Westminster Hall

Wednesday 2nd November 2022 Westminster Hall

Wednesday 2 November 2022

[James Gray in the Chair]

Black Maternal Health Awareness Week 2022

Wednesday 2nd November 2022 Westminster Hall

[Relevant Document: e-petition 301079, Improve Maternal Mortality Rates and Health Care for Black Women in the UK.]

09:30

[David Linden (Glasgow East) (SNP)]

On a point of order, Mr Gray. I do not want to take too long on my point of order, but I thought it would be helpful for the Chamber to note the fact that it is Wednesday morning and that we are delighted to be here for this debate secured by the hon. Member for Streatham (Bell Ribeiro-Addy). I suspect that the hon. Lady will have quite a lot to say over the course of the morning, and I am just keen to ensure that we are all ready to take part in the debate.

[James Gray (in the Chair)]

That is very gracious of the hon. Gentleman. It is not actually a point of order. None the less, I am grateful to him for saying it. I think the hon. Member for Streatham has nearly caught her breath, in which case I would like to call her to speak.

[Jim Shannon (Strangford) (DUP)]

On a point of order, Mr Gray. Obviously, this is a subject matter of much importance, and we should be aware of that. I am sure that the shadow Minister and the Minister are preparing copious replies for the hon. Member for Streatham (Bell Ribeiro-Addy), after she has had a chance to address this really important matter. Mr Gray, you and I and everyone else in the Chamber understand that this debate is vital. Perhaps the hon. Member for Streatham is now ready.

[James Gray (in the Chair)]

Again, that is very creditable of the hon. Gentleman, but it is not a point of order. It is worth recording that the hon. Gentleman has made known to me that in this particular debate, uniquely, he does not intend to speak. This is the first occasion I can remember chairing a debate in Westminster Hall when we did not benefit from his words of wisdom. We note that, and we are grateful to him for being here. We now come to the debate on Black Maternal Health Awareness Week, and I call Bell Ribeiro-Addy to move the motion.

09:32

[Bell Ribeiro-Addy (Streatham) (Lab)]

I beg to move,

That this House has considered Black maternal health awareness week.

Thank you very much, Mr Gray; it is a pleasure to serve under your chairmanship. I thank my colleagues for their kind points of order. I am thankful, as always, that this debate has been awarded, so that we can once again have this vital discussion about the issues surrounding black maternal health.

Whenever I discuss black maternal health, I always take time to repeat the statistics around black maternal mortality. The reason I do that is twofold. First, the statistics are harrowing, and it is only by confronting them that we can truly begin to address the issue. Secondly, the statistics have not changed at all—the findings that I repeat have not improved, despite this issue having been raised for a number of years. I know that it may take time before we see a real change in statistics, but the Government are yet to introduce any meaningful measures that give us confidence that the statistics will change any time soon. Most notably, they will not even look at producing a target.

I repeat it for everyone who may not have heard that black women are four times more likely to die in pregnancy or childbirth, women of mixed heritage are three times more likely to die in pregnancy or childbirth, and Asian women are twice as likely to die in pregnancy or childbirth. Black babies have a 121% increased risk of stillbirth and a 50% increased risk of neonatal death. Asian babies have a 55% increased risk of stillbirth and a 66% increased risk of neonatal mortality. Black women have a 43% higher risk of miscarriage, and black ethnicity is now regarded as a risk factor for miscarriage.

The last time we had this debate, one of the key themes that kept coming up was data, whether it was Members such as myself raising the fact that the data exists and research has been done—we just need the Government to engage with it—or the Minister who responded, the right hon. Member for Mid Bedfordshire (Ms Dorries), stating that black women are under-represented in the Government’s data. I am pleased to say to the Minister responding today that there is now even more research out there.

Since the last time we had this debate, Five X More has carried out and released the findings of its black maternal experiences survey. This is the largest survey of black women’s maternal experiences ever conducted in the UK. It gathered responses from over 1,300 women and looked at their experience of maternal care. The report highlights all the negative interactions that women experienced with healthcare professionals, from feeling discriminated against in their care to receiving a poor standard of care, which put their safety at risk, and being denied pain relief because of the ridiculous trope that black women are less likely to feel pain.

The report goes on to reveal how the discriminatory behaviour and attitudes that black, Asian and ethnic minority women face have been shown negatively to impact women’s clinical outcomes and their experiences of care. More than half the respondents reported facing those challenges with healthcare professionals during maternity care, and 43% of women reported feeling discriminated against, while 42% of women reported feeling that the standard of care they received during childbirth was poor or very poor, and 36% reported feeling dissatisfied with how their concerns during labour were addressed by professionals.

Further to that, 42% of respondents reported feeling that their safety had been put at risk by professionals during labour or during the recovery period. Of the women who experienced negative maternity outcomes, 61% reported that they were not even offered additional support to deal with the outcome of their pregnancy.

[Jim Shannon]

I am pleased that the hon. Lady has brought this debate to Westminster Hall, and although there might not be big numbers here today to discuss the matter, it is of great importance. Does she not agree that health trusts, which she has referred to, must ensure that no matter the level of the black, Asian and minority ethnic population, staff are adequately trained to deal with the differences with respect to different ethnic groups? Does she further agree that the messaging that comes from the Minister and the Department in this debate is the most important tool that health trusts have to ensure that women of all ages and all ethnic groups are clearly understood and supported, no matter where they are and no matter what the statistics and numbers may be?

[Bell Ribeiro-Addy]

I thank the hon. Member for his intervention, and he is absolutely right. I will come to training soon enough, and to what I believe individual trusts should be doing.

In addition to the Five X More report, Birthrights has recently published the findings of its inquiry into racial injustice and human rights in maternity care. The report uncovers the stories behind the statistics and demonstrates that it is racism—not broken bodies, as we are often told—that is the root of many of the inequalities of maternity outcomes and experiences. The study found that on a number of occasions, black women’s safety was put at risk while they were receiving care. They were ignored or their pain was dismissed, and they experienced direct or indirect racism from care givers. They were subject to dehumanisation. Their right to informed consent was violated and they faced structural barriers to receiving healthcare. Those women were going through one of the most painful experiences of their lives—one that can leave them at their most vulnerable—yet they faced institutional racism that impacted their health and the health of their babies.

During a debate on this subject last year, I called on the Government to launch an inquiry into institutional racism and racial bias in the NHS, as well as in the field of medical education. I reiterate that call today and hope the Minister will address the issue of systemic racism in medical care.

In addition to those two reports, the Muslim Women’s Network recently published a study that reviewed the experiences of Muslim women in maternity care. The report encompasses the maternity experiences of over 1,000 Muslim women, and it once again revealed that a huge proportion of respondents received poor or very poor quality care. There are many examples of substandard care by health professionals, such as dismissing concerns and, again, pain; not offering treatment to relieve symptoms; inconsistency in the way that foetal growth was measured; substandard clinical knowledge; and vital signs being missed, which contributed to poor healthcare.

Some 57% of women felt that they were not treated with respect and dignity in the way they were spoken to or in other acts of care giving, but perhaps the most shocking finding of the report was that 1% of the women who responded reported that their baby had died before or during labour, or within 28 days of birth. In a sample of this size, that equates to 10 women, which is way higher than the three to four who should have been expected.

Those statistics are shocking, but the stories are even more shocking. Each of those reports includes harrowing stories of women being neglected, and of their pain being ignored and their concerns dismissed, resulting in a near miss or, indeed, the loss of their baby. In one account, a woman was not believed when she informed the midwife that she was ready to push. It states that when she eventually began to push,

“Her baby came out still enveloped in the placenta. Several doctors came and she was taken to theatre as it became an emergency situation. It was touch and go but she survived. Due to heavy blood loss she was in a coma for three days. Her baby had to be given intensive care.”

In another account, a woman reports that her baby was struggling to breathe after birth. She says:

“I was told that it was a normal thing for newborns. No checks were done to put my mind at ease. After about 20 mins, my baby stopped breathing. Efforts were made to resuscitate her, but she later died in NICU.”

One woman recalled that during her first check-up, a nurse said that she was shocked that she knew who the father of her baby was because people like her do not usually know.

There are thousands of similar stories of black, Asian and minority ethnic women having negative experiences with healthcare professionals and maternity care. There is an urgent need to address the crisis in maternity care, and I sincerely hope that the Minister will set out concrete steps that her Department and the Government will take to address the problem.

I sincerely hope those measures will look beyond treating black, Asian and minority ethnic women as a problem. We are not the problem and our bodies are not broken. There is no flaw in our genetics and we do not need to be dealt with in a way that reduces negative statistics by just pushing the problem away. The suggestion that black women should be induced earlier because a lot of these issues present after 40 weeks is ridiculous.

The solutions need to address the distinct problems in maternity care; all the evidence suggests institutional racism. We must address biases and assumptions about black women, train medical staff to recognise common symptoms in black women, and tackle the barriers that prevent black women from receiving the quality of maternity care they deserve. That is where the problems lie, and we will overcome them by directly addressing racial disparities.

Last year when we debated this subject, the responding Minister asked me and others to continue to hold her feet to the fire on this issue. I thought they were really receptive and that we were finally going to see some meaningful steps to tackle maternal health disparities. I left the debate feeling slightly hopeful because so much awareness had been raised by the fantastic campaign groups I mentioned earlier, and there was a lot of support across the House. I was therefore really surprised and quite deflated when the next day the Minister moved Departments in a reshuffle. I know Cabinet reshuffles happen all the time—

[David Linden]

All the time.

[Bell Ribeiro-Addy]

They are a standard part of government, but we have lost count of the Health Secretaries and Ministers covering this brief. Today, we have a Minister from a different Department addressing us. I know it may seem like I am making a party political point, but regardless of reshuffles, Government priorities and resignations, the problems in maternity care continue. Although we cannot have continuity in Government for whatever reason, we need continuity in care and a strategy for dealing with racial disparities in maternity care.

It is hard to see the Government taking action when things are changing so frequently, but I sincerely hope the Minister will assure us that the Government are focused on this issue, regardless of the changes, and that her time in this role will be spent tackling black maternal health disparities.

Black women cannot afford to wait any longer for action to be taken. I do not want to have to stand up in another debate and cite exactly the same statistics without any improvement. I know things take time, but it would be sensational to come back next year and report that at least something had changed. The best way for Ministers to exact that change is to set out clearly what the Government are doing and set a clear target.

The answer I have been given in the past when I have asked for a target is that this does not happen to that many women, so a target does not need to be set. I would flip that round: if it is not that many women, surely we can set a target to address it.

09:44

[Caroline Nokes (Romsey and Southampton North) (Con)]

Thank you—Sir James?

[James Gray (in the Chair)]

Sadly no—not yet. It is in the post.

[Caroline Nokes]

That is a terrible omission. It is a pleasure to serve under your chairmanship, Mr Gray. I thank the hon. Member for Streatham (Bell Ribeiro-Addy) for leading this debate on a crucial issue.

The Women and Equalities Committee has twice held one-off evidence sessions—although there is a slight conundrum in twice having one-off sessions—looking at black maternal health. It has taken evidence from campaign groups, such as Five X More, and experts in obstetrics and gynaecology, yet the picture does not change. Looking at the evidence, we have known that there is a disparity in the health outcomes for black mothers since the early 2000s. For 20 years, we have known that there is a problem, yet still it continues. It has been a huge privilege for me to serve on panels alongside people such as Clo and Tinuke from Five X More, who have done so much incredible campaigning to highlight the issue, as has the hon. Member for Streatham. It is crucial that we begin to see progress; we cannot, 12 months or 10 years down the line, continue to have the same debate.

Raising awareness in Parliament is vital, but what we actually need is Government action. The hon. Member for Streatham made a slight dig about Government reshuffles. I am delighted to see the Minister in her place; this is an issue on which we have engaged before and she takes it seriously. I hope that the Secretary of State for Health will himself grasp the issue, and ensure that we drive it forward to see progress.

We have heard that one of the challenges is data, and the lack of specific data being collected on maternal health outcomes for black and Asian women. I pay tribute to Five X More, which carried out its own experiences survey that included 2,000 women—a huge number—reporting their experiences and findings. The thing that really hits home for me is the repeated use of the phrases, “I didn’t feel listened to,” “We weren’t listened to,” and, “What I was experiencing was being ignored.”

I am loth to say that we sometimes have very gendered healthcare, but look at the evidence. Look at the fact that when there is medical research, it is almost exclusively carried out on men; look at the fact that drug trials are carried out on men; look at the fact that some of the highest backlogs as we come out of the pandemic are in health conditions predominantly affecting women. Whether it is in cardiac, obstetrics or another sphere of medicine, too often the experience is, “I didn’t think they were listening to me.” I am sure every Member hears that from their constituents, and that has been my experience as a constituency MP. I hear from my constituents that, specifically in the area of maternity, “I wasn’t listened to. Nobody paid attention. It was my body, and I knew something was wrong.”

Only last week, I received an email from a constituent who had lost his daughter-in-law moments after she gave birth. He was with his son, helping to bring up a baby and pursue a complaints procedure against the hospital in question. Throughout his email, he kept making the point that they had not been listened to. His daughter-in-law had been a midwife, and even she was not listened to.

Talking to black and particularly Muslim women—I should declare an interest as chair of the all-party parliamentary group on Muslim women—they feel that their voices are doubly ignored, and that there is that intersectionality. Whenever I talk to journalists about intersectionality, they look at me and say, “Please don’t use that word. Nobody understands that word.” It is imperative that we all understand that word. You will be discriminated against if you are a woman, and you will be discriminated against if you are a woman from a black, Asian or other minority ethnic group; when the two come together, as we find in maternity units in particular, women’s voices are not heard or listened to.

When we talk to the Royal College of Obstetricians and Gynaecologists, as the hon. Member for Streatham has done, it calls for specific targets for black maternal health outcomes, and it is right to do so. Although it may be a small number as a percentage of births every year, it is still a significant number. The loss of one mother is one too many.

[Jim Shannon]

It is always a pleasure to listen to the right hon. Lady; she brings lots of wisdom and knowledge to these debates. Ministers in other debates we have had in Westminster Hall, in different positions in the Department of Health and Social Care, have always spoken about the issue of data. The hon. Lady is outlining examples of where data could be used to formulate a Government and ministerial response. Does she agree that the Government really need to grasp the data issue? They can then prioritise their strategy to respond.

[Caroline Nokes]

I thank the hon. Gentleman for his intervention. I did not think he would be entirely able to resist speaking in the debate. He is right: policies must be data-driven and evidenced, but the evidence is there and has been for many years. We are augmenting and adding to that body of evidence the whole time.

I will not be entirely negative, because we have some great opportunities. I was pleased to see Dame Lesley Regan appointed women’s health ambassador earlier this year. I welcome, reinforce, champion and offer anything I can to help the women’s health strategy. Finally, we have one of those, and I pay tribute to the Minister who was instrumental in getting that published. What we now need from the strategy is outcomes. That has to be the focus. What is happening to drive outcomes, and to ensure that the disparities we know exist are recognised, acted on and reduced? Our goal has to be to reduce that horrendous figure of four times as many maternal deaths for black women. We have to improve the outcomes for black babies, so that there is not, as I think the hon. Member for Streatham said, a more than 100% likelihood of stillbirth—

[Bell Ribeiro-Addy]

Increased risk.

[Caroline Nokes]

Increased risk. The hon. Lady is absolutely right to highlight that as an imperative. We must ensure that we reduce the inequity, of which there are many drivers. She was with me when the Women and Equalities Committee took evidence from Professor Sir Michael Marmot, who talks so compellingly about health inequalities and their drivers.

I will not say that there is anything wrong with black women’s bodies—there is not—but we have to look at housing conditions, air quality and the areas where they live. Air quality is a significant driver of poor health outcomes. We have to look at what we are doing around smoking cessation, which is good for not just black women, but all women. We have to look at obesity, which is, again, a crucial factor for all women.

I look forward to seeing, in the remainder of this Parliament, focused and determined action around obesity, smoking cessation and air quality. There are targets on all those things, but—how can I put this gently?—there has been a little backsliding on some of them. Targets have been pushed into the dim and distant future, and there is less commitment around drives to reduce obesity and smoking, which are incredible drivers of poor health outcomes across the population. We should double down on our commitment to those targets.

I hope that in due course—I get fed up of saying “in due course”, which is a standard ministerial answer—to see a White Paper on health disparities. It is imperative that we get that done, and that the women’s health strategy is seen as a driver to ensure that we improve outcomes. First and foremost, I reiterate the calls from the hon. Member for Streatham for targets. I am never a great fan of targets if they are just there for the collection of targets, but if they work, and we see that in many instances they do, we should have them.

We should have time-limited targets, so that in maybe three years we can look and say, “Nothing has changed.” Looking at the data and the evidence from campaign groups, I see that over 20 years, nothing has changed. I do not want to be here in 20 years’ time giving the same speech on this important issue, feeling that nothing has changed. I look forward to the Minister’s comments, and reiterate my congratulations to the hon. Member for Streatham on calling for today’s debate.

09:54

[Fleur Anderson (Putney) (Lab)]

It is a pleasure to serve under your chairship, Mr Gray, and to be in this debate, although I hope that in future there will be no need for one, because we will have solved these issues, and women using maternity services can expect the same care and equal outcomes. That is why I was keen to be here, and I congratulate my hon. Friend the Member for Streatham (Bell Ribeiro-Addy) on bringing forward the debate and on pursuing this issue. I look forward to hearing the Minister’s response because it needs to be a priority.

In Wandsworth, 30% of residents are from black and ethnic minority backgrounds, and black maternal health is a big issue for us in Putney. We have a group called Putney Black Lives Matter. We meet to discuss important local issues, and black maternal health was highlighted as an issue of major importance. We are few here today, but across the country it is a big issue for many people: last year’s petition to improve maternal mortality rates and healthcare for black women was signed by 187,520 people, of whom 200 were from Putney.

I thank the campaign groups that have raised the issue so strongly: the Five X More campaign, Bliss, Sands, Birthrights, and the Royal College of Obstetricians and Gynaecologists. They have raised the issues of systemic racism and structural barriers, which lead to the appalling statistics read out by my hon. Friend the Member for Streatham. The statistics are worth reiterating, because they are at the heart of the issue. Black babies have a 50% increased risk of neonatal death and a 121% increased risk of stillbirth. Black women have a 43% higher risk of miscarriage, and are four times more likely to die during pregnancy or up to six weeks post-partum. Women of mixed heritage are three times more likely to die during pregnancy, and Asian women twice as likely. Those are horrendous statistics. Each loss of life is a tragedy, but it is also a gross injustice about which we should all care deeply. The statistics need to be understood, and need to change.

It is important to place those awful statistics in the wider picture of health inequalities. Black women face disparities when it comes to stillbirth, cancer diagnosis and outcomes, and access to fertility treatment. That is entrenched and deep-rooted inequality, racism and sexism. It will be hard to turn that around. The Minister will need to come back to this again and again, and to knock heads together in different Departments across Government to change it. But it must be done.

I have a lovely list of seven things on which I want to see action, and I hope that the Minister will respond to it. First, we need a whole-Government approach that recognises inequalities and their links to wider Government policies, as was mentioned by the Chair of the Women and Equalities Committee, the right hon. Member for Romsey and Southampton North (Caroline Nokes). We need the White Paper on health disparities, which will look across Departments. We need a new tobacco control plan for England, public health measures to address obesity, and a new air equality target for England, because those are all factors in increased black maternal mortality figures.

Black communities in the UK have an increased risk of poorer maternal and perinatal outcomes, including stillbirth and miscarriage. There are also inequalities in exposure to air pollution; that is the link between air pollution and maternal health inequalities. We must commit to reaching the interim World Health Organisation targets by 2030, rather than 2040; we can speed that up. What gets counted counts, and if there is a target, people strain to reach it more strongly. Dangerous levels of air pollution, especially in our urban areas, must be addressed.

The second issue is the continuity of carer. I pay tribute to the NHS South West London Clinical Commissioning Group—now the NHS South West London Integrated Care Board—and its chief nurse for what they do to tackle black maternal inequalities, especially in the area of continuity of carer. Women need the same team throughout pregnancy. I also pay tribute to our wonderful Emerald midwifery team from the St George’s University Hospitals NHS Foundation Trust. Where there is continuity of carer, women are 16% less likely to lose their babies. That is a major focus for change in south-west London. Local maternity systems across the country have been asked to implement equity and action plans, which include the target of 75% of women from black, Asian and mixed ethnic groups receiving continuity of carer by 2024. I hope that we can increase that figure. Progress is being made towards the target. However, we must look at the target, find out whether there is enough data to measure it, and ensure that across the country, no matter where people live, we strive towards it. Will the Minister comment on the status of the continuity of carer target?

In their response to the Health and Social Care Committee report on the safety of maternity services in England, the Government accepted the recommendation on training for continuity of carer teams. It is essential that there be training across the board and implementation of continuity of carer teams, but obviously that relies on there being enough staff, which depends on the midwife workforce having enough funding.

Thirdly, I would like an end to charging migrant women for maternity care. Charging for care deters many women from seeking vital antenatal care, and it is shocking that the MBRRACE-UK confidential inquiry on maternal death identified that three women who died may have been reluctant to seek care because of cost. It is shocking that that happens in this day and age, in our communities—that women may be afraid to seek care because of their immigration, asylum seeker or migrant status.

