Monday 1 November 2021
[David Mundell in the Chair]
Endometriosis and Polycystic Ovary Syndrome
Before we begin, I encourage Members to wear masks when they are not speaking. This is in line with the current Government guidance and that of the House of Commons Commission. I remind Members that they are asked by the House to have a covid lateral flow test twice a week if coming on to the parliamentary estate. This can be done either at the testing centre in the House or at home. Please also give each other and members of staff space when seated and when entering and leaving the room.
I am sure that most Members will be aware that this debate was originally scheduled to take place on 18 October. It was delayed so that Members could pay tribute to our colleague and friend, Sir David Amess. His loss was felt acutely across the House, but it is a testament to him that his loss will have touched many well beyond these walls. I know it will have been particularly felt by many of those watching or with an interest in today’s debate, as Sir David was a champion of those living with endometriosis, having chaired the all-party parliamentary group on endometriosis since its inception in 2018. He was a crusader for the cause long before that, after a constituent contacted him about their struggles with the condition. His signature passion, charm and humour will be sorely missed from today’s debate, but I am confident that Members here will make contributions that do justice to a cause he cared so much about and, in so doing, pay tribute to him.
I beg to move,
That this House has considered e-petition 328570, relating to research into endometriosis and polycystic ovary syndrome.
It is a pleasure to serve under your chairmanship, Mr Mundell. Before I begin, I would like to take a moment to remember and pay tribute to our friend and colleague, Sir David Amess. Among the many worthy campaigns he fought for, Sir David was a vocal champion of women suffering from endometriosis. He launched the all-party parliamentary group on endometriosis in 2018, and he chaired it with the intention of raising awareness of the condition and the need to investigate how those who suffer from endometriosis can get support. I am certain that Sir David, ever the advocate, would have spoken in this debate. By continuing to speak out on this issue, we honour his memory.
For convenience, I will read the petition into Hansard:
“Endometriosis and PCOS are two gynaecological conditions which both affect 10% of women worldwide, but both are, in terms of research and funding, incredibly under prioritised. This petition is calling for more funding, to enable for new, extensive and thorough research into female health issues.”
The petition was open for six months and gained over 100,000 signatures, 200 of which were from my own wonderful constituency of Coventry North West. This is not the first time we have had a debate on endometriosis, nor is it the first time that polycystic ovary syndrome, or PCOS, has been brought up in Parliament. The Government’s lack of action in response to previous debates has compelled over 100,000 people to bring the lack of funding for research into these diseases to our attention.
The opening speaker in a debate does not have to speak in favour of or in opposition to a petition. They can choose to outline arguments dispassionately and open up the debate. I will not be doing that. I want to throw my full support behind this important issue. As a healthcare professional in the NHS myself, who has worked with endometriosis and PCOS patients, it is heartbreaking that we still need to plead for research money for two diseases that affect one in 10 women in the United Kingdom. That is over 3 million women.
To advocate for the petition, I will first try to clear up some crucial misconceptions about both diseases. I will also outline the specific actions that the Government must take to support women who suffer from them. Before I do that, I want to briefly explain what endometriosis and PCOS are. PCOS is the most common endocrine disorder in women, affecting one in 10, although it disproportionately impacts black and south Asian women. It is characterised by abnormal hormone production in the ovaries and can, in many but not all cases, cause women to develop cysts. Endometriosis is a condition where cells similar to those in the lining of the uterus are found elsewhere in the body. It affects one in 10 women, although, again, it disproportionately impacts black and south Asian women. Medical jargon aside, both diseases can affect women’s reproductive organs and can, if severe enough, cause fertility issues as one of many side effects.
However, after spending the last few weeks speaking with women suffering from one or both diseases, it has become clear that one of the greatest misconceptions surrounding endometriosis and PCOS is that they are often considered only to be fertility diseases. Thinking of the diseases primarily as barriers to pregnancy or simply as making women’s periods more painful is a gross oversimplification and is, in many cases, totally inaccurate. Both diseases vary widely in severity and in the way they manifest. For example, 12% of endometriosis cases target women’s lungs. Both conditions cause symptoms other than chronic pain. PCOS can cause obesity, excess facial hair and chronic acne—deeply stigmatising symptoms that can shatter a young woman’s confidence and have a debilitating effect on her mental health.
Does the hon. Lady agree that this medical gaslighting is arguably the biggest issue? Patients go to their GP—the medical practitioner they trust the most—and are told it is just a bad period. That is what we really need to change. Funding is a separate argument. That is the main problem we need to overcome before we can truly tackle the issues.
I thank the hon. Gentleman for making an important point, but I think what that highlights is the need to ensure that endometriosis and PCOS are included on the medical curriculum for GPs and healthcare professionals. That is why funding is so important: to make that difference.
I rise to support the petition as well. My constituents have also written heartfelt letters about their experiences; it took one constituent 11 years to receive a diagnosis. Is not the crux of the issue that we need a diagnostic framework to get on top of the conditions quickly so that they do not reach the severity that many women experience?
I thank my hon. Friend for making that important point. I agree, and I will come on to that issue in my speech.
To add insult to injury, funding for symptoms such as excess facial hair and chronic acne has decreased over the years. Endometriosis can cause chronic bowel and bladder-related symptoms and depression, yet I have heard from countless women that, after finally being diagnosed with endometriosis or PCOS, they are told by their GP to come back when they want to get pregnant and are then sent on their way, without targeted treatments.
It is extraordinary to think that there are the same number of women in the UK who have endometriosis as there are people diagnosed with type 2 diabetes. Nobody would suggest that a person suffering from diabetes come back when they decide to get married, so that they can manage swelling in their fingers before buying a wedding ring—that would be absurd. One in 10 people in the UK suffers from asthma, yet it would be completely unthinkable to tell someone with asthma to come back when they decide they want to run a marathon. Endometriosis and PCOS are about so much more than having difficulty conceiving.
Both endometriosis and PCOS can have a massive impact on mental health for a variety of reasons, whether related to pain or fertility. Mental health services have been chronically underfunded for years. Does the hon. Lady agree that the psychological symptoms of the conditions should be prioritised as much as the physical ones?
The hon. Lady is articulating the case extremely well. Does she share my opinion that one reason the conditions are looked at only from the perspective of their impact on fertility is that the medical establishment too often views women’s biology purely from the perspective of incubating babies, and does not think enough about the impact on general wellbeing?
I thank the hon. Member for raising such an important point, which I will come to later. I know from speaking to many healthcare professionals that some are passionate about endometriosis and PCOS but would like more funding and support, so that their colleagues and all within the medical profession get the necessary medical education in their curriculum.
Endometriosis and PCOS are about so much more than having difficulty conceiving, but funding decisions made by Whitehall treat them as though they are not. That is why it is so upsetting, but unsurprising, that the Government response to the petition discussed funding for fertility treatments. In fact, when most young women start to see symptoms at puberty, pregnancy is the furthest thing from their mind.
With that in mind, I will talk about a constituent of mine, a 14-year-old girl who was ostracised and relentlessly bullied by her peers for her excessive facial hair and acne and for weight-related reasons. She experienced such debilitating pain in her lungs and lower abdomen that she was hospitalised during a GCSE exam. After five years of calling hospitals, three painful exploratory surgeries, countless GP appointments and several specialist referrals, she was finally diagnosed with endometriosis and PCOS. The only treatment her GP could offer her was generic birth control pills, which no evidence-based studies confirm as definitive treatment for either disease.
The hon. Lady makes an excellent point. I have experience of young women being given contraceptive pills to deal with what the GP regards as period pain, only to then suffer mental health impacts because of the contraceptive pill. They then find themselves in the difficult position of having to choose between what the GP thinks is a treatment for period pain and the impact of the contraceptive pill on their mental health. Does she agree that that is simply unacceptable?
I thank the hon. Member for raising that important point. I agree that it is simply unacceptable.
Before my constituent left, the GP told her to come back when she wanted to get pregnant, leaving her to figure out how to cope on her own in the meantime. Her story of feeling shamed by her peers and gaslit when trying to get a diagnosis is not unique, as many Members have raised. On average, it takes eight years to diagnose a woman with endometriosis, and years to diagnose PCOS, which brings me to my next point.
The Government need to increase funding to study both conditions. We still do not know what causes endometriosis, effective ways of preventing it from spreading to other organs or effective non-surgical ways of managing symptoms. Some 58% of women with endometriosis had to visit a GP more than 10 times to get a diagnosis, while 21% had 10 or more hospital appointments and 53% went to A&E, with 27% going more than three times, before diagnosis. That is deeply distressing for the patient and a terrible use of NHS resources.
The hon. Lady makes an excellent case and I absolutely support everything she says. I was horrified to hear from a constituent, a qualified nurse, whom it took six years diagnose to diagnose. After two and a half years of daily bleeding and pain, she was finally offered laparoscopic surgery, but was then told by healthcare professionals that the only cure for her was to actually conceive and have a baby, while at the same time being told that she could have fertility problems. Does that not highlight that there needs to be a lot more awareness and education among GPs and healthcare professionals, and adherence to National Institute for Health and Care Excellence guidelines?
I thank the hon. Member for raising that important point, which absolutely highlights that need.
The Government urgently need to invest in research projects and create more streamlined diagnostic practice. That must start with better GP training, as hon. Members have highlighted, so that GPs no longer inadvertently gaslight or misdiagnose anyone with endometriosis or PCOS. It must extend to more accurate and less invasive screening technology to confirm the diagnosis. Once women are finally diagnosed, there is currently no targeted treatment for endometriosis—none at all. Similarly, there is no drug or treatment on the UK market that has evidence-based approval to treat PCOS. We need funding for this research, as well as facilities to carry it out.
There is only one dedicated PCOS clinic in the whole of the UK, and I am proud to say that the clinic is in my own city of Coventry. I visited the clinic recently and spoke with the head researcher, Professor Harpal Randeva, and their specialist nurse, Danielle Bate. They stressed the importance of treating PCOS as a disease in need of its own funding body. Currently, the limited funding for PCOS and endometriosis alike is attached to funding bundles for several other diseases, as is clear from the Government’s response to the petition. We should not be attaching research funding for these conditions as addendums to general funds for fertility diseases or other endocrine diseases. Endometriosis and PCOS impact millions of women in the UK. They are not afterthoughts, and we cannot continue to treat them as such in funding discourse. We should encourage funding charities to set up independent boards for PCOS and endometriosis.
Earlier this year, a Department of Health and Social Care consultation acknowledged the importance of improving research into women’s health. The strategy for that improvement is, according to the Government, now in development, and it would be great to hear from the Minister what progress is being made. I also ask the Minister whether the strategy will commit to establishing independent well-supported funding bodies for research into both endometriosis and PCOS, which are so desperately and deservingly needed.
I will end my remarks by thanking all the brave women suffering from endometriosis or PCOS who continue to fight for increased resources. Without their remarkable self-advocacy and will to advocate for each other, I am certain that we would not be here today. I hope the debate will provide an opportunity for the Government to listen and act.
It is a pleasure to serve under your chairmanship, Mr Mundell. I would like to add my thoughts and recollections of working with Sir David. As he was chair of the all-party parliamentary group on endometriosis and I was vice-chair, we worked very closely together, and I really enjoyed working with him. I found him to be a funny, engaging and generous man. He will be very missed.
As much as I am pleased to be sharing the new role of chair with the hon. Member for Livingston (Hannah Bardell), I do not think that any member of the group will quite get over the loss of Sir David. The last conversation that we had was when we caught each other near the lifts in 1 Parliament Street, if Members know it. He said, “Oh, Emma, Emma! Let’s find out who the new Minister is. We must get them to come to our APPG.”—this was during the reshuffle—“We must tell them about our report. Let’s do this together.” I said, “Brilliant!” He said, “I’ll find out. I’ll get hold of them,” and I said, “That’s great news.” I am very pleased to say that before the debate began, the Minister agreed to meet the APPG, so I thank her for that.
I would like to mention our APPG and the work we did—I can see members of the group here now—and some of the points that we came up with. It was a really detailed piece of work. We listened to thousands of women. Sir David chaired some of the events, as did I and other Members. We were both passionate about following up on the report’s recommendations. The point he made to me was, “It must not be left to gather dust, Emma,” and I said, “No, it must not be left to gather dust,” so we will push on with the recommendations.
One of the things we talked about was highlighting the unacceptable delays in diagnosis and the need for research into diagnostic methods. One of the recommendations was that Government should commission research to discover the cause of the disease. No one really understands why some women have it and some do not, and there is no research on that. Research needs to be done on better treatment and management options, and—the dream for everyone—one day finding a cure.
