Tuesday 19 March 2019
[Mr Peter Bone in the Chair]
Leaving the EU: Health and Social Care
I beg to move,
That this House has considered the effect of leaving the European Union on the UK’s health and social care sector.
It is a pleasure to serve under your chairmanship, Mr Bone. I thank the Backbench Business Committee for agreeing to the debate, and all hon. Members who have come along to take part in it. I put on the record my sincere thanks to Robert McGeachy of Camphill Scotland, to Craig Wilson and Gareth Jones from the Scottish Council for Voluntary Organisations, and to Andrew Strong of Alliance Scotland, for all their help and support in preparing for the debate.
The debate’s origins are in my private Member’s Bill, which I tabled in November 2018. It sought from the UK Government provision for an independent evaluation of the effects on the health and social care sector of the United Kingdom’s withdrawal from the European Union. Like many others, my Bill will almost certainly fall this Friday, without ever seeing the light of day or being debated. I was always prepared for the likelihood that the Bill would fall because of a lack of time, so that does not surprise me. What did surprise me, however, was my Bill’s impact on the organisations that deliver vital health and social care to so many vulnerable and needy people day-in, day-out right across the United Kingdom.
Currently, no fewer than 102 different third sector organisations, trade unions and charities have publicly supported the measures in the Bill. Not a single one of those organisations believes that Brexit will be good for the health of the people of these nations. Moreover, they all support the idea that an independent evaluation of the effects of Brexit on the health and social care sector should be carried out, and that it should examine the sustainability of public funding, the challenges faced by the workforce, and the efficiencies and effectiveness of the sector.
I will not test everyone’s patience by naming all 102 organisations that have lent their support, but I can assure hon. Members that they cover every part of the United Kingdom. They include the Western Isles Carers, Users and Supporters Network, which is based in Stornoway, the Northern Ireland Council for Voluntary Action, Disability Wales, and the London-based Mentor UK, which does great work with young people on alcohol and drug misuse. Those organisations share my concerns, and I want to put on the record my sincere thanks to each and every one of them for contacting and supporting me.
In the light of the extremely high levels of concern among those delivering services at the sharp end, I did not want this hugely important issue simply to disappear from the radar on Friday, when my private Member’s Bill will almost certainly fall because of a lack of time. I felt that I owed something, not just to those organisations, but to the most vulnerable in our society: those with disabilities; children and young people; older people; unpaid carers; those living with long-term health conditions; and those who rely on the vital contributions made by the highly valued EU citizens who provide for our health and social care needs right across these islands. Their voices are not being heard, or their views properly considered. I felt that I owed it to those people to ensure that the very serious issues that the health and social care sector will face post Brexit are examined and discussed in this place so that, 18 months from now, no one can claim not to have known what the sector or the service users were saying.
Every one of us knows that there is already a crisis in social care across the United Kingdom, with a seemingly relentless pressure on funding. Our population is ageing and has increasingly complex care needs, and we face major challenges in the retention and recruitment of the workforce required to meet those needs. One would have thought that, in the immediate aftermath of the EU referendum in June 2016, the Government would at the very least have made a top priority of safeguarding the health and care of their citizens. Guaranteeing a secure supply of the vital medicines that are manufactured in the EU, or that have to be transited through it, would have been a good starting point, particularly as the Department of Health and Social Care’s own estimate states that two thirds of the medicines that we use in the UK come from or via the European Union.
One would have thought that securing access to the essential pool of labour that we require now, and will increasingly need in future, would have been at the top of the to-do list, or thereabouts. Yet in March 2019, just 10 days from possibly crashing out chaotically, we are still discussing the dangers that the weakest and most vulnerable in our society will face as a result of Brexit, and particularly the type of Brexit that the UK Government have chosen to pursue. It is one in which their ideologically driven, self-imposed red lines will deliberately sever the essential link between the health and social care sector and the pool of labour on which it depends. Exactly two years ago, Professor Ian Cumming, the chief executive of Health Education England, said:
“Our biggest risk in the short term, as a result of Brexit, may be in the non-professionally qualified workforce across health and social care”.
Without exception, every single organisation that offered me support for this debate or prepared a briefing ahead of it highlighted the enormous damage that Brexit, and particularly the end of freedom of movement, would do to their ability to deliver care and undertake essential medical research—every single one. They include Cancer Research, CLIC Sargent, the Local Government Association, the Northern Ireland Council for Voluntary Action, researchers from the University of Birmingham, Macmillan Cancer Support, the British Medical Association and Age UK, to name but a few. They have all said that the health and social care sector values and wants to retain its EU staff, and wants nothing to stop it recruiting more of those hugely valued and important staff members in future.
It is timely that the hon. Gentleman is bringing this issue to the forefront once again. On healthcare, one of the things that certainly worries my constituents and me is the potential for the national health service to be open to predators post Brexit. As I am sure he knows, on one hand, the care side of the NHS is vastly underfunded, while on the other hand, people cannot afford care to look after their families, including elderly parents and others. Research and development in medicine and collaboration with Europe are also important, and two universities in Coventry that engage in a lot of that have voiced concerns to me about it. Does he agree with those concerns?
The hon. Gentleman is absolutely right. The fear in the sector and among care users is palpable. A recent article in The Lancet, which backs up his points, states:
“All forms of Brexit involve negative consequences for the UK’s leadership and governance of health, in both Europe and globally”.
For me, that sums up the hon. Gentleman’s point exactly. I hope that he agrees.
We cannot get ourselves into a situation in which there is a barrier between the health and social care sector and that pool of labour. Age UK recently said that
“our care workforce is in no position to withstand the loss of good…care workers, wherever they come from.”
The King’s Fund said:
“Widespread and growing nursing shortages now risk becoming a national emergency and are symptomatic of a long-term failure in workforce planning, which has been exacerbated by the impact of Brexit and short-sighted immigration policies.”
The message from the sector to the Government is therefore clear and unambiguous: we simply cannot afford to cut ourselves off from the labour markets on which we have become so reliant and on which we will depend more and more in future. One look at the frontline of the health and social care sector and its delivery, and it is easy to see how heavily it depends on workers from outside the United Kingdom. Without access to those workers, the UK home market will be required to fill the gaps, but people are not queuing up to fill the vacancies that exist now, so do the Government believe that somehow post Brexit people will suddenly become available for work in the care sector?
I congratulate the hon. Gentleman on securing the debate. He talks about the workforce, but is it not natural that as the economies of other countries get stronger, the workers who would have come here will be lost to natural erosion as they no longer want to come to the UK? The emphasis needs to be placed on training our own young people and making it advantageous for them to join the health service.
The hon. Gentleman makes a valid point, but we have to compete for workers and to have an attractive package for people to come here to work, but if we take ourselves out of the game, we are no longer in the competition—we will have cut ourselves off. There are issues relating to retraining and getting people into the sector, but unfortunately the demographics are incredibly skewed against that happening, certainly in the short and medium term. I will come on to some of the statistics.
At the end of June 2018, NHS England had more than 100,000 unfilled posts. The NHS regulator has stated that such vacancies will become even more commonplace during the remainder of 2018-19. Both the Care Inspectorate and the Scottish Social Services Council have found that 40% of social care organisations report unfilled staff vacancies. There is no professional analysis out there that does not estimate that the demand for care will only increase in future. The King’s Fund, the Health Foundation and the Nuffield Trust have predicted that NHS England staff shortages could rise from 100,000 to almost a quarter of a million by 2030. That is more than one in six of service posts. At the end of last year, Care England estimated that by 2035 an additional 650,000 care jobs will be required just to keep pace with the demands of our ageing population.
I congratulate the hon. Gentleman on securing the debate. On the statistics, did he establish whether it was also estimated what the level of vacancies was likely to be were we to remain in the EU over that 10-year period, given that there are 100,000 vacancies now, despite the UK being a member for 40 years?
I realise that many things have been blamed on the European Union, but the demographics and the population outcome of the UK cannot be blamed on it. What one can say about the present situation, however, is that we can predict that it will not get any better in the short or medium term. I think that Skills for Care has calculated that a quarter of the health and social care workforce are aged 55 and over. They will be due to retire sometime in the next 10 years, which will mean another 320,000 vacancies that need to be filled.
Let us not kid ourselves: we are facing a looming crisis. Equally, it is a crisis of the UK Government’s making, because they chose to go down this road of a hard Brexit. They want to take us out of the single market and the customs union; they chose to end the freedom of movement that has done so much to enhance the social, economic and cultural wellbeing of the UK over the past 40 years; and they did so knowing the consequences that such actions would have.
I therefore look forward to the Minister explaining exactly why the Government allowed that to happen and what their long-term plan is to fill those hundreds of thousands of vacancies facing health and social care in the coming years. If that plan includes yesterday’s launch by NHS England of the campaign to encourage GPs to come out of retirement, then heaven help us.
The primary purpose of this debate is to focus on the enormous challenges that will face our biggest asset, the people, whether they work in or rely on the sector, but as important as recruitment, retention and the level of care we provide is the issue of medicines and access to research. As I said, I have been inundated with representations from charities and third sector organisations, which are all extremely worried about the future of medical research and the ability to source vital drugs and treatment, particularly if we have a chaotic crashing out of the European Union. Who would have believed that in 2019 we would have a UK Government advising people to stockpile medicines? Those medicines might be life-saving, but we all took it for granted that they would be there if and when necessary. Now people are stockpiling, in 2019—it beggars belief.
Perhaps the Minister will answer that when he gets to his feet to respond.
How in the name of the wee man did the United Kingdom ever end up in this appalling, self-inflicted mess, in which the sick, the elderly and the vulnerable do not know who will be there to look after them, while healthcare professionals are unable to provide the comfort to their patients that everything will be all right? Only last week, Professor Andrew Goddard, president of the Royal College of Physicians, said that
“the public rightly expects candour from health professionals, and we have ultimately been unable to reassure our patients that their care won’t be negatively impacted by the UK exit from the EU.”
When the BMA wrote to the Prime Minister on 27 February, it left her in no doubt as to its thoughts, stating that
“there is no clearer immediate threat to the nation’s health than the impact of Brexit.”
Does my hon. Friend agree that part of the reason why members of the public and our constituents are so concerned is that we have no guarantee against predatory procurement in the NHS or against an interrupted supply of medicines, so how can people be reassured?
I could not have put it better myself. I thank my hon. Friend for that intervention.
Much more could be said on this topic, but I am keen for other Members to have their say. I will conclude with a number of questions, in addition to my earlier one, for the Minister to address when he gets to his feet. What assurances will he offer to each of the 102 organisations that supported my private Member’s Bill that the health and social care sector will not be adversely impacted by the UK leaving the European Union? What plans are being put in place to guarantee that the sector will be able to recruit the workforce it needs post Brexit? Will he support moves to amend the £30,000 minimum income threshold proposed for the immigration Bill, which will be so devastating for those seeking to work in the sector? Will he confirm once and for all that there will be no detrimental impact on the supply of medicines or devices if the UK proceeds to leave the European Union in a catastrophic crashing out? Finally, will he support my call for an urgent, full and independent evaluation of the effects of leaving the European Union on the UK’s health and social care sector?
It is a pleasure to serve under your chairmanship, Mr Bone, and to follow the hon. Member for Argyll and Bute (Brendan O'Hara). Above all, this debate allows a reasonable discussion of the issue, which I hope we can have, but I was struck by the similarity between it and last night’s debate in the main Chamber. Like the hon. Gentleman, I am aware of constituents who have expressed their great problems in getting drugs for two conditions, in particular: insulin for diabetes and the drugs required for cystic fibrosis. Cystic fibrosis is a particularly horrible disease that requires a continuous supply of drugs, so I can understand the concerns.
Throughout all the discussions on this matter, I have been conscious of the lack of objectivity from anyone, including the medical profession. The hon. Gentleman seems to think that those in the profession can stand aside and take an independent line, but I do not believe that is true or that what they say is necessarily helpful. Allow me to pick up where the Minister left off: the guidance published by the Government for pharmacists and members of the public is not to stockpile medicines. As part of the Brexit contingency measures, the Department of Health and Social Care has asked drug manufacturers to ensure they have a six-week buffer stock, on top of the three months already in place, but the public do not need to stockpile medicines.
The hon. Gentleman has much more leisure time than me, as he can still watch the BBC. I cannot remember when I last watched it, but I am pleased to join him in condemning its attitude. He makes a strong point. During the Brexit campaign, the health sector was dominated by the promise on the side of the famous bus, but equally, the remain campaign has lied through its teeth in saying many things. I have no real confidence that, if we were to have a second referendum, we would at any stage be able to have a debate free of exaggeration.
A constituent contacted me to say that he had been to a local hospital and was astonished to see that as a result of Brexit—although it has not happened yet—the ward was closing and had lost a large number of staff. I decided I would not let that go, but would find out the facts. I spoke to the matron who ran the ward in question. She said to me, “That is absolute rubbish. We have a full ward; this is a normal cycle of people’s leave and it has nothing at all to do with Brexit.” If we make Brexit arguments we need to ensure we have a rational and objective discussion, which so far we have not been able to have.
To have a rational and objective discussion, we have to rely on experts and take evidence from the people in the field. The contributors are objective: Macmillan Cancer Support, the British Medical Association, Cancer Research UK and CLIC Sargent have come to us to say there is a major problem. I presume the hon. Gentleman would not say that they are partisan players.
I am not sure that I agree with the hon. Gentleman. As politicians, we have the principal duty to explore the situation. There will be times when we need expert opinions, but I am complaining about the debate and discussion in this country where people on both sides use the issue as a football and produce exaggerated claims.
I have a great deal of sympathy regarding mental health, an issue on which I have done an enormous amount of campaigning. Outside the EU, there is another organisation with responsibility for mental health, the Council of Europe, on which I serve as a member of the Parliamentary Assembly. The Council of Europe has an expert committee on mental health, which is nothing to do with the EU. That means that if we leave the EU, there is a body of evidence and recommendations already in place to take forward mental health issues. That expert committee has produced a reference tool to determine the essential basket of potential rights that an individual should have, to consider whether the human rights of a patient suffering from mental disorders can be maintained with a great deal of dignity. That is an important element that we seem to ignore; we pretend it does not exist, yet many of us spend a huge amount of time at the Council of Europe trying to push forward those sorts of rights, not to take the place of the EU—it works the other way around—but to provide a safety net for people who are suffering from mental disorders.
I want to end on the issue of care. In Henley, the Government have spent about £12 million rebuilding a new hospital that is a model of how to integrate care and medical provision. The hospital was built without any beds; the beds are in the care home at the side of it. That has changed the way that doctors look at the provision of care. They do not immediately think that they should simply send patients to a bed when they can be treated better at home. I have taken various Ministers along to look at that hospital. I do not think it will be affected by Brexit in the slightest. The model set up there is one we can all take as a better way for the system to work in future. I extend an invitation to the Minister to come and see that hospital and how it operates. I hope he will enjoy the experience and see the lack of impact that Brexit will have on the provision of service.
I thank my hon. Friend the Member for Argyll and Bute (Brendan O’Hara), whose constituency is almost as picturesque and beautiful as mine, for securing this debate.
The debate is extremely important, since we have had no evaluation, independent or otherwise, of the effect of leaving the EU on the UK’s health and social care sector. I heard what the hon. Member for Henley (John Howell) said, but the Royal College of Nursing pointed out that the Brexit process is presenting new and exacerbating existing
“challenges around workforce sustainability, recruitment and retention of the existing and future nursing community”.
That should be of concern to everyone in Parliament.
We know the health and social care sector already faces a recruitment and retention crisis, for a whole host of reasons, including poor pay, the lack of recognition of the important work and professional commitment of those in the sector, and the statutory and voluntary demands of a growing elderly population. We face similar challenges across the UK, but social care in England faces a critical situation, for a variety of reasons. I am therefore extremely disappointed that so few Labour and Conservative Members are present.
The context of this debate is important. The sector relies heavily on workers from the EU, but we have no plan for filling the gaps that are increasingly being left. I have been told in previous debates that no EU workers will necessarily be forced to leave the UK post Brexit if they have been here for a certain number of years and fulfilled certain conditions, but the Minister must recognise that the environment that has been created around Brexit means we will lose many of those workers, in the health and social care sector and beyond. Why should any worker stay in the UK when they can take their skillset and professionalism anywhere they wish in the EU, where they will be welcomed and appreciated? Sadly, that is something they do not feel very often in the current UK environment.
It is deeply concerning, because it is expected that by 2035 we will need 650,000 social care workers in the UK simply to keep pace with rising demand. That is in a sector that, as we heard from my hon. Friend the Member for Argyll and Bute, already faces a range of challenges. The challenges in England are well documented, but we in Scotland are not immune to them. The Care Inspectorate and the Scottish Social Services Council found that more than 38% of social care services report unfilled staff vacancies, even before Brexit has happened. Around 104,000 of the current health and social care workforce are EU nationals, and at any one time around 110,000 positions are unfilled. In addition, about 320,000 of those working in the sector are 55 or older, so they will retire in the next 10 years or so.
The situation is alarming, and the strains are affecting not just our social care sector but our entire national health service across the UK—our nurses, our doctors and our GPs. The situation could throw rural care in particular into real danger. For example, one in five of our rural GPs in Scotland is an EU national, and it seems likely that EU-qualified clinicians are already located disproportionately in hard-to-fill specialisms and shortage occupations such as radiology.
Medical isotopes are used to diagnose and treat cancers. In 2016-17, the NHS used radioactive materials in nearly 600,000 procedures. Those medical radioisotopes have a short half-life and cannot be stockpiled, even if one was minded to do so. The Royal College of Radiologists is preparing for difficulties in accessing radioactive materials by planning a lighter workload for the week following the date of our exit from the EU. However, that will hit patients who need and deserve treatment for their cancer. I mentioned that very point in a debate in the main Chamber two years ago and I was jeered and accused of scaremongering, despite the fact that I was simply quoting the Royal College of Radiologists. The jeering has stopped, but the challenges posed by Brexit are in no way receding; they are growing.
I do not have the relaxed attitude to these challenges that the hon. Member for Henley seems to have. Throw into the mix the UK Government’s inability to guarantee uninterrupted supplies of medicine, and the future looks grim indeed. That inevitably will affect our ability to look after the vulnerable and ill people in our communities in every constituency—the people who need care and the people who need support. Of course, that is in the wider context of NHS services across the UK being open to predatory procurement, which the UK Government refuse to guarantee will not happen.
No evaluation has been undertaken of the effect of leaving the EU on the UK’s health and social care sector. That is an absolute disgrace. The Government of the day have a duty to serve and protect those they seek to represent. Too little attention has been given to the calamitous situation that awaits us unless this Brexit madness, which has been characterised by confusion, incompetence, a complete breakdown of Cabinet responsibility and not a little arrogance, ends. Those who will bear the brunt and pay the price have not featured prominently enough in this unfolding tragedy. Today, their voices and concerns are being set out clearly. The Government should—they simply must—listen and do all they can to protect our health and social care sector, on which we all at some point will rely.
It is always a pleasure to speak about this issue. I congratulate the hon. Member for Argyll and Bute (Brendan O’Hara) on setting the scene, and I support his request for the Minister and the Government to look at this issue. When I look at my constituency and at Northern Ireland more widely, I understand the criticality of this issue. So many Brexit issues need attention and urgent answers, but over and above Brexit, the NHS requires immediate attention.
I am pleased to see the Minister in his place; he seems to have been a fairly regular presence in Westminster Hall this last while in debates about issues that are his responsibility. It is also nice to see the shadow Minister, the hon. Member for Burnley (Julie Cooper), in her place. I look forward to her contribution, too.
My heart sank when an NHS staff member said to me, “Jim, being in the A&E is like living and serving in a war zone.” That shocked me and underlined the fact that we need urgent changes and more support for our NHS, not simply with respect to Brexit but to ensure the survival of that incredible system, which is overloaded, overworked and underfunded.
I am gravely concerned about the mental health of our NHS staff on the frontline, because of the sheer volume of stress they face. The hon. Member for Henley (John Howell) referred to mental health issues, in which I have a deep interest, as do other Members present. We should consider the mental health not only of patients but of staff. There is a lot of stress in Westminster at the moment because of Brexit, but stress among staff on the frontline of the NHS is at an all-time high.
Nurses are working on their off days; they feel so guilty that colleagues are working on understaffed wards and they are so interested in the job—it is a vocation for them—that they stay on, sometimes without the remuneration they deserve. That may be admirable in the short term, but in the long term it means we have exhausted staff, who work too many hours without enough rest. Their home lives and their family lives suffer as a result. The long-term mental health implications for those who are so focused on helping others that they neglect themselves must be addressed.
To address that, we need better working conditions, less reliance on the bank, and simply more staff working on the floor in wards and taking appointments. We need more GPs, so people can see a doctor when they need to instead of going to A&E because the next doctor’s appointment is not for three weeks. We must ensure that all NHS staff are able to stay in place, or that scenario will worsen. I welcome the Government’s recent NHS long-term plan, which confirmed that the workforce implementation plan expected in April will set out arrangements to help overseas recruitment. The Government have acknowledged the issue and are seeking to act in a positive way. When he responds to the debate, perhaps the Minister will provide some idea of where that is going.
EU nationals make up a sizeable proportion of the health and social care workforce and represent 10% of doctors, 8% of social care staff and 6% of nurses in the UK. They are an integral part of the NHS workforce. It is therefore recommended that the Government take steps to understand any potential impact of ending freedom of movement on the health and social care workforce. There are many options for how best to shape that workforce after the UK leaves the EU, but given our historical reliance on the recruitment of EU workers, it is important that the impact of ending freedom of movement is understood, and we must start a conversation immediately about how best to future-proof the sector. This debate provides us with an opportunity to highlight those issues, and it allows the Minister to respond with, I hope, the answers we seek.
