Seema Malhotra
MP for Feltham and Heston · Labour (Co-op) · United Kingdom
“Public sector productivity is improving, with the latest Office for National Statistics figures showing output continuing to grow faster than inputs, and Departments being challenged to improve efficiency and modernise outdated processes.”
“I was proud to support the Feltham Convening Partnership’s young leaders summer programme last month. What struck me was their ambition for themselves and their community, as well as their call for more work experience opportunities.”
“We will be working to commence the socioeconomic duty on public bodies in section 1 of the Equality Act to require public authorities to put addressing socioeconomic disadvantage at the heart of their strategic decision making. There will be more on that to follow. Let me again thank my hon.”
“For generations, the message to those who want to enter public life or elite professions has been that if they want to get on, they must sound like everybody else. When Margaret Thatcher became leader of her party in the 1970s, she famously underwent intensive elocution lessons with a tutor from the National Theatre.”
“Whether a young person chooses a degree or a trade, their journey must be determined by merit and their potential—never by whether they have to change their voice or pretend to be someone else to fit in.”
“Interestingly, studies also regularly show that regional accents such as Welsh or Yorkshire are rated by the public as trustworthy, warm and honest. Yet when those same studies measure perceived intelligence or employability, standard southern English and received pronunciation invariably top the metrics.”
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“She said that “an IFR can only be considered if the patient can be demonstrated to be clinically exceptional compared to the wider group of patients and is likely to derive greater benefit from the treatment.” At face value, all of this would appear to be true for my constituent, but the use of Maraviroc is an area where policy appears to be in some confusion. In response to a parliamentary question I asked in July about the assessment that NHS England has made of the availability of Maraviroc to patients with PML, a third Health Minister, the hon.”
“There are clinical situations when the use of unlicensed medicines or use of medicines outside the terms of the licence, known as off-label, may be judged by the prescriber to be in the best interest of the patient on the basis of available evidence. The responsibility for that falls on healthcare professionals.” Sadly, this made no difference. Following the lack of progress, I wrote again to the Secretary of State in March 2019. I quoted the helpful response that I had received from Lord O’Shaughnessy. The Health Minister in the other place, Baroness Blackwood, responded in May and referred again to the individual funding request process. She stated that the IFR can be considered only if the patient can be demonstrated to be clinically exceptional.”
“You will have already proved in what is an N=1 trial that her treatment would appear to be effective. There will almost certainly never be the size of trials in this rare disorder that would allow a definitive statement by a funding organisation. I think we have to ask who is making the decision, given that there are now three senior consultants confirming this is the right decision… Quite frankly I am appalled by the lack of humanity that is being demonstrated here.” In November 2018 I wrote again to the Minister. I received a response from Lord O’Shaughnessy in the other place, who helpfully said the following: “Maraviroc is not licenced for the treatment of symptoms of PML.”
“Although her health has been stable so far, such is the condition that it could dramatically change at any time. Aside from the issue of funding, I have been surprised over the past year by inconsistencies in NHS policy and advice. We all believe in an NHS that is free at the point of need. This is a situation where the patient, leading neurologists and all involved in her care agree that she should have the drug. In November 2018, consultant neurologist Dr Michael Gross, who was also supporting Amarjit’s care as an expert advocate, wrote to Kartik: “Thank you for confirming further information about Amarjit Rai... Professors Johnson and Ciccarelli agree that this is the appropriate treatment for Amarjit. Long term steroids have already generated severe osteoporosis in 2016 and are not her choice.”
“Maraviroc had remarkable results for her—importantly, that was also the opinion of her consultants—without any side effects. Other treatments that the NHS had sought to prescribe, such as MRIs and monthly steroids, were not just neutral but net negative. Amarjit and Kartik explained the impact that Maraviroc had had on Amarjit’s health and quality of life. I was just staggered when she told me: “I can talk. I can walk. I can go to the bathroom on my own”— things that we take for granted. Clinically, the PML lesion appeared inactive and there was a reduction in the inflammation around her brain. The drug costs around £480 a month, but by the end of June this year Ms Rai could no longer afford to pay for it herself, so she has since been without it.”
