House of Commons
(2 years, 4 months ago)
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Prayers
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09:34 - The House divided: - Ayes: 3 / Noes: 53 - Question accordingly negatived.
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Katherine Fletcher (South Ribble) (Con)
I beg to move, That the House sit in private.
Question put forthwith (Standing Order No. 163).
Medical Cannabis (Access) Bill
(2 years, 4 months ago)
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Jeff Smith (Manchester, Withington) (Lab)
I beg to move, That the Bill be now read a Second time.
Before I begin, I want to thank briefly a number of people who have advised me and helped bring this Bill forward today. Among others, particular thanks go to Professor Mike Barnes and Professor David Nutt; to Rudi Fortson; to the parents of children with treatment-resistant epilepsy who have talked to me—Hannah Deacon, Matt Hughes and Emma Appleby; to Peter Carroll and the great campaigners at End Our Pain; to the brilliant Adam in the Public Bill Office here in Parliament; and to Alex Worrell in my office in Parliament.
We have a problem that is acknowledged in this House—across this House, I think—and certainly outside this House, and I know that Ministers also appreciate the problem and want to try to find a way around it. That problem is that medical cannabis—cannabis-based medical products—is a very helpful and effective treatment for a number of medical conditions, but significant numbers of people who would benefit from being prescribed medical cannabis on the NHS are not able to get the prescriptions that they need.
When I was drawn in the private Members’ Bill ballot, I wanted to try to find a legislative way forward to address this problem. I had hoped to agree an approach with the Government. I had a number of conversations with Ministers. I do believe that Ministers want to find a way forward on this but, unfortunately, that has not been possible, which is why I have put forward the proposals that are before us today. As I say, I do not think there is a lack of will from the Government, but that reflects an inflexibility in the system, which is at the root of the problem. The Bill’s modest proposals try to find a way to help overcome the barriers. It is not a magic bullet and it will not resolve all the problems, but in due course it might help some patients to get the medicine that they need.
Jim Shannon (Strangford) (DUP)
I am very supportive of the hon. Gentleman’s Bill. My constituent Sophia Gibson—she is a young girl—and her mummy and daddy Danielle and Darren got medicinal cannabis. Some hon. Members will know the story and about how we went to the previous Minister. I can vouch for medicinal cannabis making the difference for that young girl by stopping her epilepsy. She is better today because of access to medicinal cannabis.
Jeff Smith
I thank the hon. Gentleman for his intervention. That is one example of a significant number where lives have been transformed by this medicine. There is frustration that people cannot get it as they should.
When the Government passed the Misuse of Drugs (Amendments) (Cannabis and Licence Fees) (England, Wales and Scotland) Regulations 2018, which moved cannabis from schedule 1 to schedule 2, it became legal for clinicians on the specialist register to prescribe cannabis-based medical products. That legalisation came in the wake of a high-profile campaign by patients who were unable to get the medicine that they needed. The highest-profile cases—many will remember Alfie Dingley and Billy Caldwell—were of children with severe treatment-resistant epilepsy. Medical cannabis helped their conditions remarkably, as the hon. Gentleman just outlined, but generally they had to get it from abroad—usually from the Netherlands—or on the illegal market.
The 2018 regulations, which legalised cannabis-based medical products, offered a hopeful way forward for those children and others. Hon. Members and the public would be forgiven for thinking that the problem was resolved, but, three years later, only three prescriptions for medical cannabis have been obtained through the NHS—three prescriptions in three years. Cannabis-based medical products are an appropriate treatment for a larger number of people and they have been able to access private prescriptions, but often they pay a fortune. I am told that there are about 10,000 private prescriptions for cannabis-based medicines in the UK for various conditions, including chronic pain, Tourette’s, anxiety and epilepsy, but virtually no one can access them on our national health service.
Alex Sobel (Leeds North West) (Lab/Co-op)
One public perception that is wrong is about how medicinal cannabis is produced. It is produced in secure conditions by highly trained people, creating good-quality jobs in secure premises. It is not done in a back bedroom somewhere. Should we not be bringing those industries forward to give relief to thousands of people across the UK through the NHS?
Jeff Smith
My hon. Friend makes a really important point. It is about not just medicines and health, but a life sciences opportunity that we ought to take up. The problem is that, if people cannot get the product, which, as he says, is well manufactured and safe, easily on prescription, the risk is that they will go to the illicit market and get products that perhaps should not be trusted as much as a prescribed product.
Earlier this week, I spoke to a mother who has a daughter with treatment-resistant epilepsy and she pays £2,000 a month for her daughter’s medicine on a private prescription. One of my constituents pays nearly £700 a month for his grandson’s medicine. Epilepsy prescriptions can cost £1,000 to £1,500 a month—that is not unusual. Families of patients in the most urgent need often have to resort to support from crowdfunding or individual donors to keep their medicine going. It is just not right that patients have to resort to that for a prescribed medicine because they cannot get it on the NHS. As I mentioned, many others are forced to get their medicine through illicit means.
Much of the campaigning on this issue is still focused on children with treatment-resistant epilepsy; they have been the highest-profile cohort of patients and I suspect many of the contributions to the debate will focus on that cohort. However, I want to emphasise that they are not the only patients who would benefit from access to cannabis-based medicines. They are probably the cohort most acutely affected. For many of them, it is an urgent and high-stakes issue—sometimes, it can be literally the difference between life and death—so it is right that we focus some of our discussion on them. I will offer a couple of examples to illustrate the importance and the power of this medicine to that group and others. Those in that cohort are not the only ones who can benefit.
In 2018, the then chief medical officer, Dame Sally Davies, said that there is
“conclusive evidence of the therapeutic benefit of cannabis based medicinal products for certain medical conditions”.
That is why she recommended that they should be moved out of schedule 1.
Patrick Grady (Glasgow North) (SNP)
I congratulate the hon. Gentleman on bringing forward the Bill. Although it applies to England only, many of us would like to see access to medical cannabis more widely across the whole UK, especially when we have heard testimonies from constituents and their children who would benefit. As the campaign continues, does he agree that the devolved Administrations and the Westminster Government should work together on this wherever possible and, if appropriate, ensure that powers are devolved so that the devolved assemblies are able to go further and faster if they want to?
Jeff Smith
The hon. Gentleman makes a really important point, and I agree. I do not agree with everything that the devolved Administration in Scotland do, but they do have an approach to these sorts of issues that is more focused on harm reduction and evidence than perhaps we have in England.
Cannabis-based medicines are already approved as a treatment for a small number of medical conditions. Currently, the National Institute for Health and Care Excellence guidelines recommend four licensed cannabis-based medical products that can be prescribed in the UK. I will talk about the terminology in a moment, but there are two THC-based medicines—dronabinol, which is licensed for appetite loss in AIDS patients and as an antiemetic in chemotherapy, and nabilone, which is a synthetic cannabinoid medicine licensed for nausea in individuals receiving chemotherapy. There is also Sativex, a combined THC and CBD medicine, which is licensed for muscle spasticity in multiple sclerosis patients, and Epidiolex, a CBD-based medicine—it is 99.8% CBD with less than 0.1% THC—for the two rare childhood epilepsies, Lennox-Gastaut syndrome and Dravet syndrome.
I am referring to THC and CBD; it might be helpful if I say a few words about terminology, and about the nature of cannabis, ahead of my next remarks about the proposals in the Bill. The cannabis plant is made up of something like 147 cannabinoids. They are the compounds that act on the cannabinoid system in the human body. There are also over 100 terpenes, which are aromatic compounds; flavonoids, which are pigments; and four other minor sets of compounds, so it is quite a complex botanical plant.
The complexity of the plant and its compounds is part of the issue that I will try to explain shortly, but the two main types of compounds that I am referring to are tetrahydrocannabinol, or THC, which is the psychoactive ingredient—very broadly and slightly simplistically, that is the ingredient that produces the high that recreational users experience, but it is also a painkiller—and cannabidiol, or CBD. Broadly, CBD has a more sedative effect—a kind of chill-out effect.
CBD on its own is legal in many countries, including this one; it is the THC content that makes cannabis illegal for recreational use in many countries. Different strains of cannabis plant have different balances of THC and CBD, and cannabis medicines do too. For example, Epidiolex, which is one of the most used medicines for severe epilepsy, is overwhelmingly CBD and has a very small amount of THC. Sativex has a higher proportion of THC. That is important because different treatments and balances work for different patients, and sometimes people have to adjust and tweak their treatment to find out what is right for them. If I refer to full-spectrum cannabis extract, that is a cannabis compound concentrate that preserves the full cannabinoid and terpene contents of the raw cannabis plant, including CBD, THC and other compounds. That is the plant, which is the basis of the medicine.
I want to provide three case studies of the real-life effect of cannabis-based medicines. Probably the most famous case is Alfie Dingley and his mum Hannah Deacon, whose campaign for access to medical cannabis helped to change the law in 2018. Alfie was perfectly healthy until he was four months old, when he became constantly sick and began having seizures. The seizures continued for months and he lost every skill he had developed. He was diagnosed with auto-immune epilepsy. The amount of time between Alfie’s clusters of seizures shortened as he got older. By the time he was five, they were happening every week. Each time, he needed up to five doses of intravenous steroids, which had a really negative effect on his personality and behaviour. Eventually, Alfie was diagnosed with a rare epilepsy syndrome which affects only nine known boys worldwide. There are slightly more girls with the syndrome, but only nine known boys in the world.
Hannah, Alfie’s mum, was desperate for a solution. She researched anything that might help and came across medical cannabis, so she learnt about the human cannabinoid system and cannabis medicines. At the time, Alfie’s doctors were telling her that regular steroids would eventually kill him, so to Hannah, cannabis medicines seemed like his only chance. She began the campaign for Alfie to have a prescription of cannabis medicines in the UK, where they were illegal at the time.
Once the family had raised enough money, they moved, in September 2017, to the Netherlands, where they could get medical cannabis legally. There they gave Alfie an oil prepared from Bedrolite, which is made by the Dutch company Bedrocan. That is a standardised strain of cannabis plant, with full extract CBD oil. Over the next three months, Alfie’s seizures became less frequent. They added THC oil called Bedica, also made by Bedrocan, under the guidance of their paediatric neurologist. Alfie went without seizures for 40 days. When he did have the clusters, they were less intense and were controlled much more easily. His cognitive development improved greatly.
Living abroad, however, was really hard for the family. After five months they ran out of money, so they had to come back home to the UK. In the UK, they had to fight for a prescription that contained both CBD and THC. Eventually, as a result of the campaign led by Hannah and other families, and under immense pressure from those desperate families, the Government agreed to change the law to make medical cannabis legal. Alfie finally received an NHS prescription for the products he had found so beneficial in the Netherlands in November 2018. It is still one of only three prescriptions in the UK, and his family had to go through an unusual process and special approvals to get that medicine.
Three years later, Hannah has recently reported that Alfie has not had a seizure in over 500 days. Before his medical cannabis treatment, he was having 150 fits a week. Although cannabis medicines are not a silver bullet for everyone, they have been absolutely life-transforming for Alfie, Hannah and the rest of the family. Alfie’s is a particularly unusual syndrome, but the majority of children in similar situations have not been able to get access to medicines despite their now being legal.
Andy McDonald (Middlesbrough) (Lab)
My hon. Friend is making a fabulous speech and I am sure people will study it after the event. He mentioned Mike Barnes. Does he agree with me and Mike Barnes that the children who are outside the syndromes he is so expertly describing have nothing to lose by trying to see if cannabis-based products work for them? Is it not a grave injustice that those children are denied that opportunity?
Jeff Smith
My hon. Friend makes a really important point. They have nothing to lose. The problem is that we have to balance benefit and risk and, for this cohort of children and lots of medical cannabis patients across the country, the benefit is far greater than the risk. That is the frustration, and the problem with access to medicine is that lots of patients with different conditions would benefit massively and, if we are being honest, I think we all know that the risk is pretty low.
I want to contrast Alfie’s case with the story of another mum and her son who does not have a prescription for his epilepsy. This young man is now 18; he started having seizures in 2016 when he was 12—does that add up? I thought I had got my dates wrong, but that is correct. In 2017, after trying treatment on seven different anti-epileptic drugs and 16 different combinations, he was diagnosed with drug-resistant epilepsy. A cocktail of pharmaceuticals left him with impaired cognition, memory loss and an inability to process new information. He was still having regular seizures and was often in and out of hospital, requiring emergency treatment for status epilepticus: a seizure or a series of seizures that last for more than five minutes and can be fatal.
In 2018, desperately looking for anything that might help, the boy’s mum took him to the Netherlands, where a hospital agreed to treat him with Bedrolite. The doctors there eventually concluded that conventional anti-epileptic drugs were making his seizures worse and weaned him off them gradually, resulting in his cognition and memory improving. When they tried to wean him off the cannabis-based medicine, Bedrolite, his symptoms rapidly deteriorated and he almost died. He was put back on an increased amount of Bedrolite in combination with two newer anti-epileptics, and he has now been completely seizure-free for more than a year.
That young man’s health depends on Bedrolite, which is a fraction of the cost of the emergency hospital treatment that he used to require. His Dutch neurologist said that adults with uncontrolled epilepsy as severe as his would likely have to live in an institution for their whole lives. However, the young man writes:
“I’m now able to think about my future for the first time in years and want to go to art school. We are desperate to come home but I’m really afraid of the seizures starting again if I’m not allowed a prescription for Bedrolite. My mum and I are so scared of more seizures again and that I won’t be allowed to carrying on living a healthy life like I can now.”
As a result of the barriers to access in the UK, the mother and son are effectively living in medical cannabis exile in the Netherlands. That is not right.
The third example is not a child with epilepsy. Lucy Stafford has a condition called Ehlers-Danlos syndrome. She had been almost permanently in hospital, having suffered from joint dislocations after her first surgery when she was 10 and another 19 operations throughout her teenage years. Her condition deteriorated. She became bed-bound at 17. She said:
“I was kept alive by intravenous feeding tubes and taking fentanyl to ease the debilitating pain of dislocating multiple joints a day”.
As many people know, fentanyl is an opioid that has been responsible for a very large number of overdose deaths in the USA. We do not really want people to take it if there is an alternative. The alternative to lots of opioid treatments is, in my view, medical cannabis.
Lucy faced extreme pain from a permanently dislocated jaw, and when she was in hospital, she faced potential death from sepsis. Lucy’s pain specialist suggested medical cannabis as a last resort. The prescription was turned down for NHS funding, with a letter saying that cannabis was unlikely to work and that there was a one in four chance that she would end up with psychosis, so Lucy and her mother went to Amsterdam and sourced medical cannabis. Eventually, her jaw began to unlock. She was able to reduce her opiates and other pharmaceutical medications. She has since become able to walk unaided. She is now back in the UK and she started a degree in neuroscience at the University of Sussex this September.
Lucy’s private prescription for cannabis in the UK initially cost £1,450 a month. She is now enrolled in a medical cannabis trial called Project Twenty21 run by an organisation called Drug Science. I draw attention to my entry in the Register of Members’ Financial Interests: I am an unpaid trustee of Drug Science, which does fantastic work in its research into drugs. Project Twenty21 facilitates access to medical cannabis effectively at cost price, once patients have been seen and diagnosed by specialists, so Lucy’s medicine now costs her about £450 a month. As an example of the potential saving to the NHS, when Lucy was on a feeding tube her medication alone cost more than £250 a day, and the hospital room cost very much more. Overall, the estimated cost to the NHS is probably more than £100,000 a year. Despite the huge savings, her local hospital trust refuses to allow her physician to prescribe medical cannabis for her on the grounds of
“lack of evidence of efficacy”.
That is the key problem in the UK: the difficulty of getting through the barriers in the system. Lucy’s life has clearly been absolutely transformed by medical cannabis, but because of the systemic barriers, she has not been able to access it through the NHS. That is not logical in any way. It would make much more sense for the hospital trust to support her.
We know that cannabis-based medical products work for many patients. We know that they are legal. We know that they are effective. They are being privately prescribed by some specialists in the UK, but patients cannot get them on the NHS, so ordinary families are sometimes paying a fortune for their treatment. Some are having to go to Holland to get their medication.
One thing really demonstrates the absurdity of the situation. Because of import-export problems since Brexit, it has now become even more difficult to import Bedrocan products, which are the medicines produced in Holland, so the Government have done a deal that has facilitated the imports and licensed production facilities in the UK. Virtually nobody can get medical cannabis on prescription on the NHS, but the Government accept its efficacy enough to have done a deal with the Dutch Government to ensure a supply of Bedrocan for UK families and have even gone to lengths to start having it produced in the UK. It does not make any sense at all—it cannot be right.
Why are we in a situation where patients cannot get these NHS prescriptions? The general consensus is that it stems from a nervousness regarding the evidence and the guidance about these medicines, and a consequent reluctance of many clinicians to prescribe on the NHS. There are a very limited number who will prescribe privately: in the case of childhood epilepsy, there have been only three specialists willing to prescribe. One is now retired, and the others are not able to take on any more patients, so there is another blockage. There is also a reluctance among clinical commissioning groups and trusts to fund prescriptions; Lucy’s hospital trust is a good example.
At the moment, only a small number of cannabis-based medicines are licensed by the Medicines and Healthcare Products Regulatory Agency for the small number of specific conditions that I outlined earlier, so the cannabis medicines that are generally prescribed in the UK are unlicensed and prescribed as “specials”. Clinicians, even specialists, are sometimes reluctant to prescribe those unlicensed products. In the narrow pool of those who can prescribe, there is often a reluctance to prescribe unlicensed cannabis-based medicines, owing to a lack of knowledge and training; confusion over conflicting guidance from Government bodies such as the National Institute for Health and Care Excellence, and from the NHS and professional bodies such as the British Paediatric Neurology Association; a lack of confidence in the evidence base because of a lack of randomised controlled data; and ultimately a fear of repercussions because of the personal liability when prescribing an unlicensed medicine.
Currently, only specialist doctors on the General Medical Council specialist register are allowed to initiate a prescription, although GPs can carry it on under the guidance of a specialist. The specialists who do want to prescribe usually face barriers from their NHS trust or CCG, which normally declines to fund the prescriptions. If an NHS prescription is to be made, it has to go for approval to what is called a higher authority, usually a CCG or trust, which is usually reluctant to fund because of the problem relating to evidence and contradictory guidance. I should add that that process applies to no medicines other than medical cannabis.
For some time, campaigners have pressed the NHS and the Department of Health and Social Care to explain the process and the pathway that can deliver an NHS prescription in cases in which an NHS specialist wants to prescribe cannabis-based medical products. Perhaps the Minister could enlighten us, because although the Government committed themselves to doing that in 2019, it has not happened. The only solution suggested so far is an individual funding request, but we know that families who have tried to take that route have been rejected and told that the patient has not demonstrated clinical exceptionality. It is very difficult to obtain funds in that way. If the impact that medical cannabis has on that cohort of epileptic children with extremely rare and severe diseases is not deemed clinically exceptional, I would ask what is.
There are two ways in which we need to make progress. First, we need clinicians to be confident in the specials that they are able to prescribe, and we need NHS bodies to be confident enough to fund them. Secondly, we need more safe, effective cannabis-based medicines to be licensed. That is a key issue, because although there is a wide body of evidence for the efficacy and safety of cannabis medicines, it is largely patient-reported or observational and evaluative. The UK’s medical regulatory bodies generally only license medicines on the basis of randomised control trial data. I do not think anyone would deny that double-blind placebo randomised control trial data are the gold standard for medical trials aiming to demonstrate the safety and efficacy of medicines, but they are not the only way of demonstrating those qualities, and they are very difficult to carry out on whole-extract plant cannabis products.
Cannabis-based medicines are not made up of a single compound, and patients often use bespoke mixtures to treat their conditions most effectively. Let me quote Professor Mike Barnes, as my hon. Friend the Member for Middlesbrough (Andy McDonald) did earlier. He has said:
“While there are some RCTs”
—randomised control trials—
“for CBMPs”
—cannabis-based medical products—they are generally for isolates of those products, and
“the cannabis plant doesn’t lend itself to being studied this way as it’s a botanical product with several different components.”
Many experts, including Professor Barnes, would argue that we need to look at a different evidence base to demonstrate the safety and efficacy of whole-plant extract cannabis-based medicines.
Even Sir Michael Rawlins, the previous head of the MHRA and NICE, pointed out in 2008 that RCTs were not the only way of obtaining getting evidence. He said:
“Randomised controlled trials… regarded at the ‘gold standard’ of evidence, have been put on an undeserved pedestal. Their appearance at the top of ‘hierarchies’ of evidence is inappropriate; and hierarchies, themselves, are illusory tools for assessing evidence. They should be replaced by a diversity of approaches that involve analysing the totality of the evidence-base.”
There are many other sources of evidence that could equally inform medical practice. They could include patient reported outcome measures—PROM—trials, real-world evidence effectiveness trials, pharmacoepidemiology —I can never get that word right—which means looking at real-world evidence among a large group of patients, observational research, and n=l trials.
Barbara Keeley (Worsley and Eccles South) (Lab)
I have been working with a constituent whose son is in this position. Does my hon. Friend agree that the side-effects of the synthetic elements of the products being used are a serious issue? It is all very well to say that trials and evidence are needed, but people are using other products that they are getting privately, and my constituent is desperately worried that the side-effects could proliferate over time when a child has been pushed into taking them.
Jeff Smith
That is an important point. No one is claiming that every product is absolutely safe, and products often have side-effects, as Alfie’s case demonstrated. He had been pumped full of steroids which affected him badly and would eventually have killed him. That was a medication that was recommended until he started taking medical cannabis.
There is lots of evidence from around the world. Cannabis-based medicines have been legal in Canada and some US states for some time, and there are tens of thousands of individual patient reports on the therapeutic value of cannabis-based medicines in the Canadian and, in particular, Minnesotan databases. They do not equate to the so-called gold standard double-blind randomised control trial level of proof, but they are highly suggestive of a pattern of evidence that should be taken seriously. Another issue is that many people would argue that it is not ethical to insist on RCTs for the cohort of children with epilepsy, as they would have to be taken off the medicine that is keeping them well, and keeping them alive in some cases, to put them on a placebo. Some people would question that process.
In 2019 the Health and Social Care Committee looked at the barriers to access for cannabis-based products, and the Government produced a response to its report in which they made reference to the need for observational trials to help the patient cohort of children with severe epilepsy. Even the Government argued that we should be considering other forms of evidence, and I know from my interaction with the MHRA that it is considering other forms of rigorous, well-researched evidence. Unfortunately, the Government’s view seems to have changed. I have spoken to Ministers and officials again, and they seem to be wedded to the idea that RCTs are the only way forward.
My Bill would set up a commission to propose a framework for the assessment of cannabis-based medicines and their suitability for prescription in England, to sit alongside the existing MHRA processes for conventional pharmaceutical drugs. The commission would help rigorously to assess all the existing evidence base and to consolidate all the available evidence, which could give those who are eligible to prescribe more confidence in the evidence for prescribing this particular unlicensed medicine.
I hope that the commission’s work will result in a more suitable framework for the assessment of the efficacy and safety of cannabis-based medicines, which I hope would result in more cannabis-based medicines, including whole-plant medicines, becoming licensed. That would go a long way towards addressing the problem. It would improve the likelihood of prescription on the NHS for both severe and common conditions. The commission would also be tasked with identifying any other barriers that could be overcome to improve access. That might result in the adoption of short-term solutions that I will touch on shortly.
James Daly (Bury North) (Con)
The hon. Gentleman is making an excellent speech on this important issue. From my research it seems that the manufacturers and producers of cannabis-based products are not investing in the clinical trials and evidence that would be necessary, or at least proportionate in comparison with what happens for other medicines. Will he say why that is not the case, or will he point to evidence of such trials being undertaken by the producers of these medicines?
Jeff Smith
The hon. Gentleman makes an important point. Trials are happening, but there are two problems. The first is the cost, because RCTs are extremely expensive. As I mentioned earlier, the problem with RCTs is that they are not really suitable for some of these medicines, such as whole-plant cannabis extract medicines, which is the essential problem. We can isolate compounds and put them through the RCT process, but it is much more difficult with whole-plant cannabis extract medicines. Those are the two difficulties, and I will go on to suggest that the Government could commission trials as a possible way forward.
Tom Randall (Gedling) (Con)
The hon. Gentleman is making an excellent speech, which I am following with great interest. As I understand it, he is proposing the creation of a new body to look into this matter. We often talk about NHS bureaucracy and so on. Before he goes on to the other part of his Bill, could he explain why he thinks the creation of a new body would particularly resolve the ongoing issue that he has outlined very well? Could the matter be addressed within existing NHS structures?
Jeff Smith
The matter is not being resolved in the current processes, and that is part of the problem. I emphasise that I am not proposing a new permanent body; this would be a bit like a royal commission, although I would want it to be much shorter and more focused. It would be a commission of experts to look at the problem and propose a new framework for assessment of the evidence. That would, I hope, lead to a better process for licensing. I reassure the hon. Gentleman that I am not proposing any new bureaucracy.
The other part of my Bill proposes a register of GPs trained in cannabis-based medicine, who could prescribe cannabis-based medicines for certain conditions.
Margaret Greenwood (Wirral West) (Lab)
My hon. Friend is making an excellent speech, and I know both his speech and his Bill are very much welcomed by my constituents, particularly one who suffers from progressive myelopathy. He is in almost constant pain, and I know he would like to thank my hon. Friend for all his work. On the business of creating a register of GPs trained in prescribing medical cannabis, obviously GPs adopt different specialisms according to what they are interested in and so forth, so what mechanisms would we need to deal with a situation where somebody’s GP was not registered when they might nevertheless benefit from a prescription, and how that might be addressed?
Jeff Smith
My sympathy to my hon. Friend’s constituent; chronic pain is one of the conditions for which cannabis can be very beneficial, and I hope he can find a way forward. I will talk briefly about GPs. My hon. Friend is right that they specialise, but part of the problem with GP training and medical training in general is that there is very little training on the cannabinoid system, so I would not expect all GPs to come forward. She anticipates my remarks, so I will move on, but the point is that there is sufficient interest from GPs to enable her constituent to find somebody who could help with his condition.
I should perhaps be clear that I am not expecting GPs to initiate a prescription for some of the very rare and specialist conditions, such as some of the epilepsy conditions we have talked about, although for childhood epilepsy GPs are currently allowed to continue a prescription that has been initiated by a specialist. Many other conditions that can be effectively treated by cannabis-based medicines, however, are what we might call GP conditions, and chronic pain would be one of them. Enabling trained GPs to prescribe medical cannabis should improve access for patients with symptoms commonly dealt with by GPs, such as chronic pain, muscle spasms, nausea and anxiety. Currently, patients would have to go to a private specialist doctor to access the medicine for one of those conditions. Although GPs would not be initiating prescriptions for the rare and severe patients, training more GPs could result in better outcomes for people with those conditions, such as intractable epilepsy, because their initial consultation with a GP could be more informed about cannabis as a useful treatment and could result in more effective referrals to consultants who could prescribe the medicine.
I emphasise that inclusion on the register would be on an opt-in basis for GPs. I would not expect all GPs to be required to take on the prescription of cannabis, but a significant number—the polling suggests 24%—would be willing to do so. Under the current law, a GP is not allowed to initiate prescriptions, but I am told that 73% are open-minded about playing more of a role in the prescription of medical cannabis.
Those are the two proposals in the Bill. I will briefly outline a few suggestions that have been put forward to me as alternative ways to allow patients to get the medicine they need. A number relate to the evidence base and some relate to funding, because one problem, of course, is the cost of prescriptions. One way forward could be a fund to temporarily pay the cost of the private prescriptions for patients with certain conditions, such as treatment-resistant childhood epilepsy. I know a number of hon. Members in the Chamber have called for that. I cannot propose that in a private Member’s Bill, because it is a spending commitment, but I hope the Government will consider it as a way forward, particularly for the cohort of patients with childhood epilepsy. It would be a discretionary fund to fund private prescriptions for those who need them in the interim while our collective failure to allow NHS prescribing is sorted out.
I hesitate to say this in an arena where rampant Euroscepticism has been known to raise its head, but another suggestion is to allow cannabis-based medicines that have been authorised for use by a state within the European economic area to be prescribed by a medical practitioner as if the product in question has been granted a marking authorisation for the purposes of the Human Medicines Regulations 2012. I think that would be a good way forward—it is a way partly to get around the problem—although I do not expect everybody in the Chamber to support the idea. As we know, these medicines are safe, effective and licensed in lots of countries, such as Holland, and we need to learn from places that enable patients to get their medicine.
On funding, another way forward might be to allow a slice of the NHS innovative medicines fund to go towards epileptic medical cannabis patients. Campaigners were previously told that that could be a way forward, but have been told more recently that it is not because the fund is supposed to be only for cancer medicines. That appears to be an arbitrary Government decision and there appears to be no reason why some of that funding could not be allocated to epileptic medical cannabis patients.
On evidence, we could set up a Government office for medical cannabis. The hon. Member for Gedling (Tom Randall) might not like another layer of bureaucracy, but other countries, including Australia, acknowledge the need to treat this medicine differently. They think outside the box and look at all the available evidence and evaluate it robustly. We could mandate the Government to commission more trials or mandate the commencement of an observation trial that involves all children with treatment-resistant epilepsy, as a way to make sure that they get immediate access and to ease their prescription-cost burden. The Secretary of State already has the powers to do that and could set up an observational trial that involves all children with treatment-resistant epilepsy to fund their treatment. As I say, we could establish a patient-reported-outcome-measure study, a managed-access programme—as happened with Orkambi, the cystic fibrosis medicine—or a compassionate-access scheme like the one that currently operates in Northern Ireland and is open to a wider cohort than just children with epilepsy.
There are, then, a number of ways in which the Government could help in the short term and in the longer term. The Bill proposes just two modest measures that might make a difference in due course. If the Government are not prepared to accept the proposals in the Bill, what is their solution? People are in pain and unable to access through the NHS the medicines that in some cases are keeping them alive. We cannot allow this situation to go on because we collectively fail to overcome the barriers. It has gone on for too long and we need to address it.
I suspect some colleagues will speak sympathetically but say that this Bill is not the solution; if they do, I hope they will set out what they think is the way forward and the solution. I am happy to support them if they do, because I just want to find a way forward. My Bill proposes two good ways forward, particularly for the families of children with childhood epilepsy—whose lives sometimes depend on getting these medicines—but also for the many people who benefit from cannabis-based medicines and are denied them by a combination of bureaucracy and inertia. If people are not happy with my Bill and are not prepared to support it, the question must be: if not this, what?
Katherine Fletcher (South Ribble) (Con)
I commend the hon. Member for Manchester, Withington (Jeff Smith) for bringing this really important matter to the attention of the House. He has made a wonderful speech that has stepped through lots of the dynamics in the debate.
This is a genuinely difficult topic. Many people present today want to participate in the debate and demonstrate their care, compassion and concern for the individuals at the heart of it. Indeed, that is one of the themes that I want to cover today. This is a funny place; it can be quite fraught, which might not necessarily be obvious to those observing us from outside this House. Members have to balance our compassion for an individual with the office that we hold and the responsibilities that that brings. Although I want to talk about a number of the points that the hon. Gentleman has made, I also want to highlight how difficult that trade-off can be.
Since I joined the House in 2019, I have sought, where possible, to find a way of speaking English in a normal way, and I shall try to do that on this topic. When I first pitched up here, I did not really understand the nature of the trade-off. Bills on topics such as this land at the heart of the matter, which is that this is not necessarily a particularly easy or comfortable thing to talk about. I will try to stick with what I promised and use some real-world examples.
With the House’s permission, I want to highlight the real-life experiences of one of my constituents in South Ribble, a redoubtable lady by the name of Joanne Griffiths. Joanne is a wonderful individual, but this is really about her son, who she calls “boisterous Ben”. Ben has great difficulties with his epilepsy and has struggled with treatment over the years, but before I start to highlight the case and understand how it pertains to the subject, let me give a bit of clarity. Joanne does not support the Conservative party. In the past, she has been on a leaflet with the right hon. Member for Islington North (Jeremy Corbyn). I am not trying to make a party political point; when MPs from whatever party are elected, we are here to support all of our constituents, and we take that job incredibly seriously—I want to put that on the record. She will never ever vote for me, but I will speak for her genuinely and honestly and in a way that is in her best interests. In these more febrile times, that is an important point to make, but let us get back to what is really important, which is Joanne and, more importantly, her son, Ben.
I want to put her efforts for Ben on the record, and the easiest way to do that is to quote her in her own words:
“It has been three years since the law changed, and I have spent four years fighting for access to what is very much the only medication to have any effect on my son’s hundreds of life-threatening seizures per day. Medical cannabis has transformed his life and gives him seizure freedom, and we do not wish any other parent or child in the area to go through what we have, and we are still suffering.”
When I was elected back in December 2019, as MPs we could get permission from individuals to act for them and we could take on casework from our predecessors. The complexities of the system mean that that often comes in printed paper form. I was given a large pile of handouts and one file, which must have been 1.25 inches thick. When Joanne says that she has been campaigning for four years, I can tell Members that she has been campaigning for four years. I did not so much pick up that file as weigh it. If any given set of paperwork can describe the emotion and the passion that the debate arouses, it is that sense of, “There you go! Congratulations, you’ve just won an election, you can help this lady and her family.”
Within that case file are letters and notes from Joanne’s meetings with her local MP, my predecessor. She has met Ministers, pressure groups and policy researchers. She has been a tireless campaigner. She even had members of my predecessor’s staff go with her to attend appointments with medical professionals. Reading that and reading all the correspondence, I can state confidently that Ben could not have a better mother. She is not a tiger mum; she is like a proper lioness defending her son. It is really important that I put my genuine admiration on the record today. She has fought tooth and nail for him. The question that I want the House to examine is: should she have to be that lioness of a mum?
Let me give the House the highlights of what Joanne has done over the last four years—this is by no means all of it. She has fought for medical cannabis to be legalised. She has met the Secretary of State for Health—and all Members of this House know that people do not suddenly turn up with that idea on a Tuesday and then it happens on the Friday; it takes a lot of time, effort and engagement. Along with others, she has helped to secure the legalisation of certain types of medicinal cannabis. She has fought her way through a system that is not really understanding of the issue in order to see a medical specialist. In 2019, through a private prescription, she got Ben prescribed the Bedica oral solution of 20 mg/1ml with 2% THC, and the Bedrolite oral solution 100 mg/1 ml with CBD at 10%, and less than 1% THC. Joanne said:
“For years now we have had to fund raise up to £2,500 a month to fund this medicine, use all our savings and borrow money from family and friends. We are on the verge of being broken both financially and emotionally due to the stress and with Covid, our fundraising options have all but been shut down. This is on top of running a local business whilst looking after a child with complex needs”.
That speaks for itself.
Let me turn to the efficacy of the treatment. Ben’s response to the treatment was recently described by the individual funding request panel, which the hon. Member for Manchester, Withington mentioned, as “exceptional” with
“demonstrable improvements to his condition”.
That is an independent third party effectively saying that the treatment works.
Joanne is still going, because she is still getting that private prescription. She has fought through the NHS system to see a specialist and get a clinical decision to agree Ben’s prescription, with the implication that it would be funded through the NHS, but that prescription has been rejected by the local CCG and hospital trust policy. The lioness mum that she is, she is now back in my inbox and in lots of other people’s inboxes, and is campaigning to understand what has caused the blockage in prescribing and what is happening. She has got the Secretary of State for Health and Social Care to instruct the NHS to review what is causing the issue and the blockages, so the questions are being asked at the highest level of the Department. She has also written to the Health Committee.
Tonia Antoniazzi (Gower) (Lab)
As co-chair of the all-party parliamentary group for access to medical cannabis under prescription, I know very well the person and child described by the hon. Lady. Joanne deserves better. Ben deserves better. I am so pleased that we are seeing through the party politics and that you have met Joanne, because this is a ridiculous situation. You are describing four years of hurt, pain and fighting of the lioness that is Joanne Griffiths, and yet nothing has been done. It really upset me, and I am glad that the hon. Lady is on side. You—sorry; the hon. Lady is on the Government Benches, and this situation has to change.
Katherine Fletcher
I agree with you—[Interruption.] Oh crap! I agree with the hon. Lady. [Laughter.] Might as well get something decent on the record! You can take the girl out of the north of England, Madam Deputy Speaker; I apologise profusely. I agree with the hon. Lady, but I think that there are some issues that prevent immediate “do something” action, and I want genuinely to examine them.
Katherine Fletcher
I will happily take another intervention once I have been through the issues, but I just want to continue to highlight what this lady, Joanne, is having to do. She has got the Secretary of State to ask the NHS what is going on. Along with other parents, she is still talking to the Chair of the Health and Social Care Committee, whom she and Ben previously met in his role as Secretary of State. As per the advice from the local CCG, she applied for an individual funding request for a prescription with a demonstrable improvement in boisterous Ben’s condition, but it was rejected. She appealed in July and won, but on 3 November, the appeal process was deferred awaiting clarification and more information.
As the hon. Member for Gower (Tonia Antoniazzi) highlights, that must feel Gordian—how can Joanne unpick that? She is still fighting and, as hon. Members would expect, I am supporting her. To the point that the hon. Member for Manchester, Withington raised, I have also written to the Secretary of State about participating in an observation trial.
The story is distressing. I cannot see any hon. Member who is unmoved and is not thinking about what they would do in a similar position. It is complicated and I find it hard to reconcile my personal distress.
Tonia Antoniazzi
The hon. Lady says that it is complicated, which it is, but we are now in a ridiculous situation. There is something or someone in the system blocking medicinal cannabis getting to those children. Three prescriptions are already being supported, so why can the others not be supported too?
Katherine Fletcher
The hon. Lady raises an important point, which I will come to. I think that those individuals are caught in a pincer movement between scientific proof and medical ethics. I am mindful of the challenge of the hon. Member for Manchester, Withington who asked if they cannot do it, what can they do. I will make some suggestions on that.
The distress is genuine and clearly felt on both sides of the House, but the specific definition of practical actions that address the situation is a problem. If hon. Members will forgive me, I will set out the events in order. Since November 2018, the law has allowed for prescriptions of medicinal cannabis, which is no small thing. It has been an illegal drug for a long time, and it is a Conservative Government who brought that in.
That prescription is now a legal tool in the armoury of qualified doctors. Prescription medicine is rightly the preserve of highly qualified and trained doctors. No one would want me wandering down the high street saying, “Oh you look a bit poorly today—go and have a bit of that.” It takes years of blood, sweat and tears. Ultimately, when doctors have completed that technical qualification, they take the Hippocratic oath. Today’s debate hinges on the interaction between the Hippocratic oath that doctors take as individuals on qualification—I am aware that not everybody swears on the same text—and the Government’s ability to feel qualified enough to influence, or seek to influence, doctors’ decisions. I think that is where the blockage is.
Tonia Antoniazzi
Again, the hon. Lady’s generosity in giving way is noted. On that point, is she trying to say that the prescriptions that have already been written privately by experienced clinicians are unethical?
Katherine Fletcher
The hon. Lady perhaps needs to let me make some of my points. She keeps asking me, but I am genuinely trying to get there.
Dr Neil Hudson (Penrith and The Border) (Con)
I am grateful to the hon. Member for Manchester, Withington (Jeff Smith) for bringing forward this important debate. He spoke with power and passion about a very important issue. I want to touch on the comments that my hon. Friend the Member for South Ribble (Katherine Fletcher) made about the difficulties in decision making for clinicians on the frontline. I speak as a veterinary surgeon, cognisant of the difficulties in making rational, evidence-based decisions in our profession when we are looking at licensed products for the species we are treating and having to make tough decisions about when we go off-licence. I am very sympathetic to my colleagues in the medical profession wanting a large evidence base to make them feel comfortable about making those decisions. Does my hon. Friend agree that it is welcome that NICE has made some recommendations about some trials that can take place and that there are trials under way? That will try to help us improve and increase the evidence base to help clinicians on the frontline make rational decisions.
Katherine Fletcher
My hon. Friend anticipates a couple of points I was about to make. I am talking not just about the individual who is prescribing, but about the medical system. There are rightly in our wonderful NHS medically qualified people engaged in lots of layers—my hon. Friend the Member for Gedling (Tom Randall) talks about bureaucracy—but they are people who have taken the Hippocratic oath. That is not just the person on the one-to-one with patients; it goes all the way through the system, and that is what I am worried about, basically.
Crispin Blunt (Reigate) (Con)
Where my hon. Friend talks about the challenge that faces us, she is absolutely on point. The medical profession of course wants a reliable pharmacopeia to be able to turn to, with all the supporting evidence and the rest. The problem that our profession has inflicted on our constituents is that we are 50 years behind in the research. Outside the regular pharmaceutical assessment there is all the knowledge that is on the streets. It is unreliable, but it is there, so people believe that the medicine works in all sorts of ways. We have a responsibility in this place. People are obviously turning to the criminal supply chain to get such products. That is our fault, and the hon. Member for Manchester, Withington (Jeff Smith) is trying to find a way through so that we can get the service to patients that they deserve. That is why I think this Bill at the very least deserves a Second Reading, so that these issues can be pursued in Committee.
Katherine Fletcher
I am not sure I completely agree with my hon. Friend on the translation between the two. He almost makes my point for me. He talks about the ubiquity of cannabis on the streets, which I recognise, and the normalisation of that being within people’s purview.
Crispin Blunt
There is a wholesale difference between people using cannabis for recreational purposes, which we have made illegal and is one for debate, and people using medicines—medicines that we have made illegal and stopped the research—for therapeutic purposes. That is a quite different issue.
Katherine Fletcher
I thank my hon. Friend for the clarification. I think I might have used slightly clumsy language. What I am trying to get at is that for therapeutic use, there is still a required research standard. While cannabis is ubiquitous and lots of people use it for non-therapeutic and currently not legal uses—to quote Marshall Mathers III:
“Marijuana is everywhere, where was you brought up?”—
that does not translate into something that I feel I am comfortable in asking clinicians to engage with.
I want to develop my argument. If I may, I will mention my hon. Friend the Member for Crewe and Nantwich (Dr Mullan) and the five years of blood, sweat and tears—literally, I imagine—through medical school to achieve his title of doctor and take the Hippocratic oath. For those of us who have not gone through that journey, it is worth listening to the oath. The original version—its language is a bit dated now—is:
“I will use my power to help the sick to the best of my ability and judgement; I will abstain from all intentional wrong doing or harm”.