The hon. Member for Argyll and Bute referred to many organisations—there are a large number of such organisations, and it would probably have taken him five or 10 minutes to name them all if he had tried. Specifically, however, Macmillan Cancer Support highlighted that improvements in the diagnosis and treatment of cancer mean that more people are surviving it or living for longer. Some 2.5 million people across the UK live with cancer, and that number is expected to rise to 4 million by 2030. Such figures are great news because they show that there have been significant advances in cancer research, cancer drugs and care, and that our NHS and healthcare system can do lots of good things and help people.
Given the need to support our growing population, we need an immigration system that complements the NHS’s long-term ambitions to improve cancer care across the United Kingdom of Great Britain and Northern Ireland. Across the wider workforce, primary and acute medical and social care staff shortages are impacting on people’s access to cancer care in hospitals and the community. There is a significant variation in vacancy rates, which in many places can be as high as 15% for chemotherapy nurses. In some areas, those shortages in cancer nursing staff are exacerbated by the fact that there is an ageing workforce—the hon. Members for North Ayrshire and Arran (Patricia Gibson) and for Argyll and Bute referred to the fact that the workforce is ageing, and we must prepare for that as well.
In many cancer services, more than 40% of professionals are due to retire in the next 15 years. That issue poses a significant challenge for our current workforce so we should focus specifically on those services, and on those who will be retiring and those who will replace them. That is why this debate is so important. There is a clear need to recruit and train younger staff in specialist and chemotherapy nursing, and that would go some way to countering that shortfall. Will the Minister consider that issue? Will he also consider writing off the student debts of those who serve in local GP clinics for five years? Similarly, the nursing bursary should be reviewed and uplifted, and perhaps we should also consider perks to encourage occupational health therapists to stay in their positions.
I think we have to consider something new when addressing these issues. This is not just about ensuring that immigration fills some of the gaps in our workforce, because we must also address the needs of local people and provide opportunities. Given the nature of our society and jobs, perks can be a methodology for doing that—it is not wrong to offer such measures, because if they bring in the right calibre of staff and help people to stay in their posts, that must be good news. In conclusion, all the issues that I have raised must be priority considerations for the NHS, especially in the light of us leaving the EU, and I seek clarification from the Minister about how they will be addressed.
It is always a pleasure to see a fellow member of the Procedure Committee in the Chair, Mr Bone. I pay tribute to my hon. Friend the Member for Argyll and Bute (Brendan O’Hara) for securing this debate and for the immense amount of work that he has put into his excellent European Union Withdrawal (Evaluation of Effects on Health and Social Care Sectors) Bill, which I wholeheartedly support.
I had not intended to mention stockpiling today but, like my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson), I was taken aback by how relaxed the hon. Member for Henley (John Howell) was about the issue. My wife has type 1 diabetes and relies on insulin to stay alive, so we in the Linden household are not quite as relaxed about the possibility of insulin shortages. I will leave that point with the Minister.
Despite what some might say, there is no good Brexit, and no deal is as good as the one we have now as members of a 28-strong bloc—I am pretty sure the Minister agrees with that. As my hon. Friend the Member for Argyll and Bute said, our withdrawal from the European Union will have profound effects on the health and social care sectors. This morning I will focus my remarks solely on the impact of limiting free movement of people, and the disastrous consequences that that will have on the health and social care sector.
As Members of Parliament and leaders in our communities, we have a responsibility to be up front and enthusiastic about the benefits of immigration. If we are not, major challenges will come down the track, not just for our economy and public services, but especially for social care. For example, we know that the number of people with dementia is expected to increase by about 40% over the next 12 years, which could mean more people living in care homes. Who will provide that care?
It may be a harsh reality, but the vast majority of people with whom I went to school do not generally like the idea of working in care homes. Quite simply—I would have put this point to the hon. Member for Upper Bann (David Simpson), but he is no longer in his place—for many people of my generation, the idea of personal care, serving meals or feeding people is, sadly, not attractive. I wish to change that perception, but given the current economic climate, we must understand that young people are not moving towards caring as a career choice. The Government should work to tackle that, but it is a reality we must face. If we do not confront the reality of our ageing population, we will have serious difficulties with workforce planning and meeting the demographic challenges in the years to come.
I also wish to mention some concerns raised by charities that I am proud to work alongside, particularly Children’s Hospices Across Scotland, which does amazing work for children who have life-shortening or life-limiting conditions. Hon. Members will also be aware of the sterling campaign by CLIC Sargent on child cancer costs. We know that leaving the EU without a deal could lead to significant disruption to the economy in the short and medium term. CLIC Sargent has raised legitimate concerns that the impact of Brexit on the economy, and any associated increase in food, travel and energy costs, will lead to increased costs for young cancer patients and their families. When he responds to the debate, will the Minister outline what assessment has been made of the financial impact of leaving the European Union on young cancer patients, and what measures are being implemented to mitigate that?
I am concerned that Brexit will undermine our efforts to meet those profound social care challenges, which is why it is vital that the Bill sponsored by my hon. Friend the Member for Argyll and Bute receives Government support and is expedited through the House. He is right to say that the shambles of the private Members’ Bill process makes it likely that the Bill will die at the end of the week, but if the UK Government are serious about Brexit meaning Brexit, and about us making a success of it, they should support the Bill and ensure that we confront these challenges. If we ignore them, people will look back on us and say, “That was the Parliament that abdicated responsibility.” By taking part in this debate, I wish to place firmly on the record that I did my bit to make sure that we face up to those challenges.
It is an absolute pleasure and a privilege to serve under your chairmanship, Mr Bone. I thank my hon. Friend the Member for Argyll and Bute (Brendan O’Hara) for his thorough and passionate account of why a clear focus on the health and social care system is so important. That will be true beyond Brexit, but Brexit is our immediate concern, which is why we must give it serious attention.
The NHS does fantastic work. I had the privilege of working for four years in Argyll and Bute, covering the hospital there as a forensic psychologist. Rural hospitals in Argyll and Bute are excellent and innovative in their practice. Even 10 to 15 years ago, when I was working there, we were grappling with the internet and how to engage in therapy on timescales that would best suit patients. The use of technology in those rural areas was innovative, and I commend the NHS staff I worked with, many of whom still work there, for their work to provide fantastic patient care.
Two weeks ago there was an extraordinary meeting when seven all-party parliamentary groups came together to look at health and social care. I am fortunate enough to have been the chair of the all-party parliamentary group on disability since the 2015 general election. The chairs of the all-party groups were there and we brought in carers and service users to speak about their concerns. There is growing concern in Parliament about the NHS, and about the implications of a no-deal Brexit, particularly on medicines regulation and our ability to staff hospitals and provide excellent care, as we always have. It was an important and informative meeting and I suggest to the Government that a further meeting might come out of it, with the all-party group chairs, to hear the views of the service users and carers who attended, and to take forward some of their recommendations. They are on the frontline and know what happens day to day in our services. I am sure that they will be extremely informative and constructive if they have an opportunity to meet the Minister.
When I was a member of the Health and Social Care Committee, we conducted an inquiry into Brexit, medicines, medical devices and substances of human origin. A particular concern was raised about our ability to lead on research trials, and about patients’ ability to participate in trials, particularly on diseases that are perhaps less common but where there is a need to pull in subjects or participants from a huge area such as the EU. Currently, patients here can participate in such trials, and we can also lead on some of them. That has brought some of the best scientists and researchers to the United Kingdom. I would be interested to hear from the Minister how we will ensure that continues. Also, how will our constituents continue to have access to such important trials, rather than having to wait until some way down the line to get new and innovative medications?
During that inquiry, the Select Committee urged the Government particularly to look at regulatory alignment and the implications of no deal. We raised concerns about the lack of references to Brexit in the Department’s single departmental plan. It would be useful to have an update from the Minister on that work, which I am sure is ongoing. There was also some concern about protecting the UK’s position globally in relation to pharmaceuticals. On the matter of full membership of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use, reassurance was sought that that matter would be taken up at the earliest opportunity. It would be extremely helpful if the Minister gave an update on that.
The Select Committee recommended negotiating a close relationship with the EU, including associate membership of the European Medicines Agency, and supported the Government’s intention in that respect. Our report stated:
“Failure to achieve an ongoing collaboration would signal the triumph of political ideology over patient care.”
I say firmly to everyone involved, from all parties in Parliament, that patient care must be placed firmly before political ideology. The NHS is one of our most prized institutions—for everyone across the United Kingdom—and must remain so. Our overriding message was that almost all the evidence received suggested that
“the UK should continue to align with the EU regulatory regimes”
for medicines and devices. An update from the Minister would be helpful.
The hon. Member for Coventry South (Mr Cunningham), who is not currently in his place, made an interesting intervention about predatory procurement. I understand that we do not want to be alarmist in Parliament, but patients bring such concerns to us, so reassurance from the Minister would be helpful. The hon. Member for Henley (John Howell) spoke eloquently about his constituency and talked about diabetes and cystic fibrosis. Many constituents go to their Member of Parliament seeking reassurance about the implications of Brexit for their medicinal needs. The hon. Gentleman also spoke about mental health, which we cannot speak about enough in Parliament, because for many years it was never broached. I am the Scottish National party’s spokesperson on mental health, so I thank him for raising it, because I consider it important for it to be mentioned in as many debates as possible. It has an impact in every part of our lives, and if we are to provide holistic care it must have parity with physical health in all we do.
My hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) spoke about medicinal isotopes. There is a huge pharmaceutical industry presence in my constituency, and I have been in touch with those businesses in the past month. There continue to be grave concerns about alignment and regulation for the industry. I think it is the continuing uncertainty that puts such a burden on businesses.
My hon. Friend the Member for North Ayrshire and Arran also said that one in five GPs are EU nationals and talked about our heavy reliance on workers from the EU, who do a fantastic job in the NHS. A number of witnesses to the Health and Social Care Committee told us just the same. We of course do not want to lose their valuable skills and expertise. They have built bonds with patients—or, if they work in the social care sector, with the people they care for—over a long period of time, and that cannot be overestimated. We must never undervalue their contribution. They need their place to be secure. Many of those workers do not earn over the £30,000 threshold, so we need a specialist case to ensure that the expertise stays in the country to support those vulnerable constituents of ours who need it.
Something that was repeatedly raised with the Select Committee—the hon. Member for Strangford (Jim Shannon) also mentioned this—is the fact that we have come to rely on high levels of staffing from the EU and elsewhere. It has been mooted that if we cannot attract staff from the EU, we could attract them from India or perhaps Africa. Those places in particular need their trained staff, and something must be done about training for young people in this country who want to go into health and social care settings.
My hon. Friend makes a good point, but she will be aware that many people who have qualifications are currently not allowed to work by the Home Office. Two of my constituents worked in a care home and it would have loved to have them back, but the Home Office says no. Does she share my frustration that the Government say one thing on the one hand, and then something else on the other?
My hon. Friend makes an excellent point. Things have to be joined up exactly so that we can provide the continuity of care that patients need so much. There are thousands of excellent, high-achieving students who particularly want to study medicine, as well as psychology, occupational therapy and other occupations that are badly needed to support our NHS and our community health services. We must invest in these young people as we go forward. That point was made strongly by the hon. Member for Strangford, who is always an extremely good advocate for his constituency.
I look forward to the Minister’s response on social care, on medicines regulation and on the other issues we have spoken about. My hon. Friend the Member for Glasgow East (David Linden) also expressed concern about social care and those working in care homes. We must make that a more attractive occupation for people coming from school. I did it for a few years before going into clinical psychology; it is a rewarding occupation where carers build a real bond with those they care for. I ask the Minister to meet the APPGs, and I say to him very sincerely that we want to collaborate in a constructive way.
It is a pleasure to serve under your chairmanship, Mr Bone. I am grateful to the hon. Member for Argyll and Bute (Brendan O’Hara) for bringing this time-sensitive subject to the Chamber for debate. It is my pleasure to speak on what must be the most important subject of the day.
It is true that in June 2016, the majority of people in the UK voted to leave the EU. However, they did not vote for a worsening of health and social care provision, for reduced access to medicines or for fewer nurses, doctors and care workers. They did not vote to damage medical research or to leave vulnerable people without social care. It is therefore important that we turn to some of the specifics and seek reassurance on behalf of the British people.
The question of medicines has been much talked about, not least this week in this place. Coming from a pharmaceutical background, I am extremely worried about the Government’s complacency. This is not about scaremongering; it is about listening to the real concerns of patients, patient groups and medical professions. Contrary to the comments made by the hon. Member for Henley (John Howell), it is not only helpful but vital for those groups to raise their serious concerns. I agree with the Minister that not only is it not Government advice to stockpile medication, but it is dangerous for patients to do so. One can understand why they might be driven to do so, however; it is an indication of the Government’s failure to provide reassurance on that point.
Medication forms an important part of NHS care. Each year, 1 billion prescriptions are dispensed by community pharmacies. For patients with long-term conditions, such as diabetes, asthma, epilepsy and many more, daily medication is an essential part of staying well. Whether we are talking about medication to treat cancer or heart disease, medication for the management of high blood pressure or the occasional prescription for antibiotics, we take it for granted that the medication that we need will be available when we need it.
The pharmaceutical industry is, by definition, an international business. Key ingredients are often manufactured in India and the far east, and transported to specialist manufacturing plants. Many of the plants that supply the UK are located elsewhere in Europe, and the finished products have to be imported into the UK and distributed to hospitals and pharmacies for use with patients. The entire process has to be carefully managed to ensure that everything happens in a timely way. That is particularly true for medicines with short shelf lives, such as the lifesaving EpiPens needed by those with severe allergies. It is also true for medicines with special storage requirements, such as insulin, which has to be kept refrigerated.
I absolutely agree. We cannot dismiss concerns just because we do not like their implications; it would be irresponsible to do so. Delivery into the UK is currently a just-in-time service for the pharmaceutical industry, for many of the reasons I have mentioned. It is true that in the long term, there is some manufacturing capacity in the UK and we could change the way we get our supplies, but that is not going to happen overnight. It would take a considerable amount of time, given the stringent safety requirements involved in the manufacture of safe medicines, for us to be able to do that.
I am not convinced that we have sufficient supplies or that sufficient steps are in place to ensure an uninterrupted supply. People, including those who rely on insulin, are legitimately worried. Breast cancer care organisations have raised the issue of access to radioactive isotopes needed in the vital treatment of breast cancer. It would be irresponsible of them not to raise that. It is extremely worrying, given that we have only 10 days until the UK leaves the EU, that there are still no arrangements in place. There is no doubt that the UK will need time to establish new supply chains, which is perfectly possible. It is not scaremongering. [Interruption.] I thank the Minister for the comments he has just made from a sedentary position, but we are not convinced. It we were to leave without a deal, the effects would be catastrophic.
The hon. Lady is absolutely right that we should be worried. Just last night, the Government made changes to the human medicines regulations to bring in a serious shortage protocol, under which Ministers would be able to add medicines to a list and designate a shortage. In practice, it will mean that pharmacists can replace prescribed drugs with others at the pharmacy if there is a shortage. Does that not illustrate what she is saying?
The hon. Lady makes a really important point. I would be the first to speak up for the skills of community pharmacists, but that measure is a passing of the buck. It does not put the interests of patients and their safety first and foremost, which is very worrying.
I move on to the life science industry and research, which several Members have touched on. The UK is a world leader in life sciences and a major centre for research. The sector employs 220,000 people and attracts some of the finest research talent in the world. Four of the world’s top six universities for the research and study of clinical and health topics are based in the UK. Biotech company clusters and partnerships are found across the country, making up the largest biotech pipeline in Europe. It is a fact that the UK has been the recipient a bigger share of EU research funding than any other EU nation. It is hard to overstate the importance of the EU to the biomedical sector in the UK and the health outcomes for British patients. Shared initiatives—such as the “New Drugs for Bad Bugs” programme, which aims to tackle antimicrobial resistance—in which pharmacologists from across the EU work together for mutual gain are incredibly important for the future. As we leave the EU, we risk losing the benefits that arise from being a hub for world-class research. The investment, the talent and the infrastructure, including jobs, are all at risk. The removal of those benefits has begun, and arrangements are already in place to relocate the European Medicines Agency from London to Amsterdam.
Time is short, and there are many issues of concern about this subject. One key concern is workforce. I agree with the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), and I thank our NHS staff for the tremendous work that they do. I pay tribute to the excellent service that we still enjoy, in spite of the many challenges. It is because of that excellent service that we feel so passionate today; we do not want to lose it. I also put on record my thanks to the care workers, especially those who have helped me to look after my mum. It just so happens that they come from Poland and Latvia, and they are amazing, but their status is at risk.
Hon. Members have talked about the existing challenges in the workforce, and rightly so. We already have a workforce crisis in the NHS and in social care. There are many reasons for that, including some that have already been mentioned: we do not train enough staff; we put up barriers to training, including the removal of bursaries; and working conditions and pay are often not what they should be, as the hon. Member for Strangford (Jim Shannon) said. There is no doubt that making it more difficult for EU health professionals and EU carers to work in the UK will not help the situation we face.
The scale of the contribution from the EU cannot be underestimated: 5.6% of the total NHS workforce come from the EU. In addition, we already have 100,000 care workers from the EU working in this country, and we know to our shame that we currently have 1 million vulnerable people with unmet care needs. I appreciate the points that the hon. Member for Henley made about the excellent work in his constituency, but I point out to him that the majority of care for vulnerable people is delivered in their homes—or not delivered, in many cases, which is a massive problem for us.
To replace the EU NHS staff and the contribution that social care workers from the EU make would be extremely costly to the NHS. It certainly will not be a saving to the nation. The worst situation we could face would be if the Government failed to prevent a no-deal situation. There are ways of coping with all the other areas, given time and a transition period. I am keen to stress to the Minister that this is not about scaremongering, but about sensible concerns and a reassurance that sensible provision is in place.
I want to touch on future trade deals. People rightly raise concerns that many of the current problems experienced in both health and social care have arisen as a direct result of the fragmentation and privatisation of provision following the Health and Social Care Act 2012. There is a risk that future trade deals will add to the problem of privatisation.
In the months leading up to the referendum, the people of this country were promised that there would be a Brexit dividend for the NHS, and the figure of an additional £350 million per week—surely the biggest exaggeration of the Brexit campaign—was irresponsibly promoted. However, the reality is that in the light of the Government’s own predictions of low economic growth, there will be less funding for the NHS after we leave the EU. The Government are also very clear that if we leave the EU next week with no deal, the economic cost to our nation will be even greater.
It is our duty to respect the result of the referendum, but as public servants it is our highest duty to ensure that our constituents’ standards of health and wellbeing are protected. The NHS is regularly cited by the British public as one of the greatest achievements of—I have to say—a Labour Government. Brexit was sold as a way to protect the NHS, and no matter how misguided that promise was, as servants of the people we must deliver on it. Protecting the NHS is also the will of people, as they have shown in many elections.
To protect the NHS and to respect the will of the people, can the Minister provide assurances on the specific points that have been raised today? Can he confirm that the Government will rule out no deal and minimise the potential for negative impact on the NHS and social care sectors? Can he demonstrate that he is not ignoring the legitimate concerns raised today and out there in the community, from Members of this place, from patients and their representatives and from healthcare professionals? Can he demonstrate that the Government are listening and have sensible provisions in place, and that they will take every step to avoid a no-deal Brexit next week?
It is a pleasure to see you in the Chair this morning, Mr Bone. I will start by addressing the remark by the hon. Member for Burnley (Julie Cooper). She should know that the whole of the Department of Health and Social Care, and indeed the whole of the Government, are absolutely committed to ensuring that there are in place detailed plans, which I hope I will be able to outline and reassure hon. Members about, to ensure that in any post-Brexit scenario the health and social care of our country’s citizens is our top priority.
I thank the hon. Member for Argyll and Bute (Brendan O'Hara) for securing the debate and commend him for his private Member’s Bill. He will know that the Government do not support his Bill—although we support the spirit of it—in part because, as the contribution from the SNP Front Bench showed, it is unnecessary. He is arguing for an independent evaluation and careful analysis of Brexit, but I thought the contribution from the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), frequently citing the Health and Social Care Committee, proved that there is a huge amount of independent evaluation, accountability and scrutiny of the plans.
The hon. Member for Argyll and Bute raised a number of questions. I have with me a prepared speech, but I am not sure I will get on to it, because I want to address as fully as I can some of the concerns that hon. Members have raised. He raised a number of concerns about the social care sector, and he is right to do so. Brexit or no Brexit, it is a fragile sector and any event could hinder care provision. That is why, in the light of Brexit, we are working with the sector and local authorities to ensure that we have contingency plans in place.
I will speak more, if I have time, about what we have done regarding EU nationals in the short term, but I want to stress, as the hon. Member for Burnley did, my thanks to all EU nationals who work in either the healthcare system or the social care system. They play a crucial role in delivering high-quality health and social care, and we all recognise that. It is a fact, of course, that the number of EU nationals in adult social care has increased each year, from about 5% in 2012-13 to 8% in 2017-18, but that is no reason to be complacent. That is why we have put in mitigations regarding the EU settlement scheme and are implementing long-term policies to deliver the workforce and address the supply-demand gap that exists.
The hon. Member for Argyll and Bute will of course have noticed the recent recruitment plan, Every Day is Different, which started only last month. As he challenged me directly on this, I can say that we are currently in discussions with the Home Office about the salary threshold for social care.
My hon. Friend the Member for Henley (John Howell) spoke eloquently, as he always does—I have heard him speak in several of these debates—about Henley and other matters. He challenged me to visit Henley, which I would be delighted to do—perhaps on a Friday in July, when other events are on as well.
