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backbench business
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World Antibiotics Awareness Week
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Julian Sturdy (York Outer) (Con)
I beg to move,
That this House has considered World Antibiotics Awareness Week.
It is a privilege to serve under your chairmanship, Mr Davies. Exactly one century ago, Ernest Rutherford split the atom and humanity entered the nuclear age. The groundbreaking discovery represented a momentous step forward for human progress, but at the same time it unleashed a challenge for those beyond the laboratory and academia—the avoidance of mutual assured destruction. As this debate is about World Antibiotics Awareness Week, some might wonder why I started with the splitting of the atom, but I believe that there is an equally strong argument for the aforementioned period to be referred to as the antibiotic age. It was 11 years after the splitting of the atom that Sir Alexander Fleming discovered penicillin, here in this very city of London.
No one can deny the profound impact of antibiotics on medicine, and their widespread use represents a watershed moment in our evolutionary story. However, as Fleming himself understood, shortly after making his discovery, giant leaps in scientific progress produced wholly new challenges. As antibiotics were readily available, it appeared that we had invented miracle drugs of sorts. The snag is that we now face the real and severe threat of antimicrobial resistance.
Across the globe this week, scientists and healthcare professionals are hosting a wide range of events to make antibiotic resistance a globally recognised health issue. I am delighted that we as parliamentarians are here today to represent the role that lawmakers and Governments will play in facing the challenge of antibiotic and antimicrobial resistance. The week is also intended to raise awareness of the need to preserve the power of antibiotics through appropriate use, to increase recognition that individuals, health and agricultural professionals, and Governments must play in tackling antibiotic resistance, and to encourage behavioural change and convey the message that simple actions can make a difference.
While the threat of antibiotic resistance is often considered a doomsday scenario—one might say a medical Armageddon—we must remember that that menace is all too deadly today. Currently, 700,000 people die each year from drug-resistant infections; the future threat is touted as being so severe and extreme, not because we are not living with the effects today but because of the truly appalling potential scale of the problem if we do not take co-ordinated action. If we do not act now, antimicrobial resistance will be responsible for 10 million deaths per year by 2050. That is more than the number of people worldwide who were killed by cancer in 2015. It is nearly impossible to put a number on the lives that have been saved by antibiotics; some sources put the figure at roughly 2 million, but it is entirely conceivable that we may arrive at a position where the balance tips, and antibiotics pose a greater threat than a remedy.
As I have said previously in this House, we run the risk of returning to a medical dark age, where routine operations such as hip operations cannot be carried out, and infections that are standard today become deadly. This week, the British Society for Antimicrobial Chemotherapy published a report on behalf of the all-party parliamentary group on antibiotics. The report, the briefing for which has been sent to all Members of the House, considers the AMR action plans and strategies set out by the World Health Organisation, the European Union and the UK, and asks, crucially: “Has the world lived up to the challenge?”
The overarching theme of the report is that future strategies to combat antibiotic resistance should incorporate specific, measurable, attainable, relevant and timely—SMART—targets. When the stakes are 10 million deaths each year within four decades, it is easy to become lost in the scale of response that that merits; but as is so often the case, a coherent and clear approach is our greatest weapon. I call on the Government to ensure that all steps are taken to counter AMR and explicitly to incorporate those SMART targets I listed. I believe there is much to be gained from making that standard practice and removing any doubt. I am sure that colleagues will be encouraged to read in the report that
“the UK has taken significant steps to meet the objectives of the EU Action Plan, which in turn satisfies the WHO Europe Strategic Action Plan.”
There are two aspects, however, where our country needs to up its game. First, we need to address education and public awareness, so it is entirely fitting that we meet today during World Antibiotic Awareness Week, an occasion aimed directly at bolstering an understanding of resistance and the threat it poses to humanity. We need to be forthright in promoting the “four rights” when consuming antibiotics: the right drug, the right dose, the right time and the right duration. A survey carried out across Europe in 2016 indicated that knowledge about AMR remains low, and antibiotic consumption has decreased by only 6% over the last seven years. To address that, the British Society for Antimicrobial Chemotherapy advocates the use of simple and clear language in all awareness-promoting material. There is a direct recommendation of
“monitoring the efficacy of education campaigns through online channels.”
Fleming himself was once quoted as saying that the best remedy for a common cold was a dram of whiskey.
Julian Sturdy
I know the Scottish Members would certainly agree with that. As Fleming said,
“it’s not very scientific—but it helps.”
We now need to make the message as clear as day: antibiotics are ineffective when taken unnecessarily and doing so bolsters resistance and endangers mankind.
The second area where significant progress can be made is on the incentives for antibiotic discovery, research and development. It should be noted that the antimicrobial challenge is as much economic as it is medical. We must find an alternative to the reimbursement model, whereby profitability of bringing new antibiotics to the marketplace is linked to volume of sales. That is because we are actually seeking to limit the use of such drugs to preserve their power; to use new drugs as a point of last resort, as it were. To use an analogy, it is almost like the fire service—we need it to be there and to be effective, but we do not want to use it. However, nobody would dispute the necessity of investment and funding for that key emergency service.
To overcome this task, it is essential that measures are taken to co-ordinate a review of progress in new drugs, alongside the activation of research and development by industry for new antibiotics and related products achieved by Innovative Medicines Initiative projects. On the economics, we need to seek innovative solutions, with the pricing conditions and “pull” measures needed for the long-term sustainability of new antibiotic development, so that they are promoted. An example of that is the compact initiative of the European Federation of Pharmaceutical Industries and Associations to promote a sustainable business model and adequate conditions for the introduction of effective new antibiotics.
The O’Neill review, published last year and described last week by a columnist from The Times as
“the best argued and most accessible”
report in his lifetime, was very clear on this matter. Lord O’Neill found that much more needed to be done to close the substantial gap in research and development funding between AMR and the best-funded areas of medical science. The report being launched this week quantifies this further, and states that $40 billion is needed over 10 years, representing about 0.05% of G20 countries’ current healthcare spend. I will not claim that that sum is insignificant, but it is certainly affordable given the magnitude of the threats we face.
For improvement on a global level, the report makes it clear that co-ordinated efforts must be made in the veterinary sector, where I am pleased that tangible progress has been made in the UK. Figures from the Countryside Alliance show that sales of livestock antibiotics across the sector have fallen by an average of 27%—their lowest levels since records began—which is a good start, because a failure to address AMR in livestock has fundamental implications for the treatment of human diseases. For that reason, mirrored co-operation between Government Departments is essential.
While I am delighted that we are joined by my hon. Friend the Under-Secretary of State for Health, this matter also encompasses the Department for Environment, Food and Rural Affairs, the Department for International Development and the Department for Exiting the European Union. We need a clear commitment from the Government that that co-operation is there and that an interdepartmental strategy is on the agenda. Beyond that, we require what Antibiotic Research UK describes as a “grand alliance” to come together, comprising the Government, the pharmaceutical industry, collective medical research charities and academics.
To reduce further the overall use of antibiotics in the veterinary sector, guidelines have been developed for prudent use. The EU road map also proposed the creation of an animal health legal framework, based on the principle that prevention is better than the cure. Take the example of colistin. In 2015, evidence emerged of colistin resistance with the potential for transfer and spread between bacterial species. In order to preserve colistin for human medicine and limit the spread of resistant genes, the European Medicines Agency imposed strict limitations on its use and recommended the withdrawal of marketing authorisations for all oral colistin in veterinary medical products. Professor Galloway, from the Royal College of Physicians and Surgeons of Glasgow, is calling for a full review of the use of antibiotics used in both animal husbandry and human clinical practices, and I believe the Government should actively consider that suggestion.
In the UK, some sectors have conclusively beaten the target set by the veterinary medicinal products directive. Such industries represent very clearly what we are aiming for with the SMART targets I referred to at the beginning of my speech. In many cases, progress has been made through voluntary schemes. I request that the Government look directly into specific sectors in order to investigate best practice and what we can learn from it.
However, we must go further as a global leader and recognise that this is an international challenge. Almost 80% of antibiotics used in the USA are not taken by people but used within the livestock sector, which I find astonishing. In India, people consume an average of 11 antibiotic tablets per year. Only today, data has been released showing that antibiotic resistance is growing in Europe. Progress that Britain makes will be quite simply irrelevant in the absence of a confident international stewardship programme.
The British Government must act as an example in their commitment to tackling resistance head-on globally and, while I recognise it is not in the specific gift of my hon. Friend the Under-Secretary of State for Health to dictate his published ministerial responsibilities, I believe it is timely explicitly to add antimicrobial resistance to those responsibilities. That symbolic act would send a clear message that Britain is committed to remaining at the forefront of the fight against antibiotic resistance.
Dr David Drew (Stroud) (Lab/Co-op)
I share the hon. Gentleman’s concern about the problems with antibiotics, which we see with farm animals. However, there is also now a problem over supply, due to the increased concentration of the pharmaceutical industry—there are new mergers coming along as we talk. Does he think that that is worthy of proper investigation? Those companies can turn the supply on, but they can also turn it off, which can also be life threatening.
Julian Sturdy
The hon. Gentleman makes a fair point. As I said, we have to encourage new antibiotic discovery. In our current system, the big pharmaceutical companies have been reluctant to come forward and put that money in, because the financial model just does not work.
However, encouragingly, we are now seeing smaller companies and spin-outs—from science departments within medical departments within universities—looking specifically at antibiotic discovery. There is something to be said about that, and again we have to look closely at it, because it could be used to our advantage. I encourage the Government to look at that, I encourage all Members who have a university in their patch to talk to them and I encourage those who have any of these small companies to visit and talk to them. It is incumbent on us all as parliamentarians to go out there and promote what is happening on our doorstep.
There is no doubt about it: the big pharmaceutical companies are finding it very difficult to promote new antibiotics. It takes 15 years for a new antibiotic to come to the marketplace from the start of the process of discovery. Companies have to make a huge investment. If that investment leads to a drug that is not actually used, because we are using it as a point of last resort, the financial model as it currently sits just does not stack up. That is something we have to address.
The discovery and development of antibiotics should not be seen as a curse. However, we must recognise that responsible steps now need to be taken to ensure that they persist and that we keep resistance firmly locked down. The antibiotic age can remain a golden one, and our collaborative actions can prevent a fall into what has been described by many as a medical abyss without antibiotics.
In the antibiotic age, we are all on the same side. This is not about politics or what the UK can do; it is about global action. That cannot translate into a lack of zeal and an absence of the will to win. I very much look forward to hearing what the Minister has to say. The UK Government have made great steps forward. The O’Neill report was a great start, but we have to continue that, and we have to be world leaders in this. We have a great opportunity to do that, if not for our generation, for future generations.
Theresa Villiers (Chipping Barnet) (Con)
It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate my hon. Friend the Member for York Outer (Julian Sturdy) on securing a debate on such an important issue.
As we heard in my hon. Friend’s powerful speech, antimicrobial resistance is a significant and increasing public health threat both here and in the rest of the world. It is estimated that, in the United States and Europe alone, antimicrobial-resistant infections currently cause at least 50,000 deaths a year. We can be proud of the fact that the UK Government have played a world-leading role on this issue. David Cameron was one of the first leaders to put it firmly on the international agenda when he launched the review led by Lord O’Neill in 2014.
Despite that determination and commitment, the effective work that the Government are already engaged in and commitments from many other Governments around the world, I am worried that progress is not fast enough, given the seriousness of the risks we now face. Antibiotics have saved countless lives in the 80 or so years since Alexander Fleming’s historic discovery. Ever since their use became widespread in the 1940s, they have ensured that life-threatening infections can be treated effectively and operations that would have previously been very dangerous can be performed safely. Research indicates that the use of antibiotics has probably extended our average life expectancy by around 20 years.
The consequences of antimicrobial resistance are often portrayed as a future threat, but the World Health Organisation is clear that antimicrobial resistance is already detected in all parts of the world and is already causing serious harm. Across the member states of the European Union, it is estimated that AMR currently costs around €1.5 billion in additional healthcare costs and productivity losses.
