Westminster Hall

Wednesday 2nd December 2020 Westminster Hall

Wednesday 2 December 2020

[Esther McVey in the Chair]

Covid-19: Access to Cancer Diagnosis and Treatment

Wednesday 2nd December 2020 Westminster Hall

00:00

[Esther McVey (in the Chair)]

I remind hon. Members that there have been some changes to the normal practice in order to support the new call list system. Members should sanitise their microphones and then remove and dispose of the material used for that when they leave the room. Members are asked to observe the one-way system and should speak only from the horseshoe. Members may speak only if they are on the call list. That applies even if the debate is undersubscribed. Members may not join the debate if they are not on the call list. This is a slight change, but I want to remind Members that they must arrive for the start of the debates in Westminster Hall, although they are not expected to remain for the winding-up speeches. Members may wish to stay beyond their speech, but they should be aware that doing so may prevent other Members from speaking if it is a full debate.

09:31

[Tim Farron (Westmorland and Lonsdale) (LD)]

I beg to move,

That this House has considered access to cancer diagnosis and treatment during the covid-19 outbreak.

It is a great pleasure to serve under your chairmanship, Ms McVey. I am grateful to have the opportunity to raise this issue. Of the many vital issues discussed in this place in recent months, the impact of covid-19 on cancer treatment must be at the very top of the list for importance to families right across the United Kingdom. I want to start by saying very clearly that there is a national cancer crisis—a backlog that we need to catch up with urgently—so I will be concluding my speech by asking the Minister to meet me and the clinical advisers who support the Catch Up With Cancer campaign as a matter of priority in the coming days.

Since the start of the pandemic, organisations, charities, frontline NHS staff and MPs have been urging the Government to invest in cancer services to prevent a national tragedy in cancer. Indeed, the experts we work with warned at the start of the pandemic that tens of thousands of people were set to die as a result of cancellations, delays and disruptions to their treatment. Sadly, it looks as though those warnings have been proved right, although for thousands of families it is not yet too late for us to catch up with cancer.

I have two main points to address. Both relate in large part to the covid-induced backlog and the apparent failure to make addressing it a central feature of the Chancellor of the Exchequer’s comprehensive spending review just last week. The first point I would like to address today is the scale of the cancer backlog itself. All the feedback from the frontline and from our expert clinical advisers strongly suggests that the Government and NHS management are repeatedly failing to grasp the true size and scale and danger of the backlog. The Government and senior NHS managers keep saying that services are back to normal levels and that good progress is being made on the backlog, but all the evidence from frontline staff provides a clear picture that it is just not true to say that we are back to normal.

Even then, the simple fact remains that, with the scale of the backlog, “back to normal” is nowhere near good enough anyway. Even if services were back to pre-covid levels—we contend that they are not—it would be mathematically impossible to have caught up. Why? Because the flow of patients was all but stopped for several months, but cancer, of course, did not take a break. It kept striking people at the same rate it always does, so the only way we can catch up with cancer is to have services super-boosted to levels in excess of pre-covid capacity. We estimate that cancer services need to be running at something like 120% of pre-covid levels for two solid years to catch up. That view is shared by other keen observers of this problem, such as the chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt). But the brutal reality is that services are not yet even at their pre-covid capacity. In September, treatment was at only 94.5% capacity, and as long as the treatment rate continues to be below 2019 levels, the cancer backlog will continue to grow.

We are hearing from frontline staff that services were not yet back to normal before the recent lockdown in November. One cancer centre has told us that during that lockdown, referrals have yet again “fallen off a cliff”. Analysis from Macmillan Cancer Support, using the Government’s own monthly cancer waiting times data, shows that during the pandemic around 1,000 fewer people in south Cumbria and Lancashire will have had their first cancer treatment, compared with the same period last year—a 17% drop—which suggests we are missing one in six people with cancer. There is no serious doubt about what is happening to those missing people. Their cancers will have grown and spread and, in many cases, become incurable by the time they are identified and by the time, if at all, they are treated. Across the country we hear of patients presenting with more advanced cancers due to not being seen early enough. Some staff tell us that they have never seen such advanced cases.

The all-party parliamentary group on radiotherapy, like all the all-party groups on cancer, is strenuous in its insistence on a consensual and collegiate approach, and sees Ministers, especially the Minister here today, as partners and not opponents. I am grateful to the Minister for her courtesy, her willingness to engage and her very clear concern. I am also grateful to all Members here and to those who are not present but who dearly wanted to be. Many are absent because this Chamber is not yet enabled for virtual participation. They include the hon. Members for North Devon (Selaine Saxby), for West Lancashire (Rosie Cooper), for Rhondda (Chris Bryant), for Central Ayrshire (Dr Whitford), for Liverpool, Riverside (Kim Johnson) and for Bootle (Peter Dowd).

Our collective view is that we need urgent action to catch up with cancer. I mentioned the figures for my own area, but Macmillan estimates that across England as a whole there are a terrifying 50,000 missing diagnoses. Clinicians report that more patients are now coming through needing palliative rather than curative care—people who could have survived who are now on end-of-life pathways and are simply being treated to alleviate the pain.

[Grahame Morris (Easington) (Lab)]

That is a really important point. How do we quantify the scale of the backlog to enable us to have an action plan to address it? Specialists say that whereas the ratio is currently 50:50 in terms of the therapeutic application of radiotherapy for treatable cancers and therapeutic palliative care, last year it was 70% treatable and 30% palliative. Do we not need the release of the datasets to quantify that in an accurate way?

[Tim Farron]

I am extremely grateful to the hon. Gentleman for making a very important point. I have heard the same reports from the frontline that treatment would normally be 70:30 curative to palliative and that now it is 50:50. That is a blindingly obvious consequence of the fact that when we catch cancer, we catch it too late.

I have a request of the Department, which we have made before, including in face-to-face meetings with the Secretary of State. I want the Department of Health and Social Care team responsible to sit down with the frontline experts—we can provide them this afternoon—and go through the evidence of the backlog. There is no way of tackling the problem if the NHS management and the Department are not cognisant of it and prepared to listen to the people working their socks off in cancer units all over the United Kingdom.

I want to make another important point. Whoever was in power during this time would have been handed the same challenge and would have made many mistakes. The Government have rightly sought to control the virus so that we can protect the NHS and save lives. The lives that we seek to save are those at risk from not just covid but other illnesses, including, of course, cancer.

We as a country have stood together and defended our NHS so that it has the ability to fight cancer in the midst of a pandemic, which is what every clinician is desperate to do. The great success of this year, for which Ministers should rightly be proud, is that our NHS has not collapsed and did not fall over. Our doctors, nurses, paramedics and clinicians of every sort have saved lives, defeated the odds and kept our NHS on its feet so that it can fight cancer, and yet a failure at senior levels of NHS England and in Government to recognise the scale and nature of the cancer backlog means that people are dying today who did not need to die.

We have terminal diagnoses for cancers that could have been treatable among my constituents and yours, Ms McVey—among all our constituents. Their lives have been cut short when earlier, more urgent and more ambitious action from our leaders could have saved them. What troubles me so much is that we hear statements from some in senior management in the NHS, and from within the Department, that suggest they do not quite get the scale of the backlog problem. They freely admit that they do not know how big the backlog is. On more than one occasion, I have heard the Secretary of State seek to reassure us by saying that progress has been made on recovering the 62-day wait. If people understand what is happening, however, that does not reassure them. It does the exact opposite: it sends a shiver down their spine—it confirms the problem.

Surely Ministers know that the 62-day waiting time target for treatment does not give a complete snapshot of the situation, because it captures only patients who are already in the system. I am sorry to be brutal, but as more people die, there are fewer people in the system. The target does not take into account the tens of thousands of undiagnosed patients who may be going about their daily life completely unaware that they are living with cancer.

I fear that the Government hugely underestimate the cancer backlog, and the consequence will be thousands of unnecessary deaths and lost life years. An article last month in The BMJ estimated that there will be 60,000 lost years of life as a result. Does the Minister recognise the significant fall in people receiving cancer treatment this year compared with 2019? Like me, is she worried that this will mean there are thousands of people out there with undiagnosed cancer who have yet to come forward?

I move on now to my second point, which relates to the Chancellor’s recent comprehensive spending review, which was a pivotal opportunity to signal that the Government, the Department of Health and Social Care, the Chancellor and NHS leaders understood the need for investment in the techniques and treatment required to quickly build capacity in order to clear the cancer backlog and ensure a resilient service going forward—to build the capacity that is vitally needed if we are to make sure cancer patients are not the collateral damage of covid. Far from seizing that pivotal opportunity, the Government appear to have turned it into a missed opportunity. As far as we can tell, there is no boost to cancer treatments in the comprehensive spending review. There is no increase in capacity to catch up with cancer, and there is no plan to do what is needed to save thousands of cancer patients’ lives.

The Action Radiotherapy charity estimates that the true cancer backlog could be as high as 100,000 patients. It supports the estimate of the Chair of the Health and Social Care Committee that it would take cancer services working at over 120% pre-covid capacity two years just to catch up. Members of all political persuasions, working with clinicians and experts who are desperate to make a difference, are clear about how the Government could provide the boost required to catch up with cancer and to save thousands of lives. The answer is not to exhort our heroic frontline staff to work harder—they continue to be inspirational, straining every sinew. It is not to carry on doing what we have always done, but just doing it a little better. It requires some new thinking. It requires taking an axe to some of the internal bureaucracy that has held back some treatments, such as radiotherapy. Crucially, it requires investment, but that critical investment seems to be missing from the comprehensive spending review. That is a missed opportunity on a massive scale, and I hope it is not too late to make a change.

I have to say that there has been a collective gasp of disbelief across the oncology and radiotherapy sector, as it appears—unless we are all mistaken—that there is not even an explicit mention of radiotherapy in the spending review, never mind of the investment in it. Radiotherapy is covid-safe and is required by over 50% of cancer patients. It already plays a significant role in 40% of cancer cures and is able, where clinically appropriate, to substitute for chemotherapy and surgery at times when they are deemed not to be appropriate because of the fact that we are in a pandemic. It is hugely cost-effective: it cures patients for as little as £5,000 to £7,000 apiece.

The reality is that radiotherapy has huge untapped potential to do even more to clear the backlog. For many reasons, however, it has been actively restricted and held back for years. Although radiotherapy treats 50% of cancer patients, it receives just 5% of the annual cancer budget—something for which recent Governments of all parties must share the blame. That is why the UK is massively behind on technology that could empower the workforce to do more. Pre-pandemic it was estimated that as many as 24,000 patients were missing access to radiotherapy treatment each year. It is worse now.

Faced with the current crisis, the radiotherapy community came together to put together a transformation plan for consideration at the comprehensive spending review. The six-point plan would deliver a super-boost to cancer services to clear the backlog, with innovative technology and digital solutions to deploy linear accelerators at the many covid-clean hospital sites in England, such as the Westmorland General Hospital in my constituency, that are perfectly suited to adding satellite capacity to their main cancer units while protecting patients and clinicians from covid infection risk. The plan would also see an immediate boost in precision radiotherapy at existing cancer units, upgrading linear accelerators to perform curative treatment over shorter periods. However, on our reading of the spending review, that appears to have been totally ignored. In fact, as far as we can tell, there is no clear plan of investment in cancer treatment capacity at all.

While the investment in diagnostic machines over 10 years is truly welcomed by all of us here, it is not enough. According to Freedom of Information Act requests carried out by the Radiotherapy4Life campaign, more than half of NHS trusts are using radiotherapy machines that are more than 10 years old. To replace only the machines that deliver diagnostics, or radiology, and not those that actually cure people—the radiotherapy machines—is a baffling decision, to me and, more importantly, the experts. Patients and the public will be shocked to learn that immediate solutions presented by expert professionals to the covid-induced cancer crisis are being overlooked.

Every week that we delay giving an immediate boost to cancer services—capacity, diagnostics and treatments —we increase the risk of losing cancer patients needlessly. Recent data shows that for every four weeks of delay in starting treatment there is as much as a 10% increase in deaths. Some departments report a 20% drop in the number of patients classified as curable, leading to downgrading to palliative treatment instead. Patients—our constituents, families and friends—are being told that their cancer now cannot be cured and that their treatment will be palliative instead. Yet the decision to catch up urgently with cancer has been either delayed or ignored. We will pay a huge cost for missing out on the chance to correct things at the spending review. That is why I hope it is not too late to do so. The public inquiry, when it happens, will reveal the situation. The cost of the understandable litigation by patients and families who have been failed will be needlessly huge.

We first wrote to the Secretary of State about the growing crisis in April, and we have not stopped warning of the devastating impact that there will be on the lives of cancer patients. Three hundred and seventy-five thousand people have signed the Catch Up With Cancer petition and have hundreds of patients shared their heartbreaking stories. Experts are saying that there will be as many as 35,000 unnecessary deaths and, as I have said, 60,000 life years lost to cancer because of the impact of the covid crisis. Cancer survival rates have been pushed back to where they were more than a decade ago.

I know that the Minister cares. She is a good person seeking to do a good job. I hope that she will forgive me for being direct today, but thousands of people could have their lives lengthened or saved, and their families could be spared unspeakable grief, if we acted urgently to catch up with cancer. I conclude by repeating my plea in the strongest possible terms. Will the Minister meet me and, most importantly, the expert clinicians who advise the Catch Up With Cancer campaign, in the next few days so that we can turn the tide on the crisis?

[Esther McVey (in the Chair)]

Just for the ease of colleagues, I will say that I am looking to call the Front-Bench speakers at 10.30 am, so divide the time among yourselves.

00:06

[Andy Carter (Warrington South) (Con)]

Thank you, Ms McVey. I will do a quick calculation.

[Esther McVey (in the Chair)]

You have quite a few minutes.

[Andy Carter]

It is a pleasure to serve under your chairmanship, and I am delighted to follow the hon. Member for Westmorland and Lonsdale (Tim Farron). I congratulate him on securing this important debate, and pay tribute to his excellent opening speech. I agree with many of the points that he made. The issue is incredibly important for families up and down the UK, and I am delighted to be able to join him in speaking in the debate.

I want to thank those who work in oncology in Warrington—the consultants, nurses, radiographers and, of course, GPs who are right at the frontline as the primary gateway into cancer services. Their work, and that of those in their sector across the UK, has continued through the pandemic.

Early on, I spoke to the chief executive of Warrington hospital, Professor Simon Constable, who outlined the steps his team were taking to try to maintain cancer care services in as near normal fashion as possible. Their ability to operate across two campuses, with a covid-free site in Halton, has meant that procedures such as breast cancer could operate very close to normal. The partnership formed with Spire hospital in Stretton, where the NHS has contracted bed space and use of operating theatres to give capacity for critical operations, has meant that referrals for urgent treatment in Warrington have continued.

I think that talking to real people is when we hear the true stories. Last Friday, I spoke to a constituent called Helen who lives in Lymm. It was one of the more pleasant conversations that I have had with her over the last few weeks. She very sadly discovered that her breast cancer had returned in April, which was the same week we hit the peak of the first wave. Understandably, she was incredibly concerned when she contacted her GP. Helen was referred back to a consultant and, after tests, was told that she needed a double mastectomy. I remember talking to her earlier in the year, when she told me the news, and she explained in detail her fears of catching covid when she went into hospital to undergo radiotherapy and tests. She was asked to isolate and follow detailed guidance, and she was superbly cared for by her son at home, who went out of his way to make sure she had everything that she needed. She went into hospital in Halton for treatment and last week, some eight weeks after the operation, told me that she was looking forward to going back to work as a supply teacher in one of our local schools. Her description of the care that she received from the NHS was incredible, and she said that they could not have done more for her. I highlight this story because I think we have not heard enough about the work that has continued over the last few months—but that does not mean we do not have a problem with cancer care services.

The local hospital in Warrington was treating 170 patients for covid at the start of November. It was one of the most under pressure hospitals in the entire country. The team has only been able to operate about 80% of normal services. I say only but I actually think that is pretty good, given that we are in a global pandemic and that is roughly in line with services across the north-west of England. I suspect though that the 80% headline masks many true and worrying statistics that we will discover over the next five years.

Last week I also spoke to executives at Macmillan Cancer about the local situation in Warrington, as well as the national picture. I pay tribute to the Macmillan nurses who have continued to work with patients in their homes through lockdown, particularly those who have supported families of loved ones who are near their end of life. Macmillan estimates that across the UK there are currently 50,000 missing diagnoses, meaning that, around 33,000 fewer people started treatment compared to a similar timeframe last year. That backlog of undiagnosed cancer could take 18 months to tackle in England alone. Most worryingly, if cancer referrals and screenings do not return to pre-pandemic levels, the backlog could grow by 4,000 missing diagnoses, reaching over 100,000 by October next year.

During much of the pandemic, the NHS has been open for business, and we should be proud of that. Anyone who needs care and treatment can continue to access it. When they need it, they can go to their GP and be seen, especially where delays could impose an immediate and long-term risk. I think the most worrying statistics are on urgent GP referrals in July and August. They were 72,000 lower than last year. In some ways, that highlights the most stark problem that the pandemic is storing up for us.

We have seen a significant reduction in people starting their cancer treatment in 2020. Between March and September, around 31,000 fewer people started their first cancer treatment, which is a drop of 17% compared to 2019. More than 650,000 people with cancer in the UK have also experienced disruption to their cancer treatment or care because of covid-19. For about 150,000 people, that included delayed or rescheduled cancer treatment.

I welcome the announcement of £3 billion of extra funding to support NHS recovery from covid-19 and to help tackle and ease some of the pressures in all our hospitals, allowing them to carry out more checks, scans, operations and procedures. That will help to ensure that cancer patients can access the care they need as quickly as possible, but we need to tackle the backlog, and we cannot afford to undo the great work and investment that has gone into cancer treatments in recent years. I am delighted to speak in a health debate today because of the news we have heard that a vaccine has been approved and is on the way. That is incredibly welcome, but we must put that alongside the challenges that exist in every single branch of medicine, and particularly in cancer care, where the patient backlog is extending.

One of the biggest challenges we face is caused not by money or pressure on NHS services but by putting things off. We all do it—mainly due to a fear of going into hospital. I mentioned Helen earlier, who talked about her greatest fear being to go into hospital. Lumps and bumps are not treated because we think it does not really matter at the moment. I am afraid that is particularly true for us men, and the pandemic has highlighted that. We really do need a public information campaign that says, “If you spot a problem, don’t leave it for a later date.”

As the hon. Member for Westmorland and Lonsdale said, since 2010, survival rates from cancer have increased year on year. We have a really good story to tell in this country—about 7,000 people are alive today who would not have been here if mortality rates had stayed the same—but to sustain that drop, the NHS and Government will have to take action like they have never done before. It is critical that the cancer workforce is ring-fenced against any further redeployment to ensure that cancer care continues and further avoidable cancer deaths are averted.

Before the pandemic, there were about 3,000 specialist cancer nurses, which Macmillan modelling indicates is around 2,500 below the level required to deliver basic cancer care—and given the backlogs, that figure is probably closer to 3,500. Patient feedback to Macmillan was that, though its nurses work incredibly hard, they are not getting the support that they need. I really welcome the 14,000 additional nurses we have recruited in the last 12 months as I do the additional £260 million fund allocated for Health Education England in the one-year spending review, which will go towards the Government’s commitment to train 50,000 more nurses. However, my hon. Friend the Minister will know that that alone will not address the significant shortfalls in specialist cancer care nurses. I am therefore really keen to hear from her how the Government can commit to further long-term funding support for the next iteration of the NHS people plan to eliminate the gap in the cancer workforce.

It is hugely important that the Government back the national cancer recovery plan and the additional resource needed to build capacity and help beat the backlog now and in the long-term, getting the right skills and resources in the right places to make sure we have the biggest impact possible and, most importantly, encourage people to get the treatment that they need. Getting all of us to feel comfortable with reaching out to our GPs early on, so that we can get treatment, must be our No. 1 priority.

09:59

[Tonia Antoniazzi (Gower) (Lab)]

It is an honour to serve under your chairmanship, Ms McVey. I rise as the chair of the all-party parliamentary group on cancer to talk about the worrying backlog of people who have not yet received a diagnosis of cancer. I pay tribute to the hon. Member for Westmorland and Lonsdale (Tim Farron) for securing the debate. We have been working hard cross-party to raise the issue of cancer services and the backlog, which is an issue really close and dear to my heart and one on which we need to make far more progress. I thank him for his excellent speech and his work.

Despite the amazing efforts of clinicians working in the NHS and additional support from the Government, the backlog of cancer is big and it is real. It was caused by the impact of addressing the first wave of the pandemic. I am not just talking about the backlog of people within the cancer system, which are often the figures that the Government deem to be the backlog. The real backlog is of undiagnosed people yet to come forward and present to the NHS through the three main routes: GPs, screening programmes and A&E.

In “The forgotten ‘C’” report by Macmillan Cancer Support, which uses the Government’s own data, it is projected that there are currently 50,000 missing diagnoses. The hon. Member for Warrington South (Andy Carter) has spoken in great detail about the figures, which I have also had from Macmillan. That means that compared to a similar timeframe in 2019, 50,000 fewer people have been diagnosed. That is a huge amount of people that we cannot ignore.

Macmillan Cancer Support estimate that 33,000 fewer people across the UK started treatment this year than in 2019. Working on the current rates, that backlog of undiagnosed cancer could take 18 months to tackle in England alone, not talking about the rest of the United Kingdom. Macmillan says that

“if cancer referrals and screening do not return to pre-pandemic levels, the backlog could grow by almost 4,000 missing diagnoses every month, reaching over 100,000 by October next year.”

That worries me to the pit of my stomach.

Such gravely concerning figures on the cancer backlog are echoed and supported by Action Radiotherapy, which states that the backlog of patients still waiting for potentially life-saving treatment amid the coronavirus pandemic could be as high as 100,000, with cancer services needing to work at around 120% to clear the backlog over the next two years. Those incredibly sobering and worrying statistics concern me.

In a recent parliamentary answer, the Government stated that they do not recognise those figures and they continually give an overly optimistic view of the current state of cancer services. The Government’s latest cancer waiting times from September 2020 state that urgent referrals were at more than 100% of the 2019 levels. That is over 45,000 people who have received cancer treatment, which is 96% of last year’s levels. Across the period from March to September 2020, over 291,000 cancer treatments were carried out, which was 86% of the level in 2019 and 94.5% of patients with a decision to treat received a first treatment for cancer within 31 days. Those are promising and improving statistics from the delays and disruption we saw in the first period of the pandemic. We cannot deny that.

I take this opportunity to thank the incredible and dedicated cancer workforce that has been indispensable in getting services back nearer to pre-covid levels. That is why we have to call on the cancer workforce and we need to keep them there doing their jobs. They are very precious, particularly at this time. Their efforts have been incredible and it is important to acknowledge their service to patients across the country, and their fantastic efforts in continuing cancer care across the second wave.

From all accounts, we are not seeing the delays and disruption across the board that we saw during the first wave of the pandemic. However, despite the improving situation there are many instances where the performance of the cancer system is operating at a slightly lower rate than before the pandemic. To tackle the backlog, the cancer system needs to out-perform its pre-pandemic performance, which it is not doing in all areas.

For every month that the NHS is working at below pre-pandemic levels, the backlog is building and it is not being beaten. Urgent GP referrals appeared to be roughly back to normal in September, but there were still around 338,000 fewer people not seeing a specialist following an urgent referral between March and September this year, compared to last year. I am rightly concerned about the potential for missing diagnoses. Macmillan Cancer Support estimate that it would take 17 months at 10% above 2019 levels to see 338,000 extra patients, which are striking figures.