“The application was refused and a subsequent appeal was also unsuccessful—this process went on through 2017 and 2018—seemingly on the same basis as was given to me in writing in October by NHS England, which was that the “use of Maraviroc for this condition is currently seen as experimental as the current evidence is limited to very small observational studies. NHS England has concluded that there is not sufficient evidence to support the routine commissioning of this treatment for the indications listed.” The effect on Amarjit was heartbreaking. I met Amarjit and her friend and advocate Kartik. She had a wheelchair and a walking stick, and even the most basic activities were a struggle. She had decided to fund the drug privately from her savings.”
“The hon. Gentleman makes a point that I will come on to about how the decisions need to be made on the medical evidence and with the voice of the consultants being clearly heard by those making the decisions. There is no cure for this condition, but two years ago my consultant’s neurologist advised that Maraviroc had had a positive effect on patients suffering from PML in relation to her condition, immune reconstitution inflammatory syndrome in multiple sclerosis. An individual funding request was submitted by my constituent’s consultant, national expert Professor Ciccarelli at the National Hospital for Neurology and Neurosurgery.”
“I understand that this is a technical matter in some respects, but I am a little surprised that I have not heard the Minister say anything new compared with the responses I have received to parliamentary questions. I have laid out the evidence and shown that there are nuances. In the case of my constituent, the medical benefits have been clear. I am surprised that the IFR was denied, including subsequently on appeal, and, given that I have laid out the evidence, that the Minister is not in a position to give advice on how we can move forward so that we do not keep going around in circles.”
“The Minister is very generous in giving way. Rather than restating the policy, will she support the request for the medical advice that was the reason for the treatment and funding being refused? There must have been some medical input into the decision made by the panel at NHS England. Will she also be able to meet me to review the process and what my constituent has been through? Clearly my constituent is in a very rare circumstance—she is possibly one of fewer than 10 people in the country—but surely we are able to work a bit faster and with more agility in a situation where, in a sense, the patient and the experts in the field should be leading.”
“Does the Minister agree it is slightly more problematic in this case, because the cost of Maraviroc is arguably a bit less than the MRI scans and the steroids every month that the NHS would otherwise prescribe or suggest to my constituent? The negative health impact of that treatment should also be taken into account.”
“I will make this my last intervention. I just want to welcome the work that will be done in respect of the rare disease community. May I add to the comments in this House in welcoming the Minister to her place? I know that her experience will be extremely valuable in the work that she does in the Department.”
“The Minister has repeatedly answered questions with what the Government want to do. In circumstances relating to the law, however, what is important is not necessarily what we want to do but what we might be obligated to do. May I ask the Minister a slightly different question? What is his understanding of what the Benn Act asks the Government to do if, by 19 October, neither a deal has been agreed by this House nor a no deal has been passed?”
“On a point of order, Mr Speaker. In the Chamber we have ways in which we conduct ourselves. We have rules, some written, some unwritten, about decency and the way in which we speak to each other—and, indeed, conduct ourselves in conversation with you, Mr Speaker. Could you advise me as to whether there is any capacity for a formal review about the limits of language that we may use about colleagues, because if we are to change this, experience has shown us that raising it again and again in the Chamber is not enough? Given that we have other rules about how we conduct ourselves, could you advise the House as to whether there is any capacity to review the language used so that we can create other ways in which calling a colleague a traitor could be ruled out of order?”
“Will the Chancellor meet me to review the situation, so that we can see whether the existing plans can be approved or whether any of the alternative capital funding he has announced will be available to enable this important and urgent development to go ahead?”
“I look forward to sharing plans for the Southern Rail access to Heathrow, which I hope will form an important part of the Chancellor’s new infrastructure strategy. This month, Hounslow clinical commissioning group was due to present the full business case for the planned and urgently needed Heston health centre redevelopment to its governing body. However, the project is on hold after questions about whether the local improvement finance trust scheme, which was originally advised by the Department of Health and Social Care as the best-value funding option, could still go ahead following confusion around the Treasury’s policy on LIFT schemes last year.”
“(Urgent Question): To ask the Secretary of State for Justice if he will make a statement on Her Majesty’s chief inspector of prison’s recent invoking of the urgent notification process for Feltham A young offenders institution.”
