Tuesday 1 May 2018
[Sir Roger Gale in the Chair]
Safeguarding Children and Young People in Sport
Good morning, ladies and gentlemen. Before we commence the debate, may I make the point that some relevant cases are sub judice. It would not be proper for hon. Members to refer to anything that is still before the courts in any form.
I beg to move,
That this House has considered the safeguarding of children and young people in sport.
It is a pleasure to serve under your chairmanship, Sir Roger. A few months after my election I was contacted by one of my constituents, Mr Ian Ackley, who is present here today, who told me that he was one of the people who had been sexually abused as a child by the serial sex offender and predatory paedophile Barry Bennell, who was convicted of 43 counts of historic child sex abuse in February this year. I shall briefly tell Ian’s story, to illustrate the failings of the past, and then explain what I think still needs to be done to safeguard children and young people in sport.
Ian told me how, as a talented young footballer aged nine, he had been spotted by Bennell. Bennell used his charm and suggested connections to top-tier football clubs to persuade parents to allow their sons to sign for his club White Knowl, which he ran in north Derbyshire. Ian told me that early on, as the team was doing well, and having won the trust of his parents, Bennell suggested that Ian stay overnight at his place so that he could talk tactics with him and Ian would be fresher for the game the next day. The parents, being very trusting and totally taken in by Bennell, consented to the stay-over; the sexual abuse began immediately. Ian was not the only child to stay over. On some occasions there would be a number of boys there, some sleeping in the same bed as Bennell. Staying overnight at Bennell’s place soon became the norm. It is hard to imagine that happening today, but those were different times.
Ian, in talking to me, made it clear that many parents of boys from other Manchester youth teams that his team played against were aware of Bennell’s abuse. On some occasions they confronted Bennell at matches, but it would seem they had either chosen not to report the abuse to the police or to take the matter further, or else that they had not been listened to. Ian told me that the sexual abuse stopped when he was 14 years old, when Bennell wound down his youth football club. Ian’s football career came to an end a few years later. In 1996 he went on to become the first person to publicly blow the whistle on Bennell’s abuse in the “Dispatches” television programme, which led to Bennell being convicted of a number of sexual offences against him.
The trauma and anguish of being sexually abused remained with Ian and are still with him. Since the recent revelations about Bennell came out two years ago, Ian’s personal and work life have suffered. Ian has used his experience with other abuse victims Paul Stewart, David White and Derek Bell to set up an organisation called SAVE, which seeks to engage with victims and others, to inform and provide advice about safeguarding in sport, and to raise awareness about potential loopholes and oversights in procedures and day-to-day activity.
I, like many others, assumed that the sexual abuse by Bennell that Ian and others suffered could not happen today because we live in different times from the 1980s, and sport has changed beyond all recognition since that time; but on closer inspection I think that there are areas that need improving. Before preparing for this debate I met with the National Society for the Prevention of Cruelty to Children, the head of safeguarding at the Football Association and a representative of the Lawn Tennis Association, and I spoke to a number of people involved in safeguarding. The FA has an exemplary safeguarding policy endorsed by the NSPCC child protection in sport unit, which it should be proud of. It even has a grassroots football safeguarding policy, which covers everything—recruitment of volunteers and staff, creating a safe environment, criminal record checks, travel and trips, vulnerable people and even cyber-bullying. Ideally, all clubs should fully implement and abide by those policies, but I have a concern about how very small Sunday morning football clubs, which are run predominantly by volunteers, will be able to ensure that all those steps are taken without finding them extremely burdensome.
I congratulate the hon. Gentleman on what is undoubtedly a timely debate. Of course young people and children should be safeguarded, but does he agree, having alluded to volunteers, that we must respect the integrity of the many thousands of them who are above reproach, and ensure that the tiny minority who have been abusive are completely and utterly isolated and alienated from dealing with young children in sport?
The hon. Gentleman makes an excellent point. Trying to close the loopholes, to stop abuse happening, is paramount; but we must also take into account the fact that many smaller clubs are run entirely by volunteers, and we must thank the genuine volunteers who are there for the benefit of the young people in the sport.
More structural support is needed at the regional or county level to ensure that small clubs get help with implementing safeguarding policies. There should be someone at the regional or county level who ensures that the policies are adhered to and that proper monitoring takes place. It is often at the smaller clubs that abuse will first happen, as in Ian Ackley’s case. We also need to ensure that children and young people feel able to speak out and be listened to when they call out abuse. That is why we need to make sure that they can do so in a safe environment, and that they are encouraged to speak out. Children and young people could be given confidence during player induction at sport settings about speaking up if they come across abuse, and there are other means whereby clubs can encourage young people to speak out whenever they come across abuse or anything happens to them.
When I met the Lawn Tennis Association I was staggered to discover that not all tennis clubs are affiliated to it. It has approximately 2,700 members, but more than 1,000 clubs are not registered with it. Some people might say, “So what? What difference does it make?” This year, for the first time, the LTA has made it a requirement that all affiliated clubs use only LTA-accredited coaches, who must meet a minimum safeguarding standard. Unregistered clubs, on the other hand, are free to appoint whomever they choose as a tennis coach. According to the LTA, there are more than 800 “accredited tennis coaches”. There are other coaching courses apart from the LTA’s, but it is worth noting that some accreditation can be obtained online for as little as £80. That means that a child or young person could be having lessons at an unregistered tennis club with a coach who obtained their accreditation online by answering tick-box questions.
What I am saying is in no way intended to call into question good unaffiliated tennis clubs and coaches, but, as we have seen time and again, people who abuse children and young people find a way to get close to them, just as rain gets through cracks in the pavement. The question arises whether coaching courses should be licensed and have Government-approved kitemarks to give people an idea of the quality of the safe- guarding training undergone by the coach. Perhaps that could be a role for the child protection in sport unit, which already gives ratings to governing bodies. It is often hard for parents to navigate all the different accreditations and codes, and anything that makes things simpler, and easier to understand, should be encouraged.
More needs to be done about summer sports courses. As things stand, there would be nothing to stop me or anyone else hiring a field and setting up my own summer football skills course for kids. With some clever marketing, I could be up and running with some cones, bibs and footballs. I think more checks need to be carried out in those casual arrangements, too. It is the sort of thing that local authority trading standards teams could check, provided they had the funding to do so.
I congratulate my hon. Friend on securing the debate. Does he agree that all sports clubs, at whatever level, dealing with children should have whistleblowing policies under which they can refer themselves to a Government or sports organisation and procedures that are available for parents and children alike?
My hon. Friend makes a very good point. Whistleblowing is important and must be catered for as far as possible. Clubs should be able to report things higher up and whistleblowers’ reports should be properly investigated.
Having mentioned coaches, I want to turn to the definition of “regulated activity”. The Protection of Freedoms Act 2012 tightened the definition of regulated activity in relation to children to mean working “regularly” —four or more days in a 30-day period—and “unsupervised” with children. Coaching falls into that category. If someone satisfies those criteria, sports clubs can carry out an enhanced DBS—Disclosure and Barring Service—check, with barred list check to see whether the individual is barred from working with children. However, it is an offence for a club to ask for an enhanced DBS check on an individual if the role does not require one. For example, the coach who coaches the youth team every Thursday night would be classified as falling into that category, but their assistant, who is technically supervised by the coach, would not be caught by that legislation.
Supervision does not always prevent abuse from happening, as it often happens in plain view, with people disbelieving that someone whom they have got to know well and even considered a friend could ever commit such vile acts of abuse.
I congratulate my hon. Friend on securing the debate. I would like to place on the record my support and complete admiration for those victims who have so bravely spoken out about their terrible experiences at the hands of Barry Bennell. They were let down. My constituents who were victims are fighting tirelessly so that something like that can never happen again. It is so important that no stone is left unturned.
Order. Let me reiterate my plea for hon. Members not to refer to cases that are before the courts.
He was found guilty.
I think that my hon. Friend was referring to someone who has been convicted. We should congratulate the people who came forward and whose cases led to convictions. More cases may follow, and we do not want to go into that area, but my hon. Friend makes a good point about the bravery of the people who came forward.
A predatory individual could simply seek a supervised role with a sports club that would allow them access to children and young people. They could be groomed over a long period and, once the individual had built a trusting relationship with them, they could be exploited and abused. There is evidence to show that adults who have been barred from working with children will continue to try to get access. The NSPCC has discovered that, since the definition of regulated activity was changed in 2012, more than 1,100 people who have been barred from working with children because they pose a threat have been caught applying to work in regulated activity by the DBS. I am not aware of any statistics in relation to unregulated activity.
Sports clubs can find it complex to identify which role should be classified as regulated activity and which should not, and could be at risk of committing an offence of over-checking if they decide to carry out a DBS check with barred list information on an individual in a role that does not require it. It is clear to me that that places sports clubs in a difficult position and that the definition of regulated activity needs to be amended and widened.
Another area that needs re-examining is “Positions of trust”, as defined by sections 21 and 22 of the Sexual Offences Act 2003. As the law stands, children are protected from being groomed into sexual relationships by trusted adults with power and influence over them. That applies to teachers, social workers and doctors, but not to sports coaches or youth leaders. That creates the absurd situation that, if a physical education teacher teaching football at school engaged in sexual activity with a 16-year-old child, that would be an offence, but if the same individual in a sports coaching role did the same thing outside school, that would not be. There should be no distinction between the two, and the law needs to be changed accordingly.
I congratulate the hon. Gentleman on obtaining the debate. We can put safeguards in place for the future, but what more can be done to help those victims who have been traumatised—those people who are living with the trauma day in, day out?
The hon. Gentleman poses an excellent question. There needs to be much more support for those people in relation to their mental health. Many people are suffering trauma as a result of past events. We need to ensure that there is a proper support network for them, so that they get the counselling, advice and therapy that they need in order to come to terms with the appalling effects of historical sexual abuse.
To return to the point about positions of trust, many national governing bodies for sports want to see the change to which I referred, and have told the NSPCC that more than 50% of all safeguarding cases arise from inappropriate relationships with sports coaches. I understand that last year the Minister announced that a ministerial commitment had been secured to extend the “position of trust” provision to sports coaches. I invite her to update us on the progress of that commitment.
Closer working with the police will be necessary. I have been made aware of instances in which the police have suggested that an individual may pose a risk to children at a sports club, and that has led to the individual’s suspension, only for the police to take no further action because the suspension means that there is no longer a risk. That sort of practice exposes clubs to challenges to their decisions to suspend and may have an adverse effect on an innocent individual.
Many victims of abuse will need advice and support when reporting it and also in the aftermath, when they may suffer from depression, have suicidal thoughts, be at risk of self-harm and suffer with their mental health generally. I know that last year the Government published a Green Paper on children and young people’s mental health, but will the Minister give serious consideration to out-of-hours provision of support for victims?
At the start of the debate, I touched on how Barry Bennell was able to get away with his sexual abuse of boys, despite it being an open secret in Manchester and other places. It is the responsibility of us all to call out abuse when we see it. I would like to think that, given the recent sex abuse scandals, none of us would tolerate knowing about any such abuse and not reporting it.
Playing sport should be fun, safe, enjoyable and rewarding. The purpose of this debate is to ensure that it remains so for children and young people. For the sake of people such as Ian Ackley and the other brave victims who spoke out about their abuse, and those who have not done so or were not able to do so, who have been robbed of their youth by the actions of evil men, I hope that by speaking up and taking action now, we will be preventing future abuse from happening in sport.
I appreciate that some of the matters that I have mentioned may fall outside the Minister’s remit, but I want to ensure that these issues have been properly aired and I hope that she will be able to use this debate to influence her ministerial colleagues to bring about the changes that will make children and young people in sport safer.
It is a pleasure to serve under your chairmanship, Sir Roger. I, too, congratulate the hon. Member for Enfield, Southgate (Bambos Charalambous) on securing this timely and important debate, and on the sympathetic way in which he outlined the case of Ian Ackley. I also welcome Ian to Westminster and congratulate him on his bravery, because it is only through his bravery and that of others that dangerous individuals such as Barry Bennell have been locked up—put away—and a light has been shone on this unacceptable and despicable practice.
Young people being interested in sport is key for their development and fitness, and it is important that we do everything possible to give them a positive environment when they are learning and nurturing their skills and developing the traits that we hope they will take further into a sporting career, or just into life generally as they get older. Of course it is imperative that we protect children in sport. However, it is also important, as the hon. Gentleman said, that we protect adults who genuinely want to help children in sport. We must alienate and root out the small minority who would use their place in sport to try to harm children in despicable ways.
I want to focus my remarks on what we are doing in Scotland to safeguard children in sport. There is currently a partnership between Children 1st and SportScotland, working with local authorities, local sports trusts, leisure trusts and sports clubs to ensure that we do as much as possible to protect young people in sport. Children 1st and SportScotland published a 116-page document entitled “10 steps to safeguard children in sport”. It is important that everything is in there to ensure that the maximum guidance is available to everyone involved in sport. It is imperative that we get that document to all people involved in sport in Scotland and across the UK.
In preparation for this debate, I spoke with my local sports development officer in Moray Council, Kim Paterson, who explained that she is the only tutor in Moray—quite a wide geographical area—who is delivering the safeguarding and protecting children course. Since January she has run 10 courses and each of them has had the maximum 20 participants, so 200 people in Moray have taken the course in the past few months.
Kim told me that a number of people are almost forced by their national governing body to do the course, so they approach it like a tick-box exercise—they feel that they have to do it. However, when they leave at the end of the day, they tell Kim and others involved in the class that they never knew there was so much information available about protecting children in sport. They might start the course a bit apprehensive about having to do more training, but they leave with far more information, and that is a positive development. If they want to go on further, there is the In Safe Hands course delivered by Children 1st, which is the next level up, looking at child protection officers within local clubs.
People sometimes see these courses as tick-box exercises; they attend once and then never go back. However, it is best practice to renew them every three years. We should all be encouraging people to ensure that they keep up to date with the standards expected of them. Children 1st and SportScotland are looking at an online version for refresher courses in future, which I would very much support.
The debate is timely and reminds us of the bravery displayed by Ian Ackley and others to ensure that individuals who caused harm in sport were brought to justice and did not get away scot-free. As the hon. Member for Enfield, Southgate said, we live in different times, but that does not mean that we should be complacent. If we became complacent, by assuming that this might have happened in the ’70s or ’80s but would not happen in 2018, we would all be letting down children and young people in our areas.
There has been progress across the UK—great work has been done to protect and safeguard children and young people in sport—but I truly believe that there is more to do. Today’s debate reminds us all of the horrors of the past. We must ensure that we do not allow that to be a distant memory and we keep up our efforts to ensure that our children can continue to enjoy sport, to gain from sport and to live their dreams in sport, but that they do not suffer nightmares, as many did under Barry Bennell and others.
Order. I know that this is difficult, but I would be grateful if hon. Members could keep names that are before the courts out of the debate.
I can give you a categorical assurance that I will not mention any names, Sir Roger, but I do want to speak on this subject. I congratulate the hon. Member for Enfield, Southgate (Bambos Charalambous) on securing the debate—we spoke about this issue on the train last Thursday and I understand his reasons for bringing it forward. It is a very important issue for all of us in this House. We are aware of your guidance, Sir Roger. I would like to give a Northern Ireland perspective on this debate. I look to the shadow Minister and the Minister, as always, for suitable and helpful responses.
As the proud father of three strapping young boys, and the even prouder grandfather of two young granddaughters, the issue of child safeguarding is close to my heart. As a father, a grandfather and an elected representative with direct contact with my constituency, and as someone who has been involved in sports over the years, my heart aches when I hear of a child going through any form of abuse, whether mental, physical or sexual. I wish to play my part in ensuring that no child whatsoever goes through that pain.
There are some 430,000 children under the age of 18 in Northern Ireland. Of those, almost 2,100 were identified as needing protection from abuse in 2017. We all know that that is not a true picture of how far abuse goes. We all suspect that it goes much further than that. Throughout the Province there is abuse taking place that will never be talked about, and for which justice will never be served. My hon. Friend the Member for East Londonderry (Mr Campbell) and I were just talking about that. There were probably lots of things that happened when we were younger that were never spoken about. It certainly did not happen in the circles I was in, but that does not mean it did not happen elsewhere, because obviously it did. Over 58,000 children were identified as needing protection from abuse in the UK in 2016. This is a UK-wide issue that must be addressed in a UK-wide manner. This is the place to do that: in this House with the Minister present.
I read the NSPCC’s briefing on preventing abuse of positions of trust, which was very helpful. I agree with the points that it made, and which the hon. Member for Enfield, Southgate explained so well in his introduction. It states:
“Sex crimes committed by adults in positions of trust have increased by more than 80 per cent since 2014... The number of offences where professionals such as teachers, care staff and youth justice workers targeted 16 and 17-year-olds in their care for sex rose to 290 in the year to June—up from 159 three years ago. Nearly 1,000 crimes were recorded over the period, with the figure steadily rising year on year.”
Current legislation does not include all sports roles, for example coaches, assistant instructors or helpers. We also need to include sports organisation and settings, such as clubs, leisure facilities and events, within these definitions. We need clarification. The legislation needs to be tightened so that all of that is covered. Is that something the Minister intends to do?
I thank the hon. Member for Enfield, Southgate (Bambos Charalambous) for securing this important debate. Does the hon. Member for Strangford (Jim Shannon) agree that we should also consider the role of the Charity Commission? A case in my constituency has shown that although the commission is good at ensuring that clubs and organisations have correct policies in place, it lacks the teeth to carry anything through. When concerns are raised, it is very slow to follow up with action.
The hon. Gentleman rightly outlines an anomaly that needs to be addressed. Again, I look to the Minister for a response. I would like to see it addressed in legislation, and this debate gives us an opportunity to do just that.
At present, abuse of a position of trust within most sports contexts is not illegal, although there might be circumstances in which the law does apply to sports coaches, for example if they are employed by and operating within a school. The hon. Member for York Outer (Julian Sturdy) touched upon that as well. The NSPCC’s view is that, because of the vulnerability of young people and the particular circumstances of sport, the legislation should be extended to roles and settings within sport. We are deeply indebted to the NSPCC for its briefing. It has outlined a number of things that will be very helpful to the Minister. I ask the Minister: when can this be done? When can the initiatives and helpful suggestions set out in the briefing and offered by hon. Members be taken on board? I know that the Government, the Minister and hon. Members are willing, so to me it is a matter of seeing where we should prioritise moving this. It must be high on the list of priorities and we must look for imminent legislative change.
I am sure that we were all moved by the stories of the Olympic gold medal-winning US gymnasts who eventually spoke out about their coach. I was shocked at how widespread the abuse was. My next thought was, “Could this happen in Northern Ireland, in the United Kingdom, or anywhere we have some representative, control or input? How are we protecting our children who want to excel and who put their trust in coaches and staff, but who are taken advantage of?” In Northern Ireland, people who work with children must have clearance, but that protects children only from known offenders. What legislation is in place to ensure that the first inappropriate touch or talk is reported as a crime and that steps are taken to convict? We must get to that stage.