The real issue is that Ministers are painting an over-rosy picture of the cancer backlog and trying to refute the claims that a large number of people are not having cancer treatment this year compared with previous years. The Government cannot refute their own cancer waiting times data for those starting first cancer treatment. From March to September, there were 31,000 fewer patients starting first cancer treatment in England, which is a drop of 17% compared with the same period last year.

Let us be clear: there are 31,000 people in England who currently could have cancer, and yet, for numerous reasons associated with the pandemic, have not presented to the NHS with symptoms. That is an incredibly worrying and troubling statistic. Without acknowledgement of the scale of the issue, neither the solutions to the problem nor the resources needed to tackle it will materialise.

Again, while September’s monthly activity was improving, it is still down on last year and so the backlog will continue to grow each month. Month by month, performance is below 2019 levels, which is a huge concern—and a huge and daunting task that is currently being underestimated by the Government.

The national cancer recovery plan, which is yet to be published by the Government, and only runs to March 2021, only uses metrics on the backlog that include those on the 62-day and 31-day cancer pathways, as well as those with longer waits for diagnostics or treatments above 104 days. It in no way estimates the significant number of people yet to present to the NHS. That is the real backlog, which the Government are failing to acknowledge and are failing to take significant and timely steps to address.

While the Government have made some welcome steps in adding additional capacity through the independent sector and just recently committed £1 billion extra in the comprehensive spending review to deal with backlogs in the NHS, it is uncertain how much of that money is allocated to the cancer system. Will the Minister confirm how much of that funding will be spent on beating the backlog in cancer care?

It is clear that the restoration of the cancer system is a priority at the highest levels of the Government and that significant resources have already been allocated to that endeavour, but—it is a very big but—until the Government acknowledge and plan to tackle the monumental scale of the real backlog that is still building, the health outcomes of many thousands of people out there yet to be diagnosed with cancer will be significantly grave and the Government will not be able to meet their ambitious targets for cancer within the NHS long-term plan. Will the Minister acknowledge the scale and reality of the problem, commit the strategic and monetary resources needed to tackle it now and work with key stakeholders such as Action Radiotherapy, the different all-party parliamentary groups and Macmillan Cancer Support, which have been working hard to support those living with cancer and who have been severely impacted by the pandemic?

I welcome the previous and the soon-to-be-had engagement with the Minister. We appreciate that we are working in unprecedented times. However, I was a little bit concerned to read a letter dated 30 November from NHS England’s cancer programme to the cancer alliances. The letter, which is advice on maintaining cancer recovery, shows the depth of arrangements and efforts that are being made to restore the cancer system and continue with cancer care, but it fails to acknowledge and deal with the huge backlog of people we have spoken about today—those who are yet to come forward for a diagnosis.

The national cancer recovery plan is too short term and has the wrong priorities to deal with the backlog in the long term. That is what we are concerned about; that is why we have come here today to present the issues to the Minister. I look forward to speaking with her, but I ask that this issue is dealt with immediately.

10:09

[Grahame Morris (Easington) (Lab)]

Thank you very much, Ms McVey, for calling me to speak in this important debate. I also thank my friend, the hon. Member for Westmorland and Lonsdale (Tim Farron), for securing this debate.

I am sure this will seem like groundhog day for the Minister, with a whole phalanx of MPs supporting the calls for more resources for cancer, but this is a very serious issue and I make no apology for rehearsing those arguments. Until we see tangible results arising from our lobbying efforts, I am afraid it will continue. The hon. Member for Westmorland and Lonsdale made an excellent opening speech, setting out the arguments in a thoroughly cogent and thoughtful manner. I also want to pay tribute to the NHS workforce, in particular our cancer workforce, not just the oncologists but the therapeutic radiotherapists, the technical staff who keep the service running, and those key personnel who work behind the scenes, often unacknowledged, whose expertise has the potential to improve cancer outcomes.



The speeches have been excellent so far, but I will take issue with one point raised by the hon. Member for Warrington South (Andy Carter) about our cancer performance. Our focus in this debate is on what we can do immediately to address the cancer backlog, but I would respectfully point out that, even before the pandemic, our performance on cancer outcomes was not world-beating. In fact, for the seven most common cancers, in a direct comparison with similar advanced industrialised countries, we were either bottom or second bottom. There was a job of work to be done even before the pandemic, and the impact of covid has shone a spotlight on that.

I have the great privilege to be vice-chair of the all-party parliamentary group for radiotherapy and vice-chair of the all-party parliamentary group on cancer. The charity Action Radiotherapy estimates the full cancer backlog stands at more than 100,000 patients, and it agrees that it would take cancer services working at over 120% of pre-covid capacity for two years just to catch up. The chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt), agrees with that figure, having done some research of his own.

We need a distinct plan. It cannot be a case of Members simply lobbying Ministers and asking for more resources. We need to quantify the scale of the problem; we need an action plan. I am very much aware that we have a cancer recovery plan, but we need an action plan that addresses all the issues. I also believe that we need somebody with some clout to lead it. Last week the Government announced that the Under-Secretary of State for Business, Energy and Industrial Strategy, the hon. Member for Stratford-on-Avon (Nadhim Zahawi), would be the Minister responsible for driving forward the vaccination programme. Cancer is such an important area of concern to the public and to the broader community that we need to have someone with some clout, preferably a Minister or senior person within the NHS, to be given the responsibility to drive this initiative forward.

Experts are predicting 35,000 deaths and 60,000 lost years of life, with cancer survival rates having been pushed back to where they were 10 to 15 years ago. We need to address this issue. When we have asked questions in previous debates, Ministers have responded, and I mean no disrespect to the Minister who is in her place at the moment, because I know that she fully understands the issue. I do not want to make any apology here, but there is a difference between investing in diagnostics and investing in curative treatments. There is a difference between radiology and radiotherapy, and I am not convinced that the Secretary of State understands those differences. We welcome the additional investment in digital imaging and improved diagnostics, but we must address how we get more resources and improve the number and quality of the skilled cancer workforce to get to grips with the backlog.

It is appropriate to mention the implications of the pandemic for prostate cancer, which was also referred to by the hon. Member for Warrington South. Movember, when men grow a moustache to raise awareness and funds for men’s health during November, ended earlier this week. Prostate Cancer UK has identified two major concerns. The first is the detrimental impact on GP referrals for prostate cancer. That came to mind when my hon. Friend the Member for Gower (Tonia Antoniazzi) mentioned the three referral pathways of A&E, GP referral and screening programmes. There is a massive issue. I suspect that hon. Members present have some experience of how extraordinarily difficult it is, particularly for older people, to get a face-to-face appointment with a GP at this time if they have concerns about possible early symptoms of cancer. Again, that needs to be addressed, because it is having an impact on the backlog.

The second concern is about men accessing support and communication at the time of diagnosis and when living with side effects or advanced disease. Calculations by NHS England and Prostate Cancer UK suggest that there are between 3,000 and 5,000 men with undiagnosed higher risk prostate cancer who would otherwise have been diagnosed had referral rates been at pre-covid levels.

In the time that I have remaining, I will focus on two main areas and I have some specific asks of the Minister. The first area, which I have raised on previous occasions, is data and information. We have heard statements from Ministers in the Department of Health and Social Care and from senior NHS leaders that indicate that they do not have an accurate estimate of the full cancer backlog of delayed treatments, diagnostics and screenings. The publication of the radiotherapy dataset, which is available, would show precisely the extent and character of the backlog, because it would compare the position now with the position 12 months ago.

For reasons that are not apparent to me, the publication has been delayed by NHS England, so my first ask of the Minister is, why is that? Why will those radiotherapy datasets not be published? I do not know whether NHS England is being too slow to act or whether it is some kind of bureaucratic hold up, but it must be driven forward, as it is imperative to ensure that the cancer recovery plan is accurate. That is despite the fact that NHS England and Ministers are fully aware of the effect of the pandemic on cancer services; we have been raising the issue since April.

It is clear that knowledge is power. A lack of accessible data is resulting in an inability to catch up with cancer. Let us be frank: people are dying unnecessarily as a result. There was the awful case of Kelly Smith, one of many tens of thousands of people, who was a 31-year-old mother of three who died as a result of delayed treatment for bowel cancer. It was absolutely tragic. That caused her family to launch the Catch Up With Cancer campaign and petition, which I believe now has almost 400,000 signatures. If that does not concentrate Ministers’ minds, I do not know what will.

The second area is the comprehensive spending review and, in particular, the lack of any detail or specific reference to funding for modernising radiotherapy services. The Chancellor’s announcement last week was most welcome, but when the hon. Member for Westmorland and Lonsdale asked about the cancer backlog and additional resources for advanced radiotherapy, he was referred to Health Ministers and the Secretary of State.

We should be aware that radiotherapy is safer to administer during the pandemic than alternative treatments. I am not attempting to set up a competition, but we have to recognise that radiotherapy is non-invasive and covid-safe, and has a range of applications. It is needed by about half of all cancer patients and is a significant treatment in 40% of cancer cures. I have benefited from it myself on three occasions. It is also hugely cost-effective, curing patients for as little as £5,000 to £7,000 per treatment. It is very efficacious in terms of the curative rate, and it could do much more to clear the backlog, but it is being held up by underfunding and bureaucracy, which have slowed the roll-out of new technology for a number of years.

Despite freedom of information requests showing that nearly half of trusts are using radiotherapy machines that are 10 years old or older, it appears that the spending review includes funding only for diagnostic machine replacements and not radiotherapy treatments. Even before the pandemic, Radiotherapy4Life estimated that 24,000 patients did not have access to radiotherapy and would benefit from it. Will the Minister commit to improving access to local radiotherapy by investing in new networked treatment delivery centres? Furthermore, will he consider all the elements of the six-point plan to transform radiotherapy services to ensure that we have the treatment capacity to catch up? Will he sweep away the bureaucracies that have contributed to the backlog?

There is no doubt about it. We need a supercharged—“super boosted”, to use the Prime Minister’s words—treatment capacity if we are to address this cancer crisis.

00:00

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Westmorland and Lonsdale (Tim Farron) on securing the debate and setting the scene, and all hon. Members on their incredible contributions. I look forward—I said this yesterday and need to get away from saying it again—to the Minister’s response and the contributions of the shadow Minister and the Scots Nats spokesperson.

I have been contacted by many constituents asking me to attend and speak in this debate, and as my party’s health spokesperson I am very happy to do so. One of the heartbreaking stories I have heard in the past couple of difficult days is a widow saying:

“my husband only died of cancer—he isn’t important”.

I honestly could have cried when I heard those words, because I believe that she genuinely felt that no one cared, and that is what she told me. I felt that hardness; I had a compassionate understanding of what she was saying.

We are in unknown territory and undoubtedly we are distracted. How can we save people from contracting covid? How do we treat those who have it? How do we keep people in contact with others for their mental health? How do we ensure economic viability to pay for the future health needs of this nation? We are distracted, but when we have widows and cancer patients telling us how left behind and unimportant they feel, we know that in our distraction we have got this wrong. It pains me to say that.

Throughout this pandemic, I and others have lost loved ones. Two of the girls in my office have lost loved ones: one lost a sister and the other lost two uncles. We know the devastation, but we have all lost loved ones to cancer too. It is not that one is less important than the other, so that is why this debate is so important. I am thankful for this debate, which allow me to come alongside my colleagues and friends—that is what they are—to discuss how better we can do this together.

I was contacted by a radiotherapist who highlighted the massive problems they are dealing with daily. There are two main radiotherapy centres in Northern Ireland. I know this is not the Minister’s responsibility, but I am saying this to give some context to the debate. One is in Belfast, and the other is the newer, smaller North West Cancer Centre at Altnagelvin. I am told that the main issues in radiotherapy are the result of the lack of investment and funding. There are major problems as a result of staffing—doctors, therapy radiographers and physics—including recruitment, training and retention. That has a knock-on effect on service delivery, development and research. Investment is needed to replace old radiotherapy treatment machines.

Northern Ireland would like to feel more connected to mainland UK radiotherapy, through sharing best practice, training support, data sharing, peer review and so on, and that is what we are asking for. It is important that we take an holistic approach to this across the whole of the United Kingdom of Great Britain and Northern Ireland.

The covid problems found also included more patients having their treatments disrupted in many centres in the United Kingdom and a higher proportion than average reporting a poor or very poor experience. That also worries me greatly. We have members of the all-party parliamentary group for radiotherapy in the Chamber today, and I know that every one of us understands these issues, including the hon. Member for Westmorland and Lonsdale, who set the scene. One hundred per cent of responders said they were treating patients who would usually be having chemotherapy or surgery. The additional referrals were for a range of cancers, including oesophagus, lung, breast, head and neck, upper gastro- intestinal and bladder, and also included palliative cases.

I want to speak about one specific cancer, pancreatic cancer. It has been highlighted that there was already an emergency before covid-19. This was a critical issue back in March and it is even more critical today, in December. Surgery is the only potential cure for pancreatic cancer. Before the pandemic, only one in 10 people received surgery. With pancreatic cancer, a six-month delay to surgery means a 30% reduction in survival and a three-month delay a reduction of over 17%. Unfortunately, that sets the scene, with pancreatic cancer progressing from a curative to a non-curative disease while treatment is delayed. Surgery, for some, is no longer an option. That is greatly disturbing.

Reports of service restoration are encouraging. We hear from clinicians that, in most parts of the UK, surgery and treatment are now back up and running at near normal levels, but for so many people with pancreatic cancer and their families the damage has already been done. For those diagnosed in the future, the continued delays to the restoration of clinical trials are stunting crucial improvements in treatments and outcomes.

People with pancreatic cancer have also experienced an information gap, with 40% of patients who were impacted by the pandemic reporting having received insufficient information and support about treatment, symptom management or palliative care. We have had multiple reports of people being sent home from hospital with a new diagnosis without any further information on the disease, their prognosis or treatment options. Anyone facing something incredibly dark such as pancreatic cancer at an advanced stage will want the person opposite them to tell them what is wrong and give them some light on a way forward. All of us in this Chamber today, and all of us outside it, have been touched by cancer. For every two people we meet, one of them, or someone in their family, will have had it. Unfortunately we are continually confronted by this, each and every day.

Calls and emails to Pancreatic Cancer UK’s support line nurses have been up 58% on the normal weekly average, and there has been a 34% increase in the number of people being supported each week. Again, I think those figures are the critical factor in where we are on this. Pancreatic Cancer UK has also been contacted by a larger proportion of palliative patients than normal, because that is unfortunately what pancreatic cancer often leads to. If people do not get an early diagnosis and early surgery, they are confronted with end-of-life care. For families, that is incredibly difficult and complex, and a very difficult time in their lives. People with pancreatic cancer have reported feeling forgotten and isolated, at a time when they are also unable to see friends and family due to the risk of covid-19 transmission.

We are all heartened by the tremendous news today that we are going to roll out the covid-19 vaccine late this year and into next, given the time it will take to get to everyone. That is good news, but we have to address the issues for those with cancer now. I believe we need to do better, and the changes must be implemented from here at Westminster and across the whole of the United Kingdom of Great Britain of Northern Ireland. On behalf of all those cancer patients—all the ones who have contacted us, and all those facing an incredibly difficult time—I look, as I often do, to the Minister for a response. I know we will get that, but we really do need to be reassured. We need early diagnosis and extra care, and we need to show compassion in this place for those outside.

[Esther McVey (in the Chair)]

We now move to the Front Benchers.

10:29

[Dave Doogan (Angus) (SNP)]

It is a pleasure to serve under your chairmanship, Ms McVey. I am grateful, as all our constituents will be, that this issue has been brought to the fore in the way that the hon. Member for Westmorland and Lonsdale (Tim Farron) has done in securing this debate. My only regret is that my hon. Friend the Member for Central Ayrshire (Dr Whitford), who is a cancer specialist, cannot be here to share her wisdom and knowledge on such matters because she cannot participate remotely. You have got me instead, Ms McVey.

As we see from our inbox, there is concern that the reconfiguration of our national health services to meet the projected clinical demands of the pandemic went too far, and has come at a cost to non-covid patients. There are serious concerns about a cancer backlog. Gravely ill patients were, and clearly continue to be, cared for by our four national health services consistently throughout the pandemic, thanks to the dedication of clinicians and nursing and support staff. That is not to say that the pandemic preparedness had no consequences, but to defend the qualified and proportionate repositioning of the health services in the face of we knew not what exactly, back in March. The backlog is a consequence. How can we address it now?

As we have heard, Action Radiotherapy has suggested that there have been 100,000 missed diagnoses. That is a serious challenge for us to address across these islands. The Scottish Government undertook extensive work to improve cancer treatment over the last decade, and have made every effort to ensure that it was minimally disrupted throughout the pandemic. There has been disruption, however—of course there has.

Macmillan has expressed its concern that 50,000 diagnoses have been missed. When Macmillan speaks on these issues, Ministers in all four Administrations should listen to that message. A drop of 72% in cancer referrals as a result of covid is a cause for serious concern; we do not need to be specialists to understand that. Even though only a percentage of those referrals will result in a cancer diagnosis, there will nevertheless be a backlog of referrals and resulting care plans to be worked up as a result of covid. Dr Gregor Smith and many across these islands have insisted that people should report and present to their GPs when they notice something unusual. The First Minister of Scotland has also stressed that the NHS remains available to those who need it. Advice has been sent to all cancer service centres in Scotland, including the key message that health boards are expected to maintain full and urgent cancer services.

Who among us is unfamiliar with those in our communities, usually from an older generation, who do not like or want to trouble people, so do not present to their GP? For some, particularly men, there is a somewhat understandable reticence to present for healthcare in the middle of the pandemic. We can therefore see significant presentation deferral, which needs to be acknowledged, accepted and resourced. That needs to be resolved quickly, acknowledging the time-critical nature of some of the conditions. Cancer treatment services in Scotland—and, I assume, in the other three nations—have continued as much as possible throughout lockdown, using modified operational models. I thank NHS Tayside, which employs many of my constituents and looks after the healthcare of all my Angus constituents. I especially thank those at the cancer centre in Dundee, who have worked tremendously hard. The Scottish Government invested a great deal in additional MRI scanners and CT scanners to aid diagnosis, but I accept the important difference that other hon. Members have highlighted between diagnosis approaches and resource, and treatment.

Many challenges persist in this priority issue, not least the staffing of specialist consultants. That is especially challenging now because recruiting from EU countries is challenging as a result of Brexit, and retaining domestic consultants is also challenging. At the start of covid, the average age of NHS returnees—those who nobly answered the call to assist with covid and its consequences—was 57. Many of those doctors are retired because of the punitive implications of Her Majesty’s Revenue and Customs rules on pension allowance. That really needs to be addressed soon, to allow that dormant domestic capacity to keep their shoulders to the wheel should they wish to, without being unduly penalised. That issue of doctors’ pensions is one of the most hopeless instances of the total failure of a whole-system approach in modern governance, with HMRC tying the hands of our NHS behind its back. That is a really easy win—low-hanging fruit—that we can resolve quite soon.

The UK Government must ensure that cancer treatment does not move backwards in the aftermath of coronavirus, and must focus proper additional investment on our NHS. Despite the work of the NHS in Scotland and across the UK, there is a backlog of people seeking cancer screening and/or treatment. At this stage, we have three priorities: satisfying the routine cancer demand; the health commitments in and around covid; and the cancer backlog. To ensure that this does not spiral into an enduring secondary health crisis, significant and defined supplementary investment is needed to clear the backlog of screening and treatment, and to get cancer services restored to at least the level seen before the pandemic. It is important for colleagues in England to keep a weather eye on what the Barnett consequentials are for the devolved nations as a result of funding announcements. To be clear, if there are no Barnett consequentials for the devolved Administrations, what we are seeing is simply relabelled money rather than new investment. That will not fly.

The hon. Members for Strangford (Jim Shannon) and for Gower (Tonia Antoniazzi) do not need the clinical direction of the Department of Health and Social Care—that is taken care of by the devolved Administrations—but we are umbilically connected to the funding settlement for NHS England. That is why it is so essential. The £3 billion offered for next year is a third of what the SNP has been calling for on a yearly basis. After a prolonged period of austerity, £3 billion is not even enough to cover the outstanding hospital repairs required in England alone, much less to restore cancer services. Regardless of where we live on these islands, we have all convened here this morning to try to restore cancer services and protect those affected. I respectfully look forward to any specific indications that the Minister can give us of additional funding to address this very serious and pressing issue.

10:36

[Alex Norris (Nottingham North) (Lab/Co-op)]

It is a pleasure to serve under your chairship for the first time, Ms McVey, and I commend the hon. Member for Westmorland and Lonsdale (Tim Farron) for securing the debate. When he opened it, he said he thought this was an issue on which we could work through consensus and in a collegiate fashion, which is absolutely right. The tone that he set, and that other hon. Members have followed, reflected that. He also said that he was direct in his contribution, which he was. He was right to be direct, because these are life and death issues, and we in this place need to be really focused on them in the most direct fashion.

I was lucky to meet the hon. Gentleman in July, alongside representatives from the secretariat of the all-party parliamentary group on radiotherapy, to discuss this issue. Of course the situation is not exactly the same as it was in July, but the crux of the issue is the same. It is great to go beyond virtual meetings and the back-channel conversations that we have in Parliament, and to get the subject on to the Floor of the House in order to have a public conversation about what is a very public and important matter. I particularly agreed with the hon. Gentleman’s point about “back to normal” not being good enough, because “back to normal” will not help us clear the backlog. Actually, we do not want to go back to where cancer services were in January. Hon. Members have touched on many ways to make services better—I will do the same later—and we should seek to do so. I share the hon. Gentleman’s anxiety about the gap between some of the rhetoric that we have heard from the Secretary of State, and the reality of what the numbers tell us about where we are at the moment.

Cancer touches us all at some point, as the hon. Member for Strangford (Jim Shannon) said yesterday and again today. For me, it was 33 years ago: I lost my father just before my third birthday. You come to terms with it and learn to live with it, but it is something that you carry around with you every day for the rest of your life. One of my major reasons for wanting to be a Member of Parliament is that I want there to be as few families like mine as possible. We can beat cancer to the best of our ability, so that people need not live their life in the shadow of cancer. I know that the Minister shares that aspiration. That is part of the consensus that we can build on this important issue.

The speeches this morning have been really good. The hon. Member for Warrington South (Andy Carter) started with Helen’s story, which was a really important thing to do. Lots of numbers have circulated—I will be guiltier than anyone else of throwing tens of thousands here and there—but each one of those statistics is a person and a life. That is what really matters. I strongly share the hon. Gentleman’s recognition of the creativity of our NHS.

I nodded and agreed when my hon. Friend the Member for Gower (Tonia Antoniazzi) made the point about undiagnosed cancers. I worry sometimes that when the Secretary of State talks, he is talking about the backlog and dealing with treatment for those who have a diagnosis. That is of course absolutely crucial, but it is only part of the problem that we are dealing with.

My hon. Friend the Member for Easington (Grahame Morris) has been a very good friend to me ever since I was elected in 2017, but particularly in my Front-Bench role over the past eight months. I am grateful to him for his counsel and guidance, and for constantly sharing his information with me to enrich my work. He was right to say that we have to understand the performance picture a year ago—frankly, covid was a very distant and small threat, and we had not really grasped how it would change our lives. We were not happy with cancer performance or with the direction of travel over the last decade. Certainly, as the Opposition, we were very concerned about that. We have to see the current situation in that context.