The hon. Member for North Ayrshire and Arran (Patricia Gibson) asked a number of questions. I made this clear at the start of my speech, and I will make it clear again directly to her: we value all the professionals who work in the national health service and the social care sector. We are putting plans in place, both short term and long term, to ensure that our words are followed by actions and there is practical support, and to ensure that people know how much they are valued. I heard her charge of arrogance, but she might like to reflect on the fact that some might consider it arrogant to suggest in any way that this Government are not putting in place all the necessary preparations to protect the NHS.
I am about to, if the hon. Lady will give me time, which is why I will not take her intervention.
The hon. Member for Strangford (Jim Shannon) asked about NHS investment. He knows, of course, about the increase in cash terms of £33.9 billion by 2023-24, which reflects, as I said at the outset, our top priority. He also challenged me about the cancer workforce. Baroness Dido Harding, the chair of NHS Improvement, is carrying out a rapid programme of work for the Secretary of State, engaging with relevant stakeholders across the system to build a workforce implementation plan, which the hon. Gentleman mentioned. We have charged her with making sure that her plan matches the long-term plan’s ambitions. The hon. Gentleman will know that the long-term plan superseded previous plans to establish a larger cancer workforce, and Health Education England is now working with Baroness Harding to make sure that is in place.
I listened carefully to the hon. Member for Glasgow East (David Linden), who asked important questions about insulin and the financial impact of leaving the EU on cancer patients. My officials spoke this morning to insulin suppliers, who have increased their buffer stocks so that they will hold 16 weeks of additional stocks over and above their normal supply. [Interruption.] Yes, it is stockpiling, but it is stockpiling that we have asked the whole pharmaceutical industry to undertake. As the hon. Member for Burnley rightly pointed out, there should be no stockpiling by individuals or pharmacists. I will explain the whole stockpiling issue and why we are rightly putting in place buffer stocks to ensure continuity of supply. The hon. Gentleman asked me whether buffer stocks of insulin are in place, and I can confirm that they are.
The hon. Gentleman also asked me what assessment has been made of the financial impact of EU exit on cancer patients, and what measures are in place to protect services. He will know that the long-term plan contains clear proposals for improving cancer diagnoses. That plan is fully costed. As I just said in response to the hon. Member for Strangford, the workforce implementation plan is putting in place the cancer workforce.
I also listened carefully to the hon. Member for East Kilbride, Strathaven and Lesmahagow, who asked whether my door was open to chairs of all-party parliamentary groups. The answer is yes, of course. If she wishes to contact me, I would be delighted to engage with her, and with chairs of other all-party parliamentary groups.
It is also worth putting on the record the relationship that we are likely to have with the European Medicines Agency post Brexit. The Government are clearly striving for a deal, and in the light of the withdrawal agreement being signed, the political declaration sets out that it is the UK’s intention to explore the possibility of EMA co-operation during negotiations on the future framework. In the event of no deal, we would clearly no longer be any part of the EMA, and the Medicines and Healthcare products Regulatory Agency is ready to carry out EMA functions as a sovereign regulator.
To ensure the continuity of supply, the UK will continue to accept batch testing of human medicines carried out in countries named on a list by the MHRA, including EU, European economic area and European Free Trade Agreement countries, and most third countries with which the EU already has in place a mutual recognition agreement.
I reassure the hon. Lady that we have been working since last August to ensure that companies understand the routes available to maintain continuity of supply, including air freight routes. We will ensure the potential use of those alternative shipping or air freight routes because, as she rightly points out, these are short-life products. The worst-case scenario—no deal—has been looked at, and routes will be available to ensure that medical isotopes can continue to come into this country.
The hon. Lady referred in her speech to the operationalisation of those plans, which is relevant. Normally, if sea routes are used, it can be ensured that medical isotopes or short-life products are at hospitals by 9 am. She referred to the likelihood that, if air freight routes are used, those products would not arrive until midday, which the NHS advises us would mean that some clinics would be likely to be rescheduled to later in the day. People’s opportunities to undergo treatment will not be interrupted.
I hear what the Minister says about making his best efforts to ensure that there is no interruption of supply. However, does he accept that, as of yesterday, health professionals who deal with this were not reassured? We could be in a no-deal situation in just over a week’s time. Will these arrangements hold good in a no-deal situation? Will he assure us that those vital isotopes will be in the places where they need to be?
Had the hon. Lady joined me in walking through the Lobby to vote for the withdrawal agreement—so that Brexit would happen on 29 March and leaving without a deal would be impossible—she would know that all the arrangements currently in place would pertain. We are talking about arrangements for a no-deal situation, which I and the Government certainly hope will not happen. These arrangements are specifically designed to ensure that arrangements are in place for no deal.
In the short time I have left, I will stress the continuity of supply. It is essential that any responsible Government, even if they wish for a different outcome, should prepare for the outcome that they do not want, which in this case is no deal.
I want to give the Minister the opportunity to answer the question I asked about the long-term plan to fill those hundreds of thousands of vacancies now and in future, and to reassure supporters of my Bill that health and social care will not be adversely affected by the UK leaving the EU. I would be hugely grateful if he did so in the next three minutes.
There are so many issues that I could tackle in the next three minutes. However, as the hon. Gentleman will have seen, the long-term plan has ambitions to ensure that there are new routes into nursing and that there are extra doctor training places. I said in response to the hon. Member for Strangford that we have commissioned Baroness Harding to start a workforce implementation plan. I assure the hon. Member for Argyll and Bute that driving down the number of vacancies is a priority for the Government. However, he will recognise that several of those vacancies are not necessarily unfilled posts, because they are usually filled by staff from the temporary staff bank. We need to be clear about what we are talking about. Recruitment into our national health service and our social care system is absolutely a key priority.
My Department has overall responsibility, on behalf of the devolved Administrations, for ensuring the continuity of supply of medicines and medical products. All supply arrangements take into account the whole of the United Kingdom. We have had significant support from, have given reassurance to and are constantly working with the pharmaceutical industry, the whole of the medical supply industry, clinicians and patients, and I am delighted to say that last week we held a roundtable with the devolved Administrations, so that their concerns could be listened to and directly addressed.
Several Members commented on stockpiling. We recognise that if we leave the EU without a deal, the medical supply chain will come under a lot of pressure. Around three quarters of the medicines and more than half the clinical consumables that we use come from the EU. Since last August we have been working with the industry to ensure that, before 29 March, there is at least an additional six weeks of stock over and above the usual buffer stocks in the UK.
We have also advised companies that if they are likely to face difficulties in their supply routes, there are ways of bringing in supplies outside the normal short straits route, either by using existing services or by making use of the additional capacity that the Government have procured. We are reliant on transport and freight being re-routed, but I am confident that, if everyone—including suppliers, freight companies, the health and care system and international partners, all of whom we have worked with since last August—does what they need to do and have committed to doing, the supply of medicines and other medical products will be uninterrupted.
I had intended to deliver a rather longer speech this morning, but I thought it was important to try to answer directly the questions put to me by hon. Members. There is no doubt that many areas of the health and care system will be directly affected by EU exit. We do not have time to address those today. However, it is important that the country knows that the Government are committed to ensuring that, whether we leave with or without a deal, we have in place the contingency plans needed to meet those challenges.
Order. I apologise to right hon. and hon. Members, but time has beaten us. I place on the record my particular thanks to the Minister for not reading a prepared speech and for dealing with the questions that Members asked.
Motion lapsed (Standing Order No. 10(6)).
Flooding in Cumbria
I beg to move,
That this House has considered flooding in Cumbria.
It is a huge pleasure to serve under your chairmanship, Mr Bone. I wish to speak about the situation with regard to flooding in Cumbria. In the days following Storm Desmond in December 2015, in response to our collective call for action, I was promised by David Cameron that funding would be provided to protect those towns and villages along the River Kent and its tributaries. I thank the Minister for her support in holding to that; it is genuinely appreciated.
This week, the Kendal flood defence scheme will come to the council’s planning committee. MPs are generally advised to stay neutral on planning issues, but I have chosen to intervene on this occasion because, having won the funds to deliver that flood protection, I am determined to do everything I can to give families and businesses the protection and peace of mind that they so desperately need. Having waited more than three years even to get to the planning stage and having been through many iterations during the consultation, those who still live with the trauma of Storm Desmond should not be made to wait any longer, so I place on the record my concern that the proposal should not be dragged out further by an unnecessary public inquiry.
Storm Desmond’s impact on communities in Cumbria was unprecedented and long-lasting: 7,465 properties were flooded, affecting an estimated 14,694 people, the largest number of whom were in South Lakeland. Some people were out of their homes for three years, and 3,000 children were unable to return to school until the new year of 2016. They missed a vital part of their education; for some, this was in the run-up to very important January exams. In addition, 1,029 businesses were flooded, causing huge economic damage to our communities. Jobs were lost and some businesses went to the wall. Flooding caused poverty as well as heartbreak.
The long-term toll on the tourism industry is also unquestionable. In terms of popularity, the Lake district as a destination is second only to London. UNESCO recognised that in 2017 by granting world heritage site status. The Cumbria visitor economy contributes £3 billion a year and employs more than 60,000 people. However, Storm Desmond saw a 76% decrease in tourism business profits and a drop-off in visitor numbers of about the same proportion; 57% of Cumbria’s tourism businesses also reported reduced numbers of international visitors. Four months on from the floods, 77% of businesses continued to suffer reduced booking inquiries.
As well as people’s property and livelihoods being affected, there was a significant impact on Cumbria’s infrastructure. The A591 north of Grasmere was simply washed away, cutting the Lake district in two, as its most important road was then closed for more than five months. There were 107 other road closures; there was damage to 792 bridges and the closure of the west coast main line. The impact on other vital services was devastating. More than 1,000 hospital operations were cancelled, causing significant suffering and distress.
In the light of the widespread and long-term impacts, both personally and economically, it is clearly in both the national and the local interest that the Government should invest significantly in preventing a repeat of the devastation. The current plans for flood defences in my constituency provide protection for residents and businesses in Kendal, Burneside and Staveley and are welcome, but many badly affected communities are being offered nothing by the Government.
The Derwent river catchment, which is in my constituency, has no significant flood alleviation projects in the pipeline, despite being flooded multiple times during the past 10 years, and does not qualify, under the current funding formula rules, for significant funding. The Minister is aware of our concerns, and I thank her for taking the time to listen to us on this matter, but recent alerts have led to more concerns about mental health problems among my constituents. Does the hon. Gentleman agree that we need a serious and thorough review of the current spending formula in order that all our constituents can be properly protected, as well as those in other rural areas that fall foul of the current system?
I thoroughly agree with all that the hon. Lady has said. The funding formula for Cumbria works massively against us in terms of both resilience and response to crises. I will talk later about the impact on mental health. The hon. Lady makes an extremely good point in that respect. The lasting consequences of flooding are very often huge when it comes to people’s wellbeing and their fear of what might come next.
We welcome the funding that we have got, but it is insufficient. Many areas, such as those that the hon. Lady has referred to in her own constituency, have not received that support. In my own community, we look at the failure to come forward with funding and support for places outside Kendal in particular. Windermere Road in Grange has flooded for many years, and only now has the Environment Agency been given approval to do a 12-month appraisal. We were expecting spades in the ground by now, not more chin stroking. I would appreciate the Minister’s intervention to ensure that the residents of Grange are not kept waiting for the flood protection that they desperately need. People will be reassured by tangible, visible construction and action, not by meetings and promises. The funding has been allocated for the scheme and plans have been made; we now need to move forward with actual delivery.
Flooding in the village of Holme, along Stainton Beck, in Burton and on the Strands at Milnthorpe remains unaddressed. Those places are on a list of flooding hotspots where action remains to be taken. The same is true of many other places throughout Cumbria. The Burneside and Middleton Hall bridges have been closed for more than three years, dividing and damaging communities. In the year and a half for which the Staveley bridge was closed, the community found itself cut off and isolated, without any financial support from the Government. Kendal’s bridges, including the Victoria bridge, were closed following Storm Desmond because of safety concerns. However, when Cumbria local enterprise partnership put in a bid for £25 million to make the county’s bridges and infrastructure more flood-resilient, it was rejected by the Government.
Meanwhile, the Government have failed to come forward with any plans for protections for the communities around Windermere: Bowness, Waterhead at Ambleside and Backbarrow in particular. Those communities have been completely ignored in the Government’s plans. They remain exposed and vulnerable, subject to whatever the weather throws at them next. Of all the businesses in Cumbria closed by Storm Desmond, more than one tenth were around Windermere lake.
I congratulate the hon. Gentleman on securing the debate and on the powerful case that he is making. It is extraordinary that when the Government can, at the stroke of a pen, assign £4 billion to a no-deal Brexit that it is in their unilateral power to stop, these relatively minor sums are not being spent even though they could alleviate the misery felt by thousands of our constituents. Does the hon. Gentleman agree with me and local businesses that the Government, in allocating money for alleviation schemes, should take more account of the impact on businesses?
I agree with all that the hon. Gentleman has said. He makes an important point, which is very significant to his constituents, but also to mine around Windermere lake. Residences are affected, but so are dozens and dozens of businesses, all of which are the backbone of our local economy and have a massive impact on the wellbeing of local people. The Government must now take responsibility for the failure to invest in protecting those businesses. We cannot get away from the impact on families and businesses, which cannot plan for the future because they feel that they might get hit again. Even a modest downpour can trigger real panic in people of all ages, especially children. Flood prevention is about protecting not just properties, but the wellbeing and mental health of the people who live in them.
I was hugely affected by what I saw and experienced on the morning after Storm Desmond, as we helped stricken people to empty their homes. I saw the forlorn Christmas decorations and sodden Christmas trees left out on the front garden or yard. I stood with people who had been made destitute. Barely able to afford to feed their children or pay the rent in the first place, they had forgone insurance because, frankly, they could not afford it, and they were left facing utter ruin. We cannot guarantee people that there will not be floods again, but we can massively reduce the risk. We can help people to give themselves permission to have confidence in the future and reassure their children, so that they can sleep easier at night.
A survey carried out by the Cumbria community recovery group reported that in the areas hit by the floods, a sense of vulnerability and loss of control was created, which re-emerged following further heavy rainfall of any kind. People reported anxiety and symptoms of post-traumatic stress disorder, which worsened further for those facing the loss of their employment, as well as their home.
For those flooded communities that have not received help—such as Grange, Windermere and Backbarrow—I ask the Minister to change the Government’s position and agree to intervene. There are deliverable schemes that will protect all those communities around England’s largest lake, as well as the community in Grange-over-Sands. I ask that she agrees to fund those as a priority.
The failure to hold water companies to account is a further area of concern. Despite the Kendal flood defences being built to withstand a one-in-100-year event, the water companies—in our case United Utilities—are only required to meet the standards for a one-in-30-year storm event. That is ludicrous. Millions of pounds are being spent on flood defences for our community, but the area will be just as vulnerable from surface water flooding. Surface water is one of the biggest factors to cause homes to be flooded in Cumbria over the last 10 years. On Steeles Row in Burneside, poor drainage means that residents have to deal with raw sewage overflowing into their homes and on to the street every time there is even a moderate downpour. I challenge the Minister to hold water companies, such as United Utilities, to account—to a one-in-100-year standard—so that homes receive the protection that they need.
Let us be clear that we are talking about not simply flood protection, but the mitigation of a human-created disaster—the consequences of climate change, which is more properly described as a climate catastrophe. The Government have moved away from renewable energy. They have changed feed-in tariffs, so that it is harder for businesses to invest in solar energy, while giving licences for fracking. The Guardian recently outed the Government as providing some of the heaviest bursaries for gas and oil companies. The cancellation of the Swansea tidal lagoon proves that the Government have stopped even pretending to care about climate change. Britain has the second-largest tidal range in the world, and yet we fail to use that natural, renewable resource to cut carbon and create jobs.
I want us to mitigate the consequences of our failure to tackle climate change in time to protect my communities from flooding, but I am also determined that the Government take the big strategic decisions to fight climate change. That requires a revolution in renewables and a push for energy self-sufficiency, which would protect our environment, boost our economy and give us vital energy security. I see no sign of any appetite for that from this Government. I was with students in Kendal last week, protesting against inaction on climate change. That was a reminder that the coming generation will not let us get away with it, and they are absolutely right not to.
I was in Cockermouth on Saturday with students from Cockermouth School and other primary schools, and they take the issue very seriously. In my constituency we also have to deal with coastal erosion and coastal flooding, which are greatly impacted by climate change. Does the hon. Gentleman agree that we need to build coastal protection into the broader funding formula for flooding protection?
Yes, I agree, and I will come on to the need to treat Cumbria as a special case when it comes to flood funding allocation. We have a very long coast with many tidal estuaries, which could be a source of energy but are also a source of flood risk. The hon. Lady makes a very good point.
Flooding is a problem in my patch, as well as for my constituency neighbours, the hon. Lady and the hon. Member for Barrow and Furness (John Woodcock), but it is a problem that only stands to get worse. The extreme weather events that we face are becoming more frequent. According to the Met Office website, Westmorland has the highest average annual rainfall of any place in England. The most beautiful place in the country turns out to be the wettest—who would have thought it? We have a lot of lakes to keep topped up.
I ask the Minister to re-evaluate the funding criteria, to ensure that Cumbria is treated as a special case with recurring support for flood resilience, because for us it is not a question of whether it will flood, but when and how severely. I want the Minister to intervene with emergency funding to protect the communities around Windermere, such as Grange and Backbarrow, which currently face the future with no protection. We need more than just one-off lumps of money to deal with crises; we need a fundamental change in the funding formula.
The current partnership funding mechanism focuses on the value of assets protected. That obviously favours wealthier communities and parts of the country where house prices are higher and homes more densely built. It dilutes any consideration of how likely an area is to flood. The system of classification is, frankly, not fit for purpose. Many communities flooded in 2005, 2009 and 2015; that is three floods in 10 years, each of them at least a one-in-100-year event, meaning that flood frequency estimations are now wildly inaccurate for Cumbria. Properties should now be placed in the higher risk category, based on the reality of the past 10 to 20 years. The current figures are based on statistics that are so far out of date that they have basically become fantasy.
In short, the steps that the Government need to take are clear and threefold. First, we need urgent investment now. We need to build capacity to take water out of Windermere at times of high rainfall in order to protect the communities on its banks. I have presented the Minister with a case for such a scheme made by one of my constituents, and I look forward to hearing her response. Secondly, we need the Government to hold the water companies to account, so that communities are given the long-term protection they need. Thirdly, it is clear that the Government need fundamentally to shift their thinking when it comes to the allocation of funding for flood defences, so that we in Cumbria—England’s wettest county—get the recurring funding we need to make ourselves resilient, and to keep our families and businesses safe.
I am massively proud of our people and communities in Cumbria. In the face of devastation, they pulled together to support one another at great personal cost. For example, the Kendal Cares initiative sprang up literally overnight after Storm Desmond, to meet the needs of those who had lost so much. Today, I want the Minister to commit to supporting our communities in an enduring way, so that we can prevent a repeat of the devastation that occurred in December 2015. Cumbria surely deserves that protection, and I hope that the Minister will provide it.
It is a pleasure to serve under your chairmanship, Mr Bone. I congratulate the hon. Member for Westmorland and Lonsdale (Tim Farron) on securing the debate. We have spoken previously on this topic, one to one as well as in the wider group of Cumbrian MPs, two of whom are present—the hon. Members for Workington (Sue Hayman) and for Barrow and Furness (John Woodcock). I commend them for the representations that they have made on behalf of their constituents. They are rightly passionate about trying to secure more flood funding for important projects in their constituencies.
Flood and coastal risk management is a high priority for the Government, and I am acutely aware of the impact that flooding can have on lives and livelihoods, which was the case in my constituency following the 2013 surge. People face ongoing challenges and have ongoing concerns, whether those are to do with aspects of weather or surges and high tides combining. Compelling evidence suggests that climate change may lead to increases in heavy rainfall and increased risks from fluvial and surface water flooding by the middle of this century. Both present significant risks, so we are putting in place robust, long-term national strategies to protect our communities. I am sure that hon. Members will recognise the £2.6 billion Government investment made in flood defences over six years.
There has been no major flooding since I have been the Minister responsible for flood risk management—perhaps that is why I have been in post for nearly three years—but I take a keen interest in the latest developments in Cumbria, which is an area particularly prone to the devastating impacts of flooding. That is why I think I have visited Cumbria on more occasions than any other county during my time in office, to hear the community’s experiences at first hand.
I am very aware of the extreme flooding events that have been suffered and the damage that has been caused, and I recognise the impacts, including on mental health, experienced by people and communities. I pay tribute to the responders and volunteers from across the county, and indeed the country, who worked around the clock in challenging circumstances during Storm Desmond, and for their ongoing work in flood action groups.
I also praise the ongoing work of the risk management authorities and the local community groups that contribute their time and vast local knowledge to protect their local communities. They are also involved in discussions about different projects, and they recently produced a report on how to improve funding in Cumbria, as well as a practical guide to natural flood management measures. Together with the expertise of the Environment Agency and local councils, those actions are leading to strong local decisions.
The Government have committed to spend £68 million in Cumbria as part of our current programme, which began in 2015 and will complete in 2021. Hon. Members may be aware that £10 million was initially allocated under today’s funding formula, but I am conscious that my hon. Friend the Member for Penrith and The Border (Rory Stewart), when he was the Minister responsible, allocated an extra £58 million to tackle the issues resulting from Storm Desmond. The Environment Agency continues to maintain its flood risk management assets in the county and has spent £1.4 million on maintenance since 2015.
