Westminster Hall
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Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Cervical Screening
(3 years, 4 months ago)
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Mark Pritchard (in the Chair)
Hon. Members will be aware that social distancing is no longer in operation. I remind hon. Members that Mr Speaker has encouraged us all to wear masks. I also remind hon. Members that there have been some changes to normal practice in order to support the hybrid arrangements that we have today. I remind colleagues participating both physically and virtually that they must arrive for the start of the debate, as I think they have today, and Members are expected to remain for the entire debate, please.
I must also remind Members participating virtually that they must leave their camera on for the duration of the debate and that they will be visible at all times, both to each other and to those of us here in the Boothroyd Room. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address, which is westminsterhallclerks@ parliament.uk. Members attending physically should still clean their places when they leave, to ensure that other hon. Members can come into a place that is clean.
Tonia Antoniazzi (Gower) (Lab) [V]
I beg to move,
That this House has considered e-petition 317336, relating to cervical screening.
It is a pleasure to serve under your chairship, Mr Pritchard, for this really important debate. I apologise for not being able to be there in person today, but I thank the House for these hybrid proceedings because I was pinged last week.
I will begin by putting on the record my huge thanks to Caitlin, who is Fiona’s sister, for speaking to me last week about Fiona’s case and the way that it has affected her whole family. I also thank Fiona’s friends, Melissa Macdonald and Niamh Foley, who started the petition, and all those who have signed it, which led to this debate being held today.
As a woman, I know that we all sort of dread getting the call-up for our smear test. For most women, it is not painful, but it is uncomfortable and awkward. What can someone even chat about when the nurse is having her little look? But why should it be like that? We have all been there; the nurse has seen it all before. It is just not spoken about, so we feel a sense of shame about it. It is time we stopped being so coy about it, because that may well persuade more women to go for screening and ultimately it may save lives.
Cervical cancer is one of the most common cancers in women under 35, and 99.7% of cervical cancers are caused by human papillomavirus, or HPV. In recent years, testing for HPV has meant that it is easier to identify who is at greater risk from cervical cancer at the earliest stage.
During covid, England had an attendance rate for smear tests of 72%, which means that more than one in four women are not going for screening when invited to do so. The wonderful charity Jo’s Cervical Cancer Trust has a number of ideas to increase the uptake of smear tests, and I suggest that the Minister meets it to discuss ways of increasing the number of women being tested; I know that she has a keen interest in women’s health.
I was really moved when I spoke to Caitlin, because I got a real sense of how difficult it must be to lose a sister, especially at such a young age. Fiona was only 30 when she died. She was married to Andrew and was the mother of two young children. When Fiona died, Ivy was only four and Harry had just turned two. As Caitlin said, Fiona used all her strength to stick around for Harry’s second birthday.
Fiona was called for her first smear test in 2015, but she was pregnant with Ivy and so was told not to go. When she was called again, she was pregnant with Harry, but there was no follow-up to the first appointment. Fiona never received a reminder to go to her smear test in the interim. This situation is not about someone missing appointments when called to attend them; Fiona went to every appointment that she was meant to go to.
Fiona’s cancer was finally diagnosed after a routine smear test in 2018. She did not have any symptoms, but there seemed to be a lot of hold-ups and delays before her cancer was diagnosed. Caitlin mentioned that it could perhaps have been because of Fiona and Andrew moving from England to Scotland that Fiona received her first invitation. That raises questions about communications between the devolved Administrations and about what procedures are in place to make sure that communication between different trusts and devolved countries is clear.
A hysterectomy was performed and Fiona then went through chemotherapy and radiotherapy as a belt-and-braces approach to dealing with the cancer. After that, Fiona had a number of visits to A&E, including one where the doctor later admitted that she knew the problem was cancer and not a hernia, but did not say anything as Fiona was seeing a specialist soon after.
Most of us are not medical experts. We rely on doctors to tell us the truth because we do not know what is going on, and that vulnerability is really exposed when we hear such stories. I know it is extremely rare to hear stories such as Fiona’s, and the vast majority of our doctors, nurses and other health service staff really care, but it is shocking none the less.
Before covid hit, cancer services were already struggling due to severe staff shortages. Despite the incredible efforts by staff, a backlog has built up. Relying on current staff, who again have not had a pay rise, to clear the backlog on top of delivering regular services will only lead to burnout. It is just not sustainable. Research from Macmillan Cancer Support in 2017 showed that 2,500 specialist cancer nurses were needed to maintain cancer services. By 2030, we will need 3,700 new nurses—an increase of 124% on 2017 levels. Those figures will also have been hugely impacted by the pandemic. The Government have come forward with their own cancer workforce strategy, which is inadequate, and I implore the Minister to reconsider the plans that they have and come up with something that will really help those living with cancer.
Everything that happened to Fiona came before the pandemic hit last year. We have heard countless times about the delays in diagnosis and treatment that the last 16 months has caused. Approximately 1.5 million smear tests take place every year. With the pressure on the NHS since March 2020, that could mean 1.5 million women missing out on a vital tool in diagnosing cervical cancer.
We know that the rates of covid infection are on the up. Hospitalisations for covid are rising, and some NHS trusts across the UK are already cancelling operations as they are at capacity. The recklessness of so-called “freedom day” in England and the removal of all the measures that have been in place to keep us safe is therefore unbelievable. Putting the immunosuppressed at risk, such as those going through cancer treatment, is downright dangerous, and I am glad that the devolved nations have taken a more cautious approach.
What will the extra pressure on the health service mean? Another delay in getting a smear test. And what will that do to the outcomes for so many young women? What will the Government do to make sure that those women who miss out are not left behind, and to stop a knock-on effect on testing? We are looking at new ways forward. Fiona’s case has highlighted some of the gaps that were there before the pandemic started, and things have only deteriorated since covid hit. We must work together to make sure that cancer services are the best that they can possibly be, and that our cancer workforce is protected and given all the tools that it needs to continue to save lives.
When Fiona got really ill, her daughter Ivy used to ask why mummy had to spend so much time in bed. To stop another family having to answer those questions, I want the Minister to answer the questions that Fiona’s family and friends, and all of those who have lost someone to cervical cancer, need answers to. What procedures are in place to make sure that women like Fiona do not fall through the cracks? How does that work across the devolved nations? What is the current screening backlog? What plans to increase the cancer workforce are currently in place?
Caitlin finished our meeting by saying that any change that could come from this debate—if one life is saved, or if one family does not have to go through what her family have been through—would make it worth it.
Mark Pritchard (in the Chair)
Before I call John Lamont, I have to say that even though the attendants have been fantastic in helping with the air conditioning, it is still very warm, so if hon. Members want to remove jackets, they should feel free.
John Lamont (Berwickshire, Roxburgh and Selkirk) (Con)
It is a pleasure to serve with you in the Chair, Mr Pritchard.
I am pleased to speak in today’s important date, which has attracted so much support from my constituents in the Scottish borders, with almost 3,000 signatures coming from Berwickshire, Roxburgh and Selkirk—the highest number across the United Kingdom. This can be explained by the fact that the petition was launched by borderer Andrew Mathewson, who lives in Kelso, in my constituency. As we have heard, Andrew tragically lost his wife Fiona, mother of Ivy and Harry, when she died after battling cervical cancer for 17 months, aged just 30.
I have met Andrew, and I admire the way that he has campaigned tirelessly for cervical cancer screening, in memory of Fiona, and dedicated his work to ensure that other families do not go through what they had to. Fiona’s story is close to the hearts of many people in the Scottish borders who know the Mathewsons, and indeed many people far beyond and across the country, with over 146,000 signatures recorded in total for the petition.
The NHS and this policy area are devolved to the Scottish Parliament, and my comments will have a distinctive Scottish slant. Around 850 women die from cervical cancer each year in the UK. Sadly, that is more than two women every day. Yet cervical cancer is one of the most preventable cancers for two key reasons. First, cervical screening tests check for abnormal changes in sample cells from the cervix. Cervical screening is not a test for cancer, but early detection allows action to be taken to prevent cervical cancer from developing.
Second, the HPV jab is on offer to every child between 12 and 14 in Scotland. For girls, it is designed to protect against types of HPV that cause around 70% of all cases of cervical cancer in Scotland. In most people, HPV does not cause harm and the infection clears on its own, but in some cases HPV infection can lead to cell changes that progress into cervical cancer. Taken together, cervical screening and the HPV vaccine mean that cervical cancer can be avoided.
Cancer Research UK has stated that cervical screening is the best protection against cervical cancer, yet in Scotland it is offered far less frequently than in the rest of the UK. In England, Wales and Northern Ireland, women between 25 and 49 are screened every three years, but women in Scotland face a five-year wait between each screening. Over the past year, some women were notified that their waiting time of five years would be extended as NHS Scotland rightly diverted time and resources to tackling covid-19. However, I am pleased that the resumption of cancer services, including cervical screening, are now being treated as a priority by NHS Scotland.
Alarmingly, this transparency from NHS Scotland was not mirrored by the Scottish Government, who failed to reveal that a number of women had developed cervical cancer after being wrongly excluded from the screening programme following a hysterectomy. One of those women tragically died. The SNP Government were made aware of the errors back in a December audit, but waited until the last day before the summer recess to reveal the scale of the problem to the Scottish Parliament.
This debate is not about party political point scoring, but it would be wrong of me not to highlight the concerns of anxious women, their families and the wider public, who were left in the dark by Scottish Ministers who prioritised their political campaign and attempted to avoid scrutiny. These serious errors have affected hundreds of women, with more cases potentially still to be identified.
The crux of this debate on cervical screening is about the opportunity to reduce the number of women who tragically die from cervical cancer. In my closing remarks, I would like to address some ways in which we can reduce this number of preventable deaths. Evidence shows that the women most likely not to attend a cervical screening appointment are those between the ages of 25 and 34. Yet the evidence also indicates that cervical cancer is the most common cancer in women in this age group. Awareness needs to be raised among women. There is a real incentive to ensure that resources are dedicated to this cause, since cervical cancer can be prevented.
One method that has been trialled in London has involved GPs sending text messages about cervical screening appointments, instead of relying on sending letters through the post. Stigma also needs to be addressed: personal barriers such as lack of knowledge about the purpose and benefits of the test, as well as fear and anxiety about the procedure itself, can play a role in women not attending their appointments. Finally, the Scottish Government should listen to the worries of some Scottish women, who say that they are concerned that they would develop cervical cancer within the five years and just would not know about it.
I end by again paying tribute to Andrew Mathewson and his family and friends, who have been at the forefront of this petition and have ensured that we are debating this important issue today. Andrew continues to selflessly battle on behalf of women he does not even know so that fewer families will have to lose a wife, a mother, a sister or a daughter to this cancer.
Alex Davies-Jones (Pontypridd) (Lab)
It is a pleasure to serve under your chairship today, Mr Pritchard, and I am incredibly grateful to be called to speak in this debate on a topic that, as colleagues may know, is extremely close to my heart. It is also a pleasure to follow the hon. Member for Berwickshire, Roxburgh and Selkirk (John Lamont).
Fiona’s story is tragically similar to so many other women’s stories across the country, and my thoughts and condolences are with the whole Mathewson family. As elected representatives, we have the great fortune of being able to speak up on a huge range of the issues that matter most to the people who live in our local communities. It is a fantastic privilege, and one that is not at all lost on me, but there are still certain debates that speak to us as people, not just as politicians. I will always be a vocal and loud champion of cervical screenings, and I am grateful that we are taking the time to speak about this important issue today.
We know that cervical screenings are the best way to protect against cervical cancer: the numbers speak for themselves. Indeed, cervical screenings can prevent more than seven in 10 diagnoses. Those who know me well will know that I speak about cervical screenings whenever and wherever I possibly can, mostly because a delayed cervical screening changed my life almost overnight. Like many others, I put off having my first cervical screening at the age of 25 for all the usual reasons: I was too busy, I did not have the symptoms, and I simply had other priorities. After many conversations with friends, most of whom gave me a good telling-off when I shamefully revealed that my screening had been delayed, I booked my appointment and thought nothing more of it.
While most of us will agree that cervical screening is probably not up there with our top 10 favourite things to do on a morning, the test itself is relatively quick and simple, but as many of us will know, the wait for the results—for that NHS letter arriving on our doorstep—can feel genuinely endless. In my opinion, it is the hardest part about being tested.
Fast forward to a few months after the screening, and I was sat in my local hospital undergoing a colposcopy after my initial test results came back abnormal and further examinations were required. I was genuinely terrified. Everyone had told me that a routine screening was nothing to be concerned about: that it would just be five minutes of awkward conversation with the nurse at my local GP practice, and it would be job done for the next three years in Wales. Sadly, that was not the case for me. I was told that I had abnormal CIN 3 cells that, if left undetected and untreated over a number of years, could develop into cervical cancer. We always think it will not happen to us, but there I was at the age of 25, diagnosed with CIN 3 on a large area of my cervix.
The next few weeks were a complete blur. I became obsessed with googling everything I could about abnormal cells, potential treatment and cervical cancer. I became a prolific poster on, and reader of, the excellent Jo’s Cervical Cancer Trust forum, and I found comfort in talking to others who had gone through, or were going through, exactly the same thing. Thankfully, the staff at my local hospital were incredible, and almost immediately I underwent LLETZ—large loop excision of the transformation zone—treatment to burn off the abnormal cells on my cervix. I went to that appointment alone. It was one of the most surreal moments of my life and one that, try as I might, I will never forget. After the doctor had finished—which felt like an eternity at the time—she did not look happy. More treatment was needed. She told me that on closer inspection, the abnormal cells on my cervix were embedded deeper and looked more challenging than initially expected. I will never forget those words.
The next stage for me was a cold knife biopsy. Thankfully that minor operation went smoothly, and a few weeks later I got the call that I had desperately hoped for: the clinicians were confident that all the abnormal cells had been removed. The damage was quite severe, and if I had put off that initial cervical screening test any later, the situation would have been very different. The extent of the treatment meant that I was now without the majority of my cervix. Of course, having that treatment comes with risks, such as a slightly increased chance of giving birth prematurely, but by that point I did not really care: I just wanted the nightmare to be over.
