Westminster Hall

Tuesday 30th October 2018 Westminster Hall

Tuesday 30 October 2018

[Mr Peter Bone in the Chair]

Ovarian Cancer: Diagnosis and Treatment

Tuesday 30th October 2018 Westminster Hall

09:29

[Lee Rowley (North East Derbyshire) (Con)]

I beg to move,

That this House has considered ovarian cancer diagnosis and treatment.

It is a pleasure to serve under your chairmanship, Mr Bone. I thank the Backbench Business Committee for allowing the debate, as well as everyone who is here to support this important and timely event—both my colleagues in the Chamber, and everyone in the Public Gallery. The issue is extremely important, and I am privileged to open the debate. This will be the first time since 2014 that ovarian cancer has been debated in either Chamber.

Ovarian cancer is a quiet, invasive cancer, that robs wives, daughters, sisters, mothers and grandmothers of years of their lives, often unexpectedly and quickly, with devastating impacts on their families. Today about 25,000 women are living with the cancer and every day 20 will be diagnosed with it. Despite some progress in recent years the disease still takes away the lives of 4,000 women a year, and hundreds of thousands around the world. Because of its devastating effects its survival rate is, tragically, not as high as everyone would like, and 46% of sufferers do not survive for five years or more.

[Nick Thomas-Symonds (Torfaen) (Lab)]

I warmly congratulate the hon. Gentleman on securing the debate. To improve survival rates, we need earlier diagnosis. For many years ovarian cancer was known as the silent killer, but there are a number of signs and symptoms. Will he join me in encouraging anyone with those signs and symptoms to see their GP urgently?

[Lee Rowley]

I absolutely will. That is a timely and important point. I was on Radio Sheffield only this morning talking about the debate with someone from Target Ovarian Cancer. We spent an awfully long time talking about the symptoms, because it is important that people understand them, and are aware of them, so they can get the treatment they need if they are, unfortunately, affected.

All cancers are important. Extremely sadly—sometimes tragically—ovarian cancer tends not to receive the bulk of the attention or funding. That is partly because it does not affect as many people as other cancers, but it is also because of survival rates. The 46% rate of survival beyond five years compares unfavourably with the rate for breast cancer, which is 87%, and prostate cancer, which is 85%. There are simply fewer survivors of ovarian cancer in the UK who could highlight the importance of fighting the disease and succeeding than there are survivors of other cancers. There is a need for people to speak up about ovarian cancer. Thanks to the work of those who are doing so, it has started to receive the attention that it needs. Charities such as Target Ovarian Cancer work tirelessly every day to raise the profile of the disease, support those who have been affected, improve diagnosis and treatment, and work for a cure. I pay tribute to the work of the all-party parliamentary group on ovarian cancer, and in particular the hon. Member for Washington and Sunderland West (Mrs Hodgson), who chairs it. It has been a privilege to be involved in the work and I am grateful to be able to help in a small way.

What is it about ovarian cancer that requires a particular focus? From the work I have seen, there are four things: improving awareness of the disease, as the hon. Member for Torfaen (Nick Thomas-Symonds) mentioned, so that it can be caught earlier; speeding up the diagnosis when it is suspected that someone has the disease; improving the data available for tracking the disease and our progress in the fight against it; and improving the treatment, allowing people to recover and be disease-free more quickly.

[Nick Boles (Grantham and Stamford) (Con)]

On the point about early diagnosis, my constituent and good friend Jane Sagar had a cyst of 6.5 cm, which a specialist identified. However, its removal was not recommended, although she was later told that any cyst greater than 5 cm on her ovary should automatically have been removed, because it was likely to be cancerous. As a result she is entering her fourth year of treatment for advanced ovarian cancer.

[Lee Rowley]

My hon. Friend makes an important point. Treatment around the country needs to be made more consistent and clearer, to put a stop to the issues that many of us have heard in stories from constituents.

[Theresa Villiers (Chipping Barnet) (Con)]

I apologise that I shall not be able to stay for the whole of this important debate. Does my hon. Friend agree that the additional resources that the Government are devoting to the NHS are welcome, and that it is important for it to use them wisely, which includes improving early diagnosis and treatment of cancer? Early diagnosis is crucial to successful outcomes and the raising of survival rates for ovarian and other cancers.

[Lee Rowley]

My right hon. Friend is right and I hope that the Minister will recognise that. It is a matter of getting a diagnosis, and encouraging people who feel that something may not be quite right to go to the doctor, so that the pathway starts. Then, if there is an issue—most of the time there is not—there can be progress, and people can get the treatment they need earlier.

The first step in improving outcomes on ovarian cancer is improving awareness among the general public, and among GPs and in doctors’ surgeries in general. As has been mentioned, the symptoms of ovarian cancer are often easy to mistake for something else. Too often it is easy to dismiss them as inconsequential or not worth further attention. Symptoms include bloating, a need to go to the toilet more frequently, pain in the tummy or always feeling full. Recognising that those symptoms are potentially problematic is a key to survival. Those diagnosed at the earliest stage, stage 1, are almost certain to be alive a year after the diagnosis; 98% of them will be. Only half of those diagnosed at stage 4 are alive a year later.

Awareness of the symptoms among the general public remains low. For example, only 20% of women can name bloating as a symptom, and only 3% can name feeling full and loss of appetite as an issue. A regional Be Clear on Cancer pilot on ovarian cancer symptoms in 2014 was promising. There was an increase in both spontaneous and prompted awareness of the issues. There were also promising findings from a further regional pilot last year, which focused on abdominal symptoms, including bloating. Initial findings showed that the campaign led to an increase in the number of GP referrals for suspected cancer. We ask that if the Government propose to run any future public health campaigns, they should include work to make people aware of those symptoms.

The second area where there is work to be done is diagnosis, not least because 45% of women reported that it took three months or longer from first presenting to their GP with concerns to recognition that they might have an issue. Diagnosis relies on two forms of assessment—an ultrasound and a blood test called CA125. In too many areas the assessments are done sequentially rather than simultaneously, which often means vital weeks are lost. We have urged the National Institute for Health and Care Excellence and the NHS to review that process and extend the coverage of multidisciplinary diagnostic centres. Those centres prove very useful for the sort of cancers that hide behind vague, less common symptoms, which it is important to get to the bottom of as quickly as possible.

The third area is data. There are many calls on the Government from many sources to ensure that the cancer dashboard demonstrates the progress already being made on a variety of cancers. I understand the challenge, but we also hope that in time the Government may look favourably on the idea of including ovarian cancer data in the dashboard. We hope that that would be relatively simple, as much of the data is already collected and published elsewhere. Good data is vital in driving forward and improving early diagnosis. Huge strides have been made in its collection, and making it available would help with the continuing work to drive up standards.

Finally, treatment also requires further attention. As with many health issues, ovarian cancer treatment is invasive and often difficult. It centres primarily on surgery and chemotherapy. There has been much progress in recent years on drugs to treat the cancer, with the development of a number of PARP inhibitors, providing new tools and opportunities to improve the outcome. However, spending and research on ovarian cancer remain lower than for other cancers, and there is much work to focus on. Where surgery is required there is a strong case for specialist centres around the country, supported by a detailed service specification from NHS England.

To further drive up the quality of treatment, charities such as Target Ovarian Cancer and Ovarian Cancer Action, together with the British Gynaecological Cancer Society, are funding an ovarian cancer feasibility audit. Over the next two years, it will map and analyse existing data on ovarian cancer, and look at the treatment provided and the outcomes for women.

[Liz Twist (Blaydon) (Lab)]

Will the hon. Gentleman join me in congratulating Target Ovarian Cancer and other cancer charities on highlighting this issue and putting forward some very sensible recommendations for improving treatment? Does he agree that it is shocking that our survival rates in the UK are among the lowest in Europe?

[Lee Rowley]

I absolutely do. All these things are a work in progress, but I hope that through debates such as this, through talking about it and through all the fantastic work the charities and the APPG do we can move things forward, make progress and, in time, have fewer women suffering from this and more women getting treatment more quickly than today.

The question of ovarian cancer is, however, more than a technical discussion about diagnosis, awareness, data and treatment, as important as those are. Behind each statistic is a real person who has been unexpectedly struck down by the disease and, in far too many cases, might not be around today to tell the story of their fight. As part of the preparation for this debate, the parliamentary digital team and Target Ovarian Cancer asked people to share stories of their fight and those of their family members.

I am hugely grateful to both organisations for helping with that, and to everyone who got in touch. The stories we received were heartbreaking and heartwarming in equal measure, tragic and terrific, and whatever the outcome, they were inspiring to us all. I cannot possibly do justice to everybody who got in touch or to all the stories and experiences out there, but I will share a few today to remind us of the importance of making progress on this disease.

Danielle got in touch to tell us about her mum, who was diagnosed with stage 3 ovarian cancer in September of last year. Like many other people’s, her symptoms were fuzzy: irritable bowel syndrome, feeling full, swelling and weight loss, which could have been a hundred other things. By chance, the doctor who saw Danielle’s mum also sent her for a blood test, which quickly confirmed that there was an issue. A month or so later, Danielle’s mum started chemotherapy, and in January this year she had a full hysterectomy. After a 10-hour operation, it was hoped that everything had been caught and the focus was on recovery. By June, however, the cancer had returned; sadly, a few months later, in August, Danielle’s mum lost her battle, just 10 months after diagnosis.

Forty-year-old Sarah also had symptoms such as weight loss, feeling full and ovary pain. Before the cancer was diagnosed, she tried many times to find out what the issue was, including once being told, “Well done,” for having lost weight. In Sarah’s case the blood test that often highlights an issue came back normal, which emphasises the imperfect nature of the diagnosis. A nine-hour operation and six rounds of chemotherapy later, Sarah continues to battle her cancer while looking after her two young children.

We also heard the story of the daughter of Jean, who was diagnosed in 2011 with stage 4 ovarian cancer as a result of severe bloating and loss of appetite. After major surgery and four rounds of chemotherapy, the news came through that the cancer had spread. Her battle ended early in 2013.

Emma told us about her mum, who was told she was suffering from irritable bowel syndrome; the actual issue was found too late and she lost her battle, aged 64, just six weeks after diagnosis.

Seren started feeling unwell while at university, aged just 19. Unable to get a doctor’s appointment, she came back home and was diagnosed with cancer. Her tumour was the size of a rugby ball and her operation was pushed forward as it was stopping her eating and affecting her breathing. Chemotherapy followed and today Seren is recovered and working for a cancer charity.

Christine is also one of the good news stories. She was diagnosed with stage 2 ovarian cancer aged 35, having had to visit three different GPs to resolve the problems she was suffering from, which had initially been put down to colitis and anxiety. After her diagnosis, an emergency operation and 10 chemotherapy sessions followed. That was in 1985 and Christine is still here; she has been able to share her story in the last few days.

Finally, Linda was diagnosed with ovarian cancer in September 2017, having initially felt unwell at the beginning of summer while she was on holiday. The classic symptoms were there: bloating, feeling full and knowing that something “wasn’t right”. Multiple trips to the GP followed until, finally, a blood test was taken, confirming the cancer. Linda had a full hysterectomy that same month and spent much of the next few months recovering.

I know that many hon. Members may be wondering the obvious: why am I standing here making the case about a disease that cannot and will not ever affect my body? As with so many others, although it may not have touched me personally, it has touched my family. Linda is my mum. Up until last year, she had had relatively good health and there is no history of ovarian cancer in my family. I generally try to keep my family out of politics—I was the fool who ran for Parliament, not them—but last year was a nightmare that none of us wants to experience again, and we have no wish to see anyone else experience the same. My dad, my brother and I watched my mum live through an extremely scary diagnosis, hugely invasive treatment and one of the hidden aspects of all cancers, the brush with mortality that takes time for sufferers to get to grips with.

Happily for me and my family, my mum is one of the lucky ones. She is sitting at home in north Derbyshire right now, possibly watching this debate on the internet. She has had a hard year and we are extremely proud of her. Yet I know that for every family like mine who have had good news, there are more people who face a tragic outcome. My mum and Danielle’s mum were diagnosed about the same time and I know that my mum’s journey, like that of Danielle’s mum, could have been so different. I do not want anyone else to face what those of us who know and understand what this disease forces on sufferers have faced. Better treatment, diagnosis and a cure cannot wait. I am grateful for the opportunity to discuss these hugely important issues; I look forward to the debate and the Government’s response. Together, I hope we can beat ovarian cancer.

09:46

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for North East Derbyshire (Lee Rowley) on securing this debate. He is right that ovarian cancer does not affect us men, but it affects people we know, and that is why we are here. I thank him for his introduction and for the extensive work he has done on the issue in his role as vice chair of the all-party parliamentary group on ovarian cancer. I was particularly impressed by the group’s report, “Diagnosing ovarian cancer sooner: what more can be done?”. If hon. Members have not had a chance to read it, I suggest that they do so, because it is very helpful. It was published earlier this year and contains a number of key recommendations and findings, which I will pick up on today.

Every single year, more than 7,000 women across the United Kingdom receive the devastating news that they have ovarian cancer. The hon. Gentleman, in his examples at the end of his speech, referred to those who have survived and those who have not; it is important to realise that sometimes people do survive it. Unfortunately, in my time as an elected representative, most of the people I have known who have had it have caught it at a late stage and have not lived as long as perhaps they could have. UK survival rates are among the lowest in Europe and less than half of all women diagnosed with ovarian cancer survive five years or longer.

The fact that we are at the lower end of that league table is an indication that perhaps we need to do more. I look to the Minister, as we always do, for a positive response. We also know that the earlier a person is diagnosed, the better chance they have of beating the disease. More than a quarter of women with ovarian cancer are diagnosed through an emergency presentation, for example via accident and emergency. The hon. Gentleman referred to those who thought they had irritable bowel syndrome, had a bad stomach or were bloated, or whatever it might be, and suddenly found it was something much greater. Over 80% of women diagnosed following a GP referral will survive for a year or more. I think if an early diagnosis can be made, the figures speak for themselves. We must do more to raise awareness about the disease, something I will come on to later.

Before I continue, I would like to share a bit of welcome news for ovarian cancer patients in Northern Ireland. As colleagues may be aware, drugs approved by the National Institute for Health and Care Excellence for use through the cancer drugs fund in England are now being considered in line with the country’s existing endorsement of NICE recommendations and will be equally accessible in Northern Ireland. That has just been announced recently. In cases where a drug is yet to be fully approved by NICE, it can be made available for use under the CDF. I will mention one lady who is no longer with us, Una Crudden, who I got to know when she met us here, as someone who had had ovarian cancer. I think it was six years after her diagnosis. She was a remarkable lady and her story was a very real one: I remember it probably every day of my life.

CDF-approved drugs were previously unavailable in Northern Ireland, meaning that patients had to wait for their full approval by NICE, which can take up to two years. This change in Northern Ireland will help more people to survive, and for longer.

[David Simpson (Upper Bann) (DUP)]

Whenever ladies go through this treatment, their aftercare and companionship with other people is important. Will my hon. Friend join me in congratulating a lady in my constituency, Mrs Maureen Clarke, who set up the Angels of Hope charity some years ago? It has been a tremendous help, psychologically and in every other way, for people who suffer from ovarian cancer.

[Jim Shannon]

I wholeheartedly support the tremendous work of the great many people in charities and elsewhere. Una Crudden was one of those who inspired everyone around her. We think of her often.

Without CDF approval, cancer patients in Northern Ireland have been unable to access life-extending drugs that have been approved for use in England, Wales and Scotland, such as niraparib. It is a PARP inhibitor, meaning that it blocks the action of the enzymes PARP1 and PARP2, which help to repair any damaged DNA in cancer cells while they divide to make new cells. Niraparib blocks PARP enzymes, which is incredibly important, and it is good news that we will have direct access to it in Northern Ireland. When researchers trialled niraparib on women with ovarian cancer, they discovered that the women lived for longer without the disease worsening and could go significantly increased times between treatments, meaning that they had more time between chemotherapy sessions.

Almost 200 women in Northern Ireland are diagnosed with ovarian cancer every year, and more than 50% lose their battle with it. It is particularly frustrating and upsetting for patients, and their families, who did not have access to the same potentially life-changing drugs as their English, Scottish and Welsh counterparts. However, that has changed in the last month; patients in Northern Ireland are finally set to have the same access to drugs as those in the rest of the United Kingdom. According to reports, the implementation of this policy will take place at some point in this financial year. We look forward to that. I am sure that colleagues will join me and my hon. Friend the Member for Upper Bann (David Simpson) in welcoming this fantastic news.

Access to drugs is one thing, but it is reactionary, rather than preventive. Evidence, including in the APPG’s report, suggest that much more needs to be done to raise awareness about ovarian cancer, which could affect the number of people diagnosed with the disease. Early diagnoses give longer life and prevent death. Although not limited to these, the four main symptoms are abdominal pain, bloating, feeling full quickly and needing to pass water. Most concerning is that only 20% of women could correctly identify those as being symptomatic of ovarian cancer, which goes back to a point made by the hon. Member for North East Derbyshire.

Ovarian cancer has low survival rates and, sometimes, delays in diagnosis, so we need a reinvigorated effort to ensure that the general public know what to look out for and when to see a doctor. The Be Clear on Cancer campaign was introduced in 2011, and I take this opportunity to put on the record my thanks to Public Health England for launching it. It is an excellent campaign that has undoubtedly played a vital role in improving cancer awareness more generally among the general population, which is part of the strategy’s focus.

National campaigns have been successfully run for bowel, lung, breast, bladder and kidney cancers, but only regional and local pilot campaigns have been launched for ovarian cancer. Does the Minister intend to launch a pilot campaign for ovarian cancer? A regional campaign launched in 2014 included the use of television, radio, online and face-to-face events and led to a significant improvement in women’s awareness of the symptoms of ovarian cancer and a greater inclination to visit their GP to discuss any concerns that they might have.

Raising awareness—especially about potential symptoms —is obviously important and can only be a good thing, so I will be grateful if the Minister indicates what discussions he has had with Public Health England about the possibility of running a national campaign for ovarian cancer that covers the four nations. We could work together to raise awareness at every level. I always think it is better to do things together. As you know, Mr Bone, we are better together in everything that we do, and I would like that to continue to be the case, especially for this.

Another way to improve awareness about ovarian cancer would be the introduction of a national screening programme. Screening programmes exist for breast and cervical cancer, but there is no equivalent for ovarian cancer. I understand that the UK collaborative trial of ovarian cancer screening looked at the possibility of an ovarian cancer screening programme, with a blood test to identify changes in the levels of the CA 125 protein, which is a tell-tale sign. If levels had risen, the patient would be sent for an ultrasound, so a system would be in place to offer early diagnosis, and it would be preventive as well. It is estimated that, if a national screening programme were rolled out, 12.5 million women over the age of 50 would be eligible to attend, with around 2% required to have a further ultrasound. Such a programme could take preventive help to the next stage.

I understand that, when women are contacted about making an appointment for a cervical or breast cancer screening, they are provided with informative leaflets that detail possible symptoms. Of course, although the screenings are vital, it is entirely up to the patient if they follow up and make an appointment. However, just having access to the leaflets is helpful in raising awareness. Does the Minister intend to produce a leaflet to raise awareness of ovarian cancer? Recognition of the symptoms of ovarian cancer remains low, so it would be helpful if women were provided with a similar leaflet that might help to improve awareness of this specific disease.

I understand that the cost of national screening programmes is high, but that needs to be measured against the long-term benefits. If people can be screened and ovarian cancer caught early, people have a greater chance of survival, and their long-term reliance on the NHS could well be reduced. That is ultimately cost-effective, because it reduces the amount of care that they later need.

I understand that one concern with rolling out a screening programme of that nature is the lack of sonographers, who are of course required to provide ultrasounds. Are the staff with those skills in place? I am interested to hear what consideration has been given to the use of artificial intelligence to fill the gap of highly skilled diagnosticians. Would it be possible to provide some sort of incentive for those considering postgraduate UK ultrasound qualifications? We often say this, and I know that the Minister is responsive to it, but if we set out the graduate positions that will be available in the future and encourage graduates to study towards those jobs, that will be helpful.

Prevention is vital. Approximately 15% of women with ovarian cancer develop it as a result of a mutation in the BRCA1 or BRCA2 gene. Identifying women with ovarian cancer with a BRCA mutation not only helps in designing their treatment plans; it enables family members to be tested. We sometimes look at the individual, which is important, but we should also look at the family circle—sisters and daughters and so on—and test them as well, which would allow them to make decisions about reducing their risk of developing ovarian cancer.

“Achieving world-class cancer outcomes: a strategy for England 2015-2020” calls for all women with ovarian cancer to be offered access to genetic testing at the point of diagnosis. That follows 2013 NICE guidelines that require all women with a 10% or higher risk of carrying a BRCA mutation to be offered genetic testing. However, in reality, testing varies between regions and between hospitals, because the guidelines are often interpreted differently. This clearly needs to be addressed, as the same testing should be available for all, without variation depending on postcode or because of the funding—or lack thereof—available in different genetic testing centres across the country. Obviously if eligible family members were tested to identify potential mutations, they might be able to take steps, including surgery, to ensure that ovarian cancer cannot occur.

Concerns have been raised about what genetic testing could mean for individuals with private health or life insurance. Members may not have thought of this, and the hon. Member for North East Derbyshire did not mention it, but he and others will be aware of it. For example, does a person with private health or life insurance need to declare if a genetic test has been carried out, and its results? I am interested to hear from the Minister what work the Department is doing alongside the insurance industry to address any disparity for cancer patients and their families who undergo genetic testing, which may have an impact on their private health or life insurance.

We can all agree that, while improvements have been made in the last couple of decades, survival rates for ovarian cancer continue to lag behind other cancers. We need to do more to raise awareness of ovarian cancer, to ensure that women know what to look out for and when to see their doctor—particularly those in higher risk categories, either because of family history or because of their age.

I am very pleased about the recent news for cancer patients in Northern Ireland: as is the case with genetic testing, it is unfair for patients to access different treatments, tests or drugs simply because of their postcode. I hope that the Minister will work with Public Health England and NICE to consider national campaigns, which take in all the regions, and screening programmes for ovarian cancer, as well as to ensure that guidelines are implemented and funding made available for testing.

I again thank the hon. Member for North East Derbyshire for the opportunity to speak on this subject. It is close to my heart; indeed, that can be said of all of us who are here and many who are not here because they are doing other things. Ovarian cancer is one of those diseases on which we need to give hope and support to the people affected. We all know people who are affected and we are here today to speak on their behalf.

10:00

[John Lamont (Berwickshire, Roxburgh and Selkirk) (Con)]

I, too, congratulate my hon. Friend the Member for North East Derbyshire (Lee Rowley) on securing this important debate and on speaking so compassionately and movingly about his constituents and, indeed, his family.