Those rather dry sounding points can hide the scale of the potential horror we face. The O’Neill review concluded that more than 300 million people are expected to die prematurely because of drug resistance over the next 35 years. As we heard from my hon. Friend, we could see a return to the days when straightforward operations and minor injuries can routinely result in death and childhood mortality is commonplace.
The chief medical officer, Professor Dame Sally Davies, has rightly described AMR as a “catastrophic threat”. She has warned of a “post-antibiotic apocalypse”, where 40% of the population die prematurely from infections that we cannot treat. In her view, that could amount to nothing less than
“the end of modern medicine.”
The worst-case scenarios are frightening. It is therefore vital that we take action to address the threats we face.
We clearly need to improve infection control, not only in our healthcare facilities here but around the world, and I urge the Minister to make AMR, improving sanitation and infection control a priority for our overseas aid projects. We need to bring an end to the over-prescribing of antibiotics in human medicine. That means doing much more to raise public awareness of this issue, so that more people understand the consequences of demanding antibiotics from their GP even when there is not clear evidence that they are needed or justified. It is imperative that we develop better and more accurate ways to diagnose conditions so that we no longer see so many instances of antibiotics being used in cases of viruses and other conditions where they have no effect.
As my hon. Friend the Member for York Outer said, it is crucial that we take action to end the overuse of antibiotics in agriculture. According to a letter from senior medics to the Department for Environment, Food and Rural Affairs in 2016, an astonishing 90% of all UK veterinary antibiotic use is for mass medication of groups of farm animals. As we reflect on reform of our agricultural support system in preparing to leave the European Union, the new system of farm support that we introduce must discourage intensive farming practices where animals are kept in overcrowded, unnatural and unhealthy conditions, which leads to routine prophylactic use of antibiotics. We should be promoting much more health-oriented methods of farming. It is possible to maintain a successful farming sector and at the same time significantly reduce levels of antibiotic use, and we have already seen progress in that direction, particularly in the poultry sector.
We need to ensure that we give priority to this area in Government spending on research and development as part of efforts to expand the pool of effective antibiotics. I agree that we should seek a new approach to rewarding and incentivising medical research in this area as a further means to drive forward the search for effective antibiotics. We need also to significantly improve our knowledge and understanding of the scale of antibiotic use and the threat posed by AMR in this country and around the world.
The O’Neill report made 10 recommendations, and I would welcome an update from the Minister today on the progress made on delivering those. I also urge him to make tackling antimicrobial resistance a key element of our public health policy. I hope the Government will press NHS England, local clinical commissioning groups and local authorities to make it a focus of their sustainability and transformation plans. Moreover, tackling AMR should be an important element of our foreign policy and our international aid budget, because it is self-evident that we cannot solve this problem without concerted action on a global basis.
In conclusion, there are many impassioned debates in the House on different subjects, all of which no doubt seem worth while and important at the time. However, there can be few issues of such huge significance as the one we are considering. If we fail to take action and future generations find their lives blighted by the post-antibiotic apocalypse predicted by the chief medical officer, they will look back on debates such as this and their judgment will not be kind. I say to the Minister and to each and every Member of the House that we need to take action now on antimicrobial resistance if we are to safeguard the health and wellbeing of future generations. I urge the Minister to take that message back to his colleagues in Government.
Jeremy Lefroy (Stafford) (Con)
It is a great honour to follow my right hon. Friend the Member for Chipping Barnet (Theresa Villiers) and my hon. Friend the Member for York Outer (Julian Sturdy) in this extremely important debate. As my right hon. Friend said, this issue is both important and urgent; it is not something that we can put off.
I declare my interests as a trustee of the Liverpool School of Tropical Medicine, which does research in this area, and as chair of the all-party parliamentary group on malaria and neglected tropical diseases, the significance of which I shall come to in a moment.
Both previous speakers outlined the importance of this subject. The O’Neill report said that we are looking at the possibility of 10 million deaths a year and the loss to global GDP. However, I do not want to dwell on that, because I want to talk about how we can make progress. We have to make progress because at the moment it is too slow. As the chief medical officer, Professor Dame Sally Davies, has said, we do not have time. “The Drugs Don’t Work”, to quote the title of her book.
There are four areas in which we need to make some progress. I do not claim any innovation in this. I listened to a lecture on the issue just last week and these were the four areas set out; I am just repeating what I have heard. The four areas are public education, drug discovery, the involvement of drug companies, and financial mechanisms such as advance market commitments. I shall take them in turn.
First, on public education, it is extremely important that we work together, that we bring the public with us. This country has had a great record over the years in preserving antibiotics for the most essential use, at least in relation to human health. My right hon. Friend described the problems in the animal health sector, but in the area of human health, we have preserved antibiotics. Compared with most countries in the world, we are extremely prudent in our use: doctors do not prescribe them unless they are really needed.
We can do more, however. We can involve the public—citizens—in the search for new antibiotics. I was introduced last week to a great scheme called Swab and Send, which can be looked up on the internet and which is run out of the Liverpool School of Tropical Medicine now. For a small amount—I think it is £30—people get five swab kits. They are encouraged to send in dust samples or whatever; they are encouraged to swab anywhere in their house where they think interesting cultures might be building up and to send the samples in to be tested in laboratories. I saw some of the results. Young people, children and adults all around the country are sending swabs to Liverpool for them to be tested and cultured to see whether potential new antibiotics can come out of that. The reason for doing it is that, just as with the fortuitous discovery of penicillin, we have, potentially, the answer—it could even lie somewhere in a corner of this room. We do not know, but let us get citizens involved in sending those samples in from all over the country and, indeed, the world and get them tested. We have an army of volunteer scientists and researchers out there who are able to help us to discover the next generation of antibiotics.
The second area is drug discovery. We have heard that it has been extremely difficult to make progress in drug discovery, for a number of reasons. I believe that the last major development was 30 years ago, so we have not had a new antibiotic for 30 years. The problem is that antibiotics are cheap. When drugs are cheap but developing them is expensive—it takes years, we have heard 15 years, and the cost can be in the hundreds of millions of pounds —it is simply not commercially possible for drug companies to engage in this kind of research and development. It needs a combination of public finance and private development and initiative.
At this point, I want to reflect on what has happened in relation to malaria, which I know a little about, over the last 16 or 17 years. The Medicines for Malaria Venture is a fine example of how we can have international co-operation. It supports pharmaceutical companies to develop new medicines for malaria that would not be able to be produced commercially. Seventeen years ago, in 2000, as I know myself having contracted the disease a number of times, the efficacy of standard treatments for malaria was poor, or they were pretty toxic. Resistance to chloroquine, which was the main drug, was high everywhere. Sulfadoxine-pyrimethamine, or SP, which had replaced chloroquine as the main drug in a number of places, was also becoming less effective. New drugs, based on the Artemisia annua plant, were emerging, but much more work needed to be done on them. Drugs were available, but they were not particularly well developed, and because they were single therapies, not combination therapies, there was the great risk that resistance to them would occur very quickly.
The Medicines for Malaria Venture was set up with the specific aim of working with companies to bring potential drugs through research and development to the market. I am proud to say that, since 1999, the United Kingdom has been the second largest provider of funding to that excellent organisation after the Bill & Melinda Gates Foundation, which has funded more than half the total expenditure since then, which is something like $1 billion.
What have we seen as a result of the $1 billion of expenditure over 17 years? We have seen a transformation. In 2000, there were 10 products around and being worked on: six at the research stage and four at the translational stage. There was none at the product development stage and none on the market. Where are we now, 17 years later? There are 21 in research, nine at the translational stage, seven at the product development stage and 10 on the market. That is a huge return on investment. Obviously, it was not just the investment of the $1 billion or so with MMV; it was also investment by private companies working alongside MMV that put a lot of their own money into it.
Now, therefore, we have not only a good range of very effective drugs available globally that have saved millions of lives—one estimate is 6 million; it is possibly more than that—but a very healthy pipeline: 30 drugs at the research and translational stages and another seven at the product development stage. That is exactly what we need to see for antibiotics, and not just in the future but now. There we have a model. It may not be exactly the right model for antibiotics, but it is a model. That shows that it can work and not just in relation to malaria drugs; we have seen it work in relation to drugs for so-called neglected tropical diseases. An equivalent organisation is bringing forward drugs in that area. We have seen it with vaccines. The world has come together to produce better vaccines or more vaccines to cover more diseases through the Global Alliance for Vaccines and Immunisation.
We therefore have models for drug discovery, but we need to ensure that they involve the drug companies. This cannot be done just by the public sector. The drug companies have enormous expertise and great researchers; they just need the incentive to work on the development of new antibiotics to a much greater extent. We are not talking about doing one or two; we are talking about looking at dozens and dozens. That is why it needs a co-ordinated and global approach. I think the drug companies are willing. They are out there, they are able to do it and they want to do it; they just need a bit of co-ordination and incentive—a bit of a push—and also the public encouragement that comes from knowing that this is something that we all want to do and that will benefit the entire world.
We need to look at how that finance could be introduced. I have talked about advance market commitments. That is the possibility that has been suggested to me. It has been done before. Just over a decade ago, advance market commitments were developed for vaccines. We have vaccines available around the world now, inoculating children and preventing them from getting debilitating or killer diseases, because of the commitment made by our Government in 2005-06 and other Governments, with again the UK taking the lead. That is an area in which we have expertise and have already shown commitment. Therefore, it is absolutely right, as my hon. Friend the Member for York Outer and my right hon. Friend the Member for Chipping Barnet have said, that the UK should be taking a lead in this. At this time, when perhaps our global position is changing, what could be better than showing global leadership in an area that is of great benefit to all humanity and showing that global Britain is a reality, not just a form of words?
Just a few words on how advance market commitments work. In the case of vaccines—there is no reason why it could not work in the same way for antibiotics—there is an agreement for money to subsidise the purchase of a future drug at a given price, so that people know that they are going to sell that drug at a certain price, which means that they can invest in the research and development. That gives manufacturers the incentive to invest not only in that R and D, but in capacity. We need to build that capacity. Clearly, in the case of vaccines, that was enormous because vaccine plants are extremely expensive; in the case of antibiotics, the expense would be less, but nevertheless significant. Then there is the agreement that, once a fixed amount of sales, in terms of numbers or value, has been reached, the manufacturer is contractually obliged to sell the drugs affordably in the markets or to license the technology. Let us be frank: these drugs are not going to make large sums of money for people. They have to be available at prices that everybody in the world, whether they get them through a health system or purchase them individually, can afford.
Theresa Villiers
Listening to my hon. Friend’s speech, it occurs to me that, in other areas of medical research, we see a hugely positive impact from the charitable sector. Should we be trying to read across the lessons from other areas of medical research and to get these fantastically successful charities involved in raising money for AMR research?
Jeremy Lefroy
My right hon. Friend is absolutely right. I referred earlier to the involvement of the Bill & Melinda Gates Foundation in the setting up of MMV, but there are so many other medical charities putting millions and sometimes tens of millions of dollars into these areas. That is the beauty of partnerships such as MMV, the Drugs for Neglected Diseases initiative and other partnerships: they take money from the commercial sector, charities, non-governmental organisations and from Government and everybody is working together—they are not in competition with each other over relatively scarce resources. The partnerships are using the benefits, in the case of companies, of their researchers and facilities; in the case of foundations, of their contacts, ability to deploy drugs on the ground and funding; and in the case of Governments, of the substantial funding that they can put in.
I want to conclude by saying that this is not pie in the sky—this is something we can do. We have proven in the case of malaria and other diseases that we can achieve tremendous results. We know there is a will. We know Government have a will. We know there is a will in other countries. It just needs a lot more urgency and more co-ordination. If the UK, through the Department of Health, and as my hon. Friend the Member for York Outer has said, through the co-ordination of the various Departments, were to take this by the scruff of the neck, we would have something by which the UK could again show world leadership not just in words, but in actions. I look forward to hearing from the Minister the plans that we have in that area.
