Westminster Hall

Thursday 31st October 2019 Westminster Hall

Thursday 31 October 2019

[Sir Henry Bellingham in the Chair]

E-cigarettes

Thursday 31st October 2019 Westminster Hall

13:39

[Norman Lamb (North Norfolk) (LD)]

I beg to move,

That this House has considered the Seventh Report of the Science and Technology Committee, Session 2017-19, E-cigarettes, HC 505, and the Government Response, Cm 9738.

It is a pleasure to serve under your chairmanship for the very first time, Sir Henry, in my last appearance in this Chamber, and it has been a pleasure to have you as my constituency next-door neighbour for the last 18 years. I am pleased to have secured a debate on this important work undertaken by my Committee before this Parliament draws to a close. It is great that we have been able to hold the debate in the month of Stoptober, the big anti-smoking initiative, which I think has been successful, and which I remember launching in my time as a Minister, back in the day.

Statistics released by the Office for National Statistics show that in 2018 in England, 14.4% of adults smoked. That represents a significant advance in reducing the prevalence of smoking in our country; ONS figures show that smoking rates in England have fallen every year since 2011. It is important to say that there is one exception to that advance, and it relates to mental ill health—something I care a lot about. People with severe and enduring mental ill health tend to die much younger than others, by as many as 20 years, one key reason being the prevalence of smoking among that group, around 40% of whom smoke. Although we have been very successful in reducing smoking rates in the population as a whole, we have not been successful in doing so for those with mental ill health. I will return to that.

In Great Britain in 2018, there were approximately 3.2 million vapers—6.3% of the population—which marks a significant increase since 2014, when the figure was 3.7%. Why does that matter? The tobacco control plan stated:

“Tobacco is the deadliest commercially available product in England”—

it is important to hold on to those words from the Government—

“with tobacco regulations serving to safeguard people, particularly children and young people from the avoidable disease and premature death it causes.”

The recent prevention Green Paper clearly articulated that some people are disproportionately likely to smoke, which we should all be deeply uncomfortable with:

“Smokers are disproportionately located in areas of high deprivation. In Blackpool, 1 in 4 pregnant women smoke. In Westminster, it’s 1 in 50.”

What an extraordinary contrast! Deprivation causes that significant risk to the health of mothers and babies.

According to Public Health England, vaping is at least 95% less harmful than smoking. That does not mean that vaping is safe, and it certainly does not mean that we should encourage non-smokers to start vaping, but based on all the evidence we have, vaping is considerably less harmful than smoking.

[Graham Stringer (Blackley and Broughton) (Lab)]

I put on record my thanks to the right hon. Gentleman for his time chairing the Select Committee on Science and Technology. It has been an interesting period, in which we have gone into great detail—effectively, I think—on many subjects. I was annoyed that NHS England, which has the time to put out often crass and obvious statements on health, did not have the time to come and give us advice on e-cigarettes, the use of which, as he says, is one way get people to stop smoking.

[Norman Lamb]

I thank the hon. Gentleman for that. I will call him my hon. Friend, because I am demob-happy and I do not care about the normal rules. It has been a great pleasure to work with him on the Committee. I share his concern. Given that the Government’s own tobacco control plan describes tobacco as

“the deadliest commercially available product in England”,

one would have hoped that the body that runs the NHS in England would show a strong commitment to confronting that clear risk. Despite it being very clear from all the available evidence that vaping is significantly less harmful than smoking, I none the less absolutely encourage continued research in this area. We should always be alert to anything that indicates a potential risk; that is exactly what our Committee recommends.

E-cigarettes are not only less harmful than smoking, but appear to be an effective tool for stopping smoking, as the hon. Gentleman made clear. A study published earlier this year in the New England Journal of Medicine randomly assigned adults attending UK NHS stop smoking services either nicotine replacement products of their choice, including product combinations, for up to three months, or an e-cigarette starter pack. That study of 886 participants found that the one-year abstinence rate was 18% in the e-cigarette group, compared with 9.9% in the nicotine replacement group. That is a significant difference, and we need to make sure that we act on that difference now that we have knowledge of the effectiveness of e-cigarettes as a stop smoking tool.

Results from a 2019 survey carried out by YouGov for Action on Smoking and Health—ASH—found that

“the three main reasons for vaping remain as an aid to quitting (22%)…preventing relapse (16%) and to save money (14%)”,

because people who vape spend much less money than people who smoke. That demonstrates that users perceive e-cigarettes as a stop smoking tool. E-cigarettes are therefore likely to help the Government to meet their ambition, announced in the prevention Green Paper, for England to be smoke-free by 2030. None the less, I accept that further research is needed on the effectiveness of e-cigarettes as a stop smoking tool. Will the Government or one of their agencies request further independent research on the effectiveness of e-cigarettes as a stop smoking tool?

Our report highlights the issue of what the NHS does on smoking cessation. Cancer Research UK recently pointed out that primary care clinicians face barriers to discussing e-cigarettes with patients who smoke; one in three clinicians is unsure whether e-cigarettes are safe enough to recommend. Given the death toll from smoking, it is extraordinary that it appears that clinicians are unaware of the clear advice from Public Health England in that regard.

[Gareth Johnson (Dartford) (Con)]

I agree with everything that the right hon. Gentleman has said. Does he agree that the Government could reach their ambitious target, which he alluded to, by embracing vaping, getting more information out there to those clinicians and working through the law, particularly post Brexit, to ensure that people who want to give up smoking have all the information they require in order to take up vaping instead?

[Norman Lamb]

I totally agree. The statistics that I am citing make the point about raising awareness, even among clinicians. We thought that it was just the general public who needed to understand better the relative risks, but clearly clinicians also need to understand the relative risks so that they can advise their patients more effectively.

Two in five clinicians feel uncomfortable recommending e-cigarettes to their patients who smoke. Again, that is an extraordinary finding. Fewer than three in 10 agree that their current knowledge is enough for advising patients about e-cigarettes. That extraordinary data reveals a clear need for the awareness raising to which the hon. Member for Dartford (Gareth Johnson) has just referred.

What assessment has the Minister made of the number of smoking cessation services in the NHS that are actively promoting e-cigarettes as alternatives to conventional cigarettes? It ought to be every single one throughout the country, but are they actually doing it? Do we know? Can the Minister tell us what work the Government are doing with NHS England on increasing knowledge among clinicians of the uses, benefits and risks of e-cigarettes for current smokers?

Our report recommended that NHS England should create a post for someone who is responsible for implementing the Government’s tobacco control plan. The response said:

“The Government broadly accepts this recommendation.”

However, no specific steps to implement our recommendation were set out. We pursued that with NHS England, which in January told me:

“It is our intention to appoint an individual with lead responsibility for this role. This will be an important part of our delivery programme for the NHS Long Term Plan.”

We would all assume that that person was appointed long ago and that active work is now underway to pursue this vital agenda, which will save lives, but can the Minister confirm that NHS England has created that post and, if so, is someone actually in post and doing the job?

The Government say that, in their long-term plan, provision is made for

“all smokers who are admitted to hospital being offered support to stop smoking”.

That is not due to be fully implemented until 2023-24. Again, given the extraordinary health benefits of stopping people smoking, I would have hoped for a tighter timescale than ’23-24 to implement that. Will the Minister tell us how implementation of that proposal is going and whether consideration is being given to implementing it fully before 2023-24?

Our report recommended that the NHS should have a clear policy on e-cigarettes in mental health facilities that establishes a default of allowing e-cigarette use by patients. This comes back to my point that approximately 40% of those with severe and enduring mental ill health still smoke. The attitude and culture within mental health trusts is critical if we are to enable and help people with severe and enduring mental ill health to give up smoking. We said that it should be the default that e-cigarettes should be made available in mental health facilities unless there are clear evidence-based reasons for not doing so.

The Government response said:

“NHS England will provide guidance to mental health trusts that sets out that existing vapers should be permitted to use e-cigarettes as part of smoking cessation programmes, and…tobacco smokers should be supported to stop smoking through smoking cessation programmes”.

Can the Minister tell us whether that guidance has been issued? I very much hope that it has. If not, when will it be issued and what is the reason for the delay in issuing such important guidance? If it has been issued, what assessment has been made of how it is working?

The UK is making good progress in getting people to stop smoking and use e-cigarettes to achieve that, but that is at risk from recent concerns about e-cigarette use. Those concerns have been expressed particularly in other countries. We have put the concerns to Public Health England. The first is the claim that deaths in the US have been linked to the use of e-cigarettes and vaping products. The reality is that the US operates in a totally different regulatory context and “illicit products” were

“implicated in this outbreak…including vaping cannabis derivatives.”

That is from Public Health England. It has also explained that

“the suddenness of the outbreak across many USA states in just a few months, suggests that this is not a gradual effect of long-term use, but because of a specific agent coming into use in the affected population.”

Next are the concerns that flavoured e-cigarettes are “luring” children into vaping. Public Health England’s response explained that the data it had seen so far was reassuring that e-cigarettes were not re-normalising smoking. Furthermore, the UK and the US have different rules on advertising, nicotine concentration and education on vaping, which explains why flavours of e-cigarettes are less impactful in the UK compared with the United States.

The next issue is the introduction of a ban in India on the production, import and sale of e-cigarettes because of concerns about the risks that they pose to health and to the young. Again, an assertion has been made that is at risk of infecting the debate that we have in this country. However, Public Health England has explained:

“India is one of several countries that appears to be responding to the outbreak of lung disease among cannabis”

vapers

“by proposing a ban on nicotine inhalers.”

It has also explained that smoking is far more prevalent in India and causes 7 million deaths a year there.

[Sir Kevin Barron (Rother Valley) (Lab)]

Is it not true that India has a massive vested public interest in the tobacco industry?

[Norman Lamb]

I suspect that the right hon. Gentleman knows better than I do, but I note the point that he makes. My view, based on the evidence that the Committee heard, is that the action taken by India is not based on evidence and is likely to result in more people dying of lung cancer. I think that is shameful.

I encourage all right hon. and hon. Members to read the helpful and comprehensive reply that we received from Public Health England on these issues and others, and which we have published so that anyone can delve into the detail. I am reassured that Public Health England is in “close dialogue” with a range of international partners, and I agree with Public Health England when it says:

“It is no exaggeration to say that inflating fears about e-cigarettes could cost lives.”

Incidentally, I have concerns about the attitude at the World Health Organisation, which does not take the same evidence-based approach, as far as I can see, as this country has done. Again, that has implications through the potential loss of life for millions of people across the globe.

It seems to me that people often conflate the fact that we do not have all the long-term evidence on vaping impact with an assertion that that should lead us to conclude that we should not be recommending vaping as an alternative to smoking. Frankly, that is stupid as a public policy approach, because we know that smoking is killing—I think—more than 70,000 people in England every year, and all the evidence so far shows that nothing like that is happening from vaping. According to Public Health England, it is 95% less dangerous than smoking. Therefore, the clear public health advice has to be that vaping is an appropriate way to help people give up smoking. Of course, the best thing of all is not to vape and not to smoke, but if that is not possible for someone, the clear public health advice needs to be that vaping is better than smoking.

