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Westminster Hall

Volume 726: debated on Tuesday 17 January 2023

Westminster Hall

Tuesday 17 January 2023

[Sir George Howarth in the Chair]

Doctor Training

I beg to move,

That this House has considered the potential merits of training additional doctors.

I shall start with a quiz. Who does not like a quiz? What do Members think is the most common nationality among doctors working in the NHS who trained as doctors in Bulgaria? I know that sounds like a silly question—surely Bulgarians train as doctors in Bulgaria and come to work in the NHS—but no, two thirds of NHS doctors who trained in Bulgaria are British, not Bulgarian. Indeed, there are more British people training to be doctors at a medical school in Plovdiv in Bulgaria than there are at Plymouth medical school in Britain.

I imagine Members are thinking, “That makes no sense. How can it be?” Well, those bright, young British people who are clearly capable of being doctors could not get places at medical schools in the UK, so they went off to be trained in Bulgaria before coming back to the UK to work in the NHS. Members might think that that is a stroke of genius by British policymakers—getting other countries to train our doctors; think of the money that saves the Treasury. This has been British Government policy for decades: we do not need to train enough doctors for our needs because other countries will train doctors for us, and they will come to work for us anyway. The purpose of the debate is to show that that Whitehall orthodoxy is not just seriously flawed, but against our national interest. It also harms some of the most deprived countries in the world.

The Government launched their independent NHS workforce review at the end of last year, and it will look at many of those issues. I look forward to hearing the Minister’s thoughts on the review. The purpose of the debate is to step up the political pressure to ensure that the Government reach the right conclusion, which is that, as a country, we should aim to train enough doctors for our own requirements.

I should declare that I have a big constituency interest in the issue. South Cambridgeshire is the life sciences capital of Europe with a biomedical campus, two major hospitals and two more planned, countless world-leading medical research institutes and hundreds of life science companies. All those are impacted by our national refusal to train enough doctors for our needs.

The first thing to say about our national policy of not training enough doctors is that it has clearly failed. We would have to be hermits to be unaware of the pressure the NHS is facing, with record waiting times at A&E and waiting lists for operations. There are many reasons for those, such as it being winter and the covid backlog, but one of the biggest structural reasons is the workforce. There is a shortage of medical workers of all types, including nurses but in particular doctors, and there are a staggering 132,000 vacancies in the NHS of which 10,000 are for doctors. A recent survey by the Royal College of Physicians found that 52%—more than half—of advertised consultant posts went unfilled, primarily because no one applied for them.

Despite being among the most interesting places on the planet for doctors to work—I agree; I am biased—even my own hospitals in South Cambridgeshire struggle to fill their posts. Across the country, there are doctor deserts in which health authorities have real problems in getting doctors to come and work, and rural, coastal and inner-city areas are struggling the most to fill their vacant posts. The Government are trying to implement their commitment to increase the number of GPs by 6,000, which I strongly support, but in reality, the number of full-time equivalent GPs has been dropping by about 1% a year. There just are not enough doctors.

The international figures highlight the scale of the problem. The UK has just 2.8 doctors per 1,000 people, which is significantly below the OECD average of 3.5. It is even further behind the figure for some of our European neighbours, which have more than four doctors per 1,000 people. To reach the OECD average, the NHS would need an additional 45,000 doctors. Imagine the impact they would have on our waiting lists.

Desperate hospital managers are driven to fill the gaps by employing locum medical workers at pay rates vastly greater than they would be if those people were employed directly, and the bill for locums across the NHS is a massive £6 billion a year—a huge waste of taxpayers’ money.

I do not need to labour the arguments: there is a clear political consensus that current NHS workforce planning is not working. There are many short-term and medium-term sticking plasters for the NHS workforce crisis. We need to reduce the number of doctors who leave the NHS through early retirement, leave for other professions or seek a better life overseas. We need to retain more doctors through improved conditions and financial incentives. We need to improve working practices to give doctors greater flexibility over their lives. We need urgently to update the nonsensical pension regulations that are forcing experienced consultants and GPs to retire early.

Another medium-term solution to reduce strain on doctors is empowering physician assistants, nurses and pharmacists to take on additional duties through new regulations, for example on prescriptions.

I commend my hon. Friend on his excellent speech; I agree with every single word. Would he recognise that the inflow of doctors to the NHS is part of a wider package? He alludes to the appalling high salaries being paid to locums. That is preventing doctors from getting contracts for surgeries locally, which is a problem in Bracknell. Would he also agree that we have to bring doctors back from retirement and other professions? That is about improving inflow at every level, across the whole of the service.

I agree fully with my hon. Friend that training more doctors is just one part of the solution. There is no point training them if they suddenly leave. We need to ensure that they are not incentivised to retire early, and that they stay working in the NHS.

According to a study by the health consultancy Candesic, only one in four pharmacists are currently allowed to prescribe; 6,000 pharmacists a year could be trained to prescribe, at a cost of £12 million a year. Those are all things that we should be doing anyway, but they will clearly not solve the problem on their own.

The NHS has historically attempted to make up the shortfall of doctors by hiring them from overseas. That decades-old Government policy means that the majority of new NHS doctors are now trained overseas. Only 45% of doctors joining the General Medical Council register last year were trained in the UK—less than half. A similar percentage were international medical graduates from outside Europe, and the remaining 10% came from the European economic area.

Those overseas medical workers keep the NHS going; they provide expertise and care and are part of the exchange of ideas and experience that drives medicine forward. They are very welcome, but relying on other countries to train our doctors for us is not a long-term, sustainable solution. First, it leads to a global doctor shortage, which harms the world’s most vulnerable countries the most. We are far from being the only rich country to try to save money by getting other countries to train doctors for us. In fact, when it comes to training doctors, we are in the middle of the pack. We train 13.1 medical graduates per 100,000 inhabitants. That is more than the US, at 8.5, and Germany, at 12 per 100,000, but we are behind countries such as Italy, at 18.7 medical trainees per 100,000 people, and the world leaders, Ireland, at 25.4.

The World Health Organisation estimates that the refusal by rich countries to train enough doctors has led to a global shortfall of 6.4 million doctors. It is the poorest countries, which can least afford to retain their doctors, that are most harmed. The NHS tends to recruit predominantly from south Asia and Africa. According to the GMC register, the UK is now home to 30,000 doctors from India, 18,000 doctors from Pakistan, 10,000 doctors from Egypt, 4,000 doctors from Sudan and 3,000 doctors from Iraq. Nearly all those doctors were trained in the medical schools of their home country and left to join the NHS.

Many of those countries need their doctors even more than we do. Sudan has a doctor-patient ratio of 0.3 doctors per 1,000 people, a tenth of our doctor-patient ratio. Infant mortality at birth in Sudan is ten times higher than our own. It is ridiculous that our international aid budget is paying for health projects to try to improve health outcomes in those countries, while we strip them of their doctors. If we had supplied 4,000 doctors to Sudan, we would rightly be proud of the help we had given, but instead we recruited 4,000 doctors from Sudan. Countries such as Sudan need our support, rather than our laying out the red carpet for their medical professionals.

The WHO responded to this by setting up a red list of 47 countries that are deemed to have a low doctor-patient ratio, from which other countries should not recruit. That is a step in the right direction. The NHS no longer actively recruits from those countries, but passive recruitment continues apace. The GMC still offers professional and linguistic assessment board tests in countries such as Sudan, Ghana, Pakistan and Bangladesh. In just the past year, another 500 doctors joined the NHS from Sudan, even though the Government are supposedly not recruiting from there.

The global doctor shortage is likely to get worse, as countries age and economies grow, and demand for healthcare increases. It would be foolish to think that we can always rely on importing doctors whenever we want them. We face increasingly stiff competition from the global market. From a workforce planning perspective, it is significant that the retention of UK-trained medical graduates is higher than those trained elsewhere. Nine in 10 UK graduates who obtained their medical licence in 2015 still had it in 2021, but that was the case for only two thirds of international medical graduates, and less than half of European economic area graduates. We need to minimise leakage from the NHS workforce if we are going to stop the vicious spiral of staff shortages.

The only long-term, sustainable solution, and the purpose of this debate, is to train more medical workers, particularly doctors. This really is a long-term solution, as it takes 10 to 12 years to train a GP and even longer for a specialist, but that is all the more reason to start now. We need to ensure that the supply of doctors is sufficient for our national needs, and that we retain them for the span of their whole career. It is a conclusion that the Government have arrived at before: it was once championed by the current Chancellor when he was the Health Secretary and as Chair of the Health and Social Care Committee. The Government announced an ambitious plan to increase medical training places in 2016, creating 1,500 more places—a 25% increase on the existing number. That was then the largest single uplift in our history, and it was very welcome. It was no mean feat and required the building of five new medical schools across the country, but it is still not enough.

We need to be bolder if we are to aim for self-sufficiency. It is an ambition that has widespread support: the Royal College of Surgeons, the Royal College of Physicians and the Royal College of General Practitioners are all calling for it. The British Medical Association and the Medical Schools Council support it. As I understand we will hear today, it has cross-party support. Last year, just short of 16,000 doctors joined the register. To meet our national needs, we need to double our number of training places by adding at least a further 7,500 to the existing 7,500, making a total of around 15,000 training places.

My hon. Friend makes a compelling point. Does he agree that we do not have to do a massive expansion of medical schools to expand the number of medics we are training? In Burnley we have the University of Central Lancashire, which already trains medics, but the number it trains for the UK is relatively small; it does a far bigger international programme. The university is more than willing to switch that over and train far more here for the UK. We do not need a massive number of new facilities, so the capital cost is relatively small. It is just about saying to the medical schools, “You can train more UK students.”

My hon. Friend makes a really interesting point, which I was going to touch on later. I was going to call on the Government to do a feasibility study of how we get all those extra training places, using the existing resources that we have. I was going to mention one: we now have the first medical school in the UK that does not train any UK graduates; it only trains international graduates. The facilities are absolutely there, and we need to make the most of those to start with.

I should say that training enough of our own doctors does not mean an end to international movement of doctors, and nor should we aim for that. A steady exchange of internationally trained doctors around the global health system is a force for good. It provides opportunities for doctors to experience best practice in other countries and encourages knowledge sharing, and long may that continue.

Now that the policy has cross-party support and backing from the medical profession, why are we not already training enough doctors for our needs? Well, I am afraid to say the main stumbling block has been the Treasury. The perceived wisdom in the Treasury is that it is cheaper to recruit doctors from overseas than to train them ourselves, which might be true in the short term. Medical school places are highly subsidised. Estimates vary, but it costs around £200,000, if not more, for the Government to send a student through medical school. The additional 7,500 places would equate to an additional £1.2 billion a year.

However, on closer inspection, the financial argument does not really add up, certainly not in the medium or long term. First, a considerable proportion of a trainee’s time is spent providing clinical care to patients, so training more doctors will mean that hospitals can spend less money on recruiting locums to provide the care that trainees could provide. Secondly, training more doctors will reduce the £6 billion cost of locums overall. Investing in the training of doctors will save the Treasury money in the medium term as we reduce our dependence on agency staff. Thirdly, the financial argument neglects the income tax receipts earned by the Exchequer over the lifetime of a doctor. An excellent paper just published by the think-tank Policy Exchange calculated that there is a net additional positive lifetime return to the Exchequer of £183,000 for women and £398,000 for men—why is there a difference, one might ask—compared with the most positive plausible alternative degree. In layman’s terms, the Government make a greater return if they train someone to be a doctor than if that person pursues a degree in chemistry or pharmacology.

Concerns have also been raised that taxpayers will pay for the training of doctors, who will then simply leave for countries such as Australia and New Zealand in search of better pay, working conditions and, indeed, weather—who can resist the Australian sunshine?—but that is easily sortable. The Army provides medical bursaries worth £75,000 for Army medics, in return for which they must commit to working for the Army for four years. The Government should adopt a similar policy. Trained doctors should have to commit to working for the NHS for a set period, such as four or five years; otherwise, they would have to repay a portion of their training costs.

If, as I hope the Government will do, we decide to train an extra 7,500 doctors a year, how do we make that happen? My hon. Friend the Member for Burnley (Antony Higginbotham) made this point earlier. Implementation of training places is difficult, but it is doable. We have done it before. Training a doctor is complex. There are interdependencies between different bodies that require collaborative thinking and co-ordination. To achieve 7,500 more places, we will need to not only increase the capacity of the existing medical schools and switch places over from international training, but also build an estimated 15 new medical schools.

Each new school will need access to hospitals with clinical training facilities. There would need to be enough clinical academics to conduct the training. Newly qualified doctors will need access to postgraduate courses, including foundation and specialist training.

Despite those hurdles, we managed to increase places by 25% following the announcement in 2016. We can do that again, on a greater scale. I am looking for a commitment from the Minister that the NHS workforce plan that is due out this year—it may be independent, but I am sure the Government have their view—will not only outline an ambition for the UK to do enough medical training for its own requirements but will also include a realistic plan of how that ambition could be implemented. Will the Government launch a feasibility study into how medical school places can be doubled to 15,000 by 2029?

In the meantime, on the path to that ambition, will the Government commit to reinstating the funding provided for additional medical school places during covid for the next academic year? That is a straightforward way to boost capacity in the short term.

Finally, there is a real problem with the transparency of the workforce in the NHS, because of the lack of data. Will the Government commit to providing third-party access to electronic staff records to encourage greater understanding of medical career lifestyles in the NHS?

There are other benefits that flow from increasing training places for doctors. At present, we have many hard-working, straight-A students who are perfectly capable of being excellent doctors but are denied places at medical school. Last year, the rejection rate at medical schools was a staggering 90%. To cling on to their dream, young people are being forced to turn to foreign medical schools for their studies, in places such as Bulgaria, but most of those who are rejected move into other scientific disciplines and are lost to the medical profession forever. If they have the hunger and the ability, we should be giving these students the opportunity to realise their dream of becoming a doctor.

There are clear economic advantages to training more doctors. Life sciences are set to be a major economic growth area in coming decades. To maintain our world-leading position, we need more medically trained people who can conduct the research and run the clinical trials.

Another benefit of training more doctors is for levelling up. The current distribution of medical schools around the country is poor. London has 22% of student places, but just 13% of doctors. That contributes to the increased difficulties for staffing in rural and coastal areas. We need new medical schools in places that are under-doctored—where the places are matters, as around 25% of students remain within 10 miles of their medical schools after graduating. The 2018 expansion capitalised on that knowledge and the new medical school in Sunderland is a fantastic case study. It recruits people from lower socioeconomic groups who are under-represented in medicine. Its graduates will help reduce the shortage of doctors in the north-east, a place where overseas recruitment has been ineffective, due to poor retention. A bonus is that a medical school contributes an estimated £20 million to the local economy.

The arguments are clear. We need to ensure that, as a country, the UK trains enough doctors for our own needs. Increasing training places will be good for the NHS and its patients, good for developing countries, good for the economy, good for the taxpayer, at least in the medium and long term, and good for our bright, young people who will be able to fulfil their dreams of a medical career. In short, it is the right thing to do.

We cannot waste any more time prevaricating on this issue. The medical students who started in 2018 will not be fully qualified GPs until 2028. For too long, we have kicked this issue down the road. Short-termism has been winning the day as we blindly increase our reliance on overseas recruitment. Far too often, we take the easy route and do not make the investments we need for the future. The UK must train enough doctors and other medical workers for our national needs. That is the only sustainable, long-term solution for the NHS.

It is a pleasure, Sir George, to speak in this debate, which I thank the hon. Member for South Cambridgeshire (Anthony Browne) for leading. I am happy to support the thrust of it and am pleased to be the Opposition Member speaking for it—that does not take away from others who probably wished to be here.

There is no doubt that we have faced years of NHS turmoil, and one of the main issues is a lack of sufficient staffing across all aspects of the NHS—nursing and doctors being the most prominent. There are countless reasons why we should train more doctors, but there are domestic issues hindering us from doing so. The hon. Gentleman referred to them, and I will address them from a Northern Ireland perspective. I am my party’s health spokesperson, so I am happy to speak on these issues.

I first want to put on the record—others will undoubtedly do the same—my thanks to the doctors of the NHS for all they do for our health in the United Kingdom of Great Britain and Northern Ireland. We are fortunate to have two fabulous universities in Northern Ireland: Queen’s University Belfast and Ulster University. I have spoken to many students who say there seem to be some issues with the number of places available for those who want to become doctors. Northern Ireland prides itself on the opportunities we offer to international students. We have an amazing scheme, but Queen’s can offer only about 100 places a year for medicine, and there is therefore a shortfall. If that could be increased, it would benefit us in Northern Ireland and people across the United Kingdom. The Minister is always responsive to our requests, so will he outline whether he has had any discussions with the Northern Ireland Assembly and the Department back home?

The hon. Gentleman referred to levelling up, and obviously I want Northern Ireland to be part of the levelling-up process. I welcome that the Government are committed to that, but sometimes we need to see the small print, so I ask the Minister to share some thoughts on that.

I understand that more than 10% of the 100 medicine placements at Queen’s are awarded to international students. I stated earlier that there is still a fantastic opportunity for international students, but once they have completed their degrees, a large proportion do not stay in Northern Ireland and go back home to their own countries. That means there is a gap between the number of students who are trained here, and the number who enter professions and become, for example, junior doctors.

Let me give an example from back home. Two constituents I spoke to excelled in their GCSEs, AS-levels and A-levels—the hon. Gentleman referred to qualifications and the success of education. They were both A* students whose ambition was to stay at home, train and work in Northern Ireland. Unfortunately, they were not successful in obtaining a placement in Northern Ireland, and are now in Edinburgh and Wales, given that they had no other options. Those are not the options they wanted; they wanted to be at home. That is why I asked the Minister about the discussions back home.

Our junior doctors recently voted to strike. More than 173,000 members have agreed to a three-day walk-out due to staff pay, excessive rota hours and a lack of support from superiors. Those issues have to be addressed; they cannot be ignored. I have met some of those junior doctors, nurses and consultants to discuss the issues, and I must say that the excessive hours and shifts they are being asked to work are overwhelming. There is a burden on our junior doctors and those who wish to become junior doctors at a very early stage. Sometimes they work 12-hour shifts for four to five days. Just over the weekend, I heard about the pressures that an accident and emergency unit is under. Our junior doctors are tired and feel underappreciated. Again, the importance of addressing that is clear.

Hiring additional doctors seems like an easy answer to a complex problem. It is never as simple as that, of course. People say, “Well, just hire more. The country is crying out for junior doctors.” We know that, but how do we make it happen? Although that is true, the reality is that the NHS and its staff have been underfunded for years. We do not have the money to fund our junior doctor sector and ultimately hire more. The 100 university places at Northern Ireland’s largest university are simply not enough to meet the demand. It is therefore really important that we address the issue. We must encourage our students to stay and work here, but why should they do that when they feel defeated because they are not getting placements where they want—in our case, back in Northern Ireland?

The Health and Social Care Committee stated that stakeholders have recommended increasing the number of places by 5,000 a year—the hon. Gentleman referred to that—and others have suggested that the figure should be as high as 15,000 a year. As part of the levelling-up process, we need to see the benefits of levelling up for all the regions of this great nation.

The Royal College of Radiologists has been in touch with me to say that employing additional junior doctors could assist with the oncology backlogs, which we all know is a priority for many. It has stated that there is a shortfall of 17%, or 163 clinical oncology consultants, which is forecast to increase to 26% or 317 consultants by 2026 without action to tackle the workforce crisis. What we are doing today will avert a crisis down the line, which is what we are trying to achieve. That is just one example of how our lack of junior doctors ultimately has a knock-on impact on our ability to provide priority treatment.

I will conclude, because I am conscious that eight people want to speak and I want to give each and every one of them the same time, but there is much more I could say about this matter. It is important that workers in our healthcare sector know that they are valued and that we very much appreciate their endless efforts, which can go unnoticed by some. This issue arises from an enormous variety of sources, but we have consistently heard comments about how there simply are not enough university places for the students who are willing to help. Everyone in this room knows that underfunding is also a crucial factor, so let us get the job done to make sure our NHS staff have the protections they need, are not under extreme pressures and do not feel undervalued. Today’s debate gives us the opportunity to ask for that, and the hon. Member for South Cambridgeshire has done this nation proud in his introduction. I believe the other speakers will support him in his ask of the Minister.

For the information of Members present, I do not intend initially to put a formal limit on speeches, but an advisory recommendation is that if everybody sticks to five minutes, we should be able to call everybody.

It is a pleasure to serve under your chairmanship, Sir George. I thank my hon. Friend the Member for South Cambridgeshire (Anthony Browne) for putting together an incredibly eloquent argument on an important subject. I also thank the many doctors and nurses who work in our NHS. I declare a small interest in that I worked in healthcare for a little while, in particular around general practice, which is the topic I will focus on.

My hon. Friend touched on some of the workforce and planning pressures we are facing. It is important to reflect on some of the trends he touched on, particularly the geographical disparities—the doctor deserts that he mentioned. It is also worth reflecting on the fact that we have 35% more doctors now than we did in 2010, yet we feel like we need so many more. There are some shifts underlying that, including more part-time working; yes, we are seeing some doctors return, and some doctors leave through work stresses, but working practices are changing. Our ageing society and the demographic challenge in healthcare is another real issue, but it is worth bearing in mind that the rest of the world is evolving. We use technology more and more, and the way in which we interact with each other is changing more and more, but we are not necessarily doing the same when it comes to healthcare. We are incredibly wedded to a bricks and mortar, 1980s-style of healthcare.