Patrick Grady (Glasgow North) (SNP)
It is a pleasure to serve under your chairmanship, Mr Davies. At relatively short notice I am standing in for my hon. Friend the Member for Linlithgow and East Falkirk (Martyn Day), who is not very well. I am not certain of the cause of his illness, but I am sure that if he is seeking advice, he will rightly be following the guidance of the theme of World Antibiotics Awareness Week, which states:
“Seek advice from a qualified healthcare professional before taking antibiotics”.
He will also be taking the advice, as I am sure will everyone else, of my hon. Friend the Member for Central Ayrshire (Dr Whitford), who has been impressing on us the importance of the flu jab. I can testify to the medicinal qualities of a hot toddy, from time to time, but in the careful context of appropriate medication with appropriate medical advice.
I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this debate, which gives us an important opportunity to reflect on the issue of antimicrobial resistance and the importance of being aware of the challenges. It is a timely debate, taking place during the World Antibiotics Awareness Week. Any kind of awareness week has a number of important consequences. In this context, improving the understanding of the risks faced, which we have heard clearly from other hon. Members, is key, as is presenting an opportunity to take action in response to the challenges presented.
The challenge is very clear and came through in all the speeches. The right hon. Member for Chipping Barnet (Theresa Villiers) made it clear how difficult it is to overemphasise the scale of the challenge and the risk we face. Some 700,000 deaths a year are attributable to infections from superbugs that are resistant to antibiotics, and that figure is predicted, as we have heard, to rise to almost 10 million in total by 2050.
There are huge challenges in the livestock and veterinary sector as well. I was interested to hear that academics from the University of Glasgow in my constituency are among those taking the lead. I will say a wee bit more about what the university is doing shortly.
As the hon. Member for Stafford (Jeremy Lefroy) has said, the issue also has a big impact on developing countries, where people require access to medicines and the challenge of resistance is huge, and it threatens the progress made in health and tackling poverty. Being aware of the huge risks and then using that as a motivation to action is one of the key opportunities presented by awareness week.
I will reflect briefly on the Scottish Government’s actions. A large amount of health policy is devolved, but there are good examples and good practice on which we can reflect. In March the Scottish Government announced a £4.2 million research grant to investigate the prevention and control of healthcare-associated infections, as well as to research new ways of using existing antibiotics more effectively and efficiently. Some of that funding was provided to a consortium of researchers led, as I have said, by the University of Glasgow in my constituency, working with other Scottish universities to establish a new Scottish Healthcare Associated Infection Prevention Institute, which will conduct important research, bringing together a range of academics, researchers, practitioners and so on.
The Scottish Government have also established the Scottish antimicrobial resistance and healthcare-associated infections strategic framework for between 2016 and 2021. It has a number of aims to do with the containment of antimicrobial resistance; advancing scientific knowledge and innovation; improving efficiency, transparency and accountability; and improved workforce capability. That is important for all environments where healthcare is delivered, such as care homes, community pharmacies and primary care, and for everyone involved in the delivery of care.
There are a number of things we can all do at an individual level. There was a debate in March, I think on the broader issue of antimicrobial resistance, during which we were encouraged to become an antibiotic guardian. In fact, when the sitting was suspended for a Division in the House, many of us signed up online. The number of people signing up to that campaign continues to grow and this is another important opportunity to encourage others to do so. The Scottish Health Secretary, Shona Robison, has pledged to join the scheme and to encourage as many people as possible to do so in order to reach the target of 100,000 people becoming an antibiotic guardian.
This debate has shown that the Government have some challenges and opportunities. Are we ensuring that the right levels of investment are being channelled through the right Departments? The importance of joined-up government across Departments, including DEFRA, DFID and the NHS, has been made clear in this afternoon’s speeches. Towards the end of his remarks, the hon. Member for Stafford touched on the issue of a joined-up global response. There is a sense in some quarters that Brexit might represent some sort of retreat from the world stage. Yet the Government’s response to the O’Neill report in 2016 clearly stated that a global response, including “working closely with Europe”, is required. How do they see that relationship with European institutions in the context of Brexit? How can we be sure that the bonfire of red tape and regulation that so many Brexiteers have dreamed of for so many years will not weaken those efforts? We have already heard about the possibility of chlorine-washed chicken and so on coming into the United Kingdom as a result of potential trade deals with the United States. How can we make sure that meat that comes in as a result of new trade deals is not absolutely overloaded with antibiotics and other treatments that could lead to increased antimicrobial resistance?
In conclusion, this is a significant challenge and awareness is important. Awareness weeks, debates such as this, and the antibiotic guardian scheme play a very important role in tackling some of the challenges. I was interested to hear about the Swab and Send initiative and am keen to sign up to it. I can think of several dusty corners, not just in this Chamber but elsewhere in the Palace of Westminster, where who knows what might be discovered. I think that is a challenge to us all.
We know that there are models out there that can work. The hon. Gentleman spoke about a number of them and some of the many positive actions taken to tackle malaria, as well as the challenges that remain in closing the final gap. The other day I attended an interesting meeting between DFID officials and the all-party parliamentary group on vaccinations for all. We looked at the impact of the near eradication of polio and the challenges that will present for other schemes in the future. Some of the infrastructures that have been built up to deliver that historic achievement of the eradication of polio can perhaps be adapted to meet other healthcare challenges. I am not by any means an expert, but perhaps this is one of those areas.
It is clear from this debate that we can all play our part, and it is also important that the Government lead by example. Once again, I congratulate the hon. Member for York Outer on securing this debate and I look forward to the Government’s response.
Julie Cooper (Burnley) (Lab)
It is a pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for York Outer (Julian Sturdy) for securing this debate on a really important subject during the week when we are focusing attention on the value of antibiotics and the challenges of antimicrobial resistance.
We have heard some interesting contributions, and I think there is widespread agreement across the Chamber. To reiterate some of the problems, we all agree that antimicrobial resistance is arguably the biggest challenge facing our health system. It is worth taking a moment to reflect on how fantastic antibiotics have been. We take so much for granted. Alexander Fleming’s discovery of penicillin heralded a golden age in health. Penicillin was the first of many antibiotics; it alone has saved countless lives and was rightly hailed as a wonder drug. Wide-scale access to antibiotics changed the nature of medicine forever: wounds would heal and operating theatres became safe places where life-changing and, indeed, life-saving operations could be carried out without fear of deadly infection.
However, that was a long time ago and we now too often take antibiotics for granted. We have become blasé about their use. We have become careless and irresponsible. Too often at the first hint of an infection—a cough, a sneeze or a headache—GPs come under pressure from their patients to prescribe antibiotics. Too often antibiotics are the first port of call. Too often they are made available as a precaution. Through overuse and inappropriate use we have allowed the development of resistant bacteria on a global scale.
That is not just confined to their use on humans, as has been mentioned by several hon. Members. In fact, the use of antibiotics in animal husbandry is widespread and is not just to treat infection, nor even to protect against infection. Until relatively recently it was permissible for sub-therapeutic doses to be added to animal feed to promote growth. That practice was banned globally in only January of this year. Even without that, 44% of all antibiotics used in the UK are used on animals and often inevitably find their way into the food chain and domestic water supplies. Cat McLaughlin, chief advisor to the National Farmers Union on animal health and welfare, stated:
“Arbitrary restrictions on the use of antibiotics…could have a detrimental impact on animal and plant health.”
That might be all well and good; however, the scientific consensus is that if we fail to place restrictions on the use of antibiotics, there will be a catastrophic effect on human health.
It is worth stressing that, as we have heard, antimicrobial resistance is the cause of 700,000 deaths globally each year, and that figure is predicted to rise significantly, to horrific levels, by 2050. Here in England, 5,000 people die every year from infections that have developed resistance to antibiotics. We must not underestimate the full impact of antimicrobial resistance. Let us be absolutely clear: without resort to effective antibiotics, there will be no treatment for complex infections, no chemotherapy for cancer and no treatment for cystic fibrosis, heart transplants or joint replacements. I recently visited the microbiology laboratory at the Royal Blackburn Hospital in Lancashire and the consultant microbiologist I spoke with said, “If you take one thing from your visit here today let it be this: we are so close to being unable to perform even the most minor, the most simple, operations, and so close to being unable to treat commonplace infections.” She impressed on me the need for urgent action.
The World Health Organisation identified the need for co-ordinated global action back in 2011. I am pleased to say that the UK has been a leader in responding and that at the time it published the five-year antimicrobial strategy and commissioned the O’Neill report, which has already been mentioned. It is clear that our focus should be two-fold.
First and foremost, we must raise awareness of the danger of overuse and focus on the reduction of demand. There is a lot that we can and must do. I agree with other hon. Members that we must start with a public education programme to manage expectations and to highlight the issues of inappropriate use and too frequent use. We should increase the use of diagnostic testing so that only efficacious targeted antibiotics are used.
In both those areas we should look to community pharmacists to lead. Qualified pharmacists are well placed to provide antimicrobial stewardship. Every day 1.6 million visits are made to community pharmacies in the UK, which provides ample opportunity to advise the public on appropriate treatments for ailments, to ensure full awareness of remedies other than antibiotics that may in many cases be more appropriate. The Royal Pharmaceutical Society has offered to support its members to take on new and extended roles. Why not take it up on that offer? Why not make mandatory the roll-out of minor ailment schemes in community pharmacies? Why not support community pharmacists to carry out diagnostic testing to support GPs and other dispensing health professionals? Reducing the prescribing of antibiotics is not just the responsibility of GPs.
We must also regulate to reduce the amount of antibiotics used routinely on animals that are not sick. The National Office of Animal Health refutes the call for extended regulations and rejects the call to reduce antibiotic use in food products. However, we must act to promote a global reduction, because we are not talking about insignificant amounts of antibiotic use. Here in the UK, as I have mentioned, 44% of all antibiotic use is on animals. In the USA that figure is more than 70%. Many nations do not even record the figure and there is every reason to suppose that it is far higher. We must acknowledge that this is a global problem and play our part in identifying new incidences of antimicrobial resistance.
We must invest in research and development, promoting innovation to discover the next generation of antibiotics. At the moment, fewer than 100 scientists are working in the pharma industry to develop antibiotics, due mainly to a lack of adequate reimbursements. Not only would that ensure antibiotic protection for us in future, but investment in this sphere has the potential to make a significant contribution to the UK economy. We must see the challenges as opportunities.
The UK has an opportunity to be a world leader in life sciences and antibiotic development, but the reality is that, contrary to the O’Neill report’s recommendations, there has been insufficient progress, and incentives to promote this innovative work are not forthcoming. We should stop focusing on the cost of new antibiotics and focus on the cost of not developing them. The British Society for Antimicrobial Chemotherapy maintains that the UK has failed to address the issues in three main areas: education and public awareness; veterinary and agricultural use; and incentives for antibiotic discovery, research and development.
As we mark World Antibiotics Awareness Week, I ask the Minister to outline what steps the Government will take on three fronts. What steps will he take to reduce the inappropriate use of existing antibiotics in the treatment of human illness? What action will he take to regulate the use of antibiotics on healthy livestock? What action will he take to stimulate the research and development of new antibiotics? Will he demonstrate to us that the Department is determined to take this subject by the scruff of the neck? A world without antibiotics is unthinkable.
The Parliamentary Under-Secretary of State for Health (Steve Brine)
In a rare and welcome twist for a Westminster Hall debate, I think I will have time to cover pretty much all the points that colleagues have raised.
Let me congratulate my hon. Friend the Member for York Outer (Julian Sturdy) on successfully securing this debate in World Antibiotics Awareness Week. As everyone has said, it gives us a great opportunity to draw attention to an important issue—or the important issue. On the way in, I said to my right hon. Friend the Member for Chipping Barnet (Theresa Villiers), “I didn’t know you were interested in this subject,” and she said, “This is a critical issue.” It has come on to her radar, so she has come to speak—brilliantly, I thought—in today’s debate. Say to many Members across the House, “We have a debate on AMR this afternoon,” and they would ask what that is. I do not think that will be the case for much longer, nor should it be, and I thank everyone for their contributions. Raising awareness of the importance of preserving antibiotics through their appropriate use and preventing infections in both humans and animals is part of the challenge.
