, will show that it is Leamington Spa and its immediate environs where the per capita contribution is at its greatest and most intense.

Silicon Spa, as it is known, happened by happy chance, thanks to the vision of two young brothers, the Darling brothers, who started up a business back in the 1980s that would ultimately be called Codemasters, and who had the good sense to locate themselves just outside Leamington, rather than in Banbury, Oxford or London. They then had the foresight to hire the hugely talented Philip and Nicholas Oliver. From that silicon spring, some 40 years ago, would gush Silicon Spa.

That led naturally to other developers being attracted to the area, Leamington being an obvious choice due to its reputation for great bars and good nightlife, establishing a hotbed of talent. Today, the Silicon Spa cluster employs over 2,000 highly-skilled people in 32 studios, equating to over 10% of the UK total games development sector. Per capita, that is the highest in the country, which is some sector clout. The businesses and talent are well recognised by the big players, with Electronic Arts’ acquisition of Codemasters in recent weeks for £1 billion, making it the latest big name to invest in the Warwick and Leamington area.

Back in 2008, a long time before I became the Member of Parliament or indeed was drawn to politics, I was talking to the local council about putting Warwick and Leamington on the map, because I could see the diversity and richness of talent, the breadth and opportunity of business, and the phenomenal skills pool we had in the community. At the time, I was talking to Sir James Dyson’s foundation to try to get him to invest in our towns, but unfortunately the global financial crash put paid to that.

I have long held that we have the businesses, the people and the educational resource to lead the way. That is because we also have the traditional automotive industry based in the area, which allows a fusion of skills and talent from the likes of Jaguar Land Rover and Aston Martin, just down the road. The steady stream of engineers and specialists working at their Gaydon hubs has had a knock-on effect on the games industry, with talent-switching between the industries.

This is something we are seeing with the emergence of augmented reality and virtual reality technologies in particular, which were developed in the games industry, and how they can be applied to other sectors as well. We have talked about the automotive sector, but there are a great many others. We are starting to see the AR and VR genres spreading into all other aspects of audio-visual media. It will no doubt be at least a £100 billion industry very shortly, within the next few years. Those who were lucky enough to see the Royal Shakespeare Company’s production of “The Tempest” in Stratford will realise how these skills and emerging technologies can be used in theatrical production, as well as so many other areas.

What makes the area unique is that 75% of the digital media companies there are gaming companies, whereas the figure might more typically be 5% to 10%. With a turnover of £101 million, the Leamington area’s economic contribution is the largest outside of London, or the Slough-Heathrow area, as an aggregate figure. The area has the highest percentage of games employees in the working-age population, so you are more likely to meet someone in the Leamington Spa area who works in the games industry than perhaps anywhere else, Sir Christopher. The area benefits not just the cluster, but from soft-landing opportunities, the skills and talent, the crossover, and the fusion between different sectors. It also has a relatively low cost profile, with excellent networks across the industry and world-class research on its doorstep.

When it comes to skills and education, we have Warwickshire College Group, which offers a foundation degree in games art, with the opportunity to add a further year and receive a BA (Hons) through the University of Gloucestershire on its interactive games art programme. Across the west midlands higher education institutions, there are 2,045 on games courses, 12,800 in design studies and almost 17,000 on creative courses. A huge talent coming through, perpetually, to support this industry and many others.

In 2019, Coventry University was ranked the UK’s modern university for the 7th year running, and produces internationally recognised research. Some 2,000 students study the creative art and design courses that it offers, and 1,700 computer science students also attend. As well as that, the university offers its Q-interactive digital studio. Down the road, at the University if Warwick, there is a school of creative arts, performance and visual cultures, and it is home to the largest university art centre outside of London.

Elsewhere, it is clear that the entire creative sector of our area will benefit from the redevelopment of Leamington’s creative quarter through the regeneration of its old town. We can build upon and reinforce the importance of the creative and digital industries in the town and attract inward investment to the cultural and creative sectors. With costs so significantly lower than in London or the south-east, there are good, simple financial reasons for businesses to locate there. This is recognised by the Department for International Trade, which presents the area as a centre of high potential for video games both inside and outside the entertainment sector.

I can honestly say that Leamington is absolutely the place to be, and not just in terms of investment, but in terms of skills and opportunities, and also the support. It is also the happiest town in the UK.

I am nothing if not ambitious for our area, and slightly green with envy about the work being done by the games industry veteran Ian Livingston, who is spearheading a project to open a brand-new UK academy dedicated to science, technology and digital skills. This is something I very much want to see replicated in the towns of Warwick and Leamington, as it is something that I was envisioning back in 2008. I very much hope we can see that on the horizon.

In terms of challenges, it would be remiss of me not to talk about the economic, political and legal landscape, because it is so crucial to the future of the sector. The news the other day regarding a draft decision for a data adequacy agreement with the EU is of considerable importance to the sector, and clearly to Leamington as a result. It is positive that Brussels is set to allow data to continue to flow freely from the EU to the UK after all, although the arrangement will be reviewed every four years, underlining just how fluid the landscape is right now.

The UK is and remains a major international player, particularly when we consider the number of companies that we have here relative to our GDP and population. The US has twice as many businesses, but it has a domestic market far larger than the UK’s. It is only when we look at countries such as Japan and Germany that we can understand the scale of our sector here in relative terms, which helps explain why so many nations envy greatly the commercial success that we enjoy globally. Those countries are eager to grab market share, and many, such as Canada, Sweden and eastern European nations, are making a determined effort to attract UK companies and our talent to relocate to their shores through fiscal incentives and easy visas. These are themes among many that business sector representatives such as the Association for UK Interactive Entertainment and The Independent Game Developers’ Association are working very hard on. That is also why the sector-specific video games tax relief is so important.

In August last year the Government revealed that £355 million had been spent on making more than 150 video games in the previous year. In fact, since the relief’s introduction in 2014, just under £4 billion has been spent on making 1,400 games, which shows what can be done with support. We need not only to maintain that relief, but to deepen the UK games development fund with an increase in Government investment in intellectual property while providing greater support for trade and investment activity.

When it comes to skills, it would be good to see the Government match fund an industry-led skills programme as well as ensuring UK businesses can continue to attract the best of global talent through sensible business-friendly immigration policies. All this is good, but other nations are throwing serious money at the industry to lure our businesses away. It is vital not only that these businesses remain here, but we must ensure that they continue to invest here in Warwick and Leamington, in Silicon Spa and elsewhere across the country.

No speech these days would be complete without a review of the challenges we presently face. It is clear that for many businesses the pandemic has been incredibly hard, but for the games sector it has, I am glad to say, been relatively buoyant. Of course, many people have been turning to video games in this period to stay socially connected, to maintain their mental wellbeing and to keep entertained, especially given that so much traditional support has been closed down for long periods and has suffered so greatly. That is why I am particularly thankful for the initiative shown by the sector and by my local businesses during the crisis, and for the recognition of the sector’s responsibility by taking various actions to help support players, people and public health. The “Games for Carers” campaign donated tens of thousands of free games from across the games industry to frontline NHS heroes.

Elsewhere, there was the establishment of the partnership between leading games companies and the UK Government to place central public health messaging in games, which enabled millions to be reached. That was a very good initiative. Then there were local games companies such as Playground Games in Leamington partnering with local food providers to give away free lunches to children eligible for free school meals.

It is once in a generation that a few individuals step forward—inventors and innovators—and it is particularly rare when those innovators or inventors also have the enterprise to match. Of course, it is easy to think of those on the west coast of the US in Silicon Valley and the likes of Steve Jobs and Bill Gates and the sorts of businesses that they founded, but I would suggest that the Darling brothers and the Oliver twins were our equivalents in the establishment of Silicon Spa. Thanks to them, 40 years on, Leamington and the wider region boast our own Silicon Spa, which has become a world-renowned area and sector for a hugely successful global industry, and it is very much the motor of the UK games sector. If businesses out there across the UK, or indeed elsewhere in the world, are looking for the best location, the best talent, the best skills, and maybe the happiest town in which to locate themselves, could I suggest they look no further than Leamington Spa—Silicon Spa—and that they get in touch with me?

May I just say one final thing? When this pandemic eases and we are able to return to workplaces, I look forward to visiting many of these businesses, and I very much look forward to seeing David Darling—I just have to have a demonstration of “Rock Star Ate My Hamster.”

It is a great pleasure to serve under your stewardship, Sir Christopher. I thank the hon. Member for Warwick and Leamington (Matt Western) for bringing this debate to the House today, and I am so chuffed to have the opportunity to congratulate Leamington Spa and highlight its incredible contribution to the creation and development of the UK video games sector. That sector is such a key element of our world-leading creative industries.

Only a few weeks ago, I was lucky enough to speak about the importance of Leamington Spa as a games hub. I was very disappointed that, given covid, I was not able to be there in person, and had to do it virtually. I would very much rather have been there in person, but I am delighted that the hon. Gentleman has brought Leamington Spa to me today by bringing it to life in such a vibrant and exciting fashion. He is a great advert for the town, and I very much hope, one day, that I will be able to visit some of his local companies. I was delighted to be able to provide that keynote speech, because Leamington Spa is so vibrant and such an important part of our video games sector. Its very own “Interactive Futures” virtual event showcased the incredible careers and exciting career paths in the video games sector to younger generations and their parents. That is so important: what an exciting, vibrant and interesting career it would be to be in the video games industry!

Leamington Spa—or Silicon Spa, as I think we should now refer to it—and the whole surrounding area has played such a key part in the development and growth of our UK games industry. The games hub has its origins way back in the late 1980s—which, of course, I do not remember at all—with the emergence of Codemasters and then Blitz Games. Their founders, the Darling brothers and the Oliver twins, were pioneers of the British games industry, as the hon. Gentleman highlighted so eloquently. Over the years, we have seen Leamington Spa flourish as a games development cluster, experiencing superb growth and creating major economic value, not only in the west midlands but for the whole of the UK.

The games hub is now home to such a diverse mixture of games companies and smaller start-ups. Of course, Codemasters remains today one of our biggest and most successful games companies, but the area’s world-famous studios also include Playground Games, Ubisoft Leamington, and Sega’s HARDlight studio. Some of our most recognised game titles have been developed there, including internationally acclaimed racing games such as “Forza” and “F1” and—a particular favourite of mine—“Sonic the Hedgehog”. My parents always thought that I was wasting my time with all the years of my youth I spent playing video games, but it was clearly preparing me for life as the Minister responsible for video games, so it all worked out very well.

That blend of experienced games businesses and innovative start-ups has produced an organic system of inter-business mentoring and support, which has enabled the area to flourish so successfully. That mixture of business size and professional experience encourages an impressive rate of intellectual property development, and it is therefore no surprise at all that Leamington Spa has become one of the UK’s largest hubs for indie games studios. Of course, that is why the area is referred to as Silicon Spa, given its incredibly attractive mixture of innovation, artistic design, digital growth and skilled creative professionals.

Leamington Spa, though, is just one example of the UK’s many excellent games hubs. I do not know if you know this, Sir Christopher, but video games hubs have sprung up all across the UK, from Sheffield to Guildford, from Newcastle to Bristol, from Belfast to Cardiff, and from London to Edinburgh and, of course, Dundee—one of our oldest games clusters and the birthplace of the groundbreaking, iconic games that I am sure you are well aware of, “Lemmings” and “Grand Theft Auto”. Those are just some of the concentrations of games companies that are contributing to a huge drive in economic growth, innovation and creativity. Indeed, the industry is one that I am proud to say is truly British in its geographic representation.

According to recent figures from the trade association TIGA, 80% of games development jobs are located outside London, which is something many industries would, I think, aspire to. We recognise the benefits that that can bring to local economies, and, of course, the Government are committed to levelling up across the country. Is not the games industry a fine example of how that can be achieved? It plays such an important part in helping us to achieve shared prosperity across the UK.

As the hon. Member for Warwick and Leamington said, the industry is flourishing and promises more growth and success in the years to come. The sector contributed an estimated £2.9 billion to the UK economy in 2019. That is up £0.4 billion from 2010, which is huge growth. We understand that the sector has huge potential to continue to grow, and can make an enormous contribution to the UK’s future prosperity. That is why the Government are so committed to supporting its continued growth and why we introduced the video games tax relief in 2014. That growth has supported £3.7 billion of additional investment in UK games production, helping to strengthen the UK’s reputation as one of the leading destinations in the world for making video games.

I am also delighted to say that my Department will continue to fund the UK games fund into the next financial year, to support early-phase games development and talent. That includes the games fund Transfuzer programme, which has helped 400 graduates so far. I am thrilled that the 2021 competition is now open for applications, supporting another cohort of games talent, based in a range of regional hubs. Transfuzer helps graduates to go on to great jobs in games development, which is increasingly important as the industry has such demand for incredibly talented and ambitious individuals. That demand will only continue to grow.

