Westminster Hall

Thursday 5th December 2024 Westminster Hall

Thursday 5 December 2024

[Graham Stringer in the Chair]

Cumberlege Review: Pelvic Mesh

Thursday 5th December 2024 Westminster Hall

13:30

[Chris Vince (Harlow) (Lab/Co-op)]

I beg to move,

That this House has considered pelvic mesh and the Cumberlege Review.

Thank you, Mr Stringer, for your chairmanship. I sincerely thank all Members who have come to contribute to this debate. I thank the Minister, my hon. Friend the Member for Gorton and Denton (Andrew Gwynne), and the shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson), for attending. I also particularly thank Baroness Cumberlege for coming along to the debate.

In my first MP constituency surgery I met Debbie— I am delighted that Debbie and her husband Ian are here today. Debbie was active. She was into keeping fit and socialising with friends and family but, following her operation to have pelvic mesh inserted, she was forced to give up work. She now suffers from chronic pain in her hips, pelvis, groin and legs. She often suffers from fatigue. She is unable to exercise. She suffers from incontinence, post-traumatic stress disorder, severe depression and autoimmune disease. She later found out that the operation to have the mesh inserted was not even necessary.

When Debbie had her first operation to have the mesh removed, she was told that it was removed completely, but later found out that was not in fact true. She was forced to have a second operation, where, again, not all the mesh was removed.

Despite winning subsequent court proceedings, she has received no compensation, in part due to the surgeon not being covered by insurance. Debbie’s case shows the barriers for victims of medical negligence. It took seven years for Debbie’s case to get to court. Part of her concern is that the surgeons operating to remove the mesh are the same doctors who did the initial operation to insert it.

[Sir Alec Shelbrooke (Wetherby and Easingwold) (Con)]

This is such an important debate, and many of us in this room have been working on this issue for a very long time. I point the hon. Gentleman to the Government’s review of the NHS. We only have nine centres. We have to emphasise how important it is that the review addresses the need for more surgeons in these areas. The issues that he is outlining are so common, yet we only have nine centres.

[Chris Vince]

I thank the right hon. Gentleman for that useful intervention. Following my meeting with Debbie, two further Harlow residents have come forward who have also been part of this scandal. I have spoken to Members across the House who have constituents with the same issue. More than 600 women came forward to be part of the Cumberlege review and the subsequent Hughes review. This is a huge issue that affects many people.

As many Members will be aware, on 21 February 2018, the then Secretary of State, the right hon. Member for Godalming and Ash (Jeremy Hunt), called for an inquiry. The independent medicines and medical devices safety review, chaired by Baroness Julia Cumberlege, who I am delighted to see here today and whose support I am delighted to have, published the “First Do No Harm” report in July 2020. The report considered two medications and one medical device, but I will focus on pelvic mesh implants, which were used in the surgical repair of pelvic organ prolapse and to manage stress urinary incontinence. It was hugely emotional to hear Debbie’s story—to hear at first hand the huge impact that this issue has had on her life.

In her report, Baroness Cumberlege described the accounts of women who had been affected by this issue as “harrowing”. I think we can all agree that that is absolutely the case. I will not go through the whole review, because that would take too long, but I will just highlight a couple of things said by women who came forward and spoke about the impact that the procedure had had on them.

The women said that there was a

“lack of awareness of who to complain to and how to report adverse events”

and reported

“breakdown of family life; loss of jobs, financial support and sometimes housing”.

However, the situation is even worse than that. The women also spoke about a

“loss of identity and self-worth”.

Sometimes, we fail to recognise the massive connection between physical health, including a physical procedure such as this one, and people’s mental health and wellbeing. The women also reported

“a persistent feeling of guilt”.

Nobody who is a victim of medical negligence should feel guilty about that fact.

[Sir Julian Lewis (New Forest East) (Con)]

I think that often the reason people feel guilt is because they feel that they were not given the necessary information at the beginning and they did not ask for it, but if they had only known, they would not have touched this debatable and deplorable procedure with a bargepole.

[Chris Vince]

I thank the right hon. Gentleman for his intervention and I could not agree more. In the case of Debbie, who I have spoken about, she did not even need the procedure in the first place, but clearly that information was not provided correctly to her. Many women absolutely would not have gone through with the procedure if they had known about the dangers—and, as I say, in Debbie’s case she did not need to go through with it.

The Cumberlege review made a number of recommendations. First, it recommended establishing a separate redress scheme to meet the cost of care and support for people who have experienced avoidable harm caused by the pelvic mesh. It also recommended:

“Networks of specialist centres should be set up to provide comprehensive treatment, care and advice for those affected by implanted mesh”,

and that a database should be created of all patients who received an implant of medical devices, including the pelvic mesh.

The previous Government published their response to those recommendations in July 2021. They did not accept the report’s recommendations about redress. However, in December 2022 they announced that they had asked the Patient Safety Commissioner to explore options for redress, and that project began in the summer of 2023.

On 7 February 2024, the Hughes report was published, setting out recommendations for redress for those harmed by sodium valproate—a medicine used to treat epilepsy—and pelvic mesh. The report calls for the establishment of an independent, two-stage redress scheme to provide both financial and non-financial redress for affected patients.

I realise that I have been talking for quite a long time, Mr Stringer, but I think you appreciate the importance of this subject. I will quickly go through the recommendations of the Hughes report, so the Minister is aware of them. There are quite a few recommendations and they are as follows:

“The government has a responsibility to create an ex-gratia redress scheme providing financial and non-financial redress for those harmed by…pelvic mesh. This scheme should be based on the principles of restorative practice and be co-designed with harmed patients.”

We have seen that throughout this process patients have not had a voice and it is hugely important that they have a voice in finding the solution.

The Hughes report’s recommendations also said:

“Redress should provide all those harmed by pelvic mesh or valproate”—

the other medicine I mentioned—

“with access to non-financial redress. To deliver this, the government should work with other government departments, the healthcare system and local authorities to measurably improve harmed patients’ access to, and experience of, public services.”

Another recommendation was:

“The government should create a two-stage financial redress scheme comprising an Interim Scheme and a Main Scheme… The Interim Scheme should award directly harmed patients a fixed sum by way of financial redress… The Interim Scheme should be followed by a Main Scheme. This would offer more bespoke financial support to directly harmed patients based on their individual circumstances and…those indirectly harmed”.

[Anna Dixon (Shipley) (Lab)]

I thank my hon. Friend for securing this important debate. The NHS has a clinical negligence scheme and it spends a lot of money on lawyers. Does my hon. Friend agree that victims of this particular scandal should, like many others, get no-fault compensation? And does he think the NHS should look at its clinical negligence scheme and move towards no-fault in order to reduce the spend on lawyers?

[Chris Vince]

I thank my hon. Friend for the question. I broadly agree with her. Over the last year we have seen some terrible scandals, the Post Office scandal and the infected blood scandal. When we have debates on those in this House, we recognise that things should have been done much more quickly and that we should have been much more open to providing financial support to the people affected. We should look at this case in those terms.

To continue the recommendations, the report states:

“Patients who received relevant treatment through either the NHS or independent sector should be eligible for the Interim Scheme and Main Scheme…”

and adds that patients should find the application process for both schemes “straightforward”. Again, that speaks about accessibility and making the process non-adversarial, which is really important. It comes across in both reports that victims of the pelvic mesh scandal were made to feel guilty and that it was their fault, which is absolutely not the case.

The report states that both schemes

“should be administered by an independent body which commands the confidence of patients.”

We want those patients to feel confidence in the scheme. Both schemes

“should effectively signpost harmed patients to services which can provide them with free emotional support.”

I reiterate the importance of that emotional support. Finally, the report states:

“The government must ensure that the launch of the Interim Scheme and the Main Scheme is accompanied”—

this goes back to the point made by the right hon. Member for New Forest East (Sir Julian Lewis)—

“by an awareness raising campaign to ensure that all potentially eligible patients are made aware of it.”

As I mentioned earlier, 617 people directly harmed by the pelvic mesh implants contributed to the Cumberlege report, and 471 people directly harmed by the pelvic mesh implants provided evidence to the Hughes report. That shows the huge number of women affected by the scandal. I am delighted to see how many Members from across the House have been contacted, as I was by Debbie, by constituents who have been impacted by this. In August this year more than 100 women who experienced pain and complications from transvaginal mesh implants received payouts from three manufacturers of the product, but there was no admission of liability.

I thank the Minister for his time and for giving consideration to the recommendations. I truly thank everybody from across the House for contributing to this debate and I look forward to hearing from them. I finish with a quote from the Hughes report, from a patient harmed by pelvic mesh:

“It always comes back to we innocently trusted that we were having something that was going to fix our embarrassing health condition and then from that we have had our lives shattered. This is not our fault.”

[Several hon. Members rose—]

[Graham Stringer (in the Chair)]

It looks as though hon. Members do not need reminding that if they wish to catch my eye they should bob, even if they have put in to speak. I call Sir Alec Shelbrooke.

13:43

[Sir Alec Shelbrooke (Wetherby and Easingwold) (Con)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate the hon. Member for Harlow (Chris Vince); it is encouraging that new-intake MPs are already raising this issue. As he said in his opening remarks, constituents have been to see their Members of Parliament because of the pain, suffering and injustice that they have gone through, and they are still not getting anywhere. I am not sure who the lady is, but it is very nice to see her in the Gallery because it is an exceptionally important issue for women.

Can we get back to one very important fact about this? We are dealing with people who have had their lives destroyed in the prime of life because of something they were recommended by the NHS. In all honesty, if we were at, say, the dentist’s and they said, “We need to do this to your tooth”, we would say, “Okay.” We would not say, “Can I come back tomorrow?” and then google for any issues. We trust the clinicians and listen to what they say.

Let us flip that coin and give the other side: at the time, a lot of those clinicians genuinely thought that vaginal mesh was, for want of a better description, a bit of a miracle cure. As time has gone on, it has become apparent that it was one of the worst procedures that could ever have taken place, and it is the time lag that has created the problem.

I have spoken about this topic many times. I have described some of the things that have happened to some of my constituents, including people who were once extremely active now not being able to stand up. When my constituent came to see me, she had to do the entire surgery stood up and leant over the table because she could not sit. She was younger than I am now. She eventually managed to take out private loans and have the mesh removed. There lies one of the big injustices: this was something done by the NHS, and the NHS has run away from its responsibility to solve the problem.

I accept that it is difficult for someone who has had the procedure to accept that the surgeon who put the mesh in might be the person who will remove it. But we do not have enough experts in this area, which goes back to the intervention I made on the hon. Member for Harlow: as the review of the NHS comes forward, resourcing must be considered. I have said it before and I will say it again: I believe the NHS to be a misogynistic and sexist institution that was too quick to pat women on the head and say, “Oh well, it’s just what women go through,” in so many aspects of gynaecological health, as well as other things.

I have known the Minister for a long time. I consider him to be a friend, and I know that he is in the job because he fundamentally believes in people’s rights. He has a hard task ahead of him. That hard task is not because of what the Minister wants to drive into place; it is because of the pushback that he is going to get from the NHS and the Treasury, which will say that it cannot be done. He is going to have a tough time, but we can already see that this is not a party political issue in the House. Many of us on the Conservative side criticised our own Government in debates on this subject, because they were getting the pushback from the Department of Health and Social Care and the Treasury—and we said that it was not good enough.

Removing mesh is like taking hair out of chewing gum. It is not a simple operation. It is not just that it breaks up and starts to infect other organs in the body, which is what can cause the incontinence, as it makes its way into the gut; it has now been shown that there are low-level infections within the mesh.

My constituent who finally had mesh removed had a period for the first time in 10 years. Think about that for a moment—being told, “Well, we’re not quite sure what is wrong,” and then, when the mesh is removed, suddenly having periods again after a decade. That shows how much the issue has not been taken as seriously as it should have been. The shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), and I were speaking only last week about a constituent who has a similar issue. Where could she find the mesh centres? There are nine mesh centres, but the issue affects the entire country.

