Community Debt Advice Services

Debate between Hannah Bardell and Emma Hardy

Wednesday 1st December 2021 Westminster Hall

[Emma Hardy]

I thank my right hon. Friend, who has been campaigning on this issue from the very beginning. He is absolutely right: all the forecasts—all of them—show that demand for debt advice will only increase. We know that. We also know that cases can be complex and that it can sometimes be the first time that people have got into debt. So the idea that we would cut face-to-face advice at this time seems incomprehensible.

Under the new tender, MaPS will instead have three national contracts. Its staff met me—I credit them for that—and said that these will be a mix of face-to-face, digital and phone services, with one each for the north, the midlands and the south of England, and a separate arrangement for a national call centre. However, three regional contracts, instead of nine smaller ones, as it was before, means that small, local providers that currently rely on MaPS funding for the bulk of their income face having to drop face-to-face services or close entirely. Many already know that they are not included in tender bids because they do not have the size or resources to compete individually for these tenders. Sylvia Simpson, chair of the Leeds Debt Advice Network, described the impact as “catastrophic”, with three out of four local MaPS-funded debt agencies no longer able to provide debt advice after 31 March. There are serious doubts about the rationale for the decision to restructure funding. Where is the evidence to support it and its timing? Does MaPS have confidence in the outcome itself?

Debt advisers tell me that there has been no proper consultation. In the face of the national outcry from debt advice organisations, charities and trade unions, MaPS issued a two-week call for evidence concerning the impact of the covid-19 pandemic on access to debt advice. That concluded on 29 October, but the procurement exercise for the new contracts had already taken place. The consultation will not influence a procurement process that has already gone on, so what was its purpose? It is clear that the procurement exercise expected bidders to focus on digital and telephone-based services rather than face-to-face services, despite MaPS’ own evidence showing that demand for face-to-face services was almost double supply.

A 2019 MaPS assessment of the need for debt advice said:

“Face-to-face is the channel with the smallest gap between demand and supply at the national level. Nevertheless, the levels of unmet demand are high, with demand being over two times higher than supply. It is also the channel with the biggest variation in unmet demand between countries and regions. Face-to-face unmet demand is particularly high in London, where existing supply of face-to-face debt advice could meet only just over a fifth of current demand.”

MaPS does not seem to have evidence that the need for face-to-face services will fall. On 29 November, in reply to a letter sent on 16 November from the Chair of the Treasury Committee, the right hon. Member for Central Devon (Mel Stride), MaPS provided figures showing that, for the last pre-pandemic year, 2019-20, face-to-face services accounted for 34% of its consultations. That fell by only 3 percentage points, to 31%, in 2020-21, despite the fact, let us not forget, that this was during a global pandemic that involved lockdowns, compulsory mask wearing, the adoption of social distancing and people being afraid to leave their homes. Despite all that, the demand for face-to-face debt advice fell by only three percentage points. In its letter to the Treasury Committee, MaPS notes that its most recent modelling of future demand is from autumn 2020 which, as we will remember all too well, was just before another national lockdown and before the pandemic’s third wave brutally hit, killing thousands of people in our country. That is when the modelling was done. MaPS does not say whether the modelling includes the impact of the pandemic, but I think we can assume it probably did not.

On the importance of face-to-face appointments, MaPS said that the forecast

“did not make distinctions between case complexity or channel of provision.”

If someone has a simple debt inquiry, they would probably google it and look on a website, or they might phone someone up and check. If their case is extremely complex—I refer to my earlier points on domestic abuse, mental health and such concerns—accessing a website is not going to be suitable. MaPS needs to be looking at complex cases and how it provides support.

In other words, the modelling does not tell MaPS how much demand for face-to-face appointments to expect, and the contract does not give it control over how much can be provided. MaPS claims that changes will increase accessibility to advice in those difficult-to-reach places, but those changes could mean the opportunity for face-to-face advice would no longer exist in some areas of the country. I accept—I was discussing this point with the Minister earlier—that some areas could end up with more access to advice, but that is at the expense of other areas.