The sector already employed some 27,000 people in 2019—a 42% increase on 2013. That is exactly why events such as the one at which I recently spoke, Leamington Spa’s “Interactive Futures”, and Games Careers Week, which will happen later this month, are vital. We must continue to inspire people to look for roles in our incredibly rewarding creative industries. In recent times another great success story has been the emergence of the UK’s e-sports industry, which presents another huge set of opportunities to explore, to drive growth and investment. We are excited to see how we can build on that, to see the UK established as a major e-sports destination.

However, while we can celebrate the games industry’s fantastic growth and opportunities, there are some challenges for the creative industries. The video games sector remained relatively resilient against covid-19 but, of course, the pandemic placed unprecedented pressure on some organisations and individuals across the economy, and some other sectors in DDCMS have been particularly badly hit. That is why the £65 billion three-point plan that the Chancellor set out last week, to provide support for jobs and businesses as we emerge out of the pandemic and forge a path to recovery, is vital.

The Budget announcement coincides with the publication of “Build Back Better: our plan for growth”, which sets out the Government’s plan to support economic growth through significant investment in infrastructure, skills and innovation. That highlights more than anything, I think, the digital and creative industry as a major success story in the UK’s potential future growth, and as a driver of innovation.

It is important to acknowledge some of the themes that the hon. Member for Warwick and Leamington brought out in his speech today. The industry really is an incubator for some high-end technology. He also highlighted the fantastic opportunities to gain really high-quality skills, well-paid jobs and exciting future careers.

However, we must also recognise that there is still a little bit of work to be done to ensure that video games are enjoyed safely by everybody. We know that our evolving digital technologies, such as video games, present some new responsibilities as well. There are social responsibilities to make sure that anybody using them is not exposed to harm. That is why we take seriously public concerns about loot boxes, for example, and why we launched a bespoke call for evidence last September. This sort of process will inform what we can do as a Government and as an industry to ensure that all consumers are well protected. We will announce the next steps in that process in the months ahead.

However, I want to end with a key positive message from the Government. We fully appreciate the amazing potential—indeed, the amazing achievement up to now—and the future growth potential of the video games industry. We want to exploit fully the UK games sector’s potential for growth and to cement its position as a world leader. We fully recognise the games industry’s importance and its future potential, and the contribution that the sector, which is exemplified in areas such as Leamington Spa, makes to British prosperity.

Finally, of course, something that I had forgotten to mention until now is the sheer joy and entertainment that video games bring to millions of players in the UK, not least a few in my own household. I am excited to see what opportunities the UK games sector will present in the future. It is an industry with an extremely bright future.

Question put and agreed to.

Sitting suspended.

Support for Women Leaving Prison

[Sir Charles Walker in the Chair]

I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. Timings of debates have been amended to allow technical arrangements to be made for the next debate. There will also be suspensions between each debate. I remind Members participating physically and virtually that they must arrive for the start of debates in Westminster Hall. Members are expected to remain for the entire debate. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address. Members attending physically should clean their spaces before they use them and before they leave the room.

I beg to move,

That this House has considered support for women leaving prison.

It is a pleasure to serve under your chairmanship, Sir Charles. When you look at the female prison population, you are faced with the stark reality that, for the most part, it is nurture, not nature, that has led these women down the path they are following: a path of destruction; a path that embodies a lack of self-worth; a path that has been created for them by life experiences and subsequent complex needs.

Nearly 60% of women who come into contact with the criminal justice system are survivors of domestic violence, and more than half report having received emotional, physical or sexual abuse during childhood. Both of these figures are likely to be underestimates. If we add issues such as poverty and addiction to that, we can start to see the full picture of how past trauma leads to crime, conviction and imprisonment.

I could talk—and I have talked—at great length about the need for alternatives to prison for many women in the first place. The female offender strategy gave me a sense of real hope that more would be done to advocate for women’s centres, with the emphasis on supporting and rehabilitating women in a more constructive setting. In the strategy, the Government signalled a commitment to a new programme of work for female offenders, driven by three priorities: early intervention, an emphasis on community-based solutions, and an aim to make custody as effective and decent as possible for those women who have to be there.

I was therefore shocked and disappointed by the Ministry of Justice’s announcement earlier this year of 500 new prison places for women, at a cost of £150 million, particularly when co-funding for women’s centres, which are proven to reduce offending, is being cut.

Today, I want to look at what happens to women when they finish their sentence. What support is available to them to help them rebuild their lives? What more needs to be done to reduce the number of women whose initial conviction becomes a catalyst for a lifetime in the criminal justice system?

I recently met representatives from the Safe Homes for Women Leaving Prison initiative. Shockingly, they told me that over half of all women leaving prison have nowhere safe to go. They walk through the gate with three things: the paltry £46 prison discharge grant, a plastic bag full of belongings, and the threat of recall if they miss their probation appointment. For some, the simple fact that they have been in prison a long way from home means that they have no local connections when they are released. For others, who are victims of abuse, returning to their homes, and consequently the perpetrators, comes at a huge personal risk. Yet what other options are there?

A lack of secure housing is a significant barrier to rehabilitation. According to a report by Her Majesty’s inspectorate of probation, between 2019 and 2020, 65% of men and women who were released from prison without settled accommodation reoffended. Without somewhere to live, the chances of finding employment are minimal and the impact on mental health is devastating. A return to familiar surroundings, harmful behaviour, substance abuse and crime is almost inevitable.

The duty to refer in the Homelessness Reduction Act 2017 is failing vulnerable women leaving prison. The Government must take urgent action to change this and improve the Act’s effectiveness. Although the announcement of dedicated staff to act as brokers for prisoners in order to give them faster access to accommodation on release is welcome, having this resource in only 11 prisons around the country will not come close to solving the problem. These staff need to be placed in every women’s prison in the country and be fully trained to address the challenges faced by women when they leave prison.

Likewise, the new pilot announced by the Government of temporary basic accommodation for prison leavers at risk of homelessness does not go far enough. It has been launched in only five of the 12 probation regions in England and Wales. It is limited to a maximum of 12 weeks’ accommodation and does not address the particular needs of women at all. This needs to be a national scheme that takes into account the specific issues faced by vulnerable women with complex needs and offers safe and secure permanent accommodation to enable them to achieve resettlement and rehabilitation.

Leaving prison should be the chance for a new beginning, but the way things stand, it is just the start of another battle for many women—a battle to find somewhere safe to live, to get a job, to stay clean and to not reoffend. It is a battle to avoid being recalled, because that £46 was just not enough for a fresh start.

Will the Minister look again at the Government’s commitments in the female offender strategy? Will they make commitments to take an approach that addresses vulnerability, follows the evidence about what works in supporting them to turn their lives around and treats them as individuals of value? Will he consider what could be done to improve women’s life chances on release, be it an uplift in the prison discharge grant; a pledge to look again at additional prison places, given that it is clear that women’s centres provide better outcomes; extending dedicated support across the whole female justice estate to help with accommodation before release; making available guaranteed accommodation for all those leaving who are at risk of homelessness; or perhaps all these things?

We know that the majority of women with convictions have experienced trauma. We have all heard the harrowing stories of abuse, addiction, coercion, and self-deprivation that have led these women to commit crimes in the first place. We need a system that supports their rehabilitation and offers them freedom from the past, to help them avoid recall and allow them to choose a different path; not a system that is set up for failure from the very start.

If we are to see an end to this injustice, so much more needs to be done to offer women the support and tools they need to build themselves a better future. I talk to very many women who started on this vicious journey because of the environment in which they lived. I have met women whose original crime was not having a TV licence. Unable to pay the associated fine, they ended up in prison. I have met women whose children refused to go to school. Again, unable to pay the fine, their punishment was prison. When they are released they have lost their family, their home and their dignity. They now live on the streets, and too many are working the streets and financing the pimps and the drug dealers. We have to break this cycle. The Government must act now to prevent this cycle of inevitability.

It is a pleasure to serve under your chairmanship, Sir Charles, and to follow the hon. Member for Swansea East (Carolyn Harris). I agree with every word she said. There are some people who, when they come to this place, like to play to the gallery, and there are some who come to do the right thing. The substance of this debate is one where we need to make sure we do the right thing, because the measure of a civilised society is how it treats its most vulnerable people.

Many colleagues on my side of the House have a very “Hang ’em and flog ’em” approach to criminal justice—locking people up and throwing away the key. There is a place for that. However, many people who end up in our criminal justice system or in custody are themselves some of the most vulnerable people, and they are symptoms of state failure. That is particularly true of women prisoners. As we all know, quite often people who have been in the care system are over-represented on the prison estate, as are people with addiction problems, and people with literacy and numeracy issues, and that is the state failing those people.

How we deal with people once they enter that cycle of offending and reoffending is how we should judge our success in rehabilitation and making sure that we give people a second chance. We should not be writing people off forever. We know that if we do not give them the support to be rehabilitated, they will continue a cycle of reoffending. That is not good for society at all, or indeed for the taxpayer, because putting people in prison is quite an expensive solution. We need to grasp this debate head-on. We should not be letting our criminal justice system pick up the price of state failure.

Women who have been let down by the state are particularly over-represented in the prisons system. As the hon. Member for Swansea East has alluded, many are victims of abuse, whether domestic abuse or sexual violence, and trauma is symptomatic. In fact, for some of those women, prison is probably as safe and secure an environment as they have ever been in. What a travesty for our society that we let that happen.

We know that there have been many moves in recent years to recognise that prison is not the right place for people who are vulnerable and suffering the consequences of trauma. For a long time, we had a move towards different, more community-based solutions. In particular, talking about women who are also parents, what good is there to be done by putting women in prison and putting their children into care? What is going to be the positive outcome for society of that? Other solutions can be pursued, such as treatment orders combined with community payback schemes. I think we should look at that.

The direction of travel was very much in favour of this more enlightened way of treating women in the criminal justice system, but we seem to have had a change in emphasis. As the hon. Lady mentioned, the announcement of 500 new prison places comes at a time when the women’s prison population has gone down by 600. We are talking about an increase in capacity of 1,100. We ask ourselves: what signal are we showing about how we are going to deal with people who, frankly, need support to not reoffend?

In not too recent a time, the then Cameron Government had very big ambitions for prison reform and emphasis on rehabilitation, but they seem to have died with that Government. It is easy to be populist and easy to play to a gallery that wants to lock people up and throw away the key, but we need to think about what the best outcome for society is. Surely the best outcome for society is to make sure we do everything in our power to support people to get out of that cycle of reoffending.

I often say in this place that there is no public policy issue that cannot be solved by a housing solution, and that is also true of this. It is clear that some kind of security in accommodation when people leave prison is fundamental to making sure that people do not reoffend. As the hon. Lady mentioned, there are pilots in place to give that support in housing, but I helpfully suggest to the Minister that perhaps we should have more focus on those kinds of step-down solutions for housing for people who leave prison, and that perhaps that might be a better value-for-money investment of taxpayers’ money than simply expanding the prison estate.

As I say, the more we can do to divert women away from simply being incarcerated, the better it will be for society. It will prevent some children from going into the care system, and prevent that generational flow of history repeating itself in families. We also know that, as the hon. Lady mentioned, some of the offences committed by women for which they end up with a custodial sentence are not ones that justify such a sentence. In particular, they can often be with reference to debt, and again, I think we can find much better solutions for supporting people out of that.

I have little more to add, other than to reaffirm my support for everything the hon. Lady has said. We as political leaders perhaps need to give more leadership to our communities, and to be more understanding and more forgiving of why people end up the way they are. It is when people feel excluded from society—when they feel that society is not giving them a chance—that they end up in this cycle of crime and reoffending, in and out of prison. As I say, that is our failing. We need to make sure that when we pick people up for the first time, we do what we can to help them address their problems, whether that is debt, poor literacy, or all the other traumas that they may have suffered. As we know, mental health difficulties are a big characteristic of this prison population too. Let us do our bit and not simply rely on more prison places.

It is a pleasure to speak in today’s debate and to serve under your chairmanship, Sir Charles. First of all, I thank my hon. Friend the Member for Swansea East (Carolyn Harris) for securing this incredibly important debate today; it is particularly timely, given that yesterday was International Women’s Day. It is important to see from the first two contributions that women from both sides of the House can find common ground on this really important issue. I for one am grateful that there are these issues that, as women, we can potentially work together on.

It is important to remember that as many as 70% of women in prison are survivors of domestic abuse, and that women in prison are also five times more likely to have mental health difficulties than those in the general population. However, sadly, in many cases they are simply not receiving the support they need on being released from prison. According to the Ministry of Justice, in the year ending March 2020, one in 25 women were sleeping rough on release from custody, and nearly half of women left without settled accommodation. Data from the independent monitoring boards for women’s prisons and the prisons themselves suggest that the figure is actually as high as 60%. This is a huge problem, not least because 65% of women released from prison to no fixed abode go on to reoffend. Failure to provide safe and secure accommodation is therefore preventing rehabilitation and fuelling reoffending.