There is no protection in sporting circles for 16 and 17-year-olds, who are not protected under normal sexual consent laws. That needs to change. As the hon. Member for Enfield, Southgate said, the loophole must be closed and laws on positions of trust must be extended to the work of all those involved with children. People, including us in this House, are blessed to have an input in how to help a child or a young person to grow in sport, education and life, and as a family member. It is so important to have the right laws in place to ensure that happens in the right way.
The bravery of those who have come out after years of dealing with the secret pain of their abuse must be applauded. No one in this House or further afield could fail to be moved by some of the stories that we have heard publicly—very publicly, usually. Moreover, those people must be the catalyst for desperately needed change. We must look to those people, who have come through so much, and who speak out to make a change and to ensure that no other child goes through what they have gone through, and say that we will stand with them.
I thank my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous) for securing the debate. The hon. Gentleman’s point reminded me of ChildLine, and how important a phone call to ChildLine was. Given the problem that we have, perhaps the Government should look at that again and reintroduce it across the whole of the UK to let children speak. This time, the Government should give ChildLine the money—I think it was running out of money because of its charity status. We need a lifeline for those kids so that they can speak to someone they can trust.
The hon. Gentleman is absolutely right. We are all aware of the good work that ChildLine does and the initiatives that it has set out. We need to give it support and assistance in any way we can. We should ensure that it is more available and that young people can take advantage of it. What the NSPCC did at the beginning was a great step. Many people in my constituency, across Northern Ireland and across the whole United Kingdom of Great Britain and Northern Ireland took advantage of that opportunity.
We must not only stand with those people, but speak out alongside them and act as they have acted, for the sake of my granddaughters and other children across the country. We always look to the Minister for support and guidance. Today we ask her to take action and to do what she can to protect all our children.
Before we proceed, I am aware of an element of disquiet, so I will place the ruling on the record, so that everybody understands why I have said what I have said. I imply no personal criticism to any Member. The Standing Orders for public business clearly state:
“Appellate proceedings, whether criminal or civil, are active from the time when they are commenced by application for leave to appeal or by notice of appeal until ended by judgment or discontinuance”.
They are therefore sub judice. I understand the strength of feeling in these cases—were I not in the Chair, I might share it—but the fact is that one of these cases is the subject of leave to appeal and therefore cannot be referred to.
It is a pleasure to see you in the Chair, Sir Roger. I am delighted to take part in this timely debate and I pay tribute to my colleague on the Justice Committee, the hon. Member for Enfield, Southgate (Bambos Charalambous) for securing it. He opened proceedings with a moving and powerful speech in which he spoke about the traumatic abuse suffered by his constituent. I commend everyone who has come forward for their bravery.
It is worth remembering the huge benefits that sport can have for the young. I often speak about the power of sport to influence positive change, and that is never truer than when we consider the impact of sport on the young. The power of sport can improve a young person’s self-confidence and discipline. Moreover and crucially, as we continue to debate our response to childhood obesity—nearly one third of children aged two to 15 are overweight or obese—sport can help children to lead healthier lives. Governments play a pivotal role in promoting that through policy and financing. If we in Scotland are to secure the legacy of the 2014 Commonwealth games, it will be through Scotland’s children and young people.
As a parent of two young girls, I have always encouraged them to get involved in sporting activities. Although my eldest plays football, the vast majority of their physical activity is done through the medium of dance. There is an argument to be had about whether dance is a sport or an art—I would argue that it can be both—but that is for a future Westminster Hall debate, at which I am sure the hon. Member for Strangford (Jim Shannon) will join me.
The coaching and encouragement that my daughters receive from their excellent teachers improve their self-confidence and discipline—sometimes, at least. I am aware of the trust and responsibility that all of us as parents put in coaches who help our children. I cannot speak highly enough of my daughters’ dance teachers, and the vast majority of coaches take very seriously their responsibility for the welfare of children in their care.
This debate is not about limiting the sporting opportunities for young people and children. In fact, it is the opposite: it is about how we can ensure that young people can flourish by having robust safeguards in place to ensure that they can participate in sport and physical activity safely and with confidence.
Over the past year or so, we have read horrifying headlines of child abuse cases in sport. Such cases have forced us to face the potential danger of children being exploited in sport. The courageous victims have made us confront whether appropriate safeguards are in place to ensure the protection of young people.
An NSPCC report highlighted the extent of those dangers and the real and frightening situation facing our young people. According to the NSPCC, the number of recorded sexual offences against children has increased in all four countries in the UK over the past year. Although those cases are not exclusively related to offences committed in a sporting environment, we would be foolish not to consider the issue in a sports setting and assess what can be done to ensure the welfare of young people in sport.
One way to do that is to better understand what abuse is. The NSPCC’s child protection in sport unit states that there are four types of abuse that young people in sport can experience. They include neglect, which can occur when a coach repeatedly fails to ensure that children in their care are safe; a form of physical abuse, where the nature and intensity of training or competition exceed the capacity of the child’s immature and growing body; and sexual abuse, which is another form of exploitation that young athletes experience all too often, as we have sadly seen. We also need to be mindful that young people and children can suffer from emotional abuse if they are subject to constant criticism or bullying behaviour, as was brought up in the Anti-bullying Week debate that I led late last year.
We must always remember that abuse can take many different forms, and if we are going to be successful in eliminating that type of behaviour, we must be able to better identify abusive behaviour when it happens. We need to do a lot more to support children who have been abused and we also need to take firm action to prevent it from occurring in the first place.
In Scotland, we have a fantastic organisation called Children 1st—the hon. Member for Moray (Douglas Ross) has stolen my thunder somewhat in mentioning it—which works with SportScotland, sporting organisations and clubs to ensure that they have proper safeguards in place to protect children from abuse. It provides advice and training to staff, coaches and volunteers on the development and implementation of child protection policies, and it operates a helpline for those who have concerns for a child’s welfare. As we have heard, it recently launched the Safeguarding in Sport initiative in partnership with SportScotland, which aims to improve the safeguards in place for Scottish sport. The aim is simple: to create the safest possible environment for children in sport by working with parents, coaches, teachers and volunteers to improve the child protection policies and practices that clubs should have in place to ensure the welfare of children and young people.
Safeguarding in Sport has just published advice to all junior clubs that work with young people and children. Its recommendations include having a named contact for the co-ordination of child protection. That role should be clearly defined, to ensure that the responsibility for the welfare of children is paramount. It also recommends having a child protection policy that reflects national guidelines and that is adopted by the relevant management structure in the club; a variety of child protection training methods—as we have heard from the hon. Member for Moray—at appropriate levels for those working or volunteering with children and young people in sport; a much more stringent procedure for the recruitment and selection of those who work with children and young people, including access to the protecting vulnerable groups scheme membership checks; and a disciplinary procedure for managing concerns about and allegations of poor practice, misconduct or child abuse, including provision for referrals to the children’s list.
I can speak highly of the work that Children 1st does to help to ensure that young people participate in sport safely. Its work puts the responsibility and the onus on the clubs, coaches and parents with regard to the welfare of the child, but Safeguarding in Sport will support those people in meeting that responsibility.
The SportScotland young people’s sport panel ensures that the voices of young people themselves are heard on this issue. Those young people played a crucial part in developing the new standards for child wellbeing and protection in Scottish sport. That work led to the introduction of new standards for child protection in sport, which are centred on the needs and rights of the child.
The introduction of those new standards is to be welcomed, as they will hopefully strengthen the existing safeguards. However, we should also applaud the way in which those standards were introduced and developed. Involving young people in the process ensured that their views were at the forefront of what needs to be done do ensure the safety and wellbeing of young people in sport.
There are approximately 1.1 million coaches in the UK. Most of them are volunteers who give up evenings and weekends to provide young people with sporting opportunities. Coaches accept a lot of responsibility and it is important that we support them in the same way that they support children and young people. The last thing we want to do is to design a system that deters well-meaning people, who often are parents themselves, from becoming coaches. Crucially, however, we all want robust policies in place that allow young people to enjoy sport in a safe and secure way, and it is vital that community clubs are supported in that endeavour.
Thank you for calling me to speak, Sir Roger; it is an absolute pleasure to serve under your chairmanship.
First, I thank my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous) for calling this debate. I know that this issue is so important to him, and he has been tireless in working to secure this debate. I was extremely sorry to hear the story of his constituent, Mr Ackley, who spoke so bravely about the sexual abuse that he suffered. That cannot have been easy, but Mr Ackley has provided a voice for those who do not have one.
Sport should be enjoyed and loved by all. It has a unique propensity to build communities and friendships, to inspire and motivate, and to tackle much wider issues, such as obesity and mental health. Also, as a parent of two young girls, I know how much sport can bring to children’s lives.
I am passionate about sport because I truly believe it has the power to impact positively on all of our lives, and at every opportunity we should encourage our children to be healthy and happy. That is why, most importantly, sport must be a safe space for all our children, free from predators and those who wish to cause harm.
Historical child abuse is one of the great issues of our time. For decades, it has loitered on the doorsteps of institutions. That time must end now. The scale of the revelations that we have heard about in just the past 10 years has shocked the UK to its core, and it is our collective responsibility across Government, across party lines and across governing bodies to tackle the issue. We must ensure that victims are supported and perpetrators punished, and we must do everything in our power to prevent it from ever happening again.
This issue is by no means confined to football or sport. We owe a great deal to the victims who have spoken out and I pay particular tribute to Andy Woodward, who waived his right to anonymity and told The Guardian that he had been sexually abused as a young player. His truly shocking and harrowing account paved the way for many other victims to come forward. Woodward’s actions sparked an inquiry that would change the face of football, and I pay tribute to the bravery of all those victims who have come forward since then to share their stories, not least Mr Ackley himself.
Within a few days of the revelations emerging, I tabled an urgent question for the Government and wrote to all sports governing bodies requesting a full review of their current safeguarding strategies, to make sure that there are suitable procedures in place to properly investigate historical claims and that there is capacity to root out offenders.
Given that we had discussed the issue, I am pleased that the Government have included sports coaches in the law relating to the position of trust. What progress has been made on implementing that?
I am sure that many Members present will join me in welcoming the Scottish Government’s recent decision to consult on introducing mandatory disclosure checks on all sports coaches in Scotland. However, it is important that we are not simply reactionary. We must continue to work with Sport England, the NSPCC, the police, the CPSU and national governing bodies, to ensure that we set universal standards and instil best practice.
My shadow Front-Bench colleagues and I have pushed for the introduction of mandatory reporting, to place a legal duty on people working with children to report suspected abuse, suspicions and known abuse to children’s social services. Our view has not changed and nor will it. Mandatory reporting of child abuse and neglect must be introduced, because it is more than just a tick-box exercise. It is a chance to save lives and we owe it to our children and to all those brave people who have stood up and called out their experiences. Without mandatory reporting, we will never break the culture and we will never instigate meaningful change; without it, we will allow the perpetrators to continue unchallenged, as many of them have been for so long.
Everyone here today wants to see an end to this scandal and we are all working to achieve the same goal. Now is the time to act, ensuring that good practice is shared and, where necessary, new practices are put in place, so that abuse does not take place in sport at any level.
Thank you very much, Sir Roger, for calling me to speak; as always, it is a pleasure to serve under your chairmanship.
I start by thanking the hon. Member for Enfield, Southgate (Bambos Charalambous) for securing today’s debate and I welcome the opportunity to raise awareness of this important issue and to highlight what we are doing in this area.
This is a subject very close to my heart. As the daughter of a social worker and the former coach of a football team in my constituency, I have a great appreciation for the important role of safeguarding, not only in society but in grassroots sports clubs. I have been pleased to see the positive impact that improvements in safeguarding over the years have had on young people, including at all levels of sport. However, it is vital that we build on the provisions that are already in place, so that all young people in sport receive the very best protection.
Like the hon. Gentleman and others in this House, I commend the immense bravery of all those who have spoken out about the abuse they have suffered at the hands of individuals in trusted positions in sport. I had the privilege of meeting his constituent, Ian Ackley, just before this debate. At the end of our conversation, he was generous enough to say, “Thank you for all you are doing.” My response was to say, “No, thank you”—not you, Sir Roger, obviously, but Mr Ackley—because without his bravery and that of others we might not be having this debate today. I do not want to open the papers in 20 years’ time and see another Ian coming forward because we did not pay enough attention to the systems that I am responsible for now.
I also pay tribute to Andy Woodward, whose bravery was mentioned by the hon. Member for Tooting (Dr Allin-Khan). I continue to support Andy on a regular basis and I listen to what he has to say, including where he thinks things should change. I would actually call him a friend now. I hope that is what this Government are seen as; basically, we want to ensure that we change things, so that this type of abuse never happens again.
Child sexual abuse is an abhorrent crime and it is right that we learn from it to make sure that it never happens again. Events over the last 18 months have highlighted unacceptable behaviour that went unchallenged for a long time. Sadly, this abuse has not been confined to football or the UK. Colleagues will be aware of the courageous gymnasts in the United States who have spoken out against their team doctor, and we have learned about widespread abuse within USA Swimming. In the UK, the allegations of child sexual abuse in football related to cases that took place several decades ago. The independent review commissioned by the FA into the allegations will produce some important findings that we will all need to consider when the report is published.
Safeguarding in sport is much stronger than it was in the 1970s and 1980s, when the majority of these dreadful events occurred. That said, we must remain vigilant and continue to identify gaps in provision. The Child Protection in Sport Unit, which is part of the NSPCC, was founded in 2001 to be the expert organisation on child safeguarding in sport. As part of their funding agreements with Sport England and the requirements of the code for sports governance, all funded organisations must comply with the CPSU’s standards for safeguarding and protecting children in sport. All 43 county sports partnerships and 44 regularly funded national governing bodies meet and maintain those standards. We have also taken steps to promote best practice in non-funded sports. In March, I launched a code of safeguarding in martial arts to set consistent standards and provide parents with the knowledge they need to make informed decisions about where to send their children for instruction.
In our sports strategy, we recognise that the care of participants must be a core part of our approach to boosting participation. I asked Baroness Tanni Grey-Thompson to carry out a review of sport’s duty of care to its participants. One of the key findings was that it can be difficult for people to come forward with allegations about inappropriate or harmful behaviour, particularly at the higher levels of sport. It is vital that everyone in sport feels able to speak out if they have been subject to harassment, bullying or abuse. That is why we have enhanced whistleblowing practices within the governance code of NGBs. I have been clear that sports must co-operate and ensure that they foster healthy cultures, or they will have to answer to me. I am monitoring the situation carefully and working with UK Sport to ensure that each funded sport has robust grievance and whistleblowing policies in place.
Today’s debate has rightly raised the issue of inappropriate coach-athlete relationships. Sexual abuse is a criminal offence, regardless of the age of the victim or the relationship between the perpetrator and the victim. Grooming is also a criminal offence. We encourage anyone who has been subject to grooming or abuse within sport, or is aware that it is happening, to have the confidence to report it to the police.
Concerns have been raised about seemingly consensual relationships between coaches and young athletes in their care. Children under the age of 16 are not legally able to consent to sex: sexual activity with a child under 16 has long been and remains a criminal offence. However, there are clearly concerns that a 16 or 17-year-old, who may be above the age of consent, could be a victim of coercive behaviour due to the nature of the relationship between a coach and an athlete. Colleagues have rightly pointed out that I, as the Minister for Sport, am working closely with colleagues across Government to develop proposals to extend the definition of a position of trust under the Sexual Offences Act 2003 to include sports coaches. We are also investigating what further support we can give to sports organisations to help them handle these cases.
The hon. Member for Enfield, Southgate also makes an important point about regulated activity. We must acknowledge that DBS checks form only one part of the overall picture. Employers should use a range of checks to help them make safer recruitment decisions about whether individuals are suitable to work with children. These are two areas of policy that are primarily owned by other Departments, and I appreciate that the hon. Gentleman acknowledged that, but I can assure him and others that my officials regularly discuss these matters. I am working closely with ministerial colleagues to make progress as quickly as possible.
As someone who has experienced the system as a coach and as a manager, I want to say that grassroots clubs take DBS checks very seriously. If coaches or managers do not have certificates, they can have their charter status removed by the county FA and be suspended from the leagues they are in. I assure Members that grassroots football clubs do not take this issue lightly.
I thank all Members who have contributed today, but I take a moment to thank the NSPCC and the CPSU for their tireless work protecting children. Their campaigns, support and guidance are incredible, and both organisations helped the FA enormously in the immediate aftermath of the exposé of historic child abuse in football. I encourage colleagues to highlight to their constituents the NSPCC guide to the questions that parents should be asking clubs that their children go to about their safeguarding policies. As the hon. Gentleman said, we all have a responsibility on this issue. My door is always open to anyone who wants to discuss safeguarding in sport.
At the very centre of this issue are children, who must be safe to enjoy sport free from harm. We all know of the benefits that young people gain from sport. It helps develop communication, teamwork and physical and mental health, to name just a few. Across the UK, children participate in sport with the help of thousands of supportive and responsible adults, most of whom are volunteers. We must not lose sight of the fantastic work these adults do to create fulfilling opportunities in sport for our young people. None the less, just one case of abuse in sport is too many. We have made good progress, but we must continue to respond to the new and evolving challenges we face. I want to see the UK continue to lead the way in all matters of welfare and safeguarding so that we have a system in which every child is valued, protected and safe.
First, I thank the hon. Member for Moray (Douglas Ross) for speaking about the excellent work that Children 1st does in Scotland. There is much we can learn from it, and I look forward to finding out more about that. The hon. Member for Strangford (Jim Shannon) said that unspoken abuse was a UK-wide issue. He also talked about positions of trust and roles and settings. Those are important issues, and I am grateful to him for making those points. The hon. Member for Paisley and Renfrewshire North (Gavin Newlands) spoke not only about sport but about the issues outside sport in dance and other activities. They encompass the wider child safeguarding issues we need to take into account. He also talked about getting a better understanding of the definition, the excellent work of Children 1st and the need to involve young people in setting policies and standards. Often, we draw up policies and forget to involve young people, and it is important that we bring them on board. My hon. Friend the Member for Tooting (Dr Allin-Khan) spoke about safe spaces in sport, our collective responsibility and mandatory reporting. Again, we need to take those into account. That could be progressed further.
It is pleasing to hear the Minister’s comments and about the positive steps she has taken. I hope we will see more action, particularly in relation to positions of trust and regulated activity. I hope she will keep us informed about that, but she is right that it is not only about those areas; we also need wider support to ensure that DBS checks are taken seriously at the regional and county level. She spoke about non-funded sport, which needs far more support than the governing bodies, about the duty of care to participants and about the need to speak out.
