Tag: Speeches

  • Robert Jenrick – 2022 Speech on Visas for International Doctors

    Robert Jenrick – 2022 Speech on Visas for International Doctors

    The speech made by Robert Jenrick, the Minister for Immigration, in Westminster Hall on 2 November 2022.

    It is a pleasure to serve under your chairmanship, Mr Stringer. I thank my hon. Friend the Member for Boston and Skegness (Matt Warman) for securing this important debate, and all Members who have contributed. The Government recognise the vital contribution that doctors and other health and care professionals make to the United Kingdom and our NHS. Of course, Dr Rachel Warman is my favourite doctor, and she has no doubt helped to inform the quality of my hon. Friend’s remarks.

    By happy coincidence, I am both the Minister for Immigration and formerly the Minister responsible for the NHS and the recruitment of doctors domestically and internationally, so I understand and appreciate the importance of the issues raised. This is clearly a timely debate, because the NHS faces a significant workforce challenge. About 10% of the roles in the NHS are vacant, and a larger number are vacant in social care. We all need to be focused on creative ways to resolve the challenge, including, as has been said, on retaining more of our existing GPs and other health and social care professionals.

    Last month, the former Health Secretary, my right hon. Friend the Member for Suffolk Coastal (Dr Coffey), and I announced changes to the pension provision for doctors to encourage more of them to stay in the NHS for longer, to work longer hours and not to resort to private practice as quickly as some are doing. Those changes will make a difference, although I appreciate that the BMA and a number of organisations wish the Government to go further.

    We are keen to recruit and train more GPs and doctors in the UK. Persuasive arguments have been made for raising the cap on medical school places, including by the hon. Member for Aberavon (Stephen Kinnock). That is an important debate to have, and one that I am sure will find favour with the new Chancellor, who has raised the matter many times in the past. In the interim, it is clear that we will need to rely on more international recruitment of doctors and nurses. That is exactly what the NHS is doing at the moment. For example, as a result of significant retention issues the Government are succeeding in recruiting a large number of nurses internationally. We need to make that process as simple and efficient as possible for the benefit of the NHS and trusts that are undertaking that recruitment exercise, but also for patients.

    Hon. Members will be aware that in 2020 the Government delivered and built on the commitment in our manifesto to introduce a route that made it quicker, easier and cheaper for qualified medical professionals to come and work in the UK. That was the health and care visa, which provides a significantly reduced visa fee and a dedicated Home Office team to process the applications. A number of Members understandably referred to Home Office backlogs, which do exist in some areas; most vividly, in the last week, we have had a national conversation about the backlog of asylum cases.

    Applicants for the health and care visa get a gold-plated service. Health and care visas provide cheaper fees and quicker processing, and the aim is to process applications within three weeks. Understandably, there has been an impact on processing times this year, primarily because the Department chose to redeploy so many of its professionals to work on the Homes for Ukraine scheme and other refugee and resettlement schemes, but it is our intention to get back as swiftly as possible to the service standard. In fact, we have set a target of reaching that by the end of the year and continuing to meet it into next year while continuing to manage the very large number of individuals coming from Afghanistan, Ukraine and other parts of the world that are in distress.

    Jim Shannon

    I recently chaired an event in Portcullis House on a completely different matter. When I came out, the people taking over the room were getting ready to give a presentation about how Ukrainians with medical skills could help the UK. I am not sure who the sponsor was, but I will try to find out, and the Minister’s staff might do the same. It took place at 2 pm in room Q in PCH. I had to go to another event, so I could not stay, but it seems that there are a number of Ukrainians here who have medical skills that could be used in the NHS. That is just a thought.

    Robert Jenrick

    Of course, adults who come to the UK on the Homes for Ukraine scheme have the right to work, and we actively encourage them to do so while they are here. There has also been an exercise across Government, which I have not been personally involved in, to help them to find equivalent professional qualifications while they are here, and to break down any barriers. I would be happy to look into whether there are remaining issues for doctors and nurses from Ukraine while they live here on the three-year visas that we are granting.

    Some 30,700 nurses and 14,900 doctors obtained a health and care visa up to the end of August this year. In total, including care workers and other professionals, 96,000 such visas have been issued—a very significant number, which accounts for 52% of all skilled worker visas that have been issued to people taking up work in the health sector. I would like to think that that innovation has been a success, but we take seriously the legitimate concerns that have been raised in the debate and that we have heard from royal colleges and others. Let me now turn to some of those concerns and what we might be able to do to assist.

    As my hon. Friend the Member for Boston and Skegness said, the Royal College of General Practitioners has made a number of suggestions. We believe that the best way to increase the number of international GPs taking up places in the UK is for GP practices to register as Home Office-approved sponsors. The Government have run a number of engagement events that aim to explain the sponsorship process. Sponsorship is not supposed to be onerous, and the Home Office believes that it is not as onerous as some people clearly perceive it to be. Over 48,000 organisations are licensed sponsors of skilled workers, and many are high-pressure, small organisations, such as GP practices. However, there is clearly an issue—whether in reality or in perception—so I have two proposals to answer the concerns raised by my hon. Friend.

    First, I am prepared to consider other sponsorship arrangements suggested by the sector, provided that they are consistent with the sponsorship system and that the sponsor can continue to discharge the important duties of a sponsor, which enables us to ensure that the overall system is robust and defensible. In principle, the sponsor could be an appropriate national body, such as Health Education England. It has not approached us to ask to be such a body, but I would be open to considering that. As my hon. Friend the Member for Winchester (Steve Brine) suggested, the sponsor could be an integrated care board in England or an appropriate body in Scotland, Wales or Northern Ireland, or it could be a royal college. I will therefore ask my officials to work with the sector to see whether there is a way forward to create umbrella bodies, if there is mutual support on both sides, with the caveat that any umbrella body would need to discharge the required duties in law to ensure the robustness of the system.

    Secondly, in the interim my officials would be happy to run further engagement events with the sector to talk them through how straightforward they believe it is to be a sponsor. I encourage anyone listening to the debate to get in touch with the Home Office if they would like us to host an event in their area or with their part of the health sector. I have asked my officials to organise at least one such event in the weeks ahead. We will take account of any feedback that we receive at these events, and if it is true that the system is simply too complex and burdensome, I have asked them to report back to me with that feedback and we will take it into consideration.

    The shadow Minister—the hon. Member for Aberavon —and others, including my hon. Friend the Member for Boston and Skegness, raised the fundamental question of whether five years is the right length of time to demonstrate an individual’s commitment to the UK. That is a profound question, and it is important that we approach it fairly, rather than hiving out individual sectors, however important they might be for our economy or our public services. Although I am sympathetic to the arguments around granting GPs settlement on completion of their training, my view today is that it is better to stick to five years because that has been, by the long-standing convention of this Government and their predecessors, considered the right length of time for an individual to demonstrate sufficient commitment to the United Kingdom to obtain indefinite leave to remain. We should value indefinite leave to remain, because it is an important and significant moment for anyone committing to life in our country.

    Stephen Kinnock

    I thank the Minister for setting out that clear position, but does he agree that the nature of that kind of commitment—the three years, and the type of work that somebody studying to be a general practitioner is looking into and wants to do—is in itself a demonstration of something extra in terms of commitment to the United Kingdom? It is not as if they are coming here to work for a foreign company. Should such people not be given some kind of exceptional treatment because of the nature of the work? That is an open question.

    Robert Jenrick

    The hon. Gentleman makes a valid point. Of course, one could apply that to a number of other regulated professions, whether that be lawyers, nurses or others making significant contributions to the United Kingdom. It is an important step to obtain indefinite leave to remain, and not one that we should give away lightly. Asking an individual to spend five years here in order to demonstrate that level of commitment to the UK feels to me about the right length of time, but I am open and interested to hear other contributions on that point. At the moment we do not have plans to reduce the length of time that skilled workers would need to complete in the UK in order to apply for settlement.

    The SNP spokesperson, the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald), raised a number of cases that I am aware of from my former role at the Department of Health and Social Care about allegations of the mistreatment of foreign workers—including doctors and nurses—coming to the UK. That is something we take seriously, and the Department of Health and Social Care and NHS England are investigating. If I receive further information from the Ministers in the Department of Health and Social Care, I will be happy to write to the hon. Gentleman.

    On the broader question of the ethics of recruiting healthcare professionals internationally, the NHS takes that responsibility seriously. We have ethical guidelines nationally that are set by NHS England and individual trusts in England—that may well be the case in Scotland as well—and of course we take heed of the red lists, which give a strong indication of countries from which we should not be recruiting healthcare professionals because they clearly need them to satisfy their own healthcare requirements. The NHS proactively works with countries that have an excess of doctors and nurses, or that train individuals specifically for export. In fact, one of the last meetings I had as Health Minister was with the Chief Minister of the state of Kerala, which specifically trains nurses to be exported to other countries around the world.

    That sort of arrangement is sensible and defensible by the UK, although it is not a sustainable answer in the very long term because we live in a globally ageing society; there will be competition from other states to recruit professionals. That is one of the many reasons we should be training more doctors and nurses in the UK and considering measures such as raising the cap on medical school places, if we are able to do so. That, of course, is a matter for the Treasury and the Department of Health and Social Care, not my Department. It is worth saying that it is an extremely expensive measure over time, and that the Opposition’s proposal would cost several billion pounds to deliver. That is not to say that it is not an important step, but it is worth bearing in mind the significant outlay.

    Steve Brine

    The Minister is responding very clearly to the points raised. What we really need is an independent health workforce assessment, supported by the Treasury. He will be aware that that was called for by some Members who are no longer on the Back Benches. Dare I say that he could encourage that through his good offices, because only once we have the answer will we get to a better place. If we ask the NHS what we need it will answer with what we can afford. Those are not the same questions.

    Robert Jenrick

    For a long time I have believed that one of the virtues of a national health service is that it should be able to plan for its workforce needs long into the future. My hon. Friend raises the specific campaign of our right hon. Friend the Member for South West Surrey (Jeremy Hunt), when he was Chair of the Health and Social Care Committee. I am sure that he will consider that carefully now that he has his hands on the controls as Chancellor of the Exchequer.

    Stephen Kinnock

    The Minister rightly mentions value for money. The British taxpayer pays for the training of international medical graduates in this country. Will the Government consider doing a value-for-money assessment of what the British taxpayer pays for people who train to be GPs but end up leaving our system all together because of all the visa issues? Is that not a waste of taxpayers’ money?