To better improve the flood resilience of properties, a grant of £5,000 per property was made available to homeowners and businesses that were flooded in December 2015 for additional resilience or resistance measures. I understand that 4,307 properties have received that money, which equates to more than £15 million of grant.
The important 2016 Cumbria flood action plan continues to be a living document. Of the 100 actions agreed in it, 74 are now complete, with 96% of short-term actions also complete. The remaining actions are being reviewed to determine whether they are still valid. Recently, the Rivers Authorities and Land Drainage Bill successfully completed its stages in this House and is now going to the House of Lords for consideration. If the Lords do not amend it and it becomes an Act of Parliament, I hope that it will provide a welcome opportunity to meet three actions in the plan that aim to develop water level management boards in the Eden, Derwent and Kent Leven catchments.
Several schemes to reduce the flood risk in Cumbria are progressing. As the hon. Member for Westmorland and Lonsdale pointed out, some will go out for planning consultation shortly. He referred to the preferred option for a £45 million scheme in Kendal, which is expected to reduce the risk of flooding to more than 2,500 local homes and businesses. As he points out, the determination date for planning permission is Thursday. In line with Government guidance, multi-criteria analysis has been used to assess the merits of each option against economic, technical, social and environmental criteria. That is why the Environment Agency has considered the feedback on the options to shape the scheme.
In Carlisle, following public engagement in January, a planning application was submitted for a scheme last month. The completed scheme will cost approximately £25 million and is expected to reduce the risk of flooding to more than 1,000 homes. The flood defence scheme in Egremont received £1.6 million of additional funding from a £40 million national fund to support economic growth and regeneration in 2018. The scheme will cost approximately £6.2 million and is predicted to reduce the risk of flooding to 221 homes and commercial properties. I hope that will get planning consent in May. A further 44 properties will be protected by the installation of property-level protection. In Rickerby, the flood alleviation scheme has received planning approval and, subject to the approval of the final business case, work is expected to start in the next few months.
To respond to national emergencies, the Environment Agency has 25 miles of temporary barriers, which it deployed in Braithwaite, near Keswick, when there were concerns. We continue to work hard on natural flood management to gather evidence on how best it can, or whether it can, be a key part of how we reduce the impacts of flooding. Overall, 11 communities in Cumbria are involved in the pilot project, into which we have put £2.5 million out of a total investment of £15 million. Of that, £800,000 was allocated to the River Kent catchment across eight projects.
The hon. Gentleman also referred to some specific bridges. I went to the Middleton Hall bridge—on a political visit, rather than a ministerial visit—and I know that the county council are working hard to repair the Ford and Middleton bridges that were damaged in Storm Desmond. My understanding is that it expects to complete the works this year. I am conscious that, particularly in Middleton, cars can get over the temporary bridge but emergency services and small buses cannot, which is a real source of disruption to the everyday lives of people in the area.
Will the Minister and her Department keep in mind that, notwithstanding the terrible damage that Storm Desmond did, they should not let that displace the suffering of other residents, such as my constituents, who are still feeling the effects of storm damage from previous years?
Of course, the storms of 2005 and 2009 have had a long impact, which I recognise.
On the funding policy, our current investment programme is due to protect more than 300,000 more homes, although I am conscious that not all of that will be in Cumbria by any means. I am sure that hon. Members, while fighting for their constituents’ needs, also recognise that the Government have to consider projects across the country. In the current programme, it is not possible to deliver every scheme that would reduce flood risk, but I assure hon. Members present that I am fully alive to the issues raised about Cumbria.
The hon. Member for Westmorland and Lonsdale referred to wealthy communities and the funding formula, but the funding formula specifically gives a boost to parts of the country that are not as prosperous, so that is taken into account. Our main impact and focus has been on people, rather than businesses, but I am looking at the funding arrangements ahead of a review of funding needs beyond 2021. We are working closely with the Environment Agency and the Treasury to consider future investment needs and the Government’s role in supporting the resilience of communities. My Department launched a consultation in January, which began the discussion on enabling more local funding to be raised for flood management. While considering the requirements for future programmes, I am looking carefully at the impact on Cumbria.
I am aware of the £58 million, which I have explained to hon. Members, and I am keen to build on that work and continually improve overall flood resistance in Cumbria. I reject the comments of the hon. Member for Westmorland and Lonsdale that the Government have given up on renewable energy and climate change. He will be aware of the situation regarding the tidal lagoon, which was deemed poor value for money. I think I am right in saying that a prominent non-governmental organisation also challenged the scheme because of its impact on tidal habitats and birds. We have to take a balanced approach.
As the only Member with the word “coastal” in their constituency name, I am conscious of the issue of coastal erosion, which my constituency also suffers from, and I recognise that extreme weather events cause people worry. I do not want to reject what the hon. Member for Barrow and Furness said but, dare I say it, the Government have to be responsible in preparing for a no-deal Brexit. I repeat the mantra that if hon. Members do not want no deal, they have to vote for a deal. The £2.6 billion investment has been put to good effect, however, and I will push for more to be done in the next spending review, if we can.
I have corresponded with the hon. Member for Westmorland and Lonsdale about water companies before. We have a different perspective. Some of the challenges of surface level flooding will be due to the county council not managing to drain the gullies or whatever—it will be a variety of things. Sewers are expected to have only a one-in-30-year event design standard, based on the rainfall return period, which is surface water flooding. That is different from the one-in-100-year river flood event experienced in Kendal, so it is not necessarily the case that we should compare them and make them identical.
Regarding the other aspects of the scheme that the hon. Gentleman specifically mentioned, he knows that we have considered it and that we are waiting for an Environment Agency report. He will also be aware that there is a big gap between the grant in aid for which it is eligible and the cost of the scheme. That is why I continue to encourage businesses to take advantage of the tax relief that they can get if they make capital contributions. I know that it will be an ongoing challenge for many people around the country, but I hope that we have considered it today.
Motion lapsed (Standing Order No. 10(6)).
[Steve McCabe in the Chair]
I beg to move,
That this House has considered gambling-related harm.
It is nice to see you—a Portonian—in the Chair, Mr McCabe, and to see the number of people who have put their names down to speak—although it is about not just the quantity but the quality of the speakers that we have in the Chamber.
When we think of harm caused by drugs, alcohol or tobacco, we have a very specific idea of what it looks like. When it comes to gambling, the harm may not be so obvious but it is there. The Responsible Gambling Strategy Board proposed that the following definition of gambling-related harm should be used in British policy and practice:
“Gambling-related harms are the adverse impacts from gambling on the health and wellbeing of individuals, families, communities and society.
These harms are diverse, affecting resources, relationships and health, and may reflect an interplay between individual, family and community processes. The harmful effects from gambling may be short-lived but can persist, having longer-term and enduring consequences that can exacerbate existing inequalities.”
From that definition, it is clear that the harm is not restricted to individuals, and that it can have a detrimental effect on entire communities and those living in them.
Debt incurred by gambling creates instability and insecurity, and can lead to bankruptcy. In the extreme, it results in criminal activities. Relationships can be disrupted, which often leads to emotional and social isolation. This can lead to mistrust and it erodes cohesive relationships. The consequences can include psychological distress, such as feelings of shame, stigma and guilt. Anxiety levels increase, and depression and even suicide can be the final outcome.
The Office for National Statistics has published data showing that between 2001 and 2016 there were 21 suicides
“where the death certificate mentioned ‘gambling’ or ‘gamble’.”
Furthermore, the ONS stated that
“the data is not considered completely reliable, because a coroner will not always record detailed information regarding the deceased’s history”.
According to Gambling With Lives, 4% to 11% of suicides are related to gambling, which is the equivalent of 450 to 620 deaths per year in the UK. These figures are based on research carried out by Paul Wong that appeared in the Journal of Affective Disorders in 2010 and research from Louis Appleby at the University of Manchester in 2017.
I agree with that point and I hope to cover it later on, when I will look at the educational support for kids and the possible grooming of children, normalising gambling as part of their lives.
On my last point, will the Minister consider ways whereby coroners can ensure that data around suicide can be captured, so that accurate figures can be maintained?
Jack Ritchie was 24 and from Sheffield. He was a history graduate who taught English in Kenya and Vietnam. He began gambling at 17 and would visit betting shops during his school lunch break. By 18, he admitted that he had a gambling problem and that he had lost thousands of pounds, including £5,000 given to him by his grandmother. After another gambling loss, he committed suicide in 2017, while he was in Vietnam. Jack’s mother, Liz Ritchie, compared gambling addiction to heroin dependency. The harm is real and it is growing, while the research and support is massively underfunded.
I commend the work undertaken by Henrietta Bowden-Jones at her clinic in Fulham. There are plans to open a similar clinic in Leeds, and hopefully more in Scotland and Wales. That must happen, but the funding model requires scrutiny. Currently, the industry pays a voluntary levy that raises £10 million to £14 million a year. That money is used to fund support for problematic gamblers, and campaigns to educate people and hopefully reduce harm.
That voluntary contribution of £14 million must be measured against the gambling companies’ profits. In November 2018, William Hill issued a profit warning, saying that it expected yearly profits to be in the range of £225 million to £245 million—in 2017, company profits were £291 million—whereas 888 Holdings reported pre-tax profits of £83 million on revenue of £541 million in March 2019. Paddy Power Betfair reported pre-tax profits of £219 million in 2018 on revenue of £1.87 billion, and bet365 posted an operating profit of £660 million on revenue of £2.86 billion.
The total gross gambling yield for Great Britain between April 2017 and March 2018 was £14.4 billion, which was a 4.5% increase from the previous year. The annual sum that gambling firms win from their customers has risen by 65% since the Gambling Act 2005. It is against those figures that we have to consider the voluntary levy of £10 million to £14 million. A statutory levy of 1% would guarantee £140 million a year and that sort of money, in the right hands, could do some serious good.
I congratulate my hon. Friend on securing this debate. Does he agree that, given the numbers he has cited, it is nigh impossible for local authorities anywhere in the United Kingdom of Great Britain and Northern Ireland to implement their statements while they are dealing with a marketplace in which the money created for the businesses fundamentally outweighs anything that they can do locally through a simple planning statement?
I wholeheartedly agree. I am not going to war with the gambling industry here, but we have to look at the figures, and the money that companies have to spend in order to promote gambling far outweighs anything that we have got at local council level to counteract that and the damage that has been done.
In addition, because the levy is voluntary, the amount raised can vary from year to year, and therefore budgeting for long-term treatment is extremely precarious. I ask the Minister to review how gambling-related harm reduction is funded and to investigate more effective methods.
Let me be clear: I am not asking for financial recompense from gambling companies just to improve their public image. A sponsorship deal here and a charitable donation there are no more than fig leaves to hide the companies’ own embarrassment—and they should be embarrassed. How can a family be recompensed for the loss of their son, or a child who has lost their father? I am not asking for token gestures; I am asking gambling companies to stop doing the damage in the first place. Rather than merely asking punters to “gamble responsibly”, they should run their organisations responsibly. If the Gambling Commission cannot act, and if self-regulation is not adequate, the UK Government should step in and legislate to ensure responsible working practices are in place. Will the Minister review the role of the Gambling Commission and its funding model?
While we talk about responsible working practices, companies are gathering data pertaining to the habits of online gamblers. Astonishingly, they are closing down the accounts of people who are successful and winning—even those winning small amounts—while targeting and encouraging vulnerable gamblers who are losing to continue gambling. This callous disregard for the welfare of their customers is tantamount to gross negligence.
Another outcome of the increased use of technology is that the division between gambling and gaming has been blurred by the introduction of “loot boxes”. That did not happen by accident: adults designed and wrote the software; adults considered the returns; and adults are grooming children to be the next generation of gamblers.
I thank the hon. Gentleman for giving way and congratulate him on securing the debate. He is making many points that I agree with entirely. On the point about how we can better control some of the excesses of the gambling industry, does he agree that we need to consider how the advertising strategies of the gambling industry are conducted, and in particular how they use social media and advanced techniques to target people who are already known to gamble, encouraging them to gamble further?
The hon. Gentleman is absolutely correct. We could have an entire debate about advertising in the gambling industry. It is such a deep concept, because of the methodology that can now be used by gambling and media companies to get access to people and their information and then specifically target them in a way in which they know will manipulate that information. It is a whole big data, fake news almost, subject.
We know that loot boxes can be closed down, because they have been in Belgium—they have even managed to do it in the Isle of Man—so will the Minister take action to ban loot boxes from the United Kingdom?
Where to start when it comes to advertising? Live televised sports events are swamped with betting adverts and inducements to bet. The impression is given that a sporting event is not sufficient entertainment in its own right unless we take a punt on the outcome. Gambling has become normalised through such extensive advertising and in popular discourse. Football punditry now increasingly refers to bookies’ odds, and many more sports teams are sponsored by operators. As the latter qualifies as sponsorship rather than advertising, the same regulations do not apply. With punters being encouraged at every turn, the ease with which gamblers can sign up to an online operator is of great concern. Punters can gamble 24 hours a day, seven days a week, all year. There is now no cooling-off period.
The style of games is carefully crafted to draw users in, with frequent offers of free spins and other techniques that are used to start habitual gambling behaviour. Money is readily available through credit cards, PayPal accounts and phone accounts—they are all accepted as means of payment.
Finally, to be perfectly blunt, the gambling companies have stacked the odds against the punters and the damage that is being done needs to be redressed. However, it can be done only if the money is raised and put in the right hands to support gambling addiction, advertising is curtailed and the behaviour of bookmakers, particularly regarding online betting, is monitored and adjusted accordingly.
I pay tribute to the hon. Member for Inverclyde (Ronnie Cowan) for securing the debate. I would like to feel that I played some part in making his speech happen because, had I not lost Greenock and Inverclyde, which I fought valiantly in the 1997 general election, he might not be here with us—that election in itself was something of a gamble.
I was just reviewing some of the things I spoke about when I was shadow Secretary of State for Culture, Media and Sport between 2005 and 2007, opposite the late Dame Tessa Jowell, whose memorial service I was pleased to attend. Tessa, I think, was slightly conflicted during that time. The Labour party of the day was absolutely obsessed with the idea, which it had imported from America, of inner-city super-casinos as the panacea to all the problems of inner-city regeneration. We debated that back and forth across the House and many people on both sides thought it a terrible idea. In the end, it did not really happen. At the same time, however, the issue of online gambling was beginning to emerge. Although Tessa admitted in 2006 that she had presided over an explosion of online gambling, she was concerned about the regulatory side, particularly about trying to regulate offshore gambling, which remains a problem. The Government of the day, and Governments since, have always been one step behind.
It is the Opposition’s job to be critical of the Government, and I remember being critical of the international summit on remote gambling that Tessa put on in October 2006, rather appositely at Royal Ascot—the home of racing. The conference prioritised crime, competition and safeguards for children and vulnerable people, but had little to say about how to prevent, given the growing online arena, gambling-related harm or its associated social costs.
Reviewing what I said, the questions I laid down and the debates we had in that period, it is salutary to think that we have not moved on that much. The latest Gambling Commission figures show that 48% of adults participate in some form of gambling, and for online gambling the figure is 18%. I should think, but I do not know and the Minister will be able to correct me, that that figure is more likely to increase than decrease.
Problem gambling is defined as behaviour related to gambling that causes harm to the gambler and those around them. The figures look small at face value: problem gambling is confined to 0.5% of adults, with 1.1% at moderate risk and 3.3% at low risk, according to one of the most robust estimates, the problem gambling severity index. Problem gambling is thus defined in that rather tight category, but it is more difficult to estimate gambling-related harms to society, because the term itself does not have a strict definition. The Responsible Gambling Strategy Board, the body that provides independent advice to the Gambling Commission, lists among the social costs of gambling-related harm loss of employment, health-related problems, homelessness and suicide.
My right hon. Friend makes a very good point. Although according to the headline figure only a small percentage of the general population appears to be affected by problem gambling, the reality is that the harms that manifest in that group are widespread and cause both considerable economic damage to those people and their families and damage to wider society. As my right hon. Friend rightly said, to look at just those headline figures would be misleading.
I hope that we will shortly hear from my right hon. Friend the Member for Chingford and Woodford Green (Mr Duncan Smith), who has done much work in this area, not least on fixed odds betting terminals, which are described as the “crack cocaine of gambling”. He will be better able than me to inform the debate.
I do not want to take up too much more time, other than to say that we have been debating the matter for many, many years and I do not believe that we have it right. It remains a huge problem that is difficult, but not impossible, to regulate. We want to hear from the Government how much more robust they can be.
I have just five quick points to put to the Minister. Will the Government treat gambling as a public health issue, as we do mental health? Will the Minister consider introducing tougher verification checks, which could ensure that young gamblers were not drawn online? Has she considered limiting gambling adverts during sports match breaks to one per break per company? We heard from the hon. Member for Inverclyde how online gambling organisations and organised sport are almost one and the same now. Will the Minister agree to conduct a full review of the social costs of gambling? For example, the Government have never estimated the cost to the NHS of gambling-related harm. Will the Minister ensure that gambling-related harm is included when health education is made compulsory in all state-funded schools, as part of teaching about mental wellbeing? My hon. Friend the Member for Henley (John Howell) has already mentioned schools.
Almost daily, we hear and read about problems to do with mental health, and I am glad that we now talk about mental health in a way that we perhaps never have—it is one of society’s hidden problems. However, I suggest that mental health issues in some cases—not all—can be, and are identified as being, exacerbated by dependency on drugs, alcohol and, yes, gambling. Gambling can be a hidden form of dependency, because if you are online you can do it on your computer in your own room. It is not the gambling that people think about of 50 or 60 years ago, which was a social occasion, be it at the bingo or in a casino; it is a hidden form of playing with money and, often, with people’s lives.
It is a pleasure to serve under your chairmanship, Mr McCabe, and I, too, congratulate the hon. Member for Inverclyde (Ronnie Cowan) on securing this important debate. Many hon. Friends present have campaigned vigorously for the stake on fixed odds betting terminals to be cut to £2. The blight of FOBTs was eventually acknowledged by the Government, and that stake will be reduced in April this year.
However, the harm caused by gambling goes far wider than FOBTs, as has become apparent to me and others over the months and years that we have been campaigning. For that reason, we have established a new all-party parliamentary group on gambling-related harm, which will be looking broadly at the many harms caused by gambling. It is important to say that we are not against gambling; we acknowledge that, for many people, gambling is a benign, fun activity. However, there are also many instances in which gambling becomes harmful, and it is important to ensure that the right protections and regulations are in place to protect the vulnerable and prevent harm.
I congratulate my hon. Friend on the work she has done on this issue. A constituent approached me recently whose mother had dementia and had gambled away about £50,000, even though the family kept going back into the betting shops to point out that she had this condition. Given what my hon. Friend is saying, does she agree that we should do more to protect vulnerable people, such as those with dementia, and that the industry should look closer at the legislation?
I certainly do. It appears that we are able to protect the vulnerable only when we let the press know of such stories, because the industry refuses to take responsibility for its actions.
The first priority of our APPG will be to look at the harms caused by the growth of online gambling. According to recent reports on British gambling behaviour, the prevalence of problem gambling among those who gamble online—at the casino, the slots and the bingo-style games—is very similar to its prevalence among those who play FOBTs. Currently, there are close to 3 million problem and at-risk gamblers in the UK, and 10% of them play online casino, slots and bingo.
The size, scale and structure of the industry are driving the harms that are being caused. The APPG has heard that the remote gambling sector is being run in a way that is totally unsustainable; in some cases, online companies are actively seeking to drive harmful gambling behaviour and large-scale bets to ensure their own profitability. A recent PricewaterhouseCoopers report for the Gambling Commission found that 59% of the profits of remote gambling companies come from people with gambling addictions or problematic gambling behaviour. Those companies’ models are based not on building long-term relationships with loyal customers, but on extracting as much money as possible from people, particularly those who exhibit more risky behaviour and place large bets until they effectively run out of money. The companies then move on to find other customers, and they seek to incentivise their staff to do so. Their constant drive for profit and new customers means that they have no incentive to seek a reduction in problematic behaviour. Problem gambling and high-stakes play are entirely in their interests.
Those companies’ frantic search for new customers and greater levels of spending has, in turn, led to a huge increase in gambling advertising. We have heard about cases of vulnerable gamblers being offered VIP status to encourage them to gamble and rack up huge losses. Equally, we have heard rumours about some operators not paying out to those who have rightly won money; they are happy to encourage those who regularly lose to gamble more, while restricting bets from more successful players. The message is clear: people should not go into online gambling with the expectation that they will win. The only customers that those companies want are those who lose.
There are now more diverse gambling products and experiences on offer than ever before, including live sports betting, in-play gaming and, more recently, mobile gaming. Those are relatively new products that differ from traditional bookmaking, and concerns have understandably been raised about player safety and protection, particularly for the vulnerable. Furthermore, the ease of deposit, the electronic nature of money spent, the slowness of withdrawals, the ability to reverse withdrawals, and the targeting of gamblers who win with offers to encourage further play all have the potential to create a harmful gambling environment.
The hon. Lady is making an excellent speech, and I commend her for the incredible work that she has done on problem gambling to date. Does she agree that the technology underlying a lot of these online games and gambling products is completely opaque? We have no idea how it is targeting people or how it works, and until we get to the bottom of that issue, much of this problem is going to be difficult to tackle.
