Financial Risk Checks for Gambling

George Howarth Excerpts

Monday 26th February 2024 Westminster Hall

[Conor McGinn]

On a point of order, Sir George. The hon. Gentleman has asserted that Members who spoke in favour of racing or who have racecourses in their constituency have never sat in front of grieving parents, do not know anything about addiction and have never comforted those affected by addiction. The hon. Gentleman knows nothing about me, and he knows nothing about many other colleagues who have spoken. I ask him to be very careful about how he approaches what he says, and to have sensitivity before making assertions about any Member here or their motivations, their families or their experience of addiction.

[Sir George Howarth (in the Chair)]

That is not a point of order, but the hon. Gentleman has managed to get it off his chest.

[Ronnie Cowan]

I absolutely take on board what the hon. Gentleman says. I apologise if I worded that wrongly; I was talking about the sessions that we had at the APPG for gambling-related harm. I appreciate that, as was pointed out earlier, many people have been touched by the curse of gambling addiction.

The point is that it is understandable that so many people have raced to sign e-petition 649894, which calls on the UK Government not to implement the proposed financial risk checks for online gambling. The gambling industry has led and paid for this lobbying and has been hellbent on spreading disinformation that is designed to create uncertainty and raise concerns among people who enjoy the occasional gamble. I understand the punters’ point of view. They feel the fear behind this, because it is a message that they have been fed.

The truth about affordability checks is more complicated, however. I am not a prohibitionist. How many times have I had to say that? I am not trying to ban gambling, but I do want to create a safe environment for it. It may come as a surprise that affordability checks were not the invention of the APPG for gambling-related harm. This is not some mendacious ploy that the group is using; the idea was mooted in 2019 by Tom Watson, when I believe he was still the MP for West Bromwich East. Industry leader Richard Flint, who was at Sky Bet, supported Mr Watson by saying that too many people were losing money that they could not afford online. We need to work together with the industry and the Government to limit that harm.

I think that limits on spend, rather than on stakes, are the right way to go, and those limits should be based on affordability. Richard Flint acknowledged that such limits could lead to a drop in operator revenue. He clarified:

“There will be some online firms in the short term that…make less money as a consequence”.

Getting straight to the point, he added:

“but then…that spend shouldn’t happen anyway.”

That is a point that the Jockey Club should have considered when its chief executive officer launched this petition. It has cited a potential loss of £5 million on the horseracing betting levy, which according to its own board’s annual report was worth £100 million. But what price a life? What price the number of people who have been driven to complete suicide?

I return to the need for affordability checks. A year later, at the 2020 Lords Committee, the UK’s biggest operators—the chief executive officers of the big five—spoke enthusiastically about the need for affordability checks as a key mechanism to reduce harm. An industry CEO said that

“the way to go is affordability and to ensure that, when people come to our sites, they can only afford to lose or bet an amount that, quite frankly, they can afford and were comfortable with.”

So what is new? What is new is that, since the White Paper, the Government and the Gambling Commission have proposed threshold figures for the checks. Affordability is no longer an abstract concept; it is tied to precise thresholds.

The industry does not like the fact that the White Paper has called its bluff, so it is kicking up a storm. It is clear that those who might be categorised as the pro-gambling lobby and those such as myself, who could be described as the safer gambling lobby, agree that if we are to create a safe environment, affordability is an area that needs tightening up. I wonder whether that was explained to everyone who signed the petition.

The petition states:

“The proposed checks could see bettors having to prove they can afford their hobby if they sustain losses as low as £1.37 per day.”

That figure has been scoffed at a few times in this debate, but it is £500 a year. It may mean nothing to us as MPs on 86 grand a year, but that £500 a year could be the difference for some poor people who are trying to put money in the meter or food on the table. What we are trying to do is to stop them getting to the point at which they lose that money in the first place. Please do not belittle that. If the checks say people can afford it, they can afford it. We are trying to help those at risk. Surely all gamblers can see that, because they understand risk.

The UK Government have already said that

“the proposed checks are only on the very highest spending online customers”.

The Gambling Commission estimates that

“approximately 20% of customer accounts will meet the threshold required for a financial vulnerability check”.

The next line of the petition is about the black market. The Gambling Commission has already reported to us that the size of the online black market has been overstated by the industry and must be kept in proportion. It follows that if we want to prevent the growth of the black market, the solution is regulation to prevent harm that leads to addiction. It will eliminate demand for a black market, not cause it. Harm prevention will mean fewer addicts, fewer self-exclusions and fewer attempts to circumvent the regulated market in the first place.

The key is in the last line of the petition:

“We are concerned there will also be a negative impact on British horseracing’s finances due to a reduction in betting turnover and resulting fall in Levy yield.”

That is a Trojan horse if ever I have seen one.

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[Stuart Andrew]

I am going to crack on because I do not have much time left and I want to get through as much as I can. If I have time at the end I will happily take the hon. Gentleman’s intervention.

I hope it is clear that both the Government and the commission want this to be a genuine pilot of how data sharing would work. Throughout the pilot, gambling businesses will not be expected to act on the data they receive, although they will of course be expected to continue to protect consumers by implementing their own existing consumer safety controls and to remain compliant with our existing regulatory requirements.

The Government and I are supportive of the evidence-led and consumer-centred approach that has been proposed for the pilot period, and the Gambling Commission will publish its full consultation response very soon. I remind colleagues that this is about online betting; people who go to racecourses or betting shops will not be a part of this, and the “day out” experience will not be affected.

