Alpha-1 Antitrypsin Deficiency

Nigel Adams Excerpts

Wednesday 31st October 2018 Westminster Hall

[The Lord Commissioner of Her Majesty's Treasury (Nigel Adams)]

It is always a pleasure to serve under your chairmanship, Mr Hollobone. I start by congratulating my hon. Friend the Member for Rugby (Mark Pawsey) on securing this important debate on the need to raise awareness of alpha-1 antitrypsin deficiency disease. I was unaware of the condition until I heard about the debate, and it has been enlightening to learn about it and the number of people it affects in this country. He set out, with great clarity and passion, the concerns of alpha-1 patients across the country.

With up to 8,000 rare diseases identified so far—a number that steadily grows as our diagnostic tools improve—the Government remain dedicated to improving the lives of all those living with a rare condition and to implementing the 51 commitments of the UK strategy for rare diseases, which was reinforced in the Prime Minister’s speech in June, in which she set out her future vision. That vision will be underpinned by increased funding for the NHS, so that the UK can lead the world in the use of data and technology to prevent, and not just treat, illness; to diagnose conditions before symptoms occur; and, importantly, to deliver personalised treatment informed not only by a general understanding of disease but by our own data, including our own genetic make-ups.

As we have heard from hon. Members, people with alpha-1 have low levels of the protective enzyme alpha1-proteinase inhibitor. That means that they are more vulnerable to body tissue damage from infections and environmental toxins—tobacco smoke, in particular. As my hon. Friend the Member for Rugby said, there is no cure for alpha-1, and treatment is focused on alleviating the symptoms.

My hon. Friend referred to the ongoing highly specialised technology evaluation by NICE of the drug Respreeza. That is a type of therapy called replacement therapy. It aims to boost the levels of alpha-1 antitrypsin in the blood. As those in the Chamber will know, NICE is an independent body and its highly specialised technologies evaluation committee makes recommendations on the use of new and existing highly specialised medicines and treatments within the NHS in England.

I am confident that NICE has in place a robust framework for evaluating technologies for rare diseases. As was said, it has not yet published its final guidance on the use of Respreeza for treating emphysema in patients with alpha-1, but it recently consulted on its draft guidance. As we heard, NICE’s evaluation committee is due to meet again to consider its recommendations in March 2019. That is to enable the company that makes Respreeza to prepare and submit additional information for the committee to consider. I am assured that, in developing its final recommendations, NICE will take fully into account all the comments that it received in response to the consultation, along with any additional information provided by the company. We look forward to hearing NICE’s recommendations after consideration has concluded.

As my hon. Friend and the hon. Member for Warwick and Leamington (Matt Western) mentioned, Ministers agreed with the advice of the prescribed specialised services advisory group that services for people diagnosed with alpha-1 should be nationally commissioned by NHS England and not by clinical commissioning groups. May I reassure my hon. Friend and the hon. Gentleman that NHS England is engaging with NICE on the HST evaluation of Respreeza? Once final guidance is received, following the evaluation committee’s meeting scheduled for March next year, NHS England will consider the commissioning implications in consultation with the specialised respiratory clinical reference group.

Should Respreeza be recommended by NICE, it would be for NHS England to make funding available within 90 calendar days of the positive evaluation. Should that be the case, NHS England would want to be assured that the centres initiating the treatment had the appropriate expertise and resources in place. NHS England is committed to involving patients in the development of new services, and routinely does so in line with the specialised commissioning framework, and with dedicated working groups that inform service specification and have patient representation.

As my hon. Friend said, alpha-1 is often undiagnosed or misdiagnosed. It is sometimes diagnosed late, as in the case of his constituent, Mr Leadbetter. More can be done to diagnose rare conditions earlier. Whole genome sequencing is increasingly utilised as a diagnostic tool for rare diseases in individuals with unrecognised signs and symptoms. I am pleased to report that about 25% of rare disease patients who have their genome sequenced through the 100,000 Genomes Project now receive a diagnosis for the first time.

The genomic medicine service was launched by my right hon. Friend the Secretary of State for Health and Social Care on 2 October 2018, making the UK the first in the world to integrate genomic technologies, including whole genome sequencing, into routine clinical care. The first national genomic test directory also became operational from October this year. It specifies which genomic tests are commissioned by the NHS in England, the technology by which they are available and the patients who will be eligible to access them. Alpha-1 is included in the new directory, which will be kept up to date on an annual basis to keep pace with scientific and technological advances.

Let me refer to one or two of the comments from hon. Members. The hon. Member for Strangford (Jim Shannon) talked about the prevention of disease and clinical trials having taken place. Improving the lives of people with alpha-1 through research is critical. We support continued research into rare diseases through the National Institute for Health Research. That has established 20 biomedical research centres that develop new treatments for patients with a range of rare diseases.

The hon. Member for Gower (Tonia Antoniazzi) referred to a UK-wide campaign to raise awareness of this condition. I fully agree with her and support the notion that we should always be working together to raise awareness of alpha-1. Many of our initiatives are aimed at raising awareness of rare diseases among healthcare professionals and the general public; it must be extremely difficult for a GP to have knowledge of, spot the symptoms of, and recognise up to 8,000 rare diseases. Health Education England and Genomics England have produced a range of educational materials about rare diseases aimed at those very people—healthcare professionals, including GPs, as the first point of contact in the NHS. Information about rare diseases is also provided for patients and their families.

Let me refer to some of the remarks made by my hon. Friend the Member for Rugby. He talked about allowing patients to be closely involved at all stages of the development and implementation of the service that we are discussing. NHS England routinely involves patients in the development of new services, in line with the specialised commissioning framework, and there are dedicated working groups that inform service specification development. My hon. Friend talked about a review to reflect the impact that the changes to the NICE HST guidelines have had on patient access. NICE’s methods and processes for assessing drugs have been carefully developed over time and are internationally respected. It continues to keep its procedures under review. That includes extensive engagement with patient groups.

[Mark Pawsey]

I want to press the Minister on the availability of the specialised service, on the assumption that use of Respreeza will be approved by NICE. We are running a little behind. Does he think that the service, which was intended to be available by 2019, might be available by 2020? Is there hope for sufferers that that service might be available to them?

[Nigel Adams]

It is absolutely a matter for NICE to make its recommendations, but I think that, if this was approved, we could have a situation in which it could be available by at least April 2020. I hope that that is some encouraging news for my hon. Friend.

I probably need to wrap up the debate, but my hon. Friend also talked about the Government considering the appropriateness of introducing a more formal process of conditional approval for rare disease treatments such as alpha-1 augmentation therapy. The Department has no plans currently to establish a new assessment process for the evaluation of rare disease treatments. NICE’s methods and processes for developing its recommendations have been developed over the past 20 years through extensive engagement with interested parties.

Finally, let me assure my hon. Friend and all other hon. Members who have taken part in the debate that the Government are dedicated to improving the lives of all patients with rare diseases such as alpha-1. The publication of the UK strategy for rare diseases in 2013 was a significant milestone in that respect, and the strategy is now being implemented across the UK. The strategy set out our strategic vision and contains 51 commitments concentrating on raising awareness, providing better diagnosis and patient care, and ensuring a strong emphasis on the importance of research in our quest better to understand and treat rare diseases. Research is at the heart of better treatment and, we hope, prevention. That is why in 2017 the NIHR BioResource for Translational Research in Common and Rare Diseases was launched, supported by £36.5 million of NIHR funding.

I thank those who have come to listen to the debate, and I thank my hon. Friend the Member for Rugby and everyone present for contributing to it and for highlighting and discussing these issues. For their constituents and for all those who suffer from alpha-1 or any rare disease, I hope that I have helped in some way to assure them that the Government and the NHS are working hard to tackle these conditions and to help improve the lives of, and treatment pathways for, all patients.

Question put and agreed to.

Five Year Forward View for Mental Health

Nigel Adams Excerpts

Tuesday 30th October 2018 Westminster Hall

[The Parliamentary Under-Secretary of State for Housing, Communities and Local Government (Nigel Adams)]

I congratulate the hon. Member for Manchester, Withington (Jeff Smith) on securing the debate and all hon. Members present on their contributions and interventions.

Improving care and reducing the stigma around mental health is a key priority for this Government. We welcome the report from the all-party parliamentary group, and I congratulate both the vice-chair and the chair on their work. I think my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) probably underplays the amount of effort that she and her vice-chairs put into it. The report is a timely piece of work and a well-considered contribution to the dialogue on mental health services in this country. In many ways, it mirrors the thinking we have already seen from Mind, the Royal College of Psychiatrists and others.

The statistics on mental health demonstrate the size of the challenge we face. One in four adults experiences at least one diagnosable mental health problem in any given year, yet NHS support for mental ill health has historically been seen as a “Cinderella service”, of secondary importance to other NHS services. The stigma attached to mental ill health has, at times, led mental health service users to feel marginalised.

That is why, in 2016, the Prime Minister made a commitment to improving mental health services. As has been mentioned today, we set out to achieve greater parity of esteem between physical and mental health services. In February 2016, NHS England published “The Five Year Forward View for Mental Health”. This is a timely debate in that regard; I suspect we could have done with an hour and a half at least, and I am sure that when the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), returns to her post there will be an opportunity to expand the debate.

The five year forward view was the result of wide-ranging stakeholder engagement, led by an independent mental health taskforce and chaired by Paul Farmer, chief executive of Mind. It laid the foundations for what we believe to be one of the largest transformation programmes for mental health services anywhere in Europe. The transformation may not be complete, but as my hon. Friend the Member for Faversham and Mid Kent said, progress has been made, and continues to be made.

I will just touch on funding, which formed a key part of the remarks made by the hon. Member for Manchester, Withington. To support the commitments made in the five year forward view, we have pledged £1 billion for adult mental health services between 2016 and 2021. That came on top of the £1.4 billion pledged the previous year in recognition of the need radically to improve children and young people’s mental health services.

We have delivered against those funding commitments: last year saw more than ever before spent by the NHS on mental health, with almost £12 billion spent by clinical commissioning groups and on specialised services, such as those for eating disorders. Only yesterday, right hon. and hon. Members will have heard the Chancellor’s announcement of a further £2 billion to fund mental health by 2023-24, expanding crisis services and supporting more people with severe mental illness into employment.

Today, 74% of people referred for treatment following a first episode of psychosis receive treatment within two weeks under the early intervention in psychosis programme, compared with 64% only two and a half years ago. Just under 80% of routine eating disorder referrals are seen within four weeks, compared with 65.1 % only two years ago. In 2017-18, the national trajectory of 2,000 more women accessing specialist perinatal care was exceeded and we continue to focus on developing local, integrated pathways in this area.

Things are improving outside NHS settings too. We have heard about the work that should be taking place in colleges—importantly—and workplaces. Our investment in improved facilities for crisis mental health care and changes to legislation have helped to reduce, for example, the number of people detained in police cells following a mental health crisis by more than 95% compared with 2011-12. I am pleased that the report recognised some of those achievements over what has been called a “transformational” period in the history of mental health services in this country.

