Westminster Hall

Tuesday 30th April 2024 Westminster Hall

Tuesday 30 April 2024

[Dame Caroline Dinenage in the Chair]

Glaucoma and Community Optometry

Tuesday 30th April 2024 Westminster Hall

09:30

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered glaucoma and community optometry.

First, a special thanks to the Backbench Business Committee for selecting the debate for this morning. I am my party’s health spokesperson—it is no secret—and am particularly interested in health issues. As such, I secured this debate off the back of a number of people who had contacted me. What I am particularly pushing for—I am sorry for the short notice; I put the request in the Minister’s hand only two minutes ago—is that we do something now so that we can save sight further down the line. If I were pushing for one thing only, that is the one thing I would wish to have.

Optometrists in my Strangford constituency—I will send them a copy of this debate in Hansard afterwards—asked me to secure this debate. A number of bodies here on the mainland asked me the same thing. That is my purpose, but the issue of sight and sight-loss problems affects every constituency equally throughout this great United Kingdom of Great Britain and Northern Ireland. Therefore, the approach to making the system more fit for purpose must also be UK-wide.

I am pleased to see the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), in his place. We are sparring partners, although when I say that I do not mean that we hurt each other—we fight things together. I am also especially pleased to see the Minister in his place. He has a deep interest in this subject, as well as a deep interest in Northern Ireland, which I much appreciate. He has told me about his times in Northern Ireland in the past month or so, and how much he loves going there. Indeed, every MP who visits Northern Ireland—including you, Dame Caroline—always comes back with the most wonderful memories of the occasion and of the people they meet. Just this morning, a Conservative Whip was telling me that he was in Hillsborough two weeks ago, and about how much he enjoyed it.

[Andrew Gwynne (Denton and Reddish) (Lab)]

I want to place on the record the fact that a month ago I made my first visit to Belfast. I had an incredible time meeting Members of the Assembly at Stormont, and going to Harland & Wolff, around Belfast and to an inclusive school. It is a remarkable place, and I just wanted to add, as the hon. Gentleman is putting on the record that everyone else has been to Northern Ireland, that so have I—although I know that is not the subject of our discussion, Dame Caroline.

[Dame Caroline Dinenage (in the Chair)]

Order. I gently remind Members that, charming as it is to hear about Northern Ireland—we are all wildly in favour of going there at every available opportunity—this is a debate on glaucoma.

[Jim Shannon]

Thank you for bringing me and us all back to focus, Dame Caroline. The reason why I said that is that the Minister has been to Northern Ireland and always has an interest in health issues, and I know that his journey was to Queen’s University to explore such issues. That is the connection. The fact it is a lovely place is just wonderful, but that is not the reason why we are here.

The approach to making the system more fit for purpose must be UK-wide. Whenever we ask for what we are going to ask for at the end of this debate, I know that the Minister and the shadow Minister will have similar ideas to mine. I understand that health is devolved in all the regions, but it is clear that we need joined-up thinking to a joint problem. That is what I wish to highlight this morning.

Visual impairment and sight loss cost the UK economy some £36 billion each year, yet we allow 22 people to lose their vision to preventable causes each week. That is the thrust behind what I am aiming for today: to stop 22 people losing their eyesight this week. We can work alongside the optometrists and the opticians, and have a partnership whereby people can have their eyesight tests done more often. I will give some examples. Maybe people do not think of having their eyesight tested regularly, but they should. Optometrists in my area have told me that they are happy to work with the NHS or the health and personal social services in Northern Ireland to make that happen.

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

I congratulate my hon. Friend on securing the debate. On the frequency of eye testing, does he agree that the issues we are discussing today are symptomatic of other parts of the health service? People ignore eye problems and get to the point where problems could have been solved had there been earlier detection and more frequent eye testing. Even if nothing else transpires from this debate, if we do a little to try to ensure that people have regular eye tests, we can prevent some of the problems we are discussing from getting worse.

[Jim Shannon]

I thank my hon. Friend for his intervention, and say to the Minister: that is the thrust of this debate. If nothing else comes from this debate but the answer was along those lines, I would be more than happy. That does not mean that I will sit down now, Dame Caroline— I want to give a wee bit more background and a couple of examples.

Visual impairment and sight loss cost the UK economy £36 billion. The loss of sight is the loss of independence and confidence, and for many it is the loss of their life as they know it. If it can be prevented, it must be, so it is about prevention, early diagnosis and checks. This morning my focus—excuse the pun—will mainly be on glaucoma, a group of eye diseases that damage the optic nerve, usually due to changes in pressure inside the eye, or ocular hypertension. Data from Specsavers revealed that there have been some 30,000 referrals for glaucoma in people aged 40 to 60 just in the last year. Many more have been missed, accounting for nearly a third—30%—of all glaucoma referrals.

Some years ago I spoke at an event in Cambridge. I was asked to come along as a health spokesperson to an eyesight and visual impairment event that took place at a university in Cambridge—not the University of Cambridge but one of the other ones. They were doing tests and I got my eyes tested for glaucoma. It was rudimentary, but the guy said, “I don’t want to worry you, but I think you need to go and have your eyes tested when you get home.” Whenever I got home I went to my optician right away. I could not understand it, because I had seen the optician a month before and was sure that my eyesight was okay, but the Cambridge guy had given me a wee graph that seemed to show that there were issues relating to glaucoma that needed to be addressed fairly quickly. Why is that important? Because my father had glaucoma, and they say it needs to be checked because it is hereditary and passes from generation to generation.

When I got home I went to see my optician right away and told her what was going on. I explained the circumstances and took her the graph. She said, “Look, Jim, I checked your eyes. I do not see anything wrong with them, but do you want them checked thoroughly?” I said, “Yes, definitely.” So she sent me to the eye clinic in Belfast’s cathedral quarter and I got my eyes checked. Everything is done there, 24/7—all the eye checks that are humanly possible. For ages after, my eyes were stinging. The guy came out after an hour and said to me, “I have done every possible check on your eyes. There is nothing wrong with them.” That was good news after a very thorough check. Since then, my optician has done a thorough check for glaucoma on my eyes, simply because it is hereditary and to ensure my peace of mind. I tell that story because it worked out well for me, but it does not work out well for everyone.

Typically, there are no symptoms to begin with, as glaucoma develops slowly, affecting the periphery of the vision at first. That means that hundreds of thousands of people in the UK currently have glaucoma. Betty in my office gets an annual eye test because her father had glaucoma and she was aware of the issue. When I asked my younger staff when they had last had their eyes tested they said, “Not since school. I don’t need glasses so why should I get an eye test?” I immediately asked them to book a test, and told them that it is like an MOT that needs to take place. The MOT tells us if our car runs okay and what repairs we need; it is the same when we get our eyes tested. The eyes may be known as the window to the soul, but they are also undoubtedly the window to the view of overall health that can be found in an eye test. Eye tests are imperative for finding an early diagnosis of diabetes, for example, and a host of other health concerns.

I remember two occasions when opticians saved the lives of gentlemen who came to see me in my office. One guy I know well came in and he was a terrible colour. I said, “Are you okay?” and he said, “To tell you the truth, I don’t feel at all well. I have been to the doctor who told me to see an optician, and I’m going there now.” I said, “I hope you’re okay.” He was as grey as a badger and it was really quite worrying to see him. He went straight from the optician, who referred him, just up the road to the Ulster Hospital. He had a tumour close to his eye and brain, which was removed in an urgent operation. The other person, who went to a different optician in Newtownards, had the same problem, was also referred to the hospital and also had a tumour removed.

Tests at the optician’s are incredibly important. They can diagnose not only glaucoma but many other things, so it is important to have them. Optometrists have a key role to play because they can spot the early signs of glaucoma during routine tests. For patients with stable glaucoma, optometrists have a role in monitoring eye health and helping them to manage their condition.

Alarmingly, a fifth of the population—some 21%—still do not know how often they should visit the optician for a routine check-up. The same percentage either cannot remember their last eye examination or have never had one. Opticians in my Strangford constituency, and particularly in Newtownards town, have told me they are anxious and keen to ensure that people have regular tests. It is about how to ensure that can happen. I hope the Minister will respond to requests, including from the shadow Minister, and is able to reassure us on how we can encourage a UK-wide method to help.

For those with glaucoma or suspected glaucoma who are referred to hospital, long NHS waiting lists, exacerbated by the pandemic, remain a problem. Alarming figures show that around 650,000 people are waiting for NHS ophthalmology appointments. Will the Minister indicate the steps that can be taken to reduce that number and help those 650,000 people to retain their eyesight? There are steps that we can and must take. I always try to be constructive; it is important to come with a positive attitude on how to do things better. We should be big enough to accept that changes need to be made, and then we can do it.

Although optometry services remained open for urgent care during the covid-19 pandemic, the number of sight tests dropped by 4.3 million in 2020—my goodness—which was a 23% decline compared with tests administered in 2019. In respect of that dramatic drop and the need for improvement, perhaps the Minister could suggest methodologies to address and target those who have fallen out of the system. The drop in the number of eye tests resulted in large reductions in referrals from primary care to hospitals. That is where the fall seems to be, and perhaps where it needs to be addressed. As a result, sight loss has increased hugely since the pandemic.

How can we increase referrals from primary care to hospitals? If we do that, we will have moved a long way. I will give some examples from Northern Ireland—not about how nice it is to visit, Dame Caroline, but about the issues of vision and health. In Northern Ireland there are two glaucoma referral and refinement pathways. By contrast to England, they are available at all community practices, as long as clinicians have the right accreditation in glaucoma care. It is fortunate that my GP service and many others have such access. Through the services, patients have their glaucoma tests completed in the community, and the results are then shared securely with the patient’s ophthalmologist. This joined-up approach helps to streamline the experience for the patient and ensures that optometry practices and ophthalmologists work together for the benefit of the patient. I always try to be constructive in my comments and give examples of what we do, because if we do something well, others need to know, and if the Minister does something well here on the mainland, we need to know about that in Northern Ireland as well.

There is also an ocular hypertension monitoring service in the community across Northern Ireland. The scheme allows optometrists to manage in the community patients who would previously have been seen by the hospital eye services. A significant number of patients—some 2,000 to date—have been discharged to the scheme. That is an example of how it is proactively engaging and working. It has helped to free up the capacity in secondary care to manage more complex cases.

Those successful services show that community optometry, alongside other primary care providers, is responsible for delivering the shift from secondary to community care and is able to do so at almost no cost to the taxpayer, given that it uses existing capacity. What we have is an example of how things can be done—and perhaps spread across all of this great United Kingdom—in a better way. Those working alongside optometrists, who wish to ensure that people have their tests regularly, are keen to assist and to make changes. When the Minister speaks to the Association of Optometrists—as he probably already has—I believe he will find that he is pushing at an open door and that the ideas that he and the Department have are ones that optometrists have too.

Overall, Northern Ireland has shown how a model focusing on glaucoma care in the community can be effective. The challenge in Northern Ireland is that these services sit outside the general ophthalmic services—GOS—contract, which means that they rely on non-recurrent funding and are not subject to a regular uplift in fees; indeed, fees have never been reviewed. Given the success of these services, the push in Northern Ireland is for their funding to be put on a more stable, recurring footing and to be subject to the same process for fee uplifts as GOS. I have another ask to put to the Minister, in a constructive fashion: will he see whether the fees in place can be reviewed and how best the system could be used to improve things?

I know that the shadow Minister will make an incredible speech. By the way, I am not giving him a big head; that is what he always does, because he understands these issues incredibly well and brings forward his own ideas and his party’s ideas to this process.

I want briefly to highlight the difficulties arising with cataract surgery. It is wonderful how cataract surgery can improve people’s eyesight. I am a type 2 diabetic, but some years ago, before I was a diabetic, I went to see about surgery, not for cataracts, but to improve short-sightedness. I did not have the surgery, because I was not entirely confident about it, and shortly after, I became a diabetic. I tell that story because a good friend of mine in Greyabbey—I will not mention his name—was a type 1 diabetic and went for some corrective surgery to his eyes. Unfortunately, he ended up losing his eyesight; that is not the fault of anyone, but the diabetes complicated the issue, and he is now registered blind. Again, there are complications in relation to eye surgery for those who are diabetic, just by the nature of what happens.

Cataract surgery is currently the most common NHS elective surgical procedure, accounting for the majority of the large ophthalmic backlog facing the NHS. My mother has had one of her cataracts removed; she has a second one to remove, but I suspect that, unfortunately, her state of health means that the second procedure will not be done. Between 10% and 15% of those with cataracts suffer from concomitant glaucoma, and I am bringing the issue into the debate because cataracts are often treated separately. I suggest that we consider how we could do the two together—the glaucoma and the cataract surgery.

I have been informed by a company named Clarity that there is an opportunity to treat patients for cataracts and glaucoma at the same time. It is obviously more cost-effective, and although I know we should not always dwell on the cost, we cannot ignore it. If there is a way of doing simpler, easier and cheaper surgery more effectively, let us look at that. I am ever mindful that the Minister has four competent members of staff behind him, who will clearly keep him right, so might they be able to do some research on that?

Treating cataracts and glaucoma together expedites patient backlog reduction and helps save people’s sight by preventing the further progression of glaucoma. The treatment is quite innovative, new and effective, and it is important that we should do it. Micro-scale injectable therapies produced by Glaukos can advance existing glaucoma standards of care and improve patient safety by removing the need for invasive secondary surgery and tackling ophthalmic backlogs. So many people wait for their cataract operations and for improvements to their glaucoma. If we catch things early, we can save the sight, and that is a critical factor. Again, can the Minister look at that and ascertain whether the approach I have just referred to could be a cost-effective way forward? I am sure he knows about it, but if he—and indeed the shadow Minister and others—does not, I would be happy to have a response later. The treatment seems to me to be a win-win, so will the Minister confirm whether the Government will initiate it urgently?

Local optometrist services form a vital part of the eye care patient pathway and of directing patients to vital sight-saving medical technologies. It is incredible to live in an age when 50% of all cancer patients can survive and people’s eyesight can be saved if it is checked and their problems with glaucoma are diagnosed. Are we not fortunate to live in this age? Although I am not the oldest person in the room—I suspect that my colleague on the left-hand side, my hon. Friend the Member for East Londonderry (Mr Campbell), might just be a tad ahead of me by a couple of years—I have seen the great advances we have made in medical technology. We are doing great things, and we could do more. Is it not incredible that all we really need is to check? It is not terribly costly, but if we check, we make the difference.

Optometrists are the ones who are properly trained in the pathway. We must ensure that pathways are clear and that funding is available to ensure that, instead of 22 people a week losing their sight in the United Kingdom of Great Britain and Northern Ireland, no one at all loses their sight and their independent life—something that could have been prevented. I know that the Minister shares my goal and that the shadow Minister definitely shares it, as does my hon. Friend the Member for East Londonderry. As a result of today’s debate, I hope we will have a progressive strategy going forward, and I am anxious to hear what the Minister and the shadow Minister have to say, so that we can feel that they understand the path towards achieving this goal and will focus on and direct it.

09:54

[Andrew Gwynne (Denton and Reddish) (Lab)]

I start by passing on the apologies of my hon. Friend the Member for Birmingham, Edgbaston (Preet Kaur Gill), who leads for the shadow health team on the issues we are focusing on today. She is otherwise detained on the Tobacco and Vapes Public Bill Committee, which is taking place at the same time.

I sincerely thank my hon. Friend the Member for Strangford (Jim Shannon)—I know that the custom in this place would be for me to call him “the hon. Gentleman”, because he is not of my party, but he is a friend—for securing this crucial debate and for the positive spirit he always brings to these proceedings. Glaucoma is a common yet serious condition that, if left untreated, can cause real damage. Anyone is at risk of developing glaucoma at any age, but it particularly affects people as they get older.

I declare a bit of an interest here: my grandmother had glaucoma. Because my mum died at the age of 50, they do not if the condition was hereditary, so every time I go to my opticians I have to have the glaucoma test in case it is hereditary. However, it is really important that people are tested routinely, because it is a serious condition that, if left untreated, can cause real damage.

Several factors increase an individual’s risk of glaucoma, including a family history of the condition; being of African, Caribbean or east Asian origin; and having long or short sight, diabetes or blood pressure problems. Glaucoma tends to develop gradually, and it is often entirely symptomless for a long period. As a result, many glaucoma patients are diagnosed only during routine eye tests. The impact of glaucoma can vary greatly, ranging from misty or blurry patches in vision to struggling to complete day-to-day tasks such as reading, and permanent sight loss.

When it comes to accessing basic care, many glaucoma patients face significant challenges. Across eye care, more than 600,000 patients are currently on waiting lists for treatment. Given the risk that glaucoma poses if left untreated, such extensive waiting lists are a serious threat to patient outcomes. Sadly, that statistic shows no sign of changing, and demand for ophthalmology services is set to increase by more than 40% in the next two decades. Given an estimated annual cost to the economy from sight loss of more than £25 billion, the case for action could not be clearer.

I have a degree of frustration with the Government’s approach to the issue. Given the statistics, I would like to see the Minister commit today to turbocharge access to ophthalmology services and make eye tests more commonplace for people who do not routinely test their eyes, but also to get people access to eye care services once conditions have been diagnosed.

The next Labour Government are committed to reforming the system so that those with glaucoma and other eye health conditions can access care when and where it is needed. We will provide 2 million more operations and appointments on evenings and weekends, paid for by clamping down on tax dodgers, so that patients can be seen on time again. We will have a laser-like focus on prevention, tackling the social determinants of ill health and ensuring that eye conditions such as glaucoma are tackled at source. We will ensure that the NHS shifts from an analogue to a digital service, embracing the latest developments in technology and artificial intelligence to provide the best possible care and deliver the best possible patient outcomes.

Again, I declare an interest: being a bespectacled Member of Parliament, I obviously have routine eye tests. I am short-sighted, although age is catching up with me, and this is the first time that I have had varifocals for reading and for distance. However, my optometrist, Dr Shen of Boots opticians in Denton, has brought in and embraced some of the latest technological advances for testing different eye conditions. At my last eye test, I was amazed at the wizardry and machinery they have brought in, revolutionising the way they can diagnose.

[Jim Shannon]

The hon. Gentleman is speaking very powerfully and I endorse those comments. What I have seen with optometrists in Newtownards in my constituency of Strangford is the amount of money and investment that they have put in. They have not asked for any help from the NHS for those things. They are doing it themselves. I think there is a wonderful opportunity for a partnership with optometrists who are investing money—all they need is the people to come in for testing—and that, I believe, is a role for Government.

[Andrew Gwynne]

I could not agree more with the hon. Gentleman. Boots Opticians in Denton is a franchise, and the owner of that franchise has invested in this remarkable technology. I have now seen parts of my eyes that I never believed it would be possible to be able to see. It is incredible digital technology, and it allows opticians to diagnose eye stroke. That is particularly important for people with diabetes, glaucoma, high blood pressure and cardiovascular disease. The technology can also be used to diagnose diabetic retinopathy, in which people’s retinas are leaky, which can lead to temporary vision loss, and age-related macular degeneration. That detailed eye care allows other eye problems, which ordinarily would have gone unchecked, to be found and the appropriate treatments to be provided. I have seen how transformative the use of modern technology by my own optician can be for testing for a whole range of conditions and eye health.