The Ministry of Justice has recently announced £70 million of funding to support former offenders at risk of homelessness, including a pilot to provide prison leavers with temporary accommodation for up to 12 weeks. However, that pilot is limited in scope, as it covers only five of the 12 probation regions and, as my hon. Friend the Member for Swansea East pointed out, does nothing for women in the other seven probation regions. There is also uncertainty about whether those vulnerable women leaving prison will be supported beyond the 12 weeks’ temporary accommodation to find long-term, safe and secure accommodation. That is the type of accommodation that is desperately needed, not a 12-week temporary fix.

That funding is also incredibly low, compared with the £150 million recently pledged to build 500 new prison cells for women. While Ministry of Justice figures published in November last year show that the female prison population is projected to rise by around two fifths by 2026, it is important to remember that, in the main, we need to focus on community sentences and the use of women’s centres instead of prison, especially given that 80% of women are in prison for non-violent offences. Indeed, a series of inquiries and reports in recent decades have all concluded that prison is rarely a necessary, appropriate or proportionate response to women who offend. The Government’s own female offender strategy promises a focus on early intervention and community-based solutions. Why are the Government not following that female offender strategy? Why are they investing in prisons, when actually the money is needed in women’s centres?

Specialist women’s services are best placed to address women’s complex needs, to divert women from the criminal justice system, and to prevent reoffending. The Women’s Budget Group further found that a place at a women’s centre costs between £1,223 and £4,125 per woman, depending on needs, while a place in a women’s prison costs £52,000 per year. Better investment in and use of women’s centres would therefore yield huge savings on the costs incurred directly by the criminal justice system, and on those incurred indirectly by the health, mental health, housing, welfare services that would otherwise be used by a previous offender. Instead, these specialist providers face a £10 million core funding gap from this March. The Government should provide proper ring-fenced core funding to ensure the long-term sustainability of those services.

We also seriously need to look at the presumption against short sentences. Fifty-eight per cent. of women are reconvicted within one year of leaving prison. That figure rises to 73% for sentences of less than 12 months. Meanwhile, the proportion of women sent to prison to serve very short sentences has risen sharply. In 1993, only a third of custodial sentences given to women were for less than six months. In 2019, the figure had nearly doubled to 62%. The problem with short sentences is that there is no time for any form of rehabilitation, and it often means that during that time women lose their family ties, any job they may have, and their housing. Statistics show that women are more likely to reoffend when they are given a short sentence. A review of the purpose and use of short sentences for women offenders, and their value to victims, offenders and the taxpayer is needed.

We know that women are more likely to reoffend if they are released from prison to no fixed abode. We know that women released from prison are more likely to reoffend than those serving community sentences, and that women are more likely to reoffend if they are given a short sentence in prison rather than a community sentence. Despite that, the Government are not seriously looking into a presumption against short sentences, are leaving women’s centres at the risk of closure through underfunding, and are not investing enough in measures to prevent homelessness. Instead, they are investing more in prison places, which is the one thing that has been shown to not be of use for the majority of female offenders.

Without action on those issues, the Government simply condemn many women to a cycle of crime. To truly support women in the criminal justice system we need a much more holistic, understanding approach, which ultimately would cost less to both the taxpayer and to society.

It is very nice to be in the new Westminster Hall and to make a contribution. It is certainly different and does not have the ambience of the original, but it is nice to have the debates back.

I thank and congratulate the hon. Member for Swansea East (Carolyn Harris) on setting the scene so well, and I thank those who have contributed. It has been good to hear all the valuable contributions.

Obviously, I am very pleased to make a contribution on this issue, because—like the hon. Member for Thurrock (Jackie Doyle-Price)—I have a passion to help those in society who are probably less well-off and need help. My heart’s desire and my position here is to help those who perhaps are not able to help themselves. The hon. Lady outlined the issues very clearly and I want to speak about them as well.

I thank the organisation Safe Homes for Women Leaving Prisons for its sterling work to highlight the problems that exist within the rehabilitation process for women leaving prison. When I read through the briefing notes, it was clear that we can and must do better to rehabilitate these women properly rather than their leaving prison with no support, which makes it much harder for them to make the change in their lives that they need. That is why we are here today. I am very pleased to see the Minister in his place and I know that he will be able to answer the questions that we put to him.

The briefing highlighted that each year thousands of vulnerable women really need follow-on help from whenever they leave prison. The hon. Member for Swansea East said at the beginning of the debate that people leave prison with £46—my goodness—and a plastic bag with their clothes in and probably all their life’s possessions, and with nowhere to live, which, of all things, I really worry about. There is also the threat of recall if they miss a probationary appointment. Is that the level of preparedness that is needed for the outside world? I would say not; indeed, that is why this debate is happening. Instead, they are left at the mercy of those evil and wicked people out there who take advantage of others, and who the hon. Members for Swansea East and for Thurrock both referred to.

I believe that we should give these women the dignity that they want and need, and the confidence that comes from that, so that they can leave prison well. If someone gets out of prison and they do not have a house, the first thing that they need is a house, or accommodation. But that should not be provided just as a one-off, leaving all the other things to fall into place, or hoping that that happens. It is about the follow-on help.

Who addresses the mental health issues? We have lived through a year of coronavirus, and many people in my constituency and indeed in all our constituencies have experienced mental health and wellbeing at a lower level than ever before—at least, I cannot remember in my lifetime there being a lower level. Mental health issues are affecting lots of people. Multiply that by those who are stuck in prison for the sentence that they have been given for the crime that they have committed, and for those people the mental health issues are really overwhelming.

What we do to provide follow-on help matters. Housing is the No.1 priority, as the hon. Member for Swansea East said. The next stage is to provide follow-on help for any mental health issues. We can help with simple things, for example, managing budgets and the moneys people have. Even those small things matter.

I watched a TV programme with Simon Reeve, who I quite like; he does a trip to different places. On Sunday night, my wife and I watched it together. He was doing a trip around the Americas and he went to a place in Colorado; I hope that I am right on that. It was a prison town—there were nine prisons in that town. But what they were doing in that prison town was getting people prepared for whenever they left prison.

We all have our own opinion of the US justice system. It is quite a complicated system, where someone can start off with a fine for a broken tail-light but things can multiply and they can end up being in prison, because they do not have the money to repay a debt and get themselves back in credit. However, what they were doing in this prison town was get people prepared for the outside world. The prisoners were being taught simple things, such as going to a restaurant. These are people who perhaps do not have the educational standards that they need; they probably do not have the social skills, either. For them, the outside world is a scary place and they are vulnerable to being taken advantage of.

I believe that the practice that we are debating today is a devastating one, which places vulnerable women at risk and prevents them from rebuilding their lives after a prison sentence. Safe and secure accommodation is essential for rehabilitation, but 65% of prisoners are released to no fixed abode. Basically, they go out the door of the prison and they are on their own. If they have no family, the situation is even worse, because they really are singular and alone with what happens to them. And, yes, the potential for them to reoffend emerges very quickly. Let us consider that figure I just gave; it is an incredibly significant figure. It is 65%, and this figure alone prompts calls for action to be taken.

It is only right that we give the Government credit for recognising that women have a very different experience of the criminal justice system from men, but because of that, while the Government have done some things, they have perhaps not done enough. They have committed to improving outcomes for women in contact with the criminal justice system across England and Wales, but I just wish that we in Northern Ireland had the same pilot scheme that the Government have looked at. Has the Minister had the opportunity to speak to the Justice Minister in the Assembly in Northern Ireland, Naomi Long, to discuss these things and see what we can learn from the UK Parliament to make this thing happen in Northern Ireland as well?

I also highlight that, despite that recognition, the Government have not set out any gender-specific measures to address support for, in particular, the complex needs of vulnerable women prison leavers in their new pilot scheme to house prison leavers in temporary accommodation. I welcome the pilot scheme, which really gets us to the stage where we really want to be—the first stage of trying to rehabilitate and bring people into society with better opportunities and life potential. I would love to see that, and if that that is the intention of the Minister and the Government, it is to be welcomed. However, at this stage, the Government have missed that opportunity, so I ask again whether the Minister will set out how this pilot will cater for the specific and complex needs of vulnerable women prison leavers. I really want to make sure that, when the pilot scheme is in place, what comes forward after that gets people ready for the next stage of their lives. Further, there is a question to be asked about whether this will be extended across all probation regions in England and Wales.

I also asked whether the information will be shared with Northern Ireland to ensure that new designated prison officers acting as brokers for housing are appointed in every women’s prison—I think the hon. Member for Swansea East referred to this in her contribution at the very beginning—and receive specific training on the challenges facing women prison leavers.

Back in 2019, I read an incredibly interesting article that included excerpts from a study carried out by the criminology lecturer Gillian McNaull as part of research for Queen’s University Belfast. What she said sums up this issue very well:

“Many women are not remanded due to the severity of their crime, but instead due to their vulnerability.”

If society puts people away because they are vulnerable and not because of the severity of their crime, there is something wrong. If Gillian McNaull at Queen’s University Belfast can recognise that, I am absolutely sure that Members who speak in this debate and the Minister recognise it. She also says:

“I found that a significant number of women are being arrested and remanded to custody for issues relating to mental health crisis, suicidal ideation, alcohol use issues and homelessness.”

The hon. Member for Thurrock referred to that. We really need to know the reasons why people are in prison. If it is because they have committed a crime of such severity that warrants prison, that is okay, but it is not if they are in because they are vulnerable or have nobody to turn to or are really down on their ankles.

Gillian McNaull added:

“This sees an unacceptable use of prison as a place of ‘safety’ and ‘containment’ for women—an issue exacerbated by deficits in community resources, such as a lack of gender-appropriate hostel accommodation, adequate community mental health support and social care provision.”

The hon. Member for Lewisham West and Penge (Ellie Reeves) made a similar reference. What can be done to help to achieve successful and secure hostel accommodation, community mental health support, which is really necessary, and that social care provision? If we get all those in place, I believe we can help in a more constructive way and give people hope for society for the future. That is really important.

At this time, the Justice Minister is committed to carrying out a review. I ask the Minister to ensure that all information, practices and pilots are shared UK-wide—we are very much part of the United Kingdom of Great Britain and Northern Ireland, and want to be, and we want those pilot schemes and practices shared in a way that we can take advantage of them as well—to inform what changes can be made to prevent offending and the improper use of facilities. More support is clearly needed and I believe that the effort will bring reward. I know it is the intention of everybody here, including the Minister, to lessen reoffending. It is vital that more women will be able to change their lives with the support that they are crying out for.

It is a pleasure to serve under your chairmanship, Sir Charles. This is an important debate, on which there is much agreement, and I will add to many of the things that have been said today.

If the Government are serious about reducing reoffending by women, they need to support specialist services, such as those offered by women’s centres, to help them stop offending in the first place and, if they have offended, to give them support afterwards. Providing accommodation is key because being homeless is one of the biggest factors in reoffending.

Many women who have committed crimes and are therefore in the criminal justice system are disproportionately victims of crime themselves. They also tend to be imprisoned for crimes less serious than those committed against them. Addiction or being in an abusive relationship are also factors for many of those women.

Short sentences are very disruptive for women, especially if they have children. Most women serving short prison sentences are back in prison within a year. Reoffending levels are staggeringly high, with 48% of women reconvicted within a year of leaving prison. That rises to 61% for sentences of under 12 months.

The Minister will know that women released from prison are more likely to reoffend, and reoffend earlier, than those serving community sentences. Women receiving short sentences often lose their accommodation, with many needing to be rehoused with children, as they are primary carers. As we know, such accommodation is very limited for local authorities and there are huge waiting lists.

If women are victims of domestic abuse, they cannot go back to the place where the abuse happened. There is already a chronic lack of suitable housing, including for women with complex needs. Many women imprisoned from previous addresses, to which they cannot return, lose that local connection and their ability to be rehoused.

I welcome the recent announcement from the Ministry of Justice of £70 million funding for a pilot scheme to house prison leavers in temporary accommodation for up to 12 weeks. That is in only five of the 12 probation regions. I understand that that is a pilot but I would very much welcome its extension much further. I am also concerned that the Government are spending £150 million to build 500 new prison cells for women. That clearly indicates that the problem will not be solved, that there will be more women going to prison. That addresses the symptom, not the cause.

We need to get to the heart of what will stop women offending. For me, that is support for women’s centres. We know that women’s centres are very effective in helping women who are vulnerable not to offend in the first place. A survey showed that for every £1 spent, £2.84 was saved in costs, if the money were invested in women’s centres.

When women leave prison they are given only the discharge grant of £46, which is clearly not enough. Having to survive the first week out of prison on less than £7 a day is not going to get anyone very far. We need to ensure support networks are there for women when they leave prison.

To conclude, we need to provide more accommodation for women leaving prison, increase the discharge grant and invest in women’s centres. I thank Women in Prison, Agenda and Safe Homes for Women Leaving Prison for the excellent work they do and for their briefings for today’s debate.