It has long been acknowledged that technology has left legislation way behind—in the dark ages, in some cases. Whereas there are clear limits on the maximum stakes, prizes and spin speed of gambling machines in betting shops and casinos, and big cash deposits are subject to fraud and money laundering checks, online gambling lacks similar limits. The APPG has met many times with Liz and Charles Ritchie, the incredibly courageous parents of Jack, who tragically took his own life in 2017 following an addiction that began on FOBTs. Jo Holloway’s son, Daniel, also took his own life after becoming addicted to online gambling. Those are terrible tragedies, but they are just the tip of the iceberg. Every day, approximately 70 to 80 people contact me—as I am sure they contact colleagues present—to tell me how desperate a situation they and their families are in.
What should we do to improve things? The APPG is undertaking its inquiry and will make a series of recommendations—I am sure Members would be disappointed if it did not. We will be looking at the need for new legislation, as the current legislation is unable to address adequately the loopholes created by this relatively new part of the gaming industry, and we will be taking detailed evidence from key stakeholders. Our initial view, however, is that there should be far more stringent affordability checks by gambling companies. Banks also have a role to play in carrying out those checks; a number of challenger banks and traditional banks have already put such measures in place, but it is important that all banks and financial institutions follow suit and implement that feature.
Online gambling companies should commit to funding blocking software, and offer it for free to customers who self-exclude from their sites. The sector needs to adopt a more responsible approach to advertising during sports programmes, especially to protect children and the vulnerable. I welcome the whistle-to-whistle television ban, but in order for the advertising ban to be truly effective, those companies need to go further and include shirt and league sponsorship, as well as digital advertising around pitches. Otherwise, children and vulnerable adults will continue to be bombarded with gambling adverts throughout those events.
It is also worth bearing in mind that it is the broadcasters that have been most resistant to the clampdown on advertising. The TV companies have to take an important role and admit that this issue needs to be tackled. Serious consideration must be given to a statutory levy to fund harm prevention projects, support for those who have been harmed by gambling, and research into gambling and suicide. We must also stop the use of credit cards to gamble online; it is inconceivable that somebody should be able to rack up debt in order to gamble.
Above all, the industry needs to take responsibility for itself. Remote gambling is a growing industry, and it must learn the lessons of fixed odds betting terminals. It cannot be that time after time the Government must step in to prevent large and financially powerful industries from disregarding the harm they are doing to the vulnerable in society. The scourge of online gambling is becoming a matter of national urgency. We cannot sit back and let those problems continue, and I will not do so.
It is a privilege to serve under your chairmanship, Mr McCabe, and I congratulate my friend the hon. Member for Inverclyde (Ronnie Cowan) on securing the debate—he is a fellow member of the all-party parliamentary group on gambling-related harm, and thus my honourable friend in this context. It is in order for me to follow the hon. Member for Swansea East (Carolyn Harris), which is pretty much what I do all the time when it comes to this subject—I would not change that for the world.
This is a vital debate. All those years ago, the then Labour Government—this is not a party political point; I am simply making the point that they were in government at the time—were seduced by the idea that, by releasing gambling and removing pretty much all restrictions on it, we could somehow recreate and help communities. I remember that one of the great arguments was, “This will be a fantastic load of investment into communities, because gambling will create jobs and produce a happier place.” I opposed it at the time. I set up the Centre for Social Justice, which looked into the matter. I said that an innate level of harm came from gambling and that deregulating it would be like saying, “We must increase drinking”, or, “It would be far better if we had more shops selling more drugs.”
The same idea applies with gambling, which ultimately is a harmful activity. I accept that is not the case for everyone, but it is harmful for some people, and “some people” is quite a large number. The latest figures I saw—I think they are understated, to be frank—show that 3 million people are what are called “problem gamblers”. I hate that phrase, because in every other area where there are such problems, we call them addicts. These are addicts. They are addicted to a course of action that in their right minds they would not pursue in the way they do.
Of course, the industry is smart. It has invested a lot of the extra money it has got—all those billions—into figuring out how people go about gambling. As the hon. Member for Swansea East said, we had this whole debate about fixed odds betting terminals, which were a problem. I am astonished that, given all the evidence, it took us so long to finally get movement, first from the Gambling Commission and finally from the Government. The onslaught from the gambling industry was a sight to behold. There was an onslaught of misrepresented figures and everything else. I will not go into the details, because I am sure that stands in history and testimony.
The issue is that a lot of money is at stake. That is what we are dealing with, but I prefer to look at the other side, which is that a lot of human beings are at stake, and they can little afford what is happening to them. Our single most important purpose as elected Members of Parliament, ultimately, is to fight for those who cannot fight for themselves. In this case, it is those who have found themselves trapped in a devastating downwards spiral of addiction.
The right hon. Gentleman is making a characteristically powerful and passionate speech. He made an important point. This debate is about addiction. Millions of people across the country enjoy a flutter on the horses, for example. It is a pursuit that contributes to our economy and human enjoyment. The debate is about those who suffer from gambling addiction. The problem is not gambling per se, but addiction, and he is very correct to make that point.
I am grateful for that intervention. I fully understand that gambling is enjoyed by numbers of people who enjoy it every now and again and do not get caught up in that spiral. They might go to the races or bet on the odd football match or something like that. I am a genuine believer in free choice—people make those decisions themselves—but we have to look at whether the way the industry goes about its purposes perverts that process so that individuals end up caught in that spiral. That was a helpful intervention, because I want to talk about the industry and what it is up to.
We had some fascinating work done to look at some of the behaviour, and I was astonished by what is going on. First and foremost, anyone watching the plethora of adverts that flood every sporting event on television will see that they are all aimed at one particular type of person: young men. The adverts say, “You have to be smart, savvy, intelligent and clever. You are that kind of person because you beat the odds every time. You know what is going on. We give you special opportunities to do it, but you are so smart, you have to do it.” If someone is not gambling, the corollary is that they are not very smart and therefore incapable of doing it. The whole pattern of advertising is to drive people to gambling.
We then discovered that the way this works behind the scenes is quite scandalous. For example, bet365 has recently revealed that players who rack up huge losses are rewarded with weekly cash returns of up to 10% so that they can carry on playing. In training sessions for new staff, a bet365 worker gave an example to a reporter. They said:
“If they’ve lost, say, £15,000 in that week, then we’ll give them a weekly rebate, normally on a Tuesday, and we’ll give them maybe 10% of that back.”
That is quite sinister. We can see exactly what they are after: those who habitually gamble and lose. They are not really interested in those who win. In fact, they do not like it very much—I can understand the reason—if people actually win, so they do everything they can to discourage people who ever manage to win.
There are all sorts of delayed payments and other mechanisms. Sometimes people will not even be allowed to gamble again with a particular organisation. We are taking evidence on that in the all-party parliamentary group. It is clear that the gambling companies quickly pull away those who habitually gamble. They gamble almost by impulse, and thus they become incredibly profitable for the companies. They are induced to gamble even more, because they have this habit. The idea of targeting someone who has the habit is key.
The work done by the Centre for Social Justice, which I set up, shows that such targeting not only destroys the lives of those locked into the downward spiral of misery, but drags whole families into despair. We have already heard examples of people who have committed suicide and people who have lost all their family connections. Some have lost loads of money belonging to their families and are unable to carry on a normal life.
The hon. Member for Swansea East made much of the PwC report for the Gambling Commission, which found that 59% of the profits for a remote gaming company come from those with a gambling addiction or problematic behaviour. The model is based not on any long-term relationship with loyal customers, as would be common for most business models, but on sifting out those who gamble from those who fundamentally lose. When we watch the advertising process, we can begin to realise that the companies are going to that very selective targeting. My general view is that they are completely out of control. What has been going on for some time is a front. They are trying to pretend somehow that they are reasonable and are behaving well, but they are behaving appallingly. They have set out fundamentally in the pursuit of money, and they do not care if they destroy lives.
My right hon. Friend is making a characteristically powerful speech on a subject dear to his heart. Here we are: another week, another debate on online gambling, which only goes to show how important the issue is to us all. Does he agree that a powerful start to righting some of the problems that the gambling companies have created would be a mandatory 1% levy on gross profits to fund decent research and help set up more gambling clinics?
I agree with my right hon. Friend—[Interruption.] No? He is right hon. in my book. I agree with him, because what has happened so far is too much about the voluntary. I am not one for constantly regulating—far from it—but we see the level of harm and the lack of knowledge about how deep the harms go, and it is time for the Government to do something.
I want to pick up on loot boxes, which the hon. Member for Inverclyde talked about in his very good speech. Almost the most sinister thing going on at the moment is the inducement of young people—kids, really—to get into the habit early. They are locked into their rooms—often their bedrooms—often until quite late at night. Sometimes parents do not realise what is going on, but they get into this process where they are often gambling money, but not money as we might term it; it is an alternative form. Sometimes they are gambling for clothing, which eventually becomes a monetary derivative.
Interestingly, I saw a report by Macey and Hamari for the University of Tampere on participation in skins and loot boxes. Worryingly, the report concludes that almost 75% of those participating in gambling related to e-sports were aged 25 or under. What is going on is clear: it is highly addictive and very fast. People build up a box of prizes. They get used to a process of inducement when they go on to bigger gambling. They hear about a 10% gift or going to a fancy party somewhere and it becomes a part of their lives, because they understand it from the gambling process that they were engaged in in the gaming.
My apologies, Mr McCabe, if I have gone slightly over my time. I will conclude by saying to the Minister, for whom I have huge respect—no one is more pleased than I am that she is on the Front Bench—that the Government need to right a wrong. The wrong was that we opened the whole of the regulatory process to gambling. It does not matter which Government did it; it was done. Now we need to bring the beast back under control. I simply say to her that there are recommendations—I will not read them all out—from the all-party group, and I hope that she will give them full consideration. It is time now to demand more of an organisation of companies that derive profits and in too many cases cause harm. There are good people who gamble occasionally, but others are locked into a spiral of harm. We look to the Government to change their circumstances.
I am delighted to participate in this debate on gambling-related harm, Mr McCabe. I congratulate my hon. Friend the Member for Inverclyde (Ronnie Cowan) on all the work he has done on this issue and on securing this debate. We can all agree that self-regulation of the gambling industry has not worked, and it will not work. We even see today in this Chamber that self-regulation does not work, which is why the six-minute time limit was completely ignored by other Members at the expense of their colleagues.
I wanted to participate in this debate because in North Ayrshire, the majority of which I represent, the latest figures show that in the eight years from 2008 to 2016, £32 million was gambled. In a post-industrial area facing huge economic and social challenges, that level of gambling is a major cause for concern. Before I go any further, I wish to acknowledge, as others have done, that many people gamble in a responsible way and come to no harm—good luck to them—but that is not the focus of today’s debate. Today we must focus on the adverse impacts of gambling on the health and wellbeing of individuals, families, communities and wider society. Gambling affects relationships, mental and physical health and finances, and it exacerbates existing inequalities. There is a clear link to poverty and disadvantage. Gambling addiction destroys lives. There are believed to be 430,000 gambling addicts in the UK, with a further 2 million at risk, and gambling is linked to between 4% and 11% of suicides.
Gambling is a public health matter and words alone are not enough. We need to appreciate that individuals are embedded in communities, so effective action for reducing gambling harm will include not only protecting individuals and preventing them from harm, but mitigating risks to communities and families. We need to look more critically at the opportunities to gamble—the number of betting shops—in our communities. We must look at the level of social deprivation, which is also a risk factor. We must look at the use of advertising, and at the support available for those who are living with the addiction and those who are vulnerable to developing it.
With their limited powers, the Scottish Government have already committed to using planning legislation to address the proliferation of betting shops in specified areas. However, our task as a society must be to prevent and reduce the harm that gambling causes. I very much welcome the Government’s action to reduce the stake on fixed odds betting terminals. I know there was great pressure from some Tory MPs and the betting industry itself, which has very deep pockets, to try to prevent that from happening.
The concern is that online gambling means that those who are vulnerable to addiction or already living with a gambling addiction find it increasingly difficult to escape what some might call the lure of gambling, so there must be greater regulation to ensure that there are proper and robust affordability checks in place and proper spending limits enforced. The motivation to take the bull by the horns is that doing so will offer benefits to us all. It will mean reduced health, welfare and employment costs, reduced homelessness, and potentially reduced criminal justice costs. The benefits to the families and communities of those with such an addiction are beyond price.
We are still not very far down the road in dealing with the issue. First, we need a proper, wider review of the impact of gambling on children themselves and we must identify what policy changes are needed. We need to do better. If the Government are not prepared to act and go further, and if they are going to allow themselves to be kept prisoner by gambling interests and lobbying, I urge the Minister to ensure instead that gambling policy is fully devolved to the Scottish Government and that they are given full powers to tackle the problem effectively. The UK Government have had generations to tackle the problem, and they have not done it yet.
It is a pleasure to follow the hon. Member for North Ayrshire and Arran (Patricia Gibson), a fiery lady who has put her viewpoint forcefully and correctly. I am pleased to support the hon. Member for Inverclyde (Ronnie Cowan) in raising the public policy challenge presented by gambling harms. Last Wednesday, the hon. Member for Gloucester (Richard Graham), who is in his place, had a short debate on the topic of online gambling protections. It is right that this House should continue to make gambling the subject of regular debates as we seek to improve the policy and practice around problem gambling.
In September 2017, The Lancet published a key editorial with the title, “Problem gambling is a public health concern”, and it is. The editorial stated that online gambling had
“a potentially greater danger to health than other forms of gambling, particularly for those younger than 16 years of age.”
It is a matter about which I have long been concerned, since I came into this House. In 2013, I sponsored an amendment to the Gambling (Licensing and Advertising) Bill to introduce a multi-operator self-exclusion scheme for online gambling. Indeed, with the help of the Labour party—particularly with the help of the hon. Member for Hyndburn (Graham P. Jones), who is in his place—the House divided. We did not win that vote, but we were successful in the other place as the legislation was then changed. It is now up and running in the form of GamStop.
I am sure my hon. Friend will be as disturbed as I was to learn that last year Northern Ireland had the highest statistics for problem gambling, and the statistics prove that the problem was in areas of deprivation, so we need to do more to help people in those areas.
My hon. Friend is right to call for more help. I am about to come to the figures.
It is absolutely right that GamStop applies in Northern Ireland, especially given that Northern Ireland has a higher problem-gambling rate than the rest of the United Kingdom. The figures are stark and real. Research published by the Department for Communities in 2017 found that 2.3% of those surveyed in Northern Ireland were deemed to be problem gamblers, with a further 4.9% being classed as moderate-risk gamblers. The figure for England at that time was 0.7% of the population. It is clear that we in Northern Ireland have a greater issue than elsewhere.
In April 2016, I led a Westminster Hall debate on FOBTs and we were able to work collectively. I particularly commend the hon. Member for Swansea East (Carolyn Harris) and the right hon. Member for Chingford and Woodford Green (Mr Duncan Smith) for their endeavours on this matter. The maximum stake was then reduced, as we know, but unfortunately the £2 stake applies only to Great Britain. Ladbrokes in Northern Ireland has led the way in proposing voluntary action to reduce the maximum stake to £2, and other providers have followed, so we have had some success on a voluntary basis. I acknowledge the good work that Ladbrokes has done in the Province.
In the context of the problem gambling figure being so much worse in Northern Ireland than it is in the rest of the United Kingdom—2.3% rather than 0.7%—I suggest that, while Stormont is suspended, there is one other area in relation to which the gambling industry could step up in Northern Ireland. In her speech last week the Minister said:
“There are positive signs that the industry is stepping up to the challenge...but there is scope to go further. I want to see the industry meet GambleAware’s donation target of £10 million by April this year.”—[Official Report, 12 March 2019; Vol. 656, c. 96WH.]
I fully appreciate that if the money was extracted through the statutory levy in the Gambling Act 2005, the relevant moneys would apply only to England, Wales and Scotland, because gambling is devolved to Northern Ireland, but there is no reason why it could not voluntarily also apply to Northern Ireland. I therefore ask the Minister: is there any possibility of some of that money coming to us in Northern Ireland to address the issue? Will she clarify whether any portion of that £10 million goes to projects to help problem gamblers in Northern Ireland?
I am conscious of the time. It is striking that there is voluntary action to support problem gamblers in Northern Ireland through GamStop and the reduction in the FOBTs stake. Again, those struggling with problem gambling need not only self-exclusion, but other means of support, which are currently offered through the voluntary contributions paid by gambling companies for research, education and treatment. Indeed, if the Government finally decide to go down the route of the levy, just as the FOBT reduction and GamStop are being applied voluntarily in Northern Ireland, that could happen for a mandatory levy. Problem gamblers everywhere need assistance, but today I make a plea for additional help for those in Northern Ireland, through the voluntary scheme and any future mandatory levy. I hope that they will receive some positive news from the Minister.
I want to say at the outset: is it not about time that those who win are not precluded from gambling, as seems to be the practice? That is something that the Minister should consider, immediately.
I thank the hon. Member for Inverclyde (Ronnie Cowan) for securing the debate, which is part of an ongoing debate on the problem of gambling. I take the issue seriously and have strong views. We should look after the vulnerable, because the consequences of gambling can be serious. The debate has moved on over the years, and it needs to continue to move on, because technology, platforms and the gambling industry are evolving. There are new methods and types of gambling, into which people are drawn. Gambling has had a devastating effect on some people, and we must approach the issue responsibly and thoughtfully and not dismiss it.
I was interested to hear the comments of the right hon. Member for Chingford and Woodford Green (Mr Duncan Smith), who spoke powerfully. To summarise, if I may, he said that the gambling industry was far too clever for its own good and was acting in a particularly pernicious way with respect to problem gambling. I would add that it almost replicates some of the practices used by the tobacco industry over 60 or 70 years. Although I hear other Members saying the opposite, I want to point out that the thing about the tobacco industry that the gambling industry tries to replicate is making the issue a medical one, rather than a matter of precaution. The reason for that is that if it is a medical issue, and we talk about problem gamblers, we actually allow them to gamble and rack up debts—and we will sort the problem out afterwards. It is a simple and clever strategy, and we must be minded to see through it. We should operate on a precautionary principle. There is a reason why the gambling industry does not want us to do that, which is that it would mean acting before people engage in harmful gambling.
We have accepted the precautionary principle in the case of fixed odds betting terminals. I am delighted that the cap has been lowered to £2 and I congratulate those, including my hon. Friend the Member for Swansea East (Carolyn Harris) and the right hon. Member for Chingford and Woodford Green, who were in the vanguard of the campaign. Equally, going back to 2012, the hon. Member for Strangford (Jim Shannon) will remember the efforts of my hon. Friend the Member for West Bromwich East (Tom Watson) who was one of the first people to raise the matter in this place. He expressed great concern, which I shared at the time, and I do not think thanks have been expressed to him in the debate.
On the point about raising new concerns about gambling, is my hon. Friend aware of the use of loot boxes in video games, which many countries recognise as gambling? People aged under 18 who are using loot boxes sometimes rack up hundreds or thousands of pounds of debt, but the Gambling Commission does not view it as gambling.
My hon. Friend makes a powerful point, which other Members have made in the debate, about children being drawn into gambling by derivatives of money or by tokens simulating money. That is a huge and significant concern and we must all be worried about it.
I appreciate that the gambling industry makes a contribution to the economy and provides employment, including in my constituency. I go into bookmakers, and am happy to work with the staff there. I recently went into William Hill in Accrington to support good causes. I do not in any way think there should be all-out war on bookmakers. We should have a reasoned argument about gambling, what to do about the considerable number of people who have been entrapped into gambling, and how to prevent others from becoming victims—if I may say that—of gambling products and the gambling industry in future. We must take a balanced approach.
According to official data on fixed odds betting terminals, which, as everyone knows, allow users to bet up to £100 every 20 seconds on the spin, the amount that British gamblers lost on them last year doubled. The last figure is for 2016 when it went up from £1 billion to £1.8 billion. That is a colossal amount of money to have been lost, and dividing it up by constituency allows us to appreciate how much. If the council tax collected by my local district council is compared with the amount spent in the same area by being pushed into fixed odds betting terminals, the contrast between the two figures is dramatic. Of course the amount that goes into FOBTs is far more significant.
The evidence for problem gambling is significant, too. The Gambling Commission has reported that there are some 430,000 gambling addicts, and 2 million vulnerable players at risk of developing an addiction. That takes me back to the point that we should not necessarily see the problem as medical—although for those who are addicted we should. We should never forget that we need to apply the precautionary principle. I want to finish with—
It is a pleasure to speak under your chairmanship, Mr McCabe. I congratulate my hon. Friend the Member for Inverclyde (Ronnie Cowan) not just on securing the debate but on his incredible, dogged work on the issue. He has pursued it with serious vigour and—as I am sure applies to other Members who have worked on the matter of fixed odds betting terminals—under huge pressure from betting firms.
I draw attention to what the Library briefing for the debate says about the statutory levy:
“Under section 123 of the 2005 Act, the Secretary of State can make regulations requiring gambling operators to pay an annual levy to the Gambling Commission.”
The reality is that there are powers. More needs to be done, but existing powers are not even being implemented. Many Members have given statistics and spoken about the challenges and issues, and the damage that gambling-related harm is doing to society and communities. I draw the attention of the Chamber to a study by Robert Lustig, who is a professor of paediatrics, with a focus on endocrinology, at the University of California, San Francisco. He is also the author of “The Hacking of the American Mind”. He told a conference on technology addiction that the brain reacts to technology similarly to the way it reacts to other addictive substances:
“Technology, like all other ‘rewards’, can overrelease dopamine”.
In 2017 we heard that the level of extreme internet use among UK teenagers is among the highest in the OECD. The think-tank, the Education Policy Institute, reported in 2017 that more than a third of 15-year-olds can be classed as extreme internet users—meaning that they use it for six-plus hours a day. If that is translated into online gambling and its proliferation we are heading for a serious crisis among young people—the adults of tomorrow.