That is why this debate is relevant and why changes across the system are clearly needed. That is most evident in community optometry. There is a real potential to utilise, as the hon. Member for Strangford has said, the existing capacity on our high streets and in our town centres—crucially, where people are—to get a firm grip on the crisis in eye care. That is why the next Labour Government have committed to seeking negotiations with high street opticians to strike a deal to deliver more NHS outpatient appointments. That partnership, which the hon Gentleman was rightly discussing, will underpin Labour’s eye care policy.

With 6,000 high street opticians serving communities across the country, we cannot afford to sit back and waste their incredible potential. We will work with high street opticians to beat the backlog and to get the system moving again. By utilising community capacity, we can free up specialists in the NHS to support those patients with the greatest need, providing greater accessibility, convenient care and, most importantly for all of us taxpayers, better value for money for the public purse.

This approach is backed up by evidence, proving the tangible impact of community-based eye care and eye health services. A 2014 study of the introduction of minor eye care services in Lewisham and Lambeth showed how significant that impact is. GP referrals to ophthalmology specialists in Lambeth decreased by 30%, with an even greater reduction—75%—in Lewisham. Costs in areas without minor eye care services increased, while there was a drop in costs in Lewisham and Lambeth of 14%.

Given that the sector is in clear need of reform, with patient outcomes continuing to suffer, will the Minister back Labour’s plan to unlock the potential of community optometry? With more than 550 patients suffering sight loss because of delays in the NHS since 2019, does the Minister accept that further inaction is simply not an option? These are people whose lives, and those of their loved ones, have been fundamentally changed through no fault of their own. We owe it to them to fix this system once and for all, working in partnership with the devolved Administrations across the United Kingdom, as the hon. Member for Strangford says, so that there is not a postcode lottery on these services, and we get the best outcomes for all British citizens across the United Kingdom. We owe it to them to ensure patients with glaucoma and other eye health conditions get the care they need, when they need it, and where they need it.

We will support the Government in the remaining weeks or months that they have to get this policy right, but mark my words: the next Labour Government see this as a priority and we will act.

10:07

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

It is always a pleasure to see you in the chair, Dame Caroline. Can I start by thanking the hon. Member for Strangford (Jim Shannon) for raising the importance of eye health to the wellbeing of people across our United Kingdom. No Westminster Hall debate is the same without him. I also thank the hon. Member for East Londonderry (Mr Campbell), and the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), for their contributions.

Losing one’s eyesight can be devastating. I pay tribute to the charities that have done so much to help people living with glaucoma, or which are researching a cure: Glaucoma UK, the Glaucoma Foundation and the Royal National Institute for Blind People to name just a few. This morning, we are focusing on glaucoma and the role that can be played by community optometry. This afternoon, there will be a debate on the broader issue of preventable sight loss. I am responding to both debates on behalf of my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), who is the Minister responsible for primary and secondary eye care services. She is otherwise engaged, as she is a member of the Tobacco and Vapes Bill Committee. I know she would want me to put it on the record and reassure Members throughout the House that that remains one of her top priorities.

As I am standing in today, I want to reassure Members that this is a subject close to my own heart. Glaucoma affected several people on my father’s side of the family—my great aunt, Emily Stephenson, lost her eyesight in her 60s because of glaucoma. I remember visiting her as a child and seeing the RNIB talking book cassette tapes, which she loved, and I am delighted that that service continues today in more formats and with more titles than ever before. My mother, too, lives with glaucoma, so I take this issue very seriously.

Up and down the country, community optometry plays an essential role in protecting people’s eye health. It also plays a key role in the early detection of glaucoma, as most glaucoma patients are identified through routine sight tests. Glaucoma cannot be felt—it does not cause any symptoms, and the eye pressure does not cause any pain. That is why regular sight tests are essential, so that problems such as glaucoma can be diagnosed and treated as early as possible.

As the hon. Member for Strangford suggested, everyone should have a sight test every two years. The NHS invests over £500 million every year in providing sight tests and optical vouchers. Between 2022 and 2023, we delivered over 12 million NHS sight tests free of charge. The tests are widely available for millions of people and the budget is entirely demand led, meaning that there is no cap on how many we will provide. We understand that some people may not prioritise sight tests compared with other healthcare, or they might not know that eye tests are recommended every two years. That is why we are always looking for opportunities to remind the public to have a test, through social media and other campaigns. Sight-test providers such as Specsavers and others on the high street display information about NHS sight-test eligibility.

We are committed to making greater use of community optometry to help to alleviate pressures in secondary care. Many integrated care boards are already commissioning a greater range of services on the high street, including minor and urgent eye care services, pre and post-cataract checks, and glaucoma referral filtering and glaucoma monitoring.

Glaucoma referral filtering schemes have delivered fantastic results, with additional tests that double-check whether a patient really needs to be referred to secondary care. These are tried-and-tested schemes that can save patients time and worry while freeing up space for those who most need specialist attention in hospital. Devon is a great example of that. An old Nightingale ward has been repurposed with equipment to screen large numbers of glaucoma and medical retina patients. The diagnostics hub has demolished the hospital’s backlog from just under 4,000 in April 2022 to just below 500 in October 2023—almost a 90% decrease. In Milton Keynes, 70% of suspected glaucoma patients were discharged following refinement of initial referrals made on the high street. About 50% of integrated care boards currently have a version of those schemes in place, and we are assessing the potential for encouraging the roll-out of those schemes even further.

It is vital that patients who need secondary care have access to timely diagnosis and any necessary clinical treatment. The hon. Member for Strangford is right to say that those services suffered during the pandemic, just as they have across the NHS. That is why we have set an ambitious target to recover services through the elective recovery plan, supported by more than £8 billion of dedicated funding, and it is why we have expanded surgical hubs and harnessed the capacity of the independent sector, so that more patients can be seen more quickly. That has been particularly successful for cataract surgery.

Our plan is working and it is delivering results, as waiting times are falling. The number of patients waiting 78 weeks or longer for ophthalmology has been reduced by 96% since its peak, but we know that we have to go further. As well as cutting waiting lists today, we are looking at how we can reform eye care services to meet the demands of tomorrow. NHS England’s transformation programme is running seven projects across each integrated care system area, such as those that test how improving IT links between primary and secondary care could allow patients to be assessed and triaged virtually, saving them time and freeing up more hospital capacity for patients who need specialist face-to-face care the most. NHS England is gathering data and evaluating different interventions, looking to develop a convincing case on what works best and supporting further expansion.

We are going further and faster to free up hospital capacity. Today, many glaucoma patients often have their condition managed in hospital, but in some cases, where clinically appropriate, there is no reason why they cannot be seen somewhere else in their community that is more convenient for them. In England, it is up to ICBs to commission services based on local need, and some ICBs are already trying new ways of working to do just that.

Finally, on research, I want to recognise just how much potential there is for research and innovation to change the lives both of people who suffer from sight loss and of their families. The UK leads the world in research; we could not be more committed to pioneering new treatments and improving our understanding of sight loss. We put our money where our mouth is by awarding the Moorfields Biomedical Research Centre £20 million to carry out another five years of world-leading research in December 2022. Thirteen out of the 100 leaders and innovators in ophthalmology across the world who were included in The Ophthalmologist’s “Power List 2023” were researchers from Moorfields, and we should be proud that that centre of excellence is right here in London.

[Jim Shannon]

I thank the Minister for his very positive and helpful response. The shadow Minister referred to ophthalmology services increasing by 40% over the next 20 years—those figures might not be entirely accurate, but I think that is what he said. That certainly indicates to me that we need to have a progressive and active programme to ensure that people can get tests in partnership with opticians. The Minister mentioned ICBs and how that will be done; I say this respectfully, but can we have some meat on the bones as to how that would work? I am ever mindful that the Minister wants to see that, but we wish to see that as well.

[Andrew Stephenson]

NHS England is looking at a range of different interventions across the country. One of the benefits we have across England, and of course across the United Kingdom, is that we can try different things, such as models of delivery, in different parts of the United Kingdom and learn lessons from one another.

The current strategy pursued by the NHS is to look at different programmes across England and evaluate them to see what delivers the best outcomes for patients. That will help us to improve access for patients and deliver quality treatment. We hope that that evaluation will enable us to suggest best practice. It will still be up to ICBs to commission services—we believe they should be commissioned locally—but we hope that by providing an evidence base for them they can take decisions in the best interests of their local communities. To address the point made by the shadow Minister, that will address the growing demand for services. We recognise the fact that there will be more demand in the years to come. It will also help to address some of the backlogs with which we have struggled since the pandemic.

I hope I have said a few things to convince the hon. Member for Strangford that, while we still have much to learn from Northern Ireland, the Government take glaucoma extremely seriously. Community optometry is helping us manage the flow of glaucoma patients and it is already deployed effectively in many areas across the country to support patients.

We should be under no illusion about how many people watch Parliamentlive.tv. I think it was Stanley Baldwin who once said that the best way to keep a state secret was to announce it on the Floor of the House of Commons. Nevertheless, I wish to end with an appeal to anyone watching this debate at home: remember to take an eye test and please check the NHS website to see whether you are eligible for help. In preparing for today’s debate, I decided to do just that and I will be having my eyes tested tomorrow morning.

[Dame Caroline Dinenage (in the Chair)]

That is good to know; thank you very much. I call Jim Shannon to wind up the debate.

10:16

[Jim Shannon]

I thank the Minister. That appeal was a wonderful way to end this debate. I began the debate today by asking that we move towards measures to getting more people tested. The Minister has just done that. He has thrown out a challenge to everyone across this great United Kingdom of Great Britain and Northern Ireland, to do just that.

My hon. Friend the Member for East Londonderry (Mr Campbell) is well aware, as I am, of the merits of what we do in Northern Ireland, of the investment that optometrists are making personally and the need to work together. I am encouraged by the helpful contributions of the Minister, the shadow Minister and my hon. Friend.

The hon. Member for Denton and Reddish (Andrew Gwynne) referred to the fact that routine glaucoma testing can save eyesight. We all know that, and that is the purpose of the debate. We need more people to take the test—that is the purpose of the debate. The response from the Minister outlined a plan. I loved the term the hon. Member for Denton and Reddish used when he referred to turbocharging access to ophthalmology services. Wow! That is exactly what we need: a turbocharger. The Minister, in his response, turbocharged the challenge of eye tests and optometry.

The hon. Member for Denton and Reddish also referred to Labour’s commitment to making eye care a priority, which I welcome. I think that is where we are, and that that will follow hard on what the Minister and the Government are doing. The hon. Gentleman also referred to the 6,000 opticians on the high street with whom we can have a better partnership, and he stated that inaction was not an option—how true that is. He said that it was important to ensure there was not a postcode lottery, and he said that Labour would act.

The Minister always tries to be helpful, positive and proactive in his responses. That is what I like in any Minister, and it is what I particularly like about this Minister. It is helpful to have something to be encouraged by. The Minister has grasped the modus operandi of the debate, and why it is important, even though the subject is not in his portfolio. He referred to the need for people to have an eye test every two years, and said that the Government were working with high street opticians to ensure ICB involvement. He also said that the Government were pushing to increase the number of ICBs engaged with that. He said that the pandemic had created some problems, but also referred to an increase in cataract surgery. I think that is positive. Another positive that is sometimes forgotten, to which the Minister referred, is research. Well done, Minister and well done to the Government.

The Minister referred to £5 million of pioneering technology from the United Kingdom. We lead, across the world, in relation to that. He also referred to a new model within the NHS: proactive, progressive ICB best practices.

Today, we have been encouraged by the Minister. We are very pleased with his response. I can tell people who watch this debate on Parliamentlive.tv or who read Hansard—people will get copies from me in my constituency —and want to know what we are doing that we do not need to do anything really expensive. We just need to be proactive.

I look forward to the implementation of the plan to which the Minister referred, and I very much welcome the turbocharged priority that the shadow Minister and his party are prepared to give to the issue. I thank you, Dame Caroline, as always, for your chairship. You make so much of these debates and we appreciate that.

[Dame Caroline Dinenage (in the Chair)]

Thank you very much.

Question put and agreed to.

Resolved,

That this House has considered glaucoma and community optometry.

10:20

Sitting suspended.

Sport Horse Industry: Import and Export Controls

Tuesday 30th April 2024 Westminster Hall

09:30

[Dame Caroline Dinenage (in the Chair)]

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

[Helen Morgan (North Shropshire) (LD)]

I beg to move,

That this House has considered the impact of import and export controls on the sport horse industry.

It is a pleasure to serve with you in the Chair, Dame Caroline. Horses are among the most travelled animals in the world, and in the UK we are lucky to have a thriving competition and breeding industry. My constituency of North Shropshire is home to a significant amount of that activity in the sport horse sector, with centres of excellence for both artificial insemination of mares and competition training.

Implementation of new import controls went live today. They have been causing consternation in the industry, with an additional issue around export controls for live animals and animal products, which are also having a significant impact. I will come to each in turn. I note that the issue of export controls is for the Department for Business and Trade and not necessarily for the Department for Environment, Food and Rural Affairs. When I sought this debate last week, the former did not want to take it and advised that I speak to DEFRA.

I will focus a bit more on import controls because that is the Minister’s area of expertise. I hope he will take on board some of my points about export, and work with his colleagues in the Department for Business and Trade to consider some of the challenges being faced in the industry in that area.

First, on imports, we all recognise that there is a serious risk of disease, and that biosecurity is a top priority. I am not here to suggest otherwise. More than 95% of sport horse mares are artificially inseminated using chilled equine semen. It is important to have checks on that, so that we do not import unwanted diseases into the country. However, it is important to remember that these are high-health animals that are carefully monitored here and on the continent. There has never been an incident of disease imported in this manner. When looking at the type of checks that might be suitable, we can take that into account and consider what is proportionate to the risks. The logistical challenge of classifying those products as high risk at the border control point has the potential to cause havoc in the importing process.

I am grateful to Ministers in DEFRA, including Lord Douglas-Miller, who met me and one of my constituents who is affected by this problem. A pilot scheme is being run from today, with checks on those products carried out by the inseminating vet rather than at the border control point. I hope that pilot is successful, because it would remove some of the logistical problems of importing a product that has to be used within 48 hours of collection. It is collected in Europe and it takes time to transport it to the UK. The logistics of getting it to its courier and destination are very tight. The pilot is a welcome development and I thank the Department for listening carefully.

It is important to note that getting to this point has been chaotic and that the change of process was made with only weeks to go. I understand, from speaking to the British Horse Council earlier this week, that that process is being piloted at East Midlands, though not at Stansted airport, where a smaller proportion of these goods come through. We now have a dual process, which is not ideal because there is scope for confusion and for the process to break down at Stansted. Businesses affected by this problem have wasted considerable time in getting ready, and expended much worry over the potential outcome, so the process has not been ideal.

[Jim Shannon (Strangford) (DUP)]

The hon. Lady is outlining a specific case, but we in Northern Ireland also have a specific case, which the Minister will know, in terms of the protocol and the Windsor framework, which has curtailed the movement of livestock within the UK. Does the hon. Lady agree that while her case is specific to her and her constituents, we have a specific case too? Might the Minister in his answer also consider how movement of livestock, and particularly of horses, from Northern Ireland to Great Britain can be addressed?

[Helen Morgan]

I thank the hon. Gentleman for his intervention. As always, it is highly relevant to the issue. There is an issue around Northern Ireland, because there is a risk that with different controls we compromise our biosecurity and that people use Northern Ireland as a back door to circumvent those controls. It is therefore important that we have consistency between all the devolved nations, including Northern Ireland.

We are talking about an £8 billion industry in the UK, so it is not such a niche issue and it is well worth ensuring that the industry can operate effectively. We have had a lack of clarity on charges. It is my understanding that both East Midlands and Stansted border control points are not Government-run and that there is a lack of clarity about the level of charges. Again, it is difficult for businesses to plan for a big change that is coming in if they do not know exactly what it will involve.

A lot of the effort has focused on the import of germinal products, but we have stallions in this country whose products are being exported. If we streamline and make the process of import cost-effective, which is very important, we are unfortunately putting our exporters at a disadvantage compared with European producers. This is therefore the point when I ask the Minister to work closely with the Department for Business and Trade to see if we can streamline the export process and put our own stallion breeders on a level playing field.

One of the reasons there has been concern about the process is that vets did not have access to the TRACES system—a database maintained by the EU and used to monitor health and travel documents in 90 countries. Will the Minister clarify whether the UK systems will be able to interface with that system and whether that has been properly tested? Also, out of interest, why did we not stick with the TRACES system, which might have reduced some of the cost in the process of moving horses in and out of the country?

We have talked about germinal products, but I also want to talk about live horses. As I mentioned at the beginning, sport horses are some of the best-travelled animals in the world. They go to Europe frequently to compete, and this is essential for breeders to prove their breeding and competition credentials; thousands of horses go every year. A couple of weeks ago, I was lucky to meet Safira from Springfield Stud in North Shropshire, who has been selected for the Brazilian Olympic team. She travels backwards and forwards to Europe regularly and it costs hundreds of pounds each time because she has to have export documentation and a veterinary check. That process is not streamlined and it is expensive.

That is also an issue for the thoroughbred industry, about which I confess I know less. Thoroughbred horses have to be naturally covered, which means a lot of international movement is required in the industry to ensure gene pool diversity, leading to a huge associated cost every time a horse moves in and out of the country. There has been an estimated 18% reduction in imports of thoroughbred horses, which shows the scale of the problem and its potential impact. There is also evidence of a reduction in the number of European horses coming here. UK businesses, such as Springfield Stud in my constituency, are considering moving to northern Europe to avoid some of the cost and red tape involved. That is hugely damaging to the industry and has the potential to affect North Shropshire in particular.

I want to return to the point that, in this debate, we are discussing high-health animals, whose health is continuously monitored. Many are held in quarantine before they are used to produce semen, and they must have high levels of documentation and accreditation to go and compete with other horses across Europe, so the risk around them is potentially quite low. I therefore ask the Minister: how can we slim down the process and reduce the cost and red tape involved so that breeders stay in Britain and continue to effectively compete in Europe?

The identification process, I am informed, is one such area for improvement. There are about 70 passport-issuing bodies in the UK feeding into a central database, and because there are so many bodies involved, the data is inevitably of variable quality. My understanding is that the Government have accepted that this needs to be simplified and improved and the industry is waiting on the statutory instrument needed to do it, but it has been repeatedly delayed. I wonder whether the Minister could give us a date on which that change will come in, so that we can see a more streamlined database for health and travel documentation.

I also want to touch on the point that the hon. Member for Strangford (Jim Shannon) made about the importance of consistency. My understanding is that Wales is set to follow the same set of rules as England. Obviously, that is very welcome, but it is very important that the Government work with their Scottish counterparts to ensure that we have consistency throughout the whole United Kingdom and that we do not see people trying to get through loopholes and back doors because of a lack of joined-up thinking. When that happens, our biosecurity is put at risk. It is important to ensure that we have the same types of controls across the whole country.