It is a genuine pleasure to see you and serve under your chairmanship, Sir Charles. I am also grateful to my hon. Friend the Member for Swansea East (Carolyn Harris) for calling this important debate and for her stonking speech. There have been excellent contributions today from Members on both sides of the House.

This Government’s female offender strategy set out some very clear principles, and we agree totally that we need to address vulnerability, acknowledge the role of gender, treat women as individuals with the potential to make a positive contribution, and break the cycle of reoffending. To do this, the strategy made it clear that

“Short custodial sentences do not deliver the best results for female offenders”.

It acknowledged the essential role of women’s centres and made it clear that when women leave prison, the support they receive has to respond to their complex needs. Again, we agree. However, it has been almost three years since the strategy was published and, as we have heard, as many as six out of 10 women leaving prison are being released into homelessness—60%. The strategy is simply not being successfully implemented.

We know that without a home, it is so much harder to find work. Reuniting with children and family is even more difficult. Meeting probation commitments and accessing healthcare and substance misuse treatment is that much harder. Not having a stable home damages mental health. It destroys life chances and lives. It kills hope. This Government have acknowledged that the likelihood of reoffending can be as much as 50% higher for those released into homelessness. Between 23 March and 31 August last year, during the height of the first lockdown, more than 3,500 prisoners, including 275 women, were released into homelessness. During those first terrifying months of covid, 65 women were sent out to sleep rough on our streets on their very first night out of prison. Some of the most vulnerable people in our society were effectively sent by the Government to sleep on the streets, when the rest of us had been told to stay home, to stay safe and to protect the NHS. It beggars belief.

We have got to acknowledge that outcomes for women leaving prison are frankly terrible. One reason is clearly the lack of accommodation, but another significant reason is the lack of continuity of care for those in need of drug or alcohol abuse treatment when they leave prison. Last year, the national average of continuity in care in England was just 35%. When drug-related deaths are at an all-time high and when a third of people in prison are there for reasons related to drug use, surely to heavens continuing treatment outside of prison must be a priority? I am told there is an ambitious Government target to go from this derisory 35% to 75%, but there are simply no details of how that will happen. I am hoping that the Minister will tell us today how and when that 75% target will be met.

It cannot be a surprise to anyone listening to this extremely well informed debate that reoffending is rife. Of women who have served a sentence of under a year, 73% will be convicted of another offence within a year. If we are to tackle reoffending and if we want fewer victims of crime, we have to tackle the root causes of that crime. The Government’s own research tells us that often women in prison are dealing with enormous trauma caused by sometimes years of abuse.

That is why my hon. Friend the Member for Swansea East was absolutely right to highlight the need for women’s centres. The evidence is clear that they slash reoffending, they cut crime and they help many women to heal and create better lives—and, unlike short prison sentences for women, they are great value for money. Some women’s centres have managed to demonstrate that they save £2.80 for the public purse for every £1 invested, so why are the Government planning to spend £150 million on women’s prison expansion when they have committed just £2 million to women’s centres? That is 75 times more to be spent on something they have admitted does not than on something that does. Why?

Let me touch on one aspect we have not yet discussed: the specific needs of black, Asian, Gypsy, Roma and Traveller women and all of those from other minority ethnic communities. We know, and the Government know, that projects led by women from a community are best suited to develop effective resettlement within that community. There are excellent examples like the Khidmat centres in Bradford, but there are not nearly enough of them across the country. Why?

As we recover from covid, it is even more important to have additional support in place for women leaving prison. It is good to see that the Government plan to take some action on homelessness among prison leavers, but, as we have heard, only five of the 12 probation regions—less than half—are likely to receive some funding for temporary accommodation pilots, even though the value-for-money case for better accommodation is overwhelming. Why? May I gently point out that London and the south-east are two of the areas where the problems of prison-leaver homelessness are greatest, yet neither is included as a pilot?

I have been doing this job for less than a year and I have already worked out that the Ministry of Justice is, frankly, addicted to pilots, but there is no follow-through. Time and again, projects are proven successful but they are simply not rolled out. The truth is that, when it comes to women prison leavers, we need ambition and commitment. We need to provide accommodation, and that accommodation needs to be fit for purpose. Women domestic abuse survivors may need to relocate away from their area. Homes often need to be able to accommodate women’s children. If those needs are not met, women do not get a second chance, their families do not get a chance, and reoffending becomes even more likely.

Despite all those facts, in their announcement on temporary accommodation the Government went out of their way to trumpet just how basic and temporary the planned accommodation for prison leavers will be. I ask the Minister gently: how will the new accommodation address the specific needs of women leaving prison and the needs of their families? How will it stop the very expensive revolving door? I have to ask: is the priority cutting reoffending and cutting crime, or is it about dog-whistle politics and cutting costs? If it is about cutting costs, the Minister should know that that is a false economy. His own research shows that. The lack of approved premises for women around the country has been a huge problem. How many of the 200 new places planned will be in specialist women’s hostels? When will they delivered? Where will they be located? Perhaps the Minister can inform us today of the progress of the approved premises for women in the south-west.

Another public relations announcement was that of a paltry £6 million for through-the-gate support for prison leavers. Only one of the 16 prisons receiving that funding will be a women’s prison: New Hall in West Yorkshire. Why?

Frankly, when women are put into prison but are not supported to deal with the trauma and violence that they have experienced in their lives, or with the addiction that has put them there, and when they are released knowing that their only option is to sleep on the street, and they are condemned to the revolving door of reoffending because support services for drugs and alcohol just are not there, that is an injustice. It is Government failure. Women are not being given a fair chance to change their lives, or their children’s lives, for the better.

The Government must demonstrate that they truly understand their own research. They need to demonstrate real commitment to and ambition for their own strategy. They need to begin to create a criminal justice system that truly understands the root causes of women’s offending, and that starts to treat women fairly.

It is a joy to appear under your moderating hand once again, Sir Charles. I am grateful to the hon. Member for Swansea East (Carolyn Harris) for this important debate in the aftermath of International Women’s Day. I ought to start by reassuring her and other hon. Members, and indeed my hon. Friend the Member for Thurrock (Jackie Doyle-Price), of my long-standing commitment to smart justice over tough justice.

Just over 10 years ago, I became devotee of Mark Kleiman, a remarkable academic in the United States, who sadly died a couple of years ago. He wrote a seminal book, which I would recommend to hon. Members if they can get hold of it, called “When Brute Force Fails”. It is an examination of the American criminal justice system, where many years of locking up more and more prisoners for longer and longer in the hope that it would do something about crime actually produced the reverse. It proposed a series of smarter, more innovative approaches towards criminal justice, which were, a decade or so ago, showing some potential.

I am pleased to say that one of those proposals—sobriety tagging for those for whom alcohol is driving their criminal behaviour—is now rolling out across the country. It has started in Wales, where just the other day we managed to tag our 100th offender with a sobriety tag rather than sending them for a custodial sentence. Compliance in that particular project is running in the high 90th percentile. It will be rolled out in England at end of this month. I hope that for all kinds of offenders—male, female or other nomenclatures—it is the kind of smart approach that will have benefits beyond the positive and negative of incarceration.

I will start by reaffirming what the hon. Member for Swansea East referred to as our ambition and commitment to fully delivering the female offenders strategy, which was published, as she said, back in June 2018. I am pleased that she expressed real hope about that strategy. As she said, it has three main aims: fewer women coming into the criminal justice system and reoffending, fewer women serving short custodial sentences, with a greater proportion managed successfully in the community, and better conditions in custody to enable rehabilitation and improved outcomes.

The strategy clearly articulates why we need a different approach for female offenders. They make up less than 5% of the prison population, but are among the most vulnerable in society in terms of both the prevalence and the complexity of their needs. Many live chaotic lives, as the hon. Member for Strangford (Jim Shannon) pointed out, and have experience of abuse, as well as of mental health issues, substance misuse, accommodation needs, and debt and finance problems. Female prisoners are more likely than male prisoners to have been taken into care and to have witnessed violence in the home as a child. More than 60% of female prisoners reported having experienced domestic abuse, as the hon. Gentleman mentioned, compared with 7% of male prisoners. Outcomes for women in custody are worse than for men, including high levels of self-harm.

Women are also more likely than men to be living with dependent children before imprisonment, and the consequent impact on families is therefore greater, increasing the risk of intergenerational offending. Each of the strategy’s aims is equally important, and each one is equally relevant to the subject of the present debate on support for women leaving prison. Clearly there will be fewer women leaving prison and requiring support if we can successfully reduce the number of women entering the criminal justice system and reoffending. Equally, if more women are managed effectively in the community, there will be fewer serving short prison sentences. For those women who must be sentenced to prison because of the severity of their crimes and to protect the public, providing better conditions in custody improves the chances of effective rehabilitation.

A number of Members mentioned the Government plans to build 500 more prison places in women’s prisons. Many Members argue that this proves the Government have abandoned their female offenders strategy, particularly the aims of having fewer women in custody serving shorter sentences, and more being managed successfully in the community, but I hope that my comments thus far make clear that that is not the case. However, the impact of the extra 20,000 police officers, with the likely increase in charge volumes, cannot be ignored and doing nothing is not an option. The long-term prison population is expected to increase over the six-year project horizon.

While custody should remain the last resort for most women, in line with the female offenders strategy in meeting projected demand, the expansion of the women’s estate will provide better conditions for those who do require custody. Our design principles include requirements around being trauma-informed and gender-specific, ensuring suitable visiting spaces are provided, greater in-cell communications options informed by the covid learning, and in open design the potential inclusion of rooms to support overnight visits for mothers and their children, currently available in only two women’s prisons. If we succeed in reducing demand for prison places, we will be able to close older, less suitable accommodation. Having reaffirmed the Government’s commitment to fully delivering the female offenders strategy, I would like to highlight our activity in two specific areas of support raised by Members this afternoon specifically for women leaving prison: accommodation and employment.

Offenders face significant barriers to securing suitable accommodation, often linked to their lack of access to the necessary funds, availability of local authority housing supply and affordability of or access to the private rented sector. A £70 million investment programme was announced in January to provide stable accommodation to these prison leavers. The investment will bring together the work on approved premises and the Bail Accommodation and Support Service with a new tier of provision for prison leavers at risk of homelessness.

To reduce reoffending and provide health and wellbeing support, we are launching a new accommodation service providing up to 12 weeks of basic temporary accommodation for prison leavers who would otherwise be homeless. This will launch in five of the 12 probation regions in England and Wales, and all individuals aged 18 and over released from prison and at risk of homelessness will be eligible, as will those moving on from approved premises who are also at the same risk. It is anticipated that the new intervention will begin in summer 2021 and provide support for approximately 3,000 service users, who will be subject to supervision by probation and have ongoing support from their community offender manager.

As part of its response to the covid-19 pandemic, the Ministry of Justice secured £11.5 million to support individuals at risk of homelessness on their release from prison and help them to move on to permanent accommodation. The scheme initially ran between 18 May and the end of August and provided up to 56 nights’ accommodation per individual, meaning some prison leavers were accommodated until 26 October. We reinstated the scheme on 22 October to run up to 31 March, meaning individuals may receive accommodation support up to 26 May this year.

While the scheme is an immediate response to support prison leavers at risk of homelessness, the Ministry of Justice is keen to utilise the learning gathered from the scheme to help develop longer term improvements. We have started to draw together learning with the intention of publishing a report in the autumn. To support the oversight of its covid-19 response, Her Majesty’s Prison and Probation Service set up seven homelessness prevention taskforces to help find accommodation for offenders upon release. These teams have been very successful in securing improved accommodation outcomes and building new local partnerships with local authorities and housing partners. The service is considering how they might be a feature of the future landscape.

On employment, Her Majesty’s Prison and Probation Service’s New Futures Network has a dedicated employment broker focused on partnering employers with prisons across the women’s estate. These partnerships result in work opportunities for serving prisoners that provide training skills, qualification and employment on release. Opportunities are available across a variety of industry sectors.

More recently, to mark International Women’s Day, Sodexo announced the launch of its SheWorks skills-building programme in three prisons. With the support of the New Futures Network, this will be extended to further prisons over the course of the year. Sodexo aims to fill 5% of its job vacancies with prison leavers and those with an offending background by 2023.

Additionally, from the end of April this year, the Clink charity’s kitchen training programme will be expanded to women’s prisons at Eastwood Park, Send and Downview, as part of a broader roll-out of the programme. The training scheme provides the opportunity to transform job prospects by delivering industry-recognised qualifications, training and work experience.

The Minister is setting out clearly some of the good things that can be done. Within those, in my contribution I mentioned social skills. It is important that people can leave prison and interact with people in a way that they can understand and feel the confidence that they need. Is this one of the measures that the Minister will introduce for those who are leaving prison?

The hon. Gentleman is absolutely right. In discussions in the Ministry of Justice I have made it clear that my view, which I think is shared broadly by Ministers in the Department, is that there are three foundations for success in life post-prison. They are a job, a house and a friend—effectively, someone to hold your hand. If someone leaving prison has those three pillars in their life, they are much more likely to succeed on the outside. Too often, people have one, or possibly two, but certainly not all three. In the role that I am trying to put in place around integrated offender management—the reboot of that effort—that is what we are going to try to achieve.