Will the Minister set out what contact the Government —she or other Ministers—have had with other countries on international approaches to e-cigarettes? In particular, what are they doing at the World Health Organisation to encourage a more enlightened approach? What assessment have the Government made of the effects of those international approaches on public perception of e-cigarettes in the UK? What steps will the Minister take to ensure that this misinformation on e-cigarettes is challenged?

[Graham Stringer]

It is not only the World Health Organisation that is not using evidence for its advice, but the EU. The EU’s directive on the size of the bowls used and the amount of substance put in is not based on evidence. It is likely to mean that those people getting a nicotine kick—much less dangerous than cigarettes—will not find the products satisfactory and will go back to smoking.

[Norman Lamb]

I share the hon. Gentleman’s concern about the directive and the proscriptive rules relating to vaping, which do not appear to be sufficiently evidence-based.

E-cigarettes are positive in helping current smokers to stop smoking, and they are significantly less harmful than smoking conventional cigarettes. Yes, there are unknowns about long-term risks, and we need to maintain research on e-cigarettes, but doing nothing is not an option when people’s wellbeing and lives are at risk. I look forward to the contributions of other right hon. and hon. Members, and to the Minister’s reply.

13:51

[Bill Grant (Ayr, Carrick and Cumnock) (Con)]

It is a pleasure to serve under your chairmanship, Sir Henry. I congratulate my friend, the right hon. Member for North Norfolk (Norman Lamb), on securing this important debate.

E-cigarette use in the UK has followed a gently rising trend over the past few years, and last year, statistics from the Office for National Statistics showed that 6.3% of those over 16 were regular users—a rise of less than 1% over five years. In our August 2018 report, the Science and Technology Committee concluded that e-cigarettes should not be viewed in the same way as conventional cigarettes. They are an effective stop smoking aid and should be formally considered as such.

In its response to the letter sent on behalf of the Committee by the Chair, Public Health England confirmed that it believed, as the Committee did, that e-cigarettes are around 95% less harmful than conventional smoking. As our Committee found:

“A medically licensed e-cigarette could assist smoking cessation efforts by making it easier for medical professionals to discuss and recommend them as a stop smoking treatment with patients.”

Existing smokers should be encouraged to give up, but if that is not possible, they should switch to e-cigarettes as a considerably less harmful alternative.

We must acknowledge that there are uncertainties about the longer-term health effects of e-cigarettes. They have not been in circulation long enough for any scientific research to be certain. Concerns have been raised in the United States, as was mentioned, about an isolated outbreak of serious lung injury linked to illicit vaping products, but I suspect, as the right hon. Gentleman said, that there may have been other factors at play in that instance. In any event, we have not seen that replicated in the UK, largely because, as ASH confirms, we have a strong regulatory system in place, which is not yet the case in the US.

The Government mandate strict conditions, namely a minimum age of sale, a ban on advertising in broadcast media, print or the internet, and a stipulation that products containing over 20 milligrams per millilitre of nicotine need a medicinal licence. Products must also be child-resistant and tamper-evident, and packs must carry a health warning covering over 30% of the surface area.

Moreover, to be balanced, any judgement on the future of e-cigarettes must take account of human nature and the most likely alternative to vaping, namely returning to harmful conventional cigarettes, which have proven to be a serious health risk over time. While some groups would prefer the firmest possible line—Cancer Research UK, for instance, is pressing for a tobacco-free UK within the decade—most groups agree that e-cigarettes can provide a useful route towards quitting harmful conventional cigarettes.

We have seen clear evidence that e-cigarettes are an effective quitting aid for adult smokers and, crucially, the percentage of young smokers trying e-cigarettes in Britain is small, with continued use smaller still. They flirt with the e-cigarette, but do not continue with it. There is little evidence to suggest that such products act as a gateway to conventional smoking—they are not, as some would suggest, a stepping-stone to conventional smoking—and figures show that almost 3 million people in the UK today are using e-cigarettes as an aid to quitting harmful conventional cigarettes.

Unfortunately, the Committee found that some aspects of the regulatory system for e-cigarettes are holding back their use as a stop smoking measure. Restrictions on the strength of refills and maximum tank size have led some users to move away from e-cigarettes and return, sadly and regrettably, to conventional smoking. There seems to be little scientific basis for these limits, and I am pleased that the Government, in response to our report, intend to consider these anomalies and how to address them. It is good to see that the Government also agree with our conclusion:

“There should be a shift to a more risk-proportionate regulatory environment; where regulations, advertising rules and tax duties reflect the evidence of the relative harms of the various e-cigarette and tobacco products available.”

Such a move might well bring about the welcome improvements in health that we, as a society, desperately seek, particularly from lung cancers and other by-products and unintended consequences of smoking. It is proven beyond doubt that conventional smoking is harmful. I look forward to seeing those changes implemented.

I take this opportunity to speak directly to conventional smokers. Despite being a fire officer for 31 years, sadly I was a 50-a-day smoker for many years, although I have long since stopped. Believe me: being a smoker was a costly, smelly and unhealthy mistake in my life. I only realised that afterwards. Yes, I enjoyed my cigarettes then, as the smoker today does. Even in my time in the fire service, when I left a fire with my breathing apparatus on and pulled the face mask off, some kindly colleague would have a pre-lit cigarette for me. It was certainly madness at the time, and I indulged in it. It is not easy to stop, but anything that is good is not always easy. Believe me, it can be done. My plea to those who do smoke is: you can stop if you put your mind to it, and it is absolutely worthwhile.

[Norman Lamb]

The hon. Gentleman kept that information very quiet on the Select Committee.

[Bill Grant]

It is something to be neither proud nor ashamed of. It was part of the culture of the time. I was part of that culture. There are two things in life that I have never regretted: marrying my wife, Agnes, and giving up smoking. They are equally wonderful.

I have had the pleasure to serve on the Science and Technology Committee since shortly after I was elected to this House, and it has been a fascinating and often inspiring journey. I am incredibly proud of the work we have undertaken as a Committee, ably assisted by a very fine secretariat, and I wish to put on record my thanks to them for their support. Indeed, as my friend the right hon. Member for North Norfolk and I both intend to retire at the forthcoming election, this will be our last debate together, and I wish to thank him for his fine stewardship over the two years.

13:58

[Sir Kevin Barron (Rother Valley) (Lab)]

I am really happy to be here this afternoon, also giving my last speech in Westminster Hall, which is something that I have been looking forward to for a considerable time—since 2016, when something that I do not want to mention happened.

I have been active in smoking cessation over many years in Parliament. This is a good, well sourced and evidenced report about where we should move in the future to protect our fellow citizens. Let me admit two things—this is a bit of a confession. First, it has been more than 40 years since I stopped, but I, too, used to smoke cigarettes; I was quite addicted. Secondly, I ought to mention that although there is no money in it, I am an honorary fellow of the Royal College of Physicians.

The report makes it clear that e-cigarettes have proven to be a unique opportunity to steepen the decline of smoking rates in this country. They lack the dangerous tar and carbon monoxide components of conventional tobacco cigarettes and are consequently 95% safer, as Public Health England says. It should also be noted that second-hand vapour from e-cigarettes is substantially less dangerous than from tobacco cigarettes. As we all know, e-cigarettes can and do operate as a pathway from conventional smoking to quitting altogether. At present, something like 2.9 million Britons use them as a pathway towards quitting, with tens of thousands successfully stopping each year.

We were all surprised that under the previous tobacco control plan we got well below the target adult smoking rate: it is below 16% now, which is extraordinary. Sadly, that was not because e-cigarettes were used in smoking cessation programmes, although in my view that should be the future; it was because millions of our fellow citizens were buying those products themselves. Getting adult smoking below 16% is no mean feat, but more than 80,000 of our fellow citizens are still dying prematurely from tobacco use each year. We should never forget those statistics. If anything else were taking lives in this country every year at that level, we would be up in arms and this House would have done more to stop it.

Cancer Research UK’s briefing recommends that e-cigarettes be used as a tool to aid smokers who wish to quit in achieving their goal. However, it rightly points out —as the Chair of the Science and Technology Committee, the right hon. Member for North Norfolk (Norman Lamb) did—that unfortunately surveys have shown that 40% of clinicians are uncomfortable recommending e-cigarettes to their patients, and a further third are unsure whether they are safe to recommend, notwithstanding what Public Health England says about them. Moreover, just 30% feel that their knowledge is sufficient to advise patients on vaping.

Healthcare professionals must be made aware of the benefits of e-cigarettes in aiding people to quit. Although vaping is not completely risk-free, the reality is that it is significantly safer than smoking conventional cigarettes. Healthcare professionals must be made fully aware of that, so that they can ensure that their patients have the strongest chance of quitting smoking. It is difficult, and it may not necessarily be something that new doctors or doctors in training will be looking at. However, any health professionals attending or reading this debate, especially general practitioners, could do worse than go round to the vaping shop on their local high street to talk to the people who sell the products, because those are the people who trace their patients. They will know people who have gone from 50 cigarettes a day to none, or who used to need higher hits of nicotine but are now on lower and lower doses. I know people who still vape but use no nicotine at all; they are satisfying not an addiction, but a habit of using their hands. That is what ought to happen. It is quite true that there is no long-term evidence, just as there was not when the first heart transplant happened in South Africa, but it is pretty clear that there is evidence out there in our communities. We need our health professionals to go and talk to the people who have probably been dealing with their patients for some time.

Naturally, many people have raised deep concerns about whether vaping can operate as a gateway to smoking conventional tobacco cigarettes, but there is no evidence to suggest that such a phenomenon has materialised in any meaningful or demonstrated way. ASH, which I have been active with in this country for decades, has been monitoring what is happening annually, particularly around young children, and there is no evidence that it is causing nicotine addiction and leading people on to cigarettes.

I have to say that some of the evidence that we have seen about vaping in America is shocking. Some of the stuff that they put in is class A drugs—that is why we are having deaths. I know from going to America from time to time, where I have two step-grandchildren, that one company, which shall remain nameless in this debate, has been promoting vaping to young children with different flavours, although not necessarily with nicotine. When we talk to schools about it, they are up in arms about the nuisance and the litter. There is something to think about there, but we should not be too scared of it.

Although there are advertising restrictions and regulations on vaping, they are less stringent than those that apply to tobacco products. In June, the Library published a briefing paper that is well worth reading, “Advertising: vaping and e-cigarettes”. I first campaigned against tobacco in the 1993-94 Session when I introduced the Tobacco Advertising Bill, a private Member’s Bill to ban tobacco advertising and promotion. We are a long way down the road now, but there are still lessons to be learned from the Library’s paper about how these products are advertised.

The Science and Technology Committee has recommended that cigarette pack inserts could be used to refer smokers to e-cigarettes as a healthier alternative, but unfortunately that is currently banned under the Standardised Packaging of Tobacco Products Regulations 2015. We need to think quickly, because the people addicted to cigarettes are the ones who are going into shops and buying e-cigarettes. They are the people we should be targeting; I do not think that we can do it with things like websites. We could change those regulations in super-quick time—I can’t, because I’m off, but Parliament could, which would put us in a position to get to the people who are still addicted.