I was without the majority of my cervix, but my life was saved. Sadly, for many—as we have heard, tragically, in Fiona’s case—that is not the case, and I count my lucky stars that my friends gave me the push I needed to book my cervical screening when they did. After receiving treatment, I attended screenings every six months to ensure the abnormal cells did not return. Even now, years down the line, my screenings are more common than most, and I go on an annual basis.
It would be wrong of me to pretend that I have not been impacted on by the ordeal I went through. The physical scars might be internal, but I will always grapple with the mental effects. Even years on, I still get that nervous feeling in my stomach before I go to my screening. However, we have all seen the numbers—my hon. Friend the Member for Gower (Tonia Antoniazzi) touched on them in her opening remarks—and we can all recognise the devastation that cancer, in its myriad forms, can have on those suffering and on their close friends and family. It goes without saying that we should be doing everything we can to protect those who may be particularly at risk of developing cervical cancer, and regular cervical screenings are absolutely key if more lives are to be saved.
Although I am pleased to say that there has been progress on specific incentives to encourage more people to attend their screenings, cell changes such as mine often fall through the gaps, along with HPV. HPV diagnosis is still associated with high levels of fear, confusion and stigma and a lack of understanding, despite it being an incredibly common virus. Jo’s Cervical Cancer Trust recently surveyed its community of users who have HPV and found that one in two people said they knew nothing about HPV prior to receiving a diagnosis. Interestingly, people with recurrent or persistent HPV report feeling let down by their bodies and anxious about the ongoing and uncertain nature of the condition, and they often feel that there is no support or information for them either. There is clearly a need for increased education when the vaccine is first given, greater awareness of how common it is and how it affects the body, and greater information and support for those affected.
The same goes for cell changes such as mine. Around 220,000 women each year will be told that they have cell changes, and many will be treated to prevent the potential development of cervical cancer. There are opportunities to improve the care that is offered. We know that treatment for cell changes is highly effective at preventing the development of cervical cancer, the impact of which can be truly devastating, but more must be done to ensure that women diagnosed with cell changes are properly supported before, during and after treatment. Research from Jo’s Cervical Cancer Trust found that 20% of women said the possible impacts and side-effects of treatment were not explained to them beforehand. Even more shockingly, 60% were not told about the different types of treatment that were available to them. It is clear that although progress has thankfully been made on the dialogue around cervical screenings, we still have a long way to go to change the situation more broadly.
I am hopeful that today’s debate will send a reminder to those who, like me, put off their cervical screenings. I also hope that by touching on issues such as HPV and cell changes, people can learn about the broader benefits of screening too. Although health is of course devolved to the fantastic Welsh Labour Government, I truly believe that this is an issue that crosses the political divide. Indeed, I look forward to hearing from the Minister about the work that she is doing, including across Government Departments and the devolved nations, to encourage better understanding of the widespread benefits of cervical screening.
Margaret Ferrier (Rutherglen and Hamilton West) (Ind)
It is a pleasure to serve under your chairmanship, Mr Pritchard, and an honour to speak in this important debate. It is an absolute pleasure to follow the hon. Member for Pontypridd (Alex Davies-Jones) and hear her personal story. I am sure we are all glad to see her today.
The petition is a proposal to introduce yearly cervical screenings for all women. As we have heard, the campaign for Fiona’s law was launched after the untimely death of 30-year-old mum Fiona from Kelso in the Scottish borders. Cervical screening is unequivocally the best method of protection against cervical cancer, and I think I speak for us all when I say that I hope to see greater uptake of screening. Unfortunately, prior to the pandemic one in four women across the UK did not accept their invitation for screening. The figure is higher in areas such as London and Glasgow, among women under 30 years of age, and among groups who face additional systemic barriers to their attendance—for example, this issue disproportionately affects LGBTQ people, with 40% of lesbian and bisexual women in the UK having been told that they do not require cervical screening. Experience of trauma or violence can also deter women from attending, with 72% of women who have experienced sexual violence delaying or cancelling their appointments.
Most clinicians would largely disagree with the proposal to make cervical screening annual. The UK National Screening Committee sets the eligibility criteria for screening programmes and makes recommendations about changes in order to maximise the benefits and minimise harm. Cervical screening starts at the age of 25, not 18, as HPV is very rare in younger women, with fewer than four cases per 100,000, due to the high uptake of the HPV vaccine. Around 90% of HPV infections are cleared naturally by the body in two years, and many cell changes return to normal without the need for treatment. Research generally suggests that a lower screening age does not substantially reduce cases and can in fact lead to over-treatment, which can have serious implications on physical and mental health, including on the ability to carry a child to term.
A more viable option for increasing the uptake of cervical screening would be to roll out widespread HPV self-sampling, which would allow women to enjoy the comfort and convenience of performing the test in their own homes. Research by Jo’s Cervical Cancer Trust suggests this would greatly increase uptake, with 47% of women who rarely or never book a test preferring self-sampling to clinician-led screening. Only 9% preferred clinician-led screening, while 50% of women who are overdue for an appointment and 34% of women from black, Asian and minority ethnic backgrounds also preferred self-sampling. Some 63% of those living with a physical disability have noted that their disability made it impossible for them to attend screening. Making self-sampling possible would put the screening process into women’s own hands.
For that to be recommended by the UK National Screening Committee, far more research into this procedure is required. At the moment, only a few pilot schemes are being run: one in Scotland, in Dumfries and Galloway, and another in London. It is essential that progress on these vital studies continues. It would be helpful to know whether the UK Government plan to increase support for such schemes, to accelerate studies into the viability of HPV self-sampling nationwide, and to give an estimate of when the necessary research will be collected by NHS England.
While annual cervical screening may not be realistically viable or desirable, we can take concrete steps to ensure that access is widened, risk is adequately assessed and appointments are not missed. I hope the Department of Health and Social Care will take on some of these considerations, especially with regard to advancing the research into, and roll out of, home HPV self-sampling.
Taiwo Owatemi (Coventry North West) (Lab) [V]
It is a pleasure to serve under your chairmanship, Mr Pritchard, and to follow the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), who spoke with great passion about this crucial issue. Cervical cancer is something that all women fear. It is not only a deadly disease but one, like breast cancer, that strikes at the heart of how we view ourselves as women.
The petition that we are discussing on Fiona’s law received more than 146,000 signatures, with many from my constituents. That figure represents a groundswell of people who are concerned that not enough is being done to ensure detection of cervical cancer for women in the UK. We cannot ignore them. To detect cervical cancer early, we have developed highly accurate screening tests that enable women to know whether they have pre-cancerous cells, and if so, to receive the proper treatment. In fact, women will be tested for HPV before they get cervical screening, because 99.7% of all cervical cancers are caused by HPV. Simply put, thanks to our researchers and all the medical professionals across our NHS, tests for cervical cancer are more accurate than ever before.
There is much debate in this country about how early and how frequently women should be screened for cervical cancer, but women are only able to have their cancer detected if the screenings are successfully performed. Research on how often women access existing appointments should give us real cause for concern. We all know that the pandemic has had devastating effects on women’s ability to access life-saving cervical cancer screening. Jo’s Cervical Cancer Trust estimates that around 600,000 tests failed to go ahead in the UK in April and May 2020, and figures show that cancer screening for women in the 25-to-64 age group—the most vulnerable age group—decreased by nearly 7% from the previous year. These figures are completely unacceptable and show that the recent physical barriers to screening have a strong negative impact on women’s access to preventive services.
However, figures also show an equally strong mental impact. Unfortunately, this life-saving smear test remains a source of great anxiety to many. Earlier this year, it emerged that around one in four women eligible for smear tests do not take up the invitation. New research has found that, among those who do not go for their cervical cancer screening, 75% are scared at the thought of going and 81% are embarrassed to go.
The Government must do more to create public awareness about the test. They must normalise it, so that women do not feel embarrassed to seek this vital service, and bust other myths that induce anxiety about it. Perhaps most worryingly, Jo’s Cervical Cancer Trust has published a study that reveals that women from black, Asian and minority ethnic backgrounds are twice as likely to be strongly worried about contracting a virus at their cervical cancer screening as their white counterparts, and a third more likely to feel unsafe visiting a doctors’ surgery than white women.
It is vital that the Government look more closely into the cultural and mental barriers preventing black, Asian and minority ethnic women from accessing life-saving screening in much higher proportions. They must dedicate more resources to learning why women, especially those from minority backgrounds, are not taking up their testing appointments. That is crucial to achieving a reproductive health programme that is not only thriving but equal. I look forward to hearing from the Minister on the work that she is doing.
Jim Shannon (Strangford) (DUP)
It is pleasure to serve under your chairmanship today, Mr Pritchard, as I often have in this Chamber, and I very much look forward to the Minister’s response. I very much look forward to speaking in this debate on cervical cancer screening.
I stand here to speak on behalf of my female constituents, whom this directly affects, and I speak in complete support of the e-petition, which had 146,000 signatures. Cancer is a tragedy that all of us know only too well. I am sure it has touched the lives of everyone in the room today. I am sure the Minister will not mind me saying that she has been directly affected, and we are very pleased to see her here as a survivor.
We must take every necessary step to catch cases sooner rather than later. The petition for Fiona’s law applies to women in England. However, I speak on behalf of my constituents and the women of Northern Ireland. It is estimated that some 3,200 women will be diagnosed with cervical cancer every year in the UK. Eighty people in Northern Ireland are diagnosed every year, and roughly 20 to 30 of those women will, sadly, pass away from the disease. The Public Health Agency in Northern Ireland has said that early detection and treatment can prevent seven to 10 types of cervical cancer. As the hon. Member for Berwickshire, Roxburgh and Selkirk (John Lamont) mentioned, Northern Ireland offers screening every two years. I would like to see it done better. I would like to see it every year; that is the best way to do it. The request is for early detection and treatment as the way to prevent cervical cancer.
It is important to remember that screening is not a test for cancer; it is a test to help prevent it. That is what we are trying to do, and that is why, to assist in preventing cervical cancers, we must do more to ensure that women have screening appointments regularly. Current legislation states that women between the ages of 25 and 49 will be invited for screening once every three years, and those aged 50 to 64 every five years. That is in line with the NHS’s long-term plan to detect 75% of cancers at stage 1 or 2.
I cannot stress enough the importance of screening appointments for women. First, I can only imagine that it is not a comfortable or easy procedure to go through, but I do believe that the prolonged interval of three years only increases the anxiety. Secondly, yearly screening would allow for more effective diagnosis, but it also provides an opportunity to make a procedure that a lot of women dread having more familiar and comfortable, if that is possible.
The UK’s leading cervical cancer charity, Jo’s Cervical Cancer Trust, report that 51% of women admitted to delaying their screening, that 24% delayed for over a year and that 9%, one in 10 women, have never attended a screening. Those are shocking figures, but they are understandable at the same time. These are lives being lost, and because of the frequency of cervical screening it is getting worse.
There needs to be more communication about screening so that people are aware of what they are going into. That would then provide confidence and would increase the numbers attending, which would ultimately result in lives saved: more mothers, more daughters, more sisters, more grandmothers and more wives living longer and healthier lives. My wife went through it. She did not for one second wish to go. She found the whole thing very uncomfortable and, honestly, a little embarrassing. Obviously, we encouraged her. My mother encouraged her, and I think that probably helped—from lady to lady is probably better. She went for the tests and got the all clear.
Cancer of all kinds has destroyed lives and families for too long. We must do all we can to increase early diagnosis, as the petition calls for, especially in the light of the impact of the pandemic, which has seen a further decrease in screening figures. We need to get back on our feet and allow women yearly screenings. I urge the Minister to undertake discussions with the UK National Screening Committee to ascertain why it feels that women do not warrant screenings every year.
To anyone who is offered a cervical cancer screening, I say please go. I say to the Government that the encouragement from the Minister will start here. More must be done to get more frequent appointments, more awareness of the benefits and more discussion around the appointment itself, because there is nothing more promising than the prevention of disease.
Mark Pritchard (in the Chair)
Before I call Mike Kane, there has been a slight adjustment to the call list. I will call Dr Philippa Whitford after Mr Kane, and then Alex Norris.
Mike Kane (Wythenshawe and Sale East) (Lab) [V]
Thank you, Mr Pritchard. It is a pleasure to serve under your chairmanship. I add my congratulations to the petitioners on securing a debate in Parliament on such an important topic.
In January 2021, the Minister stated:
“While we do not hold waiting lists for National Health Service screening programmes, NHS England…are confident that no one eligible for cervical screening has missed an invitation for an appointment.”
An invitation is one thing, but being able to book and access a test can be quite a different matter. In the third quarter of 2021, no clinical commissioning groups in England achieved 80% coverage of women invited for a test. I am, of course, aware of the pressures placed on the NHS during the pandemic, and my speech does not denigrate it at all, but 600,000 cervical screening opportunities are estimated to have failed to go ahead in the UK just in April and May of last year.
In October 2019, NHS England commissioned an independent review of adult screening programmes. It highlighted that demographic factors—levels of affluence and deprivation, and ethnic diversity—have a huge impact on whether women take up the tests. For women who live in areas with higher levels of deprivation, such as parts of my constituency of Wythenshawe and Sale East, the coverage of screening programmes is lower than average.
Hologic, a fantastic innovative medical technology company in my constituency, focuses primarily on improving women’s health and wellbeing. It specialises in high-volume population screening. We know that more than 99% of cervical cancer cases are preventable and that, alongside HPV vaccination, cervical cancer screening is one of the most effective ways to prevent that cancer.
There are opportunities to improve screenings, both for clinicians and for patients, by adopting new innovative screening technologies. One such method is using HPV mRNA testing for primary cervical screening. The tests provide significantly higher clarity and would safely reduce the number of women who require a colposcopy, thereby reducing unnecessary fear, anxiety and stress for the women involved. It would also reduce the pressure on an already overburdened system, save the NHS an estimated £15 million a year, and potentially prevent 30,000 unnecessary colposcopy procedures.