The New Futures Network continues to support businesses that are part of the employers’ forum for reducing reoffending, to deliver new, tailored employment for women. Initiatives to be trialled include mentoring and thematic virtual sessions covering the development of soft skills, as the hon. Gentleman said. These will be offered to women serving the last few months of their sentence. The framework of support will be tested in three prisons.

Given the ambition of the hon. Member for Swansea East for the Government to go further, she will be pleased to know that as part of the January announcement to tackle and reduce reoffending, we are seeking to introduce and test new approaches and roles across education, employment, accommodation and substance misuse. HMP New Hall, which was mentioned, has been selected to ensure the specific needs of women are captured, so that learning can be shared across the female estate more broadly.

To conclude, I hope I have removed any doubts about the Government’s ongoing commitment to deliver fully the female offender strategy and that, in the time available, I have been able to provide clear examples of how we are working to properly support women leaving prison. As far as the extra 500 places are concerned, I hope that the hon. Lady and others will understand that, while we have to plan for the worst, and the impact of 20,000 police officers on the prison estate cannot be ignored, we will work very hard between then and now for a much better outcome than an increase in the prison population.

I thank all Members for their contributions—I am pleased to see so many people here. I came to this debate feeling really apprehensive about the subject—it is something I have sleepless nights about. I am leaving terrified at the prospect of 20,000 extra police on the streets spending a large proportion of their time filling 500 spaces for women in prisons in order to justify the money that the Government have spent on this. That is certainly not what we need to be doing. We need to provide a different service for women. We need to recognise the fact that women have specific needs. They are in large part victims, despite the fact that they have been labelled as criminals. Most of them are victims of society and, I am afraid to say, victims of this Government’s disinterest in providing anything for them.

We have to stop perpetuating the cycle of criminality and incarceration, criminality and incarceration. We have a moral duty to provide sustainable, productive, appropriate and holistic support and to encourage these women to be productive and to re-engage with society. That is a far better way of using taxpayers’ money than freeing up spaces in prisons. We have to be more humane in the way that we provide for these vulnerable and all too often exploited individuals. That is where we need to concentrate our efforts, not on putting them in prisons. I ask the Minister to please rethink the strategy. Too many women will lose their life, dignity, children, families and homes. We cannot perpetuate this any longer.

Question put and agreed to.


That this House has considered support for women leaving prison.

Sitting suspended.

Teignmouth Hospital

I beg to move,

That this House has considered the future of Teignmouth Hospital.

It is a great pleasure to serve under your chairmanship, Sir Charles. This is the story of a hospital being closed by stealth. Teignmouth Hospital, which is in my constituency, was built in 1954. It was one of the first purpose-built NHS hospitals and offered a wide range of services. Even today, it has three community clinics, in audiology, physiotherapy and podiatry, which have largely been funded by the League of Friends. In addition, there are out-patient clinics dealing with abdominal aortic screening, anaesthetics, breast, cardiology, chronic fatigue—there are 23 of them in total, so I will not labour through all of them, in the interests of time and to allow a proper discussion of this issue. The hospital also has an operating theatre, which takes day cases relating to eye complaints and skin issues.

However, all of this was put into a quandary in 2014, when the local clinical commissioning group decided to look again at how health and care should be properly provided in Teignmouth and Dawlish. That is absolutely the right thing to do. However, my issue is with how it has been done, and with the evidence that has been collected and the way it has been evaluated.

The consultations took the following steps. First of all, they looked at removing two of the in-patient wards within Teignmouth Hospital. So, at a stroke in 2016 and after two consultations—one in 2014-15 and one in 2016—a decision was made to remove two whole wards. As anyone can imagine, the local community were not at all happy and the only thing that helped was the promise of 12 new rehabilitation beds to help in the community. That would have been very appropriate in a rural community with an ageing population, which mine is, and with a state-of-the-art physiotherapy unit paid for, as I have said, by the League of Friends. However, what was even worse was that those rehabilitation beds were never delivered. A unilateral decision was then taken in 2017 that there would be no rehabilitation beds. No evidence was produced and no consultation took place.

Then, in 2018 a further consultation looked at a reconfiguration of services. The creation of a new health hub, which was the core proposal, was and remains absolutely the right thing to do, and is in accordance with the NHS Long Term Plan. It would house the GPs in Teignmouth and an integrated care hub, with individuals from the voluntary sector, and the three community clinics. However, the out-patient clinics—all 23 of them—were to be relocated to another hospital in Dawlish. It is not that far away, but given our transport problems it is quite far enough away to be problematic for an ageing population.

The consequence suggested—but with no questions asked—because of the hub and the relocation of services to Dawlish, was that Teignmouth Hospital would necessarily close. There was no consultation. It seems to me that although there has been a consultation on reconfiguration, there has been no consultation on a hospital closure. It is my understanding that legally—never mind to ensure best care—such a consultation should take place.

I and a number of colleagues were very disquieted by all this. Indeed, the health scrutiny committee at Devon County Council was sufficiently concerned about the lack of evidence and the failure to consult that it went to the reconfiguration panel to take informal advice as to what it should do. It is only the health scrutiny committee, under current legislative provisions, that can, in effect, call in such a decision. It is my belief that, had it done that formally, the reconfiguration panel would have had to take a much more serious approach. Instead, its response to the request for advice was, frankly, a bit of a pat on the head: “Go and talk to the clinical commissioning group; I’m sure you can resolve your differences,” or words to that effect. I do not really think that is a responsible reply to a very urgent and well meant request for assistance, and my view would be, in the light of that response, that the county council, through its scrutiny committee, should now make a formal application.

The issue is that Teignmouth Hospital is to close, without any consultation at all. Why does that matter? It matters because there has been no assessment of the health and care outcomes for residents of Teignmouth. Without such a consultation, how can we be clear that health and care needs are being properly met? Worse, the consultation takes no account of what is happening in the landscape of social care. In Teignmouth there are no nursing care homes, so there is no fall-back; there are no other beds in the community that can be used.

Why are the health scrutiny committee and I so exercised about the flaws in the reconfiguration, which mean that closing Teignmouth Hospital without consultation is a real mistake? First, the decision is based on an assumption that all intermediary care can be undertaken at home, with the balance in nursing care homes. I contend that it is simply unrealistic to consider that all intermediate care can be undertaken in an individual’s home. There are lots of reasons for that. First, we do not have any nursing care homes in Teignmouth. Secondly, even if we did, rehabilitation is not what nursing homes are all about. Thirdly, some of these elderly people have to have help come to them from some distance, which makes it a challenge. We also have an acute lack of domiciliary care provision. That puts a very big question mark over the key assumption that underpins all the decision making.

The evidence that was presented is inadequate in quality and in quantity. There was a lot of data; I am drowning in data, but I have very little genuine information and very little genuine analysis. On that basis, I am very unhappy with what I have seen. It is fundamentally desk-based research by the clinical senate and the University of Plymouth—two outstanding institutions. However, the information that they have used is simply records of beds and their use, whether in a hospital setting or otherwise. It looks at discharge and delayed discharge, but because there are no beds at the moment in Teignmouth Hospital, there is nowhere for people to go other than home, or a care home outside Teignmouth, so is it surprising that we find an argument being made that those beds that were in Teignmouth Hospital are not needed? It seems to me that a negative cannot prove a positive.

Of more concern is the fact that there is no research whatever on the patient experience. Given the lack of domiciliary care provision, that is a crucial omission. People should bear it in mind that, at this point in time, the hospital’s beds have been closed for two years. Why has no evidence been gleaned as to the quality and quantity of the care provided to people in their homes? That seems to me a glaring error, which must be resolved.

It also seems to me that the evidence is definitely defective. It takes no account of this new, post-covid world. I accept that the consultation started before covid, but it has lasted through covid, and for me that has made one thing clear: the old system we had, which was very much just in time, is no longer the way forward. We must have a resilient care system. That means taking into account the impact of covid. We know long covid is following covid. We know that that specifically requires a lot of rehabilitation care. I raised that with the clinical commissioning group, who believed it was inappropriate to take account of the figures for 2020-21 because those covid figures were unrepresentative. I find that strange, because, if those are unrepresentative of the real need, surely the figures for 2019 are equally not representative. That causes me real concern.

I will turn to the proposal in relation to the other services, not beds in Teignmouth Hospital. That care is to continue to be provided in Dawlish Hospital. Dawlish is, effectively, to take double the number of referrals—23 out-patient clinic patients on top of its existing load of patients. The “building works”, which I would not really call building works, will simply reconfigure the maternity room into two consulting rooms. It is a bit like moving the deckchairs on the Titanic. There is no evidence of any real effort to ensure that Dawlish is properly configured to meet what will be an increasing demand.

As for the hub itself, there is no evidence that it will have the capacity to take all the GPs, all the community service clinics, the integrated care hub and the voluntary sector representatives. Yes, planning permission has been put in for and, indeed, granted. It is clear how the rooms will be configured in the new hub, but not how they will be used, and until they are used we simply do not have evidence that they will be sufficient for the need.

What is the way forward? It seems to me—because we have two years during which the hub is to be built—that the first priority is to collect the missing data. Let us collect the data for 2020-21, and look properly at bed occupancy and why it is as it is. Let us look at discharge, readmissions and waiting lists. Let us look particularly at the impact that long covid will have in that period on rehabilitation care and growing need. Let us also undertake some research on the quality and quantity of home-based care. There is no evidence about either of those in anything that has been presented by the clinical commissioning group. Worse, there is nothing on the patient experience at all. When all the data has been gathered, let us have a separate consultation on Teignmouth Hospital—not only after the data has been gathered but after the hub has been opened and we can see whether it is adequate, and Dawlish has taken on its additional work.

To be clear about the impact of the reconfiguration on Teignmouth residents, all those things must be taken into account. That is right and responsible. If we get the decision wrong, we could well find that we are closing a facility only to spend money on reopening something else to meet the rehabilitation need that is not met. That is lose-lose. I would be the first to agree that it is an ageing hospital, but it could be improved—not to become state of the art, and I am not looking for that; but it would cost just over £600,000 to get it to a position where it could continue to provide the services that are needed.

My ask of the Minister and the Secretary of State is, first, to intervene to stop this automatic closure of Teignmouth Hospital, as the Secretary of State did to stop the closure of Chorley hospital accident and emergency department in Lancashire. I quote regional director Bill McCarthy:

“We have received instruction from both the secretary of state for health and the minister of state for health, to work with the integrated care system and local leadership to develop an option that provides safe, high quality care, that continues to include Chorley”

emergency department. That was reported in “North by Northwest” in February this year, not many weeks ago.

I do not have an opinion as to whether that was the right decision, but the Secretary of State said expressly in the very recent latest White Paper—which will lead to an NHS Bill—that he intends to enable power to be given to him to call in decisions such as the Teignmouth one and to remove the reconfiguration panel. From the experience I have had, that panel is not fit for purpose.

My second ask is that the Secretary of State and the Minister instruct the reconfiguration panel that no closure of any hospital or facility should be made going forward without the impacts of covid having been taken into account and a proper impact assessment having been made.

My third ask is for the Secretary of State and the Minister to instruct the clinical commissioning group to put in hand a separate consultation specifically on the closure of Teignmouth Hospital, after the data I referred to have been collected, and to mandate the CCG to collect the necessary evidence on patient experience, on the impact of Dawlish Hospital and on the adequacy of the new hub at Teignmouth. The group should then review the data collected and analyse it properly.

Teignmouth Hospital deserves better and the people of Teignmouth deserve the Secretary of State’s support. I ask the Minister in his place to grant that support and to do what he and the Secretary of State are more than capable of doing, so setting an example of how important health and care are to him and to us. That would set a marker that covid has changed the game and that covid, and long covid in particular, must influence and guide future decisions on hospital closures. I thank you for your indulgence, Sir Charles, and I look forward to the Minister’s response.

It is a pleasure to serve under your chairmanship, Sir Charles, in a sense for the second time. In my first Committee post in the House, when I was first elected, I served under your chairmanship on the Procedure Committee.

I congratulate my hon. Friend the Member for Newton Abbot (Anne Marie Morris) on securing this debate on such an important subject, and one that I know she has taken a close and long-standing interest in on behalf of her constituents, for whom she is a very strong local voice. From the outset, I pay tribute—I suspect with her—to the amazing work during the pandemic that has been done by not only all those working in our NHS but those in her local trust and hospital. I hope I might prevail on her to pass on my thanks to her local team.

