Grand Committee
Arrangement of Business
The Deputy Chairman of Committees (Lord Griffiths of Burry Port) (Lab)
My Lords, by popular acclaim and knowing that some have greatness thrust upon them, we will begin the proceedings. If there is a Division in the Chamber while we are sitting, the Committee will adjourn as soon as the Division Bells are rung and resume after 10 minutes. We have one hour for each debate. I should have stood up to say that; will noble Lords forgive that I did not, or shall I do it again?
Constitutional Commission
(2 years, 5 months ago)
Grand CommitteeRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Wigley
To ask Her Majesty’s Government, further to the recent (1) local elections, and (2) Northern Ireland Assembly elections, what plans they have to set up a commission to consider options for a new constitutional relationship for the four nations of the United Kingdom.
Lord Wigley (PC)
My Lords, I am truly delighted to open this debate with the noble Lord, Lord Griffiths, in the Chair—at least for these few moments.
The recent elections in Wales, Scotland and Northern Ireland underline the stark political differences between the two nations and the Province on the one hand, and the largest nation in these islands, England, on the other. In Northern Ireland, Sinn Féin, for the first time became the largest party in the Assembly. I only hope that devolved government will soon be functional there. In Scotland, the SNP continues to dominate elections, as it has for 15 years: it gained control of one additional council. In Wales, Labour gained control of one council and now controls eight in total; Plaid Cymru gained three councils and now controls four; 10 have no overall control. In England, however, although Labour and the Liberal Democrats had some gains, the Tories, despite difficulties here at Westminster, still control 35 councils. The contrast is stark.
In both Wales and Scotland, the Conservatives do not control a single council. In Anglesey, with a Tory MP, Plaid Cymru increased its number of councillors from 14 to 21 to gain control. The Conservatives fought every ward and won no seat. YouGov polls suggest that the Tories would now lose most of their Welsh MPs. In some elections, as recently as 2001, not a single Tory won a seat in Wales. Since 1867 there has never been a majority of Conservative MPs in Wales, yet for two-thirds of that time Wales was governed by Tory Governments we did not elect and whose priorities were not ours.
Misgivings with the present constitutional settlement have, over the past decade, triggered an escalating movement for greater independence. These include the perception that devolved powers are being clawed back by Westminster. On Monday I had the First Reading of my Private Member’s Bill, which I think is available today, addressing this issue.
Secondly, there is the manner in which Wales has been short-changed on the pledge that the pre-Brexit structural and social funds would be maintained. In fact, in this three-year period we shall be £770 million poorer.
Thirdly, there is the way in which appointments to senior Civil Service positions in Wales are controlled centrally, with the danger that people lacking a knowledge of Wales are parachuted into key jobs. Wales needs its own integrated public service career structure.
Fourthly, when independent commissions recommend additional powers for Wales’s Senedd—the Silk commission recommended devolved police powers and the report by the noble and learned Lord, Lord Thomas of Cwmgiedd, recommended changes in the legal framework in Wales—their recommendations are simply ignored by UK Governments.
Such arrogance drives people to consider political independence. Today Wales looks more to its own Senedd for the way forward, reflecting our own priorities, values and aspirations. Never was this more clearly seen than in the Welsh Government’s handling of the Covid crisis. The overwhelming majority in Wales believe that our Senedd, Labour led with Plaid support, did a better job than the Boris Johnson Government.
This growing confidence in our own institutions led to growth in the YesCymru cross-party independence campaign. Opinion polls have indicated that up to 39% are tempted by the notion of full independence. The Senedd has established its own commission, chaired by former Archbishop Rowan Williams and Professor Laura McAllister, to explore future relationships between the nations of these islands. One reason for this is the prospect of Scotland becoming an independent country. Thereafter, Westminster would be endlessly ruled by right-wing Governments anathema to Wales. If Scotland quits the union, many believe that Wales will soon follow.
The Scottish electorate have shown consistently since 2007 that they support SNP-led Governments. Their Government at Holyrood have a mandate for another independence referendum, which should be honoured within the lifetime of this Westminster Parliament. If the SNP’s mandate is thwarted by Westminster, unionist parties could be wiped out in Scotland in the next UK general election. A referendum could no longer be denied, particularly if the SNP holds the balance of power in the Commons. If that resulted in a majority for independence, the UK Government would surely have to deliver.
Northern Ireland may conceivably, in the foreseeable future, have a majority for reunification. For that to be acceptable to unionists, there would surely have to be no barriers to the movement of Irish people, goods and money to and fro to Scotland, Wales and England. This too would be the sentiment for Scotland and Wales regarding their relationship with England. Nobody in their right minds, anywhere in Britain, would want to rebuild Offa’s Dyke or Hadrian’s Wall to isolate England from Wales and Scotland. Whatever the ultimate constitutional settlement between our respective nations, there should always be free movement of people, goods and money, with no greater barriers than there are today between Luxembourg and Belgium, or between Ireland and the north of Ireland.
Whether Scotland votes for independence before or after the UK elections, parties at Westminster should consider alternative models for independence, how they would work, and their respective merits and drawbacks. The worst possible scenario would be for Westminster politicians to play a collective game of King Canute, ignoring the new geopolitics of these islands.
With the reunification of Ireland and a pro-independence vote in Scotland at least possibilities, where does that leave Wales? Although Wales currently has no majority for independence, the departure of Scotland and Northern Ireland might well change attitudes.
With these scenarios at least a possibility—some say a probability—I ask the Government whether they intend to sit back and let events dictate policy, as happened with Ireland a century ago, or should there be serious study of alternative models for the post-independence relationship of the nations of these islands? Some colleagues, particularly on the Liberal Democrat Benches, favour a federal constitution for the United Kingdom, but would this be a federation of four nations each with parity, leaving England outvoted by the other three, or weighted by population, leaving the others always outvoted by England? If it were based on English regions, Wales and Scotland would hardly warm to such a status.
Another model makes more sense to me: a confederal approach, in which sovereignty of the three nations and the Province is acknowledged, but they pool their sovereignty for certain purposes—for example, the recognition of the Queen as the head of a Britannic confederation. Plaid Cymru and the SNP currently accept the monarchy as the Head of State, recognising a Britannic dimension to our identity as well as our own national identity. Secondly, there might be an acceptance of sterling as the currency and a reconstituted Bank of England acting as a central bank for a confederation. Thirdly, there is scope for defence co-operation. The SNP supports an independent Scotland being part of NATO, though this is obviously complicated by the question of nuclear weapons. There is surely a pragmatic solution to enable defence co-operation.
The central issue relates to the free movement of goods across the nations of these islands. I accept, sadly, that Brexit will not be reversed in the immediate future, but there is a way forward with not only a free-trade area between the three nations of Britain but, if we include Northern Ireland, a free-trade agreement with the EU itself. That offers a solution to the cross-border Irish problem and could unlock the present impasse, which is threatening stability and peace in Northern Ireland.
I realise that a stumbling block may be Brussels’ insistence on European court jurisdiction, but is it impossible to devise a sui generis new court structure to deal with a confederal Britain? Might there be a parallel court comprised of representatives of the Britannic confederation, the European court and even the Dublin Government with an independent chair, possibly from a country such as Switzerland? That would not only facilitate the Britannic free trade area but safeguard free trade with the EU and solve current difficulties faced by Northern Ireland. This is surely worth exploring now in its own right.
I come to my main objective: to seek a commission to consider the future constitutional relationships of these islands and, in particular, the practicality of a confederal model for the co-operation of the three independent nations, its implications for Ireland and the possibility of a free trade area with the European Union. This commission should be asked to report within 18 months. Many commissions have considered similar issues over the past century. I appeared before Lord Kilbrandon’s commission in 1969 and Lord Richard’s in 2003. I hope this practical suggestion will be considered by the Government. It offers a positive way forward. We have a mutual interest in finding a constructive solution to the constitutional challenges facing the countries of Britain. I invite noble Lords to be equally positive in their response.
Baroness Fraser of Craigmaddie (Con)
My Lords, I thank the noble Lord, Lord Wigley, for securing this debate. I was moved to speak as I felt it was important that there is a Scottish voice. It is a lost opportunity that, unlike Plaid Cymru, the SNP does not feel moved to send representatives to our House. There is nothing the SNP wants more than a new constitutional relationship with England, Wales and Northern Ireland.
The recent local elections and the subsequent council administration pacts illustrate again how divided Scotland remains along constitutional lines. I take issue, however, with the interpretation of the results of the noble Lord, Lord Wigley. The unionist vote is split among the three unionist parties, hence the SNP always seems biggest. The SNP has a woeful record at both local and national level, but its relentless promise of a second referendum, the politicisation of our flags and, frankly, the othering of those who do not share its constitutional view plays to its supporters but continues to divide us.
I led a debate on Scotland in the Chamber on 9 December last year. I commend to noble Lords the contribution that afternoon by my noble friend Lord Dunlop, he of the report. His key message was about getting the tone right. If we want to see a cohesive and co-operative union, he urged
“a culture change from a Whitehall used to issuing directives”.—[Official Report, 9/12/21; col. 2029.]
This Platinum Jubilee weekend was a good time to consider the cohesiveness of the union. I find myself drawn to the New Statesman and a very good article by Helen Thompson, who says:
“Like the Union, the monarchy works”
best when it is allowed, “in all its complexity”, simply to carry on. The monarchy is a shining example of how to successfully navigate the differing nuances of the four nations, celebrating our distinctiveness while acting as a unifier.
Whatever our differences, most Scottish people want the Scottish and UK Governments to work together to ensure the best possible outcomes for everyone. I therefore urge the Minister and Her Majesty’s Government to look first to Westminster. I would like to see a “union filter” applied to every bit of legislation and policy published, but I fear this does not always happen in practice. Too much centralised power is as dangerous in Westminster as it is in Edinburgh. We cannot do anything about the unrelenting focus of Edinburgh on pursuing constitutional change, but let us not do the SNP’s job for it.
We do not need to open the Pandora’s box of a constitutional commission. As Covid and the vaccine rollout demonstrated, the structures for co-operation are already in place; it is just politics that is getting in the way.
Lord Murphy of Torfaen (Lab)
My Lords, I have worked with the noble Lord, Lord Wigley, for the benefit of the people of Wales, I hope, for nearly 35 years and I have much respect for him, but I am not tempted by independence for Wales. I agree with him that there is a movement which goes towards that direction, but by no means anything like what is happening in Scotland. However, the thrust of the noble Lord’s speech was about the improvement of relations between the relevant parts of the United Kingdom and that is absolutely spot-on. The landscape has changed dramatically: he mentioned the situation in Wales, where there is now a legislative assembly called the Senedd; in Scotland, the SNP is of course dominating affairs; and in Northern Ireland, the Assembly and the other institutions are, unfortunately, currently suspended, but it has changed.
Many years ago, I held Cabinet responsibility for intergovernmental relations between the different Parliaments—very primitively in those days. It was not very good, to be honest, and over the last 20 years has got worse, if anything. The Whitehall departments still do not quite understand what devolution is all about. I sometimes think some government Ministers are ignorant of what devolution is all about, although the landscape has in fact changed dramatically.
I very much welcome the excellent report of the noble Lord, Lord Dunlop. There were some very good ideas in it. I welcome Michael Gove’s latest report, also excellent, on how to improve the intergovernmental committee and all the various ministerial committees that exist between the devolved Administrations of these islands. What could be improved is to have more reliance on the institutions of the Good Friday agreement—for example, strand 2 on the north-south relations in Ireland, strand 3 on relations east and west, and the British-Irish Council, which was set up by the Good Friday agreement. The British-Irish Intergovernmental Conference could be dealing with the issue of the protocol but it is not at the moment. There are institutions set up by the Good Friday agreement which could be used to improve relations between the various parts of our country.
I think your Lordships are aware that there is a commission in Wales looking at the constitution at the moment, chaired by Rowan Williams—Lord Williams. I gave evidence to it some weeks ago. It is an excellent committee and will come up with some very interesting suggestions. The Government of Wales are already looking at how the Welsh Parliament, the Senedd, is to be elected and the Labour Party has a commission, of which I am a member, led by Gordon Brown on what might be the nature of these intergovernmental relations in future. So although we do not have, as I think we should, a government-sponsored United Kingdom commission to look at those relationships, work has been done in Cardiff and in the Labour Party. I hope that the Minister can assure your Lordships that the Government are seriously looking at whether a commission could be used for the rest of the United Kingdom.
Baroness Humphreys (LD)
My Lords, I thank the noble Lord, Lord Wigley, for securing this important and timely debate. It deals with an issue that we need to continue highlighting.
Last month’s local government elections in the UK have given many of us food for thought. The Conservatives lost around 500 seats across the UK and nearly half of their seats in Wales, where they now control no councils at all. Conwy County, where I live, sums up their situation: they saw their total number of councillors halved, to five, and their further 42 candidates failed to gain seats. This is in a constituency with a Conservative MP, a Conservative Member of the Senedd, a fully staffed office and seemingly unlimited funds to spend on their campaign.
As I said in my response to the gracious Speech, with such election results I query whether this Government can still claim to have a mandate for their policies in Wales. Their policies have damaged our devolution settlement, undermined the powers of the Senedd, depleted funds available to the Senedd for economic projects and led to an upsurge in those considering opting to vote for independence in any future referendum.
The election results in Northern Ireland bring a border poll ever closer. In Scotland, the pro-independence SNP gained further seats. Voters in the devolved nations are disenchanted by the aggressive unionism on offer from this Government. They find nothing attractive in it and feel that they are faced with a binary choice between this and seeking independence.
From these Liberal Democrat Benches, we would support the setting up of a commission to examine the constitutional relationship for the four nations. Our vision, of course, is of a federal United Kingdom based on a stable, long-term framework in which real power is exercised by and within empowered nations, together with the regions and local communities. Although I will always be grateful to the Tony Blair Government for beginning the devolution process that I hold dear, I regret that our destination has never really been clear. There has never been a route map to guide us. Perhaps a commission at some point might have helped. Crucially, there has never been a place for England in the devolution process.
The UK is an unequal and unbalanced union, and a union that is beginning to fracture. In the words of WB Yeats:
“Things fall apart; the centre cannot hold”.
If we believe that our political centre cannot hold, it is our duty as politicians to examine alternative structures and present them to the electorate to enable them to make informed choices—a process that the Welsh Government have already begun for the people of Wales in the form of a constitutional commission.
Baroness Ritchie of Downpatrick (Lab)
My Lords, I want to take this opportunity to congratulate the noble Lord, Lord Wigley, on securing this debate, which focuses on the establishment of a commission to consider options for a new constitutional arrangement and relationship.
I come from Northern Ireland, where we have just had Assembly elections. They have led simply to further division, with no government institutions up and running. I say to the Minister that it is incumbent on both the British and Irish Governments, as co-guarantors of the Good Friday agreement—as the noble Lord, Lord Murphy, said, the agreement contains all the various aspects of a British/Irish, north/south and internal arrangement in Northern Ireland and therefore provides the facility for an embryonic commission—to ensure that those institutions are up and running to provide the necessary devolution that the people of Northern Ireland require, where local decision-making on a partnership basis can take place.
Sadly, because of the DUP’s opposition to the protocol, we do not have consent for the institutions, whether the Assembly, the Executive, the North/South Ministerial Council, the British-Irish Council or the British-Irish Intergovernmental Conference. I agree with the noble Lord, Lord Murphy, that they could provide some solutions if discussion and dialogue took place between the parties that should be forming the Executive in Northern Ireland—along with the SDLP, which will be in opposition, and both Governments. Of course, we could also add in the EU to provide the necessary information and encourage willingness to compromise in this instance.
I come at this as a democratic Irish nationalist who wants to see the people of Ireland united in a totally reconciled new Ireland. The provision for that is already in the framework of the Good Friday agreement. We must use the framework of the agreement and the institutions to build that necessary partnership, with power-sharing and mutual understanding—all the ingredients that the noble Lord, Lord Murphy, discussed and which he was part of as one of the negotiators of that agreement.
