Westminster Hall

Wednesday 30th October 2024 Westminster Hall

Wednesday 30 October 2024

[Derek Twigg in the Chair]

Children’s Hospices: Funding

Wednesday 30th October 2024 Westminster Hall

09:30

[Ian Byrne (Liverpool West Derby) (Ind)]

I beg to move,

That this House has considered funding for children’s hospices.

It is a pleasure, as always, to serve under your chairship, Mr Twigg.

“To me and my family, Zoe’s Place represents one word… family…They gave my confidence to give my angel 10 years of a fantastic life and provided the most outstanding care when she passed away last year.”

Those are the words of Abbi, mother of Evie-Kate, who relied on Zoe’s Place, a children’s hospice in my constituency. Abbi said:

“Without Zoe’s Place and the support, friends, families and being able to go visit my baby girl’s plaque on her final day…I would be a broken woman.”

Another parent, Jennifer, mother of Theo, said Zoe’s Place means that

“Theo gets the love and care that he has at home, they have been amazing, I can’t put into words how much we will miss the girls…The pure joy in Theo’s face as we pull up and see the Teddy bear. So yes, to us Zoe’s Place is our family…Zoe’s Place has been a massive support and a lifeline, without Zoe’s Place we wouldn’t have got Theo home from Alder Hey after being there for 12 months.”

Those parents are far from alone in finding Zoe’s Place to be an absolute lifeline. If I had more time, I would love to tell hon. Members about countless other families and children supported by Zoe’s Place. But I applied for this debate because earlier this month, we received the shocking news that Zoe’s Place was going to close. Jennifer spoke of her “devastation” on hearing the news, and Abbi said:

“Please don’t take this amazing place away.”

Zoe’s Place opened in my constituency in 1995 and has supported thousands of children and their family members over the years, providing respite and palliative and end of life care for babies and children up to the age of five. It is one of two wonderful children’s hospices that my constituency is home to and which I am so proud of. The other is Claire House, another place of love and warmth, with the most wonderful staff, who do so much good when families are facing such heartbreak. I see that at first hand when I volunteer at that wonderful place, and I find speaking to the families so enlightening. The absolutely life-changing service offered and given by those places is why we could not accept the news, when it was announced three weeks ago, that spiralling costs meant there was not enough money to build a planned new home for Zoe’s Place.

[Matthew Patrick (Wirral West) (Lab)]

I congratulate the hon. Member on securing a debate on such an important issue. He mentions Claire House, which also has a site in my constituency. Claire House is an essential part of our health and social care system, and on my visit there, I could see the clear passion and pride that people have in that service and the important work it does for my constituents. With integrated care board funding for children’s hospices varying so significantly across England, does he agree that more must be done to ensure that every seriously ill child and their family, regardless of where they live, have equitable access to palliative care?

[Ian Byrne]

I thank the hon. Member for that wonderful intervention; I wholeheartedly agree about what Claire House does and with his asks.

Three weeks ago, it was announced that spiralling costs meant that there was not enough money to build a planned new home for Zoe’s Place and that the baby hospice would close for good at the end of the year. It was therefore with real trepidation that we met the trustees on the Thursday after the announcement. We entered Zoe’s Place with the staff—many had been there for decades—feeling devastated after being issued with the consultation period ahead of the planned closure. At the meeting, we were desperate to find a future for Zoe’s Place. The trustees and the staff present outlined what we needed to do: raise £5 million in 30 days and then Zoe’s Place could have a future.

[Kim Johnson (Liverpool Riverside) (Lab)]

I thank my good friend for giving way and I congratulate him on securing this important debate. Will he join me in congratulating the wonderful community of Liverpool on its amazing work to secure nearly £5 million for Zoe’s Place? However, does he agree that instead of relying on charitable trusts to support these important hospices, we need to think about how we put them on a statutory footing to provide better end of life care for everybody?

[Ian Byrne]

I thank my hon. Friend for her excellent intervention; I wholeheartedly agree.

We had to raise £5 million in 30 days to give Zoe’s Place a future, so I asked the trustees to let us give it a shot, harnessing the spirit of the city, which has been galvanised since people heard the news, and the love for this wonderful institution. We put the call out in Liverpool, and I have never seen a response like it in my life. It has been my great city at its very best, for the world to see. We have had kids going door-knocking with fundraising buckets, raising money because one of their friends is being supported by the hospice; parents who turned to Zoe’s Place in times of need organising fundraising walks and sponsored motorbike rides; and support from MPs, such as my right hon. Friend the Member for Hayes and Harlington (John McDonnell) promising to carry on playing his unique take on “You’ll Never Walk Alone” on his trombone if we did not raise the funds—the city has spoken, John, and I’m saying no more. Cafés have pledged their takings to the campaign, running raffles to raise money, and local businesses have got involved, donating tens of thousands of pounds, and their time and expertise, which will never be forgotten.

[Richard Burgon (Leeds East) (Ind)]

Will my hon. Friend accept from me the congratulations of the people of Leeds, who value Martin House Children’s Hospice in Wetherby so highly? Many people in Leeds will look to Liverpool with great admiration at the incredible fundraising efforts, which have impressed and inspired so many. They have also led people to conclude that we cannot allow places such as Zoe’s Place to go to the wall, and that guaranteed full funding for palliative care and children’s hospices is a must.

[Ian Byrne]

I thank my hon. Friend for that excellent intervention, with which I wholeheartedly agree. Former football stars from Liverpool joined the efforts, donating more than £150,000. The local paper, the Liverpool Echo, and its staff led by Liam Thorp, have thrown their weight behind the campaign, doing everything they could to save the hospice. On Monday, we had the incredible news that Liverpool-based company Home Bargains was pledging £2.5 million to the campaign, bringing us within touching distance of the total.

The tireless and wonderful work of so many has been invaluable over the past few weeks. There are so many to thank, if I had the time, but I must pay tribute to the wonderful comic, Adam Rowe and fellow funnyman, Willie Miller, who have done so much to raise this issue both publicly and behind the scenes, and John Gibbons from “The Anfield Wrap” for his tireless efforts over the past few weeks.

There are still 10 days to go, and we are not over the line yet, but we are proving that if any city can do it, Liverpool can. The community, the solidarity, the togetherness—I have never been prouder to be a Scouser. Today, the plans for the future are coming together. Last week, we announced what the new Zoe’s Place Liverpool would be like, operated and run in Liverpool, putting it on a footing to care for kids from across Liverpool and beyond for generations to come. I am really optimistic that we will do it.

But the truth is this: talk to the families who rely on Zoe’s Place and Claire House, see the support that those hospices give to seriously ill children, babies and families, and you will know that that support is not a luxury—it is essential in a modern, functioning society. They provide a vital service that should not require charity to keep it going. Everyone who needs it should have access to high-quality palliative and end of life care, but that is not happening at the moment. Not just Zoe’s Place, but children’s hospices across the country are in crisis, with many more fearing for their future.

That is why today’s debate is important to families up and down Britain. Despite children’s hospices providing an essential service, they are overwhelmingly funded by charity. Less than a third of their income—around 30% —is public money, with the remaining 70% coming from charitable donations. That is a broken model. Let me be clear that I have the utmost respect for people who give up their time and money to support our hospices, but as one constituent said to me recently:

“We shouldn’t have to sell charity cupcakes to make sure kids are cared for”.

But that is what is happening at the moment.

The public funding element of children’s hospices is both inadequate and messy. Most of it comes from the children’s hospice grant. Introduced by the previous Labour Government, it was designed to provide direct funding to children’s hospices. Today, it stands as a £25 million grant, but it has an uncertain future. It was renewed by the previous Government for 2024-25, but the new Government have not yet said whether the funding will continue. According to the charity Together for Short Lives, if the grant is not renewed, there will be a profoundly negative impact on lifeline care and support. Eighty-two per cent of children’s hospices told the charity that they would have to cut or stop providing respite care or short breaks; 70% said they would have to cut or stop providing emotional and psychological support; and 45% said they would have to cut end of life care.

Will the Government commit to maintaining the £25 million children’s hospice grant as a ringfenced fund in 2025-26 and for the long term? Will they commit to making it centrally distributed once again? Many care homes have said to me that they are opposed to the integrated care board model that NHS England is using, as it has led to delays in children’s hospices receiving money.

The next biggest pot of public money for children’s hospices comes from integrated care boards, which have a legal duty to commission palliative care, but the funding is patchy and falling. Research shows that the funding per child with a life-limiting or life-threatening condition varies wildly across the country. It is just £30 per child in Northamptonshire but £397 in Bristol, north Somerset and south Gloucestershire. In my area, Cheshire and Merseyside, it is slightly above average at £206, but there should be no postcode lottery in funding care for kids. And the funding is falling—last financial year, children’s hospices on average received almost 10% less funding than the year before, and almost a third less than the year before that. What are the Government doing to make sure that every seriously ill child and their family, regardless of where they live, have fair and equal access to palliative care?

Local authorities have a duty

“to provide services designed to assist”

family carers of

“disabled children to continue to”

provide care

“or to do so more effectively, by giving them breaks from caring.”

Local authorities, which are under immense pressure, account for just a small fraction of children’s hospice public funding—about 2.5% of the total. The funding fell by 26% from last year to this year, and more than half of children’s hospices received no funding at all from their local authorities. What conversations is the Minister having with colleagues in the Ministry of Housing, Communities and Local Government to ensure that local authorities meet their legal duty to provide short breaks for disabled children who have life-limiting or life-threatening conditions?

The funding streams are insufficient for children’s hospices at the best of times, but we really are at crisis point. That is why we are all here today. With public funding falling, charitable donations squeezed as the cost of living crisis bites—the cost of living crisis, again, is affecting us all— and increased energy prices, children’s hospices have seen their income fall. That is having grave consequences. More than half of children’s hospices in England ended the last financial year with a net deficit, and it gets worse: next year, more than two thirds of children’s hospices forecast a deficit. Unless more public money is found, more and more children’s hospices will have to cut back, more services will be reduced, more kids will miss out, more families will have nowhere to turn and more children’s hospices will be put at risk, just like Zoe’s Place in Liverpool. Extra funding is needed just to stay still, let alone to build the world-class care system that our constituents deserve.

According to research from Together for Short Lives, the NHS needs almost £300 million extra to meet the standards for children’s palliative care set by the National Institute for Health and Care Excellence. That is the inheritance of 14 years of Conservative chaos, with deeply damaging NHS reforms and chronic underfunding of our public services. Our new Labour Government promised change, and that must be delivered. Will they use the opportunity of the NHS 10-year plan to fill the almost £300 million gap in funding for children’s palliative care?

Let me remind everyone that there is money in this country to fund children’s palliative care. Our problem is not a lack of wealth, but its extremely unequal distribution. In the run-up to today’s Budget, I was one of the MPs who called on the Chancellor to raise taxes on the richest, with policies such as a 2% wealth tax on assets over £10 million, which would raise £24 billion a year—enough to meet the palliative care funding gap 80 times over. That is why I introduced a private Member’s Bill yesterday that would launch a review of the funding for children’s hospices and guarantee high-quality care for all seriously ill children and their families. I really hope that the Minister will take up that call.

In Liverpool, the people have risen to the challenge, and we are on the cusp of saving Zoe’s Place. Now this place has to rise to the challenge as well, and we have to give children’s hospices the funding they need to survive. The children and families who rely on these incredible institutions do not have time to waste.

[Derek Twigg (in the Chair)]

I remind Members to bob if they wish to speak—I am pleased to see that they are doing so.

09:45

[Vikki Slade (Mid Dorset and North Poole) (LD)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I thank the hon. Member for Liverpool West Derby (Ian Byrne) for securing this debate. Every time I meet a parent whose family is supported by a children’s hospice, I am immensely moved by their resilience. Gemma, whose three-year-old son Finlay has been cared for by Julia’s House for more than two years, wrote an incredible blog about parental mental health, which can be found on the Julia’s House website. In the debate about money, we should never forget that there are not only children whose lives will be shortened, but parents whose capacity to follow their careers and support their wider family is curtailed and siblings whose childhoods will look very different—so-called glass children, who look strong on the outside but are so fragile they could smash to a thousand pieces.

Children’s hospices and other charities that support young carers and siblings, such as MYTIME Young Carers and Mosaic in Dorset, deserve our unwavering support. They should not have to rely on charity shops and crazy challenges to make ends meet—although this crazy MP has agreed to do a crazy challenge for her children’s hospice next year. My local children’s hospice, Julia’s House, is just half a mile from my home on the border of Broadstone and Corfe Mullen and I have visited numerous times since it opened 20 years ago. It has one of the lowest public funding streams across the hospice sector, with only 8% of its funding coming from the NHS. I had no idea that the support it provides for a child in the last six weeks of life is effectively unfunded. I find it shocking that we expect the NHS to fund the birth of our children, but we are relying on charity to fund care at a child’s death.

When I visited Julia’s House on Monday, I was greeted by a nurse clutching her mobile phone. She showed me the rooms that were prepared for a family who were expected to arrive at any time because their child was approaching the end of their life. The mermaid suite, which was built to support a child’s needs both before and after their death, was ready to welcome them. However, I heard that the nurses would need to be available around the clock and would receive no funding from the NHS, despite the fact that hospice care releases intensive care hospital beds. The cost of end of life care was three times the hospice’s usual per-child funding because of the medication and end of life support. The hospice would have to take that money from the respite, sibling support and regular care programmes to make sure that the family could be given the choice they are entitled to under the NHS gold standard.