E-cigarettes need to be endorsed as mainstream in cessation programmes. About three years ago I visited the Leicester smoking cessation programme, which has been at the forefront of using such products. It has a wonderful scheme—led by a nurse at the time—in which pregnant women vaped at least throughout their pregnancy, which greatly enhanced the health and the life chances of their child. There is no reason why we should not make that mainstream. I know that people who smoke will now be referred to community pharmacies; that is good, but we should be looking at specific interventions with these products for people who are vulnerable, including unborn children.

Smoking cessations ought to be funded directly by the tobacco industry. I know that that would be an issue for the Treasury, but the Minister will need to talk to it. We often talk about making the polluter pay; tobacco companies should be paying for our smoking cessation programmes. Sadly, as we have said in previous debates, some of those programmes are now fading away. There are parts of this country that still have heavy and intense levels of adult smoking but have no smoking cessation programmes at all. That is wrong and, with more than 80,000 deaths a year, it should be stopped.

14:07

[Gareth Johnson (Dartford) (Con)]

Unlike the three previous speakers, I rather hope that this will not be my last speech in Westminster Hall—but that is up to the people of Dartford, not me.

I am pleased to contribute to the debate, because I feel strongly that vaping is something that we should embrace as a country. It has been mentioned that Public Health England says that vaping is 95% risk-free; that is really significant, and it is not just Public Health England making such statements. Cancer Research UK says that there are significant benefits from vaping in comparison with tobacco consumption. ASH, the British Heart Foundation and the British Lung Foundation—organisations that understandably have traditionally frowned on anything associated with smoking—recognise that vaping saves lives. That is what we are talking about, and the sooner the country recognises that we have an invention that could save thousands of lives in the UK, let alone the rest of the world, the sooner we can start saving the maximum possible number of lives.

It was with great regret that we heard the stories coming out of the United States. It was only when we starting drilling down and saw that the deaths were potentially linked to acetates, cannabis oil and so on—those are the irritants actually causing the deaths—that we recognised that we should not allow those tragic circumstances to cloud people’s image of vaping. It is not only clinicians who are unsure about vaping, and whether they can recommend it to patients; the general public are also unsure whether vaping is as safe as some experts have said. We need to educate people, and say that it is a well-known fact that tobacco seriously damages health and therefore is highly risky, but that with vaping the risks are substantially smaller.

Nobody in this debate, or anywhere in the House of Commons that I am aware of, is suggesting that people who do not smoke should take up vaping. The suggestion is that it is people who smoke, and who are addicted to tobacco and nicotine, who will benefit from vaping. There are risks associated with pretty much anything, and vaping is no exception. The message should go out loud and clear that people who do not smoke should not start vaping, but people who smoke may wish to try that alternative as an effective way of reducing their tobacco consumption, or helping them to come off tobacco completely.

I welcome the fact that some tobacco companies have embraced vaping; they realise its potential. Japanese Tobacco International has highlighted to me some of the dangers associated with products that do not contain nicotine, and so do not come under the Tobacco and Related Products Regulations 2016 and can be targeted at children. They can be marketed to look like food, or something trendy that people will want to get involved with, and as they do not have to comply with the tobacco regulations, their ingredients are not known. We need to look at that.

The Science and Technology Committee, chaired by the right hon. Member for North Norfolk (Norman Lamb), has looked at the 2016 regulations, which have serious flaws. For a start, they should not lump together tobacco and vaping products; they should be covered by separate regulations. That would bring an end to the ridiculous situation whereby a vaping product that has no nicotine in it must have a warning on its front saying, “This product contains nicotine”. If the vaping company does not put that warning on its product, it will fall foul of the regulations, but if it does, it might fall foul of other regulations. It is a crazy situation that has developed.

We need to consider whether it is right to allow more advertising of vaping products. I believe that it is, but regulations seem to prevent that. I think it is right that we should enable people to be educated, and aware of the products available and their potential benefits.

I do not want to turn this into a debate on Brexit, but there is no getting away from the fact that once we leave the European Union, we as a country can look at the regulations ourselves, and see what best suits our needs and what would be a sensible approach to vaping. We can ensure that people are aware of vaping and can benefit from it, so we should do so.

I have met a number of organisations that are trying to push forward a change in vaping regulations. Imperial Brands—formerly Imperial Tobacco—is doing a lot, and there is also a company called Blu, whose products are pioneering. That is a key part of the process. Companies are investing a lot in developing products that will be attractive to smokers, in that they will satisfy their cravings, so that they feel less necessity to smoke cigarettes.

I do not want to demonise smokers. If an adult chooses to smoke, knowing the risks, that is their decision. However, it is incumbent on the Government to ensure that people are aware of the alternatives to smoking, of the risks, and that there is comparatively less risk associated with vaping.

The Government are rightly pursuing a target of reducing the number of people who smoke and eventually eliminating smoking in this country. That is very ambitious, and if we are to achieve that, it will be necessary to introduce people to vaping through their GP.

[Sir Kevin Barron]

On this idea that smoking is an adult thing, very few people start smoking after the age of 21. The hard reality is that for most people, the starting point comes when they are quite young. I think I was about 11 or 12 when I started getting addicted to nicotine. I think we have to be very careful about this. It is not really an adult choice; it is just something that adults have done from a very early age.

[Gareth Johnson]

I totally agree. I take the view that if adults want to smoke, knowing the risks, that is up to them. However, there is a duty of care on the Government to ensure that tobacco products are not consumed by children. That is absolutely clear, and it is right that we keep the age at which people can start vaping at 18; we do not want vaping products targeted at children. In my experience, no responsible vaping company would do that or has done that.

The Government approach is sensible. I believe that they can embrace the potential of vaping to save lives. There are so many measures that could be taken—through the taxation system, through advertising, through education, and by making people aware of these products and making them more accessible to smokers.

We must recognise that for the first time in my life, there is something that genuinely can help people to get off tobacco—something effective that works. If we look at a graph of the number of people smoking and a graph of the number of vapers in this country, we can see a direct correlation: the more people vape, the fewer people smoke. We need to highlight that and celebrate it, and the Government should take that forward.

14:16

[Jane Dodds (Brecon and Radnorshire) (LD)]

I have not put my name forward to speak, but I would like to say a few words.

[Sir Henry Bellingham (in the Chair)]

Yes, indeed. I call Jane Dodds.

[Jane Dodds]

Thank you, Sir Henry. I wanted to draw attention to the correlation between people who have mental health difficulties and the propensity to smoke. I pay tribute to my right hon. Friend the Member for North Norfolk (Norman Lamb), who has championed the cause of mental health throughout his time in Parliament. I hope that Committee members will not mind my thanking him for everything he has done.

This debate relates specifically to England, and I am a Welsh MP, but I draw attention to the issue of cross-border healthcare. Many people in Wales who need to attend a residential mental health unit have to travel to England, and of course there is complete disparity between the practice in Wales and that in residential units in England. I realise that this is not totally within the Committee’s brief, but I would like it to consider how the policy for mental health units in England, which have particular rules and regulations around access to e-cigarettes, could be married up with the policy in Wales. There are significant differences between them. We talked earlier about learning from international bodies and countries around the world, but there is also a need to look at the whole UK, and consider how we can get parity between the nations. Thank you, Sir Henry, for allowing me to speak. Diolch.

14:17

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Henry. I apologise if I sound a bit croaky; I have a cold that is going round. Hopefully I will get rid of it soon, given what is to come over the next few weeks.

I thank the right hon. Member for North Norfolk (Norman Lamb) for introducing this debate, and for his characteristically well-informed speech. It is sad to think that it could very well be his last speech in what has been an illustrious career as an MP. I am sure that it will not be his last speech as a campaigner or activist. I also congratulate him on his work chairing the Science and Technology Committee, and on the excellent report that we are considering.

I thank all the other right hon. and hon. Members who have spoken, including the hon. Member for Ayr, Carrick and Cumnock (Bill Grant), and my right hon. Friend the Member for Rother Valley (Sir Kevin Barron), who I have enjoyed working with for many years. He has also had an illustrious career, and was an excellent Chair of the Health Committee for a number of years; he will be sorely missed in this place. There were also speeches by the hon. Member for Dartford (Gareth Johnson) and by the hon. Lady who has just spoken; I did not catch the name of her constituency.

[Sir Henry Bellingham (in the Chair)]

Brecon and Radnorshire—by-election win.

[Mrs Hodgson]

Excellent. Thank you.

As we have heard, there is still some uncertainty about the use of e-cigarettes. They entered the UK market only 12 years ago, and because this technology is still so young, we do not know for certain what its long-term impacts on health will be. What we do know is that e-cigarettes are around 95% less harmful than conventional cigarettes, and because of that, an estimated 2.9 million people in the UK are using them to stop smoking. Each year, tens of thousands of people successfully use e-cigarettes to quit. A randomised controlled trial, published in the New England Journal of Medicine earlier this year, found e-cigarettes used in a stop smoking service to be nearly twice as effective as licensed nicotine replacement therapies, such as patches and gum.

The importance of e-cigarettes as a smoking cessation tool should therefore not be dismissed. However, that must come with the caveat—I think everyone has made this point—that using an e-cigarette is not completely risk-free. There has been a recent outbreak of serious lung injury in the US linked to vaping, although that has not been replicated in the UK. Currently, 3.6 million people vape in the UK, yet the number of cases of severe respiratory pathology associated with vaping is low and diverse, with reports over a long period.

I agree with ASH’s recommendation that e-cigarette users should buy vaping products, including e-liquid, only from mainstream suppliers that sell regulated products, because using black market products may carry lethal risks. They should report any adverse effects from e-cigarettes to the Medicines and Healthcare Products Regulatory Agency using the yellow card scheme. If they experience serious adverse effects that they think are due to vaping, they should immediately stop vaping and get advice from their doctor.

Has the Minister considered launching an e-cigarette safety education programme that will ensure that e-cigarette users know the risks, and what to do if anything goes wrong and they manifest any such symptoms? That may lessen the possibility of manifesting the same patterns that we have seen in the US of lung injuries linked to e-cigarettes.

The Committee’s recommendation 4 says that NHS England should issue e-cigarette guidance to all NHS mental health trusts, and the default should be to allow e-cigarette use by patients. As we have heard, people with mental health issues smoke significantly more than the rest of the population, and could therefore benefit significantly from using e-cigarettes to stop smoking. Encouraging and allowing patients in mental health units who are smokers to switch to e-cigarettes as a means of smoking cessation would allow them to engage with their treatment sessions in the facilities without the interruption of smoking breaks.

A third of the 50 NHS trusts that responded to the Committee’s survey ban the use of e-cigarettes. The Government have agreed to issue guidance to NHS trusts about e-cigarettes. Will the Minister please tell us when she anticipates that it will be published? I know that she might have to rush it out in the next couple of days, but she might have a magic wand and be able to do that. Doing so could allow patients in mental health units to engage more fully with their treatment, which could improve outcomes.