I want to touch on the question of what we want the doctors we are training to do. That may seem like a strange question, but doctors—particularly those in general practice—have become almost a catch-all for all the problems we are looking to solve. Without identifying what the different strands of healthcare can do, we are creating a crisis in almost every bit of it. General practice is not working, and in my opinion is a model that needs reforming almost entirely, but that is creating a huge strain on our hospital system. When it comes to training young people, it is worth bearing in mind that there are three times more applicants to study medicine than there are places available; it is not that people do not want to become doctors. I know my hon. Friend the Member for Wantage (David Johnston) is going to talk about the people who want to become doctors, so I will not steal his thunder, even though he has a really good stat that I like a lot.

We need to look at the doctors we are hiring. I agree with my hon. Friend the Member for South Cambridgeshire that we need a covenant to say that people need to stay working in the NHS, although I do not think five years is anywhere near long enough because it costs £230,000 to train a doctor. If we are going to ask doctors to stay in the public sector, as we absolutely should, we need to square up with them and say, “Actually, we can use technology in a completely different way.” For example, people who are under 50 and have no underlying health conditions should be able to see a doctor in another part of the country using technology. That would help to solve a huge issue. We should train doctors to use technology for communication and for monitoring. We do not do that, despite huge advances on that front.

We also need to square with the public what healthcare is meant to be. I agree with many comments made about other aspects of healthcare, particularly regarding the way community pharmacists and diagnostic centres can take away some responsibilities from doctors. There is no point in hiring another 7,500 doctors every year if we reinforce the problems that are already built into the system.

Given that I have only five minutes to speak, I would like to finish with the thought that if we are going to try to train more doctors, let us use them wisely and think about the role they can fulfil. We are a long way from full utilisation, especially in general practice.

I entirely agree that we need to train additional doctors; there is no question about that. The point has already been made that we need a diverse workforce and the creation of a number of new careers with shorter training periods. As my hon. Friend the Member for South Cambridgeshire (Anthony Browne) said, developing someone into a fully qualified GP, never mind a hospital consultant, is extremely time consuming. As my hon. Friend the Member for Bolsover (Mark Fletcher) said, we need to look at what we want our medically qualified practitioners to do and at how we can create the right career paths, some of which will be shorter and more specific to meet the needs that have been clearly demonstrated. There is no question but that various factors, including the growing population, covid and the ageing population, mean we face a real challenge.

I declare an interest because I represent a rural constituency in Devon and I have chaired the all-party parliamentary group for rural health and care. A couple of years ago, the APPG produced a report on the issue, looking at what needed to change. There are particular barriers in rural communities, compared to other areas. We have an increasingly ageing population with complex co-morbidities and a problem with attraction because, as has already been said, qualified doctors tend to want to stay where they were trained and not come to what they may see as a rural backwater. We also have a challenge finding accommodation for them, because our accommodation rates are very high compared to the level of income.

For me, one challenge is recognising the issues and then training and developing accordingly. We need more specifically oriented rural training opportunities and rural medical schools. There are one or two now, with the latest being in Lincoln, but the curriculum does not have adequate rural content or experience in all cases. It is abundantly clear, as demonstrated by the examples given by hon. Members, that that challenge will be met by recruiting people who live in rural areas. That may sound discriminatory but it would fill the national need for individuals to work in rural areas, and it has proved successful elsewhere.

Australia is well ahead of the game in terms of specific training programmes, but closer to home, in Scotland, there is a programme at the universities of Dundee and St Andrews where 50% of the course, in terms of content and practice, is focused on working in the highlands and other rural locations. Scotland and England may appear to be different, but some very rural parts of England face exactly the challenges as those in Scotland, so there is no reason why the same approach should not be applied. Scotland is also looking at conversion courses for nurses and pharmacists to become doctors—a point that was made earlier—but they are still awaiting approval.

The other key point is that many doctors will find themselves disproportionately in general practice and disproportionately dealing with geriatrician-type problems, so we need to ensure that general training goes through many more years of the curriculum because it often drops off once doctors get into F1, F2 and beyond. We also need to ensure that more doctors have a geriatric element in their training courses, rather than just leaving it to the specialisms, because every single doctor, whatever they land up doing, will find themselves dealing with older people with complex comorbidities. There is no question about that at all.

The real challenge is to focus on not just the need for more doctors, but to recognise what those doctors will be asked to do. That will impact not just on how and who we recruit, but on the nature and content of the training courses. It also ought to give us an insight into the big issue of retention, which is one of our biggest challenges. In the south-west, vacancy rates for doctors and nurses in 2018 was 7,743. In 2022, it was 10,755, so those are big issues that need to be addressed. I shall end on that note so that others can continue, hopefully in a similar vein.

It is upsetting for young British students who have the grades and desperately want to be doctors in a country that desperately needs them to be turned down. I nearly went through that as a parent; I have an interest because my eldest daughter is a junior doctor, and the agonies that she went through, and that we went through as parents, wondering whether she would get the grades and get a place, were awful. Many British families go through that, and it is simply not right when, as my hon. Friend the Member for South Cambridgeshire (Anthony Browne) has said, we have 30,000 doctors from India and 3,000 from Iraq. We should be able to train more.

I am encouraged that the Chancellor of the Exchequer has at last said that the Government will introduce a plan to ensure that the NHS has the workforce it requires to meet future need. The plan will be for the next five, 10 and 15 years, taking into account improvements in retention. That is absolutely right and, frankly, we should have backed it when he was Chair of the Health and Social Care Committee and made the same point. But better late than never—a sinner who repents and all that.

I want to talk mainly about general practice, but we have to get the training right for our doctors everywhere—in hospitals and in general practice. They work incredibly hard under huge stress. I will be delighted to visit the junior doctors’ mess at the Luton and Dunstable Hospital, as I had an invitation recently. I will listen very carefully to what is said there. Today I want to talk about general practice, and in particular about ensuring we have somewhere to train those young GPs as they go through their career. I was very upset to learn last Wednesday that my integrated care board—Bedfordshire, Luton and Milton Keynes—had to turn away eight trainee GPs, because there is nowhere for them go. That is an appalling situation.

Some 14,000 new homes are being built in my constituency. The NHS uses the measure of 2.4 people per home, which means 33,600 new residents, and we are really struggling to expand general practice. Last Wednesday, my integrated care board scrapped 30 of the 53 proposed expansions in primary care across its area—where we could have trained young GPs—for the lack of £2.95 million out of a £1.7 billion budget.

I think about those eight trainee GPs that Bedfordshire, Luton and Milton Keynes had to turn away. My constituents are particularly angry because to the east of Leighton Buzzard is a big new development called Clipstone Park. I have with me a copy of what Barratt Homes, Taylor Wimpey and David Wilson Homes say in the planning application, which states that the development will see the delivery of a doctor’s surgery. No ifs, no buts, no caveats; it will happen. People bought those homes on the basis that there would be a surgery where we could train the young doctors we are talking about. It is not happening, so is it surprising that there is a breakdown in trust among our constituents? It is simply not good enough. Two health hubs that desperately believe in integrated health and care have also not been given the go-ahead. Furthermore, I have discovered that of the £7 billion of section 106 money to fund facilities, including healthcare facilities to train doctors, less than £187 million went into health. That is simply not good enough.

We either take health seriously or we do not. We need to get waiting times down in hospitals. However, we also need to get down the time that many of our constituents spend waiting at 8 o’clock every morning, day after day, trying to see a young doctor, so many more of whom we need to train.

I remind Members that I will be calling speakers from the Front Benches at 10.30 am. To get everybody in, I will now impose a formal four-minute limit on speeches.

It is a pleasure to serve under your chairmanship, Sir George. We all agree that we need more doctors and I think we all welcome what the Government have done to increase the number of places and of medical schools. We had 2,671 trainees start in 2014 and we have had 4,000 start in the most recent year. That is all welcome. We know it takes time and costs money, in the region of £250,000 per person, but it is clear the Government want to get a grip on the problem.

The Government need to do that. I have had a huge population growth in my constituency and have seen a number of GP surgeries close their books. I have seen a surgery in Wallingford close its books, as have all the surgeries in Didcot. In some parts of the constituency we have helped a building expand to ease the problem, but here, without more doctors, it becomes difficult to serve the growing population.

Will the Minister comment on one thing that concerns me about the people we are training? I had an interesting conversation with one of my GP practices just a few weeks ago and I was told that a lot of the trainees now want a portfolio career. Of the cohort from which they have a trainee at the moment, only one intends to be a salaried GP. No one wants to be a partner; it is seen as the drudgery or boring part of the profession. People want to do some days as a locum in urgent care, specialist clinics and so on. I do not know the extent to which Government are looking at that and at how the profession is marketed. It seems to me that a salaried GP is a key pillar of the community, but, much like other people of their age, trainees are looking to do a range of different things, rather than the thing I believe we most need them to do at the moment.

My hon. Friend the Member for South Cambridgeshire (Anthony Browne) set out the challenges of training in superb detail and I am grateful to him for securing the debate. As my hon. Friend the Member for Bolsover (Mark Fletcher) commented, one key issue for me is about the make-up of the profession. Medicine is the most socially exclusive profession in the country. Only 6% of doctors come from a working-class background and someone is 24 times more likely to become a doctor if their parent is a doctor. If anyone wants to intervene and say that that reflects the country’s talent, they are welcome, but I simply do not believe it.

Medicine outstrips every other profession that we think has a problem, such as politics, journalism and law. In all the work I did on social mobility with young people on free school meals, a high proportion of whom are from ethnic minorities, inner-city areas, coastal towns and so on, it was the most popular profession. As others have said, this is not an issue of medicine not being popular or people not applying or not meeting the grades, as the grades have to be met to be able to apply. Applying is a complex process that involves all sorts of things, from personal statements to interviews and work experience. People get work experience very easily if they are related to a consultant but they do not get it without those connections, yet it is essential to getting into the profession. To make the most of the country’s talent, the profession needs to look at that very closely.

It is a pleasure to serve under your chairmanship, Sir George. I congratulate my hon. Friend the Member for South Cambridgeshire (Anthony Browne) on securing the debate.

At the core of the debate lies the increasing demand for healthcare and how we meet it. As our population ages and new treatments emerge, the demand for doctors will grow, not just in the UK but overseas. I note that in 2018 the Government increased the number of medical school places in England from 6,000 to 7,500 a year and opened five new medical schools. Yet is that cap the right one for the future? Does it reflect the demand-based decision making that we should have, or does it reflect funding-based or supply-side decision making, particularly from the Treasury? As has been mentioned, the cap is not down to a lack of demand among domestic students to be a doctor. In 2022, the Health and Social Care Committee found that record numbers of students are applying to medical school, but around three times more people are applying than there are spaces available. There are vacancies, but there is still strong demand to be given the chance to train for a career as a doctor.

Before I briefly turn to how domestic training levels should change, I must turn to what has inherently been the fall-back option when the domestic supply of doctors has not met domestic demand: recruiting abroad. I helped to create the health and care visa and supported the setting up of the Talent Beyond Boundaries pilot scheme, which assists refugee doctors in taking up jobs in our NHS, so I am delighted to see the many amazing medics who make the UK their home. They are the backbone of many local NHS and social care services and they help to sustain and improve them. I therefore thank them, particularly those who work in Torbay’s NHS, who literally make our bay better.

We must not assume, however, that international recruitment is always guaranteed. During my time as Immigration Minister, I often found that for some employers it became an article of faith that immigration would always provide access to an unlimited pool of skilled labour, and that therefore any vacancies must be solely down to there not being a good enough visa for the role—rather than to a lack of training or planning for the future needs of the industry concerned. With doctors, as in many other cases, there is a shortage of that skill across the whole world, which means that access to global labour markets via visa policy can make only a contribution: it is not a guaranteed long-term solution.

We need therefore to fix and ensure a sustainable supply of doctors to meet future demand here in the UK. Last year, the Health and Social Care Committee concluded that,

“the number of medical school places in the UK should be increased by 5,000 from around 9,500 per year to 14,500”,

and that

“the cap on the number of medical school places offered to international students should be lifted”.

The then Chair of the Committee is now the Chancellor of the Exchequer, which makes this an opportune moment to raise the issue.

I am conscious that the Minister with us today would not want to pre-empt the publication of the longer-term strategy that is now due, but it would be interesting to hear his thoughts on, for example, how the Government will seek to future-proof such a plan given the advance of new technology in creating new treatments. How will the decision making on future training places be determined? Will it be demand-led, or will it be funding-led? It has often been funding-led: we argue about what we should spend on medical training, and then a few weeks later have a meeting to talk about what future demand will be. In particular, how will the Government work to expand geographical locations for training? There are some exciting projects, such as the building a brighter future project at Torbay Hospital, which will expand regional health services. Is there an opportunity to expand training as well?

The debate is not just about the future of our NHS services. As has been so well argued, it is about ensuring that youngsters have the chance to follow their ambition to join those they feel inspired by: the people they see working across the community to save lives and provide care.

I strongly congratulate my hon. Friend the Member for South Cambridgeshire (Anthony Browne) on laying out the arguments and highlighting the need for more training places for doctors to level up our great country. More training places would be an engine for social mobility, as my hon. Friend the Member for Wantage (David Johnston) pointed out, and level up our rural counties, as my hon. Friend the Member for Newton Abbot (Anne Marie Morris) pointed out so well.

I declare an interest in the Alexandra Hospital in Redditch. I have never stopped campaigning on it, and I have been re-elected twice to continue campaigning for the hospital and the healthcare that my constituents deserve. Key to that is training more doctors locally in our wonderful new Three Counties Medical School, which was opened and supported by the Government. That is the obvious route, and I very much welcome the Government funding that has enabled the medical school to open in order to train more doctors locally.

When doctors are trained locally, they want to stay and work locally. In Worcestershire, over the years we have seen a problem where local young people who are training to be doctors do not stay in the county because they have opportunities to work in Birmingham and in larger centres elsewhere. That is great for Birmingham, but not so great for Redditch. Better services for my constituents in Redditch is absolutely what I want—and what they deserve, more to the point—but we need more people to deliver them. We always come back to services being constrained because we lack the workforce to deliver them.

I am grateful for the chance to support what my hon. Friend is saying about the Three Counties Medical School. It serves the three counties of Worcestershire, Herefordshire and Gloucestershire, building on the partnerships established through the Royal Three Counties Show and the Three Choirs Festival—the country’s oldest festival. Does she agree that it would be great if the Minister could say whether the Government will support the Three Counties Medical School? In the absence of that, does she agree that all 14 Members of Parliament for the three counties should get together with the Minister to pursue that case?

My hon. Friend makes an excellent point. I strongly agree with him and I hope the Minister will respond. While I am speaking about our three counties, I thank my hon. Friend the Member for Worcester (Mr Walker) who has led the discussions with the health and care trust and other health and care authorities—including Health Education England—to continue to press the case.

The University of Worcester has funded 20 places at the Three Counties Medical School. Unfortunately, we have not been successful in attracting any Government funding from the Minister’s Department. It seems like a missed opportunity. Will the Minister speak to his colleagues in the Department and at NHS England to see what he can do to get the medical school fully funded? I want to give young people in Redditch and Worcestershire opportunities to follow their dreams to practise locally, for the benefit of my constituents.

I thank everybody in Redditch who works for the NHS, across the whole healthcare system. GPs, doctors in different services, mental health providers and nurses are all part of the effort. Social care is also a vital ingredient. We have a great story to tell in Redditch. The Alexandra is a fantastic hospital. It is receiving record levels of Government investment thanks to this Government and previous ones, and the efforts of current and previous Health Secretaries. That investment will see expansion into innovative services and lifesaving treatments, such as robotic surgery for people with prostate conditions, as well as diagnostics and other innovations. The hospital has a bright future ahead of it.

I want to continue campaigning to enable the hospital to deliver services for everybody who lives in Redditch, which is a growing town. My hon. Friend the Member for South West Bedfordshire (Andrew Selous) also made that point. When new residents come in, they expect local healthcare to be there. I am looking forward to the Minister’s update on the NHS workforce plan, which I am sure is the route to solving this conundrum.

I thank my hon. Friend the Member for South Cambridgeshire (Anthony Browne) for bringing forward this important and timely debate. Health services in Cornwall are under strain, as they are in other places. I put on record my thanks to all the doctors and health and social care practitioners in Cornwall for their outstanding work, not only throughout the pandemic but throughout what is proving to be a difficult winter following a difficult summer. I will touch on that later.

In Cornwall, we actually have a slighter greater number of GPs than we had in 2018, but more are choosing to work part time, owing to the intensity of the workload. Our register of GP trainees has also slightly increased in head count since 2018, but the whole-time equivalent has slightly decreased over the last four years despite the head count going up.

Further good news is that the Cornwall training hub has had success in attracting GPs into Cornwall through the introduction to Cornwall scheme and flexible working international GP initiatives, which is encouraging those who train here to remain in Cornwall. However, our geography means we cannot share staff with other areas or trusts, so such schemes are vital to our staffing levels.

The University of Exeter’s Medical School Truro campus is a centre of excellence for the delivery of medical education and training at the Royal Cornwall Hospital. The centre does an excellent job of training up the next generation of doctors; I would like to see more junior doctors training at the university considering a move to Cornwall to start their careers. Who would not want to move to Cornwall? Those who do will find themselves surrounded by a community of extremely welcoming and friendly people, both students and staff, as well as the beautiful outdoors, with the ocean on their doorstep. Who would not want that?

As chair of the APPGs on baby loss and on women’s health, I am grateful to the Government for commissioning NHS England’s long-term workforce plan. My co-chair of the baby loss APPG is now the Chancellor; this is an issue that he has campaigned on for a really long time, so I am encouraged that we will get somewhere now. The Government are growing the health and social care workforce, with more than 4,000 more doctors compared with last year, and it is so important to Cornwall that those doctors are spread throughout the country.

I go back to my point about the hard summer. Because Cornwall is so beautiful, we get 2 million visitors a year. Unlike in other parts of the country, our health service gets no respite in the summer before a difficult winter. Staff have been working at top speed since the beginning of the pandemic without any respite. We need to talk to the Government about fairer funding to try to mitigate some of the effects so that staff can take holidays and have some respite, so that there are enough staff to pick up the slack, and so that our health service can move forward in caring for our ageing population. As I already mentioned, our geography means that we cannot share staff.

The Government must do all it can to tackle Cornwall’s housing crisis. GP surgeries and other employers across the entire health service in Cornwall often say that they offer jobs but that people cannot take the work because they cannot find housing. That applies for every kind of healthcare worker, from healthcare assistants to consultants; it certainly applies to our GPs and hospital doctors. As I have called for in Parliament before, we must ensure that key workers in both the public and private sectors can afford to buy and rent affordably in the area. I am pleased to say that that will be a priority for developments in Langarth and in Pydar Street in Truro.

I join my colleagues in calling for additional training places for doctors. I hope that the Government recognise that those wishing to train in Cornwall are a key part of the solution. I look forward to continuing to work with the Government on all aspects of improving the health service, with a particular tilt towards rural and coastal areas and, of course, I invite the Minister to Cornwall to talk to our healthcare providers to see their particular challenges.

I am grateful to the hon. Member for South Cambridgeshire (Anthony Browne) for securing this debate, which provides me with the opportunity to make a number of political points, but, with your indulgence, Sir George, I will start with a personal one. I put on the record my gratitude and thanks to all the staff of the Scottish NHS. This happens to be my first debate back since being taken ill at the end of last year and undergoing emergency surgery. I am pleased to say that, from every angle—from the local GP right through to the Royal Infirmary in Edinburgh—I was treated fantastically, despite which I hope that I do not have to avail myself of those services again any time soon.

In opening the debate, the hon. Member for South Cambridgeshire said much with which I agree. In fact, we have heard much on which there is probably a great degree of consensus. For years now, across the UK, there have been various issues with finding qualified staff to fill vacancies in our NHS, especially in a number of specialities. When combined with the aftermath of covid, that has resulted in a backlog that is putting immense pressure on frontline services and those who bravely staff the wards.

Staff shortages lead to delays in the whole system, which can mean longer waits for appointments, operations and getting home from hospital. It is vital that each of our nations is fully able to further recruit both domestic and international professionals. We should not ignore the fact that Brexit is exacerbating difficulties in recruitment. In addition, we have the related issue of staff retention.

As Members will know, health is a devolved area, but many of the levers affecting staffing levels, such as pensions and immigration, remain reserved to Westminster. Along with many others, the Scottish Government warned the UK Government of Brexit’s effect on the health and social care workforce, the supply of medicines and medical devices, and the economic impacts that would inevitably harm health outcomes.

Research by the Nuffield Trust in June, based on data relating to May 2021, suggests that NHS England could be short of 12,000 permanent hospital doctors and over 50,000 permanent nurses and midwives. The Nuffield Trust also recently produced research marking six years since Brexit, which demonstrated that

“Across medicine, nursing and social care, there has been a decline in EU recruitment and registration since the EU referendum in 2016.”

The Nuffield Trust also found:

“There is clear evidence that Brexit is likely to be reducing the incomes of people in the UK relative to a counterfactual of continued membership, through its impact on GDP, investment, and trade. The current economic situation means that this is likely to be an additional reduction on already falling real incomes, rather than slower growth. The link between health and income is well documented, and this is likely to lead to worse health outcomes and higher demands of the NHS.”

I share those concerns, and anti-immigration rhetoric around Brexit should have no place in our NHS or anywhere else in our society. Scotland needs people. Perhaps the Minister can tell us whether his Government will devolve control of immigration powers, so that Scotland can get labour force that it wants and needs—or is that a level that we will only benefit from with independence? Where Scotland does currently have powers, it has seen the number of doctors in training rise by 24.3% under the SNP. Scotland already trains more doctors per head than elsewhere in the UK. Scotland’s share of the UK intake in undergraduate medicine has grown to 13%.

While it is right that we discuss recruitment, we must also consider staff retention. That is why pay and terms and conditions are so important. I implore the UK Government to get around the negotiating table with health unions, just as the Scottish Government are doing, to mitigate the risk of strikes.