Referring to what my hon. Friend the Member for Faversham and Mid Kent said about core services, we recognise that there is still much unmet need in mental health. That is particularly true for those suffering severe mental illness. Across the country, we are seeing innovative examples of community mental health services working well to provide timely support close to home, to help prevent in-patient admissions.

We also need to look beyond the NHS. Public attitudes towards mental health are improving. That is in part due to the Time to Change campaign, for which this Government provided £1 million of funding. We want to be recognised as a global leader when it comes to mental health, which is why, only three weeks ago, we hosted the global inter-ministerial conference.

I know time is running out, so let me turn quickly to some of the other remarks made by the hon. Member for Manchester, Withington on workforce. We have committed to 21,000 new posts, which will ideally be filled by 19,000 NHS staff. That has been written into local plans and some local areas are making progress, but it is too early to be able to count the number of people in post. The hon. Member for York Central (Rachael Maskell) mentioned further education, and as part of the Green Paper on children and young people we will incentivise every school and college to identify and train a senior designated lead for mental health issues.

To conclude, given the time available, we recognise that there is still much work to be done. I am proud of the work that this Government are doing to improve mental health, ensuring that many more people can access vital, high-quality mental health support. I hope we get an opportunity to debate the subject in future, but I also hope I have provided reassurance today that we are absolutely committed to delivering against the commitments set out in the five year forward view for mental health.

Motion lapsed (Standing Order No. 10 (6)).

Folic Acid Fortification

Nigel Adams Excerpts

Thursday 25th October 2018 Commons Chamber

[The Parliamentary Under-Secretary of State for Housing, Communities and Local Government (Nigel Adams)]

I beg to move,

That this House has considered folic acid fortification.

This week is Spina Bifida and Hydrocephalus Awareness Week, so it seems fitting to be having this debate today. The House will have heard the Minister with responsibility for public health, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), announce during Health questions on Tuesday that the Government are launching a public consultation in early 2019 on the proposal to add folic acid to flour. This issue has attracted wide interest from a large group of stakeholders, and it is important that we properly consult on the proposal, to ensure that all people have an opportunity to register their views. We will be encouraging people to take part in the consultation.

[Sir Greg Knight (East Yorkshire) (Con)]

During his speech, will the Minister tell the House why the Government have apparently ruled out a publicity campaign to encourage those who are at risk to take folic acid supplements and are instead proposing this mass medication?

[Nigel Adams]

We will be encouraging all stakeholders, as well as the public, to take part in the consultation. I will certainly look into the matter that my right hon. Friend has raised and ensure that someone writes to him.

[Owen Smith (Pontypridd) (Lab)]

Given the evidence that neural tube defects such as spina bifida emerge between the 18th and the 28th day after conception and that most women are not taking folic acid supplements in accordance with the Government’s guidelines before conception or during their first trimester, does the Minister agree that supplementation alone does not work?

[Nigel Adams]

The hon. Gentleman takes a keen interest in this matter and has done some extraordinary work on it. He makes an important point. This is why awareness is crucial for all women of childbearing age, including those who are not pregnant but might be considering becoming pregnant.

[Will Quince (Colchester) (Con)]

I recall that we did not know our first child was on the way until 22 weeks; we were not particularly planning to have a baby. It is not always easy to foresee these eventualities. Will the Minister take into consideration the fact that not everyone can prepare for eventualities that they are not expecting?

[Nigel Adams]

My hon. Friend makes a perfectly plausible point from personal experience. Not everyone can see into the future and plan accordingly. A large number of pregnancies are unplanned, so I understand his point.

[Rebecca Pow (Taunton Deane) (Con)]

Will the Minister give way?

--- Later in debate ---

[Nigel Adams]

I will. I will get past my second paragraph at some point.

[Rebecca Pow]

When I was pregnant with my third child, I took folic acid supplements and ate lots of green vegetables, which contain folic acid. However, as colleagues have said, many people do not know that they are pregnant early enough to start doing that. Also, they might not have received the right advice from the medical profession. This consultation is important on those grounds, but will my hon. Friend also ensure that it is very wide ranging so that consideration can be given to all aspects, including the appropriate safeguarding of voluntary fortification by the food industry? Will consideration be given to coeliacs, who use gluten-free flour? This has to be a very comprehensive consultation if it is to be effective.

[Nigel Adams]

It does; my hon. Friend makes an incredibly important point. A number of foods already contain folic acid, and the consultation will have to take that into consideration. It will also look into what a safe upper limit is in that regard. This is why we want to ensure that the consultation is as thorough as possible.

[Anna Turley (Redcar) (Lab/Co-op)]

The Minister is being extremely generous in giving way; we are not allowing him to make much progress. May I take it from his last assertion about an upper limit that the consultation, which we welcome, is not so much about whether folic acid will be included in flour but about what the upper limit will be?

[Nigel Adams]

I do not want to prejudge the outcome of the consultation, and I am sure that the hon. Lady would not expect me do so. It will have to take an upper limit into consideration; indeed, that will be an incredibly important part of the consultation. We want to ensure that the consultation is properly done, that it is thorough and that it can advise Ministers. We will be coming back to the House to report back on it.

I shall move on, if that is okay with colleagues. I think from the tone of the debate thus far that the announcement has been well received. We will be properly consulting on and considering all aspects of this very important issue. I note that many colleagues are well informed about it and that they are aware of the reason behind the calls for mandatory fortification, but it might be helpful to summarise again what we are trying to prevent. Neural tube defects are birth defects of the brain, spine or spinal cord. They happen in the first few weeks of pregnancy, often before a woman even knows that she is pregnant. The two most common neural tube defects are spina bifida and anencephaly. These are devastating conditions, and the Government are fully aware of their effect on the individuals themselves and their families. We have already heard the acute interest and strength of feeling on this issue from Members of this House and in the other place, including on what can be done to ensure that pregnant women have healthy pregnancies and give their unborn babies the best protection during the crucial early weeks of development.

Unless someone is pregnant or thinking of having a baby, they should be able to get all the folate they need by eating a varied and balanced diet. Existing pregnancy advice to women who are trying to conceive or who are likely to become pregnant is that they should take a daily supplement of 400 micrograms of folic acid until the 12th week of pregnancy. They are also advised to increase their daily intake of folate by eating more folate-rich foods, to which my hon. Friend the Member for Taunton Deane (Rebecca Pow) referred. Examples are spinach and broccoli, as well as foods voluntarily fortified with folic acid, including a wide range of breakfast cereals.

We know, however, that around half the pregnancies in the UK are unplanned. In those that are planned, it has been estimated that only half of all mothers took folic acid supplements or modified their diet to increase folate intake. This has led to calls for the mandatory fortification of flour with folic acid so that women can get it from dietary sources other than foods that naturally contain it. Successive Governments have not considered that mandatory fortification of flour with folic acid to be the best way to protect public health and have instead promoted the use of folic acid supplements as a part of a wide range of pre-conception and post-conception advice to women of childbearing age. However, we are now taking the opportunity that this consultation presents to seek the public’s opinion on this proposed important change.

My colleague the Minister with responsibility for public health responded to a Westminster Hall debate in May 2018 that was secured by the hon. Member for Pontypridd (Owen Smith), who has campaigned tirelessly on this issue. In his response, the Minister confirmed that the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment—I shall refer to it as COT from now on—had agreed to take forward for further consideration the issue of tolerable upper limits for folate. COT published its interim conclusions in July 2018, but it has yet to finalise its detailed review. In summary, COT concluded that the potential masking of pernicious anaemia was still an appropriate and relevant endpoint on which to base a tolerable upper level, but that the level at which this effect started to occur was unclear. It concluded that further analysis of the data was necessary, but that the upper level would not decrease—that is, it would stay at 1 microgram a day or could be increased—as there was no convincing evidence that masking occurred at levels of intake below 1 microgram a day.

COT has discussed this again at this week’s meeting, and as soon as the outcome of its consideration becomes available, it will inform Ministers’ thinking in respect of the Scientific Advisory Committee on Nutrition’s recommendations on the mandatory fortification of flour and about folic acid advice generally. We will reflect that outcome in the consultation document, together with whether we need to take any other action, such as discussions with the industry on removing folic acid from products that are currently voluntarily fortified, such as breakfast cereal. We will also be working closely with colleagues in the Department for Environment, Food and Rural Affairs on the consultation, its responses and any resulting conclusions.

[Rebecca Pow]

It goes without saying that it would be worth examining the results of tackling anaemia by fortifying flour with iron and of tackling tooth decay by putting fluoride in toothpaste. Similar things have been influenced by approaches to general health, and we could learn great lessons from such examples.

--- Later in debate ---

[Nigel Adams]

My hon. Friend is absolutely right. There is be research and evidence in these areas from around the world, and we hope that it will feature in the consultation. We certainly need to learn from the approaches taken elsewhere.

[Nigel Dodds (Belfast North) (DUP)]

I am grateful to the Minister for what he is saying and warmly welcome the announcement made by the Under-Secretary of State for Health and Social Care, the hon. Member for Winchester (Steve Brine), on Tuesday. It is a tremendous step forward. As for looking at what has happened across the world, well over 85 countries, including the United States, have mandatory fortification of flour, so there is an awful lot of evidence out there, and clearly it should be taken into account.

[Nigel Adams]

It certainly will. The right hon. Gentleman takes a keen in this area, and other countries such as the United States, as he mentioned, Canada and Australia have introduced mandatory fortification. We need to learn from all that, but we also need to understand the dietary habits of the United Kingdom. It is worth mentioning that no EU country currently has mandatory folic acid fortification, but he is right and we will certainly be learning from the experiences elsewhere.

I assure the House that Ministers have always taken the issue of pre and post-conception advice seriously, and the public consultation will allow us to fully explore the fortification of flour. This is the start of a detailed dialogue with the industry, the general public, relevant charities—I thank Shine, which has done so much campaigning in this area—and members of the scientific community. This Government will ensure that the decisions we take will come after the full consideration of all views. It is my pleasure to introduce this important debate, and I look forward to hearing the contributions and views of Members.

--- Later in debate ---

[Nigel Adams]

With the leave of the House, I echo the hon. Member for Washington and Sunderland West (Mrs Hodgson) in saying that we have had a fantastically well-informed debate. It is good to see the House coming together. I am sure that everyone will agree that the tone of the debate has been extremely welcome. We have heard Members’ views about the proposal to fortify flour with folic acid, and I thank all of them for their contributions and interventions. This will ensure that the consultation document reflects both the scientific evidence base and the very personal impacts of the consequences for families dealing with an NTD birth. What has been clear from the debate is that we must move forward on this issue as soon as possible.

On modelling, the Government will consider all current dietary habits of women of childbearing age to help to inform the impact of this proposed mandatory fortification of flour to ensure that we are reaching the desired outcome. All dietary patterns will be considered whether they be cultural, religious or just personal preference.