    Robert Jenrick

    The hon. Gentleman raises an important point. It really is a matter for the Department of Health and Social Care. I do not want to stray too far into policy questions that are rightly its domain, but clearly the UK benefits from retaining as many doctors who train here as possible. Staying will not always be the intention of those coming to the UK—many clearly want to make use of our world-class medical education and then return to their country of origin, or other countries that, for lifestyle reasons, they want to live in—but we benefit from encouraging more to stay.

    Stuart C. McDonald

    I have one final thought. I appreciate that the Minister will go away and task officials with looking at a possible umbrella sponsor—that is very positive news. The other issue is the length of visa for IMGs. From the Health and Social Care Committee inquiry, it appeared that there is a severe pressure between finishing up and being able to find a job. Extending the grace period a little might allow more people to stay.

    Robert Jenrick

    I will happily add that to the list of homework for my officials after the debate.

    I thank my hon. Friend the Member for Boston and Skegness for securing this important debate, and the many colleagues on both sides of the House who have attended to register their interest in the topic. I assure them all that we will reflect carefully on the points raised, and in particular that I will task my Home Office officials to work with stakeholders in the sector to give greater consideration to the central question of whether there is a simpler way in which GP practices can apply for relevant visas. If that can be delivered by appropriate umbrella bodies, we would be pleased to see whether it can be taken forward.

    Matt Warman

    We are all hugely grateful for the fantastic work that doctors do for us all, as the Minister alluded to. I do not just say that because I am married to one, although it brings it home—literally. In the course of the debate, the Home Office has been accused of intransigence. Within days of his arrival, the Minister has demonstrated more progress on this important issue in the commitment that he has made to us today than we have seen in some years. He is the human embodiment of cross-Government working in the sense that he brings together the Department of Health and the Home Office remits. We could all learn from the value of cross-Government working. I am immensely grateful to all Members who have brought the issue to life, and I look forward to continuing to work with the Minister on the outcome of the review, which will make a real difference to our constituents, and to doctors up and down the country.

  • Stephen Kinnock – 2022 Speech on Visas for International Doctors

    Stephen Kinnock – 2022 Speech on Visas for International Doctors

    The speech made by Stephen Kinnock, the Labour MP for Aberavon, in Westminster Hall on 2 November 2022.

    It is a pleasure to serve under your chairship, Mr Stringer. I thank the hon. Member for Boston and Skegness (Matt Warman) for securing this important debate. His speech was an excellent example of a constructive critique of where his own party is on the issue, and he put forward some practical and thoughtful ideas. I hope the Minister has taken note. I suspect there is more chance he will take note of the hon. Member’s comments than he will of mine, but we never know. This debate is a great example of the cross-party discussion that we can have in this place.

    Let me start by setting out the Labour party’s position on work-based migration in Britain, as it is important to set the context before drilling down into the specifics of the issue we are discussing today. In a nutshell, we support the points-based immigration system for migrant workers; it was of course the Labour Government in 2008 that introduced that system for immigration from outside the European Union. We are clear that there will be no return to the European Union’s freedom of movement. We want to build on and improve the points-based system currently in place. It is a very blunt, one-dimensional instrument that could be significantly improved.

    Our long-term ambition is to make sure that every employer across the private and public sectors is recruiting and training more home-grown talent to fill vacancies before looking overseas, but we recognise that simply turning off the tap of labour from other countries without having the appropriate workforce structures, plans, training, skills and productivity strategies in place, our private sector and our public services will deteriorate, our businesses will struggle to meet the Labour party’s ambitions to make, buy and sell more in Britain, and we potentially risk jobs disappearing overseas.

    We cannot have a situation like the one we have had in the farming sector over the past year, where 30,000 pigs were slaughtered and £60 million-worth of crops were burned. Indeed, we cannot have a situation in the NHS where we are short of doctors, all because our immigration system puts up red tape and barriers that prevent, or at least severely discourage and disincentivise, doctors who have come to the UK from overseas to do their three years of general practitioner training from staying on to fill critical vacancies in the job market. That is utterly counterproductive, not least because 47% of new trainees in England in 2020-21 were international medical graduates. Labour’s shadow Health Secretary, my hon. Friend the Member for Ilford North (Wes Streeting), has been clear that it is madness for the NHS to lose GPs whom the British taxpayer has paid to train.

    Successive Conservative Governments have already cut 4,700 GPs over the last decade, meaning that patients are finding it next to impossible to get an appointment. There is a chronic lack of doctors, nurses and healthcare staff in the NHS. Staff shortages are reaching dangerous levels, when the need for NHS treatment is incredibly high, with huge backlogs and millions of people forced to wait for treatment. Patients are finding it impossible to get a GP appointment in many cases, and GPs are leaving the health service at an alarming rate. Last year, one in six people who tried to speak to a nurse or GP were unable to get an appointment at all. The hurdles placed in front of international medical graduates are a barrier to our NHS filling vacancies and providing the medical care that the British public deserve.

    A survey by the Royal College of General Practitioners found that around 30% of all IMG trainees consider not working as an NHS GP because of all the difficulties and red tape with the visa process. The first of those difficulties is that IMG GPs are not eligible to apply for permission to stay permanently until two years after completing their training. GP training takes three years to complete, and it is only after five years that IMGs can apply for indefinite leave to remain, in line with wider UK visa rules. That problem is unique to general practice: other medical specialty training takes a minimum of five years to complete.

    The second difficulty is that international GPs must find employment with a GP practice with a visa sponsor licence before their existing visa expires in order to be eligible for a visa that allows them to stay and work as a GP after their training, and ultimately apply for permission to stay permanently. However, practical and bureaucratic obstacles can make that extremely difficult, because GP practices may struggle with the costs and bureaucracy associated with obtaining a licence to sponsor a foreign worker. The Royal College of General Practitioners warns that the cumulative effect of visa difficulties on IMGs is that some are

    “feeling forced to take roles elsewhere in the NHS and others considering leaving the NHS, and in some cases the UK, altogether.”

    The Government have so far been utterly intransigent on the issue of IMGs, and on tweaking the visa system to remove the red tape. Labour would look closely at the issue as part of our wider improvements to the points-based system. Those improvements would involve the Government working hand in hand with employers, trade unions and other key stakeholders to ensure that we have a properly planned, sector-by-sector approach, with a proper strategy that works for businesses, workers, the public sector, customers and patients alike. As part of that, we will review the length of work visas, processing times and the existing path to citizenship to ensure that they are all working for our economy and for the public.

    Labour already has a long-term workforce plan for the NHS. That involves doubling the number of medical school places, which in turn will deliver more home-grown GPs. At the heart of the plan is the doubling of medical school places—an increase of 7,500—which means we will double the number of doctors trained in a year. Our shadow Health Secretary will also produce long-term workforce plans for the NHS for the next five, 10 and 15 years, which will ensure that we always have the NHS staff we need to get patients treated on time. The plans will not only provide good jobs for British workers and fill shortages in our NHS, but prevent us from having to do dirty deals, as mentioned earlier, with some of the poorest countries in the world—those on the WHO red list—and from recruiting medical professionals from impoverished communities that desperately need that medical knowledge locally. That is exactly what the British Government have done recently with Nepal.

    In the short term, Labour has consistently pushed for a fix to punitive doctors’ pension rules. The fix would do away with the cap above which NHS workers incur additional tax burdens. That would support short-term recruitment and prevent the exodus of workers. The Government are yet to deliver on that.

    The Labour party is committed to making the points-based system work, and to our NHS workforce plan. The current system is simply not fit for purpose, and at this time of crisis we risk losing newly qualified GPs because of unnecessary red tape. The Conservatives have broken promise after promise on GPs. Their 2019 manifesto promised to deliver 6,000 more GPs by 2024-25. The former Health Secretary, the right hon. Member for Bromsgrove (Sajid Javid), admitted that the Government are not on track to deliver that.

    In contrast, the next Labour Government will put patients first, ensuring that they are able to get a face-to-face appointment when they want one, bringing back the family doctor to deliver continuity of care and implementing our workforce plans. The current Government are out of ideas, and we need practical solutions.

    Steve Brine

    It is interesting that the hon. Gentleman mentioned continuity of care, because he will be aware that that came up yesterday during Health questions. Would the Opposition introduce direct management of lists back into the GP contract from when it is next renegotiated? That is how we achieve continuity of care.

    Stephen Kinnock

    The key piece of our plan is to cancel non-dom status, which is estimated to generate approximately £3.2 billion for the Exchequer, and to use that money to invest in more GPs, doctors and nurses—indeed, doubling the numbers. We can have the best plans and legislation in the world, but we need the resources to deliver them. That is how we will pay for our plans and generate the kind of care that we need for our public. It is time for that Labour Government, so that we can clear the backlogs holding our country back, which we see right across Government, and get Britain’s public services back on track.

  • Stuart McDonald – 2022 Speech on Visas for International Doctors

    Stuart McDonald – 2022 Speech on Visas for International Doctors

    The speech made by Stuart McDonald, the SNP MP for Cumbernauld, Kilsyth and Kirkintilloch East, in Westminster Hall on 2 November 2022.

    It is good to see you in the Chair, Mr Stringer. I also start by welcoming the Minister to his place. I wish him good luck; he probably needs it, as much as any Minister in Government, because his is an incredibly challenging post. We will, of course, have significant political differences on this topic, but it is an important issue, so if there is an opportunity for constructive and positive engagement, I am up for that, wherever possible. I thank the hon. Member for Boston and Skegness (Matt Warman) not just for securing the debate but, as ever, for his expert introduction to the topic and advocacy.

    Moving to the subject at hand, like other Members I will start by recognising the extraordinary contribution of non-UK nationals to all parts of our NHS. I suspect everybody in the room has benefited from that, never more so than in recent times. GP practice is no different, and nationals of other countries will continue to play an important part, both now and in the future. As the hon. Member for Boston and Skegness alluded to, figures suggest that 47% of new GP trainees in England in 2020-21 were international medical graduates.

    Another important context for this debate is the extraordinary pressure that our NHS is under, particularly in the light of covid, but also for all sorts of other reasons, which we could perhaps touch on in another debate. High vacancy rates are among them. As has been mentioned, challenges in recruitment and retention affect GP practices as well as everywhere else.

    Against that background, the hon. Member identified what at first seems to be a technical problem in the operation of the immigration system, but one which, when examined, is significant. A failure to solve it leads to some absurd and harmful consequences. As he pointed out, the pain will ultimately be felt by patients. He explained that the three-year GP training regime for IMGs leaves them, on completion, two years short of being able to apply for settlement. That is unlike other specialisms, which have longer training periods.