As the Committee has found, e-cigarettes have a role to play in our society and in the Government’s commitment to achieving a smoke-free generation. However, we must ensure that advice on the safety of e-cigarettes, both short and long term, is updated regularly and publicly, so that users have the most relevant and up-to-date information available to them. The Government must also consider the role that e-cigarettes play in mental health services and improving patient outcomes across the NHS.

Every contact counts, especially when it comes to smoking cessation, and none should be missed. However, due to the Government’s public health budget cuts since 2013, which I know the Minister is not personally responsible for, smoking cessation services have suffered, leaving the most vulnerable smokers behind, without any support to quit smoking. That must change. Again, I ask the Government to reverse those public health budget cuts, so that local authorities can provide the smoking cessation services that their local communities need and deserve. I look forward to the Minister’s response.

14:19

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

It is a pleasure to serve under your chairmanship, Sir Henry. I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing the debate, and I thank the whole Committee for the report, for its tone, and for the intelligent way in which it has approached the difficult subject of trying to stop behaviour that is detrimental to individuals.

We want smoking to reduce to zero, and for us to be smoke-free by 2030. It is an ambitious programme, but it will benefit many more people than just the individuals who smoke themselves, as it affects those around them. I thank the right hon. Gentleman, whom I have always highly respected, for his important work leading the Science and Technology Committee, and for his broader work on the health agenda. Although today’s debate might be his last in this place, I hope that it will not be the last time I hear him waxing lyrical on the airwaves about this subject. I say the same for the right hon. Member for Rother Valley (Sir Kevin Barron), who has really been quite formative in this area, both on the Health Committee and in his work with the all-party parliamentary group on smoking and health.

It is timely that we are having this discussion at the very end of this year’s Stoptober campaign; I pay tribute again to the right hon. Member for North Norfolk for his work in starting it. There is never a better time to stop smoking, and I encourage everybody who is thinking about doing so to visit their local stop smoking service, or to go online, and consider all the options available to help them to quit.

I am really proud of the tobacco control work over the past two decades and the progress that has been made, for which we have been recognised internationally. According to the Association of European Cancer Leagues’ tobacco control scale, the UK has been rated consistently as having the most comprehensive tobacco control programme in Europe. As we have heard from the numbers discussed, it is working—but we are not there yet.

Smoking remains one of the leading causes of preventable illness and premature death, with more than 78,000 deaths a year. That is not only a waste but a personal tragedy for all families affected. We are determined to do more, as set out in our tobacco control plan, the NHS long-term plan and the prevention Green Paper, which only concluded on 14 October. I am looking forward to seeing the results of that consultation.

Our ambition is to be smoke-free by 2030. We know that we need to work harder in certain groups, including pregnant women and those with mental health issues. Like the right hon. Gentleman, I was struck by the extremely high prevalence of smoking in some areas. He mentioned Blackpool but, as he knows from representing a coastal region, in many coastal areas there is a very high prevalence of pregnant women who smoke. They interact with many healthcare professionals during what should be the enjoyable, exciting time when they are expecting a baby. We should use every single one of those interactions to help them to quit.

I have already asked officials whether there are other forms in which we can message that particular group in a way that helps them to understand the risk, as well as the things that are available to help them. I listened to the right hon. Gentleman’s point about people with enduring mental health issues. Facilities should allow e-cigarettes and provide more support. That is an ongoing part of the agenda. I will write to Simon Stevens to see where we are, and I will let the Committee know.

[Norman Lamb]

I thank the Minister for her very kind comments. I am pleased that she will write to Simon Stevens, because pressure from Government Ministers on NHS England to recognise the significance of the subject is really important. I am conscious that I asked a lot of questions in my contribution, and she may well be unable to answer them all, but will she write to me before Parliament rises next week, if possible, to answer those questions that she is able to, so that we get that on the record?

[Jo Churchill]

I will do my very best. If there is anything I have not covered, I hope that the answer will be winging its way to the right hon. Gentleman on Monday.

The Government are absolutely clear that quitting smoking and nicotine use entirely is the best way for people to improve their health. We recognise that e-cigarettes are not risk-free, as has been stated by all Members who have contributed; however, they can play an exceedingly important role in helping smokers to quit for good, particularly when combined with stop smoking services. It is an addiction, and we are trying to achieve a step change in people’s practices and behaviours that enables them to quit entirely. We do not know the long-term harms of e-cigarette use, and no authorities in the UK assert that they are harmless. Based on current evidence, Public Health England and the Royal College of Physicians estimate that e-cigarettes are considerably less harmful than smoking because of the reduction in levels of exposure to toxicants in e-cigarette aerosols compared with tobacco smoke. However, I reiterate that quitting smoking is the best option.

It is fair to say that opinions on e-cigarettes are divided, both in the UK and globally. It is important that we listen to concerns, while looking objectively at the evidence base and seeking to build it further, which I think is the point that the right hon. Member for North Norfolk was making. On the question of research, I assure him that there is an NHS England dedicated lead—a director for prevention—in place, overseeing the NHS long-term plan commitments. I note the right hon. Gentleman’s comments about India and the fact that making decisions too quickly, not based on the research that is available, has unintended consequences.

As the House is aware, we have introduced measures in the UK to regulate e-cigarettes: to reduce the risk of harm to children; to protect against e-cigarettes acting as a gateway to starting smoking—another important point that has been made today—to provide assurance on relative safety, and to give businesses legal certainty. Regarding what has happened in the United States of America, we take those concerns seriously—we are aware of the tragic deaths associated with vaping in the United States and are monitoring the situation carefully. Public Health England and the Medicines and Healthcare Products Regulatory Agency are in close contact with the US agencies. Investigations are ongoing; they have not yet been able to confirm the definite cause of the deaths, although it appears that the majority of those who died had used illicit cannabidiol with THC products, which led to those unfortunate deaths.

To date, there have been no known deaths from e-cigarette use in the UK. The MHRA yellow card reporting system is in place to report any adverse effects. It has been running for three years and, to date, has been notified of about 85 individual cases; all have been minor, and none has been considered life-threatening. However, I assure the right hon. Member for North Norfolk and all other Members who have contributed to this debate that we remain vigilant on the issue and are grateful for all research done in this area, including—my hon. Friend the Member for Dartford (Gareth Johnson) alluded to this—by those within the charity sector who do a great deal of work in looking at the harms caused.

In our tobacco control plan, we made strong commitments to monitor the impact of regulation and policy on e-cigarettes and novel tobacco products. To inform future policy, we are looking closely at the evidence on safety, uptake, health impact and the effectiveness of these products as smoking cessation aids. Public Health England will continue to update its evidence base on e-cigarettes and other novel nicotine delivery systems.

The use of e-cigarettes by young people was mentioned by the right hon. Member for Rother Valley and by my hon. Friend the Member for Dartford. Such use currently remains low, at 2%, and we have not seen the rise that has occurred in the United States. However, we will monitor the data closely to ensure that regular use does not increase and it is not seen as a gateway to tobacco use, and will also keep a close eye on any new evidence about long-term harms caused by flavourings. If the evidence shows that we need to address either or both of these issues, we will consider taking action, including further regulatory action where necessary. I would like the industry to show stronger leadership in the areas of e-cigarette product labelling and, in particular, design to ensure that its products do not appeal to young people. Some of the current naming appears to lean in that direction.

In future, we will have the opportunity to reappraise current tobacco and e-cigarette regulation to ensure that it continues to protect the nation’s health. I thank all Members who have spoken today, particularly the right hon. Member for North Norfolk, who will be leaving this House. Today has been a bit of a goodbye party for him, for my hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant)—I am staggered by the revelation that he smoked 50 a day; I wonder that he had time to do much else, let alone run around being a fireman—and for the right hon. Member for Rother Valley. I am sure that all of them will continue to work in this area.

I reiterate the Government’s commitment to help people quit smoking, which is ultimately the best course of action, and to seek evidence on reduced-risk products. We will continue to be driven by that evidence. Although we can celebrate the fact that adult smoking in England has fallen by a quarter and regular smoking among children has fallen by a half, I will truly be able to celebrate—like all right hon. and hon. Members present, I am sure—if we reach the goal, which both the report and the Government are aiming for, of being smoke-free by 2030.

14:36

[Norman Lamb]

I thank the Minister for her response to the debate and for her kind comments. There has been a remarkable consensus about the action we are taking in this country, and the need for it to be evidence-based. It is clear that the United Kingdom is ahead of the game internationally on smoking cessation work, and that is something we should celebrate. However, we should never allow ourselves to feel that we have done the job. We have so much still to do, particularly given the number of people who die every year from smoking, as the right hon. Member for Rother Valley (Sir Kevin Barron) made clear. The carnage—the death toll—is enormous, so the work needs to continue.

We have heard some wonderful admissions. The right hon. Member for Rother Valley and the hon. Member for Ayr, Carrick and Cumnock (Bill Grant) have admitted to smoking heavily in the past; they are both wonderful living examples of life after smoking. [Interruption.] Less coughing, please. They are wonderful examples to others of the potential value of giving up smoking, and I wish both of them a very happy retirement from this place.

I will quickly pick up on one or two points. I agree with the right hon. Member for Rother Valley that inserts in packs are a very good way of targeting an important public health message directly at people who need to hear it, and who need to be reassured that giving up smoking and vaping instead is going to help their health—a point we made in the report. I also agree with him about the case for the tobacco industry making a contribution to the cost of smoking cessation services, on the basic principle that the polluter pays.

My hon. Friend the Member for Brecon and Radnorshire (Jane Dodds), who has had to leave, made some important points about cross-border health issues. I applaud her for championing access to mental health support in Wales, which is incredibly important. The point in this debate is that every mental health facility and, in particular, every in-patient mental health facility, whether in England, Wales or Scotland, should offer the same access and support to enable people to give up smoking, using vaping as the mechanism to do so. Giving up smoking will lead to significant gains in not only people’s life expectancy, but their mental health; smoking harms their mental health as well as killing them earlier.

The hon. Members for Dartford (Gareth Johnson) and for Blackley and Broughton (Graham Stringer) both made the point that regulation must always be evidence-based. That has not been the case with the European Union directive or internationally, given the debate we have had about the World Health Organisation and the approach that is taken in America. In this country we want our regulations to be evidence-based, to give people the best chance of giving up smoking and having a healthier life.

On a personal basis, not in my role as Chair of the Select Committee, I agree with the hon. Member for Washington and Sunderland West (Mrs Hodgson) that investment in public health is important. There is much evidence that investment in early prevention work of all sorts, and in public mental health, provides—in brutal economic terms—a return on investment. It also changes lives. The plea to whomever becomes the Government after 12 December is this: make the investment in public health, because we will all benefit.

I thank you, Sir Henry, for your stewardship of the debate, and I wish all hon. Members well for the next few weeks. I am very relieved that I am not fighting to retain my seat in the middle of winter.

