Infected Blood Inquiry

John Glen Excerpts

Tuesday 19th November 2024 Commons Chamber

[John Glen (Salisbury) (Con)]

May I first commend the hon. Member for Gedling (Michael Payne) for his maiden speech? I think we can all agree that it was very moving, and that he does great credit to his family and constituents. I apologise for not having been here for the first few minutes; I was running over from Portcullis House.

I had the privilege of being the Minister with responsibility for the infected blood compensation scheme. On 21 May, I brought the scheme to the Floor of the House, speaking from the Government Dispatch Box. In the six months prior, I had been determined—not knowing when the election would be called—to do everything I could to bring that compensation scheme to life after so much delay. That delay has been, as the hon. Member for Blyth and Ashington (Ian Lavery) rightly said, totally unacceptable for too long.

In my remarks to the House, I will pay tribute to the victims, explain some of my experiences as a Minister, and make some observations on what lessons and next steps may need to take place. First, I acknowledge the work of my successor as Paymaster General, the right hon. Member for Torfaen (Nick Thomas-Symonds). He has done virtually everything that I would have done, had the electorate overall given us a different outcome. Though I will always be available to members of the public to ask questions in this House, as is my responsibility as an Opposition Back-Bench MP, I believe that he is doing everything he can to move the scheme forward as quickly as possible, and I will come on to the mechanics of that in a moment.

During the month of May, I participated in 18 meetings. I met representatives of 40 groups in London, Leeds, Birmingham, Cardiff, Belfast and Edinburgh. Each meeting was a profoundly emotional and moving moment for me and the officials who accompanied me. I met people who had gone through unimaginable suffering and uncertainty for not just a matter of months, but, in some cases, a number of decades. Some had been infected through their marriage. Some had been born as haemophiliacs and had been treated in ways that had the consequences we have spoken about today. Some had transfusions when giving birth to their children. Some received blood transfusions from imports that proved to be defective. Some had hepatitis C or hepatitis B. Some had HIV. Many had a combination of different conditions. Some had been family members of those who had been infected. It was a humbling but tragic set of moments. In those conversations, I looked those individuals in the eye and said, “I am deeply sorry on behalf of the British state.” It was a great privilege to be asked to do that on behalf of His Majesty’s Government, but we must learn lessons collectively from the enduring failure to come to terms with what has happened over the course of so many Governments and so many decades.

Many of the individuals I met had campaigned relentlessly, and I pay tribute to them today. I will not draw on individual names, because there are just so many people, and it would be unfair to all those whom I met. It was right that we brought forward a second interim payment, and it was right that we recognised the affected communities as well as the infected communities. It was tragic to see that there were sometimes disputes and divisions among many of the communities, because so much time had passed and so much fear existed around who would be looked after first, and about whether there would therefore be constraints on the money available.

I will step back to last year. After the Remembrance weekend in 2023, I was asked to move from my long tenure in different roles in the Treasury to the Cabinet Office to become Paymaster General. The year before, I had had some exposure to the challenge of making provision for compensation, and my immediate predecessor, the former Member for Horsham, had done a lot to try to ascertain what had been done collectively in government. The truth is that there was a very wide envelope: it may have been between £2 billion and £20 billion, and it had moved around according to what analysis could be done. That was because the parameters were fundamentally going to be based on how much compensation we would pay the different groups who were infected and affected. My predecessor started that process, and I pay tribute to him for what he did.

I also pay tribute to the former Chancellor, my right hon. Friend the Member for Godalming and Ash (Jeremy Hunt), who said to me when I left the Treasury, “You have one duty in that job. That is a moral duty to resolve the compensation scheme.” I honestly believe that he was critical in ensuring that we got to where we did on 21 May. I pay tribute, too, to the right hon. Member for Kingston upon Hull North and Cottingham (Dame Diana Johnson), who did so much. At every question session, she sat just behind where I stand now, challenging me on what I was or was not doing. As the Paymaster General knows too well, there are always constraints; his officials will say, “I wouldn’t say that at this point.” We are always trying to say more, but I was acutely aware of how frustrated all the communities were, and that unless what I said was crystal clear, it would set off another storm of speculation on social media.

On the advice of my officials, I appointed Sir Jonathan Montgomery, who in the early months of 2024 assembled a small group of technical experts to advise on how to translate the compensation study of Sir Robert Francis into a full compensation scheme. We asked how, across the five heads of loss—injury impact, social impact, autonomy, the care award and the financial loss award—we could put a number on the relative suffering across all the different conditions. How could we put a number on the loss of a normal life, the loss of the ability to work, the loss of a sense of respect from the community in which people lived, and the stigma that other Members have referred to?

It was suggested to me at the time that I had done it the wrong way round—that I should have engaged with the community. I took the view that we were not going to get this resolved if we had done it that way round, but I knew it was critically important for all the communities to be engaged with, and I always had that expectation and intention. That is why, when I announced the scheme to the House on 21 May, I established a series of engagements where Sir Robert Francis met representatives of the infected and affected communities to go through the scheme and establish where changes needed to be made. Those engagements happened in June. I pay tribute to my successor, the Paymaster General, who engaged with the output of that work and—as per the timetable that had been agreed—made virtually all of the changes that were requested.

Today, understandably, I hear speed being urged across the House—that this should happen quicker to get the payments made. I totally understand that, and to some extent, I agree with it. However, I want to reassure the House that David Foley, who is now setting up and, I think, heading up the Infected Blood Compensation Authority as an arm’s length body of Government, is a superbly experienced civil servant. Neither I nor the Minister could have written the cheques ourselves to set up the processes and systems for evaluating entitlement and getting money out as quickly as possible. For those infected individuals who are alive—around 4,000—speed is obviously an imperative. The reason I took the decision on the £210,000 second interim payment, alongside the £100,000 from October 2022, was that I received advice, and I pressed and challenged my officials to get to a number that was the maximum that everyone would receive.

However, it is of course wholly necessary not just to get a first tranche fully paid out, but to get everyone else paid out. I acknowledge that there are questions about how to verify the date of infection, but despite all the bad things that have happened, obviously we must reconcile speed and effective decision making with ensuring that we pay the people who are entitled to the payments.

In Sir Brian Langstaff’s seven-volume report, of which I went to see the publication on Monday 20 May, he made a number of recommendations, and the Minister has indicated the Government’s willingness to honour those—the national memorial, and biannual meetings with those who have suffered in order to get to grips with the duty of candour. I want us as a House to be clear and honest about what we are really asking for, because the report spanned decades and different generations of Ministers, civil servants and orthodoxies in the medical profession. We need to encourage curiosity among individuals who see things going wrong but are held back from being truly candid because there tends to be group-think which prevents a thorough interrogation of what should be done.