We need increased awareness. It feels as though we are becoming more aware of the condition, but I still find myself having conversations with people who ask, “How do you say that? What is endometriosis? I have not heard of that before.” We should do anything we can to raise awareness and increase understanding among health professionals of the severity of the condition.
We need to recognise endometriosis in statutory support as a source of chronic disability, and we have talked before about having a debate about that. Sir David and I, along with other members of the group, wrote to the Minister in the Department for Work and Pensions about personal independence payments, disability benefits and women’s difficulty in accessing them for conditions such as endometriosis. The definition and criteria for statutory sick pay do not recognise long-term conditions such as endometriosis. Everybody who needs it should have access to the appropriate care.
I would like to mention the women that I met during my recent Big Conversation event. I pay tribute to Mr Phillips, who is an incredible consultant and an expert in endometriosis, for all the work he does in my local area. The women at the event reported the same things as we have heard from the women here: this is a condition that takes seven and a half years to diagnose, it is not taken seriously and they are left in extreme pain for long periods of time. However, I want to offer some hope to everybody. I am really pleased that Dr Barbara Guinn and Leah Cooksey, a PhD student at the University of Hull, have just been given £10,000—a pitifully small amount, one could argue—to look into researching biomarkers for endometriosis. That would be revolutionary if it came through. The idea is that someone could give a urine sample to identify the biomarkers that mean they are likely to have the disease, without the need for the current invasive medical procedures.
My final, specific ask for the Government concerns the Health and Care Bill. The Royal College of Obstetricians and Gynaecologists is asking that it be made mandatory for integrated care systems to ensure that NHS organisations for which they are responsible conduct and resource clinical research. Can measures about mandatory research into this condition be included in the new Health and Care Bill? I am very sorry that Sir David is not here with us, but we will continue to push for all the recommendations and points that he stood for so proudly in our all-party group.
May I associate myself with your words, Mr Mundell, and with the words of the two previous speakers in regard to Sir David Amess, who was a great personal friend of mine? I was so happy to be able to work with him on this cause. He brought to it his characteristic passion and commitment, and frankly, he was good at keeping us all on the ball. We will miss his leadership, but we will endeavour to make sure that the points he campaigned for are delivered. As has been mentioned, he took up this issue when he was visited by his constituent, Carla Cressy. The cause is one of the main beneficiaries from the sales of his book, “Ayes & Ears”, which is available in all good bookshops; I encourage everyone to make their donation there.
As the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) has outlined, Sir David led an inquiry for the all-party group on endometriosis. As many as 11,000 members of the public got involved in it, and that is quite an achievement for an all-party group. It is a testament to the fact that he always used good publicity to draw attention to the issues that he really cared about.
For a condition that affects 10% of women, there has been staggeringly little focus on endometriosis. If something affected 10% of men, would we be having this kind of debate? I think not. We really owe it to all the women who suffer for years with the most debilitating and chronic pain and disability because of this condition. I am grateful to the hon. Member for Coventry North West (Taiwo Owatemi) for mentioning the obsessive focus on fertility, because the truth of the matter is that women who suffer from endometriosis start to suffer from it the moment they start their periods.
We could do so much if we had a greater understanding of what a healthy period is. We are all brought up to think, “This is your lot in life; it’s all quite normal.” We might be struggling with the most debilitating pain and thinking that everybody else is going through the same thing, when in fact they are not and we are suffering from very unhealthy periods. We need much more understanding not just in the medical profession, but among girls, so they can be more alive to problems and not wait eight years for a diagnosis. As the hon. Lady said, endometriosis is often diagnosed only when women are trying to get pregnant, by which time so much damage might have been done. If the condition had been diagnosed earlier, treatment could have been given to alleviate it.
We often talk about funding, and one of the biggest challenges in the NHS is not so much the quantum of funding but whether we spend it wisely. If we gave people tools to look after their conditions and enable them to know when they are suffering from ill health, we would reduce the amount that the NHS has to spend on the condition. It is a no-brainer. I am pleased to see the Minister in her place. She has had to listen to me bang on about these issues many times—I never miss an opportunity to beat Ministers over the head when it comes to women’s health—but I know she gets it.
We need to think properly about the wellbeing of women, and the impact that their biology and gynaecology have on wellbeing, and we must think beyond childbirth and pregnancy. Only last year Baroness Cumberlege produced her report “First Do No Harm”, one of the headline conclusions of which was that women are not heard. When women seek medical advice, they are belittled, diminished, shunted along and told, “This is all very normal.” That must stop, because women are important. Women will have healthy pregnancies if they get support earlier. We will all be better off, because we will have less work absence, a more productive economy and less demand on the NHS. It is a no-brainer. I ask the Minister for more research into endometriosis and more awareness so that people can be diagnosed earlier.
It is a pleasure and an honour to speak in this debate. As Members before me have done, I pay huge tribute to and give thanks for the work of Sir David Amess. He worked tirelessly to raise awareness and improve services for those affected by endometriosis. His loss is felt keenly across the House and among those involved in the causes that he fought so hard for, such as endometriosis. It will be a true honour and a privilege to follow in his footsteps with the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy). We decided that it was important to make a cross-party effort to take on Sir David’s role, because that was the spirit in which he approached the issue. In fact, the last conversation I ever had with him was about how we could ensure that the report did not sit and gather dust, and how we could include and encourage local groups in our constituencies. I know we all have many of them in our constituencies.
I want to take a moment to mention and pay tribute to Endo Warriors in West Lothian, where Candice and Claire are tireless campaigners—that is why the fourth largest number of signatures to this petition came from my constituency. I also pay tribute to Endo Bonds, which works tirelessly across Scotland, and to Andrew Horne and Emma Cox at Endometriosis UK. There are many people in this space and a lot of sufferers, many of whom I have met. When we did that report, I took evidence from sufferers in Scotland. The stories were truly heartbreaking. That was in the middle of the pandemic, when those who suffer from endometriosis were having to wait longer than ever to get treatment and diagnosis. The number of Members who have taken an interest and want to speak in this debate shows that so much more time, effort, money and research must be dedicated to both endometriosis and PCOS, which devastates and blights the lives of women and sufferers across the UK.
As we know, endometriosis is a gynaecological condition, but many do not know that it is as common as diabetes. It affects one in 10 women and those assigned female at birth, thus affecting millions across the UK. It is a condition with a wide spectrum of symptoms. I have friends who suffer from it, and it has such a profound impact on their lives. As other hon. Members have said, the response of some medical professionals simply needs to change. We need ongoing medical intervention and research to improve sufferers’ lives.
From an economic perspective, endometriosis costs the UK £8.2 billion per year through treatment, healthcare costs and the impact on work and employment. This is not necessarily about the financial impact, however; it is about the impact on the lives of those who suffer. Despite the prevalence and impact of endometriosis, there is very little research funding for it or widespread awareness about it, unlike with cancer or diabetes. Yet it is ranked by the NHS as one of the top 20 conditions involving pain so disabling that it can prevent sufferers from doing daily tasks. That list includes well-researched and well-funded conditions such as heart attacks, kidney stones, appendicitis and arthritis, to name a few.
Men have held positions of power for centuries and, as the hon. Member for Thurrock (Jackie Doyle-Price) said, if the sufferers were men, we would probably have a solution and a cure by now. The fact that Sir David was so determined to fight, in such an inclusive way, for the women who suffer from the condition is a reminder to us all of the need to take that work forward.
In 2018, only 2.1% of publicly funded research in the UK went on reproductive and menstrual health, down from 4.5% in 2014. In Scotland, we have committed to reducing the time taken to obtain a diagnosis from eight and a half years to 12 months during the life of the next Parliament—that is an ambitious target. So often, the nations of the UK are played off against each other. Of course, this is an area where we should compete, but we also need to work together so that we can share ideas, fresh thinking and opportunities. That is what the hon. Member for Kingston upon Hull West and Hessle and I will do in the all-party parliamentary group. We look forward to working with Members and having many more debates on endometriosis and PCOS so that sufferers do not continue to suffer, as they have done for so long.
It is always a pleasure to serve under your chairmanship, Mr Mundell. I pay tribute to the late Sir David Amess for all his work to establish the APPG on endometriosis, and I am very grateful to him for his efforts.
Like Sir David, I was visited at my constituency surgery by a constituent who has campaigned tirelessly to raise awareness of endometriosis to ensure that other women do not have to go through the pain that she has endured. That constituent, Maddy Howarth, first began to suffer severe stomach cramps aged just 13. By the age of 17, she was visiting A&E practically every month because of the pain she was in and the effects of the drugs that she was taking to manage it, and still the condition went undiagnosed.
Eventually, after several years had passed, Maddy was referred to a gynaecologist for investigative surgery. While waiting to see a specialist for diagnosis, she was forced to give up her home and her job, as she was unable to work through the unbearable pain or access the support that she needed. Then, at the age of just 22, Maddy made the difficult decision to have a hysterectomy to finally stop the pain. I am pleased to say that her health has since improved, but not all women are so lucky.
An inquiry by the APPG last year found that the average waiting time from the onset of symptoms to diagnosis was eight years, and that although nearly all of those with the condition felt that their mental health had suffered as a result, the vast majority have never received any psychological support. That cannot be allowed to continue. Several years ago my partner, Beth, was diagnosed with endometriosis. She has had to suffer intense pain, but she is still on the waiting list for surgery. Needless to say, this issue is very close to my heart.
We all know about the impact that the pandemic has had on NHS waiting lists. Countless constituents have contacted me about how difficult they have found it to access a GP appointment, and about the repeated delays to routine operations. Women with endometriosis have lived through that experience for decades. To stop more women and young girls going through the life-altering pain felt by those such as Maddy and Beth, and if we are serious about building a more resilient and preventive healthcare system, we have to change. That means cutting waiting lists for diagnosis, improving our clinical understanding of the condition, creating a dedicated care pathway and providing stronger mental health and physical support for those currently living with stage 4 chronic endometriosis. This will not be an easy task, but it is a necessary one.
Now is the time for these difficult conversations about how we view and treat women’s health, and now is the time for us to end once and for all the unacceptable situation in which women are left living in fear with unbearable, undiagnosed and untreated pain. We must change that now.
It is a pleasure to serve under your chairmanship, Mr Mundell. I also want to pay tribute to Sir David Amess because, on coming into Parliament, I found it very impressive that for once a man was taking up an issue that affected so many women. I know it is usually the women in the House who put these issues forward, so we definitely have to pay tribute to Sir David Amess for the feminist that he was in that respect.
Even though the condition is so common and the impacts are so devastating, we have heard time and again that research is woefully lacking. PCOS is definitely one of the leading causes of fertility problems in women, and endometriosis can be as well. It can also have a devastating impact on someone’s self-esteem, and if not properly managed, it can lead to additional health problems later on.
I know this because I have endometriosis. My own experience began when I was young, and I did not think it was a particular issue. I always had extremely painful periods, and that was just life. With all these things that have to do with women, we are told, “Once you have a baby, you’ll be fine,” and on being diagnosed with endometriosis or potentially having it, I was told, “Once you have a baby, you’ll be fine.”
I remember that when things began to get bad one night in 2017, I was sitting up in the office of my right hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott), for whom I worked. I began to feel twinges while I was working late, and things got so bad—the piercing pain got so bad in my side—that I had hobble over the river to St Thomas’s Hospital. I was in so much pain that I was kept in for the next couple of days.
I then began waiting for an appointment from my GP. I had to wait so long for it that I called up and asked, and they were confused about what they were meant to do next. It was only after many months that I was able to get that appointment, and I then had to wait for the next appointment time, as we often do. That was a longer process, which went on for another two years.
Throughout that time, I would have pain every day, as I do now, and I would have to wake up quite late, because I would have pain mostly in the night-time. For the majority of women, their bosses are not so understanding. However, thanks to my right hon. Friend, I was able to make it work with my times by coming into work slightly later and working slightly later to work around my pain. How many employers would be that understanding?
Eventually, I was given a date for a laparoscopy in May 2019—I will not mention the hospital, because it will be hearing from me—and it went so badly it was unbelievable. I was in and out of there so quickly: I had the procedure, those involved woke me up and told me they had not found anything, and they said I would come to soon and would go home. I was in so much pain that I could not walk, and instead of treating me any further, they said there was nothing they could do for me, put me in a wheelchair—still in the gown I had had on for the operation, with blood on—and wheeled me round to A&E.