I agree with the Minister on the excellent work the NSPCC has done. Its briefings for this debate were exceptional. We need to involve it as much as we can in these issues. Obviously, we should not forget the support that comes from adults and volunteers. As she rightly said, one case of abuse in sport is too many. I hope that she will come back at some stage with positive news about positions of trust and regulated activity. I am grateful for her response today. It has been a helpful debate, and I hope it will be the first step in ensuring that young people and children enjoy sport and get amazing benefits from it, but are kept safe for as long as possible.
Question put and agreed to.
That this House has considered the safeguarding of children and young people in sport.
Bowel Cancer Screening
I apologise to Members for my late arrival; the previous debate finished early and I was under the impression that I was in the Chair only until 11 o’clock.
I beg to move,
That this House has considered bowel cancer screening.
It is a great pleasure to serve with you in the Chair, Sir Roger, and I am glad that you have taken your seat.
Bowel cancer is the fourth most common cancer in the UK. Sadly, around 16,000 people die from the disease each year. It is estimated that between now and 2035, around 332,000 more lives could be taken by this awful condition. Nearly everyone will survive bowel cancer if it detected at its earliest stage, but unfortunately only 15% of bowel cancer patients fall into that category.
I congratulate the hon. Gentleman for securing the debate. Does he agree that early-stage cancers are not only easier to treat, but less costly for a cash-strapped NHS? That is why we need an effective screening programme that includes lowering the screening age to 50 and implementing the simpler and more accurate faecal immunochemical test. That would help to get the earlier diagnosis, to stop the cancer.
I entirely agree with the hon. Gentleman about the need for an optimal screening programme—I will come to that in a moment.
In Wales around 2,200 people are diagnosed with bowel cancer each year. Nearly half of those are diagnosed at a late stage. Approximately 900 people in Wales will die from bowel cancer every year, but 78% of patients will survive for one year or more, and 58% for five years or more. These figures are not mere statistics; every single extra day with the people we love is a great joy.
I lost my own mother, Pamela Symonds, to bowel cancer on new year’s day this year. She lived just under two years after her formal—too late, I am afraid—diagnosis. She was one of the 10,000 people diagnosed annually at the late stage of bowel cancer. I know only too well the impact that bowel cancer has on families.
I pass on my condolences to my hon. Friend. With all candour, I know what he is going through: I lost my father in 2003 to bowel cancer. He was just 51. Does my hon. Friend agree that we need to start screening people for bowel cancer at the age of 50?
I absolutely agree with my hon. Friend and I pass on my condolences to him, even though the loss of his father was some time ago.
Along with my father Jeff, my wife Rebecca and my mother’s many friends, I supported her through three arduous rounds of chemotherapy, helping her to achieve her goal of living long enough to meet her grandson, my son William, who was born some three months after she was diagnosed. Owing to the care and treatment she received, her inspirational bravery and her sheer determination, she lived not only to see him born but to see him reach his first birthday in September 2017, and to see her beloved granddaughters, Matilda and Florence, reach the ages of eight and five—precious moments that are now my precious memories.
For families dealing with cancer, time is everything. Those who are diagnosed with bowel cancer have the best chance of surviving—and of surviving for much longer—if they are diagnosed at the earliest stage. This is why screening is so important.
I thank the hon. Gentleman for securing this important debate. I offer him my condolences on his dear mother’s death. He will be aware of the enormous public petition—it has received 446,000 signatures—that was started all those years ago by Lauren Backler, who also lost her mother. I have supported that campaign for a long time. Does he agree that the evidence is clear that we should be screening at the age of 50, so it is surely time for an end to shilly-shallying from the Department of Health and Social Care? Will the Minister agree to at least pilot screening for bowel cancer at 50? It is obvious that the evidence from such a pilot would be irrefutable.
Order. The situation we are in is entirely of my making, and for that I can only apologise. Given that there are so many Members present who might wish to intervene, I am prepared to stay in the Chair for six minutes of injury time to enable the hon. Gentleman to take interventions. I am sure that is illegal, but I am willing to do it, provided that the Minister and the hon. Gentleman, who are in charge of the debate, are prepared to accept that.
I am grateful for that kind offer, Sir Roger. I am delighted to hear that we can continue for an extra six minutes.
The hon. Member for Eastbourne (Stephen Lloyd) is absolutely right. This is a cross-party issue. I believe that his predecessor spoke in favour of the system that he proposes, and the hon. Member for Hexham (Guy Opperman) contacted me to draw attention to the debate that he led back in 2011. There is broad cross-party consensus for looking at the screening age and at more accurate screening methods, which I will come on to.
Participation rates remain an issue. We should send a very simple message to people: “Please do not ignore your bowel cancer screening kit, which could save your life.” There is no doubt that we must also do more to raise awareness of symptoms. Bowel cancer is often mistaken for other conditions, such as irritable bowel syndrome. That only reinforces the point that a number of hon. Members have made about the importance of highly accurate screening.
Previously, the standard screening test was considered to be the faecal occult blood test—the FOB test, as it is known—and all men and women between 60 and 74 received a home test kit, but that has been changing across the country. The best available test is now the faecal immunochemical test—the FIT—which can detect more cancers and can be set to different sensitivity levels, enabling any traces of human blood that are found to be investigated. The Royal College of Pathologists sent me a useful briefing, in which it indicates that it would expect a 45% increase in demand on pathology if the test were set at one level, but a 480% increase if it were set at a more sensitive level. That sensitivity level is important.
The Welsh Government are introducing the FIT from March 2019. I believe that it was due to be introduced in England in April. I hope that the Minister can update the House on when that will happen. I hope that there will be a decision for Northern Ireland soon. Of course, Scotland already screens people using the FIT at age 50.
As ever, it is lovely to have you in the Chair, Sir Roger. We forgive you, of course.
My youngest sister had bowel cancer. Mercifully, she had an early diagnosis because she had a wonderful GP. The hon. Gentleman mentioned Northern Ireland. In the continued absence of a functioning Northern Ireland Assembly, will he and his colleagues, and colleagues from other parties, please support the very active campaigners in Northern Ireland who, like me, wish to see the screening age for bowel cancer reduced to 50?
I am pleased to hear the good news that the hon. Lady’s sister was able to recover well. Of course Members across the House should look to support those campaigners. I am in favour of consistency across the UK. One of the great things about devolution is learning from best practice in different parts of the United Kingdom, and people in Northern Ireland absolutely should benefit too.
There are other differences in testing. In England and Scotland, people aged over 75 can obtain a screening test by calling a free bowel cancer helpline. In England, a one-off bowel scope screening is promised for those aged 55, but only around half of areas currently offer that. Will the Minister update us on how progress towards all areas being covered can be sped up?
As I indicated in answer to the hon. Member for Eastbourne, there is cross-party support for reviewing the age at which testing starts. I ask the UK Government and all the devolved Governments to look at and keep under review the age at which screening begins—that is crucial—and the sensitivity of the tests that are used. It seems to me that reducing the screening age, which many Members have pointed out, and increasing the sensitivity of tests are the two uniting themes.
My hon. Friend is making a powerful argument. Like him, I lost my mother to bowel cancer when she was only 53—an age I am now approaching. Does he have evidence on whether there should be a lower screening age at least for those of us with a family history of bowel cancer, even if the screening programme cannot be extended to everyone under 60 or 55?
I absolutely agree. Although we all want a blanket reduction in the screening age across the United Kingdom, there are a number of risk factors for bowel cancer, one of which is family history, and we certainly need to look at having flexibility around the country so that screening can be done earlier where those risk factors are present.
The charities Bowel Cancer UK and Beating Bowel Cancer seek an optimal screening programme for men and women from 50 to 74. They rightly point out the importance of early diagnosis and the real opportunity to reduce the number of people who die from this awful disease.
I pay tribute to the hon. Gentleman for bringing forward this debate at what must be a difficult time for him. My sympathies are with him. A member of my close family—my father-in-law—is suffering from bowel cancer. Thanks to the superb support of the NHS, we hope he is on the road to recovery. That has brought home to me the importance of early diagnosis. I just want to put on the record the fact that I would support the hon. Gentleman on a cross-party basis to ensure that we bring down the screening age and improve testing wherever we can.
I am sure that all hon. Members would join me in sending their very best wishes to the hon. Gentleman’s father-in-law. I would be grateful if the hon. Gentleman passed those on. I welcome the cross-party support for reducing the screening age. I referred to Bowel Cancer UK, and I should point out that I have been pleased to do a number of runs to raise money for that charity through sponsorship.
I realise that we must deal with two other things to ensure that lowering the screening age and improving the screening process across the UK is effective. First, pathology capacity must be increased, because there will obviously be vastly more samples to deal with. Secondly, we need high-quality colonoscopy capacity to deal with the increased numbers of people referred on for further investigation as more sensitive tests yield further results that need to be checked out.
I extend my condolences to my hon. Friend on the sad loss of his mother. I worked in pathology before I became an MP, and I am grateful to him for mentioning it and the increase in capacity that will be required if it is found to be indicated clinically that we need to reduce the screening age to 50.
I am grateful to my hon. Friend for her sympathy and for her bringing her experience to bear on the debate. Such increased capacity will be so important.
That we need to be ambitious on pathology and colonoscopy capacity should not deter us from the ultimate goal, however; I want to see every eligible person across the United Kingdom have access to the best and most effective screening methods so that we can finally defeat this cancer. Saving lives—giving more families more precious moments with their loved ones—should be the only incentive we need to make progress.
I congratulate my friend the hon. Member for Torfaen (Nick Thomas-Symonds) on securing the debate. I pass on my condolences, as others have, for his loss just a few months ago. It takes a great deal of bravery to stand up in the House of Commons and talk about the passing of a mother so soon after it happened—I am not sure that I could have done so when it happened to me. As the Minister with responsibility for public health and cancer, I thank him for his interest in this subject and for the support he has shown. He mentioned the runs he has done—I am sure I could not do that—and his support for our excellent bowel cancer charities, Beating Bowel Cancer and Bowel Cancer UK, which recently joined together to become one charity. We await with interest what the new name will be—answers on a postcard to the Department of Health and Social Care.
Let me start by assuring the hon. Gentleman that bowel cancer is a priority for me, the Government and NHS England. That is simply because it affects so many of our constituents—about one in 20—during their lifetimes. It is the fourth most common cancer in the UK and the second leading cause of cancer deaths, with up to 16,000 people sadly losing their lives to the disease each year. If we want to improve on what are the best ever cancer survival figures, we need to do better with bowel cancer and, indeed, with all other cancers. Thankfully, more than 76% of men and women now survive for one year, which is a crucial landmark, and about 60% survive for five years. It is encouraging that survival in those detected and treated following bowel cancer screening is about 97%.
Let me talk about FIT, the subject of our discussion. Rolling out FIT—faecal immunochemical testing for haemoglobin, to give its full title—is recommended in the independent cancer taskforce’s strategy for England. We have much more to do to catch bowel cancer early and achieve better figures, which is why the Government accepted the recommendation of the UK National Screening Committee, which provides the Government with independent, internationally regarded evidence relating to screening, that FIT should replace the current home test. The pilot work showed that FIT will increase by about 7% the proportion of people taking part. Importantly, we expect those communities not returning the current home test kits to show the most interest in using the new ones. That is an important part of England’s cancer strategy. I am sure we will all welcome that contribution to the reduction of inequalities in screening and cancer mortality for those communities.
NHS England, Public Health England and NHS Digital are working together to finalise a number of practical arrangements regarding sensitivity, rightly mentioned by the hon. Gentleman, as well as production and distribution of FIT kits and diagnostic and pathology workforce capacity—I will return to that—to ensure that when FIT is implemented, it is, critically, sustainable.
It was important to get this right first time. When I was appointed last June, I was aware of the issue. One of the first questions I asked was about it, and I am as frustrated as anyone that it has taken so long. However, I am pleased to say that we fully expect that FIT will begin to be rolled out in the autumn. The hon. Gentleman mentioned NHS Wales and next spring and it being great that devolved Administrations follow best practice. Perhaps NHS Wales could follow NHS England’s best practice and bring forward its timetable.
I am grateful to the Minister for his tone and constructive approach. May I press him for a little more detail? He said that FIT will be introduced in England in the autumn, but when will we get closer to a precise date?
I cannot give the hon. Gentleman the precise date today, but I know of his and other Members’ interest in the matter, and as soon as I can give that date I will tweet it and tag him. I assure Members that I will let the House know as soon as I have the date, and I have a funny feeling that Members will be watching closely for that.
On lowering the age for screening, many right hon. and hon. Members and their constituents are concerned that the age at which we invite people for bowel screening should be 50 rather than 60. Such concern is sometimes driven by personal experience of the impact of cancer on families as well as on constituents. The hon. Member for Eastbourne (Stephen Lloyd) feels particularly strongly about the issue and has worked on it for a long time—I worked with him a lot during his first iteration as an MP, and it is good to see him in his second chapter. I thank him and his constituent Lauren Backler, who sadly lost her mum to bowel cancer, for personally delivering to my Department last week a petition on the screening age with, as he said, 400,000-plus signatures. I was in my constituency; otherwise, I would have come down and got it myself. I saw him on “ITV News Meridian”, our local news, walking up Victoria Street with the petition. I thank him for that and will take great note of the petition. We will, of course, consider it carefully and respond in due course, but I hope what I will say today will give him some cause for optimism.
When the bowel cancer programme was introduced in 2006, it focused in the first instance on those aged 60 to 69, and then in 2010 it was extended to 70 to 74-year-olds. When we consider that eight in 10 cases are in over-60s, we can understand why that was the starting point, but that does not have to be the end point. It is therefore crucial that the clinician looking at the bowel following a finding of blood in a stool is as skilled an expert as possible, and the NHS has to make sure there was enough clinical capacity to follow up referrals.
The hon. Member for Torfaen rightly mentioned NHS England capacity, which is critical. To boost clinical capacity in the NHS in England, Health Education England has recently pledged to fund the training of 400 clinical endoscopists by 2021, which will significantly increase the endoscopy capacity in England and is a key part of the jigsaw.
This decision to screen from the age of 60 was also based on the fact that, as I have said, the risk of bowel cancer increases with age and people in their 60s are found to be most likely to complete a testing kit. However, that does not have to be the end of the conversation. Therefore, five years ago, in 2013, we started to introduce bowel scope screening for those aged 55. In the research that underpinned that decision, those who took up the offer of a bowel scope test and follow-on treatment reduced their chances of dying from bowel cancer by more than 40%. Those are good stats. Now, with the introduction of FIT, we have an important, evidence-supported opportunity to consider the totality of the bowel cancer screening programme and maximise the benefits of bowel cancer screening.
One of the issues with the scope test is its geographical spread: as I understand it, at the moment only about half of England is covered. First, will the Minister comment on when it will be extended? Secondly, I would welcome his commitment to reviewing screening in its totality.
I will indeed ask the question that the hon. Gentleman raises about geographical spread. It is a key point.
I am pleased to say that the UK National Screening Committee is now considering how to optimise bowel cancer screening using those two evidence-based testing methods, namely bowel scope screening and FIT. It will advise on the optimal strategy—the hon. Gentleman rightly used that term—for England, this summer. To inform that advice, it ran a consultation, which ended on 9 April. That focused on whether the current evidence supports a change to the current tests approved for use in bowel screening programmes. In particular, it considered whether an optimal bowel screening programme should use both BSS and FIT. Both those screening methods require significant numbers of highly trained people and significant amounts of hospital resources in the NHS. With the introduction of FIT, it is therefore timely to carry out further work to decide the best combination of tests for the English programme; that includes the issue of sensitivity. I know that there is a lot of debate in the clinical community about the range and the number of people affected. We must get that right.
I am pleased that as part of its deliberations, UKNSC will also consider the most appropriate age at which FIT screening will start. It would be wrong of me, however, to pre-empt its recommendations or, as the hon. Member for Eastbourne said, to announce an exclusive from Westminster Hall. However, it is being considered and Ministers, including the Secretary of State, take a close interest. That is as clear as I can be. We are clear that recommendations must be achievable, so the availability of high-quality follow-on tests—colonoscopy and pathology—will be central to ensuring that we can turn the benefits of a better test into thousands fewer people getting and dying from bowel cancer. I am asking NHS England to consider that carefully. It knows of my clear interest in the matter.
I am thankful that survival rates are improving year on year, with about 60% of bowel cancer patients now surviving for five years or more, compared with about 25% 40 years ago. That is a significant change. As hon. Members have said, early diagnosis is vital—for all cancers, but certainly for bowel cancer—which is why the independent cancer taskforce included driving a national ambition to achieve earlier diagnosis among its six strategic priorities in the cancer strategy for England, which I am passionate about implementing. We remain on track to deliver that priority and to deliver every one of the 96 recommendations in the strategy by 2021. We are, of course, thinking about post-2021 as part of the long-term vision for the NHS, which the Prime Minister spoke about at the Liaison Committee recently.
We hope that the introduction of FIT as the primary test in the bowel cancer screening programme later this year will further enhance the drive towards early diagnosis and ensure that we catch more cases of bowel cancer early and allow for better treatment outcomes.
Northern Ireland has not had a Health Minister since January 2017. It would be enormously encouraging if the Minister would confirm that he has spoken to the permanent secretary for the Northern Ireland Department of Health about introducing the FIT technology in Northern Ireland, which is a part of the United Kingdom.
I personally have not, but I will do so, as a takeaway from this debate. The hon. Member for Strangford (Jim Shannon), who is no longer in his place, has made the same point to me in other contexts. I shall speak to my officials and make sure that happens. I will keep the hon. Lady informed.
I have mentioned the bowel cancer charities I have a regular roundtable with all the cancer charities—it is one of the great privileges of my position. They have worked on the narrative of needing, as they put it, to talk about poo. When mainstream drive time presenters talk, as they did on BBC Radio 5 Live last week, about looking at poo and “taking a look back” as the presenter put it, it shows how far we have come. Breaking down barriers and Members talking about their experience is important, as is the way in which charities approach the subject. We look forward to seeing what the new combined charity can do. It is an important part of changing the narrative and culture, in addition to the Government’s work with NHS England to change the testing regime and the other issues I have mentioned. The battle is long, as it always is with cancer, but with the support of “Team Cancer”, in which I count all hon. Members present, I think we are winning.
Question put and agreed to.
[Mr Gary Streeter in the Chair]
I beg to move,
That this House has considered NHS cancer targets.
I thank Mr Speaker for granting this important debate, and I thank you, Mr Streeter, for chairing it and the Minister for taking time out of his busy schedule to address it.
The matters I will raise today, as briefly as possible, are matters I have raised throughout my nine years at the helm of the all-party parliamentary group on cancer. As I near the end of my chairmanship, I thank all those parliamentarians, and the wider cancer community, who have supported and continue to support the group. They have been great stalwarts; the group has achieved much and has much to achieve. I look forward to remaining involved, but at the same time I look forward to handing over the reins.