On safety, we will continue to listen to COT’s advice to ensure that a safe upper limit is not exceeded by proposed changes to the folate intake from fortified flour. I hear what the hon. Member for Pontypridd (Owen Smith) says, but we have a duty to listen to COT’s advice. On pre and post-conception advice, we will ensure that a clear public health message is provided so that young women can properly understand what this proposed fortification change means for them having a healthy pregnancy.

Let me refer to some of the contributions to the debate. I thank the hon. Members for Blaenau Gwent (Nick Smith) and for Redcar (Anna Turley) for their interventions, and also the Scottish National party spokesman, the hon. Member for Glasgow North (Patrick Grady), who spoke in such an informed way. I really need to pay tribute to the hon. Member for Pontypridd for his work as co-chair of the all-party group on folic fortification and for highlighting those individual cases that he referenced. In particular, there was that incredibly moving story of the young girl, Nicky, which must have touched everyone here. As a Department, we are incredibly grateful for all the work that he has done. He, like the hon. Member for Washington and Sunderland West, was right to reference the work of Lord Rooker. We are extremely grateful for what he has done in this area and for his campaign on folic fortification.

The right hon. Member for Belfast North (Nigel Dodds) speaks eloquently and brilliantly on all issues in this House. It has been a great privilege to listen to his contributions over the past eight years, but particularly in this debate. To come to this Chamber and to speak on a personal level about his experiences must have been incredibly challenging, and the way in which he talked about his son, Andrew, was incredibly moving. Both he and the hon. Member for Pontypridd, as co-chairs of the all-party group, should be very proud of their work to get the Government to this stage. I am absolutely sure that Andrew would be incredibly proud of his father’s work.

The hon. Member for Leeds North West (Alex Sobel) rightly highlighted the costs—the relatively small costs—involved in this area. That is a great reminder to the Government that this is an issue that is not particularly expensive to deal with. There are not that many flour mills around the country, as he said. I am very grateful to him for his contribution.

I turn now to the comments of my friend, the hon. Member for Washington and Sunderland West, whom I have had the great privilege of working with on various campaigns over the years in this place. She asked exactly when the consultation would be launched and how long it would last. I know that other Members will want to know that as well. We do not have an exact date, but it will be early in the new year. I can assure her that it will happen as soon as we have been able to finalise the impact assessments. There is no fixed time for such an important consultation, but we expect it to last around 12 weeks to ensure that everybody has had a chance to consider the matter and respond. She asked whether there was an expectation of when we would have the results. Well, we will consider the outcome of the consultation as soon as it closes. Again, I cannot give her an exact date today in the House, but I can assure Members that we are committed to no delay and to responding as quickly as possible on this very important matter.

The hon. Lady also asked whether the consultation would consider the fortification of flour, or whether it would just establish an upper limit. I can assure her that the consultation will consider whether the calls to fortify wheat flour will achieve the objective for pregnant women. COT is considering the safe upper levels as part of that and its conclusions will be reflected within the wider consultation. She asked which Department will be responsible for leading the consultation, and I can tell her that it will be the Department of Health and Social Care. She also asked about gluten-free flour and whether fortification will include just wheat flour, or other types of flour such as cornflour for those with coeliac disease. We will consider all food in the modelling to ensure that the policy reaches its objective. We will also discuss with industry the issue of foods that are currently voluntarily fortified, such as breakfast cereal.

Finally, the hon. Lady asked how charities such as Shine can support the Government in ensuring that the announced consultation progresses quickly. We are very grateful to Shine and other charities for their tireless promotion of this important issue. Until we know the outcome of the consultation, it is too soon to consider which legislative vehicle might be needed to give effect to any decision, but the consultation process will allow us to make a decision once we have that outcome.

We very much hope that the consultation will raise public awareness of the need to continue to take the recommended folic acid supplement before conception and up to the 12th week of pregnancy. That is vital, as we have heard, and I really hope that this message can be brought to the attention of women both now and in respect of any future change. I am confident that this public consultation will give a proper channel to allow everyone to make their feelings on this issue known. I am sure that everyone who has participated in the debate will very much look forward to its outcome.

Question put and agreed to.

Resolved,

That this House has considered folic acid fortification.

World Menopause Day

Nigel Adams Excerpts

Thursday 18th October 2018 Commons Chamber

[The Lord Commissioner of Her Majesty’s Treasury (Nigel Adams)]

I congratulate the hon. Member for East Lothian (Martin Whitfield) on securing this very important debate on World Menopause Day. This is a very welcome opportunity to discuss, and raise the profile of, the menopause. Is it not encouraging that a man has come to this Chamber on World Menopause Day and introduced this debate? Who would have thought, a couple of years ago, that that would happen? Who would have thought that a male Minister would be responding to this debate? Well, a week ago, I did not think I would be doing that, but it has been an absolute privilege for me to listen to the contributions made here today.

It is fantastic to see the hon. Member for Motherwell and Wishaw (Marion Fellows) in her place. She talked about how nervous her daughter was about what her speech might contain. I can tell the hon. Lady that there are those who are very nervous about what my speech might contain, not least in the Adams household, and also in the Whips Office. As Members can see, I am surrounded by Whips today, so I am going to stay on message, especially if I am to stay in the sisterhood referenced by the hon. Member for Swansea East (Carolyn Harris).

I am here today on behalf of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price). She has responsibility for women’s health and would very much have liked to be here to discuss a topic that she is incredibly passionate about. She has taken a very close interest in women’s health, including the menopause, and I know that she will be watching this debate.

The debate has provided us with a number of positive opportunities. First, we, as Members of Parliament, can play a role by helping to raise awareness of the menopause and by encouraging people to have more open conversations about this topic. This is a very significant life stage for every woman, as we have heard, and it has been all too rarely discussed in the House. Today, we have this opportunity to put that right.

Secondly, this debate gives us the opportunity to reflect on the positive things that employers and the health system are already doing to support women who are suffering from menopausal symptoms. More women are likely to have a better experience of the menopause if we share and promote the best examples of existing support.

We also have the opportunity to discuss what more needs to be done. We know, for example, that there are inconsistent levels of awareness around the menopause, and that that reflects a history of stigma attached to the issue. The benefits of tackling stigma head on and having the right menopause support in place are clear. That is the right thing to do for women who are suffering from adverse symptoms or who feel unable to have open conversations about how they are feeling.

Openness, as we have heard, goes for men as well as women. It is important that we improve how we educate men about the menopause for the benefit of their partners, relatives and colleagues—and, crucially, for the benefit of their own understanding. There is also a strong argument based on economic inclusion. Our national workforce is ageing, and positive action by employers will benefit employee engagement, productivity and retention.

We cannot stress enough that the menopause is a natural part of ageing and will be experienced in one way or another by every single woman. As we have heard from several Members, every woman will experience the menopause differently, and the types and severity of symptoms can vary. The menopause can occur naturally or be triggered or accelerated by medical interventions such as some surgeries or cancer treatments. The menopause can have physical and non-physical symptoms, but both can cause discomfort and, in many cases, social embarrassment. There are clear consequences for wellbeing. Women experiencing troublesome menopausal symptoms report lower health-related quality of life and greater use of healthcare services than women without symptoms.

Let us look at the numbers. There are more than 3.5 million women between the ages of 50 and 65 in employment in the UK. One in four women in the workplace is going through or has gone through the menopause. Over half of those women report that they experience symptoms that impact their work. The number of women over the age of 50 continues to grow, and the employment rate for women in the UK has never been higher. Women go through the menopause at a life stage when they are often dealing with demanding responsibilities such as work, caring for elderly relatives and dealing with teenage and adolescent children. Difficult symptoms can really add to the challenges of life.

No two menopauses are exactly alike. That is why the guidance produced by NICE recommends adopting an individualised approach at all stages of diagnosis, investigation and management of menopause. NICE also recommends that information on menopause is given in different ways, to encourage women to discuss their symptoms and needs.

Hormone replacement therapy can be an effective way of relieving many menopausal symptoms, as well as preventing osteoporosis. Usually, women may start HRT as soon as they begin experiencing menopausal symptoms, and their GP can advise on the different types of HRT that are available. However, HRT is not always the most suitable treatment, and women can discuss alternatives with their GP. Psychological interventions can be helpful for symptoms of anxiety or for those suffering from low mood. When making judgments about treatment, healthcare professionals can draw on advice from the British Menopause Society, a specialist society affiliated to the Royal College of Obstetricians and Gynaecologists.

But we can always do more. I know that the Mental Health Minister, my hon. Friend the Member for Thurrock, is leading work on improving women’s health and their experiences of healthcare. Her work partly focuses on raising awareness and breaking taboos—we have heard that word many times this afternoon—around common health morbidities, such as problem periods and incontinence. She is working closely with the Royal College of Obstetricians and Gynaecologists to achieve that. I know that one of her concerns is that women’s experience of the diagnosis and treatment of common gynaecological issues is not always what it could be. The all-party parliamentary group on women’s health pointed that out in its report earlier this year, and I am sure that the Minister will have more to say about that when she returns to the Commons.

For many women experiencing the menopause, the best help often comes from other women. Services can build on that support so that women can make lifestyle choices that will help to give them a better experience of the menopause, including stopping smoking, exercising regularly and eating healthily. Partners in the healthcare system can also offer support. Menopause Matters is a website that provides up-to-date information about the menopause and treatment options, as well as hosting a forum for women to discuss their experiences of the menopause. The Daisy Network is a charity that provides information and support specifically for women who are going through premature menopause.

As has been mentioned several times this afternoon, we also need to look to workplaces as a source of support for women with menopausal symptoms. Many women report that they feel they do not have the opportunity to have open conversations with their employer about menopausal symptoms at work. That needs to change—I am specifically targeting these remarks at male managers in the workplace. This has to change. If two men can get up in the House of Commons and talk about the menopause, male managers in the workplace should be doing exactly the same.

We know from a 2017 review of the effects of menopause transition on women’s economic participation that the menopause is not well understood or provided for in workplace cultures, policies and training. Sources of guidance are available for employers who want to do more to support women with menopausal symptoms. The Faculty of Occupational Medicine has produced a factsheet and infographic on menopause and the workplace, as requested by the chief medical officer in her 2014 report on women’s health. It contains practical guidance for employers on how to improve workplace environments for menopausal women, and it stresses the importance of regular, informed conversations between managers and employees.

It can often be important for managers simply to acknowledge the menopause as a natural stage of life and reassure women that their employer is open to making adjustments that they may find helpful. Equally, some women may not be comfortable discussing their symptoms with a manager, and access to occupational health can also be very valuable. Specific actions that employers can take to help women experiencing menopausal symptoms include considering changes to working patterns or responsibilities, providing employees with sources of information about the menopause, and challenging taboos and negative expectations about the menopause.

There are good examples of employers—we have heard one or two in this excellent debate—who have taken action to make their workplaces menopause-friendly. We have heard from my hon. Friend the Member for Redditch (Rachel Maclean), who takes a really close interest in this issue. She spoke so passionately this afternoon, as she has done previously in this House. She highlighted the example of the West Midlands police, which provides tailored support that helps women to build their confidence and stay in the workplace. As the hon. Member for East Lothian mentioned, she has spoken openly and bravely on this subject in the Chamber on several occasions. I know she is also working closely with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock.