The hon. Member for Shipley (Anna Dixon) mentioned the NHS compensation scheme. We moved on from that because it simply was not working. People were not getting the compensation from the scheme because it was not really accessible, and it was confrontational. That comes back to the point of the NHS doing something but not wanting to take responsibility for it. I am afraid that the Minister will be under pressure from people saying, “You must defend the NHS. That is your job. You represent the NHS. When people criticise the NHS, they are criticising you and the Government.” But that is not true: the Minister will have our full support for pushing back in that way.

This is the Thalidomide situation again—it is as controversial and, frankly, as scandalous as Thalidomide. We are talking about the “miracle drug” that women took in pregnancy to stop them from getting morning sickness, and it took years before it was banned; in some countries, it was used for several years after that. We pay compensation to victims of Thalidomide for the rest of their lives. I am proud to have been the Member of Parliament who in 2012 got the health grant extended for another 10 years. It is now a lifetime health grant. I am proud of that; it is something we did in this House. People turn around and say, “Redress is something we have to assess because there are so many people,” but why is that? There are so many people because the procedure was done willy-nilly and now those involved do not want to take responsibility.

Many other Members want to speak, and I will let them have their say. The Minister has my full support and, I am sure, the full support of many Members here—and he is going to need it. I ask him to stay strong, to keep in mind why we are doing this and to remember the victims who have had their lives destroyed in every single aspect. They must have the redress and the ability through the NHS to have the situation rectified so that they are not borrowing £25,000 to go privately to the same surgeon they would see on the NHS.

13:51

[Anna Dixon (Shipley) (Lab)]

It is an honour to speak under your chairmanship, Mr Stringer. I again congratulate my hon. Friend the Member for Harlow (Chris Vince) on securing this important debate and highlighting the trauma caused to many women, such as his constituent Debbie, by the pelvic mesh scandal.

Before entering Parliament I spent 20 years in the health and care sector, including at the Department of Health and Social Care as a senior civil servant. Patient safety and quality were part of my responsibilities. I was involved with some of the inquiries into tragedies of maternal and infant deaths, such as at Morecambe Bay; with the Government response to the Francis inquiry into the tragic deaths at Stafford hospital; and with subsequent reviews by Sir Bruce Keogh. That is more than a decade ago.

As my hon. Friend was saying, the NHS is fantastic at its best; it is there to heal and cure. But it is a tragedy that there continue to be patients who suffer harm as a result of medical care and treatment. The pelvic mesh scandal, I am afraid, follows a long line of other scandals—not least the infected blood scandal. I am obviously pleased that the Government have recognised the harm caused by that scandal and are committed to a full and fair compensation scheme. Obviously, here we are seeking redress for the women who have been harmed. It is important that we learn from the past as well as prevent scandals such as this from happening again in future.

As has been the case with many other Members, a constituent approached me about this issue. I am pleased with the male allyship on show today. The voices of women are often not heard; there are power issues when it comes to surgeons, who are often male. This follows other scandals involving unnecessary hysterectomies, for example. We need to remember some of the horrific consequences for women such as Julie, who lives in Baildon in my constituency. Her story is similar to some of those that have already been shared. The details are pretty harrowing. Her life has been torn apart as a result of both the mental and physical consequences. I will not go into the details of her case, which are similar to those already mentioned. We must look for redress for the unnecessary suffering and seek to put the issue right.

Like other Members, I pay tribute to Baroness Cumberlege for her work on the review. I have admired her from afar for a long time; in the 1990s, she was Health Minister when I was early in my health career and she did fantastic work on maternity services in 2015. That resulted in recommendations and the setting-up of networks; we have seen progress on that as well as care and advice, and obviously I welcome that. For women who had mesh inserted, particularly for urinary incontinence and vaginal prolapse, it is vital that such services are accessible in every region, as my hon. Friend the Member for Harlow said.

More needs to be done. In particular, under the Consumer Rights Act 2015 the statute of limitation for faulty medical devices is just 10 years. That is obviously too short a timeframe for pelvic mesh, because it can easily take longer than 10 years for the most serious negative effects to come to light. I have written to the Secretary of State for Business and Trade, seeking an amendment to that Act to increase the statute of limitation to 20 years for faulty medical devices and products. I am pleased to say that a review is under way. Will the Minister follow up on that and ensure that the representations made are followed through on behalf of people affected in the future and seek justice?

Drawing on my professional background, I want to address the points made about the products. There are significant clinical trials for drugs and pharmaceuticals, but we do not gather sufficient evidence before products such as mesh go into widespread use. I again urge the Minister and others, including the National Institute for Health and Care Excellence and the National Institute for Health and Care Research, to ensure that all devices and products—particularly implants—go through a proper clinical trial process before they are licensed. That relates to the point about device licensing. Drug licensing is very strict and takes place over many years, but do we have sufficient device regulation for these sorts of implants?

On professional regulation, we obviously give the surgeons the benefit of the doubt and hope that they were using best practice at the time, but we have to recognise that in some cases surgeons and doctors do not operate in the best interests of the patient, and that full informed consent may not be given. We have seen examples of that, even after the problems with pelvic mesh came to light. I urge the Government to look at whether the professional regulation is strong enough.

Since my early work in this area, I have maintained an interest in patient safety. As the newly elected vice-chair for the all-party parliamentary group on patient safety, I look forward to continuing to work with the chair, the right hon. Member for Godalming and Ash (Jeremy Hunt); I worked with him when he was Secretary of State for Health and Social Care. Hopefully, we will work with other Members across the House to improve safety in the NHS and address the pelvic mesh scandal and other issues. I hope that no one suffers in the way that women such as Debbie and my constituent Julie have in the past. We must protect patients for the future.

13:58

[Liz Jarvis (Eastleigh) (LD)]

It is a pleasure to serve under your chairship, Mr Stringer. I am grateful to the hon. Member for Harlow (Chris Vince) for securing this important debate and for the opportunity to speak about the devastating impact of pelvic mesh impacts and the systemic failures surrounding their use.

Among those affected is my constituent Rachel. In 2014, she was assured that a pelvic mesh implant was the best solution to her incontinence, but instead it led to years of unrelenting pain, infections and a diminished quality of life. Repeatedly dismissed by medical professionals, she was left self-catheterising and enduring ever-worsening symptoms. She eventually had to borrow £12,000 for private surgery to remove the mesh, only to find that her pain and nerve damage persisted. Today, she is in debt, relies on strong pain medication, and struggles daily with the physical and emotional toll of her ordeal.

Equally distressing is the experience of Suzi, the daughter of two of my constituents. After her initial surgery to relieve mild stress incontinence, she experienced severe complications, including debilitating pain and a hole in her urethra caused by the mesh. Over the years, she underwent multiple surgeries to remove it. Each time she was told that the problem had been resolved, but each time fragments of the mesh remained, prolonging her suffering and leading to permanent damage. Her pain was dismissed as psychological. Today, Suzi lives with chronic pain, relies on a wheelchair and battles PTSD. Her life, once full of independence, activity and joy, has been irreversibly changed.

Thousands of women have suffered avoidable harm as a result of pelvic mesh implants. The Cumberlege review described the health system that allowed this to happen as

“disjointed, siloed, unresponsive and defensive”,

and recommended a comprehensive response, including the establishment of dedicated redress schemes. The recommendations have not been fully implemented, and there is still no redress scheme. Victims have been failed.

The Government must act now to implement the Cumberlege review in full. That includes accepting the call for a moratorium on pelvic mesh implants, ensuring appropriate care and psychological support, and urgently addressing the lack of redress for victims. The absence of a formal compensation scheme is a glaring failure. Even though the Patient Safety Commissioner reiterated the need for action earlier this year, no meaningful progress has been made.

We know the scale of harm is vast. At least 10,000 women in England have been affected, although campaigners suggest that the true figure may be closer to 40,000. These women trusted the healthcare system and were let down at every turn. They were misled, gaslit and left to suffer alone. They were promised a risk-free procedure, only to endure life-altering complications. When they sought help, they were ignored or dismissed and told that their symptoms were imagined. Women’s health must be taken seriously.

There has been a financial settlement for some women, but it came with no admission of liability. That is not justice. The Government must provide clarity on their plans and not leave my constituents, their families and women across the country in limbo any longer.

14:01

[Daniel Francis (Bexleyheath and Crayford) (Lab)]

It is a pleasure to serve under your chairship, Mr Stringer. I thank my hon. Friend the Member for Harlow (Chris Vince) for raising this important issue. As he did with his constituent Debbie, I recently met with my constituent Paula, who shared her experience of the impact of having pelvic mesh fitted.

In 2015, Paula had her mesh fitted to resolve urinary incontinence, but her experience with pelvic mesh has been painful and inconvenient. Between 2020 and 2023, she had various painful bladder stones that attached to the mesh, and in July 2023 she was informed that the mesh had eroded into her bladder. I understand that the mesh is now cutting into Paula’s urethra, causing her terrible pain and incontinence. Paula will now need to undergo three major operations to remove the mesh, and she has told me of the toll that it has taken on her. In her own words, her life has

“gone from working full time, holidaying, socialising and running, my big passion covering 5k around three times a week, to losing my job,”

not being able to run and feeling “isolated and very depressed”.

Paula now plans her life around the availability of toilet facilities. She is unable to take long journeys and lives in fear of the issues that incontinence causes her. As we have heard, this is an issue that affects many women who, like Paula, say that they did not have the risks and potential harms of surgical mesh properly communicated to them.

It is not mandatory for individuals to report the side effects of surgical mesh to the NHS, so many women like Paula were not properly informed of the potential long-term effects on their health and wellbeing. Requiring side effects to be reported would ensure better regulation and allow patients to fully understand the implications of medical procedures, so I will welcome the Minister’s comments on the points raised by Members and the need to implement in full the recommendations of the Cumberlege review.

14:03

[Sir Julian Lewis (New Forest East) (Con)]

Listening to the heartfelt contributions of so many new colleagues, I get the impression that most if not all of them had, like me, never heard of this problem until a constituent walked into their surgery and told them of the terrible experience that they had had.

I have a practical suggestion: at the end of this debate, which will no doubt follow in the footsteps of several previous debates that were equally well informed, passionate and horrifying, we should perhaps put our names to a joint letter to a man called Nick Wallis. He is a freelance journalist who did a wonderful thing: he researched the Post Office Horizon system disaster and wrote a book called “The Great Post Office Scandal”. If I remember correctly, it was serialised for a week on Radio 4, and subsequently he was the consultant to the remarkable production, “Mr Bates vs. The Post Office”. We can have these debates regularly, as we have been doing, and we can upset and horrify each other by recounting our constituents’ pain and the appalling negligence that led to these terrible outcomes, but until the issue grasps the public imagination, I do not think people will get anywhere.

Interestingly, one point that has not been mentioned is the possible responsibility and liability of the large pharmaceutical company that manufactured the mesh in the first place. What research did it undertake? What responsibility does it have? What help can the Government give people who have been irreparably harmed to go after that company for compensation?

There has been one great positive development, which has been referred to several times, and that is the magnificent work of Baroness Cumberlege, who certainly did the whole community of damaged women the best possible service in conducting that excellent review. The question is to what extent will her recommendations be implemented?

I pay tribute in particular to my right hon. Friend the Member for Wetherby and Easingwold (Sir Alec Shelbrooke), who spoke earlier, and the hon. Member for Washington and Gateshead South (Mrs Hodgson), from whom we are about to hear, for their exemplary leadership of the all-party parliamentary group on this terrible disaster and for keeping the flame burning all these years. I say “all these years” because it has been a long time. Looking back on my own website to check my contributions, I see that this is now the fourth full- scale debate in which my colleagues and I have gone over the same ground. If anybody is interested, the dates of the previous three debates, which were packed with testimony and interesting information, were 19 April 2018 —slightly longer ago from now than the entire duration of the second world war—8 July 2021 and 3 February 2022. It would not be appropriate for me to go over in detail what has been said previously, as it is all there on the record, but it is important to recognise that we are talking about thousands and thousands of damaged women—10,000 at the very least, and as we have heard, some estimates put the number as high as 40,000.