I say to the Government that, rather than talking about legislation to disapply parts of the protocol, they must re-energise negotiations with the EU to achieve a resolution to the technical details in the protocol. I asked a Written Question: what technical meetings took place and what technical meetings have taken place since February of this year? We know that no technical meetings have taken place, but in the Answer I got a list of all the meetings that took place from September last year. They were simply fly-in meetings of the then-Minister, the noble Lord, Lord Frost, and Maroš Šefčovič. But we need the people involved in the technical details to work out resolutions to the issues to allow our economy to blossom.
Consent and agreement are key to building trust and partnership, whether we are talking about the resolution of difficulties with the protocol or the resolution that will enable the institutions to be up and running. As the noble Lord, Lord Murphy, said, the facility lies within the Good Friday agreement because of all the institutions it provides for the relationships between Britain and Ireland, Northern Ireland and the Republic of Ireland, and within Northern Ireland, and to help build good further relationships between these islands—notwithstanding where I lie in terms of democratic Irish nationalism.
Lord Shipley (LD)
My Lords, I thank the noble Lord, Lord Wigley, for enabling us to have this debate. I agree with him about the need to set up a commission and consider options for a new constitutional relationship for the four nations of the United Kingdom. I want to add to that list the urgent need for a devolution settlement for the regions and sub-regions of England. Doing that requires a commission.
As my noble friend Lady Humphreys has just said, there has never been a place for England in the devolution process and there needs to be one. In three of the countries, Scotland, Wales and Northern Ireland, we currently have a block grant system, and we need a block grant system for the regions and sub-regions of England, to be controlled and managed more locally. To do that requires a commission to examine the options. You cannot run England out of Whitehall; it is simply too big. All the key decisions impacting on England are taken in Whitehall on a hub-and-spoke model in which Whitehall is the hub and elected mayors of combined authorities become the spokes. They compete with each other for resources at a time when budgets are being cut.
My attention was drawn to a report from March this year by the Institute for Government on the theory and practice of the Barnett formula. I will quote two paragraphs from it.
“Our view is that, in principle, Barnett should be replaced by a system that shares out resources in line with a clearly stated set of funding principles, applied consistently and transparently to devolved governments across the UK and to the cities and regions of England”.
I agree entirely. We have now reached a point where this has become essential. The noble Lord, Lord Wigley, referred to the shared prosperity fund and the figure of—I think I quote him rightly—£770 million lost to Wales as part of the loss of direct European funding. Of course, that has impacted on England. It would be helpful if the Government wrote to Members taking part in this short debate to explain what has happened to the loss of ERDF and ESF funding because it is very serious for the rest of the UK and, in respect of what I am trying to argue, for the regions and sub-regions of England. They have also all lost the six-year programming they had from European structural funding.
I am very concerned about how decisions are made in Whitehall. On the shared prosperity fund, yesterday the Public Accounts Committee said clearly that the total sum is lower than the European funding produced by the ERDF and ESF, so some facts and figures from the Government would be helpful. The Public Accounts Committee criticised the ill thought-out levelling-up plans through the allocation of funding yesterday, saying they were “unsatisfactory”. One reason for that is the excessive central control exercised by the Government.
Baroness Bloomfield of Hinton Waldrist (Con)
Perhaps the noble Lord could come to a close. We are very short of time today.
Lord Shipley (LD)
I am sorry; we have no clocks in front of us—that is the problem. In conclusion, the noble Lord, Lord Wigley, talked of the stark political differences there are now. He talked of the clawing-back of devolved powers and he is absolutely right. That commission is needed more urgently than it has been for many years.
Lord Anderson of Swansea (Lab)
My Lords, I congratulate my noble friend Lord Griffiths on his willingness to stand in the breach to chair so brilliantly. I also congratulate the noble Lord, Lord Wigley. He and I were on very different sides in the 1970s, when Plaid had a more separatist agenda and I was a member of the so-called gang of six. There has been a degree of convergence since and I am delighted to debate this issue with him. It is topical and timely now, because of the number of initiatives under way, as has been said.
I make a simple point: no institution is static; all institutions are dynamic. No one seriously expects the current settlement between the different nations of the United Kingdom to be the same in, say, five years. There will be some form of development, so the question is: in what form and what direction will it take? Will it be ad hoc, modest, incremental and with no end in sight? Or will it be a more radical project, as perhaps envisaged in the initiative taken by the Government of Wales? That is the basic subject of our debate.
The noble Lord, Lord Wigley, called for options, but we all know what they are. There is a whole spectrum of options. If the noble Lord, Lord Wigley, and I were to sit down together, we would say that at one end of the spectrum is independence; at the other is the status quo. There is a whole series of steps in between. I am personally inclined to favour the more federal or quasi-federal system, perhaps a more ad hoc or à la carte one, as in Spain. That is something I think should be examined well.
I will not touch on the human rights Act the Government are proposing, as I think they could run into great difficulties with the European Convention on Human Rights.
I make one final point: we have been here before. I am old enough to recall the Crowther-Kilbrandon report of 1969 and 1973, which clearly set out the options in parts 5 to 8. That commission, with all the good of the people who put their best endeavours and expertise together, has been forgotten. It is hardly a footnote in an academic treatise. There are surely some lessons for us: we should not be concerned about just options, but the political will to deliver any options around which a consensus may form.
Baroness Bloomfield of Hinton Waldrist (Con)
As the noble Lord is going over his speaking limit, perhaps he could bring his comments to an end.
Lord Anderson of Swansea (Lab)
Let us be aware of and beware the precedent of Kilbrandon, and decide to deliver.
Lord Jones (Lab)
My Lords, I thank the noble Lord, Lord Wigley, for his deeply committed introduction to this debate. I acknowledge his long-standing campaigning for devolved government in the other place, in the then Welsh Assembly and across the length and breadth of the lovely land of Wales—my own homeland.
In May 1945 Winston Churchill wrote to Clement Attlee suggesting the continuation of the wartime coalition and putting the suggestion to the people by means of a referendum. Mr Attlee replied:
“I could not consent to the introduction into our national life of a device so alien to all our traditions as the referendum”.
As a balance in this debate, I offer the Economist from April and its leader headlined “These septic isles”. It was blunt and severe, but it calls for a new constitutional settlement. I quote:
“Relations with Westminster are dysfunctional … Under devolution, powers were crudely handed out around the United Kingdom, but the politics favour blaming the centre rather than working with it … Under New Labour, the devolved parliaments in Edinburgh, Cardiff and Belfast were meant to bring bread-and-butter issues … before each country’s voters. Instead such issues are neglected, because elections are dominated by unresolved arguments about the constitution.”
Let us have the commission, but please get on with making the lives of ordinary citizens better. Our schools and the health service are urgent priorities.
Today the Cardiff Senedd offers good, honourable governance of integrity. It should be proud of its two decades of social and economic advances. It was a brilliant, seamless transfer of constitutional powers from London to Cardiff. It deserves a renewed vote of confidence. Devolution is here to stay; it is irreversible, and surely much more is to come. These two decades of powers are but an eye-blink in Wales’s national history.
Commissions there have been aplenty, but how often are their proposals effected? Harold Wilson said, smiling wickedly, that commissions decided upon in minutes take years to report. I say to the noble Baroness, Lady Fraser, that Professor Helen Thompson, in the current issue of the New Statesman, emphasises:
“The Crown and the military are still the most important symbols of Britishness.”
It is a fact that Mr Gordon Brown, at the request of the party chairman and high command, is examining devolution and constitutional change. I bet he proposes more devolved government and further constitutional change. I guess that change refers to your Lordships’ House also; he is mindful of my noble friend Lady Jay’s defenestration of some 600 aristocrats not so long ago. Lastly, my further guess is that Her Majesty’s Opposition will largely espouse Mr Brown’s findings in their manifesto. A changed Government after the general election would, in all likelihood, embrace devolutionary and constitutional advances.
Baroness Bennett of Manor Castle (GP)
My Lords, I feel I should declare some positions: the England and Wales Green Party has long championed a Cornwall assembly, a Yorkshire assembly or parliament and similar around the rest of England; the Welsh Green Party has said it will campaign for independence should a referendum be called; and the Scottish Greens have long been pro-independence.
Having put those cards on the table, I thank the noble Lord, Lord Wigley, both for securing this debate and for his creative, positive introduction to it. I particularly thank him for the chance to celebrate the local election results, which were truly spectacular for the Green Party. One of the outcomes is that there are now 18 councils, as well as the one council we run, in which we are part of some form of rainbow coalition—groupings of a number of parties working together co-operatively for the common good.
These are usually classified as councils under “no overall control”. One thing I would like to highlight is that we really need to rephrase that terminology and look at these as councils in co-operative operation, where people are working together to govern. This is a very different model from the traditional model of British governance and, I argue, demonstrably a far better one. To suggest some of the places I happen to know about where this is working well, Lewes is a particular highlight. In diverse places such as Herefordshire and Sheffield, this is working well.
Of course, in Scotland we have Green Party Ministers. I will pick up a point from the noble Baroness, Lady Fraser, who suggested that there was perhaps an exclusionary model of Scottish nationalism. The nationalism championed by the Green Party is very much a civic, inclusive nationalism—one that acknowledges that the Syrian refugee who arrived last week is as much a part of the community as anybody else. Maybe England could learn from that form of nationalism.
It is clear from this debate that pretty well everyone agrees that what we have now is broken. Indeed, the noble Lord, Lord Jones, just mentioned the Economist, the Government promised in their manifesto to have a commission, and the Labour Party would have a commission. We have heard a lot of suggestions, but even the commission, which would be a positive step forward, is still very much the establishment rearranging the deckchairs on the Titanic: the great and the good sit in a room like this, possibly under some dreadful art like in this room, and decide how to rearrange things.
I have an alternative proposal. Let us have a people’s constitutional convention, an assembly that represents all the peoples of these isles—of course, we could have them at different levels in the nations as well—and collectively allow the people to democratically decide how we should change, start from scratch and redraw our currently totally outdated, dysfunctional, unworkable constitutional arrangements between the nations and, indeed, in this House and the other place et cetera. We need change. Let us not draw up the changes; let us let the people decide.
Lord Griffiths of Burry Port (Lab)
My Lords, I am a shooting star for a minute and a half, with due thanks to my noble friend Lord Wigley.
In the time that I have been in your Lordships’ House, I have noticed a number of measures moving through to completion that had constitutional dimensions to them. Therefore, I feel that a situation we thought we understood has, either by accretion or erosion, been sometimes quite severely affected. What I pick up from the Question as central to a need felt more keenly now than it could have been before is that we need to take time out to have a convention—call it what you like—where we look at what is happening in a situation where, if we are honest, power is not only held and disposed of centrally but disposed of by the Executive at the expense of other aspects of government.
Granted the anomalous situations that exist in Scotland and in Wales, and ominous possibilities of what might or might not happen in Ireland, this should be a moment where we stand apart and take a good look at what has become of us. I would like the methodology that underpins such a convention to resemble more what happened to bring the Good Friday agreement into being in Northern Ireland: namely, endless talks behind and out of sight to achieve something that gives us an opportunity to create ideas we can live with.
I do not think a debate of this kind, for all the worthiness of some of the things put forward, can possibly achieve the outcomes we are looking for, but it can hint at something. I end simply by taking other lines of WB Yeats’s poem that was partly quoted earlier. Yes, it is true that “Things fall apart”, and “The centre cannot hold”. It is true that
“Mere anarchy is loosed upon the world”
and that
“The ceremony of innocence is drowned;
The best lack all conviction, while the worst
Are full of passionate intensity.”
Was there ever a description of now better than that, although it is 100 years old? Was there ever a statement of how things are that better describes our need radically to look at where we are and how we can move forward, with trust and respect, one for another?
Lord Wallace of Saltaire (LD)
My Lords, I must declare an interest as I had a memo published in the Kilbrandon commission’s report; one can find it in the second half of volume 10. That shows my age.
It is a huge disappointment to us all that the commitment in the 2019 Conservative manifesto to hold a commission on the constitution is one of the many promises that our Prime Minister has broken. We need one; there is general agreement here that we need one. It is a huge disappointment that we have such a London-based Government. The resentment against them is not only in Scotland, Wales and parts of Northern Ireland; we are increasingly seeing it in the north and south-west of England.
It is a puzzle for many of us that the most devolved part of England is London itself. It has more powers than the regions and allows two levels of representative government, whereas we in Yorkshire are told that we all must have only one level. The new model for this absurd, single-tier government that has just been imposed on North Yorkshire was very reluctantly accepted by the people there.
The assertive, aggressive unionism that this Government respect is as disastrous as the unionism represented in the 1880s and 1890s. The extent to which AV Dicey, the authority on Westminster sovereignty, was quoted to me last year by a government Minister as defining our approach to sovereignty, governing this Government’s assumption that they are allowed to tell everyone what to do, is part of what is wrong. Remember that AV Dicey wrote what he wrote because he was avowedly against Irish home rule and aggressively unionist. What did it lead to? The division of Ireland and nearly a civil war.
That is where we are. I recognise that Boris Johnson is very much part of the problem. Last weekend, I was talking on the phone to one of my Scottish relations, who I know voted Liberal Democrat in the local elections in Edinburgh. He said to me, “If he’s still there in three or four years’ time, I know which way I’ll vote in another referendum”. That is there—the noble Baroness, Lady Fraser, knows it—in the way a lot of people in Scotland think. I am going up to Scotland tonight; I have no doubt that, tomorrow, lots of people will tell me much the same thing. We need to address this. We cannot ignore the problem.
I merely wish to add that resentment in the regions of England about what is going on is also rising. If you saw the Yorkshire media’s response to the integrated rail strategy provisions, you will have seen the extent to which the assumption is that everything is done for London: “You don’t begin to understand what happens in the north and you’ve cut down the degree of autonomy that we thought we had, even in local government”. We need a constitutional commission. We need to consult as widely as possible, using citizens’ consultations, if we are to hold this country together. We should not ignore the real possibility that the United Kingdom could disintegrate.
Lord Khan of Burnley (Lab)
My Lords, I thank the noble Lord, Lord Wigley, for securing this debate and introducing it so eloquently. It has been a pleasure to listen to the debate and hear from noble Lords with such extensive experience of championing devolution.
Ron Davies, a former Secretary of State for Wales, once said:
“Devolution is a process, not an event.”
The successes of devolution, but also the immense challenges facing it, are only too evident today. It has now been a month since the Northern Ireland Assembly elections and voters are still without a functioning Assembly or Executive. With Parliament currently considering multiple pieces of Northern Ireland legislation, including Bills that we hoped and expected would be debated in Stormont, there could not be a more timely moment for today’s debate.
For all the reasons we have heard today, the Labour Party is looking closely at the future of devolution. Labour is currently operating a constitutional commission to consider the future of our United Kingdom and how power, wealth and opportunity can be devolved to the most local level. This commission is considering all parts of the United Kingdom and will focus on delivering real, lasting economic and political devolution across our towns and communities and to people across the country. It is crucial that we are ambitious about the future of devolution. We need the Government to treat this with the care and thoughtfulness it deserves—not, as has proved the case too often in recent years, as an afterthought.
As well as in Wales, Scotland and Northern Ireland, we need to look at unleashing the potential across the English regions. The Government must make sure that powers coming back from Brussels are not centralised in Westminster but shared across the regions and nations of the United Kingdom. They must also hear from, and work with, our great mayors and council leaders, using their experience and ideas to guide next steps. We must always make the positive case for devolution and champion the process, but also consider how we can strengthen the relationships and co-operation which underlie the union.
The noble Baroness, Lady Fraser, cited Professor Helen Thompson’s article about the monarchy and how the union must also “carry on”. My point to the Minister on this issue is that we need to give it due respect, consideration and attention. We cannot carry on as normal. I look forward to hearing the Minister’s response and, more importantly, the plan. We want to hear the plan that the Government will bring forward to address this very important and timely issue.