My fourth point is about further evidence, research and data, which was mentioned by other hon. Members. Differences in outcomes and the reasons for them are unclear and under-researched, but we know that what gets counted counts. I join campaigners in calling for an annual maternity survey of black women, and increased research to identify the conditions that disproportionately affect black women. We should improve the ethnic coding of health records, and the system through which women submit feedback, so their voices are heard. It should be as easy as possible for them to provide feedback while they are still in hospital or under maternity care, so that we can hear those voices and they can feed into the survey data.

My fifth point is about maternity bereavement services. As was highlighted last week during the debate on baby loss, there is a difference in bereavement services across the country. On whether there are adequate bereavement services for those women who, sadly, suffer bereavement, the figures are shocking. St George’s University Hospitals NHS Foundation Trust, of which Queen Mary’s Hospital in my constituency is part, now has two bereavement midwives, two specialist consultants and one part-time psychotherapist in the maternity bereavement team. There are dedicated places for those who have suffered bereavement in maternity services across the NHS South West London Integrated Care Board area, which is to be welcomed. However, is this happening across the whole country? That is questionable. That support is very important at the time of loss, but also during care in future pregnancies.

Sixthly, I request, as others have, a White Paper on health disparities. That is important if we are to tackle the issue and look at the many other underlying reasons for the statistics. Seventhly, I ask for a target. In any ministerial meetings on this important issue, I hope that a target will be the Minister’s No.1 ask. We need one, followed by a concentrated effort to achieve it. I hope that will lead to the change we need.

In conclusion, black women cannot afford to wait any longer for action. There needs to be a clear action plan, data, transparency and a target. I look forward to hearing the Minister’s response, but I look forward even more to action. I thank all the midwives, in maternity services throughout the country, who give extraordinary care, and who go above and beyond.

[James Gray (in the Chair)]

The hon. Member for Leicester East (Claudia Webbe) was not here at the start of the debate, but unusually we have plenty time, so I am happy to call her to speak.

10:03

[Claudia Webbe (Leicester East) (Ind)]

You are very kind, Mr Gray, and it is an honour to serve under your chairship. I thank the hon. Member for Streatham (Bell Ribeiro-Addy) for securing this vital debate.

The health of our nation is reflected in the health of our mothers, and the shocking statistics paint a picture of nothing short of gross negligence. I thank Tinuke and Clo for producing the groundbreaking “Black Maternity Experience Report”. Their platform, Five X More, helped to spread information about the survey. I also thank the participants for sharing their powerful testimonies, and the all-party parliamentary group on black maternal health for demanding an urgent solution to the crisis.

It is worth repeating that black mothers are four times more likely to lose their life during childbirth, and they are up to twice as likely to have severe pregnancy complications. Some 42% of women surveyed in the Five X More report felt that the standard of care they received during childbirth was poor or very poor. Successive Governments since at least the 1970s have systematically failed to address the shocking statistics on black maternal health, including on the standard of care they receive during childbirth. The “Black Maternity Experiences” report reveals that, even today, professionals still display racist and white supremacist attitudes and insensitivity towards black mothers without remorse. Black mothers suffer in silence through fear of reprisals, and fear that their care will become worse if they complain.

If ever there was a need for the Government’s long-promised White Paper on health inequalities, it is now. Will the Minister urge for it to be put back on the agenda? Shelving the health disparities White Paper only compounds the suffering and pain of black mothers. Without it, any progress made by the newly appointed maternity disparities taskforce will be slowed.

There is a crisis in midwifery up and down the country. Home birth teams are underfunded, delivery suites are closing, and the maternity workforce have seen management changes that prevent them from doing their jobs effectively. The disproportionate number of deaths of black mothers and their babies cannot simply be reduced to genetic or cultural factors. Equity in access to first-class healthcare is a must, and that means setting targets and specific funding for highly trained healthcare professionals, as outlined in the Five X More report. We know that black women are poorer, live in inadequate housing and suffer disproportionate environmental pollution, and that their educational chances and outcomes are disproportionately lower. Wealth inequalities are rampant.

The fiscal shortfall of £35 billion that was recently announced by the new Chancellor will drive the Government’s tax-and-spend plans; the Government are looking at 101 ways to cut spending. This is the worst news possible for black maternal healthcare. It demonstrates a callous ideology that seeks to cut spending instead of taxing earth-shattering levels of idle wealth—an ideology that risks further harm to black women and other racialised groups by avoiding wholesale investment in healthcare.

As we know, all mothers are superheroes who nurture babies, children and society, but black mothers have to overcome systemic barriers put in place by successive Governments, which result in black women’s wealth, health, education and environmental access not being equal to that of their counterparts. Alongside improving treatment and care, we have to start having frank conversations about the racialised distribution of wealth in the UK and what we need to do to tackle it and eradicate race inequalities in health outcomes. Mr Gray, I am sure you will agree that black mothers cannot wait any longer. The time for action is now.

10:09

[David Linden (Glasgow East) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Gray. I, too, congratulate the hon. Member for Streatham (Bell Ribeiro-Addy) on securing the debate and on opening it so well.

I was not due to speak in this debate on behalf of the Scottish National party; it was supposed to be my constituency neighbour and hon. Friend the Member for Glasgow North East (Anne McLaughlin), who has sadly been incapacitated and remains in Glasgow. I hope that those present will bear with me.

I speak primarily from my position as chair of the all-party parliamentary group on premature and sick babies, because our APPG has looked into the issue of racial disparities in maternal healthcare, as well as inequalities more generally in maternal healthcare and neonatal services. These topics merit more attention from the Government. As hon. Members have said, there have been numerous debates, questions, early-day motions and all those kinds of things on this topic. The benchmark for whether the Government are getting this right is whether we will be back in this Chamber in 10 or 15 years’ time to have the same conversation. I certainly hope we will not.

The Birthrights report, “Systemic racism, not broken bodies”, outlines the systematic racism in maternity services. That report confirms the devastating fact that black, Asian and mixed-ethnicity women are more likely to experience baby loss and illness, or to become seriously ill, and have worse experiences of care during pregnancy and throughout childbirth. I want to advocate for the report’s conclusion, which calls for a commitment to anti-racism by all maternity and neonatal services, and a commitment to ensuring that there are more black and brown women and birthing people decision makers in the wider maternity system. We have to look at the ticking time bomb in the neonatal and maternity workforce; that absolutely has to be in the mix. The report also calls for a safe and inclusive maternity and birthing experience for all parents, which I think we would all want to get behind.

Healthcare is devolved in Scotland, which is largely why I do not want to impose too much in this debate. However, the SNP Scottish Government believe that there needs to be an open and honest conversation about race and institutional racism right across these islands—Scotland is not immune—in order to identify solutions that will lead to equality and positive outcomes for black and minority ethnic communities. Members have asked a number of questions of the Government; for the sake of brevity, and so as not to repeat what has been said, I will just say that I would like to hear the Minister respond to those, particularly the seven points made by the hon. Member for Putney (Fleur Anderson).

I am very grateful to the hon. Member for Streatham for securing this debate and giving us an opportunity to focus on this issue. Most importantly, I am looking forward to hearing what the Government have to say, and to seeing what best practice can be rolled out in Scotland, because no part of these islands have a monopoly of wisdom or ideas.

10:12

[Yasmin Qureshi (Bolton South East) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Gray. I thank my hon. Friend the Member for Streatham (Bell Ribeiro-Addy) for obtaining this debate, and for all the work she has been doing on this issue for many years. I also thank the incredible campaigners who continue to work tirelessly to end black maternal health inequalities.

Maternal health inequalities exist throughout our country. It is very much a case of hit and miss: in some parts of the country the statistics are good, while in others they are not. However, black maternal health inequalities do seem to persist throughout our country. I also thank the right hon. Member for Romsey and Southampton North (Caroline Nokes), the Chair of the Women and Equalities Committee, who talked about the work that her Committee has done, but also noted that although this issue has been discussed for so many years, not much progress has been made on many of the concerns. My hon. Friend the Member for Putney (Fleur Anderson) spoke eloquently about the issues in Wandsworth and generally. In particular, she touched on bereavement services, the quality of which varies across the country as well. I thank the hon. Member for Leicester East (Claudia Webbe) for the very passionate speech she made. I agree with her: all mothers are superheroes. I do not think any debate would be complete without an intervention or speech from the hon. Member for Strangford (Jim Shannon), who is not in his place; I thank him for his intervention as well.

As we have heard repeatedly in this debate, it is shameful that black women continue to be over four times as likely, and Asian women over twice as likely, to die in childbirth or pregnancy than white women. I am very grateful for the work of campaigners, obstetricians, midwives, and black and Asian women with lived experience of maternal health complications for sharing their experiences and expertise on the issue. They are clear that socioeconomic determinants and comorbidity only partially explain those disparities in treatment. Black and Asian women and their partners are not being listened to, they are not being respected and they are certainly not being cared for. When they voice pain or concern during pregnancy or childbirth, they are often branded as aggressive or angry, while dangerous stereotypes about the strong black woman mean that they are often not offered the same treatment as white women. Meanwhile, the lack of cultural competency in medical training in our country means that many complications are not spotted early enough.

That structural inequality exists both inside and outside our health services. Many black, Asian and ethnic minority women experience it long before and long after pregnancy. However, the Government have done nothing to address this outrageous inequality. In fact, on their watch over the last 12 years, maternal mortality for black women has actually increased from 28 deaths per 100,000 in 2013 to 2015, to 34 per 100,000 in the years 2016 to 2018.

Gynaecology wait times are very high. A survey from the charity Five X More found that 27% of women surveyed felt that they received a poor or very poor standard of care during pregnancy, labour and postnatal care. Also, 42% of women repeatedly felt discriminated against during their maternity care, with the most common reasons given being race, at 51%, ethnicity, at 18%, age, at 17%, and class, at 7% of respondents. More than half the women reported facing challenges with healthcare professionals during their maternity care, while over half the black women reported not receiving their preferred method of pain relief.

Where is the Government’s action on this? In the last 18 months alone, we have seen their response to the Commission on Race and Ethnic Disparities fail to address black maternal inequality, as well as a women’s health strategy that completely fails to establish what concrete action the Government will take to protect the lives of black, Asian and ethnic minority mothers. It is hardly a surprise that the women’s health strategy has failed black, Asian and ethnic minority women, given that just 2% of the respondents who were surveyed were Asian and 3% were black. I am not trying to be party political here, but while the Government are busy crashing the economy and causing chaos at a time of national crisis, black, Asian and ethnic minority women continue to face the consequences of their inertia and ineptitude.

Last year, in passing the Health and Care Act 2022, the Government had an opportunity to prioritise the health of black, Asian and ethnic minority women by voting for Labour’s amendment to mandate the Secretary of State to prepare and publish a report on disparities in the quality and safety of England’s maternal services, including maternal mortality rates. However, the Government chose to vote against it. It was a very simple measure that could have helped, but no, they voted against it. The Labour party has committed to setting a target to end the horrendous inequality faced by black, Asian and ethnic minority women as soon as we are in government.

That will be part of our commitment to end structural inequality at the root, with a landmark race equality Act to be introduced by the next Labour Government. We are committed to pulling the NHS out of crisis so that it can deliver for everyone, including black, Asian and ethnic minority mothers. We will enact the biggest extension of medical school places in history. We will double the number of district nurses, train 5,000 new health visitors and, crucially for maternal health, introduce an extra 10,000 nursing and midwifery clinical placements each year. Our fully costed plan will be funded by ending the non-domicile tax status regime, which, it is estimated, would raise more than £3.2 billion every year. Growing the NHS will also grow the economy and eradicate these inequalities once and for all.

I welcome the Minister to her new position. Like me, she has just recently joined this brief. While we wait for these changes, what is being done to address structural inequalities and build trust in maternity services for BME mothers, their partners and midwives from ethnic minority backgrounds? Additionally, what plan does the Minister have to improve cultural competency and unconscious bias training in medical schools and the health service?

There is also the huge issue of the lack of available data, which has not been tackled in either the women’s health strategy or the Government’s response to the Commission on Race and Ethnic Disparities. As we have heard, accurate data disaggregated by ethnicity is central to closing the gap in maternal mortalities. Will the Minister commit to ensuring that all maternity services record the specific ethnicity of all mothers? Fatalities are just the tip of the iceberg, with many women speaking of near misses and poor treatment, so will the Minister commit to collecting and publishing that data?

Some midwives also consider that the continuity of carer model could help to end these inequalities. A 2016 study found that women who see the same midwife throughout their pregnancy are 16% less likely to lose their baby. Despite that, the NHS has recently been forced to drop targets included in the NHS long-term plan to ensure continuity of carer for 75% of BME women by 2024 as a result of staffing shortages. It is clear that the Government are failing these women. What steps is the Minister taking to end the staffing shortages in maternity care so that those targets can be reintroduced and met by 2024?

I have to say, it is scandalous that the Government have not yet even set a target to end this inequality. They have been in power for 12 years—that is a very long time in which to have comprehensively changed the system. Will they now commit to doing so immediately? We did it for stillbirths. Why has black maternity mortality not been a priority for the Government?

This is an avoidable inequality. There are many steps we could be taking to end these awful disparities. Instead, the Government have done nothing while the issue has got worse. The Government must take action to address maternal health inequalities. We need a national strategy to tackle health inequality as a matter of urgency, which must include a commitment to eradicating the mortality gap between black, Asian and ethnic minority women and white women. Only Labour can deliver that strategy as part of our plan to tackle structural inequality at the root and lift the NHS out of crisis.

I hope that the Minister will answer some of those questions today and commit to specific action that will be taken, because this cannot go on. These appalling statistics—the fact that black women have four times the mortality rates of others—are not acceptable in a decent, civilised society.

10:25

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

It is a pleasure to serve under your chairmanship, Mr Gray. I thank the hon. Member for Streatham (Bell Ribeiro-Addy) for securing this debate. As she highlighted, we had a similar debate recently. I hope that my comments reassure her that we are taking action and making progress in this area.

I take the issue of maternal disparities very seriously; that is why when I was in post previously I set up the maternity disparities taskforce, which has brought together a range of specialists and campaigners. We have heard from groups such as Five X More and the Muslim Women’s Network to hear their views on what is going wrong right now, what systems we need to put in place to improve outcomes and also the experiences of black women in maternity services.

The data shows the disparities in black maternal health. We have heard about them clearly this morning, and I do not think anyone is in any disagreement about the scale of the problem we are facing. As the hon. Member for Streatham said, it is harrowing to hear those figures. The MBRRACE annual surveillance report shows that women of black ethnicity are four times more likely to die from pregnancy and birth compared with white women. I do not think there is a dispute about that; we fully acknowledge it and we want to reverse that trend as quickly as possible.

[Caroline Nokes]

I want to make a quick point about MBRRACE and the data. Data collection remains tricky, with some hospitals not reporting women’s deaths—not necessarily maternal deaths—until up to 500 days after they have happened. Then there is a delay with the medical records and notes, which might indicate the reasons for that. What reassurance can the Minister give that she will work to reduce those times?

[Maria Caulfield]

My right hon. Friend is absolutely right. Although Five X More does its surveys about the experience of women, the data on outcomes is very delayed. When we put measures in place, we cannot see the difference they make until the data comes through, roughly 18 months to two years later, as my right hon. Friend said. That lag does not help us determine whether the measures we are putting in place are actually making a difference. Getting that on track is a key priority for me so that we can accurately measure what is happening.

From the data that we do have, The Lancet series in April last year found that black women have an increased relative risk of 40% of miscarriage compared with white women, and the stillbirth rate in England for black babies is 6.3 per 1,000 births, compared with 3.2 per 1,000 births for white women. That is completely unacceptable, and as the hon. Member for Streatham said, we cannot come back here, debate after debate, without seeing those figures move. One potential cause for optimism is that we do not have up-to-date data on the benefits of the interventions that we have put in place, so it might be better than we think. However, we absolutely need that data, not only to measure what is happening, but to know whether we are heading in the right direction if we set targets in the future.

To reassure Members, I want to clarify the point about not setting a target because the problem is too small. I do not agree that the problem is too small; it is a significant problem. Even if it is affecting one or two women, it is a significant problem, so that is not a reason not to set a target. As the hon. Member for Putney (Fleur Anderson) pointed out, there are multiple factors in why black women often face poorer outcomes in pregnancy and birth, and for their babies. It is a mix of personal, social, economic and environmental factors. Air quality, which the hon. Member touched on, also has an impact on overall health. The maternity disparities taskforce found that being in a lower socioeconomic group has a significant effect on maternal outcomes, and black and ethnic women are often in those groups and so face a double whammy in terms of their likely outcomes.

We cannot just fix this in isolation at the Department of Health and Social Care. That is why I am pleased that in my role for women’s health—I am also the Minister for Women, across the board—I can bring in other Departments, because we need to take a cross-Government approach to this issue. Whether it is the Department for Environment, Food and Rural Affairs on air quality, the Department for Levelling Up, Housing and Communities on housing, or the Department for Work and Pensions on employment, we need to work together so that all the factors affecting black maternal health are addressed in tandem to address this issue.

We know from a health perspective that pregnant black women are more likely to suffer from some chronic diseases that will affect their maternity outcomes, and in particular cause poorer mental health. There are health initiatives that we can put in place to ensure that we improve the outcomes for black women, but that cannot be done in isolation from the other factors that also negatively affect them.

Given the risks that such conditions pose in pregnancy, there is a need for safe personalised care for black women and women from ethnic backgrounds, because the needs of women from each and every community are so different. Just nationally introducing blanket systems will not address some of the problems; there is no one single solution that will improve the statistics and improve the outcomes for women.

The issue is not just the outcomes from maternity services. As we heard from the hon. Member for Streatham, the Five X More survey also reflects the general experience by black women of the healthcare system. Although black women are often at a more difficult point to start with, when they engage with health services they often have a very negative experience. We have seen that in the recent publication of the East Kent maternity report and in the Ockenden maternity review, which highlighted that there is racial discrimination present in some parts of the maternity services.

We cannot allow that to continue, because if we want black women to come and engage with services and to come forward when they have concerns, if they feel that they are not being listened to or if they raise concerns and they are dismissed, why would we be surprised when they do not engage with services in the future? Regarding the East Kent report in particular, I will look at the calls for action on how we improve black women’s experience of the healthcare system and considering how we can address those issues as urgently as possible.

When we consider the actions that we are putting in place, and I will touch on some of the ones that have already started, I am very much a supporter of Professor Marmot’s idea of proportionate universalism, whereby we introduce good services across the country but then we target those people who are most in need; in the case of black maternal health, that is clearly women from the black community. We need to go to them rather than expecting them to come to the health service: we have a universal offer, but ensure that it is targeted specifically at those who do not experience the best outcomes.

On targets, as my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) touched on earlier, we have an issue with data collection across the board in health services, including in maternity services. Black women often experience the worst outcomes, although some of the data that we are seeing is from 2020. For some of the initiatives that we have put in place in the last year or 18 months, we are not yet seeing the benefit of those initiatives in terms of outcomes. I am being very candid here: we have not got a handle on what is making a difference, or on which parts of the country are doing well—as was acknowledged by the hon. Member for Bolton South East (Yasmin Qureshi), the shadow Minister, there are some very good practices in place—and which parts of the country are still not supporting women in the way that women want.

We are working with NHS England, the Office for National Statistics, MBRRACE-UK and the National Neonatal Research Database, because there are also multiple sources of data. We need to pull all the data together and get it as close to real-time data as we can, so that when we introduce interventions and measures we can know whether they work.

As part of the maternity disparities taskforce, I am also keen to make sure that we include black women more in the national patient survey, because the shadow Minister was quite right that we had over 100,000 responses to the women’s health strategy but only a small percentage of those responses came from black and ethnic minority women. That illustrates the problem that we are talking about—that black women do not feel represented, or do not feel engaged with the process. So we have to change things and work is being done to address that situation.

We are introducing some measures. First, we have set guidance that each local maternity system is now working in partnership with women and their families and their local areas to draw up equity and equality action plans. For each local maternity system’s local area, there has to be a plan in place about how to improve the outcomes for women. The plans are agreed by the local maternity systems and the new integrated care boards, which were set up in the summer. They were published last week, so I encourage hon. Members to look at their local action plans to see what they are putting forward and to challenge them if they feel that they are not meeting local community needs. That is why they are done on a local basis: what is appropriate in my constituency of Lewes may be different to what is needed in Streatham, Putney, Leicester East, or Romsey and Southampton North. It is really important that we look at those action plans to make sure that they address the problems that we are concerned about. Every plan is being reviewed by NHS England, which will identify areas of good practice and the support that is needed to drive them forward.

In addition, we have also commissioned 14 maternal medicine networks covering the whole of England, which will ensure that women have access to specialist management. We know that black women are more at risk of high blood pressure, diabetes and sickle cell anaemia and yet many of those risk factors for their pregnancy and birth are not dealt with or managed. The maternal medicines network will bring in specialists so that, at an early stage of their pregnancy, those women can access those specialists to help them manage their pregnancy. They will also be offered pre-conception advice for further pregnancies. We have never done that before. We are targeting the risk factors of black women, and all women who are at risk, to make sure that they get the medical support and advice that they need during and after their pregnancy.