Much has changed since I was an avid gamer, playing such games as “Sonic the Hedgehog” in search of gold rings. Loot boxes were not a thing. I have recently learned a lot more about them. I am the Scottish National party spokesperson on digital, culture, media and sport. The party takes online harms seriously and I have increasing concerns about them. I know that the Government want to get things right in the White Paper, but they need to speed up the process. There are clearly huge issues for young people—to do not only with gambling but with pornography. Loot boxes are clearly gambling, and we share the concern about them. They allow players of online video games—usually children—to pay money for an unknown prize. I read through some of the recommendations in ParentZone, which include measures such as not having credit or debit cards attached to children’s profiles.
Earlier I mentioned education, and a couple of weeks ago there was a Westminster Hall debate on the importance of sex education in school, and of not removing children from that. It was concerning to hear the number of Members who backed what, to my mind, was an ill-informed online petition. Many people said that parents should be allowed to teach their children about sex and teach social and religious education at home, but in reality many children and young people are vulnerable, particularly online, and their parents may not have the facilities and information to support them at home.
Loot boxes are used in the context of an uptake in gambling by young people, and it has been reported that 40% of 11 to 16-year-olds engage in gambling. Horseracing was mentioned earlier, and I was recently visited by Bill Alexander, who runs an organisation called Sportjumping. He had some concerning facts, which I will write to the Minister about. His view was that the Department for Digital, Culture, Media and Sport withheld information that levy contributions from the betting industry are offset as tax credits from the EU competition commission, and he queried state aid for the sport. Horseracing generates a huge amount of money and is very popular, but there are concerns about it, such as the fact that many jockeys suffer from osteoporosis, have to “sweat down”, or have depression as a result of weight loss, not to mention the number of horses that are killed. I hope the Minister will consider that issue.
It is a pleasure to serve under your chairmanship, Mr McCabe, and I thank my hon. Friend the Member for Inverclyde (Ronnie Cowan) for securing the debate. He has been an assiduous campaigner for the reform of gambling regulations since he entered the House in 2015, and I pay tribute to his work thus far.
This has been an excellent debate, with no fewer than 17 Back-Bench contributions from right hon. and hon. Members—a remarkable figure for Westminster Hall. My hon. Friend spoke about the consequences of debt due to gambling, such as relationship breakdown, anxiety and depression, and he spoke movingly about a young guy, Jack, who sadly took his own life. He spoke about the eye-watering profits of the gambling industry, which have increased by 65% since the Gambling Act 2005, and he touched on the relationship between sport and gambling, particularly in advertising—there is much more to be said on that, but that is probably a different issue for a different debate.
The right hon. Member for East Devon (Sir Hugo Swire) reflected on his time as a shadow Minister in 2005, and he spoke about the move to online gambling and his concerns about offshore regulation—concerns that I share. The hon. Member for Swansea East (Carolyn Harris) is probably my favourite Labour MP in the House, and we rightly pay tribute to her work on the all-party group on gambling-related harm. I look forward to joining that group in its inquiries from next week onwards. She was right to say that we must consider the growth in online gambling. Sadly, legislation does not always keep pace with new technology, and it is important for the all-party group to consider that.
The right hon. Member for Chingford and Woodford Green (Mr Duncan Smith) also reflected on the 2005 Act. He was right that there is overwhelming evidence about FOBTs, and it took the Government and the Gambling Commission a long time to address that issue. I hope that we will not see that again, although I will reserve my judgment.
My hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson)—I think the hon. Member for Strangford (Jim Shannon) referred to her as the “fiery lady”—rightly spoke about the need to move on from self-regulation. It is fair to say that it is no longer appropriate for the gambling industry to mark its own homework, and she made that point powerfully.
The hon. Member for Strangford—my fellow season ticket holder for Westminster Hall—spoke powerfully about the situation in Northern Ireland. I confess that I was not aware of that difference between Northern Ireland and the rest of the UK regarding FOBTs, and I suspect it has something to do with the Stormont Assembly not currently sitting. It would be good to see that issue move on. The hon. Member for Hyndburn (Graham P. Jones) spoke about maintaining momentum and keeping up with the pace of technology, as well as the need to make gambling a medical issue, which I echo. My hon. Friend the Member for Livingston (Hannah Bardell) said that powers to address problem gambling do exist but they are not currently used well, and I share that concern.
The liberalisation of gambling, which was exacerbated by the 2005 Act, has had a profound impact on my community and many of my constituents. Even today on Main Street in Baillieston, three bookies are lined up next to each other, separated only by a fast food shop—not exactly great diversity for a local high street. Many years ago a Channel 4 survey suggested that there were an average of six betting shops for every 100,000 people in an affluent area, but 12 in a more deprived area. My constituency has fewer than 100,000 people—there are around 70,000—yet we have in excess of 35 betting shops. Bookmakers and gambling firms disproportionately target areas of high deprivation, such as my constituency of Glasgow East.
As the hon. Member for St Helens North (Conor McGinn) said, many Members do not have a problem with folk who want to go for the odd punt on the horses. I had an enjoyable evening at a parent council fundraiser race night a couple of weeks ago, and we all accept that, when done in moderation, there is no problem with gambling. My hon. Friend the Member for Inverclyde was right to say that we must focus on the harm caused by gambling, and the vulnerable people whom it impacts, and I am glad we are having this debate.
Public health, and particularly children’s health, must be given utmost priority in these matters, and urgent action should be taken if children are engaging in gambling. As Members have suggested, there is a risk that technology is developing at a pace that we in Parliament do not perhaps keep up with, and that is especially true when it comes to apps. As my hon. Friend the Member for Livingston said, many mobile phone apps are designed to be stimulus-driven, and we know the impact that has on dopamine levels. Earlier this week, the all-party group on social media and young people’s mental health, which is chaired by the hon. Member for Ogmore (Chris Elmore), produced a powerful report on the impact that social media and apps are having on young people, and some of the issues that we are discussing tie in with that.
Having added to the picture that has already been eloquently painted by hon. Members, I would like the Government to commit to radical action in this area, although the recent shenanigans with FOBTs reform lead me to conclude that they are reluctant to take more action on gambling. I would like that legislation to be devolved to Scotland, because I do not want this issue to get left behind. During the debate on FOBTs, I recall the bullying that Members of this House received from the Association of British Bookmakers, and on a public health issue such as this, it is important not to give in to bullying by big industry or lobbyists. We in this House should, quite rightly, tell the Association of British Bookmakers where to go.
I want the Government to take real action on this issue. I have a lot of respect for the Minister, whom I encountered when she was a Whip, as well as in her new role. She was there the day that the statutory instrument on FOBTs was passed, so I will reserve judgment and listen to what she has to say. However, if Westminster will not take action on the issue, my own Government at home in Scotland will. As my hon. Friend the Member for North Ayrshire and Arran said, although we have limited powers to act on the issue, we have not been shy when taking action on the proliferation of FOBTs. If we go back and consider the liberalisation in the 2005 Act, and the problems we have been left with today, we should come to the conclusion that no action is no longer an option. There is cross-party support in this House to get something done, and we look to the Minister for that action.
It is a pleasure to serve under your chairmanship, Mr McCabe. All Members have made incredibly valuable comments. I especially pay tribute to the hon. Member for Inverclyde (Ronnie Cowan) for securing this essential debate. As I am sure he is aware, the Labour party has been driving improvements in protections and care for gamblers, and I am pleased that there is cross-party consensus when it comes to reducing gambling-related harm. [Interruption.] I hope that his chuckle is in acknowledgment of that.
Gambling addiction currently affects 430,000 people in the UK. That many people could fill Wembley stadium four times over. Last year’s debate on fixed odds betting terminals showed us what can be achieved when politicians, experts and campaigners come together on such an important common cause. Despite opposition from the industry and, I am sorry to say, reluctance from some within the Minister’s party, we were able to achieve reform that will save lives, benefit communities and better regulate the market. I am proud that the Labour party was the driving force behind that reform.
We now need to go further. I am pleased that the fixed odds betting terminals all-party parliamentary group will continue its work under the new banner of the all-party parliamentary group on gambling-related harm. I am also proud that my hon. Friend the Member for Swansea East (Carolyn Harris) is working with the hon. Member for Inverclyde and other parliamentarians to investigate the impact of gambling-related harm in our communities. The excellent work being done by campaigners such as Liz and Charles Ritchie at Gambling With Lives powerfully reminds us of what that harm means, and the deep destruction that it has on individual lives and families.
Last year the Labour party published our review of problem gambling and its treatment. In that review, we cited the need for additional resources in treatment, and recommended achieving that by placing a mandatory levy on gambling companies that would allow for greater training, capacity and expertise in those services, and for the establishment of specialised regional gambling treatment centres. I am pleased that the case for a mandatory levy has been taken up by other parties and organisations, and I expect it to come into effect in the coming year.
However, we also need to have a real conversation about how the money from that levy would be best allocated and spent. The Labour party believes that the debate on gambling-related harm needs a stronger and committed public health focus. In our review, we called for the formation of a working group between the Department for Digital, Culture, Media and Sport and the Department of Health and Social Care to co-ordinate that, and we would want to see similar co-ordination with a gambling mandatory levy and other public health-related priorities.
At the moment, gambling harm is too often seen as a side issue to other parts of addiction and public health. We want it at the forefront of public health thinking and, crucially, seen as an addiction in its own right. In my professional capacity as an emergency doctor, I have first-hand experience of seeing families torn apart by gambling and mental health issues—families who have lost loved ones, and walked in on their child trying to commit suicide.
Two things will be needed moving forward: first, training for GPs and healthcare professionals, to ensure proper diagnosis of problem gambling; and secondly, more dedicated clinics opened across the country. Research has shown that problem gambling is linked to social deprivation, with the highest number of betting shops clustered in areas of Liverpool, Glasgow and Birmingham that have a higher rate of unemployment. Yet the only specialised NHS treatment clinic in the entire country is in London. Even with a new clinic in Leeds, clearly much more must be done. We need to go further when it comes to the exposure and influence of gambling.
In our review, the Labour party called for a change to advertising rules—namely, a whistle-to-whistle ban. Before Christmas we saw an industry initiative that proposed a ban but that, in reality, dealt only with TV advertising. That is meaningless when more than half of our football teams’ shirts are sponsored by gambling companies, and there is rolling advertising on pitch-side billboards. The Labour party calls once again for a ban on shirt sponsorship by gambling companies.
I will conclude by looking forward to a new frontier of gambling-related harm: online gambling. Last month my hon. Friend the Member for West Bromwich East (Tom Watson) gave a speech in which he outlined how online gambling can be better regulated, with limits on spend, stake and speed. Limits on how much internet gamblers can stake and spend online would be introduced under a Labour Government. Online companies have a responsibility to protect their customers from placing bets that they cannot afford, but too often operators have either neglected the care of their customers or have been too slow in their due diligence.
On spending, the Labour party would like affordability checks to be made a requirement before gambling takes place, so that people cannot lose huge sums of money that they cannot afford. Crucially, that requires a ban on credit card gambling. On stakes, the Labour party wants caps introduced on the amount that can be gambled on certain online products that are linked to harm. There was cross-party support for FOBTs stake reduction, and I hope that there will be similar support for that approach to online gambling. Labour would tackle the problems by creating a new category in the current legislation—the Gambling Act 2005—specifically for online betting, to introduce a system of thresholds placed on the spend, stake and speed of betting, giving safeguards to consumers.
The social cost of addiction, including treatment, welfare, housing and criminal justice, is as much as £1.2 billion a year. That does not even begin to cover the untold costs borne by the families and loved ones of those addicted to gambling. I know that the Minister values the lives of all those important families, who have had their lives ripped apart by gambling. I hope that she will take on board what has been said, and agree that we need to do more—indeed, that we must do more.
I, too, congratulate the hon. Member for Inverclyde (Ronnie Cowan) on securing this important debate, and I thank all Members for their thoughtful and passionate contributions.
As I outlined to the House last week, reducing gambling-related harm is a priority for the Government. The Secretary of State and I are very clear on that. Millions of people enjoy gambling safely. It is a harmless social activity for many, whether in the form of a day at the races—I was at Cheltenham festival last week—or popping down to the pier on a holiday and enjoying time with family, as I do sometimes with my daughters. As we have heard today, for a small number of people who experience harm the consequences can be devastating, and Members have raised the problem of addiction. In response to my right hon. Friend the Member for East Devon (Sir Hugo Swire), the latest data that I have states that the estimated problem gambling prevalence rate among adults in Great Britain is 0.7%, which is approximately 340,000 people.
In my response, I will try valiantly to answer as many points as I can, but I will concentrate on two things: first, the protections that are already in place to prevent harm, and what we want to do more on and, secondly, how we are working with the Department of Health and Social Care. The hon. Member for Tooting (Dr Allin-Khan) will be pleased to know that we have many ongoing policy workstreams across both Departments to ensure that we get the help to those who need it and learn from experiences.
Many Members mentioned the Gambling Act 2005, because it predates the current internet age. It is supported by the Gambling Commission, which is a regulator with broad powers to ensure that all forms of gambling are free from crime, are fair and open, and protect children, our young people and the vulnerable. However, we recognise the challenge regarding gambling online. Wherever an operator is based, it must have a licence from the commission and must obey the conditions of that licence. The commission regularly checks that its requirements are still right, changing and updating them as needed.
In answer to the questions asked by my right hon. Friend the Member for East Devon and the hon. Member for Swansea East (Carolyn Harris) about age verification and identity, the commission is consulting on strengthening the customer interaction and looking at credit cards and gambling. The Secretary of State and I also recently met banks and challenger banks on that.
The Government will intervene where there is evidence of harm. We did that on the B2 machine stakes in betting shops, and I am pleased that those changes will come into effect in two weeks. Let me be clear to any operator who thinks that that is the end of Government action that if there is evidence that a product is causing harm, we will act. Operators are simply mistaken if they think that we will not intervene.
The hon. Member for Glasgow East (David Linden) challenged me about Government action. As the gambling and lotteries Minister, I will not give in to any bullying tactics from big business when it comes to intervening where there is harm. I want to be very clear about the further work necessary to ensure that operators act in a socially responsible way: if we see signs that they are not intervening where there are problems, we will act. Where operators fail to protect customers from harm, the Gambling Commission has the teeth to act and has done so. I am sure that the commission will look at the all-party group’s work with interest, as we do; I commend all those who are doing that work. Where operators may be giving incentives to gamble to those who suffer the highest losses, we are absolutely on the case. It is time for everyone to come to the table and be responsible.
[Ms Karen Buck in the Chair]
Accountability for business, social responsibility and customer protection are key, as we heard from my right hon. Friend the Member for Chingford and Woodford Green (Mr Duncan Smith). The industry has a key role in preventing harm. The Gambling Commission’s rules are clear that operators must identify where people’s gambling is putting them at risk. Responsible business is the only kind of business that I want to see in the sector—I have been clear about that ever since I took this job. The power to prevent harm is in also in the hands of businesses, as we have heard today. The Secretary of State and I are absolutely stepping up to the challenge of working with financial institutions, across Government and across sectors.
The hon. Member for Inverclyde mentioned loot boxes and gaming. We are aware of concerns that loot boxes could encourage gambling-like behaviour. Alongside the Minister for Digital and the Creative Industries, I continue to look at the evidence, and we will listen to the all-party group and work with the tech and gambling industries. GamStop, which was rolled out last year, can really help people with online problems. For the first time, we have seen some outcomes: it currently extends to 90% of the market, and I call on the rest of the providers to step up and ensure 100% coverage. I was pleased last week to meet Gamban, which I will soon visit at its Southampton base. It provides extra protection and has a background in understanding this challenge and using tech and all the devices that it can engage with to help people. Work is being done where people know the challenges and can respond.
The hon. Member for Inverclyde also raised concerns about gambling advertising. I reassure hon. Members that we have looked carefully at the review’s evidence on advertising and will continue to do so. There are strict rules on adverts that target children and vulnerable people; guidance has been strengthened further as a consequence of the review, and the commission has toughened its sanctions for operators that breach the rules. The whistle-to-whistle ban has already been mentioned, and we have worked with GambleAware to launch the Bet Regret advertising campaign. I thank the hon. Gentleman for his support for Bet Regret.
The industry is also responding to public concern about TV adverts more broadly. From this summer, there will be a ban on betting adverts during sports events before 9 o’clock. That is a step forward, but as Minister for sport, I say directly to sports bodies that they must look very carefully at their responsibilities to their fans and followers, because they, too, can play a part in reducing the risks and in raising awareness of them. There are sports that have an overreliance on types of sponsorship that some could see as irresponsible. They know who they are—they need to take stock, think about their fans, including young children, and support the vulnerable.
Let me turn to concerns about suicide. Any suicide is a tragedy for so many families. As has been said today, we need robust understanding. GambleAware has commissioned new research, which will be published soon and will help us to work with health professionals in the sector. We want to continue to work with the Department for Education on stigma and on concerns about gambling problems. I agree that we need a better awareness of people’s risks and problems from a younger age, so that we can direct help where it is needed. GambleAware and GamCare have some fantastic initiatives, including programmes for schools, to reach out to our young people. I intend to work with ministerial colleagues to see what advice we can give to parents, who absolutely need to know what is out there.
It is important that we continue to listen to those with lived experience, and I thank the Ritchies and Gambling With Lives for their important and ongoing work. We are also working closely with the Department of Health and Social Care, and I am pleased that in our long-term plan for the NHS we committed to expanding specialist support for people with gambling addictions. As has been said, GambleAware is evaluating its current services and looking to increase access.
Health surveys show links between poor mental health, substance abuse and problem gambling—2.2% of people with probable mental health issues are problem gamblers—so we need to ensure that we understand the public health harms. Working with Public Health England to carry out a review of the evidence is our next step; the Responsible Gambling Strategy Board has also published a paper that sets out a potential framework for measuring harm. We want stronger evidence so that we can appropriately target our resources and, ultimately, our intervention.
Further research is needed on the factors behind suicide. I recently met the Minister for suicide prevention, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), to understand more about gambling as a factor in suicide, which is a key priority for her as well. I want to see a stronger evidence base. We heard today about some of the academics who are working in this important area, but I encourage more academics to do so and help us to understand the challenges of harm. Preliminary research on gambling-related suicide will be published soon, and we will work across Government so that we do not see any more tragedies in this area.
Let me focus on support. I assure those who are currently experiencing harm that help is there. There is an NHS clinic in London and there will soon be one in Leeds. GambleAware funds a national gambling helpline and a network of counselling services led by GamCare. It is open from 8 in the morning to midnight, seven days a week, and—for those tuning in—the number is 0808 8020 133. I met GamCare last week and heard all about what it has been doing for the past 20 years to frame frontline service provision. It shows that if people reach out for help, they can move forward and get out of the cycle.
GamCare’s helpline is an essential starting point. It is doing all it can to raise its visibility among GPs, and it is working with GambleAware to ensure that appropriate resources are available for health workers, frontline staff and debt advisers—in fact, people often come to banks as their first line of help. That important work is funded by industry, and I encourage it to maintain and increase the support that it gives. We want the voluntary system to work, and the Gambling Commission is committed to reviewing and helping to strengthen it.
On the levy question, I remind all those who are watching or listening that nothing but responsible business is acceptable. The Government will act and make changes where evidence so directs, leaving open for consideration all funding options for future treatment.
I am glad that recognition of gambling-related harm has increased, as we have seen today. It is a serious issue and a lot of work is being done by a range of bodies, and it is important that we acknowledge their good will and commitment as well as recognising where we need to go further. Strong protections are in place and they are being further strengthened, but we continue to gather knowledge and evidence of harm. I look forward to working with the House, updating hon. Members and working with business on this area to ensure that only responsible practices and actions remain.
Thank you, Ms Buck; I also thank Mr McCabe, in his absence, for guiding us with a strong hand, and the Minister for her very comprehensive response, which I really do appreciate. I have sat down with her on previous occasions to discuss the matter, and she has proved very knowledgeable and sincere.
I am in debt to all hon. Members who contributed to the debate. When the right hon. Member for Chingford and Woodford Green (Mr Duncan Smith) mentioned deregulation, it struck me that we had opened a Pandora’s box for bookmakers. When that happens, of course, all the miseries of the world fly out, but—as those who are familiar with the story will know—what is left behind is hope. I hope that today the Government are listening and will act accordingly.
Question put and agreed to.
That this House has considered gambling-related harm.
GP-Patient Ratio: Swale
I beg to move,
That this House has considered the ratio of GPs to patients in Swale.
My constituents have a number of major concerns, including local roads, the level of housing in our area, and the ratio of GPs to patients. The three issues are intertwined, as I will explain, but to set the issue in context, I will explain a little about my area. The local authority district of Swale is on the north-east Kent coast. It covers the whole of my constituency of Sittingbourne and Sheppey and also includes part of the constituency of my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), whom I am delighted to see here today. However, the Swale clinical commissioning group area is not coterminous with Swale Borough Council. Instead, it has responsibility only for Sittingbourne and Sheppey. Faversham falls within the remit of the Canterbury and Coastal CCG.
Swale CCG is one of the smallest CCGs in the country, if not the smallest, because when CCGs were first set up, Medway CCG did not want to include Sittingbourne and Sheppey, nor did any of the east Kent CCGs, because my constituency has, historically, a number of areas with a high incidence of health deprivation. Life expectancy in Swale is the lowest in Kent. Within Swale itself, there is a huge, 10-year gap between the highest and lowest life expectancy. In some of the more affluent areas, life expectancy is 84 years, while in the more deprived areas, life expectancy is just 74 years.