The hon. Member for Strangford was yesterday the Member in charge of a brilliant debate on cancer in children and young people. Collectively, we raised and analysed really important issues, and I know that the Minister took an awful lot away from that. The hon. Gentleman’s contribution today was very much in the same vein. It was about an holistic approach, across the four nations, all of which are represented today, which is really nice. As the hon. Member for Angus (Dave Doogan), who speaks for the SNP, said, this is of course a devolved issue. But we need to tackle it collectively.

I will make a few points of my own. In yesterday’s debate, I touched on the impact that covid has had on cancer diagnosis and treatment in children and young people—a demographic that is often both reluctant to visit the doctor and diagnosed slowly; it often takes multiple visits for that to happen. We will need to do things differently to tackle the pre-existing issues such as that and to catch up in relation to where we are.

Of course it was right that we prioritised covid during the first wave and have continued to make tackling the pandemic an important priority. We should take real pride in the fact that our NHS has taken such a strong punch to its capacity and stood there; that was not inevitable. We have seen other health services around the world overwhelmed, so we should be really proud of ours. It is a real testament to the institution that it has stood firm.

Nevertheless, we know that we now have an undiagnosed and untreated backlog of cancer. It is hard to estimate its true size because it is unknown. However, working off the best estimates of experts in the field—I shall use many of the numbers that the hon. Member for Westmorland and Lonsdale did in opening the debate—we are talking about a backlog of about 100,000 patients, which it would take about two years, working at 20% higher capacity than pre-covid, to capture. We cannot do that just by wanting it to be better or wanting people to put their shoulders to the wheel even more, after a year in which the NHS has been working flat out. We will have to do things fundamentally differently. If not, the price will be preventable deaths. Every four weeks of delay in starting treatment can cause an increase of up to 10% in the risk of death. The estimate is that the backlog could cause between 30,000 and 60,000 deaths, which starts to become of the same order of magnitude as the number of deaths from covid itself. That is how serious the situation is. As we emerge from the pandemic, we need to tackle cancer with the urgency and focus with which we have tackled covid.

There is particular concern about missed screenings. Cancer Research UK estimates that 3 million screenings were missed over the last year. Also, we know that fewer people went to the GP with symptoms during that time, because they were worried about other issues or capacity issues. As a result, about 350,000 fewer people were referred between April and August than we would normally expect, and there was a consequent 39% drop in the number of key diagnostic tests undertaken in that period.

I was really glad to hear yesterday from the Minister that the numbers of GP referrals are now back around pre-pandemic levels. That is a good sign. Actually, there were more referrals in September 2020 than in September 2019, but the two-week wait target of 93% is not yet being met, so there is definitely some context for that.

We need to understand that this issue will still not apply evenly throughout the population. Cancer does not know who we are when it grows in our bodies, but different demographics are affected differently—yesterday we talked about young people—and there are issues about different cancers, too. The points that the hon. Member for Strangford made about pancreatic cancer were well made.

The scale of the problem is exceptional and it calls on us in this place to make it a real focus and to have really strong, robust plans; so, now that I have talked about the problems, here are my suggested solutions. For me, this goes across four phases—planning, resourcing, new treatments, and workforce.

In August, the Secretary of State said that he very much hoped that the backlog would be cleared

“within a matter of months”.

Since I assumed my role, I have used three out of four sessions of Health questions to ask about cancer and try to get the Government on the record on that, which is why it is so great that we are having this debate. My heart sank when the Secretary of State said he thought the backlog could be cleared within a matter of months, because there is a problem; I do not think it is rude or unkind to say so. It has been recognised, during the pandemic, that some of the rhetoric that comes out of the Department is wishful and not grounded in reality. We are always told that things will be “world-class” and that things will be done “by the end of next month”. People’s hopes are got up and then dashed. We do not need exaggerated rhetoric here; we need exaggerated action.

I cannot see how anybody thinks that we can clear the backlog—the real backlog, which includes the lack of diagnosis as well as delayed treatment—within a matter of months. I do not think it helps anybody to talk in those terms. However, in October, at the Health questions before last, the Secretary of State gave me a categorical assurance that he has a cancer recovery plan that will drive down waiting lists each month for the rest of the year. I welcome that. That could be done and I am keen to hear the Minister reflecting on progress on that.

Similarly, at the most recent Health questions, the Minister for Health, the hon. Member for Charnwood (Edward Argar), said that there was greater capacity to deal with these things.

[Grahame Morris]

I cannot dispute the answer that my hon. Friend received from the Minister. It was an obvious answer, but the waiting lists have reduced because people are not presenting. There are fewer screening programmes, people are finding it harder to see their GP and things have become more and more difficult, so there is bound to be a reduction in waiting times, but that does not reflect the true picture of the backlog.

[Alex Norris]

Those points are very well made and get to the heart of what we as an Opposition want, what all Back Benchers want—and in fact, everyone. We do not want to beat cancer on paper and in statistics; we want to beat it in reality. We are not making this an issue of politics. It has to be an issue of coming together, as the hon. Member for Westmorland and Lonsdale said in opening the debate, with new and challenging things. Critically, at the heart of this, there is an indication of a plan, so I hope that today the Minister will commit to publishing it, give us greater detail on what is in it, update us on its progress in recent months and tell us whether it works through the full pathway, from symptoms to treatment, or whether it is just a diagnostics plan. To what extent is it being maintained in the second wave, and, with the national cancer recovery plan expiring next March, will there be a longer-term successor? I know that is a peppering of questions, but this is our best opportunity to ask, so I hope the Minister will take that in the spirit intended.

On resources, there was £1 billion in the spending review to tackle backlogs. Will the Minister clarify how much of that will go to cancers? Although the money is welcome, it is less than all the health experts have called for. The Chancellor has promised to give the NHS what it needs, and this is a “what it needs” issue, so resources are important.

On innovation, I am lucky enough to have lots of innovative companies contact me to talk about their treatments. It cheers the spirit to hear about developments in chemotherapy that will make it possible for drugs to be tailored to individuals. That is remarkable. However, I will make a point about radiotherapy because of the hon. Members between me and the door; I will not get out unless I do. Radiotherapy is safe to deliver in a pandemic, is significant in 40% of cures and is cost-effective. That is an area where we can make a real impact. Will the Minister commit to follow what my hon. Friend the Member for Easington said and publish the delayed radiotherapy dataset? That would be a nice step forward.

Macmillan has raised concerns that the long-term plan for the NHS will not be matched by the workforce available. It thinks we need a further 2,500 specialist cancer nurses. Where are we up to with that?

The most important message that any of us can send today is to a person listening to this, watching this or following the coverage who has a hacking cough, a lump or bump or blood in the stool, and has previously used the pandemic—as perhaps many of us would—as a reason not to access care. I ask them to please not do that. The NHS is there for them. We need them to access it. It will be there.

[Esther McVey (in the Chair)]

I am about to call the Minister, but am mindful that Tim Farron needs time to wind up.

10:44

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

It is a pleasure to serve under your chairmanship, Ms McVey. I have been given nine minutes to answer an enormous number of questions, so I will canter through in the hope that I answer some of them. We are a group that meets and discusses these things on a fairly regular basis. Indeed, I am back here this afternoon for a lung cancer debate, so this is an ongoing conversation, which I appreciate is vital. It is right that we recognise, as several hon. Members have, that the NHS has stood up during the pandemic, which was a blow to its very belly. We have put much effort into retaining services, not only for cancer, but for stroke patients and others, so that they can go to our NHS in their time of need.

I thank the hon. Member for Westmorland and Lonsdale (Tim Farron) for securing this debate and for all the work he does as chair of the APPG. He has such a formidable set of musketeers supporting him on what is one of the most focused APPGs. We are due to meet in January, but I will try to fit in a short meeting this side of the recess.

I have never said we were world beating—I came to this place because we were not; we had challenges before. Up to March last year, there were 2.4 million patients, which is 1.4 million more than in 2010. We were on a trajectory and covid hit us hard, and I would be the first to say that it has presented major challenges for the entire healthcare system.

The significant impact of shutting down services resulted in a sharp reduction in the number of people being referred urgently with suspected cancer and from screening programmes. That is a statement of fact. I am not going to stand here and say that it did not happen, but I am also not going to say that Herculean efforts have not been made since then.

I am really pleased that the cancer services recovery plan has had input from many cancer charities, including Macmillan, which has been mentioned, as well as many Royal Colleges, including those of General Practitioners, of Pathologists, of Radiologists and of Surgeons. It is vital that the right people make the recovery plan, which is being led by Professor Peter Johnson and Cally Palmer. It is in their hands together—a coalition—and I hope the recovery plan very much leads the way on a route to addressing the backlog and making sure that we take opportunities.

I think we all agree on some of the challenges, including those on data, referral systems and the lack of optimal radiotherapy machines in Westmorland. Again, that is a statement of fact and we need to address how we improve that situation so that every single person has appropriate access to treatments. As treatments advance or are shorter—more oral chemotherapy can be given at home, for example—there is a chance to redesign services to make them better and deliver more for patients. Every single day, I think of those patients. The hon. Member for Easington (Grahame Morris) made a comment about the loss of individuals. Every single day, that is what motivates me.

I thank my hon. Friend the Member for Warrington South (Andy Carter) for his comments about how hard the workforce are working. Whether it is a cancer nurse specialist, a radiotherapist, a radiographer or a surgeon, they are putting their back into this effort, because it could be a member of their family. They are a tremendously committed workforce, to whom I extend enormous thanks—but we need to get more of them. How do we convince a young nurse that his or her route is to become a cancer nurse, even though all the other specialists are also asking for them? We should also be working on that as a coalition, saying, “This is a fantastic area.”

We want to eradicate breast cancer by 2050. The survival rate for testicular cancer is now at a 98%. Pancreatic cancer is a dreadful disease, but we are now seeing not a two-week death sentence, but a couple of years. There are advances all the time and we must optimise that. Each and every person deserves to see that power, particularly on today of all days, when a vaccine has been approved and we know how brilliant this country’s life sciences industry is. We can beat this disease, but it takes time. I am absolutely committed to the patient-centred approach. One in four patients presented at A&E before this crisis—they presented too late. We know what the golden thread is.

There have been some positive announcements. I was encouraged to hear that we will pilot the Grail blood test, which can detect cancer from saliva. I am also pleased that in November’s spending review there was a further £325 million of investment in diagnostic equipment. The allocation of that will be determined in the next few weeks. I cannot give hon. Members any promises, and they would not expect me to say what will be allocated, but I understand the lobbying and the importance of not necessarily having shiny, sparkly front doors to walk through but getting the kit on the ground that can help save people’s lives. We know that no one single thing gives people the best chance of survival—it is the golden thread of swift referrals and screening that gives us early diagnosis—so we need those faecal immuno- chemical tests and to roll out the lung cancer pilots, and we are doing that. We need to ensure that we drive up those workforce numbers. We also need shorter waiting times for optimal treatment that will ultimately turn the tide on this disease.

Our strategy for maintaining services concentrates on stepping up hubs for cancer surgery and optimising independent use, which we have done as a Government. We stood up; we did not shy away from it. There have been no arguments about us using the private sector during the pandemic, have there?

[Grahame Morris]

rose—

[Jo Churchill]

I am really sorry but I have only got two minutes.

The NHS will accelerate the roll-out of rapid diagnostic centres. As I said in this Chamber yesterday, in March we had 17 of them and we now have 45—we have stood up 28 of them in the course of the pandemic. Most importantly, they will support early diagnosis, which we know is key. I am pleased that we are concentrating on recovering and maintaining cancer services. Through the newly formed cancer recovery taskforce, led by Professor Peter Johnson, we can drive that commitment forward with everybody.

The workforce have adapted, flexed and cared for individuals in the most challenging of circumstances. Every death concentrates my mind. My first text yesterday was from a friend who told of the passing of someone who had lost her fight against breast cancer after seven years. The disease does not go away. I am sure my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) would be here if she were not going through treatment and, as she would tell us, it sucks. The cancer workforce are a special part of the NHS family and I want us to ensure that they know how special they are so that people come forward to join them.

We know that referral rates have been variable across different cancer types. Arguably, some cancers have really challenged us, and particularly those that need endoscopies and colonoscopies. We are still not there because of the treatment. Lung cancer referrals were poor before we went into the pandemic. What would someone think if they had a persistent cough? They might get a covid test. Actually, if that test is negative, we need to ensure that they are referred by 111 to the system for a lung cancer test.

I have a lot more that I would like to tell hon. Members, but I dare say that we will be back here imminently. On that note, I will hand over to the hon. Member for Westmorland and Lonsdale.

10:58

[Tim Farron]

The hon. Members for Warrington South (Andy Carter), for Gower (Tonia Antoniazzi), for Easington (Grahame Morris), for Strangford (Jim Shannon), for Angus (Dave Doogan) and for Nottingham South (Alex Norris), and indeed the Minister, all made excellent points, and I am extremely grateful. I thank the Minister for what she said and for agreeing to meet us this side of the recess. To be specific, we are after a meeting with her, of course, and departmental finance officials so that we can revisit the investment decision—that decision is problematic—and have our experts meet hers to get to the bottom of the data. We need to see the datasets so that we can explore the extent to which there is an urgent crisis—we are certain that there is one.

Finally, the Minister talked about the importance of diagnosis. The Government are making progress on diagnostics. Of course, in the NHS long-term plan, we see the desire to find more cancers earlier so that we can treat them. If we find more cancers early, however, we will have more people to treat. That is why the radiotherapy investment that we have called for is essential, not just now but in the long term.

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

[Esther McVey (in the Chair)]

I will suspend the sitting for two minutes so that hon. Members can exit safely and the next lot can come in safely.

11:00

Sitting suspended.

Local Government Reorganisation: Somerset

Wednesday 2nd December 2020 Westminster Hall

11:02

[Mr Ian Liddell-Grainger (Bridgwater and West Somerset) (Con)]

I beg to move,

That this House has considered local government reorganisation in Somerset.

This is a great opportunity. I am delighted to see the Minister in her place and to be working with her once again, as I have done for many years. I am grateful to be able to raise the subject of local government reorganisation. It is important to many people, but at the moment it is an irrelevant sideshow due to the awful pandemic. The only reason it is on the agenda now is that the leader of Somerset County Council pushed, bullied and forced it down the throats of our local party.

When the virus started to spread, the voice of David Fothergill boomed out across local radio. Unfortunately, his numerous broadcasts had nothing to do with the worst health crisis in a generation. Instead, Councillor Fothergill polished his ego and got his leg over his personal hobby-horse named One Somerset. It was “Somerset calling, Somerset calling.” It was impossible to avoid hearing or seeing the message, or the man. He made dozens of videos and droned on and on about the golden advantage of single unitary status and the perils of accepting anything less.

One Somerset was already becoming a dangerous distraction to the main task of fighting the disease. One day, we may discover what really happened to some of the huge grants that the county council was given to fight covid. Did the cash go where the Government intended? Did it help to save lives? Was it diverted and at what human cost? I sincerely hope that the county council is not found to have blood on its hands.

The Minister’s Department had hoped to publish a White Paper on the future of local government this year, but launching such a policy document would have been insensitive while the Government grappled with the worst of the crisis. It was a good call that I totally agree with. Councillor Fothergill, however, refused to wait; the man has no patience. He boosted the county council’s publicity team to 28. That is actually more than the Downing Street press unit. He set aside a war chest of £2 million, I am told, to fight for his vision for One Somerset. He also hired a unitary fanatic from Wiltshire with the unlikely name of Carlton Brand—it really is true. Dr Brand, I am told, is being paid in the region of £200,000 for his work. However, Dr Brand’s model is riddled with holes and was completely out of date when Wiltshire went unitary in ’09. When I last looked, it was £21 million in the red already and its relationships with its parish councils have turned desperately sour. I would not buy a pair of used bicycle clips from Dr Brand, let alone a pair of lycra cycling pants, but Fothergill has paid him a small fortune to take the ancient Wiltshire model with a few tweaks, and foist it on us.

In the shadowy world of used car dealers, One Somerset is what they call a cut and shut job. It looks safe until it is found that the front end is a wreck and is welded on to the back end of another wreck, and the paint job at both ends does not match. One Somerset is a municipal death trap. The county councils could not believe Fothergill’s timing. To launch that cobbled-together rust bucket when people were dying from covid was crass, inept and totally unnecessary. It was the tactic of a ruthless smash and grab monster; and that is still his aim—to smash the district councils and grab their cash reserves. His case is based on propaganda and lies. He is Taunton’s answer to William Joyce, and we all remember what happened to that particular traitor—Albert Pierrepoint’s first customer, as I seem to recall.

There is an important question of geographical involvement. What is the exact area of Somerset that we are talking about? It is not a silly query, even for a Member of Parliament who represents a big part of it. When it was established, in 1889, Somerset County Council mirrored Somerset’s traditional borders. It was enormous, bringing in Avonmouth just south of Bristol, and including Weston-super-Mare, Bath and everything in between, including places such as Midsomer Norton, the quaint town where “Midsomer Murders” was filmed. How appropriate. All those picturesque settlements are in Somerset and have nothing to do with Somerset County Council. If I asked Members to draw me an outline of Somerset County Council’s area, many would be stumped. Perhaps my hon. Friend the Minister has an idea. In her patch it should be easy. Kent County Council still has traditional borders, and I am delighted for it; but the county council is a mishmash and a muddle in Somerset—a misnomer, and a minefield for any Minister of the Crown. The county has been reorganised so often that it is now unrecognisable. How on earth are local people expected to take it seriously?

Somerset County Council is also broke. It has been on skid row for two decades. In ’07 it had only £11 million in reserves. Here we are 13 years later and the reserves are dangerously low. What scares the pants off me is that Fothergill’s One Somerset master plan suggests running the same risk. He allows a mere 10% contingency, as opposed to the 25% that is recommended by the Treasury. If an unexpected crisis happens—and Somerset County Council’s dismal record is littered with expensive crises—there is very little left in the kitty. The county council usually reflects the spending cuts and redundancies that a bunch of new smooth-talking consultants with a magic bullet have left. That is roughly what happened in 2007 when Alan Jones, Somerset’s teeny chief exec, stuck his thumb in the air, thought he felt a wind of change, and yelled “Eureka!” He had a beady eye on the reserves of the district councils all those years ago. He reckoned if the Government agreed to scrap the districts he could save the county from bankruptcy. Labour was in power and Jonesy thought he would get away with it. Wiltshire county was pitching for unitary status and so was Cornwall. The unspeakable little man jumped on the bandwagon and then fell off it. Quite simply, he had not bargained on the most important: the people.

Somerset folk are really canny and strong willed, as I can testify. They may not love their district councils, but at least they know who they are and why they are there. They hate and reject the face of unapproachable bureaucracy. The districts demand a referendum and should have one. The county council refused, so we did it ourselves: a full vote with polling booths and all the trimmings. It cost a bit, but it proves the point. Four hundred thousand people cast a vote and 82% rejected the unitary plan. Mr Jones limped away with his tail between his legs and left the council. Bad chief execs come and go but tightrope walking should not be part of the job description. After the referendum defeat, Alan Jones signed the county up to a lunatic outsourcing scheme called Southwest One. It had disaster written all over it. The four district councils were too sensible to touch it. Our Mr Fothergill was in favour. Southwest One promised to save hundreds of millions of pounds. It fell flat on its face and cost the county £70 million in payments.

Why does this county council always end up with second-rate top brass, incapable of walking along a corridor, let alone a tightrope? The men and women who do the hard graft—the staff—are more like lions, but they are constantly led by donkeys. They are donkeys that lurch from crisis to crisis, blaming everyone else: adult social care, children’s services; the list goes on. Today we have a class A jackass running the county, preaching the only way, and the leader is Fothergill.

In reality, west Somerset should be called three Somerset. This great county has already got two unitaries. Back in 1996, North Somerset, and Bath and North East Somerset were created. Both are struggling today. They are far too small to survive much longer. I wonder if anyone can identify the architect of the biggest, first reorganisation in 1974, when the demolition of our historic county began. That was the Minister who pushed the boundaries as far down as Midsomer Norton. We could call him the Midsomer murderer, after the TV series. Does anybody recall his name? Here is a clue: the poor man died in 1981 and, in a by-election, his safe seat fell to Shirley Williams of the SDP. It was the late Sir Rodney Graham Page. Be warned, history always forgets those who carved up our county.

Counties may be going out of fashion, which may be fair enough. We understand that local government must never stand still, but intelligent change is the best way, Minister. That is why the Government are right to insist that big ideas should come from the councils themselves and not be imposed on them. It is also vital to demonstrate genuine local support. I think the Minister will use the term good, local support. What does that mean?

If a county council votes for reorganisation, does that represent good support? No, surely not, if all four districts vote against One Somerset. Far more elected councillors booed than cheered Mr Fothergill’s hobbyhorse. If a county council secures the backing of a handful of prominent figures, is that good support? How many endorsements are needed? I think we should be told. I note, with great concern, that One Somerset is bragging—bragging, of all things—about the support of Mrs Mountstevens, the police and crime commissioner. Mrs Mountstevens’ reputation for dishonesty now matches Mr Fothergill’s. No wonder they are mates. She broke the rules and picked her own deputy by simply giving him the job; a typical crooked stich-up. To make matter worse, her deputy used to be a lawyer who set up Southwest One, the failed outsourcing partnership. What goes around comes around.

How are the public going to be consulted? It is not good enough to offer cheap online quotations, yet that is the system that Somerset has opted for. Can anyone fill in a form on a website? Lord Haw-Haw could sit all night ticking boxes in his favour; perhaps he does. That is wide open to abuse. Precisely the same dodgy process was tried when Taunton Deane Borough Council set about swallowing west Somerset. I will remind the Minister what happened. It was another half-baked scheme from another corrupt council leader, who—and I will say this only once—claimed to be a Conservative. The people never got a proper say and, when the elections were held for the new council, the Conservatives were basically wiped out.

The people will always punish stupid decisions and stupid people at the ballot box. We should never forget that as MPs. I would like to think that the Minister and the Secretary of State for Housing, Communities and Local Government will select a much more open and honest form of public consultation for this proposal.

I realise this is short notice, but I will provide some detail today. If it is fair, it will have my enthusiastic support. Frankly, we need something that is more thorough than a referendum. I know that, if necessary, the districts are willing to run their own referendum. I hope the Minister can see that that will not be required. I bring today for the Minister a letter from the leader of Sedgemoor District Council, which is partly in my constituency, along with Somerset West and Taunton. He asks the Government to consider bringing back the old county—for the Secretary of State to consider bringing us together, back to 1974, when the travesty of destroying our wonderful county was seen to be important. This is an opportunity.

Colleagues in this place and in Somerset understand that we want to be given a say. The critical mass of the existing county, with the ridiculous proposal to save only £18 million, will do nothing—nothing, Minister. It will just enable it to limp on, but limp on to what? Another oblivion; another loss. This letter—this opportunity—means that we can secure our self-esteem, and bring our historic heartland and the people we represent together.

The MPs of this area are mainly of one party, which is the most successful democratic political party in the world. Why? Because we listen to the people and understand what they say, and it is important that we continue to do so. I ask the Minister to urge our right hon. Friend the Secretary of State to think about this long and hard, because I hope that today is the start of chance for the Government to put right a terrible wrong, and to understand that the will of the people matters beyond all else. I will pass this letter to the Minister and thank her for her courtesy in listening.

11:16

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

It is a pleasure to serve under your chairmanship for the first time, Ms McVey. I congratulate my hon. Friend the Member for Bridgwater and West Somerset (Mr Liddell-Grainger) on securing this debate. His passion for Somerset and its history is well known across the House. He often treats us to interesting snippets of historic fact.