The Department also launched the £7.6 million health and wellbeing fund last year, which is supporting 19 projects throughout England to try to generate best practice guidelines that we can introduce to help reduce disparities. These projects include supporting expectant young black fathers in child development and providing perinatal mental health support for black mothers. If we can get some evidence-based best practice, we can look to roll that out across the country in the coming months and years. There is a lot of work going on.

I will touch on the issue of racial discrimination. It is clearly unacceptable that black, Asian and ethnic minority women feel that the health service is not accessible or not responsive to their needs. There is education and training for NHS staff on health disparities to eliminate bias and racism in obstetrics and gynaecology. The Royal College of Obstetricians and Gynaecologists’ race equality taskforce has developed e-learning cultural competencies. They now form part of the colleges’ members continuing professional development. The Nursing and Midwifery Council is also looking at how to promote and embed equality and respect in professional practice, so that they can create an environment where everyone feels that they can access the services they need. We will obviously continue to look at this with the maternity disparities taskforce, which is bringing in campaigners, experts and professionals to try to drive momentum on this issue.

Data is the key. I can give a commitment here that has been highlighted already. We need that data. We cannot be working with data that is two years old to see if we are making a difference because, if we are, we will not know about it for two years and will not be able to roll out good practice in other parts of the country. In my brief as the Minister for Women, I am aiming to bring that across other Departments as well.

I hope I have reassured hon. and right hon. Members in today’s debate that I am committed to continuing the work to tackle the disparities in outcomes to ensure that everyone has the opportunity to live a long and happy life. I am happy to work with the APPG on black maternal health, which is chaired by the hon. Member for Streatham, because it is only by working together to identify good practice and raising it when things are not working well that we can eliminate the disparity: it is unacceptable that black women are four times more likely to die during pregnancy simply because they are black women.

10:38

[Bell Ribeiro-Addy]

I thank all Members for participating in the debate and adding their voices to all those that are calling for steps to be taken to end racial disparities in maternity care. It is always reassuring to hear just how much support there is across the House when the issues are raised. I thank the hon. Member for Strangford (Jim Shannon), who is always a huge support in a range of different debates, but who has been particularly helpful today. I also thank the right hon. Member for Romsey and Southampton North (Caroline Nokes), who does fantastic work as the Chair of the Women and Equalities Committee and also as the chair of the APPG on Muslim women.

I will point out some of the disparities that she has touched on, including those detailed in a report from the Muslim Women’s Network. That report showed that Muslim Somali women who had given birth in other parts of Europe found that, although they faced worse discrimination in society in those other parts of Europe, they received much better maternal care in hospitals in those other European countries, namely Norway and Sweden, than they did in the UK. They had better outcomes as well. That is definitely something for us to look at.

My hon. Friend the Member for Putney (Fleur Anderson) and the right hon. Member for Romsey and Southampton North pointed out the different factors that affect black maternal health outcomes, which all come full circle to point to the institutional racism that black women face across society. I thank the hon. Member for Leicester East (Claudia Webbe) very much for raising the issue of the health disparities White Paper. We absolutely need to see the White Paper soon. Without it, I am not sure how we are going to set a benchmark for things changing overall.

The hon. Member for Glasgow North East (Anne McLaughlin) is not here, but she is hugely supportive, and I hope she feels better soon. The hon. Member for Glasgow East (David Linden) did some great work with the all-party parliamentary group on premature and sick babies, and I was pleased to see the group calling for anti-racism across care. That has been particularly important.

Yesterday, we had a lobby in Parliament in which Five X More lobbied parliamentarians. I thank all those who signed the pledge calling on the Government to use existing data to close the gap and to address overall disparities in maternal outcomes. Tinuke and Clo from Five X More continue to punch well above their weight. Five X More is the only black maternal health charity focused specifically on the outcomes for black women, and also the only such charity that I can think of that receives no funding. It has been able to do all this work off its own bat, which is testament to Tinuke and Clo and their dedication to resolving these disparities.

How could I forget my hon. Friend the Member for Bolton South East (Yasmin Qureshi)? I welcome her to her new post of shadow equalities Minister, and I was very pleased to hear her commit the Labour party to bringing about that target. That was very clear, and it shows that the party is listening to what black women have asked for over the past few years when these issues have arisen.

The research has already been done and we simply want the Government to engage with it. While we are calling for more data to be captured, we want the Government to engage with the data that already exists. That is key because so much work has gone on with other organisations, including the Muslim Women’s Network and Birthrights, to produce the reports that we have referenced today, and to lobby and campaign. Those things exist and they need to be acted on.

Those organisations have gone out and spoken to a great many women—sadly, women who did not want to engage with the Government’s surveys, which is worrying and something that needs to change. I pay tribute to all those women because it is difficult to relive your trauma in that way and to recount all those awful things that have happened. I know it has been for me, but I thank all those women who came forward to share their stories. They need to understand, as I am sure they do, that that makes a difference moving forward.

I thank the Minister for her response to the debate and the detail about what is already being done. That is really helpful, and I am pleased to hear a change in attitude as to how these issues are addressed. I have been concerned in the past, particularly with respect to the Commission on Race and Ethnic Disparities report and some of the responses that I have received personally, about the willingness of Ministers to admit that racial disparities exist and to focus on those, rather than saying that they do not exist. I would encourage you to read all the reports I have referenced today, but you say you have, which is great. Not only the statistics, but the personal accounts, do not make for easy reading, but they definitely make for a greater understanding of what has been happening.

I want to touch on one thing or two things that the Minister said specifically. You are absolutely right that people’s socioeconomic status has a direct effect on health outcomes, but the Five X More report, and the other two reports, found that black women report the same disparities regardless of their level of education and socioeconomic status. We need to look closely at that and acknowledge that the issue is purely racism: institutional racism goes far beyond all the other factors that we would usually expect to have an impact.

I want to leave the Minister with a few more suggestions about things that you might wish to introduce.

[James Gray (in the Chair)]

That she might wish to introduce. The hon. Lady keeps saying “you”, but when you say “you”, you mean me. I am not involved in any of these things. She might do those things.

[Bell Ribeiro-Addy]

My apologies. I would like to leave the Minister with a few more suggestions about measures that her Department might wish to introduce. The first is for the Government to introduce this target. I understand your reasoning—

[James Gray (in the Chair)]

Her.

[Bell Ribeiro-Addy]

I understand the Minister’s reasoning for not having a target. It may appear logical, but given that the data shows that those women’s children have a 43% increased chance of being miscarried, and a 121% increased chance of being stillborn, I do not understand how the Government can say that they will look at all these measures surrounding the issue but will not specifically set a target to bring it to an end. That is not acceptable, and I do not believe that the women who continuously campaign for a target will accept that, so I ask the Minister to look at it again.

I understand that there are great challenges in looking at disparities across the board. All those things need to be addressed and different Departments need to be brought in, but as I said in relation to socioeconomic status and other factors, there is a culture of institutional racism in our NHS, which needs to be resolved. Obviously, that will start with data. The NHS must improve the quality of ethnic coding and ensure that the data is accurately recorded. I am really concerned about how skewed the recording is.

At our APPG meeting yesterday, we heard that even when it comes to simple things such as trying to find out how many women have claimed compensation for things that have happened, the women’s age and the area they have come from is recorded, but their race is not. That seems like a major oversight, especially when other pieces of data are being gathered.

I support Five X More’s call for the Government to introduce an annual maternity survey targeted specifically at black women, similar to the Care Quality Commission’s maternity survey, because I believe that its results could be used to inform public and parliamentary accountability and improve maternity health services. Although few women contributed to the Government’s survey, there is a willingness among black, Asian and minority ethnic women to record their issues and experiences, as the other campaigns have proved.

I reiterate the call for an inquiry into institutional racism in the NHS. That is the only way that we will change some of the outcomes, especially given the information that has been gathered on what the issues are. Yes, we have to look at air quality and other co-morbidities, but until we address racial bias, assumptions among medical staff, and teaching and training, certain things will just not change.

Finally, please engage with the campaigners. I understand that there is a lot of listening going on. In the past few years, there have been more conversations, and they are more likely to be included in working groups, but it is one thing to say, “Yes, we have to look at this. This is really awful,” and another thing entirely to engage with them, work with them across different issues and show that the things they are asking for are being met within the NHS’s plan. Please do engage with the campaigners. They know what they are talking about and have the data that the Government have not been able to collect from women. They understand the issues and are making the right calls about what we need to do to bring this horrible disparity to an end, to close this racial divide and ensure that black women, Asian women and women of mixed heritage have safe births.

Question put and agreed to.

Resolved,

That this House has considered Black Maternal Health Awareness Week.

10:50

Sitting suspended.

Derry Addiction Centre

Wednesday 2nd November 2022 Westminster Hall

10:09

[Colum Eastwood (Foyle) (SDLP)]

I beg to move,

That this House has considered delivering on New Decade, New Approach commitments to a Derry addiction centre.

It is a pleasure to serve under your chairmanship, Mr Gray. I will begin with a quote from a service user of the Northlands addiction centre in Derry, which has served the people of our city for almost 50 years. It reads:

“My mother on one side of me, crying her heart out, my elder sister on the other side with a Kleenex in one hand and her head in another. I didn’t know how I felt. I didn’t know how to feel. I was numb. No tears, no emotions, just nothingness. All I could do was stare at a spot on the carpet and try not to look up and see the hurt and pain in my mum’s face.

That was over two years ago, and thankfully, I haven’t had to lift a drink since I came in here. Today though, I can feel, I can cry, and I can see what my mother and my sister meant all that time ago. I can see for myself the hurt and the pain and the despair my drinking was causing to my family and myself. Today, the difference is, I can do something about it. I am learning about myself and this horrible disease every day of the week, and for today anyway I didn’t drink, and for me as an alcoholic, that’s a miracle. The treatment in Northlands along with the help of AA since then has given me my life back; it’s given me a life!”

That is just one of many thousands of stories from people in the city of Derry and right across Northern Ireland who have been affected by the disease of alcoholism and drug addiction, and who have been helped by the wonderful volunteers and staff at the Northlands centre in Derry.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for bringing this issue forward. I talked to him at the airport on Monday, and today as well. Unfortunately, what he is referring to in his constituency is replicated across Northern Ireland and in my own constituency, where there are addiction and drug issues, and where young people are committing suicide. I know that is replicated in the hon. Gentleman’s constituency, so I commend him for securing the debate.

My understanding is that the Department of Health is holding the money up. Does the hon. Gentleman feel that, through this debate and through the Minister, we might be able to ensure that the money that was promised can be allocated to the maiden city, and to the hon. Gentleman’s constituents, to make things better for them? There seems to be a wee hold-up.

[Colum Eastwood]

The hon. Gentleman is absolutely right to say that the impact of the disease of addiction is felt keenly right across our constituencies. Of course, it is important to say that the Northlands centre, which is referred to in the New Decade, New Approach agreement, serves people from right across Northern Ireland. Every single constituency is affected by it.

Now that I see the former Secretary of State, the right hon. Member for Skipton and Ripon (Julian Smith), in the Chamber, I might say a word about how we got to this point. For three long years, we did not have an Executive—it feels a bit like we are approaching that period again. During the long hours of torturous negotiation, there was a lot of publicity around a couple of issues, but some of us were focused on a lot more. We wanted to see an Executive back, but an Executive that actually worked on issues that matter to people.

Late one Friday night, the right hon. Gentleman and I had a long discussion about what it would take to get us back into the Executive if we had a successful negotiation. People will understand that, for me, one of those things was the expansion of the Magee university campus. Another was the Northlands centre, which, after many decades of work, has a strong proposal for a world-class addiction centre in Derry. True to his word, as always, the former Secretary of State got that commitment into the New Decade, New Approach agreement. I was very grateful for it, as were the people of Derry.

However, as we know in Northern Ireland, words on a page are not enough. What we need is money in a bank account and proper commitment. To be fair, we had that commitment from the previous Government in the form of New Decade, New Approach, and I have had support from the current Government. We now really need an Executive in Stormont to deliver that. Unfortunately, even when we had an Executive—and we had a Minister up until last Friday—we still could not get the money out.

There are a number of things that I would like this Government to commit to now. What we need is an understanding of what happens if we do not have an Executive. I think all of us in the Chamber want to see an Executive as soon as possible. I would love to see all parties commit to get into government urgently—to get round the table and do the job that we were all elected to do. However, I want the Minister to answer a number of questions for me in the event that that does not happen.

Are the British Government still committed to delivering on the Derry addiction centre aspect of NDNA? We hear an awful lot about all the commitments, but this is a very important commitment for many people. What is the impact of the political instability on this particular proposal, and how will this Government act if we do not have a functioning Executive? As much as we all will it and want it, if we do not get to the point of having a functioning Executive, will those people who rely on this world-class service, and those who do not even know that they are going to rely on it, be able to access it?

[Mhairi Black (Paisley and Renfrewshire South) (SNP)]

Last year and the year before, on average almost every day in Northern Ireland somebody died because of the way that they misused alcohol. Does the hon. Member agree that if that number of deaths were caused by any other issue, Government would absolutely be on top of it and we would have the Executive up and running and functioning? Does he agree that there is no excuse for the lack of clarity from Government?

[Colum Eastwood]

The hon. Member is absolutely right; one person every single week dies from alcohol-related disease in Northern Ireland. If we add in drug-related deaths, we are talking about 10 deaths a week. Imagine the outcry if that was happening in full public view; we would be rushing to deal with the issue at every level of Government. Frankly, there is no excuse any more for anybody to stand in the way of this commitment.

New Decade, New Approach was an international agreement, signed off by two Governments and supported by five political parties. Some of us actually went into government on the basis of this and other commitments. Everybody in the Chamber knows about the cost of living crisis and the time it takes to access the health service. We should all know about the impact of drug addiction and alcoholism in our communities. We should be rushing to get this money out the door and spent.

Northlands has a very proud record. I want to put on record just how grateful the people of our city, and the people of Northern Ireland, are to all the staff and volunteers at Northlands, as well as all the people who put their money in the boxes to support that wonderful service. Over the past five years alone there have been 1,186 weeks of treatment for hundreds of people attending the six-week residential programme at Northlands, and 12,886 non-residential counselling slots have been used. On average, over 35% of people for whom the data is available in that period are in recovery, with an average of under 10% in relapse management.

[Julian Smith (Skipton and Ripon) (Con)]

Will the hon. Member talk a little more about the team behind Northlands? I recall from my time as Secretary of State that it is not a commercial or money-making enterprise; it is local people who understand the specific issues with addictions in Derry and are passionate about those priorities. They are deeply impressive, and I think it would be useful for the Minister to hear a bit more about the people behind Northlands.

[Colum Eastwood]

I am grateful for the right hon. Member’s intervention and I want to put on record my gratitude to him for getting the commitment in writing in the agreement. He went to meet the people behind the Northlands centre—people like Denis Bradley and many others, who over many years gave of their time, expertise and love for the people of our city and the people who have been struggling with this disease. The House would not believe the number of people who are very grateful for the work they have done.

It is also important to say that in our city and in other parts of Northern Ireland, we are faced with another problem: the grip of paramilitarism. Paramilitaries use drug addiction and abuse to coercively control communities in a way that needs to be tackled. In my view, the best way to tackle it—because we have tried everything else—is to deal with the root cause, which is addiction. Organisations such as the Northlands centre do that in a way that needs huge support. What better way to do that than to get this money into that organisation’s bank account and to get this project delivered?

Before I finish, I ask again: will the Government continue to be committed to funding this service? What will happen if we do not see an Executive formed as a matter of urgency? Will this Government step in if we do not get a Health Minister at Stormont? I hope that we do, and I assume the Minister is going to talk about the need for an Executive. He has no bigger supporter in that call than me, but if we do not get an Executive, what are this Government going to do? Of course, it was this Government who committed to getting this money to Northlands and getting the project up and running. I am grateful to the Minister for being here, but I will be even more grateful if we can get this money spent, as has been committed to.

11:11

[The Minister of State, Northern Ireland Office (Mr Steve Baker)]

It is a real pleasure to reply to this debate, Mr Gray, and I am genuinely very pleased that the hon. Member for Foyle (Colum Eastwood) has secured it; in this, we can make common cause. I am also pleased to see the former Secretary of State, my right hon. Friend the Member for Skipton and Ripon (Julian Smith), in the Chamber today. I pay tribute to all the work he did to get the New Decade, New Approach agreement in place.

The Government welcome this opportunity to make it clear that we are committed to supporting the Derry/Londonderry addiction centre and providing it with £1 million from unique circumstances funding under the New Decade, New Approach agreement. The hon. Gentleman particularly mentioned Northlands. I will come back to that, but I know it is a very valued service, and it seems to me a very sensible approach to use Northlands to deliver what is required.

Health is, of course, a devolved matter in Northern Ireland. The issue of a lack of clarity came up, but we are absolutely clear that health is a devolved matter, and we would like it to be governed, and governed well, in Northern Ireland. It is therefore for the relevant Northern Ireland Executive Department—in this case, the Department of Health—to formulate its proposals on how to use the allocated £1 million of unique circumstances funding to support those experiencing addition in Northern Ireland.

Before I go any further, I want to say that I am personally very committed to this issue, as I know the hon. Member for Foyle and other Members present are. A few years ago, I had the opportunity to participate in an inner-city challenge with the Centre for Social Justice, which saw me spend three days and two nights in rehab with some very serious ex-offenders, including people convicted of murder. It felt like a much longer time. I went through with them, in their counselling sessions, what it means for them to be addicted and how they had come to be in the circumstances they were in. I was particularly moved by the service user’s account that the hon. Gentleman shared.

Given the social problems that our country faces—indeed, that all countries face—with drugs, we need to get alongside people where they are and lift them up. It is too easy for people to see the tremendous consequences of addictions on our society and rush to condemn, but people in the grip of an addiction need treatment and sympathy. That is one of the things I saw when I was with those people in that centre. Indeed, I have stayed in touch with one of them, and I was in touch with him last night when preparing for this debate. He has completely rebuilt his life, become a good father and got into work. It is an amazing thing to see.

In thanking the staff of Northlands, and all staff across the UK who deal with addictions, including in Wycombe, I particularly want to acknowledge the point that the hon. Member for Foyle made about the countless people who are grateful. That needs to be understood by everyone. Genuinely, countless people are affected by addictions, because the consequences that spread out as people suffer under addictions are enormous and almost impossible to see. Those consequences spread and spread, generationally as well as geographically, so it is really important that we understand addictions and deal with them. As such, I am personally committed that this money needs to get into Northlands and to deliver against NDNA.

I stress that the Government stand ready to provide the funding once we have received and approved the Northern Ireland Executive Department of Health’s proposals for the Derry/Londonderry addiction centre. As I said earlier, Northlands seems a particularly sensible way to proceed. The Northern Ireland Office continues to engage with counterparts in the Executive to make that happen.

We do not have an Executive, and we are moving towards declaring an election, as is our legal duty. We fervently hope that a functioning Executive will be in place as soon as possible. Our officials have been advised by the Northern Ireland Department of Health that, at this stage, it is too early to state what impact, if any, the absence of an Executive will have on the delivery of its proposals. However, NIO officials will keep that aspect under review with the Department of Health.

The hon. Member for Foyle asked four specific questions. First, what happens if we do not have an Executive? We will have a response plan, and we will take the steps necessary to ensure that public services continue. However, as he knows, we do not wish for direct rule any more than he does; we wish to have a functioning, stable and high-quality devolved Government. We have to proceed with great caution. I know that he will not expect me today to pre-empt announcements that we will make in due course.

Secondly, the hon. Gentleman asked whether we are still committed. I think I have made it absolutely clear that, personally and as a Government, we are absolutely committed. Thirdly, he raised the impact of instability, which is very real and very much felt in people’s lives. I absolutely appreciate the strength of feeling and the real concern of Unionists, in particular my friends in the Democratic Unionist party. I am a proud Unionist and a proud Brexiteer, and I very much regret that we have the problems we have with the protocol, which are keenly felt by the DUP.

Let me take this moment to put it on the record that everyone needs to understand that we will be challenged to deliver a devolved Government until the issue of the Northern Ireland protocol is resolved. That, I am afraid, puts things firmly in the hands of the European Union. Until it is willing to negotiate on the basis of regard for the legitimate interests of Unionism—a point I have tried to make clearly, but respectfully so—we will not be able to satisfy the DUP or many Conservative MPs that we have made progress. If we cannot satisfy the DUP, it clearly has the power and the opportunity to prevent a devolved Government from being formed. I wish to be respectful about that, just as I have been respectful—I think famously—to the EU and Ireland about their legitimate interests.

The hon. Gentleman asked about the impact of instability specifically in relation to the addiction centre. Here we see the impact of political instability, which causes real harm to real lives, not just for those who are addicted, but for their family and the many people who suffer the consequences of addiction.

Fourthly, the hon. Gentleman asked what we will do. We will of course proceed to govern as best we can in the absence of devolved institutions, within the bounds of not wishing to institute direct rule. We will announce our response plan in due course. I hope that we will be able to satisfy the hon. Gentleman. As he has raised the issue, I will certainly make it my priority to investigate what is happening with the centre.

This debate is an excellent example of democracy working. We have so many things before us at this time, but this debate secured by the hon. Member for Foyle on behalf of those he represents has raised the matter up my priority list. Working with my officials, I will try to ensure that we drive it forward.

