Westminster Hall

Thursday 19th May 2022 Westminster Hall

Thursday 19 May 2022

[Christina Rees in the Chair]

Child Maintenance Service: Reform

Thursday 19th May 2022 Westminster Hall

13:30

[Marion Fellows (Motherwell and Wishaw) (SNP)]

I beg to move,

That this House has considered reforms to the Child Maintenance Service.

It is a pleasure to serve under your chairmanship, Ms Rees, and I thank the Chairman of Ways and Means for allowing me to secure today’s debate on child maintenance reform. I honestly did not know how to start this debate. I have been campaigning on this issue for seven years, and in a debate in July 2019 I asked for sweeping reforms of the Child Maintenance Service, which is a cry I repeat today. At the risk of repetition, deviation and very little hesitation, here I go again—that is the only funny in my speech.

I thank One Parent Families Scotland, Gingerbread and Mumsnet for their helpful briefings, and I thank One Parent Families Scotland and Gingerbread for the work they do to support families with child maintenance issues. I reaffirm that my interest and campaigning on this issue is based on the needs of the children involved, on the Child Maintenance Service being able to work effectively to support them, and on ensuring that those children receive the maintenance they are due.

It can be difficult for folk in a stable relationship to understand the difficulties faced by parents with care when trying to receive child maintenance from previous partners who renege on their responsibilities. There are millions of relationships that have fallen apart, but at no point should a relationship breakdown mean that parents do not have a responsibility for their children. It is a fact of life, however, that some parents just walk away and try to shrug off those responsibilities. At that point, I believe that the responsibility should fall on us all to support those children and make their lives better, yet in these rich nations children fall into poverty, and the Department for Work and Pensions fails them with a system that does not help them, writes of huge debts to them, and does not adequately enforce payment.

Child poverty in the UK is a national disgrace and a reflection on the Government’s attitude to welfare. This is a Government who think it is fair to impose a benefit cap on families, for example, but children do not ask to be part of one-parent families where the paying parent is not facing up to their responsibilities. The Government and the DWP should not be failing them too.

Single parents with children are more likely to be in poverty, so any reduction in income is likely to be particularly harmful. In the face of the Tory-made cost of living crisis, maintenance matters even more in protecting children from poverty. That is why the SNP has been calling on the UK Government to introduce a minimum maintenance payment, to provide parents with care and their children a guaranteed income, and to prevent hardship and ensure a dignified standard of living.

Child maintenance arrears have also been exacerbated by shortfalls in making payments to parents who lost income during the pandemic and the current cost of living crisis. A Joseph Rowntree Foundation report in January this year showed that nearly half the children in lone-parent families live in poverty, compared with one in four children in couple families.

The workings of the CMS have been criticised by colleagues from all parties, either here in Westminster Hall or in the Chamber, and all Members will, at some time, be asked to help constituents with issues relating to the CMS. When the National Audit Office recently spoke to parents involved with the service as part of its report, they confirmed what many parents tell third sector organisations and their MPs: the system does not work for them or their children. In advance of this debate, I forwarded a list of asks to the Minister in order that I may have a fuller response today, and I really hope that will work.

The DWP is meeting its objectives in reducing reliance on state-administered maintenance, but Gingerbread is deeply concerned about the laissez-faire approach to understanding why so many families have no maintenance arrangements in place. One Parent Families Scotland states:

“A functioning CMS needs to offer bespoke advice and support to parents to reflect individual circumstances. It needs to give confidential help to those with more challenging living arrangements, such as domestic abuse, to safeguard the vulnerable. For instance, it should remove face-to-face meetings with ex-partners who have carried our domestic abuse to avoid power imbalances and coercive control. The CMS needs to advocate better on behalf of single parents to ensure that their voices are heard. However, the feedback from parents suggests that these objectives are not at present being met.”

A Mumsnet survey states that just 11% of parents described their experience of using the CMS as positive, with 73% describing it as negative, and 72% saying that using it has made their mental health and wellbeing worse. Paying and receiving parents told the NAO investigation that the CMS was not working properly for them.

The recent NAO report explores the failures of the CMS, showing that it is simply not working for far too many single parents. The report found that the UK Government have not learned one of the key lessons from the now-defunct Child Support Agency, and that in preventing arrears build-up, enforcement can be too slow to be effective. The report suggests that unless the UK Government write off more CMS debt, outstanding arrears will grow indefinitely. Indeed, they are forecast to reach £1 billion by March 2031 at current rates.

The DWP does not yet fully understand why those without an effective arrangement do not use its service, and it could do more to help prevent around half of direct-pay arrangements from failing, leaving maintenance unpaid. The DWP still has significant problems with its customer service, which undermines trust in the CMS. According to the latest DWP figures, in the quarter ending December 2021, out of over 158,400 paying parents due to pay via the collect and pay service, 32% paid no maintenance, 68% paid some maintenance, of which 23% paid up to 90% of the maintenance due for the quarter, and 45% paid over 90%. I do not like to use statistics in debates like this, but it is absolutely incredible that 32% of parents paid no maintenance.

The percentage of parents paying something toward their child’s maintenance has fallen by four percentage points to 68% since the last quarter. The last time a compliance rate of 68% was observed was in March 2020. There has been an eight percentage point decrease in the percentage of parents paying over 90% of the maintenance due for the quarter since the quarter ending March 2021, falling steadily from 53% to 45%.

All concerned organisations representing parents and children involved with CMS are calling for the abolition of the £20 application fee and a 4% deduction from collect and pay arrangements, as those are a barrier to the poorest parents becoming involved with CMS in the first place. It might be hard for some of us to imagine the difference that £20 or 4% of a maintenance arrangement would make, but to some people that is a huge amount of money.

I am calling on the Minister and the Government to reduce the income charge threshold—currently 25%—to ensure that low-income non-resident parents are not disproportionately charged, and that higher-income non-resident parents pay their fair share. That is important when people change or lose jobs, as it affects the ability of some parents to pay the amount of maintenance due.

The withholding or restricting of child maintenance payments can be used as a tool for economic abuse. According to DWP data, in the quarter ending in December 2021, 60% of new applicants to the CMS were recognised as being survivors of domestic abuse, which is why the way they are treated is so important. When will DWP introduce a trauma-informed service delivery and appropriate training for staff to identify ongoing financial abuses, given the increasing number of CMS customers who have experienced domestic abuse? When will the service introduce better customer service and management for parents, such as having the same caseworker for individual cases? Having to phone up repeatedly, and getting someone different every time, is almost an abuse in itself.

The Government announced in March that they have plans for future changes to the CMS, such as including unearned income in child maintenance calculations, for which I have been calling for quite a while. The caveat, however, is that the Government have said they will do so

“when the legislation timetable allows”.

How long is that long grass? Why is this not a priority now? There is a cost of living crisis going on, and think of the difference it would make to children.

DWP figures also show that since 2021, when the CMS began, £451.1 million in unpaid maintenance has accumulated. That amounts to 8% of all maintenance due to be paid since the start of the service. The SNP has repeatedly called for effective enforcement action to be taken in the collection of maintenance arrears. Much stronger systems and resources need to be dedicated to tackling parents who attempt to avoid or minimise child support payments, and those who do not pay what has been agreed. Many parents game the system—they know that if they do not pay and are then called to account, they can pay a little and slip off the immediate register, and the children suffer even more.

The CMS simply is not working for some parents, and closer attention has to be paid to what parents are saying. One parent said:

“I tried to claim child maintenance and received a few erratic payments. It had to be collected through earnings arrestment. Every time the dad moved job, payments stopped and wouldn’t restart for months. CMS said they couldn’t find him and they were not allowed to search for him…I was told I should write him a letter that would be passed onto him. I didn’t/couldn’t…so I didn’t make a new claim.”

Another said:

“I would improve the customer service; those working with communicating with parents using the service can be so insensitive when discussing personal situation and lacking in knowledge about the services provided.”

Another parent said:

“I’ve had to wait for more than a year for a response on more than one occasion (despite chasing) which is completely unacceptable. Upon phoning, any random person becomes your case worker and as my case is complex this is soul destroying. I’ve had complaints closed down without my agreement. Calculations performed incorrectly. The actual running total has had technical issues twice, so I don’t know how much is owed etc and it’s taken months to sort out. If you don’t chase nothing is actioned. The portal can be like a black hole.”

Another said:

“Although I am on Collect and Pay the paying ‘parent’ is still getting away with non-payment and nothing is being done about payment of the arrears. Then they have the audacity to charge me 4% even though none of this is the child’s fault and it’s the child who is being deprived of what she is owed.”

When will the CMS stop writing off arrears, some still from the Child Support Agency? That money is due and should not be written off as children reach adulthood.

The hon. Member for Crewe and Nantwich (Dr Mullan) secured an Adjournment debate on Tuesday on the specific issue of maintenance arrears, which he was correct to raise. He suggested home curfew as a consequence of not paying child maintenance. Although that sounds like a positive thing, it has unintended consequences in cases of domestic abuse and control, so I would urge caution on that. However, at present the DWP does have sanctions, such as confiscation of passports and driving licences. DWP figures show that from the quarter ending December 2019, four passports have been subject to either suspended or immediate confiscation orders, 10 driving licences have been disqualified either immediately or under a suspended order, and 362 prison sentences, suspended or immediate, have been passed. Do any of us really believe that is good enough?

I will not go over the list of asks because I have done that so often. I know the Minister will respond, but I want to reflect on what the organisations that deal daily with parents in the CMS system have said. The chief executive of One Parent Families Scotland, Satwat Rehman, said:

“Parents are facing huge delays in hearing back, poor customer service, and ultimately a failure to collect the payments. At a time when the cost of living is rising to impossible levels, with many families forced to choose between food and fuel, addressing these issues is more important than ever. No child should have to go without because one parent is choosing not to provide them with financial support when they are able to.”

The chief executive at Gingerbread, Victoria Benson, said:

“Child maintenance is not a 'nice to have' luxury, in many cases it makes the difference between a family keeping their heads above water or plunging into poverty.”

She also said:

“It’s clear that urgent changes need to be made to ensure the child maintenance system is fit for purpose and works for those who need to use it. Without reform more single parent families will experience poverty and more children will be exposed to ongoing disadvantage. Single parents and their children should be supported to thrive because of their family make up—not in spite of it.”

Mumsnet founder, Justine Roberts, said:

“Providing for your children is a fundamental responsibility, and it’s genuinely surprising that the Child Maintenance Service allows so many adults to evade it. Children from these families deserve better than to be treated as collateral damage when relationships break down.”