Treatment centres have been mentioned, but there is a particular question about who has the skill to practise in the treatment centres. Who will put themselves forward as being appropriately skilled? It will be the very people who inserted the mesh in the first place.

In one of the earlier debates, I cited a constituent who was 35 when she was given what was described to her as “routine surgery”, 16 years before the debate in question took place. I said then:

“She was initially told that it was her fault that her body was rejecting the two mesh implants. She then went through a cycle of implants, the removal of protrusions and eroded segments and seven bouts of surgery. Three TVTs—trans-vaginal tapes—are still inside her, she suffers chronic pain from orbital nerve damage, constantly needs painkillers and has had constant side effects, indifferent treatment and a refusal to admit fault or to refer her to an out-of-area specialist in mesh removal.”—[Official Report, 19 April 2018; Vol. 639, c. 508.]

[Sir Alec Shelbrooke]

My right hon. Friend has just made an important point. He spoke about the removal of protrusions and seven surgeries. That almost puts a gloss on what has happened. We have all heard from women who have had the surgery and the experience of many of them is that they have been butchered. It is important to make that clear in this debate, especially for new Members, because we have discussed this in Parliament before: when we think of surgery, we think of any other normal surgery, but this surgery leaves huge amounts of scar tissue and has butchered women in ways that I will not go into now. That must be recognised when we describe some of the remedials that have happened, mainly because those carrying them out do not really know what they are doing at this stage.

[Sir Julian Lewis]

Exactly right. That is why my constituent said at the time, “I do not want anyone from the hospital coming near me ever again. I have lost complete faith in them. I have been lied to and told repeatedly that it was my body rejecting the mesh. But unbelievably they kept putting more in.”

Over this period of six or more years I have probably tabled about 12 or 15 questions for written answer, obviously to a previous Government. I will quote three, which were all in the aftermath of the Cumberlege report. In June 2021—for the benefit of Hansard it was question 16777—I asked the Secretary of State for Health and Social Care

“what checks his Department carried out to ensure that surgeons awarded NHS contracts for the removal of failed vaginal mesh implants had not previously been responsible for (a) originally implanting them, and subsequently (b) denying that anything had gone wrong with them; and whether any personnel awarded NHS contracts to work at mesh remediation specialist centres are known by his Department to be currently facing legal proceedings for implanting mesh which injured women who are now seeking its removal at such centres.”

The answer, which came from the then Minister of State, read:

“It is the responsibility of the employing organisations”—

presumably the NHS—

“to ensure that the staff undertaking mesh implantation and/or dealing with mesh complications are qualified and competent to do so. NHS England’s procurement process to identify the specialist centres to deal with the complications of mesh considered a range of clinical and service quality issues. No assessment was undertaken regarding National Health Service contracts or staff facing legal proceedings.”

Somebody in the process of suing a surgeon but still needing ongoing care may have no other option but to go to a mesh centre headed up by—guess who?—the surgeon who she is suing because he damaged her in the first place.

The second written question I will refer to was in July 2021—question No. 31274—which read:

“To ask the Secretary of State for Health and Social Care, with reference to the debate on the Independent Medicines and Medical Devices Safety Review on 8 July 2021…what steps he plans to take to research new and improved techniques for removal of eroded surgical mesh implants.”

As we have heard, it is intolerably difficult to remove this stuff. One would think that the very least the NHS could do would be to make a dedicated effort to develop new techniques for doing it. The description of it being like removing hair from chewing gum is vivid. I have sometimes speculated—I am not in any way qualified to do so—that maybe the answer to this might be to develop some sort of technique that could harmlessly dissolve the material and let it be gradually flushed away, rather than physically trying to disentangle it with the risk of doing more damage. That may be completely and utterly impracticable, but my point is that we do not know because no proper national effort is being made to find a way in which this disaster can be, to some extent, effectively rectified without harming the victims further.

[Anna Dixon]

I think the right hon. Gentleman makes a very valid point. Obviously, from my professional background, I see myself as fairly well-informed, but the scale of the damage done by this particular implant—the pelvic mesh—is also a shock to me. It is really timely that new Members are made aware of this issue. Hopefully, we can support any efforts to continue to raise it, and I commend Members who have been in this place for longer on their work to date.

I hope that the Minister will reflect on the specific point about research. As someone with a research background, I absolutely agree with you—I am sorry, Mr Stringer; I meant the right hon. Gentleman—that more effort needs to be put into research, not only on how we might treat such cases in future, but on the remedial effect.

[Graham Stringer (in the Chair)]

I thank the hon. Lady for correcting herself and acknowledging that “you” refers to the Chair. I also remind all hon. Members that interventions should be brief and to the point.

[Sir Julian Lewis]

That being said, Mr Stringer, I am absolutely delighted that the hon. Lady made that intervention. When someone of her expertise and experience says that even she had not realised the scale of this issue, it shows the magnitude of the task that faces us. This is every bit as bad as we heard in the excellent introduction from the hon. Member for Harlow (Chris Vince)—I apologise for not paying tribute to him earlier. He has done us all a great service by bringing this debate to Westminster Hall. This is on a level with the infected blood disaster, and it deserves the same level of treatment and remediation in so far as that is possible.

Reverting to the written question I asked, the Minister of the State at the time answered:

“There are no current studies specifically relating to new and improved techniques for the removal of eroded surgical mesh. However, there are five studies ongoing on surgical mesh implants and the National Institute for Health Research welcomes funding applications for research into any aspect of human health, including on the removal or implantation of vaginal mesh. There are currently no plans to establish a unit in order to train mesh removal specialists.”

I want to quote a third and final written question of those 15. Question 124936, from February 2022, stated:

“To ask the Secretary of State for Health and Social Care, what recent progress has been made in establishing the South East Regional specialist centre for the treatment of women damaged by mesh implants; and whether checks will be carried out to ensure that such women, when seeking remedial treatment from that specialist centre, are not placed in the hands of surgeons who were responsible for (a) implanting the mesh originally, (b) denying that anything had gone wrong with the implants and (c) claiming that women reporting extreme physical pain from the implants were imagining it.”

After a fairly long paragraph in reply, the answer concluded:

“Patients can discuss their choice of surgeon with the multi-disciplinary team if they have concerns regarding a specific clinician and can also discuss a referral to a surgeon in another specialist mesh centre.”

Think of the conversation that would require. A patient would have to explain to the person who had—to quote my right hon. Friend the Member for Wetherby and Easingwold—“butchered” them that, because they did not want to have his or her ministrations any further, they wanted to be referred to somebody else a long way away. Good luck with all that.

I will briefly touch on some points raised by people in the community of damaged women. I have been told about difficulties regarding personal independence payment applications. It has been suggested that staff managing PIP applications and renewals need better training and understanding of mesh injury. There has been some progress, apparently, in the gradual acceptance that many women had not given informed consent at the beginning, and this is perhaps beginning to make itself felt in relation to the legal actions that some people are undertaking. Just imagine being in constant pain and having the burden of undertaking those legal actions.

There is concern that mesh removal centres do not seem to have the same approach across the board for treatment or surgery. There are also very lengthy waiting lists if someone opts for a second opinion, for the reason I have already explained or any other reason. Mental health support and counselling is not readily available, which is another gap. We have already heard an excellent contribution by the hon. Member for Shipley (Anna Dixon) noting that the 10-year limitation for legal action on medical devices needs to be reviewed, because by the time some women have confirmation that the mesh is the problem, the 10 years could well have passed.

I have already mentioned that the Government ought to be looking to assist the legal cases against the pharmaceutical company or companies. It would be interesting to know whether the Government are making any progress on the subject of interim payments, which I believe the Cumberlege report recommended prior to any more bespoke payments based on individual circumstances. Will the Government encourage the yellow card Medicines and Healthcare products Regulatory Agency reporting to be made mandatory? If people are not reporting in when these things go wrong, how can we be sure of the scale of the problem? Finally, it is noted that there is a clear need for transparency for the public to be aware of exactly what payments medical professionals in the health sector receive from the pharmaceutical industry when they recommend these “routine procedures” that so often go wrong.

I conclude with a case that I have deliberately anonymised. Nothing should be drawn from where I happen to represent as to which surgeon in which mesh centre I might be referring to. This is what one victim has said about someone I will call surgeon X. He

“operated on me in 2009 to insert the mesh, which was described as a simple procedure that would solve my problems. Mesh was eroding through the vaginal wall immediately, and I had seven further ‘repair’ surgeries, which did not solve the erosion problem. In 2016, he advised me he could remove the mesh, so I paid privately for the surgery. During the surgery, nerves were damaged, causing severe pain and limitations, and the mesh was not all removed. I am left with the pain and limitations permanently, and have been told by another surgeon that full removal is now not possible. This surgeon is the clinical lead of the mesh centre”

local to her. She concludes:

“No surgeon should ever be allowed to cause damage to multiple patients, yet not only continue to perform the same surgeries, but to be head of the very centre which should be helping women. I feel sick at the thought of passing him in the street, let alone needing to see him as a health professional. I am sure we all feel the same.”

14:24

[Mrs Sharon Hodgson (Washington and Gateshead South) (Lab)]

Do you want to give some guidance on how long is left, Mr Stringer, so I can cut my speech accordingly?

[Graham Stringer (in the Chair)]

I intend to call the spokesperson for the Liberal Democrats at 2.30 pm.

[Mrs Hodgson]

In the short time I have available, I will try to make some important points. It is a pleasure to serve under your chairmanship, Mr Stringer. As co-chair of the all-party parliamentary group for first do no harm—along with Baroness Cumberlege, who it is a pleasure to see in the Public Gallery—it is a pleasure to speak in this important debate. I also point out how many officers of the all-party group are here in the Chamber, on a Thursday and on a one-line Whip. That speaks for itself as to how important the issue is to the House and to all of us. I thank my hon. Friend the Member for Harlow (Chris Vince) for securing this important debate to shed further light on this still under-discussed scandal.

Members present, campaigners watching at home, and especially patients, will all be aware of the extent of the injustice. I have had the privilege of working with wonderful campaigners over many years, and I take this opportunity to pay tribute to Kath Sansom from Sling the Mesh, who is a key campaigner for mesh victims and has been a great support to me and to colleagues over the years. I am glad that she is in the Public Gallery to watch the debate, alongside Debbie, who is the constituent of my hon. Friend the Member for Harlow, and who brought this scandal to his attention.

My first contribution in this House on surgical mesh was in 2017, during my time as shadow Minister for Public Health, and I am glad to see the actual Minister for Public Health and Prevention in his place to hear this debate. I have continued to campaign tirelessly on the issue through debates and my work with the all-party group ever since.

The issue is not only of political importance to me; it matters to me on a profoundly personal level. As I am sure some in the Chamber will know, among the thousands of women affected by mesh complications is my mam, who was one of the 617 mesh-damaged women who met, or made submissions to, Baroness Cumberlege for her review. I took my mam along to an evidence session in Gateshead, and she was able to meet Baroness Cumberlege and tell her story personally. She still talks about that to this day—she is very grateful.

After suffering mild stress incontinence, as we have heard from a number of people who went through the procedure, my mam had SUI surgery to have some tension-free vaginal tape inserted, which was a quick and common treatment offered to women for incontinence. However, had she known the life-limiting complications she was about to suffer as a result, dealing with slight stress incontinence would not have seemed very bad at all.

Two to three years post-surgery, my mam had one health complication after another. She suffered all sorts of autoimmune reactions, recurrent urinary tract infections, and was in constant pain in her groin, arms and legs. She became a shadow of her former self, and it took us quite a few years to work out what was causing the symptoms and pain. It was only through my research for that debate back in 2017 as the shadow Minister that I was able to join the dots together, and from that moment on we both wished constantly that she had never had the operation.