In the letter, MaPS mentions an equalities and vulnerability impact assessment. That has not been made available and I hope the Minister is able to use his influence to say to MaPS that it should be published. At the moment, MaPS is saying to me, “We do not know, because we are still commissioning. We are not sure how much will be face to face; we are not sure how much will be on the phone or remote. We haven’t made any decisions.” If that is true and it does not know where it is going to end up, how can it have done an equalities and vulnerability impact assessment? When MaPS has made up its mind about what it wants, I assume another impact assessment will be needed. I hope that one is made public.

I hope I have explained clearly why face-to-face advice is the only way of supporting a significant proportion of people in debt, and why a reduction in capacity and coverage will fail some of the most vulnerable in our society. I hope that MaPS does more to reach out more effectively to practitioners with a lifetime of experience and knowledge in the field. Debt advice groups such as AdviceUK believe that MaPS’ vision for debt advice is deeply flawed, does not meet the needs of the diverse communities across England and does not enable the provision of flexible, in-depth and sustainable debt advice services.

MaPS cannot explain why it has made the funding allocations it has done or what impact they will have on people with complex needs. Of course, the pandemic has been a huge disrupter. Its effects are still being played out and the future remains hard to predict, but we do know that there will be an increase in the number of families in debt. We know that we are only beginning to see the devastating impact of the cost of living crisis. I hope the Minister is able to use all the influence he has—accepting, of course, that MaPS is a separate organisation and that this is a commercial contract—to call on MaPS to place an immediate hold on the procurement of new debt advice contracts, pending a thorough and effective consultation into the likely demand for face-to-face services in the near future; and to insist that there should be no loss of debt adviser jobs and an increase in funding for community-based face-to-face services. Consultation with frontline advisers through their trade union should also be essential for all future decisions affecting jobs and service delivery.

I finish by reminding the Minister of my earlier comment: more than 100,000 people attempt suicide each year because of debt. The services these organisations provide can literally be life-saving. Having the right debt advice is too important to get wrong.

[Hannah Bardell (in the Chair)]

I now call the chair of the all-party parliamentary group on debt and personal finance, Yvonne Fovargue.

Independent Medicines and Medical Devices Safety Review

Debate between Hannah Bardell and Emma Hardy

Thursday 8th July 2021 Commons Chamber

[Emma Hardy]

Absolutely. One of the points that I will come to later is that people who have had rectopexy and hernia mesh implants have also been badly affected.

The recommendation that I want to focus on is the one that requires immediate action from the Secretary of State to set up an implementation taskforce to oversee the progress of the other eight recommendations, and to offer a timeline for the actions. Unfortunately, the Government declined the recommendation and instead offered the creation of a patient reference group to

“ensure that patients voices are heard”.

With respect, patients’ voices have been heard in the Cumberlege report. We already know that women are not listened to in the healthcare system. We need action to change that, rather than another review kicking the can down the road. I would be interested in hearing from the Minister how the Government intend to ensure that women’s voices are placed at the centre of their treatment when the patient reference group publishes its report.

[Hannah Bardell (Livingston) (SNP)]

Like others, I thank the hon. Lady for securing this vital debate. Does she agree with me that we need to encourage women to speak up and to support them to deal with their own health issues, but that comments made by some in Government recently that it is down to women individually to speak up can be unhelpful? We have to see this through the lens of the institutional challenges that women have faced for decades. Although we need to celebrate our clinicians, we really need to do more to educate them and give them resources and support to ensure women are not treated in the way the hon. Lady is describing.

[Emma Hardy]

I thank the hon. Lady for her intervention and I agree with her absolutely, which brings me on to the point about the redress agency, which is one of the recommendations in the report that has been rejected. Instead, the Government have said:

“The government and industry have previously established redress schemes without the need for an additional agency.”