As my hon. Friend set out, Teignmouth Community Hospital is part of Torbay and South Devon NHS Foundation Trust and provides health and care services to patients across Teignmouth and Dawlish. She set out their work very clearly in her speech, alongside a very helpful exposition of the broader health and social care context in the area in which she serves as the Member of Parliament. She recognised it, quite rightly—I hear her plea—as a whole system, and the broader picture, rather than as individual siloed parts of a health system. In the past, she and I have had the pleasure of discussing what she cares deeply about, which is the future evolution of health and social care as a coherent single model. I hope that it will not be too long before we can have those conversations in person again in this place.

As part of its work on ensuring that services across Devon are, as the CCG sees it, fit for the future and fully address the aspirations of the NHS long-term plan, the CCG, as my hon. Friend says, has been reviewing how services are provided and how to best integrate services in order to make improvements for the most vulnerable people in the communities that it serves. Considerable progress has been made in this area, for which I highlight the work of the CCG.

However, the ongoing review process has highlighted that three main cases for change remain, in the view of the CCG: that the joined-up community care now provided means that, in the CCG’s view, the 12 rehabilitation beds previously promised for Teignmouth community hospital are no longer needed, and my hon. Friend made very clear her views on that on behalf of her constituents; that there is a pressing need to safeguard the future of primary care across the entirety of the area she represents; and that both the national local strategies to integrate care further make the best use of the NHS estate.

The CCG’s reviews of the need for rehabilitation beds at Teignmouth hospital led it to believe that the health and wellbeing team was successfully meeting the needs of local patients without them, but my hon. Friend set out clearly her concerns about that conclusion and the reasons why she has those concerns. I will mention at this point an important contextual point. While hopefully many things we have seen in the past year relating to covid will become things of the past soon, it is highly likely that covid has changed the nature of how we look at the provision of healthcare, and that there are lessons to learn there for the long term and for the future. I think I heard her clearly saying that we should not lose that by virtue of something that was begun before covid not being able to scoop up and learn those lessons for the future—i.e. future-proofing the services that her constituents rely on. I am sure that the CCG will have heard her message loud and clear on that particular point.

My hon. Friend talked about the consultation and the decision-making process in some detail. Clearly, as I gather from that and from a letter she has recently written to the Secretary of State, which I will turn to in a moment when I conclude, she has undertaken a lot of work in looking at these consultation processes, the history of them, the genesis of them and how over time they have changed what they have been looking at.

As my hon. Friend said, the CCG undertook a formal consultation from 1 September to 26 October 2020—I caveat that with the point that my hon. Friend and I made earlier, which is that that was mid covid and not after the covid pandemic—which proposed to move high-use community clinics from Teignmouth community hospital to a health and wellbeing centre in Teignmouth; to move specialist outpatient clinics from Teignmouth community hospital to Dawlish community hospital, four miles away; to move day-case procedures from Teignmouth community hospital to Dawlish community hospital, which she picked up on clearly in her speech at the opening of the debate; to continue with that model of community-based intermediate care; and to reverse the decision to establish 12 rehabilitation beds at Teignmouth community hospital, as advocated by the CCG and, it asserts, as supported by previous public engagement in 2018 on the success of the service provision without the beds.

I understand that NHS England’s position is that the consultation in 2020 set out that a likely consequence of the reconfiguration was that the requirement for those beds in Teignmouth would no longer be there for the local NHS. However, I hear what my hon. Friend says; she highlighted that, in her view and that of her constituents, that is worthy of a more discrete and focused consultation.

The consultation was overseen by the independent Healthwatch for Devon, Plymouth and Torbay, which analysed the just over 1,000 responses received, finding that 61.3% of respondents were in favour of the overall proposals. The equality impact assessment undertaken indicated that, overall, the impact on people using the services affected by this proposal was deemed by them to be of benefit, while the EIA indicated that, overall, the impact on people using the services affected by this proposal was neutral or of benefit.

Following a review of both consultation feedback and the quality and equality impact assessments, the steering group approved the consultation and agreed to make a recommendation to the CCG governing body that all four elements of the consultation proposal be approved. The Teignmouth steering group approved the consultation and the local NHS plans to continue to review the proposed model of care in light of potential changes in levels of need within the local area, as well as—they have related to my office—the impact of covid-19 on ways of working. I will turn to that in a minute, as well as an offer that I will make to my hon. Friend when I conclude.

I am aware that, as she has said, local councillors recently wrote to the independent reconfiguration panel to seek informal advice on this reconfiguration, and have been advised to continue to work co-operatively with the CCG to find a local resolution. My understanding is that the IRP is constrained in what it can or cannot do and how it can engage where it is not a formal referral, but I understand from what my hon. Friend said that that remains a possibility, so I will be a little cautious about prejudging whether that may or may not happen. She asked a number of specific questions—for example, about Chorley, and then her asks at the end of her speech. What I would say about Chorley is that we do not have the power to instruct in the context of reconfiguration at this point, hence the legislative proposals that she talked about. We requested that they look at this, which they accepted, but I add the slight caveat that, as I understand it, we do not have the legal power to instruct the local CCG to do x or y at this point in the reconfiguration.

However, what I can offer to her within that legal constraint, which may be of help to her, is that first, of course, I will endeavour to reply to her letter swiftly, with responses to the detailed points she has raised in it. Secondly, although the legal powers available to me in the name of the Secretary of State are limited until and unless an IRP referral is received and the advice is then given, I am always delighted to meet with my hon. Friend if she feels that would be helpful. It may be helpful to her if I arrange to meet with her outwith this debate, to discuss with her in more detail some of the process points and legal constraints, but also to listen in more detail than she is perhaps able to set out in a debate of this sort. I would expect her CCG to have heard her voice in the House today loud and clear, as I suspect it does in her capacity as the local Member of Parliament on the ground in Newton Abbot.

It is right that all reconfiguration decisions are taken in the best interests of patients and the local population following the due process, and it is that due process that slightly constrains what I can say or do in this context. However, the Government are committed to ensuring that the appropriate resources are available to the NHS in Devon to support patients, and to continue to provide the people of Devon and of her constituency with the best possible care, so the people affected by these changes need to be involved in making the key decisions—including my hon. Friend, of course, as their elected voice. I would hope and expect that the CCG will set out a clear plan to engage proactively with her and with the local population, and would encourage all of her constituents to be involved in that process.

I will reiterate two things on the record. First, I will of course reply to my hon. Friend’s letter. Secondly, I repeat my offer to meet with her separately to discuss in more detail what is and is not possible within the legal constraints around the reconfiguration process, and also to learn more about Teignmouth Hospital. I hope that in more normal times, when such things are possible, I might be able to come down and see my hon. Friend in sunny Devon, to visit that hospital with her.

Question put and agreed to.

Sitting suspended.

Cyber-troop Activity: UK

I beg to move,

That this House has considered cyber troop activity in the UK.

It is a pleasure to serve under your chairmanship, Sir Charles. I secured this debate because I feel that we cannot go into another round of elections in May with our heads in the sand about a very real threat to our democracy: industrialised disinformation by state and political actors. Across political divides we must stand against the forces that seek to smear, manipulate, speak untruths and undermine the legitimacy of Governments or political opponents, through underhand and under-regulated techniques.

Politics, by its nature, will always host opposing and differing views, and that is absolutely right, as is the opportunity to debate the points around these views, but it is incumbent on all of us to ensure that the public can have confidence in the information that they see presented from politicians and those who report on political events. The old adage that a lie can get halfway around the world before the truth gets its boots on certainly applies here, but at a whole new industrialised level, with mass distribution only ever a mouse click away.

Social media has been both a blessing and a curse. It is, in theory, a great leveller, providing an open platform for the discussion of ideas and helping the disadvantaged to organise groups to get their voices heard. It opens up publishing to citizen journalists, speaking without gatekeepers. However, in many ways, instead of widening the debate, it has become increasingly polarised and dominated by echo chambers, with information provision ruled by mysterious algorithms. The lack of editorial content control has created a nightmare for fact checking and fairness, and increasing numbers of nefarious actors have learned how to manipulate the system, fuel conspiracy theories and sow division. The waters have become murky and it is a pool in which many people no longer want to swim.

It cannot be dismissed simply as modern-day political spin. The new technologies create far more poisonous possibilities for the most Machiavellian practitioners of the dark arts, and there is plenty of evidence that they are taking advantage of these new superpowers. Those who want to see standards and integrity in public life maintained cannot simply stand by and ignore it.

Millions are being spent on orchestrated disinformation in what the Electoral Reform Society described as the unregulated “wild west” of online political campaigning. Organised cyber-troop operations use an increasingly sophisticated armoury to alter the nature and course of legitimate political debate, to smear and discredit opponents, to interfere in foreign affairs and generally to create distrust in the very processes on which democracy relies. Facts get confused, opposing points of view are tainted and people are turned off by an onslaught of hate, misleading propaganda and deliberately divisive content.

Techniques used by these cyber-troops include armies of trolls or political bots amplifying particular opinions or hate speech, harassment, doxxing, smearing, doctoring images and videos, mass reporting of content and illegally harvesting data to micro-target with misleading information. They do it because it works.

Fergus Bell, the co-founder of London-based media consultancy Fathm, has worked on many elections and believes that false information shared online has been “very successful” at swaying voters. It does not have to be direct in its influence but, as he says,

“if you cause division between people, or if you can change someone’s mind on one tiny thing that might make them vote differently, you can push an election”.

The cyber-troops have precise, data-driven strategies to home in on the soft spots, and they know exactly where those are.

People who are targeted by these tactics may be disenfranchised by the processes, become disillusioned with everyone involved in politics and no longer bother to participate in democracy. In some cases, this appears to be the purpose of cyber-troop activities, as Channel 4 reported in the US elections, where they found evidence of micro-targeting by the Trump campaign to deter 3.5 million black Americans from voting at all. That type of voter suppression should alarm us all.

The rapid rise of disinformation industries is evidenced in the Oxford Internet Institute’s report, “Industrialized Disinformation: 2020 Global Inventory of Organized Social Media Manipulation”. It is quite a wake-up call for those who think that these things could not happen or do not happen here. The report found that 81 countries are now using social media to spread computational propaganda and disinformation about politics, including the UK, which is a jump from 70 countries in the previous year.

The report found evidence of Chinese, Russian and Iranian-backed disinformation campaigns about covid-19 to amplify anti-democratic narratives and undermine trust in health officials. Microsoft has also warned that hackers operating out of Russia, China and Iran were targeting the staff and associates of both Donald Trump and Joe Biden ahead of the US election last year. In Argentina, a “deepfake” video was used to manipulate the Minister of Security to make her appear drunk.

As for China, a 2017 Harvard paper estimated that the Chinese Government employ 2 million people to write 448 million social media posts a year. The primary purpose of this activity is to keep online discussions away from sensitive political topics. Closer to home, the long-delayed Russia report from the Intelligence and Security Committee confirmed that there was “credible open source commentary” suggesting that Russia tried to influence the Scottish independence referendum and subsequent elections. Yet astonishingly it seems that the Government have not yet sought to find evidence of interference in the EU referendum and instead took an ostrich-like approach to defending our democratic process. At the very least, I would hope that the Government could be looking to implement the recommendations of the ISC report.

It is not just foreign interference that is at stake here; the UK has to get its own house in order. There are questions about data-driven profiling and Facebook advertising by political actors in the UK. In the 2019 general election, 90% of the Conservative party’s Facebook advertisements in early December were labelled as misleading by Full Fact. The real danger of this kind of misleading content is that cyber-troop tactics can then be used to amplify it to the extent that, by the time it is rebutted, it has already reached thousands of feeds. The Conservatives even tried to rebrand their Twitter output during a debate as coming from “factcheckUK”, changed its logo to hide its political origins and pushed pro-Conservative material in a way that deliberately confused it with independent fact-checking sites.

Another question is why Topham Guerin, one of the communications companies behind the 2019 campaign, was awarded a £3 million covid-19 contract by the Government. It is yet more evidence of the need for my Ministerial Interests (Emergency Powers) Bill, which aims to hold the Government to account, to be supported in all quarters of the House—but that matter is for another day.

Although it is not always clear who is behind these actions, there is always clear evidence of bots being used to swell numbers artificially and drive political positions. A study by the Institute for Strategic Dialogue identified that almost all of the 10 most active accounts on Twitter discussing the Brexit party appeared to be automated bots, while prior to the 2019 general election a report found that a third of the Prime Minister’s own Twitter followers were bots.

Tackling this issue is not about silencing voices; it is about getting back some semblance of a level playing field, recognising the range of genuine voices and turning down the noise from the fakes. The UK is one of 48 countries identified in the Oxford report where cyber-troop manipulation campaigns are being run by private firms on behalf of Government or political actors. The report found that almost $60 million had been spent on hiring these firms since 2009, but I suspect that this figure is only the tip of the iceberg. There needs to be greater transparency and a tightening of the links between the public sector and private contractors.

Cyber-troops sometimes work in conjunction with civil society organisations, internet subcultures, youth groups and fringe movements; groups who may be motivated by genuinely held beliefs but whose causes may ultimately be damaged by those who strategically spread disinformation or computational propaganda. Take, for example, Turning Point, a right-wing youth pressure group. A US Senate report found that its social media activity was regularly co-opted and reposted by the Internet Research Agency, which is known in Russian slang as the “trolls from Olgino”.