My mam will be 80 in January, and she would say that she is one of the lucky ones. Since I first spoke on the topic, she has been able to get the mesh surgically removed. It was a long delicate operation, thankfully carried out by the amazing Suzy Elneil, which she had to undertake in London in order to avoid the surgeon who put it in her in the first place—something that the right hon. Member for New Forest East (Sir Julian Lewis) and others have spoken about. That is something that many mesh-damaged women will understand. With the removal of the mesh, many of her health complications vanished immediately. The road to recovery is far from smooth for many mesh-damage victims, however, and my mam is no exception. She is still recovering to this day and, in her words,

“will never be the same again.”

I sat next to my mam at her local hospital and watched her be gaslit and undermined by her original surgeon when she first sought help with her pain and symptoms. Our doctors, surgeons and healthcare providers are meant to protect us, not harm us. Hence, “first do no harm”—an unwritten contract between patients and healthcare providers that rightly makes us feel that when we seek medical help, we trust that we will be made better, not worse. Surely the least we can expect in cases where harm does happen is accountability and for wrongs to be righted. Instead, we see a culture of defensiveness and a lack of accountability. It is therefore shocking that the surgeons responsible for the implantation of this life-shattering mesh are the very same people tasked with removing it.

I was going to talk about Baroness Cumberlege’s recommendations—which we have had success with and which we have not—but sadly the right hon. Member for New Forest East used up all the time, so I cannot.

14:30

[Sarah Green (Chesham and Amersham) (LD)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank the hon. Member for Harlow (Chris Vince) for securing today’s debate. We are here because four years after being published, the Cumberlege review has not been implemented and there is still no redress scheme. I will turn in more detail to the progress made on those recommendations, but first I pay tribute to the many individuals who have campaigned so hard for so long to be heard, for their experiences to be taken seriously, to receive some sort of justice, and to know that the same harm will not be done to others. Some of them are in the Public Gallery today and I thank them for their tireless campaigning.

I also pay tribute to the right hon. Member for Godalming and Ash (Jeremy Hunt), when he was Health and Social Care Secretary, and to the former Member for Maidenhead, when she was Prime Minister, for commissioning the review in the first place in February 2018. Baroness Cumberlege has never stopped giving voice to those she encountered during the two years she led that review. She has gone to great lengths to keep this issue on the agenda. She is due to retire shortly and we will miss her. I would like to say how grateful I am, as I know others will be, not just for her advocacy on this issue but for her encouragement and support of hon. Members in this place to do the same. If I may be so bold, Baroness Cumberlege has played her part. It is now up to us in this place to hold this new Government to account and to ensure that her recommendations are implemented in full.

Let us not forget that the Cumberlege review was called “First Do No Harm”, because at its centre are people who suffered avoidable harm—harm done to them by our health system. I was first introduced to this issue by my constituent Carol. I have shared her story before and remain in awe of her dignity and desire to help others despite having experienced the most devastating medical trauma. She needed her MP to help her get a visa for the United States for urgent medical treatment during the pandemic because of the travel restrictions that hon. Members will remember. She had undergone a hysteropexy and a rectopexy using surgical mesh.

Instead of resolving Carol’s pelvic organ prolapse, the procedures left her with a serious autoimmune disease, struggling to walk and unable to continue her normal daily life. She had to take long-term sick leave from her job as a doctor and could not remember a day without pain. When she contacted me for help with her visa, she was seriously unwell and had been told that she urgently needed her mesh removed or her prognosis was not good. We managed to get her the visa she needed. She is now mesh-free following a successful removal, and she is the first person in England to have undergone successful rectal mesh removal. She is still suffering, but is no longer in the same danger that she was. She is clear that she was able to look outside the NHS and the UK only because her medical training and personal resources enabled her to find Dr Veronikis, who treated her successfully. I should say at this point that there needs to be more awareness of rectopexy mesh, which affects men, women and children.

Carol and others like her were given hope when the Cumberlege review was initiated, and again when it was published in July 2020 with its nine recommendations. I am sorry that to say that not enough progress has been made on those recommendations since. The reality is that only two of the nine recommendations have been implemented in full. The first was an apology, which was given as soon as the report was published. The second was to establish the office of the Patient Safety Commissioner.

Beyond that, things have stalled. Recommendations 3 and 4 called for an independent redress agency, and for redress schemes to be established for all three interventions. After originally rejecting those two recommendations, the Health Minister at the time asked the Patient Safety Commissioner in late 2022 to look at the options for providing redress for those who had been harmed by mesh and valproate. The commissioner’s report—the Hughes report—was published in February. I was present at its launch, and it really felt like a milestone; it felt as though progress had been made. Surely the Department would not commission that work if it had no intention of following through on a redress scheme.

That was in February this year. By the summer, when the election was called, the previous Government were still saying that they would respond to the report, so they never gave a formal response. To date, there has been no official response from the new Government to the Hughes report. In the words of the Patient Safety Commissioner:

“it is now urgent for the government to give those families some clarity. Many of them live with pressing financial hardship, as well as physical pain and disability…we must not compound the physical and mental harms experienced by these families by setting and raising false expectations if there is no intention to deliver on redress.”

[Mrs Hodgson]

I am grateful to the hon. Lady for covering the recommendations, which I was not able to do. That has relieved me somewhat. We have at last seen some compensation for the victims of Windrush, the infected blood scandal and the Horizon scandal. Does she agree that it is incumbent on the Government to treat this scandal with the same seriousness, fully accept recommendation 4 and put the redress scheme in place?

[Sarah Green]

I could not agree more. This is where I must pick up Carol’s story again. She tried to pursue her claim against her original surgeons through the courts, and she hit on an unexpected problem. She approached multiple legal firms who would not take her case because one or both of the surgeons were advising them on other cases and, as such, it would have been a conflict of interest. Indeed, the same surgeon who caused Carol life-changing injuries acted as an expert witness in an unrelated surgical mesh negligence case. The judge in that case said:

“he had cherry-picked those parts of the evidence which were supportive of the Defendant’s case and did not comment on those parts which were consistent to the Claimant’s. That is not the correct approach to be taken by an independent expert, whose duty is to the court. His evidence lacked balance and was unpersuasive.”

On this occasion, the judge called it out, but that is not the only instance of the medical profession closing ranks—it is not a unique occurrence. Such clear bias and conflicts of interest are a huge barrier to justice for mesh victims around the country.

The point of recommendation 3 in the Cumberlege review was to establish a non-adversarial avenue for redress after someone has been harmed in a healthcare setting. Both the Hughes report and, more recently, the Darzi report found that the current clinical negligence system is difficult for patients to navigate and prevents the healthcare system from learning from its mistakes. It is also eye-wateringly expensive for the taxpayer. If it is the dead hand of the Treasury blocking a redress scheme, Ministers would do well to reflect on that. As the Patient Safety Commissioner points out, the clinical negligence system is behind only nuclear disarmament and pensions on the list of liabilities on the Government’s balance sheet. I must ask the Minister when the Department will respond to the options outlined in the Hughes report, and when families can expect to see redress schemes up and running.

Recommendation 5 relates to the establishment of mesh centres around the country, and while such centres have been established, they get mixed reports from patients. My question on the mesh centres is about their outcomes. How is the Department ensuring a consistent service across them all, and how are outcomes being measured? With so many people reporting dissatisfaction with the centres, it is not enough that they exist; they need to be working well for the patients they are there to serve. Recommendation 6 relates to the MHRA, and it is clear that we still need the yellow card reporting system to improve. I would also welcome the Minister’s thoughts on progress against recommendation 7, which is about creating a central patient-identifiable database. To my understanding, it is still a work in progress.

The previous Government’s decision not to take forward the eighth recommendation, which is for a mandatory register, is disappointing. The recommendation called for

“Transparency of payments made to clinicians”

and

“mandatory reporting for pharmaceutical and medical device industries of payments made to teaching hospitals, research institutions and individual clinicians.”

I fail to understand why more progress has not been made on that. I know that campaigners have written to the Department asking it to consider a sunset Act that speaks to that recommendation, and I urge the Minister to chase a response to them.

[Graham Stringer (in the Chair)]

Order. The 10-minute time allocation is up. I now move to the official Opposition.

14:40

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate the hon. Member for Harlow (Chris Vince) on securing this important debate. I draw Members’ attention to my entry in the register of interests, as I am a practising NHS consultant, although in paediatrics rather than in any form of gynaecological surgery.

I begin by expressing my heartfelt sympathies to the women affected by injuries from pelvic mesh and, indeed, mesh in other sites, as we have heard about. Mesh is a surgical material and technically, therefore, a medical device, which was implanted in thousands of women to treat organ prolapse and urinary incontinence. However, in many cases, as we have heard today, it has caused serious long-term effects, including chronic pain, infections, organ perforation and, in some cases, permanent disability, which continues even after the mesh has been removed.

The exact number of affected women is still not known. Some have estimated the number to be 10,000, and today we have heard an estimate of 40,000. However, it is clear that it is a very large number of women. I echo the hon. Member for Chesham and Amersham (Sarah Green) in thanking Baroness Cumberlege, the Conservative peer who published the independent medicines and medical devices safety review in 2020. The review panel spoke to more than 700 women and their families from across the country. The document is exceptionally comprehensive, and it puts patients’ and families’ views at the heart of the review. Their experiences make for harrowing reading. The women speak of lives damaged, families put under immense strain, relationships destroyed, careers broken, financial ruin and chronic pain.

Last week, I spoke to a woman who is suffering after having had such mesh put in. Following the surgery, the skin never healed because of a low-level infection. That lady faces awful difficulties. The mesh is visible through the skin, from the surface. It is incredibly difficult to remove. Indeed, she has not been able to find a surgeon who is willing to even try to remove it, so she suffers in the house, unable to go out and experiencing infection after infection, an increasing number of which are resistant to some antibiotics. She knows that without the mesh removal, her prognosis is poor. It is an awful situation to be in, as I am sure the Minister will agree. I know he will be doing his best to try to help. Our healthcare system has to learn from those it has failed, such as that lady, and ensure that patients are put at the front and centre of healthcare so that this cannot happen again.

The Minister needs to focus on two things: how we help those affected by the mesh scandal, and how we prevent similar incidents with medical devices that we do not yet know the harms of, or that may not yet have been invented. People should not have to pay privately for treatment to rectify things that the NHS has done wrong. When someone has had a mesh put in and the mesh needs removing, the NHS should pay for that care. If the NHS cannot provide it, the NHS and the Minister must find a way of funding that care, provided by whoever can provide it, so that women are not financially out of pocket to the tune of tens of thousands of pounds for something that is not their fault.

The nine centres have been set up, and that is a good thing; they have been set up with a full multidisciplinary approach, which is also good. However, as we have heard, the outcomes are not 100% good in all cases. Surely it is intuitive that women should not have to see the same surgeon again. They should not be forced to make that explicit. It should be automatic, unless they want to see the same surgeon; it should be an opt-in system.

I urge the Minister to look at what the centres do. They provide help for women who have had pelvic mesh repair, but there are people suffering with mesh problems who have had mesh put into other places, for example near the rectum or in the abdominal wall. That may be women, but it may also be men, and they may suffer quite significant problems as a result. They need a centre, or several centres, of people who can support them and ensure that their mesh is removed, or their treatment needs are met, to stop the suffering they are experiencing.

We need a balance between ensuring that a similar scandal does not happen again and that long-term effects are picked up, and not restricting people’s access to new and innovative good treatments. In this place, we often have debates on treatments that are widely available, but not necessarily available here yet. We want to make good treatments available here quickly, but we need a robust system to identify problems as quickly as possible.

Part of that system includes the Medical Devices (Post-market Surveillance Requirements) (Amendment) (Great Britain) Regulations 2024, on which the hon. Member for Harlow, the Minister and others were recently involved in debate. When that statutory instrument was discussed in the Lords, the noble Lord Cryer said that the Government intended to introduce implant cards, and that the SI was part of a wider review of the regulation of medical devices that would be carried out in due course. Will the Minister give us some information on what that will entail? What are his thoughts on the process, and when will it happen? People need these things quickly.