In the meantime, we have also challenged the industry to be more transparent with customers. Currently, requirements are in place for gambling operators to identify customers at risk of harm and to take action, but there are no specific safer gambling requirements on how or when gambling operators must consider the financial circumstances of their customers. Where there have been failures to identify and act on clear signs of harm, the Gambling Commission has not hesitated to take action, including with fines, but there has been inconsistency across the sector. That is why we and the commission are working closely with the industry with it, so that we have a much better system in this interim period.

In the light of that, and in my meetings with colleagues and with the Horseracing Bettors Forum, I have urged the members of the industry to work together to mitigate the impact of customers having to provide information and documentation while we develop the new, frictionless system of checks. We understand that they are working towards delivering an industry-led code that would apply in the interim period. I know that progress is being made and I hope that we will be able to report that an agreement has been reached soon, so that customers have more clarity about what is expected.

Let me address the concerns raised here today about the black market. I assure colleagues that I take the threats posed by illegal online marketing and markets very seriously indeed. We know that they can pose a variety of risks to consumers, including by allowing access to those who have self-excluded through GAMSTOP. That is unfair to those businesses that abide by the rules. As set out in the White Paper, we committed to giving the Gambling Commission more powers to block and disrupt illegal gambling websites. We are delivering on that commitment through the Criminal Justice Bill, which will allow the commission to suspend IP addresses and domain names if they are being used for the purposes of serious crime connected with unlicensed gambling. The commission has also been able to invest in work to combat illegal gambling and it has succeeded in disrupting and reducing illegal traffic into British gambling markets. That work should be enhanced by the new disruption powers that the commission will receive once the Criminal Justice Bill has passed through Parliament.

I will now address horseracing specifically, as it has been raised here today. The British Horseracing Authority and other stakeholders in the industry have voiced concerns about the impact of the checks on the sport. I assure everybody that we have heard the concerns and take them extremely seriously. I have already met with many colleagues here today, including members of the APPG on racing and bloodstock. I have also met the Horseracing Bettors Forum to hear a customer perspective. I will continue to engage with the sector and those affected by the reforms, because the Government are strong supporters of horseracing. I acknowledge the many points that have been made about the significant contribution that horseracing makes to our economy and the central role that it plays in the livelihoods of rural communities. The employment that it supports across racecourses, training yards, breeding operations and related sectors reflects a powerful industry that is respected at home and abroad. Many colleagues have spoken here today or written to me on this subject, and I saw at first hand the care that is given to racehorses on a recent visit to a training yard in Middleham. I am therefore clear that we must ensure that the checks do not adversely affect racing or those who work in the sector, or interrupt the customer journey. They also must not push away high-net-worth individuals such as owners and trainers that invest in the sport.

The Gambling Commission has worked very closely with operators to explore the practical aspects of implementing the checks, and colleagues have said that they have seen an improved relationship between the commission and the industry. The commission has also been carefully considering responses to the consultation, which have helped to shape the implementation plans. We want to protect those at risk—I make no apology for our doing that—with minimal disruption to the majority, who I recognise bet on horseracing with no ill effect.

We recognise the importance of horseracing, but we know also that the levy is an important piece of work. I am about to run out of time, but I will happily write to colleagues to update them. Discussions are ongoing—I know that the Betting and Gaming Council had discussions this morning about an offer that is on the table for the levy—and I hope to be able to update colleagues shortly. With that, given that my time has run out, I apologise for not covering all the points, but this was an extensive debate.

[Sir George Howarth (in the Chair)]

Very briefly—Christina Rees.

Excess Death Trends

George Howarth Excerpts

Tuesday 16th January 2024 Westminster Hall

[Sir George Howarth (Knowsley) (Lab)]

I am afraid that the evidence the hon. Member for North West Leicestershire (Andrew Bridgen) is basing his arguments on is highly controversial and strongly contested as to its reliability. I will shortly explain what I mean by that assertion.

I attended two meetings on the issue that the hon. Gentleman chaired, the latter of which, late last year, included a panel of “experts” who made presentations. I attended both meetings on the basis that I am aware that there are cases in which some people with underlying or pre-existing medical conditions were vaccinated inappropriately, in some cases with lethal consequences. I support the case for some form of restitution for them and their surviving families.

At the second meeting, I was alarmed that some of the evidence given was polemical rather than scientific. The nature of some of the expert presentations alarmed me—specifically, the misleading and inaccurate assertions, similar to those made, for example, by Andrew Wakefield on the measles, mumps and rubella scandal, which tried to make the link between vaccination and autism. That was thoroughly discredited subsequently, but the consequence of that, which is still being felt, is that children are not being vaccinated and there is now an upturn in the incidence of measles, in some cases with serious consequences.

The meeting I attended involved a number of “experts” who gave presentations that included data that I am frankly sceptical about. At that meeting, I undertook to raise my concerns about the accuracy of the data with the Office of National Statistics, and I have done so. In his response, Professor Sir Ian Diamond, the national statistician, said that he has undertaken to

“consider and investigate any possible misrepresentation of the data.”

I am grateful to Sir Ian for that undertaking.

In a report in The Times today, reference is made to a study published in The Lancet that said:

“Missed vaccines ‘caused 7,000 Covid hospitalisations and deaths’”—

that is missed covid vaccines.

[Sir Gary Streeter (in the Chair)]

Order. Ten seconds please.

[Sir George Howarth]

I am drawing to a close. By the way, that evidence involved 67 million people. The hon. Member for North West Leicestershire quoted some research based on unreliable data, but that is a major undertaking published in The Lancet, and it makes completely the opposite point to his.