Distortions happen, recollections have varied and medical professionals would make different judgments now from those they would have made at different points in the past. We need to be wise about what the duty of candour will look like, but we need to grasp the core argument that Brian Langstaff makes: we have to change the culture across Government and public service and in politics. I hope the Minister does not move on, but if he does, I hope he moves up. If he stays in his position, however, he can have an impact over time. When Ministers move, they have a received wisdom from their officials of a previous iteration, and we sometimes need to encourage the infusion of new Ministers to ask challenging questions and allow progress to be made.

I have profound concerns about public inquiries. A lot has been said in recent months about the multiple public inquiries that have occurred—how we can make them more systematic and aligned; the secretariats and the processes they run can obviously be streamlined. They are presented as the only cathartic method for the British state to come to terms with something that has gone wrong, and they are often not constrained in any way. They are typically led by retired High Court judges, and I have nothing against them, but we sometimes need to broaden the expertise such as by having economists and other people involved in looking at these things.

I pay tribute to Brian Langstaff, because the inquiry was a massive undertaking, but seven years is an enormous amount of time. I am not an expert on this, but let us think about the read-across to the covid inquiry. Many people have expectations of what that will deliver, but in other countries such analyses have brought forward recommendations and changes much more quickly. We have to get the balance right—not to cover up anything, but because we end up putting things into the long grass for so long. We as a Parliament need to come to terms with that.

I have probably spoken for too long, but I hope I can be forgiven for doing so given the role I had. I want to pay tribute to the work that has been done by those responsible for bringing us to this point. I pay tribute to all the victims and campaigners who have been so determined despite numerous knock-backs from Governments over the years. My own Government absolutely have to take their full share of the blame. Interim arrangements were made and ad hoc compensation schemes were set up, but responsibility was not taken by the British state, and it is absolutely right that we have done so now.

I do not think that social media is very helpful in trying to come to terms with the trauma of all this, or in giving clarity to those who need it. I wish David Foley and the IBCA well. I think there will be a series of letters about how to interpret individual recommendations, but he is setting up an efficient mechanism which, once it starts delivering, will deliver more and more rapidly—I am convinced of that. For some it cannot come soon enough, but I hope that very soon we can draw the right enduring lessons from this national scandal, and I hope it will never happen again.

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[Pete Wishart (Perth and Kinross-shire) (SNP)]

It is always difficult to follow somebody who has said almost exactly what I had intended to say in my speech. What I will try to do for you, Madam Deputy Speaker, is rephrase it in a way that will hopefully be helpful and useful to the House. I am grateful to follow the hon. Member for Eltham and Chislehurst (Clive Efford), who raised a number of really important issues about which those on the Government Front Bench should listen carefully.

I noticed the Paymaster General’s reaction to the hon. Member for Eltham and Chislehurst; he has got to relax a little. We are trying to help and to be the voice of the community, who are telling us these things. They want to be engaged and properly consulted with. They want to be part of the process. That is what they are telling the all-party parliamentary group on haemophilia and contaminated blood, and that is what we are hearing from all the representative groups right across the United Kingdom. Perhaps the Paymaster General should just take on board some of the things that we are trying to put forward about the feelings and opinions of a lot of the community and what they are saying to us directly as a consequence of what is happening.

I congratulate the Government on honouring their commitment to have a debate. It is a pity that we did not get the full day, but one thing I have noticed is that it is getting a bit quieter in the Chamber when we have these debates and statements. I hope that there will not be fatigue when it comes to discussing important issues relating to the infected blood scandal, as we as a House will need a detailed approach to the ongoing compensation schemes.

I really hope that we will not get to a stage where the Government see this as “job done” and another box to be ticked, thinking, “There we go: infected blood is dealt with and we can now move on.” It is incumbent on all of us who were involved in the campaign to ensure that we continue to press the Government, ensuring that we talk up on behalf of our constituents and those impacted and affected.

I really hope that we start to see some newer Labour Members, in particular, taking a bigger interest—we used to have really involved, detailed debates where people turned up and played their part—as I am sure that many of them represent people who are impacted and affected. It would be good to see a few of them turn up.

[John Glen]

I think it is it is a good sign that there are fewer Members of Parliament in the Chamber, because it shows that there has been meaningful progress. I do not see tetchiness from the Minister; what I see is somebody who has listened carefully to the representations of the community and acted on them. I accept and acknowledge that there are outstanding matters, but actually, when infrastructure has been set up—in some cases for 20 years—to campaign, it can be quite difficult to adjust to delivery mode.

[Pete Wishart]

There is no one in the House more experienced than the right hon. Gentleman. I pay tribute to what he did in government and how he brought this issue forward. He is right; we must be a bit careful, but all of us involved are just trying to take the debate forward. He is possibly right that there may be satisfaction that things have moved on and we are at a different stage in the campaign, but it is still important that we continue to ask questions of Government. That is what we are all trying to do in this debate.

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[Andrew Gwynne]

I agree with the hon. Gentleman, which is why IBCA is operationally independent—that is the crucial thing here. It does not have the fingerprints of Ministers all over it, because that is where the distrust comes from. It operates independently, but as a public body it is accountable to this House for how it spends that money and how it operates as an organisation. While IBCA is operationally independent to ensure a separation between Executive Ministers and the functioning of that body, it is accountable to this House. I think that is absolutely the right balance.

[John Glen]

I endorse what the Minister has said about the way in which IBCA has been set up. It seems to me an entirely sensible arrangement that respects the need to have some distance from Government, but clearly there cannot be a bespoke arrangement for every single entity that is set up. This was the point I was trying to make, respectfully, about Sir Brian Langstaff earlier: he did a brilliant job, but some aspects of this issue will need a slightly different judgment made by Ministers. I welcome the decision that the Minister and his colleagues have made.

[Andrew Gwynne]

I thank the right hon. Gentleman for that intervention. I hope that Members across the House can see why we have set IBCA up in the way we have. It is for precisely that reason: we have to have that operational separation from Ministers and the Executive, but there also has to be political oversight from all quarters of this Chamber, because this is a public body spending public money—and a great deal of public money at that.

As I have said, we are aiming for the second set of regulations to be in place by 31 March 2025. That will support our intention that payments to the affected begin next year. There are important details, especially in relation to Sir Robert Francis’s recommendations, the majority of which the Government have accepted, that must be worked through ahead of the second set of regulations. This includes details such as the eligibility criteria for people who are affected, and how the Government should define the parameters of the definition of unethical testing.

Turning to payments, the selection of those who have been contacted for first payments was a decision for the Infected Blood Compensation Authority. The first group of people who are receiving invites to claim are: first, those who are known to be already eligible for compensation; secondly, those registered with support schemes, which means we are likely to have much of the necessary information for these people already; thirdly, those from areas across the UK; and fourthly, those who represent a range of infection types and of severity within those infections.