I have a few words to say about addiction, which is a complex and multifaceted issue that affects the whole of our society. It takes a terrible toll on family and friends. It is therefore vital that people in Northern Ireland and indeed across the UK are able to access the right addiction and support services at the right time. As I said, it is a devolved matter, but the Government are committed to providing the additional funding. That commitment reflects the Government’s strong desire to see improved health outcomes for everyone across Northern Ireland.

The Government’s commitments under the New Decade, New Approach agreement include making £40 million available for a range of projects focused on addressing Northern Ireland’s unique circumstances. The unique circumstances projects are aimed at supporting community and reconciliation initiatives to remove barriers, to bring the people of Northern Ireland together, and to build a safer and more secure society in Northern Ireland.

One of the projects identified was the Derry/Londonderry addiction centre. The Government are steadfastly committed to providing £1 million in funding as a non-Barnett addition to the Northern Ireland Executive’s block grant. We of course continue to urge all those involved to form an Executive to deliver the proposals but, as I said, I appreciate why that has not proven possible so far. Funding for unique circumstances projects is an important component of the New Decade, New Approach agreement, and the Government remain focused on ensuring the investment of this funding for the benefit of the local community.

It may help to say a little more about the context of New Decade, New Approach. The agreement was reached between the UK Government, the Irish Government and Northern Ireland parties in January 2020, and it enabled the restoration of the Northern Ireland Executive after a three-year hiatus. Again, I pay tribute to the former Secretary of State, my right hon. Friend the Member for Skipton and Ripon, for his leading role in that work. The agreement contains commitments for the UK Government, the Irish Government and the Northern Ireland Executive to fulfil. This Government have delivered over half of their commitments under the New Decade, New Approach agreement and we will continue to implement the remainder of the agreement to support a stronger, more prosperous and inclusive Northern Ireland in which everyone can participate and thrive.

The agreement was accompanied by a £2 billion financial package, consisting of £1 billion of additional funding and a £1 billion Barnett-based investment guarantee. It is the largest deal from a Northern Ireland talks process to restore the Northern Ireland Executive. The UK Government have now honoured the £1 billion Barnett-based investment guarantee, as set out in NDNA. The investment guarantee was that the Executive would get a capital department expenditure limit Barnett consequential of at least £1 billion over a five-year period, from 2021 to 2024-25. That has been honoured as, based on the spending review 2021 settlement, the Northern Ireland Executive will receive over £1 billion by 2024-25 in additional CDEL Barnett consequentials.

We expect that £769 million from the £1 billion financial package in the agreement will have been spent by the end of the current financial year. The release of funding has been tied to the delivery of reform and transformation of Northern Ireland’s public services, which I will now discuss in a little more detail.

The agreement reflected the unique challenges faced by Northern Ireland. The aims of the financial package were to provide immediate support to the health service and to address budget pressures, to enable investment to transform public services, to turbocharge infrastructure delivery in Northern Ireland, and to address Northern Ireland’s unique circumstances. The Government’s substantial package played a vital role in supporting the incoming Northern Ireland Executive and in promoting economic growth. Of course, we are deeply disappointed at the continuing lack of a fully functioning Executive, but we will continue to press forward to serve the people of Northern Ireland.

The £769 million spent so far has been used to bring to an end the nurses’ pay dispute in January 2020, with £200 million used over three years to deliver pay parity with nursing counterparts in England and Wales; to provide a one-off funding settlement to the Northern Ireland Executive of £350 million in 2021-22 to relieve budgetary pressures and deliver effective public services in Northern Ireland; and to drive the transformation of public services by providing £142 million to support the Northern Ireland Executive in its transformation programme. The Executive have so far directed the transformation funding towards improving health outcomes. The NDNA transformation projects are embedded in the Northern Ireland Department of Health’s rebuild framework, “Building Better, Delivering Together,” which progresses health and social care system rebuilding work in Northern Ireland.

The funding has supported the Northern Ireland Executive in delivering a fleet of low-carbon buses for Belfast and the north-west, with £50 million invested in low-carbon transport. Government funding under NDNA means that 100 zero-emission buses have been produced by Wrightbus in Northern Ireland. The funding also led to the opening of the Northern Ireland graduate medical school in Derry/Londonderry to students in September 2021. So far, we have invested £11.5 million, with another £48.5 million to be invested, to deliver a brand-new facility and investment for the north-west of Northern Ireland. The training of more doctors will also help address the shortage of medical professionals in Northern Ireland in the long term.

Turning to the unique circumstances money, the Government have committed £140 million to address Northern Ireland’s unique history. That consists of £100 million for legacy implementation and £40 million for those unique circumstances. The £40 million in Government funding has been reserved for the themes set out on page 53 of NDNA, in annex A.

The funding is to be deployed in areas including mental health, which I am sure will matter to everyone here; tackling paramilitarism; and tackling deprivation and improving opportunity—of course, one of the major factors leading to deprivation is addiction. The funding is also to be deployed on a culture and community fund; support for marking the 2021 centenary and related projects; support for languages and broadcasting; support for the armed forces and veterans; a fund to promote the competitiveness of Northern Ireland’s economy; additional funding to support the Derry/Londonderry addiction centre; and the UK contribution to the international fund for Ireland.

As I run through those commitments, I think the whole House will appreciate the extraordinary work led by the former Secretary of State, my right hon. Friend the Member for Skipton and Ripon, with all the relevant parties, to deliver so much for Northern Ireland. What we now need to do is press forward.

The five parties reached the NDNA agreement, leading to the restoration of the Northern Ireland Executive in January 2020. The funding allocations were later agreed by the previous Secretary of State with the First Minister and Deputy First Minister. Good progress continues to be made, and funding has been approved across a range of projects, including on tackling paramilitarism, support for veterans, the Veterans Commissioner, NIO centenary projects, and so on.

On tackling paramilitarism, the Government’s funding has helped to support the Executive’s Communities in Transition project, which is designed to support and empower those communities that have been most impacted by paramilitarism, criminality and ongoing coercive control. Many Members present will appreciate the interaction between drugs and paramilitarism; I do not wish to get into that in great detail, but the two subjects are closely related. By tackling paramilitarism and criminality, we will help to deal with the problem of addictions.

The Government’s commitment to veterans under the agreement resulted in the appointment of Mr Danny Kinahan as the first Northern Ireland Veterans Commissioner in September 2020. As with the release of all Government funding, we undertake robust assessments and business case approvals before funding is provided.

Despite the absence of a Northern Ireland Executive, the Government continue to deliver on their NDNA funding commitments. That includes releasing the remaining £276 million of funding, including £103 million to drive public service transformation; £48.5 million to help fund the graduate medical school at the Magee campus in Derry/Londonderry; £100 million to address the unique history of Northern Ireland, including legacy; and £24.5 million of the £40 million reserved for the 13 themes referred to on page 53 of NDNA, in annex A.

The Government’s financial package was accompanied by stringent financial conditions to deliver a greater level of accountability for public spending, and to ensure that the Northern Ireland Executive build sustainable public services for people in Northern Ireland. Members will know that that is extremely important at the moment. It included the creation of the independent Northern Ireland Fiscal Council in 2021. That body is an important component in delivering greater accountability for public spending, and it is already playing a valuable role in Northern Ireland.

Earlier this year, Parliament passed the Northern Ireland (Ministers, Elections and Petitions of Concern) Act 2022 to implement the institutional reforms agreed in NDNA. These reforms have included enabling Northern Ireland Executive Ministers to continue in office for a defined period to allow time for Executive formation—although I lament that in this case that has not worked—reforming the petition of concern mechanism used in the Northern Ireland Assembly, and updating the ministerial code of conduct with regard to the expectations and behaviour of Ministers.

The Government’s priority continues to be a return to a fully functioning and stable devolved Government as soon as possible, and to ensure the necessary delivery of public services for the people of Northern Ireland. We regret that the parties failed to elect a Speaker and form an Executive before the 28 October deadline. In line with his legal obligation, my right hon. Friend the Secretary of State will soon confirm the date of the next Northern Ireland Assembly election, as required by law. Following that election, and regardless of the result, the Northern Ireland parties really do need to come together to restore the devolved institutions and lead the people of Northern Ireland through the challenging times ahead. I think we all appreciate the significance of that to people in Northern Ireland; the hon. Member for Foyle made very clear the real impact on people of not having an Executive to deliver.

The significance of NDNA in this context cannot be forgotten. The agreement shows how collaborative working and compromise can create the right conditions for stability—

[James Gray (in the Chair)]

Order. I am sorry to stop the hon. Gentleman, but I must now suspend the sitting until half-past 2 this afternoon.

Motion lapsed (Standing Order No. 10(6)).

11:30

Sitting suspended.

International Doctors: Visas

Wednesday 2nd November 2022 Westminster Hall

[Graham Stringer in the Chair]

10:24

[Matt Warman (Boston and Skegness) (Con)]

I beg to move,

That this House has considered visas for international doctors.

It is a pleasure to serve under your chairmanship, Mr Stringer.

This is a debate about doctors, but I want to begin with the story of a hypothetical patient. Let us call her Marjorie and say that she lives in Skegness. She is in her 80s or thereabouts. She is registered with a local GP practice, and she has a trainee doctor as her GP. They have a really good relationship and know each other well. They have the continuity of care that means that Marjorie’s needs are looked after. For a couple of years, Marjorie has gone back and forth to her doctor with little ailments, as people often do. In her final consultation, her doctor mentions that she will be moving on relatively soon.

Thereafter, Marjorie finds herself with another GP, and the continuity of care is broken. Marjorie struggles to get the type of relationship that she built up over the past few years, and she finds herself bouncing in and out of hospital. She is fine, but not as well as she would be if her care had been provided by a doctor who was able to make sure that they knew each other well. The reason for the break in continuity of care is that the doctor she had in training was an international medical graduate who was being trained at the surgery in Skegness. Unfortunately, for a whole host of reasons, the surgery was not registered to take international medical graduates once they had qualified, and it was not what is called a sponsoring practice—it was not able to say that it would sponsor the visa for that doctor.

The reason I make that point in such a way is because the people who are suffering as a result of the approach we currently take to visas—on one level, they are doctors who are dealing with the immensely stressful visa process—are ultimately patients, who should be our priority. The doctor I mentioned is one of 40% of trainee GPs who come from abroad. While they are training, their visas are sponsored by Health Education England.

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

A result of the difficulties around trainee GP visas is that many IMGs feel that they have no choice but to take on other roles within the NHS, or they leave the NHS altogether. Many may even return home. Does the hon. Member agree that this is yet another area where the Home Office must look at the bigger picture, rather than trying to plug gaps on an ad hoc basis?

[Matt Warman]

Ultimately, this is where we need joined-up government, whereby the Home Office and the Department of Health and Social Care deliver on the same priorities, and I really do think that they can.

As I say, 40% of trainee GPs come from abroad. In the final months before they qualify as GPs, the last thing they should be doing is dealing with the stress of a potential visa application and considering whether the practice where they might want to apply for a job is registered on the programme, and whether they can reasonably jump through the Home Office hoops at that precise moment. We are increasing stress for doctors, and we are increasing the risks for patients at the same time.

The hon. Lady alluded to figures from the Royal College of General Practitioners which show that some 30% of GP trainees are considering not working as GPs when they qualify for these visa-related reasons, and some 17% think they might have to leave the UK either temporarily or, at worst, permanently. That is some 1,200 doctors who are considering not working in the health service as a result of this system. In Lincolnshire alone, a third of practices have thought about registering as a visa-sponsoring practice, but just one in 10 have actually done it. We are really limiting the options for GP trainees and for the health service.

This is a political choice, and it reveals an inequality between different sorts of doctors. It will probably take a hospital doctor five years to qualify. After those five years, they will qualify for indefinite leave to remain in a much easier way. Because GP trainees take just three years to complete their programme, they need to go through this visa process, because three years is not five years, and the Home Office has decided that five years is what is required.

There are other associated problems. When it comes to applying for a visa, the GP practice that needs to register will consider whether that process is worth while. It may, in theory, be worth while in advance, and some practices do register in advance, but many do not. They then find themselves confronted with a brilliant candidate, and they try to register, but with the best will in the world, the timescales are very tight for doctors to apply for visas when they have a job offer from a practice that is already registered. There are lots of things to line up, and it is stressful for practices and for doctors. Even if there were no backlog in the Home Office, it would be a very tight timescale.

[Mrs Pauline Latham (Mid Derbyshire) (Con)]

I thank my hon. Friend for giving way and congratulate him on securing this important debate. I have recently returned from an International Development Committee visit to Jordan, where I spoke to a number of highly educated Jordanians, as well as Syrian refugees. Some of the Jordanians were already doctors and nurses, and the Syrian refugees in the camps in Jordan cannot get an education beyond the age of 18 but wish to become doctors, engineers and so on. They speak amazing English and would love to train here in the UK.

At the moment, Germany is hoovering up a huge number of these doctors and people who would like to study to become doctors, to satisfy the demands of its health service. Does my hon. Friend agree that it would be helpful for the Minister to consider opening up more visa routes for brilliant young medical students from countries such as Jordan that have long been strong international partners of the UK, in order to ease some of the workforce pressures on our NHS? It is important that we increase the numbers, and that would be one way of doing it.

[Matt Warman]

I absolutely agree with my hon. Friend that increasing all those routes is hugely important. Of course, we would all like to see more doctors trained in this country, and the Government have gone some way towards doing that, but where people want to work abroad, Britain should be as attractive a place as we can be. That is why, on the GP point specifically, the Government should be removing every single barrier in that visa process.

The most straightforward thing we could do, which would remove the need for a practice to register as a visa-sponsoring practice, is simply to say that when a GP qualifies in this country, they get the indefinite leave to remain that other doctors get. These are people in whom the UK has already invested. They are already here; they already have a visa. The extension of that visa into another form seems simply to be a bureaucratic hoop that we are putting in their way as doctors and in the way of GP practices. We are putting extra bureaucracy into a system, while on the other hand the Government say, “We desperately need people to come to this country to work in the NHS, and we will try to do everything we can.” The health service does hugely good work to try to recruit such people and specifically encourages them to train as GPs, but then we put an additional barrier in their way.

The response from the Government in the past has been, “Actually, the visa process registration is not terribly onerous and GP practices can do it.” They point to the numbers that have and do, which is fine as far as it goes, but it does not answer the question of why we put a barrier in the way in the first place. It should not be a cost of doing business when we say that we really want to make it as easy as possible.

Equally, it should not be a reasonable thing to put different sorts of doctors on different sorts of levels. It is not reasonable to say to people that, just as they have gone through the most stressful part of qualifying with exams, they should also be thinking about their immigration status. That calls into question their probity when we have things such as the General Medical Council making sure that they are upstanding members of our communities, and many of them have tens of thousands of patients to testify to that.

I do not think it really washes when the Government say that we need to put barriers in place, and I do not think that the Department of Health, where the Minister was previously a Minister of State, would agree, in an ideal world, with the Home Office stance. We could work together across Government to try to secure a sensible outcome.

I have talked about GPs, but there are broader issues around visas for doctors, many of which come back to the Home Office backlogs that I know my right hon. Friend the Minister is working really hard to address. There is a good argument for simply scrapping visa fees altogether for people coming to work in the health service. That is an argument for another day, but when it comes to GPs I think that lowering the five-year limit for indefinite leave to remain to three years is the neatest way to address the issue.

On the broader issues, ultimately this comes back to how many doctors we are training in the UK. We all want, as I said to my hon. Friend the Member for Mid Derbyshire (Mrs Latham), to see more people trained in this country. That is what we are doing and that is what the Government continue to pursue, but until we reach that moment—the NHS has never reached entire self-sufficiency in the UK—we should make it as easy as possible for doctors, dentists, nurses, people working in social care, and all those who work in different parts of the health service, to come to the UK. It is not primarily a question about backlogs; it is a question about process. At the moment there is a degree of bureaucracy that simply does not need to exist.

[Steve Brine (Winchester) (Con)]

It is great to hear my hon. Friend making such an eloquent case, as always—more so than I can. The issue matters for all the reasons he has set out, but would he agree that because of the retention challenge in the health service, the more we pour in at the top is sometimes, in part at least, offset by those who go out at the bottom? There is a wider picture here to do with pension pots—the whole retention piece is part of the wider jigsaw, which I appreciate is not the remit of this Minister, but perhaps was in his previous job.

[Matt Warman]

I thank my hon. Friend for that intervention. It is always tempting to ask the Minister to go and have a word with his former self, but we cannot do that. I think he has read the last couple of points that I want to make.

There are a number of relatively low-hanging pieces of fruit that the NHS has repeatedly asked for. I want to thank the RCGP, the British Medical Association, the radiologists, the British Dental Association, and also groups such as EveryDoctor, which have helped me with this debate and have identified the fact, as my hon. Friend implied, that there are a small number of things that could and should be sorted as quickly as possible. Busting the barriers around pensions and the bureaucracy around visas are things that would make a real difference to recruitment and retention across the health service. There are plenty of things that are difficult when it comes to addressing the NHS’s challenges, particularly as we approach winter. On the narrow point of GP provision, we have a visa process that puts pressure on, in particular, small GP practices, where the added burden of registering as a visa sponsoring practice is even greater now as they are under such huge pressure. It is also a burden on GPs at what is a particularly stressful point in their careers.

I know the Minister will make entirely legitimate points around putting a process in place, but the reality is that there is a political choice to be made to ease some of those burdens. There is a powerful, compelling case to be made for doing a small number of easy things that could address the GP crisis in particular, which, as my hon. Friend the Member for Winchester (Steve Brine) alluded to, is acute.

I appeal to the Minister and the Government to work as closely as they can with the Department of Health and Social Care to understand these challenges and see what can be done, and I urge my right hon. Friend to take seriously the suggestion that if someone qualifies as a medical doctor in this country, and in particular as a GP, they should have indefinite leave to remain. At the moment, it effectively comes with that if they qualify in a hospital but not in general practice. That is an inequality that the Minister can look to fix, and I hope he will do so as soon as is practicable.

14:46

[Jim Shannon (Strangford) (DUP)]

I thank you for allowing me to participate in the debate, Mr Stringer. I thank the hon. Member for Boston and Skegness (Matt Warman) for bringing this matter to light. It is good to see the Minister in his place—a return to duty in his ministerial role—and I am confident that, like the rest of us, he will be keen to address the key issues of the debate and why this issue is so important. I wish him well in this new role and look forward to his response to our questions.

The issue of visas is always a difficult one. I am incredibly aware of the need to protect our country and ensure that only those who have a desire to enjoy British life and to enhance it should be given visas. I understand the system of immigration and agree that it should be rigorously implemented. However, within that, we very much need to have the appropriate systems for the appropriate types of visa. That is why I believe that changes need to be made, as outlined by the hon. Member. Talented and skilled doctors want to come here and contribute to our society but unfortunately, due to the visa system, they are not always able to do so. For me, the issue is: how can we help them to help us in the United Kingdom of Great Britain and Northern Ireland?

[Margaret Ferrier]

As the hon. Member for Boston and Skegness (Matt Warman) said, a difficulty that many international medical graduates face is that many GP practices do not have a visa sponsorship licence in place, making it harder to meet the requirements before the student’s studies end. Does the hon. Member share my concerns about the general level of the Home Office backlog and the associated impact on IMGs?

[Jim Shannon]

I agree with the hon. Lady. I hope that through today’s debate and contributions, this issue can be addressed. Again, we look to the Minister to give us some help, direction or support in how we can go through the vigorous bureaucracy that is clearly there. People with talent and skills want to come here; it is about how we can make that happen.

I have raised immigration on multiple occasions with Home Office Ministers—in particular, with regard to visas for those working on fishing boats in my constituency and the skilled work done by Filipino fishermen. The previous Minister was most helpful. That work is undoubtedly skilled, but it is under the pay threshold, so visa requirements sometimes restrict that opportunity.

Junior doctors, nurses and others do work that is not highly paid but highly skilled and necessary. That is why there must be time-sensitive application systems for those vital jobs and staff members. We need flexibility in the system. I say this again because it is important: those highly skilled and highly talented people who wish to come here will add to society and enable us to fill some of the vacancies.

I cannot speak for the United Kingdom mainland, but I can certainly speak with some knowledge of Northern Ireland. I am my party’s health spokesperson, and the research we did for this debate shows that 6,613 vacancies are listed for the five trusts in Northern Ireland. I know that they are not entirely for medical staff, but it is clear that we are desperately in need of staff, and there are many opportunities for doctors.

In my constituency and neighbouring constituencies, we are having problems in relation to GPs. I absolutely agree that there is a need for restrictive immigration, but we must not cut off our nose to spite our face. I am sure those numbers are replicated throughout the entire UK; perhaps the Minister will give us some figures for GP vacancies. I know that the Government have set out a strategy for employing and recruiting more GPs—that is good news.

During the Brexit discussions, we were told that there would be distinct differences between the visa systems. That is as it should be. The hon. Member for Boston and Skegness said that the system needs to be altered to meet the need, and that is what we need to do today.

The hon. Gentleman mentioned GPs, and we are of the same mindset. In a neighbouring constituency, a GP surgery, which is 10 minutes from my office, is set to close down because there are not enough GPs. In response, the GPs in my area have issued a moratorium on joining or leaving local practices. In other words, they will not take any more patients, and in some cases they are directing patients who live outside the area—that was okay a few years ago—to go elsewhere.