The use of third-party campaigning organisations can also be a way to rig the system—to channel illegal levels of funds and campaigns, or at the very least to exploit gaps in our outdated electoral laws in order to press political agendas. Many questions have rightly been asked about the official Vote Leave campaign’s techniques, their links to other groups, the “dark money” spent and their micro-targeting techniques, used in breach of privacy laws.

As the Vote Leave campaign demonstrated, tougher rules are needed in the conduct of future referenda, as well as elections. The Scottish Government introduced the Referendums (Scotland) Act 2020 to better regulate the conduct of any future referendum, where they have the power to do so, including on campaign spending and donations. I would like to see further action to tighten the rules in this place too.

Fighting cyber-troops is complex and has to be tackled on several fronts, with governments, civil society, academia and technology businesses all having a role to play. The social media giants must certainly be better regulated and take greater responsibility for what is published. I therefore welcome the moves to improve regulation through the online safety Bill.

However, the misinformation and disinformation being propagated by cyber-troops is clearly an ongoing and growing aspect of online harms, so it is disappointing that this aspect has not been robustly tackled through these proposals. There are half-hearted plans from the Government for digital imprints, which is a move in the right direction, towards greater transparency, but it does not go far enough or fast enough. The get-out clause, which is that the imprint can be located in an

“accessible alternative location linked to the material”,

is not good enough.

Online political advertising remains largely unregulated, and there is nothing from the Government so far that shows a determination to better regulate against indecent and dishonest material, dark ads or data targeting. At the very least, we need to see who is using citizens’ data and why, as well as why people see particular ads. I believe that, on this front, the European regulatory plans go further than those of the UK.

I am aware of the challenges with regulating and fact-checking political content, but it is not impossible to overcome these, and it is essential that this is looked at urgently. It is no longer enough simply to rely on a sense of fair play and “a fair crack of the whip for all sides” to manage the truth amidst the overwhelming barrage of information being dumped upon us. There is no chance for rebuttals from opponents when so much content can spread so widely and maliciously, without any clarity or transparency on the sources.

It is not enough to treat the threat of cyber-troops as solely an electoral phenomenon. The Government’s counter-disinformation unit is usually only operational during periods of heightened vulnerability, when we know that cyber-troops are working to sow division and discord every minute of every day.

Much needs to be done to reform the rules, strengthen democracy and restore faith in our democratic processes, yet there has been disappointingly slow progress so far. Many organisations, such as Reset and the Fair Vote Project, are working on this alongside the all- party parliamentary groups on electoral campaigning transparency and digital regulation and responsibility. They are doing the research and taking forward proposals on a cross-party basis, so a lot of the heavy lifting has already been done on the Government’s behalf.

However, the Government have given no indication that they collect data on cyber-troop activity, despite the important role that they should be playing in analysing and assessing this threat. When I have raised questions about cyber-troops, I have been advised, in response, that the Government’s fine-sounding “defending democracy programme” is tackling this. However, from what I have found so far, it does not seem to be doing very much. Perhaps the Minister can point me to something other than that when she responds today.

We need to stop kicking this into the long grass. There is plenty of evidence of the threats from both within and outwith the UK. I have previously called for a debate, in Government time, on the need for electoral reforms to protect free and fair elections. However, if I cannot have that, we need to have it moving forward on another basis.

This is not a party political issue; it is about integrity in public life. Political differences are healthy, as is debate, but the tactics of division and disinformation from cyber-troops are a cancer on all political discourse, and it is spreading too fast to ignore. We all have a moral imperative to take action, and I call on this Government to do so.

I thank the hon. Member for Midlothian (Owen Thompson) for setting the scene so well. He knows that we do not agree on everything—far from it—but there are many things that we do agree on, and I echo his concerns. This is not about hearing a point of view that we may disagree with; it is about whether something is right; whether it is true.

I was looking through The Times today, and one of the stories refers to fake news and also a fake review, where facts are disputed and questioned. Fake news, as the hon. Gentleman referred to, can suddenly become the perceived truth when quite clearly it is not. I remember many years ago, when I was a young boy, some people at school telling me that if you tell a lie often enough, people will believe it. Whether that is true or not, I suspect that sometimes it is true. People tell a story or a so-called fact over and over, and suddenly somebody will say it is true. That worries me greatly.

The hon. Member for Midlothian referred to voter suppression, and he mentioned the United States of America as an example. What happens in America very often ends up happening here—it is said that when America sneezes, we catch a cold. If that is right, then we need to be really on top of what is happening. The hon. Gentleman referred to three countries, but I will refer to four. Other countries that are very much involved in voter suppression, fake news and telling the truth in a way that suits their political ambitions are Russia, China, Iran and North Korea. In the press a few months ago they were talking about the ability that North Korea now has to do this as well.

I think the Government really need to be on top of this and know what has been put out as wrong and untruthful, and respond to it in a really positive fashion. I have done the armed forces parliamentary scheme over the years. The last time we did it was with the Royal Air Force and the first couple of times was with the Army. Last time, even with those few years of difference between when I did it way back in 2012 and 2013 and again in 2018, I could see how the role of the Ministry of Defence and the RAF was changing, even compared with just four or five years ago. I just wanted to highlight that. I very much look forward to the Minister’s response—I say that nicely, but she knows I mean it—which I hope will give us the important reassurance that we seek.

I do not want to say much more but I will refer to a couple more things if I may. Misinformation can be a danger. A comment deliberately taken out of context can and has caused irreparable harm. The good book—the Bible—says that the word is mightier than the sword. It certainly is. It can hurt more. Surgically, the sword can bleed you, but words spoken out of tune, out of place and hurtfully can strike deeper to the heart than anything else. I am always very aware of that as well.

I support the notion of combating this at Governmental level, which is why I look to the Minister for a positive and helpful response. However—I know the hon. Member for Midlothian will understand my point—neither can we be in the position of becoming the guardian of speech. Sir Charles, you are one of those who believes in free speech, and I believe that we must remain free; we must possess the ability to have opposing views, and a way that we can agree to differ and still be friends at the end of it. That is always what I look to do in the comments that I make. We must possess the ability to have opposing views and state them in a non-threatening factual way, with the truth very much in place.

I watched the polarisation that took place in the United States over the last election, and in this nation in reference to Brexit. I am a Brexiteer, and I am glad that we are out of the EU—as a Northern Ireland MP, I know there are obviously issues with the deal, but I am glad that we are out—but how much of that was due to the influences of a variety of forms of social media?

The hon. Member for Midlothian referred to social media, which we all know can be a plus, but it can also be an absolute curse that can destroy people and carry all the wrong things. We all know friends, including colleagues in my party, who have been trolled, as I have been. Some of the comments are absolutely despicable My staff probably try to protect me from it, which, by the way, is not a bad thing, because an ill spoken word can be mightier than the sword.

We need to watch our words and ensure that our truth does not eclipse the truth. When I say, “our truth”, I do not mean my truth or the hon. Gentleman’s truth; I mean someone putting out what they refer to as “the truth” when it is not. The balance will be hard to find, but I believe that he, like me, wants to find that balance. That is the thrust of what he said, and I support that. I encourage the Government to use publications such as the “Industrialized Disinformation: 2020 Global Inventory of Organized Social Media Manipulation” report, published by the University of Oxford, along with other evidence to find an informed and balanced way forward.

The hon. Gentleman referred to integrity and said that debate is healthy. So it is. I am always happy to speak to anyone who has a different point of view from me because there is no threat in that, but we should be able to debate in a healthy and constructive way and, at the end of it, still be able to go our different ways, perhaps still with our own points of view.

I finish with a biblical quote as I sometimes like to do in debates, and I hold strongly to this. I was sat here, thinking:

“the truth will set you free”.

I knew that from an early age as a young boy in the children’s meetings in my village and back home in Ballywalter. It is true in political life, it is true in social life and it is true in everything. The truth will set you free. We need to hold to the truth. I very much look forward to the Minister’s response.

It is a pleasure to see you in the Chair this evening, Sir Charles, and to serve under your chairmanship for this debate secured by my hon. Friend the Member for Midlothian (Owen Thompson).

Disinformation, and state-sponsored disinformation campaigns in particular, is an issue close to my heart, and I know it is close to my hon. Friend’s heart. Disinformation represents a growing threat, as was adumbrated in the Oxford Internet Institute’s report he referenced in his opening remarks. It is not just that there are now more so-called cyber-troops working on disinformation campaigns but that they are growing in sophistication, the amount of money being spent on that around the globe has grown into the many millions, and the threat is going only in one direction.

As we know from the events in Capitol Hill in January, disinformation has to radicalise only a relatively small percentage of the population to be a serious and violent threat not just to others in society but to democracy itself. Of course, there are countless examples of that in history throughout the world. We can even look—if anyone cares to—at the example of the bronze soldier of Tallinn in Estonia in 2007.

The hon. Member for Strangford (Jim Shannon) is right to highlight that this is not about regulating people’s opinions and views. He is a staunch Unionist who I have a lot of respect for, and I am a staunch supporter of Scottish independence. It is an idea that has been around since around 843 AD and is a perfectly mainstream view to hold, albeit that I accept it is not held by a majority of those appearing in the debate this evening. However, the Scottish National party recognises how we in particular can be targeted, to be used as a means to sow division, through hostile actors weaponising a mainstream, legitimate idea. We do not want that to happen. We want our debates to be conducted entirely properly.

I want to call for a couple of things. Members of Parliament need a greater understanding of the threat picture. When we talk about the sophisticated network of cyber-troops, exactly what does that mean? I ask the Government to facilitate briefings on the threat picture. I also want us to have a national strategy to counter disinformation. It should build information resilience, and not just among young people in schools—important though that is. The strategy should reach every part of the population. The pandemic has surely shown us why that is important.

Lastly—we could go on much longer, I am sure—I plead with the Government, while accepting that it is not the departmental responsibility of the Minister: the ISC recommendations in the Russia report must be implemented. There is agreement across all the parties in the House on that, and the Government must implement those recommendations, disinformation being one of the many areas where not just the UK but many open societies are vulnerable. There is a good discussion that we could have, that would be free of party political heat, to ensure that we do that, and build a resilient democracy that allows ideas to be debated and to flourish as they should in any free, open society. I think we can all agree on that.

In these one-hour debates the two Opposition Front Benchers get five minutes each, but, since we have a bit of time, if the Labour shadow Minister would like to take a little longer, she can. I hope that all Ministers’ and shadow Ministers’ offices make them aware of the rules on Westminster Hall debates and timings; but please, shadow Minister, have a little longer. It is not as if we are short of time at the moment.

Thank you, Sir Charles. I greatly appreciate that, but in any case I would like to start by saying what a pleasure it is to serve under your chairship, and what appropriate discretion you show.

I congratulate and thank the hon. Member for Midlothian (Owen Thompson), who called today’s debate. The internet plays an ever-increasing role in our lives, as the pandemic has shown. Our work, social and family lives, and our Parliament, are all largely online, and we get our news from online sources and develop our politics digitally. Research by Ofcom shows that Facebook now rivals ITV as the second most popular news source for UK adults. That is reflected at party level. In 2018 the UK’s three largest parties spent £3.7 million on Facebook advertising alone, which, as Members have observed, is largely unregulated.

We live in a digital age and there are, unsurprisingly, perhaps, emerging digital threats to our democracy, so today’s debate is overdue and I am concerned that the Government are weak on online protections, and are presiding over continuing delays to the online safety Bill as well as failing to decisively oversee the impact of Huawei on our telecoms networks.

As we have heard, cyber-troops are Government military or political party teams, committed to manipulating public opinion over social media. I want to congratulate the hon. Member for Midlothian again. I was the first Member of Parliament to mention the internet of things in the House. As I understand it, he is the first Member of Parliament to mention cyber-troops in a debate, and in congratulating him—it is, as we have heard, a very important subject—I wonder why the Government are not bringing forward or raising issues of this importance. It has been 11 years since the earliest reports of organised social media manipulation in 2010, which coincided with the first Conservative Government after Labour.

Members have mentioned the research by the University of Oxford that found that cyber-troop teams use a variety of strategies, tools and techniques, but they often have an overarching communications strategy that involves creating official Government applications, websites or platforms for disseminating content, using accounts that are either real, fake, or automated to interact with users on social media, or creating substantive content such as images, videos or blog posts—fake images, as well. They do not have to be sinister or abusive in themselves: for example, Israel deploys the policy of positive interactions with social media users who are critical of the Government, and the Czech Republic seeks to provide neutral fact-checking services. However, negative strategies are used, as we have heard.

These Government-sponsored accounts are not always run directly by the services whose message they are spreading, nor is that message always obvious. The University of Oxford research found one Russian cyber-trooper who ran a fortune-telling blog that provided insight into relationships, weight loss, feng shui, and just occasionally geopolitics, with the goal of weaving propaganda seamlessly into what appeared to be the non-political musings of an everyday person. The serious point is that this can be very hard to detect by the most informed consumer.