Question put and agreed to.

Resolved,

That this House has considered the Seventh Report of the Science and Technology Committee, Session 2017-19, E-cigarettes, HC 505, and the Government Response, Cm 9738.

14:41

Sitting suspended.

Disability-inclusive Development

Thursday 31st October 2019 Westminster Hall

[Mr Nigel Evans in the Chair]

13:15

[Stephen Twigg (Liverpool, West Derby) (Lab/Co-op)]

I beg to move,

That this House has considered the Thirteenth Report of the International Development Committee, DFID’s work on disability-inclusive development, Session 2017-19, HC 1880, and the Government Response, Session 2017-19, HC 2680.

It is, as ever, a pleasure to serve under your chairmanship, Mr Evans, not least because you serve as a distinguished member of the International Development Committee. I thank you, and indeed the other members of the Committee who are not present, for your service on the Committee. I also thank the hon. Member for Stafford (Jeremy Lefroy), who previously served with great distinction on the International Development Committee and who, like me, is standing down at the forthcoming general election. He has played an extraordinary leadership role on the Conservative Benches and in working cross-party across a range of development and humanitarian issues. I pay tribute to him for that and wish him well for the future. I thank the Minister, the shadow Minister and the Parliamentary Private Secretary for their attendance today at what I hope will be a positive and focused debate on an important issue.

In July, the International Development Committee released our thirteenth report, addressing the Department for International Development’s work on mainstreaming disability inclusion. Earlier this month, the Government published their response to the report. I am pleased that they responded very positively, accepting either wholly or partially all but two of our recommendations. I look forward to hearing from the Minister how DFID intends to achieve progress in the areas to which it is committed.

When we launched this short inquiry last December, we invited submissions on all aspects of the Department’s work on disability. We had a particular focus on whether the Department’s new disability strategy provided an adequate framework for approaching disability-inclusive development. I am grateful to everyone who gave evidence to our inquiry, and I put on the record my thanks to the fantastic Committee staff, some of whom are in the Public Gallery, for their hard work on the inquiry.

We have seen in recent years a substantial increase in DFID’s focus on disability. The Department launched its first ever strategy for disability-inclusive development, and the United Kingdom co-hosted the first global disability summit with the Government of Kenya and the International Disability Alliance. It is against that backdrop that we took an early look at this work. Overall, we were very pleased that the Government have reacted positively to this agenda.

It was under my predecessor, Lord Bruce, that the International Development Committee made a number of recommendations, including that the Department should develop a specific strategy on disability. I believe it is a critical step both in boosting disability inclusion and in ensuring that the Department has a clear commitment to disabled people right the way across its programming on development and in humanitarian crises. It is crucial in the context of the global goals—the sustainable development goals. As the UN Secretary-General, António Guterres, outlines:

“Societies will never achieve the SDGs without the full participation of everyone, including people with disabilities.”

Disability is surely at the heart of this endeavour. A billion people, or around 15% of the world’s population, have some form of disability. It is estimated that around four in five of people with disabilities live in the world’s poorest countries, and that one in five people in those countries have some form of disability. They are perhaps one of the groups most at risk of being left behind. In many countries, what we would regard as basic or essential services for disabled people are not available—or if they are available, they are of very poor quality.

The “UN Flagship Report on Disability and Development 2018” found that poverty rates are higher on average for disabled people. On global goal 2—zero hunger—it found that:

“the average percentage of persons with disabilities who are unable to afford a meal with protein every second day is almost double that of persons without disabilities.”

Of course, we live in a world scarred by conflict. Armed conflict is a major cause of disability. Research by Human Rights Watch across a number of countries, including Cameroon, Syria and Yemen, shows that people with disabilities in situations of armed conflict face a disproportionate level of violence, forced displacement and ongoing neglect. Even more horrifying, Human Rights Watch found that, in some cases, disabled people are simply abandoned in their homes or in deserted villages for days or even weeks, with very little access to food or water.

I recently met Bahia Zrikem, Humanity and Inclusion’s humanitarian and policy co-ordinator for Syria. For the past eight years of the Syria conflict, Humanity and Inclusion, previously known as Handicap International, has deployed rehabilitation teams and partners to help Syrians, particularly in Jordan and Lebanon. More than 60% of refugee households from Syria have someone with a disability, and one in five Syrian refugees now living in Lebanon or Jordan have a disability. The challenges that they face are enormous.

I support Humanity and Inclusion’s Stop Bombing Civilians campaign. I hope that ending the use of explosive weapons in populated areas will be at the centre of the Government’s forthcoming review of the protection of civilians strategy. I pay tribute to Humanity and Inclusion and all the other organisations working in this field for advocating the rights of people with disabilities. Such organisations represent the experience and views of people with disabilities, and the Committee did its utmost to ensure that those voices shaped our inquiry and its resulting recommendations.

I pay tribute to Sightbox, a small charity born out of the passion and leadership of Dr John Patterson, who is the headteacher of St Vincent’s School for the visually impaired in my constituency in Liverpool. Pupils at St Vincent’s have created Sightbox containers filled with equipment, providing blind and visually impaired children with the means to access education and sport, and to have a more independent lifestyle. The boxes have been sent around the world to countries including Nepal, Gambia and Pakistan.

Too often in the past, development programmes have left out people with disabilities, and disabled people have not been involved in the decisions that affect their lives. That is why we welcome DFID’s decision to mainstream disability inclusion across the work of the Department.

Last year’s global disability summit was an important step forward. The Department announced initiatives that became part of the disability strategy, alongside the charter for change, which was signed by participating countries. The Committee commends those initiatives, which demonstrate true global leadership. We know that disability inclusion was a high priority for the previous DFID Secretary, who is now the Home Secretary, and particularly for her successor, the right hon. Member for Portsmouth North (Penny Mordaunt). We have seen a lot of change in the Department this year, and I urge the Minister to reflect on that. It is so important that DFID maintains momentum on delivering on the global disability summit commitments, and that it continues to take the lead in urging other donors to act and deliver on their commitments. I hope that the priority given by the two previous Secretaries of State will be maintained—the current Secretary of State was very positive when we asked him about the subject last week.

I welcome the Government’s commitment in their response to develop robust accountability on this issue. I hope the Minister can say a bit more about the Department’s plan for an independent secretariat and governance structure, so that everyone, including DFID, is fully accountable for the delivery of its commitments

As part of its strategy for disability-inclusive development, the Department has a twin-track approach that involves funding projects that are disability-specific alongside mainstreaming disability across other programmes. The Department takes a similar approach in other cross-cutting thematic areas, such as climate change, and the Committee believes that in principle it is the right approach. It has the potential to achieve real and sustainable improvements, provided the commitment is there in a sustained and sustainable way. Early progress has been positive, but much work still needs to be done.

The Committee received several pieces of evidence expressing concern that aspects of the strategy and delivery plan were vague, adding to a broader worry about the lack of clarity about what is expected of the staff who are to implement mainstreaming. Programmes, business units and teams across the Department need clarity about what mainstreaming involves in practice, so that they can implement it as effectively as possible. As Humanity and Inclusion told us,

“Disability Strategy’s Delivery Plan does provide a framework for actions, with lead departments, and as such is a vital and welcome tool for outlining DFID’s work on inclusion. But in many cases actions are too vague and lack specific outcomes.”

The Committee is concerned that there is a risk that implementation might be inconsistent across DFID, and difficult to measure. I am pleased that DFID has committed to monitoring the progress of its business units in meeting inclusion standards. Hopefully that will help provide a better understanding of how effective the two-strand approach to inclusion is.

Sightsavers, a fantastic charity, recommended that DFID republishes its delivery plan to make it more specific, and to include a clear evaluation mechanism, and a timeline for when all business units should meet the minimum standards. The Department has extended the deadline for its republished plan to June next year. I really appreciate the desire to get it right, so I hope that the Minister can outline what opportunities there will be for a consultative update on planned changes to the delivery plan in that period. I hope also that DFID will use the opportunity to update its strategy to include some of the more neglected areas on which there should have been specific commitments, such as health, ageing, and the inclusion of people with intellectual disabilities.

The Committee feels strongly that barriers to education should be removed as a top priority. The Minister leads on education for the Department and gave evidence to the Select Committee on it earlier this week. I know that his personal commitment is strong. We know from the evidence that disabled children face huge barriers to education. We know from constituency casework, and the evidence that comes before us and the Education Committee, that that is the case in our own country. The Education Commission has estimated that half—50%—of all children with disabilities in not only low but middle-income countries are out of school. Of course, that is an average. In some of the poorest and most fragile countries, the figures are even worse.

As we said in the IDC’s 2017 report on education:

“DFID has shown leadership on education for girls and young women...The Department should now use its influence in the same way to shine a light on the needs of disabled children. It has made great progress with the Disability Framework, but needs to now ensure this is being implemented across all DFID programmes.”

I know that DFID’s education policy, “Get Children Learning”, is working towards that aim, and is supporting children with disabilities in moving into mainstream education wherever possible. It supports comprehensive and cost-effective interventions, and most importantly, it is increasing the number and quality of teachers and support staff available. I urge DFID to do all it can to address the specific needs of children at each stage of education, starting with the early years and early child development, and taking into account both the obvious and less obvious barriers to education.

I welcome the Prime Minister’s commitment, reflected in the Queen’s Speech, to all girls having access to 12 years of quality education. The UK’s pledge at the recent UN General Assembly to higher investment in education is very positive, but we must as part of that address the particular needs of those who are disabled. I hope the Minister can provide assurances that children with disabilities will be front and centre in the Government’s efforts to secure 12 years of quality education in the Leave No Girl Behind initiative.

A key commitment of DFID’s at the disability summit was the inclusive education initiative, which aims to accelerate action by countries and to support their efforts in making education more inclusive. The initiative does this by helping Governments and other stakeholders to mobilise finance and develop programmes that ensure inclusive education. When he responds, will the Minister set out how the Government will build on the initial investment and, in particular, how we can bring other donors on board to maximise its impact?

Of course, it is important when implementing such programmes that we put pressure on national Governments to budget for the costs of disability inclusion in their planning. DFID agreed to the Committee’s recommendation that the Government should create a framework to ensure that programmes identify correctly the specific challenges in each host nation, and provide the technical guidance to deliver education projects that address those challenges. National Governments should also be encouraged to plan and budget for disability inclusion in their own education programmes.

More broadly, disability should not be an obstacle to participation in economic and social life. We welcome the inclusion of social and economic empowerment as pillars of DFID’s strategy. This reflects the high living costs and barriers to healthcare, employment and other economic opportunities that people with disabilities face. As we know, a large majority of people with disabilities are either not employed or are under-employed. If they are in work, they earn lower wages than people without disabilities. For women with disabilities, gender inequality compounds that divide.