Like other hon. Members present, I am sure, I was inundated with emails and correspondence from constituents urging me to take part in the debate, so I want to make a few remarks on their behalf. Of course, those emails come from the lucky ones—the women who, like Amanda Gilham from Makerstoun in my constituency, benefited from timely diagnosis and treatment. Amanda was totally unaware that she had ovarian cancer and was diagnosed only because she was fortunate enough to be given a blood test, as her GP suspected that something else entirely was wrong.

When talking about statistics, it is important to remember that the numbers on spreadsheets represent people—our constituents—and, in the case of ovarian cancer, grandmothers, mothers and sometimes daughters. Clearly, early diagnosis and treatment are crucial to tackling ovarian cancer, as they are to tackling all types of cancer. If ovarian cancer is found early, the five-year survival rate is 90%, compared with 4% if it is found late. Although survival rates have doubled in the past 40 years, survival rates in the United Kingdom are lower than the European average, and still not enough people are diagnosed early.

The NHS in Scotland is of course entirely devolved and therefore the responsibility of the Scottish National party Government. I want to spend a little time talking about the situation in Scotland and the circumstances that my constituents have to experience. Patients in Scotland are being let down. Much more needs to be done to improve diagnosis and treatment. This summer, for example, the Scottish Medicines Consortium approved the use of niraparib, but only for women without a gene mutation that affects about one fifth of women living with ovarian cancer. That restriction does not apply in England, meaning that women with a BRCA gene mutation in England and Wales have more treatment options than their counterparts north of the border, in Scotland. A postcode lottery for accessing life-enhancing drugs is unacceptable. I agree with Ovarian Cancer Action that women in Scotland deserve better.

Women in Scotland also deserve better in terms of the time that it takes to receive a diagnosis and treatment. Scotland’s cancer treatment waiting times are at their worst in six years. Only 87% of patients with ovarian cancer started treatment within 62 days of referral. In response, the Scottish Government have admitted that that is “simply not good enough”. Just last week, the Scottish Government announced that they were not planning on meeting their own diagnosis target until at least 2021. That was spun as a new “three-year plan” to meet waiting time targets—something that was supposed to be good news. Given that the SNP has been in charge of the NHS in Scotland for the past 10 years, the Scottish Government’s record, particularly on cancer treatment, deserves further scrutiny. I hope that some of the extra £2 billion a year that the Scottish Government will be receiving to spend on the NHS, thanks to yesterday’s Budget, can be put to good use to reduce those waiting times.

Ovarian cancer is not the most common type of cancer in the United Kingdom and is not easily diagnosed at the moment, but the impact of early diagnosis is significant. I again congratulate my hon. Friend the Member for North East Derbyshire on securing this important debate. I support the efforts across the United Kingdom to improve diagnosis and treatment of this terrible disease.

10:04

[Angela Crawley (Lanark and Hamilton East) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Bone. I congratulate the hon. Member for North East Derbyshire (Lee Rowley) on securing the debate and on bravely speaking of his own experience and that of his mum, Linda. I am sorry to hear about the experience that his family have had in the past year and I wish Linda well.

I thank hon. Members on both sides of the Chamber for highlighting the issues faced by their constituents. They have talked about both the successes of the health service and the lessons that need to be learned for the future. Healthcare in Scotland is of course devolved to the Scottish Government, so I can only speak to that experience, but ovarian cancer is one of the most common types of cancer in women. It typically affects those who have been through the menopause, and more than 7,000 diagnoses are made each year across the UK. In Scotland, 350 women die of the disease each year. However, the survival rate for ovarian cancer is high compared with that for other types of cancer and, like other cancer survival rates, it increases with early detection.

One key issue with this disease is that awareness of the symptoms is still low among both GPs and the general population. As we have heard from both sides of the Chamber, more needs to be done to raise awareness of the early signs and to secure an early diagnosis. Most women with ovarian cancer are diagnosed when the disease has, unfortunately, reached an advanced stage.

In many regards, Scotland still leads the way on UK ovarian cancer diagnosis, but there is no denying that there is always more to do in this area. Scotland has improved its diagnostic pathway and the access to much-needed treatments. The SNP Government developed the Detect Cancer Early programme to improve survival rates through diagnosis and treatment at an earlier stage. Scotland has been able to tackle cancer through world-class scientific research. The Scottish Molecular Genetics Consortium uses DNA to detect a range of genetic disorders, including cancer. The Scottish Genomes Partnership is pioneering Scottish research in human genome discovery in four key research areas, of which cancer is one. That partnership involves the Universities of Edinburgh, Glasgow, Aberdeen and Dundee. However, although that research is saving lives, its funding is being slashed. The proportion of EU funds allocated to universities in the UK has already dropped and will continue to fall because of Brexit and the uncertainty about the future. Programmes such as those will collapse unless a post-Brexit Government are prepared to plug the funding gap.

In Scotland, the SNP wants to improve cancer care and treatment, which is one reason the Scottish Government are investing £100 million in their new cancer strategy. In addition to the SNP Government’s work on prevention and early detection, the strategy includes enhanced radiotherapy services through new technology, and recruitment drives to reduce waiting times and improve patient outcomes. The Scottish Government have outlined actions for end-of-life care needs through the “Strategic Framework for Action on Palliative and End of Life Care”, which encourages a culture of openness and dignity around dying and death.

In June, I was contacted by a constituent from Hamilton, Mr Gerard Murphy, who sadly lost his wife, Elizabeth, last year after a battle against late-diagnosed ovarian cancer. Mr Murphy expressed a lot of the sentiments articulated during this debate, calling for publicly funded awareness campaigns so that women and GPs know the symptoms to look out for, faster diagnosis so that women can start treatment earlier and have a greater chance of survival, and treatment in specialist centres such as the Beatson West of Scotland cancer centre, where Elizabeth was treated, in his words, “wonderfully well”. I am sure that Mr Murphy would welcome any advances for other families experiencing this disease.

We have heard calls from both sides of the Chamber for greater knowledge and awareness of the signs and greater investment in early diagnosis. This is something that we would like to tackle across the House. I hope that the Minister will pay heed to the comments that have been made.

10:09

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bone. I thank the hon. Member for North East Derbyshire (Lee Rowley) for securing this very important debate and for his vice- chairmanship of the all-party parliamentary group on ovarian cancer, which I am extremely proud to chair. We work very well together. Indeed, earlier this year he and I shared the chairing responsibilities for two oral evidence sessions as part of the preparation for publication of our report entitled “Diagnosing ovarian cancer sooner: what more can be done?” to mark World Ovarian Cancer Day 2018. I thank him for that also.

The hon. Gentleman made an excellent and extremely moving opening speech. He shared many examples of women’s lived experiences of this awful disease, including his own experience with his mum Linda. I have no doubt she will be proudly watching him lead this debate. We are all MPs—that’s for sure—but we are also real people with lived experiences and families. Sharing those personal experiences can improve the debate, as it has done today. I thank the hon. Members for Strangford (Jim Shannon), for Berwickshire, Roxburgh and Selkirk (John Lamont) and for Lanark and Hamilton East (Angela Crawley) for their contributions to this important debate. We have also had some excellent interventions.

Many of the key statistics around this awful disease have been covered so far in this excellent debate, but if something is worth saying once, it is worth saying twice. Over 7,000 women are diagnosed with ovarian cancer every year in the UK, but sadly survival rates are among the lowest in Europe. Less than half of women diagnosed with ovarian cancer survive five years or more. Tragically, 4,000 women in the UK die each year because of this awful disease. Although progress has been made in diagnosing and treating ovarian cancer, there is still much more to be done and I want to highlight some ways the Government can do that.

I was extremely grateful to the Minister for meeting with me recently to discuss the key recommendations from the APPG’s report, which I just mentioned, and I will raise some of them now. Diagnosis is one of the key ways that women with ovarian cancer are often let down. Many women report experiencing delays in diagnosis. An astonishingly high proportion, 45%, say that it took three months or even longer to receive a diagnosis after first approaching their GP with symptoms. As we have heard, symptom awareness is one of the key things we must address. This is most concerning because we know the significant impact early diagnosis can have on chances of survival. Nine in 10 women who receive an early diagnosis of ovarian cancer can survive for five years or more, compared with less than five in 100 women who are diagnosed at a very late stage.

I want to share a story, as a few hon. Members have. My constituent Gail wrote to me ahead of this debate telling me the experience of her younger sister, who has stage 3 ovarian cancer that has spread to her stomach lining. Although she is currently responding to treatment, it took a long time to get the diagnosis in the first place. At one point, she was being incorrectly treated for rheumatoid arthritis. That changed only when she developed blood clots in her legs, which led the hospital to look for cancer. We can only imagine the added distress that this kind of delay can cause in an already extremely difficult experience.

As a result of her sister’s diagnosis, Gail underwent genetic testing and discovered that she had the BRCA2 gene, which, as we know, gives her a high predisposition to ovarian and breast cancer. My constituent underwent elective surgery at the start of the year to remove her ovaries and fallopian tubes, and is awaiting the next step with regard to the breast cancer risk. This case shows how important it is that patients are diagnosed as soon as possible, not only for themselves, but for their family members who may have to undergo further testing.

On early diagnosis, will the Minister support a review of the referral pathway for ovarian cancer, particularly in relation to the introduction of the shortened pathway that we have seen in Scotland, so that, as the hon. Member for North East Derbyshire also requested, the CA125 blood tests and ultrasound tests can be done at the same time, rather than sequentially, as they are now? What steps has the Department taken to ensure that NICE guidelines, which say that women should be offered BRCA testing at diagnosis, are adhered to? Ovarian Cancer Action found that 30% of women are not being offered this testing. I know that the new multidisciplinary diagnostic centres will also help with early diagnosis, but they are in the pilot stage and limited to 10 sites. Will the Minister confirm whether there are plans for more centres, so that everyone can have access to those services regardless of where they live?

As we know, the four key symptoms of ovarian cancer are a bloated tummy, needing to urinate more often or urgently, experiencing tummy pain and always feeling full. Anyone newly experiencing those symptoms 12 times a month or more is advised to see their GP. However, awareness of these symptoms is worryingly low. According to Target Ovarian Cancer, just 20% of women can name bloating as a symptom and only 3% can name feeling full or loss of appetite. Awareness campaigns run by Public Health England have been shown to be highly effective. The one currently running focuses on blood in urine. Considering that we know how important it is that those with ovarian cancer are diagnosed quickly, it would be helpful to know whether Public Health England has any plans to run a Be Clear on Cancer campaign that focuses on either ovarian cancer or a cluster of symptoms for a range of cancers, including ovarian.

I recently attended Ovarian Cancer Action’s research grant award ceremony, where I heard about some of the incredible work being funded across the UK. The innovation and determination of some of the projects is truly astonishing. One project—it is hard to describe, but I will give it a go anyway—had a huge number of examples of DNA that needed going through on an individual basis and labelling. Due to the sheer quantity of data that needed sifting, those in charge of the programme invented a Tinder-style app—I know it sounds unusual—that enabled people to quickly categorise the different examples of DNA by swiping left or right. That information was then fed back into the research team’s data, to build up a comprehensive body of data.

Another project that received funding was that of Dr Jonathan Krell and Dr James Flanagan of the Ovarian Cancer Action Research Centre. They are investigating how changes to our genes can play a big part in the risk of developing cancer, including assessing how feasible it would be to implement a new genetic testing model that identifies and supports families at risk of ovarian cancer because of an inherited BRCA1 or BRCA2 gene mutation. With that in mind, does the Minister’s Department have any plans to increase Government funding into medical research for the early detection, diagnosis and prevention of ovarian cancer?

Finally, I want to cover the issue of surgery. As the Minister knows, surgery for ovarian cancer is widely considered one of the biggest factors in survival rates. Surgery for ovarian cancer is extremely difficult. Someone I know well who had the surgery once described it to me as being like trying to remove a bunch of grapes, and if any of the grapes was punctured or broke that would cause huge internal damage by spreading the cancer. Although there are a number of surgical centres of excellence across the UK, there are many women who do not have access to them and are being operated on by general surgeons—no generalist will ever be as good as a specialist. Through no fault of their own, those women will have a lower chance of survival than those who receive the specialist surgery. What assurances can the Minister give that steps are being taken to ensure that all women with ovarian cancer have access to a specialist surgeon and that the regional variation can be brought to an end?

Before I conclude I want to pay tribute to some of the incredible organisations and campaigners that I have had the pleasure of working with on this issue over the years. They work tirelessly not only to combat the disease, but to provide support and comfort to those who have it. They include Ovarian Cancer Action, the Eve Appeal and Target Ovarian Cancer, which also does much to support the work of the APPG on ovarian cancer in its role as the secretariat to the group. I look forward to hearing from the Minister about the ways in which the Government can support the work of those great charities and campaigners, and support the thousands of women across the country who sadly suffer from this disease.

10:20

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

It is a pleasure to see you in the Chair, Mr Bone. I, too, congratulate my hon. Friend the Member for North East Derbyshire (Lee Rowley) on securing the debate. As vice-chair of the all-party parliamentary group on ovarian cancer, the subject means a great deal to him. We also heard more about why it means a lot to him. I place on record my thanks to the all-party group and to the excellent ovarian charities. Target Ovarian Cancer is the biggest, but others work tirelessly in that space, such as Ovacome.

Watching my hon. Friend brought back memories of sitting in that exact chair as one of the vice-chairs of the all-party parliamentary group on ovarian cancer almost exactly seven years ago, in October 2011. I was talking about ovarian cancer, which has also had an impact on my family, although sadly not with the outcome that my hon. Friend currently has. I described it as a “silent national scandal”, which was then trending—quite something in 2011. I was also present for the 2014 debate that he remembers, which was the last time the subject was specifically debated in the House. It was a pleasure to hear him today; he reminded me of me—but I put on record the warning that this is where I have ended up.

I was pleased to meet with the hon. Member for Washington and Sunderland West (Mrs Hodgson) and Target Ovarian Cancer a couple of weeks ago to discuss the all-party group’s report, as the hon. Lady said. As she knows, I take the all-party groups very seriously. I have the report here—this is my coffee table copy in the Department of Health and Social Care, and anybody who knows my office knows that what is on the coffee table is what counts. It is an excellent report with many important recommendations and I will return to it a lot in my remarks. I have already committed to responding fully to it and the hon. Lady knows that I will do that.

I am responding to my third cancer debate in the House in less than two weeks, which demonstrates that improving cancer diagnosis and treatment is a priority for right hon. and hon. Members, as it is for me as the Minister with responsibility for cancer, the Government, the Prime Minister and the Opposition. In this job, I am fortunate to see first hand the superb work being done by our NHS staff and by our many partners and charities across the cancer community in implementing the 96 recommendations in the cancer strategy for England.

We are three years into that work and cancer survival rates have never been higher, as has been said. About 7,000 people are alive today who would not have been had mortality rates stayed the same as before Cancer Research UK and Harpal, who led the work, published the strategy. As I make clear every time I respond to a cancer debate, however, I know that we must do more and that people want us to do more, because we still lose 12,000 women a year to breast cancer and far too many women to ovarian cancer. We must do better. Despite the huge strides that I have mentioned, and the best-ever survival rates, ovarian cancer survival rates in the UK are among the lowest in Europe with fewer than half of all women diagnosed surviving five years or more, so there is much that we need to do.

[Mr Marcus Jones (Nuneaton) (Con)]

The Minister has mentioned the success rates in dealing with cases of ovarian cancer in our country compared with some of our European partners. Can he set out what we can learn from them in improving outcomes for women in this country?

[Steve Brine]

I will certainly cover that. Put bluntly, as I will come on to in a second, and as almost all hon. Members have mentioned, it is about early detection. That has an impact because, as the former chair of the all-party parliamentary group on cancer, my hon. Friend the Member for Basildon and Billericay (Mr Baron), has said many times, early diagnosis is cancer’s “magic key”. We have that magic key in some cancers in this country. We do very well in breast cancer, where the early-stage survival rates are well over the 75% target that the Prime Minister set out at the party conference earlier this month, but it is true that we do not yet have the magic key in enough cancers. I will come on to what we need to do.

I was pleased when the Prime Minister announced the ambitious package of measures for cancer care and treatment earlier this month, which will be at the heart of our long-term plan for the NHS. It will be backed up by the new funding that was announced in the summer and confirmed in yesterday’s Budget. We will overhaul screening programmes, provide new investment in state-of-the-art technology to boost our research and innovation capability and, critically, transform how we diagnose cancers earlier. As I have said, our ambition is to diagnose 75% of all cancers at an early stage, which will result in an estimated 55,000 more people surviving cancer for five years in England each year from 2028.

All hon. Members have mentioned early diagnosis, and many have mentioned some stats—or the same stats. The important one for me is that a quarter of women with ovarian cancer are diagnosed through an emergency presentation. When I first became an MP, I remember going to meetings with the all-party parliamentary group on ovarian cancer and the all-party parliamentary group on cancer, where I was shown the stats for my constituency of the number of people who presented in the emergency department with cancer. That really frightened and shocked me—it still does—and along with my personal history, it was one of the reasons I wanted to get involved in health and cancer when I joined the House.

Of that quarter of women with ovarian cancer who are diagnosed through an emergency presentation, just 45% survive for a year or more. That is no surprise—if someone is diagnosed in an emergency department, they have exhibited more outward symptoms, so they are at a later stage and their survival rate is lower. The survival rate is more than 80% when women are diagnosed following a GP referral, so it is crystal clear where improvements are urgently required. That is why early diagnosis is a key strategic priority in the cancer strategy. As has been said, it allows for more options for treatment and, crucially, the earlier a cancer is diagnosed, the more likely it is that doctors will be able to provide successful treatment or operate on the “bunch of grapes”—that is a good analogy, which I have heard before.

My hon. Friend the Member for North East Derbyshire talked about the multidisciplinary diagnostic centres. NHS England and the Department are testing new innovative ways of diagnosing cancer earlier. As regular attendees of cancer debates will know, I never tire of praising the accelerate, co-ordinate, evaluate—ACE—centres, which are the multidisciplinary diagnostic centres for patients with vague or non-specific symptoms. As the hon. Member for Washington and Sunderland West said, they are being piloted across 10 sites in the country. They offer patients a range of tests on the same day—a point that has been made by several hon. Members—with rapid access to results.

The centres are magnificent. I visited the ACE centre at the Churchill Hospital in Oxford earlier this year. I met the practitioners who work there, the commissioning group and the GPs who are involved in it. GPs are tremendously, and rightly, excited about the centres. They will make a huge step-change improvement in early diagnosis, particularly for cancers such as ovarian cancer, where symptoms can be vague and can appear less serious at first. The plan is for that innovation to address the delay that the hon. Member for Washington and Sunderland West and other hon. Members spoke about, so instead of a GP having to refer for one test and wait for the results, then refer for the next test and wait for an appointment, the ACE centres will allow for a snappy, quicker turnaround. They could be a game-changer and could unearth the magic key when it comes to ovarian cancer.

The APPG’s report says that we should roll out ACE centres nationwide, so I am delighted, as I know the hon. Member for Washington and Sunderland West is, that the Prime Minister recently committed to doing just that, as part of our long-term plan. I do not get excited easily, Mr Bone, as you well know, but I am excited about the ACE centres and they are potentially transformative.

I turn now to early diagnosis in primary care. Other support measures are necessary to ensure that more cancers are caught in primary care. The NICE guidelines for suspected cancer referral recommend safety netting for those people who are at higher risk of cancer but who do not meet the referral criteria. Both Cancer Research UK and Macmillan have produced additional advice and support for GPs to implement those guidelines, including the safety netting that I have just mentioned, over the last few years.

I was blown away to meet Macmillan GPs at Britain Against Cancer earlier this year. They are an excellent innovation and have an awful lot to give, but they are few in number. I am very interested in them and I talk to Macmillan about the potential use of Macmillan GPs in helping to transfer specialist knowledge of cancer to wider general practitioners. I always say of GPs that they are not dissimilar to MPs when we hold our surgeries, in that almost everyone who comes to our surgeries is more of an expert on the subject that they have come about than we are, because we are general practitioners. So GPs get a hard rap, but they are general practitioners and that is the area of the profession that they have chosen to go into.

We need to support GPs better through diagnosing cancer, from our targeted lung cancer screening in the lorries in car parks in the north-west—we trialled that approach in Manchester and it has been very successful—to the ACE centres that I have mentioned. That is all aimed at supporting the NHS, especially GPs, to identify cancer earlier.

The shadow Minister asked about the review of the referral pathway. As she knows, the implementation of the faster diagnosis standard requires trusts to review and speed up diagnosis pathways for suspected cancers. NHS England and NHS Improvement are working closely together to emphasise the key principles for improvement that we need in this area, which include ensuring that the most value is derived from each appointment. The standard is being measured for a year from April 2019 to April 2020, when it comes into place. That will ensure that patients are told that they have a cancer diagnosis or an all-clear within a maximum of 28 days of being urgently referred by their GP for suspected cancer. As I always say, 28 days is not a target; it is a maximum. When someone has a cancer worry, 28 minutes can seem like a lifetime, and such things always seem to come on a Friday night, when the weekend lies ahead. Twenty-eight days is our new target, but it is certainly not what we aim for; we aim to do better than that.

We heard from several Members—including the hon. Member for Strangford (Jim Shannon) and the shadow Minister—about Be Clear on Cancer. That campaign is one of the great successes of public policy in recent years. The APPG’s report also recommends, as the hon. Lady said, running a Be Clear on Cancer campaign to raise awareness of ovarian cancer symptoms. However, she is experienced and smart enough in this area to know that Be Clear on Cancer cannot focus specifically on a cancer type, such as breast cancer; it is about clusters. That is where we have found it to be most successful.

Public Health England, for which I have ministerial responsibility, takes a number of factors into account when deciding which campaigns to develop; of course, there is healthy competition in this space and unfortunately there is always more demand than supply. One of the main criteria in deciding which campaigns to run with is the scope to save lives through early diagnosis; that measure is what I will judge that work against.

Campaigns can be effective only if the cancer has a clear early sign or symptom that the general public can act upon if it should emerge. Being honest, even blunt, that is part of the challenge here, as has already been said and for the reasons that have already been given. So the regional Be Clear on Cancer pilot for ovarian cancer took place in the north-west of England in February and March 2014—a while ago now—with this simple key message:

“Feeling bloated, most days, for three weeks or more could be a sign of ovarian cancer. Tell your doctor.”

PHE is currently undertaking new data analysis and research to determine Be Clear on Cancer campaigns for next year, which is 2019-20. At this time, no decisions have been made, and I will take the bid from today’s debate very strongly. The outcomes from the regional pilot—and a pilot that focused on a range of abdominal symptoms such as diarrhoea, bloating and discomfort, which can be indicative of a number of cancers, including ovarian cancer—will of course be taken strongly into consideration, and that is where I think we will head with this work.

