Westminster Hall

Wednesday 20th March 2024 Westminster Hall

Wednesday 20 March 2024

[David Mundell in the Chair]

Access to Migraine Treatment

Wednesday 20th March 2024 Westminster Hall

09:30

[Dehenna Davison (Bishop Auckland) (Con)]

I beg to move,

That this House has considered access to migraine treatment.

It is, as ever, a pleasure to serve under your chairmanship, Mr Mundell. Let me start by stating the blooming obvious: migraine is not just a headache. It is a complex neurological spectrum condition, of which a headache is just one possible symptom. This is a very strong early message to anyone suggesting that migraine attacks can be cured with a couple of paracetamol: it is time to learn and to be better. Listen to this debate and to the testimonies of those living with this debilitating condition, and help us together overcome the stigma surrounding migraine, which for centuries has acted as a barrier to accessing quality treatment for those suffering.

Before I get into the full swing of things, I want to express my gratitude to the House authorities for organising a survey to which more than 500 migraine patients responded. I am grateful to each and every one of them, and to others who reached out to me separately to share their experiences. Some of those testimonies have been eye-opening and some have been quite harrowing. I will endeavour to include as many as I can in this speech. As ever, my thanks go to the National Migraine Centre and the Migraine Trust not only for their support for this debate but for their round-the-clock work to support people living with migraine.

We cannot have a Westminster Hall debate without a bit of a history lesson at the beginning, so I did a bit of a dig through the history of migraine and found that the earliest known references to it date back thousands of years to ancient Egyptian times. The father of medicine, Hippocrates, was the first to document clinical observations about migraine in about 400 BC. Classifications of headache were first outlined in the first century AD by Aretaeus of Cappadocia, whose category of heterocrania displayed many similar symptoms to migraine. Galen wrote of severe pain affecting almost half the head in the second century, and the Iranian physician al-Rāzī devoted an entire chapter of his book to the symptoms and treatment of migraine in the 9th century. Then in the 17th century, Thomas Willis published his theory that megrim owed to the dilation of blood vessels within the head.

Throughout the years, key figures are reported to have experienced migraine. They include leaders such as Julius Caesar and Napoleon Bonaparte, Ulysses S. Grant and Robert E. Lee, Woodrow Wilson and John F. Kennedy; great thinkers such as Sigmund Freud, Friedrich Nietzsche and Charles Darwin; artists such as Van Gogh; writers such as Virginia Woolf; and actors such as Elizabeth Taylor, Hugh Jackman and Gwyneth Paltrow. There is even strong speculation that the trippy nature of “Alice in Wonderland” was inspired by Lewis Carroll’s own migraine attacks with aura. In his diaries from 1885, Carroll talks of the

“odd optical affection of seeing moving fortifications followed by a headache.”

His works led to the term “Alice in Wonderland syndrome” being coined to describe

“Certain hallucinations peculiar to migraine”.

In Carroll’s diaries of 1856, he records a trip to see William Bowman, one of the top ophthalmologists of his time, to discuss the visual disturbances in his right eye, which Bowman was unable to formally diagnose. Perhaps that was because it was not until the 1870s that visual manifestations of migraine began to gain more widespread recognition among medical professionals.

Migraine is than twice as likely to affect women, but in that period it was believed that we weak women merely had hysteria and fragility of the mind, unlike the ambitious men who got migraine only because of how hard they were working. Women being taken seriously in healthcare is a bit of a pet peeve of mine. Although I greatly welcomed the women’s health strategy, I was a little disappointed not to see migraine more formally mentioned. Perhaps the Minister will discuss that with me separately.

The 1870s were 150 years ago, and we might naively assume that in that time the magnificence of medical innovation has created cures and solutions that mean that people no longer suffer the terrible symptoms of migraine. Back in 1954, the then Minister of Health told those affected by migraine:

“Cheer up; there is a good deal of work going on, mostly under the Medical Research Council”.

That led to a response in 1960 by John Rankin, then the hon. Member for Glasgow, Govan, who said.

“For six years, and long before that time, the good work, so we are informed, has been proceeding, yet nothing appears to be happening.”—[Official Report, 4 March 1960; Vol. 618, c. 1671.]

More than 60 years later, despite migraine affecting roughly 10,000 people in every constituency in the UK, a Hansard search informs me that there has been no full debate on migraine in Parliament since the 1960s.

[Mr Philip Hollobone (Kettering) (Con)]

I congratulate my hon. Friend on her powerful and extremely well informed speech. One of those 10,000 in the Kettering constituency is Lisa, who has written to me to say,

“I spend most of my weeks, either with a migraine or with the after effects, which include complete exhaustion that can last two or three days. I have medication that does not always work. I get facial paralysis and will often have slurred speech, light sensitivity, nausea, dizziness, along with immense pain and pressure in my head. It is an awful existence.”

I want to pass on to my hon. Friend that Lisa adds,

“I am so glad to know that it is being debated in Parliament today.”

[Dehenna Davison]

I am grateful to my hon. Friend for passing on Lisa’s remarks. She is one of millions in the country living with this condition and experiencing the debilitating effects. I hope that, following today’s debate, we will see improved access to treatment. I ask my hon. Friend please to pass that on to Lisa.

As I said, there are 10,000 people in every constituency but no debates in Parliament since the 1960s. I make special mention of Lord Londesborough for raising a question on migraine in the other place in October last year, rightly arguing that this invisible disability deserves much greater priority and resourcing across the NHS.

It is 60 years since the last parliamentary debate. Those suffering the crippling effects of migraine alone might feel that, even now after all that time, little progress has been made, but I am here to be optimistic. New treatments, such as CGRP blockers, are proving highly effective for many migraine patients, helping to reduce the severity, longevity and frequency of migraine attacks. For many taking CGRP blockers, they are often called a lifeline. One patient responded to our survey, saying that CGRP injections have “virtually eradicated my migraines”.

Although new effective treatments are being developed, they are not easy to access through the NHS. Across today’s debate, I will outline the key difficulties being faced by patients at each stage of the migraine journey, and will outline possible solutions to improving access to treatments and, ultimately, the lives of migraine patients. That is something that I think we can all agree is very much beyond politics.

Let us start with the basics and discuss what it is like to live with migraine. We had an example from Lisa, the constituent of my hon. Friend the Member for Kettering (Mr Hollobone). When experiencing a migraine attack, common symptoms can include a severe headache; nausea and/or vomiting; visual disturbance, such as blurry vision, spots of light or zig-zag lines; sensitivity to light and sound; an inability to concentrate and brain fog; difficulties forming words, which is not helpful in this place; and fatigue.

Interestingly, I had experienced migraine for years before I recognised some of the symptoms linked to it. I recall sitting at home reading “Managing Your Migraine” by Dr Katy Munro last autumn, with a coloured pen in hand, underlining all the symptoms that I experience when I get a migraine attack; and there were eight different symptoms. A severe attack can leave sufferers bed-bound in agony, with curtains closed, cowering in the darkness, unable to eat, unable to think clearly, and utterly miserable. Attacks can be completely debilitating, and I have experienced my fair share of them.

I am not the only hon. Member who lives with migraine. The hon. Member for Caerphilly (Wayne David) is unable to attend today but asked me to read his testimony in his absence. He said:

“I have suffered from migraine since I was a young man. It used to be extremely debilitating, but in recent years I have been able to minimise significantly the severity and frequency of attacks. There are so many different causes and triggers of migraine. For me, it is stress related. Manage my stress and I can usually manage my migraine.”

The hon. Member for Banff and Buchan (David Duguid) said:

“I first experienced migraine in my early teenage years, when I regularly had to be excused from school. I remember being particularly distressed at the disorientation and confusion, as well as the extreme headache and nausea, of course. Migraines have become no less debilitating as I have grown into adulthood but they have become less frequent, and I generally know what to expect when symptoms start, and what medication to take. Like my father before me, I now watch my 12-year-old son experiencing his first migraines and the confusion it brings. As much as I can empathise with my son, I am only too aware of how little I can do to relieve his distress.”

The frequency of migraine attacks can vary. Some people will experience a small number of attacks over a lifetime, some one or two a month, but for others migraine can become chronic, meaning that headache is present more than 15 days a month, with at least eight of those having other migraine symptoms. That is the condition that I live with, as do around a million other people in the UK. For me, that means that I have a headache all day, every single day. Although they vary in severity, they are none the less draining, particularly on the many days when they are coupled with other migraine symptoms.

Recently, I spoke to Mollie Campbell, a brilliant young woman who like me lives with chronic migraine. Her journey helps to outline some of the difficulties that patients face in accessing treatment. In her own words, she remembers her first attack vividly:

“on a normal day, I woke up in agonising pain in my eye, eyebrow, and head. When I say ‘pain’, I mean torturous and excruciating pain, the kind that makes you roll around on the floor sobbing in agony.”

Mollie sought help from her GP, but it took months, several misdiagnoses, a number of unsuitable drugs being prescribed and, eventually, her paying to access a scan privately before she was eventually diagnosed with chronic migraine. Unfortunately, Mollie’s story is not uncommon. It can take patients months, if not years, to get a diagnosis.

A commonly expressed sentiment is that GPs do not always take the condition of migraine seriously. One patient who responded to our survey explained that they waited

“five and a half years from first presenting to a doctor taking them seriously and investigating”.

Another said that

“it took 19 years to be diagnosed with migraines”,

and another:

“Doctors just don’t seem to know or understand enough about it and I have been fobbed off a lot.”

[Matthew Pennycook (Greenwich and Woolwich) (Lab)]

I was contacted by a constituent who wishes to remain anonymous and who suffers from debilitating hormonal migraines. She is frustrated by the lack of general awareness among medical professionals, GPs in particular, about the specific treatment and medication that those who suffer from that type of migraine need. Does the hon. Lady agree that to make progress in addressing the condition, we need to ensure greater knowledge among medical professionals about the specific treatments needed by those who suffer perimenopausal and menopausal migraines?

[Dehenna Davison]

I completely agree with the hon. Gentleman. He will be interested in a paragraph that I will be reading out shortly, which addresses his very point.

Another testimony said:

“I have suffered migraines for approximately four to seven years but never went to the doctors until recently through fear of being dismissed.”

Some believe that is because GPs across the board just do not know enough about migraines. One GP said to the Migraine Trust:

“In medical school, neurology is a small part. Unless you have specifically chosen to do neurology, you will not have any formal training.”

GP training on migraine and headache disorder is patchy at best, and often relies on local champions spearheading that, rather than a more formalised structured. Our clear ask to the Minister, therefore, is to ensure improved training on headache and migraine as part of the medical training for GPs, to ensure that early diagnosis is possible.

For those who get a diagnosis, seeing a neurologist or headache specialist is a crucial step in helping with ongoing management, not least because specialist treatments cannot be accessed through primary care—I will return to that point shortly. On waiting lists to see specialists, experiences vary, but the broader picture is not as positive as it could be. Two patients outlined how, after many years of waiting for a diagnosis, it took a further four years from that point until they saw a neurologist. One said:

“I waited five months to receive an appointment letter then another five months until the actual appointment date”,

and the other said that they:

“waited 15 months to see a neurologist who then referred me to a specialist. I have been waiting for seven months for that, with no appointment yet.”

Even when eventually under the care of a specialist, some outlined that the continuity of care was not there. One patient said:

“I was prescribed a treatment to try, and was discharged, and then I had to be re-referred to try and alternative when the first option didn’t work.”

Recent analysis from the Migraine Trust found that, on average, it takes 29 weeks to access a neurologist or headache specialist, which has doubled from 15 weeks in 2021. Even then, neurologists may specialise in other conditions such as stroke and Parkinson’s rather than headache and migraine. Part of the issue is a lack of neurologists and headache specialists around the country. The UK has around 1.1 full-time equivalent neurologists per 100,000 people, versus four per 100,000 in France and Germany. Regional variations mean a postcode lottery, with major disparities between waiting lists from trust to trust. Here, our key plea to the Minister is to ensure that more specialists are trained to plug the gaps in neurology and headache specialists and, ultimately, to speed up access to treatment.

Once a diagnosis is in place, the obvious next step is treatment. Often, GPs will prescribe acute medications such as triptans to help manage attacks when they occur. For those suffering more frequent migraine attacks, preventive medications can be prescribed, but many of those were not designed specifically for migraine, such as topiramate, an epilepsy drug, amitriptyline, an anti- depressant, or candesartan, for the treatment of high blood pressure. Some people do report an improvement in the severity and frequency of their migraine attacks, many do not, and can in fact experience negative side effects from such medications. Nevertheless, there are now treatments designed specifically for migraine, such as CGRP blockers, as already referenced, and there are many different kinds, such as wafers that dissolve on the tongue, injections or infusions.

However, National Institute for Health and Care Excellence guidelines are, for many, getting in the way of early treatment. Take, for example, the CGRP blocker erenumab—I always pronounce that wrong. A 2021 study in the Journal of Clinical Medicine by Maraia, Ricci and others found that, as a treatment for the prevention of migraine, erenumab successfully reduced the mean number of monthly migraine days and the acute medication used per month in 96% of cases—a real success story. However, NICE recommendations state that the drug

“is recommended as an option for preventing migraine in adults, only if…they have 4 or more migraine days a month”

and

“at least 3 preventive drug treatments have failed”.

Let us take a second to understand that. If someone is struggling with migraine, they must try three drugs that are not designed for migraine, usually for at least three months each, and if those are unsuccessful, they may be able to access a drug that is specifically designed to prevent migraine attacks. That makes little sense, and it can delay patients’ access to successful treatments for months, if not years. One survey respondent said:

“Getting treatment has been difficult. To access the latest treatments, you have to fail so many preventatives.”

The American Headache Society and migraine expert Professor Peter Goadsby suggest that CGRP blockers should be available as a first-line therapy, not as a last resort. We support that call, so I ask that the Minister requests that the NICE guidelines are updated to allow specialised treatments such as CGRP blockers to be accessible first, which would provide earlier, much-needed relief for migraine patients.

Similarly, despite NICE approval for many CGRP blockers, whether individual NHS trusts even allow access to them is a postcode lottery. One respondent said:

“Once help is found, though, it can be difficult to access as it depends on which area you live in.”

Another said that

“my NHS trust only allows the trial of one of the anti-CGRP drugs and if it doesn’t work you are not allowed to try another as it’s not funded.”

A Migraine Trust freedom of information request, which I found shocking, found that only 29% of trusts in England allow access to CGRP medications. Here we make yet another ask of the Minister: the postcode lottery in access to CGRP medications should be addressed and fixed, perhaps through fresh NICE guidance and a dedicated push from the Department of Health and Social Care for trusts to allow more access to these life-changing medications.

Another key change that could help those living with migraine to access positive treatment sooner would be allowing treatments such as CGRP medications to be prescribed by primary care practitioners. I have spoken of the success of some CGRP blockers, yet they can be prescribed only by specialists, such as neurologists, who can have extensive waiting lists, as we have discussed. Even if someone sees a specialist, they need to demonstrate that other treatments have been ineffective. If specialist drugs could be prescribed in primary care as a first resort, we could reduce dramatically the impact of chronic migraine on patients. Pilot work in Scotland has seen community pharmacy playing a greater role in prescribing drugs to prevent and manage migraine. A further ask for the Minister, if he will forgive me, is a review of CGRP blockers and other new treatment options, so that they can be prescribed in primary care.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Lady on securing the debate. On making the blockers more widely available, does she agree that, as well as the requests that she has put to the Minister, there should be discussion and consultation with the devolved institutions, so that people right across the United Kingdom can avail themselves of the same?

[Dehenna Davison]

I completely agree with the hon. Gentleman. As I said, migraine is a condition that does not discriminate. Roughly one in seven people in the world live with migraine, so it is as relevant in the devolved authorities as it is anywhere else. We want to ensure that migraine patients across the whole of the UK have access to the best possible treatment.

For those who cannot access CGRP blockers or alternative treatments through their local NHS trust, or who simply cannot bear the extensive waiting lists to see specialists, drugs bought privately can be incredibly expensive. For example, rimegepant is around £270 per month when taken as a preventive, Botox injections for migraine are around £700 every 12 weeks and Vyepti infusions are around £600 every 12 weeks, and that does not include the cost of seeing specialists and having the prescriptions written, which of course means an additional fee. For those on low incomes, those options are completely inaccessible without NHS treatment, yet some are unable to access them regardless because of the decisions of their local NHS trusts. One survey respondent said:

“I had to spend £8,000 on CGRP treatment privately before moving to a hospital who would fund me under the NHS.”

Nobody should be priced out of quality healthcare, particularly when that healthcare can be truly life changing.

In all, I have outlined a number of tangible steps that could be taken and which would have a real and positive impact on those living with migraine, but let us return to Mollie’s story because, sadly, her experience is an example of how the current system does not always work for patients. In her words:

“Four and a half years later, there is not one second of any day in which I am not in pain. My pain is an average of 7/10 a day, and it soars up to 10/10 at least ten times a day...When it reaches these levels on a daily basis, every single day, you simply cannot live life normally anymore. I can no longer work, see my friends, or do any of the hobbies I used to enjoy. Every single thing that brings me pleasure is now impossible for me.”

For those living with severe chronic migraine, the huge detrimental impact on day-to-day life should not be understated. I have reached the point where I get anxious making plans, either for work or with family and friends, for fear that a severe attack may mean that I have to cancel at the last minute. With attacks seemingly getting more and more frequent, it feels increasingly like cancellation is an inevitability. This may sound really silly to some, but it is a really human example for me. I am a lifelong Swiftie and I managed to achieve the holy grail of getting Taylor Swift tickets for the Eras tour, but I am petrified that on the day a migraine attack might hit and take away my opportunity to see her live, because I would be devastated. Some might say that that is a silly example, but it is one of the things that are on my mind. If someone is living healthily, they do not have to have those sorts of considerations when making plans.

Many survey respondents reported similar concerns. One said:

“Migraine has impacted every job, social occasion and holiday over the last 15 years...It’s caused me countless days of agony. Migraine is a curse I wouldn’t wish on my worst enemy.”

Another said:

“I can’t make plans with people due to migraines making me cancel them last minute. I missed an expensive, once in a lifetime concert opportunity that I had been waiting 12 years for as I had a migraine that day. I had to leave a friend’s funeral early and not attend his wake due to a five-day migraine.”

One said:

“I have missed many family gatherings—New Years, Anniversaries etc. I have also missed events that I have purchased tickets to as I have been too unwell, losing out on both money and experiences.”

Another said:

“I gave up working 14 years ago, stopped socialising and even dread going on holiday, and travel was the thing I always most looked forward to.”

I received an email yesterday from June about her daughter. She is 35 and her migraine attacks are so severe that, in June’s words,

“she can no longer look after her children. At this moment in time,”

she

“cannot complete a simple jigsaw with her two-year-old daughter. This is my daughter who gained a first in her degree...She is upset about missing out on so much of her children’s lives, aged 5 and 2.”

I raise these examples to show that migraine has more than just a trivial impact on the individuals who are suffering; it has a real impact on them and on their loved ones and wider circle.

Many also spoke about the impacts of migraine on their working life. Mollie had just embarked on her dream internship when migraine hit, so she was unable to complete that internship and has struggled to work since. She is not alone. Many here will know that I gave up my ministerial role, as migraine meant that I could not keep up with the additional demands of government. Research by the Migraine Trust found that 29% of people with migraine had to move from full-time to part-time work and 25% had left a job altogether. One survey respondent said:

“I have been at risk of losing my job in the past due to having to take time off for migraines.”

Another said:

“I recently lost my job due to the number of migraine related absences I had.”

[Paul Girvan (South Antrim) (DUP)]

I thank the hon. Member for securing this debate. In the light of what she has just said, I will say that many people who suffer from migraine lose their job and have difficulty even accessing the likes of personal independence payment, because migraine is so debilitating whenever it happens but it is also unpredictable. Their life can become awkward when it comes to just doing things normally, but they have difficulty accessing PIP because of it.

[Dehenna Davison]

I agree with the hon. Member. In severe cases, migraine is absolutely a disability. It ruins lives. There is a separate discussion to have with the Department for Work and Pensions—I do not want to put all the pressure on the Department of Health and Social Care—about how it addresses chronic migraine and intractable migraine when making its assessments. I thank the hon. Member for raising that really important point, which came through from a number of our survey respondents as well.

Some workplaces make adjustments, such as allowing flexible working, but there are also reports of workplaces not making suitable adjustments. One respondent said:

“There is a complete lack of understanding that chronic migraine is a disability and employers are not willing to make allowances for this condition in the way they do with other disabilities.”