Despite the fact that, when in government, both main parties have highlighted improving survival rates and supported process targets as a means of driving change, it remains an inconvenient truth that cancer survival rates in England and, indeed, the rest of the United Kingdom continue to lag well behind the international average. What is more, there is only limited evidence that we are catching up. In 2009, the Department of Health estimated that we could save an extra 10,000 lives a year if we matched European average survival rates. In 2013, the OECD confirmed that our survival rates rank near the bottom compared with other major economies, and for some cancer types only Poland and Ireland fare worse.
Of course, Health Ministers are right to point out that cancer survival rates continue to improve. That is welcome news, but it is not the full story. As our survival rates have improved, so have those of other countries, and there is very little evidence of our closing the gap with international averages, despite the considerable increases in health spending in recent decades. The major inquiry by the APPG on cancer in 2009 uncovered the main reason our survival rates are so far behind international averages. It is not that the NHS is worse at treating cancer—once cancer is detected, NHS treatment generally bears up as strongly as that of other healthcare systems—but that it is not as good at catching cancers in the early stages when treatment has the best chances of success. Late diagnosis, therefore, lies behind our comparatively poor survival rates, and addressing that is the key to improving our cancer performance. Early diagnosis is cancer’s magic key.
So how can we best achieve it? Since the publication of our 2009 report, we as an all-party group and the wider cancer community have come together and successfully campaigned for a one-year cancer survival rate indicator to be built into the DNA of the NHS, especially at a local level. Clinical commissioning groups are now held accountable for their local survival rates through both the delivery dashboard and the Ofsted-style scores.
I congratulate the hon. Gentleman: we all know the hard work he does through the APPG and his personal passion for the subject. It is important to put that on the record, because we know why he is here. I have apologised to him, and I apologise to you, Mr Streeter, because I cannot stay. I have a meeting with a Minister at 3 o’clock, so unfortunately I cannot make the contribution that I would have liked to have made. I am sure that the Minister is disappointed, but none the less he will hear from me again in the near future.
Is the hon. Member for Basildon and Billericay (Mr Baron) aware that the target for 95% of patients with an urgent referral to wait no longer than 62 days for first treatment has not been met at all in the past year and, further, that the target for 98% of patients to receive first treatment within 31 days of a cancer diagnosis has also not been met in any of the last four quarters? Does he share my concern and, I am sure, that of the Minister?
I thank the hon. Gentleman for his kind words. I am aware of those statistics, and I will come to the 62-day target specifically later in my address. He is right to say that many CCGs and cancer alliances are not close to achieving many of those targets. That is obviously a problem when treating cancer, but it highlights a bigger issue: we should be focusing on outcome indicators rather than process targets as a means of encouraging earlier diagnosis. I will address his point specifically in a moment.
We tried very hard to get the one-year survival rates into the DNA of the NHS. The Government listened, and we now have CCGs being held accountable for their one-year survival rates, which is good news. The logic is simple: earlier diagnosis makes for better survival rates, so by holding CCGs to account for their one-year figures and, in particular, the actual outcomes, we encourage the NHS to promote earlier diagnosis and therefore improve detection.
A key advantage of focusing on outcome measures is that it gives the local NHS the flexibility to design initiatives tailored to their own populations to improve outcomes. CCGs can therefore choose whether to widen screening programmes, promote better awareness of symptoms, establish better diagnostic capabilities in primary care, embrace better technology or perhaps improve GP referral routes—any or all of those, in combination—to try to promote earlier diagnosis, which in turn will improve the one-year cancer survival rate figures.
Rather than the centre imposing a one-size-fits-all policy, the local NHS has been given the freedom to respond to and focus on local priorities, whether that be lung cancer in the case of former mining communities or persuading reticent populations to attend screening appointments. As an all-party group we try to do our bit. Each summer, the group hosts a parliamentary reception to celebrate with the 20 or so CCGs that have most improved their one-year survival rates. Successive cancer Ministers have supported that in the past, including the incumbent.
There is strong evidence, however, that that outcome indicator is being sidelined by hard-pressed CCG managements, who are focused on those process targets that are connected to funding. If the process targets are missed, there is a cost; if the one-year figures are missed, there is not. In recent decades, the NHS has been beset by numerous process targets that, instead of measuring the success of treatment, measure the performance against process benchmarks, such as A&E waiting times.
I pay tribute to the hon. Gentleman, because I know he has a strong interest in this issue for a number of reasons—as we all have, because cancer in one form or another touches nearly every family in Britain. I agree with him that it is the outcomes that matter, not the input. I wonder whether the targets are in the wrong place; I may be wrong, and the hon. Gentleman knows more about it than I do, but I think he has made an important point. The problem seems to be how to get the NHS to implement that.
I completely agree. The problem as I understand it is that, according to the House of Commons Library, there are something like nine process targets focused on cancer alone. Briefly, it is an inconvenient truth that, if we look back over the past 20 or 30 years, we will see that the NHS has been beset by process targets from both sides and for the best of reasons. The bottom line is that we have not caught up with international averages in any meaningful way over those 20 to 30 years, so we must start to question the efficacy of those process targets when what we are trying to do is to improve survival rates. If we get the NHS focused on one-year survival rates, it should look at the journey as a whole, not just a small part of it, in trying to promote initiatives to encourage earlier diagnosis, which at the end of the day is what we all have to do if we are to improve survival rates.
I am the mother of somebody who died of breast cancer and I would argue that this is about the lived experience. It is not just about survival; it is also about the journey—getting there. If care is not adequate or good enough along the way, whether somebody survives or not—well, it is better to survive, of course, but I would argue that this is absolutely about the journey. Targets are meaningless if they are not about people and their lived experience.
I completely agree. My worry about targets is that they focus on a very small, specific part of the journey when we should be talking about the journey as a whole. What I have not mentioned so far is that it was not just the one-year figures but the five-year figures that we were arguing for. We have to take a longer view of the journey in order to ensure that we take into account all aspects of it, including the support, the surround sound—the way of living—and so on. We have to ensure that those who survive receive enough supported, but my central point is that if we really are intent on encouraging earlier diagnosis, the process targets have been too blunt a weapon. We all love them. Politicians love them. Both sides love them, and the Opposition can hit the Government with them if they are missed. It is a short-term approach. In reality, they have not improved survival rates to the point where we are catching up with international averages, and that is the key problem.
I echo the hon. Gentleman’s concern about process targets being just waiting times, particularly when we know that the wait for a patient to get up the courage even to go to see their GP will often be much longer than the wait on the pathway. Does he share my concern about not having a focus on the clinical evidence of what treatment should be? My concern about leaving everything to CCGs to decide is that we are not then sharing what we know to be the best way to treat any particular cancer. We need clinical standards that are also measured.
I have a lot of sympathy for what the hon. Lady says, and that is why I think that cancer alliances have a decent role to play. They can take more of an overview and more responsibility for ensuring that best practice spreads and is learned from, but they can also take more of a role when it comes to clinical evidence in relation to treating cancer. My suggestion to the hon. Lady is this: if we get the NHS properly focused on improving its one-year figures and, therefore, its five-year figures, it will come closer to embracing the journey as a whole and coming up with initiatives, particularly at primary care level, that are designed to encourage earlier diagnosis. I fully accept that that is not the only answer—it is about supporting people and so on—but at the end of the day we are using blunt weapons to try to improve cancer survival rates, and the evidence clearly shows that we are not succeeding.
I will make some progress, but I will be happy to take more interventions later. In recent decades, the NHS has been beset by numerous process targets, as we have just discussed. Those have a role to play. It would be too revolutionary for me to stand here and say that we should discard them all and just bring in the one-year figures. I think that that would be too much for the NHS to grasp, but I do believe that process targets are too blunt a weapon. They offer information without context and, in my view, can hinder rather than help access to good treatment, especially when financial flows are linked to process targets, which has been the hallmark of our NHS since 1997. What is more, those targets, being very ambitious, have a tendency not to be met—a point made by the hon. Member for Strangford (Jim Shannon)—except in the very best of circumstances. They can easily become, as I have suggested, a political football between parties eager to score short-term points when in reality a longer-term approach is required. All sides are guilty of that.
Cancer has been no stranger to process targets. As I have mentioned, the House of Commons Library suggests that no fewer than nine process targets currently apply to cancer, most notably the two-week wait to see a specialist after a referral and the 62-day wait from urgent referral to first definitive treatment. Process targets, as I have suggested, can pose a particular problem when the NHS’s performance against them is used as a metric to control financial flows, which tends to skew medical priorities. Such targets are only part of the journey when trying to improve one-year survival rates, yet CCGs, although held accountable for outcome measures, in practice follow process targets, because they are the key to unlocking extra funds. That is one of the key issues that we need to explore further in the months and years ahead. I am talking about the fact that process targets account for only part of the journey when we need a longer term view.
I also suggest that process targets are not the best means of helping when it comes to rarer and less survivable cancers, which for too long have been the poor cousins in the cancer community. Rarer and less survivable cancers often fall between the cracks of process targets. Data on those cancers is not used routinely in much of the NHS. That encourages the NHS to go for the low-hanging fruit of the major cancers. That has to change. Given that rarer cancers account for more than half of cancer cases, serious improvements in cancer survival will not be possible unless rarer and less survivable cancers are included. Outcome measures have the advantage of encouraging their inclusion when seeking to catch up with average international survival rates.
The all-party group’s most recent report, launched at the Britain Against Cancer conference in December, highlighted an example of how process targets can act against patients. In 2016, as I think all hon. Members in the Chamber will be aware, NHS England announced £200 million of transformation funding, intended to help the newly formed cancer alliances to achieve the standards set out in the five-year cancer strategy to 2020, and bids were invited. This should be straightforward. An extra £200 million is coming in and is being handed over by the Government to NHS England. The money should be going where it is most needed—to help cancer services at the front line to deliver on the cancer strategy.
However, after the bidding process closed, a requirement for good performance against the 62-day target was introduced retrospectively. That was after the deadline—by some weeks, if not months. It resulted in multiple alliances whose performance was not deemed good enough not receiving their expected funding allocation. Oral and written evidence was taken by and submitted to the all-party group last autumn. I see members of the group in the Chamber. For those who arrived late, I point out that I have thanked the members for their help and stalwart support over the years. The oral and written evidence given to the group when we were conducting our inquiry suggested that the retrospective application of the 62-day condition was causing real problems at the frontline. We heard in effect a cry for help from those at the frontline of our cancer services. Our December report, as the Minister will be fully aware, called for a breaking of the link between the 62-day target and access to the transformation funds. Let us break that link and get the transformation funding down to the frontline, where it is needed to help to implement the cancer strategy.
It is an iniquitous situation, as the conditionality on process targets prior to funding release means that high-performing alliances receive even more money, while those that are struggling and could therefore most benefit from the extra investment do not receive the extra support. That is against the whole spirit of transformation funding.
I congratulate my hon. Friend on securing the debate and thank him for all that he has done to raise these important issues consistently during his time in the House. I, too, must leave a little before the end of the debate, so please accept my apologies, Mr Streeter. With regard to funding, notwithstanding the fund that my hon. Friend has mentioned, NHS core funding often tends to be diverted to prop up the acute sector during winter crises; that happens year after year. We are now missing cancer targets, whatever we think of them—they have ceased to be meaningful to many trusts at local level. Does he therefore agree that, if we are to make a difference, we must ensure that more of the money from the core NHS budget goes to community services and cancer services?
I broadly agree. Although a system as big as the NHS must always be able to respond to short-term emergencies, such as the winter crisis, longer term thinking is needed to address key issues such as cancer survival. At the moment we have an absence of long-term thinking, let alone long-term funding, which is harming patients to the extent that we are not focusing on outcomes. In 2009 the then Department of Health’s own figures showed that 10,000 lives were needlessly lost because we were not meeting European averages for survival rates. I agree that we need longer term thinking, and that is where outcome indicators, such as one-year and five-year cancer survival rates, would encourage not just long-term thinking, but long-term funding.
That is a problem right across the NHS. We need to take the NHS out of the political arena. The absolute bottom line is that we need a proper, long-term strategy.
I thank the hon. Lady for her support. I have been non-partisan on this matter, as I have been as chairman of the all-party group. Both sides have been guilty of trying to score political points on the back of process targets, because no Government have met them all in their entirety; we play this short-term political game when in reality what we need to do is, as best as possible, take the NHS out of politics and encourage long-term thinking. The best approach, at least with regard to cancer, would be to get the NHS to focus on those one-year and five-year survival rates. We could then stand back and say, “You are the medical experts and we are the politicians. We will hold you accountable, but use your expertise now to come up with the best plans to improve your one-year and five-year figures.” That would certainly encourage longer term thinking and funding.
I am conscious that other hon. Members want to contribute, so I will not bore everyone with the ins and outs of the all-party group’s efforts to encourage the Government to break the link between the 62 days and the transformation funding, because discussions are still ongoing. However, I will share with the House the fact that I raised the issue at Prime Minister’s questions back in December. During a positive, subsequent meeting in March, the Prime Minister agreed that all transformation funding should be released immediately, provided that relevant cancer alliances promised to produce a 62-day plan—the promise is the important thing; they did not have to produce them.
I am now in discussions with officials from No. 10 and the DHSC, because the system has been slow in following through what was agreed at that meeting. Following my further question at Prime Minister’s questions last Wednesday, the Prime Minister has agreed to meet me again, should we continue to make insufficient progress. Negotiations are now in train and I hope that we can get the funding released as quickly as possible, without waiting for the alliances to actually hit the 62-day target. The Prime Minister clearly said that she wants the transformation funding released on the promise that they will produce a plan to hit the 62-day target.
In the long term, the NHS needs to rebalance its focus away from process targets in favour of outcome indicators, such as the one-year cancer survival rates, that best help patients. If outcome measures are good and being hit, it follows that the processes will also be good; one cannot have good outcomes if there are not good processes. Patients will be seen and diagnosed in a timely fashion appropriate to their illness. These outcome measures will also have the benefit of allowing the NHS to design services and pathways flexibly, and without the straitjacket imposed by blunt process targets. That is the key issue here: focusing on the outcomes encourages the NHS at the frontline to devise ways of encouraging earlier diagnosis, including better awareness campaigns, wider screening uptake, better GP referral routes and better diagnostics. The NHS is encouraged to make those decisions at the frontline in order to drive forward earlier diagnosis.
I congratulate the hon. Gentleman on securing the debate and on the excellent work that he has done, not only with the all-party parliamentary group, but on a wide range of events over recent years. On the transformative nature of events, does he agree that we need to see international best practice, which he alluded to earlier, employed in the United Kingdom to ensure that cancer sufferers here, and their friends and families, can see the benefits?
I completely agree. Our inquiry into cancer inequalities in 2009 found that the NHS is as good as any other healthcare system internationally, if not better, at treating cancer once it is detected; the problem is that we do not detect it early enough and we never catch up. The line of international averages compared with UK averages shows that we are always behind, and there is little evidence that we are catching up. We get behind at that early one-year point, because we are not diagnosing as early as other healthcare systems, and not matter how good our treatment, we do not catch up. That is how we are losing those tens of thousands of lives, because we are not matching the European averages for survival rates.
Having been through treatment in the past, I appreciate that early diagnosis can, if dealt with correctly, save an absolute fortune. Everyone has heard the saying, “A stitch in time saves nine.” Unfortunately, leaving it too late, rather than intervening early, and having to treat the symptoms as they progress costs the health system a lot more money.
I completely agree. I have not mentioned that aspect, because I have been focusing on patients, but the hon. Gentleman is absolutely right. If we were to diagnose earlier, the NHS could save a lot of money. We all know that, by and large, the more invasive the treatment, the more costly. Given how large the NHS is, too few health economists are trying to quantify this. When I ask my local CCG or cancer alliance, they do not know the cost savings associated with earlier diagnosis. That is a great shame.
My hon. Friend makes a good point. When we talk about quality-adjusted life years—there are other measures of the cost-benefits and cost-efficiency of treatments—it seems extraordinary that a more holistic view is not taken, particularly looking at quality-of-life indicators in cancer treatment. I am sure that he will want to press the Minister on that.
I am sure that the Minister has taken that on board and I look forward to his comments. It goes without saying that the earlier we diagnose, the more money we save, which could then be ploughed back into frontline cancer services. We need to try to quantify that, and we are nowhere close to doing that at the moment.
That is why, in conclusion, I come back to the point that we need to take a longer term view on our plans for cancer care—longer term funding and thinking. Process targets actually act against that, because the focus is on specific issues, which can skew priorities, particularly when they are associated with funding. In the end, that has proven not to be in the best interests of patients, given our failure to catch up with international averages. Outcome measures retain the focus on accountability, which quite rightly governs our health service. They provide the best of both worlds: they encourage long-term thinking and long-term funding, while at the same time we as politicians rightly have to hold the NHS accountable. We are talking about £115 billion to £120 billion of taxpayers’ money. We have to ensure that there is the element of accountability in the system, but that is where outcome indicators could be very helpful.
One cannot cover everything in a debate such as this. I am glad that the HPV issue will be given a proper airing in tomorrow’s debate. I think that the vaccine should be extended to boys. I also think that the big issue of prevention is important. Healthier lifestyles make for lower cancer risks, but this specific debate is about targets. It has been a helpful debate and I thank everyone for their interventions. I look forward to other contributions and to the Minister’s comments at the conclusion.
I do not want to repeat a lot of what the hon. Member for Basildon and Billericay (Mr Baron) has said because he has already said some of what I was going to say. I am here because when I was elected I was asked by Breast Cancer Now to be an ambassador and I readily agreed. I will highlight a few things on its behalf.
Breast Cancer Now says that, although some CCGs meet diagnosis and detection targets, there are national geographical inequalities in the provision of care, and diagnosis and detection are taking priority over treatment for secondary breast cancer, which is an issue. Transformation funding has been mentioned, and Breast Cancer Now feels that such funding must be decoupled from waiting time targets immediately.
My CCG is failing to hit the targets, which means it does not get the funding. If it is failing to meet the targets, how will withholding the money make things any better? I want the Government to tell us how that makes things any better. I understand about targets and measures, but how does not giving CCGs money to treat people properly make things any better?
NHS cancer targets have tended to focus on early detection and diagnosis, which means there is less focus and resource allocated to supporting people after they have finished treatment and are living with secondary cancers. One in four people find that the end of their treatment is the hardest part and they do not always have access to a clinical nurse specialist. My daughter did not. Things moved fast for my daughter. She was diagnosed and died within 13 months. She was just 35 and she left a husband and three children behind. To get her back into hospital was an absolute nightmare. I knew all the right things to say to get her into hospital and I finally managed it, but the support was not there. People try and do their best, but the support was not right and it was not good enough. The treatment for secondary breast cancer is not good enough and that really needs to be looked at.
Every cancer patient coming to the end of their treatment should have a recovery package. A clearer picture of progress on the availability of health and wellbeing events for people living with and beyond breast cancer across England is urgently needed. The Government, as the agency that ultimately decides how our NHS is run, must deliver on that and answer for that.