Annabelle’s family have been through that already. Annabelle had a genetically inherited condition and was a frequent visitor to Julia’s House, where she enjoyed respite stays, made friends, joined the hospice choir and even got to meet a member of her favourite pop band, the Vamps. She passed away earlier this year at the age of just 18, and her family now face the agonising prospect of losing Robbie to the same condition. He is now receiving care at Julia’s House. But it is not just Robbie; another sibling is also receiving care and support through counselling, and both parents benefit from the respite breaks that will ultimately give them a chance of staying together. I dread to think what will happen to such families if hospice services are cut back.

The hospice grant has not been confirmed beyond 2025. It needs to be guaranteed in the long term and cover every child that meets the threshold, right up to the point of their death. In Dorset, seven months into the financial year, the contracts with local health services have not yet been confirmed by NHS Dorset and NHS Bath and North East Somerset, Swindon and Wiltshire. I ask the Minister to write to the ICBs and insist that they passport 100% of the grant to our precious children’s hospices and commit to a sustainable future for our children’s hospices.

09:49

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

It is a pleasure to serve under your chairship, Mr Twigg. In my constituency, we are amazingly served by Shooting Star CHASE hospice, a children’s hospice that serves 14 London boroughs across south-west and north-west London—quite why that configuration exists, I am unsure—and boroughs and councils within Surrey. I calculate that that is around 1.5 million people. The service provides support to 544 children and their families.

In essence, the funding crisis is due to the unique and specific services that that hospice provides to those children and families. No public body owns it, and those it serves are so dispersed that any integrated care board can simply ignore the tiny number of families in its area. Every social services department in those 14 London boroughs—all of them beset by the huge problems involved in looking after children—will have a tiny number of children and families, who can therefore be ignored. That is why, despite the desire to bring everything down to the most local area or unit, we would like the Minister to hear the strong argument for maintaining the ringfenced grant for children’s hospices. To bring that down to local level would be to give it to services that are already under pressure, where numbers and leverage are equally small.

The breakdown in hospices and children’s hospices always has a cost. If a family cannot get support to look after a child with a life-limiting condition at home, in the end the NHS and social services will step in. I appreciate that it is difficult for Governments of all shades to look at issues in this way, but in the long term and in the round hospices save public money. They prevent family breakdown and ensure high standards of care. Few of us would argue anything but that the best place for a child with a short life is at home, supported by the wonderful professionals we have all met.

I ask the Minister to support the continued central funding of children’s hospices, as well as to look at what can be done for those services with ICBs and social services departments to ensure that they are held to account for their funding and how they allocate it. Given that we have the opportunity of the 10-year plan for the NHS, is it not time to consider palliative care as part of that framework?

Unlike some Members, I think there is a role for volunteers in raising funds, for instance in shops. I have seen the value of that for individuals who contribute, and I am sure that the amazing constituents of my hon. Friend the Member for Liverpool West Derby (Ian Byrne) have all benefited greatly through what they have done to save his children’s hospice. However, hospice funding cannot be jeopardised by being left just to volunteers; the community and its Government, hand in hand, need to look after the most vulnerable children in our country.

[Several hon. Members rose—]

[Derek Twigg (in the Chair)]

Order. If hon. Members can keep speeches to not more than four minutes—that precedent has been set well so far—I will not have to impose a time limit at this stage. Interventions will obviously extend the limit.

09:53

[Bradley Thomas (Bromsgrove) (Con)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I thank the hon. Member for Liverpool West Derby (Ian Byrne) for securing the debate and telling his moving story. I know that all hon. Members will be united in our support for hospices across the country. I rise in particular to speak in support of Acorns, a children’s hospice that serves the wider Worcestershire, as well as the wider west midlands region and is headquartered in my constituency.

Established in 1988, Acorns Children’s Hospice has delivered the essential care that hundreds of local children have needed for the past 36 years. Without it, many families would have been left with nowhere else to turn. When the unimaginable happens and a child receives a devastating diagnosis, Acorns children’s hospice has always been there to help. It provides lifelong supportive care for children with life-limiting and life-threatening conditions across the west midlands and Gloucester from three hospices—in Birmingham, Worcester and Walsall—as well as in the community and in family homes. It helps children and families to fill the time they have together with love, fun and laughter and to create lasting memories, and provides tailored care to meet each child’s individual medical, emotional, cultural, religious and spiritual needs. I put on record my thanks to all the staff and volunteers at Acorns for their compassionate dedication to the care they provide.

More families than ever need our vital children’s hospice care, and that number is expected to continue to grow. However, for the first time in its history, Acorns is facing the prospect of turning away a child in need. The children’s hospice grant has existed since 2007 and aims to provide some of the funding required for children’s hospices across England. In 2019, NHS England increased the children’s hospice grant to £25 million per year for 2023-24 and ringfenced that money specifically for children’s hospices. However, that funding is no longer certain under the current Government. I therefore join Acorns Children’s Hospice in urging the Minister to protect and maintain the children’s hospice grant as a directly distributed ringfenced grant, so that Acorns and every children’s hospice in England can continue to provide the care that children and families desperately need.

To give Acorns and local families the assurances they need, the Government must also guarantee the children’s hospice grant for at least five years and increase it by at least the rate of inflation each year. Guaranteeing this core funding will allow Acorns and hospices across the country to continue to be there for every child and family who need their vital support.

09:56

[Yasmin Qureshi (Bolton South and Walkden) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I thank the hon. Member for Liverpool West Derby (Ian Byrne) for securing this debate. I do not have any children’s hospices in my constituency as such, but we do have Bolton Hospice, a brilliantly run organisation that serves adults well. Francis House Children’s Hospice serves the Greater Manchester area and some children from Bolton will have been cared for there.

I will not try to repeat everything that everyone has already said, except to raise a few salient points. When we see a loved one unwell and suffering, it is incredibly painful, but we can all agree that the pain is even more acute when a child or young person is suffering and reaching the end of their life. Let us remember what hospices are there for: for children and young people, and of course adults in the adult hospices, who are dying. That will be their last few weeks and months. Surely, to have a kind, decent society, we should be able to provide them with the best service possible for their last few weeks and months in this world.

There should be, and should always have been, central provision for palliative care across the whole of the United Kingdom. It should never have been left to local authorities, integrated care boards, charities, the voluntary sector and all the different people who contribute. I agree with my hon. Friend the Member for Mitcham and Morden (Dame Siobhain McDonagh) that there is a role for volunteers, and I pay particular tribute to the people of Liverpool for rallying round and getting money for their hospice, but we should not have to rely on that. We should have £285 million—I believe that is the figure—to provide proper facilities for everyone across the UK so that hospices can plan. With living expenses rising, we know we need experienced and skilled people. If the hospices know they have regular funding coming in, they can plan for things properly, so that it is not a case of, “Gosh, we’ve got a bit of money this month, and we can use it for this facility.” They should be able to plan for the whole year and for years to come.

I congratulate the Minister on his new position. I know will have many such issues to deal with, but I ask him, as colleagues already have, please to think about palliative care in the 10 year NHS review plan and to make it a national plan so that it is given to everyone across the United Kingdom.

10:02

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Member for Liverpool West Derby (Ian Byrne) for setting the scene. It is nice see him in his place; he used to be in opposition, and now he is in government. He has been elevated, so well done.

I was saddened to hear about Zoe’s Place in the hon. Gentleman’s constituency having to become a stand-alone charity to encourage investment. There are many children who rely on these services, so it is never nice to hear the sort of news which he has presented today. Our hospices are pivotal within their local communities, so it is great to be here to discuss how to support them further.

It is also a pleasure to see the Minister and the shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson), and I look forward to their contributions. About a fortnight ago I attended a pop-up hospice charity shop here in Parliament. It was helpful to discuss the funding crisis facing our hospices with other Members and representatives. I also signed an open letter to the Minister of State for Care, and I look forward to hearing his responses in relation to these issues.

Over the years, I have supported the Northern Ireland Children’s Hospice, which holds three or four charitable events in my constituency of Strangford every year. People are very generous and incredibly kind. The money that John and Anne Calvert help to raise through those charity events is something we all appreciate.

To give some background on the situation in Northern Ireland, the Northern Ireland Children’s Hospice is instrumental in providing endless amounts of support for people and is incredibly helpful. Horizon House in Newtownabbey is a seven-bed in-patient centre that aids the local community, including through sibling and bereavement support. It goes beyond what would normally be expected, providing community care alongside hospice at-home and palliative care for 350 babies across Northern Ireland, which is really important.

In February this year, the hospice had to reduce its bed capacity to six due to a reduction in Government funding, with the intention of running six beds from Monday to Friday, and three beds on Saturday and Sunday—a drastic change from the seven beds, seven nights model. Incredibly active fundraisers added a huge £14 million to the four hospice care facilities back home.

[Mr Gregory Campbell (East Londonderry) (DUP)]

My hon. Friend is making a fundamental point about the community raising millions of pounds to support hospices, particularly palliative care, across society. Does he agree that that has to be seen, not as a replacement for Government funding, but an addition to it?

[Jim Shannon]

I thank my hon. Friend for that intervention. He is absolutely right. The £14 million raised in Northern Ireland for hospice care is extra money and—I say this very gently to the Minister and those in positions of power—that should not be taken by the Government as, “Well, we can take £14 million off what they’re doing in Northern Ireland because we’ve got £14 million from the volunteers.” That £14 million is vital to ensuring that the care goes forward.

With increasing reports of closures and decreases in some services, there is a clear need for the Department of Health, wholly supported by the Barnett consequentials, to find ways to financially aid our hospice services so that, years down the line, we do not see impending closures. The core priority, I believe, is to protect these vital services that provide so much to families across the United Kingdom of Great Britain and Northern Ireland.

Together for Short Lives revealed that the Northern Ireland’s Children’s Hospice has forecast a budget deficit of £1.46 million for 2023-24. That is due in part to a 6% cut in the hospice’s statutory income. Our hearts— and, most importantly, our thanks—are with the staff of hospice centres who work tirelessly to support those young children and families through that end of life palliative care.

I conclude with this, Mr Twigg—I am trying to keep to time—I strongly sympathise with the hon. Member for Liverpool West Derby and his constituents on what they are going through. I have every hope that the Government can do something to support the devolved nations, and indeed NHS England, in the funding crisis. This is the responsibility of the Department of Health back home, but that must be fully supported by Westminster, right here.

10:04

[John McDonnell (Hayes and Harlington) (Ind)]

I congratulate my hon. Friend the Member for Liverpool West Derby (Ian Byrne) not just on securing the debate, but on his work over the past couple of months or so on raising the funds for Zoe’s Place. He rounded up every Scouser he knew, including those of us who live in exile, and asked them to contribute in some way.

My contribution, to which my hon. Friend made reference, was to do a rendition of “You’ll Never Walk Alone” on the trombone—[Interruption.] “Oh dear”, I agree, but let us be charitable about this. The video was used to say, “If you don’t pay the money, we will keep on playing it.” My brother Brian, an ardent Liverpool supporter, contacted me to ask, “Why were you playing ‘Three Blind Mice’?” This man, my hon. Friend, has nearly raised the money, but I want the message to get out there: we are not yet over the line, and we need it for such a valuable resource.

I also congratulate my hon. Friend the Member for Mitcham and Morden (Dame Siobhain McDonagh) for her work in the all-party group for children who need palliative care. She and Lord Balfe met the Minister, and I believe it was a helpful ministerial meeting. I reiterate the requests that she made of the Minister: the idea of at least extending the £25 million is key, and ensuring that it is ringfenced. It is not that we do not trust the ICBs—eventually they will get into action and will be geared up—but if the money goes directly to them, this will be compete against their other priorities and it is difficult to see how it could be maintained and secure for the future.

Another petition has been raised as well, by Corin Dalby, who wrote to me, calling for £100 million of the money that is raised in fines by the Financial Conduct Authority to be transferred to hospice funding. I think that is worth looking at to fill a short-term gap in the coming period, but the long-term issue is exactly as my hon. Friend the Member for Mitcham and Morden said: we need a comprehensive plan. We accept that that could be a 10-year plan, but people want security over time. I want to see that money integrated into Government funding. Of course, charities raise funds, but additional funds—overall, I think it has to be core funding.

I want to make one final point. I chair a group of unpaid carers, and have done so for the past two years. For someone who is an unpaid carer in this country at the moment, whether they are looking after someone who is sick or a child with a terminal diagnosis, they have almost certainly been thrust to the edge of poverty, because the carer’s allowance is so little. That causes untold worry and stress for those parents, which is unnecessary.

We will see what happens in the Budget today, but I put in a plea and hope that the Government will address the carer’s allowance. It needs a dramatic uplift, which would help to alleviate some of the stress and pressures placed on parents looking after children with a terminal diagnosis.

10:07

[James MacCleary (Lewes) (LD)]

I thank the hon. Member for Liverpool West Derby (Ian Byrne) for securing the debate.

As a parent myself, with two young children, I live in awe of the strength shown by parents of children with life-limiting conditions. It is incumbent on all of us to ensure that funding and support is there, so that those parents can enjoy those precious years that they will have with their children, those moments of joy that sometimes, perhaps, some of us take for granted with our own children. Such families face immense challenges, yet the support they receive varies drastically, depending on where they live. The postcode lottery they face is simply unacceptable.