Obviously, those in A&E were absolutely fuming, because the staff are not meant to do that, and they sent me back up to the gynaecological ward. Again, I was gaslighted there, as somebody told me that I would have to think about what I was doing because I clearly just had some sort of muscle pain. I tell this story today, with not much time, because I cannot tell you how many women have experienced that.
My diagnosis took five years. Thankfully, I went to King’s College Hospital, where I was born. I probably should have gone there first; I turned out okay, which shows that it is a good hospital. It was able to treat my condition, and I instantaneously felt the relief of having the endometriosis removed, as much as that is possible. But it grows back, so I am now on the list, with other women, waiting for further treatment. We cannot keep women waiting this long.
I can say from experience that the amount of pain you go through really does affect you every day, so I say to Members right across the House that if they ever see me looking at them slightly strangely, unless they have said anything particularly obnoxious, it may just be because I am in a lot of pain. Thank you very much, Mr Mundell, for allowing me—oh no, I still have some more time.
It is a pleasure to serve with you in the Chair this afternoon, Mr Mundell. I associate myself with your remarks and those of others during this debate about our colleague Sir David Amess, and my thoughts and prayers are with his wife and kids at this very difficult time.
I am pleased to participate in this debate today in order to recognise publicly the great work that Endo Borders, set up by Tao McCready—who lives in my constituency—is doing on behalf of women who suffer from this terrible condition. Mr Mundell, as the other Member of Parliament for the Scottish borders, I know that you are familiar with that group and the important work it is doing in our area. Tao was diagnosed with endometriosis in 2017, following multiple misdiagnoses, and went on to set up Endo Borders in 2019, giving up a career to focus on supporting the local community and raising awareness of the condition. Not only is it a fantastic group for women in the Scottish borders; it also reaches out to women across the country who are suffering from endometriosis. I had the privilege of attending a recent meeting of Endo Borders, and was really impressed by the courage of the women who were sharing their stories.
Endo affects one in 10 women in the United Kingdom, but despite its prevalence not much is known about it and relatively few people have heard of it—I certainly had not until I met that group. There is currently no cure for endo, and its exact cause is unknown. In Scotland, the average diagnosis time is eight years. The difficulty is that there is not a specific list of symptoms for endo, as the condition presents differently in different women. Research by Endometriosis UK found that 54% of the UK population were unaware of the condition, and 45% of women were unaware of its symptoms. To put that in perspective, a far greater proportion of the population has heard of diabetes, and endometriosis affects a similar number of people.
What can be done to help women suffering from this condition, particularly those who live in my constituency in Scotland? First, clearly awareness about endometriosis needs to be raised, and it is crucial to ensure that Scotland comes into line with England by providing menstrual health education at school. Without learning about the menstrual cycle at a young age, conditions such as endo will continue to go unrecognised, marginalised and misunderstood.
Secondly, although there are three specialist centres for endo in Scotland, the all-party parliamentary group on endometriosis found that because those services have been commissioned at a local level, it can sometimes be difficult to get referrals to the different health board areas in which those services are based. It cannot just be a postcode lottery. My colleague Rachael Hamilton MSP recently called on the Scottish Government to present a credible plan for how to reduce their own waiting time target for diagnosing endometriosis from eight years to less than one year, and I eagerly await the publication of that plan.
Finally, I am absolutely clear that more can and should be done to improve research into this condition that affects so many women and the way they live their daily lives. I therefore support calls to ensure that funding is directed towards new research into the diagnosis and treatment of this terrible illness, ultimately focusing on a cure.
To conclude, I thank the petitioners for securing this important debate, and the team at Endo Borders for the invaluable work they do to support women suffering from this terrible condition.
It is a pleasure to serve under your chairmanship, Mr Mundell, and I congratulate the hon. Member for Coventry North West (Taiwo Owatemi) on opening the debate so ably. As she noted, on average, it takes eight years for a diagnosis of endometriosis to be made. Unfortunately, in Wales it now takes nine years on average, compounding the suffering of people who suffer from marginalisation and poverty in their communities in many parts of Wales. It is essential that that be addressed as soon as possible by the Welsh Government.
I also thank my constituent Kate Laska, who for a number of years has been a tireless campaigner for greater support for those who suffer from this condition in Wales. She has shown remarkable determination and has been working essentially alone on this matter. As part of her campaign, Kate has pushed for menstrual products to include labels that list their ingredients. Men and women—everyone—deserve to be empowered with vital information about the products they use, and to be assured of their safety; menstrual products are no different. Is the Minister aware of any ongoing discussions on that issue with the Office for Product Safety and Standards? I am not drawing attention to the issue to raise undue concerns, but my constituents would certainly be glad to be reassured that it is receiving proper attention.
Caseworkers also highlighted the lack of specialist support available in north Wales, which means that lots of patients have to travel across the border, to the excellent Liverpool Women’s Hospital, to have attention. The long distance to travel is, of course, a further burden. There is also, I am afraid, an almost complete lack of service through the medium of Welsh. The ability to discuss a condition of this nature in the patient’s language of choice is a particular issue, and not only in Wales but throughout the UK. I do not know how much attention that matter has had, but I draw it to the attention of the Minister.
Endometriosis is not just a health issue for those with the condition. It is debilitating, there is a lack of support and, as hon. Members have mentioned, statutory sick pay is available to an employee for a maximum of only three years. That penalises those with chronic long-term conditions such as endometriosis and others. Many of those severely affected have struggled to access personal independence payment and universal credit. Clearly, we need more understanding and education—specifically, more research. I end by quoting Kate Laska, who told me:
“Women with endometriosis suffer in silence and very often alone because no one around them can imagine their pain.”
It is a pleasure to serve under your chairmanship, Mr Mundell. I thank the hon. Member for Coventry North West (Taiwo Owatemi) for securing and leading this important debate. More importantly, I also thank the hon. Member for Streatham (Bell Ribeiro-Addy) for her own personal story, which I found very moving. In common with everyone else in the Chamber, it would be remiss of me not to mention Sir David Amess and the very important work that he did as chair of the all-party parliamentary group.
As we have heard, endo affects one in 10 women in the UK. It is a common, chronic, complex and fluctuating condition that brings about unimaginable pain. Like many Members here, I first found out about endo shortly after I was elected; I had never heard of it before. It was in a constituency surgery, where Katie came to meet me. She talked about her debilitating pain, the impact on her mental health and her endo sisters who were taking their own lives because of the pain while awaiting treatment. She described the gaslighting she had to go through—“It’s just a bad period.” That is just the norm for anyone suffering from endo, and we should all be ashamed of that.
It is clear from today’s debate, from previous debates and from constituents across the UK that, despite the severity of the condition, it is still taboo to talk about women’s health and gynaecological conditions. I remember speaking in last year’s debate on the Cumberlege report. It is a damning and concerning fact that we talk about and listen to women’s health issues only when men talk about them. Many in this Chamber have been giving their own personal stories, and I fear that we are at risk of still not truly understanding the issue because men are not talking about it. We spend so much more money on erectile dysfunction than on endometriosis—that shows where our priorities are.
Workplace attitudes often do not help. We have heard the stories over and over again in the House when it comes to endo: women are often not believed or supported by doctors, employers or even loved ones. It is shocking that in 21st-century Britain women are still being dismissed as lazy, unreliable, dishonest and a nuisance in the workplace. In the 2020 BBC survey on endo, almost all the women responded by saying that they felt that their careers had been hampered by having the disease.
If appropriate workplace support for employees suffering from endo and polycystic ovary syndrome is to be obtained, we need business leaders and managers to be equipped with the necessary information and knowledge to be compassionate when dealing with these cases. We should begin by encouraging employers to become endo-friendly, making sure that there is access to support for all those who suffer from it.
The current definition has been highlighted by the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy). Unfortunately, endo sisters do not qualify for statutory sick pay because the condition is long-lasting and chronic. That is something we can quite easily and quickly fix. We have already heard that before covid it took, on average, eight years to be diagnosed with endometriosis. That backlog will only have become worse. We need to factor in GPs’ ability to understand the condition better. We can do so much more, and we have a duty to do so.
In conclusion, endometriosis costs the UK £8.2 billion per year through treatment, healthcare costs and the impact on work and employment. We need to deal with this, and not just from a financial perspective but from a moral one.
It is a pleasure to speak in the debate with you in the Chair, Mr Mundell. I thank my hon. Friend the Member for Coventry North West (Taiwo Owatemi) for the way she opened this important debate.
Endometriosis and polycystic ovary syndrome affect one in 10 women and those assigned female at birth in the UK. As we have discussed, that means that over 1.5 million individuals are enduring a painful condition that can affect every aspect of their life. It is staggering that these conditions are so under-recognised. Common symptoms for a diagnosis include severe pain and heavy bleeding, but for those who have these conditions, that description barely scratches the surface of the reality of living with such a severe gynaecological disease.
One constituent wrote to me with a powerful testimony about her experience of living with polycystic ovary syndrome. She told me of the wide range of debilitating symptoms of her condition. She felt lacking in confidence and scared for her health and future. She felt that no one understood her, and she felt alone and overwhelmed by the condition. Constituents who have contacted me about endometriosis or PCOS report significant diagnosis times of between four and 14 years. This is an unacceptable amount of time for patients to wait while not getting the right care or even having a name for the condition that is causing their symptoms.
I had endometriosis and it had a big impact on my life. I was not diagnosed until the age of 32. I had multiple surgical interventions over more than 10 years. Surgery, as we have heard from my hon. Friend the Member for Streatham (Bell Ribeiro-Addy), does not cure endometriosis; it just comes back and back. Delays in diagnosing and managing endometriosis and PCOS can affect quality of life. Worse than the impact on quality of life, they result in a dangerous progression of the disease.
We have all touched on the work of the all-party parliamentary group on endometriosis, and I join Members in paying tribute to the work of Sir David Amess as its chair. There was an excellent report produced following an inquiry. I recommend that report and its 34 recommendations to the Minister, particularly those on investment in further research into gynaecological diseases, so that the waiting time for diagnosis can be reduced.
To these recommendations, we must now add the need to address the gynaecology backlog made worse by the pandemic. NHS England data indicate that the waiting list for gynaecology services has seen the largest increase of all the specialties since the pandemic began. Endometriosis UK’s recent survey showed that four fifths of patients with confirmed or suspected endometriosis had had NHS appointments for their condition postponed or cancelled due to the pandemic, and a third had not been given a new appointment date.
Sarah Lambrechts told the Health and Social Care Committee about her experience of having surgery for endometriosis delayed due to the backlog caused by the pandemic. The delay is, in her case, going to be for 18 months to two years. She said:
“I am 25 years old. For the next 18 months or two years—however long—I cannot plan my life. I cannot plan my career progression. I cannot plan to have a family. I cannot take care of myself some days.”
It is very sad that Sarah and thousands of others have experienced such an impact from the disease. We need urgent action so that those who have lived with the debilitating symptoms of endometriosis and PCOS for so long are not suffering because of a long wait for treatment caused by the backlog in NHS care. We owe it to those who have lived with these symptoms, often for many years, as I did, to reduce diagnosis time, improve treatments and, eventually, find a cure.
I associate myself with your comments about Sir David, Mr Mundell, and those of other hon. Members present. Sir David and I shared a passion for animal welfare and for women’s health, so I put on the record my thanks for all his incredible work to raise awareness of endometriosis. Among many other things, that is Sir David’s legacy and a testament to him as a fantastic campaigner.
As my hon. Friend the Member for Coventry North West (Taiwo Owatemi) rightly said, endo and PCOS are two gynaecological conditions that affect roughly one in 10 women—10% of all women or all those assigned female at birth in the UK today. Some 1.5 million people live with endometriosis and deal with symptoms ranging from chronic pain and fatigue to infertility.
Yet our research and awareness of these conditions still lags behind. We have already heard at length that the average diagnosis time for endometriosis in the UK is almost eight years. For women dealing with those symptoms and living with that pain, that is simply not good enough. In the worse cases, I am aware of women who have been told that the symptoms that they are experiencing and the debilitating pain that they are living with—like my hon. Friend the Member for Streatham (Bell Ribeiro-Addy)—are a normal part of life or that they are somehow imagined or exaggerated.
Women with endometriosis have double the risk of infertility of other women, yet many report receiving little information from their doctor about the impact of their diagnosis on their future ability to have children. They are just told, “Try and have a baby; it might help.”