We have a threat to the efficient operation of a valuable and thriving UK industry that we are all proud of. I have a particular interest in it, because eventing and show-jumping horses are important and thriving in North Shropshire. DEFRA is moving in the right direction on some of these issues, but the process so far has been more chaotic than we would like. We want the Department for Business and Trade to be involved as well, because horses move backwards and forwards and we do not want to disadvantage our own breeders.

Before I finish, I would like to thank David Mountford from the British Horse Council, Claire Sheppard from the Thoroughbred Breeders’ Association and Jan Rogers of the Horse Trust for making sure I was well informed before this debate. I also thank my own constituents, Tullis Matson from Stallion AI and John Chambers from Springfield Stud, for taking the time to explain their concerns and their issues to me in so much detail.

11:11

[The Minister for Food, Farming and Fisheries (Sir Mark Spencer)]

It is a pleasure to serve with you in the Chair, Dame Caroline. I also pay tribute to the hon. Member for North Shropshire (Helen Morgan) for securing this important debate. I recognise the great economic, social and cultural benefits of the sport horse industry to this country, and I am pleased to have the opportunity to speak on the Government’s support for it.

On the introduction of the new import controls under the border target operating model, the introduction of biosecurity controls on imports is not optional. Now that we have moved away from the EU’s rigid biosecurity, surveillance and reporting systems, we are responsible for protecting our own biosecurity from threats such as foot and mouth disease, African swine fever and the African horse sickness virus, which we must remain alert to despite it never having reached these shores. Otherwise, such threats could devastate UK industries and cause significant damage to the environment, public health and the wider economy. We remember the impact of foot and mouth in 2001, which cost British businesses nearly £13 billion in 2022 prices. It caused massive disruption to many industries, including the sport horse industry.

Biosecurity controls are also essential to protect our exports and international trading interests. Our trading partners want to be reassured that we maintain the highest biosecurity standards. Maintaining our reputation for high biosecurity standards is in the interests of the sport horse industry, to ensure that we can continue to move first-class animals and germinal products in and out of the country.

[Dr Neil Hudson (Penrith and The Border) (Con)]

I congratulate the hon. Member for North Shropshire (Helen Morgan) on securing this important debate. I declare my interest as a veterinary surgeon. The Minister will be aware that a couple of years ago the Environment, Food and Rural Affairs Committee published our report on the movement of animals across borders. There is a balance between allowing the smooth movement of animals and protecting the biosecurity of our animals in the UK. We looked at the key issues of trying to replicate the tripartite arrangement, which allowed for the smooth movement of high-health horses between the UK, France and Ireland, and progressing the digital identification system for horses, both of which would allow smooth but safe movement. Government progress in those areas would help to protect our industries and our biosecurity.

[Sir Mark Spencer]

I am grateful to my hon. Friend for his intervention and for his work in this subject area. He is very informed on these matters and the House benefits a great deal from his expertise. We will continue to work with the sector. We want to have as much freedom of movement as possible, but in a way that protects our biosecurity. I am sure there will be more opportunity for us to benefit from my hon. Friend’s expertise as we find solutions to the challenges.

The new controls begin today. They require high-risk consignments, including equine germinal products from the EU, to enter GB via an appropriately designated border control post, where 100% documentary, 100% identity and 1% to 5% physical checks are undertaken. We are aware that the sport horse industry and its representatives, including the hon. Member for North Shropshire, have been concerned about the controls coming in during the peak season for the import of equine germplasm. We have been glad of their engagement on this topic and for their having drawn their concerns to our attention so that we can address them and make sure we get the implementation right.

The import of equine germinal products provides for genetic diversity and the rapid genetic improvement of British breeding horses. Using the chilled rather than frozen product enhances conception rates, as the hon. Member for North Shropshire pointed out. We know that the movement of these goods is highly time sensitive, if they are to be successful, so we have to consider appropriate measures that work for the sector. We have considered that in the context of the new BTOM controls.

Thanks to representations from the hon. Member for North Shropshire and others, we are aware that on some import routes logistical challenges mean that some checks required by the BTOM cannot currently be undertaken within the required timeframe for the products to reach their destination mare. DEFRA officials have therefore worked closely with the main importers of chilled equine germinal products, port health authorities and the British Equine Veterinary Association to develop and secure approval for a temporary contingency measure with an optional additional adaptation. That will facilitate trade while maintaining essential biosecurity controls.

The contingency measure temporarily reduces the requirement for official identity checks from 100% to 20%, and allows them to take place at a border control post or at the destination, using the optional temporary adaptation pilot process with the BEVA. As a result, the consignments, which also benefit from 100% documentary checks before arrival in GB, complete official import controls in the minimum time possible.

On the movement of live horses—which the hon. Member for North Shropshire was keen to address—in planning and implementing controls we aim to reduce any disruption or administrative burden as far as possible. We recognise that in the case of the sport horse industry we can often rely on robust industry processes that are in place to assure the health of the animal. For that reason, when new border controls on live animal imports come into force, we have developed and agreed, with the help of industry, an exemption for certain horses that meet a definition of high health. Verified equines used in racing, competition, breeding and sales can all qualify for that facilitation if arriving from the EU and sanitary group A countries.

We estimate that approximately two thirds of equine imports will be eligible for the exemption. They will be cleared for import on the basis of a documentary check, and their identity as a high-health horse will be verified with industry databases. That provision will allow them to avoid attendance at a border control post for a physical inspection unless a concern raised during the documentary check triggers such an inspection.

We are also focused on ensuring that the border control post infrastructure, which we will have in place for equines that must come through one, works as well as it can for the animals and their requirements. It is intended that the existing airport BCPs will be supplemented with Government-run BCPs at Holyhead and at Sevington in Kent, which will have the additional impact of assisting animals transferring from the island of Ireland and our friends in Northern Ireland. We are confident that we will have sufficient infrastructure, given the planned exemption for high-health horses, but we will continue to test that position over the intervening months.

We have already been fortunate to have had the benefit of the expertise within the industry to help to shape the physical design of the equine facilities at Sevington, and we have made many adaptations because of that advice. That co-design will undoubtedly make the site more effective in the way it operates. We hope to continue that joint work to test and challenge the operational procedures at the border control post in relation to the way horses travel to the site and are handled and inspected. Of course, that will be an area of focus for our work over the coming months.

We continue to welcome the open and supportive dialogue that we have with the sport horse industry. I again thank the hon. Member for North Shropshire for securing the debate. This is an important set of issues, and I am grateful for the opportunity to discuss them.

Question put and agreed to.

11:21

Sitting suspended.

Social Cohesion and Democratic Resilience: Khan Review

Tuesday 30th April 2024 Westminster Hall

[Sir Mark Hendrick in the Chair]

11:34

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

I beg to move,

That this House has considered the Khan Review on threats to social cohesion and democratic resilience.

It is a pleasure to serve with you in the Chair, Sir Mark. I am grateful for the opportunity to talk about this important topic. The UK’s democracy is the oldest and most established in the world. We have set an example for countless countries to follow. Brave men and women from these islands and the Commonwealth fought and died in defence of the values that have shaped our great nation. However, as the Khan review sets out, we cannot get complacent. Advancing our democracy and ensuring that it is safe requires constant vigilance.

In the United Kingdom, Europe, the United States and further afield, democracy sadly continues to be under threat. Elected representatives in this country are being threatened like never before. This year we have seen MPs from across the political divide intimidated and threatened by extremists intent on tearing apart our democratic framework. Very tragically, in the past decade alone we have seen two Members of Parliament, Jo Cox and Sir David Amess, killed by the far right and an Islamist terrorist respectively.

Across the western world we have seen a shocking rise in antisemitism and anti-Jewish hate in the wake of the 7 October terrorist attacks committed by Hamas. In the UK specifically, the House of Commons Library notes that police forces in Manchester, Yorkshire, the west midlands and Merseyside reported an increase in antisemitism. I am horrified by reports that the Jewish community are scared to visit the capital city of this country and that Jewish schoolchildren are hiding badges on their school uniforms for fear of being discriminated against.

In Stoke-on-Trent we have seen very real threats to our own democracy and social cohesion. At a recent fundraising event for Stoke-on-Trent and Staffordshire’s Conservative police and crime commissioner candidate Ben Adams, protestors hijacked a local Conservative party dinner in Shelton. Some protestors were known to have been supporters of Hizb ut-Tahrir, which the Government have now rightly proscribed as a terrorist group. They managed to enter the facility, threatening local activists and behaving aggressively in the presence of children of the attendees. That is a clear example of malign actors threatening social cohesion. They are capitalising on tensions and unrest caused by events in the middle east to push their dangerous and divisive agenda at home.

As the Khan review points out, “freedom-restricting harassment” is threatening social cohesion and testing our democracy like never before. When the Prime Minister stood on the steps of Downing Street on 1 March this year, he made it clear that we have seen

“a shocking increase in extremist disruption and criminality.”

That is why the Khan review is both timely and necessary. The geopolitical environment has become increasingly unstable and unpredictable, which exacerbates the threat of social media to social cohesion. The tragic events of 7 October, when Hamas committed the worst pogrom since the holocaust, have presented us with an immense challenge.

On reading the Khan review, I was deeply concerned that the continuing activity of far-right and Islamist groups poses serious challenges to cohesion when they capitalise on the backdrop of geopolitical instability to stir division. These malign groups have sophisticated networks. Community spaces such as gyms are used as a recruiting ground, and vulnerable young people are targeted. If we want to tackle these challenges head on, we must be prepared to consider the findings of the Khan review and work constructively to deliver social cohesion once again.

On the steps of 10 Downing Street in March, the Prime Minister stated:

“Immigrants who have come here have integrated and contributed.”

I see that at first hand in Stoke-on-Trent, where we have a thriving migrant community who work in our NHS, schools and other civic institutions. However, our city’s multi-ethnic and multifaith community is being deliberately undermined by forces intent on tearing us apart.

Far-right organisations play on people’s real concerns about the economic impacts of migration to make the case for their narrow-minded and nationalistic worldview. In the same way, radical Islamist groups will use fear to stoke up division in favour of their nihilistic worldview and argue that institutions set out to undermine minorities’ personal freedoms and individual liberties. Soaring immigration levels currently make it virtually impossible for people to properly integrate into British society, and with huge unrest in our streets we cannot build a more cohesive society built around British values like democracy, the rule of law, respect, tolerance and individual liberty unless we control the number of people coming in from overseas.

As the Khan review points out, cities like Stoke-on-Trent will fall through the gap if there is no coherent approach to national security. That demonstrates the urgent need for stronger borders, which will help to facilitate social integration and stop malign groups exploiting the immigration question to push their divisive agenda. In April 2023, the deputy director of Prevent, Katherine Elsmore, informed me that Stoke-on-Trent City Council would no longer receive money to deliver Prevent strategies in Stoke-on-Trent; the Khan report suggests it would be useful to revisit that decision. My hon. Friends the Members for Stoke-on-Trent South (Jack Brereton) and for Stoke-on-Trent Central (Jo Gideon) and I have written jointly to the Home Secretary to make that case.

While I have time, it is worth while to put on the record what we believe to be the arguments for reintroducing Prevent funding in the city. First, as outlined in Dr Khan’s review, the far right puts social cohesion at serious risk in the city. Groups such as Combat 18 and Stoke-on-Trent Infidels always seek to exploit domestic and international instability to suit their own ends. In 2002, the city elected its first councillor from the banned far-right British National party, and by 2009 had nine BNP councillors. I am proud that my hon. Friend the Member for Stoke-on-Trent South led the fightback against them in the city, to offer a true centre-right conservatism option on the table. That led to the final expulsion of those extremists, and therefore allowed proper centre-right debate, alongside our colleagues in the Labour and Liberal Democrat parties and others, who are much more in the mainstream of party politics.

Alongside the clear threat of far-right extremism, radical Islamist groups also have a footprint in the city. The starkest reminder of that to me was when Usman Khan stabbed Jack Merritt and Saskia Jones on London Bridge near Fishmongers’ Hall in November 2019, tragically taking their innocent lives. Sadly, that terrorist was born and grew up in Stoke-in-Trent and Staffordshire, where he had links to Islamist groups such as al-Qaeda and al-Muhajiroun, which has close links to Anjem Choudary, the face of militant Islamism and Islamic extremism in Britain. Given that 80% of counter-terrorism police networks’ live investigations are of Islamist terrorism, it is vital that we remain vigilant to the threat of other people who could be influenced by divisive and malign actors.

Earlier in the year, I welcomed the Home Secretary’s proscription of Hizb ut-Tahrir as a terrorist organisation. That vile antisemitic organisation encourages terrorism and praises the abhorrent terrorist attacks by Hamas on 7 October. Given that that vile group has a strong footprint in Stoke-on-Trent, where it runs local gyms and community centres, I fully support the Prime Minister’s decision to ban it. Sadly, that heinous group seeks to use events in the middle east to argue against values that underpin the UK as the world’s most successful multi-faith and multi-ethnic society.

To me, all that suggests that Prevent should review its decision to suspend funding for Stoke-on-Trent, because there is a clear threat to democracy and the rule of law from malign actors, from the far right and radical Islam, that needs attention in our city. Given that Stoke-on-Trent North, Kidsgrove and Talke have historically had some of the lowest turn-out rates for general elections in the UK, it is of paramount importance to help to ensure that people have trust in democracy, as well as in those who are elected to represent them. In part, that is about core issues such as levelling up so that people in our industrial heartlands no longer feel they are being left behind when competing with other areas, like London and the south-east.

The Khan review makes it clear that the financial vulnerability of one in five councils across the UK means that

“the potential impact on social cohesion in the short and long term could be destabilising to our country.”

Without doubt, that makes the case for levelling up, in respect of which we need continued investment, as we have seen recently in the Potteries, to improve socioeconomic conditions and regenerate areas that fall behind. Alongside boosting local economies and getting more people into work, we need to ensure that we have systems in place to stop people being influenced by malign groups that are intent on undermining our way of life.

The Khan review makes it clear that prevention is

“far more effective than cure”.

Given the unprecedented threats posed to democracy and social resilience, I urge the Minister to ensure that Prevent is aware of the new challenges that Stoke-on-Trent faces, so that we can help to promote social cohesion in the Potteries. The review makes it clear that it is essential have a co-ordinated approach to support vulnerable people in areas such as Stoke-on-Trent. That involves rejuvenating the local economy so that people feel the Government are supporting them, and having adequate systems in place to ensure that people from all faiths and ethnic groups believe in our democracy and play a role in it.

14:39

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairship, Sir Mark. I thank the hon. Member for Stoke-on-Trent North (Jonathan Gullis) for leading this debate on an issue that is so important in modern society. It is also important that the lines on unity and solidarity do not become blurred.

I am blessed to represent my constituency of Strangford. We are a multicultural community. We have welcomed many people from Latvia, Lithuania and Poland, and in particular from Ukraine, as well as from Bangladesh, over the last number of years. Also, under the Government’s scheme for Syrian refugees we took in a number of Syrian families. Those families have integrated into Newtownards with a real positivity, and the people of Ards and Strangford have embraced them as well.

Last Friday night I was invited to attend an event in St Patrick’s hall, which is a Roman Catholic chapel hall up on the north shore in Newtownards. There is a very strong Indian diaspora in my area. I never realised how big it was until Friday night. More than 100 people are part of it, all of whom live in Newtownards. Every one of those people is here with a visa and the status that they have to have, and they contribute to our health sector in the hospitals in Ards and throughout Ulster, including the Royal Victoria Hospital in Belfast. I make that comment because I see lots of positivity at the same time; it is not all negative.

I will give three examples. They do not necessarily embrace my constituency but do embrace the situation in Northern Ireland. I think they clearly illustrate what the hon. Gentleman referred to and the problems that arise. But last Friday was a wonderful occasion for us all, including elected representatives, to come together and have a really good and fun time. I cannot remember an occasion when I have laughed as much in a long time. It was wonderful and that is what communities can do if they come together.

At the same time, across the UK and indeed globally there are so many democracies and communities that face internal polarisation, so it is great that we can look at the Khan report and apply it to modern society, in order to assess what more can be done to ensure that all opinions are represented.

A large majority of the public—85%—believe that freedom-restricting harassment currently occurs in the UK, with 60% believing that the problem is worse than it was five years ago. I see a change in society and I am not quite sure whether covid was the main reason, but it was certainly part of it, when people were able to make comments at a distance, and interaction and social engagement were lost to a certain degree. Some 44% of people have witnessed freedom-restricting harassment online, and 44% say they have witnessed it in person, so there is something difficult in society. The issue the hon. Gentleman has brought forward is about social cohesion and democratic resilience, and it is really important that we try to encourage those things and do not dwell on the divisions.

There is absolutely no doubt that social media plays a massive role in the opinions that are gathered and eventually expressed, which often provoke controversy in society, and there is no doubt that a conversation must be had regarding people’s disillusionment with democracy and about how we can restore confidence in it. I think that is what the hon. Gentleman is seeking to achieve. Hopefully after the shadow Minister—the hon. Member for Blaydon (Liz Twist)—and others have spoken, the Minister can give us some encouragement about the Government’s way forward to try to make the situation better and to engage people in society.

We had a debate in Westminster Hall yesterday on assisted dying—or assisted suicide as I call it, and as many others also call it, by the way. I have a very clear opinion on that; other people have a very different but clear opinion on it. What I think we need, and what I always seek to achieve, is that we at least respect each other’s viewpoints. “Agree to differ” is the terminology that I often use, because it is not always good to dwell on the things that we disagree on, and we must at least be respectful and understanding.

There are two main dimensions to social cohesion: the sense of belonging in a community and the relationships with others in that community. The event on Friday night was an example of what we can do if we commit ourselves. There has been a natural shift in societal norms, which is welcome, but those who hold what are seen as traditional opinions or conservative views, like me and many of my constituents, feel that they no longer have a right to express them—that it is no longer acceptable or welcome. I have tried all my life to be respectful of other people. I do it in this House—I never attack anybody in this Chamber or the main Chamber. I try to respect people, and even if I do not agree with them and they do not agree with me, we have an understanding of how to do things.

Everyone has the right to express their belief in a rational and respectful manner. In Northern Ireland, we recently discussed changes to the relationships and sex education curriculum. The legislation was passed here, and the Northern Ireland Secretary then reflected that in Northern Ireland. We expressed a lot of concern about how that was done, but now that the Assembly is up and running again we can, I hope, move forward. Last week, we discussed changes to the RSE curriculum proposed by the Alliance party, which many parents feel incredibly unsettled about; so many people have written or emailed me, expressing their concerns. A meeting was held to inform and discuss the issue with those parents, and Eóin Tennyson MLA of the Alliance party summarised the Let Kids Be Kids campaign as a

“disgusting dog-whistle to the far-right”—

a disgraceful comment. We are not, and my constituents are not, on the far right. They are parents who have concerns about their children’s education and teaching, and care about our opinions. I want to put that on the record, because the number of parents who have emailed me to express their concerns has been incredible.

I had a staff member sit in on the meeting and listen to every word that was said, and I can assure the public that those who have such concerns are not far right. They are parents, they are carers, who are invested in protecting the innocence of children, as is their right. I would expect every parent to do that with zest and enthusiasm, as they have a commitment to protect their children. The fact that freedom of speech allows those people to be called far right shows how far wrong we have gone.