However, let me clear that PHE and NHS England have had a very clear steer from me that I want to run the campaign on lower abdominal symptoms as soon as practicably possible. We have to make sure that the operational capability is in place across the NHS, because the worst thing that we could do is create a demand without being able to meet it. That is a rather boring, practical reality, but it is a reality. I reiterated this point to the APPG recently when we met and I will of course keep Members updated; I know they follow these matters very closely.

The hon. Member for Strangford also asked about genetic testing and its role in identifying the increased risk of ovarian cancer. One area where England is very much at the cutting edge of cancer diagnosis is in the creation of the new national genomic testing network, which will be delivered through seven new genomic laboratory hubs, as we call them. They will give patients access to state-of-the-art tests that can diagnose their disease or help to inform their treatment. So the genomic lab hubs will do three things: provide consistent and equitable access to genomic tests, which is very important, as it will ensure there is a level playing field; operate to common national standards, specifications and protocols; and deliver the single national genomic testing directory, which will cover the use of all the genomic technology, from the single gene to the whole-genome sequencing for cancer and for rare and inherited disease.

The labs are in a period of transition, to embed fully the new infrastructure and the new national genomic test directory. I hope that this transition will ensure the safe roll-out of the service without disrupting clinical care. Patients will continue to receive the testing they need to inform their clinical care, and the new national test directory will also include the BRCA testing for women with ovarian cancer in line with NICE guidance, which the hon. Gentleman rightly mentioned.

While I am talking about the hon. Gentleman, or “the hon. Member for Westminster Hall” as I like to call him, I note that he also touched on screening programmes, as did the Opposition spokesperson and my hon. Friend the Member for North East Derbyshire. The UK National Screening Committee is awaiting the updated results of the UK trial of ovarian screening, which is the UK collaborative trial of ovarian cancer screening, as it is known. The secretariat is in contact with the researchers and the committee will review the findings as soon as they are published.

The hon. Gentleman was absolutely right to talk about the workforce. On page eight of its report, the APPG outlines the importance of sonographers. There will be increased emphasis on diagnosing cancers earlier, but we will not be able to find the magic key without those people who do the searching, who are our NHS workforce. So we must ensure that we have the right workforce in the right place to deliver that frontline care and meet the Prime Minister’s ambition.

Last December, Health Education England published its first ever cancer workforce plan, committing to the expansion of capacity and skills. HEE will follow that plan up with a longer term strategy that will be aligned with the NHS long-term plan, which seems sensible to me, and that will look at workforce needs beyond 2021. We have to look at a very long landscape when it comes to the NHS workforce. I will not pre-empt that plan, but I can assure hon. Members that it will set out how we will ensure that a sustainable cancer workforce are in place to deliver on the ambitions that we have set out.

My hon. Friend the Member for North East Derbyshire talked about the cancer dashboard. The APPG report, which of course he was involved in drafting, also recommends including ovarian cancer data within the dashboard. The dashboard was first published in May 2016 as a tool to help the cancer alliances, the commissioners and the providers in the acute trusts to quickly and easily identify the priority areas for improvement, and to enable easy tracking of progress towards our national ambitions.

PHE is working with NHS England’s cancer programme team on the next phase of the dashboard development, and that will be informed by the needs of the key stakeholders and the cancer charities, with which I hold a regular roundtable; some of those charities’ staff are here in the Gallery today. It is no secret that hon. Members know that I am frustrated about the cancer dashboard. I am impatient about most things, as my private office will sadly attest, and I am incredibly impatient about the dashboard being limited to the top four cancers. I want to see it expanded and I intend to see it expanded: NHSE and PHE have a very clear direction from me that I will be watching their work and I expect to see it producing what I and other Members in this House want.

The hon. Member for Washington and Sunderland West spoke about surgery and the mixed picture around the country. I do not want to short-change her by not giving her the detailed answer I want to provide to her good point, so I will look into it and write to her and the other Members who have been in the debate today. We obviously must diagnose early, as that gives us better and less radical treatment options, but for some surgery is a sad reality. We must ensure that the NHS is good at not only sharing best practice but implementing it, and that is as true in surgery as anywhere else.

I pay tribute to the hard work and professionalism of our dedicated cancer workforce, and to the Members who care so passionately about the subject and have brought it to the House today. Ultimately, it is our workforce who will determine the success of the cancer strategy and the long-term plan for the NHS. We can only set the direction and the ambition and ensure that the resources are in place, and I believe that I am doing that, as Minister for cancer.

I am excited by the huge potential for the next 10 years of cancer diagnosis, treatment and support. We have fully established the 19 cancer alliances. We have backed them with the funding they need to transform services, and will go on doing that, to ensure that the NHS long-term plan can be delivered on the ground through the alliances, with cancer at its heart. The plan can turbo-charge all that we have achieved through the cancer strategy. I have said before, and I will say again, that I want the alliances to be much more open and accountable and much more approachable, especially by Members of Parliament in England, who should be able to call them to account much more than they do. I suspect that many Members here have the chief executive of their local trust on speed dial; I hazard a guess that they do not have the leader of their cancer alliance there also, and that should change.

It was interesting to get the Scottish perspective from my hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (John Lamont). We would like to see the ambition in England matched across the whole United Kingdom and we absolutely stand ready, as always, to work with Scottish Members and the Scottish Government. If there is anything we can do to help share that ambition, we will do it.

NHS England, Public Health England and I, with the tireless support of our cancer community—team cancer as I always call it—are committed to making a reality the ambitions that the Prime Minister has set out. That will ensure, as I said in this place not two weeks ago, that we continue to make huge leaps forward over the next 10 years to a future where cancer has no future.

10:40

[Lee Rowley]

I thank all right hon. and hon. Members who have contributed to this exemplary debate. It has been one of those debates that we all aspire to have, in which we talk about the detail and leave out a lot of the politics, and in which there is unity regarding wanting the same outcome: we all want to be able to treat the disease more quickly, with better outcomes and fewer people experiencing it. I am grateful to everyone for entering into the discussion in that spirit.

I thank the hon. Member for Strangford (Jim Shannon) for attending this morning, for highlighting the importance of the issue to him, and for mentioning all the work being done in Northern Ireland—particularly for raising the point about genome testing. I thank my hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (John Lamont) for sharing his experience north of the border. He, like so many others, provided some of the most important elements of the debate—examples of constituents’ own experiences. I also thank the Front-Bench spokespeople: the hon. Member for Lanark and Hamilton East (Angela Crawley) for also sharing her experience north of the border; and my colleague on the all-party parliamentary group, the hon. Member for Washington and Sunderland West (Mrs Hodgson), who spent so much time highlighting the group’s great work. It has been a privilege to be part of that work over the past few months; the report is a great piece of work and I hope to see improvements coming out of it.

I also thank the Minister. I am a relatively new Member, but I can often tell in debates when Ministers are going through the motions and when they actually care, and today I have heard a speech that demonstrates a genuine interest. It was great to hear about the Minister’s personal connection and about how he cares about the issue, and it was interesting to hear some of the things he highlighted. “Lots to come” is the summary I think it is fair to say we can take from the speech, with regard to the ACE centres, the potential for more public health campaigns, the genome point and the screening. I was particularly glad to hear about the dashboard, which I hope, in time, will give us an opportunity to push forward and demonstrate greater transparency.

Although they are not all still in their place, I thank my hon. Friends the Members for Grantham and Stamford (Nick Boles) and for Nuneaton (Mr Jones), my right hon. Friend the Member for Chipping Barnet (Theresa Villiers), and the hon. Members for Blaydon (Liz Twist), for Torfaen (Nick Thomas-Symonds) and for Upper Bann (David Simpson). I am incredibly grateful for their contributions. I also thank everyone in the Public Gallery, who has listened and provided support. I am aware that there are Members in the room to whom the matter means much but who, by convention, are not able to speak: my hon. Friend the Members for Erewash (Maggie Throup) and you, Mr Bone. You are undertaking a different role today, as Chair, but you were so kind in supporting me when we applied to the Backbench Business Committee for the debate. I am grateful to you and my hon. Friend for your silent but heartfelt support.

This is an important area. It has affected me personally, but it is not about the personal effects; it is about ensuring that we make progress as a country in sorting out the disease and resolving the issues, reducing the number of people out there who get a diagnosis. The debate has shown that a lot has been achieved, that a lot can be done, and that there is a lot of progress we can make, and I look forward to seeing that progress in the coming years.

[Mr Peter Bone (in the Chair)]

I thank all Members for the excellent debate.

Question put and agreed to.

Resolved,

That this House has considered ovarian cancer diagnosis and treatment.

10:20

Sitting suspended.

Leaving the EU: Port of Sheerness

Tuesday 30th October 2018 Westminster Hall

11:00

[Gordon Henderson (Sittingbourne and Sheppey) (Con)]

I beg to move,

That this House has considered use of the Port of Sheerness after the UK leaves the EU.

I will try to keep my remarks in order, Mr Bone, and I hope everyone else will, too. Whether or not the Government agree an acceptable post-Brexit deal with the European Union, something will have to be done to relieve pressure on the port of Dover. As my hon. Friend the Minister will know, most of the roll-on/roll-off traffic in south-east England is via the Dover-Calais route. That means that Dover handles a huge volume of business. It is one of the world’s busiest passenger ports. In 2017, some 11.7 million passengers, 2.6 million lorries, 2.2 million cars and motorcycles, and 80,000 coaches passed through Dover. In addition, Dover’s cargo terminal handles 300,000 tonnes and 9,000 containers every year, and business is increasing. As you can imagine, Mr Bone, with all that traffic heading in and out of Dover, the local roads are badly congested, even at the best of times. When there is a problem with the ferries—often caused by strike action at Calais—that congestion gets even worse and Dover becomes gridlocked.

The Dover traffic assessment project, otherwise known as the Dover TAP, holds around 1,000 lorries on the A20 just outside Dover and has been used hundreds of times recently. Thankfully, Dover TAP has been preventing a repeat of Operation Stack. I am sure my hon. Friend will recall it bringing the roads in Kent to a near standstill for a month in 2015. If the UK leaves the EU without a deal, what happened to Kent’s roads in 2015 could look like a walk in the park. Indeed, unless a contingency plan is put in place to combat a no-deal scenario, the situation could become critical and have a huge impact not only on Kent’s economy, but on that of the UK as a whole.

Highways England has been looking for an alternative to Operation Stack, including closing the M26 and using it as a car park. In my opinion, such an option would not solve the problem, but simply move it from one part of Kent to another. Some days, 10,000 lorries pass through the port of Dover in a 24-hour period. If those lorries were held up, that would be equivalent to a queue more than 90 miles long. That is a lot of potential traffic congestion, and it could see whole swathes of the south-east grind to a halt, but such a scenario is avoidable. Parking up thousands of lorries does not have to happen, because there are other solutions. For instance, rather than relying on Operation Stack or similar parking arrangements that have not worked in the past, would it not be better to provide lorry drivers with alternative routes to and from the continent? The port of Sheerness offers one such alternative.

Mr Bone, you might ask, “Why Sheerness?” Well, it has a number of advantages. For a start it has a ro-ro terminal that is available for use today. It was built to service the Olau Line, which ran a ferry service from Sheerness to the Netherlands. Although that ferry service stopped running in 1994, the ro-ro terminal is still in perfect working order. The port of Sheerness has other excellent facilities and is already one of the major ports for the importation of cars into the UK. Unlike Dover, it has plenty of spare space and room to expand. Although Sheerness is further away from Calais by sea than Dover, it is closer by road to London and the midlands, so the longer sea journey from France would be counter-balanced by a shorter road journey to the lorry’s final destination. In addition, Sheerness is closer than Dover to the Netherlands, which opens up the possibility of routing more freight via the Dutch ports, such as Rotterdam.

It is worth pointing out that Sheerness is the only port in England with water as deep as that at Rotterdam, so it would make a perfect partner. Another advantage of encouraging a Rotterdam-Sheerness route is that the road journey from Germany and eastern Europe to Rotterdam is shorter than that to Calais. Once again, although the sea journey would be greater, there would be a saving on road travel at both ends. While having a longer sea journey might seem a disadvantage, in a post-Brexit world it would be an advantage, because it would give more time for the customs paperwork to be sorted out electronically at either end. That is what is happening at Felixstowe, which manages to import £86 billion of goods every year from inside and outside the EU without the need for lengthy customs checks. Such a system replicated in other ports, such as Sheerness, would ensure frictionless borders and no hold-ups.

One final advantage of using the port of Sheerness is the amount of commerce that already takes place in the area. In my constituency, I have the Morrisons regional distribution centre; the new Aldi regional distribution centre; the Kemsley paper mill, which is the second largest fibre-based paper operation in Europe; and the Sittingbourne Eurolink, which is one of the largest industrial and manufacturing estates in southern England. As you can imagine, Mr Bone, all those industries generate a lot of lorry movements, many from the continent. Routing those lorries via Sheerness would reduce pressure on Dover and makes a lot of sense logistically.

Making better use of the port of Sheerness post-Brexit would require some investment. For example, the A249 dual carriageway would have to be extended half a mile into the docks. An improved electronic customs system like that at Felixstowe would have to be installed to ensure lorries could be cleared with as little delay as possible. I appreciate that that would come at a cost to the Exchequer, but when we consider the wider impact on the country if goods are held up at either Calais or Dover and the costs involved with providing an alternative to Operation Stack, the investment would be a small price to pay for what would effectively become a safety net for Dover.

11:07

[The Parliamentary Under-Secretary of State for Transport (Ms Nusrat Ghani)]

It is a pleasure to serve under your chairmanship, Mr Bone. I congratulate my hon. Friend the Member for Sittingbourne and Sheppey (Gordon Henderson) on securing this important debate. It highlights an issue that is topical for both his constituency and the wider economy.

Our ports are key to our economic success. They deliver 95% of our exports and imports. I hope that we can agree that first and foremost, the United Kingdom ports are exemplary. My experience visiting our ports as Maritime Minister has reinforced my belief that our ports are the best in the world. We have the most liberalised ports sector in Europe and arguably the world, with the private sector predominating and ports competing to attract and facilitate trade with both the EU and the rest of the world, all on a fully commercial basis with minimal expense to the taxpayer. This responsible sector has invested vigorously throughout fluctuating conditions in world trade and the domestic economy. It has adapted to changing patterns of demand, including radical changes in the requirements for energy generation over recent years. Consequently, it is well placed to meet the challenges and opportunities that the country will welcome as we resume our position as an independent trading power.

The Government have set a highly facilitative context for private investment through the national policy statement for ports, which was designated in 2012. It sets a strong presumption in favour of socially and environmentally responsible development. The sector has long recognised its environmental stewardship duties as it often occupies sensitive sites at the land/water interface. Moreover, ports have permitted development rights that help to facilitate modest adaptation of port estates in a nimble way where that has no adverse environmental implications.

Our ports have many strengths, especially being nimble and flexible, so the ports sector as a whole stands ready to meet challenges. As the ports sector is such a competitive one, I must remain neutral in that commercial arena, so I hope my hon. Friend will understand if I do not sing the praises of Peel Ports or of any other individual port operator at the expense of others.

Many other hon. Members will doubtless be quick to point out that they have equally alert and vigorous ports in their constituencies, which I know to be true as I have had the privilege of seeing several in operation at first hand.

[Gordon Henderson]

I want to make it clear—I thought I made it clear in my speech—that I was using Sheerness as an example only because it is in my constituency and I know a lot about it, but the case could apply to many other ports. We should point out to those who are filled with doom and gloom about what will happen post-Brexit that we have ports other than Dover. That is all I am trying to say.

[Ms Ghani]

My hon. Friend makes an important contribution. He is absolutely right. We must seize the opportunity and recognise that we have many productive and flexible ports up and down our country.

One of the reasons prompting this timely debate is the success of the port of Dover, along with the channel tunnel, which is why any sizeable proportionate reduction in their traffic would be so challenging to replace elsewhere. My hon. Friend talked about the level of traffic and freight going through the port of Dover, and he also referred to the port of Felixstowe. That remains the largest UK container port and is another example of a world-class port capable of accommodating today’s ultra-large container vessels. Its sister port, Harwich, is a versatile ro-ro facility that handles both accompanied and unaccompanied ro-ro trailers. Also, Associated British Ports has advertised the strengths of its Humber ports for unaccompanied ro-ro and is also investing in short sea container capability at Immingham. Those are just a few examples. The Government are involving the whole UK ports industry in discussions on resilience issues directly and through the UK Major Ports Group and British Ports Association. Nevertheless, the initiative of Sheerness in promoting its ro-ro facilities is a good example of an enterprising and positive transport sector.

My hon. Friend will have heard from Ministers that we are confident of securing a withdrawal deal with the European Union that is in the interests of both the UK and the EU member states as trading partners, for this is not a zero-sum game. All the participants in international trade stand to gain, and that applies as much to the UK’s ro-ro business with the EU 27 after we leave as it does to our trade with the rest of the world, so we expect an agreement and a transition period that will enable a sensible adaptation to the inevitable technical changes in border arrangements. However, as a responsible Government, we must plan for all eventualities.

There has been a great deal of speculation, especially in the past week, about the Government’s intentions in the event of a no-deal outcome. The Government have made it clear that UK border controls—those that we control—will continue to enable trade to flow as frictionlessly as possible, which is what we are working towards.

[Gordon Henderson]

I am sorry to interrupt again. I accept everything the Minister says, but, because the Calais-Dover route is so short, it does not lend itself to electronic trans-shipments at the moment, so we have to upgrade those facilities. My understanding is that the software used at Felixstowe could be changed to accommodate Dover. When asked how long it would take, someone said a few minutes, and we should explore such options.

[Ms Ghani]

Once again my hon. Friend makes a positive intervention on how our ports can continue to be flexible and take on board new technology to ensure that all the checks are made in good time, especially when we consider the very short journeys to Dover.

Certain checks and controls, including those already undertaken from time to time on EU goods, have to take place at the frontier to be effective, and that will continue to be the case. But there is much that we can and will do to expedite flow, especially where checks can be undertaken away from the physical frontier. We cannot control what controls the EU will require or what member states will do in response to those requirements in the event that we leave without a deal. We can seek to influence such things, of course, but ultimately there remains a risk that the flow of traffic will be affected.

The Dover strait, encompassing the channel tunnel, concentrates the greater part of accompanied HGV trade with the continent. It is a 24/7 operation that includes a stream of ferries departing at half-hourly intervals. Inevitably, such a dense flow of HGVs could become subject to some constriction in the event that prolonged checks feed back into the queue of arriving vessels. We would be failing in our duty to the public if we did not take such possibilities very seriously and prepare for all eventualities.

On the opportunities proposed at Sheerness, earlier this year Peel Ports issued its pamphlet, “Brexit unlocked—A Contingency Option Using Uncongested Ports”. That report highlighted the ability of ports that are geared up to welcome and handle unaccompanied trailers to provide a service to customers whose cargo is not perishable or otherwise necessarily quick to the market. That can have further benefits, allowing a little more time to clear border controls in either direction and within commercially agreeable bounds to use temporary storage on ports rather than increase stockholding in the customer’s onsite warehouse or distribution centre.

Of course, unaccompanied cargo is nothing new. Indeed, the pamphlet itself points out that more than 70% of unit-load traffic from ports in France, Germany, Belgium and the Netherlands already travels unaccompanied, whether in trailers or sea containers. Equally, of course, Dover and the tunnel will remain open for business whatever the outcome on borders, and along with the ferry operators will themselves continue to attract a powerful commercial pull through geography as well as customer service, especially on the more time-critical traffic, although not limited to that. It is not my job to pick winners or direct traffic. Decentralised decision making by traders who are best placed to weigh their own needs and time pressures will continue to do that. However, it is my and my Department’s job to consider all reasonably possible outcomes and pursue the overarching objective for traffic to be as frictionless as possible. That is what we have been doing and will continue to do. I am glad that port, ferry and rail operators are also engaging with those challenges.

My hon. Friend raised the issue of traffic management. My Department, Highways England and other partners are working closely with the Kent Resilience Forum and other partners to develop contingency plans that will replace Operation Stack. First, we have established the Dover TAP—traffic assessment protocol—which has successfully avoided the need to deploy Stack since 2015. That will continue and Operation Stack will be superseded by Operation Brock, which will ensure that the M20 can be kept open and that traffic will continue to flow in both directions at times of cross-channel disruption from whatever cause.

Operation Brock consists of three phases: a contraflow queuing system between junctions 8 and 9 of the M20, with holding areas at Manston airport and, if necessary, on the M26. This represents a significant improvement on previous deployments of Operation Stack when junctions were closed and traffic diverted off the M20 on to local roads, adversely affecting local communities and businesses in Kent. We will therefore have substantial truck-holding capacity while maintaining flow of traffic on the M20. Obviously, we hope that none of that will be needed, but I hope my hon. Friend will be reassured that the Department and the agency are working hard to cover all eventualities and improve the quality of our collective response.

[Gordon Henderson]

Although we have been talking about the implications of Brexit, I said at the beginning that we have to solve the problem whether or not we have a no-deal scenario. It is bad for Kent and for the country. Whether or not we have Operation Stack, we need more lorry parks. Every constituency in Kent suffers from all its lay-bys being cluttered with lorries. Lorries are parked on the M2 every night. We have to do something about that. I have been working with Kent County Council and Highways England, and I have offered sites in my constituency for lorry parks, but nothing ever happens. I hope that the Minister can encourage something to happen on that.

[Ms Ghani]

My hon. Friend again raises the important issue of lorry parks. We know we need more, but no Member would like them in their constituency. I value his contribution, and I will ensure that his passion for ensuring that we have lorry parks is passed on to the Roads Minister.

I know that the A249 is important to my hon. Friend. Road connections are vital to any ro-ro port, and indeed to most others. Our port connectivity study, published just last April, surveyed the situation in England nationally. It acknowledged that there is a good case for strengthening sections of the strategic road network and specific potential to upgrade sections of the A249 near Sheerness. The study is a platform for future investment in worthwhile improvements at a range of ports including Sheerness, but of course the port is open for business with its existing connectivity. I would welcome another meeting with my hon. Friend to try to take that forward, especially with the Roads Minister.

[Gordon Henderson]

rose—

[Ms Ghani]

I see another intervention on its way.

[Gordon Henderson]

I am sorry to intervene yet again. The A249 and the link I mentioned into the port are important. I mentioned it to the Secretary of State a year ago, and he instructed Highways England to go down and have a look at it. The response from Highways England was that it is not necessary because it is not busy enough. Highways England does not seem to understand that we will make it busier only if we get the road link in. That is where it is sadly not always singing from the same hymn sheet as the Department for Transport.