Sussex, where my constituency is located, with its population of nearly 442,500 children, has an estimated 2,980 children living with life-limiting conditions. That means that approximately 67 out of every 10,000 children in Sussex require specialist palliative care. Those children and families deserve consistent, high-quality care but, sadly, that is not always the reality. A report from the campaign, Together for Short Lives, has revealed that Sussex is failing to meet its required standard for 24/7 end of life care at home. That means that families in Sussex are less likely to have access to around the clock nursing care and specialist advice when their child needs it most. It is hard to imagine the additional stress and heartbreak that that inflicts on families already coping with the unimaginable.

This situation is sadly not unique to Sussex. The report highlights the fact that only a third of local areas in England meet the required standards for 24/7 end of life care. That points to a systemic problem: a lack of funding, workforce shortages and a lack of accountability for delivering equitable care across the UK. I want to see a roadmap for change. Increased funding is essential to close the gap in NHS spending on children’s palliative care. We need more specialised nurses and paediatricians trained in this field. Most importantly, we need to hold our local NHS and local councils accountable for implementing existing policies, as mentioned by other Members, and ensuring that every child in Sussex and in the rest of the country, regardless of their postcode, has access to the care they need.

I hope we will see some good news in the Chancellor’s Budget statement later this morning to close the funding gap for children’s palliative care. This is not just about statistics; it is about real families facing real challenges. We must act now to end this postcode lottery. Children with life-limiting conditions deserve the best palliative care.

10:10

[Wendy Morton (Aldridge-Brownhills) (Con)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I pay tribute to the hon. Member for Liverpool West Derby (Ian Byrne) for introducing the debate. We all agree that children’s hospices do absolutely amazing work, including Acorns in Walsall, which is a lifeline to families in my constituency. Much of its work goes unnoticed by many, but not by those who rely on their services—the children, the families and the siblings. With that in mind, I pay tribute to Councillor Kerry Murphy who, at a recent meeting at Walsall council, gave an incredibly moving and emotional speech, touching on her own personal experience as a carer, a mum and a wife who relied on the services of Acorns hospice. Whether it is accessing short breaks for respite, help for accessing the right services or support for the loss of a child, children’s hospices are a crucial source of support for seriously ill children and their families.

It costs around £11 million every year for Acorns to run its care services, and only a small percentage of that is funded by Government. That money currently comes through NHS England. Children’s hospices, as we have heard this morning, are left increasingly reliant on their charitable income and reserves to provide that vital care and support. Thanks to the commitment, determination and ingenuity of the Acorns team, it has increased its fundraising efforts, with a whole programme of activities, including its shop in Aldridge, but it is not sustainable to expect such reliance to continue.

If the Government fail to maintain the existing £25 million NHS England funding for the children’s hospice sector, families and children will suffer. They will miss out on the extraordinary care and support that they need and rely on. Their child will miss out; their siblings will miss out. I really fear that if this funding issue is not addressed properly, as we have heard this morning, our hospices will face some of the toughest decisions, which none of us would like them to have to face. That cannot be right. We have a responsibility to the sector, which needs clarity and commitment from the Minister, and I hope we will get that today. It needs the certainty of sustainable funding, starting with a return to NHS England distributing the grants centrally in ’25-26. With care costs growing rapidly, the £25 million must be maintained and increased.

I will make a further point on the role of the ICBs. We know that ICB funding for children’s hospices is patchy and variable and nowhere near the level that is really needed. Greater accountability and transparency are required, so I urge the Minister to listen to the hospice sector and recognise that its strong preference is for the funding to go through NHS England. I am conscious of time, but I urge the Minister to listen to us and to maintain, ringfence and centrally distribute the budget beyond ’24-25, with increases at least at the rate of inflation.

10:13

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

It is a pleasure to serve under your guidance today, Mr Twigg. I pay tribute to the hon. Member for Liverpool West Derby (Ian Byrne) for bringing this important debate to this place at this time and for making astonishingly good use of it. There is no doubt whatever that Zoe’s Place and the fundraising appeal will have been benefited materially from his putting this issue before this place, and therefore before the country and his community. I pay tribute to his community for their generosity.

I speak on behalf of the children’s hospice Jigsaw, which serves Cumbria, north Lancashire and the south-west of Scotland, and of Derian House in Chorley, which also serves some of my constituents. The scale of the heartbreaking reality of young people living with life-limiting conditions is mind-blowing. Nobody could fail to be moved by that reality and the impact on the families. It is worth also bearing in mind the immense compassion and professionalism demonstrated at Jigsaw and, indeed, all our hospices. It is true that there is a value in the hospice movement having independence and charitable status. It values that but there is a limit, and what we are looking at today is hospices, particularly children’s hospices, being stretched beyond the limit of their ability to raise the funds that they need to take care of the very poorly children whom they lovingly and so professionally do take care of.

The scale of the issue is worth bearing in mind. For the ICB that covers the southern part of my constituency, Lancashire and South Cumbria, there are currently nearly 3,500 people aged 0 to 24 years with life-limiting or life-threatening conditions. For the ICB for north Cumbria, which includes the whole north-east of England as well, the figure is more than 6,000. The money spent per head is £18.86 per child. If we think about the whole hospice movement serving Cumbria—St Mary’s at Ulverston, St John’s at Lancaster, Derian House, Eden Valley Hospice and Jigsaw—we are talking about the taxpayer, the NHS, being saved £33 million every single year because of the support that those hospices give in providing palliative and end of life care for people of all ages.

There is a particular thing that I want to raise about Jigsaw and the threat that it faces. It is a relatively small children’s hospice serving a very large rural county. The hon. Member for Strangford (Jim Shannon) talked about the importance of hospice at home, for example. The support that Jigsaw gives families outside the hospice is also massively important. But in recent years, of course, inflation has had an impact on fundraising. Look at energy bills: there has been an increase of something like 30% in overheads for most children’s hospices, including Jigsaw. Also, of course, hospices need and want to compete with the NHS on the pay that they give their excellent staff, but they are not funded. When the NHS has a pay rise, each part of the NHS, generally speaking, gets the funding to cover it, but not children’s hospices, so we are calling for ringfencing and central distribution of the money to hospices and for increases if at all possible.

I want to say a particular word about the complexity of our communities. I do not want to overly criticise our ICBs, but we have a children’s hospice that serves two, and as a result, getting the money out of them can be very difficult. It should not be for children’s hospices to work so tirelessly to drag money out of the public sector and to raise so much from voluntary services when what they are trying to do is to provide compassionate, professional, end of life care for children. It is time today for the Chancellor to step up and fund our hospices, including Jigsaw, in a way that is permanent, reliable and sufficient.

10:18

[Iqbal Mohamed (Dewsbury and Batley) (Ind)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I thank the hon. Member for Liverpool West Derby (Ian Byrne) for securing this important debate. In preparing for it, I learned that more than half of children’s hospices around the UK reported a deficit in 2023-24. As a result of a lack of long-term and sustainable statutory funding, coupled with the increasing costs incurred when providing lifeline care to seriously ill children and their families, more than half of children’s hospices in England ended the year in deficit. Looking ahead to 2024 and ’25, the picture gets even worse, with nearly three quarters of children’s hospices forecasting a net deficit and with the total shortfall across 35 organisations estimated to reach £25 million.

In Kirklees, where my constituency sits, Forget Me Not Children’s Hospice is an essential part of our local health and care system. It offers vital palliative care and support to seriously ill children and their families. Despite that, however, the hospice is facing a turning point: crucial services, including respite and end of life care, will be cut if the Government fail to maintain the existing £25 million NHS grant funding for children hospices. For Forget Me Not, the impact of losing that grant would be catastrophic and result in a significant reduction in services in our area. That comes on top of already fragile sustainability as a result of historic underfunding, making it one of the least funded hospices in the UK.

Amid a year of high inflation and the growing costs of recruiting and retaining skilled and experienced staff, children’s hospices’ costs are rising. UK Government Ministers must act urgently to ensure that seriously ill children and their families can access the crucial hospice and palliative care services they need. I stand here and join other hon. Members in asking the Minister to maintain the £25 million as ringfenced, centrally distributed NHS funding for children’ hospices beyond 2025, and to ensure that that funding increases by at least the rate of inflation. I also ask the Minister to use the new 10-year plan for England to review the way in which children’s palliative care is planned and funded, and to ensure that those vital and critical services are funded in full and not left to rely on community fundraising.

10:21

[Zöe Franklin (Guildford) (LD)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I start by thanking the hon. Member for Liverpool West Derby (Ian Byrne) for organising this very important debate on the funding of children’s hospices. I have had the sobering privilege of visiting Christopher’s children’s hospice, which is run by Shooting Star Children’s Hospice Association of the South East, just beyond the border of my constituency of Guildford, on two occasions in the past year. Each of those visits has left me with a lasting impression, as I witnessed the incredible work that the dedicated staff team do to support not only the children with life-threatening conditions in my constituency, and well beyond, but their families.

My reason for speaking today, just as so many others have done, is to highlight how challenging the financial situation that hospices are experiencing has become. We have heard that only a third of the funding required by hospices comes from the NHS and central Government, and the rest is sourced from charitable donations. We are really fortunate to live in a society where fundraising for children’s hospitals can keep them funded, but is that really how we should be providing the majority of the funding for crucial services for children with life-limiting and life-threatening conditions? The £25 million allocated by NHS England is intended to support children’s hospices, but the distribution through ICBs has led to significant delays in accessing that funding for the upcoming 2024-25 financial year, and there is a really troubling uncertainty whether it will continue into 2025-26 and beyond. That only exacerbates the already daunting task of financial planning for hospices.

Given those circumstances, it is perhaps not surprising that, in a recent survey of children’s hospices, Together for Short Lives found that hospices would prefer NHS England funding to be distributed centrally, according to an overwhelming 83% of respondents. That would provide the certainty and stability that is crucial to them. I am sure that everyone here can agree that children’s hospices play a vital role in our communities, and I want to put on the record today a really big, heartfelt thanks for the care that hospices and their honestly incredible staff provide to children and their families. I particularly thank Christopher’s in Shalford for the care it provides for my own local residents, as well as those across Surrey and beyond. Those families and their children are going through some of the toughest challenges imaginable. However, our gratitude is not enough. I really urge the Minister today to commit to a fair, long-term deal on funding for children’s hospices and to ensure that the NHS funding returns to being a centrally managed grant.

10:24

[Mr Joshua Reynolds (Maidenhead) (LD)]

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

I thank the hon. Member for Liverpool West Derby (Ian Byrne) for securing this important debate. Children’s hospices provide an essential service, offering specialised care for children with life-limiting and life-threatening conditions. However, they are not just a place of medical care; they are sanctuaries of love, comfort and dignity, ensuring that every child can experience joy and the best possible quality of life.

Nevertheless, like many institutions in the UK, children’s hospices have been struggling over the past few years. In 2023-24, they spent 15% more than they did in 2021-22 while receiving 31% less funding from ICBs and 11% less from local authorities. Compounding that situation is the fact that since 2019-20 there has been a 41% increase in the number of children receiving end of life care in hospices.

Alexander Devine Children’s Hospice Service in Maidenhead is a shining example of children’s hospices. In November 2001, Alexander Devine was diagnosed with a brain tumour at the age of four. At that point, his whole family became consumed by hospital appointments, doctors, nurses, operations, treatments and scans. Sadly, four and a half years later, Alexander died, aged eight. The Devine family knew clearly at that point that Berkshire needed its own children’s hospice and the Alexander Devine hospice has become a lifeline for countless families across Berkshire, bringing together the community and the community’s compassion.

The impact that Alexander Devine Children’s Hospice Service has on the community is profound. In the last year, it has provided over 18,000 hours of care and support for families, which is not just a statistic for those families; it means countless moments of relief and joy, and the creation of precious memories for families, all of whom have challenging lives. However, that is set against the backdrop that 83% of the hospice’s funding comes from donations, fundraising and gifts in wills. The reliance on charitable contributions underscores the precarious nature of funding in this sector.

We understand that children’s hospices are not luxuries but necessities, filling a critical gap in our healthcare system. However, if they are to do that, we need to fund them properly. I will not repeat the calls on the Minister that every other speaker has made today, but it is clear that we need to see forward movement. I am really hopeful that our wishes this morning will be reflected in the Budget later.

I close by reflecting on the words of Fiona and John Devine:

“The word ‘hospice’ is not a word that many relate to with happy thoughts; I much prefer the Latin ‘a resting place on life’s journey’. I know from my experience that you cannot go into a children’s hospice and not be filled instantly with love, laughter, happiness and tears.”

[Derek Twigg (in the Chair)]

I thank Members for their co-operation in terms of the time they are taking for their speeches. I say to the Front-Bench speakers that I am keen that the hon. Member for Liverpool West Derby (Ian Byrne) should get a chance at the end of the debate to wind up for a minute or so.

10:27

[Alison Bennett (Mid Sussex) (LD)]

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

I begin by thanking the hon. Member for Liverpool West Derby (Ian Byrne) for securing this really important and timely debate. I also pay credit to his efforts and the efforts of the good people of Liverpool for all the work they have done to save—hopefully—Zoe’s Place. However, the fact that all those efforts, including the trombone-playing, have been required means that today we are not where we should be. Based on the contributions across the Chamber this morning, there is widespread agreement among Members that this total dependence of children’s hospices on fundraising—putting out the begging bowl to keep them going—is unacceptable and something that we would like to see change.