The threat from extremism has been growing for many years, and what has been described as the pervasiveness of extremist ideology in the aftermath of the terrorist attacks on Israel on 7 October 2023 has highlighted the need for further action. At the outbreak of the Israel-Palestine conflict, I received calls and emails to my office about an incident that occurred at the city hall in Belfast. I remember it well. I reported it to the police; I was on to the police on a number of occasions about it. I say this because it is an example of how evil and wicked some people are in their intentions. There were pictures and videos going around on social media of Lasair Dhearg activists—those of a nationalist opinion—projecting on to city hall an image of Hamas fighters paragliding into Israel, alongside the words “smash the Zionists”. I think it was wrong, and I made a number of complaints about it. I contacted the Police Service of Northern Ireland to ensure that they took action to detain those involved and ensure that those who displayed those inflammatory comments on Queen’s University, the city hall in Belfast and other places were held accountable for their actions.

Some people displayed on the city hall the statement “From the river to the sea”. We all know what that means. That means death to Jewish people—death to Israeli people. That, I believe, is inflammatory; I believe that the police needed to take action. To be fair, the police did immediately take action, but the fact that it was allowed to happen in the first place—to the annoyance, the anger of many of my constituents who were in Belfast doing their shopping, and other people from my party as well—was outrageous.

I raised that issue with the PSNI, and a section of the Jewish community contacted local representatives stating that the antisemitic language frightened them. So that is the society we have. When the hon. Gentleman brought forward the debate, he did so for a purpose: to factually and evidentially record the things that are happening. I have recorded those two things because I think it is important from the point of view of how my constituents feel.

To conclude, those are just a few examples of how democratic resilience can be improved—yes, it can be improved—and how we can improve social cohesion to ensure that people feel protected within their communities. I look to the Minister, who is a genuine man and who has the same impression as the rest of us, to try to make people’s lives better and to have a society where we can live together in such a way that we do not have to fight or be antagonised. I look to him for the reassurance that he will do his best, as I know he will, to ensure that all forms of rational and respectable opinion are upheld within society. I look forward to the contributions by the shadow Minister, the hon. Member for Blaydon, who is a dear friend of mine—she knows that—and others to the debate.

14:50

[Jack Brereton (Stoke-on-Trent South) (Con)]

It is a pleasure to serve with you in the Chair, Sir Mark, and to follow the hon. Member for Strangford (Jim Shannon). I warmly congratulate my hon. Friend and city colleague the Member for Stoke-on-Trent North (Jonathan Gullis) on securing this important debate.

The Khan review is welcome, and we can all be grateful to Dame Sara Khan for the considered work she has done. I am grateful to her for taking the time to visit Stoke-on-Trent and speak with community groups and various organisations in our city. Also, she has spent a considerable amount of time meeting MPs, including myself, for which I am grateful. She has helped shine a light on some of the serious challenges we face around social cohesion and countering extremism. There is much to agree with in her report and much to support in her recommendations, but there are also points that need to be raised and highlighted for the sake of further clarity, and that is what I intend to do in my remarks.

I echo my hon. Friend’s words about the foolhardy cessation of funding for Prevent and its work in our city of Stoke-on-Trent. That followed the previous removal of counter-extremism support. The report makes it clear that:

“Without such support, places like Stoke fall through the gaps despite the permissive extremism environment and harm it is causing to the city.”

It is not nice to have to say that our city still needs the close attention of Prevent. It would be wonderful to say that Prevent’s job was done and dusted, but the reality is that there are those in the city who reject our liberal, western, democratic values. Worst of all, there are those who have been prepared to act on their hatred by engaging in, or attempting to engage in, murderous terror. I am very concerned about the robustness of the decisions taken by the Home Office and how it is prioritising resources across the country.

Sadly, we have seen both Islamic extremism and far-right extremism in Stoke-on-Trent. Hizb ut-Tahrir and al-Muhajiroun have been active in some communities in Stoke-on-Trent, radicalising young people and attempting to spread their perverse view of religion. That is why it is welcome to see the Government take action recently to proscribe Hizb ut-Tahrir, and I hope they will continue to closely monitor those who are now seeking to get around the proscription and continuing such activities under another guise.

There is also a history in the city of far-right activism, with the BNP, the English Defence League and a number of other organisations that my hon. Friend mentioned, which has in some cases resulted in the permeation of more serious radicalisation. In 2010, we saw attempts to blow up the City Central Mosque. Fortunately, those attempts were stopped, but that demonstrates an undercurrent of extremism that the far right has propagated.

Concerningly, we have seen attempts from extremist groups to undermine and control our democratic systems. Cases have been reported of Islamic extremists attempting to discourage participation and interfere with elections. With the far right, as my hon. Friend mentioned, we saw the BNP get up to nine councillors in 2008-9. The reason for their electoral success was their exploiting the political vacuum left by a declining Labour party. Many hundreds, indeed thousands, of voters in Stoke-on-Trent felt that voting BNP was the only way to make the main political parties listen to those voters’ mainstream concerns. Of course, the BNP was only too keen to take advantage of that situation. Our city felt forgotten and left behind. People felt that they were being told they were wrong to be proud to be British. They felt that a metropolitan and globalist London elite was sneering at traditional working-class communities. I am glad to say that we have won those voters back to mainstream politics, and we must keep those voters with mainstream concerns within mainstream politics.

I know that Dame Sara has expressed concern about the mainstreaming of extremism. There are concerns that engaging with extremist groups or individuals gives them legitimacy. She also highlighted a number of serious concerns about freedom-restricting harassment. It is particularly concerning that the report suggests that this problem is getting worse, stating that 60% of people feel that the problem is worse than it was five years ago.

I would like also to see more of a focus on what, for want of a better turn of phrase, I am going to call “extreming of the mainstream”. This is something that my hon. Friend the Member for Strangford, I think, was touching on, where we see the alienation of hard-working, patriotic communities. It is not extreme to want to hear “Rule, Britannia” at the Last Night of the Proms, or to sing it when and wherever you like in the UK. It is not extreme to fly the St George’s cross or to have an England flag tattoo. Rather, it is extreme to want to ban “Rule, Britannia”. It is extreme to want to ban the flag of England. And yet we all know that there are attempts to chip, chip away at our shared icons, heroes and ways of life.

The same can be said for religion. It should not be considered extreme to have strongly held religious beliefs, whether Christian, Muslim or of any other religion. Most faith is about peace, tolerance and respecting others. We have often seen faith communities throughout north Staffordshire come together in the toughest of times, when this cohesion is challenged, resisting fundamentalists and calling out those who attempt to cause and sow division.

I am glad that the Cass report has also brought public debate about life-altering medical interventions for minors back to the mainstream place of sanity and biological objectivity. It was beyond bizarre that it took legal action to determine that Maya Forstater was worthy of respect in a democratic society for her perfectly mainstream recognition of biological reality. That is an area in which I would like further clarity. The Secretary of State for Levelling Up, Housing and Communities has already said that of course “gender-critical” and, indeed, non-voluntary trans activist voices would not be affected by the definition of extremism. However, if a new body is created to report back on extremism annually, and to promote cohesion and so on, what is to stop that body becoming another national institution that is captured by those with extreme views of their own, which it wants to present and push as being mainstream and anti-hate? I hope we can hear how that will be safeguarded against.

As my hon. Friend the Member for Stoke-on-Trent North said, the UK is one of the most open, multicultural and freedom-loving countries in the world. The rule of law, religious freedom and free speech are some of our core democratic British values. However, we cannot take these values for granted, especially at a time when we see these values under increasing threat around the world. Democracy is fragile. We must redouble our efforts to protect our shared values and democratic rights, and we must see robust action against those who threaten to undermine or suppress our way of life—something I have made very clear to Staffordshire police and others.

In conclusion, I welcome the important review and I look forward to hearing further from the Minister how the next steps will be taken. We must be wary of extremes, particularly those that bring violence with them, and we must also be wary of attempts to paint the mainstream as extreme, because doing so pushes mainstream voters into the arms of extremists.

14:59

[Naz Shah (Bradford West) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Mark. I congratulate the hon. Member on Stoke-on-Trent North (Jonathan Gullis) for securing this important debate.

Our democracy faces significant challenges threatening social cohesion and wellbeing, with the rise of extremes on all sides, as the hon. Member for Stoke-on-Trent South (Jack Brereton) outlined. The rampant spread of dangerous conspiracy theories and disinformation, alongside unregulated technological advances in artificial intelligence, pose a direct threat to our democratic ability and stability. Additionally, as we have seen in more recent times, politics and politicians at large, across the globe, have utilised populism to boost their own political gains at the expense of minority communities and those on the receiving end of their political attacks.

The Khan review uncovers a phenomenon of freedom-restricting harassment, where individuals are coerced into self-censorship through abuse and intimidation. That harassment is reported as suppressing the freedom of expression of individuals. Eighty-five per cent of the public acknowledge its presence in the UK and 60% perceive it to be worsening over the years. The report highlights a link between the erosion of democratic resilience and the absence of a national strategic framework.

The recommendations in the report for protecting victims of harassment and incitement are welcome and to be encouraged, as is the recommendation for a new independent office for social cohesion that genuinely works, in good faith, to balance the rights and freedoms of all with the need for social cohesion across the United Kingdom. In addition, schools should be safe havens for learning, free from intimidation. I therefore also support the review’s proposal for buffer zones around schools, to curb protests and provide support for staff and students. However, while aspects of the report are welcome, it completely ignores the role that the Government are playing in breaking down social cohesion in this country.

The recent statement by the Secretary of State, Michael Gove, on a proposed new definition of extremism is concerning, particularly due to the approach that he presents, which targets Muslim groups. On one hand, the Government acknowledge there is a problem with social cohesion and people policing their ideas and opinions. On the other hand, we have a Secretary of State targeting Muslim organisations and dangerously labelling them as extremists without an evidence-based approach or any right to appeal.

In addition, the Secretary of State fuelled speculation in the media that he would label the Muslim Council of Britain as an extremist organisation. He also took away funding from the Inter Faith Network and its work because a member of tits board was linked to the Muslim Council of Britain. The irony is that an interfaith charity that champions the work of social cohesion had to close down because the Government ended its funding—the same Government who acknowledge we have an issue with social cohesion.

It gets worse. The Secretary of State for Science, Innovation and Technology used her position to target a professor over her support for Palestine by wrongfully accusing her of extremism. The result was the taxpayer footing a bill for £34,000 to pay for the price of the right hon. Lady’s libellous attack. Let us not forget that a former Home Secretary tried to silence hundreds of thousands of genuine people demonstrating for a ceasefire in Palestine by labelling the protests as “hate marches”.

Do the Government want to be part of a solution, fixing social cohesion, or part of the problem? The evidence is stacked on the latter. It is difficult to look at top Conservative figures today and not find someone who is actively working to damage social cohesion in this country. Seriously—how can we advocate for social cohesion in the UK with Susan Hall as the Conservative candidate for Mayor of London? The Conservative nominee for Mayor of London embodies a hard-right politics profoundly disconnected from the essence of London, its diversity and its values. She endorses Donald Trump, Boris Johnson and Suella Braverman. She perceives London’s diversity as a weakness. Susan Hall spouts Islamophobic tropes that have stirred up division and hatred against Muslims. She likes tweets about Enoch Powell, and a tweet by Katie Hopkins describing Sadiq Khan as “the Mayor of Londonistan”.

Susan Hall is actively involved in Facebook groups sharing antisemitic, white supremacist content and racially charged threats against Sadiq Khan. That is the Tory mayoral candidate for London. The election is only a few days away, yet the Government want to lecture people on social cohesions and the impact it has on society, and the Tory candidate for London epitomises the very definition of divisiveness.

I am a proud Bradfordian, a proud Muslim, and a proud Member of the British Parliament. When we talk about community cohesion, there are vulnerabilities that Dame Sara Khan references—the issues of job security, and the issues that make communities feel threatened, and people feel otherised. These issues require people to know that they matter, that they belong, and that people care. Instead, what we have is senior people like the former Home Secretary and the former Prime Minister who compared women to letterboxes and other things. As a result of his column, there has been a 335% increase in attacks against Muslims. I associate myself with the comments that the hon. Member for Stoke-on-Trent North made about antisemitism, but I add to that the increase in Islamophobia. That is led right from the top.

When we are elected, we as politicians are expected to lead with authenticity, with congruence, with leadership that unites people. The definition of cohesion is sticking together, working together, tackling problems, and mutual support for positive futures. That is the definition of community cohesion, but is that the rhetoric we get from the Tory Benches? No, it is not. The Government need to understand the role they have played to get to the point where this report was even needed. I have been in this House since 2015— I just started my 10th year —and it is a slippery slope every year, pandering to hard-right narratives, with Members of Parliament having to apologise to the Leader of the Opposition because they have retweeted far-right conspiracies.

I get it—I completely get it. I understand why MPs ask whether a career in politics is worth it, because of the abuse we get. People are stepping down in this place, but that did not start on 7 October, and the conversation about the ceasefire—that started when Brexit was happening. That started when people in this place and the media were perpetuating headlines about people being traitors, and there was no response from the Government then. There was no condemnation then, when all those things were happening, yet here we are, with this whole review, and the Minister will stand up and say how committed the Government are, when they cannot tackle the rot from their own Front Benchers to temper their language or epitomise leadership, walk the walk and show what it looks like to lead. We certainly have not had that from the Government.

I will simply finish on this. It is not just about the issue of the mayoral election going on in London right now. Social cohesion is imperative for Great Britain, but that means leadership, and calling out people like the former Prime Minister who rubbed shoulders in America with Steve Bannon, who said, “Tommy Robinson is our hero”. Tommy Robinson is putting out videos of him fixing his tie in the House of Lords—people like that, entertained in our Palaces! That is why we have to fix social cohesion. The message comes right from the top, from the media, and from social media platforms. I am afraid that this Government certainly do not do that. It is important that the Government learn the lesson, lead by example, and do not preach something that they do not practise themselves.

[Sir Mark Hendrick (in the Chair)]

Thank you. Before I bring in the Front Bench spokespeople, I remind Members that referring to other Members by name is not correct. They should use their title, ministerial positions or whatever role they occupy in the House.

15:09

[Liz Twist (Blaydon) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Mark, and I thank the hon. Member for Stoke-on-Trent North (Jonathan Gullis) for securing this important debate.

Dame Sara Khan’s report does not make for easy reading, but it is vital that we tackle extremism and radicalisation head on. I hope the Government will take this opportunity to reflect, and to consider how we can work constructively to build more cohesive, resilient communities. At its heart, this is about how we as a society live well together. It is not only a matter of security, but a matter of public health, and speaks to our fundamental wellbeing.

I thank all those who have contributed to the debate. We heard from the hon. Member for Stoke-on-Trent North (Jonathan Gullis), who talked about the importance of the review; from the hon. Member for Strangford (Jim Shannon), who looked the experience of his own constituency, and talked about the importance of democratic resilience and social cohesion; and from the hon. Member for Stoke-on-Trent South (Jack Brereton), who also talked about the Khan report and the situation in his constituency. Finally, we heard a very spirited speech from my hon. Friend the Member for Bradford West (Naz Shah), who talked about the importance of language and how people speak about things, as well as the need for a national strategy. She also discussed Islamophobia, and, in a very passionate speech, said that the Government needed to walk the walk.

To say that this has been a challenging period for our communities would be an understatement. We continue to see the impact of the ongoing conflict in Gaza on community relations. Meanwhile people are finding it tough to make ends meet, and our public services have been struggling. The Khan review’s position on this point is clear: these difficulties risk undermining our social contract, fuelling disillusionment with our democratic system, and allowing extremism, disinformation, and conspiracy theories to take root. The House can, and should, work together to tackle these serious issues, and the Minister can be assured that my party is ready and willing to engage in good faith with these discussions. We are here to represent our constituents, and we should come together to reject extremists who seek to undermine these efforts.

That involves recognising the shortcomings in the Government’s work on this to date. As the Khan review clearly outlines, those shortcomings have left local authorities to deal with the fallout following the most challenging incidents of community conflict. We must remember that it is councils that are dealing with these issues on the frontline, whether that is fulfilling their statutory duties by organising community safety partnerships and safeguarding boards, or developing more bespoke partnerships in response to local issues. The unprecedented levels of demand that councils currently work with have made it more difficult to carry out the broader upstream work that is desperately needed.

Meanwhile many councillors face appalling levels of abuse and harassment simply for serving their communities. We heard about the impact on Members of Parliament, too, as they go about their work, and how sadly, in two cases, Members have lost their lives. It is imperative that central Government work as a supportive partner with local government on this, providing the space for local authorities and other agencies to come together to share best practice. The reality, as Khan says, is that

“there is no strategic approach within Whitehall’s machinery to deal with these threats to social cohesion and our country’s democratic resilience.”

We have had review after review, and still no sense of where tensions are, how to prevent them, or how to rebuild after conflict. The constant political turbulence certainly has not helped matters. The integrated communities action plan has had some success, but of 70 commitments listed in it, just 14 have been delivered. We were told that the cross-ministerial group responsible would meet every six months, but in the end, it met only once. This is part of a wider pattern: we are still waiting for an update on the hate crimes strategy, promised in 2020, and it seems that the anti-Muslim hatred working group and the antisemitism working group are no longer meeting. I hope that Sara Khan’s review gives the Government an opportunity to refocus and demonstrate the political will needed to make lasting preventive change. Actions speak louder than words. We need to see that this is made a priority.

The review also invokes the Government’s record on housing asylum seekers and the Home Office’s failure to communicate effectively with local authorities before placing asylum seekers in their areas. Shockingly, some local authorities told the reviewer that far-right groups knew about local asylum hotels before they did. We desperately need a new approach, which has to include new strategies on counter-extremism and community cohesion. The Secretary of State has said that the Government will be publishing a more detailed action plan, which will include funding commitments to support organisations on the ground working to build community resilience. I look forward to hearing about the progress made on that, but in the meantime, I want to ask the Minister the following questions.

First, the review is clear that we must take a more proactive approach to community cohesion. That includes learning more about what makes local areas particularly vulnerable or resilient to extremism. Will the Minister say what his Department is doing to address those knowledge gaps? The recruitment of a new Islamophobia adviser continues to be in doubt. Will the Minister shed some light on any progress made on that issue?

Technological innovations have created further challenges in maintaining cohesive communities. What steps is the Minister’s Department taking to tackle new forms of radicalisation, including radicalisation that takes place online? The tensions that we are currently seeing are playing out at all levels of our society, including in our classrooms. What discussions has the Minister had with colleagues in the Department for Education about providing the support that teachers need to manage difficult conversations? Finally, can he tell us whether the Government have given up on refreshing the hate crime action plan?

Social cohesion is not a “nice to have”. If we do not show leadership and support local authorities to address concerns within their communities, extremists will fill the void. We must start thinking about how we approach proper preventive work that engages communities, rather than waiting for flashpoints to occur. I hope we can work together on these most fundamental issues.