Let me turn to some of the questions raised about this area. The hon. Member for Eastleigh mentioned people dying before compensation is awarded. I hope I can reassure her that when a person with an eligible infection has, tragically, died before receiving compensation, we will ensure that their personal representatives can claim compensation on behalf of the deceased’s estate. I hope that clarifies the point for her.

My hon. Friend the Member for Swindon North talked about the exclusion of victims with hepatitis B from the compensation scheme. People with chronic hepatitis B and those who die in the acute period are eligible for compensation, as are their loved ones as affected. I suggest that my hon. Friend writes to the Minister for the Cabinet Office with his constituent’s details, so that we can look more closely at his case. My hon. Friend the Member for Eltham and Chislehurst asked whether there will be payments by the end of the year. The answer is yes, and as I have said, there will be payments to the affected from next year, when we have the new regulations in place.

The right hon. Member for East Hampshire asked about the steps taken to provide accessible information on compensation. I want to spell out to him that Sir Robert recommended that there should be a higher award of £15,000 for children subject to unethical research at the school in his constituency. That is why there is a difference, which I hope clarifies that point for him. As I have said, at the start of November the Infected Blood Compensation Authority invited the first cohort of people to make compensation claims.

Candour in the civil service and in Government was raised by my hon. Friend the Member for Eltham and Chislehurst and the hon. Member for Perth and Kinross-shire in their contributions. The King’s Speech set out the commitment to bring forward legislation to introduce a duty of candour for public authorities and public servants. This legislation will be the catalyst for a changed culture in the public sector. The Prime Minister confirmed at the Labour party conference that legislation on the duty of candour would be delivered by this Government. He confirmed that the duty will apply to public authorities and public servants, and it will include criminal sanctions. The Bill will be introduced to Parliament before the next anniversary of the Hillsborough disaster in April 2025.

In closing, today I hope the House has heard how we are starting to deliver compensation and how we are starting to respond to the inquiry recommendations. Admittedly, they are still small steps, but they are steps in the right direction. This work is far from over. We owe it to the victims and their families to see it through, and we will of course regularly update the House as this progresses. I reiterate on behalf of the Government and the Department of Health and Social Care, and as a mere ordinary Member of Parliament for Gorton and Denton, representing some of the infected and affected, that we are truly sorry. We let you down. We will learn from these lessons, and we must never ever let anything like this happen again.

Question put and agreed to.

Resolved,

That this House has considered the Infected Blood Inquiry.

National Insurance Contributions: Healthcare

John Glen Excerpts

Thursday 14th November 2024 Commons Chamber

[Karin Smyth]

I am so pleased to see my hon. Friend in her place. As I said to the hon. Member for Aberdeenshire North and Moray East (Seamus Logan), the SNP has been in charge of Scotland for a very long time. We have certainly missed having a Scottish Labour voice in this place. She makes an excellent point and shines some sunlight in this place on the actions that have been taken up in Holyrood.

[John Glen (Salisbury) (Con)]

Julia’s House hospice does amazing work across Wiltshire and Dorset, but its chief executive Martin Edwards came to Parliament on Tuesday to tell me that the additional national insurance contributions will cost the hospice £250,000 a year. For that hospice, and Naomi House, which does similar good work, the changes are a significant concern. I know that the people of Wiltshire and Dorset will do as much as they can to raise additional funds, but will the Minister reflect on that unexpected gap and offer some reassurance?

[Karin Smyth]

I agree with the right hon. Gentleman that his hospice, and the hospices in many of our constituencies, do great work. We are aware of the precarious situation that they have been in for a number of years, and we want to ensure that they are fully part of end of life care. He will know from his time in the Treasury that there are complicated processes, both in the Treasury and in the Department of Health and Social Care. When I talk about the normal processes for allocating money, I think he understands that well. We are mindful of hospices’ concerns, and we will continue to talk with them.

Mental Health Support

John Glen Excerpts

Thursday 10th October 2024 Westminster Hall

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

Thank you, Mr Dowd, for allowing me to take off my neck brace to speak. I congratulate the hon. Member for Ashford (Sojan Joseph) on speaking so powerfully on this topic. I was a doctor before I came to this House, so for me the topic is important. There is a clear distinction when we debate this topic between mental wellbeing and mental health. Lockdown proved that everyone’s mental wellbeing gets punished, but not everyone has a mental health issue. That is important when we are trying to segregate services: how do we supply the correct services to the people who need them the most?

I have spent the last five years in Parliament campaigning around body image and for a men’s health Minister, particularly with regard to suicide. But I turn my attention to something close to my heart that is really important: the issue of adolescent mental health, because I am deeply concerned by the increase in children who are suffering. It is not just things such as eating disorders; we are seeing attention deficit hyperactivity disorder, we are seeing anxiety and we are seeing autism.

I plead with the new Minister to think radically, in a positive way, when it comes to the NHS. In my area of Leicestershire, 40% of child and adolescent mental health services is taken up by dealing with ADHD and autism. That takes a lot of attention away from the kids who are self-harming, or have eating disorders or significant serious depression or psychosis. There is a radical solution: pull out education and health and pool those services as specialisms. That would build on the work that the last Conservative Government did on placing representatives and mental health workers in school, and would allow GPs and CAMHS the freedom to concentrate on what they need to deal with.

[John Glen (Salisbury) (Con)]

On that point, may I draw my hon. Friend’s attention to the role of care co-ordinators with adolescents, and the problems and challenges of the transition to adult care? That moment can be critical in securing a pathway to an effective outcome. Often, the confusion over where responsibilities are delineated and begin has been a difficulty for my constituents.

[Dr Evans]

My hon. Friend is absolutely spot on. The cliff edges that exist in the NHS—and education and social services—cause a real problem, particularly for families, because at 18 someone does not just lose their diagnosis.

It is important to pool those areas because it allows us to stratify the way that we use our limited resources, and we know that health costs will continue to go up and spiral. I urge the Minister to have a think about potentially creating almost a national special educational needs and disabilities service, which would pool education and health experts together, releasing schools and relieving GPs’ primary care and secondary care with specialists. Now we have the set-up of ICBs, there is scope to do that regionally across the 42 areas.

It is well worth thinking about pooling those resources together, because it would be possible to give specialist help; and as the hon. Member for Ashford said, identifying people early means that they will not end up in a crisis. That brings us back to preventive care, to identify those who are having problems with wellbeing or who have mental health issues. For me, that is the crux of what we need to do: how do we pool the resources in a way that is sustainable for the taxpayer and, most importantly, service users and providers—the children and adolescents, and the staff who have to cope with some of the most difficult problems? I leave the Minister with that thought.

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[Dr Simon Opher (Stroud) (Lab)]

On World Mental Health Day, I am wearing this slightly ghastly yellow tie. May I also do a little promotion? In room M in Portcullis House at 3 o’clock, at the end of the debate, we have some young people, through YoungMinds, telling us what they think of the service. It is really important, particularly with young people, to make sure that we develop services that they want and that we do not dictate.