“What support is there for those young people living in great distress at Feltham young offenders institution? How fit for purpose does he consider Feltham to be, how quickly does he plan to produce his action plan, and how will he keep Parliament and me informed, particularly over the recess?”
“The Government desperately need to get to grip with the causes of the rapid decline and to support the staff and inmates in turning the situation around. Given that we are talking about children—140 boys aged 15 to 17 are being held at Feltham A in the care of the state—will the Minister update us on why Feltham was left without a governor for five months last year, what the impact has been, and what assessment he has made of the root causes of the steep decline in performance? The Minister says he has supplied resources, but why does he believe they have not been sufficient? What additional skilled resources does he intend to provide to support the staff and management to address the culture and behaviour management issues that are so significant?”
“I thank the Minister for his response and for notifying me of the letter yesterday. Feltham young offenders institution was a prison left without a governor for five months last year, and the findings of the recently announced inspection have been distressing for the staff and all those involved with Feltham. There was talk of a dramatic decline in safety, which is a matter of great concern for us all. I extend my thanks to the POA trade union and the staff and management, who have been working at that prison in very difficult circumstances. The problems at Feltham are long standing and the current situation should have been avoidable. The Government have much to answer for regarding why the decline has been so fast, with a steep rise in violence against staff, allegations of assault and levels of self-harm.”
“I welcome the Minister’s reference to understandable concerns, and I get the sense that she will want to see this issue concluded as quickly as possible. I have been contacted by at least six constituents who are unable to work and support their families as a result of the alleged cheating in TOEIC. They have lost their visas and been threatened with deportation, and their children’s education has been put at risk. They have not had the chance to prove their innocence. Their lives are on hold, and their families are under great strain. They are living in limbo. How reassured should my constituents feel by the Minister’s statement that they will be able very soon to get the chance to clear their name and, indeed, to get justice for what they have been through?”
“The combined number of banks and building societies is falling steadily, and in 2018, the number of free-to-use ATMs fell for the first time in 20 years.”
“Cuts to welfare, stagnant wages and economic instability in the last decade have exacerbated the precarious position of millions of people in the UK. The Money Advice Service estimates that 22% of UK adults have less than £100 in savings, which makes them highly vulnerable to a financial shock such as job loss or an unexpected bill. Some 8 million people rely on high-cost credit to pay essential household expenses, and may frequently turn to alternative forms of finance such as high-cost lenders or illegal loan sharks to make ends meet. Recent Financial Conduct Authority data shows that the number of high-cost short-term credit firms has decreased, but the volume of lending has increased. Ten years ago, six in 10 transactions were made in cash, but by March 2019, that number had halved to three in 10.”
“We need a joined-up plan led by the Government that looks at the cost and effectiveness of our wholesale cash infrastructure, programmes for digital inclusion and incentives to diversify services based on complex customer needs. We need to ensure that those services can reach people, and that we both maintain free access to cash for those who need or choose cash as their method of payment and ensure that cash remains accepted. There is clear cross-party interest, which the Chair of the Treasury Committee referred to in her recent correspondence with the Chancellor. That gives me hope and confidence that we are setting the right foundations for moving forward and addressing the challenges ahead. Fundamentally, the bigger picture is inclusive economic growth and flexibility, security and choice in personal and family finance.”
“There is considerable interest in the debate, so I will try to keep my remarks to about 15 or 16 minutes. I will set out some of the context; where progress is being made, which we should recognise; opportunities that we should seize, including a particular mention for credit unions; and the importance of joining up to move forward together. I will also cover the potential for and importance of future legislation, which the Government have so far resisted and I am sure the Minister will mention. As the map of stakeholders shows, access to cash is an important and complex issue that can no longer be primarily led by industry.”
“I beg to move, That this House has considered financial exclusion and the future of access to cash. It is an honour to serve under your chairship, Sir Henry. I thank the Backbench Business Committee for granting our request to hold the debate. I also thank the Access to Cash Review panel, Joe Fortune from the Co-op party, the RSA, Responsible Finance, Hounslow Council, UK Finance, the Payment Systems Regulator, the Treasury Committee Clerks, Visa, Mastercard, the Financial Inclusion Commission, Citizens Advice, the Money Advice Service, Age UK and many others for their help in preparing for the debate. I mention them as an indication of how widespread the concern is and how much of a contribution many stakeholders are making. I also declare an interest as a recent nominee to become a new commissioner on the Financial Inclusion Commission.”