It is clear that the debate comes at a fortunate time, given that today marks the start of National Fertility Awareness Week. Sadly, many women with endometriosis and PCOS have been left under the impression that they will struggle with their fertility, even though research from Endometriosis UK suggests that 60% to 70% of people with the condition can get pregnant spontaneously. As someone who has experienced infertility, I know at first hand how difficult, challenging and upsetting such news can be.
Many women have struggled to get access to the care they need to understand and manage their fertility, and have been baffled to find out that, due to a lack of research, the link between endometriosis and fertility is not properly understood. National Fertility Awareness Week is an important opportunity to raise the issue and I would be grateful if the Minister could outline what steps her Department will take to ensure that people with PCOS and endometriosis understand the impact of their condition on their fertility.
The petition rightly calls for greater research into cures and treatments for endometriosis and PCOS, and I look forward to hearing from the Minister what actions her Department will take to support that work. I know of women who do not want children who have felt that their pain and symptoms were not being treated seriously by medical professions simply because they were not directly related to fertility.
Not only can the symptoms have a major impact on people’s quality of life, but there is also evidence that they have a major impact on women’s ability to get on in the workplace. As we have heard, women experience a lack of understanding from employers, from an outright dismissal of their illness as “women’s problems” to losing their jobs for taking too much sick leave. Greater research and understanding of endometriosis are vital, as is education on the condition and its impact.
For too long, women’s health has not been taken seriously. Although I am glad that progress has been made in Wales and across the UK, as outlined by my hon. Friend the Member for Coventry North West, we still have a long way to go to ensure that conditions such as endometriosis and PCOS are taken seriously and understood not just by medical professions but by everyone from employers to teachers. For the 1.5 million women living with these conditions, we cannot afford to wait.
I appreciate your fitting me in, Mr Mundell, and I apologise for being unable to bob throughout the proceedings. Two hon. Members—the hon. Members for Thurrock (Jackie Doyle-Price) and for Livingston (Hannah Bardell)—have asked, “If 10% of men were in this situation, would it be the same?” It is a fair question, and the right one to ask. I am sad to say, as a man, that the answer is not one that we in this House should be proud of.
I say that honestly and honourably because I knew little of endometriosis or polycystic ovary syndrome, like the hon. Members for Bury South (Christian Wakeford) and for Berwickshire, Roxburgh and Selkirk (John Lamont). Like other hon. Members, I have learned an awful lot through the strength and courage of the individual constituents who have come to see me and share personal and intimate information, around which there is a taboo.
One lady, whom I have known for more than 10 years, only told me in the last two weeks that, at 16 years old, she found herself before the GP with a suspected diagnosis of endometriosis and was advised that it would be a great help if she were to have a baby. No GP should look a 16-year-old in the eye and suggest that pregnancy is the answer to a medical condition, yet that was the experience she had. One constituent was put on an urgent waiting list in 2017; she is still awaiting surgery for her condition. She was a care worker. Care work is a physically demanding job, so she had to stop. She applied for universal credit, but was turned down and advised to find work in a more manageable setting. That is not good enough.
I am therefore encouraged to hear about the work of the APPG on endometriosis. I would be keen to get more involved. I am here because of the stories that have been shared with me. What is happening is harrowing and wrong. The Minister is not responsible for our devolved nations, but I like to think that here at Westminster there is that convening authority across our United Kingdom. None of our trusts in Northern Ireland is accredited for surgery in this respect—none of them. The Western Health and Social Care Trust was—that is Londonderry, the second largest city in Northern Ireland—but it has lost its accreditation. The Belfast Health and Social Care Trust was on its way to getting accreditation, but because of coronavirus and no surgery, it cannot get accredited; it has no plans to do so. I asked the question, “What are you doing with patients who need help?” And the answer was, “We are not referring individuals on at this time.” I therefore ask the Minister: across Scotland, England, Wales and Northern Ireland, if there are services available and our constituents could use them from Northern Ireland, please make them available. Please find out the exact state of play across the trusts and across the four nations and provide the assistance that these ladies so desperately need.
It is a pleasure to serve under your chairship, Mr Mundell. I am grateful to the hon. Member for Coventry North West (Taiwo Owatemi) for leading this important debate so powerfully, and to all the women—so many women—who signed the petition, including the 241 in my constituency of East Renfrewshire.
Endometriosis and polycystic ovary syndrome affect so many women, yet we hear so little about these conditions day to day, so this debate is really important, because it allows us to focus on areas such as research, where I will be seeking assurances from the Minister. It is really important, too, that this afternoon we are shining a light on these conditions and helping a bit by letting people know about the reality and the challenges of daily life for women who are affected.
I will not speak a great deal about endometriosis today, not because it is not important—it absolutely is—but because colleagues from across the Chamber have spoken so knowledgeably and eloquently. But I would first like to echo what others have said about Sir David Amess and the huge contribution he made. And I would like to reflect on a few things that we have heard that bear further examination.
My hon. Friend the Member for Livingston (Hannah Bardell) spoke so eloquently about the support of women campaigners. I really take my hat off to women like that. They are amazing people. The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) noted the importance of recognising the mental health impact of both these conditions. And we have heard from hon. Members across the Chamber about the impact on people’s working lives. But I think the hon. Member for Streatham (Bell Ribeiro-Addy) spoke most powerfully. She spoke so well about her own experience—a really hard experience—as a woman with endometriosis. I hope that the Minister is able to reflect on that in the context of her response and the need for research.
I want to concentrate today on PCOS. I have been contacted by several constituents who have PCOS, and I have PCOS myself. Like many women with PCOS, I have not really spoken it a great deal—and to be perfectly honest, I had not intended to speak about it in the context of my work. It is a personal thing, but I decided that I would speak today because the silence around this condition really has to change. So many women are affected by PCOS, but so little is said about it, written about it and, frankly, known about it. We really need to shine a light on this condition and to push for far greater understanding and a far greater commitment to the research that can make a difference.
I was diagnosed with PCOS about 20 years ago, but to be honest, even though I initially spent quite a lot of time trying to research it myself, that was difficult, because much of the information that women would want to find and anticipate being able to find does not actually exist, because of the glaring lack of research. Like so many other women with PCOS, I have been in the dark most of the time, just because there is not enough understanding out there of this condition, which has certainly impacted on my day-to-day life.
I see that the Royal College of Obstetricians and Gynaecologists has helpfully put this in a nutshell for us all. It has established that less than 3% of the overall medical research funding in the UK is focused on women-specific diseases, such as endometriosis and PCOS. They are holding back women’s health outcomes and experiences and holding back our lives, yet that is the kind of priority—less than 3% for women-specific diseases—that these conditions are given. I reflect again on what the hon. Member for Streatham described.
I am pleased that the new Scottish Government have in their first 100 days published a new women’s health plan that includes several actions to improve access to appropriate support, speedy diagnosis and the best treatment for endometriosis. That is practical progress, and I hope it will have a knock-on effect for PCOS. That kind of practical action is really important and will make a difference to people’s daily lives, but we are working with one hand tied behind our backs if we do not focus on the dearth of research on, and lack of conversation around, both these conditions.
That is one call from Verity, the national PCOS charity, which does a fantastic job despite being volunteer-run. Those volunteers deserve our grateful thanks for their work and focus. We might want to take a wee minute to wonder why this condition, which affects up to 10% of women, has to rely on volunteers, however professional, influential and brilliant they are—they are all that. That is not illustrative of a collective appreciation of the harm PCOS causes daily to women throughout their lives.
The fact is that, like endometriosis, the cause of PCOS is unknown, and there is no cure. That can be quite devastating to hear, because as we have heard, some of the symptoms can have a significant impact on daily life—on what we would call normal life—and in a variety of ways. Bear in mind that some women will experience multiple issues once, including irregular periods, or a complete lack of periods. Again, that is not a topic I ever thought I would touch on at my work.
Does my hon. Friend agree that her speech and that of the hon. Member for Streatham (Bell Ribeiro-Addy) show the very reason why diversity in our Parliament, including women who will come forward and be so brave as to share their personal experiences, is absolutely crucial?
My hon. Friend is right: we have to listen to women’s experiences, and I think the hon. Member for Bury South (Christian Wakeford) referenced that too. That really matters here. I never imagined talking about my experience of menstrual irregularity, ranging from nothing at all to a full, continuous six months of periods, which was both debilitating and, frankly, somewhat concerning.
It is fair to say that these are the kind of challenges that women would really rather do without. We heard about the irregular nature of fertility, including irregular ovulation, or no ovulation, which is an issue for women with PCOS, who of course probably do not know that until they find out that they are not pregnant when they are trying to be; reduced fertility—difficulty becoming pregnant—can be the reason why many women become aware that they have PCOS. That was certainly my experience, and it explained many other things. I may have a wee glimmer of light in what is possibly a quite depressing contribution: I have two amazing sons thanks to just a wee bit of PCOS-related medical assistance.
I can tell hon. Members, as we heard so eloquently from others, that women with PCOS can have a difficult time in many ways, particularly with issues such as hirsutism—unwanted facial or bodily hair. I cannot emphasise strongly enough how women are influenced by this. Again, there is no solution. Imagine the impact on the self-esteem of young women in particular. However, PCOS does not only affect young women, and young women are not alone in facing a severe impact on their life from these kinds of issues. None of us wants to sprout a beard, feel unable to go swimming or have to cover up from head to toe. Noting symptoms as oily skin and acne do not really cover the magnitude of those either.
PCOS is often assumed to related only to fertility, and that is a big issue, but all these other issues affect how the world sees us and how we present ourselves to the world. Thinning hair—male pattern baldness, basically —2014 is crushing to have to deal with. Being overweight is so common among PCOS-affected women because our bodies metabolise differently. For some women, that has a significant impact on both their health and on how they interact with the world. There are also depressions and mood changes. If I went through everything, we would be here all day. So many things have a connection to PCOS but, again, we cannot say exactly what or why because the research is not there.
As a younger woman with no idea of where to go for support, it was heartening to hear of women, such as the hon. Member for Streatham, speak about communities supporting one another. That is really helpful when diagnosis is not straightforward or where the issues are not resolvable, but we need to do better than that DIY approach. For young women and teenagers, it is rubbish in the age of Instagram to have to deal with unexplained weight gain or hair growing where it should not, and worries about the future. As for menopause, I have no idea what it will mean, but I would certainly like to know. When I looked into aging women, the best I could establish is that it is thought to be a medical black hole. That is simply not good enough, and that is why research is needed.
To conclude, I thank all the women who have been in touch with me about this matter—so many of them. I thank Verity PCOS and my constituent Anji Sandhu, who is in the process of setting up a group to raise awareness of PCOS and its challenges so that we can talk about it more. That will help because so many women are affected and rely on us here to take it seriously. At the moment it feels to them like a big, dirty secret, and that is what needs to stop. That is why we need research, and I hope that the Minister has something positive to say on that.
Mr Mundell, you talked about doing justice to Sir David’s memory. Like possibly everybody in this place, my friendship with David was one that was funny and light. I loved how serious and passionate he was about the issues that he cared about, so I think we have done justice to his memory today. Everybody can be proud of that, none more so than my hon. Friend the Member for Coventry North West (Taiwo Owatemi), who, as she said, could have talked dispassionately about this issue, but it was much better for her not having done so.
Similarly, I always have pride and admiration for anybody who goes down the petitions route to secure a debate in this place, because it is very hard to do. The fact that they have been successful demonstrates the strength of feeling. If that petition came from a place of frustration that these two conditions, endometriosis and polycystic ovary syndrome, lack public prominence, I hope this debate is a part of tackling that and that they take pride in that.
There were too many contributions to cover individually, but in aggregate colleagues have written for the Minister a manifesto for where to go next. There were common themes—a desire for better diagnosis and better understanding in primary care—and strong themes around the desire for more research and better support at work or through the welfare system. I hope the Minister will take from that four very concrete things that can be done quickly and can be focused on.
There were contributions that I did not want to miss, particularly from my hon. Friends the Member for Streatham (Bell Ribeiro-Addy) and for Worsley and Eccles South (Barbara Keeley), and from the hon. Member for East Renfrewshire (Kirsten Oswald), who talked about their personal experiences. I hope that the many people watching this, either in the Public Gallery or online, who are themselves experiencing these conditions, took some comfort from hearing about the lives of their representatives and how brave and willing they are to tell their own stories, which really enriched the debate.
My hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) and the hon. Member for Livingston (Hannah Bardell) are the new co-chairs of the all-party group on endometriosis. We can have a lot of confidence in their leadership of that important parliamentary group. They brought hope in their contributions, so that gives us optimism for the future.