Shockingly, the Migraine Trust found that 56% of migraine patients said that their workplace had not made reasonable adjustments. That is why the organisation has launched its workplace pledge this week to encourage employers to make small, often low-cost adjustments that can make a huge difference for staff with migraine. We must remember that with one in seven people living with migraine, there is a good chance that even if someone does not, at least one of their colleagues probably does.

The impact of migraine on the workplace is not just confined to individuals dealing with the stress of potentially losing a job and income; there is a wider impact on the economy too. The Work Foundation has found that migraine causes between 28 million and 43 million lost work days per year in the UK, at a cost of around £4.4 billion. When we add the cost of that absenteeism to the cost of presenteeism—showing up and putting on a brave face but not being able to function normally —the Migraine Trust estimates that the total cost is closer to £9 billion.

We often talk about the need to improve productivity here in the UK, so surely helping those living with migraine access quicker and better treatment so they are able to work and fire on all cylinders would be a great step forward. That is especially so when coupled with the fact that, according to the Journal of Health Economics and Outcomes Research, the excess fiscal costs to the Government of one person living with migraine come to £19,823. That is the cost for one person, when there are 10 million in the UK battling the illness.

Giving up work for health reasons is not a choice that anyone makes lightly. For many, as well as the financial cost, there can be a significant cost to people’s mental health. Research by the Migraine Trust found that 78% of those living with migraine said it had a negative impact on their mental health and 65% reported experiencing anxiety as a result. People are missing work, cancelling arrangements with friends, missing out on social experiences that they have been looking forward to—and paid for—and feeling like they are a burden on their family. Others may not believe them, and they may wait months if not years to see a specialist; or they have the hope of trying another preventive that might work, only to have that shatter when it is another one that does not do so, and all the while they are living with excruciating pain. They are losing friends, losing relationships and feeling like they are losing their mind.

For some people such as Mollie, the darkness takes over entirely. She said that

“deep inside, I still had that same passion for life that all people in their twenties do. I want nothing more than to go outside and live my life, but this condition has me trapped in my own living room. My pain is now so severe, it has impacted on my mental health so intensely I contemplate suicide every single day of my life and have almost succeeded at times simply because I want the physical pain to end”.

We are here today to help people such as Mollie. We have a responsibility to help them and the millions of others suffering through migraine who need a lifeline. By improving access to treatments we can give them that lifeline. I hope the Minister will agree to meet me and the two brilliant charities represented here today to discuss further how we can do just that together.

[David Mundell (in the Chair)]

I ask hon. Members who wish to be called to bob.

09:58

[Sir Gavin Williamson (South Staffordshire) (Con)]

It is a pleasure to serve under your chairmanship, Mr Mundell. I congratulate my hon. Friend the Member for Bishop Auckland (Dehenna Davison) on securing the debate. It is hard to imagine that this issue has not been discussed in Parliament for such a long time. That is especially true, as she so brilliantly articulated, given its impact on so many people in every one of our constituencies. One in seven people suffer from migraine, and over 1 million suffer from chronic migraine, so the impact on people’s lives and on families is widespread.

I am fortunate that I am not one of those one in seven people, but I have the experience of living with someone who suffers from chronic migraine. When we do not suffer from migraine, we do not understand how debilitating it can be. We cannot comprehend how it can take over someone’s life and stop them doing the things they most want to do—that they get pleasure from, that they live for. When that migraine seizes them, they just cannot do anything. They have to lie in a darkened room and cannot function in the way we expect and hope people can function.

Some of the statistics are concerning and saddening. My hon. Friend touched on the fact that 29% of respondents surveyed by the Migraine Trust had had to move from full-time to part-time work. That impacts not just what they do, but their whole family, what they can expect from life and their ambitions for the future. It can change the course of their lives. It is also concerning that 43% of those surveyed felt that their workplace did not believe them when they came in and said they had had a migraine. My hon. Friend touched on the sense of a migraine being just a bad headache. That is not what people have to live with and what they experience; this is something that seizes them totally and utterly.

We need to be more open about the wider impact that this is having on so many people. The fact that 34% feel discriminated against at work is just so wrong. I hope that by talking about this issue and highlighting its impact on so many people, we can improve understanding, not just among the Minister and those in his Department, but in workplaces right across the country, so that they can adapt and work with people who suffer. In that way, they can ensure that those people can give their best all the time while dealing with something we would not wish anyone to have to deal with.

The loss of days worked has a wider impact on businesses and individuals, so we have to start thinking differently, not just in our hospitals but, as has been touched on, in general practice and pharmacy as well. If people were suffering from a more visible disease or condition, the Government would be not just spending £150 million a year but looking at investing so much more in treatment and research so that they could deal with it. Sadly, migraine is one of those conditions where there is not one single answer that can be rolled out to deal with what every single person is suffering.

More and more people in this country are turning to A&E to be treated for migraine, but it is not the best place for them to be treated; it is not good for the hospitals or the individual. All of us in the room will know how important it is to get the right primary care and the right level of support for people, so that they can prevent migraine as much as possible, because when it has set in, it is so much more difficult to treat.

We also see understaffing. We have 1.1 neurologists per 100,000 people in the United Kingdom, compared with four per 100,000 in France and Germany. In addition, so few GPs have the true specialist knowledge they need to be able to sit down with their patients, talk through this issue and have a proper understanding of the type and range of treatments best suited to that individual. The Minister will talk about how all GPs cover neurological conditions, including migraine, in their basic training. However, with the prevalence of migraine in society, we need general practitioners to have not just a bit of general knowledge on it, but more specialist knowledge, certainly in the larger practices. We can then get those individuals who are unfortunate enough to suffer from migraine the specialist advice, treatment and knowledge they need. As we are so short of neurologists across the NHS, we must ensure that the burden is lifted away from our hospitals.

I would put in a particular plea in relation to pharmacies. It is not always that easy to see a doctor when a migraine is starting to emerge—when the indicators that it is about to hit start to show themselves. That is why it is important to ensure that support and help are widely available. I urge the Minister to go back to his Department and use his characteristic imaginative, thoughtful and revolutionary style to encourage it to be a little more bold and radical in its thinking—to be a little more “action this day”, as opposed to having another report. There are many things that can make a difference to people’s lives very quickly. One is ensuring that we make better use of our pharmacies, thereby lifting the pressure off the wider NHS. Another is ensuring that there is better training for GPs so that larger practices have that specialist knowledge.

I will finish with a final plea. My hon. Friend the Member for Bishop Auckland mentioned CGRP blockers. We are all aware that there is not a silver bullet to this problem, but they are one of those things that give so many sufferers a little hope that there is something that can actually help. It is awful that people in many parts of the country cannot access them; they are not in a position to get the help they desperately need. I urge the Minister to go back to his Department and to look at CGRP blockers closely, along with the other actions that have been suggested. He could do something transformative for the lives of hundreds of thousands of people, and lift the misery they have to live with far too often.

10:08

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

I congratulate my hon. Friend the Member for Bishop Auckland (Dehenna Davison) on having secured this important debate. I am going to be a little bit cheeky: it is always a privilege and a delight to follow my right hon. Friend the Member for South Staffordshire (Sir Gavin Williamson, but I have absolutely no memory of him advocating radical and bold behaviour from the Dispatch Box when he was Chief Whip—in fact, quite the opposite.

Migraine treatment is a serious subject. In November last year, I was privileged to host an event for the Migraine Trust. My hon. Friend the Member for Bishop Auckland did an incredible job of setting out the history of migraine and explaining in detail the challenges that sufferers face. When I agreed to host an event for the Migraine Trust, I thought I understood migraine and recognised the symptoms and impacts and how sufferers endure the most horrible events in their lives. That was right up until I spoke to some of the sufferers who were there that evening.

We have focused on the one in seven people—the 10,000—in each of our constituencies who suffer from migraines, but I was particularly struck by the chronic migraine sufferers who were there that evening. They are triggered endlessly by such a radical thing as light, and they were having to stand in that room with dark glasses on and with ear plugs in to avoid noise. They were telling me about the food and drink they avoided rigorously, because they could identify each individual trigger that would perhaps set off a period when they would have a migraine literally every single day for days on end. It was eye-opening for me, because I thought I understood migraine after the first attack I had when I was about 10 years old.

We should not focus exclusively on our own experiences, but I remember my first attack to this day. I blame my father—I blame him for many things—because he took me to McDonald’s when I was 10 years old. The blue light in those McDonald’s in the early 1980s—I can remember where this McDonald’s was; it was in Southend—triggered a migraine in me that day, and I did not understand what was happening to me. That is the challenge for children: they do not understand and they cannot process that this is something that, if they lie down quietly and take their medications, they may get through. It impacts their education and their entire childhood because they become anxious, as my hon. Friend detailed. They become anxious and worry endlessly about when the next one will come. Of course, as we know, stress can trigger migraines, so the sheer act of worrying about the next migraine can in fact trigger one.

My evening with the Migraine Trust talking to those chronic migraine sufferers was incredibly eye-opening and made me absolutely determined to redouble my efforts to tackle the lack of knowledge and the stigma that surrounds migraine. I was quite surprised to hear from only one constituent ahead of the debate, but I want to focus on her story, because many of the issues have been highlighted today. She has suffered from migraines for 30 years—30 years in which it has impacted every single job she has had. Not a single employer has understood that this is not just a headache, but something utterly debilitating, and that she will not be able to attend work or function normally. As a result, she has had extreme difficulties with her employers. Her ask of me is that I advocate to the Minister—and I do so now—that we should perhaps look at considering migraine as a disability, because, to be frank, it absolutely is.

My constituent also talked at length about exactly the point my hon. Friend highlighted about medications. As we have heard, there is no one silver bullet; some medications will work for some people, and some will work for others. It is almost a process of trial and error, with someone going three months with a medication that they know is not working—going through the different steps and jumping through the hoops—so that they can demonstrate that it has not worked and then move on to the next stage of medication.

I want to talk briefly about the stigma and how some of us are too embarrassed and ashamed to talk about this issue. I remember taking beta blockers for migraines when I was a Minister, so let me talk about the side effects of beta blockers and how impactful they are. When I stood at the Dispatch Box, beta blockers made me feel stupid, slow and dull. The one thing that everyone expects a Minister to do at the Dispatch Box is to answer a question immediately, wittily and with facts tripping off the tongue instantly. When I was taking beta blockers, I found that I simply could not do that. I would stand there and feel dull, detached and as if I was not really in the room.

I stopped taking beta blockers and resorted to a type of medication that is hugely stigmatised. Botox is approved by NICE for migraine and is, for me, incredibly effective, but it is incredibly expensive because I cannot get it on the NHS. I was frantically tapping on my phone—I was not sending messages; I was using the calculator—to work out how much I might have spent on Botox over the past 15 or so years. It appears to add up to a phenomenal £20,000—just to ensure that I can stand in this place, talk relatively coherently and, at times, make sense.

I remember vividly being sat in the Tea Room and not being able to think of the right word. I thought, “Well, that’s fine. We all get a little bit of brain fog when you get to my age,” but it was not that, and it got worse and worse. The longer I sat there, it was not just that I could not think of the right word; I could not think of any word, and then I found that I had been sat in the Tea Room silent for about half an hour because I could not actually speak. As I mentioned, my right hon. Friend the Member for South Staffordshire, who is sitting next to me, is a former Chief Whip, and he would no doubt have been absolutely delighted if I had gone through entire spells of not being able to speak. I am sure the current Chief Whip would also be very happy if I lost the power of speech. But it is absolutely terrifying, and has a profound impact.

I resort to expensive treatments that are socially stigmatised. Everybody assumes that it is vanity—I prefer to use the phrase, “Two birds, one stone.” The impact those have means that I can live my life, but it is not a choice available to very many people. That is the stark reality. As Monica would tell us, she wants the new CGRP medications to be more easily available. She wants them to be available in every NHS trust so that there is no postcode lottery. Most of all, she wants the stigma to be beaten down so that she never again has to explain to an employer what a migraine is, and that it is not just a headache.

It was fascinating to hear the tales of the hon. Member for Caerphilly (Wayne David) and my hon. Friend the Member for Banff and Buchan (David Duguid), who cannot be here, about not only their migraine experiences, but watching a child suffer from them. As I said, I blame my father for my migraines, and my daughter blames me for hers. There is clearly quite a significant genetic link to suffering. We need to have much more research and investigation into not only the condition more widely, but some of the specifics we have heard in this debate.

We need to reflect that stress can be a phenomenal trigger of migraine, and we therefore need to be much more holistic in the way we approach it and think about how we manage our lives. If my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) was here, she would undoubtedly be making a pitch for a new Government Department for wellbeing, and that approach could sit very firmly in that. If we address the mental health challenges around stress, we can also address the challenges of migraine. I do not pretend that we can address all of them—there is clearly a crucial and important role for medication, which needs to be much more widely available.

I finish with the thought that this is a complex, difficult subject. There is no silver bullet, but what we require in this place is a real drive from the Department to make sure it is thinking about including migraine in all of its health strategies. I stand here as the Chair of the Women and Equalities Committee, and I was really struck by the fact that women are more than twice as likely as men to suffer from migraine. If we look around this Chamber today, it appears, as ever, that it is a male problem. We cannot allow things like the women’s health strategy, which is crucial, and which I welcome, to be about stereotypical women’s conditions. We also have to have a thread that weaves through the fact that in almost every health condition, women are under-represented in research and in how it is treated. As my hon. Friend the Member for Bishop Auckland mentioned, too often we are deemed hysterical as opposed to actually ill. My final comment to the DHSC is: please, can we make sure that the impetus on the women’s health strategy is maintained and kept up, and that we do not allow it to become about just reproductive health? It has to include the whole of women’s health to make sure that we are being treated fairly.

10:18

[Owen Thompson (Midlothian) (SNP)]

I commend the hon. Member for Bishop Auckland (Dehenna Davison) on not just bringing this debate, but all the work she has done on raising awareness and campaigning for those who suffer with migraine. Like many, I spent a long time not realising that I was getting migraines. I am very lucky—I do not get migraine very often, and I know I am very fortunate in that, but when I do, I am absolutely floored. I tend to get clusters due to stress, as others have mentioned. I am very fortunate that it does not happen very often, but it took me many years to realise that that was what was happening. I was very lucky that I had a GP who was able to understand what I was saying to them. I now know what my triggers are and what I need to do when it happens. That does not make it any easier to deal with, but at least I know what needs to happen.

It is common for many of us to know what migraine is, but the fact that we have not had a debate about it in this place for so long—even when so many in this Chamber alone are talking about our own personal experiences—says that, even here, it is not something that we want to talk about very often. I give huge thanks to the hon. Member for Bishop Auckland for ensuring that we are, and we definitely need to do so more often.

We have heard from others how prevalent the condition is, but we still fall so far short in addressing its stigmatising nature. We have heard others say, “It’s just a headache”, and that it is easy to look past. I suppose I was very lucky that, in one of my earliest jobs, my boss suffered from migraines, so there was a level of understanding there. But that was just fortunate circumstance, and we need to have much clearer opportunities for anyone suffering from this condition.

There has definitely been improvement, albeit the waiting times for treatment in Scotland, England and Wales are lengthening, according to the figures put out by the Migraine Trust. We all need to be doing better in that sense, but the Scottish Government are certainly supporting a very high standard in migraine care, with 86% of health boards giving access to the CGRP blockers. That is welcome, but we cannot rest until that is 100% everywhere, and we certainly cannot be complacent.

We know that migraine attacks can signify impact on all aspects of a person’s life, as we have heard, and there is so much more that we could do. We have heard about CGRP blockers, which are one medication, but there are others. I have personally done some work looking into the potential for alternatives like psilocybin, about which we have had some debates previously in this place. I think it was last June, or thereabouts, that I met Professor Jo Neill at the University of Manchester, who highlighted some of the challenges that it faces simply in trying to research the potential for psilocybin. It is still classed as a schedule 1 drug, like crack cocaine or heroin, so the blocks to simply researching what is possible are a massive hurdle to moving forward what could be a significant and useful treatment for many people. As we have heard, not all treatments work for all people, and everybody will have the thing that works best for them. A vast body of research exists, but again, so much more could be done. I ask the Government to consider again what more they could do about those blocks in particular to make research slightly more straightforward, so that we can all have a much better understanding of what is possible.

There are glimmers of hope, and the Centre for Sustainable Delivery has published the “National Headache Pathway”, which will help to drive standards further in migraine care across the NHS, certainly in Scotland. The SNP continues to push the UK Government on the right for flexible working. There is a right to request flexible working in legislation; we think that it should be a right, not simply a request. A Migraine Trust report called “Heading in the wrong direction” said that there should be greater awareness of the pathways that exist for managing migraines, and revealed that half of Scottish health boards said that

“they had undertaken work to review their headache and migraine pathways.”

Again, that is encouraging, but a half is only a half—it is still not enough. As I have mentioned, Scotland was found to have the best access to medication, but more still needs to be done. The Migraine Trust report said:

“There are less than 80 GPs with Special Interest…for headache and migraine across the UK”.

That is simply not enough. People are very lucky if they find one with that understanding, but given that we are talking about universal healthcare, 80 GPs across the isles of the UK is nowhere near enough.

Robert Music, the chief executive of the Migraine Trust, said:

“Not only are patients struggling, but poor management of migraine is putting unnecessary additional strain on an already struggling NHS. We are seeing rising A&E admissions for migraine across the UK. There is a shortage of GPs, consultants and nurses specialising in headache to meet the need that we know exists, and a broad lack of understanding of the condition, meaning patients are not being treated in the right place or at the right time, if at all.”

That is simply not good enough for any of us, and we need to be pushing. I hope debates such as this help to raise that awareness, show that this is a very serious condition and that we need to be doing so much more. Dr Brendan Davies, the chairman of the British Association for the Study of Headache and consultant neurologist at Royal Stoke University Hospital, said,

“Migraine is the most common of all the neurological disorders yet is vastly under-recognised. The time has come for a nationally agreed educational framework and quality standard for primary care, as we have with other important long-term conditions.”

As I and my party persistently advocate for enhancing devolved powers, it will be no surprise to anyone present that we would like to see further devolution of employment powers, so that we can address the issues previously mentioned on employment and flexible working options. While not addressing treatment, that would at least help individuals to best manage their condition in a way that works for them. If we could all look to identify the best treatments, it would be beneficial not just to the individuals but to the economy.

Each passing day that the Government neglect to use their reserved powers to address workplace changes underscores the need for us to be able to make these decisions in Scotland. I hope I will hear something positive from the Minister. Everyone in here is coming from the same place; we recognise that while a great deal has been done, significantly more can be done. It is on all of us to embrace and take forward this challenge. I look forward to hearing the Minister’s response on what steps we could take both immediately and in the longer term, and I once again commend the hon. Member for Bishop Auckland on bringing today’s debate.

10:26

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Mundell. I thank the hon. Member for Bishop Auckland (Dehenna Davison) for opening the debate and sharing her personal experience of how the condition has affected her, which was very powerful for others to hear. We have heard some fantastic contributions today. We know that one in seven people in the UK are living with migraine, and that women are disproportionately affected. I agree with the Chair of the Women and Equalities Committee, the right hon. Member for Romsey and Southampton North (Caroline Nokes), that this needs to be addressed. Women are under-represented in research and development more generally and we need to understand why—beyond reproductive issues—in the women’s health strategy.

Migraine attacks can be hugely debilitating. They can last between four and 72 hours or even longer, often causing pain, vomiting and dizziness. We have heard from the right hon. Member for Romsey and Southampton North about the impact on children, and very movingly from the right hon. Member for South Staffordshire (Sir Gavin Williamson) about the all-consuming impact on family life. They affect every part of life, including social life, education and employment, yet they are often misunderstood and under-diagnosed.

Migraines affect people’s ability to access full employment, with 29% of those who suffer reporting that they have had to move from full time to part-time work, and a further 25% having left a job altogether. People listening to this debate who might think they are in control of their careers—maybe even at the Dispatch Box—will find it very powerful to understand that they are not alone. This adds to the number of people who are economically inactive because of long-term sickness, which has risen to more than 2.5 million—an increase of more than 400,000 since the start of the pandemic. That has a huge impact on our economy and on individuals’ health, wellbeing and ability to support themselves and their families.

I am deeply concerned that the measures laid out by the Government to tackle the leading health-related causes of economic inactivity are not ambitious enough. I join the former Chief Whip, the right hon. Member for South Staffordshire, in exhorting the Government to take greater action and governance. The Access to Work scheme faces huge backlog, so we want to hear from the Minister today what the Government can do to support those suffering from debilitating migraines and help them access work.

Furthermore, support from employers is vital to everyone living with chronic migraines. We have heard a debate about whether this should be considered a disability, but even those who are identified as disabled and are working for Disability Confident employers do not report much better experiences than those working for employers that are not members of that scheme. We need more action from the Government to ensure that disabled people and those with long-term conditions such as chronic migraine can access the support they need at work.