“In addition, research by the University of Bristol on the distribution of ATMs in that city has found that the provision of cash is almost opposite to the geographical need for it. Lower-income communities are poorly served by current cash infrastructure. ATMs are changing from free to fee-charging, with deprived areas disproportionately hit. Of the 16 ATMs in Bristol that changed from free to fee-charging between October 2018 and March 2019, 11 were located in deprived areas.”
“Member for Solihull (Julian Knight) for being here and for his work on the all-party parliamentary group on financial education for young people. I will say a few words about supporting the cash infrastructure. We know that The Telegraph reported last year that there were about 123 cash deserts—postcode areas that do not have a single ATM in their geographical coverage—and there are more than that now. A further 116 areas have just a single ATM, 36 of which are fee-paying ATMs. The Association of Convenience Stores also highlights how convenience retailers and ATMs enable financial inclusion, but they are also under threat from high business rates bills and cuts to interchange fees.”
“The gaps in broadband provision, including in rural communities, can make access to cashless payments more difficult. Indeed, broadband notspots are not confined to rural areas; an estimated 1,000 households in my constituency do not have access to decent-speed broadband. Hounslow Council’s work to help to end notspots is a key part of the jigsaw, which will take years to deal with. The question is how we are going to respond to the drivers of such changes, including new technologies, lifestyles and uneven economic progress, and the consequences of the increasing cost of our nation’s wholesale cash infrastructure, alongside the need for better financial education and financial inclusion. I thank the hon.”
“People who have less access to cash are already subject to a poverty premium; they have been left behind by contactless and digital payment technologies and cannot shop around to get the best deals. There are also difficulties for disabled people. Eleanor Southwood’s evidence to the Treasury Committee recounted how people who are blind or partially sighted can struggle to use a taxi driver’s touch screen PIN pad, and then often need to give away their PIN. It is important to think about the role of assistive technology in this space. As chair of the all-party parliamentary group for assistive technology, I understand the potentially transformative impact of accessible technology and why it needs to be part of the debate about how financial services move forward.”
“This year, the Access to Cash Review’s significant report found that 17% of Brits say that they would not cope without cash. As has been said, they are the most vulnerable people, such as the disabled, the poorest and the elderly, who are unlikely to be early adopters of contactless technology. Figures from the Financial Inclusion Commission suggest that they are also more likely to be among the approximately 700,000 people in the UK who want a bank account but, for various reasons, cannot open one. There are significant regional, area-based and income-based disparities. More than 15% of people with an income under £10,000 rely completely on cash, in contrast with only 2.5% of those in the highest income bracket.”
“In the RSA’s excellent report published earlier this year, “Cashing Out: The hidden costs and consequences of moving to a cashless society”, the situation is described as a “disorderly dash from cash” with “a misalignment of incentives between individual banking institutions seeking to shed their costly physical infrastructure…and the needs of…thousands of communities that remain reliant” on what, for them, are essential financial services. The report finds that substantial numbers of people rely wholly on cash and that access to bank branches is about not just the older generation but the younger generation, small and medium-sized enterprises and increasing numbers of self-employed people, who all have an important stake in the debate.”
“My hon. Friend makes an important point about the situation in his constituency, and that is why regulation is increasingly important. In future, the issue will be maintaining not just access to cash but free access to cash. There has been a renewed focus on the issue of the last bank standing in a community. As Sian Williams of Toynbee Hall pointed out, however, when we get to that point, it is often too late. There is an urgent need to join up, particularly in areas that are more likely to be left behind. Financial institutions have not tended to talk to one another, so towns and communities have been left with piecemeal and inaccessible financial services. The change has not been orderly.”
“My hon. Friend makes an important point. I agree that this whole debate also needs to be part of a strategy for towns, which are often left out of how progress is made, how policy is implemented and who is the first to benefit when new resources are rolled out. The provision of financial services and ATMs is absolutely vital for ensuring economic progress and the viability of businesses.”