I am still a practising GP in Stroud. More than 90% of mental health consultations take place in primary care and more than 40% of GP consultations concern mental health. I am sure the hon. Member for Hinckley and Bosworth (Dr Evans) will concur with me on that front. I would like to divide mental health into two sections. There is serious mental illness, which is serious and enduring, affecting about 130,000 people in this country. I will make a little plug: they tend to die 10 to 20 years earlier than other people and we must promote their physical health.

The other area is anxiety and depression. We have 8 million people in this country on antidepressants—selective serotonin reuptake inhibitors—and at least 2 million of them are trying to get off. We need to ensure we do not over-medicalise mental health. I was pleased to hear what my hon. Friend the Member for Ashford said about mental wellbeing and mental health. We all get a bit pissed off sometimes—that is normal for humans—and it is extremely important that we do not conflate that with mental ill health.

[John Glen]

May I just say how much I agree with that remark? We may disagree about resourcing and what has happened over the past 14 years, but we need the confidence to talk about building resilience and prevention so that people do not get to the point where they need medical intervention. We have the responsibility to talk about that in this place and in our communities so that we get to the root causes, which are not always to do with socioeconomic matters.

[Dr Opher]

Absolutely; I fully agree with that.

I want to make a couple of comments about the state of mental health services, for which there are extraordinary waits: a patient of mine had to wait six months following a suicide attempt. That is simply not good enough. In Stroud, we have to wait four years for neurodiversity assessments because we do not have enough resource. In my opinion, we need to move the resource into the community.

I also support what my hon. Friend the Member for Ashford said about health and education. We need mental health support teams in our schools, and we must spread SEND provision evenly.

The Under-Secretary of State for Public Health and Prevention is with us, so I want to talk about the prevention of mental health issues. There is quite a lot of evidence about promoting maternal and infant mental health, and also about parenting and bullying at school. Using arts and culture is an incredibly strong way of improving mental health.

I was impressed with what my hon. Friend the Member for York Central (Rachael Maskell) said about the community basis of mental health treatment. For many lower-level conditions, there is no need for consultant-led care. Support that takes place in the community costs much less and can be really effective.

The CAMHS waiting list is appalling, and we have a crisis with SEND and delays with education, health and care plans. We do not have enough educational psychologists either. I want to stress what my hon. Friend the Member for Ashford said about care co-ordinators. Young people’s social prescribers are very effective and tend to de-medicalise things that can be supported in the community.

I am really impressed that we are going to get 8,500 more mental health workers. I am also impressed by what they will be doing in schools. We need to improve the physical health of people with serious mental illness, reduce the number of SSRI antidepressant medications, and promote social prescribing, the arts and community care in our mental health services.

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[Andrew Gwynne]

My hon. Friend is absolutely right. At the heart of the health mission that the Labour Government want to see is the shift from hospital to community, from analogue to digital and from sickness to prevention. What we do in the community really matters. Our ambition for the future of mental health services is wrapped up in those shifts, particularly the shift from hospital to community.

[John Glen]

Could I share my experience as a Minister? When we looked at social prescribing when I was in the Treasury, it was always difficult to establish an evidence base to justify the allocation of resources. I urge the Minister to continue that battle to make the case, because I am sure that the instinct of all Members throughout the House is that there is something in that ambition, and we must find a way of unlocking it so that we can get social prescription out into the community where a variety of provision is available.

[Andrew Gwynne]

The right hon. Gentleman is absolutely right. That will be one of the big challenges with the prevention agenda more generally, because often the investment we have to make today does not pay dividends immediately and there is a bit of a punt. Having been a Treasury Minister, he will know the challenges that that can present to the Treasury orthodoxy, but we have to push on this agenda.

I always say that being an MP and a GP is only one letter apart. We are often dealing with the same people who present with the same problems but from a different angle. We go away as Members of Parliament trying to fix the issue as they have presented it to us, and the GP will write a prescription and send them off having sorted out the issue as it was presented to them. However, the beauty of social prescribing is that there is an opportunity to deal with the whole issue in the round. The argument has been won with almost everybody, and any tips from the right hon. Member for Salisbury (John Glen) so we can get this over the line with the Treasury will be welcome.

I should mention my hon. Friend the Member for Darlington (Lola McEvoy), and welcome the hon. Members for Winchester (Dr Chambers) and for Runnymede and Weybridge (Dr Spencer) to their Front-Bench positions.

In the minutes I have left, I want to say to the House that many of the issues raised by Members during the debate are symptomatic of a struggling NHS. If we look at the figures, the challenges facing the NHS are sobering. In 2023, one in five children and young people aged eight to 25 had a mental health problem, which is a rise from one in eight in 2017. The covid-19 pandemic has exacerbated need, with analysis showing that 1.5 million children and young people under the age of 18 could need new or increased mental health support following the pandemic.

NHS Dentistry

John Glen Excerpts

Thursday 20th October 2022 Commons Chamber

[John Glen (Salisbury) (Con)]

I rise to speak on behalf of a number of dentists in my constituency. Nicola Jones, an oral surgeon at Salisbury District Hospital, contacted me to say that the lack of available NHS dentists is causing significant challenges in the constituency. I recognise that from my mailbox over recent weeks. I met Matthew Clover, a specialist orthodontic practitioner, in February. He took me through the challenges of the “units of dental activity” model: it does not discriminate properly when it comes to the classification of the different activities that he has to undertake.

The challenges derive primarily from the lockdown two years ago and the interruption to supply: 38 million appointments were lost. I welcome the Government intervention earlier this year to provide the additional £50 million and 350,000 additional dental appointments. I also welcome the Government’s statement in July, but this is an opportunity for the new Minister to challenge his officials and work with industry representatives to find a deeper and more enduring set of changes that address some of the ongoing challenges that have existed for a very long time.

I would not suggest that I have anything like the expertise of my hon. Friend the Member for Waveney (Peter Aldous), the hon. Member for Bradford South (Judith Cummins) or, particularly, my hon. Friend the Member for Mole Valley (Sir Paul Beresford), who has a lifetime of experience at policy level and as a practitioner. But I am aware that since 1951 there has been a model of co-payments, in which dentists act as independently contracted professionals to the NHS but also typically receive an income from private practice work as well.

[Wera Hobhouse]

The hon. Gentleman makes a very good point that, basically, private patients have been cross-financing NHS patients, but that model is no longer sustainable.

[John Glen]

I respectfully say to the hon. Lady that my mother is a resident of Bath and has received excellent service from her NHS dentist. Although I recognise this problem exists in different spots of intensity across the country, it needs a comprehensive solution.