In this debate, I have tried to raise some of the issues expressed by those who use the service, because it is important that their voices are heard. The Child Maintenance Service has not been working effectively for years. I know there are huge numbers of parents who use direct pay, who are involved in collect and pay services, and who pay on time, but I am not here to press their case. I am here to make the case for children affected by parents who do not face up to their responsibilities—indeed, I think all hon. Members are here for that reason. Let us try to make the CMS work for the children who need it.

13:45

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

It is always a pleasure to serve under your chairship, Ms Rees. I congratulate the hon. Member for Motherwell and Wishaw (Marion Fellows) on securing a debate on a service that is not often seen as a priority despite the essential issue that it should tackle.

When the Child Maintenance Service replaced the Child Support Agency in 2012, it was done under the guise of creating a more efficient system that would foster more collaboration between parents and ensure that children are properly supported financially. The Government are bringing forward further legislative reform to the service, and although that reform is absolutely necessary and long overdue, it must be done right. We cannot let another decade pass with problems going unaddressed. Parents have to pay to access the service, but the level of satisfaction is appallingly low.

In Scotland, about 92% of lone parents are single mothers. The poor accessibility of child maintenance is intrinsically gendered. Thirty-nine per cent. of children who live in single-parent families live in poverty, which is much higher than the average for all Scottish children. Research shows that if child maintenance were being paid as it should be, some 60% of those children would be lifted out of poverty. There is no excuse for that not to be immediately addressed.

In September last year, 59% of new claimants were recognised as victims of domestic abuse, as the hon. Lady said. Those women and men—they are overwhelmingly women—have been through some unimaginable things. We live in a society that tends to blame victims, whether consciously or not. We ask, “Why doesn’t she leave him? Why does she allow it to happen? Why isn’t she doing the right thing to protect her kids?” In most cases, domestic abuse happens slowly, so a victim might not realise it is happening until it is too late. There are so many barriers to leaving such situations, but they would not occur to someone who had not been through it.

When a victim does leave and manages to get the children out as well, she is further victimised by a system that allows her ex-partner to continue to exert his control without consequence. She is left to pick up the pieces and become the sole provider to children they both created. Too many see child maintenance as some unjust tax that they have to pay to fund their ex’s lifestyle. They do not see it for what it is: their financial responsibility towards ensuring that their children have what they need to survive.

My office is no stranger to CMS complaints, and each complaint is as frustrating as the next, with the same problems and the same inadequate response. Most commonly, constituents come to me after receiving a mandatory reconsideration notice prompted by a request from their ex-partner to the CMS to lower payments. Sometimes, those payments are not even being made when a parent requests such a review. The notice invites the custodial parent to submit any evidence that they have in their favour. It does not explain on what grounds the reconsideration has been requested, however, and if the receiving parent does not know what the paying parent’s argument is, how can they provide evidence to counter it?

At the moment, I have two almost identical open cases that are completely unrelated. They both concern single mothers to two young sons and ex-partners who were working full-time until child maintenance was calculated. In a successful effort to avoid payment, the fathers went under the radar by claiming universal credit while working full-time for cash in hand. Both women have extensive evidence of that, which they have shared with the CMS and Her Majesty’s Revenue and Customs only to be told, “Sorry—nothing we can do.” In one of those cases, a CMS adviser even told a member of my staff over the phone that it was really frustrating and unfortunate because although my constituent had done everything right—everything she possibly could—it just would not change the outcome. That cannot be right.

I have seen parents’ statements showing that the paying parent owes them thousands in unpaid maintenance, yet the CMS has no power to address that—the same CMS that custodial parents are paying to provide that service. We have now reached a point whereby many parents do not even bother making a claim for child maintenance because it is more stress than it is worth for the pitiful amount that they will receive if they are lucky enough to receive any at all.

The National Audit Office’s March report found that there was no clear change in the number of families with functional maintenance arrangements, including those made outside the CMS. It estimated that for only one in three separated families—one third—is the agreed level of maintenance being paid in full. That is shocking. The NAO found the following:

“As at September 2021, 38,000 paying parents (around one in four) with an ongoing arrangement had not paid any maintenance on their Collect & Pay arrangement for more than three months, and 22,000 (around one in seven) had not paid for more than six months”.

The report also highlighted the issues about enforcement, and that enforcement of arrears did not necessarily impact on future compliance. There is really no consequence for avoidant parents.

Although reform of the system is of course hugely welcome, it must get to the root of the issues; it cannot be another plaster over the cracks. The DWP must be sure that it fully understands the heart of the issues, and any proposed solutions must work for the receiving parent. It is categorically wrong that the receiving parent, who already shoulders the overwhelming burden of providing for their children, is charged to use the service. One Parent Families Scotland reports that the minimum cost of raising a child in the UK is £190,000 for single-parent families. That is £30,000 higher than for couples. It is no secret that child maintenance is rarely equitable. The custodial parent will almost always pay significantly more. They should not be charged for the small amounts that they are able to recoup, especially in the worst cases. Although victims of domestic abuse are not charged the 4% on the collect and pay service, that exemption requires disclosure, which can be incredibly difficult for victims.

Ministers must also create strong cross-agency measures that change the way enforcement works, creating faster and better means of sharing intelligence and for how intelligence is then, more importantly, acted on. The CMS needs to be better resourced to respond to the needs of the parents using the service—both receiving and paying parents. I have spent a lot of time dwelling on the worst kind of avoidant parent, but there are many paying parents out there who are compliant, or would like to be, but need some adjustments. Cases need to be reviewed individually; it should not be one size fits all. Communication by the CMS in the round—both to constituents and to MPs’ offices—needs to be much, much better.

I have spent so much of my speech talking about the impact on parents. It is important to remember that at the heart of this are innocent children who are missing out, many having already been through the trauma of the breakdown of their family unit, often exacerbated by a deteriorating relationship between the parents where maintenance is an ongoing issue. I hope that the Minister and his colleagues will keep those children at the forefront of their minds when looking at the CMS and what it could do better. A child should not be living a poorer quality of life than they have to because the parent they live with cannot access the support to which the child is entitled.

13:58

[Jim Shannon (Strangford) (DUP)]

May I apologise to you, Ms Rees, for being a few minutes late to the Chamber? I was in the Pass Office. It has moved, which I did not know, and there was a queue, so I apologise for not being here for the whole introduction to the debate.

This subject is very close to my heart and one that I am very pleased to speak on. I spoke, in the form of interventions, in the Adjournment debate on this issue the other night, and the hon. Member for Motherwell and Wishaw (Marion Fellows) was also there. I thank the House of Commons Library for its notes and advice. It always gives us lots of good information.

I think I should start by saying that I understand that the figures show that an estimated one in three separated families in the United Kingdom of Great Britain and Northern Ireland have a child maintenance arrangement that is paid in full. That is good news, and something to say before we start. As elected representatives, we will always be the ones people come to with their problems. People do not come to us all the time—as you know, Ms Rees, and I know—to say, “That’s a great job. Well done.” They come to tell us their complaints, so unfortunately, Minister, although I am not being negative, I want to say some things about where the fall-downs are.

The NAO report stated that the aim of increasing the number of effective maintenance arrangements overall was based on a wider, cross-Government set of policies on separated families. However, that broader set of cross-Government actions have yet to emerge as the chances that we hoped to see. In most of the cases that people bring to me, it is often the man who controls the money and that is where the problems lie. It is a fact of life that relationships break up. I am always sorry that it happens, and I do not like to see it, but sometimes it does happen, for various reasons. We are not here to condemn or identify why that is, but relationships do break down.

The DWP research does not explain why take up of the CMS is lower than expected. The CMS has improved its maintenance calculations and was designed to limit fraud and error, but the DWP has not estimated how many calculations are incorrect due to fraud and error. When an MP is presented with the case as the elected representative, it is very hard, especially when there is a lady sitting across the desk who is in absolute floods of tears and does not know what to do next. There are probably two or three children who are outside in the office, or maybe with their mummy. We can see the pressure on that lady in the office at that time.

CMS debt money is not collected, and outstanding arrears will continue to grow indefinitely. They are forecast to reach an eye-watering £1 billion. I find that quite hard to understand. Perhaps the Minister can tell us what is being done to collect the arrears. I know the Minister is a man who understands the issue very well, and always responds to MPs in a way that gives us some hope for the future. We are looking for that same consideration today, and I want to make some constructive comments.

I want to give some examples of real difficulties from my office. As I mentioned in the Adjournment debate on Tuesday night, the inconsistency of not being able to get the same person at the end of the phone to speak to about a constituent’s case is infuriating. I know that during covid people were ill and that meant changes every day, but even before covid, it was difficult to speak to the same one person about a constituent’s case. Then, when I got put on to somebody else, what happened? It all started again—the process just started with each new person. The timescale it took for things to happen was infuriating. Perhaps the Minister can give us some indication of what is happening in that regard.

There are also the pressures of the job. In Belfast, even before covid-19, many staff were moving on. I hope the Minister can give us some reassurance on what can be done or needs to be done to retain staff. Can the Minister give us some figures for the internal movements in civil service jobs? I do not expect him to have all the answers today. The DWP is under the control of Westminster, so will the Minister give us figures for movement on child maintenance within the DWP Belfast office in particular?

I have had mothers come to see me at the end of their tether with children under their care and without the wage and income that they once had. I have witnessed blatant attempts to not make child maintenance payments. In almost every case—99.9% of cases—it is the man, although sometimes it may be the lady who has the bigger income. In all those cases, it was husbands who had closed their businesses, transferred moneys and removed moneys from bank accounts prior to those accounts being checked, and who had handed valuable properties to parents or new partners. I know that marriages and relationships break down, but that anyone should try to walk away or abandon their children is outrageous.

I am aware of people who are property millionaires on paper and had large bank accounts, yet the hesitancy of the CMS to pursue them effectively was truly frustrating. They returned financial accounts showing a profit of less than £15,000 per year, when they are driving a car worth more than 30 grand and are sitting in properties that show their income is higher than that. If someone is withdrawing moneys from the bank account before a relationship break-up, there is a case to answer.

Why is it so important? Ladies are squeezed financially. They cannot pay their mortgage when they are left with all the bills. They cannot pay the electric. In some cases, they cannot even buy food for the house. They are desperate.

My constituents have given me lots of examples. In my office, as I am sure is the case in everybody’s office here, we quite regularly get such cases. We find it frustratingly difficult to negotiate through their process with constituents. I want to raise some points to the Minister. First, is it possible to put urgency into the request from us, as elected representatives, to the CMS? There is real urgency to get things done quickly and to, importantly, have a process at the end of it. Secondly, can we assign one officer or staff member to look after each case? I am ever mindful that officers might be off sick, but there should be someone who knows the case, so that we do not have four, five or six people. Thirdly, checking the bank accounts before the breakup would give an indication, I suspect, of where the process is.