In Mid Sussex, where I live, I know somebody called Carey who I first met in 2019. I went to his house for a cup of tea and he pointed to a photograph on the wall and said, “Just so you know, this is my son Fred, and Fred died when he was a teenager.” Roll on to 2024, and Carey and I are no longer fellow constituents—he now lives just outside Mid Sussex—but we are both served by the wonderful Chestnut Tree House Children’s Hospice in Arundel, which serves families right across west Sussex.

Chestnut Tree House did an incredible job for Carey, Fred and the whole of their family as Fred approached the end of his life. Carey said he is certain of the fact that

“without the support of Chestnut Tree House for our lovely Fred, and for us as we helped him, on his journey from lively teenager to death, we would all have been broken beyond endurance”.

What Chestnut Tree House did for Carey was to make his and his family’s most difficult years as bearable and as happy as they could be. Every child whose years are shortened and every family involved deserves such support. I fear that unless the Government take decisive action, such vital support services will continue to wither, and children like Fred and family members like Carey will be left to fend for themselves in truly dark times.

This is not an issue to be addressed at a later date, but one that has consequences for children and families throughout the country today. The challenges faced by children’s hospices are daunting. Each year hospices across the UK provide vital services to around 300,000 people, including approximately 7,500 children with life-limiting or life-threatening conditions. That is why we Liberal Democrats firmly believe in the necessity of a fair funding deal for hospices. It is time to address the inconsistencies that Members have spoken about in children’s palliative care funding, and ensure that all hospices are properly resourced to meet even the most basic NHS standards.

Charities such as Together for Short Lives have identified systemic problems that stop children getting the care they need. With the large majority of funding being private or charitable, the sector is precariously poised. Although the increase in the children and young people’s hospice grant to £25 million is a positive step, I am sad to say that it falls woefully short of the £295 million gap in NHS spending on children’s palliative care identified by charities such as Together for Short Lives.

A staggering two thirds of local areas in England fail to meet the required standard for 24/7 end of life care for children at home. Alarmingly, only 14% of integrated care boards—just six in total—currently fund services that provide round-the-clock access to children’s nursing care and specialist paediatric palliative care consultations.

The postcode lottery is very real. In 2022, NHS funding for children’s hospices varied dramatically. Areas such as Norfolk and Waveney allocated £511 per patient; others, such as South Yorkshire, provided a mere £28. This disparity is totally unfair. It leads to unequal access to essential services, including therapies like physiotherapy, which can make a genuinely life-changing difference for so many children. These are not just statistics: they translate into real-life consequences for families who need and deserve every bit of support they can get.

Meanwhile, rising costs have not been matched by appropriate funding increases, and the lack of transparency in funding and services is concerning. Freedom of information requests revealed that only 31% of integrated care boards could confirm how many children with life-limiting conditions accessed hospice care in their area, while 14% could not even report on their spending in this critical area. This is unacceptable. We must have a clear understanding of the needs in our communities to ensure that no child is left behind. We cannot allow our most vulnerable children and their families to be at the mercy of a fragmented and inadequate system.

We have a moral obligation to act. Together we can create a future in which every child, regardless of their circumstances, or where they live, receives the best possible palliative care. That can happen when, first, the Government fix the postcode lottery; secondly, they review the declining charitable incomes of hospices and the links to deteriorating services; thirdly, they review commissioning for palliative care, which too frequently leaves hospices out of pocket for providing basic services and which leads to significant disparities within and between communities; and finally, they introduce a specific national hospice workforce plan to cut vacancy rates with the utmost urgency.

It is vital that the Government commit to action to ensure that every child whose years are shortened, and every family involved, can make the most of every moment they have left together, just as Fred, Carey and the rest of the family were able to do.

10:34

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I congratulate the hon. Member for Liverpool West Derby (Ian Byrne) on securing this important debate and on his work to raise funds for this important cause. I will look on YouTube later to see whether I can find the right hon. Member for Hayes and Harlington (John McDonnell) playing the trombone; I am sure it will be a great rendition.

Losing a child is every parent’s very worst nightmare, but every day parents throughout the country are caring for children with life-limiting diseases. There are now 99,000 seriously ill children and their families in the UK. For those families the children’s hospices are, as we have heard today, a necessary lifeline. As an NHS consultant paediatrician, children’s palliative care is an issue close to my heart and I have cared for many children with life-limiting illnesses. I have also been the person who has delivered that bad news and been there through families’ journeys, and also in those final moments.

My role as a politician now gives me the opportunity to stand here and advocate for those families and those children, and to use this platform as a vehicle for positive change to make the treatment and care for those children much better. It is an opportunity I have taken before. I was pleased to hear my hon. Friend the Member for Bromsgrove (Bradley Thomas) and my right hon. Friend the Member for Aldridge-Brownhills (Wendy Morton) talk about Acorns hospice. In 2019, the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) and I co-chaired the all-party parliamentary group for children who need palliative care, and heard of the financial difficulties faced by Acorns and other hospices. Our campaign, and an Adjournment debate held in July 2019, led to an announcement from the Minister at the time, my hon. Friend the Member for Gosport (Dame Caroline Dinenage), that the hospice grant would be doubled from £12 million to £25 million. That certainly helped the hospices then, but time has moved on.

Demand is increasing; there are more children affected, sadly; those children are living longer, which means they need the services for longer; and the complexity of the care they require has increased. In fact, on average, children’s hospices in England spent 15% more in 2023-24 compared with 2021-22. Charities have raised money to fill the gap, but we have heard that they find it more difficult to raise funds in some areas than others, depending on the relative affluence of the people who live in the area surrounding the hospice. That relates not to their generosity but simply to their means to provide extra funding. It is important that we ensure that all children have access to such services, regardless of where they live.

Progress was made in the previous Parliament on improving access to palliative care for children. As part of the Health and Care Act 2022, the Government added palliative care services to those that must be commissioned by the ICB. As part of that, £1.5 billion of extra funding was provided at national level to support ICBs with inflationary pressures, and a further £25 million was allocated in grant funding for the 2024-25 period. However, it is important to say that we still have increasing demand and we still need more funding. We also need certainty, as hospices cannot plan from year to year. They need the Government to give them the sort of certainty of financial support that they were given previously.

I am concerned about the Budget this afternoon, because we have been briefed that national insurance contributions for employers will rise. We have also been briefed that NHS direct employers will be protected, but that will not necessarily protect hospices and others who deliver healthcare services. We will look carefully at that this afternoon.

As I said, the ICBs are now responsible for allocating funding for children’s hospices, but Together for Short Lives has highlighted the variation in how they have allocated that grant. Some have paid the allocation in full, some are paying it quarterly and others have not paid at all. What steps will the Minister take to hold the ICBs to account for allocating the grant and supporting hospices?

I recognise that there is great value in the ICBs providing local services, locally commissioned, to best target local services at the population they serve, but there is also a recognition that some services are low volume but high complexity and best commissioned nationally. I urge the Minister to consider carefully whether the balance is right for children’s hospices, which are certainly relatively low-volume, high-complexity services, and whether they should be nationally commissioned. In either case, it is wrong that ICBs do not have access to the statistics showing the number of children they have to care for, because without them they cannot plan their funding. I ask the Minister to do what he can to ensure that he has the right information to make the right decision.

Many children with life-limiting conditions have cancer. The children and young people cancer taskforce was set up earlier this year to drive improvements in how we detect, treat and care for children with cancer. What is the Government’s alternative to the cancer taskforce, which has been paused, and how quickly can we expect it to be put in place?

I appreciate that it is difficult for the Minister to make commitments, given that the Budget is just a few hours away, but will he commit to reviewing the locations of children’s hospices? A report produced by the APPG for children who need palliative care—including the hon. Member for Mitcham and Morden (Dame Siobhain McDonagh)—in conjunction with Together for Short Lives demonstrated that because children’s hospices are often set up charitably, their locations are not always spread evenly across the country, so particularly in rural areas people find it difficult to access one. Given that all children must have access to hospices, will the Minister commit to at least looking at how to ensure that access?

Will the Minister restate the Government’s commitment to the provision of short breaks? Children’s hospices provide excellent palliative care at the end of life, but they also provide significant care during life. Part of that is short break respite care, which is so valuable to many families. Will the Minister commit his Department to ensuring that is funded?

10:41

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I thank my hon. Friend the Member for Liverpool West Derby (Ian Byrne) for securing this vital debate. I know that this sector—this community—is very close to his heart. I thank him for all his work to support it and raise awareness of the issue generally, and in particular for the heroic work he has been doing for Zoe’s Place. I know Zoe’s Place faces an uncertain future, but I also know that my hon. Friend is spearheading its fundraising campaign and has been part of the discussions with its trustees and builders about securing a new site for the hospice to ensure it has a long-term future. I am very much aware of the work that the Liverpool-based Home Bargains is doing, particularly in pledging an incredible £2.5 million towards the campaign. I wish my hon. Friend and the hospice every success in those vital endeavours, and I pay tribute to Home Bargains for its outstanding community spirit.

I thank the many hon. Members who have attended this important debate and contributed so powerfully to it. We have heard some really excellent contributions. Hon. Members have shown how important this issue is to the House. I thank all the people who work in children’s palliative and end of life care, including in hospices throughout the country, which provide vital care and support to those who need it.

We all recognise the importance of palliative and end of life care services, including hospices, which provide personalised care and support at the most difficult times for children and young people with complex needs, and their families and carers. It is estimated that there are more than 86,000 children and young people with life-limiting conditions in the UK, but it is predicted that, as we continue to make medical advances, that number will increase.

Palliative and end of life care for children with life-limiting conditions is provided by a broad range of organisations and professionals across multiple settings, including primary care, community care, hospitals, hospices, educational settings and children’s own homes. This system-wide approach to providing palliative and end of life care should be sufficient to ensure that the local offer to patients is personalised, of high quality and sustainable. The majority of palliative and end of life care is provided by NHS staff and services, but we recognise the essential part that voluntary sector organisations, including hospices, play in providing support to people at the end of life and their loved ones.

Children’s hospices are a vital part of that system-wide approach, because they provide a wide range of health and care support to meet the physical, emotional, social and, indeed, spiritual needs of children, young people and their loved ones. Care is often provided by a multi-disciplinary team, and often in collaboration with statutory services, to ensure that the entire family is supported.

The support provided by hospices can include practical advice and information; short breaks or respite; specialist therapies such as physiotherapy, art therapy or play therapy; 24/7 end of life care; and bereavement support. Short breaks are a key part of a range of provisions that support disabled children and their families. They can include the provision of day, overnight and weekend activities for children and young people, and can take place in the child or young person’s own home, the home of an approved carer, or a residential or community setting.

Local authorities have a statutory duty to assess the social care needs of disabled children and young people, and to provide respite care where necessary. Where it is appropriate, local authorities can fund respite care provided by hospices, either as a short-term stay or as a service that the hospice team provide to the child or young person in the family home. Local authorities and ICBs regularly liaise to plan and commission the most appropriate package of respite care for children and young people with life-limiting or life-threatening conditions in their area.

The Government do not monitor the use of social care for children with palliative and end of life care needs, but local authorities are required to publish a local short breaks duty statement, which shows what services are available, how they respond to the needs of local carers and how they can be accessed, including any eligibility criteria. Local authorities must consider the needs of local parents and carers when preparing their statements, and they must review them regularly.

Palliative care services are included in the list of services that an integrated care board must commission. That promotes a more consistent national approach and supports commissioners to prioritise palliative and end of life care locally. To support ICBs in that duty, NHS England has published statutory guidance and service specifications, which include specific reference to ensuring that there is sufficient provision of specialist palliative care services and hospice beds, as well as future financial sustainability.

Most hospices are independent charitable organisations that receive some statutory funding from the NHS.

[Wendy Morton]

If funding for children’s hospices is to go through ICBs—I hope the Minister will take account of the sector’s view—what assurance can he give us that it will actually go to the children’s hospices? I fear that if we are not careful, we will pit one healthcare sector or charitable sector against another, and that would not be in anybody’s interest.

[Stephen Kinnock]

The right hon. Lady is absolutely right: funding that is earmarked for palliative care must go to palliative care. There is statutory guidance from the NHS, and it is vital that we continue to liaise with ICBs from the centre, to ensure that the allocated funding goes where it needs to go. If she is aware of cases in which that funding is not going where it should go, she should make representations; I am happy to receive a letter from her on the issue.

The amount of funding that each charitable hospice receives varies both within and between ICB areas. That funding will vary depending on demand in an ICB area, but will also depend on the totality and type of palliative and end of life care provision from both NHS and non-NHS services, including charitable hospices, in each ICB area. There are inequalities in access to hospice services, especially for those living in rural or socio- economically deprived areas. That is why including hospices as part of a system-wide approach is so important.

I understand that charitable hospices value their independence and autonomy, which allow them the freedom to provide services beyond the statutory offer, which is one of the wonderful parts of hospice care. That independence also gives a sense of shared purpose, in which the community cares for the hospice, and in turn the hospice cares for the community and is something to be cherished. That is indicative of the compassion that is found in hospices and communities all over the country.

In addition to ICB funding, at a national level, NHS England has supported palliative and end of life care for children and young people through the children and young people’s hospice grant, totalling £25 million in ’23-24. While ’23-24 marked the final year of the grant in its previous format, in ’24-25 NHS England continued to provide £25 million of funding for children and young people’s hospices. A prevalence-based model is used for that funding, which supports the move away from a traditional model of bed-based funding, better reflecting population needs. In ’24-25, that funding was transacted by ICBs on behalf of NHS England for the first time, rather than being centrally administered. I am aware that the shift to an ICB-transacted model for ’24-25 has not been as smooth a transition as we in the Department certainly would have hoped. We are working closely with NHS England to resolve any remaining issues with the ’24-25 funding, and to learn from what did not work so well this year.