I understand his long-standing interest in this matter. The Government are committed to levelling up all areas of the country and empowering our regions by devolving money, resources and control away from Westminster. We will in due course set out our detailed plans in the local recovery and devolution White Paper, as my hon. Friend mentioned.

At the spending review, the Chancellor announced a new £4 billion levelling-up fund, building on the success of our £3.6 billion town fund. Local areas across England will be eligible to apply directly to the fund to finance things that communities need and people want. The spending review makes available up to £600 million in 2021-22, and we will publish a prospectus for the fund, launching the first round of the competitions in the new year. Further finding will spread over subsequent years, up to 2023-24.

The Government consider that locally led changes to the structure of local government, whether in the form of unitarisation or district mergers, can be the appropriate means of saving taxpayers’ money, and improving service delivery and local accountability. However, we are clear that any reform of a local government area is most effectively achieved through locally led proposals, put forward by those who know the area best—the very essence of localism, to which the Government remain committed. There is no question of, as my hon. Friend referred to, top-down imposition of Government solutions. Any proposal for change will need to meet our long-standing criteria and must be likely to improve local government in the area, command a good deal of local support and lead to unitary councils covering a credible geography.

This brings me to local government reorganisation in Somerset, one of the three areas of the country where, on 9 October, the Secretary of State invited all the principal councils to submit locally led proposals for unitary local government. The other areas where councils received an invitation were Cumbria and North Yorkshire. Councils in these areas have been developing ideas about restructuring local government in their areas for some time and have requested such invitations.

In Somerset, all five councils published a report on the future of local government there in January 2019, looking at a wide range of options for improving local services. It is right that Somerset councils should now have the opportunity to take their local discussions to a conclusion and, if they wish, make a proposal for unitary reform. We have received two outline proposals from Somerset councils—one from the county council proposing a single unitary for the area, and one from the district councils proposing two unitary councils. The councils will now have until 9 December to submit their proposals in full.

I welcome the healthy debate that this process represents on the best way forward for local government in Somerset to ensure that councils can deliver excellent services for their businesses and residents. It would not be appropriate for me to comment today on those proposals as they are yet to be submitted in full, but I would like to outline the steps that we plan to take after the full proposals have been received.

The next step is for the Secretary of State to consult. The statute requires that any such consultation consult any councils that would be affected by a proposal but did not submit it, as well as any other persons that the Secretary of State considers appropriate. We will be keen to gather views from a wide range of stakeholders, including councils, other public service providers, businesses, voluntary sector organisations and, very importantly, local residents. Of course, we look forward to hearing from all local MPs.

We would hope to launch any consultation in early 2021. We may consult on the proposals received, or we may decide at that point not to take a proposal further, if for example it was not in compliance with the invitation. Hence, we may undertake the consultation on both proposals for Somerset.

Following the consultation, the Secretary of State will carefully consider the proposals, assessing them alongside the long-standing criteria that I described earlier. He must have regard to all representations that he has received in relation to the proposals, including those received through the consultation exercise, and all other relevant information available to him.

Where the Secretary of State decides that a proposal should be implemented, he will seek parliamentary approval for the necessary secondary legislation—the structural changes order—with which my hon. Friend the Member for Bridgwater and West Somerset is familiar. Such an order would need to be considered by each House. If Parliament approves the implementation of such a proposal, it is likely that a new unitary council will be established from 1 April 2023. The majority of the implementation work that councils will undertake will be in 2022-23, with elections to shadow or preparing councils in May 2022.

I just want to touch on elections. The Secretary of State has the power to postpone local elections. We recognise that, when making proposals, councils may request that the May 2021 local elections in the area be postponed for a year. There are precedents for a one-year postponement of local elections where unitarisation is under consideration, the examples being the Buckingham and Northamptonshire unitarisations. Such a postponement avoids members being elected for a short period and confusion for the electorate, who are asked to vote for councils for the future that are under consideration and may be abolished. We will carefully consider any such request from any councils and any other representations that we receive on that.

I thank my hon. Friend for securing this debate, and I look forward to having further discussions with him on the matter. I am grateful to him for passing on the letter addressed to my right hon. Friend the Secretary of State about the issues that he has raised.

With the invitation, councils in Somerset now have an opportunity to move forward with reforms that can open the way to achieving significant benefits for local people and businesses, delivering service improvement, facilitating economic growth and contributing to the levelling up of opportunity and prosperity across the country. I very much hope that we see successful proposals and outcomes for Somerset and indeed the rest of the country.

Question put and agreed to.

11:24

Sitting suspended.

Homelessness and Temporary Accommodation

Wednesday 2nd December 2020 Westminster Hall

[Sir Edward Leigh in the Chair]

14:30

[Ms Karen Buck (Westminster North) (Lab)]

I beg to move,

That this House has considered homelessness and temporary accommodation.

It is a pleasure to speak in this debate under your chairmanship, Sir Edward. I am grateful for the opportunity to speak, and delighted, as well, that the debate has attracted support in the Chamber on an issue that is central to much of our work as Members of Parliament but not discussed as often as we would like. Although there is a great deal to cover under the topic of homelessness and temporary accommodation, I shall concentrate particularly on conditions, and I hope that colleagues will address some of the other important issues that come under its umbrella.

“I feel like I am being punished.”

Those were the words of a desperate mother accepted as homeless after experiencing domestic violence, and placed in temporary accommodation by my local authority, Westminster City Council, like tens of thousands of others. There were 98,300 households in temporary accommodation in June, including 127,240 children, and that was up by 14% in the last year alone. The mother was found a private flat by the council, somewhat misleadingly described as temporary, because she has stayed in that limbo for seven years already. That is not my personal record for temporary accommodation. The current record is 21 years, and 10 years is not at all unusual.

The properties that the mother in question and everyone like her have been placed in are expensive. Their rents are similar to full market-level private rents. In a particularly cruel twist, those high rents mean that a high percentage of homeless households are immediately caught by the benefit cap, even though the occupants had no choice about where they were placed, or the rents they would pay. They are also insecure, as the mother in question is. Families such as hers are forced to move constantly, not just within the local area but across the city and beyond, regardless of the schools that the children attend or their personal needs.

A heavily pregnant constituent, who was registered blind, was placed first in north London, in a property with multiple stairs, that was not self-contained and where she was at risk of falling, and then in east London, where she was expected to navigate totally unfamiliar surroundings. She said to me:

“I’m very frightened from places I’m unfamiliar with, as I can’t get around”.

A family with two blind young adult children attending college were told they simply had to learn new mobility routes, as they were sent to the other side of London. These are all recent cases. Someone else told me:

“We were living locally for 19 years, and working in the hospital. We were evicted from our flat and had to approach Westminster council for help. We were placed in an emergency self contained flat that we were told was just for six weeks, so we couldn’t change our daughter’s school. But unfortunately its lapsed to 7 months. The transport is too expensive from West London just to take my daughter to the school. The cost is £60 weekly which we can’t afford any more—and the journey is too long—my wife has to leave home at 6AM to reach the school at 9AM. She find it very hard with little girl who is just 28 months old.”

The stories of dislocation and of the crisis of affordability could fill this debate alone, but I want to concentrate on the condition of the properties that my constituents are placed in. Those conditions are beyond belief, particularly given the amount of public money that is going into supporting the almost entirely private landlords providing the accommodation.

The family commuting five hours a day to school also reported:

“The condition of the flat is very bad & cold we are on the top of the building, & all is glass, with damp everywhere, the water leaking through the glass all around us”.

The same mother I referred to at the beginning of the speech, who was homeless owing to domestic violence, contacted me a few weeks ago to say:

“The property we are in is a shambles with mice, rats and rising damp and mould throughout. The Council has contacted the housing association managing the property, who has contacted the landlord. She sent her surveyor to the property in August. He was shocked to see how much damp we have. He said it would need major work done. I have postnatal depression and suffer from an illness which means I get migraines with stroke-type symptoms with them. I am on medication. My eldest son also has asthma and rising damp is in the kids room. The damp in my room is so bad myself and the baby are now sleeping on the floor in the front room and the new born is having problems breathing”.

Another mother wrote to me—all these examples are from this year, in the time of covid:

“I am in shock that the council can give properties to people in the state I was given mine especially with a six week old baby. I was told last minute after just giving birth that the temporary emergency accommodation I was in needed to be vacated. I was given a flat on the other side of London despite explaining all my support system was locally which is important to me as someone who suffers depression and anxiety with a history of attempted suicide which has gotten worse since I’ve been moved so far already.

Now I’m sitting in the living room on the first night nursing my new born when suddenly there is leaking from the ceiling and water is falling fast. The next day a contractor comes and tells me this is a previous issue that wasn’t fixed by Westminster and if he hadn’t come today the ceiling would have collapsed on me! He had to cut two big holes in the ceiling to dry out the ceiling as a water pipe had been leaking for some time before I moved in. Now the ceiling in the kitchen is leaking with water falling through the smoke alarm”.

There are more, oh so many more:

“Dear Ms Buck. I live in a Westminster temporary council flat, one of my 3 children is autistic. My neighbour down stairs shouts and kicks my door because of the leaking water in her flat which we reported to the agency A2Dominion”—

the housing association responsible for managing the property—

“and no one fixed. My kids are scared—especially the autistic child—they can’t sleep and so are doing no good in school”.

Another constituent came to me after being referred through the council’s children’s services. Even then—although Westminster council has now responded to this and one or two of the other cases—the council took 10 months to resolve the problem, despite being told:

“The mould is so severe because it was left for a very long time untreated…I can send you a copy of the EH”

environmental health—

“report and at least 40 pictures to outline the severity of mould and dampness and how it ate the plastering off the walls. This mould releases spores into the air which makes everybody inside this place always in hayfever condition. We have to keep all windows open for at least 5 hours every day. You could imagine the cost of heating…as we have a little boy who is autistic and had a very serious breathing condition and needs medical attention if he gets a simple cold. It is not only my son getting constantly ill but our food is mouldy and the clothes inside the cupboards are mouldy too.”

Another constituent wrote:

“Although we are on the waiting list for many years now, A2Dominion has not kept up its maintenance of this property. We have mould in all the rooms, carpets and furniture. The floor is a hazard as initially it did not even have underlay. Due to the wear and tear of 15 years we were advised to remove it and now we are without carpet. Winter is settling in and we will be cold. In the last few weeks, we have had to kill 6 mice. There are holes in floorboards and walls where they come in”.

Another said:

“I am in a temporary accommodation…by Westminster council placed in Leyton. I have written to my landlord to tell them that repairs are needed for three years now. I have allowed a reasonable time for my landlord to do these repairs, but they have not done them. I reported these problems to my landlord: Mould everywhere, walls are wet and the flooring wet everywhere. My son now has respiratory problems and hard breathing due to the property state, and is now under the hospital for his respiratory infection…it’s getting worse day by day. The house is all mould and suffocating for me and child—it’s life threatening to me and my son. I have contacted the housing at Westminster, the receptionist keeps telling me she will send an urgent email and someone will call me back but not a single person is. Ceiling has fallen down on me and my 3 years old in the bathroom…The agency came to try to cover it up and the man working for the agency when he opened the ceiling roof said this is life-threatening and it needs to get repaired but the landlord refusing to pay a lot of money as it costs too much.”

Another wrote to me:

“I am writing to inform you of my revolting state of living in this temporary accommodation of mine and the neglect of A2Dominion. I am a mother of two autistic children under the age of 10. Both suffer from severe disabilities…My temporary accommodation has horrid dampness…which has affected our cardiovascular medical condition and has made my children and I suffer tremendously during the past one year and a half ever since we moved into here. The carpets are damp to the point where you cannot keep your feet on the ground for too long while sitting. In addition to rats and mice that were roaming through the flat freely my electric meter caused a huge fire in the building which was luckily put out...Due to this, I have been without electricity for almost a week now.

I have spent the last 6 days in the most difficult state. I have not had any help or support from A2Dominion nor the council. Both are throwing the responsibility on another, while I am staying in a home everyday in order to keep my kids warm and fed in this cold winter. We are literally homeless right now and nothing has been done to fix the electricity and replace the meter, regardless of the hundreds of calls and pleas for help that I have made. I have no option but to turn to you for help. I am desperate and exhausted. My children are struggling and suffering with me. Their medical conditions are a huge obstacle, as they unable to accept change.”

And another:

“I’m writing this email in the hopes you could help me…I’m currently in long term temporary accommodation in Newham with my 4 month old baby…I’m from Westminster and have been accepted by the council. I’m currently in an unsuitable accommodation which…is infested with mice and vermin. I moved in in March this year and by the third day I reported the infestation of mice and large holes in the bathroom, kitchen and living room. Due to covid-19 the landlord refused to fill out any holes forcing me to do it myself very unprofessionally and desperately whilst heavily pregnant. When Lockdown came to an end the landlord did send out two different men…to fill the holes, and they did nothing…I pressured the housing to help force the landlord to fill the holes and it was a back and forth for a couple of weeks resulting in the maintenance team saying ‘the house is 200 years old…there’s nothing more I can do’ and ‘The kitchen flooring has water damage causing wood decay along the whole flooring for the kitchen which brings in rodents from the basement’…now as there’s holes everywhere and I even hear them eat through some holes and they come in…some eat the poison and die in my house…I’m stranded alone dealing with this, and it’s worsening my postpartum depression and anxiety. I can’t stay in this house another week. Due to lockdown new restriction of staying in other households I am really fighting my depression as I can’t even sofa surf due to safety issues. Please, please help us.”

And the last:

“In 2018 my family had been placed by Westminster in our current flat which has been deemed unfit to live in and determined to be detrimental to our health on a number of occasions during our stay (there is black mould/fungus/bacteria covering our walls). In addition to this, due to the building being quite literally bent out of shape, and slowly collapsing in on us, the windows in the living room are unable to close…making the entire house very cold, especially as we approach winter times. We have lived in these deteriorating conditions for…2 and a half years now despite it being considered urgent by every inspector that came to inspect the building saying that we should be rehoused immediately”.

I have managed to get two or three of these cases resolved in the last week. These are a selection, and I could have doubled, tripled or quadrupled the examples of the conditions that people are being kept in. The harshness of the conditions that people are experiencing as they go through the homeless system has to be seen to be believed. I do not understand how local authorities let this happen. I do not understand how the housing associations that are intermediaries—A2Dominion, Genesis, and Stadium housing associations among the worst, in my own experience; others will have other examples—allow this to happen. I do not understand how the Government allow it to happen, given the amount of public money that is being put into this.

The pressure of numbers is taking its toll. The figures are creeping up every year, year on year since 2011. Local councils are unequipped to cope with and pay for the homes that are required. Two thirds of all households that are homeless in Britain—62,670 households—were placed in temporary accommodation by London local authorities. Even prior to covid-19, London boroughs’ expenditure on homelessness was expected to rise to a total of £1 billion by 2021-22. Nearly a quarter of this is unfunded by central Government, thereby increasing the pressure on other services. There is no doubt that the pressure of those figures means that the ability to manage the quality of the accommodation is undermined, and the Government are failing to make good on the requirement to support these services. Unless the Government act on this, the brutal experiences being endured by my constituents will only continue to worsen.

Research from Shelter earlier this year revealed the explosion of the temporary accommodation industry. Between April 2018 and March 2019, councils spent over £1 billion on temporary accommodation—a rise of 9% in a year, and 78% in five years. Shelter’s research shows that 86% of this money is flowing directly to private providers, most of whom are unregulated. This explosion in expenditure has been fuelled by a chronic lack of investment in decent, genuinely affordable social housing.

The Minister will, I fear, just tell us how much the Government are spending. That is utterly meaningless unless there is a recognition of how far short funding falls, compared with what is needed, and of the wider context of cuts to social security, local housing allowance, local councils and social house building. I hope that I will be disappointed and that that is not what the Minister will say.

We need fundamental changes to housing supply and housing support in the social security system. We need proper management of and accountability for the homes that vulnerable and homeless people get stranded in. We need to strengthen the welfare safety net, remove the benefit cap, reverse the freeze to local housing allowance and ensure that rents align with the 50th percentile of market rents. We need urgent legislation to give private renters more security and end no-fault evictions, which remain one of the leading causes of homelessness. We need to invest in a new generation of social housing to provide families with stable, permanent and affordable homes.

Local councils need their homelessness costs to be fully funded. Homeless households need to be accommodated locally, except in exceptional circumstances, and the routine use of out-of-borough housing must be ended. Ministers have previously assured us that that will happen. They have promised us that it should be the exception rather than the rule, but that commitment is honoured only in the breach. Capacity and resources need to be made available to ensure that standards of accommodation are acceptable.

Homelessness is always a hellish experience, and the people who endure it are almost by definition already highly vulnerable. It should not be a punishment, but my constituents ask me this question again and again: “Why am I being punished for the sin of being homeless?”

[Sir Edward Leigh (in the Chair)]

I am afraid that there are a lot of people trying to take part, so if you want me to get you all in, we will have to limit you to three minutes. I am sorry.

14:46

[Joy Morrissey (Beaconsfield) (Con)]

I thank the hon. Member for Westminster North (Ms Buck) for her very compelling speech and for the personal accounts of her constituents. All Members have experience of similar emails and one-to-one encounters, so I thank her for raising this important issue. I also thank the Minister for the Department’s commitment during the pandemic to tackling rough sleeping and trying to end it across England. We have had the highest commitment in funding that I can remember to tackle the issue during the pandemic and enable local councils to house those who are sleeping rough, so I thank the Minister for that.

The hon. Lady’s excellent speech was about the conditions of temporary accommodation, and I want to focus on temporary accommodation for families. As she said, this is particularly a London issue, given the high cost of living, the high population and the lack of affordable and social housing. It is something that I saw at first hand in my previous roles, when I worked as a community outreach worker. I saw families who were living in rat and cockroach-infested multi-dwelling homes with other families. It was a London issue that I saw over and over again.

I have visited other parts of the UK, including the west midlands, to look at best practice in places where we have tackled this problem proactively. Something that I noticed in the west midlands was the approach of linking housing to employment. Andy Street, the Mayor of the west midlands, has done an excellent job of providing housing, employment opportunities and transport. As housing is a devolved matter, mainly to the Mayor or local authorities, it would be worth the Mayor of London looking at how he can support families who are trapped in temporary accommodation.

I also ask that the Minister consider the high cost of temporary accommodation in urban areas. Between 2018 and 2019, councils spent more than £1 billion on temporary accommodation. That explosion in expenditure has been fuelled by a chronic lack of genuinely affordable social housing, and that is particularly true in London.

This is an incredibly complex issue to tackle, and as I said it is the devolved power of the Mayor. Unfortunately, the expansion of permitted development rights has inadvertently led to the creation of some low-quality and unsuitable accommodation—

[Sir Edward Leigh (in the Chair)]

Order.

14:50

[Christina Rees (Neath) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Sir Edward. I congratulate my hon. Friend the Member for Westminster North (Ms Buck) on securing this important debate. No civilised country in the 21st century should have people living on the streets. Governments of all persuasions have tried to combat the problem of homelessness, with varying degrees of commitment and success. Despite those efforts, it took a pandemic to demonstrate the scale and scope of the action needed to eradicate homelessness once and for all.

The UK Government appear to have pledged to end rough sleeping, but it is the Welsh Government who have developed truly ambitious plans. During the pandemic, the decisive and compassionate action of councils in Wales in partnership with Health, the third sector, registered social housing and voluntary organisations to bring people off the streets has saved lives. Homeless people were placed in safe and secure accommodation, engaging with local services perhaps for the first time. That was all achieved in a few weeks, but providing temporary emergency accommodation does not end homelessness, so the Welsh Government are determined to transform that into long-term accommodation. The second £50 million phase of the Welsh Government’s homelessness programme will therefore provide 2,266 people in emergency accommodation with long-term homes, whereas the equivalent UK Government programme in England—the £105 million next steps accommodation programme—merely suggests in its guidance that housing provided for homeless people by councils in England during the pandemic will have tenancies of just two years.

Since the start of the pandemic, the Welsh Government have allocated three times the funding available in England. Councils in Wales have received £10 million to tackle homelessness, compared with £3.2 million in England, where councils deal with a far greater number of rough sleepers. Migrants with no recourse to public funds, and those who have sofa-surfed, are included in Welsh Government policy, whereas in England that is not the case. The policy in Wales is predicated on the belief that everyone has the right to live in a secure, permanent home.

Latest figures show that not one homeless person died from covid-19 in Wales up to 26 June. The chief executive of Crisis, Jon Sparkes, said:

“Only the Welsh Government is committed to putting in place comprehensive policies to end homelessness by providing permanent homes for everyone in need”.

However, there is so much more to do. The Welsh Government Housing Minister, Julie James, said:

“There’s no easy solution to this. I’ve been clear all the way through we have not solved this problem, but we’re on the right road to making sure people are housed and not sustained on the streets.”

We must therefore tackle the problems rooted in homelessness—poverty, substance misuse and mental health issues. We need a holistic approach. Therefore, as we head into winter, which is a challenging period in any year, let along during the pandemic, I ask the Minister to support the Welsh Government’s endeavours to eliminate homelessness—

[Sir Edward Leigh (in the Chair)]

Order.

14:53

[Anthony Mangnall (Totnes) (Con)]

It is a pleasure to serve under your chairmanship, Sir Edward. I congratulate the hon. Member for Westminster North (Ms Buck). I represent a very rural constituency, so I suspect there is a great deal of difference between our two patches, but I recognise from my constituency a great many of the things she said about addressing rough sleeping and homelessness.

As the virus began, in March, all of us across the House were deeply concerned about the impact it could have by closing businesses, driving up job losses and leaving people unable to make their rent and mortgage payments. Moreover, there were concerns about rough sleepers, who lived in close proximity to one another, and many of whom had pre-existing health concerns and could have been particularly hard-hit by the virus. That is why I welcome the unprecedented action of both the Government and local authorities across the country to support rough sleepers and homeless people in the face of covid-19. The Government’s furlough scheme has protected 9 million jobs and helped safeguard people’s pay packets, which has helped them keep on track of mortgage and rental repayments. However, as ever, there is more to be done. We need to help those who have suffered so very badly over the year.

With today’s welcome news from the Health Secretary that the covid vaccine will be rolled out from next week, more thought should be given to how to end homeless- ness and rough sleeping. First, we need to ensure that those rough sleepers who have been provided with accommodation as part of our response to the pandemic are never returned to the streets. The Government’s £433 million investment to provide 6,000 safe and long-term homes for rough sleepers will be invaluable in achieving that. We should be providing rough sleepers with the wraparound support that they need to tackle the long-term mental health and addiction problems that some of them may be suffering from.

Evidence from around the world shows that a Housing First approach is the best way to help rough sleepers rebuild their lives off the streets, and the Government have taken the initiative in piloting such a project in Greater Manchester, the west midlands and the Liverpool city region. I believe it is highly advisable to roll out a Housing First programme throughout the rest of the country, as it would be beneficial for all those in need of housing across the country.

Secondly, the key to ending homelessness is not just supporting those already sleeping rough or living without their own roof over their head, but tackling the long-term structural problems in our society that can lead to homelessness. Above all, more must be done to ensure that we can enable everyone to afford to buy or rent their own home. Although my community is blessed with relatively low levels of rough sleeping—that has not always been the case—the latest count, from autumn 2019, found that just one person was sleeping rough in my local area. That is not true—it is undeniably not true. The statistics collected by the Ministry of Housing, Communities and Local Government on that are wrong, as local charities will be able to see, so we need to review how we are engaging and calculating that data.