I recognise the work that my right hon. Friend the Member for Wetherby and Easingwold (Sir Alec Shelbrooke) has done over a long time on many topics affecting women’s health, including the menopause and other concerns, and I congratulate him on that work. He represents female constituents very effectively. He talked about the fact that when surgeons inserted pelvic mesh, they often thought that it was the right thing to do. Only over time did it turn out not to be the panacea that it had been thought to be.

I remember in my medical training being told that a good surgeon is not just a surgeon who can operate well; the best surgeons are those who know when they should not be operating. It is very sad to hear that for many of the women, treatments that did not involve surgery could have been done instead, and that would have meant that those women did not suffer in the way they have done.

I highlight the point made by the hon. Member for Shipley (Anna Dixon) and my right hon. Friend the Member for New Forest East (Sir Julian Lewis) on the importance of research. When we are trying to resolve the problems caused by the mesh, we need to know that we are doing that in the most effective way. We need someone to look at the clinical outcomes and ask what we are doing, whether we are doing it in the best way and what other options might be available. This problem is not limited to the United Kingdom. What is being done elsewhere? Are there international comparators that do this better, and can we emulate what they are doing?

What we need from the Minister is rapid action to address the problems faced by women who have had this mesh put in. We need him to assure us that he is doing what he can to introduce proportionate regulations that will ensure that any other devices in use and in circulation across the United Kingdom do what they are supposed to do, and do not do any harm.

[Graham Stringer (in the Chair)]

I remind the Minister to leave two minutes at the end for the Member who secured the debate to reply.

14:49

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

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate my hon. Friend the Member for Harlow (Chris Vince) on securing such an important debate on pelvic mesh and the independent medicines and medical devices safety review, also referred to as the Cumberlege review. We are all privileged to see the noble Lady Baroness Cumberlege in the Public Gallery. We thank her sincerely for the work that she has done over a number of years on women’s health, and on this issue in particular. I also thank my hon. Friend for the opportunity to contribute to this vital debate.

I am responding today on behalf of Baroness Merron, who leads on women’s health and patient safety in the Department of Health and Social Care. I will try to address as many as I can of the issues that right hon. and hon. Members have raised in this debate. If for any reason I do not get round to addressing something, I will ensure that Baroness Merron, as the Minister responsible, writes to Members.

This debate came about because of a meeting between my hon. Friend the Member for Harlow and one of his constituents, Debbie. As we have heard, Debbie described undergoing a failed procedure to remove vaginal mesh, which has caused her severe pain. She has remained in constant pain since the operation, and I express my deepest sympathy to her for her ongoing experience. It should never have happened.

My predecessor as a Minister, Nadine Dorries, placed on the record in 2020 the previous Government’s apology. We are a new Government, so I take this opportunity to make the same apology today on behalf of His Majesty’s Government elected on 4 July. This should not have happened, and I say to every single person it has happened to that we are sorry and we have a duty to put things right. That is what this Government will seek to do, and at pace.

This Government will build a system that listens, hears and acts with speed, compassion and proportionality. Complications from vaginal mesh can be devastating and have included severe and chronic pain, recurrent infections, reduced mobility, sexual difficulties and psychological impacts. It can be hard to imagine the avoidable suffering that many women have endured and the damage that has been inflicted on their lives. It is unacceptable that concerns raised by women were not listened to and that women were left to suffer alone. It is vital that we acknowledge those failures and ensure that the mistakes of the past are not repeated.

I assure the right hon. Member for Wetherby and Easingwold (Sir Alec Shelbrooke) that the 10-year health plan that the Government are consulting on will ensure a better health service for everyone, regardless of their condition or service area. A core part of the development of the 10-year plan, including its approach to women’s health, will be an extensive engagement exercise with the public, NHS staff and stakeholders.

We have heard about the nine specialist mesh centres that NHS England has established across England. The intention behind them is that every woman, in every region, who experiences mesh-related complications receives the appropriate support.

I hear the message of my hon. Friend the Member for Shipley (Anna Dixon) that more needs to be done on accessibility, outcomes and listening to women. I agree, and I will take that message back to Baroness Merron.

I share the concerns of the right hon. Member for Wetherby and Easingwold—I thank him for his support on this—about the battles and challenges that lie ahead to get the system right. The Government will consider how we build on existing provision in a sensitive way that meets the needs of the women. At the heart of all we do to try to put things right is addressing the needs of the women involved, and their families, who have been so dramatically affected by what went so tragically wrong.

Each mesh centre is led by a multidisciplinary team that comprises urology, gynaecology and colorectal consultants, in addition to nurses who specialise in a range of things that I am unable to pronounce, and in urology and incontinence, which I can pronounce. Patients also have access to other healthcare professionals, including psychologists, occupational therapists and pelvic floor specialists, to help with pain management.

I recognise the trauma that women have experienced and the vital need to exercise patient choice. That is especially true for women who are rightly concerned about being treated by a surgeon who previously operated on them. I hope that things have moved on since the answer that the right hon. Member for New Forest East (Sir Julian Lewis) received, but I will ensure that what Members have said, with the sincerity and the strength of feeling, is communicated back to Baroness Merron. I agree with the right hon. Gentleman that the process set out in that written ministerial answer is not acceptable. Yes, women have the right to choose treatment from another surgeon, but I actually agree with the shadow Minister that there should be an automatic assumption that their treatment should be done by somebody who did not operate on them previously, unless that woman does not mind. That is a stress and a trauma for many women, and we have to think about their rights.

I also recognise that there is a need to support GPs’ knowledge and understanding of pelvic mesh so that they can identify the symptoms of mesh complications and refer patients on to the appropriate services. I do not want any woman to be in the position of my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson), or any other woman who has had her body tampered with in the most inappropriate way, when the procedure was not even necessary, and has suffered lifelong complications as a result. We have to move on at pace.

Following Baroness Cumberlege’s recommendations in 2018, the national pause on mesh remains in place for the use of vaginally inserted mesh to treat prolapse and the use of retropubic suburethral mesh sling to treat stress urinary incontinence. That means that mesh can be used only in exceptional cases where clinicians are of the opinion that there is a clinical urgency and no suitable alternative exists. NHS England continues to monitor progress on the conditions associated with the national pause and will only make changes to it linked to clinical advice and following consultation with a wide range of stakeholders, including patients, professional bodies and NHS organisations.

The Cumberlege review made nine recommendations, and the then Government accepted seven. Of those seven, four have been delivered, including the appointment of Dr Henrietta Hughes as the first Patient Safety Commissioner in England, the establishment of nine specialist mesh centres across England and the establishment of a patient reference group. Through our ongoing work, the Government are committed to delivering on the remaining three recommendations.

On redress, I will mention briefly the recommendation set out in the Hughes report, which was published in February. I first thank the Patient Safety Commissioner, Dr Henrietta Hughes, for her commitment to improving patient safety. Although the Government are not yet in a position to comment on the recommendations, I assure Members that we are considering the wide range of work set out in the report. I agree with the hon. Member for Eastleigh (Liz Jarvis) that the previous Government were too slow on that. It is a priority for this Government. We are working at pace, and we remain focused on making meaningful progress. This is a complex area of work, involving several Departments, but we are committed to providing an update at the earliest opportunity. I have heard the desire for urgency today, and I hope that we can make the progress that Members want to see.

I am afraid that I have left my hon. Friend the Member for Harlow 30 seconds to sum up, but I hope we have made some progress.

14:59

[Chris Vince]

I thank everyone who has spoken about this vital issue. At its heart, it is about women who have been let down and made to feel guilty because they are the victims. That is just not right.

I thank everyone who has taken part in this debate. My right hon. Friend the Member for New Forest East (Sir Julian Lewis)—today, we are all hon. Friends—rightly said that we have had this debate time and again. My ask is for the next debate to be after a ministerial statement—

[Graham Stringer (in the Chair)]

Order.

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

Higher Education: Financial Sustainability

Thursday 5th December 2024 Westminster Hall

[Valerie Vaz in the Chair]

15:00

[Adam Thompson (Erewash) (Lab)]

I beg to move,

That this House has considered the financial sustainability of higher education.

It is a pleasure to serve under your chairship, Ms Vaz. Our universities are integral to a thriving United Kingdom. They drive economic growth, ensure that the workforce has the skills necessary for the jobs of tomorrow and boost the UK’s global standing. They are engines of social and economic progress, but behind those important functions lies an equally important reality: the financial sustainability of this vital sector and our economy.

For almost a decade, universities have faced declining investment, despite recognition of our world-leading higher education and research system. As the chair of the all-party parliamentary university group, vice-chancellors from a range of institutions have told me that the pressure to deliver world-class teaching and research with less is becoming more acute. The Government’s announcement on 4 November 2024 of an inflationary increase in tuition fees in England cannot have been an easy decision, but it was necessary. Prior to that announcement, tuition fees had risen only once, by £250, since the introduction of £9,000 fees in 2012. Inflation has cut their value to just £5,924 in 2012-13 prices, while Government grants for teaching have declined by 78% over a decade in England.

The financial picture across the UK is equally challenging. Welsh universities had their fees capped at a lower level than English institutions until 2024, and over the past decade, funding per student in Scotland has declined by over £2,500. In Northern Ireland, funding per student has lagged behind England by over £1,000 a year. The Office for Students estimates that by 2025-26, there will be a net reduction in income for the sector of £3.4 billion and, without significant mitigating actions, a sector-level deficit of £1.6 billion, with up to 72% of providers being in deficit and 40% having low liquidity.

[Jim Shannon (Strangford) (DUP)]

This is a really important debate, but it does pose a question, and I want to ask the hon. Gentleman for his thoughts on it. He referred to the cost of living pressures that every family has, wherever they may be in this United Kingdom. I suspect that those, combined with the increase in higher education fees, will mean that we are in danger of going back to a state where only well-off families can afford to have their children in university, while the rest will have to go to work to provide the moneys just to live. Does he share my concern about that?

[Adam Thompson]

The hon. Member raises an excellent point, and it is important that we bear that in mind. This is a danger that we need to contend with. The conversation that I hope to start with this debate is about how we might address those issues going forward, and I will touch of some of those points in my speech.

I know from conversations with vice-chancellors that while the causes of the funding challenges vary significantly between institutions, they all feel the pressure to deliver more for less. An inflationary rise in fees is important, because it prevents further erosion of university funding for teaching undergraduates, but it does not reverse the real-terms decline in the value of the tuition fee. That is why there needs to be a concerted and strategic effort by universities and the Government to secure the long-term financial sustainability of our universities—that touches on the point made by the hon. Member for Strangford (Jim Shannon).

What are the main financial risks that universities face? Analysis from PwC shows that a significant number of universities are vulnerable to reductions in international student numbers, increased expenditure and reduction in the growth rate of domestic undergraduate students. The risks identified by PwC’s analysis are not just hypothetical. In many cases, we are already starting to see their impact, especially in terms of international student recruitment. After almost a decade of stagnation, the UK experienced a period of significant growth in international student numbers between 2019 and 2022, driven by a combination of Government policy and the openness of the UK immediately following the covid-19 pandemic.

However, the numbers of international students choosing to study in the UK has since declined, as both political and market factors have changed, and the attractiveness of the UK as a study destination has fallen. According to data released by the Home Office on 28 November, 392,969 visas were issued to international students between October 2023 and September 2024. That is 19% fewer than were issued in the previous year.

Universities understand that growth in international student numbers must be sustainable and that the experience for those choosing to study here should be truly world-class. However, policy changes under the previous Government, such as restrictions on dependant visas, increased visa and immigration costs, and threats to the future of the UK’s post-work study offer, have had a significant impact on the attractiveness of the UK as a study destination, as well as the perception of the UK as an open and welcoming country.

A key finding from IDP’s “Emerging Futures 6” report was that the biggest influence on study destination choice for prospective students was post-work study opportunities, and indeed work opportunities. I commend the Secretary of State for Education for reaffirming the Government’s commitment to supporting and valuing international students. Will the Government back that up by committing to maintaining the graduate route on its current terms for the duration of this Parliament?