The number of staff leaving the profession is also of concern. NHS figures show that in the last year there has been the highest turnover rate in a decade. Between March 2021 and March 2022, although 19,309 staff joined the NHS, 15,389 left. The Scottish Government published their workforce strategy for health and social care in March. The target is to grow the NHS workforce by 1% over the next five years. It is no surprise that winter plans also include aims to recruit additional staff, including some from overseas. As part of Scotland’s recovery plan, the Scottish Government launched a new national recruitment campaign and established a national centre for workforce supply.

The Scottish Government have sought to retain junior doctors by preventing them from working seven full night shifts in a row and more than seven days or shifts in a row, as well as implementing a rest period of 46 hours off following a run of full shift nights. The Scottish Government agreed with the British Medical Association last year that by February this year, no junior doctor rota will contain more than four long shifts in a row, and we are already 99% compliant with that target. However, internationally and within the UK, there is competition to recruit staff. With record high vacancies, it will take a major drive to plug the workforce gap.

The Scottish Government have introduced new national guidelines, making it easier for retiring NHS staff to return to the NHS to support it as it continues to recover from the pandemic while also drawing their pension. However, there is a substantive issue of pension tax rules encouraging senior clinicians to reduce their commitments or retire early, and pension taxation is a wholly reserved matter. The UK Government need to provide a permanent solution that will help efforts to retain senior NHS staff.

There is little doubt that training of more doctors is required to attain the adequate levels of staffing that we all need, but people should be under no illusion that with fiscal and immigration powers reserved to this place, Scotland has to achieve that with one hand tied behind its back. Given yesterday’s unprecedented use of a section 35 order to strike down devolved legislation, even devolved powers may now be under attack, such that the days of devolution are numbered. All of this demonstrates the need for Scottish independence.

It is a pleasure to serve under your chairmanship this morning, Sir George. I thank the hon. Member for South Cambridgeshire (Anthony Browne) for bringing this important debate to Westminster Hall, and I praise the contributions of all Members, which covered the whole host of issues affecting the NHS workforce.

We have heard throughout the debate that we must train more doctors, yet this summer the Government cut medical school places by 30%, turning away thousands more straight-A students from training to become doctors when we need them more than ever, with the NHS in the midst of a chronic workforce crisis and people finding it impossible to get a GP appointment or an operation when they need one. We have 7.2 million people waiting to start planned NHS treatment; the Minister will want to know that that is nearly triple the number in 2010, when Labour left power.

As we have heard, there are over 133,000 NHS vacancies, 10,000 of which are for doctors. There are simply too few doctors to meet demand. The latest Royal College of Physicians census found that 52% of advertised consultant physician posts went unfilled in 2021, the highest rate since records began. I am therefore really pleased that we are discussing this issue today.

We cannot build a healthy economy without a healthy society, and we cannot have a healthy society without training more doctors. The chief executive of the NHS, Amanda Pritchard, said recently that more medical school places are needed. However, I worry that the Government are being short-sighted and are unwilling to provide those places. It was only recently that they finally heeded their own Chancellor’s calls to assess workforce needs.

The Government are missing open goals. This weekend, we heard that the Three Counties Medical School at the University of Worcester, a new school set up to boost the number of doctors in England, has been told that it will not receive funding for domestic students. This sounds mad but, during a massive crisis in the number of doctors, the Department of Health and Social Care is maintaining its cap on the number of university medical school places that it funds.

The University of Worcester says that, next year, it will have to recruit only international students, who are less likely to stay and work locally. That is despite the NHS Herefordshire and Worcestershire integrated care board spending over £70 million a year on locum and agency staff because it does not have enough doctors. Thousands of straight-A students are being turned away from studying medicine and the Government have no long-term answer or solution.

Members will not be surprised to hear that Labour does have a plan for the NHS—the hon. Member for South Cambridgeshire referred to it. Labour will double the number of medical school places from 7,500 to 15,000, train 10,000 extra nurses and midwives every year, double the number of district nurses qualifying each year and create 5,000 more health visitors. That will be paid for by abolishing non-dom tax status, because patients need treatment more than the wealthiest need the tax break.

I do not have much time, so I am going to continue.

The Government could have adopted Labour’s policy, which the Chancellor himself said that he agrees with. In an email to supporters of the patient safety charity that he founded, he wrote:

“The medical school place increase is something I very much hope the government adopts on the basis that smart governments always nick the best ideas of their opponents.”

I would be grateful if the Minister set out why his party has decided not to listen to its own Chancellor.

Let me turn to retention. We need to train additional doctors—we have heard no opposition to that in today’s debate—but we must also focus on keeping the doctors that we already have. More than three quarters of respondents to a December 2022 survey of Royal College of Physicians members said that they were very or somewhat stressed at work, with clinical workload and staff vacancies in teams being the leading factors. The 2021 NHS staff survey found that 31% said they often thought about leaving. The Royal College of General Practitioners 2022 GP survey found that 42% of GPs say that they are planning to quit the profession in the next five years. I would be grateful if the Minister considered job satisfaction, and therefore retention of current staff, and set out what the Government are doing about that.

Existing doctors need support and additional training so as not to get burned out and to stay in the role, and training of new and current staff cannot come soon enough. Patients and NHS staff cannot afford to wait. I look forward to the Minister’s response.

It is a pleasure to serve under your chairmanship, Sir George, and I am hugely grateful to my hon. Friend the Member for South Cambridgeshire (Anthony Browne) for raising this important issue and for his hugely constructive proposals and suggestions.

The workforce are the beating heart of everything our NHS does and stands for, and doctors make up an important part of the workforce and are invaluable to our NHS. I am hugely grateful for the incredible work they do day in, day out. I also thank all those who have contributed to the debate. I will try my best to respond to as many of the themes raised as possible in the time available to me.

Let me turn first to workforce pressures, which were raised by a number of hon. Members. We know, and I certainly recognise, that the workforce remain under sustained pressure having worked tirelessly through the covid pandemic to provide high-quality care to those who need it. I recognise, too, the huge and important role that doctors play in supporting our NHS. That role is as important as it ever was, which is why I am passionate about supporting our doctors, particularly in challenging times.

As the hon. Member for Strangford (Jim Shannon) rightly said, it is vital that we support the workforce not just now, but in the future. I recently met with the British Medical Association, the Hospital Consultants and Specialists Association and other unions to discuss, among other things, what we can do to ensure that NHS staff continue to feel valued in their work, but also how we can improve such things as their working environment and working conditions, which are really important. I look forward to continuing those discussions.

The crux of the debate is growing the workforce. What have we seen in the past year? We have seen record numbers of staff, including record numbers of doctors working in our NHS—since October 2021, 4,700 more doctors, representing a 3.7% increase—but I recognise that demand for NHS services continues to grow, which is why we have done a significant amount already to invest in training additional doctors and our future workforce.

As my hon. Friend the Member for South Cambridgeshire said, the Government have created and funded 1,500 more medical school places each year for domestic students in England. That is a 25% increase over three years, and the expansion was completed in September 2020. It has delivered five new medical schools for England. My hon. Friend mentioned levelling up, which of course was part of the motivation behind that expansion, hence the new medical schools in Tyne and Wear, west Lancashire, mid-Essex, Lincolnshire and Kent.

My hon. Friends the Members for Gloucester (Richard Graham) and for Redditch (Rachel Maclean) mentioned the Three Counties Medical School. I know some of the issues around that, some of which I think are specific. I would be happy to meet my hon. Friends, and my hon. Friend the Member for Worcester (Mr Walker), who has also raised the matter with me, to discuss this further.

In addition—I am conscious of the fact that we are talking about medical places—we temporarily lifted the cap on medical places for students completing A-levels during the pandemic, in 2020 and 2021. That resulted in an intake of nearly 8,500 in each year, which was significantly above the planned figure of 7,500.

My hon. Friend the Member for Newton Abbot (Anne Marie Morris) asked what we are doing to look at new routes into medicine. That is an important point: yes, we have the traditional routes, but what are we doing to consider other ways in? I am delighted that, only last week, Health Education England announced funding for the first 200 apprentices to begin training as doctors over the next two years. That marks an important step in making a career in medicine more accessible. My hon. Friend the Member for Wantage (David Johnston) made a similar point: we have to make medicine more accessible. I am really excited about those apprenticeships and what can be done in that space.

Turning to the long-term workforce plan, I heard what my hon. Friend the Member for South Cambridgeshire and others said in calling for us to be bolder and more ambitious, and I know that we need to do more to ensure that the NHS has the workforce that it needs for the future. I heard my hon. Friend’s call for a feasibility study on doubling the number of places, and I will take that away and look at it. I also heard his call for an increase of circa 1,000 places next year. That would have a significant financial implication, which would not sit within our spending review allocation. Again, I will have to take that away and look at it, and have those conversations with the Chancellor.

We have commissioned NHS England to develop a long-term plan for the NHS workforce for the next 15 years. That high-level, long-term NHS workforce plan will look at the mix and number of staff required across all parts of our country, and it will set out the actions and reforms needed to reduce supply gaps and improve retention. My hon. Friends the Members for Bolsover (Mark Fletcher) and for Torbay (Kevin Foster) eloquently set out why we need a workforce that will reflect the changing nature of medicine and technology, and demographic changes. That is vital, and those will be key parts of the NHS long-term plan.

My hon. Friend the Member for Wantage rightly said that those going into medicine understandably want a portfolio career. General practice is still an attractive option and we have more people wanting to be GPs, which is a great thing, but I wonder how many people would want to be Members of Parliament if they were just doing surgeries, which is part of the role, all day every day. In medicine, a portfolio mix involves some time in the hospital and some time in general practice. It is really important that people have the ability to develop their skills and have a specialism, but they should not lose their generalist skills. I think we will see more people wanting to be GPs but also to spend time in hospitals and other settings, and our NHS long-term plan must reflect that.

We have committed to publishing the plan this year. As the Chancellor set out in the autumn statement, it will include independently verified forecasts for the number of doctors, nurses and other professionals needed in five, 10 and 15 years’ time, taking full account of the improvements that we need in retention and productivity. The plan will ensure that we have the right people with the right skills to transform and deliver high-quality services fit for the future.

The hon. Member for Strangford asked about Northern Ireland. He is absolutely right to do so, because a plan cannot work in isolation. NHS England is looking at the NHS long-term plan, but it could not do so without having those all-important discussions with the devolved Administrations around our United Kingdom. There are a number of plans, but there is commonality of interest because of the nature of our United Kingdom, and inevitable join-up. I know that NHS England is having those conversations, and I will ensure that we have them at ministerial level too.

We have touched on international recruitment. As we grow the domestic workforce, ethical international recruitment remains a key element of achieving our workforce commitments, and we are ramping up efforts through targeted support for NHS trusts with recruiting from overseas. My hon. Friend the Member for South Cambridgeshire mentioned our code of practice for international recruitment, which aligns with the latest advice from the World Health Organisation. It guarantees stringent ethical standards when recruiting health and social care staff from overseas, and ensures that we can work collaboratively with other Governments around the world. Although it restricts active recruitment from particular countries, which my hon. Friend correctly referred to as the red list, he rightly pointed out that an individual still has the right to migrate. Therefore, we will still see individuals applying independently for vacancies in our NHS in the UK, which is known as direct recruitment. We are not actively recruiting, but people can nevertheless apply.

Our long-term NHS workforce plan is about ensuring that we get the balance right between international recruitment and domestic training places. As health systems develop around the world, we have to build our domestic resilience to ensure that we are training enough doctors here in the UK. Having said that, internationally trained staff have been a key part of our NHS since its inception in 1948, and they continue to play a vital role. Let me put on the record that we value hugely their contribution to providing excellent care.

Retention was another issue raised. I do not underestimate the importance of staff retention, which is as important as recruitment. As well as training more staff, which is vital, we have to ensure that we keep those highly qualified, experienced clinicians. We have to ensure that they feel supported and valued within in our NHS, not just at a national level, but at a local, individual trust level. We have the actions set out in the 2020 NHS people plan, which are helping us to build that culture and will help support us to ensure we get it right. They include a much greater focus on health and wellbeing, strengthening leadership and increasing opportunities for flexible working, which I know is important in a modern workforce.

A number of hon. Members mentioned pensions, and I understand that challenge. I meet the senior clinicians we need to retain in our NHS. We announced a package as part of our plan for patients in the summer, continuing the temporary retirement-return easements. We also announced the intention to introduce a number of permanent retirement flexibilities from 1 April this year. I know the Chancellor and the Secretary of State for Health and Social Care are acutely aware of the issue and are exploring what more can be done.

In the short time I have, I will cover specialty training. My hon. Friend the Member for South West Bedfordshire (Andrew Selous) rightly raised the important issue of GP training places. One challenge with more funding for medical schools is to ensure that there are specialty places for people to go into. It pains me when I hear that people want to train as GPs but there is not the space in GP practices for those specialty places. I know my hon. Friend has met my fellow Minister, my hon. Friend the Member for Harborough (Neil O’Brien). I am also happy to meet him to discuss this issue from a workforce perspective.

I was pleased when, only last week, Health Education England announced the creation of nearly 900 more specialty placements. That is hugely important, especially because there is a focus on areas such as mental health and cancer, where we know we have shortages. It pains me to hear of anyone wanting to be a GP but not having access to specialty training, because I know we need more of them.

Conscious of the fact that I intend to leave a little time for my hon. Friend the Member for South Cambridgeshire to respond, I thank all hon. Members for their constructive contributions to this morning’s debate. It has given me, the Department and, dare I say it, the Treasury some food for thought about the long-term future of medical training places.

Through the programme of work that I outlined and the long-term planning that NHS England has under way, which will be published this year, we are ensuring that the NHS has the robust and resilient workforce that we know it needs for the future. Doctors are, of course, an integral part of that. We are working to ensure that we have the right people with the right skills in the right places. We are working to ensure that they are well supported and looked after so that they, in turn, can look after those who need our great NHS services, and so that they can keep delivering that great standard of care that people need now and in the future.

It has been a pleasure to take part in this debate under your chairmanship, Sir George. I thank my hon. Friends the Members for Truro and Falmouth (Cherilyn Mackrory), for Newton Abbot (Anne Marie Morris), for Redditch (Rachel Maclean), for Torbay (Kevin Foster), for Bracknell (James Sunderland), for Burnley (Antony Higginbotham), for Wantage (David Johnston), for South West Bedfordshire (Andrew Selous) and for Bolsover (Mark Fletcher), and the hon. Member for Strangford (Jim Shannon)—it is not a debate if he is not here—for their very constructive contributions.

There has been huge support from Members from across the House, including from Labour and the DUP, for increasing the number of training places for doctors, for all the reasons that I laid out and other Members raised in their contributions. I thought the social mobility point was incredibly well made. I am also delighted that so many people invited doctors to go and train in their constituencies, including down in Cornwall. I will pass that on to some of my trainee doctors.

I particularly welcome the Minister’s very constructive support. The Government are aware of this issue and want to do the right thing. The message I want to send the Government—the Department of Health and Social Care and the Treasury—is that there is huge political appetite and cross-party support for increasing the number of training places. We really need to do that for the sake of the NHS and the country. I am sure we will all be watching the developments over the coming months as the NHS develops its workforce plan. We fully support the Government’s aim to be as ambitious as possible.

Question put and agreed to.


That this House has considered the potential merits of training additional doctors.

South East Water

Order. I will shortly call Greg Clark to move the motion, and then if there are no other speakers I will call the Minister to respond. If there is another speaker, they will be taken next. I remind Members that there will not be an opportunity for the Member in charge to wind up, as is the convention in 30-minute debates.

I beg to move,

That this House has considered the performance of South East Water.

I am very grateful to have secured this debate, and I convey my thanks to Mr Speaker for allowing it. It is a pleasure to serve under your chairmanship, Sir George.

The purpose of a water supply company is simply to supply running water to its customers—water to drink, water to cook with, water to wash and bathe in, water to clean clothes and dishes, water to operate central heating boilers and water to flush the toilet. It is the most basic, essential service in Britain in the 21st century, and we rightly take it for granted, and yet for eight days, including the week before Christmas, many thousands of people in my constituency, in Tunbridge Wells and the surrounding villages, had no water. That followed an earlier period in November in which other parts of my constituency were cut off from running water.

South East Water, the company granted the privilege of operating a local monopoly, failed in its only purpose. By South East Water’s own admission, on 19 December, to take one particular day, 3,500 households—about 10,000 people—were without water. As the days went on, many people endured conditions of stress and, frankly, squalor. I will share with the Chamber some examples from the deluge of emails I received from desperate constituents in what became the nightmare before Christmas.

One constituent emailed me to say,

“Our home, in which four adults live, has absolutely no water whatsoever. We have no water to wash ourselves, wash our dishes, wash our clothes, flush the toilet—nothing. It feels as though we are living in the past and have gone backwards in time.”

Another constituent wrote to say,

“I’m at my wits end and this has been the worst week. We have lost water every day for the last 5 days and been forced to buy water. We been told we can collect water from Tesco but if you don’t drive it’s a 45 min walk in the ice! And it’s just tiny bottles as my neighbours have driven to get.”

Another constituent emailed me and said,

“My son was diagnosed with Type 1 diabetes a month ago and is having to come to terms with his new way of life which now includes four insulin injections a day and multiple blood prick tests throughout the day. The lack of water to keep everything clean for him is really affecting every part of our day now. We are having to travel to family members for even the most basic of tasks including showers, washing clothes, washing plates never mind the necessity for my son to take his insulin with clean hands and a clean environment.”

Yet another constituent said,

“It is becoming unbearable. I cannot understand how not having water is a recurring issue we face in 2022. I have a new born baby and am finding it harder and harder each day due to the lack of running water. As your probably aware babies are unable to drink bottled water so I am having to drive to friends’ houses to fill up with tap or buy expensive pre made formula for him to drink.”

Another constituent wrote and said,

“I left for work on Friday morning and got home half an hour ago. I’ve worked all weekend covering various clinical hospice duties when really I should be up in my bed with hot lemon and paracetamol. I chose to prioritise caring for my end of life patients over my own health needs. So getting home tonight to no water yet AGAIN has left me speechless and super upset. I am physically and emotionally broken. The one thing I wanted to do tonight before crawling into my sick bed was to have a hot bath but it wasn’t possible. ”

Another constituent said,

“Thank you for bringing up the water supply issue on the news last Friday. I really thought it would have been fixed by now, but we still have no water! We are struggling to cope. We have two young children. All our toilets are now blocked. I’ve just had to remove all the excess excrement and dispose of in the garden! The water shortage has been going on for weeks. Way before the cold spell. What is going on with South East water!”

Finally, in terms of this debate—but by no means finally in terms of the communications I had from constituents—one person wrote to say,

“the dialysis unit in Tunbridge Wells was forced to close until Boxing Day as they were unable to guarantee full dialysis for their patients—more than 80. I spoke to an engineer who waited all day at the unit for a tanker that did not arrive. The nurses worked until 1 am on the day they had water to dialyse as many people as possible. An extraordinary situation that put incredible pressure on staff and huge stress on patients.”

What on earth could be the reason for such a catastrophic set of events, resulting in those cuts to our water supply? The answer is a catalogue of failures over the preceding weeks that exposed a network lacking in the resilience needed to do the job of supplying water reliably to our residents.

Floods in November had put out of action water treatment works at Groombridge and Tonbridge, and a power cut at around the same time had hit suppliers from Bewl Water. Those incidents caused quite significant loss of water for many households throughout my constituency, but they also had a knock-on effect. Those failures meant that one of the main holding reservoirs that supplies the town of Tunbridge Wells, an underground facility on the Pembury road, fell to less than 20% of its normal capacity. When the cold snap hit in December, with the water leaks from burst pipes that that entailed, the reservoir was too low to supply the population that relied on it. It could not refill, because as much water was being taken out through burst pipes as was being put in.

That may be an explanation, but it is in no way an acceptable excuse. If heavy rain followed by snow and ice—pretty normal winter weather—can knock out water supplies, the network is not resilient enough. During that time, the company’s response was not nearly good enough, either. I attach no blame to the South East Water maintenance engineers who worked day and night to find and repair burst pipes during that period, but communication with customers was totally inadequate. During my daily conversations with the chief executive, I was able to glean an understanding of the engineering problems that I have just described and report it to constituents, but that should have come from the company from the outset.

Without running water available, it was essential that bottled water should reach people who were desperate for supplies. Yet for many days, the only distribution point for bottled water was in the car park of Tesco at Pembury. At times, it became totally overwhelmed, causing gridlock on the surrounding roads. South East Water and my constituents have reason to be grateful to Tesco and, in particular, its managers Jon Briley and Justin Alexander for allowing the car park to be used, despite the fact that this happened the week before Christmas—their busiest trading time of the year—and caused huge disruption to the store’s operation.

As anyone with knowledge of Tunbridge Wells knows, Tesco at Pembury is a long way from many of the properties affected in the town and to the south and west, in places such as Hawkenbury and Langton Green. Even at the best of times, the Pembury Road that leads to the store is probably the most notorious in Tunbridge Wells for congestion. Yet it took several days of pressure from me and the chief executive of the local borough council before another, more central site was opened at the Salvation Army headquarters, by kind permission of Captains Graeme and Zoe Smith.

To my immense relief and that of my constituents, supplies finally resumed on 23 December, though many properties suffered a loss of water from airlocks and local burst pipes even after that point. It was too late to save Christmas for the pubs, cafés, hotels and restaurants that had had to cancel bookings for customers they had expected during the previous week, at a cost to their reputation, as well as to their income.

There must be a reckoning for what happened last month, and it must never be repeated. I thank the Minister for being extremely helpful to me throughout the crisis, having multiple phone calls and convening a meeting with South East Water at the height of the crisis in December. Will she now support me in two further respects to secure two things from South East Water?