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[Neale Hanvey (Kirkcaldy and Cowdenbeath) (Alba)]

Time is tight, so I will cut to the chase. I pay tribute to the hon. Member for North West Leicestershire (Andrew Bridgen) for his courage and determination on this important matter. I also challenge the right hon. Member for Knowsley (Sir George Howarth) on his assertion that these were so-called experts at that meeting. They are world-renowned experts in their field; that is just a matter of observable fact.

I want to focus on the safe use of novel mRNA agents and on concerns over their alleged role in driving excess deaths. I repeat a point that I have made previously in this place and directly with the Minister: any agent has the potential to cause harm or injury to the subject. For the avoidance of doubt, the position I have taken is based on decades of involvement in the management and delivery of clinical trials. Politicians who dismiss the data and emerging clinical evidence are acting in a wholly irresponsible manner, and posing a real threat to the duties of honesty and candour at the heart of good clinical practice. If substantiated, the concerns surfacing around falsified or concealed data are the most serious that I can imagine.

[Sir George Howarth]

The hon. Member is defending the “experts”, but has he actually checked their backgrounds? Has he checked the criticisms and the fact that, in some cases, they have had their medical practitioner status withdrawn?

[Neale Hanvey]

I am not going to get into the detail of that; I have far too little time and too many important points to make. I have worked in the same institution as Professor Dalgleish, and his credentials are impeccable.

Addressing this matter is necessary because we are talking about the standards on which good clinical practice, or GCP, is based. GCP is not about a nice bedside manner or knowing what treatment to prescribe; it is a set of internationally recognised ethical and scientific requirements, which must be followed when designing, conducting, recording and reporting on clinical trials that involve people, and have their origin in the declaration of Helsinki.

The rights, safety and wellbeing of trial subjects are the most important consideration, which should prevail over interests of science and society, including commercial or political interests, and I will conclude with a reflection on that important principle. The foundation of good clinical practice is under threat. In their December 2023 pathology research and practice paper on gene-based covid-19 vaccines, Rhodes and Parry gave the following warning:

“Pandemic management requires societal coordination, global orchestration, respect for human rights and defence of ethical principles. Yet some approaches to the COVID-19 pandemic, driven by socioeconomic, corporate, and political interests, have undermined key pillars of ethical medical science.”

None of these clinical experts are quacks or conspiracy theorists. As the Government said so often during the pandemic, we must follow the science.

Post Office Horizon Scandal

George Howarth Excerpts

Wednesday 10th January 2024 Commons Chamber

[Kevin Hollinrake]

I thank my right hon. and learned Friend for his work and for his advice over recent days. As he has said while we have been trying to resolve this issue, there is no perfect solution and there are going to be compromises. We are keen to reach out to the people he has identified who have not entered the system because they are deterred by the processes that they would have to go through in order to gain access to compensation. I am keen to continue to work with him on all the measures that we will need to put in place over the next few weeks to ensure that we get this right, and get it right first time.

[Sir George Howarth (Knowsley) (Lab)]

I join others in thanking the Minister for his statement, during the course of which he acknowledged that people would worry about the possibility that good intentions would not be backed by action. To counter that, would he consider publishing some target dates by which both the legal and the administrative matters ought to be concluded, so that people might gain some reassurance that this is not going to drag on for a very long time like, for instance, the Hillsborough and contaminated blood scandals?

[Kevin Hollinrake]

We hope to complete all the legal and administrative aspects of the compensation payments by August, while Sir Wyn Williams’s inquiry is due to conclude by the end of the year. We should see the conclusions of that inquiry very rapidly and hope to publish them as soon as possible, given that it is a statutory inquiry. Following that, the authorities may well decide that there are grounds for prosecution. We are certainly taking a keen interest in who else might pick up the cost of the compensation, which is significant and is currently being borne by the taxpayer. Where we can identify others who are responsible, we are keen for them to pay for their wrongdoing.

Youth Programmes and Girlguiding

George Howarth Excerpts

Tuesday 19th September 2023 Westminster Hall

[Sir Julian Lewis]

I will take the opportunity to stress that when Girlguiding UK says that only 10% of the movement uses the five centres, we are still talking about tens of thousands of young people. The response to the situation has been not, “We have to close one centre in order to subsidise the others”, but, “We have to close the whole lot while simultaneously losing millions upon millions of pounds on inappropriate investment in property hotel ventures.” That has to be questioned. The reason for donating Foxlease to Girlguiding 101 years ago was not so that it could be used for commercial development; it was donated to be used by young people.

[Sir George Howarth (in the Chair)]

Order. I need to bring the Minister back in now. We are very short of time.

[Stuart Andrew]

Thank you, Sir George. One of the challenges of trying to answer a debate about a decision made by an independent organisation is that there are limits to what I am able to say. That is why I made a commitment at the beginning to highlight the concerns of hon. Members. My right hon. Friend the Member for New Forest East raises another valid point, and I will ensure that his question is in the letter that I send. As I promised, he will receive a reply.

Youth services and organisations such as Girlguiding provide an essential service for young people and communities. As a Department, we are committed to ensuring that all young people in England have access to regular clubs and activities, to those important adventures away from home and to opportunities to volunteer. To deliver the services that young people want and deserve, a partnership must happen between central and local government, the private sector, young people themselves—crucially—and the great organisations that have provided so much. I recognise the strength of feeling raised in this debate. I have made the commitment to write to the organisation and highlight those issues, because I recognise that this concerns all the Members I mentioned at the beginning of the debate.

Question put and agreed to.

Legislative Definition of Sex

George Howarth Excerpts

Monday 12th June 2023 Westminster Hall

[Andrew Lewer]

That is exactly right, and it is why this clarity is needed. Here is another quote from BMA guidance:

“A patient does not have a right to know if a healthcare worker has a gender different to the sex they were assigned at birth.”