Lord O’Neill has been rightly lauded and much mentioned this afternoon for his review of AMR, which was published last year. I agree that it is an excellent and accessible piece of work. The former Chancellor of the Exchequer, George Osborne, and David Cameron deserve great credit for having the foresight to ask him to do it. His review said that, by 2050, an estimated 10 million deaths a year could be caused globally by AMR if no action is taken. In comparison, cancer causes 8.2 million deaths per year—I am also the cancer Minister for England —and diabetes causes 1.5 million, to put that in context.
AMR is part of the Darwinian process of natural selection, as microbes adapt following exposure to antimicrobials. The problem is greatly amplified by the inappropriate use of antimicrobials—in particular, antibiotics. All Members who have spoken today mentioned public education. It was one of the four points made by my hon. Friend the Member for Stafford (Jeremy Lefroy). While he spoke, I googled Swab and Send—I was listening at the same time; I can multitask, contrary to popular belief—which looks absolutely excellent. I look forward to finding out a bit more about Dr Adam Roberts’ project; he has done excellent work.
If any Members or constituents wish to find out more about the science of AMR, I heartily recommend the new “Superbugs” exhibition at the Science Museum in London. It explains both what AMR is and how we are using science to tackle it. The exhibition is an excellent example of the cross-sectoral collaboration that has enabled the UK to take such a leading role in tackling AMR.
While I am on the subject of science museums, may I give a shameless plug to my constituency—this does not happen often for a Minister? Public awareness is critical and that was a key point in the O’Neill report. A few weeks ago, I went to the Winchester Science Centre, which has just launched a new partnership with the University of Southampton. It has a brilliant new exhibit on AMR called, “The most dangerous game in the world”, which gives children—it is mostly children who visit the centre—the chance to understand what AMR is. They play an interactive game to try to understand the threat it poses to us and what we are doing to tackle it. Through the Association for Science and Discovery Centres—there are science centres all around the country; some will be in the constituencies of Members here today—we have the chance to raise the profile of the public education role that is needed for AMR. I suggest that raising awareness among our young people would be a brilliant place to start.
This debate is timely as it follows the publication last week of the all-party group’s antibiotics report, which was mentioned by my hon. Friend the Member for York Outer. The report made recommendations for us and others to consider in our development of future action plans to combat AMR. I thank the group for the report. Its recommendations will be useful as we develop the refreshed UK AMR strategy and the new action plan; the current one comes to the end of its five-year life at the end of 2018. In addition, the UK strategy makes the commitment to assess the effectiveness of the implementation plan at the end of the five-year period. The policy innovation research unit at the London School of Hygiene and Tropical Medicine is undertaking a full evaluation of the current UK five-year strategy, looking at the evidence underpinning the key mechanisms of change across human and animal health sectors. Its work will further inform the development of the refreshed strategy.
It is World Antibiotics Awareness Week and European Antibiotics Awareness Day is on Saturday 18 November. The two events take a “one health” approach, with human and veterinary health professionals working closely to give a unified message on the subject. They provide opportunities to engage with healthcare professionals and the public on AMR and what we can all do to help to address it. As part of World Antibiotics Awareness Week, letters are sent from the chief professional officers for England and other national leaders inviting colleagues who are working in the NHS, local authorities, universities and professional organisations to support activities for the week. Links are provided to a wealth of AMR-related resources.
Our chief medical officer, the much mentioned—rightly so—Professor Dame Sally Davies, works closely with her opposite numbers in Edinburgh, Cardiff and Belfast. She falls within my responsibility and I see her regularly. We always talk about this, and her book, “The Drugs Don’t Work”, which was mentioned by my hon. Friend the Member for Stafford, is a brilliant piece of work. I recommend it to anybody with an interest in the subject.
The national Keep Antibiotics Working campaign was launched across the country last month by Public Health England, for which I have ministerial responsibility, to raise awareness of AMR and, using TV, radio and social media advertising, to reduce demand for antibiotics by the public. I hope that Members have seen, heard and watched that campaign.
In addition, the antibiotic guardian scheme, which was mentioned by the hon. Member for Glasgow North (Patrick Grady), was launched in 2014, providing brilliant tools for healthcare professionals to raise awareness. That has now signed up more than 50,000 individuals, of whom I am one—people pledge personally to commit themselves to use antibiotics more prudently. When I signed up I did not see in the drop-down options a dram of whisky, but why not? The people behind that website are probably listening or watching, so surely it is only a matter of time.
The debate is also timely in that the Government are due to publish shortly the third annual progress report on implementation of the UK five-year AMR strategy. The report will set out the range of activity that went on through 2016—we look at the year before—to implement the strategy and points to the reduction in antimicrobial use in 2015 throughout the UK. Data for England in 2016, published just last month, show a continuing reduction in antimicrobial use in humans. Significantly, the annual sales data for antimicrobial use in animals, published last month, show a 27% drop in the use of antibiotics in food-producing animals since 2014. That meets the Government commitment two years ahead of target.
At this point I want to touch on colistin, which my hon. Friend the Member for York Outer referred to. Sales of colistin decreased by 83%—below the maximum target recommended by the European Medicines Agency—during the lifetime of the plan so far. On whether a review is looking into colistin use, I am not aware of any specific review, but its use is highly restricted and controlled now; it has dropped by 83%, as I said, and we continue to monitor it extremely closely, I am sure he will be pleased to hear.
This is just the beginning; our work is by no means complete. Last month, Responsible Use of Medicines in Agriculture launched a set of sector-specific reduction targets that we aim to and will deliver by 2020. The Government have also set challenging ambitions to halve the number of healthcare-associated gram-negative bloodstream infections and the inappropriate use of antimicrobials in humans by 2020-21. Gram-negative infections are growing in incidence. Gram-negative bacteria are more resistant to antibiotics and are increasingly resistant to most available antibiotics.
E.coli infections, for example, make up the bulk of the healthcare-associated gram-negative bloodstream infections we aim to reduce. A report published by Public Health England last month revealed that four in 10 patients with an E. coli bloodstream infection in England cannot be treated with the antibiotic most commonly used in hospitals; that relates to a point made by the hon. Member for Burnley (Julie Cooper). In 2017-18 we aim for a 10% reduction in all E.coli infections. Just two days ago, on Tuesday, the Secretary of State hosted an event with over 200 frontline staff from primary and secondary care to share good examples of actions to tackle such infections—I am sure that colleagues from Lancashire were there—and to develop improvement plans for 2018.
The consumption of antibiotics is a major driver of the development of antibiotic resistance. We have implemented a range of initiatives to help prescribers to improve their use of antibiotics, including the provision of guidance and tool kits and the use of behavioural change initiatives and financial incentives. AMR local indicators are provided in the Public Health England Fingertips portal, bringing together local information on prescribing and infection rates to allow local teams to benchmark their performance against others in similar areas so they can develop strategies for improvement that are appropriate for their local circumstances.
That gives me a chance to touch on the point made by my right hon. Friend the Member for Chipping Barnet, who mentioned sustainability and transformation partnerships. We absolutely expect AMR to be included, and it was included in the planning guidance for developing STPs. Take-up in local areas has been limited, but I suggest that MPs apply pressure to their local STPs by encouraging the STP leads to consider AMR. For the record, STPs that are in my good books—the apples of my eye—are Cheshire, Wider Devon and the Black Country. If Members wish, they can refer their STP leads to those as places to look for good practice that are involving AMR in their planning.
Most Members who have spoken have touched on new drugs; my hon. Friend the Member for Stafford certainly did so at great length. Although preventing infections and protecting the antibiotics that we have are the first two pillars of any approach to tackling AMR, the third is promoting the development of new drugs and alternative treatments. However, as has been said, no new treatments have been brought to market for many years. We fully support action to address this market failure through market incentives such as market entry rewards, championed by the O’Neill review, and other solutions, and we welcome the commitment made this year by G20 leaders to consider how such solutions could be implemented regionally and internationally. My hon. Friend’s ideas are welcome, and he is dead right in calling for a co-ordinated approach and for us to give them a bit of a push, to use the expression that he used.
Jeremy Lefroy
My hon. Friend’s commitment to the subject shines through; it is great to see his leadership. I gently suggest that although global work and co-operation are extremely important and will, in the end, produce the kind of results that we need, we could take a step ourselves as the United Kingdom. The amount of money required to start something like, for instance, the Medicines for Malaria Venture is not great, particularly if it comes from a combination involving Government. The UK has provided 20% of the funding, as I said, alongside the Gates foundation. Sometimes it takes quite a time to get the world to work together. Perhaps we could consider doing something ourselves with as many co-operators as we can, and getting it going right now. As my right hon. Friend the Member for Chipping Barnet (Theresa Villiers) said, we could consider using the official development assistance budget, because this is for the benefit of everybody in the world, and it certainly is for poverty reduction.
Steve Brine
My hon. Friend is quite right. I have made a note and passed it back to the team. There are many pulls, of course, on the UK aid budget—that is a topical subject about which he knows far more than I do—but I will definitely take away that point and speak to our colleague, the new Secretary of State.
That point fits neatly into where I was going next. Although it will take time to develop an appropriate global model on the pull incentives, we are making significant progress on the push side. The UK has committed £50 million over the next five years to the global AMR innovation fund, which has been discussed in the House many times. The first tranche of £10 million will fund a bilateral UK-China AMR research collaboration, which we expect to open next spring.
At the same time, we are working with pharmaceutical companies through the joint Government-industry working group. A number of Members have said that this cannot all be left to the public sector, and it absolutely cannot. Through the working group, we are seeking to develop a NICE health technology assessment-based reimbursement model—another snappy title. As my hon. Friend the Member for Stafford said, that means that we would pay for antibiotics based on their value. A team at York University—I know that this will be of great interest to my hon. Friend the Member for York Outer—is working on the evaluation process and will report back to me in the spring. We will then decide on and announce the next steps. I hope that that is useful to Members.
To return to international issues, last week I attended the G7 in Milan—the presidency is held by Italy this year—to discuss international health matters. AMR was one of the three key items that we discussed, which shows the importance of taking a “one health” approach. It was a meeting with many challenging conversations as we attempted to produce a communiqué, which we did in the end, but I can report that the AMR discussion was not one of them. All attendees—the seven Governments, international bodies such as the World Health Organisation and other non-governmental organisations—were in complete alignment that AMR is an urgent global issue and the problems that it raises cannot be solved by individual countries. There was unanimity.
This was the third time that AMR had been prioritised on the G7 agenda, which shows our continued dedication to tackling it and the importance of countries working together. I had an interesting bilateral conversation with the Health Minister from Canada, which will assume the presidency next year in January. I urged her to keep the issue at the forefront of her mind; I hope that that went in. Each country needs to take action to tackle AMR, but we are obviously stronger together.
Our chief medical officer, to refer to Sally again, works tirelessly to raise the profile of AMR in the WHO and international circles. She travels far more than I, and ensures its place not just as a health and agricultural issue but as a political and financial one; a number of Members have mentioned the fiscal cost of AMR. The United Nations declaration secured in September last year made it clear that we will not be able to deliver the sustainable development goals if we do not tackle AMR. As a number of Members have been kind enough to mention, we have been at the forefront of shaping action on AMR through proactive engagement, and Dame Sally has an awfully big role to play in that.
Indeed, at the G7, the OECD recognised and acknowledged that the UK is leading the way in providing experience on how to tackle AMR. Although many challenges will come as a result of our decision to leave the European Union, in this area, as in so many others, we lead the world, and it is very much in the world’s interest to continue working closely with us and benefiting from our experience. The bottom line is: why wouldn’t they?
I will also mention the Japanese, who are passionate about tackling AMR and with whom I had conversations around the G7. I was pleased to learn that they are as dedicated as we are to addressing AMR. This week, our chief medical officer attended an AMR conference that they hosted in Tokyo with other Asian countries. I understand it went well and look forward to getting a formal readout when she returns.