I want to respond to the question my hon. Friend the Member for Redditch posed about GPs not prescribing HRT on some occasions for women who need it. HRT can help to relieve most of the menopausal symptoms. The guidelines from NICE—NG23 on the diagnosis and management of the menopause—recommend HRT as part of an individualised approach to treatment and management, and women must be able to access the treatment they need to manage such symptoms effectively.

My hon. Friend, like the hon. Member for Swansea East, correctly mentioned teaching children about the menopause in schools, which is absolutely critical. The Government are making relationships education compulsory in all primary schools, sex and relationships education compulsory in all secondary schools and health education compulsory in primary and secondary state schools. The Department for Education has launched a consultation on the draft guidance and regulations, which closes on 7 November. I am sure my colleagues in the Department for Education will have heard the well-qualified remarks made this afternoon.

The draft guidance currently does not mention the menopause explicitly, but at primary level it includes teaching about puberty, menstruation and changes to the adolescent body, and at secondary level pupils will be taught about sexual and reproductive health and wellbeing, including fertility. The underpinning focus in these subjects is to equip young people to develop positive attitudes to health, relationships and wellbeing both now and as they progress through adult life.

[Martin Whitfield]

Does the Minister agree that when there is teaching about fertility in high school or secondary school education, the fact that the menopause is not mentioned almost plays into the taboo he mentioned earlier? Such a discussion is not had, and our children are therefore not getting a full picture or understanding of what is going to come to most of them.

[Nigel Adams]

I agree with the hon. Gentleman. It is absolutely crucial to have teaching about puberty, periods and reproductive health, which provides crucial opportunities for schools to refer to the menopause. I had no idea when my mother was going through the menopause, which was referred to as “the change”. She was very, very poorly. I remember being in the living room —my dad was at work—when the doctor was called. My mother was 50 years old and having a really bad experience. She was taken off to a mental institution. She was carted out of the house and ended up in what can only be described as a Victorian asylum. I am really glad that things have moved on in that regard—this was some time ago. It is absolutely crucial that we get to children early enough to make sure they understand the causes of a condition that affects every single woman.

Turning to the brilliant and characteristically brave speech by the hon. Member for Motherwell and Wishaw, she referred to the fact that every woman has a different type of menopause. That is absolutely correct. She talked about breaking the taboo around menopause and women’s health. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock, is leading work on improving the health of women and their experiences of healthcare. That work is partly focused on raising awareness and breaking taboos around common health morbidities, including problem periods and incontinence, not just the menopause.

The hon. Member for Motherwell and Wishaw also talked about sexual wellbeing during the menopause. It is important that women experiencing menopause have access to support and advice on that. It is common for women to lose interest in sex around the time of menopause, but treatments are available. We have heard that HRT often helps. If it is not effective, testosterone supplements can be offered.

The hon. Lady also rightly talked about the importance of the workplace. The hon. Member for Swansea East also wisely focused on that area. Workplace policies that take the menopause into account can benefit both women and their employers. The Government commissioned an evidence review into the menopause, which was published last July and highlighted the important role that employers can play in supporting women. Following that, the Women’s Business Council developed a toolkit for employers of all sizes, which enables employers to make the right adaptations to physical workplace environments, supporting flexible working and raising awareness to tackle this issue.

I want to close by restating the importance of approaching the menopause as a natural and normal stage of a woman’s life, while recognising that, as we have heard, for many women that life stage comes with some incredibly challenging symptoms. It is essential that all employers and health professionals are fully informed and ready to provide women with the best options for treatment and support. The right thing for individuals is also the right thing for our economy.

We have had a fascinating and fantastic debate this afternoon. It is important that we continue to speak openly and confidently about the menopause, so that embarrassment does not prevent women from accessing treatment and support where necessary. I thank all hon. Members for their brilliant contributions and for this opportunity to mark World Menopause Day.

Mental Health: Absence from Work

Nigel Adams Excerpts

Wednesday 17th October 2018 Westminster Hall

[The Parliamentary Under-Secretary of State for Housing, Communities and Local Government (Nigel Adams)]

It is a pleasure, as always, to serve under your chairmanship, Mr Betts. I congratulate my hon. Friend the Member for North Warwickshire (Craig Tracey) on securing this important debate and on putting his point across with such characteristic eloquence.

I was particularly struck by the recognition in the debate that employers and Government both have a stake in the nation’s mental health. The Government provide the necessary health support, offer a safety net when people are out of work and promote the right action in the workplace. However, employers are increasingly recognising that they have a crucial role to play in creating healthy workplaces to enable their employees to remain in work and thrive, providing a supportive environment in which their employees can discuss health issues, and helping people return to work promptly when they fall ill.

Mental health is a matter of national importance. It is particularly relevant this month, following World Mental Health Day on 10 October, during which the Prime Minister announced that the Government are providing £1.8 million over the next four years to cover the cost of calls to the Samaritans helpline. This will enable more people to receive support when they reach out for help.

The Prime Minister is personally committed to improving mental health services and addressing one of the most burning injustices in our society. As we have heard, the Government are backing that up by investing record levels in mental health, with annual spending reaching just under £12 billion last year. In addition, the Prime Minister announced a five-year funding settlement, which will see the NHS budget grow by more than £20 billion a year in real terms in the next five years. In return, she has asked the NHS to develop a long-term plan for the next 10 years. She has been clear that mental health needs to be a key element of that.

Financial difficulties can have a serious detrimental impact on mental health, but mental health problems can devastate our finances, too. As we heard from the hon. Member for Dewsbury (Paula Sherriff), one in four people who suffer from mental health problems may have debt problems as well. Supporting people with their financial resilience is vital. We are committed to addressing issues faced by people who fall into problem debt. This year, the Government commissioned the Money Advice Service and spent just over £56 million to provide help to more than 530,000 people.

The NHS provides some services to people who may be experiencing the symptoms of debt problems or financial difficulties. Mental health services, including improving access to psychological therapies, may also signpost patients to debt advice services as part of their care. In our 2017 manifesto, we committed to developing a breathing space scheme for people in problem debt. We will publish a consultation shortly and lay before the House regulations on breathing space by the end of 2019. The Prime Minister has also announced a review of the practice of GPs charging patients to complete debt and mental health evidence forms. We are considering options to end the need for GPs to charge their patients to provide this information to their creditors, and I know that that will be welcomed.

We know that too many people with a mental health condition do not participate fully in key activities of society, including work. The figures are stark: people who are unemployed for more than 12 weeks are between four and 10 times more likely to suffer from depression and anxiety. That is why this Government are committed to supporting people with mental health conditions who are out of work, including through our Jobcentre Plus network. All work coaches across the network receive training on supporting people with health conditions and disabilities. In addition, the roll-out of the health and work conversation across the UK supports work coaches to continue to build engagement with claimants who have disabilities and health issues.

The Government also continue to invest in mental health-related trials and studies. These include doubling the number of employment advisers in IAPT services and launching a £4.2 million challenge fund to build the evidence base of what works to support people with mental health conditions, as well as musculoskeletal conditions.

The good news is that staying in or returning to work after a period of mental ill health can help mental health recovery. Good work supports our good health. It keeps us healthy, mentally and physically. It enables us to be economically independent and gives us more choices and opportunities to fulfil our other ambitions in life. Our Command Paper, “Improving lives: the future of work, health and disability”, which was published jointly by the Department of Health and Social Care and the Department for Work and Pensions last November, sets out a comprehensive strategy for achieving the Government’s challenging target of ensuring that 1 million more disabled people are in work by 2027.

Given the scale of this ambition, a key part of our programme is to achieve transformational change by focusing action on three key areas: welfare, workplace and health. We have made good progress. Employment rates are at historic highs and the number of disabled people in work reached 3.5 million in 2017, having increased by nearly 600,000 since 2013. The Government recognise the crucial role of employers in creating mentally healthy workplaces. Too many people fall out of work because of their mental health. We are asking employers to do more to prevent that.

That is why, as we heard from my hon. Friend the Member for North Warwickshire, in January 2017 the Prime Minister commissioned Lord Dennis Stevenson and Paul Farmer, the chief executive of Mind, to conduct an independent review into how employers can better support all employees, including those with mental ill health or wellbeing issues. The review set out a compelling business case for action, with the central recommendation that all employers should adopt a set of six core mental health standards to encourage an open and transparent organisational culture that supports employees’ mental health. Those standards included developing mental health awareness among employees, encouraging open conversations about mental health and routinely monitoring employee mental health and wellbeing.

The review went further by recommending that all public sector employers, and private sector companies with more than 500 employees, deliver mental health enhanced standards, including increasing transparency and accountability through internal and external reporting. We have made progress with implementation and are developing with partners, including employers, a framework for voluntary reporting on mental health and disability. We will publish supporting guidance, including on the important issue of how to encourage employees to disclose health issues.

It will take time before we can call all of our workplaces truly healthy and inclusive, but we have been encouraged by the level of engagement and commitment to this agenda. Momentum is building around the challenge to all employers to adopt the core standards that lay the basic foundations for good workplace mental health, and to larger businesses to adopt the enhanced standards. Following the Prime Minister’s acceptance of the Stevenson-Farmer recommendations as they apply to the NHS and the civil service as major employers, both organisations are making progress.

Working in partnership is vital. The Government recognise the collaborative approach that has created the new mental health at work gateway, which is aimed at employers, senior management and line managers, to help them to support a colleague, challenge the stigma or learn more about mental health in the workplace. Looking at the wider system in which employers make decisions, the Government are committed to reforming the current system of statutory sick pay so that it supports more flexible working, which can help people to return to work after a period of sickness.

I will use this opportunity to take a moment to address some of the points raised by hon. Members in the debate. I will come on to my hon. Friend the Member for North Warwickshire shortly. The hon. Member for Strangford (Jim Shannon), who gave a characteristically eloquent exposition of the issues, talked about employees sharing responsibility. I could not agree more, and nor could the Government. Employers have a key role to play in creating good working conditions and providing supportive line management so that people have the opportunity to speak out about issues and keep in contact with employees. I was encouraged by what he said about ensuring that his own staff took breaks and had some downtime during the working day.

It is also important that we keep in contact with employees who happen to go off sick. The Government have worked with Mind to produce a new website resource, and we are reviewing current obligations and incentives to see what we can do to encourage more good behaviour. The hon. Gentleman talked about suicide prevention; as hon. Members will be aware, on World Mental Health Day the Prime Minister announced not only the appointment of my hon. Friend the Member for Thurrock (Jackie Doyle-Price) as Minister for suicide prevention, but, as I mentioned earlier, almost £2 million to cover the costs of calls to the Samaritans helpline, where there will be help for people who reach out.

The hon. Gentleman also talked about parity of esteem for mental and physical health. It was this Government who legislated for parity of esteem by making mental and physical health an equal responsibility for the NHS in the Health and Social Care Act 2012. We are also backing our commitment with a significant increase in funding.