We, alongside NHS England, absolutely recognise the importance of sustainable funding for the palliative and end of life care sector, including hospices, and we will consider the future of children’s hospice funding in the context of Budget discussions. I have absolutely heard the representations by hon. Members on both sides of the Chamber today about the need for the Government to maintain the £25-million grant, and I assure hon. Members that I am working very closely with NHS England to get that confirmed as a matter of urgency.

[Dr Johnson]

The Minister talked about maintaining the grant, but does he recognise that many hon. Members have also raised the increasing costs that hospices are facing? Will he look to not just maintain the grant but increase it?

[Stephen Kinnock]

We are certainly looking at all those issues in the round, including ensuring that the grant is sustainable and that there is a real-terms financial input to the system. We are working on that as a matter of urgency. I totally recognise and understand why the sector needs certainty and stability; it is very difficult for hospices not to be sure what is happening after this in-year position.

The 2010s were a lost decade for our health and care services, which now too often are not there when we need them. That is also true for hospice care, where we see a postcode lottery for services across the country and variation in quality and access. Hon. Members will know that we have committed to developing a 10-year plan to deliver an NHS and care system that is fit for the future, by driving three shifts in the way that care and health services are delivered.

We will be carefully considering policies, including those that impact children with palliative and end of life care needs, with input from the public, patients, health staff and our stakeholders as we develop the plan over the coming months. That engagement process was formally launched last week, and I strongly encourage the sector, including hospice providers, service providers and their families, and indeed every parliamentarian in this Chamber, to engage with that process: please go on to change.nhs.uk and make your voice heard. That will allow us to fully understand what is not working as well as it should, what the solutions are, and where the opportunities are for the future.

One of the three strategic shifts that our 10-year health plan will deliver is the Government’s determination to shift more healthcare out of hospitals and into the community. Community health teams play a vital role in supporting children and young people with complex health and care needs to live as well as possible, providing proactive care and preventing exacerbations and hospital admissions where possible. That shift from hospital to community includes our commitment to roll out neighbourhood health services to ensure that patients and their families receive personalised care in the most appropriate setting in their community, and indeed as close as possible to home. Palliative and end of life care services, including hospices, will have a major role to play in the fundamental shift from hospital to community, and in shaping that shift.

Additionally, the Department, through the National Institute for Health and Care Research, is investing £3 million in a new policy research unit in palliative and end of life care. That unit launched in January 2024 and will build the evidence base on all-age palliative and end of life care, with a specific focus on inequalities. In closing, I thank once again the hon. Member for Liverpool West Derby for securing this vital debate on children’s hospice funding. I again express my heartfelt thanks to all those who support children, young people and their loved ones when they need them most.

10:55

[Ian Byrne]

It has been a privilege to listen to hon. Members and sense the unanimous feeling that where we are now is not sustainable or acceptable. We do not want to see more cases like Zoe’s Place to happen in constituencies across the country. Once again, I thank the House and all hon. Members here for what they did, and the Minister and the shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson), for their responses. I hope that we can find the solution moving forward; I will certainly be having conversations with the Chancellor about it.

Question put and agreed to.

Resolved,

That this House has considered funding for children’s hospices.

Childcare: Black Country

Wednesday 30th October 2024 Westminster Hall

10:57

[Derek Twigg (in the Chair)]

I will call Sonia Kumar to move the motion and the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention for 30-minute debates.

[Sonia Kumar (Dudley) (Lab)]

I beg to move,

That this House has considered the quality and availability of childcare in the Black Country.

It is a pleasure to serve under your chairmanship, Mr Twigg. It is an honour to introduce this debate. I want to talk about the importance of high-quality and accessible childcare in the Black Country, a region that is rich in history, resilience and community spirit.

The Black Country, with areas such as Dudley at its heart, has always been a place where working families thrive, and where communities are built with hard work and strong values. For those families to thrive they need support, and childcare is a crucial part of the network for that. This is not just a family issue; it is also about children’s future in Dudley, our community strength and the local economy. Good affordable childcare supports parents in the workforce, boosts child development and helps build the foundation for a stronger society.

As of June 2024, Dudley has 45 registered childcare providers offering about 1,126 places for children under eight. Despite those numbers, much of the Black Country, including Dudley, is classified as a childcare desert. Families in the Black Country have long supported each other through community efforts but now face a lack of critical childcare options, with only 17 places per 100 children in Dudley. Those figures fall far below the national average of 25 per 100. Can Members imagine if every time they needed childcare, three out of every four doors they tried were shut? That lack of access leaves parents with fewer options and waiting longer, forcing them to make tough decisions about work and family care. The Black Country early years education sector faces unique challenges, especially for children with special educational needs and disabilities. The YMCA reports that over a third of children in its Black Country settings—34%—need additional support. That is significantly higher than the 13% in the most affluent areas of the UK, yet there is a shortage of resources, SEND assessments and funding, which limits vital one-on-one and specialist care. Without those early interventions, many children risk falling behind, underscoring the need for more targeted support in our community.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for securing this debate and directly underlining the issues pertinent to her constituency. There are also other important issues to consider, including autistic children, children who need speech therapy and the one-to-one support needed in nurseries and childcare. Does she agree that a special priority needs to be given in circumstances where children need care early? By getting care early, they can get to a stage where they can do their schooling and are set up for their future life.

[Sonia Kumar]

I agree with the hon. Gentleman. Intervention is so necessary at early ages. If we catch children early, we can help their future development as they move from early years into schools, and if we help their development we can make sure that they succeed in the future.

It is about not just the availability of care, but the quality of care. Quality is just as critical as availability. Among 28 local providers inspected by Ofsted, only 7% received an outstanding rating, compared with the national average of 14%. Although most providers were rated good, Dudley still lags behind the national quality standards. Since 2022, rising costs have strained early years funding, making it difficult for childcare providers to maintain higher standards. Labour’s commitment to increase funding and expand access to vital services is essential for families that deserve and need them.

Rising poverty and inequality make those childcare challenges even tougher. In Dudley, child poverty rose from 22% in 2014 to 32% in 2023, while, across the UK, the rate rose from 15% to 20% over the same period. For local families under financial pressures, finding affordable childcare is significantly challenging. Department for Education data from 2023 shows that although 72% of mothers are working, nearly half of non-working mothers say that they would work if they had access to convenient and affordable childcare. For families with children under four, that number rises to 54%. With limited childcare options, many parents, particularly mothers, are forced to stay outside work, adding to family stresses and limiting the local economy.

Labour pledges to offer free quality childcare for children aged two to four, which will help parents to manage costs and allow more people to return to work. I welcome Labour’s promise to open 300 more nurseries within the year and use empty school classrooms to meet the demand for more childcare spaces, which are very much needed in places such as Dudley and the Black Country. By covering up to 80% of childcare costs for qualifying families, Labour’s plan to offer meaningful relief for working parents will help to build a foundation of support for children in the future.

Investing in early years education benefits not just families, but the entire economy. Studies show that universal childcare brings more parents, especially mothers, into the workforce, generating tax revenues that can help to cover programme costs. The Centre for Progressive Policy estimates that inadequate childcare access costs the UK about 1% of GDP a year. Imagine the positive effect that this would have in places such as Dudley if more parents could work with affordable, reliable childcare in place. Research from Ofsted highlights the significant role that early years education plays in lifelong learning and development. Its “Best start in life” report outlines four critical areas—literacy, mathematics, understanding the world and expressive arts and design—that provide young children with the foundation for academic and personal success.

As we look to the future, I urge the Minister to prioritise childcare reform and ensure that it matches local need. I have the following asks. How will the Government address the persistent childcare deserts in areas such as Dudley, where places fall below the average? With child poverty rising, what specific measures will the Government put in place to ensure that families in financial hardship can access childcare, especially in places such as Dudley? How will the Government support childcare providers who face inflation-driven costs that continue to rise and that are a burden on the provision of good-quality care? Will the Minister visit the constituency of Dudley to see what the childcare provisions are and the areas where improvement could be made?

We need a childcare system that strengthens our communities, supports our economy and ensures that every child has the chance to succeed. Quality depends on not just childcare, but its accessibility for families—not only for those who can afford it, but for those who need it most. By investing in early years education, we are investing in a stronger and more resilient future for the Black Country and my constituency of Dudley. Let us work together to make quality childcare a reality for every family, giving each child the foundation that they need to thrive and each parent the support that they deserve.

11:06

[The Parliamentary Under-Secretary of State for Education (Stephen Morgan)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I thank my hon. Friend the Member for Dudley (Sonia Kumar) for securing a debate on this important subject, especially on such a busy day in the House. I know already that she is a real champion for children and young people in her constituency.

This Government believe that all children, regardless of who they are, where they come from or their parents’ income, deserve access to high-quality early education. This mission-driven Government have committed to the best start in life pillar, reinforcing the importance of available and affordable high-quality early years education and childcare. The new Government are committed to delivering the childcare entitlements that families have been promised, giving every child the opportunity to have the best start in life. Local authorities and early years providers have worked diligently to deliver the latest expansion of entitlements in September, and more than 320,000 parents are already accessing a place.

Over the weekend, we confirmed £1.8 billion to support the expansion to 2025-26 and a further £15 million of capital funding to expand school-based nurseries. Eligible working parents of children aged nine months are currently entitled to 15 hours of Government-funded childcare a week for 38 weeks a year. From September next year, this will increase again to 30 hours, but we have to be honest with parents in the Black Country and across the country about the scale of that final, more challenging phase.

Around 70,000 additional places and 35,000 early years educators are needed to deliver the expansion to 30 hours next September. Our analysis tells us that more than half of local areas need to increase their capacity by between 10% and 20% to meet the demand for next September and that the highest uplifts are needed in some of the most disadvantaged areas. We will continue to work tirelessly to bridge the gaps ahead of next September. However, in some parts of England, though parents may receive the hours they were promised, they may not get their first choice of nursery or childminder.

I know from my engagement with councils that local authorities are working hard to generate growth in available places and to develop the workforce they need. My Department has regular contact with each local authority in England to discuss the sufficiency of their childcare places and the issues they are facing. Where needed, it links local authorities with Childcare Works, an organisation contracted by the Department, to support them.

The size and quality of early education and childcare provision in the Black Country is significant. Across Dudley, Sandwell, Walsall and Wolverhampton, there are around 770 providers that provide approximately 32,000 places. My hon. Friend will be pleased to know that local authorities in the Black Country area are not reporting any issues with their sufficiency.

As my hon. Friend rightly states, high-quality early years education plays a crucial role in improving children’s life chances. It has a positive impact on children’s outcomes in the short and long term, particularly for the most disadvantaged. Under this Government, growing the early years education system will not come at the cost of quality. We have already announced the extension of the early years stronger practice hubs programme until at least March 2025, with a continued focus on supporting children from disadvantaged backgrounds. In July, the Government committed to extend the funding of evidence-based early language interventions in primary schools, so that every child can find their voice. We will also drive up standards in early maths education and increase the quality of provision.

Following consultation, with strong support from the sector, we have published our response to proposals to strengthen safeguarding requirements in the early years foundation stage statutory framework. The Department will implement all the proposals, including those on safer recruitment, child absences, safer eating, safeguarding training and paediatric first aid training. Additionally, new proposals on providing employment references and supporting whistleblowing will be introduced. These changes are set to be implemented from September 2025 and will formalise existing best practices to ensure that all early years educators have the knowledge and support they need to deliver safe, high-quality early education and childcare.

I thank my hon. Friend the Member for Dudley for securing this important debate, and I thank all Members who have contributed. The Government will continue to work hand in hand with the sector to deliver an early years system that gives every child a firm foundation and sets them up for their next stages in life.

Question put and agreed to.

11:11

Sitting suspended.

NHS Winter Readiness

Wednesday 30th October 2024 Westminster Hall

[Sir Roger Gale in the Chair]

14:30

[Helen Morgan (North Shropshire) (LD)]

I beg to move,

That this House has considered NHS readiness for winter 2024-25.

It is a pleasure to serve with you in the Chair, Sir Roger, and I am grateful to have secured a debate on the crucial topic of preparing the NHS for winter. This is particularly timely on a day when the Government have delivered the Budget and outlined their priorities for the coming year, and indeed, the years after that.

We all know that due to the Conservative failure to protect the NHS, winter is a time when pressure on the NHS peaks. Every year, we suffer what we describe as a winter crisis. But for the millions of people stuck on waiting lists, the thousands of people treated in corridors and the legions of staff battling to keep people safe, it must feel like the winter pressure never ends.

I am sure we would all agree that the health and care crisis requires long-term action—improving public health, focusing on primary care, training and retaining more doctors, dentists and nurses, fixing the crumbling NHS estate, and fundamentally, finally addressing the crisis in social care. But while we wait for that action, winter is now looming. The clocks have gone back and time to prepare for winter has run out. I am here to find out what the Government are doing both to get the NHS through the upcoming winter and, following the Budget statement, to get the NHS ready for the winters to come.