The first is compensation for constituents who were affected. I realise that a financial sum cannot expunge the memory of the misery that people endured, nor bring back the pleasure forgone of what should have been a relaxed and festive week before Christmas—the first that people have been able to have since the pandemic. However, financial compensation is owed to them by a company that, after all, made more than £83 million in profit last year from those same customers. That compensation should go beyond the statutory minimum and reflect the cumulative and aggravated impact of rolling cuts to supply over many days, and the extreme uncertainty and anxiety that the prospect of having no water caused. I have also asked—I think it is appropriate—that South East Water make a wider contribution to our whole community, over and above individual compensation, to reflect the disruption caused to our area at an important time.

Secondly, can the Minister support me in obtaining an urgent plan from South East Water to increase—indeed, to guarantee—the security of our water supplies against things that have the potential to disrupt them, whether they be power cuts, floods or freezing weather? Every action that can make a difference should be assessed urgently, and measures should be fast-tracked now.

South East Water exists for one reason, and one reason only: to supply water reliably to homes and businesses, but it has failed to do so. If it cannot make us confident that the same thing will not happen again, the company should be removed from that role.

I congratulate my right hon. Friend the Member for Tunbridge Wells (Greg Clark) on securing this important debate today, and I thank him and our Minister for allowing me to make a few short remarks this morning.

My constituency of Maidstone and The Weald borders my right hon. Friend’s constituency of Tunbridge Wells. Many of my constituents were also completely or substantially without water between 19 December and Christmas day. The main areas affected were Staplehurst, Marden, Cranbrook and Benenden. The problem occurred because of a very large number of leaks and burst pipes following a 20° swing in temperatures from -7° to 13°. The combined effect of a 300% increase in burst pipes led to the loss of 100 million litres of water from the system in 24 hours. In addition to people’s homes and Christmas plans being affected, businesses such as Iden Manor Farm in Staplehurst were unable to supply drinking water to their livestock. Staplehurst’s only pub, the Kings Head, had to close for several days from 20 December to Boxing day. It lost considerable business at a critical time of year.

Sadly, the initial communication response from South East Water was well below standard. There were few updates on websites and people could not get through on emergency telephone lines. Those that did get through were given false timescales for when the water would go back on. In Benenden, people were told that drinking water was available in Pembury, but, as my right hon. Friend knows, Pembury is 13 miles from Benenden, so that was a completely unrealistic suggestion.

However, like my right hon. Friend, I am very grateful to the South East Water engineers and teams on the ground who worked continuously, including on Christmas day and Boxing day—I believe new year’s day, too—to make sure that most people’s water was back on by Christmas day. Thankfully, water levels in my constituency now are back to normal levels for this time of year.

My office has convened a multi-agency meeting with the chief executive of South East Water, Mr David Hinton, on 7 February. Clearly, there are serious questions to be answered and lessons to be learned. We also need to know what its plan of action is, going forward, to avoid a repetition. I want to hear from our Minister today about the availability of compensation for those who suffered financial loss, and I also want to know how we can build a much more resilient water system to deal with the effects of climate change now and in future.

It is a pleasure to see you in the Chair, Sir George. I thank my right hon. Friend the Member for Tunbridge Wells (Greg Clark) for bringing the serious matter of what has gone on with South East Water to the Chamber—one of his constituents said, “What on earth is going on?” I must also thank him for his plain speaking. There is no need to beat about the bush here. Similarly, my hon. Friend the Member for Maidstone and The Weald (Mrs Grant). Let us say it as it is. I was very disappointed in the repeated supply issues experienced by South East Water’s customers and the impacts that it has had on them. Some pretty heart-rending examples were given, particularly where they related to health issues such as the diabetes example and the closing of the dialysis unit. Those are really serious knock-on effects; as my right hon. Friend the Member for Tunbridge Wells said, and as I say regularly, access to water is a right, and that should not be in question.

I will first explain a bit about the position of the Department for Environment, Food and Rural Affairs when emergencies such as this arise, particularly in response to the December issue. As my right hon. Friend the Member for Tunbridge Wells knows, water companies have a statutory duty to provide

“a supply of wholesome water”

under the Water Industry Act 1991, and must ensure the continuation of their water distribution functions during an emergency. Where the scale or complexity of an incident demands central Government co-ordination or support, DEFRA is designated as the lead Government Department for the water sector in England. As the lead Government Department, DEFRA is responsible for the planning, response and recovery phases for major disruption to water supplies, and also sets policy and produces guidance to ensure that water companies have appropriate emergency plans in place.

In December 2022, multiple critical incidents occurred across the country, which—as we have heard—were largely due to the fact that we had had that period of sustained cold weather for nearly two weeks, and a rapid freeze-thaw straight afterwards. The Environment Agency and many water companies gave warnings to consumers that that could happen. It led to an increase in mains bursts across the country throughout December, which increased the rate that water leaving storage areas, such as reservoirs, went through the system—that was part of the problem.

During the incident, DEFRA engaged with water companies in England to obtain accurate and timely updates on the scale, impact and response to those bursts, seeking assurances that the incidents were being resolved as swiftly as possible and impacted customers—particularly vulnerable customers—had access to alternative sources of water, such as bottled water. The prolonged water outages were experienced in Hampshire, East Sussex and Kent. Water supply was fully restored across all companies by 24 December.

Assurance and enforcement of the emergency response is overseen by the regulator, the Drinking Water Inspectorate—also known as the DWI—which has requested that affected water companies submit a follow-up report on their freeze-thaw incidents; those are known as 20-day reports. The DWI will then assess those responses and consider whether action can be taken where it is in its regulatory scope and in line with its enforcement policy. The Government fully support regulators in taking any appropriate action where necessary.

I will get back to South East Water. The data that we have heard about is absolutely stark. In 2021-22, 39,000 South East Water customers were without water for between one hour and 126 hours, and their average interruption in minutes per property is over an hour, at one hour, 12 minutes and 23 seconds. It is all accurately monitored. South East Water’s performance commitment at the start of the price review period was to achieve just six minutes and eight seconds of interruption time, so we can already see that things have gone wildly astray. It is the worst performer in the sector on this metric of supply interruptions.

My right hon. Friend the Member for Tunbridge Wells went on to refer to a “catalogue of failures”—not just the supply interruptions—and, looking back at the data, I cannot disagree with him. Let me make it really clear: South East Water must act urgently to significantly improve its performance for customers and address the issues that lead to loss of supply. While there may be particular geographical features, such as the lack of rainfall—everybody understands that we had a drought and reservoirs were low over the summer—which present challenges for the company, there is no evidence that South East Water faced worse conditions compared with other companies in the area that performed considerably better. I will not accept excuses for poor performance; trust me, I received some.

In relation to the specific incidents in Tunbridge Wells and East Sussex on 19 December 2022, a major incident was declared with approximately 18,500 properties potentially subject to loss of water supply, including 3,000 in Tunbridge Wells and 15,000 in East Sussex, in East Grinstead, Haywards Heath and Crowborough. We also heard about all of those affected in the constituency of my hon. Friend the Member for Maidstone and The Weald.

I had a great deal of communication with my right hon. Friend the Member for Tunbridge Wells and I thank him for getting in touch with the Minister so swiftly. The DEFRA team was already looking into the incident, but when I was informed I was able to raise other issues, particularly that of communication. On 21 December, I called an urgent meeting with David Hinton, the chief executive officer of South East Water, to discuss the response and to seek his assurances that the company would swiftly resolve the matter. I made it very clear that much better contingency plans had to be in place to prevent such widespread losses happening again.

In line with its responsibility as the economic regulator, Ofwat has written this week to all water companies, including South East Water, to ask them to provide a report by the end of February on their performance during the freeze-thaw period. The letter asks specifically what companies will do to improve the management of such incidents. Ofwat will assess the responses and take further action. That goes some way towards answering the question my right hon. Friend the Member for Tunbridge Wells asked about future plans, but I have also asked for a wash-up meeting with David Hinton to go over what happened, how the incident was managed, future contingency plans and wider performance. That will touch on my right hon. Friend’s question about the future plan.

I assure the House that Government and regulators take water company under-performance extremely seriously. As a result of missing its performance commitment targets between April 2021 and April 2022, Ofwat has directed South East Water to return over £2.8 million to customers in the 2023-24 reporting year, although the latest incident will go into the next year. The Drinking Water Inspectorate is also assessing the five events from November and December and considering whether enforcement action will be necessary.

The issue of compensation was rightly raised. In accordance with the guaranteed standard of service scheme, which is a set framework to assess what compensation should be offered, relevant customers in both constituencies will be paid compensation by South East Water by the end of January. Customers do not have to apply for that compensation, as it will be automatically triggered.

I am grateful to the Minister for her response. I am pleased to hear that this important action by the regulators is taking place and that she has a meeting with the chief executive. In terms of the payments that are provided for under statute, does she agree that they provide a minimum, not a maximum amount? Providing it exceeds the minimum amount, the company is entirely open to make its own assessment. When there is a rolling series of outages over such a length of time, it is essential that not just the letter of the compensation provisions is abided by, but the spirit of them, in order to reflect eight days or more of disruption.

I hear what my right hon. Friend says. There is a format for these payments: water companies must make a payment of a minimum of £20 for a household and £50 for a business when supply is not restored within the initial period—typically, 12 hours—and then a minimum of £10 for households and £25 for businesses for each 24-hour period after that. I hear what he says, however, and I hope South East Water has listened to this debate by the time I have my meeting with Mr Hinton. I also took my right hon. Friend’s point about whether water companies should consider some sort of wider community recompense. Obviously, that is for them to consider, but the point was very clearly made.

I have made it clear, and will make it clear again, that South East Water must act urgently to secure a resilient water supply for its customers. It is critical that it adapts its water efficiency programme to target customer demand. Its draft water resources management plan is currently out for consultation. It sets out how the company will provide a reliable and resilient supply of drinking water for the next 50 years. That includes investment of £2.2 billion for new supply infrastructure, and a further £2.1 billion for reducing leaks and customer water use. That consultation closes on 20 February, and I urge all relevant people to take part in it. It includes proposals for a potential reservoir at Broad Oak in Kent, desalination projects and a potential reservoir at Arlington or Broyle Place at Eastbourne in Sussex, so there are lots of proposals in there.

Before I finish, I want to turn to the action the Government are taking more broadly to improve water supply resilience. We have been very clear that water companies have to act to reduce water demand, alongside investing in new infrastructure. To achieve that, RAPID—the Regulators’ Alliance for Progressing Infrastructure Development—was set up by Ofwat in April 2019. It brings together teams from Ofwat, the Environment Agency and the Drinking Water Inspectorate to ensure we have a smooth regulatory path for strategic water resources infrastructure so that we can improve England’s resilience on water supply for the future. The national framework for water resources, which was published in 2020, sets out the detail of how we will improve water resilience in the longer term.

Water companies are investing £469 million in investigating some of these strategic water resources options, including inter-regional water transfers, reservoirs, water recycling and desalination. It is quite unusual that Ofwat, the economic regulator, has allowed them to devote that money to such investigations.

Our landmark Environment Act 2021 proposed new statutory water demand targets for water companies so that the water used per person in England is reduced by 20%. We recently published our consultation on mandatory efficiency labelling on appliances—showers, washing machines and so forth. That will be a really important step in our aim to reduce our personal water consumption to 110 litres per person per day. At the moment, it is about 143 litres, so that is a big change. We will need 25% more water than we are using today by 2050, so we need more infrastructure and we need to reduce the amount we use.

The Government are also working to support broader resilience. We have much higher expectations on water companies to retain their supply, fix leaks and improve performance. Ofwat has set stretching targets for all companies to reduce bursts by 12% and supply interruptions by 41% between 2020 and 2025. It has to be said that South East Water is not doing too well on its supply interruptions. In fact, it is the worst performer.

I hope I have made it very clear that if water companies do not achieve what is expected, the Government and regulators will take action. My right hon. Friend the Member for Tunbridge Wells and my hon. Friend the Member for Maidstone and The Weald raised some really important points and have put matters clearly on the agenda. We need to see an improvement.

Question put and agreed to.

Sitting suspended.

Child Maintenance Services

[Derek Twigg in the Chair]

I beg to move,

That this House has considered potential improvements to child maintenance services.

It is a pleasure to serve under your chairmanship, Mr Twigg. I am very grateful for being granted the time to shed light on the Child Maintenance Service, which I will refer to as the CMS, not least because I, along with the help of colleagues, set up a new all-party parliamentary group on this issue in October last year, and because the Government have published an important review this morning, which I will come to shortly. I want to put on the record my thanks to organisations such as Gingerbread, One Parent Families Scotland, Refuge, Women’s Aid and Surviving Economic Abuse, which have taken the time to educate the APPG on this issue. I also thank the brave constituents from all over the UK who have shared their experiences with us.

To put it plainly, I am afraid that the CMS is not working. It is failing receiving parents, paying parents and survivors of domestic abuse, but, most of all, it is failing children. Roughly 120,000 children in the UK receive no maintenance, and a high number receive a meagre portion of what they are entitled to. Since launching the APPG, we have received floods of correspondence from people who do not know which way to turn. I put it to you, Mr Twigg, that the CMS is broken, and we MPs cannot make it work on an individual case-by-case basis. I believe it is time for a complete overhaul of the service.

I congratulate my hon. Friend on securing this important debate. He started by rightly pointing out the many cases that cross constituency MPs’ desks, and our caseworkers have to deal with very sensitive and difficult cases, the vast majority of which involve mothers. I have had a terrible case of a mother tirelessly pursuing her ex-husband to pay up for nine years, and he has found every which way to game the system. I have also heard from a father who has erroneously paid £18,000 of arrears, despite having evidence from His Majesty’s Revenue and Customs that he was not earning money during the period for which he has been charged. Does that not show the complete incompetence of the CMS? It needs to be able to work with HMRC and communicate clearly with parents, but it also needs to have the teeth to take enforcement action where parents are not paying up.

My hon. Friend makes some very valid points indeed. Perhaps I should also pay tribute to the staff in my own office, and in the offices of all other MPs, who do fantastic, challenging and difficult work. It is very stressful for the staff members involved, so I pay tribute to them.

I want to focus on the ways in which the CMS can better support survivors of domestic abuse and safeguard receiving parents and their children from falling into poverty. It is quite clear that the CMS is not specialised or tailored to support survivors of domestic and economic abuse, so we in the APPG are glad to hear that the Government plan to use Dr Samantha Callan’s recommendations to introduce new domestic abuse training for CMS caseworkers, which will be delivered by a third-party external agency rather than in-house, as set out in the review published this morning, for which I thank His Majesty’s Government. However, our concern is that this does not go far enough. The training should be delivered by a specialist organisation, such as any of the organisations I have already thanked.

I am also glad to hear that the Government plan to protect survivors from having direct contact with abusive ex-partners when trying to obtain child maintenance payments, by giving them the choice to be moved on to collect and pay, the system by which the CMS collects a payment from the paying parent and pays it to the receiving parent without either party having to make direct contact, allowing claims to be made safely. That is an important point.

I understand that the system is more costly for the Government, but we strongly urge that these charges to the paying and receiving parents—20% and 4% respectively —are dropped for survivors of domestic abuse. The charges exacerbate already abusive relationships; they make them worse. Abolishing them would also be a simple way to safeguard against further refusal to make payments.

When it comes to safeguarding receiving parents from falling below the poverty line, I support the call for the CMS to make mandatory minimum payments to survivor receiving parents and to chase the paying parents themselves. This would take the burden of feeling forced to make direct contact away from the survivor and protect them from potential financial ruin. Given the historic failure of the CMS to enforce payments from perpetrators of economic abuse and the current cost of living crisis, we believe that the Government should seriously consider this recommendation.

Many of the problems come down to a fundamental breakdown of communication between the Department for Work and Pensions, and His Majesty’s Revenue and Customs. Perpetrators of economic abuse are able to get away with declaring no income if they are self-employed or a business-owner, therefore escaping the obligation to pay maintenance; this will be a situation familiar to Members of this House from all parties. The perpetrators are also able to avoid payments as the CMS has no legal enforcement capability, despite child maintenance being a legal obligation.

The Public Accounts Committee found that unpaid maintenance owed to parents on collect and pay to distribute payments is set to rise to £1 billion by March 2031. Can you believe that? The review by the National Audit Office in March 2022 stated that the work of the CMS has

“not, so far, increased the number of effective child maintenance arrangements across society.”

This work on child maintenance is incredibly important. The Work and Pensions Committee has also been looking at these issues and I have found the Ministers and the teams at DWP to be very receptive. Does the hon. Gentleman agree that when we are considering how to get money to parents through an enforcement process, the speed of the implementation of enforcement is just as important as the actual tool, and that involving courts can sometimes seriously delay the enforcement? Also, would he be willing to look at my private Member’s Bill about child maintenance enforcement options, which has Government backing?

I thank the hon. Member for her intervention. I think I can safely speak for all members of the APPG in saying that we would endorse what has just been said and we would gladly look at her Bill. One of the most encouraging aspects of the work—early as it is—of this new APPG is the cross-party support that there is for it. Regardless of political colour, there is a recognition that there is something very wrong and I am sure that we can improve that.

I will re-emphasise my opening point that currently the CMS is not working for anybody. In my own office, the bulk of cases come from constituents who are paying parents and who are being unfairly treated by the CMS. We have found that it is often the case for parents who have shared care that one parent has the child for more days than the other and is entitled to various child benefits but then asks for maintenance on top of that, despite the other parent caring for the child for two to three days a week without receiving any support from the Government. So there are different ways of looking at this issue.

In my office, we have also seen cases where parents have been making their payments properly and on time, but they have had those payments treated as being “voluntary”, and so they are not counted towards assessed payments.

It is clear that we need a fundamental overhaul of the way that the CMS works, so that it better protects receiving parents from economic abuse and the threat of poverty, and so that paying parents are not being unnecessarily chased by the CMS for payments they do not owe. This would require a proper and thorough understanding of domestic and economic abuse, a fundamental link between the DWP and HMRC, and an urgent review of the internal administrative efficiency of the CMS.

In closing, I will simply say that I make these remarks in this place in all sincerity and I hope that we can move forward on a cross-party basis, with help from His Majesty’s Government, to tackle this issue, which cuts deeply into many people’s lives and for the worse.

It is a pleasure to serve under your chairmanship, Mr Twigg, just as it is a pleasure to serve alongside you as a neighbouring MP. I thank the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) for leading the debate. His speech was eloquent and powerful, and contained some useful pointers for the Minister. As my good friend and colleague stated in his opening remarks, this is a cross-party issue. We have constituency offices and teams that are inundated by the consequences of a system that is not fit for purpose. I welcome this opportunity to speak about the ways in which we can improve the Child Maintenance Service. Other MPs will highlight specific cases to inform the debate, and undoubtedly the Minister will have a number of takeaways.

The parents of hundreds of thousands of children are in receipt of child maintenance at any one time. When issues occur, they can blight family relationships. Many have already broken down, and some are quite toxic, in terms of domestic violence and so forth. Ultimately, the real harm and hardship are focused on the children. They are who the system is about: the system is there to protect children and help with their life chances. It is vital that it functions well.

We all agree that the CMS has many problems—not least the fact that so much maintenance goes unpaid. Only one third of families with maintenance arrangements have working agreements that see the money paid in full. That is not good enough. Almost half of children in single parent families live in poverty, and in-work poverty has hit record levels. It is no surprise that, as the evidence clearly shows, receiving child maintenance on time and in full lifts children and their families out of poverty.

I want to raise a particular case that my staff and I have been dealing with. We have been dealing with many cases, but this one highlights a number of the problems that constituents face. My constituent is called Danielle. She was forced to contact the Child Maintenance Service after a former partner refused to pay the amount calculated by the CMS to support their two children. A deduction of earnings order was implemented. When, in November, Danielle did not receive the payment, she was told that, although the employer had taken the money from the father that month, it had not forwarded that payment to the CMS.

My constituent works full time, but without that money, she was forced to go into her overdraft to pay for the basics in life. The cost of living challenges at the moment are well documented. Although Danielle has now received that money, the next payment did not arrive either. She was advised by the CMS that the employer stated that it would not transfer anything further until February. She was also told that she was not the only parent waiting for maintenance payments to be sent from that employer. It is clear that that employer is causing a multitude of problems not only for Danielle but for a number of constituents in my patch and in other constituencies in the area. The CMS may be forced to take the company to court to obtain the money, but the decision will be balanced against the cost to taxpayers of taking such action. That may result in my constituent waiting even longer for the money that she and, very importantly, the two children desperately need.

In the meantime, Danielle has been forced to incur additional costs by using an extended overdraft and borrowing hundreds of pounds from her pensioner parents, who do not have much money themselves. That could go on for a considerable time. She is talking about actually finishing work, coming out of the labour market and looking at other options, such as benefits. Surely the system is shooting not only Danielle in the foot, but her children and the taxpayer itself. The enforcement system is simply not working to protect children. There has been mention of the report that has finally been published today. I need time to digest that, as I am sure other hon. Members do. I hope that it addresses some of these issues and some of the issues already highlighted in the Chamber today.

Finally, and more specifically in relation to the case that I have raised here, will the Minister comment on how we can improve the deduction from earnings system, so that employers do not force families into debt or overdrafts or even on to benefits, and we ensure that children have the best start in life with a system that works effectively?

It is a pleasure to serve under your chairmanship, Mr Twigg. I express my sincere thanks to the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) for securing today’s debate and for setting up the child maintenance services APPG. Two of my constituents, Laura and Nicola, attended a meeting of the APPG this morning to share their experiences of the Child Maintenance Service, and that has done a great deal to make them feel that finally their voices are being heard.