Another significant financial risk is membership of the teachers’ pension scheme, which affects a lot of universities. Universities that are statutorily obliged to be members of the TPS—primarily modern post-1992 universities—are now required to pay pension contributions of around 29% for 58,000 members of staff compared with 16.4% in 2019, which is a very significant increase. That is one of the highest employer contributions of any pension across the whole country. Universities cannot exit the TPS or take actions to reduce the employer contribution, and they have not been granted the same additional funding as schools and colleges to meet the cost of the scheme. Will Ministers in the Department for Education commit to working with Ministers in His Majesty’s Treasury to explore how universities can be provided with flexibility to allow consideration of alternative pension pots?

I will turn to the structural issues in university research funding, and in my background as a research scientist, that was something I faced daily prior to my election to this place. Research funding risks seeing the UK’s world-class capabilities and competitive advantages being eroded. Despite recent increases in investment, the current system relies on disproportionate and growing cross-subsidy from universities to make research viable, which, given the current financial challenges faced by universities, has produced a huge gap in funding.

To cite the VCs that I have spoken to recently, research operates at a loss, which is a significant issue that they face. It is estimated that for every pound of public money invested in university research and innovation, the country gets back £10 a year—a huge return on investment. But in 2022-23, UK universities incurred a £5.3 billion deficit in research activities. In short, the system is structurally unsustainable. Although the Budget recently highlighted how serious the Government are about funding university research, we urgently need an ambitious and long-term approach from the Government to funding university research. I would welcome the Minister’s views on that point.

Why does all this matter? The UK’s performance in HE and research is exceptional, in my opinion and life experience, and it surpasses significantly our international counterparts. UK universities deliver the highest degree completion rates across the OECD. They are recognised as world-class and generate £25.6 billion of export earnings, while broadening the UK’s soft power and strengthening global relationships. The UK has the third largest share of the world’s academic publications at about 6.3%—that is what I spent much of the last decade of my life producing—behind only China and the United States, with an even larger share of the world’s most highly cited publications at 13.4%, which is a great achievement and shows how good our universities are.

The latest figures show that the UK higher education sector’s teaching, research and innovation activities had an economic impact of £265 billion, so we are talking about a huge sector here. This impact is felt across the country, including in the east midlands, which I represent, where universities contributed £6.3 billion in gross output and £4.2 billion in gross value added to the UK economy. These figures include contributions from my former employer, the University of Nottingham, and a range of other excellent institutions across my region, all with unique and valuable offerings to their communities and beyond.

Underfunding will restrict universities’ ability to drive inclusive economic growth and the UK’s global competitiveness, and to provide opportunities to current students that are comparable to previous years. Sustained funding that ensures a high-quality student experience and enhances the UK’s ability to deliver world-leading research and innovation will rapidly accelerate the positive contributions of our universities.

The current funding system in England affects students’ ability to meet living costs, which touches on points made by the hon. Member for Strangford, and it is hard to make the most of the range of experiences and activities that make up university life. Frozen household income thresholds and a failure to adequately uprate the maintenance package with inflation mean that the average student’s maintenance loan is estimated to fall £504 short of covering their living costs each month. That particularly affects disadvantaged students, who are forced to take on higher levels of debt and find paid employment, which limits their ability to study. I commend the Government for last month announcing an inflationary increase to maintenance support for students in England, but will they commit to reintroducing maintenance grants for students from the most disadvantaged backgrounds? Can they indicate a timeframe of when that might be possible, if it is indeed possible?

Greater effectiveness and efficiency are necessary for our universities to thrive in the coming decade. They must reform and do things differently, and prioritise some things while deprioritising others. Operating models need to evolve to become more effective and efficient. I know from conversations with vice-chancellors that universities in all four nations in the UK are already making significant changes to adjust to these pressures, including in some cases through significant restructuring and transformation programmes. Indeed, around the time of the election, as I was leaving my former employment, my own university was going through a significant redundancy package.

Without a small change to the overall context, many universities will be forced to make cuts that are in the interests of their institution but not the national interest. Such cuts will jeopardise the crucial role that all types of universities play in their local communities. Some have a profoundly local mission of educating the public sector workforce for their local areas, while others attract amounts of investment. They all play a part throughout the country.

Many of our universities are currently making difficult decisions, which colleagues will know, I am sure. This means closing degree courses that may have low student demand but are of national strategic importance, such as modern foreign languages and arts and humanities courses. We are losing a lot of those courses. There is a real risk that certain courses will be available in a limited number of institutions only, meaning that they will slowly recede out of the reach of students who cannot travel to study or cannot meet highly competitive entry requirements.

Diminished financial stability for universities clearly has potentially harmful repercussions for students, staff and our wider national economy. Therefore, it is essential that change is not just about doing more with less. Universities’ underlying operating models need to evolve to become more efficient and as effective as possible. They must be supported by the Government to do so at the national level.

My understanding is that Universities UK, the collective voice of 141 UK universities, is committed to establishing a cross-sector transformation and efficiency taskforce to seek savings through greater collaboration. The task force is one of the main recommendations from Universities UK’s recent report “Opportunity, growth and partnership: a blueprint for change”, which I strongly encourage colleagues to have a good read of. The taskforce will be established by the end of 2024 and will report for the first time in summer 2025.

The taskforce will take a three-step approach. First, it will evaluate progress and lessons learned since the last major review into sector efficiency, identifying what has been achieved in the past decade while looking forward to the next and making recommendations to unlock opportunities that lie ahead. Secondly, it will identify opportunities for savings through greater collaboration between universities.

There are already some great examples of collaboration. The UCAS system is effectively a shared service, with the university sector’s IT network run by Jisc. Individual universities have found creative ways of working together to share resources, such as the shared out-of-hours IT service set up by Northumbria University, which is now used by a third of universities around the country.

Finally, the taskforce will bring university leaders together to look at structural changes, creating regional groupings of universities, or even mergers and acquisitions where appropriate, which could deliver savings in the long term. I strongly encourage the Government to engage with the sector as deeply as possible as it embarks on the creation of the taskforce.

I will now turn to the steps necessary to support our universities so that they can in turn support our nation’s renewal. Universities UK’s recent blueprint report recommends a two-phase approach for universities and Government. Phase 1 requires some immediate steps, including

“increasing funding for teaching to meet the real costs through a combination of index-linking fees to inflation”

each year and restoring the teaching grant to previous levels. The Exchequer now only contributes 16% of the cost of funding a student through higher education, with the other 84% picked up by the graduate in England. The balance needs redressing through increased Government investment.

Other parts of the first phase outlined in the report include

“ensuring policy stability in relation to international students in order to achieve sustainable, managed growth”

and

“working with the sector to establish a sustainable solution for universities in relation to the significant increase in contributions to the teachers’ pension scheme”.

Finally, Government and the sector should have

“a clear plan to implement should an English university find itself in severe financial distress.”

That is a very real possibility at the moment, although alleviated by the Government’s recent efforts.

The report also recommends:

“Plans to manage the immediate situation and to protect the reputation of the higher education sector should be in place, with the support of independent experts, to guide the institution”

in financial difficulty

“in finding a viable way forward. There are different possible models for such an intervention, but it is crucial to protect students and others who depend on the university, including local public services.”

To summarise, the second phase of the taskforce effort will involve some longer-term steps, which will probably include developing a contract

“with the university sector to deliver sustainable, managed growth in international student recruitment”,

changes to the way that VAT is charged so that it is easier for universities to share services and, finally,

“introducing a transformation fund to enable and accelerate changes to universities’ operating and business models in order to achieve greater efficiency.”

15:17

[Rachel Hopkins (Luton South and South Bedfordshire) (Lab)]

It is a pleasure to serve under your chairship, Ms Vaz. I congratulate my hon. Friend the Member for Erewash (Adam Thompson) on securing this important debate today, and making such a comprehensive speech with some very important points, many of which have been made to me locally as the MP for Luton South and South Bedfordshire.

Great universities are one of our success stories here in the UK, with rankings showing that Britain boasts more top-ranking institutions than across the entirety of the EU, and the UK having long been an attractive destination for students and academics from around the globe. The University of Bedfordshire, in my constituency, is no exception. I declare an interest both as a former employee and a former masters student.

With an education heritage going back more than 100 years, first as a technical college, subsequently a college of higher education and now a university, it is an internationally recognised, award-winning institution that plays an important role in Luton and the surrounding area. It gives young people from less advantaged socio-economic backgrounds, who are often the first in their family to go to university, the opportunity to open doors through study.

The university also acts as a major employer and community stakeholder in Luton, engaging with our diverse community and supporting key regeneration projects in the town. The make-up of the student population is perhaps what sets it apart from others. Around 70% of students are mature returners to education, 50% are from ethnically diverse backgrounds and more than 4,000 annually are international students. That is testament to the thriving and welcoming culture for people of all ages and backgrounds to learn.

As we have heard, however, unfortunately the higher education sector is currently in crisis. Universities are facing severe financial challenges after years of neglect by the Conservatives, leaving students and taxpayers to bear the brunt. Many universities are trying to find ways to reduce their budgets to combat these challenges, but that comes at a cost—losing staff via redundancy schemes, cuts to specific departments or courses, or sadly going bust altogether.

While the recent tuition fee cap increase, announced by the Education Secretary, allows breathing room for some universities—a difficult decision though it was—the University of Bedfordshire is experiencing significant issues due to changes introduced by the previous Government. The impact of the policy restricting those on student visas bringing dependants has resulted in approximately a 16% decline in applications across the country this year, and for institutions such as the University of Bedfordshire, that policy has been detrimental. Every level of leadership—from the vice-chancellor through to the student union representatives from Beds SU, including representatives of the Unison trade union—has raised that matter with me, emphasising the worry it is causing. The university has previously been held afloat by international admissions, but with ever-declining numbers that is not sustainable. I should be grateful if the Minister would confirm whether her Department has done any impact assessment to establish whether that policy change has been positive for higher education settings.

Fundamentally, none of us want to see our higher education settings close their doors, and I am proud that this Labour Government are committed to fixing the foundations and delivering change for students, as well as undertaking a major package of reform to deliver value for money for taxpayers and students, ending the cycle of students being asked to pay more while getting less. The University of Bedfordshire does so much to raise the status of our town and bring investment, enterprise and employment. So, as we fix the foundations of now, it is vital that we support it to deliver the high-class, transformative education that students expect and deserve, to break down those barriers to opportunity, as it produces the future leaders of tomorrow from all backgrounds and all socioeconomic circumstances.

15:21

[Max Wilkinson (Cheltenham) (LD)]

It is a pleasure to serve under your chairship, Ms Vaz. I congratulate the hon. Member for Erewash (Adam Thompson) on securing this important debate. University funding is undoubtedly in crisis. We have heard mentions of universities around the country, and there is a very similar story at mine, which I will tell later.

The previous Government broke the sector’s finances. That left the country with a system that is unfair to students, while pushing many institutions to the brink. We should not forget, in among that, the lecturers who work so hard in our universities too, as well as all the support staff. On the other side, we have students who increasingly feel burdened by the cost of living crisis and the long-term repayment of loans. When I speak to students today in my constituency of Cheltenham, it is a very different picture from the one that existed when I went to university in the early noughties in terms of how much they pay for rent, food and energy bills.

The previous Government made the tuition fee system unfair. The Liberal Democrats, however, cannot support simply raising fees at this stage without substantial reforms. At this stage, the right thing to do would be to undertake a full review of finance in the sector to consider ways to improve access to, and participation in, degrees, as well as the quality of courses, because value for money for students remains extremely important.