I am aware that the Chancellor has just announced a £22 billion cash injection into the NHS, although further detail on that was scant, so we will put forward our ideas in this debate and hope that they come to fruition over the next few weeks. For the sake of staff and patients, it is crucial that winter crises become a thing of the past. We have reached the point where winter pressure is normal all year around. We should be striving for the reverse, where pressure is relieved and the forecasted crisis does not happen. I am pleased to hear some of the measures that the Government have outlined today, but I remain worried that fundamental issues are still being ignored—most crucially, the crisis in social care. Until that is resolved, we will not be able to fix the NHS.

So what is the state of play? Dr John Dean, the clinical vice-president of the Royal College of Physicians, warned that the latest NHS statistics show the health service

“is in an extremely concerning position as we head into winter.”

He is not alone in holding such concerns, for it has already been a really busy year for the NHS. In fact, it has been the busiest ever summer for A&E departments in England, with NHS staff managing 6.8 million attendances in just the past three months, according to a briefing by NHS England on readiness for winter. Last month, emergency departments had 2.2 million attendances—the highest such number for a September on record—with more than 38,000 people waiting longer than 12 hours after the decision to admit them. Meanwhile, the weekly average of extra bed days for patients remaining in hospital beyond seven days due to delays in discharge was the highest since December 2022.

A look at my local hospital trust in Shropshire illustrates the situation well. In Shropshire, at the Shrewsbury and Telford hospital NHS trust, our bed occupancy rate is constantly around the 95% mark. That is not unusual; it has become the norm at acute hospital trusts up and down the country, and not just in winter, but all year around. Hospital staff constantly have to juggle resources to try to secure people the care they need. As the wards fill up, A&E becomes crowded and care moves on to corridors.

Every month, I am contacted by constituents who are shocked by what they have encountered in the hospital: being forced to wait for hours in pain on plastic chairs, or having their dignity taken away as they occupy a trolley in a corridor, in agony and in full view of the public. Many people remain unaware of how common that is until they find themselves with a loved one in that situation.

The “Dispatches” documentary filmed at Shrewsbury and Telford hospital trust earlier this year brought the reality home to the nation. The issues with hygiene and infection control were startling enough on their own—I am pleased that the trust is addressing those directly—but most stark was the human impact on the patients. Scenes included that of the elderly man who was forced to urinate while on a trolley in a corridor, in full view of staff, or the woman who cried out in agony for hours, with staff being left in despair at the terrible situation they were trying to deal with. That was not in the depths of winter; it was in April and May.

Corridor care takes a toll on patients and a huge toll on the staff who are forced to attempt to cope. However, the full scale and the impact of corridor care are unknown, because there is only patchy reporting on the level of care in temporary environments. As we seek to better understand and prepare for pressure in the winter, and all year round, will the Government consider mandating the recording and publishing of the number of patients receiving care in temporary environments, such as corridors? Honesty and transparency are key if we are to properly prepare for the winters to come.

Every month, more than 2,000 patients spend more than 12 hours in the A&E department at Shrewsbury and Telford, and one in every three of the many ambulances arriving outside have to wait more than an hour to hand over their patient—not in winter, but in every month of the year. Since April, ambulances have lost around 15,000 hours through waiting outside the two hospitals in Shropshire, and one poor patient was stuck in an ambulance in Shrewsbury for 15 and a half hours. As we have discussed many times, that keeps ambulances off the road, and has a knock-on effect on how long people who may be in life-or-death situations have to wait for help. This leads to situations such as the one in my constituency in April this year, where a carer was left alone performing CPR for 23 minutes while being told by the 999 call operator that no ambulance was available. Tragically, the victim died, and the carer who tried so hard to save her has been left traumatised—as, I would imagine, has the 999 call operator.

As I mentioned in the Chamber a couple of weeks ago, an 11-year-old in my constituency, Charlotte, has an adrenal deficiency that leads to her needing an urgent injection of hydrocortisone if she has some kind of trauma. When that happens, she is logged as needing an automatic category 1 ambulance response. Recently, a car crash happened involving Charlotte and her mother, and when an ambulance was called for, they were told that none was available, and the family had to make their own way to hospital. That is not good enough. It is endangering lives.

The target for a category 1 response time is an average of seven minutes. So far this year in Shropshire, the average has been 11 minutes and 57 seconds. For a category 3 response, which still means that the person urgently needs an ambulance, the average wait is more than two hours, which is more than double the target time. That is not new, but it is very wrong, and it demonstrates the pressure already facing the health service as we head into winter.

Perhaps more worryingly, the situation in many areas this summer has been getting worse, rather than better. West Midlands Ambulance Service, which serves my constituency, described a

“significant, rapid deterioration of delays at hospital in September which has continued further in October.”

The service has been operating with the highest level of risk score for the past year. October is forecast to be the second worst month on record for lost handover hours, with the equivalent of 130 out of 600 ambulance crews in the west midlands being lost to delays every single day—and it is only October. That takes a huge toll on the mental health of the hard-working staff involved at every level. It also undermines staff retention, which will be crucial for any NHS plan, such as the 10-year plan or any winter plan to come. We must retain these experienced professionals; we cannot rely on recruitment alone to solve the staffing crisis in our NHS.

These wonderful staff have been stretched to breaking point by years of neglect and mismanagement by the Conservatives. Labour must do better, yet patients and staff are understandably fearful as we approach winter. According to a recent poll commissioned by the Liberal Democrats, one in four people in Britain have avoided calling an ambulance because they were frightened that it would take too long to arrive.

Of course, many pensioners are particularly fearful this year. Winter is a perilous time for older people, given the additional diseases that they might catch, and many will be more at risk after being denied the winter fuel payment for the first time. This will be the first winter without the payment being universal, and the annual uprating of the state pension will not make up the shortfall until next spring, which will be too late for people to pay their electricity or gas bill—and if someone in my constituency has to top up their oil tank now, it is too late for that, too. There is a danger, as happened when fuel costs increased two years ago, that people will reduce or turn off their heating entirely, with possible consequences for their health and a knock-on effect on the NHS.

So what are the solutions? First, we need to stop throwing money at the fire and instead prepare properly. As we all know, the most cost-effective cure is prevention in the first place. Over the past seven years, the Conservative Government announced an average of £376 million of emergency funding each year to tackle the winter crisis, much of which arrived too late to make any meaningful difference.

The Liberal Democrats want to create a winter taskforce armed with a ringfenced fund of £1.5 billion for the next four years. That would be used to build resilience in hospitals, A&E departments, ambulance services and the discharge of patients, and allow integrated care boards and NHS trusts that are struggling to balance their books to plan their budget more effectively in advance to cope with the winter crisis. The taskforce would bring together senior leaders from the NHS and the Government, along with staff representatives, to ensure better co-ordination and preparation for winter. It would be empowered to deliver rapid changes in day-to-day operations to ensure a co-ordinated response—for example, by deploying more beds to certain hospitals or boosting social care capacity where it is most needed.

Tackling the issue of patient flow is the most fundamental aspect of steering our health system through this winter and the years ahead. If patients are to be treated on time, they need an ambulance to arrive on time, and that ambulance must be able to hand over its patient to A&E as soon as it gets there. If A&E is to have more capacity, we need to reduce the amount of people there in the first place through prevention and investment in primary care. We must make hospital beds available so that patients can be moved out of the A&E department and into the medical or surgical part of the hospital, as appropriate. If we are to move patients on when they are ready to go home, when they would be better served in their own home with the proper therapy, we must invest in social care and deal with its capacity issue, which is at the heart of so many of these problems.

Half a million people in England are waiting for care, stranded in hospital beds that are so important to free up over winter, and those in power have continually ignored social care for many years. I am extremely worried that the Government have not said an awful lot about social care in the Budget today. The additional money announced for local councils, £600 million of which is for social care, will presumably be gobbled up largely by the increase in national insurance contributions and the minimum wage. It is really concerning that those councils will not be able to meet their social care commitments in the future. We urgently need cross-party talks so that, between us, we can commit to a long-term solution to the crisis in social care.

Liberal Democrats believe that we should introduce free personal care along the lines of the model in Scotland. That would help people to stay in their own homes and out of hospital and ease the pressure on the NHS. We should pay for a fairer deal for unpaid carers and a higher carers’ minimum wage, which of course, we saw some movement towards in today’s Budget. We welcome that and look forward to the review of the cliff edge in the unpaid carers’ allowance. Critically, a higher carers’ minimum wage must be fully funded, because councils will be pushed over the edge if they are not given the money to support that, as will many small care providers, which provide the vast majority of paid social care in this country.

We need to ensure that people can see a GP when they need one, so that they do not end up adding to the overwhelming pressure on A&E departments. I recently spoke to someone in my constituency who waited seven weeks for a telephone consultation. We must ensure that we focus on the outcome for the patient, which is why we would give everyone the right to see a GP within seven days, or within 24 hours if the need was urgent, and we need to increase the GP workforce by at least 8,000 to deliver that. As I said, it is crucial that that is done through retention as well as recruitment and more training.

We also need to reform the NHS dental contract and guarantee access to an NHS dentist for anyone needing urgent or emergency dental care, ending the dental deserts that exist in my North Shropshire constituency and the rest of the country. The biggest reason for a child to go into hospital is to have a tooth extracted, because their teeth are in such a poor state. That is scandalous, and I look forward to hearing what the Government will do to address that issue.

We also need to support community pharmacists, who are critical to the preparedness of the NHS, by making sure that everyone has access to the healthcare advice and medicines that they need. Pharmacy First is an excellent idea and helps to relieve the pressure on the NHS, but community pharmacists are closing at an alarming rate, and we risk that good idea going to waste. Are enough people being vaccinated against the “tripledemic” of flu, covid and respiratory syncytial virus, including staff? Analysis by the Health Service Journal showed that 283,000 fewer staff received a flu jab last winter than at the end of 2019, despite the number of frontline staff growing. If staff are not protected, fewer patients will be protected when they get seriously ill, and staff will not be able to go to work to treat ill people. Increasing the awareness of what is on offer at pharmacies and reversing the cuts to the public health grant to increase the health and fitness of people up and down the country are both integral to relieving pressure on hospitals and preparing the NHS for winters to come.

Stories and statistics from up and down the country show that the NHS was already under extremely severe pressure this summer. That has been the case throughout this year and last year. It is autumn now, so it is critical that the Government outline their plans to deal with the added pressure of the winter to come. More fundamentally, we need bold, long-term action so that winter crises become a thing of the past. We need to train, recruit and retain staff, and make them proud and happy, instead of tired and stressed, with them then leaving the system. We need to fix our crumbling hospitals so that money can be spent on care instead of fighting fires and draining floods. We need to invest in all aspects of primary care, including dentists, doctors, pharmacists and optometrists, as I reminded Members in the Chamber last week. Most crucially, we must confront the crisis in social care.

Earlier this week, the Secretary of State said that the Budget will arrest the decline in the NHS, but I am afraid that that is not good enough. The annual winter crisis costs lives, jobs and patient dignity. It also costs the taxpayer more than we can afford. We must invest now; we cannot afford not to do it. We must invest to save so that we have an NHS fit for the future.

14:46

[Jess Brown-Fuller (Chichester) (LD)]

It is a pleasure to serve under your chairmanship, Sir Roger. I thank my hon. Friend the Member for North Shropshire (Helen Morgan) for bringing forward this important debate on a very busy day for all Members, given the Budget announcement in the Chamber.

Last winter was nothing short of a catastrophe for the NHS and everyone who depends on it. NHS figures show that, between November 2023 and March 2024, nearly three quarters of a million people endured A&E waits of more than four hours and nearly a quarter of a million waited for more than 12 hours. In west Sussex alone, there have been 25,000 cases of 12-hour A&E waits so far this year—a 36% increase on the same period last year. Those figures leave patients and staff in my constituency of Chichester deeply anxious as we approach another winter, especially given that we have had the busiest summer on record, with NHS staff managing a staggering 6.8 million attendances over just three months.

In many cases, being seen quickly is literally a matter of life or death, especially in acute and emergency settings. Rory Deighton, the director of the NHS Confederation’s Acute Network, warned us that:

“Without immediate funding there is a very real risk the NHS falls into crisis this winter, with ambulance response and handover delays, overcrowded A&Es and people stuck in hospital beds because of a lack of community and social care.”

It is evident that many of my constituents in Chichester have lost faith in emergency health services. A recent poll conducted by the Liberal Democrats showed that one in four Britons has avoided calling an ambulance for fear that it will take too long to arrive. NHS paramedics, nurses and doctors consistently go above and beyond, and yet the system they are working in has stretched them to breaking point. Patients are bearing the consequences: they suffer each winter as the NHS crisis intensifies.

The Chancellor’s Budget announcement today that a 10-year plan will be introduced in the spring will not address the immediate crisis on our doorsteps. It was disappointing to hear very little attention paid to social care, which we know causes a huge number of beds to be used in hospitals. We cannot fix the bed crisis by just buying more beds; we must invest in the workforce that supports those beds. We must ensure that, this winter, my constituents in Chichester do not sleep in corridors or wait in uncomfortable waiting rooms—an experience that is all too familiar for me because, last winter, my grandmother ended up in a corridor, after being admitted in agony, in full view of the public. That would be an incredibly distressing experience for anybody, let alone somebody suffering with acute dementia.

There is no point in throwing money at a leaky bucket if the funding will not get where it needs to go to address the issues across the healthcare system. In my role as Liberal Democrat spokesperson for hospitals and primary care, I have had the opportunity to meet professionals from across primary and secondary care and hear what they are calling for so they can successfully provide a service across the board this winter. They are asking to be able to plan, with budgets that have a shelf life longer than 12 months, and allow them to innovate for the future. Year after year, the previous Conservative Government resorted to spending hundreds of millions of pounds in emergency funds every year to manage the winter crisis.