Currently, just 54% of all samples in England are processed using that form of testing, meaning that 1.5 million women in England do not have access to the technology. England should move towards a system in which mRNA HPV primary screening is the gold standard used by all labs. With better co-ordination within NHS England, cervical screening would, for example, be commissioned by the same part of the NHS as colposcopies, enabling clinicians to work more effectively together and have a positive impact on patient experience and outcome.
Another innovative technological advance is digital cytology. This advanced imaging technology, used to identify lesions and pre-cancerous cells, which stores cervical images using cloud-based technology, would help maximise screening capacity, enabling any cytologist with capacity in the network to access a particular image. That would provide a much more flexible deployment of the workforce, would speed up time from result to treatment if necessary, and provide physical efficiencies, such as less need for storage and for the transportation of cervical images and slides.
Rolling out such technologies would save not only money and time, but would, in time, reduce the stress on women and girls at a worrying time, as has been pointed out today, as well as reducing the need for unnecessary gynaecological procedures. It would also provide a streamlining of these lifesaving services. I would welcome any comments that the Minister has about those suggestions.
Dr Philippa Whitford (Central Ayrshire) (SNP) [V]
It is an honour to serve under your chairmanship, Mr Pritchard. First, I want to extend my sympathy to Fiona’s family and friends, who were moved by her loss to set up the petition in her name. I have seen at first hand the impact of cervical cancer, as one of my friends lost her beautiful and vibrant daughter at the age of just 28 to this horrible disease. As a breast cancer surgeon for more than 30 years, I know the devastation caused by the death of any young woman.
Before we go further, I want to emphasise that any woman with symptoms of vaginal discharge or bleeding should not wait for a screening appointment, but should go and see her GP. There is usually a simple cause, but it is always important to get checked out.
Although the petition specifically calls for annual cervical smear tests, what we are all actually trying to achieve is the prevention and eventual elimination of cervical cancer, as called for by the World Health Organisation last August. For that we have to understand the cause of cervical cancer, and that is where our knowledge has developed considerably. We know that 99.7% of cervical cancers are caused by high risk strains of human papillomavirus, or HPV, and that is therefore the target of our efforts. This is through a two-pronged strategy, providing protection to the younger generation through vaccination against HPV and using more sensitive polymerase chain reaction testing to detect HPV on cervical smear samples to identify those at increased risk.
The HPV vaccine was introduced for young teenage girls in 2008 and initially included those up to 18 years, so that they would be vaccinated before leaving school. Research from the Scottish cervical screening programme in 2017 reported a reduction in the presence of HPV in the smears of vaccinated women from 30% to 4.5%, and by 2019 demonstrated an 89% fall in grade 3 cervical intraepithelial neoplasia—the cell changes that can evolve into cervical cancer if left untreated. That dramatic reduction in CIN 3 among the first cohort of vaccinated girls gives great hope that we will see a fall in cervical cancer in that age group in the coming years.
The vaccine is now also provided to boys, both to protect them from other HPV-related cancers and to provide additional protection to women by reducing how many men carry HPV in the first place. It is vaccination against HPV that really offers the chance to eliminate this terrible disease by the end of the decade. To achieve that, we need to vaccinate 90% of all teenagers, and our uptake rates have drifted below that level over the past five years. Some of that is likely due to fears that the vaccine was associated with health issues such as chronic fatigue or regional pain syndromes. However, a review by the European Medicines Agency found that those conditions were very common among teenagers generally, and there was no increase among those who had been vaccinated.
To reduce the risk of cervical cancer, we need to get rid of the stigma of HPV and ensure that all women and young people understand its importance in the development of cancer. It is a very common virus, which, in the vast majority of cases, causes no harm and is cleared by the body’s own defences, but some strains pose a higher risk of causing malignant change. After vaccination, the other critical approach to preventing cervical cancer is, of course, screening itself, but here too the focus is now on detecting HPV as the driver of cervical changes that can eventually lead to cancer. Classical cytology, which looks for abnormal cells within cervical smears, does not pick up every case, while PCR, about which we have heard so much during the pandemic, is more sensitive in detecting HPV and identifying the women at higher risk.
The UK National Screening Committee has therefore recommended changing to a two-step testing procedure, with the cervical sample tested for HPV first and then cytology performed on those samples that contain virus. Currently, that is carried out on one sample, which is collected in the traditional way—a clinician having to visualise the cervix directly. If the sample contains HPV, cytology is carried out on the cervical cells. If any changes are found, the patient is referred to a gynaecologist for a colposcopy, where the cervix is examined and biopsied to assess the grade of cell changes.
If the woman is HPV-positive but has no cell changes and therefore would never have been highlighted under the old system, she will undergo repeat screening the following year; if the virus persists after two years, even without cell changes, she will be referred for colposcopy. By focusing on the presence of the virus, women carrying HPV and at higher risk are provided with more intensive follow-up. It is the UK National Screening Committee that has recommended that women who are HPV-negative and therefore at very low risk are offered routine repeat screening every five years, from the ages of 25 to 65. That system has been fully rolled out in Scotland since March last year, but I highlight that the same approach is planned across all four UK nations once the PCR testing and data systems are in place.
Screening remains vital in detecting cervical cancer and its precursors in women who did not have the opportunity to be vaccinated against HPV. But uptake is at a 20-year low, with just over 70% of women attending overall. Attendance is even lower among younger women and those from minority ethnic groups or more deprived communities, as well as among lesbian or transgender people, who make mistakenly think that they are less at risk of HPV infections. The challenge is there for how to engage more women to take part in cervical screening. Changing to annual cervical examination might actually cause more women to withdraw from the programme.
HPV is found in only about 10% of cervical smear tests, so carrying out a simple vaginal swab to test for HPV could reduce the number of women who have to undergo a formal cervical smear with direct visualisation of the cervix. That would avoid the need to use a speculum and reduce the discomfort, which puts some women off taking up future appointments. It would also greatly reduce the difficulties experienced by those with physical or learning disabilities. Indeed, disabled women have been campaigning for years about the fact that those with the greatest physical difficulties often struggle to take part in screening at all.
A team at Dumfries and Galloway health board in Scotland established a trial in 2012 in which over 5,000 women took vaginal swabs themselves as well as getting a formal cervical smear done in the traditional way. That demonstrated both the accuracy and acceptability of this approach and the team is working with the Scottish Government to consider making that part of our routine screening programme. The UK National Screening Committee is still evaluating that approach, but research by Jo’s Cervical Cancer Trust suggests that this simpler method of sampling could get more women to engage and take up HPV testing as the first step of screening.
The issue is particularly important among groups that currently have a much higher risk of cancer but a lower engagement with a screening programme. NHS England has now begun a trial offering self-administered HPV swabs to 31,000 women in parts of London who have failed to attend their routine appointments. My one gripe with that excellent project was that the publicity and social media around its launch described the tests as self-administered smear tests instead of explaining that they were simple vaginal swabs, which a woman should easily be able to carry out at home. That caused a lot of consternation among women, who wondered how on earth they were meant to ensure that they visualised, or took a sample from, their own cervixes. It could put some off from trying to take the sample in the first place. Describing them as smear tests could also lead someone who is HPV-positive to fail to attend their GP practice for formal assessment, if they are under the mistaken impression that they have already had a cervical smear.
The NHS project in London is designed to engage those who have not taken up their routine invitations, but I hope that simple vaginal swabs to test for HPV will eventually become a routine step available to all women—whether self-administered in the privacy of their own home, or by a clinician in their local GP practice. HPV vaccination holds the potential to drastically reduce the number of young women who are even at risk of cervical cancer, but screening will always be important in order to detect cell changes or early cancer, and all of us need to encourage high uptake of both vaccination and screening. Although I recognise the anguish that led Fiona’s family to start the petition, I hope they can see that our understanding of this terrible disease and its cause opens up new and better approaches to eliminating cervical cancer in this coming decade, so that other families do not suffer the loss that they are going through.
Alex Norris (Nottingham North) (Lab/Co-op) [V]
It is a pleasure to serve under your chairship, Mr Pritchard. I would not normally make the Front-Bench contribution for the Opposition virtually, but I am afraid that I, too, have been pinged by the NHS app, so I am beaming in live from Nottingham. I thank my fellow pingee, my hon. Friend the Member for Gower (Tonia Antoniazzi), for securing the debate through her role on the Petitions Committee. The points that she made about testing have been a common thread throughout the debate, but she also mentioned the impact of covid, which I will reflect on shortly.
The petition has received close to 150,000 signatures, which is frankly an incredible effort. As well as showing the strength of feeling on this important topic, it is a physical demonstration of the legacy and impact of young mother Fiona Mathewson, who tragically lost her life to cervical cancer last April, at the age of 30. I send my best wishes to the Mathewson family—Andrew, Harry and Ivy. I lost my father to cancer when I was Harry’s age, and I know the impact that it has on a family. I hope the Mathewson family can take comfort from the incredible campaign that they have run, and from the way that they have been able to turn such awful grief into positive action. It is because of them and because of Fiona that we are here today. I hope they have seen that across the debate all four countries of the UK have been represented with very thoughtful and impressive contributions, starting with their own Member of Parliament, the hon. Member for Berwickshire, Roxburgh and Selkirk (John Lamont). He mentioned the twin giants of prevention—screening and HPV jabs. I, too, will reflect on those.
My hon. Friend the Member for Pontypridd (Alex Davies-Jones) was very generous with her personal experience, and we are glad that it has had the ending that it has had. It might make people watching the debate think about a screening they have missed, whether it relates to their cervical health or otherwise. That is a really important lesson that people have taken from her, and I know that she inspires people in that way.
Important points were also made by the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) around health equity, particularly in the lesbian and bisexual community but also around those who suffer from sexual violence. We really must ensure that we tailor our messages and the way we contact people, in order to understand their different circumstances. They may present in different ways or need different support, and we would always want that support to be available to them.
As always, my hon. Friend the Member for Coventry North West (Taiwo Owatemi) brings her experience as a senior oncology pharmacist. She knows much about the impact of cancer on people’s lives and how to design cancer services. When we talk about covid in the cancer space, we generally talk about missed screenings, the backlog or late presentation, but she made an important point about the mental impact. It is hard for me to imagine what it is like to be called for a smear test, but she talked about hurdles getting in the way and said that this is very big hurdle that can make people set it to one side. That point was very well made and linked to what the hon. Member for Strangford (Jim Shannon) said about the importance of effective communication.
Finally, my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) talked about the importance of brilliant British science, which is something we have seen clearly over the last 16 or 17 months. We need to back our brilliant British science companies, in order to get the best possible outcomes for ourselves here in Britain, and around the world.
As we have heard, every year in the UK around 3,200 people get cervical cancer and Cancer Research UK estimates that 857 people died of cervical cancer in 2018. While the incidence rates have not fallen significantly in the last two decades, the good news is that mortality rates have continued to fall, especially among older patients. Since the beginning of the 1970s, the mortality rate has dropped from 10 women per 100,000 to approximately 2.5 per 100,000. That is significant progress that has saved the lives of many women.
The NHS cervical screening programme is a huge part of this, with the NHS estimating that it saves 5,000 lives a year, which is truly wonderful. In 2019, HPV primary screening was added to the programme, replacing cytology, as the hon. Member for Central Ayrshire (Dr Whitford) said—a major step that the NHS believe has the potential to eliminate cervical cancer by spotting earlier those 14 types in the HPV infection that combine to be the main cause of cervical cancer.
Earlier diagnosis makes such a difference; quite simply, it saves lives. Where the cancer is diagnosed at stage 1 or 2, one-year survival is over 90%, which drops to 75% at stage 3 and 50% at stage 4. Data from the National Cancer Intelligence Network also shows that the cervical cancer three-year relative survival rate is higher among people diagnosed by screening than by any other route. If there is a message to come out of today’s debate it is the importance of screening.
We know there is scope to improve in this area. Exciting new advances using mRNA, gene therapy, artificial intelligence, combination therapies, robotics and many more, such as those mentioned by my hon. Friend the Member for Wythenshawe and Sale East, will transform our care in cancer. As we restore services affected by the pandemic, we should not be looking to restore what we had 18 months ago, but to embrace new developments and build new pathways of care.
On screening frequency, which this petition relates to, cervical screening in England is offered to the cohort aged 25 to 64. While routine screening is now offered every three years up to the age of 49, and every five years between the ages of 50 and 64, the UK National Screening Committee has recommended that for those who test negative for high-risk HPV, the interval can be extended to five years. I understand that this will be implemented once necessary IT developments allow it. Can the Minister confirm when that is likely to be?
I fully sympathise with and appreciate the arguments for more screenings that have been made in the petition. Any lives saved strengthen the case far more than anything I can say, but I strongly believe that it is right that this decision is made by the experts on the UK National Screening Committee and not by us politicians. Where clinical evidence supports their decisions to screen at the intervals they say and not to extend testing to 18-year-olds, which I know there have been calls for, then we support that.
Beyond that, the Government must do more to increase take-up and ensure that all those eligible for a cervical smear test attend their appointments when they are invited or as soon afterwards as possible. We must also ensure that preventative measures, such as the vaccination, get out into secondary schools and are fully taken up. I would be interested to hear the Minister’s reflections about further plans to develop this, because we know we are not getting it quite where we want to.
The aim is for 80% of women to access their test, with 75% being considered acceptable. In the year prior to the pandemic, it was 72%, a little bit up from 71.9% the year before. That is not where we want it to be and we must do something different. As my hon. Friend the Member for Gower said, the pandemic has worsened the situation.
Jo’s Cervical Cancer Trust estimates that around 600,000 cervical screenings failed to go ahead in the UK in April and May 2020. NHS England’s own data shows that no clinical commissioning group screened over 80% of eligible women in the third quarter of 2021. These numbers are people who could be living either with high-risk HPV or with cancer itself and do not know it yet. I hope that the Minister will expand on the data to paint a fuller picture of the situation as she sees it and to share with us the steps for how these services will be caught up, so that we can reach those who have missed out.