The Minister of State, Home Office and Department for Levelling Up, Housing & Communities (Lord Greenhalgh) (Con)
My Lords, I thank the noble Lord, Lord Wigley, for securing a debate on this incredibly important topic. The Constitution Committee recently published its report on the union of the United Kingdom and, in addition to the points raised in that report, it has been very interesting for me to hear the contributions from noble Lords.
I take issue with the idea that there is an aggressive form of unionism. This Government are really committed to strengthening the union of the United Kingdom, protecting and promoting its combined strengths and the values that we all share, and ensuring that the institutions of the United Kingdom are used to benefit people in every part of the country, building on hundreds of years of partnership and a shared history since the Acts of Union.
We are also great believers in devolution, and that it allows communities across the four nations to reap the benefits of the broad shoulders of the union, while benefiting from decisions being placed closest to those who they affect. We remain committed to working collaboratively with the devolved Administrations to support people across the whole of the UK. As my noble friend Lady Fraser put it, we have the structures in place and now need to focus on getting the tone right. The arrangements agreed in the intergovernmental relations review herald a new era for collaboration across the United Kingdom, facilitating the sharing of experiences and learning. I point out that there were 110 ministerial meetings in the first quarter of this year alone and 440 such meetings last year, so collaboration is strong.
We are focusing across the United Kingdom to deliver better outcomes for citizens to tackle the shared challenges that we face, from providing up to £400 billion in Covid support for individuals, business and public services to close collaboration on the approach to settling the Ukrainian refugee issue. We should recognise that the Autumn Budget had the first allocation of the UK-wide growth funds, including the levelling-up fund and community ownership fund. That provided the largest annual block grants, in real terms, of any spending review settlement since the devolution of 1998.
I point out to the noble Lord, Lord Shipley, that the UK shared prosperity funding for Scotland, Wales and Northern Ireland matches the size of the ERDF and the ESF in real terms, when it is fully ramped up to 2025. I reject the notion of any kind of power grab; there is 25% more per person for the Scottish Government, 20% more per person for the Welsh Government and 21% more per person for the Northern Ireland Executive, when we look at UK government spending over the SR21 period.
In response to the noble Lord, Lord Murphy of Torfaen, on looking seriously at any of the independent commissions, we will continue to make sure that constitutional arrangements remain fit for purpose. Instead of a single commission, we are already taking forward separate workstreams, such as the Judicial Review and Courts Act, and delivery of the Dunlop review. The noble Lords, Lord Khan and Lord Wigley, and others mentioned the Welsh constitution commission. The Secretary of State for Wales and the Minister for Levelling Up, the Union and Constitution have given evidence to that commission, and we are looking forward to heading its findings in due course.
The noble Lord, Lord Murphy, and the noble Baroness, Lady Ritchie, raised the importance of using the structures of the Good Friday agreement and ensuring that they are used to get the Administration up and running again. The institutions of the Good Friday agreement are up and running and the next British-Irish Council is on 7 July. The focus should be on wider issues such as the cost of living. That is what the polling suggests.
We recognise that collaboration is at the heart of the Government’s core mission for the whole of the United Kingdom. That is reflected in our levelling-up White Paper. We recognise that in Northern Ireland it is vital that the parties form an Executive as soon as possible. We are very keen that that is through negotiation but, if not, we are looking at other ways of dealing with that.
Finally, I thank noble Lords on all sides of the Committee for their contributions today. I know it has been hard to stick to time without a clock, but we have managed to get through the debate in the allotted time. I particularly thank the noble Lord, Lord Wigley, for securing this incredibly important debate.
Arrangement of Business
The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)
My Lords, may I very respectfully make a suggestion in view of what the Minister has just said? Those noble Lords who have a mobile telephone with an alarm function could set it for the number of minutes they have available to them and watch that rather than the evidently malfunctioning clock. I say that because I just gave that advice to the noble Baroness, Lady Fookes, and she seemed to know what I was talking about.
Tree Health in England
(2 years, 5 months ago)
Grand CommitteeRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Harries of Pentregarth
To ask Her Majesty’s Government what assessment they have made of the health of trees in England; and what progress they have made towards developing a variety of ash that is resistant to ash dieback.
Lord Harries of Pentregarth (CB)
I know that two fundamental assumptions will underly all the contributions to this debate by your Lordships: first, trees are absolutely essential for the environment, the future of the climate and human well-being; secondly, many of them are in a very poor state indeed. They are under threat, notably because of ash dieback.
In 2018 the Government produced their Tree Health Resilience Strategy. Four years later is a very good time to ask the Government what progress has been made on what they set out to do in that. What success has there been? I know your Lordships will want to focus on a range of issues, not least bio protection, but I want to concentrate on ash and elms.
We know how ash dieback came into the country, how rapidly it spread and how devastating its effect has been. But there is some good news to report. In 2009 it was reported that researchers from Queen Mary University of London and Kew sequenced the DNA from over 1,250 ash trees to find inherited genes associated with ash dieback resistance. About this, Professor Richard Nichols said:
“Now we have established which genes are important for resistance we can predict which trees will survive ash dieback. This will help identify susceptible trees that need to be removed from woodlands, and provide the foundations for breeding more resistant trees in future.”
This is obviously very hopeful, but the words are “This will help”. It would be good if the Minister could say anything more certain about how far it is now possible to identify resistant trees and whether they are being successfully developed.
There is more good news. Research from the Nornex project led by the John Innes Centre in Norfolk was reported in April. It has developed three genetic markers which enable it to predict whether a tree is likely to be tolerant of disease, and even whether it is likely to be mildly or strongly tolerant. In particular, it has developed a tree it has named Betty that shows strong tolerance. Again, it would be good if the Government could say any more about the timescale and when any significant proposals for replanting might come about.
All this is encouraging, and I recognise that this kind of research is complex and time consuming, but there is an urgency about this task. It is now some 50 years since the devastation caused by Dutch elm disease. It was once one of the most familiar and loved trees of the English landscape, painted by John Constable among others, but 25 million elms were wiped out: 90% of the population. Again, there is some good news to report here. Apparently, in 2019 some elms resistant to the disease had been developed, but the information is somewhat sparse.
More recently, nursery and garden centre company Hillier has described a variety of elm called Ulmus New Horizon that it states is 100% resistant to Dutch elm disease. It has been cultivated since the 1990s, but it took until 2019 to build enough stock to launch it commercially. This is not a native English elm and, from what has been said, it looks as though we will not be able to get native elms back, but it is a closely related hybrid.
It is also worth noting the Great British Elm Projects, which stated:
“This involved a propagation programme … of a large number of Sapporo Autumn Gold elms, a disease resistant hybrid developed by the University of Wisconsin.”
I also note the Centre for Forest Protection, which was established as part of the 2021 English trees plan and launched in May this year along with the new Forest Research Holt Laboratory. Their work will be vital for the future.
A lot is going on around the place, and I recognise that research takes a long time, especially with slow-growing organisms such as trees, but with the kind of genetic testing now being used for the ash, which was simply unavailable 50 years ago for the elm, surely it must be possible to speed up research and replanting. We cannot afford to wait 60 years for the ash, as we have for the elm. There is an urgency because of climate change. As has been well put:
“Trees are the ultimate carbon capture and storage machines. Like great carbon sinks, woods and forests absorb atmospheric carbon and lock it up for centuries … They also … help … Prevent flooding … Reduce city temperature … Reduce pollution … Keep soil nutrient-rich”.
The Government have a policy to try to increase tree planting. Their target, as set out in 2018, was to increase tree cover in England to 12% by 2060 by planting 180,000 hectares of trees, including a new northern forest. Can the Minister say anything more about what progress has been achieved towards that target?
To conclude, there is good news, but there is urgency about this task. If more money was put into research in this area, would it in fact speed it up? If it would, it would surely be justified. It is obvious from what I have said that research is going on in all sorts of different institutions in different places. Does Defra have a special subunit monitoring what is going on and keeping on top of it? It would be very useful if it had, because this information needs to be widely propagated and kept under permanent review.
The Earl of Caithness (Con)
My Lords, I think we are all extremely grateful to the noble and right reverend Lord for introducing this important debate. It is not just the loss of diseased trees that we need to consider but all the consequences. Ash holds a special place in the ecosystem of woodlands. Because of its characteristics, it is a good tree for reducing atmospheric CO2, while 1,058 species from birds to lichens are associated with ash. As with elm trees, the large-scale loss of ash is having a significant impact on a range of species and habitats, as well as the economics of broad-leaved woodlands.
Much is known about the phenology of autumnal leaf fall, gene tolerance and microbial symbionts associated with resistance of ash, but progress on that alone will not solve the problem. Far too many in the forestry establishment still think that disease is an act of God and wilfully do not look at the influence of us humans and the effect we have on this situation. That influence is called management; more accurately, I call it bad management. We know that most of our woodlands in this country are in bad condition—what an indictment.
Planting blocks of the same species with a view to clear-felling is a recipe for increasing disease and pest problems and is unnatural. For over 50 years I have banged the drum for working with nature and for mixed, uneven-age forestry. Dense woods put the trees under pressure and ash, like oak, is very intolerant of lateral competition. Stressed trees are more susceptible to disease. Dense stands lead to quiet, humid conditions, which increase spore production and retention within the stand.
Some enlightened companies, such as SelectFor Ltd, have been pursuing irregular silviculture and continuous cover for many years. It has backed its belief with scientific research, using the universities of Salford and York. Initial results indicate that even with genetically tested trees other factors, such as environment and management, are involved in the trees’ ability to survive infection. The University of Birmingham’s work supports this: initial results show that ash survive better if planted alongside cherry but worse if planted alongside lime.
These bits of work demonstrate the importance of management and Defra should help to fund them. Management should feature strongly in the forthcoming government paper. On funding, how much is Defra spending on trees and disease research in the current year? What is the budget for the next two years? Why are some NGOs receiving 100% grant support when taxpayers’ money is better utilised to leverage private sector finance?
I also ask my noble friend to stop everybody using the facetious slogan “right tree in right place”. I remind him: right tree—lodgepole pine; right place—Flow Country in Caithness; result—disaster.
Baroness Young of Old Scone (Lab)
My Lords, hear, hear. I declare an interest as chairman of the Woodland Trust. Ash dieback is very serious. The study in 2019 showed that the long-term economic and environmental cost would be about £7 billion over the next 10 years. Ash supports more than 900 other species, of which 44 are entirely dependent on ash. They are very important—particularly, in my view, because they are the most prevalent form of standard trees in hedgerows, and hedgerows with standard trees are vital for the movement of species across the countryside that will be required with climate change.
The noble and right reverend Lord, Lord Harries, outlined how some trees appear more resistant, or at least tolerant, of ash dieback, but there is a long way to go before we are in a position where we will have tolerant seed stock on a widespread scale and are able to plant trees that will persist in the environment. The reality is that we should not hold our breath on the research. We need to take steps now. One of them is not to cut down trees that have ash dieback unless they are a risk to human health and safety. We are unnecessarily destroying trees that may recover or show signs of tolerance or resistance.
Ash dieback is only one of the diseases that affects trees. There is now a pathogen, pest or disease for almost every single species of tree that we have in this country—and if not here already they are lurking somewhere on the continent, ready to come. It is vital that we take tree health and biosecurity seriously across the board, particularly in view of the fact that we are dashing to plant and regenerate trees in the face of climate change: there is no point in increasing the tree cover if it is promptly going to die.
In conclusion—I have already had two minutes and 15 seconds on my timer—I urge the Minister to think about three things in terms of tree health measures. First, let us really have a drive to reduce imports by promoting the UK nursery sector. Will he support—as he is already doing—and promote even more firmly the UK and Ireland Sourced and Grown accreditation system, which aims at all tree stock, from seed to mature tree, being grown in this country or Ireland?
Will he tell us and get on with—this is more of a government-wide issue—the delayed last stage of implementation of the UK sanitary and phytosanitary regime? We still have distressing examples of new pests getting past port controls: the recent introduction of the pine processionary moth in April is just one example. So, when will we finally get the SPS fully implemented?
Lastly, will the Minister tell us when we will see the new version of the GB plant biosecurity strategy and, particularly, its associated industry plant health accord? It is vital that the whole tree planting and nursery industry, along with the conservation world, is massed behind this effort if we are to see healthy woodlands providing places for biodiversity, places for people and combating climate change—and I have finished before the end of my alarm, which was going to quack like a duck.
Baroness Fookes (Con)
My Lords, I must first declare my interest as co-chairman of the All-Party Parliamentary Gardening and Horticulture Group—and what a mouthful that is to say. I would like to make a general point first about the three types of trees: there are those that are involved with forestry; those involved with woodland management; and those involved with arboriculture—the amenity parts of trees. I have a suspicion that the Government take the arboricultural side of things less seriously, and I hope I can be told I am wrong by the Minister when he comes to sum up. But they are an extremely important aspect when dealing with the health of trees.
I will not dwell on the issue of ash dieback, as it has been so comprehensively dealt with by the noble and right reverend Lord, Lord Harries, and others before me. I want to concentrate now on threats to come. I have been told that there are at least 47 pests and diseases beyond our shores, at present, but which may reach our shores in the next decade. Therefore, it is extremely important that every measure possible is taken to deal with that issue.
I spoke a year or two back to the director of horticulture at Kew’s Royal Botanic Gardens and I thought that their policy on new trees was a lesson for us all. First, they seek to buy from British sources only—British nurseries. If that is impossible, they will buy imported trees but those are then, rather like dogs of old, quarantined for six months in a special area before they are allowed out into the wider community.
That may be a counsel of perfection not possible for all, but it chimes with the point made by the noble Baroness, Lady Young, that we need to increase production in tree nurseries by helping and supporting them. I guess there is a limit to the number of sites on which they can produce, but it is important that they have some knowledge of the future orders that might be placed by local authorities or the Government. They need good warning, because it takes up to five years to produce the sorts of trees required for such schemes.
Next, it is important that the public are warned loudly, clearly and frequently about the dangers of bringing in a few little plants that they saw abroad and think would be rather nice to have at home. That is one way in which pathogens, pests and diseases can come in.
Finally, there is the position of the Government in dealing with both research and, more importantly, biosecurity measures for imports. I hope there will be both thoroughness and speed because, if things take too long and are too bureaucratic, living creatures may die on the way to their destination. That must be avoided. It would help if the Government had a list of the most dangerous pests and diseases and concentrated their controls on those they regard as the most difficult to deal with. That would help the nursery trade and others to deal with a very serious situation.
Among the 47 is the emerald ash borer. On this pessimistic note, because it might nibble horribly at trees that we hope are resistant so must not get in at any cost, I rest my case.
Lord Inglewood (Non-Afl)
My Lords, I begin by declaring my interests in the register and explaining that I own some ash trees. One of my abiding memories of the Platinum Jubilee weekend was the obvious impact of ash dieback on the tree cover of Cumbria: everywhere were black, skeletal twigs protruding through the tree canopy. This pandemic predates Covid and moves more slowly, but it is a real pestilence just the same. We have not talked about it as much as Covid-19, fortunately, but the noble and right reverend Lord, Lord Harries, has done us a good turn in bringing this debate.
We should not be surprised by something such as this happening. After all, Dutch elm disease occurred in this country’s living memory and, before that, in the 1930s. Pundits have predicted this kind of thing and historians of nature, ecology and the environment have chronicled this kind of happening regularly, from time to time over the centuries. That is not to say it is not sad. We regret that the landscape, as we know it, is losing a very important component and is dying in front of our eyes. But something else will emerge. While it is destroying part of our living world, it is not destroying the world itself.
As other noble Lords have said, I understand that some trees are likely to be resistant. As long as they are spared the woodman’s axe and their natural offspring are allowed to grow, we, in partnership with plant breeders, will be able to replenish our countryside’s ash trees. As has been said, the life cycle of trees is long. It is not the end of the ash, any more than Dutch elm disease completely wiped out the English elm or wych elm.