As with too many medical conditions, waiting lists are long. Once someone is diagnosed, it can take up to 29 weeks for them to access a neurologist or headache specialist. Fourteen years of Government mismanagement have left our NHS unable to deliver a full and comprehensive range of health services, which is impacting on care and treatment for migraines.

That is why Labour will build an NHS fit for the future, providing it with the staff, technology, resources and reform that it needs to improve patient care, cutting waiting lists and ensuring timely diagnosis and treatment for the millions of people affected by migraine by getting the NHS working around the clock. That will give staff the opportunity to earn more for working weekends and evening shifts. Getting local hospitals working together will mean that the NHS can deliver the extra 2 million operations, scans and operations a year that are needed. What measures will the Minister take to tackle those waiting lists, particularly the services around neurology?

We have heard today how new treatments can give hope to those suffering from migraines. CGRP antibody medicines have been approved by NICE to prevent migraine in adults. However, as we have heard, only 52% of sufferers are offered them; people have to take a long route before becoming eligible. NICE last updated its guidance in this area in 2021. I would be interested to hear whether the Minister is having further discussions with NICE about ensuring wider access to migraine treatments.

Migraine is a condition that can be isolating and debilitating. We know that pressures on mental health services are acute, but with 78% of respondents to the Migraine Trust’s survey saying that migraine impacts their mental health and 65% reporting that they have experienced anxiety as a result of migraine, it is vital that we consider the mental health impacts of living with migraine.

I am keen to see Labour’s proposals for a whole-Government strategy to improve mental health outcomes and make early interventions becoming a reality for people. That is why the next Labour Government would implement an ambitious plan to cut waiting lists by recruiting over 8,500 additional mental health staff, providing access to mental health support in every school and delivering an open-access mental health hub for children and young people in every community. That would help to redress the current situation in which young people and children do not have sufficient understanding of the debilitating effects of this illness.

Finally, further research into migraine is really important, because we still do not fully understand what causes it; the SNP spokesman spoke very eloquently about the need for research into its causes. We would support our research community with a new regulatory innovation office, which would make Britain the best place in the world to innovate by speeding up decisions and providing clear direction based on a modern industrial strategy. The new office would help to improve outcomes for those living with migraine, tackling the NHS backlog by accelerating the approval for clinical trials, the number of which has fallen off a cliff under this Government, and delivering better access for patients to the latest treatments.

Those living with migraine should be able to access care when and where they need it, and the next Labour Government will ensure that we have the staff and resources needed to improve waiting lists and the right research environment, which would improve access to new treatments.

10:32

[The Minister for Health and Secondary Care (Andrew Stephenson)]

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

I start by thanking my hon. Friend the Member for Bishop Auckland (Dehenna Davison) for securing this very important debate. I know that she has long been a champion for those living with migraine, and that her own ongoing struggle with chronic migraine, which she talked about, made it difficult, if not impossible, on some days to keep up with the demands of her ministerial role. Since leaving that role she has continued to shine a light on the impact of migraine at work and on what it means to live with migraine.

I also pay tribute to the outstanding charities that support the estimated 10 million people in the UK who live with migraine. For example, the Migraine Trust does fantastic work in empowering, informing and supporting patients, and in driving improvements in treatment and care.

I thank my right hon. Friends the Members for South Staffordshire (Sir Gavin Williamson) and for Romsey and Southampton North (Caroline Nokes), my hon. Friend the Member for Kettering (Mr Hollobone), and the hon. Members for South Antrim (Paul Girvan), for East Londonderry (Mr Campbell), for Midlothian (Owen Thompson), for Greenwich and Woolwich (Matthew Pennycook) and for Bristol South (Karin Smyth) for their contributions to the debate. In those contributions, almost all right hon. and hon. Members talked about the stigma around migraine, with many setting out their own personal experiences of it. We all know that awareness is key to addressing discrimination, so I very much welcome each and every contribution to this morning’s debate.

Migraine is one of the most common neurological conditions, affecting about 10 million people in the UK, yet in this House we very rarely speak about it and its impact. Many of us have first-hand experience of migraine, or at least some insight into the enormously debilitating effect that it can have on people living with it. Indeed, my own sister, Andrea Stephenson, who I know you know, Mr Mundell, and who many other Members may know, suffers from migraine and I have seen the impact that it has had on her over the years.

As we have heard this morning, migraine is a severe and painful long-term health condition and, as my hon. Friend the Member for Bishop Auckland so eloquently said, it is so much more than just a really bad headache. Anyone who lives with migraine knows that it can have a very significant and negative impact on quality of life. Perhaps the cruellest aspect of the condition is its ability to strike with little or no warning, disrupting people’s ability to perform even the most basic daily tasks. Migraine symptoms can last for days, affecting all aspects of life, including family and work life and the ability to engage in social activities. Even between attacks, migraine can impact on quality of life, especially when people try to limit daily activities to prevent another migraine.

Although the human cost is important—it is the most important factor—it is worth reflecting on the economic cost, which my hon. Friend the Member for Bishop Auckland and my right hon. Friend the Member for South Staffordshire set out so well in their speeches. That is why timely access to appropriate and effective care and treatment is so important. Accurate, timely diagnosis can ensure that people can access migraine treatments as early as possible, helping them to get the care that they need to treat attacks when they strike and prevent future ones. There is no specific test to diagnose migraines; for an accurate diagnosis, GPs must identify a pattern of recurring headaches along with the other associated symptoms. Migraines can be unpredictable, sometimes occurring without the other symptoms normally associated with the condition, so obtaining an accurate diagnosis can take some time.

The NICE guidelines on headaches and the diagnosis and management of headaches in young people and adults, last updated in December 2021, set out best practice for healthcare professionals in the care, treatment and support of people who suffer from headaches, including migraine. They aim to improve the recognition and management of headaches and migraine with more targeted treatments to improve the quality of life for people with headaches and reduce unnecessary investigations. NICE has also produced a clinical knowledge summary on migraine. Clinical knowledge summaries are concise, accessible summaries of the current evidence for primary care professionals, focusing on the most common and significant presentations in primary care. They give trusted information to support safe decision making and improve standards of patient care.

The usual treatment approaches to migraine are designed to either stop or prevent attacks. Treatment for acute migraine includes medications such as analgesics, triptans and antiemetics. Treatments to stop or reduce the frequency of migraine attacks include medications such as beta blockers, tricyclic antidepressants and anti-epileptics. We are committed to supporting timely and consistent access to new, effective medicines for NHS patients, so I am pleased that in October 2023, NICE published technology appraisal guidance recommending Rimegepant for the acute treatment of migraine. Rimegepant is recommended where patients have tried at least two triptans but they did not work well enough; where patients cannot take triptans or where they were not tolerated; or where other medication has been tried but did not work well enough. In separate guidance, last year NICE also recommended Rimegepant as an option for preventing episodic migraine in adults where at least three previous preventive treatments have failed, opening a way for 145,000 people in England to choose that option.

[Sir Gavin Williamson]

I appreciate the Minister’s setting out all that has been done. A few hon. Members mentioned CGRP blockers. I am sure that an exciting announcement may be coming, but if not, can the Minister reassure us that they can be looked at, to ensure that something emerges and is done about them?

[Andrew Stephenson]

My right hon. Friend anticipated my next point. Several hon. Members mentioned the difficulties experienced by some patients in accessing CGRP blockers. That issue was raised by the hon. Member for East Londonderry in his intervention. I note my right hon. Friend’s concern, and the comments of my hon. Friend the Member for Bishop Auckland about the NICE guidelines being reviewed to allow specialist treatment such as CGRP blockers to be made available as a first-line therapy.

NICE develops its recommendations independently, based on an assessment of the available evidence of clinical effectiveness and cost-effectiveness and through extensive engagement with interested parties. It is right that those decisions are taken independently on the basis of the available evidence, so it would not be appropriate for me to intervene directly. However, NICE keeps its recommendations under active surveillance, and if significant new evidence emerged it would review its guidance. I very much hope that NICE has been listening to what has been said by hon. and right hon. Members in this debate and looks at the emerging evidence from charities, such as the Migraine Trust, which might prompt it to review the guidance.

The NHS in England is legally required to make funding available for treatments that have been recommended by NICE. If there are any concerns about the availability of a NICE-recommended treatment in a particular area, it is important that hon. and right hon. Members raise those with their local integrated care boards in the first instance. However, I would be more than happy to look into situations where Members still have concerns.

My hon. Friend the Member for Bishop Auckland raised the issue of CGRPs and prescribing rights in primary care. That is an interesting point. I have asked the Medicines and Healthcare products Regulatory Agency to look into this matter and I will write to my hon. Friend in the coming days.

Similarly, I will take away the point made by my right hon. Friend the Member for South Staffordshire about what more we can do to better utilise our local pharmacies. The Under-Secretary of State for Health and Social Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), is responsible for pharmacy policy. She has already overseen the roll-out of Pharmacy First, ensuring that more conditions than ever before can be addressed by pharmacists, rather than people having to wait to see a GP.

At the moment, we expect that patients suffering from migraine would normally be treated first by their GP. If this failed to resolve the problem, patients would be referred to a consultant neurologist for further investigations and tests. We recognise the challenges within secondary care, in terms of waiting list size and the length of wait, with patients waiting far too long to access the specialist care they need. Neurology is particularly challenging at the moment, with a need for more neurologists, specialist nurses and allied health professionals.

We are committed to reducing waiting lists. To this end, we commissioned NHS England to develop a long-term plan for the NHS workforce for the next 15 years, which was published in June 2023. This sets out how we would deliver the doctors, nurses and other professionals that will be needed, also taking into account improvements in retention and productivity. The plan looks at the mix and number of staff required and has set out the actions and reform across the NHS that are needed to reduce the supply gap and improve retention. The plan will help ensure that we have the right number of staff with the right skills to transform and deliver high-quality services for the future.

My hon. Friend the Member for Bishop Auckland, the hon. Member for Greenwich and Woolwich and my right hon. Friend the Member for South Staffordshire all raised the issue of awareness amongst GPs. UK medical schools determine the content of their own curricula. The delivery of these undergraduate curricula must meet standards set by the General Medical Council. The standards require the curriculum to be formed in a way that allows all medical students, by the time they complete their medical degree, to meet the GMC’s outcomes for graduates, which describe the knowledge, skills and behaviours they must show as newly registered doctors. Therefore, whilst not all curricula will necessarily highlight specific conditions, they all nevertheless emphasise the skills and approaches that a healthcare practitioner must develop to ensure accurate and timely diagnoses and treatment plans for patients, including for migraine.

All healthcare professionals, including GPs, are responsible for ensuring that their clinical knowledge remains up to date and for identifying learning needs as part of their continuing professional development. The Royal College of General Practitioners has developed e-learning resources to update primary care clinicians on the nature of migraine, the different diagnoses and how to approach a patient with headache.

Through NHS England’s getting it right first time—or GIRFT—programme, we are also offering practical solutions for managing the demand for services within secondary care. There have been major advances in treating neurological conditions, including migraine, but services often struggle to keep pace with innovation, which has a significant impact on outcomes for people living with those conditions. GIRFT is a national programme which is designed to improve the treatment and care of patients through in-depth, clinically led review of specialties to examine how they are currently being done and how they could be improved. The GIRFT national specialty report for neurology, published in September 2021, makes a number of recommendations applicable to migraine. For example, the report highlights that providing support and advice to GPs in diagnosing and managing patients with headache can improve management of patients without a patient necessarily having to be seen as an out-patient. GP access to CT and MRI imaging would also enhance GPs’ ability to manage headaches in the community using appropriate guidelines.

As several right hon. and hon. Members said, research is key. Investing in research is a key component of supporting people living with migraine. It plays a vital role in providing those working in the NHS with the evidence they need to better support patients and provide access to pioneering treatments, diagnostics and services. The Department of Health and Social Care funds research through the National Institute for Health Research, which has funded and supported a range of research projects on migraine over the past five years, including studies to assess the efficacy and cost-effectiveness of drugs to prevent and treat migraines, and resources and training on self-management. For example, a study that is close to completion is looking at the comparative clinical cost-effectiveness of pharmacological treatments for adults with chronic migraine.

I once again thank right hon. and hon. Members for their insightful points. I hope they and my hon. Friend the Member for Bishop Auckland are reassured by some of the measures I have outlined today. I recognise that we must go further, and I assure them that I will continue to support people living with migraine through system transformation, NIHR research and exploring and investing in new treatments to ensure we are delivering real results for patients on the ground.

10:46

[Dehenna Davison]

I am very grateful to the Minister for his remarks, and particularly for the fact that he has already actioned some of the points we raised by asking the MHRA to look into primary care prescribing. He also said that the Under-Secretary of State for Health and Social Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), is potentially exploring the further use of pharmacies, which is clearly a positive step.

My right hon. Friend the Member for South Staffordshire (Sir Gavin Williamson) made the brilliant comment that we clearly need to tackle migraine differently. I hope there can be a bit more oomph from the Department when it comes to recommendations from NICE. I appreciate that independence is crucial, but by raising awareness as we are doing today, and hopefully with some input from the Minister, we can perhaps still ask for another review without asking NICE specifically what to put into its guidance.

I am grateful to all right hon. and hon. Members who attended. They made some very interesting points and raised the cases of constituents living with this horrible condition. My right hon. Friend the Member for South Staffordshire talked about the wider impact of migraines, which many of us touched on. This is a health condition that does not just come on every so often; it has a wider impact on a person’s life and causes anxiety. It is about the in-between days when they are wondering when an attack might next strike. I am grateful to the Minister for recognising that and for talking about his own family’s experience of migraine, given that his sister suffers from the condition.

I am grateful to my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) and the hon. Member for Midlothian (Owen Thompson) for sharing their experiences of migraine. Though their experiences were different in some ways, they were very similar in others, such as in the severity of attacks and the anxiety about how to tackle them. I was absolutely staggered by the amount that my right hon. Friend the Member for Romsey and Southampton North has spent on tackling her migraine. Botox can be an incredibly effective treatment, yet so many are unable to access it on the NHS, despite it being an approved treatment. That is another lifeline that we need to address. She raised the case of Monica, her constituent, who has had issues with her employer. I completely agree with my right hon. Friend and the hon. Member for Midlothian that migraine should formally be considered a disability, so that employers not only should, but have to put in place reasonable adjustments.

The hon. Member for East Londonderry—

[Paul Girvan]

South Antrim.

[Dehenna Davison]

South Antrim. I have my DUP colleagues confused—I can only apologise. It is because they both share a brilliant passion for Northern Ireland and for tackling the issue of migraine. I thank the hon. Member for South Antrim (Paul Girvan) for raising DWP assessments and the difficulty people have in accessing support when they are out of work as a result of chronic migraine. We have heard the statistics about how many people unfortunately have to give up work as a result of this disease, so hopefully we can take that up with DWP next time so that it can review its processes. Certainly, having chronic migraine listed as a formal disability would be a positive step in helping ensure that that is done.

The hon. Member also discussed the point around the devolved bodies. We heard some great testimonies from the SNP spokesperson, the hon. Member for Midlothian, about the positive steps being taken in Scotland and particularly the number of Scottish trusts that allow CGRP blockers to be prescribed. As he rightly said, that number is still not 100% and we need to go further to make sure that new, innovative treatment options that can work for so many people can be accessed by all those who are struggling.

I am grateful to the shadow Minister, the hon. Member for Bristol South (Karin Smyth), not only for responding here, but for getting in touch with me in advance of today’s debate so we could share a few notes about the impact chronic migraine can have. She is right to raise the impact on children—I did not particularly cover that in my speech, but my right hon. Friend the Member for Romsey and Southampton North touched upon it, given that she started experiencing migraine at such a young age. In some ways, it is even more terrifying for children because there is that lack of awareness of what is happening when a migraine attack strikes. Again, that is one example of how we need to get this right, in order to give people a better quality of life.

The hon. Member for Bristol South also talked about long-term workplace inactivity. Frankly, the best way we can tackle that is by getting people earlier diagnosis and earlier treatment that actually works. Part of that, as has been mentioned, comes down to knowledge and I am grateful to the Minister for talking about how medical training is outlined and done. It is great to hear that there are e-learning modules specifically on headache and migraine available for GPs and other medical practitioners to access—but I say we need to be bolder and I say we need to go further.

Off the back of this debate, therefore, I will be contacting some of those medical bodies to ensure they know just how debilitating and difficult migraine can be, in the hope that they can ensure not only that their educational modules are top notch and delivering the right information to the right people, but that people are taking those modules. They are not an optional extra; they are an absolute necessity.

I have probably missed some bits—yes, I have: I am grateful to the hon. Member for Greenwich and Woolwich (Matthew Pennycook), who is no longer in his place, for raising a point about knowledge, particularly of hormonal migraine, which many people experience. It is right that we continue to research that and make sure that medical practitioners have the knowledge they need.

My hon. Friend the Member for Kettering (Mr Hollobone) also raised the experience of his constituent. Again, it was another human story that tells the tale of chronic migraine; another human story that tells the tale of just how difficult this blooming thing can be. I am grateful to all hon. Members here today for taking part in the debate, for getting involved and for showing that there are people here in Parliament who care. To people watching at home, I say, “We are here, we hear you and we are going to do all we can to make this better.” I will keep nagging the Minister until we really see improvements in migraine care.

Question put and agreed to.

Resolved,

That this House has considered access to migraine treatment.

10:53

Sitting suspended.

Conduct of Elections

Wednesday 20th March 2024 Westminster Hall

11:00

[David Mundell (in the Chair)]

I will call Wendy Chamberlain to move the motion and then call the Minister to respond. As is the convention in 30-minute debates, there will not be an opportunity for the Member in charge to wind up.

[Wendy Chamberlain (North East Fife) (LD)]

I beg to move,

That this House has considered the conduct of elections.

It is a privilege to serve under your chairmanship, Mr Mundell. We are approaching a general election at some point this year, or maybe next, and it will not be a snap general election. A lot has happened since the previous one in December 2019, and the country has experienced a number of events since then, but the intention of this debate is to note that a number of changes to our democracy will be fully tested for the first time in a general election since 2019. It is worth while assessing whether those changes have improved our democratic systems, or whether they are tools for the current Government to improve their position.

In the 2019 Conservative manifesto the Government committed to a number of changes, including the scrapping of the Fixed-term Parliaments Act 2011, updating and equalising boundaries through the Parliamentary Constituencies Act 2020, and maintaining first past the post. I wonder whether the former vice-chairman of the Conservative party and now Reform MP, the hon. Member for Ashfield (Lee Anderson), agrees with that, given that he is now a member of a party that is committed to electoral reform and has signed up to the Make Votes Matter good systems agreement. It is always worth noting that the only other country in Europe that has the first-past-the-post system is Belarus.

In additional, the Government committed to maintaining the voting age of 18, introducing voter ID, and restricting postal vote harvesting and foreign interference in elections. It is a pity they have been slow to move on that issue when it comes to party finances. They also committed to preventing that intimidation of candidates and voters, and I am sure we can all agree with that.

The Government also committed to introducing a constitution, democracy and rights commission within the first year of the new Parliament. In December 2020, the Public Administration and Constitutional Affairs Committee held oral evidence sessions on the subject of a commission but, other than independent reviews of administrative law and the Human Rights Act 1998, the reports of which have resulted in further consultations, there is no commission.

Indeed, the Constitution Unit has suggested that the Government’s failure on that manifesto commitment is because the underlying goal is to bolster their position and weaken parliamentary and judicial checks, and that a more fragmented review process may help to obscure the combined effort of any reforms and divide opponents. I hope the Minister will provide clarity on the future of the commission and whether it will come into being before the election.

As MPs, when people come to us for assistance, the first thing we do is check that they are our constituents. We do that by finding out where they live. I am sure the vast majority of MPs point out on their standard automated acknowledgment that the person who has emailed must be a constituent in order to get assistance. It is important to note that constituencies are not organised on that basis, but on the number of registered voters within them.

The Parliamentary Constituencies Act 2020 set a tolerance of 5% of the electoral quota to produce what the Government insist are equal constituencies, to ensure that each vote applies equally. That has resulted in huge differences in the constituencies to be fought in the upcoming general election. Only 55 of the 533 English constituencies remain unchanged by boundaries. The geographical boundaries have shifted and the names of some of the new constituencies are a mouthful, linking areas that are not necessarily linked in other obvious, definable ways.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for securing this debate. She brings many things to Westminster Hall and the Chamber that are of great interest to us all, and I thank her for giving me the chance to intervene. The changes in the 2020 Act apply to the United Kingdom parliamentary elections, police and crime commissioner elections in England and Wales, and local elections in England. Some provisions apply to Northern Ireland Assembly elections and local elections. Does the hon. Lady agree that all provisions of the Act should apply to all elections in all regions of the United Kingdom of Great Britain and Northern Ireland?