To conclude, those who raised this petition deserve real commendation for their excellent efforts. I am sorry that perhaps the evidence is not pushing us in the direction that they have encouraged us to take. However, I hope that when Harry and Ivy are teenagers, they might look back on this debate—perhaps wondering why we are all beaming in from different parts of the country, in our own bedrooms or in other rooms in our homes—and see that this was a galvanising moment for politicians to come together across Great Britain and Northern Ireland to improve screening rates and the uptake of the HPV vaccine. I also hope they see that, as we went forward, we embraced improvements in technology and cancer care, and that, as a result, we got more and more brilliant outcomes for women in this country. I hope that when they look back in many years’ time, they will be very proud of their role, and the role of their family and their family friends, in achieving that.
The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
It is a pleasure to serve under your chairmanship, Mr Pritchard.
First, as I think everybody else has done, I thank those who initiated this petition in Fiona Mathewson’s memory, and I join others in extending my sympathy to Andrew, to Ivy, to Harry, to Caitlin and to Fiona’s broader family, as well as to the 3,000 individuals in Kelso and across the borders who signed the petition.
Like other hon. Members, for example, the hon. Member for Pontypridd (Alex Davies-Jones), I know how frightening it is to be given this kind of diagnosis, but I can only imagine the impact on Andrew and the loss that he feels. However, if I may say one thing, it is that this debate today is in itself a huge legacy for Fiona, because we are discussing sensibly what we need to do to help women. We are talking, as many people have said, about something that is often seen as a little bit embarrassing. In response to the points by hon. Members that we must improve take-up, I could not agree more. However, we will not achieve that by not talking about some of the challenges that exist.
Cancer screening is crucial and I thank each and every Member who has shown their support for it and contributed to today’s debate. It was eloquently introduced by the hon. Member for Gower (Tonia Antoniazzi), as the Petitions Committee allowed us to have this conversation across the United Kingdom. The simple fact is that screening saves lives and that is why we need to drive uptake. As we have heard, screening can prevent cancer from developing. It can catch cancer earlier and, as we know, the earlier people are diagnosed the better the outcomes, because there is a greater chance that treatment can be successful.
Thanks to the tremendous work of dedicated screening staff up and down the country, the NHS cervical screening programme reaches about 4.6 million women in England every year and currently saves about 5,000 lives. However, we have heard repeatedly that only about 70% of women actually take up the opportunity, for a plethora of reasons. If everybody did attend, that number of lives saved would be closer to 7,000. More lives would be saved, so when a woman receives an invitation to attend a screening appointment, I encourage her to go.
As the hon. Member for Central Ayrshire (Dr Whitford) said, if you notice anything amiss, such as bleeding after sexual intercourse, between periods or during menopause, discuss it with a medical professional. Do not wait—it is your body and just treasure it. I say that because screening is one tool, but that knowledge of yourself is another tool that you have to access treatment quickly. NHS services are open, safe and ready to help you. That is another thing that has come through: I want to reinforce the fact that the NHS is open and the services are safe. You must come forward when your invitation for an appointment.
Alex Davies-Jones
The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) talked about some of the challenges faced by the lesbian and bisexual community in accessing appointments, but we also need to recognise some of the challenges faced by our trans community, especially trans men, in accessing appointments. Many of them are not sent reminder letters because of administrative policies at GP services. Will the Minister look into that to ensure that everyone with a cervix who is eligible to attend a screening receives a reminder?
Jo Churchill
Indeed I will. I would be happy to write to the hon. Lady, because I have looked at that issue. If there is a chance that someone may have abnormal cells, they should get them checked out. The hon. Member for Coventry North West (Taiwo Owatemi) spoke about making sure that we reach those communities who would not necessarily come forward, for a number of reasons.
The hon. Member for Wythenshawe and Sale East (Mike Kane) spoke, as several did, about using technology better, and about the challenges of screening and the health inequality that there is in certain communities for access to screening. I have met NHS England several times about that, to think how we can use that technology and different avenues—I will speak in a minute about the self-sampling sample.
We have to think differently about how we encourage women, because not every woman will come forward in the same way. We have different pressures on our lives at different times. Perhaps we are not as good at the younger end, because people think, as the hon. Member for Pontypridd said so eloquently, “I didn’t think it would happen to me.” Perhaps they have a young family or are busy at work. All those things mean that we have to make it as easy as we possibly can to access screening wherever you are and in whatever form suits you, because there are also cultural barriers for some not only to cervical screening but to breast screening, where they are hesitant to come forward.
Jim Shannon
I referred to my wife, who had some difficulty making the appointment. What she did was talk to my mum. I feel women talking to women is much easier. We should not always push to the back of the queue, for instance, a family member having a substantial discussion. Sometimes it starts with a discussion, before they go to the hospital. It very important to have family members around to support and give advice.
Jo Churchill
I could not agree more. We heard earlier that a good group of friends can give someone that nudge when they are feeling a little hesitant. As Members said, it is not the greatest outing of an afternoon, but it can be one of the most important appointments that you may keep, so I urge you to keep it.
I want to assure all women that screening staff are excellently trained to ensure that they feel reassured and comfortable. For those who feel anxious, there is information available online to help them plan their appointment. As many have done, I would like to commend the work of Jo’s Cervical Cancer Trust in raising awareness about what cervical screening entails and how important it is.
Let me turn to the nub of the debate—why screening is not offered on a yearly basis. Currently, cervical screening in England is offered to individuals between 25 and 49 every three years, and between 50 and 64 every five years. For those aged 65 and over, screening is offered if one of the last three results detected any abnormalities. Although health, including how screening is delivered, is a devolved matter, the debate has shown that wherever we are in the country, we need to ensure that health is a priority. We automatically transfer data on a woman’s history to the devolved authorities in Northern Ireland and Wales. I think it was the hon. Member for Gower who raised the question of how we work with devolved authorities: that information goes automatically to Wales and Northern Ireland, but it is still a manual process with Scotland, and work is in progress to make sure we get there.
As I have said, this matter is devolved, but as others have said, we all follow the expert advice of the UK National Screening Committee. The hon. Member for Central Ayrshire pointed out how important it is that we follow the advice of a central body, and in 2015, the UK NSC recommended that a test for HPV be used as the primary screen, because 99.7% of cervical cancers are caused by the high-risk HPV types. I could not agree more with one hon. Member—I apologise; I do not remember who it was—who said that we should talk about HPV in a normal, non-stigmatising way. We should have a conversation: it is important that we talk about those things that affect our bodies, to enable people to seek treatment and do something about them. If HPV is detected, you are referred for further testing. Cells are tested for abnormalities and, if present, you are tested again to see if treatment is necessary. If not, a follow-up appointment is always made for the following year, and if HPV is not detected no action is required, because it is highly unlikely that any abnormal cells are present and the chance of developing a cancer within five years is very small.
That process has been in place since December 2019, and since March 2020 in Scotland. It has made cervical screening more effective, improved detection rates and, crucially, requires women to be screened less frequently: there is a very salient point that the more often something is required, the risk that it is not taken up becomes greater. Making sure that we have the best tests at the best time interval, advised by the experts, is how we will proceed. However, that is not to say that all the technologies aptly described by the hon. Member for Wythenshawe and Sale East, as well as others that are available, are not being looked at all the time in all these areas. If there is a positive from the pandemic, it is that we have moved forward in many areas of technology, and as several Members have said, we need to harness that.
Given the strong link between HPV and cervical cancer, the national HPV immunisation programme is a key way to save lives. Introduced in 2008 and extended to boys in 2019, those vaccines have already led to dramatic reductions in HPV infections in England, and it is hoped that immunisation will eventually eradicate HPV and save hundreds more lives each year. The past year has been a challenging one, but as soon as the pandemic hit, we charged those in charge of the scheme with making sure that they had caught up with HPV vaccinations in schools by this August. They have used schools, community centres, and so on to make sure we do not fall behind on what is such an essential part of the programme—we know about the protection that it gives.
I do, however, acknowledge that screening is not perfect: HPV infection or abnormal cells can be missed, and can develop and turn into cancer between screening tests. That is incredibly rare, and the science supports the hope—I have this hope—that with the introduction of HPV testing and vaccination, many more cancers can be detected and prevented. The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) spoke of self-sampling, as did others. I am incredibly interested in this proposal. The YouScreen trial currently taking place in London is sending home-testing kits to some of those who have not taken up the offer of screening, making sure that we offer it to women who might find other environments difficult to be part of—because of time or a whole range of reasons—and who may prefer to do a simple swab test in their own home. That is what this trial is designed to do. It is particularly targeted at disadvantaged groups who may not have attended screenings.
As I say, there are busy lives, there is embarrassment and there are cultural barriers, so making sure we push that forward is important. There are plans for a nationwide trial to offer self-sample kits to women as an alternative to a nurse taking the sample. I have asked my officials to keep me informed of the trials. I eagerly await the UK NSC’s analysis once the trial is complete, and the subsequent recommendations on how self-sampling may be incorporated into the cervical screening programme.
I think we all agree on the need for women to come forward. I thank hon. Members for the tone of the debate and for how everybody expressed their concern that we make sure that we get to those women. I reassure people that, while we did indeed cancel those invitations early on in the pandemic, there is currently no national backlog of people waiting for an invitation to the NHS cervical screening programme. We have been working with and supporting providers to work above pre-pandemic levels to manage diagnostic backlogs. Waiting times for some appointments have increased in some areas, and in those areas specifically we are working with Public Health England’s screening quality assurance service and the relevant clinical commissioning groups. The problem is not everywhere, but I am aware that there is a problem in certain parts of the country.
I thank everyone for their contributions, and I express my sympathy—I know I speak for each and every Member here—to Fiona’s family and friends. The most effective way to prevent deaths from cervical cancer is for as many women as possible to attend their routine appointments, as opposed to yearly screening. Cervical screening undoubtedly saves lives, so once again: when you receive the invitation, please go, and if you notice any worrying symptoms in the meantime, contact your GP. NHS services are open, safe and ready to help you and help keep you safe. You have to help us by attending, so that the screening programme reaches as many as possible and we can drive that rate up into the sort of levels that mean we can prevent each and every woman from having what is, in effect, a preventable cancer.
Tonia Antoniazzi [V]
I thank the Minister for her response. I also thank the hon. Member for Berwickshire, Roxburgh and Selkirk (John Lamont) for his contribution. As Andrew Mathewson’s MP, he made a heartfelt contribution on behalf of Fiona’s family and all her friends. In the really powerful and very personal speech of my great friend, my hon. Friend the Member for Pontypridd (Alex Davies-Jones), we heard about the serious risks that missing a screening can cause. Her story is a stark reminder of the importance of keeping appointments and being tested regularly.
The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) touched on many of the groups that are less likely to attend their appointments and the Government’s duty of care to improve messaging to those in harder-to-reach communities. In fact, in her intervention on the Minister, my hon. Friend the Member for Pontypridd highlighted the fact that non-binary and trans men should not miss their cervical screening appointment, and that it is important to record biological sex on medical records to ensure that that does not happen.
The hon. Member for Strangford (Jim Shannon) was very clear in his message that screening is not a test for cancer but a test to prevent cancer. That is a really important message to get across to all women. My hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) highlighted the fact that not one trust in England achieved 80% coverage of the test. He highlighted the work of Hologic, a cutting-edge company in his constituency that specialises in high-volume population screening. We need to take full advantage of that resource when beating cancer.
I echo the call of the hon. Member for Central Ayrshire (Dr Whitford): if you have vaginal discharge or bleeding, go and see your GP—not your MP—and do not wait for an invitation. She also mentioned the 30% to 4.5% reduction as a result of the HPV vaccine. She noted the difficulties that physically disabled people have in attending their cervical smears. The Minister spoke about the self-sampling project that is going to be rolled out nationwide, which is going to be key to getting as many women as possible to attend cervical screening tests. My hon. Friend the Member for Nottingham North (Alex Norris) drew on his vast knowledge of health issues and made a powerful case for building back better our screening capabilities and using all of the available technological advances that have been mentioned today.
In conclusion, I thank the Minister for her comments. I am glad that Members, cross-party and from all of the devolved countries of the UK have been able to discuss this issue sensibly. The bottom line is that we must improve take-up and we must talk about it, because screening saves lives.
Question put and agreed to.
Resolved,
That this House has considered e-petition 317336, relating to cervical screening.
Mark Pritchard (in the Chair)
Would colleagues please leave the room via the door marked “Exit” and observe social distancing? Thank you again to our excellent technical teams.
Amnesty for Undocumented Migrants
(3 years, 4 months ago)
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Stewart Hosie (in the Chair)
Hon. Members should be aware that social distancing is no longer in operation, but I remind you that Mr Speaker has encouraged us to wear masks. I also remind Members participating physically and virtually that they must arrive for the start of Westminster Hall debates, and Members are expected to remain for the entire debate. Members participating virtually should leave their cameras on for the duration of the debate and must be visible at all times, both to each other and to us in the Boothroyd Room. If Members attending virtually have any technical problems, they should email the Westminster Hall clerks at westminsterhallclerks@ parliament.uk. Members attending physically should clean their spaces before they use them and as they leave the room.
Tom Hunt (Ipswich) (Con)
I beg to move,
That this House has considered e-petition 567681, relating to an amnesty for undocumented migrants.
It is a pleasure to serve under your chairmanship, Mr Hosie. The petition calls on the Government to
“grant an urgent Amnesty to Undocumented Migrants living in the UK.”
It attracted 103,440 signatures, and I thank each and every one of those people for participating in our democracy by signing the petition, which has led us to debate this very important issue.
It is clear that covid-19 has added a bit of impetus to the decision to sign the petition. There has been concern about the ability of undocumented migrants to get access to a vaccine, which is of benefit both to them and to the wider society, because we know that people are less likely to transmit the virus when they have had the vaccine. That seems to have given the petition a bit of added impetus, because having an unstable existence is made even more challenging through covid-19. As for many things, covid-19 has made a challenging situation more challenging, so I can understand the decision of 103,440 people to sign the petition.