Back in May, the hon. Member for Motherwell and Wishaw (Marion Fellows) led a debate here in Westminster Hall on this very topic, and in that debate I spoke about some of the long-running difficulties that my constituents had been having in getting the payments that they were owed by the paying parent in their cases. “Disappointing” is not a strong enough word for how it feels to be here seven months on, knowing that those constituents have yet to see any meaningful changes in their cases.

It is hard for me and my team when we see a new CMS case cross our desk. We know that constituents expect us to be able to do something to sort the problem out for them. We have the same expectations of ourselves. But we also know that there will be months of back and forth and most likely very little to show for it at the end. That is not because we—both Members and our staff—are not trying hard enough, and I am sure that it is not because the staff at the CMS do not have sympathy or want to help. It is because the system is not fit for purpose. Reforming it for the benefit of the service users must be an urgent priority for Ministers.

I know that some headway is being made. I welcome Dr Samantha Callan’s report today on the CMS response to domestic abuse, for example. I also welcome the response to that report from the new Minister on this matter, which reflects support for changes that many CMS users and their elected representatives have been calling for.

I am very glad that the hon. Member has made a point of drawing a line between the best efforts of the CMS staff, and the system. I want to place it on the record that my own office has no problem with the people on the other end of the email or the telephone. I do not want that to be misunderstood.

I thank the hon. Member for making that point; it is exactly what I was meaning. It is not incumbent on the CMS staff to sort out every single problem, but they need to be given the tools to be able to help us as parliamentarians and to help, ultimately, our constituents.

The report today by Dr Samantha Callan is a long report, and I admit that I have not yet had an opportunity to review it in full, but I am pleased that long-running issues are finally being reviewed and addressed. Dr Callan’s report rightly highlights the fact that the space in which the CMS operates is unusual and tricky and that, as she puts it,

“The CMS is a state agency that is tasked with intervening in an area of social life—parental separation—that is often highly emotionally charged, where people are not always able to act rationally, and where contact with both parties is required in order to get money flowing for the benefit of children.”

She also highlights the fact that the CMS’s remit is to administer the scheme, but it does not have a statutory safeguarding responsibility or duty of care.

One of the key recommendations that Dr Callan’s report has made, and Ministers have accepted, alongside others, is to allow receiving parents who are survivors of domestic abuse to access the collect and pay service without the consent of the paying parent. The reasons behind that are clear and it is welcome that they are being recognised through changes to the system.

I have heard deeply upsetting stories of paying parents using the direct pay system—where they pay maintenance into the receiving parent’s bank account—to continue to control and abuse their ex-partner. There are stories of payments being split into small chunks, with abusive messages left in the payment reference box as a means to continue the abuse. It is correct that that has changed, but I think that the change could and should be applied more broadly. Where paying parents refuse to keep up with payments via direct pay, receiving parents should be able to request use of the collect and pay method and to feel reassurance that their request will be granted.

In fact, that was the request my constituent Nicola made to the CMS, which refused. She is no longer in contact with the paying parent, but she has been told on various occasions that she would need to go away and gather information on his earnings or her daughter’s entitlement. She is not the only one of my constituents to be told that. She says she is made to feel like a neurotic, money-grabbing woman every time she complains about the system.

Another constituent, Laura, has explained that her mental wellbeing and self-esteem have taken a real knock from the ongoing back and forth with the service. Imagine someone being made to feel in the wrong for fighting for the money they are entitled to in order to meet the basic costs of raising a child. As it stands, it is far too easy for paying parents to avoid payments, under-declare their income and hide income streams. That is a key aspect of almost every case involving CMS that comes to my team.

Constituents report that they are even advised by the CMS to subsidise their income—essentially to claim benefits—if the paying parent does not keep up with their financial obligations. That entirely defeats the original intention behind the reform of the Child Support Agency into the Child Maintenance Service that we have today, which was to remove the state’s financial burden and its involvement in child support arrangements as far as possible.

If Government Departments and agencies addressed the issues head on and communicated with each other, a lot of the pressure caused by this avoidance by paying parents could be quickly eased. We know—this point is crucial—that communication between the child welfare scheme, DWP and HMRC is frankly not good enough. We also know that there are reasons for that, such as the regulations around information sharing and how intelligence is acted on. But what I do not understand is why the Government have not brought forward measures to fix things much sooner.

Women and children are victimised again and again by this outdated, underperforming system. I understand that both men and women can be, and are, victims of domestic violence and economic abuse., and we heard about that this morning at the APPG. That said, the gender aspect of this problem cannot be ignored, and it stems from historic and deeply held misogyny in society’s subconscious.

We have children literally ageing out of the system, without seeing a fraction of the money they are entitled to to enable them to have a normal, comfortable childhood. It is clear that the current system does not work, if it ever has. My constituents and their children need more. They need a commitment from Ministers that the Government will really get into the detail of the failings of the CMS. They need a commitment from Ministers that they will be offered the right support and that the communication between Departments will be addressed and improved. They need a commitment that this will be done urgently. I hope the Minister is in a position to provide those commitments.

It is a pleasure to serve under your chairmanship, Mr Twigg. I thank my hon. Friend the Member for Caithness, Sutherland and Easter Ross (Jamie Stone) for securing this important debate. In the past year, I have observed a marked increase in the number of constituents contacting me to share the difficulties they are having with the Child Maintenance Service. I would like to say at the outset that I echo the comments made about the individuals at the end of the hotline desperately wanting to help and to be supportive. It is the system itself that I have an issue with.

The first point I want to raise is about the need for improvements in customer service and case management. The CMS is, in the words of one constituent,

“absolutely too difficult to deal with.”

People are left waiting on the phone for hours to speak to caseworkers, only to be told that they are unable to help with the query. Electronic communications often leave much to be desired. One constituent told me they receive updates at 10 pm on a Friday, resulting in a weekend of stress, as they are unable to seek further information or take action until the following Monday. Many individuals relying on the CMS are already under immense emotional strain, and the service should not add to that burden.

When things go wrong, they are not always addressed quickly enough. One particularly concerning example came from a constituent who, despite taking over custody of his two children in March last year, is yet to receive any child maintenance payments for one of them. We are told that the failure is down to an IT error—the child’s middle name is used in one location and not in another. It is “computer says no” gone mad. We are told the CMS is working to resolve the issue, but my constituent first raised it in July, and it still is not resolved. Given the serious financial implications that the error could have, it should be resolved urgently, particularly given the rising cost of living. It is just not good enough that a parent has not received the child maintenance they have been owed for so long because of an IT error.

Several of my constituents do not feel that the service has sufficient power to ensure that paying parents contribute what is owed to the welfare of their child. In one case, a constituent’s ex-partner has not been required to make payments because, as far as the CMS is concerned, they are not working. However, they are simply not working in the United Kingdom, while receiving a sizeable income from assets in Australia.

In a similar case, another constituent’s ex-partner qualified for the nil rate of child maintenance due to a failure to take into account the rental income they earned from properties. There appears to be a real difficulty with CMS accounting for income that takes any form other than a regular salary or wage. That allows paying parents who are asset-rich to get away with not paying towards the care of their children. What steps are being taken to improve communication between HMRC and CMS?

Finally, I want to raise the issue of the collect and pay service. I have encountered several cases in which payments made using direct pay have been used to inflict continuing economic abuses and coercion on victims of domestic violence, so I welcome this morning’s news that the Government have accepted Dr Samantha Callan’s recommendation to amend legislation to ensure that direct pay cases can be moved to collect and pay when there is evidence of abuse. I wait with interest to hear more from the Government on how they will facilitate that and how they plan to define evidence of abuse.

I am, however, disappointed that the Government have no intention of removing the 4% deduction applied to the sum received by the receiving parent under the collect and pay service. I raised the issue on behalf of one constituent in a letter to the Secretary of State in November. The reply I received from the Minister for Pensions was concerning. It stated:

“there are no plans to abolish the 4 per cent collection charge for receiving parents. This charge only applies to the Collect and Pay service and is intended to provide a parent with an incentive to use the Direct Pay service which has no ongoing fees.”

I find the insinuation that receiving parents require an incentive to stay on direct pay troubling, when the move to collect and pay generally occurs due to the failure of the paying parent to meet their financial obligations. It appears that CMS is deliberately using the 4% penalty as a deterrent, which seems misplaced. This is particularly pertinent in cases of domestic abuse, as it leaves victims facing the choice of either dealing with their abuser directly or risking a decrease in the money they receive to care for their child. I am disappointed that the Government are not looking to change that policy, and I ask the Minister to reconsider.

Ultimately, we must remember that the purpose of the Child Maintenance Service is to ensure that the children of separated parents receive the financial support they deserve. The system should work with them, not against them.

It is a pleasure to serve under your chairmanship, Mr Twigg. I congratulate the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) on securing the debate, and I thank him for chairing the APPG on child maintenance services this morning. As the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) alluded to, I have done this before. In fact, I have lost track of the number of times I have taken part in or led debates on the Child Maintenance Service. It is quite difficult to stand here and recall that nothing appears to have changed in the seven and a half years I have been pursuing this important topic. I will try to remain calm and measured and not get upset, as I sometimes do when thinking of the cases that have gone through my constituency office.

I want to make it clear that I am not here raging against paying parents alone. I am not here raging against receiving parents alone. I am here, as I have always been in these debates, to help the children involved. It is important that we all remember that, at the end of these esoteric debates, with everything we talk about, there are children who—through no fault of their own—are being pushed into poverty and who are part of the emotional abuse that sometimes takes place when parents separate.

I will do the formal bit—the bit with figures. DWP figures show that since 2012, when the CMS began, £512.6 million in unpaid maintenance has accumulated. That does not take into account the maintenance arrears that the CSA accrued over time. The CMS was supposed to be an improvement on the CSA system, but I cannot see—nor have I ever been able to see—that that is the case. The SNP—in the whole—and I have repeatedly called for effective enforcement action to be taken in the collection of maintenance arrears. Gingerbread ran a huge campaign on the issue as well. Some children go right through the system without getting what they should and then pass out of the system. They have been brought up in poverty as a result of parents not paying what they should.

There need to be much stronger systems and more resource dedicated to tackling parents who attempt to avoid or minimise child support payments and who do not pay what has been agreed. The withholding or restricting of child maintenance payments can be used as a tool for economic abuse. According to DWP data, in the quarter ending September 2022, 53% of new applicants on CMS were recognised as survivors of domestic abuse. It is not just physical abuse we are talking about here, but economic abuse. The hon. Member for Rutherglen and Hamilton West talked about the nasty remarks made on bank statements as part of the reference for money paid by paying parents. I want to thank the person who came to speak to the APPG this morning about the economic abuse side of this issue. You will forgive me, Mr Twigg—I have covered this table in papers and I cannot find the name I am looking for—but we heard from a member of Surviving Economic Abuse, which has been working on this issue for a number of years.

Some paying parents continue the economic abuse of their previous partners to the detriment of their children. It is utterly shameful. Little is done when a paying parent pays a token amount; it seems to halt processes at CMS, meaning that those children do not get what they are entitled to and—especially nowadays, in a cost of living crisis—what they absolutely need to keep themselves out of poverty. Children in poverty do not thrive and, at the end of the day, are not able to contribute to society in the way that they might otherwise have done.

The hon. Lady is speaking with extraordinary power on this issue. Does she agree that even if a child is fortunate enough to get through this, it can still leave a mark on them for the rest of their lives?

I have papers in front of me from a case in my constituency. The parents have separated, and the father was going through court to try to get residency for his daughter. His daughter has now left school, and his ex-partner is still claiming child benefit, which is an abuse of the social security system. His daughter has now left home, is impoverished and has no contact with her father. He sees this as a failure of the state to help bring up his daughter properly. He has been paying, but he has now tried to walk away from the court case because he cannot afford to continue. It also would have meant that his ex-partner ended up in prison. It is a terrible case. I did say I would not get involved and get too emotional, but it is difficult to listen to what happens to children because of failures in the CMS.

A Joseph Rowntree Foundation report from 2020 found that nearly half of children in lone-parent families are in poverty. This has to stop. Satwat Rehman, the chief executive of One Parent Families Scotland, said:

“parents are facing huge delays in hearing back, poor customer service, and ultimately a failure to collect payments”


“a time when the cost of living is rising to impossible levels”.

Victoria Benson, chief executive of Gingerbread, said:

“Child maintenance is not a ‘nice to have’ luxury, in many cases it makes the difference between a family keeping their heads above water or plunging into poverty.”

Mumsnet founder Justine Roberts said:

“Providing for your children is a fundamental responsibility, and it’s genuinely surprising that the Child Maintenance Service allows so many adults to evade it. Children from these families deserve better than to be treated as collateral damage when relationships break down.”

The Scottish Government do all they can to mitigate child poverty. The child payment fund in Scotland, which has been quadrupled recently, is a good start, but it is still not enough. The real issue is that the CMS isnae working. That is it in a nutshell. Parents spend hours on the phone—either the paying parent or the parent with care—and they do not get the same person on every call. They get conflicting advice, they end up in tears and they end up wasting their entire weekend with worry, as Members have said. It is not good enough.

Looking back to the contribution from one of my constituents at the APPG this morning, the problem is not just the communication between the CMS and the constituent, but the fact that constituents are told they will get a call back. On several occasions that has not happened. Does the hon. Member agree that that adds to the poor mental wellbeing of those parents?

I could not agree more. I have numerous cases like that, and I have had them over the piece.

I want to commend Cyrene Siriwardhana, who was the person from Surviving Economic Abuse who spoke this morning. She raised the issue of how, when the paying parent is charged an additional 20% in collect and pay because they do not have a voluntary arrangement, that leads to even more economic abuse of parents. They game the system; they pay a little, and everything stops. Then, eventually, they pay a little more. That just is not right.

One difficulty in all this is the lack of communication between the DWP and HMRC. Many parents have provided the CMS with evidence about what their ex-partner is earning and doing, only to be told, “We cannot help.” HMRC is also involved and does nothing either. It is imperative that we get the system to work properly for the children involved and that we stop parents gaming the system.

I was encouraged by the issuing of today’s report and the Government’s response to Dr Callan’s independent review of the Child Maintenance Service response to domestic abuse. I was glad to see that the Government have accepted almost all the recommendations. However, I am concerned that the last one—recommendation 10—has been declined. They should all be accepted.

The last one recommended that the DWP produce an implementation plan with a specifically tasked team within the civil service to take forward the recommendations, with a remit to report directly to the independent reviewer. I try not to be a cynic. I try very hard to see the best in everyone and to believe that the Government really want to help the children who are suffering because they are not getting their maintenance payments. Recommendation 10 would be a good way to keep all the review recommendations that have been accepted firmly on track.

I find it difficult to trust a Government whom I have been calling on for seven and a half years to make changes to help parents who have to go to the collect and pay system and in many cases have no choice. The Government have made various concessions over the years—they said they would take away people’s passports, for instance, but they have not really done that or taken other measures to try to enforce payment. The issue is really important. Can the Minister tell me why the Government declined that last recommendation?

I have spoken briefly to the Minister before. One of the other issues that we have as parliamentarians, and especially as Back Benchers, is that the Minister responsible for the CMS—I am not entirely certain how long this has been the case, but I think it matches my tenure in this place—has always been based in the House of Lords. That means that every time we have a debate in the Chamber or Westminster Hall, we do not get to look into the eyes of the Minister responsible for the Child Maintenance Service. I have had many meetings with Baroness Stedman-Scott over the years and I look forward to having many meetings with Viscount Younger of Leckie. However, I would be much happier if I could have a debate with the Minister directly responsible for the Child Maintenance Service so I could take forward some of the worst cases that I have and have had in my caseload over the past seven and a half years.

In conclusion, we have to stop having these debates about the Child Maintenance Service, how it is failing and what needs to be done to improve it. We just need the Government to get on with it. We need them to do the right thing and make sure that children do not live in poverty because two or three Government Departments cannot get their act together and chase down people who are abusing either the DWP benefits system or the HMRC system for paying tax because they are working in the black economy and their earnings cannot be shown and used in calculations for what is due to the children.

I will sit down now because I do not want to get started on how the CMS calculates payments. I could be here for another hour. Will the Minister please look at the issue and give us a good reason why the Government have not accepted recommendation 10? We need to know that the Government will do what they say they will do, and that will go back to Dr Callan, as the independent reviewer.

It is a pleasure to respond to the debate under your chairmanship, Mr Twigg. I congratulate the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) on securing the debate, on his work on the APPG and on a powerful opening speech.

The contributions that we have heard this afternoon draw on the casework that Members of Parliament have brought to them, many of which are deeply harrowing and very powerful, and reinforce a point made several times: we do not want to be here debating the failure of the system. We want to be able to concentrate on other topics, knowing that the management of this policy area has been brought under control once and for all.

The debate is timely: the highly critical report by the National Audit Office on child maintenance was published last March and we will be closely studying the Government response to the review of the Child Maintenance Service response to domestic abuse, which has been published today. There are also two private Members’ Bills on aspects of the service going through Parliament at the moment.

Child maintenance may no longer attract the almost entirely negative headlines that it attracted a couple of decades ago, but, as we have heard, it concerns 2.4 million separated families with 3.5 million children, only half of whom have in place an effective management maintenance arrangement, where any maintenance at all is being paid. That figure is effectively unchanged since 2011-12.

We know that maintenance payments are important in reducing child poverty. It has been estimated that one in five single parents on benefits is lifted out of poverty by maintenance payments—a figure that can and should be a great deal higher. For hundreds of thousands of families, the system is failing to ensure that maintenance is paid or paid in full. Remarkably, the National Audit Office says

“it receives more correspondence on child maintenance than any other single issue.”

In addition, the DWP receives more complaints on child maintenance than on any other subject.

Ideally, we would all prefer not to need an agency such as the Child Maintenance Service, or to need it a great deal less than we do. We would prefer that the overwhelming majority of separated families had voluntary arrangements in place, where the separated parent fully met their responsibilities to their family, so that it was unnecessary for the state to intervene. However, we do not live in such a world and we cannot bring it about just by wishing it.

There are major problems in the enforcement of maintenance obligations, as we have heard and as I will return to, but it is important to recognise that the issue is not simply one of enforcement of statutory maintenance arrangements, which involve only 18% of separated families; it is no less importantly about the absence of any arrangements whatever. As the NAO has shown, 44% of separated families simply have no maintenance arrangement in place, whether statutory or voluntary, effective or ineffective.

Nobody wants to return to the days of the old Child Support Agency, but the present situation is hugely out of line with the expectations of the DWP when the system was reformed a decade ago. As the NAO has reminded us, back then the Department’s assumption was for voluntary arrangements to rise to 35% of separated families by 2019. That expectation was slightly exceeded, at 38%, which is welcome.

However, the Department also assumed that take-up of the statutory scheme would fall only from 46% to 33%. In the event, that expectation was hugely overshot, with only 18% of families now using the statutory scheme. It was thus a matter of simple arithmetic that the percentage of families with no maintenance arrangements in place at all rose from 25% in 2011 to 44% in 2019-20. Remember, the Government’s stated objective in 2012 was to increase the proportion of separated families with effective maintenance. That objective has simply not been met. There has been no change at all, as the NAO has shown. The explanation lies as much in the low take-up of the statutory scheme as in non-compliance with it. Why did the Government think that the 2012 reforms would increase the number of families with effective maintenance arrangements? The NAO said:

“The Department’s 2011 green paper...set out the need to better integrate support provided to families to help them make family-based arrangements with other services such as those provided to parents going through separation, the family justice system and the then Sure Start system.”

The Government then proceeded to devastate the Sure Start system, cutting provision by more than a third. What steps are DWP Ministers taking to improve take-up of the direct pay and collect and pay options offered by the CMS? The question is not about what might be achieved through unspecified integrated support with other services, but what the Department itself intends to do. How will Ministers ensure that the intention is driven through the Department and how will they ensure accountability in line with the expectations?

None of that is to suggest that enforcement is not an issue; it just should not be used to distract attention away from other failures. There are huge problems in the enforcement of statutory maintenance arrangements. It was understandable that enforcement action was negatively affected by the pandemic. CMS staff were redeployed to manage the surge in universal credit claims. The courts were closed. The number of liability orders in process fell from 6,900 in March 2020 to 2,400 in September 2020. All that was understandable, but since 2020 there has been only the most partial recovery. The figures for June 2022 are not only far lower than they were before the pandemic, at 4,200, but lower than they were in June 2021—by over 1,000 cases. The number of enforcement agency referrals in process is less than half what it was before the pandemic.

We need a child maintenance system that works: with voluntary arrangements where possible, but with statutory arrangements that reach the families who need them and are enforced far more effectively than they are now. Will the Minister set out exactly how the DWP intends to rise to those twin challenges, so that we do not need to come back to this Chamber and once again debate the failures of the Child Maintenance Service?

It is an honour to serve under your chairmanship, Mr Twigg. I congratulate the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) on bringing this important debate before us. I welcome his efforts on the new Child Maintenance Service all-party parliamentary group, and I welcome the contributions from all Members from across the House today. The hon. Member for Westminster North (Ms Buck) spoke about the difference it makes to youngsters’ lives when parents work together to support them. Hon. Members know that, and I appreciate their passion and interest in the Child Maintenance Service.

The CMS plays an important role in ensuring that children are best supported financially when their parents do not live together and are unable to come to private financial arrangements to support them. Our aim with the CMS is to help parents provide vital support for their children, and we are sensitive to the needs of both parties. It is designed to promote collaboration between parents where possible, but it offers a statutory scheme if that is not possible. We must all reiterate that child maintenance is so effective at lifting youngsters out of poverty and enhancing the life chances of children from separated families. I will come on to that later.