[Ms Ghani]

I hope Highways England will acknowledge my hon. Friend’s intervention. Our port connectivity study made it clear that that part of the A249 requires investment to ensure that our ports continue to do what they do best, which is not only bringing freight in but moving it up and down the country.

I thank my hon. Friend for raising an important topic. He has rightly highlighted the potential of an important port business in his constituency, as well as of other significant businesses up and down the country. I am sure that he and I agree that it is part of a wider picture of readiness to seize commercial opportunities across the UK ports sector. I look forward to working with him in flying the flag for UK ports. I have no doubt that you will agree, Mr Bone, that the UK was a great maritime trading power for many years before we joined the European Union, and we will continue to be a great maritime nation after Brexit.

Question put and agreed to.

11:23

Sitting suspended.

Beauty and the Built Environment

Tuesday 30th October 2018 Westminster Hall

[Ms Nadine Dorries in the Chair]

14:30

[Mr John Hayes (South Holland and The Deepings) (Con)]

I beg to move,

That this House has considered beauty and the built environment.

It is a great pleasure to speak on this subject. I am prepared to be corrected if anyone knows better, but I imagine that this is the first House of Commons debate specifically on beauty for a very long time indeed. Yet the journey through life should be the pursuit of the sublime. It should be a search for absolute truth. In it we should experience and rejoice in all the exposure to beauty that characterises each and all of our journeys.

Beauty, whether in the laughter of a child, the scent of a rose, a glorious landscape or the setting sun, makes life richer and more fulfilled. In doing so, it does not merely satisfy our aesthetic needs; it takes us closer to the understanding of truth. As Keats wrote:

“Beauty is truth, truth beauty—that is all”.

What Keats meant was that absolute truth is exposed to us—explained to us, one might say—through the experience of beauty. It is very hard for human beings, who are frail, faulted and fallen, to understand that truth except through the means that I have described: those touches or experiences of something pure, special and magical.

Sadly, we live in an age that is dull and utilitarian and in which mystery and magic are extraordinarily unfashionable. It is odd that that should be, for it was not true for most of our history, and has not been so for most great civilisations. It is unusual to be as utilitarian as we are, but now it is time for a change—for a renaissance. It is time for beauty to be put back at the heart of Government policy. I am delighted that the Minister shares that view, as I know from our conversations. It is a delight to have a Housing Minister who cares about the quality of housing, and all that says about its look and feel and our sense of place, rather than simply the quantity of houses that we build. I shall say more about that in my long and fascinating speech.

The scale of the housing problem means that some may dismiss concerns about style, regarding them as indulgent or even irrelevant. “Aren’t there more important things to worry about?”, we hear people say. Indeed, the focus of housing policy has long been on targets for quantity rather than quality. We risk having a competition across the political spectrum to build the most houses the most quickly by stacking them high and selling them cheap, regardless of their quality or what they look like. That is not good enough. It short-changes our countrymen and the generations to come. Everyone should have the opportunity to live in a place of which they can feel proud and through that to develop a sense of place that informs their sense of worth, which in turn feeds social solidarity through fraternity.

[John Howell (Henley) (Con)]

I am sorry to interrupt my right hon. Friend in the flow of such an elegant speech, but does he share my view that we gave ordinary people the ability to concentrate on the essence of good design as one of the key things in putting together neighbourhood plans? I am disappointed that very few have taken that up. Will he help me to try to instil it in the minds of those who are conducting neighbourhood plans?

[Mr Hayes]

That is a good and important point that relates to something I shall say later about taking a bottom-up approach to delivering better-quality housing, rather than imposing top-down targets. My hon. Friend is right that we need to inspire a new generation to believe that this can be done, because there are some who say that it does not matter or even that it cannot be done—that it is no longer possible to build wonderful, lovely things, and that we are no longer capable of imagining what generations before us created. I just do not believe that. I think we can and should do better, and my hon. Friend rightly describes one of the mechanisms that might achieve that.

To dismiss concerns about the quality of what we build is both wrong and, ultimately, destructive. We cannot hope to change the public perception of new development unless we fundamentally change its very nature. Beauty should be at the heart of the public discourse. It should be part of our conversation about housing and development. As the great philosopher Roger Scruton puts it,

“we are losing beauty, and there is a danger that with it we will lose the meaning of life.”

If I am right that the journey through life requires us to experience beauty to build the personal fulfilment and communal contentment necessary to make a society that works, ignoring beauty does not merely short-change future generations; ultimately, it will destroy our chance to make a nation of which we can all feel proud. There is a close relationship between the sense of place and the social solidarity necessary to build a harmonious society. I could say a lot about harmony, but that is a subject for another time or another debate and His Royal Highness the Prince of Wales has spoken about it far more eloquently than I ever could, so perhaps I should defer to him.

The first misconception that I would like to quash, which sometimes prevents the debate about quality from taking place at all, is that the kind of approach that I am trying to articulate, which concentrates on beauty, is both marginal and gets in the way of getting things done. According to that view, constantly demanding more of development—I am talking about commercial as well as domestic buildings, because this is not wholly about housing—somehow acts as a barrier, an impediment, to delivering the bigger objective of building to provide a basis for growth and prosperity. I just do not believe that. Actually, I think the opposite is true.

When Her Majesty the Queen came to the throne, her reign was marked by talk of a new Elizabethan age. After the destruction caused by the war, people looked to new development with optimism. They believed that we could create a society that both looked better and was better to be part of. How curious and how sad that during Her Majesty’s reign, attitudes to development have diametrically altered. Whereas people once anticipated development with joy, they now very often look on it with despair. Frankly, that is the result of successive Governments and local authorities of all political persuasions; I cast no slur on any single party in this House.

[Mr Jim Cunningham (Coventry South) (Lab)]

rose—

[Mr Hayes]

And certainly not on my dear friend the hon. Gentleman, to whom I am delighted to give way.

[Mr Cunningham]

As usual, the right hon. Gentleman takes a difficult topic and makes it understandable—to say the least—in a very jocular way. I am sure he will remember as I do when Governments used to announce at general elections that they would build about 300,000 houses a year. That has gone by the board now.

Planning is one issue when we talk about housing, and particularly social housing, in this day and age, but, more importantly, many years ago we used to have the Parker Morris standards for social housing. That is all gone now. Even in the private sector, we very often see houses that are nothing better than boxes. They look okay on the outside, but inside they are very small indeed. I do not think people are getting value for money. There is the design, but there is also the importance of bringing local people’s views into the discussion as well, and Members will probably have heard me talk of the King’s Hill area in Coventry, which is a beauty spot with lots of history where they now want to build houses. Before I sit down, I would just add that when we had a problem in Coventry with council houses, we let residents take part in the process of the design of alterations. That went very well. We have to get back to times like that—

[Ms Nadine Dorries (in the Chair)]

Mr Cunningham, that is a speech, not an intervention. I call Mr Hayes.

[Mr Hayes]

I am delighted to say that I agree with every word that the hon. Gentleman said. I think of where I was brought up in south-east London. It was a council estate built, as so many were, in that period during the war and just after. Houses were not only well built—they were attractive. Care was taken about the design of the house. There were a variety of house styles across the estate. There were houses of different sizes to accommodate different kinds of people; there were smaller properties, suitable for elderly people, and large homes suitable for families. The variety of houses, the look and feel of the development, the street layout, the presence of a widely used parade of shops, the church, the school, the community hall, and so on, were the component parts of a functioning community, of which everyone felt part. I am not sure that can be said of many developments now.

The hon. Gentleman is right that privately owned, but also rented properties, are often soulless, ubiquitous and indistinguishable from one another, looking the same from Penzance to Perth, with no sense of the vernacular, no sense of local personality and thereby, incapable of inspiring the local and particular sense of place necessary to build communal feeling. That is where we have got to. It is extraordinary that we have, given the opportunity that existed in the post-war years after the bombing of many of our cities. The redevelopment could have been not only regenerative, but inspiring. I have to say that we, as a nation, failed. Now, this Minister in his time in this job has the opportunity to put that right.

In my roles in the various offices of state, I have tried to influence the quality of development and what we build. As Energy Minister, I acted to ensure that wind turbines were constructed in appropriate locations after proper consultation with local communities, which is critical. Consideration about the impact on landscape became a vital part of the approval process. Some then simply dismissed the argument I made as irrelevant, on the basis of the easily grasped but utterly crass notion that beauty is in the eye of the beholder. The notion that beauty is relative has been used to justify much of the ugliness imposed on our towns and cities by architects, planners and developers since the war. Such developments have succeeded only in undermining public confidence in new housing. What is often not appreciated is how the public’s perception of development has changed.

I think what I have already described would be agreed by Members across the House of Commons, and certainly beyond it, but the sad fact is that planners by and large still have not learned their lesson. Even today, for example, some still laud the idea of streets in the sky. Plans are apparently afoot to extend the misconceived network of elevated walkways constructed in the City of London after the war. Streets in the sky were never a substitute for real streets—for architecture on a human scale, in proportion and in harmony with its environment. As anyone who has ever attempted to walk to the Barbican Centre knows, urban walkways are alienating, confusing and a poor substitute for design that puts people first. The Barbican is far from the worst example. There were any number of large developments, mainly of social housing, with walkways and gantries that not only became havens for criminals but often isolated rather than united blocks of flats.

[Andrew Lewer (Northampton South) (Con)]

This is not a whimsical issue for my right hon. Friend, but a long-standing issue of concern, as it is for me. My postgraduate thesis was on the Gothic revival in domestic architecture in the mid-18th century. That brings me to my question. How do we reconcile space for innovation, as the Gothic revival was in some respects, with respect for the vernacular in our very different counties and neighbourhoods?

[Mr Hayes]

As a direct result of that intervention, let me make my first demand of the Minister. I have more demands to make at the end, so I will get this one out of the way now—I see the Minister glancing at his civil servants nervously.

It is critical that every local authority has a design guide that is not only particular to its locale, but that has site-specific design appraisals for those most important regenerative opportunities. It is not enough for a local authority to rely on some county-wide or area-wide design guide or very broad general motherhood-and-apple-pie design principles. There have to be specific requirements for developers, which allow places to continue to change in a way that is in keeping with what has been done before. That is about materials, scale and sometimes eclecticism; there are particular places that look a particular way. We do not want every high street and every housing development, every town and every city to be indistinguishable one from another, but that will happen only if we are very demanding of what we expect of developers.

As you know, Ms Dorries, I have been Minister or shadow Minister for virtually everything, and I was once shadow Housing Minister. I met many big developers, big names that we could reel off if we wanted to, and they all said to me, “John, if you are clear about the requirements, we will build our business plans to meet them. We understand that you want to build lovelier places, and we know that that is what people want anyway. We are quite happy to build things that people will like and want to buy, or places they will want to rent. Be very clear about your requirements and we will work to them.” It is not about taking on developers; it is about working with them, but being demanding of them.

[Mr Jim Cunningham]

One of the things I learned in local government when I was leader in Coventry was that if someone is clear about what they want to do, they do not get any major problems—that happens when they are vague and unclear. I was reading an article in one of today’s papers, which showed a link between crime among young people and the design of buildings, particularly social housing, and certainly in areas in London, for example. Has the right hon. Gentleman read that report? It is worth looking at.

[Mr Hayes]

The hon. Gentleman knows of my extremely strong views on social justice and the redistribution of advantage in society. If we are going to redistribute advantage, as I think we should, it is not good enough to suggest that people who are less well-off, people who need to rent a home or young people who are looking to make their first home could make do with something inadequate, while those who are advantaged and privileged can buy the kind of lifestyle that was available to my working-class parents. The lifestyle I enjoy in my constituency in Lincolnshire is a bit like the lifestyle I enjoyed when I was a little boy on that council estate. We still use local shops, we have a garden to play in, we have a nice home and we have what might be called a traditional way of life because I am in a position to be able to provide that for my children—going to the village school and all the rest of it—but if I went back to places such as the place where I was brought up, by and large that life would not be available to most people who are rather like my mum and dad were that short time ago. I emphasise that it was a short time ago, Ms Dorries, but you knew that anyway. I want beauty for all, not for some or for the privileged or rich alone.

[John Howell]

Will my right hon. Friend give way?

[Mr Hayes]

I happily give way to my hon. Friend, who is just as committed to social justice as I am.

[John Howell]

My right hon. Friend is being incredibly generous with his time. One point that I would bring out strongly is something that he has mentioned in passing but has not concentrated on: the need to include the environment in housebuilding, to be able to enjoy the space that comes with that, and to be able to provide opportunity for the family.

[Mr Hayes]

It will be alarming to some, but a delight to others, to know that I am only on page 3 of my very long speech, and I want to make a bit of progress. My hon. Friend is absolutely right that part of the sense of place, to which I referred earlier, is about green space. I will come in a moment to some of the research done by His Royal Highness the Prince of Wales’s organisations on what people want, because a lot of the interventions have mentioned the role of consultation, engagement and involvement in shaping policy around what people actually want. There has been a lot of work done on this by a variety of organisations, to which I want to refer.

Let us be clear about what we aim to achieve. We aim to build homes of which people can be proud. Le Corbusier, who is responsible for many bad things, said:

“A home is a machine for living”.

A home is not a machine for living. Homes are a reflection of our humanity. William Morris said:

“Have nothing in your home that you do not know to be useful or believe to be beautiful.”

That was because Morris understood that beauty and wellbeing are inextricably linked, and that a politics that is serious about welfare and wellbeing must be serious about beauty. It is not possible to believe in the common good as passionately as all those here in the Chamber do but not care about aesthetics—the two are inseparable.

That beauty is somehow detached from matters of fairness and social justice is the second misconception that must be challenged. For the ancient Greeks, aesthetic and moral judgements were inseparable. In the 19th century, many artists considered beauty to be the vital link between freedom and truth. I sense that today there is once again a growing understanding of how aesthetics are a vital part of our judgment of value and worth. That is partly intuitive; people instinctively understand the connection between the value of beauty and a wider conception of worth.

This can be seen in protests at the ugly buildings that developers still attempt to foist on communities against their will. It can be seen in the despair at identikit supermarkets that lack any sense of craft or character, built with no consideration of the past and no regard for the future. Indeed, at the heart of modern architecture, like all modern art, is the Nietzschean idea that the past is irrelevant and we can create our own value system. Much modern architecture, like modern music, fails precisely because it rejects those principles of harmony that time has taught us to delight in, and that excite our senses not because they are discordant, but because they are harmonious.

Where modern design does succeed, that is largely by accident or because, where form has at least followed function, a building has a high degree of utility. That is important, because we often hear architects, planners and engineers speak about ergonomics, but they frequently confuse ergonomics with aesthetics. It is not sufficient for a building to be ergonomically sound, irrespective of its aesthetic.

Just occasionally, a combination occurs that unites those two things—the extension to King’s Cross is a very good example. Looking at the extension to King’s Cross and the engineering of the roof, it is clear that what is a functional requirement has been turned into a work of art, as aesthetics and ergonomics have come together. That is such an exception that it is frequently mentioned, because people are searching for an example of something joyful. Every time I go to King’s Cross station, which I do frequently on my journey to and from Lincolnshire, I look in wonder at that development. I know that we should be doing that time and again in towns and cities across the county—if not in scale, certainly in essence.

These lessons are not new, and I offer nothing that is not the wisdom of the people. The buildings that are most often treasured and valued by the public at large—our constituents—are usually older buildings that are shaped by vernacular style, where architects have taken care to be in harmony with the surroundings and where craftsmen have laboured over detail. A study by the Commission for Architecture and the Built Environment found that, when asked to name the most beautiful buildings in Sheffield, most respondents cited the two cathedrals.

Even the very same architects, planners and technocrats who foist ugliness on the rest of us often choose to live in beautiful, old houses in communities that still have a sense of place and a link to their surroundings. In fact, it is quite alarming that most modernists choose to live in Georgian or Victorian houses. That is the problem: escaping to gated lives, they leave well alone those who are forced to live in the kind of houses that the hon. Member for Coventry South (Mr Cunningham) mentioned, and that is just not acceptable. Beautiful housing has become increasingly unaffordable to the kind of people he mentioned, precisely because it has become so scarce. We have seemingly become incapable of building anything of comparable quality or of planning new developments with a similar sense of place and community, which are values that matter directly to our quality of life, our sense of wellbeing and our health and happiness.

It cannot be fair that beauty is increasingly the preserve of the few, which brings me to the third misconception that cannot be left unchallenged: that beauty belongs to the past. It is often considered, sometimes unthinkingly, that it is no longer possible to build beautiful buildings. We have somehow, rather depressingly, come to believe that the supply of beauty is both finite and exhausted, perhaps because people assume that it must be dated, kitsch or whimsical to build according to the principles of classical architecture, or to extend such a vision across a development so that it is harmonious, with a sense of community and place.

Such snide comments are sometimes made about the Prince of Wales’s vision for Poundbury, although the popularity of that place reminds me of what one wit said about the original Broadway production of “The Sound of Music”: “no one liked it, apart from the public”. The truth is that, when surveyed, the public repeatedly identify those kinds of place as places where they would like to live and that they aspire to own one day.

Beauty does not have to come at too high a price and it does not have to be sacrificed for the sake of utility. Those assumptions are false. When the city fathers of Birmingham, Nottingham and Manchester built great town halls in classical or gothic style, they did so because they understood that these styles had endured. A fine example is Nottingham, a city I know very well, having lived there for 20 years, studied there and been a county councillor in Nottinghamshire. The Council House in the centre of Nottingham, which is a great neo-classical building, was built in 1929. Right up until then, we understood, but the problem has grown in scale and depth since the war. Those planners, engineers and architects built something that they wanted to last, and they succeeded. The modernist library in Birmingham’s Chamberlain Square was recently demolished, just 40 years after it was built, but no one would seriously consider doing the same to the classical town hall or the other great public buildings of the Victorian era.

Despite their appearance, those buildings are, in other respects, modern: they were built using modern construction techniques. In historical terms, compared with the cathedrals I mentioned, they were built yesterday. Many were built in the late 19th or early 20th century. There are no good reasons that we cannot continue to build beautiful buildings, as the Prince of Wales has demonstrated to such wonderful effect.

While I am dealing with the Prince of Wales, I want to return to the issue of what the public want. The Prince’s organisations consulted widely on the principal things that people want and do not want. I will highlight four. They do not want their town or village to lose a strong sense of identity; they do not want green space to be unduly threatened by urban sprawl; they do not want too many tall or large buildings, out of scale with what is there already, to be built; and they do not want change to be too rapid or overwhelming. In other words, people want building development on a human scale that is incremental and in tune with the existing built environment. Is that really too much to ask of our generation? I think not, and I hope the Minister agrees.

The irony is that many modern and postmodern buildings are more expensive than buildings built and designed according to classical principles. Even in cases where improving design and build quality comes at a price, in the longer term that will save money, and not just on maintenance. A British Land study estimates that better design could save the UK economy an estimated £15.3 billion by 2050, making us all happier and healthier.

Good design has the power to strengthen communities and improve physical and mental health through abundant green space and walkable streets. It has the power to improve safety and security through the abolition of semi-private spaces, walkways and underpasses, which trap people and encourage criminality. All those considerations should be fundamental to planning policy.

It would be a genuine tragedy if concerns about the supply of housing led us to revisit the failed post-war experiment in high-rise living. That is not the answer. Tower blocks are actually built at lower densities than terraced housing. We must consign such misconceptions to the past, and in their place develop a planning system that has true regard for people and communities. For almost 60 years, our planning system has encouraged or allowed out-of-scale buildings. We need fundamental change.

I will say one other thing about His Royal Highness, who put this issue in such clear terms and speaks, I think, for the people when he said that he did not want the place

“which I love greatly disappear under a welter of ugliness”.

How many communities and individuals have felt that? How many have felt that their voice is not heard by architects, planners, engineers and—I have to say it—politicians of all persuasions?

We need fundamental change. In the future, buildings should be in harmony with the landscape, vernacular in style and built from local materials, and they should offer local distinctiveness, which is the foundation of people’s sense of place. Pride in communities is unlikely to flourish if people have no say in how housing is built or how their neighbourhood develops.

As the hon. Member for Coventry South and my hon. Friend the Member for Henley (John Howell) said, that obliges us to engage and involve local people in the character, shape and scale of developments close to them. Although the revised national planning policy framework now encourages local authorities to produce design codes and styles, we must go much further.

[Ms Nadine Dorries (in the Chair)]

Order. Just to make the right hon. Gentleman aware, there are three Front-Benchers to speak, and other Members have requested to speak.

[Mr Hayes]

That is most kind of you, Ms Dorries. I always regard your advice seriously, and I will move reasonably swiftly to my exciting peroration so others can contribute.

Policy Exchange found that most people do not want to live in glass-covered high-rises or sprawling concrete estates. They want homes that are built in traditional styles, such as Georgian and Victorian-style terraced housing, and tree-lined streets. Similarly, research by Create Streets found that, in overall planning, people value green spaces; walkability, both in terms of consecutiveness and street-level interest; and a minimisation of the internal semi-private space that is a function of tower blocks, walkways and so on.

The success of the “Save our parks” campaign run by The Mail on Sunday is indicative of how much we value green space, yet parks and open spaces across the country are being lost, eaten up by greedy developers and unprotected by careless councils. We should not just protect green spaces, but build new parks and squares. I was pleased by the Budget yesterday, but we need to do more. Why does the Minister not stand up and say that it is his plan, ambition and intention to create 100 new parks and green spaces in towns and cities across the country?

In practice, much greenfield development is degenerative. All development should be regenerative where possible. It should be not a bolt-on to communities, but an opportunity to enhance and develop them in a way about which we can all feel proud. Policy Exchange estimated that, in London alone, there are 6,122 hectares of brownfield land, the mixed use of which could accommodate between 250,000 and 300,000 new homes. Bad design must no longer be tolerated. I want beauty for all.

I am coming to my exciting peroration, Ms Dorries, so excitement can build from now on—just in case anyone wanted notice of the need to be excited. We plant trees for those born later—for our children and grandchildren—and we should build for future generations, too. The built environment we leave behind is our children’s inheritance. We must not leave them a poisoned legacy of lost beauty and present ugliness. Such a legacy has already led to the burgeoning interest in local history. Bookshops are filled with illustrated history books, invariably with the word “lost” in their title. Towns and cities, pictured as they once were and no longer are, fascinate our constituents, because once we knew how to build and develop. They show a lost world of proud local shopkeepers, well-kept shopping arcades, community and Victorian civic pride. How much more can we afford to lose before we end this destruction? When will we start adding to our stock of beauty once more? Beauty once lost must now be regained. The Government can play their part. We must demand and do more. We must deliver beauty in our time.

[Several hon. Members rose—]

[Ms Nadine Dorries (in the Chair)]

Order. The Front Benchers are going to have 10 minutes each. Two other Members wish to speak, so to be fair and equitable they have just over 10 minutes each.