I think that touches on the point my hon. Friend the Member for Penrith and The Border (Dr Hudson) made about how, to avoid doing harm, there needs to be some certainty either way. In its more up-to-date form—this is the oath that doctors from the University of Exeter take—it states:
“I…pledge”—
I am not pledging myself—
“that I will do my best to serve humanity—caring for the sick, promoting good health and alleviating pain and suffering.”
Doctors are coming in wanting to do that, and I do not think the “blockage” that was referred to is anything to do with intention or fuddy-duddyness. Another of the lines they say is:
“I will care for all patients equally and not allow prejudice to influence my practice.”
Again, any doctor looking at a child as sick as Ben can be when his seizures are bad are not, having taken that oath, going to go, “Oh, well, there’s something I could prescribe.” Forgive me for continuing to emphasise the point, but the oath goes on:
“I will respect the autonomy and dignity of my patients, and will uphold their confidentiality. I…support…teachers, colleagues and all those who sustain the NHS.”
Then it gets to these lines:
“I shall never intentionally cause harm to my patients, and will have the utmost respect for human life.
I will practice medicine with integrity, humility, honesty and compassion.
I recognise that the practice of medicine is a privilege with which comes considerable responsibility and I will not abuse my position.”
This oath is a signifier of the integrity of individual doctors and medical ethics. It is their loadstone at the core of what they do, and I agree with them that it needs to be protected at all costs. Each doctor needs to weigh their own decisions, but for these complex cases—especially for some of the people who, by anecdote and, as I would put it, a good old case of looking at, have hugely benefited from medical cannabis—there is not one doctor in the system, but a series of them. While Ben has secured one NHS professor’s support for prescription and one private doctor’s support for prescription—I draw no distinction between the scale of the personal challenge and the qualifications that somebody has regardless of where they work—other medically qualified professionals within the CCG or funding panel are saying that they need more evidence.
Dr Kieran Mullan (Crewe and Nantwich) (Con)
I think it is very important for Members to remember that, at various stages through medical evidence building, there have been occasions when people have said very strongly that something, anecdotally, was working, yet further down the line we have discovered that that was not the case. There is therefore hesitancy when it comes to that kind of observational medicine as evidence, because I am afraid it is not reliable.
Katherine Fletcher
I thank my hon. Friend for his intervention, and if I do not embarrass him too much, may I also thank him for his service in hospital during the covid pandemic? It is the strength of experience and the variety of experience on these Benches that makes sure, when we do put stuff through, that the laws of this country are scrutinised by people from different perspectives, and he is a great example of that.
Joanne position’s is that she is coming to me with Ben saying, “This doctor says he can have medical cannabis, and then I have another set of doctors saying, ‘Well, we need more evidence before we can prescribe it’.”
Katherine Fletcher
No. Would the hon. Member let me, honestly, make a bit of progress? I hope she does not mind; I think I have been very fair.
We have a loving family in a state of limbo, we have medical professionals deeply concerned about whether it is the right thing to do and whether it is breaking their Hippocratic oath to prescribe, and we have someone who is not remotely qualified to make this decision being asked, in effect, to engage in a medical ethics debate when I am not qualified to do so.
I want to turn to another aspect, and this may be the point at which I have to declare my biology degree and a distinct possibility that this might get a bit nerdy. I apologise for that, but geeks may take over the world. I think we need an examination of the other side of this issue: how do the scientists, whether or not they are medically qualified doctors, and how does science provide an evidence base that gives the doctors some confidence and cuts out all of the nonsense? Effectively, I am asking for the House’s forbearance on the topic of standards of scientific proof.
To recap, the families of the children, including Ben, believe, based on the evidence of their own eyes—a No. 1 eyeball—that medicinal cannabis has an enormously positive effect on the seizures; seizures that are so distressing. I do not want to keep walking away and making this a theoretical concept, because it is not.
The family have secured the support of two medically qualified individuals, but others believe that the scientific literature lacks the evidence base—as has been pointed out, we do not have the evidence base because we made it illegal for 50 years and it became legal only three years ago—to prescribe specific compounds and drugs. There has not been enough research to understand formally, in the gold standard of a double-blind trial, whether these cannabis medicines do work.
The hon. Member for Manchester, Withington talked about the availability of different formulations of this generic thing, with different strains and different levels and ratios of THC and CBD. He mentioned a trial and error process to get these very sick children and adults a stable medicine that works for them. If it was my child, in extremis and in an emergency, I would want to go through that process, but as I scientist I think that trial and error can lead to rally big problems. It is not good enough to say, “We think medical cannabis has worked, so we’ll give you 0.5% or we’ll give you 10%”.
Tonia Antoniazzi
The problem is that we have been having this discussion for many years—ad infinitum. The hon. Lady is standing here today painting that picture. Ben has already had every single possible licensed or unlicensed medicine through the NHS. This is the only one that makes his life incredibly better. It is not a miracle cure, but it gives him a quality of life that he deserves. So do those other children. There is more than anecdotal evidence out there. I think she is insulting the families by making that case today.
Katherine Fletcher
The hon. Lady is being unfair. Listening to my words, she will understand that I have that level of emotion about a very poor and sick child, but I am trying to find a way of helping him that does not potentially put other children at risk because we are giving something on anecdote. I remind her that thalidomide was thought to be fine. If we step away from—[Interruption.] I cannot hear her chuntering at me from behind a mask. If she wants to insult me personally, stand up please.
Tonia Antoniazzi
I would not personally insult the hon. Lady because I do not think that this place is the place to do it. I will happily have a conversation with her afterwards. The issue we have here is that the word “anecdotal” has been thrown around. None of the experiences and none of the work that has been done by many of the people involved is anecdotal. this is not anecdotal. It is not about ethics. It is about getting medicine to the children who need it because the situation is now intolerable.
Katherine Fletcher
The term “anecdote” means, within a scientific context, not statistically proven. While the emotion that the hon. Lady shows on behalf of Ben’s family and other families is important, it is also important to step back. If nothing else, the pandemic has shown us the power of science to find the right answers to solve problems.
Dr Mullan
It is very important that we do not allow our compassion and our concern about individual cases to cloud our judgment about the fact that the NHS, the Department of Health and Social Care and the MHRA have to put systems in place that apply to every medicine across all the many treatments that are used. Questions like this arise repeatedly about many medicines. We should not use one case or one example to change the whole approach, which overall—as my hon. Friend has explained—aims to keep people safe.
Katherine Fletcher
If the Bill solved a specific problem, it could enjoy my support.
Jeff Smith
The hon. Lady is making a thoughtful and important speech. May I go back to the mention of thalidomide, which I think is an unfair comparison? Thalidomide went through all the randomised controlled trials. People have used cannabis for thousands of years and nobody has ever found any evidence of any resulting foetal abnormalities, although there have not been randomised controlled trials.
The hon. Lady may wish to correct my impression, but she seems to be saying that randomised controlled trials are the only way to get evidence. I just think that we need to look beyond that. There is a whole wealth of evidence out there—a body of evidence. I am no scientific expert, but that is why I am proposing a commission of experts to look at the evidence and recommend a way forward. I just think that the comparison with thalidomide is not one that we should be making.
Katherine Fletcher
I made the comparison with thalidomide because it was an inappropriately researched product that had hugely deleterious effects, because people were not looking properly. I am happy to clarify for the record that I am in no way suggesting that medicinal cannabis could have the same side effects as thalidomide. I am talking about the scientific method.
Katherine Fletcher
This sitting Fridays thing is fascinating. I would absolutely love to give way.
Jim Shannon
The hon. Lady refers to evidence. Sophia Gibson, the daughter of my constituents, has had the use of medicinal cannabis for three and a half years. It has greatly improved her quality of life, reduced her epileptic fits and given her the opportunity to transcend from primary school to secondary school this year. Her parents have a very strong evidential base that it works.
Katherine Fletcher
I know her parents do, but as a scientist taking a decision on an n of 3—n being the number—it is not possible.
Several hon. Members rose—
Katherine Fletcher
Let me make a little progress. I am trying to defend science, but I am incredibly conscious that others want to speak and have other perspectives on the matter.
August bodies such as the British Paediatric Neurology Association, the General Medical Council, the National Institute for Health and Care Excellence and the Royal College of Physicians have all issued guidance around the original change in the law, which was initially cautious. NICE has recently updated its guidance to state:
“There is no recommendation against the use of cannabis based medical products.”
However, it still does not address the issue of a positive evidence base for the safety and effectiveness of these drugs. How do we do that?
Mark Fletcher (Bolsover) (Con)
In response to some of the passions expressed, I want to say that my hon. Friend is making an incredible speech. Not only is it emotional, but it outlines the difficulties of ethics, decision making, science and research. I have listened for the past 30 minutes, captivated by the way in which she is presenting the matter to the House. On behalf of all hon. Members here today, may I say thank you?
Katherine Fletcher
I thank my hon. Friend. I reassure the House that it is not only a surname that we have in common.
I think we are getting somewhere. We need a scientific evidence base that we can prescribe to doctors or the system more broadly that will give them more confidence—or, as the hon. Member for Manchester, Withington suggests, effectively a bypass mechanism that says, “I know we haven’t got any evidence, but on this we’ll have to look at the very compelling but relatively small numbers.” There is an implication that we should just throw out what is working very well.
This is where the hon. Member might welcome what I am trying to get at—well, he might. The gold standard randomised controlled trial requires a very strongly controlled placebo. There are two cohorts of people who absolutely do not know whether they are on the placebo or the real thing, because there are a series of cognitive biases that can kick in if they think they are receiving a medicine and are not. I agree 100% with, and understand why, anybody whose child is currently taking medicinal cannabis and is stable and happy, would never put themselves in a position where they would have a one in x chance of receiving a placebo as opposed to the medicine. I spoke with Joanne Griffiths directly about that and I understand that.
However, during the covid pandemic the scientific establishment has changed trial design and its ways of doing things, so it has to be possible to find a placebo cohort of children with similar conditions who are not taking additional cannabis medicine. There are a number of reasons why people might choose to not use it. The UK is not an island. The other problem is that the numbers are fantastically low, so there is a relatively low pool of people to play with. However, the UK has shown itself to be a leader in global science. I think it would be possible to find, in other countries where they have not taken the progressive steps we have taken in the UK to legalise medicinal cannabis, a group of children with similar medical conditions and use them as the placebo. There is an opportunity for the scientific community to maintain the gold standard of a double-blind trial, but not necessarily put people in the position where they need to come across.
My call to Government would be to speed up the current observation trials and to engage with scientific leadership—remember, it is this Government who are putting extra billions into research and development because we are a science superpower—on a more creative RCT trial, looking for the placebo that proves or disproves it over a series of numbers on a global scale.
I will draw my remarks to a close. It is in the pincer between medical ethics and standards of evidence where, tragically, young men like Ben sit, and we see the distress. There are potential solutions. I see the sense of measures in the Bill, but they come back too much to the idea that by voting for the Bill as an MP and as an unqualified individual, I will be telling a medical professional what to do. That is how I read the Bill.
Katherine Fletcher
I am very conscious that others want to come in, so I am going to crack on.
While I am a nerd and I can understand the science, I think we are on shaky ground if elected individuals get into a position where we are strongly incentivising the system or telling medically qualified people who have taken an oath what to do. I do not think it is possible for us to say, “Okay, I know we do not have peer review evidence that that particular drug x on that percentage formulation can work, but the family says it does and I can see it does, so off you go and prescribe it.” Simply put, I do not think we can tell doctors what to do. I say that with a genuinely heavy heart.
I hugely commend the hon. Member for Manchester, Withington for bringing the Bill before the House today. I thank the hon. Member for Gower for her passionate contribution. I know she will continue to stick pins in me to make sure I continue to work behind the scenes. [Laughter.] My final message to Joanne is this: “I know you think I don’t care. I do. I just cannot support the Bill today.”
Andy McDonald (Middlesbrough) (Lab)
I confess to having been depressed many a time in this Chamber, but after that last contribution I cannot remember feeling as low as I do at this moment. [Interruption.] I ask Members please to take this Bill seriously. It is not in any way about telling medical practitioners what to do. I ask them please to read the Bill. The proposition opposite the argument around placebos that we would somehow look to a cohort in some other jurisdiction for available children to participate fills me with absolute and utter horror.
I rise to speak in support of the Bill, and in doing so I congratulate my hon. Friend the Member for Manchester, Withington (Jeff Smith) on his masterclass. If anybody needs to understand what Members have tried to persuade this place to do over many years, they should read that speech in Hansard. It was a comprehensive account. But we are here yet again. With respect to the hon. Member for South Ribble (Katherine Fletcher), she has taken us back years in going back to the basics—to the very beginnings of this debate—and I regret that bitterly. My hon. Friend has brought forward a modest, focused and eminently reasonable Bill, which I trust and hope will gain the support of the entire House.
The application of medical cannabis extends to and is of benefit to those with conditions such as intractable nausea, vomiting and chronic pain, but I want to focus my remarks on cases of epilepsy. We have had many a debate in this place about medical cannabis and heard incredibly moving stories from families about its wonderful efficacy in response to severe treatment-resistant epilepsy. Only last month, we had an excellent debate in Westminster Hall, secured by the hon. Member for South Leicestershire (Alberto Costa), who spoke with such eloquence and forensic accuracy about the efficacy of these treatments. We also heard from the right hon. Member for Hemel Hempstead (Sir Mike Penning), who has been a determined advocate in this campaign.
Notwithstanding the welcome change to the law to facilitate NHS prescriptions of medical cannabis, only three such prescriptions have been issued in the three years since 2018. As such, the parents of children with intractable epilepsy, knowing that the medical cannabis treatment they have procured works, with seizures much reduced or eliminated, have been left at breaking point emotionally and financially, having to find up to £2,000 a month to pay privately for this medicine. There can be no question but that those who issued those prescriptions did anything other than obey the Hippocratic oath.
None of us can imagine how on earth those loving parents cope with such massive costs. Up to £2,000 a month—that is the equivalent of an additional and very substantial mortgage; in fact, it would dwarf many people’s mortgage payments. Not even we MPs, on over £80,000 a year, could cope with that. How on earth can we expect those families to withstand those huge costs simply trying to keep their children alive and free from the ravages of seizures by accessing a known and proven prescriptive solution? That these families cannot secure NHS prescriptions for their children, when it has been proved beyond doubt that cannabis is efficacious, is a monumental shame. The campaign group End Our Pain rightly said that this saga has dragged on for far too long. Those families have petitioned, marched and campaigned with such dignity. They should not and must not be ignored.
The new Secretary of State for Health and Social Care was pivotal in the change in the law when he was Home Secretary. I urge him, the Minister and the Department to give effect to that change and remove all barriers to getting medical cannabis to those patients. The Bill will make an invaluable contribution to increasing prescription capacity by pointedly freeing up one of the blockages in getting these vital prescriptions to the people who desperately need them and who so evidently benefit from them.
It is a simple Bill with a mere three substantive, but very precise, clauses. The overall effect will be, first, to require the General Medical Council to operate a register of general practitioners who may prescribe cannabis-based products in England, changing the position from prescription only by consultants. It will also require the GMC to set the criteria to include training and professional development requirements to enable GPs to be on the register. It is up to each GP to decide whether they participate.
The second limb of the Bill will establish a commission to bring forward a framework for the assessment of cannabis-based medicines and their suitability for NHS prescription, and it will task such a commission with recommending measures to overcome barriers to gaining access to cannabis medicines on the NHS. I am sorry that the hon. Member for South Ribble is not in her place.
My hon. Friend the Member for Manchester, Withington has made provision in such a commission for the careful consideration of evidence other than from conventional controlled trials, including from observational studies and other countries where cannabis-based medicines are more readily prescribed. This is not a case of licking a finger and sticking it in the air. It is about proper research on which we can rely. We have heard it explained to us how randomised trials are not the appropriate way to go about business. In any event, that being held up as the gold standard is certainly open to debate.
I am afraid that the mantra of conventional random trials is simply inhumane. We have a situation where patients and their families know that this works, but the current system is trapped in inflexible and flawed processes that badly fail epilepsy sufferers, who have to mortgage all that they have to pay for these prescriptions or continue to suffer the ravages of seizures and often some dreadful side effects of powerful drugs. This Bill is a careful step along the way in addressing one small part of the blockage to sufferers getting the right treatments.
Somewhat belatedly, I must declare an interest, Madam Deputy Speaker, as I have a 26-year-old son with epilepsy and severe developmental delay and special needs as a consequence. I would like to explore further whether medical cannabis might be of assistance to him, but hitherto, the system is as resistant as the condition itself. He had two older brothers, one of whom we lost when he was just 16 years old, 15 years ago—colleagues will have heard me mention him before. I do not know whether medical cannabis would have helped him, had we even known about it then, but I will do everything I can to assist families right now in their determination to get the medication that their children need.
We were confronted with our beloved Rory locked in status. I recall so vividly calling the ambulance and having him whisked off to hospital, where the consultant told us we better call a priest, and then all of us, my wife Sally, my son Paddy and my daughter Rosie, holding Rory as he died. I never want to have any of those families suffer such an outcome. I bitterly regret that I have not shown the courage and determination of people such as Hannah Deacon in securing that medication for her child. How I wish I had been as wise as she. I beg right hon. and hon. Members not to talk this Bill out today, as they have been instructed to do, but to do the right thing and help to take this small step today, to remove one of the barriers placed in the way of people so desperately in need of these treatments and to give them access to this life-changing and indeed life-saving treatment.
Mrs Natalie Elphicke (Dover) (Con)
I am extremely moved and saddened by the comments of the hon. Member for Middlesbrough (Andy McDonald). My great sympathies and good wishes to him and his family.
This is such an important topic to be discussing today, and I thank the hon. Member for Manchester, Withington (Jeff Smith) for introducing his private Member’s Bill. The issue affects many people up and down the country, adults and children alike. I welcome the opportunity to speak in this debate and will focus my remarks on epilepsy in children.
My constituent, Teagan Appleby, who was mentioned earlier, is one of those who cannot access medical cannabis on the NHS. Teagan is reliant on medical cannabis to manage her epilepsy so that she does not suffer hundreds of fitting episodes. I pay tribute to Teagan’s mother Emma for her superb care of Teagan. It is simply unfair and unacceptable that, in addition to looking after Teagan, Emma has to raise thousands of pounds each month to get hold of Teagan’s medicine. That should not be the case—that is what our NHS is there for. The law was changed by my right hon. Friend the Secretary of State for Health and Social Care when he was Home Secretary, but too many people simply cannot get an NHS prescription in practice even after that change.
Teagan’s case was one of the first constituency surgery cases I worked on after being elected in December 2019. As is the case for many hon. Members representing children who have epilepsy and need medicinal cannabis, the issue has gone on for many years—too many years. Many hon. Members have worked hard to secure access to the medicine, and I pay tribute to them for all the work that has been undertaken. I attended the debate on this topic here just over a month ago, on Thursday 4 November, which followed the Westminster Hall debate on 3 November, to which the hon. Member for Middlesbrough referred, where the narrower topic of the situation for epileptic children was explored.
Pursuing the situation for Teagan, I had fully expected that it would be a case of, “Where there’s a will there’s a way”. I am sorry to say that has not been my experience of the NHS in this case. Instead it seems to be, “Where there’s no will, no one will pay”. I do not mean political will. As has been set out time and again in this place, the political intent is clear and I truly believe it is cross-party.
I was present when the Minister for primary health, my hon. Friend the Member for Lewes (Maria Caulfield), said last month:
“The Health Secretary and I are committed to doing everything in our power to accelerate this work.”
I have spoken to her personally about the sad situation that affects Teagan and I have absolutely no doubt about her resolve or that of the Government resolve on this. She said further:
“We have changed the law, but that has clearly not been enough. We need to find a resolution, so that we can get these medications licensed if the clinical evidence is there, and we need to work with the regulator.”—[Official Report, 4 November 2021; Vol. 702, c. 1120-21.]
I agree with her: the law has changed, but that is not enough. It is not enough to ensure that Teagan gets the medicine she needs on the NHS.
In my own experience of pursuing the matter as a constituency MP, I have seen the blocks and barriers to helping Teagan at first hand, as I am sure many others have in many other cases within the NHS. These blocks and barriers are harder to overcome because of the specialty of dealing with those children and with specialised medicines in a shared care environment. This is one aspect that clause 1 seeks to address.
Medical cannabis can be prescribed on the NHS, and changes were made in November 2018 to legalise that position. Although that class of drugs is unlicensed, it is not unlawful. Plenty of unlicensed medicines and treatments can be prescribed on the NHS. Indeed, I once read that exercise might be available for prescription on the NHS, but I am not sure whether that is the case. I have been able to confirm that the National Institute for Health and Care Excellence has approved the funding of the Alexander technique for Parkinson’s disease, as well as ginger and acupressure for reducing morning sickness.
This particular drug, cannabis, is illegal, and I support that position and fully oppose a relaxation on or general legalisation of cannabis. The same is true of morphine, which is sold illegally as heroin. I support that position and fully oppose the general legalisation of heroin, but I have needed morphine in hospital and have been utterly and profoundly grateful for the relief it gives—other Members may have had the same experience. I am mindful of that, which is why it is vital that we find a way to support Teagan and those like her who need access to the medicine that works for them.
That support is twofold: money and prescribing. I am afraid it cannot wait for the outcome of years of medical trials or the vague hope that some company will want to invest in developing further research in this area, because this is an issue that affects, in numbers, relatively few children, but its impact on their quality of life and their condition is utterly profound.
Of course, medicines need to meet the highest standards, and there must not be a question of opening Pandora’s box and legalising cannabis through the back door—I know some hon. Members are concerned about that aspect of the debate. That will need to be explored further in Committee to ensure that the Bill is entirely robust.
For me, the question is how I can help Teagan and other children like her to get the support they need paid for by the NHS. Subsection (2) of proposed new section 34CA of the Medical Act 1983 sets out that a register may be kept of prescribing GPs. At the present time, there must be concern that the terms and conditions of what is described in the subsection as the “criteria” and “training” elements may not resolve the problem faced by Teagan, and a number of Members have referred to the hesitancy within the medical profession on some of these issues and have recognised the immense specialty of these issues.
Let us suppose that Teagan’s GP is willing to prescribe. The money to pay for prescriptions currently needs to come from the area’s clinical commissioning group or the main NHS funding for exceptional medicines. I have tried both sources for Teagan without success. I ended up in a perpetual loop: essentially this is not an approved medicine, so it will not be funded, even though it is a legal medicine that can be prescribed. Some specialist consultants do not accept that the medicine works, even though it clearly does work for those families who have children taking it. Teagan’s mum knows it works, which is why, month after month and year after year, she tirelessly gets the money through fundraising to help her daughter get the medicine she needs. If Teagan does not get the medicine she needs, she gets more ill; if she gets the medicine she needs, she is better. Sometimes the particular type of medicine she needs has to change in order for it to remain effective. Then it is changed, and she is better again. That seems to me to be unquestionable and reliable evidence. Indeed, it can be found in Teagan’s own medical records, including those that are kept when she is hospitalised, which she is on occasion.
I am mindful of what was said by my hon. Friend the Member for Crewe and Nantwich (Dr Mullan), but I would suggest that that is documentary and professional evidence, given that it is in Teagan’s medical records. Prescriptions are being given for this medicine. I therefore do not accept that the evidence is simply observational, as was suggested by my hon. Friend the Member for South Ribble (Katherine Fletcher). I realise that she was referring to it in a scientific context, but, as she said herself, we are having a debate that people can understand and connect with. These are not “observations” by Teagan or her family; they are clinical notes in her formal medical records, and I think that some of the evidential base that is needed can be found in those few but very well-observed and well-documented cases in which children are using this particular medicine.
Dr Mullan
I think we need to understand that this is not just about whether a treatment works for a particular patient. There are plenty of treatments that work, but with more study and better understanding we come to recognise that there are many side-effects, and that problems that might crop up among a small number of patients could turn out to be devastating. We must be careful about what we mean when we say that a treatment is effective. We have all just experienced the process of approving a vaccine which we know works, but which we also know has severe side-effects. We must look at a bigger picture than what happens in the case of any one individual patient.
Mrs Elphicke
My hon. Friend clearly has considerable practical experience in medicine, and, as I have said, the subject of medical cannabis and the treatment of children is very much a specialist area. However, it would be perverse indeed for people to be ordered to have a medicine that they do not want—my hon. Friend has raised the question of research and the covid vaccines—while others are prevented from getting medicines that they do want when they know that they work.
James Daly
My hon. Friend is making a powerful speech, and I ask this question with the aim of developing my own knowledge of the subject. According to what the hon. Member for Manchester, Withington (Jeff Smith) said about the two-stage process of being referred for treatment, there is a clinical referral which is then considered by the clinical commissioning group. In Teagan’s case, after the clinical referral did the CCG cause the blockage? If so, were clinicians at a CCG level or non-medically qualified people making that decision?
Mrs Elphicke
As I said earlier, that is the perpetual loop. This is not an approved medicine, so it cannot be funded despite being a legal medicine that can be prescribed. The prescription element is of particular concern to a number of Members. In view of the hesitancy and the expertise about which we have heard today, the pool of people who might be able to prescribe this medicine on the NHS is not a large one, and I think that that is largely what is driving the proposals in the Bill.
I want to say something about professionalism, a subject that has arisen more than once today. Private prescriptions from qualified GPs are being given by qualified specialists in this area. As with so many areas of medicine—and Members who are doctors will know this better than anyone—some doctors believe that one medicine will work for some patients and another will work for others, and different doctors take different views. It is important to note that these are professionally prescribed private prescriptions. The issue is that the prescriptions are not available where they are needed on the NHS.
I will move on to funding and why the drug might not be funded because of the status of the medicine and the licensing. I have heard the Minister for primary care refer to the licensing tests of quality, safety and efficacy, which all hon. Members would agree are important. The quality and effectiveness of medical cannabis in the few cases relating to epileptic children can be satisfied. It is obtained openly via private prescriptions through recognised channels. As I have said—and I emphasise this for Conservative Members in particular—that is lawful. It is medication lawfully prescribed by doctors. It is NHS prescribing that is the barrier.
On safety, there is always a risk in having any medicine, and there are consequences of not having it. A professional doctor and those involved in medical care will look at what happens when someone has a particular medicine and its potential risks, and what will happen if they do not. In this case, not having the medicine results in worse health outcomes, and a worse quality of life, for Teagan. If the Alexander technique, acupressure and ginger can be funded on the NHS, it should be considered whether the right bar is being set for Teagan’s medicine to be funded.
My hon. Friend the Member for South Ribble mentioned the speed with which the covid vaccination got regulatory approval—a pace and speed that we have not seen with medical cannabis. Some of the Acts that we pass in this place have effects that can be measured in centuries, such as the Environment Act 2021; we will move on to discuss climate change more generally later. Some of the decisions that we make in this place, however, have an impact on lives that can be measured in days, months and years. I suggest that this is one of those cases.
The Government have authorised the medicine to be available—that decision was taken. It is about completing the journey, so that there is the intended effect of ensuring that where clinically appropriate and in a child’s best interest, that child can be treated with the right medicine for them under the correct supervision and that that medicine can be funded on the NHS.
Teagan Appleby needs medical cannabis to improve her serious health condition. Without it, she suffers from fits. With it, she is so much better. That is why I support the prescription of medical cannabis on the NHS for little Teagan and the other children who clearly need it. I pay tribute Teagan’s mum, Emma, who has been a tireless and energetic campaigner on behalf of her daughter to get the medical treatment that she needs. I close by thanking again the hon. Member for Manchester, Withington for bringing forward the bill and the Minister for her attention to Teagan’s case and the matter.
Jim Shannon (Strangford) (DUP)
It is a pleasure to follow the hon. Member for Dover (Mrs Elphicke). I wholeheartedly agree with her point of view, as do other hon. Members. I refer to what she said about “completing the journey”, which is what we want to do today, so that we can get to where we want to be. I commend the hon. Member for Manchester, Withington (Jeff Smith) for bringing forward the Bill, which I am pleased to see being debated in the House. I commend the hon. Member for Middlesbrough (Andy McDonald) for his personal story, which served to emphasise to us in this House how important it is for the Bill to pass. I know that it was hard for him to tell us that story, but it was also hard for us to listen to it because we sympathised with him. I thank him for sharing his story and for giving us that force of personal experience, which makes a difference.
I thank you, Madam Deputy Speaker, for allowing me to speak this morning. I will not detain the House for long; I intend to keep my comments fairly concise. I shall give as an example one story, which I will leave with the House. Along with other Members, who are all in their places today, I am well known for advocating medicinal cannabis under specific circumstances. I fought furiously for young Sophia Gibson in Newtownards to get the medication that her parents knew would make a difference to that sweet little darling of a girl. The following note is from her mum and dad who fought night and day for their child. They went to live in Holland, as others have said, and tried to raise funds. They did all of this alone and in desperation, which underlines the battle that is faced by parents throughout the United Kingdom of Great Britain and Northern Ireland and why I am supportive of access to medicinal cannabis in certain circumstances. As the hon. Member for Dover said, I am not talking about a universal application or prescription for medicinal cannabis; it is specifically for those whom it can help from a medicinal point of view. That is what I have always said. Perhaps I put things very simply, but that is what I think this Bill is about, which is why I support it.
I do not want to take too long, but I will quote the parents’ story:
“Three years ago, our lives were changed when Sophia received the great news that she would get her whole plant medicinal cannabis medicine via an NHS prescription. The expert panel was set up to help children like our daughter, but was quickly scrapped. Three years ago, the law surrounding medicinal cannabis was changed, but nothing has changed since. There are still only three whole plant medicinal cannabis NHS prescriptions in the United Kingdom. Why, we asked, when this marvellous medicine has kept our daughter out of hospital for over three years, has improved her life immensely, and kept her seizures the most controlled that they have ever been in all her young life. Some say that this is classed as anecdotal evidence”—
I say that it is not. It is real evidence, as the hon. Members for Dover and for Manchester, Withington have also said—
“but we are with Sophia the most and see the difference. The hospital records speak volumes: Sophia has not needed to avail herself of ambulances, of A&E visits and of hospital ward visits for over three years.”
Is that not evidential basis for thinking that change can make a difference? I respect the fact that others have much more understanding of medical and health matters than I, but, I have seen evidence from my constituents. The parents continue:
“These are facts. Why can’t other children and adults avail themselves of this medicine via the NHS? Why has it become a two-tier system that, if you have the money, you can avail yourself of it? Why are so many forced into fundraising, selling their personal belongings, or taking loans out just to keep their loved ones safe?”
The hon. Member for Middlesbrough referred to that. The parents said:
“Imagine every month having to add over £1,000 to your essential bills for a medicine, because that is exactly what some families are forced to do, being so scared that if you don’t have that money what will happen to your child.”
That is the reality for some in the United Kingdom today. Let me read on:
“We know we are blessed and so fortunate to have an NHS script because we know that we couldn’t afford that money each month for a private prescription. We thought three years ago that, after the three prescriptions, many more would follow, and what a let-down it has been. Soul destroying for us because you feel bad that you have an NHS script and others don’t. Why do our loved ones need to suffer—whether it be physically with seizures or mentally—and have this additional stress when, three years after a standstill, we have some of the best resources, doctors and health service in the world?”
I pay tribute to our NHS and to everyone involved. In this House, we are privileged to have those who make a contribution to it every day. The parents end with these words:
“We could have been leading the way, but instead we are stalling, passing the buck with no answers or resolutions for these families. How many more lives will be taken or be at risk before they can get the medication that they want”—
that is what the hon. Member for Dover said and that is what I endorse as well. They said:
“Families have enough stress and worry without having to do all this. We hope someone, somewhere”—
in this House—
truly listens and can have the answers for us all.”
That is a wee summary of Sophia’s story.
Sophia has not been in hospital since July 2018, which is three and a half years ago. Her seizures have reduced dramatically and are managed at home, as they are so brief. The change is almost miraculous, yet families throughout the UK are forced into a two-tier system where if they can afford a private script to help their child, they can have it. Sophia’s parents have said, “We know we are blessed”—and they are—“and so fortunate”. They still to this day do not know why Sophia’s consultant had a change of heart, but he did, and my constituents today benefit from that and his courage to stand out from the crowd and take a chance on the only medicine that has helped Sophia.
This year marks the end of Sophia’s time in primary school and her transitioning into high school next year. Did Sophia’s parents ever think that would happen? There were times they thought they would never see the day, as they thought on many occasions that they would lose her. They and we thank God every day that her neurologist in Belfast prescribes the medicine. Whole-plant medicinal cannabis worked for their precious little girl. We just need other NHS neurologists to listen and take the chance and give all those loved ones a chance at a better quality of life.
I understand that people have a different point of view, and I always respect other points of view, even though I may not agree with them, but I urge those who are not yet convinced—I look to the Minister, for whom I have great respect on a personal basis and as a Minister, and she knows that—that today we have an opportunity to change lives in this House with something that I have seen makes a difference.
To conclude, nothing I could say could explain it better than Sophia’s story. That is why I stand today for Sophia Gibson’s story, and also for the family of Jorja in Dundonald in the constituency of my hon. Friend the Member for Belfast East (Gavin Robinson), so that they can have the new life they need for their child, like with Sophia. I again commend the hon. Member for Manchester, Withington on bringing forward the Bill. I implore—others have said they would beg, and I would beg if that is what it takes—the Minister to make the change and make it happen today. It will save lives. It will lift quality of life and it will, I believe, be an answer to prayer.
Crispin Blunt (Reigate) (Con)
What a terrific debate to have the privilege of taking part in. I have spoken on this subject before, so I will try to keep my remarks to a minimum, because many of them are already on the record, and I want to respond to the points raised in the debate.
First, I record an interest—it is not a financial interest—as I chair the Conservative Drug Policy Reform Group Ltd. I am unpaid for it and have no stake in it, but it is a think-tank that I have set up to try to get evidence-based policy delivered and to make the case on drug policy in its widest forms. We are dealing today with the opportunities we have missed due to the absence of drugs from the development of medicine. Given also the awful criminal justice consequences of our wider drugs policy over 60 years, I believe it is vital to get proper evidence into this space to guide our policy. That is why I welcome the Government’s drug strategy, published just a few days ago, with its commitment to evidence and data, and it is on evidence and data that we should be formulating policies.
It has been a terrific privilege over the past four years to work with the promoter of the Bill, the hon. Member for Manchester, Withington (Jeff Smith), who has become my friend in this cause. To colleagues, and in particular to my hon. Friend the Member for South Ribble (Katherine Fletcher)—she gave a very brave speech to juxtapose the almost unanswerable case of her constituent with the wider challenge of exercising our duty as Members of Parliament—when she says she wants to oppose the Bill, I say to her, “Not yet.” The issues that have been engaged in here, and the debate that is being had, deserves to go to a Committee of this House so that discussion can continue. It would be quite wrong to oppose this Bill on Second Reading. It is fine that, after all the efforts of the Government, who have been trying to engage with the hon. Member for Manchester, Withington to find a route that they could support, we have not yet been able to get that route, but let us continue that discussion in Committee. The debate will continue anyway; we are trying to find the right construction of our analysis of the evidence in order to arrive at a better answer than we have today.
The raw emotion engaged by the magnificent speech from the hon. Member for Middlesbrough (Andy McDonald), and the emotion surrounding speeches made by other colleagues on behalf of their constituents, is incredibly powerful in its own right, but my hon. Friend the Member for South Ribble quoted the doctors’ oath, which says:
“I will…not allow prejudice to influence my practice”.
If only our profession had done the same, because the position of cannabis and the psychedelics in schedule 1 to the Misuse of Drugs Regulations 2001 is not supported by any evidence. Why on earth is heroin subject to fewer controls for research purposes than the psychedelics? I am not aware of any cases where the psychedelics have directly caused harm—obviously nothing like the scale of harm caused by drugs that have been made legal, such as alcohol and tobacco, or by the opiates. In response to parliamentary questions, the Home Office has been unable to produce the evidential base.
The rotten truth about cannabis is that its position in the regulatory framework rests on the racist policing of the United States in the 1950s, which is the basis of the world’s approach to drugs policy, and that basis is morally bankrupt. When we have now to deal with the consequences, we ought to bear that in mind. We have a duty to try to find a way to make good the damage that we have done. When I say “we”, I mean 50 or 60 years of politicians, who have avoided engaging in these difficult questions. We have put ourselves on a moral high mountain, and have not been prepared to engage with the difficult trade-offs that are engaged by this issue. Our objective should be to protect the public good and to have a positive outcome for society through medicines and treatments—the positive things that drugs can do—as well as to minimise the damage that they can do.
I want to draw the attention of the House to the work of the magnificent people who work at Conservative Drug Policy Reform Group Ltd. The organisation is not part of our party, but I fully accept that its principal objective is aimed at our party because the position on the centre right is naturally rather more resistant to change than, perhaps, other parts of the political spectrum. Eighteen months ago, the group produced a terrific review of where we are on medicinal cannabis, called “The UK Review of Medicinal Cannabis”, which identifies, as a consequence of our policy, how many people are being driven into criminality in order to get the therapeutic use of a medicine based on cannabis.
It is not right that there are about 50,000 people growing their own cannabis to try to treat their multiple sclerosis. We should be in a better place and serve people better. We should not need Carly Barton to have to produce a pass to say that people have a diagnosis that might suggest that they would need medicinal cannabis in order for them to avoid arrest. All those people are formally at risk of 14 years in prison in order to access a therapeutic product. We are not in the right place on this issue, and it is up to us to try to correct it.
I totally agree with my hon. Friend the Member for South Ribble that we should not impose the answer on medical professionals, scientists and researchers, but I am afraid that that is what we have done, which is why we are held in collective contempt by the body of science and research. Opportunities have gone begging over decades because our drugs policy, in its widest sense, has not been informed by evidence and data.
Katherine Fletcher
My hon. Friend paints a picture that I recognise in part, but I am sure that he would welcome recent innovations and changes in the law, such as the Government allowing psilocybin—magic mushrooms—to be used in research on clinical depression. Does he welcome the fact that there is movement in this space despite, I grant you, more than a century of ignorance in the area?
Crispin Blunt
I fear that I missed what my hon. Friend refers to, because it still sits in schedule 1. When my team first presented the case for moving psilocybin out of schedule 1 so that we could actually do some research at scale, I thought that the case was so blindingly obvious that it would take about five minutes to speak to a Minister and get it done; indeed, I had a conversation with a Minister that rather implied that. But then we ran into what colleagues might in other circumstances call the blob—the endless circuit on which the family of Teagan Appleby have found themselves, as my hon. Friend the Member for Dover (Mrs Elphicke) explained.
I simply say to colleagues, given the data that I will publish through the Conservative Drug Policy Reform Group next week, that it is a substantial majority position in this House that our drugs policy is not working and we need to do something about it. The worst signal that we could send would be that we are not going to continue the conversation about the proposal in the Bill by sending it into Committee. If we do not give it a Second Reading, that is what we will be doing. Let us get it into Committee and continue to have the conversation. Whether it is fit for Third Reading, or for the Government to support, is a decision we can take later.
Tonia Antoniazzi (Gower) (Lab)
I rise to support the Bill. I am very proud of the work that my hon. Friend the Member for Manchester, Withington (Jeff Smith) has done to break the barrier that is there. I commend the hon. Member for Dover (Mrs Elphicke); I know Emma Appleby and Teagan very well, and I listened with joy to the hon. Member’s words, which show her great understanding of the situation that Emma finds herself in for her child to survive. She is one of many parents we work with. As co-chair of the all-party parliamentary group for access to medical cannabis under prescription— with the hon. Member for South Leicestershire (Alberto Costa)—I am very proud of our work, particularly with the hon. Member’s predecessor, the right hon. Member for Hemel Hempstead (Sir Mike Penning).
This has been a journey. I have been in this House for nearly four and a half years, which is not a long time—I am quite a youngster by many standards—but I remember standing at the doors on a Friday, overhearing the conversations of peers from across the House. Basically, they were laughing at a Bill introduced by my late hon. Friend the Member for Newport West, Paul Flynn. It really did break my heart, because Paul worked tirelessly to break that barrier and get medicinal cannabis legalised. Soon after he passed away, we had a breakthrough thanks to the campaigning of the right hon. Member for Hemel Hempstead, the End Our Pain organisation and the tireless work of Hannah Deacon and Peter Carroll. Those people must be remembered in this House, along with the many, many parents and people working alongside them, as well as the hon. Member for Reigate (Crispin Blunt). Many people are fighting for the cause.
We are in a ridiculous situation, and I am very emotional. My hon. Friend the Member for Middlesbrough (Andy McDonald) has spelled out what it is like to be a parent and have that loss. I cannot even bring myself to imagine it. It does not matter whether you are a parent or not; to see these children is heartbreaking. It is four and a half years since I stood here incredulous at the mockery made of the Bill that was being brought forward. The law has changed; we have had three prescriptions on the NHS. We have had no other change.
I thank the Minister and the Secretary of State for our recent conversations about this situation. While there is a lot of empathy in this House, there is little action. I have stood with the parents and we have had many meetings here in the House. Members have gone to meet the parents and sometimes the children—most recently outside of the House because of covid regulations—to hear their story at first hand, and there is an empathy. But those parents and children have had to wait. They had to wait because Brexit was going on and they were on the back burner; they had to wait again because there was an election in 2019 and they were put on the back burner; and then there was covid, albeit nobody saw that coming, and they had to wait. They have been hospitalised, they have not been able to get hold of their prescriptions, there have been problems in fundraising to get their prescriptions and, as has been said, they have been unable to pay for their prescriptions, even having to sell their house. The situation they have been put in is inhumane.
I see that the hon. Member for South Ribble (Katherine Fletcher) is leaving, but I was going to pay tribute to her. I am so glad that she has engaged with this debate with her constituent Joanne and Joanne’s son Ben. It is wonderful that she has listened to them and continues to want to fight, even though she knows Joanne will not be voting for her, which is very amusing for us. It is good that there is that engagement. I do not stand here with a geeky knowledge of science, to use the hon. Lady’s words, or as a general practitioner, but I stand here with four and a half years’ experience—the experience of a mother—to see the passage of the tireless work that has been done across the House, only for nothing to have changed. That is why I pay tribute to the Bill.
Jim Shannon
The hon. Lady is right. If the Government are not minded to support the Bill, as it seems they may not be, does she, like me, ask, “Well if you’re not going to help, what are you going to do?”
Tonia Antoniazzi
Absolutely. I really want to know what they are going to do. This has been collaborative, cross-party work, and I have had good conversations with the Secretary of State this week and with the Minister a week ago. The solution that has been put forward to me is quite interesting. They say, “Oh, well you could find one of these drug companies that you know and work with, and maybe they could put an observational trial together, and we could have the conversations with the necessary bodies, we could work on this and then it could move forward”—this is the point I was coming to—“in another two to three years.” After four and a half years, we are already in a situation where some of these children are now adults, so we are going to be looking at another, completely different situation. This situation has to change.