    That requires IMGs to find a GP practice that has become a tier 2 sponsor, which is not easy. The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) alluded to statistics highlighting that, with half of all IMGs having struggled with the visa process, 30% having considered moving away from GP practice and 17% thinking about leaving the United Kingdom.

    The Minister’s predecessors appeared to dig their heels in and say, “We just need more GP practices to become tier 2 sponsors.” I agree with the hon. Member for Boston and Skegness that that prioritises Home Office bureaucracy above the health service. Ultimately, it is the wrong answer for patients who are struggling to access a GP. We are going to lose skilled and dedicated GPs as a result.

    There is one issue where I do have some sympathy for the Minister’s predecessors, and that is the rejection of the idea that a route to settlement should simply be shorter. Settlement is an important and significant thing. There are aspects of that where I am open to persuasion on the case to shorten routes generally and in some specific cases, for example, family members. However, an argument to shorten the route to settlement simply because a training course lasts a certain time is perhaps not the most persuasive. It is not one that I am closed to, but it is not one that I immediately find the most persuasive.

    However, the Home Office should be pragmatic about other possible solutions that have been put forward. Its current insistence that 8,166 GP practices right across the UK should just invest time—and over £4 million—in becoming tier 2 sponsors on the off chance that they might want to recruit an IMG is simply not realistic. The £4 million in fees from those GP practices would go to the Home Office—I wonder if that has something to do with its intransigence at the moment.

    The alternative approach of a practice only becoming a sponsor once it has already had an application for an IMG is also far from ideal. The delay that that causes is bad for all affected, and the pressure on IMGs to find a tier 2 sponsor to satisfy immigration requirements prior to their existing visa expiring means that they cannot wait. As evidence given to the Health and Social Care Committee earlier this year highlighted, newly qualified GPs have received removal letters from the Home Office soon after their qualification. That is absurd, because we not only need them but have spent tens of thousands of pounds on training them to do a job that we urgently need them to do. I hope good sense will prevail over the Home Office’s current intransigence.

    I now turn the other solutions, which I think are perfectly reasonable, that the Royal College of General Practitioners has put forward. The first solution is to create a new post-medical training visa that works in the same way as a graduate visa. The second is to create umbrella bodies that could operate as a sort of super-sponsor. That could be the NHS or whichever training body had already sponsored the first three years of the IMG’s presence here. Who knows—it could be the Royal College of General Practitioners itself. I do not have the answer as to which option would be best, but any of them would clearly be better than the absurd situation we find ourselves in.

    Steve Brine

    I have a suggestion, at least for England: the primary care networks or the new integrated care boards could quite easily act as an umbrella sponsor, thereby taking the bureaucracy away from the practices, which is part of their purpose.

    Stuart C. McDonald

    That is a valid proposition, and we could do the same with health boards in Scotland. If we knock our heads together, we can come up with a way to fix this. It just requires a little bit of pragmatism.

    There is a second issue I wanted to raise—when I saw the motion for this debate, I wondered if the hon. Member for Boston and Skegness would raise it. That issue relates to recent reports from the BBC flagging complaints of poor treatment and conditions for international doctors in private hospitals, as well as highly questionable recruitment practices. I will touch upon it briefly because it has not been raised, although it is important to draw it to the House’s attention and to see if the Minister will investigate and respond. There were reports from 11 October suggesting that doctors from some of the world’s poorest countries were being recruited, by Nuffield Health in particular, to work in private hospitals under conditions prohibited in the NHS. There are reports of doctors being on call 24 hours a day for a week at a time, not being able to leave the hospital grounds and, unsurprisingly, suffering from extreme tiredness, putting both patients and doctors at risk.

    Nuffield Health denies those allegations, but a British Medical Association and Doctors’ Association UK questionnaire of 188 resident medical officers adds some credence to the claims. It shows that 81% of respondents were recruited from Nigeria, and most complained of extreme working hours and unfair salary deductions. The conclusion of the Doctors’ Association UK was that we now have a two-tier system: one for the NHS and one for other international recruits in the private sector. I ask the Minister to look into that.

    That issue highlighted to me another fundamental problem with how the immigration system operates. We have all sorts of checks and regulations that focus on ensuring that people who come to work here abide by their visa conditions, and they include the doctors we have been talking about—the IMGs—where the Home Office is on their case as soon as they have qualified to see what they are doing next. However, little or no checks are done to protect people who come here. That is not just in the NHS and with doctors; I have been firing off parliamentary questions and freedom of information requests in relation to the agricultural sector. That is a sector wide open to exploitation, but as far as I can see there is no concerted effort to protect people from that exploitation.

    As the Minister will appreciate, Nigeria is a red-list country for recruitment. According to both the World Health Organisation and the Government, that is not where we should be finding doctors.

    Jim Shannon

    Does the hon. Member agree that, when it comes to the criteria used, one thing we should perhaps be seeking from the Minister is an assurance that greater weight will be given to the skills that people have, as opposed to the money they could earn?

    Stuart C. McDonald

    That is absolutely fair. The point I am making is that we should also consider—and in fairness, we do—where it is that we are recruiting from. We do not want to leave some of the poorer countries in the world without the skills they need.

    Nigeria is a red-list country, but the report highlighted that both the General Medical Council and the British Council are involved in establishing and overseeing a professional and linguistic assessment board test in Lagos. I encourage the Minister to look into those reports. I appreciate that he might not be able to tell us about them today.

    Various broader issues have been raised, including visa fees, pensions and so on. We could talk about the impact of free movement and how that has mired certain services, including GP practices, in red tape and bureaucracy, but we will keep that discussion for another day.

    I again congratulate the hon. Member for Boston and Skegness on securing the debate. Throwing out skilled and desperately needed GPs in whom we have invested tens of thousands of pounds in training is utterly absurd. The hon. Member for Strangford (Jim Shannon) put it very nicely, as he always does. The question is how we can help them to help us. There are pragmatic solutions available. This is an early test for the Minister on whether he will be a pragmatist or take what I would characterise as the more dogmatic approach of the previous Home Office regime. I very much hope it is the former and that he is a pragmatist.

  • Jim Shannon – 2022 Speech on Visas for International Doctors

    Jim Shannon – 2022 Speech on Visas for International Doctors

    The speech made by Jim Shannon, the DUP MP for Strangford, in Westminster Hall on 2 November 2022.

    I thank you for allowing me to participate in the debate, Mr Stringer. I thank the hon. Member for Boston and Skegness (Matt Warman) for bringing this matter to light. It is good to see the Minister in his place—a return to duty in his ministerial role—and I am confident that, like the rest of us, he will be keen to address the key issues of the debate and why this issue is so important. I wish him well in this new role and look forward to his response to our questions.

    The issue of visas is always a difficult one. I am incredibly aware of the need to protect our country and ensure that only those who have a desire to enjoy British life and to enhance it should be given visas. I understand the system of immigration and agree that it should be rigorously implemented. However, within that, we very much need to have the appropriate systems for the appropriate types of visa. That is why I believe that changes need to be made, as outlined by the hon. Member. Talented and skilled doctors want to come here and contribute to our society but unfortunately, due to the visa system, they are not always able to do so. For me, the issue is: how can we help them to help us in the United Kingdom of Great Britain and Northern Ireland?

    Margaret Ferrier

    As the hon. Member for Boston and Skegness (Matt Warman) said, a difficulty that many international medical graduates face is that many GP practices do not have a visa sponsorship licence in place, making it harder to meet the requirements before the student’s studies end. Does the hon. Member share my concerns about the general level of the Home Office backlog and the associated impact on IMGs?

    Jim Shannon

    I agree with the hon. Lady. I hope that through today’s debate and contributions, this issue can be addressed. Again, we look to the Minister to give us some help, direction or support in how we can go through the vigorous bureaucracy that is clearly there. People with talent and skills want to come here; it is about how we can make that happen.

    I have raised immigration on multiple occasions with Home Office Ministers—in particular, with regard to visas for those working on fishing boats in my constituency and the skilled work done by Filipino fishermen. The previous Minister was most helpful. That work is undoubtedly skilled, but it is under the pay threshold, so visa requirements sometimes restrict that opportunity.

    Junior doctors, nurses and others do work that is not highly paid but highly skilled and necessary. That is why there must be time-sensitive application systems for those vital jobs and staff members. We need flexibility in the system. I say this again because it is important: those highly skilled and highly talented people who wish to come here will add to society and enable us to fill some of the vacancies.

    I cannot speak for the United Kingdom mainland, but I can certainly speak with some knowledge of Northern Ireland. I am my party’s health spokesperson, and the research we did for this debate shows that 6,613 vacancies are listed for the five trusts in Northern Ireland. I know that they are not entirely for medical staff, but it is clear that we are desperately in need of staff, and there are many opportunities for doctors.

    In my constituency and neighbouring constituencies, we are having problems in relation to GPs. I absolutely agree that there is a need for restrictive immigration, but we must not cut off our nose to spite our face. I am sure those numbers are replicated throughout the entire UK; perhaps the Minister will give us some figures for GP vacancies. I know that the Government have set out a strategy for employing and recruiting more GPs—that is good news.

    During the Brexit discussions, we were told that there would be distinct differences between the visa systems. That is as it should be. The hon. Member for Boston and Skegness said that the system needs to be altered to meet the need, and that is what we need to do today.

    The hon. Gentleman mentioned GPs, and we are of the same mindset. In a neighbouring constituency, a GP surgery, which is 10 minutes from my office, is set to close down because there are not enough GPs. In response, the GPs in my area have issued a moratorium on joining or leaving local practices. In other words, they will not take any more patients, and in some cases they are directing patients who live outside the area—that was okay a few years ago—to go elsewhere.

    The trust is hopeful that it will get more GPs to take over the practice, but the fact is that we simply do not have enough GPs. That puts more pressure on the existing ones, which leads to more burnout, and the vicious cycle continues. GPs are under incredible pressure. Patients want to meet their GP; they want face-to-face appointments. That has been lost to them over the past two and a half years due to covid, but they are trying hard to get back in the queue.

    The hon. Gentleman said that 40% of all GP trainees are international medical graduates—the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) referred to that—but they have difficulties obtaining visas. I do not have the exact numbers for Northern Ireland, but I do know that we cannot afford the loss of any more GPs. I therefore add my voice to those of others in the Chamber requesting that a special dispensation be granted not simply to allow those trainees to stay but to enable us to recruit further.