15:18

[The Minister for Housing, Planning and Building Safety (Lee Rowley)]

It is a pleasure to serve under your chairmanship, Sir Mark. I begin by thanking all hon. Members. In particular, I thank my hon. Friend the Member for Stoke-on-Trent North (Jonathan Gullis) for securing the debate, for opening it in such a temperate and balanced fashion, and for asking some immensely reasonable questions relating to his own community and, more broadly, the importance that we all attach to ensuring that social cohesion is strengthened across the country and that we make progress on this hugely important agenda.

The first thing to say is that the battle against extremism and the rise of extremist ideology across our country is something that everyone here cares passionately about, as all hon. Members who have spoken today have articulated. In particular, my hon. Friend the Member for Stoke-on-Trent North powerfully underlined in his opening speech the need to counter the spread of extremist beliefs among young people in our schools, the importance of confronting issues when young people fall victim, the importance of the Prevent programme to ensure that communities are cohesive and strengthened and, more broadly, the importance that, as a Government and a country, we must attach to making progress on these hugely important issues over time.

That is one of the reasons why we commissioned the Khan review, why we gave Dame Sara Khan the space, the time and the support to look at these matters in the round, and why we welcomed the publication of her report a number of weeks ago. She was charged with examining these issues in greater depth, to investigate the scale, the causes and the impact of extremism in local communities, and to provide insights into how we can build resilience to better support those involved, local authorities and civil society.

As a number of Members have said, the report outlined some of the challenges we face, not because of decisions that the Government have made—I will come back to the point that the hon. Member for Bradford West (Naz Shah) made in a moment—but, if we are going to have a mature debate about this, because of long-term issues that are impacting western democracies across the world and will impact this democracy whoever is in power. As a consequence, the hon. Lady should be careful about some of the statements that she makes. Those who seriously want to make progress will deal with the issues in front of them rather than calling others who are involved in the conversation names.

The report highlighted particular issues around disinformation, harassment and intimidation; the climate of self-censorship that hon. Members have outlined, not just among people in this place or associated with politics, but across all walks of life; a wider disillusionment with democracy that is starting to seep into parts of our civic society; and decreasing trust in politics, particularly among the young. All of that aggregates to create a vacuum that extremism and extremist ideology can fill.

The Government very much welcome Dame Sara Khan’s work and we thank her for it. We wholeheartedly agree that democracy is a precious asset. That is a view that all of us in this place—right hon. and hon. Members who have the privilege of representing communities up and down the land in Parliament—would share.

The report shines a light on some fundamental gaps in our system, and it clearly sets out Dame Sara’s view of what the Government should do to address those flaws. As has been articulated, my right hon. Friend the Secretary of State for Levelling Up, Housing and Communities recently set out measures that will ensure that the Government do not inadvertently provide a platform to those who want to subvert our democracy and deny other people’s fundamental rights. That is just the first of a series of steps the Government will take in the coming weeks and months to tackle extremism and protect our democracy, including the publication of a full response to the Khan review before the summer break. While I am not able to go into the details at this stage, we have committed to publishing a response to the review in the weeks ahead.

I want to turn to some of the individual points that hon. Members have made. My hon. Friend the Member for Stoke-on-Trent North raised a number of hugely important points about the need to ensure cohesion, and drew upon the experience that he and his colleagues in Stoke-on-Trent have over the long term. I wholeheartedly endorse many of those points.

My hon. Friend has a specific concern with regard to Prevent funding. He will be aware that I am unable to speak absolutely about Prevent funding from the perspective of the Department that I represent, but he indicated that he has written to the Home Office, and I will certainly make sure that, yet again, those points are telegraphed to my equivalents in the Home Office. I recognise that he and my hon. Friend the Member for Stoke-on-Trent South (Jack Brereton), and those involved in Stoke-on-Trent politics in general, feel very strongly about that.

I understand that part of the restructuring of the Prevent funding was about regionalising some elements of the funding, and there are still elements of the support that are available to all local authorities. I understand—at least from the notes that I have been given, accepting that I am not the lead for Prevent—that Stoke-on-Trent City Council may not have taken advantage of all the support that is available. I know that my hon. Friends will make sure that the council does that if it has not done so already, recognising the very valid points that they made.

My hon. Friend the Member for Stoke-on-Trent South outlined in even more detail the very long-term challenges that were created with the rise of some of these extremist ideologies in his home town, the time and effort that it took to try to beat those back, and all the work that was done to do so. He rightly highlighted the importance of giving space to very mainstream views that are shared in places such as Stoke-on-Trent, Bradford, the north-east and definitely in my part of Derbyshire. We must not suggest that it is illegitimate to be proud of this country and to celebrate its history, its culture, its institutions, its norms and representations of it. Those who over the past 20 years have tried to diminish those things, remove them and pretend they did not happen—those who suggest they are old-fashioned and have no place in our society—are absolutely wrong and do nothing for community cohesion. They do nothing to build the strength and tolerance that our country has thrived on for many decades.

My hon. Friend the Member for Stoke-on-Trent South is absolutely right: like many others, I may not choose to go to the Proms or to indulge in “Rule, Britannia”, but it is vital that we have a shared understanding of the norms, culture, history, traditions and identity that we share in this country, which have brought us to the place we are today. We should be immensely proud of that.

My hon. Friend highlighted some of the read-overs to other areas. Fundamentally, there is an ideology—postmodernism—that has seeped out of our universities over the past 50 years, and which seeks to dismantle the nation state as a concept. There is absolutely no underpinning logic to it; it is essentially a play—a game, an attempt to twist things—and it does not actually help us build communities. It does not seek to build things up; it seeks only to tear down institutions that have worked so well for centuries on end, and to eliminate the concept of the nation state.

Too many people in this place and elsewhere do not understand the incredibly nefarious effect that postmodernism will have on our society if we are not clear about it. That ideology seeps out of universities, moves into our institutions and infects parts of our public sector, and then moves out into civil society as a whole. It explicitly encourages people to have no shared understanding of our history—it effectively wishes to abolish history—to have no shared lexicon and to play with words to such an extent that reality is completely subverted because we say something is one thing on one day and then pretend it is something else on another. There are entirely arbitrary rules underpinning it, which change based upon the fashion, whoever shouts the loudest, and the time of the day and the day of the week. That is an ideology that will fail, and if we allow it to infect our institutions, our civil society and the work we do in this place and elsewhere, our country will be much weaker, poorer and less able to build the kind of cohesive society that we want.

My hon. Friend is absolutely right: we have not had a discussion in this place or elsewhere about what we must do. When people play with the building blocks of civic society, words, institutions, basic concepts and shared endeavour, how can we build the kind of cohesive society that we want? Whether it is expressed in a temperate way, like my hon. Friends the Members for Stoke-on-Trent North and for Stoke-on-Trent South did, or in a more emotive way, like the hon. Member for Bradford West did, we have a shared endeavour, but postmodernism absolutely prevents that from happening. We should call it out, stop it and say it has no place in our country and our academic and civil institutions, because it will fail and will lead to a less cohesive society.

[Naz Shah]

I was just thinking about the Minister’s warning that I should be careful. I am just trying to work this out. There is this idea that we should have a shared history, but we are not teaching our history in its entirety to our children. We are not talking about togetherness. The Minister might want to read the lecture by the first Muslim Cabinet member, the former Tory chairwoman, Baroness Warsi, who talked about the idea that Muslims do not matter. Does the Minister agree that, if we want a cohesive society, language is key, and the message has to come right from the top in 10 Downing Street? Muslims must not be otherised. Does he not include Muslims in that conversation, because it certainly feels like that?

[Lee Rowley]

I am grateful to the hon. Lady, because she articulates yet again the care that is required in language and assertions, which has been sadly absent from her contributions to the debate, both a moment ago and previously. Of course Muslims matter. Of course people of all faiths matter. It is frankly outrageous that there is a suggestion that that is not the case. Of course they matter.

Those of us who are trying to build a cohesive society—an endeavour that I know the hon. Member for Bradford West shares—believe that such statements should not be made. They send a message to people who are listening today that, for some reason, there is some kind of fundamental difference and that those of us who have the privilege to sit in this place do not believe in cohesion and want to separate people out on the basis of the skin or the religion they have, and that is fundamentally untrue.

What I find most offensive, most outrageous and most egregious in this culture of grievance that is perpetuated by comments such as the ones put forward a moment ago is the separation of people within our community into backgrounds or experiences or skin colour.

[Naz Shah]

Will the Minister give way?

[Lee Rowley]

No, I will not give way.

[Sir Mark Hendrick (in the Chair)]

Order. The Minister talks about being temperate and using temperate language. Could I please remind him to observe that when he makes his comments?

[Lee Rowley]

With absolute pleasure, Sir Mark. I absolutely intend to do so. As has been outlined, my concern is that it is important that we are very clear and very careful about the language we use, which I have sought to be, and about suggestions as to the motivations of others, which I have sought to be. Equally, it is important that we are robust about calling out cases where that care is not taken. All of us have a responsibility in this place and elsewhere to utilise the best and most careful language, assertions and arguments. Today has been an indication of where that is not occurring in places, and I will come on to that more in a moment.

[Naz Shah]

Will the Minister give way?

[Lee Rowley]

I will make some more progress before doing that.

The hon. Member for Strangford (Jim Shannon) raised a number of important points and made some very strong points about social media. We are all dealing with our interaction with social media, its importance now and its pervasiveness in daily life, as well as with the opportunities and challenges it brings as a whole. The reality is that social media is entirely embedded in our daily lives, in the way it was not even a few decades ago when I was growing up. The situation is extremely different, most obviously for children, who are having to learn how to deal with it as they grow up, but also across society as a whole. That is something we will have to grapple with for the rest of our lives, and it will not be immediately clear for many years exactly what that means. We are all going to have to learn, and to take things extremely carefully, as we try to understand how we ensure that social media is embedded in our life in a way that accentuates the positives and minimises the negatives.

The hon. Member for Strangford also talked about the challenges of cynicism about democracy, and I accept that point as well. From my personal perspective, one of the challenges in recent years is that there has been a baselining of issues in our country that we actually need to debate much more often. The rights that people talk about quite freely—often too freely in many instances—which I support, and which I know everybody in this place and beyond supports, do not just appear; they are not guaranteed.

[Naz Shah]

Will the Minister give way?

[Lee Rowley]

I will give way in a moment. Those rights are hard won and hard fought for—people have died for them—and we must continually repeat and confirm that in order to ensure that people recognise that these rights are not automatic. All of us involved in politics and the political process have work to do. The situation we are in, including the relatively benign environment we have grown up in, and our right, when we go home to our respective communities, to have the kind of debates and discussions we want, need to be nurtured. If they are not, they wither on the vine; they ossify, and they do not work. We cannot get away from this principle—this indulgence—that if we do not accept that all of that is built on the concept of the nation state, the United Kingdom and the values our country has, ultimately it will not work in the long run.

[Naz Shah]

I am grateful to the Minister for giving way. He is right, and everybody has that right, including me. I represent the great people of Bradford West, and 60% of my constituency is Muslim, as I myself am. I find it really offensive that the Minister is offended that I am stating facts. I am demonstrating that the Government are not walking the walk when delivering on their so-called cohesion policies or their so-called attempts to deliver equality. In fact, I am even more offended at any suggestion that my interventions are about a grievance narrative, when they are actually all about Muslims just wanting equality. We are not talking about special treatment; nobody in my constituency wants special treatment. What they do want—will the Minister give it and agree?—is equality.

[Sir Mark Hendrick (in the Chair)]

Order. Interventions are meant to be short.

[Lee Rowley]

I thank the hon. Lady, who makes some of my case for me. However, turning to her comments, I agree with some of what she says. It is important that we build a shared understanding and a shared set of values in this country. I agree that we should be temperate with language. Where she has called out inappropriate behaviour—I do not agree with all her points—I accept that no party is perfect. I accept that some of my colleagues will have made mistakes. I accept that some words have been looser than they should have been.

However, I hope the hon. Lady will accept that that is not limited to my party or to the Government—there have been multiple examples. However, if we just trade off on the basis of who said what where, or make some kind of case that one political party is worse than the other, when we know that they have all had significant issues with community relations over many years—only one party got into the place it did with regard to antisemitism a number of years ago—we will be much poorer in the debate about this issue.

The hon. Member for Bradford West referenced facts, and I am happy to talk about some of the challenges around the facts she provided a moment ago. She knows that the Inter Faith Network’s funding was withdrawn because of a decision to appoint somebody who had a background in a particular organisation—that was a choice that the organisation made, and it appointed that person. The policy of non-engagement with the Muslim Council of Britain has been in place since the Labour party was in power. Indeed, it was the former Labour Member for Salford—the Secretary of State in the predecessor to my Department—who started that policy of non-engagement with the Muslim Council of Britain in 2009, which my party continues to this day. It is perfectly logical to extend a policy that was introduced and endorsed by the Labour party, on the basis of logic put forward by the Labour party, because of the challenges that we now have. The hon. Member for Bradford West shakes her head, but those are the facts on the assertion that she made.

[Liz Twist]

Will the Minister give way?

[Lee Rowley]

I am afraid I will make progress. I have given way a number of times.

The hon. Member for Bradford West made a number of comments about populism and raised a number of concerns about extremism and its definition. When she next speaks in debates like this, she needs to define the specific issues she has with the definition of extremism, because that was not part of her speech when we strip back all the criticisms about individuals. We can always have a robust debate, but if we want to have a mature one, which the hon. Lady claims she does, it would be better to focus on concerns about the specific definitions the Government are trying to bring forward, and what they do and do not achieve, as opposed to spending much more time talking about individuals.

I will probably leave it there. I have many more things I could say about the hon. Lady’s speech, but maybe it is better to deal with those in another forum at another time. I will just say that I do not agree with much of her speech, and I hope that, in time, she will reflect on many of the points that were made.

Putting aside some of the challenges mentioned in Members’ speeches, and what was contained in at least one of them, I think today has shown that all of us feel extremely passionately about ensuring that we build a society that is cohesive and resilient for the long run, and about seeking to utilise what the Government can do to move forward the things we see in our individual communities, whether that be Stoke-on-Trent, Blaydon, North East Derbyshire, Bradford, Strangford—the hon. Member for Strangford is no longer in his place— or elsewhere. We also want to identify the issues that we need to deal with in the years ahead, which is exactly what the commissioning of the Khan review sought to do.

Despite the robustness of the debate, and despite my fundamental disagreements with some of the points that were made, I think it has been a useful debate and a good debate. Again, I am grateful to my hon. Friend the Member for Stoke-on-Trent North for giving us the opportunity and space to have the debate, and I am glad that he and my hon. Friend the Member for Stoke-on-Trent South have had the opportunity to raise specific they are concerned about within their great city. I hope that such robust debates—next time, the language will hopefully be slightly more cautious and temperate—highlight the interest and need of everybody, wherever we sit on the political spectrum, in terms of getting this matter right and making progress for the long run, which is something we all want to achieve.

[Sir Mark Hendrick (in the Chair)]

I call Jonathan Gullis to wind up the debate.

15:40

[Jonathan Gullis]

Thank you, Sir Mark. I thank all Members who took part in this important debate, and I thank the Minister for his words and reflections, particularly on the Prevent funding for Stoke-on-Trent, and for saying that he will pass on our comments to the Home Office. My hon. Friend the Member for Stoke-on-Trent South (Jack Brereton) and I will continue to push for that additional uplift, to make sure that we can retain that important service.

I want to reflect on a few of the things that have been said. First, the hon. Member for Strangford (Jim Shannon), who is no longer in his place, should rightly be horrified to antisemitic tropes, words and images projected on to buildings in Belfast, as we sadly saw happen here on Elizabeth Tower. It is completely abhorrent that that kind of thing is taking place, and the police must crack down on it.

I visited the hon. Gentleman’s constituency—in fact, I gave a talk to members of his party, as well as to the wider community—and it was great to be surrounded not only by passionate patriots and Unionists, but by members of the community who have lived side by side. They may have different religious or nationalistic views, but they have ultimately grown up side by side as neighbours, friends and colleagues, and I am immensely proud to see the way that that country has moved forward.

My own stepmother, Janet Harbison, set up the Belfast Harp Orchestra, and a member of her family was once an Irish nationalist Member of this Parliament—as you can imagine, our dinner table can be quite interesting at times. She wanted to take part in the peace process by using culture as a way of bringing the community together, and she faced death threats from the IRA, despite coming from the Republic of Ireland and despite her family’s recent history of representing people wanting a united Ireland at that stage. Even she was targeted, with people sending her images of her younger sister, alongside death threats, letting her know that they knew where her family lived. That was truly shocking.

When Janet married my father, who is half-Irish and half-English by birth, they were targeted with abuse and threats; bomb threats were literally made against them, which saddens me to my core to this day. That meant that I was not able to visit my father as much as I wanted to, purely for my own safety. Rightly, my mother and stepfather, and my father and stepmother, wanted to make sure that I was safe.

That shows how far the country has now come, which is why what happened in Belfast is so sad. To see such things being played out again—although in a different guise, using what is happening the middle east as a background—is very sad indeed for a community that has been divided on the basis of birth or religion.

I commend my hon. Friend the Member for Stoke-on-Trent South, who is fellow Stokie, although I am obviously an import—my accent gives it away—while he is from there by birth and by breeding. In fact, “Brereton” is all over the bloody roads and in the names of streets, because my hon. Friend’s family were responsible for building many of them in the not-too-distant past. It is great to see him standing up again for the community that we serve, and he is right to do so.

I am proud to wear or wave the St George’s flag, as I am the Union flag. I am proud to say that I am British and English. I am proud to sing “Three lions on a shirt” as much as I am to sing “Rule, Britannia”, which will not come as a shock to the Minister. I am proud to stand shoulder to shoulder with many fine patriots across our great community of Stoke-on-Trent North, Kidsgrove and Talke, 73% of whom voted to leave the European Union in the 2016 Brexit referendum. I appreciate that there were unfair comments, and the hon. Member for Bradford West (Naz Shah) talked about people being called “traitors” in this place. I was not in this place at the time, but I of course entirely understand that it would have been completely inappropriate to refer to people in that way.

It is important to understand that there was a groundswell of anger among the public, including people like myself, who voted to leave and who campaigned to leave the European Union. We felt that this place was, sadly, not hearing or representing those views and that others in this place—not the hon. Lady but others, who are no longer here—were pushing the idea that people were somehow thick, uneducated or racist in wanting to see that democratic right delivered. That fed into some of those far-right extremist groups, which were able to proliferate off the back of that.

It has taken a long time to rebuild that trust. These things led to an undermining of our democratic system, which is why 42% of people still chose not to cast a vote in the 2019 general election. That is very sad indeed and was used by groups such as Hizb ut-Tahrir, which actually encouraged people not to take part in the democratic process—sadly, in this case, the Muslim community, in particular.