A number of areas in my constituency have been identified as being in the bottom quintile on the national deprivation scale—a clear demonstration that not every area in the south-east is affluent—and there is an above-average incidence of obesity-related illnesses in my area. The number of people admitted to hospital in Kent because of health problems related to obesity has rocketed in recent years—around half of Kent’s 1.5 million population is now overweight or obese—and the highest rate in Kent was recorded by Swale CCG, where 1,726 people per 100,000 were admitted to hospital due to obesity-related conditions. My constituency also has a higher incidence of lung-related disease than many other areas in the country. That is particularly true on the Isle of Sheppey.
Such health problems put huge pressure not only on our local hospitals, but on primary care, yet my constituency has the worst ratio of GPs to patients in the whole country. To give an idea how bad the situation is, in Rushcliffe, the ratio is 1:1,192; in Camden—hardly the most prosperous area in the country—the ratio is 1:1,227; and in Liverpool, it is 1:1,283. By contrast, in Sittingbourne and Sheppey, there is just one permanent GP for every 3,342 patients.
My local CCG recognises that the lack of doctors is a problem and managers are doing everything they can to improve the situation, but to succeed, they need to attract more GPs to our area, and to do that they need more help, and more money.
I congratulate my hon. Friend on securing this debate on a really important topic. My constituents also face some difficulties getting access to a GP in my area of Swale borough, and also on the Maidstone side of my constituency, where in one practice the ratio of GPs to patients is 1:4,000. It is a real problem. I am concerned that there is not enough of a sense of urgency among some CCGs about fixing the problem. When the Minister sums up, I would be grateful if she could confirm the CCGs’ responsibility, and what metrics they are held to account for, for access to GPs.
I accept and understand my hon. Friend’s concerns, but I would put on the record that Swale CCG is doing everything it can to resolve the problem, and does not fall into the category that she mentions.
I accept that Swale is not alone and that the shortage of GPs is a national problem, and that the reason for that shortage is complex. There is little doubt in my mind that successive Governments, including the Labour Government that was in power from 1997 until 2010, and the coalition Government that followed, which of course had to clear up the financial mess left by its predecessor, failed to invest enough in training the doctors we need today. Let us not forget that it takes 10 years to train a GP. To have them practising today, they would have had to start their training back in 2009.
Although there is a nationwide shortage, the problem is more acute in my constituency, and across Kent generally. Indeed, out of the top five areas in England with the worst GP to patient ratios, three of them—Swale, Thanet and Bexley—are in our county. That cannot be a coincidence.
Why is there such an acute shortage in Kent? I believe that the reason is twofold. First, doctors can earn more working in London than they can in Kent, because of the London weighting allowance. I would like to see the London weighting allowance extended to cover Kent, which would make it easier to recruit not only doctors, but also other public sector professionals, such as nurses, police officers, teachers, fire-fighters and prison officers, all of whom it is difficult for us to recruit.
Secondly, doctors undertake their training in London, so they tend to settle in the capital when they qualify. I am pleased that the Government have recognised that problem and a new medical school will be opening in Kent next year. We hope that doctors training in Kent will be more inclined to stay in the county once they have qualified. However, the reality is that any such newly qualified doctors who do decide to stay in Kent and go into general practice will not be available until at least the year 2030, by which time the need will be even greater because of other factors. That is where the two other concerns I mentioned at the beginning of my speech—roads and housing—come into the equation.
The roads infrastructure in my constituency is close to breaking point. We have continual problems of congestion, particularly on the M2, the A2 and the A249, and that congestion is creating ever higher levels of air pollution. As I mentioned, my constituency suffers from a high incidence of lung-related diseases. Ever more traffic congestion will produce ever more air pollution and increase the number of people who, in the future, will seek medical help. Their first port of call will naturally be a GP, putting even more strain on an already stretched primary care system. Something must be done to improve the strategic roads infrastructure in Sittingbourne and Sheppey in order to reduce congestion and air pollution, and that something must be done soon. Time is running out.
The second concern, and a major contributor to our poor GP to patient ratio, is the huge number of housing developments in my constituency over the past 20 years. The area has been transformed and is changing beyond all recognition. Housing numbers have already grown dramatically, and the housing targets being imposed on Swale Borough Council by the Government will see that growth accelerate. The reality is that we are facing the prospect of an ever-growing population at the same time as the number of GPs is diminishing, because the shortage that I spoke about earlier is being made worse by the number of doctors in our community who will retire in the next few years.
If the Ministry of Housing, Communities and Local Government were represented here today, I am sure that it would insist that any future housing developments should have planning conditions placed on them to require the developers to provide health facilities such as a local health centre, as the Ministry has done in the past. What is the use of section 106 money and the community infrastructure levy if we fail to recognise an inconvenient truth: forcing a developer to build a health centre is all well and good, but without the necessary doctors to staff it, at the end of the day it is just another building? Somehow, we have to ensure that something is done to reduce housing targets in areas in which GPs are in short supply, such as my own, until such times as more doctors come on stream.
I appreciate that the Minister has no responsibility for either roads or housing, but I hope she will at least join me in lobbying her colleagues in the Department for Transport and the Ministry of Housing, Communities and Local Government to provide Sittingbourne and Sheppey with the help that is needed to solve the road congestion problem and reduce the planned level of house building. If we can do that together, we will go some way towards improving the health of my constituents and reducing the pressure on primary care in Sittingbourne and Sheppey.
It is a great pleasure to serve under your stewardship, Ms Buck, and I congratulate my hon. Friend the Member for Sittingbourne and Sheppey (Gordon Henderson) on securing this incredibly important debate. He speaks very passionately about his constituency and has raised a number of pressing issues that, to a greater and a lesser extent, I have responsibility for tackling. He has described the pressure that primary care is under in Swale very well. We know that Swale is not alone; I have received representations from other hon. Members, including my hon. Friend the Member for Horsham (Jeremy Quin), who raises very similar points about these pressures.
When my hon. Friend the Member for Sittingbourne and Sheppey talks about the impact of inadequate road infrastructure and excessive housing development exacerbating the challenges with GP accessibility, he could almost be speaking about my own constituency—it is like looking in a mirror in so many ways. I completely recognise the challenges he describes, because my constituency faces almost identical issues with accessing GPs, inadequate roads, housing developments and trying to attract GPs to the area. The Government recognise that this is an issue that affects the care patients receive. We are working very hard to address it and are pushing harder than ever to grow the workforce by the extra 5,000 GPs to which we have committed.
A growing, ageing population and patients with long-term conditions are putting strain on the system. We need to look very closely at recruiting and retaining GPs, but that is not the whole story; we must also look at what GPs are telling us are the biggest issues, including workload, indemnity and risks associated with the GP partnership model. There are a number of tasks that we have to consider.
We recognise the importance of general practice, which is the absolute heart of our NHS. In 2015 we set the ambitious target to grow the workforce by 5,000; we are a long way from achieving it, but more GPs are now in training than ever before. The NHS long-term plan made a very clear commitment to the future of general practice, with primary and community care set to receive at least £4.5 billion a year more in real terms by 2023-24. That was followed by the new five-year GP contract, which will see billions of pounds of extra investment for improved access to family doctors, expanded services at local practices and longer appointments for patients who need them.
The new GP contract will address workload in general practice as a result of the workforce shortage that my hon. Friend the Member for Sittingbourne and Sheppey so beautifully articulated. We need a culture change in the range of health professionals who people are prepared to see when they go and visit their local health centre. NHS England has committed to expanding community-based, multi-disciplinary teams, which will provide funding for 20,000 other staff in primary care networks, such as physician associates and social prescribers.
I welcome the Minister’s words and accept that the Government are doing something. I also accept that it is not just my area that has a problem. Does she recognise, though, that Kent has a particular problem? To give an example, somebody living in north Kent can travel 20 minutes up the A2 and get £6,000 or £7,000 a year extra. Although the Government are expanding the opportunities for the other professionals, we cannot even get them. It is not just doctors; it is all the professionals.
My hon. Friend makes an excellent point, and I completely understand that places in the London catchment area can very easily lose key public sector professionals. It is very difficult to compete with the potential extra wages that they might be able to achieve by working in the Greater London area. It is important to acknowledge that diversifying the range of different medical professionals who people can see will immeasurably help general practice to cater for the additional number of patients. It means bigger teams of staff providing a wider range of care options for patients, which effectively frees up more time for GPs to focus on those with more complex needs.
I was very pleased to hear that the CCG general practice in Swale is already using the skills of a wider workforce, including pharmacists working alongside GPs and paramedics providing home visits. We are training more GPs than ever before, and last year Health Education England recruited the highest number of GP trainees ever: 3,473. As my hon. Friend said, a new medical school is opening in Kent next year.
It has been made easier and quicker for qualified doctors to return to the NHS through the national GP induction and refresher scheme. Yesterday NHS England launched a new “Return to Practice” campaign, which is aimed at promoting the support that is available to GPs who have left practice, with a view to trying to tempt them and encourage them back. To bridge the gap while that training is ongoing—my hon. Friend rightly says that it takes a very long time to make a GP—NHS England’s international GP recruitment programme is bringing suitably qualified doctors from overseas to work in English general practice.
I completely agree with what the Minister is saying about the importance of a greater range of healthcare professionals—it is not always about seeing a GP, so there needs to be a shift in expectations—and the plans to increase the number of GPs in the system, including through the Kent medical school, for which I campaigned very hard. I urge the Minister to come, if she can, to my point about an access metric. It would be really helpful to have a better way for patients to know what level of access they should expect. At the moment, we seem to have the proxy of a GP-to-patients ratio, but it is not good enough. It would be helpful if she could address that.
It is quite tricky. As my hon. Friend knows, general practices are independent contractors. Each general practice is required to meet the reasonable needs of their registered population, so there is no exact metric or recommendation for how many patients a GP should have, as the demand that each individual places on a GP can be significantly different. There is obviously much greater pressure on a practice in an area with a much older population—with more retired people and those with more complex needs—than on practices in other areas. That is where the complicating factors arise.
It is really important to work on innovative ways not only to bring in a new raft of GPs, but to hold on to the ones that an area already has. I understand that Swale CCG is working with GP practices across the area to improve retention. Supported by funding from NHS England, it is shortly due to launch a pilot GP recruitment and retention scheme. It is being proactive in recruiting the next generation of general practice staff and has been working with local schools and colleges to encourage local students to consider healthcare, and particularly primary care. I understand that three training practices in Swale offer placements for trainee medics, to give them the opportunity to experience general practice and consider general practice training. As of December, there were 11 direct patient care apprentices working in general practice across Swale.
My hon. Friend the Member for Sittingbourne and Sheppey rightly made the point that three of the areas with the highest patient to GP ratios are in Kent. I have been advised that, alongside the CCG’s work, the Kent and Medway sustainability and transformation partnership has set up a primary care workforce group, and has secured £1.5 million from Health Education England and NHS England to implement its workforce transformation plan.
The range of other issues that deter medical graduates from general practice include the spiralling cost of purchasing professional indemnity cover, which is a major source of stress and financial burden. We have addressed that in the new GP contract and from 1 April this year, the new state-backed clinical negligence scheme for general practice will bring a permanent solution to indemnity costs and coverage. That will help drive recruitment and retention of GPs.
We recognise the huge contribution that the general practice partnership model has made to patients over the lifetime of the NHS, but we also recognise that increasingly that model faces challenges, as fewer young GPs want to become partners. An independent review, led by Dr Nigel Watson, reported in January and made seven recommendations on workforce business models and risk, to which we will respond shortly.
My hon. Friend made the point well that air pollution, road infrastructure and congestion contribute massively to the pressure on general practice. The Government recognise that air pollution poses one of the biggest environmental threats, particularly in the case of frail elderly people and young children. Removing congestion from roads is certainly one of the sure-fire ways to reduce some of the air pollution hotspots. My Department will always be happy to furnish him with data that he needs on the health impact of pollution, to support any of his activities for attracting the local road investment that will tackle the problem and help his constituents.
My hon. Friend also raised a concern that housing targets placed on Swale Borough Council by the Government put additional pressure on doctor’s surgeries. The national planning policy framework, which was published last year, makes it very clear that strategic policies must make sufficient provision for community facilities, such as health education and cultural infrastructure. As he says, it is not enough to build a building; we need staff inside it. The views of local clinical commissioning groups and NHS England must be sought with respect to the impact of any new development on health infrastructure and demand for healthcare services.
Examples of primary care being delivered in an innovative way can be found across the country, for example using other professionals to deliver care or GP practices grouping together to work more collaboratively. That is exactly the kind of innovation and co-operation envisaged in the long-term plan, which seeks to change the balance in how the NHS works by shifting more activity into primary and community care. That is enabled by expanding multidisciplinary team working. The NHS long-term plan also commits to the recruitment of 1,000 social prescribing link workers by 2020-21. I encourage my hon. Friend to have a conversation with Swale CCG to see if any of those innovative measures could be introduced to help his constituents.
That was never in any doubt as far as I am concerned, but sometimes CCGs may not have thought of some of the more innovative ideas that are used in other parts of the country. I am sure that my hon. Friend, in his highly esteemed role in the local community, is best placed to raise that issue with the CCG.
The Government are well aware that recruitment and retention of GPs is a huge issue. We know that there are problems and we are doing everything that we can to tackle them. We will keep my hon. Friend updated and I thank him for his contribution to the debate and for raising this very important matter.
Question put and agreed to.
Civil Service Compensation Scheme
I beg to move,
That this House has considered the civil service compensation scheme.
It is a pleasure to serve under your chairmanship, Ms Buck. I refer to my entry in the Register of Members’ Financial Interests—I chair the Public and Commercial Services Union parliamentary group. I want to raise the important matter of the civil service compensation scheme, and will first outline how we have got to the present situation.
It would be fair to say that the civil service compensation scheme has had a troubled recent history. Having run smoothly and been untouched for decades, since 2010 it has been the subject of much change, acrimony and litigation, leading to three judicial reviews. The first judicial review was in 2010, when the then Labour Government introduced changes to the scheme that would cut the redundancy terms of civil servants. PCS launched a legal challenge to those changes, and on 10 May 2010 the High Court ruled that the judicial review had succeeded and that amendments to the civil service compensation scheme were to be quashed. In essence, Mr Justice Sales concluded that the Superannuation Act 1972 provided that the agreement of PCS was required in order for any changes to proceed. The Court quashed the changes because they had not been agreed by the union.
There was a further judicial review in 2011, when the Conservative-Liberal Democrat coalition established primary legislative changes to implement cuts to the civil service compensation scheme. The legislation was amended to the effect that the obligation to reach an agreement with the union on any changes was replaced with an obligation to consult with a view to reaching agreement. The proposals were agreed by the FDA, GMB and Prospect trade unions, but they were rejected by PCS, the Prison Officers Association and Unite the union.
At the time there was another legal challenge by way of judicial review. The primary grounds for the challenge were that the changes to the civil service compensation scheme constituted unlawful interference contrary to the rights of civil servants under article 1 of protocol 1 of the European convention for the protection of human rights and fundamental freedoms. In essence, the argument was that civil service compensation scheme terms were its members’ possessions and that depriving them could not be justified. Mr Justice McCombe ruled that the scheme terms did constitute possessions under the convention, but that the state could interfere with them within a margin of appreciation. The Government cited deficit reduction as the reason for the changes, so the Court ruled that the interference was reasonable and the judicial review application was dismissed.
At that time, the coalition Government made some commitments. The then Minister for the Cabinet Office, Francis Maude, said that
“constructive negotiations with the unions can work and the result is a package that is fair for civil servants and fair for other taxpayers.”
He went on to say:
“From the start, we said we would do everything we could to engage with the unions on the best way to reform a scheme, which was unaffordable and way out of line with private sector and…public sector schemes.”
The hon. Gentleman makes an interesting point, because that is exactly what happened. I will come on to that later.
Gus O’Donnell, the then head of the civil service, echoed Francis Maude’s comments, stating:
“It was important that we achieved a scheme which is sustainable, affordable and fair.”
However, those were hollow words, as just five years later the Conservative-majority Government elected in 2015 decided to proceed with further cuts to the civil service compensation scheme. On 8 February 2016, the Cabinet Office launched a consultation on reforming the scheme. During the consultation, it took the extraordinary step of debarring the trade unions that refused to agree cuts as a pre-condition for talks.
PCS balloted its members on the final offer and it was overwhelmingly rejected. Unsurprisingly, PCS again took the matter to the High Court. The primary argument was that, by debarring the union from talks, the Cabinet Office had breached its obligation to consult the trade unions with a view to reaching agreement. Mr Justice Sales and Mrs Justice Whipple agreed. They held that:
“The Minister could not lawfully exclude the PCSU from the consultation which ultimately mattered in terms of his statutory duty”.
They added that he
“was not entitled to impose additional entry conditions above and beyond those stipulated in the 1972 Act for participation in that consultation, in the form of the pre-commitments he required the unions to make.”
Accordingly, the Court quashed the changes. That was a significant victory for civil servants, which forced the Government to restore the terms of the scheme so that many members achieved higher payments and the pace of job cuts in some Departments slowed.
Not content to leave it there, the Government announced in September 2017 a further consultation on reforming the scheme. It is believed that the consultation is another attempt to make cuts. The Government’s position will worsen even the proposed 2016 scheme terms that PCS members overwhelmingly rejected in a ballot and that were overturned by the High Court. Nevertheless, the trade unions engaged in talks with the employer.
PCS has been clear that there is no case for changing the terms of the scheme that were reinstated by the High Court. Notwithstanding that, it is engaging to protect its members’ interests, as would be expected. It is participating in talks alongside other unions—the GMB, the Prison Officers Association and Unite the union, which have also adopted the position that there is no case for cuts in the scheme. Those unions represent the overwhelming majority of trade union members affected by the scheme, and they have been in detailed discussions with the Cabinet Office since late 2017. The objectives of the negotiations are fair: to secure maximum protection for the lowest paid; to secure maximum protection for the greatest possible number of members—more often than not they are the lowest paid—and for those who want to remain in a job, thereby prioritising compulsory redundancy terms over voluntary exit and voluntary redundancy terms; and to eradicate the age discriminatory aspects of the current scheme.
I was sent a note by the Prison Officers Association, and I will reiterate its concerns. After prison officers are injured in the line of duty, how they are treated appears to be a lottery. In some cases, if the injury is judged severe enough—by outsourcers and privateers, naturally—they will be issued with a medical retirement, at which point they are entitled to their accrued pension. However, they can instead be issued with a medical inefficiency, which can have severe financial consequences. To be clear, we are talking about the same scenario: officers being so severely injured by prisoners that they cannot return to work. In one case they can retire and keep their pension, sometimes along with permanent injuries, while in the other they are often left in a position where they cannot even afford the urgent medical care they need.
The Prison Officers Association believes that the planned cuts to that scheme threaten to make an unfair situation even worse, by limiting further the number of weeks that critically injured prison officers can receive pay. That literally adds insult to injury, and this Government must act to make sure those brave men and women are not further penalised for working in such dangerous conditions while they diligently protect the public.
Does my hon. Friend agree that one of the problems that runs alongside this and most pension issues is a total lack of communication? A constituent who is affected by the changes contacted me; once my office got involved, it took four months to get any clear answers, excluding the amount of time that my competent constituent had spent trying to fix the problem on her own. There is a complete blame game between Departments, rather than an attempt to resolve things.
That is certainly my experience from some of my casework relating to the scheme. I hope that the Minister takes cognisance of my hon. Friend’s remarks about how we should try to fix these issues.
The Minister should be under no illusion that the crisis unfolding in our prisons is anything less than a health and safety emergency, with violence against staff not only at a record level but rising at a record rate. According to Ministry of Justice figures, there were more than 10,000 assaults against officers in England in the past 12 months—an average of 28 each and every day.
It is perfectly reasonable to argue that these days many roles and professions, from shop worker to firefighter, unfortunately involve some exposure to violence, and that there is nothing unique about prison officers facing assaults at work. That is true, and I wish to see proper pension protection for those workers too, but prison officers work in a uniquely violent environment. According to their trade union, which will hold a march and a rally on this issue at Westminster tomorrow, it is the most violent and dangerous workplace in western Europe.
Beyond the chaos and carnage that the Government unleashed by sacking 7,000 prison officers, which opened the gates to unseen levels of violence, we must accept that prisons are inherently violent institutions. They are places where hundreds of criminals, many of them guilty of violent crimes, are held against their will using the threat—and sometimes the application—of force. That makes prisons unique workplaces. We expect the brave men and women who serve inside them to confront violence when necessary. When prison officers are injured in the line of duty, protecting the public from dangerous criminals, we as a society have a special responsibility to protect them. Quite simply, if they are too badly injured to return to work, we must not add insult to injury by leaving them in financial as well as physical peril.
I turn to the current talks and the counter-proposal that the trade unions have sent the Government. After a year of talks, during which the 2010 terms remained in place, to the benefit of civil servants, the Government took the position that they could bring the negotiations to a close unless the unions made a counter-proposal. The trade unions agreed to submit a counter-proposal to the Government’s plans, in line with their negotiating objectives.
The unions’ proposal seeks to redistribute the scheme so that those affected by office closures and other redundancy situations—those who require the compensation the most—receive the most from the scheme. In other words, they argue that people being forced out of their jobs against their wishes should be prioritised. The trade unions met the Minister on 6 February to present their counter-proposal. He undertook to consider those representations and then to respond formally. As I am sure he will tell us, a further meeting is scheduled for next week.
The onus is now on the Government. It is expected that the Minister will soon come to a conclusion about his approach. I ask him to take cognisance of the following key factors before he does so. First, the commitments given by Francis Maude following the 2010 changes should hold firm. Reneging on those commitments now would only lead people to conclude that the commitments of Conservative Ministers count for nothing.