We are all extremely delighted to see the hon. Member for Motherwell and Wishaw (Marion Fellows) in her place, and it was a genuine pleasure to hear from her. It takes enormous courage to admit that one has suffered mental health problems, so to hear that from the hon. Lady was incredibly moving, and it was a privilege to be in the Chamber for that moment. It is important that employers create the right supportive environment. One thing we are doing is investing to make sure that there are 1 million mental health first aiders in the workplace, which is crucial.

The hon. Lady talked about the impact of low wages, and I agree with her. That is why we introduced the national living wage and are providing in-work financial support through tax credits and now through universal credit. That also makes it easier for people to move in and out of work, removing difficult transitions. She mentioned work capability assessments; it is true that they are designed to determine benefit eligibility, but they should not be viewed in isolation. We provide personalised and tailored support through work coaches in our jobcentres.

Moving on to the remarks of the hon. Member for Dewsbury, I politely and gently remind her that the funding picture in the NHS is not quite so gloomy as she painted it. We are backing our commitments with some significant funding increases in this space. We have record levels of investment in mental health, with annual spending reaching just under £12 billion just last year. The Prime Minister, as I have mentioned, has announced a five-year funding settlement. That is not the picture that the hon. Lady paints.

[Paula Sherriff]

How would the Minister respond to the professionals I speak to every single week, who tell me that mental health services—particularly child and adolescent services—are in crisis; that on some weekends there is not a single psychiatric bed available in the country; and that people are travelling up to 300 miles to get an inpatient psychiatric bed? Perhaps there are positives out there, but it is difficult to say that things are not so gloomy when that is what I hear every week.

[Nigel Adams]

The hon. Lady makes a fair point. The need to travel hundreds of miles out of area, in some cases, for inpatient treatment is something that we desperately need to tackle, and we are tackling it. That is why we are putting in the investment. I gently remind her again of the additional £20 billion a year in real terms for the NHS over the next five years. Nobody is saying that this is a perfect situation, but we are matching our words with real-terms cash and investing a further £1.4 billion for mental health services for children and young people, which I am sure she would support.

We briefly mentioned the Stevenson-Farmer report, and I remind the hon. Lady that we responded in full through the “Improving Lives: the Future of Work, Health and Disability” Command Paper and fully supported all 40 recommendations of the Stevenson-Farmer review. Progress is being made, and has been made, on implementing those recommendations.

My hon. Friend the Member for North Warwickshire raised the role that the insurance industry can play. We recognise the positive aspects of group income protection for helping to retain sick employees, in particular access to expert-led health services and the financial certainty it offers individuals. I am not entirely sure that the product is widely known out there in the business space; I have run businesses for the last 20-odd years and was not aware that such insurance products were available. I very much hope that my former colleagues are tuned in at this precise moment and will do some research on it.

GIP is clearly a product that works well for those employees who choose to buy it, and we encourage the industry to continue to promote its benefits. I am sure the Association of British Insurers is doing a good job of that. However, we believe that small and medium-sized enterprises, in particular, lack sufficient incentives to invest in GIP as it is currently structured, because they often choose not to offer sick pay for periods beyond statutory requirements. That is why we have been looking more broadly at incentives and obligations on employers. We will continue to engage with the industry, and I know that the ABI will play a big role in that as well. We are listening closely to employers’ views about the appropriate products that retain the positive aspects of GIP and that overcome the existing barriers to increasing take-up.

By working with our partners, including employers, the Government can continue to tackle poor mental health, ensuring that disabled people, and people with physical and mental health conditions, go as far as their talents can take them.

Eating Disorders

Nigel Adams Excerpts

Tuesday 16th October 2018 Westminster Hall

[The Parliamentary Under-Secretary of State for Housing, Communities and Local Government (Nigel Adams)]

I congratulate the hon. Member for Bath (Wera Hobhouse) on securing this incredibly important debate on a topic that is a key priority for the Government and for the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who unfortunately cannot be here; that is why I am responding to the debate.

It is clear from the testimony we have heard today that having an eating disorder can be devastating. The hon. Lady is absolutely right that people should have the correct mental health support—in the right place, at the right time and, most importantly, without the fear of stigma.

Eating disorders are serious, life-threatening conditions with the highest mortality rates of any mental health disorder. They can have severe psychological, physical and social consequences and they often start and are prevalent when people are young. We know that early intervention is absolutely vital, as noted by the hon. Member for Dewsbury (Paula Sherriff), and we recognise how important it is that everyone with an eating disorder can access quick, specialist help when necessary. That is why we set up the first waiting times, in order to improve access to eating disorder services for children and young people, so that by 2020-21 some 95% of children with an eating disorder will receive treatment within one week in urgent cases and within four weeks in routine cases.

Latest available waiting time figures for children and young people with an eating disorder indicate that NHS England is on track to meet that standard by 2020-21. First quarter data showed that 74.7% of all patients started urgent treatment within one week and over 81% of patients started routine treatment within four weeks. The number of people who are seeking treatment is rising and it is greatly encouraging to see a commensurate increase in patients getting the care they need, as well as a significant reduction in waiting times compared with last year.

However, there is further to go. Beat, the eating disorder charity referred to this morning, which does fantastic work, reports that on average it takes people over a year to seek help after first recognising the symptoms of an eating disorder. We recognise the importance of raising awareness and reducing stigma so that more people feel able to talk about their eating disorder and to seek treatment.

In January 2017, the Prime Minister committed to making mental health first aid training available to all secondary schools, aiming to have trained at least one teacher in every secondary school by 2020. In the first two years of the programme, over 2,000 school staff have received training, helping to reduce stigma in school environments. The Government have also committed to equip 1 million people to be better informed about looking after their own mental health. Public Health England is leading the development of a £15 million national mental health campaign called “Every Mind Matters”. The first pilot began earlier this month in the midlands, ahead of a national launch next spring.

I move on to community services for children. In-patient treatment should be seen as a last resort wherever possible, which is why the Government announced in 2014 that they would invest £150 million to expand and improve eating disorder community-based care. We are making good on this promise and as a result 70 dedicated new or extended community services are now either open or in development. This has led to swift access to effective eating disorder treatment in the community, with the number of children and young people accessing treatment increasing from 5,243 in 2016-17 to 6,867 in 2017-18.

The services are designed to give young people with eating disorders and self-harm issues early access to services in their communities, provided by properly trained expert teams that deliver evidence-based psychological and medical intervention, aiming to avoid the need for hospital stays. By improving care in the community, we can improve outcomes and recovery, reduce rates of relapse or prevent eating disorders continuing into adulthood and, if admission is required as a very last resort, reduce lengths of stay.

I will now address some of the issues raised by hon. Members in the debate. The hon. Member for Bath made a series of incredibly important points, particularly about training for GPs. Early identification is crucial and it is vital that professionals look out for potential signs that indicate an eating disorder. GPs are trained to identify symptoms and help patients discuss the issues, but in response to the recommendations in the Parliamentary and Health Service Ombudsman report on the tragic death of Averil Hart, as referenced by the hon. Member for Dewsbury, Health Education England is reviewing its current education and training offer and, crucially, identifying any gaps. It is working with eating disorder experts to scope existing evidence-based practice, to inform any new education and training resources.

The hon. Member for Dewsbury was right to mention that being under weight and body mass index are not good criteria for treatment. The NICE guidance is clear: rejection for treatment on the grounds of weight and BMI is not in line with any of the published guidance and should not occur. The hon. Lady also mentioned travelling too far for treatment, as did the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron). We are committed to ensuring that everyone with an eating disorder has access to timely treatment, as close to home as possible. That is why we are seeing a shift to community services, to try to reduce, wherever possible, out-of-area placements. The hon. Lady talked about ring-fencing funding for these services. This is important too, as local areas need to fund services based on local needs. That is why I was alarmed to hear the figures from the hon. Member for York Central (Rachael Maskell). I will ensure I take this up with our local clinical commissioning group. As the hon. Member for Bath said, funding must reach the frontline. We already have in place the 70 community services, designed to give young people with eating disorders early access to services in their communities.

My hon. Friend the Member for Angus (Kirstene Hair) talked about having the confidence to speak out. She is right and we welcome Beat’s work in helping to improve awareness. I am delighted that the hon. Member for East Kilbride, Strathaven and Lesmahagow will be meeting my hon. Friend the Member for Angus, following her powerful speech. The hon. Member for Islwyn (Chris Evans) brought up an awful case concerning a constituent. I can assure the hon. Gentleman that my officials have heard what he said and, with his permission, we will follow up and make sure the Department of Health and Social Care comes back to him about that case. The hon. Member for East Kilbride, Strathaven and Lesmahagow was correct to mention service provision in rural areas.

Several hon. Members raised the issue of social media, including my hon. Friend the Member for Boston and Skegness (Matt Warman), the hon. Member for Enfield, Southgate (Bambos Charalambous) and, not least, the hon. Member for Strangford (Jim Shannon). It would be very unwise of me to attempt to keep up with the Shannons, but I can tell the hon. Gentleman that the Government recognise the impact that social media can have on mental health. Increasing evidence is showing that excessive social media use may have a detrimental effect on young people’s mental health.

The hon. Members for East Kilbride, Strathaven and Lesmahagow and for Enfield, Southgate also raised body image, as did the hon. Member for Islwyn in his incredibly powerful and moving speech. Those promoting the perfect body image should be forced to watch this debate, to listen to the testimony we have heard and to be made to think about what they publish and the devastating impact it can have.

To conclude, I extend my thanks again to the hon. Member for Bath for securing the debate and all hon. Members here today for their powerful speeches. I am proud of the work the Government are doing to improve eating disorder services. We have a long way to go. I am also proud of the incredibly brave young people who have come here today to listen to the debate and who have been mentioned in the speeches. I hope I have been able to provide some reassurance that we are absolutely committed to reducing the stigma associated with all mental health conditions, including eating disorders.

Homelessness among Refugees

Nigel Adams Excerpts

Tuesday 17th July 2018 Westminster Hall

[The Parliamentary Under-Secretary of State for Housing, Communities and Local Government (Nigel Adams)]

I congratulate the hon. Member for Stretford and Urmston (Kate Green) on securing this crucial debate. It was a little interrupted, and I am grateful to hon. Members for coming back to the Chamber to hear a response from the interim Minister—I guess we are all interim Ministers in this job, as it is ultimately down to the will of the electorate.

[Melanie Onn]

Is the Minister going to resign as well?

[Nigel Adams]

I have no intentions in that regard.

I thank the hon. Member for Stretford and Urmston for her work in this area. Her important work with the all-party group on refugees has raised the profiles of issues that impact on refugees, and I thank all right hon. and hon. Members for their contributions today.

We have a proud history of providing protection for those who need it, and the Government are committed to ensuring that all refugees can take positive steps towards integration and realise their potential. This country should work for everyone, especially the most vulnerable in our society, and we remain committed to ensuring that everyone has a roof over their heads and receives the support they need to rebuild their lives.