“My hon. Friend’s extremely important point is one I was about to go on to. We have seen this debate previously in relation to post offices, and have then seen post offices become an important part of the strategy for maintaining access to cash—Mastercard and others are also working with them. Research from the Post Office shows that about 44% of small businesses believe that the convenience of cash is essential to their business, and also that they use post offices. Yet, alongside this debate, we see these warnings, and alongside the challenges that the post office network faces, deprived and rural communities will have even poorer access to cash.”
“Mobile technology, which some of our financial services have already begun to use, has been vital in supporting women, particularly in rural areas—to set up their own businesses and manage their household finances. I thank organisations such as City Pay it Forward that make an important contribution to increasing financial education in our schools; as I mentioned before, I consider that to be extremely important. Our new local charity, Hounslow’s Promise, is working to make sure that we have financial understanding and financial literacy, which are vital to ensuring that people can take advantage of new services that are on offer.”
“We also need considerable programmes for digital inclusion, and incentives to diversify services within the industry. We need to make sure that those services continue to reach the people who need them and that cash continues to be accepted. I also hope that we can have a discussion about how this issue forms part of wider economic strategies, including industrial strategy. Labour has talked about regional banks providing an opportunity to ensure financial inclusion; there are examples from abroad that we can learn from, including the Sparkassen, and the Mann Deshi bank in India—I have been looking at whether we can do some reverse learning from that bank in my constituency.”
“Given the importance of this work, Parliament and Government must act to promote the role of local government in making sure that we preserve access to cash and financial services. To conclude, joining up how we move forward together is increasingly important, because of the complex map of the stakeholders involved. We are not going to get multiple chances at this; change is going to take time, and it has to be done right. It has to be done with the right research, the right underpinning and the right policy frameworks, with confidence, and with the message that if all those involved in financial services who have a stake and a role, including banks and those involved in cash infrastructure, do not play their part effectively, there will be regulation and legislation.”
“Those changes have come through welfare reforms, but also from the housing crisis that we face—a number of people are in temporary accommodation, and may have been waiting for a long time—and are affecting people’s access to services in many ways, as well as their resilience. I am pleased that there are more innovations in communication and that better research into segmentation is under way, including understanding the financial capabilities of council tenants. A higher than expected number of those tenants do not have bank accounts into which payments can be made, whether welfare or other payments. That is why it is important that we all, including local authorities, revisit the idea of closer working with credit unions.”
“The Swedish legislature was recently forced to create a cross-party commission on access to cash, due to a public outcry after hospitals announced that they would no longer accept cash payments. Swedish bodies and representatives repeatedly told the Access to Cash Review that we needed to act now, as it is much harder to re-establish cash infrastructure than to preserve it. Local authorities are an important part of this jigsaw and of our response. My local council in Hounslow, led by Steve Curran and Lily Bath, is taking steps towards financial inclusion, which is vital as local authorities are at the forefront of helping local citizens deal with a lot of changes.”
“I would also be grateful if he told us what progress he expects to be made by the autumn, when I understand the Access to Cash Review panel plans to meet and review its progress; which consumer bodies will be involved in the development of the strategy, particularly co-operative institutions; and how the group will respond to the individual recommendations made by the Access to Cash Review panel. We face unique challenges in the modern world, and we need to make sure that both Parliament and the Government are responding to those challenges. Access to cash is not a problem that is unique to the United Kingdom, and neither is the need for robust legislation—as and when necessary—and regulation to ensure it.”
“The Treasury Committee took evidence and produced an important report on consumers’ access to financial services, which was published last week. The Treasury announced that it was commencing a new joint authorities cash-strategy group, involving the Treasury itself, the Payment Systems Regulator, the Financial Conduct Authority and the Bank of England. There will indeed be much work for the new body to do. I would be grateful if in his response the Minister updated Members on strategy formulation, and how the work of the group will operate alongside the work being done by the Bank of England. There needs to be more joined-up working, rather than silos, overlap and duplication.”