Before I make a couple of points of my own, I want to reflect on the points made by the hon. Member for Thurrock (Jackie Doyle-Price) about the gendering of healthcare in this country. Once again we saw great parallels from the debates following the Cumberlege review and the same messages coming back. To be clear, Mr Mundell, there is a one in 10 chance that either of us might present to our GP with erectile dysfunction. I know for certain that the GP would not say to either of us to come back when we wanted to have a child, and they certainly would not suggest removing the offending organ. Just as we would not tolerate that attitude, we should not tolerate it for anybody in this country.
Turning to endometriosis, Sarah Harris is a 23-year-old freelance journalist from my city of Nottingham, who has written about her experience. I will read a couple of paragraphs because they explain powerfully about life with endometriosis. She wrote:
“It’s hard to remember a time in my life where I wasn’t in pain. Memories of my youth are intertwined with flashbacks; hiding in toilets as blood soaked through my primary school uniform, curled up on the floor of the nurse’s office during secondary school whilst clenching my stomach in agony, skipping lectures in the first few weeks of university as I changed my sanitary pad for the third time that hour.
For a long time, I thought this life was normal. After all, from the age of 12 onwards doctors had been telling me that this was all just a ‘part of being a girl’ and I had to ‘deal with it’. By the time I realised this life was in fact far from normal, it was too late.”
Sarah’s story is not unusual. We have heard that the average diagnosis takes about eight years. Last year’s parliamentary inquiry found that nearly 60% of those with symptoms who were later diagnosed with endometriosis had visited the GP more than 10 times; one in five had had 10 or more hospital appointments; more than half had gone to accident and emergency, and one in four had gone more than three times—all of that happening before diagnosis. That is a real system failure. To put it in pounds and pence—if we really have to—that is more than £8 billion a year, through treatment, healthcare and the impact at work. It is a very significant challenge which behoves action.
Similarly, PCOS affects one in 10 women. We know that while there is no cure, there is treatment. PCOS can exacerbate long-term health conditions such as cancer and type 2 diabetes and, similarly to endometriosis, diagnosis can take many years. There is evidence of a genetic link and, as my hon. Friend the Member for Coventry North West said, a higher prevalence in certain ethnic groups, such as black and south Asian women. Again, it is something that Parliament ought to get a grip on. Those significant challenges are happening at a population level. As I said, the common theme is that it happens to women and those assigned female at birth.
We are currently debating the Health and Care Bill in Committee, which resumes for the final day tomorrow. We have discussed issues such as women’s health, reproductive health and the Cumberlege report on multiple occasions. There is nothing in the Bill on those issues and, I am sad to say, our amendments have not been accepted. What I have heard consistently from Ministers is that the women’s health strategy is coming and that action will be taken through that. I hope that the Minister in closing will make that commitment herself, because an awful lot of people are putting an awful lot of stock in that strategy.
I particularly hope that we will hear a commitment on research, because women’s health is under-researched. The “UK Health Research Analysis 2018” report showed that only 2.1% of publicly funded research in the UK was on reproductive and menstrual health, which is less than half of what it was in 2014. Of the more than 8,000 research projects funded by the National Institute for Health Research—an outstanding body—10 were on endometriosis and one was on PCOS. There is clearly significant space to do much better on research in this country. Only last year, the Australian Government committed $9.5 million to that research—we need that sort of ambition in this country as well.
I want to leave the Minister plenty of time to come back on all the important points that have been raised, so I conclude by saying that I think colleagues have written a really good manifesto for her. We want better diagnosis, better understanding in primary care, more research and better support at work or through the welfare system.
I thank the hon. Member for Coventry North West (Taiwo Owatemi) for securing the debate, as well as all the petitioners who made it happen. I join everyone in paying tribute to Sir David Amess; I know he would have been here, holding my feet to the fire on what I was going to do about the important issues that have been raised.
Members on all sides of the House have spoken about the challenges faced by women suffering from endometriosis and PCOS. I pay tribute to the hon. Member for Streatham (Bell Ribeiro-Addy), who could not have put it better on not only the struggle for diagnosis, but the trauma of going through treatment. That is not an uncommon experience, unfortunately. There are serious issues to address. As my hon. Friend the Member for Thurrock (Jackie Doyle-Price) said, the conditions affect a significant number of women across the country. We are not talking about a small problem; its effects are on a wide scale.
Members have spoken about the pain, the heavy periods or lack of periods, and the facial hair or hair loss. However, it is about not only the symptoms, but the long-term implications. Fertility is an issue for both conditions, but they also affect relationships, the quality of life and mental health. The effects are wide-ranging.
It is unacceptable that the average diagnosis time for endometriosis is seven to eight years and that 40% of women take 10 or more appointments even to get to the stage of getting tests done and being diagnosed. It is imperative to have a greater focus on women’s health and to address some of those inequalities.
Although hon. Members have rightly said that this is not just about fertility, if it is about fertility for some women, those seven to eight years may be the only chance they have. That is seven to eight years too long. That is why we are embarking on England’s first women’s health strategy, which will set out a new agenda. I can confirm that it will include a section on gynaecological conditions, including endometriosis and polycystic ovary syndrome, and it will look at the research element. In the short time I have, I cannot expand too much, but I will announce more details shortly, because we hope to publish that before the end of the year.
I know that many, many women, men and families will be listening to this debate, and I want to put it on the record that I hear the concerns and issues that are being faced. I have my listening ears on and we will be taking steps to deal with some of the issues. The NICE guidelines on endometriosis are really clear. They list the symptoms that should be picked up and addressed, and that should alert healthcare professionals to the need to refer women, not gaslight them. It is concerning that, despite the NICE guidelines, many women are struggling in the way that they are. For PCOS, the clinical knowledge summary highlights symptoms that should be picked up and that should be flags for referral and care.
I take the point of the hon. Member for Belfast East (Gavin Robinson). We heard from the hon. Member for Arfon (Hywel Williams) that, when there are issues in Wales, women can access services in Liverpool. I am happy to meet the hon. Member for Belfast East to see what options are available for women in Northern Ireland.
In the short time I have, I want to turn to research—the subject of today’s debate. We have a world-class research system, as the vaccine rollout has shown, but we know that women are under-represented generally in research, whether that is older women, women from ethnic minority groups, women of childbearing age or women with disabilities. There is evidence that research is not addressing women’s issues. It is crucial that we have an evidence-based approach to dealing with endometriosis and PCOS because that is how we will ensure that the gold standard of treatment is being followed and that women know what they should expect. That is half the problem: women are in the dark about how they should be treated and their condition managed.
Funding is available. Over the past five years, the National Institute for Health Research has funded £8.52 million of endometriosis research. There is a £2 million trial on peritoneal endometriosis, looking at surgery versus non-surgical interventions to manage chronic pain. There is a study of endometriosis in primary care and the experience of both GPs and patients to see what is going wrong at the diagnosis stage. A practical toolkit has been put together to help patients and clinicians. We are also funding a study interviewing up to 80 women about what it is like to have a urogynaecological condition and the experiences they go through. There is £6.65 million of research into PCOS, including a £2 million randomised control trial looking at fertility options for women whose eggs are not being released from their ovaries.
Research is happening. My plea to researchers is that funding is not the barrier. There is a really robust system whereby research is presented, whether from clinicians, researchers, charities or other organisations, and judged on its merits in terms of what it is trying to achieve. The funding envelope is not the barrier. I encourage those who want to do research to come forward. If that is not happening, I am very happy to work with the APPG to find out where the gaps are and, if the research is not being accepted or funded, where we can do better.
The Minister has not yet covered the serious point I made earlier about the backlog in gynaecology. Some 80% of women who are confirmed or suspected to have endometriosis have had their NHS appointments postponed or cancelled because of the pandemic. In my remarks, I quoted somebody who will now have to wait 18 months to two years for her surgery. That is not acceptable.
I absolutely take the hon. Lady’s point. In the spending review, money for elective procedures was allocated to clear some of that backlog. People are waiting a long time, and every effort will be made to clear the backlog as soon as possible.
I reassure colleagues that we want to ensure not just that there is an evidence-based pathway for both endometriosis and PCOS in the NICE guidelines, but that it is followed in clinical settings, so that women know what to expect; in clinical education, to improve both undergraduate and postgraduate training, so that clinicians have the knowledge that they need on both conditions; and in primary care, to ensure good robust knowledge among GPs about both conditions, which are not just about bad periods or abdominal pain, and about the referral pathways that should be followed. On school education, it is so important that young women know what is and is not acceptable in relation to both conditions, so that they are pushing GPs rather than waiting seven to eight years for diagnosis or 10 to 12 appointments for an answer.
Research can make a real difference in a number of areas. Before I hand back to the hon. Member for Coventry North West, I reassure colleagues that funding is available. I urge all researchers who want to conduct research in this area to submit applications and bids, because there is no way that we will deal with many of the issues that have been raised today without them.
I thank all hon. Members who have spoken so passionately in this important debate. I look forward to hearing from the Government about their strategy to make funding for endometriosis and PCOS more readily available, and about how their strategy to improve research on women’s health will establish well-supported and dedicated funding bodies for both endometriosis and PCOS research.
I will highlight some of the many important remarks made during the debate. My hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) underlined the fact that we do not know what causes endometriosis and that we need dedicated funding to determine the cause of the condition. I completely agree with the hon. Member for Thurrock (Jackie Doyle-Price) on the crucial point about the need to destigmatise and demystify many of the symptoms associated with endometriosis and PCOS.
Finally, I thank my hon. Friends the Members for Streatham (Bell Ribeiro-Addy) and for Worsley and Eccles South (Barbara Keeley), as well as the hon. Member for East Renfrewshire (Kirsten Oswald), for their powerful stories, which illustrated better than statistics or figures ever could the need to support women who suffer from these conditions. Simply put, we need more funding for research into endometriosis and PCOS so that we can combat both. I thank every Member who participated in the debate.
Although I am sure that Mr Norris was correct in saying that Sir David would have been pleased with the terms of the debate, as the Minister said, I am sure that Sir David would also have been holding her feet to the fire afterwards.
Question put and agreed to.
That this House has considered e-petition 328570, relating to research into endometriosis and polycystic ovary syndrome.
Carbon Emission Charges
[Mr Laurence Robertson in the Chair]
Before we begin, I encourage Members to wear masks when they are not speaking, in line with the current guidance from the Government and the House of Commons Commission. I remind Members that the House asks that they have a covid lateral flow test twice a week if coming to the parliamentary estate, either at the testing centre in the House or at home. I also remind Members to give one another and staff plenty of space when seated and when entering and leaving the room.
I beg to move,
That this House has considered e-petition 574678, relating to charges on carbon emissions.
It is an honour to serve under your chairmanship, Mr Robertson.
The world’s eyes are on the UK for the COP26 climate change conference. Indeed, many Members wanted to contribute to this debate but are at the COP26 climate change conference, making these arguments directly, I am sure. Tackling climate change can sometimes feel like such an enormous and challenging task that we just do not know where to start. It can also feel a little too abstract to cut through people’s day-to-day concerns about their jobs and the cost of living.
I want to start with a reminder that while meeting our climate goals is certainly challenging, it is very achievable. Thanks to the Climate Change Committee, we can put concrete figures on the cost of the transition. The committee estimates that we must raise investment in low-carbon technology by around £50 billion per year over the next 10 years. Most of that will come from the private sector, and will go towards meeting the Government’s 2050 target. It sounds like a lot, and the Government will need to take the lead on it, but it works out at less than 1% of GDP over the next 30 years —around an eighth of the current annual investment.
As the Government’s net zero review consistently points out, the upfront cost of meeting the net zero target is dwarfed by the cost of not acting. Government and Parliament have committed to that transition. It has been legislated for and it must happen. We know the cost of achieving net zero is manageable with the right support. We also know, however, that the impact of the transition will not be felt equally across the economy or society. Because of the confusing array of climate policies currently in place in this country, it can be difficult to determine where the impact will be felt and to what extent. There is a great deal of uncertainty around not just the development and impact of low-carbon technologies, but how to design policies and the unequal effect that they will have on sectors and households.
Carbon emissions and the climate change they cause are a classic example of market failure. Individuals and businesses do not face the full cost of the emissions that they create; all else being equal, we would expect them to emit more than is optimal for society. For some time, economists have argued that the answer is to put a price on emitting greenhouse gases, so that individual firms face the full cost of their choices.