My hon. Friend the Member for Manchester, Withington has worked tirelessly on the Bill, giving the Government an option to move this issue forward, yet yesterday I was told, “Don’t worry, Tonia; talk for as long as you like, because they’re going to talk it out anyway.” We have had debate upon debate upon debate. This is a private Member’s Bill. It would address the issues and move everything forward. That is the disappointment of this place. When the parents we work with know there is going to be a debate, they get all excited, and then nothing happens. Unfortunately, because of the way the parliamentary system works, that is how it is. That is why the Bill is so brilliant. It absolutely hits the nail on the head and I want it to pass—but we know that is unlikely.
We know there is a blockage in the system. I will not stand here and call out where I think that blockage is, but it is my personal view and my experience. It is what I have read and what I know. When somebody very high up in the system says, “We do not want this to happen,” it usually does not happen. There is a blockage, and that blockage has to be broken down. I am not a GP or a medical expert, but it is wrong that this is not being looked into properly.
In the conversations that the right hon. Member for Hemel Hempstead and I had with the NHS we were promised an observational clinical trial, but that had changed to an RCT by the time of our next conversation with the same people. Why? We had the perfect situation. These children were already on the medicine and were already proving that it makes their lives better.
Dr Mullan
I want to make it clear that we said there are approved and allowed uses of this treatment, and I do not doubt that it helps in some circumstances, but today we have ended up having a general debate about types of evidence, with Members almost criticising RCTs and pumping up observational trials as an effective way forward. I caution Members to remember that the MMR scandal, which we now know led to the deaths of children because of how medical practice was changed, was based on an observational study of a small number of people—[Interruption.] It is not rubbish; it is true. Those parents were absolutely convinced that the MMR vaccine had caused autism in their children. They were very passionate about it and, when we looked at it properly with a longer lens, we saw that it was wrong. Be cautious about talking down RCTs and talking up observational studies. [Interruption.]
Madam Deputy Speaker (Dame Rosie Winterton)
Order. We must not have conversations across the Chamber. It is very confusing, not least for the Hansard writers.
Tonia Antoniazzi
I understand what the hon. Member for Crewe and Nantwich (Dr Mullan) is saying, but he is not making a like-for-like comparison. Rachel Rankmore and her partner Craig have looked after Bailey through thick and thin, and she has just sent me this message:
“We were told that Bailey may not wake up the Bailey you know because of brain damage from seizures and the very potent pharma drugs or not wake up at all the last time he was in hospital suffering 100s seizures before cannabis. He now lives an amazing quality of life out of hospital.”
She is furious about what has been said in the House today. The improvements they have seen in their child are being cast aside. Bailey would be dead if not for medicinal cannabis, and so would many others.
Tonia Antoniazzi
I will not give way because I need to make progress, and I said I would not take up too much time.
We got somewhere with the previous Minister, the hon. Member for Bury St Edmunds (Jo Churchill). She talked about the innovative medicines fund, and innovative medicine is exactly what this is. It has been around for a long time, and we do not have time to wait.
The Government need to set up a compassionate fund now, while the trials are happening, because these children will not go on to an RCT. They will not have the drugs flushed out of their system and take that risk, as happened to Bailey, who nearly died in a hospital bed. That is not going to happen, and we have to realise that this Bill and a compassionate fund for these children is the way forward, so that they do not have to lose their house and so they have the same access to medicines that others have.
We talk about intractable epilepsy, and they have tried everything else. From the risk-benefit analysis and the conversations I have had with clinicians, the benefits outweigh the risks in all these cases, which is why we are so strong and emotional about it. I do not want the Government to take us backwards but, in the recent conversations that I and my APPG co-chair have had with them, we have been told that we will have to wait another two to three years. That is unacceptable. We need to take the next step to move on. We are legislators, and the law has changed, but there have been only three NHS prescriptions—that must change.
I pay tribute once again to my hon. Friend the Member for Manchester, Withington for offering a sensible way forward. The children of the parents with whom we work deserve to live their best life. It is about time that the Government started to listen.
Selaine Saxby (North Devon) (Con)
On sitting Fridays, I often find that we have much in common with Opposition Members and that, when we work together, such as through all-party parliamentary groups—the hon. Member for Gower (Tonia Antoniazzi) referenced such work—we are divided only by how, rather than whether, we will get there. I recognise what an emotive topic this is and send my deepest sympathies to the hon. Member for Middlesbrough (Andy McDonald), who shared his story. I am grateful not to have such a case in my inbox, because this is an incredibly emotional issue.
When we hear about individual cases of children and families with drug-resistant epilepsy who have found relief from whole-plant extract medical cannabis, all we want to do as human beings is help. Most of us came here to make people’s lives better, and we all want to expedite such things as far as is possible. I am a mathematician by training—I will not draw on medical GCSEs and A-levels—and, as I do not have such a case and therefore an emotional tie, I would like to use logic and talk through what the Government have done to make progress in the area before looking at the specifics of the Bill and how we have, hopefully, started to make some progress.
In November 2018, cannabis-based products for medicinal use, known as CBPMs, were rescheduled under the Misuse of Drugs Regulations 2001 from schedule 1 to schedule 2, as detailed in the excellent opening speech by the hon. Member for Manchester, Withington (Jeff Smith). I thank him for bringing the matter to the House to enable us to speak on it again. The change followed advice in July 2018 from the UK Government’s chief medical adviser and the Advisory Council on the Misuse of Drugs, both of whom said that the rescheduling of such products would facilitate the development of clinical evidence.
I have not been in this place that long but, for most of my two years here, we have been in a global pandemic. Again, my heart goes out to the families tied up in this, but the pandemic has slowed down medical trials and treatments for a huge number of people. My hon. Friend the Member for Crewe and Nantwich (Dr Mullan) referenced the need for research in the area. In the last 12 months, 18 trials of cannabis-based products for medicinal use have come forward, and six are now complete. Things are therefore moving, although perhaps not at the pace that we would like.
Since the change in the 2001 regulations, doctors on the General Medical Council’s specialist register have been able to prescribe an unlicensed CBPM if clinically appropriate for their patients. As we have heard, the law allows GPs to prescribe these products under the direction of a specialist as part of a shared care arrangement. Currently, all the CBPMs prescribed by specialist doctors are, as we have discussed, unlicensed medicines, which unlike licensed medicines have not undergone rigorous tests for quality, safety and efficacy. As has been said so passionately, such unlicensed medicines are treatments of last resort, and patients at that stage in their treatment pathway will be under the care of a doctor with specialist knowledge in their field and all the treatment options to take responsibility for such prescribing.
As we know, access to medical cannabis has been debated at length in both Houses. However, while it is understandable that these campaigns continue for greater access to unlicensed cannabis-based products for medicinal use funded by the NHS, as detailed so beautifully by my hon. Friend the Member for Dover (Mrs Elphicke), these products have not had their safety, quality or efficacy assessed or assured by the Medicines and Healthcare products Regulatory Agency or their clinical and cost-effectiveness assessed by the National Institute for Health and Care Excellence, otherwise known as NICE, which is the basis for NHS routine funding.
It is critical to progressing public funding decisions that manufacturers of those products invest in those clinical trials and prove that the products are safe and effective so that more of our constituents are able to access them. The National Institute for Health Research remains open to receiving good-quality proposals for research in this area. The latest clinical guidelines from NICE demonstrate a clear need for more evidence on the clinical and cost-effectiveness of the unlicensed medicines.
Sally-Ann Hart (Hastings and Rye) (Con)
On the NICE guidelines and the clinical evidence, does my hon. Friend agree that all medication, whether cannabis-based, heroin-based or cocaine-based medication, must have rigorous testing through clinical trials so that we understand the possible side-effects and everyone—GPs, all doctors and patients—has full knowledge in making the ultimate decision on whether a drug should be prescribed?
Selaine Saxby
I agree with my hon. Friend: it is vital that we fully understand the side-effects of these drugs that we know, when used in the wrong way, have clinical downsides.
The Government continue to support the establishment of clinical trials with NHS England and the National Institute for Health Research, but they have been clear that the law enables lawful access where deemed clinically appropriate. The most significant barrier to access on the NHS is the lack of evidence on the quality, safety, and clinical and cost-effectiveness of these products. That sounds uncaring, but I want to revisit the black-and-whiteness behind the terrible emotion tied up with these individual cases.
I understand that the Royal College of General Practitioners is supportive of the Government’s position that, until the evidence base has developed further, GPs should not be asked to initiate prescribing these products independently of a specialist. I suspect that trust in doctors in this particular area is well placed, which in my mind makes clauses 1 and 2 hard to support.
There is indeed clear merit in understanding, then overcoming any barriers to accessing unlicensed cannabis-based medicines on the NHS. That is why in March 2019 the then Health Secretary commissioned NHS England and NHS Improvement to review NHS systems and processes and identify and recommend any actions necessary to addressing barriers to clinically appropriate prescribing of unlicensed cannabis-based medicines on the NHS.
The findings of that review were reported in August 2019 and the majority of recommendations have now been implemented. Since this work has been undertaken recently and the recommendations acted on, I find it hard to support clause 3 of the Bill, as so much has already been achieved by non-legislative means. I very much hope that trials will progress to enable more families to access this treatment, and I take this opportunity to thank the hon. Member for Manchester, Withington for introducing his Bill.
Dr Rosena Allin-Khan (Tooting) (Lab)
I must begin by paying tribute to my hon. Friend the Member for Manchester, Withington (Jeff Smith), a fantastic campaigner who is working across party lines and with affected families up and down the country to make a real difference, both for those who are unable to obtain the treatment they need and for those who are left paying huge sums of money for private prescriptions. I also pay tribute to my dear and hon. Friend the Member for Middlesbrough (Andy McDonald), whose bravery in speaking today adds powerful testimony to this debate. I know 100% that his story echoes those of the people we are fighting for in this debate.
The objectives of this Bill, for me, are clear and simple, but I fear, listening to some of the contributions today, it has been misunderstood. It would be a huge step forward for patients who need access to medical cannabis, and it creates a register of general practitioners trained in medical cannabis who are allowed to prescribe it, in addition to the specialist doctors who are already able to do so. Inclusion on the register is on an opt-in basis for GPs. The Bill importantly creates a commission to propose a framework for the assessment of cannabis-based medicines and their suitability for prescription in England, to sit alongside existing Medicines and Healthcare Products Regulatory Agency processes for conventional pharmaceutical drugs.
I think it is very clear that what the Bill is asking for is a step forward with an end in sight for the pain, anguish and heartache, not to mention bankruptcy, experienced by many families. No one is saying that there should not be a robust examination of all evidence, but we are saying that there are current mechanisms in place to protect people on the medication and that, while we wait for some extremely timely processes, there are families who cannot wait and who are very clearly benefiting from the medication. It is very important that we recognise that.
The commission is also tasked with recommending any other measures to overcome barriers to access on the NHS, which has been mentioned. Those changes would be welcome, as they would certainly help to reduce many of the barriers patients currently face when attempting to access medicinal cannabis. Progress in making cannabis-based medical products available to those who need them has been extremely slow. As we have heard today, there are people who have transitioned from childhood to adulthood while waiting for further progress on something that is important. The impact of continued seizures means that there is developmental delay for young people—the children we are talking about—and their ability to achieve their full potential in life. We cannot ignore that.
Labour welcomed the fact that the Government accepted the therapeutic use of cannabis in 2018, but it still remains too difficult for suffering patients to obtain the treatment that they need. Despite that change in the law over three years ago, the vast majority of people who would benefit from cannabis-based medical products are still unable to access them through the health service. The campaign group End our Pain believes that only three prescriptions have been granted through the NHS. That is surely nowhere near the levels that this House, patients and the wider medical community would have anticipated.
Andy McDonald
My hon. Friend is making a wonderful summary and presentation. Is she as frustrated as I am by some of the contributions that have been made today, which seem to suggest that we need to start again when having this debate? We have been through this process. The law has been changed to allow the prescription of these products, yet all we have are three. Is it not really frightening that we are now challenging the original decision to change the law? That is what has happened today.
Dr Allin-Khan
Absolutely. I thank my hon. Friend for his contribution. To take any further step backwards from the progress we have made in a cross-party collegiate manner would be a travesty. We would be letting down families across the country.
Lia Nici (Great Grimsby) (Con)
The way the discussion is going at the moment is that we are talking about going backwards. The reason my hon. Friends are having those discussions is that the law has already changed, and I do not believe we need to legislate. We need to say, “We need to get these medicines that are approved already on the NHS.”
Dr Allin-Khan
I thank the hon. Member for that contribution. That is exactly right. The Bill seeks to move that forward, not frustrate the process. I welcome any intervention that underscores that.
Lia Nici
When we talk to members of the public and our constituents about the debates we have, we explain that we learn a lot by having this exchange of views. It is wonderful. Every school and business should have such debates in this collegiate way. It is not that we are against the Bill, but that we believe the law is already in place. We just need action on NHS funding and to get more of these approved, tested medicines on the lists.
Dr Allin-Khan
In three years, we have had three prescriptions on the NHS. In three years, we have seen people in fear of not having roofs over their heads because they cannot afford to give life-changing medication to their children.
Dr Allin-Khan
I will make a bit more progress and then I would be absolutely delighted to give way.
The situation that we face, whereby only three prescriptions in three years have been allowed, pushes more and more patients into the hands of private providers, who, as we have heard, are charging extortionate amounts of money each month for treatment. For the vast majority of people, that is simply out of reach.
Let me add something that I was not originally going to say: I, too, am a science geek. I have a biochemistry degree and I worked in medical research before even going to medical school. I understand the importance of robust, evidence-based medicine, but I can also tell hon. Members that people searching in a very desperate way for things that will improve the quality of their life, or even keep their children alive, might also go to places where absolutely no thought is given to the purity of a drug. They may seek alternatives that are increasingly more dangerous for their children. It is important to recognise that.
Christian Wakeford (Bury South) (Con)
As another science geek with a chemistry degree, in which I specialised in drug design and synthesis, I completely agree with the hon. Member’s point. That is part of the concern. It is about having not just the product right now, but the right product, and about making sure that we have efficacy and safety. I completely appreciate all these points. That is why I do not necessarily agree with the perspective on the commission, but I have a lot of sympathy for clauses 1 and 2, which will go some way to help. However, the main stumbling block is the financing. We have already legalised the product. Every time it falls down, is it because it has not been licensed? Maybe, but finance seems to be the stumbling block at every single level.
Dr Allin-Khan
I do not need to tell the hon. Member, who has mentioned his CV—as many of us scientists have today—the cost of not investing in these young people. Think of every time a young person who would benefit from this drug goes into intensive care with seizures, every time they have alternative, expensive sedatives keeping them alive on a ventilator or the fact that they do not fulfil their potential, cannot go on and work and cannot give back to the economy. It is a false economy not to invest in this.
Colum Eastwood (Foyle) (SDLP)
Does the hon. Lady agree that it would be much better if we had less sympathy from Government Members and we got them to stop talking the Bill out and come with us to vote it through?
Dr Allin-Khan
I could not agree more; my hon. Friend puts the point across perfectly. If anyone is planning on talking the Bill out today, please will they ask themselves who benefits from that and whether they would feel proud of frustrating a process for many children and families that would mean that they did not have to go through, frankly, the hell that we have heard described?
James Daly
The hon. Lady is being extremely generous with her time; she will please forgive me for intervening, but I want to call on her expertise. The specific intent of Parliament was to allow medical professionals to prescribe non-licensed cannabis-based products. It cannot be any clearer than that; that is where the law is now. I agree with the point that was made—the fact that there have been only three prescriptions is ridiculous. However, perhaps she can address this question: the medical professionals who are considering such matters can see the evidence that we have talked about—it has been incredibly well articulated by all hon. Members—so why are they not referring those matters on and saying, “This patient needs this treatment”?
The other question that I want to ask—very inarticulately—is about the two-stage process of the clinical referral and then the money within the CCG. Is the problem that it is getting through the first bit—the clinical referral—but the money in the CCG is stopping it? I wonder if she could address those points in her remarks.
Dr Allin-Khan
My understanding and my belief, unless someone has an alternative proposal, is that clinicians are often screaming from the rooftops in the knowledge that their patients need this medicine. We are where we are, however, with only three prescriptions having been granted in three years. This Bill seeks to improve that and move us forward.
Families being forced to pay for treatment from private providers creates an unjust two-tier health system. A founding principle of our health service is that we do not believe that people’s access to treatment and services should be based on their ability to pay—it is as simple as that. The barriers in accessing medicinal cannabis are causing exactly that situation. We would not tolerate that for any other medication, so we should not tolerate it here. The Government must speed up and improve the availability of medical cannabis on the NHS and guarantee that patients across the country can access those products where appropriate.
We have all heard the testimonies of children who receive no respite from their seizures and of patients whose chronic pain has become a constant of their lives. Working in hospitals, I regularly meet those people and their families, who beg me and other doctors to help their loved ones. Witnessing their suffering never gets any less upsetting, especially when we know that there are options to alleviate it. Unrelenting pain can be so devastating for all involved. It is imperative that we listen to those who would benefit from access to cannabis-based products and allow them to guide our future thinking.
We have a voice in this place. I commend hon. Members from both sides of the House for using their voice today to speak up for those families who cannot be here to make the case themselves. Hon. Members have been begging, but we should not have to beg to do the right thing for the people who we serve.
Tonia Antoniazzi
Some of the voices that we have heard in the House today have talked about an unlicensed drug. The children who we have been talking about have been taking unlicensed drugs. I went to The Hague with two different families—two mothers—to pick up a prescription there before they could get it here. We walked into a pharmacy and picked it up, just as I would pick up my inhaler from Boots. There should be no fear. This is an over-the-counter drug in places such as the Netherlands, not an awful unlicensed drug that it is impossible to get. Does my hon. Friend agree that we need to break down that barrier and move on?
Dr Allin-Khan
As usual, I could not agree more with my hon. Friend, who makes a passionate and fair point.
The Bill serves as an opportunity to move forward in a way that even the sceptics could support. I say again that anyone who is planning to talk out the Bill should take a long hard look at themselves in the mirror and ask themselves what they are doing. They need to walk a mile in the shoes of the families who are worrying about whether their child will be alive the next day.
Last month, we had two debates on the issue in a matter of days. I would like to think that that demonstrates the collective will in the House to make progress, but that will and the warm words it brings are not enough for the thousands of people who should have benefited from those prescriptions in 2018 and since. We now need further action, and I wholeheartedly believe that the Bill would go some way towards achieving that. I trust that the Government believe that too.
Elliot Colburn (Carshalton and Wallington) (Con)
I join others in congratulating the hon. Member for Manchester, Withington (Jeff Smith) on securing time for us to debate the Bill today. He is clearly very passionate and knowledgeable about this issue, and I learnt a huge amount from his opening speech, for which I am extremely grateful. I also pay tribute to the hon. Member for Middlesbrough (Andy McDonald) for his moving testimony. It is characteristic of sitting Fridays that we tend to work more collegiately across the House. My hon. Friend the Member for North Devon (Selaine Saxby) said that it is not a question of whether we do but of how we do, and I entirely agree with her.
I am really here today at the behest of a constituent who asked me to come to the House and share his experiences, but before I delve into those, it may be helpful for me to give some of my own perspective. Before coming to this place, I too was employed in the NHS, although not as a frontline practitioner; I was not a doctor or a nurse. I worked for the sustainability and transformation partnership, the footprint of the new integrated care systems in south-west London. Along with commissioners across six south-west London boroughs, I looked at all the services that those boroughs provided, and this was a topic that arose during that time. It was obvious to me, when I spoke to colleagues, that there was almost a nervousness, almost a—confusion, I suppose, is the word I am looking for; it is a bit hard to describe—about commissioning medicines of this type.
I thought it might be helpful for the Front-Bench team to hear a bit about the experience of frontline commissioning, but, as I said earlier, I am really here at the behest of one of my constituents to share his story. I hope the House will indulge me if I go into a bit of detail, because I did find this very profound, and I hope that other Members will agree with me. My constituent sent me an email, in which he wrote:
“I would like to explain to you a little of my life which unfortunately has been plagued with intractable chronic migraines and the fallout from such.
Although suffering all my life with Migraine attacks, 5 years ago I was diagnosed with severe chronic migraine which after a long wait I was prescribed 9 different medications to try and bring the migraines under control, none of which worked only causing nasty side effects.
Having…sickness constantly with added migraine pain—1 was left diagnosed with intractable chronic migraine with attacks 6 days out of 7, putting me out of work and putting me in a state of deep depression.
I was fortunate to meet a Dr. who was testing the benefits of Cannabis in neurological cases and after a discussion I decided to follow her strict advice and started self-medicating Cannabis which unfortunately meant sourcing off the black market, something that I’m not in any way proud of but the impact of using cannabis for my ailment was profound.
Within three days of my first use, my migraine frequency dropped significantly as did…the usual nausea which accompanies my attacks. Within a week, I felt for the first time somewhat normal, depression had lifted, I was able to start work again almost immediately (I was open and honest with my employer who welcomed me back into the workplace and to this day has been extremely supportive).
Summarising my experience, I went from someone who saw no hope in any way with modern medicine to someone who almost overnight got their life back.
I have one son—aged 12 who has got his father back, and my wife although extremely anti-drugs (a doctor who works in the dental profession) has seen the relief I experience, especially after seeing me for many years hiding in a dark room, in pain, hiding from the world most days to someone who now is relishing in family life.”
My constituent went on to say:
“The stigma of the word Cannabis is something that I have had to deal with”.
This, he said, included
“seeking out black market providers which in its self I would not want anyone to go through”,
and I think all Members would agree with that.
Lia Nici
On that point, which I was going to raise later, quite often the issue is semantics. There is a fear about the word “cannabis”, be it medical or not, and we need to get over that. One of my concerns about the Bill is the use of the broad term “cannabis”. I think that my hon. Friend’s constituent has been fighting with that issue.
Elliot Colburn
My hon. Friend has taken the words right out of my mouth. When talking to Carshalton and Wallington residents, I have found that there is a sense of stigma, and a stereotype, associated with the word “cannabis”.
Christian Wakeford
Earlier this week, we started talking again about drugs from a public health perspective. We need to tackle the stigma of not only drugs, but alcohol addiction. No one chooses addiction. There are many things that we can do, including removing the exclusion of addiction from the Equality Act 2010, and properly funding addiction and rehabilitation services, but, again, this comes down to the financing.
Ben Everitt (Milton Keynes North) (Con)
My hon. Friend is being very generous with his time. A point that occurred to me earlier is that one of the problems that we have when we debate this issue in Parliament and elsewhere is the conflation of national drugs policy and policy relating specifically to medicinal drugs—in this case, specifically medicinal cannabis. In many ways, it is deeply unhelpful when those two matters are conflated, because people come at them with strong opinions. However, the case study that my hon. Friend is outlining today shows the relationship between the two, and I am grateful to him for bringing that to the attention of the House. May I make a plea to everybody here—I hope that he agrees—not to fall into the trap of conflating the two issues, because although they are very important and we should have a discussion about both, they are vastly different?
Elliot Colburn
I totally agree. Indeed, I had no intention of opening the can of worms around recreational use, decriminalisation, legalisation, or whatever term we might want to use. I hope that my hon. Friend can rest easy in the knowledge that I will not go there, as they say.
My constituent said that he would not want to put anyone else through having to seek out black market providers, and that somewhere in the back of his mind was always the worry of being prosecuted, but to him the benefit outweighed the risk tenfold.
Lia Nici
The case that my hon. Friend is outlining highlights real concerns about the side effects of smoking recreational drugs, including potential mouth cancer, potential throat cancer and potential psychosis, as well as the unpleasant social activities. I have had constituents who have had to live next door to people who take recreational cannabis, and it really is not a pleasant situation to be in—and then we get into the issue of potential secondary smoking and all those kinds of things. That is why constituents such as my hon. Friend’s should not have to go through that route.
Elliot Colburn
I totally agree. It might be of some use to the House if I read a little more of my constituent’s reflections, as he went on to say:
“Then came along the introduction of Drug Science and their Project Twenty 21, this gave me the ability to seek professional help, to be able to get a prescription to legal Cannabis flower to which I vape as a preventative and when needed as a pain killer. I still get migraines but luckily now I have a medicinal way to cope and quell most of the side effects, literally giving me my life back.
Although this does sound like a fairy tale, with a happy ending, there is a darker side to this.
Currently the expense and experience of being with a private clinic and private dispensary/pharmacy is quite strained, adding anxiety and stress into the situation. We rely on the ability of both the clinic’s and Dispensary’s to keep us in prescription which does not happen and is quite literally floored. Medication is imported into the UK, its very often caught up in customs and the added issues with Covid has broken supply chains.
Dispensary’s are often out of product and the clinics are not kept abreast of this so many re-writes of prescriptions have to happen and thus costing time to get the needed medication and cost for re-writes. This all breaks down to us the patients being without medication, sometimes up to a month, putting us back at square one (prescriptions have to be written monthly).
On top of the supply and demand issues, quality is also something that has been with issue, many reporting to Yellow Card unusable medication due to sub-standard product and often mould that cannot be used – with no way of a refund or quick turnaround of a re-stock.
Without a shadow of a doubt this would never happen under the NHS but as we have no other choice in the matter its either suffering under private clinics or unfortunately breaking the law and turning back to the black market.
There are many thousands like me in this position, I’m but a single drop in a large ocean of people with similar experiences, I would like to draw your attention to this so you may air this as unfortunately the situation is not getting better. I understand that the primary concern is for children with epilepsy though there is a much larger footprint of people benefiting from medical cannabis and this should whole heartedly be pulled into the NHS to better control and support patients.
I would be grateful if you could keep this all”—
he refers to all of us in this place—
“in the back of your mind so you have some real world information from one of your local constituents of the big picture surrounding medical cannabis, it’s time for this to be pushed forward as it was supposed to have been back in 2019…
Luckily medical cannabis has given me my life back, I hope others can benefit in the future but it needs to be under the protective umbrella of the NHS.”
I thank that constituent for sharing what was obviously a harrowing story, and for permitting me to raise it on the Floor of the House this afternoon. I am sure colleagues will agree that that was incredibly brave, so I am very grateful to that person for allowing me to do so.
We have heard many constituents’ stories during the debate, although we have explored just two elements of them—childhood epilepsy and the migraines that my constituent has suffered. I would like quickly to bring in one more, which is the exploratory research being conducted on the use of CBD for fibromyalgia and other treatment-resistant neuropathic pain.
I know the suffering that those conditions can cause, especially when there is so little known or understood about them; I have many family members who have been diagnosed with fibromyalgia or similar conditions. Again, I have seen the benefits that CBD can bring, but I agree with colleagues about the need for robust research. I do not think it is a question of whether we will get there, but a question of how. I hope that the Minister has been able to take on board the experience—
James Daly
Does my hon. Friend agree that the law is very clear that medical professionals can prescribe non-licensed cannabis products, but the question is why clinical commissioning groups are not funding that? That is what we have to address, to force them to fund it.
Elliot Colburn
I totally agree with my hon. Friend. I have experience of working in what we might call a super CCG, which is now an integrated care system, looking at commissioning at a strategic level across six London boroughs, which is by no means a small footprint—we commissioned services for more than 1 million people when I was there, including for four of London’s biggest hospitals. I agree with the shadow Minister, the hon. Member for Tooting (Dr Allin-Khan), that practitioners were screaming from the rooftops that they wanted to be able to give such prescriptions and, indeed, felt confident about that. I will not say that they all were—a lot of the colleagues I used to work with in the NHS were not—but a significant amount were confident. From a commissioning perspective, when we were sat in our offices in Wimbledon, talking about commissioning services and looking at the health of the six south-west London boroughs we were tasked with dealing with, there was a clear sense of nervousness and even confusion among commissioners. That obviously needs to change and there needs to be some way to support commissioners to make the positive decisions to deliver the funding. I hope that when the Minister responds we will hear a little bit about what the Government can do about that.
In bringing my remarks to a close, I emphasise that the constituent experiences we have heard about in this debate, including from the constituent who was kind enough to allow me to read out their story, have been profound. That should be in the back of all our minds when we discuss this issue, because there are real-life implications that we do not always see when we pore over the details of text. I look forward to hearing from the Minister what we can do to unlock some of the issues we have explored in this debate.
Barbara Keeley (Worsley and Eccles South) (Lab)
I thank my hon. Friend the Member for Manchester, Withington (Jeff Smith) for introducing this important Bill that could improve the lives of so many people. As we have heard, it could particularly help families with children affected by serve treatment-resistant epilepsy, for whom cannabis-based products may be the only treatment that works. I pay tribute to my hon. Friend the Member for Middlesbrough (Andy McDonald) for his powerful appeal on behalf of the Bill.
My constituent Zoe Kirkman contacted me several years ago when she was seeking treatment for her son Riley, who experienced severe seizures up to 30 times a day that were very distressing for both him and the rest of his family. Ms Kirkman told me she was worried that he could die at any moment as a result of a seizure. These are the fears of parents and that is what drives them.
Riley’s condition has led to his missing a lot of education and being out of school a lot. As she could not access cannabis-based treatment for Riley on the NHS, Zoe Kirkman was forced to purchase THC and CBD products privately. As we have heard, many families are in a similar position, left with no choice but to pay hundreds of pounds a month—in some cases thousands—for private prescriptions. THC products work better for Riley, but Zoe Kirkman told me that there was little support alongside the prescriptions when they were purchased privately. The fact that parents are pushed into private prescriptions with little support must have some weight with us.
Thankfully, the cannabis-based treatments that his mother bought have reduced Riley’s seizures significantly and allowed him to stop taking a lot of his medications. However, he is still out of school because his school cannot include the cannabis-based treatment in his rescue package, as it is not prescribed on the NHS. For the same reason, Riley cannot access respite care, which would help him, at St Francis children’s hospice. Will the Minister say why schools and respite-care facilities such as hospices cannot be allowed to administer the oils that make such a difference to children such as Riley? Zoe Kirkman tells me that if Riley has a seizure because of a gap in the treatment, it can take weeks for his condition to settle down again.
In July 2018, I wrote to the then Home Secretary to raise Riley’s case. I received a belated response from a Home Office Minister in January 2019—more than six months after my initial letter—saying that following the changes to the law in November 2018, he hoped Riley would be receiving the treatment he needed. Of course, he is not receiving that treatment. The campaign group End Our Pain estimated that, a full three years on from the rescheduling of cannabis-based products to schedule 2 to the Misuse of Drugs Regulations 2001, just three children living with severe epilepsy have received an NHS prescription. As we know, two of them were at the centre of the 2018 campaigns. We have heard that a number of times in this debate and it is right that we focus on the fact that there have been just three prescriptions, and ask why.
When the Health Committee ran its inquiry on medical cannabis in March 2019, it heard from Peter Carroll, the campaign director at End Our Pain—we heard about him in earlier speeches—who said:
“What has happened is that hopes have been correctly raised, because this offers a lot of hope and benefit to a lot of people, but we have now moved across to implementation and the honest reality is that it is a disaster…The families…should be getting prescriptions…and watching their children…hopefully…improving day after day.”
After the Government raised hopes with the change in the law, it is a great pity that they have not increased access to medical cannabis for those who need it in line with the findings of the review that they commissioned in 2018. I hope that the Minister will explain why.
While I accept that we still need more research and studies into the effectiveness of cannabis-based products for treatment-resistant epilepsy in children, the Bill would offer important measures to increase the number of doctors who could prescribe such products and widen access to them through its proposed commission.
I asked Zoe Kirkman what she hoped for. She told me it was a purer form of the medication, because the products available to purchase contain a lot of synthetic ingredients and she worries that they could have long-term side effects for Riley. I hope that, through the Bill, Zoe Kirkman and Riley, and many families like them, will finally be able to access the treatment they need through the national health service.
The Bill contains a proportionate set of measures, with a commission to propose an assessment framework for cannabis-based medicines and their suitability for prescription and to make recommendations of measures to overcome the barriers that we have heard about in CCGs and other NHS structures to accessing cannabis from the NHS for medical reasons.
We have had a lengthy debate about different forms of trials. The commission could consider evidence from observational studies and from other countries as well as conventional control trials. My hon. Friend the Member for Manchester, Withington made an important point about evidence that could be weighed from EU countries—it is time that we started to think about that. It could also consider the important register of GPs who may prescribe cannabis-based medicines and permit them to do so. That would help to avoid the side effects of the cannabis-based products that Zoe Kirkman is currently forced to buy as the only option available. Most importantly, Riley would be able to attend school and have respite care when he needs it.
Let us end the years of pain. As my hon. Friend said at the end of his excellent speech, if not this Bill, what else?
Sally-Ann Hart (Hastings and Rye) (Con)
I welcome this important debate brought by the hon. Member for Manchester, Withington (Jeff Smith). Since 1 November 2018, cannabis-based products for medicinal use have been listed in schedule 2 to the Misuse of Drugs Regulations 2001. The change in law was based on expert advice from the chief medical adviser to the UK Government and the Advisory Council on the Misuse of Drugs, both of whom said that the rescheduling of such products would facilitate the development of clinical evidence.
All of us in this House have enormous sympathy with individual cases. I pay tribute to the hon. Member for Middlesbrough (Andy McDonald) for telling his family story, which I heard with great sadness and compassion. We also have a wider duty to safeguard through clinical evidence. I feel strongly about safeguarding.
A change has also occurred in that specialist doctors included on the General Medical Council’s specialist register can now prescribe cannabis-based products for medicinal use where clinically appropriate and in the best interests of patients. GPs may prescribe licensed cannabis-based medicines subject to any restrictions under the product’s marketing authorisation, but the law prevents GPs from prescribing unlicensed cannabis-based products for medicinal use unless it is done under the direction of a specialist doctor. That, at the moment, until we have more licensed cannabis-based products, is there for safeguarding purposes.
There are licensed cannabis-based products—not very many, but I think there are two or three—already routinely available on the NHS, and access to those licensed products has been promoted. For example, the chief pharmaceutical officer recently issued a reminder to clinical commissioning groups and the NHS trusts in England, highlighting that Sativex, for example, is recommended by NICE and available on prescription. There is also cannabis-based epilepsy medication available.
On Sativex, I wonder whether that sort of cannabis- based medication would have helped my aunt, who died aged 38 from multiple sclerosis. By the time she died at 38, she was practically blind and wheelchair-bound, so I feel very strongly that the right medication must be clinically looked at and evidenced in order for the right prescriptions to be made.
Mark Fletcher
We have heard a number of incredibly personal stories of family members or constituents today, but my hon. Friend’s point is that we should not only let the personal impacts influence us, but ensure that the evidence comes forward as well. Does she agree that it is vital we have both in this debate?
Sally-Ann Hart
I thank my hon. Friend for that comment. Very often in political debate we are driven by emotion, and that is right, because we have that emotion driving us forward to make change. However, that emotion must be tempered sometimes by evidence. When we are trying to get legislation through Parliament, we all know that there must be a good evidence base for us to work with to drive that legislation through.
In addition to the licensed cannabis-based products, since the change in regulations, doctors on the GMC’s specialist register have been able to prescribe unlicensed cannabis-based products for medicinal use if clinically appropriate for their patients. The law allows GPs to prescribe those products under the direction of a specialist, as part of a shared care arrangement.
If a GP decides to accept ongoing shared care responsibilities and prescribing, they must be competent to exercise their share of clinical responsibility and confident and happy to accept the associated legal and professional responsibilities of doing so. It is right that we put those decisions in the hands of specialist clinicians, those with the best knowledge of all the treatments available for the conditions they are specialist in.
However, the law did not relate to funding those products within the NHS, which is governed by a range of processes and procedures to ensure equitable distribution of funding, prioritising funding for those medicines that have proved their safety, quality, whether they work and their cost-effectiveness. This is where the evidence base is vital.
Currently, almost all cannabis-based products for medicinal use prescribed by specialist doctors are unlicensed medicines, which, unlike licensed medicines, have not undergone rigorous tests for quality, safety and efficacy. They are treatments of last resort, and patients will be at a stage in their treatment pathway where they will be under the care of a specialist doctor who has expert knowledge of their field and of all treatment options and will take responsibility for prescribing. Prescribing is limited to specialist doctors because it is important that that restriction forms part of the checks and balances that the Advisory Council on the Misuse of Drugs asked the Government to put in place when rescheduling cannabis-based products for medicinal use to minimise the risk of misuse and diversion. No matter how much we all want to see a change made, we are all aware that unfortunately there are people out there who would use medical cannabis as an excuse for recreational drug use. We have to avoid that at all costs.
Ben Everitt
On specialist prescribers, perhaps the barrier is not just the fact that prescription is limited, but the stigma around it. GPs are reluctant to engage with anything to do with cannabis because they almost feel that they might get professional blowback as a result of prescribing it.
Sally-Ann Hart
My hon. Friend raises a very good point. I would add that perhaps the reason why GPs are not forthcoming when it comes to working with specialist doctors is that they want to prescribe medicines that they know have been rigorously tested and to be aware of the possible side effects. We have to be aware that GPs take an oath, as my hon. Friend the Member for South Ribble (Katherine Fletcher) said, and part of that oath is that they will not do anything that will damage a patient. If a GP cannot be sure of the side effects or sure that drugs have not been rigorously tested with clinical evidence, they will be less inclined to offer those drugs.
Dr Hudson
There has been a lot of commonality today in the quest for increased knowledge about what is going on and for improving the evidence base, but also for the confidence of practitioners in being able to prescribe. Does my hon. Friend agree that it would unite us across the House if there were a renewed impetus from the Government to increase the information for medical practitioners about what can be done, so more of them can be confident in doing it, as well as a renewed impetus for the funding for research trials? That would give us a common momentum towards what we are all hoping to achieve.
Sally-Ann Hart
I thank my hon. Friend for his points. I have now forgotten his first point—I apologise for that—but I will come on later to clinical trials and the funding for them. Could he repeat his first point?
Dr Hudson
It was about renewed impetus from the Government to improve the outreach of information to medical practitioners so that more of them are aware of the licensed products, their capabilities and the clinical indications. As a veterinary surgeon, I feel very sympathetic to my colleagues in the medical profession, who want to be able to treat their patients with the best evidence base and the best information possible. Ministers could renew the impetus for more information for practitioners, as well as more funding for research. Those were my first and second points.
Sally-Ann Hart
I thank my hon. Friend so much. I just want to reiterate that the chief pharmaceutical officer recently issued a reminder to clinical commissioning groups and NHS trusts in England, highlighting the fact that cannabis-based drugs are available. What my hon. Friend is suggesting is that GPs need to be given even more regular information.
Jeff Smith
Immediately before the last few interventions, the hon. Lady said that we all know that people would try to use medical cannabis as recreational cannabis. I have to ask her where the evidence is for that. The fact is that these medicines are not the same as recreational cannabis. Look at Epidiolex or Bedrolite: people do not use them to get high. We are talking about completely different things. I really think that that is a red herring that the hon. Lady should not have thrown in.
Sally-Ann Hart
I thank the hon. Gentleman for his comments. I retract the statement that “we all know”, but there is a risk that some people may use medicinal cannabis as an excuse for growing cannabis for recreational use.
James Daly
My hon. Friend is making a very good speech. I fully accept the points that other hon. Members are making, but when the law was changed in 2018, it was not changed with a proviso that there had to be a certain amount of medical evidence to support the use of non-licensed cannabis treatments. It gave specialist practitioners the right to suggest that those products should be used. The problem a lot of the time, as my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) said, is that the clinical commissioning group—the people with the money—will not financially support such a recommendation. There are two sides to this, but a lot of practitioners do want to make sure that these medications come in and are used to support treatments at the earliest opportunity.
Sally-Ann Hart
I am sure the Minister has heard my hon. Friend’s comments and will take them on board.
Sally-Ann Hart
I will give way, but can I then make some progress? Is it on this point?
Mark Fletcher
It is slightly separate, as I am going back in my hon. Friend’s speech, but I thank her for giving way. She has taken many interventions, and I think she is doing a marvellous job. I want to go back to her point about specialists being able to prescribe versus GPs. I have a particular concern about the pressures on GPs at the moment, particularly coming out of the pandemic and the fact that there is such demand and such a backlog in the system. My concern is that this is a further complication that GPs would have to work through. Although I am not necessarily against the thrust of where we are going with today’s Bill, does she share the concern that GPs have a lot on already?
Sally-Ann Hart
I would agree with my hon. Friend on the basis that GPs have a lot on at the moment. I know that they are having to get involved in the roll-out of boosters and more vaccinations for covid. Therefore, when doctors in general practice are actually looking after patients, whether face to face or in a telephone conversation, they need to have the certainty, surety and confidence that whatever they are prescribing for their patients has been approved by NICE or whichever organisations are required to approve our medicine prescriptions.
Ben Everitt
I am very grateful for my hon. Friend’s generosity, and perhaps this intervention may allow her to pivot to the rest of her speech. We are almost in a chicken and egg situation now, with only three treatments available through the licensing system, but needing to get so many more through. With GPs or prescribers having only those three to choose from and really not trusting all the evidence before them, we need more evidence. This goes back to what my hon. Friend the Member for Crewe and Nantwich (Dr Mullan) said about needing more hard evidence to give the licensing authorities the confidence to push these things through and, crucially, GPs and prescribers the confidence to be able to make the call about whether these things are the right medicines for the right people. Again, as he pointed out, not every treatment is suitable for everybody, and we need to be absolutely clear that we have the evidence to show that the side-effects are minimal for all groups before prescribers make such calls.
Sally-Ann Hart
Yes, I absolutely agree with what my hon. Friend says, and I will be coming to the call for evidence a little bit later in my speech—
Sally-Ann Hart
Can I just finish one sentence?
I will be coming back to the need for more evidence and for manufacturing businesses to come forward, because there is huge potential. There is huge potential for manufacturing businesses and pharmaceutical companies to come forward with evidence to expand the amount of cannabis-based products that will and should be available on prescription from the NHS, so that the mothers who are trying their best for their young people and children are not having to pay a fortune to get this medicine privately.
Barbara Keeley
It is obvious to see what is going on here—Government Members are trying to talk out the Bill—but an argument was made in the previous intervention that we needed more evidence. This Bill would provide that, because it would bring forward a commission that would consolidate evidence and give a suitable framework for assessing cannabis products. That is what it is all about. Government Members worried about evidence should vote for the Bill.
Dr Mullan
Yes. I gently ask Opposition Members to consider whether they can think of any example where we have used primary legislation to further the advance of research for a particular series of treatments. It is not how we do it. There is a whole series of programmes and ways in which we do that in our NHS, and primary legislation is not it.