That goes to the point that she made, because this puts the burden of redress in entirely the wrong place: on the victims, not on those responsible. Seeking redress requires enormous effort on the part of those who are already suffering, not just financially but emotionally, as was set out in Baroness Cumberlege’s report. It recommends that without waiting for the establishment of a redress agency:

“Separate schemes should be set up for each intervention…to meet the cost of providing additional care and support to those who have experienced avoidable harm”.

Sadly, no such moves have been made, so I would be interested if the Minister gave an indication of the progress on such schemes.

The report also recommends transparency on payments to clinicians, with a UK-style Physician Payments Sunshine Act 2010 to require the mandatory reporting of all payments made to doctors, teaching hospitals, research institutions and charities. The Government’s interim response said that they would “consider” this recommendation, in discussion with other parties, including the General Medical Council. I understand that there are suggestions that this could be done by expanding the voluntary system of reporting, but, as we have seen, voluntary systems simply do not work.

By way of a quick example, a high-profile academic recently admitted that he had failed to declare £100,000 from the manufacturer of one of the types of vaginal mesh implants that he was assessing. He has now published a correction, but this is almost seven years after he first did his report and it came only after a complaint was made about him. A section 60 order in the Health and Care Bill would allow for legislation to cover this, because transparency is vital to patient safety. There should be no opportunities for payments made by industry to introduce bias into prescribing or the scientific literature that is used to inform our National Institute for Health and Care Excellence guidelines. This report recommended creating a database to record which device was used when, in which person, and what the outcomes were in terms of safety and patient feedback.

The roll-out of the medical device information system has begun, but questions are arising as to what data is being collected. This is really important. To give an indication of that, let me raise the case of Kath, an extremely fit and healthy woman who used to be interested in skydiving. She had mesh implants and afterwards was in such pain that she was unable to move or get out of bad. This completely changed her life forever. However, her procedure was recorded as a success because she no longer had incontinence and that was the measure being looked at. We need to be looking at all patient outcomes when we are recording that data in those data sets.

That brings me on to my next point, which relates to the current moratorium on using mesh, as recommended in the report. Kath has said that there is no way she would ever have had this procedure had she had any indication of the risk of harm. I understand that there is pressure from some of the surgeons to reintroduce mesh, but I do not believe we can do that without fully informed consent, and we can have that only if patients are fully aware of all the risks. They can be fully aware of all the risks only if all the data is collected and recorded accurately. Until that is done, we cannot have informed consent and we should not consider lifting the moratorium on the use of mesh implants.

Cervical Cancer Smear Tests

Debate between Hannah Bardell and Emma Hardy

Monday 28th January 2019 Westminster Hall

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Roger. I thank everybody who signed the petition and all the women who have come to listen to the debate. I know that getting down to London can be quite tricky—I say that because I come from Hull—so I thank them all for coming.

I agree that having a smear test is not pleasant, but I think that we would all agree that it is crucial. While we are in a sharing mood, I will share a little bit with you all as well. I too had abnormal smear tests and was found to have pre-cancerous cells when I was in my early 20s. I had just finished university and decided to move to Leeds to spend time with my sister. It was fine, because I had the biopsy and—they had to remove the cells—went through the various bits and pieces of the operation. Since then I have been on a yearly recall, so I have had so many smear tests. Every time I ask whether I still need to be on a yearly recall, they say, “We’ll let you know,” and then the following year I have to go back. I am due to go back again, so this debate has prompted me to pick up the phone and arrange that.

I did not take my mum with me to that procedure, because unfortunately she was unable to come, so I took my sister, who is five years younger than me —I was only about 21 or 22. The experience of coming in to watch terrified her; she was there to offer me moral support, but I found myself reassuring her throughout my operation, saying. “Don’t worry; it’s fine. I’m perfectly okay.” I think that we should be a bit more open and honest about these things.