    If there a block of trainee GPs who have almost completed their degrees and courses and are ready to come here, let us encourage them to do so. The question is not why it cannot happen, but how we can make it happen. The thought of training GPs to understand how we do medicine and run our practices, only for them to leave—not because they want to but because the system is not working for them—is madness. That needs to be addressed through this debate.

    Recently, medical professionals outlined to me that the mental health and self- esteem of our medical community are at an all-time low because the staff are simply burned out. I have met many nurses, GPs and surgeons who are absolutely exhausted with the work they do. For those who are on call and have a duty rota to complete, being sent an SOS text to cover shifts is no longer exceptional; it is standard. That tells us that the GPs need to be employed and some of the pressure taken off.

    We need to change the way that things are done, by giving GPs more admin support and funding for on-site nutritionists, physios and mental health teams, which we need within all health clinics. In my constituency, they are trying to do that regularly, and it should help to diagnose early, whether the problem is diabetes, arthritis or dementia. Whatever the issue, doing that correctly in GP surgeries is the way forward.

    It is impossible to imagine that things can go on much longer the way they have for the past two and a half to three years throughout the United Kingdom of Great Britain and Northern Ireland. We need change, flexibility and help, Minister. We do not want to put all the pressure on the Minister, but in this case there are ways forward. The hon. Member for Boston and Skegness has outlined them, as have I and others. We look forward to a successful conclusion to this debate, with a way forward from which we can all benefit across this great United Kingdom of Great Britain and Northern Ireland.

  • Matt Warman – 2022 Speech on Visas for International Doctors

    Matt Warman – 2022 Speech on Visas for International Doctors

    The speech made by Matt Warman, the Conservative MP for Boston and Skegness, in Westminster Hall on 2 November 2022.

    I beg to move,

    That this House has considered visas for international doctors.

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

    This is a debate about doctors, but I want to begin with the story of a hypothetical patient. Let us call her Marjorie and say that she lives in Skegness. She is in her 80s or thereabouts. She is registered with a local GP practice, and she has a trainee doctor as her GP. They have a really good relationship and know each other well. They have the continuity of care that means that Marjorie’s needs are looked after. For a couple of years, Marjorie has gone back and forth to her doctor with little ailments, as people often do. In her final consultation, her doctor mentions that she will be moving on relatively soon.

    Thereafter, Marjorie finds herself with another GP, and the continuity of care is broken. Marjorie struggles to get the type of relationship that she built up over the past few years, and she finds herself bouncing in and out of hospital. She is fine, but not as well as she would be if her care had been provided by a doctor who was able to make sure that they knew each other well. The reason for the break in continuity of care is that the doctor she had in training was an international medical graduate who was being trained at the surgery in Skegness. Unfortunately, for a whole host of reasons, the surgery was not registered to take international medical graduates once they had qualified, and it was not what is called a sponsoring practice—it was not able to say that it would sponsor the visa for that doctor.

    The reason I make that point in such a way is because the people who are suffering as a result of the approach we currently take to visas—on one level, they are doctors who are dealing with the immensely stressful visa process—are ultimately patients, who should be our priority. The doctor I mentioned is one of 40% of trainee GPs who come from abroad. While they are training, their visas are sponsored by Health Education England.

    Margaret Ferrier (Rutherglen and Hamilton West) (Ind)

    A result of the difficulties around trainee GP visas is that many IMGs feel that they have no choice but to take on other roles within the NHS, or they leave the NHS altogether. Many may even return home. Does the hon. Member agree that this is yet another area where the Home Office must look at the bigger picture, rather than trying to plug gaps on an ad hoc basis?

    Matt Warman

    Ultimately, this is where we need joined-up government, whereby the Home Office and the Department of Health and Social Care deliver on the same priorities, and I really do think that they can.

    As I say, 40% of trainee GPs come from abroad. In the final months before they qualify as GPs, the last thing they should be doing is dealing with the stress of a potential visa application and considering whether the practice where they might want to apply for a job is registered on the programme, and whether they can reasonably jump through the Home Office hoops at that precise moment. We are increasing stress for doctors, and we are increasing the risks for patients at the same time.

    The hon. Lady alluded to figures from the Royal College of General Practitioners which show that some 30% of GP trainees are considering not working as GPs when they qualify for these visa-related reasons, and some 17% think they might have to leave the UK either temporarily or, at worst, permanently. That is some 1,200 doctors who are considering not working in the health service as a result of this system. In Lincolnshire alone, a third of practices have thought about registering as a visa-sponsoring practice, but just one in 10 have actually done it. We are really limiting the options for GP trainees and for the health service.

    This is a political choice, and it reveals an inequality between different sorts of doctors. It will probably take a hospital doctor five years to qualify. After those five years, they will qualify for indefinite leave to remain in a much easier way. Because GP trainees take just three years to complete their programme, they need to go through this visa process, because three years is not five years, and the Home Office has decided that five years is what is required.

    There are other associated problems. When it comes to applying for a visa, the GP practice that needs to register will consider whether that process is worth while. It may, in theory, be worth while in advance, and some practices do register in advance, but many do not. They then find themselves confronted with a brilliant candidate, and they try to register, but with the best will in the world, the timescales are very tight for doctors to apply for visas when they have a job offer from a practice that is already registered. There are lots of things to line up, and it is stressful for practices and for doctors. Even if there were no backlog in the Home Office, it would be a very tight timescale.

    Mrs Pauline Latham (Mid Derbyshire) (Con)

    I thank my hon. Friend for giving way and congratulate him on securing this important debate. I have recently returned from an International Development Committee visit to Jordan, where I spoke to a number of highly educated Jordanians, as well as Syrian refugees. Some of the Jordanians were already doctors and nurses, and the Syrian refugees in the camps in Jordan cannot get an education beyond the age of 18 but wish to become doctors, engineers and so on. They speak amazing English and would love to train here in the UK.

    At the moment, Germany is hoovering up a huge number of these doctors and people who would like to study to become doctors, to satisfy the demands of its health service. Does my hon. Friend agree that it would be helpful for the Minister to consider opening up more visa routes for brilliant young medical students from countries such as Jordan that have long been strong international partners of the UK, in order to ease some of the workforce pressures on our NHS? It is important that we increase the numbers, and that would be one way of doing it.

    Matt Warman

    I absolutely agree with my hon. Friend that increasing all those routes is hugely important. Of course, we would all like to see more doctors trained in this country, and the Government have gone some way towards doing that, but where people want to work abroad, Britain should be as attractive a place as we can be. That is why, on the GP point specifically, the Government should be removing every single barrier in that visa process.

    The most straightforward thing we could do, which would remove the need for a practice to register as a visa-sponsoring practice, is simply to say that when a GP qualifies in this country, they get the indefinite leave to remain that other doctors get. These are people in whom the UK has already invested. They are already here; they already have a visa. The extension of that visa into another form seems simply to be a bureaucratic hoop that we are putting in their way as doctors and in the way of GP practices. We are putting extra bureaucracy into a system, while on the other hand the Government say, “We desperately need people to come to this country to work in the NHS, and we will try to do everything we can.” The health service does hugely good work to try to recruit such people and specifically encourages them to train as GPs, but then we put an additional barrier in their way.

    The response from the Government in the past has been, “Actually, the visa process registration is not terribly onerous and GP practices can do it.” They point to the numbers that have and do, which is fine as far as it goes, but it does not answer the question of why we put a barrier in the way in the first place. It should not be a cost of doing business when we say that we really want to make it as easy as possible.

    Equally, it should not be a reasonable thing to put different sorts of doctors on different sorts of levels. It is not reasonable to say to people that, just as they have gone through the most stressful part of qualifying with exams, they should also be thinking about their immigration status. That calls into question their probity when we have things such as the General Medical Council making sure that they are upstanding members of our communities, and many of them have tens of thousands of patients to testify to that.

    I do not think it really washes when the Government say that we need to put barriers in place, and I do not think that the Department of Health, where the Minister was previously a Minister of State, would agree, in an ideal world, with the Home Office stance. We could work together across Government to try to secure a sensible outcome.

    I have talked about GPs, but there are broader issues around visas for doctors, many of which come back to the Home Office backlogs that I know my right hon. Friend the Minister is working really hard to address. There is a good argument for simply scrapping visa fees altogether for people coming to work in the health service. That is an argument for another day, but when it comes to GPs I think that lowering the five-year limit for indefinite leave to remain to three years is the neatest way to address the issue.

    On the broader issues, ultimately this comes back to how many doctors we are training in the UK. We all want, as I said to my hon. Friend the Member for Mid Derbyshire (Mrs Latham), to see more people trained in this country. That is what we are doing and that is what the Government continue to pursue, but until we reach that moment—the NHS has never reached entire self-sufficiency in the UK—we should make it as easy as possible for doctors, dentists, nurses, people working in social care, and all those who work in different parts of the health service, to come to the UK. It is not primarily a question about backlogs; it is a question about process. At the moment there is a degree of bureaucracy that simply does not need to exist.

    Steve Brine (Winchester) (Con)

    It is great to hear my hon. Friend making such an eloquent case, as always—more so than I can. The issue matters for all the reasons he has set out, but would he agree that because of the retention challenge in the health service, the more we pour in at the top is sometimes, in part at least, offset by those who go out at the bottom? There is a wider picture here to do with pension pots—the whole retention piece is part of the wider jigsaw, which I appreciate is not the remit of this Minister, but perhaps was in his previous job.

    Matt Warman

    I thank my hon. Friend for that intervention. It is always tempting to ask the Minister to go and have a word with his former self, but we cannot do that. I think he has read the last couple of points that I want to make.

    There are a number of relatively low-hanging pieces of fruit that the NHS has repeatedly asked for. I want to thank the RCGP, the British Medical Association, the radiologists, the British Dental Association, and also groups such as EveryDoctor, which have helped me with this debate and have identified the fact, as my hon. Friend implied, that there are a small number of things that could and should be sorted as quickly as possible. Busting the barriers around pensions and the bureaucracy around visas are things that would make a real difference to recruitment and retention across the health service. There are plenty of things that are difficult when it comes to addressing the NHS’s challenges, particularly as we approach winter. On the narrow point of GP provision, we have a visa process that puts pressure on, in particular, small GP practices, where the added burden of registering as a visa sponsoring practice is even greater now as they are under such huge pressure. It is also a burden on GPs at what is a particularly stressful point in their careers.