[Wendy Chamberlain]

The hon. Member always brings an additional dimension to debates. From a democratic perspective, it is important that devolution is respected where it exists. It is also important to recognise that the Welsh and Scottish Governments did not provide legislative consent to the Elections Act 2022 and are looking to legislate themselves. I want to see consistency across our electoral systems in the UK. As a Scottish MP, I always enjoy speaking to voters, regardless of the election, and understanding how clever and able they are. They know exactly what to do with the different electoral systems for the different institutions.

I want to touch on the impact of overseas voters. The legislation on overseas voters means that UK nationals who live overseas are no longer affected by the rule saying that if they have lived overseas for more than 15 years, they cannot vote. One challenge with that change is that we do not know where overseas voters are likely to vote. In many cases, local authorities do not keep electoral registers that go back more than 15 years, and we are basing the estimates on where people assure us they lived previously. We have a 5% rule, which makes each vote count equally in equally sized constituencies, and the change introduces an unknown number of people to a number of constituencies. Will the Minister talk about what the Government have done to ensure that overseas voters are registered in the right place? What are the estimates for the numbers of people registered?

The Minister will be pleased to know that I am not about to talk at length about first past the post—as a Liberal Democrat, that is something I always do—but it is worth pointing out that trust in politics is at an all-time low, and that a system that is arguably unable to deliver fair votes and make everyone’s vote count is unlikely to improve that situation. In my constituency, only two votes separated the Liberal Democrats and the SNP in the 2017 general election—I should add that I was not then the Liberal Democrats’ candidate—and many more constituents voted for someone other than the winner. That is what marginal seats mean, and it is important that we recognise that.

Unlock Democracy’s recent report, “Register Every Voter”, illustrates some of the challenges that the Government’s approach has produced in terms of whether electoral registers support our democracy. The report evaluated registers on the basis of four considerations: register completeness is

“the extent to which every person who is entitled to be registered, is registered”;

register accuracy

“can be usefully defined as the extent to which there are no false entries on the electoral registers”;

register equity

“refers to the extent to which there is an even distribution in the completeness of the electoral register across educational, socio-demographic, ethnic, gendered or other groups”;

and administrative robustness means that electoral registration processes

“must be deliverable without errors which can lead to citizens not being able to vote or the trust in the system being undermined. This requires sufficient staffing, resource and capacity.”

The report estimates that up to 8 million people are missing from the electoral register or are not correctly registered to vote. Unsurprisingly, it finds:

“Those who were under registered were more likely to be in urban areas…more mobile; private renters; younger; from Asian, Black, Mixed or ‘other’ ethnic backgrounds; non-UK nationals; from lower socio-economic groups and with lower qualifications”.

I would argue that those are exactly the people who need good politics and good support from locally elected representatives.

Even more concerning is the fact that the number of people registering to vote is falling. As MPs, that should concern us all. An increase in the UK population of 6% since 2011 has not been reflected in voter registration. I accept that registration usually increases at the time of a general election—we have not had one of those for a while—but the overall trend is worrying. Will the Minister indicate what the Government are intending to do about that? Will the Government seriously consider automatic voter registration, which is used by half of the world’s countries?

Voter identification requirements may also be playing their part. In an urgent question last September I highlighted the Electoral Commission’s report that warned that disabled people and the unemployed find it harder to show accepted voter ID, as do younger people and people from ethnic minorities. It also reported that on average a higher proportion of people were turned away in more deprived areas, compared with less deprived areas. The Local Government Information Unit reported that approximately 14,000 voters were not given a ballot paper because they could not show an accepted form of ID, and significantly more were deterred from voting because of the ID requirement.

[Jim Shannon]

Northern Ireland has had voter ID for a number of years—this is not a criticism; I am trying to be positive—and it has been successful. I think it is a matter of what the Government can do to help people to get their IDs. There is a proactive campaign in Northern Ireland to make that happen. I say genuinely, constructively and honestly that voter ID in Northern Ireland has worked because the Government went overboard to make it work.

[Wendy Chamberlain]

The hon. Member and I rarely disagree and we can find points of consensus. One thing that Northern Ireland has done very well is that it has been much more proactive in getting people registered to vote, working in schools and elsewhere, which means that in some respects voter ID is less of an issue because people have been encouraged to vote and have the right ID at an early stage. Having one and not the other makes things much more difficult for people. If people do not have voter ID or acceptable voter ID, it can suggest that the Government are comfortable with the idea that those people are not in a position to be able to vote.

The Commons Library briefing on voter ID states that 90% of voters were likely to think that voting was “safe” after last year’s local elections in England, but that pattern was unchanged since before voter ID was introduced, so introducing voter ID has made no difference to public perception of the safety of voting. The Government response to the Electoral Commission report in November last year rejected a number of the commission’s recommendations that arose from the report. Given that the Minister was responsible for that response, will he advise what additional measures will be available for the GE, particularly for groups such as disabled people, to ensure that those who are entitled to vote can?

I have already mentioned the Elections Act 2022 in response to an intervention from the hon. Member for Strangford. It included measures to address the impact of candidate and voter intimidation—I am sure we all want to see less of that, particularly when MP security and safety has been back in the public eye and discussed in recent weeks—but it is fair to say that those elements of the Act did not constitute the areas of debate when the Bill made its passage through Parliament. In addition to voter ID, the concerns expressed by other parties, including my own, were about finance and the independence of the Electoral Commission.

It is accepted that the next election will be the most expensive ever, and not just because of recent high inflation levels. We know who that will disproportionately benefit: the current party of Government, the Conservatives. The Electoral Commission said in November that it saw no reason to substantially raise the spending limits. We are seeing reporting on huge increases in literature that is being delivered—as a Liberal Democrat, I deliver a lot of leaflets—and also in terms of social media. When we look at disinformation it is really important that we get things right. The data rules that are changing are also part of the challenge. Simply put, the changes reward the biggest pockets. Social media and other means of communicating with voters are important, but I believe that being out on the doorsteps and speaking to voters is most effective, particularly from the trust perspective.

In the last couple of weeks there has been a lot of discussion about the Government’s donations, particularly from their donor Frank Hester. The Government have said that his comments were wrong and racist, but have not ruled out accepting future donations and, importantly, have not ruled out granting a peerage to Mr Hester—something that seems to happen quite a lot with Conservative donors. I hope the Minister can find reassure us on that.

Does the Minister generally agree that big money is potentially a further drain on public trust in politics, and that a cap on political donations would help with that? It would also level the playing field. Myself and parliamentarians from smaller parties such as the SNP and Plaid Cymru would benefit, and I would argue that that is not a bad thing because plurality of opinion is important. We have created a system in which two parties are in the lead, and nothing changes.

To conclude, it is quite clear that there has been a number of changes since 2019, and we will see at the general election whether the fears that I expressed this morning are going to be upheld or the Conservatives have made changes that do not have such an impact. Despite all the arguable rigging of the rules, all the polls currently suggest that the changes the Conservatives have made will not help them now, nor in October, November, December or even January. If they genuinely believe in the changes they have made to our democracy, they should call a general election now.

11:15

[The Parliamentary Under-Secretary of State for Levelling Up, Housing and Communities (Simon Hoare)]

It is a pleasure to serve under your chairmanship, Mr Mundell. I am grateful to the hon. Member for North East Fife (Wendy Chamberlain) for instigating this debate. The topic set out on the Order Paper is “the conduct of elections”, which is a wide canvas. We had no reference to any specific points the hon. Lady was going to draw the House’s attention to, so I am working from manuscript notes based on my own knowledge as elections Minister.

Let me shoot stone-cold dead two foxes that the hon. Lady has tried to set running round Westminster Hall this morning. First, she said that she thought the Elections Act 2022 and subsequent guidance was—I quote directly —“a tool of the current Government to improve their own position.” It is absolutely not. I say gently to her that she cannot turn around in good faith and in all conscience and say that our electorates need to have faith and confidence in the robustness, resilience, honesty, transparency and integrity of the system, and then say, in almost the juxtaposed breath, that the Government were trying to rig the rules in their favour.

If the hon. Lady does not believe me, I ask her to look at the evidence and the facts. I suggest to the House that the results of last year’s local elections demonstrate beyond peradventure that even if they had been planned to improve the position of the Government, the plan did not work. They were not results that my party welcomed. I am afraid that the hon. Lady’s fox is not only shot but buried on that point. I take her point entirely that the public need to have faith in the system, and I politely suggest to her that it is our job as parliamentarians, along with our colleagues across the local government sector, to ensure that the public have that. Her opening remarks did not help in that important endeavour.

The second fox I want to shoot and butcher is that we are in some way undermining the independence of the Electoral Commission. The commission’s independence is sacrosanct. The chairman and the chief executive of the commission know that, and we work well and closely together. I made that point very clearly on the Floor of the House when I made my statement. We have to have faith and confidence in the robust independence of the commission, and that is a ditch I will die in to defend.

The hon. Lady raised a number of other issues. She described almost as some sort of elections equivalent of the Russian revolution our revocation of the Fixed-term Parliaments Act. It was not an ancient piece of UK constitutional architecture; it was always envisaged to be a temporary piece of legislation, wisely brought in by the then coalition partners—the coalition of which the hon. Lady’s party was a key and important part—to provide stability and confidence for the markets and the electorate that there was a secure and stable Government that, having inherited an absolute horror show of a financial legacy from the Labour party, would take difficult decisions to restore the nation’s finances. The Act was always envisaged to be temporary; it is no longer required. It is for no other reason that it was revoked.

The hon. Lady spoke about the boundary reforms, which were long overdue. She will remember, although it was before her time and mine, that there was a bit of horse-trading between my party and hers and we had a referendum on changing the first-past-the-post system. My side won and her side lost, but the Liberals seem to be very poor losers and, rather like the SNP, who always try to resurrect the question of an independence referendum, they keep picking away at the scab of first past the post. I am not entirely sure that the electorate are with them on that, given the results of the referendum that was held on changing the voting system.

The Boundary Commission review of parliamentary seats was long overdue. We know full well that that will now take place every eight years, so the next review will be required to report by 2031 and will be based on the registers as at December 2028. It is about time we had that as part of an iterative process, to ensure that as populations grow and shrink, and new housing development comes on stream, our parliamentary boundaries broadly reflect an equal number of constituents to ensure that it really is one Member, one vote, and all of us are equal in this House.

[Wendy Chamberlain]

Will the Minister give way?

[Simon Hoare]

I might in a moment, but the hon. Lady covered a lot of ground and I want to give respect to her by covering the very serious and sensible points that she made.

On voter ID, the underpinning of the Act and the subsequent statutory instruments that we have brought forward is that we cannot rest on our laurels. The hon. Lady is absolutely right that in broad terms, the way our elections have been conducted in this country has been robust and fair, and everyone—both those who have won and, more importantly, those who have lost—has accepted the results, but I do not think we can rest on our laurels. She will know, as I do, that we are living in a changing world, in which western democratic principles are under acute pressure, and the rise of populism and social media brings challenges that our forefathers had not foreseen. To that purpose, we reflected on, reviewed and updated the rules that govern our electoral processes, in order to ensure that they are fit for purpose and demonstrably capable of being changed and reformed.

There is a very long list of qualifying documentation for voter ID, and 99% of all voters have at least one form of acceptable ID, and many have more. There is also the voter authority certificate, which is free and lasts for three years. That meets the needs of the 1% of the population who do not have an acceptable form of ID. We have a list, which is quite long, but it is not carved in tablets of stone. I hope the hon. Lady will welcome my saying that this is an iterative and organic process: as technologies change and new forms of ID come on board, Government will of course respond. We reviewed the situation post the local elections of 2023 and we will have to do a quick review post the coming elections in May 2024. Tweaks could easily be made, if required, in preparation for the general election later this year. I think that is the right way to go.

Turnout for the local elections in 2023 was broadly commensurate with that in previous years. The hon. Member for Strangford (Jim Shannon), who is no longer in his place, rightly referenced the fact that within boundaries of the United Kingdom, voter identification has been an accepted part of the electoral landscape in Northern Ireland—again, with no demonstrable negative impact on turnout.

The hon. Member for North East Fife and I share an absolute keenness—as do the Government, the Electoral Commission and local government—to maximise our attention to what all the survey work has pointed to, which is driving up registration and participation of those we might colloquially describe as hard-to-reach groups. That can be students, the very elderly, people from black, Asian and minority ethnic communities, or those with disabilities—in particular disabilities that make it a challenge to come into new spaces, or to meet and interact with new people.

We take this matter absolutely seriously and I want to put it clearly on the record that we want to make sure that anybody and everybody who is eligible to vote in any electoral event has the right to do so, and that if they wish to exercise that right they must be free to do so. We are deploying the strength and power of gov.uk, working with the commission, turbocharging the engines of local government communication, and reaching out to faith groups, disability groups and the voluntary sector. We are focused, Exocet-like, on driving up registration in those communities, as well as participation, with a greater awareness of voter ID. That is key and it is right. If the hon. Lady and I agree possibly on nothing else in this debate, I hope that she will welcome that.

On overseas votes, the hon. Lady repeated a line that is the third fox that I need to shoot in response to her remarks. A qualifying overseas voter cannot just choose willy-nilly which constituency to register in. I appreciate that sitting in the ivory tower of Marsham Street, one can sometimes seem slightly caught between theory and practice, but on Monday I visited a local authority election office, where I completed some of the applications processing—I did it all fairly and was supervised! We admitted two applications, but one was not sufficient because the applicant said they had been on the paper register but that had not been digitalised. Such applications are then put into the “pending” box and further proof of ID is required to prove where the individual, if qualifying, lived in that constituency and therefore that they have a right to vote there. I know that some feared that parties would organise themselves to motivate people to apply to vote in their most marginal seats, but one has to demonstrate without any form of a doubt that they have a link to that last constituency. That is important.

The hon. Lady asked what I thought the numbers may be. We assess that the potential quantum, in totality —including those already qualifying to be overseas voters under the old 15-year rule—to be about 3 million.

[Wendy Chamberlain]

I want to make it clear for the record that that was not a third fox. I was not suggesting in any way that there would not be robust processes in place for people to register in a particular seat. I was asking about the numbers, because I think the Minister must accept that if we are making an estimate of 3 million, we cannot say exactly where those 3 million will be, and the numbers will alter the overall electoral register in each affected constituency.

[Simon Hoare]

The hon. Lady makes a good and clear point. Clearly, when it came to the subsequent boundary review—at a time when, one would have to presume, those who had qualified would have already taken up and exercised that right—those who were reviewing our parliamentary boundaries would take those numbers into account. That is the one number that will never move, because one will not be able to change a historical link to a constituency.

The hon. Lady made an important point about devolution and different settlements. I assure her that while there are differentials between the nations of the United Kingdom, the four of us who are charged ministerially with dealing with elections, and the Northern Ireland Office, work closely together to ensure that parity can be delivered as and when it can, and when it is deemed to be desirable, and to try to maximise the points that the hon. Lady talked about—namely, simplicity and transparency across these islands.

The hon. Lady mentioned automatic voter registration. Again, that is something that any Government would keep under review. We have decided that individual registration is the best way. We all talk about rights, but sometimes we do not talk about responsibilities, and I actually think that that individual motivation to register—deciding to go on the electoral register, obviously without being forced to vote—begins a contract between the young qualifying adult and the state in all its manifestations.

This has been a fascinating debate, which we now draw to a conclusion. I am grateful to the hon. Member for North East Fife. I just hope that I have assured her on the two key charges that she levied against us: the commission’s independence is clear and without challenge; and we are in no way trying to gerrymander. The Conservative party is the oldest political party in the world. We have always extended and widened the franchise, and that is a historical tradition that we intend to continue.

Question put and agreed to.

11:29

Sitting suspended.

Sri Lanka: Human Rights

Wednesday 20th March 2024 Westminster Hall

[Dame Maria Miller in the Chair]

14:30

[Elliot Colburn (Carshalton and Wallington) (Con)]

I beg to move,

That this House has considered human rights in Sri Lanka.

It is a pleasure to serve under your chairmanship, Dame Maria. Sri Lanka’s 2009 conflict ended in a horrific bloodbath. Tens of thousands of Tamils were killed in the final months, with accusations pointing to intentional targeting of civilians by the Sri Lankan military. That dark chapter remains open, with an estimated 70,000 to 170,000 Tamils unaccounted for and presumed dead. The Government’s continued denial of war crimes, crimes against humanity and even genocide fuels anger and blocks the path towards healing. The situation for Tamils, and indeed other minority groups, such as Muslims, in Sri Lanka remains precarious. Impunity reigns, human rights violations persist and heavy militarisation casts a long shadow. Sri Lanka’s failure to address accountability and pursue transitional justice mechanisms hinders any hope for lasting peace and reconciliation.

The international community’s call for accountability has not translated into concrete action, and the United Nations Human Rights Council rightly identifies the lack of accountability as the critical missing piece to Sri Lanka moving forward. We have seen decades of ineffective governance and policies driven by nationalism, which was a root cause of the conflict, continue to plague the nation, contributing to its current political and economic crises. It is vital that the international community continues to hold Sri Lanka accountable for past and present human rights violations, because only through the effective mechanisms for international investigation and prosecution can Sri Lanka achieve meaningful justice and reconciliation and finally turn a page on this dark chapter.

Sri Lanka has witnessed a chilling escalation in a suppression of Tamil remembrance this past year. As Tamils prepared to commemorate Maaveerar Naal remembrance day, and even during the ceremonies that took place, police actively disrupted events, physically blocked people from attending, destroyed memorials with violence and arrested participants. That is not a new tactic—Tamils in the north-east have historically faced harassment leading up to Maaveerar Naal—but last year, crackdowns intensified despite court orders permitting the commemorations.

Since the memorial, fear and injustice have gripped the Tamil community. The notorious Prevention of Terrorism Act was once again wielded, leading to arrests of Tamils simply for carrying decorations or attending remembrance ceremonies. Even those providing logistical support with vehicles or generators faced arbitrary detention. That draconian law, which is a stain on the country’s human rights record, has fuelled decades of abuse: prolonged detentions, disappearances and torture, particularly against Tamils and Muslims. Those are the horrific realities of the PTA. Stronger action from the UK is crucial to abolish that Act.

The shadow of militarisation looms over Sri Lanka’s Tamil north-east population. Despite Sri Lanka boasting one of the world’s largest militaries, a staggering 18 of its 20 military divisions occupy the north-east region, with 14 concentrated solely in the north. That overwhelming presence comes at a steep cost: Sri Lanka spends more on its defence than it does on healthcare and education combined. There have been recent claims of de-escalation and demilitarisation, but that has not occurred, so concrete action is needed. The UK must continue to push with its international partners for the de-militarisation of the north-east, dismantling the intrusive presence and allowing Tamils to rebuild their lives free from the constant shadow of the military.

As Sri Lanka tackles its economic woes, the UK must acknowledge the lack of political will to protect Tamil livelihoods and urge an end to the land grabs of Tamil land. Frustration continues within the Tamil community in Sri Lanka and overseas, which has long demanded a lasting solution that tackles the root cause of conflict. Years of empty promises and unmet aspirations from successive Governments have only fuelled those demands.

In February 2023, Tamil protestors defied intimidation and surveillance to stage a four-day protest across the north-east, in a powerful rejection of the 75th anniversary of independence day. That served to symbolically reclaim Tamil homeland and issue a clear set of demands, including the end to military occupation, justice for the Tamil genocide and uncovering the truth about those who disappeared.

President Wickremesinghe pledged to solve the ethnic crisis and hold talks with Tamil parties, but those efforts have proven fruitless: the Tamil community awaits concrete action, not empty words. The country is clinging to a troubling legacy; those accused of war crimes against Tamils continue to enjoy protection, with some even receiving pardons and diplomatic postings. That blatant disregard for accountability exposes the shortcomings in the justice system and underscores the current administration’s tolerance for impunity.

There is a clear lack of political will to deliver justice for Tamil victims, and that is evident even in high profile cases. The unresolved Trinco 5 killings, which were high- lighted both by the UN Human Rights Council and during recent Generalised Scheme of Preferences Plus trade discussions, stand as a stark example. The UN High Commissioner for Human Rights has aptly noted that not a single emblematic case has resulted in conviction. Sri Lanka’s path forward hinges on genuine commitment to accountability—a path they have yet to take.

[Sir Iain Duncan Smith (Chingford and Woodford Green) (Con)]

I very much support what my hon. Friend has been saying. I agree that settling this issue and getting the right human rights for those Tamils who are suffering—many of whom have fled over here into many of our constituencies—is important.