We should also do the brilliant thing that we all do when we get a little embarrassed: laugh about it, because it can actually be quite comical. As I said, I have had so many smear tests, and when my friends are worried about them, I joke about the ridiculous, small piece of blue towel that is meant to preserve our modesty. The midriff is hidden by the piece of blue towel while all the rest is exposed to the world—that is funny. It was also quite funny when, not long after being elected, I was lying there and someone asked, “Are you our local MP?” I said, “Oh, yes. I am.” We then proceeded to have a conversation about how I was finding life at Westminster. I said, “Well, slightly more comfortable than this, thank you very much!” We should find those things funny and we should laugh.

While I am in the sharing mood, I have a little tip for all the women out there. If, like me, they suffer from a hidden cervix—apparently mine is quite shy—a towel or cushion under the bottom lifts it up so it comes into view. That is a little bit of health advice while I am here.

In all seriousness, there is a growing problem. In Hull, the figure for women having smear tests has dropped to only 73.1%—that is a huge fall. The figure is slightly higher in East Riding, at around 78%, but that is nowhere near the 80% for which the NHS is aiming. I echo the words of all hon. Friends and hon. Members who have spoken when I say that the Government need to conduct some kind of survey to find out why. Is the problem, as my hon. Friend the Member for Warrington North (Helen Jones) said, that women associate smear tests with sexual activity? Do they think that they have no need for one? Do their working hours mean that they are not able to attend tests? Let us find out and make life that bit easier for all of them.

We know, when looking at the NHS cure rates, that 92% of those whose cancer was detected are cured. That is wonderful. I cannot possibly say what would have happened to me had mine not been removed—I do not know. I am here today, all is well, and I will book my next smear test. Some 66% of all those diagnosed after developing symptoms are also cured. We need to do more to push that message out to people and get rid of the myths. I absolutely support what my hon. Friend the Member for City of Chester (Christian Matheson) said in his beautiful speech about the importance of reducing the age to 18 under a doctor’s advice.

I have been involved in a campaign for teaching menstrual wellbeing in schools, on the education side of the issue, because I am not sure that everybody understands what the abnormal signs or symptoms are. I became involved in the campaign through my support for the charity Endometriosis UK, but I think that removing the taboo around periods, smear tests and so on would also help a lot of people. We must start talking in schools about menstrual wellbeing, what normal and abnormal periods are, and what normal and abnormal symptoms are. If we start to have that conversation, we will give people the language and ability to talk about the matter without feeling really shy and saying, “I’ve got a problem with my—I can’t say the word.”

We should be able to talk about it, which reminds me of a brilliant story. When I was doing a radio show for my campaign on vaginal mesh, I spoke to the show’s producer before I was due to speak live. He said, “We’re very supportive of the campaign, but it’s a breakfast show, Emma, so could you not say the word ‘vagina’?” I therefore spent the entire interview talking about problems with “mesh” that was “in” women’s bodies. We need to dispel all of that nonsense and shyness and start being a little more open, and I implore the Minister to work with the Schools Minister in support of my call for menstrual wellbeing to be taught in schools.

[Hannah Bardell]

I absolutely agree with the hon. Lady about how, for some reason, we cannot talk about parts of our bodies at that time in the morning. In the same way, I still find it incredible that adverts for sanitary products depict women’s period blood as being blue rather than red. I do not know about anyone else, but I have never bled blue in my life.

[Emma Hardy]

Perhaps that is the royal family only. The hon. Lady is absolutely right. For years I was convinced that if we used Tampax, it would suddenly make us fitter, more active and able to roller-skate—[Laughter.] Sorry, we are descending into farce.

On a serious note, I ask the Minister, please, to look at what my hon. Friend the Member for Warrington North said about lowering the age to 18 when doctors give a recommendation. I also ask him to support my call for menstrual wellbeing to be taught in schools, and to have a wider survey into understanding why people are not attending tests, so that we can do something to change that for the future.