Good global surveillance is essential to provide a co-ordinated global response, as underlined by last week’s G7 discussions. For that reason, we support low and middle-income countries through our £265 million Fleming fund to improve their surveillance capacity and capability. UK official development assistance will improve in-country laboratory capacity for AMR surveillance through a “one health” approach. It has already supported 31 countries worldwide to develop AMR national action plans that follow on closely from what we have done.
Many hon. Members have mentioned that a cross-Government approach is needed in Whitehall. That goes without saying. The officials advising me today are from the Department of Health and from the Department for Environment, Food and Rural Affairs. We work closely with officials and Ministers across Departments. AMR is a global problem that will not be addressed in the lifetime of any single strategy. Although the UK has led the way and made significant progress at home and overseas, this is a long-term, serious and urgent problem. I welcome initiatives such as World Antibiotics Awareness Week that enable us to continue to discuss the issue, give us a media hook to hang it on, keep it high on the agenda for professionals across all sectors and, vitally, keep it in the minds of members of the public.
Julian Sturdy
I thank all hon. Members for their contributions and the Minister for his response. From speaking to him previously and from what he has said today, I know he understands the task ahead not only for us in the UK but globally. It is important to remember and to pay tribute to the work that has already been done, which was ably led by David Cameron and the O’Neill review—one of the most important reviews that was set out by the then Prime Minister.
We have a job to do in this House. I have attended packed Westminster Hall debates on issues such as cycling and bee health—I am not decrying those important issues; I do not want my inbox full of emails on that tonight—but if we are not getting hon. Members from all sides of the House in for a debate on something as important as antibiotic resistance that affects us all, all our constituents, our country and the globe, that is quite worrying. If all hon. Members take that away from this debate, that will be encouraging.
We are an immensely fortunate generation to have been born and to have grown up in the world of the antibiotic age. I look at this issue for the sake of future generations. I have an interest in that because I have young children, and I think the Minister has children of a similar age. When the next generation hit their 30s and 40s and begin to start families of their own, there is a real possibility that their children will be born into a world without antibiotics—a post-antibiotic age. That is quite terrifying. It is essential that the required steps are taken for that next generation.
If we get that right, no medals will be handed out. No statues will be erected in the streets. If the Minister becomes the Minister with responsibility for antibiotic resistance and succeeds in his pledges, he will not be immortalised in a statue in the centre of London. The world will continue as it is, and many will not even know the threat that faced them. If we stand by and do nothing, however, history will be extremely unkind to our generation. It is essential that we act. The UK is making great steps forward, but there is so much more to do and it has to be done on a global stage.
Question put and agreed to.
Resolved,
That this House has considered World Antibiotics Awareness Week.
Support for Care Leavers
(6 years, 5 months ago)
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Alex Burghart (Brentwood and Ongar) (Con)
I beg to move,
That this House has considered the Department for Work and Pensions’ support for care leavers.
It is a pleasure to serve under your chairmanship, Mrs Gillan. I am extremely glad to have the opportunity to debate this important subject in Parliament. I have been interested in the care system, and the young people who grow up in it and move out of it into adult life, for the past 10 years. When I first came to Westminster, my main interest was in education, but I quickly became aware of the large number of young people in our society—approximately 70,000 of them—who are in care because life at home has gone wrong. Without a stable foundation, so many opportunities are diminished and hindered.
The Minister will be pleased to hear that I believe that the most important work with young people in care, which is ultimately for the benefit of care leavers, is done in other Departments. Perhaps some of the most significant spends that are required are on matters that she can address with her colleagues and that fall within their budgets, such as early intervention for parents or children suffering from poor mental health or addiction problems. I am sure she has such conversations with her colleagues in the Department for Education, the Department of Health and the Department for Communities and Local Government.
Too often, we give the impression that the care system in our country is irretrievably broken. I do not believe it is. Some 60% of care leavers do not become NEET—not in education, employment or training—on leaving school, which is a sign that the care system has worked for them and has provided them with opportunities they might not have received if they had stayed at home. However, that is not to say that the system cannot be improved; it can be, and I believe it has been over the past 10 years. The Munro review of child protection and Martin Narey’s reviews of residential care and fostering for the DFE have contributed to the quality of care that young people in our country receive.
Obviously, the care system is extraordinarily varied. It is often said that England has not one care system, but 150—one for each of the local authorities that take in children. Those systems and the legal framework in which they operate remind us that young people in care are our children. Because the state has decided to take them away from their families and try to create a new family environment for them, the responsibility for their wellbeing, opportunities and success lies strongly with central and local government. We should always remember that when we consider the policy interventions we can make to improve their lives.
With that in mind, what can the Department for Work and Pensions do to help young people as they embark on adult life and look for the opportunities that everyone wants, such as a stable family, a job, a chance to prosper and decent accommodation? On work and training, one wonderful initiative in the past few years has been a bursary of about £2,000 for young care leavers to go to university. I know from having spoken to care leavers that it has created opportunity where there was none before. Young people also get help with accommodation and on-site help at their universities.
That is a great start, but relatively few care leavers go to university; the majority go straight into the world of work. Modern apprenticeships, which provide a new route into employment for our young people, have been a very successful Government initiative that is growing year on year, but they do not offer care leavers the same advantages as young people living at home with their families. Indeed, the system rather assumes that apprentices have a family home to live in. Having talked to care leavers who have to manage their household bills and finances on the very low initial income that new apprentices receive—about £3.50 an hour—I ask the Government to look again at the issue.
I know that the apprenticeships programme falls within the DFE’s purview, but it is also in the DWP’s interest to ensure that young people do not become unemployed. We know that young people who become long-term unemployed when they leave school are much more likely to be long-term unemployed later in life, so it is crucial for the system to help them to avoid that pitfall. I suggest to the Minister that a little upstream investment could save a lot of money in subsequent benefit payments. A few years ago, the DWP part-funded ThinkForward, a very interesting initiative to identify young people at risk of becoming NEET and support them with long-term mentoring in the years before they left school. It dramatically reduced the number of NEETs in the target group. The DWP has a good track record with this work, and I encourage it to do more.
Many care leavers start adult life on welfare, receiving help with their bills and the necessary support to have somewhere to live. It is important that we ensure that our welfare system is adapted to their needs, especially with respect to up-front accommodation costs. As hon. Members know, the shared accommodation rate gives young people in the benefits system money for a room rather than a flat, under the assumption that they live with others, but care leavers are subject to an exemption until the age of 22. That exemption is a good Government policy, but charities I have spoken to—including the Children’s Society, which gave me some very good advice before the debate—point out that it would be better to extend it to the age of 25, when a different benefit payment rate kicks in. I strongly encourage the Minister to consider such an extension, which would ensure that care leavers have no hiatus in pay to overcome. The Children’s Society estimates that it would cost about £5 million—a small cost that would be far outweighed by the good it would do.
When I was director of strategy at the Office of the Children’s Commissioner, I spent a lot of my time going around the country to talk to local authorities that had excellent care-leaving units. Some areas, particularly Trafford, had a very detailed local strategy to ensure that the personal advisers who helped care leavers worked with their colleagues in the local jobcentre. That is important for various reasons. First, a decent personal adviser will be there to give advice on how the complexities of all the new systems work. However, it should also be a two-way conversation. If a young person has left care and falls into trouble—and is perhaps trying to get their head around meeting appointments or making sure that they do the right things to be able to claim their benefits—their personal adviser will be there to walk them through the system. We have a good generation of new work coaches who are extremely helpful when someone gets into the jobcentre, but it is important for some care leavers to have advice outside of the jobcentre to make sure that they can follow the system without falling into difficulties and becoming sanctioned. They need to know what they are entitled to.
I know there is good practice going on in the country, but I also know it is not standardised. I welcome any attempt by DWP and DFE to bring together directors of children’s services and regional heads of jobcentres so that conversations can be held at a high managerial level and cascaded down to other parts of the country.
The Centre for Social Justice, for which I used to work, contacted me before this debate about a little glitch in the welfare system for care leavers taking apprenticeships. They have to wait a month for their first payment, and the CSJ suggested that those care leavers be enabled to retain their benefits for that month. Again, that bridges a gap so as to prevent young people from falling into debt when they have made the correct decision to get an apprenticeship, build their skills and move into work. Similarly, we should allow care leavers to retain housing benefit at the existing level when they move into an apprenticeship, again reducing the risk of their acquiring arrears and getting into debt.
As I wrap up, I want us to think about data. DWP, DFE and the Ministry of Justice have come on in leaps and bounds in recent years, plugging their different enormous datasets together. That means it is increasingly possible to see how children from certain backgrounds and with certain experiences go on to achieve certain outcomes. The value of that is obviously enormous. This country has very good national datasets, which means we will be able to identify which young people become long-term unemployed and what their experiences have been at school, in the care system and in childhood before that. Similarly, it will enable us to identify the young people who had poor experiences and who then went on to be successful. If we do that, we can dig down into what made the crucial difference for those people: what children’s services department, what charity, and what intervention helped change their lives. Then we can seek to extend that good practice to other areas, truly creating a wonderful learning environment.
Finally, I encourage the Minister to let her data analysts roam free over the extraordinary wealth of knowledge that is sitting in Government Departments.
Steve McCabe (Birmingham, Selly Oak) (Lab)
It is a pleasure to serve under your chairmanship, Mrs Gillan. I congratulate the hon. Member for Brentwood and Ongar (Alex Burghart) on securing this important debate. As I listened to him, I was pleased to note that he and I have quite a common view on many of the issues. He was very clear in his opening remarks; there is a danger that we might forget that when we use the term “care leavers” we are talking about young people who have already encountered more than their fair share of troubles. They have not usually enjoyed the benefits of a stable family life that are available to others. They may have had little or no contact with their natural parents and family members, or those relationships may have been abusive and traumatising, so we are talking about people who have not had the best of starts. They are significantly more likely to be classed as NEETs—not in education, employment or training—if we compare them with their non-care counterparts, which is an important point to bear in mind, and of course they are much more likely to be subject to benefit sanctions. I suspect that is because sufficient account is not taken of the other things happening in their lives in the way in which the benefits system sometimes processes those transactions.
Our starting point should be to say that these young people are full of potential, but they need something extra by way of support and encouragement from the welfare state, which needs to pick up some of the corporate parenting role every bit as much as the local authority to ensure that those young folk get the assistance necessary to achieve their full potential.
The Government, to their credit, have sought to identify their corporate parenting responsibilities. In 2016 they published “Keep on caring”, a cross-departmental strategy paper designed to provide better support to care leavers. It identified five key outcomes, two of which are particularly relevant to this debate. One was improved access to education, employment and training: encouraging supported internships, meeting training costs and providing employment opportunities for care leavers in Government Departments and their agencies. Another was to ensure that care leavers achieve financial stability. That involved a promise to exempt care leavers from cuts in housing support due to be applied to all other 18 to 21-year-olds. The strategy also promised a review of the case for extending the exemption to shared accommodation rates within universal credit up to the age of 25, which is something that the hon. Member for Brentwood and Ongar asked the Minister to pursue. It also promised a further review of the personal adviser role to ensure that care leavers can get support to help them manage their finances.
As I have said, the Government deserve credit for the approach that “Keep on caring” set out. I do not doubt the sincerity of Ministers on these issues, but there are doubts about implementation, especially against the backdrop of cash-strapped local authorities, worries over the roll-out of universal credit, and large funding cuts to other services. I am advised that care leavers not in education or training do not have access to a personal advisor until the age of 25, but I believe there is provision within the universal credit arrangements for work coaches to suspend work requirements during periods of particular hardship or difficulty, for example, if someone is homeless. Are such measures available to care leavers who find themselves in similar difficult, confused circumstances? If not, will the Minister consider adopting that approach?
Does the Minister have any information on how many care leavers are claiming universal credit and how many of them are currently in rent arrears? As I understand it, there is a DWP marker for care leavers, but only if they self-identify as a care leaver, and I am not clear that that arrangement will necessarily continue under universal credit. I should say that I do not think that what I am talking about is part of some grand conspiracy. I am merely asking whether it has been thought about; are things joined up? I say that because I recognise that “Keep on Caring” was a cross-departmental document, and I am kind of keen to know what work is going on to reduce the bureaucracy that care leavers experience as they try to negotiate local authorities and jobcentres in pursuit of such things as housing, housing benefit, training, job opportunities and other financial support. I recently visited a London jobcentre to look at the roll-out of universal credit, and I was impressed by the work coaches I met, but I was particularly interested to know whether there is any specific training for them on the issue of corporate parenting principles: how are we going to take that bit of “Keep on Caring” and translate it into the work that is done on the ground? It would be helpful to know that.