Sally-Ann Hart
I agree with my hon. Friend, because we have a regulatory pathway in place—I will come back to this a little later, when I can move on with my speech—under the Misuse of Drugs Act 1971 regulations and medicines regulation, through which cannabis-based medicines have already been approved for use in the NHS.
To go back to prescribing, the prescriptions are limited to specialist doctors and GPs working with those specialist doctors. They are not the first-line treatments, and patients will always be at a stage in their treatment pathway where they are in the care of a specialist doctor. While the evidence base remains limited—we have all spoken about how important it is to ramp up that evidence base—it is right that the decision to prescribe unlicensed products lies essentially with specialist doctors, because they have that expert knowledge in their field, and they take the responsibility for prescribing.
I completely understand why some groups have campaigned for greater access to unlicensed cannabis-based products for medicinal use funded by the NHS. However, I feel very strongly that these products—we are looking at a drug that has multiple chemicals in it, and I will come back to that later—have not had their safety and quality, and whether they work and are efficacious, assessed or assured by the Medicines and Healthcare Products Regulatory Agency or their clinical or cost-effectiveness assessed by NICE, and that has to be the basis for all NHS routine funding. The NHS has a duty of care. People trust it. We trust the NHS. We trust our doctors to ensure they are giving us the best possible advice and prescribing the best possible medicine that has been rigorously tested and has a clinical evidence base.
When GPs are looking at medicines and whether something is approved, they are looking at a cost-benefit analysis. Throughout covid, we have been looking at what age to give people vaccines. At the beginning, a cost-benefit analysis was made about whether the benefit of giving an over-18 a vaccine outweighed the cost or risks involved. We have to be very careful about that when taking any medication forward.
It is critical to progressing public funding decisions that manufacturers of these products invest in clinical trials and prove that their products are safe, effective and work. The National Institute for Health Research remains open to receiving good-quality proposals for research in this area as a priority, and it is clear, as I said earlier, that there is huge potential in cannabis-based medicines. Manufacturers need to ramp up putting quality proposals forward for research, so that more cannabis-based medicines can be approved for NHS use. That is not for us in this House to dictate, but for those businesses to put forward their proposals to get clinical trials going, so we have a much wider selection of drugs available for NHS prescriptions.
Lia Nici
Does my hon. Friend agree that it is not just about drug companies missing out on a huge business opportunity, as well as the health benefits? It is for the NHS and clinical commissioning groups to ask for, and to promote the fact that they are looking for good-quality research and good-quality products to put in their systems.
Sally-Ann Hart
I agree with my hon. Friend. That reminds me of a request I made to our local CCG. It is up to MPs to lobby local CCGs and for constituents to lobby their MPs. I lobbied our local CCG recently with regard to—[Interruption.]
Katherine Fletcher
I apologise for the heckling of nerdery. Neurofibromatosis.
Sally-Ann Hart
I thank my hon. Friend for prompting me to remember it. Neurofibromatosis is a terribly rare disease. It would be great if we could have the café au lait marks put in children’s red books, but of course we need the evidence base to do that. I lobbied our local CCG to see if it could do that and I know it has been taken higher up the chain to see what evidence base we need. I quite agree with my hon. Friend the Member for Great Grimsby (Lia Nici), because we can lobby and the CCG can do the same.
Mark Fletcher
On both sides of the House, there is a clear demand to see that evidence base come forward. We are sending a very powerful message to companies and manufacturers by saying, “Please provide us with this evidence, because we want to go in the same of direction”. My hon. Friend is doing a very good job on that front.
Sally-Ann Hart
I thank my hon. Friend for his comments. I agree that there is huge scope for the pharmaceutical industry in this area.
The latest clinical guidelines from NICE demonstrate a clear need for more evidence on the clinical and cost-effectiveness of unlicensed medicines to support routine prescribing and funding decisions on the NHS. That is why access on the NHS remains limited and prescribing is almost entirely within the private sector. We have to ask why there are so few licensed products. As we have all highlighted today, that is up to manufacturers and we cannot force manufacturers to apply for marketing authorisation. It has to come from them. While we can encourage, as my hon. Friend the Member for Great Grimsby pointed out, we are dependent on manufacturers being prepared to subject their products to rigorous clinical trials to demonstrate their benefits; and to demonstrate that those benefits outweigh any significant risk, as well as the cost-benefit analysis and the fact that they provide a material benefit over and above more established treatment options.
The MHRA is well equipped to provide independent advice to researchers and companies wishing to conduct clinical trials in the UK. We need to get the message out that they are there waiting for manufacturing businesses to come forward with their clinical trials. The MHRA, which is rightly recognised internationally for requiring the highest standards of quality, safety and efficacy, will assess any information submitted in support of applications for marketing authorisations.
I shall move on briefly to clause 3, which proposes that a commission be established to
“propose a framework for the assessment of cannabis-based medicines and their suitability for prescription in England”.
As I have discussed, there is already a regulatory pathway in place under the Misuse of Drug Regulations 2001 and other medicines legislation through which cannabis-based medicines have been approved for use on the NHS.
Jane Hunt
Is this more about trust? If the regulations are in place, that would give GPs and other medical professionals the chance to be bold. This is a bit like what I said to the Secretary of State for Education about the dreadful case of poor Arthur, which was about social workers having the opportunity to be bold. We should recognise that these people have years of professionalism behind them, so why not give them the opportunity to be bold? The Bill proposed by the hon. Member for Manchester, Withington (Jeff Smith) has given us an opportunity to say, “We support you to make those decisions. Please make them and let us have that evidence as well.”
Sally-Ann Hart
I agree with my hon. Friend. We all have huge sympathy with the Bill. I hope that, with the debate and the discussions going on today, we all—the manufacturers, the Ministers and us—are emboldened to look at how we can promote the matter and engage with manufacturing industries so that we have a better choice of cannabis-based medicines for prescription purposes on the NHS. It is important to note that.
Obviously, as has been discussed today, we are all aiming for the same thing. We sit as Members of different parties in this House, but we very often want the same thing. We want to create a better healthcare system. We want to create a better medicine prescribing system. We want to reduce poverty and disadvantage. We want to create better education systems and so on. Sometimes, though, we have a different way of doing it. That is what the debate entails; it is about the way that we do things.
Tom Randall
I have been listening intently to my hon. Friend. During the course of the debate, we have heard from many self-professed science geeks, talking about the nature of cannabis and other issues. Given that we are talking about primary legislation here, and given my hon. Friend’s background as a solicitor, I wondered whether she had given any thought to the usefulness or the appropriateness of using primary legislation to achieve the goals that the hon. Member for Manchester, Withington (Jeff Smith) seeks to achieve by bringing this Bill before the House this afternoon.
Sally-Ann Hart
I am not a science geek. I would not even say that I was a legal eagle geek, but I do understand that primary legislation is very important in certain circumstances, but perhaps in this sort of situation it is not the right route to go down, because there are so many other methods that are perhaps better—methods where you involve the manufacturers, the doctors and clinical staff—
Tonia Antoniazzi
What has been put to the House today is a solution and a way forward following almost four and a half years’ work. Every single option has been explored, and it really disappoints me to see hon. Members from the 2019 intake talking out the Bill because they have been told to do so. All the Government want to do is kick the can down the road. That is not acceptable, and it is not a way forward. We all have empathy and sympathy for these families, so let us get something done and let us use this Bill to move forward.
Sally-Ann Hart
I thank the hon. Lady for her passion. The whole point of debates in this Chamber is to properly scrutinise proposed legislation so that we make the right decisions.
Sally-Ann Hart
I will give way in a minute.
We already have legislation and pathways in place. The Government have made big inroads on facilitating cannabis-based products for NHS prescription. We are on the path. Do you think primary legislation will force the hand of pharmaceutical companies or manufacturing businesses to bring forward products for clinical trials?
Tonia Antoniazzi
That is quite incredible. I invite every Conservative Member to join the APPG on access to medical cannabis under prescription, to understand better where we are. We are not in a good place. We have explored all the options, and this is not a request for big pharma to come in. I used to play rugby, and I have a friend who followed me in playing for Wales. She is a wonderful woman, and her child is now going on to Epidiolex because the family cannot afford to go on to Bedrocan. She knows she has to give Epidiolex a chance, but she knows it will not work and she is not being given the option because of the two-tier system this Government created.
Madam Deputy Speaker (Dame Eleanor Laing)
Before the hon. Lady answers the intervention, I must ask her not to use the word “you.” When one says “you,” one means the Chair. I have not interrupted the flow of her speech, but she has said “you” a few times, and I would be grateful if she would say “the hon. Lady” rather than “you” because “you” means the Chair.
Sally-Ann Hart
Thank you for your advice, Madam Deputy Speaker. I take it on board, and I apologise for using that term in the House. I know I should not be saying it. When you are—[Laughter.] When one is going with the flow, it just comes out.
Madam Deputy Speaker
For the sake of clarity, it is okay if the hon. Lady says “when you are” when she means “when one is” because it is vernacular. I would not be so pernickety as to pick her up on that, and it is absolutely fine.
It is not often that I have the chance in a quiet House to clarify the rules that a lot of people do not understand, and that the hon. Lady clearly understands very well indeed. There are good reasons for the rules. It is not some old-fashioned tradition that we are sticking to because it is a tradition; it is because it changes the tenor of the debate. She is proceeding perfectly properly.
Sally-Ann Hart
Thank you, Madam Deputy Speaker. I understand that we have to use the right terminology because it depersonalises the debate, which is most important.
I am not sure whether I answered the intervention by the hon. Member for Gower (Tonia Antoniazzi), but I had better move on.
Barbara Keeley
The hon. Lady is talking about needing a debate on the Bill, but that debate could happen in Committee. All the points that Conservative Members are making—excruciatingly slowly to spin out the time and talk out the Bill—could happen there. The way that the legislative process works is that we get to Second Reading and vote for the Bill, then the details that Conservative Members are so keen to bring up now can be thrashed out in Committee. Let us make some progress.
Sally-Ann Hart
I thank the hon. Lady for her intervention, but if we only had debate in Committee, many hon. Members would not get to put forward their view, because they might not be on that Committee.
Madam Deputy Speaker
Order. Please, it is “hon. Members” not “you”. I have not achieved anything at all today.
Sally-Ann Hart
Hon. Members have made great strides today.
To go back to clause (3)(1)(a), which proposes that a commission should be established to,
“propose a framework for the assessment of cannabis-based medicines and their suitability for prescription in England”,
I have already said that there is a regulatory pathway in place under the Misuse of Drugs Regulations 2001 and medicines legislation. It would be inappropriate to establish a commission or any other body that aimed to circumvent existing regulatory controls or to subject medicinal cannabis to any less stringent assessment than is the case for other medicines used for serious or chronic conditions.
Mark Fletcher
One of my difficulties with the Bill is with clause 3 and the precedent it would set that the House effectively gets to decide which medicines we should prioritise and for which conditions. Does my hon. Friend share my concern that, if we go down that route, we undermine our independent regulatory system that is based on science and evidence?
Ben Everitt
On that point, broadly, not many of the tricky problems that we deal with in this place are solved by the addition of more Government. Certainly, the danger of undermining NICE and the role of CCGs should not be underestimated. We need to take action to speed up the licensing of drugs as they come through, but I do not think that more Government is the way to do it.
Sally-Ann Hart
I agree on that point, and I wholeheartedly agree that we need to take more action to speed up the registering of prescription drugs, particularly if they are cannabis-based and there is an evidential base that they help many people who are in desperate need of that sort of medication.
The legislative changes presented in the Bill will not improve or expedite the development of the evidence required to support routine prescribing and funding on the NHS. I have raised the issue that manufacturing businesses and pharmaceutical companies need to come forward with their products for clinical trial. That is the most important thing.
I welcome the fact that the Government continue to support the establishment of clinical trials with NHS England and the National Institute for Health Research. From 1 April, a national patient registry was introduced to record patient outcomes. We talk about the amount of funding to do this or to do that, but we need closely to examine outcomes, because we need to know whether whatever goes in has a beneficial effect at the other end; that is vital, and we all have to take responsibility to ensure that it happens.
In recent years, there has been a lot of research into how medicinal cannabis can help epilepsy, mainly involving children with rare and serious epilepsy syndrome. Most studies have focused on CBD. The studies suggest that CBD may be an effective treatment for some rare types and hard-to-treat forms of epilepsy. There have been reports of side effects in about one in three people taking CBD, including drowsiness, reduced appetite and fatigue.
Most studies look at cannabis as an additional treatment for those who already take a number of prescribed epilepsy medicines, so it is difficult to tell whether cannabis works when taken on its own, and we have to be honest with ourselves about that. In addition, there do not appear to be any studies comparing medical cannabis with other medicines already licensed for treating epilepsy, so there seems to be no evidence—or not enough evidence—on whether medical cannabis is more or less safe, or more or less effective, than other epilepsy treatments.
Tonia Antoniazzi
I thank the hon. Lady for her generosity, but it is very frustrating to be sitting on these Benches and listening to what she is saying, because it is not true. The problem is that children have been dying, and these families have tried absolutely everything. The unlicensed drugs that children have had to take before they even had access to medicinal cannabis put them practically into a coma just to be alive; that is not acceptable. Please—I beg her to come and join the all-party parliamentary group, and to educate herself and her colleagues better.
Sally-Ann Hart
I thank the hon. Member for her intervention, but more clinical evidence is required on cannabis-based drugs. It is really important that that clinical evidence is there for everybody to see.
Ben Everitt
My point relates to the evidence available for the CBD-related products and therapies to which my hon. Friend has been referring. There is a lack of evidence on the THC end of things. THC is the chemical in cannabis that gets people high, and there has therefore been a reluctance for researchers and so on to look into the evidence base. We need more structured and reliable evidence on medicinal cannabis across the board. As my hon. Friend the Member for Crewe and Nantwich has said in interventions, the evidence needs to be something on which we can rely, so that we can make better policy and push these treatments through the licensing paths quicker.
Sally-Ann Hart
I completely agree.
It is a really positive step that the NHS refractory epilepsy specialist clinical advisory service has been established to support clinicians working with patients to optimise the treatment of refractory epilepsy, and that an e-learning model has been developed by Health Education England. This shows what can be done as we move forward.
I have to highlight my concern with some of the arguments surrounding the legalisation of cannabis for medicinal use in the UK, especially those that call for sick people to be permitted to grow their own cannabis under licence. I recognise that the hon. Member for Manchester, Withington mentioned my concern that, if we give permission, we have to be careful that people do not abuse it for recreational purposes. We have to be aware of that. The argument that the continued ban on cannabis is irrational because cannabis works as a medicine for a number of medical conditions indicates that there may well be a push for cannabis to be legalised without any real proof required of safety and effectiveness.
Katherine Fletcher
My hon. Friend is making a really interesting point. It is very important that we are careful not to conflate the legalisation of cannabis for recreational use and what is already legal. I know she is not, but does she accept that clarification?
Sally-Ann Hart
I do not want to conflate them, but we have to be aware of that. We must also be aware that using cannabis, medicinally or otherwise, carries risk. There is really not enough data on the effects of cannabis on a child’s brain development, for example. Cannabis carries significant mental health risks for some individuals, and using it increases the risk of developing psychosis, depression and anxiety, as highlighted by Professor Colin Drummond, chair of the addictions faculty at the Royal College of Psychiatrists.
Dr Allin-Khan
What effect does the hon. Member think it has on a child’s brain to have upwards of 30 seizures a day?
Sally-Ann Hart
I absolutely welcome that intervention from the hon. Lady. Thirty brain seizures a day would have a devastating impact on a child, but we also have to look at the cost-benefit analysis of the drugs that are being administered.
Tonia Antoniazzi
On that point, the cost of having a child at home on medicinal cannabis is a lot less than the cost of having that child in hospital. We have 20 children who are living proof of that. We have been asking for over four years for an observational trial of those children. That was agreed to by the NHS and then it was reneged on. There is RESCAS—the Refractory Epilepsy Specialist Clinical Advisory Service—but RESCAS does not work. I am afraid that the hon. Lady is not speaking with a clear and informed view. Unfortunately, that is stopping these children getting what they need today with this Bill.
Sally-Ann Hart
The hon. Lady is clearly very passionate about this, but I feel very strongly that we have to make sure that all the right safeguards are in place. Many of these patients are children, and we have to make sure that they are not damaged when it comes to drug prescriptions.
In summary, it is vital that access to unlicensed medical cannabis must have safeguards and that cannabis-based medicinal products are rigorously tested in clinical trials to ensure safety, quality and efficacy. The social let alone economic costs are otherwise too high. The Government have been clear that the law enables lawful access where it is deemed clinically appropriate. The most significant barrier to access on the NHS is the lack of evidence of the quality, safety and clinical and cost-effectiveness of these products. In the absence of that evidence, clinicians are reticent to prescribe, as has been highlighted, and there are no legislative levers that the Government could support that would change that. Producers of unlicensed cannabis-based medicinal products, like those of any other medicine, need to invest in clinical trials to support the use of their products and be prepared to submit their products for scrutiny by the medicines regulator and NICE.
Dr Kieran Mullan (Crewe and Nantwich) (Con)
I welcome the opportunity to speak in this debate. I congratulate the hon. Member for Manchester, Withington (Jeff Smith) on introducing the Bill and highlighting the issue. I understand that he is trying to improve the situation for patients who are struggling, and I accept that he has the best intentions in that regard.
At the outset, I think we have to unpick some of the debate so far. We are talking about two different things, potentially: unlicensed and licensed treatments. Some of the criticisms that have been raised about lack of evidence are very valid in relation to unlicensed treatments, but not so valid in relation to licensed treatments; that is an issue about how we spread best practice. What we are talking about today affects a lot of the NHS and a lot of treatments in many different ways: how we test and evaluate treatments, the accountability of our doctors and other healthcare professionals, and how we spread learning and best practice in the NHS.
We have come an incredibly long way with testing and evaluating treatments in the NHS. I will try to give some of the history and the context of the challenge of knowing what good treatment is, because it is an enormous challenge. If people understood the history and how badly we have got it wrong on so many occasions, they might better understand why healthcare professionals can often be reluctant when it comes to unlicensed treatments.
The starting point is the time when medicine was practised almost entirely without evidence. It was practised for a very long time without what we would now consider evidence. Clinical medicine has evolved organically over hundreds of years, if not thousands, from a starting point at which even the concept of evidence-based medicine was alien. In fact, there were occasions when individuals who sought to advance the cause of understanding the body and disease were castigated for challenging established understanding, even in relation to the most basic things.
An old example that illustrates how fundamental the challenge of understanding good practice can be relates to handwashing. We all now take handwashing for granted as something that we should all do and that helps to keep us safe, particularly in relation to a pandemic, but that is largely down to the efforts of one man: Ignaz Semmelweis, a German-Hungarian physician and scientist born in Hungary in 1818. He died in an asylum in 1865 having suffered a nervous breakdown, ostracised by the medical establishment that rejected his theories, which we now know to be true.
Semmelweis looked after women giving birth at a Viennese hospital. He worked in two different clinics; one had a maternal mortality rate of about 10% because of the infections that women would get after giving birth, while the other had a maternal mortality rate of about 4%. The difference was so stark that women begged to be admitted to the second clinic because it was common knowledge that they were much more likely to die in the first.
Semmelweis noticed that difference and set out to understand it. He studied every detail of what was happening in each clinic, eliminating all possible differences, and discovered that the only major difference was the people working there. The first clinic taught medical students; the second did not. He combined that knowledge with the incidental finding that a friend of his who had pricked himself with a scalpel when performing an autopsy had become sick and died, in the same way as the ladies in the first clinic, of a general unwellness—germs were not even understood at that point.
Semmelweis theorised that the connection must be something to do with contact with bodies among people at the clinic who were looking after the women giving birth. He instigated what we now take as common sense: handwashing with a chemical for anybody who had had any contact with those bodies and who went on to look after the women. When he instituted that policy, the maternal mortality rate in the clinic fell to exactly the same rate as the other’s.
That theory is a landmark in our understanding of clinical medicine, but at the time it was considered extreme and Semmelweis was widely mocked. He was eventually dismissed from the hospital for political reasons, harassed by the local medical community and forced into an asylum; he ended up dying in terrible circumstances. That just goes to show how fundamental it is to doctors that we recognise that at various times medicine has got it very badly wrong in all directions. That guides a lot of what we do when we decide what treatments to give.
Sometimes our beliefs about treatment are based on an incorrect understanding of the nature of disease, false assumptions about how the body works or misconceptions about cause and effect. If people get better after treatment, we very often assume that the treatment helped, when often it was just incidental. We now know about the placebo effect, an incredibly powerful effect that generates improvements in patients without the benefit of any evidence whatever. From 1898 to 1913, a heroin-laced aspirin was available for the treatment of sore throats, coughs and colds, with a particular focus on it as a treatment for children; it was only in 1924 that heroin was banned completely as a treatment.
We still have a long way to go. Some research suggests that up to half the treatments we use even now lack what we might consider a full and reliable evidence base. Importantly for this debate, we can be badly wrong not just in identifying an effective treatment, but in understanding its side effects in the longer term. I have listened carefully to the descriptions of benefits for individual patients and I do not deny in any way, shape or form that they are benefiting, but when we aggregate that across the whole population, we can discover side effects, particularly in the long term, that we are simply not aware of when considering the benefit for an individual patient.
There was some criticism of my hon. Friend the Member for South Ribble (Katherine Fletcher) for raising this example, but I had planned to raise it, too. People will have heard about the thalidomide scandal. That is important not as a comparison with a particular side effect, but in understanding how we get things wrong with medicine. Thalidomide was licensed in July 1956 for over-the-counter sale. No doctor’s prescription was even required in Germany. By the mid-1950s, 14 pharmaceutical companies were marketing thalidomide in 46 countries and, by 1958, that included the UK. A UK Government warning was not issued until May 1962 and, in the intervening period, the drug was responsible for a wide range of birth defects in children who would otherwise have been born healthy.
Fen-Phen was a weight-loss drug used in the 1990s. It is estimated that as many as 6.5 million people took it. People taking it experienced heart disease, lung and pulmonary problems, and millions of pounds in compensation was paid out to people who took it after it was withdrawn.
Vioxx was taken off the market in 2004 after having been available for five years. That is considered to be one of the largest drug recalls in history. Vioxx was given to more than 20 million people as a painkiller for arthritis, but was later found to be responsible for an increased risk of heart attack and stroke. The Lancet reported that as many as 140,000 people could have suffered from serious coronary heart disease from taking this drug in the US alone. One study that I reviewed in anticipation of this debate found that 462 medicinal products were withdrawn from the market between 1953 and 2013 alone. This provides an important context for our discussion in terms of medicinal safety.
Modern clinical training teaches us how easily we can get our understanding wrong, how it can change and how difficult it can be to really understand the short and long-term benefits and harms of a medicinal treatment. We have a much more sceptical, vigilant workforce in healthcare as a result, and we must not be quick to rush to judgment when there is uncertainty about a particular treatment. We have come a long way with bodies such as the MHRA, NICE and others that attempt to support clinicians in making evidence-based decisions, because we realise that leaving it to the individual clinician is not necessarily helpful.
Tonia Antoniazzi
Do I understand the hon. Member well in thinking that he is saying that medical scientists do not know anything? We have allowed these children to have the medicinal cannabis. Is he saying that the scientists are wrong?
Dr Mullan
I encourage the hon. Lady to listen carefully to what I am saying. I said at the start of the debate that, absolutely, there are very good reasons for individual patients to receive this treatment. I have acknowledged that there are licensed treatments based on evidence, so I think she is kind of misrepresenting what I said. I said clearly that I am giving context to the—
Madam Deputy Speaker (Dame Eleanor Laing)
Order. I am sure that the hon. Member for Gower (Tonia Antoniazzi) was not misrepresenting what the hon. Member for Crewe and Nantwich (Dr Mullan) said. She is doing whatever he is suggesting that she is doing, but it will not be misrepresenting, because that would not be honourable.
Mark Fletcher
Far from doing what has just been accused of you, I felt as though you are giving a—[Interruption.] The hon. Gentleman is giving a cautionary tale and providing context for this debate, and that is very important for this discussion.
Tonia Antoniazzi
I thank the hon. Gentleman for his generosity in giving way again. This debate has been had in the House for many years. We have spoken about it a lot. I would like to extend an offer to him and other hon. Members to join the all-party group on access to medical cannabis under prescription and to educate themselves.
Dr Mullan
With the greatest possible respect, I do feel that I understand the challenges that the hon. Lady is talking about. I will go on to answer her question about the fact that we have talked about it for a long time, so how do we move it forward? As I will explain, unfortunately, that applies to a very wide range of treatments and clinical practices in the NHS and across the world. This is about the appropriateness of picking out one specific area of clinical practice and using primary legislation as a way to overcome one particular problem. That is my concern.
Andy McDonald
The hon. Gentleman is failing to grasp that we have done it. The change has been made. What I am hearing time and again from Government Members is them rewinding and revisiting the process. The medications we are talking about are authorised and have been prescribed. We do not need to go through this exercise again—we have done that, and we want to move on.
Dr Mullan
I have explained that there are two challenges here. There are licensed, accepted treatments that are not being used, and there are very many examples across the NHS and healthcare globally of accepted, best practice, effective treatments that are not necessarily used as widely as they should be. We should not be picking out a particular treatment and using primary legislation as a mechanism to overcome that in one example; we should be working across the system and doing the hard work that has to be done to change clinical practices, as I will go on to explain.
In terms of reopening the debate, as I have explained, there is still a debate to be had about unlicensed treatments where there is not an evidence base for their use. We are talking about two things today, and I wish hon. Members would be more careful in understanding the distinction between the two and not—[Interruption.] That is the argument I have made. I will carry on and make progress on the other issues I wish to discuss.
Mark Fletcher
I think there has been an accusation from the Opposition Benches that my hon. Friend does not seem to be educated in this particular area. Can he outline for the benefit of the House how much he understands medicine?
Dr Mullan
I thank my hon. Friend. When it comes to the issues I want to come on to talk about, it is not so much my practice as a doctor, but the fact that several years before becoming an MP I worked for the national clinical audit commission. The whole task of that organisation and very many other organisations in the NHS is to attempt to get clinical practice to change. There can be evidence and acceptance of what is best, and it does not happen, for very many reasons. That is the point I am trying to get across today.
I understand the focus on this particular treatment and I do not in any way underestimate the impact on patients but, as a constituency MP, I have several other examples of other treatments and other things people want to have on the NHS that they are not able to access. We have to think about how we tackle that in the broader sense, and I do not believe that picking out a particular treatment and putting it into primary legislation is the way to do that.
Ben Everitt
In an effort to draw some unanimity across this House, we are all keen to move things forward. We do not want to wind the clock back; we want more treatments through the licensing process. Does my hon. Friend agree that what he is calling for is a cautious, evidence-based way of doing that? We are not winding the clock back—[Interruption.] The shadow Minister intervenes from a sedentary position, but it was she who pointed out that the legislation is already there and that this private Member’s Bill does not seek to frustrate that. I think we are all pushing in the same direction and I would like to draw us to push further.
Dr Mullan
The point to draw from my hon. Friend’s intervention is that I have been working in this field for some time and I cannot think of any other example where we have decided to set aside all the ordinary processes that have been developed over many years, with great thought and attention to ensuring they are equitable in terms of resources, the NHS’s time and NHS researchers’ time, and come up with a whole separate process for determining the evidence on a particular treatment. That has never happened before that I am aware of.
I am happy to take an intervention from anyone on the Opposition side who can give me an example of when we have ever done that before, putting in place and encouraging the use of a particular treatment. I notice they do not—
Jeff Smith
The hon. Gentleman is right, and I respect his view. He is very knowledgeable in these areas. The point, as I tried to outline earlier, is that there are very many experts who think the process we have at the moment is not appropriate for the cannabis plant and the full plant cannabis extract. All I am asking is for the wider evidence base to be looked at. That is also what the NHS asked for in 2019 and what Sir Michael Rawlins said we should be looking at. There are a lot of people who think that randomised controlled trials are not necessarily the right way forward in this particular instance. All I am asking is for the evidence to be looked at.
Dr Allin-Khan
Without doubt, no one in the House wants anyone to suffer unnecessarily. However, most of us understand, as I am sure the hon. Member does, that in this case a randomised control trial would be immoral. The recipients of these medications are in such dire need that to find a group of children in as dire need and deliberately withhold treatment from them would be immoral. I respect him for his clinical and professional practice and as a Member of Parliament, but what is his alternative? The Bill, which has already gone through several stages with cross-party agreement and understanding, seeks to take this forward in unusual circumstances, where an RCT would be immoral.
Dr Mullan
I respect the experience that the hon. Member brings to her role. At no point have I said that the only way in which we can proceed is through RCTs. Earlier in the debate, when Opposition Members started talking in broad terms about observational studies and, to my mind, they were unfortunately disparaging RCTs, my comments were about being cautious. RCTs are incredibly important—they are fundamental to the vast majority of clinical medicine. I agree that other types of studies will be needed in some circumstances, but people need to make those arguments to the National Institute of Health Research. It is not for us as parliamentarians to override well-established processes designed to ensure that things are done in an appropriate, fair, thought-through and well-funded way.
Andy McDonald
The hon. Member is eloquent, but he is making a case for the commission. As the explanatory note says, the commission would be
“required to consider the role of evidence other than from conventional controlled trials, including from observational studies and other countries in which cannabis-based medicines are more widely available.”
So the net is wide. We are not pre-determining the evidence that would be considered. Opposition Members are saying that randomised control trials are not appropriate—we agreed on that; he has said that that is problematic—and there are other ways to look at this. We are not pre-determining it. We are saying that a commission of experts should do exactly that. Can he not see that he is speaking in favour of the Bill?
Dr Mullan
No. The point I am making is that nothing in the NIHR’s work says that it will only consider research and applications that are RCTs, and nothing prevents NICE from looking at any number of other methods of research. Opposition Members are saying that the Bill is the only way to get people to look at the evidence more broadly, but that is simply not true.
Katherine Fletcher
Briefly, I think I heard the hon. Member for Tooting (Dr Allin-Khan) talk about an RCT being immoral, implying that there is only one specific type of study design. She is talking about an RCT that would include forcing a placebo on children who are receiving medicine at the moment, but does my hon. Friend agree that RCTs can be designed in other ways and that we should not tar them all with one brush?
Dr Allin-Khan
Having a number of research degrees, I am very aware that there are many different types of trials and that a randomised control trial is not the panacea in all cases. That exactly speaks to the importance of the Bill, which considers a number of other options. It talks about looking at evidence from a widely cast net—it is in agreement with the hon. Member. If he does not agree with the Bill’s suggestions, which he is speaking to, what is his alternative?
Dr Mullan
I will go on to talk about what I think you need to do—when I say “you”, of course, I mean the clinical community rather than the hon. Member—to advance these issues. I am afraid that very difficult work needs to be done across many parts of the clinical community, involving engagement with individual clinicians. The last thing we should be doing is creating a new mechanism for the appraisal of a clinical treatment in the NHS. I cannot support that when there are already well-established, well-developed mechanisms for the purpose which do not rely on any particular randomised control trial, for example. We know that, because several treatments have been approved, although it has been argued that cannabis-based treatments cannot be approved in the existing frameworks.
Barbara Keeley
Both the hon. Gentleman and one of his hon. Friends have questioned the use of primary legislation such as this wonderful Bill to advance this cause and remove these barriers. His hon. Friends have done the same on a number of occasions when private Members’ Bills have come before the House. What about the Autism Act 2009? What about the Down Syndrome Bill, which we discussed last week? When an issue—such as a medical condition—is not receiving the attention, or the appropriate treatment, that it should be receiving from the NHS, Members present Bills to deal with that. Such Bills are generally applauded here, but somehow this particular instance of using primary legislation to remove these barriers for this group of people—
Barbara Keeley
The hon. Gentleman sits there shaking his head, which he has been doing for about an hour, but it is not reasonable to pick this out as a separate issue.
Dr Mullan
There is a difference between presenting a Bill that seeks to establish frameworks and approaches that have had a wider application and seeking to use a Bill to advance a particular medical treatment. There is not another example of that in the House. The examples that the hon. Member has given did not seek to advance a particular medical treatment through primary legislation. I do not consider that acceptable.
Tom Randall
This is a point that I hope to address in my own speech, should I have time to make it this afternoon. I know that many Members wish to contribute.
I spoke in the debate on the Down Syndrome Bill last week. Does my hon. Friend agree that the difference between that Bill—and the Autism Act—and this legislation is that whereas the Down Syndrome Bill was seeking to fill a gap, trying to bring different agencies together to create a common framework because there was obviously a deficiency and they were not working together, this Bill, as I understand it, seeks to duplicate the work of a body that already exists and is already functioning? In that sense, the two Bills are very different and cannot be compared.
Dr Mullan
I entirely agree. For example, if this legislation were seeking to reform or amend the general approach that we take to the appraisal of healthcare technology treatments in the NHS, I might have more sympathy with it, but it is not seeking to do that. Its promoter has picked out a particular line of medical treatment and sought to use primary legislation to drive it forward, and for the reasons I gave earlier relating to the history of deciding what treatments doctors should or should not be using, that is something about which I am extremely uncomfortable, although I am very sympathetic to the individual cases that Members have been raising.
James Daly
In November 2019, NICE conducted a review of the international evidence available in respect of this important issue. The report that followed was essentially inconclusive, but it did consult widely and obtained a wide range of information on some of the issues that Members have rightly identified. If the commissioning proposal in the Bill went ahead, how would the relationship with NICE and its statutory responsibilities work in this situation?
Dr Mullan
As my hon. Friend says, this is creating complexities and competing relationships that need to be given considerably more thought, rather than our aiming to promote a particular treatment.
We have talked about the risks. I now want to describe some of the many ways in which healthcare practitioners are held to account for their decisions. This is particularly important in relation to the unlicensed use of a medicine. First there is the sense of personal, moral or social responsibility that we would hope anyone involved in healthcare feels. Even if we do not necessarily take the Hippocratic oath any more, we are signed up on the basis of the fundamental principle, “First, do no harm”. Understanding that can be complicated, as I have tried to explain in relation to side-effects, for example.
Secondly, we are accountable to our employer. For example, a person working in a hospital is not free to practise as they wish. Their employer will have reasonable expectations that they ensure that their practice is safe, evidence based and works in the best interests of their patients. Increasingly, employers will place a big emphasis on following best practice guidelines from royal colleges, the National Institute for Health and Care Excellence and others that restrict their practice in some regard.
Andy McDonald
There is nothing in this Bill that will substitute our view and our professional assessment for that home medical practitioner. I want to congratulate the Members on the Conservative Benches: the clock is running down to 2.30 and they have successfully talked out this Bill. May I just ask anybody on those Benches to volunteer some explanation that I can take back to my constituents who wanted to see us make progress today, and we have not. By the way, can they also think of something that I may be able to say to my wife?
Dr Mullan
I think the hon. Member will understand that legislative progress is not an exercise purely in discussion. We should not be putting forward legislation if Members on one side of the House do not feel that that legislation should be passing into law. I am very happy to say that, for the reasons that I have outlined and will continue to outline, I do not feel that this legislation is appropriate, and I do that and will still sleep soundly tonight. It does not mean that I do not understand the deep concern, the hurt, and the anguish that individual parents are feeling. As I have said, I have worked in this field for a long time. There are very many people who suffer hurt and anguish in relation to treatments. I can talk about my own personal experience. My mother was diagnosed and treated for cancer. There was a period of a couple of years where I had seen a treatment that I wanted her to be on because I felt that it would be effective. There was some evidence to suggest that it was effective. We had to wait a couple of years for the further studies to come out, recommending that particular treatment. I have a young boy in my constituency, or a neighbouring constituency, whose family has raised an enormous amount of money to go to another part of the world to try a treatment that we do not consider to be sufficiently evidence-based—
Dr Mullan
Members say that they do not want to achieve that, so why are they bringing forward this legislation? If they do not think that it will make a difference to the use of a treatment, why are they bringing this Bill before the House? They must think that it will have an impact.
Jeff Smith
I think the hon. Gentleman might have inadvertently misrepresented things. I have not proposed the Bill to try to have unlicensed medicines—as I think he said—put forward. What I am trying to do is to introduce a Bill that will enable clinicians to look at a wider evidence base in order to get those medicines licensed. That is what I am trying to do. I want to listen to the hon. Gentleman because he is very knowledgeable and I respect what he is saying. I think he is making an important speech. It is disappointing, however, that Members have spoken for so long that the Minister will not be able to speak. That is a bit of a poor show from the Government.
Dr Mullan
As I said, my view is that there is nothing at the moment in any of the legislation or roles of the bodies that we already have in place that restrict them from looking at any particular type of evidence. That is simply not true. They are allowed to look at whatever evidence they choose to look at. It is whether that evidence is there, is available to them and is sufficient.
Tom Randall
I know that there has been a lot of talk in this debate about a campaign that has been going on for four years. My hon. Friend speaks with his medical experience, and many of us on these Benches do not. Does he agree that there has been a churn in the representation of this House over the past four years and there are new MPs who are coming to this debate afresh? This debate has been very useful in illuminating and educating those Members who are newer to the debate and that has been a very productive exercise. Does he further agree that, in spite of the understandable emotions that exist within this debate, the primary duty of Members of this House is to pass good legislation?
Dr Mullan
I completely agree. I would just add that processes are in place because we are at the greatest risk of making mistakes when we are faced with people in very desperate circumstances. The risk is greatest when a parent is extremely concerned for the welfare of their child, or when someone has a terminal illness. Those are the types of scenarios where people are most at risk of having the wrong treatment. I gave the example, which is incredibly important to remember in the wider discussion, of the MMR cases. Parents were advocating very, very strongly that that treatment had caused damage and distress to their children. Doctors were involved in amplifying and giving credibility to that circumstance. As a result, fewer people took their vaccines. I say this with all compassion to individual parents, but we have to retain a degree of objectivity, and I am afraid that parental passion is not a substitute for the systems we put in place.
Lia Nici
We all know there are a huge amount of emotions around this argument. All of us, I think, across the House would like to see the situation move forward. The issue is that the proposed legislation will not move things forward. In fact, it has the potential to slow the whole process down. If I understand it correctly, a private Member’s Bill cannot bring forward any money resolutions. What we need here is money, and for CCG and NHS processes to be working properly. We do not need primary legislation to do exactly what hon. Members across the House want. We just need to get on with it via the NHS and CCGs.
Tonia Antoniazzi
I thank the hon. Gentleman for giving way. The hon. Member for Great Grimsby (Lia Nici) makes a valid point. We have asked for a pot of money. We went to the Department of Health and Social Care. The hon. Member for Bury St Edmunds (Jo Churchill) was on the verge of organising it and getting it sorted so that we could have that pot of money. The Bill was the next option, because that option was no longer available when she was replaced as Minister. What next? There are 20 families, and hundreds more, who need something to happen. Inertia is not what we want. We have to move on. What is being done by the Government?
Dr Mullan
I am not familiar with the discussions the hon. Member may or may not have had—I am sure the hon. Member did have them—with the Government in relation to pots of money. Again, I will gently say that there are enormous pressures on NHS budgets. That is why we have NICE, for example, to take out some of the emotion and personal feelings people have in relation to clinical care, and to try to look objectively at what secures value for money. I am not aware of what work the Department may have done on whether this represented an equitable use of resources for this particular area of clinical care. I will be happy to write to the Minister and make inquiries, as I am sure Opposition Members and the all-party group have done.
Andy McDonald
On cost-efficiency, does the hon. Member not agree that, considering the cost of emergency admissions to hospital and the use of intensive care and expensive medicines that do not work as effectively, this system would be a much better use of national health resources and would actually be a financial economic benefit to our nation, not a detriment?
Dr Mullan
I agree. I am sure that that is part of the reason why some treatments secured a licence and NICE approval. Again, we must not give the impression to people listening to the debate that the NHS’s systems are not engaging with this issue. I am sure that some treatments were approved. I am sure—or would hope, if the evidence is there—that future treatments might also secure approval as we go forward, particularly if the evidence is there to demonstrate that they are of use. I just reiterate that the things that Members on the Opposition Benches have been asking for have been happening. It may be at a rate that frustrates them, but I share that frustration, as do many others, and it goes across lots of different clinical treatments. I have direct experience of it, and it is not just an issue for the NHS; it is a global issue for modern healthcare systems when a vast amount of money is going into medical research with new treatments all the time. Governments need systems to decide which treatments they approve and so that they can look at the evidence properly. That is why we have the MHRA, NICE, the royal college guidelines and NHS best practice guidelines. All those things are in place.
Business without Debate
(2 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text
Hon. Members
Object.
Bill to be read a Second time on Friday 14 January 2022.
British Goods (Public Sector Purchasing Duty) Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 14 January 2022.
Clean Air Targets (World Health Organization Guidelines) Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 18 March 2022.
Consumer Pricing Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 14 January 2022.
Broadcasting (Listed Sporting Events) Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 14 January 2022.
Puppy Import (Prohibition) Bill
Motion made, That the Bill be now read a Second time.
Madam Deputy Speaker (Dame Eleanor Laing)
It is lucky there are no rules about repetition in this place.
Employment (Application Requirements) Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 14 January 2022.
Public Sector Website Impersonation Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 14 January 2022.
Hunting Trophy Import (Prohibition) Bill
Motion made, That the Bill be now read a Second time.
John Spellar (Warley) (Lab)
On a point of order, Madam Deputy Speaker, is there any way of putting on the record that this immensely popular Bill, both in this House and with the public, has been blocked by a Government Whip when the Government have still not produced their own Bill?
Madam Deputy Speaker (Dame Eleanor Laing)
There is no way of putting that point on record. We have now had repetition, deviation and opportunism.
Armenian Genocide (Recognition) Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 14 January 2022.
House of Lords (Hereditary Peers) (Abolition of By-Elections) (No. 2) Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 14 January 2022.
Employment and Trade Union Rights (Dismissal and Re-engagement) Bill
Resumption of adjourned debate on Question (22 October), That the Bill be now read a Second time.
Hon. Members
Object.
Debate to be resumed on Friday 18 March 2022.
Climate and Ecology Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 18 March 2022.
Public Advocate Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 14 January 2022.
Local Government (Disqualification) Bill
Consideration of Bill, not amended in the Public Bill Committee
Hon. Members
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Bill to be considered on Friday 14 January 2022.
Ambulance Waiting Times (Local Reporting) Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 18 March 2022.
Copyright (Rights and Remuneration of Musicians, Etc.) Bill
Resumption of adjourned debate on Question (3 December), That the Bill be now read a Second time.