I was asked to mention the collection of data and access to clinical nurse specialists, because there has been no progress. Breast Cancer Care’s 2015 research showed that only a third of NHS trusts were collecting full data on secondary breast cancer, and three quarters of NHS trusts and health boards say there is not enough specialist nursing care available. People with secondary breast cancer feel they are second rate. Lynsey used to say that. She said, “It was all right, Mum, when I was having chemo and radiotherapy and everybody was buzzing round me, but now there is nothing. There is no support at all.”
I spoke on Breast Cancer Now’s 2050 vision in Parliament a couple of months ago. If we all act now, by 2050 everybody who develops breast cancer will live, and I really hope that that happens.
The first point that the hon. Lady made about the iniquitous position that many CCGs now find themselves in is a strong one. The Government have given transformation funding of £200 million to NHS England, but a lot of it is sitting there when it is desperately needed, particularly by those that need to do a lot of catching up. It was not meant to be withheld in such a fashion. It is iniquitous also that the 62 days was retrospectively applied.
The hon. Lady spoke most powerfully.
It is a real pleasure to serve under your chairmanship, Mr Streeter. I congratulate the hon. Member for Basildon and Billericay (Mr Baron) on securing this debate. It is a good opportunity for us in this House to recognise the excellent work and service that he has given in leading the all-party group over nine years. I am pleased that he is still in post. I suspect he will continue to serve the cancer community for ever, so we are grateful for that. I pay tribute to the courageous personal testament of my hon. Friend the Member for Lincoln (Karen Lee) and her role as a breast cancer champion, particularly in highlighting the need to do better on secondary breast cancer, which everybody wants us to deal with much better.
For all but one month since April 2014, the 62-day target for patients to have received their first treatment since initial referral has been missed, and 81 trusts failed to meet the 85% target last year. When we do not meet targets, we let patients down in one way or another. As has been said, the target is not perfect. It does, however, set our sights on what we are trying to achieve: securing treatments, reducing waiting lists and improving outcomes. The target is important because it helps to measure the patient pathway. It gives us a better understanding of what patients are going through and offers the opportunity to prevent unnecessarily long waits.
Waiting can be a very anxious time. While treatment is on hold, life carries on. Bills still need to be paid, the kids still need picking up from school and jobs still need to be done. Life does not stop, and cancer does not stop, so it is important that we have the 62-day target. It performs a function, but it is not everything. As the hon. Member for Basildon and Billericay has said, we need to move to outcome measures such as the one-year survival rate, or indeed the five-year survival rate. He spoke most eloquently about how that has the potential to change behaviours in a positive way. However, unless we have targets, we do not know how they impact on behaviours; they are always imperfect, but they are useful measures.
As the all-party group’s December report said, we need to break the link between the 62-day performance target and access to transformation funds. As the exchange between my hon. Friend the Member for Lincoln and the hon. Member for Basildon and Billericay demonstrates, unfortunately that can have iniquitous consequences and the areas that most need support get least support. Of course, the support needs to go where it can be most effective. I think we all have confidence in the Minister. Like many other people who work to help tackle cancer up and down the land and for whom we can have only the greatest admiration, he is fighting every day to try to make things better for cancer patients, cancer survivors and their families.
As the hon. Member for Basildon and Billericay has said, early diagnosis is the key. It is the magic wand, the holy grail, the silver button, but if it was easy to achieve it would have been achieved by now. Rarer cancers make up more than 50% of cancer cases, so we need to provide transformation funding for cancer alliances so that it can help drive early diagnosis and achieve NHS targets. It is crucial that the less survivable cancers benefit from allocation of transformation funding. The funding must continue to be used to tackle hard-to-treat cancers such as pancreatic cancer. I speak as chair of the all-party group on pancreatic cancer. It has the lowest survival rates of the 20 most common cancers. Its one-year survival rate is sadly still 24%, far behind the 75% one-year survival target set in the cancer strategy. So there is still a long way to go and we know that it is a massive challenge. Things are moving in the right direction, and we are right to be impatient, but we need to use our impatience to help us to work with the Government to bring about the positive changes we all want.
As an example of what is being done to tackle pancreatic cancer, and the need to get the transformation funding in the right place, Mr Keith Roberts and his team in Birmingham have created a faster pathway to surgery for pancreatic cancer patients by redesigning services. With the fast-track pathway, a patient receives surgery for a tumour quickly, avoiding the need for a separate procedure for jaundice. A patient not on the fast-track pathway would have a procedure for jaundice followed by a separate surgery, which could take two months on average. Going straight to resection cuts out the delay. At present, surgery is the only treatment that can save lives, yet fewer than one in 10 people with pancreatic cancer have access to it. The pathway is achieved in part through the use of a dedicated clinical nurse specialist, who is appointed to support and prepare patients to receive surgery within 16 days of referral. The results of the fast-track surgery pathway have been quite compelling. It has increased the number of patients whose surgery was successful by 22%, and patients received surgery within 16 days as opposed to two months from referral. It has saved the NHS an average of £3,200 per patient, and we would expect those savings to have reached £100,000 within a year.
The initial fast-track findings were so successful that the NICE guidelines on pancreatic cancer, which were published in February, now recommend the fast-track pathway, unless the person is taking part in a clinical trial requiring other treatment. However, despite all those benefits, the savings to the NHS and the fact that the pathway is recommended by NICE, Mr. Roberts’ team is still struggling to secure funding for a full-time clinical nurse specialist, which means it has one fewer than a year ago. That does not make logical sense, but sometimes in the real world things that make no logical sense happen because of the other pressures on people. The fast-track pathway and its patients are being challenged. That situation is a good example of the need to get transformation funding to the right places, and is probably one of many around the country. It is not because people do not want them that the things in question do not happen; it is because the system does not work as everyone wants it to. One of our jobs is to use our voice here to help to unlock the barriers, so that the things we want can happen, and so that patients are seen faster and have the transformational treatments that are needed.
The all-party parliamentary group on cancer has called on the NHS to ensure that the cancer alliances are given the necessary transformation funding and support, and it is crucial that the NHS delivers that. Cancer alliances everywhere need to be able to use their funding to implement the NICE guidelines, including those on pancreatic cancer. Fast-track surgery is recommended for certain patients with jaundice. Yet it will not be available to most patients because the pathway is not in their area. We need to make sure that it is accessible. Cancer alliances must prioritise innovations for less survivable cancers and ensure that opportunities are provided, because, as the hon. Member for Basildon and Billericay reminded us, 50% of cancers are rarer ones that are more difficult to address.
I have one or two other points to make. The cancer dashboard has been helpful in driving improvements in cancer treatment. It might be worth looking at whether blood cancer could be included, as I think it would be of assistance. I very much support what the hon. Member for Basildon and Billericay, the chair of the all-party group, said about the HPV vaccine. It seems like an opportunity for prevention, which is always better than cure, particularly if it is reasonably cost-effective, as I believe that vaccine is. There are opportunities to raise awareness, such as the “Be Clear on Cancer” campaign on difficult abdominal pains, which was piloted in the west midlands. Such things help to increase patient and GP awareness, and the chance that people will go to their GP at the right time and get an assessment. That can drive them into early diagnosis, so that things can be moved forward. Such things, which I know the Minister is keen on, are opportunities that can help, and are to be applauded and encouraged.
It is estimated that by 2020 2.4 million people in England will have had a cancer diagnosis at some point in their lives. We cannot let them down. Our job is to do the best by them. We need to do the best with the 62-day target, but also to continue the debate on whether process targets take us where we need to be or whether we should look more carefully at outcome targets. We must use whatever means we can to improve early diagnosis, and do all we can to support patients from the day they receive the news no one wants to hear to the day they receive the all clear. If we achieve those things, not only will we improve the NHS but we will save hundreds of lives every day of the year.
I declare an interest; I was for 30 years a breast cancer surgeon, and I am co-chair of the all-party parliamentary group on breast cancer. Cancer affects one in three people in the United Kingdom at this point, but that is expected to rise to one in two for the population born after 1960. Part of the reason for that is that we live longer, and unfortunately still have not improved our lifestyles to a significant degree. In particular, we all know about smoking and cancer, but we should also be aware that obesity is the second most common driver of cancer, and is increasing.
The hon. Member for Basildon and Billericay (Mr Baron) spoke about process targets—particularly on waiting times. I remember when the cancer-specific waiting times came in, in Scotland, and I welcomed them. Before that, there was only the standard waiting time of 18 weeks. If a manager was told, “We are struggling to keep up with breast cancer”, but the 18 weeks had not been exceeded, there was no interest. That is the problem with any target; once a target is set, anything that is not subject to a target starts to be neglected. We welcomed targets at first. As the hon. Gentleman mentioned, the 31-day target is either being met, or is close to being met, because once people are diagnosed, all four NHSs switch into high gear and manage to treat people within the 31 days.
The problem is that that is only a little bit of the journey. The 62 days are meant to cover the time from seeing the GP to the referral to the clinic, from the clinic to the diagnosis, from the diagnosis to discussion and planning and a multidisciplinary team meeting, and from that point to the first treatment. If we look into it, the delay is often between being seen in the clinic and the diagnosis. With breast cancer we luckily tend to meet the 62-day target at around 95%, because our clinics are largely one stop. The patient usually gets all the tests on one day. However, in England the 62-day figure is below 83%, even though the 31-day figure is over 97%, and we can see how big the fall is, in trying to get people diagnosed. There is a huge workforce challenge in radiology, and in breast cancer a cliff edge is coming, because the generation who were appointed when screening started in 1991 are all retiring right now, and that is a real issue.
As I said earlier, in an intervention, it is not just a question of the time on the pathway; the biggest delay is getting people to go to see their GP. We need to get rid of the fear, embarrassment and stigma, particularly when a more embarrassing part of the body is involved.
We all run projects such as, in Scotland, Detect Cancer Early, and in England, Be Clear on Cancer, but it is important that such campaigns bubble along, rather than become intense. People need to see those adverts when it is in the back of their head that, yes, perhaps their bowel habits have changed, there is blood in their urine, or they find a lump. If that happened six months ago, it is no use. When we ran our first Detect Cancer Early campaign in Scotland with the comedian Elaine C. Smith, it was very humorous and well picked up. We got a 50% increase in people referred to breast clinics, but there was no significant difference in the diagnosis of cancer. It meant that the clinics were completely overwhelmed. We were doing clinics at night and at weekends to try to catch up, but the people who had cancer actually ended up waiting longer for their diagnosis. It is important that we generate not fear but education, and that first experience was taken into account in future campaigns.
Early detection has been mentioned, and screening is the best way of doing that if the cancer is screenable. Such screening will result in an increased incidence of cancer. People often do not think about the fact that if screening is introduced or expanded, or the technique is improved, more cancers will be diagnosed. The system must be ready to deal with that, and we need not to see it as a negative.
Since bowel screening was introduced in Scotland, there has been an 18% drop in colon cancer in men. Bowel screening, which was debated in this Chamber this morning, is not just a screening technique; it is actually preventive. When we test for blood in the stool, we can also diagnose polyps, which can then be treated to avoid them developing into cancer. That is a drop of almost one fifth over 10 years in our incidence of colon cancer. Bowel screening in Scotland starts from the age of 50 and runs to 75. Those over the age of 75 can request a kit, but they will not be sent it automatically. We have now moved to the faecal immunochemical test, which requires only one sample. It is also more sensitive, and there seems to be an almost 10% increase in uptake. Again, that will mean more colonoscopies and more diagnoses, and people must be prepared for that.
Process and outcome targets have been mentioned, but an important group of targets in between is those on quality of treatment. It is not good enough just to leave things to clinical commissioning groups or cancer alliances to work out the best way to treat various types of cancer. The data are international and national, and we need a group of experts to pool them together and come up with something that no one will quibble about, and that everyone agrees is what we should be aiming to achieve for various cancers, in people’s surgeries, after their diagnoses, and with their radiation or chemo.
In 2000, what is now called Healthcare Improvement Scotland developed clinical cancer standards for the four common cancers. I had the honour to lead on the development of breast cancer standards, and I led that project until 2011. We are now on the fifth iteration of our standards, and they have been slimmed down. We have moved from looking at four cancers in 2002, to 11 cancers in 2012, and now 18 cancers have detailed clinical targets for which they are audited, and for which peer review takes place. We do not set league tables, but we set standards that every unit can aim to pass. There is no point in being told, “The best unit is 500 miles away”; people want their local unit to be good.
The first two standards in our quality performance indicators state that every patient with breast cancer must be discussed at a multidisciplinary team meeting, and that patients must be diagnosed non-operatively by needle biopsy. When I started in my unit in the mid-1990s, our pre-op diagnosis rate was about 40%; it is now about 98%. If those two standards had been in place in England, the rogue surgeon Ian Paterson might have been picked up earlier. We now know that he tended to make his own treatment decisions, and he operated on women without proof of cancer. Obviously, the standards cover all sorts of things, including surgery, diagnosis, chemo and radiotherapy. Data are collected at the MDT meeting with a member of audit staff present. That means that they can capture evidence of recurrence and patients who develop metastatic disease, and everyone on the team is aware that that has happened.
To respond to the point raised by the hon. Member for Lincoln (Karen Lee), my unit discussed whether we would have separate cancer nurse specialists for those with recurrent or secondary disease, or whether it would be better if the original nurse followed the patient through, and that is what we went for—our nurses work between the surgical clinic and oncology, so that people see a face they already know. Having done it for years, I know that breaking bad news a second time is infinitely worse than breaking it the first time.
In England there are screening data from breast cancer and guidelines from the National Institute for Health and Care Excellence. There are, however, no audit data that are peer reviewed and compared. We get no financial reward for improvement in our targets. Money is not part of it; it is simple, clinical pride, and a wee touch of competitiveness. In Scotland we meet every year in the breast cancer service, and our data are put up. That is open and public; people can look for any of our reports on the internet, and they will see all the details about the numbers of patients treated and what has been achieved. Peer review and peer pressure is a great way to drive up quality.
The hon. Member for Basildon and Billericay mentioned early diagnosis and the need for one-year outcome figures, but spending all the money to gain another couple of per cent in a waiting time is not necessarily the best way to go. A comparison was made between breast cancer treatment in the UK and in Denmark, and because of screening—the UK was one of the earliest nations to pick up breast screening as a population screening—we have a higher percentage of patients diagnosed at stage 1 than Denmark. We do not, however, have a better survival rate because we have very slow access to new drugs. It takes new, expensive cancer drugs three or five years to get into common use. Yes, if someone is diagnosed early they might not need those drugs, but if they are unlucky enough to have a really nasty, aggressive cancer, they may end up fighting to get them.
For a whole host of reasons mentioned by the hon. Lady, one area that perhaps shows promise in improving early diagnosis is breast cancer. In general, however, we fall behind international averages at that one-year point. The whole point of focusing the NHS on one-year survival rates, and encouraging it to improve those rates, is to send a message down the line and encourage early diagnosis across the whole panoply of primary care services, including improving screening rates and participation.
I totally agree. People who have died before one year—that is, in essence, what is being measured by our one-year survival rate—are largely those who presented with an advanced or incredibly aggressive disease. We are measuring people for whom we did not have a treatment, rather than just early diagnosis, and we will see that much more in the five-year figures. I am not saying that we should not have those measurements, but if a clinician is just being told, “You have to get better one-year figures”, should they take a bigger margin? Do they use this chemo or that one? They need guidance on what evidence shows will provide better one-year figures.
On prevention, there has been a drop of more than 17% in men with lung cancer, because of the fall in smoking in men. Unfortunately, there has been a rise in lung cancer in women. There has also been a rise in malignant melanoma in men, because they are catching up with women in the use of sun beds and overseas holidays. We still have a long way to go simply to try to prevent cancer, because the gold standard is not getting it in the first place. As I have said, obesity is the second most common cause of cancer. We do not need strategies that are just for cancer. We need health in all policies to try to make people healthier, and that way we will reduce the number of people who are suffering from cancer.
It is a pleasure to serve under your chairmanship, Mr Streeter. I congratulate the hon. Member for Basildon and Billericay (Mr Baron) on securing the debate and on his considered and balanced speech. As chair of the all-party parliamentary group on cancer, he commands a great deal of respect on both sides of the House for his commitment to improving the way we deal with cancer, as has been reflected in the tributes paid to him by hon. Members.
I also pay tribute to my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), the shadow Public Health Minister. She contributes a huge amount through her work as co-chair of the APPG on breast cancer and as chair of the APPG on ovarian cancer, and through her involvement with countless other organisations. Were it not for a long-standing, important commitment, she would be responding to the debate.
We have heard several contributions. My hon. Friend the Member for Lincoln (Karen Lee) spoke movingly from personal experience about the difficulty of getting the right care for her daughter. She described feeling a lack of support when the condition moved away from traditional treatments. I hope that her time in the House and her experiences will enable an improvement in the treatment experience of patients, particularly those suffering from secondary breast cancer. She made an important point about the geographical inequalities in treatment for secondary breast cancer. She also said that the transformation funding should be decoupled from the targets, as did most other hon. Members. The hon. Member for Basildon and Billericay talked about retrospective conditionality, which neatly highlights the absurdity of the situation.
I pay tribute to my hon. Friend the Member for Scunthorpe (Nic Dakin) for his work on the APPG on pancreatic cancer. He spoke in defence of the 62-day target and set out very well why it is important, not just for measuring some elements of performance, but because the wait between first being suspected of a condition and receiving treatment is probably the most anxious time for a patient. He also said that the link between the 62-day target and access to the transformation fund should be broken, and that funding should be available for conditions that are harder to treat, such as pancreatic cancer. He spoke in some detail about the fast-track surgery pathway. I am pleased to hear that the NICE guidelines have been amended to reflect the success of that initiative, but it was disappointing to hear about the funding difficulties and the fact that it has not yet been rolled out to other areas of the country.
As all hon. Members have said, cancer is a difficult subject to talk about. It touches all our lives in some way. One in two people will be affected by cancer at some point in their lifetime. Every two minutes, someone in this country is diagnosed with cancer. It is right that the tone of the debate has been about trying to do the best we can to improve outcomes for people touched by cancer.
As has been said, there has been a steady and welcome improvement in cancer survival rates in this country, which can partly be attributed to considerable improvements in early diagnosis, but the sad and inconvenient truth is that we still lag far behind our European counterparts, as the hon. Member for Basildon and Billericay said. Five-year survival rates in the UK are far behind European averages in nine out of 10 cancers. Of the five largest EU countries, we have the highest mortality rates and the lowest survival rates. It is estimated that up to 10,000 deaths a year in England could be attributed to lower survival rates compared with those in the best performing countries. The OECD has said that our survival rates for certain types of cancer are near the bottom of the table. Several hon. Members made the point that although we have improved, other countries have progressed at a similar rate, so our relative performance is still a considerable challenge.