    I know the Minister will make entirely legitimate points around putting a process in place, but the reality is that there is a political choice to be made to ease some of those burdens. There is a powerful, compelling case to be made for doing a small number of easy things that could address the GP crisis in particular, which, as my hon. Friend the Member for Winchester (Steve Brine) alluded to, is acute.

    I appeal to the Minister and the Government to work as closely as they can with the Department of Health and Social Care to understand these challenges and see what can be done, and I urge my right hon. Friend to take seriously the suggestion that if someone qualifies as a medical doctor in this country, and in particular as a GP, they should have indefinite leave to remain. At the moment, it effectively comes with that if they qualify in a hospital but not in general practice. That is an inequality that the Minister can look to fix, and I hope he will do so as soon as is practicable.

  • Steve Baker – 2022 Speech on Derry Addiction Centre

    Steve Baker – 2022 Speech on Derry Addiction Centre

    The speech made by Steve Baker, the Minister of State at the Northern Ireland Office, in Westminster Hall on 2 November 2022.

    It is a real pleasure to reply to this debate, Mr Gray, and I am genuinely very pleased that the hon. Member for Foyle (Colum Eastwood) has secured it; in this, we can make common cause. I am also pleased to see the former Secretary of State, my right hon. Friend the Member for Skipton and Ripon (Julian Smith), in the Chamber today. I pay tribute to all the work he did to get the New Decade, New Approach agreement in place.

    The Government welcome this opportunity to make it clear that we are committed to supporting the Derry/Londonderry addiction centre and providing it with £1 million from unique circumstances funding under the New Decade, New Approach agreement. The hon. Gentleman particularly mentioned Northlands. I will come back to that, but I know it is a very valued service, and it seems to me a very sensible approach to use Northlands to deliver what is required.

    Health is, of course, a devolved matter in Northern Ireland. The issue of a lack of clarity came up, but we are absolutely clear that health is a devolved matter, and we would like it to be governed, and governed well, in Northern Ireland. It is therefore for the relevant Northern Ireland Executive Department—in this case, the Department of Health—to formulate its proposals on how to use the allocated £1 million of unique circumstances funding to support those experiencing addition in Northern Ireland.

    Before I go any further, I want to say that I am personally very committed to this issue, as I know the hon. Member for Foyle and other Members present are. A few years ago, I had the opportunity to participate in an inner-city challenge with the Centre for Social Justice, which saw me spend three days and two nights in rehab with some very serious ex-offenders, including people convicted of murder. It felt like a much longer time. I went through with them, in their counselling sessions, what it means for them to be addicted and how they had come to be in the circumstances they were in. I was particularly moved by the service user’s account that the hon. Gentleman shared.

    Given the social problems that our country faces—indeed, that all countries face—with drugs, we need to get alongside people where they are and lift them up. It is too easy for people to see the tremendous consequences of addictions on our society and rush to condemn, but people in the grip of an addiction need treatment and sympathy. That is one of the things I saw when I was with those people in that centre. Indeed, I have stayed in touch with one of them, and I was in touch with him last night when preparing for this debate. He has completely rebuilt his life, become a good father and got into work. It is an amazing thing to see.

    In thanking the staff of Northlands, and all staff across the UK who deal with addictions, including in Wycombe, I particularly want to acknowledge the point that the hon. Member for Foyle made about the countless people who are grateful. That needs to be understood by everyone. Genuinely, countless people are affected by addictions, because the consequences that spread out as people suffer under addictions are enormous and almost impossible to see. Those consequences spread and spread, generationally as well as geographically, so it is really important that we understand addictions and deal with them. As such, I am personally committed that this money needs to get into Northlands and to deliver against NDNA.

    I stress that the Government stand ready to provide the funding once we have received and approved the Northern Ireland Executive Department of Health’s proposals for the Derry/Londonderry addiction centre. As I said earlier, Northlands seems a particularly sensible way to proceed. The Northern Ireland Office continues to engage with counterparts in the Executive to make that happen.

    We do not have an Executive, and we are moving towards declaring an election, as is our legal duty. We fervently hope that a functioning Executive will be in place as soon as possible. Our officials have been advised by the Northern Ireland Department of Health that, at this stage, it is too early to state what impact, if any, the absence of an Executive will have on the delivery of its proposals. However, NIO officials will keep that aspect under review with the Department of Health.

    The hon. Member for Foyle asked four specific questions. First, what happens if we do not have an Executive? We will have a response plan, and we will take the steps necessary to ensure that public services continue. However, as he knows, we do not wish for direct rule any more than he does; we wish to have a functioning, stable and high-quality devolved Government. We have to proceed with great caution. I know that he will not expect me today to pre-empt announcements that we will make in due course.

    Secondly, the hon. Gentleman asked whether we are still committed. I think I have made it absolutely clear that, personally and as a Government, we are absolutely committed. Thirdly, he raised the impact of instability, which is very real and very much felt in people’s lives. I absolutely appreciate the strength of feeling and the real concern of Unionists, in particular my friends in the Democratic Unionist party. I am a proud Unionist and a proud Brexiteer, and I very much regret that we have the problems we have with the protocol, which are keenly felt by the DUP.

    Let me take this moment to put it on the record that everyone needs to understand that we will be challenged to deliver a devolved Government until the issue of the Northern Ireland protocol is resolved. That, I am afraid, puts things firmly in the hands of the European Union. Until it is willing to negotiate on the basis of regard for the legitimate interests of Unionism—a point I have tried to make clearly, but respectfully so—we will not be able to satisfy the DUP or many Conservative MPs that we have made progress. If we cannot satisfy the DUP, it clearly has the power and the opportunity to prevent a devolved Government from being formed. I wish to be respectful about that, just as I have been respectful—I think famously—to the EU and Ireland about their legitimate interests.

    The hon. Gentleman asked about the impact of instability specifically in relation to the addiction centre. Here we see the impact of political instability, which causes real harm to real lives, not just for those who are addicted, but for their family and the many people who suffer the consequences of addiction.

    Fourthly, the hon. Gentleman asked what we will do. We will of course proceed to govern as best we can in the absence of devolved institutions, within the bounds of not wishing to institute direct rule. We will announce our response plan in due course. I hope that we will be able to satisfy the hon. Gentleman. As he has raised the issue, I will certainly make it my priority to investigate what is happening with the centre.

    This debate is an excellent example of democracy working. We have so many things before us at this time, but this debate secured by the hon. Member for Foyle on behalf of those he represents has raised the matter up my priority list. Working with my officials, I will try to ensure that we drive it forward.

    I have a few words to say about addiction, which is a complex and multifaceted issue that affects the whole of our society. It takes a terrible toll on family and friends. It is therefore vital that people in Northern Ireland and indeed across the UK are able to access the right addiction and support services at the right time. As I said, it is a devolved matter, but the Government are committed to providing the additional funding. That commitment reflects the Government’s strong desire to see improved health outcomes for everyone across Northern Ireland.

    The Government’s commitments under the New Decade, New Approach agreement include making £40 million available for a range of projects focused on addressing Northern Ireland’s unique circumstances. The unique circumstances projects are aimed at supporting community and reconciliation initiatives to remove barriers, to bring the people of Northern Ireland together, and to build a safer and more secure society in Northern Ireland.

    One of the projects identified was the Derry/Londonderry addiction centre. The Government are steadfastly committed to providing £1 million in funding as a non-Barnett addition to the Northern Ireland Executive’s block grant. We of course continue to urge all those involved to form an Executive to deliver the proposals but, as I said, I appreciate why that has not proven possible so far. Funding for unique circumstances projects is an important component of the New Decade, New Approach agreement, and the Government remain focused on ensuring the investment of this funding for the benefit of the local community.

    It may help to say a little more about the context of New Decade, New Approach. The agreement was reached between the UK Government, the Irish Government and Northern Ireland parties in January 2020, and it enabled the restoration of the Northern Ireland Executive after a three-year hiatus. Again, I pay tribute to the former Secretary of State, my right hon. Friend the Member for Skipton and Ripon, for his leading role in that work. The agreement contains commitments for the UK Government, the Irish Government and the Northern Ireland Executive to fulfil. This Government have delivered over half of their commitments under the New Decade, New Approach agreement and we will continue to implement the remainder of the agreement to support a stronger, more prosperous and inclusive Northern Ireland in which everyone can participate and thrive.

    The agreement was accompanied by a £2 billion financial package, consisting of £1 billion of additional funding and a £1 billion Barnett-based investment guarantee. It is the largest deal from a Northern Ireland talks process to restore the Northern Ireland Executive. The UK Government have now honoured the £1 billion Barnett-based investment guarantee, as set out in NDNA. The investment guarantee was that the Executive would get a capital department expenditure limit Barnett consequential of at least £1 billion over a five-year period, from 2021 to 2024-25. That has been honoured as, based on the spending review 2021 settlement, the Northern Ireland Executive will receive over £1 billion by 2024-25 in additional CDEL Barnett consequentials.

    We expect that £769 million from the £1 billion financial package in the agreement will have been spent by the end of the current financial year. The release of funding has been tied to the delivery of reform and transformation of Northern Ireland’s public services, which I will now discuss in a little more detail.

    The agreement reflected the unique challenges faced by Northern Ireland. The aims of the financial package were to provide immediate support to the health service and to address budget pressures, to enable investment to transform public services, to turbocharge infrastructure delivery in Northern Ireland, and to address Northern Ireland’s unique circumstances. The Government’s substantial package played a vital role in supporting the incoming Northern Ireland Executive and in promoting economic growth. Of course, we are deeply disappointed at the continuing lack of a fully functioning Executive, but we will continue to press forward to serve the people of Northern Ireland.

    The £769 million spent so far has been used to bring to an end the nurses’ pay dispute in January 2020, with £200 million used over three years to deliver pay parity with nursing counterparts in England and Wales; to provide a one-off funding settlement to the Northern Ireland Executive of £350 million in 2021-22 to relieve budgetary pressures and deliver effective public services in Northern Ireland; and to drive the transformation of public services by providing £142 million to support the Northern Ireland Executive in its transformation programme. The Executive have so far directed the transformation funding towards improving health outcomes. The NDNA transformation projects are embedded in the Northern Ireland Department of Health’s rebuild framework, “Building Better, Delivering Together,” which progresses health and social care system rebuilding work in Northern Ireland.

    The funding has supported the Northern Ireland Executive in delivering a fleet of low-carbon buses for Belfast and the north-west, with £50 million invested in low-carbon transport. Government funding under NDNA means that 100 zero-emission buses have been produced by Wrightbus in Northern Ireland. The funding also led to the opening of the Northern Ireland graduate medical school in Derry/Londonderry to students in September 2021. So far, we have invested £11.5 million, with another £48.5 million to be invested, to deliver a brand-new facility and investment for the north-west of Northern Ireland. The training of more doctors will also help address the shortage of medical professionals in Northern Ireland in the long term.