Hon. Members
Object.
Debate to be resumed on Friday 14 January 2022.
Illegal Immigration (Offences) Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 14 January 2022.
Plastics (Wet Wipes) Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
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Bill to be read a Second time on Friday 4 February 2022.
NHS England (Alternative Treatment) Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
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Bill to be read a Second time on Friday 21 January 2022.
Public Health (Control of Disease) Act 1984 (Amendment) Bill
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Hon. Members
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Bill to be read a Second time on Friday 21 January 2022.
BBC Licence Fee Non-Payment (Decriminalisation for Over-75s) Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 14 January 2022.
Caravan Sites Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
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Bill to be read a Second time on Friday 21 January 2022.
Green Belt (Protection) Bill
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Hon. Members
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Bill to be read a Second time on Friday 14 January 2022.
Public Sector Exit Payments (Limitation) Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 21 January 2022.
Covid-19 Vaccine Damage Bill
Motion made, That the Bill be now read a Second time.
Colum Eastwood (Foyle) (SDLP)
On a point of order, Madam Deputy Speaker. Could you offer me some advice? We have had to endure very lengthy speeches today, which has had the effect of ensuring that we did not get to vote on the very important Medical Cannabis (Access) Bill before the House. We did not even get to discuss the Climate Change Bill in my name, which thousands of people support because of the massive damage that is being done to this planet through Government inaction. Can you please advise me when and how I can get some parliamentary time to discuss and debate a Bill that has lots of support out there among the public?
Madam Deputy Speaker (Dame Eleanor Laing)
The hon. Gentleman makes a perfectly reasonable point, and I can understand his disappointment that his Bill has not been aired today. I think that when we came to his Bill I asked him to name a day for Second Reading, and he named the day. I cannot now recall, having done 27 others, exactly which day he named, but whichever day it was, I hope that on that day we will have a chance to hear what he has to say about his Bill and to discover how much support it has. I hope that is helpful to the hon. Gentleman.
Children and Young People with Complex Needs
(2 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Sir Charles Walker (Broxbourne) (Con)
Sadly, some children and young people are not able to live safely with their families. The significant majority of these children have experienced trauma at a point during their developmental years, resulting in a range of behaviours, many of which cause distress to them or others. Those behaviours include self-harm and an increased vulnerability to criminal exploitation.
If a young person is unable to live safely at home, he or she may come into the care of the local authority or require hospital care. There is currently an insufficient supply of specialist care to meet the needs of such young people. As a result of the challenges posed by covid-19, health and social care professionals describe an unprecedented level of complexity and acuity of need, making an already difficult situation worse.
When a young person comes into care they will require either a children’s home, with staff skilled and experienced in meeting complex needs, or in some instances a court-directed placement into a secure unit, to keep them safe. Over the past 18 months, Hertfordshire children’s service has made three applications to the national secure bed bank. Despite repeated referrals, a secure placement was achieved for only one child. The most recent referral was made approximately six weeks ago, and on that occasion the local authority was advised that there were 50 referrals for only four available beds. That means that a secure bed was not available for 46 young people who had been assessed as requiring such accommodation to keep them safe. In each of those cases, the relevant authorities, including Hertfordshire, were required to make their own arrangements while the secure referral remained active.
Increasingly, local authorities turn to the courts for a deprivation of liberty order in the absence of more appropriate secure placements. Such orders are sought as a last resort, even though when granted they can place local authorities in the invidious position of having knowingly to place children in environments that are not best suited or equipped to meet their complex needs. Similarly, young people who require psychiatric hospital care find such care unavailable because of a shortage of appropriate hospital beds. In Hertfordshire, a number of young people have been assessed as detainable under the Mental Health Act 1983 and are waiting for appropriate hospital beds. The number waiting for a placement often rests at around 10 children, which means that in each of their cases their needs are not being met.
Despite people’s best efforts, the whole system is creaking because it is unable to cope with the demand. Problems with recruitment and the increasing complexity of some children’s needs mean that Ofsted and the Care Quality Commission too often find themselves in the position of having to close providers down, or reduce their bed capacity. It is important to note that there is a difference between physical beds and usable beds. Many beds are not in service because, in meeting the increasingly complex needs of children in care, there is not the staff capacity safely to service all the available beds in a home.
Not only is the current situation having a detrimental impact on young people, but its impact on the public purse is significant. Delivering bespoke care to a young person, often through a commissioned provider, is very expensive, particularly because these young people, due to the risks they present, will require high staffing levels. Placements are expensive: they can cost from £4,500 a week to upwards of £30,000 a week. Often, a child who has difficulty accessing support further down the needs scale quickly ends up requiring a far most costly set of interventions and specialist care.
It is of course important to intervene early to work with young people in the community to prevent family breakdown and the escalation of needs, but the current placement situation must be addressed, so in this debate I wish to ask regulators to work with the care sector to reopen closed beds through the development of a specialist taskforce that supports providers—be they mental health providers, social care providers or specialist schools—that struggle to deliver good-quality care. Alongside such efforts, we should make a national intervention to reassure providers that their Ofsted rating will not be negatively impacted if they admit children with the most challenging of needs. Too often, specialist care providers will refuse these children because they are concerned that if a child absconds or creates a high level of service demand, that will negatively affect their Ofsted rating.
We also need a national campaign both to challenge the stereotypes about children in care and to recruit residential childcare officers. Such schemes are already in place for fostering and adoption, and we have Teach First and Think Ahead. A similar programme now needs to be introduced to attract people into child social care and, in particular, the care of children with high levels of need.
Backing up this recruitment drive, we need a programme of support to design children’s homes that can accommodate children with the most complex needs but, as I have already said, without extra specialist staff the Government programme to match fund local authorities to develop new children’s homes will face significant challenges. New homes require skilled staff if they are to be viable. Also, in wanting to build new specialist homes, we need to appeal to the better part of people’s human nature, as too many of these specialist homes, when they come up for planning approval, are opposed by local communities.
When it comes to registering specialist residential care homes and facilities, we need to find a way of expediting the Ofsted registration process, which can take upwards of three months. In an emergency, a local authority will sometimes use one of its bedroomed properties as a care setting for a vulnerable child or adolescent, with a rota of specialist social care staff in attendance. Without Ofsted registration, such facilities will be operating outside the regulatory framework.
Darren Henry (Broxtowe) (Con)
I hear my hon. Friend’s point about care in the community, which is essential and something we need to focus on. Children and young people with complex needs too often end up in hospital, which is not the right place for them, as they end up being affected by people in hospital with other issues. Care in the community is essential. How can we give local authorities the onus and the investment to make this happen?
Sir Charles Walker
I thank my hon. Friend for his intervention, and I will come on to that. We need to have the right setting delivering the right care—the care that the child needs. The child needs to be at the centre of that care.
How does a care emergency arise? That question is often put to me. Beyond the national shortage of beds, a provider can notify a local authority, with only a few hours’ notice, that it will be terminating a young person’s placement in its facility. They can say, “In just a few hours, you will have this child back. This child is now your problem again.” This practice needs to be eliminated, but eliminating it will only alleviate the need for the provision of emergency accommodation and care; it will not end it. That will be done only through the provision of more beds, in both the social care sector and the psychiatric care sector. In the psychiatric care sector, it is not just the overall quantum of beds that counts; it is also the type of bed. These will cover general adolescent units, eating disorders, low-secure units and psychiatric intensive care units.
Almost all the concerns I have highlighted and will highlight this afternoon were identified in Sir Martin Narey’s independent review of residential care and in the Government’s response of 2016. We need to implement the findings of this report and tie them into a review of the Care Standards Act 2000 and the children’s homes regulations.
If anyone watching or listening to this debate wants to learn more about what is happening in this sector, I refer them to an excellent report by the BBC correspondent Sanchia Berg that can be found on the BBC website, dated 12 November, “The court orders depriving vulnerable children of their ‘liberty’”. The report contains harrowing accounts of what is happening, and they are framed throughout by the concerns of the High Court judge Sir Alistair MacDonald, who is deeply concerned about what he is witnessing in the courts and family courts.
Let me return to Sir Martin Narey’s independent review. Beyond its implementation, we need better joined-up care between the NHS and local authorities. The continuing healthcare framework has much to recommend it in relation to children and adolescents, but it is still heavily slanted towards their physical health. A robust commitment to parity of esteem would see the framework cover clinically diagnosed mental illness, as well as the challenges caused by trauma, attachment difficulties and, increasingly, autism. Let me say, as an aside, that all Department of Health legislation should make it perfectly clear that health means mental health and physical health; we cannot have one without the other.
Why is mental health so important? There are still far too many lengthy debates between local authorities and the NHS as to whether a child is suffering from a mental illness or a behavioural difficulty. To many, this seems like dancing on the head of a pin, as the debate does not change the fact that at the heart of the discussion is a child in crisis, as referred to by my hon. Friend the Member for Broxtowe (Darren Henry). A good solution has to be more joint commissioning between health, education and care providers, thereby removing barriers to joint funding. An example of best practice can be found in my own county of Hertfordshire, where we are opening up a three-bed unit that will be jointly staffed by social care professionals and mental health professionals. Perhaps this initiative could pave the way for a national programme of hybrid mental health children’s homes, with a hybrid model of worker.
I must conclude by returning to staffing and recruitment. There really is a need for an enhanced programme of training for residential workers that recognises the unique challenges of the role and the high level of skill required to deliver an effective service. Residential work currently requires a lesser qualification than social work, yet those working in residential settings have significantly more direct contact with the most vulnerable children with the most complex needs. Better training would lead to better pay and an enhanced profile, thereby making the role a career of choice and one which is attractive to graduates.
I have made these recommendations and observations today on behalf of the excellent Hertfordshire County Council, which does a fabulous job across my county, and, of course, on behalf of the children for which it cares. Both Hertfordshire County Council and I want to support the Government’s programme to develop more beds in the secure estate, but we want an estate that is compassionate and able to provide the high levels of care and support that I know, the Minister knows and Madam Deputy Speaker knows, it wants to provide.
The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)
I thank my hon. Friend the Member for Broxbourne (Sir Charles Walker) for securing this important debate on care for children and young people with complex needs, and thank him for highlighting good practice in his constituency and across his local authority.
The Government are committed to ensuring that all children and young people who need care—be that health or social care—receive the safe and compassionate care that we should all expect. We are taking action to support all children and young people’s mental health, and to support those with complex needs to stay well in the community. This support starts at birth.
The Chancellor recently announced £300 million for family and early years support in half of upper-tier local authorities over the next spending review period. This includes: £100 million to roll out bespoke parent-infant mental health support to nurture parent-infant relationships, and improve access to perinatal mental health support; £50 million to fund evidence-based parenting programmes; and £82 million to create a network of family hubs. In addition, the Chancellor confirmed £200 million for the supporting families programme, increasing the number of families supported by the programme from 70,000 in 2021-22 to more than 100,000 in 2024-25.
For school-age children, we continue to implement the proposals of the children and young people’s mental health Green Paper. In March, we announced £79 million to boost mental health support for children and young people in England. Part of that will accelerate the roll-out of mental health support teams in schools and colleges to cover around 3 million children and young people by 2023. In May, the Department for Education announced funding worth £9.5 million, which will allow up to 7,800 education settings in England to train a senior mental health lead from their staff in the next academic year.
We are also taking steps to support children and young people with learning disabilities and autism through our newly published national autism strategy, the first autism strategy to be extended to children and young people as well as adults. The strategy is backed by over £74 million for the first year. That includes £3.5 million to help local systems identify children and young people on waiting lists who might be at risk of crisis, and £3 million for respite and short breaks to help families and autistic children and young people with and without learning disability who have struggled during the pandemic.
The independent review of children’s social care, which commenced in March 2021, will look at the needs, experiences and outcomes for the children supported by children’s social care. We know, sadly, that there are some children and young people who will need in-patient care or a place in a secure setting. NHS England is accountable for the provision of in-patient mental health services for children and young people. In line with the NHS long-term plan, some of the commissioning tasks and relevant budget have been delegated to NHS-led provider collaboratives.
Darren Henry
My understanding of the point that my hon. Friend the Member for Broxbourne was making is that we should make sure that the investment goes into residential care. The Minister is talking about the money and the investment being put into in-patient care, but that should really be put into residential care. Will she please comment on that? In addition, taking that a step further, should areas with residential care and the staff equipped to deal with children with complex needs not eventually get people into supported living so that we can ultimately get them into independent living?
Maggie Throup
My hon. Friend makes a very good point, and I will come to that later in my speech.
The lead provider works collaboratively with other providers to ensure the appropriate level of in-patient provision in their area; it is important that we have the right mix of provision, whether it is in-patient or community support. They also ensure that the right community services are available to support children and young people when they are discharged to prevent further crises.
Wherever possible, collaboratives will aim to provide high-quality alternatives to admission. However, where stays are required, they should be short and close to home in a high-quality, safe and therapeutic service. We must of course ensure that the rights of children and young people who are placed under the Mental Health Act 1983 are respected.
We published our White Paper on reforming the Mental Health Act in January 2021, setting out proposals to make the Act work better for people. We are committed to ensuring that the reforms we want to make to the Act also benefit children and young people. We will work to ensure that the rights we plan to introduce for patients are also available to children and young people detained under the Act. Reforms to the Act will limit the scope to detain people with a learning disability or autistic people, helping to reduce unnecessary detentions. To ensure that in-patient settings are therapeutic for autistic people, we are providing £4 million to enable in-patient settings to become more autism friendly.
In children’s social care, we are committed to doing everything we can to support local authorities in ensuring that the most vulnerable children are protected and that there are sufficient places for children in their care. The Government have given more than £6 billion in un-ringfenced funding directly to councils to support them with the impact of covid-19 spending pressures, including in children’s social services.
I take the opportunity to refer briefly to the a point made by the Secretary of State for Health and Social Care in the House a few days ago. He set out that we will be taking further measures to support and protect social care against the threat posed by the omicron variant. We will set out a package of measures at the earliest opportunity. I reassure hon. Members that the timing of the announcement will not have an impact on our ability to implement those protections on the intended date.
The Government are also taking additional steps to support local authorities to fulfil their statutory duties. The spending review 2021 announced £259 million over the spending review period to maintain capacity and expand provision in secure and open residential children’s homes. That will provide high-quality safe homes for some of our most vulnerable children and young people.
We recognise that those in the secure estate are some of the most vulnerable in our society. Children and young people in secure settings are more likely than other young people their age to have additional healthcare needs. The integrated care framework aims to support trauma-informed care, and formulation-driven evidence-based whole-system approaches to creating change for children and young people within the children and young people secure estate.
My hon. Friend the Member for Broxbourne talked about beds. In the NHS long-term plan, we committed to investing at least an additional £2.3 billion in mental health services by 2023-24. That will see 345,000 children and young people a year accessing NHS-funded specialist mental health support if they need it. On 5 March, we announced an additional £79 million of funding that will be used to expand children’s mental health services significantly in this financial year. It will also help to improve access and reduce waiting times for NHS community mental health support.
There is much to be said about how we are supporting and should further support children and young people, not least those who, because of mental illness, learning disabilities, being autistic or complex trauma, are some of the most vulnerable in our society.
Sir Charles Walker
On a point of order, Madam Deputy Speaker. The Minister’s Department asked for my speaking notes, which I provided earlier in the week, but barely a question I raised was answered by her. It is not her fault, but I have just had generalities; we got on to social care when I was talking specifically about care for children with a high amount of need. I am confused: what is the point of providing notes to officials in advance of an Adjournment debate if the Minister is not equipped—it is not her fault—with the speech to respond?
Madam Deputy Speaker (Dame Eleanor Laing)
I took the hon. Gentleman’s raised eyebrows as an indication that he wished to raise a point of order before I adjourn the House. We could have had more time on the debate, so I gave him the opportunity to make the point. The Minister is at liberty to say whatever she wishes at the Dispatch Box—that is not a matter for me—but she may wish to respond to his point.
Maggie Throup
Further to that point of order, Madam Deputy Speaker. I promise to write to my hon. Friend on the specific issues that he raised and I will look into them very seriously.
Sir Charles Walker
Further to that point of order, Madam Deputy Speaker. I thank the Minister for that kind offer. It was not an attack on her—I think she is as disappointed as I am.
Madam Deputy Speaker
I appreciate the points that the hon. Gentleman and the Minister have made.
Question put and agreed to.
Written Statements
(2 years, 4 months ago)
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Concussion in Sport: Government Response
(2 years, 4 months ago)
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The Parliamentary Under-Secretary of State for Digital, Culture, Media and Sport (Nigel Huddleston)
I wish to inform the House that the Government have today published their response to the report by the House of Commons Digital, Culture, Media and Sport Select Committee into concussion in sport.
Sport is a central part of our national identity and culture. The welfare and safety of everybody taking part in sport is of paramount importance, and the Government are committed to taking action to reduce the risks involved. The actions set out in this report do not represent the final word on the subject and we recognise there is more work to do to continue to make sport as safe as possible for all those who participate in it.
The Government are grateful to the DCMS Select Committee for undertaking its extensive inquiry into concussion in sport. The Committee’s report has reinforced the importance of the topic and provided valuable insights that have helped inform the Government’s thinking.
Our response outlines the Government’s approach to reducing the risks associated with concussion and head injuries in sport. This will involve working with partners from across the sport, health, education, academic and technology sectors.
A full response to each of the Committee’s recommendations is also provided in a separate annex to the report.
Within the report, the Government have committed to:
Commission a set of shared high-level protocols around concussion in sport across the UK.
Write to UK Sport and Sport England to explore ensuring funded bodies make use of these shared protocols.
Work across Departments to improve the protocols and pathways for use in treating concussion in sport injuries in NHS A&E settings.
Direct sports to work with Player Associations on training protocols for players’ long-term welfare.
Convene a sports concussion research forum of experts to identify the priority research questions and improve the coordination with research funding bodies.
Write to National Governing Bodies to emphasise the importance of player welfare (including concussion) when formulating their governance procedures.
A copy of the Government response to the DCMS Select Committee report will be placed in the Libraries of both Houses.
[HCWS465]
Fisheries: Annual Negotiations
(2 years, 4 months ago)
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The Minister for Farming, Fisheries and Food (Victoria Prentis)
At the time of writing, annual negotiations on fisheries are ongoing between: the UK, EU and Norway (the Trilateral); the UK and the EU; the UK and Norway; and the UK and the Faroes Islands.
As regards the Trilateral, which will determine catch limits for six jointly managed stocks in the North Sea (cod, haddock, saithe, whiting, plaice, herring), discussions have been fruitful and we expect agreement between the three parties to be reached later this afternoon (Friday 10 December).
Bilateral negotiations between the UK and the EU on 2022 fishing opportunities on jointly managed stocks are ongoing. Discussions have been constructive so far and there is opportunity to intensify talks before 20 December if necessary.
We are continuing to discuss possible exchanges of fishing opportunities with Norway and the Faroes. If there are agreements to be reached, of which we remain optimistic, we hope to conclude them in the next few weeks.
We have also concluded a number of other negotiations this year, including in Regional Fisheries Management Organisations (RFMOs) and on catch limits for three straddling species (mackerel, Atlanto-scandian herring, and blue whiting) with coastal State partners in the North East Atlantic.
[HCWS466]
Delivery Supply Chain: Planning Controls
(2 years, 4 months ago)
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The Minister for Housing (Christopher Pincher)
I wish to update the House on the measures the Government are taking to facilitate flexibility within the delivery supply chain and mitigate challenges faced by construction sites.
Due to the covid pandemic, the logistics sector is facing an exceptional challenge resulting from the acute shortage of HGV drivers across the distribution network. This has resulted in missed deliveries which have the potential to lead to significant shortages and hinder economic growth.
Through a previous written ministerial statement made by the former Secretary of State, dated 15 July 2021, the Government responded to these pressures proactively by ensuring the industry had the tools available to adapt effectively and minimise any disruption to the public. The statement made it clear that local planning authorities should take a positive approach to their engagement with food retailers and distributors, as well as the freight industry, to ensure planning controls are not a barrier to deliveries of food, sanitary and other essential goods.
I am now expanding the scope of these measures. The purpose of this written ministerial statement, which comes into effect immediately, is to make it clear that local planning authorities should take a positive approach to their engagement with all supply chain stakeholders to ensure planning controls are not a barrier to the supply of all goods and services.
Many commercial activities in England are subject to controls which restrict the time and number of deliveries from lorries and other delivery vehicles, particularly during evenings and at night. These restrictions may be imposed by planning conditions, which are necessary to make the development acceptable to local residents who might otherwise suffer from traffic, noise and other local amenity issues. However, this needs to be balanced with the public interest, for all residents, to have access to shops which are well stocked.
The National Planning Policy Framework already emphasises that planning enforcement is a discretionary activity, and local planning authorities should act proportionately in responding to suspected breaches of planning control.
Local planning authorities should not seek to undertake planning enforcement action which would result in unnecessarily restricting deliveries, having regard to their legal obligations.
Construction output has also been inconsistent in recent months and not returned to pre-February 2020 levels. Construction sites in England may also be subject to controls which restrict the hours within which they can operate. Wherever possible, local planning authorities should respond positively to requests for flexibility for operation of construction sites to support the sector’s recovery.
The Government recognise that it may be necessary for action to be taken in relation to the impacts on neighbours of sustained disturbance due to deliveries and construction outside of conditioned hours, particularly where this affects sleep. In this case a local planning authority should consider any efforts made to manage and mitigate such disturbance, taking into account the degree and longevity of amenity impacts.
This statement will replace all the previous statements on these matters.
This written ministerial statement only covers England and will expire on 30 September 2022, giving direction to the industry and local planning authorities over the next 10 months. We will keep the need for this statement under review.
[HCWS467]
Intelligence and Security Committee: Annual Report 2019-21
(2 years, 4 months ago)
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The Prime Minister (Boris Johnson)
The Intelligence and Security Committee of Parliament has today laid before Parliament a report covering the work of the Committee between July 2019 to July 2021. The Government welcome the independent and robust oversight of the security and intelligence agencies and the wider intelligence community that the Committee provides. As this report demonstrates, the work of the Committee is wide-ranging, on topics vital to ensuring the public can have confidence that our world-class intelligence agencies continue to operate effectively and proportionately in light of the threats we face.
The period covered in this report has been a particularly challenging one, and it is a testament to the Committee that it has been able to provide oversight despite disruption to its work plan from the pandemic. The Government look forward to seeing the conclusions of a number of ongoing Committee inquiries.
The agencies and wider intelligence community value the oversight the Committee provides and have ensured Committee requests in this period have been given high importance. However, it is proper and right that agency and intelligence community resources continue to be appropriately prioritised to ensure the safety and security of our nation; the agencies have shown both resilience and ingenuity in continuing to deliver despite the challenges this period has brought. the intelligence community and Government were in touch with the Committee during the drafting of this report, and would remind the Committee of the importance of mutually agreeing timelines for returns to ensure these are reasonable and achievable.
During the period covered by the Committee’s report, the Government have published three formal responses to ISC reports, which address the recommendations and conclusions the Committee have made: Russia, published on 21 July 2020; Northern Ireland-related Terrorism, published 11 February 2021; and GCHQ Procurement: A Case Study, published 22 July 2021.
The Government remain confident that the current memorandum of understanding with the Committee is sufficient to allow for robust oversight of the agencies and wider intelligence community. The National Security Adviser has written to the ISC Chair to restate this position.
I would like to again thank the Committee for its work, and I look forward to working with it as it continues its vital oversight duties.
[HCWS464]
House of Lords
Freedom of Speech
(2 years, 4 months ago)
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The Archbishop of Canterbury
That this House takes note of contemporary challenges to freedom of speech, and the role of public, private and civil society sectors in upholding freedom of speech.
The Archbishop of Canterbury
My Lords, I am most grateful to the Leader of the House, the usual channels, all noble Lords who have taken the trouble to be here today and, especially, the noble Lord, Lord Parkinson, for answering on behalf of the Government in order that we may have this debate. It is a return to an Advent tradition, interrupted in recent years by elections and pandemics. Should your Lordships worry that I am infectious in some way, I have been tested to the limits of testing. I have my granddaughter’s cold, for which I would like to record my grateful thanks.
We on these Benches have our critics—I have a large number—but for all our present failings you would be hard-pressed to find a more disastrous move by the Lords spiritual than when, in 1831, 21 of them lined up behind the Duke of Wellington and opposed the Great Reform Bill. Had they voted the other way, it would have passed. The people, denied their rights, responded with riots, and bishops were particularly targeted, some with violence. In Bristol, the Bishop’s Palace was burned down. A dead cat was thrown at my predecessor Archbishop Howley, narrowly missing him but striking his chaplain in the face. “Be glad it wasn’t a live one,” Howley is reported to have responded.
I start with this dive into the past because it illustrates a present point. The grey area between, on the one hand, peaceful protest and reasoned criticism and, on the other, incitement to hatred or to violence is one that we are still trying to navigate today. The Church of England knows about that. I must start by suggesting that our society should never follow our historical example of coercion, Test Acts and punishment. There is still a prison at Lambeth Palace at the top of the Lollards’ Tower, with room for eight people. It was used for the Lollards—I have a little list.
President Obama touched on the subject of freedom of speech and of religion in a powerful address on 5 February 2015 to the US national prayer breakfast. Speaking of freedom of speech, he said that, for that and freedom of religion, we need humility. He said that
“humility is also recognizing in modern, complicated, diverse societies, the functioning of these rights, the concern for the protection of these rights calls for each of us to exercise civility and restraint and judgment.”
What is it that we are debating today in this House when we talk about freedom of speech and why does it matter? Free speech is not just frank speech but fitting speech. It is a necessary condition to the building of good communities—that is my essential point in this speech—which are healthy enough to disagree well and which challenge power misused. If I may use flattery, but true flattery, for a moment, your Lordships’ House is such an example. Here we are in a place that, after much tragedy and disagreement, has learned that what matters is not just communication but good communication. The House encourages a community of sharp disagreement in a shared space, where politics is done in the classic Aristotelian sense, issues are settled and the classic misuses of power are rejected. Misused power is shown by killing, coercion or causing the opponent to flee. The alternative to those three things is politics.
Politics takes it for granted that human beings are not merely declarative but communicative; that is to say that there is an absolute link between freedom of speech and a healthy community. That is why it matters so much. It is not just a free-standing right, a good in and of itself, but the means—the only means—to the end of a just and generous society. That is surely something of which we all dream.
Having said that, I will touch on three of the major threats to freedom of speech today, as I see them: the fear of reprisal, the distortion of truth and the dehumanisation of those with whom we disagree. They are great threats and, as throughout our modern history, we should not underestimate the fragility of our society when it comes to the enjoyment of our freedoms. They must always be defended and guarded or they fail, and with the loss of freedom of speech go justice and generosity.
When it comes to the principle of freedom of speech, I am instinctively in favour of a maximalist and communitarian approach. When a columnist for the Spectator said that his hopes for the coming year included that I be
“mugged at knife-point by a gang of refugees”,
I did not feel threatened or, for that matter, offended—not only because I doubt that many refugees are avid readers of his column but because, like my predecessors, I stand here in a position of privilege that, though it makes me noticed, also confers security.
In this Chamber we are all heard by virtue of our position. Sometimes, the height of that pedestal— or pulpit—means that we will be knocked off it very swiftly and publicly when we make a mistake, as I frequently have. But others do not have the privilege of a red leather cushion to land on. The dynamics of power matter greatly.
In that context, I pay tribute to those around the globe and in this country for whom freedom of speech is genuinely something to die for. We will hear more of this later, I suspect and hope. When I spend time with people who cannot speak freely, as I did recently, practise their faith freely or refuse all faith freely, I am reminded of the huge security that we have in this country and of our power, collectively, as its citizens. Those others know the dangers of constraints on speech.
Our understanding of the importance of freedom of speech and the threats to it needs to keep pace with the threats to its existence. Government regulation alone cannot be the answer. I welcome the Government’s moves to tackle online harms, but while we can protect those most at risk, we cannot—and should not—try to legislate ourselves to good behaviour. Dr Martin Luther King said that we cannot restrain hatred, but we can restrain haters. That is the limit of law. Fittingly robust and vehement debate should characterise our national life. Online harms Bills, or cancel culture being itself cancelled, cannot make us obey the command to engage with opponents as people, to face them and to destroy our enemies not with forms of suppression or law but
“when we make them our friends.”
That is another quote from Dr King. David Amess was an example of frank speech and strong opinions that were fitting and based in communication, not mere individualism.
In his encyclical Fratelli Tutti, Pope Francis spoke of the pervasive characteristic of power and violence in our societies—I am most grateful to the noble Lord, Lord Parkinson, for the water; I shall take his Lordship off my little list.
Pope Francis spoke of the need to call out the abuse of power over others rather than the building of renewed communities by sharing power with them. The vehemence of social media is often the voice of those previously unheard and for that reason it is resented by those who have always been heard.
We hear much nonsense of the snowflake generation who seek safety. Younger generations are more concerned than their older counterparts about the safety and protection of minorities and more willing to call for restrictions on speech to achieve this. We need to keep a sense of perspective here. No-platforming is not a new phenomenon and there is evidence to suggest that it is very limited. The way I can remember minorities being addressed 40 to 50 years ago shows that more concern about safety then would have been a good thing. Freedom of speech sometimes means freedom for the powerful to bully and abuse.
When we speak of freedom of speech, we create two false binaries. First, we set freedom of speech against safety. Freedom demands safety—there is no freedom in acting out of fear—and safety, in turn, demands freedom. Also, there is no conflict between freedom and community; they are absolutely interdependent.
If freedom of speech is to flourish in this country despite its enemies, how might we foster those habits of the heart and mind that encourage a society that listens, reflects and responds with generosity and grace? Just as importantly, how might we ensure that in our desire to curb the extremes we do not silence the prophetic or those who challenge injustice and speak uncomfortable truths or that we do not push them to the margins? I hope to hear more today about the institutions and bodies that can enable that to be the characteristic of our society—what my great predecessor William Temple called the intermediary institutions.
One of the most important is the BBC, in both its domestic and World Service versions. Of course, it gets things wrong, but its continual history of being banned by tyrants, which goes on to this day, demonstrates the fear that impartial reporting—true freedom of speech—generates in those who seek to stifle all liberty. The BBC usually speaks frankly but also fittingly.
Increasingly, we also see the faith communities in many places as proponents of freedom, living out the Reformation truth that free speech opens the way to communities that challenge injustice. I think today of a senior Anglican overseas, whom I speak to very regularly but cannot name for his own security, who constantly speaks for free speech in a place of great insecurity.
Timothy Garton Ash summarised three vetoes of freedom in an illuminating way: techniques to silence others include shouting them down, which he calls the “heckler’s veto”; declaring what they say to be offensive, which he calls the “offensiveness veto”; and, in extreme cases, killing them or threatening to do so—the “assassin’s veto”. We have witnessed all these throughout history. The real issue of freedom of speech has been not regulations, measures or laws that oppress it but these three vetoes, often acting in partnership. Yet attacks on freedom are shape-shifters, and their most dramatic metamorphosis has been in recent years.
MPs and Members of your Lordships’ House will know what it is to be on the end of robust criticism, which we expect; abuse, which we put up with; and sometimes physical threats, which we have learned, through grave and tragic experience, to take seriously. At its most intense, this kind of targeting can make fear the senior partner of judgment. The anticipation of being howled down on social media is a constraint on speaking freely. It is fear not of being argued with but of the abusive and threatening hecklers in their thousands and tens of thousands. The setting up of fake websites, the use of hacking and the effectiveness of bots all bring the heckler’s veto from a point of irritation to a threat to sanity and stability, even to the threat of social chaos. Algorithms reinforce choices. At the same time, we must bear in mind that, in many countries, social media has been the main bulwark of struggles for freedom.
As we will hear later, the online world has completely changed the way in which we share and receive ideas. We are increasingly our own curators, editors and publishers. The partial upending of traditional power dynamics is a good thing, but we find ourselves in somewhat uncharted territory, in grey areas where the law is just beginning to catch up, and in a different culture in which the rules of engagement are still being developed and understood. We see trade-offs, in that our exposure to variety is determined by impersonal and market-driven algorithms. Privacy is as much a choice as it used to be a given. Oh! I have two cups now.
The lesson from all times, including from monopolistic owners of media companies in the past and social media today, is that all legislation and social pressure must stand against the commodification of speech. When it becomes a tradeable commodity, it ceases to be a freedom-building community. We see this reflected in the words of Zechariah Chafee, a key figure in the modern American First Amendment tradition, who said:
“It is hopeless for the law to draw the line between liberty and license”,
but we can look into our own hearts and make that decision before we speak out.
The struggle in a connected world is to distinguish what is morally reprehensible from that which is criminally punishable. In our society in this country, we are at the point where we say that, if we explicitly incite violence and stir hatred that will lead to violence, there should be criminal sanctions. Outside incitement or our established defences of slander and defamation, we must focus our efforts on cultivating—through education, higher education, further education and many other ways—a culture that is permissive rather than prohibitive, by which I mean encouraging of fitting speech rather than attempting to ban bad speech.
Freedom of speech also requires respect for truth. The spread of misinformation by conspiracy theorists—notably around the vaccine—political agitators or hostile actors is a serious problem that big tech companies and Governments must do more to tackle. I look forward to hearing more from my right reverend friend the Bishop of Oxford about this and online harms, which he will focus on in his speech.
The third threat to our freedom of speech is the dehumanisation of those with whom we disagree: the devaluation of others to diminish their arguments. We must be alert to how our habits of communication can stifle our creative imagination—how they might make us see others as somehow less than fully human. Much of what is problematic with the online world is that it is not conducive to seeking truth and that it gives equal opportunity to deliberate and dangerous misinformation designed to cloud the truth. To put it another way, sunlight is no more always the best disinfectant—no more than disinfectant is ever medicine for treating Covid. When people are too scared to express their genuinely held and legally protected beliefs, that is very dangerous for democracy.
Finally, as a Christian, I believe that Jesus Christ is the truth revealed—but that truth is so profound, so deep and so incomprehensible to us that, 2,000 years later, we in the Church are still deepening and reflecting on our understanding of the truth of God. That deepening of truth requires a deepening of community, and that requires freedom of speech. Within the 165 countries of today’s global Anglican Communion, we have radically different understandings on almost everything—that is far from new—but the most productive thing that we have done is forming groups called “bishops in dialogue”, where bishops from all over the Anglican Communion discuss, talk and evaluate the practical implications of what they hear and believe. This is freedom of speech, building freedom of community.
My great predecessor Lord Williams said:
“No one’s interests are best served by avoiding the hard encounters and the fresh insights.”
In John’s Gospel, Pilate asked Jesus, “What is truth?” He does not wait for an answer—he washes his hands of the situation and pronounces judgment to appease the mob. At Lambeth Palace we seek to avoid the vetoes, the coercion and the causing to flee. We have published the “Difference” course, which seeks to reimagine how we engage across difference.
I believe that God’s purpose for humanity is to have not fearful slaves but loving children. We are called to treat each other as we would ourselves like to be treated, with recognition of our flawedness, space for forgiveness and support of our freedom. In so doing, we are able to create good communities of justice, truth and generosity.
I hope that this debate will be an occasion for more light than heat, which is sadly too often not the case in so much of our public dialogue about freedom questions. I greatly look forward to hearing contributions from across the House. I beg to move.
Lord Griffiths of Burry Port (Lab)
My Lords, for a Methodist Minister to be standing second to the Archbishop of Canterbury is the nearest that he will get to preferment. I hope that it will guarantee some quick access to heavenly places in due course. We are all grateful to the most reverend Primate for securing this debate and for delivering his speech with such courage. We wish him well in getting over his ailment. This is a subject of great concern, and I did not know whether to begin my remarks by thinking of the times—the years—that I spent at Hyde Park Speakers’ Corner; freedom of speech is pretty much written into the raison d’être of that particular experience.
However, I start somewhere else. I am a member of the Communications and Digital Select Committee and I am happy to note that other members of the committee are here to speak on this important matter later in the debate. Our report was published in July, and many of the points in it have been raised by the most reverend Primate the Archbishop in his remarks a moment ago. Of course, all of us on the committee are looking forward very much to the day that the House gets round eventually—I repeat “eventually” for the ears of the Minister—to debating the report.
One of the people we interviewed in the course of our deliberations was Alan Rusbridger, the former editor of the Guardian newspaper and currently a member of the oversight board of Facebook, which we must now call Meta. I remember his rigorous defence of free speech. He insisted that offensive speech should not be regulated or banished simply because it is offensive. Bad speech should be met with better speech, offensive views should be countered with determined and constructive argument. He was clear that where offensive matter is intended to stir up hatred and even violence, it should be dealt with under the provisions of the Equality Act. Such matters are not part of the case that I wish to make now. As far as is humanly possible, civil society, public and private sectors together should envisage maintaining the possibility of open discussion, even when offensive views are uttered.
Faith communities have not, over the years, proved to be exemplary in these matters—the most reverend Primate hinted at this in his own speech. From the very beginning of Christianity, “heresy” was the word used to describe those to whom freedom of speech was to be denied: those who held divergent views from the “orthodox” mainstream. They were often persecuted or exiled—or worse. The examples of the history of the formulation of the Nicene Creed, the split between Western and eastern Christianity, the Protestant Reformation and, even at a humble level, the ejection of Methodists from the Church of England for the ignoble sin of being enthusiastic all offer ample illustration of the way that Christians have fought bitter battles which have ended in fragmentation and division. The notions of excommunication, heresy and blasphemy—polar opposites of free speech—are only too evident in the history of the Christian Church. It seems indeed to be part of our DNA: just read any account of the making of the Nicene Creed, or Aldous Huxley’s Grey Eminence, Fyodor Dostoevsky’s Brothers Karamazov or even Richard Llewellyn’s How Green Was My Valley to get the picture of these goings-on in the first five centuries of the Christian Church, or the 17th-century, or 19th-century Russia or even 20th-century Wales.
The Motion that we are discussing asks us to be “contemporary” in our consideration of these matters, so let me move from the past to the present and from the general to the particular. I am a Christian and, consequently, my values are focused on and flow from the person of Jesus Christ. I admire his teaching, I am ready to commend his example to all and sundry and I will proudly advocate his cause in debate with anyone, anywhere, at any time. Here is someone who has been subject to continuous and intense scrutiny down the centuries, much of it negative. So how should I take some of the treatments of this man, to whom I owe such complete allegiance? He has variously been described as an adulterer, a homosexual, a social revolutionary, a fanatic, other-worldly, a fool, a clown and much else. I could easily point to the films, poems, novels, diatribes, statues, paintings and dogmas that are inspired by these critiques.
Far from feeling threatened or offended by these often dismissive views, I must say that it somehow pleases me his persona is considered important enough to go on being given attention down the centuries. Indeed, I feel stimulated by such categorisation, caricature and critiques to put forward an alternative viewpoint. I know that the strongest recommendation for anything one believes in can come only from the way that one lives one’s life. But there is a proper place for argument, discussion and debate, and I want this to be as lively, real and honest as possible, however cantankerous it may sometimes be.
From these remarks and in the short time available in this debate, let me assure noble Lords that I would happily put on a series of lectures somewhere on the premises at any time for those who would like a fuller treatment of each of these schematic points. A Welshman who has been to university both has something in his head and, especially, the gift of being able to put it into words—so there you go; that is an offer.
In conclusion, I hope that noble Lords will feel that I have addressed the Motion before us directly and honestly—and personally. If this approach to offensive discourse is valid in the realm of faith, I suggest that it may be equally applicable in other areas of our lives too.
Baroness Featherstone (LD)
My Lords, free speech, established by our laws and by our values, has always had its limits, but now it is under threat as we grapple with a world that seems to be full of hatred of “other” and intolerance of views that differ from our own, all amplified by the internet and social media and condoned and contributed to by those who should be setting an example of good behaviour—from the Prime Minister downward. We now have a proliferation of ways to abuse each other, whether it is because people disagree with us, or are richer than us, poorer than us, a different colour, religion, gender, class or sex, or even those who simply think differently. We have developed a sort of football team binary mentality: you are with us or you are against us.
And freedom of speech? Well, everyone is worked up about online safety—quite rightly—and we will no doubt have a worthy online safety Bill; we already have the recent inquiry, as has been said by the noble Lord, Lord Griffiths, who is a member of the same committee on which I sit and so declare an interest; and we will no doubt have a further onslaught of frenzied activity by numerous regulators and digital platforms, all of which are there to push back this tsunami of hatred, intolerance, harm and threat. All of this is sadly necessary and will curb, hopefully, the worst of the harm, lies, misinformation, cancel culture, bullying and hate, without curtailing free speech.
In the end, however, I would say that, whatever the medium, that is not the real villain; it is the human messengers and the message itself that the public, private and civil society sectors need to have a role in, as do we as individuals. That is why the most reverend Primate the Archbishop of Canterbury is so right to frame the debate in the way that he has. I congratulate him on doing so and on his wonderful speech.
So why are we all so angry, so rude, so insecure, so scared, so mean and so judgmental? Obviously, I do not mean anyone in this House. As they say, fish rot from the head and in recent days, I am sad to say, we have seen the most unedifying behaviour on show from those from whom we expect better. But I will not personalise this, as tempting as it is. The issue is no longer about being able to distinguish right from wrong and truth from lies, or to care; the issue is making money and that there is no real loss of status for bad behaviour. This is decline and fall, because the pillars of our civility are being undermined. So, yes, fish rot from the head but the tail is also angry. We have had terrible rows around Brexit and trans, all of which should not be held in the manner they are—the “I’m right, you’re wrong”, and not allowing alternative views to be expressed without shouting, whether on Twitter or in the street. However, I actually believe that most people are good and most people are decent—they are, perhaps, too silent.
Most politicians, despite what is said about us, from councillors to Lords, know right from wrong, believe in public service and have a basic desire to use their time and energy for the betterment of the human race. Sadly, we had the recent example of the appalling murder of David Amess. Only then, the truth surfaced: that he was a brilliant constituency MP and much loved. Good news does not sell, but the media and us— well, apparently, we all prefer hate, aided and abetted by a terrible truth: we feel better if we denigrate others.
So, it is up to all of us to change our own behaviour and demand that those in public, private and civil society set a better example of behaviour. We need trusted mediums so that we can trust the message. We need facts. Truth is not arbitrary, it is actual, and without it, we have nothing. We need our institutions to rediscover their role in rectitude and uprightness. British values, of which we are rightly so proud, are falling, right now, into an abyss. The media, whether that be broadcast, internet-based, newspaper or platform, are all guilty, because arguments and misery sell.