We should listen to the wife in those cases, the lady who knows. She knows where the dead bodies are buried. She knows where her husband’s moneys are. She knows what property he owns. She knows about the bank accounts. She knows. We should be looking towards that evidential base. It is not right that husbands can abscond or ignore CMS letters. The legal authority to investigate must be central to the obligations. I know that the Minister has great understanding and that he wants to assist. I ask him to hear the four requests and others have made. I appreciate the evidential base that they have, but I do feel that the DWP can do better and must do better.

I am probably old fashioned. I am a traditional person, and I believe in the sanctity of marriage and commitment. That is just me. A man must remember his obligation to his wife and children. We need the law of the land tightened, thereby ensuring impartial treatment for men and women. There is much to do, Minister—much to achieve and change. I value the Minister’s help and commitment to trying to make changes that ensure we have a system that really works for the lady. I think that is the way it should be.

14:07

[Chris Stephens (Glasgow South West) (SNP)]

It is a pleasure to serve under your chairmanship, Ms Rees. I congratulate my hon. Friend the Member for Motherwell and Wishaw (Marion Fellows) on securing the debate. She has campaigned on the issue for many years now, and I hope that much of what she has said will be taken on board by the Minister and that action will be taken.

The SNP is clear that, at a time of a cost of living crisis, child maintenance matters even more to protect children from poverty. We are calling for a long-overdue root-and-branch review of the Child Maintenance Service so that it can work more effectively for the children it is supposed to serve. I also want to take the opportunity to ask the Minister about the 91,000 civil service jobs that are supposed to be disappearing. I know you will appreciate this point, Ms Rees, as a friend of the worker. A press release last Friday said that 91,000 civil jobs will disappear. I would hope that not one of them is from the Child Maintenance Service, because it seems to me they need more workers. No worker in the Child Maintenance Service should find themselves out of work as a result of those changes.

What we want to focus on today are the clear, systemic errors that happen and affect so many people. That is why in the root-and-branch review, we have to come back first to the fact that the Government introduced charges for parents seeking support from a former partner through the child maintenance service. There is a fee of £20 for using CMS, unless someone is under 19 or has suffered domestic or violent abuse. The paying parents must pay an additional fee of 20% to use the service, and the receiving parent 4%. The fees imposed on receiving parents using the child maintenance service include the 4% surcharge for using collect and pay and the original £20 charge. I believe that that unfairly penalises receiving parents who are not receiving proper payments, and charging lone parents to access their right to support for their child is deplorable. We would certainly demand an end to that tax on child support, and we should continue to demand an end to Child Maintenance Service fees for parents receiving the payments.

A recent National Audit Office report, which was touched on earlier by previous speakers, exposes the failures of the Child Maintenance Service and shows that it simply is not working for far too many lone parents. The report found that the UK Government do not appear to have learned one of the key lessons from the now defunct Child Support Agency about preventing appears from building up, and that enforcement can be too slow to be effective. The report suggests that unless the UK Government write off more CMS debt, outstanding arrears will grow indefinitely. As my hon. Friend the Member for Motherwell and Wishaw said, they are forecast to reach £1 billion by March 2031 at current rates, and the Department for Work and Pensions does not yet fully understand why those without an effective arrangement do not use its service. It could do more to help prevent around half of direct pay arrangements failing and leaving maintenance unpaid. There seem to be significant problems with its customer service, which undermines trust in its service, as the hon. Member for Strangford (Jim Shannon), my hon. Friend the Member for Motherwell and Wishaw, and the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) identified in their contributions.

The latest DWP figures are for the quarter ending in December 2021. Of the 158,400 paying parents due to pay the collect and pay service, 51,300 paid no maintenance and 107,100 paid some maintenance—and of those, 36,500 paid up to 90% of the maintenance due for the quarter, and 70,600 paid over 90%. The Department for Work and Pensions figures also show that since 2012, when the Child Maintenance Service began, £451.1 million in unpaid maintenance has accumulated. That amounts to some 8% of all the maintenance due to be paid since the start of the service. The SNP has made it clear that we are calling for effective enforcement action to be taken in the collection of maintenance arrears.

Like the hon. Member for Rutherglen and Hamilton West, I am grateful for the excellent briefings that we have received from One Parent Families Scotland, Gingerbread and Mumsnet. In the survey that Gingerbread and Mumsnet did in England in 2020, 86% of Child Maintenance Service customers said that the service had allowed their ex-partner to financially control or abuse them post separation. Some 83% said they would likely never receive what they were owed in arrears, and just 11% of those parents described their experience of using the Child Maintenance Service as positive. That really cannot continue, and people need more confidence in the Child Maintenance Service going forward.

Lone parents and their children are facing increased hardship as a result of the combined effects of the pandemic and the cost of living crisis, which is why it is vital that family income must be protected for over 800,000 children across the United Kingdom who rely on it. Some 803,000 children are covered by Child Maintenance Service arrangements—an increase of 5,000 since September 2021—with 510,000 covered through direct pay arrangements and the rest covered through the collect and pay service. The number of children covered by Child Maintenance Service arrangements has increased steadily over the last two years.

Lone parents of children are more likely to be in poverty, so any reduction in income is likely to be particularly harmful, which means that, in the face of the cost of living crisis, maintenance matters even more for protecting children from poverty. That is why the SNP is calling on the Government to introduce a minimum maintenance payment to provide parents with care and their children a guaranteed income, in order to prevent hardship and ensure a dignified standard of living. We are also clear that a long-overdue root-and-branch review of the Child Maintenance Service is needed—not only to enforce the payments, but to ensure that the process does not put vulnerable families through additional stress. It is ultimately the children who are being permanently disadvantaged.

The Scottish Government are using their devolved powers to ensure that children and families are supported during this difficult time and prevent them from being pushed into fuller hardship. The Scottish Government have invested £770 million per year in cost of living support, including in a range of family benefits not available elsewhere in the UK, doubling the Scottish child payment, mitigating the bedroom tax and increasing Scottish benefits by 6%, which was the figure in April. The Scottish Government are putting money into the pockets of families now and helping them to deal with that cost of living crisis.

I look forward to the Minister’s remarks and response. I would hope that he can confirm that there will be a root-and-branch review, and that he will give us some positive news on staffing and other matters.

14:15

[Alison McGovern (Wirral South) (Lab)]

It is a real pleasure to serve under your chairship, Ms Rees. I begin by thanking the hon. Member for Motherwell and Wishaw (Marion Fellows) for securing this debate. All of us constituency MPs deal with child maintenance cases on a regular basis, and we owe her a debt of service for bringing this extremely important debate. To pay back a little bit, I am going to be brief, because she set out the case for reform very well, as did other Members who have contributed. I want to make three very brief points on behalf of the Opposition to ask the Minister a few questions. I know that we will all be keen and enthusiastic to hear what the Minister has to say. The case for change is broadly accepted and has been well made.

I will briefly respond to the hon. Member for Strangford (Jim Shannon). He says that he is a traditionalist; I am a progressive. We differ on very many things, but I feel sure that we agree, as will every Member of this House, that what matters in this discussion is the children who should be supported by this money. I am sure that we will all put them first.

First, hon. Members who have spoken in this debate have been right to highlight the connection between being a single parent and the risk of poverty. We know that that is true. It has held true for a very long time in this country. That is why we believe that children are entitled to support from both parents, and that the Government ought to play their role in making sure that that happens, but also that children should not grow up poor in this country. It is anathema to all of us that there has been an increase in children needing support via food banks and other emergency charities. Every pound we can get into the pockets of their parents helps, whether it comes from this source or the welfare state.

This debate matters because this country should have a mission to end child poverty. Many of us still believe that. What we do with the Child Maintenance Service can make a real contribution to that. I put on the record my thanks to Gingerbread and two other charities that work very hard, year round, to stand up for single parents and make sure that the specific and different challenges they face as families are recognised in the system. As the NAO report pointed out, in the quarter ending September 2021, paying parents moving from direct pay on to collect and pay owed an average of £1,100—around five months of maintenance. Given the price hike of basics such as bread, putting petrol in the car or buying bus tickets, I can only imagine what that £1,000 means to a single-parent family. It is huge. Single parents are at the frontline of making ends meet in this country. We must put this debate in the right context, which is about stopping families from suffering the inequity and indignity of poverty.

Secondly, as other Members have already said, every Member of Parliament knows only too well what happens when the service goes wrong. The problems in my own case load have two features: the time taken to resolve issues is simply too long, as people find the length of time they are waiting incredibly stressful, and the enforcement action taken by the service is often not effective—a point that has been very well and amply made. That is frustrating and, as has been said, often dissuades people from using the service at all. I cannot believe that a Government of any colour or hue would want an important public service such as this one to put people off.

I am anxious to hear from the Minister about the plans for reform. I hope that we can move quickly to get a better service, not least given that the NAO found that it could take years before payments are made. The NAO also uncovered the issue of enforcement, and said that it

“has not been properly built into the Universal Credit system”.

I think the Government will want to address that.

Finally, I agree with fellow Members on the issue of domestic abuse. Unfortunately, I know only too well from my own constituents that parents who are victims of domestic abuse often see that abuse continued via the officers of the state. Again, I do not believe that a Government of any kind would wish their own services or operations to be used by perpetrators of abuse to continue their abuse once a relationship has come to an end. I simply do not believe that any Government would want that.

We are learning much more about how this continuation of abuse is done and how institutions of the state can protect against that. As the hon. Member for Motherwell and Wishaw said, it is crucial that we have a trauma-informed service in every function of DWP work and that we continually look to reform, given that we now know more about how domestic abuse is perpetrated. I hope the Minister will respond to those three points about poverty, improving the service so that it actually does what we want it to and making sure that it is informed by the suffering and trauma of victims of domestic abuse, and I look forward to listening to what he has to say.

14:22

[The Parliamentary Under-Secretary of State for Work and Pensions (David Rutley)]

It is an honour, as always, to serve with you in the Chair, Ms Rees. I congratulate the hon. Member for Motherwell and Wishaw (Marion Fellows) on championing this cause and bringing this debate before us today. She is a recognised and well-respected champion on these matters.

Notwithstanding her strong loyalty to Motherwell and to Wishaw, I am sure she will join me in congratulating Rangers Football Club on their achievements this season which, despite the vagaries of the penalty shoot-out, were magnificent.

[Several hon. Members rose—]

[David Rutley]

I give way to the hon. Member for Glasgow South West (Chris Stephens).

[Chris Stephens]

I thank the Minister and, as my constituency takes in Ibrox stadium, I associate myself with his remarks. I inform the House that an early-day motion will be tabled, praising the Rangers team for their achievements in the Europa League this season.