As the hon. Member for Brentwood and Ongar was saying, on the issue of apprenticeships, £3.50 per hour may be fairly meagre, but I suppose it is conceived on the basis that an 18-year-old living at home with one or both parents could get by on that sort of money. My question is how it incentivises a young care leaver to take up an apprenticeship, and, if we are being honest, how on earth we expect them to manage on that kind of money. I know that the Minister will not be able to help me too much, because as far as I understand it the Government freely admit that they have no idea how many care leavers start or complete apprenticeships; nor do they know how many employers receive the additional apprenticeship payment for taking on a care leaver. The hon. Gentleman concluded his remarks by discussing how much use we could make of data. If only the Government collected some of it. I was surprised when I tabled parliamentary questions to discover that that information was not collected. I should have thought it was a good opportunity for the Government to measure the progress they were trying to make.
I certainly endorse the suggestion of an apprenticeship bursary—I presume that that is what the hon. Gentleman was suggesting—to mirror the higher education bursary; it would be a good idea. From the figures that I have seen it does not look in any sense cost-prohibitive. If it is part of the aim of “Keep on Caring”—something that the Department for Work and Pensions can play a major role in delivering—to make it possible to get a job and a stable life, it seems that we should strive to provide good-quality apprenticeships.
I note that the 2016 care leavers strategy states that the DWP is willing to explore what more can be done in the benefits system to support those wishing to return to education between the ages of 21 and 25. Is the Minister in a position to update us on any progress being made in that area? A lot might be learned from organisations such as Become, whose Propel project supports care leavers into further and higher education.
Finally, as the chair of the all-party group on looked after children and care leavers, I am in the privileged position of getting to hear the views and experiences of quite a lot of young people who have been part of the care system. I note that there is a promise, in the corporate parenting consultation by the Department for Education, to incorporate young peoples’ understanding of corporate parenting responsibilities into the work that it is doing on the local offer. It would be a good idea if the DWP could say it was going to adopt the same approach. Perhaps I may conclude by inviting the Minister to attend a future meeting of the group, where she could listen first-hand to what some young care leavers say. It would make a real difference to them.
Mrs Cheryl Gillan (in the Chair)
I have had a request to accommodate a colleague, and will therefore call Patricia Gibson and then Will Quince.
Patricia Gibson (North Ayrshire and Arran) (SNP)
Thank you, Mrs Gillan; I appreciate your calling me at this time. To clarify things for colleagues, I have made a request to leave a little early. I am thankful for the opportunity to speak in this important debate, as I would have been sad to miss it. I thank the hon. Member for Brentwood and Ongar (Alex Burghart) for securing it, as the young people in question need as much support as we can provide for them.
Young people leaving care are in the unique position of having the state as their corporate parent, and their educational, health and employment outcomes, sadly, are significantly poorer than those of their peers. The support to which they have access should be monitored and reviewed periodically; it should be shaped by the lived experience of care leavers, to ensure that it is effective and responsive to their particular needs.
The facts in relation to DWP support for care leavers make uncomfortable reading. A disproportionate number of care leavers have support removed, or live with punitive sanctions that are imposed on them by the welfare system. Care leavers have reported problems such as having financial support removed. That affects them acutely—perhaps more acutely than it affects those in many other sections of the population—because often they do not have family support, or even social support, when financial support is withdrawn.
According to recent information uncovered by the Children’s Society, in England between 2013 and 2015 nearly 4,000 sanctions were applied to care leavers, representing one sanction for every 13 of them. Indeed, care leavers in England are three times more likely to have had a benefit sanction than members of the general working-age population, where the rate is one sanction for every 39 people. As has already been pointed out, we can be pretty sure that the true number of care leavers facing a sanction is likely to be far higher than the figures suggest.
The DWP currently collects information on self-reported care leavers, which means that if a care leaver does not identify their status, they are not included in the figures. Such practice has encouraged the First Minister of Scotland to announce a root-and-branch review of the care system in Scotland, which will be driven by the experience of those in care, taking into account the views of 1,000 young people who have experienced care.
Outcomes for care leavers trail quite badly behind those for their peers, so doing more to help them to achieve positive destinations will have a significant impact on their future, despite the many and varied challenges that they may have faced in the past. The past cannot be changed, but we can change what their future may look like.
The care experienced employability programme is a one-year pilot project in Scotland to help 270 young care leavers between the ages of 16 and 29 to move into appropriate work, training or educational opportunities. It will be led by the third sector Young People’s Consortium, which consists of Barnardo’s Scotland, Action for Children and the Prince’s Trust. It will enhance and add value to existing youth employment provision for those young people who are often excluded from attaining their full potential through education and employment. By supporting more young care leavers to access employment, training and educational opportunities, and by working to close the attainment gap with their peers, we can send a clear signal that improvement in supporting that group of young people is necessary.
I hope that the Minister will set out some clear actions to tackle the fact that in England 40% of care leavers are not in education, training or employment, compared with 14% of their peers. That is a very poor comparison. In Scotland 78% of care leavers reach positive destinations within three months of leaving secondary education, but that is still not good enough, given that the figure for their peers is 93%.
I also hope that the Minister will indicate how the Government will address the fact that their own figures show that nearly one in five care leavers between the ages of 19 and 21 were either in accommodation that is considered unsuitable or in accommodation whose suitability was not known.
The reoffending rates of care leavers in England are now four times higher than those of all other young people. A recent study by Her Majesty’s inspectorate of prisons found that 27% of young people in the young offenders institutions it surveyed had previously been in care, but the figure for female young offenders was 45%. This situation represents a huge swathe of wasted opportunities and potential, but it is hoped that the Children and Social Work Act 2017, which came into force in April, will help to turn around the tragedies that lie behind those figures.
I ask the Minister to look carefully at some of the Children’s Society recommendations to help our care leavers to reach their true potential. The introduction of an apprenticeship bursary, which has been mentioned and which would support care leavers during the first year of their apprenticeship, would provide better financial support and ensure better long-term employment prospects for care leavers. The early warning system for care leavers at risk of sanction must be explored further by the DWP, to see whether it reduces the level of sanctioning. DWP staff should also ensure that universal credit is tailored to meet the particular circumstances of care leavers. Communication between Jobcentre Plus staff and care leavers should be more flexible. For example, if it is appropriate and will simplify communication, texting should be used.
A whole raft of measures have been proposed. Some of them would not cost very much at all, but they could have a significant and lasting impact on the lives and long-term prospects of care leavers. I ask the Minister to ensure that all of those measures are fully and carefully considered and explored by the Government, so that we can ensure that fewer of our care leavers fall through the cracks when they are young and consequently never catch up and reach their full potential. If they do not reach their full potential, that is bad not only for care leavers but for our society.
The DWP should always seek to make its support for care leavers more creative and innovative, and more responsive to the lived experience of our young care leavers, who are too important to be left behind.
Will Quince (Colchester) (Con)
Thank you, Mrs Gillan, for calling me to speak; it is a pleasure to serve under your chairmanship. I congratulate my hon. Friend the Member for Brentwood and Ongar (Alex Burghart) on securing this important debate.
This debate is ultimately about improving life chances, and the stats on care leavers are concerning. They are five times more likely to have been excluded from school and five times more likely to be convicted of a criminal offence or subject to a final warning or reprimand, and, as my hon. Friend mentioned earlier, only about 6% of care leavers end up going to university. However, the most troubling statistic for me is that care leavers are at considerably higher risk of homelessness, which is an issue that I care passionately about and that is the perspective from which I want to contribute to the debate.
I serve as the co-chair of the all-party parliamentary group on ending homelessness, alongside the hon. Member for Bermondsey and Old Southwark (Neil Coyle). In July we produced a report that examined homelessness among three specific cohorts: victims of domestic violence, prison leavers and care leavers. Everyone in this Chamber would agree that care leavers, given that often they will have grown up in challenging circumstances, should have all aspects of their wellbeing taken care of, and yet their housing needs are sometimes overlooked, as my hon. Friend mentioned earlier. When our APPG held its inquiry, we were told that a third of care leavers become homeless in the first two years after leaving care.
Norman Lamb (North Norfolk) (LD)
I am grateful to the hon. Gentleman for giving way and I apologise for not being here earlier; I was at a suicide prevention conference in Belfast. I very much share his concerns. In Norfolk, when children being cared for by foster carers reach the age of 18, in many cases the carers’ payments go down significantly. Does he agree that we need to avoid creating perverse incentives that might end up with children having to leave home and therefore being at risk of homelessness?
Will Quince
Broadly, I agree with the right hon. Gentleman, and I am pleased that the Minister has heard that point. I hope she will take it on board.
We also found that 25% of homeless people have been in care at some point in their lives. The Government’s care leavers’ charter states:
“We promise…To find you a home”.
We have to make sure that the benefits system supports that aim.
The APPG’s report recommends that care leavers should be exempt from the shared accommodation rate up to the age of 25. To provide some background, in 2012 the Government extended the shared accommodation rate to everyone under 35. The rate is the maximum amount that an individual can claim in housing benefit for a private rented property, and it is based on the cost of a room in a shared property rather than the cost of self-contained accommodation.
The rationale for that change, which incidentally I agree with, was to
“ensure that Housing Benefit rules reflect the housing expectations of people of a similar age”,
meaning a similar cohort who are not on benefits. Yet it is often the case that care leavers have had a really challenging upbringing; they might have suffered traumas that other people of their age might never experience.
We already recognise that we should have different expectations of care leavers compared with those we have of their peers. We currently exempt care leavers from the shared accommodation rate up to the age of 22. Nevertheless, most young people have the option of staying at home if they are unable to move out, but that choice is not available to care leavers. Furthermore, in our evidence sessions we heard from care leavers who said that they would feel unsafe in a shared home.
Exempting care leavers from the shared accommodation rate up to the age of 25 would give them the space and security of their own home, which would make a tremendous difference to their transition into adulthood. That suggestion has actually been recognised by the Government. The 2016 “Keep on Caring” strategy stated that the Government would be
“reviewing the case to extend the exemption to the Shared Accommodation Rate…for care leavers to age 25”.
Obviously, such an extension would have a financial cost, as my hon. Friend the Member for Brentwood and Ongar pointed out earlier. Currently, we do not know the number of care leavers who are affected by the move to the shared accommodation rate. I found that out—or, rather, tried to find it out and failed—when I submitted a written parliamentary question. However, the Children’s Society estimates that the potential case load is about 3,300. With an average difference between the shared accommodation rate and the one-bedroom rate of about £1,600, the cost of exempting care leavers would be about £5.3 million. Given the potential difference that change could make to the lives of care leavers, that is not an unreasonable figure.
The state has a responsibility for care leavers, young adults who are often among the most vulnerable in our society. We need to ensure that their housing needs are looked after just as well as their other needs. By exempting them from the shared accommodation rate, we can give them safe and secure accommodation, and help them in that all-important transition to adulthood.
I know that the Minister is as passionate as I am about improving the life chances of care leavers and ensuring that we address and minimise the risk of homelessness. I hope that the Government will take that recommendation on board and look at it. I will send the Minister a copy of the APPG’s very good report and hope that the Government will also look at its other recommendations.
Mrs Cheryl Gillan (in the Chair)
We move to the winding-up speeches. I call Mr Alex Cunningham.
Alex Cunningham (Stockton North) (Lab)
It is a pleasure to serve under your chairmanship this afternoon, Mrs Gillan.