In other words, the patient has no right to know whether the person treating them is the same sex as them. That is heartless beyond words. We are talking about a woman who may be worrying about serious illness and is feeling exposed and vulnerable. Professional bodies are instructing healthcare providers to gaslight her. They are saying that it is perfectly fine for a man to touch her unclothed private parts when she has refused that, because of how he identifies. As the hon. and learned Member for Edinburgh South West (Joanna Cherry) said, it is more than heartless, it is illegal. If a man provides such care to a woman who says that she is only willing to receive it from another woman, it is a sexual assault.

Have we reached the point where medical associations are instructing care providers to sexually assault women in the name of inclusion? That is why it is essential that the meaning of sex in the Equality Act is made much clearer, in order to end this and save lives.

[Sir George Howarth (in the Chair)]

Order. The hon. Gentleman has exceeded the time limit. Can he give one line by way of a conclusion before I move to the next speaker?

[Andrew Lewer]

I have finished.

--- Later in debate ---

[Jess Phillips]

I have seen it come about that we now have non-gendered areas, and I have to say that I think there is a bit of a red herring. Lots and lots of women would still like to have a women’s changing area, but I have seen the solution to the issue being non-gendered areas.

[Sir George Howarth (in the Chair)]

Order. Before the hon. Gentleman resumes, there is a Division. We will suspend the sitting for 15 minutes.

--- Later in debate ---

On resuming—

[Sir George Howarth (in the Chair)]

Before Lloyd Russell-Moyle resumes, I should say that, because of the Divisions, the debate will now conclude by nine minutes past 8 and the wind-ups will begin no later than 7.39 pm. Could hon. Members bear that in mind?

[Lloyd Russell-Moyle]

I want the flexibility for these things to be locally determined—proportional means for legitimate ends. The current law works. Of course there will be examples that are wrong and need correcting, but that is why we need the Government to give greater guidelines. The problem is that the trans community do not have trust that those guidelines will be fair and balanced.

For me, the real issue—the injustice—is about the woman who will turn up tonight at Brighton, be told that there are no spaces in the refuge and be put into hostel accommodation with rapists down the corridor who have only just come out of prison. The real tragedy will be the young trans person tonight who cannot get access to mental health services. The real tragedy is 12 years of austerity and cuts from the Conservative Government, not some dog whistle about whether there should be clarity or not. There is. The law is clear. What we need are services.

--- Later in debate ---

[Caroline Ansell (Eastbourne) (Con)]

It is a pleasure to serve under your chairmanship, Sir George. It is rather ironic speaking so late in the debate because the point I wanted to make and the argument I wanted to win were made and won before the debate started, when your predecessor in the Chair counselled Members that there were two live court cases associated with this subject. My point is that we are allowing individuals to operate in this seeming legal grey space, rather than us direct in Parliament. Those individuals and organisations are forced to run the legal gauntlet case by case, isolated and alone, and sometimes at very great cost to their reputation, to their career and to their health.

In common with many colleagues here, I rise to support the petition to clarify—not change—the Equality Act. The hon. Member for Aberdeen North (Kirsty Blackman) seemingly endorsed that change when she said we are currently failing trans people and failing women. Change is an imperative, because we must be very clear with trans people what the law can and cannot do. Equally, we must safeguard the rights of women to those same-sex spaces.

It would be indefensible if Parliament, seeing the outworkings of this conflation and confusion, did not act. It is a highly relevant point that the lead petitioner, Maya Forstater, spent nearly two years and £100,000 just to determine that she was indeed covered in the Equality Act by the protected characteristic of belief, and her case was won. The judgment of the employment tribunal in 2021 made it clear that the law could only mean that a GRC changes a person’s sex for certain legal purposes; it could not force other people to change their belief, and therefore their perception, of that person’s sex. Yet individuals continue to face complaints and investigations in every corner of the land and in every sector for asserting the protections they have under the Act.

Just last week, a young woman with the pseudonym of Maria told her story to the press of being investigated and driven out of her employment at Oxfam simply for defending J. K. Rowling against being called transphobic. Closer to home, as a Sussex MP, I saw with horror how Professor Kathleen Stock was hounded from her post and chased off the university campus simply for saying the truth: that male people and female people are two different groups. A woman who remains anonymous under the name “Sarah Surviving” is suing Brighton’s rape crisis centre for discrimination because it refused to provide a women-only peer support group. I would hope that my near neighbour, the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle), would speak with equal passion in her defence too.

When we look at each of these legal cases, a commonality we see is not only that the women concerned have to put themselves on the line to try to clarify the law, but that the judges invariably say how poorly suited the subject matter is for determination by the courts, as compared with Parliament. They caveat their judgments by saying that they are not pronouncing on broad debates on trans rights and women’s rights. The confusion in terms and in rights and responsibilities is souring the cultures of businesses and charities alike as they wrestle with what is required of them. The EHRC has fallen out with itself over this challenge. The debate in society is increasingly toxic.

I started my own consideration of this complex and sensitive issue some months back, when I knocked on a door in Eastbourne. After a chat, a grandad shared with me his dismay and heartache. His grandson aged five had come home from school and said, “We were learning if we were in the wrong body.” That is of course a serious question to be answered, but what was really chilling was that he said he was too scared to speak up, so I promised him that I would. It is our duty to speak up, so I commend clarity in the Act.

[Sir George Howarth (in the Chair)]

Order. It is worth reminding Members that there is some concern about sub judice. When my co-Chair opened the debate, she stated that Mr Speaker has agreed to exercise the discretion given to the Chair in respect of the resolution on matters sub judice to allow reference to the cases, given the issues of national importance that are raised. I call Anna Firth.