My time is almost up. As I said, there is more to be done, and I hope that the Government will listen to us on what we have been asking for.

14:56

[Stephen Timms (East Ham) (Lab)]

Thirty-six years ago, I was a new Newham councillor. My hon. Friend the Member for West Ham (Ms Brown), who is in her place, was elected a few years later, but at that time, 36 years ago, I was placed in a working party on the borough’s temporary accommodation crisis. We set a target that everybody should be in a permanent home by Christmas, and all 30 households were. It was a different world. In June this year 5,574 Newham households, including more than 7,000 children, were in temporary accommodation. It is shocking how far those problems have worsened even since I was elected a councillor. How is it that we have allowed things to become so bad?

It would be great to hear from the Minister some proposals for reducing those shocking numbers. I suspect that we will not hear those and the problems will carry on getting worse, but given that backdrop, I want to put two points to the Minister. First, will she consider a new national policy on standards and length of stay in temporary accommodation? Temporary accommodation is not covered by the Homes (Fitness for Human Habitation) Act 2018. Landlords are largely unregulated. There is no limit on how long people can stay temporarily. Will the Minister take an initiative on that?

Secondly, will the Minister act to safeguard children living in temporary accommodation, especially those in shared housing? At the moment they have fewer education rights than other children, and an article in The Lancet earlier this year pointed out that they are at high risk of

“immediate and long-term effects on growth…health, and brain development.”

Newham has the largest number and highest proportion of households in temporary accommodation and spends the most on it. The figure was more than £60 million in 2017-18. One problem is that the borough represented by my hon. Friend the Member for Westminster North (Ms Buck) is competing with my borough for accommodation, and that forces the price up. A lot of the housing used is in dreadful condition. Rooms are damp and mouldy, as my hon. Friend pointed out, and children develop breathing problems. Families move frequently. They change their GP every time, and sometimes their school, and they do not get any choice. And often they do not even dare to ask for repairs.

I pay tribute to the Magpie Project in our borough, set up by Jane Williams. It does superb and caring work among families in temporary accommodation. Many have been hit by the benefit cap. Three quarters have no recourse to public funds.

Will the Minister take forward the two specific things that I mentioned—regulation on standards and protections for children?

14:59

[Imran Ahmad Khan (Wakefield) (Con)]

I appreciate the continued advocacy by the hon. Member for Westminster North (Ms Buck). Homelessness is a plight that has no place in our society. In 2018, approximately 726 people died of homelessness in England and Wales. In Wakefield district, 216 individuals were being housed in short-term shelter in December 2019 after they had asked for help. It is nigh-on impossible truly to understand the ordeal of being homeless without the experience of being so. Attestations by the Community Awareness Programme in Wakefield note the poor levels of physical and mental health, which are worsened by a lack of access to support through the GP system.

Throughout the covid-19 pandemic, Her Majesty’s Government have taken unprecedented steps to provide aid to those who are homeless. On 26 March, the Government asked local authorities in England to help ensure that we got everyone in. Shelters and assessment centres have been set up and made covid-secure for rough sleepers. I know I speak on behalf of all Members when I commend the herculean efforts made, including block-booking hotel rooms and securing alternative accommodations, such as bed and breakfasts, student accommodation and so on, as well as working to supply food and medical care and other support, where needed.

The Government have provided £105 million for shorter-term accommodation and immediate support, £91.5 million of which was allocated to 274 local authorities. An additional £161 million will be provided to deliver 3,300 units of longer-term, move-on accommodation and support. Currently, £150 million has been allocated to 276 schemes across England, which are expected to be delivered by March 2021. The statistics speak for themselves. By the end of June 2020 there were 98,300 households in temporary accommodation—a rise of 14% on June 2019. A study published by The Lancet outlined that 266 deaths were avoided during spring 2020 by the measures set out by the Government.

Over these winter months, a £10 million cold weather fund will enable local authorities to provide self-contained, covid-secure accommodation. The Government’s response has been exemplary, but those measures merely alleviate symptoms of homelessness, rather than deal with the root problem. If we wish truly to eradicate the plight of homelessness, we need to enable those suffering from that horrific ordeal to achieve and prosper, providing pathways to secure employment, such as paid training schemes, to financial security, such as providing support to set up a bank account, and to permanent shelter, such as support to find somewhere to rent. All are vital in achieving that objective.

I wish to end by paying tribute to Ernest Hibbert, co-founder of the aforementioned Community Awareness Programme. Ernest passed away peacefully on Sunday 8 November. He and his wife Elizabeth established the organisation in 1997. It is thanks to their vision, compassion and energy that the service thrives as much as it does today, reaching out to help people in need in Wakefield. In honour of Ernest, I wish us to commit to seeing no rough sleepers in Wakefield by 2024.

00:03

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

How temporary is temporary? Sir Edward, if you had a family in front of you at your advice surgery, how would you explain? I would explain that families who were housed in temporary accommodation two years ago have another six months to go. For a family in front of me today, I would say I could not predict, but probably the time would be about five or six years, as long as things do not get any worse. Temporary, in that vein, is taking the English language to its severe extreme. There are 100,000 families—127,240 children—of whom 27,650 families are forced to travel 16 times round the globe, or 400,000 miles, in order to access temporary accommodation. That was a figure found by Ross Kemp in his recent documentary on homelessness.

Where do we go and how do we deal with it? In the few minutes I have, I would like to point the Minister to a really interesting email that we received from the Association of Accounting Technicians, no less, only last Wednesday, which points out that the spending review confirmed that the Government would provide £254 million of additional resource funding to tackle homelessness in 2021-22, of which £103 million had already been announced. The AAT points to the issue of taxing overseas purchasers of properties in the UK.

In September 2018 the then Prime Minister, the right hon. Member for Maidenhead (Mrs May), announced that a stamp duty surcharge of up to 3% would be imposed on overseas residential property investors, and that all the money generated would be used to tackle homelessness. It was expected to raise £140 million. Six months later, that was watered down to 1%—effectively an £80 million loss for homelessness projects. Having campaigned for the rate to be restored to 3%, the AAT was delighted when the right hon. Member for Richmond (Yorks) (Rishi Sunak), as Chief Secretary to the Treasury, announced a return to that during the 2019 general election. During the 2020 Budget, however, that was changed to 2%, meaning a £40 million loss.

Since it was announced in 2018, the rate of surcharge has been 3%, 1%, 3% and now 2%, without ever coming into force. It is due to be implemented in April 2021. The only way to deal with homelessness is with more money. This small suggestion will not resolve homelessness, but making available another £40 million by going back to a 3% tax on overseas purchases will help an awful lot of people.

00:01

[James Sunderland (Bracknell) (Con)]

On the surface, the current picture of homelessness in the UK seems relatively positive, but the reality sits much deeper. Some £4.6 billion of non-ring-fenced funding has been given to councils to decide on their own priorities. A further £254 million was announced in the spending review for rough sleeping, which brings the total this year to £676 million. The six-month moratorium on evictions from March to September has also been extended for a further six months.

Of the several thousand households recently assessed in the veterans community, which is important to me, only 440 were officially recorded as requiring support due to serving in the armed forces—5% of veterans’ families. It is not true that veterans are mad, bad or sad, but any figure above 0% is too high. We must sort that out.

In my constituency, the rough sleepers unit does a fantastic job and has reduced homelessness from 31 people to 12 since 2019, and the remaining 12 have all been swept up and looked after. The unit aims to have referrals off the streets and into temporary accommodation within 24 hours, so I know that that is possible. The night shelters in Bracknell are run by a fantastic organisation called Pilgrim Hearts Trust. This year, due to covid, it cannot open so the situation is serious. It does a drop-in centre for meals and day care that includes a mobile doctor’s surgery. Again, it can be done.

The lived experience of those affected is what really matters. We must do more. It is a case of not just throwing more money at the problem, but effecting change through locally focused, effective measures. We know that more affordable housing is needed in the right areas. The decision in the recent spending review to freeze the value of the local housing allowance will hinder efforts to prevent homelessness. I urge the Minister to press for that decision to be overturned. If we can get homelessness relatively under control during the worst pandemic in memory, why can we not do that in 2021 and in perpetuity? Sustained Government funding, backed by good local solutions, remains the key to solving that awful problem.

00:04

[Mr Tanmanjeet Singh Dhesi (Slough) (Lab)]

The Government’s current policy on homelessness and temporary accommodation is strangely perverse. In spring, Ministers marshalled all the resources at their disposal to all but end rough sleeping and to protect public health. As Dame Louise Casey, then head of the rough sleeping taskforce, said:

“We just went for it”

with the Everybody In programme. That proves what can be done when there is the political will. Now, with the harsh winter approaching and the virus still at large, the Government’s policy seems to be “everybody out”. Thousands of people have been forced back on to the street or into hostels—why?

There has been a 78% increase in the number of homeless children since 2010. I can only imagine the fear, misery and sense of danger felt by someone facing life on the streets for the first time. No wonder Crisis, Shelter, St Mungo’s, council leaders, the Royal College of Physicians, the Royal College of General Practitioners and others have spoken with one voice: “We need everybody in too.” I know from working closely with groups such as SHOC—Slough Homeless Our Concern—the London and Slough Run, Slough Outreach and the many local gurdwaras, mosques, temples and churches, and from seeing the increase in homelessness casework in my office, that the crisis is getting worse. I have been contacted by an increasing number of constituents concerned about keeping a roof over their heads—some with no recourse to public funds, others unaware of the complexities of housing legislation and parents concerned about living in cramped conditions with their growing children.

Some 218 households approached Slough Borough Council for homelessness assistance between April and June 2020. On 30 June, the number of households in temporary accommodation in Slough was 379. That amounts to 314 children living in temporary accommodation. The recession will undoubtedly force many people in Slough who are already living precariously over the edge.

I ask the Minister this afternoon to address my two key concerns. Will she provide an emergency programme to get rough sleepers into covid-safe accommodation and will she commit to a major programme of housebuilding for people on low and medium incomes, such as nurses, teachers and care workers—the true heroes of the pandemic?

15:11

[Andy Slaughter (Hammersmith) (Lab)]

I cannot do justice to this subject in three minutes, so I am more than usually grateful to my hon. Friend the Member for Westminster North (Ms Buck) for setting out the case so well in her opening remarks.

As in other areas of public policy, we do not start from a benign position. The past 10 years of austerity has included the local housing allowance freeze, the benefit cap, a freeze on temporary accommodation subsidy, shared room rates and discretionary housing payments, and all these things have created a crisis in temporary accommodation. Even where work has been done, such as with rough sleeping and the eviction ban, when we come out of the crisis local authorities will need more assistance to cope with what will be an additional wave of homelessness.

There are 1,200 households in temporary accommodation in Hammersmith and Fulham at the moment, but I would like the Minister to address the long-term issues as well. Shelter, Crisis and other organisations say that we need at least 90,000 social homes to be built a year and the Government are building not even 10% of that. What is the issue? Is it ideological? We have heard Conservative Members say in this debate that we need more social housing in this country. Where is the recipe for providing that, because it is the only long-term solution?

I will refer to a couple of cases in my constituency, not because they are exceptional in any way, but because they exemplify the typical problems of temporary accommodation. The fact is that this is not a temporary problem—it is often a lifelong problem for people in these situations.

A mother with a five-year-old came to the attention of Hammersmith and Fulham Council five years ago. She was housed in Enfield, which may not sound that far away, but it was away from her support network, and she had to travel to get her kid to school and get to work on time, so consequently she has been late for work and was paying additional fees to after-school clubs. She was taking time off because the conditions in the property were so bad; she was dealing with infestations and sewage leaks and things of that kind. When she was rehoused in the borough, it was in a one-bedroom flat, which means they have to use the living room as a bedroom. She now has two children. Her prospects of being rehoused in adequate temporary, let alone permanent, accommodation, are very low, simply because of the lack of housing. Is that a way for anybody to live and bring up their children?

Another typical example is a young man who was thrown out of home at the age of 16, who has lived in hostels and had to give up his sixth form, was sofa surfing until he outstayed his welcome, got work but then had to leave work, was ripped off by landlords, has suffered punishing anxiety attacks and for the last year under covid has been sleeping rough. Is that any way to give a young person a start in life?

15:14

[Ms Lyn Brown (West Ham) (Lab)]

I am grateful to be able to speak in this debate, Sir Edward, and to my hon. Friend the Member for Westminster North (Ms Buck), who speaks with more authority than any of us on this issue.

Newham has the highest rate of homelessness in the country. We do not yet know how bad it has got this year, but last Christmas one in every 12 of Newham’s children was homeless. I am going to focus on a few typical cases today.

Let me tell hon. Members about Katie. Katie works on the frontline in our NHS. She has been frantically trying to find an affordable home, but nothing is available. Ever since the last time Katie was made homeless, she has had to rely on her family to house her and her two-year-old, but her toddler was getting older, the situation with her family became harder and this May, regardless of the eviction ban, Katie and her baby were kicked out. They are sofa-surfing to stay off the street and desperate for, in Katie’s words, “somewhere to call home.” What mum does not want that?

Katie tells me that the only temporary accommodation she was offered was in High Wycombe or Leeds, so Katie and her child have sofa-surfed and have had higher risks of infection. They have endured terrible insecurity and our local NHS faces losing a much-needed frontline worker. It is not just Katie; far from it. Many families have remained stuck in temporary accommodation without any sense of security or comfort, and they have been without a true home for horrifying lengths of time. I will give just a couple of my cases from this pandemic year.

A teaching assistant has lived with her children in a damp, noisy, polluted property, for two and half years and counting. A single mum has been living in one bedroom with her four-year-old daughter, with damp and rats, since 2015—five years and counting. A mum has been stuck in a two-bedroom flat with her three children, one of whom is disabled and with complex needs, for eight years and counting. A grandfather has been living in temporary accommodation with his adult children and his granddaughter for 14 years and counting. They are all in temporary accommodation. How much longer?

How much longer do we have to wait for a Government willing to build social housing at scale, who will not pinch pennies from the housing support that keeps our families off the streets. How much longer?

00:02

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

It is a pleasure to serve under you as the Chair today, Sir Edward. I congratulate my hon. Friend the Member for Westminster North (Ms Buck) who continues to champion the needs of the most vulnerable in our communities.

When someone comes into politics, they take the power given to them to bring about change. The Minister has the pen in her hand and has the power today to make a significant difference to all of our communities. We have to see a step change, because over the last decade we have seen homelessness and temporary accommodation use increase on such a scale. This is not about bricks and mortar; it is about people’s lives and their existence. They are challenged day by day by the system.

I call on the Minister to build those houses—not the luxury flats that are going up in my constituency that, quite frankly, nobody can afford to live in. We need to look at housing as a human right in a human rights city, such as York. That is my call today.

The Housing Minister has said that we have to evaluate the Housing First programme. It has already been evaluated by the University of York. Professor Nicholas Pleace has put that evaluation in place, so there is no excuse to delay. We need that rolling out because it makes a difference, ensuring that people have the stability of a home and the wrap-around support that is so vital. I want to focus on bringing those services together, around the individual, to meet their needs.

Some of the funding that the Government have brought forward has focused on taking people off the streets. It should be about settling people in stability in their lives and in their new homes. It is a perverse incentive because if the money is then withdrawn, because people are no longer on the streets, then there is not money to invest in people’s lives. It is absolutely crucial that we look at that to ensure that that money is ongoing.

I draw attention to the York system change network, which I met yesterday. We know that people have complex lives and needs, and that it is only when agencies come together that we can often solve those particular needs for individuals. In York we have a network of the police, mental health, community and voluntary sector organisations, the local authority and substance misuse services, that is there to break cycles in people’s lives and to work towards complex solutions. We should be championing those initiatives in order to drive down the complex issues that surround people when they are homeless.

The Minister has choices when she comes to respond to the debate, and I trust that she will, for once, give real hope that we will solve the homelessness and temporary accommodation crisis that we are facing in our country.

15:20

[Helen Hayes (Dulwich and West Norwood) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Edward. I congratulate my hon. Friend the Member for Westminster North (Ms Buck) on securing this important debate, her passionate speech and all the work that she does on this issue.

The work done by local authorities and voluntary sector organisations with additional funding under the Everybody In campaign at the start of the pandemic shows that homelessness is not inevitable, and that when there is the political will to end it great progress can be made. It is regrettable that the support shown at the start of the pandemic has not been sustained, and that many of those who had temporary respite are now back on the streets at a time when the weather is at its harshest and coronavirus is still circulating in the community.

I pay tribute to Crisis and the Robes Project. They work in my constituency, and will be working hard to bring people in from the cold again over the Christmas period, but I want to focus on the hidden homelessness crisis of temporary accommodation. The figures are stark. The numbers of households in temporary accommodation have been rising steadily since 2011, with 98,300 households in temporary accommodation in June this year, including 127,240 children. Those families are often in the worst accommodation available, with no stability or security, while councils pay over the odds to exploitative landlords.

The situation is a direct result of the dysfunctionality of the housing market, particularly but not exclusively in London, and the Government’s refusal to accept the reality of the gap between what the local housing allowance pays and what landlords actually charge. My constituency covers part of Lambeth and part of Southwark; I have figures from Southwark, but the situation is no different in Lambeth. The local housing allowance shared accommodation rate is £515.10 a month, but the median rent for a single room is £700—a gap of £184.90 a month.

For a one-bedroom flat, the LHA pays £1,146.86 a month compared with a median rent of £1,350—a gap of £203.14. For a three-bedroom home, the gap between what the LHA pays and median rent rises to £479.59. How does the Minister expect a family on a low income to find that additional rent? That is a very real, practical concern facing thousands of my constituents. The Government’s housing support policies simply ignore the reality of a housing market with spiralling rents.

There is much more to say, including on the dysfunctionality of our Dickensian immigration system, which traps people with no recourse to public funds for years at a time, while providing no timescale, certainty or closure on their applications. This Government, and Tory Governments for the past decade, have utterly failed to address our housing crisis, but it must be addressed. We need to build council homes and social housing at speed, but in the short term the Government must fix the affordability crisis and reform private renting to give security and stability to tenants, and stop so many people having to endure the misery of temporary accommodation.

15:23

[Abena Oppong-Asare (Erith and Thamesmead) (Lab)]

I begin by thanking my hon. Friend the Member for Westminster North (Ms Buck) for securing this vital debate. For many Members present, it need not be said how appalling it is that the debate needs to take place. Year on year, the number of people facing homelessness at Christmas rises, and we are yet to see any change from the Government.

More than 67,000 families and 136,000 children in England spent lockdown trapped in temporary accommodation—that is more than 100,000 children who will spend Christmas in temporary accommodation, which is often overcrowded and unfit for purpose. We spend a lot of energy talking about homelessness in terms of numbers and statistics. Yet the numbers alone are not landing, so let me interpret the data and speak about actual people. Children, friends, family members, colleagues, employees and, yes, some of my staff live in temporary accommodation. Furthermore, thousands of Erith and Thamesmead constituents are presently surviving statutory homelessness.

Let me tell Members the story of one of my constituents, a lone parent from Bexley who has been furloughed—a change of circumstances that has resulted in rent arrears, due to delays in housing benefit administration processes. She continually struggles with acute physical and mental health conditions, to the extent that she is now under the care of NHS psychiatrists and suffers from chronic pain caused by a spinal condition.

The local authority attempted to discharge its duty into the private sector. However, the property it offered was unsuitable on grounds of affordability. When I say this sentence, it sounds like it is a relatively straightforward process, with the words just sailing out of my mouth seamlessly: “the property was unsuitable on grounds of affordability”. But the lived experiences and the reality behind having to surmount such a challenge are traumatic and exhausting.

Families such as my constituent’s are really struggling. My constituent has been struggling to put food on her table as she was denied a discretionary housing payment. Her homelessness and struggles have had a surprising impact on her son, who is just eight years old. He went to school having soaked up all the stress imposed on the household by way of discharge of duties letters and eviction notices. The eviction dated 19 November was to go ahead smack in the middle of the second lockdown at a time when, according to the Government’s guidelines, evictions were not to go ahead. I wrote to the Secretary of State for Housing, Communities and Local Government and he replied:

“On 16 November we changed the law in England to ensure bailiffs do not enforce evictions”.

Why, in the midst of a global pandemic, was my constituent not supported to access increased housing benefit after being placed on furlough, which caused a 20% reduction in wages? Why was she not treated with compassion and supported to find suitable accommodation, given the needs of the family and their household finances?

I contacted Bexley council on the 17th to inform it and have yet to receive a response.

10:14

[Thangam Debbonaire (Bristol West) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Edward. I want to start by saying to the Minister that in this room she has some of the best housing campaigners anywhere in the House. She has people with expertise, knowledge, passion and dedication—none more so than my hon. Friend the Member for Westminster North (Ms Buck), who has brought this debate to the Minister’s and to our attention, as she has throughout her time in this place.

My right hon. Friend the Member for East Ham (Stephen Timms) and my hon. Friends the Members for West Ham (Ms Brown) and for Mitcham and Morden (Siobhain McDonagh) set out in chilling terms both the cost and the brutal reality of life in temporary accommodation. My hon. Friends the Members for Neath (Christina Rees), for Slough (Mr Dhesi), for Hammersmith (Andy Slaughter), and for Erith and Thamesmead (Abena Oppong-Asare), have shown, as always, their determination and attention to detail in showing how their constituents need to be treated.

My hon. Friend the Member for Dulwich and West Norwood (Helen Hayes), who was instrumental in introducing the Homelessness Reduction Act 2017, described today the spiralling rents and the impact of no recourse to public funds that still trap people in homelessness, despite that Act. My hon. Friend the Member for York Central (Rachael Maskell) highlighted how that is not only a problem for London, but across the country. So too did Government Members. We have heard them today calling for more social housing and for attention to rough sleeping. I respectfully say to the Minister that there is a lot of knowledge in this room, and I really hope she will commit to taking away every single suggestion and every bit of the passion and dedication shown by hon. Members across this room in order to prevent homelessness.

To prevent a crisis of the use of temporary accommodation, we have to start by saying that it is a civilised nation’s moral failing to have anyone on the streets and anyone in so-called temporary accommodation for anything other than what could genuinely be called temporary. It is a moral failing that we have misused both the words “temporary” and “affordable” to such an extent that people such as the constituent of my hon. Friend the Member for West Ham, who actually works in the NHS, is not able to find accommodation at a price she can afford.

Other hon. Members have given us statistics and facts and also case studies. I made a resolution when I first came to the House never to repeat what others have already said better, but the Minister needs to heed what has been said here today. By autumn 2019, despite the Homelessness Reduction Act, homeless households had increased in number to 87,410. By June 2020 there were considerably more, as my hon. Friend the Member for Dulwich and West Norwood said, and that included 127,240 children in temporary accommodation—where they will not get anywhere decent to eat, play, do homework and study, or have anything approaching a family life. As so many Members have said, temporary does not seem to mean temporary. That is a moral failing, which I will say again at least once before the end of my remarks.

The public also need to know that despite the fact that councils are spending £1.19 billion on this temporary accommodation, people are living in the conditions hon. Members have described, with damp, roofs falling in, rodents and poor access to public services. As the National Audit Office has said, the cost to other public services of people living in such poor temporary accommodation includes the cost to the health service, admissions to hospital and admissions to out-patients. There are also the costs to the policing and justice systems when people fall into extreme difficulties through no fault of their own because they do not have the money to pay. The Department does not have a thorough system for assessing the additional costs and therefore does not currently know the full and true cost of homelessness in temporary accommodation and otherwise. It is therefore unable to quantify the benefit to us all of reducing homelessness. That must change.