In terms of what the petition calls for, it is as simple as granting an amnesty to all undocumented migrants living in the UK, except those who have a criminal record. The petition was quite clear that if someone has a criminal record, they should not be the beneficiary of the proposed amnesty, but I have to say that there is not much more detail than that. I assume that the petitioners want to treat every undocumented migrant the same, regardless of whether they are someone who has been living here for over 10 years and who has put down extensive family roots, or somebody who, quite frankly, arrived here last weekend on a dinghy from Calais. That is something that the petition is missing, because there is no clarity. I can only assume that the petition is essentially referring to every single undocumented migrant. I also assume that it would be a one-off amnesty for all undocumented migrants, but I am unsure about whether the petitioners wish it to be something that happens routinely—for example, every five or 10 years. That is also not clear. What is clear is the desire to regularise the status of all undocumented migrants, which is what we will be debating today.
The arguments in favour of the petition are clear. There are many individuals and families who have come here as undocumented migrants. Some may have come illegally in the first instance. Some may have come here legally, but the legal time that they are allowed to be here has expired and they are looking to regularise their position. It is a combination of both of those. However, there are many who are making a positive contribution to our country in difficult circumstances. At the moment, it is a very challenging situation for them.
There is also an argument that, by regularising their status, it actually leads to their paying more taxes, which is beneficial to the taxpayer. I have some sympathy with the argument that says we should treat people a bit differently if they have been here for 10 or 12 years and have put down extensive family roots. Is it really realistic, or likely, that the Government will deport migrants at that stage? It is incredibly unlikely. If we are of the view that it is incredibly unlikely that we are ever going to deport migrants in those circumstances, there does seem to be a strong argument that we should regularise their status, and perhaps an argument could be made for an amnesty. However, in terms of the arguments against, and in relation to the petition, I simply cannot support treating a family who may have been here for more than 10 years the same as somebody who came here last weekend in a dinghy.
We also cannot make assumptions about every single person who is in the undocumented migrant category. The reality is that there will be some people who have come into this country through an illegal route. We do not know whether they are genuine refugees; it is impossible to know whether all of them will be. Among them there will be some economic migrants, so ultimately those individuals would likely be the beneficiaries of the blanket move as suggested by the petition. That is something that I cannot support.
If we were to support a blanket amnesty for every single undocumented migrant, it would be impossible to sustain that position while at the same time not being in favour of open borders. I find it very difficult to understand how you could support an amnesty—and potentially have one regularly, every five or six years—and not support open borders. As a Member of Parliament of this country, I would never support open borders. It would put unsustainable amounts of pressure on our public services. There would be all sorts of problems with social integration if migration was unmanaged to that extent. It would also limit our country’s ability to show compassion towards the most genuine refugees and to have a laws-based, rules-based immigration system that allows us to welcome the brightest and the best who want to come to this country to make a positive contribution. More to the point, it would be a slap in the face for all of those people who have moved to this country legally and who have followed the—often cumbersome—rules. They have followed them. They have done their side of the bargain. They have moved here legally. This would be a slap in the face to them.
Anne McLaughlin (Glasgow North East) (SNP)
Does the hon. Member know that a lot of the people that we are talking about, undocumented migrants, have come here legally? They are undocumented not through any fault of their own. Does he accept that?
Tom Hunt
With the greatest respect to the hon. Member, I did make the point that the proposal would apply both to those who may have entered the country illegally and to those who may have entered legally but for a fixed period of time that has expired. Yes, it is a mixture. That is why I am against a blanket amnesty. It would be a significant movement away from the case-by-case approach that the Government are currently taking, which takes into account the differences between cases and the nuances of different circumstances. An amnesty would not do that.
Yes, some of the individuals who would benefit from an amnesty would be those who came here legally but whose time has expired, who are struggling with the process, who have been here for 10 years and who are making a positive contribution. However, it would also include those people who have shunned the laws of our country, who have deliberately come here illegally and who, frankly, have no more right to be here than the families or individuals who are patiently waiting to come here legally. That is the reality of the situation.
We are also talking at a time when the Government are dealing with the significant challenge of the illegal crossings from Calais—
Tom Hunt
No, I am not going to take another intervention. That is a situation in which individuals, regardless of their circumstances, are knowingly deciding not to engage with the legal process for claiming asylum or to immigrate here in a legal way, but to shun that legal approach and come here in an illegal manner. The danger of a blanket amnesty is that it would send out a message to all of those people who come over illegally and fuel an evil trade in human lives. It would potentially make the situation a lot worse. The money fuelling this evil trade in human lives would increase and potentially more lives would be put at risk, because if we adopted a position such as the one set out in the petition, which is very close to an open borders immigration policy, essentially the message would be: “Once you’re in, you’re in. So get over here, ignore the processes, because it’s worth the risk”. The risk is very real; it could lead to the loss of lives.
Anne McLaughlin
Would the hon. Member be surprised to hear then that his own Prime Minister has toyed with the idea of exactly what is being called for in this petition—an amnesty for anybody who has been here for a certain period of time? The Prime Minister has also talked about it recently.
Tom Hunt
With the greatest of respect, if the hon. Member has read the motion in the petition, she will see that that is not what this petition is calling for. It mentions nothing about being here for 10 years. Essentially, it is a blanket amnesty for every single undocumented migrant. People across the political spectrum have floated and supported the idea of a limited amnesty targeted at those who have been here, say, for over 10 years. As I said earlier in my speech, I believe there are some merits in those arguments.
However, this petition is not calling for such an amnesty; it is calling for a situation that sits very closely to an open border policy, in my view. I think it would lead to chaotic results, unintended consequences, unsustainable pressure on public services, problems with social integration and, as I also said earlier, it would limit our capacity to promote a compassionate, generous, rules-based immigration system and approach to refugee resettlement, which could benefit this country and which, I believe, is supported by the majority of people in this country.
That is sort of the wider picture. Of course there will be examples of where the status quo fails individuals and individual families, and we need to work with that system to improve its efficiency and how quickly it deals with these cases, so that it can turn them around as quickly as possible and get people the outcome they need as soon as possible, so that they can plan their lives with certainty. Of course, that is something that I support.
However, the current Government position is that if someone has been in the country for a long period of time, there are opportunities to regularise their status. Nevertheless, I think it is appropriate and fair that that is done on a case-by-case basis, because we cannot make huge generalisations with regard to those who come under the category that we are talking about today, because the motors vary and the circumstances vary enormously.
In conclusion, although I sympathise with the reasons why people have signed this petition and their concern about the circumstances that many people face at the moment, the petition is not focused enough in what it is calling for. To me, it is calling for a blanket amnesty for every single person, many of whom have come here illegally and shunned the legal process. It would be a slap in the face for those who have come here legally, and there would be serious unintended consequences.
If the hon. Members taking part in this debate believe in this petition as it stands, they should run with that policy in a manifesto in a general election. There would be a resounding answer from the British people, namely that they would not support this proposal. The vast majority of people in this country see the benefits of immigration and are compassionate towards refugees, but they want a rules-based system and this petition would fly in the face of that.
For all those reasons, I would be unable to support this petition, but I am glad that this subject will have a good airing today. Having looked at the call list, I predict that perhaps we will hear some arguments being raised that are different to those I have raised. There probably will not be much reiteration of the arguments I have just made, until perhaps the end of the debate.
Stewart Hosie (in the Chair)
I will put on an informal time limit of five minutes at the moment and we will see where we get to with that.
Mr Virendra Sharma (Ealing, Southall) (Lab) [V]
It is always a pleasure to serve under your chairmanship, Mr Hosie.
Undocumented migrants are not some enemy of the state; they are not a risk to this country. The vast majority of them are desperate people who are keen to work and secure a future for themselves and their families. It is with that in mind that they must be given the legal right to live and work in the UK, which will give them the chance to prosper in this country and stand on their own feet, rather than being treated like criminals.
It is obvious that the majority of undocumented migrants are in some form of work, albeit illegal and, in all likelihood, exploitative. I strongly believe that such migrants will have undoubtedly honed their skills and developed their knowledge and experience since they first moved here, and that they are all desperate to contribute to this country. At a time when UK employers are suffering from the most profound labour shortage in a generation, we should turn to a hard-working, talented and resilient resource that already exists here in the UK—undocumented migrants.
Far from the picture painted of them by some Members, a recent Joint Council for the Welfare of Immigrants survey estimates that 82% entered through legal routes and later fell out of status. According to the research, a migrant on the 10-year route to settlement will have paid £13,000 in application fees by the time they are granted indefinite leave to remain. The sheer cost and complexity of this broken system forces those who are here legally to then become undocumented. Once they fall out of status, it is extremely difficult and unlikely that they will receive it a second time.
This bewildering system limits the life chances of our most vulnerable and puts them at risk of rank exploitation from rogue employers and those who seek to prey on the defenceless. Under the Government’s hostile environment, their situation has become even more precarious.
I was shocked and disturbed by the report of the Bureau of Investigative Journalism last week, which showed that most GP surgeries in the UK refused to register undocumented migrants in spite of NHS policy. Not only is that position cruel and denies them the help that they desperately need, but it holds back our aim of vaccinating every adult in the UK and of beating this hideous disease. That policy puts us all at greater risk. I wrote to the Home and Health Secretaries on that point, which they ultimately agreed with, so pressure must now be put on the GP practices.
Amid the despair, there is still great hope among migrants. During the recent annual refugee week at the end of June, I took part in a Working West London employment event hosted by East London Advanced Technology Training, which offers training and skills development courses for refugees and migrants. I met a group who were crying out to contribute to this country, and I could see the rich array of skills, talents and passion that they have to offer.
Migrants play an important role in our society and are a statement of who we are. Not only are they people with aspirations and hopes, but they represent our values and demonstrate our humanity and decency. To the majority here in the debate today and the 100,000 people who signed the e-petition, it is clear that the Government must urgently reform our immigration system to prevent people from falling out of status, and must simplify the routes to regularisation. A commitment to an amnesty by the Government could only ever be the beginning of this, which should be swiftly followed by a fundamental reform of our immigration system and by ditching the hostile environment.
That change is not just the right thing to do. It will benefit this country and everyone living here. The Government must show some flexibility, pragmatism and humanity—principles that have long been at the heart of British policy making—and give undocumented migrants the chance to truly succeed in and contribute to our society.
Adam Holloway (Gravesham) (Con) [V]
It is a great pleasure to speak under your chairmanship, Mr Hosie. My speech will be quite short.
Most migrants to the UK have taken the trouble to apply properly through our immigration system. Here in Gravesend we live with highly successful immigration— notably, the Sikh community. But a blanket amnesty is not sensible if it applies to every undocumented migrant. Potentially, this proposal would allow tens of thousands of people—more perhaps—who are in the UK illegally to regularise their status. I entirely sympathise with their desire to build a better life, and I might do exactly the same thing myself if I were in their circumstances, but an amnesty like this would do nothing to reduce illegal immigration, which is what we are trying to do, and it would act as an additional pull factor to those wishing to come to the UK.
As my hon. Friend the Member for Ipswich (Tom Hunt) points out, an amnesty like this is akin to having open borders. It means our immigration system would no longer be rules based. He raises the interesting point that if the Labour party put this in an election manifesto, it might not be a vote winner.
Finally, I entirely support any effort to attract undocumented people to vaccination centres without fear.
Rushanara Ali (Bethnal Green and Bow) (Lab) [V]
It is a pleasure to serve under your chairmanship, Mr Hosie. I thank the hon. Member for Ipswich (Tom Hunt) for opening the debate and laying out the strongly-held opinions on both sides of this debate.
It is important for us to have a sensitive and nuanced debate on this important issue, because there are hundreds of thousands of undocumented people in our country. If we do not engage with or discuss this subject, we create bigger problems for our society. I want to focus on those who face severe exploitation because they have found themselves as undocumented migrants in our country.
I have no truck, as I am sure most in our country do not, with those who are deliberately and wilfully flouting our legal system and breaking the law in this country. However, I am interested in what we can do to protect and support those who arrived in this country, often through legitimate means, according to the JCWI, and found themselves becoming irregularised.
In many of our constituencies, there are countless examples of people facing violence or being trafficked, and of women facing domestic abuse. They sometimes arrived on spousal visas and then faced huge amounts of exploitation. Although people who face domestic violence can apply to stay in the UK even if their spouse does not sponsor them, they often do not pass many of the requirements, because if they do not have police reports and so on, it is difficult to prove to immigration officers that they have faced domestic abuse and violence.
This is a complex area for those who face exploitation and who are vulnerable. I have met many individuals who have faced those sorts of issues and, although we may have different views about the text of the petition, it is important to build a consensus around those who are particularly vulnerable and who should be given an amnesty.
Since the pandemic began last year, the issue of what we do with undocumented migrants, what healthcare provision they get and whether they have access to covid vaccines affects all of us. That is why it is a no-brainer to look at some of these issues carefully and to think about how they benefit us as a society, in terms of healthcare and protection for all of us. We have already heard about some of the issues around vaccination programmes and people being fearful about going to get vaccinated. Many GPs require people to register with them in order to access vaccines. There are one-off vaccination offers to undocumented migrants, but that is not comprehensive. On the public health benefits for the whole of society, to combat the pandemic we need to ensure that the estimated 800,000 to 1.2 million people who, according to the JCWI, are undocumented in our country, are given protection.
What should we do going forward? As the hon. Member for Glasgow North East (Anne McLaughlin) said, as recently as earlier this year the Prime Minister said that when people have been here for a very long time and have not fallen foul of the law, it makes sense to try to regularise their status. When he was Mayor of London, he talked about an “earned amnesty” for some 400,000 people who live in the capital. It is important that we look at how to address this issue in a sensible way that does not lead to a pull factor, which many have raised concerns about.