There is an international element, but there is also a local one within England. If all clinical commissioning groups were able to achieve the level of early diagnosis in lung cancer that the best CCGs manage, 52,000 people would be diagnosed earlier, which could save lives. The introduction of the CCG dashboard has helped to raise the visibility of such issues and, as the hon. Member for Basildon and Billericay said, the flexibility afforded to CCGs has enabled them to adjust their approach and take account of local priorities.
The hon. Gentleman was right to express the concern that process targets can have funding consequences, which sometimes have a distorting effect on priorities. My hon. Friend the Member for Scunthorpe raised an important issue about the applicability of blood cancers to the CCG dashboard.
We all agree that the most important element of any cancer treatment is time; as hon. Members have said, it is key to a successful outcome. It is generally agreed to be the single most important reason for lower survival rates in England, so it is vital that we do better not only on early diagnosis, but on prevention and awareness. The hon. Member for Central Ayrshire (Dr Whitford) spoke well about the challenge we face in encouraging people to go and see their GP as soon as symptoms present.
That is why it is vital that early diagnosis continues to be a priority. As the hon. Member for Basildon and Billericay said, we should take a wider view about longer term survival rates. We know that 35% of lung cancer patients are diagnosed only after presenting as an emergency, and one in 20 are not diagnosed until after they have died. The Roy Castle Lung Cancer Foundation found that if a person is treated early, their chance of surviving for five years or more is up to 73%, but the current five-year survival rate is only 10%. For ovarian cancer, the National Cancer Registration and Analysis Service found that more than 25% of women are diagnosed through an emergency presentation. Of those, just 45% will go on to live for a year or more, compared with more than 80% of women who survive beyond a year if they are diagnosed following a referral from their GP.
We also know that once patients have been diagnosed, they have an agonising wait for treatment, as my hon. Friend the Member for Scunthorpe said. The 62-day target has now been met only once in the last four years since January 2014, and more than 100,000 people have had to wait longer than two months for their treatment to start. Although we are talking about some of the merits of those targets, it is important to ask the Minister if he can update us about the steps that are being taken to meet them in future.
One of the key elements in meeting those targets is having an adequately staffed workforce. From our experiences of visiting hospitals, we all know how reliant we are on the members of staff who go above and beyond the call of duty each day. Without them, the staff shortages that we are experiencing would have a much more significant impact on the services that are offered. Across the workforce, we have immediate challenges and demographic issues that are likely to have a significant impact in the near future, and that is before we consider the implications of Brexit.
Cancer Research UK has observed that the vacancy level across diagnostic radiographers, radiologists, gastroenterologists and histopathologists is at least 10%. In the cancer patient experience survey, 7% of cancer patients said that there were rarely or never enough nurses to care for them properly. The most recent report by the APPG on cancer highlights that 28% of radiographers are forecast to leave the profession by 2021. There are also reports that visa restrictions are hampering trusts’ recruitment plans.
This is not meant to be a political point, but if we want people to train as medical staff, we need to look at the funding for that, such as the nursing bursary, which has now gone. It has been noted that the number of people applying for training has fallen since the bursaries were withdrawn.
I thank my hon. Friend for that intervention. We have touched on the impact of the nursing bursary on a number of occasions, and Labour has a commitment to restore it. There are also implications for the ongoing training and continuing professional development for nurses and other health professionals who wish to specialise. The budgets available for those kinds of initiatives are being continually squeezed.
Turning back to the issue of overseas recruitment, it is worrying to hear that there is a block on recruiting trained and “ready to go” staff from other parts of the world, because it is evident from the numbers we have talked about today, and not only in this area but in other areas across the NHS, that there is a funding crisis and a recruitment crisis. Actually, staff in some of the disciplines that we have talked about do the essential behind-the-scenes work that helps us to reach patients that bit quicker and makes the targets easier to meet.
Only yesterday, Macmillan Cancer Support released research showing that hospitals in England have more than 400 specialist vacancies for cancer nurses, chemotherapy nurses, palliative care nurses and cancer support workers. Macmillan said that cancer patients were losing out, with delays in their receiving chemotherapy, and that cancer nurses were being “run ragged”, as they were forced to take on heavier workloads because of rota gaps. It also reported that vacancy rates for some specialist nurses are as high as 15% in some areas. Clearly, those kinds of gaps will have an impact on our efforts to achieve the outcomes that we all want to deliver.
There is little doubt that we would enjoy much more success in meeting some of our aims, particularly in the cancer strategy, if the workforce had the resources they need. We welcomed the publication of the cancer workforce plan in December, although we would have liked to have seen it much earlier. I would be grateful if the Minister could update us on the progress of that plan, if he has time to do so when he responds to the debate.
More generally, the “two years on” progress report on the cancer strategy was published last October, and it set out some of the progress that has been made, but we are now six months on from that. Again, if the Minister has an opportunity, I would be grateful if he could provide us with an update. If he is unable to do so today, could he indicate when the next formal update will be available?
In conclusion, it is wholly unacceptable that we continue to lag behind many of our neighbours with regard to outcomes, but I believe that, with the right funding, the right strategy and support from the Government, the situation can change. I hope that the Minister, when he responds to the debate, will confirm that there are plans to put in place the world-class services that our patients truly deserve.
I call the Minister. If he could leave two minutes at the end for Mr Baron to respond, that would be most helpful.
Thank you very much, Mr Streeter, and it is a pleasure to see you in the Chair. As always, it was a pleasure to hear the debate.
I, too, congratulate my hon. Friend the Member for Basildon and Billericay (Mr Baron) on securing yet another debate on cancer in this place. I do not know how he does it; he must have a special line to Mr Speaker.
My hon. Friend and I worked very closely together in my previous iterations on the Back Benches. I am hugely appreciative of all his work as chair of the all-party parliamentary group on cancer. I did not know until today that he is coming towards the end of his tenure, but my goodness—he has certainly done his bit. He will be a hard act to follow, and I do not know who will succeed him. Who knows? Maybe that next person is with us today, Mr Streeter; you never know.
We have had some excellent contributions today. I do not know why the hon. Member for Scunthorpe (Nic Dakin) is looking at me that way; he is welcome to intervene on me.
May I just say that the hon. Member for Central Ayrshire (Dr Whitford) made a speech that was, as always, very sensible, balanced and packed with experience, which most of us can only hope to get near to. It is very welcome and very important in these debates that she speaks about her long time working in the breast unit in Edinburgh—
In Ayrshire—sorry. The hon. Lady is one of my successors as the chair of the all-party parliamentary group on breast cancer and she was so right in what she said about prevention; she was right in a lot of things she said, but she was so right about prevention. As we meet here in Westminster Hall, a certain well-known TV chef is giving evidence to the Health Committee upstairs; I am sure that can be seen on all good news channels this evening. One of the things the Committee is considering as part of its inquiry is child obesity, and one of the first things that I did in this job was to publish the tobacco control plan. I am passionate about that and I am also passionate about our alcohol challenge.
Plenty of people in this country—the majority—have a very healthy relationship with alcohol, but there are some people for whom that is not the case. As the hon. Lady knows, alcohol is also a big cancer risk factor. She was spot on in saying that this debate is not just about a cancer plan; it is about a health plan. I see the obesity challenge, the smoking challenge and the alcohol challenge as a holy trinity, if you like, in the task of tackling cancer.
I would just like to mark the fact that Scotland starts its minimum unit pricing on alcohol today. That will not be a panacea, but we hope that it will at least help to make the dirt-cheap white ciders no longer dirt cheap and keep them away from our teenagers.
The obesity strategy introduced by the previous Prime Minister appeared to be quite comprehensive, yet the final version published by the current Government—or the Government before; it is always hard to keep track—was only about a third of the original strategy. Is a much more ambitious plan likely to be issued and will it include attempts to tackle things such as advertising, which make our living space so obesogenic?
Nice try. We always said that addressing child obesity was chapter 1 and therefore the start of a conversation. There are a lot of things within that plan that we are still to do, or in the middle of doing. For instance, Public Health England will shortly publish the initial results of the sugar tax on soft drinks—the industry levy—and we said that we would watch that tax very closely, to see whether we needed to continue the conversation. The hon. Lady will also know that there have been lots of discussions in this Chamber and in the main Chamber about advertising, “buy one, get one free”, labelling and reformulation. As she knows, I am very interested in said agenda and I watch these things like the proverbial hawk. So I thank her for raising that issue.
I always enjoy listening to the hon. Member for Scunthorpe; he speaks so well and I see him at so many different events in this House. He mentioned the cancer dashboard and blood—or non-solid—cancers. He knows that I agree with him; it is something that I am looking at very closely with officials and with NHS England. I also pay tribute to the work that he does on pancreatic cancer. I met one of the pancreatic cancer charities with my right hon. Friend the Secretary of State for Health last week—or was it the week before last? Time flies.
The hon. Gentleman talked about the survival figures for pancreatic cancer, and they are terrible in comparison with those for other cancers. However, sometimes we have to recognise that there is an enormous challenge with pancreatic cancer, in that it is very hard to diagnose because often it is not symptomatic until its latter stages. That is one of the reasons why I was very interested in the 16-day referral to surgery pathway that he talked about and the challenge that he identified within his cancer alliance. My officials will have heard what he said, and I will take it away and consider it, because it is a really important point.
The hon. Member for Ellesmere Port and Neston (Justin Madders), who is the shadow Minister, asked about the cancer strategy and the next update to it. It is not a “three year on” update, but the next update will be in the autumn of this year. I was glad to hear his welcome for the first ever cancer workforce plan, which Health Education England published in December. It sets out how we will expand the workforce numbers. Just last week, I was with Harpal Kumar of Cancer Research UK before he steps down, and we were talking about the critical importance of that plan. I, too, would have liked to have seen it sooner, but we are committed to training 746 more cancer consultants and 1,890 more diagnostic and therapeutic radiographers by 2021.
I was at the Royal College of Radiographers annual dinner last week in London, and its members did not miss an opportunity to make the case to me about the workforce. The cancer workforce plan is a really positive innovation, and I look forward to working with HEE and my colleagues as we take it forward.
I said in this place this morning that cancer is a huge priority for this Government, and I think that everyone in here knows it is a priority for me. Yes, survival rates have never been higher. Our latest figures showed an estimated 7,000 more people surviving cancer after successful NHS treatment compared to three years earlier, and our aim is to save 30,000 more lives by 2020. However, we know that there is a huge amount still to do, and that is why we accepted the 96 recommendations in the cancer strategy and have backed that up with the £600 million of additional funding up to 2021.
Two years into the implementation of the strategy, we are making progress, as I said in the Backbench Business debate that my hon. Friend the Member for Basildon and Billericay secured in February. I hear what he says about standards and targets, and in some part I agree, but they are only part of the story. The alliances are not targets; they are about pathways and best practice—not just learning best practice but implementing it. The NHS is very good at sharing best practice, but perhaps not always brilliant at implementing it. The example given by the hon. Member for Scunthorpe about the pancreatic pathway—
I will not give way. I remember Mr Streeter’s ruling.
There are eight cancer waiting time standards and, since one in two of us born since 1960 will be diagnosed with cancer in our lifetime, they are an important indicator—to patients, clinicians and politicians and the public—of the quality of cancer diagnosis, treatment and care that NHS organisations provide to millions of our constituents every year. They are a component of the success we have had with survival rates, so it is good that we are discussing them here today. I use the word “target” cautiously, because I have always been clear that standards should not necessarily be targets. If someone has a suspected cancer, 28 days is 28 lifetimes too long—I will talk about the urgent diagnostic centres in a moment. Sometimes we are not trying to get to the maximum, so “target” can be a misleading term.
As has been said, we are currently meeting six of the eight standards. One of those we are not meeting is the 62 days from urgent GP referral for suspected cancer to first treatment, which is important because we want to ensure that patients receive the right treatment quickly, without any unnecessary delays. The standards contribute to cancers being diagnosed earlier—only “contribute to”—and that is crucial to improving our survival rates. However, our rates have historically lagged behind those of some of the best-performing countries in Europe and around the world. That is why we have the cancer strategy; we want to do better. The primary reason for those rates is late diagnosis. Early diagnosis is, indeed, the magic key. My hon. Friend the Member for Basildon and Billericay has used that term many times—I have heard him use it at the Britain Against Cancer conference—and he is absolutely spot on.
Going back to the 62-day standard and the recovery thereof, my hon. Friend the Member for Basildon and Billericay will know that due to factors such as an ageing population and the increase in obesity, which we have touched on, the incidence of cancer is increasing. The NHS is treating more patients for cancer than ever before. It is testament to the hard work of NHS staff across all four nations of our United Kingdom that we are treating more people, and do so with the care and compassion for which we know the NHS is world-renowned. However, those numbers are making the achievement of the 62-day standard challenging. To be perfectly honest, the standard has not been met since December 2015 and, although we do not yet have the figures for March 2018, it is unlikely to have been met in 2017-18 either. However, we remain committed to the standard and want to see it recovered. That is why, through this year’s mandate from the Secretary of State to NHS England, we have agreed that the standard will be achieved in 2018-19, while we maintain performance against other waiting time standards.
Will the Minister give way?
I will very quickly. I know that my hon. Friend wants me to come on to the funding.
The Minister will be aware that about a quarter of all cancers are first detected as late as at an emergency procedure. What I would like him to do in the few minutes he has left is to focus on the need to break the 62-day target link with the transformation funding because it is unfair, penalising as it does those cancer services that need help most. Will he consider that?
That is exactly what I was coming on to. I know that my hon. Friend has expressed concern, to put it mildly, about the methods used to allocate funding for the alliances in 2017-18, and in last December’s report by the all-party parliamentary group on cancer it was clear that the alliances should not be linked to achieving the 62-day target. I am aware that my hon. Friend has met with the Prime Minister to discuss the issue and I will reiterate what I am sure she will have told him. Achievement of the 62-day standard is not a pre-requisite for funding. Instead, it provides a basis on which NHS England and NHS Improvement, along with senior clinical advice, can assess an alliance’s readiness to transform services.
The alliances are an important mechanism for us in improving performance on the 62-day standard from urgent referral to treatment. They bring together clinicians from primary and secondary care, ensuring collective responsibility for the multidisciplinary teams and the services that they provide, and enabling the leadership that is crucial to the transformation of services. But the bottom line is that it is taxpayers’ money that is being allocated, and it is right and proper that alliances can demonstrate their preparedness for the funding. In 2018-19, NHS England has modified how it will fund alliances, and I can confirm that all alliances will receive transformation funding to support earlier diagnosis and better quality of life for patients.
The national support fund is a genuinely new approach to distributing funding that we have introduced in 2018-19, within the £200 million over two years funding envelope announced in 2017-18. That was in no small part in response to advocacy by my hon. Friend the Member for Basildon and Billericay, and I pay great credit to him and to others for their work on the link—but not the pre-requisite—that was introduced in 2017-18 between transformation funding and 62-day performance.
The fund has a number of purposes. NHS England uses it to help iron out significant variations between alliances in the amount of funding for which they originally bid. The money will be used to support alliance activity to improve 62-day performance, as well as to enable all alliances to deliver priorities, such as accelerated pathways for lung, colorectal and prostate cancer, and other innovations, such as those we heard from the hon. Member for Scunthorpe, which are included in the 2018-19 CCG planning guidance. The Secretary of State, NHS England’s national cancer director, Cally Palmer, and I all agree that the link to the 62-day standard is the right approach and the right thing for patients. I hope that that clears the matter up, even if it does not go all the way towards satisfying Members.
Although I accept that there is anxiety in some quarters about the link between the performance and the funding, I and the Government are of the view that retaining the link is in the very best interests of patients. Ultimately, they must be our primary focus, and this is public money. We will keep the matter under review. I thank my hon. Friend for his advocacy on the subject.
By the end of the cancer programme, we want to have improved survival and provided equity of access to the highest standards of modern care across all our constituencies in England. As the cancer Minister, I seldom sleep and when I am not sleeping I think very little about anything else, because we are focused on meeting the recommendations in the cancer strategy and doing better for all our constituents—those who are here, those who will live with cancer, those who are living with it now, and those who have passed, who we all know. We are on our way to realising the transformation in services that we all want to see, to make our NHS the world leader in the treatment of cancer that I know it can be.
I thank everyone who has participated in the debate, and the Minister for his response. No one doubts his genuine care and concern about cancer patients and the need to improve treatment. I will look closely at his words. The national support fund may not be quite as new as he thinks, but putting that to one side, all I urge him to do is to look at the pleas for help from the cancer frontline services. As far as they are concerned, there is a strong link between the 62-day target and the release of the cancer transformation funding. That is iniquitous, because the services that need it most are being denied it. I ask the Minister to go away and have another look at that, because many frontline services say that the link exists and because of it they are not getting the transformation funding they require to deliver on the cancer strategy. I will continue to pursue that matter until the transformation funding is released.
In the 15 seconds that are left to me, all I say is that a quarter of all cancers are first diagnosed during an emergency procedure. That is far too late; we all accept that. We also accept that we are failing to catch up with international averages when it comes to survival rates, despite all the talk about improving them. We have to focus on outcomes.
Motion lapsed (Standing Order No. 10(6)).
Solitary Confinement (Children and Young People)
[Mr Philip Hollobone in the Chair]
I beg to move,
That this House has considered use of solitary confinement for children and young people in the justice system.
It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank the Speaker’s Office for granting this debate. I thank the Minister for coming to respond and all Members who have joined me for this discussion. May I also put on record my appreciation for the British Medical Association, the Howard League for Penal Reform, the Royal College of Psychiatrists and the Royal College of Paediatrics and Child Health for their tireless campaigning on human rights in the context of healthcare?
Two weeks ago I hosted a roundtable in Parliament with the BMA, the Royal College of Psychiatrists and the Royal College of Paediatrics and Child Health. They have issued a joint call for solitary confinement to be banned for children who are locked up in the UK. That call is based on evidence of harm, and they have urged the Government to act. Importantly, they have also produced guidance to help improve care for those segregated by prison officers until any ban is in place. The roundtable was attended by peers and MPs, including my hon. Friends the Members for Brentford and Isleworth (Ruth Cadbury), for Liverpool, Wavertree (Luciana Berger) and for Stretford and Urmston (Kate Green).
In response to a written parliamentary question that I tabled in January, the Government said:
“We do not use solitary confinement. Young people can be removed from association under careful control where they will not be permitted to associate with other young people.”
The Minister repeated last Friday that the UK does not use solitary confinement. Solitary confinement is defined under international human rights law as
“the confinement of prisoners for 22 hours or more a day without meaningful human contact.”
Many I have talked to have said they are not clear on the distinction between solitary confinement and removal from association. Indeed, YoungMinds says that regardless of the term,
“we consider any individual who is physically isolated and deprived of meaningful contact with others for a prolonged period of time to be in solitary confinement.”