    Turning to the unique circumstances money, the Government have committed £140 million to address Northern Ireland’s unique history. That consists of £100 million for legacy implementation and £40 million for those unique circumstances. The £40 million in Government funding has been reserved for the themes set out on page 53 of NDNA, in annex A.

    The funding is to be deployed in areas including mental health, which I am sure will matter to everyone here; tackling paramilitarism; and tackling deprivation and improving opportunity—of course, one of the major factors leading to deprivation is addiction. The funding is also to be deployed on a culture and community fund; support for marking the 2021 centenary and related projects; support for languages and broadcasting; support for the armed forces and veterans; a fund to promote the competitiveness of Northern Ireland’s economy; additional funding to support the Derry/Londonderry addiction centre; and the UK contribution to the international fund for Ireland.

    As I run through those commitments, I think the whole House will appreciate the extraordinary work led by the former Secretary of State, my right hon. Friend the Member for Skipton and Ripon, with all the relevant parties, to deliver so much for Northern Ireland. What we now need to do is press forward.

    The five parties reached the NDNA agreement, leading to the restoration of the Northern Ireland Executive in January 2020. The funding allocations were later agreed by the previous Secretary of State with the First Minister and Deputy First Minister. Good progress continues to be made, and funding has been approved across a range of projects, including on tackling paramilitarism, support for veterans, the Veterans Commissioner, NIO centenary projects, and so on.

    On tackling paramilitarism, the Government’s funding has helped to support the Executive’s Communities in Transition project, which is designed to support and empower those communities that have been most impacted by paramilitarism, criminality and ongoing coercive control. Many Members present will appreciate the interaction between drugs and paramilitarism; I do not wish to get into that in great detail, but the two subjects are closely related. By tackling paramilitarism and criminality, we will help to deal with the problem of addictions.

    The Government’s commitment to veterans under the agreement resulted in the appointment of Mr Danny Kinahan as the first Northern Ireland Veterans Commissioner in September 2020. As with the release of all Government funding, we undertake robust assessments and business case approvals before funding is provided.

    Despite the absence of a Northern Ireland Executive, the Government continue to deliver on their NDNA funding commitments. That includes releasing the remaining £276 million of funding, including £103 million to drive public service transformation; £48.5 million to help fund the graduate medical school at the Magee campus in Derry/Londonderry; £100 million to address the unique history of Northern Ireland, including legacy; and £24.5 million of the £40 million reserved for the 13 themes referred to on page 53 of NDNA, in annex A.

    The Government’s financial package was accompanied by stringent financial conditions to deliver a greater level of accountability for public spending, and to ensure that the Northern Ireland Executive build sustainable public services for people in Northern Ireland. Members will know that that is extremely important at the moment. It included the creation of the independent Northern Ireland Fiscal Council in 2021. That body is an important component in delivering greater accountability for public spending, and it is already playing a valuable role in Northern Ireland.

    Earlier this year, Parliament passed the Northern Ireland (Ministers, Elections and Petitions of Concern) Act 2022 to implement the institutional reforms agreed in NDNA. These reforms have included enabling Northern Ireland Executive Ministers to continue in office for a defined period to allow time for Executive formation—although I lament that in this case that has not worked—reforming the petition of concern mechanism used in the Northern Ireland Assembly, and updating the ministerial code of conduct with regard to the expectations and behaviour of Ministers.

    The Government’s priority continues to be a return to a fully functioning and stable devolved Government as soon as possible, and to ensure the necessary delivery of public services for the people of Northern Ireland. We regret that the parties failed to elect a Speaker and form an Executive before the 28 October deadline. In line with his legal obligation, my right hon. Friend the Secretary of State will soon confirm the date of the next Northern Ireland Assembly election, as required by law. Following that election, and regardless of the result, the Northern Ireland parties really do need to come together to restore the devolved institutions and lead the people of Northern Ireland through the challenging times ahead. I think we all appreciate the significance of that to people in Northern Ireland; the hon. Member for Foyle made very clear the real impact on people of not having an Executive to deliver.

    The significance of NDNA in this context cannot be forgotten. The agreement shows how collaborative working and compromise can create the right conditions for stability—

    James Gray (in the Chair)

    Order. I am sorry to stop the hon. Gentleman, but I must now suspend the sitting until half-past 2 this afternoon.

  • Colum Eastwood – 2022 Speech on Derry Addiction Centre

    Colum Eastwood – 2022 Speech on Derry Addiction Centre

    The speech made by Colum Eastwood, the SDLP MP for Foyle, in Westminster Hall on 2 November 2022.

    I beg to move,

    That this House has considered delivering on New Decade, New Approach commitments to a Derry addiction centre.

    It is a pleasure to serve under your chairmanship, Mr Gray. I will begin with a quote from a service user of the Northlands addiction centre in Derry, which has served the people of our city for almost 50 years. It reads:

    “My mother on one side of me, crying her heart out, my elder sister on the other side with a Kleenex in one hand and her head in another. I didn’t know how I felt. I didn’t know how to feel. I was numb. No tears, no emotions, just nothingness. All I could do was stare at a spot on the carpet and try not to look up and see the hurt and pain in my mum’s face.

    That was over two years ago, and thankfully, I haven’t had to lift a drink since I came in here. Today though, I can feel, I can cry, and I can see what my mother and my sister meant all that time ago. I can see for myself the hurt and the pain and the despair my drinking was causing to my family and myself. Today, the difference is, I can do something about it. I am learning about myself and this horrible disease every day of the week, and for today anyway I didn’t drink, and for me as an alcoholic, that’s a miracle. The treatment in Northlands along with the help of AA since then has given me my life back; it’s given me a life!”

    That is just one of many thousands of stories from people in the city of Derry and right across Northern Ireland who have been affected by the disease of alcoholism and drug addiction, and who have been helped by the wonderful volunteers and staff at the Northlands centre in Derry.

    Jim Shannon (Strangford) (DUP)

    I commend the hon. Gentleman for bringing this issue forward. I talked to him at the airport on Monday, and today as well. Unfortunately, what he is referring to in his constituency is replicated across Northern Ireland and in my own constituency, where there are addiction and drug issues, and where young people are committing suicide. I know that is replicated in the hon. Gentleman’s constituency, so I commend him for securing the debate.

    My understanding is that the Department of Health is holding the money up. Does the hon. Gentleman feel that, through this debate and through the Minister, we might be able to ensure that the money that was promised can be allocated to the maiden city, and to the hon. Gentleman’s constituents, to make things better for them? There seems to be a wee hold-up.

    Colum Eastwood

    The hon. Gentleman is absolutely right to say that the impact of the disease of addiction is felt keenly right across our constituencies. Of course, it is important to say that the Northlands centre, which is referred to in the New Decade, New Approach agreement, serves people from right across Northern Ireland. Every single constituency is affected by it.

    Now that I see the former Secretary of State, the right hon. Member for Skipton and Ripon (Julian Smith), in the Chamber, I might say a word about how we got to this point. For three long years, we did not have an Executive—it feels a bit like we are approaching that period again. During the long hours of torturous negotiation, there was a lot of publicity around a couple of issues, but some of us were focused on a lot more. We wanted to see an Executive back, but an Executive that actually worked on issues that matter to people.

    Late one Friday night, the right hon. Gentleman and I had a long discussion about what it would take to get us back into the Executive if we had a successful negotiation. People will understand that, for me, one of those things was the expansion of the Magee university campus. Another was the Northlands centre, which, after many decades of work, has a strong proposal for a world-class addiction centre in Derry. True to his word, as always, the former Secretary of State got that commitment into the New Decade, New Approach agreement. I was very grateful for it, as were the people of Derry.

    However, as we know in Northern Ireland, words on a page are not enough. What we need is money in a bank account and proper commitment. To be fair, we had that commitment from the previous Government in the form of New Decade, New Approach, and I have had support from the current Government. We now really need an Executive in Stormont to deliver that. Unfortunately, even when we had an Executive—and we had a Minister up until last Friday—we still could not get the money out.

    There are a number of things that I would like this Government to commit to now. What we need is an understanding of what happens if we do not have an Executive. I think all of us in the Chamber want to see an Executive as soon as possible. I would love to see all parties commit to get into government urgently—to get round the table and do the job that we were all elected to do. However, I want the Minister to answer a number of questions for me in the event that that does not happen.

    Are the British Government still committed to delivering on the Derry addiction centre aspect of NDNA? We hear an awful lot about all the commitments, but this is a very important commitment for many people. What is the impact of the political instability on this particular proposal, and how will this Government act if we do not have a functioning Executive? As much as we all will it and want it, if we do not get to the point of having a functioning Executive, will those people who rely on this world-class service, and those who do not even know that they are going to rely on it, be able to access it?

    Mhairi Black (Paisley and Renfrewshire South) (SNP)

    Last year and the year before, on average almost every day in Northern Ireland somebody died because of the way that they misused alcohol. Does the hon. Member agree that if that number of deaths were caused by any other issue, Government would absolutely be on top of it and we would have the Executive up and running and functioning? Does he agree that there is no excuse for the lack of clarity from Government?

    Colum Eastwood

    The hon. Member is absolutely right; one person every single week dies from alcohol-related disease in Northern Ireland. If we add in drug-related deaths, we are talking about 10 deaths a week. Imagine the outcry if that was happening in full public view; we would be rushing to deal with the issue at every level of Government. Frankly, there is no excuse any more for anybody to stand in the way of this commitment.

    New Decade, New Approach was an international agreement, signed off by two Governments and supported by five political parties. Some of us actually went into government on the basis of this and other commitments. Everybody in the Chamber knows about the cost of living crisis and the time it takes to access the health service. We should all know about the impact of drug addiction and alcoholism in our communities. We should be rushing to get this money out the door and spent.

    Northlands has a very proud record. I want to put on record just how grateful the people of our city, and the people of Northern Ireland, are to all the staff and volunteers at Northlands, as well as all the people who put their money in the boxes to support that wonderful service. Over the past five years alone there have been 1,186 weeks of treatment for hundreds of people attending the six-week residential programme at Northlands, and 12,886 non-residential counselling slots have been used. On average, over 35% of people for whom the data is available in that period are in recovery, with an average of under 10% in relapse management.