The trust is hopeful that it will get more GPs to take over the practice, but the fact is that we simply do not have enough GPs. That puts more pressure on the existing ones, which leads to more burnout, and the vicious cycle continues. GPs are under incredible pressure. Patients want to meet their GP; they want face-to-face appointments. That has been lost to them over the past two and a half years due to covid, but they are trying hard to get back in the queue.

The hon. Gentleman said that 40% of all GP trainees are international medical graduates—the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) referred to that—but they have difficulties obtaining visas. I do not have the exact numbers for Northern Ireland, but I do know that we cannot afford the loss of any more GPs. I therefore add my voice to those of others in the Chamber requesting that a special dispensation be granted not simply to allow those trainees to stay but to enable us to recruit further.

If there a block of trainee GPs who have almost completed their degrees and courses and are ready to come here, let us encourage them to do so. The question is not why it cannot happen, but how we can make it happen. The thought of training GPs to understand how we do medicine and run our practices, only for them to leave—not because they want to but because the system is not working for them—is madness. That needs to be addressed through this debate.

Recently, medical professionals outlined to me that the mental health and self- esteem of our medical community are at an all-time low because the staff are simply burned out. I have met many nurses, GPs and surgeons who are absolutely exhausted with the work they do. For those who are on call and have a duty rota to complete, being sent an SOS text to cover shifts is no longer exceptional; it is standard. That tells us that the GPs need to be employed and some of the pressure taken off.

We need to change the way that things are done, by giving GPs more admin support and funding for on-site nutritionists, physios and mental health teams, which we need within all health clinics. In my constituency, they are trying to do that regularly, and it should help to diagnose early, whether the problem is diabetes, arthritis or dementia. Whatever the issue, doing that correctly in GP surgeries is the way forward.

It is impossible to imagine that things can go on much longer the way they have for the past two and a half to three years throughout the United Kingdom of Great Britain and Northern Ireland. We need change, flexibility and help, Minister. We do not want to put all the pressure on the Minister, but in this case there are ways forward. The hon. Member for Boston and Skegness has outlined them, as have I and others. We look forward to a successful conclusion to this debate, with a way forward from which we can all benefit across this great United Kingdom of Great Britain and Northern Ireland.

14:56

[Stuart C. McDonald (Cumbernauld, Kilsyth and Kirkintilloch East) (SNP)]

It is good to see you in the Chair, Mr Stringer. I also start by welcoming the Minister to his place. I wish him good luck; he probably needs it, as much as any Minister in Government, because his is an incredibly challenging post. We will, of course, have significant political differences on this topic, but it is an important issue, so if there is an opportunity for constructive and positive engagement, I am up for that, wherever possible. I thank the hon. Member for Boston and Skegness (Matt Warman) not just for securing the debate but, as ever, for his expert introduction to the topic and advocacy.

Moving to the subject at hand, like other Members I will start by recognising the extraordinary contribution of non-UK nationals to all parts of our NHS. I suspect everybody in the room has benefited from that, never more so than in recent times. GP practice is no different, and nationals of other countries will continue to play an important part, both now and in the future. As the hon. Member for Boston and Skegness alluded to, figures suggest that 47% of new GP trainees in England in 2020-21 were international medical graduates.

Another important context for this debate is the extraordinary pressure that our NHS is under, particularly in the light of covid, but also for all sorts of other reasons, which we could perhaps touch on in another debate. High vacancy rates are among them. As has been mentioned, challenges in recruitment and retention affect GP practices as well as everywhere else.

Against that background, the hon. Member identified what at first seems to be a technical problem in the operation of the immigration system, but one which, when examined, is significant. A failure to solve it leads to some absurd and harmful consequences. As he pointed out, the pain will ultimately be felt by patients. He explained that the three-year GP training regime for IMGs leaves them, on completion, two years short of being able to apply for settlement. That is unlike other specialisms, which have longer training periods.

That requires IMGs to find a GP practice that has become a tier 2 sponsor, which is not easy. The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) alluded to statistics highlighting that, with half of all IMGs having struggled with the visa process, 30% having considered moving away from GP practice and 17% thinking about leaving the United Kingdom.

The Minister’s predecessors appeared to dig their heels in and say, “We just need more GP practices to become tier 2 sponsors.” I agree with the hon. Member for Boston and Skegness that that prioritises Home Office bureaucracy above the health service. Ultimately, it is the wrong answer for patients who are struggling to access a GP. We are going to lose skilled and dedicated GPs as a result.

There is one issue where I do have some sympathy for the Minister’s predecessors, and that is the rejection of the idea that a route to settlement should simply be shorter. Settlement is an important and significant thing. There are aspects of that where I am open to persuasion on the case to shorten routes generally and in some specific cases, for example, family members. However, an argument to shorten the route to settlement simply because a training course lasts a certain time is perhaps not the most persuasive. It is not one that I am closed to, but it is not one that I immediately find the most persuasive.

However, the Home Office should be pragmatic about other possible solutions that have been put forward. Its current insistence that 8,166 GP practices right across the UK should just invest time—and over £4 million—in becoming tier 2 sponsors on the off chance that they might want to recruit an IMG is simply not realistic. The £4 million in fees from those GP practices would go to the Home Office—I wonder if that has something to do with its intransigence at the moment.

The alternative approach of a practice only becoming a sponsor once it has already had an application for an IMG is also far from ideal. The delay that that causes is bad for all affected, and the pressure on IMGs to find a tier 2 sponsor to satisfy immigration requirements prior to their existing visa expiring means that they cannot wait. As evidence given to the Health and Social Care Committee earlier this year highlighted, newly qualified GPs have received removal letters from the Home Office soon after their qualification. That is absurd, because we not only need them but have spent tens of thousands of pounds on training them to do a job that we urgently need them to do. I hope good sense will prevail over the Home Office’s current intransigence.

I now turn the other solutions, which I think are perfectly reasonable, that the Royal College of General Practitioners has put forward. The first solution is to create a new post-medical training visa that works in the same way as a graduate visa. The second is to create umbrella bodies that could operate as a sort of super-sponsor. That could be the NHS or whichever training body had already sponsored the first three years of the IMG’s presence here. Who knows—it could be the Royal College of General Practitioners itself. I do not have the answer as to which option would be best, but any of them would clearly be better than the absurd situation we find ourselves in.

[Steve Brine]

I have a suggestion, at least for England: the primary care networks or the new integrated care boards could quite easily act as an umbrella sponsor, thereby taking the bureaucracy away from the practices, which is part of their purpose.

[Stuart C. McDonald]

That is a valid proposition, and we could do the same with health boards in Scotland. If we knock our heads together, we can come up with a way to fix this. It just requires a little bit of pragmatism.

There is a second issue I wanted to raise—when I saw the motion for this debate, I wondered if the hon. Member for Boston and Skegness would raise it. That issue relates to recent reports from the BBC flagging complaints of poor treatment and conditions for international doctors in private hospitals, as well as highly questionable recruitment practices. I will touch upon it briefly because it has not been raised, although it is important to draw it to the House’s attention and to see if the Minister will investigate and respond. There were reports from 11 October suggesting that doctors from some of the world’s poorest countries were being recruited, by Nuffield Health in particular, to work in private hospitals under conditions prohibited in the NHS. There are reports of doctors being on call 24 hours a day for a week at a time, not being able to leave the hospital grounds and, unsurprisingly, suffering from extreme tiredness, putting both patients and doctors at risk.

Nuffield Health denies those allegations, but a British Medical Association and Doctors’ Association UK questionnaire of 188 resident medical officers adds some credence to the claims. It shows that 81% of respondents were recruited from Nigeria, and most complained of extreme working hours and unfair salary deductions. The conclusion of the Doctors’ Association UK was that we now have a two-tier system: one for the NHS and one for other international recruits in the private sector. I ask the Minister to look into that.

That issue highlighted to me another fundamental problem with how the immigration system operates. We have all sorts of checks and regulations that focus on ensuring that people who come to work here abide by their visa conditions, and they include the doctors we have been talking about—the IMGs—where the Home Office is on their case as soon as they have qualified to see what they are doing next. However, little or no checks are done to protect people who come here. That is not just in the NHS and with doctors; I have been firing off parliamentary questions and freedom of information requests in relation to the agricultural sector. That is a sector wide open to exploitation, but as far as I can see there is no concerted effort to protect people from that exploitation.

As the Minister will appreciate, Nigeria is a red-list country for recruitment. According to both the World Health Organisation and the Government, that is not where we should be finding doctors.

[Jim Shannon]

Does the hon. Member agree that, when it comes to the criteria used, one thing we should perhaps be seeking from the Minister is an assurance that greater weight will be given to the skills that people have, as opposed to the money they could earn?

[Stuart C. McDonald]

That is absolutely fair. The point I am making is that we should also consider—and in fairness, we do—where it is that we are recruiting from. We do not want to leave some of the poorer countries in the world without the skills they need.

Nigeria is a red-list country, but the report highlighted that both the General Medical Council and the British Council are involved in establishing and overseeing a professional and linguistic assessment board test in Lagos. I encourage the Minister to look into those reports. I appreciate that he might not be able to tell us about them today.

Various broader issues have been raised, including visa fees, pensions and so on. We could talk about the impact of free movement and how that has mired certain services, including GP practices, in red tape and bureaucracy, but we will keep that discussion for another day.

I again congratulate the hon. Member for Boston and Skegness on securing the debate. Throwing out skilled and desperately needed GPs in whom we have invested tens of thousands of pounds in training is utterly absurd. The hon. Member for Strangford (Jim Shannon) put it very nicely, as he always does. The question is how we can help them to help us. There are pragmatic solutions available. This is an early test for the Minister on whether he will be a pragmatist or take what I would characterise as the more dogmatic approach of the previous Home Office regime. I very much hope it is the former and that he is a pragmatist.

15:05

[Stephen Kinnock (Aberavon) (Lab)]

It is a pleasure to serve under your chairship, Mr Stringer. I thank the hon. Member for Boston and Skegness (Matt Warman) for securing this important debate. His speech was an excellent example of a constructive critique of where his own party is on the issue, and he put forward some practical and thoughtful ideas. I hope the Minister has taken note. I suspect there is more chance he will take note of the hon. Member’s comments than he will of mine, but we never know. This debate is a great example of the cross-party discussion that we can have in this place.

Let me start by setting out the Labour party’s position on work-based migration in Britain, as it is important to set the context before drilling down into the specifics of the issue we are discussing today. In a nutshell, we support the points-based immigration system for migrant workers; it was of course the Labour Government in 2008 that introduced that system for immigration from outside the European Union. We are clear that there will be no return to the European Union’s freedom of movement. We want to build on and improve the points-based system currently in place. It is a very blunt, one-dimensional instrument that could be significantly improved.

Our long-term ambition is to make sure that every employer across the private and public sectors is recruiting and training more home-grown talent to fill vacancies before looking overseas, but we recognise that simply turning off the tap of labour from other countries without having the appropriate workforce structures, plans, training, skills and productivity strategies in place, our private sector and our public services will deteriorate, our businesses will struggle to meet the Labour party’s ambitions to make, buy and sell more in Britain, and we potentially risk jobs disappearing overseas.

We cannot have a situation like the one we have had in the farming sector over the past year, where 30,000 pigs were slaughtered and £60 million-worth of crops were burned. Indeed, we cannot have a situation in the NHS where we are short of doctors, all because our immigration system puts up red tape and barriers that prevent, or at least severely discourage and disincentivise, doctors who have come to the UK from overseas to do their three years of general practitioner training from staying on to fill critical vacancies in the job market. That is utterly counterproductive, not least because 47% of new trainees in England in 2020-21 were international medical graduates. Labour’s shadow Health Secretary, my hon. Friend the Member for Ilford North (Wes Streeting), has been clear that it is madness for the NHS to lose GPs whom the British taxpayer has paid to train.

Successive Conservative Governments have already cut 4,700 GPs over the last decade, meaning that patients are finding it next to impossible to get an appointment. There is a chronic lack of doctors, nurses and healthcare staff in the NHS. Staff shortages are reaching dangerous levels, when the need for NHS treatment is incredibly high, with huge backlogs and millions of people forced to wait for treatment. Patients are finding it impossible to get a GP appointment in many cases, and GPs are leaving the health service at an alarming rate. Last year, one in six people who tried to speak to a nurse or GP were unable to get an appointment at all. The hurdles placed in front of international medical graduates are a barrier to our NHS filling vacancies and providing the medical care that the British public deserve.

A survey by the Royal College of General Practitioners found that around 30% of all IMG trainees consider not working as an NHS GP because of all the difficulties and red tape with the visa process. The first of those difficulties is that IMG GPs are not eligible to apply for permission to stay permanently until two years after completing their training. GP training takes three years to complete, and it is only after five years that IMGs can apply for indefinite leave to remain, in line with wider UK visa rules. That problem is unique to general practice: other medical specialty training takes a minimum of five years to complete.

The second difficulty is that international GPs must find employment with a GP practice with a visa sponsor licence before their existing visa expires in order to be eligible for a visa that allows them to stay and work as a GP after their training, and ultimately apply for permission to stay permanently. However, practical and bureaucratic obstacles can make that extremely difficult, because GP practices may struggle with the costs and bureaucracy associated with obtaining a licence to sponsor a foreign worker. The Royal College of General Practitioners warns that the cumulative effect of visa difficulties on IMGs is that some are

“feeling forced to take roles elsewhere in the NHS and others considering leaving the NHS, and in some cases the UK, altogether.”

The Government have so far been utterly intransigent on the issue of IMGs, and on tweaking the visa system to remove the red tape. Labour would look closely at the issue as part of our wider improvements to the points-based system. Those improvements would involve the Government working hand in hand with employers, trade unions and other key stakeholders to ensure that we have a properly planned, sector-by-sector approach, with a proper strategy that works for businesses, workers, the public sector, customers and patients alike. As part of that, we will review the length of work visas, processing times and the existing path to citizenship to ensure that they are all working for our economy and for the public.

Labour already has a long-term workforce plan for the NHS. That involves doubling the number of medical school places, which in turn will deliver more home-grown GPs. At the heart of the plan is the doubling of medical school places—an increase of 7,500—which means we will double the number of doctors trained in a year. Our shadow Health Secretary will also produce long-term workforce plans for the NHS for the next five, 10 and 15 years, which will ensure that we always have the NHS staff we need to get patients treated on time. The plans will not only provide good jobs for British workers and fill shortages in our NHS, but prevent us from having to do dirty deals, as mentioned earlier, with some of the poorest countries in the world—those on the WHO red list—and from recruiting medical professionals from impoverished communities that desperately need that medical knowledge locally. That is exactly what the British Government have done recently with Nepal.

In the short term, Labour has consistently pushed for a fix to punitive doctors’ pension rules. The fix would do away with the cap above which NHS workers incur additional tax burdens. That would support short-term recruitment and prevent the exodus of workers. The Government are yet to deliver on that.

The Labour party is committed to making the points-based system work, and to our NHS workforce plan. The current system is simply not fit for purpose, and at this time of crisis we risk losing newly qualified GPs because of unnecessary red tape. The Conservatives have broken promise after promise on GPs. Their 2019 manifesto promised to deliver 6,000 more GPs by 2024-25. The former Health Secretary, the right hon. Member for Bromsgrove (Sajid Javid), admitted that the Government are not on track to deliver that.

In contrast, the next Labour Government will put patients first, ensuring that they are able to get a face-to-face appointment when they want one, bringing back the family doctor to deliver continuity of care and implementing our workforce plans. The current Government are out of ideas, and we need practical solutions.

[Steve Brine]

It is interesting that the hon. Gentleman mentioned continuity of care, because he will be aware that that came up yesterday during Health questions. Would the Opposition introduce direct management of lists back into the GP contract from when it is next renegotiated? That is how we achieve continuity of care.

[Stephen Kinnock]

The key piece of our plan is to cancel non-dom status, which is estimated to generate approximately £3.2 billion for the Exchequer, and to use that money to invest in more GPs, doctors and nurses—indeed, doubling the numbers. We can have the best plans and legislation in the world, but we need the resources to deliver them. That is how we will pay for our plans and generate the kind of care that we need for our public. It is time for that Labour Government, so that we can clear the backlogs holding our country back, which we see right across Government, and get Britain’s public services back on track.

15:15

[The Minister for Immigration (Robert Jenrick)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank my hon. Friend the Member for Boston and Skegness (Matt Warman) for securing this important debate, and all Members who have contributed. The Government recognise the vital contribution that doctors and other health and care professionals make to the United Kingdom and our NHS. Of course, Dr Rachel Warman is my favourite doctor, and she has no doubt helped to inform the quality of my hon. Friend’s remarks.

By happy coincidence, I am both the Minister for Immigration and formerly the Minister responsible for the NHS and the recruitment of doctors domestically and internationally, so I understand and appreciate the importance of the issues raised. This is clearly a timely debate, because the NHS faces a significant workforce challenge. About 10% of the roles in the NHS are vacant, and a larger number are vacant in social care. We all need to be focused on creative ways to resolve the challenge, including, as has been said, on retaining more of our existing GPs and other health and social care professionals.

Last month, the former Health Secretary, my right hon. Friend the Member for Suffolk Coastal (Dr Coffey), and I announced changes to the pension provision for doctors to encourage more of them to stay in the NHS for longer, to work longer hours and not to resort to private practice as quickly as some are doing. Those changes will make a difference, although I appreciate that the BMA and a number of organisations wish the Government to go further.

We are keen to recruit and train more GPs and doctors in the UK. Persuasive arguments have been made for raising the cap on medical school places, including by the hon. Member for Aberavon (Stephen Kinnock). That is an important debate to have, and one that I am sure will find favour with the new Chancellor, who has raised the matter many times in the past. In the interim, it is clear that we will need to rely on more international recruitment of doctors and nurses. That is exactly what the NHS is doing at the moment. For example, as a result of significant retention issues the Government are succeeding in recruiting a large number of nurses internationally. We need to make that process as simple and efficient as possible for the benefit of the NHS and trusts that are undertaking that recruitment exercise, but also for patients.

Hon. Members will be aware that in 2020 the Government delivered and built on the commitment in our manifesto to introduce a route that made it quicker, easier and cheaper for qualified medical professionals to come and work in the UK. That was the health and care visa, which provides a significantly reduced visa fee and a dedicated Home Office team to process the applications. A number of Members understandably referred to Home Office backlogs, which do exist in some areas; most vividly, in the last week, we have had a national conversation about the backlog of asylum cases.

Applicants for the health and care visa get a gold-plated service. Health and care visas provide cheaper fees and quicker processing, and the aim is to process applications within three weeks. Understandably, there has been an impact on processing times this year, primarily because the Department chose to redeploy so many of its professionals to work on the Homes for Ukraine scheme and other refugee and resettlement schemes, but it is our intention to get back as swiftly as possible to the service standard. In fact, we have set a target of reaching that by the end of the year and continuing to meet it into next year while continuing to manage the very large number of individuals coming from Afghanistan, Ukraine and other parts of the world that are in distress.

[Jim Shannon]

I recently chaired an event in Portcullis House on a completely different matter. When I came out, the people taking over the room were getting ready to give a presentation about how Ukrainians with medical skills could help the UK. I am not sure who the sponsor was, but I will try to find out, and the Minister’s staff might do the same. It took place at 2 pm in room Q in PCH. I had to go to another event, so I could not stay, but it seems that there are a number of Ukrainians here who have medical skills that could be used in the NHS. That is just a thought.

[Robert Jenrick]

Of course, adults who come to the UK on the Homes for Ukraine scheme have the right to work, and we actively encourage them to do so while they are here. There has also been an exercise across Government, which I have not been personally involved in, to help them to find equivalent professional qualifications while they are here, and to break down any barriers. I would be happy to look into whether there are remaining issues for doctors and nurses from Ukraine while they live here on the three-year visas that we are granting.

Some 30,700 nurses and 14,900 doctors obtained a health and care visa up to the end of August this year. In total, including care workers and other professionals, 96,000 such visas have been issued—a very significant number, which accounts for 52% of all skilled worker visas that have been issued to people taking up work in the health sector. I would like to think that that innovation has been a success, but we take seriously the legitimate concerns that have been raised in the debate and that we have heard from royal colleges and others. Let me now turn to some of those concerns and what we might be able to do to assist.

As my hon. Friend the Member for Boston and Skegness said, the Royal College of General Practitioners has made a number of suggestions. We believe that the best way to increase the number of international GPs taking up places in the UK is for GP practices to register as Home Office-approved sponsors. The Government have run a number of engagement events that aim to explain the sponsorship process. Sponsorship is not supposed to be onerous, and the Home Office believes that it is not as onerous as some people clearly perceive it to be. Over 48,000 organisations are licensed sponsors of skilled workers, and many are high-pressure, small organisations, such as GP practices. However, there is clearly an issue—whether in reality or in perception—so I have two proposals to answer the concerns raised by my hon. Friend.

First, I am prepared to consider other sponsorship arrangements suggested by the sector, provided that they are consistent with the sponsorship system and that the sponsor can continue to discharge the important duties of a sponsor, which enables us to ensure that the overall system is robust and defensible. In principle, the sponsor could be an appropriate national body, such as Health Education England. It has not approached us to ask to be such a body, but I would be open to considering that. As my hon. Friend the Member for Winchester (Steve Brine) suggested, the sponsor could be an integrated care board in England or an appropriate body in Scotland, Wales or Northern Ireland, or it could be a royal college. I will therefore ask my officials to work with the sector to see whether there is a way forward to create umbrella bodies, if there is mutual support on both sides, with the caveat that any umbrella body would need to discharge the required duties in law to ensure the robustness of the system.