As hon. Members have said, our manifesto pledged to halve rough sleeping during this Parliament and end it altogether by 2027, and that is in addition to an ambitious homelessness reduction programme. We are making good progress on our refugee resettlement commitments. Last year, more than 6,000 vulnerable refugees received protection under one of our resettlement schemes, and we are now more than half way towards meeting our commitment to resettle 20,000 refugees fleeing the Syrian conflict by 2020. There is much good practice from the Syrian vulnerable person resettlement programme, and we will build on that as we go forward.

A key commitment in the Government’s integrated community strategy was to work with civil society, and others, to increase the integration support available to those granted refugee status after arrival in the UK. That is a significant development in our approach, which recognises the importance we place on integration for all refugees. We agree that for newly recognised refugees, securing accommodation and accessing benefits or employment are crucial first steps without which longer term integration simply cannot happen. That is why we have introduced a number of initiatives to support refugees during the 28-day move-on period, to which the hon. Member for Stretford and Urmston rightly referred.

The post-grant appointment service is a joint initiative with the Home Office and the DWP, which helps refugees access benefits by arranging an appointment with a local DWP office—a jobcentre. The process is now being rolled out across the UK. Hon. Members referred to the pilots and issues that have been found in them. It is crucial that we monitor the progress of this work. I am sure that my colleagues at DWP have heard such comments and will follow up on them. The process has been rolled out. We plan to publish information about the schemes shortly, but the indicators are that, provided refugees attend the appointment, benefit claims can be processed quickly and a payment can be provided, before the 28-day move-on period expires.

MHCLG is currently funding the first year of a two-year pilot of 35 local authority asylum support liaison officers in 19 local authority areas in England with some of the highest numbers of asylum seekers. They will offer tailored support to newly recognised refugees. That will include working closely with the local authorities and a range of third-sector agencies during that 28-day move-on period, to secure accommodation for new refugees to move into, following a successful asylum decision. That should thereby reduce this vulnerable cohort’s risk of homelessness and rough sleeping. We want to work with civil society, local authorities and other partners, to consider what more could be done to support newly recognised refugees in the move-on period and the longer-term journey to integration.

More broadly, homelessness and rough sleeping is a key priority for the Government. As I have mentioned, we have allocated more than £1.2 billion to tackle homelessness to 2020. That funding will assist people to get the help they need and prevent homelessness and rough sleeping in the first place. Newly recognised refugees are entitled to homelessness assistance from their local authority and will benefit from the changes we are implementing through the Homelessness Reduction Act 2017, which many hon. Members have referred to. That came into being in April. We believe it is the most ambitious legislative reform in decades. Some of the changes introduced in the Act should mean that more people, whether they have priority need or not, are receiving the right support. For clarity, the new duties in the Act include providing and developing personalised housing plans based on an assessment of that person’s need, help to find accommodation and to access debt advice, and, potentially and crucially, help towards finding work.

For refugees, I recognise that the 28-day move-on period is less than the 56-day prevention duty in the Act. Home Office accommodation providers for asylum seekers already have a contractual duty to notify the local authority of the potential need to provide housing where a person in that accommodation is granted status. Combined with support from LAASLOs, the post-grant appointment service and the strengthened multi-agency approach to preventing homelessness, this referral by those providers should mean that the refugees get a range of support to access mainstream accommodation and services within the 28-day move-on period.

In order to deliver the new duties under the Act, we have provided new burdens funding of £72.7 million to ensure that local authorities can deliver their new duties. Funding, however, is not enough to ensure the Act is implemented correctly. That is why we have created the homelessness support and advice team. They have worked with authorities over the last year on a range of issues, but in particular they have supported them in the implementation of the Act.

We are going further on homelessness by committing to halve rough sleeping, as I have mentioned previously, in this Parliament and ending it entirely by 2027. In answer to the hon. Member for Great Grimsby (Melanie Onn), the Opposition spokesman, we will be publishing the rough sleeping strategy this summer, to set out our plan on how to achieve this. We are taking action now through the rough sleeping initiative. It is providing £30 million this year and the money has been allocated to the local authorities with the highest numbers of people sleeping rough. It is the product of many months of work by our cross-governmental rough sleeping and homelessness reduction taskforce, supported by an advisory panel of experts from across the sector and local government.

We have announced £28 million for Housing First pilots in Greater Manchester, the West Midlands and the Liverpool city region, which will focus on housing around 1,000 people with some of the most vulnerable and complex needs. The pilots will provide individuals with stable, affordable accommodation and, more importantly, intensive wrap-around support, which will help them to recover from complex issues such as substance abuse and mental health difficulties, and to sustain their tenancies. We expect the first people to move into the accommodation in the autumn. I very much look forward to the positive impacts of those pilots being realised.

To help local authorities support non-UK national rough sleepers, the controlling migration fund has funded projects that are working to support rough sleepers into accommodation and employment, and to return home voluntarily where that is appropriate.

I would like to respond to a number of points raised by Members. I apologise if I do not manage to respond to them all, but I will write to everyone who has contributed today with full answers to the points raised.

The hon. Member for Stretford and Urmston asked whether refugees would be given priority in housing services. Newly recognised refugees are eligible for assistance under legislation for homelessness and must be provided with accommodation if they have priority need, for example, if they are pregnant or have children. If they have been supported by the Home Office, they are deemed to have a local connection with the local authority in which they have been accommodated.

The hon. Lady asked about local authority asylum support liaison officers and the assessment of how they are working, and tier one classification and national insurance. Each of the 19 pilot areas will produce a report at the end of the first and second years. My Department is in the process of deciding how the evaluation of the pilots will fit into a broader evaluation of the controlling migration fund. On conversation with the DWP regarding reclassification to tier one, I do not know the answer, but I will ensure that the hon. Lady is written to and that she is updated.

On national insurance cards, refugees do not need to have a national insurance number to claim benefits because DWP centres provide one if an individual does not have one. From January 2018, procedures were put in place that mean that the national insurance number is now printed on all biometric residence permits provided to refugees.

The hon. Lady talked about social housing allocations. Certain people must be given reasonable preference under social housing allocation schemes, including people who are homeless. That is to ensure that the priority goes to those who need it the most.

In the time I have left, I will try to respond to hon. Members who are here in the Chamber. The hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) mentioned the integrated communities strategy. The Green Paper, published in March, recognised the importance of integration for all refugees, as well as committing to working with civil society. The consultation closed on 5 June and we are currently considering the responses. Last week, we launched the £7 million integrated communities fund.

The hon. Member for Bristol West (Thangam Debbonaire), who does fantastic work on the APPG, asked about access to English classes. English language tuition is fully funded for refugees who are unemployed and looking for work. I know she raised lots of other points and I will certainly write to her on them. I am conscious that I want to give the hon. Member for Stretford and Urmston a short period to sum up.

[Kate Green]

I thank all hon. Members who participated in this excellent debate. It was really good to have interest from parties on both sides of the House, sharing the concern about how we welcome and look after refugees.

[Nigel Adams]

I apologise for interrupting the hon. Lady, but I did not manage to mention this point. I know that she is keen for the Home Office to engage with this matter and I will ensure that the relevant Minister from the Home Office meets her and interested colleagues to take these issues forward.

[Kate Green]

I am very grateful to the Minister. I am sure that the all-party parliamentary groups that my hon. Friend the Member for Bristol West (Thangam Debbonaire) and I chair will be very happy to facilitate that meeting.

As we heard in the debate, what refugees, in common with all of us, need to be able to settle and build their lives is a chance to be in contact with their families, a chance to have a decent job if they are able to work and, importantly, a chance to have a secure home. As the Minister, I think, has acknowledged, that requires a response right across Government, and I am very grateful to him for his offer to pass on details of this debate to his colleagues in other Departments.

We have obligations—international obligations and human rights obligations—to ensure that we care for refugees here properly, and that will require an approach that extends right across national and local government, as I have said. I hope that the promises that the Minister has made of new policies and strategies delivering an improved service for refugees will come to fruition and will mean that some of the problems identified in today’s debate become a thing of the past. I can assure him and his ministerial colleagues that if that is not the case, we will be back here again to press the case for action in the best interests of refugees.

Question put and agreed to.

Resolved,

That this House has considered homelessness among refugees.

Five-year Land Supply

Nigel Adams Excerpts

Wednesday 4th July 2018 Westminster Hall

[The Parliamentary Under-Secretary of State for Housing, Communities and Local Government (Nigel Adams)]

It is a pleasure to serve under you, Sir Christopher, for the first time in this hot seat. It is also a great pleasure to have listened to some fantastic contributions from colleagues from across the House.

I congratulate my hon. Friend the Member for South Suffolk (James Cartlidge). Everyone who has contributed to the debate has been an outstanding champion for their local area. It was heartening to hear so many passionate speeches from right hon. and hon. Members. Before I respond to some of the points made, I thank my hon. Friend for his continuing work to raise such important issues. He has great knowledge of the area and has spent many years of his professional life in the sector. I also read his well-informed “Red Box” piece in The Times today.

Many years before I was elected—before I had even considered going into politics—I asked the Member of Parliament for Selby at the time, the late Michael Alison, “What takes up most of your time?” He told me about the various issues, and I asked, “What about planning?” He said, “Planning is simple—I ignore it, don’t get involved in it and leave it to the council. That’s the way forward.” Times have changed a bit, because I think we can all agree that planning takes up an enormous amount of our time in this day and age.

I should point out that the Secretary of State, as Members know, has a quasi-judicial role in the planning system. I am sure everyone understands that it would not be appropriate for me to comment on the detail of individual decisions or plans, but I can talk about the issues that have been raised more broadly. I will set out our national policy aims and then speak more generally about the technical points of each case. I just need a steer on when I am meant to be finished by, following the 25-minute suspension.

[Eddie Hughes (Walsall North) (Con)]

Eight minutes past.

[Nigel Adams]

I have about nine minutes left—that is about right. My thanks go to a great Parliamentary Private Secretary.

Issues with the current five-year land supply model and slow build-out were a key feature of the housing White Paper. The Government are seeking to address that through a package of reforms to the planning system, including revising the national planning policy framework, which will be published this summer. The review of the NPPF is fundamental to delivering the 300,000 homes a year we need, and sets out a comprehensive approach to ensure that we get the right homes, built in the right places and to the right quality.

The revised framework implements around 80 reforms that were announced last year, and retains the emphasis on development that is both sustainable and locally led. Those changes include clearer expectations of local authorities and developers to deliver their commitment to unlock land, fulfil planning permissions, provide essential infrastructure, and ensure that homes are built to meet the diverse needs and expectations of communities. The measures include a standardised way of assessing local housing need; reforming the plan-making system to ensure that every part of the country produces, maintains and implements an up-to-date plan; and an opportunity for local authorities to have their five-year housing land supply agreed on an annual basis. The last two points are particularly relevant to today’s important debate.

It is important that local authorities plan effectively for the new housing required in their areas. Ultimately, new homes need to be provided through up-to-date local plans, produced in consultation with local people and communities. These are a vital element of the planning system. They are the starting point for planning decisions by planning authorities and inspectors. I welcome the progress that Babergh District Council, working with Mid Suffolk District Council, has made with their local plan preparations. I understand that the local authorities are aiming to submit them for examination by the Planning Inspectorate in spring next year.