    Julian Smith (Skipton and Ripon) (Con)

    Will the hon. Member talk a little more about the team behind Northlands? I recall from my time as Secretary of State that it is not a commercial or money-making enterprise; it is local people who understand the specific issues with addictions in Derry and are passionate about those priorities. They are deeply impressive, and I think it would be useful for the Minister to hear a bit more about the people behind Northlands.

    Colum Eastwood

    I am grateful for the right hon. Member’s intervention and I want to put on record my gratitude to him for getting the commitment in writing in the agreement. He went to meet the people behind the Northlands centre—people like Denis Bradley and many others, who over many years gave of their time, expertise and love for the people of our city and the people who have been struggling with this disease. The House would not believe the number of people who are very grateful for the work they have done.

    It is also important to say that in our city and in other parts of Northern Ireland, we are faced with another problem: the grip of paramilitarism. Paramilitaries use drug addiction and abuse to coercively control communities in a way that needs to be tackled. In my view, the best way to tackle it—because we have tried everything else—is to deal with the root cause, which is addiction. Organisations such as the Northlands centre do that in a way that needs huge support. What better way to do that than to get this money into that organisation’s bank account and to get this project delivered?

    Before I finish, I ask again: will the Government continue to be committed to funding this service? What will happen if we do not see an Executive formed as a matter of urgency? Will this Government step in if we do not get a Health Minister at Stormont? I hope that we do, and I assume the Minister is going to talk about the need for an Executive. He has no bigger supporter in that call than me, but if we do not get an Executive, what are this Government going to do? Of course, it was this Government who committed to getting this money to Northlands and getting the project up and running. I am grateful to the Minister for being here, but I will be even more grateful if we can get this money spent, as has been committed to.

  • Maria Caulfield – 2022 Speech on Black Maternal Health Awareness Week

    Maria Caulfield – 2022 Speech on Black Maternal Health Awareness Week

    The speech made by Maria Caulfield, the Parliamentary Under-Secretary of State for Health and Social Care, in Westminster Hall on 2 November 2022.

    It is a pleasure to serve under your chairmanship, Mr Gray. I thank the hon. Member for Streatham (Bell Ribeiro-Addy) for securing this debate. As she highlighted, we had a similar debate recently. I hope that my comments reassure her that we are taking action and making progress in this area.

    I take the issue of maternal disparities very seriously; that is why when I was in post previously I set up the maternity disparities taskforce, which has brought together a range of specialists and campaigners. We have heard from groups such as Five X More and the Muslim Women’s Network to hear their views on what is going wrong right now, what systems we need to put in place to improve outcomes and also the experiences of black women in maternity services.

    The data shows the disparities in black maternal health. We have heard about them clearly this morning, and I do not think anyone is in any disagreement about the scale of the problem we are facing. As the hon. Member for Streatham said, it is harrowing to hear those figures. The MBRRACE annual surveillance report shows that women of black ethnicity are four times more likely to die from pregnancy and birth compared with white women. I do not think there is a dispute about that; we fully acknowledge it and we want to reverse that trend as quickly as possible.

    Caroline Nokes

    I want to make a quick point about MBRRACE and the data. Data collection remains tricky, with some hospitals not reporting women’s deaths—not necessarily maternal deaths—until up to 500 days after they have happened. Then there is a delay with the medical records and notes, which might indicate the reasons for that. What reassurance can the Minister give that she will work to reduce those times?

    Maria Caulfield

    My right hon. Friend is absolutely right. Although Five X More does its surveys about the experience of women, the data on outcomes is very delayed. When we put measures in place, we cannot see the difference they make until the data comes through, roughly 18 months to two years later, as my right hon. Friend said. That lag does not help us determine whether the measures we are putting in place are actually making a difference. Getting that on track is a key priority for me so that we can accurately measure what is happening.

    From the data that we do have, The Lancet series in April last year found that black women have an increased relative risk of 40% of miscarriage compared with white women, and the stillbirth rate in England for black babies is 6.3 per 1,000 births, compared with 3.2 per 1,000 births for white women. That is completely unacceptable, and as the hon. Member for Streatham said, we cannot come back here, debate after debate, without seeing those figures move. One potential cause for optimism is that we do not have up-to-date data on the benefits of the interventions that we have put in place, so it might be better than we think. However, we absolutely need that data, not only to measure what is happening, but to know whether we are heading in the right direction if we set targets in the future.

    To reassure Members, I want to clarify the point about not setting a target because the problem is too small. I do not agree that the problem is too small; it is a significant problem. Even if it is affecting one or two women, it is a significant problem, so that is not a reason not to set a target. As the hon. Member for Putney (Fleur Anderson) pointed out, there are multiple factors in why black women often face poorer outcomes in pregnancy and birth, and for their babies. It is a mix of personal, social, economic and environmental factors. Air quality, which the hon. Member touched on, also has an impact on overall health. The maternity disparities taskforce found that being in a lower socioeconomic group has a significant effect on maternal outcomes, and black and ethnic women are often in those groups and so face a double whammy in terms of their likely outcomes.

    We cannot just fix this in isolation at the Department of Health and Social Care. That is why I am pleased that in my role for women’s health—I am also the Minister for Women, across the board—I can bring in other Departments, because we need to take a cross-Government approach to this issue. Whether it is the Department for Environment, Food and Rural Affairs on air quality, the Department for Levelling Up, Housing and Communities on housing, or the Department for Work and Pensions on employment, we need to work together so that all the factors affecting black maternal health are addressed in tandem to address this issue.

    We know from a health perspective that pregnant black women are more likely to suffer from some chronic diseases that will affect their maternity outcomes, and in particular cause poorer mental health. There are health initiatives that we can put in place to ensure that we improve the outcomes for black women, but that cannot be done in isolation from the other factors that also negatively affect them.

    Given the risks that such conditions pose in pregnancy, there is a need for safe personalised care for black women and women from ethnic backgrounds, because the needs of women from each and every community are so different. Just nationally introducing blanket systems will not address some of the problems; there is no one single solution that will improve the statistics and improve the outcomes for women.

    The issue is not just the outcomes from maternity services. As we heard from the hon. Member for Streatham, the Five X More survey also reflects the general experience by black women of the healthcare system. Although black women are often at a more difficult point to start with, when they engage with health services they often have a very negative experience. We have seen that in the recent publication of the East Kent maternity report and in the Ockenden maternity review, which highlighted that there is racial discrimination present in some parts of the maternity services.

    We cannot allow that to continue, because if we want black women to come and engage with services and to come forward when they have concerns, if they feel that they are not being listened to or if they raise concerns and they are dismissed, why would we be surprised when they do not engage with services in the future? Regarding the East Kent report in particular, I will look at the calls for action on how we improve black women’s experience of the healthcare system and considering how we can address those issues as urgently as possible.

    When we consider the actions that we are putting in place, and I will touch on some of the ones that have already started, I am very much a supporter of Professor Marmot’s idea of proportionate universalism, whereby we introduce good services across the country but then we target those people who are most in need; in the case of black maternal health, that is clearly women from the black community. We need to go to them rather than expecting them to come to the health service: we have a universal offer, but ensure that it is targeted specifically at those who do not experience the best outcomes.

    On targets, as my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) touched on earlier, we have an issue with data collection across the board in health services, including in maternity services. Black women often experience the worst outcomes, although some of the data that we are seeing is from 2020. For some of the initiatives that we have put in place in the last year or 18 months, we are not yet seeing the benefit of those initiatives in terms of outcomes. I am being very candid here: we have not got a handle on what is making a difference, or on which parts of the country are doing well—as was acknowledged by the hon. Member for Bolton South East (Yasmin Qureshi), the shadow Minister, there are some very good practices in place—and which parts of the country are still not supporting women in the way that women want.

    We are working with NHS England, the Office for National Statistics, MBRRACE-UK and the National Neonatal Research Database, because there are also multiple sources of data. We need to pull all the data together and get it as close to real-time data as we can, so that when we introduce interventions and measures we can know whether they work.

    As part of the maternity disparities taskforce, I am also keen to make sure that we include black women more in the national patient survey, because the shadow Minister was quite right that we had over 100,000 responses to the women’s health strategy but only a small percentage of those responses came from black and ethnic minority women. That illustrates the problem that we are talking about—that black women do not feel represented, or do not feel engaged with the process. So we have to change things and work is being done to address that situation.

    We are introducing some measures. First, we have set guidance that each local maternity system is now working in partnership with women and their families and their local areas to draw up equity and equality action plans. For each local maternity system’s local area, there has to be a plan in place about how to improve the outcomes for women. The plans are agreed by the local maternity systems and the new integrated care boards, which were set up in the summer. They were published last week, so I encourage hon. Members to look at their local action plans to see what they are putting forward and to challenge them if they feel that they are not meeting local community needs. That is why they are done on a local basis: what is appropriate in my constituency of Lewes may be different to what is needed in Streatham, Putney, Leicester East, or Romsey and Southampton North. It is really important that we look at those action plans to make sure that they address the problems that we are concerned about. Every plan is being reviewed by NHS England, which will identify areas of good practice and the support that is needed to drive them forward.

    In addition, we have also commissioned 14 maternal medicine networks covering the whole of England, which will ensure that women have access to specialist management. We know that black women are more at risk of high blood pressure, diabetes and sickle cell anaemia and yet many of those risk factors for their pregnancy and birth are not dealt with or managed. The maternal medicines network will bring in specialists so that, at an early stage of their pregnancy, those women can access those specialists to help them manage their pregnancy. They will also be offered pre-conception advice for further pregnancies. We have never done that before. We are targeting the risk factors of black women, and all women who are at risk, to make sure that they get the medical support and advice that they need during and after their pregnancy.

    The Department also launched the £7.6 million health and wellbeing fund last year, which is supporting 19 projects throughout England to try to generate best practice guidelines that we can introduce to help reduce disparities. These projects include supporting expectant young black fathers in child development and providing perinatal mental health support for black mothers. If we can get some evidence-based best practice, we can look to roll that out across the country in the coming months and years. There is a lot of work going on.

    I will touch on the issue of racial discrimination. It is clearly unacceptable that black, Asian and ethnic minority women feel that the health service is not accessible or not responsive to their needs. There is education and training for NHS staff on health disparities to eliminate bias and racism in obstetrics and gynaecology. The Royal College of Obstetricians and Gynaecologists’ race equality taskforce has developed e-learning cultural competencies. They now form part of the colleges’ members continuing professional development. The Nursing and Midwifery Council is also looking at how to promote and embed equality and respect in professional practice, so that they can create an environment where everyone feels that they can access the services they need. We will obviously continue to look at this with the maternity disparities taskforce, which is bringing in campaigners, experts and professionals to try to drive momentum on this issue.