While the sector is struggling, we must absolutely not lose sight of the key challenge—removing barriers to entry for new students. That is why the Liberal Democrats believe that the reintroduction of maintenance grants is a vital first step, and I was heartened to hear the hon. Member for Erewash raise that in his opening remarks. Maintenance grants were scrapped by the Conservatives in 2016, which makes it so much harder for young people from less well-off backgrounds even to get to university in the first place. It is regrettable that the new Government are not yet committing to the full restoration of maintenance grants, and we urge Ministers to consider them as a way of bringing fairness back into the system. Scrapping maintenance grants was not the only way in which the Conservatives made the system less fair for students, lecturers, universities and everyone else. They stretched the repayment period so far into the future that some of today’s students will be paying back their loans until 2066. They also lowered the repayment threshold, leaving students paying back an extra £206 a year.

The earlier mentions of foreign students by the hon. Members for Erewash and for Luton South and South Bedfordshire (Rachel Hopkins) were pertinent, and I will now move on to that issue. The combination of the visa crackdowns and the rhetoric about foreign-born students placed further stress on the sector. The upshot is that the Office for Students suggests that about 40% of universities are likely to run a deficit this year. Locally, the University of Gloucestershire—based in my constituency and those of the hon. Member for Gloucester (Alex McIntyre) and my hon. Friend the Member for Tewkesbury (Cameron Thomas)—tells me that, of a turnover of £85 million, £65 million is from tuition fees, and around £20 million of that is from foreign students, but this year it has reductions in foreign students for both the January and autumn intakes. As I said, this is not just about the visa issue; it is also about rhetoric. The university tells me that its agents who recruit students from abroad say that the feedback from those students is that they are perhaps not quite so wanted in the UK as they once were, so they are selecting degree courses in Australia, America, Canada—elsewhere, where they feel more welcome.

The result is a £4 million hit to the University of Gloucestershire’s tuition fee revenue. That is significant. As a result, the university is closing some courses and consolidating others, reducing student choice. Some courses combining multiple humanities are the first to close; fashion is likely to go as well. That said, the university is doing what the Liberal Democrats have suggested too—cutting non-teaching costs and innovating.

The university is also taking advantage of Cheltenham’s cyber-security future. It recently opened a new £5.8 million cyber and digital centre, which will help cement Cheltenham’s position as the cyber capital of the UK. That places the university in the same sphere as CyNam, the local industry group, and alongside high-performing small and medium-sized enterprises that drive the local economy.

That kind of innovation has to be at the centre of what universities do in the future. However, the university warns that the benefit of the £300 tuition fee increase the Government offered this year is likely to be wiped out by the changes to national insurance for employers. I would like the Minister to respond to that point later.

The challenge for the new Government is to put things right, change the rhetoric and reinstate as much fairness in the system as they possibly can. We know that that is not going to be easy—we have all had challenges in the past, haven’t we?—but the Liberal Democrats cannot support an increase in fees at this stage. Reports now suggest that fees are to break the £10,000 barrier fairly soon and rise to £10,500 over the next five years. Before we could support that, more work is needed to undo the failures of the previous Government and restore fairness to the system.

15:27

[Neil O’Brien (Harborough, Oadby and Wigston) (Con)]

It is a pleasure to serve under your chairmanship, Ms Vaz, and to have listened to some excellent speeches this afternoon from the hon. Members for Erewash (Adam Thompson), for Luton South and South Bedfordshire (Rachel Hopkins) and for Cheltenham (Max Wilkinson). I took different things from all of them.

I am going to concentrate on the teaching side of universities. However, I will note at the start that the previous Government put a huge amount more money into research, growing Government spending on it from £9.8 billion in 2011 to £16.1 billion, and increasing research and development as a share of the economy. I was part of that, and I am proud of what we did on that front.

Turning to the teaching side, which is perhaps the most topical part of this discussion, it is absolutely the case that a number of institutions—of course, I will not be naming them today—are financially stressed and thinking hard about their future and how they operate. I know people working in some of those institutions, and it is not easy, but I want to take a step back and examine the context before we talk about those pressures.

Working together with the Liberal Democrats, we brought in fees that did not necessarily work out politically for the Liberal Democrats at the time. However, it is good that we once again find ourselves in agreement that it is not sensible to simply increase fees without reform. As has been noted, the financial benefit to universities of the fee increase is wiped out by the increase in the national insurance contribution. One broken promise not to increase taxes is paying for another broken promise not to increase fees—it is a real connoisseur’s policy decision. In real terms, universities are left with less as a result. The pressures alluded to by the hon. Members for Erewash and for Luton South and South Bedfordshire are now made worse by the Government’s decisions.

The successes of the system, which we should note, are that it has hugely increased participation rates, causing participation in England to grow dramatically faster than in the devolved authorities in Wales, Scotland and Northern Ireland. In particular, it has dramatically increased the participation of the poorest people in our society. We can measure that in three different ways. We can look at free school meals: the proportion of those on FSM going to university has doubled, while the proportion of non-FSM kids going to university has gone up by about a third. We can look at the participation of local areas metric, which is the sector’s own measure of localities from which not many people go to university. We can see that, in both absolute and relative terms, the disadvantage gap has shrunk.

We can also use, as Universities Wales does, the index of multiple deprivation. Looking at the bottom fifth of the index—the fifth-poorest areas in each of the nations—we can see that although Labour-run Wales and England had similar numbers of people going to university back in 2006, at about 13% or 14%, the participation of poorer students has grown much more rapidly in England; it is up to 33%, compared with just 20% in Wales. That is because we made some difficult decisions, from which there have been benefits.

Much of the growth of higher education is a good thing. My generation was the first in my family to go to university. It was wonderful; it was a great experience, and it is generally a very good experience for most people who go. Universities are a wonderful thing because of not just the research and wonderful teaching that goes on in them, but the wider benefits to the community and the impact on their local society. I remember going to the University of Huddersfield as a teenager; if somebody looked nonchalant and like a student, they could just wander in and read all these wonderful books. That is just one of benefits they bring to lots of our country.

However, not all is perfect in the garden, because a university education is not cheap. We have put in a lot of resources, and while the decision to hold down the resources in recent years in order to hold down the costs for students has reduced the funding per student in real terms, it is still above the level it was at when I went to university; it is still higher in real terms than it was in 1997. But university really is not cheap for the students. The Government have just raised tuition fees to £9,535 a year. A maintenance loan for people who are not at home is £10,227, or £13,348 for those in London. After a typical three-year degree, a student is paying back £59,000, or £68,000 in London. That is a lot of money.

The Government have already increased fees once in this Parliament. Having promised to reduce the cost for graduates, they increased fees instead. There must be a decent chance that fees will continue to go up from now on—unless the Minister wants to contradict me on that. Yet, over the last decade, we have worried a lot about the financial plight of younger people. Ever since David Willetts’s amazing book “The Pinch”, we have been thinking about how we can make it easier for younger people to get on in life. Having these huge amounts to repay—and, in some cases, rather high marginal rates—makes it much more difficult for them.

We can see that, as has been alluded to, the point at which somebody starts repaying their loan to make the system financially sustainable for taxpayers has reduced over time. In 2005, a person had to be earning about 30% more than someone working full time on the minimum wage to start repaying. As of next April, a person can earn 2% less than someone working full time on the minimum wage and still be repaying. This has become more like a graduate tax. It is not quite like a tax—people do not repay it if they are not earning—but it is high.

If somebody is a postgraduate on top of that, or has a couple of kids and ends up being hit by the high-income child benefit charge, they face extraordinary marginal rates, even on middling incomes. In the £50,000 to £60,000 range, if a person has one postgraduate loan or two kids, they can end up paying a 70% marginal tax rate as a young person. That is insane. The Government have made the decision not to reform the high-income child benefit charge, so the problem will go on and get worse.

All of that context is by way of saying that, yes, there are pressures in higher education, but there are also pressures on young people; it is not easy. So before we increase charges further, increase tuition fees even more and tip in more money, we absolutely must think about reforms. Advocates of higher education, including me, say, “Look, there is a lot of higher education that is brilliant for people’s earnings and a good economic investment.” However, we know, because of the decision taken by the last Government to create the longitudinal educational outcomes database, that not everybody benefits from going into higher education, at least not economically. The seminal report on this issue by the Institute for Fiscal Studies stated that

“seen over the whole lifetime, we estimate that total returns”—

combining the perspective of both the taxpayer and the student—

“will be negative for around 30% of both men and women.”

For about 30% of people, at least in economic terms, this is not working out.

Now, economics is not the only thing in life, and it will always be worth us funding some things simply for their own sake—if they are beautiful and good and we think they are nice—but let us not forget that a lot of things that are economically beneficial are also beautiful, true, interesting and worthy in their own right. For example, it is cool to know that the word “Lent” comes from the Old English word for “lengthen”, because plants grow in the spring, which is when Lent is. That is the origin of the word, and it is cool to know things like that. It is also cool to know how to build an ion drive, how monoclonal antibodies work or innumerable other things in the hard sciences and other subjects as well.

We will always want to spend on some things that are just worth it in their own right, but the question is how much. If we are spending £20 billion a year on student loans, and let us say, hypothetically, that the IFS is about right, and that about 30% of that is not worth it, that is £6 billion. That is about 10 times what we spend on the Arts Council. How much do we want to spend on higher education that is not economically beneficial? Should thinking about some of those courses not be the first port of call before just increasing taxes on young people?

We could potentially do things to reform the system, as the last Government were starting to do, which would be of benefit to both the young person and the wider economy. We are not doing a young person a favour if we put them on, for example, some creative arts course and say, “This will be great for you. You are going to be the next Jony Ive. You are going to design the next iPad. You are going to have great outcomes. This degree is going to take you where you want to go”, when that is not true. Some people have fantastically low earnings. They feel like they have been lied to; they feel like they have been mis-sold something. Thankfully, that is not the median experience of students, but it is the experience of quite a lot of students. We have to worry about that.

I am totally sympathetic to those who say, “Let’s find more resources for the best of HE,” but we also need to have the conversation about HE that is of lower economic value—if I can call it that—before we just start increasing taxes even further on young people who are so hard pressed already. There are many questions about how exactly we would do that, and lots of technicalities, but in principle that should be our first port of call. Finding those resources would either let us do more in high-value higher education or let us help the perpetual Cinderella sector that is further education, or we could take the burden off of young people a bit more.

It is not for me in this debate to set out our entire vision of how we would reform HE, so I have a couple of questions for the Minister. In particular, I want to encourage her to talk about a decision taken this week by the Office for Students to stop accrediting new institutions. That has numerous consequences that are bad. First, it is a block to brilliant new entrants such as the New Model Institute for Technology and Engineering in Hereford, Dyson and other places that have come in and been brilliant additions to the higher education sector. It also potentially locks very large numbers of young people out of student support. What estimate has the Minister made of the number of young people who will now not be able to access student support as a result of that decision by the OfS this week? Secondly, how long will this “pause” go on for? I saw Ministers defending this decision, and it was initially presented as a pause. I hope it is not a permanent end to any new entrants coming into the sector. Will the Minister tell us a little about when she plans to end this pause?

We have been playing a game of cat and mouse across Parliament about the national insurance increase. Bizarrely, one Department—Defence—has answered the question of how much the national insurance increase will cost it. Defence can answer it, but seemingly no other Department can. The questions I asked the Department for Education a month ago about how much this is costing schools, universities and so on have somehow not been answered. The same is true across about 50 domains in Government. We cannot have a meaningful Parliament and we cannot have meaningful discussions in this building if the Government are not prepared to answer basic questions about the consequences of their own policies.

The Government want to say, “We are giving you this wonderful increase in spending” in whatever field it might—maybe it is childcare or schools or something outside education—but that actually turns out not to be true. The university sector has worked that out for itself. We know exactly how much the Government are putting in, because of the fees increase, and we can see that that seeming gift is completely wiped out by the national insurance increase. The Government are giving with one hand and taking away with the other. In other sectors, they are just refusing to answer the question. That is really poor.

When the Minister stands up today, can she promise me that she will finally answer the question I asked a month ago, not just for higher education, but for childcare and schools, and tell us the most basic information that taxpayers and voters deserve to know? How much is the national insurance increase going to cost our public services? Why do the Government think they cannot answer this question? It is genuinely disgraceful.