The fundamental point is this: how can the model of rewarding dentists incentivise the maximum amount of engagement? All dentists start their professional life wanting to help people and wanting to do as much good as they can. I totally embrace what my hon. Friends the Members for Mole Valley and for Gloucester (Richard Graham) said about the need to deal with the oral health and education of young people, including how to clean their teeth at an early age. There will need to be a focus on how those practices can be embedded in a funding model that has to pay some respect to the geographic coverage of a dentist, while ensuring that each cohort of the population has access to basic dentistry.

The proposed new dental contract goes some way towards dealing with some of the challenges of the UDA model, but it probably does not go far enough. I urge the Minister to go beyond what his officials may be suggesting to him, to think radically and to take this opportunity to ask, “How can we reset after the dislocations caused by covid?” I urge him to come up with something that incentivises dentists to offer an holistic service to people of all means and to help those communities that have cold spots of dentistry supply.

I would like to make a few observations about supply and, again, my hon. Friend the Member for Mole Valley made some very good points about streamlining bureaucracy to ensure more people qualify as dentists in this country. Of course, it is right that we have ongoing quality assessments through the CQC, but that organisation’s focus, as across all industries, needs to be on where there are vulnerabilities and risks. When we think about NHS medical and dental services, I feel we are continually trying to be perfect and to remove all the risk, which sometimes has a cost because it involves using resources to fill in bureaucratic processes that might not necessarily, in most cases, give us much return.

My message to the new Minister is to build on the good start made by his predecessor in the summer, but to consider a more radical and fundamental review of the UDA funding model, to consider the volume of patients and to consider the real dynamics of the choices a dentist makes about how to maximise the number of patients they see who cannot afford to make a contribution.

I feel hopeful that the enthusiasm to provide the service I saw from my dentist in Salisbury means there will be a solution. I wish the Minister well, and I acknowledge the contribution of my hon. Friend the Member for Waveney, who showed a mastery of this subject.

Procurement of Evusheld

John Glen Excerpts

Wednesday 12th October 2022 Westminster Hall

[Daisy Cooper]

The hon. Member is absolutely right. Many people are clinically vulnerable because they have a health condition, and their physical health is getting worse, as it would when someone is stuck at home for two and a half years, but the mental health impact is also incredibly profound. We know that many of our constituents have experienced suicidal thoughts.

I turn now to the advice of the RAPID C-19 oversight group, which has been mentioned. The Government refused to share this advice for some time, and many of us were asking for it. I was pleased to see that this advice was finally published last Thursday on 6 October. I was pretty shocked for two reasons. First, the report actually says that the group looked at real-world data and the impact on people and that data was very strong. Then it looked at the data in a non-clinical setting and decided not to roll it out. That seems absurd to me.

There is a second problem with the evidence that was published last week. It lists the evidence that the group reviewed, and it leaves out one very critical scientific study by the Francis Crick Institute—a study that I believe the Government commissioned themselves. That study was commissioned to look at the effectiveness of a different drug: sotrovimab. That report concluded that sotrovimab was effective, and the Government are using that report to justify why they continue to use sotrovimab. However, the report also concluded that Evusheld was even more effective. So why not buy Evusheld too? Perhaps the Minister can enlighten us.

On the same day the Government published this RAPID group report, The Lancet—the world’s highest-impact general medical journal—carried an article by 19 experts calling on the World Health Organisation to update its guidance on Evusheld, based on the study the Government commissioned. In the article, those experts say that Evusheld should be used for not only preventative, prophylactic use, but treatment. The UK Government are really trailing behind. Can the Minister tell us why the RAPID study ignores this vital piece of research, which they must have known about?

Many of the people we are talking about have already had five or six vaccine jabs, even though they will mount very little, if any, response. The Government say it is important that these people get those vaccines, because they say some response is better than none. Why does that same test not apply to Evusheld? Why is it being singled out and held to an impossible standard?

Let us look at what the Government are proposing, instead of following the science. Ministers have referred Evusheld to NICE for further clinical and cost-effective assessment; apparently, we might hear back in April 2023. That is another delay—another six months of isolation—even though every other covid treatment and vaccine was urgently procured before being appraised. I ask again, why is the Government’s treatment of Evusheld so inconsistent?

[John Glen (Salisbury) (Con)]

My constituent Helen Nash asked me to be here to support the case that the hon. Lady is making. She makes the key point: while the Government did a lot of great work to accelerate the availability of vaccines for the population at large, this particular cohort seems to be subject to a very different set of criteria. That is the great concern. While we must rely on clinical advice, we must also have the same situation for all people, regardless of their status.

[Daisy Cooper]

I agree with the hon. Gentleman. One of the big concerns that has not been answered by the Government so far is why their approach to this drug is so inconsistent with their approach to others. As I say, Ministers have referred Evusheld to NICE, and it is not at all clear why their treatment of it is so different.

Meanwhile, the Department of Health has proposed that immunocompromised patients have an antibody test, and that those who do not respond well enough could join an Evusheld trial. Let us be clear what that trial would mean in real life. It would require some of the people who have been shielding to stay alive for two and a half years to come out of shielding like the rest of us, but without any protection from covid vaccines, knowing that they might only be given a placebo. It would be like taking lambs to the slaughter. I would be astonished and appalled if that proposal passed anyone’s ethics test. I do not know if the Minister would support one of his loved ones taking part in such a trial, but I certainly would not. Can the Minister therefore tell us why his Department wants to take this dangerous approach instead of the approach suggested by the Drug Safety Research Unit, which has called on the Secretary of State to roll out Evusheld now, for this winter, and to run an observational study of the impact?

Another question that has arisen is whether there are problems with supply. The answer is no. AstraZeneca has dismissed that claim.

Income tax (charge)

John Glen Excerpts

Monday 16th March 2020 Commons Chamber

[David Mundell (Dumfriesshire, Clydesdale and Tweeddale) (Con)]

I am pleased to have the opportunity to speak in this debate. Harold Wilson said that a week was a long time in politics. During Brexit we found out that a week was even longer, but the Budget, only last Wednesday, seems a lifetime ago. Even when listening to the Chancellor, I still harboured hopes of a long-planned personal visit to New York this weekend, but for all the reasons we see around us that is simply not able to happen. Three weeks ago, I was in Rome for the Scotland-Italy rugby match. At that point, the talk was of difficulties in the north. No one envisaged that instead of the crowds in St Peter’s Square or outside the Colosseum there would be nobody.

As a Member of Parliament, I am often asked about the most difficult issue and time I have had to deal with. For me, the answer is very straightforward: the 2001 foot and mouth crisis, which affected my constituency deeply. I want to be very clear that I am not making any comparison between that disease and coronavirus. The comparison relates to the impact of an event of that scale on businesses and their continued prosperity, and on the wider community. There was also, as a report from Strathclyde University and others identified, the impact of isolation. During that period, very stringent measures were taken and many farmers had to be isolated on their own properties and could not leave. The report, two years later, made very clear the long-term consequences of isolation. We need to take those findings on board and think about them. We need to learn the lessons of such events, with measures that might come into place. I am sure those issues will be debated when we have more focused debates on coronavirus.