Do not get me wrong, the media are the fourth estate and they have the wonderful ability to save us by exposing the bad, the evil and the guilty in a way that an individual cannot often do, but their modus operandi is sales, and if we look closely at the internet—or not even closely—the same is true. Clickbait is the model for sales of advertising. Sales and clicks are all, and they feed upon this frenzy of a downward cycle, cataloguing the cataclysm, with the emphasis on the negative and the nasty, the banal and the low-grade. Reality TV, 24-hour news, advertising, the competing society, the lack of social mobility and the inequality gap—all exist against the backdrop of a destabilising western democracy and political short-termism.
The deal always was that we behaved well because religions, parents, teachers, the police and our Government said we should, and they set an example of good behaviour and expected us to do the same. If we did, we were rewarded with approbation from our family, friends, teachers, the community or God, depending on our personal proclivity. From our establishments, our institutions and their leaders came a code of social conduct that we all basically understood. There was either a penalty for deviating from the expectation of good behaviour—such as social exclusion, civil or state punishment or excommunication—or there was the simple reward of doing the right thing to fulfil our own expectations of ourselves, stemming from our innate sense of good behaviour.
I am glad the rigidity has gone, but we certainly need to behave better on our own cognisance. I guess the trick will be to work out a new framework, for individuals and institutions—a new social contract that preserves this greater freedom while restraining licence—and all without having to resort to increasingly punitive but ultimately ineffective ways of keeping order, with ever more stringent laws, surveillance, rules, regulations, targets, punishments and curtailment of free speech, all of which achieve so very little in actually changing behaviour. It is time for some sort of radical change to give our young people a wider, broader and more challenging base; to teach them comradeship and bravery and a welcoming of discussion, argument and differing views and beliefs; to give them a new vision of how life can and should be.
Baroness Falkner of Margravine (CB)
My Lords, I too thank the most reverend Primate for giving us the opportunity today to discuss this profoundly important human right. In doing so, I declare an interest as set out in the register, but I emphasise that I am speaking from a personal perspective. I shall draw on my own background and experiences, as they have profoundly shaped my view of why this human right, the right to express oneself freely, is so important to those of us who care about a freedom-loving democracy.
As I grew up, I lived in several countries. What united them was that they were all authoritarian and all socially conservative. All were politically repressive in varying degrees, but the combination of the two, if you were a woman, was, at minimum, stultifying and at worst, led to a life lived in social and political ostracism. That loss of voice eventually snuffed out your fundamental autonomy. You retreated into family, religious sect and tribe, with a narrow space to express yourself that got narrower and narrower. For those of us who have been lucky enough to make it to democracies—I think I speak for many who arrive on our shores today—the allure of a democracy is palpable. It has meaning beyond knowing that you can vote; it is expressed most tangibly in the ability to think what one wants and to express that as one wishes, with bounds, but with few bounds. These two, the freedom to think and free speech, are inexorably bound together. One cannot have the one in the absence of the other.
For me, a thriving democracy is one where contestation is rife and vigorous debate allows us to change our minds, to be open to contrary perspectives and, indeed, to disagree—to disagree well, as the most reverend Primate the Archbishop of Canterbury reminded us. The role of the Opposition in a democracy’s constitution reflects that public disagreement, and the reason we elevate and provide for the formal role of an Opposition is precisely because we accept that others have the right to hold a different view from ours. Periodically, we accept that their views must hold, and we peaceably move over to allow them to rule over us. That is the compact and we all observe it.
But we know that this space is being eroded, and its erosion is most dangerous in institutions which are integral to our values. I speak of education for young people and universities. In both spheres of education, there appears a diminution of the value of opposing thought, and an elevation of that of respect and tolerance, a perspective where individual “safety” is elevated as the principal objective, and where “harm” is alleged by exposure to ideas that might provoke. Let me be clear: I do not for a second believe that respect and tolerance are not important values. Indeed, without them, in this increasingly multi-ethnic and multicultural society, we could not rub along together in coexistence, so they really matter. My point is that they are values that command our loyalty only because they follow from the freedom of speech and thought that is intrinsic to a democracy. The fact that we know we can disagree and express that disagreement publicly allows us to put up with views and actions that offend us. When we do not like what is said, we can say so and be listened to.
However, as we saw in Sussex University, in the case of Professor Kathleen Stock, and numerous others, we are in danger of a situation where tolerance for one perspective applies only when it is our perspective. “Join my tribe or lose your job”. She lost her job, supposedly because she made some people feel “unsafe”. Could it be that when young people open themselves up to these other, contrary ideas, which may be uncomfortable to accept, universities are actually playing an important role, beyond knowledge? They are building our resilience to prepare us for later life, when we all have to leave our tribe and rub along with, and even tolerate, those who do not hold our views. As a member of a minority, an ethnic and religious minority, I can testify that this is especially true for us. If universities become primarily spaces where, beyond a formal curriculum, in all other activities group-think prevails, eventually all are diminished, not only the academy itself.
One has only to look at the current issue of Prospect magazine; the noble Lord, Lord Griffiths of Burry Port, referred to Alan Rusbridger, its new editor. Prospect this month has an article about freedom of expression, and it has a sorry list of academics, journalists and others who have been subjected to sanctions in the United Kingdom and the US, both societies, one would have thought, that pride themselves on freedom.
I close with a simple thought: in order to uphold our freedoms, we accept the proposition that the struggle to keep them is for every single one of us—every day, every year, as we go forward. Today marks the day the Universal Declaration of Human Rights was adopted in Paris 73 years ago. It has served us well, as it enshrined for the first time freedom of expression in international law. Today is a good day to celebrate that.
The Lord Bishop of Birmingham
My Lords, as we have been hearing, speech is one of the most precious gifts for humanity, freedom of which is easy to take for granted, as we may do from week to week in this House, but even easier to abuse. Speech is so important that, at this season of the year, for people of Christian tradition, we even call the son of God’s appearance the word of God—the word made flesh.
In the same scriptures in which we read that story, there is warning of the danger of the use of the tongue:
“If anyone thinks he is religious and does not bridle his tongue but deceives his heart, this person’s religion is worthless.”
Of course, I do not refer to anyone who stands on the platform at Speakers’ Corner or any other venue of that kind. We remember also
“the tongue is a small member, yet it boasts of great things. How great a forest is set ablaze by such a small fire!”—
the blaze of instant phone recordings or a tweet out of context.
Good law is in place; we have just heard about the anniversary of the Universal Declaration of Human Rights in 1948, and Article 19 in it, and there is also our own Human Rights Act 1998 and its Article 9,
“Freedom of thought, conscience and religion”,
and Article 10, “Freedom of expression”. We give thanks for those, but we also notice laws around the world that need challenge and change; for example, blasphemy laws in countries such as Nigeria, Egypt and Pakistan, where organisations such as Christian Solidarity Worldwide draw our attention to the sort of things we have just been hearing about from the noble Baroness.
Today, even when good law is in place and upheld in public, personal and public speech can perpetuate prejudice and division—or it can extend the benefit of these hard-won freedoms. Our most reverend friend mentioned the importance of intermediate activity in this area. Between the nation and the individual is the need to soften and remove the inhibitions on speaking up or speaking out, to allay the fear of exclusion or reprisal and to give new confidence in conversation. This is where civil society and faiths can create and convene safe spaces where difference can be spoken with care and understanding can be deepened, truth revealed and progress made towards a common good. I will give one or two examples of putting this into practice from my personal experience—in South Africa, Birmingham, the Church of England, as mentioned already, and the City of London.
In South Africa, following the intense need for truth and reconciliation, there are continuing deeper conversations—courageous conversations, as they are called—convened by the Archbishop of Cape Town, Thabo Makgoba. These conversations are focused on the key industry in the country, extractives and mining, and they bring together each element of people who find it really difficult to talk to each other—senior politicians, the companies themselves, the trade unions and, essentially, the communities most affected by the activity, either economically or personally. This is an accomplishment model of good, courageous conversations that could not happen in public but can happen with Chatham House rules and appreciation, in particular of the dignity of the person—starting with a relationship and moving on to possibility, opportunity, action and result. There is no quick win, but a deep transformation of relationships through honest speech.
In Birmingham, interfaith conversations have been an essential follow-up to the mechanical mechanisms of Prevent, along with other things that try to resolve extreme differences in our local society. Conversations are bringing together the six main religions—Christians, Muslims, Buddhists, Hindus, Sikhs and people from Judaism—in the same room to listen appropriately and begin to gather the issues that really matter so that we can build up a public discourse and necessary change. The Feast in Birmingham is a youth example of that, with principles of engagement in which friendship is the key. They may seem very obvious: listen to what everyone has to say, do not tell others what they believe, do not force people to agree with your views and so on.
In the Church of England, we have mentioned the difference course. There are also the six pastoral principles, which are really painful, for those of us who are grown up, mature and confident, to be aware of as we face difficult conversations which may end in disagreement. They are: ignorance, power—as has been mentioned—fear, prejudice, silence and hypocrisy. We keep those in mind when trying to face up to disagreeing well on hard-won social issues.
Finally, just to mention another example, the Financial Services Culture Board, in that great industry, is trying to develop a culture of openness and honesty, where whistleblowing is not a necessary and brave thing to do but where issues can be raised easily and functionally so that, in an assessment of progress, we can see a benchmark model of improvement in how good speech and behaviour are improving in an important part of our society.
Noble Lords may be familiar with these principles. I am arguing that the intermediate activity of each individual in their groupings is the only way forward for actually practising these principles, which are enshrined in law. Some of them need to change worldwide, but we need to practise them. I hope those examples will give us encouragement to join in and change ourselves as much as we want to change others. Let us have difficult conversations and take this place for a creative, lively, compassionate and honest use of this precious gift of freedom of speech, for the good of all.
Baroness Stowell of Beeston (Con)
My Lords, it is a great privilege to take part in the most reverend Primate’s annual debate. I think it is the first time I have done so since becoming a Member of your Lordships’ House. In responding to his Motion, I will take a perhaps more practical approach than many others speaking today.
I should start by being absolutely clear that freedom of speech is critical to a healthy society and democracy. Institutions across all sectors must allow all of us to exercise that fundamental right. However, I would be concerned if we felt it necessary to make this a primary purpose for organisations which exist to serve everyone—especially in an age which feels increasingly intolerant and hostile when people disagree. Let me try to explain why.
I start by stating the obvious. Our institutions play a vital role in society. Many are the glue which unites us, so we need them to keep pace with and stay relevant in a modern world. If they have been established for the benefit of everyone more broadly, they need to retain the tacit support of everyone. Those responsible for running these institutions must be respectful of other people’s points of view. To be clear, I mean views which may be different to their personal opinions. That sounds obvious, but too often in practice institutional leaders are not doing it as well or as consistently as they need to. That is often why too many of our very important institutions get embroiled in controversies and why some of them are in jeopardy. Indeed, it is why some people feel that they are contributing to society’s divisions instead of helping us bridge our divides.
For me, our starting point should be demanding that our institutions, which exist to serve everyone, deliver their central purpose in a way that shows they understand and respect the expectations of everyone. In simple terms, that means being open and accountable, taking every legitimate complaint seriously and taking every complainant seriously. These are reasonable expectations in exchange for the support they rely on from taxpayers, customers or consumers, many of whom will have different views or a different perspective on a whole range of things to those who run these institutions. Their difference does not delegitimise them. Indeed, many people whose support institutions rely on will not even have definitive opinions, ready for instant expression, about the root causes of inequality, how best to tell the story of Britain, or even on the exercise and limits of free speech. They just want what they are paying for to meet the standards that they expect and for some of our most important institutions to be an antidote to politics and division, not another front on which to wage a war against political enemies.
I know that those same institutions will say that their dilemma is how to serve everyone in this increasingly complex and fractured world without taking sides, and how to stay relevant and meet the demands of a forever-changing, modern world. The short answer is that there is no easy or quick answer, which is why, understandably, they often find it hard to resist when a new movement or campaign comes along with what seems like a short cut to modernity or easy access to an underserved section of the population that they have a duty to serve. However, any cause that promotes a position as if it is accepted wisdom and what all right-minded people think, when it is a contested matter, needs to be treated with huge caution. When you exist for everyone’s benefit, you cannot jeopardise the support of your old friends in favour of some new ones. You need to think carefully and move slowly.
Our independent institutions, which are so important, need to understand that politics is not just partisan. In fact, they do not get to decide what constitutes “political” in the eyes of the public. Those who object to what they see as the politicisation of institutions are not, as is often alleged, themselves committing a political act. Their concerns need to be taken seriously by the people responsible for those institutions, not just those at the extreme of either side of a political divide or a contentious debate.
It is possible to modernise and bring everyone with you. I am proud to say that the House of Lords demonstrated that when we debated and passed the equal marriage legislation eight years ago. The critical thing we did, which was different to the way in which MPs operated in the House of Commons, was remove the politics and show respect for people who were uncertain about what was proposed. In return for that respect, we were given a hearing to make the case for something new, big and bold. That led to bigger majorities here than in the other place, so we have shown that it is possible to do these things and bring people with us.
I am grateful to the most reverend Primate for securing today’s debate; as I said, it is a real privilege to take part in it. In my view, the best way for our institutions to uphold the principle of free speech is to respect and keep pace with modern public expectations in fulfilling their fundamental purpose and to stay out of all politics.
Baroness D’Souza (CB)
My Lords, we all agree that free speech is one of the most important of our individual rights and, some would argue, the cornerstone of democracy. However, it is increasingly hijacked by social media platforms to spread sensation, hate and disinformation, and by the so-called woke community to prevent views other than its own being expressed. The issue is how to balance much-needed regulation with the protection of free speech.
It is reliably reported that large sums of foreign money were invested in recent US and UK elections, as well as in the EU referendum. In 2019, political parties or leaders in some 45 democratic countries used computer propaganda tools to amass fake voter support, and a further 26 authoritarian states used social networks to control and/or supress public opinion and media freedoms.
Democratic public discourse is threatened by disinformation. It diminishes the quality of democracy by fostering confusion and disbelief. It distorts the electoral process, resulting in electoral instability, and limits the freedom of the individual to make informed choices and exercise their political rights. It encourages dangerous polarisation, making it easy to just tap into one’s preference, and it drowns out opinions that run counter to the prevailing wisdom. It was, after all, John Stuart Mill who said that Victorian liberalism would be destroyed by the conformity imposed by public opinion. We need dissident voices, unpopular views and robust debate but we absolutely do not need vicious trolling, often contributing to loss of employment and immense personal distress.
However, regulation is a tricky area and open to abuse by those who seek to control information. In 2019, a Russia-led and China-backed UN resolution on combating cybercrime by controlling information and supressing political dissidence was passed, despite opposition from several major western powers. Many would, for these reasons, rule out legal restrictions.
There is intense discussion at the moment in the context of the draft Online Safety Bill to find guaranteed safeguards, such as a statutory duty of care on the part of social media companies. It is hoped that self-regulation will itself become a market force as more people turn away from those sites that spread hate and disinformation. It is, perhaps, a vain hope, but it is a hope nevertheless. A proper code of practice on misinformation and annual reports from social media platforms on what content has been removed in other jurisdictions would inform the user about the degree of authoritarianism in other nations. It is also suggested that there be a Joint Committee in Parliament to consider the regulation of the digital environment and proper monitoring of compliance.
However, these mechanisms will prove effective only if the public are actively involved—for example, enabling choice as to which platforms to use, such as those that have verified their identity, or limiting any one platform from being the default search engine on mobile phones. Digital citizenship and media literacy at early school levels, kitemarks for responsible platforms and the sharing of best practice models would together create a culture of much-needed public and individual responsibility.
Finally, civil society has an important role to play. For example, Full Fact—an organisation that will be familiar to many noble Lords—is one of the first of a growing number of independent organisations whose sole purpose is to expose disinformation by forensically examining false claims and political coercion. The US civil society organisation Blackbird has identified a Twitter campaign in the US whose goal is to delegitimise the Democratic Party because of its early warnings on Covid. Increasingly devious mechanisms are constantly being uncovered and Parliaments around the world have a duty to monitor these threats and act, preferably at the international level.
Lord Stevenson of Balmacara (Lab)
My Lords, I thank the most reverend Primate the Archbishop of Canterbury for securing this timeless debate and for his excellent speech. Indeed, it should have been evidence to the Joint Committee on online harms; I hope that he will consider forwarding it to the members, who might well be inspired. I declare an interest as a member of both that committee and the Communications and Digital Committee of your Lordships’ House.
The Joint Committee on the Draft Online Safety Bill agreed its report at 10 o’clock this morning; it will be published next Tuesday. It has been a very good experience, along the lines of what has already been referenced in this debate, in terms of working well together, the collegiate nature of what we were about and the determination, despite the limited time that we were allocated, to report in the best interests of the public. The report is embargoed so I and the noble Baroness, Lady Kidron, who will speak later, cannot quote or anticipate it, but I think that noble Lords will be able to read in what I am about to say one or two of the things that may well appear on Tuesday—do not tell the chair.
The report attempts, I hope successfully, to deal holistically with the issues already raised by several Members of your Lordships’ House on how to protect freedom in the digital world and counteract the adverse impact on freedom of expression that arises from the systemic risks created—and they are created—by the social media companies themselves in pursuit of their business plans. It is true that the online world has revolutionised our lives; the underlying systems, designed to service business models, shape the way in which we experience it.
As the most reverend Primate the Archbishop of Canterbury said, algorithms decide what we see, hear and experience, like it or not. Keeping users online, regardless of what they are looking at, is the true business aim of the companies involved. This can result in amplifying the false over the true, the extreme over the considered and the harmful over the benign. There are of course huge benefits from this brave new world, but there is a human cost, which can sadly be counted in events in Myanmar, in the persistent failure to raise the level of vaccination against Covid-19, in mob violence on Capitol Hill and in children and vulnerable adults being damaged by exposure to illegal content.
Based on the evidence that we saw during the committee’s work, it is my view that, for far too long, online services have argued that they should not be held accountable for the design of their services and that regulation should not be applied to mitigate the risks presented by the content and activity that society has deemed unacceptable. This must change. I hope that our report will start that process. Because of the embargo, I cannot say more, but I am sure the noble Baroness, Lady Kidron, will be able to add a little more for your Lordships’ delectation and delight later in the debate.
I will use the rest of my time to talk about a particular problem related to the world that we are now entering, namely the retention of our records, so that we can learn from the experiences that we are all having online. Noble Lords will be aware of statutory deposit, which has existed in this country since 1662 and is well known. It obliges publishers to place at least one copy of everything that they publish physically in the UK and Ireland, from books to music and maps, at one of the six designated copyright libraries.
When I was director of the British Film Institute, I led a campaign to extend statutory deposit to moving image material, because I believed that that also has a lot to contribute to our knowledge and understanding of the world. As a result—it was only a partial success, I am afraid—we have extensive collections of broadcast television, held in the BFI National Archive at Berkhamsted. The BBC archive is also well maintained and looked after and we should be grateful for that. The situation for film and sound recordings is less satisfactory, as all the material in the collections is deposited on a voluntary basis and the collections are therefore not complete.
In 2013, the Government introduced new regulations that required digital publications to be systematically preserved. Since then, the six designated copyright libraries have automatically collected UK websites at least once a year to gather a snapshot of what they contain. Some important websites, such as news sites, are collected daily. They also collect e-books, electronic journals and videos, so we have a good collection of this material, but it is a tiny fraction of the material that we all know is available on the internet. You cannot base knowledge and research, or indeed future policy, on snapshots.
Access to this material is extremely limited: historic pages for only 19,000 or so websites can be accessed through the UK Web Archive’s online portals, in person at the copyright libraries and only after explicit permission has been granted by the creators to allow access—if they can be traced. The framework also permits only one researcher to use a piece of material at any one time, which is surely a rather otiose limitation when talking about digital materials.
When he comes to respond, I hope that the Minister will accept that there is an issue here that needs further investigation and that action will be needed to ensure that the record of the internet and the impact that it undeniably has on all our lives, for good or ill, is not being ignored in the process of learning from it. I would be happy to meet him to discuss this point if he thinks that that would be helpful.
Lord Walney (CB)
My Lords, it is a privilege to follow the noble Lord, Lord Stevenson. I greatly anticipate the report that his committee is due to publish next week on the critically important area of regulation of the internet. It is of great interest, as he will understand, in relation to the report that I am writing for publication in the new year in my capacity as the Government’s independent adviser on political violence and disruption, looking at the far right, the anti-democratic far left and single-issue groups, as well as the scale of the threat that they pose and measures leading into that. It is clear that freedom of speech and the ways in which the internet can be used or misused are of significant importance to that.
I was struck by the Roger Scruton Memorial Lecture given by Lord Sumption just last month, which examined at length the issue of freedom of speech. He made the point, which has also been eloquently expounded in many of the contributions today, about the importance of freedom of speech to the proper functioning of our liberal democracy. This is not simply freedom of speech as an abstract concept, but the need to enable, allow and tolerate a breadth of opinions within it, to ensure that our liberal democracy can remain resilient, so that we are not simply a country that has elections every few years but one that has the underpinning of understanding, tolerance and an ability to move that actually makes a country a democracy.
I feel a little self-conscious talking about a secular crisis of faith in front of the most reverend Primate the Archbishop of Canterbury and probably the most revered Anglican audience that it is possible to have, but I hope that he and they will indulge me, because I feel that this is relevant. I spent most of my life as a progressive, new Labour youngster activist and then a Front-Bench Member of Parliament and am now here on the Cross Benches. In most of my time growing up, I thought that I had a sort of Enlightenment view on equalities, with the idea that there were progressive opinions that were good and conservative opinions that were bad and that there would be an onward march of progressive legislation and culture change that would lead to ever-increasing benefits to humankind. In that context, if anyone had engaged me and my fellow new Labour acolytes on the idea of freedom of speech, we would not have had a great deal of interest in it. In fact, we would have spent more time engaging in no-platforming demonstrations for reprehensible people who we thought should not be given a platform in particular places.
The clash of rights, if I can call it that—I realise that that in itself is a highly contested way of describing this—between people with different views on rights related to biological sex compared to gender has profoundly shaken my faith in this sense of an ever-expanding sense of right as opposed to a clear sense of wrong. I am pleased that my noble friend Lady Falkner mentioned the plight of Professor Kathleen Stock. I add that the way in which the author JK Rowling is being pursued, with attempts to silence her, should profoundly concern us. It plays directly into this idea that we need a breadth of opinion to be able to make changes and decide where we want to go as a society.
It is sometimes seen as heretical or an abusive thing to say if one points out that many of the campaigners who now wish to place the views expressed by the likes of Kathleen Stock and JK Rowling as outside acceptability held views of that same kind 10 or 20 years ago. That is not to say that they were wrong then and right now, or right then and wrong now, but that you need that breadth of opinion to be able to understand where we want to go. I feel that that is being profoundly questioned now by people who are doing so for the best of intentions but who may well do significant damage to our democracy in doing so.
Turning to the partly related issue of online safety, one of the reasons I am seeking guidance from the committee and others is the profound tension regarding who, if anyone, should regulate the debate. It is potentially as problematic for a Government to regulate what should be within those bounds as it is for a very narrow group of people within Facebook. If you reject both those things, you are still left with the problem of where the boundaries should be, what the level of regulation should be and how you go about reaching an understanding.
I was really pleased to hear the noble Baroness, Lady D’Souza, talk so compellingly about disinformation. I feel that too often, we put together hate speech, misinformation and disinformation. However, I hope that a greater focus from government and the state on who is perpetrating disinformation—which countries and organisations—could unite all of us in what is otherwise a profoundly contested debate over where the boundaries of freedom of speech ought to lie.
Baroness McIntosh of Pickering (Con)
It is a great pleasure to follow the noble Lord, Lord Walney, and I add my congratulations to the most reverend Primate on leading us in this debate today. He eloquently referred to the role of democracy; I would add to that the rule of law. Clearly, during times of war, freedom of speech, democracy and the rule of law are simply swept aside.
My mother was born in Copenhagen, Denmark, in 1920 and lived through German occupation of her country during the Second World War. Many will have heard of Kaj Munk, who was a Danish pastor, a writer and a leading playwright. Through his writings and speeches, Kaj Munk became a symbol of the Danish resistance movement. That led to his assassination by the Nazis in January 1944. Listening to my family and hearing their experiences made me appreciate how Europe came together after the war and how both NATO and, I would argue, the European Union have protected our fundamental freedoms, including the freedom of speech, since that time. At no time has it been more important for us to continue to work with our NATO and European partners, both for our own safety and to ensure the freedom of speech of others. I think at this time of the people of Ukraine, Poland and other parts of Europe, who feel threatened by the active, aggressive presence of Russian troops.
I had the privilege to sit on the Rural Affairs Group of the Church of England under the excellent leadership of the right reverend Prelate the Bishop of Exeter. I pay tribute to the role of the Church in rural communities. At no time was that seen to be more effective then when, during the foot and mouth outbreak of 2001, the then most reverend Primate the Archbishop of York pleaded with the then Prime Minister for a delay to the general election so that those living in the countryside, such as isolated farmers, could exercise their democratic right to vote. I greatly value the work of the Church and in particular the Rural Affairs Group. I make a plea to the right reverend Prelate today to ensure that rural affairs continue to hold a special place in the Church of England. Even though the rural affairs committee may be wound up, I am very conscious of the dwindling numbers, particularly in parochial councils and fundraising.
Sadly, the church where I grew up, attended Sunday school and where my husband and I were married has closed owing to rot and the floor having to be removed. It is a matter of great sadness to me that St Mary the Virgin in Middleton-in-Teesdale, County Durham—it is close to Barnard Castle, which now always gets a laugh because it is so well known in political circles—will most likely never reopen as a church but will become a heritage centre to educate people on the importance of the church and farming life in the countryside. However, I hope that it will continue to be used as a place of prayer going forward.
Finally, I would like to consider the role of social media and online harms, particularly the dangers and risks that they pose for children and young people. I was particularly grateful to the noble Lord, Lord Stevenson of Balmacara, for talking about the work that the committee has been doing, and we look forward to reading its report, which is hot off the press. I hope that the Proof of Age Standards Scheme, whose board I chair, can play its part, particularly in developing a digital standard for proof of age going forward to ensure that children and young people can access the internet safely. As the most reverend Primate put it, balancing privacy and freedom of speech—to which I would add safety of access—has proved to be one of the most difficult contemporary challenges we face.
I congratulate the most reverend Primate the Archbishop of Canterbury on introducing today’s debate. Given the contemporary challenges to freedom of speech that he so eloquently addressed, at no time could this be more appropriate. Each of us in your Lordships’ House has a part to play, starting with the oath we take on being introduced to this House, when we are given a voice to speak up on behalf of others. It is incumbent on each of us to use that voice wisely and to speak up on behalf of those who have no voice in Parliament or our counsels and assemblies. I welcome this debate and the opportunity for us to consider the contemporary challenges to freedom of speech, and I look forward to hearing the rest of the contributions today.
Lord Harries of Pentregarth (CB)
I thank the most reverend Primate most warmly for initiating this debate and for his truly excellent speech.
Truth matters, and we are truth-seeking animals. To give up on truth and to take the view that one opinion is simply as good as another is not so much to sell our human birthright for a mess of pottage as simply to throw it away. When I was growing up as a child, to tell a lie was the worst crime you could commit. You might do something wrong but if you admitted it and did not lie about it, all could come right. You simply did not lie. How does that obligation to tell the truth stand in our society now, I wonder? Does it still stand strong? I am glad it is still a crime to lie in court, and a punishable offence to lie to Parliament.
I mention this because the primacy of truth provides the moral background for our debate today. Freedom of speech matters because truth matters, and we are truth-seeking animals. Of course, people have different perspectives and they weigh facts differently. Above all, some speak from a position of power; others from one of extreme vulnerability. How right the most reverend Primate was to remind us that we should not enter into any of these debates without an acute sensitivity to the relative power relations of the people who are engaging in them. But, that said, the objective of any disagreement or debate must be to get at, or at least closer to, the truth, and we do this by rational debate.
After all, there are only two alternatives: to go on trying to resolve difference by rational discussion, or to impose one’s view by force. That is of course the policy of vast numbers of countries around the world where there is no or very limited freedom of speech. But we claim to be a democracy in which freedom of speech is fundamental. If this is so, it has to characterise all our institutions, especially our universities.
However, before getting on to that, I pay tribute to those reporters in the media who are committed to discovering and reporting the truth. At what is now the main entrance to the BBC in London is a statue of George Orwell, with his words inscribed on it:
“If liberty means anything at all, it means the right to tell people what they do not want to hear”—
and this of course especially means telling Governments what they do not want to hear, speaking truth to power. This can come at a price. On the altar of the church of St Bride’s in Fleet Street are the names and photos of all those reporters who in recent years have done this at the cost of their lives. There are scores of them.
Returning now to debates in universities and other institutions, we have to accept that a view might be legal but still hurtful for someone to hear it. It is fundamental to good debate to recognise that some people are very vulnerable and can, understandably, be hurt. This is obviously the case with people who are in the process of changing or have already changed their gender. They are vulnerable and need to be treated with respect and sensitivity. Nevertheless, there is a real and serious debate here between feminists about the social and political implications of someone being transgender, and it needs to be heard.
The way JK Rowling was treated for expressing one side of this debate was quite disgraceful. The way Professor Kathleen Stock was treated at Sussex University is even more shaming, for universities, above all, should be places where the truth is sought by rational discussion. I do not do social media—perhaps I am not brave enough—but Rowan Atkinson has described cancel culture on social media as a place where a medieval mob is
“roaming the streets looking for someone to burn”.
On this issue we have to be aware not only of organised lobbying and campaign groups but of some foreign countries that are interfering in academic discussion in this country. I read recently of an academic conference on what is happening now in India, which is of course very serious. Pressure was put on some academics to withdraw their names from speaking at the conference—which, sadly, they did.
The law is quite right to forbid any kind of stirring-up of hatred because of a person’s race, religion, gender or sexuality. But if an opinion, however disagreeable and however wrong, does not do this, it has to be heard and combated only by rational means. For example, I have long supported gay rights and argued that the Church should have accepted permanent, stable, loving relationships and offered a service of blessing. But I accept that a conservative evangelical can still treat someone who is gay with respect and sensitivity while holding views that are mistaken and hurtful. Their views are hurtful to gay and lesbian people, but it is as wrong to label such people as in principle “homophobic” as it is to label others “transphobic”. There is hurt, but it still has to be resolved by argument, not by ostracism and no-platforming.
This is a serious issue, absolutely fundamental to true democracy, and right at the heart of what we are as human beings: rational, truth-seeking animals. We need to get at the truth by free discussion, to uphold freedom of speech in universities and society as a whole. In recent years, it has been seriously under threat.
The Lord Bishop of Oxford
My Lords, it is a great privilege and honour, as always, to follow the noble and right reverend Lord, Lord Harries, one of my distinguished predecessors. I am grateful for this timely debate and to the most reverend Primate for his very comprehensive introduction. In a few days’ time, as we have heard, the scrutiny committee of both Houses will publish its report on the online safety legislation: a potentially vital web of provisions to prevent harm to individuals and, I hope, to society.
The debate around the online safety Bill will raise questions of principle about freedom of speech, and I very much support the most reverend Primate’s case that the free exchange of ideas is a keystone of our society and democracy. In many areas, as we have heard, those freedoms need a more robust defence. In others, the rights of the most vulnerable need protection from harm.
According to Proverbs 15, verse 1:
“A gentle tongue is a tree of life, but perverseness in it breaks the spirit.”
Words can be an immense blessing but, when amplified through social media, also weapons of mass destruction to people and societies. Consequently, as a society, we will need wisdom to discriminate and to make judgments about the limits and boundaries of our freedoms in the light of these new technologies, and this debate in the coming months must avoid lapsing into hollow slogans on either side.
We have seen the rapid evolution and spread of social media over less than 20 years. Regulators have struggled to keep up, or even to reach the starting line. The big tech companies at present largely set their own rules and evaluate their own compliance.
I have learned that the development of ethical guidance for new technologies is not about the invention of new moral codes or principles. It is largely about the sensible translation and application of existing moral standards to the online world, especially in the protection of children, minorities and the most vulnerable. Freedom of speech is indeed to be preserved, but it, too, must be subject, online as offline, to a yet higher law of civility and mutuality. The UK Government have decades of experience in regulating broadcast content around these tensions, and it is this experience which must now be applied to new technologies.
It must be right, therefore, that major corporations which act as publishers of potentially harmful content should have a duty of care both to individuals and to society. A greater share of the immense profits realised in advertising needs to be ploughed back into protection of the vulnerable. Algorithms must be subject to scrutiny, especially when they are shown to amplify hatred and to target those already at risk. There must be robust protection for the young through careful age verification, which is urgently needed.
Anger, hatred and vitriol are all around us because the social media companies have discovered that this is where the greatest profits lie. It would be perfectly possible for social media to bring to the top of our feed stories of faith, hope and love rather than of cruelty and venom. Honest argument and exchange of ideas is one thing, but, at present, opaque microtargeting sold to the highest bidder distorts the societal context of freedom, challenging the very nature of democracy.
A century ago, the British Government took the significant step of establishing the British Broadcasting Corporation in the face of rapidly developing new technology—then, radio. The BBC was founded in an intermediate space: on a strong ethic of public service, including freedom of speech and independence of governance. Public service broadcasting has provided a model of best practice in these debates, alongside the work of regulators.
Is it possible to imagine a similar public service provider for the 21st century, search engines free of advertising, social networking freed from the blind pursuit of profit, messaging services which do not mine our data—and all protecting the rights of the child? Perhaps the Minister could indicate in his reply whether the Government might be willing to explore this kind of radical intervention—social media in public service—in this vital area.
The existing tech sector is urgently in need of both new regulation and a wise regulator, new rules which will enable all to enjoy the benefits of technology without the dangers and, I hope, a new and match-fit regulator in Ofcom. It will be essential that Ofcom itself pays careful attention to gathering wisdom and to the ethical formation of its board and senior team.
We need a public debate on online safety that extends far beyond this Parliament, but I also hope that, as we consider the proposals that will be published in the coming days, we in this Chamber avoid a lazy caricature that uses freedom of speech as some kind of trump card to dissipate all regulation. Instead, I hope and pray that we will, through reason and argument, seek to balance the preservation of those freedoms with robust regulation and a wise and independent regulator.
Baroness Jenkin of Kennington (Con)
My Lords, the past year or so has seen a troubling increase in intolerance and the so-called cancel culture. Many of us have been, at best, naive about what is happening at universities and among activist groups. A number of recent cases have focused on attempting to silence those who are gender-critical or biological realists. Many of them are women, from MPs Rosie Duffield and Joanna Cherry to academics Raquel Rosario Sánchez and Professor Jo Phoenix, barrister Allison Bailey and tax expert Maya Forstater, all forced to take legal action to protect their reputations and livelihoods. They also include artists, such as Jess de Wahls; only this week, dancer Rosie Kay was forced out of the charity that she set up for daring to express her view that biological sex is real.
These women have been intimidated, harassed and bullied for simply expressing opinions that everyone once took for granted: that women are adult human females, and that biological sex matters. Professor Kathleen Stock has been hounded out of her job at Sussex University for her belief that biological sex is binary and immutable—a belief that I would call a scientific fact and a fact of life. Professor Stock was accused of making trans people feel unsafe. Why should scientific facts make anyone feel unsafe?
Trans people do not all think alike. What about those who agree with Professor Stock, such as Dr Debbie Hayton? How do they feel? Debbie Hayton is a transsexual who transitioned in 2012. She has written extensively in the press, and I find her perspective rather refreshing. She has defended Professor Stock and written in support of JK Rowling. She has little time for what she calls “gender identity ideology”. Her views could be summarised in a line from one of her own articles: that
“gender identity is bollocks; you either have them or you don’t.”
It is fair to say that Hayton divides opinion with such views, but should she not have the right to express them? No, according to what she called the “transgender thought police”. She may have a point but, while they may police thoughts, they are not necessarily transgender themselves. They use transgender rights to attack and cancel others.
You do not need to search too far on social media to observe the hate directed at Hayton, presumably for being the wrong sort of trans person:
“Lord Haw-Haw Hayton, the quisling wannabe … Debbie Hayton is a monster, a completely twisted human being”.
Sadly, such abuse is all too frequent, as are death threats. She gets those too:
“Debbie Hayton is a traitor to her community and should be afforded the proper respect as such.”
That tweet continued with images of three large knives. However, while her attackers hide behind anonymous profiles, Hayton campaigns under her own name. She is a science teacher, and it is not difficult to identify the school where she teaches. She is therefore vulnerable to being cancelled, not only on social media but in her employment. The chatter on Twitter shows that pressure is being applied:
“It amazes me that Hayton’s employer still employs her in any capacity in education and that the relevant anti-terrorist policing department hasn’t acted.”
Someone else then added:
“They’re as transphobic as she is. I’ve tried to complain a few times, they just said, ‘She’s just concerned.’”
Earlier this year, Hayton added her name to a letter criticising the decision by the Women’s Prize for Fiction to longlist a book written by a trans woman. One of her opponents tweeted the school where she teaches directly:
“How do you continue to endorse Debbie Hayton when she is happy to sign a truly transphobic letter? Your continued support for her is transphobia.”
I commend Hayton’s courage for being prepared to say what she thinks. I also praise her school for standing firm.
In many cases, employers have responded to such criticism rather differently. When we ask ourselves why more people—and, indeed, more trans people—do not speak out in support of those such as JK Rowling and Kathleen Stock and defend the rights of women, maybe we have an answer. Campaigning might be part and parcel of a democratic society, but it rarely pays the bills or puts food on the table. This debate is not a dispute between women on one side and trans people on the other. Stock and Hayton appear to be on the same side, and are both attacked for making rational arguments. It is not just abuse on social media, as if that were not bad enough. Their freedom of speech is threatened in part because their livelihoods are threatened. That is wrong. Professor Stock was hounded out of her job at Sussex University. Hayton hangs on to hers, but what are we doing as a society to protect their right to speak and not be punished for it?
Criticism of gender identity ideology is not an attack on trans people. It is not transphobic to support women’s rights. Trans people such as Debbie Hayton make this very clear. Hayton has described it as an authoritarian, quasi-religious cult—one where you must believe or be thrown out. As she rightly points out, I am an apostate. We must do better for Dr Hayton, Professor Stock and anyone willing to stand against an ideology. The rights of women and the safeguarding of children may depend on it.
Lord Brown of Eaton-under-Heywood (CB)
My Lords, as a Jew, albeit a non-believer, I am not insensible to the sensitivities of mankind, by which I mean humankind. At school in the early 1950s, it would have been surprising, as a Jewish boy, never to have been referred to as a “Yid”. Occasionally—rarely—one was but, generally, such a term was used entirely carelessly, not with any malice or hostility, and one was inclined to ignore it rather than allow it to interfere with established relationships and friendships.
Later in life, it became impossible simply to ignore an anti-Semitic remark, however obviously unmalicious. Because I do not look obviously Jewish, apparently, when recognising that a particular conversation might be heading in that direction, my habit has been to pre-empt such a remark by at once pointing out that I am Jewish and the speaker therefore better be careful about what he is going to say. I do this to save him the embarrassment of having to apologise and explain rather than to save myself from unintended offence. The plain fact is that most such ostensibly prejudiced remarks are not offensively intended but are the result of thoughtless, careless habit.
Of course, we should all strive to correct our ways, but some—the stupider and, let us face it, often the more elderly—are less corrigible than others. There seems today to be a growing tension, often apparently intergenerational, between those ever ready to identify themselves or others as victims and those who insist, no doubt carelessly, on invoking their general right to freedom of speech and expression. Most of my generation is deeply distrustful of wokeness. However, as was tellingly pointed out in a recent letter to the Times from the headmistress of Benenden, woke is merely a shorthand to describe those who are awake to the principles of social justice. Which of us would not wish to be woke in that sense? If you broaden out the debate to include, for example, such sensitive and challenging issues as the tension between trans rights and feminist rights, discussed already this morning, and, more fundamentally, the tension between freedom of expression and freedom from the expression of discomforting views, the way ahead sometimes becomes less clear.
In the context of free speech, we all know—and I need not repeat—Voltaire’s celebrated aphorism. However, today, there appear to be those among us who would invert it. Their attitude is this: “I agree entirely with all that you say, but I will fight to the death to prevent your saying it”.
My essential point is this: let us try to take thoughtless unintended insensitivity in our stride. Those inclined to take offence should be more resilient and refrain from demonising those whom, we feel, could and should be more sensitive to the sensibilities of others. Where possible, save them embarrassment. Eschew, rather than assert, victim status. Try to pre-empt rather than await unintended insult. Whenever a clash is threatened between freedom of speech and freedom from possibly hurtful speech, start with at least a partial affection for freedom of speech.
In the context of the PCSC Bill now before the House on Report, do not enlarge the scope of hate crime to include misogyny. Obviously that is a very different kettle of fish from encouraging violence by incels but, generally, do not go out of one’s way to emphasise hate speech. Another part of the Bill deals with registering it even when it is not in the context of a crime.
In short, what we need today is more sense and less sensibility. I am sure Jane Austen would agree.
Lord Faulks (Non-Afl)
My Lords, it is a great pleasure to follow the extremely woke noble and learned Lord, Lord Brown of Eaton-under-Heywood. Free speech is extremely important to all of us. I declare a particular interest as chair of the Independent Press Standards Organisation, which regulates the vast majority of what I might call the traditional printed press and its online manifestations. As an independent regulator, I am careful not to give my opinions on the issues of the day too often, for fear that this might be perceived as showing a lack of independence.
We in IPSO are lucky enough to have a very good communications department, which always advises me against offering my views if at all possible—wise advice, I am sure. This week, I said to our head of communications that I was planning to speak in a debate on free speech. A worried look crossed her face and she said to me, “You’ll have to be very careful what you say”. I decided to reject her advice but I will not speak about the important matters raised by the noble Baroness, Lady Jenkin, such as free speech in universities, the balance in the Human Rights Act between freedom of speech and Article 8 or the difficult issues with which the Law Commission has had to grapple. Rather, I will focus on the important role of journalism of what one might call the traditional sort.
The low point of the reputation of our press—it has had plenty of low points—was probably the practices that led to the Leveson report. Better regulation was one of the main takeaways from Leveson and the threat of state regulation of the press hovered, which worried most of us profoundly. More than seven years have passed, and the threats to the traditional press have altered. I hope that press regulation has become better; judging by the volume of complaints that IPSO receives, it is better understood by those who wish to complain. Newspapers are, on the whole, much better behaved.