[David Rutley]

I give way to the hon. Member for Motherwell and Wishaw.

[Marion Fellows]

I have never said this in public, but my late husband was a Rangers fan, man and boy, and I could feel his presence when I watched the match last night. It was such a sad ending.

[David Rutley]

I give way to the hon. Member for Strangford (Jim Shannon).

[Jim Shannon]

I loved the comments made by the hon. Member for Glasgow South West (Chris Stephens) and, in particular, the hon. Member for Motherwell and Wishaw (Marion Fellows). I also associate myself with the Minister’s comments. I have been a Rangers supporter since I was a wee boy. Rangers may not have won last night, but they made this great kingdom of the United Kingdom of Great Britain and Northern Ireland better together. It was a showcase for us all.

[David Rutley]

I agree. Other hon. Members may not quite agree with everything that the hon. Gentleman just said, but I think we can all agree that it was a remarkable achievement.

We can all also agree that this debate is important. Even though my current ministerial brief does not cover this area, it is vitally important. The Child Maintenance Service plays a valuable role in ensuring that children are supported in instances where parents do not live together and where they come to a private arrangement. We know that the vast majority of separated parents quite rightly take their responsibilities extremely seriously, as the hon. Member for Strangford pointed out. Our aim is to help parents to support their children and we are sensitive to the needs of both parties. The CMS is designed to promote collaboration between parents, and it offers a statutory scheme where collaboration is not possible.

The central focus in all of this is that the children are supported. The intent of child maintenance reform is to encourage parents to meet their responsibilities and provide their children with the financial support they need to get a good start in life, and that intent is well supported by the evidence. I will come on to that point in a second.

We are committed to maximising the positive impact of the Child Maintenance Service and ensuring that good arrangements are put in place for children, no matter where they are growing up. As the hon. Member for Strangford pointed out, parents need to honour their responsibilities to their children. We believe the CMS has made substantial improvements in the pre-covid period, notwithstanding that there is further room for progress, and the statistics support that. The compliance rate for parents on the collect and pay service has increased significantly, with the percentage of parents paying something rising by eight percentage points between the quarter ending March 2018 and March 2020. From March 2016 to December 2021, the percentage of CMS cases where no maintenance is being paid fell by about 30%, from 46% in March 2016 to 32% in December 2021.

CMS investigators have the power to deduct directly from earnings and to seize funds owed in child maintenance payments where requests for payments are consistently refused. For example, the CMS has the ability to seize funds held by a third party that they owe to the paying parent. Over 800,000 children are now covered by the Child Maintenance Service arrangements, up from 700,000 in mid-2019. We are making a difference to the support that children have been receiving: since 2019, over £1 billion in child maintenance has been arranged each year through the direct pay service and the collect and pay service. The hon. Member for Wirral South (Alison McGovern) made an important point about poverty. She and I have regular debates on this subject, but it is important to note that around 140,000 fewer children are growing up in poverty as a result of child maintenance payments. That is good progress, but clearly more work needs to be done.

The hon. Member for Motherwell and Wishaw rightly raised points about the fee for an application to the Child Maintenance Service, which is set at £20 for all CMS participants. That fee is intended to encourage parents to consider whether they really need a statutory scheme case, but it is not so high that it creates an insurmountable obstacle. Applicants who are victims of domestic abuse or under the age of 19 are exempt from paying the application fee. It is not our intent to create a barrier for vulnerable customers; in fact, around 60% of applicants do not pay that fee. Collection charges, which are 20% for the paying parent and 4% for the parent with care, only apply to the collect and pay service, and are intended to provide both parents with an incentive to collaborate. The collection charge for the receiving parent is deducted only when maintenance is paid, so the receiving parent does not owe money to the Child Maintenance Service if maintenance is not paid. If there were no charge for receiving parents, there would be no incentive for them to use the direct pay service.

The Child Maintenance Service may also review the income of a paying parent if earnings decrease or increase by 25% over a year—a point that was raised by the hon. Member for Motherwell and Wishaw. That 25% threshold ensures that liabilities remain stable so that both parents can budget with certainty, which aims to provide ongoing certainty for the child as well.

[Marion Fellows]

Will the Minister give way?

[David Rutley]

I will, but can I just make one further point, which I think might answer the hon. Lady’s question? Most people’s income does not change to that degree over the course of one year. The threshold also ensures that minor changes in income do not interfere with the efficiency of the system, thereby increasing costs for the taxpayer. I recognise that there is an important issue here, and I assure hon. Members that DWP Ministers will keep that tolerance under very active review.

[Marion Fellows]

I just wanted to thank the Minister for that, because it is a very important point. I know those changes are not frequent, but they can prevent money from going to children, which is the issue that this debate is all about.

[David Rutley]

I underline for the record that that issue is kept under active review.

Within the CMS, arrears are written off in exceptional circumstances only. With regard to CSA arrears, the Department carried out its compliance and arrears strategic review. Over the course of that review, 250,000 receiving parents were written to, explaining the situation. There are fewer than 60,000 cases remaining with CSA debt, and more than 35,000 of those are undergoing collection and enforcement activity. In instances where the receiving parents ask, the CMS undertakes further action to seek to recover the funds. Crucially, this exercise has allowed the CMS to focus its effort on parents who told us they wanted us to try to collect the money that they are owed and the money that will benefit children now.

We are determined to go further and not content to stand still. We are always looking to improve the way we deliver this vital service. The Department continues to keep child maintenance policy and our operational delivery under review. Those who have met Baroness Stedman-Scott will know that she is also a redoubtable champion on these matters and not somebody to be messed with. She is very keen to drive further action forward.

We are also considering how other countries arrange child maintenance. We are gathering examples of good practice and looking at what can be learned from other systems. This includes researching what interventions are used to encourage parents to make their own maintenance arrangements without Government involvement. The CMS has introduced new digital services such as the apply online service that allows parents to make an initial application more easily. That option is available 24/7 and allows greater flexibility for separated parents to use the CMS and manage their child maintenance arrangements in a way that suits them.

That brings me to the standard of service that customers receive when they go to the CMS—a point raised by numerous colleagues today. The CMS is committed to delivering service to the highest standard and has created a more customer-focused culture over the years. In the past, the CMS has experimented with personal caseworkers —a point raised by the hon. Member for Strangford—but it was found that that does not offer the best service. Instead, the CMS organises caseworkers into more tightly formed teams, which allows for knowledge and expertise sharing, so any caseworker can deal with any of their team’s cases. We find that that is the best way forward, but I will gladly pick that point up separately with the hon. Gentleman later.

The hon. Members for Motherwell and Wishaw and for Rutherglen and Hamilton West (Margaret Ferrier) raised the incredibly important issue of domestic abuse survivors. The CMS takes domestic abuse very seriously and has substantially strengthened its procedures to ensure customers can use the CMS safely. The CMS updated its domestic abuse training programme to give clear guidance to caseworkers on how to support victims of domestic abuse. The Department also commissioned an independent review of ways in which the CMS supports survivors of domestic abuse, including those facing and suffering from financial abuse.

The review was conducted by Dr Samantha Callan, who consulted a range of domestic abuse stakeholders and leading charities, as well as CMS customers who have, sadly, experienced domestic abuse. The Government will, of course, carefully consider the findings of the review and any recommendations.

Moving on to the issue of unearned income, we are also looking to take new measures to ensure that income gained from sources other than earnings is distributed fairly. The CMS compliance and arrears strategy 2018 introduced powers that allowed notional income from assets such as coins and gold, income derived from capital, and any foreign income to be used in the assessment, but we want to go further. We propose making changes in legislation that enable the child maintenance calculation to include unearned income that is not currently captured—for example, savings and investment income, and dividends.

[Jim Shannon]

I thank the Minister very much for what he has said so far. I think that each and every one of us here today—and, indeed, those who are not here—have the very same issues, particularly that of men trying to hide their incomes. For instance, before a couple separates, money could be moved out of bank accounts and properties could be shoved sideways into the ownership of parents, brothers, sisters or new partners. Does the DWP have the power to investigate such cases in a thorough, almost forensic way? That is really what is needed.

[David Rutley]

I understand the point that the hon. Gentleman makes—with conviction, as always—but until an application is made to the CMS, it has no jurisdiction to investigate finances. It is important that applications are put in place so that that sort of action can move forward.

[Jim Shannon]

Does that mean that there is going to be a review of the system and that it will lead to such action? If it does, that is a giant step forward.

[David Rutley]

That is a point on which the redoubtable Baroness will need to come back to the hon. Gentleman. I will write to him on that point.

[Jim Shannon]

Will the Minister give way one further time?

[David Rutley]

The hon. Gentleman is very persuasive. I will allow him one last intervention, because he is a good man, but then I think we better move on.

[Jim Shannon]

I thank the Minister for giving way, and I thank you as well, Ms Rees, because I would not be able to intervene without your say-so.

I also made a point about the evidential base. The ex-wife has great knowledge of where the money is. I referred to her knowing “where the dead bodies are buried”. She knows everything. Discussions with the wife are really important. Can that also be part of the process that the Baroness is considering?

[David Rutley]

I will ensure that the Baroness hears these views. We have all had cases as parliamentarians that have shown us that there are real challenges. We want to lean into this and tackle the challenges appropriately. I have a couple of concluding remarks, which I hope will give Members some confidence.

We have talked about dividends and unearned income. This addresses the point raised by the hon. Gentleman, to some extent. Including that income will reduce the scope for parents to organise their financial affairs in such a way as to reduce their financial liability for their children, which is the situation that we need to stop. Parents need to honour their responsibilities. I also recognise the current cost of living pressures as a result of rising prices around the world and the impact of the Ukrainian war. We will strive to introduce this change as soon as possible.

On enforcement, between January 2020 and December 2021 we arranged a total of 14,300 deduction orders, which represents about 33% of non-paying collect and pay parents. We also referred 15,000 parents to enforcement agents, which represents about 35% of non-paying collect and pay parents. These enforcement actions are taken before sanctions are considered.

During the same period, where further action was needed the CMS initiated almost 6,000 sanction actions against non-paying parents, which represents about 13% of non-paying collect and pay parents. That led to 249 prison sentences—244 suspended of them and five immediate.

We are always looking for new, innovative and effective ways to encourage paying parents to provide the financial support that their children need. As my right hon. Friend the Secretary of State for Work and Pensions has set out, we are aiming to introduce curfew powers before the end of the year—I understand the point made earlier by the hon. Member for Motherwell and Wishaw—and changes to the measures on unearned income after that, which will increase the range of enforcement measures available. Having listened to today’s contributions, I think that those changes will meet with the approval of the hon. Members in attendance.