[Anna Firth (Southend West) (Con)]

It is a pleasure to serve under your chairmanship, Sir George. I rise to support the first petition to make the Equality Act clear, but I want to use my short time this afternoon to focus on the importance of protecting single-sex spaces and services.

I might be going back to the beginning, but, after such a long debate, that is not a bad thing. I want to begin by saying that people who are transgender must be supported to play a full part in society and public life. They should not be harassed or discriminated against. We in this place must be very careful not to stoke hatred of any kind towards them or any other section of society.

However, this debate is not about trans people or, more formally, people with the protected characteristic of gender reassignment. Their rights remain, quite properly, protected and unchanged. The issue is whether the 6,000 or so trans people who have a gender recognition certificate count for the purposes of equality and sex discrimination law as members of their own sex or of the opposite sex. Clarifying the Equality Act as suggested would make it clear that having a gender recognition certificate does not give male people the right to compete in women’s sports, undress or shower with women and girls, or be employed in a job that involves intimate contact with women, such as the example so very well described by my hon. Friend the Member for Northampton South (Andrew Lewer), in hospitals or women’s prisons.

Families, women and children in Southend West want to know that when the sign on the door says or indicates female, that is not up for negotiation. The only people who should be in that space are biological women. Biological males or trans women or non-binary people should simply not be in those spaces.

Like the common law, legislation regarding equalities and sex discrimination has evolved over time and it can be very complicated, but what we are talking about this afternoon is a very simple clarification. When we talk about sex discrimination in the Equality Act, we are talking about biological sex—nothing more and nothing less. We know that it is important that the law is clarified because we know there are exceptions throughout the Equality Act that allow for single-sex services, including, as we have talked about, specialist services such as women’s refuges, women’s prisons, women’s health services, and also everyday services such as public toilets and showers at gyms.

As well as making it clear that where the Equality Act refers to sex, that means biological sex, we must also be clear that the definition of a woman is someone who was born female and the definition of a man is someone who was born male. Of course people should be able to express themselves, but the simple fact is that someone who was born male, if they gain a gender recognition certificate, is not the same as someone who was born female, and they should not be accessing as of right female-only spaces and services.

Quite simply, as has already been said, if the Equality Act is not clarified, it will be impossible for service providers to exclude a biological male with a gender recognition certificate from any female space or specialist service. “Case by case” simply does not work. Operating without clear rules simply shifts the responsibility to service providers to make very difficult decisions about who should have access to female-only spaces and services, and who should not. A simple search on the internet reveals the extent of the confusion that reigns. To give just one example, the NHS promises single-sex accommodation in hospitals, yet NHS England’s annex B policy tells hospitals to allow trans and non-binary people to choose whether they are housed with men or women.

The situation is simply not clear. It is said that sporting bodies set sex-based rules, so clarification is not needed. I would say the exact opposite: the law must be clear about sex if sporting bodies are to feel confident setting sex-based rules.

I see that I am about to run out of time. I end by saying that recently I was horrified by the story of the fight between the boxer Fallon Fox, who identifies as a trans woman, and Tamikka Brents. Fox hit Brents so hard that she suffered from a concussion and a fractured skull, and received seven staples to her head. Purely and simply, that was a man fighting a woman. I do not believe that that is right or fair, and I do not want to see that happening in this country.

[Sir George Howarth (in the Chair)]

I call the SNP spokesperson.

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[Tonia Antoniazzi]

It is our privilege and responsibility to weigh up different groups’ rights, needs, interests and demands as we debate and amend the laws of this land. That is the bread and butter of the work of this House. I applaud all hon. Members—whatever their position on the substance of the two petitions—who have turned up to discuss them, and who have ignored the calls for no debate. We are doing our work, and this is a democracy.

The two petitions concern only the question of whether a GRC changes a person’s sex for the purposes of the Equality Act; they are not about gender self-ID. Also, the purpose of the GRC is nothing to do with what some speakers referred to as “intersex”. The question of whether GRCs change a person’s sex for the purposes of the Equality Act has nothing to do with those medical conditions, and people with those conditions have said many times that they do not want to be drawn into these discussions. They, and organisations that represent them, have said that these are complex medical conditions. There is no third sex or intermediary sex, and people with those variations on the sex development pathway are either male or female.

What has come across very strongly in arguments today is that one of the purposes of single-sex spaces is risk management. Speakers have made it clear that it is not about suggesting that all male people or all trans people are predators; it is just that single-sex spaces are an important risk management tool, given the overwhelming statistics in the patterns of male violence.

It has been an important debate for me to lead for the Petitions Committee, and to hear various views from across the House—some respectful, some less so. We are responsible for legislating, and we have to discuss issues. I wish no ill on anybody, whether they be trans, lesbian, gay or bisexual. This is important to me and to my trans community in my constituency, and it is important to all of us.

[Sir George Howarth (in the Chair)]

Before I put the Question, let me say that my co-Chair appealed to people at the start of the debate to deal with this sensitive issue in a respectful manner. Before she left, she pointed out to me that, during her time in the Chair, it had been dealt with in that way. I thank everybody, as others have, for the respectful and thoughtful way in which they have put their arguments during my time in the Chair. People feel strongly about this issue, but it is no reason to be abusive, and I do not think that people have been. Thank you for that.

Question put and agreed to.

Resolved,

That this House has considered e-petitions 623243 and 627984, relating to the definition of sex in the Equality Act 2010.