Secondly, in the interim my officials would be happy to run further engagement events with the sector to talk them through how straightforward they believe it is to be a sponsor. I encourage anyone listening to the debate to get in touch with the Home Office if they would like us to host an event in their area or with their part of the health sector. I have asked my officials to organise at least one such event in the weeks ahead. We will take account of any feedback that we receive at these events, and if it is true that the system is simply too complex and burdensome, I have asked them to report back to me with that feedback and we will take it into consideration.

The shadow Minister—the hon. Member for Aberavon —and others, including my hon. Friend the Member for Boston and Skegness, raised the fundamental question of whether five years is the right length of time to demonstrate an individual’s commitment to the UK. That is a profound question, and it is important that we approach it fairly, rather than hiving out individual sectors, however important they might be for our economy or our public services. Although I am sympathetic to the arguments around granting GPs settlement on completion of their training, my view today is that it is better to stick to five years because that has been, by the long-standing convention of this Government and their predecessors, considered the right length of time for an individual to demonstrate sufficient commitment to the United Kingdom to obtain indefinite leave to remain. We should value indefinite leave to remain, because it is an important and significant moment for anyone committing to life in our country.

[Stephen Kinnock]

I thank the Minister for setting out that clear position, but does he agree that the nature of that kind of commitment—the three years, and the type of work that somebody studying to be a general practitioner is looking into and wants to do—is in itself a demonstration of something extra in terms of commitment to the United Kingdom? It is not as if they are coming here to work for a foreign company. Should such people not be given some kind of exceptional treatment because of the nature of the work? That is an open question.

[Robert Jenrick]

The hon. Gentleman makes a valid point. Of course, one could apply that to a number of other regulated professions, whether that be lawyers, nurses or others making significant contributions to the United Kingdom. It is an important step to obtain indefinite leave to remain, and not one that we should give away lightly. Asking an individual to spend five years here in order to demonstrate that level of commitment to the UK feels to me about the right length of time, but I am open and interested to hear other contributions on that point. At the moment we do not have plans to reduce the length of time that skilled workers would need to complete in the UK in order to apply for settlement.

The SNP spokesperson, the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald), raised a number of cases that I am aware of from my former role at the Department of Health and Social Care about allegations of the mistreatment of foreign workers—including doctors and nurses—coming to the UK. That is something we take seriously, and the Department of Health and Social Care and NHS England are investigating. If I receive further information from the Ministers in the Department of Health and Social Care, I will be happy to write to the hon. Gentleman.

On the broader question of the ethics of recruiting healthcare professionals internationally, the NHS takes that responsibility seriously. We have ethical guidelines nationally that are set by NHS England and individual trusts in England—that may well be the case in Scotland as well—and of course we take heed of the red lists, which give a strong indication of countries from which we should not be recruiting healthcare professionals because they clearly need them to satisfy their own healthcare requirements. The NHS proactively works with countries that have an excess of doctors and nurses, or that train individuals specifically for export. In fact, one of the last meetings I had as Health Minister was with the Chief Minister of the state of Kerala, which specifically trains nurses to be exported to other countries around the world.

That sort of arrangement is sensible and defensible by the UK, although it is not a sustainable answer in the very long term because we live in a globally ageing society; there will be competition from other states to recruit professionals. That is one of the many reasons we should be training more doctors and nurses in the UK and considering measures such as raising the cap on medical school places, if we are able to do so. That, of course, is a matter for the Treasury and the Department of Health and Social Care, not my Department. It is worth saying that it is an extremely expensive measure over time, and that the Opposition’s proposal would cost several billion pounds to deliver. That is not to say that it is not an important step, but it is worth bearing in mind the significant outlay.

[Steve Brine]

The Minister is responding very clearly to the points raised. What we really need is an independent health workforce assessment, supported by the Treasury. He will be aware that that was called for by some Members who are no longer on the Back Benches. Dare I say that he could encourage that through his good offices, because only once we have the answer will we get to a better place. If we ask the NHS what we need it will answer with what we can afford. Those are not the same questions.

[Robert Jenrick]

For a long time I have believed that one of the virtues of a national health service is that it should be able to plan for its workforce needs long into the future. My hon. Friend raises the specific campaign of our right hon. Friend the Member for South West Surrey (Jeremy Hunt), when he was Chair of the Health and Social Care Committee. I am sure that he will consider that carefully now that he has his hands on the controls as Chancellor of the Exchequer.

[Stephen Kinnock]

The Minister rightly mentions value for money. The British taxpayer pays for the training of international medical graduates in this country. Will the Government consider doing a value-for-money assessment of what the British taxpayer pays for people who train to be GPs but end up leaving our system all together because of all the visa issues? Is that not a waste of taxpayers’ money?

[Robert Jenrick]

The hon. Gentleman raises an important point. It really is a matter for the Department of Health and Social Care. I do not want to stray too far into policy questions that are rightly its domain, but clearly the UK benefits from retaining as many doctors who train here as possible. Staying will not always be the intention of those coming to the UK—many clearly want to make use of our world-class medical education and then return to their country of origin, or other countries that, for lifestyle reasons, they want to live in—but we benefit from encouraging more to stay.

[Stuart C. McDonald]

I have one final thought. I appreciate that the Minister will go away and task officials with looking at a possible umbrella sponsor—that is very positive news. The other issue is the length of visa for IMGs. From the Health and Social Care Committee inquiry, it appeared that there is a severe pressure between finishing up and being able to find a job. Extending the grace period a little might allow more people to stay.

[Robert Jenrick]

I will happily add that to the list of homework for my officials after the debate.

I thank my hon. Friend the Member for Boston and Skegness for securing this important debate, and the many colleagues on both sides of the House who have attended to register their interest in the topic. I assure them all that we will reflect carefully on the points raised, and in particular that I will task my Home Office officials to work with stakeholders in the sector to give greater consideration to the central question of whether there is a simpler way in which GP practices can apply for relevant visas. If that can be delivered by appropriate umbrella bodies, we would be pleased to see whether it can be taken forward.

15:30

[Matt Warman]

We are all hugely grateful for the fantastic work that doctors do for us all, as the Minister alluded to. I do not just say that because I am married to one, although it brings it home—literally. In the course of the debate, the Home Office has been accused of intransigence. Within days of his arrival, the Minister has demonstrated more progress on this important issue in the commitment that he has made to us today than we have seen in some years. He is the human embodiment of cross-Government working in the sense that he brings together the Department of Health and the Home Office remits. We could all learn from the value of cross-Government working. I am immensely grateful to all Members who have brought the issue to life, and I look forward to continuing to work with the Minister on the outcome of the review, which will make a real difference to our constituents, and to doctors up and down the country.

Question put and agreed to.

Resolved,

That this House has considered visas for international doctors.

15:30

Sitting suspended.

Airport Parking Charges

Wednesday 2nd November 2022 Westminster Hall

16:00

[Sir Bill Wiggin (North Herefordshire) (Con)]

I beg to move,

That this House has considered airport parking charges.

Drivers are being forced, tricked or directed to pay extortionate amounts to drop off or collect passengers at airports. To make matters worse, two thirds of the UK’s busiest airports have put their prices up. Of course, airports are entitled to charge when the land is privately owned, but the taxpayer has already paid for the road up to the airport. Yet the signposts do not send the driver to a safe and free place for drop-off or collection. No-stopping zones on the roads leading up to the airport mean that the principles of choice and safety are not obvious. That means that drivers are being deliberately exploited.

Airports must be required to offer drivers a free and safe place to drop off and collect passengers, and, where they do, that must be clearly signposted on the approach to an airport. Although it may seem that there are craftily many different options for parking at airports, given the pressure of traffic, it is chaotic and stressful for drivers to locate the correct one.

The increasing number of train strikes mean that many passengers depend on a friend or relative to drop them off at an airport. As a result, those drivers suffer, rather than the actual holidaymaker. In that sense, the drop-off charge is a small tax on generosity. Failure to signpost free options effectively means that drivers are at risk of breaking the law either for stopping on a nearby roundabout or for dropping someone off on a red route leading up to the airport; such routes are rightly enforced for reasons of security. Indeed, drivers caught stopping on those red routes are fined £100.

In 2019, the Parking (Code of Practice) Act received Royal Assent, promising greater regulation to prevent motorists from being treated unfairly by private parking companies. Airports were considered as part of the code of practice. However, this June, the private parking code of practice was temporarily withdrawn,

“pending review of the levels of private parking charges and additional fees.”

It would be welcome if the code of practice brought greater clarity and consistency to airport parking charges to better regulate the industry for both airports and motorists, which I believe the Government have a duty to do.

Ironically, the Civil Aviation Authority, in its review of market conditions for surface access to airports, claimed that environmental factors played a part in airport parking decisions. The Airport Operators Association, which represents over 50 UK airports, claims that high airport parking charges are there to force consumers to travel to and from airports sustainably. Nice try, but everyone knows that aeroplane journeys emit far more carbon dioxide per passenger than cars over set distances. Who are airports trying to fool by claiming to be going green by charging higher parking fees to deter a few short car journeys while air travel accounts for 2.5% of global CO₂ emissions?

It is right that the Government encourage people to use public transport, which does not incur a drop-off fee. However, with the looming threat of militant unions striking, would you really rely on public transport to get to the airport on time, Mr Stringer?

Last week, I met Nicholas Lyes, head of roads policy at the RAC, who informed me that in theory, some airports provide free drop-off options. However, Heathrow and Gatwick airports, which used to provide free drop-off points, now charge £5 to enter the drop-off zone by the terminal. Imagine if people knew they had a choice—which they do not. On top of that, at Gatwick, people are then charged £1 for every minute over and above the allocated 10 minutes at the drop-off site. To enter through the barrier—again, with no choice to escape—find a parking space, park, unload baggage, say goodbye, and exit through the barrier all within the allotted 10 minutes seems optimistic for anyone, let alone those who are elderly or families with young children. Most expensive of all is London Stansted, which charges £7 for just 15 minutes’ parking and £25 for more than 15 minutes in drop-off zones. In the case of Exeter airport, there is no free option at all. Do the Government really expect someone to throw their loved one out of the car miles away from the terminal in order to avoid being fined?

With flight delays becoming increasingly common, those collecting family and friends who must find a place to wait could end up paying through the nose through no fault of their own. The UK Civil Aviation Authority has recorded that in 2022 the average flight delay has increased to 25 minutes per flight, up from 15 minutes in 2019. At Bristol airport, those giving a lift to friends and family are required to pay £5 for just 10 minutes to drop off or collect them. That fee increases to £7 for between 10 and 20 minutes, and £20 for between 20 and 40 minutes. That seems excessive for someone who is merely trying to collect someone whose flight has been delayed for half an hour, yet drivers collecting passengers from delayed flights are left with no viable alternative.

Recent airport staffing shortages have also led to lengthy delays of several hours at passport control in airports such as Heathrow and Stansted. With delays at airports becoming increasingly commonplace, those collecting passengers are left unsure of how long they will be required to wait—what initially seemed like a 10-minute wait might quickly become an hour. Where are those people supposed to wait that does not charge extortionate prices?

Additionally, not all taxi drivers are exempt from the charges. In the event of a long delay, a taxi driver on a pre-booked job might see his profit completely slashed because of the waiting times, meaning that through no fault of his own, he would have done better to have stayed at home. Bristol airport is one of the very worst offenders, using vans with cameras to follow drivers and try to levy fines for stopping, irrespective of how confusing that airport’s signage is.

Airports are exploiting their own regulations just as rogue parking firms used to. Drivers are forced to find the nearest free drop-off zone, which of course is impossible, as those zones are hidden. Where airports provide free options they tend to be far away from the terminal, and a shuttle bus to the terminal is not always provided. As a result, passengers with mobility issues or heavy bags are bound to struggle. Is my hon. Friend the Minister aware that, allegedly, the free option for drop-off at London Heathrow is located far away from the terminal, in the long-stay car park? I suggest that if someone were driving into an airport and looking for a place to park for a short amount of time, the long-stay car park would be the last place they would look. Passengers are then expected to take a shuttle bus to the terminal, only adding to their stress and to the extra time needed to catch a flight. I know that many airports are struggling for money, but do the Government think it is right that they attempt to hoodwink airport visitors to make up for it?

[Mr Jonathan Lord (Woking) (Con)]

I congratulate my hon. Friend on securing the debate, and for his very powerful words on the subject. In Woking, we have both Gatwick and Heathrow within a reasonable distance, and I have had a lot of correspondence from constituents about the removal of free drop-off parking. I am also a great supporter of aviation. During covid times, I helped my hon. Friend the Member for Crawley (Henry Smith) with his excellent efforts to support the aviation industry—both airlines and airports. As my hon. Friend the Member for North Herefordshire (Sir Bill Wiggin) said, airports have had a difficult financial time, but will he look to the Minister and, indeed, to airports to ensure that when we reach a new normal—as things might not go back to where they were before covid—that airports reinstate free drop-off parking, so that this ridiculous removal of any sort of free parking does not continue?

[Sir Bill Wiggin]

I agree with my hon. Friend, who quite naturally has delightful constituents who generously want to take their friends and family to and from the airport. Of course, that may not be an option for people who live further away. He is right to speak up for those people and insist that normality, which we all now enjoy, is returned to on parking as quickly as possible. When I finish this last blast, I know the Minister will do all he can about the theft from these poor, innocent and good people, who are just trying to do the right thing. That is why I believe it is essential that airports provide free and safe drop-off and pick-up points for motorists, as well as clear and helpful signs.

The Department for Transport must make it clear on approach roads where these free and safe options can be found. The Government need to ensure that the road tax payer has the right to remain on public roads, which we have paid for, rather than be herded onto private land where we are exploited. No amount of hand-wringing is acceptable, otherwise airports will continue to close. The greenwash, fudging and theft are wrong, and I know the Minister will do all he can to correct that as soon as possible.

16:12

[The Minister of State, Department for Transport (Huw Merriman)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate my hon. Friend the Member for North Herefordshire (Sir Bill Wiggin) on securing the debate on airport parking charges and delivering his asks with his usual robust purposefulness. I recognise that the issue will be of interest to many people who use our airports, in particular those travelling abroad again for the first time to see friends and relatives or go on a much deserved holiday. I have listened to and had the opportunity to speak to my hon. Friend. I have certainly taken into account his comments and will try to address most of them.

I will say at the outset that, in years gone by, I was involved in many consumer campaigns with Which? on the benefits of free access to airports and other transport modes. I agree that it can be frustrating when we use something that was previously free and then it is charged. As my hon. Friend the Member for Woking (Mr Lord) said, while many of these charges came in during the covid period, many had actually been planned in advance around the sustainability point and decarbonisation. I will touch on that later in my speech.

Increasingly, we are seeing airports transform into regional transport hubs that support multiple businesses, labour markets and population centres. They provide significant economic benefit to their local areas, and reliable and efficient surface access connections play an important part in achieving that. I am pleased, as I hope we all are, to see an increased demand for aviation and air travel as the sector continues to recover from the covid-19 pandemic, and I certainly recognise the contributions of both my hon. Friends on what they did to make that happen. It is important that we aim to balance the sector’s recovery with the UK’s environmental goals, as I touched on previously. We therefore expect that airports, through their surface access strategies, set targets for sustainable passenger and staff travel to the airport. These targets should, where possible, meet the ambitions set by Government and be monitored by their respective airport transport forums.

[Mr Lord]

I am rather disappointed in the Minister’s opening remarks, which seem to be on the side of the airports on sustainability grounds. When a family is going on holiday, perhaps with a frail elderly person or someone who is disabled, does it make any sense to have to go to the long-stay car park, unload all the baggage and try to get the disabled or frail elderly person on to the bus—only to have to do it all again on the way back? That is not right. I was not aware that the airports were thinking of introducing this pre-covid. The letter that I got from Heathrow when I wrote on behalf of constituents placed the main emphasis on the financial shortfall over covid and said that the airport therefore needed to introduce the measures. I am surprised that the Government might support that.

[Huw Merriman]

I am sorry to be a disappointment to my hon. Friend. The situation we have is that unlike, for example, our rail provision, airports are private organisations and there will be a direct contract between those using the airport and the airport operators—it is down to them. I have indicated my sympathy as regards the requirement to put charging in. Heathrow’s expansion is predicated on its ability to reduce air pollution; that is one of the key issues in allowing Heathrow to expand. What the aviation industry and the airport operators are doing is responding to the need to reduce the carbon emission footprint around the airport. That is one such measure.

Drop-off and parking arrangements at most airports are subject to contractual agreements between airport operators and car park companies. Those arrangements are covered by consumer laws. Most airport websites contain information on the drop-off and car park options available at the airport, and recommendations on the best options depending on length of stay. I will go on to talk more about signage and information shortly, because that was one of the key requests from my hon. Friend the Member for North Herefordshire.

Most airports in the UK choose to charge a premium for drop off at their terminals. I understand that Cardiff, Bristol and Birmingham airports, all of which are closer to my hon. Friend’s constituency, charge fees for the use of drop-off zones. I recognise that the introduction of a charge for dropping off passengers, when it might have been free of charge previously, may be frustrating to some motorists. However, the provision and charging of car parking at airports, including drop-off charges—this comes back to the point I made to my hon. Friend the Member for Woking—is a matter solely for the airport operator, as a commercial business, to manage and justify.

The arrangements for drop-off charges at airports are not a tax on the motorist; they are a contractual arrangement between the airport, the car parking company and the driver. That is the same as the different charges for the use of short and long-stay car parks, which can be located further away from the terminal buildings. It is a choice that the driver can make when planning their trip to the airport, but I recognise that some people have more choices than others because of mobility. I recognise the points that have been made about that.

[Mr Lord]

I have two points. On the point the Minister just made, normally a service provider will provide a service for which they charge. There is no service being provided. We just want an area where we can drop off our passengers. To go back to the earlier point about sustainability and air quality around Heathrow: if that was a main driver, should not electric and low-emission vehicles be able to drop off for free?

[Graham Stringer (in the Chair)]

Order. I remind the hon. Gentleman that interventions should be short and to the point.

[Huw Merriman]

I will go into detail on the second point, but to come back to the point about electric vehicles, that is something that airports are developing. They are slightly hampered by the lack of HGVs, but it is something that they are working on in conjunction with other matters.

Let me address the point that drop-off zones were supposed to be temporary during covid. Airports have been implementing drop-off zones and charges since before the pandemic, as part of their work on delivering sustainable and affordable travel options. Charging for the use of drop-off zones may encourage airport users to make more journeys to airports by public transport, which will assist with the wider sustainability ambitions of the Government. However, I recognise that at airports such as Bristol, rail options are few and far between. As demand for air travel returns, with people understandably keen to resume their lives, airports have further indicated that drop-off charges will help to avoid a car-led recovery.

I know that information and signage is important to my hon. Friend the Member for North Herefordshire. Given the choice for drivers, it is even more important that airports are transparent in their parking offer. The Government expect and encourage airports to be clear on the available choices for parking on their websites, along with information on how to access them. I agree with my hon. Friend’s comments on this matter. This information must ensure that there is a clear and visible signage point at the airport to ensure that drivers are well informed and aware of the arrangements and requirements, as well as the other parking options. I have raised this matter with my colleague, the aviation Minister, Baroness Vere, to see whether we can underline the importance of this matter in our communication with airports, and she has confirmed she will do just that on behalf of my hon. Friend the Member for North Herefordshire.

[Sir Bill Wiggin]

I thank my hon. Friend for that. I want to say a huge thank you. What upsets us is that we have paid for a public road and then we are fined for parking, and there has been no opportunity to choose. Choice is the key. I do not mind if we have to pay for environmental things, or if we are being distracted or even being sent places we do not want to go. However, we really do need a choice, because, as taxpayers, we have already paid for the road. I thank the Minister very strongly indeed.

[Huw Merriman]

That is very kind of my hon. Friend. As a constituency MP who has long been frustrated when people are not treated as they should be, I know that information is key, so I completely agree with him.

Government guidance on the use of signage on public roads can be found in the Traffic Signs Regulations and General Directions 2016, which prescribe the design and conditions of use for traffic signs, including road markings. Parking trade associations such as the British Parking Association provide guidance in their codes of practice to their members on the use of signage, with due regard to the existing regulations. All of that goes alongside the assurance I have given my hon. Friend.

Earlier, I mentioned that airports are responsible for setting their surface access strategies. I encourage airports to set out their intentions in respect of drop-off charges and parking, and to use specific airport transport forums to develop and oversee the implementation of plans for future surface transport provision. That will help not only to prevent confusion and the risk of drivers inadvertently entering drop-off zones, but to reduce the chances of accidents due to drivers taking evasive action to stop themselves entering such zones. All of this will, I hope, assist in making each stage of the journey to an airport as easy as possible. If drivers feel that signage at airports does not make them aware of the arrangements and requirements for drop-off charges, they can submit an appeal to the Parking on Private Land Appeals Service. We will continue to keep this provision under review as part of the Government’s work on a single code of practice for parking companies.