15:08

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in this important debate. I congratulate the right hon. Member for South Holland and The Deepings (Mr Hayes) on securing it and, as ever, for speaking so eloquently and poetically. I would never be able to emulate his use of the English language and his flow, but others might be able to—I suspect that the right hon. Member for Wantage (Mr Vaizey) will do so.

The focus of this debate is the national planning policy framework, which provides a framework for producing local plans for housing and other developments. Those plans, in turn, are the background against which applications for planning permission are decided. I appreciate that the NPPF applies only in England, but it is important to have well-designed and visually attractive developments across the whole of the United Kingdom of Great Britain and Northern Ireland.

I am sure most, if not all, hon. Members will have heard me talk about my beautiful constituency of Strangford, which I have the honour and privilege of representing, and working and living in. I genuinely believe it is the best place to be in all of the United Kingdom of Great Britain and Northern Ireland. Other hon. Members will say, “I expect the hon. Member for Strangford to say that,” but I honestly believe it. I urge those who have not been there to make that journey. When they see the beauty that we have, they will undoubtedly have the same opinion as me. We have large towns, small towns and lots of small villages, but for the most part we are a rural constituency with rolling green hills, a glistening lough, beautiful walks, canoe trails, and much more, all under the protective gaze of Scrabo Tower as it looks down from the edge of Newtownards down to Strangford Lough and across the constituency of Strangford.

Those of us who represent rural constituencies know how important it is to balance the need for development with the need to maintain natural beauty, ensuring that buildings are in keeping with the local area. In 1943, having seen a burnt and crumbling House of Commons, Winston Churchill remarked:

“We shape our buildings and afterwards our buildings shape us.”—[Official Report, 28 October 1943; Vol. 393, c. 403.]

That is spot on. As a boy, one of my childhood heroes was Winston Churchill, as was Blair Mayne and a former Member of this House, Dr Ian Paisley. To receive planning permission to build in the countryside in Northern Ireland, one of the requirements is to

“promote high standards in the design, siting and landscaping of development”.

It is no longer enough for buildings to be structurally sound and to simply do the job. It has to be more than that. They must also be aesthetically pleasing to the eye, whether they are in the countryside or an urban area.

While we battle to maintain our green spaces, we also recognise the demands for more housing and the infra- structure to support it and keep villages and towns connected. In Northern Ireland, the regional development strategy—RDS 2035—sets out eight aims, two of which are:

“Promote development which improves the health and well-being of Communities”—

and—

“Protect and enhance the environment for its own sake”.

According to neuroscientists, buildings and cities can affect our mood and well-being—I believe they do—and specialised cells in the hippocampal region of our brains are attuned to the geometry and arrangement of the spaces we inhabit. For example, evidence shows that people’s happiness levels can be more easily achieved by living in an aesthetically beautiful city or a beautiful location in the countryside. I declare an interest as chair of the all-party group on healthy homes and buildings. Last week we launched a white paper in which we outline the need for modern homes to be energy-efficient, to have the correct air quality, and to be aesthetically pleasing to the eye inside and out. Last week the hon. Member for South Norfolk (Mr Bacon) introduced a ten-minute rule Bill on those issues and how we can make housing more accessible to people right across the United Kingdom.

[John Howell]

The hon. Gentleman talks about the need to provide infrastructure along with housing, but environmental infrastructure is the big thing that is mostly missing in the development of new housing estates.

[Jim Shannon]

I agree with the hon. Gentleman. He is right. That is why we make sure that the environmental impact is a big part of development approval in Northern Ireland. He is clearly right and that should be at the centre of any development on the mainland as well.

Studies have shown that growing up in a city doubles the chances of someone developing schizophrenia and increases the risk for other mental disorders such as depression and chronic anxiety. Despite a higher concentration of people, much of that stems from a lack of social cohesion or meaningful neighbourly interaction. It could be one of the reasons that access to green spaces, where people can gather and escape, is so important for people living in cities. The correct environment around someone helps emotional and mental well-being.

Although we face potentially different issues in rural areas, the need to ensure that developments are in keeping with the area and, if possible, enhance it rather than detract from it is vital. The greatest problem in rural areas is the increasing need and demand for developments, and, as a result, improved infrastructure in terms of roads and transport. Of course, rural development always poses difficulty, especially in areas that have either seen an influx of new buildings or in more remote areas that are almost untouched by architecture or by any development at all. In both cases—I can speak with some authority on this because it is something that many constituents have come to speak to me about—the fear is that something is being lost, and that natural beauty and natural habitats are being replaced by concrete and stone. Perhaps unsurprisingly, that rarely sits easily with residents.

We are also, arguably, more aware than we ever have been before of the impact that we are having on the world: our carbon footprint and the increase in pollution and waste. That is an issue for us every day in this House and outside. Those are fairly new considerations that architects now must deliver as well as ensuring that buildings are safe and structurally sound, along with providing an element of beauty for the local area. The Government have set some money aside within the health budget to address mental health issues. I read the other day that among students and young pupils in school there has been a 50% increase in mental and emotional issues. In Northern Ireland we have 10,000 children who have such issues. It is good that the Government have set that money aside. We need to have departmental co-operation and interaction to ensure that what we deliver in terms of houses also helps to reduce the mental and emotional issues.

In rural areas we must ensure that the requirement to bring something to the local area and to enhance it—at the same time as complementing the local environment—is always met. In urban areas more needs to be done to ensure that, where possible, residents have access to green open spaces and that architecture can respond to the demand for something different and interesting, particularly as simple and monotonous architecture has already been shown to have a more negative impact on citizens. When something as simple as our surroundings can have such an impact on our daily lives and therefore on our mental health, it is important that measures to improve the aesthetics of new and existing buildings should be considered.

Again, I congratulate the right hon. Member for South Holland and The Deepings on securing this debate and I look forward to other contributions.

15:16

[Mr Edward Vaizey (Wantage) (Con)]

I am grateful for the chance to appear under your chairmanship, Ms Dorries. I thank my right hon. Friend the Member for South Holland and The Deepings (Mr Hayes) for securing this important debate. He started by asking whether we could remember a time when beauty had ever been debated in this mother of Parliaments. I confess I cannot recall a particular date, but what is lodged in my mind is 6 June 2005. The Tory party was still on its knees after yet another election defeat, but that great man, my right hon. Friend the Member for West Dorset (Sir Oliver Letwin), made a speech about beauty.

That has always stuck in my mind, because it was the first and probably the last time that a politician talked about beauty. My right hon. Friend was the environment spokesman, and he made many of the points that my right hon. Friend the Member for South Holland and The Deepings has made so eloquently in today’s debate, with almost mirror-image quotes about how people despise litter and love their landscapes, and how people are up in arms if someone threatens to build over much-loved parts of our country. So why do politicians not talk about beauty when most people live their lives yearning for beauty in some shape or other?

Of course, the language of bureaucrats and bureaucracy takes over, but when we talk about planning we are really talking about beauty. Planning is a system that is designed in some shape or form to try to regulate beauty. It is ironic that many of the buildings and much of the architecture that my right hon. Friend praised were built when planning laws were much more relaxed. When we walk through the medieval streets of the City of London we walk through an entirely unplanned city, which would have been planned after the great fire of London had not the merchants revolted against Christopher Wren’s masterplan, but we cherish such beauty.

Modern planning is a system to try to regulate beauty. As a new Back Bencher and then later as Minister for Culture, I lobbied hard for the terminology of beauty to be put into our national planning framework. When my right hon. Friend the Member for Welwyn Hatfield (Grant Shapps) was Housing Minister, he came up to me in the Lobby after the 2010 election and thanked me for being a pain over our years in opposition when I was lobbying him to put design principles in the national planning policy framework, and he thanked me for helping him to understand its importance.

Nevertheless, we have not covered ourselves in glory since. I, for one, hold my hand up as having been at the Department for Culture, Media and Sport when we downgraded and merged the role of the Commission for Architecture and the Built Environment—I think it was subsumed into the Design Council. I should be interested to hear from the Minister what engagement he has with what is left of it.

I do not say that CABE was a perfect model, but to have just one organisation out there holding planners and, more importantly, developers to account for design principles was important. In fact, someone from CABE, when it was still alive, kindly took me around a development in my constituency and pointed out where the developers had put in money and effort, and where that had petered out, resulting in the creation of buildings that were not, of course, unliveable, but were certainly not designed in a way to create harmonious surroundings. It was not really a question of money; it was a question of laziness.

What my right hon. Friend the Member for South Holland and The Deepings said about how easily things could change is true. I remember bringing the architect Terry Farrell to my constituency. I am not going to defend his buildings, but as an urban planner he is quite impressive. He sat down with residents of Wallingford, a medieval town in my constituency, pointed to the thousand-year history of settlement around it—towns and villages that developed around what had been marshland—and talked about how it might be developed sympathetically and harmoniously. The residents were supportive. I do not say that if his master plan had come to fruition and the houses had been build they would not still have manned the barricades, but just to be engaged and have someone acknowledge the history of their beautiful town was enough.

I should like to hear from the Minister not only about the incorporation of design in planning principles, but about a slightly more mundane although still important issue—the quality of new buildings. Linden Homes, probably the worst developer in my constituency—the bar is pretty high—is building houses in Cholsey that are literally falling down. I have had to go and visit constituents. Miller Homes in Drayton and Kier in Shrivenham have also had some problems with their buildings. The quality of building is shockingly bad. The great irony is that the building trade has not yet been disrupted by technology. Despite the terrible connotations, we should be building prefabricated homes. The Germans have done so for years. We could build quality homes in factories and erect them at lower cost, and with higher design quality, than the terrible homes being built by Linden Homes at the moment.

My right hon. Friend the Member for South Holland and The Deepings mentioned the work that Policy Exchange is doing, which I applaud. A remarkable meeting is happening at lunchtime on Thursday, when a Syrian architect called Marwa al-Sabouni will be interviewed by Sir Roger Scruton. In the middle of the bombardment of Homs, that lady emailed him to ask him a question about his book on aesthetics. His talk is about the role of architecture in the Syrian civil war, which sounds completely out there, until one hears her quotation about the “lack of beauty” in Homs and

“the promise of a good life that architecture can inspire”.

She said:

“The old city of Homs used to be known as ‘the mother of the poor’. You didn’t need money to live there. It was a place of trees, and jasmine and fruit.”

That phrase could almost have been written by my right hon. Friend. She continued:

“But then the new city, with its corruption and its modern blocks, developed over it, bringing with it a lack of hope, despair.”

She is someone who, in the midst of an incredible conflict, with her family at risk and her friends being killed, was able to take time out to appreciate the importance of beauty.

Everything I shall say after that will seem mundane, but I certainly want design and beauty to be incorporated into planning principles. Policy Exchange has called for places of special residential character. The idea was put to me by the Duke of Richmond, about Chichester, for example. Could a heritage listing be given to some of our great cities and towns, to preserve them?

Will the Minister update us on whether what I read in the newspaper last week is true—that the wonderful, protected views of St Paul’s in London are now under threat from developers? That really would be a case of knowing the price of everything and the value of nothing. Those wonderful views keep London as the green, liveable city it remains, despite its being one of the world’s most globally successful cities. Everywhere we look in public policy, design and beauty are vital. How pleasing it was, even given the delays with Crossrail, that design and beauty were thought about in the design of stations. How pleasing it is that design is being made central to the character of High Speed 2; I hope it will get built. To echo, again, what my right hon. Friend said so eloquently, within the design of HS2 people in Birmingham want to build a station that is a homage to the great stations of the 19th century—a place of arrival, great welcome and beauty.

I want finally to give a small nod to my old beat of the arts, and mention the White Paper that I managed to publish before I got fired. It put place making at the heart of cultural policy—the opportunity to work with the arts to help to create and support places of great beauty.

15:26

[Douglas Chapman (Dunfermline and West Fife) (SNP)]

It is a pleasure to serve under your chairmanship, Ms Dorries, and I thank the right hon. Member for South Holland and The Deepings (Mr Hayes) for bringing this important debate to the Chamber. I reacted to some of the points he made with great empathy and understanding, and I appreciate his approach.

When I first looked at the Order Paper, and thought about the legislation and the planning frameworks that underpin these matters, it seemed on the face of it that this would be a very English debate, because the frameworks in Scotland are different. However, the speeches have been very full in their coverage, and we have had an exciting view of what the future might bring if we can get the frameworks right.

My constituency contains one of the largest housing developments in western Europe—the Dunfermline eastern expansion—and perhaps that fact allows me to contribute to the debate on design and beauty, which are applicable in all constituencies and communities, irrespective of the planning guidelines that are used. The eastern expansion has brought what seems like never-ending growth to our mid-sized Scottish town, which has grown by easily a third in the past 10 to 15 years. The homes can be regarded as fairly similar in their design, reminding me of the song about houses that are

“all made out of ticky tacky

And they all look just the same”.

However, while there are some good examples of design and layout within that massive development, quite a lot of opportunities have probably been missed. If all the houses were triple glazed, with higher standards of insulation, and had solar panels or different kinds of renewable power built in as standard, that would give an environmental boost to the way we look at homes. The fact that people now need to retrofit some of that new technology is a backward step. Perhaps we should pay more attention to the guidelines on how to make homes more environmentally friendly in future. Some of the things I have mentioned are not visually appealing, but when we put less pollution into the environment that is surely a benefit for all citizens. It improves the environment we live in, especially when such things as air quality are so far up the environmental agenda.

Scotland starts with quite an advantage, in terms of general layout. Urban Scotland is more green than grey, and green space covers more than half of urban land in Scotland; I think 54% of urban land there is deemed green space. That translates into the equivalent of a tennis court-sized piece of publicly-accessible green space for every person, which is quite a high bar to have set and to maintain. This is not just a matter of the new homes such as those in the eastern expansion. We can surely get big wins, if we have imagination, by bringing empty houses and derelict land back into positive use, especially if that breathes life into town centres.

A great example in my constituency is the rebuild of an old linen mill that lay empty and unloved for the best part of 10 years. It is now being restored and rebuilt to create 200 new flats, but without losing all the outward appearance of the old mill building. That new life will bring vitality to our town centre, not to mention new homes for people to rent or buy.

The Scottish Government fund the Scottish Empty Homes Partnership, in conjunction with Shelter Scotland, to help councils to work with owners of empty homes to bring them back into use. Some 700 homes have been brought back into the market this year alone, and Scottish local authorities can remove council tax discounts on empty homes. They can even increase council tax on those homes, so that there is an incentive for homeowners to refurbish, re-let or sell their properties, and perhaps allow an uncared-for home, or an eyesore in a town or village, to come back into use. That initiative is supported by the £4 million Scottish empty homes loan fund, which supports 17 housing projects and is targeting 500 homes across the country.

The old linen mill I mentioned is a short walk from the new Dunfermline galleries and library—a development that was crowned “Scotland’s best building” in 2017. It has already won numerous design awards and is likely to be shortlisted for many more. The architects have managed to integrate the older Carnegie library, which was built last century, with a new glass and stone structure that has an open aspect across to the 10th-century Dunfermline Abbey and views across the Firth of Forth. Taking in that view, we can see Dunfermline High School, which opened a few years ago. I am particularly proud of that development, because in a previous life I was one of those councillors who Members mentioned in thinking about how we can encourage councillors and people who make local decisions to be more open to the visual aspects of our buildings.

I was chair of the council’s local education committee when Dunfermline High School was built, and I remember the endless meetings, care and attention that went into the design and functionality of that new school. In the end, we got a school that is light, airy and fit for purpose. Many Members have highlighted the psychological effects of good planning and design, and how that can affect our mental state and general outlook. Educational attainment figures for Dunfermline High School have risen on the back of that new building, and such examples highlight why good investment in public design and smart, aesthetically pleasing architecture raise both spirits and performance, and give us all a feel-good factor.

This has been a bit of a constituency tour—I am sure other Members have examples of great buildings in their constituencies—and I have saved the best to last. The Queensferry Crossing opened last year, on time and under budget; I am sure the Minister would be interested in having budgets like that all the time. It is a superb structure of immense architectural beauty, and it is framed against the backdrop of the Forth road bridge, and the iconic UNESCO-recognised Forth rail bridge. Those bridges were built in different centuries—if Members are interested, they can look on my Twitter feed, @DougChapmanSNP, because I managed to take a picture of all three bridges during my flight on Monday morning. If people want to see those views, they should do so. That might raise their spirits for the rest of the afternoon.

This has been an extremely valuable debate, especially in Budget week. Usually, anyone in charge of spreadsheets knows the price of everything and the value of nothing, but this debate has shown that many Members do know the value of our built environment, albeit it sometimes comes at a price. If we can better train our councillors and planning authorities to value design and beauty, and if we give them the planning frameworks and legislative tools, such as the Scottish Government’s Creating Places policy, we can start to put those factors at the heart of the communities we are trying to build or rebuild. If we can do that, today’s debate will have been very worth while, and I look forward to the Minister’s comments.

15:35

[Dr Roberta Blackman-Woods (City of Durham) (Lab)]

It is a pleasure to serve under your chairmanship again, Ms Dorries, and I congratulate the right hon. Member for South Holland and The Deepings (Mr Hayes) not only on having the most beautiful name for his constituency, but on securing this important debate on beauty. I will return to his comments in a moment, but first I wish to thank the hon. Member for Strangford (Jim Shannon) for his remarks. I think he introduced a very important aspect of this debate, which is the link between beauty, a healthy environment and people’s health, including their mental health. He also reminded everyone how wonderful and beautiful Strangford is. After everyone has been to visit Durham, I encourage them to go and visit Strangford—I hope he is happy with that.

The right hon. Member for South Holland and The Deepings made an amazing speech. I will not be able to match his eloquence in any way, but I hope I can offer him a service by endorsing his comments, which were long overdue. I hope that this debate starts a different discussion in this place about what planning can and should deliver.

The right hon. Gentleman raised an incredibly important topic that I learned about early on as a young academic in Belfast. One of the first projects on which I was included in the research team evaluated the impact of Divis flats on the health of the local community. Some Members might not know this, but the Divis flats were completed in 1966, as were a lot of deck-access blocks in this country. There were 12 eight-storey deck-access blocks, with one 20-storey block at the edge. I carried out my research in the 1980s, but people had maintained for many years that those blocks of flats adversely impacted on their health and wellbeing.

During the study we discovered huge amounts of asbestos; that ultimately led to the blocks being demolished, which is what the local community wanted. People were propelled into campaigning, however, by the fact that they simply felt that they were not living in a good environment. They had to walk a long way along deck-access corridors that frequently had no lights, and they could not easily access transport. All the space was common space—there was very little external space. I do not know whether what replaced the Divis flats would pass the test set by the right hon. Gentleman, but it is interesting to note that those flats were replaced by streets of houses with lots of garden space and public areas of green space. The streets are near the city centre, and there is access to employment. People got better access to bus routes, and the community went from having a great many problems to being self-sustaining. I learned early on that the scale and quality of a development is very important to our sense of wellbeing.

This is not a new topic; it is a lesson we have learned before and we appear to have to learn it again. Raymond Unwin, whom I think we all accept as the father of town planning, said in 1909 that we needed to make a real case for the importance of attaching beauty and art to town planning policy. Somewhere along the way, we lost that attachment, and that needs to be addressed. ResPublica found that English people believe beauty to be a right rather than a luxury, and 81% of those polled believed that everyone should be able regularly to experience beauty, whether in the natural environment or through other methods, including those that planning can deliver for local areas.

Through the debate, the right hon. Gentleman has encouraged us all to focus on what the fundamentals of planning should be and how planners working with local communities—I will say more about that in a moment—can deliver a vision for what an area needs. Tools are also needed so that that vision can be realised in a way that local people are happy with, which means that planning has to move from using the very technocratic methods that it employs at the moment to doing something more visionary and inclusive.

As we are in the middle of a housing crisis and know that we need to deliver many more homes every year, much of our discussion in this place concentrates on the need to improve housing delivery. I hope that the right hon. Gentleman can usher in a new discussion about place making, because although it is important that we have the homes that we need, those homes sit in communities. All too often we do not pay attention to the other things that communities need to thrive: proper infrastructure, access to public services and access to employment.

We do not talk enough about good-quality design, or about how to not only save green spaces, but make them. The Minister could consider incentivising taking brownfield land in cities back to being green space, because there is often no land that has not been built on to be made into such a space. I also hope that he will consider how to give the national planning policy framework more teeth. It is okay to exhort people to have better design and have discussions in this place about it, but unless we get some regulation in the system and create the level playing field for developers that the right hon. Gentleman talked about, we are never going to raise the quality of new building. In particular, local people need to be involved at an early stage, so they can talk about the type of development that they want and make the historical and modern references that they would be willing and able to make if they were supported through the planning system.

The Minister also needs to look at permitted developments. Yesterday, I was horrified to hear the Chancellor say that there might be more. Permitted development is leading to some of the poorest housing we have had in this country for a long time—barely a third of it meets basic standards. We need proper planning in place to deliver the quality homes that we need, but permitted development does not provide that, and having more of it on our high streets could be a problem. Of course, we want change of use and a flexible planning system—it has to reflect changing needs—but permitted development ushers in poor quality, and I hope that the Minister will reject it and look instead at developing a new planning system that is much more community focused. That system could have regional or national planning tiers and focus on what our neighbourhoods need and what people say they need to thrive as communities. I know that the Minister is quite new to his job, but I look forward to hearing his response.

15:44

[The Minister for Housing (Kit Malthouse)]

It is a pleasure to serve under your chairmanship for the first time, Ms Dorries. You and I were both brought up in a city punctuated by architectural superlatives, but also scarred by some of the worst examples of architectural vandalism over the last three or four decades, so this debate is of interest to us both. I congratulate my right hon. Friend the Member for South Holland and The Deepings (Mr Hayes) on his fantastic speech. It will sit in his canon, alongside his groundbreaking and remarkable speech, “The journey to beauty”, which I have read several times now. He gave it as Transport Minister and it caused quite a stir in the industry at the time. He is without doubt an aesthete and a patriot, and I salute his indefatigability in the face of the ugliness that he rightly calls out. I am tempted to say “I agree” and sit down. He knows however that the issue of beauty in the built environment is close to my heart, so I shall continue.

One of the advantages of having a poet on your speechwriting team in the Department is that they quite often recall to us some of the poetry of our youth. In preparing for this speech, we considered Larkin’s “An Arundel Tomb”—a wonderful poem—which reminds us, with his image of the earl and countess captured in stone, that the things we build today could last for centuries, and that we have a duty to future generations to ornament their lives as ours have been ornamented by the generations that preceded us.

When the Prime Minister asked me to take this job, she was clear about my task: she wanted more, better, and faster homes. Those are the three indivisible words by which I live. We are talking in particular today about the “better” bit; building more beautifully, because in the words of the architect Frank Lloyd-Wright:

“If you foolishly ignore beauty, you will soon find yourself without it.”