It is important that adequate land is available to build the homes we need. Local authorities play their part by producing up-to-date local plans and identifying a five-year supply of housing sites. That provides clarity to local communities and developers about where homes should be built so that development is planned rather than the result of speculative applications. Every right hon. and hon. Member in the Chamber will have had experience of that. I have great sympathy with communities that feel that they have no control over planning, and nobody wants to see companies overtly gaming the system. However, we need more homes, and that is why communities should consider a neighbourhood plan—championed by many right hon. and hon. Members here today—to give them more control over the issue.

Demonstrating a deliverable pipeline of housing sites has been a long-standing Government policy. Since the existing NPPF was introduced in 2012, local planning authorities have been asked to identify and update annually a supply of specific deliverable sites, and to demonstrate a five-year land supply. Where the local authority cannot demonstrate that, the lack of supply means that plan policies are not considered to be up-to-date, and applications are assessed against the presumption in favour of sustainable development. However, the presumption in favour of sustainable development does not, and should not, mean development at all costs. Any adverse impacts of the development will still need to be taken into account.

The housing White Paper acknowledged that the current policy has been effective in bringing forward more permissions but has had some negative effects, as we have heard today from my hon. Friend the Member for South Suffolk. In response, we have proposed reforms to how land supply is calculated. The draft revised NPPF includes proposals to allow local authorities to agree their five-year housing land supply position on an annual basis and to fix it for a one-year period. The Department believes that taking up that opportunity should reduce the number and complexity of appeals, and provide greater certainty to all parties.

[James Cartlidge]

The Minister is making a fantastic speech. I am glad he has reached that point about appeals, because it seems to me very welcome that once someone has the five-year land supply and it has been signed off, they then have 12 months of security. At the moment, as soon as a council says, “We’ve got the five-year land supply,” there can be an immediate appeal by a developer and the certainty goes away. The issue therefore arises with councils that do not yet have the five-year land supply and do not have that security, but are giving many permissions. Can there be greater flexibility on that, as my hon. Friend the Member for Milton Keynes South (Iain Stewart) suggested?

[Nigel Adams]

My hon. Friend raises a valid point. We are hopeful that that will go a long way to eradicating some of the issues that he and right hon. and hon. Members have experienced. The idea is that it can be fixed at a one-year period. We will also see what other reforms are proposed as part of the review that my right hon. Friend the Member for West Dorset (Sir Oliver Letwin) is planning.

It is worth mentioning that in return for being allowed to agree their five-year housing land supply position on an annual basis and to fix it for a one-year period, local authorities will need to be more realistic in planning to meet housing needs. The draft NPPF includes further clarity on how to calculate five-year land supply, and we intend to provide further guidance to support local authorities in their role.

I know my hon. Friend the Member for South Suffolk has concerns about the time that it takes to build homes after sites are identified and permission is granted. The Government want homes to be built faster, and expect house builders to deliver more homes, more quickly and to a high standard. However, as my hon. Friend mentioned, it is important to recognise that after planning permission for new homes is granted, a variety of factors can prevent development from starting and can slow down delivery.

Last year, my right hon. Friend the Member for West Dorset was commissioned to examine what can be done to speed up building on major sites. The review has been looking into the build-out of sites that have been granted planning permission. The aim is to close the significant gap between housing completions and the amount of land permissioned for new homes. The initial analysis, which was published last month, has presented some interesting findings on the delays in building out large sites and what helps to speed up build-out rates. I look forward to reading the final report, which is due in the autumn.

Coming on to the points raised by right hon. and hon. Members, my hon. Friend the Member for South Suffolk talked about local communities not having a say on speculative development. Applications for speculative development are still subject to local consultation, as are all planning applications. He also mentioned, as others did, that existing permissions are not being taken into account. The draft NPPF encourages the use of shorter timescales for starting development before the permission will expire, to encourage developers to build the permitted homes more quickly.

The hon. Member for Stroud (Dr Drew), who is flying the flag brilliantly for Her Majesty’s Opposition, talked about viability assessments. We recognise those concerns and, again, the draft NPPF includes new policies on viability assessments. My right hon. Friend the Member for Arundel and South Downs (Nick Herbert) talked about burning effigies at the start of his speech; that was slightly worrying, as I live in York, where Guy Fawkes was from. I hope my right hon. Friend takes that into account. Neighbourhood planning protection was included in the draft NPPF. We consulted on the draft wording, and I thank him for his continued work and suggestions in this area. We are considering those responses and will publish the final NPPF in the summer.

My hon. Friend the Member for North Cornwall (Scott Mann), who I cannot see in his place, talked about what we are doing to encourage small developers. We need to support small and medium-sized house builders and bring forward a greater variety of sites. My hon. Friend the Member for Henley (John Howell), who does a fantastic job as the champion of neighbourhood plans, said that the Government do not know how many authorities have a five-year land supply. Guidance is being produced to advise local planning authorities on how to publish their supply figure, so it will be publicly accessible.

I thank and pay tribute to Councillors Lamb and Stephenson, the hard-working councillors of my hon. Friend the Member for Elmet and Rothwell (Alec Shelbrooke), who continue to fight for their local communities but appear to be being ignored by their local council, Leeds City Council. I hope that Leeds will have heard today’s debate and my hon. Friend’s excellent contribution. My hon. Friend the Member for North East Derbyshire (Lee Rowley) talked about the reporting of a five-year land supply. Alongside the—

Persistent Rough Sleeping in Nottingham

Nigel Adams Excerpts

Monday 2nd July 2018 Commons Chamber

[The Parliamentary Under-Secretary of State for Housing, Communities and Local Government (Nigel Adams)]

First, I would like to commend the hon. Member for Nottingham South (Lilian Greenwood) for securing such a worthwhile debate. I am sure the Under-Secretary of State for Housing, Communities and Local Government, my hon. Friend the Member for South Derbyshire (Mrs Wheeler), will have heard her kind words.

Homelessness and rough sleeping is an issue that I am sure is close to all our hearts. It goes to the heart of who we are as a people and as a society. The Government recognise the challenges in Nottingham and across the country in tackling rough sleeping, and we are absolutely committed to tackling it. That commitment is enshrined in our manifesto pledge to halve rough sleeping by 2022 and end it altogether, more importantly, by 2027. The hon. Lady rightly mentioned the report by Dr Bowpitt and Karan Kaur about the persistent rough sleeping in Nottingham, and I know that our officials will have noted it with interest. I will certainly be following that up with officials with some form of response.

As many right hon. and hon. Members will be aware, we are doing a significant amount of work in this area, and we will be publishing the strategy shortly. First, if I may, I will outline some of the work we are doing in this area nationally, as well as what we have been doing in Nottingham, to tackle rough sleeping. This March, we announced our new rough sleeping initiative, which has been mentioned. It comprises tried and tested measures designed to bring down the levels of rough sleeping in the immediate term. A key part of this is the £30 million that the hon. Lady mentioned, which we have provided to the 83 local authorities that are the most challenged by rough sleeping.

I know that the hon. Lady and other hon. Members from that fine city will welcome the fact that, as part of this fund, we have allocated it just over £420,000 from the rough sleeping initiative. This will enable the council to bring down rough sleeping numbers this year, before the annual count, and we are providing help through our new rough sleeping team. The team is made up of experts from the sector, as well as from charities and local authorities. It is part of our initiative to ensure that our ambition comes to pass. Nationally, the rough sleeping initiative funding will allow local authorities to recruit over 500 new staff focused on the problem. Crucially, that will include more outreach workers to engage with people on the streets, specialist mental health and substance misuse workers—they have been mentioned—and dedicated co-ordinators to drive efforts to reduce rough sleeping in their areas.

[Lilian Greenwood]

I want to record that I did not include in my speech reference to a new service in Nottingham, Edwin House, set up by Framework and the Recovery Nottingham Network. It is specifically providing residential detox, but also residential care in a controlled environment for people with a record of substance misuse. Would the Minister like to come and visit the service, which has opened only very recently, to see for himself the work that is being done in Nottingham?

[Nigel Adams]

I certainly would—any excuse to go back to Nottingham. I remember going there very often as a child to visit family, and I would very much like to do so. I am sure my diary secretary will be scribbling down something to ensure that we get it in the diary in the near future.

This initiative will also provide over 1,700 new bed spaces, including in both emergency and settled accommodation. As I mentioned briefly, another key part of the initiative is the rough sleeping team that we have established. It comprises experts from local authorities across the country, Government agencies and charities. They will support this work and ensure that resources are applied effectively. They are continuing to work in partnership with staff in each area to support local authorities, voluntary sector partners and others to ensure this work delivers the real change we need.

We were delighted to announce recently that the rough sleeping initiative will be led by Jeremy Swain. I am sure the shadow Minister, the right hon. Member for Wentworth and Dearne (John Healey), is very aware that he brings with him 30 years of valuable in the sector, most recently as chief executive of Thames Reach.

While the initiative is focused on bringing down rough sleeping numbers this year, there is an existing project, now in its second year—the hon. Member for Nottingham South referred to it—which has focused on Nottingham and neighbouring local authorities. The £20 million rough sleeping grants, announced in December 2016, have seen 48 local authorities take forward bespoke projects that are relevant to their area’s needs. In Nottingham, the city council has received £371,000 to establish a rough sleeper prevention service. As we have heard, this includes the roll-out of “No second night out” beyond the city and multi-disciplinary outreach services, such as the provision of health support. This has enabled support for more entrenched rough sleepers with complex needs. As hon. Members from the city know, the programme in Nottingham is now in its second year, and I am delighted to say that it supported more than 300 rough sleepers in the first year.

More broadly, to support local authorities to tackle homelessness and rough sleeping generally, we have committed £617 million in funding in the form of our flexible homelessness support grant. This ring-fenced fund gives local authorities more control and flexibility in managing local homelessness pressures. The hon. Lady will be encouraged to hear that, as part of that support grant allocation, Nottingham City Council has received £623,000.

As I have noted, tackling rough sleeping is a key priority not only for me, but for the Prime Minister and her Government. In order to meet our manifesto commitment to end rough sleeping for good, we are developing a cross-Government strategy that will make clear how we will achieve that. The development of the strategy is being overseen by a ministerial taskforce comprising relevant Ministers from across Whitehall. The taskforce is being support by a group of experts, in the form of our rough sleeping advisory panel. We are grateful to St Mungo’s for being part of the panel—I had the pleasure of speaking to its representatives this afternoon at the launch of its latest report. The strategy will set out the Government’s course of action for working with local authorities, the voluntary sector and the wider public sector to meet our aim of eliminating rough sleeping by 2027. We will be setting out further details shortly, but I can tell the House that our focus will be in three core areas—prevention, intervention and recovery—so that by 2027 nobody should have to sleep on our streets.