Covid presented a real challenge to everyone, not least the newspaper industry. It has just about survived, so far, but there was a major decline in advertising revenue and circulation. Newspapers had to cope with the real challenge of what was truthful and accurate in reporting about Covid. IPSO has just published a report based on its analysis of how the press performed and responded to various complaints. It shows the press in an extremely good light and emphasises the value of good journalism.
The real threat to the traditional press, and thus to free speech, comes from social media, mentioned by so many noble Lords. I entirely accept the most reverend Primate’s observation that it has provided a voice for those who do not often have one but, too often, it is unaccountable, often defamatory, recklessly damaging to reputation and damaging to the interests of vulnerable members of society. Too many of us were initially enthralled by social media, I fear. Compare the position of the traditional press, which is curated and regulated—I hasten to add that newspapers are not always happy with the decisions of the regulator—with that of social media, where news is often stolen from other sources, including local news, which is an important and dwindling asset. Editing is based on algorithms geared not necessarily to establish truth or accuracy but for commercial ends.
The Online Safety Bill has a lot of heavy lifting to do in this regard. It is innovative and will not be perfect, but I am excited to read what the committee has suggested. In the course of considering the very laudable aims of this Bill, we should not let perfect be the enemy of good. This could witness a real sea change in the attitude to freedom of speech through the media.
Of course, freedom of speech has never been an absolute. It is what my lecturers at university used to call a residual right, but there have even been challenges to what the first amendment of the United States constitution means. As pointed out by the noble and right reverend Lord, Lord Harries, traditional journalism can involve enormous risks to journalists, not just in reporting from conflict areas but in speaking out against dictatorial regimes. However, it is a central part of what we regard as valuable democratic values. Therefore, let us respect the interests of free speech served by journalists doing their job in a situation where they are properly regulated and accountable. It is a valuable contribution that we should not lose sight of.
Lord Kirkham (Con)
My Lords, I heartily thank the most reverend Primate the Archbishop of Canterbury for today’s debate and for reminding us that free speech is fundamental to a just and generous society. Indeed, he said that it is the only means for a just and generous society. Clearly, freedom of speech is precious and should be protected.
Freedom of speech is protected by parliamentary privilege within these walls but, everywhere else in our country, it seems to be under unprecedented threat. How can it be right, as we heard from my noble friend Lady Jenkin, that senior academics are being hounded out of their jobs and prominent authors cancelled because of their views on biological sex? Speakers are “no-platformed” by universities because they may offer a view challenging the currently fashionable, progressive consensus. People are deprived of their livelihoods, without warning or notice, because they tried to tell a joke. I doubt that there is a more challenged profession in the UK in 2021 than that of the comedian, whether amateur or professional.
Unquestionably, every citizen in this country has the absolute right not to be victimised or abused for their race, religion, gender, appearance or way of life, but no one has the right not to be offended by someone else’s expression of their views or by their sense of humour, unless what they say is specifically prohibited by law. Very often we find that offence is taken vicariously by those anxious to protect the feelings of what they perceive to be sensitive minority groups. I and I am sure many of you know Muslim, Hindu and Jewish families and those of other faiths who celebrate Christmas with just as much enthusiasm as their Christian neighbours, who cannot begin to understand why some wish to remove references to Christmas out of concern for their imagined feelings, and who most certainly do not regard people of other faiths and traditions joining in the celebrations of their own feasts and holy days as unwelcome cultural appropriation.
We have not merely bent over backwards to avoid giving offence, but contorted ourselves into an almost unbelievable mess by feeling we have to pause and think before we utter even the most commonplace phrase or saying. Will I upset someone in my audience if I kick off my after-dinner speech with the traditional words, “Ladies and gentlemen”? Indeed, what, in 2021, is an acceptable alternative? Should I add my preferred pronouns to my correspondence, even though I have yet to meet anyone doing this who does not prefer the pronoun I would instinctively have chosen for myself? Am I committing a microaggression if I mispronounce a name or raise my eyebrows when someone else is speaking?
I do not use social media, which is probably just as well, but in this context I can see the sense of inserting a personal filter and pausing to think before joining a debate—of asking myself whether what I propose to say is compliant with the law and whether any offence I might give was justified by the strength of my argument. Too few people do this, not only because they are so utterly convinced of their absolute right to free speech but because in many places they are protected by anonymity. It is far too easy to post cruel and hurtful things under the shelter of an anonymous Twitter handle that the poster would surely hesitate to say face to face, or indeed online under their own name.
In my business life, every statement made to the public via the stock exchange was carefully checked by lawyers to ensure that it was true. That is the norm. Newspapers similarly take great care to ensure that anything that might put them at risk of a libel action is similarly checked and found to be legally watertight before the presses roll. There is no such check or restraint on social media, and the quality of our discourse as a society has become cruder and crueller as a result.
Even so, the list of the things we are not allowed to say in public, or indeed in private, should be kept as short as possible. Of course no one should have the right to incite war, stir up racial hatred or persecute minorities, but equally no one should have the right to absolute protection from being offended, particularly by a joke. In an ideal world we should all be kinder to each other, with that kindness extended to understanding the challenges of the older generation, who so often struggle to keep up with the words they have used all their lives suddenly becoming offensive. If we can only apply common sense and resist the zealots on both sides of the argument, we can defend, guard and protect free speech in a way that allows all of us to enjoy the civilised conversations and healthy debate that are at the heart of any worthwhile human society.
Lord Cashman (Non-Afl)
My Lords, as a member of a minority, I am particularly pleased to follow the noble Lord, Lord Kirkham. This is an extremely important debate that strikes at the very heart of the kind of country and society we are. I will introduce my personal point of view.
Recently in your Lordships’ House, we discussed freedom of speech and expression during Questions. I was particularly struck by something the noble Lord, Lord Cormack, mentioned, which was a reflection in relation to Salem. He was, of course, referring to the witch trials of Salem. As someone who is trans inclusive and has continually defended the rights of trans people to become themselves, defending trans men, trans teenagers and trans women in particular, I too have felt that it is like Salem. I will not regale your Lordships with some of the unpleasant accusations levelled against me because I have dared to defend and support trans people and their right to be themselves—their right to be treated equally. But I have noticed that the attacks on those of us who support trans equality have been particularly nasty. Organisations and institutions that defend trans equality have equally been targeted and attacked.
Individuals who voice pro-trans views in the public sphere are frequently attacked by those who wish to silence them. On social media every day, people who advance reasonable views in support of trans people are often harassed in the most vicious ways. Organisations that support trans people and their families and others that support wider equality, including trans inclusion—organisations such as the Girl Guides; Mind, the mental health charity; and the National Trust—are all attacked and piled on to because they support LGBT+ equality.
So yes, I agree that it feels like Salem. I want all sides and those in the middle to be recognised as suffering for what we believe, but it should not have to be like this. Just because I have an opinion does not make me right and it does not make me wrong. I have an opinion on this issue based in principle and in law, and in the defence and promotion of equality.
The absence of trans voices from this debate has not helped matters, but can one honestly wonder why trans people have hesitated before engaging? The defamation, stigmatisation and misrepresentation of trans people—trans women in particular—and the depiction of them as a threat are deeply toxic and place them in dangerous territory. Fears about trans people have been whipped up, often without a shred of evidence, in your Lordships’ House and the other place, and by a biased and partisan media eager to grab controversy. This helps no one—certainly not the vulnerable, nor those in fear of what they are told might happen to them. This misrepresentation diminishes every single one of us.
We are not helped when the media and members of the Government indulge in and stoke up so-called culture wars. None of us is helped by this, because what I do know is that when the rights of one minority are diminished it is not long before the rights of other minorities are attacked and diminished. The history of the 1930s so painfully reminds us that we must speak out. We must have the courage to stand in the shoes of the others.
That includes standing in the shoes of those who feel that they are threatened. So I stand in the shoes of that trans woman and I imagine what it must be like to be her—to face the misrepresentation, defamation and dehumanisation reported in the media, regurgitated in bars and whispered on the streets as she walks along them. I wonder what it must be like to live with that kind of hatred daily. I stand in her shoes and I know that I would not want it to happen to me, and if I would not want it to happen to me, how dare I allow it to happen to others? Therefore I will not be silent, which would be easy in such a heated and whipped-up moral panic, and I will not acquiesce. I want my voice and the voices of others to be respectfully heard.
Of course we must take note of the contemporary challenges to freedom of speech but, importantly, we must also recognise our own individual responsibility in recognising and exercising the right to freedom of speech in ways that promote the freedom for us all to live our lives without fear. Freedom of expression is without question the lifeblood of a democratic society and, because of this, the right to freedom of expression, as our own human rights law recognises, comes with duties and responsibilities.
This means that we should never use freedom of expression to extinguish the freedoms of others, especially those so often unseen, misrepresented and shamefully unheard. The Constitutional Court of South Africa recently reminded us that speech is powerful:
“it has the ability to build, promote and nurture, but it can also denigrate, humiliate and destroy.”
That court eloquently reminded us that hate speech is
“the antithesis of the values envisaged by the right to free speech—whereas the latter advances democracy, hate speech is destructive of democracy.”
For this reason, I am very pleased that this week the Law Commission made recommendations to strengthen the protection of trans people from the hatred that they are too exposed to. I end by reiterating that we all have a responsibility to exercise our cherished right to freedom of expression in ways that promote and do not diminish equality. Equality threatens no one. The rights of one reinforce the other.
Baroness Sanderson of Welton (Con)
My Lords, it is a pleasure to follow the noble Lord, Lord Cashman. I, too, thank the most reverend Primate for tabling today’s debate. As we have heard, the threats to freedom of speech in today’s world come in many and varied forms. I shall speak about the challenges in one area, and that is literature.
I was prompted to do so after reading an interview recently with Dame Rose Tremain, one of our best and best-loved writers, who has said that she is not sure whether she will write another novel. This is not because of her age—I hope she will not mind me saying that she is now in her eighth decade—nor is it because of her health. Indeed, this is a woman who refused chemotherapy after being diagnosed with pancreatic cancer because it could have damaged the feeling in her hands which could have left her unable to write. Yet now, here she is, a couple of years on from that diagnosis, with one further novel under her belt but unsure whether she will ever write again because of the climate we have somehow found ourselves in, a climate which not only threatens our freedom of speech but in this instance, it seems, our freedom of thought and imagination as well.
Dame Rose is a writer famous for inhabiting various different characters from a transgender man to a European immigrant, books that arguably she would struggle to have published nowadays because now, as she says:
“There’s a whole debate about … whether we’re just constrained to write about ourselves ... Supposing Dickens had only written about himself … I feel a bit stuck as to what I can be allowed to write. What pathway can I take? How can writers like me, who have always gone elsewhere, find the next subject? I keep searching in my mind … and thinking, ‘No, that won’t do, that won’t do.’ So whether I’ll find anything to write about is, I think, now a moot point.”
Noble Lords heard her—she said
“what I can be allowed to write.”
So who decides that? The publishers would argue that, ultimately, the market decides although, as we know, it is not that simple anymore. Once again, in this, as in so many other areas of life, we come back to social media. I, too, agree with the most reverend Primate’s point about those previously unheard, but we must also take account of the damage done when storms are whipped up and reputations torn to shreds in in just a matter of hours. When American Dirt, a best-selling novel by Jeanine Cummins, was deemed racist by the online mob, reviewers felt compelled to back-track on their earlier praise, while the author’s tours had to be cancelled after threats of serious violence.
Rachel Rooney, a successful children’s author, has said that her career is now over after she dared to write a book, My Body is Me!, helping children to understand and accept themselves rather than simply assuming they have been trapped in the wrong body. Such is the vicious nature of the current debate on this issue, as we have heard across this House today, that Rooney was accused of promoting terrorist propaganda and, after two years of online smears, has effectively been drummed out of publishing. Perhaps it should not come as a surprise that Sir Kazuo Ishiguro has warned that young writers are now self-censoring and less willing to take risks because they want to avoid being targeted by online lynch mobs.
Others will argue that this is simply the old guard failing to catch up with the prevailing ethics of the current generation, but I do not agree. We should worry about the real-life consequences of this online intimidation. As David Shelley, CEO of Hachette, told our own Communications and Digital Select Committee:
“I have not seen an instance of so-called cancel culture or people getting exercised by anything that has not originated from Twitter, Instagram or one of a few big tech platforms.”
What to do in upholding freedom of speech in this context? Personally, I do not think the answer lies in sensitivity readers, a phenomenon popular in the US and now over here, whereby people vet manuscripts for problematic language or stereotypes. It definitely does not lie in an older generation of writers feeling forced into hanging up their boots. Surely the answer, at least for the industry, lies in seeking out wider views and more authors from diverse backgrounds. Change is happening—not quickly enough, but at least it is going in the right direction. Certainly, some of the best novels I have read in recent years have come from newer voices; they have enriched and improved my understanding of the world. Surely, that is what literature is for.
Sir Kazuo Ishiguro also said, this time in his Nobel speech:
“Good writing and good reading will break down barriers.”
As the most reverend Primate the Archbishop of Canterbury says, it should help us to disagree well. In my view, it should certainly encourage greater empathy, not lead to immovable judgment. That is why I want to read Kiley Reid and Kamila Shamsie—but I also very much hope to read a new novel by Rose Tremain.
Baroness Kidron (CB)
My Lords, as a young child I had an operation that meant I was unable to speak for a year. I arrived at secondary school, aged 11, complete with a horn to attract attention, like Harpo Marx, and attached to my waist a pen and paper on which I could ask or answer questions. It was embarrassing, alienating and occasionally hilarious, but from my silence I noticed who spoke, who listened and who got ignored. Even at that young age, I understood that having a voice requires the circumstances in which to be heard, as well as the freedom to speak.
I declare my interests as set out in the register, particular as chair of 5Rights Foundation and a member of the Joint Committee on the Draft Online Safety Bill. I am really sorry if I disappoint noble Lords by failing to offer spoilers; I am far too frightened of the chair, Damian Collins MP. I hope my words speak to the urgency of our recommendations.
Earlier this year, the Center for Countering Digital Hate found that just 12 accounts were responsible for 65% of Covid misinformation across 800,000 posts subsequently seen by 59 million people. In 2016, a Facebook internal review found that 64% of people who joined an extremist group did so only because the company’s algorithm recommended it. This year thousands of people, including many children, have undertaken TikTok challenges that have resulted in hospitalisations, fires, dangerous driving and the death of a 10 year-old girl from accidental asphyxiation. After 6 January, the assault on the Capitol, Twitter removed 70,000 accounts known for sharing QAnon content and thereby reduced the amount of QAnon content on its platform by 70% to 80%. If it had been done a little earlier, it may have changed those very same events. The penalty shoot-out in England’s best European Championship performance for decades meant that the young men who should have been national heroes were instead subject to sustained abuse.
In each case, speech that might in other contexts be ill-informed, frustrating, foolish or full-on hateful—but totally manageable—was supercharged and spread to epidemic proportions online. As it spreads, it mutates: disappointment turns to rage, uncertainty and suspicion; difference turns into dispute; the marginal turns into the mainstream; and the digital turns into injury and death.
I am neither a technophobe nor a tech pessimist. On the contrary, it is still possible to do anything. The digital world is synthetic, entirely human-engineered and eye-wateringly well resourced; it can set its sights on any outcome. But it is optimised for three holy grails: growth, engagement and time spent, which simply means keeping as many people online, engaging as often as possible for as long as possible. This engagement drives the value and revenue of a sector now responsible for 25% of the world’s GDP, and it has made giants of those who, often in the name of freedom of speech, have built personal fortunes by controlling what we see, read and hear from the relative safety of Silicon Valley.
When she gave evidence to the Joint Committee, Frances Haugen, the Facebook whistleblower, said that
“engagement-based ranking does two things. One, it prioritises and amplifies divisive polarising and extreme content and, two, it concentrates it … It does not matter if you are on the left or on the right … Anger and hate is the easiest way to grow on Facebook … The … system is biased towards bad actors and biased towards those who push people to the extremes.”
Those extremes become our new normal, in which children who look for exercise videos end up with material that valorises eating disorders, in which Covid misinformation is more prevalent than advice from the WHO and in which whole peoples are set against each other in tribal or religious conflict, such as those in Ethiopia and Myanmar, in both of which Facebook has played a role. Perhaps most ironic of all, they create a new normal in which girls, women, people of colour, minorities and the oppressed can be silenced by algorithmically fuelled abuse and hate in the name of other people’s freedom to speak but, perhaps more truthfully, in the company’s freedom to monetise and whip up difference.
It is frequently said that the digital world offers great opportunities but brings terrible harms. This framing is a false binary. A car with no brakes is not an opportunity, and neither is a supermarket with a poisonous product hidden on every other shelf. They are, respectively, a case for product recall and shutting up shop. But both, with some judicious redesign, would be rather useful.
Not all the harms of the world can be attributed to one sector, however powerful, but our freedoms are being exploited by a system that allows any amount of algorithmic distortion but holds no liability. Our discourse is undermined by the monetisation of engagement, and children are being denied a childhood for profit. Three weeks ago, in this Chamber, I set the Government a series of challenges that they have yet to answer. In short—and, believe me, it was not in short on that occasion—I asked why the Government did not act immediately to introduce privacy-preserving age assurance online to give children the protections that they so desperately need. And I say it here again. Children also have the right to participate, speak and assemble online, but they also have a right to protections from violent and sexual commercial exploitation.
This is not the theoretical plaything of a debating club that pits freedoms against protections but rather a matter of life and death. This is not about undermining our freedom but about finding our voice. I do not wish to be standing here in the new year reporting to the Minister more compelling evidence or a new tragedy for which his department will bear some responsibility. I am grateful to the most reverend Primate for bringing this debate forward, and I urge the House, as we go forward to the online safety Bill, the data Bill and multiple trade Bills, not to sacrifice our freedoms or those of our children on the altar of Silicon Valley. Instead, I urge that we find our voice and, with it, the circumstances in which others can both speak and be heard.
Baroness Uddin (Non-Afl)
My Lords, it is such a pleasure to follow the noble Baroness, Lady Kidron. I thank her for her outstanding championship in this regard. I am sure that if the Government have not listened, they will soon.
I am grateful too to the most reverend Primate for calling us together to consider this precious gift of freedom of speech and citing the critical pillar of interfaith work which takes place in all corners of our communities. At a glance, it can be argued that we have advanced in the freedom of expression that we enjoy, heralded by the heroic efforts of the suffragette, civil rights and disability movements, which have achieved fundamental transformation of our social, legal, cultural and political system, with embedded presumptions of the indispensable rights of individual liberty, choice and freedom of expression, belief and practice.
Like all noble Lords, I hold these values dear to my heart, underpinned by the formative years of childhood experience which instilled principles of valuing, respect and love of neighbours and friends whose faith was different from that of my family—a family that experienced the wrath and threat of far-right fascists over a prolonged period. At the same time, as a person in public life, I am also all too aware that others’ freedom of speech and expression towards me and my faith is often loaded with preconceived presumptions, value judgments and interpretation.
Therefore, I am compelled to agree with the most reverend Primate that in our society there is still a great discrepancy and power imbalance in who is deemed fit to have freedom of expression. During my 24 years in this House, I have regrettably witnessed significant parts of our communities feeling disempowered and disconnected, with their rights and freedoms eroded as result of the way we do business in Parliament.
It has been clear to see that the most vulnerable in our society—the elderly, the disabled and minority women and communities—remain absent in reality and unable to access adequate resources or influence social policy. Consequently, for vast sections of our communities, the realisation of freedom of expression rings hollow, belied by marginalisation and discrimination and with an extremely limited prospect of experiencing meaningful change.
Over recent months, I have had the honour of working with a number of women-led NGOs, particularly within smaller community sectors, which strive to advocate social justice. Time and again, they share the same frustration of not being able to engage or influence decision-makers for the betterment of their local communities or to help improve the life chances of the vulnerable. We know why: we still have a culture of who is seen and judged as the acceptable face of civic society leadership, with the majority of NGOs that are well funded and considered successful remaining in white and male leadership, even in geographical areas where large, well-established minority populations exist and thrive. Therefore, lack of effective and representative leadership is one of the prevailing challenges that impact on societal changes, which continue and maintain the deficit in the economic, social and political empowerment, particularly of women—a central tenet of our national and international aspirations.
We have spoken often in this Chamber about the gaping hole in paper strategies and polices that do not match reality on the ground, where freedom of expression is challenged and more constrained. The result is that some sections of our communities do not enjoy parity of rights and do not feel of equal value as citizens.
If the question for our consideration today is what our precious libertarian advances and freedoms have done to improve our overall conditions, the jury is out on whether citizens are able to overcome the long- standing, pervasive inequalities and barriers, as well as discrimination, which inevitably impede these rights.
The other consideration is the challenge of managing the Covid virus. We have witnessed and are experiencing seismic changes to the characteristics of our freedom, liberty, rights and choices as Covid legislation tears through our democratic processes. They are being replaced by extraordinary processes of executive decision-making, leading to structural inequalities, social upheaval and discrimination, resulting in significant sections of our communities already feeling excluded, as we are yet again considering emergency measures, including vaccine passports, which are likely to prevent citizens accessing statutory services and jobs if they cannot provide proof of vaccination. I will do my utmost to uphold my right to object to these measures.
I need not tell this House how difficult it has been to get information and data out of Ministers on what has led to the deaths of thousands of elderly and disabled people. Perplexing questions remain about DNR decisions made about those with disabilities without consulting their families. These are important considerations in upholding citizens’ rights and trust in democratic governance. My misgivings are even greater when I wonder where future decision-making will take us. Even as Members of this House, we have sometimes failed to safeguard these precious democratic values and restraints on the Government. They continue to impose some of the most draconian regulations and an endless list of measures curtailing freedom of movement, prohibiting assembly, segregating by geographical tier system, and using drone technology for surveillance by police forces, disproportionately against Black Lives Matters protests. We seem to have given up on education and informed choice. As we assemble, Parliament is being asked to endorse regulations that contravene the right of choice: the Covid passport may exclude vulnerable people from receiving care and support. Questions arise about how we hold our Government responsible, given the evident absence of the accountability which is the linchpin in upholding democracy and freedom.
I suggest that our civil liberties are under serious threat when police forces feel that it is now legitimate to use drones to monitor and film perfectly legal public protests; that includes the disproportionate use of technology against Black Lives Matter.
This conversation is reassuring and it is comforting that, as a collective, we remain ever vigilant and determined to safeguard our fundamental and absolute right of freedom of speech and expression, while at the same ensuring that we protect those who may suffer injustice and discrimination.
Lord Sandhurst (Con)
My Lords, my focus today will be on universities, from which come our future leaders. In December 2019, the Policy Institute at King’s College London published an important report after a survey of some 2,150 students. It observed that universities increasingly face criticism over freedom of expression and for a perceived increase in safe-space policies and no-platforming. Yet this perception, it found, was often disproportionate to the number of instances where freedom of expression had actually been violated. Students, it said, were generally far more concerned about freedom of expression in wider society than in their own university. None the less, it is important to note that the same report found signs of a “chilling effect” whereby some students were reluctant to express their views for fear of repercussions.
The institute produced a follow-up report in August last year. It found, after talking to students again, that as many as 20% felt uncertain about whether they could express their views freely at their university. They did not believe that it is a university’s place to shield people from intolerant or offensive ideas and felt that safe-space policies and the suppression of demonstrations or rallies representing unpopular political views posed a threat to freedom of expression. That was one-fifth of the students. So where are we going?
In March last year, Cambridge University issued a policy on freedom of speech, requiring its staff, students and visitors to be
“respectful of the differing opinions of others”.
But last December, Regent House, the governing body of that university, voted by a huge majority, 87%, to overturn that obligation to respect the opinions of others. The requirement now, thankfully, is to “tolerate” others’ opinions. For, as Dr Arif Ahmed, reader in philosophy, told the Times:
“Everyone else just becomes a little bit more worried, a little bit more reluctant to say what they think about the Empire, trans issues, Israel and Palestine, or a whole range of issues from the left or the right. The more long-term danger is that this language will be weaponised so that we will be subject to discipline if we try to invite someone who’s disrespectful, or if we ourselves speak in a disrespectful way.”
Events elsewhere show how prescient he was. As we have all heard, only this autumn, aggressive intolerance of Professor Kathleen Stock’s writings has driven her from her post at Sussex University. The university failed to protect her against the bullies. Just this November, a row erupted at the Oxford Union after a speech by the well-known art critic Andrew Graham-Dixon. Offence was taken not so much at the content of his speech but because, intending satire—some of his audience could not grasp that satire—his mannerisms in delivery mimicked Hitler. They simply could not see that he was mocking Hitler, making fun of him.
This week at Durham University, following an edgy speech by the well-known journalist Rod Liddle, some students took offence. I do not mind that—they are free to take offence—but student presidents of every university association at Durham University have now called for content warnings for future speakers. That is the road to censorship. I ask, what would happen to Alexander Pope or Dean Swift today? Students and academics have to regain a sense of proportion and, above all, humour. Significant numbers seem to have lost sight of the core importance of freedom of expression to the vitality of university life. Talk of safe spaces, in which students will not be exposed to contrary opinions strongly expressed, is, I suggest, dangerous nonsense.
We would do well to remember the words of Frederick Douglass, the escaped slave and abolitionist. He had suffered appallingly. He knew what a safe space really was and how it felt to risk life, limb and liberty. Speaking in 1860, Douglass said:
“To suppress free speech is a double wrong. It violates the rights of the hearer as well as those of the speaker.”
One hundred and sixty-one years later, who are we to disagree? Essential liberties have not yet been lost, but they are, I fear, under constant assault. Our universities and institutions must not swaddle the oversensitive. The idea that there should be safe spaces and content warnings is absurd and dangerous. It will bring totalitarian controls of thought and knowledge. Those who do not go to university—50% of the population or more—do not enjoy safe spaces. They live in the real world. Those who enjoy the privilege of university must be exposed to challenge and disagreement. They must open their minds to edgy humour and provocative ideas. They must sharpen their intellects on the steels of humour and debate. They, and we, must all relearn to listen and even to laugh.
Lord Wallace of Tankerness (Non-Afl)
My Lords, I am pleased to follow the noble Lord, Lord Sandhurst, and express my delight at being able to participate in this important and timely debate initiated by the most reverend Primate the Archbishop of Canterbury. I am also pleased to speak not only as a Member of your Lordships’ House but from the perspective of Moderator of the General Assembly of the Church of Scotland. That is a privilege that I cherish. Indeed, as the most reverend Primate noted in his speech—a speech that will be well worth reading again in the Official Report—we do well to reflect on the privilege that we have as noble Lords to speak here. But, as with all privileges, it comes with a responsibility to exercise it wisely.
From a Christian perspective, and as we approach Christmas, we should recall that when Jesus came to live among us, he was not born to a position of privilege, nor did he have a platform of contemporary power and influence. Rather, he came alongside those at the edges of power. When exercising our freedom of speech, do we not also need to feel a moral or spiritual obligation to listen and walk in the shoes of others to understand better the fear and anxiety at the impact of words and behaviours on those without power? Should that not make all of us more careful in our own choice of words?
It was 38 years ago last June that I was first elected to the House of Commons. Over my years as a Member of Parliament and then a Member of the Scottish Parliament, I engaged in debates with other MPs and MSPs of different political hues. These debates could be very robust. We often differed, but, with very few exceptions, I always felt that my opponents, by their own lights, were expressing views that they thought best served their country and their constituents.
I also note that, during my time in front-line politics, I was spared much of today’s vituperation and abusive language. There is a trend today towards ever greater bitterness, anger, slander and malice, which, I fear, risks being normalised on social media. In his book published last year, Let Us Dream, Pope Francis despaired that at times our politics, society and media seem like one long shouting match. I sometimes think that our female politicians are more often the victims of unacceptable targeted abuse, but it is not just politicians who are on the receiving end.
I profoundly disagree with anti-vaccination campaigners, but I acknowledge that they hold that view often passionately. But let us recall that during the summer a former nurse attacked those in the medical profession administering vaccines with the words:
“At the Nuremberg trials, doctors and nurses stood trial and they hung.”
Recently, I spotted a tweet from ScotRail that reproduced a Twitter message received—with many words necessarily redacted, and certainly not repeatable in your Lordships’ House—and the comment:
“This is your periodic reminder that a real human being reads every tweet and DM sent to this account. This kind of behaviour isn’t acceptable in person or online”.
I very much doubt whether doctors and nurses being compared to Nazi war criminals or ScotRail employees reading vicious bile in Twitter messages can possibly experience anything at all uplifting or encouraging.
When the First Minister, Nicola Sturgeon, addressed the Kirk’s General Assembly in 2019, she said,
“perhaps these days we can be too quick to retreat into political tribes, with a focus on areas of conflict rather than agreement. So all of us—and political leaders especially—have a responsibility to resist the momentum for division and polarisation … And when politicians forget or fall short of that responsibility—as all of us sometimes do—the Church is, I think, well placed to remind us of it.”
I believe that, as people engaged in the political process, we have a leadership role in setting an example. If those in positions of political responsibility are ever tempted or apt to “forget or fall short”, the Church has a role to remind them of the responsibility so well-articulated by the First Minister.
That should not in any way make politicians any less passionate about what they believe in. If they are prepared to put their name on a ballot paper, it is to be hoped that they are fired up with commitment to do rather than to be. Inevitably when dealing with issues such as this, the question arises of whether the Government should strengthen legislation to tackle online abuse. The convener of the Church of Scotland’s Faith Impact Forum, Dr Susan Brown, called on the Government as long ago as summer 2020 to bring forward what even then was thought to be overdue online safety legislation. Joined by faith leaders from the Jewish, Muslim and Hindu communities, among others, she said:
“Words always have consequences and we would encourage people to use them to break down barriers, not build them.”
We have heard today that the committee report on the draft legislation will shortly be published. In replying to the debate, it would be helpful if the Minister could tell us when the actual legislation might be brought forward. However, one important lesson that I have learned from years of engagement in both law and politics is that they have their limitations. I have come to realise that laws do not necessarily change hearts, so we should not kid ourselves that legislation can or will fully solve the many manifest problems associated with online abuse.
To follow up on the quote from Dr Martin Luther King cited by the most reverend Primate, Dr King also said:
“Morality cannot be legislated for, but behaviour can be regulated. Judicial decrees may not change the heart, but they can restrain the heartless.”
Yes, some laws are worth while, where they provide welcome and necessary protection, particularly for vulnerable groups or individuals, including ethnic and religious minorities. In the sphere of social media, some of the big tech giants need some prodding to ensure that customers comply with user agreements, which include rules on standards and codes of conduct. From a Christian perspective, however, I would claim that changing hearts requires something more than laws: it requires love. Arguably, the message of the parable of the good Samaritan would be far more effective in bringing about a society more at ease with itself than any number of Acts of Parliament.
I believe that there is a role for churches to play in trying to bring about a much-improved public debate on a host of issues. In the very contentious Scottish independence referendum in 2014, the Kirk—not least through the offices of the then Moderator, Dr John Chalmers—created space for a respectful dialogue between the two sides. I dare say that some of the voters who attended perhaps found it beneficial to have a discussion that provided more light than heat. Surely a host of contemporary contentious issues would readily lend themselves to a respectful dialogue and a responsible exercise of free speech, for which our churches and others might be facilitators.
It has been a privilege to take part in this debate. It augurs well for when your Lordships consider the online safety Bill, not only in showing the value that we place in the exercise of freedom of speech but also in giving us an opportunity to speak up for those who are on the margins and do not have the privilege of a voice in Parliament.
Lord Cormack (Con)
My Lords, that is a refreshing and stimulating speech to follow and I congratulate my friend, the noble and learned Lord, Lord Wallace of Tankerness. I join all others in paying tribute to the most reverend Primate for introducing this debate and for the manner in which he did so.
I was struck by a number of speeches that, in the last hour, have sought to bring a sense of perspective to this debate. I single out the speech of my noble friend Lady Sanderson of Welton—I entirely echo what she said about Rose Tremain—and the invigorating speech of the noble and learned Lord, Lord Brown of Eaton-under-Heywood, who effectively said to us, “Don’t look for offence when it is not necessarily intended”. We are in danger of becoming oversensitive, because free speech is indeed—as the noble Lord, Lord Cashman, said—the life-blood of a free society and democracy.
I remember sitting in the gallery of another place in 1965, I think it would have been. I was a young Conservative candidate for Grimsby, having bloodied myself in Bolsover in 1964. Michael Foot held the floor. He later became a close and dear friend, much as I disagreed with most of what he said, although we bonded over Bosnia and addressed a rally together in Trafalgar Square. In the House of Commons, Michael Foot was holding forth. He said, “You need vigorous debate in the House and in the country. When I am addressing rallies, I don’t duck: I wait until I see the whites of their eggs.” Michael Foot was true to that.
One of my most undying memories is of a party we had—parties are very fashionable at the moment, are they not?—in a colleague’s house not far from here to mark the 80th birthday of Enoch Powell. There were two great parliamentarians; I disagreed with both of them on many things, although I had the honour of giving the address at Enoch’s funeral. What struck me there was that the speech of appreciation was made by Peter Shore and the presentation of a silver salver inscribed with the words “Poet, scholar, soldier, orator” was made by Michael Foot. He and his wife Jill used to meet Enoch and his wife Pam on a regular and frequent basis because they respected each other as parliamentarians. You do not have to agree in order to respect. Many of the better things in this House and the other place are achieved by parliamentarians of different political persuasions working together.
A sort of intolerance has crept in, accentuated by social media; if I could have one Christmas wish, I would uninvent it, although of course I cannot. It creates a situation where recently, for instance, it came to my notice that a group of people from outside the House refused to attend a meeting inside it because they disagreed with the views of the chairman on a wholly different subject. We must get beyond that. We must really respect.
One of the problems is that we have social media but we no longer have many real meetings. When I was a young candidate, and at all the 10 general elections I won, I used to have meetings in my constituency every night. In the 1960s and the early 1970s, they were often quite packed. The attendance tended to fall off but I kept the meetings; I never had fewer than 20 people there but, in the 1960s and the early 1970s, it was not unusual to have 100 or 200 people. There was vigorous debate but there was no bitter argument. There is a difference between vigorous debate and bitter argument. We have to try to get the bitterness out of public life and not be overly sensitive.
I do not agree with a lot of what the noble Lord, Lord Cashman, said but, to quote Voltaire—to whom the noble and learned Lord, Lord Brown, alluded—I would defend to the death his right to say it. Now we have a group of people who are saying, “I don’t like what you say and I will do everything possible to prevent your saying it”. That is a real difference.
In the area of gender, some women have been vilified to an absolutely unpardonable extent. Professor Kathleen Stock has been mentioned a number of times in this debate, as has JK Rowling. They are merely stating views and opinions—some of us would say facts—that have been indisputable since time immemorial. It is important that they are not vilified. The term “cancel culture” is perhaps the most sinister in our modern political vocabulary. The most reverend Primate has done a great service in giving us the opportunity to debate some of these things. I beg noble Lords in all parts of the House to remember, in this season of good will, that toleration and understanding are as important as they ever have been.
Lord Sentamu (CB)
My Lords, I, too, thank my noble and learned friend Lord Brown for his powerful speech, which is still ringing bells of challenge in my ears.
On 6 January 1941, the President of the United States of America, Franklin Roosevelt, addressed Congress on the state of war in Europe. At the close of his address, he said that he looked forward to
“a world founded upon four essential human freedoms”,
which he named as freedom of speech, freedom of worship, freedom from want and freedom from fear. These words are still remembered but the ideals have not been realised anywhere in the world.
In this debate, we are invited by the most reverend Primate the Archbishop of Canterbury, given the contemporary challenges to freedom of speech, to map out the role of the public, private and civil society sectors in upholding it. In a book of essays I edited in 2015, On Rock or Sand? Firm Foundations for Britain’s Future, I referred in my introduction to two noble and learned Law Lords. It is still my view that what they offered us is not sand but rock—that is, firm foundations that would enable us and the public, private and civil society sectors to uphold freedom of speech.
First, in his book, The Rule of Law, Lord Bingham has a beautiful translation of the Magna Carta, from the Latin into English. Clause 39 states:
“No free man shall be seized or imprisoned, or stripped of his rights or possessions, or outlawed or exiled, or deprived of his standing in any other way, nor will we proceed with force against him, or send others to do so, except by the lawful judgment of his equals or by the law of the land.”
Clause 40 states:
“To no one will we sell, to no one deny or delay right or justice.”
Those words from the Magna Carta were written 800 years ago, and echo the law and prophets of the Hebrew scriptures.
Lord Bingham’s examination of the meaning of the rule of law makes clear that it is not an arid legal doctrine but the foundation of a fair and just society, a guarantee of responsible government and an important contribution to economic growth, as well as offering the best means yet devised for securing peace and co-operation. He advocates eight conditions that capture its essence, as understood in Western democracies. Today, I will give four of them:
“The law must be accessible and so far as possible intelligible, clear and predictable … Questions of legal right and liability should ordinarily be resolved by application of the law and not the exercise of discretion … The laws of the land should apply equally to all, save to the extent that objective differences justify differentiation … The law must afford adequate protection of fundamental human rights.”
Lord Bingham ends by saying on page 174 that the rule of law
“is one of the greatest unifying factors, perhaps the greatest, the nearest we are likely to approach to a universal secular religion. It remains an ideal, but an ideal worth striving for, in the interests of good government and peace, at home and in the world at large.”
It is key in freeing and energising us all, in the public, private and civil society sectors, to uphold freedom of speech with cheerfulness and hope.
For me, justice goes beyond the simple administration of laws. Justice is possible only when law, religion and morals are intermingled. I call my second witness: the noble and learned Law Lord, Lord Denning, to whom I also referred in On Rock or Sand?. Lord Denning wrote in The Changing Law in 1953 that the severance of law from morality, and of religion from law, has made many people
“think that religion and law have nothing in common. The law, they say, governs our dealings with our fellows, whereas religion concerns our dealings with God. Likewise, they hold that law has nothing to do with morality. Law lays down rigid rules which must be obeyed without questioning whether they are right or wrong. Its function is to keep order, not to do justice ... Although religion, law and morals can be separated, they are nevertheless still very much dependent on one another. Without religion, there can be no morality, there can be no law.”
Rabbi Lord Jonathan Sacks, in his book Morality: Restoring the Common Good in Divided Times, published in 2020, argues that
“there is no liberty without morality, and no freedom without responsibility … all of us must play our part in rebuilding our common moral foundation”—
the kinds of things we heard from the noble and right reverend Lord, Lord Harries. The book goes on to say that
“a nation is strong when it cares for the weak, and rich when it cares for the poor.”
I ended the book On Rock or Sand? Firm Foundations for Britain’s Future with these words:
“Individualism and consumerism are sand. Freedom, Fellowship, Service for God and neighbour, and the Rule of Law are rock. These are the firm foundations for Britain’s future.”
On these foundations let us uphold and restore freedom of speech. I hope we do not allow the two reactions to the book On Rock or Sand? to happen to freedom of speech. The first reaction was from those who read On Rock or Sand? Then there were those who hated it.
Baroness Jones of Moulsecoomb (GP)
I thank the most reverend Primate the Archbishop of Canterbury for tabling this debate. He gave an excellent speech and, in spite of being an atheist, I agreed with almost every word; I was very impressed.
This debate comes after a few years of increasing suppression of civil liberties and human rights here in the UK. Freedom of speech is about engaging with all sorts of ideas, biases and creeds to make up the public discourse. As a Green, I am well aware of how important it is to talk and try to convince people about the environmental crisis—especially those in power who can actually do something about it, however little. I might regard this Government as political enemies, and as arrogant and repressive, but I think it is worth engaging and very much hope they feel it is worth engaging with Greens.
I like the way people in society at the moment are questioning whether schools named after slave owners ought to change their names, or whether country houses need to explain to their visitors the dark side of their history by putting front and centre how their owners made their fortunes. All that is part of robust debate; if some people feel uncomfortable, perhaps they should be.
There are things I do not like. I do not like Russian bots on Twitter and the made-up Facebook profiles that distorted the discussion about Brexit and still seek to destabilise our democracy. I do not like the way social media gives the impression of free and equal debate, but has in fact allowed dark money to contaminate that debate and to give those with money the ability to divide and rule. Nor do I like the way some social media platforms created algorithms that promote rage and division. Social media should give us the chance to share information, reach out and engage, but instead it is often designed to reinforce the bubble culture of people finding others they can agree with. I definitely do not like the way some women have been silenced and de-platformed for raising concerns about what they see as an erosion of their rights. I also do not like discourse that is rude and threatening, because that is another way of silencing people who are just trying to be who they are inside.
In the UK at the moment there is a huge gap between respecting our political enemies and the sort of legislation this Government are introducing, which attempts to crush dissent. The assault on our democracy by this Government is the biggest threat to freedom of speech and even freedom of expression. That is the threat that deserves most of our attention, because each bit of legislation we pass here is making that threat grow. This Government are silencing campaigners and turning dissent into a crime while rewarding the lobbyists and money men. They are removing democratic safeguards on ministerial power while setting up a special unit to filter freedom of information requests that might reveal something damaging to them.
Things were far from perfect in the past, but the last decade has seen a vast extension of the repressive state. The old normal was undercover police spying on campaigns for justice, such as those of Doreen Lawrence—now the noble Baroness, Lady Lawrence—and a thousand other non-violent campaign groups. The new normal is giving those undercover police legal immunity for any crimes—this came through your Lordships’ House. The old normal was D notices that stopped the public finding out national secrets like the bunkers that sheltered the rich and powerful in the event of nuclear war, but the new normal is referring school kids to Prevent for supporting the eco-warriors of Greenpeace.
The old normal was the Special Branch holding files on Labour Ministers. The new normal is putting tens of thousands of people on databases as domestic extremists. I am proud to say that I was on that police database for domestic extremists while a member of the Metropolitan Police Authority, fighting, at the time, for the traffic police to get more resources to deal with road crime. Caroline Lucas, at the other end, was labelled a domestic extremist, as was a local Green Party councillor and thousands of others. We were elected to give a voice to hundreds of thousands of people who voted Green, yet we were watched and monitored by the police.
While I welcome this debate on freedom of speech, I feel that we in your Lordships’ House actually can and should do more: we should be a watchdog by protecting the right to effective protest and stopping the worst excesses of state power. That starts with rejecting the draconian powers in the Police, Crime, Sentencing and Courts Bill, which we are currently dealing with and which will be with us next year as well. That rejection of those measures would be a defence of free speech.