It seems to be agreed that tree nurseries spread the disease from spores contained in stock raised on the continent. In this context, we need to be clear that we have always had phytosanitary arrangements and being in the single market did not affect that. As others have said, we have to tighten them up. I suspect that, in addition to a number of pernicious plant diseases, we will see more invasive species that are likely to carry out a lot of damage. I put it to your Lordships that the grey squirrel has probably done more damage to British tree cover than ash dieback has. We have to plan for this happening. The problem is that, like generals, we are always tempted to fight the last war. It has also been suggested that spores may have blown over the North Sea. If that sort of thing happens again, it will be rather more difficult to deal with.
What should we do? First, we should breed and propagate resistant ash trees. Secondly, we should replace them but, if that is expensive, with diversified species, as has been said. We should not be too frightened of these alleged non-native species, such as sycamore, beech and Spanish chestnut. The greater the diversity we have, the greater the chance is of some of them dying.
If an outbreak of some disease is discovered, we should monitor it, destroy it and—I add this deliberately —properly compensate for those trees lost. It is much cheaper to spend a bit of money and properly wipe out the disease than for people not to report it and then for it to run out of control.
Finally, we obviously must cut down and destroy the infected trees. It is on this point that I wish to conclude, since many of these trees are on the edge of the highway. For safety reasons, they have to be taken down quickly. For that to be done, it is necessary to have traffic lights, which require a permit from the local authority. These require a payment. I gather that the amount varies significantly from local authority to local authority. It looks to me as if some are profiteering from it. I ask the Minister to look into this and suggest that permits should be issued either free or for a nominal sum. It does not seem right that local authorities look as if they profit from this, in the same way that it was said that some suppliers of PPE did in the Covid outbreak.
Lord Framlingham (Con)
My Lords, like us all, I have a great love of trees and have been involved with them one way or another all my working life. I attended a meeting at the Forestry Commission’s headquarters in Savile Row in the 1960s, called to discuss Dutch elm disease. Despite the testimony of a roomful of experts in both arboriculture and silviculture, the Government insisted that the situation was not serious. They maintained that Dutch elm disease had been with us since the 1930s, that there had been many peaks and troughs and that this was just another peak. How wrong they were and how tragically that illustrates the need for government to maintain the closest possible contact with organisations that have experts in the field, such as the Arboricultural Association and the Woodland Trust.
The English elm has gone, destroyed by a shipload of logs from Canada. No longer can we enjoy that great majestic cauliflower-crowned tree, so beloved by landscape painters and an intrinsic part of our English countryside. We tried to save it: we pruned it and injected, but all to no avail. However, there is a glimmer of hope. Every year, the elm produces large amounts of new growth in our hedgerows. It increases in size until trunks are about as thick as your wrist and then they succumb again, but it keeps coming. It is tenacious, so there is hope that resistance will come.
The same fate has now befallen our ash trees—again an integral part of our countryside and our lives. They are not just beautiful to look at but very much part of our daily lives, from Morris Minor Traveller woodwork to hockey sticks. There is no cure available: just prune, fell if dangerous and hope for resistant strains to emerge. It is spread by the wind, they say, but it was undoubtedly ably assisted by us importing infected trees and distributing them around the country—unforgivable. Emerald ash borer has already been mentioned—another nasty. It has not yet arrived but is waiting in the wings, if there are any ash trees left to infect.
Oak processionary moth was first imported some years ago, but until recently it was confined to the Home Counties. Then in, I think, 2019, and perhaps again recently, we contrived not only to import it but to distribute it all over the country, saving the insects the task of spreading. Again, that is unforgivable.
Most dangerous of all is Xylella fastidiosa, now on its way through Europe towards us. If this gets in it will be truly disastrous, not least because of just how many different species of plant it can kill. Few will be resistant. We have learned not to plant too many trees of the same species in one location, creating a monoculture, which is very susceptible to a total wipeout if struck by a disease specific to that type of tree, but even a careful mixture of species would stand no chance against Xylella.
For all sorts of reasons, demand for trees and shrubs has increased rapidly, and sadly, for all sorts of reasons, has completely outstripped our own producers’ ability to meet it. Importation is on a massive scale and with it all the attendant risks. There are temptations to bend the rules and perhaps not inspect as carefully as necessary.
Two things are vital if we are to win this battle. First, we must have in place the most stringent rules—banning species if need be—that are always on the side of ultra-caution, and look again at the question of quarantine. Secondly, we need an immediate and huge increase in our campaign on awareness, particularly at airports, ferries and other terminals, but in the media generally. As has been mentioned, despite all the dangers, most holidaymakers would not think twice about bringing a plant back from a holiday in Europe. If we can summon up the resolve and the finance to do these two things as a matter of the greatest urgency, we stand a chance. If not, I fear the worst.
Lord Colgrain (Con)
My Lords, I declare my interest as a woodland owner, sadly with far too many dead and dying ash trees in the woods. Shortly after the then Prime Minister David Cameron asked us all to hug a hoodie, I was told that hugging an ash tree was an indication as to whether the tree was mature enough to withstand Chalara. The thinking was that if you embraced an ash tree and your fingers could meet around its back, it was deemed small and immature, and thus susceptible to the disease. If your fingers could not touch, it might be robust enough to resist. I have to report, with much sadness, that this unscientific approach has not proved accurate and that many of the trees I tried to embrace and thought might survive have not.
I mention this because it is no less plausible an approach to identifying those vulnerable to the disease than many others that have been put forward. I am told that approximately 10% of the ash on the continent are surviving the disease, not 20% as the Woodland Trust states. Consequently, there should be a similar percentage of trees surviving here in England but, notwithstanding what the Minister will no doubt say, there seems to be a woeful lack of science currently at work.
Dutch elm disease occurred decades ago and it is only now that inward trials are taking place with resistant whips from UK stock—one site, I am delighted to say, is located in my own county of Kent. At the end of this month, a symposium is taking place at Kew on elm trees and their associated diseases. Given how long it has taken for such a symposium to come about, what does this mean for ash trees? Can the Minister tell us how long we will have to wait before we have similar developments at work on ash?
The Tree Council says that the ash population may recover over 50 years. I fear that this is fanciful; it has not proved to be the case with elms, and there is no prospect of an indigenation of elms regrowing yet. Is there really any meaningful difference between ash and elm? Forest Research says that its ash seed orchard should begin producing resistant trees from the mid-2030s, which really does seem a lifetime away.
For a whole variety of unrelated reasons, we seem to be being visited by one tree disease or pest after another, the spruce Ips beetle being one of the most recent. As my noble friend the Minister knows—I thank him and his department for all their helpful responses to date on this—the compensation payment claims that relate to this one disease are currently clogging up Forestry Commission resources, with the consequence that some felling programmes are being delayed. Disease firewall benefits are thus not coming into being.
Can the Minister give assurances that the necessary staffing resources are being deployed to overcome this impediment? Can he indicate what work is being done to encourage the introduction and planting of new tree species that will be resistant to the climate changes already being experienced, as well as those anticipated? Can he also direct more effort towards the granting of funding for the management of existing woodland, particularly coppicing, rather than directing funds towards new plantings, which are often taking place in inappropriate locations with inappropriate species, as my noble friend Lord Caithness alluded to earlier?
Baroness Bennett of Manor Castle (GP)
My Lords, I thank the noble and right reverend Lord, Lord Harries of Pentregarth, for securing this really important and interesting debate. Like the noble Baroness, Lady Fookes, I am going to concentrate on what she labelled as amenity trees—what I might call street trees or urban trees in general. That is because I want to put some positive spin in here. We need to think about some positive news; we have heard lots of negative news and there is certainly a lot of that around on tree health.
I can attribute campaigners in Sheffield as playing a really important role in raising understanding of the importance of street trees, in particular to public health and well-being, as well as to biodiversity and in cooling our climate emergency-heated cities as well. I note that 19 cities in the UK have now taken the Tree Cities of the World award. A number of these were awarded last month. Sheffield was among them and it is notable that Leeds, Hull and Bradford were too, perhaps influenced by all the public interest in the news that came out of Sheffield, so we are really seeing the valuing of street trees.
But just as we need trees for healthy cities, trees need a healthy environment to flourish in cities. I pick up the point of the noble Earl, Lord Caithness, who talked of the need to a healthy phytobiome of a diversity of trees. Of course, what we also need is clean air; it is good for us and for the trees. I have to point here to my noble friend Lady Jones of Moulsecoomb’s Ella’s law clean air Bill, which is now in your Lordships’ House.
Hard surfaces make trees chronically stressed if they are not given sufficient space, so we desperately need to think about the planning and design of our cities for people and trees. Taking note of the point the noble Earl, Lord Caithness, made, I am not going to say “the right tree in the right place”, but I am going to say that we need the right tree in the nursery. Lots of people have been saying how much we need to grow so many more of our own trees, but we need to think about what kind of trees we are propagating in our nurseries to be street trees. What kind of signals are we giving to the industry? At the moment lots of the street tree plantings are very small rowans and birches, but we want to see the addition of some of those magnificent trees the Victorians planted—the big specimens that truly shade and enrich our cities in ways that little saplings meant to be lollipop trees are never going to.
We have to think about how we make sure we plant trees in cities so that they survive. In Britain, the current figures suggest that around 13% of street trees die in their first couple of years. In a study in Canada, 50% were dead within one year, so we really need to look after our trees.
Finally, I want to focus on a question for the Minister. There is a desperate shortage of trained arborists. The Institute of Chartered Foresters estimates that we need 70% more trained people to meet the Government’s tree-planting goals. Thinking about the pressures on the health of our trees, we desperately need the people who can look after them. I would be interested to hear from the Minister what the Government plan to do to tackle that issue.
Baroness McIntosh of Pickering (Con)
My Lords, I add my congratulations to the noble and right reverend Lord on securing this debate. Will my noble friend the Minister join me in paying tribute to and recognising the work of Fera at Sand Hutton, York, on tree health? I will refer to it in a moment.
In March 2014, in response to the immediate threat of ash tree dieback, the Environment, Food and Rural Affairs Select Committee, which I had the honour to chair, published a report, Tree Health and Plant Biosecurity. Its recommendations and conclusions have stood the test of time. I refer in particular to recommendation 18,
“that ring-fenced funding is provided for long-term research and development work that focuses on preparation for future plant health threats”;
recommendation 20, that Defra set up
“immediate initiatives … to address the lack of relevant expertise in the field of plant health”;
and recommendation 22, to develop resistant strains of ash trees without diverting funds from other, more immediate control measures. These recommendations have stood the test of time and I hope that Defra will continue to honour them.
It is a matter of note, as set out by my noble friend Lady Fookes, that there is a very wide range of potential tree and pest combinations that may be of concern heading towards this country. I welcome that Defra, FERA and others, such as Forest Research, contribute to Defra’s risk register, which helps to prioritise action against pests and diseases posing potential threats to UK species.
I take this opportunity to raise a number of questions with my noble friend the Minister. The practice of exporting ash tree seeds from the UK to, for example, Denmark and Poland—areas where trees subsequently reached high levels of infection in the early 2010s—and then reimporting them as saplings contributed at the time to infection of ash tree disease in this country. Will my noble friend consider whether it would be worth banning this practice outright rather than allowing it to continue, potentially contributing to the spread of the disease? Do we need to tighten up tree inspections at borders to ensure the health of trees and that they are safe to import? I refer to the fact that there is no longer a requirement to pre-notify consignments of high-risk trees, yet all plants for planting are effectively pre-notified via the phytosanitary certificate system. I am told that saplings coming into the UK will have been classified as healthy at the country of origin and will likely face an inspection—but how likely? Should we therefore tighten up inspections at the port of entry?
Developing ash trees that prove resistant to future strains has not been that successful so far. Up to 90% of UK ash trees are still at risk of infection. I understand from the Tree Council’s toolkit that only a third of local authorities have signed up to tree strategies. I believe that this should be increased.
Finally, as my noble friend Lord Caithness asked, what is the current funding for the tree strategy and the prevention and control of tree diseases? Will the Minister ensure that FERA has all the tools that it needs at its disposal to ensure that it can keep controls and innovation up to speed to protect us from future infections and diseases from other parts of the world?
Baroness Jones of Whitchurch (Lab)
My Lords, I am grateful to the noble and right reverend Lord, Lord Harries, for tabling this Question and provoking such an interesting debate. I should declare an interest through my involvement at the Rothamsted agricultural institute.
As noble Lords have vividly illustrated, a record number of pests and diseases are arriving on our shores and threatening our native tree population. Species of oak, elm, Scots pine, beech and birch are all at increasing risk from invasive bugs, fungi and bacteria. Quite rightly, there is real concern that our native woodlands could suffer wholesale devastation, with catastrophic impacts for not only the local landscape but our wider environmental and economic objectives.
We all recognise the vital role that trees play in carbon capture and sequestration. This is why we on these Benches have supported the Government’s tree-planting targets, challenging though they have proved to be. For every tree that dies as a result of invasive pests and diseases, meeting the planting target becomes even more of a challenge. So what can we do to prevent the inevitable drift towards woodland devastation?
First, as noble Lords have said, our warmer climate is becoming a magnet for new pests, while others that would have been killed off in harsh winter months continue to thrive and breed in the warmer climates. It is absolutely vital, not only for the obvious reasons but for those reasons as well, that we hit our net-zero targets. Perhaps the Minister can update us on whether he feels that we are playing our part in planting new trees to do that.
Secondly, international travel has fuelled a taste for exotic plants and the globalised trade in live plants has been allowed to outweigh our more pressing concerns about the host plants infecting our native species. As noble Lords have said, we need stronger vigilance and enforcement. We also need an urgent programme to invest in our domestic nursery sector, reducing our reliance on imported saplings.
Thirdly, perhaps most importantly, we need to invest in research into both the prevention and the cure. We need to understand what makes a tree pest-resistant and how we can replicate its genes. We need to understand what natural allies can be harnessed, such as natural microbes that could be enlisted to fight the diseases. We need to understand more about the natural habitats that make trees strong and healthy, including the benefits of planting and protecting diverse native woodlands, smaller woods and natural woodland corridors—a number of noble Lords made this point. We also need to ensure that we have the trained staff for the long-term care and nurturing of woodlands, to maintain them for the longer term. Can the Minister update us on the training programme for a rollout of skilled arborists and foresters to meet those new challenges and provide that support?
Finally, the Government’s tree health resistance strategy has at its heart the need for international collaboration and the sharing of research data, so can the Minister clarify whether we are continuing to participate in the EU pest and disease notification systems? Can he update us on the replacement for TRACES? Are we fully able to map the spread of pests and diseases using this system? Can he also update us on the future of the biological research programmes being funded through Horizon Europe? Will those schemes continue or will the researchers now get equivalent EU funding? As many noble Lords have said, the key and solution to all this is detailed long-term funding, so I would be grateful if the noble Lord could quantify how much actual cash is going into that research. How much is available now and how much in the future? I look forward to his response.
The Parliamentary Under-Secretary of State, Department for Environment, Food and Rural Affairs (Lord Benyon) (Con)
My Lords, I start by referring to my entry in the register. As other noble Lords have, I congratulate the noble and right reverend Lord, Lord Harries of Pentregarth, on securing this debate and other noble Lords on their powerful contributions. This is an emotive subject for me. I was looking at a woodland at home the other day, two-thirds or possibly three-quarters of the canopy of which is or was ash. As has been said, this is the first tree disease where the wider public are seeing something really tragic happening to our green and pleasant land.
Trees are of central importance in our efforts to fight back against climate change and biodiversity loss—a point powerfully made by the mover of this debate. That is why the Government have committed to increasing tree planting rates across the country to 30,000 hectares per year by the end of this Parliament. But planting trees is not enough. It is critical that we also protect them from the threats of pests and diseases. Our current treescape has an asset value of £175 billion, but the threat from plant pests and pathogens is significant and growing, driven by increasing globalisation and by climate change.