On the provision of alternatives, I welcome the consideration my hon. Friend the Member for North Herefordshire has given to alternatives to drop-off zones, including the use of other car parks, both short and long stay, although I hear his point about how far away long stay actually is. While I accept that additional transfers are required, I would make the point that, at the very least, long-stay car parks provide an alternative to paying. Airports including Gatwick, Manchester and Bristol offer free drop-off zones at designated car parks a short walk from the terminal or with the option of a shuttle bus service. I encourage airports to ensure that such options are readily available to drivers so that they can plan their journeys in advance.

I note the concerns raised by my hon. Friend that motorists may incur additional parking costs through no fault of their own when delays or disruption caused by late flights or industrial action result in a longer than expected stay. I note his example of the charges at Bristol airport, where the drop-off zone charges are £5 for up to 10 minutes, £7 for between 10 and 20 minutes and £10 for between 20 and 40 minutes. I note that Bristol’s short-stay car park is often cheaper for the same amount of time—having done some earlier research, he will be glad to hear—costing £5 for up to 20 minutes or £7 for between 20 and 40 minutes.

Airports already highlight the potential disruption to passengers and how that might affect their journeys. Again, I would be happy to raise with the aviation Minister what more airports can do to ensure that drivers and passengers are well informed and offered flexibility of provision if there is disruption. I acknowledge that at some airports, such as Bristol, there are no rail links and alternatives to cars are more limited; Civil Aviation Authority figures for 2019 highlight that 68.3% of passengers arrive by car.

On the regulation of airport parking, if an airport contracts a private parking operator to manage parking on the land, the parking operator must be a member of a trade association and follow its respective codes of practice and appeals procedures. The two trade associations are the British Parking Association and the International Parking Community. Their codes set out the requirements that parking operators must follow, including on signage, if they wish to access the Driver and Vehicle Licensing Agency data to issue parking charges to the owner of a vehicle. Both associations offer, on behalf of their members, an independent appeals service to motorists who receive a parking charge and wish to dispute it. On my hon. Friend’s point about the proposed parking regulations being withdrawn, that has indeed been the case due to judicial review, but I look forward to the regulations coming back, to see how they can be further improved upon.

I again congratulate my hon. Friend the Member for North Herefordshire on securing this debate. It has been an opportunity for both him and my hon. Friend the Member for Woking to draw attention to expectations for car parks at airports—that they should be managed appropriately and that consumers should be treated fairly. I assure my hon. Friends that the Government are keen to improve the regulation of the parking industry. We continue to consult on changes to parking charge levels and additional fees with the industry, with the aim of reissuing the parking code of practice as soon as possible.

The charges associated with car parking at airports are solely a matter for the airport operator to manage. Airport users entering into parking arrangements are covered by consumer law. We will all ensure that such arrangements treat the airport user fairly and respectfully, and we will see what more can be done on the points that have been raised.

Question put and agreed to.

International Students: Contribution to the UK

Wednesday 2nd November 2022 Westminster Hall

16:29

[Alyn Smith (Stirling) (SNP)]

I beg to move,

That this House has considered the contribution of international students to the UK.

It is a pleasure to see you in the Chair, Mr Stringer, and to see so many colleagues here today.

The contribution that international students make to our domestic society and economy is a subject close to my heart. I was an international student and did my Erasmus year at Heidelberg University, and I did a master’s at the College of Europe in Warsaw. Prior to that, I studied in Scotland’s near abroad—Yorkshire—at Leeds University, and at Nottingham Law School. We must not lose sight of the important fact that so many of the world’s best and brightest are willing to come to our countries and work with us towards the light of science.

I declare an interest as vice-chair of the all-party parliamentary university group. It is a pleasure to see so many good colleagues from the group present, and I look forward to the discussion. I am grateful to a number of organisations for the briefs that we have had prior to the debate, particularly Stirling University in my constituency, Forth Valley College, Universities Scotland, Universities UK, the Russell Group, Imperial College London and UCAS. I refer colleagues to the House of Commons Library brief, which provides a really good state of play on where things are and a very helpful overview of the situation.

I stress that this is a good news story. Since I came into the House of Commons in 2019, I hope it has been clear that I do not do point scoring. I am here to work towards a common ambition: I want to see the UK do well. Global Britain is not the Scottish National party’s project. I believe that Scotland’s best future is as an independent state back in the European Union, and we will have a referendum about that in due course—it is not for today. In the meantime, it is important for me to say to colleagues that I do not wish global Britain harm. If I were trying to undermine global Britain, I would cut the international aid budget, defund the BBC World Service, shut down British Council organisations worldwide and jeopardise our contacts with the European Union. All those things are happening under the Government right now, and I ask the Minister, whom I do not regard as part of the problem, to urge his colleagues to stop them.

This is a success story and a good news story. The contribution that international students make to Scotland and the UK is significant, but it is a success story that cannot be taken for granted. Scotland and the UK have a huge interest in this issue, although Scotland’s interest is disproportionate. In 2020-21, 24.1% of university enrolments in Scotland came from outwith the UK, compared with 22.2% in England, 21.3% in Northern Ireland, and 14.9% in Wales. All the home nations have a significant interest in retaining and attracting international students, but Scotland has a disproportionate interest in doing so. We have an interest in the UK Government’s policies, particularly on immigration, that threaten progress on this matter, which is surely in all our interests.

In 2020-21, we had 5,000 international students based at Stirling University—30% of the campus-based student population. UK-wide, the number is obviously bigger, with 605,100 international students at various higher education institutions across all our constituencies and countries. We are talking about hundreds of thousands of the world’s best and brightest, who have paid us the supreme compliment of coming to our home to work with us. I am conscious that a number are watching, and I say to them, “You are welcome here. You are welcome in our society. You enrich our society by your presence, and you enrich the institution that you are committed to. You are working with us towards a global science.”

[Kate Green (Stretford and Urmston) (Lab)]

I declare an interest as a member of the board of governors at Manchester Metropolitan University. I agree with much of what the hon. Member is saying, except about independence for Scotland. I believe we are stronger together.

I endorse the hon. Member’s point about the value that is added by international students, particularly in commuter universities such as Manchester Metropolitan. Our students may have less opportunity to travel abroad because of caring and other responsibilities, and being able to mix with international students who come to our country to study gives them an important connection to the global economy into which they will graduate.

[Alyn Smith]

I thank the hon. Lady for her intervention, except for the part about independence, which we will probably come back to at some point. I strongly agree with her, and I pay tribute to her for the power of work she has done in the all-party parliamentary universities group.

I thank the international students who so enrich our communities and institutions by their presence—and that is before we get on to the economics. It is the dismal science, but the economic impact is considerable. To be clear with colleagues, that is not my starting point; I do not regard universities as money-making widget factories. Universities are seats of learning, seats of exchange and seats of research. They form a globally interconnected network of the exchange of people, ideas and knowledge.

There are only two things that drive human progress—science and art—and universities have a crucial role to play in that. It was Isaac Asimov who said:

“There is a single light of science, and to brighten it anywhere is to brighten it everywhere.”

Science is global. Universities are global by their very nature, and the exchange of students, people and ideas is fundamental to what they do. However, I am Scottish, and the money does not hurt.

The contribution of international students is significant. We have calculated that international students contribute £66.4 million net to the Stirling economy. For the whole of Scotland, their contribution is £1.94 billion net, and for the UK economy, a single cohort of international students contributes £25.9 billion net. At a time of straitened budgets and economic turbulence, we need to safeguard that progress, not undermine it either deliberately or by accident.

I am conscious of time, so I will wrap up on two particular points about the Government’s rhetoric, which risks undermining progress, and about EU relations, in which there is huge opportunity that the Government could unlock by changing course.

The comments by the Home Secretary and various other members of the Government about limiting international students are wrong politically, societally and economically. Limiting international students would be a “hammer blow”. Those are not my words, but those of Vivienne Stern, the chief executive of Universities UK. I will ask the Minister some questions from Universities UK that I think it is worth putting on the record—I appreciate that I am blindsiding him slightly, so I will happily accept a letter after the debate.

What assessments have the UK Government made of the economic cost—including the loss of tuition-fee income, living cost expenditure and knock-on expenditure —of restricting the number of international students and their dependants entering the UK’s world-leading university sector? Are the Government committed to retaining the graduate visa route established in 2021? That fact that it is under threat is utterly wrongheaded, but it has been called into question by some senior people, so I would be very grateful for reassurance that it is safe. Are the Government committed to the successful international strategy outlined in 2019, including the target to host 600,000 international students, which has since been achieved, and to bring in £35 billion of export income every year by 2030?

Before turning to EU links, I declare an interest: I was a Member of the European Parliament from 2004 to 2019, and as a member of its Committee on Industry, Research and Energy, I helped draft some of the regulations on Horizon Europe and on student and educational exchanges, so this matter is close to my heart. Scotland and the UK are research-intensive places, and Scottish and UK involvement in the EU frameworks for this stuff is a win-win-win for everybody. I regret deeply that the UK has left the European Union, but I am not here to fight old battles. There are ways of interacting with what is going on in the EU that stop short of EU membership.

I was in Brussels recently and in Berlin just the other week. There is a real willingness on the part of our European friends to see the UK play a full part in institutions and networks such as Horizon Europe, Erasmus+, Copernicus and Euratom. As I have said, it is a win-win-win to be part of those projects, but a chill is under way: in Erasmus, there has been a huge reduction in the number of EU nationals applying to UK institutions, which is deeply regrettable.

On 22 July, the EU announced the cancellation of 115 grants for UK-based scientists because they were not part of the reference networks or frameworks. There is a big prize here: Horizon Europe is worth €95.5 billion, and that money could—but does not—work towards not just the EU’s science but our own. The single biggest thing blocking progress on all those fronts, and that holds back our universities and academics, is the lack of trust between the UK Government and the EU.

That lack of trust has crystallised around the Northern Ireland Protocol Bill. The fact that the UK introduced that Bill, which has been passed by the House of Commons and is now in the other place, calls into question the UK’s good faith on all of this stuff. The EU will not allow us an ad hoc, legally undefined membership when the UK is clearly willing to rip up legal order, as it has done with the Bill.

Let us scrap the Northern Ireland Protocol Bill. That would unlock progress on all these real-world opportunities and give our university sector and our students an advantage. There is a huge prize to be won. Global Britain is not part of the SNP’s project, but academic exchange is. We very much want to be part of the exchange of ideas and people, and I want to see the UK play a full part in that. I am grateful for the discussion, and I look forward to questions and comments, and, above all, to the Minister’s response.

16:39

[Paul Blomfield (Sheffield Central) (Lab)]

It is a pleasure to contribute to the debate with you in the Chair, Mr Stringer, and to welcome the Minister to his position; his is probably one of the better appointments made recently. I am pleased to contribute to the debate as chair of the all-party parliamentary group for international students, a role that I share with Lord Bilimoria, the former president of the CBI. An important part of our role is celebrating the contribution of international students, so I am grateful to the hon. Member for Stirling (Alyn Smith) for securing the debate and for many of the points and questions he raised.

My constituency of Sheffield Central—as you well know, Mr Stringer, as one of our graduates—has more students than any other constituency. We know the huge value of international students, but it is important that we do not stop the discussion at their contribution to the local economy. As my hon. Friend the Member for Stretford and Urmston (Kate Green) said, they also enrich the learning experience of UK students—what an extraordinary opportunity for UK students to study alongside students from so many other countries and continents, all providing their input to classroom discussions. In addition, they enhance the cultural vitality of our city, and they provide us with ambassadors for Sheffield when they move on and continue their lives in business, politics and other areas.

Recognising those benefits, our APPG makes the case for policies that encourage and support the recruitment of international students. It seems obvious that we would want to do that, but that has not been the case. Back in 2010, when David Cameron was elected with a pledge to reduce immigration to tens of thousands, the then Home Secretary, the right hon. Member for Maidenhead (Mrs May), went for easy wins on immigration numbers—despite the damage to the UK—by cutting the number of international students, removing the graduate visa route and putting in place other barriers. That was celebrated by our competitors in Australia, Canada and the US. I remember hosting an event with the former Australian higher education Minister, who began by saying, “I would like to congratulate your Home Secretary. Without her efforts, we wouldn’t be doing so well in recruiting international students to Australia.”

With strong, genuine cross-party support, the APPG campaigned for seven years for change, and in 2018 we produced our inquiry report, “A Sustainable Future for International Students in the UK”. I am pleased that our two main recommendations—to set an ambitious target for growth of international student numbers and to offer a new post-study work route—were embraced by the Government in their 2019 international education strategy, which set

“an ambition to increase the value of our education exports to £35 billion per year, and to increase the number of international higher education students hosted in the UK to 600,000 per year, both by 2030.”

All of us on both sides of the House celebrated the Government’s ambition, and I thought that was the end of the argument—after seven long years, we had finally convinced people—but recent comments by the new Home Secretary provoked an awful feeling of déjà vu. Lessons learned have been forgotten; instead of tackling the real issues facing the Home Office—passport delays, visa delays, the asylum backlog, the failure to end dangerous channel crossings—the Home Secretary has turned to the distraction technique employed by the right hon. Member for Maidenhead.

Recent rhetoric has included tired tropes about overstaying and suggested the illegitimate use of visas. That has caused enormous offence in India, one of our most crucial markets not just for growing international student numbers, but for reducing our dependence on China, which dominates the market at the moment. It will also impact the Government’s attempts to secure a trade deal with India. If the Home Secretary tells international students that they cannot bring their families to the UK, as she seems to be suggesting, they will simply turn to one of the many countries that will say, “You’re welcome here.”

The problem is not only the policies but the rhetoric, which is beginning to undo the work that many of us who support the cause of international students have done to repair the damage that the Government caused. After so many years of international students being told that they are not welcome here, we have all come together, as the hon. Member for Stirling said, singing one song: “You are very welcome here.” The Home Secretary’s recent rhetoric undermines those efforts.

Although this is not just an economic argument, research from the Higher Education Policy Institute last year shows that international students bring nearly £30 billion a year to the UK economy, supporting jobs and businesses across the country. They play an important role in our universities and in enriching our campuses, and they bolster Britain’s place in the world at a time when we need it.

Locally, an economic impact assessment commissioned by the University of Sheffield, based on 2018-19 data, found that overseas students at the university—it is just one of our two universities—support £184 million gross value added and just over 3,000 jobs in the Sheffield city region. That is more than we employ in the steel industry in Sheffield. Those jobs are across a swathe of industries, from transport to hospitality, food and retail.

More recently, “The costs and benefits of international higher education students to the UK economy,” published by the Higher Education Policy Institute and Universities UK International, analysed the 2018-19 international cohort. I should probably declare an interest, because it found that Sheffield Central remains the top parliamentary constituency for net economic benefit. Every person in Sheffield and its surrounding area is £2,520 better off on average because of international students. They are hugely important for the university’s financial stability and for the sub-regional economy. That is the critical point.

We should recognise that universities are a unique public asset. They are distributed around all the regions and nations of the United Kingdom; the economic benefit is not concentrated in London and the south-east. Obviously, there is a significant number of fine institutions down here, but the benefit is shared around the country. If the Government are serious about their levelling-up agenda—obviously, we doubt they are—universities are a critical driver of economic activity all over the country. At a time when the Government claim to be focused on growth, it is utterly incoherent to reduce the benefits from one of our strongest exports—higher education.

[Kate Green]

My hon. Friend makes an important point about the wider benefits to local and regional economies. Part of the economic contribution comes from our universities’ capacity for research. Does he share my concern that if the number of international students declines, the contribution they make to subsidising the cost of research in universities will also decline, and that will make our regional economies and our national economy poorer?

[Paul Blomfield]

My hon. Friend makes a powerful point. That is absolutely correct, and it complements what the hon. Member for Stirling said about the way our research base is threatened outside Horizon Europe.

Frankly, the UK needs all the help it can get on the international stage. Given that the Government cannot decide whether it is worth turning up to key global events such as COP and are trashing our reputation by claiming that the jury is out on whether our key partners and neighbours are friend or foe, we cannot afford further mishaps. The QS World University Rankings assess universities on six key indicators, one of which is the international student and international faculty ratio. A highly international university demonstrates the ability to attract quality students and staff from around the world, and implies a highly global outlook and diversity of culture, knowledge and thought. It makes us more competitive. It is therefore hugely important that we maintain those numbers.

As for soft power, when I was campaigning for change I met the ambassador from one of our important allies in the far east, an important economic partner. We were talking about these issues and he said, “Paul, do you realise that three quarters of our Cabinet were educated at UK universities?” That is soft power that the rest of the world would die for, and it is hugely important. The 2022 HEPI soft power index shows the benefit of international students, with 55 world leaders having taken advantage of UK higher education.

I hope the new Minister will take on board these arguments and, with his colleagues in the Department for Education, do all he can to make the case to colleagues in the Home Office that we do not want to go through this again. Let us not have that whole seven years of making the mistake, trawling back from it, and then setting an ambition to do what has been undone by such negative policies.

I hope the Minister will not only answer the questions posed by the hon. Member for Stirling, but reflect on the implications for our universities, our regional economies and our international standing if we go back on the Government’s own ambition, set out in the international education strategy.

[Graham Stringer (in the Chair)]

I intend to call the SNP spokesperson at 5.10 pm at the latest. If Members wish to speak, whether or not they have written to Mr Speaker, will they stand to indicate that? That is a help to the Chair.

16:52

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to follow the hon. Member for Sheffield Central (Paul Blomfield), who genuinely brings knowledge to these debates, not just because he represents a university town but because he knows his subject. I want to put that on the record and thank him for it. It is also nice to see the Minister in his place. We have had a long friendship in this House, and it is not before time that he has been elevated to Minister. I am pleased to see him as a Minister for a subject in which he has a deep interest. I look forward to hearing what he has to say.

I congratulate the hon. Member for Stirling (Alyn Smith) on bringing the debate forward. For the record—I am sure he knew I would say this, but I have to say it—I disagree intensely with him on one matter that he referred to. He said that we should do away with the Northern Ireland Protocol Bill. No, no—we should get the Northern Ireland Protocol Bill put through this House. Then we can be equal to everybody else in the United Kingdom—those in Wales, Scotland and the rest of the UK mainland. It is not a matter of either/or. I want to speak about international students, the subject of the debate, but I also want to say very clearly that Northern Ireland MPs are anxious to see the Northern Ireland Protocol Bill go through as it is. Then we can all have the same level of representation and the same Britishness that we all love to have.

I am proud to hail from Northern Ireland. Queen’s University Belfast and the University of Ulster, as well as our other higher education institutions, are world class and attract a large number of international students. Northern Ireland has a sterling reputation for providing a high-class education. The result of that is a highly skilled education system, which others wish to feed from. Since the peace process and the cessation of troubles, we have seen a dramatic increase in international students coming to our shores, an unsurprising number of whom wish to stay on. We have many students who come to Northern Ireland, get good jobs, and stay there. How could they not, with all that we have to offer?

The latest statistics show that of the 66,245 students enrolled in Northern Ireland’s higher education institutions in 2021, 74% were from Northern Ireland, 5% from GB, 3% from the Republic of Ireland, 1% from EU countries and 17% from non-EU countries. They also suggest that international students from outside the EU are worth about £102,000 each to the UK economy for the duration of their study. That is not something we can ignore. There is a financial impact, and we want to continue to gain from it. Non-EU students typically pay much higher tuition fees than local, EU or UK students: they can pay between £15,000 and £30,000 a year for courses in Northern Ireland. We have a thriving higher education sector, which we wish to see retained and built upon.

Analysis suggests that international students delivered a net benefit of almost £26 billion to the UK in 2018-19. As the hon. Member for Sheffield Central referred to, this is a market that should clearly be encouraged, especially at our two local universities, Queen’s University Belfast and Ulster University. International students account for about £49 million of those universities’ income through fees and grants—a substantial amount of money for us in Northern Ireland—showing the importance of us having education at that level in Northern Ireland. The accounts of Queen’s University Belfast show that international students generated some £43.8 million in fees and grants in 2019-20, while Ulster University received just under £5.1 million in overseas student fees in the same period.

When we have education debates in this place and are talking about universities, I often refer to the partnerships that Queen’s University Belfast in particular has with big business, finding cures for illnesses across the world such as diabetes, heart disease and cancer. Those partnerships are incredible, and international students are part of making them happen. There have been a great many success stories over the past few years, and Queen’s University plays a critical part in those, as do other universities across the United Kingdom.

The students in Northern Ireland come from 135 different countries and are certainly a welcome addition. I am very pleased to see them coming, and I would like to build on that for us back home. I believe more should be done to encourage others like them to see the potential of study in Northern Ireland, with low rent, low-cost food—the past couple of months might not suggest that, but the costs are low compared with some places—and friendly locals with a warm and welcoming culture. I believe we are missing a trick by not promoting that more robustly. I think that, as other hon. Members have rightly said, we could do that for the whole United Kingdom.

Northern Ireland boasts world-class research facilities at Queen’s University and Ulster University, with both universities ranking in the top 10 across the UK for bioscience research. I referred to some of their research on cures for the ailments that plague us, not just in this United Kingdom but across the world. Their researchers are recognised as being at the forefront of technology, health data analytics, statistics, modelling, simulation and the use of artificial intelligence, which I know the Government here are keen to promote as well. Those are the good things that universities do, quite apart from their cultural value. The hon. Member for Stirling referred to the fact that when students come here, they bring much to this great United Kingdom culturally, individually, socially and emotionally. That is something we should cherish and try to build upon.