Back in 2010, just 134,000 net additional homes were added to the country’s housing stock, but today, the Government are in delivery mode. The number of additional homes is up 55% to 217,000 per annum, and we are well on our way to reaching our target of 300,000 per year. We have always been clear that building more does not mean that we cannot build better. As my right hon. Friend said, we have to quash the myth that quality and quantity cannot go together. In fact, the more we build, the more important it is that we get it right. While I accept his challenge that beauty is not a relative term, when it comes to our built environment it is often in the eye of the beholder, so no matter what we do, some people will be unhappy.

We all know what beauty should feel like. Beautiful places not only make us happy but keep us well, and move us from fear and anxiety to hope and happiness. They welcome us, inspire us and elevate the mundanity of human existence. Great housing developments do not have to be billion-pound projects—the overall winner of last year’s Housing Design Award was a mixed-tenure regeneration scheme in Camden—and critically, beautiful places to live and work should not be the preserve of the wealthy, as my right hon. Friend also pointed out. No matter where one stands on design, our first obligation is to ensure that communities get what they need in a form that they appreciate.

The Government are leading on that by putting beauty at the heart of our housing and communities policy. In both the housing White Paper and the social housing Green Paper, we are focused on creating great places and on design quality. Homes England, our new and more assertive national housing agency—I launched its strategic plan this morning with an exhortation to beauty in all that it does—is promoting design quality through its programmes. In July, our revised national planning policy framework put another stake in the ground. It states that

“permission should be refused for poor design”

especially when it

“fails to take opportunities to improve the character and quality of an area.”

In decades to come, we want to look back on this golden age of housebuilding not through the windscreen of a bulldozer, but with a view to treasure, preserve and invest in what lies before us.

We must learn the lessons of the 1960s and 1970s. My right hon. Friend referred to the Birmingham central library, which has now been demolished. The same is true of Robin Hood Gardens, as well as Pimlico school—a brutalist concrete school in a ward where I served as a councillor—which I played a part in having demolished. They are temporary buildings.

[Mr John Hayes]

While the Minister still has 10 minutes left, let me ask him if he will agree to three things: first, to draw up a blacklist of blight, which would allow us to demolish many more buildings of that kind; secondly, to put in place obligatory local design guides so that local authorities have to build in a style that is suitable and appropriate; and, thirdly, to back the Mail on Sunday campaign to protect urban green spaces. The hon. Member for City of Durham (Dr Blackman-Woods) spoke about level playing fields, but any playing field will do. Playing fields are places where people dance, play, meet friends and enjoy the open space. We need to protect them. Will my hon. Friend do those three things?

[Kit Malthouse]

My right hon. Friend raises some interesting issues. As he knows, I am in the process of producing the guidance to the NPPF, and I shall certainly take his advice as I do so. He might be interested to know that when I was at City Hall, I suggested a competition for Londoners to vote each year for a building that should be demolished, and that we should provide grant support to assist in the demolition of that building, if required. However, let us see where we get to with the guidance.

My right hon. Friend mentioned local materials and the vernacular, and we want to draw from the history of any area the use of materials that mature and age gracefully. Critically, we want to build the conservation areas of the future. That is a challenge I have put to the housing development community in a number of forums over the past three or four months that I have been in this job. That does not mean that all new homes and public buildings need to be a replica of the local style, but they do need to fit in, in the broadest sense of the term.

We are therefore supporting high-quality, high-density housing such as mansion blocks, mews houses and terraced streets, typical of the English urban townscape and rural context with which we are all familiar. In particular, I am keen to see the re-emergence of that great British gift to the world of architecture, the garden square. It is possible for modern, efficient and technology-driven design to echo our history and to reflect the local area without becoming pastiche. That is something we have sought to achieve with our garden communities programme.

More than a century ago, Sir Ebenezer Howard first outlined his idea of a garden city. He had a vision of places where people could work, raise families, travel easily and enjoy green spaces. We are renewing that idea for the 21st century, and we have set out clear expectations for high-quality place making across our country. That is a chance to aspire beyond identikit housing, which my right hon. Friend identified, and town centres that look like everywhere and nowhere. We are championing ambitious councils, which see garden communities as a central part of their plans for housing and growth. Our programme supports 23 places to deliver more than 200,000 new homes by the middle of the century. I hope that we might be able to rise to his challenge to produce 100 new parks, if each of those places has four.

We are not only building homes; we recognise that we are building neighbourhoods. Developments of 500 units or more are bigger than most villages, so we have to think in terms of neighbourhoods that function, as my right hon. Friend pointed out. To achieve that, however, we know that local planning authorities need design capacity, so we have directed almost £5 million to 26 local authorities through our planning delivery fund, to support them in developing innovative ways to increase design skills throughout the country.

We are also running workshops for councillors, to help them to understand and to support their role in ensuring beauty in the built environment. The workshops will offer them the opportunity to discuss the challenges that they face and, importantly, to share their own experience of promoting design quality. We are bringing in people from across the sector—from local authorities to developers, housing associations and architects—to share their ideas about beauty and great design.

[Mr John Hayes]

Will the Minister—we are lucky to have him, by the way, and the shadow Minister—agree to meet me and the Prince of Wales’s organisations to discuss how to learn from the work he has done and is now doing?

[Kit Malthouse]

I am more than happy to meet. In the past, I have worked closely with the Prince’s Foundation for Building Community—I knew Hank Dittmar quite well before he sadly passed away—and I would be delighted to become reacquainted with the prince’s work, not least because earlier this year we held a design quality conference, the first of its kind, which was attended by 380 people from across the sector, and we want to do more of that kind of work, because the responsibility to build more beautifully rests with all of us.

Where the Government are leading, I encourage the private sector to follow. When I bring that message of “more, better, faster” to the sector, I always stress how design matters at every level, from planning to community acceptability: build beautifully and get permission, build beautifully and sell more houses, and build beautifully and communities will actually welcome developers, rather than drive them out of town at the tip of a pitchfork.

[Mr Vaizey]

First, I echo what my right hon. Friend the Member for South Holland and The Deepings (Mr Hayes) said: we have had far too many Housing Ministers, and I call upon the Prime Minister to keep this wonderful man in office until the 2022 election and many years beyond. Secondly, I caution against this debate tipping over into an attack on modern architecture. Robin Hood Gardens may not be lamented, but Park Hill in Sheffield—a similar design—has been restored and is much loved. As the Minister who listed Preston bus station to much anger, I am delighted that it is now treasured by the local community.

[Kit Malthouse]

I acknowledge what my right hon. Friend says, but as my right hon. Friend the Member for South Holland and The Deepings said, that is often an accident of ergonomics, form and beauty coming together, just as it did for the roof at the British Museum—an extraordinary structure in which, exactly right, ergonomics and form come together.

Some of the best examples of beautiful buildings are delivered by small and medium-sized enterprises, from self-build to the refurbishment of historic buildings. Sadly, the 2007-08 economic crash killed a number of such growing developers, and we are yet to see a new talent pool emerge. I believe, however, that SMEs are part of the key to the challenge. That is why we are directing our home building fund towards SMEs—to give them the confidence to grow and build, and to raise the bar on design quality. By having more players in the market, we shall get them to compete on innovation and quality.

Ultimately, it comes down to delivering houses that people want to live in, buildings where people want to work and places that people want to call home. More than that, we must build things that elevate and entertain. That is what the Government are hoping to and will deliver in the future. I look forward to working with many hon. Members on that most important of missions. I close by—

[Mr Vaizey]

London views?

[Kit Malthouse]

Sorry, yes. I asked my team to update me on the London views. Apparently, there is a campaign by London First and other developers to relax the protections, but so far they remain in the draft London plan. We shall see where that plan lands.

I shall finish my speech by returning to that Larkin poem. Members may remember—I am sure that my right hon. Friend the Member for South Holland and The Deepings does—that the most affecting part of that poem is in the second stanza, when Larkin reveals that the couple he has been looking at are actually holding hands. They have been holding hands for the centuries for which they have been lying there. At the end of the poem he ends with that famous line:

“What will survive of us is love.”

In 200 or 300 years’ time, what will future generations see as a symbol of our love for them, projected forward in time? All that will survive of us is those things that we build today. We are joined in our ambition to ornament their lives and to create the beauty that will enhance their existence for centuries to come, as ours has been enhanced by the generations who came before us.

[Ms Nadine Dorries (in the Chair)]

I am not sure, Mr Hayes, if there is any point to me asking if you would like to have the last two and a half minutes.

15:58

[Mr John Hayes]

Simply to repeat, Ms Dorries, that we are lucky to have a Minister—and, by the way, a shadow Minister—of such calibre. He is right: we are talking about what we do for generations to come—those born later, as I described them.

Speaking of Larkin, urban planners have done to too many of our fellow Britons what Larkin said all our parents do to us. Now it is time for Government to raise their sights to a more distant horizon. Beauty is not a bolt-on, an extra or something that we may opt for; it is intrinsic to developing a sense of place, which is essential to a sense of value and worth, as the Minister clearly understands. That is not only about future generations, but about the common good now.

As the Government move forward on their plans for housing, they need to have a debate about quality and not to be limited to a debate about quantity. It is absolutely right for those two things not to be paradoxical. It is entirely possible to build homes that people want to live in.

I hope that the Minister will make the ambition of 100 new parks come to life; that he will prohibit development on the green spaces where, as I said, people play, make friends, dance and dine; and that he will be insistent that all that he has said today informs not only his thinking but Government policy into the future. It is right for buildings to elevate, as he said, but more than that the buildings and the politics should enthral. That is not merely an aspiration, but the duty of all of us, which is why I am delighted to have introduced this debate.

Question put and agreed to.

Resolved,

That this House has considered beauty and the built environment.

Five Year Forward View for Mental Health

Tuesday 30th October 2018 Westminster Hall

[Mr Philip Hollobone in the Chair]

16:00

[Jeff Smith (Manchester, Withington) (Lab)]

I beg to move,

That this House has considered the five-year forward view for mental health.

It is a pleasure to serve with you in the Chair, Mr Hollobone. The key purpose of the debate is to represent the recent report of the all-party parliamentary group on mental health, of which I am vice-chair. We published “Progress of the Five Year Forward View for Mental Health: On the road to parity”, which is a report on the progress of the five year forward view at the halfway stage.

I pay tribute to the cross-party group of MPs and peers who took part in the inquiry, particularly the hon. Member for Faversham and Mid Kent (Helen Whately), who is the chair of the APPG; she is with us in this debate and I think she will make some remarks. I also pay tribute to Rethink Mental Illness and to the Royal College of Psychiatrists, which provided us with excellent secretariat support and supported us throughout the inquiry. I thank the Secretary of State for Health and Social Care, who attended the parliamentary launch of the report and engaged in a very helpful question and answer session.

The report is a summary of more than 70 pieces of written evidence, two oral evidence sessions, a focus group of service users and carers, and a visit to a mental health trust. It is a serious and informative piece of work that could help to make a difference in informing the NHS’s long-term plan. There are three main sets of recommendations in the report, including some important ones on joining up work with other services, particularly social care and housing, but this is quite a short debate so I will focus only on two questions.

I am interested to hear from the Minister about the Government’s plans to support people with severe mental illness. The report shows that adults severely affected by mental illnesses such as schizophrenia or bipolar disorder are left behind. We saw no consistent and coherent approach on how to support people diagnosed with personality disorders. The inquiry heard that there are no targets for how long adults should have to wait to access eating disorder services. Those illnesses have a severe impact on people’s day-to-day lives and can be lifelong conditions. It is not acceptable that people who are the most ill often wait the longest to get care.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing the debate. Although I appreciate, as he will, how big a task this is, I welcome the Government’s commitment to mental health funding in the Budget. But I am concerned that we are getting nowhere in reaching parity of esteem. The number of children and young people experiencing mental health problems has risen sharply, and they often go to A&E for help. Does he share my view that funding is needed to ensure that children and young people suffering with poor mental health have safe places in the community to turn to for help and support, without having to rely on A&Es, which are already under duress?

[Jeff Smith]

I very much agree with the hon. Gentleman. Although I will never say that increased spending on mental health is not good, the announcement in yesterday’s Budget of extra funding for mental health teams in A&Es points to a problem because we should not have to increase spending on A&Es. We should try to cut the number of people who have to go to A&Es at an earlier stage, and we must invest at an earlier stage.

[Rachael Maskell (York Central) (Lab/Co-op)]

I am very grateful for the APPG’s work. One of the biggest concerns is about mental health support in further education colleges, which seems to have gone completely off the radar. Both colleges in York have told me that there is increasing crisis in further education, particularly on self-harm by young people—now that there are more exam-based assessments, that is escalating at a pace. Does my hon. Friend agree that we must focus on prevention in FE colleges, to ensure we have the right health professionals based in those colleges?

[Jeff Smith]

I absolutely agree with my hon. Friend. Child, adolescent and early adult mental health is a big and growing problem.

The five year forward view recognised creating treatment pathways for people with bipolar disorder, adult eating disorders and personality disorders, but halfway through the plan, the inquiry found that those are still to be published. It is vital that NHS England implement in full all pathways recommended in the five year forward view.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate the hon. Gentleman on securing this debate. I draw Members’ attention to my entry in the Register of Members’ Financial Interests. Although there has been a commendable focus on increasing talking therapy through the IAPT—improving access to psychological therapies—programme, that tends to be cognitive behavioural therapy. The evidence base for helping people with personality disorder, particularly emotionally unstable personality disorder, is dialectical behaviour therapy. There is a real paucity of other talking therapies such as DBT available throughout the country, but particularly further north than where we are sitting, in London.

[Jeff Smith]

The hon. Gentleman has great experience and knowledge of those issues and makes an important point. He has anticipated some of the comments I will make and I strongly agree with him.

[John Howell (Henley) (Con)]

We, as MPs, are among the first to come across the sort of patients the hon. Gentleman is talking about. Does he agree that training ought to be provided for MPs, so that we know how to deal with those people when they appear at our surgeries?

[Jeff Smith]

That is an excellent point; some training packages are available for MPs’ staff. I encourage all colleagues to take advantage of that.

The vast majority of people severely affected by mental illness will receive support within a community mental health team, which is the type of core service that provides help to around 700,000 people in England, often with quite complex needs. Although some specialist services have benefited from additional funding and targets, core services for adults severely affected by mental illness have stood still. Core community services did not receive any funding under the five year forward view, and we found that only £50 million was allocated to other core services nationally.

[Mike Hill (Hartlepool) (Lab)]

In Hartlepool, there is no drop-in centre for people in crisis. Crisis teams are stretched to the limit, and often people wait for two hours or more to access them. Given the current funding review, does my hon. Friend agree that we must urgently resolve such situations?

[Jeff Smith]

Again, that is an excellent point and I strongly agree. The report makes it clear that core services are underfunded and under pressure. There has been great success in getting people better access to psychological therapy, but while IAPT is an excellent service it is not designed for people with severe mental illness. Core services are too overstretched to provide timely talking therapies to people with more complex needs, so those who are most ill often have to wait the longest to get help. Simon Stevens, the head of the NHS, said at the Global Mental Health summit that he believed that we must restrike the balance between new talking therapy services for patients with less severe conditions and the core services for those with long-term and severe mental health needs.

We heard many examples of people with severe mental illness struggling to get therapy. One service user came to us; they had a history of psychosis and were told by their GP that if they wanted to access psychological therapy quickly, they should lie to the IAPT team about having psychosis to avoid being rejected for treatment, because it was too difficult to get the treatment they needed for their condition.

In the worst case scenario, people can be hit with the double whammy of being told they are too ill for IAPT but not ill enough for a core mental health team. People are then left struggling. Another service user, Dani, who has a diagnosis of borderline personality disorder, spoke at our parliamentary launch and contributed to the report. She said that she felt it was strange to be called a service user because her experience was mostly of being told that she was not suitable for services, rather than actually using them.

The inquiry saw the consequences of what happens when people do not get timely support in the community. First, there is a rise in inappropriate out-of-area placements. At the end of June this year, there were 645 inappropriate out-of-area bed placements. Secondly, there is a rise in mental health crises. The report notes that attendances at A&E for a mental health problem have risen 94% since 2010. In our inquiry, we heard from service users who expressed their frustration at turning up at A&E and waiting hours to be seen, before being sent home after a brief chat with a professional. Extra services in A&E, as we were promised yesterday, are positive but a much better solution would be intervening so people do not have to go to A&E. A model already exists where mental health calls to 111 or 999 are redirected to a specialised 24/7 support service staffed by experienced psychological wellbeing coaches, social workers and mental health nurses, who can provide assessments and real-time support. That is successful and it could be rolled out as a national standard approach, which is something the report recommends.

Mental health crises should not be considered an inevitability for people severely affected by mental illness. It is entirely possible to stop people having to go to A&E in a crisis if community services intervene early enough to support them. Support across the country is patchy, unfortunately, as core services struggle to meet the increased demand on budgets. We should not be creating a system that steps in only when people reach breaking point. That is why the report recommends that NHS England should increase resources for core mental health services, such as community mental health teams. Will the Minister set out how the Department of Health and Social Care will help people with severe mental illnesses who are being left without support?

Secondly, I would like to focus on the issue of workforce. Will the Minister set out how we will ensure that we have the staff to meet the needs of everyone with a mental illness? Throughout the inquiry, we heard regularly that the issue of workforce is the biggest barrier to achieving the five year forward view. When workforce and funding for them do not meet demand, the thresholds for accessing treatment rise. That is a problem not just in core services, but in child and adolescent mental health services and across the board.

[Dr Poulter]

The hon. Gentleman is again making an important point. It is all very well talking about the aspiration of putting more money into mental health and expanding services, but improvement cannot be delivered without the workforce on the ground to provide care. There are serious recruitment and retention challenges across the mental health workforce. If we are talking about the crisis with young people, there is a real problem attracting people into the CAMHS workforce, particularly to become CAMHS consultants and CAMHS psychiatrists. That is an issue that the report picks up in great detail, but I hope he will join me in urging the Government to address this as a matter of urgency.

[Jeff Smith]

The hon. Gentleman makes another excellent point. Health Education England’s plan commits to 19,000 more people working in mental health by 2021, but between March 2017 and March 2018 the number of mental health staff in the NHS increased by just 915 people. That does not look like progress is on target. One in 10 consultant psychiatrist posts is empty and between April 2010 and 2018 there was a 12% fall in the number of mental health nurses. What are the Government’s plans to tackle the problem of the mental health workforce?

The report makes some recommendations and suggests that Health Education England and the Government look at all measures to increase the mental health workforce. There is a huge interest in mental health among young adults. Until we undertook the report, I did not realise that psychology was the third most popular undergraduate course for students starting university in 2016. We should make it easier for those capable, ambitious and keen graduates to work in NHS mental health services.

The hon. Member for Central Suffolk and North Ipswich (Dr Poulter) made the point earlier that recruiting more psychologists for specific therapies, such as dialectical behaviour therapy or cognitive analytic therapy, would mean that people had a wider choice about the type of therapy they received, instead of, as often happens, just being prescribed cognitive behavioural therapy—if they are able to get a prescription at all—because it is the only therapy available.

[Danielle Rowley (Midlothian) (Lab)]

As well as having more specialists in the NHS, does my hon. Friend agree that to tackle mental health we need good training in schools, workplaces and all the different parts of society? The point was made earlier that we, as Members of Parliament, need to have training, as well as being able to encourage a more positive attitude to mental health.

[Jeff Smith]

My hon. Friend makes an excellent point. I am probably not going to take any more interventions because I want to give the chair of the all-party parliamentary group on mental health time to make remarks and to hear from the Minister. I will rattle through the rest of my comments.

The report suggests that the peer workforce, where people with their own personal experience of mental illness support those who are currently in mental health services, should be expanded. Service users told us that it was invaluable not only in terms of positive role models, but to prevent an “us and them” barrier between patient and professional. It is effective and leads to a reduction in readmissions.

Finally, funding—the elephant in the room, as always. The five year forward view came with a headline commitment of over £1 billion invested each year in mental health by 2021. This has undoubtedly improved lives. However, the APPG heard that it is difficult to be certain that funds are reaching the frontline and that historical underfunding means that mental health is still the poor relation in the NHS. I note that a report from the Institute for Public Policy Research suggests that spending on mental health will have to double from £12 billion to £23.9 billion in the next decade to make parity of esteem a reality.

The mental health investment standard means that every clinical commissioning group has to increase mental health spend in line with its overall increase in health spending. However, last year, 24 CCGs reduced the amount they spent on mental health. Eight CCGs were classed as meeting the mental health investment standard despite the fact that they cut the amount they spent on mental health. We would welcome clarification on what the Government are doing to ensure that each CCG meets that target.

The five year forward view was never intended to solve every problem in our mental health system, but where it has been focused it has made a difference. For example, there has been success in perinatal mental health and improving access to IAPT. This report focuses on where the gaps are. We need to prioritise investment in core services and to ensure that we have a robust NHS workforce. I hope that the Minister, with NHS England, will respond positively to the report and hopefully this will reform NHS long-term planning.

16:18

[Helen Whately (Faversham and Mid Kent) (Con)]

I sincerely thank the hon. Member for Manchester, Withington (Jeff Smith) for giving me a chance to speak in the debate, as that was entirely at his discretion. It has been a real pleasure working with him on the report. I also reiterate his thanks to Rethink Mental Illness and the Royal College of Psychiatrists, which have done a huge amount of the work that has been condensed into the report. A great deal of hard work went into it, and they did most of the legwork.

I have been on quite a journey with this report. We originally conceived it back in 2016 and it came to fruition this year, at a moment that feels timely because we are mid-way into the five year forward view. NHS England is working on its long-term plan for the NHS and I hope it will be drawing on the recommendations in the report. The Chancellor has just announced a welcome £2 billion of funding for mental health out of the £20 billion for the NHS.

During the inquiry we heard about some areas of mental health where real progress has been made. We heard some truly inspiring success stories of how the five year forward view and the changes in it are changing people’s lives. For instance, we heard about new perinatal services—four new mother and baby units—which mean that when a mother is severely ill, she will be able to receive in-patient treatment and have her baby there with her, rather than their being separated, as has too often been the case in the past.

We heard about the success of talking therapy services and how many people are getting timely access to them. We also heard about the success of early intervention in psychosis. In the past, a diagnosis of psychosis could be seen as a life sentence, but early intervention really does make a difference and we heard success stories of people recovering and going on to lead mentally healthy lives.

Although there are some real success stories, there is much more to do. The report makes 24 recommendations, but given the time I will mention just three of them. There will be a little bit of repetition of what the hon. Member for Manchester, Withington said, although I will try to avoid it as far as I can, but I think it is worth emphasising these three areas.