The noble and right reverend Lord, Lord Harries, asked what assessment Her Majesty’s Government have made of the health of trees. I assure noble Lords that we have a robust and comprehensive plant health system, operating pre-border, at the border and inland, to reduce the risks of pests and diseases entering the country and to manage the impact of established pests. We cannot overlook the professionalism in our nursery sector. I will name Nicholsons in Oxfordshire, which I visited the other day. It has superb phytosanitary policies in place and huge amounts of expertise in its staff, which complements the work done by government employees.
The Government’s UK plant health risk register—this answers a point raised by a number of noble Lords—tracks and prioritises plant health risks. Over 1,200 pests and diseases are listed on the register, 30% of which are capable of attacking trees. Risks are reviewed monthly for action, such as further regulation or increased inspections.
The process also enables us to consider factors that may be pertinent to climate change adaptation, such as identifying pests and diseases that might be expected to increase in range or prevalence due to climate change. Our plant health research and development programme is investigating these potential issues further, aiming to identify and prioritise exotic plant pests and pathogens with the greatest likelihood to establish or spread in the UK as a result of a change in climate.
I chair a monthly biosecurity meeting attended by officials and the Chief Plant Health Officer and I am brought up to date on a more regular basis on the progress across Europe of tree pest and diseases, which are always alarming. My noble friend was right to raise the nightmare potential of Xylella. You only have to go to southern parts of Italy and other parts of southern Europe to see whole landscapes devastated by that disease. It is an absolute priority that we keep it out of these islands.
Since leaving the EU, we have strengthened our import regime by introducing a prohibition on imports of the highest-risk trees, including many native species, and a requirement for phytosanitary certification of all plant imports. We require the pre-notification of all imports of regulated plants and timber to allow for official inspection. Our border inspectors now carry out over 70,000 physical checks each year. We also have a significant inland surveillance programme and have invested additional resources to drive increased inspection rates at the highest-risk sites.
The Forestry Commission is responsible for carrying out ground surveys of over 40,000 trees for priority pests and diseases, such as bark beetles, sweet chestnut blight and canker stain of plane. The Animal and Plant Health Agency carries out over 5,500 inspections at nurseries each year. The Forestry Commission also carries out risk-based aerial surveillance of over 1 million hectares of woodland each year. Aerial surveillance is a powerful and cost-effective tool, with new technology supporting it that enables the Forestry Commission to survey a significantly larger area than would be feasible using ground-based surveys alone.
Citizen science and sightings from the public further enhance surveillance. The Observatree network of trained volunteer health surveyors is a network of over 200 trained volunteers in England, Wales and Scotland, and is supported by a dedicated team of professionals. Lastly, the TreeAlert service is run by Forest Research and receives reports from the general public. These surveillance programmes produce rich datasets, which feed into the Tree Health Diagnostic and Advisory Service, which diagnoses potential pests and pathogens and produces quarterly reports. New statistics released last month show that last year, up to March 2022, the service dealt with a record 3,790 inquiries or samples of suspected tree diseases and pests—a nearly 25% increase on the previous year. This is the public getting involved in science and the risk that we face. The most commonly identified pests and disease were oak processionary moth and ash dieback.
We also aim to limit and manage the outbreaks that occur and are currently taking robust, official and urgent action—the word “urgency” was rightly used by a great many noble Lords—to contain or eradicate a number of regulated pests, such as Ips typographus, Phytophthora pluvialis, Phytophthora ramorum and oak processionary moth, using tree removal or treatment of infested trees. We are deeply indebted to landowners such as my noble friend who, in the south-east of England, have faced the arrival of Ips typographus and are helping us create a cordon sanitaire, so that other insects that blow over from the channel will have nowhere to go because there will be none of that type of spruce there. Dealing with outbreaks is costly so, where feasible, we aim for eradication. One example is the eradication of a small outbreak of Asian longhorn beetle in Kent between 2012 and 2019, which cost around £2 million. In comparison, the cost of managing the insect in the United States, where eradication has not been possible, has been at least $373 million.
An outright ban on plants and trees may seem to some like a simple solution. However, UK production does not currently meet demand and trade in plants and plant material is essential for many reasons, including food security and resilience to climate change. Additionally, many invasive pests, such as ash dieback and Ips typographus, can arrive independently across the channel, having been blown here on warm winds. It is therefore impossible to reduce the risk of new pests and diseases arriving to zero, which is why we have in place this comprehensive system of surveillance and reporting for tree health threats.
We have recently invested £5.8 million to build a new world-leading quarantine laboratory at Forest Research’s Alice Holt site in Hampshire. The new facility means we now have the capability to undertake research and diagnostic work on quarantined pests and pathogens in a secure and contained environment. On top of this, we are investing in measures to increase the resilience of our treescape to future threats. We provided up to £10.5 million in the last financial year to support the sector to increase UK production of diverse, high-quality tree-planting stock and to enhance biosecurity.
At the risk of falling out with my friend, the noble Baroness, Lady Young, I challenge the view among some that we should restrict our plantings in this country just to native species. We face such threats of diseases and climate change that if we put our eggs in too few baskets, the chance of this green and pleasant land remaining so is put further at risk. I want the whole sector, whether NGOs such as the Woodland Trust, which I respect and admire, Confor and the forestry industry, the amenity planters or local authorities, as mentioned by the noble Baroness, Lady Bennett, to work together with a single sense of purpose.
I am running out of time. I will try to address some of the other points raised. On ash dieback, we have planted thousands of the most resistant plants in the south of England and we are monitoring them. As has been said, a lot of work is being done on the genome. There is a relentless attempt to try to home in on the most resistant ash trees, to take stock from them and to build, and not to have to wait for five decades, as we have with elm.
We recognise that the tree-planting targets, which have been referred to, are ambitious. We recognise the importance of hedgerow trees as well. That is a very important point. The loss of ash from that landscape is as devastating as the loss of the elms that I remember.
Noble Lords made many other points; I will sit down and write to them with replies.
Our plant health regime aims to detect and stop new issues at early stages. Where this is not possible, our surveillance systems give us the best chance of discovering and managing, or eradicating, those pests and diseases which do arrive. Government-funded research and development provides hope even against established diseases.
As noble Lords will no doubt appreciate, tree health is an active area in which the Government have invested in recent years. Later this year we will publish an updated plant biosecurity strategy, which the noble Baroness, Lady Young, asked about. On 23 May, we signed a new plant health accord with industry, trade bodies, the Woodland Trust and others. In the accord, we have agreed to work together to promote biosecurity best practice for all—an effort in which I know we are all united.
I am sorry that we have run out of time. A great many questions were asked. I will endeavour to answer them by another means.
NHS: Respiratory Syncytial Virus Infections
(2 years, 5 months ago)
Grand CommitteeRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Ritchie of Downpatrick
To ask Her Majesty’s Government what assessment they have made of the cost to the NHS associated with managing Respiratory Syncytial Virus infections.
Baroness Ritchie of Downpatrick (Lab)
My Lords, I thank the Minister and the Front-Bench speakers in this important debate, particularly as we emerge from Covid-19 and given the other respiratory viruses that are live in the community. I declare a personal interest: as an infant, I had pneumonia, which was one of these deep-seated respiratory viruses. I am talking about 64 years ago, but the viruses were all put in the family of pneumonia. Out of that emerged bronchiolitis.
Several questions are raised about this issue. The first is: what is respiratory syncytial virus infection? It is a leading cause of severe lower respiratory tract infections among young children and infants. An RSV infection usually causes mild and self-limiting symptoms in children and adults, which resolve within a couple of weeks. Symptoms can include a runny nose, fever and persistent cough—something that most of us can identify with. However, modelling suggests that the virus is responsible for 50% to 90% of hospitalisations among young children due to bronchiolitis, which is a common lower respiratory tract infection predominantly affecting babies and children under two years old. Up to 40% of hospitalisations are due to pneumonia.
So why the concern about RSV now? In late 2021 and early 2022, modelling predicted that RSV levels may double compared to a normal year, with a 100% increase in cases in young infants and a 40% increase in overall infections expected. As a result of the Covid-19 pandemic, the 2021-22 RSV season may be longer, with spikes in infection expected sooner than usual. There was a significant reduction in respiratory viruses during Covid-19 lockdowns, which limited infant exposure to RSV and thus impacted overall immunity. As the restrictions eased, it became apparent that there had been a significant rise in RSV cases and admissions.
Most hospital admissions for RSV in the UK occur in babies who are otherwise healthy. Despite the risk to all infants, studies suggest that 88% of pregnant women and 66% of midwives have no or little awareness of RSV. There are now widespread concerns in the medical community around the impact of RSV on an already stretched health service in the coming months and the cost to the health service of managing RSV infections—hence the subject of this debate.
In an average season in the UK, RSV is estimated to be responsible for more than 450,000 GP visits in children and adolescents, 125,000 cases of ear infection and 416,000 prescriptions of antibiotics. On secondary care, the Academy of Medical Sciences said:
“A lethal triple mix of COVID-19, influenza, and the respiratory virus Respiratory Syncytial Virus (RSV), could push an already depleted NHS to breaking point this winter unless we act now”.
With RSV, there is a cost to the health system, including £48.2 million for secondary care and hospitalisations. There is a direct cost of £65 million, with £15.7 million being spent in primary care on GP consultations. There is also a socioeconomic cost from the direct financial losses of the family and carers of children diagnosed with RSV. These estimated costs are just over £14 million in productivity losses every year. In addition, RSV in children under the age of five is estimated to cost an accumulated total of almost £1.5 million from the out-of-pocket costs incurred to families.
We have to ask what should be done to alleviate the burden on the NHS and to provide relief to infants and young families. In the wake of the Covid-19 pandemic and the nature of RSV infections, what consideration have the Minister and the Department of Health given to this matter? What assessment have the Minister and the department, working with the NHS, undertaken on those costs, bed blocking and the impacts on primary and secondary care? What is the impact on hospital and workforce capacity and waiting lists? What consideration have the Minister and the department given to ensuring that RSV infections could be treated in the community and in homes?
There are other questions to which I would like answers. What steps is the Department of Health and Social Care taking or planning to take to reduce the costs of managing RSV for the NHS, families and the economy, particularly with the overprescription of antibiotics leading to problems with resistance? What is the proper treatment? What discussions have taken place with medical professionals and clinicians to ensure that infants and young children receive the best treatment for full recovery? What learnings from the Covid-19 pandemic is the Department of Health and Social Care considering implementing for other respiratory viruses, such as RSV?
In conclusion, the bottom line is to ask what plans are being made and what funding has been set aside to ensure that protection against respiratory viruses remains a health priority for the upcoming season this autumn and into the winter and that there is better management to deal with them. What new policies are being forged to address RSV infections and to cope with the demands on the NHS? We must not forget that not only the infected child feels the burden of RSV; their families, carers and the health service are also impacted. The seasonal and contagious nature of this infectious disease has raised wider concerns over the possible impact on healthcare capacity, which has been re-emphasised during the Covid-19 pandemic, particularly when the NHS has been overburdened and overstretched.
I look forward to the developing debate and the answers that the Minister can provide. I like to think that this will be the first stage of an opportunity to give this subject a greater level of debate in your Lordships’ House, as it will become much more acute and apparent as we emerge from the Covid-19 pandemic and approach this autumn’s influenza and RSV season.
Baroness Brinton (LD) [V]
My Lords, I congratulate the noble Baroness, Lady Ritchie, on securing this important, and for me very personal, debate. As she outlined, RSV is a common respiratory virus that affects large numbers, mainly of children younger than five, but also some elderly and immunocompromised people. The burden of RSV includes not only ill health for children but the emotional and practical burdens of the affected families and carers and the impact that that has on productivity in the economy, alongside the costs of providing healthcare.
I found the key findings from a very interesting report by RAND published earlier this year, which did a desktop review of recent literature and published data on RSV in the UK. It approximated the annual healthcare costs of having RSV at £80 million. That equates to a mean cost of £97 to the NHS per child under five with RSV. Just over £40 million of that is due to productivity loses, £1.5 million is due
“to out-of-pocket costs incurred by parents/carers, and the remaining nearly £65 million to healthcare costs.”
Estimates suggest that each year 33 children under five die from RSV. While most cases of RSV have very short-term impacts, some children may face long-term respiratory issues later in their life.
Children born prematurely account for nearly 20% of the total cost burden of RSV in the under-fives. My twin granddaughters were born very early. The smaller of the two, Amelia, was 700 grams when she was born and at that point 30% of her lung tissue was dead. She was very unwell for the first few weeks of her life; we were lucky that she survived. Once she was home, within two or three days she picked up an infection, which transpired later to be bronchiolitis. It presented with all the traditional things you hear from Public Health England. Two parents were at home with premature twins and one was suddenly finding breathing very difficult. All the signs you are told to look for were already evident in her and 999 was used.
The Evelina Hospital was absolutely brilliant. My granddaughter remained in and out of hospital for the next year of her life; she was about three months old when this happened. The intensity to which the disease took over was extraordinary, on top of her underlying prematurity problems. She was in PICU—the premature intensive care unit—for some time and then did a step down to the next tier of ward. She then spent months on the lovely Snow Leopard ward—in the old days we would have called it a community hospital, but it is inside the Evelina—where the focus is very much on helping the families to understand the consequences of their child’s problems.
That was where I learned as a grandmother how to put on her ventilator every night, which she needed until she was three. I learned how to put on her heart monitor, because she also had heart problems, and to spot the signs of any infection, including future infections of influenza or anything else. Her skin was very pale and blue a lot of the time. I do not believe she was immunised with the monoclonal antibody, but she certainly had a substantial amount of medication as well. The most useful thing my son and daughter-in-law saw was how it was managed and how they could manage it and help her and themselves in the future.
Now, this bouncy six-year-old girl still has lung damage; you cannot revive dead lung tissue. She still cannot run around the way her twin sister does, but without the care of that extended paediatric team she probably would not be with us today. She is a shark expert, a budding oceanographer and absolutely determined to live her life to the full. The cost of her bronchiolitis was certainly in the upper economic numbers provided by the RAND desktop survey. But the benefit to the family is absolutely inestimable—in the support of the hospital and a large range of healthcare professionals who made it possible for her to go home. There were considerable difficulties, but she did.
She has a baby brother, born a year before Covid. His experience of RSV earlier this year, aged two, was very different. He has absolutely no problems. His experience was a very heavy cold with some croup and minor bronchiolitis. He saw the GP, but no more. His parents were very relaxed, while all their friends whose children were having RSV like that were getting very worried—but that is life when you have had a child who has had quite a severe illness.
RSV is with us and will be with us. As the noble Baroness, Lady Ritchie, said, as Covid starts to lift, we must expect to see more of it as small children mix with each other, as it is extremely infectious. She is right to be concerned about the overprescription of antibiotics. For some it is necessary but it needs to be checked. What is really clear from Public Health England’s guidance is that families can help themselves; they can recognise the symptoms of RSV and do what I did as a mother with my eldest child, who had quite severe croup, which is to make sure that there is lots of humidity in the atmosphere—with the kettle boiling away to make sure that there is steam in the room to help the bronchioles open and ensure that your child is protected.
However, it is not just about parents. Unfortunately, far too many GPs, community nurses and childcare staff do not recognise RSV either. I hope that one of the things we can ask of the Minister is to hear that that will change, and that this illness will be part and parcel of normal paediatric training. For some children, RSV is extremely serious, and the cost to the NHS and the families of those children—let alone to their long-term future—can be severe.
Baroness Wheeler (Lab)
My Lords, I too thank my noble friend Lady Ritchie for her excellent speech and her tenacity and determination in drawing this important issue to the attention of the Committee. Her warning was timely when she last raised her concerns, earlier this year, about the serious impact of the Covid-19 pandemic on the epidemiology of other seasonal viruses such as flu and RSV, pushing them out of sync. It is vital that plans are in place to ensure that the NHS has the capacity and resources to cope with a potentially extended, or more than normally prolonged, winter season, in particular of RSV.