Northern Ireland has several unique advantages for medical research and clinical trials, with a small population of just under 2 million, an integrated health and social care system, and the electronic care record, which makes it possible to access digital health from cradle to grave. We have such a technological advantage in Northern Ireland, given our universities and the research they are involved with to try to find cures. We have much to offer, and now it is on us to promote that effectively.

I know the Minister always seeks to give us answers, so let me ask him whether, in the short time he has been in post, he has had any discussions with his colleagues in the Department for Levelling Up, Housing and Communities to secure funds to promote our UK-wide education system globally. If he has not had those discussions yet, I know he will. We have a great education system in Northern Ireland. I want to see it grow and thrive, and I believe this debate gives us an opportunity to help it do just that.

16:59

[Patrick Grady (Glasgow North) (Ind)]

It is a pleasure to serve under your chairmanship, Mr Stringer, and to catch your eye slightly spontaneously—it is much appreciated. I also congratulate my hon. Friend the Member for Stirling (Alyn Smith) on securing this important and timely debate. I did not necessarily need to speak, because I basically agreed with every single word that he said.

Like the other speakers, I am proud to represent a university constituency, and the University of Glasgow has an incredibly long and proud international history. I do not mean that as a cliché—it was literally founded by a papal bull in 1451, so it has a very long history indeed, and it is proud of its international outreach since that time.

One of the outstanding points in its history occurred in 1837 when it awarded James McCune Smith his medical doctorate. He was the first African-American to be awarded a medical degree, and went back to the United States, where he practised medicine and pharmacy and was an absolute pioneer and champion of the anti-slavery and equal rights movements in those days. Today, the James McCune Smith learning hub bears his name and sits proudly on University Avenue in the west end of Glasgow. It is testament not just to his achievements and to the university’s achievements over all the years, but to the very presence of the international students in such great numbers that have made the institution what it is today—as many of 14,000 of them, if I am reading the statistics correctly, across undergraduate, postgraduate taught and postgraduate research courses. They come from dozens and dozens of countries; as far as I can tell, practically every country in the world is represented by at least a handful of students on the campus and in our city, and that is testament to all the points that have been made by Members today. That is true of the city as a whole.

I am proud to represent the University of Glasgow. I am also proud to be a graduate of the University of Strathclyde, and everything that I say about what international students bring to the city and the country applies equally to the University of Strathclyde, to Glasgow Caledonian University, to Glasgow School of Art, to the Royal Conservatoire of Scotland and to the many further education institutions that the city and the country are so rightly proud of. As I say, that impact is visible across the city as a whole, in the shops, in the catering outlets and in the visible presence of the cultural festivals that the student cohorts bring to the city. It is present and visible in the way in which the campuses themselves have been shaped, with the incredible new facilities provided in the new buildings, many of which are available for use by the public as a whole, contributing to the society and economy of the communities to which the universities belong in exactly the way that we have heard.

The presence of international students, as other Members have said, raises ambitions and standards in the institutions and in the communities as whole. That is not without its challenges. Anyone, particularly students trying to find accommodation in Glasgow over the last few months, will be able to testify to that, and that is true of other cities as well. However, that speaks to the importance of creating a welcoming environment and the importance of having the infrastructure in place to support the presence of so many students. A big part of that involves providing certainty about numbers and certainty of access.

That starts to speak to the UK Government’s policies on funding for institutions, and particularly on access to visas and country entry requirements. It is not just about study visas, but about post-study work visas. This is not purely transactional, and students should not just come for three or four years, then leave again, but can be inspired to settle, make their home here and continue to contribute to our economy and society.

Sadly—and I suspect anyone with a university in their constituency will find this— the casework continues to suggest that is not always the case. I remember one of the very first constituents who came to see me in 2015 was literally a rocket scientist and could not get a visa to work here. In the end, I think we managed to make some kind of progress, but the people we want to attract are banging their head against the wall of the universe of the UK Government’s hostile environment policy. This is where, as with so much of the new Government’s agenda, the reality of their stated ambition is going to have to confront the practice of what they are trying to input because, if they really do want growth and a global Britain, putting up barriers to people coming here is contradictory to both of those things. It will not achieve either the outcome that they want to see or the outcome that those of us who believe in multiculturalism and internationalism want to produce: a growing and diverse society.

The main Chamber is currently discussing the concept of independence, and Government Members—and indeed some Opposition Members—want to make the case for the strength of the Union. However, limiting and undermining the ability of further and higher education institutions to attract students from all around the world is not an argument in favour of the Union. That does not speak to the strength of the UK.

Again, if strengthening the Union is one of this Government’s priorities, they need to look at their policies in these areas. I echo all of the points made by my hon. Friend the Member for Stirling and the hon. Member for Sheffield Central (Paul Blomfield), and, indeed, much of what the hon. Member for Strangford (Jim Shannon) said. I pay tribute, once again, to the incredible community at the University of Glasgow. Long may that internationalism—that outreach to the world and that bringing of the world to our fantastically diverse city—continue.

[Graham Stringer (in the Chair)]

I would just say, for the future, it really does help the Chair to allocate time if hon. Members stand if they want to make a contribution.

17:06

[Kate Green (Stretford and Urmston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I take on board your advice about making use of the time and ensuring that the Chair is aware in advance. However, since we have almost four minutes spare—you indicated that the Front Benchers would start speaking at 5.10 pm—this is an opportunity for me, on behalf of the universities in our city of Manchester, of which we are immensely proud, and the universities right around the country, to endorse the comments made by the hon. Member for Stirling (Alyn Smith) in opening this debate.

Our universities are economic, social and intellectual powerhouses in cities and communities up and down our country. We should welcome the diverse ideas, thinking and vision that international students contribute. However, we also know that the sector faces financial challenges. In England, where university student fees for UK students have been effectively reduced in real terms as a result of freezing, the financial contribution from international students becomes all the more important to support both the teaching of UK and international students and the vital research work of our universities.

Of course, the research programmes carried out in universities also help to power our economic success. The financial contribution that international students make, both directly, to the financial stability and success of higher education institutions, and indirectly, to the greater success of our whole economy, cannot be overestimated.

I strongly endorse what my hon. Friend the Member for Sheffield Central (Paul Blomfield) said about the importance of soft power and the relationships that are established when international students come to this country to study, and indeed when international academics come here to teach and research with UK colleagues. The influence, relationships, and opportunities for using soft power that that creates for this country is an immense asset to us. We should recognise and celebrate the contribution of international students to that.

Mr Stringer, I very much welcome this afternoon’s debate and I am grateful to you for giving me the opportunity to contribute briefly to it. I know that I speak for university vice-chancellors up and down the country when I say that we want to welcome international students to our higher education institutions. I also know that I speak for communities that are home to universities up and down the country when I say that we are delighted to welcome our international friends into our communities.

17:09

[Carol Monaghan (Glasgow North West) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank my hon. Friend the Member for Stirling (Alyn Smith) for securing this debate. It is unusual that we have so much consensus in a debate. Mind you, we do not have any speakers on the Government’s side other than the Minister. I hope that we get some consensus from him as well.

I do not have a university in my constituency, but I do have a huge number of international students living there. My hon. Friend the Member for Glasgow North (Patrick Grady) has pointed out that, in Glasgow, as well as the University of Glasgow, we have the University of Strathclyde, Glasgow Caledonian University, the Glasgow School of Art and the Royal Conservatoire of Scotland, and, of course, very close to Glasgow, we have the University of the West of Scotland. We also have Glasgow Kelvin College, Glasgow Clyde College and City of Glasgow College within the city, all of which attract huge numbers of international students. It is impossible to underestimate the contribution that they make to the economy. All Members have made that point, but I think the hon. Member for Strangford (Jim Shannon) really hammered home the financial aspect and the economic multipliers that come as a result of having those students in our communities.

It is not just about the financial contribution. International students make critical contributions, particularly in areas such as science, technology, engineering and maths, where we are short of skills. They also contribute to the teaching staff of many universities. It is impossible to overestimate the damage that this Government have done to our international student community. As a result of this Government’s actions, the demographic has changed considerably. We have heard mention of the make-up of international students. We have seen a huge increase in the number of Chinese students coming to our universities. While, of course, they are very welcome, we have to appreciate that if the geopolitical situation is changed or disturbed we suddenly have a huge shortfall because we have not been recruiting actively enough in countries where we would have recruited in the past. That has to change. All the eggs have been put in one basket, and it is a pretty shaky basket at the moment.

The hon. Member for Sheffield Central (Paul Blomfield) made a point about the decision made by the then Home Secretary, the right hon. Member for Maidenhead (Mrs May), to scrap the post-study work visas. That decision was entirely illogical; it spoke to a certain type of person, but it certainly did not speak to anybody who was hoping to develop new businesses or to bring in new skills and talent. That decision exacerbated skill shortages, again particularly in science and technology. That hostile immigration policy worked against the public interest.

I am pleased that the Government have finally recognised their short-sightedness and reintroduced the post-study work visa. However, the ramifications of that initial decision are still being felt. When the UK closed its doors to that talent, individuals looked and went elsewhere, as the hon. Member for Sheffield Central mentioned. Other countries recognised those skills and benefited from them. As mentioned by the hon. Member for Stretford and Urmston (Kate Green), it is not just our academic institutions that are casualties of that policy; it is also the wider community. We have lost brain power and entrepreneurs—we are still on the back foot today. Our academic institutions are trying to re-establish links with those countries, but that will take time. At a critical point, when we are trying to re-establish those links, the Home Secretary talks about reducing numbers. It is economically stupid, and it causes more reputational damage.

My hon. Friend the Member for Stirling talked about the European institutions that are under threat, and our membership of those institutions is not guaranteed. That is not just about the money that we get from Horizon Europe, it is about the rich collaborations with organisations such as Euratom, Copernicus and Galileo. As a result of Brexit, EU students are now forced to pay international student fees and, as a result, we have seen a 73% decline in EU students coming to the UK. That is a huge hit to us and changes our demographic. Students from the EU are more likely to come and contribute and stay longer. If we do not have them here in the first place—not to mention the loss of Erasmus—we have a problem.

I will finish by talking about the rhetoric. Both my hon. Friend the Member for Stirling and the hon. Member for Sheffield Central talked about the Home Secretary’s recent comments. The rhetoric is problematic and it has to change. International students enrich our campuses and make a vital, positive contribution to our economy, culture and society. Research from Universities UK found that in my constituency alone, for one year, the economic benefit of international students was nearly £50 million. The fact that the Home Secretary may seek to limit international students and the wealth of knowledge and talent that they offer this country is hugely damaging. I welcome the Minister to his place; will he make representations to the Home Secretary in his new role to ensure that we can keep the flow of international students coming to enrich our communities?

17:15

[Matt Western (Warwick and Leamington) (Lab)]

It is good to see you in the Chair, Mr Stringer. Let me express my thanks for the way that you have chaired the debate. I congratulate the hon. Member for Stirling (Alyn Smith) for bringing this debate about, and I welcome the Minister of State, Department for Education, the right hon. Member for Harlow (Robert Halfon), to his new role.

We have heard widely about the passion for higher education across these islands. The hon. Member for Stirling talked about its importance and power to inform, enlighten and aid discovery. We heard from my hon. Friend the Member for Stretford and Urmston (Kate Green) not just about the economic contribution that universities make, but about how they are cultural, social and economic powerhouses. My hon. Friend the Member for Sheffield Central (Paul Blomfield) talked about the soft power that our institutions have earned among Governments and institutions around the world, and the great achievements of the APPG. It is not just the size of the contribution that our institutions make that is so impressive; their cultural, societal and economic value cumulatively adds to the UK’s global reputation.

Let us be clear: the UK is the aspiration destination for most international students. Through a powerful combination of our world-class lecturers, leading facilities and institutions’ international standing, UK higher education is the benchmark around the world. As my hon. Friend the Member for Sheffield Central said, that is clearly seen in the Higher Education Policy Institute’s soft power index, in which the UK is positioned second.

The virtues of British higher education are reflected and amplified through Governments and leaders around the world. Closer to home, international students turn university campuses into melting pots of cultures, traditions, languages and thinking. Only two weeks ago during a visit to Oxford Brookes University, I sat around a table with half a dozen students hailing from Bulgaria, Nigeria and Hong Kong, as well as from the UK, all studying international development and sustainability. They were using their individual experiences from back home to help to shape their learning and that of their fellow students. Many expressed a desire to return to their country of birth to show what they had learned from their lecturers and fellow students, but many want to stay.

International students add enormous value to the UK economy and research base. The Entrepreneurs Network estimates that nearly half of Britain’s 100 fastest-growing start-ups have at least one immigrant co-founder. That leads me nicely on to the economic value of international students. Their precise economic value is really secondary to the wider social and cultural benefits that they bring, but it is still an important contribution to the UK.

Research conducted by The London Economic and HEPI, commissioned by Universities UK, found that the 2018-19 cohort of international students delivered a net economic benefit of £26 billion to the UK economy. Although our economic benefit is most concentrated in London, as we have heard, the material benefit to each of our constituencies is marked, ranging from £460 per constituent in the north-east and Scotland to £330 per constituent in the south-east, and a staggering £2,200 in Sheffield Central. In spite of the clear and obvious benefits that international students bring to the UK, Government rhetoric on migration, including international students, has tarnished the UK’s reputation as the aspiration destination—a point made by the hon. Member for Glasgow North West (Carol Monaghan).

I note the fiscal black hole caused by the recent Budget, which hovers at £40 billion to £50 billion. Let us put that into the context of the £26 billion that international students bring to the UK. It is important that we welcome international students and do all we can to enhance our reputation rather than to trash it. Two weeks ago it was suggested that the then Home Secretary was set to announce sweeping reforms that would have seen international student numbers capped and limits imposed on the number of dependents that international students can bring. Not long before that statement was due, she resigned. Policies such as those, circulating in a sea of chaos at the heart of Government, dent the UK’s international reputation and risk putting off international students. I urge the Minister to set out his Department’s commitment to international student numbers and to seek a commitment from the Home Secretary that international students will not be the latest front in her culture war.

In contrast, Labour is fully committed to protecting, encouraging and advancing the interests of all students, including international students. A simple comparative approach between the replacement Erasmus+ scheme in Labour-run Wales and SNP-run Scotland shows that, where action is required, Labour will always put opportunity for our young people ahead of political manoeuvres. Earlier this year, the Labour Government in Wales launched Taith.

[Graham Stringer (in the Chair)]

Order. Can I ask the hon. Gentleman to bring his remarks to a conclusion, so I can bring in the Minister?

[Matt Western]

I will. Gambling on our young people’s prospects with politics is short sighted and narrow. The same could be said of the UK Government’s decision to withdraw from the European University Institute, a university based in Bologna that provided opportunities for young people, free of charge, to study for masters degrees and PhDs. Guided by our beliefs in opportunity, collaboration and partnership, Labour will support international students and continue to champion their worth, because, put simply, universities are forces for public good, and we should all champion and be proud of the international students who contribute to that good.

[Graham Stringer (in the Chair)]

Minister, before I call you, can I ask you to leave a couple of minutes at the end for the winding-up speech? That will be at about 5.28.

17:21

[The Minister of State, Department for Education (Robert Halfon)]

It is a pleasure to serve under you, Mr Stringer. I congratulate the hon. Member for Stirling (Alyn Smith) on a very thoughtful speech. I love what he said about science and technology. I have a picture of President Kennedy on my wall in the Department for Education, because he put a man on the moon, and moved the whole engine of government, universities and science to achieve that purpose.

There has been a fair bit of doom and gloom, but our higher education sector has an extraordinary reputation. Four of the top 10 universities in the world are in the UK. It is no surprise that Britain is such a destination of choice for students around the world. We had the ambition of housing at least 600,000 international students in the UK per year by 2030, and we met it, for the first time, nearly 10 years early. There are 68,180 international students in Scotland. The hon. Member for Glasgow North West (Carol Monaghan) talked about EU students, but my figures show that, according to data from the Higher Education Statistics Agency, EU-domiciled student entrants increased by 4% in 2021 compared with the previous year. I am guessing that the hon. Lady’s figures are based on UCAS applications.

It has rightly been highlighted that international students contribute £25.9 billion to the economy, which is quite extraordinary, and are the source of over 60% of the UK’s education export earnings. Every resident is about £390 a year better off as a result. On the question asked by the hon. Member for Sheffield Central (Paul Blomfield), the net economic impact per student was estimated to be £95,000 per typical international student in the 2018-19 cohort. In other words, every 11 international students generate £1 million-worth of net economic impact for the UK economy over the duration of their studies.

I want to be clear that the target remains 600,000 students. That is something to be proud of. I am as keen on soft power as the hon. Member for Stretford and Urmston (Kate Green). She gave an example of meeting somebody who had studied in the UK. I have met many people as well. When I was over in Taiwan, I met an incredible person who started showing us slides of the Beatles. He was in charge of national security, and we were wondering what was going on. He said, “I went to the University of Liverpool, and that is why I love your country.” I get it. I have seen people from Iraq—I know that the hon. Member for Stirling has been involved in Iraq. I have seen the incredible work that goes on with Kurdistan in northern Iraq, particularly; so many of the leaders came to this country. I completely understand why international students are so important. I am a liberal interventionist: I believe in soft power as much as hard power.

I accept what the SNP spokesperson, the hon. Member for Glasgow North West, said about relying too much on one cohort, or on people from certain countries. Just as a business should be cautious about being overly reliant on a single supplier, universities should be cautious about having a single source of income.

I remind Members that the Government appointed Sir Steve Smith as the UK’s international education champion. His job is to make the most of the opportunities in key priority regions. We have roughly 84,000 Indian students in our country, and he is exploring the opportunities for UK skills partnerships.

The Government should be proud of the Turing scheme. I know it is for students further afield, but it supports our students to go to places such as Germany or Spain, and all over the world. The Turing scheme is much wider than the Erasmus scheme and has students in vocational education. Some £100 million is being invested in it, and it has more than 38,000 students—not just from universities, but from further education providers and schools.

The hon. Member for Glasgow North (Patrick Grady) talked about Glasgow City College in his constituency, which was very interesting.

[Carol Monaghan]

City of Glasgow College.

[Robert Halfon]

Sorry, the City of Glasgow College, which has worked with Indonesian polytechnic colleges on skills for the maritime sector. That is what motivates me—skills and apprenticeships, and higher education—which is why the Turing scheme and other schemes are so important.

Of course, there are pressures on the overseas aid budget. I absolutely get that, and hopefully things will return to normal as soon as the financial conditions allow, but look at what we are doing to support Ukrainian students in the UK. A lot of work has gone into that. There is a twinning initiative set up by Universities UK and the Cormack Consultancy Group, which partners with a Ukrainian university. There are partnerships with higher education providers, including the University of Glasgow, Cardiff University, Queen’s University Belfast and Sheffield Hallam University, and there is the work of the University of Stirling. I saw that it won sporting awards not so long ago, and it is offering Ukrainian students the opportunity to apply to transfer on to courses matching their original programmes.

In England, we have extended access to higher education student support, the home fee status tuition caps, advanced learner loans, and further education funding for those who are granted leave under one of the three schemes for Ukrainians that have been introduced by the Home Office. If that is not soft power in action, I do not know what is. It is all about spending our overseas aid money wisely, and migration changes.

I want to make it absolutely clear in my last few seconds that we remain committed to working towards our ambitions, which are set out in the international education strategy, to host at least 600,000 students per year in the UK by 2030. We will continue to welcome and attract international students to the UK in order to enable our domestic students to experience and hear fresh perspectives, and to allow our HE sector to thrive.

17:28

[Alyn Smith]

I thank all right hon. and hon. Members for their contributions to the debate. It is good to see the emergence of an SNP-Labour-DUP coalition on these matters—together at last. Perhaps we are having a glimpse into the future. Who knows? Aside from our domestic world views, there is a lot of consensus among Opposition parties.

I am grateful to the Minister for his thoughtful response. If he has President Kennedy and the moon landing on his wall, he cannot be all bad. I did not think he was part of the problem before the debate, and he has confirmed today that he is not. However, I have to say that there are elements of the Government and his party who are. There are people who are trying to misrepresent student immigration by talking about the wider problem of immigration. I acknowledge that that needs to be addressed but, as the hon. Member for Sheffield Central (Paul Blomfield) said powerfully, the failure to address it does not mean that students should bear the brunt of that limitation. I was glad to hear the Minister’s confirmation that the 600,000 target remains in place.

I say to the hon. Member for Strangford (Jim Shannon) that David Hume, a great Scottish philosopher, said that the truth emerges from an honest disagreement among friends. We sincerely disagree on the Northern Ireland Protocol Bill, but I do not doubt for a second the hon. Gentleman’s sincerity. I acknowledge concerns about the Northern Ireland protocol and how it is operating, but there are lots of ways in which it could be reformed within the protocol. The European Commission has put forward a number of proposals that would go a long way to address those concerns, and the Northern Ireland Protocol Bill is holding back progress in so many other crucial and important aspects of the higher education sector, for Northern Ireland as well as for the rest of us. We disagree and will have further discussions on this issue, but I do not doubt his sincerity.

17:30

Motion lapsed, and sitting adjourned without Question put (Standing Order No. 10(14)).