The businesses most affected by those circumstances were the self-employed and contractors, so we need to give those groups the maximum possible support. The hospitality industry was also very badly affected. One lesson from that experience is that small businesses need grants not loans. I remember taking part in a demonstration—I know that that will surprise you, Mr Deputy Speaker—outside the offices of Scottish Enterprise Dumfries and Galloway with colleagues in small businesses to make just that point. Grants, not loans, were needed to see them through. Rates relief is to be welcomed and I welcome the package of measures the Scottish Government have announced, but it is capped and we need to look again at whether that is appropriate.

The other big players are the banks. From my perspective, the situation that we face will be easier to deal with because it affects the whole United Kingdom, so the banks that are based outwith the south of Scotland and that are being asked to support businesses understand what is happening on the ground. We need that unity of purpose from the banks. Hon. Members who have dealt with the banks know that they always say the right thing, but doing it is something else, especially when the computer says no. We need to make sure that they follow through on their commitments, and on the positive tone that the Chancellor set in the Budget.

We need a uniformity of approach from the Government at all levels—the UK Government, the Scottish Government and local government. The underlying philosophy of all those institutions must be that we want to keep our businesses going and that we are not jobsworths who want the returns in on the exact date. That is why I welcome what the Chancellor said about VAT holidays and flexibility with Her Majesty’s Revenue and Customs. I am sure, however, that hon. Members on both sides of the House have experience of HMRC not being particularly flexible, so we need that to be followed through. That unity of purpose from government will be vital.

As has already been said in an intervention, the hospitality and tourism industry is the most vulnerable in a constituency such as mine. Often, as I found out during the foot and mouth crisis, businesses that have done well and are planning for the future are the worst hit. For example, the Gretna Green Famous Blacksmiths shop in my constituency, one of the most visited tourist attractions in Scotland, has won numerous awards for its attempts to attract Chinese visitors. A large number of Chinese visitors go to that location, but not any more—there are none. Its business model has already been seriously disrupted by these events. It is a bigger business, not a small business, but it needs help and support too, if that sector of the economy is to survive after these events.

Hotels in my constituency were already in difficulty; many, such as the Moffat House hotel, have closed. One local hotelier told me that they were facing a perfect storm of events, of which, at that stage, coronavirus was not one. I appeal directly to the Scottish Government on that issue, because the way that our business rates system in Scotland works for the hospitality industry, and particularly hotels, is still not right.

As I indicated, there are lots of lessons to learn. I hope that there is still the institutional knowledge in the Scottish Parliament and the Scottish Government to learn lessons from 2001, and that the Government can take some of those lessons on board, particularly in relation to isolation, as I said.

I welcome the Budget as a whole for Scotland, in particular the £640 million of additional funding for Scotland, which was £172 million more than the Scottish Government had anticipated. By any analysis, the Scottish Government got extra money. In my experience, they have not always welcomed, or even acknowledged, extra money—indeed, sometimes it was the wrong kind of money, even if they did acknowledge it. I hope that on this occasion, and in these circumstances, they will acknowledge the extra money.

As I said, I am pleased with what the Scottish Government have had to say about spending on business support in relation to coronavirus, but I would also like the money that is coming forward to be spent on infrastructure. Back in the ’90s, before the Scottish National party was in power, and when it held the constituency of Galloway and Upper Nithsdale, as it then was, the A75 and A76 were described as the most important forgotten roads in Scotland that needed to be substantially upgraded. Of course, since 2007 there has been an SNP, or SNP minority, Scottish Government, but that investment has not been forthcoming. I use this occasion to plead for the needs of the A75 and A76. I am sure that there is somebody in the SNP who remembers those previous commitments.

Obviously coronavirus is significantly affecting today’s debate, and rightly so, because it is the issue that most affects our constituents at the moment, but I want to highlight one other issue on which I wrote to the Chancellor ahead of the Budget, together with 15 Conservative colleagues, the Association of Convenience Stores and the British Retail Consortium: access to cash. It is a big issue; in a crisis, many people like to have some cash available, so that they have flexibility in how they approach difficult circumstances. There is a crisis in access to cash, and it affects large rural constituencies such as mine in particular, but also many other communities.

Some of the most deprived communities in our country bear the hardest impact. I had not realised until relatively recently that the average withdrawal from a cash machine is around £10 or £20. A fee of up to £3 to take £10 out of a cash machine is a very significant mark-up. A report has indicated that about 8 million people in our country are not ready to cope with a cashless society. A cashless society may come; indeed, when I travel from my constituency to central London, I feel that central London is, in many ways, a cashless society—in which there are, ironically, hundreds of cash machines. We need to do something about this issue. I welcome the Chancellor’s promise in his statement to legislate to secure the long-term future of cash, but it is very important that the steps that he takes are the right ones.

[The Economic Secretary to the Treasury (John Glen)]

indicated assent.

[David Mundell]

I am pleased to see the Minister nodding; I hope that he will nod when I say that those steps should include reversing the arbitrary cuts to the LINK interchange rates paid by banks to fund the network; exempting free-to-use ATMs from business rates; and recognising that ATMs are the only infrastructure through which we can guarantee national access to cash. Of course, cashback at convenience stores and other places has a role to play, but it is very important that we have a sustainably funded network of cash machines throughout the whole country, given the many branch closures we have seen in our constituencies—particularly Royal Bank of Scotland branch closures in Scotland.

I agree with the hon. Member for Ellesmere Port and Neston (Justin Madders). The consequences of these events—such as the foot and mouth crisis that afflicted much of the south of Scotland 20 years ago—go on for years. They do not just end when someone declares that the crisis is over. They go on for a long, long time for the businesses, individuals and communities that have been affected. We do not just pledge support to those individuals and communities today; we pledge it to see them all the way through the consequences. I think that that will mean revisiting some of what was announced in the Budget and some of what was announced by the Scottish Government, and if that is necessary, so be it.

Young People’s Mental Health

John Glen Excerpts

Thursday 27th October 2016 Commons Chamber

[Andrew Bingham]

Exactly. I mentioned this to Martha and Lucy and they did not know what SWALK was. I can tell my hon. Friend that it stands for “Sealed with a loving kiss”. Those days are long gone. Now everything is done via social media. It is out in the open for everyone to see and it is also there forever. The SWALK letter is read. If it is not reciprocated, it is thrown away; if it is reciprocated, it is replied to. On social media, it remains there forever.