Finally, I was in your Lordships’ House yesterday and wanted to take part in a debate. The Labour Benches were quite full, so I sat on the Bishops’ Bench. When I tried to speak, I was told that I could not speak from there. I tweeted about it, and someone tweeted back:
“Ridiculous they can stop you speaking the truth from the wrong seat but in the other house they can’t stop you from lying from the dispatch box.”
Lord Hannan of Kingsclere (Con)
My Lords, what a pleasure it is to follow the noble Baroness, Lady Jones of Moulsecoomb. She and I met, somewhat implausibly, on the slopes of Mount Sinai some 30 years ago. She was then in a previous incarnation as an archaeologist. I like to think that we have been friends ever since. When I say friends, I do not mean that we are on nodding terms when we pass in the corridor; I mean that we are actual friends—we like each other. I do not think that I have ever felt the need to preface my remarks by saying, “Although we rarely agree” or “Although we have very different views”. It is odd that so many people feel the need to handle opponents with tongs in that way. It strikes me as both a belittling and a self-absorbed way of putting distance between people. Why on earth should we be expected to agree with our friends? Would it not have gone without saying for most of our recent history that you could have friends across the divide? No one would have thought it remarkable.
In 1644, John Milton wrote:
“Give me the liberty to know, to utter, and to argue freely according to conscience, above all liberties.”
I cite the blind sage for two reasons. First, there is a certain karma in quoting him here: John Milton was no fan of the House of Lords, and he was no fan of the episcopacy in particular. Indeed, the man that Dr Johnson referred to as an “acrimonious and surly republican” was so against all kinds of authority that his libertarian principles spilled over even into his magnum opus, Paradise Lost, in which it is notable that the Almighty Himself gets some rather bad lines. It is as though Milton’s dislike of prelates and princes spilled over into a certain disdain even towards his creator.
But I also cite him for another reason: to ask your Lordships to dwell on the extraordinary fact that those words could have been uttered in 1644. How radical, revolutionary and earth-changing they must have seemed. Up until then, every civilisation had assumed that there was a supreme truth and that it was interpreted by some aristocratic or sacerdotal class. The idea that you could reach the truth by experimentation—by argument, trial and testing ideas—was extraordinary, and it was largely developed in the language in which you are now listening to these words. The phrase “civil liberty” dates from 1644, and it was a long time before any other tongue came up with an equivalent. In English, the phrase “liberty of conscience” dates from 1580.
I want to dwell on just how extraordinary it is that we moved away from this tribal ethic that had defined our entire existence as a species until then—the fundamental ethic of “my tribe good, your tribe bad”—to this idea that you could have a constant test and would get to the truth through a cacophony of different ideas.
Milton would have shared the most reverend Primate’s definition of whether it is “fitting” as well as “frank”; he made a great deal of the distinction between liberty and licence. For him, licence was giving in to your animal appetites; liberty was a virtuous application of reason, a kind of informed consent. When you had read up about the subject, you could make a free choice in a more intelligent way. “Knowledge”, he once wrote, is but “opinion in good men”. In other words, what people begin by putting forward as a radical idea becomes the accepted consensus if it turns out to be true: the good ideas drive out the false, over time.
This may sound terribly basic when I say it now, but I do not think it is. We have lived through this little bubble in which we have taken those ideas for granted. A lot of societies never got there; we did not until fairly recently. I wonder whether we might come to look back on recent years, the last two or three centuries, as a brief interglacial with long stretches of cold before and in front, when people went with certainty and tribal identification, rather than with the idea of piloting or trialling ideas, or letting others argue against them.
The primary duty of inculcating this rather difficult idea, of teaching people this counterintuitive thought that someone you do not like might still have something to tell you, that you do not know everything, that we all start from ignorance and can constantly refine our understanding, fell mainly on our educators. We needed constantly to habituate people to this way of thinking.
The great philosopher Hannah Arendt, the chronicler of the Eichmann trial, once wrote:
“Every generation, western civilisation is invaded by barbarians—we call them ‘children’.”
By that, she meant that you and I came into the world with pretty much the same mental and operational apparatus that we would have done 5,000 years ago. The reason that we do not live in the way that our ancestors lived then is because we are able to build culture—civilisation—on accumulated knowledge. We are able to do that because we accept empiricism, reason, the scientific method and the ability to test ideas, refine and improve them over time. And what worries me is that we are ceasing to do that. Not only our universities but our secondary schools are reverting to a much older heuristic of holding up identity, accident of birth and physiognomy above reason.
Over the summer I participated in teaching in a school, appropriately called the John Locke Institute. Rather like what the right reverend Prelate the Bishop of Birmingham was describing in his home city, it tries to teach young people the idea of what the administrators of the course call “generous listening”. It is a lovely phrase. Generous listening means not waiting, patiently or impatiently, for the other person to stop speaking so that you can jump in. It means properly trying to engage with where they are coming from. If they use a loose word, do not pounce on it. Do not engage with their weakest argument; engage with their best argument.
The Oxford Union organised something they called “ideological Turing test debates”, where young people would be given a topical debate—should statues come down, should private schools be abolished—and you had to guess whether they really meant it. In other words, they had to master the other point of view well enough that they would have passed the Turing test and people would not have been able to tell whether they believed what they were saying. Is that not the sort of thing that all our schools and universities should be doing, in order to equip people to function in modern society? I fear that, when they do the opposite and say, “The most important thing about you is that you are female, white” or whatever it is, instead of teaching those countercyclical truths, they are teaching procyclical tribalism.
I close by citing—at some risk, in case she is watching —my elder daughter, of whom I am very proud. She is reading French and linguistics, and as a condition of being where she is at university, she was told that she needed to do an unconscious bias test. What does that have to do with French? Well, two hundred years ago, had she not been female and had been at the same university, as a condition of matriculation she would have been subject to the Test Act. She would have had to abjure the doctrine of transubstantiation: she would literally have had to swear an oath saying that she did not believe that the bread and wine in the Eucharist were the literal body and blood of our Lord. What has that got to do with French? As much or as little as the unconscious bias test—and if you cannot see that, you are in the matrix. In the 200 years between those two Test Acts flourished a free civilization. By heaven, we will miss it when it is gone.
Lord Singh of Wimbledon (CB)
My Lords, I too am grateful to the most reverend Primate the Archbishop of Canterbury for initiating this important debate, and it is a real pleasure to follow the noble Lord, Lord Hannan, and his very clear message.
Article 19 of the Universal Declaration of Human Rights reminds us:
“We should have the right to share our ideas with who we want, and in whichever way we choose.”
The law of the land rightly states that this right is not absolute and makes it an offence to promote hatred or fear of any individual or group.
History reminds us that it is all too easy to gain popularity by appealing to human bigotry, with devastating consequences for vulnerable minorities. It is therefore important to be able to discuss religious and cultural differences openly and honestly. This is increasingly overlooked on some university campuses, where some with perfectly valid views and concerns are not only denied a voice but publicly vilified.
Political correctness bordering on censorship is seen in the media use of camouflage words such as “Asian”, used by the BBC and the print media to obscure the fact that most members of grooming gangs in the north of England were from the Pakistani Muslim community. This led some members of the public to believe that Hindus, Sikhs and Buddhists were also responsible. The standard reply to complaints was that the description “Asian” was factually correct. It was only after I pointed out that it would also be factually correct to say that “Europeans” were responsible for the Holocaust that notice was taken and the issue taken seriously. IPSO guidance now cautions against the use of that blanket term.
Another example of near paranoia about giving offence to powerful minorities at the expense of smaller ones was seen in the BBC “Thought for the Day” attempt to censor my talk on Guru Tegh Bahadur, who gave his life standing up for the right for freedom of belief for Hindus being forcibly converted by the Mughals. The previous Archbishop of Canterbury, Rowan Williams, publicly applauded this stance. The forced conversions were being carried out by a man who had imprisoned his own father and murdered his brother to become emperor some three centuries ago. It was said that this might offend Muslims today.
Unthinking political correctness rooted in ignorance and irrational fear of giving offence to more vocal communities has led to some groups claiming special protection. Concern over anti-Semitism, rooted in the Holocaust and sometimes in the culture of this country, is understandable. Unfortunately, however, “anti-Semitic” is now used by some to smear those with genuine concerns over Israeli policies towards Palestinians. Also concerning is the use of the emotive term “Islamophobia” to curb debate and cultural or political criticism. No doubt some will see my remarks as anti-Semitic or Islamophobic. However, the Sikh daily prayer reminds us to look beyond ourselves or our group to the well-being of all.
In the past, interreligious differences, as the history of this place reminds us, frequently resulted in horrendous persecution and conflict, and a tacit consensus emerged in the West that religion should be seen as a private matter and not a subject for public discussion. We could, of course, say nasty things about other people far away in distant lands. We could talk of “heathens”. The dictionary definition of “heathen” is someone who is not of the Abrahamic faiths, such as a Sikh or a Hindu.
Isaac Watts, the writer of some of my favourite hymns, also wrote:
“O Lord, I ascribe it not to chance … but to your grace,
That I was born”
a Christian
“and not a Heathen or”
of the Jewish race.
Religions are essentially guidebooks, telling us what to do and what to avoid in our journey through life, but ethical and cultural guidance embedded in holy books to meet social, political and cultural norms of the distant past can be at variance with the needs of today. For example, while some religious texts take slavery for granted and refer to women in negative terms, such language has no place in the world of today.
There is now a clear need for religions to do a little spring cleaning and move us from the simple recitation of past guidance to societies that no longer exist and place underlying imperatives in the context of today’s very different world. A Christian hymn reminds us:
“New occasions teach new duties
Time makes ancient good uncouth
They must upwards still and onwards
Who would keep abreast with truth”.
This is no easy task, and it will be resisted by conservative elements who clearly see dated texts as the unalterable word of God, and by those who use them to promote hatred and violence towards others, or questionable social attitudes.
No religion has a monopoly of truth and, to emphasise this, Sikh scriptures contain uplifting verses on Hindu and Muslim saints. I frequently quote from Christian texts to underline common imperatives which I believe can help us move our suffering world to more harmonious and peaceful living.
Baroness Fox of Buckley (Non-Afl)
My Lords, the noble Lord, Lord Singh of Wimbledon, has, through using some very challenging and hard-hitting ideas, just illustrated the value of free speech, because we learned something. I was a bit offended, I agreed with some of it—but it had my attention, and that is what it is all about.
Like other noble Lords, I commend the most reverend Primate for holding this debate, because many of us who raise concerns about attacks on free speech have sometimes been accused, including recently, of confecting the problem in order to stir up culture wars or even to cover up our own bigotry. In a bestselling book in the United States, the author Gavan Titley states that freedom of speech
“has been adopted as a primary mechanism for validating and re-animating racist ideas.”
In other words, even arguing for free speech has been turned into a toxic idea.
This hints at one contemporary challenge. Although everyone says they believe in free speech, it is often caveated. How often do I hear, “I believe in free speech, but …”? Often, after the “but” people will say “not for hate speech”, or “not for bigotry”. I appeal to noble Lords: when you hear the “but” after “free speech”, watch out for censorship. I also appeal that we do not take the demonising labels of hate and bigot at face value. Hate is a nebulous concept that even in hate-crime legislation is based on perception rather than objective criteria.
In this way, the subjective label of “hate” can be used to delegitimise a wide range of opinions and can be used cynically to discredit political opponents. For example, LGB Alliance, the fastest-growing campaigning charity for the rights of lesbians, bisexual people and gay men, has been maliciously and erroneously dubbed a hate group on a par with far-right extremists. Or what about the police arresting a number of street preachers for allegedly homophobic hate speech, when what they were actually doing was—wait for it—quoting the Bible? They would have a field day in here. We should note that religious freedom, the bedrock of a secular society, is very much at risk under the auspices of hate speech. Nottingham University recently initially blocked the appointment of a Catholic chaplain for explaining his—well—Catholic views on social media, which were depicted as hate-fuelled. Hate speech, I would say, is often the free speech of those views that we hate.
More generally, we have seen the ratcheting up of sensationalised labels to the level of hate in order to silence opinions which are deemed beyond the pale. For example, everyday sexism, however boorish, is now routinely exaggerated and described as misogyny or hatred of women, and we promiscuously stigmatise ever-growing numbers of people as fascists, Nazis, extremists or fundamentalists. I did a study post 2016 of the various variations of “Brexity, knuckle-dragging gammon”—I was often included in them—and there were thousands of versions of that.
While some noble Lords here suggest that we need to curtail free speech, perhaps to protect marginalised groups, in the name of social justice—although I worry that is a little condescending—many of the least powerful in society are excluded from debate by being labelled as beyond the pale by new powerbrokers, especially around identity politics, who basically describe people as not being worth debating with by using stigmatising labels such as “knuckle-dragging gammon”.
I am also worried when sceptics who wish to query political or scientific orthodoxies are similarly marginalised. In 2019, the Guardian updated its style guide, instructing that climate sceptics should be referred to as “climate change deniers”. The same rhetorical strategy was applied to those sceptical of some lockdown restrictions or who asked questions about the science, who have been labelled “Covid deniers”. This gross exploitation of the legacy of the Holocaust as a way of demeaning individuals and views as so morally reprehensible that they can be banned without qualm is dangerous.
Of course, some people do have repellent and bigoted ideas, and some, even if only a few, are indeed Holocaust deniers. I do not want to duck out of the hard argument. One of the most tricky issues if, like me, you adhere to the principle of free speech is having to defend the indefensible. This is made more difficult by the fashion for falsely conflating the defence of the free speech rights of bigots with endorsing those views. Indeed, this form of guilt by association is used to get people cancelled. For me, it is important not to concede the principle of free speech, which is so foundational to democracy that we should not become squeamish about defending the right of a racist to spout garbage. I think we should answer it with more speech and—yes—sunshine. Also, as Thomas Paine explained centuries ago:
“He that would make his own liberty secure, must guard even his enemy from oppression; for if he violates this duty, he establishes a precedent that will reach to himself.”
Another contemporary challenge is that we live in a period in which we have institutionalised the idea that safety trumps liberty, brought so viscerally alive when we consider the ease with which civil liberties were suspended and online censorship officially endorsed under the heading of “misinformation” to keep us safe during the Covid virus. On this, I disagree with the most reverend Primate because I think that free speech is increasingly seen as too dangerous to go unchecked by endless regulations. JS Mill’s harm principle has now expanded in our therapeutic times.
The online safety Bill, which I think is a frightening legislative threat to free speech—but I will wait for Second Reading—proposes censoring lawful but harmful speech if it is deemed to cause harm, even psychological harm. When University of Sussex activists targeted Professor Kathleen Stock, the posters read “Kathleen Stock makes trans students unsafe”—as though a fine, reasoned, philosophical exploration of the material reality of biological sex was the equivalent of a gun or a knife. At the University of Exeter, 100,000 people have signed a petition opposing the very existence of the Students for Life society because it is argued that the pro-life group
“threatens the safety and well-being of women”.
Instead of challenging the society to a debate that they then win, my side, the feminists who are pro-choice, have the instinct to retreat, act as victims and call for a ban.
Another contemporary challenge is cancel culture, and this goes way beyond no-platforming, as noble Lords have noted today. It is a tactic of public shaming and humiliation, often targeting individual employers and demanding that people are disciplined. On the advice, one of the problems is that too many in power are cowardly in the face of cancel culture. I call for courage in facing down the cancelers.
Lord St John of Bletso (CB)
My Lords, I thank the most reverend Primate the Archbishop of Canterbury for initiating this debate, which is timely, this being international Human Rights Day. Coming last to the crease before the wind-up speeches, and after so many excellent speeches, I will not detain your Lordships for the full seven minutes.
There is no doubt that we live in an era wrought with cultural and political hostility, driven largely by the increasing open public discourse on social media sites. I entirely agree with my noble friend Lady D’Souza that freedom of speech has often been hijacked by social media platforms. While freedom of speech should be protected, recent examples have shown us that false information, often pedalled by digital companies, has allowed their platforms to affect real political outcomes and frame important narratives. The challenge is how to strike a balance.
One of my concerns is that social media sites have free reign to censor and moderate content as they please, often doing so unevenly and unfairly, posing a threat to freedom of speech. Facebook’s content moderation and hate speech rules, which tend to favour elites and Governments over grassroots activities and racial minorities, are a case in point. I welcome their recent efforts to tackle these issues. However, not enough has been done.
By controlling what people can and cannot see, effectively acting as publishers rather than platforms, these social media sites have effectively gained control over the dissemination of information online. Bearing in mind that many people, particularly the youth, read their news on social media, it poses the question of whether self-regulation is more stringent or more rigid regulation is needed. In many ways, it is hard not to admire the innovation and creative genius behind much of what has emerged from Silicon Valley, but one cannot doubt that the age of social media has been just as corrosive as it has been productive. As we move from the universe to the metaverse, these issues will only be exacerbated if they are not tackled now. The algorithms of platforms such as Twitter are undoubtedly designed by data scientists who may have a particular political or social agenda and great power to influence others.
I fear that some of the academic institutions in this country have been overtly censorious in nature. I refer to Amber Rudd being banned from speaking at the Oxford Union. For those who called for her to be de-platformed, my response is that they should not have banned her but challenged her and engaged her in debate. If we remain divided, and some individuals continue to feel silenced, we face the increased risk of political extremism and populist backlashes. The question is how we uphold freedom of speech that balances liberty with the protection of those who need protecting.
Institutions such as the Free Speech Union are gaining traction, stepping in to protect those who cannot, as they call it, be cancelled for controversial things that they say or do. A balance needs to be struck between regulating harmful content online, such as child pornography and hate speech, and protecting real and legitimate speech to preserve the forum as the modern marketplace of ideas. Certainly, the Covid pandemic has illustrated the far-reaching powers that social media companies have in controlling a narrative and vital information online. In summary, my call is for a level playing field where social media enterprises are held to account and where ideas, grievances and beliefs can be aired in public and be rejected, endured or challenged.
Baroness Merron (Lab)
My Lords, after a debate of this range and depth, I do not mind admitting to your Lordships’ House that it is a somewhat overwhelming task before me, but not as overwhelming as the task for the Minister, who is surely facing a Herculean task, and I wish him well. I thank most sincerely the most reverend Primate the Archbishop of Canterbury for giving your Lordships’ House a rich opportunity today to consider such an important matter of our time, which is so deeply affecting on so many different aspects of our lives. As he so wisely observed, free speech is not just frank speech, it is fitting speech, and it is the pursuit of this on which I believe the debate today has focused.
In your Lordships’ House, we pride ourselves on being a pillar of democracy and, indeed, this is so. However, as the noble Lord, Lord Walney, observed, a democracy is not something that should be rigid; it should be able to flex and it also needs resilience. That means the accommodation of a breadth of opinion and thought. As my noble friend Lord Cashman said, hate speech destroys our democracy, and it is this that we must seek to protect. Yet we find ourselves challenged by a broad societal shift, whereby so much discourse seems to be conducted as confrontation. As the right reverend Prelate the Bishop of Birmingham observed, it is not just about the views that we hold but about how we conduct ourselves. So, how do we shift ourselves away from the attitude of “How can I win?” to an attitude of how do we, as a collective, win? How do we balance freedoms with a sense of personal responsibility? How do we ensure effective statutory protection from offensive behaviour? These are all questions that we will continue to have to answer in today’s society.
Freedom of speech is part of a wider concept of freedom of expression, and we should remind ourselves that this includes freedom of the press, the right to petition the Government and freedom of political association. It is widely recognised as an essential foundation of a liberal, democratic society, and as we have the blessing to live in one such society, there is of course a great tendency to take it for granted. As the noble Baroness, Lady Falkner, observed, those coming to these shores are acutely aware that this is a precious gift to be treasured, and we can learn much from this.
The United Nations 1948 Universal Declaration of Human Rights, the anniversary of which we celebrate today, recognises freedom of expression is a fundamental human right to be universally protected. Article 19 reads:
“Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive, and impart information and ideas through any media and regardless of frontiers.”
Yet this freedom is not an unrestricted right. The European Convention on Human Rights, adopted in 1950, was explicit that the right may be limited by law and added the caveat that restrictions may be imposed for a variety of reasons, including to protect the rights of others, something that has come through loud and clear today.
Of course the Joint Committee on Human Rights summarised what this has come to mean in the UK: everyone has a right to free speech within the law, and, unless it is unlawful, speech should usually be allowed. So we have a strong statutory framework in this country, yet we find ourselves in a situation where the reality and practice is rather more testing for us. I certainly look forward, as I know your Lordships’ House does, to the report of the Joint Committee on the Draft Online Safety Bill, as so tantalisingly promised by my noble friend Lord Stevenson. This report will indeed help us to navigate the way ahead.
My noble friend Lord Griffiths, the noble and right reverend Lord, Lord Sentamu, and many other noble Lords—unsurprisingly in this debate—spoke of the importance of faith and morality, while the noble and learned Lord, Lord Brown, spoke of what it is like to experience anti-Semitism as someone who is Jewish. I feel moved to add that hatred towards Jews does not require a Jewish person to even be in the room. It is the world’s oldest hatred and, like so many hatreds, can express itself behind the cloak of free speech. It gives free speech a bad name; it is hatred, pure and simple. As I am the former chief executive of the Board of Deputies of British Jews—the organisation that represented the Jewish community in this country— I know only too well the importance of calling out wrongs wherever they come from and whoever peddles them. I know the value of bringing clarity to guide where there may be ignorance and to bring transgressors to book where hatred raises its ugly head.
As we consider today the role of public, private and civil society in the upholding of freedom of speech, I want to refer to the working definition of anti-Semitism, as laid out by the International Holocaust Remembrance Alliance, and adopted by Governments, universities, sports clubs, councils, organisations and many others across the UK and indeed across the world. It helps us to guide and confirm for us what is and is not anti-Semitism—something raised by the noble Lord, Lord Singh. For example, when talking about criticism of Israel, the definition says that:
“Manifestations might include the targeting of the state of Israel, conceived as a Jewish collectivity. However, criticism of Israel similar to that leveled against any other country cannot be regarded as antisemitic.”
So, what is anti-Semitic? It is, as the definition states—I find the examples extremely illuminating—
“Applying double standards by requiring of”
Israel
“a behavior not expected or demanded of any other democratic nation … Drawing comparisons of contemporary Israeli policy to that of the Nazis … Holding Jews collectively responsible for actions of the state of Israel.”
I mention this definition as an illustration to assist us. As we go forward, I hope that we can be bold in offering protection through clarity and a determination to say what is right and what is wrong. I know that this House will play its part.
I am aware that ongoing attempts by some to promote culture wars are doing little to help move society in the right direction. Rather than bringing people together, it puts communities at odds. Again, as my noble friend Lord Cashman, observed, when the rights of one minority are infringed, it is not long before the rights of other minorities and groups are infringed. So we are indeed all in this together, even though some may seek to pitch us against each other.
I welcome the previous Labour Government’s action in enshrining the European Convention on Human Rights in domestic law via the Human Rights Act, ensuring protection for freedom of expression while making it clear that such freedoms are subject to certain constraints and responsibilities, including protections against hate speech. It is vital that we do not give houseroom to any notion of scrapping the Human Rights Act, which would open the door to a fundamental rewriting or reinterpretation of convention rights.
The most reverend Primate has spoken previously of the need for people to disagree well; we need to challenge each other, lest we end up so firmly in our own bubbles that we are unable to relate to each other. However, it feels as though societal division has increased rather than improved. It has certainly not been our greatest hour as a society to see and hear the nature of debate on issues such as Brexit and Covid. This will not be the first or last time that political topics divide people from their families and friends, but it does feel as if people’s views are so deeply entrenched these days that relationships are being needlessly destroyed purely because of differences of opinion.
On Brexit, there was the toxicity of the campaign, which focused constantly on immigration and misleading claims—for example, potential Turkish membership. There were also the media headlines, which screamed, among other things, that judges were to be seen as the “enemies of the people”. This toxicity infects the very nature of society in the way it pits person against person and throws away regard for institutions that protect our way of life.
On Covid, freedom of speech and thought is one thing, but the sight of anti-vaxxers screaming in the faces of children outside school gates is surely a bridge too far. The peddling of conspiracy theories on social media, of which the noble Baroness, Lady Kidron, spoke, threatens the health of people as well as the health of our democracy.
We have a responsibility to support the true worth of freedom of speech, while having the courage, insight and determination to put all that we need to in place to protect those who need protections and to allow our democracy to thrive. These are responsibilities from which, I am sure, your Lordships’ House will not shy away.
The Parliamentary Under-Secretary of State, Department for Digital, Culture, Media and Sport (Lord Parkinson of Whitley Bay) (Con)
My Lords, I am very grateful to the most reverend Primate for giving us this important and, if I may say so, enjoyable debate. As he said, this is a return to tradition for your Lordships’ House—a tradition which, as a relative newcomer, I have not had the privilege of participating in before.
This debate is on a fundamental issue. Without freedom of speech and open debate, no other question can be adequately settled. It is a debate that is both ancient and timely. These are age-old questions, and noble Lords have pointed to many examples down the ages where society has grappled with them. However, we are beset by contemporary challenges, as the most reverend Primate’s Motion draws our attention to. He outlined three threats in particular: the fear of reprisal, the distortion of truth and the dehumanisation of those with whom we disagree. All seem to be growing.
Free speech seems to be more complicated than ever. Many more people are involved in the conversation, and debates seem to happen with the fast-forward button on. Previously, they were curated in fora such as this, with parliamentary privilege and the mandate of election or a Writ of Summons, in academia with challenge from examiners or peer review, and in books and newspapers with selection by publishers or editors and rights of reply. Social media has changed that; as the most reverend Primate said, we are increasingly our own curators, editors and publishers.
Anyone with an opinion, however crass or simplistic, can express it, and anyone can engage with it. Those with fringe opinions can find like-minded people and caucus to amplify their voices. The powerful and mighty can be challenged and mocked in full public view. I have tried to state these changes neutrally, for they have both good and bad consequences, but they have changed the way we engage in public discourse—as have the algorithms which funnel us into silos and echo chambers and the fiat of online platforms over the content they do and do not allow, as the noble Lord, Lord St John of Bletso, mentioned.
The most reverend Primate cited Timothy Garton Ash’s three vetoes: that of the heckler, the offensiveness veto, and that of the assassin. To begin with, I might say something about our work as a Government to overcome each of these.
The voices of the heckler are heard most loud online, and the online safety Bill, which has been mentioned by many noble Lords, will tackle abuse while upholding the right to free speech. As noble Lords reminded us, it is before a Joint Committee for pre-legislative scrutiny. I agree with the noble Lord, Lord Stevenson of Balmacara, that today’s debate, particularly the speech of the most reverend Primate, is essential reading for the members of the Joint Committee.
That Bill will usher in a new era of accountability for tech companies, upholding free expression and pluralism online. All platforms in the scope of the Bill will need to consider and implement safeguards for freedom of expression when fulfilling their duties. Although companies must take robust action to tackle criminal activity, in order to protect free speech regulation will not require the removal of legal content, nor prevent adults accessing or posting legal content. Platforms will therefore not be able arbitrarily to remove harmful content. They will need to be clear what content is acceptable on their services and to enforce the rules consistently. Services that are high risk and high reach will have additional duties to protect democratic and journalistic content, and must consider whether the public interest in such content outweighs the potential harm it can cause.
The noble Baroness, Lady Kidron, the right reverend Prelate the Bishop of Oxford and others spoke about our particular duty to the most vulnerable and to children. The strongest protections in the Bill will be for children. Our aim is to make the United Kingdom the safest place in the world to be a child online.
I also agree with the noble Lord, Lord Stevenson, about the challenges of the disappearing record of the internet. The historian in me worries about the archives of the future and the material that will not be available to those who look back on our era. It also has an impact on the way we conduct ourselves and post such content: if we think our comments are ephemeral then perhaps we do not give them the weight and consideration they deserve. I would be very happy to speak to him about that further.
The second veto is that of offensiveness. There is no right not to be offended. Increasingly, we hear people asking for views not to be aired because they make them feel unsafe or uncomfortable. As the most reverend Primate says, a duty lies on the speaker to be fitting in what they say, but that is, in the most part, a moral duty rather than a legal one. There is a duty on the listener too to understand that the offence they take may not be shared by everybody and to allow a range of views to be heard.
History is littered with examples of what happens when we do not air dangerous views in the open and confront them head on. I agree with the noble Baroness, Lady Merron, the noble and learned Lord, Lord Brown of Eaton-under-Heywood, and others in their comments about the evils of anti-Semitism. Dangerous views fester in the darkness and grow more dangerous still.
I was very glad that the noble and right reverend Lord, Lord Harries of Pentregarth, pointed to the statue by Martin Jennings of George Orwell outside the BBC’s Broadcasting House and the quotation from that author, which is worthy of repeating:
“If liberty means anything at all it means the right to tell people what they do not want to hear.”
Perhaps nowhere is that more important than in the academy. Many noble Lords spoke of free speech in higher education, citing a number of instances; I hope they will forgive me if, under the pressure of time, I do not dwell on each one.
I certainly agree with the noble Baroness, Lady Falkner of Margravine, that one of the important roles of our universities is to build resilience, so that people are equipped to engage with ideas in later life, including those with which they disagree, if people feel unsafe listening to certain speakers, reading broadsheet newspapers, or even listening to debates in your Lordships’ House and in Parliament. That is why the Government have brought forward the Higher Education (Freedom of Speech) Bill. We are clear that higher education providers in England must have a duty to ensure that freedom of speech within the law is secured for students, staff and visiting speakers. Academic staff must feel safe to question and test received wisdom, and to put forward new ideas and controversial or unpopular opinions without the risk of losing their jobs, their privileges or their chances of promotion. The noble Baroness, Lady Falkner, cited the list in Prospect magazine of the many academics who pointed to the treatment they received and the fears they have as evidence that this is, I fear, a growing problem on campus.
My noble friend Lord Sandhurst alluded to the proposed new code at the University of Cambridge, which was rightly amended following a campaign by many members of that university, including the noble Baroness, Lady Smith of Newnham. We should tolerate the views of others, but while we should always endeavour to engage respectfully, we should not be forced to respect views with which we disagree. A key sentiment that has come through in noble Lords’ speeches today is that we must be free to disagree well. Following on from the comments of my noble friend Lord Hannan, I disagree with many of my friends—they certainly disagree with me—but it is important that we can maintain friendship and respectful debate while disagreeing.
I must briefly pick up on the comments of my noble friend Lord Sandhurst. He mentioned the row about Andrew Graham-Dixon. That was actually at the Cambridge Union, not the Oxford Union, an older and more distinguished society and one where, I am happy to say, the issue was quickly overcome.
The third area of veto is that of the assassin, whether literal or the challenges of violence that so many face. We see that in those who defend our open media at home and around the world, as the noble Baroness, Lady D’Souza, highlighted in her contribution. It can be seen in the award of this year’s Nobel Peace Prize to Maria Ressa and Dmitry Muratov, the first journalists to receive it since 1935. Their recognition also served to underline that many jurisdictions have taken the opportunity of the pandemic to strengthen their already repressive machinery to reduce freedom of speech and critical voices.
The UK has a long and proud history of promoting freedom of expression globally, underpinned by our commitment to the Universal Declaration of Human Rights, which was signed, as noble Lords have rightly noted, 73 years ago today. We remain a co-chair, with Canada, of the Media Freedom Coalition, which is taking action to defend media freedom, including through statements on the deteriorating situation for organisations in Egypt, Belarus, Hong Kong and Russia. Ensuring that the global news industry not only survives but thrives is an essential part of our development work. The UK has provided more than £400 million of official development assistance to support global media outlets in the past five years, and we are proud of our commitments there.
These reflect our long-standing commitment to freedom of the press at a domestic level. The UK is rightly proud of its fine global reputation, underpinned by a common recognition across society that freedom of the press is fundamental to a healthy democracy. The Government do not—and will not—intervene in what the press can and cannot publish, as long as it abides by the law of the land. What we can and must do is support the efforts of those who hold the powerful to account. To that end, the UK has set up the National Committee for the Safety of Journalists, and we have published a National Action Plan for the Safety of Journalists, setting out concrete initiatives which will provide genuine support to journalists facing both abuse and threats to their personal safety as well as encroachments on their freedom of expression.
Another area in which we are tackling violence and intimidation is through the Elections Bill, which is guided by the Government’s determination to ensure that our democracy remains secure, fair and transparent. We are the stewards of a fantastic democratic heritage which we must secure and cherish in our age. British democracy has always been robust and oppositional. Critical debate is a fundamental part of it, but a line is crossed when disagreement mutates into intimidation and abuse. In particular, intimidating someone into changing their vote or abstaining from voting is unacceptable and strikes at the very heart of our democracy. That is why a new electoral sanction against intimidation, effective all year round, will protect candidates, aspirant candidates, campaigners and elected officeholders from intimidation on and offline.
When I first saw it, I thought there might be an omission in the most reverend Primate’s Motion, although I am glad to say that there was not one in his speech. He talks of the role of public, private and civil society sectors in overcoming the challenges to freedom of speech, but there is a role for individuals too—for each and every one of us. Free speech, as he says, should be fitting speech: we must choose carefully the words we use. We cannot legislate ourselves, as he says, to good behaviour. The most reverend Primate rightly paid tribute to the way we do that in your Lordships’ House. Today’s exchanges have been a case in point.
I will take the opportunity to speak a little about my portfolio and talk about the arts as another vital means of free expression—for art is about ideas, emotions and identity. It is a way of seeing the world through others’ eyes, down the ages and across the globe. Because of this, art is often controversial, and rightly: it should provoke us, confront us and challenge us to think anew. Politicians are often asked their views on these controversies, and of course they have a right to engage in the debates that artists provoke as much as anyone else. My approach so far, which I hope to maintain, is to try to see the work of art in question before commenting on it. Context and nuance are essential, and dialogue and debate rely on both sides to engage faithfully and with open minds.
Art can illuminate the big questions that face us, such as the one that we are debating today. The Turner Prize was awarded earlier this month in Coventry, City of Culture. The winner was the Array Collective, a Belfast-based group, which won with an installation of a pub, bedecked with banners and placards representing some of the most thorny and emotively charged debates of our age: on abortion, gay rights, race and gender. But perhaps the most important message was conveyed in the list of pub rules inside that pop-up pub. These included the entreaty that, while debating these issues, you must have a laugh. In a part of our country that knows all too well the dangers of sectarianism and what happens when open debate is replaced by the violence of the bomb and the gun, how powerful and necessary it was to see a work of art that champions the shared spaces where we can talk and disagree in an open, welcoming and good-humoured way. I congratulate them on their win.
Last night, I had the privilege of attending the opening night of “Best of Enemies”, the new play by James Graham—a shrewd and sensitive chronicler of our age—at the Young Vic. It concerns the televised debates in 1968 between Gore Vidal and William F Buckley Jr. It contains so many of the themes that we have touched on in our debate today: the polarisation of political debate; the role of the media in shaping and mis-shaping that; questions of race, sexuality and national identity; and the role and challenges of political protest—in this case, the clashes on the streets of Chicago during the Democratic National Convention. Half a century on from the events in that play, the questions that it poses us are as arresting and important as ever. I warmly encourage noble Lords to go and see it.
Like every aspect of public discourse, art benefits from a wide and diverse range of voices and views. That is why it is so important that previously marginalised groups are given the chance to tell their stories and make their voices heard. That is why we must all have the humility and open-mindedness to re-examine our convictions, however long or earnestly held, in the light of new insights and perspectives. That is why we must also protect those who express heterodox views as well as those who defend or reflect old orthodoxies. I was especially pleased to hear my noble friend Lady Sanderson of Welton drawing attention to the concerns expressed by Dame Rose Tremain and Sir Kazuo Ishiguro, who have done so much to understand and increase our wider understanding of people with experiences far removed from their own.
I have already had some illuminating and thought-provoking discussions with people working in different parts of the arts, for this is a growing and impassioned area of debate. Just a few days ago, I saw that Eddie Redmayne wondered, with great care and reflection, whether he would play the role of a trans woman today, as he did in “The Danish Girl”. For my part, I am glad he did, for I thought that he did so with great sincerity and brought to wider attention the experience faced by trans people. Like the noble Lord, Lord Cashman, I think that we benefit from trying to walk in the shoes of others. But what matters is not just who tells the story but how they tell it—the research that they do and the spirit in which they do it—and I agree with my noble friend Lady Sanderson that we need to hear more voices and an ever more diverse range. The answer lies in addition, not subtraction.
If there is any institution that knows the difficulties and the importance of championing the orthodox and the unorthodox, it is the Christian Church. As I say, today’s debate is part of an Advent tradition—the season in which we await the arrival of that great disruptor, the child who would go on to rebuke the Pharisees, draw the ire of the Roman Empire, and inspire the devotion of new followers for more than two millennia. We have heard from noble Lords of all faiths and none but, because that is the reason that the most reverend Primate is here in your Lordships’ House and has been able to give us this debate, this is an appropriate point with which to conclude my remarks. I thank all noble Lords who have taken part in this debate.
The Archbishop of Canterbury
My Lords, by the grace of God my voice is giving out entirely. It is 2.05 pm and I will be relatively brief. We have just heard an absolutely magnificent summing up from the Minister. He has saved me a lot of time in following that. I will just pick up some basic principles that seem to have come out of what, to me, has been a remarkable debate. Not a single speech has failed to attract a lot of notes in my notebook. It has been an extraordinary contribution by a wide range of very wise people.
It is a fortunate coincidence, and particularly fitting, that this is international Human Rights Day. It is also clear—I had not added it up in my mind—that not only do we have the report on online safety coming, as the noble Lord, Lord Stevenson, pointed out to us, but we also have a whole rank of legislation to which the principles we have talked about today will be applicable. I will come back to that in a minute.
I will draw on some things that seem to have been brought out. The noble and right reverend Lord, Lord Harries, and other noble Lords quite rightly emphasised the importance of truth. That centrality of what we are trying to arrive at—a truthful, generous and just society—is at the heart of what we are doing.
The noble Baroness, Lady Stowell, referred to many of the institutions, some of which she has headed, that have a role in regulation in our society. I agreed entirely with her very good speech. My only question was when she said they should not be political. I say that all existence is political. They should not be partisan, but I suspect she was using the word in the way I use “partisan”. It was very helpful as she went through those things.
The importance of truth is first. Second is the importance of debate and reason. Many things have been raised here, so I will skip over most of my notes. I simply say that I was deeply moved by the long list from the noble Baroness, Lady Jenkin of Kennington, of those who have suffered from the intolerance that many have been going through, particularly those such as JK Rowling and many academics. That is a principle we have to bear in mind as we go forward.
Third is the recognition of power. My right reverend friend the Bishop of Oxford did an extraordinary job outlining what I had referred to too briefly in my opening speech as the commodification of freedom of speech. His expertise in that area is very important. Particularly, he drew out the fact that algorithms come from money and profit. They are driven more by hatred than by politeness and courtesy.
I was particularly struck by the remarks of the noble Lord, Lord Hannan, about generous listening. I thought that was a powerful phrase, because generous and careful listening undermines power differentials. Talking of power differentials, the noble Baroness, Lady Jones, was not allowed to speak from these two Benches yesterday. I am not allowed to speak from any Bench apart from these two, so I am more persecuted than she is. I am kidding. Archbishops of Canterbury are never persecuted—although they are occasionally executed. What the noble Baroness, Lady Uddin, said about power was extraordinarily powerful. I took extensive notes and will reflect on them at some length.
Fourthly, on equipping and training for free speech, the noble Lord, Lord Sandhurst, spoke eloquently and powerfully about the danger of safe spaces. The only quibble—it is a quibble—I would make is that the term “safe spaces” is misused. There are plenty of safe spaces that are designed as such. Think of what the noble Baroness, Lady Merron, said in her summing up: a Jewish society at a university is not obliged to invite people who deny the Holocaust. It is a safe space from that point of view. Debating societies remain safe spaces because they have rules about the quality of debate. This place is a safe space because it has rules about what you can and cannot say. If I were to say what I thought about the right reverend Prelate the Bishop of Barchester—that I believe he is a drunken, cowardly sot—I would rightly, if he existed, be picked up almost immediately. There would be cries of “order” all around and I would be asked to withdraw. That makes this a safe space. Safe spaces can exist without restricting freedom of speech. However, we need to equip and train people for freedom of speech. I draw your Lordships’ attention to the rules of the University of Chicago on freedom of speech; google it and you will find a fascinating account of how, for more than 100 years, it has been one of the formative principles of that university. It is well worth looking at.
Fifthly, we need to challenge. We need the importance of truth, debate and reason, the recognition of power, equipping in training and the challenge of vetoes and assassins—of the tendency to kill, coerce and cause to flee. The noble Baroness, Lady Merron, was particularly powerful on this in what she said about culture wars and toxicity. We met each other when she was running the Board of Deputies; the Church of England has also signed up to the IHRA, just so you know. I am sure that she knew that already but it was not mentioned. Noble Lords know the old rule: everything has been said but it has not all been said by me.
I was particularly moved by the characteristically generous and thoughtful speech of the noble Lord, Lord Singh. His call to move with the times as a way of avoiding the toxicity of culture wars was very powerful indeed. In moving with the times, I come to the question of the church of St Mary the Virgin in Teesdale, raised by the noble Baroness, Lady McIntosh. I hear from the right reverend Prelate the Bishop of Durham that there has been no decision to close it yet. There will have to be a lengthy consultation. When we do consultations in the Church of England, we think in centuries, sadly.
Sixthly, I hope that the Government will reflect on the principles that have been so wisely shared across this House as they bring forward the legislation they are bringing forward at the moment. I hope that there are ways of testing the quality of that legislation, because this is not purely political. All these subjects, including in the PCSC Bill, are extremely difficult to legislate on. May these principles, which have been so widely brought out, be the principles on which we do our legislating. They include others that I will just mention in a few sentences.
The noble Lord, Lord Cashman, talked about the way we label for exclusion. I have talked about anti-Semitism and picked up what the noble Baroness, Lady Merron, said. My final point comes back to what the noble and right reverend Lord, Lord Sentamu, said about the importance of law. That is why we must bring this debate together with the legislation because, as he quoted from two books I have also read by Law Lords, I recognise the centrality of that in expressing in words what we hope to develop in attitudes.
Finally—genuinely finally—I was deeply touched by the stories that the noble Lord, Lord Cormack, told about his friendships with people with whom he disagreed almost entirely. At the heart of freedom of speech is the interlinking between freedom of speech, just and generous communities and healthy relationships across our society. He brought that out wonderfully. I am sure that when we take up the offer of the noble Lord, Lord Griffiths, of a series of lectures, he will be able to expand on that better than I ever could. Once again, I thank your Lordships for an absolutely wonderful series of speeches. I am deeply grateful for your taking time on a Friday and I will not detain you any longer.