First, the report includes the recommendation that the Government develop evidence-based treatment pathways more widely. We heard from the eating disorders team at North West London NHS Foundation Trust that having firm waiting time targets and a clear pathway for treatment had immeasurably improved care, but although the five year forward view included a timeline for creating treatment pathways across all areas of mental health, there are many areas where they have not been implemented.

Secondly, the question of workforce came up time and again as the biggest barrier to achieving the ambitions of the five year forward view for mental health. There is a desperate need to train, recruit and retain more staff at every level. We simply cannot make meaningful improvements to services without the staff to deliver them; there must be new routes into the NHS workforce, making use of psychology graduates—as has been mentioned—and psychotherapists, and bringing in more people with lived experience of mental illness, who do valuable work. It is also important that all frontline staff get some mental health training.

We heard that mental health training now forms a greater part of the training for new nurses and doctors, for instance, but there is a huge established workforce who could benefit from at least some mental health training. We heard from one carer who had done a mental health first aid course and said she had more of knowledge of mental health than her sister, who was a nurse.

Thirdly, core services are truly the backbone of mental health care. We heard that they are consistently struggling to cope with demand, leaving more people unable to get help until they reach crisis point. The focus on some of the new, exciting services has perhaps meant that the focus has turned away from those vital core services.

To sum up, great progress has been made. We are on the road to parity between mental and physical health. I feel optimistic because of the Government’s attention to this agenda and the extra funding coming in for mental health, but there is indeed some way to go.

16:23

[The Parliamentary Under-Secretary of State for Housing, Communities and Local Government (Nigel Adams)]

I congratulate the hon. Member for Manchester, Withington (Jeff Smith) on securing the debate and all hon. Members present on their contributions and interventions.

Improving care and reducing the stigma around mental health is a key priority for this Government. We welcome the report from the all-party parliamentary group, and I congratulate both the vice-chair and the chair on their work. I think my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) probably underplays the amount of effort that she and her vice-chairs put into it. The report is a timely piece of work and a well-considered contribution to the dialogue on mental health services in this country. In many ways, it mirrors the thinking we have already seen from Mind, the Royal College of Psychiatrists and others.

The statistics on mental health demonstrate the size of the challenge we face. One in four adults experiences at least one diagnosable mental health problem in any given year, yet NHS support for mental ill health has historically been seen as a “Cinderella service”, of secondary importance to other NHS services. The stigma attached to mental ill health has, at times, led mental health service users to feel marginalised.

That is why, in 2016, the Prime Minister made a commitment to improving mental health services. As has been mentioned today, we set out to achieve greater parity of esteem between physical and mental health services. In February 2016, NHS England published “The Five Year Forward View for Mental Health”. This is a timely debate in that regard; I suspect we could have done with an hour and a half at least, and I am sure that when the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), returns to her post there will be an opportunity to expand the debate.

The five year forward view was the result of wide-ranging stakeholder engagement, led by an independent mental health taskforce and chaired by Paul Farmer, chief executive of Mind. It laid the foundations for what we believe to be one of the largest transformation programmes for mental health services anywhere in Europe. The transformation may not be complete, but as my hon. Friend the Member for Faversham and Mid Kent said, progress has been made, and continues to be made.

I will just touch on funding, which formed a key part of the remarks made by the hon. Member for Manchester, Withington. To support the commitments made in the five year forward view, we have pledged £1 billion for adult mental health services between 2016 and 2021. That came on top of the £1.4 billion pledged the previous year in recognition of the need radically to improve children and young people’s mental health services.

We have delivered against those funding commitments: last year saw more than ever before spent by the NHS on mental health, with almost £12 billion spent by clinical commissioning groups and on specialised services, such as those for eating disorders. Only yesterday, right hon. and hon. Members will have heard the Chancellor’s announcement of a further £2 billion to fund mental health by 2023-24, expanding crisis services and supporting more people with severe mental illness into employment.

Today, 74% of people referred for treatment following a first episode of psychosis receive treatment within two weeks under the early intervention in psychosis programme, compared with 64% only two and a half years ago. Just under 80% of routine eating disorder referrals are seen within four weeks, compared with 65.1 % only two years ago. In 2017-18, the national trajectory of 2,000 more women accessing specialist perinatal care was exceeded and we continue to focus on developing local, integrated pathways in this area.

Things are improving outside NHS settings too. We have heard about the work that should be taking place in colleges—importantly—and workplaces. Our investment in improved facilities for crisis mental health care and changes to legislation have helped to reduce, for example, the number of people detained in police cells following a mental health crisis by more than 95% compared with 2011-12. I am pleased that the report recognised some of those achievements over what has been called a “transformational” period in the history of mental health services in this country.

Referring to what my hon. Friend the Member for Faversham and Mid Kent said about core services, we recognise that there is still much unmet need in mental health. That is particularly true for those suffering severe mental illness. Across the country, we are seeing innovative examples of community mental health services working well to provide timely support close to home, to help prevent in-patient admissions.

We also need to look beyond the NHS. Public attitudes towards mental health are improving. That is in part due to the Time to Change campaign, for which this Government provided £1 million of funding. We want to be recognised as a global leader when it comes to mental health, which is why, only three weeks ago, we hosted the global inter-ministerial conference.

I know time is running out, so let me turn quickly to some of the other remarks made by the hon. Member for Manchester, Withington on workforce. We have committed to 21,000 new posts, which will ideally be filled by 19,000 NHS staff. That has been written into local plans and some local areas are making progress, but it is too early to be able to count the number of people in post. The hon. Member for York Central (Rachael Maskell) mentioned further education, and as part of the Green Paper on children and young people we will incentivise every school and college to identify and train a senior designated lead for mental health issues.

To conclude, given the time available, we recognise that there is still much work to be done. I am proud of the work that this Government are doing to improve mental health, ensuring that many more people can access vital, high-quality mental health support. I hope we get an opportunity to debate the subject in future, but I also hope I have provided reassurance today that we are absolutely committed to delivering against the commitments set out in the five year forward view for mental health.

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

Local Government Funding: Merseyside

Tuesday 30th October 2018 Westminster Hall

16:30

[Maria Eagle (Garston and Halewood) (Lab)]

I beg to move,

That this House has considered local government funding in Merseyside.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am happy to welcome several of my Merseyside colleagues to the debate.

The Prime Minister says austerity is over. The Chancellor says austerity is coming to an end. Aside from the clear difference between those two statements, neither is the experience of local government leaders and councillors on Merseyside, nor is it set to be their experience over the next few years. My constituency covers two local authority areas, Liverpool City Council and Knowsley Metropolitan Borough Council. I see that my right hon. Friend the Member for Knowsley (Mr Howarth) intends to speak in the debate, so I will focus my remarks on the situation facing Liverpool City Council and he will deal with that facing Knowsley Metropolitan Borough Council. I confine my remarks in that regard to simply saying that the challenge facing Knowsley is equally difficult to Liverpool’s, although it is a smaller authority.

Liverpool City Council has already had to cut £340 million from its budget—some 58% of its total resource—since 2010. This year, it must find a further £41 million of cuts to make up the balance of the £90 million reduction it has been seeking over the city’s three-year budgeting period, which comes to an end next March. By 2020, it will have cut £420 million in total, which was 64% of its budget before austerity was unnecessarily and zealously imposed to such a high degree by the Lib Dem-Tory coalition Government in 2010. Those figures show that there is a lot more cutting to come over the next two years, regardless of what the Chancellor said to us yesterday. Austerity is set to continue for Liverpool City Council, no matter the measures in yesterday’s Budget.

According to the National Audit Office, local authorities in England have seen a 49% reduction in Government funding since 2010, so the cuts imposed on Liverpool have been far higher than average, despite its people having higher levels of deprivation and poverty than the average. Indeed, Liverpool City Council is ranked as the fourth most deprived local authority in the latest indices of multiple deprivation statistics. In fact, 10 of the city’s 30 wards contain a local area within the 1% most deprived nationally, with one—Speke-Garston—in my constituency. Liverpool is ranked as the third most deprived for health and disability and the fifth most for income and employment.

In any fair system, central Government would mandate below-average cuts on Liverpool; that would happen in any system that took any note of the needs of the people of different areas. However, the way the coalition and Tory Governments since 2010 have imposed austerity most emphatically does not take account of the relative needs of the people of different areas who have to deliver the cuts demanded of them. Liverpool has been doubly disadvantaged by facing a larger cut in addition to having more and greater needs to meet.

Take social care as an example. In 2010, Liverpool City Council spent £222 million supporting adults who need help in the community, either because of age, infirmity or disability. That has been reduced to £152 million, despite our ageing population and our population having higher levels of ill health than in many other areas—as set out in the indices of multiple deprivation—meaning more people need the help provided by adult social care services.

[Conor McGinn (St Helens North) (Lab)]

I thank my hon. Friend for securing the debate and for the leadership she gives to Merseyside MPs on these issues. To put this in context, central Government cuts to St Helens Council’s budget are the equivalent of two years of its social care budgets. Similar to Liverpool, we have an ageing population and an expected increase in people suffering from conditions such as dementia. Does she agree that that is completely unsustainable, and that austerity certainly has not ended, for my constituents or hers?

[Maria Eagle]

I agree with my hon. Friend. It is impossible to see how anybody looking at these facts could assert that austerity is either over or is even coming to an end. We obviously do not know what the Government think between those two poles, but it is one or the other, depending on where they are. From where we are, it does not seem that either assertion comes near to explaining the truth.

In Liverpool, £70 million less is being spent on adult social care alone due to the cuts caused by austerity—this political choice that Governments since 2010 have made. Thresholds for eligibility for that help have therefore clearly had to increase, so fewer people get it despite more people needing it. The lack of that support, which should be there and would have been in the past, creates extra burdens on individuals and their families. That is the direct consequence of these cuts in Government funding.

[Mr Jim Cunningham (Coventry South) (Lab)]

This is a timely debate. Coventry has experienced exactly the same sort of local government cuts as Liverpool, and through the loss of grants—that is what caused all this—well over 50% of its budget is really not there anymore. One big problem in Coventry—I am sure my hon. Friend will touch on it—is the funding of children taken into care. She just touched on social care. Lots of families now have to find money for social care that they can ill afford, driving them into the hands of money lenders.

[Maria Eagle]

My hon. Friend will know the figures for Coventry very well. He set some out, and they sound similar to some of the figures we have seen on Merseyside. Any application for Coventry to join Merseyside will of course be considered by the appropriate authorities, if my hon. Friend wants to take that back to Coventry.

Nationally, £7 billion has been cut from social care budgets, so the £650 million announced by the Chancellor yesterday—to much fanfare—will make little impact on the size of the problem created by the Governments he has been a member of since 2010. I saw today that that figure will cover not only adult social care but children’s, and it also apparently includes money for NHS winter pressures next year, so perhaps that figure is not quite all it was cracked up to be in the Budget statement. However, even if it were, it would not be enough to deal with many of the problems created by the cuts to Liverpool’s social care that have had to be made in the last eight years and are still ongoing.

What about reserves? Tory Ministers frequently answer questions about the scale of the cuts faced by suggesting that authorities should spend their reserves; we often hear that cry. Liverpool has spent £146 million of its reserves to support social care spending, even at the reduced levels it now provides. Its reserves are down to £17 million, so I hope that the Minister was not planning to tell me that Liverpool City Council should spend its reserves. It is clear that that is not a long-term solution. In fact, it is not a solution that will work for much longer at all. Indeed, the NAO says that one in 10 authorities nationally will have nothing left in three years’ time if they continue to use their reserves to pay for social care, as Liverpool has done. Even if those remaining reserves were spent only on social care and nothing else, local authority reserves would be completely used up by 2022.

What about new money? The Mayor of the city of Liverpool, Joe Anderson, has adopted—quite entrepreneurially, I think—an invest to earn strategy, for which he has been criticised but which has yielded so far an extra £13 million a year in new revenue. His original idea was to use that money to support growth in the local economy. However, because of the extent of the cuts in Government funding and the damage they have done—the dire impact that they have had on some of the poorest and most vulnerable members of society in Liverpool—he has had to use the money to support services that would otherwise have been cut even further. For example, all our Sure Start centres have been kept open, even though some of the services they provide have gone. However, the tide of extra need being caused by ongoing cuts in Government support and social security benefits is likely to overwhelm the extra funding that the Mayor has brought in via invest to earn, and to do so soon. In that regard, the roll-out of universal credit will mean 55,000 people in the city being transferred on to it.

[Ms Angela Eagle (Wallasey) (Lab)]

Does my hon. Friend recognise the experience in Wirral with the roll-out of universal credit? That has led to a need for 30 extra tonnes of food and created a 32% increase in the use of food banks because of the hardship that it has caused.

[Maria Eagle]

My hon. Friend, perhaps unsurprisingly, has anticipated my next point—we tend to be on the same wavelength. The Trussell Trust says that in areas where universal credit has been rolled out, it sees a disproportionate increase—my hon. Friend reports a big increase in Wirral—in food bank referrals, as opposed to a lower increase in other areas. The Chancellor is putting some money back in for universal credit, to ameliorate the cuts made by George Osborne in Department for Work and Pensions budgets, but that will not prevent millions of poor and vulnerable people from losing money. They will just lose a little less—and that is without the administrative chaos and design features of this benefit that cause poverty and destitution in Liverpool. Only the Liverpool citizens support scheme, the mayoral hardship fund and the discretionary housing payments, on which the Mayor spends more than central Government provide in moneys, stand between many families and destitution.

The Mayor of Liverpool, Joe Anderson, has repeatedly invited Ministers to Liverpool to inspect the books and tell him just what else he is supposed to try in order to deal with the funding crisis that austerity has created, but not one has taken up the challenge. Indeed, he even sent train tickets to Eric Pickles, when he was Secretary of State, to facilitate a visit, but he did not use them. Perhaps this Minister can take up the offer to inspect the books and see what else he can suggest that Liverpool City Council do; we would be most happy to welcome him. If not, perhaps he could indicate that the Mayor of Liverpool’s suggestion of a royal commission on the funding formula will be seriously considered. After all, with things going as they are, soon there will be no consideration of levels of deprivation or need in any of the ways that funding is allocated to local authorities, nor will any account be taken of the ability of the people of a local area to pay for all that is needed themselves; there will be no elements of redistribution. That is a recipe for entrenching disadvantage and ending social solidarity.

According to the Local Government Association, 168 councils will soon receive no revenue support grant at all and will rely only on business rates and council tax for their income. That disadvantages Liverpool again, because the council tax mix and base is so low. For example, Liverpool has more people than Bristol, but raises £38 million less in council tax, because almost 60% of Liverpool properties are in band A, compared with an average of 24% across the country, and 90% are in bands A to C, compared with 66% nationally. In addition, almost 36% of council tax payers are eligible for a discount because of their circumstances, whereas the national average is 16%. However, Government funding takes no account of these issues. That makes a big difference. If Liverpool was at the national average for these things, that would have meant an additional £97.7 million in council tax available to be collected every year. As it is, Liverpool can raise only £167 million in council tax. Similarly, less is raised in business rates in Liverpool than in many other places, because of the density and mix of local businesses.

Forcing the people of the city to rely, for meeting higher levels of local need, on weaker business rate and council tax yields is not a fair way to fund local services. I therefore finish by asking the Minister to have the courage that his predecessors lacked and visit Liverpool to inspect our books and make some suggestions as to what else, if anything, can be done. I also ask him to address the question of establishing a royal commission on local Government funding to ensure that the Government of which he is a member do not entrench existing deprivation and remove elements of redistribution that have in the past ensured social solidarity and improved life chances, and equality between different areas of the country. We need that now more than ever.

[Several hon. Members rose—]

[Mr Philip Hollobone (in the Chair)]

Order. The debate can last until 5.30 pm. I am obliged to call the Opposition Front-Bench spokesman no later than 5.13, and the guideline limit is five minutes for the Opposition, 10 minutes for the Minister and then time for the mover of the motion to sum up the debate at the end. That means that the Back-Bench contributions can run till 5.13. Five Members are seeking to catch my eye. Three of them have written to Mr Speaker, but I am a generous soul, so I want to get everybody in. If contributions are longer than five minutes, those at the end will get less. The first Member who has applied to Mr Speaker is Dame Louise Ellman.

16:46

[Dame Louise Ellman (Liverpool, Riverside) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate my hon. Friend the Member for Garston and Halewood (Maria Eagle) on securing this important debate and on the excellent way in which she opened it.

Local government is vital. It is responsible for essential services such as education, social care and road safety. It is a lifeline for people in need. It drives regeneration and civic pride. In Liverpool, the City Council, with Mayor Joe Anderson, has protected people from the brunt of ongoing and severe Government cuts. It has displayed innovation and civic leadership. By 2020, more than 64% of central Government funding will have been removed from Liverpool. That is a real-terms loss of £444 million. For the fourth poorest local authority in the country, that is a great injustice.

The Chancellor’s statement that austerity is ending rings hollow in Liverpool. Government cuts continue as the council struggles to care for people who need social care and children who just want a chance in life. Nurseries remain underfunded and schools still struggle. The impact of the Government’s cumulative cuts in benefits, often affecting working people, takes its toll. Universal credit threatens to make people poorer. We do not know what the Chancellor’s reassurances in the Budget will mean to people on the ground—not very much, I suspect. Rhetoric needs to be matched with positive action.

Despite increasingly vociferous warnings, fire and police services are denied the essential cash that they need to protect the community. Cuts in fire services are causing increasing public concern, and in Liverpool and Merseyside as a whole gun crime is now increasing. Over the city hangs the threat of Brexit—threats to the economy, to EU-funded initiatives and to the European collaborative research that is so important to our universities and to the city of Liverpool.

I call on the Government to change course and match their words with positive change. They must revisit their plans to put an even tighter squeeze on local services by changing local government funding after 2020 to eliminate central Government support for Liverpool. That is grossly unjust in a city where there is a low council tax base and a 1% rise in council tax raises only £1.4 million; a 1% increase in a place such as Surrey raises £6 million.

Liverpool has a responsible and innovative council protecting Liverpool people from a Government intent on cutting back. I call on Ministers to match their rhetoric with deeds, stop the cuts and give Liverpool a fair deal.

16:49

[Ms Angela Eagle (Wallasey) (Lab)]

Thank you for calling me to speak, Mr Hollobone. I would like to add to the congratulations to my sister, my hon. Friend the Member for Garston and Halewood (Maria Eagle), on securing this debate at such an important time. As she has pointed out, local authorities in general have seen a cut of nearly 50% to their budgets, but local authorities in Merseyside have suffered even greater cuts.

My local authority, Wirral, has suffered a 53% cut in real terms since 2010, which is above average. That means that it has lost well over half its 2010 budget, which is £635 less in resource every household in Wirral. Wirral’s local authority is expected to continue to cut £130 million more between now and 2021, despite the Chancellor and his jocular toilet jokes in the Budget yesterday.

How do these cuts affect my constituents? Behind all the cuts and the many service reductions we have been forced to experience in the past few years are people who are often very vulnerable, not being looked after or being left to fend for themselves when circumstances make it impossible for them to survive independently. The social safety net has been deliberately destroyed by this Government in pursuit of their ideological obsessions with a smaller state. Not only do they pursue those obsessions and hit the poorest hardest, but when we have debates such as this they smirk and laugh, and do not believe the tales that we bring to the House about the real results their cuts have had. The Minister looks to me to be doing the same again today.

We have seen an increase in food bank use, homelessness and destitution, as well as anxiety and insecurity, which has led to increases in mental health breakdowns. A lot of these cuts are actually false economies. In Wirral, the adult social care budget has been cut by over a quarter since 2010, but because of our low council tax base the capacity to raise tax locally is severely constrained. A council tax increase of nearly 6% this year raised only £8 million, half of which is ring-fenced for social care, but because Wirral has an above average number of older people, that increase does not even cover the extra demand being generated by our ageing local population. It is not acceptable for the national Government to wash their hands of the different levels of demand for social care in different areas and leave council tax payers to pick up the bill when council tax bases vary so dramatically—my hon. Friend the Member for Garston and Halewood said of Liverpool’s case—between different areas, because of different property prices.

In my constituency, over 11,000 people are providing unpaid care to their loved ones, many for 50 hours a week with little and diminishing help. We have seen real-terms cuts in spending on youth services. When Labour was in government, spending on youth services doubled, but since 2010 it has gone down by 7% nationally. Spending on young people’s services, such as counselling and youth centres, has fallen by over half. Some 1,000 Sure Start centres have closed and many preventive, proactive services have been wiped out. In Wirral, that has led to a huge increase in the number of children taken into care, which is up from 650 two years ago to 810 this year.

These cuts are a false economy, because as less is spent on preventive work, more has to be spent on much more profound and costly interventions later. How is it moral to wait until a young life is ruined, rather than spend less to prevent it from happening in the first place?

In Wallasey, 20 out of 26 schools face budget cuts. With nearly £3 million cut between 2015 and 2020, per-pupil funding has fallen by 8%. Since 2010, 50% of the Merseyside fire authority’s grant been taken away. Instead of having 42 fire engines, we now have 22, with only 14 available for immediate response. The number of firefighters has reduced by nearly 40% from 927 to a mere 580. After years of decline, fire deaths have increased by 10%. The Merseyside police budget cuts have led to the loss of over 1,000 officers and crime is rising. As the recent Home Affairs Committee report demonstrated, the police are becoming less and less able to cope. As crime rises, we see the number of arrests and charges falling.

Once more, the emergency services are so stretched that they can barely cope with emergencies, and they certainly cannot do preventive work, so lives are put at risk as public sector workers face relentless pressure, being expected to do more for less. This is not my definition of fairness and it is not my definition of the end of austerity. It is an ongoing, rolling scandal, which is placed at the door of this Government.

16:55

[Stephen Twigg (Liverpool, West Derby) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Hollobone, and I congratulate my hon. Friend the Member for Garston and Halewood (Maria Eagle) on securing this debate and leading it so powerfully. Along with my hon. Friend the Member for Liverpool, Riverside (Dame Louise Ellman), she set out fully the impact of austerity on Liverpool City Council.

Last week in this Chamber, we had a debate led by my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) in which we shared the horrific stories from our constituents about the increased use of food banks, and the impacts of austerity and the changes to social security benefits. I strongly echo what my hon. Friend the Member for Garston and Halewood said about the efforts of Liverpool City Council, under the leadership of Mayor Joe Anderson, despite the scale of cuts in the support from central Government, still to deliver for the people, and in particular to deliver for some of the most vulnerable communities in our city. I second the idea of a royal commission to really address the issue of the fairness of local government funding. I also pay tribute to those who work in our public services who, despite austerity, do their utmost to deliver the very best services at local level.