We have called on the Department to gather more evidence on the impact of poverty reduction on social protection programmes, and to work with Governments and stakeholders to fund and support the inclusion of people with disabilities in existing social protection schemes, or, where necessary, to develop appropriate new schemes targeted at the particular needs of disabled people. The Department should also ensure that disability inclusion is mainstreamed throughout its economic development programming. Clearly, one of the most important opportunities for disabled people is to set up their own business, to get work, and to get the training that they need so that they have the skills required for the jobs of the future. Disability inclusion should also be an aspect of broader investment decisions, particularly by CDC, which should have a disability-inclusive approach to its investment.

Palladium, a contractor, said to us in evidence:

“Encouraging diversity in the supply chain by engagement of companies owned or led by people with disabilities and by encouraging programme implementers to do the same will increase economic empowerment and bring diversity of thought to DFID programming.”

People with disabilities should be assisted in overcoming skills gaps or accessibility issues that may prevent them getting work with DFID.

The disability strategy, alongside the summit, has provided a renewed focus on boosting disability inclusion. It has rightly been commended across the sector, but the progress needs to be sustained. As I implied, there is a concern that disability might not have the priority that it previously had in the Department, and that it was very much a personal priority of two previous Secretaries of State, but I am sure the Minster will be able to reassure us that disability inclusion absolutely remains a top priority for the Department, so that we really do leave no one behind. I hope that the Department is scaling up its spending on disability-specific projects, while further embedding disability inclusion across the strategy and budget of DFID.

This is the final report that I will have the opportunity to present as Chair of the International Development Committee. I am very proud of the work that the Committee has done, but I am particularly proud of the work that my predecessor did on this issue, which contributed to disability being a higher priority in the Department’s work. That goes to the very heart of the sustainable development goals.

I want to finish by speaking about a project I have spoken about previously, because it is so impressive. Two years ago, the Committee went on a visit to education projects in east Africa, and the one that sticks in my memory is the Girls Education Challenge programme in Kisumu in Kenya, which is funded by DFID and run by Leonard Cheshire. We were so impressed by the programme, which is aimed at girls with disabilities, that we reflected, on a cross-party basis, that we wanted more of those sorts of programmes to be funded by DFID. We also want DFID to act as a catalyst to enable Governments in countries such as Kenya to spread the very best practice—like what we saw in Kisumu—through their countries. It felt to me as if the very best of UK aid was reaching those who are often left furthest behind, and that it was also giving UK taxpayers the best value for money.

I applaud the Department for using its influence to shine a light on the needs of disabled children, just as it has successfully shone a light on the needs of girls and young women. UK aid should be about not just removing barriers but supporting people with disabilities to thrive in every facet of life. There is no surely no better example of leaving no one behind than enabling every child to go to school and every adult to participate in economic and social life and, perhaps above all, ensuring that the voices of disabled people are heard, listened to and acted on.

15:21

[Jeremy Lefroy (Stafford) (Con)]

It is an honour to serve under your chairmanship, Mr Evans. It is also a great honour to follow the hon. Member for Liverpool, West Derby (Stephen Twigg)—the two years I spent on the Select Committee under his chairmanship were among of the most enjoyable of my time in Parliament. He has been a great Chair of the Committee and it is the House’s loss that he is standing down. However, I am sure that he will make a huge contribution to the area in question in his future career, wherever that will be.

I declare an interest as a board member of the Liverpool School of Tropical Medicine. I want to talk about neglected tropical diseases, an area in which the school does great work, which is why I am declaring that interest. I am also chair of the all-party parliamentary group on malaria and neglected tropical diseases.

I want to pay tribute to the hon. Member for Wirral South (Alison McGovern). I seem to remember that in the 2010 to 2015 Parliament, when we produced the first report on DFID and disability, she was one of the main instigators of work in that area, along with my hon. Friend the Member for Mid Derbyshire (Mrs Latham) and myself.

There are three areas that I want to address: neglected tropical diseases, jobs in the private sector, and nutrition. All of those have a strong relationship with disability and DFID’s work on it. Neglected tropical diseases are those that, as the name suggests, have been neglected, but I am glad to say that they are much less neglected than they used to be, because of the strong work done by many around the world—not least DFID and the United States, and increasingly now other countries, such as Germany.

It was a great honour when I recently chaired a meeting of the all-party group where we helped to publicise DFID’s new programme on accelerating the sustainable control and elimination of neglected tropical diseases. ASCEND covers five of the worst diseases: trachoma, lymphatic filariasis, onchocerciasis, schistosomiasis and visceral leishmaniasis. There are two programmes within ASCEND—one covering east and central Africa and one covering west Africa. The programme aims to accelerate sustainable control and elimination of neglected tropical diseases and is spending £200 million over the period between this September and March 2022.

The work that I have seen on tackling neglected tropical diseases, particularly in Africa but also elsewhere, is not only essential but incredibly cost-effective. DFID did an evaluation of work on NTDs and said that it paid back something like £30 or more for every £1 spent. Why is that relevant to disability? It is simple: those diseases, even if people are treated for them, lead to disability, or in some cases they cause disability that can then almost be cured by the treatments.

A few weeks ago I had the honour of visiting, with the hon. Member for Stockton South (Dr Williams), a clinic in Rombo in east Kilimanjaro, where we saw surgery being performed on people’s eyelids, through the Commonwealth Fund and with the help of Sightsavers and DFID. The people had a condition that almost removed their eyesight, but after a few days they could see much better. It was wonderful, because often those were people in their 60s, 70s or 80s—there was even one woman in her 90s—and they were suddenly given a new lease of life and could perform tasks that they could not perform before, because of that simple but hugely beneficial operation.

Another great thing about that experience was that I saw the ophthalmic surgeon not only performing the operation but teaching two highly skilled nurses how to do it; it was training as well as an operation. What gave me great joy was the fact that at the end I shook the surgeon’s hand and he asked my name. When I gave it he said, “Are you related to Dr Lefroy?” I said, “Yes, she’s my wife.” He said, “She trained me at the medical school in Kilimanjaro, the best part of 20 years ago.” It was lovely to see the link between the work that Janet did all those years ago, training a young man who is now an experienced eye surgeon and who also trains experienced eye nurses. That gave me great joy, but probably not as much as seeing those men and women undergoing a quite difficult operation with great fortitude and stoicism, having their eyes bandaged, and then moving out, knowing that in two or three days’ time their lives would be made a lot better by being able to see. They would be able to perform jobs and tasks, and engage in activities that they would not otherwise have been able to do.

I remember a second visit, a few years ago, just south of Dar es Salaam in Tanzania, where we saw a programme, also with DFID funding, working together with the Tanzanian Government. The point I would make is that those programmes are working together with the Government in health facilities supported by the Government, whether they are faith-based or Government-owned. They are integrated into the Government system. They are supported by other organisations such as Sightsavers, which is excellent, as the hon. Member for Liverpool, West Derby has said, but they are integrated into the work that is already going on.

The programme I saw was tackling lymphatic filariasis, otherwise known as elephantiasis. It is a very disabling disease and, as the name suggests, it causes the swelling of limbs. People were being taught how to look after and treat their condition so that they would be able to work again. The other element of the programme was to take away some of the stigma. As the hon. Member for Liverpool, West Derby has said, stigma is a big issue in connection with disability, and there is great stigma attached to lymphatic filariasis.

I want to praise the work that DFID, its partners and others in the sector are doing, and to encourage the United Kingdom to continue the work. The programme is worth about £60 million to £70 million a year, and it has a huge impact. If one considers that the number of people affected by NTDs around the world is in the order of 1.4 billion—these programmes are helping hundreds of millions to cope with disabilities, and are treating and preventing disabilities—one can see how important that work is.

The second area that I would like to tackle is jobs and livelihoods. The report is very good on that, and section 113 and those following it talk about the private sector. Again, I have personal experience of this, as my father was disabled. His disability came in his mid-30s, and he found it very difficult to get work. I pay great tribute to the Church of England, because he was a vicar and it supported him. Understandably, in the 1960s he found it very difficult to find places that would accept somebody who was disabled. Nevertheless, he was supported right the way through by the congregations he served in London, which in those days was quite unusual.

From that experience, I have always wanted the United Kingdom to take a lead in disability support within the workplace, particularly within the private sector. I was very encouraged by the example given in the report of the hotel chain ITC Welcom Group, which has produced a disability handbook for industry. It argues that employees with disabilities

“tend to have better attendance records, stay with employers longer and have fewer accidents at work”.

It highlights other important benefits, such as improving the company image and boosting staff morale. That applies in the United Kingdom and across the world. I welcome DFID’s work, together with that of its private equity arm, CDC, in putting that at the forefront of their work.

Nutrition does not feature highly in the report, but I fully understand that not everything can be covered. Just last week I was talking to the head of the World Food Programme for Burundi, where 56% of the population are malnourished. It is one of the poorest countries in the world, but sadly, because of the serious problems with governance there, it has been neglected by the international community. I know that the hon. Member for Liverpool, West Derby shares that view. I encourage DFID to strengthen its support in Burundi.

The point is that if we do not support babies and children in the first 1,000 days—this is shown by work that DFID has done on nutrition, the work that Melinda Gates has done on the issue, and the work of my hon. Friend the Member for Worthing West (Sir Peter Bottomley) and others in this country—the problems last for the rest of their lives. If babies, children and young people do not have access to adequate nutrition, they will be much more susceptible to acquiring disabilities, either at a young age or later. Will the Minister address the issue of Burundi, where I believe there is a hidden nutrition crisis—indeed, more than a crisis? I know he is aware of that, but what can we do about it? How is DFID’s work on nutrition, which is of the highest order, feeding into its work on disability?

I am most grateful for this opportunity to speak. I am very grateful for the work that DFID is doing in these areas. I encourage the Minister and the whole Department to make further progress on their work with disability, but I thank them for what they have done over the past five years, moving from the framework to the strategy, and for taking a leading role in this most important of areas.

15:34

[Mr Jonathan Lord (Woking) (Con)]

It is an enormous pleasure to follow my hon. Friend the Member for Stafford (Jeremy Lefroy). It is a great sadness to many of us that he has decided to stand down from this place. His speech demonstrated to us in a very real way the things that inspire him in politics. It was a vision of compassion, of looking outwards and of helping others. I know that he will not mind me saying that it was also inspired by his Christian faith. We will miss him very much in this place. We thank him for all his efforts in the arena of international development, and on the other issues that he has taken up in this House.

I also pay tribute briefly to the hon. Member for Liverpool, West Derby (Stephen Twigg), who has chaired the International Development Committee extremely well. As I think he knows, he is not only very well respected across the House, but very well liked. We will certainly miss him too. I wish him well for the future.

I wanted to speak for two reasons. In general terms, our country is grappling with its future place in the world, and perhaps some of our friends around the world, and indeed our enemies, are wondering when the UK will regain a surer footing on its vision for the future. The work that this country does, ably led by our Department for International Development, in trying to alleviate poverty and suffering around the world, gives a strong signal—it is perhaps not publicised widely enough or known about—to all the countries around the world that might be harbouring one or two doubts about the political difficulties of the past couple of years. It gives a powerful signal that this country stands for the right values, is compassionate and wants to have a leading, positive role in the world.