    Data is the key. I can give a commitment here that has been highlighted already. We need that data. We cannot be working with data that is two years old to see if we are making a difference because, if we are, we will not know about it for two years and will not be able to roll out good practice in other parts of the country. In my brief as the Minister for Women, I am aiming to bring that across other Departments as well.

    I hope I have reassured hon. and right hon. Members in today’s debate that I am committed to continuing the work to tackle the disparities in outcomes to ensure that everyone has the opportunity to live a long and happy life. I am happy to work with the APPG on black maternal health, which is chaired by the hon. Member for Streatham, because it is only by working together to identify good practice and raising it when things are not working well that we can eliminate the disparity: it is unacceptable that black women are four times more likely to die during pregnancy simply because they are black women.

  • Yasmin Qureshi – 2022 Speech on Black Maternal Health Awareness Week

    Yasmin Qureshi – 2022 Speech on Black Maternal Health Awareness Week

    The speech made by Yasmin Qureshi, the Labour MP for Bolton South East, in Westminster Hall on 2 November 2022.

    It is a pleasure to serve under your chairmanship, Mr Gray. I thank my hon. Friend the Member for Streatham (Bell Ribeiro-Addy) for obtaining this debate, and for all the work she has been doing on this issue for many years. I also thank the incredible campaigners who continue to work tirelessly to end black maternal health inequalities.

    Maternal health inequalities exist throughout our country. It is very much a case of hit and miss: in some parts of the country the statistics are good, while in others they are not. However, black maternal health inequalities do seem to persist throughout our country. I also thank the right hon. Member for Romsey and Southampton North (Caroline Nokes), the Chair of the Women and Equalities Committee, who talked about the work that her Committee has done, but also noted that although this issue has been discussed for so many years, not much progress has been made on many of the concerns. My hon. Friend the Member for Putney (Fleur Anderson) spoke eloquently about the issues in Wandsworth and generally. In particular, she touched on bereavement services, the quality of which varies across the country as well. I thank the hon. Member for Leicester East (Claudia Webbe) for the very passionate speech she made. I agree with her: all mothers are superheroes. I do not think any debate would be complete without an intervention or speech from the hon. Member for Strangford (Jim Shannon), who is not in his place; I thank him for his intervention as well.

    As we have heard repeatedly in this debate, it is shameful that black women continue to be over four times as likely, and Asian women over twice as likely, to die in childbirth or pregnancy than white women. I am very grateful for the work of campaigners, obstetricians, midwives, and black and Asian women with lived experience of maternal health complications for sharing their experiences and expertise on the issue. They are clear that socioeconomic determinants and comorbidity only partially explain those disparities in treatment. Black and Asian women and their partners are not being listened to, they are not being respected and they are certainly not being cared for. When they voice pain or concern during pregnancy or childbirth, they are often branded as aggressive or angry, while dangerous stereotypes about the strong black woman mean that they are often not offered the same treatment as white women. Meanwhile, the lack of cultural competency in medical training in our country means that many complications are not spotted early enough.

    That structural inequality exists both inside and outside our health services. Many black, Asian and ethnic minority women experience it long before and long after pregnancy. However, the Government have done nothing to address this outrageous inequality. In fact, on their watch over the last 12 years, maternal mortality for black women has actually increased from 28 deaths per 100,000 in 2013 to 2015, to 34 per 100,000 in the years 2016 to 2018.

    Gynaecology wait times are very high. A survey from the charity Five X More found that 27% of women surveyed felt that they received a poor or very poor standard of care during pregnancy, labour and postnatal care. Also, 42% of women repeatedly felt discriminated against during their maternity care, with the most common reasons given being race, at 51%, ethnicity, at 18%, age, at 17%, and class, at 7% of respondents. More than half the women reported facing challenges with healthcare professionals during their maternity care, while over half the black women reported not receiving their preferred method of pain relief.

    Where is the Government’s action on this? In the last 18 months alone, we have seen their response to the Commission on Race and Ethnic Disparities fail to address black maternal inequality, as well as a women’s health strategy that completely fails to establish what concrete action the Government will take to protect the lives of black, Asian and ethnic minority mothers. It is hardly a surprise that the women’s health strategy has failed black, Asian and ethnic minority women, given that just 2% of the respondents who were surveyed were Asian and 3% were black. I am not trying to be party political here, but while the Government are busy crashing the economy and causing chaos at a time of national crisis, black, Asian and ethnic minority women continue to face the consequences of their inertia and ineptitude.

    Last year, in passing the Health and Care Act 2022, the Government had an opportunity to prioritise the health of black, Asian and ethnic minority women by voting for Labour’s amendment to mandate the Secretary of State to prepare and publish a report on disparities in the quality and safety of England’s maternal services, including maternal mortality rates. However, the Government chose to vote against it. It was a very simple measure that could have helped, but no, they voted against it. The Labour party has committed to setting a target to end the horrendous inequality faced by black, Asian and ethnic minority women as soon as we are in government.

    That will be part of our commitment to end structural inequality at the root, with a landmark race equality Act to be introduced by the next Labour Government. We are committed to pulling the NHS out of crisis so that it can deliver for everyone, including black, Asian and ethnic minority mothers. We will enact the biggest extension of medical school places in history. We will double the number of district nurses, train 5,000 new health visitors and, crucially for maternal health, introduce an extra 10,000 nursing and midwifery clinical placements each year. Our fully costed plan will be funded by ending the non-domicile tax status regime, which, it is estimated, would raise more than £3.2 billion every year. Growing the NHS will also grow the economy and eradicate these inequalities once and for all.

    I welcome the Minister to her new position. Like me, she has just recently joined this brief. While we wait for these changes, what is being done to address structural inequalities and build trust in maternity services for BME mothers, their partners and midwives from ethnic minority backgrounds? Additionally, what plan does the Minister have to improve cultural competency and unconscious bias training in medical schools and the health service?

    There is also the huge issue of the lack of available data, which has not been tackled in either the women’s health strategy or the Government’s response to the Commission on Race and Ethnic Disparities. As we have heard, accurate data disaggregated by ethnicity is central to closing the gap in maternal mortalities. Will the Minister commit to ensuring that all maternity services record the specific ethnicity of all mothers? Fatalities are just the tip of the iceberg, with many women speaking of near misses and poor treatment, so will the Minister commit to collecting and publishing that data?

    Some midwives also consider that the continuity of carer model could help to end these inequalities. A 2016 study found that women who see the same midwife throughout their pregnancy are 16% less likely to lose their baby. Despite that, the NHS has recently been forced to drop targets included in the NHS long-term plan to ensure continuity of carer for 75% of BME women by 2024 as a result of staffing shortages. It is clear that the Government are failing these women. What steps is the Minister taking to end the staffing shortages in maternity care so that those targets can be reintroduced and met by 2024?

    I have to say, it is scandalous that the Government have not yet even set a target to end this inequality. They have been in power for 12 years—that is a very long time in which to have comprehensively changed the system. Will they now commit to doing so immediately? We did it for stillbirths. Why has black maternity mortality not been a priority for the Government?

    This is an avoidable inequality. There are many steps we could be taking to end these awful disparities. Instead, the Government have done nothing while the issue has got worse. The Government must take action to address maternal health inequalities. We need a national strategy to tackle health inequality as a matter of urgency, which must include a commitment to eradicating the mortality gap between black, Asian and ethnic minority women and white women. Only Labour can deliver that strategy as part of our plan to tackle structural inequality at the root and lift the NHS out of crisis.

    I hope that the Minister will answer some of those questions today and commit to specific action that will be taken, because this cannot go on. These appalling statistics—the fact that black women have four times the mortality rates of others—are not acceptable in a decent, civilised society.

  • David Linden – 2022 Speech on Black Maternal Health Awareness Week

    David Linden – 2022 Speech on Black Maternal Health Awareness Week

    The speech made by David Linden, the SNP MP for Glasgow East, in Westminster Hall on 2 November 2022.

    It is a pleasure to serve under your chairmanship, Mr Gray. I, too, congratulate the hon. Member for Streatham (Bell Ribeiro-Addy) on securing the debate and on opening it so well.

    I was not due to speak in this debate on behalf of the Scottish National party; it was supposed to be my constituency neighbour and hon. Friend the Member for Glasgow North East (Anne McLaughlin), who has sadly been incapacitated and remains in Glasgow. I hope that those present will bear with me.

    I speak primarily from my position as chair of the all-party parliamentary group on premature and sick babies, because our APPG has looked into the issue of racial disparities in maternal healthcare, as well as inequalities more generally in maternal healthcare and neonatal services. These topics merit more attention from the Government. As hon. Members have said, there have been numerous debates, questions, early-day motions and all those kinds of things on this topic. The benchmark for whether the Government are getting this right is whether we will be back in this Chamber in 10 or 15 years’ time to have the same conversation. I certainly hope we will not.

    The Birthrights report, “Systemic racism, not broken bodies”, outlines the systematic racism in maternity services. That report confirms the devastating fact that black, Asian and mixed-ethnicity women are more likely to experience baby loss and illness, or to become seriously ill, and have worse experiences of care during pregnancy and throughout childbirth. I want to advocate for the report’s conclusion, which calls for a commitment to anti-racism by all maternity and neonatal services, and a commitment to ensuring that there are more black and brown women and birthing people decision makers in the wider maternity system. We have to look at the ticking time bomb in the neonatal and maternity workforce; that absolutely has to be in the mix. The report also calls for a safe and inclusive maternity and birthing experience for all parents, which I think we would all want to get behind.

    Healthcare is devolved in Scotland, which is largely why I do not want to impose too much in this debate. However, the SNP Scottish Government believe that there needs to be an open and honest conversation about race and institutional racism right across these islands—Scotland is not immune—in order to identify solutions that will lead to equality and positive outcomes for black and minority ethnic communities. Members have asked a number of questions of the Government; for the sake of brevity, and so as not to repeat what has been said, I will just say that I would like to hear the Minister respond to those, particularly the seven points made by the hon. Member for Putney (Fleur Anderson).

    I am very grateful to the hon. Member for Streatham for securing this debate and giving us an opportunity to focus on this issue. Most importantly, I am looking forward to hearing what the Government have to say, and to seeing what best practice can be rolled out in Scotland, because no part of these islands have a monopoly of wisdom or ideas.