Secondly, there is no majority in the House in support of the Government’s proposed changes; all parties, bar the Conservatives, oppose them. That includes the Democratic Unionist party, which—unsurprisingly, given the dangers that loyal, hard-working civil servants have been exposed to in its part of the world—supports the trade unions in this campaign and recognises that those workers should not be treated with contempt.
Thirdly, the counter-proposal put forward by the trade unions delivers the Government’s stated objective of producing significant savings for the taxpayer, while ensuring that those most in need of the scheme derive the most benefit from it. That is in line with the Government’s stated objectives of helping those who are just about managing and preventing excessive pay-outs at the top.
Fourthly, low-paid civil servants who work in towns and cities subjected to office closures will find it harder to obtain work. Take, for example, the office closure programme of Her Majesty’s Revenue and Customs. In many towns, HMRC is the largest employer. The highest-paid civil servants will be able to obtain other employment in the public sector, but it will be more difficult for those at the lower end, who will see the largest employer move out of the area, to obtain other work.
We call on the Minister to hold good to previous commitments and not to proceed with cuts to the civil service compensation scheme. Failing that, we call on him to adopt the counter-proposal put forward by the trade unions. I look forward to his response.
Thank you for calling me to speak, Ms Buck. I congratulate the hon. Member for Glasgow South West (Chris Stephens) on securing the debate.
Here we are again, debating the negative impact of this Government’s policies on workers. Debates in Westminster Hall or in the main Chamber that lay bare the real consequences of the Government’s austerity agenda seem to be an almost daily occurrence, yet the Government very rarely recognise the need to address the problems caused by austerity. I suspect that this debate will be no different, in spite of the clear consequences of the Government’s proposed reforms to the civil service compensation scheme.
Civil servants have been fighting a continuous battle against reforms to the compensation scheme for years with successive Governments. The battle started in 2009 with the Labour Government, who sought reforms to the scheme that they believed would help control costs. Civil servants and their trade unions, particularly PCS, mobilised against those reforms and launched a successful judicial review against them in 2010. After the 2010 election, the Conservatives and the Liberal Democrats tried to cap payments for voluntary and compulsory redundancies, but the civil servants and their unions fought back, which resulted in higher caps.
This Government are continuing the trend of attempting to reform the scheme, but they are doing so by undermining the trade unions. The Government pursued a consultation process in all but name, imposing conditions on trade union participation. In the 2017 judicial review of the consultation, the High Court found that the Government’s reforms were illegal as a result of their failure to engage in proper consultation. However, an appeal has since been lodged against that decision, and we await the outcome from the Court of Appeal. Regardless of the outcome, let me put on the record that I will always stand alongside civil servants and their trade unions in opposing the Government’s attempts to railroad through reforms to the scheme without meaningful consultation. I will be out supporting them again tomorrow.
It is clear to me that the real intention behind the Government’s reforms is to erode the terms and conditions of our civil servants. Just look at the differences between the 2010 compensation scheme terms and those that the Government seek to introduce. Civil servants are guaranteed a tariff fixed at one month’s salary per year of service in both voluntary and compulsory redundancies. The Government seek to reduce that fixed tariff to just three weeks per year of service. The maximum amount payable to civil servants in a voluntary redundancy is 21 months’ salary. The Government seek to reduce that to 18 months’ salary. In a compulsory redundancy, the maximum amount payable currently stands at 12 months’ salary, but the Government wish to reduce that to nine months’ salary. Notice periods are generally around six months, but the Government seek to reduce that to just three months for new starters.
The Government continue to pursue these reforms in spite of overwhelming opposition from the 3,000 respondents to the consultation, who were told by the then Minister for the Cabinet Office that the 2010 compensation scheme terms were both “fair” and
“right for the long term”.
These reforms must be opposed by all of us in this House who value workers, value good terms and conditions, and value our public services.
While I am speaking in support of civil servants, let me say that it is time the Government treated our civil servants with respect and dignity. Civil servants are dedicated, professional and hard-working, just like all those who work in our public services, such as doctors, nurses, teachers and, as my good friend the hon. Member for Glasgow South West mentioned, prison officers. However, they continue to be denied a fair pay rise as a result of this Government’s ongoing decision to limit civil service pay rises to between 1% and 1.5%. Civil servants received one of the lowest pay increases in the public sector in 2018-19. I call on the Minister to scrap the cap and give our civil servants a proper pay rise. They deserve much more than they are getting from this Government.
It is a pleasure to serve under your chairship, Ms Buck. I am not sure if it constitutes an interest under the legislation, but I am a member of the Public and Commercial Services Union. In the interest of full disclosure, I am happy to declare that before I begin my remarks.
I support my hon. Friend the Member for Glasgow South West (Chris Stephens) in bringing forward this motion and I associate the third party with the body of his remarks. I have some additional points. First, it is really not a good look for the United Kingdom Government that three times over the last nine years, under three different Governments of different political complexions, the Government workforce has found it necessary to take its employer to court, and on two out of those three occasions the workforce has won. That does not speak well about good will and industrial relations inside the civil service, or about relations between the Government and those on whom they depend to implement their policies. Something is awry and it needs to put right.
That is even more true when we consider what is about to befall the public sector, if Brexit goes ahead. The degree of upheaval, change and restructuring that will be necessary to cope with leaving the European Union will undoubtedly require the good will and support of the workforce. I implore the Minister to try to do what he can to diverge from the attitude and the work of his predecessors.
I support the principles that underline the trade unions’ counter-proposal on the compensation scheme. I do not want the Minister to disclose his negotiating hand—it is proper that he responds to the trade unions directly on 25 March—but will he indicate whether these principles find support with him? I am minded to support them—not just the provisions that focus compensation towards those on the lowest incomes or those who are being made compulsorily redundant, rather than opting for voluntary severance, but most of all the idea that compensation should be related to the status of the employee who is being made redundant. After all, we are talking about not a bonus or a pension scheme, but compensation for losing livelihoods. Therefore, compensation ought to take into account the consequences for the individual and their ability to survive after they leave the civil service.
In that regard, although I cast no aspersions on such people as workers, a distinction has to made between a relatively high-paid civil servant working around the corner in Whitehall who is made redundant in the centre of the capital city and who has the experience and opportunity to readily seek alternative employment, and someone working at a basic administrative grade in Gateshead or somewhere else where there may be more challenges in the labour market. I commend that principle to the Government in their approach.
Finally, as with so many other things, I ask the Minister to look north for inspiration and see what is happening across the border in Scotland. Scottish civil servants, if they are working directly for the Government, are under the auspices of the same scheme, but they constitute only a small part of the public sector national workforce in Scotland. With regard to the rest, the Scottish Government are undertaking a consultation about severance arrangements in the public sector more generally. In Scotland, they have proceeded on the basis of consultation. The Government are not being taken to court and there is a not an imminent dispute with the civil servants’ trade unions. If this can be done correctly in Edinburgh, perhaps the Minister can take inspiration from that and make sure it is done correctly in Westminster.
It is a great pleasure to serve under your chairmanship, Ms Buck. I do not intend to detain the Chamber for too long; I am sure Members are more interested in hearing what the Minister has to say.
I pay tribute to my good friend, the hon. Member for Glasgow South West (Chris Stephens). One reason why I do not need to speak for too long is that he gave such a clear exposition of the problems faced by workers in the civil service, and members of the PCS and other trade unions, because of the changes to the civil service compensation scheme. The matter has been particularly prominent recently in the area that he represents because of the changes to benefits offices and jobcentres, as a result of which low-paid workers are being offered jobs that may be many miles away from their settled workplace. They cannot take those jobs, and the only option available to them is to take a pay-off under the civil service compensation scheme, which is now being cut.
I do not want to go into too much of the excellent detail that the hon. Member for Glasgow South West set out, but I will make two points. The first point was touched on by my hon. Friend the Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney). If this change were being made on its own, it would be a matter of sadness and there would be some hope that perhaps an agreement could be reached with the trade unions. Unfortunately, however, it appears to be part of a pattern when it comes to how the Government and the senior management of the civil service deal with their members.
In 2010 the Government implemented a two-year pay freeze, which was followed by a six-year pay cap of 1%. During that period, average salary levels in the civil service fell in value, in comparison with inflation, by between 8.8% according to the CPI calculation and 15.2% according to the retail prices index. Average pay in local government, health and education—all areas that we know have suffered from Government cuts and depressions in pay—has seen increases higher than those in the civil service; the Government have capped civil service pay rises at between 1% and 1.5%.
The Government spending review, which we are currently looking at, has set departmental budgets until 2020. The chief executive of the civil service recently told union negotiators that for 2019, funding for pay increases was 1%. He said that Departments could negotiate higher pay increases by sacrificing terms and conditions. An example of this approach arose in the Ministry of Justice last year. The management proposed a pay increase of 11% over five years, in exchange for a longer working week, cuts to overtime and cuts to sick pay. I make those points about civil service pay because my concern is that a pattern is emerging where, to put it bluntly, civil service management—or, dare I say it, Ministers—seem to have an agenda of driving down terms and conditions across the civil service.
The hon. Gentleman makes an excellent point. Does he agree that the changes to civil service pay, civil service pensions and the civil service compensation scheme are a triple whammy for civil servants, many of whom are low paid? Is it not ironic that the directors of all these UK Government Departments have agreed that there should be a 1% pay rise for civil servants, and does that not make a mockery of the 200 different sets of pay negotiations in the civil service?
The hon. Gentleman is absolutely right. He mentioned the civil service pension changes, which complement and add to the pattern of behaviour that I am identifying. It gives me great concern that there is an agenda out there of driving down civil service pay. Suffice it to say that the official Opposition hope that an agreement can be reached with the trade unions. I remind the Minister that trade unions represent many tens of thousands of Government employees. They have a legitimate role in representing their members.
We keep being told that we are coming out of the tunnel after 10 years of depression, that austerity is over, that the Government are being extremely successful in their management of the economy and that sunlight is beaming down through the dark clouds. If that is the case, now is the time to start treating the Government’s own employees more fairly and, in the context of this particular debate, acceding to the requests of the trade unions that represent the Government’s own employees. That means sorting out this dispute—it is, dare I say it, a needless dispute—on the civil service compensation scheme and giving those civil servants a decent pay rise. That decent pay rise will be a percentage of a much smaller amount than it would have been, because their pay has been depressed for so long, but I urge the Minister in the meeting on 25 March to take this matter seriously, to take his employees the civil servants seriously and to give them a fair settlement.
It is a pleasure to serve under your chairmanship, Ms Buck. I congratulate the hon. Member for Glasgow South West (Chris Stephens) on securing this debate, and welcome the opportunity to respond to the points he has made.
Further to the point raised by the hon. Member for City of Chester (Christian Matheson), I want to put on the record right from the beginning that of course the trade unions have a valuable and important part to play in debates around civil service terms and conditions. Indeed, I have met them frequently—both PCS and the other principal unions, Prospect and FDA, as well as GMB and others.
I know that in his role as chair of the PCS parliamentary group, the hon. Member for Glasgow South West takes a close interest in these matters, and I pay tribute to him. Whatever our political differences, I know he is a strong and effective advocate for the trade unions and for PCS, and he has demonstrated that again today. In my experience both as a Minister in the Cabinet Office and in my previous time working at 10 Downing Street, I have worked with some of the most committed, talented and hardworking public servants in our country.
At a time when the nation faces significant challenges, those public servants’ work is more important than ever, so I am happy to join hon. Members, in particular the hon. Members for Coatbridge, Chryston and Bellshill (Hugh Gaffney) and for Edinburgh East (Tommy Sheppard) in paying tribute to them. As the hon. Member for Edinburgh East said, we need their skills more than ever at this time, as we face Brexit.
I certainly share hon. Members’ belief that all civil servants should be rewarded for the work they do, so that we can attract the best and brightest into the heart of Government. This debate relates principally to the compensation package available to civil servants when they are made redundant, but since hon. Members, particularly the hon. Member for City of Chester, have raised the question of pay I want to address that briefly before addressing the rest of my remarks to the substance of the debate. The hon. Gentleman raised the point about the Government’s fiscal position and the spending backdrop against which we are making these decisions. I am glad he has recognised that the Government have made considerable progress in reducing the deficit. He is right that we have made a lot of progress: the deficit is down by four fifths since 2010, from about 10% of GDP to about 2%. None the less, the Government are still borrowing more than £40 billion every single year, so the pressure has not gone away and we must still take some difficult decisions.
The reason we must take those difficult decisions is that we spent over £50 billion on debt interest last year. That is more than we spend on schools, and more than we spend on our police and armed forces combined. There is still a strong countervailing pressure from the need to continue to bear down on expenditure. Pay forms a large part of Government expenditure, so pay has to be part of that mix.
The overall approach taken to pay is that the Chief Secretary to the Treasury has made it clear that the overall cap has been lifted, but given the financial constraints within which we are operating, which is what the chief executive of the civil service was alluding to, it remains the case that central Government Departments have pencilled in—in fact, penned in—their funding. It is very clear from the Treasury how much budget has been allocated for pay rises, and in the coming financial year that is 1%.
That does not mean that Departments cannot go beyond that, but if they do, they must find efficiency savings to do so. In respect of all delegated levels of pay—that is to say, below the senior civil service—the process for determining pay awards is that it is up to each different Department to determine its pay award.
I am hoping to secure a separate debate on civil service pay, but since we have touched on it, I am sure the Minister remembers, as he was on the Front Bench, that we debated this last year and he agreed to look at the situation of having 200 separate pay negotiations across UK Government Departments. I think he is sympathetic to my view that that is a bit foolish. Given that permanent secretaries have agreed a joint position, as I understand it, of 1% to 1.5% across Departments, is it not better to have one pay negotiation for the whole civil service?
I should say from the outset that no decision has been taken or agreed by permanent secretaries. There is a very clear process for this, which is that for delegated pay, which is that for civil servants below senior civil service level, the framework is set by the Cabinet Office in conjunction with the Treasury and then it is up to each individual Department to make individual decisions.
On the point about co-ordination, the Chancellor of the Duchy of Lancaster and I want to ensure that we have a proper process of engagement with the principal trade unions as we set the delegated framework, but it is important to say that that is not a pay negotiation. We need to understand their position, but the individual pay negotiation must be done by each individual Department. I think having each Department make its individual determination is the right approach, but I am keen to ensure that we engage with the trade unions and others as we consider the overall approach to delegated pay. As I understand it, correspondence is ongoing with the trade unions on the best way of doing that.
Beyond the delegated framework, there is also potential for further efficiency savings to allow for higher pay rises. I have signed them off as a responsible Minister; for example, the Foreign Office recently agreed a two-year pay deal funded by efficiencies, allowing for a 6.4% average uplift for non-SCS staff. It is possible, through smarter ways of working, to fund higher pay awards. I hope that gives hon. Members an overall sense of the approach the Government take to pay.
Thank you, Ms Buck; I will take that injunction seriously and, if I may, I will write to the hon. Gentleman to set out the policy in more detail, so that I do not detain Members any longer on this point. Following your lead, Ms Buck, I turn to the substance of the debate.
The Government have a responsibility to ensure that the civil service is both efficient and cost-effective, and that includes the compensation scheme to support civil servants when exits are necessary—the hon. Member for Glasgow South West outlined the overall history. Important steps towards this goal were taken in 2010 when Lord Maude, then Minister for the Cabinet Office, introduced important reforms to modernise redundancy arrangements in the civil service. A revised civil service compensation scheme was launched in December 2010; at that time, Lord Maude set out his hope and intention that it would be a fair settlement for the long term. I fully acknowledge that point.
However—this is the key point—over the years since 2010, it has become apparent to the Government that those reforms did not fully deliver on their aims. If hon. Members will allow me, I will set out the reasons for that. Part of the rationale for the 2010 reforms was cost savings, and it has become clear that the expected cost savings did not fully materialise. The average compensation entitlement under the 2010 scheme is considerably higher than was intended when the scheme was first introduced. In 2010, the average compensation entitlement for voluntary exits and voluntary redundancies was expected to be £33,754, but by 2017 it was estimated to be £40,513.
More widely, it has become clear that other aspects of the scheme were not appropriate. To give an example, the compensation scheme provisions for early access to pensions for staff aged as young as 50 enable them to retire and draw all of their civil service pension without a reduction for early payment. That is often very expensive for the employer and is increasingly out of line with the Government’s wider aim of encouraging longer working lives.
In recognition of those concerns, the Government introduced new civil service compensation scheme terms in 2016, which, as the hon. Member for Glasgow South West highlighted, were challenged by way of judicial review in 2017. It is important to point out that the court accepted the Government’s reasons for making the reforms, but it found that the Government had not fully met their obligations with regard to how the consultation process was carried out. The 2016 terms were accordingly struck down and the 2010 terms reinstated.
Although the Government of course accepted the court’s judgment—as we must—we still believe that the 2010 compensation scheme reforms have not fully met their objectives, and that there remain good reasons for reforming the scheme. Accordingly, we launched a new consultation on reforming the civil service compensation scheme in September 2017, which set out the Government’s objectives. Principally, the objectives are to align with the principles of the compensation scheme reform expected across the wider public sector; to support employers in reshaping and restructuring their workforces to ensure that they have the skills required for the future; to create significant savings on the cost of exits and ensure the appropriate use of taxpayers’ money; to ensure that any early access to pensions remains appropriate; to ensure that efficiency compensation payments are appropriate for the modern workplace; to support the flexible use of voluntary exits; and, where possible, to implement a set of reforms that are agreed by the trade unions.
The consultation also set out a proposed new set of civil service compensation scheme terms that the Government believe would deliver on those objectives. In summary, those are a standard tariff of three weeks’ salary for a year of service, voluntary exit and redundancy payments of up to 15 months’ salary, compulsory redundancy payments of up to nine months’ salary, employer-funded pension top-up payments allowed only from the age of 55, increasing in line with the state pension age, and that the efficiency compensation tariff should align with the compulsory redundancy tariff.
The Government took the view that those terms would meet the objectives set out in the consultation document, and considered that the scheme would offer a good level of support to civil servants to bridge the gap until they found new employment or entered retirement, and would provide the flexibility needed to support employers in reshaping and restructuring their workforces to meet the challenges that they will face. It will also be fair to taxpayers, who ultimately fund the cost of civil service exit payments, as Members know.
I recognise that this is an area in which trade unions rightly have strong views. The Government are therefore carefully consulting with unions with the aim of reaching an agreement if at all possible. The consultation has already stretched for more than 18 months—a very long period—and has included numerous meetings between my officials and union representatives and between my predecessor and union representatives, and I myself have now held two rounds of meetings with union representatives, which have been extremely useful in helping me to understand the unions’ positions on the proposed reforms.
I am pleased to say that throughout the process PCS and all the other unions engaged openly and constructively with the consultation, notwithstanding their overarching position, which I acknowledge, that the Government should not be reforming the compensation scheme. I place on the record my thanks to all the unions—Prospect, FDA and PCS—for their work in engaging constructively with the process.
As well as engagement through meetings, unions have also put forward detailed counter-proposals setting out their alternative vision of what a reformed scheme should look like. As has been highlighted by hon. Members—particularly the hon. Member for Glasgow South West—those proposals are detailed and well thought through and reflect the considerable effort that has clearly gone into their preparation. Again, I thank the unions for that constructive engagement.
As a result of the meetings and counter-proposals, I am left in no doubt as to the unions’ positions. I understand the areas that they consider priorities for reform, their concerns about the Government’s proposals and their preferred alternative reforms. Contributions to the debate have further increased my understanding of the position of PCS and the other unions it is working with on this consultation. I am very grateful to hon. Members for their contributions.
The Minister has been most generous in giving way. If the trade unions put forward a counter-proposal that met the Government’s expected savings target, would the Government be more sympathetic? Does he understand the principles behind what the trade unions have put forward, including looking after those who are lower paid rather than those at the top?
I certainly understand what the trade unions are trying to put forward and I completely understand their concerns about lower-paid workers. However, it should be noted that there is already provision for a minimum payment that covers lower-paid workers, although a discussion about the level at which to set that forms part of the consultation.
I do not want to pre-empt my final determination, but I am concerned about the scale of the cost savings. At the moment, I still have significant questions about whether what has been proposed by the trade unions meets the cost-saving requirements of the reform that we have set out. That is one principal consideration that will affect my final determination. However, I am very much conscious of the arguments that have been clearly put forward by the trade unions on these points, particularly on help for the lower-paid.
As I have said in recent meetings with union representatives, I am now genuinely carefully considering the counter-proposals that all unions have made. I remain keen to reach agreement with the unions if at all possible, and I am considering whether the Government’s proposals can be adjusted to help to facilitate that, while remaining consistent with our overall objectives for reform. As Members have noted, I intend to make a decision on any amendments to the Government’s proposals shortly. Following that, my intention is then for a period of further consultation with the unions, in advance of the Government’s making a formal offer of revised terms to the unions in the hope that they are accepted.
I conclude by repeating that the Government greatly value the work of civil servants. We are keen to reach agreement on a set of compensation scheme terms. I believe that the consultation proposals are fair and provide a good level of support to civil servants, while recognising the need for continued reforms and savings. I once again thank hon. Members for their contributions and I hope I have set out the Government’s approach clearly.
I thank the Minister for his detailed response. As many supporters are likely to be elsewhere at the moment, I hope the Minister does not underestimate the support across the House for civil servants. Given their pay and pensions policies, the Government should not want to make a mistake in relation to the civil service compensation scheme. As has been said, this issue has been to court three times. I hope that, on Monday 25 March, the Minister will positively engage with the trade unions’ counter-proposals, to ensure that civil servants are treated fairly if they are made redundant or have to suffer a voluntary exit.
Question put and agreed to.
That this House has considered the civil service compensation scheme.