That brings with it perils and pressures. Relationships, appearance, fashion, style—all are analysed in the public glare. Relationships, attitudes and opinions once shared privately between friends are now put out for the world to see, with every comment seemingly soliciting a further comment or response and the rhetoric growing from that. With, for example, chat groups on applications such as WhatsApp, it is very easy for what could be seen as a little verbal leg-pulling or teasing to take on a sinister complexion. We increasingly hear stories of cyber-bullying and the posting of revenge pictures. I am sure all of us in this House have at one time or another been on the receiving end of comments online that we would see as offensive or upsetting. However, for a teenager, maybe uncertain, vulnerable or lacking in confidence, such remarks can have a shattering effect on their self-confidence and in turn their mental state.

Let us look at the media in general. The modern media seem to present all young people in reality programmes such as “Made in Chelsea” as perfectly formed human beings, which puts pressure on so many young people to be absolutely perfect. The slightest imperfection, perceived or otherwise, can become a major issue. We hear a lot about body image, too, and young people’s attitude towards it. Again, the desire to be perfect crops up, so when a perceived imperfection is not only remarked on but ridiculed via social media, it can be amplified and re-tweeted, when “likes”, “unlikes” and “comments” can become very cruel, particularly to uncertain and vulnerable teenagers. This can severely damage the self-esteem and mental health of a young person.

Our consumer society is another issue. As we see with mobile phones, clothing and computers, everywhere we look there is a thirst for the latest, the best, the biggest, the fastest and the shiniest, while anything less than the optimum is seen as a problem. This is another issue that ratchets up the mental pressure on young people. I am not saying that a young person’s not having the latest iPhone will lead to mental health problems, but I am saying is that if someone is vulnerable and has low self-esteem, this sort of thing can work to enhance those insecurities and push someone into the territory that we are discussing today.

We need to remember, too, that all these pressures—I have mentioned only a few—are impacting on young people at a time when their minds, brains and characters are still growing and forming. As we get older, we form our minds and personalities, and we develop our own resilience to many of these outside pressures.

[John Glen (Salisbury) (Con)]

My hon. Friend is putting forward a pertinent case and providing an accurate analysis of the pressures on our teenagers. Does he agree that it is important to recognise that we need an integrated solution, which requires education and NHS response, so that schools can get in very early and start tackling some of the behaviours that lead to poor mental health outcomes?

[Andrew Bingham]

My hon. Friend is absolutely right, and his point about the need for a whole school approach is acknowledged in the conclusion of the report. It states that when children leave school, they should be conversant with all the issues around mental health, which the hon. Member for Dulwich and West Norwood also mentioned in her speech. As I was saying, as we get older, we develop our own resilience, but in young people that development is not complete. That is the issue that we need to be aware of, and it is where schools need to play a part in helping to develop that resilience.

As we know, a stigma is attached to mental health—and nowhere more so than with young people. No young person wishes to admit to it for fear of being labelled, and people often are labelled in this society. Parents are similarly affected, so this leads to a situation of potential denial—I am not sure that “denial” is exactly the right word—which further exacerbates the problem. There seems to be a lack of willingness to say, or a fear of saying, “Look, I have a problem, and I need some help.” There should be no stigma attached to any young person admitting that they are struggling with certain issues, and neither should there be any barrier to parents making a similar plea.

Young people should have somewhere to go to ask for help—the report mentions a counsellor—without fear of ridicule. They should not be judged or labelled either by their peers or by society. Parents can be the strongest help and support for any young person, and we should look to families and family support units as well. We need to enable parents to play as full a part as they can. A young person who is getting some help at 15 can find on turning 16 that they are suddenly deemed to be an adult and their parents can be almost excluded from playing a full part. An attentive parent who is trying to help can face being told, “We can’t discuss this with you, because your girl or boy is now 16.” We should look to see whether there is a way around that problem.

In conclusion, I would like to thank Lucy Boardman and Martha Banks Thompson for their help. They have given me an insight into the world of the modern teenager and into how 21st-century pressures impact on their lives in a way that did not impact on my life as a teenager or that of many other Members here today. It was a very illuminating and educational experience for me, and I pay tribute to both of them for their candour and their honesty. As I have said, talking about these issues freely takes a lot. Many of my remarks today have come as a result of their contribution.

I say gently to the Minister that we must not in any way fall into the trap of dismissing mental health issues in the young as mere growing pains. This is a serious matter. I know she understands, but let us recognise that to provide the help needed, it needs to be not only readily and easily available, but available for as long as it is needed for each person according to their individual needs.

Health Service Medical Supplies (Costs) Bill

John Glen Excerpts

2nd reading: House of Commons & Programme motion: House of Commons
Monday 24th October 2016 Commons Chamber

[Mr Hunt]

It will deal with some of those concerns, and we will listen to all the concerns raised by hon. Members during the progress of the Bill. On the particular issue the hon. Gentleman raises, the CMA is already investigating the behaviour of pharmaceutical companies in certain situations, but it has become clear to us that there is a particularly unethical and unacceptable practice of drugs companies getting control of generic drugs for which they command a monopoly position and then hiking the prices. There was one product whose price increased by 12,000% between 2008 and 2016, and if the price had stayed the same as before the increase, the NHS would have spent £58 million less. The Government’s conclusion is that the simplest and quickest way to sort this out is through new legislation, but I will happily take the hon. Gentleman’s other concerns offline and look into them further.

[John Glen (Salisbury) (Con)]

I welcome the provisions of the Bill that will close a loophole and deal with terrible examples of where the NHS is in effect exploited, but can my right hon. Friend point to the future in light of the suggestion that the drugs bill will increase to £20 billion by 2020—a much more significant increase than can be afforded under the projected expenditure in the NHS? What bigger measures need to be put in place for us to deal substantively with that bigger problem?

[Mr Hunt]

My hon. Friend is right in that we see demand for NHS services, which includes treatment and drugs, increasing by a total of around £30 billion over the next five-year period, which is a huge amount and certainly more than we as a country can afford without changing practice. That is why we are implementing a very challenging series of efficiency reforms designed to make sure that we can afford to continue current levels of NHS service on the £10 billion increase this Government are putting in. Part of that is indeed measures such as those in this Bill to control the drugs bill. My hon. Friend is also right that going forward over the next 25, rather than five, years we will be seeing the bigger issue of the accelerating pace of innovation in science. That provides great opportunities for the NHS, but potentially great pressures for the budget, and I am sure we will continue to discuss those issues extensively in this House.

NHS Sustainability and Transformation Plans

John Glen Excerpts

Wednesday 14th September 2016 Commons Chamber

[Richard Fuller]

I very much appreciate the hon. Lady’s question, because it gets to my point. I am actually quite sceptical about what consultation means. She might not know that Bedford has been through a review process for our acute services. I was trying to measure the length of that process in terms of Members of Parliament for Corby: it preceded Louise Mensch becoming Member of Parliament, carried on through the whole period of Andy Sawford being Member of Parliament, and is now taking up the time of my hon. Friend the Member for Corby (Tom Pursglove). We do not involve Corby any more; it is now just Bedford and Milton Keynes. That process included consultation and participation, with the NHS saying that it wanted to listen to people. It consulted them, yes. Did it listen to them? No. It was the NHS’s own process. It ticked all the boxes, but it was a complete and utter disgrace to local accountability.