We want a managed migration process with legitimate routes for people to come here to make a contribution, whether to study, to work or to join family members, while recognising that some people came to this country over the past decade and beyond and, for different reasons, have found themselves in the irregular status category but did not break the law. Those are the people I am particularly concerned about—those who then fell foul of the system. I hope that we will look at how to protect people who have been exploited and trafficked and who have faced huge challenges in our country, and at opportunities for them to make a contribution to our economy, given that they have been here for a long time.
Although I do not agree with the exact wording of the petition, it is important that we look at how to protect those who have huge vulnerabilities and ensure that, in the middle of a pandemic, those who are not documented have access to vaccination programmes, testing and treatment for covid.
Seema Malhotra (Feltham and Heston) (Lab/Co-op) [V]
It is a pleasure to serve under your chairship, Mr Hosie.
My constituency of Feltham and Heston had the fourth highest number of signatories to this e-petition, reflecting—[Inaudible.]
Stewart Hosie (in the Chair)
Order. Can you speak up a little? I think there is something wrong with your microphone. We cannot hear you well at all.
Seema Malhotra
My constituency of Feltham and Heston had the fourth highest number of signatories—[Inaudible.]
Stewart Hosie (in the Chair)
Order. I am sorry, we simply cannot hear you. Try again, and if it does not work, we will come back to you.
Seema Malhotra
My constituency of Feltham and Heston had the fourth highest number of signatories to this e-petition, reflecting in my view—[Inaudible.]
Stewart Hosie (in the Chair)
Order. Again, I am sorry, but the sound is not working. We will have one of the engineers get in touch and we will come back to you. I call Ruth Cadbury.
Ruth Cadbury (Brentford and Isleworth) (Lab)
Thank you, Mr Hosie. I think this is the first time I have served with you in the Chair—it is a great pleasure to do so.
The e-petition on undocumented migrants has been signed by over 900 of my constituents. It notes that:
“Undocumented Migrants are suffering in silence, with no access to adequate Financial support, or any help.”
I know from my casework and from listening to hon. Members’ speeches so far that, sadly, that assessment is far too accurate. Not only are they suffering in silence; their suffering is made worse by the careless, heartless and reckless Home Office, which continues to inflict a hostile environment on so many. They face long delays, irrational and inconsistent decisions, and inadequate legal support, especially for those with low or no income. Many of the people affected are victims of modern slavery. They are adults who came over as small children, or children joining the only family members they know are alive in this world.
The petition says that these people want to be able to
“live their lives as normal human beings and pay tax to help the UK economy”,
and we know that migrants who have legal status and are taxpayers are more likely to be net contributors to Her Majesty’s Revenue and Customs than the average person in our population. I am not saying that I agree with all the wording of the petition, but it is really important that it is debated today.
As the Joint Council for the Welfare of Immigrants makes clear in its recent survey, 82% of people in the UK who are undocumented arrived through a legal route, so I will start by addressing the extortionate and unfair immigration fees that impact not only those who are undocumented, but all those who have to navigate our immigration system here in the UK. People accept the concept of paying a fee to cover the cost of the service, but it is simply unfair for the Home Office to charge excessive fees that go well beyond the cost of providing the service. The fees are disproportionate compared with those of other countries: the average cost of a regularisation application in France, Spain, Portugal, the Netherlands and Germany is less than a tenth of its cost in the UK, and the cost of applying for permanent settlement in the UK is 20 times more than the average cost in those countries.
The Government keep increasing those fees. In 2014, the cost of a limited leave to remain application was £601; it has now risen to over £1,000 per person. For many applicants, that cost is multiplied by the number of people in their family. I know from listening to people locally that the costs are having a huge impact, and the JCWI rightly cites the high cost of fees as a major reason why people remain undocumented. These fees leave families in limbo, with the JCWI noting:
“Families who are unable to raise thousands of pounds every few years are at risk of losing their status and becoming undocumented, or forced to choose which family members maintain their status while others cannot.”
However, this debate is not just about fees, but about a wider system that is set up to create a hostile environment for undocumented migrants. We hear a lot of warm words from the Prime Minister, the Home Secretary and junior Ministers about the Home Office’s change since the appalling Windrush scandal, but the hostile environment that the Windrush generation faced is still impacting so many people here in the UK, and the net number of people it ensnares only seems to be expanding.
Just this morning, we read in The Guardian of a Spanish woman who was less than a year old when she arrived in the UK. She has been sacked from her job in a care home because she is unable to prove she has a right to work in the UK. She applied for settled status before the deadline for EU citizens closed, but she is still waiting, and her employer has said that it was forced into this action because of the fines it faced. Of course, she will not be eligible to claim benefits until this is sorted out. This is yet another example of the awful hostile environment—a hostile environment that I fear is now going to impact on the millions of EU citizens living in the UK, including many in my own constituency.
I will finish by focusing on the real impact that these decisions and actions by the Home Office have. It is easy for us to become focused on numbers, but every number is a story of a family pushed into hardship, unable to pay bills or to cover the cost of food, and left in limbo. Many of these migrants have children who are UK citizens. We know that undocumented migrants experience domestic violence at three times the average national rate, yet the Government recently rejected an amendment to the Domestic Abuse Bill that would have sought to provide support to migrant women suffering from abuse. Once again, the Government’s rhetoric does not match the reality. This Government cannot claim to be compassionate or just until they end the hostile environment faced by my constituents and many others around the country.
Mr Tanmanjeet Singh Dhesi (Slough) (Lab)
It is a pleasure to serve under your chairmanship, Mr Hosie, and I congratulate the well over 100,000 people who signed the petition to secure this important debate. Indeed, many of my constituents have contacted me to raise their concerns, and more than 2,100 of them have signed this official petition.
In essence, those people are saying that they reject the Home Office’s hostile environment, and that what we need is a fair, transparent system that provides a safe harbour for those fleeing war, genocide, domestic abuse, violence and other forms of persecution—a system that has at its heart our true British values of compassion, justice and humanitarianism. They highlight that the UK system of asylum and immigration is mired in crisis. Although I am not advocating a policy of open borders, we do need a fair, rules-based asylum and immigration policy.
A recent report makes for grim reading. The Joint Committee for the Welfare of Immigrants published a report called “We Are Here” just a few weeks ago. I am sure the Minister has read it. The report looks at the routes by which people become undocumented. Often a small error, a period of illness, bad advice or mental problems can lead to someone becoming undocumented and entering a Kafkaesque nightmare of impossible bureaucracy, social exclusion and exposure to the criminal underworld. These are people who are bewildered, disoriented and traumatised and who often suffer from post-traumatic stress disorder, and the system makes things worse for them.
We know that people without access to benefits and work are coerced into criminal activity or forced into dangerous work, but the pandemic has highlighted that, shamefully, undocumented migrants are also denied access to basic healthcare. The JCWI reports that they are scarred by the whole experience and are scared of seeing a GP, going to hospital or getting a covid vaccination, for sheer fear of arrest. I do not need to tell the Minister that this creates a danger to public health for everyone. There is obviously a huge unmet need for vaccinations. Is it not clear that the only people who the current system helps are criminals? We are fuelling exploitation and rewarding organised crime groups and people traffickers.
The Joint Council for the Welfare of Immigrants has set out a series of entirely sensible policies: namely, new and simplified routes to status based on five years’ residence; British citizenship for children born in the UK; making visa renewals automatic and affordable; and scrapping the illegal working offence and creating a route to status through work.
What have the Prime Minister and his Conservative Government proposed instead? It is hypocrisy, back-tracking and hostility. The Prime Minister himself advocated the creation of a migrants’ amnesty when he was the London Mayor in 2008. In 2016, as Foreign Secretary, he called measures to give amnesty to undocumented migrants who had lived in the UK for longer than 10 years “economically rational”, but after raising so many people’s hopes, and when he has the opportunity as Prime Minister to make a real difference and ensure that it is easier and simpler for those who are undocumented to become regularised, he has done nothing for the last two years. It is just not fair for those who could make a huge positive contribution through taxes to our Exchequer, and who have to suffer excessive Home Office fees, as hon. Members have already highlighted, to have their hopes falsely raised and then cruelly dashed.
I hope the Minister will have the confidence to deviate from the notes prepared by Home Office officials and to engage with those points with the seriousness that they merit. He can end the uncertainty, which has devastating consequences for the lives it affects. Undocumented migrants who have been here for several years deserve clarity.
Stewart Hosie (in the Chair)
We will go back to Feltham and Heston and see whether we have any more luck.
Seema Malhotra [V]
It is a pleasure to serve under your chairship, Mr Hosie.
My constituency of Feltham and Heston had the fourth highest number of signatories to the petition, reflecting the humanity of our local community and our rich history of immigration and diversity. With over 150 languages spoken in Hounslow alone, our diversity is also our strength. Neighbours, colleagues, business owners and key workers come from all over the world and contribute to our local economy.
This important debate is focused specifically on action to support undocumented migrants. I support the call from my hon. Friend the Member for Bethnal Green and Bow (Rushanara Ali) for consensus on how we move forward. Caritas Europa defines the challenge well, saying that while the fight against irregular migration has dominated the political agenda for years, undocumented migrants remain a sizeable population in Europe. The lack of regular resident status often goes hand in hand with a huge amount of suffering and vulnerability. Referred to as undocumented migrants or people without papers, these people may find themselves in a protracted limbo situation, living on the margin of society under continuous stress and anxiety, their basic rights often disregarded. As has been said, hundreds of thousands of undocumented migrants are being blocked from booking covid vaccinations, despite Ministers saying that everyone should have access to vaccines regardless of immigration status. As a result, we are all less safe.
This issue is not without complexity, but we cannot be without humanity and compassion. The current system locks people out of vital services—often families with children. Research conducted by the Joint Council for the Welfare of Immigrants shows that 82% of respondents to its surveys entered the UK through legal routes and later fell out of status. Expensive and stressful reapplication processes, which can cost more than £12,000 by the time genuine cases are granted indefinite leave to remain, push families into enormous debt that lasts for years. These extortionate fees are not a deterrent. Instead, they push people into exploitative work. These are people who are ambitious to do well for themselves, their families and their adopted country.
That was the case with Navin—not his real name—whom the JCWI noted became undocumented after he was wrongly advised by a lawyer that his leave was still valid. He intended to rectify this when right-to-work checks meant that he lost his steady job in a restaurant. He could not afford to pay the fees required to regularise the status of his entire family, leaving them all undocumented. He took on cash-in-hand work at a car wash. He was regularly underpaid or simply not paid at all, and feared that social services would take his children away if they found out about his situation. He said:
“My kids were born here, and I don’t know where else I would go. I’ve got nothing back in Mauritius at all, no family, no one I know. I left when I was young, a long time ago. Here I have my life, my family.”
In so many cases, falling out of status is due to situations outside the control of the migrant. JCWI’s research found that this can happen for a variety of reasons too, including relationship breakdown, domestic violence, poor legal advice, inability to pay those extremely high fees, or a simple mistake. However, once the migrant falls out of status, it can be difficult to obtain it again. The impact of falling out of status results in people being trapped in limbo. As in these stories, the vast majority of undocumented migrants have been settled in the UK for more than five years, or indeed 10, and arrived legally. The UK has the second largest number of undocumented migrants in Europe behind Germany. The insecurity and, often, destitution of these families has worsened through the pandemic, with many also dependent on food banks.
This intractable problem needs a different approach, which is why I believe it is time that the Government reformed the current system to create a simplified route to regularisation, so that migrants can access services, rent a home, work and pay taxes, and live a life free from fear. Addressing the damagingly high application fees alongside simplifying the process is an approach that has been taken in Ireland. According to the Institute for Public Policy Research, there are also precedents for an amnesty policy intervention. It is interesting that Greece, Italy and Portugal all implemented amnesty programmes in recent months. There is also clear economic evidence that if undocumented migrants can move out of informal employment and into more secure jobs, there are many benefits for wider society. According to The Economist, studies in America suggests that citizenship for its 11 million undocumented immigrants could boost the economy, with GDP rising up to $1.5 trillion over 10 years.
In conclusion, undocumented migrants clearly need a different way so that they and their families can move forward. The JCWI powerfully remarks that
“once someone becomes undocumented, the criminalisation of their everyday lives drives them into exploitation. Their voices are silenced, and they are unable to…tell anyone about their plight. Under the Hostile Environment, almost everyone who should keep them safe…is part of the system of immigration enforcement and surveillance trying to rip them away from their families”
and their homes. We need a sensitive, long-term solution to the undocumented migrants crisis. As a first step, we should simplify the process to make it easier for those who are undocumented to become regularised, and reform the extremely high fees, which mean that people cannot pay for visa applications. Surely, in the interests of our economy and effective administration, which covid now demands, and in the interests of humanity, there needs to be a much better answer to the issue of undocumented migrants.
Claudia Webbe (Leicester East) (Ind) [V]
It is a pleasure to serve under your chairship, Mr Hosie. I congratulate the hon. Member for Ipswich (Tom Hunt) on securing this important debate, although I disagree wholeheartedly with what he had to say.
I congratulate the more than 100,000 people who signed the petition calling for this debate, including the more than 1,200 Leicester East residents. Although I wholeheartedly support the petition’s call for the urgent regularisation of undocumented migrants, with a safe pathway to citizenship after five years, I suggest politely that its use of the word “amnesty” is not quite accurate because it implies wrongdoing. The reality is that in nearly all cases undocumented people are not criminals but have simply fallen through the cracks of the Government’s callous hostile environment policies.
Last year I tabled an early-day motion calling on the Government to take immediate action to ensure that leave to remain is granted to undocumented migrants, irrespective of their nationality or immigration status, so that they can access healthcare, food and housing. The issue came to a head when it became clear that undocumented migrants would be left out of the vaccination programme. It was clear to many that we were only ever going to be as safe as the most vulnerable among us. Earlier this year, I pushed again, including with another early-day motion calling for undocumented migrants to be granted leave to remain so that no one is excluded from that necessary protection. Such exclusionary practices are not only morally abhorrent; they also undermine the whole purpose of a vaccine. While people and institutions discriminate, the virus does not. The only way for the vaccine to be effective is by ensuring that everyone is protected from the virus.