That emergency funding was a short-term fix that often arrived in those hospitals far too late to address the problem, as my hon. Friend the Member for North Shropshire pointed out. It was short-term fix rather than a comprehensive long-term plan to invest ahead of the crisis. Liberal Democrats have long called for a winter taskforce to oversee a dedicated, ring-fenced fund to build resilience for hospital wards, A&E departments, ambulance services and patient discharge pathways over the next four years.

I have no doubt that this will not be the last time we talk about NHS preparedness for winter. I fear that the Budget today will not have alleviated the concerns and fears of my Chichester constituents, nor those of the staff working in health care in my area. I urge the Government to use our ideas and prepare the NHS for not just this winter but future ones. We are ready to work constructively with the Government to that end.

14:51

[Jim Shannon (Strangford) (DUP)]

I am just chewing a sweet, Sir Roger; my apologies. It is a pleasure to speak in this debate. I congratulate the hon. Member for North Shropshire (Helen Morgan) on setting the scene so well. Today, we had some good news in the Chamber: that £22 billion will be spent on the NHS. The good news for us is that, through the Barnett consequentials, some of that will come to Northern Ireland. We do not yet know how much, but we are sure that some of it will come.

As the DUP health spokesperson, I join colleagues in expressing concerns for my constituents and their access to good health care this winter. Everyone has spoken about that; we cannot ignore the issue. We hope what the Government have put forward today is a helpful financial solution that will go some way to addressing the issue. I am aware that health is a devolved matter, but funding is not devolved, nor is the obligation of Government to implement their promised NHS reform throughout the entire UK.

When I asked the Secretary of State for Health about that reform, he was very clear in his commitment that everyone in the United Kingdom of Great Britain and Northern Ireland would see the benefits. I hope today is a step in the right direction. The Department for Health has released the preparedness document for last year. I welcome some of the impetus, such as strengthening the urgent and emergency care system to provide alternatives to emergency departments, including urgent care centres, urgent streaming services, rapid access clinics and the local phone first services.

The hon. Member for North Shropshire, who set the scene, referred to ophthalmology. It is important to include that because there are some questions along those lines. We had an event yesterday called “The eyes have it”. As the party’s health spokesperson, I try to go to as many health events as I can in the House of Commons. Those attending outlined a number of things they wish to see. Perhaps the Minister can give us some ideas on how we can improve ophthalmology across the United Kingdom.

I welcome the £3.4 million funding provided to general medical and out of hours services, to support GP practices to increase their capacity in light of the anticipated increase in demand over the winter. A figure of £4.3 million has been provided to support GP practices across Northern Ireland to provide proactive support and care to those in nursing and residential care homes. That is again an example of what can be done. I will mention some of the other positive things. I am hopeful that some of the extra money allocated to the NHS today by the Chancellor will filter its way towards Northern Ireland.

The hon. Member for North Shropshire referred to the ambulance service. The Northern Ireland Ambulance Service is increasing its range, capacity and clinical expertise at the ambulance emergency control to help ensure that cases are appropriately managed, without time delays. The enhanced hospital capacity, with 45 beds opened for last winter in my local Ulster hospital, will continue to be funded. Those are some of the good stories and news.

Another is the rolling out of the Pharmacy First pilot service for uncomplicated urinary tract infections in women aged 16 to 64 years. That will expand the current pilot of 62 community pharmacies to the entire pharmacy network of some 500 pharmacies right across Northern Ireland through an investment of £410,000. Again, money is being allocated in the right places to do the right job, which will hopefully make lives better. Over the winter period, it is estimated that this will deliver 12,000 consultations, freeing up capacity in GP practices.

The whole idea of the Pharmacy First pilot service was to ease pressure on GPs, and I know the Minister has always been committed to that. There are good things that can happen, and hopefully after today even more good things will be able to happen. Some £265,000 has been allocated for a new Pharmacy First sore throat test and treat service, which is being piloted this winter. When winter comes, there are colds, flus, sore throats and days off, and everyone rushes to the GP. This will reduce the impact on GPs. These good schemes can be of overall benefit to the NHS. The sore throat service will be piloted in 40 pharmacies, and it is estimated that 8,000 consultations will be delivered this winter, which is good news.

All these measures were welcomed, but none brought the result of an NHS that was prepared last winter. Indeed, that has increased my conviction that we are in a more difficult situation this winter and that the pressure on the NHS cannot be relieved by these small measures. If the Minister can, will she say how the moneys announced by the Chancellor today will be allocated and how that will improve the NHS’s response to this winter?

We need GP practices to be able to refer their patients for an MRI and know that they will be seen in reasonable time, rather than making the referral and then telling the patient to go and spend the day in A&E to get the MRI. Such small but significant things would make a difference and improve the service overall. GPs also tell me that they do not trust the red flag system and that A&E is turning into that red flag system for tests. How can we blame GPs for trying to ensure that they do not miss anything and for using the system in this way?

We need more capacity for MRIs, CAT scans and mammograms, and we need more trained radiographers. One of the things announced today was a significant investment in radiography, but when it comes to allocating the funds we must consider the need to ensure that we recruit and retain radiographers. The Minister may not have the answers to these questions, but does she know what has been done to train more radiographers and improve our NHS?

As a result of there being too few radiographers, 188,881 people in Northern Ireland—nearly 10% of the population—are waiting for a diagnostic test. The wait means that treatment such as radiotherapy is delayed and cases become more complex. That is the nature of having a health problem; people should get seen early and respond early. For some patients, even a two-week delay can mean the difference between life and death.

This long-term issue needs a long-term vision. That is why I am asking the Minister to take seriously schemes that would encourage our intelligent and capable young people to train here and stay here. I have been a great advocate of this and have raised this issue on numerous occasions over the years. We want these young people to train here and stay here with their skills. University bursaries or forgiveness of student debt in return for a period of employment in the NHS would be a positive way forward. Could the Minister look at that too?

Young people go into debt very early on and find it hanging over their shoulders for years to come. If we offer them a job in the NHS and they commit to staying, we can improve things. We have incredibly capable, intelligent British students, and we need to invest in their long-term careers in the NHS and allow them to work alongside junior doctors. We must prepare them for the marathon of NHS life rather than give them sprints that they cannot sustain. We should get the system moving in that direction. I believe that there is work to do not simply for this winter but for every day of the winters yet to come.

14:59

[Steff Aquarone (North Norfolk) (LD)]

It is a pleasure to serve under your experienced chairmanship, Sir Roger. I congratulate my hon. Friend the Member for North Shropshire (Helen Morgan) on securing this vital debate. Our rural constituencies share many similarities, and the NHS winter crisis will be as great a source of concern for her constituents as it is for mine. She may or may not have noticed that she was speaking at the same time as the leader of the Liberal Democrats, my right hon. Friend the Member for Kingston and Surbiton (Ed Davey), was in the main Chamber. I am grateful to the Minister for attending the debate at the precise time that her colleagues are responding to my right hon. Friend’s questions. This debate could not be more timely, given the context of today’s Budget and the winter we are rapidly heading into.

As I hope many Members will know, North Norfolk is proudly the constituency with the oldest demographic in the country. That means that when our NHS struggles, North Norfolk is acutely vulnerable to its effects. I pay tribute to the hard work going on in Norfolk to prepare for winter in our health services. Our GP surgeries and community nurses are working day in, day out to deliver flu and covid vaccinations for thousands of eligible residents. I encourage anyone eligible who is yet to take up their free vaccinations to contact their GP and do so. That work is vital to building the resilience of our communities ahead of the cold winter months, and I know that local residents are incredibly grateful for it.

We are once again heading into a difficult winter. In my constituency we have historically had some of the longest ambulance waiting times in the country. In towns and villages such as Blakeney, Cley and Wells-next-the-Sea, people are subjected to appalling and unacceptable wait times for urgent calls. Nationwide, people are fearful of the crisis, with recent polling stating that one in four people have avoided calling an ambulance because they are worried it would take too long to arrive. This cannot carry on.

To ease the pressure on our hospitals this winter, we need people to be able to leave acute settings when they are ready, and to keep well enough to avoid going back in. To add to what my hon. Friend the Member for North Shropshire said about delayed discharges of care, that is yet another reason why I find myself completely baffled by the decision of the Conservative-led Norfolk county council to close the Benjamin Court reablement facility in Cromer. I declare an interest as a sitting Liberal Democrat member of that council.

The Benjamin Court facility helps to bring people back into the community, enabling them to recover in a more familiar setting. We know that convalescence works, reducing readmittance and enabling people to spend more time with their families as they recover. The integrated care board for Norfolk and Waveney says it wants to place a greater focus on recovery at home. I appreciate that may work for some, but it will not work for many. I am working alongside the campaign to save Benjamin Court to secure the future of the facility. I would greatly appreciate it if the Minister could take the time to meet me and representatives from the campaign to discuss why that vital service must be maintained.

Winter exacerbates one of the major challenges for people in North Norfolk accessing healthcare, which is our inadequate rural public transport. Wintery conditions and car reliance do not mix well; that is the reality that will present to many if they have an early morning appointment at one of our hospitals. People are faced with multi-hour round trips when using rural buses, and limited times when they could make an appointment, let alone the impact that any winter-led delays will have on their plans. To improve my constituents’ access to healthcare, we must also improve their access to public transport.

I fully support the Liberal Democrat plan to winter-proof our NHS, and a winter taskforce with ringfenced funding will go a long way to building the resilience that we need in North Norfolk. We cannot keep lurching from crisis to crisis each winter, stuck in one of the doom loops that the Chancellor spoke about before the Budget. We need to see a change of approach, a funding settlement that is proactive and not reactive, and an NHS that can fully support people across North Norfolk all year round.

15:04

[Richard Foord (Honiton and Sidmouth) (LD)]

It is an honour to serve under your chairship, Sir Roger. I, too, pay tribute to my hon. Friend the Member for North Shropshire (Helen Morgan) for securing and speaking in this debate on a day when she, as the Liberal Democrat health spokesperson, has a lot else to do.

As we face another winter, our NHS is under severe strain. In east and mid Devon, where I am from, the situation is all too apparent. We have five community hospitals across Axminster, Honiton, Seaton, Ottery Saint Mary and Sidmouth, where we see hard-working staff do their absolute level best to deliver a whole range of vital services, such as audiology, X-ray and rheumatology. The hospitals have had their services reduced or even removed over time, which has led to the overburdening of the large acute hospitals.

The unfortunate reality is that the NHS is struggling in terms of acute hospitals like the Royal Devon and Exeter hospital in Exeter. The statistics in the south-west from last winter illustrate that well. Across Devon, 33% of patients in A&E waited more than four hours in February last winter, which is well above the national average. That means that rather than ambulances being out in the streets and lanes saving people’s lives, they spend 30 minutes or more waiting in queues outside, with 31% of ambulance arrivals at the RD&E last winter unable to offload patients in a timely manner. That might suggest to some that we need to put more money into ambulances and acute care, but that is not borne out in the research as the exclusive solution to the problem.

A King’s Fund report recently found that the failure to grow and invest in primary and community health and care services ranks as one of the most significant and long-running failures of health policy over the past 30 years. Today, we heard a Budget from the Government that pledges more funding for the NHS; we worry about what that might mean in respect of the absence of support for social care. Because the system is reactive, we spend increasing amounts on acute hospitals and crisis response rather than on the proactive primary and community care that could reduce hospital demand in the first place. That imbalance means that funding is funnelled into hospitals, where people go once they are very ill, and it leaves the community services that could prevent crises unable to do the preventive work they should be doing.

Our community hospitals in places like mid and east Devon are proof that effective healthcare is not just about big hospitals. I would like to see localised, specialised care that prevents and treats issues early and close to home. Community hospitals should offer more than just treatment; they are also about routine check-ups and screenings. They are places that people go to manage chronic conditions and to receive other ongoing care.

I stress that we have excellent healthcare staff in Devon—in the community hospitals, in primary care, in GP surgeries and in the acute hospitals—but year after year they are asked to do more with less. With more community-based teams, working closely with social care providers, we could avoid many of the delayed discharges we see in the acute hospitals. More than one in eight acute beds in England is essentially blocked, with 14,000 patients clogging the system. I do not mean to put it in those terms—I know that individuals filling acute beds because they are unable to be discharged sometimes feel like a burden, and I do not want that to be the case—but the fact of the matter is that there are acute beds that could be released for other needy patients.

Winter brings respiratory infections, flu and respiratory syncytial virus, all of which hit the elderly, the young and those with long-term health conditions the hardest. Flu vaccine uptake in the south-west is not where it needs to be, at only 46.5% last winter, and I urge people with long-term conditions to get vaccinated. When flu and other winter illnesses surge, the community health services and facilities can pick up some of the slack and reduce some of the pressure on hospital beds.

If we can shift to a focus on community help, it will be about preparation. I know it is challenging—it must be, or we would have done it in the last three decades—but we now need a concerted effort from national and local leaders to support that shift and support people in managing their own health before they are in crisis, so as to relieve the pressure on acute hospitals.

15:10

[Dr Danny Chambers (Winchester) (LD)]

I thank my hon. Friend the Member for North Shropshire (Helen Morgan) for securing this timely debate.