“Fourthly, early changes should be introduced in the new legislative programme, to take the opportunity to build on the pre-election Treasury consultation on credit unions and dismantle obstacles that prevent the transformation of the UK credit union movement into a player with the significance of its international peers. Elsewhere, although there are market differences, credit unions are significant players: in Ireland 73% of the population are members of credit unions and in North America the figure is 43%. I am pleased that, following the publication of the Access to Cash Review report, there were moves to respond to it very quickly. The Bank of England announced that it would convene relevant stakeholders to design a new system for distributing cash on the basis of the concerns that had been identified.”
“I hope he can discuss how, in his role, he will continue to join up that work across Government and where we might see faster progress. The second suggestion is that all workers be given the right to save in a credit union directly from their pay. Some 39% of the population have no savings, and to counter that we believe that all employees should be given the right to save directly in a credit union, by payroll deduction and at no cost to them. Thirdly, all schoolchildren ought to be given the right to join a credit union school savings club. Good savings habits for life should be encouraged at an early age. All policies in this area should reference credit unions as able to take such deposits, in the same way as banks and building societies can.”
“I want to make a few suggestions about how we can support the expansion of the UK credit union sector. A response from the Minister today on that would be helpful, and perhaps we can continue the discussion after this debate, which is only an hour and a half long. The first suggestion is to appoint a Minister for credit unions [ Interruption . ] Yes, but I hope that the Minister has a cross-cutting responsibility and is committed to placing credit unions at the centre of retail financial services to ensure more competition and choice in banking. The Minister will know that the Treasury is responsible for credit union legislation and that other Departments also have an important stake, especially the Department for Work and Pensions and the Cabinet Office.”
“Within that, there are important roles for national and local government, banks, regulators, FinTech, building societies, payment systems operators and others. I also want to mention credit unions and their role, and I hope that the Minister will be able to respond to this important issue, as we plan for the next decade and beyond. There are 1.9 million members saving £2.4 billion in the UK’s 500 credit unions. Credit unions are financial co-operatives and are therefore member-owned and democratically run. They have huge potential to play much more of a role, but that will need support and Government leadership. The Treasury Committee recently raised concerns about credit unions either going bust or having to consolidate to survive, and there is an urgent need to consider how we better support them.”
“The hon. Gentleman makes an important point. Indeed, he has made similar important contributions in his work on the Treasury Committee. He talks about the acceptance of cash needing to be part of the debate, and I know that other hon. Members will be speaking on that issue later. It is an important part of the jigsaw. I want to make a few points about our policy response and about how we need to move forward. The report from the Access to Cash Review made five broad and important recommendations: to guarantee access to cash, to ensure that cash continues to be widely accepted, to create a more resilient wholesale cash infrastructure, to make digital payments an option for everyone and to ensure joined-up regulation of cash.”
“Government action is welcome, but it cannot be on a slow burn—for example, the no-interest loan scheme pilot, which was announced last year, has not yet progressed. We need to continue working together on this issue, and I look forward to doing so. Question put and agreed to. Resolved, That this House has considered financial exclusion and the future of access to cash.”
“We also need to ensure that it continues to be affordable to accept cash, requiring joined-up action to reduce the cost, reform our cash infrastructure and ensure efficiency and resilience. Where needed, we must also incentivise joint industry working in the design of consumer services and products that are based on need. If that requires further supply-side reforms to enable hubs and provide more opportunities to work together, we need to grasp that challenge—both in terms of policy and of shifting our culture. I recognise some of the interesting ideas coming from Mastercard and Visa—including jam-jarring to help with savings, and support for credit union infrastructure—but there needs to be so much more. I thank Natalie Ceeney and her panel for their work on the Access to Cash Review.”
“I thank the Minister and the shadow Minister for their remarks. I also thank the Minister for recognising that this is a confusing time, that the rate of change is faster than we had predicted, and that cash is required. He made a very important point on cash being a back-up if a system of technology fails. I thank all hon. Members who have taken part in the debate, including the hon. Member for Hitchin and Harpenden (Bim Afolami), who helped me pitch this subject to the Backbench Business Committee. We absolutely cannot sleepwalk into a cashless society. Equally, we cannot turn the clock back on progress. However, the market is failing and we need to intervene.”
“Will the Minister commit to ensuring that survivors of domestic abuse with insecure immigration status have safe and confidential reporting systems, without fear of being returned to their country of origin?”