Most migrants enter the UK through legal routes. As we have heard, the Joint Council for the Welfare of Immigrants estimates the figure to be 82%. Every two and a half years, a migrant must pay thousands to stay. A migrant on the 10-year route will have paid £12,937 in fees alone. They will have been denied legal aid to seek legal advice about, or appeal the refusal of, their applications. If at any point they are unable to submit the right application at the right time and with the required fee, they will become undocumented. This is deeply unjust.
There are an estimated 1 million undocumented workers who lack any entitlement to support from the state and who are, therefore, entirely without funds to feed, clothe and house themselves and their families. For a demographic who already face uncommonly difficult challenges in their daily lives, the pandemic has only deepened fears over how to maintain an income, remain healthy or even stay alive.
Many undocumented people are destitute and live in the shadows, fearful of what would happen to them if they identified themselves. They cannot access healthcare, emergency shelter or food, nor report or seek protection from domestic violence, sexual assault, exploitation and other awful abuses. Following the Immigration Acts of 2014 and 2016, the invisibility in which undocumented migrants are required to live has led to many of their human rights being effectively denied by the criminalisation of their right to work and to rent housing, while limiting their access to healthcare, contravening article 25 of the United Nations universal declaration of human rights. For people forced to endure this level of instability, it is impossible to comply with any Government guidance on self-isolation and social distancing. It is morally and practically imperative that the basic needs of all those living in this country are met.
The tragic irony is that many undocumented people who live in constant fear of the British state work in the frontline services that the Government have been at pains to praise and even clap for during this crisis. We must ensure that all workers, regardless of their immigration status, are valued and protected as we rebuild our economy and society. It is essential that the Government take immediate action to ensure that leave to remain is granted to everyone in the UK, irrespective of their nationality or immigration status. All migrants, regardless of status, ought to be granted rights that respect their humanity and allow them to live with dignity and fully participate in society.
Hate crime has more than doubled since 2013, so it has never been more important for the Government’s demonisation of migrants to end. Together, we can build a society in which everyone is valued, no matter their country of birth. More than ever, what is needed is status now.
Sarah Owen (Luton North) (Lab)
It is a pleasure to serve under your chairship, Mr Hosie.
Human beings are not illegal; first and foremost, they are humans. For me, that has to be the starting point of this debate and any debate about immigration. Over the last few days, I have been contacted by dozens of people from across Luton North asking me to speak in this debate, and I was glad to see that 446 people from across my constituency had signed this petition online. That shows the strength of feeling among many of my constituents, and our unifying belief in human rights, in particular for women and children who are fleeing from some of the most horrific circumstances across the world.
When someone is locked out of the system and shut out of safe and legal routes through the immigration system, they are unable to get a job, rent a home, open a bank account or obtain a driver’s licence. It is not an easy life. People living here who have come from abroad are considered temporary for a decade and must reapply for the right to remain in their homes and jobs every two and a half years. As we have heard already, each application costs thousands of pounds per person. At present, a migrant on the 10-year route to settlement will have paid £12,937 in application fees by the time they are granted indefinite leave to remain.
I am sure most Members here will have seen in their inboxes and casework the impact that this situation has on people’s family life and wellbeing. The 10-year route to settlement is the default rate for most categories of visa holders. If at any point during the 10-year period the visa holder is unable to submit the right application at the right time, they will be classified as undocumented. Research by the Joint Council for the Welfare of Immigrants found that that can happen for a variety of reasons, including relationship breakdown, domestic violence, poor legal advice, a physical or mental health crisis—for the applicant or one of their relatives—an inability to pay extremely high fees, or just a simple, honest mistake.
In this pandemic, we are currently seeing how the ability for everyone in this country to access healthcare is crucial to our country’s collective wellbeing. As a principle, healthcare should be free at the point of use in our country. This virus does not care what someone looks like or where they come from. If someone is living in poor conditions, or is too scared to get the vaccine because of what might happen to them or because they might leave a paper trail for the NHS, this virus will catch up with them. I pay tribute to all the vaccination hubs that are reaching out specifically to these overlooked groups.
In my role as co-chair of the all-party parliamentary group on hate crime, I and Lord Sheikh have been taking up the difficulties that undocumented people have faced during this pandemic, specifically around vaccination. I welcome the early announcement by the Minister for Covid Vaccine Deployment that people will not need an NHS number or a fixed address to get a vaccine. However, those are not the only barriers for people reaching out for help. I wrote to him in March to ask how his Department was actively reaching out to that incredibly hard-to-reach group. I am still waiting for a response, but perhaps the Minister can shed some light on that. I appreciate that everybody is busy, but from March is a long time to wait for a response to a letter from an APPG.
This debate is ultimately about our values as a country. I am not a fully-fledged football fan, but I am a fan of our England team because of who they are and what they represent—the kind of England that stands up for and alongside one another. But do our Government reflect that? Do our leaders treat other human beings as equals? Over the last 11 years we have seen a hostile environment for people from overseas grow in our country—a hostile environment where vans were driven around neighbourhoods, where people’s aunts, nans, grandads and uncles have lived for years, telling them to go home or face prosecution; a hostile environment where as many as 170,000 NHS heroes from overseas are still waiting for the refunds they were promised by the Prime Minister for the charges they have to pay to use the NHS that they work in and support; and a hostile environment where a person from overseas whose first language is not English is more likely to have contracted covid and more likely to have ended up in hospital over the last year.
Even today, a Bill being debated in the main Chamber would see our country turn its back on some of the most vulnerable people in the world. It risks breaching international law and lowering our global standard as a country even further, and it undermines global efforts to support victims of war and persecution, while criminalising even the Royal National Lifeboat Institution for saving people from drowning in the English channel. What have we become? A human being is a human being, and our responsibility to others is not determined by what passport somebody holds.
One of Luton’s strengths is its diversity. One can visit the whole world in one street. A dear friend of mine coined a phrase: “One town, many voices”. That is very true of where I live now. Our Government could learn a lot from Luton. It is time the Government stopped the divide-and-rule style of politics, because we are all the poorer for it.
John McDonnell (Hayes and Harlington) (Lab) [V]
Before I comment on the speeches so far, I want to mention this. Today I visited the Crowne Plaza hotel in my constituency, which has housed asylum seekers for the last year. This weekend a young Sudanese man died at the hotel. I will not name him because I am not sure whether his family have been contacted yet, but I want to send my condolences and sympathy to all his friends that I met today. It exemplifies the precarious nature of the life of many of the people who come here to seek safety and security. We are not sure of the cause of death. There were reports this morning about the large numbers of young men who come here and go on to take their own lives. We need to learn some lessons and approach the issue with compassion. I have listened to all the speeches, and I do not think I can add to any of the recommendations that have been made, bar one.
All I can do is bring my experience to the debate. Sometimes these debates are no longer rational. They are delivered by emotions, including the emotions that I feel. I have been dealing with asylum seekers in my constituency for over 40 years, as an activist campaigning for our local law centre, or as a Greater London Council councillor, and then as the local MP. I have met hundreds of asylum seekers and hundreds of families. Their lives undocumented have been scarred and sometimes broken by the asylum system that we now have.
As others have said, the system is complex, slow, incompetent, inefficient, brutal and inhumane. And it is expensive, especially for those living in poverty because they have been forced by the hostile environment on to the margins of our society and because there is no access to legal aid. As someone has already said, most of the people we are talking about came legally into the country and went into the process but dropped out. In my experience, people drop out in many instances, first, because of appallingly poor legal advice, with people being ripped off and given expensive legal advice that was going nowhere, and, secondly, because of the huge mental health issues that they have faced, both through their suffering in their country of origin and in their travels here, and when they arrived here—a place where they thought they would find security and succour.
The issue around the fees is important because by criminalising work for these people, it means that they are exploited. In the cases I have dealt with, because work has been criminalised it forces them into illegal work, being ripped off and often not being paid. I have dealt with many women who have been exploited sexually as a result of their vulnerability, because their work is illegal. In some instances, when they have gone to the authorities and reported it, they have been picked up as an illegal. That is why people do not report and often do not identify the perpetrator of some of these appalling acts of exploitation and, in some instances, sexual violence.
I therefore agree with all the proposals that have been put forward by my hon. Friends. Some Members who have spoken today may not accept an amnesty. It has worked elsewhere, as others have said, and I think it should be considered, just as the Prime Minister considered it when he was the Mayor of London. I welcomed the statements that he made then. If people cannot go as far as that, my hon. Friends the Member for Slough (Mr Dhesi) and for Feltham and Heston (Seema Malhotra), along with others, have set out a number of reforms that are readily available to us and could transform the lives of hundreds of thousands of people who are living in our communities. They come here for safety and security, but they also want to contribute to the society of their host community.
One further reform that I would like the Government to consider is the scrapping of no recourse to public funds, because it is forcing people into destitution, exploitation and, in many instances, situations of vulnerability that put their health and their lives at risk. The plea from the people who signed the petition, nearly 4,000 of whom were my constituents, is the same that others have made in the debate today, which is that this system is not working, even on the Government’s own terms, because 99% of people are not intimidated by the hostile environment to return their countries of origin because they are so vulnerable there. If the system is not working, even on the Government’s own terms, now is the time for reform, and it is needed urgently because people are suffering and, as we have experienced today in my constituency, people are dying as well.
Stewart Hosie (in the Chair)
I call Anne McLaughlin, who has eight minutes.
Anne McLaughlin (Glasgow North East) (SNP)
It is an absolute joy to serve under your chairmanship, Mr Hosie, even though we are not speaking about anything particularly joyous today.
I have just come from the House of Commons Chamber where right this minute, as we debate the suffering of undocumented migrants on these islands, the Nationality and Borders Bill is getting its Second Reading. It is a horrible piece of legislation that will discriminate against those who, according to the refugee convention, to which we are signatories, enter the UK legally but by boat. It will give preferential treatment to those who have been fortunate enough to be able to use the very few safe and legal routes.
The debate today is about undocumented migrants, stuck in legal limbo and trying to find a route to resettlement. What we are hearing is that even when migrants use those safe and legal routes, the state often continues to neglect, to discriminate and to punish, leaving them vulnerable to exploitation. A number of Scottish National party colleagues and I supported an early-day motion tabled by the hon. Member for Streatham (Bell Ribeiro-Addy) on the regularisation of undocumented migrants in May this year and many of my colleagues have spoken regularly about this issues.
As others and I have said, there can be numerous reasons why someone is undocumented. They might not be able to get legal advice or life might have got in the way, for example through a bereavement or an illness, theirs or that of someone close to them. They might make minor mistakes on their application. A friend of mine sent a copy of her wedding certificate instead of the original. Yes, it was her mistake but, instead of allowing her to rectify it, she had to go through the entire palaver again, including paying the fee again.
As several hon. Members have said, another big reason is that many are simply unable to pay the extortionate application fees, as mentioned by the hon. Member for Brentford and Isleworth (Ruth Cadbury). It is also worth noting that some hon. Members, including the hon. Member for Bethnal Green and Bow (Rushanara Ali), spoke about people being trafficked to these islands.
My hon. Friend the Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald) has spoken repeatedly about the costs for children registering their right to British citizenship. Most people would be surprised to hear that children born here are not automatically citizens. Indeed, they used to be, but that was repealed by the British Nationality Act 1981, which came into force in 1983. At least in 1983, a fee of just £30—that is equivalent to £100 today—was charged to register a child as a British citizen. That really raises the question about why the Home Office currently charges more than £1,000 for a migrant child, or even a child born here of migrants, to register. I appreciate that that is under review at the moment, but only because the courts are forcing the Government to look again.
I want to share the story of Paul—that is not his real name, of course—who is a constituent of mine from Nigeria. He was on minimum wage, so he was just getting by and no more, but he was doing a really good job of keeping a roof over his son’s head, and making sure that he was healthy and educated—all the things a good dad would do. He realised that his leave to remain was due to be renewed or considered, so he went to apply, only to discover that the cost was more than £2,000, which would have required him to save up £1,000 for every year of his leave to remain. That is just not possible on the minimum wage.
Paul’s leave to remain then expired, so he became an undocumented migrant, but he was doing nothing wrong. His employer had to let him go because he did not have the right to work. He had no recourse to public funds—I completely agree with what the right hon. Member for Hayes and Harlington (John McDonnell) said about that—leaving him with no food, no electricity and rising rent arrears. He did not know what to do. He had no choice but to send his son to live with his mum.
By the time I met Paul, he was in a terrible state. He had been unable to face responding to the letters from his housing association, which was ready to evict him. When I contacted those at Spire View Housing Association, they could not have been more helpful. Reassured by the fact that I had had a meeting with the Minister to plead Paul’s case, they agreed to pause proceedings, and they then gave him money to get food and electricity. I really thank them for that, but it was all so unnecessary, as we have heard many times in the debate.
Here is the other problem: Paul got two and a half years’ leave to remain after the fee was waived. The first year of that was spent in lockdown, so understandably, he is still unemployed. In around a year’s time, he will again have to apply for an extension, and he will have to find another £2,500 or hope that the fees will be waived, but there is certainly no guarantee that they will be. If they are not, he will yet again be an undocumented migrant. With the best will in the world, if he gets another minimum wage job, it will not be possible for him to pay back his rent arrears, which have been clocked up through no fault of his own, and save that amount of money.
Paul’s was the first case that I took to the Minister, who sorted it out, to his credit. I thank him for that, but we cannot keep going to the Minister with every single case. That said, I will take this opportunity to highlight the case of another constituent, who contacted me at the weekend to say that because of an error, the fee for his wife’s spousal visa had been taken twice. He was told by the Home Office in November that it would be refunded within six weeks. He is still waiting. Last week, he was told for the umpteenth time that it would be with him in six weeks. To add insult to injury, each phone call he makes costs him £5 because of the 65p a minute charge. He really needs that £2,000. The Home Office agrees that it owes it to him, and I hope that when the Minister responds, he will offer to look into this urgently, as he did with Paul.