However, there is also another side of this. The need for the Sri Lankan Government, as a result of not resolving this issue, to station so many army divisions and spend so much on the military is one of the reasons why the Chinese were able to secure a 99-year lease on the Hambantota port. The Chinese are able to have their ships in that port because the Sri Lankan Government is bankrupt. That has a very big impact on the UK’s wider views on the far east.

[Elliot Colburn]

My right hon. Friend is absolutely right; there is increasing concern about Chinese influence on the island. That is something my right hon. Friend has spoken very powerfully on, and I hope that the Government have listened.

Sri Lanka has a long history of truth commissions—they have held over 15 since independence—but none of them have delivered meaningful justice or accountability, and the proposed truth and reconciliation committee seems destined to follow the same path. The Tamil community remains deeply sceptical; it advocates for an independent international mechanism with the power to investigate and prosecute impartially. The Government however appear to view the TRC as a way to escape international scrutiny at the UN Human Rights Council.

Truth-telling is crucial for transitional justice, but it should not come at the expense of holding perpetrators accountable. The Sri Lankan Government’s past failures to deliver on those promises raises serious concerns. A genuine TRC should prioritise justice for victims, not serve as a tool for escaping international pressure.

Sri Lanka’s commitment to the UN Human Rights Council process has crumbled. After failing to show meaningful progress on resolution 30/1, they shockingly withdrew their co-sponsorship of it in 2020. Even the limited progress that has been made is now being reversed. A recent UN report from September last year painted a bleak picture:

“Sri Lanka suffers from a continuing accountability deficit”.

From war crimes, to recent human rights violations, corruption and abuse of power, the path to justice remains blocked. No Government has established a judicial mechanism to deliver justice in the emblematic cases outlined by the UN Human Rights Council. Allowing Sri Lanka to continually renege on its international commitments weakens the credibility of the UNHRC and its member states. The fight for accountability must not be abandoned.

Sri Lanka’s war crimes remain unpunished. Despite overwhelming evidence, no perpetrators have faced sanctions under the UK’s new Magnitsky Act-style legislation. This inaction stands in stark contrast to Canada, which sanctioned former President Rajapaksa for his wartime actions, and the US, which sanctioned General Shavendra Silva—whose division still stands accused of horrific abuses. The UK must act; holding war criminals accountable is essential for justice and a crucial step towards a more peaceful future.

I believe that the UK’s relationship with Sri Lanka needs a critical review. Military co-operation must be suspended until Sri Lanka removes personnel implicated in human rights violations from its security forces. The UK should also refuse diplomatic access and diplomatic roles to anyone accused of such abuses. Trade deals and concessions require re-evaluation in light of Sri Lanka’s failure to uphold human rights commitments, and sanctions are a potential tool to pressure reform.

Furthermore, the UK should make all future bilateral and multilateral ties with Sri Lanka contingent on concrete progress, that includes reconciliation among ethnic and religious groups. Sri Lanka should investigate and prosecute war crimes and human rights violations, return stolen land, resolve disappearances and reduce the military presence in former conflict zones. Ultimately, the island must demonstrate respect and uphold the rights and freedoms of all its people, regardless of ethnicity or religion. Investigating and prosecuting human rights abuses is critical to achieving that. By linking its support to those vital changes, the UK can play a significant role in pushing Sri Lanka towards a more just and peaceful future.

Sri Lanka’s human rights record casts a long shadow and demands a firm international response. The UK, along with other nations, has a crucial role in holding the country accountable. First, those accused of human rights crimes cannot escape unscathed. Targeted sanctions against officials can deliver a powerful message. Additionally, the principle of universal jurisdiction allows countries to pursue legal action against perpetrators on their own soil, regardless of where the crimes were committed.

The International Criminal Court offers another avenue for justice. The UK can collaborate with civil society to submit communications to the ICC’s prosecutor, urging a preliminary examination of potential crimes that fall under that court’s jurisdiction. Furthermore, Sri Lanka’s potential breaches of human rights treaties cannot be ignored. The International Court of Justice can be used to address the issues we are talking about —specifically, torture, enforced disappearance and racial discrimination.

Trade concessions granted to Sri Lanka under the developing countries trading scheme should not be unconditional. The UK can leverage those benefits by making them contingent on demonstrable progress in three key areas: the military must be purged of those implicated in human rights abuses, the Prevention of Terrorism Act must be repealed, and those responsible for well-documented human rights violations must be brought to justice. By employing that approach, the UK and the international community can send a clear message that human rights violations will not be tolerated. Those actions can and will exert significant pressure to push Sri Lanka towards a future in which the rights of all its people are respected. In particular, the Tamil people should achieve the peace, justice, accountability and truth that they have so long fought for.

[Dame Maria Miller (in the Chair)]

I call Jim Shannon.

14:42

[Jim Shannon (Strangford) (DUP)]

You threw me there, Dame Maria. I expected that the hon. Member for Mitcham and Morden (Dame Siobhain McDonagh) would be in front of me. I am very pleased to be called to make a contribution. Thank you for giving me the opportunity to speak. I congratulate the hon. Member for Carshalton and Wallington (Elliot Colburn), who regularly speaks up for minorities and raises human rights issues in Westminster Hall and the main Chamber; we appreciate his efforts.

I have spoken about human rights in Sri Lanka before. It is hard to come back and say that things have not changed, but unfortunately they have not. That is why this debate is so important—the hon. Gentleman outlined that very clearly. I will speak about the freedom of religion or belief, which is encompassed within the definition of human rights. Taking away human rights affects religious belief, and taking away religious belief affects human rights—the two are married together. Whenever we talk about one, we talk about the other.

The question for us today is how can we address this? More reasonably, how can we be part of the process of securing human rights for a needy people? Their history makes my heart sore, as it does for anyone who has compassion. They have lost everything—their dignity, their possessions, their human rights and their freedom of religious belief—all because of an autocratic regime that, as the hon. Gentleman said, spends more on defence than on feeding the country, health or education. It moves me to tears when I think about it.

I believe that steps can be taken and progress can be made on reconciliation through accountability, justice, acknowledgement and a correction of the situation for religious minorities. That must be considered by our Government and the Minister. I am pleased to see the Minister in his place—I always am—because he clearly understands our feelings and thoughts. I hope that he will provide some assurance on the issues, given that our Government develop foreign policies.

I am also pleased to see in their places the shadow Minister, the hon. Member for Cardiff North (Anna McMorrin), and the shadow Minister for the Scots Nats, the hon. Member for Argyll and Bute (Brendan O’Hara). He and I have been good friends in this House for many years. We have spoken on issues together and have had different adventures overseas, visiting some of those countries where the suppression of human rights and religious freedom is rampant. Although we have different outlooks on the constitution, we have the very same opinion on the issue of human rights, and our social consciences are married together, as indeed is our faith, which we hold strongly.

Sri Lankan Government agencies unlawfully occupied the property and religious sites of minority Tamil and Muslim communities. Additionally, in September 2023 a judge resigned and fled the country after he received death threats for a ruling that he made against the Department of Archaeology, which had constructed a Buddhist monument on the site of a Hindu temple. As chair of the all-party parliamentary group for international freedom of religion or belief, I speak out for those with Christian belief, other beliefs and, indeed, no beliefs, because that is what I believe in my heart and that is where I come from. If a Hindu temple is disrespected and a Buddhist temple is built on it, that is against the human rights and the religious belief of those of a Hindu faith in Sri Lanka. That is done because it is encouraged by a Government who have little or no concern or respect for any other religion.

How do we address those issues? I hope to outline that, but the major issue is that we should be using aid to change the opinion of the authorities in Sri Lanka. As acknowledged in the briefing for this debate, Sri Lanka’s Online Safety Act and other proposed and enacted laws have severely limited civil liberties. How are such laws impacting on freedom of religion or belief?

The rights to freedom of expression and freedom of assembly are heavily intertwined with the fate of FORB, as I mentioned at the beginning. I can never get myself away from that definition of where we are and how I and many others in the Chamber and further afield see it. We must ensure that our foreign policies—this is where the Minister and our Government come in— encourage compliance with article 18 of the universal declaration of human rights and the international covenant on civil and political rights, which Sri Lanka ratified in 1980. It was ratified, but no action was taken, and I am disappointed that the Sri Lankan Government have disregarded article 18 in its totality.

FORB is also intricately linked with women’s and girls’ rights. I mention that because some of the things that are happening in Sri Lanka are bestial and disgraceful. The Muslim Marriage and Divorce Act, which governs marriage in the Muslim community, contains numerous provisions that violate the rights of women and girls, including by allowing child marriage without setting any minimum age.

I get real angst when I think about that. I look at my grandchildren and think how, if they were living in Sri Lanka, they could be abused—they could be married at the age of nine and 15, even though their bodies and emotions are clearly not in any way ready for that to happen. As a father and grandfather, how could I not condemn what the Sri Lankan authorities are doing against young women, and especially young girls? The Act stipulates that only men can be judges in the quazi—family—court, which makes it easier for men than women to obtain a divorce. It does not require a woman’s or girl’s consent to be recorded before the registration of her marriage, which should be an absolute precondition.

I am ever mindful that the Minister is not responsible for what is happening in Sri Lanka. I just ask him if there have been any discussions with the Sri Lankan authorities in relation to this specific issue to ensure that there will be no under-age marriage whatsoever.

Following on from that, in cases of child marriage, the penal code in Sri Lanka permits under the MMDA what would otherwise constitute statutory rape. In no country in this world should the statutory rape of young girls be permitted. Those girls, who have not reached puberty, can be abused by people just because they have got the right to do it by the law of the land. When it comes to the MMDA and the divorce Act, what are the Government and the Minister doing, and what are we doing as a people of conscience, to help those young ladies in Sri Lanka?

The UK must take laws into account as well as helping to develop aid strategies and distribution policies for Sri Lanka. Additionally, the UK must consider the position of refugees in Sri Lanka. There are lots of refugees there. I think that the hon. Member for Carshalton and Wallington referred to 14 divisions in the north of Sri Lanka who are there primarily and objectively to intimidate all the Tamils, the local populations, and local religions as well. How can that be disregarded by our own Government or by our own people?

There are several religious minorities in Sri Lanka, including the Ahmadis. The hon. Member for Argyll and Bute and I were in Pakistan and had an opportunity to see and meet the Ahmadis on a regular basis. I really have to make a plea for them. They fled from persecution in Pakistan and are still awaiting resettlement in other countries.

I am conscious that I am asking the Minister a lot of questions, but I do so because I feel they must be put on the record, and very strongly feel that we need answers to them. While the resettlement considerations may not be in the realm of the UK’s authority, are there ways in which we can help Sri Lanka to develop policies and processes to ensure that the rights of refugees are protected? Can we work with Sri Lanka, for instance, and relevant communities and Governments to resettle the refugees in third countries? We should have a role, working alongside other countries to make that happen.

Finally, will the UK be able to take in such refugees as part of its UK resettlement scheme for the United Nations High Commissioner for Refugees? That is a question that we must ask ourselves. We cannot solve the world’s problems by ourselves, but we can play a role in making lives better by bringing such refugees to our shores. Equally, we can help them to resettle elsewhere. We have international obligations to fulfil.

I conclude with this as I am ever mindful that others want to speak and want to give them all a chance to contribute to the debate. I have spoken about human rights in Sri Lanka on many occasions, because the stories that I and others hear in this House move me to do all that I can. The question for our Government must be: have we been moved as much to do all we can? If not, will we begin to be moved today?

We take the right to live, the right to work and the right to hold our own beliefs for granted in this great United Kingdom of Great Britain and Northern Ireland, but we are tasked with the responsibility of speaking up for those who do not have those human rights—including freedom of religious rights—in Sri Lanka. I believe that we must speak for those who have no voice. In our debate today, I want my voice and the voices of others in the Chamber to be the voices for the voiceless of Sri Lanka, who need us to speak up for them and to do our best for them.

14:52

[Dame Siobhain McDonagh (Mitcham and Morden) (Lab)]

It is a pleasure to serve under your chairship, Dame Maria. I congratulate the hon. Member for Carshalton and Wallington (Elliot Colburn) on securing the debate, and it is a pleasure to follow the hon. Member for Strangford (Jim Shannon), who has so frequently spoken in support of the Tamil people.

I hope that I am a friend of the Tamil community: a community that is hard-working and entrepreneurial, and that has given so much to our country and our capital city. It has an almost obsessive desire to educate its children to ensure that they are the future doctors, lawyers, engineers and accountants who will make such a great contribution.

I am well aware of the tenacity of the Tamil community. In the 14 years since the end of the Sri Lankan civil war, I have stood alongside Tamils in my constituency of Mitcham and Morden on the road to justice, peace and accountability. Those 14 years have presented so many challenges and such little progress, but so much pain.

Not only have we called for accountability for the terrible war crimes committed 14 years ago, but we are calling for an end to the human rights abuses that are still being experienced by the Tamil community in Sri Lanka today. That starts with repealing the sixth amendment, which continues to be a barrier to Tamil self-determination. The sixth amendment criminalises support, in Sri Lanka or abroad, for the establishment of a separate state within the territory of Sri Lanka. Anyone convicted of violating the sixth amendment faces losing their passport and will not be able to sit for public exams or even qualify for a trade that requires a licence. It prevents Tamils at home and abroad from coming together freely to express their political aspirations.

It is not just about the sixth amendment—we need to go further than that. The 13th amendment stops elected members of provincial councils from using their powers and instead gives them to unelected governors controlled by the Sri Lankan President. That leaves Tamils powerless when the state takes ancient Tamil places of worship and converts them into Sinhala Buddhist temples. Tamils have nowhere to go.

Back in the UK, I had hoped that at the last Cabinet reshuffle we might have got a Foreign Secretary who would take some action on Sri Lankan human rights—a Foreign Secretary who had more than warm words for British Tamils calling for justice. What did we get? We got Baron Cameron of Chipping Norton, who has spent his time out of office being paid by a Chinese state enterprise to promote a commercial court in Sri Lanka, promoting a Rajapaksa-era mega-infrastructure project.

[Dame Maria Miller (in the Chair)]

Order. I remind the hon. Lady that she should not be criticising colleagues who are sitting in the House of Lords.

[Dame Siobhain McDonagh]

I will then make a statement of fact: David Cameron worked on behalf of a Chinese state enterprise to promote a commercial port in Sri Lanka, promoting a Rajapaksa-era mega-infrastructure project. I do not believe that that was in the interests of the Tamil people in Sri Lanka, and I do not think it was in the interests of this country, either. My Tamil constituents deserve better.

There seems to be an attitude in the Foreign Office, which I have witnessed during Labour Governments and Conservative Governments, of there always being a need for discussion and encouragement. Nothing that I have seen in Sri Lanka over the years since the civil war suggests that the Sri Lankan Government will ever react to anything but force and determination, rather than encouragement or negotiation. Hundreds of thousands of people who disappeared during the civil war have still not been found, and not one person has been prosecuted for committing a war crime.

There are more questions than there have ever been. On occasion, it seems to me to be just ticking a box and some mealy-mouthed diplomacy. Tamils deserve a UK Government that will take the lead in calling for Sri Lanka to repeal the sixth amendment, which would give Tamils in Sri Lanka and abroad the ability to come together and call for the political solution they hope for. Then we would have a Government with a principled position on Sri Lanka.

14:59

[Brendan O’Hara (Argyll and Bute) (SNP)]

It is a pleasure to see you in the Chair, Dame Maria. I too would like to thank the hon. Member for Carshalton and Wallington (Elliot Colburn) for securing the debate and for the way he opened it. I would also like to thank the hon. Members for Strangford (Jim Shannon) and for Mitcham and Morden (Dame Siobhain McDonagh) for their excellent contributions. As hon. Members will be aware, this House is well acquainted with the issue of Sri Lankan human rights. We have discussed it often because it is important. It should matter not just to us and to the diaspora, but to all who care about human rights, international law, justice and accountability.

However, we have to be realistic. We have debated and highlighted these issues for decades in this place, and yet the situation in Sri Lanka remains largely unchanged; unfortunately, I suspect the community will say they have heard it all before. From a glance at Hansard this morning, I found Russell Johnston, the Liberal MP for Inverness, urging the Government in 1975 to do more to end human rights abuses in Sri Lanka; in 1984, Plaid Cymru’s Dafydd Wigley pleading with the Government not to forcibly repatriate the Tamils to Sri Lanka, given the levels of sectarian violence; in 1985, a very young right hon. Member for Islington North (Jeremy Corbyn), demanding an arms embargo on Sri Lanka due to its appalling human rights record; and, exactly a decade later, the right hon. Member for East Ham (Sir Stephen Timms) asking for those fleeing the regime’s persecution to be granted asylum in the UK. Even at the start of the new millennium, Elfyn Llwyd from Plaid Cymru was urging the cancellation of arms export licences to Sri Lanka following verified reports of extrajudicial killings. On and on it goes: as recently as last December, Members of this House quite rightly and properly raised the hugely important issues of fundamental human rights in Sri Lanka.

If nothing else, we in this House have over many years shown tenacity and resilience. We will appeal once again to the UK Government, as a believer in the rule of law, to use their position and strength to encourage the Sri Lankan Government to finally abide by their international obligations and act in accordance with the accepted international standards of human rights.

As we have heard so often in these debates, Sri Lanka is a founding member of the Commonwealth, and we know that the Commonwealth foundational principles are peace and democracy. By no stretch could Sri Lanka be considered to be a champion of those principles when the Tamil minority, numbering just around 11% of the population, is still subject to human rights violations at the hands of their Government.

In its 2022 country report, the US State Department’s Bureau of Democracy, Human Rights and Labor said that Sri Lanka’s human rights practices included credible reports of unlawful and arbitrary killings, torture, arbitrary arrest and detention, a lack of an independent judiciary, violence against journalists, serious restrictions on internet freedom, restrictions on freedom of movement, serious Government corruption and a lack of accountability for gender-based violence and crimes involving violence targeting members of national, racial and ethnic minority groups. The US State Department concluded that the Sri Lankan Government took minimal steps to identify, investigate, prosecute and punish officials who committed human rights abuses or were engaged in corruption, saying there was impunity for both. By any standard, that is a damning report. If we are honest, though, none of it would come as a surprise to any of us in this House who have watched Sri Lanka’s treatment of the Tamil minority over the years.

From the state’s inception, the Tamil minority has been treated as outsiders in their own land. The Ceylon Citizenship Act of 1948 effectively rendered Tamils stateless, leading to the deportation of many thousands of Tamils to India between the 1960s and 1980s. That was quickly followed by the 1956 Sinhala Only Act, which made Sinhalese the only official language of Sri Lanka, completely excluding Tamil and making it abundantly clear that Sri Lanka’s Tamils, as well as their history, language and culture, had no place in that new country. Given that level of state-sponsored discrimination, it is little wonder there has been such an appalling catalogue of violence and atrocity crimes perpetrated on the Tamil people.

Time and again, Tamils have been the victim of oppression and systematic violence, which dates back to the 1950s and continues to the present day. Violence, including serious accusations of widespread sexual violence, is being perpetrated against women and girls by both the Sri Lankan military and Sinhalese mobs during the numerous anti-Tamil pogroms, which stretch back decades.

[Jim Shannon]

The hon. Gentleman just reminded me in what he said that along with the things that we ask for, we need accountability for those who carried out some of those despicable—and worse—crimes. That ensures that they do not think they are getting away with the crimes that they have carried out and that there will be accountability in the courts of the land. They will get their justice in the next world, but you, Dame Maria, I and many others want to see them get their justice in this world.

[Brendan O’Hara]

I thank the hon. Member for that intervention. He is right, and I will touch on that momentarily.

It is absolutely essential that there is accountability and that people are held to account. We must use what powers we have to ensure that that happens, because various UN bodies, Human Rights Watch and other human rights organisations have long criticised successive Sri Lankan Administrations for failing to investigate seriously and prosecute those responsible for the most grievous of human rights abuses. Amnesty International has identified that despite mounting global pressure to act, those violators have gone scot-free. The issues have remained unaddressed, and groups pressuring the Government to act have been harassed and marginalised.

The hon. Member for Carshalton and Wallington talked about the 1979 Prevention of Terrorism Act. That has been an area of real, grave concern for many of us. The Act has allowed arbitrary arrests, detention without charge, false confession and torture of anyone suspected of terrorism. The Government have used that Act for 40 years to arrest and detain opponents and suppress the Tamil community. More recently, it has been used to detain protesters and anyone speaking out against the Government, even if their comments were made on social media. However, there are now real fears that its replacement, the Anti-Terrorism Bill, may be actually worse, and that the Government’s attitude towards minority groups has not changed one iota.