I do not have distrust of Pauline Philip, chief executive officer and leader of our STP, and I do not need to know everything. I want to know that our local authorities are having their voice heard in the process just as much as our local CCG, as they are our representatives. I feel relatively comfortable that the process will lead to options that are more acceptable to the population, because it involves local authorities as well as the NHS. We should, however, expect the outcomes of the process to be highly varied around the country. Some will be correct and acceptable, and will go forward. Others will be controversial, and others will be downright wrong. We should not curse this whole process across the country, because it achieves a difference in outcome in different parts of the country. We should be prepared to look at each on its own merits and judge them accordingly.

[John Glen (Salisbury) (Con)]

Is there not a real challenge to reconcile the reticence to change and adapt with the clear imperative to have new technologies and new ways of doing things that can offer a step change, which are often resisted? Consultation will not necessarily deal with that.

[Richard Fuller]

My hon. Friend is right. I come back to the central part of what is different about STPs: they involve local authorities. On issues such as mental health and care in the community, that voice will be heard much more clearly. Our local authorities represent our local people—that is their interest. Their voice will make a substantial difference.

I have two brief final points about Bedford to which the Minister can perhaps reply. First, our CCG is under legal direction. Will that affect local decision making? Secondly, our CCG set up a joint committee with Milton Keynes to review acute services. Is he in a position to assure me that that joint CCG will not take any part whatever in the decision processes when the result of the STP is reached?

Defending Public Services

John Glen Excerpts

Monday 23rd May 2016 Commons Chamber

[John Glen (Salisbury) (Con)]

It is a pleasure to follow the hon. Member for Huddersfield (Mr Sheerman). Having listened carefully to his remarks, I would take issue with his assertion that many on the Government Benches are fully committed to the notion that private sector is always good and public sector is always bad. That is not my approach. I wanted to speak in this the third day of the debate on the Queen’s Speech because I think that the delivery of quality public services is critical to what we deliver to our constituents, and it is really important that we have an open mind about how we deliver those services effectively. The biggest employer in my constituency, Salisbury hospital, is from the public sector. It has just gone through the rigours of a Care Quality Commission inspection, and I am grateful to Professor Sir Michael Richards for his constructive observations around that and the way to move forward.

I welcome the many Bills in the Queen’s Speech that seek to address the biggest issues facing our nation, both now and under all Governments: how we create the conditions where the most vulnerable can be helped on to a better pathway. I was genuinely shocked and saddened when listening to the response from the Leader of the Opposition last week, when he said:

“Apparently, it is all about instability, addiction and debt—all things that can be blamed on individuals about whom Governments like to moralise… Poverty and inequality are collective failures of our society as a whole, not individual failures.”—[Official Report, 18 May 2016; Vol. 611, c. 16.]

I agree that it is a failure of society as a whole that people in our communities must endure complex, ongoing problems, but it is not about labelling society collectively or people individually as failures, and it certainly is not about moralising; it is about a credible analysis of the diversity of individuals’ problems, recognising that it is incumbent on Government to deliver a customisation, adaptation and reformulation of public service delivery if they are sustainably to meet the needs of our communities. It is naive to say that a financial measure of poverty, by itself, is likely to provoke a meaningful recognition of the complexity of poverty.

I want to make some observations about several of the proposed Bills, but three themes will emerge as I contemplate them. The first is about the need to innovate in public service delivery and the second is about the need to integrate. Going back to my opening remark, it is not about public versus private; it is about recognising that sometimes we need to innovate and integrate good public services, bringing in new ideas and providers able to improve how we have done things to date. The third important element is about timeframes. I vividly remember, in my six years’ service as a magistrate, seeing individuals come back again and again before the court for crimes related to the same underlying problems—typically addictions—in their lives. On average, it takes people seven attempts at rehabilitation to overcome some of those addictions. There is no one template for delivering those sorts of services. That is why we need to be careful, when we frame the legislation, to put in place reasonable measures of what success looks like and to show an understanding of the complexity of the lives of the people we are trying to help.

My enthusiasm for the children and social work Bill is infused with a strong conviction that the Government are absolutely right to look at looked-after children and care leavers, who experience some of the worst outcomes, in terms of life trajectory, of any in our society. It is important, however, that innovation is examined. In local authorities near me and across the country, we are beginning to look at schemes, such as those run by Safe Families for Children, where trustworthy families are engaged to look after children when underlying issues need to be dealt with in families. I recognise that the pathway to securing the engagement of safe families for children obviously necessitates more work in order to complete the process of safeguarding, but this is an example of where innovation and integration with existing public sector provision—in this case, within local authorities —can deliver enhanced outcomes.

On all the Bills, we need to look at how health, education and social services can work better together, so that the payback is significant. I remember, three or four years ago, being asked to visit a residential centre in Devon, with the Amber Foundation, which was working with young adults leaving the criminal justice system and in grave danger of not finding their way—often they were without family support and, being low-skilled, finding it difficult to get into employment, and typically they had been engaged in the criminal justice system previously. I hope that when we come to consider the proposed legislation, we will find room to enfranchise groups such as the Amber Foundation into the delivery of services. It is through commitment over time that those individuals are able to find a sustainable trajectory into independent living. We need to be honest and real about the challenges that those individuals face. I welcome the overdue reform of adoption. I have seen too many cases in which the evaluation stresses reasons why not, while in the meantime too much time passes and the individuals are left behind.

I welcome the education for all Bill, and there is particular enthusiasm in my constituency for the fair funding formula. Wiltshire is the third worst funded local authority, and that has a significant impact on the ability of schools to plan their budgets going forward. It is critical at the moment in the formation of a multi-academy trust, because trying to anticipate what the uplift will be is significant in giving assurance to governors as they come together.

When we look at options facing young people at 18-plus, it is important to be clear about the integration of the great macro-policy goal of having 3 million new apprenticeships with enabling children from difficult backgrounds to get on to a pathway that will deliver the skills and employment opportunities that they crave.

The prisons and courts reform Bill is also very welcome. The emphasis on rehabilitation to reduce reoffending is wholly necessary. Importantly, it will introduce new boards with external experts and emphasise prisoner education and the necessity to have a pathway to employment.

Finally, there is the digital economy Bill, and this is a massive issue for rural Wiltshire. I have campaigned on it for many years. We must have a reliable plan for the last 5% in particular. The universal service obligation must have meaning and teeth in ways that my constituents and those across rural England can fully understand.

I finish where I started. I have no ideological objection to the integration of innovative ways of delivering public services. I hope that this Government will continue to have ambition and will measure their success in a way that allows further developments to take place so that we can meaningfully address the conditions of the poorest in our society with solutions that give them dignity and the justice that they deserve.