As noble Lords have underlined, raising awareness among parents about RSV and how to spot the more severe symptoms is crucial. I pay tribute to the Sanofi Pasteur Together Against RSV campaign and its excellent report from last November highlighting the costs to the NHS of RSV, which were outlined so ably by my noble friend and the noble Baroness, Lady Brinton. The Mumsnet baby health website is also doing a great job in supporting parents and linking them to the Sanofi guidance and briefings. However, the fact that its recent survey showed that 37% of parents feel that they have a lack of understanding on how to manage their child’s respiratory illness from home, while 69% have found online information from various health sources overwhelming or confusing, shows the scale of the work still to be done.
Earlier this year, the Minister assured the House that the NHS has plans in place for raising awareness of RSV among parents and at schools. I look forward to hearing the detail of those plans from him. How will be Government support the Together Against RSV awareness-raising campaign among parents? When will government guidelines be updated to adopt the much more user-friendly and accessible information provided by this campaign and parent support organisations, such as Mumsnet?
The pressures on NHS primary care from RSV in children, in terms of GP visits, hospitalisations and antibiotics prescriptions, as highlighted in the Sanofi report and demonstrated by my noble friend Lady Ritchie, are pretty stark: 450,000 GP visits, 125,000 ear infections, 416,000 prescriptions and 30,000 hospitalisations in an average UK RSV season. Hospitalisations and GP visits are substantially higher among younger children infected with RSV than among those who have flu. Last year, the British Lung Foundation warned parents of young children to be alert for signs of RSV after a sharp rise in cases. It estimated that 1,000 children in England alone had needed hospital care for it in just three months. I thank the noble Baroness, Lady Brinton, for explaining her experience with her own grandchildren and underlining how serious RSV can become, as it did in the case of her granddaughter; I am glad that she is now recovering.
Noble Lords have also underlined the global effect of RSV. Experts behind the recent Lancet study, which showed that RSV kills more than 100,000 children worldwide, believe that more children are likely to be affected in future because lockdown and mask-wearing have meant that they have little or no natural immunity to it. Again, my noble friend Lady Ritchie referred to this reduced immunity point.
In the UK, we know that 92% of hospitalisations are estimated to occur in infants under the age of two. During winter months, one in six of all UK paediatric hospital admissions are bronchiolitis-related, with RSV estimated to be the cause of 60% to 80% of those admissions. As the Sanofi guidance warns:
“It is not only the infected child who feels the burden of RSV: families, carers and the health systems are all impacted. The seasonal and contagious nature of this infectious disease has raised national concerns over the possible impact on healthcare capacity at a time when it is already over-stretched … the UK faces a future with co-circulating RSV, Covid 19 and other respiratory viruses”.
What is the Government’s latest assessment of the impact of these co-circulating viruses on primary and secondary care, and on workforce capacity?
We also know that the very young and elderly are at the greatest risk from RSV. The Government guidance points out:
“Only a minority of adult infections are diagnosed, as RSV is not widely recognised as a cause of respiratory infections in adults.”
It also explains:
“Elderly patients are frequently not investigated microbiologically, as there are fewer viruses present in their respiratory secretions compared with children.”
As a result, adult infections are underestimated. Older adults are at greater risk of serious complications from RSV than younger children because our immune systems weaken as we get older. This can lead to exacerbations of underlying lung and cardiac disease. Can the Minister explain what action is being taken to improve testing, reporting and treatment for older adults?
Obviously, the good news is that RSV infection causes mild respiratory illness for most people and can be reduced or prevented through the standard infection control measures that we all got so used to—and, I hope, permanently wedded to—for Covid, of respiratory hygiene, handwashing and cleaning surfaces. My noble friend stressed the importance of working with the devolved Governments on tackling RSV and increasing awareness of the threat it poses. I hope the Minister can reassure us on this, and on how learning, awareness-raising, prevention and treatment are being shared across the UK.
I understand from an article I read in Nature of 21 December last year that there is also hopeful news in the development of a vaccine for RSV after what researchers have called decades of failure. There are four vaccines in late-stage clinical trials involving stabilising the F protein that the RSV virus uses to fuse with cells and infect them. The structure of the F protein has been identified as the best target for making vaccine-induced antibodies that could prevent the virus entering human cells. I understand that these trials are initially testing older people aged over 60. Does the Minister have any further information on this? Can he tell us what research into and funding of RSV are currently taking place?
This has been a valuable debate, and it is clear that there must be action to stop the rampant spread of RSV post Covid—especially this coming winter—causing poor health, soaring costs for the NHS and particular threats to young children. I look forward to hearing the Government’s future plans for addressing this infectious but not widely known about virus.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
My Lords, I thank the noble Baroness, Lady Ritchie, for raising this subject, not only today but a number of times via an OPQ and a number of Written Questions that I have received. The work she has done to raise awareness adds to the overall awareness, but it is really important that this forces the Government to respond and raise even more awareness.
I also thank the noble Baroness, Lady Ritchie, for sharing a very personal story, and the noble Baroness, Lady Brinton, for sharing her family’s story. Sharing these stories sometimes makes you realise that this is not about just words on a page; it really is about how it affects people’s lives on a day-to-day basis, which makes it real for us in seeking to understand it.
Before I answer all the detailed questions, perhaps I should begin by laying out the Government’s current understanding of RSV. The noble Baroness, Lady Ritchie, has already laid out some of the facts. We know that RSV is a common respiratory virus that usually causes mild, cold-like symptoms. It is widespread in humans, partly due to the lack of long-term immunity after infection. We know that children of under five are the most impacted by RSV. They are at risk of paediatric critical care admission, often linked to bronchiolitis. As has been said, every winter the NHS faces pressure from the increased prevalence of seasonal respiratory viruses. This includes Covid-19 and flu, where the rollout of our immunisation programme is critical in protecting individuals and lessening the burden on the system, but it also includes RSV.
In 2021, in response to the scenarios provided by the UK Health Security Agency, there was a cross-health system response to prepare for a more severe RSV epidemic—starting as early as mid-August—due to the almost complete suppression of the virus after measures were put in place to protect the public from Covid-19. As a result of increased disease activity in September 2021, NHS England and Improvement has estimated that the total cost of paediatric hospitalisations due to RSV was 24% higher in 2021-22 compared to 2019-20. The total estimated cost of paediatric hospital care due to RSV, based on the 2022-23 national tariff, was almost £20 million—£19.9 million in 2021-22.
Typically, the RSV season runs from October to February, with a peak in December. However, one recent complication arising is that, due to measures put in place for the Covid lockdowns, in some ways we now see an unseasonal activity of RSV. The NHS released an estimated £22 million centrally to support the paediatric respiratory surge response. This is focused on a number of issues: first, increasing the resilience of the paediatric transport services and, secondly, bringing forward the annual Palivizumab immunisation programme for at-risk infants from October to July. The cohort of at-risk infants eligible for immunisations was expanded and the doses administered increased in number from five to seven, to ensure protection for the duration of the longer-than-usual RSV season. Thirdly, we also allocated additional funding for the voluntary, community and social enterprise sector. This supported families but was also about that important question of raising awareness in our local communities, as noble Lords referred to, and how to manage respiratory infections.
In addition, the system procured 4,000 specialist paediatric pulse oximeters to be distributed to GP practices to support primary care to help assess sick children. Finally, there has been a development of an online platform and digital skills passport. This has provided additional training to the paediatric and adult workforce to raise awareness, among the workforce and wider. It is important to note that the costs I have mentioned do not consider the cost of urgent care, NHS 111 or primary care presentations due to RSV. But it is clear that Covid-19 and RSV did have an impact on the system, for example the increased requirement for PPE which increased the NHS’s day-to-day running costs, making the delivery of frontline services more expensive.
Having laid that out, allow me to try to respond to some of the points made by noble Lords. One question raised was how the department will ensure that infants receive the right treatment without increasing antibiotic resistance. This is really important. One part of my job is that I do international health diplomacy for the DHSC. This is an issue—particularly AMR—that some people call the coming silent pandemic. How do we make sure we reduce our reliance on antibiotics, not only for humans but for animals and agriculture? Also, how do we make sure we do this globally? We may be able to do it in the richer, more developed countries, but there are other countries where it is the culture or they need to use antibiotics, so we need to make sure there are sufficient alternatives available.
We have committed to a vision where AMR is contained and controlled by 2040 and are halfway through delivery of our five-year national action plan. Optimal antibiotic prescribing is a key theme of this work, and we continue to take steps to better support clinicians to make appropriate prescribing choices. In relation to AMR, or to make sure we are aware of this, we are working globally with a number of countries. Also, RSV is a virus, and we should not—by my understanding—be using antibiotics on viruses.
A number of other questions included what considerations the department made on the treatment. The cross-systems exercise took place in June 2021 and I reassure noble Lords that it involved the devolved Administrations. It focused on resilience planning for the potential increased surge. After the exercise, regional NHS England teams finalised annual paediatric critical care winter surge planning to anticipate any increase in RSV cases, including for paediatric intensive care beds. NHS England and Improvement also signed off on regional plans which were submitted to the national team. This built on local exercises and included equipment requirements.
In June 2021, we saw the UK palivizumab prevention programme, with a central alerting system bulletin issued to inform NHS trusts to initiate the programme as soon as possible in line with updated policy of up to seven doses at monthly intervals, rather than the five previously. This was stood down at the end of January 2022, because palivizumab provides about a month of protection against RSV, with the aim of reducing the risk of hospitalisation.
In addition, the UK Health Security Agency and NHS England and NHS Improvement have led on public-facing communications, including press releases on RSV highlighting the likelihood of a rise in infections and encouraging parents to look out for symptoms of severe infection in at-risk children, which included advice on reducing transmission to others. That is in addition to the work we are doing with civil society and with clinicians at both primary and secondary level.
Noble Lords also asked what solutions we are looking to in future, and the noble Baroness, Lady Wheeler, mentioned a treatment that has potential. There is a key antiviral treatment under development by Enanta Pharmaceuticals, but there are also a number of developments in RSV immunisation innovation, and I shall go through a few of them.
First, there is the infant monoclonal antibody, called nirsevimab, by AstraZeneca and Sanofi, and that is progressing. GSK was looking at a maternal vaccine, but I understand that that is currently paused. Pfizer has a maternal vaccine, which is progressing, as is a Pfizer older-adult vaccine. Johnson & Johnson is also looking at an older adult vaccine, as is Moderna. Some vaccines are currently in phase 3 trials, such as those for older adults. The UK Health Security Agency and the JCVI will continue to monitor the development of those trials. The MHRA will ultimately be responsible for the approval of new vaccines, licensing and marking authorisation for new medicine in the UK.
As for our plans, there is currently an out-of-season rise in RSV cases and we have seen RSV swab positivity increasing to almost 4%, with the highest positivity in the under-fives, at 14%. A lessons learned exercise took place in February 2022 to identify and share learning to inform future responses and strengthen the resilience of paediatric services longer term. There is continued surveillance and the data continues to be monitored. Especially given the experience of the unseasonal paediatric programme, it is really important that we are aware of this all year round. Clearly, some lessons have been learned from Covid, such as the whole-system approach to support surge planning and how we rely on established relationships between and within regions, but also via local community organisations. That is, first, to ensure that all clinicians at all levels are aware of RSV and are looking out for it, as well as working with local voluntary and community organisations to raise awareness in parents, families and communities.
We have also been co-operating internationally to model data from other countries that have experienced it, in particular Australia, New Zealand and South Africa. UKHSA and others have been in contact with them to try to understand what lessons could be learned for the UK. NHS England and NHS Improvement also brought forward critical care planning.
I talked about community investments and some of the preparations. It is really important that we are aware at primary and all care levels. The children and young people’s transformation programme procured 4,000 specialist pulse oximeters from the NHS supply chain, which were used to supply primary care—I think I talked about that. In the workforce, Health Education England is working closely with specialised commissioning teams in the operational delivery network to support more awareness. I talked about the online platform. The numbers here may not mean much, but there are 437 resources uploaded, 3,400 users and 62,000 tailored resources. There is also practical guidance developed by the Royal College of Paediatrics and Child Health and NICE. They have reviewed and updated their guidelines with a focus on improving patient flow and recommendations for early safe discharge.
In addition, there is a children’s safer nurse staffing framework for in-patient care, which includes awareness and more support. I have a number of lines about non-paediatric action, but perhaps it would be better if I wrote to noble Lords after the debate summarising them and picking up any questions that I may not have answered in detail today.
In closing, I thank the noble Baroness, Lady Ritchie, for raising awareness, not only today but more generally—I know that she will, rightly, continue to hold the Government to account—and all noble Lords for their questions. I hope that, if I have not covered them, I shall do so in writing. Be reassured that the health system in England mobilised resources prepared for the surge in RSV cases and hospital admissions. This was essential to protect at-risk groups, including infants and the elderly, but also to work across the four devolved Administrations of the United Kingdom to make sure this action is UK-wide, not just in England. I am grateful to noble Lords for taking part in the debate today.
Neurological Conditions
(2 years, 5 months ago)
Grand CommitteeRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Dubs (Lab)
My Lords, I welcome the opportunity to debate this matter in order to hear the Government’s plans to improve health and care services for people with neurological conditions and to ensure that the sector’s workforce is properly staffed and adequate to meet demand.
It is estimated that one in six people have a neurological condition. Living with such a condition can be a daily battle—a battle made harder by a system that turns away people who are in need of mental health support, where people experience waits of more than year for a few minutes with a specialist and where people do not get the information they need when diagnosed. Of course, in one sense, this is an invisible condition for many people. Some people have obvious neurological conditions but some do not and, because it is invisible, they do not get the care and support they would otherwise attract.
I thank some of the people with neurological conditions who have been helpful and the organisations that represent them, including the MS Society, the Neurological Alliance, the MS Trust, Overcoming MS, MS National Therapy Centres and the Migraine Trust, which provided briefings to inform my remarks today. Of course, I also thank the client engagement team from Parliament, which carried out a survey.
I should mention in passing that, yesterday, I went to a Carers Week event in the Attlee Room in Portcullis House. A lot of caring organisations—not necessarily those connected with neurology—were there to explain what they are about. It was a very impressive occasion, particularly in terms of the voluntary carers and the work they do. It left me quite emotionally drained when I heard how they cope and how people have spent years caring without any time off.
I should declare an interest. My son has MS, a condition that affects 130,000 people in the UK. It can be painful and exhausting, and can cause problems with how people walk, move, see, think and feel. It can gets worse over time. However, it can be managed—at least partly—through timely treatment, access to rehabilitation services, lifestyle changes and specialist support.
Yesterday, the Neurological Alliance published its report, Together for the 1 in 6. Unfortunately, I was unable to be there because I was in a Select Committee but I have managed to read the report quickly. It is based on a survey of some 8,500 people affected by neurological conditions across the UK. The data found that one in five adults waited
“more than 12 months between first seeing a GP and seeing a neurologist.”
More than half of people with MS had experienced long delays; I will not go through all the statistics.
In the year to March 2022, the number of people waiting for a neurology appointment on the NHS rose from 120,000 to 180,000, according to the latest NHS waiting times data. Some 37% of people are waiting more than 18 weeks for a neurology appointment. The Migraine Trust is calling for simple pathways for those who need to be referred to a neurology or specialist migraine clinic with reduced waiting times. We are talking about a situation where there are long waiting times and difficulties in getting access to mental health support. Most of the surveys support the finding that there is a lack of support; people therefore feel that the system has failed them.
Let me turn to treatments. The Neurological Alliance survey showed that 35% of adults with MS who require drug treatments in hospital experienced delays in accessing these essential treatments in the past year, including disease-modifying therapies. DMTs are a vital form of MS care as they can slow the progression of MS for some patients. DMTs need to be started as early as possible after diagnosis, which of course means that early diagnosis is needed, and prolonged delays between doses can be harmful. Of course, there is a difference between those people who have progressive MS and those who have relapsing-remitting MS. There are more therapies available for relapsing-remitting MS than there are for progressive MS. This is also made more acute because relapsing-remitting MS sometimes converts into progressive MS.