I thank hon. Members for their participation in this important debate and I hope they will join me in agreeing that the CMS provides an important service. We will continue to keep under review options with regard to CMS policy and operational reforms. Hon. Members can be assured that we will strive to continue addressing the needs of separated parents and producing better outcomes for children—it is a clear priority.

14:38

[Marion Fellows]

I thank all hon. Members who have taken part in the debate. I know that this is not a particularly popular time, so I really appreciate them being here. I thank the Minister for his response, although I will be investigating it further. I did not want to say this, but I think I have to. The noble Baroness plays an important role—I have had meetings with her and she is redoubtable—and also speaks well of her Department and tries to move things forward, but it is a pity that she is in the other place and is therefore unable to be directly scrutinised in the Chamber of the House of Commons. That often makes it difficult for Ministers to respond directly to folk like me and other Members present. I am well aware that there was a push on enforcement last year, but I will be writing to the Baroness directly to ask whether that push is going to be continued. I still do not think I have had an answer to, “How long is the long grass?” regarding when legislation will appear. [Interruption.] The Minister is indicating “quite short”, but I think everyone involved would like some more surety about that.

I thank you, Ms Rees, for presiding over today’s debate so well, and I thank all the organisations that have helped us to have it. We are all concerned, and the Minister can take it that we will remain so and will keep a very careful watch on folk in the DWP. The staff in the Child Maintenance Service work hard and do their best. They do not need to be reformed; what needs to be reformed is the systems, and the way in which they are enforced.

Resolved,

That this House has considered reforms to the Child Maintenance Service.

14:41

Sitting suspended.

Dialysis Care Outcomes

Thursday 19th May 2022 Westminster Hall

[Sir George Howarth in the Chair]

14:59

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered dialysis care outcomes.

I thank you for chairing this debate, Sir George, and thank those who are here to participate—they are colleagues, but also friends. I am pleased to see the shadow Minister, the hon. Member for Enfield North (Feryal Clark), in her place and am especially pleased to see the Minister in her place, too. I am not being condescending when I say that; I am encouraged because the Minister understands the issues very well. I look forward to her response—no pressure, Minister. We are pleased to have this opportunity.

I thank our guests in the Gallery, particularly Fiona Loud, who has been instrumental, through me, in achieving this Westminster Hall debate. I thank the Backbench Business Committee for allowing the debate. I applied for it some time ago, but the Queen’s Speech meant that those applications to the Committee fell. It was originally supposed to take place on the Thursday before recess, but we are having it at the same time, 3 o’clock, as it would have happened on that day.

Dialysis is an important issue to raise, especially at this time of rising daily costs that directly impact people who choose to receive their treatment in their own home. In a question to the Prime Minister yesterday, the right hon. and learned Member for Holborn and St Pancras (Keir Starmer) referred to Phoenix Halliwell and the cost for those receiving dialysis treatment at home. There might have been a bit of confusion around how the question was asked and how the answer came through—I know that others will speak to that—but it pinpoints a key issue for this debate, which is the impact of the cost of electric and energy on people receiving dialysis treatment at home. That is of particular concern to me and others at this time of rising costs. There are global pressures on the price of energy. This is not a debate on energy, but on what is happening to those who have dialysis treatment.

It is not just adults who are affected by this issue. Fiona and I spoke to the Minister beforehand; we appreciate that very much. It seems that not every postcode covers children. Local providers have discretion as to whether they reimburse the utility costs for children. I know that Fiona, who I spoke to beforehand, is concerned about that, and I certainly am. One person who contacted us said that her son has been on peritoneal dialysis since January. It used to cost £115 per month for combined usage, but it is now up to £350—a massive increase of 220%.

Although this debate covers a health issue, it also focuses on the predicaments of those people in the health system. We need to review that and think about it again, so that we can understand it better. It is important for those we are concerned about that we understand where the pressures are—financial pressures are coming from all sides.

Others will refer to this, but even on the warmest day of the year—we experienced the highest temperature of the year on Wednesday—a person receiving dialysis will feel cold. Cold weather puts even greater pressures on household energy costs, but people who receive dialysis at home are being very adversely affected by rising fuel and heating costs. I will refer to that later, but I wanted to put those two issues on the record. They have been brought to my attention and are of deep concern.

I know that this is not the Minister’s responsibility, but I will give some facts from Northern Ireland, where attempts are made for every patient to be given approval to receive dialysis at home at first. It does not always happen, because sometimes patients are sent to the renal department at the Ulster Hospital, which is my nearest hospital and which I have visited on a number of occasions over the years.

Analysis by the UK Renal Registry showed the rate of home dialysis in areas of deprivation at the end of 2020. Unfortunately, however, there was no data available for patients treated in Scotland. My colleagues and friends from Scotland may have some figures. Overall, the rate of home therapy was lower for patients from the more deprived areas of England, Northern Ireland and Wales. In England, 22.9% of patients in the least deprived areas were able to access home dialysis, compared with 15% in the most deprived areas. The rate of home dialysis for patients in Northern Ireland was 7.2% in the least deprived areas, whereas it was 9.8% in the most deprived areas. I am alarmed at these figures. If someone has a certain amount of income, it means that they have to pay for their energy. However, someone who is deprived is under pressure to ensure that the energy, electric and heating levels in their house are at a certain level, so the impact on those in deprived areas is much greater than it is anywhere else.

Those from lower socioeconomic backgrounds are affected by renal failure in the same way as anybody else, but they do not have equal access to home dialysis and the freedom that that choice offers. I look to the Minister, as I always do, for a positive response on how we can take things forward constructively in a way that can deliver for dialysis treatment patients across this great United Kingdom. We need to address this issue on a UK-wide basis, and greater equality must be achieved. I am my party’s health spokesperson, so it is always a pleasure to speak in these debates and to highlight issues that are brought to my attention by people such as my friend Fiona Loud from Kidney Care UK.

Kidney disease costs the NHS more than breast, lung, colon and skin cancer combined. It has a greater financial impact. It is estimated to cost £1.4 billion a year—equivalent to £1 in every £77 of NHS expenditure. That is a massive figure and a significant expense, with 21 people developing kidney failure every day and almost 30,000 people on dialysis in the UK. Unfortunately, it shows no signs of slowing.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

Acute kidney injuries usually come about as a complication from another illness, and they are more deadly than a heart attack. As the hon. Gentleman said, research indicates that about 30% of acute kidney injury deaths could be prevented with better care or treatment. Does he agree that this is an area that requires urgent attention, looking at kidney disease outcomes in the round?

[Jim Shannon]

I thank the hon. Lady for those wise words, and I absolutely agree with her. She is right. We should never be guided entirely by finance, but we cannot ignore the financial implications. If we—by which I mean the NHS—could better use the moneys for early intervention, early diagnosis and early medical action, and reduce the cost, that would be beneficial to the NHS.

The clinical and cost benefits of home dialysis are well established, but despite 17 years having passed since the National Institute for Health and Care Excellence first highlighted its ambition for just 15% of patients to take advantage of home haemodialysis, as many as eight out of 10 dialysis patients are still treated in centre. That is a big challenge, but it is something I believe in, and I am confident that the Minister can embrace that challenge and give us some idea of how we can move forward in a positive fashion to deliver even better.

Some of those people will have successful transplants, although a transplant is only a form of treatment, not a cure. I have a particular interest in this matter because I have a nephew called Peter Shannon, born with a kidney the size of a peanut, or the wee nail on my finger. I remember when my boys were running about—obviously, young boys or young girls are always full of life, but he never had the energy. He was always a terrible colour—yellow, the colour of a bowl of custard—and he never really moved forward physically until he had a transplant at the age of 16. When he had that transport, his life transformed; if only that were possible for everybody, but it is not. I have been a great supporter of organ transplants all my life, and I am very pleased that the Government accepted the legislative change to make everybody a donor unless they opt out. I was always in favour of that legislation. In Northern Ireland, my party —the Democratic Unionist party—had perhaps not truly embraced it in the past, but it has now. I cannot say I am a pioneer in the party, but I am pleased that that legislation has also been endorsed by the Northern Ireland Assembly.

Many other dialysis patients will have no choice but to dialyse to replace their kidney function and to stay alive. The majority will do so three times a week at a hospital or clinic, every week for the rest of their lives, because once a patient starts dialysis, they are on it forever unless they receive a transplant. Across this United Kingdom there are nearly 30,000 people, from young to old, on dialysis. They come from all walks of life and are united by a remarkable strength and resilience to continue with this long-term, gruelling, life-saving medical treatment.

When dialysis is needed, in an ideal world the patient and their care team will consider and decide together whether to dialyse at home or in-centre. There are two forms of home dialysis therapy, with haemodialysis being the most common. Tubes are attached to needles in the arm or via a line to the neck, with blood passing through an external machine that filters the toxins and water from the blood before returning it to the body—it is almost like a cleansing process, but medically. Suitable patients can safely undertake that procedure themselves at home, carrying out sessions that meet their clinical needs to a routine that fits their lifestyle, including overnight while they sleep. In peritoneal dialysis, which is the other form of therapy, a catheter is placed into part of the abdomen via a surgical procedure.

Since its introduction in the 1960s, most dialysis care is delivered in-centre, with patients required to travel to a hospital three times a week for four hours of treatment. Many patients who dialyse in-centre benefit from the care of the UK’s excellent nephrologists, nurses and support staff, and from a sense of community with others receiving dialysis. However, that treatment is more intense over a shorter period of time, which might not suit everybody. It can be extremely draining, and it often leaves patients feeling physically exhausted as the body is pushed so hard during those treatments, and their toxin and fluid levels build up again immediately while they face a long wait until their next dialysis session. As a result, those patients must adhere to strict fluid and diet restrictions, and they must also travel to and from their dialysis centre, which is a time-consuming and often exhausting experience.

I visited the dialysis renal unit at Ulster Hospital in Dundonald some time ago. It is a new centre, and I met many of the people there. I knew two of those people personally. One was Billy McIlroy, who passed a few years ago. He went there for his dialysis treatment three days a week, which I know kept him alive. Another guy called David Johnson also attended that dialysis unit. He got a kidney transplant eventually, so his life changed greatly. I had already been given the details of what happens in dialysis, but actually seeing it showed the reality—it gave a physical understanding—of what those people were going through three times a week. For them, travelling from home and going home again was six hours of their day.

[Margaret Ferrier]

On that point, the impact of kidney disease and treatment on patients’ mental health is huge. Good mental wellbeing can make a big difference to a patient’s recovery and ability to withstand difficult treatment. Does the hon. Gentleman agree that ensuring patients have access to mental health support is paramount to improving outcomes, and that the NHS must be better resourced to provide that?