The Office of the UN High Commissioner for Human Rights has already stated that the new Anti-Terrorism Bill does not get anywhere close to sorting out the defects in the Prevention of Terrorism Act, saying:

“It is deeply regrettable that the proposed legislation does not remedy any of these defects”.

Earlier this month, Human Rights Watch reported on the proposed new laws, which it says will “severely curtail civil liberties”. The new laws, including an Online Safety Act, an Electronic Media Broadcasting Authority Bill and a Non-Governmental Organisations (Registration and Supervision) Bill, will grant broad powers to security forces and severely restrict the right to freedom of assembly, association and expression. They will impact on not only the civic space, but the business environment.

Sri Lanka appears to be going backwards in its adherence to the principles of upholding and protecting fundamental human rights that we hold dear. As the hon. Member for Mitcham and Morden said, that represents a collective failure by the international community. It says that we and our partners have not done nearly enough to pressure the Sri Lankan Government to change their behaviour. Thus far, I believe that we have not used all options open to us. Is it not time that, as well as discussing and debating in this place, and the Foreign, Commonwealth and Development Office persuading and pressuring in its place, the UK actually flexes its muscles where it can? It should apply targeted Magnitsky sanctions against those who can be identified as active or complicit in human rights abuses. Other countries can do it, and other countries have done it. That is the very least that the victims of the war—both living and dead, both here and in Sri Lanka—could and should expect from us.

15:09

[Anna McMorrin (Cardiff North) (Lab)]

It is a pleasure to serve under your chairship, Dame Maria. We have heard some really strong speeches and interventions today, not least from the hon. Member for Carshalton and Wallington (Elliot Colburn). I congratulate him on bringing forward this really important debate. I thank the Members who have contributed today. The hon. Member for Strangford (Jim Shannon) outlined the incredible importance of the freedom of religious belief, and my hon. Friend the Member for Mitcham and Morden (Dame Siobhain McDonagh) spoke powerfully about the need to protect human rights in Sri Lanka, and the need to protect the Tamil community.

Issues of human rights and international law will always be central to how the Labour party approaches international affairs. I am grateful for the opportunity to speak on this topic. My hon. Friend the Member for Hornsey and Wood Green (Catherine West), the shadow Foreign Minister for Asia and the Pacific, is currently travelling on parliamentary business so she has asked me to speak in her place.

There are many close ties between the UK and Sri Lanka and many living links between communities in both countries. Sri Lanka is a member of the Commonwealth and has been through a challenging period of economic crisis in the last few years. It is also, quite rightly, one of the FCDO’s 32 human rights priority countries, which is clear recognition of the serious ongoing human rights concerns there, including concerns for the rights of minority groups.

The Labour party believes that central components of the UK’s approach to Sri Lanka must be support for human rights, for accountability and, importantly, for reconciliation. Sri Lanka’s long civil war has left deep scars on the people of that country and, in the final months of that war, thousands of civilians, mainly from the Tamil community, lost their lives. That period included extensively documented reports of atrocities, torture and extra-judicial killings. It is deeply troubling that, 15 years since the end of that bloody conflict, so few people have been held accountable for their actions and little progress has been made. It remains an elusive search for justice. The reality is that the Sri Lankan Government have sought to evade accountability and delay scrutiny. It is therefore important that we call that out as unacceptable and we will continue to do so.

Many colleagues and hon. Members, from across the House, will be aware of the strength of feeling on these issues among many in the diaspora communities of our country. Many people write to us with concerns about the ongoing lack of accountability for what happened during that terrible period. I know many colleagues across the House, many of whom cannot be here today, have received that correspondence.

Justice and accountability are critical elements of building a durable and inclusive peace. That is why my hon. Friend the Member for Hornsey and Wood Green, the shadow Foreign Minister for Asia and the Pacific, welcomed the announcement, made in May last year, that the Sri Lankan Government will be undertaking a national unity and reconciliation commission. However, there are many outstanding concerns. Several major non-governmental organisations, including Amnesty International and Human Rights Watch, have raised concerns about the commission. There appears to be a genuine lack of confidence in the milestones involved. Progress in transitional justice depends on the support of victims and their communities and it needs to be properly resourced. It needs to be independent and it needs to be transparent. It needs to be a proper truth and reconciliation commission that gives confidence to the international community. Can the Minister, therefore, outline the Government’s view on the commission, and what progress has been made with it?

With domestic justice processes being so long delayed and denied, we must also look at alternative routes. I want to mention two. First, are the UK Government willing to consider human rights sanctions against those deemed responsible for grave human rights abuses during the civil war? The Minister might tell me he cannot commit, but will he at least acknowledge that key allies of the UK, such as the US and Canada, have already imposed sanctions, including against General Silva? What is stopping us doing the same? Can he answer that today?

Secondly, on international routes to legal accountability, will the Minister make it clear whether he believes, based on the evidence at the International Criminal Court, that there is a case to be answered to prosecute international crimes committed during Sri Lanka’s civil war? Will he let us know if the UK Government are supporting that process in any way?

Tamil communities, as well as other minority communities, continue to face harassment, land seizures and marginalisation, including against civil activists. Just last week, eight Tamil Hindu worshippers were arrested while engaging in festival rituals. They were detained for more than 10 days and allegedly subjected to abuse. That only serves to sustain and deepen tensions and divides between the communities. Will the Minister outline what steps his Government are taking through their funded programmes in Sri Lanka on human rights to address the long-standing issues facing minority communities, particularly the Tamils?

We all want to see a pathway for Sri Lanka to become a pluralistic, multicultural democracy in which all people can flourish, but for the people in Sri Lanka and its diaspora whose lives were destroyed by this terrible civil war, truth, accountability and reconciliation are essential stages on that journey. I hope the Minister can give confidence to our constituents right across the country and those who care deeply about human rights that the UK Government are doing their part to support justice and peace.

15:16

[The Minister of State, Foreign, Commonwealth and Development Office (Mr Andrew Mitchell)]

I believe this is the first time we have been joined in such an endeavour during our time in the House together, Dame Maria, and it is a huge privilege to serve under your chairmanship. I am extremely grateful to my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) for securing the debate, and I congratulate him on the way in which he presented what he had to say to us. Somewhat similarly to the Opposition spokesman, the hon. Member for Cardiff North (Anna McMorrin), I am standing in for the Minister for the Indo-Pacific, my right hon. Friend the Member for Berwick-upon-Tweed (Anne-Marie Trevelyan), as she is unable to attend, but it is my pleasure to respond on behalf of the Government to the excellent and interesting debate we have just heard. I am extremely grateful for the contributions of all hon. Members who have spoken. I will seek to respond to all points raised, and if I omit any, I will of course immediately write to hon. Members.

One point I want to pick up at the outset, which was made by my hon. Friend the Member for Carshalton and Wallington, is to do with the British military engagement in Sri Lanka, but I hope to pick up the rest of his points during my remarks. The British strategy for defence engagement in Sri Lanka focuses primarily on professional military education, strategic leadership and international development. We continuously monitor the context and viability of the approach to ensure that UK assistance is in line with our values and consistent with our domestic and international human rights obligations, and assures the process of selecting appropriate personnel for any UK-sponsored training.

I am particularly grateful to my hon. Friend the Member for Strangford (Jim Shannon), who was questioning me just an hour or so ago on issues to do with Hong Kong. I recognise the specific interest and experience he brings to a debate like this because of his knowledge and understanding of reconciliation, conflict and healing. I heard him say—and how right he is—that he speaks up always in this House for human rights and for the voiceless.

The hon. Member for Mitcham and Morden (Dame Siobhain McDonagh) spoke movingly on behalf of her Tamil constituents, and I will seek to come to at least some of her comments. Likewise, the hon. Member for Argyll and Bute (Brendan O’Hara) raised important issues from his experience of these matters. The hon. Member for Cardiff North raised a number of points that I will come to, but she asked me two specific questions. The first was about human rights sanctions, and as I think she inferred, we certainly keep such matters under review as appropriate, but she will not be particularly surprised to hear me say that we do not discuss them in advance and neither would we discuss our thinking across the Floor of the House. She also, secondarily, made a point about the importance of accountability. I will come to some of this in my further remarks, but I want to be very clear to her that we regard transparency and accountability as fundamental parts of reconciliation. I will say more about that in a moment.

Let me turn to the current situation. Human rights in Sri Lanka remain a priority for the Government, and we monitor closely the situation and developments there. The fact that Sri Lanka is a human rights priority country for the British Government reflects our concerns about a range of human rights issues and, quite rightly, hon. Members have highlighted a number of those concerns.

Civil society continues to face surveillance, intimidation and harassment by state authorities. Those points were eloquently set out during some of the contributions we have heard today. We are concerned about a trend towards a more constrained civic space, including the use of laws to limit freedoms of expression and assembly, such as the misuse of the international covenant on civil and political rights, or the Prevention of Terrorism Act, which was mentioned earlier. Britain continues to call for the replacement of the draconian PTA with legislation that is consistent with Sri Lanka’s international obligations and to uphold a moratorium on the use of the provisions of the PTA.

We are also concerned about the Online Safety Act, which was recently passed. It has the potential to restrict severely online communication and could criminalise many forms of expression. Proposals to strengthen the regulation of non-governmental organisations and broadcast media raise fears of efforts to restrict civic space.

[Elliot Colburn]

I am grateful to the Minister for giving way. On the point about the online space, it is indeed being encroached on internationally. In fact, here in the United Kingdom, the Tamil Guardian and other Tamil publications have faced deplatforming from places like Meta, Facebook and Instagram, for example, due to complaints made elsewhere in the world under the auspices of the PTA and other bits of legislation. Can he perhaps take away the question of how we can protect the rights of Tamils to express themselves freely online when they are outside the geographical space of the island?

[Mr Mitchell]

Yes, I will certainly take that away, as my hon. Friend requests, and I hope that some of what I will have to say will assist in addressing that point. We want to encourage the Sri Lankan Government to hold comprehensive consultations with stakeholders and enact amendments to align legislation with Sri Lanka’s human rights obligations.

As this House acknowledged in a debate—I think, in December—a number of different communities, including Tamils and Muslims, face marginalisation by state authorities. There have been increasing tensions around land, which have sometimes centred around religious sites, such as the most recent incident at a Hindu temple in Vavuniya. These actions and incidents have troubling implications for freedom of religion or belief. There have been reports of state-sponsored settlement of traditional pastureland in Batticaloa, which threatens the livelihoods of local farmers. These events have increased the risk of communal tensions and stoked perceptions of forced displacement from traditional Tamil areas in the north and east of Sri Lanka. There have been several incidents of heavy-handed policing of peaceful protests and commemorations, and the ongoing special police operation, which is ostensibly aimed at combating drug trafficking, has raised serious concerns over arbitrary arrests, seizures of property and ill treatment in detention.

I now turn to what Britain specifically is seeking to do: promoting human rights, reconciliation and justice, and accountability. Those are key strands of the UK Government’s policy towards Sri Lanka. The Minister of State for the Indo-Pacific, my right hon. Friend the Member for Berwick-upon-Tweed, raises our concerns about the human rights situation in Sri Lanka on a regular basis. When she visited Sri Lanka in October, she raised concerns with the President, the Foreign Minister and the Justice Minister, and she again saw the Sri Lankan Justice Minister when he was in Britain last week.

When in Sri Lanka, my right hon. Friend met the governor of Northern Province, Tamil representatives and members of civil society. She raised the need for progress on human rights for all communities in Sri Lanka, and the need for justice and accountability for violations and abuses committed during and following the armed conflict. The British Government have an £11 million programme that supports human rights and reconciliation in Sri Lanka. We have specific projects and programmes that help to tackle the legacy of the conflict, support civil society and democratic processes, promote gender equality and reduce inter-community tensions.

We have been a leading member of the core group of countries in the United Nations Human Rights Council that work to improve human rights, justice and accountability throughout Sri Lanka. We have worked within the UN human rights system to raise concerns and build international support to strengthen human rights. We used our statement to the UN Human Rights Council on 4 March to raise our concern on recent legislative developments relating to human rights, reconciliation and civic space.

Our statement urged the Government of Sri Lanka to ensure meaningful consultation on the proposed commission for truth, unity and reconciliation. Britian has stressed the importance, as I mentioned in my early remarks to the hon. Member for Cardiff North, of transparency, accountability and inclusivity in any process, and of building meaningfully on past work and recommendations that address the root causes of conflicts and impunity.

The British delegation in the UN Human Rights Council led work on the most recent resolution on Sri Lanka. We remain ready to support Sri Lanka in addressing the UK-penned resolution 51/1. In the resolution, we focused international attention on the human rights situation and shortcomings. We succeeded in renewing the mandate of UN human rights experts to report on these issues and to preserve evidence of abuses and violations—turning specifically to the point the hon. Lady made—committed during the armed conflict, so that justice can be pursued. We call on the Government of Sri Lanka to engage constructively with all UN human rights initiatives, and to take up the offers of support available to them.

There are some positive signs. We welcome steps taken by the Sri Lankan Government to address some of the community grievances, and civil society and international community concerns. The release of some disputed lands is a helpful step, as is the release of some long-term PTA detainees. We welcome the Government’s initial steps to engage with representatives of the Tamil community on a long-sought political settlement. We have urged the Government to consider further confidence-building measures and engagement. We welcome steps taken by the Government of Sri Lanka to improve connectivity between the north and countries in the region, including through regular flights. That should help increase economic opportunities for Tamils and others in those communities.

I will conclude on this note. Britain closely monitors human rights developments in Sri Lanka. We welcome the ongoing attentions and contributions of right hon. and hon. Members, and the spotlight they bring to this issue. We are concerned by the ongoing land disputes, the continued harassment and surveillance of civil society and the limitations on freedoms of expression, assembly and association, including through recent and proposed legislation. We will continue to urge the Sri Lankan Government to adhere to their human rights obligations, fulfil their commitments on transitional justice and legislative reform, and take steps to build trust in their institutions.

Our projects and programmes in Sri Lanka will continue to target the drivers of conflict and support improvements in human rights. Ministers and officials will continue to engage with the Government and wider society on human rights and transitional justice. We will remain a leading voice on the international stage, working with civil society and through the United Nations to deliver meaningful human rights improvements for the Tamils and all the people of Sri Lanka.

15:30

[Elliot Colburn]

I thank the Minister for his response. I also thank all right hon. and hon. Members for their contributions, particularly my right hon. Friend the Member for Chingford and Woodford Green (Sir Iain Duncan Smith), and the hon. Members for Strangford (Jim Shannon) and for Mitcham and Morden (Dame Siobhain McDonagh)—I have not yet had a chance to congratulate her on her damehood.

We cannot allow the lack of progress to continue. We will no doubt be back here again, not least because our Tamil constituents will demand that of us. As the hon. Member for Mitcham and Morden said, particularly in London we are lucky to be blessed with large Tamil populations. I represent many Tamils in my Carshalton and Wallington constituency. They are excellent community voices. They are very active in our community, and are keen UK citizens. They are active in our public services—something like one in 10 doctors is Tamil, and a Tamil was on the team of doctors who came up with the first covid vaccine at Oxford. We thank the Tamil population for their contribution to the UK, and commit ourselves to doing all we can for them to secure peace, justice and accountability.

Question put and agreed to.

Resolved,

That this House has considered human rights in Sri Lanka.

15:31

Sitting suspended.

Defibrillators

Wednesday 20th March 2024 Westminster Hall

14:30

[Jonathan Gullis (Stoke-on-Trent North) (Con)]

I beg to move,

That this House has considered public access to defibrillators.

It is a pleasure to serve with you in the Chair, Dame Maria.

Every year, 160,000 deaths—nearly a quarter of all deaths in the United Kingdom—occur as a result of heart and circulatory diseases. Of that figure, an estimated 100,000 people die each year from sudden cardiac arrest. Shockingly, the survival rate for out-of-hospital cardiac arrest has been persistently low, at around 8.5%. There is an urgent need for parliamentarians and the Government to improve the survival rate and radically change the way we approach cardiac arrest.

As chair of the all-party parliamentary group on defibrillators, I have heard some deeply moving stories that have led me to conclude that public access to defibrillators should be one of the Government’s foremost priorities. The APPG has undertaken a detailed inquiry into public access to defibrillators, which was published today. Its primary aim is to understand the impact of out-of-hospital sudden cardiac arrest and the need for improved public access to defibrillators. The plain reality is brutal: without defibrillation or cardiopulmonary resuscitation, someone’s chances of surviving cardiac arrest drop by 10% every minute. If a sudden cardiac arrest victim does not receive CPR or defibrillation within 10 minutes, they are unlikely to survive.

The quicker a defibrillator can be accessed, the more likely someone is to survive cardiac arrest. However, the APPG found that there are considerable regional disparities in access to defibrillators. The National Institute for Health and Care Research found that deprived areas had far more limited access: while 45% of the most affluent areas had at least one device, the figure was only 27% for the most deprived areas. Further, according to the journal Heart, people in England and Scotland’s most deprived areas are between 99 metres and 317 metres further away from their nearest 24/7 defibrillator than those in more affluent areas. Rural areas are also at a significant disadvantage: while 64% of urban areas have at least one device, the same can be said for only 36% of rural areas. Ambulance response times in rural areas are also considerably slower than in urban areas, heightening the risk of death by cardiac arrest. That should make access to defibrillators an imperative in those areas, but, much though I would like it to be, that is not currently the case.

Given the sad truth that socioeconomic factors, education, diet and stress can increase or decrease someone’s chances of cardiac arrest, that all goes to show that we need to improve public access to defibrillators significantly, especially in disadvantaged communities.

[Sir Gavin Williamson (South Staffordshire) (Con)]

I congratulate my hon. Friend on securing the debate. I know that he has done so much on this issue. In Stone in Staffordshire, we have the amazing charity AEDdonate, which does so much on installing defibrillators. One of the key points that it always hammers home is the importance of having defibrillators registered so the emergency services know where to direct people. Does my hon. Friend think that is critical to ensure that we get the best use out of them?

[Jonathan Gullis]

I could not agree more with my right hon. Friend about the need, which I will come to later, to ensure that devices are registered. Having visited AEDdonate myself, I can say that it is made up of fantastic custodians working incredibly hard, not just in rural Staffordshire and Stoke-on-Trent but across the country, to make sure there is access. I know that my right hon. Friend is a doughty champion for its cause, as well as for the community he serves in ensuring access to these lifesaving devices.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Member for Stoke-on-Trent North (Jonathan Gullis) for bringing this subject forward. Many in the House, and others, will be aware that I brought the Automated External Defibrillators (Public Access) Bill to the House in 2020. The Government at the time accepted the necessity of having defibrillators in schools, and that was a fantastic milestone in this campaign, which the hon. Gentleman has taken further. Does he agree that it is one thing to have defibrillators installed, but that more must be done to educate people in schools, such as teachers, and teachers’ associations, to use defibrillators properly and make the most out of them, thereby saving more lives?

[Jonathan Gullis]

I thank my hon. Friend for that intervention. He is a great champion for the people of Strangford and it was an honour to visit his local community with him and see the fantastic work that he is doing there. That Bill still has my full support. I will come to the importance of improving education, so that it is not just a one-off. It needs to be repeated year in and year out, so that children in particular are immune to seeing what will be a distressing scene but, most importantly, have the muscle memory and are able to put that lifesaving support into action. The Minister himself is regularly saving lives, not just in his constituency but across his wider region, with the work that he does, so I am sure that he will understand the importance of persistent and regular education and training.

In September last year, I was pleased to see the Department introduce the community automated external defibrillator fund. This £1 million investment will help to increase access to these lifesaving devices and put an extra 2,000 defibrillators on the streets. That is an important step forward by the Department, but I urge the Minister to do far more to address the clear imbalances that I outlined.

The APPG on defibrillators and I have concluded that there is no co-ordinated national strategy to ensure that defibrillators are placed in areas with the highest need. With previous research illustrating that cardiac arrest is more likely in deprived areas, the Government must ensure that those areas have better or at least equal access to lifesaving equipment to more affluent areas. At this moment in time, that is simply not the case.

With over 30,000 out-of-hospital cardiac arrests in the UK each year and a survival rate of just one in 10, it is crucial that bystanders and emergency responders can locate and access the closest defibrillator immediately. The British Heart Foundation, NHS England, St John Ambulance and Resuscitation Council UK provide the NHS with vital information about the location of defibrillators. The Circuit is a nationwide, data-led map of defibrillators in the United Kingdom. Currently, over 86,000 have been registered, but it is estimated that tens of thousands are still unaccounted for.