There are very few treatment options for people with progressive MS. There is a new one called siponimod. Although this should be good news, NHS data shows that, nearly a year after its approval by NICE, just 1.5% of those eligible have been able to try it. The problem is that there are long waiting times for some new therapies. It is vital that people with neurological conditions have access to symptom management treatments and evidence-based lifestyle changes. The MS Society found that only 10% of people with MS were able to access any form of symptom management treatments.
Some people living with MS use cannabis to alleviate their symptoms. Although there is a product called Sativex, very few—I think only 17.5%—of those for whom it would be helpful have access to it. Some people say that cannabis does not help, but my view is that where a patient feels that cannabis is helpful it is by definition helpful. It is no good a doctor saying there is no evidence it is helpful; if the patient feels it is helpful then it clearly helps.
I also thank the noble Lord, Lord Blencathra, who regrets that he is not able to be here this afternoon, for sharing his experience accessing fampridine, which has been helpful for mobility. However, again, NICE has decided to no longer prescribe this drug to selected new patients.
Let me talk briefly about the workforce in neuroscience. This is what I find quite shocking. According to the Association of British Neurologists, the UK ranks 44 out of 45 European nations for the number of neurologists for each person with a neurological condition. Adjusted for the population, France and Germany have over seven neurologists for every two that the UK has. These are absolutely unacceptable figures, which mean that the caseload for neurologists in this country is much too high and they cannot give each patient the treatment they need.
Let me turn very briefly to MS specialist nurses. Neurological nurses in the more general sense, but specifically specialist MS nurses, can provide excellent help. They provide a holistic approach. I believe that if the Minister was to do an assessment he would find that having MS nurses reduces the pressure on GPs and might even reduce hospital admissions. It could be financially helpful as well as beneficial to the patients. Some studies should be carried out to see whether this hypothesis can be borne out in fact. Many people with MS do not have access to MS nurses. The MS Society’s survey found that 63% of professionals were finding it extremely, or very, challenging to provide a good service to their patients.
Most of the problems I have discussed will not be overcome without addressing the chronic workforce shortages in neuroscience, whether neurologists, MS nurses or other specialists who can provide support. I would welcome the Minister’s remarks on what the Government are doing to attract, recruit and retain the neuroscience and other allied health professionals needed to deliver holistic care on a sustainable basis. The key is holistic care; there are piecemeal approaches, but holistic care is the most efficient and effective way of providing support. I believe that specialist MS nurses are a profession who can possibly co-ordinate support in a way that can lessen the burden on others. The NHS must take forward recommendations from NHS England’s Getting It Right First Time adult neurology report and must urgently explore opportunities to free up clinicians’ time by ensuring all MS teams have a sufficient number of admin staff to carry out non-clinical duties. Again, that would reduce the burden on doctors and specialist nurses.
Regarding the way forward and positive action, I would be extremely grateful if the Minister would meet MS and neurological charities, including the MS Society and the Neurological Alliance, to discuss establishing what I would call a “neuro-taskforce” to bring together relevant departments, health and social care bodies, professional bodies, people affected by neurological conditions and the voluntary sector from all four nations of the UK. That should cover all areas of health and care, including rehabilitation, mental health, and access to treatments. I would like the Minister to see this as a challenge. It would be a good way forward. It is a way to improve the conditions of people with neurological conditions. It is long overdue, and I hope the Minister will accept this proposal.
Baroness Fraser of Craigmaddie (Con)
I thank the noble Lord, Lord Dubs, for securing this important debate. It is, unfortunately, late on a Thursday afternoon, but as he said, it coincides with the publication of the joint patient experience survey, undertaken for the first time by all four Neurological Alliances from across the UK. I declare lots of interests: I am a trustee of the Neurological Alliance of Scotland, I am chief executive of Cerebral Palsy Scotland and I chair the Scottish Government’s National Advisory Committee for Neurological Conditions.
As part of that, this debate and survey took me back to work undertaken in 2018 with the Scottish burden of disease study, which highlighted not only the invisibility of neurological conditions but, to use the not very good language of the study, the “burden” of living with a long-term, complex condition, and the burden that already places on health and care services. This population live for a long time and are already using health and care services, but are invisible. Improvements are therefore difficult to make because of that invisibility. The conclusions and recommendations of the Neurological Alliance survey illustrate how services are patchy and fragmented, but they give us a barometer for where to concentrate action. I have three areas for action that I would like to highlight.
First, we have to better understand prevalence. Data on numbers of all neurological conditions remains woeful. The data we do have is mostly estimates. We seriously underestimate prevalence due to the inaccurate and inconsistent way that neurological conditions are recorded across all healthcare settings. We have to look at the system of coding: how do we make it simpler?
At Cerebral Palsy Scotland, we have campaigned for the development of a national cerebral palsy register, building on existing work from Queen’s University Belfast, supported by the Northern Ireland Government, and work undertaken by the Welsh Government. Working on the principle that if you are not counted you do not count, part of ensuring better services is to prioritise reliable data in order to plan not only for future services but for future workforce needs.
Secondly, we have to deliver seamless care between the different parts of the system and to take a more holistic view of the workforce. It is important to look beyond neurologists. People with neurological conditions come into the NHS through numerous routes. That is part of the problem. The role of the consultant neurologist is to exclude conditions and to provide a diagnosis. It is important that this should be achieved as quickly and as efficiently as possible. However, since people with neurological conditions can live for many years post a diagnosis, the important question is: who will deliver their care? It will not be the neurologist.
As the noble Lord, Lord Dubs, outlined, clinical nurse specialists are key to managing care for some conditions, MS being one of them, but sadly too many other conditions do not have clinical nurse specialists and are therefore left out. We need to be more imaginative about roles and responsibilities in multidisciplinary teams and in planning for future workforce needs, and perhaps to work more collaboratively with other areas, such as MSK and stroke services.
The majority of health and care services required by this population are provided by primary and community care services and by AHPs. People with cerebral palsy, for example, rely on regular access to physiotherapy to prevent further deterioration and to stay well, but access to neuro physios and other rehabilitation services is completely inadequate and comes nowhere near the standards and guidelines set by NICE for adults with CP. It is the same for many other neurological conditions.
The Question refers to services covering the whole of health and care. As the noble Lord, Lord Dubs, also mentioned, this is Carers Week. Carers are an integral part of this workforce too. But I believe that anybody—health, care or social workers—who has any input into delivering care for someone with a varied and complex condition must have access to information and training about that condition. Far too often, it is left to the third sector to pick it up in a piecemeal and underfunded way that cannot hope to reach all those in need.
Thirdly, support for mental health needs to be provided at diagnosis. It has to be an integral part of condition management for children and adults. Too many people, children in particular, report that their mental health needs are not being met at all. If raised with professionals, their concerns are dismissed as being just a part of their condition that they have to live with. There are, in theory, a range of mental health services that can be accessed by people with neurological conditions but, again, there are huge variations in equity of access, both geographically but also for the different conditions.
To address the issues highlighted in the Neurological Alliance’s survey, we require leadership and vision. Will the Minister therefore commit not only to taking up the challenge of the noble Lord, Lord Dubs, but to developing an overall strategy to support people with neurological conditions? In Scotland, we already have the framework for action for neurological care and support, which I was involved in creating. The ambition must be that health and care services support people with neurological conditions to live well on their own terms, with access to the right person at the right time and in the right place. This is essential. I look forward to supporting the Government in achieving this ambition.
Lord Monks (Lab)
My Lords, I thank the noble Lord, Lord Dubs, not just for initiating this debate but for his work over many years in championing the fight that needs to go on all the time against MS and related neurological problems. I also thank the MS Society, which produced some very useful briefing material for this debate.
There is no need today to labour the destructive nature of these diseases, MS in particular. Like others in this debate, I come from the front line in the battle against MS. My son, for whom my wife and I care, is in the National Hospital for Neurology and Neurosurgery today, with complications to his advanced secondary progressive MS. He and we have had 20 years of it—20 years of overworked consultants and stressed MS nurses, and 20 years of feeling like poor relations to more fashionable illnesses.
The basic problem, in our view, is the shortage of skilled staff. I must say that, despite the shortages that exist, we have had excellent treatment at King’s College Hospital under the care of Dr Silber. But the pressures are obvious. As soon as you enter the clinic’s waiting room, large numbers of patients are milling around awaiting a consultation. Sometimes it resembles a railway station in the rush hour; the atmosphere is like that, rather than the calm and friendly system that you like to see when you go into a hospital.
How come, as the noble Lord, Lord Dubs, said, the UK ranks as 44th out of 45—I did not even know there were 45 European nations but apparently there are—in the number of neurologists if it is adjusted on a per capita basis? Do the Minister and the Government recognise these figures, which are so bad in comparison with France and Germany, which were mentioned earlier?
The Government often boast that the UK is a world leader in this and that. Occasionally, they might even be right. On MS, however, we are shameful laggards and I wonder whether the Minister would accept what I am saying with that particular charge? Is MS treatment not a prime candidate for the levelling-up agenda? I mean levelling up internationally, of course, against the best in class in Europe, rather than being right at the bottom of the league, but also levelling up nationally among the four nations. We have sharp regional imbalances; some parts of the country are better off than others at tackling MS by providing access to disease-modifying drugs and treatments.
Thankfully, there are exciting new drugs emerging to combat secondary progressive MS but, as has been said, their rollout is slow and they are subject to a postcode lottery. The MS Society’s survey found Northern Ireland to have the best access, while Wales and some of the English regions have the worst. The society is also worried about the establishment of integrated care systems and that these might widen the differences in MS treatment in particular, as different priorities are chosen within different systems. I wonder whether the Government share these worries. If so, how can we guard against even more inequality developing as far as the treatment of MS is concerned?
I ask the Minister: is it not time to launch a major levelling-up exercise for the neurological illnesses, with our place in that European league table firmly in our minds? Next, what can be done to address the urgent shortages in the workforce of people with neurological skills who can work together and provide the kind of holistic treatment that others have referred to? Finally, I agree very much with my noble friend Lord Dubs, and with what has just been said, about the need for a neuro task force that brings together all the relevant bodies in all four nations of the UK to address the challenges that we face on the MS front. What is the Government’s view on this proposal?
Baroness Thomas of Winchester (LD) [V]
My Lords, I too thank the noble Lord, Lord Dubs, for securing this debate, and the Neurological Alliance for undertaking such a large patient survey of people living with a neurological condition in the UK. Its findings include the views of people like me who are living with a muscle-wasting or neuromuscular condition, in my case Pompe Disease.
Muscular Dystrophy UK recently published Shining a Light, a report which demonstrated that people living with muscle-wasting conditions have struggled to access critical services such as specialist muscle clinical appointments, specialist respiratory care and specialist neuromuscular physiotherapy, especially because of the pandemic and shielding. This lack of provision has had a negative impact on their overall physical and mental well-being.
As a result, an ever-increasing backlog of patients is waiting for appointments and, in many cases, the delay in access to specialist services has resulted in a more acute progression of a person’s condition. This has, in turn, led to the need for additional treatments and longer stays in hospital, thus putting even more pressure on an already strained service. This is evident as Muscular Dystrophy UK’s findings indicated that delayed access to muscle clinics, physiotherapy and hydrotherapy would result in irreversible muscle weakness and muscle loss.
All people living with muscle-wasting conditions should be able to access fully equipped multidisciplinary teams, diagnostics and clinical services when they need them, no matter where they live in the UK. Staffing is a crucial aspect of improving neuromuscular care, and I support the need for the Government to develop a strategy to attract, recruit and retain the neuroscience workforce, specifically the front-line specialist nurses and other clinicians needed to deliver holistic care on a sustainable basis. I believe, as others have said, that establishing a neuro task force will go some way to solving this increasingly complex problem affecting this patient community.
Baroness Murphy (CB)
My Lords, I am so pleased that the noble Lord, Lord Dubs, raised this issue. One is always humbled in speaking in a debate where so many participants either can bear witness to the personal impact of a life-changing disorder or have been close enough to have supported people throughout.
I share with the noble Baroness, Lady Fraser, the notion that we want not only neurologists. She referred to what I call the “hit-and-run brigade”: you go, you see them, you are diagnosed and you are off. That is it; you might get a follow-up appointment if you are lucky. I know because I have been there: I have been one of those people. I know how difficult and frustrating it is to provide a service. I trained for two years at what was then called the National Hospital for Nervous Diseases in Queen Square and its outpost, a delightful hospital at Maida Vale. It was one of the most fulfilling expenses of my life. It was very lovely. They used to bring us junior doctors a little silver teapot every afternoon for afternoon tea. Those were the days, when the NHS was a little different if you were at a posh hospital, which that was. In the end, I retreated to my first love, psychiatry, but I have obviously seen a lot of neurological conditions since then.
The problem is that we are down to one neurologist per 170,000. France has one per 50,000. Italy has one per 5,000 head of population. They are very well-trained neurologists, who are almost all dually trained in psychiatry. That makes a phenomenal difference to access and to the importance of the specialty in the general bargaining power.
Some very welcome changes have happened. National clinical directors are to be appointed in neurology, neurosurgery and spinal surgery. They will be crucial, because the commissioning of these neuroscience services will be devolved rather than done centrally. Those appointments will be utterly crucial for making an impact. Noble Lords might ask what difference they will make, but I remind them about getting the right person in the right place. When I was at Queen Square, stroke disease was not a neurological condition, even though it is the commonest neurological condition there is. It took a neurologist, Charles Warlow, in Edinburgh and his colleagues saying, “No, important physicians and neurologists should be interested in this as a core business.” In part, we need that focus again around these very disabling, chronic disorders.
I have a special interest in one range of disorders: that spectrum that goes from Parkinson’s disease through Lewy body dementia through Alzheimer’s disease. They are similar, but if you treat one with the wrong medication you get adverse reactions. They are highly disturbing and very disabling conditions. It is a very sad way to end your life with any of these conditions when they become very serious. Because we do not have access to neurology or specialist neuropsychiatrists, we have a situation where access to diagnosis and to the right kind of support and care just does not happen. People fight for months to try to get a diagnosis; it goes on for years. People get one diagnosis after another, and shoved from pillar to post. Sometimes it is only five to 10 years later that people actually get the right diagnosis.
It is crucial that we get some kind of agreement about who should care for these people and how we should get them channelled. The number is increasing as the population ages; naturally, the prevalence is rising in the older population. I give major support to the notion that we should have a neurological task force to look at the increasing demands of these serious and disabling disorders.
Baroness Brinton (LD) [V]
My Lords, I, too, thank the noble Lord, Lord Dubs, for securing this important debate. I also thank the Neurological Alliance, the Chartered Society of Physiotherapy, the Royal College of Occupational Therapists, Parkinson’s UK, the MS Society and Merck for their helpful briefings. I declare my interest as a vice-president of the Local Government Association.
The noble Lord, Lord Monks, spoke movingly of his son’s personal experience: that, despite the excellent treatment, the service feels in constant crisis, not least because of staff shortages—not just clinicians. As the noble Baroness, Lady Fraser, outlined, the Neurological Alliance surveyed more than 8,500 people with neurological conditions, including Parkinson’s, about their experiences. It found a shortage of neurology specialists, as outlined by other noble Lords. It is shocking that the UK was ranked 44 out of 45 European countries for the number of neurologists. The Royal College of Physicians found that 48% of consultant geriatricians in England are set to retire within the next 10 years.
Mental health services, which we have debated quite a lot in your Lordships’ House recently, are an absolutely integral aspect of care for people with neurological conditions, but a Written Answer to a Parliamentary Question two years ago revealed that the Government were on course to miss the recruitment target for expanding the mental health workforce by 50%. I do not think the last two years have helped that.
Delays to treatment and care can change your life for ever. More than half of adults, children and young people living with a neurological condition experienced delays to routine appointments with specialists last year. The Neurological Alliance is calling on the UK Governments to establish a neurology task force to get to the bottom of these problems and create real change.