Given what the hon. Lady has said about the definitions of solitary confinement, it would be helpful to know how many people she thinks are trapped in the solitary confinement system, so that we can get a feel for how big the problem is.
I will come on to that point. One point I will make is about the inadequate collection of data. What information we receive comes partly through the lens of healthcare providers and charities that are taking calls from prisoners in distress.
To continue the point I was making, I would be grateful if the Minister could clarify the substantive difference between the international definition of solitary confinement and the Government’s definition of removal from association.
Let me outline the current situation. Under rule 49 of the young offender institution rules, a prison governor can authorise removal from association for up to 42 days. That can be extended further after application to the Secretary of State. I understand that, as we have just discussed, national data on the use of solitary confinement within the youth secure estate are not currently collected. That is concerning, as it means that no accurate data exists as to how many children and young people are being held in isolation and for what period of time. However, anecdotal evidence from the Equality and Human Rights Commission and others suggests that it is on the increase. Will the Minister clarify the situation on data collection? What steps can be taken to change it?
According to the recent BMA guidance, “The medical role in solitary confinement”, the use of solitary confinement in the UK youth justice system is much more widespread than we might realise. According to studies that the guidance flags, almost four in 10 boys in detention spend some time in solitary confinement—some for periods of almost three months. Some estimates suggest the duration of confinement can range anywhere from an average of eight days up to 60 or even 80 days. Children and young people are also increasingly being kept in conditions of solitary confinement—in cells or rooms for up to 22 hours a day—amid reports of staff shortages and increased violence. There is also evidence referred to by the Children’s Commissioner that certain groups may be more likely to experience isolation.
Does my hon. Friend agree that all the scientific and medical evidence points to the profound negative impact on the child, such as paranoia, anxiety and depression? Solitary confinement does not create a constructive pathway to rehabilitation and reintegration into society.
My hon. Friend makes an incredibly important point that goes to the heart of this debate. The use of solitary confinement in the justice system potentially increases harm and can impact on the young person’s life not only during a period of detention in the justice system, but in the longer term.
Black and mixed heritage children are three times more likely to experience isolation. Children with a recorded disability are two thirds more likely to experience isolation. Looked-after children are almost two thirds more likely to experience isolation. Children assessed as a suicide risk are nearly 50% more likely to experience isolation. The problem we have is that the policy is not without harm.
There is an unequivocal body of evidence on the negative health effects of solitary confinement. As has been mentioned, the symptoms observed include anxiety, depression, rage and aggression, cognitive disturbances, paranoia and, in the most extreme cases, hallucinations and psychosis. The experience can also trigger adverse childhood experiences. For children and young people—about whom this debate is most concerned—who are still in the crucial stages of developing socially, psychologically and neurologically, the health effects of isolation and solitary confinement can be particularly damaging.
Does my hon. Friend agree that there is growing international consensus that solitary confinement should never be used for children and young people? The Government need to accept that this country is increasingly out of step with the rest of the world.
I thank my hon. Friend for making that point. I will come back to it. It is interesting to note that the use of solitary confinement was banned by former President Barack Obama in 2016. There are some lessons we can learn from what is happening in the USA.
If a young person is a danger to themselves and others, what remedies, whether elsewhere in the world or in our system, is the hon. Lady recommending? Solitary confinement, as she puts it, is presumably being put in place largely for safety reasons for the young person concerned and those in the same institution as him or her.
The hon. Gentleman makes an extremely valid point about the possible reasons for removal from association, in terms of safety for prison officers or the young person. However—I will make this point in my concluding remarks—I think it is incumbent on the Government to look for alternative non-solitary confinement options that can be used in the youth secure estate. Other countries do not have the same kind of youth detention estate as us, yet they still have youth crime that they need to deal with.
There is evidence that the policy of solitary confinement can be counter-productive. Rather than improving behaviour, it can fail to address the underlying causes of some of that disruptive behaviour and, as my hon. Friend the Member for Slough (Mr Dhesi) has said, create additional problems with reintegration.
During the recent roundtable in Parliament, the Howard League highlighted the case of AB, which has been covered extensively in the media. AB was a 15-year-old boy in Feltham young offenders institution in my constituency who called an advice line run by the Howard League. The adviser who answered could tell that he was miserable and fed up. He had attention deficit hyperactivity disorder and had been locked, alone, in a cell at Feltham young offenders institution for 23 hours a day, for weeks on end. He was allowed outside only to shower and exercise. Understandably, he wanted to end his solitary confinement and was appealing for help.
Cases are complex, but these are children. The Howard League stated that it
“had no option to go for judicial review”.
AB’s case was heard last year at the royal courts of justice in London. The court found that his treatment was unlawful. It stopped short of finding it “inhuman or degrading”, but that is also being challenged. I am also very pleased that we have heard this week that the Joint Committee on Human Rights is launching an inquiry on solitary confinement and the restraint of children in the youth justice system. I hope that it will take some of these important issues further.
The Howard League received more than 40 calls last year from or about children in prison who were isolated. For those reasons and others, as my hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury) has pointed out, there is a growing international consensus, from groups including the United Nations Committee on the Rights of the Child, the European Committee for the Prevention of Torture, and the United Nations special rapporteur on torture, that solitary confinement should never be used on children and young people. As I have said, Barack Obama, when in office, banned the use of solitary confinement for juvenile offenders in the federal prison system. He said:
“It doesn’t make us safer. It’s an affront to our common humanity.”
With Feltham young offenders institution in my constituency, I am greatly concerned that vulnerable children are entering a justice system, elements of which could result in additional long-term harm. Solitary confinement, as defined by international law—however it is referred to and whatever terminology may be used—should be abolished and prohibited. Until it is, the health needs of those subject to it should be met, and there is an essential role for doctors and, indeed, our prison governors in ensuring that that happens.
We should be clear that any mechanism that results in a child or young person being physically or socially isolated for prolonged periods of time should have no place in a humane justice system. I would therefore be grateful if the Minister could address how he defines removal from association; what steps he is taking to get a full and accurate picture of the number of instances of it; what assessment his Department has made of the level of harm caused by it; what steps he is taking to create alternative, non-solitary confinement options in the secure estate for young people, with adequate resources and staff to meet their needs; and how he envisages us moving forward to end this practice in the United Kingdom.
It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Feltham and Heston (Seema Malhotra) on securing this important debate on a difficult issue that is worthy of further discussion after today. I am grateful for the opportunity to respond.
The number of children entering the youth justice system has continued to decrease in recent years. In 2016-17, juvenile convictions and cautions were down by 83% since 2006-2007, with first-time entries down by 85% in the same period. The number of under-18s in custody also fell by 70% during that time, and in February stood at 870. That represents a success story, and everyone involved in youth justice should be pleased by those figures. However, the decline in overall numbers has resulted in a concentrated cohort of young people in the secure estate, many of whom demonstrate complex and challenging behaviour.
I am pleased about the overall reduction but, as the Minister says, there is now a cohort of perhaps more difficult offenders. I admired the eloquence of the hon. Member for Feltham and Heston (Seema Malhotra), but I do not think that she was able to answer my earlier question. If someone in a young offenders institution is a danger to themselves and others, what alternatives are there to removal from association?
I thank my hon. Friend for his question. Staff in young offenders institutions up and down the country are sometimes confronted with extremely difficult circumstances, with particularly troubled and violent young people. We have introduced an enhanced support unit at Feltham, and we are hoping to bring another on-stream elsewhere. We have found that the use of such units, where there is a higher staff-to-offender ratio, has worked in managing behaviour. Ultimately, the removal from association of a troublesome, very difficult young person is often the only course of action that a responsible governor can take.
The safety and welfare of children held in custody is one of my highest priorities. The hon. Member for Feltham and Heston alluded to the fact that there are definitions of solitary confinement internationally, but there is not a sole definition. There are the Mandela rules, the Istanbul convention and a variety of others, but there is not one clear definition. I would like to be clear from the outset that I have been assured that young people are never subject to solitary confinement in this country. When a child in custody is putting themselves or others at risk, segregation can be used as a last resort for limited periods of time and under regular review, when no other form of intervention is suitable to protect both the child and others. Segregation should never be used as a punishment for young people.
When a young person is removed from association, they will be given as much access as possible to the usual regime, including education and healthcare. That is monitored on a regular basis by the youth offenders institute and the independent monitoring board, in order to protect the young person.
I welcome the Minister’s statement that solitary confinement is a last resort, but a very high number of young people and children in the criminal justice system have one or more mental health illnesses, learning disabilities, ADHD, autism spectrum disorders, addiction and probably other conditions. Once those children are being punished in the criminal justice system, surely they need proper specialist medical care therapy, as happens in most other countries?
I acknowledge that the youth justice population has an over-representation of the issues that the hon. Lady has just outlined, although the diagnosis of each of those is broad and, in and of itself, not straightforward. I know that the appropriate care is made available to individuals who particularly need psychiatric input. I look at that on a regular basis, and I personally see it as my responsibility to ensure that that is the case. If the hon. Lady would like to write to me with evidence of where that is not the case, I would be more than happy to receive such a letter.
At an absolute minimum, young people in segregation in young offenders institutions will be given time in the open air, outreach education provision, healthcare, physical education and access to legal advice. Individual regime plans are agreed for each young person by a multi-disciplinary team, taking account of all those issues and any other relevant information. They are reviewed frequently on an individual basis—again, in the interest of the young person. All under-18 young offenders institutions have been given additional training on the use of segregation and the rules governing it.
I note with interest the recent inspection report from the independent monitoring board for Feltham YOI, which is of course located in the constituency of the hon. Member for Feltham and Heston. The report noted that significant improvements have been made in addressing violence and praised the dedication and commitment of staff within the establishment. I take this opportunity to reiterate my thanks to staff at Feltham and across the youth secure estate for their continued hard work in looking after the young people in their care.
The report also noted, however, that too frequently staffing levels within the establishment affected the daily regime and the ability to provide sufficient purposeful activity and time out of room. I share those concerns and am encouraged that, across both sites at Feltham, recruitment is swiftly improving. As of the end of March, there were 105 prison officers booked on to entry-level training. I believe that every child and young person should have access to and be engaged in meaningful activities, including education and physical activities. The regime should be purposeful, meet the needs of the cohort, keep young people occupied and active all day and deliver the highest quality education. That needs to sit alongside effective behaviour management, so that young people can be out of their rooms and able to participate safely in the regimes and activities provided.
That is why we have developed a new approach to behaviour management, which includes the roll-out of the custody support plan, to provide each young person with a personalised officer to work with on a weekly basis in order to build trust and consistency. We are also implementing a conflict resolution strategy, applying restorative justice principles to help resolve conflict. However, while acknowledging the work that is continuing to be progressed to address safety in youth custody, as demonstrated in the latest inspection reports from Her Majesty’s inspectorate of prisons for Werrington and Parc young offenders institutions, I am clear that levels of violence within the youth estate are too great, which is why we are reforming youth custody to reduce violence and improve outcomes for young people.
Investing in our workforce is a cornerstone of those reforms. We continue to be impressed by the dedication and pride that our staff show in their work with young people, as evidenced by the fact that more than 200 frontline staff have voluntarily enrolled on a youth justice foundation degree funded by the Ministry of Justice. We want to build on that success and ensure that working in youth justice continues to be seen as the respected and rewarding profession that it is.
We know that many establishments have struggled with staffing, especially in the south-east, which is why we are increasing frontline capacity in public sector young offenders institutions by bringing in more than 100 new recruits and introducing a new youth justice specialist role. We have started recruitment for those additional frontline posts in order to relieve the immediate operational pressures, alongside additional psychology roles in the YOIs. In addition, we are developing a bespoke recruitment campaign and process for the youth custody service, to target those with a passion to work with young people. The first phase of this—a new website and targeted marketing material—was launched last week.
We will develop strong leaders, building the workforce required to create a therapeutic and aspirational culture in our establishments. Our reforms will empower the leaders, giving them the freedom to deliver the right suite of services to meet the needs of the young people in their care. We are working closely with NHS England to implement Secure STAIRS, a framework for integrated care in the youth secure estate, which aims to co-ordinate the services of health and non-health providers into a coherent package, supporting trauma-informed care and a whole-system approach.
I am a strong believer in the benefit that sport and physical activity can provide to children in custody. As well as the obvious health benefits, it can provide young people with a sense of achievement, enhancing self-esteem and transforming lives. For those reasons, I commissioned Professor Rosie Meek of Royal Holloway, University of London to conduct an independent review into the role of sport in the justice system, to identify best practice and make recommendations for improvement. Professor Meek’s report will be published shortly and I await its findings with interest.
We are also looking to support organisations that want to work with young people in the youth justice system and seek opportunities to build on existing collaborations between establishments, sports clubs and providers. For example, Saracens rugby club’s Get Onside programme, which runs at Feltham for young adults, is a shining example of how sport can engage young people. The young adults who have been through this 10- week programme, which uses the ethos of rugby to teach skills such as leadership and teamwork, have shown notably lower rates of reoffending than their peers. That is just one example of how sport can help young people lead a better, more productive life, away from crime.
Finally, we continue to work on our proposal to develop secure schools. Our model will be informed by best practice from outstanding alternative provision schools, and secure schools will be set up, run and managed in a similar way to free schools.
I am encouraged by a lot of what the Minister has said and I urge him to keep up the good work in his Department and with these institutions. Does he agree that, given that solitary confinement has a clear definition in this space, and no young people are subject to solitary confinement in the UK, that pejorative phrase should not be used in such debates? Where removal from association is used as a last resort, we obviously urge that those young people benefit in the future from the sort of regime that the Minister is outlining.
Yes, it is always important to use language appropriately. As I tried to point out at the start, use of the term is difficult when internationally no clear definition is agreed upon. The hon. Member for Feltham and Heston can be assured that I look at this issue all the time. I cannot talk about individual cases, because one is still running with the courts, but we consider the issue all the time. There have been other cases where difficult decisions have to be made. I am assured that at all times we are thinking about the child at the centre of the case, and the children being held with the child who is showing such troubling behaviour.
Secure schools will be operated on a not-for-profit basis by child-focused providers with strong leaders who will have the freedom to provide integrated services based on individual need, with education and healthcare and, if I get my way, sport at its heart.
I am under no illusions about the challenge we face. We are talking about some of the most challenging, often damaged young people in the country. However, our reforms will support establishments to provide better levels of care and enable more young people to engage in purposeful activities, outside their rooms, and work towards a brighter future.
I congratulate the hon. Member for Feltham and Heston on her speech, and thank my hon. Friends the Members for Henley (John Howell) and for Woking (Mr Lord) and the hon. Members for Slough (Mr Dhesi) and for Brentford and Isleworth (Ruth Cadbury) for their contributions. I will take away the points about the collection of data and the numbers of children who could be affected in this way, and I will be happy to receive any correspondence on the issue from any parliamentary colleague.
Question put and agreed to.
Cosmetics Testing on Animals
I beg to move,
That this House has considered a global ban on cosmetic animal testing.
It is a pleasure to serve under your chairmanship, Mr Hollobone. In his first keynote speech back in July 2017, the Secretary of State for Environment, Food and Rural Affairs made global standards on policies for farm animal welfare and air quality a priority. In responding to the row about the Government’s non-inclusion of animal sentience in the European Union (Withdrawal) Bill, he vowed to ensure that Brexit works not just for citizens, but for the animals we love and cherish. This initiative to end the cruel, unnecessary and outdated use of animals in cosmetics testing is the perfect opportunity for the Government to set global standards and ensure that our laws work for animals and the UK’s animal lovers.
The public overwhelmingly want cosmetics testing on animals to end worldwide. More than 5.5 million people to date have signed a petition, jointly with the Body Shop and Cruelty Free International, for a global end to cosmetics testing on animals, which can be achieved by adopting an international agreement reflecting the combined will of United Nations member states to map a harmonised framework that would end the use of animal tests for cosmetic products and continue the development and international validation of non-animal methods.
What has Parliament done already? The fact that 116 Members across Parliament have already signed early-day motion 437 shows that there is cross-party support for that proposal. The EDM calls on the Government to lead on such an initiative by tabling, actively pursuing and supporting a resolution at the UN General Assembly for an ad hoc committee, as the UK-based Cruelty Free International has called for.
Cosmetics testing on animals has been banned in the UK since 1998. We have led the way on this issue. The UK was in fact the first country to take that step, and we motivated the EU ban on testing and sales. It is time to make that commitment global. If the use of animals in cosmetics testing is wrong in the UK and the EU, it is wrong everywhere around the world.
Order. I am sorry to interrupt the hon. Lady, but a Division has just been called in the House. We will suspend for 15 minutes if there is one Division, and an extra 10 minutes for any subsequent Divisions. As soon as Dr Cameron and the Minister are back in their seats, we can resume the debate.
Sitting suspended for a Division in the House.
A majority of the public surveyed—74%—agree that much more needs to be done to find alternatives to using animals in all forms of research. That is particularly their view when it comes to animal testing.
Where policy starts, industry follows. Following the EU’s ban, growth in the non-animal methods industry surged. There are now 33 scientific facilities working on alternatives to animal testing. Internationally, that market is expected to reach $8.74 billion by 2022, up from an estimated $6.34 billion in 2017. Such growth is widely attributed to the increasing adoption of alternative methods in the cosmetics industry. I highlight to the Minister that the UK is well placed to lead that work, and even more so in a globally harmonised market.
I congratulate the hon. Lady on securing this important debate. I echo what she said about this country’s role and our proud history of taking the lead. However, is it not also the case that the UK is reported to be the biggest user of animals in experiments within the whole EU? Not all of those experiments are for serious medical conditions. For example, skin rashes account for a high proportion of animal experiments, where non-animal alternative already exist and are considered to be more scientifically sound.
I thank the hon. Gentleman for that important intervention. Yes, I agree that much more needs to be done to look at non-animal testing methods in all forms of research, particularly for those types of experiment for which other methods are available. Animal testing should always be the last resort. I chair the all-party parliamentary dog advisory welfare group, and just the other month we heard about the 400-odd dogs tested—a figure that was reported to me as in Hansard. I was then told that the number had not been reported accurately to me and that it was more likely to be 4,000 across the UK. Will the Minister get back to me on that point? That also highlights that much is done underground, and we need to be much more transparent. We need to have the figures and to know that animal research is the last alternative, as it is meant to be. I absolutely agree with the hon. Gentleman that much more needs to be done about the transparency of the animal research industry.
Although no global ban has yet been enacted, the European Union ban on animal testing for cosmetics and on the sale of cosmetics tested on animals came fully into force in 2013. Other bans, some more comprehensive than others, are now in place in many countries. Guatemala, New Zealand, India, Israel, Norway, South Korea, Switzerland, Taiwan, Turkey and Vietnam have legislation, and things are moving forward in Brazil Argentina, Canada, Chile, South Africa and China. In the USA, state-level bans have been enacted, as well as some mandated alternative laws. In a global market, it is essential that all countries ban the practice, to avoid testing simply moving around the world to countries with no effective laws, to ensure a level playing field and to put an end to animal suffering. The challenge is to make cruel cosmetics a thing of the past once and for all, and to achieve one coherent global ban on animal testing for cosmetics.