The Children’s Commissioner this year concluded that living in a B&B has never been appropriate for a child but that the problems have been amplified during covid-19. We have to stop using covid-19 as any sort of cover for any of what is happening. It should have the opposite effect. Spending time in a B&B during covid-19 is bad for everyone. It is bad for health and education, and it is increasing inequality. I make no apology for speaking very much from the heart.

The Government showed earlier this year that political will makes a difference. The Everyone In call made a difference. It brought people in off the streets, and gave them somewhere warm, safe and dry to live. Then, however, things unfortunately went backwards, and councils that were told, “You will have whatever it takes,” found that that did not happen. Unfortunately—I repeatedly asked the Department for accurate figures—people who came on to the streets after Everyone In were frequently not included.

The situation for people with no recourse to public funds remained obscure and, as my right hon. Friend the Member for East Ham showed in his brilliant work on the Liaison Committee and the Work and Pensions Committee, which he so ably chairs, that affected a huge number of children and families, as well as single people. They were hard-working people who had done their best and were contributing to this country, and through no fault of their own they had a sudden catastrophic drop in income and got no help. My right hon. Friend had to explain that to the Prime Minister. I know that that is not true of the Minister, and that she understands what no recourse to public funds means. I hope that she will address the issue.

To solve the problem, as I said, we need to accept that it is a moral failing and that it is fixable. There should be some hope. We got hope today from the Secretary of State for Health and Social Care, and I want the Minister to spread some hope as well today—I hope she will be able to do that—by saying, “Yes, it is a failing, but, yes, it is fixable,” because it has been demonstrated time and again that political will can provide answers to really difficult problems. We need to focus not just on the after-effects and what happens when people end up in temporary accommodation, but on prevention. There must be a relentless focus on increasing the supply and the true—not pretend—affordability of high-quality, warm, safe, dry, healthy net zero homes.

Ultimately, everyone in this Chamber, wherever in the country they represent and whatever political party they are in, knows that we have a chronic problem with the shortage of truly safe and affordable homes. That must be solved, and it is solvable, because in building back better—the language we are all using at the moment—there is scope to do that.

An example of where the Government could have done better was the long-awaited social housing White Paper, which was published without any commitment to building more social housing. I know that the reason for the White Paper was the Grenfell tragedy, and it was right that the Government committed to a great deal in it—to things that had to be there—but the lack of a commitment to building more social housing was duly noted.

I will write to the Minister with the questions that I have—there are a lot. However, I should like her to try to answer at least some of them now, if she can. I shall try to sum them up. How will the Minister represent to other Departments the need for additional support, such as Housing First to deal with homelessness, and other additional support, such as outlawing section 21 of the Housing Act 1988—the so-called no-fault evictions provision? Why not do that now? The Opposition have said that we would work with the Government to do that now, under emergency legislation.

Where is the renters reform Bill that the Government promised in the Queen’s Speech? When is it coming? What steps will the Minister take to reform and reduce the use of temporary accommodation, so that it is really temporary and is not used for the 14 years and more that some of my hon. Friends have talked about today? By what date does she hope to have eliminated—not reduced, but eliminated—the use of bed and breakfasts for anything other than extremely short emergencies, and never for families with children? Will she ensure that there is Housing First nationwide, as Conservative Members have asked for? Will she commit to high standards on quality and length of stay for temporary accommodation?

Will the Minister recommend to the Department for Work and Pensions that, for instance, local housing allowances increase to the average, at least for the life of this crisis, and that the mortgage interest loan scheme is brought forward earlier so that people are not waiting nine long months before they can get help? Will she consider the examples of what the Welsh Labour Government are doing to prevent homelessness during this crisis, which my hon. Friend the Member for Neath (Christina Rees) mentioned? Will she commit to ensuring that her Department has good and accurate data on the full cost of homelessness to not only individuals and their families but public services and public health? Will the Minister explain to the constituents of my right hon. and hon. Friends, and to those of colleagues elsewhere in the Chamber, what she will do to deal with the quality of temporary accommodation, as described? Finally, will she commit to talking to her colleagues, so that they commit to ending the use of expensive, unsuitable and downright unsafe temporary accommodation, to solving the underlying problem of supply by building and retrofitting truly affordable, secure, safe homes, and to fighting to ensure that everybody has somewhere safe and affordable to live?

15:36

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

It is a pleasure to serve under your chairmanship, Sir Edward. I congratulate the hon. Member for Westminster North (Ms Buck) on securing the debate on this important issue, which everybody has been pleased and willing to speak about with passion. She has spoken passionately about this topic before, including when we spoke last week about another element in this sphere. I am really grateful to all right hon. and hon. Members who have taken the time to attend and to speak on behalf of their constituents. I welcome the opportunity to address their points.

May I start by saying that I, too, am an MP who has worked hard for my constituents? I was very pleased to take on the role as Minister for homelessness, because of my involvement prior to being elected as a Member of Parliament. What I am hearing today is support for a lot of the work that the Government are doing, and a willingness and commitment in terms of the Government continuing to work to reach our objectives.

It is unacceptable that anyone should have to sleep rough. I recognise the incredible achievements in the last eight months by local councils and the homelessness sector—supported by this Government—meaning that in September we had successfully supported more than 29,000 vulnerable people during the pandemic, nearly 19,000 of whom have been provided with settled accommodation or move-on support.

I respect the hon. Member for Westminster North greatly, but I will have to disappoint her. I will outline further the funding that this Government have put into rough sleeping and homelessness. Although we say that this is not just about money, it is also about providing available funding and about what happens on the ground. We cannot ignore the unprecedented action that this Government have taken over recent months.

Our work on rough sleeping is not only world-leading, but has protected hundreds—

[Ms Buck]

Before the Minister moves off that point, will she explain exactly why, if the Government are spending more money, homelessness has risen by 14% in the last year alone?

[Kelly Tolhurst]

I thank the hon. Lady for her intervention. We have spent an unprecedented amount of money, and we are continuing to invest in those pilots and schemes in order to tackle all parts of rough sleeping and homelessness. There is a distinction between what we have done with Everybody In and what we are doing with Housing First, with regard to our social housing pilots. We are talking about a vast landscape. We are committed to solving rough sleeping and dealing with homelessness. The funding from the Government is an incredibly important part of that, and so are the right interventions on the ground, delivered in the correct way. That is something that I have particularly focused on since I have been in this role.

The spending review demonstrates the Government’s commitment to build on the fantastic progress of Everyone In and to support rough sleepers and those at risk of homelessness during covid-19. Next year, we are going even further and will provide more than £750 million to tackle homelessness and rough sleeping. That includes the additional funding to support frontline services through the rough sleeping initiative and to enable local councils to fund their statutory duties to prevent homelessness. We are also providing capital funding to continue our landmark drive to bring forward thousands of homes for rough sleepers. That will support our commitment to end rough sleeping in this Parliament and fully enforce the Homelessness Reduction Act 2017.

On temporary accommodation, I am absolutely clear that we always want to see homeless individuals and families moved into settled accommodation as soon as possible and permanently. The action we are taking to increase the delivery of social housing will support that. I also recognise the important role that temporary accommodation can play in the meantime in ensuring that no family is ever without a roof over their head. Although the overall numbers of households in temporary accommodation have been rising, the number of households with children has remained relatively stable since the introduction of the Homelessness Reduction Act. However, I accept that we must go further. The increase in temporary accommodation numbers since the Act took effect has been almost entirely driven by single households receiving help that was previously unavailable to them. More recently, the increase has also been driven by our action to accommodate rough sleepers during the pandemic.

The Homelessness Reduction Act requires for the first time that local authorities, public services and the third sector work together actively to prevent and relieve homelessness for people at risk, irrespective of whether they are a family or a single person. That means that more single people are getting the help they need. They might otherwise have been on the streets. Since the introduction of the Act, 270,000 households have had their homelessness successfully prevented or relieved through securing accommodation for more than six months.

The hon. Member for Westminster North rightly raised the issue of the quality of temporary accommodation. In 2019, we gave £6.7 million to more than 180 local authorities to boost their enforcement in relation to quality on the ground.

[Siobhain McDonagh]

As the Minister will know, the code of guidance from her Department says that councils should not place families outside their borough boundaries, except in exceptional circumstances, but we know that 27,650 families were placed all over the country—most of them were from London, and some, I suspect, went to the Minister’s constituency—because of the problems. Will she consider introducing an Ofsted-style regulator to ensure that local authorities’ temporary housing practices are inspected?

[Kelly Tolhurst]

I thank the hon. Lady for that intervention, and she is absolutely right. I am talking about enforcement on the ground. I appreciate and accept the issues that she is talking about—I have frontline experience of them. I am not trying to make excuses, but I have been in post for only two months. There are many issues that I want to shine a spotlight on with regard to rough sleeping and homelessness. That issue is worth investigating and looking at further. It has an impact on authorities outside London, which may be being put under pressure. I am prepared to look at that.

We have heard stories from hon. Members—they are not stories, but people’s experiences—about the quality of accommodation that people live in. It is unacceptable that people are living in damp conditions, and that they are not having their concerns and issues, which are being raised directly with housing associations or landlords, dealt with. That is why we gave tougher powers to local authorities to use. They can fine landlords up to £30,000 in penalties, issue rent repayment orders and ban landlords.

The other thing—I have seen this personally since being in this role—is that we agreed to review the housing health and safety rating system in 2019, which is the operational tool that local authorities use to assess accommodation. We have completed the first part of that, which will cover things such as fire, damp and excess cold in properties. We are commissioning some more work early next year. It is a highly technical tool, and I do not know whether Members have come across in their work with their local authorities, but I am always willing to talk further with them about it.

Where temporary accommodation is required local authorities have a duty to ensure that it is suitable for the applicant and all the members of the household who would normally reside with and who might reasonably be expected to reside with them. Consideration of whether accommodation is suitable will require an assessment of all aspects, and the location of the accommodation will always be, and should be, a relevant factor. We are clear that local authorities should, as far as possible, avoid placing households out of their boroughs. However, in some areas where there is a limited supply of suitable accommodation, we are aware that that is happening on occasion, as Members described. That is often done to place households in temporary accommodation, but that should really be a last resort. Housing authorities have a continuing obligation to keep the suitability of accommodation under review and to respond to any relevant changes in circumstances that may affect suitability. On request, applicants may ask for review of the housing authority’s decision that the accommodation offered to them is suitable.

[Siobhain McDonagh]

On that point, can I raise a small example? Councils all over south London were using a converted warehouse in my constituency. When we approached Bexley council and said, “Do you know that you are placing your families in the middle of an industrial estate?” it said, “We wouldn’t do that. We just never checked it.” It is not that councils do not want to do these things; it is that they are overwhelmed. If councils have 5,000 families in temporary accommodation, they are not doing any checking of the temporary accommodation, because they simply cannot manage it. Unless councils have a regulator that inspects them and forces them to do this, it is not going to happen.

[Kelly Tolhurst]

If Members have particular concerns about local authorities, such as the concern the hon. Lady has mentioned, I am more than happy to meet them and to take those concerns up personally. However, it is true that local authorities have the powers I set out, and we must all work together so that they are used on the ground.

The Government have been clear that the long-term use of bed and breakfast accommodation for families with children is both inappropriate and unlawful, and we are determined to stop this practice. To help local authorities deliver their new duties under the Homelessness Reduction Act, the Government created a team of specialist advisers with expertise in the homelessness sector to support and challenge local authorities in tackling homelessness in their area, at the same time as supporting councils to deliver a transformation in their homelessness services. This team of specialists has also helped local authorities to deliver a 28% reduction in the number of families housed in bed and breakfast accommodation for longer than six weeks.

As many hon. Members have mentioned, a key part of achieving our ambition to reduce homelessness and end rough sleeping will be building the homes this country needs, closing the opportunity gap and helping millions of young people into home ownership. We have committed to delivering 300,000 new homes every year by the mid-2020s. We will deliver that by committing at least £44 billion of funding over five years to build more homes. We have extended the current £9 billion affordable homes programme to March 2023, to secure the delivery of homes that would otherwise have been lost due to covid-19. This programme will deliver around 250,000 affordable homes.

[Andy Slaughter]

I am glad the Minister has come on to talk about mass house building programmes, but will she specifically address social housing? There are really good social housing estates in my constituency. Some were built by charities 150 years ago or as “homes fit for heroes”. Others were built as garden estates or through slum clearance. Some were even built by the Labour council in the 1980s and 1990s, which I can take some of the credit for. Where are the new quality estates of hundreds and thousands of units of social housing? What are her plans for that?

[Kelly Tolhurst]

The hon. Gentleman makes an important point about social housing, but we must also accept that within the realm of affordable housing there are different categories: social rented, shared ownership and affordable rent. I know that he accepts that when we are talking about a national problem and challenge, there are different needs and drivers in different parts of the country. It is important that in our drive to deliver on those numbers, local areas can have an impact to ensure we get their needs right and deliver the properties and accommodation that are required on the ground, which may not be the same in different parts of the country. We are committed to that.

We have launched the successor programme of £11.5 billion. I will not apologise for talking about money, because it is a key part of the delivery of our objectives and being able to build more homes. The £11.5 billion affordable homes programme will deliver up to 180,000 additional affordable homes, if economic conditions allow. At least 10% of that delivery will be used to increase the supply of much-needed specialist or supported housing.

[Stephen Timms]

I welcome the Minister’s agreement to look at the idea of a regulator. Will she consider the idea of setting standards for temporary accommodation for that regulator to monitor?

[Kelly Tolhurst]

As I have outlined, we have a lot of opportunities to look at how much further we can go and for further intervention. As I have said many times since I have been in this role, I am open-minded and I will look at ways in which we can tackle the issue that we face. However, I must emphasise that I do not recognise the characterisation that this Government are not moving forward. We are taking great steps in tackling those issues. We are announcing funding and talking about the biggest house building project in decades. I believe that we are taking our responsibilities incredibly seriously.

[Thangam Debbonaire]

The Minister is being incredibly generous in giving way. Does she accept that whatever is ahead in future decades, her party has been in charge for the past decade, so they must take some responsibility for how we have ended up where we are today? [Interruption.]

[Sir Edward Leigh (in the Chair)]

I remind the Minister to leave a reasonable amount of time at the end.

[Kelly Tolhurst]

Thank you, Sir Edward. I recognise that this Government are responsible for ensuring that we are able to develop policies and tackle some of the challenges this country faces. However, I would like to talk about what we are doing, what we have done and what we will continue to focus on. We could talk about what successive Governments have and have not done. I am speaking as Minister today about what we are doing moving forward. Throughout the pandemic, we have provided unprecedented support to ensure that the most vulnerable in our society are protected and our communities are kept safe.

[Christina Rees]

Will the Minister give way?

[Kelly Tolhurst]

I will not give way now. I take issue with the hon. Member for Slough (Mr Dhesi) when he says that the Everyone In campaign has stopped—I do not recognise that. The ongoing Everyone In campaign has been a huge success and we are determined to ensure that people supported during the pandemic do not return to the streets.

The Next Steps accommodation programme provides vital funding to help people move on from emergency accommodation. In September, £91.5 million was allocated to 274 councils across England to pay for immediate support for those individuals.

In October, we announced the allocation to local partners to deliver long-term move-on accommodation. More than 3,300 new long-term homes for rough sleepers across the country have been approved, subject to the due diligence, and backed by £150 million. In response to the period of national restrictions, the Prime Minister announced last month the Protect programme—the next step in our ongoing targeted support for rough sleepers. It provides £15 million to support the areas that need it most to address housing and health challenges for rough sleepers throughout the winter months. That is on top of the £10 million cold weather fund that we are providing for all councils for covid-secure accommodation this winter.

We have supported renters to ensure that they can continue to afford their housing costs. The Government have put in place a package of support. We have quickly and effectively introduced a significant package of welfare. Those measures include increasing universal credit and working tax credit by £1,040 a year for 12 months, and significant investment in local housing allowance of nearly £1 billion at the 30th percentile of those rates. Obviously, the discretionary housing fund payments were made available and, in a short time, Ministers in DWP will be able to make those decisions.

15:57

[Ms Buck]

We could have had a whole day of debate on this important and wide-ranging subject. We heard a number of superb speeches. I hope that we will return to this because a number of questions remain to be answered by the Minister. The cold, brutal and inescapable fact is that we are going backwards. We are going backwards on homelessness. It has risen by 14% in a year and by half in a decade. Rough sleeping has doubled in a decade.

Everyone In showed that the rough sleeping problem can be tackled. It ended and we now have people back on the streets. Local councils should not place people out of borough, but they are. What is the Minister going to do about it? Two thirds of my homeless households are placed out of borough. Local authorities should not be placing them in temporary accommodation in the conditions that we heard about in my examples and others, but they are. We have a proposal to do something about it. Will the Minister take that up?

The Government can talk about how much they have spent. They have cut housing support, social housing, assistance for renters, and the local housing allowance. They cut the social security budget by £9 billion in 2015 alone. That is why we are in the state we are in and why 1.1 million people are on council housing waiting lists. We have not heard answers; we have just what is being done. It is clearly failing.

Can we meet the Minister? Can we return to this issue and take forward the Opposition’s positive proposals to find a way to help our desperate homeless constituents?

Question put and agreed to.

Resolved,

That this House has considered homelessness and temporary accommodation.

Covid-19: Lung Cancer Pathway

Wednesday 2nd December 2020 Westminster Hall

[Siobhain McDonagh in the Chair]

[Relevant document: e-petition 552734, Ensure access to treatment and screening for all cancer patients during covid-19.]

16:03

[Derek Twigg (Halton) (Lab)]

I beg to move,

That this House has considered the effect of the covid-19 outbreak on the lung cancer pathway.

The effect of the covid-19 outbreak on the lung cancer pathway is of real concern and has been brought into sharp focus by the UK Lung Cancer Coalition’s report, “Covid-19 Matters”. I will refer to that report as well as to discussions with Martin Grange, Professor Mick Peake OBE and Dr Robert Rintoul from the coalition.

When we discuss health matters in Parliament, we often focus on policies, funding and statistics. Of course, those are important, and I will discuss them later, but when we speak about a specific disease that most people will have little knowledge of, we should explain its impact on patients and their loved ones. In doing that, I will share a real example of a lung cancer case. The patient concerned had a persistent cough for a few weeks. After prompting from their family, they went to see the GP. The GP prescribed some medication and advised them to come back in two weeks if the cough persisted. It did. The GP sent the patient for an X-ray and, the next day, called the patient in to see him. It did not look good—there appeared to be a large tumour in the right lung, and it had spread.

The patient was given an urgent referral to the local acute hospital. Tests were done, and they confirmed stage 4 small cell lung cancer, which had also spread to the rib, liver and lymph glands. The consultant told the family as sensitively as he could that it was terminal and that, at best, the patient would have six to nine more months of life. The oncologist said he wanted the patient to try some chemotherapy, but it had risks. If a patient gets an infection, it could cause serious complications. Unfortunately, the patient developed an infection and was rushed to hospital the following day, very poorly and in great pain.

The hospital gets the pain management wrong. The patient is admitted, but it is another 24 hours before the pain management team sees the patient to get control of the situation. A “no resuscitation” form is signed, but the patient recovers from the infection and goes home. However, more infection occurs in the lung. The lung collapses and the infection gets worse, filling the lung with pus, and the smell is awful. The patient must go to another hospital to have a drain inserted into their chest, but it does not always drain the pus in the way intended, so the patient needs to return to the hospital on several occasions to have the drain looked at. As the lung has filled up with so much fluid, it occasionally needs to be drained by the brilliantly caring specialist nurse practitioners. Despite all that, the patient finds some inner strength in the final few weeks and manages a bit of travel to tick off a couple of things on their bucket list. They then give a knowing nod to the family to say, “I assured you that I could do it.”

Then there is the inevitable weight loss, loss of appetite and puffing up of the face from steroids. After being reduced by one course of chemotherapy, the cancer comes back with a vengeance and quickly spreads to many parts of the body. The family feel helpless and just want to do everything they can to help support the patient and show their love. The patient is brave and more concerned about the impact on their children than on themselves. The pain management and care from the GPs and district nursing team is exceptional. Eventually, in just 48 hours, matters take a turn for the worse. On the final day, in a matter of hours, the patient slips into unconsciousness. The end comes, just over six months from diagnosis. The family feel numb, and the intense grief and sadness take over. This is the reality of lung cancer.

Lung cancer is the leading cause of death in the UK. Approximately 35,000 people die every year with lung cancer, which is more than the figure for breast cancer and bowel cancer combined. Despite the high mortality associated with lung cancer, it is not the most common cancer in the country. Breast cancer is the most common cancer but is generally diagnosed earlier—by stage 2—resulting in a much higher survival rate. That is not the case for lung cancer. Some 49% of lung cancer patients are diagnosed at stage 4. Late diagnosis is the main reason why lung cancer is the cause of most cancer deaths in the UK. Patients present so late because symptoms do not appear until stages 3 or 4

Like other cancers, the earlier the detection, the more likely the survival. Only 19% of lung cancer patients will survive beyond one year if they are diagnosed when the disease has spread. We know that the people most likely to suffer with lung cancer are 55 and over. They are likely to live in an area with high pollution levels and to have been a smoker at some point in their life. As the lungs are so large, symptoms often become apparent only in the latter stages, which results in small tumours, cancerous or benign, having no instant impact on the person. It is only when the tumour grows larger that it begins to affect the lungs’ ability to function, which is when and why the coughing begins. Something as simple as a cough is often the first symptom when a patient sees their GP, but they might be sent away with antibiotics. As symptoms present so late, the speed of diagnosis is of the utmost importance. As we exit the pandemic, it is likely that we will see a backlog of lung cancer cases.

[James Daly (Bury North) (Con)]

The hon. Gentleman is giving a very powerful and articulate description of the appalling disease that is cancer. The petition that forms the basis of today’s debate comes from my constituent Andrew Jenkinson, whose wife Emma sadly died of brain cancer during the pandemic. His concern regards the ongoing issue of patients receiving cancer treatment during the difficult period that we are in. Will the hon. Gentleman join me in paying tribute to Mr Jenkinson for the tireless work he has done to bring this issue to people’s attention not only at the local level in my constituency of Bury North, but nationally?

[Derek Twigg]

I will of course pay tribute to Mr Jenkinson, and I offer him my condolences on his loss. The hon. Gentleman raises a very important point about the impact of the pandemic on cancer treatment and survival, and I will shortly address that in more detail.



It is vital that we do not take risks with people’s health and that we ensure that a proactive approach is taken. There is widespread concern that, during the covid-19 pandemic, there have been too few face-to-face appointments. Lung cancer experts have told me that they believe that face-to-face appointments are important for referring people for urgent fast-track checks, and that they should resume as soon as possible. GPs need to see patients and patients need to know that they are receiving a full and thorough examination when they present to their doctor with problems.

My constituency has one of the highest lung cancer rates in the country. It is also a hotspot for other respiratory diseases such as chronic obstructive pulmonary disease and asthma. Widnes and Runcorn are old industrial towns that are famous for their former Imperial Chemical Industries plants. Many of the older generation suffer from the pollution that they inhaled as children and young adults. Those people, who were also encouraged to smoke in the 1950s and 1960s, are most likely to suffer from lung cancer. Simply, the situation that they find themselves in, through an accident of birth, puts them at a higher risk of developing lung cancer.

It is not widely known that people who have never smoked can also be the subject of the disease. In fact, non-smoker lung cancer is the eighth biggest cancer killer in the country and is responsible for about 6,000 deaths a year—I was shocked to find that out. We have come to believe that only people who have smoked can develop lung cancer, but that is simply not the case.