I want to focus first on education, and secondly on crime and policing. As my hon. Friend the Member for Garston and Halewood rightly said, Liverpool City Council has done its utmost to protect its children’s centres, because we know how powerful the evidence is that investing in the early years of children’s lives makes the biggest difference. If we are serious about seeking a more equal and just society, investment in those early years is crucial. I ask the Minister to speak to his colleagues in the Department for Education about the importance of those early years.

Last week, I raised the issue of the important role that nursery schools play in our communities—I make no apology for raising it again. I have two brilliant nursery schools in my consistency, Ellergreen and East Prescot Road, both of which are rated outstanding by Ofsted. They are very concerned about their long-term funding, because of some of the considerations that the Department for Education is undertaking. We are all concerned that the adoption of a national funding formula poses a threat to our schools’ funding. Schools in my constituency and around the country will not be comforted by getting some money for the “little extras” as the Chancellor set out in his speech yesterday—that is frankly insulting. We need a serious, long-term settlement for schools funding.

I will finish by saying something about crime and policing, because that is an issue of massive concern to my constituents. I ask the Minister to share the issues that have been raised during the debate with his colleagues in the Home Office. Again, this speaks to the question of injustice in funding, which all three of my colleagues have spoken about. Funding cuts have hit all parts of the country, but they have hit some parts much harder than others, and it tends to be the areas with the greatest social and economic need, such as Merseyside, that have been hit the hardest. Merseyside police relies on central Government to provide 75% of its funding. In contrast, Surrey can raise most of its funding for its police locally. Therefore, an equivalent cut to both forces does not hit the two areas the same—it hits Merseyside much harder than it hits Surrey.

As my hon. Friend the Member for Wallasey (Ms Eagle) has just pointed out, since 2010 in Merseyside we have lost 1,700 staff and police officers—1,700 gone—and had a cut in the number of police community support officers of around 35%. Last year, the chief constable of Merseyside, Andy Cooke, warned that Merseyside police was reaching breaking point, as budgets are stretched to the limit.

Crime is going up, but officer numbers are at their lowest in years. Office for National Statistics figures show a 14% rise in crime in Merseyside in the year to September 2018. Of particular concern in my constituency are the 18% rise in robbery and the 16% rise in violent crime. I say to the Minister, who speaks for communities and who can lobby his Home Office colleagues, that that has to change. Surely dealing with crime and protecting the public are the most basic responsibilities of any Government.

I ask the Minister please to listen to our chief constable and our police and crime commissioner, Jane Kennedy. We need a fair deal for policing in Merseyside, alongside a fair deal for local authorities, about which my hon. Friends have spoken so eloquently.

17:00

[Mr George Howarth (Knowsley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I, too, congratulate my hon. Friend the Member for Garston and Halewood (Maria Eagle) on the typically thorough way in which she introduced this important subject. I will confine my remarks to the effects of the cuts in grant to Knowsley specifically, but before I do, I echo what my hon. Friend the Member for Liverpool, West Derby (Stephen Twigg) and other hon. Friends have said about the impact of cuts on policing and on fire and rescue services.

As my hon. Friend the Member for Garston and Halewood indicated, Knowsley Council is the council in the country hardest hit by funding cuts, which amount to £100 million less to spend on vital local services. To bring that down to a human scale, that equates to a cut of £485 in grant support for every person in the borough, compared with a national figure of £188. To bring that down to an even more human scale, Windsor and Maidenhead Council has had a £49 cut in grant per head and Wokingham Borough Council has had a £43 cut in grant per head. I began to wonder whether something in the grant formula was weighted towards local authorities that begin with the letter w, but if that had been the case, it would have applied to the Wirral too. As my hon. Friend the Member for Wallasey (Ms Eagle) eloquently described, however, it does not.

Knowsley Council has told me that its biggest challenges are funding children’s social care, which my hon. Friends have mentioned; the need for a permanent funding solution for adult care; and the impact of moving the cost of funding services provision on to council tax payers. Funding social care is not just a problem for Knowsley. In the north-west as a whole, the number of looked-after children has increased by 12% since 2003. In Knowsley, the additional pressures on the budget for children’s social care are expected to exceed £3 million as a result of a combination of increased costs for all placements, even higher increased costs for specialised placements and the scarcity of suitable residential placements.

The Government’s response, however, has been wholly inadequate and falls well short of providing the funding and certainty needed to keep up with growing demands. The Minister will say that there was an announcement in the Budget yesterday. We have not seen how that will be distributed, and we do not know what it will mean for any given local authority, but if the total sum mentioned is distributed evenly, it will hardly make a dent in the difficulties that areas such as Knowsley are experiencing.

Some additional funding for adult social care has been announced in the past few years, but it does not reflect the resources needed to offer adequate and sustainable services and, moreover, it was a one-off. In March 2017, £9 million of additional resources was announced from the better care fund to help to fund increasing demand and rising costs. So far, however, the Government have not confirmed whether that support will continue beyond 2019-20. Can the Minister commit to continuing that funding? If he cannot, the council’s budget will inevitably mean that services suffer still further. Moving the cost of service provision on to local council tax payers is, frankly, nothing short of disgraceful. The move away from a grant distribution formula that provided a weighted recognition of the needs of an area is entirely regressive in how poorer, more deprived areas such as Knowsley end up as the biggest losers. How can that be fair?

The Government argue that need should be replaced by a funding system that rewards councils based on the level of economic growth and prosperity. Knowsley has some important and successful local companies such as QVC in my constituency and Jaguar Land Rover in the constituency of my hon. Friend the Member for Garston and Halewood, but their success and that of other companies locally, though important and welcome, can have only a limited impact on the revenue generated for Knowsley Council and falls short of the area’s needs.

We have already seen the effect on services. Anything that is not a statutory requirement has inevitably had to bear the brunt of the cuts. As we have seen elsewhere, we are at the point at which local councils cannot meet even those statutory requirements. As need is increasingly sidelined, that trend will sadly continue. The grim conclusion has to be that unless the Government acknowledge the need for a fair funding system that properly reflects local need and deprivation, areas such as Knowsley face a bleak future in which the consequences of the Government’s austerity programme are visited on the communities least able to bear them.

17:07

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I thank my hon. Friend the Member for Garston and Halewood (Maria Eagle) for securing the debate and for the manner in which she opened it. I am honoured to be among my hon. Friends representing constituencies on Merseyside, especially in the face of a Tory Government who have chosen to impose unfair and disproportionate cuts on our constituents. I use the word “chosen” carefully because, as we know, austerity is a choice, which makes the damage done to our constituents’ lives so much worse. It is not just what is in the pot but how the Government have chosen to cut it up that has hit the most deprived the hardest, because the Government have removed the weighting for deprivation from many of their funding formulas. As we saw in the Budget yesterday, those cuts are not going away anytime soon, despite the Prime Minister’s promise that “austerity is over” earlier this month.

Tory cuts have hit Merseyside so hard that there has been a £440 million reduction in Liverpool City Council’s Government support since 2010-11, which is a cut of 64% to the council’s overall budget. We are at the point at which our most basic services are in crisis, and many hon. Friends have articulated examples of where that is the case.

The revenue budget of Merseyside fire and rescue service has been reduced from £73 million to £59.9 million. These cuts might be just figures on a spreadsheet to some, but they have real-life consequences. Our fire and rescue authority has been forced to reduce the number of firefighters it employs from 923 to 620, and to reduce the number of fire engines from 42 to just 24. In turn, the response time for life-risk incidents is on average 35 seconds slower than in 2010-11. What if there were a major incident in Merseyside?

Similarly, Merseyside police has faced startling cuts from central Government, as my hon. Friends have said. Many hon. Friends have articulated the connection between local authority funding and our police, and how we have been disproportionately hit. Our police workforce has been cut by nearly a quarter, so we have 1,600 fewer police staff than in 2010-11. I ask the Minister to reflect on that and I hope he is listening carefully.

Ultimately, the combination of all the cuts to our local authority, our fire service and our police force has led to a reduction in service for many different community services throughout the course of life—from our children’s centres to our youth services, to our leisure and recreation service, to what happens on our roads, to our community services and to services for the elderly and social care.

We have an incredibly stretched council, fire service and police workforce who do so much in such challenging circumstances, and what we are seeing is an impact on real life for too many of our constituents. We are seeing an increase in people in crisis. We are here today because we think it is socially and morally illiterate to see so many people in crisis. It is also financially illiterate. We are sitting here in front of a Minister from the Ministry of Housing, Communities and Local Government, but this situation has wider, far-reaching consequences for all Departments. We have heard about the impact on our national health service and that we are going to see £20 billion extra spent on our NHS, but again this disproportionate focus on crisis is so much more expensive. It does not make any economic sense.

Other colleagues have clearly articulated the impact of cuts, including the increase in crime. I will just reflect on the fact that we are now seeing the most brutal run of gun violence in Liverpool in recent years. In just a 10-day period at the beginning of this month, there were two fatal shootings, one of which was in my constituency, and four non-fatal shootings. This increase in serious crime has far-reaching and serious consequences for our constituents.

However, it is not until we compare the cuts that we have sustained on Merseyside with those elsewhere that we truly see the disproportionate level of austerity with which our constituents have been burdened. Whereas each household in Merseyside has experienced a cut of £712.57, the average reduction per household across England is just £320.99. That is still an unwarranted reduction, but of course it is nowhere near the cuts that the people of Merseyside have to cope with in one of the most deprived areas of the country. It is nothing short of a tragedy that the Government’s own figures have shown that if Liverpool City Council had been subject to that same average reduction, it would have been £71.6 million better off in 2019-20 than it is expected to be. What is worse and most galling is that some authorities have seen an increase in their spending power—colleagues have mentioned Surrey.

Neglect by a Tory Government is nothing new to the people of Merseyside, whose independence and resilience make our region proudly what it is, and our city, under the leadership of Joe Anderson, is doing so much in spite of this Government. Can the Minister tell us when our constituents will be given an equal chance and some relief from this disproportionate burden?

17:12

[Jim McMahon (Oldham West and Royton) (Lab/Co-op)]

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

I would say that it is also a pleasure to respond to the debate, but it is not a pleasure at all; it is heartbreaking, when we consider the human stories that sit behind the numbers that we have heard today. However, I pay tribute to my hon. Friends the Members for Garston and Halewood (Maria Eagle), for Liverpool, Riverside (Dame Louise Ellman), for Wallasey (Ms Eagle), and for Liverpool, West Derby (Stephen Twigg), my right hon. Friend the Member for Knowsley (Mr Howarth), and my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), for how they have stood up to represent their communities in the face of absolutely devastating cuts to vital public services.

I should declare an interest as a vice-president of the Local Government Association and I will use some of the LGA’s information in my speech. The truth is that austerity is not over, but it was never going to be over, because as things stand the Government do not believe in strong local public services. We have heard talk today about how the Government do not like a big state. The truth is that the Government actually do not mind a big state, provided that it is a big national state, because the workforce data today says that the national Government workforce is the biggest since comparable records began, compared with local government, which is now at its smallest since comparable records began. The disproportionate cut has not only been to local government; within England the most deprived communities have been the hardest hit. The most deprived communities have seen cuts of about £220 per person, compared with about £40 per person in the least deprived, so austerity has been targeted on local government and then within local government it has been targeted on the areas that could least afford to take the hit, in the way that we have seen.

The Government have completely ignored pleas from the cross-party LGA to do two things: first, stop the in-year cut of £1.3 billion; and, secondly, fund forward the £5.8 billion that would have addressed homelessness, adult social care and children’s services. Let us be honest—when it comes to the £410 million that is being put forward, the majority of people who work in social care are paid the minimum wage. When the national minimum wage goes up in April, those people will rightly be uplifted, but there is a cost to that for the providers. Much of the money announced in the Budget will go not to additional care for over-65s who need it, but to pay people who are being paid the lowest possible rate for providing an essential community service. I do not believe that is fair, the LGA does not believe that is fair and councils across the country do not believe that is fair, but again we see the Government turning a blind eye to it.

We all know where the real impact has been felt; we know the numbers on adult social care and the fact that 1.2 million people who would have had care in 2010 do not get that care today. We know that there are more young people who have been taken into care because they are at risk if they are kept at home, and the cost of that to local authorities. We also know, because the Government have walked away from their responsibilities, that the only way that councils can fund that care is to reduce eligibility and take the money from vital neighbourhood services.

The services that council tax payers see and value that come from the council tax that they pay have been the very services that have been taken away to fund the pressures on people’s services in every community in the country. The public say, “I’m paying more council tax, but the bins are being emptied less often, the local library has closed and the park doesn’t get maintained in the way that it used to.” All those really important services have been affected.

I hoped that when we had a change in Secretary of State that the new Secretary of State would finally have the ear of the Treasury, so that they could finally get a fair hearing and make the case for these vital community services, but it strikes me that one or two things have happened. Either the Ministry did not bother making the case in the first place, or—it could be both these things—the Treasury just does not care about the human impact of austerity and how we have seen it distributed across the country.

What I want to know, what people in the Chamber want to know and what people in England want to know is, what will the Minister do to address such chronic underfunding? It will be on his watch that an older person will die because they do not get the social care they need, or a child will be made to feel vulnerable because they are not getting the protection they need. Where will the money come from?

17:16

[The Parliamentary Under-Secretary of State for Housing, Communities and Local Government (Rishi Sunak)]

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

I start by congratulating the hon. Member for Garston and Halewood (Maria Eagle) on securing this debate and it is good to see a strong turnout from Merseyside colleagues as well.

It did not sound like the hon. Lady was aware that in fact my very first visit as Minister for Local Government was indeed to Liverpool, both to see the City Council and to work with the troubled families programme, and I was delighted to accept an invitation from the hon. Member for Liverpool, Wavertree (Luciana Berger) shortly after being appointed to this particular role.

Being relatively new to this role, I am the first to say that local authorities have done a commendable job over the past few years, maintaining a strong level of services in the face of rising demand. In responding to the specific points that the hon. Member for Garston and Halewood made, I will first outline my broad vision for the role of local government, which consists of three particular areas: first, to drive economic growth; secondly, to help the most vulnerable in our society; and, lastly, to build strong communities. I will take each of these areas in turn, specifically in relation to the points that have been made by hon. Members about Merseyside.

I will start with the economics. In this financial year, councils on Merseyside— including Sefton, Knowsley, Liverpool, Wirral, Halton and St Helens—had an aggregated core spending power of around £1.3 billion. Core spending power is the standard measure of a local authority’s key financial resources. It includes money from the central Government grant, which is typically known as the revenue support grant, but also the money raised locally from council tax, the money raised through the business rates system, and further specific grants from central Government for things such as adult social care, the better care programme and, indeed, the new homes bonus.

Across Merseyside, core spending power is up every single year in this four-year spending period and up 2% this year as well.

[Maria Eagle]

I received a parliamentary answer from a colleague of the Minister about police spending, which said that over the last year £5.1 million of extra money had been given to enable the police to tackle the very serious crime that my hon. Friends the Members for Liverpool, Wavertree (Luciana Berger) and for Wallasey (Ms Eagle) referred to. In fact, that money came from the Government simply allowing a precept increase; it all came from hard-pressed council tax payers in Liverpool and not one penny piece came from the Government. How can the Minister justify the ridiculous figures that he is using, which hide the Government’s contribution by referring to everything else that can be raised in any other way? That is a way of abdicating responsibility.

[Rishi Sunak]

I totally reject the suggestion of hiding. It would be ridiculous to look at any local authority’s financial resources without considering the various ways in which such an authority funds itself. I am delighted that the hon. Lady is focused on keeping council tax low. Indeed, the Government have ensured that council tax today is lower in real terms, across the country, than it was in 2010. We have heard various suggestions from Labour Members about doubling council tax, which is something I assume the hon. Lady, being on the side of hard-working taxpayers like us, would reject.

The idea that the funding formulas do not take account of deprivation or the differing ability of areas to raise council tax is totally erroneous. For example, when the adult social care precept was introduced, it was understood that different areas would raise different amounts from it, which is why in the incremental billions of pounds that the Government have injected into the social care system directly through the better care fund there is an equalising measure to take that into account. That is exactly why, today, the most deprived authorities have a core spending power per household—taking into account all those things, council tax included—that is 23% higher than that of richer authorities. Indeed, that is why areas with larger council tax bases provide more of their area’s resources from council tax; Merseyside provides less than half of the amount those areas do, because the council tax base in Liverpool is that much lower. It is totally wrong to suggest that that is not taken into account.

I think it was alleged that I, or the Government, had removed deprivation from funding formulas. I can categorically say that I have not removed it from any funding formula. We are in a root and branch review of how local government is funded. We are in the midst of various consultations and I would be delighted to have hon. Members’ suggestions.

[Mr Howarth]

If that is the case, will the Minister explain why Knowsley, which is one of the most socially deprived parts of the UK, has had a £100 million cut in its grant? His figures just do not add up.

[Rishi Sunak]

I can tell the right hon. Gentleman that Knowsley’s core spending power per household is about 20-something per cent. higher than the average for a similar metropolitan authority, which takes into account exactly his point. He talked about the fair funding review and, as I said, that is exactly where all the issues will be considered, ensuring that deprivation or, indeed, multiple other factors, are taken into account in the new funding formula.

[Ms Angela Eagle]

Will the Minister give way?

[Rishi Sunak]

No. I will try to make some progress.

When it comes to that point, I am convinced and confident that those factors are taken into account. Indeed, as we restructure the fair funding formula, they will continue to be taken into account fairly and accurately.

Beyond Government grants, driving economic growth locally is the only sustainable way to ensure that we can raise the money we need to fund our services, and business rates retention is one such opportunity. I am delighted, and I am sure hon. Members here will join me in recognising, that Merseyside is in the fortunate position of being a 100% business rates retention area, which means that the local councils keep all the growth they generate from those rates. That is not something that is enjoyed by every local authority—[Interruption.]

[Mr Philip Hollobone (in the Chair)]

Order. We do not really want sledging in the Chamber. The hon. Member for Wallasey (Ms Eagle) is sitting opposite the Minister and he must be heard with courtesy. Her side of the House was heard with courtesy during all its contributions. I know that the hon. Lady’s attempt to intervene was not accepted by the Minister, but she could have another go. However, she is more likely to be successful if she does not keep shouting across the Chamber.

[Rishi Sunak]

Thank you, Mr Hollobone. I think the hon. Lady was being snide about the fact that Merseyside is a business rates retention pilot. I am sure that the £54 million that Merseyside will keep this year in additional funding as a result of the pilot is nothing to be snide about, and will make an enormous difference on the ground, helping the people I know she cares about. Many other local authorities across the country would be happy to be one of the pilot areas, so if she thinks that Merseyside would rather not be one and would give up the opportunity to others, I would be happy to talk to her afterwards.

[Jim McMahon]

Will the Minister give way?

[Rishi Sunak]

I will try to make some progress.

Business rates retention is not the only incentive for local growth, as it sits alongside the other support the Government give to local authorities’ wider ambitions through local growth deals. For example, £2 million has been invested to create the first dedicated digital skills academy in the UK, at the City of Liverpool College, and more than £13 million has been invested in a highway infrastructure scheme comprising a series of essential and integrated improvements along the A565 corridor. In sum, the Government strongly support Merseyside’s economic growth, whether through direct investment or business rates retention, and thus enable it to fund services over the years to come.

[Dame Louise Ellman]

Will the Minister give way?

[Rishi Sunak]

I will make some progress.

The second vision I outlined, which is undeniably one of the most crucial roles for local government, is to continue to help the most vulnerable in our society. It is local authorities, as we have heard, that support the elderly, the disabled and our children in need, and we owe an enormous debt of gratitude to councils for their incredible work. I am delighted that the Government back local authorities to carry out those vital duties. Last year, the Budget provided an additional £2 billion for social care. Earlier this year, another £240 million was announced for social care winter funding, and in the Budget yesterday the Chancellor announced that a further £650 million will be provided for care services next year.

In contrast to what we have heard, the flexibility to use the funding for things such as children’s services is something that local authorities have specifically asked for. They will have the flexibility in each local area to use the funding for different care services, rather than its use being dictated by central Government. I would have thought that all Members appreciated their local areas having such flexibility to make the best use of the money, in the way they see fit.

I am pleased to say that that increased investment and better working between the NHS and local government is paying dividends on the ground. We have seen social care free up 949 beds a day since the peak two years ago—a 39% reduction in social care delayed transfers of care. In Merseyside, progress has been seen particularly in St Helens, and I commend the local authority on reducing such transfers by 72% since the February 2017 peak.

I have mentioned the troubled families programme, which is making amazing strides to support our society’s most vulnerable families. When I visited the Clubmoor children’s centre in Liverpool, it was a privilege to talk to several of the families participating and to see the life-changing work at first hand. I am proud to say that the Government have invested £1 billion in the programme over this spending cycle, with 130,000 families nationally achieving significant and sustained progress against the goals they have been set. In almost 17,000 of the families, one or more of the adults has moved into work, and the families I spoke to told me that that was central to their ambitions.

Across Merseyside, 10,000 families are being helped with more than £20 million of funding, and I pay tribute to Liverpool City Council in particular for doing a very good job, working with early help assessments. We heard from the hon. Member for Halton (Derek Twigg) about the importance of early intervention. Referrals to children’s services in Liverpool were down 3% in the most recent year—

[Mr Howarth]

On a point of order Mr Hollobone. I want to place it on record that, had he been here, my hon. Friend the Member for Halton (Derek Twigg) would have made a significant contribution, but he is, in fact, not here.

[Mr Philip Hollobone (in the Chair)]

Thank you for that point of clarification. It will be on the record.

[Rishi Sunak]

I apologise to the hon. Member for Liverpool, West Derby (Stephen Twigg), who mentioned the importance of early intervention. I thank the right hon. Gentleman for the point of order. That great work in the last year builds on three successive years of reductions in referrals to children’s services.

We talked about the importance of local authorities in building strong communities and the Government back that, whether through the funds for Liverpool City Council from the controlling migration fund, ensuring that communities are connected through the roads fund that was announced yesterday, or bringing high streets together and creating pocket parks—something that Liverpool has benefited from. Whether through building economic growth, supporting communities or helping the vulnerable, the Government are determined to recognise the role that local government plays and to back it with what it needs.

17:19

[Maria Eagle]

I am disappointed that the Minister chose to take away half of my time to respond. I am afraid he did not deal with the points that were made in the debate, and that is a shame. It is ridiculous for him to suggest in the way he did that the Government take account of deprivation. I would like to see how he came up with the figures in his speech. Liverpool’s local authority has lost 64% of its money, and Knowsley 58%. Our police have had the worst cut in the country, losing 31% of their money, with the fire authority losing 50% of theirs. Liverpool Community College has lost £5 million over the past four years. If that is strongly supporting Merseyside, I hope that the Minister and his Government will stop supporting us, because it is terrible.

Question put and agreed to.

Resolved,

That this House has considered local government funding in Merseyside.

17:19

Sitting adjourned.