[Jim Shannon]

I thank the hon. Lady for reminding us all of that. We often focus on the physical aspects of this condition, as we should, but we must also remember the mental health and anxiety issues that come alongside it. Patients suffer with uncertainty about how they are going to feel the next day, uncertainty about their future health, and uncertainty about their personal and financial issues and their family. The hon. Lady is right to remind us of that point.

By comparison, home dialysis therapies offer flexibility and have been shown to have a positive effect on a patient’s health. When patients dialyse more regularly, they are more effectively replicating the natural function of the kidneys. Studies have shown that longer, more frequent dialysis sessions, undertaken at a schedule of the patient’s own choosing, achieve better results than a thrice-weekly in-centre schedule. People doing alternate-day dialysis have been shown to experience fewer symptoms, such as shortness of breath, high blood pressure and left ventricular heart damage. People on home haemo- dialysis have an up to 13% lower risk of death than those on in-centre haemodialysis. That shows that if people can do more home treatment, we can improve their longevity. NHS England has acknowledged the limitations of standard in-centre haemodialysis, and in particular the increased risk of hospitalisation or death after the weekly two-day break between in-centre sessions.

The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) is right about the importance of mental health. Depression is the most prevalent psychiatric illness in patients with end-stage kidney disease, and she made that point powerfully. One study shows that rates within the dialysis population vary from 22.8% to 39.3%. Wow—those are big figures, and they show what the condition does. Studies have also shown that depression is a significant predictor of mortality in dialysis patients. That is particularly important for younger people on dialysis, who report a lower quality of life than young adults in general.

People who have the choice of dialysing for as long as they need and at a time of their choice have freedom and control. They can also better respond to their body’s reaction at that time, in the comfort of their home and with the reassurance of their family around them. Home treatment probably addresses some of the issues of depression and mental health issues as well. It enables patients to have a life outside their dialysis schedule and hold down a job. It allows them to have a normal life and pursue the dreams and ambitions that should be the right of any person, young or old. I can attest to that through my nephew, Peter Shannon, who has had an organ transplant. I have seen his life change. He bought his first house just last week, incidentally, at probably the highest time for house prices in the whole United Kingdom.

In the last 18 months, covid-19 has exaggerated the negative impact of differences in dialysis care, and heightened the need radically to increase home therapy provision. Analysis from the UK Renal Registry has demonstrated that the relative risk of death associated with covid-19 among in-centre dialysis patients was much higher than that of the general population in England, especially among those of a younger age.

The UK kidney community has been calling for patients to be provided with greater choice in their dialysis care, recognising the need for increased awareness and education around home therapies and greater equity of access across the country. In the UK, however, the overall percentage of dialysis patients receiving home therapies has increased only from 3.4% in 2011 to 7% in 2022. Although that has doubled, it is a long way off the figure of 15%. It needs to double again, and I think, respectfully, that the Government should set a higher target.

In 2021, the NHS’s Getting It Right First Time programme recommended that a minimum of 20% of patients in every dialysis centre should be on home dialysis. It set that target, and NHS England’s Renal Services Transformation Programme is working to increase the provision of and access to home therapies, in line with recommendations made by Getting It Right First Time.

Although there are dialysis centres exceeding the target, which we welcome—it is not all negative; many are trying to achieve those targets and goals—GIRFT’s own report highlighted that 33 out of 52 centres in England have not yet met the target. Again, I respectfully ask the Minister—she knows I do this constructively; I just want to get the stats so that we can understand the problems and how to do things better—to tell us what has been done to increase the number of those 33 out of 52 centres that have not yet reached the target. The Getting It Right First Time target of a 20% prevalence rate for home dialysis compared to in-centre care could be transformative for patients, and could deliver considerable cost savings for the NHS at a time when they are desperately needed. We can do the treatment better, deliver the medication and dialysis better, and we can do it for a better price. That seems to me to be good value.

To address adequately the low uptake of home care, a review of dialysis reimbursement should take place to ensure that training and educational needs can be met, and to incentivise higher frequency dialysis at home, such as alternate day treatments to support all dialysis centres to meet the 20% target. What steps are the Government taking to reach that 20% target? It is essential that clinicians are offered the tools needed for them to meet the GIRFT targets in an effective manner, such as providing staff and patients with detailed, unbiased education to empower them to make informed decisions about their dialysis. I see it—as I often do—as a partnership, with clinicians working alongside Government policy and patients to do better.

One of the most pressing issues facing people who receive treatment at home rather than in hospital is the rising cost of fuel and energy. I referred to that at the beginning, and there are three points that I wanted to make. People receiving dialysis at home are at particular risk from rising energy costs. The figures that I cited, and the question asked by the Leader of the Opposition at yesterday’s PMQs, gives an indication of the issue. There seems to be an uncertainty, and perhaps a postcode lottery, as to where there is help for energy costs, but the figure that I gave of £118 per month for a child, or whatever it is, but that now costs £350, indicates that there is a way to go yet. Dialysis machines, with their high energy consumption, keep people alive. Dialysis treatment at home adds between £593 and £1,454 to utility costs per year, and that is before this year’s 54% energy bill rise.

One effect of dialysis treatment is that many patients frequently feel cold due to the associated anaemia and the process of dialysis, so they need to heat their homes more often and for longer during the year. When we feel warm, they feel cold. When we feel exceedingly warm, they might feel normal. There are not many times in the year in this great United Kingdom of Great Britain and Northern Ireland when we have Mediterranean heatwaves, so for the dialysis patient, feeling cold is almost an everyday occurrence. We do not want people to have to decide between giving up the freedom and independence that home dialysis gives them, and going into a hospital setting just to save costs. Again, I ask the Minister urgently to address that matter, because the barriers to employment for people on dialysis, posed by frequency and length of treatment, and the physical toll and intense fatigue, already compound financial insecurity for home dialysis patients.

The NHS service specification advises that NHS trusts reimburse the additional costs of home dialysis, but reimbursement is inconsistent across the country, and many patients receive no or very little financial support to pay for the additional costs of treatment. For most home dialysis patients, the £200 repayable relief on energy bills and council tax deduction will simply not be enough, and a special, specific provision is needed. It is regrettable that the spring statement was a missed opportunity for the UK dialysis community. Consistent reimbursement, longer-term capped tariffs for vulnerable groups and immediate financial support are urgently needed. Again, I look to the Health Minister and the discussions that she has with her Secretary of State for Health, and ultimately with the Chancellor, to ensure that we can deliver extra, specific financial help for those on dialysis treatment.

Many in the kidney community feel that their voices have been unheard in Westminster for too long, and when a friend from the kidney charity asked me to secure this debate, I was very pleased to do so. I think that today’s debate does two things. It raises awareness—that is No. 1—but it also directly asks the Minister to become involved and address some of the anomalies. I welcome the re-establishment of the all-party kidney group. Its work, led by the hon. Member for Bassetlaw (Brendan Clarke-Smith), aims to promote improvements in the health and care services that are available to improve the health of people with renal failure.

I call on the Minister to respond to calls from voices in the renal community to support them, and ensure that a straightforward, accessible system is in place to enable people on home dialysis to be reimbursed for the additional cost of utilities, as set out in the UK Kidney Association guidance. Would the Minister perhaps be agreeable to that request? If I may, I would ask for a meeting on behalf of the APPG—perhaps the chair of the APPG, our friend and colleague, would do that—because then we could look at some of those issues. Those who are involved in this debate might wish to attend that meeting as well. NHS tariff payments for home dialysis must be sufficient to cover all associated costs, including reimbursement for additional utilities usage that should and must reflect current price increases. Again, I look to the Minister to pledge to work with energy companies, and the Chancellor to develop capped tariffs for people on medical treatments at home, such as dialysis.

Renal units should proactively offer support to all patients undergoing dialysis, to build their confidence and ensure that they are dialysing in the right way for them at the time. Again, Minister, we need to address the low uptake of home dialysis by implementing a review of the dialysis reimbursement tariff—I think we referred to that in the discussion that we had outside the Chamber, and I look forward very much to the Minister’s response. We must also ensure that training and educational needs can be met, and incentivise higher-frequency dialysis at home, such as alternate-day treatments, to support all dialysis centres to meet the 20% target. Let us meet that target. Let us do it here and back home as well, and achieve the significant cost savings that home dialysis can bring.

I will close with this comment: it is vital that all renal unit staff receive updated training to build their home dialysis knowledge, in order to help find solutions to the issues facing patients, and so that information for patients about transitioning to home therapies is standardised and includes details on the practical and financial support available. I place on the record my thanks to all renal staff. They do magnificent work; they are saving lives and they are keeping people alive. It is wonderful, and we thank them for it. The support available should also include a consistent approach to utility bill contributions from the NHS, in order to ensure equality for every renal dialysis patient across this great United Kingdom of Great Britain and Northern Ireland. The Government must ensure that educational resources are also provided to local authorities and trusts, enabling them to respond appropriately to the needs of people in their area who want to choose home therapies.

Thank you very much, Sir George, for the chance to raise the issue of dialysis treatment and bring it to Westminster Hall in a way that, I hope, both raises awareness and lets people out there on dialysis treatment know that we in this House care for them—I believe we do—and that we are seeking change. I look forward very much to other contributions in the Chamber today, but I look forward particularly to the response from the Minister.

15:28

[Kenny MacAskill (East Lothian) (Alba)]

It is a pleasure to serve under your chairmanship, Sir George. First, I pay tribute to the hon. Member for Strangford (Jim Shannon) for securing this debate and for putting forward such an eloquent statement, including the passionate and compassionate testimony. There is something about oral testimony. Whether it is as an elected Member or, indeed, a Minister, if we can actually see something, or hear or feel it, that is much more powerful, no matter how good a briefing may come from an individual, a member of our staff, or indeed an able civil servant. The comments regarding Peter Shannon and his family hit home.

I think that we were all aware, even before we were briefed on this issue or became elected Members, that people with kidney and renal disease suffer greatly. It is life threatening. Clearly, once someone is on dialysis, that is a significant issue. Not only is it life threatening if they do not obtain the treatment, but the treatment itself is life changing, not only for the individual—their life circumstances change in deeply restrictive ways, including through a loss of employment, as the hon. Gentleman said—but through its impact on other members of the family. Treatment can require family members to change their employment situations, and it can affect youngsters who perhaps do not get the same parental attention that would be available to others.