In an article for the Journal of the Royal Society of Medicine, Anand Bhopal, Michael Peake, David Gilligan and Paul Cosford discuss never-smoker lung cancer, which they note is increasing in absolute and relative terms compared with the decline in smoking. Their research shows that, although second-hand smoking is a contributing factor, it is not the main reason for that. They also note that never-smokers feel a stigma about their diagnosis. We must work to destigmatise lung cancer, particularly as the number of never-smoker patients rises. At the same time, publicity campaigns would help to raise the profile of that silent killer among never-smokers. As we know, there has been some good progress in the battle against second-hand smoking.

[Yvonne Fovargue in the Chair]

It is not only never-smoker lung cancer patients who need to be destigmatised, but smokers and ex-smokers, who can feel blamed for having lung cancer. As I said, decades ago—for a generation of people—it was acceptable to smoke. There needs to be more support and positive encouragement to quit. The message should ultimately be that it is better to be safe than sorry.

GPs need to make more referrals for chest X-rays to increase the chance of early diagnosis. They should screen patients to target those most at risk, and the Government should provide them with more resources. X-rays are relatively inexpensive and quick for the NHS to perform. They are often available in the local community, as is the case in my constituency, so they cause little if any inconvenience to the patient.

The pandemic will have adversely affected the detection of lung cancer. As we know, a new continuous cough is one of the main symptoms of covid-19. It is not unreasonable to suggest that people out there could have been suffering with, and potentially died from, lung cancer during the pandemic without any diagnosis or treatment. They could also have presented too late. It is vital that people who have had a cough for longer than three weeks see their GP.

There was a staggering 75% drop in the number of patients urgently referred to lung cancer specialists during the first wave of the pandemic. During that time, 55% of UK lung cancer specialist nurses or team members were redeployed or unable to work as a result of covid-19. It is estimated in the UK Lung Cancer Coalition’s “Covid-19 Matters” report that at least one third of lung cancer patients have already died since the beginning of the pandemic. There is also a chance that some of those deaths were labelled as covid-19 due to similar symptoms.

The Government should heed the advice of the UK Lung Cancer Coalition and pilot a “Be clear on lung cancer and covid-19” campaign to increase awareness of potential lung cancer symptoms and increase the confidence of the public across the UK to engage with the healthcare system early. The UK Lung Cancer Coalition also wants national NHS bodies to support the resumption of lung cancer screening programmes at the earliest opportunity. When will they resume? There was a report in the Health Service Journal yesterday of a shortage of equipment and staff.

The UK Lung Cancer Coalition pushed to increase the five-year survival rate from 16.2% in 2017 to 25% by 2025. It felt that target was achievable, but now believes that is unattainable by 2025 because of the pandemic. It is clear that the pandemic has had, and will continue to have, a detrimental effect on lung cancer patients.

Lung cancer patients are also at particular risk of contracting viral infections such as covid-19 because of their underlying condition and the immunosuppression associated with many lung cancer treatments. The Health Service Journal reported yesterday that, since the start of the financial year, two-week wait referrals for lung cancer stand at 18,400, down 42% from 32,000, in the same period last year.

Paula Chadwick, the chief executive of the Roy Castle Lung Cancer Foundation, told me that since the start of the pandemic it has seen the requirement for support significantly increase. Calls to its Ask the Nurse helpline have risen by 93%, with patients and carers understandably anxious, with questions about shielding, diagnosis and treatments. Recognising the effect of covid on lung cancer, the foundation took action, accelerating and extending its activity for the Lung Cancer Awareness Month campaign. It also launched the Still Here campaign, with the aim of increasing awareness of the disease and symptoms—as the foundation says, for example, a cough does not just mean covid—and encouraging those with symptoms to contact their GP.

Going forward, we need a strategy that gets us back on target to achieve the five-year survival rate of 25% set by the Lung Cancer Coalition. We need campaigns to encourage people to visit their GP if they have symptoms of lung cancer, especially if they live in high-risk areas. The battle to end lung cancer will be a long and painful journey. Every year that we fail to reach the 25% target, people will be dying who would have had a longer life. Memories that could have been made will be taken away. Families that could have been spared grief will have to endure the pain of losing a loved one. That needs urgent action, before that progress turns out to have been made in vain.

In summary, lung cancer should be a top priority as we move out of the pandemic. A shocking 75% fall in urgent referrals is deeply worrying. We must ensure that urgent referrals are at the pre-pandemic level as soon as possible. We need the return of face-to-face consultations, so that patients can have confidence in the treatment they are receiving and the right diagnosis. We need to ensure that places such as Halton, which has a high prevalence of lung cancer, are prioritised for a programme of targeted screening and chest X-rays.

That would mean targeted campaigns, such as those suggested by the UK Lung Cancer Coalition, to encourage those at risk to see their GP, while also encouraging GPs to take a more cautious approach, when someone in an at-risk group presents with a cough, in the years and months to come.

00:03

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

It is a pleasure to serve under your chairmanship, Ms Fovargue. I congratulate the hon. Member for Halton (Derek Twigg) on securing the debate and sharing patients’ stories, showing not only the huge care delivered by the NHS workforce but the challenges for patients, as they struggle to get a diagnosis and navigate the system. In the patient’s story that the hon. Gentleman articulated, there was already spread: not only was the disease at stage 4 but was metastatic, so affected different sites in the body.

All these things pose a challenge, and the hon. Gentleman very articulately laid out the challenges of late diagnosis and how we can improve. The UK Lung Cancer Coalition report articulated how we must not lose the progress that we have seen over the past 10 to 15 years, but must absolutely focus on the aim to extend survival up to 2025. I hope I can reassure him that the initial measures that we took at the beginning of the pandemic, because we did not know what we were dealing with, have not been the focus since June, when we began to refocus and double our efforts on trying to ensure that cancer patients can have full access to services.

There are still some challenges. I have had conversations with thoracic surgeons. There are particular challenges with the trajectory of this disease, because of where it is on the body and some of the aerosol-generating procedures that are needed in diagnosis and so on. I can say to the hon. Member frankly and honestly that we are aware of those issues and we are working hard to get back not just to where we were, but, as I think Professor Peake said, to a normal that is better than what we had at the start.

I also pay tribute to the constituent of my hon. Friend the Member for Bury North (James Daly), Andrew Jenkinson, and add my condolences for the sad loss of his wife. I congratulate him on his energy in campaigning. It is often the biggest tribute someone can give to a person they love, to try to drive forward and make things better for others.

[James Daly]

I thank the Minister for those kind comments, which will mean a lot to Mr Jenkinson. His petition is titled:

“Ensure access to treatment and screening for all cancer patients during Covid-19”.

We know there have been challenges and the pandemic has thrown up things we never dreamt we would be dealing with. Will my hon. Friend offer some assurance that the issues that Mr Jenkinson highlights in his petition are being addressed and that there are positive signs going forward?

[Jo Churchill]

I will indeed come to that, and hopefully give him and others the reassurance that we are focusing hard on making sure that we not only deliver, but learn from the pandemic. That was highlighted in the Lung Cancer Coalition report as well. Where we can make improvements to speeding up delivery of diagnoses or treatment, we need to make sure that we do so.

Lung cancer is one of the country’s most invidious cancers and it is important that it is diagnosed as early as possible, for treatment to be successful. As the hon. Member for Halton highlighted, it is one of the worst cancers for being diagnosed too late, largely at stage 4, and it has often spread. The challenge then is that treatment options are reduced because of the grade of the cancer.

When someone does present, it is vital that they are referred swiftly for further diagnostics, remembering that we are in a pandemic with a disease that attacks the respiratory system as much as anything. I have stood here talking about teenage cancers and diagnostics and treatments already this week. Not all cancers are the same; they all need a bespoke approach. It is important to remember that.

I spoke to a thoracic surgeon at the cancer hub during the summer. He explained to me in some detail the challenges, but also the opportunities now before us. I thank the cancer workforce for all that they have done through the pandemic and their continued effort to restore services. It has been a herculean effort and they have really flexed the service, joining together in cancer hubs and ensuring that areas are covid-secure for patients. Part of the challenge is to encourage patients to come forward for tests. If someone has a persistent cough, or signs of other cancers, they need to do something about it.

I spoke in the debates yesterday and this morning, and I know only too well the devastation that Mr Jenkinson must be feeling. The particular concern with lung cancer is the overlap with covid-19 symptoms. That was highlighted in the Lung Cancer Coalition report and by a plethora of clinicians. To that end, we have updated 111 protocols. If somebody has received a negative covid test but has a persistent cough, it may indicate lung cancer and they are directed to appropriate clinical care. One challenge has been a sustained fall in people coming forward for lung checks, with the number of people seeking checks at only 76% of pre-pandemic levels. This is about ensuring that we encourage people to come forward, driving forward campaigns such as the Greater Manchester Cancer Alliance and the Northern Cancer Alliance’s campaign “Do It For Yourself”. Ensuring that people are aware of the signs and symptoms is really important, and has an impact on the number of lung cancers diagnosed and treatments started. I cannot stress enough that if individuals do not come forward, we cannot get them into the optimal pathway, which has shown real improvements in how we can help people through their cancer journey.

I was pleased with the £150 million of capital funding issued to regions in October to invest in diagnostic equipment such as MRI and CT scanners. Again, that was very much called for. I know that instant referral to a CT scan is an objective of the report, but getting the equipment so that we can start to deliver quicker routes is part of the issue. The further £325 million for new diagnostic equipment in the spending review, once we know exactly how it is going to be allocated, will, I hope, result in more delivery of diagnostics into cancer care. It is vital that we use that money to maximise equipment in as many places as possible so that individuals can be treated as rapidly as possible.

We know that access to earlier diagnostic screening improves clinical outcomes and that the late stage is really one of the challenges. That is why I am really pleased to see the hugely successful pilots of the targeted lung health check programme rolled out. Those pilots offered places such as supermarket car parks and lorries where people could easily access a check, particularly in areas of high prevalence or high inequalities, making it as simple as possible for somebody to get a check. There were dramatic improvements in those attending and huge upturns in the number of people diagnosed. The pilots were paused due to covid-19, but I am really keen that we turbo-charge them now that we have them back on track, so that they operate more broadly as soon as is safely possible. The programme will be rolled out to 23 clinical commissioning groups, focused on areas with some of the highest rates of mortality from lung cancer.

Because I am short of time, I will not repeat what the hon. Member for Halton said, but we know that we have regional variation, and we need to target more effectively for lung cancer where we have those problems. It is important that we do that geographically in the light of the need to minimise trips to the hospital, particularly for people who may be more vulnerable to covid-19. Radiotherapy services have made use of fewer fraction protocols as evidence has emerged.

The focus on recovery has been on embedding the use of hypofractionated treatment. In addition, the NHS is supporting providers to accelerate the delivery of stereotactic ablative body radiotherapy for non-small cell lung cancer and oligometastatic indications, starting with the treatment of non-small cell lung cancer. In some cases, that is an alternative to surgery. Again, I think the report picked up on that. The challenge is that if someone gets covid-19 at the same time as they are having the surgery, it dramatically increases the mortality rate.

It was right to react at speed. Where clinicians say, “We need to be doing it this way,” we have tried to give the direction so that they can. Individuals can safely go to their GPs. If people have worrying symptoms that could be cancer, GPs are open for business and ready to help patients. It is about ensuring that the “Help us help you” campaign from earlier in the year delivers and gets more people coming through the door so that we can treat them quicker.

[Derek Twigg]

Will the Minister give way?

[Jo Churchill]

Yes, of course. Are we allowed the extra minute or two, Ms Fovargue?

[Yvonne Fovargue (in the Chair)]

I do not think so, no.

[Derek Twigg]

Just on the issue of GPs, it is important that they see these types of patients face to face.

[Jo Churchill]

Indeed, and GPs stand willing and ready to see those patients and give them care. Ensuring that they can refer quickly has been part of this drive.

The cancer recovery taskforce, led by Professor Peter Johnson and involving cancer charities, clinicians and other expert stakeholders, is also driving to meet some of the objectives to which the hon. Gentleman alluded: ensuring that we get people into treatment as quickly as possible, that systems and pathways are clear and understandable for the patient and that we do see that capacity rise.

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

Broadband Rollout: Devon and Somerset

Wednesday 2nd December 2020 Westminster Hall

16:31

[Neil Parish (Tiverton and Honiton) (Con)]

I beg to move,

That this House has considered the rollout of broadband in Devon and Somerset.

I want to start by speaking about the importance of broadband. Covid-19 has accelerated the need for faster broadband connections. Whether it is for online voting in Parliament, meeting on Zoom or online shopping, we are more reliant than ever on the internet. Even I have taught myself how to use Zoom—you will not realise what that involved, Ms Fovargue. Doing Zoom meetings in the office or at home on the farm has had the added benefit of my being able to put up the Devon flag behind me.

Living on a farm, I am fortunate to have been connected through a fibre-to-the-premises connection in the last few weeks, but I want all my constituents in Tiverton and Honiton to have the same. Unfortunately, the rollout of broadband has been anything but superfast and too many people do not have access to superfast connections. Nationally, 95% of premises can receive a superfast broadband speed, but in Tiverton and Honiton the figure is just 82%. We are 627th out of constituencies in the UK, and we are 9th lowest in England for superfast availability. In Bampton, just 60% of properties have superfast broadband access. In Beer, it is just 68%. In Kilmington, Colyton and Uplyme, it is just 39%.

Two other constituencies in Devon—Torridge and West Devon, and Central Devon—have even lower superfast broadband speeds available than Tiverton and Honiton. And I expect that my hon. Friends the Members for North Devon (Selaine Saxby) and for East Devon (Simon Jupp) will probably say that the connection there is not brilliant. It is bound to be brilliant in Totnes, of course.

I appreciate that the constituencies in Devon and Somerset are rural, but the Government have been making promises on this matter for years. In 2010, when I first became an MP, the coalition Government promised that the UK would have the best superfast broadband in Europe by 2015. The UK is currently 13th in Europe, behind Hungary, Bulgaria and Romania. In 2015, my right hon. Friend the Member for Uxbridge and South Ruislip (Boris Johnson), who is now the Prime Minister, arrived in Parliament and quickly became co-chair of the all-party parliamentary group on broadband and digital communication. He will know more than most that the rollout of broadband has been far too slow, complicated and bureaucratic. In fairness to the Prime Minister, he has put resources in to put that right.

In Devon and Somerset, we have seen Connecting Devon and Somerset promising—again—the world for years, but consistently missing its own deadlines, avoiding scrutiny and then putting out press releases about how fantastically well everything is going. I am afraid there is very little credibility left. In 2012, £27 million of state aid funding was provided by the Government to fund the Connecting Devon and Somerset phase 2 rollout of superfast broadband, and we were all very excited by it. That was eight years ago, and there has not been a great deal of progress since.

In November 2014, Connecting Devon and Somerset launched its first invitation to tender for phase 2, but cancelled it the next month. In 2015, CDS began negotiations with BT Openreach to hand it all phase 2 contracts. Those negotiations then collapsed: BT said that CDS was not prepared to pay enough money, and CDS claimed that BT was not investing enough of its own. There was great history between both organisations. I imagine the fault was on both sides, but that is a real problem.

Further on, in December 2016, five phase 2 contracts were awarded to Gigaclear, and one in north Devon was awarded to Airband. I will put my hand on my heart and say that I was happy to bring in Gigaclear, but listen to what happened next: in September 2018, CDS suspended all five Gigaclear contracts after Gigaclear requested an extension. There is no doubt that Gigaclear overstretched and was under-capitalised, but, again, that extension request beyond the completion date of 31 December 2020. Now we would think that that date was quite close, would we not, Minister?

In December 2019, after cancelling the Gigaclear contracts, CDS launched another tendering process to award the phase 2 contracts. The announcement was meant to be made last month, but we are still waiting for it—all the time, there are delays. Instead of blaming other people for their failures, we need full transparency from those at Connecting Devon and Somerset, and we need the Minister to whip them into shape. I know that the Minister has put someone from his Department on the CDS board, but he ought to take over the board if he wants to make any difference. I do not believe in taking prisoners, as the Minister knows, and I have no intention of taking prisoners today, because I have lived through all this. I actually supported CDS in the past, but it has not delivered.

Throughout the process, there has been great concern about value for money. I am glad that we have a responsible local council in Devon that always thinks carefully about taxpayers’ money, but because of the delays over the last eight years, constituents have had no option but to pay for alternatives. Business and residents have had to pay Openreach themselves to move into the 21st century, forming community fibre partnerships. I pay great tribute to those who have done so and to the Government for putting forward the voucher system.

We have had other entrants into the market, such as Jurassic Fibre, which has connected a lot in Honiton and Axminster and has done a good job. Great companies such as Jurassic Fibre are trying to connect people with faster broadband because the local government scheme is failing to act quickly enough. Of course, as we connect all those industrial states and take out the bigger sections, we are also making it more expensive to deliver the whole project. Every year, as we delay, it basically gets more expensive.

Even if CDS did manage to announce new phase 2 contracts this side of Christmas, we have already been told that there is a six-month implementation period. How much longer an implementation period do we need, Minister? We have had eight years already! Then, the contracts will take at least four years to complete, taking us to 2024. Is that acceptable, Minister? Was the whole point of cancelling the Gigaclear contracts not that December 2020 was too late? Now we are talking about 2024.

Surely, the system is far too bureaucratic and slow. I know that this is very politically incorrect, but was it not George Bernard Shaw who said, “If you lose one wife, that’s acceptable. If you lose two, that’s careless”? How many contracts does CDS need to lose before it is considered careless? Like I say, it is all terribly politically incorrect, but hon. Members can see the point I am making.

What more can be done to bring CDS to heel and speed up the entire process? We need to build in the more rural and disadvantaged areas of the UK, where the commercial market will not build without subsidy. That is what the Minister and the Government have been doing.

I understand that we have set £5 billion of funding to deliver broadband to the final 20% of properties that will not be reached by the commercial networks, but in the 2020 spending review last week the Chancellor allocated just £1.2 billion of that funding for the years 2020 to 2025. Will the Minister please explain why that funding seems to have been cut? Will it be replaced? The Government have also downgraded their ambitions in the national infrastructure strategy to 85% gigabit-capable coverage by 2025, instead of 100%. Again, why has that happened?

The danger is that broadband companies will concentrate on building their networks in areas where they can make a commercial return—who can blame them for that?—and put their plans for rural Britain on the backburner. When the other companies that are building in my constituency are asked about the Blackdown hills, all of a sudden they go very quiet and say, “That may take a little longer.”

I thank the Minister for being here today—I am sure he is enjoying it. We all want to get broadband to our constituents. I have made light of it, but far too many mistakes have been made over the past 10 years and I want to avoid that happening again. What reassurances can the Minister give my constituents today that the Government, through Connecting Devon and Somerset, have a workable plan that will deliver, change lives for the better and connect them and the constituents of my fellow MPs from Devon and Somerset? Joking aside, it has been too long. A lot of public money has been put into it and it has not delivered. Not all the problems are with Connecting Devon and Somerset, but it has been a very sorry story. I do not want to come here in a few years’ time to make the same speech and say, “We’ve wasted more years.” Please, Minister, can we have some answers today?

16:42

[David Warburton (Somerton and Frome) (Con)]

It is a real pleasure to follow my hon. Friend the Member for Tiverton and Honiton (Neil Parish). As ever, he is dauntless in his defence of and support for our rural communities. I congratulate him on securing this debate.

I seem to be the only representative of Somerset here, so I will fly the flag as best I can. I do not disagree with anything that my hon. Friend said, but Connecting Devon and Somerset, Somerset County Council and the Government have achieved some things in improving connectivity for us. They have connected more premises than any other English programme. Coverage is now 90%, and more than 300,000 homes and businesses have decent broadband. CDS has nearly 5,700 broadband vouchers out on the streets, which is 7% of all UK vouchers, I understand.

Despite all that has been achieved so far, there is still a great deal more to be done. The mistakes that my hon. Friend highlighted are all too apparent. It is still the case that too many homes and businesses across our counties do not have access to decent broadband speeds, and the pandemic has shown even more clearly that digital connectivity is like being connected to water or electricity—it is an essential utility and a vital service.

Sadly, I see people’s frustrations—particularly those from rural and very rural areas, like much of my patch—weighing heavily in my inbox every day. I am sure Openreach is sick of my letters and emails, but tackling those frustrations is crucial for the communities that I am proud to represent.

Rural communities throughout the UK—Somerset is no exception—suffer from a productivity gap with urban areas and, as I said in last month’s debate on the rural productivity gap, the answer lies in technology and infrastructure. Even before lockdown, a quarter of the rural population worked from home, and that will only increase, but Somerset is sprinkled with areas that have unreliable, intermittent or very slow connectivity—including my own house. If small and medium-sized enterprises are the engine of the rural economy, how can we get that engine started and running smoothly?

Investment in those rural dead zones is of course great news. The shared rural network agreement is another step forward, but there is still the idea that the rural economy is all based around agriculture. Actually, alongside agriculture, there are huge numbers of blossoming, blooming, burgeoning start-ups and growing businesses. For example, the logistics and supply-chain company Vallis Commodities in my own Frome utterly depends on Somerset’s digital infrastructure. We must stoke those businesses’ fires and feed them the nutrients they need—if I am not mixing my metaphors.

The Government were elected on a promise to level up the UK, and I hugely welcome the investment in physical infrastructure that the south-west is beginning to see, with the dualling of the A303—finally—being a great example and a huge relief. In my constituency, I am delighted that we have got the Restore Your Railways feasibility funding for a new station between Somerton and Langport. We are starting to bridge the physical divide in the country, which will pay great dividends, but our counties have vast untapped economic potential, and it is the digital divide that needs to be bridged for that to be truly unlocked. With every passing day, the divide grows and becomes more and more impassable. So my message to the Minister is: come on folks, let’s get building.

16:47

[Simon Jupp (East Devon) (Con)]

I thank my near neighbour, my hon. Friend the Member for Tiverton and Honiton (Neil Parish), for securing the debate. I hope he will not mind me highlighting his personal interest in the issue: on weekly calls among Devon MPs, we often miss his contributions because his internet falls down. I am grateful for the opportunity to speak about the challenges we face as a region and highlight the need to improve connections across our two counties.

We must deliver superfast broadband across East Devon, not least because many more people are working from home and—let us face it—some will not return to the office. For far too long, East Devon has suffered from delayed contracts and patchy upgrades. It is not acceptable for anyone in Sidmouth, Exmouth, Budleigh Salterton, Topsham, Ottery St Mary, Cranbrook, St Loyes, Whimple, Clyst St Mary or any village in East Devon to be unable to make a video call or watch a TV programme using a decent internet connection in 2020. Feniton and Whimple, for instance, have only 63% superfast availability with download speeds of at least 30 megabits per second as defined by Ofcom. That compares with 97% for Exmouth.

Given the failures of Gigaclear, covered by my hon. Friend the Member for Tiverton and Honiton, to roll out superfast broadband under the Connecting Devon and Somerset programme, Jurassic Fibre is plugging some of the gap successfully for a large part of East Devon, stretching from Clyst St George to Exmouth. I commend Jurassic Fibre for cracking on and connecting more of East Devon, but in the village of Farringdon, internet download speeds have been less than 5 megabits per second. One of the village’s first upgrades earlier this year was LittlePod, who manufacture and export around the world a special kind of vanilla paste, as the International Trade Secretary saw at first hand this time last year. It now has a 500 megabits per second business connection—and I am extremely envious.