As mentioned, until recently the day-to-day policy responsibility for child maintenance sat with Baroness Stedman-Scott. She was incredibly passionate and strident in her desire for the CMS to be at its best. I witnessed that first hand, and I am sure that view is shared by Viscount Younger of Leckie, who has now taken over ministerial responsibility for the CMS. However, I reassure Members that my day-to-day work in DWP is supporting the most disadvantaged people, who have the most challenges: single parents, people leaving care and refugees—you name it. My job is to support people who need help, and supporting single parents, separated families, women and people leaving domestic abuse is an absolute priority. I hope that reassures Members that I will be working strongly with the new Minister, and I will outline some of that in my comments today.

I have a lot of points to address on how the CMS will improve its service to separated parents, and I will do my best to cover as many as I can. Many Members will have heard this topic being raised by constituents or in this House; it attracts great interest, as we have heard. I, too, am a constituency MP, and we have much better engagement and far fewer challenges in my area than in the past, but they are incredibly concerning. I appreciate all the MP caseworkers, charities and organisations who assist our constituents.

Family breakdown and partnership breakdown are extremely hard. As a single parent myself, I know how deeply emotional and different all those situations are. We would all want a magic wand in our constituency surgeries to help people going through such difficulties. I reassure the House that we are offering child maintenance support sessions with MPs’ offices in March to help with those constituency casework opportunities, so I am keen to hear from Members about particular areas they would like to cover. I hope that is of note.

I agree with the hon. Member for Westminster North (Ms Buck) about the challenge of how to best support separated families, and with regard to the poverty challenges if we do not get this right. She is completely right. Through family-based arrangements and the CMS, it is estimated that receiving parents got £2.4 billion annually in child maintenance payments between 2019 and 2021. As a result, 140,000 children were lifted out of poverty. The hon. Member for Weaver Vale (Mike Amesbury) mentioned that people are being held back from progressing and that the CMS is not working, and I would be very keen to see the constituency cases that he has raised.

I want to take the opportunity to reflect on the review. It was announced today, so this debate is incredibly timely and I thank the hon. Member for Caithness, Sutherland and Easter Ross for securing it. I am grateful for the excellent independent review of the CMS conducted by Dr Samantha Callan, who I met yesterday, and for the Government response to the review, which will be in Members’ inboxes this afternoon. The review was announced this morning, with an update. For those who are not aware, the Government response was released today and circulated to all Members of Parliament this afternoon. The report is really important and recognises that the CMS has worked very hard to improve the service and experience for those who are survivors of abuse, and remains motivated to take the practical step change to support parents to set up safe arrangements.

In meeting Dr Callan yesterday, I also met and engaged with Lorna McNamara, who has campaigned for changes after the loss of her sister, Emma Day. She has taken part in the review and has been engaged during the process. Yesterday, ahead of the announcement, I engaged with Refuge, Gingerbread, Families Need Fathers, ManKind, the Domestic Abuse Commissioner, the chief executive officer of the Surviving Economic Abuse charity—who, as we heard in the debate, was giving further evidence today—my hon. Friend the Member for Hastings and Rye (Sally-Ann Hart) and the hon. Member for Birmingham, Yardley (Jess Phillips) in order to go through each and every recommendation and explain the Government’s thinking on this issue.

On recommendation 6, which the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) mentioned, it is that vital cross-Government work that will make the difference. Whether by working with separated parents groups or family hubs, we will absolutely ensure that, where we can pre-empt conflict and take the sting out of things, we do that across Government. That is a firm commitment.

The hon. Member for Motherwell and Wishaw (Marion Fellows) mentioned recommendation 10 and said she was trying hard not to be a cynic. I will help her out with that. On the working group and the implementation plan, we had conversations yesterday with stakeholders, which I need to discuss with my noble Friend in the other place. He has had other duties in his House, so we need to come together following the engagement yesterday to discuss timelines and the working group. It is important that we discuss how people feel engaged. We are still looking at that and listening to feedback.

I may have missed something here. Can I assume that the Minister and the Minister in the other place either have or will meet the organisations I mentioned?

Yes. To be clear, yesterday afternoon we went through the review step by step and took on board some of the feedback. On recommendation 10, there is some feedback with regard to timelines and implementation that I need to take to my noble Friend to try to unpick some of the questions that were raised yesterday and have been raised during this debate. On the review and the taskforce, we are aware of what has been reported today. I am keen to look at that because, again, it has been picked up today. I hope that clarifies things for the hon. Gentleman. [Interruption.] Yes and no, then.

As I say, in the Government’s response we were keen to ensure progress, to ensure that parliamentary scrutiny and engagement with stakeholders occurred, and absolutely to look to what the hon. Member for Motherwell and Wishaw mentioned. I hope that we will find, in essence, a middle way. I cannot speak too roundly for my noble Friend, but I am very keen to engage on this matter.

On the wider recommendations, I am engaging in this place on the question of amending the legislation to prevent direct pay from being used as a form of coercion and control. The removal of the requirement to report domestic abuse to qualify for the application fee waiver has been accepted. On piloting the use of dedicated caseworkers for complex domestic abuse cases, that is absolutely something that we will bring forward. In addition, the hon. Member for Caithness, Sutherland and Easter Ross asked about reviewing the calculation formula to ensure affordability for low-income paying parents and including a broader range of agencies in CMS training, as did many of the charities and organisations I spoke with, and Dr Callan recommended that too.

Crucial work is being done both in the review and through the two private Members’ Bills mentioned by the hon. Member for Westminster North. The Bill promoted by my hon. Friend the Member for Hastings and Rye, which is supported by the Government, will help to ensure that anyone using the service who has suffered any form of domestic abuse can feel safe and be reassured that their case will be handled sensitively and efficiently.

I would like to outline some improvements we have made in the CMS area, but I want first to cover a few other points that have been made. The hon. Member for Caithness, Sutherland and Easter Ross mentioned training. The CMS reviewed its domestic abuse training in 2021, with input from Women’s Aid, but it has been challenged about whether that is enough to ensure that our caseworkers are fully equipped to support parents in these multiple and challenging vulnerable situations. Some aspects of the training teach caseworkers how to recognise the various forms of domestic abuse, as well about checking on previous reports of abuse and providing appropriate signposting to domestic abuse support groups.

Following the independent review of the ways in which the CMS supports survivors of domestic abuse, the CMS will review the training to ensure that it is up to date and fully in line with best practice. The CMS also uses a complex needs toolkit for its caseworkers, which includes clear steps to follow to support customers who are experiencing abuse. The CMS will continue to review and evaluate the effectiveness of the guidance and training with regard to domestic abuse.

Issues around enforcement have been raised in the debate—certainly by the hon. Member for Weaver Vale, who mentioned deductions from earnings. Deductions from earnings orders have proved efficient and effective as a tool for collecting child maintenance. In the quarter ending September 2022, almost half of child maintenance —£29 million—was collected from paying parents who had a deduction from earnings order in place at the end of the quarter. We are working closely with employers to ensure that they understand their legal obligations and to help them to collect and pass on payments to the CMS much more quickly.

On minimum payments, operating a scheme in which the Government guarantee child maintenance payments is not the intent of CMS policy. The role of the CMS is to encourage parents to take financial responsibility for their children. However, as I say, we are often in a very challenged place when managing this issue. In the UK, CMS payments do not have any impact on the money received from other benefits, which has a positive impact on child poverty.

I apologise to you, Mr Twigg, and to the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone); I was in the main Chamber for questions and could not be here earlier, although I wanted to be here and I had a speech prepared.

May I ask about how we chase those who are reluctant to make child maintenance payments? In most cases they are men, and in many cases they are self-employed. I know of cases in which they return end-of-year statements that show minimal income yet live in half a million pound houses—paid for—and have top of the range cars that are worth perhaps £60,000. Their assets and quality of living would indicate that their income is far above what they declare. Is there any way that those cases can be looked at? I apologise to the Minister for not being here at the beginning of the debate.

The hon. Gentleman was clearly double parked this afternoon—in two places at once. I will come on to his point; I will try to cover that for him.

The Child Support Collection (Domestic Abuse) Bill, the private Member’s Bill promoted by my hon. Friend the Member for Hastings and Rye, would amend the grounds for transferring people from direct pay to the collect and pay service in order to allow victims of domestic abuse to be transferred to collect and pay, and consideration is being given to exempting parents transferred for that reason from collection charges. The Bill will have its Report stage on 3 March, and I encourage Members to participate in that debate if they are able to.

Let me turn to unearned income, which has been mentioned this afternoon. The Government’s response to the consultation “Child Maintenance: modernising and improving our service” was published in March 2022. Currently, for certain taxable income a parents earns, such as income from property or investments, either parent must ask for that to be taken into account in the calculation. Our intention is to change the approach so that unearned income is identified at the initial case set-up stage and included in the calculation at that point. That will provide a more accurate reflection of the paying parent’s overall income; as the hon. Member for Strangford (Jim Shannon) alluded to, there are certainly concerns that that is not always the case. The change will require amendments to the legislation that governs the Child Maintenance Service, and we are exploring how that could be implemented. I shall come on to enforcement.

Hon. Members raised the issue of the 4% collection fee for the receiving parent, which is a contribution to the cost of using the collect and pay service. The fee is taken only from any maintenance received. The CMS often has to take action to secure child maintenance payments in the collect and pay service. There is a balance here, with the taxpayer subsidising a difficult service, but the fee acts as a nudge to encourage people to consider whether a voluntary arrangement can be made, whereby there are no fees to pay. However, I have heard hon. Members’ concerns about the fee.

With regard to the NAO findings on effective arrangements, the CMS is designed, as I have said, to encourage people to agree their own family-based arrangement. Some 40% of parents are now doing that, compared with just 29% before the CMS was established. This is a better system for children and families, and for the taxpayer. It is vital that we continue to push for such engagement.

I again apologise for not being here to get the full gist of what the Minister and others have said. Over the years, I have had some ladies come and tell me that their husband has transferred their house, their rental properties and everything else into his mum’s and dad’s names; the husband has actually moved out of the property that they were living in to live with their mum and dad. Quite clearly, that is an abdication of responsibility by those men. Is there a mechanism within the changes and the new legislation that the Minister has outlined to ensure that those people who blatantly and systematically try to avoid making payments for their children can be caught?

I thank the hon. Gentleman for his intervention and I completely agree with him. The lengths that some parents will go to are astounding, which is why we support the work by my hon. Friend the Member for Stroud (Siobhan Baillie) on this issue.

At the end of the day, we all should be responsible parents who do the right thing. We know that the vast majority of parents want to do the right thing and do it. However, it is absolutely clear that some people are prepared to do something very different. We need to ensure that child maintenance is paid. That is appropriate, because we know—I have reiterated this point today—the difference that it makes.

Where a parent fails to pay on time or in full, the CMS takes a proportionate approach. Importantly, it first tries to re-establish compliance. That gives the parent the opportunity to get back on track and to prevent the build-up of arrears. There are two different sorts of cases—those where people actively avoid payment, and those where people find that their circumstances change—and we need to be cognisant of that.

Where somebody consistently refuses to meet their obligations towards their children, the CMS will be robust in using enforcement measures. As I have said, it has powers to make deductions from earnings, bank accounts and certain benefits. It can also use enforcement agencies—previously known, in old language, as bailiffs—to take control of goods, and it has the power to force the sale of property. Baroness Steadman-Scott encouraged the CMS to be bold in using its enforcement powers and to leave no stone unturned to ensure that youngsters are adequately protected, supported and provided for. The hon. Member for Strangford outlined very important action that the CMS has to take, although it must be balanced in its approach. I know that some paying parents whose circumstances change wish for that to be understood more fully.

We are absolutely committed to the highest standard of engagement in terms of the customer experience, which has been raised today, with a focus on getting back to people and communicating better, and making digital improvements so that people can update us and engage with us more quickly. The phone line has been mentioned today, but customers can also apply online; indeed, over 90% of applications are now made digitally, which makes it easier for parents to access support. There is now an online service—My Child Maintenance Case—that allows customers to access and maintain data themselves. Parents can now report 20 different changes of circumstances online, and automation means that it will be much quicker for them to manage their arrangement.

Key changes have also been made to help people arrange child maintenance. A more accessible, 24/7 digital service helps customers try to work out the most suitable arrangement for them. It is a more modern, flexible service for the majority of customers and ensures that our caseworkers are able to focus on the most complex cases and the ones with which parents need more support and engagement.

In this conflicted parental environment and in supporting troubled families, customer satisfaction is key. We are reviewing the customer service framework through the digitalisation and transformation programmes. There is a focus on gathering customer insight and perception. Anecdotes from Members of Parliament are key, but it is important that we use that voice and change things in real time more quickly. The CMS recently piloted real-time customer feedback to better understand the customer experience and is now supporting a wider roll-out. We are focused very much on efficiency and improvements, and of course the review that I have responded to today and the two private Members’ Bills will help.

The Minister is being most generous—I want to put that on the record. Another concern that my constituents tell me about is the time it takes for an investigation to start and conclude. In the changes that the Minister has referred to, which I welcome, by the way, will a timescale be put on an investigation so that a lady who applies for a benefit can say, “In three months’ time”—or whatever the time is—“I will have this concluded”?

That is a really important point, and I will take it away with me. This is often something that we hear from constituents in the process: “How does it work? How long will it take? What can I expect?” Certainly when it comes to supporting families, I can understand the point that the hon. Gentleman raises.

I want to conclude by saying that I appreciate all the insights and engagement from across the Chamber this afternoon. The response to the CMS independent review has been roundly welcomed by the sector and many of those who have heard some of our response today. I look forward to engaging further. I can assure hon. Members that although responsibility for the policy sits predominantly in the other place, there is interest across both Houses. That will not change as we try to support and help youngsters and families in these difficult times.

I thank Members for the opportunity to respond to this debate. I have tried to cover most of their points and I thank them for their constructive and helpful feedback. The DWP and the CMS will follow reports by the all-party group and other with great interest, and will always do what is best to support families and youngsters to get the best opportunities by working together.

It is clear to all of us that the Minister has gone into this in some detail and has been thorough in her approach. I am sure we are all grateful for that. I happen to know her noble Friend in the other place because we were at university together many years ago, and I know him to be a man of good faith. I thank the hon. Members who have contributed so very well and made the points that needed to be made with some passion, which shows how important the subject is. None of us underestimates the task that we have to carry out or the problem that we have to solve, but I believe the good will is there. If we can work together, we can do something that will be good for young people caught in this terrible trap.

Question put and agreed to.


That this House has considered potential improvements to child maintenance services.

Sitting suspended.

BBC Local Radio

I will call Gregory Campbell to move the motion and then the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention for 30-minute debates.

I beg to move,

That this House has considered the BBC’s role in promoting locally-based radio reporting.

A few years ago, a previous Secretary of State for Culture, Media and Sport, the right hon. Member for Staffordshire Moorlands (Karen Bradley), gave the standard mantra that the BBC constantly uses:

“The BBC should always have the editorial and operational independence to decide how best to serve its audiences”.

I think most people would subscribe to that, which is why I describe it as a mantra. None the less, the Government have a duty to ensure that the BBC acts in the best interests of the licence fee paying public, which is why I am grateful to have been granted the debate. I am also grateful that the Digital, Culture, Media and Sport Committee alluded last week to the subject matter that I raise today, which is the downgrading of my local BBC radio station, BBC Radio Foyle, which serves Londonderry and the north-west.

It may surprise some people—hopefully not too many—that I raise this subject, as I am sometimes described as an arch-critic of the BBC. My view is that when the BBC does well, I wish to acknowledge that, and when it deserves criticism, I am more than content to offer that. I will leave others to judge on that basis whether the description of arch-critic is accurate, given the number of times I have either criticised or praised the BBC. That is a matter for another day.

I was first interviewed on BBC Radio Foyle not long after it opened in 1979, which seems like an awful long time ago. In fact, when I think about it, it is an awful long time ago. There are a number of changes that I wish to see applied to my local radio station, but its downgrading is not one of them. Last week, at the sitting of the DCMS Committee that I have alluded to, the director-general, Tim Davie, was asked about the downgrading of Radio Foyle. He responded:

“The savings plans we have announced affect many different people and teams within BBC NI…This is a painful saving, but we believe we should be investing more in digital and be doing more across the whole of Northern Ireland in terms of developing the production sector and other things.”

Many of us would make the point that local radio is often a lifeline when things are difficult locally, and the past 24 hours are a classic example. At home, we have had exceptionally bad weather—frost and snow—with roads difficult to navigate and schools closing between last night and this afternoon. That all happened in the geographic area of Londonderry, Limavady and Strabane, in the north-west of Northern Ireland, which is right in the middle of BBC Radio Foyle’s catchment area. This morning, the very programme that the BBC is seeking to axe was able to carry information live to listeners in the catchment area who would be affected by road and school closures so that they could take action, either to avoid roads that would be closed or to ensure that their children could move to another location rather than navigate difficult roads to schools that were going to be closed. All in all, the very day that we are discussing the issue is a day that shows the importance of a local radio station. Along with the downgrading of the station and the axing of the very popular breakfast-time programme, on between 7 am and 9 am, the hourly news bulletins are to go, according to Mr Davie.

There is a concern in some sections of the community that the BBC decision is part of an anti-Londonderry bias. I want to make it clear that that is not a view I share. If it was BBC radio in Enniskillen, Portadown, Newry, Newtownards or Ballyclare, my view is that the BBC may well have come to the exact same decision. I believe it is a cost-driven decision, not a bias against a geographic location of Northern Ireland. If it had happened in their area, I would expect local representatives to do exactly what I am doing now and stand up for a local radio station in their community.

I thank my hon. Friend for securing the debate. He has been an advocate for the BBC. Perhaps he is not always in favour of it, but today he is speaking very much in its favour. As my colleague is aware, the promotion of Ulster Scots is a passion of mine. Although I do have many an issue with the BBC and its so-called impartiality, I have been pleased by the time given on local radio to Ulster Scots and Irish music celebration. Does my hon. Friend agree that the removal of those avenues of access leaves that essential cultural programming homeless and ensures that the BBC retains the title of being a mouthpiece for a politically motivated agenda, rather than inspiring an uplifting programme?

My hon. Friend is indeed right. I hope the Minister will be able to help with seeking meetings with the BBC to try and ensure that those types of programmes are reflected on a local basis.

The issue is that local radio stations very often give a voice to local people. If it was left to a more centralised BBC—in England a London-centric approach, or in Scotland a Glasgow/Edinburgh-centric approach—we would find that the further afield areas in the geographic location are not covered. That is the fear that there is in Northern Ireland about this decision: that there will be a centralisation of all reporters and researchers in the Belfast area and at Broadcasting House in the centre of Belfast.

What about when events happen 40, 50 or 80 miles beyond the confines of Broadcasting House? Remember, Northern Ireland is quite a small place, and as I have discovered—I may well discover again when I go back home—the Glenshane pass is a very impassable road whenever the weather is bad. That may well be a reason, or perhaps an excuse, for not sending a reporter over the Glenshane pass to locate a school, hospital or some other story when another one is more easily accessible five miles down the road.

The hon. Member is making a great speech. The issues he identifies with the Glenshane pass are exactly the same as those my constituents might face with the River Severn. Just as for him, the idea of a reporter based in Belfast being able to report the weather out near Londonderry is crazy, from the perspective of my constituents who spent the weekend carefully listening to radio bulletins about the level of the River Severn, where it would flood and which roads would be closed, the idea that we could lose that weekend programming to Birmingham is absurd.

I agree with the hon. Member in totality. I remember a number of occasions when people in Belfast who were unfamiliar with the local terrain would refer to the locality of—Hansard may have some difficulty with this— “Magherafelt”. That is not the pronunciation. Local people wondered, “Where on earth is this Ma-geer-a-felt?” It is actually Magherafelt—that is the local pronunciation. That happened because people were unfamiliar with the local terrain; local reporters would not make that mistake.

I thank my hon. Friend for giving way. In relation to Magherafelt, some people may well say that that mispronunciation does not affect them. One of the areas is that I am concerned about is cost-cutting. When there is a big sporting event that everyone wants to be at, BBC Northern Ireland, for example, will send a delegate, even though other BBC delegates are there, sitting two rows down from them in the press area, reporting back to the BBC on exactly the same thing. Why do they all have to be at such major events?

My hon. Friend severely tempts me to go down the road of criticising the BBC. On another occasion I will glad succumb to that but I will resist the temptation today, although I acknowledge his concern.

The BBC has made its announcement and indicated that it is now embarking on a consultation process. I hope that in her response, the Minister will be able to indicate that the Government intend to make representations to the BBC to ensure that the motion is reflected in the actions and decisions of the BBC. BBC decision making is often driven by what it describes as the cost-effectiveness of its output. Although I support a cost-effective decision-making process, that should not be at the cost of locally based reporting and knowledge driving the agenda so that the BBC more accurately reflects all aspects of geographic area it represents to its listeners and viewers.

I hope that will be the outcome of the consultation process, and that whatever it decides to do, it will have heard what has been said in this debate and outside, that it will listen to what local people are demanding and that it will say, “We have decided to review this.” Hopefully, the BBC will overturn the decision and ensure that the local radio station is there to reflect the needs, concerns and wishes of local people in the geographic area represented by that radio station.

It is an honour to serve under your chairmanship, Mr Twigg. I have an interest to declare as I worked for the BBC for many years and am occasionally in receipt of very small cheques from said organisation.

I am an ardent supporter of the BBC and, probably uniquely in this place, have visited the studios of most BBC local radio stations. As I toured the country, I went to those wonderful places where local people reported on local news and, more importantly, told local people that I was coming to their town in a show very soon. It was important that they understood exactly why I was there, what I was doing and how important it was for the local community.

I believe that the BBC should not become entrenched inside the M25. We need the BBC to have local reporters in local towns—people who grew up there and understand the community. The BBC is the flagship of the UK’s news and media, and it is in charge of local reporting, importantly doing so with honesty, clarity and, above all, impartiality. It has a unique position and it directly affects and improves local people’s lives.