First, I congratulate the hon. Member for Brentwood and Ongar (Alex Burghart) on securing this debate. I am pleased that we are united in recognising that we can all do more to give care leavers the best possible start to their adult lives. If the hon. Gentleman never says anything important again in this House, he said something important today: “Young people in care are our children”. That is a very important statement. I find it quite difficult to find much to disagree with in his speech, although the Government’s success is perhaps not quite as rosy as he thinks. In fact, his speech offered real challenges to the Government and I will go on to offer some of my own.
My hon. Friend the Member for Birmingham, Hall Green—
Alex Cunningham
It says “Hall Green” here. I looked it up specially. I am sure that my hon. Friend is correct and I am wrong. He has spent a lot of his time championing looked-after children in this place, and I congratulate him on and thank him for that. He mentioned that these young people are full of potential. All young people are full of potential; we just need to give them the extra support they need to achieve that.
The hon. Member for North Ayrshire and Arran (Patricia Gibson) talked about services being developed with the knowledge of the young people involved. I agree with that, and it is something we tried to do when I was a councillor in Stockton. She went on to give shocking statistics on the number of former care leavers in the criminal justice system. That is all the more reason for us to do much better.
I thank the hon. Member for Colchester (Will Quince) for his work with the all-party parliamentary group for ending homelessness. The study it did focused on care leavers. I have spent a lot of my life trying to get people to focus more on care leavers, and it is great that we see that happening across the piece. He talked about the importance of them having the security of their own home, and I agree with that.
This subject is close to my heart. Although it is not my particular brief, I am pleased to be here today. I was the lead member for children’s services in Stockton. I very much enjoyed the time I spent with care leavers, even if I was left wondering how as a corporate parent I could do more for the likes of them, bearing in mind that they would be cast out into the wider world much younger than my own two sons, John and Andrew, who opted to leave home in their mid-20s. John and Andrew returned home, and I am always pleased to see them, but that is not an option for care leavers.
The situation that stuck out the most for me in recent years was not a young person from Stockton—it was when I met a young woman during a visit by the then Education Select Committee to deepest Kent. She was a care leaver and told of being all but abandoned in her room at a hostel and having to regularly put up with men braying at her door asking her to party with them. She was frightened. She felt at a loss as to what to do next, and she lacked the necessary support to get on with her life. As MPs, we are not formally corporate parents, but that does not mean we cannot recognise that, even though care leavers at 18 may be legally adults, there are many ways in which they need much more support than an average 18-year-old, who most likely has the support of a family. We can play our part in giving them that. We can start with the opportunity to move into high-quality training and employment opportunities—something we want for our own children and grandchildren. The rates of young people not in education, employment or training are too high, with care leavers almost three times less likely to be in education, employment or training at the age of 19. That figure can no doubt be associated with an often unstable journey through the care system. Other Members have described that.
Progress has been made over the past 20 years, and that is worth reflecting on. The Labour Government took the Children (Leaving Care) Act 2000 through Parliament, which created the role of the personal adviser. While it is fair to say that the provision is not perfect—local authorities still struggle to maintain this level of service with shrinking budgets—in its day it was a real innovation. In 2009, the Labour Government introduced a requirement for all care leavers at university to receive a £2,000 bursary from their local authority.
It is not just Labour that has improved provision. In 2014, the coalition Government created the role of the virtual school head, whose job it is to promote the educational achievement of looked-after children in each area. I welcomed that. It was something we had been doing in Stockton. I welcomed the decision by the last Government to extend the provision of local authority support from 21 to 25 through the Children and Social Work Act 2017.
My own borough council, Stockton, has an excellent reputation for delivering for vulnerable people. It has removed the requirement for care leavers to pay council tax for a period of time while they are adjusting to their new independent life. Others have followed suit, and I wonder whether the Minister could encourage more to do likewise.
We all owe a debt of gratitude to the Children’s Society. Members have spoken about it and other organisations, such as Barnardo’s, and thanked them for their work with care leavers and the briefings and statistics they provide us all with. Statistics have been in evidence in the debate. We know that 40% of care leavers aged 19 to 21 are not in education, employment or training, compared with 14% of all other 19 to 21-year-olds. Outcomes under the Work programme for care leavers were significantly worse than for others. They were around half as likely to spend the minimum amount of time doing work experience within a 12-month period than peers aged 18 to 24 claiming jobseeker’s allowance.
The Department for Work and Pensions could do a lot more to improve the way the social security system works for care leavers. That cohort is five times more likely to face benefit sanctions than their peer group. The system of personal advisers introduced by Labour was a positive step, but the Children’s Society has highlighted that there is often a lack of co-ordination between personal advisers and work coaches. It has called for early warnings to be used when considering a sanction for a care leaver and for no sanction to be imposed without the personal adviser being notified. Will the Government look at that, and innovative schemes such as the one in Trafford, where there is a protocol between the DWP and the local council that allows for two-way communication between a care leaver’s personal adviser and work coach on their claim?
The Children’s Society also argues that sanctions should be at a lower rate, as for 16 and 17-year-olds, and be for no more than four weeks. What is the Minister’s view on that? Another idea is that the DWP could send reminders of jobcentre appointments to young people by text or WhatsApp. The NHS does that already because of the cost of missed appointments. Care leavers do not have parents to prompt them to attend, so that might be something they could benefit from in particular.
For many who have recently left care, and those about to do so, their first experience of applying for benefits will be with universal credit. If the Government do not do something to help, they could face the same severe negative impact that universal credit is having on people and their wellbeing. In August 2017, the Children’s Society report on care leavers and the benefits system highlighted that the DWP introduced a marker to identify care leavers on the labour market system used by DWP staff to ensure that they received more tailored support. My hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) spoke about that. There does not appear to be any such marker for universal credit, so will the Minister tell us what plans there are to change that?
Universal credit has also had implications for 18 to 21-year-old care leavers who are subject to the youth obligation, which effectively means increased conditionality compared with legacy benefits. They receive intensive work-focused support from the start of their claim. That may be positive, as it is not a good thing for young people to start their adult life with a prolonged period of unemployment. However, care leavers may face more challenges at that stage in their lives than the vast majority of their peers, so will the Government look at how they can pause that intensive search for work if the young person needs more time to attend to the other issues in their lives?
Under universal credit, the leaving care team cannot begin to set up the claim until the young person has turned 18, so payment will not be received for at least five to six weeks. This afternoon in the main Chamber we have been talking about universal credit, and Conservative Members themselves were saying that the period needed to be much shorter. The Minister could help to support local authority leaving care teams carrying out the administrative work to set up a claim four to six weeks before the young person leaves care, so that they will receive payment without delay. Will the DWP also provide more training for jobcentre staff to support care leavers, and work with local authorities to provide training for personal advisers so that they can understand universal credit better and make care leavers in their charge aware that alternative arrangements are possible?
In its briefing, the Children’s Society also highlighted that care leavers might lose up to £45 from housing benefit when they turn 22 as a result of the existing rules on the shared accommodation rate of local housing allowance. Other Members covered that in detail. Finding affordable housing is already a severe problem for young people, so it is important that the impediments are addressed. A Centrepoint survey found that 26% of care leavers have sofa-surfed and 14% have slept rough. Stability in housing has to be one of the most fundamental needs in ensuring stability in people’s lives.
The cross-departmental leaving care strategy stated that the Government would look into extending the age at which young people switch from the single bedroom rate of local housing allowance to the shared accommodation rate when living in private rented accommodation, which is a reality for many, given the shortage of social rented properties. Local housing allowance rates have been frozen until 2020, so a delay to the age at which care leavers begin to receive the shared accommodation rate—which can be £30 less per week—is particularly urgent. That move to a lower rate of support does not occur in a vacuum. It happens at a time when young people are only entitled to a lower rate national living wage, and at an age when their entitlement under universal credit is noticeably lower. That cut in monthly housing support eats into already stretched budgets, putting tenancies at risk and causing stress and anxiety.
Can the Minister share with us her assessment of the case for delaying the cut in the move to the shared accommodation rate from 22 to 25? I also ask her how the DWP could ensure that care leavers get the meaningful financial education they need. Many of us want it to be universal for all young people, but I would suggest that care leavers could do with a bit of extra help to ensure that they do not get into debt. If they do get into debt, they need even more robust support. I would be interested in her view on the breathing space being proposed in the Financial Guidance and Claims Bill for care leavers. That would halt creditors imposing interest charges and extra fees, which only worsen the debt.
I hope, and am sure, that the Government will listen to all the points made today, and act to show that we are all on the side of care leavers and want them to realise their full potential. I just hope that the Minister, like every individual who has spoken this afternoon, will become that real champion for care leavers.
The Parliamentary Under-Secretary of State for Work and Pensions (Caroline Dinenage)
It is a pleasure, as ever, to serve under your chairmanship, Mrs Gillan. I, too, thank my hon. Friend the Member for Brentwood and Ongar (Alex Burghart) and congratulate him on securing this important debate on the support given by the Department for Work and Pensions to care leavers. I also thank hon. Members across the House for their valuable input to this important discussion. They have raised a number of really important issues on how the Government and, indeed, my Department support care leavers. I am very pleased to have the opportunity to address all—or at least most of—the questions that have been raised, and to set out some of the actions that we are taking.
Let me start by reassuring my hon. Friend, and indeed all Members, that the Government are committed to improving the lives of, and outcomes for, care leavers. We recognise that care leavers are among the most vulnerable groups of young people. We of course understand that sadly many were taken into care because of neglect or abuse as children. We understand that as they leave care, they often have to make the transition to adulthood and independent living at a younger age than their peers, and usually without the support of a family network, as other Members have said.
The exceptionally difficult challenges that care leavers face mean that their educational, health and employment outcomes can be significantly worse than those of their peers. That is why we introduced the first ever cross-government care-leaver strategy in 2013, and updated that strategy in 2016. The strategy sets out the steps that the Government are taking—from housing to health services; from the justice system to educational institutions; and from financial support to work—to support care leavers to live happy, healthy and independent lives. The Department for Work and Pensions was proud to play a full and active role in supporting the Department for Education in developing that strategy. In the time available today, Members will forgive me if I focus as specifically as I can on the actions that the Department for Work and Pensions has taken, but it is important to remember, of course, that they are part of a cross-Government approach, which needs to be joined up as far as possible.
My Department has put in place a comprehensive package of support and protections for care leavers who need to claim benefits to make the transition from local authority care to independent living. That support ensures that they are offered the help that they need to take that important step, including the necessary assistance to find employment. That is where universal credit is an enormous benefit. The new work coach model means that each claimant stays with the same work coach throughout their claim, giving continuity of support for claimants. It also means that work coaches are able to identify very early a claim by someone who has complex needs—someone who may require individualised, tailored support. That, of course, includes care leavers.
A couple of hon. Friends and hon. Members mentioned that very important data collection exercise. My Department is working very hard to try to collect better data on claimants with complex needs, including care leavers. Information that someone is a care leaver is held on the claimant profile as part of the universal credit system. We are at the very early stages of the process, and we are still working through what data is being collected and what the data is telling us. We will, of course, keep a very close eye on that, and see if further markers are needed. That is why we have built into the universal credit system a pause-and-learn approach, which means that we can incorporate the benefits of our learning as we go. The Department for Education continues to publish valuable care leaver outcome data for 17 to 21-year-old care leavers. A data-share agreement is in place between Her Majesty’s Revenue and Customs, Department for Work and Pensions, and the Department for Business, Energy and Industrial Strategy to explore the link between educational achievement and labour-market outcomes. They will also explore the quality of outcome information that the data-sharing provides for specific groups, such as care leavers.
In universal credit, work coaches can tailor interventions to the needs of the individual, and the support that they can offer is incredibly wide-ranging. It can address a variety of barriers to work, and might include improving job-search skills, referral to skills and other work-related training, and other types of support. The work-related training can include traineeships, apprenticeship places, and work experience. I will speak a little more about apprenticeship places later on.
Jobcentre Plus districts work closely with their local authority care leaving teams to put in place protocols and processes to support care leavers who need to claim benefits. There are some great examples across the country of effective working protocols between job centres and local leaving care teams. Barnet care leaver hub, for example, involves a Jobcentre Plus work coach, co-located in the local authority leaving care premises with the Drive Forward foundation, the care leaver charity that delivers intensive one-to-one work support. Jobcentre Plus partnership managers are working with their local authority leaving care teams to facilitate contracts and joint working protocols. We are working with the Department for Education to encourage local authority leaving care teams to contact Jobcentre Plus.