Eating Disorders Awareness Week

George Howarth Excerpts

Tuesday 28th February 2023 Westminster Hall

[Wera Hobhouse]

I completely agree. Indeed, the all-party parliamentary group on eating disorders inquiry on research funding found how crucial it is, and in particular that eating disorder research should be ringfenced. Some progress has been made, and the eating disorder charity Beat has made good progress on the issue, but more research needs to be done.

For too long, sufferers have been left feeling trapped and alone. Here in Parliament, we have been raising the alarm for some years about this rising epidemic, which still needs more urgent action from the Government. However, I want to acknowledge the good working relationships the eating disorders APPG has had with various Ministers. I hope that will continue, and that today’s debate helps us to make progress together.

The theme for this year’s Eating Disorders Awareness Week is eating disorders in men. Eating disorders do not discriminate. Many people think that eating disorders affect only women, but at least one person in four affected by an eating disorder is a man, and 89% of men and boys aged 16 to 18 in my county of Somerset worry about how they look. Those experiences are often overlooked.

Toxic stereotypes are pervasive, and half of respondents to a recent survey of men’s experience carried out by Beat did not believe that someone like them would develop an eating disorder. One male sufferer in five has never spoken out about their struggle. That is why the debate is so important. We must encourage men to speak up and get the help they need.

Other rigid perceptions of eating disorders persist. Eating disorders are frequently misunderstood and viewed as a lifestyle choice. Contrary to popular belief, eating disorders are most common among people with severe obesity. Too many people are still being turned away from treatment because their body mass index is too high. To imply that someone seeking help for an eating disorder is not skinny enough is a terrible mistake that can lead to added suffering, and I commend Hope Virgo for her tireless campaign, Dump the Scales, which has made a significant difference.

Owing to those perceptions, people with eating disorders face a postcode lottery in trying to access specialist treatment. Beat has found large inconsistencies in the availability of treatment for binge eating disorders. Only 12 of the 51 providers in England that responded to Beat’s freedom of information request offered all three services for binge eating disorders recommended by the National Institute for Health and Care Excellence.

In some areas, treatment for people with bulimia is being rationed according to the frequency of binging and purging episodes. In others, treatment is simply not available. The Somerset and Wessex Eating Disorders Association, also known as SWEDA, has seen a 150% increase in people seeking help for eating disorders compared with pre-pandemic figures. Its children’s service has been overwhelmed with young people and their parents desperately trying to get support.

Eating disorders can take years to recover from, and many children and young people need to continue their treatment into adulthood. Young people miss out on so many educational and social opportunities. These years are stolen from them, and that is not to mention the potentially irreversible effect on their physical health. Again, this affects girls and boys, men and women—eating disorders do not discriminate.

[Sir George Howarth (Knowsley) (Lab)]

I thank the hon. Lady for securing this important debate. She will be aware that the variation of eating disorders called T1DE—type 1 diabetes with disordered eating—is a growing problem that affects young men as well as young women. The right hon. Member for Maidenhead (Mrs May) and I have been co-chairing an inquiry into that variation of eating disorders. I will not pre-empt what our report will say, but one thing is clear: professional support, both psychological and physical, is vital to these young people, who could otherwise end up seriously ill if they do not take their insulin—in some cases, it is fatal.

[Wera Hobhouse]

I thank the right hon. Member for his intervention. As I mentioned, eating disorders manifest themselves in different forms. We need to increase our understanding of the different types of eating disorders, and much more specialist treatment needs to be available to cater for people’s different needs. I thank him for mentioning that specific form of eating disorders among people who are suffering from diabetes.

As I mentioned, eating disorders result in years being stolen from young people, and they can take many years to recover from. Some of the figures are just staggering. A third of people with eating disorders recover fully, a third never really recover, and a third get worse. For the third that never really recover, it is a lifetime sentence of a life that is not as good as it could be. That is why early intervention and understanding the symptoms of eating disorders are so crucial. The earlier someone receives intervention for their eating disorder, the more likely they are to make a full recovery. The longer symptoms are left untreated, the more difficult it is for the person to recover.

Healthcare should focus on prevention before cure, and early access to the right treatment and support can be life-changing. Some 75% of SWEDA’s staff and volunteers have lived experience of an eating disorder, which is another aspect of this issue that is so important: we need to hear from more people who have lived experience of an eating disorder. Their speaking up and leaving behind the stigma that is still associated with eating disorders is so important, and I commend everybody who has come forward and talked about their lived experience. I understand how difficult that can be, but we need them to do it. All those working for SWEDA say that they wish they could have accessed help long before they were offered it. That is why such organisations are so important: they offer specialist therapy and support to people with eating disorders and body image issues before they become ill enough to need more intensive treatment.

However, those organisations cannot cope on their own. Waiting times for eating disorder patients are out of control, and waiting lists for children’s eating disorder services have doubled since March 2020. From 2021 to 2022, only 61% of urgent cases started treatment within a week—well below the current NICE standard of 95%. I hope the Minister will be able to respond to that. For adults, there are not even targets in place. The Independent has revealed that more than 80,000 adults with eating disorders are waiting to be seen for therapy—a record number—while just 30% of adults got treatment within four weeks of their referral. Again, I hope that the Minister will refer to adult eating disorder services, where we do not have any waiting list targets or targets for support. It is very important that adult services get the same support as children’s services, where we have made progress because there are targets.

Data from the eating disorder charity Beat showed an average delay of three and a half years between someone’s eating disorder symptoms emerging and their accessing treatment. That is simply not good enough. Targets are crucial if we are to tackle this epidemic. An access and waiting time standard for adults would provoke significant extra funding and focus. If we want to encourage people to seek help, we need to give them a guarantee that they will be seen.