To market a product, a company must demonstrate its safety. Of course, we all agree with that, but that can be done by using approved non-animal tests and combinations of existing ingredients that have already been established as safe for human use. Increasing awareness of animal sentience and the pain, suffering and death inflicted upon animals via product testing has led the public to reject the idea in their droves. The number of companies seeking certification under Cruelty Free International’s leaping bunny programme is increasing, as their market insights tell them that consumers want cruelty-free personal care products.
The information that historically was gained from animal tests is increasingly being provided through quicker and more reliable non-animal methods. Modern methods are more relevant to humans and have been found to predict human reactions better than traditional animal-model methods. For example, an evaluation of the reconstituted skin model for skin irritation found that it predicted human skin reactions better than the cruel Draize skin test on rabbits.
Rabbits, guinea pigs, mice, hamsters and rats continue to be injected, gassed, force-fed and killed for cosmetics testing worldwide. It is estimated from OECD figures that more than half a million animals are killed each year for cosmetics testing. Examples of the types of tests that are undertaken include repeated dose toxicity: to assess toxicity, rabbits or rats are forced to eat or inhale a cosmetic ingredient or have it rubbed on to their shaved skin every day for 28 or 90 days, and are then killed. Several reviews of the ability of rodent tests to predict human toxicity have found that they are only 40% to 60% predictive. They also include reproductive toxicity tests: to assess such toxicity, pregnant female rabbits or rats are force-fed a cosmetic ingredient and then killed, along with their unborn babies. Such tests take a long time and use thousands of animals, although studies have shown them to detect only around 60% of known human reproductive toxicants.
In toxicokinetic testing, rabbits or rats are forced to eat a cosmetic ingredient. They are then killed and their organs examined, to see how the ingredient is distributed in their bodies. Animals have significantly different metabolisms and physiology to humans. Thus, before the available non-animal alternatives were routinely used by the pharmaceutical industry, the failure rate of drugs for poor prediction in this area was 40%.
Although some finished product tests take place, they are increasingly rare; most animal testing takes place on ingredients. It is important that consumers are aware of that; otherwise, they might unwittingly buy products that carry a meaningless claim, stating that the finished product has not been tested on animals, when the ingredients could well have been.
What are the alternatives? Companies can prove that their products are safe by using non-animal methods and utilising established ingredients. There are almost 30,000 ingredients on the EU’s database for which some safety data are available. There is an increasing number of non-animal methods available to replace outdated animal tests. To assess skin irritation, for example, we can use alternatives such as reconstituted human epidermis, such as the Episkin model developed by L’Oréal. More than 700 brands across the world are “leaping bunny” certified. Other companies may also follow this example and remove animal testing from their supply chains but, sadly, animal testing continues.
Some questions have been asked about the completeness of the EU ban. Since the introduction of the EU cosmetics directive, the European Regulation on Registration, Evaluation, Authorisation and Restriction of Chemicals—REACH—has come into force. Although Cruelty Free International has fought hard against the animal testing provisions in REACH, it does have implications for many types of chemicals, including some that may be used in cosmetics. That is something to highlight to the public.
Some 80% of the world’s countries still allow the practice of testing cosmetic products on animals. In the global cosmetics market, it is essential that all countries end the practice of testing on animals, to avoid it simply moving around the world to countries with no effective laws. That ensures a clear playing field for this country and others that have done the right thing and gives consumers confidence that they are buying cruelty-free.
Being able to claim that a product is cruelty-free is the most important packaging claim for a beauty product. A 2015 Nielsen study found the “not tested on animals” claim to matter the most to consumers. By ending animal testing for cosmetics, businesses will gain a competitive advantage here, across the EU and in the global cosmetics market. Worldwide consumers are increasingly demanding ethical, sustainable and humane products and services.
Cruelty Free International, which is represented in the Public Gallery this afternoon, has partnered with the global beauty brand The Body Shop. In less than a year, more than 5.5 million people worldwide signed their joint petition calling for a UN resolution to end cosmetics animal testing across the globe. They are aiming to bring 8 million signatures to the UN by October 2018, which would make it the largest ever animal protection petition. The overwhelming support from the public in more than 60 diverse countries shows clearly that people want international leaders to work together to adopt this resolution. The resolution would also be compatible with the sustainable development goals.
I ask the Minister to ensure that, once again, we are at the forefront of championing animal rights right across the globe. With sufficient political support from different regions around the world, including our own, member states could submit a resolution under the sustainable development item of the UN General Assembly second committee agenda, ahead of the 74th session in September 2019. That timetable would create enough space for consultation and learning, but would be flexible enough to adapt to change.
The UK Government must continue to lead on this issue. The public are calling for it. Let us stop the cruelty now and make that happen.
I will begin by thanking my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron). I have found from other debates that I probably have the distinction of being the only Member in the Chamber who can pronounce her constituency properly. I am delighted to participate in this debate to call for a global ban on animal testing, for which, as she so eloquently put, the time has definitely come.
Cosmetic testing on animals has been banned in the UK since 1998, and we have heard that there has been a ban on the sale of all testing of cosmetics on animals in the EU since 2013. Noticeably, that has not prevented the EU cosmetics industry from thriving; indeed, it provides about 2 million jobs. However, Members of the European Parliament have expressed concern that most cosmetic product ingredients are also used in many other products, such as pharmaceuticals, detergents and food, and may therefore have been tested on animals under a different legal framework. It is therefore important that the EU develops alternative testing methods, and that those methods receive international regulatory acceptance for use in the safety assessment of cosmetic ingredients and products.
Despite the progress that has been made in the EU and the United Kingdom, we still have a long way to go globally, as my hon. Friend has pointed out. Astonishingly, 80% of countries still allow animal testing and the marketing of cosmetics tested on animals. China has a major cosmetics market that not only allows but requires products to be tested on animals in Government labs before being approved for sale. It is generally thought that China’s mandatory animal testing requirement for imported cosmetics is likely to be the biggest challenge for a global ban.
As my hon. Friend has pointed out, there is also a lack of reliable animal-testing data for cosmetics imported into the EU. We need to ensure that no product on the EU or UK market was tested on animals in a third country, and that requires us to do a little more work. I am heartened that our partners in the European Parliament have called on EU leaders to use their diplomatic networks to build a coalition and launch an international convention within the EU framework. I hope that a ban will be in force before 2023.
We know that a UN treaty would not guarantee a global ban on the testing of cosmetics on animals, but it would be a bold and progressive step in the right direction, and I think the UN and everyone in the Chamber would agree that it really must take that step. That would certainly help considerably in encouraging China and other countries that mandate testing to modernise and to stop blinding, poisoning and killing animals so that we can have lipstick, mascara and blusher.
As we have heard, what is most distressing about this issue is that cosmetic testing on animals is wholly unnecessary yet it causes our fellow creatures huge suffering. Transferring the results of animal tests to humans has proven problematic and even, at times, misleading. Using approved tests that do not involve animals, and sticking to the many combinations of existing ingredients that have already been established as safe for human use, would be a better way of ensuring safety. We heard from my hon. Friend that consumers are becoming increasingly ethical when it comes to purchasing power and consumer choice, so, aside from the cruelty aspect, a ban on testing on animals would make sense as a response to consumer demand.
Despite the availability of alternatives, countless animals around the world continue to be subjected to cruel tests so that a new eyeliner or perfume can be developed. I acknowledge that progress has been made, but the lack of concerted global action means that the cosmetics industry in large part continues to test as it always has done. We know that if the industry were legally required around the world to stop testing on animals, it would adapt, survive and thrive. Modern science is replacing last century’s animal tests with kinder, faster and better tools for consumer safety. Global action is needed; otherwise, as my hon. Friend has said, testing will simply move to countries where there is no ban.
There is huge public support for a global ban. As my hon. Friend has pointed out, there is clearly widespread political support for such a measure—I believe that we have support from every party in the House and right across the European Union. We should harness that support to influence the bad practices that we know go on in other parts of the world. Testing cosmetics on animals is indefensible from an ethical viewpoint—our fellow creatures suffer unnecessarily for our vanity, because of global inaction—and a scientific viewpoint. There is a better way. It is time for cosmetic testing on animals to stop. The beauty industry needs a makeover, and it is time for global action.
It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for securing this important debate.
An end to testing cosmetics on animals was first promised in the 1997 Labour manifesto. I am proud that that was delivered here in the UK, under a Labour Government, 11 years before the EU-wide ban was brought in. Labour led the way then, and we continue to lead the way now.
Although testing practices have advanced greatly in recent years, there is still a lack of transparency about project licence applications and the allowance of “severe” suffering, as it is defined in UK legislation. That is one of the reasons the Labour party stated in our recent animal welfare plan that we will review animal testing. Our 50-point plan includes important proposals to build on our already proud record, and I encourage anyone who is interested to look at those proposals and give us their comments. We started by banning animal testing for cosmetics here in the UK, and it was then banned in the EU; it is incredibly important that it is now taken out globally.
As the hon. Lady said, animal testing has been banned for finished cosmetic products since 2004 and for cosmetic ingredients since 2009. It has also been illegal since 2009 to market in the EU cosmetic products containing ingredients that have been tested on animals. Those bans have done a lot to boost animal welfare due to the EU’s economic influence. As was said, the EU is the world’s largest market for cosmetic products. From soap and shampoo to moisturiser, perfume and make-up, it is estimated that consumers use about seven different cosmetic products every day. EU rules ensure that those products are safe for us to use, but not at the expense of animal welfare being ignored.
As we leave the EU, consumers tell me that they are concerned. They need reassurance that any trade deals that we do with countries that do not share our standards, such as the US, will not result in our sales ban being watered down, and that cruel cosmetics will remain a thing of the past in the UK. I would be grateful if the Minister provided an assurance that our ban on testing cosmetics on animals will not be undermined by any trade deals.
I welcome the resolution of the European Parliament’s Environment, Public Health and Food Safety Committee, which aims to establish a global ban on testing cosmetics on animals by 2023. As we heard, that resolution proposes the drafting of an international convention against testing cosmetics on animals within the UN framework, and calls for that to be included on the agenda of the next UN General Assembly meeting.
The hon. Member for North Ayrshire and Arran (Patricia Gibson) pointed out that about 80% of countries still allow animal testing and the marketing of cosmetics that are tested on animals. We also heard that China’s major cosmetics industry requires products to be tested on animals before they are allowed on the market. That is one of the biggest challenges we will have to overcome if we are to implement a global ban.
We must also be clear that the cosmetics industry has a key role to play. It is simply unacceptable that those cosmetic brands that claim to be cruelty-free and not to engage in animal testing yet undertake such testing are able to sell to Chinese consumers. Many of those large cosmetic companies state online that they do not engage in animal testing but indicate that exceptions are made where required. For instance, Estée Lauder’s website says that it
“does not test on animals and we never ask others to do so on our behalf”.
However, it has the caveat:
“If a regulatory body demands it for its safety or regulatory assessment, an exception can be made.”
That can be confusing for consumers, who may believe that a company does no animal testing at all. Those loopholes and inconsistencies allow companies to brand themselves as cruelty-free while making exceptions if they want to trade in countries such as China.
There can be no excuse for causing distress and suffering to animals for the sake of make-up, soap and toiletries. In the global market in which we live, the only way to avoid animal testing of cosmetics is by having a ban across all countries; otherwise, as has been said, testing will simply shift to those countries that allow it. Work towards a ban must run in parallel with the further development of alternative replacement test methods worldwide. The EU can lead on that, working to speed up the development, validation and introduction of alternative testing methods. We know that the EU ban on animal testing has not jeopardised the cosmetic sector. As we have heard, it is the biggest market in the world, and it is thriving.
The EU resolution that aims to establish a global ban on animal testing for cosmetics by 2023 is a real step forward in improving animal welfare and closing loopholes on cosmetic animal testing worldwide. The EU resolution and events such as this debate do much to help increase visibility of this important issue. If countries outside the EU such as Guatemala, India, New Zealand and Turkey can put in place bans, every other country can, too.
It is a real pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron)—I hope I pronounced that right; it always throws me—on securing this debate on an incredibly important issue on which, as she pointed out, the UK has a considerable track record.
Animal welfare is dear to my heart, and dear to all of our hearts. In recent months, both the Secretary of State and I have made a number of important changes to promote and improve animal welfare regulation. Recent announcements have included introducing a ban on ivory and steps to reduce cetacean bycatch. We have published a draft animal welfare Bill that will recognise animal sentience and introduced tougher regulations on pet vendors and puppy breeding. We have also announced our intention to control live animal exports further than we do now, and just yesterday we introduced regulations for mandatory CCTV in slaughterhouses.
The UK has a long track record of being first when it comes to animal welfare. In 1822, this Parliament was the first ever legislature to implement laws to protect animals when it introduced the Cruel Treatment of Cattle Act—“an Act to prevent the cruel and improper Treatment of Cattle”. As long ago as the 1950s, the UK was the first country to introduce new regulations outlawing certain types of inhumane traps for wild animals, and more recently we have promoted humane trapping internationally.
We have also always taken a leading role in international wildlife conventions such as the convention on international trade in endangered species, the convention on migratory species and the convention on biological diversity. This year, I hope to go to the International Whaling Commission, where the UK has a longstanding role in arguing for the ending of commercial whaling. Also, through various regional fisheries management organisations, we promote issues such as shark conservation. Finally—this is relevant to animal welfare in particular—we are a member of the OIE, the World Organisation for Animal Health, currently as an EU member. The duty of loyal co-operation means that we have to attend it as part of an EU delegation, but the UK intends to use its freedom when it leaves the EU to argue strongly and powerfully for improved animal welfare standards around the world through the OIE.
The Minister is reeling off an impressive list of achievements, and rightly so. On the opportunities post-Brexit, we cannot ban live exports now, but will be able to do so after we leave the EU. Does he believe that Brexit will enable us to raise the standard of those products we import so that they meet the animal testing standards that people in this country expect? Is Brexit an opportunity to go further than we can currently?
Those opportunities do present themselves once one has an independent trade policy, so yes, it is a potential opportunity to look at these issues and take our own independent seat on wildlife conventions such as CITES. I always remember a former Labour Minister telling me of their frustration when they wanted to restrict the sale of bluefin tuna, which was in a perilous state. The UK argued for that, but the European Commission took a different position and we had to fall in line with that. There will be opportunities for us as an independent country to be vocal on those issues, particularly in forums such as the OIE.
As the hon. Lady is probably aware, the OIE’s remit, somewhat surprisingly, does not extend to the welfare of animals and issues such as cosmetic testing. As she rightly pointed out, the UN is the right place for that. I should also point out that many Government Departments have overlapping interests. She may be aware that responsibility on animal testing and licensing of any such testing is the Home Office’s responsibility, deliberately not that of the Department for Environment, Food and Rural Affairs. DEFRA has responsibility for animal welfare issues, and obviously the Foreign and Commonwealth Office has responsibility for issues pertaining to the United Nations.
As the hon. Lady pointed out, in 1998 the UK was the first country in the world to implement a ban on the use of animals in cosmetic testing. The European Union’s ban on the use of testing in cosmetics was first introduced, I think, in 2013. Ever since we introduced our ban, the UK has shared our knowledge and expertise in this area with other countries. Most recently, for example, we provided support and advice to China on ending unnecessary cosmetics testing on animals and advised on a science-based approach for the use of non-animal alternative testing. In 2015, the Government implemented a similar ban on the testing of finished household products on animals as well as a qualified ban on ingredients. We therefore continue to make progress in this area in terms of both tightening our regulations and sharing our expertise with other countries.
I turn to the regulations in this country. My hon. Friend the Member for Richmond Park (Zac Goldsmith) raised concerns about the number of animals on which cosmetics are still tested. There was a 5% reduction from 2015 to 2016. The Home Office publishes an annual report that gives details on the statistics for animal testing, which it is important to note is down considerably from a high point in 1971, when 5.6 million animals were used in animal tests; that was the peak. These days, some tests are, for instance, for animals that have been genetically altered, rather than what many people would regard as conventional animal testing. Nevertheless, it is a stated commitment of the Government to reduce the number of tests continually.
We recognise that in some instances animals can be an important tool in scientific research and can build on our understanding of how biological systems work. However, animals are not used lightly in that work, and the Government maintain a rigorous regulatory system under the Animals (Scientific Procedures) Act 1986. That regulatory system ensures that animal research and testing is carried out only where there are no practical alternatives and under controls that keep suffering to a minimum.
As I said, the UK has played a leading role globally in supporting the development and adoption of scientific techniques to replace, reduce and refine the use of animals, known as the three Rs. The three Rs principle is robustly applied to every single research proposal that requires the use of animals, to ensure that animals are replaced with non-animal alternatives wherever possible, that the number of animals is reduced and that procedures are refined as far as possible to remove any suffering that animals might incur during those tests.
The hon. Member for East Kilbride, Strathaven and Lesmahagow made some important points about the role the UK will take in highlighting the issue internationally. It is already the case that, as the first country to adopt such a ban, we are keen to share our knowledge and experience in this area with many other countries. We have already done so recently with China. She cited a number of other countries that have introduced a ban.
I have made it clear that our general stance, particularly on the OIE, for which DEFRA is responsible, will be to agitate for higher animal welfare standards around the world. I hope the hon. Lady will appreciate that we need cross-Government discussion on this specific issue with other Departments, notably the Home Office and the Foreign and Commonwealth Office, which have a particular locus in this area. However, I will draw to the attention of the Ministers who lead on this the points that the hon. Lady raised today, and also the point that the shadow Minister made about other work to highlight this matter within the UN, to ensure that the UK plays an active part and does its utmost to spread the good practice that we began all those years ago in 1998.
It has been a positive debate. We have come such a long way, but there is so much more to do. I am reassured to some degree by the Minister’s response, and I hope that he will highlight this issue to the other Government Departments, because I understand that they will have to work collectively. Perhaps he could write back to me. It is important that we are seen to lead the way on the UN resolution. The public definitely expect us to do that.
The final point I hope the Minister can take forward relates specifically to beagles, which are tested on more than any other breed of dog. An excellent local charity that tries to rehome beagles who have been subject to animal testing told the all-party parliamentary dog advisory welfare group that it was finding it extremely difficult to engage with the scientific community about rehoming dogs that were suitable for rehoming. I hope the Minister can have a discussion with the scientific community; the public want to see animals, particularly dogs—I am chair of the dog welfare group, so I have a particular interest—rehomed wherever possible. Beagles make excellent pets, and we would like to see as many as possible in a secure home. I thank all hon. Members who took part in the debate.
Question put and agreed to.
That this House has considered a global ban on cosmetic animal testing.