A key element of that is the facility to prepare a claim in advance of the claimant’s 18th birthday. With the support of their local authority leaving care adviser or a Jobcentre Plus work coach, a care leaver can begin preparing to make that benefit claim four weeks before their 18th birthday. That ensures that all the identification and evidence checks are completed before they leave care and prevents any unnecessary delays in benefit payments. It also provides the opportunity to arrange advances and to direct rent payments to landlords where appropriate.
Alex Cunningham
The Minister is describing lots of good practice, but I wonder how we can get to the stage where a young person can be asked at their first point of contact with the DWP whether they are a care leaver, so that identification can follow them through the system?
Caroline Dinenage
That is something that we have discussed at length, and we are looking in detail to see whether that proposal could be incorporated. I would like to reassure my hon. Friend the Member for Brentwood and Ongar and other hon. Members across the House that we have worked hard, and are continuing to work hard, to ensure that universal credit works and is beneficial, not only for the majority of straightforward cases but for care leavers and those with complex needs too. That is why we have introduced a series of measures aimed at safeguarding and supporting care leavers.
I would like to go through a few examples, which people may or may not be aware of. We have exempted care leavers from waiting days in universal credit. Those who are under the age of 22 do not serve the seven waiting days and are entitled to universal credit from the very first day that they make their claim.
We have introduced the second chance learning initiative to enable care leavers up to the age of 22 to catch up on the education they may have missed out on when they were younger. That means income support or universal credit are available to care leavers who take up full-time study in non-advanced education. We have exempted care leavers from the removal of automatic housing support for 18 to 21-year-olds in universal credit.
The hon. Member for Stockton North (Alex Cunningham) talked about exempting care leavers from council tax. The Government have given councils the flexibility to support vulnerable groups, including care leavers, to manage their council tax bills. The Department for Communities and Local Government wrote to all councils in 2016 to remind them of the powers they have under the Local Government Finance Act 1992 to support vulnerable groups. A number of councils have already taken the decision to support care leavers through an exemption or discount in their council tax bills, as I think he said his local council was doing.
Steve McCabe
I do not get that many opportunities to praise Birmingham City Council, but it is one of the authorities that apply the exemption. Will the Minister consider writing to her colleagues at DCLG to ask them to publish a full list of the councils that exempt care leavers from council tax? Quite rightly, that is not something the Government can do, but it is a practice that almost all councils should follow unless there is a very good reason why they are not doing it.
Caroline Dinenage
The hon. Gentleman represents Birmingham beautifully—Selly Oak and also other parts of Birmingham, as we have learned today. He makes a good point.
Caroline Dinenage
He is clearly very talented. We would be very happy to do that, and I pay tribute to him for his work as chair of the all-party parliamentary group for looked after children and care leavers. I would like very much to accept his offer to come and join that APPG for at least one of its meetings.
Patricia Gibson
The Minister talked about councils being written to, to remind them of their flexibility and how they can implement the council tax exemption. Is she willing to give some money from central Government to help local authorities absorb the exemption that they are willing to give? That has happened in Scotland, where between 6,000 and 7,000 care leavers will be exempted from council tax, up to the age of 26. Will any money from central Government be given to help local authorities, including those in Scotland and other parts of the UK, to fund that?
Caroline Dinenage
The hon. Lady tempts me to make spending commitments on behalf of the Department for Communities and Local Government. While I would, of course, be absolutely delighted to do so, it is a little bit beyond my job description. I am sure the Department will read with great interest her comments in Hansard.
Norman Lamb
I am grateful to the Minister for giving way; she is being very generous. The former Minister Edward Timpson introduced a very good reform to enable payments to continue to children in foster care beyond their 18th birthday, which was widely welcomed. However, if the rate paid for the most complex children being looked after by very experienced foster carers goes down at their 18th birthday, it creates an incentive for the foster carer to encourage them to leave, which is the very last thing we should be doing. Does she agree that we should seek to find ways of ensuring we provide incentives for them to stay at home, as happens in every other family?
Caroline Dinenage
I am grateful to the right hon. Gentleman for drawing attention to my former colleague, Edward Timpson, who was a most fantastic Minister in the Department for Education and a great advocate for care leavers. We are supporting the Staying Put arrangements that the right hon. Gentleman alluded to, which mean that care leavers who remain with their ex-foster carer can claim means-tested benefit from their 18th birthday up to the age of 21, but I will look at everything he has said.
In addition, we have exempted care leavers from the shared accommodation rate until they are 22. The shared accommodation rate is normally paid to single people aged under 35. That means that care leavers can claim the higher local housing allowance one-bedroom rate of housing benefit until their 22nd birthday.
I have listened to the arguments made by hon. Members about the issue today. I particularly welcome the comments of my hon. Friend the Member for Colchester (Will Quince); he gave an eloquent description. I also thank him for the significant contribution he has made as chair of the all-party parliamentary group on homelessness, where he does a sterling and very valuable job.
We have always said that this is something we would like to achieve, but at the moment we do not have plans to extend the exemption for care leavers from the shared accommodation rate to age 25. I assure my hon. Friend and other Members who have raised the issue today that we will continue to keep it under review and will consider evidence from stakeholders on the impact that the shared accommodation rate has on care leavers.
We have given care leavers priority access to personal budgeting support in universal credit. That includes benefit advances, rent paid direct to landlords, payments more frequent than monthly and budgeting advice, including debt advice, which was raised by the hon. Member for Stockton North.
We have a fantastic “See Potential” campaign—I say fantastic as it falls under my ministerial portfolio. It encourages employers to recognise the benefits of recruiting people from all kinds of backgrounds, including care leavers. I was so pleased to celebrate the inspiring workplace and training achievements of young people, including care leavers and others, at the Land Securities Community Employment Awards recently—we saw the incredible growth, development and achievement of some very inspiring young people.
I am pleased that the Government are leading by example by setting up a cross-Government scheme to provide employment to care leavers. My Department’s own care leaver team includes a quite brilliant care leaver intern, who I have had the pleasure of meeting, and who is providing us with very valuable insights into issues that care leavers face and helping us improve our services for care leavers. She is very cool as well—she is in the room, which is why I am saying that!
In developing our support for care leavers, we have worked closely with stakeholders. I am particularly grateful for the input from the Children’s Society, representatives of which I met shortly after being appointed to the Department. When I met with them, I was made aware of the fact that in some cases care leavers have difficulty taking up apprenticeships and a number of hon. Members have raised that today. We know that without the support of a family, they struggle economically. Having had that meeting, I hotfooted it straight over to the Department for Education and met the Minister for Apprenticeships and Skills to discuss the idea of an apprenticeship bursary, which would ensure that apprenticeships were an affordable option for care leavers, who do not have the family support that most apprentices can rely on.
The Department for Education are reviewing how the new apprenticeship funding approach is supporting all those who are disadvantaged, including care leavers, with the intention of improving how the system supports those individuals from 18 to 19, so that apprenticeships offer a more attractive opportunity to them and a greater chance of success. It has agreed to explore the proposal for an apprenticeship bursary.
The debate has raised some really important issues, and I am grateful to all right hon. and hon. Members for the points they have made, which will continue to inform our work to support care leavers, alongside our discussions with our valuable stakeholders.
Alex Cunningham
Just before the Minister sits down, there were two further points raised during the debate—first, the imposition of sanctions at a lower rate and, secondly, the opportunity to develop a way in which local authorities can work with care leavers applying for universal credit ahead of reaching their 18th birthday.
Caroline Dinenage
The hon. Gentleman is right to remind me about the sanctions—I pulled that little bit of paper out, but had forgotten to pick it up—but I think that I covered applications in advance of the 18th birthday earlier in my speech.
With regard to sanctions, I would like to stress that the Department for Work and Pensions recognises the unique set of circumstances faced by care leavers. Therefore, we allow care leavers to apply for hardship payments of 60% of their normal benefit payment from day one of the sanctions. Sanctions are used in a very small minority of cases, when people fail to meet each of the requirements that they agreed in their claimant commitment without good reason. That said, conditionality and sanctions are part of a fair and effective system that supports and encourages claimants to move into work, towards work or to improve their earnings. Work coaches are very well trained to deal with vulnerable claimants, and have the flexibility to tailor the requirements according to each individual’s circumstances, and that includes the needs of care leavers.
We do not impose sanctions lightly. Claimants are given every opportunity to explain why they failed to meet their agreed conditionality requirements before a decision is made. A well-established system of hardship payments is available as a safeguard if a claimant demonstrates that they cannot meet their immediate and most essential needs, including accommodation, heating, food and hygiene, as a result of their sanction. UC claimants are able to apply for a hardship payment from the first accounting period in which the sanction reduction is applied.
I have spoken to care leavers, and we do not do them any favours by insulating them from the challenges of the day-to-day reality and responsibilities that their peers face. The care leavers I have spoken to tell me that they do not want to be wrapped in cotton wool. They want a little extra support and help, but they do not want to be entirely insulated from the challenges and responsibilities that their peers face.
I am pleased to have been able to put on the record our commitment to supporting care leavers and the action we are taking, but I hope I have made it clear that we are not complacent. I am passionate about improving the lives of care leavers. We are determined to ensure that the welfare system in general and universal credit in particular help care leavers make a successful transition to independent living and working life, and that we support them as best as we can.
Alex Burghart
I thank the Minister for her very interesting statement, and I thank all hon. Members who took the time to participate in this important debate. It is a real pleasure to speak in a debate in which there is a lot of cross-party agreement both about the challenges that young people face and about some of the solutions. I welcome that.
To our friends in the Public Gallery who are listening, I want to say that there are a lot of other Members who wanted to be part of this debate, but a debate in the main Chamber on welfare ran over. I am very grateful to the hon. Member for High Peak (Ruth George) for coming. I am also grateful to the hon. Member for Birmingham in general—the hon. Member for Birmingham, Selly Oak (Steve McCabe)—and the hon. Member for Stockton North (Alex Cunningham) for joining in.
I am particularly thankful to the hon. Member for Stockton North for acknowledging that Governments of all stripes have helped to improve the system as the years have gone by. He did not mention—neither did I—the important reform that Edward Timpson introduced, Staying Put, but we were put right by the right hon. Member for North Norfolk (Norman Lamb). I am also grateful to the Minister for detailing some more of the exemptions, opportunities and reforms that DWP has introduced to improve outcomes for care leavers.
There is, of course, more to do. I was very interested to hear the contribution of my hon. Friend the Member for Colchester (Will Quince) about how we can help to prevent homelessness. I urge the Minister to look at the shared accommodation rate. I was pleased that she said that it is now possible for young people to set up their claim before they leave the care system. I hope that support is being given to work coaches and personal advisers to ensure that young people are aware of that opportunity and that they can get through it.
We have also had an interesting debate about how we help people in jobcentres to identify young people’s needs early on. One of the ways of doing that may be to ensure better engagement by personal advisers and to set up meetings between the people who run the jobcentres and those who run the local children’s services. As a number of Members said, that is being done well in Trafford.
I very much like the idea suggested by the hon. Member for Birmingham, Selly Oak that councils should publish whether they are offering council tax exemptions for care leavers. That would be a good way of nudging some councils into doing the right thing, and it would also give councils that have already made the change the credit they deserve.
Lastly, I am delighted to hear that the DFE and the DWP are looking together at the issue of apprenticeships, with which we started the debate. I know not only that they are a great route into employment but, as the hon. Member for Stockton North said, that there is enormous potential in our care leavers. The care leavers I meet are fizzing with ideas. I see in them future businesspeople, entrepreneurs, doctors, teachers and the like, but we must ensure that they fulfil that potential. I hope that this debate has brought to the fore a number of the ways in which DWP can play its part in ensuring that those young people get the best out of life.
Question put and agreed to.
Resolved,
That this House has considered the Department for Work and Pensions’ support for care leavers.