Having clear standards can facilitate service improvements. Standards introduced in 2015 for waiting times for children and young people’s eating disorder services have been crucial in driving service improvements. However, similar standards have been lacking in adult services. Shockingly, sufferers are reaching the point of emergency hospitalisation before they can access care. Again, that is not good enough. It also costs a lot more money if we reach people only at that crisis point.

Clinicians have reported a significant increase in the proportion of young people first presenting when they are already severely ill. NHS figures show that hospital admissions for people with eating disorders in England have risen by 84% in the past five years. For children and young people, there was a 35% increase in the past year alone—and among men and young boys, hospital admissions have risen by 128%. There is an increasingly alarming picture that eating disorders in men and boys are being overlooked and not treated early enough. That is why today’s debate is so important.

Tragically, people are losing their lives. Take the terribly sad death of Zara Taylor after two years of struggling to get the right treatment for her eating disorder. An investigation by the Health Service Journal found that at least 19 lives were lost to eating disorders in England over the past five years. At least 15 of those were deemed avoidable and resulted in coroners issuing formal prevention of future deaths reports. Coroners described patients’ safety risks being missed or poorly managed because of limited knowledge of eating disorders among doctors and health professionals, and delays in accessing appropriate treatment. That is why it is so important to have more research into eating disorders, and focus on the more specialist and rare forms of eating disorders. Those same failings were among the key issues identified five years ago by the Parliamentary and Health Service Ombudsman in its report “Ignoring the Alarms”. Surely, we need to do more and to do better.

I was disappointed that the Government decided against publishing a 10-year cross-Government mental health and wellbeing plan for England. Instead, they have developed and published a major conditions strategy that would include mental health alongside other groups of conditions, including cancers, cardiovascular disease and dementia. That is not helpful. Compared with physical health, mental health has been a Cinderella service; for years, we have been asking for parity. If everything is put together again, we run the risk of losing special attention to mental health.

Can the Government not see that for targeted and varied issues we need targeted and varied strategies? I point them to Hope Virgo’s eating disorder manifesto, which calls on the Government to implement an evidence-based national eating disorder strategy, with a plan outlining how they will tackle the huge rise in people affected by eating disorders.

I want to single out Hope Virgo for her tireless campaign. She has made such progress in helping us to understand what it is to suffer an eating disorder and access services. She has continually engaged with us and Government in order to achieve improvements. She has done fantastically well. The strategy that she calls for should integrate obesity and eating disorder prevention plans, given the overlapping factors between the two. The Government should also look at reforming treatment approaches. I hope they are looking seriously at Hope Virgo’s manifesto and strategy.

A recent University of Oxford study found that using the integrated CBT-E—enhanced cognitive behaviour therapy—approach over the current in-patient approach reduced readmission rates for people with anorexia by 70% over a year. That means that we need to treat this as a mental health condition first and foremost, and to treat people’s physical health as a result of the mental health issues. If we do not tackle the mental health issues, we will not cure the physical problems.

The strategy should also include better training. According to Beat, 20% of medical schools do not include eating disorders in their teaching at all, while those that do provide less than two hours on the topic. Training should be compulsory in order to spot early signs of eating disorders. Many participants in a 2021 Beat survey reported having a negative experience when they first sought help from a GP. There are many brilliant practitioners in the NHS delivering excellent care, but I want every doctor to complete their training with the knowledge and skills to best support people with eating disorders.

The crisis in the NHS has decimated mental health services. Staff shortages are growing. According to the National Audit Office, between 2021 and 2022, 17,000 staff left the NHS mental health workforce. The Royal College of Psychiatrists 2021 workforce census shows that since 2017 there has been a 30% increase in the number of vacant or unfilled consultant posts in England. That is not good enough. How we can encourage specialists into services is a big question that the Government need to answer.

Eating disorder psychiatry has one of the highest numbers of vacancies, with just 28 full-time consultants. We need significant investment in staff retention. The RCP’s members report high workloads and poor work-life balance. NHS trusts should be supported to meet important improvement targets for retention. I hope that the Government will keep their commitment to publish an NHS workforce plan and that they will bring that forward early, along with adequate investment.

Mental health services need proper funding. This financial year, only 13.8% of local health spending has been allocated to mental health services, although mental illness accounts for 21.3% of the total disease burden in England. The money spent on young people’s eating disorder services has not kept up with the number of young people who need treatment. I support the NHS Confederation’s call for £12 million of additional funding to be made available over the next year to get children and young people’s eating disorder services back on track.

The funding that is provided needs to reach frontline services. An inquiry by the APPG on eating disorders, which I am proud to chair, found that 90% of the additional NHS funding given to clinical commissioning groups for children’s services did not reach the services to which it was pledged. We wrote to CCGs at the time, and the answers that we received were not satisfactory. The Government must ensure that their funding pledges are not empty words and that money is getting where it is needed. A one-off boost for children’s mental health services is not enough. Soaring demand for underfunded services will lead to children missing out on care.

We are all aware that the NHS is in crisis. We hear harrowing stories about ambulance and A&E delays, but the impact on mental health services has received little attention. I hope that today’s debate will make a difference and that we will hear more about the crisis in mental health service provision.

The Liberal Democrats firmly believe that physical and mental health should be treated equally in the NHS. Eating disorders are an epidemic. The sooner we realise that, the sooner we can treat them with the attention they deserve. No one should be condemned to a life of illness, nor should anyone be dying from an eating disorder in 2023.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Ms Harris. I thank the hon. Member for Bath (Wera Hobhouse) for securing this important debate. Both as an MP and as chair of the all-party parliamentary group, she has long been a champion of those with eating disorders.