Along with the noble Baroness, Lady Murphy, I am particularly interested in wider healthcare support, including rehabilitation, and was delighted to receive the briefings from physiotherapists and occupational therapists because, with my own long-term condition, I am very reliant on their expertise. The Royal College of Occupational Therapists surveyed staff working in rehab multidisciplinary teams, including physios, speech and language therapists, nurse specialists, dieticians and many more. Its survey found that 82% had seen an increase in demand for rehab support in the past six months. It is vital to those with chronic and deteriorating long-term conditions to have access to rehabilitation, so the ability for patients to access rehab is a lifeline, frankly. If it is not there, deterioration can speed up.
This is an area that cannot continue to work in constant crisis. One of the main problems in the short staffing in the MDTs is the load on clinicians. This is not just the allied healthcare professionals but those invisible administrators, who have a key role in smoothing access to the full range of services for patients. That is why the alliance is seeking a fully funded national two-year rehab strategy to ensure that people who have seen significant deterioration in their condition have the therapeutic support they need.
Too often, one key part of public services is involved too late. It is one that society—particularly the health sector, I am afraid—just does not plan for. I am referring to housing. Research over many years by Habinteg, a housing association that campaigns for the raising of accessibility standards in new homes, shows that for a small amount extra to pay at the time of a new build or major renovation, adaptations for patients with mobility problems can be overcome cheaply and easily. One thing that many patients with neurological conditions say is that the adaptions to their home are difficult and expensive.
Finally, one expert is too often overlooked. The expert patient programme is for people with long-term conditions, where patients take a six-week course and are trained and supported, often by tutors who have a long-term condition themselves. The course aims to give patients the confidence to self-manage their health and be active participants in the care of their condition. The course looks at general topics, including healthy eating, dealing with pain, relaxation techniques and coping with negative feelings, along with very specific advice on their condition. I know of it from the rheumatology sector, but I know friends who are expert patients in the MS community. Multidisciplinary teams welcome their expert patients. A patient’s understanding of when to seek help means more timely interventions and, often, improved outcomes. It is not just beneficial for the patients, it is cost-effective.
Is there specific support to spread the expert patient programmes to more neurological conditions? Will the Minister respond to the Neurological Alliance’s recommendation of a neurology task force? When do the Government plan to publish a workforce strategy for the neurology workforce? As we discussed a lot in debate on the then Health and Care Bill, this is one element of wider workforce planning that really needs to happen now and be visible. Therefore, how will the Government ensure that any such strategy delivers a sufficient number of health professionals to fill the gaps in staffing for neurological conditions?
Baroness Wheeler (Lab)
I am very pleased that my noble friend Lord Dubs secured this important debate and grateful for his excellent speech. We know that he values every opportunity to underline the urgent need to improve services in social care for all people with neurological conditions. We have often spoken about MS, the impact the disease is having on his son and the experience of his whole family in caring for and supporting him. We also heard from my noble friend Lord Monks of his experience of the care of his son. He also spoke very movingly today.
One in three people with MS does not get the social care or rehabilitation they need to cope with the disease and be able to lead as independent a life as possible. The experience of both my noble friends over many years, sadly, reflects that. The noble Baroness, Lady Thomas, also made a compelling plea for muscle-wasting and other neurological conditions to be better and more effectively managed through timely treatment and access to rehabilitation services and specialist support, with regular access to specialist teams.
I also pay tribute to the work of the 80 charities within the Neurological Alliance. I hope yesterday’s Westminster Hall launch of its excellent survey—which I was, sadly, unable to attend—went well and received the attention and support it deserves. Noble Lords’ contributions have drawn heavily on the survey results in respect of a range of neurological conditions, including MS, dementia, migraine and Parkinson’s. My noble friend Lady Gale is always a great advocate of the work of Parkinson’s UK, but was, sadly, unable to be here today.
My special focus is on stroke, as a carer for a disabled adult stroke recoverer. Stroke strikes every five minutes in the UK and 100,000 people have strokes each year. It is a leading cause of death and adult disability in the UK, with more than two-thirds of people who have had a stroke leaving hospital with a disability. To underline the neuro survey key data highlighted by noble Lords, the one in six people in the UK who have a neurological condition have the lowest health-related quality of life of any long-term condition. One in five adults waited more than 12 months between seeing a GP and then a neurologist, and 55% experienced referral delays in routine neurologist appointments—all of which needs to change, as we have heard. The Chartered Society of Physiotherapy estimates that only 40% of people receive essential neurorehabilitation.
Workforce shortages are the biggest reason behind delays, and I look forward to the Minister explaining the Government’s specific plans to address the chronic neurological staff shortages across all key conditions. How do they account for the UK having only two neurologists for each seven that France and Germany have, and how is this situation being addressed? Does this not reinforce the urgent need for the long-term workforce plan to tackle these and other acute staff shortages, as we have been calling for? In Parliament yesterday, almost as an aside, the Secretary of State referred to work being undertaken “on a 15-year strategy”. That is the first time we have heard mention of any timeframe, so perhaps the Minister could tell us more about who is leading the strategy’s development and when it is expected to be published.
Specifically on MS, last year, NHS England’s Getting it Right First Time adult neurology report recommended that all MS teams have enough administrative staff to carry out non-clinical duties and free up clinicians’ time to treat patients. Can the Minister update the Committee on what progress has been made?
The Government’s acceptance of the alliance’s call for a UK-wide neurological task force of key stakeholders from Governments, departments, professional bodies and the voluntary sector must be a key factor in identifying how treatment, rehabilitation and social care support can be provided and improved, running alongside the strategy, resources, front-line specialist workforce and other clinicians that are vitally needed where shortages are most acute. I hope that the Minister will recognise this as a key way forward.
I have a few further points. The My Neuro Survey rightly makes much of the impact on unpaid carers and families of the lack of support available for the people they care for; a number of speakers mentioned this. In this national Carers Week, it is important that carers feature strongly in today’s debate. According to the Alzheimer’s Society, unpaid carers supporting someone with dementia save the economy £11 billion every year. On Tuesday, the Minister promised that the Government want to help carers to make sure that they are looked after while they provide a service for their loved ones. Can he say what specific immediate steps are being taken to do this?
Specifically on social care, NHS data shows that only 14% of the total social care budget is spent on people living with neurological conditions. Living well with neurological disease means getting the right home support and equipment, regular occupational and physio therapy, and eating, washing, dressing and other essential social care help. But as the latest social care directors’ ADASS survey showed, more than 500,000 people in England are waiting for a social care assessment, for care to begin or for a review of their care. Can the Minister explain how this immediate situation is to be addressed, given that the existing resources pledged for social care at best just shore up existing wholly inadequate services?
Finally, what research is being undertaken by the Government into the impact of long Covid on neurological conditions, following the two studies by Mater Hospital in Dublin that found “significant evidence” of it leading to new neurological conditions? Have the Government any further information on or assessment of this? How is this troubling link being monitored? I look forward to the Minister’s response on all these issues.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
My Lords, I thank all noble Lords who took part in this debate, especially the noble Lord, Lord Dubs, for raising this issue. I also thank him and the noble Lord, Lord Monks, for sharing their personal experiences. As the noble Baroness, Lady Wheeler, rightly said, hearing people’s personal experiences, rather than simply reading words on a page, really does bring it home. I also thank the noble Baroness, Lady Murphy, for sharing her experience from the other side, as it were; that was a very valuable contribution for us all.
I should start by talking about the overall plan. I will then focus on some of the conditions discussed today. We have to acknowledge that the pandemic affected health and care services, which is why we must have a recovery service. The priority of that recovery is to address the pressures caused by the pandemic. Noble Lords will be aware of the Delivery Plan for Tackling the COVID-19 Backlog of Elective Care, published in February 2022, which sets out a long-term plan to look at bringing that down. It also looks at creating extra capacity, including through partnerships with the independent sector and in the NHS, to undertake more complex work, such as neurosurgery, with improvements for the most clinically urgent patients.
To support the ambitions in the delivery plan, the department has committed more than £8 billion over the next three years, from 2022 to 2025. This investment is in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund already made available to the health and care system to push the recovery forward.
We know that there can be significant variation in the services provided for people with neurological conditions. I can confirm that NHS England is currently recruiting for a national clinical director for neurology to tackle this variation and provide national leadership and specialist clinical advice. This will complement existing work to improve neurology services—particularly the work of the neuroscience transformation programme, which will support services to deliver the right service at the right time for neurology patients closer to home. The noble Baroness, Lady Brinton, and others made this point.
NHS England also continues to work closely with the National Neurosciences Advisory Group to ensure continued service improvement and support neurosurgery networks with transformation and implementing changes that could have the highest impact. The National Neurosciences Advisory Group has developed a series of best practice optimal pathways for neurosurgery and neurology. They are being used to inform the proposed changes to the neurology service model, which will in turn be used to revise the service specification for neurology. This work is anticipated to be completed during this financial year.
We also know we cannot increase health service capacity and access to treatment without expanding our workforce capacity. As was made clear in many debates during the passage of the Health and Care Act, the Government commissioned Health Education England to come up with a strategy. The Act mandates the Government to publish a workforce strategy and plan every five years, on not only a national level but a bottom-up local level. We want to avoid Soviet Union-style planning which does not understand local communities, local trusts and areas. Bottom-up planning will happen at primary and secondary care level, trust level and ICS level. I will make some more comments about that.
We have made some progress so far with nearly 29,000 more hospital and community health service staff in March 2022 compared to the previous year, which includes nearly 11,000 more nurses and 4,300 more doctors. Working with the NHS, we will continue to identify and address these gaps across key types of staff. To support long-term planning, as I said, we have commissioned Health Education England.
On the social care workforce specifically, we know that many people living with neurological conditions rely on support from care workers. We recognise the challenges the sector faces in recruiting and retaining staff. Noble Lords will be aware that we launched the national register. It was voluntary at first, as some concerns were raised in the initial consultation about people not wanting to register. We want to build that confidence so we can understand the existing landscape and the myriad qualifications. How can we ensure we rationalise it so that it is a more professional service which people will feel attracted to, and what issues will we have to address so that we recruit more? To support local authorities and providers to address workforce pressures, there is the health and care visa and shortage occupation list, alongside work with DWP. We hope to boost recruitment in these areas.
Let me go into some more specific issues. It might be handy for me to discuss how the NHS generally, and the department, look at neurological conditions. When I was being briefed on this, I asked if I could be sent a list of all the neurological conditions. I now realise that was a naive question; apparently there are over 600 types. That shows that awareness is one of the big issues and barriers. If you want change, you have to realise what the issue is. If you think of how we as a society have developed, things that we now consider neurological conditions are things where, in the old days, people were told to pull themselves together. There were quite offensive names for some conditions that people had. We are now far more aware of them, which is really important. They can be broadly categorised into sudden onset conditions, intermittent and unpredictable conditions, progressive conditions and stable neurological conditions.
The noble Lord, Lord Dubs, and the noble Baroness, Lady Wheeler, rightly raised the issue of unpaid carers. During the debate there was consensus on the work that unpaid carers do, often with little reward, and what support should be available. As a result of the pressure rightfully put by noble Lords on the Government, the department and NHS have been interacting with Carers UK. I also put on record our thanks to the noble Baroness, Lady Pitkeathley, for all her work in this area and for pushing the Government to make sure that we first understand what support is needed. Sometimes it can be as simple as respite; at other times, far more support is needed. It is also about awareness and training, and we have the reform funding programme. We want to make sure that we not only recruit more motivated carers, giving them a proper career path, but do not forget the unpaid carers—recognising who is an unpaid carer and what support can be available, working from national government level and at local level.
The noble Lord, Lord Dubs, and my noble friend Lady Fraser also raised the issue of mental health. In addition to managing neurological conditions, we recognise that patients quite often do not get enough mental health support. We are committed to expanding mental health services. We also have the long-term physical health pathway. We are integrating improving access to psychological therapies—IAPT services—and have launched a public call for evidence in developing a new cross-government 10-year plan for mental health. I hope I can encourage all noble Lords to highlight that.
The noble Lords, Lord Dubs and Lord Monks, rightly raised the issue of multiple sclerosis and spoke about their own experiences of it. NICE has updated its guidance on management, diagnosis, treatment, care and support of people with MS. Following diagnosis, and with a management strategy in place, we aim for most people with MS to be cared for through routine access to primary and secondary care. NHS England has commissioned the specialised elements of MS care through the 25 specialised neurological treatment centres across England. The various parts of the NHS systems have also started to implement the guidance set out in the progressive neurological conditions RightCare toolkit, which includes a specific section on MS and was developed in collaboration with key stakeholders, such as the MS Trust and the MS Society. The RightCare toolkit provides the opportunity to assess and benchmark current systems to find out how we can improve. But it also has to be a continuous learning system, not just one set of guidelines that are followed for ages until someone tells you they are out of date.
Another important aspect of this is the research, as my noble friend Lady Fraser rightly raised. The Department of Health and Social Care funds research into neurological conditions through the National Institute for Health and Care Research. In 2019-20 the NIHR spent about £54 million on research through the Medical Research Council and is open to more bids, but it does not assign for particular conditions. Quite often, why NIHR does not assign a pot for certain conditions comes up in debates. It is open to research bids in all areas, including neurological conditions and so far it has given £54 million, but it welcomes more applications. Other areas are really important as well, such as motor neurone disease and others. That is why we urge the research community to come forward.
We also want to make sure that there is more awareness throughout the workforce, as noble Lords rightly said. As a speciality, neurology is popular and generally sees a 100% fill rate for training places. There has been an expansion in neurology posts across England and postgraduate trainees will start in August 2022. The National School of Healthcare Science is recruiting more trainee scientists to its three-year, work-based training programme, which leads to a master’s degree in neurosensory sciences. But the point is taken that it is not only these specialists we need; we also need to make sure that staff across the system are aware of these conditions and how we deal with them.
The noble Lord, Lord Dubs, raised the issue of cannabis. In November 2018 the UK Government legalised cannabis for medical use but imposed strict criteria. Specialist doctors are allowed to prescribe medicinal cannabis but there are still concerns about this not being enough people. I take the point that the noble Lord, Lord Dubs, made: if the patients feel that it benefits them, then it benefits them. That is important. I can offer to write to the noble Lord, Lord Dubs, or to have a further discussion.
We have seen increases in the number of full-time doctors working in this specialty, in neurology, including consultants, but as I have said, it is important that they are not just specialists.
Turning to strategies, there are two at the moment, one for dementia and the other for acquired brain injury. Once again, I am open to suggestions and happy to listen if people want to raise issues about this.
I should just touch on the neurosciences transformation programme. The NSTP itself came up with a new definition for specialised neurology and a model for new neurology services. The clinical pathways and the optimal pathways have been developed and indicators are being designed in partnership with stakeholders to support services delivering the right service at the right time for all neurology patients and, critically, closer to home or in the home. What we hope to see is that this approach will be built in as part of the integrated pathways, through the ICSs being set up.
On some questions that I am unable to give specific answers to—for example, on housing and a number of other issues—I offer to write to noble Lords. I think the noble Lord, Lord Dubs, asked whether I am prepared to have a meeting. Usually I say yes—I am sure noble Lords recognise that I met frequently during the passage of the Health and Care Act—but I just want to make sure I am the relevant Minister. If the relevant Minister is not available, I am very happy to meet, or to meet with the relevant Minister. I would really like to learn more and, either on my own or in partnership with the relevant Minister, to meet with the noble Lord, Lord Dubs—
Lord Kamall (Con)
The task force, yes—I thank the noble Lord for the prompt.
That is all I will say for now. I apologise if I have not covered all the questions; I will endeavour to write. I will diligently read Hansard and offer to write to noble Lords on those questions I have not answered. I thank the noble Lord, Lord Dubs, for raising this issue and all noble Lords for taking part in the debate and for their questions. It means I have to go back to the department and not only learn more myself but make sure we have some meaningful answers to the questions that noble Lords asked.