With the vast range of activities, sources and strategies deployed by cyber-troops, it is important to keep up with the changing geopolitical landscape, so I ask the Minister to tell me what assessment has been made of these measures deployed by cyber-troops across the world, and specifically what the impact is on UK citizens and our democracy. The emergence of these strategies and threats is a threat to our democracy, which emphasises the importance of collaboration with our friends and allies to fully map the threats that we face. We have heard of the well-publicised Russian disinformation campaign in the US 2016 election, as well as our lack of resilience, and even as our service personnel are mobilised to help contain the pandemic, our adversaries are feeding disinformation and division into our communities. That shows how essential public understanding is in a crisis, and that the enemies of democracy will exploit every weakness. The Government launched the armed forces cyber-regiment last year. That is good, but I ask the Minister why it took so long, and whether we have already been exposed to digital hostility.

The hon. Member for Strangford (Jim Shannon) emphasised the changing role of the armed forces, and I pay tribute to his work with the armed forces. What discussions has the Minister had with the Secretary of State for Defence specifically on cyber-troops? There can be confusion between the responsibilities of the National Cyber Security Centre and those of Ofcom in this key area, so could she outline where the demarcation is there? As we have heard, cyber-troops operate primarily on social media: Facebook, Google, YouTube, Instagram, Reddit, Twitter, and all parts of our social lives, as well as our work lives and consumer lives. However, we have little control over how that content is curated. Facebook itself says that millions of users have been exposed to coronavirus disinformation, so I ask the Minister why we are so slow to introduce any effective regulation of online content, when the online safety Bill will be before us, and whether it will include anything to address cyber-troops.

The hon. Member for Midlothian also highlighted the impact of disinformation on our democracy specifically. What discussions has the Minister had about the need to reform our electoral system to protect it from foreign interference, as the Electoral Commission and the Law Commission have set out in a number of reports? Does she accept that cyber-troops warrant reform to our electoral laws, and what recommendations does she have, if any?

It is harder than ever to trust what we see online, with fake images pretending to be from reputable sources such as the BBC and so on. As we have heard, the Government were themselves guilty of that during the 2019 general election, when they changed their official social media channels to appear as unbiased, neutral fact-checkers. The bots may be following the Prime Minister, but is the Prime Minister following the bots?

So far, the Government appear content to leave those issues to the market, but it is a market that has allowed the spread of disinformation, opening the door to cyber-troops. Self-regulation by the social media giants has failed, and they have made little progress. Twitter has begun checking some of its posts, and Mark Zuckerberg has rolled back on his declaration that Facebook would not become the arbiter of peace, but that is too little, too late, and there is not enough progress. Will the Minister explain why the only requirement that she places on those platforms is that they should not make money from disinformation? Surely there has to be a higher standard than not directly profiting from it.

Finally, anonymity is a complex issue, but the sheer scale of misinformation, online abuse and extremism means that there has to be more we can do. We recognise anonymity as a shield for whisteblowers, victims finding refuge online, or children in minorities exploring self-expression, but how does the Minister see the relationship between anonymity and the work of cyber-troops? Is she looking at the trade-off of protecting privacy and free speech—the hon. Member for Strangford talked about the importance of free speech, and I echo that point—and protecting our democracy and citizens from harm and abuse? Inaction is to make the worst trade-off of them all.

This Government have been in place, in one form or another, since 2010, and in that time we have seen a dramatic change in the prominence and the role that the online world plays in our lives, our democracy, our news and our understanding of the world, yet we have seen no action from the Government. Understanding mapping and measuring the impact of cyber-troops on UK citizens is an action that any responsible Government should be taking. We have heard today about the ways in which cyber-troops are deployed, controlled and developed, but those strategies will not stay the same—they will continue to evolve—and we are not even playing catch-up, because we do not seem to be in the game at all. I am really pleased that those key points have been raised in the debate, and I hope that the Minister will set out in her response the action that the Government will take.

It is a great pleasure to serve under your stewardship, Sir Charles. I join everyone else in thanking the hon. Member for Midlothian (Owen Thompson) for bringing forward this really important topic. I know that he has long been a really powerful and strong voice on the subject, and he is absolutely right to keep bringing attention to the issue, because the worrying industrialisation in disinformation is something that we should all be concerned about.

A number of Members have spoken about the increasing sophistication of digital technology. Even this week there was a deepfake of Tom Cruise on TikTok; it was incredibly lifelike and plausible and was not intended for sinister purposes. That only underlines what is the art of the possible if that technology is in the hands of those who are up to no good. It has always been vital that UK citizens have access to accurate information when it comes to elections but also situations such as our current pandemic; it is vital to our democracy and everyday life as well. Disinformation and mis-information, which is spread without intention, threaten our democratic freedoms and can cause harm to individuals and society, and it is an issue that the Government take incredibly seriously.

That is why we established a dedicated counter-disinformation unit, which brings together cross-Government monitoring and analysis capabilities to build a comprehensive picture of disinformation and misinformation. It works with partners to ensure appropriate action is taken. The hon. Gentleman rightly said that this unit that has generally been stood up at elections; it was stood up during the European parliamentary elections, the UK general election in 2019 and again in March last year to respond to the covid pandemic, and it remains operational. The component parts of the unit remain operational all the time—organisations such as the 77th Brigade, for example.

Throughout the pandemic particularly, the unit has been working closely with social media platforms to quickly identify potential harmful content on their platforms and help them respond to it. We have seen major platforms update their terms of service and introduce new measures to tackle disinformation and misinformation related to covid-19. This is not just about not being able to profit from it; a really important part of the agreement is that they also put up links to reliable, Government-backed sources of information. We welcome this, and there is clearly more to do. We continue to put pressure on platforms to ensure that their policies and enforcement are fit for purpose, while respecting freedom of expression. The unit also works with Government communications teams to ensure that public communications and community engagement address false information where appropriate to do so.

I thank the Minister for her comments and the information she is giving. Before she moves on from the unit for disinformation, when I asked recently how many full-time employees it had, the answer was none. She has talked about how spread out it is, but given the increased importance of disinformation, will there be full-time employees in the unit or will they all have other things to do as well as disinformation?

It is a unit that expands. There are full-time members of staff dedicated to this, but that is obviously a tiny number in normal circumstances. It expands enormously when the Government disinformation unit is stood up.

The hon. Member for Newcastle upon Tyne Central (Chi Onwurah) has referred to the numbers in the unit, but surely the close working with the police forces across all the regions gives extra numerical strength to what the Government are trying to do.

The hon. Gentleman is absolutely right. We are working closely with the police and also the Army, as I have mentioned. I am always slightly nervous about what I am allowed to say around this issue, not being an MOD Minister, but there is the 77th Brigade, which is a military unit dedicated to this sort of activity and with which we work very closely.

While such information can come from a range of sources, we know that certain states routinely use it as a tool to exploit our open system by sowing division and undermining trust in our democracy, as the hon. Gentleman said. This can be through disinformation, cyber-attacks and other methods. We have made it clear that any foreign interference in the UK’s democratic process is absolutely unacceptable—it does not even need to be said—and it is, and always will be, an absolute priority to protect the UK against it. The UK, along with our G7 and NATO partners, is working hard to protect our democracy against disinformation as we work together to tackle the shared threat of covid-19.

We remain firmly committed to protecting our democratic values and our electoral processes, which I know the hon. Member for Midlothian is concerned about, and we have robust systems in place to protect the UK against foreign interference. As he says, it is all about working collaboratively. These systems bring together Government, civil society and private sector organisations to monitor and respond to interference in whatever form it takes. The hon. Member for Newcastle upon Tyne Central (Chi Onwurah) talked about these things sometimes coming in the guise of something that could look quite harmless but can actually be incredibly sinister.

It is absolutely vital to ensure that our democracy stays open, vibrant and transparent. The Government are strengthening our legislative framework, enhancing capabilities and engaging with partners to expand our efforts to ensure the maximum impact. That joined-up approach is supported through the defending democracy programme, based in the Cabinet Office, which provides a strategic co-ordinating forum, drawing together work and expertise across Departments on a number of fronts to protect democratic processes, strengthen the integrity of elections, encourage respect for open and safe democratic participation, and promote open, fact-based discourse.

The Government are taking steps to strengthen elections by introducing legislation, as the hon. Member for Midlothian said, to ensure that the framework is fit for the modern age, for example by updating online campaigning rules. In May 2019, the Government committed to introducing a digital imprints regime, which will inform voters about the source of online campaign material. In August, we launched a technical consultation on this proposal. It closed in November, and further details will be set out shortly.

During major democratic events, the Government stand up an election cell—a co-ordinated structure that works with relevant organisations to identify and respond to emerging issues and protect the safety and security of the democratic process. The counter-disinformation unit works closely with the election cell, co-ordinating the Government’s operational response to any evolving threat of disinformation and other forms of online manipulation. The Government are working really closely with partners to support the delivery of safe and inclusive elections. Of course, the next ones will be very shortly, in May.

The Government welcome the valuable analysis and insight from academia, including the Oxford University report, and we take seriously the findings of other experts in this field. Countering disinformation and other forms of manipulation requires a whole-of-society approach, and the Government are working closely with the Oxford Internet Institute and other stakeholders from civil society, academia and industry to much better understand the issues in this space. In particular, last year the Government launched a counter-disinformation policy forum, bringing together key actors in industry, civil society and academia to improve responses to misinformation and disinformation and, crucially, to prepare for future threats. This forum contributes to the collective understanding of challenges to the information ecosystem, allows us to improve the responses that our organisations can deliver to better mitigate evolving threats posed by false narrative and helps us to prepare for future advances in technology, which is of course what we are all really worried about; as we have already said, the technology evolves rapidly.

We are entering a new age of accountability for the tech industry. The hon. Member for Midlothian and others mentioned the online safety legislation. We announced plans at the end of last year for a groundbreaking rulebook that will make tech companies responsible for tackling harmful content on their sites. This new regulatory framework will give digital businesses much more robust rules of the road, as it were, so that we can seize the brilliance of modern technology to improve our lives while protecting children, building trust and, crucially, tackling criminal activity online.

The full Government response to the online harms White Paper was published at the end of last year and set out how the proposed legal duty of care on online companies will work in practice. It will of course defend freedom of expression and the role of the free press. The new laws will also ensure appropriate checks and balances on platforms’ power over public discourse and will promote a thriving democracy where pluralism and freedom of expression are protected. The laws will have robust and proportionate measures to deal with misinformation and disinformation. That is crucial, because we know that they can cause significant physical or psychological harm to an individual. An example is the anti-vax falsehoods that we are seeing around covid-19 at the moment. Crucially, the Bill will give Ofcom the tools it needs to understand how effectively disinformation is being addressed. That will be done through transparency reports, and then it can take action in the appropriate way, as required.

I thank the Minister for her comments. I asked about the role of Ofcom with regard to cyber-troops and electoral disinformation and whether she sees a role for Ofcom and the NCSC there.

As the hon. Lady knows, the NCSC is not a regulator, but it provides authoritative advice, and the online harms response says very clearly that it is vital that Ofcom is able to take advice, if necessary, from experts in whatever field, whether civil society, charities, academia or businesses. They will have to work together very collaboratively, because it is Ofcom’s job to hold companies to account to ensure that this issue is being tackled appropriately.

It is important to say that we really do support freedom of expression as a fundamental right. It is an essential element of the full range of human rights. Therefore, while we take action to address false narratives online, we have to remain committed to protecting the freedom of expression that we are so well known for, across our nations. However, our commitment to tackling misinformation and disinformation in all their forms remains an absolutely key priority. Our challenge as a society is to help to shape the internet so that it remains open and vibrant but still protects users from all kinds of harm. It is a really difficult balance to strike, but our commitment to protecting our democratic freedoms and processes from outside interference by any actor, whether state or non-state, remains unwavering.

Thank you, Sir Charles. I will briefly thank all hon. Members for their contributions this afternoon. I think we have seen a very clear understanding that it is in all our interests to ensure that we tackle this issue and get it right. I very much endorse the comments of my hon. Friend the Member for Glasgow South (Stewart Malcolm McDonald) about seeking a strategy, because we are starting to see a swell of opinion for tackling some of these things, especially misinformation online. We have seen the importance of that through the current pandemic. The public need to be able to have confidence in the information that they access.

In a nutshell, the issue comes back to what the hon. Member for Strangford (Jim Shannon) said. He very ably made the point that it is so important that we are able to agree to disagree. I do not think that anybody is suggesting that we need to have any kind of thought control or that everybody has to have the same opinions. It is important that we do not, but it is important also that we can have confidence that those views and opinions are presented in a way that is accurate and factual.

I thank colleagues for facilitating and conducting such an excellent debate.

Question put and agreed to.


That this House has considered cyber troop activity in the UK.

Sitting adjourned.