I thank the hon. Member for East Londonderry (Mr Campbell) for securing this important debate. As has been mentioned, people become isolated, but with BBC local radio they feel connected. They feel they have a friend coming through the speaker, talking to them about issues around them, such as snowfall or the inability to cross the Severn.

Plans to cut the BBC locally have been fought with outrage in my part of the world. I have been contacted by many constituents who listen to reporters from different brands of local radio. Even a local respected Member cannot understand the current proposals and completely opposes them. The national BBC does a very fine job reporting as impartially as it can, but it does not hit home in the same way as my local BBC radio station, BBC Radio Essex, which people hear and understand. They say, “How would I know about the traffic queues on the A12 if it was not for local radio?” The A12 is frequently at a standstill and we all need to know about that. I make this appeal to the BBC: do not cut those services, find a way to keep it local. Centralisation is a cut, in a sense. There will be fewer reporters on the ground to cover local stories, especially as we have a problem with local newspapers at the moment. They are dying and their staff are being reduced. Local reporting is becoming increasingly important, and radio is the last bastion of honest, local news media.

My hon. Friend is making an important point about the supply of the next generation of national journalists. They typically start their career in local journalism, whether that is the local newspaper or local radio station. As someone who has been on BBC Radio Essex, as my hon. Friend will know, whenever I have been on it has always been very local-centric. When I was a councillor, it was useful to go on that radio programme to talk about local issues, because I knew it would all be relevant to the listeners.

I take my hon. Friend’s point absolutely. BBC local radio is a training ground for our national reporters, as in the old days repertory theatre was for the likes of me. The loss of local radio stations is a damaging decision from the BBC. We know that the BBC is operationally and editorially independent from Government, as we are so often reminded, but that does not mean that Government can just be quiet and allow that to happen. I look forward to hearing the Minister’s comments and hope that the BBC reconsiders its position.

Thank you, Mr Twigg, for your chairmanship of this debate. I am grateful to the hon. Member for East Londonderry (Mr Campbell). Passionate views have been expressed in the Chamber, and also across the House in recent months, on these decisions by the BBC. I apologise for missing the Backbench Business debate on the matter. I was unfortunately taken down by covid, though I rather sadly watched it from my sickbed, and listened to all the comments that were made.

Since its first local radio service was launched in the ’60s, the BBC has played a vital role in promoting locally produced radio reporting. In my view, as I have said in the House before, it is that distinctive and precise local content that makes it a true public service broadcaster, with that unique relationship with the public that follows. Important radio appearances by my hon. Friend the Member for Clacton (Giles Watling) about what will be on at the local theatre, along with the local traffic report and so on, are what make an authentic and true public service.

Today, the BBC’s 39 local radio services in England reach 5.8 million listeners a week. They have a huge reach which is incredibly valued by people across our nations. We have heard in this debate how valued those services are. My hon. Friend the Member for South West Hertfordshire (Mr Mohindra) made the point that BBC local radio can be an important incubator for local talent, training those skilled broadcast professionals who go on to feed our creative industries and important broadcasting sector.

I want to recognise at the outset that the BBC’s announcement towards the end of last year of changes to radio services in Northern Ireland has caused concern in Government. It was raised by the hon. Member for Foyle (Colum Eastwood) with the Prime Minister in November last year. More recently, the Mayor of Londonderry and Strabane wrote to the BBC’s director-general Tim Davie to invite him to the city to discuss the BBC’s plans. I am not sure whether that invitation was taken up. I note the request made of me to try to facilitate meetings, and I will happily look into that. Mayor Duffy also wrote to the BBC chairman, Richard Sharp, and stressed the importance of BBC Radio Foyle in the community.

My hon. Friend the Member for The Cotswolds (Sir Geoffrey Clifton-Brown) reiterated to the BBC directly the concerns that have been raised in the Public Accounts Committee.

I am grateful to the Minister for giving way, and thankful to the hon. Member for East Londonderry (Mr Campbell) for securing the debate. Tim Davie has offered a number of meetings to some of us. We would like him to come to Derry to see the impact of the cuts, which in my view will end up closing the station.

He will not get to Derry today, because most people in Derry, and even the airport, are totally snowed in. People right across our community have been tuning in to Radio Foyle this morning to find out whether the schools were closed, whether roads were open, and whether they could move around the town and greater area. That would not happen if Radio Foyle did not exist. It is absolutely clear that the intention behind the cuts is to end up without Radio Foyle. Does the Minister agree that without locally connected broadcasters, we will not be able to have the same connection to the BBC and the same valuable public service broadcasting?

I hope my memory does not fail me, but I think there are something like 650 BBC roles in Northern Ireland, of which 36 will be cut. I understand that some of the concerns are about whether those roles will be disproportionately removed in areas such as Derry. Concerns were raised about the geographical sensitivities of some of the job losses, which I appreciate the hon. Member for East Londonderry does not share, but such issues are deeply sensitive in the context of Northern Ireland, and I do understand them.

The hon. Member for East Londonderry said that there has been a mantra from the Government about the operational decisions made by the BBC. Equally, I understand that there are various levers in our relationship. The BBC is a public service broadcaster, and I assure him I met the director-general and the chairman to raise some concerns that have been brought to my attention by Members of different parties. We have various mechanisms in our relationship with the BBC, one of which is the mid-term review. The way in which the BBC organises its resources across the organisation is not directly within that remit, but we are looking at issues of impartiality and at the extent to which the BBC’s moving into an online presence has an effect on the commercial radio market. All those questions are up for grabs, and we take them seriously.

Last week I met the chairman of Ofcom to discuss this issue and others. Ofcom is the regulator of the BBC and has a role in holding it to account. I do not think it has quite the same level of concern that we in this House have about the changes, but the BBC’s public service essence comes down to how it responds to parts of the market that are not being served by the commercial sector. That is why people support the licence fee: the BBC provides some unique services that would not otherwise be provided, and local content is vital.

The Government want the BBC to succeed as an incredibly important British broadcaster that has a wider impact on the creative industries. In so far as we have an involvement in its “digital first” policy, which is what it wants to move towards—that is part of the justification for the changes to its local radio input—I want to have a wide-ranging conversation with the BBC about that strategy. It is about how we support the BBC to thrive, but also how we ensure that its fundamental public service broadcasting operations, such as those in radio, are not undermined as part of the shift. It is understandable and necessary, but I emphasise that we need to ensure, particularly for those who are served primarily by radio—older listeners and listeners in certain geographies—that people are not neglected in the shift to digital that all broadcasters are having to undertake.

I do not have the power to direct the BBC on where it places its resources, but these points are all elements of broader conversations I have with the organisation as a Minister. I try to reflect the sentiments, feelings and strong passions of this place when I have my conversations with the BBC.

I appreciate the sentiment about independence, and the point about commercial pressures being removed by the licence fee being part of the BBC’s set-up. Most importantly, I would have thought that the BBC would be talking to older people, who may not be able to access digital things. Older people in my constituency—I include myself—would be pleased to know they would still have mainstream online BBC services.

It is necessary to ensure that the BBC is uniquely able to access audiences who may not be moving online in quite the same way as the majority of audiences. That is a key role for the BBC. The charter requires the BBC to provide distinct content that reflects and represents people and communities in all corners of the UK, and that extends to all socioeconomic groups and age groups. We believe that local content that is relevant to audiences is incredibly important in the BBC’s public service remit. Again, it is the public service remit by which we hold the BBC to account, and it is part of the discussions when it comes to deciding the licence fee and so.

The BBC has an “Across the UK” strategy that includes important content production commitments, such as a pledge to increase the BBC’s out-of-London spend for both radio and music to 50%. In May 2022 we embedded that target in our framework agreement, requiring 50% of expenditure on network radio and BBC Sounds programmes to be made out of London by the end of the charter period. I hope the communities that Members represent will start to see that benefit.

The charter requires the BBC to work collaboratively and partner with other organisations in the creative economy; we see that in things such as the local news partnerships, which have been raised by the DCMS Committee. The BBC supports Two Lochs Radio, Britain’s smallest commercial radio station, which produces public interest journalism in the Gairloch and Loch Ewe areas of Wester Ross in Scotland. That is the kind of unique thing the BBC can do with its spending power and reach, which is reflected in the kind of content produced in Members’ constituencies.

As of July, 180 media organisations were supported by the BBC as part of local news partnerships, and that collaboration is incredibly important. I have made it clear that I am disappointed that the BBC is planning to reduce that local radio output. I have also made clear my disappointment at the proposed changes to the output in Northern Ireland, including cuts to BBC Radio Foyle. As the hon. Member for East Londonderry will be aware, BBC Radio Ulster—including Foyle—reaches nearly a third of radio listeners in Northern Ireland, and it is an incredibly important part of that media landscape.

I met the BBC’s leadership at the end of last year and expressed everybody’s concerns, and that meeting has been built on; following the issue being raised in Prime Minister’s questions, the Prime Minister met the director-general and the chairman of the BBC. The Secretary of State has also written to the BBC to remind it of its responsibilities under the charter and to express our concern that we received notification of the changes only on the date they were made, rather than receiving any advance notice; that makes an urgent question rather difficult to respond to.

The DCMS Committee has been looking carefully at the BBC and its planned changes to local radio. I always appreciate the work of the Committee and its valuable contributions. I have asked the BBC for advice on how it will manage major local incidents that require a dedicated rolling news service, given its important responsibilities under the charter to support emergency broadcasting; the weather has been referenced in the debate, and providing that information is a valuable part of what the BBC does.

Beyond the BBC’s role in promoting locally produced radio reporting, there is its role in the wider local media ecosystem. Local commercial radio stations, such as Radio Clyde and Downtown Radio, reach 43% of adults every week, and most have licence obligations to provide local news in peak hours, which again provides trusted content. When I raised the issues about cuts to broadcasting with the BBC, I was told that it would protect the local news bulletins and the distinct content for each of the stations in question. I wrote to hon. Members who had spoken in the UQ to set out some of the BBC’s response to me; I hope they received those letters.

We want to ensure that everything we do supports community radio stations, and various provisions in the media Bill—which I know everybody is keen to see—will support the wider radio ecology. I hope to be able to provide further details on that Bill in due course. We are providing financial support for technical trials of small DAB broadcasting technology and to license small-scale DAB networks. I hope that that assures hon. Members that not only do we support the BBC in what it does in local radio, but we are looking at how we can have a thriving grassroots commercial and voluntary radio sector at the same time, so that the withdrawal of the BBC does not lead to a large gap in local content.

We all agree that the BBC is a national asset; its centenary year has allowed us to reflect on just how much it has contributed to lives on both a local and national level, and how much it is truly valued by our constituents; the reaction to these radio changes really underlines that point. We want the BBC to continue to succeed for the next century, and that requires it to change, but not at the cost of some of its fundamental public service broadcasting responsibilities. I reassure hon. Members that I have been consistently making that point to the BBC’s leadership, and I want to work with them to ensure that, as the BBC moves into new broadcasting challenges, it does not lose its very essence and the public support that underpins its funding model.

Question put and agreed to.

Sudden Unexplained Death in Childhood

I beg to move,

That this House has considered sudden unexplained death in childhood.

It is a great honour for me to give my first speech as a Back Bencher in about six years on this vital subject. We are here to discuss something that is incredibly difficult to deal with, emotionally very taxing, and one of the most serious medical phenomena in our country—something that has not had the public attention it deserves: sudden unexplained death in childhood, or SUDC.

This vital subject was brought to my attention while I was still in Government. Julia and Christian Rogers came to see me at the beginning of October, when I was still Chancellor of the Exchequer. In that role, I would not have been able to raise this vital subject personally. I pay tribute to my constituency neighbour, my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), for his diligence in pursuing the subject while I was still in Government. Luckily, as a matter of privilege to me, I can now raise it myself. I cannot think of a better, more urgent subject to raise in my first Back-Bench debate for many years.

When Julia and Christian came to see me in October 2022, they told me the story of their son, Louis, who tragically passed away in 2021 before he reached the age of two. Julia and Christian lived with Louis in Shepperton in my constituency, and they loved their little boy with all their hearts. Of course, no occurrence is more tragic than the death of a small child. It was particularly disturbing that they knew very little about the illness that took away Louis’ life. One can only imagine the horror of discovering one’s child lifeless, and the sheer bewilderment of trying to understand the causes of that tragedy.

Julia and Christian introduced me to other bereaved parents who had gone through this heart-wrenching occurrence. The national charity SUDC UK does vital work to promote more understanding and sensitivity around a subject that, as I said, has drawn too little attention in the past. SUDC is among the leading categories of death in England and Wales for children aged between one and four. As a community, we have to engage more vigorously with this phenomenon.

Technically, SUDC is the sudden and unexpected death of a child between one and 18 years of age. Those deaths, by their definition of sudden and unexpected, often remain unexplained after a thorough investigation, including a post-mortem. This is one of those areas that modern medical science has still not really got to the bottom of, despite the great advances we have made.

It is good that we can unite and collaborate to address some of the issues raised by SUDC. Christian’s aunt is my constituent, so I learned about Louis from her. Many of us here are parents, and this issue is deeply worrying. Like the hon. Member for Runnymede and Weybridge (Dr Spencer), I was a public health consultant and have come here from working in the NHS. This issue has not had the profile it needs—just 50 research papers, compared with 12,000 on sudden infant death syndrome. I hope we can do some joint working on the issue to raise the profile of risk factors and so on.

I am very pleased to join the hon. Lady in raising the profile of the condition. This category of death has never really gathered the attention it deserves. As far as I know, this is the first time it has been debated on the Floor of the House in this Parliament.

I pay tribute to my constituents, the Grogan family, in particular Sarah, a teacher at Cobbs Infant School in Appleton. She has been in touch with me to tell me about her experience with Frankie, her little boy, who died at the age of three. Sarah has helped to inform medical professionals, including GPs, through the videos she has made. I have learned a tremendous amount from her, and I am sure my right hon. Friend will join me in paying tribute to her for her work on this important topic.

I am delighted that my hon. Friend has made that contribution. I must press on to the end of my remarks and look forward to what other hon. Members have to say on this sensitive, moving and tragic subject. The silver lining is that we will be able to make more progress in the years ahead.

It is vital to get on the record an undertaking from the Minister and his Department to encourage consistent medical education and training—there is currently very little—to help prioritise research into this category of death. Our urgent, immediate request is an undertaking to increase public information about this tragic phenomenon. How will the Minister help to prioritise scientific research to better understand this phenomenon, and to work out ways we can prevent and reduce the tragic deaths such as those experienced among many of our friends and wider communities?

I have written to the chief executive of the NHS to ask for more and better public information. The website should be updated. I urge the Minister to engage with NHS officials and managers through a commonly agreed platform, on which we can progress.

The initial response to this debate has been incredibly heartwarming and impressive. In the last few days, dozens and dozens of people have written in. They have outlined their experiences and told us about their own tragedies and their families, which have been torn apart and devastated by this phenomenon. It would be invidious of me to talk about those responses individually, but common themes run through all the submissions in this overwhelming response—in all the evidence we have accumulated in the last few days.

The thing that comes out most tragically and vividly to me is the sense of utter bewilderment about the cause of death. Many of us in our lives have dealt with personal tragedy and the passing of loved ones. In most of those instances, we have understood the nature of the illness, and there has been a degree of timing and ability to adjust to an appalling series of events. But let us imagine the death of a child who has all of his or her life in front of them and it is suddenly ended. If we can imagine that for one of our own children, we get a sense of how tragic and difficult that occurrence is. I commend the many people here who have gone through that heart-wrenching experience, who have had the courage to reach out to come and speak to MPs, and who work incredibly hard to make sure this goes further up the agenda.

The other principal thing that I have noticed is that there is not only bewilderment and the initial horror and confusion around the event, but a marked degree of ignorance about this phenomenon among the wider public. People do not know about this. We used to read and hear about what was called cot death, which was technically applied to children under the age of one, but, for the age group between one and four and for older children, there was not even a word or a phrase to describe what happens. If this debate can start a wider conversation about SUDC, I will feel that we have done a bit of our job. This is not the end; this is just the beginning of a wider debate on a deeply tragic occurrence.

Finally, because we do not have much time, I want to thank Nikki Speed, the chief executive officer of SUDC UK, who is here, and Julia and Christian Rogers for bringing this important subject to my attention and enabling us to have a wider debate. As I have said, I think it is the first time that this has been discussed, certainly in my experience as an MP of 12 years, in these precincts. I hope we can continue to work together to find adequate solutions and improve outcomes for people in this country.

We have had successes on the phenomenon of cot death—we made huge strides with that—and it is vital now that we turn our attention and expertise to SUDC. I thank Members from across the House who have listened with real respect not to me, but to the gravity of the debate. I am very interested to hear what my hon. Friend the Minister will say in response to our speeches.

May I remind Members that they should bob if they wish to be called in this debate? There are five standing, so I must limit speeches to five minutes or so to get everybody in. I am sure you will all work together to try to achieve that before the wind-ups. I call Tim Farron.

It is a pleasure to serve under your chairmanship, Mr Twigg, and a pleasure to follow the right hon. Member for Spelthorne (Kwasi Kwarteng), who made a very moving and thoughtful speech. I especially congratulate him on securing this really important debate.

SUDC is an unimaginable tragedy to strike any family. We are here because people in our communities have reached out to us to share their experiences with us. I know we all feel that it is a huge responsibility and an honour to share their experiences.

I spoke last night and previously to my constituent Charlotte and her husband Andy regarding their little son Wilfred, who was two years and 10 months old when he died a little over a year ago. Charlotte and Andy refer to Wilfred as a

“vibrant, energetic little boy who had a vivacious and fearless lust for life.”

She goes on to say:

“The shock that reverberates into every aspect of your life when your child dies unexpectedly and suddenly is unimaginable”.

Unimaginable it is to those of us who have not personally experienced that tragedy. As I seek to honour Wilfred, perhaps the best thing that I can do is speak briefly about actions that could spare other families from experiencing the grief and tragedy with which Wilfred’s family continue to live.

The challenges are what to do with the evidence and what to do about the lack of evidence. Those are the two things that it would be good to consider. Let me first turn to what to do about the evidence. Wilfred passed away at two years and 10 months. At 10 months old, he suffered his first febrile seizure. He was never referred for further investigations to ascertain the cause or to ascertain whether a febrile seizure could lead to anything more dangerous. Wilfred had his sixth febrile seizure, which led to a cardiac arrest, and he passed away just a few days later.

Research by the US branch of the charity Sudden Unexplained Deaths in Childhood shows that roughly a third of sudden unexplained child deaths happen to children with a history of febrile seizures. So they are not totally unexplained, are they? At least some of them are not. However, febrile seizures are mostly not treated as serious or potentially serious. Most NHS trusts do not have a pathway to deal with children who have suffered a febrile seizure, and that surely must be addressed urgently. Febrile seizures must be seen as a red flag that all NHS providers should be aware of, and they should be equipped to act accordingly.

I want also to refer to something that tends to affect not very young children, but young people who are still minors: deaths caused by undiagnosed heart conditions. In particular, I want to refer to the work of CRY—Cardiac Risk in the Young—which does tremendous work in screening young people, particularly those who have any kind of family history but even those who do not, to see whether there is a potential risk. Thousands of people have been assessed by Cardiac Risk in the Young, which is a wonderful charity that works across the north-west and further—indeed, it has done sessions in Kendal. I encourage the Minister to look into how we can screen young people, particularly if there is any family history, to ensure that we do not lose them to undiagnosed heart conditions.

That is what to do with the evidence. What do we do about the lack of evidence? Simply, for the children we lose to sudden unexplained death, it is indeed totally unexplained: there are no clues. We ask collectively today that the Government prioritise scientific research into sudden unexplained deaths among children, potential causes and modifiable risk factors. We also ask that the Government and the NHS prioritise medical education to increase awareness.

I agree with what the hon. Gentleman said. I am here because a constituent told me about the tragic death of her two-year-old nephew in 2021. I am educating myself, with the help of SUDC UK, but it is difficult because there is so little debate, publicity and awareness. I hope that this well-attended debate will mean that research and education is forthcoming. It is a very rare but absolutely devastating condition.

I agree with the hon. Gentleman.

In memory of Wilfred, in honouring his family, and as we remember all those who have tragically died and we seek to support their loved ones, we ask that the Government take practical steps to help us to tackle the horror of sudden unexplained deaths among children.

I spoke to another family—I will not name them—who talked about the loss of their child not so long ago. The mother said to me:

“It clouds everything you do, feel and breathe. I hate that it happened to him and not me. I will never not be able to see him in A&E, thinking this can’t be happening, he is healthy, and I left him a couple of hours ago absolutely fine.”

There is a reason why it is such an uncomfortable issue, but it is important to grasp uncomfortable issues, not only in honour of the memory of Wilfred and everybody else who has passed away and to honour their families, but to prevent any other families from going through the same thing in future.

It is a pleasure to serve under your chairmanship, Mr Twigg. I am pleased to be here supporting the charity SUDC UK. I pay tribute to my right hon. Friend the Member for Spelthorne (Kwasi Kwarteng) who introduced me to the work of SUDC UK. I am proud to have played a very small part in helping to support it and getting this debate.

Last year, after said introduction, I had the pleasure of meeting Nikki Speed and Julia Rogers. They are two incredibly brave parents involved in SUDC UK, which is the charity that works to understand and prevent sudden unexplained death in childhood. I was saddened, upset and touched by their personal stories. I was also inspired by their commitment to supporting others, trying to improve understanding, pressing for further research into sudden unexplained death in children and making sure that others do not have to go through such a tragic event as they did.

As a parent myself, I cannot imagine anything worse than losing a child, but not knowing why they died must make it even harder still. While sudden unexplained death in childhood is frankly very rare, it affects about 40 children in the UK each year. That is 40 families each year facing the same questions and challenges. SUDC UK works to support those families and ensure that better and more consistent support is made available. Crucially, it campaigns to gather more information in the hope of understanding and ultimately preventing such deaths in future.