The hon. Gentleman eloquently put forward many points that I support and sustain. We are all largely on the same side in the debate. Nobody enters party politics or, indeed, comes to Westminster, to make their constituency worse off or endanger the livelihoods of their constituents. I will make some points on which I have differences with the Government, however. There are Governments in other countries who do not share my political hue or perspective—they are probably closer to right-of-centre than the UK Government—but who have policies that I will suggest later. I want to touch on two aspects of the debate: first, the difficulty people have in obtaining treatment for themselves or their children, and secondly, the difficulties faced by those undergoing home dialysis treatment, who the hon. Gentleman correctly mentioned.

The travel problem is a constituency issue, as the hon. Gentleman said in his speech. A constituent of mine—a Polish woman trying to sustain her life and her family—came to see me because her child requires dialysis treatment. In Scotland, it is difficult enough to get dialysis treatment for adults, but for children it can take place only in Glasgow or Aberdeen. She lives in East Lothian, and taking her child to Glasgow would mean travelling a considerable distance. He cannot go on his own; he has to be taken by his mother or father, who would have to take time off work. That affects the wider family and creates costs.

That is not a matter for the Minister but for the Scottish Health Secretary, and I have written to him and await a reply. At the present moment, treatment is a postcode lottery. Some health boards are particularly generous; others are entirely lacking. For my constituent in Musselburgh, trying to get treatment is financially draining, extremely difficult, and traumatic—not just for her son, but for her whole family. These matters have to be addressed along the road. I have no doubt that similar issues in England must be considered, and the Minister will no doubt consider them.

Home treatment has been worsened by covid—in mental health terms—and by the fuel crisis, which is causing real difficulties. At the moment, there is an entirely spurious euphemism about people “self-disconnecting.” There is no such thing as self-disconnection. People are not saying, “I’m going to save for a holiday in Marbella, so I won’t put my power on”. As is often said, they have to choose between heating or eating.

For people on dialysis, the issue is far worse. It is not simply about access to heating, which is necessary—as the hon. Gentleman said, people feel the cold more when they are ill—but about access to power. Power means that people can charge their mobile phones so that they can call 999 if there is a significant problem; it means that they can wash their clothes in the washing machine if they have to go to the doctor’s or to hospital and want to uphold their decency and values by looking smart and presentable; and it means that they can afford to keep their dialysis machine on when it is ratcheting up the costs. The euphemism of “self-disconnection” is an entire fraud. There are significant issues for those who are on dialysis.

As the hon. Gentleman pointed out, people in deprived areas tend to have treatment elsewhere rather than at home. There is a reason why: most people on prepayment meters are unable to access a dialysis machine. I can understand why restrictions are imposed and why it is difficult, but that is fundamentally wrong. They should be able to access machines. The way to solve the problem is to level the charges for those on prepayment meters—not just the most deprived, but those who live in private tenancies and who have those meters forced on them. At the moment, those on prepayment meters pay a higher standing charge and a higher tariff even though they have lower incomes—that is perverse. There is no technical impediment to power companies levelling the charges, and it could be dealt with. It requires Ofgem to take action and the Government to impose it, so that is my point on prepayment meters.

I subscribe to aspects of work done by other countries, even by those that do not have a left-of-centre position. Other countries bring in social and disability tariffs, so that those who have least or who are sick can be charged at a lower rate. Belgium, for example, operates a system where the third of people with least are charged at a lower rate, and other countries have circumstances where people who receive dialysis can get financial support.

At present, the financial support provided in this country is haphazard and goes nowhere near meeting the costs required to run and operate a dialysis machine. On that basis, there has to be political change and the Minister has the power to provide that. It is not a matter of blaming Ofgem, because Ofgem takes its directions from the Department for Business, Energy and Industrial Strategy. It is those decisions that have to change.

We all agree that we have to provide greater sympathy and mental health support, as well as better access for people to get to treatment centres, but, fundamentally, those being treated at home have to be able to pay for the treatment they require.

15:36

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Sir George. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this important debate and on his continued advocacy on the issue. He is a voice for issues that often do not get enough time in this place.

I thank the hon. Gentleman for sharing the experience of his nephew, Peter, because experiences help to paint a picture of how these conditions impact on real people’s lives. Yesterday, I was delighted to meet two kidney patients, Dale and Tejal, through Kidney Research UK, who told me about their experience of suffering with kidney disease and of dialysis, and about the impact that is having on their life.

I praise the important contributions made by the hon. Members for Rutherglen and Hamilton West (Margaret Ferrier) and for East Lothian (Kenny MacAskill). It is a pleasure to have the Minister in her place. It is the first time we have had an exchange in a debate in Westminster Hall, so I welcome her today.

I pay a huge tribute to the fantastic advocacy undertaken by charities such as Kidney Care UK and Kidney Research UK. They are great champions for patients and will no doubt have been a support to colleagues in their preparation for the debate.

As we have heard, today’s debate is particularly timely, given that tomorrow marks the second anniversary of the law that changed organ donation to an opt-out system. That change has made, and will continue to make, a massive difference for patients with kidney disease and other conditions, and it is right that we recognise that.

In the UK, some 3.5 million people, and rising, are living with kidney disease, so we cannot afford to ignore the issue. We know the debilitating effect that living with kidney disease and undergoing dialysis can have on patients. As the hon. Member for Rutherglen and Hamilton West said, it is not just the disruption that it causes to their everyday lives that we must consider, but the physical and mental consequences of living with a long-term condition.

Unlike treatments for conditions such as cancer and heart disease, treatments for kidney disease, such as dialysis, have barely changed in the last few decades. For patients living day in, day out with the effects of dialysis, that lack of progress is simply not good enough. Research led by Kidney Research UK has shown that new developments in treatment, such as high doses of intravenous iron, can make a real difference to patients.

Sadly, such new developments are not being delivered uniformly across the UK, leading to the kind of postcode lottery that affects so many long-term conditions. It is no surprise that those who are already the most vulnerable are the worst-off when it comes to being able to access treatment at home. The hon. Member for Strangford highlighted that point, and we place further emphasis on it because of the stark health injustice facing people in this country. The rate of patients receiving at-home treatment was almost 23% in the most affluent areas of England, compared with 15% in the most deprived areas.

We know that people from lower socioeconomic groups are more likely to develop and die earlier from chronic kidney disease. We also know that when people from those groups experience kidney failure, they have poorer survival rates on dialysis and fewer are treated with peritoneal dialysis. That inequality extends to lower rates of kidney transplants and increased rates of transplants being affected by episodes of rejection.

Those inequalities are stark and cannot and should not be tolerated. We can and must do more to ensure that everyone, regardless of their background, can access the treatment that works best for them, including being able to dialyse at home. For too many people, at-home dialysis is just not an option.

People with chronic kidney disease, for which there is no cure, already experience financial difficulties because of barriers to employment and additional costs of disability. With utility bills soaring, people have to shut off their heating or skip meals just to be able to afford to continue their vital treatment, as colleagues have mentioned. Figures from Kidney Care UK show us that the additional cost for a dialysis patient doing five overnight sessions a week is £1,454. That was before the energy price cap increased in April. As hon. Members have already set out, that is a stark increase in bills. Energy prices are already soaring and are set to rise even further when the cap rises again in October. What assurances can the Minister give to dialysis patients who face those added pressures that they will be protected from the cost of living crisis, here and now? Some 30,000 people in the UK rely on dialysis to stay alive. They cannot afford to wait.

Just yesterday at Prime Minister’s questions, we heard the Prime Minister reassure patients that the NHS is responsible for covering the costs for at-home dialysis patients. Sadly, that simply does not chime with the experiences of dialysis patients up and down the country. Although the NHS service specification advises that NHS trusts reimburse the additional costs of home dialysis, reimbursement is inconsistent across the country. Many patients receive no or very little financial support to pay for the additional costs of carrying out treatment at home. Some do not even have the luxury of having the option of a reimbursement scheme discussed with them; they are simply left to fend for themselves.

There are some wonderful charities supporting patients living with kidney disease and on dialysis. The work they do to support patients is incredible and invaluable. Kidney Care UK handed out more than half a million pounds-worth of grants to patients and their families in 2021. In that time, they saw a rise in demand of 47% for their immediate hardship grants of £300. Patients are having to rely on charities to be able to fund their bills to pay for treatment, because the Government are not implementing their own policy properly. This is simply not acceptable and it must be changed.

Millions of our disabled, elderly and vulnerable neighbours are at the sharp end of this crisis. They simply cannot afford to live with dignity. Many are living through this nightmare, feeling like they have been totally abandoned by the Government. Labour’s plan for a windfall tax on oil and gas companies would take up to £600 off household energy bills and put it back in people’s pockets. I am sure the Minister will have heard yesterday, and many times before, that that will make a real difference to people on dialysis. It will make a difference now.

Many Ministers have been asked this, but I am asking the Minister today: will she back Labour’s plan for a windfall tax? Patients on dialysis deserve better security and the respect of the support they are entitled to. It is time for the Government to deliver. I look forward to hearing the Minister’s response.

15:45

[The Minister for Care and Mental Health (Gillian Keegan)]

It is a great pleasure to serve under your chairmanship, Sir George. I would like to begin by thanking the hon. Member for Strangford (Jim Shannon) for securing a debate on this important issue and for his kind words.

I heard his impassioned case for improving outcomes for patients receiving kidney dialysis treatment. I also appreciate how kidney health is an issue of personal importance to the hon. Gentleman. It was very moving to hear the story of his nephew, Peter, who required a kidney transplant and happily got one when he was 16, after being born with posterior urethral valves. The hon. Member for East Lothian (Kenny MacAskill) mentioned how important it is in this place to share those stories. It really brings the debate to life. It shows why we are here, and why this matters.

We heard other moving stories from across the House. We heard about the stresses and strains that chronic kidney disease and dialysis treatment put on lives. We heard about Billy McIlroy and David Johnson from the hon. Member for Strangford, and about Dale and Tejal from the hon. Member for Enfield North (Feryal Clark). They spoke about the impact the treatment has on the lives of those around the patients. I would like to thank all Members for giving those patients a voice and making their stories real to us all.

I also recognise the fantastic work being done by charities, including Kidney Care UK, Kidney Research, the National Kidney Federation and the Polycystic Kidney Disease Charity, on behalf of people living with chronic kidney disease and their families. They are ensuring that issues such as those covered today are kept at the forefront of our thinking. That is why such debates are so important. I would particularly like to commend those charities for their recent work supporting World Kidney Day, which raised awareness of the issues faced by those with chronic kidney disease. I also commend Kidney Care UK’s campaign on the impact of the rise in energy costs on those who undergo dialysis at home. It is a very important matter.

I would like to reassure the hon. Member for Strangford that the Government remain absolutely committed to improving both access to and the quality of dialysis treatment that many kidney patients across the UK depend on, in particular to ensure that treatment at home is available to those for whom it is suitable, which we heard about today. The Government are working closely with NHS England to implement the renal services transformation programme, which was commissioned in September 2021, following specific recommendations published in Getting It Right First Time’s national report on renal medicine mentioned by the hon. Member for Strangford.