I have every sympathy with those who are under financial pressure in higher education institutions. In some cases there has been misadventure, where people have taken out ridiculous loans that are now rolling over, or they have become very exposed to one type of overseas student. I was intrigued to hear the contributions from the hon. Members for Erewash and for Luton South and South Bedfordshire, encouraging the Government to allow more students’ dependants as a way of selling higher education. I remember a speech in this House—I think it was yesterday—where one hon. Member stood up and condemned the open borders experiment of the last Government. I thought, “This is a wonderful, road-to-Damascus moment from the Labour party. They finally agree with people like me and do not want to endlessly increase immigration in an attempt to prop up high education.”

[Rachel Hopkins]

Will the hon. Member give way?

[Neil O'Brien]

I will give way. The hon. Lady mentioned that she thought it was good that the Government are increasing fees to allow more resources for universities. Will she confirm that she shares my understanding that overall resources are going down in real terms because of the national insurance increase?

[Valerie Vaz (in the Chair)]

Order. The shadow Minister has gone over his time.

[Rachel Hopkins]

Would the hon. Member mind clarifying his memory of what I actually asked? I asked whether an impact assessment had been done on that decision, rather than giving an opinion on it one way or another.

[Neil O'Brien]

Sorry. I misunderstood the hon. Lady; I thought she was pressing the Minister to reverse that decision and allow more overseas dependants as a way of encouraging overseas students to prop up higher education. I totally misunderstood—I thought she was pressing for something that she clearly was not.

I will conclude, because I am over time. I hope the Minister will answer some of those questions. I actually sympathise with her: there is a difficult challenge here and it is a knotty policy question. I will be behind her when she makes sensible decisions, and I wish her all the best in her endeavours to tackle some of those problems, not just for our universities, but for our young people.

15:41

[The Parliamentary Under-Secretary of State for Education (Janet Daby)]

I begin by congratulating my hon. Friend the Member for Erewash (Adam Thompson) on securing this important debate. As he eloquently expressed, he has a keen interest in the financial stability of the higher education sector and many other areas, and so do this Government. I agree with him how great our universities are and I will attempt to respond to many points that he has raised.

I join the hon. Member for Cheltenham (Max Wilkinson) in acknowledging our fantastic lecturers, as well as some of the excellent work of our universities up and down the country. I thank my hon. Friend the Member for Luton South and South Bedfordshire (Rachel Hopkins) for her many contributions, including around international students.

I will respond to the shadow Minister, the hon. Member for Harborough, Oadby and Wigston (Neil O'Brien). However, I find it difficult to hear the many things he said about the pressures on young people when the last Government had 14 years to take our universities out of the dire situation they now find themselves in. I find it quite astonishing that the previous Government and the shadow Minister have taken no responsibility, offered no apology and shown no acceptance of the disadvantaged situation our universities are in.

[Neil O'Brien]

Will the Minister give way?

[Janet Daby]

I am going to make some progress and respond to the many points that have been raised—unless he would like to make an apology.

[Neil O'Brien]

The Minister is complaining about the lack of resources in real terms for universities. Can she confirm that because of the national insurance increase resources in real terms are going to go down, wiping out the impact of the tuition fee increase, with the price of everything going up?

[Janet Daby]

Indeed: no apology, no recognition of what I just said, and no recognition of having been in Government for 14 years previously.

There are many questions to respond to, and I will focus first and foremost on my hon. Friend the Member for Erewash, who secured the debate. The Government recognise that our world-leading higher education sector makes a vital contribution, as both education and research institutions, to our economy, to society, to industry and to innovation. They contribute to productivity and growth, and play a crucial civic role in their communities. However, the sector needs a secure financial footing to face the challenges of the next decade. We recognise that the financial position of the sector is under pressure, and the Government have already acted to address that.

In July, Sir David Behan was appointed as interim chair of the Office for Students, the independent regulator of higher education in England. Sir David is overseeing the important work of refocusing the role of the Office for Students to concentrate on key priorities including the sector’s financial stability. In recognition of the pressures facing the sector, on 2 December the Office for Students announced temporary changes to its operations to allow greater focus on financial sustainability. To protect the interests of the students, the OfS will work more closely with providers that are under significant pressure. The OfS has rightly stated that an increasing number of providers will need to take bold action to address the impact of these challenges. All providers must continue to adapt to uncertainties and financial risk.

While the OfS has statutory duties in relation to the financial sustainability of the higher education sector, the Government have a clear interest in understanding the sector’s level of risk. My Department continues to work closely with the OfS, higher education representative groups such as Universities UK, and other Government Departments such as the Department for Science, Innovation and Technology. That helps us to understand the financial sustainability in the sector. If a provider was at risk of unplanned closure or found itself in the process of exiting the sector, my Department would work with the OfS, the provider and other Government Departments to ensure that students’ best interests were protected.

Of course, higher education providers are autonomous bodies. As such, they are ultimately responsible for the decisions they make about their operating model, day-by-day management and sustainability. However, the Government very much recognise the need to put—and sustain—our world-leading higher education sector on a secure footing to ensure that all students have the confidence that they will receive the world-class higher education experience they deserve.

After seven years of frozen fee caps under the previous Government, on 4 November the Secretary of State for Education announced that maximum fees for undergraduates will increase in line with inflation. In the 2025-26 academic year, fees will increase by 3.1%, from £9,250 to £9,535 for a standard full-time course, from £11,100 to £11,440 for a full-time accelerated course and from £6,935 to £7,145 for a part-time course. I am aware that yesterday the Welsh Labour Government also announced that tuition fees will rise from £9,250 to £9,535 for standard full-time courses. While this was a difficult decision, I believe the right decision has been made for UK higher education. I want to be clear, however, that in return for the increased investment that we are asking students to make, we expect our providers to deliver the very best outcomes for students, their areas and the country.

The Government also recognise the impact that recent inflation has had on students. That is why, in addition to increasing tuition fees to support our higher education providers, the Secretary of State announced that maximum loans for living costs for undergraduate students will also increase in line with forecast inflation. In the 2025-26 academic year, maximum loans for living costs will increase by 3.1%, from £10,227 to £10,544, for an undergraduate student living away from home and studying outside London. That will ensure that the most support is targeted at students from the lowest-income families, while keeping the student finance system financially sustainable.

As part of the Secretary of State’s announcements on 4 November, she set out our five priorities for reform of the higher education system. We will expect our providers to play a stronger role in expanding access and improving outcomes for disadvantaged students; to make a stronger contribution to economic growth; to play a greater civic role in their communities—many already do excellent work in this area—and to raise the bar further on teaching standards to maintain and improve our world-leading reputation and drive out poor practice. I am very sure that that is also their ambition. Underpinning all that, the sector must undertake a sustained efficiency and reform programme. We will publish our plan for higher education reform by summer 2025 and will work with the sector and the OfS to ensure that the system delivers those priorities.

I take this opportunity to respond to my hon. Friend the Member for Erewash and reaffirm the Government’s commitment to a United Kingdom that is outward looking and welcomes international students, as commented on by my hon. Friend the Member for Luton South and South Bedfordshire. For too long, international students have been treated as political footballs and not valued guests. This Government will take a different approach and will speak clearly. Be in no doubt: international students are welcome in the UK. That is why we offer international students who successfully complete their studies the opportunity to remain in the UK to work, live and contribute to our national life. I know there have been other questions on that issue, and I will endeavour to get back to Members on them.

I am aware that there have been calls to bring back maintenance grants. The Government continue to provide means-tested, non-repayable grants to low-income students with children and/or adults who are financially dependent on them. Students undertaking nursing, midwifery and allied health professional courses qualify for non-repayable grant support through the NHS learning support fund. As we know, this is a space where much more needs to be done. We need to rebuild our NHS and put it back on a secure footing.

These are just some of the ways in which this Government are trying to mend the failures of the past. However, we recognise there is much more to be done to support students from disadvantaged backgrounds, and we are determined to reverse the decline in participation rates for disadvantaged students. We expect the higher education sector to do more to support students by working with the Government and the OfS and by making the most of the lifelong learning entitlement. We will be setting out our longer-term plans for the sector next year.

I understand that there have been some concerns regarding the recent OfS announcement that it is enacting temporary changes to its operation to allow a greater focus on financial sustainability. As the Minister for Skills explained in the House of Lords yesterday, this decision by the OfS reflects the Government’s determination to move our providers towards a firmer financial footing. The refocusing of the OfS on the issue of financial sustainability and our decision to increase tuition fees demonstrate our ambition to create a secure future for our world-leading higher education sector.

Before I close, I will briefly set out the Government’s position on research funding, which is the responsibility of the Department for Science, Innovation and Technology. We committed to record funding for research and development in the recent Budget. We are increasing core research funding to more than £6.1 billion to offer real-terms protection to the UK’s world-leading research base and to support UK Research and Innovation in delivering on the UK’s key research priorities. This Government are determined to work with the sector to help it to transition to sustainable research funding models, including increasing research grant cost recovery.

I again thank everybody who has contributed significantly to this debate—

[Neil O'Brien]

I just wanted to rephrase my question. Do this Government think it is okay not to answer basic questions about how much the national insurance increase is costing education providers—be they nurseries, schools or universities? Can the Minister confirm that she will answer those questions?

[Janet Daby]

I understand that there are some concerns regarding how the sector will contend with increases to employers’ national insurance contributions. As the Chancellor set out in the Budget, raising the revenue necessary to fund public services and restore economic stability requires difficult decisions on tax, which is why the Government are asking employers to contribute more. We strongly believe that this is the fairest choice to help to fund the NHS and wider national priorities, which were failed by the previous Government and strongly need a greater focus on building up public services and public provision.

As set out in the November update on the financial sustainability of the sector, the OfS estimates that the fee uplift will represent up to an additional £371 million of annual fee income. The national insurance contribution changes for employers will result in additional costs for the sector of £133 million in 2024-25 and of £430 million in each year from 2025-26. The Department plans to publish its own estimates shortly, as part of its assessment of the impact of the planned tuition fee and student finance changes.

We are committed to creating a secure future for our world-leading higher education sector so that it can deliver for students, taxpayers, workers and the economy. Although the Government have already taken action to help to move the sector towards a more sustainable and stable financial footing, we recognise that a real change of approach is needed, both from the Government and from the sector itself, to support our broader plans for higher education. For that reason, we look forward to working in partnership with the sector, the Office for Students, the Department for Science, Innovation and Technology, and UK Research and Innovation to shape the changes to Government policy.

15:57

[Adam Thompson]

It remains a great privilege to serve under your chairship, Ms Vaz.

I thank hon. Members, the shadow Minister, the hon. Member for Harborough, Oadby and Wigston (Neil O'Brien), and the Minister for their participation today; they have all made fantastic points in this debate.

My hon. Friend the Member for Luton South and South Bedfordshire (Rachel Hopkins) talked about the importance of supporting diverse communities and people from disadvantaged backgrounds. She spoke particularly about the University of Bedfordshire, but I know that many of our post-1992 institutions do an excellent job in that regard, so I thank her for raising that issue.

The hon. Member for Cheltenham (Max Wilkinson) talked about maintenance grants and international students, and the importance of supporting both as we move forward; I agree with him on that. I thank the shadow Minister for his contribution. He made many important points that are salient for us as we move forward.

I very much thank my hon. Friend the Minister for her response to the debate. I associate myself with her comments about the importance of our universities and how fantastic our lecturers are, and I welcome her points about the OfS’s new focus on financial stability, funding for research and ensuring that the best interests of students are protected throughout the sector as we move forward.

I also very much welcome the Secretary of State’s priorities on the Government’s commitments for the sector. There is a fantastic opportunity for us to work cross-party on this issue, because it is a very difficult and complex problem that affects many of our universities across the country, and it is not going away. I am very grateful to have started this conversation and to all the Members who have come to Westminster Hall today. Thank you again for your chairship, Ms Vaz.

Question put and agreed to.

Resolved,

That this House has considered the financial sustainability of higher education.

15:59

Sitting adjourned.