Improving treatment for eating disorders is a key priority for the Government and a vital part of our work to improve mental health overall. We have heard from right hon. and hon. Members from across the political divide about how urgent this issue is and how many of our constituents are affected by it. It is national Eating Disorders Awareness Week, and raising awareness is an important part of improving the outcome for those suffering with this serious and often life-threatening condition. It can affect anyone of any age, gender or background.

As has been mentioned numerous times, Beat has done tremendous work in this space. It estimates that 1.25 million people live with an eating disorder in the UK. Of those, one in four is a man. I am really pleased that this year’s national Eating Disorders Awareness Week is focusing on eating disorders in men. I think that every Member who spoke in the debate covered the fact that men are often reluctant to come forward and ask for help. There is a stigma around eating disorders, particularly for men. It is important that healthcare professionals recognise that this is also an issue for men, so that if a man or a young boy seeks help, that is taken seriously.

It is vital that we recognise that these issues affect men, so that we can break down the stereotypes and help men to speak up and get help, because having an eating disorder is devastating, and not just for the individual. As the hon. Member for Strangford (Jim Shannon) highlighted, it can also be devastating for those around them, whether family or friends. We know that recovery is possible, which is why it is so important that people come forward to ask for help and support, and get timely access to the right treatment that can save their lives. That is why, under the long-term plan for the NHS, we are investing £1 billion extra in community mental healthcare for adults with severe mental health illness, which includes treatment for eating disorders. The extra funding is being used to enhance capacity for new and improved community eating disorder teams, covering the whole of England.

Hon. Members have raised concerns about long waiting times in their communities. Integrated care boards, which were set up in July, now commission services. We will hold them to account for their timelines, but hon. Members can also hold their local commissioners to account. The funding is given to them for mental health services. We do not dictate how it is spent, because that will be different for different communities, and the prevalence of eating disorders will be different in different parts of England. We expect commissioners to commission those services and to ensure capacity and timeliness for their local population, but if Members of Parliament feel that is not being done, we are happy to meet them to discuss how we can improve things locally.

Since 2016, investment in children and young people’s community eating disorder services has risen every year; there has been an extra £53 million per year from 2021. As my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) highlighted, the pandemic continues to have an impact on the mental health and wellbeing of many people, and has caused a large increase in demand for eating disorder services. Services were almost closed, or certainly severely reduced, for nearly two years during covid, and covid itself had an impact, and there is now a tsunami of people coming forward. Data shows that the number of children and young people entering urgent treatment for an eating disorder in 2021 increased by 11% on the previous year, to over 2,600, and in the year before that it increased by 73%, from around 1,300 to close to 2,400, so there are more referrals than ever before.

A number of Members, particularly my right hon. Friend the Member for Romsey and Southampton North, mentioned online safety. I reassure colleagues that we are working with Ministers from the Department for Culture, Media and Sport on the online safety legislation, but also on other issues, because there is so much work that needs to be done to ensure that online influence is reduced where it is causing significant harm.

To return to the funding being made available, this is the first Government to really put mental health on the same footing as physical health. I am proud that we are creating parity of esteem, not just in planning services but in funding services. As part of the £500 million covid recovery plan funding for the mental health recovery action plan, we have invested an extra £79 million to expand young people’s mental health services, which has allowed 2,000 more children and young people to access eating disorder services. We have delivered this, with over 4,000 more young people entering treatment for an eating disorder than did in the previous year.

A number of Members talked about setting targets for children. We have indeed set targets for children’s eating disorders services. For adults, NHS England has consulted on setting a target for mental health services. I am particularly keen for that to be introduced as quickly as possible. I am meeting NHS England’s clinical lead for mental health services in the coming days and hope to be able to update Members on progress on that, because what gets measured gets done. While we may not be meeting the target for children yet, because of the sheer scale of demand, at least we have a target, and we know which parts of the country can and which cannot meet it, and I am keen that we do the same for adults.

The issue of BMI was raised, and I take the points made extremely seriously. Let me be clear: rejection for treatment on BMI grounds should not occur. If there are instances where that has happened, I am happy to address them; that practice is not in line with any guidance, including National Institute for Health and Care Excellence guidance, so it should not be happening. If there are examples of it happening, we are very keen to hear about them. If it is happening at a local level, I urge hon. Members to contact their local commissioners to find out why, because the guidance does not recommend that practice at all.

The hon. Member for Sheffield, Hallam (Olivia Blake) raised the issue of restraint, which I was concerned to hear about. We introduced new legislation in 2018 on restraint in mental health in-patient settings. If there are loopholes in that legislation, I am very keen to look at them. Restraint should not be happening at in-patient mental health settings, but if someone is outside of that setting and it is happening, we need to look at that. The rapid review across in-patient mental health settings is looking at the safety of those services. We will be looking at the results of that review in the coming weeks. I am clear with hon. Members that this Government sees mental health services as a priority.

[Sir George Howarth]

The Minister may recall that I intervened on the hon. Member for Bath (Wera Hobhouse) about the problem of type 1 diabetics with eating disorders. Is the Minister aware of the two trials taking place, one in London and the other in Bournemouth in the west country? Once an evaluation of the success of those integrated approaches is available and published, will she undertake to look at it, because it could have some indications as to how to treat other kinds of eating disorders as well?

[Maria Caulfield]

Absolutely; I will look out for the results of those trials. I am keen that we use evidence-based medicine, and if something has proven to be effective in clinical research, it absolutely needs to be rolled out. An hon. Member touched on the lack of research into eating disorders. The National Institute for Health and Care Research does have funding available, so I would encourage clinicians, researchers and charities that want to undertake research into eating disorders to apply for funding for those trials. We need more research into eating disorders, particularly around men and high-risk groups, such as diabetics.