It is very important that we use the opportunity we have in this place. I taught religious education for eight years in secondary state schools across Birmingham and London, and Islam is a religion of peace. It is stated very clearly that to take one life is effectively to take the lives of all humankind. It is therefore entirely appropriate to make it abundantly clear to extremist groups—those on the far right, but also those in the Islamic community that pursue a twisted perversion of what Islam is actually about—that that is simply wrong and abhorrent. The word “jihad”, which is sadly now used in terrorist atrocities, actually has a very different meaning—that if, God forbid, holy war is required, innocent women and children of all races and faiths are to be left aside, and all religions are to be left in peace. Ultimately, it is only done in the defence of one’s faith—

[Sir Mark Hendrick (in the Chair)]

Order. Could the hon. Member wind up his speech, rather than start another debate on a related subject?

[Jonathan Gullis]

I do apologise, Sir Mark. I appreciate the point. As I say, I wanted to make sure that I use this opportunity, because as Members of this place, our words carry a lot of importance. I represent a large Pakistani and Muslim community, and given the recent tensions around what has unfolded in the middle east, its members may feel that I do not advocate their particular view as much as they would like me to. I want to let them know that I do, and I will always stand up for the positive nature of that community and what it has done. Indeed, for the first time in Tunstall, we have seen the election of a member of the Pakistani-British community, Councillor Tabrase Din, who is doing great work on trying to make our streets safer and tackling the backlash in recent times, particularly around extremism.

The hon. Member for Bradford West made an impassioned speech. I would just remind her that political parties across this House have people in them who have done very silly things, and he who is without sin may cast the first stone. I remind her that it was, sadly, the Labour party that was found to have breached or undermined the human rights of those in the Jewish community, in particular. I saw that with my predecessor, Baroness Anderson of Stoke-on-Trent, who suffered tremendous antisemitism at the hands of extremists, who had, sadly, proliferated in her party. I commend the fact that the Leader of the Opposition has done a lot of work to try to drive that out, despite what we saw recently in the Rochdale by-election.

No party can sit here and say that all its members have been perfect, and we have all seen and needed to call out extremism in all its forms. However, I kindly remind the hon. Member for Bradford West that calling people such as Donald Trump or Boris Johnson extremists is completely wrong and drives the feeling that they need to be marginalised even further. They are mainstream, centre-right politicians who have a view and who were democratically elected by overwhelming majorities in both their nations at different times, and they should be respected, even though we may have political differences about what they did.

It is important that we continue to have this informed debate and that we make sure that all sides of the argument are heard. Most importantly, however, we must allow mainstream views to continue to be held by mainstream parties in a good-quality, good old-fashioned democratic debate, rather than allowing the wider public to feel marginalised, so that they look to the extremist elements of society, thinking that their views will be heard or supported there. It is for us in this place to make sure that people feel that they can be heard and that their views are supported, and we will continue to do that.

Question put and agreed to.

Resolved,

That this House has considered the Khan Review on threats to social cohesion and democratic resilience.

15:48

Sitting suspended.

Life Sentences: Public Understanding

Tuesday 30th April 2024 Westminster Hall

17:10

[Sir Mark Hendrick (in the Chair)]

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

[Dr Kieran Mullan (Crewe and Nantwich) (Con)]

I beg to move,

That this House has considered public understanding of life sentences.

It is a pleasure to serve under your chairmanship, Sir Mark. I welcome this opportunity to discuss crime and justice, one of the topics that motivated me to enter politics and that I have focused on in my time as an MP. As the son of a policeman, and having spent time volunteering as a special constable, I am acutely aware of the way that crime can destroy families and upend the lives of decent, law-abiding people. Wanting the victims of crime and their families to benefit from a more just justice system is something that I feel passionately about. I always aim to contribute to the debate and to edge the system in a direction that I think better delivers the justice that it should be set up to deliver. I have spoken before in this place about my concern that all too often the victims of the most serious crimes and their families do not see justice done.

Before I speak about the use of the term “life sentences” specifically, I will set out the background. My time campaigning in this area has taught me that there is what I have described previously as “intellectual snobbery” about people who think that our justice system is at times insufficiently punitive. There are well-meaning and in many respects important groups that lobby hard to make the system less punitive, and nothing that I believe invalidates their arguments or counteracts efforts to deliver reform and rehabilitation of offenders. If such efforts work and overall there are fewer victims of crime, that will be a good thing, but as a Conservative, I believe that we should keep one eye on reality as well as one eye on the ideal future. Criminal behaviour is not going anywhere any time soon, and even the best rehabilitative systems see recalcitrant and very serious offenders.

Also, we have to recognise that, in and of itself, punishing offenders is a public good; in fact, it is recognised in the law as one of the purposes of sentencing. Whether we like to admit it or not, it helps victims and their family and friends to feel that justice has been done, and in the aftermath of a serious crime, whatever comfort we can bring to victims’ families is incredibly important. I would argue that punishment is fundamental to our system. It tells victims and their families that they should not take matters into their own hands, because the justice system will deal with things fairly.

Of course, there are no black-and-white answers stating what that will mean in every case, but almost nobody who argues for less punitive measures would suggest, for example, that a murderer—even one who we could guarantee would not offend again—should spend just four weeks in prison. Nearly everyone accepts that punishment is necessary, and it is easy to suggest outcomes that 99% of people would agree instinctively are too lenient. In the most serious cases, there is in my view a huge—indeed yawning—gap between what most fair-minded people would think constitutes justice and what actually happens.

I am also concerned that the Department itself—the Ministry of Justice—does not sufficiently engage with this issue. That engagement is sometimes missing from impact assessments and policy changes, and perhaps even more worrying is its absence from the MOJ’s own annual report. The focus is on victims’ experiences of the processes of the justice system, which is of course important and to be welcomed, but I think that what most victims and their families want most of all is for justice to be done, and the MOJ has little to say on whether or not the justice system as it stands is actually delivering that. I have suggested before that we could start by at least asking people what they think about this issue, but there has been little appetite for that.

I will never forget what the father of Sarah Everard said when the murderer of his child was sentenced to a whole-life order—a very rare thing in our justice system. He said that it was the only thing that brought him any comfort. I do not think that he would have felt any different if the perpetrator had not been a policeman, even though it was only because the perpetrator was a policeman that a whole-life order was given. I believe that the view that father expressed is common among the families of murder victims.

Because this is a subjective issue, I think that the views of victims’ families and the public at large should act as a powerful and important standard against which we hold ourselves, albeit it should not be the only consideration. I remember discussing this question with Elsie Urry, a lady whose three children were brutally murdered in 1973 by a man who she thought was then sent to prison for the rest of his life, only for him to be released in 2019 when he was considered to be no longer a danger to others.

That brings me on to the use of the term “life sentence”. The first thing we need is transparency about what our justice system is actually delivering. Without it, the public do not necessarily know what is happening, and if they do not know what is happening, politicians will not be held to account properly, which is very unfortunate in a democracy. The focus of my debate is to highlight the fact that, in the current system, what is happening is frequently misreported and misunderstood, giving the impression that our justice system is more punitive than it is, particularly when it comes to the most serious offences.

What is called a life sentence is in fact, in sentencing practice—a sentence of a minimum term of imprisonment, after which there is an opportunity for release with the remainder of the offender’s life spent on licence. But what is actually reported? What do the public get told? I was pleased to be able to explore this issue in more depth in the Justice Committee’s report, “Public opinion and understanding of sentencing”, which states:

“The use by major news outlets of the phrase “jailed for life” when they are not referring to a whole life order is an example of how media coverage risks perpetuating misunderstandings of the law on life sentences among the public. Reporting of sentencing that potentially inflates expectations of how long a person will serve in prison risks damaging public confidence.”

A whole-life order is a term of lifelong imprisonment; it is different from a life sentence.

Since late last year, my office has regularly monitored this issue, and I am afraid that it is not just the media that spreads this misunderstanding. Even more concerning is the fact that police forces and, on one occasion, the Crown Prosecution Service have incorrectly used the phrase “jailed for life” to describe a life sentence. Just today, Nottinghamshire police force released a statement with a headline saying that two murderers had been “jailed for life”. That is simply not true. The two individuals had received life sentences with minimum terms of 16 and 19 years. That is very different from being jailed for life, as we can reasonably expect both of them to be released.

Since October 2023, we have had to contact eight police forces for using the phrase “jailed for life” in their headlines about 13 cases. On six occasions, the police forces in their opening paragraphs failed even to explain the minimum tariff set by the courts, and once a police force failed entirely to mention that there was a minimum tariff. I am pleased to say that three police forces admitted their mistake and subsequently changed their statements after we contacted them, but the majority have not. That matters. People do not always read all the details of a news article, let alone of an official press release from a police force. Every time “jailed for life” is used of someone subject to a life sentence, people get a false impression of what is happening.

I do not want to diminish the many positive things that this Government have done to introduce what I think are fairer punitive elements into the system, not least the big step change away from Labour’s halfway early release to a two-thirds release for the worst offenders, and the introduction of a whole-life order for premeditated child murder. I welcome the planned introduction of whole-life orders when there is a single victim whose murder involved sexual or sadistic conduct, instead of the existing requirement for two victims.

There is much for me to welcome, but I am clear that we must go further on child murder. I think the requirement for significant premeditation is too high a burden, as it excludes, for example, a parent battering their own child to death in a rage. In addition, where multiple offences are involved, our system is too quick to have sentences served concurrently. We have seen this in cases of historical child sex abuse, where there are sometimes dozens of victims and hundreds of offences. Measures need to be in place to impose whole-life orders in some cases of that type.

Such changes are difficult to make. They are expensive changes for the Government, and there is always pressure on prison places. We can hope for success only if people understand how rarely whole-life orders are used, and that life sentences are not in any way comparable, especially given the usual minimum terms. If most people serving a life sentence did in fact spend most or all of the rest of their life in prison, this would be less pressing, but they do not. On average, they serve 20 years.

Some people will argue that the term “life sentence” is accurate because it describes the rest of an offender’s life being served on licence. When we make that argument, however, we risk offending the victims and their families. Families of victims of murder are really serving a life sentence of grief, trauma, and terrible memories of what happened to their loved one. Someone serving their sentence on licence out in the community is basically just being asked to do what all of us are asked to do, which is to not offend. That is a burden that we all face, and I do not see it as in any way equivalent to spending time in prison. None of this is an issue for those familiar with legal jargon, but when a member of the public who is less well informed of what the terminology means reads “jailed for life”, they are being misled.

I am aware of an almost diametrically opposed view of the public understanding of sentencing, though. A commonly made argument is that, broadly, away from the issue of what a life sentence means, the public underestimate sentencing lengths and think we are less punitive than we are. That is undoubtedly driven by media reporting, where journalists, who have a good innate sense of what the public will think is reasonable, are quick to report cases where they sense that that has not happened. Often, however, an unjustified logical step is made by advocates of less punitive approaches: that because of that, we do not need to make the system more punitive. That approach forgets that two things can be true at the same time: people can think our system is less punitive than it is, but they can also think, even when presented with the reality, that it is not punitive enough.

There is another argument based on research in which the public are asked to go through more detailed theoretical cases and sentencing exercises. Studies suggest that people agree with the sentences normally given when they have the full picture. However, almost universally, these exercises look at less serious offending and cases that are full of mitigating circumstances. My focus has always been on the worst and most serious offending. I do not think I have ever seen one of these exercises take someone through the case, for example, of a serial rapist in and out of prison who refuses to engage in behavioural change programs, or of a parent who batters, tortures, neglects and then murders their own child. That leaves me still firmly of the view that, in the most serious cases, the problem of misreporting remains important.

There are things we can do about this. First, as part of the Justice Committee’s inquiry into the public understanding of sentencing, the Committee travelled to Finland and the Netherlands to speak to officials and stakeholders about how they approached reporting sentencing to the public, including the role of media or press judges engaging with the media on reports. The press judges undertake their media duties in addition to their role as a judge, so that when a sentence is handed down, communication with the media is managed by a press judge rather than the sentencing judge. I was not able to be there, but I know the Committee heard that press judges actively engage with the media on public interest cases in particular, even participating in interviews. Committee members also visited the Helsinki District Court, where judges were encouraged to write their own press notices following the passing of a sentence, in order to take the news into their own hands. As a result, early reports on a sentence were often based upon the judge’s press notice, ensuring greater accuracy in initial media accounts of the sentencing decision. That is something we could consider.

Ultimately, we have to accept that the term “life sentence” is at the root of the problem. It is too easily misunderstood and therefore too easily misreported. If terminology is causing a problem, we should change it. We just do not need the term. The judiciary can describe and report what they are doing: passing a minimum term with an opportunity for future release, followed by continuous monitoring on licence. I do not expect extinguishing the term to cause an overnight change. The media and public bodies are used to using it and “jailed for life” is a catchy headline, but over time we could see a change and have a more honest understanding of our judicial system.

It may be that I and those who share my views have no more success in making the case for changes on the matter of substance—the sentences actually being served—but at least we will be making that case in a more honest environment. I am arguing for transparency in sentencing, because I know that that is important to victims of crime and their families, and to the public. I hope the Minister sees the value in that, and will reflect on what I have said and try to find a positive way forward.

17:22

[The Parliamentary Under-Secretary of State for Justice (Gareth Bacon)]

It is a pleasure to serve under your chairmanship, Sir Mark. I start by thanking and congratulating my hon. Friend the Member for Crewe and Nantwich (Dr Mullan) on securing a debate on this important subject. I commend him on his excellent work supporting victims, bringing these important issues to the attention of parliamentarians, and campaigning for sentencing changes. I completely agree that sentencing fitting the crime and improving public understanding is vital to public confidence in the justice system. As he mentioned, he is an active and engaged member of the Justice Committee, whose vital report, “Public opinion and understanding of sentencing”, I will refer to later in my speech.

A life sentence is the most severe punishment that our courts can impose. It is vital that the public have confidence in sentencing, and are able to understand the circumstances in which sentences are given and how they operate in practice. Our efforts to ensure that the justice system is open and transparent are embedded in the working cultures, procedures and practices of our courts and tribunals; consequently, such considerations will always form part of the ambitions for reforming the justice system.

The availability of judgments and the accessibility of sentencing remarks, including those given in life sentence cases, are key components of the principle of open justice, helping to build understanding and confidence in sentencing. The Sentencing Act 2020 puts a duty on the courts to explain how they have determined the sentence and what the sentence means for the offender.

My hon. Friend has extensive knowledge of the sentencing framework, but it may be helpful if I set out some information on life sentences. Life sentences, which apply to a range of offences, usually have a minimum term, which is set by the court, as my hon. Friend said. This period must be served in prison in full before the offender can be considered for release, at the discretion of the Parole Board. The minimum term is for the purposes of punishment and deterrence. It is essential that sentences for the gravest offence—murder—and other offences sufficiently serious to attract a life sentence have a minimum term that punishes the convicted offender and acts as a deterrent to others.

Mandatory life sentences must be imposed on anyone convicted of murder. Schedule 21 to the sentencing code contains the statutory framework for setting the minimum term. The schedule includes starting points depending on the circumstances surrounding the murder and non-exhaustive lists of aggravating and mitigating circumstances. For adult offenders, those range from 15 years right the way through to a whole-life order, as my hon. Friend the Member for Crewe and Nantwich said. Many offenders on life sentences remain in prison beyond their minimum term, and some may never be released. If they are released, they will, as my hon. Friend said, remain on licence for the rest of their life and will be subject to recall to prison at any time if they breach any of the conditions of their licence.

We have delivered and continue to deliver several initiatives aimed at strengthening public understanding of sentences, some of which we set out in January in response to the insightful report produced by the Justice Committee, of which my hon. Friend is a member. Our response described a wide range of actions that we have taken. I want to focus on a few specific issues that my hon. Friend has raised today, especially the terminology in sentencing and the points he raised about the murder of a child.

Sentencing terminology is at the heart of today’s debate. I agree with my hon. Friend that it is important that this terminology should always be accessible and comprehensible to the public. On terminology used for life sentences in particular, the Government recognise the concerns raised by my hon. Friend around understanding how life sentences work and the phrase “jailed for life”. We acknowledge his concern around the lack of understanding that the minimum tariff set by the judge represents the punishment part of the sentence, and the decision from the Parole Board concerns only the public protection element after the minimum tariff is served. It is not an avenue for early release, as some consider it to be; however, I accept that it can be misunderstood by the general public.

We have also noted that the Justice Committee’s report highlights the Sentencing Academy’s work to review the terminology of sentencing, which is an important piece of work that could contribute to broader initiatives or proposals in this domain. The Government, like the Justice Committee, await its findings, and will review them with great care.

Most important, as I am sure my hon. Friend would agree, given his speech, is the question of how we can support victims in understanding this terminology. Under the victims code, victims, including bereaved families, are entitled to be told the sentence the offender received, including a short explanation of the meaning and effect of the sentence by the witness care unit, which is a police-led function. If they have any questions about the sentence that the witness care unit is unable to answer, the victim will be referred to the Crown Prosecution Service, which will answer their questions for them.

To ensure that agencies know what is expected of them, the Victims and Prisoners Bill places a statutory duty on the relevant agencies to provide services in accordance with the victims code, unless there is good reason not to. It introduces a compliance framework by placing a new duty on criminal justice bodies to collect and share code compliance information with police and crime commissioners. We will hold a full public consultation on the code once the Bill receives Royal Assent, which I hope shows how seriously we treat today’s topic.

It is important that we turn for a few moments to the role of the Parole Board, which determines whether to release offenders eligible for automatic release by deciding whether it is necessary for the prisoner to remain confined. The Victims and Prisoners Bill, which is currently before Parliament, introduces a range of reforms to the parole process that are designed to help to protect the public and to bolster public confidence in the system. Through the Bill, we will codify the release test, making clear that minimising risk and protecting the public are the sole considerations for release.

The Bill introduces a new power to allow Ministers to direct a second check by independent courts in cases where the board has directed the release of one of the most serious offenders, which would, of course, include those convicted of murder. We hope that this measure will reassure the public that the process is as rigorous as possible, and that there is an extra safeguard in the release process for the most serious offenders.

In recent years, the Government have introduced several policies to improve the openness, transparency and public understanding of the parole process. In 2018, we introduced decision summaries, which enable the Parole Board to provide victims and others with an explanation of the reasons for its decisions. In 2019, we introduced the reconsideration mechanism, which provided a way to challenge a parole decision if it appears legally or procedurally flawed. Finally, in 2022 we amended the Parole Board rules to enable parole hearings to be heard in public, if it is in the interests of justice to do so. There have been four such hearings to date.

I now move on to my hon. Friend’s points about child murder. I want to acknowledge that all murders are terrible acts, but those where the victim is a child are particularly so. The murder of those most vulnerable in our society causes extreme grief and devastation for the loved ones left behind. I understand entirely why society feels it necessary to ensure that those responsible for these terrible crimes are properly punished.

As my hon. Friend set out, under section 21 of the Sentencing Act 2020 the starting point for the murder of a child involving sexual or sadistic motivation, or their abduction, is normally a whole-life order. There may then be aggravating factors that could result in an increase to the minimum term due to the victim being a child. I understand my hon. Friend’s concern that a requirement for premeditation is too high a threshold for imposing a whole-life order, but I contend that it is right that we set a high threshold in legislation for the imposition of such an order, which is the most severe punishment that our courts can impose.