I can see you looking at me, Mr Hosie, so I will sum up. I urge the hon. Member for Ipswich (Tom Hunt)—I went on holiday to Ipswich last year—to read what the Prime Minister actually said about the notion of an amnesty for undocumented migrants. As welcome as some form of amnesty would be for those who are currently battling for the right to remain, the system as a whole needs reform. The hostile environment is alive and kicking. After an amnesty, we would bear witness to a whole new generation of migrants being subjected to this endless cycle.
Let us reform the whole system root and branch, and save ourselves and them all this unnecessary grief. Otherwise, as the hon. Member for Luton North (Sarah Owen) asked, what have we become?
Bambos Charalambous (Enfield, Southgate) (Lab)
It is a pleasure to serve under your chairmanship, Mr Hosie. I congratulate the 103,440 people who signed the petition, including 447 from my constituency of Enfield, Southgate, enabling the debate to take place. I thank the hon. Member for Ipswich (Tom Hunt) for leading the debate on behalf of the Petitions Committee.
It is not often that I find myself speaking in a debate in which the Prime Minister has a different view from the official Government position, but this is one such time. On previous occasions, both as Mayor of London and as a Cabinet Minister, the Prime Minister stated his support for having an amnesty for undocumented migrants. Whereas the Government say that the immigration rules already provide for undocumented migrants to regularise their status, and that such provision would unduly reward those who have not complied with immigration law, that fails to recognise the reality of the situation. There are tens of thousands of people in the UK who are undocumented, and the Government are either unaware of them, which smacks of incompetence, or unwilling to deal with the problem.
As the Prime Minister pointed out in a radio interview on LBC in 2013, when he was Mayor of London:
“If you have been here for 10 or 12 years, I’m afraid the authorities no longer really pursue you. They give up. Why not be honest about what is going on? Ultimately, you have got to reflect reality. Otherwise they are not engaged in the economy, they are not being honest with the system, they are not paying their taxes properly and it is completely crazy.”
Expanding on the topics that the Prime Minister touched on, the Joint Council for the Welfare of Immigrants points out in its excellent briefing for the debate that, according to its research, 82% of those who are undocumented arrived in the UK via legal routes and have fallen out of status. That point was made passionately by my hon. Friend the Member for Feltham and Heston (Seema Malhotra).
The first point I wish to make is that the current immigration system, and its cost, is a factor in people becoming undocumented. Many Members, including my hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury), mentioned the cost of making applications to become regularised. The prime route for acquiring indefinite leave to remain is 10 years of continuous residency, but people have to apply first for temporary leave to remain for two and a half years, then keep renewing it until they have acquired the 10 years. Applying for leave to remain is expensive—a successful applicant under this route will have had to pay a total of £12,937 in fees. The application process is very complex, and lots of evidence is required to be submitted. If someone slips up just once and does not submit the correct forms during the 10 years, they will become undocumented. As a consequence, adult undocumented migrants will be able to regularise their status only by applying for indefinite leave to remain, but they qualify for ILR only if they are aged 18 to 25 and have lived in the UK for over half their life. If they are over 25, they have to show that they have lived in the UK for more than 20 years and prove that they have strong ties to the UK and cannot relocate to their country of origin. Talk about making it tough for people to regularise their status. It smacks of a continuation of the hostile environment that was used mercilessly against certain sections of the community.
With undocumented migrants being denied access to work, accommodation and health services, they are easy prey for those who want to exploit them. As a consequence, they are driven underground, do under-the-counter work and are totally dependent on the shady individuals whom they now serve. The exploitation of migrants was excellently commented on by my hon. Friend the Member for Bethnal Green and Bow (Rushanara Ali) and by my right hon. Friend the Member for Hayes and Harlington (John McDonnell). As the Prime Minister pointed out, if tens of thousands of undocumented migrants are working but not paying taxes, it will impact on the economy, so it is in everyone’s interest to ensure that urgent action is taken to regularise their status. It is not just the economy that would benefit—so would our public health, as it was only last week that we heard that, in some parts of London, undocumented migrants were being turned away from GP surgeries, where they were trying to get vaccinated against covid, because they are reluctant to give their names and addresses, for fear of being arrested. Meanwhile, those who were turned away are not putting just themselves at risk. As my hon. Friend the Member for Luton North (Sarah Owen) and the hon. Member for Leicester East (Claudia Webbe) pointed out, they risk spreading the virus among the wider community.
The Home Office does not know even roughly how many undocumented migrants are present in the UK, and it was heavily criticised for that by the Public Accounts Committee in its September 2020 report, “Immigration enforcement”. Another problem that the Government face is that they have hollowed out the immigration enforcement system. As such, they have effectively outsourced the service to the general public, leaving it up to landlords, employers and the NHS to notify the Government if someone is undocumented. The National Audit Office last did an estimate of the number of undocumented migrants living and working in the UK in 2005, and it put the figure at 430,000. There has been no official assessment of the number since then, so not only do the Government not know the scale of the problem, but even if they did and these figures are still accurate, they could not do much about it.
Can the Minister tell me whether the Home Office has made any assessment of the number of people who are currently here and are undocumented, and what the Government’s plan for tackling this issue is? The Minister will no doubt say that anyone who is here and is undocumented is here illegally, but if the Government know this, what are they doing about it? Even the Prime Minister does not believe that the Home Office will detain and deport 430,000 people, so we have a perfect storm of the Government being aware of a problem and being unable and unwilling to deal with it, with tens of thousands of people living and working in the UK undocumented.
The petition proposes an amnesty for all undocumented migrants, but a more comprehensive approach would be to focus on an accessible “route to regularised” system and meaningful reforms to stop people from falling out of status, as mentioned by my hon. Friends the Members for Slough (Mr Dhesi) and for Ealing, Southall (Mr Sharma). This will offer a longer-term solution to the problem. I note that the Irish Government are currently looking at new plans for a fairer pathway to regularisation for undocumented migrants with a period of four years’ residency in Ireland. The current methods of regularising status in the UK are onerous and cumbersome, and need an urgent overhaul. In addition, the exorbitant level of fees for visas is scandalous, and clearly another barrier designed to make it harder for people to regularise their status—a continuation of the Home Office’s malevolent hostile environment.
I therefore ask the Minister whether, as this problem is not going away any time soon, the Government will make it easier for undocumented people to have their status regularised, and what the long-term plan for addressing the problem is. It is surely in all our interests that the basic needs of everyone here are met, and that— undocumented or otherwise—everyone can contribute safely, openly and without fear to our communities. For that to happen, we need to see change.
The Parliamentary Under-Secretary of State for the Home Department (Kevin Foster)
It is an absolute pleasure to serve under your chairmanship, Mr Hosie, and I thank my hon. Friend the Member for Ipswich (Tom Hunt) for having opened this debate—opening a petition debate is always quite a challenge, compared with others. It has been an interesting debate, and I will attempt to respond to the points that have been raised. However, I hope colleagues will appreciate that with eight minutes in which to speak, it is unlikely that I am going to cover the full gamut of our immigration rules and our position in this area.
My first point is to reflect on comments I made at the Dispatch Box last year at the start of the pandemic. I made very clear that for those approaching the NHS in relation to covid-19—either exhibiting symptoms and therefore looking for treatment, or looking for vaccination —the information they give will not be used for the purposes of immigration enforcement. Their status will not be checked: that is not a relevant consideration if they are approaching the NHS for treatment. We not only encourage people to come forward for vaccination, but have facilitated those who have arrived irregularly to access vaccination services. Given some of the stuff that exists on the internet about this, and given some of the comments we have heard throughout the debate, I want to make very clear that such treatment is in line with how those people would have been able to access vaccinations if they had been a UK national, now that vaccination is available to everyone over 18. From a Home Office perspective, the NHS’s operations to tackle the pandemic are not items that we will look to use for any purpose of immigration enforcement.
It might be helpful if I set out some of the background on the issue we have been debating today. First, it should be noted that the definition and coverage of this group is complex: the term “undocumented migrants” often interchanges with “illegal” or “irregular” migrants. As evidenced in this debate, it can include illegal entrants, who have perhaps arrived in the back of a lorry; overstayers who have stayed beyond the term of their visa; failed asylum seekers whose claims have been declined; those not adhering to the conditions of their stay; and even those who remain in the UK without status, but whose situation is temporary and who intend to leave in short order. For today, I will include all of those groups in our definition.
Secondly, there is no current, reliable and accurate estimate of the number of those without status who are resident in the UK. As my shadow, the hon. Member for Enfield, Southgate (Bambos Charalambous), touched on, the last official Government estimate was made in the mid-2000s, when the population was believed to be around 430,000. In 2009, a report by the London School of Economics estimated that the number of irregular migrants was around 618,000. An obvious part of the problem in formulating an accurate estimate is not just calculating and agreeing on the different groups this population involves but the fact that, for obvious reasons, many of them will not come into contact with the Home Office or make their presence known here in the UK. The petition proposes an immediate amnesty for all those groups provided that they do not have a criminal record.
Kevin Foster
I will not, as I have less than five minutes and this has been a lengthy debate.
The Government remain committed to an immigration policy that welcomes and celebrates people who are here legally but also deters illegal immigration. We want to encourage people with skills and potential from around the world to make the UK their home and help make the UK a dynamic global economy, but we must not reward those who exploit the system and break the rules. We must also prevent the abuse of benefits and services paid for by UK taxpayers and disrupt the criminals who exploit and profit from the vulnerable, who will be tempted to use dangerous and irregular routes to get here if they can see a clear reward at the end of it. That is right both for the British public who pay for welfare services and for those wishing to visit and settle in the UK who played by the rules.
The Government recognise that we have a responsibility to help the vulnerable and have established several schemes and programmes to assist those most in need. One example is the work that we have done to resettle genuine refugees fleeing directly from regions of conflict and instability and to provide the necessary support to help them build a life in the UK and integrate as self-sufficient members of our society. In the past six years, the Government have offered protection to 25,000 people in this way—more than any other country in Europe in that period—through a planned resettlement scheme. That is in addition to welcoming a further 29,000 people through refugee family reunion between 2015 and 2019. We have also recently introduced a new pathway to citizenship for British national overseas status holders and their family members facing draconian new security laws in Hong Kong, with an estimated 5.4 million people potentially being eligible for the scheme.
We believe that a fair and balanced system is about guaranteeing integrity in the UK’s immigration system. We must support those in need, but we must also make sure that there is a cost for those who intend to break the rules, as have Governments of all colours since the introduction of our modern immigration system, despite some of the comments we have heard today.
The proposal to offer amnesty to all those without permission to be in the UK undermines the integrity and effective working of the UK immigration system. To recognise the stay of those who have wilfully and deliberately broken our laws is first and foremost an affront to those who have done the right thing and migrated here lawfully and contributed by paying visa fees and the immigration surcharge. An amnesty for those not playing by the rules could prove divisive for those groups who feel an injustice when they have complied with our policies, and it is safe to say that it is unlikely to build public confidence in the migration system. As my hon. Friend the Member for Ipswich said, it would certainly be interesting to see the public reaction if such a policy were included in an election manifesto.
The debate is about not just the impact of those ignoring our migration rules and refusing to leave but making sure that the public feel that there is confidence in the system. Why would someone bother to apply for status or renew their visa if they knew that they could just stay and be granted that status anyway? A point ignored by the petition and by some Members is the fact that the immigration routes already provide for undocumented migrants who have not broken the law except for by remaining in the UK without lawful immigration status.
Kevin Foster
I have less than two minutes, I am afraid. I appreciate that you wanted to give people time, Mr Hosie, but as the Minister I have only eight minutes to wind up, which is pretty short.
People who fear the situation in their country of origin may choose to claim asylum, and there is no cost to that. Those with qualifying family members who are present and settled in the UK can apply under the family rules, for example where there is a qualifying partner and insurmountable obstacles to family life continuing outside the UK. The private life rules provide for those who have been in the UK for a particularly long time to regularise their status. That said, we are in the process of reforming our immigration rules and, as many Members may be aware, I have met the group We Belong to discuss the current process for those who arrived here as children or were born here but did not qualify for British citizenship. We aim to simplify the settlement rules in the near future, as part of our wider work on the new migration system, which will include some changes in response to the points raised by that group, and we will reduce the number of people ending up on the 10-year route to settlement. We accept that too many people are on that route.
I have had to give a fairly short summary of the Government response, but we do not believe that granting an amnesty, as proposed by this petition, would be appropriate. It would undermine the rules—actually, it would make the whole creation of rules pointless if people could just ignore them and get status anyway.
Stewart Hosie (in the Chair)
I call Tom Hunt for a brief winding-up speech.
Tom Hunt
The hon. Lady should not worry. As I was saying, it has been a pretty balanced debate in which we have heard both sides of the argument. I also think that there is a shared concern for the individuals in question. However, this is a very complicated issue, with unintended consequences.
It seems to me that very few Members agreed with the petition’s call for pretty much a blanket amnesty for every single undocumented migrant. However, I think there is space somewhere for a very important debate about how we can potentially do something in this area.
Obviously, one of the real concerns is what amnesties might mean in terms of encouraging future illegal crossings. In some respects, if the Opposition supported the Bill going through Parliament today and if that Bill were enacted, as I hope it will be, they might think that the public were in a much better place to have a debate about a reasoned amnesty and pathway for citizenship because there would be public confidence that, in doing so, we were not fuelling illegal crossings from the continent. That may be, at some point, where we get to: if there is confidence that we have a rules-based immigration system and we are confident that we are in a better position to tackle illegal crossings and make determinations about the people who aspire to live in our country, perhaps at that point we could have that important debate about amnesties.
Actually, there are some shortcomings when it comes to an amnesty for those who have been here for over 10 years. I said that I saw some of the arguments in favour of that, but it is a complicated issue.
Clearly, though, this has been a productive debate. This issue needs to be debated much further; I am sure that it will be. Again, I thank the more than 100,000 people who signed the petition. Hopefully, they will feel that, at the very least, the issue—in a general sense—has had a good airing and been thoroughly debated today.
Question put and agreed to.
Resolved,
That this House has considered e-petition 567681, relating to an amnesty for undocumented migrants.