[Alan Mak (Havant) (Con)]

I thank my hon. Friend for securing the debate and for giving such an excellent speech. Hayling Island Community Responders is a voluntary emergency response group in the Havant constituency. The responders carry defibrillators and train volunteers to use them. They are often the first people on the scene in a medical emergency. Will my hon. Friend and my right hon. Friend the Minister join me in supporting community responders, encouraging more defibrillator training and encouraging more volunteers to join community medical response groups across the country?

[Jonathan Gullis]

I thank my hon. Friend for the undoubted effort that he puts in regularly in his constituency to raise the profile of that fantastic community group of dedicated volunteers. That relates to the point made earlier by my right hon. Friend the Member for South Staffordshire (Sir Gavin Williamson). These groups, who go in day and day out, do not expect much money at all, but try to do everything that they can at cost, in their own time, to literally save lives. I wholeheartedly congratulate the organisation that my hon. Friend the Member for Havant (Alan Mak) referred to, and I congratulate him on using this opportunity to mention its name and ensure that it is in Hansard for all the right reasons. Ultimately, those people are lifesavers, quite literally, and without them our community would be poorer. I am grateful to him for giving me an opportunity to praise them.

It is vital that “defibrillator guardians” register their device on The Circuit, so that ambulance services can access their data. The national view provided by The Circuit means that if 999 is called in the west midlands but the call handlers of the West Midlands Ambulance Service are all busy, the call can be diverted to call handlers elsewhere, who can locate the nearest defibrillator if it has been registered.

By creating a comprehensive AED map, The Circuit provides data identifying where defibrillators are needed. The “Complete The Circuit” campaign by the Express led to a further 16,000 defibrillators being registered, but we need to ensure that every lifesaving device is registered. I hope the Minister will be able to clarify whether the Government will pursue that.

Since becoming the chair of the APPG in January 2023, I have made a conscious effort to monitor public access to defibrillators in my constituency of Stoke-on-Trent North, Kidsgrove and Talke. I have visited several local organisations and groups over the past year to see what access they have to a defibrillator. For example, in October 2023, I was delighted to visit Linley and Kidsgrove rugby club, which had written to me earlier last year about getting a defibrillator on site. It was an honour and a privilege to present the club with a CellAED, which will ensure the wellbeing and safety of players, spectators and the wider community. The device is portable, meaning that it can be taken to away games, too, which could prove vital.

It was also fantastic to visit the Jolly Carter pub in Middleport, which installed a defibrillator late last year after a charity drive to raise funding for one. When I met the landlady, Nicola Fisher, I was surprised to hear that the defibrillator had already saved the life of a man involved in a car crash. The Ford Green pub, which I visited in May, also got its own defibrillator last year, thanks to the hard fundraising efforts of Jayne Bushell and her team. The pub is at the heart of a very busy local community, and the defibrillator could help save lives. And a defibrillator that I personally donated towards—thanks to Mr Rob Matthews bringing the campaign for it to my attention—is now located on Chell Heath Road in the Bradeley and Chell Heath ward. Slowly but surely, public access to defibrillators is improving, but it is essential that we do everything we can to rapidly speed up the process to better protect the public.

The APPG’s report suggested mandating that every emergency vehicle must have a defibrillator. At an APPG session in May last year we heard the tragic story of Naomi Issitt, who tragically lost her 18-year-old son Jamie because a defibrillator was not available when he collapsed at two in the morning. Shamefully, ambulances did not arrive within the required response time, and the police car was not equipped with a defibrillator despite the force believing it had one. The sad reality is simple: had the police car been equipped with a defibrillator, Jamie might still be with us today.

The APPG also found that only one in 11 police cars have access to a defibrillator. We sent freedom of information requests to all the police forces in the UK, and we found that many forces have defibrillators in less than 1.5% of vehicles. We met a representative of Lancashire police who told us that the majority of specialist police vehicles—roads and armed-response vehicles—already carry defibrillators, but most standard police vehicles do not.

Putting a defibrillator in every emergency vehicle and ensuring that all emergency workers know how to use them could help save lives. If only ambulances and specialist police vehicles have these lifesaving devices then there is a high possibility that a police officer could get to the scene of a cardiac arrest and be unable to help in the way that they would wish. Jamie’s death should be a wake-up call. I urge the Minister to consider urging emergency services to better protect the public and ensure that all vehicles are equipped with these lifesaving devices.

Alongside improving access to defibrillators, we need to ensure that people know how to use them. As a former teacher, I know just how important education is in developing people’s understanding of key issues like this. The APPG made it clear that integrating comprehensive first aid training with a strong focus on CPR and defibrillator use can play a pivotal role in equipping younger generations with lifesaving skills. I am pleased that every state school is now mandated to have a defibrillator through the Government’s Defibs4Schools programme. That is an important step forward in widening access to defibrillators, and saving lives as a result.

However, there is a concern that legislation fails to mandate that schools must store their defibrillators on the outside of buildings. I sadly need to revisit the tragic story of Naomi Issitt. She told me in an evidence session that, as well as the issues surrounding the emergency services’ lacklustre critical response time, Jamie had collapsed near a school that had a defibrillator equipped, but because the defibrillator was located inside the school premises, it was inaccessible. The APPG and I agree that it is essential that defibrillators in schools and other public places are accessible 24/7 to heighten the chances of survival through quick access to a defibrillator.

Alongside having physical access to a defibrillator, it is vital that the public are aware how to use them. The fact that the survival rate is depressingly low is due in part to the lack of skills and confidence in performing lifesaving CPR among the UK population. With survival dependent on rapid support, it is the responsibility of policymakers and politicians to campaign to ensure that as many people as possible have those lifesaving skills.

According to a survey of over 4,000 adults conducted by YouGov, over a third have never learned CPR. Nearly half cited a lack of awareness about where to learn, and a quarter of respondents said they lacked the confidence to learn. Those figures are striking. We need to find radical solutions to better equip the public with the skills needed to save lives.

The APPG and I heard from Dr Thomas Keeble, a consultant cardiologist and associate professor at Anglia Ruskin University, who revealed that defibrillators are used in only one in 10 cardiac arrests where lifesaving defibrillators are available. His research revealed that not only are people inadequately equipped with lifesaving CPR skills, but they lack the confidence to use a defibrillator when it is available.

The APPG and I have met some incredibly inspiring individuals and groups over the past 12 months, including Mark King from the Oliver King Foundation. The foundation was established in 2012 following the tragic death of 12-year-old Oliver at a school in Liverpool. Oliver died from sudden arrhythmic death syndrome, a hidden heart condition that kills 12 young people every week. The foundation, set up by Oliver’s father, Mark, provides training in defibrillator awareness and first aid, and has placed 5,900 lifesaving devices in schools and organisations across the United Kingdom. At an APPG session, the foundation emphasised the importance of education, telling me that confidence is key when using a defibrillator, and that removing the fear factor is vital when teaching children how to use it.

The Defibs4Schools programme is a welcome step, but I urge the Minister to consider rolling out CPR training in primary schools. In addition, it is essential that we extend the regulations to ensure that defibrillators should be part of first aid sessions too. These are simple yet effective ways to bridge the gap and empower individuals to become first responders from a young age.

Alongside bettering young people’s understanding and confidence with defibrillators in schools, the APPG has heard that many European countries require people to undertake first aid training to complete a driving test. That is another way in which we can help to develop public awareness and, ultimately, save lives. In Switzerland, applicants must demonstrate that they have undertaken 10 hours of first aid instruction from a Government-approved company to complete their theory test. Germany also requires seven hours of first aid training—nine lessons of 45 minutes each—for all categories of driving licence. Similar models are used in the Czech Republic, Austria, Slovenia, Hungary and the Baltic states. In the UK, around two thirds of young people aged between 21 and 29 have a driving licence. That presents us with a remarkable opportunity to empower a significant portion of the population with life-saving capabilities.

Let me turn to VAT on defibrillators. Defibrillators vary in cost, but the average unit is around £1,250. That is a considerable expense for many groups, charities and sports clubs, especially considering that a sizeable portion of that is the 20% VAT. On average, small businesses, community groups, charities and private users must pay added tax on top of all defibrillator purchases, bringing costs up by £200 to £500 per defibrillator.

I know that my hon. Friend the Member for Colchester (Will Quince) regularly raised this when he was a Minister in the Department. Sadly, he could not make it to this debate, but he wanted to reiterate his support for the Government to re-evaluate this. Some charities are exempt from paying VAT on defibrillators: not-for-profit hospitals; charitable institutions that provide care or medical or surgical treatment for disabled people; and rescue or first aid services. However, most sports clubs and community groups do not qualify.

Last summer, I visited AED Donate, as my right hon. Friend the Member for South Staffordshire has mentioned. It obviously supports the placement and use of automated external defibrillators in local communities. It told me that the removal of VAT would have allowed them to install another 223 additional defibrillators in communities in 2023—they could not do that because of VAT. I look forward to hearing the Minister’s response to that.

Improving survival rates for sudden cardiac arrest rests on increasing public access to defibrillators. It is of paramount importance that we tackle the clear barriers that are preventing lives from being saved by improving public access in disadvantaged areas and through better education. I hope that this debate, which I thank all my hon. and right hon. Friends for engaging with, will raise awareness and that the Minister will take some of my suggestions on board.

16:17

[The Minister for Health and Secondary Care (Andrew Stephenson)]

It is a pleasure to serve under your chairmanship, Dame Maria. I start by congratulating my hon. Friend the Member for Stoke-on-Trent North (Jonathan Gullis) on securing this important debate. I know that he is a passionate and vocal supporter of increasing access to life-saving public defibrillators and first aid training. I pay tribute to the work of the all-party parliamentary group on defibrillators and look forward to reading its report in due course. I also pay tribute to the hon. Member for Strangford (Jim Shannon), my hon. Friends the Member for Havant (Alan Mak), and my right hon. Friend the Member for South Staffordshire (Sir Gavin Williamson) for their contributions to this short debate.

Public defibrillators can really be the difference between life and death for people who suffer what are known as out-of-hospital cardiac arrests. According to the British Heart Foundation, automated external defibrillators, AEDs, are used by bystanders in around only 10% of these types of incidents, but early defibrillation—within three to five minutes of collapse—can increase survival rates by as much as 50% to 70%. That is why we are working hard to increase the number of community defibrillators, increase public awareness and tackle the wider causes of heart attacks. I am proud that we have introduced the community automated external defibrillators fund. The £1 million match fund allows communities across England to bid for AEDs in places with high footfall, in more remote areas that have longer waiting times for emergency medical responses, in areas with high numbers of vulnerable people, and in areas that host activities that mean they are more likely to be needed.

[Sir Gavin Williamson]

I congratulate the Department of Health and Social Care on that fund. My hon. Friend the Member for Stoke-on-Trent North (Jonathan Gullis) and I referred to the charity AED Donate. There is a lot of charitable work going on in this sector. I wondered whether it would be possible for the Minister to arrange for the charity to meet up with suitable officials, so that it can best understand how it can deliver the Department’s aims and so that the Department has an understanding of what it is delivering in communities across the country.

[Andrew Stephenson]

My right hon. Friend makes a very important point. I join him in paying tribute to that organisation. I would be happy to arrange a meeting with relevant officials in the Department.

Our partners on the programme of rolling out defibrillators are Smarter Society and the London Hearts charity. They have been assessing applications for delivering additional AEDs, working with a wide and diverse range of groups. The first hundred devices that Smarter Society distributed were fully funded, and our partners at the University of Warwick helped us to prioritise the areas of greater deprivation without an AED in situ.

I am delighted to update hon. Members and tell them that, as of 12 March, Smarter Society and London Hearts have now delivered 1,590 AEDs and are working to deliver more. I would also like to pay tribute to the work of my hon. Friends in the Department for Education, who are ensuring that every state school has access to a defibrillator. I am told more than 20,000 devices have been delivered to almost 18,000 schools. That will drastically increase the chances of surviving cardiac arrest for pupils and school staff across England.

The Department for Education has supported schools in making the defibrillators available to the community, having offered external heated defibrillator cabinets to primary, special and alternative provision schools in areas of deprivation, where access to defibrillators is typically lower. It has also provided internal cabinets to secondary schools with two or more defibrillators, so one device can be placed at a sports facility where cardiac arrest is more likely to happen.

All state-funded schools are required to teach first aid as part of the mandatory relationship, sex and health education curriculum—another positive change made by the Conservatives since 2010—since we have been in government. That involves children over 12 being taught CPR and the use of a defibrillator. The Department for Education has also provided awareness videos showing how simple the defibrillators are to use, and it is encouraging schools to share the videos in staff meetings and assemblies. That will ensure that as many people as possible are able to respond in an emergency.

I know that making defibrillators as affordable as possible is important to my hon. Friend the Member for Stoke-on-Trent North, as he set out in his speech. The Government and I agree, although we have to keep these matters under review. He will appreciate that matters relating to VAT are for my right hon. Friend the Chancellor of the Exchequer.

Although having access to defibrillators is important, just as important is knowing where they are, so that they can be used in a time of crisis. That is why the NHS is working in partnership with the British Heart Foundation, the Resuscitation Council UK and the Association of Ambulance Chief Executives to set up The Circuit, which my hon. Friend talked about. The Circuit is a national database that will make it easier for ambulance services quickly to identify the nearest defibrillator when assisting someone who is having an out of hospital cardiac arrest.

As of 1 March, there were 86,337 defibrillators in the UK—68,509 in England— registered on The Circuit. We encourage everyone with an AED to register it. I can assure the House that all defibrillators granted by the community automated external defibrillator fund must be registered on The Circuit. The registration is completed by what is known as a defibrillator guardian—someone nominated by the organisation hosting the device. That role involves registering it on The Circuit, regularly checking the defibrillator to ensure that it can be used, and keeping the record updated. As I hope my hon. Friend appreciates, that is both an effective and a pragmatic approach to ensuring that defibrillators are where we think they should be, and that they continue to be ready for use in times of crisis.

I reinforce the fact that defibrillators are designed for ease of use. If there is one message I want to land in today’s debate, it is that these simple devices are easy to use, yet life-saving. Anyone can use them without formal training. That said, training is actively helpful in increasing the confident use of defibrillators in a community setting. For that reason, the NHS has partnered with St John Ambulance to help people gain the skills they need. That includes a national network of community advocates championing the importance of first-aid training, and training up 60,000 people, which will save up to 4,000 lives a year by 2028.

I would like to take the opportunity to pay tribute to those organisations and others that work tirelessly to improve defibrillator access and first aid training in communities across the country. Their contributions are crucial in getting help for people in some of the toughest moments of their lives and I cannot thank them enough.

My hon. Friend the Member for Stoke-on-Trent North has raised the idea of requiring defibrillator training as part of driving tests. My hon. Friend the Member for Colchester (Will Quince) was a strong supporter of that as my immediate predecessor in this role. While this is primarily a matter for the Department for Transport, I know that my hon. Friend the Member for Stoke-on-Trent North will continue to make representations in this area. I assure him that the Government are always happy to engage in those discussions.

I am also aware of my hon. Friend’s interest in ensuring that all emergency vehicles carry AEDs as a matter of course. While the Government fully recognise that the equipment carried by emergency vehicles is an operational matter, I encourage all services to consider the benefits of carrying AEDs as a matter of routine.

On a personal note, I would like to pay tribute to David Brown, the incredible team leader of the Pendle, Padiham and Burnley community first responder team, of which I am part. I was backed up by David on the first ever cardiac arrest I attended as a community first responder almost 10 years ago. He does incredible work delivering CPR training across Pendle, as well as putting in thousands of hours as a volunteer with the North West Ambulance Service.

I would also like to pay tribute to my late constituent, Ruth Sutton. In 2016, Ruth saw a photo of me in the local newspaper unveiling a new community defibrillator in the Pendleside village of Blacko. She contacted me to see how we could get even more defibrillators across Pendle. Over the following months, she worked with me and the North West Ambulance Service, investigating possible locations to install new defibrillator cabinets. By 2018, Pendle had the best coverage for public access defibrillators in Lancashire, with 20 cabinets installed: a real, lasting legacy of a remarkable lady.

I hope that our prevention and treatment work, including the forthcoming major conditions strategy, which my Department is in the final stages of drawing up, will act as a guiding light for a faster, simpler and fairer NHS. In combination with our efforts to increase defibrillators and increase first aid training across the country, we will improve our ability to intervene in an emergency situation and to save lives.

I once again thank my hon. Friend the Member for Stoke-on-Trent North for securing this incredibly important debate. I look forward to working with him long into the future to make progress on this vital issue.

Question put and agreed to.

Prevention of Future Deaths Report: Terance Radford

Wednesday 20th March 2024 Westminster Hall

16:29

[Lee Anderson (Ashfield) (Reform UK)]

I beg to move,

That this House has considered lessons learned from the Terance Radford Prevention of Future Deaths Report.

It is a pleasure to serve under your chairmanship, Dame Maria. Today, I want to tell the story of two men. One of them, Terance Radford, was born on 11 August 1931 and died on 19 April 2019, aged 87. Terance was an upstanding citizen, a gentleman who made an outstanding contribution to his country, well-loved and well-respected throughout the community. The other man is a gentleman called Gavin Collins. He was a thief—that is the best way that I can explain it.

I will talk briefly about Terance—or Terry, as his family call him—and what kind of man he was. It is important to say that we are talking about not just a name, but a person, whose lovely family are in the Public Gallery on his behalf. Terry was an amazing dad and grandad, and all his family loved and respected him. They were, and still are, in awe of everything that he achieved in his life. He was born in Mansfield Woodhouse, which is the next constituency. The MP there, by the way, is Ben Bradley, who is very supportive of the case.

[Dame Maria Miller (in the Chair)]

Order. The hon. Gentleman means the hon. Member for Mansfield.

[Lee Anderson]

Sorry—the MP there is the hon. Member for Mansfield (Ben Bradley). I apologise, Dame Maria.

Terry was born in Mansfield Woodhouse and lived there all his life. He was proud of his village, and he cared deeply about his community. He went to the national school and had a traditional upbringing. His dad was a miner and his mum was a housewife who created a loving home for Terry and his three sisters. He excelled in his studies, and when he left school he went to work for the Metal Box Company in Mansfield, which was a major local employer and a place where my mother and many of my friends worked, actually. To further his education, Terry went to a local college to study engineering at night school, and he excelled. He went on to do his national service, in which he served in the Royal Navy as a petty officer working on minesweepers. He was an incredibly brave and dedicated man. When Terry had done his service, he went to work for Rolls-Royce in the aero-design team—he worked proudly on the RB211 fan blades. His job regularly took him to the United States for several weeks at a time to work for their sister company, and he always enjoyed coming back and sharing his knowledge with younger people.

When he was in his 50s, Terry decided to become a teacher; he worked at Valley Comprehensive School in Worksop, teaching woodwork and metalwork until he retired. Despite always having a demanding job, that was not enough for Terry. He always tried to serve his community in the best way that he could. He was a local councillor for many years and also took the post of head governor at several local schools in the Mansfield area. He was also a justice of the peace—a job that he enjoyed from 1971 to 1985.

Everyone in the community valued Terry for his honesty and integrity. He would always take time to help people. He was what we would probably call a salt-of-the-earth type of gentleman. He loved life. He was highly intelligent, a great conversationalist and great fun to be with. Everyone in his family loved to spend time with him. Terry was extremely fit for his age—he was 87 years old when he died. He used to go to the gym and use all the apparatus there, and he would go swimming three times a week, but his favourite time was time spent with family and friends, and especially with young people. He liked to spend time with his grandchildren and their friends. He was the family rock, the hub, the person his family would go to if they needed advice or comfort. That is a brief description of the type of chap that Terry was.

I will now talk about Gavin Collins. On 9 November 2017, Gavin was in court being sentenced to five months for an offence that he committed in May 2017. He had spent time on remand, which meant he was released the following day. He was re-arrested for offences including burglary and theft, all committed in December 2017. On 11 July 2018, Gavin Collins was sentenced to three years for burglary and theft from a dwelling. That is the sentence he was released early from.

On 4 April 2019, Collins’s paperwork was sent to Governor Archer at His Majesty’s Prison Ranby, who granted Collins early release for 18 April 2019; it was agreed that Gavin would go home on a tag. At that time, Collins was in segregation away from all the other prisoners because he had set fire to his cell twice and injured a prison staff member with a plastic knife. Collins had been placed on report. On 13 April 2019, the police informed the prison that they had decided not to pursue a criminal investigation as it was a matter that could be dealt with by the prison directly; that is a failure there. There are statements that Governors Archer, Cope and Fretwell had conversations on 15 April 2019 regarding Collins’s early release date. They were looking at a release date of 18 April due to the upcoming bank holiday—Friday 19 April was Good Friday. Collins was due to be released anyway on 29 April, but the investigation of him setting fire to the cell would have gone beyond that. The very earliest date for his release should have been 29 April, and that had always been scheduled.