In this way, the requirement for premeditation is on a par with the other circumstances that govern when the murder of a child would normally attract a whole-life- order starting point—namely, the murder of a child if the abduction of the child is involved, or sexual or sadistic motivation. All cases of child murder are rightly punished severely by the courts, and all those who are convicted and given minimum custodial terms face long prison sentences, possibly with no prospect of Parole Board release.

[Dr Mullan]

I recognise what the Minister says, but if he cannot express an opinion from the Government on whether the situation should change, that does leave a yawning gap. The cases that most upset the public can be when a parent kills their own child, and the circumstances are very often without premeditation. When the public have heard us wanting to deliver a promise on child murder and see these cases reported without the whole-life order being applied, does he think that will lead to further frustration, even if he thinks it is justified frustration?

[Gareth Bacon]

I am a father, and I read some of the cases of child murder with the same level of horror that my hon. Friend does. I have to say that if my child had been brutally murdered in that way, I would expect and hope for a whole-life order.

However, the point that has to land in the Chamber today is that judgments are made, particularly in the press and in the general public, that are not based on full knowledge of the facts presented to the court. That is why we are trying to educate the public on how and why sentences are being given in the way they are. It is not possible to do that in every case, but it must be done based on the facts presented to the court for the jury to find the defendant guilty.

The Government have also increased the powers available to the courts by raising the maximum penalties for acts of cruelty. As I mentioned earlier, I just want to reiterate that there is no early release for those who commit child murder and are given a life sentence. The minimum term must be served in prison in full before the offender can be considered for release at the discretion of the Parole Board.

In the time that I have remaining, I want to touch quickly on my hon. Friend’s point about concurrent sentences. Judges will generally impose concurrent sentences where there are multiple offences arising from the same incident, or where there is a series of offences committed of the same or similar kind, especially against the same person. Consecutive sentences are generally imposed where the offences arise out of unrelated-factor incidents, even if they are part of a wider pattern of behaviour.

As I hope my hon. Friend will appreciate, however, sentencing is a matter for our independent courts. Parliament has provided them with a broad range of sentencing powers to deal effectively and appropriately with offenders. Courts also have a statutory duty to follow sentencing guidelines developed by the independent Sentencing Council for England and Wales.

Although sentencing is a matter for independent judges, the Government have committed to locking up the most dangerous criminals away for longer—to protect the public and deliver the justice the public expects. Since 2010, average sentence lengths have increased by 49% to the year ending June 2023. We have introduced tougher punishments for the worst offenders, including extending whole-life orders to premeditated child murders and ending the automatic halfway release for serious crimes, which my hon. Friend acknowledged in his speech.

We are going further still, and the Sentencing Bill will ensure that rapists and serious sexual offenders serve their full custodial term in prison. As acknowledged by my hon. Friend, in the Sentencing Bill we are also adding murder with sexual or sadistic conduct to the list of those offences that will become the subject of a new duty to impose a whole-life order, unless there are exceptional circumstances.

In conclusion, I am grateful for the opportunity to respond to this debate, to my hon. Friend for securing it and to others for attending—although I think they may be here for the next debate. I found the debate very valuable in my consideration of the issues at hand, and I hope I have reassured my hon. Friend and those in attendance, at least to an extent, that I and the Government continue to take these issues into account as we strive to improve the criminal justice system.

Question put and agreed to.

Preventable Sight Loss

Tuesday 30th April 2024 Westminster Hall

17:35

[Margaret Greenwood (Wirral West) (Lab)]

I beg to move,

That this House has considered preventable sight loss.

It is a pleasure to serve under your chairmanship, Sir Mark. I would like to begin this debate by asking Members who have good eye health to consider these questions. How would you feel if you lost your sight? How would it affect your life and your ability to connect with family and friends or earn a living, travel independently, enjoy the place you live in, the hobbies you have or visit new places? If you were to lose your sight, how would it make you feel to subsequently find out that it actually could have been saved?

Sadly, hundreds of our constituents are going through this very experience. In England, over 600,000 patients are currently on NHS waiting lists to begin treatment for ophthalmology—the branch of medicine concerned with the diagnosis and treatment of disorders of the eye. A survey by the Royal College of Ophthalmologists from this year shows that only 25% of NHS ophthalmology departments feel able to meet patient need, and 70% of departments are more concerned about out-patient backlogs compared with 12 months ago. These are incredibly alarming statistics. Alarming, too, is the fact that it was reported last year that, in 551 confirmed instances, patients had lost their sight as a result of delayed appointments since 2019.

Alongside the problems with ophthalmology in the NHS, we have seen the growth of the independent or private sector. I ask Members to consider the impact that the increased use of private sector provision is having on eye care. Independent sector providers now deliver almost 60% of NHS-funded cataract procedures. That has more than doubled from around 25% before the coronavirus pandemic. Although it has helped to bring down cataract waiting lists, the Royal College of Ophthalmology has found that 67% of NHS ophthalmology departments reported that the impact of independent sector providers on patient care in their area is negative. Let us reflect on that: over two thirds of ophthalmology departments in the NHS believe that the impact of independent sector providers on patient care is negative. It is important that we understand why.

The three aspects those departments have said they are most worried about are training opportunities for junior doctors, funding for the NHS ophthalmology department in which they work, and the available workforce. They believe that these will hamper the long-term ability of their departments to deliver sight-saving care for patients. Every Member of this House should be concerned about that.

The Royal National Institute of Blind People has said that the role of the independent sector has been associated with significant challenges that pose an increasing risk to the sustainability of comprehensive eye care services in the NHS. I believe that the impact on many of our constituents could be, and is likely to be, devastating.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

Does my hon. Friend agree that the use of the independent sector creates a postcode lottery as well? More affluent areas get to the front of the queue more quickly, and we see regional variations where the independent sector is stronger. That is a real concern for people waiting to have this treatment.

[Margaret Greenwood]

My hon. Friend makes an important point, and I will touch on regional variations later.

A paper published last month by the Centre for Health and the Public Interest reported that in the period 2018-19 to 2022-23, the NHS paid the private sector around £700 million for cataract treatments. While cataract operations are very important and can transform people’s lives, it is crucial that those responsible for health policy consider whether the increase in the number of them being delivered comes at the expense of other sight-saving treatments.

We must ensure that the NHS is comprehensive in the range of treatments that it provides. The Centre for Health and the Public Interest warns that the increase in the percentage of the NHS budget being spent on cataract operations is likely to mean that there are fewer resources available to treat other eye care conditions, such as glaucoma and macular degeneration, which are generally considered more serious and lead to irreversible sight loss. Ophthalmologists have also told me that it is impacting capacity for the treatment of conditions such as cancer care, urgent treatment and the treatment of newborn babies.

Data received by the charity from 13 NHS trusts has shown that waiting times for some irreversible conditions have increased between 2017-18 and 2022-23, including for glaucoma and diabetic retinopathy. Waiting times have also increased for cataract operations. The charity also reports that the rise in expenditure on cataract services has been accompanied by an increase in the number of private, for-profit clinics, which have been established to deliver NHS cataract services. Its paper states that 78 new private, for-profit clinics have opened over the past five years.

It is not surprising that some senior ophthalmologists have raised concerns that the increased expenditure on NHS cataract provision, carried out predominantly by the independent sector, is being driven not by patient need but by the commercial interests of the companies delivering it. Last December, Professor Ben Burton, president of the Royal College of Ophthalmologists, warned that the entire commissioning process needed looking at, with local integrated care systems unable to effectively control their use of resources, resulting in some patients with

“very mild cataracts getting surgery at the expense of other patients going blind”.

He added that the approach of unplanned commissioning means that

“the NHS is losing consultants, money and trainees to the private sector”

and that the profit margin is “too high”, meaning that

“companies can pay three times the NHS overtime rate...So, unsurprisingly, people are dropping sessions in the NHS and doing cataract surgery at private companies.”

Professor Burton further warned that:

“We are trying to train the next generation of cataract surgeons, but they’re not getting any straightforward cases to train them on, because the NHS is being left with the more complex cases, with the less complex ones being outsourced.”

That very much chimes with the arguments raised by the Centre for Health and the Public Interest. In other words, the independent sector is cherry-picking the less complex work.

When he responds on behalf of the Government, will the Minister set out what discussions they have had with NHS England about sorting out the perverse outcomes caused by the unplanned commissioning that Professor Burton has highlighted? Unless we see a change of course by policymakers as a matter of urgency, there are real concerns that we will see the breadth of eye care provided within the NHS diminished to the point where some complex sight-saving treatments are no longer available on the NHS. They might be things such as the treatment people need when they are in urgent care after a road traffic accident, the treatment needed for newborn babies or treatment for cancer.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing forward this debate. First, this is a terrific subject. She will know that this morning I had a debate on optometry care, which is a similar topic, and the issue is clear. In that debate, I said that 22 people weekly lose their sight to preventable loss. The hon. Lady knows that. Does she agree that the annual eye test should be pushed as forcibly as a dental check-up, and that the message should start in schools and resound right through the community? I think she will agree that optometrists and opticians want to be part of that move forward. If that is the case, we need the Minister and his Department to work alongside them to push for appointments from an early age.

[Margaret Greenwood]

I thank the hon. Gentleman for his intervention; it was characteristically appropriate. I particularly welcome his call for the message to start when children are in school because it is massively important.

In the not too distant future, we may face eye care deserts in some parts of the country, in much the same way as has happened with dentistry, with some people missing out on crucial treatment. That is exactly what Professor Burton has warned could happen. He said:

“There is a risk that the NHS loses ophthalmology completely, like it has dentistry, in terms of it being a service which is available free at the point of delivery.”

It is not difficult to see how such a conclusion has been arrived at. The great tragedy we face if that happens is that some people will lose their sight from treatable conditions.

The use of the independent sector for ophthalmology has tended to be more prevalent in some parts of the country than in others, so Members representing constituencies in those areas may be particularly concerned. A regional analysis of trends published by the Royal College of Ophthalmologists in 2022 found that in 2021 the north-west of England had the highest proportion of NHS-funded cataract procedures delivered by independent sector providers, at 61%. The midlands, the north-east, Yorkshire and the south-west of England also had figures over 50%. Those figures have increased greatly since 2016. Although there is regional variation, we should be concerned about that right across the United Kingdom.

NHS staffing levels for ophthalmology are also a matter of extreme concern. As I said earlier, NHS ophthalmology departments are worried about training opportunities for junior doctors and the available workforce. In response to a recent written parliamentary question, the Under-Secretary of State for Health and Social Care, the right hon. Member for South Northamptonshire (Dame Andrea Leadsom), failed to provide clear information about the Government’s plans for specialty training places for ophthalmology. She said:

“A decision regarding which specialties these places will be allocated to will be made nearer the time that the places are required for the expanded workforce. NHS England will work with stakeholders to ensure this growth is sustainable and focused in the service areas where need is greatest.”

Will the Minister clarify that? When Under-Secretary of State for Health and Social Care spoke of stakeholders in that context, was she talking about the independent sector as well as the NHS? If so, will the Minister ask NHS England what progress it is making towards meeting its commitment, set out in the 2023 elective recovery taskforce implementation plan, to

“track, monitor and evaluate independent sector’s impact on the long-term NHS capacity landscape”?

That is an incredibly important matter, and if the Minister is not able to reply today, I would welcome it if he can write to me on that point.

How confident is the Minister that the full breadth of ophthalmology expertise will be there in the NHS for any one of us in five or 10 years? Data from the most recent workforce census from the Royal College of Ophthalmologists shows that there is real cause for concern, given that 76% of NHS ophthalmology departments report not having enough consultants to meet patient need. In reality, NHS ophthalmology departments are increasingly relying on costly locums to cover workforce gaps, and nearly two thirds—65%—use locums to fill consultant vacancies.

Typically, UK-trained ophthalmologists will have undertaken the vast majority of their training in the NHS, including those now working for independent sector providers. There are concerns that the increase in NHS staff working in the independent sector on cataract provision is reducing the availability of training opportunities that enable NHS staff to train in more complex areas. That is potentially a time bomb for the future, and could mean that we will not have anywhere near enough staff trained to carry out work on treatment for conditions such as glaucoma and wet macular degeneration.

It is clear that we are facing a sight loss health emergency, and there is an urgent need for a national eye health strategy. The RNIB has suggested that the goal of such a strategy should be to establish eye health as a public health priority, and it should aim to prevent irreversible sight loss.

As the Royal College of Ophthalmologists pointed out, it is imperative that NHS ophthalmology departments across the UK are supported to deliver high-quality and timely care for all patients, regardless of their condition and where they live. Among other things, it is calling on policymakers to support the development of a multi-disciplinary eye care workforce fit for the future. That should include delivering an additional 285 ophthalmology training places in England by 2031 and boosting investment in the ophthalmic practitioner training programme so that more eye care professionals can work to the top of their licence.

The royal college is also calling for better integrated eye care through investment in digital solutions such as interoperable electronic patient records between optometry and ophthalmology, and a further development of integrated pathways for optometry so that patients receive the most appropriate and accessible care and are prioritised based on clinical need. It is calling for the reform of commissioning, tariff and data reporting systems, which it believes will ultimately help the NHS ophthalmology services. All those things should be part of a national eye health strategy.

The strategy must be inclusive and must address the needs of everybody. The charity SeeAbility has pointed out that people with learning difficulties are 10 times more likely to have a serious sight problem than other people, but are far less likely to have a sight test. What is happening to ophthalmology services in the NHS is clearly a matter of extreme concern and is one example of just how damaging the privatisation of NHS services is to the delivery of a universal and comprehensive national health service.

The increasing use of the independent sector to treat NHS patients leaves us vulnerable to the vagaries of the market. Under this Government, the use of private-sector companies in health has increased. Indeed, the Health Service Journal reported last December that the amount spent by NHS trusts on outsourcing activities to other providers has almost doubled from £2.4 billion in 2019-20 to £4.7 billion in 2022-23. The HSJ stated that independent providers are

“likely to make up the bulk of the spend”.

The Minister will say that the Government are not privatising the NHS, but that is smoke and mirrors. The World Health Organisation defines privatisation as

“a process in which non-government actors become increasingly involved in the financing and/or provision of health care services”.

We have seen that in ophthalmology, with the commercial interests of private companies driving the increased expenditure on NHS cataract provision. That is the view of ophthalmologists. No doubt the Minister will say that the Government are providing the national health service with record levels of funding—again, smoke and mirrors. The fact is that, as pointed out in the 2023 report “The Rational Policy-Maker’s Guide to the NHS”, NHS spending has not been enough to keep pace with need when we factor in and combine the effects of inflation, population growth, population ageing and increased morbidity.

I ask Members to think about the questions I raised at the beginning of the debate. How would you feel if you lost your sight, how would it impact your life, and how would you feel if you then found out that the loss of your eyesight could have been prevented? How would you feel if you found that you could not get the treatment you need because less serious conditions were being treated as a priority in the independent sector by specialists who were lured there, away from the NHS, due to how commissioning works and because the market is increasingly influencing what is and is not treated?

RNIB figures show that every day, 250 people in the UK start to lose their sight. We need the national eye health strategy, the goal of which should be to preserve vision and prevent irreversible sight loss. I call on the Government to address those issues as a matter of urgency. The Government must invest in the national health service and strengthen it as a public service to ensure that it is universal and comprehensive. For that, they must build the capacity of expertise within the NHS so that we can be confident that the service is there to treat all eye conditions. In the words of Professor Ben Burton, the chief executive of the Royal College of Ophthalmologists,

“the key to ensuring long term capacity to deliver patient care is to invest in comprehensive NHS services, workforce and infrastructure.”

17:52

[John McDonnell (Hayes and Harlington) (Lab)]

I congratulate my hon. Friend the Member for Wirral West (Margaret Greenwood) on securing this debate. That was a comprehensive and detailed, but succinct, assessment of where we are at. Sometimes, the role of Members of Parliament is to identify an issue before it comes into crisis so that we can advise Government on the action that is needed, and that is exactly what my hon. Friend has done.

When some of my constituents identified this topic as the subject of an Adjournment debate, they approached me to raise an issue I have been dealing with for the last 20 years: people whose eyesight has been damaged as a result of refractive eye surgery, or laser treatment, as some know it. The refractive eye surgery sector is now a huge profit-making industry. Many gain through the use of refractive eye surgery, and their eyesight is benefited, but there are many others—in fact, thousands every year now—whose vision is damaged as a result of the surgery.

Many years ago, a campaign called My Beautiful Eyes was launched by a woman called Sasha Rodoy. Some people will know of her if they have dealt with these laser treatment issues in any way. She is a heroine. Each year, we organise a lobby of Parliament called Bad Eye Day. We bring together individuals whose eyesight has been damaged by refractive eye surgery and their families. When I say “damaged”, for many of them, it is to the point where their eyesight is nearly lost. Many others have heartbreaking stories of losing their employment or being severely disabled.

In 2004, Frank Cook, who was then a Labour MP, introduced a private Member’s Bill to address the issues confronting people whose eyesight had been damaged by refractive eye surgery. I co-sponsored the Bill, which basically called for regulation of the sector. In 2013, I produced a ten-minute rule Bill that reflected many of the proposals that Frank had put forward. We have had debates, meetings with the royal colleges and ministerial meetings. All we have been asking for over the past 20 years is greater regulation—effective regulation—but progress has been limited. Even in the Government’s own inquiry into cosmetic surgery, Sir Bruce Keogh identified laser surgery as something that should be subject to further regulation. To be frank, nothing has followed from all those ministerial meetings and debates, from all the legislation we put forward or from the Government’s own inquiry.

We need effective regulation that runs through every aspect of the process. The first aspect is the marketing and advertising of these treatments. As Sasha Rodoy says, the industry is notorious for making outlandish claims about the effectiveness of surgery. On a few occasions, we have taken companies to the Advertising Standards Authority and they have been found guilty of exaggerating their claims about the treatment.

Secondly, we want regulation of the advice provided to people who commission the surgery. It is about getting appropriate advice, and about whether the individual’s eye is appropriate for the type of surgery. At one stage, we found that advice was being provided by members of staff who were not qualified and were simply selling the product. We want the provision of advice to be regulated, supervised and monitored.

We also want surgical practices and professional standards to be supervised and monitored. I have dealt with several cases in which professional standards have fallen below what we would expect and people have been harmed as a result. When things go wrong, the company will often fail to put things right adequately. It will delay its response and will often try to get beyond the limit when legal action can be taken. Those individuals then have to fall back on the NHS.

Time and again, the NHS has to address complex injuries as a result of laser treatment, yet the financial burden falls not on the companies but on the NHS itself. We have argued that the performance records of those private companies and, if necessary, of the surgeons involved should be published to identify where harm has been caused as a result of action taken. Where NHS involvement is needed to correct or address the concerns that people have been left with, maybe there should be a levy on those private companies so that the cost burden does not fall on the NHS.

We are now 20 years on from that first piece of legislation, which Frank Cook brought forward because—if I recall rightly—he had gone through that experience and was interviewed by the media about it. All of a sudden, he received a flood of correspondence from people saying, “The same thing’s happened to me: I’ve had the same sort of injuries.” When I raised the issue in 2013, I had literally hundreds of emails coming in. We have a national lobby each time, and some of the stories are absolutely heartbreaking.