The reason I talk about that private sector involvement —ostensibly just one commercial provider in a portion of Devon and Somerset—is because it has made a real difference. Connecting Devon and Somerset, working with Devon County Council, will have to plug the gaps in commercially funded networks. Clearly, as has been highlighted in the debate, there is more to do on all fronts.

Connecting Devon and Somerset is working to solve the issues and listening to concerns raised by MPs on behalf of constituents. It will need to be held to account and be transparent on public reporting processes, so that it can clearly demonstrate the progress it makes. It must crack on and get our counties connected.

The last Budget contained a commitment to spend £5 billion on connecting hard-to-reach premises. I know the Minister is committed to exploring every opportunity to get fibre broadband rolled out across East Devon and our county. We must work together to deliver for Devon and ensure that no community is left behind.

00:01

[Anthony Mangnall (Totnes) (Con)]

It is a privilege to serve under your chairmanship, Ms Fovargue. It is also a privilege to follow my hon. Friend the Member for East Devon (Simon Jupp), who name-checked every part of his constituency with great confidence and remains a strong champion for his patch, and for digital connectivity. I congratulate the hon. Member for Tiverton and Honiton (Neil Parish) on securing the debate. It is pleasing to hear that he has managed to learn the delights of Zoom and I suspect that the whole House will be waiting to see how he gets on with Google Connect, Skype and Microsoft Teams. Perhaps we can have another debate about how he does with those.

As has already been raised in weekly calls with Devon MPs, the problem of connectivity is profound in the south-west, as was alluded to by my hon. Friend the Member for Somerton and Frome (David Warburton). That issue has been readily addressed and identified by those who have been sent home to work from home over the past 11 months, and who have seen the need to interact with colleagues and businesses, and find investment and opportunity through their digital connectivity. Failing to identify and address the issue is only likely to see that gap and gulf in the south-west expand beyond where it is already, and to see a lack of opportunity presenting itself compared with some cities.

Investment was mentioned. The south-west needs investment. It is a big policy of this Government to make sure that we are levelling up across all regions. Well, the south-west needs that. In Bristol and Exeter we have seen the benefits that investment can bring, but unless we can ensure that we have a robust digital telecommunications network that not only allows people to work from home, but attracts businesses to operate from across the peninsula, we cannot hope to see the investment and opportunity that we seek to provide for younger generations in years to come.

While I do not have the historical knowledge of my hon. Friend the Member for Tiverton and Honiton about Connecting Devon and Somerset, I do have a sense that CDS has failed to deliver in the short time since I was elected. In my constituency there are 52,000 premises, of which 10,000 residential and non-residential properties are still outstanding to be connected. The failure to connect them has been an ongoing issue for over five years. That makes it impossible for many of my constituents to launch their businesses, work from home or do any of the things that they might have been expected to do this year.

As has been mentioned, CDS has collaborated with Openreach and it is welcome that there is a £6 million programme and vouchers, and that Airband is being promoted across the area. Unfortunately, unless CDS’s phase 2 contracts are issued there will be no opportunity to build on what we have tried to suggest in our manifesto and in the Budget, in terms of levelling up in the south-west. The delay has come at a significant cost to residents, who have had to shoulder the burden themselves rather than expecting a service that is widespread across the country to be delivered. We have promised it and it is our duty to be able to deliver it for them.

If we look at our opportunities in terms of the businesses that we have, whether it is the great Salcombe, Brixham and Dartmouth gin distillers who wish to sell their produce across the world—and they do, by the way—or the photonics industry, a £13.5 billion industry that relies on digital connectivity even to function, we need to make sure that we have robust connectivity. Our fishermen and farmers also need to make sure they have strong access, to fill in their quota forms or report back to the Department for Environment, Food and Rural Affairs that they are fulfilling the environmental land management programme in future years. Those are all things that allow our society and our communities to function better. I hope that the Minister will address those issues and really assume the leadership that we need in the south-west. The south-west MPs are united on the issue. Digital and transport connectivity are essential, and we will keep knocking on his door about the issue until it is addressed. I hope that we will not need to have another debate like this.

00:02

[Selaine Saxby (North Devon) (Con)]

My constituency’s connectivity means it is ranked 634th of the 650 UK constituencies.

[Neil Parish]

You beat me.

[Selaine Saxby]

I did beat you.

Almost a fifth of residents still do not receive the universal service obligation’s 10 megabits per second. Our average download speed is less than 37 megabits per second, compared with a UK average of 61. The only thing slower than our broadband speed is attempts to connect properties by CDS. I am delighted that things are now progressing, and I recognise the complexities of procurement in this area, but an alarming amount of time seems to have been taken, still to be selecting suppliers.

I note that major players in the sector are not participating in the current procurement process, because we are a whole technology behind in Devon and Somerset. I am determined that North Devon will not continue to languish at the bottom of the broadband league, and have taken it upon myself to connect my own community to fibre broadband through a community fibre partnership, in conjunction with Openreach. Using our Department for Digital, Culture, Media and Sport vouchers and working directly with the industry seems to be the most likely method of connecting up my rural constituency; but the continuation of the Government’s voucher schemes is key to enabling communities to get connected. I hope that the Minister will be in a position to confirm that today.

Last week’s announcement that only 85% of the country will be connected by 2025 rather fills me with dread, as there seems to be an inevitability about hard-to-reach rural constituencies such as mine continuing to be left behind. Without the 100% target and full £5 billion commitment, will the industry be able to commit the resources and train the army of new engineers needed for even 85% to be reached? Given that CDS is still so busy with the previous technology, I ask that someone else manage the procurement and delivery of high-speed fibre in North Devon, and that that should be rapidly instigated, as the most commercially viable parts of my constituency are now being over-fibred by competing fibre companies, leaving harder-to-reach communities even less likely to see fibre.

When we talk about levelling up North Devon we are not expecting a new railway or motorway. We desperately need broadband to enable our businesses, young people and communities to have access to what other parts of the country take for granted. I spend far too long lobbying the Minister for better broadband, and I shamelessly do the same today. Please speed up everything to do with broadband in North Devon.

00:04

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

It is a great pleasure to serve under your chairship, Ms Fovargue. I want to thank the hon. Member for Tiverton and Honiton (Neil Parish) for calling the debate. It has been a huge pleasure for me to listen to so many excellent and well-informed contributions. As a north-east MP, who is not allowed to travel far at the moment, I feel that I have been on a tour of Somerset and Devon and I very much appreciated it. I feel for the Members who have eloquently expressed concern about the impact of the lack of the digital infrastructure they need and deserve on the people of Devon and Somerset. I do not know whether the Minister has enjoyed the debate quite as much, but I shall briefly summarise some of what was said.

I was amazed to learn that Tiverton and Honiton’s ranking was as low as 627th, but then I found that North Devon is even further down. Obviously there are comparisons to be made, and someone has to come top and bottom. Even so, despite Devon and Somerset having 1.5% of households in the country, 5% of homes there are located in notspots. In Somerset West, one in 20 households are unable to receive the minimum 10 megabits, which is the Government’s definition of decent broadband. That figure increases to nearly 12% of households in east and west Devon. The hon. Members for Somerton and Frome (David Warburton), for East Devon (Simon Jupp), for Totnes (Anthony Mangnall), for North Devon, and for Tiverton and Honiton all emphasised how the pandemic had truly brought home to us the importance of connectivity at this time.

Every Member referenced the Connecting Devon and Somerset broadband scheme, which the hon. Member for Tiverton and Honiton described as too slow. However, the scheme exceeds the UK’s superfast broadband roll-out target set by the coalition Government, which called for 90% coverage by 2015. Unfortunately, mismanagement under the coalition Government meant that, nationally, the target was not reached and was missed by a year. If a local scheme that outperforms the Government’s is too slow and needs to be reviewed, the Government’s own position on broadband has been lacklustre and should also be up for review. [Interruption.] I do have mobile coverage here.

[Anthony Mangnall]

The hon. Lady started her speech by saying that she felt the experience of our lack of connectivity in the south-west. She is more than welcome to come and experience it at any time.

[Chi Onwurah]

I really am grateful to the hon. Gentleman for that timely intervention. I meant to say that I felt for the experience, but I am keen to feel the actual experience in the gorgeous surroundings that he has so well described. The products and services sound so very attractive.

We have had 10 wasted years for telecoms infrastructure under this Government. I was a chartered engineer who worked in telecoms for 20 years before coming into Parliament, which I mention from time to time, and the decade that I have been in Parliament has coincided with a rapid relative decline in the quality of our telecommunications infrastructure. Labour made great strides in building a digital economy. Our Communications Act 2003 set out the strategy and vision for a decade. Our office of the internet was a world leader, and we oversaw the roll-out of the first generation of broadband to more than 50% of households by 2009.

Labour’s plans would have seen two-thirds of UK households have access to services of up to 40 megabits by 2015. Unfortunately, that is now not the case, consecutive Tory Governments having squandered that world-leading position. Several Members mentioned the need for effective competition and not the over-building of fibre to one home, and not the absence of any competition or a monopoly provider. Under Labour, we had competitive infrastructure competitions, including the local loop, but since then we have seen U-turns, dither and delay in infrastructure roll-out, including the BDUK scheme, which re-emphasised Openreach—indeed, BT—effectively as a monopoly provider. All phase 1 contracts and funding under the scheme went to British Telecom, and the Public Accounts Committee warned that that restricted the Department’s ability to insist on value for money. Will the Minister set out his strategy for encouraging effective competition, particularly in rural broadband? It is concerning to see that as a country that invented the fibre-optic cable—

[Neil Parish]

I shared the hon. Lady’s concern that Openreach had too much of a monopoly, but I have to say that since Openreach has stepped back from connecting Devon and Somerset, the situation has actually got worse, not better. Openreach is training 5,000 engineers every year, so there is a real need for it. Now that it has been split away reasonably successfully from BT, we can use Openreach much more.

[Chi Onwurah]

The hon. Gentleman shows an understanding of network competition that I rarely find in this House. I can only agree with him that it is necessary to have effective separation. If Openreach is effectively separated and open to different over-the-top providers, having a monopoly position does not lead to monopolistic behaviours such as raising rents or offering low customer service, but it is necessary for that separation to occur. As I think has been said, it is also the case that BT responded to many of the Building Digital UK bids and ended up having a monopoly position. That was BT, not simply Openreach.

I want to focus for a couple of minutes on the economic importance of rolling out broadband. In 2018, the Conservative-run Somerset County Council highlighted the worry about regional productivity in its economic development strategy, which said:

“We are not as productive a District as we could be. Evidence shows a relative lack of dynamism in our economy with productivity levels below our potential and lower than those of the South-West and national levels.”

Across the country, only 8% to 10% of premises are connected to full-fibre broadband, compared with 97% in Japan. We are an innovative nation, but our innovation needs the digital platform to allow our small businesses to grow, particularly as our economy shifts online and we face the challenges and opportunities of the fourth industrial revolution, with its implications for everything from manufacturing to smart cities and addressing climate change.

I do not want to reiterate the Prime Minister’s sad history of flip-flopping over promises on delivering full fibre, but I will summarise it. Full fibre was supposed to be delivered by 2025, but that was then downgraded to gigabit-capable broadband to every home by 2019. As we have heard, only last week the Government sneaked out the Chancellor’s spending review plans to water down their broadband promise instead of keeping that manifesto commitment, and a smaller proportion of money has been made available.

The hon. Member for Tiverton and Honiton cited George Bernard Shaw. My recollection is that it was Oscar Wilde who wrote:

“To lose one parent…may be regarded as a misfortune; to lose both looks like carelessness.”

That quote is absolutely appropriate in this case, because although we might understand one change in the Government’s commitment to broadband, a series of changes is either carelessness—which is negligent, given the importance of digital infrastructure to our economy—or, I am afraid, deliberately misleading.

I hope the Minister can set out how we will achieve in Devon and Somerset the digital infrastructure that is so richly deserved. I also hope he will talk a bit about the divide in digital skills, because as well as having the infrastructure, we need to ensure that everyone has access to the digital skills that mean they can use the infrastructure and reap the economic benefits. I am particularly concerned about access to infrastructure at home, which enables Zoom meetings and online education. Some 50% of rural premises have patchy and unreliable mobile reception, so I hope the Minister will say a word about 5G roll-out and the delays in coverage. We cannot allow the digital divide to exacerbate the current rural divides. I hope that the Minister will mention the universal service obligation, which the Government launched in March to great fanfare and which allows rural households to demand connectivity from BT. As I am aware from the north-east, however, an estimated 60,000 households across the country may be charged up to £100,000 for installation under that initiative. Does that count as a universal service obligation? How much does the Minister believe is too much to pay for the internet?

Digital is now at the heart of almost every policy area and online access is integral to people’s lives. I thank the hon. Members for Somerton and Frome, for East Devon, for Totnes and for North Devon—and, of course, the hon. Member for Tiverton and Honiton—for their considered contributions to the debate, which represent their constituents’ interests now and in future. We must ensure that, as we build back better and level up, there is no rural digital divide that holds back parts of our country and a significant number of our constituencies.

00:02

[The Parliamentary Under-Secretary of State for Digital, Culture, Media and Sport (Matt Warman)]

I thank my hon. Friend the Member for Tiverton and Honiton (Neil Parish) for securing this debate; I do not think that anyone has ever tried to duff up the Government in such a good-natured way. That spirit was shared by all hon. Members, for better or worse.

I have had these conversations with all hon. Members present and other MPs across Devon and Somerset, because broadband now matters more than any other utility. Over the last year or so, we have learned how important digital connectivity is. It is not that useful for me to talk about how extensive the superfast programme has been or how 96% of the country is covered, because if people do not have it, they do not have it. I understand why hon. Members want to go back with good answers to parents trying to educate their children and to farmers trying to deal with the Department for Environment, Food and Rural Affairs—a whole host of people from every aspect of society. Digital is what we now rely on, and what we will continue to rely on for economic growth and for essential parts of everyday life.

I completely understand why the debacle of the 13% of houses that Connecting Devon and Somerset has not managed to get connected is important to all hon. Members present. As my hon. Friend the Member for Somerton and Frome (David Warburton) generously pointed out, 87% of the programme has been delivered, but the fact remains that not far off 50,000 premises will be, at worst, nearly five years late. For what it is worth, I am sorry. It is important that, whether we blame Carillion for letting down Gigaclear, or Gigaclear for overpromising, the Government are sorry that we are in this position. That is an important starting point.

[Neil Parish]

I thank the Minister for taking my comments in such good part. The Government have put people in from the Department to look at Connecting Devon and Somerset and to sit on its board, but that needs to be strengthened. These mistakes cannot go on being made time and time again. My plea to him is to pick it up. I understand that the Government may not want to run the scheme themselves, but, for goodness’ sake, they cannot let Connecting Devon and Somerset behave in that way any longer.

[Matt Warman]

I thank my hon. Friend for that. I want to try to look to the future. There are some bits of good news. I cannot remember his precise phrase—I am not sure if he literally asked me to grab Connecting Devon and Somerset by the throat—but we have certainly worked closely with it. He mentioned that we have made an appointment to the board. That is a signal of how closely and intensively we have worked with CDS to get these forthcoming procurements to a much better place.

I will talk about Devon and Somerset specifically, but it is also important to bear in mind that nationally, we are doing things to ensure that every barrier to a nationwide roll-out is removed; we are legislating for improved connectivity in blocks of flats and new builds; we are making it easier to dig up the roads and easier to repair the roads in a way that makes all of the nationwide roll-out go that bit faster. In Devon and Somerset, CDS is now in the final phase of that £38 million procurement that will deliver those final connections. Working with us in DCMS, what it has done—as is already public knowledge—is divide the remaining 50,000 premises into six lots to cover all parts of the region not currently addressed by the live Airband contract. The reason for taking that approach is to maximise competition, speed, and speed of roll-out wherever we possibly can.

We have teams in Building Digital UK that have covered commercial interest, state aid, value for money and delivery, all working intensively with CDS throughout the procurement process and supporting it at every stage. We could not have worked more closely, and that is in part because of the commitments that I made to Members when I came to the area to talk about CDS and we first made the decision that Gigaclear was not going to be in a position to revise its contract. We worked very closely with Gigaclear to try and get it to a point where we did not have to restart the process but, ultimately, I believe that restarting the process was the best way to secure the speed of connections that we need.

It is this close management that has ensured that the procurement is on the very shortest path to delivery that we could possibly have envisaged. To give my hon. Friend the Member for Tiverton and Honiton an idea, one procurement might routinely take nine months. Those six lots—those six procurements—will have been completed in around 10 months. He rightly highlighted the fact that we had aimed to get them done by the end of November. I think he would accept that quite a lot has happened this year that we were not expecting, but it is my expectation that they will be done by Christmas.

[Neil Parish]

Will my hon. Friend give way?

[Matt Warman]

If my hon. Friend will let me continue. I know everyone says it will be done by Christmas, but I mean this Christmas. That procurement process, as he can imagine, is very much ongoing now. I ask him gently not to tempt me to say anything that might derail that procurement process in the last three weeks, but that is where we are at.

[Neil Parish]

I understand the point that the Minister is making about the six contracts, but he should not forget it was Connecting Devon and Somerset that decided to split it up into six contracts. I am not necessarily against that, but I do not think it can be broadly said it has managed to deliver six contracts in 10 months. Previously, it was one contract; CDS decided to split it up, so it is taking more time. Yes, it will be at Christmas, all being well, but the contracts are going out to 2025. In this great new spirit of transparency, how much is going to be announced so that people can actually get connected well before 2025? We have had no transparency.

[Matt Warman]

My hon. Friend is absolutely right. A crucial part of the future programme will be much greater communication with Members of Parliament, which is important up to a point, but also with the public. One of the most important things we can do is say to people, as he said, yes, the whole procurement will take several years, but there will be many shovels in the ground and many connections made well before the end of that period. We need to give people as much transparency as we possibly can, so that the entirely legitimate criticism that my hon. Friend made of the previous contract is not the case for the future contract.

It was right that CDS gave Gigaclear the opportunity to make things work, because it could speed things up, but we are where we are. It also important from a national perspective to say that Gigaclear has delivered in large swathes of the country: in Oxfordshire, Berkshire, Essex, Herefordshire and Gloucestershire. There are many problems, given the situation we are in today, but part of this is that we cannot lay them all at the door of any one entity.

On the new procurement, while some may think it easier to award the contracts to a larger supplier, the fair and open process across six lots was intended to promote speed and competition. When my hon. Friend gets his Christmas present, I hope he will be able to greet that, and we will give him some of the transparency that we have talked about.

I thank CDS for working with DCMS as closely as it has. That is why we have got to the position of doing six procurements in ten months or thereabouts, taking the people of Devon and Somerset to a significantly better place. The overall delivery, in stages between 2021 and 2024, and 2024 and 2025, is the right approach but it needs to be as transparent as possible, and should go as fast as possible. It should be communicated as quickly as possible. I have made that point to DCMS and CDS because, once awarded, these new contracts will deliver the balance of the connectivity that should have been delivered by Gigaclear. It is worth remembering the UK Government target of 95% for superfast coverage. The latest figures in my hon. Friend’s constituency show that 84.35% of his constituents have superfast connectivity —slightly up from the figures that he has given. The bad news is that the other two constituencies that he mentioned have gone up slightly faster. Tiverton and Homerton now has the lowest connectivity in Devon and Somerset, and I know that he is not going to let up until that is at a significantly higher level. We will pick up the superfast connections with these remaining procurements, we will be more transparent and we will go as fast as we possibly can.

It is also important to talk about the forthcoming UK gigabit programme that my hon. Friend mentioned and be absolutely clear that this remains a £5 billion programme with a 100% target. The judgment of industry and the Government is that the initial phasing of the spending reflects the maximum that can be delivered in the period up to 2025, but we will continue to work with industry so that if we can go any faster at all, then we will. If we can exceed that 85%, then we will. It is not an 85% maximum—it is a 100% ambition and we will go as far and as fast as we can.

My hon. Friend the Member for North Devon (Selaine Saxby) mentioned vouchers. They will be a key part, but not the only part by any means, of that future procurement, because it is horses for courses, as we know. Some communities are able to work together, but in some areas that is simply not the right approach. A host of different approaches will inform how we spend that £5 billion because that is how we will make it go as fast as possible and how, with an eye on value for money, we will manage to make sure that we spend it as quickly as possible. I know what matters to hon. Members in the Chamber is getting those connections done as quickly as possible. In the period to 2025, we will focus that funding, wherever possible, on premises that do not have access to superfast broadband. That means that the focus will be disproportionally on constituencies such as Somerton and Frome, and Tiverton and Homerton, where an 80-something per cent. of people have it. I obviously cannot make promises about any individual connection, although I am glad that my hon. Friend the Member for Totnes (Anthony Mangnall) has recently been upgraded and I have hopes for my hon. Friend the Member for Somerton and Frome, but it is important that the Government are clear that we will focus the £5 billion gigabit programme on getting as many people connected as possible. We will focus on those who need it most, and we will continue to work with the industry to refine the programme and maximise coverage.

[Chi Onwurah]

I thank the Minister for the good-natured way in which he is addressing our concerns, but I want to ask him about the commitment to universal gigabit broadband. Does it remain, and if so when will it be achieved?

[Matt Warman]

As I said, we think we will get to 85% or thereabouts by 2025. We will go as fast as we possibly can and we will get to 100% as quickly as we possibly can. I know the hon. Lady wants me to put a date on that, but the point is that we will go as fast as we possibly can. We will talk more about what the phasing looks like as we talk more about the gigabit programme. We will release some details this side of Christmas and some more in the new year. If the hon. Lady will be slightly patient, we will be able to release some more details. One of the key factors for the gigabit programme has to be providing people with transparency about what happens when.

I thank my hon. Friend the Member for Tiverton and Honiton for securing this debate. It is a hugely important issue for everyone across Devon and Somerset. I understand and share the frustration. I would be very happy to have another one of these debates, but I really hope we will not need one.

17:26

[Neil Parish]

I thank my hon. Friend the Member for Somerton and Frome (David Warburton) for his contribution to the debate. I like the way he managed to get roads and rail into a broadband debate—excellent. As my constituency neighbour, my hon. Friend the Member for East Devon (Simon Jupp), went through all his villages, he stole one of mine. Feniton belongs to me—will he take his troops away? He made a very good point about how we need to get everybody connected. I thank my hon. Friend the Member for Totnes (Anthony Mangnall) very much for his contribution. He was able to talk about gin distillers, farmers and fisherman all in the same breath—excellent. My hon. Friend the Member for North Devon (Selaine Saxby) said that she has less connection than me, but the Minister told me that I have the worst in Devon, so that should definitely cheer me up.

At the end of the day, this is very much about connecting our constituents. I made the point that it does not matter who does it or how we do it, but they must be connected. Over the years, I have been concerned about Openreach and BT and their monopolies, but they are training 5,000 engineers a year. They are the big players out there, so we have to make sure we use them with the outside-in programme and the voucher scheme. There has been a history of antagonism between Connecting Devon and Somerset and Openreach, and I do not want that to hold back the delivery of broadband. This is not only about our businesses; we talked about children’s education and the health service—most doctors’ surgeries are now being done online because of the pandemic. There is lots of serious stuff that we need to sort out.

I do not apologise for being very forthright because I think it was necessary, but I accept what the Minister said. We really need to do better. The last comment that I will make, Ms Fovargue, is that if you think this is bad, if I have to come back a second time it may be even worse.

Question put and agreed to.

Resolved,

That this House has considered the rollout of broadband in Devon and Somerset.

17:29

Sitting adjourned.