On 16 April 2019, Collins woke up other prisoners in the night shouting that he was dying. He was medically checked over and found to be medically fit. Later that day, he was lying down on the ground in the exercise yard. He claimed to have been poisoned by methadone. The doctor was made aware of his behaviour. On 18 April, Collins was released in the early morning from HMP Ranby. A family friend collected him and said that he did not look right; he was talking funny and his behaviour was strange, as though he had been on drugs. The friend took him home and told family members how concerned he was for Collins. That was when the trail of havoc started.

On 19 April 2019, Collins forced his way into several people’s homes and stole three cars. He crashed the first two cars and then forced his way into a woman’s home by smashing the back door. Collins then used blood from his injuries to daub crucifixes on the heads of the women and her children, while talking about God and making threats to kill them. He then stole the woman’s car, which he used to drive into Mr Radford. Before he got out, he shouted, “I’ve killed him, I’ve killed the devil.”

Mr Radford had just gone out for his morning walk and was waiting near a bus stop, minding his own business. He died at the scene. Collins was later jailed for 21 years for manslaughter on the grounds of diminished responsibility, but Terry’s death need not have happened. Terry might still be here today had it not been for the failures of HMP Ranby and the three governors who made the wrong decision to release Collins, which ultimately led to the death of Terry Radford.

Terry’s family are sat in the Public Gallery today, and they think it is unacceptable. I think that is putting it mildly; it is actually criminal. They are unable to find out the outcome of the disciplinary proceedings of the prison governors concerned; had the proceedings taken place in a criminal court, they probably would have known by now. They attended the inquest every single day and found out the names of the people responsible for letting Collins out of prison. They saw the faces of the governors and watched them as they told untruths throughout the process, but the coroner knew the truth and got to the bottom of it. It is all now in the public domain and accessible to everyone, but the family are still not allowed to know what happened to the people who let Collins out of prison. That is wrong.

Terry’s family think that, as usual, the wrongdoers are protected and innocent people are left with no closure. They are doing their very best to move on, but they cannot move on because they want to know what has happened to the people who were ultimately responsible for the release of Gavin Collins, and then for their father’s—Terry’s—death. They think, and I agree with them, that the governors should have faced a criminal court for their actions, not just disciplinary proceedings. They do not understand why no one within the justice system wanted to take this further.

How could the governors get away with taking the law into their own hands by releasing the prisoner when they had no authority to do so? Why was it not investigated by Nottinghamshire police? The family know that the police went to HMP Ranby on the day of the incident to retrieve records. If the police had investigated thoroughly, they would have known what had happened. If the coroner could work out what had happened, then why could the police not do so? Should Nottinghamshire police have investigated this failing? I think they probably should have. In the prevention of future deaths report, the coroner’s answer to the question, “Was Mr Radford’s death avoidable?” was, “Yes.” Had Collins remained in prison, Mr Radford might have been here today.

There are many failings in the whole investigation, and many similarities, sadly, with the stabbings in Nottingham city last year. The family feel that no lessons have been learned. They want to know what actions have been taken against the individuals responsible, and whether any of them have been dismissed, downgraded or transferred from the Prison Service. The fact that they are not allowed to know makes them feel as if there has been a cover-up. Their wish is that none of these people are still working within the Prison Service, as that would be an absolute travesty.

I want to ask the Minister to look at the family here in the Public Gallery. This family, who lost Terry. We have two of his sons here; they have lost their dad—their loving father. They have come here today for justice. They want closure. I want him to look at them in the eyes when he rises to speak and to tell them what happened to those governors.

16:42

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Member for Ashfield (Lee Anderson) for setting the scene so well, with the compassion and understanding that we expect of him and he has delivered on many occasions. Our sympathies are clearly with the family who are here seeking justice and understanding of what took place. The hon. Member has outlined the case very well, and I just want to make a few comments. It will not take very long, Dame Maria, but I think it is worth putting them on record because of the implications of the case.

I am pleased to see the Minister and the shadow Minister, the hon. Member for Brentford and Isleworth (Ruth Cadbury), here. We seek an understanding of what happened, how it happened and why it will not happen again. That is what I want to speak about.

When I read the details of the case, I was sickened and shocked. My thoughts immediately went to the family of, as the hon. Member described him, a spritely old gentleman, who had holidays planned and was enjoying a full life when it was taken from him by someone who had demonstrated that he had absolutely no regard for human life. To see this early release under curfew has undoubtedly shown, and sown concern about, a major flaw in the process.

The Minister is a compassionate man, who understands the issues. In his response, he will try to answer the questions we all have, and his response to the coroners’ report and recommendations is clear. The family of that gentleman and others in this place have asked how this was allowed to happen in the first place. How could a man who could not be kept under control in prison have been expected to abide by curfew obligations once released? The hon. Member for Ashfield clearly outlined the attitude of the man in prison, what he did, his threats to staff and his destruction of property. The ordinary person would say that he could not understand why this man was ever released, and yet because legislation or guidance did not directly say this, unfortunately, Terance Radford died.

To me, this is an indication of how decisions are made looking at the letter and not the spirit of the law. This was not about justice, compassion and understanding for family. No reasonable person could have determined that the spirit of this curfew option was for people such as this—I do not normally use this word—thug who had set fires and attacked prison guards in custody. Yet there is such a fear of impinging on the human rights of the prisoner that it must be black and white that this is only an option for those for whom it is safe. I firmly believe that we must come away from this fear and instil in our decision makers—in the courts of the land and in the authorities who make decisions—the confidence that judgment can and should be used, and that they will be supported in such decisions.

The lesson of Terance Radford is, I believe, a shame on society. It was a shame and disgrace that Gavin Collins could be released under the scheme. Here today we must ensure that this slavish adherence to the letter of a law, or omission of expressly stated reasoning, is never—and never can be—sound reason for releasing dangerous people on to our streets until we absolutely have no choice to do otherwise. We must have confidence in the law of the land and in the justice that we seek, support and wish for. This lesson is a hard one. It has been hard for the hon. Member for Ashfield to tell his personal story in this room today. It is harder still for Terance’s family, who grieve his loss and the grief of a society who understand how badly we have failed Terance, and them.

16:47

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

It is a pleasure to serve under your chairmanship for what I believe is the first time, Dame Maria. I thank the hon. Member for Ashfield (Lee Anderson) for obtaining this important debate today, and for the humanity he brought to his speech. My thoughts are with Terance Radford’s family and friends for their bravery throughout this time, and for coming here today.

I have read the coroner’s report, the Ministry of Justice’s response and—perhaps most powerfully—what Terance’s family said in the aftermath of the killing. Terance, or Terry, was an 87-year-old grandfather who had served this country—a retired teacher and a former magistrate who was simply waiting for a bus before he was struck and killed by a car driven by a man released from prison the day before.

I will focus today on the specifics of the case, the wider issues within our prison, probation and justice system, and finally, the issues that remain within the home detention curfew system and other early release schemes. Three crucial issues in this case were ignored before the release of the driver whose actions killed Terance. First, he was being kept in a segregated wing after committing acts of violence, yet this was not considered to be a factor to prevent early release. Secondly, an ongoing investigation into his behaviour was still outstanding. Thirdly, the probation service had not done a proper risk assessment about his release. The report by the corner is damning—organisations not talking to each other, risk assessments not being carried out, and gaps in the early release scheme not being closed until it was too late.

Terance was failed by the justice system and by the Government. One key purpose of prison is to keep the public safe. We need to uphold confidence and support for our justice system, as other Members have said. I thank the hon. Member for Strangford (Jim Shannon) for his, as always, careful and considerate remarks.

Cases such as this have shaken our constituents’ faith in the justice system, and no more so than that of Terance Radford’s family and friends. According to reports, the driver had assaulted prison officers, threatened to kill an officer and set two fires to the prison. That is not an isolated case. Yes, the specific factors cited around home detention curfew may have been case-specific, but too often we have seen individuals released from prison without proper risk assessments and without different services talking to each other. We have seen three serious case reviews—Damien Bendall, Jordan McSweeney and Joshua Jacques—where individuals were released after incorrect or insufficient risk assessments, sometimes by staff with too little experience, and then the offender went on to commit a serious further offence.

We might ask why our justice system is in this state. For 14 years, we have seen a crisis in our criminal justice system—crises in our courts, our prisons and our probation sector. The loss of experienced staff and a high turnover in the staffing of prisons and the probation service means a crisis in which ever-bigger gaps are forming—gaps that create more victims.

The report from the former chief inspector of probation was damning. Too often, proper risk assessments are not happening. I am repeating myself, but that is no coincidence; time and again we see serious cases like this, where an individual has died, a report is released finding gaps, the Minister comes to this place and tells us that it is all broadly fine, and we are expected to wait until the next serious report to repeat the cycle.

It is on that subject that I want to probe the Minister on how we prevent that from happening, being quite aware that there is an outside chance that I might be in his position after the general election. The Government are currently looking to expand home detention curfew in the Sentencing Bill. Last Monday, in a statutory instrument debate, I asked the Minister when that Bill would be coming back. We have since read in The Sunday Times that the Justice Secretary has been having angry phone calls with No.10 about this, so I will give the Minister another chance: could he confirm when the Sentencing Bill will come back to this House? Do the Government still plan on expanding home detention curfew?

Likewise, if it is expanded, what specific safeguards will be in place to protect victims of crime, including victims of domestic violence? How will the Government ensure that there are adequate probation officers to carry out the required risk assessments if more people are released on home detention curfew? The Ministry of Justice impact assessment estimates that an additional 850 offenders will be managed by probation as a consequence of the changes. The probation service is already overstretched; how will it cope with an additional 850?

I also want to put on record my concern about the lack of transparency on the end of the end of custody supervised licence—ECSL—scheme. It is another scheme to release prisoners early, and it is now being expanded to release more prisoners, yet the Minister says that the Government will only publish numbers annually. Also on the ECSL scheme, I have seen an example where a victim of domestic violence saw their abuser released and housed near them. It was only after an intervention and escalation that alternative housing was found somewhere else. What is specifically being done to protect victims when prisoners are released early under the ECSL scheme?

We know that our criminal justice system is in crisis. It is heartbreaking and wrong that people such as Terance—a man in his 80s just waiting at a bus stop—end up featuring in reports and having their names echoing around this place, when those years of his life should have been spent with his family and loved ones. I look forward to the Minister’s response.

16:54

[The Minister of State, Ministry of Justice (Edward Argar)]

I am grateful to the hon. Member for Ashfield (Lee Anderson) for securing a debate on this important issue. It is, as we have all seen, inevitably a sad debate, given the nature of the tragic events we are discussing.

First, I express my deepest sympathy to the hon. Member’s constituents and to Mr Radford’s family and friends. I want to highlight, as the shadow Minister, the hon. Member for Brentford and Isleworth (Ruth Cadbury), did, the dignity that they have shown throughout what has been an horrific set of circumstances. The circumstances of Terance’s—Terry’s—death are truly terrible, and my thoughts are with them and the rest of his family. I also extend my sympathies to the other victims of Mr Collins’s crimes that day.

The hon. Member for Ashfield has rightly been tenacious in raising and pursuing this matter, and I am conscious that, prior to my appointment to my role in November 2023, he engaged with my predecessor. I have taken the time to read carefully his extensive correspondence with the previous Ministers.

The circumstances of this crime, and the other serious offences committed on 19 April 2019, are not just deeply troubling but deeply upsetting. I am grateful to the coroner for her work in highlighting areas in the home detention curfew policy, as it was at the time, that require action. That helps to ensure that we have updated, improved policies and practices in place to help prevent things like this from happening again.

I note the shadow Minister’s points, but I am going to focus on the specifics of the case, rather than ranging more widely into the broader political sphere. We took the findings and recommendations in the coroner’s report extremely seriously. I will explain the Government’s actions in response, although I fully appreciate that those will not lessen in any way the pain and the loss to Terry’s family and friends. I acknowledge that the internal investigation into the case identified errors and failures, which it is also important for me to speak about.

It may be helpful for me to say a little about the home detention curfew scheme, or HDC, under which Collins was released. It has been in place for over two decades, having been created and introduced in 1999 by the then Home Secretary, Jack Straw. It is a tool in successfully managing the transition of eligible offenders from custody back into the community. It does so by enabling certain prisoners to be released before their normal automatic release date while remaining subject to significant restrictions on their liberty, including a curfew, which is monitored by electronic tag. The scheme is limited to certain types of offenders: all sexual and serious violent offenders, for example, are excluded from it, as are those subject to Parole Board release. Offenders are required to undergo a robust risk assessment to ensure they are released only if there is a plan in place to manage them safely in the community.

I am sorry to say that, having looked into this case following the hon. Gentleman’s tabling of the debate, the process in Collins’s case was clearly found to have fallen short of what was expected and what people had a right to expect. Although the offences for which Collins was serving his sentence were correctly identified as eligible and suitable for HDC, the risk management planning was undertaken without all the relevant information being obtained, as the hon. Gentleman has highlighted. That included information about the mental health of Mr Collins at the time. I will say a little more about the investigation and its findings.

Protecting the public must be our overriding priority, and it is therefore right to keep HDC policy and practice under review, to ensure that it remains as robust and safe as possible. Of course, that must mean learning lessons and taking action when something goes tragically wrong, as it did on this occasion. Every failure or serious incident committed by someone who has been released on HDC is, rightly, taken incredibly seriously, and what happened in the case of Terry’s death was truly appalling.

I should have mentioned at the beginning that I am grateful to the hon. Gentleman for painting a very human picture and making this House, and those following our proceedings, very much aware that this is a real person. This was someone who served his community, served his country, and was much loved by his family and friends. He was only going about his normal daily life, which he should have been able to enjoy peacefully. I am grateful to the hon. Gentleman for making this a very human story and bringing that across in our debate.

We have taken actions to investigate what happened and address the concerns raised by the coroner. I would never wish in any way to detract—in what I say or in the lessons learned—from the huge impact that that has clearly had.

I will turn now to the lessons learned from the prevention of future deaths report. The report raised three central concerns about the HDC policy that was in place at the time of Collins’s release. First, the coroner —I pay tribute to His Majesty’s coroner, then Her Majesty’s coroner, for the work on this—highlighted that the prisoner in this case, at the time he was released on HDC, was being held in prison segregation due to his poor conduct in custody and concerns about the risks he might present to others in the prison, as highlighted by the hon. Member for Ashfield in his remarks. The coroner rightly raised concerns about release in that context and, as a result, we have since taken action to address that issue.

The policy framework has been amended to ensure that those in segregation are not released on HDC unless the most senior governor in the prison, the governing governor, has specifically considered those circumstances and determined that the offender can be safely managed in the community. It is now the policy that no one is released on HDC directly from segregation, unless the risks have been explicitly considered and a decision actively made at the time of release that HDC remains a safe and appropriate route.

Secondly, the report highlighted that the policy at the time required decision makers to consider the risks that the offender might present to those at the proposed curfew address, but not to the public more widely. Rightly, changes have been made to address that, too. The policy now in place requires that, when considering a prisoner for release on HDC, account must be taken of the risks presented overall to people in the community, not just those at the address the offender is going to. It has been made clear that those wider, more general risks must form part of the process of determining whether an offender is safe to be released on HDC.

Thirdly, concerns were raised that the HDC policy contained insufficient guidance on the need to share information properly between the various agencies and professionals involved in managing releases. I fully agree that such information sharing is vital to ensuring that any risks or concerns about a potential release are picked up and acted on. Therefore, again, the policy framework has strengthened the requirement to draw on information from all relevant departments of His Majesty’s Prison and Probation Service and from external agencies, including the police and social services, when making such HDC decisions. Again, it has been made clear that prisoners are not to be released on HDC if any important risk-management information is missing. The failings—let us call them what they are—and tragic circumstances of this case underline the importance of prisons, probation and the wider system working together to ensure the safe release of prisoners on HDC while maintaining public protection.

The hon. Member for Ashfield, entirely understandably, asks about the officers at HMP Ranby involved in this case, and the decision to release Collins on HDC. A thorough internal HMPPS investigation was conducted by senior managers into the release of Collins and the decisions leading up to his release on HDC, as the hon. Gentleman highlighted. That investigation concluded that Collins should not have been released from on HDC from HMP Ranby in April 2019, as the decision to release was not in line with HMPPS policy—I have already highlighted that not all relevant information about risk had been obtained to inform that decision.

The investigation also found that, as Collins had been subjected to adjudication proceedings, the HDC process should have been paused to allow those proceedings to take place. It also made a number of recommendations about policy and practice that have been taken forward, in addition to the changes I have described to the national policy framework to strengthen the approach to assessments, information sharing and decision making on HDC.

In the light of the investigation, HMPPS did decide that there were sufficient grounds to bring disciplinary proceedings against staff at the prison. As part of any internal disciplinary process, if the investigator finds any evidence that a criminal offence could have been committed, the matter is referred to the police to investigate. No evidence of criminal conduct by the three members of staff at HMP Ranby was found, so the matter was not handed to the police.

The hon. Gentleman mentions the police in that context. I am conscious that he will be aware that the police operate independently of the Government and indeed of the Home Office, their sponsoring Department, for want of a better way of putting it, and they make their own decisions. I am sure that his point will have been heard in that context, and I suspect that, knowing the hon. Gentleman as I do, he will have communicated those points directly to Nottinghamshire Police on behalf of his constituents. The hon. Gentleman is right to highlight that, absent criminal proceedings or public trial, there has been no public process around this.

Concluding that there was no evidence of criminal conduct, HMPPS then took action under its own disciplinary proceedings. I appreciate the points the hon. Member for Ashfield makes, and I understand why he makes them. Although it pains me, I am legally unable to disclose the details of those disciplinary proceedings, as I am advised that to do so would be acting in breach of the law. I totally appreciate and understand the point that the hon. Gentleman makes as, prior to taking this portfolio in November of last year, I served for a number of years as the Minister for Victims and Community Safety. I appreciate the importance of closure and of people being able to move on, even in a tiny way.

That said, I am sure that the process and decisions in this case have been looked to very carefully by senior officials in HMPPS. Following the hon. Gentleman’s securing of this debate, as well as the research I have done and the information I have asked to be provided with for it, it is an issue I intend to return to with my officials. I will continue to look into the points that the hon. Gentleman has raised. If it is helpful to the hon. Gentleman, I offer him a meeting with relevant senior HMPPS officials and me to discuss how that disciplinary process works and the legal implications of it. I suspect he would rightly put across his point there courteously but firmly. If he indicates that is helpful, I would be happy to have that conversation with him. I appreciate it will not go anywhere near as far as he may wish, but it may none the less be of some help. I leave that offer with him.

[Lee Anderson]

I completely understand that the Minister would be breaking the law to tell us what sort of disciplinary measures were taken on the three governors. However, can the Minister confirm whether the three governors are still working in the Prison Service?

[Edward Argar]

I am afraid, as I have said, I am unable to give any details on the nature of that disciplinary process in the Chamber. I hear everything the hon. Gentleman says, and I hope he will take up the offer of a conversation. That is his choice, and I will respect whatever decision he makes on that.

We take our responsibility to keep the public safe very seriously. Where there have been lessons to learn from horrific and tragic cases such as this, where the most horrendous outcome has occurred, we have taken decisive action to address and respond to the issues raised. I am incredibly grateful for the contributions to this debate, for its tone, and for the approach adopted by the hon. Member for Ashfield. I repeat my heartfelt condolences to Terry’s family and friends, who have suffered so terribly. I reiterate my gratitude to the hon. Gentleman for securing the debate and allowing us to cast a light on important issues that are of great concern both to those in the Chamber and more widely. I hope he will consider the offer of conversation.

17:09

[Lee Anderson]

Obviously, the family will be very disappointed with the outcome of the debate. I know that. Although I was encouraged by some of the things the Minister said about strengthening the framework—that is good news—we have governors who cannot carry out the most basic of tasks. Anybody in this room today would know that Mr Collins should not have been released on that day. Strengthening frameworks is all well and good, but when there is incompetence at the highest level—they are supposed to be carrying out the framework—it will not work.

Anybody who was part of that prison system at that time and who read Collins’s report would have said he was not fit for release. It appears to me that they just wanted to get rid of him and get him out of there, because he was a nuisance in the system. The consequence of that is the people sat in the Public Gallery, without their dad and without their family member. Strengthening frameworks is all well and good, but if we have incompetent people at the very top in the prison system, it is pointless.

[Dame Maria Miller (in the Chair)]

May I join others today in sending deepest sympathies to the family members of Terry who are with us today?

Question put and agreed to.

Resolved,

That this House has considered lessons learned from the Terance Radford Prevention of Future Deaths Report.

17:10

Sitting adjourned.