I know that there are demands on the Minister’s time, but it would be really useful if, like some of his predecessors, he met victims of refractive eye surgery who have become campaigners and the professionals they work with, so that we can address the current situation, get an objective overview of where we are and then agree a programme for reform. All that people are asking for is adequate regulation based on monitoring of professional practices, so that they feel protected. At the moment, as my hon. Friend the Member for Wirral West said, there is a real risk of eyesight loss. It is one of the worst things that can happen to people, because they become completely isolated from the world. It is incredibly distressing.

That request fits with the demand for a national eyesight strategy, which is desperately needed. What my hon. Friend described is happening across the country. There is a fear that if we do not address it now, we could quickly get into a crisis as a result of the loss of professional staff to the NHS in particular. My hon. Friend the Member for Leeds North West (Alex Sobel) also mentioned the postcode lottery of access to those services. I hope that the Minister will agree to meet campaigners on this issue, which is worth addressing, so that at least they can have their say and he can take advice on the programme of reform that we need.

[Sir Mark Hendrick (in the Chair)]

We now move to the Front-Bench contributions.

18:01

[Kirsty Blackman (Aberdeen North) (SNP)]

Thank you for chairing the debate, Sir Mark. If my voice goes during my speech, I will just sit down, and hon. Members can assume that the rest of it would have been fabulous.

I congratulate the hon. Member for Wirral West (Margaret Greenwood) on securing this important debate. As the right hon. Member for Hayes and Harlington (John McDonnell) said, it is important to highlight these issues before we get to the point of total crisis. I will talk about what has been happening in Scotland on preventable sight loss.

I thank and commend everybody who works in eye care, whether they work as optometrists or in ophthalmology in hospitals, and everybody who provides those incredibly important services to people. We recognise the hard work and dedication that they put in to ensure that as many people as possible continue to have the best possible eyesight.

As the hon. Member for Wirral West said, whether someone can see properly has a significant impact on their life. When I was eight years old, I lost my eyesight completely over a week. I had optic neuritis, which is incredibly unusual for an eight-year-old. For a short period, I genuinely could not see almost anything. Thankfully, I was treated well and helpfully by the team at Aberdeen Royal Infirmary and got my sight back entirely, which does not always happen with optic neuritis. Although I did not have to deal with that situation in the long term, I am aware of how terrifying it is. It has a major impact on people’s lives.

With our public platform, we should do everything we can to encourage people to get their eyes tested regularly and have regular eye examinations. Eyesight is important, but most people probably take it for granted most of the time. Regular checks can ensure that optometrists and community optometrists discover any possible future eye conditions and that people are given treatment as early as possible. Eye checks can also highlight more serious conditions such as cardiovascular issues, high blood pressure or diabetes. In Scotland, we have free universal NHS eye checks in community optometrists. Those check-ups are available for everybody—UK residents, refugees, asylum seekers and some eligible overseas visitors— and people do not have to pay. I encourage people to get their eyes checked regularly: it is important to go along.

I will talk about our strategies and workstreams for ophthalmology. In Scotland we have what is called the national ophthalmology workstream, which has brought together the views of a huge number of people working in ophthalmology, particularly around hospital care, to ensure that the best possible service is provided to everyone. There are workstreams on things like cataract surgery, which the hon. Member for Wirral West has mentioned, to ensure that people are given the best cataract surgery as early as possible. Successful surgery in the first instance also reduces the need for follow-up appointments.

The strategy tries to ensure that, even with Scotland’s fairly unique geography, as many conditions as possible can be treated close to people’s homes and in their communities. If hospital appointments are needed, they should be there, but if the need for hospital appointments can be reduced by providing the same or a similar service closer to home, that is encouraged.

We recently had a pilot of the NHS glaucoma service in communities, which started in Glasgow and has been rolled out across Scotland. It aims specifically to ensure that the number of hospital appointments is reduced. Going to hospital when you do not necessarily need to can be stressful. If someone can be treated in a primary care setting that they are used to, it is easier and better for everybody. It takes some of the stress off NHS services, ensuring that the necessary services are delivered and that capacity matches demand where possible. As I say, it is about providing the best possible services that suit people, as close to home as possible. We cannot get away from the fact that there is a capacity and workforce issue, not just in England but across these islands, but we have been doing what we can to recognise that. The strategy has been in place since 2017 and is leading to real differences and real improvements for people.

We have a couple of other things in place in Scotland. The See Hear strategy is specifically about ensuring that services are improved for sensory-impaired people. Under the See4School system, every pre-school child has their eyesight tested to ensure that they are as ready as possible to learn when they go to primary school and that those conditions can be picked up as early as possible.

Lastly, I encourage everybody to please get their eyes tested. For anyone who has not been for some time, I thoroughly recommend going. It is not just about being able to see incredibly well with 20/20 vision; it is about ensuring that conditions are picked up. I ask everybody to encourage their constituents to go.

18:07

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

It is a pleasure to serve under your chairship, Sir Mark. I congratulate my hon. Friend the Member for Wirral West (Margaret Greenwood) on securing the debate. She is a fierce campaigner on bringing down NHS waiting lists, and for an NHS that remains true to the principle on which it was founded: to be a service that is there for everyone when they need it and that is free at the point of use. I also thank my right hon. Friend the Member for Hayes and Harlington (John McDonnell), who made a powerful speech about how eye care is often a neglected topic.

The RNIB estimates that more than 2 million people in the United Kingdom live with sight loss. Shockingly, at least half of that sight loss might be avoidable. A recent Royal College of Ophthalmologists workforce census found that 63% of eye units estimate that it will take at least a year to clear their backlogs; a quarter of them estimate that it will take more than three years. Across our country, the demand for ophthalmology services has risen rapidly and is set to increase by 40% over the next 20 years. The economic cost of sight loss is estimated to be £25.2 billion a year. Surely that is too big a price not to act.

The current Government have treated eye care as an afterthought. Today in England, 619,000 people are on a waiting list for a hospital eye appointment, and 250 people start to lose their sight every day. Yet this Government have no strategy for eye health in England, unlike every other UK nation.

The next Labour Government will take eye health seriously. We will crack down on the tax dodgers and use the money to bring down waiting lists. We will train a new generation of doctors, nurses and midwives to treat patients on time. We will double medical school places to ensure that we have the workforce we need, including across ophthalmology. We will reform the system, too, so that everyone can access the right care when and where they need it.

Moving more care to the community will help to support those who are suffering sight loss, as will focusing on the provision of non-clinical community support to complement the work of community optometrists, ophthalmologists in hospitals and rehabilitation officers. That is why the next Labour Government will seek to negotiate a deal with high street opticians to deliver NHS out-patient appointments for eye conditions such as glaucoma. There are currently 6,000 high street opticians in England, equipped with specialist staff and kit that can get patients seen faster. We will put them to work to beat the backlog and free up hospital specialists to treat the patients in serious need. That will all mean greater convenience for patients. As these are routine appointments, it will be less expensive to the taxpayer to deliver them on the high street than in hospital.

We know that delivering eye care in the community works. A 2014 study considered the impact of the introduction of minor eye care services in Lewisham and Lambeth on ophthalmology hospital departments. GP referrals to hospital ophthalmology decreased by 75% in Lewisham and by 30% in Lambeth. Costs in areas that did not have a minor eye care service increased, but costs in Lewisham and Lambeth decreased by 14%. A separate dataset from Hereford in 2022 showed that 92% of referrals to eye casualty by GPs could have been seen by an optometrist via the minor eye care services, and 83% of self-referrals could have been seen by MECS.

Perhaps the Minister can say today whether he backs Labour’s plan to try to strike a deal for high street opticians to deliver additional clinical services. Has he made an estimate of how many people now on hospital waiting lists are waiting to be seen for issues that could easily have been seen in community optometric services? According to a report published last year, more than 550 patients have suffered sight loss since 2019 because of NHS delays. That is absolutely tragic.

It is not just patients who stand to benefit from Labour’s plans. GPs stand to benefit from the removal of low-value, time-consuming paperwork that could be dealt with in opticians’ shops by optometrists themselves. Patients can already go directly to sexual health clinics, as well as to physiotherapists in some parts of the country, without seeing a GP; in Greater Manchester, where lung cancer is the biggest killer of people under the age of 75, patients with risk factors can now get walk-in chest X-rays. Opticians who spot a problem should not have to send patients to their GP for referral to an eye specialist instead of referring them directly. Why is direct referral not the case everywhere? Labour’s plans will see best practice adopted everywhere to allow opticians themselves to refer patients to eye specialists, meaning that patients can be seen faster and GPs can get on with more important and meaningful work.

We know how important eye care services are to our communities. Vision loss in older people has been proven to affect their physical and mental health and to increase the speed of cognitive decline. We know that sight loss can be a symptom of serious disease. The Government must set out a plan for these services, with a mix of strengthened community-based care and prevention policies. It is right that we address the gaps in care co-ordination that disproportionately affect those with the greatest need, to give everyone the best opportunities to access education and employment and to live well in older age. Let us give everyone a right to sight.

18:13

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

It is always a pleasure to see a fellow Lancastrian in the Chair, Sir Mark. I thank the hon. Member for Wirral West (Margaret Greenwood) for bringing forward the debate. This is the second debate today on eye health to which I am responding on behalf of the Under-Secretary of State for Health and Social Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), who has been busy in the Tobacco and Vapes Bill Committee. I also thank those who contributed to the debate—the right hon. Member for Hayes and Harlington (John McDonnell), the hon. Member for Aberdeen North (Kirsty Blackman) and the shadow Minister, the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill)—for their thoughtful contributions.

Preventing sight loss remains one of my right hon. Friend’s top priorities, and it is right that we should dedicate parliamentary time to this important issue. Losing one’s eyesight can be devastating, and I want to pay tribute to some of the charities that I did not have time to mention in this morning’s debate—Fight for Sight, the Vision Foundation and Sightsavers, to name just a few more.

About 2 million people live with sight loss in our country. That number is projected to double by 2050, mainly because of our ageing population. We are doing a huge amount to reduce the number, through preventive measures and early detection. One of the best ways to protect eyesight is through regular sight tests. That point was made eloquently by the hon. Member for Aberdeen North, and I am pleased to confirm to her that I am having my next eye test tomorrow morning.

This debate is why the NHS invests more than £500 million every year on free eye tests for people on benefits, people over 60, and people at risk of serious conditions. That investment delivered more than 12 million NHS sight tests to those groups between 2022 and 2023, and extensive discounts on glasses and contact lenses for children and people on income-related benefits, through NHS optical vouchers.

We have also taken great strides in preventing some of the causes of sight loss, including smoking and obesity. As I mentioned at the start, my right hon. Friend the Member for South Northamptonshire is taking our landmark Tobacco and Vapes Bill through the House, and we are backing quit-smoking campaigns with unprecedented funding and support.

On obesity, we have taken a raft of measures on sugar reduction and healthy eating. We have made strong progress in reducing the average sugar content in soft drinks through the soft drinks levy, and almost halved their sugar content between 2015 and 2019. For two years, we have also been restricting the placement of less-healthy products in shops and online, thereby helping consumers to make healthier choices.

Our wider prevention work goes hand in hand with our efforts to catch eye problems early. Glaucoma—which was covered in the debate this morning—and diabetic retinopathy are two of the main causes of preventable sight losses, and both can cause blindness if left untreated. That is why we are offering screening tests to nearly 4 million patients with diabetes at least once every two years. Since 2010, the number of adults between 16 and 64 who became visually impaired from diabetic retinopathy fell by almost a fifth. Our approach has been commended by the World Health Organisation, and we will build on that progress. In October, we begin phasing in optical coherence tomography scans as part of the screening programme, to reduce unnecessary referrals to hospital eye services and improve the quality of the service overall.

It is vital for patients who need to be in secondary care to have access to timely diagnosis and treatment. That is why we have set ambitious targets to recover services that suffered over the pandemic, through our elective recovery plan, which is backed by more than £8 billion of funding, and why we have expanded surgical hubs and harnessed capacity in the independent sector so that more patients can be seen more quickly. Our plan is working and it is delivering results. Waiting times are falling. The number of patients waiting 78 weeks or longer for ophthalmology treatment has reduced by 96% since its peak. But we know we have much further to go.

While we work to recover from the pandemic, we are reforming eye care services to be fit for the future. NHS England’s transformation programme is currently funding seven projects across each ICS area, testing how improved IT links between primary and secondary care could allow patients to be assessed and triaged virtually. Where appropriate, that would keep patients out of hospital, freeing up hospital eye-service capacity for those who need specialist care the most.

The initiatives have shown promising results. For example, the project in North Central London ICS has improved the flow of information from community optometry to Moorfields Eye Hospital, reducing the triage time from 11 days down to one. The appropriate use of clinics has doubled to more than 70% and reduced the waiting time for first appointments by up to 35 days. NHS England is now using the data from the projects to build the case for a wider roll-out.

[Kirsty Blackman]

I appreciate what the Minister is doing in this policy area. Some of the initiatives he just mentioned, such as electronic assessments and triaging electronically, were put in place in Scotland seven years ago. We decided that they were working and that we would roll them out. Has he spoken to Scottish colleagues and looked at the work done in Scotland in order to ensure that the Government do not have to replicate the same pilots that we have proven do work, so that people can get treatment and things can be put in place more quickly?

[Andrew Stephenson]

As a proud Unionist, I am always happy to learn from different parts of the United Kingdom. After I was appointed to my role, one of the first things I did was to go to Edinburgh and visit various universities and companies across Scotland, and I saw some of the great work going on in Scotland. I also met the then Health Secretary, Michael Matheson, to talk about areas where we can work together, particularly on things such as research. However, we can also trial different things in different parts of the country. Many people in this House talk about regional variations, which can be a concern. Nevertheless, one of the benefits of being able to trial different things in different regions is that we can learn the lessons, learn what works and then build on that best practice.

As well as helping our primary and secondary care sectors to reach their full potential, we have a long-term plan in place to support our workforce and put it on a sustainable footing, which is the first ever long-term workforce plan for the NHS. We have again increased training places for ophthalmologists in 2024 and improved training for existing staff, helping them to deliver for patients while reaching their full potential.

The right hon. Member for Hayes and Harlington raised what sounded like a very important and serious issue. He will forgive me for saying that this area is not my specialist subject, but I am happy to raise his concerns with my right hon. Friend the Member for South Northamptonshire. However, I will say now, in response to his comments on laser eye surgery, that refractive laser eye surgery is not generally available on the NHS. Doctors who perform such surgery must be registered with the General Medical Council and the Care Quality Commission. All locations where refractive eye surgery is carried out should be monitored and are required to report any adverse events. As I say, I will be happy to relay his concerns to my right hon. Friend.

[John McDonnell]

I appreciate the Minister’s response; that is really helpful. It would also be useful if a Minister met some of the families who have experienced issues in this area, because over the last 20 years we have had the same ministerial response with regard to regulation, and there have just been too many examples where that regulation and monitoring have not worked and therefore people have been endangered. That is why in the Government’s own report Professor Sir Bruce Keogh recommended further regulation; I think we need to revisit that.

[Andrew Stephenson]

I thank the right hon. Gentleman for making those points. I am not instinctively anti-regulation; indeed, just a few weeks ago I put through this place the statutory instrument on the regulation of physician associates and anaesthetist associates. There are certain parts of the healthcare sector where regulation is very much needed and I would very much advocate for it. As I have said, I will defer to my right hon. Friend the Member for South Northamptonshire. This is her ministerial responsibility, and I am sure she will read the right hon. Gentleman’s comments with interest and may want to take the discussions further.

Finally, on research, the Government are backing scientists and researchers to take strides in understanding sight loss and in making new treatments available. Two years ago, we awarded £20 million to Moorfields Biomedical Research Centre to undertake another five years of vision research, and almost £6.5 million to Moorfields Clinical Research Facility to support cutting-edge treatments for all eye conditions.

Eye care services face challenges and we are taking decisive action to address them, both now and in the long term. The hon. Member for Wirral West and I will never agree on the use of the independent sector. I strongly believe, and think the Labour Front Bench team strongly agrees, that using the independent sector enables us to fully realise our healthcare system’s capacity and to reduce the time that patients spend on waiting lists. I would argue that that does not represent any move to privatise our NHS. As I have said on the record before, the overall proportion of NHS England’s spend on independent sector providers has not increased significantly in recent years. In 2013-14, 6.1% of total health spending was spent on the purchase of healthcare from independent sector providers; in 2022-23, the proportion was 6.5%.

This morning, the shadow Minister in the first Westminster Hall debate, the hon. Member for Denton and Reddish (Andrew Gwynne), talked about making better use of the independent sector to help to ensure that we deliver the best outcomes for patients, and the shadow Minister in this debate, the hon. Member for Birmingham, Edgbaston, reiterated that point. On the use of the independent sector, then, I gently say that it is something on which there is broad cross-party support. While recognising that there are always challenges with the use of the independent sector, it is not in any way a privatisation of the NHS.

I firmly believe that through prevention, innovation and investment in our workforce, we will deliver for all our people across the United Kingdom access to the important healthcare services, including ophthalmology services, that they deserve.

[Sir Mark Hendrick (in the Chair)]

I call Margaret Greenwood to wind up the debate.

18:23

[Margaret Greenwood]

The Minister said that he is never going to agree with me on the use of the independent sector. Will he look back over this debate and consider the points I have made—and not just my views but those of the Royal College of Ophthalmologists and the RNIB—and the outcomes that are arising as a result of the increased use of the independent sector? He takes an ideological position, but what I am asking him to do is look at the practical outcomes of what is going on.

I thank all Members who contributed to the debate, including my hon. Friend the Member for Leeds North West (Alex Sobel) and the hon. Member for Strangford (Jim Shannon), and in particular my right hon. Friend the Member for Hayes and Harlington (John McDonnell) for his work on behalf of those who have had their eyesight damaged through laser surgery. I hope the Minister will pick up on his call for further regulation and for a meeting with the victims of that treatment. I also thank the many organisations that contacted me in advance of the debate with their thoughts and briefings. It is vital that we do all we can to ensure the provision of comprehensive and universal eye care in the national health service.

The growth of the independent sector in delivering almost 60% of NHS-funded cataract procedures is having a negative impact on patient care, as more than two thirds of NHS ophthalmology departments have said. As a result, treatment for other eye care conditions in the NHS—such as glaucoma and macular degeneration, which are generally considered to be more serious and which lead to irreversible sight loss—are being adversely impacted. We must also consider the potential impact of the availability of treatment for people in urgent care after, for example, a road traffic accident; the treatment needed for newborn babies; and the treatment of cancer both now and importantly for future generations.

Currently, the market is influencing what is and is not treated, and private companies are cherry-picking the treatment that they want to deliver. This is no way to protect and strengthen the national health service. We need a national eye health strategy to preserve vision and prevent sight loss as a matter of urgency. We need a comprehensive and universal national health service that is there for us all when we need it for eye care and all other areas of health. I thank everybody who contributed to the debate.

Question put and agreed to.

Resolved,

That this House has considered preventable sight loss.

18:27

Sitting adjourned.