In its simplest terms, the petition calls for the Government to work towards a single carbon price across almost all sectors. The campaign argues that a single carbon price would amalgamate the many existing price instruments, including the carbon price support and the UK emissions trading scheme—a different form of carbon charging—into a simple, transparent carbon charge. Zero Carbon points out that our current policies cover emissions across only about a third of the economy, giving the biggest polluters free allowances while the consumers are left to pay. I pay tribute to the petition’s creator, Isabella Goldstein, who is the senior campaign manager at the Zero Carbon campaign.
The theory behind this form of carbon charging is straightforward. If we had, for example, a single carbon price of £75 per tonne of CO2, it would incentivise people and businesses to pursue any methods of emission reduction that cost less than £75. Hon. Members will be aware that we are far from having a single carbon price across sectors. Instead, we have a patchwork of policies that incentivise or disincentivise emissions in ways that are often unclear. While overall they have the effect of, for example, discouraging the burning of fossil fuels, the cost varies hugely depending on the source of the emissions. It is argued that the key benefit of working towards a uniform carbon price is that it avoids a situation where some sectors face higher carbon prices, and must therefore make more expensive carbon reductions, while others could more easily and cheaply reduce their emissions but do not.
To be successful, a carbon charge must be accompanied by extensive investment in low-carbon technologies. The state—the Government—would have to lead on that. It would, by and large, leave businesses and households to decide how best to reduce their emissions in the most efficient way possible. It would not affect everyone equally.
However, I know that the petitioners do not advocate a purely market-based approach. When I spoke to Hannah Dillon, the head of campaigns at Zero Carbon, one of her biggest concerns was that we design policies to tackle climate change in a fair and equitable way. However, it is not just about the principled argument for fairness; ensuring that the most adversely affected are supported is crucial in maintaining public and political support for net zero. An obvious answer is that charges aimed at tackling climate change would also raise revenue, and the revenues could be used to compensate the groups that are most adversely affected.
However we address this issue, it is essential that the Government set a clear path for policy, and introduce support through our social welfare system to give households and businesses time to adjust. This is a complex and difficult policy area, and it will have a huge impact on our living standards for decades to come. Therefore, decisions must be taken with care and be subject to proper scrutiny. We must all accept the urgency of the climate crisis, and the need to take action as soon as possible.
Another key challenge relates to the emissions embedded in imports. In line with international practice, emissions in imported products are simply ignored for the purposes of our climate targets. Research from the World Wildlife Fund suggests that almost half of the UK’s emissions come from this source. In theory, we could reach net zero on paper even if our consumption of imported goods led to a higher level of global emissions. The lead petitioners have called on the Government to address this issue with carbon border adjustments, which ensure that there is a price to pay for carbon-intensive imports and shield UK competitors who do not face equivalent charges. I know that this is something that the EU is working on. It will take some years to implement, but without some form of carbon adjustment at the border, there is a danger that UK climate policy could simply drive industry to locations with fewer restrictions, increase carbon-intensive imports to the UK and, ultimately, increase global emissions.
Before I conclude, I want to ask the Minister a specific question on the UK emissions trading scheme. The Government previously said that they would consult on the implementation of a net-zero-consistent cap for the UK emissions trading scheme. We know that it is supposed to happen this year, and it was referenced in the Government’s net zero strategy, but details on the timescales have been vague. When the Minister responds, will she tell us when that review is going to happen?
To conclude, all eyes are on the UK for the COP26 conference. The planet cannot wait, and this petition has underlined the need for action in three key areas. First, we need to facilitate the shift to low-carbon alternatives within households and ensure businesses take responsibility for the emissions they produce. Secondly, we must protect those who are most vulnerable to the unequal impact of climate policies. If we do not do so, not only will the outcome be regressive; it will undermine public support for the transition to net zero. Finally, we must take measures to stop carbon leakage. It would be catastrophic if we were to achieve net zero domestically at the expense of triggering a carbon-intensive import boom. This is our time to show that this country will lead, not lag, in the global fight against climate change, and I for one—joined, today, by over 100,000 petitioners—hope that we take it.
It is a pleasure to serve under your chairmanship, Mr Robertson, and to follow the speech made by the hon. Member for Newcastle upon Tyne North (Catherine McKinnell), the contents of which I very substantially agree with. One of the wonderful things about this debate is that it stretches across the divide that so often separates the views of people in this House.
However, I approach this matter from a slightly different perspective—albeit arriving at similar conclusions—because I see this as the role of the free market. As a former businessman and entrepreneur, I want to unleash the power of the free market to help solve some of the problems that its historical performance has helped create. Too often, the market has been seen as the villain. We talk about business profiteering at the expense of the environment, or businesses trashing the world’s resources, and that applies not just to carbon net zero but to biodiversity. As Professor Dasgupta noted in his report earlier this year, in terms of the biosphere our current practices are using the resources of 1.6 worlds.
It is true that historically, the market has been almost totally blind to the cost of carbon in its economic transactions. When I buy a product—such as this glass—I pay for the raw materials, the design process, the manufacturing, the marketing, the transport and the profit, but I do not pay for the cost of the carbon emission, because that is described as an externality: it dissipates into the atmosphere and there is no significant cost attached to it. The result of that misallocation of resources is that the transaction is incomplete. As a purchaser, I am not having a true economic exchange with the supplier, because I am paying for only part of the product, not all of it. As a result, there is no signal for consumers to look at two separate products and identify the differential cost between the manufacturing process of a high-carbon glass and that of a low-carbon glass. As consumers we are blind, so all those myriad consumer decisions that we take in our economy every day are ineffective in helping give a signal to manufacturers. The process does not provide a signal to consumers; and consumers, in turn, do not provide a clear market signal to entrepreneurs and businesses.
What are we left with? At governmental level, we all know that the climate change crisis is a huge problem, so we have plans from Government, who are picking technology winners by investing in hydrogen, for instance. I hope that hydrogen will be a key part of the solution in our progress towards net zero by 2050, but it might not be. The real problem is that we are currently relying on the Government to take those kinds of decisions because the market is substantially blind. We need to unleash its power through a price for carbon.
We know that markets are without question the most efficient decider that man has ever come up with for the use of resources. They do so not for moral but for wholly personal reasons: they wish to maximise profits, and the way to maximise profits is to minimise inputs. Properly directed by market signals, the market is the most efficient resource user we can come up with. It informs millions of decisions. Crucially, the market and its myriad transactions create the individual wealth that can go on to fund the additional Government action that the market alone is unable to provide. Although I am a free marketeer, I am not a free marketeer red in tooth and claw. There is absolutely a role for Government to set the structures and give the long-term signals for the free market, and to provide assistance and support for those left-behind parts of our community that otherwise would be disadvantaged by that process.
Our biggest challenge in creating a price for carbon is that the United Kingdom economy is not self-contained; we are part of a global economy. If we increase the price of carbon in this country, which is really another name for increasing the price of energy, that will have a very direct and immediate risk to our domestic economy, particularly our manufacturing base. Increasing the price of energy in our domestic economy would result in an increase in the costs of our manufacturing base, which would then either go offshore and relocate to a lower-cost environment abroad, or it would stay and get undermined by the sucking in of lower-cost, higher-carbon imports. That would result in the worst of all worlds: the destruction of our own economic base and an actual increase in greenhouse gas emissions as transport costs are added to the costs of production.
As an economy, we have been very timid in our approach to applying a cost of carbon. We do apply it in some sectors—about a third of our manufacturing base is affected in some way by carbon pricing through the emissions trading scheme. But that is only a third: two thirds of our manufacturing base has no carbon pricing attached to it at all, and none of this country’s imports are assessed or priced for their carbon content.
How do we address this seemingly impossible conundrum? The answer is, in principle, quite simple: a carbon border adjustment mechanism. That means that, at the edge of the economy, when imports reach the border, we assess those products for their carbon content and take a similar approach to that taken in the domestic market by applying a tariff. That is not protectionist in principle, because it would apply the same price and create a level playing field, as opposed to disadvantaging exports in favour of domestic manufacturing. It must also be transparent and within the permissible exceptions of the World Trade Organisation, which allows for tariffs in environmental cases.
This approach allows, in principle, for the increasing of the price of carbon for the domestic market, safe in the knowledge that imports will have a similar price attached. A lot of work has been done by think-tanks and others—and, I hope, by the Treasury and the Department for Business, Energy and Industrial Strategy —on how we can start applying this approach in practice. Conceptually, it is a very simple process, but it has the potential to be fiendishly difficult to apply. If we can apply it, the benefits would be enormous. The market signals would incentivise the reduction in carbon manufacturing processes that this country seeks to achieve.
The benefits would also expand beyond our borders. If a manufacturer in a third country—let us say, for example, in China—exports its product to the United Kingdom, they will not want to receive a significant tariff addition to the price of the product. The Chinese Government—or any other third-party Government—have a choice. They can think to themselves, “Well, we can either have a tariff applied to our exports, which then gets paid to the UK Treasury, or we can apply a similar process ourselves and keep the money here in China.” The third option is that they reduce their 70% to 80% reliance on coal for their energy, and reduce the differential between their carbon production and our own. All these are very positive international signals that we can spread beyond our borders through the imposition of a CBAM.
There is evidence that this is already working. On 15 July the European Union published a draft Bill to implement a carbon border adjustment mechanism throughout the European Union. Even before that has come to fruition—it is just at draft stage—there is evidence that automobile manufacturers in South Africa are already seeking to decrease the carbon content of their manufacturing process, because they are concerned that they will be adversely affected by the imposition of a CBAM in the European Union. Even the publishing of a Bill—a draft Bill—is already having real-world positive impacts on the reduction of carbon.
Another advantage is the potential for reshoring manufacturing production to the United Kingdom. It removes one of the current disincentives for high-energy or relatively high-energy production in this country because we do have a price for carbon through the ETS. That is not sufficiently significant to change consumer behaviour on a more widespread basis, which we wanted to do, but it is enough to provide a minor disincentive to have manufacturing in this country. If we can remove that disincentive, it will encourage reshoring. Research undertaken, I think by Capital Economics, into the steel industry in the United Kingdom has concluded that steel manufacturing’s international competitiveness would actually be increased through the imposition of a carbon border adjustment mechanism by between £50 and £75 per tonne through the 2020s.
In my submission, we have a political opportunity now not just with the advent of COP26, but, more significantly perhaps, with the publication of a draft Bill by the European Union. This gives us an opportunity to address one of the key challenges to a CBAM, which is how we deal with the concern or disapproval of large exporting countries that have a high carbon input—for instance, China. We have an opportunity to join forces with the European Union and have a more internationalist approach to the introduction of a CBAM now. It would not hurt given that, dipping into another language, we have a certain froideur across the channel currently, and sticking to the same approach, what about a bit of rapprochement?
There is a joint objective here. With Brexit, we are allowed to be nimble of foot. We can come up with these policies ourselves, and we are not held back by a pan-European approach. Equally, it does not prevent us from agreeing and co-operating with the European Union when it is in our national interests. I think this is a great example of where our national interests and those of the European Union coincide very neatly, and it gives us an opportunity to build bridges should we wish to do so. It also helps us with the potential approach to China, in that it is the entire European market that is taking—or potentially taking—this approach, as well as with the United States of America, which has expressed an increasing interest in the concept of some form of carbon border adjustment mechanism.
I mentioned earlier that CBAMs are simple in principle and hard to apply in practice. I am agnostic as to how we do it, and many different approaches have been suggested. We could expand on the current ETS. We could, as Mr Carney has suggested, take the key products that are internationally traded—steel, cement, aluminium, chemicals and so forth—and start on that basis, but then build out into the wider economy as we gain confidence and competence in the process of a CBAM. We could apply it by sector assessment by country, which would be more of a purist approach, but much more complex to apply. I suspect that the answer is to start small and to grow as we learn; but the sooner we start, the better. I conclude my speech by challenging anyone to come up with a way in which we can impose a price for carbon without some form of carbon border adjustment mechanism.
It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate the petitioners on bringing forward the petition and the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) on presenting the debate and making some key points. It is a worthwhile time to debate this subject, given that COP26 is taking place in Glasgow as we speak, and how we achieve net zero in the fairest way is something that needs serious discussion. It is a slight disappointment that there were not more Back-Bench contributions, but so be it.
I completely agree with the three key points made by the hon. Lady. Obviously, we need to generate the shift to low-carbon technologies, but it is critical that we protect the most vulnerable and stop carbon leakage. The hon. Member for Broadland (Jerome Mayhew) also made that point. He made an interesting contribution, and I will try to summarise it. I think he said that although he is a proud free marketeer, he is not really a free marketeer because interventions need to be taken. That is quite an interesting dynamic. He also seems very much to be a protectionist when it comes to imported goods—but again for the right reasons, because we are talking about carbon border adjustments.