I am proud that my town and borough of Woking proactively decided to take in Syrian refugees. I am able to report to the House that it has worked extremely well. Some of the refugees had severe health and disability issues. I pay tribute to the efforts of our local national health service’s efforts in giving them the help and support they needed. I also pay tribute to our local mosques, particularly the Shah Jahan mosque, and our Christian churches, which rallied around those people, who had come from a terrible war-torn situation. Many of them had very difficult personal stories of what they and their families had been through. It was very moving when many of those refugees, who are now fully settled—most are looking forward to a future in this country, but if they wish to return they will be helped to do so—decided to cook a feast at the end of Eid and invite the community, particularly the faith communities from the mosque and our churches, to celebrate together. They made it clear how thankful and grateful they were to the churches, the mosque and the wider Woking community for giving them such a warm welcome after their times of trouble.

I will not detain hon. Members any longer. The work that our Department for International Development does is very valuable around the world. It is important that the International Development Committee scrutinises it and encourages it in its efforts; we thank the Committee for its work. I hope that the Minister will tell us in his response a little more about this country’s international development efforts to help and support people from conflict zones, such as Syria and Yemen. The House would be grateful to hear more about its work in those areas.

15:39

[Alex Norris (Nottingham North) (Lab/Co-op)]

It is a pleasure to serve under your chairship, Mr Evans, and to respond for the Opposition on a very important and impactful report, to which many hon. Members have contributed, not least yourself as a member of that Committee. The report is clearly the culmination of the Committee’s work and focus spanning several chairships, and as my hon. Friend the Member for Liverpool, West Derby (Stephen Twigg) said, it will be his final report. The Committee’s work will continue to make a difference.

I pay tribute to my hon. Friend—he is my friend—for whom I have considerable admiration and lots of respect. I believe that that view is shared not just among Labour Members, but by hon. Members across the House, who know that he is a man of great integrity, personal character and obvious and clear talent, and that he is fundamentally a very decent person. As we know, there is lots of room for that across the House. In that spirit, I would say that I am sad to see him go, but he will only be a phone call away, so I will still be able to ask him daft questions which he will take in the spirit in which they are asked. I will not take my tribute any further because I know that that is not what he wants, but it was important to say that. The report is excellent and it is characteristic of my hon. Friend’s time as Committee Chair and of the excellent colleagues who served with him.

It was impossible not to be moved and struck by the story about east Kilimanjaro told by the hon. Member for Stafford (Jeremy Lefroy). If ever there were a story that characterised a small world, that is it. It also made a really important point about Britain’s future place in the world and the importance of being generous with our knowledge, whether in medicine, as in this case, in sciences, as we talk about tackling climate change globally, in nutrition, in farming and so on. We have an awful lot of expertise and excellent academic institutions in this country, and we have lived experience as well. We ought to be really generous with how we share that. If we do, we can make a really big impact. We will always talk about aid in terms of the 0.7% of GDP commitment, which is exceptionally important, but sharing knowledge is a soft way of contributing even more, and that is really important.

The hon. Member for Stafford also made a point about jobs. I often say that my love for development stems from my values. The things that I want for my community are the things I want for the rest of the world. His point about employment and employers is really important. In Nottingham, when that has been done well, it has been transformative for people and businesses, but when it has been done poorly it has had quite the opposite impact, and that applies around the world. I hope that we can be generous in the way that we support others to do as well as they can. I wish the hon. Gentleman very well in the future.

The hon. Member for Woking (Mr Lord) spoke about Britain’s place in the world, which chimed with the previous contributions. He mentioned the Syrian refugee programme, and I do not think I would be too bold to say that there was a universal sense across all communities of just how good that scheme was, and how much communities stepped up and rallied around. We are very proud of that in Nottingham; it is clearly the case in Woking, too.

We should not be shy of acknowledging the importance of faith communities in such schemes. Whatever their faith, people from faith communities in my constituency make a massive impact on a daily basis for those who have the least. They do that because they think it important. I suspect that other hon. Members will agree that when the road is long from visiting projects, and we are having difficult days, seeing those schemes and meeting those people fills our hearts and sends us off with a spring in our steps. We should not miss the opportunity to highlight and trumpet that work whenever we can.

As my hon. Friend the Member for Liverpool, West Derby said, 1 billion people—almost one in eight globally—live with disabilities. Among the poorest people in the world, that number is one in five, and rising. Including people with disabilities in development and humanitarian interventions is not a side issue; it directly affects millions of people in fundamental ways. I commend DFID for the global leadership that it has shown on this issue in recent years. Only when we lead by example can we raise the bar internationally, and I believe that DFID has made a significant effort to do so. That work is a good example of what an independent DFID can do and of the leadership that it can show at home and abroad. On behalf of the Opposition, I put on record our commitment to the DFID’s disability agenda and affirm that it is crucial in the fight against inequality of justice. We would plan to make significant steps in the leadership of that fight, perhaps from 13 December.

I would be interested to hear the Minister’s reflections on three points. First, as my hon. Friend said, momentum and political will on disability should not be lost. I welcome the Government’s agreement with the report’s first recommendation on developing a robust accountability mechanism for commitments made at the global disability summit in July 2018. A significant amount of time has passed since that summit, and once the election period is over, it will have been 18 months. The mechanism is not likely to be in place until 2020. We risk losing a bit of momentum from the summit. Will the Minister tell us what is taking so long? Can he elaborate on what the plans and timing are, and whether a follow-up summit is planned in due course?

As my hon. Friend said, there has been significant political change in the Department in recent years. Obviously, there have been four Secretaries of State, two of whom—the right hon. Members for Witham (Priti Patel) and for Portsmouth North (Penny Mordaunt)—have made disability a real priority. I want Ministers to make it clear today that this is a departmental priority, not just a priority of individuals; that this will not relate to the politics of the day; and that any future changes will not mean that this will be lost as a priority. It is important to have that clarity on the record.

Secondly, it is important that we talk positively about the impact that businesses have in this area, but also reference some of the risks involved in that, and our part in the world and in global trade in future. I welcome DFID’s work, set out in its response to recommendation 29, to better include people living with disabilities in its humanitarian interventions. Whether in conflict, in the climate crisis or in humanitarian crises, people living with disabilities are by definition the most vulnerable and at risk of being forgotten and/or excluded. Inclusion or exclusion can be the difference between life or death.

We know that conflict causes disabilities, life-changing injuries and trauma, and that over 90% of the casualties of such conflicts are civilians. It is therefore good and important that in Vienna, countries agreed to work together towards a new international political declaration to stop the use of explosive weapons in populated areas. Do the UK Government support those efforts unconditionally, and if not, why not? We have to accept our own place within that. We must accept that if there is any sense that British-made bombs have caused these problems, that undermines the case that we make in our communities about the importance of British aid and helping people with disabilities. That is an inconvenient truth, but one that we must not lose from this conversation.

Thirdly and finally, there must be coherence between our international and domestic approaches. In the Government’s responses to recommendations 19, 20 and 21, they affirm that DFID will want to strengthen the access of people with disabilities to social protection in developing countries, and in some cases, agree to go further in the future. There is the challenge of that not chiming with constituents who contact me about experience at home. We of course know from the UN Committee on the Rights of Persons with Disabilities about some of the challenges in this country. Those are issues for the next six weeks, so I will not go any further than that, but there will be a challenge for us on the credibility of both public policy and aid policy, which is so important, if we do not demonstrate that we are practising and preaching at home the values that we believe in and hold globally. That is exceptionally important, and I would be interested to hear the Minister’s response.

I thank you, Mr Evans, for chairing the debate and hon. Members for their contributions. I thank the hon. Member for Stafford and my hon. Friend the Member for Liverpool, West Derby for everything that they have done, and for their leadership. We stand on their shoulders. I find it comforting to be able to say that, and we wish them nothing but the best in the future.

15:39

[The Minister of State, Department for International Development (Andrew Stephenson)]

It is a pleasure to serve under your chairmanship, Mr Evans, for what I think is the first time. It is good to see my constituency neighbour in the Chair.

I congratulate the hon. Member for Liverpool, West Derby (Stephen Twigg) on securing the debate, and I thank International Development Committee members for their long-standing interest in disability-inclusive development. They have consistently shown strong support and leadership on this issue. Their most recent report will be an invaluable contribution to our achieving our ambition. I thank my hon. Friends the Members for Woking (Mr Lord) and for Stafford (Jeremy Lefroy) and the hon. Member for Nottingham North (Alex Norris) for their informed and thoughtful contributions.

Disability inclusion is a top priority for DFID and will remain so. Momentum is building, but we recognise that we have to do more. The world will not achieve the sustainable development goals, or deliver its commitment to leaving no one behind, without a sustained, concerted effort to include people with disabilities at all stages of their lives.

Disability inclusion is a neglected issue internationally. Although 180 countries have ratified the UN convention on the rights of persons with disabilities, implementation is slow. There are an estimated 1 billion people with disabilities globally; 80% of people with disabilities live in developing countries. People with disabilities are poorer than their non-disabled peers, in terms of access to education, healthcare, employment, social support and civic involvement. As the hon. Member for Liverpool, West Derby said, the differences are particularly stark in education; more than half of the 65 million children with disabilities in low and middle-income countries are not in school.

I will add some personal reflections. In 2008 I had the privilege of attending the Paralympics in Beijing to watch my university friend Helene Raynsford win gold in the women’s single sculls. I remember the event vividly, but I also remember being told how the Paralympics had helped transform Beijing from a city that was almost totally inaccessible to disabled people to one ready to welcome disabled people from across the globe.

More recently, last month I met Charlotte Frost and Joshua Hartley, two International Citizen Service volunteers from Barnoldswick in my constituency. In 2018 Joshua spent three months in Ghana volunteering on a disability project for people with visual impairments. After that, he returned to his job at Pendle Borough Council and helped set up a goalball team—a sport designed for people with visual impairments—in Blackburn. That is a great example of a DFID-funded project benefiting disabled people in a developing country, and bringing knowledge and learning back to the UK.

Without efforts to reduce barriers, many people with disabilities would be trapped in poverty. We know that women and girls with disabilities are even more marginalised and discriminated against because of their gender as well as their disability. That is why this issue is so important. If we are to deliver real change for people with disabilities, we all need to fundamentally change the way we do business.

We are pleased that the Committee concludes from its assessment that DFID is making good progress on this aim. We were particularly pleased to see that its report commends our leadership on the global disability summit in 2018, and supports our five-year disability inclusion strategy. That gives us renewed confidence that the strategy, published in December last year, will achieve real and tangible outcomes for people with disabilities. The strategy includes time-bound commitments over the next five years, and sets out how we will mainstream disability inclusion in DFID’s systems, structures and culture.

DFID agrees with the vast majority of the recommendations in the report. We recognise that this is a long-term, complex agenda, and the recommendations will help shape our future direction. Our priority is to continue to be a leading light in disability inclusion. I will highlight four main areas where we will continue to do this. The first is in leadership and culture. Leadership on this issue is essential—not just senior leadership or leadership from Ministers, but leadership throughout the organisation. A number of Members have commented on the personal commitment of the previous Secretary of State to this issue. I was pleased that the Secretary of State reconfirmed last week to the Committee that disability inclusion is a top priority for DFID.