Before moving on to the other action that the Government are taking to tackle rough sleeping, I want to draw Members’ attention to the recent decrease in the number of people recorded as sleeping rough in London. Data from the combined homelessness and information network shows that there has been a decrease of more than 600 since last year. That is an encouraging sign, and we are committed to ensure that it continues, and at an increasing rate.

In pursuit of that objective, to support some of the most entrenched rough sleepers off our streets, we have announced three innovative Housing First pilots, to which the hon. Lady referred. The pilots will focus on around 1,000 of the most entrenched and persistent rough sleepers, making sure that they get the bespoke support and care they need to make a long-term recovery from their homelessness and rough sleeping. The £28 million fund that we have made available to support the pilots will provide individuals with stable, affordable accommodation and, importantly, intensive wrap-around support. That will hopefully help them recover from complex issues, such as substance abuse and mental health difficulties, and also sustain their tenancies so that they can stay in their homes. We expect the first people to move into the accommodation in the autumn, and I very much look forward to the positive impacts of the pilots being realised.

The hon. Lady asked about widening the Housing First programme. We will be analysing the results extremely carefully as soon as we get them. She asked whether there will be additional funding for the rough sleeping initiative after this year. We will announce the funding for 2019-20 shortly. She asked whether we will review the allocation of the Care Act 2014 in the strategy, and we will be looking at that—she made her arguments incredibly well, but I ask her to be a little patient. She also asked about the causes of homelessness and rough sleeping. We are certainly doing lots of work across Departments to ensure that we understand the causes fully. We will be commissioning a feasibility study to determine how we can carry out robust and useful research in that regard. She asked what we are doing about migration, with regard to people who are not entitled to benefits. The controlling migration fund provides local authorities with funding for projects to tackle rough sleeping by non-UK nationals, and funded projects are working with non-UK national rough sleepers in a range of ways, including supporting them to secure regular employment and accommodation, or facilitating a voluntary return to their country of origin.

The Homelessness Reduction Act 2017, which came into force in April, will fundamentally transform homelessness service delivery. I have seen some fantastic results in the borough of Southwark, where the provisions have been implemented for over 18 months. We are working closely with local authorities to examine the data on this, and we will be supporting them to implement the Act.

I thank the hon. Lady once again for bringing this worthwhile debate to the House. I hope that I have gone some way towards assuring her, and other Members representing Nottingham constituencies, that the Government are absolutely committed to tackling rough sleeping, and not just in Nottingham South but across the country.

Question put and agreed to.

Windrush: 70th Anniversary

Nigel Adams Excerpts

Thursday 14th June 2018 Commons Chamber

[The Parliamentary Under-Secretary of State for Housing, Communities and Local Government (Nigel Adams)]

Thank you, Mr Deputy Speaker. It is a great privilege to be at the Dispatch Box for the second time in front of your good self. I thank and commend the hon. Member for Dulwich and West Norwood (Helen Hayes) for securing this fantastic but vital debate. It has been incredibly powerful, and I congratulate all right hon. and hon. Members on sharing stories and memories of their families and those of their constituents. We have had passionate, brilliant and moving contributions not just from the hon. Member for Dulwich and West Norwood, but from my hon. Friend the Member for Tonbridge and Malling (Tom Tugendhat) and the hon. Members for Glenrothes (Peter Grant), for Bath (Wera Hobhouse) and for Brent Central (Dawn Butler). We also heard, yet again, an incredible speech from the right hon. Member for Tottenham (Mr Lammy). I hope to be able to address some of the points raised in the time that is left.

Seventy years ago, in 1948, Britain had just emerged from an exhausting, destructive but victorious second world war. The country was making key decisions about its future direction, its prosperity and its position in the world. We rose to the challenge in that year by creating the national health service and by hosting the global community at the London Olympic games.

[Damien Moore (Southport) (Con)]

I had the opportunity to learn about the Windrush generation at university. Does my hon. Friend agree that we should give children in schools the opportunity to learn about the contribution that that generation made to this country in getting Britain back up off her knees after the second world war?

[Nigel Adams]

That is a very fair point. It is incumbent on schools and on teachers to ensure that the Windrush generation is included in the curriculum, because children could learn an awful lot as a result.

As has been discussed today, another seminal and momentous occasion took place as the United Kingdom welcomed the HMT Empire Windrush at the port of Tilbury on 21 June 1948, and what followed the day after has been subsequently and regularly debated in this House. While it should be recognised that black British history does not start with the Windrush, the arrival of 492 West Indians, many of them ex-servicemen and women, has become synonymous with the first wave of mass migration and the beginning of modem British multicultural society. Those people include Alfred Gardner, who lives up the road from me in Leeds. I understand that he is still going strong at the great age of 92, and I am sure that the whole House sends Alfred its best wishes.

Many from the Windrush generation left their homes to answer the call to come to a strange, foreign and cold land in order to help rebuild the mother country. The welcome for many from that community, and many other communities that followed, was mixed at best. I would not do this debate justice if I did not mention and recognise the struggle to adjust and to put down roots, with many arrivals receiving a hostile reception. A well-documented phrase present outside many houses at the time was “no blacks, no Irish, no dogs”. As a white man brought up here, it is difficult for me to understand how terrible the Windrush generation would have felt as they walked the streets of London and other cities looking for accommodation. Many people have stories about that and other appalling discriminatory times in the UK. The unique challenges for acceptance, integration and recognition were most noticeable in the Notting Hill riots of 1958, the Race Relations Act 1965 and the Scarman and Macpherson reports, to name but a few, and this struggle has come to symbolise part of the story.

[Mr John Hayes]

Earlier I mentioned the British Caribbean Association, with which a number of Members will be familiar. The association was formed following those riots in Notting Hill in the year of my birth, and it was formed precisely to foster good relations between the indigenous people and those incoming people—people with very much the values the right hon. Member for Hackney North and Stoke Newington (Ms Abbott) tellingly identified in her speech. The welcome those people deserved but did not get does not mean the Government should now take an approach of unrestricted immigration, and it certainly does not mean conflating the Windrush issue with illegal migration. The right hon. Lady is absolutely right that that conflation is very unhelpful, and very unhealthy, too.

[Nigel Adams]

My right hon. Friend makes an incredibly important point, and the right hon. Member for Hackney North and Stoke Newington (Ms Abbott) made it, too. Conflating the two issues is deeply damaging to this debate, and we all have to be mindful of that.

Nevertheless, the enduring spirit of the Windrush generation to overcome this struggle, hardship and adversity must not be understated or dismissed. This is part of our history, and we should all be proud of the patriotic, courageous men and women who, in spite of adversity, helped to rebuild this country after the war and have therefore enriched us not just economically but culturally and socially.

Several hon. and right hon. Members have rightly mentioned the Grenfell tragedy, which is particularly important today. The Grenfell fire was a terrible tragedy that should never have happened, and today is a time for reflection. My focus, and I am sure the focus of everyone in this House, is firmly on the community who were affected. Today we all remember those who lost their lives and the families and friends who lost loved ones on that terrible day. It is incredibly important that we respect the privacy of the community at this time.

The hon. Member for Dulwich and West Norwood, in her brilliant speech, asked whether we would be announcing an annual Windrush Day, which the right hon. Member for Hackney North and Stoke Newington also mentioned. The United Kingdom has long been a country of inward and outward migration. Post-war immigration, including of people on the Empire Windrush who were at the forefront of that migration, means we are now a richly diverse society. Members of our minority communities have made an enormous contribution to our social, economic and cultural life, and this should be celebrated.

To make sure that we commemorate the Windrush anniversary in the appropriate way, my colleague Lord Bourne has met key figures from community groups over the past few months to decide how best to celebrate it. We thank all those stakeholders for the excellent meetings and for the work they have done together. We are keen to continue these engagements to ensure that our work on the Windrush celebrations extends beyond the 70th anniversary and to ensure a lasting legacy of this celebration of British history.

It is important that we celebrate the contributions of the Windrush generation and their descendants each year, as they are part of what makes us the wonderfully diverse country we are today. Further information will be announced very shortly.

The hon. Member for Dulwich and West Norwood went on to mention the Black Cultural Archives and the funding difficulties it has had. She asked whether we will work with colleagues in the Department for Digital, Culture, Media and Sport on tackling this fantastic facility’s problems. The financial difficulties of the Black Cultural Archives are well known to us, and we agree that more should be done to protect these vital archives. I am pleased to confirm that my colleague Lord Bourne of Aberystwyth has been speaking to colleagues at DCMS on this very issue.

My neighbour the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper), who is no longer in her place, asked about her Select Committee’s interim report on the hardship fund for the Windrush generation. We recognise the hardship that some of that generation have suffered, through no fault of their own. Sadly, that Select Committee does not scrutinise my Department, but I assure her that the relevant Department will respond in due course.

The right hon. Member for Tottenham gave a typically passionate and eloquent speech, in which he touched on the shameful practice of slavery. The transatlantic slave trade caused extreme suffering to millions of people, who lost their liberty and were forced to work as slaves. We have expressed our deep sorrow for what happened and fully recognise the strong sense of injustice that remains. We firmly believe that we should always remember history, no matter how difficult that history can be. He also went on to mention the hardship fund for the Windrush generation. He is absolutely right to say that we should design a compensation scheme that effectively addresses the issues faced by the Windrush generation, and to do that we have to listen. The Home Office has completed the call for evidence, which has given individuals and community groups the opportunity to share their stories and experiences.

The hon. Member for Glenrothes had the tricky job of following the right hon. Member for Tottenham, but he made a terrific speech.

[Ms Abbott]

I understand about the arrangements for compensation, but what about a hardship fund now—an interim hardship fund?

--- Later in debate ---

[Nigel Adams]

We have only a couple of minutes, but I can say to the right hon. Lady that I understand the Home Secretary has written to the right hon. Member for Tottenham to say that the hardship scheme remains under review. I am sure the Home Office will be coming forward with more on that. As I was saying, the hon. Member for Glenrothes made a fantastic speech, referencing his family history.

At this point, I wish to turn to the recent immigration issues faced by the Windrush generation. I would not want anyone who has made their life in the UK to feel unwelcome or be in any doubt about their right to remain here. I wish to conclude in order to give the hon. Member for Dulwich and West Norwood enough time to finish off the debate, so let me turn to what the Government have been doing to celebrate the Windrush generation, as it is also vital that we show our appreciation for what they have achieved.

Lord Bourne responded to a debate in the House of Lords in January to answer the question of what we are doing to support the 70th anniversary. As he said, he has set out to work with stakeholders across the country to ensure that the Government celebrate the anniversary in the most appropriate way. He has done exactly that, meeting the relevant stakeholders. There will also be a suite of events taking place across the country in areas with prominent connections to Windrush, including Hackney, Tilbury and Lambeth.

So in this year of seminal commemorative events, Windrush 70 stands alongside NHS 70 and Vote 100 as a hugely important reminder of the progress and achievements this country has made over the past century. The contribution of the Windrush generation and their descendants to Britain cannot be overstated—we would be much diminished as a country without their presence, and it is vital that we fully recognise the importance of Windrush communities to Britain’s history and present.