It is possible that I was being slightly flippant when I used the word “protectionist”. I take his point that if we are going to do this correctly, it will have to be in collaboration with other countries. I agree with that.
If we believe in the basic principle that the polluter pays, a carbon tax makes sense. If we are serious about achieving net zero, we need to give serious consideration to carbon taxes. However, as has already been said, any such taxation needs to be fair. It cannot be structured in such a way that companies feel obliged or rewarded for relocating to other countries, therefore defeating the purpose. Critically, it must also not lead to the poorer in society paying a bigger burden, especially if a tax is levied on gas bills. The reality is that the more affluent will be able to switch to heat pumps, but those struggling to pay their energy bills will have no chance of doing so. We cannot leave the most vulnerable to pick up the carbon tab for others as the energy sector transitions to net zero.
The recent Government policy of £5,000 grants for heat pumps is still insufficient for most people to be able to afford the installation of a heat pump. The unit cost of a heat pump is still in the price range of £6,000 to £10,000. A £5,000 grant goes only part of the way, but it does not make up for all the additional work that is also required. We need to have proper energy efficiency measures, which are welcome but cost money, such as a new water tank, possibly new radiators, decommissioning boilers, and then there is decoration works that need to be done to a property once all that work is completed. That £5,000 grant is clearly not the pathway to increasing the number of heat pump installations from current figures of 30,000 per year to the Government target of 600,000 a year. Going forward, we need to look at that in the mix. Before a carbon tax is introduced, we need to ensure that it does not create more people who are fuel poor, and also look at how we use the revenues from the carbon tax to help get heat pumps and energy efficiency measures for those who need them most.
At the moment, decarbonisation of the power sector is being paid for by levies from our electricity bills. The UK Government have acknowledged that that is unsustainable, because roughly a quarter of electricity bills are made up of those levies. That needs to change; there needs to be a fairer system. That is where carbon taxes could be looked at, but—I am repeating myself—it is important that the most vulnerable are protected.
In wider industry, cost-effective decarbonisation solutions need to be available to industry when a carbon tax is introduced, and taxation must be structured so that it is fair and equitable across the UK. Recently, the UK Government opted to fast-track two carbon capture and storage clusters in the north of England but, disgracefully, they have made the Scottish cluster a reserve cluster. That means that, despite the Scottish cluster being the most advanced in project development and deliverability, it is estimated that the two other clusters will proceed at a faster rate.
It would be inherently unfair for the Government to support, either via direct taxation or consumer levies, some industries in some areas of the country while potentially slapping a carbon tax on another area just because they have not been progressed at the same rate. These things have to be looked at in the round. The Scottish cluster takes in the two biggest carbon dioxide emitters in Scotland—Peterhead gas station and the INEOS facilities at Grangemouth. As the biggest polluters, they have to pay to remedy that—that is where we are right—but will they make that investment? They need that assistance, and they must not be disadvantaged when others are getting support.
Revenues from a carbon tax must be reinvested in green initiatives targeted at the most vulnerable and the hardest sectors to decarbonise. They must also be completely transparent. We have had a carbon tax in the airline industry for years: air passenger duty, which is supposed to follow that basic principle of polluter pays, in relation to aircraft emissions. The actual reality is that, over the years, APD has become nothing more than a Government revenue stream. It is not ring-fenced or reinvested; it becomes part of the “money in” column and is added to the mix of Government expenditure.
It is outrageous that over the years, so-called environmental taxes have been levied and never ring-fenced and reinvested in the way they should have been to reduce emissions. Last week, the Chancellor made the crazy announcement of lowering APD on domestic legs of return journeys. We need a serious debate about support for the airline industry and the wider travel industry, but a reduction in air passenger duty should apply only to airlines that use sustainable aviation fuel, which costs more money. At least companies would be incentivised to lower their emissions, with the offset reward of reduced APD. It makes no sense in the current climate to do a blanket APD cut.
In the aviation industry as a whole, for years consecutive Governments of different colours have maintained a policy that aviation fuel is duty free. We pay our petrol duties at the petrol pump for domestic use in our cars, but all these years, aviation fuel has been duty free. That makes no sense. It needs to be looked at in the round. I do not want to kick the airline industry when they are down and make it harder for them, but we need a system that is fair for everyone on carbon taxes, emissions and incentivising behaviour to drive change. The Government need to look at that.
In the oil and gas sector, £350 billion of revenue has come from Scotland over the years. Those were carbon taxes, but that money has never been ring-fenced or reinvested. A sovereign wealth fund has never been created. Most countries across the world have created sovereign wealth funds, which they are using now, in these tough times, either to help their economy, stimulate their economy, or do green initiatives on the path to net zero. But the UK Government have never done that. It is to their shame that we do not have that money, as a legacy, to go forward.
Today, I actually managed to attend a COP26 panel event before I got on the train to come down to Westminster. There was a representative at the event from Louisiana; he was explaining how for years it has used its offshore revenues to pay for climate adaptation measures along its coastline. Obviously, Louisiana is one of the areas most affected by coastal erosion. That shows us what can be done with long-term thinking, but it needs the initiative to look at revenues that are coming in and how to use them wisely. That is what I am calling for. If there is carbon taxation coming in, it must be transparent and it must be available to be reused to fight climate change.
In a similar vein, I represent a former coalfield area. Carbon taxes had been applied to the extraction of coal over the years, but a few years ago, when the open-cast coal industry collapsed in my constituency, it left massive craters that needed reinstatement work at a cost of millions of pounds. Carbon taxes came from my constituency to the Treasury, but they just went into the black hole. When we asked for assistance for restoration work on those abandoned coalmines, the answer that came was, “No. Too bad. That money came in and it has been used. There is no money coming back to your constituency. It doesn’t work that way.” That shows the folly of not ring-fencing a tax for the purpose that it should be ring-fenced for. Again, transparency is utterly critical if we are to go forward.
I would also say on transparency that the Treasury will have to develop these taxes following open consultation with industry, non-governmental organisations and charities. I also suggest that it would be worth the UK Government’s following the lead of the Scottish Government and having a just transition commission that is able to advise the Government on fairness, look at policies across the board and advise the Government accordingly. Equally, the Treasury cannot be left with the power to introduce exemptions from carbon taxes without robust and transparent procedures, or else it is a lobbying exercise and it becomes open season for donors and cronies to lobby the Government and possibly get exemptions. Again, anything that comes forward needs to be transparent.
I have just one further warning about the money not becoming a Treasury income, because that nearly happened post Brexit. The Department for Business, Energy and Industrial Strategy had devised an emissions trading scheme, which was agreed with all the devolved nations, but at the eleventh hour the Treasury wanted to throw away all that work and replace it with the introduction of a carbon tax. That was clearly just because the Treasury saw it as an income stream. That cannot be allowed to happen; the Treasury cannot have carte blanche to do what it wants. It also shows us that carbon taxes have to be developed in conjunction and consultation with the devolved nations.
In Scotland, we have our own net zero by 2045 target. We have, as I said, the Just Transition Commission. We are working with our own policies, so it is only right that carbon taxes be introduced in such a way that they do not adversely impact our direction of travel.
I am getting near my conclusion, Mr Robertson. I have some concerns about a carbon tax, but largely I do favour the concept. I pay tribute to the work done by the Zero Carbon campaign, which has illustrated and highlighted the fact that surveys prove that such a tax is generally popular with the wider public. They understand the need for net zero; they understand the benefits of a carbon tax being introduced, but again, the critical question is whether that is being done fairly. Scotland’s Climate Assembly has had similar findings with the delegates who have participated in the assembly.
Things can be done to resolve the concerns. Again, that is about transparency. It is about targeted reinvestment. Ireland is already doing that: it targets top-up social welfare payments. That is something that this Government could look at, especially with the cost of living and the fuel and energy cost crisis at the moment. They could put more money into supporting electric vehicles as we try to transfer away from the internal combustion engine.
Something that the Scottish Government are doing is interest-free loans. They have extended interest-free loans to the second-hand market to try to extend affordability, but the UK Government are cutting the grants available. If we are going to have carbon taxes, we need to further stimulate the electric vehicle market and ensure that some people are not left behind.
The decarbonisation of our heating systems is absolutely critical. It would be good to step up energy efficiency installations, treat energy efficiency as a capital infrastructure programme and speed up the upgrading of all properties to EPC––energy performance certificate––band C. That would reduce emissions and fuel costs. What could be a fairer way of using the carbon taxes that are levied?
I agree with the two contributions so far about introducing a broader carbon adjustment to minimise leakage or offshoring. We know that carbon taxes can be successful in changing behaviour. We know that they seem to have wider support if they are introduced fairly and transparently, so let us continue with this serious discussion. Let us find a way to introduce them but ensure that it is done in a way that helps us get to net zero and is part of a just transition.
It is a pleasure to serve under your chairship, Mr Robertson.
I thank my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) for introducing this debate on behalf of the Petitions Committee. May I welcome the Minister to her place? This is the first time that we have faced each other and I look forward to debating with her on many issues. I also thank the hon. Member for Broadland (Jerome Mayhew), who spoke passionately about the climate crisis and made recommendations for changes. I found that really insightful.
I want to begin with some general points about the Government’s approach to net zero, the Treasury’s role and what Labour believes we should be doing differently. I will then make some specific points about carbon pricing and the emissions trading scheme.
As my hon. Friend the Member for Newcastle upon Tyne North said, the debate comes while COP26 is taking place in Glasgow, which I think has affected attendance at this debate. I want to state clearly that Labour hopes that COP26 is a success. We do not believe that the Government have done enough in the run-up, but for the sake of our planet and our future, we hope that it is a success.
A couple of weeks ago, the Government published their long-awaited net zero strategy and the accompanying Treasury review. We welcome the fact that the Government have published a detailed strategy for reaching net zero, but we are concerned that there are serious flaws in the strategy and the Government’s overall approach. The strategy does not go far enough to close the gap between the Government’s promises and delivery. First, in too many areas, there are issues: heat pumps, hydrogen, electric vehicle infrastructure, heavy industry and carbon capture and storage. We are not seeing credible plans from the Government that match the scale of ambition that is needed.
Secondly, the strategy underlines the total failure to provide the investment that is needed. The blame for that falls squarely on the Treasury and the Chancellor. The Treasury’s net zero review argued against borrowing to invest in the net zero transition because it would deviate from the polluter pays principles and would not be consistent with inter-generational fairness. That is extraordinary––an extremely worrying statement. It is precisely future generations who will benefit from the green transition, cleaner air and the jobs of the future. There is a failure to act and it would be an unfair legacy to leave this to future generations. I hope that the Minister will reconsider that statement.
It is also staggering that, in last week’s Budget, the Chancellor did not use the word “climate” once: on the single biggest issue facing the planet, the Chancellor has said nothing. When we look in detail at the Budget, we can see why, because it failed to take the decisive action needed on climate change. The Budget had no plans for economic growth, and certainly no plan to invest, at scale, in the transition to a zero carbon economy.
In contrast, the shadow Chancellor has set out Labour’s climate investment pledge: £28 billion of green capital investment each and every year for the rest of the decade. That would go towards critical sectors, such as retrofitting and insulating 90 million homes, bringing down energy bills in the process, and helping industries, such as steel, to transition and keep the good jobs that so many communities rely on.
Unlike the Government, we will not leave households and businesses to face the costs of net zero transition on their own. That has been welcomed by a number of environmental and business groups as a serious offer that meets the scale of the challenge. Business groups and others know that the cost of inaction is far greater than that of action. Just last week, the Office for Budget Responsibility said that the Government’s failure to set out a clear plan for apportioning net zero costs between businesses, households and Government is a source of long-term fiasco risk.
We feel that a responsible Chancellor must be a green Chancellor, and I am afraid that our current Chancellor is simply not either. In fact, one of the major announcements in the Budget was to cut domestic air passenger duty, as has already been mentioned by the hon. Member for Kilmarnock and Loudoun (Alan Brown). We are talking today about the price of carbon, and yet the Chancellor is cutting duty on domestic air travel, which produces significant emissions, while failing to invest properly in rail travel. That is not a choice that Labour would have made, and it is baffling that the Government did.