Our worldwide network of 67 disability champions will continue to share best practice and inspire action. We are supporting offices in undertaking stock-takes and implementing actions plans to embed disability inclusion properly in their systems and structures. Of the 52 offices that completed a recent self-assessment, 48 indicated that they were on track or had achieved the standard for creating an inclusive office culture.

Secondly, we must focus on getting the right expertise to deliver our agenda. The Committee made a number of recommendations on improving the diversity and skills of our staff, with which we fully agree. We strongly believe that people with disabilities should be at the forefront of DFID’s work. We are working with human resources to improve access and opportunities for people with disabilities. That is happening alongside DFID’s wider efforts in areas such as gender equality and race.

To deliver on the strategy, we need to develop the technical skills of our staff in the UK and in our country offices. Alongside a dedicated helpdesk, we are developing an interactive resource site containing detailed guidance notes, tools and advice to support the roll-out of the strategy. Our central team provides bespoke support to country offices, especially those working towards high achievement standards. Our offer also includes training courses for staff on specialist topics such as mental health. That is already having an impact. We have seen a significant rise in the number of programmes marked as disability inclusive, from 19% in November 2017 to over 31% now.

For example, in Jordan, assistive technology is being integrated in humanitarian programming. People with disabilities are being provided with assistive devices, such as crutches, wheelchairs and prosthetic limbs. Through the Girls Education Challenge, mentioned by the hon. Member for Liverpool, West Derby, we have helped over 46,000 girls with disabilities receive an education in countries including Kenya, Uganda, Tanzania and Zimbabwe.

Thirdly, we recognise that we cannot achieve outcomes for people with disabilities by working alone. We must work in partnership with others and continue to bring new actors to the fore; that was a success at the global disability summit. We agree with the Committee’s recommendations on working with the private sector and deepening our relationships with country Governments. DFID is uniquely placed to influence other organisations and drive up standards in the sector. We welcomed the publication of the UN disability inclusion strategy in June 2019 as evidence of continued momentum on the part of other agencies.

We need to be able to hold ourselves and others to account. We plan to create an independent secretariat to drive progress on the 968 commitments from the global disability summit. We know that change is not possible without shared responsibility. We all have to hold each other to account if we are to deliver the change we want. Our continuing relationship with the Committee will be crucial to that.

Importantly, we recognise that DFID should strive to consult more meaningfully with people with disabilities and their representative organisations, and should build their capacity. We have seen an improvement in this area across DFID; country offices routinely consult with disabled people’s organisations. Through our disability catalyst programme, we are working with the International Disability Alliance and the Disability Rights Fund to build the capacity of disabled people’s organisations. We fully agree with the Committee’s recommendation that we should continue to advance this work. It remains the responsibility of us all to embrace the disability movement’s principle, “nothing about us without us.”

Finally, improving data collection and gathering rigorous evidence on what works will be a key part of our work on disability-inclusive development. The Washington Group questions are an important tool to improve measurement of disability. We are strengthening their use throughout our programming to ensure that we can measure our impact. Our inclusive data charter action plan, released in March 2019, articulates how we will gather high-quality data on people with disabilities.

We recognise that there are gaps in our knowledge of what works and how to reach the most marginalised. Our £37-million disability-inclusive development programme will deliver best-in-class research to address this. Working across a range of sectors, this programme will test a range of innovative solutions and then take them to scale.

We welcome the Committee’s scrutiny of our activities, and are pleased that the recommendations are almost uniformly in line with our own thinking. We would like to express further thanks to the many civil society partners and stakeholders who contributed to the report.

I turn to the questions that Members asked. The hon. Member for Liverpool, West Derby asked about economic development programming. That is one of the four pillars of the strategy. We know we need to close the employment gap, and have to work with the private sector to do that. For example, our RATE programme—the Responsible, Accountable and Transparent Enterprise programme—works with multinational and local businesses to be more accountable for poor workers, including people with disabilities. Our UK Aid Connect programme, run by Sightsavers in conjunction with Leonard Cheshire Disability, is also supporting thousands of people with disabilities in four countries.

The hon. Gentleman mentioned what we are doing with CDC to ensure that it focuses on disability and inclusion. CDC is working jointly with the World Bank to develop a good practice note in order to incentivise private sector companies to invest in making their work inclusive of people with disabilities. That was one of the commitments made at the global disability summit.

Once again, I thank the Committee for its continued interest in this area. We look forward to engaging further in the coming months and years. I thank all the Members who have spoken, particularly my hon. Friend the Member for Stafford. It is a huge shame and a great loss to this place that he is standing down. As was evidenced by his speech, and as he has shown in his many speeches over the years, he has a huge wealth of knowledge on topics in this area, such as neglected tropical medicines and all sorts of other things. My mind is often boggled by his depth of knowledge. I pay tribute to him for everything he has done for his constituents in Stafford, and on humanitarian issues, education and a range of issues over the years. I will take away his point about Burundi; we are spending £4.6 million in Burundi on education, sexual reproductive rights and humanitarian programmes run by partners. We have some challenges due to the EU sanctions that prevent us from giving money directly to the Burundi Government, but as a personal commitment to him, I am very keen to go away and look at what more we can do in that country.

Finally, on behalf of the Department for International Development, I pay tribute to the outgoing Chair of the Committee, the hon. Member for Liverpool, West Derby. I thank him for his service over the past four and a half years. In that time, I believe he has seen off five Secretaries of State and 13 junior Ministers, his Committee has published 28 reports, and he has found the time for 11 official country visits. He has been a prominent and tireless advocate for, among other things, global education, the safeguarding of beneficiaries, the implementation of the sustainable development goals and humanitarian action across the globe. I am sure he will enjoy his time away from this House, but he will undoubtedly be missed as a Member of it.

[Mr Nigel Evans (in the Chair)]

Before I call Stephen Twigg to make his closing remarks, I thank everyone who has taken part in the debate. As a member of the Committee, I must say that this subject has been overlooked in the past, and I am delighted that it has been addressed in this report. It has been an honour and a joy to serve with the hon. Member for Liverpool, West Derby (Stephen Twigg) as Chair of the Committee. He is passionate about this subject and has shown great leadership throughout his tenure. I am sorry to see him go and I hope he will find a role somewhere outside this House, perhaps in a similar position.

It was an honour and a joy also to serve alongside the hon. Member for Stafford (Jeremy Lefroy) when he was a member of the Committee. He was absolutely dedicated; indeed, the only reason he is no longer a member is that he stood aside to allow another Member to take up his position, as there were no women on the Committee. That shows just how principled he is. I love the story about Janet—a wonderful, personal tribute to your wife and the legacy she has left behind. Thank you, Jeremy, and good luck for the future.

16:03

[Stephen Twigg]

Thank you, Mr Evans, not only for your chairmanship today but for your service on the Committee. I wish the Committee well in future. You anticipated one of the things I was going to say, as did the Minister. He made the point that in my four and a half years as Chair of the Committee, there have been five Secretaries of State for International Development, but what has been striking has been our ability to work together, not just as a cross-party Committee but with Government Ministers. No matter who takes over as Secretary of State after the election, today’s debate has demonstrated the strong cross-party commitment from the Minister and the shadow Minister to disability at the heart of our approach to inclusive development.

Mr Evans, you mentioned that the hon. Member for Stafford (Jeremy Lefroy) stood aside from the Committee, which was a huge loss, to enable the hon. Member for Mid Derbyshire (Mrs Latham) to remain a member. I pay tribute to her; she has been a Committee member since 2010. She spoke up on sexual exploitation, abuse and harassment before the various issues were covered in the media last year. She has been a tenacious rapporteur on that issue and a passionate voice on other international development issues. I hope that when the new Parliament convenes, we shall not again be in a position where there is only one woman on a Committee of 11 in such an important area. We must ensure that Labour’s delegation on the Committee is not entirely male. We must have a more appropriate gender balance in this important area.

We have had an excellent debate. I join the tributes to the hon. Member for Stafford for his service to the House, the Liverpool School of Tropical Medicine and the all-party parliamentary group on malaria and neglected tropical diseases. In particular, I echo what he said about Burundi, which we took the opportunity to raise with the Minister when he appeared before us earlier this week.

The hon. Member for Woking (Mr Lord) made a passionate speech. In what he said about Syrian refugees, he spoke for all of us and for the best of this country, with that generosity of spirit. I hope that we can learn from that in our broader policy. After I became the Chair in 2015-16, the Committee’s first report was on the Syrian refugee crisis. One of our recommendations was that in taking vulnerable refugees in resettlement, the UK should absolutely focus on those with disabilities, so I welcome the local example from Woking. I also echo what he said in the context of the UK and Brexit. Whatever happens with Brexit, our commitment to development and humanitarian relief is an important part of our country’s soft power. As he said, our values of compassion, and of seeking and leading a positive role, should be at the heart of the approach.

My hon. Friend the Member for Nottingham North (Alex Norris) made several powerful points. We echo his point on the coherence of domestic and international policy, which is important in this area and others. The Committee raised that in the context of the sustainable development goals because, as we know, the global goals are universal. They say that, yes, no one should be left behind because of their disability in sub-Saharan Africa, but neither should they be in Nottingham, Liverpool, Stafford, Woking or any of our constituencies. Achieving that coherence is an important challenge for every Government.

I was delighted to hear the Minister reaffirm once again that disability inclusion is a top priority for the Department and that, in his words, it will “continue to be a leading light”. That is hugely welcome.

I thank everyone for their kind words on the work I have done with the Committee. It would not have been possible without the other Committee members or, in particular, without the amazing staff and specialist support that the Committee gets from advisers and the hugely vibrant sector. As the Minister said, there are very strong NGO, business and academic sectors in this area, and we rely on them for the best evidence that we get as a Committee. He rightly reminded us of the point that comes so strongly from disability organisations: nothing about us without us. That is the message of the debate.

I hope that next Tuesday I will catch the Deputy Speaker’s eye when there will be an opportunity for valedictory speeches. I intend to say that it is so important that we maintain the consensus for our global engagement, for our commitment that 0.7% of gross national income goes to development, and for DFID as a stand-alone Department. I know that there is not unanimity in the House on those issues but I hope that, moving forward, the cross-party consensus will continue behind those commitments, which speak to our moral purpose and sense of mission as a country. As the hon. Member for Woking said, they enable us to be an influential player in the world, rooted in the best universal values that this country has long been committed to.

I thank the Minister for his response. I feel confident that disability inclusion will remain a priority for the British Government. I am equally confident that, whoever takes over from me as Chair, the Committee will continue to press whoever is in Government to ensure that that is the case.

Question put and agreed to.

Resolved,

That this House has considered the Thirteenth Report of the International Development Committee, DFID’s work on disability-inclusive development, Session 2017-19, HC 1880, and the Government Response, Session 2017-19, HC 2680.

16:10

Sitting adjourned.