As a scientist by background, I agree that understanding has to be built on sound data, but the challenge with understanding sudden unexplained death in childhood begins at the very start. Currently, variation in investigation and certification following the sudden unexplained death of a child means we cannot know exactly how often SUDC occurs. There is no single specific code recorded, so gathering evidence on prevalence and mapping any factors or trends that might be present is very difficult, and the information is almost certainly incomplete.

Without that, it is difficult—nigh impossible—for research into SUDC to be conducted. Let us compare that with sudden infant death syndrome, which is the unexplained death, usually during sleep, of a seemingly healthy baby who is less than a year old. That is recorded. There have been thousands of studies conducted, as the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) pointed out, and research papers published, which have helped to contribute to the safer sleep advice that led to an 80% reduction in that category of infant deaths. In contrast, my understanding is that only 55 research papers into SUDC have been published worldwide.

The requests of SUDC UK are quite simple. It asks the Government to recognise SUDC and, by doing so, to ensure that consistent support is available for those affected. It also asks that clear, consistent information is provided about SUDC, for families and for the medics who may experience it in their careers. The charity asks the Government to support changes to enable clear and consistent data to be gathered, and research to take place as a result, so we can learn more about sudden unexplained death in childhood and, hopefully, learn one day how to prevent such tragedies. That makes complete sense when it comes to tackling the challenges and, we hope, turning around the horror that is sudden unexplained death in childhood. I look forward to hearing the Minister’s response and his and the Government’s thoughts on what we can do to take this forward.

In the spirit of the debate, I welcome the approach of Government and Opposition Members who see this as the start of a journey and of the work we need to do in this area to have the same impact on SUDC as has been made on SIDS over the years. I give my huge thanks to Nikki and Julia for their incredible strength and dedication to this work. There are a whole host of people involved in SUDC UK, and I thank everybody who is part of the team. It is incredible what they are doing by taking this forward. I hope the Minister and the Government support the work of SUDC UK not only in this debate, but in the months and years to come.

I congratulate the right hon. Member for Spelthorne (Kwasi Kwarteng) on starting the parliamentary conversation on this important issue. The fact that this is the first debate on the subject suggests to me that it is the beginning of a productive conversation.

I speak today on behalf of my constituent Alexander. On Friday I sat down with Alexander’s mum, Emily, and his dad, Darren, at their home in Lancaster. I also met his younger brother Freddie and baby sister Isabelle, who Alexander never got to meet because he died suddenly with an unexplained death on Boxing day 2021. He was three years old.

I will start my contribution by saying a little about Alexander. He was a happy, healthy three-year-old. He was doing well at nursery, and he loved Peter Rabbit and all things vehicles. He was a really loving big brother to Freddie, and he was really looking forward to meeting his new baby sister, as his mum was six months pregnant when he passed away. After a perfect Christmas day, Alexander appeared under the weather, and his mum took his brother Freddie out for a walk to give Alexander time to have a rest and a nap. Emily did not know that by the time she returned to the family home in Lancaster, her world would have changed forever.

Aside from a previous history of febrile seizures, there were no signs that Alexander was seriously ill or at risk of dying suddenly and unexpectedly. That is the reality of SUDC. It is sudden, and we currently do not know if there is any way to reduce the risk. There is no preparation and no warning, and families are left with little or no answer about why their child has died.

It would be very easy to use this debate to set out all the things that went wrong and could have been done better, but I want to talk about something that went really well. Emily and Darren were given a SUDC nurse, Jo Birch, who has been a real support to the family through a year that has been, quite frankly, horrific. This is something that is in place in Lancashire, but not everywhere. I take this opportunity to thank Jo for her work and share with the House her role. Jo is part of a nurse-led SUDC service. It is the first nurse-led SUCD service in the country—most are paediatric-led. The service began in 2008 and covers the whole of Lancashire. It follows each case through until the final stage of the process, which is the child death overview panel. For the first 10 years, the service was just two nurses working Monday to Friday, but since 2018 it has become a seven-day service. I am pleased to learn that there are now a couple of other nurse-led teams, although Lancashire remains the only one like it in the north of England.

Emily, Darren and their family ask the Government to do better by the families who are affected. They would like the Minister to take up the issue, as outlined by the hon. Member for Westmorland and Lonsdale (Tim Farron), of consistent national medical education on SUDC. Alexander’s parents feel that we particularly need to examine the links between febrile seizures and SUDC, as the limited research that exists suggests that there is an association. His parents were frequently told that such seizures were normal and he would grow out of them.

One thing that was very clear in my conversation with Alexander’s parents is that they never want any other family to have to go through what they have been through. They want to improve public information on SUDC, and that has to start with the information on the NHS website. I ask the Minister if he will encourage the NHS to urgently and immediately include appropriate information on SUDC on the NHS website. None of us can do anything to bring Alexander back, but we can all learn from his life and take action to ensure there is more research and more information on SUDC.

Finally, I want to say that Alexander is blessed to have a mummy like Emily and a daddy like Darren. Their love for their son shines through in all that they are doing in his memory. In his three years with us, Alexander touched the lives of so many people that he met, from his key workers and staff at the Lancaster University Pre-School Centre, to friends and neighbours. I thank all those constituents—there have been so many—who have written to me about today’s debate, asking me to attend and speak on behalf of Alexander.

It is a pleasure to serve under your chairmanship, Mr Twigg, and I commend my right hon. Friend the Member for Spelthorne (Kwasi Kwarteng) for securing this really important debate.

Nikki Speed was referenced earlier, and she is in the Public Gallery. She is actually one of my constituents, and I will use the words the hon. Member for Hammersmith (Andy Slaughter) used earlier: “Thank you for educating me.” As someone who has not been blessed with children, I was not aware of SUDC until the run-up to this debate. The really important point about today’s debate is that it is about educating more people about SUDC.

I will come on to various themes a bit later, but I hope the Minister will take away three important aspects: one is about education, the second is about research and the third is about the need for more public information. In my eyes, it would be quick win to update the NHS website with details about SUDC.

I have also been very moved by the many constituents who have written to me on this issue. My hon. Friend mentioned three points, all of which are important, but does he agree that the key one is perhaps research, which focuses in on causation? Although we will be able to see some common factors, no information we give will be helpful unless we understand the causation?

Unsurprisingly, my hon. Friend makes an excellent point, and I will cover it in a short while.

Mortality statistics from Nomis indicate that about 128 children between one and 19 died of SUDC between 2013 and 2021. That is 128 families and their friends who have been devastated by sudden death. Unfortunately, in Hertfordshire, we had six deaths between 2017 and 2022; indeed, they were all in 2020.

I know that Nikki has put her own journey—her own story—on her website, and would I direct people to visit SUDC UK website. She went through great trauma back in 2013 when she lost her second child, Rosie. When my staff and I were researching for this debate in my office, all of us were emotionally moved by that, because we could all relate to the fact that this could potentially have happened to a loved one. Actually, not that long ago—back in December—I referenced the fact that I have another new niece, and I remember the joy I felt when I described her in the main Chamber. The other side of the coin would be the emotional shock of having to talk about the distress of losing someone at a young age.

With Rosie’s story, what made things worse was that it was the run-up to Christmas—there was a reference earlier to another family who unfortunately lost their child on Boxing day. For those families, what is meant to be a joyous time for families and friends will, unfortunately, forever be a real sore spot of emotional trauma, and the unknowns mean there has not really been much in the way of closure.

We have spoken about research. Hopefully the Minister, who is a very good Minister, will take away from the debate the fact that more research needs to be done. The Government have levers to help influence that, but I would urge academia to do more as well. It should not always require a Government steer to do the right thing.

We have spoken about the success of research into sudden infant death syndrome and about how, off the back of 13,000 research papers, there has been an 80% decline in deaths from SIDS. To date, according to my research, we have had only 55 research papers on SUDC, so there is a huge gap there, which can potentially—hopefully—be rectified.

In December 2022, the National Child Mortality Database reported data on SUDC for the first time ever. I hope we will continue to be report it, and in more detail, because what we have heard in other speeches today—my right hon. Friend the Member for Spelthorne articulated it amazingly well—is that the lack of knowledge is the main barrier to finding a long-term solution.

I will leave it at that, because I am sure there will be other excellent speeches forthcoming. However, I echo my right hon. Friend in saying that I believe that this is the start of the journey in educating more people in this place, and hopefully up and down the country, about SUDC.

It is a pleasure to serve under your chairmanship, Mr Twigg, and I thank my right hon. Friend the Member for Spelthorne (Kwasi Kwarteng) for securing this really important debate, which will hopefully shine a little light on the sad topic of sudden unexplained death in childhood.

It is only right that I begin my contribution by telling the story of a family from Silsden in my constituency whom I had the pleasure of meeting just last Friday. Cheryl, a senior nurse in our local A&E department, and Darren, a local police officer, are incredibly loving parents to two wonderful children. On Christmas day, they put their loving, happy and fun-going little boy, Jack, who was only 16 months old, to bed, only for him not to wake the next morning. That is incredibly sad news, and it was undoubtably devastating for the family. One cannot pull together the words to express the deep sense of loss, anguish, grief and heartbreak that Cheryl and Darren will be feeling. Of course, this also has an impact on their older son, Louis, who has lost a brother he will now not be able to grow up with and share that unique brotherly bond with. Since Jack passed away only on Christmas day just past, the family have had no answers as to what has happened, and investigations are still ongoing.

Sudden unexplained death in childhood is the fourth leading category of death for children aged one to four years old in England and Wales. Approximately 40 children are affected by SUDC in the UK each year—that is one to two seemingly healthy children passing away every fortnight, often going to sleep and never waking again. As we have heard, SUDC affects not just young children under one year old; more one to nine-year-olds die of sudden unexplained death than die as a result of road traffic accidents, drowning or fires.

Published epidemiological data suggests a common profile for children affected by SUDC. Most commonly, they are one to two years old, they are male and, most worryingly, they are dying unwitnessed, alone as they sleep. The child’s development is usually normal and their vaccinations are up to date.

Of course, as all of us have said, awareness is absolutely key, because if a parent, family member or friend does not know why the death has occurred, they will constantly ask, “Why?” Over 13,000 research papers have been published on sudden infant deaths. That has helped to pioneer safer sleep advice, which has led to an 80% decline in infant deaths. However, only 55 research papers have been written on SUDC.

Last year, 8 December marked the publication of the groundbreaking report “Sudden and Unexpected Deaths in Infancy and Childhood” by the National Child Mortality Database—I have read it, and it is well worth reading, for those Members who wish to do so. It concludes that, of the sudden and unexpected deaths in 2020 that have been investigated and reviewed, 16% are still classified as unexplained. It provides greater awareness and accuracy around understanding exactly which of the many children who are affected by seizures are at risk. It helps to address some of the knowns but, as many of us have outlined, there are still many unknowns. That comes back to the issue of why research is so important. I ask the Minister what we are doing to increase that research, as well as awareness, training among medical professionals, and the public information out there.

This is undoubtably a difficult topic to talk about, but we must never forget that at the heart of all this is the sad loss of a child. They leave behind a heartbroken family—parents, brothers, sisters and grandparents—and friends. In Jack’s case, he leaves behind a loving mother, father and three-year-old brother, Louis. I would like to thank them for their time in sharing their story and for educating me in the meeting I had with them last Friday.

It is a pleasure to serve under your chairmanship, Mr Twigg, and to speak on behalf of the shadow Health and Social Care team about this tragic and vital issue. I pay tribute to the work of the right hon. Member for Spelthorne (Kwasi Kwarteng), who has been such a strong advocate in addressing sudden unexplained death in childhood. I extend my sincere condolences to his constituents, Julia and Christian, who lost their son Louis to SUDC. Their work, alongside representatives of the charity SUDC UK, to raise awareness of this tragic cause of death has been extraordinary. I would like to place on record my recognition of the work that they and others have done.

As has been outlined, SUDC is the unexpected and unexplained death of a child. Data from the Office for National Statistics estimates that around 40 children are affected by SUDC in the United Kingdom each year. As we have heard in other Members’ contributions, it is the fourth leading category of death in children aged between one and four. SUDC is similar to SIDS—sudden infant death syndrome—but whereas SIDS applies to a child who dies before they are 12 months old, SUDC can occur between the ages of one and 18. Another important difference is that SIDS research has resulted in vital safer sleep guidance, whereas there is currently no guidance and there are no recommendations to mitigate the risks of SUDC in children aged one to 18.

I cannot even begin to imagine losing a child—there can be nothing worse and no pain more unimaginable. The additional cruelty of SUDC lies in its inexplicability, because we do not know what causes it. As it stands, these deaths are unpredictable and largely unpreventable. I know I speak for those on both sides of the Chamber when I say that it is incredibly important that the Government do everything they can to support research, awareness and understanding of this tragic disease. We also need to ensure that families burdened with grief after such an enormous loss have access to the mental health and emotional support that is undoubtedly necessary after losing a child.

The National Child Mortality Database has done amazing work to improve understanding of the scale and risk markers associated with SUDC. A recent study conducted by the NCMD highlighted the role that poverty plays in a higher risk of SUDC. Some 42% of unexplained deaths of infants happened in deprived neighbourhoods, as opposed to 8% in the wealthiest.

I would appreciate it if the Minister could outline what work is ongoing to understand SUDC and what action his Department is taking to support parents and families who have lost a child to it. I would also like to impress on him the importance of tackling socioeconomic inequalities, which we know drive poorer health outcomes for those living in the most deprived communities. If we are to build a happier and healthier future for every family, irrespective of where they are born, we must get a grip on these endemic inequalities across England. I would be grateful if the Minister could update the House on the Government’s work to tackle health disparities, with SUDC particularly in mind.

We must ensure that every child gets a healthy start in life—something that has informed Labour’s commitment to train 5,000 additional health visitors. Health visitors are skilled in spotting where there may be a problem with a child’s health and are therefore key to prevention and providing that support to families.

We also need to raise awareness. In preparing for the debate, I was incredibly surprised to discover that there is currently no information about SUDC on the NHS website, as we have heard from other Members. There is no co-ordinated national research and very little public awareness. I want to use the debate to support the calls for improved public awareness, information and research, and I hope the Minister will join me in that respect and set out what discussions he will have with the NHS to improve the availability of SUDC information and support.

In closing, we owe it to the families who have lost children, the campaigners who have raised awareness and the researchers who work around the clock to better understand and ultimately defeat SUDC.

I am grateful to my right hon. Friend the Member for Spelthorne (Kwasi Kwarteng) for securing the debate on this incredibly important issue. It is the first debate of its kind in this House and he made a number of important points, which I will address.

The first point was about raising awareness, which is something that the debate itself does. We recognise the devastation to families caused by the sudden and unexpected death of a child. Each death is a tragedy and that we are unable to offer the families an explanation for the child’s death after what will have been a long and potentially invasive process, including a coroner’s investigation, must compound the family’s confusion. For the death to be unexplained just adds to the trauma.

I thank hon. Members for some powerful speeches and interventions, including those from my hon. Friends the Members for Warrington South, for Runnymede and Weybridge (Dr Spencer), for South West Hertfordshire (Mr Mohindra), for Witney (Robert Courts) and for Keighley (Robbie Moore), and the hon. Members for Westmorland and Lonsdale (Tim Farron), for Oldham East and Saddleworth (Debbie Abrahams), for Hammersmith (Andy Slaughter) and for Lancaster and Fleetwood (Cat Smith), as well as hon. Members who have listened but not been able to speak today.

I acknowledge the advocacy work of the organisation SUDC UK, which is raising the profile of the issue and providing valuable support for families. We all share the same end goal, which is to reduce the risks of sudden unexplained death in childhood, and I welcome the contributions that have been made to today’s debate.

As has been mentioned, there has been a reduction of around 70% in the number of unexplained deaths in infancy since the early 1990s. The risk factors are well recognised and the steps that parents can take—safer sleeping practices or stopping smoking—have formed clear messages for years. We are still sponsoring more research on infancy to help reduce those risks further.

The Minister mentioned sudden infant death syndrome. One of the asks that has come from both sides of the House has been whether the Department and the NHS can give the same priority to SUDC as it gives to SIDS in terms of education, research and provision of information to the public.

That is exactly what we want to do. We are committed to the health service learning from child deaths. In 2019, the Government published the “Child Death Review Statutory and Operational Guidance (England)”, advising NHS trusts on how they should support, communicate with and engage with families following the death of someone in their care. Listening to bereaved families and ensuring clear communication is integral to the process, and putting clear support in place is a top priority. That guidance sets out the full process that follows the death of a child in England. It builds on the statutory requirements set out in “Working Together To Safeguard Children” and clarifies how individual professionals and organisations across all sectors involved in the child death review should contribute to reviews.

It is important that when a child dies, bereaved parents should be supported to understand the child death review process and how they are able to contribute to it. The family should be assigned a key worker to act as a single point of contact for the bereaved family, who they can turn to for information and who can signpost them to sources of support. The hon. Member for Lancaster and Fleetwood mentioned one particular, excellent way to do that.

Each local authority area has a child death overview panel that is responsible for reviewing information on all child deaths, looking for possible patterns and potential improvements in services, with the aim of preventing future deaths. This process enables us to act quickly to address local failings within the system.

The first step towards understanding the problem is to get the data. In 2018, NHS England supported the establishment of the national child mortality database to reduce preventable child mortality in England. The NCMD records comprehensive data on the circumstances of children’s deaths and is the first of its kind anywhere in the world. The child death review process aims to ensure that information regarding every child death is systematically captured and submitted to the NCMD to enable learning to prevent future deaths.

In December, the NCMD published its report into sudden and unexpected deaths in infancy and childhood. The Government are grateful to the NCMD for its important research, which is a significant step forward. Of the 204 unexpected and sudden deaths of children reviewed by child death overview panels in 2022, 32 were classified as unexplained. The report highlighted that both explained and unexplained deaths in this age group were associated with a history of convulsions, but that association still needs further research, which I will come back to later.

The NCMD provides evidence for investigation, responding to deprivation, housing and other potential risk factors, which the hon. Member for Denton and Reddish (Andrew Gwynne) asked about. Housing Ministers are already strengthening the powers of the regulator of social housing to tackle unsafe homes, and introducing a decent home standard for the private rented sector for the first time ever, which will make sure that privately rented homes are safe and decent.

My right hon. Friend the Member for Spelthorne asked how we will improve medical education, and the report recommends consistent national training on the child death review statutory process and on sudden unexplained death in childhood. Sudden deaths of children over 12 months of age are not well understood, especially where those deaths remain unexplained. As I have outlined, child death overview panels will continue to develop their processes following the publication of the child death review statutory and operational guidance, and they will be supported by the NCMD and work with relevant professional bodies where appropriate.

We are modernising healthy child programme resources to improve available evidence for health and other professionals who work with children. This will include stronger evidence on safer sleep and sleep hygiene for older children, and NHS England is also making commitments to improve knowledge. The children and young people programme is reviewing the patient information made available, so that it is relevant and appropriate. This will involve a review of all NHS-commissioned information, including on febrile seizures. NHS England is also conducting a review of the leaflet that is handed out when a child dies, which will provide further information on sudden unexpected death in childhood.

The hon. Member for Lancaster and Fleetwood asked specifically about the NHS website. The team are reviewing the information with patient groups, so that it is appropriate.

A number of Members have quite rightly called for more research, and the report calls for further research into SUDC to better identify modifiable factors. My officials have contacted their counterparts at the University of Bristol to discuss potential research priorities, and I am happy to continue that dialogue with Members of this House and others, to scope further research priorities. Such research will help us better understand what can be prevented. The National Institute for Health and Care Research welcomes funding applications for research into any aspect of human health, including sudden unexplained death in childhood, and NHS England will be working with the NCMD to track trends in modifiable factors further. Their work will help to raise awareness across professions and identify key areas for research. My officials are also in contact with the chief nursing officer in England about any opportunities linked to the CNO’s research strategy. I look forward to hearing experts and parents’ suggestions on research, so that we all have better data on prevalence and a shared understanding of risks around gender, ethnicity and other characteristics.

Someone would have to have a heart of stone to not be moved by the contributions to today’s debate. By raising awareness and developing the understanding of modifiable factors, we can provide better information to parents and professionals, and help to reduce the risks, so that more families will not have to suffer in the same way.

Thank you, Mr Twigg. We have heard some fabulous and heartfelt speeches from across the House. In many years in Parliament, both on the Front Bench and on the Back Benches, I have debated many issues of national importance, but I do not think that any of the issues I have ever spoken about has had such emotional impact on the people affected. I was particularly struck by the concordant note—the note of agreement—from Members of all parties. It seems to me that there are a number of things on which we all agree—a number of important issues where there is broad consensus, and on which we will be challenging the Minister and his colleagues to make progress.

Undoubtedly, research is the key element. We heard that there are something like 13,000 papers on SIDS, by contrast with 50 on SUDC. That balance has to shift somewhat if we are to get improved outcomes on SUDC. Clearly, public awareness has to be a big part of getting better results. Hon. Members have mentioned the NHS website, and I feel very strongly that it should be improved to incorporate many of the things we have discussed today.

Finally, it is really important that we continue to revisit this issue. On many occasions, I have had debates here in Westminster Hall or in the main Chamber where we have said lots of warm words, but we have had very little in the shape of follow-through. On an issue of this kind, which is so important and has touched everyone emotionally, we have to be able to follow through. I urge the Minister to meet Nikki, other families and people involved in SUDC UK’s vital work, so that we can have a dialogue and achieve much better outcomes than we are currently seeing today.

Question put and agreed to.


That this House has considered sudden unexplained death in childhood.

Sitting adjourned.