I will now make a few points about the UK’s emissions trading scheme. In the Government’s response to the petition we are considering, they say,
“The UK has now launched its own Emissions Trading System (ETS) to replace membership of the EU ETS. This will be the world’s first net zero cap and trade market, delivering a robust carbon price signal and promoting cost-effective decarbonisation by allowing businesses to cut carbon where it is cheapest to do so.”
We support that in principle, but I have questions for the Minister on how the ETS is operating and what plans the Government have for its development.
First, the Minister will know that two thirds of emissions are not currently covered by the UK ETS. Will she update us on what plans the Government have to expand it into more sectors? Secondly, the Government have previously stated that they are open to linking the UK ETS to other international schemes. Have they made any progress on that? Are the Government in discussion with the EU about linking it with the EU ETS? Thirdly, there have also been concerns about the stability of the UK ETS, given its relatively small size. Can the Minister tell us how the market is functioning in this regard, and whether the Government consider any changes are required?
Finally, can the Government tell us what further plans they have for carbon pricing policy? The Treasury’s net zero review leaves us with many big questions unanswered, such as how costs will be rebalanced from electricity to gas, the future of vehicle and fuel taxes, and where new sources of revenue will come from.
To conclude, we need the Treasury and the Chancellor to get serious about our net zero transition. We need to end the delays and insufficient investment. We need a plan backed by funding to help us meet our moral obligations to the planet and to future generations. Anything less is simply not good enough.
It is a pleasure to serve under your chairmanship, Mr Robertson. As many other Members have, I begin by recognising that today is a significant day for international efforts to tackle climate change. Like other hon. Members, I suspect that that is why the Chamber, which I would have expected to be extremely full, is a little sparser than we expected. I am sure that all those who would have wanted to attend are debating this very issue in Glasgow. I thank, recognise and congratulate the more than 100,000 petitioners on securing a debate on this important subject. I do not think that there is any disagreement among the Members present, from both sides of the House, that this is a fundamental issue that we in the UK, as well as others across the world, need to address. As the Prime Minister said at the G20 meeting yesterday,
“If we don’t act now, the Paris agreement will be looked at in the future not as the moment that humanity opened its eyes to the problem but the moment we flinched and turned away.”
I cannot, of course, pre-empt the outcome of the discussions in Glasgow, but I repeat for the record that the Government are absolutely focused on tackling climate change, and we are taking action on a number of different fronts. As the hosts of COP26, we have been determined to promote ambitious action to deliver the urgent transformational changes required by the Paris agreement. We are also seeking to play our own part, as any responsible nation should. As I am sure hon. Members know, between 1990 and 2019 the UK reduced its greenhouse gas emissions by 44%, compared with 5% for the G7 as a whole. Since 2000, the UK has reduced emissions faster than any other country in the G20.
Turning to the specifics of the petition, and some of the points that hon. Members raised, I was grateful to the hon. Member for Erith and Thamesmead (Abena Oppong-Asare) for recognising the importance of the Government’s net zero strategy, which sets out the plan to reduce our emissions, and outlines measures to transition to a green and sustainable future. As my hon. Friend the Member for Broadland (Jerome Mayhew) recognised, we cannot reach net zero by Government action alone. The plan leverages up to £90 billion of private investment by 2030 and confirms £26 billion of public capital investment since the 10-point plan. That investment, and the package of policies in the net zero strategy, will keep the UK on track to meet its carbon budgets and our 2030 nationally determined contribution and to reach net zero by 2050. In doing that, we will lay the foundations for a clean and resilient energy supply by investing in wind, nuclear and carbon capture and storage, as well as accelerating decarbonisation in sectors such as transport and buildings.
The hon. Member for Erith and Thamesmead suggested that the funding was not enough. I reiterate the commitment to a total of £30 billion of domestic investment for the green industrial revolution from 2021-22. She also suggested that the Chancellor was not doing enough, but he is leading on COP26 in liaising with other Finance Ministers on this subject. We will see $100 billion investment by a variety of countries to support developing countries to reduce carbon emissions in their own countries by 2023. We expect to exceed that investment of $100 billion between 2023 and 2025. The Prime Minister is obviously also leading the work at COP26.
A key part of the debate has been about carbon pricing, which most hon. Members talked about. The petition specifically calls for a carbon charge to
“encourage industries and organisations to reduce their carbon emissions”.
The 2020 energy White Paper set out our aspirations to continue to lead the world on carbon pricing in the run-up to COP26 and beyond. The Government believe that carbon pricing is indeed one of the most efficient tools of decarbonisation and has a key role to play in helping the UK to achieve net zero emissions by 2050. That is why we have committed to maintaining an ambitious carbon price to ensure in turn that those who pollute with their emissions pay for them.
The UK already has two carbon pricing policies: the carbon price support and the UK emissions trading scheme. Hon. Members will know that the carbon price support rate is a tax on the fossil fuels used in electricity generation. Since the CPS rates were introduced in 2013, they have contributed to a fall in coal use for electricity generation. The amount of electricity generated from coal fell from 40% in 2012, prior to the CPS, to just 5% in 2018.
At the beginning of the year, the UK launched its own emissions trading scheme, which covers a third of UK emissions and applies a carbon price to the power, industrial and aviation sectors. We have committed to exploring expanding the UK ETS to other sectors. It works on the cap and trade principle by setting a cap on the total amount of certain greenhouse gases that can be emitted by covered sectors. Companies in covered sectors must obtain and surrender sufficient carbon allowances to cover their emissions.
My hon. Friend the Member for Broadland and the hon. Members for Newcastle upon Tyne North (Catherine McKinnell) and for Erith and Thamesmead highlighted that, at the moment, the scheme covers only a third of those emissions and asked what more we would do. I reiterate that we have committed to exploring expanding that scheme to the two thirds of emissions that are not currently covered. The hon. Member for Newcastle upon Tyne North also asked when we will review the carbon price trajectory in the ETS. I reassure her that we remain committed and intend to bring forward a consultation in the coming months. That commitment was reiterated in our net zero strategy.
Several hon. Members, such as the hon. Member for Newcastle upon Tyne North and my hon. Friend the Member for Broadland, recommended that the Government introduce a carbon border adjustment. I reassure them that we are following developments on the EU carbon border adjustment mechanism closely. As COP and G7 president, our instinct is, obviously, that we need to work together with our international partners on how to tackle climate change. We are continually assessing a range of options on that issue.
I apologise to the Minister for pushing the issue, because I can see that she does not have a clearer response. “In the coming months” is as vague as the timings that we have already been notified of. Can she give either a clearer picture of the timescale that we are talking about or a reason why there is no clear timescale for the consultation?
I thank the Minister for giving way again. I will not push her again on that point, as I can see that she does not have a clearer timeframe. Obviously, it is of keen interest to those who are following the debate.
The other issue that I will flag is that she has so far made no reference to ensuring that this is a just and equitable transition so that polluters pay and we do not expect consumers to continue paying more to enable the net zero transition. I wonder whether the Minister just has not got to those comments yet or whether she can say something to assure us that the Government are looking to spread the cost, as well as the responsibility, of meeting our net zero targets.
I thank the hon. Member for her intervention. The two schemes that we already have in place are obviously ones through which the polluter pays; they are about industry recognising that when it pollutes, it must pay for that.
The hon. Lady, as well as the hon. Member for Kilmarnock and Loudoun (Alan Brown), talked about what the Government could do to support individuals. The issue of heat pumps, and the importance of such measures not being too burdensome on those who need to implement them, has been raised on two occasions. A number of Ministers have made this point clearly, but I reiterate that we are not forcing people to take measures such as installing heat pumps: we are saying that if they wish to do so, a grant is available to them. Regarding heat pumps in particular, I would like to make it clear that we expect the price to come down. I suspect that that will happen when we have a requirement for all new homes to be net zero by 2025. When there is the volume of supply of heat pumps that we need, I suspect that their price will come down, as we have seen in relation to electric cars, for example.
My understanding is that it is not the price of the product that will go down, because France is already installing 400,000 heat pumps, so there is volume in product. Interestingly, it is about the mechanism of installation: when the big electricity suppliers begin to install heat pumps, rather like British Gas does with boilers today, that is when the prices will really come down.
The Minister is being very generous with her time. I am sure she appreciates that it is important that the polluter pays, but many polluting businesses will pass that cost on to consumers, and we need to be really transparent about where those costs are going to land. I hope the Government are going to take steps to ensure that we do not push people further into fuel poverty and that, if we are installing fuel pumps, we help people to insulate their homes. There is a lot that the Government can do to make sure the poorest do not pay, even if it is by the back door.
I assure the hon. Member that as we bring in policies—I am responsible for tax, and I know this is the case for my area—we are always very conscious of whether the prices are going to be passed down to consumers. As she knows, we already have a number of mechanisms through which we protect those on the lowest incomes: for energy costs, for example, we have the warm home discount and the energy price cap. Of course, we are conscious that we do not want costs to just be passed down.
I will make a little bit of progress, because I am about to address a point that the hon. Member himself mentioned, which was about aviation duty. The point about a domestic increase in air passenger duty has been made over the past few days, but I would like to highlight some other work that is being done in this industry to try to ensure that it is compliant with our net zero targets and ambitions. We have the Jet Zero Council, which is looking at how we revolutionise this industry and make it more carbon neutral.
The Budget set out a number of measures to ensure decarbonisation. There was a significant amount of spending in relation to decarbonisation in various transport areas, including the electrification of cars. We have already talked about heat pumps, and in relation to the airline industry, the hon. Member will remember that as well as reducing the tax on domestic airlines, we increased the tax on long-haul flights, recognising that it is not particularly carbon friendly for people to travel further.
I would like to address two important points that were not really raised in the debate but which were in the petition. The petition makes the link between air quality and subsidies to fossil fuel companies. I want to highlight that the UK has been a long-standing supporter of the multilateral efforts to promote fossil fuel subsidy reform since they were first proposed in 2009, including through the G7 and the G20. In December 2020, the UK announced its support for the statement on global fossil fuel subsidy reform. Inefficient fossil fuel subsidies encourage wasteful consumption, reduce our energy security, impede investment in clean energy resources and undermine efforts to deal with the threat of climate change. In March of this year, the Government went further, confirming that the UK
“will no longer provide any new direct financial or promotional support for the fossil fuel energy sector overseas”
other than in tightly defined and limited circumstances, such as technical or regulatory assistance that supports health and safety or to support decommissioning.
The other important matter raised in the petition was air quality. I want to underline that the Government are taking significant steps to improve air quality in the UK. It is not just tax measures, but non-tax measures, that achieve our aims, which is why we have a strong and proportionate regulatory framework that requires industry to reduce emissions, including of carbon dioxide, nitrogen oxide and particulate matter. The industry has responded with investment and innovation to meet those standards.
I would like to conclude by saying that it is a pleasure for the Government to answer on this extremely important topic. The petitioners’ success in securing this debate should not come as a surprise to any of us—it is simply evidence of the widespread recognition of the challenge we face, the importance of the issue and the cross-party support for tackling climate change. As the Prime Minister said yesterday,
“The UK has proved it can be done—we have lowered our greenhouse gas emissions by 44%... And we’re cutting our contribution to climate change more and more every day.”
I reassure hon. Members and the thousands of petitioners that the Government take the issue extremely seriously. We will continue to act on many fronts, both nationally and internationally.
I thank the Minister for her response and for being very generous in taking interventions.
The debate has highlighted the need to be up front and transparent about the costs and benefits and the trade-offs that will need to be made on the road to net zero. The Prime Minister said that we are at “one minute to midnight” on climate change. We all know we have to change the way we live and the way we do business, but that process is made so much harder by the confusing and opaque nature of much of what is happening. It is very difficult to work out the right thing to do, particularly for consumers, although the landscape is also very confusing for businesses.
We need much more transparency on the sources of carbon emissions. We need to ensure that polluters pay, but we need to ensure that that does not become just words—we need to see action. We also need to end the absurd situation where choosing to be climate-conscious consumers ends up costing us more, which drives the poor decision making and more carbon-intensive behaviour that all of us would rather avoid and that we need to avoid.
The net zero review recognises that the impact will not fall equally. That is where the Government really need to step up and be up front about who the winners and losers will be in the transition. We need now to put in place steps to mitigate that impact, to ensure not only that the transition is fair and equitable, but that it has buy-in from everybody, because we will all benefit from and contribute to it.
We know that the world is watching and waiting for this historic agreement in Glasgow. Leaders at home and abroad know that it is time to turn meaningful words into real action.
Question put and agreed to.
That this House has considered e-petition 574678, relating to charges on carbon emissions.