The aims are to reduce unwarranted variation in both the quality and accessibility of renal care, which the hon. Gentleman mentioned. One of the key priorities of the transformation programme is to increase the provision of home dialysis, with the aim of increasing the percentage of patients per renal centre receiving home therapies to 20% in each renal centre. That target of 20%, which was mentioned, is still in place, but several centres have actually exceeded that target and gone beyond 30%.

However, the Government acknowledge that there is a concentrated drive within the renal community for increasing access to at-home dialysis treatment, and for good reason. We heard some of those reasons. Home dialysis has the potential to deliver significant benefits for patient experience and outcomes, giving patients both flexibility and autonomy in their treatment. By investing in home dialysis so that patients do not need to make long and disruptive trips to hospital for regular treatment, local systems will be able to deliver better experiences and outcomes for patients and reduce spending on the transportation of patients to hospital dialysis centres. That makes sense, and we will of course ensure that those services are available to all people from all backgrounds. It is very important that they are equally available across the country.

A range of guidance, produced by the National Institute for Health and Care Excellence, is available for commissioners and clinicians to support patients’ access to home dialysis treatments when appropriate for the individual. Patients and their family members or carers should be involved in the decision-making process, alongside healthcare teams, when considering treatment options, and should be offered regular opportunities to review their treatment and discuss any concerns or changes in preferences. That includes a choice of at-home or in-centre dialysis modalities to ensure that the decision is informed by both clinical considerations and patient preferences.

In support of that, NHS England has set up 11 renal clinical networks, which are working closely with integrated care systems to determine local priorities. Providers of renal services, ICSs and regional commissioners will continue to monitor uptake of home dialysis via the UK renal registry and NHS England renal datasets. The transformation programme has also appointed a national clinical adviser specifically for dialysis, to develop and share best practice. The programme will provide recommendations to all renal services to support achieving the 20% prevalence rate.

The Government know that the impact of rising energy costs is a concern for many. I share the concern, raised in today’s debate and by patient charities, that those undergoing dialysis treatment at home may be particularly vulnerable to the impact of rising costs due to the high energy consumption of the dialysis machines that they rely on for their treatment.

I am pleased to be able to provide reassurance, as the Prime Minister did in PMQs yesterday, that provisions are already in place for patients receiving haemodialysis treatment at home to be reimbursed for additional direct energy costs as a result of their treatment. The arrangements are outlined in the “Haemodialysis to treat established renal failure performed in a patient’s home” service specification, and the NHS meets those additional direct utility costs through the payment of the national tariff to the patient’s usual dialysis provider.

There is no national policy on determining the amount to be reimbursed to patients, with costs to be agreed between the provider and the individual based on the amount of energy used and charged. However, the amount reimbursed is expected to match increases in the patient’s utility tariff. We fully expect providers of at-home dialysis services to inform patients about that financial support available to them, and I have asked my officials to keep me informed about rates of reimbursement over the coming months, to ensure that the policy is working well. I would also be delighted to meet with the APPG, where we can discuss this further and ensure that that progress is being made.

NHS England is working closely with renal networks to support consistency of approach regarding the reimbursement arrangements. That work has already commenced, with NHS England providing clinical networks with examples of formulas to calculate electrical outputs from dialysis machines to support that reimbursement for patients. Examples of good practice in supporting utility costs from dialysis centres have also been shared across renal networks during April 2022, so very recently.

NHS England has also agreed to communicate directly to all commissioned providers of home dialysis, and renal clinical networks, to remind them of the reimbursement arrangements within the adult service specification and that they should proactively alert eligible patients to the arrangements.

The hon. Member for Strangford also mentioned support for children on home haemodialysis.

[Feryal Clark]

I thank the Minister for giving way. The issue with a lot of the reimbursements is that renal patients are having to wait months—three or four months, in some cases—for that reimbursement. They are being treated as if they are a company that has put in a claim to the trust. Will the Minister ask NHS England to look into that and see if it can reduce that wait, or have a set time, so that people are not having to wait three or four months to be reimbursed? In this cost of living crisis, they need the cash back in their pockets quickly.

[Gillian Keegan]

The hon. Lady makes an important point. Hopefully the best shared practice includes that reimbursement should be paid very quickly. Clearly, the billing systems that are in place across the various providers will differ. It is important to state that best practice when it comes to reimbursement is to do it as quickly as possible.

We were talking about home hemodialysis support for children. That applies to about 20 children, as of February 2022, and it is currently at the discretion of individual providers. However, the renal service clinical reference group has begun an urgent review of the reimbursement process for children. Hopefully that will give some comfort to the hon. Member for Strangford.

If people with chronic kidney disease and their families need further information, there are a range of resources available on the excellent Kidney Care UK and National Kidney Federation websites, including information on treatment options, financial support and other support services to help people live well. NHS England will continue its work with those charities and others to engage their support in promoting awareness of reimbursement options available for those on home hemodialysis. In terms of wider ambitions, the renal services transformation programme is developing optimal pathways, tools and resources that will transform the delivery of renal services across England. That will support better healthcare outcomes for patients undergoing dialysis treatment, and provide integrated care systems with a whole-patient pathway approach to commissioning renal services.

The hon. Members for Rutherglen and Hamilton West and for Enfield North both mentioned the importance of providing suitable mental health support for dialysis patients. The Government acknowledge that this is very important. There can be a detrimental impact on an individual’s mental health when undergoing complex dialysis treatment. To address that, the national adult renal services transformation programme has identified psychosocial support in renal services as a key theme for improvement. Work is being taken forward with clinicians, patient representatives and other subject matter experts to identify best practices that can support patients’ psychosocial needs, as well as the steps that are needed to spread those best practices. Those suffering with renal issues can also access mental health support via self-referral to Improving Access to Psychological Therapies, which the Government have invested £110 million in to expand access.

As the hon. Member for Strangford is aware, health policy is a devolved matter, and I understand that there are different arrangements for Northern Ireland, although commissioners and trusts remain equally committed to excellent care and better outcomes. The transformation programme has established a multi-agency programme board with representation from key stakeholders, including regional commissioners, patient charities and relevant national bodies, to ensure that a full range of views are considered. It has also established five expert-led multi-disciplinary clinical workstreams, including work- streams on improving access, identifying best practice and developing solutions in chronic kidney disease. All transformation programme workstreams intend to make key deliverables available by April 2023. That will include documentation outlining best practice, a data dashboard outlining key metrics to support better decision making, and support for the review of the renal service specification led by NHS England’s renal clinical reference group.

I was asked earlier what the Government are doing to fund research into kidney conditions and their treatment. We are committed to supporting research and funding it through the National Institute for Health and Care Research. For the financial years 2016-17 to 2020-21, the NIHR spent £113.2 million on kidney research. That research includes kidney disease, but also explored why people with kidney disease are at an increased risk of death and disability following a heart attack, the relationship between covid-19 and kidney disease and whether aspirin reduces the risk of major vascular events in patients. There is a full research programme ongoing.

Once again, I extend my continued gratitude to all charities working to support improved outcomes for people with chronic kidney disease. We are very happy to continue to work with them; we all have the same objective.

Finally, I thank the hon. Member for Strangford for securing the debate and giving me the opportunity to promote the vital schemes that are available to support patients with chronic kidney disease, to make sure people know what is coming next and are aware of the financial support available to them, and to outline the strong programme of work we are undertaking across the country to transform these services. I urge all patients receiving dialysis at home to speak to their provider so that they receive the full NHS support they are entitled to through their care.

16:00

[Jim Shannon]

I thank all hon. Members who have spoken, and I thank the kidney charities that the Minister and everybody else referred to very much for what they have done.

The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) made some very pertinent points about depression, mental health and the psychological impact that dialysis treatment has on people. The Minister very kindly referred to that in her response, and she outlined the case.

The hon. Member for East Lothian (Kenny MacAskill) referred to the travel costs of taking children to the few centres, and he talked about the impact that has on families. He said that dialysis patients have higher levels of treatment. He also referred to prepayment meters, which can prevent people from accessing home dialysis treatment to start with. I know that is not the Minister’s responsibility, but the hon. Gentleman highlights an issue. We all know the Minister is very thorough, and that she will pass on the issues that have been brought up but are not her responsibility to the relevant Departments.

The shadow Minister referred to the two kidney patients she met yesterday. She also thanked the charities and referred to the 3.1 million people living with kidney disease in the United Kingdom. As we all did, she underlined the need for equal treatment, access and cost reimbursement across the whole of the United Kingdom.

I thank the Minister very much for her comprehensive, detailed response to the issues. She referred to the 11 renal networks and the regional care systems that feed into the transformation programme recommendations.

All hon. Members referred to rising costs. Energy tariffs are not the Minister’s responsivity, but perhaps she will be able to refer that to the right person, whoever it may be. Hon. Members also referred to proactivity and the need to reimburse people. As we were sitting here, Fiona Loud, who is in the Public Gallery, sent me a wee note that said that at least some of the people are getting their money. Perhaps people are taking note of the fact that this Westminster Hall debate is happening, because people are getting their money out—there is a commitment.

All NHS trusts must act and respond better. We need to address the reimbursement of moneys as soon as possible. The shadow Minister referred to that. It is great that the Minister and the Government are setting a target of 20% for home dialysis. We want to see that target achieved.

I welcome the chance to communicate with the Minister outside with the kidney charities, to understand better what the real problems are. We have to thank the charities for their campaigns. The reason I have knowledge is half the time because of them. Without them, none of us would be able to deliver the details, as the hon. Member for Rutherglen and Hamilton West has done.

I always look forward to the future. We bring forward issues to the Minister, and then we look forward to the response. The response we have listened to today sets out a programme of events, strategies and visions for the future. We want to see things improve. We will probably regularly come back to the Minister—I hope we do not have to, but we may have to. If we do, we will do that collectively in a positive fashion. In my life, I always try to do things positively. We bring things to the Minister and say, “Here’s where the shortfalls are. Here’s where we can do better.” What we heard today from the Minister has given us some heart, hope and confidence for the future. On behalf of all kidney charities, on behalf of the patients out there and on behalf of us all, we thank the Minister. I thank you, Sir George, as always, for the excellent way you chair these debates. I appreciate it very much.

[Sir George Howarth (in the Chair)]

I thank the Front Benchers and the Back Benchers for the constructive and consensual way in which this debate has been conducted. It is a model of how we should conduct all our debates.

Question put and agreed to.

Resolved,

That this House has considered dialysis care outcomes.

16:06

Sitting adjourned.