In Winchester, the NHS is the No. 1 issue for nearly everyone, and it will be the same for the rest of the country. Patients and staff are aware that we have a huge challenge every winter. Hospital managers and chief executive officers must be so frustrated that they have to face that challenge every year. From what I understand, having spoken to quite a few hospital managers and CEOs of hospital trusts, over the last few years, at about autumn time, they have applied for extra funding to deal with what will be a winter crisis, and by about November they have heard whether they will receive it and how much they will get. They have then received the money by about January, when we are already halfway through the winter, despite the fact that winter comes every year and we know that there will be a winter strain on the NHS.

In the spirit of constructive opposition, I will talk about four issues that we should consider when it comes to future winter challenges. The first, as has been mentioned by nearly everyone, is social care. In the Hampshire hospitals foundation trust, there are between 160 and 200 people at any given time who are well enough to go home but do not have anywhere to go, often because of the lack of social care packages. We have talked about the flow through hospitals; if A&E cannot take patients into hospitals because the beds are occupied, ambulances end up queuing outside hospitals, and the knock-on effect is a huge delay in ambulance response times.

My hon. Friend the Member for Chichester (Jess Brown-Fuller) mentioned that one in four people now worry about calling an ambulance over the winter because they are worried that it will be a long time until it arrives. The frustrating thing is that providing social care packages is more cost-effective than keeping someone in a hospital bed, so while not having social care packages in place so that people can be moved out of hospital in a timely way is not good for patients, it is not even cost-effective for the taxpayer.

Nearly every speaker has brought up primary care: everything from doctors and dentists to mental health and public health. Some 22% of the people who arrive at a typical A&E are there because they cannot get a GP appointment. People are turning up with tooth root abscesses, and often end up needing general anaesthetic to sort out dental problems that could have been avoided had they been able to get an NHS dentist.

Desperate mental health patients, who are often already on a waiting list, walking into A&E take up a huge amount—up to 30%—of an A&E department’s time and resources. People wait years after being referred for mental health care by their GP and then end up in A&E, taking up time and resources during the winter crisis. That is not a good use of taxpayers’ money, it is not good for the patients, and it is hugely stressful for the staff. It is always more cost-effective to keep people healthy in their community and treat them early than to treat them in A&E. It is not the place for people in a mental health crisis, people with severe dental issues, or people who just cannot get a GP appointment.

My hon. Friend the Member for North Shropshire mentioned vaccination and when we talk about public health, we talk about prevention and cost-effectiveness. Vaccines are the single most cost-effective health intervention that has ever been developed throughout the world for pretty much any disease, but it is concerning to hear that the number of NHS staff being vaccinated is dropping. That is dangerous both for their health and for patients’ health. We should certainly examine and unpick that, and try to explore why the number of NHS staff taking the flu vaccine has gone down. We need to engage with them to give them the confidence to take the vaccines as well as access to them to ensure that we have as high a vaccination rate as possible.

My hon. Friend the Member for North Shropshire also mentioned this, and we need to act in our communities because of flu, covid and RSV. The situation is always worse in winter. We know that it will be worse and the risk of immunocompromised people turning up to a hospital and waiting in an A&E department, surrounded by other patients who are infectious because they have not managed to get a vaccine, is a huge issue.

The hon. Member for Strangford (Jim Shannon) talked about pharmacies and community care, which are a huge part of the jigsaw in making vaccinations available to the general public. Local pharmacies need all the support that we can give them to ensure that they are open at convenient times—and that they stay open, because a lot of pharmacies have closed. Ideally people—especially vulnerable people—should be very close to a pharmacy so they can get the vaccinations that they need.

Finally, every other Liberal Democrat Members who spoke today talked about the Liberal Democrat winter taskforce and how we would really appreciate the Government looking into our proposals seriously. We are spending the money in bit-pieces every winter anyway, so we should have a much more joined-up and long-term plan about how we deliver healthcare over the winter and ease the pressure on our hospitals. That would be hugely beneficial.

I pay tribute to NHS staff. I imagine that they dread winter coming. This is the time of year when they will be bracing themselves, knowing that they will be busier, knowing that they will be working without the right resources and knowing that some of them will get sick with flu, covid and all the other diseases that come in. We thank them for putting their health at risk and for putting in their time and expertise to look after our health. As the Liberal Democrat mental health spokesperson, I acknowledge what a drain it must be on their mental health to work in such situations.

Finally, I have a question for the Government. We know that winter will come every year; it will come next year as well. What are we doing to ensure that we do not have a planned crisis in the NHS next winter?

15:17

[Saqib Bhatti (Meriden and Solihull East) (Con)]

It is a privilege to serve under your chairmanship, Sir Roger, and I thank the hon. Member for North Shropshire (Helen Morgan) for securing this debate on what is an important day.

As the hon. Member for Winchester (Dr Chambers) has, I pay tribute to NHS staff who are dealing with significant demands in urgent and emergency care, which are particularly acute in a post-pandemic world. In the time that I have available, I will press the Government on the actions they are taking to increase vaccination uptake and to make use of available private sector capacity. Vaccination was the key to protecting the population from covid-19 and to ensuring that the virus could be managed and contained like other respiratory illnesses. Delivering the successful vaccination programme was one of the many benefits of leaving the European Union, which was a cause championed by the previous Government.

We must continue the push to protect the most clinically vulnerable and to reduce hospital admissions for RSV, flu and covid-19. I welcome the national RSV vaccine programme that was launched earlier this summer, and I would welcome an update from the Minister about the uptake of that vaccine among eligible groups.

I am concerned by recent data that shows that the uptake of the flu and covid-19 vaccines among eligible groups is lower compared with the same time last year. Figures on the uptake of the flu vaccine in the week commencing 20 October 2024 showed that the vaccination rate was 48.2% for all those aged 65 or over, which is lower than it was in October 2023. That means the picture for those people is worse. In the clinical risk group, only 20.8% of people had been vaccinated, which again is a worse uptake rate than that for last October. Given these worrying figures, what actions will the Government and the NHS take to promote vaccinations among eligible groups, particularly those at greater clinical risk?

As other hon. Members have stated, many NHS hospitals and secondary care settings are working at close to full capacity. For that reason, we must maximise the use of private sector hospitals and other facilities to reduce the pressure on the national health service. The Telegraph recently reported that private health providers have written to the Chancellor and the Health Secretary to propose a major expansion in the use of private sector facilities and staff for NHS treatment. It was stated that private sector investment could help build diagnostic capacity and,

“develop new surgery units and intensive care facilities.”

If I am not mistaken, the Health Secretary has spoken about the use of private sector facilities, so will the Government support the proposals, which would see an extra 2.5 million patients treated in private hospitals with the potential to cut NHS waiting lists significantly?

As we are talking about waiting lists in the winter, I want to turn to the winter fuel allowance, which is being cut. What is the Government’s assessment of the impact and pressure on hospitals from the withdrawal of the allowance? I believe that the Labour party put out an analysis back in 2017 stating that 4,000 people would be at risk of death from such a withdrawal. Can the Minister clarify whether that analysis is still correct and what the thinking is in the Health Department in response to the withdrawal?

During the winter months, protecting bed space for elective treatment is particular important for keeping waiting lists down. That is why we must also build on the capacity provided by community diagnostics centres and surgical hubs in recent years. The previous Government invested £2.3 billion to establish CDCs, which represented the largest cash investment in MRI and CT scanning capacity in the history of the national health service. In addition, the Independent Health Foundation has highlighted the positive impact that surgical hubs made in reducing waiting lists and increasing bed capacity. Despite their impact, Lord Darzi’s report on NHS performance made no reference to the role of CDCs and surgical hubs in helping to reduce waiting lists. On expanding the network of surgical hubs, and bearing in mind that the Budget is taking place in the main Chamber, it would be helpful to get some clarity on where the additional funding will be spent. Will the Minister commit to having more surgical hubs so that more patients across the country can access elective care quicker?

Will the Minister also commit to expanding the network of CDCs, which have delivered more than 7 million tests, scans and checks since 2021. The last Government supported national health service trusts to increase elective activity after the pandemic, particularly through the elective recovery fund, which reimbursed trusts for the operations they delivered. However, earlier this month the Health Service Journal reported that Ministers were considering whether to pause or cap the fund. At the election, Government Ministers stood on a manifesto that pledged to reduce waiting times for elective care, such as on hip and knee replacements, to 18 weeks by the end of the Parliament. Pausing or capping the elective recovery fund will surely affect the Government’s pledge to cut waiting times and risk placing further pressures on national health service finances. I am sure NHS leaders would greatly appreciate the Minister providing clarity on that point, so can she rule out the elective recovery fund being capped or paused this year?

To finish, as has already been said, I want to encourage anyone who is eligible to make sure they go and get vaccinated in advance of this winter.

15:23

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Sir Roger. I thank the hon. Member for North Shropshire (Helen Morgan) for securing the debate and hon. Members for taking part.

We have all just rushed from the main Chamber and I think I am the only person here who has come out enthused and excited after what we heard about the massive support offered—particularly for the NHS. It is the first Labour Budget delivered after the 14 years of the coalition and the Tory party’s time in power, and it lays the foundations for fixing our economy.

Just in case people did not clock all the figures, there will be £22.6 billion in day-to-day extra spending on the health budget, including a £3.1 billion increase in the capital budget, £1 billion of which helps address the backlogs of repairs that have been allowed to fester over the past 14 years. There is also an additional £1.5 billion for beds, new capacity for diagnostic tests, surgical hubs and diagnostic centres, to address the key point made by the hon. Member for Meriden and Solihull East (Saqib Bhatti). Let us take some of that funding and not just stop the decline but fix the foundations, setting the path for the next 10 years, as we have clearly articulated in the few weeks that we have been in government. When I speak to my constituents in Bristol South, they are most concerned about the NHS spending every penny of taxpayers’ money wisely, properly and where it needs to be focused. That is why we have concentrated on our three shifts and launched this national conversation—I hope everyone takes part.

We all know the problems, and that is what Lord Darzi helped us address. We also know that winter is a difficult time for our health and care system. Although we cannot predict the severity of the weather, we can predict much of the activity, we know what is likely to hit us most of the time, and we can certainly plan better. I remember working on the issue as a NHS manager back in the day, across primary, community, and secondary care, as well as with ambulance services and local authorities. A systems response is needed, and it is important that we are all involved in preparing and planning.

I also remember just how demoralising it was for staff in the early 2000s, coming into work every day to fight fires and sort out the awful trolley waits—not to mention how unacceptable that was for patients and families. The point about the impact on staff’s mental health and morale was well made by the hon. Member for Winchester (Dr Chambers). I also saw, and was proud to be part of, the changes we made under that Labour Government to end those trolley waits, and we will do that again. That is what Lord Darzi’s report shone a searing spotlight on, including the chronic lack of capital investment that has put many hospitals into a perpetual bed crisis, particularly during peak periods such as winter cold snaps.

While we have inherited a broken NHS, it is not beaten. As we have just heard from the Chancellor, this Government have taken the first steps towards fixing the annual crisis with new capital investment. However, one Budget cannot undo the last 14 years of failure, so while we fix the foundations we are also mitigating the immediate risks. At the very least, going into this winter we will be better prepared than we were last winter. That is because the managers in the NHS will be preparing for winter rather than planning for strikes, which is what they had to do the last three years—already a significant improvement.

The health service does face challenges on all fronts, and the figures are sobering. We have heard some of them today. In September, provisional statistics showed that almost one in 10 A&E patients waited over 12 hours to be admitted, transferred or discharged. The mean category 2 response time in September stood at about 36 minutes—around double the NHS constitutional standard. I recently attended a meeting where officials highlighted the number of attendances requiring admissions are already up by 1.8% in September compared to 2023, which is continuing to place increased pressure of patient flow. Those are the results of deep structural issues in the NHS that will not be fixed overnight. But work is already under way to rebuild resilience and manage pressures across the health and care system this winter.

I will come on to the specific work being done, but I assure hon. Members that the Government are taking the issue extremely seriously. I am already meeting senior leaders in NHS England and the UK Health Security Agency every two weeks to ensure that the risks can be identified quickly and that pressures are managed effectively. Once the peak winter period hits, the meetings will move weekly and include the Secretary of State.

Local NHS systems are best placed to determine how to respond to issues in their local area. That is why NHS England has worked with local systems to ensure robust winter plans are in place at a local level. As someone who knows exactly what is involved in that planning, I pay tribute to the staff for their skill, motivation and commitment to protecting every patient this winter.

[Jim Shannon]

There is no better choice the Government can make than committing that money to the NHS—we all welcome that. Anybody who does not would be insane. I always try to be constructive in my contributions. I asked about staffing and made the suggestion to retain students wherever they do their training. Sometimes they come to the end of it and go somewhere like Australia or New Zealand to get a job. Instead of that, if Government were to consider a bursary-type system to retain the staff, I think we would be able to address some of the pressure that we have.

[Karin Smyth]

I will come on to staffing to address some of those points. The hon. Gentleman makes an excellent point about staff recruitment and retention, which is a key part of our future look at the system.

On winter planning, the Government should not be micromanaging people in local systems as they do their job. Rather, we need to focus our efforts on where they are needed the most. Notwithstanding the excellent work of individual staff, let me repeat: the NHS is broken. None of us should underestimate how difficult this winter could be, but we are taking immediate steps to cushion the blow. First, we have set out our national winter planning priorities to NHS systems, local authorities and social care providers to support operational resilience over the coming months. Secondly, we are standing up the winter operating function seven days a week to respond to pressures in real time.

Thirdly, we are expanding the operational pressures escalation levels framework to give us a clearer picture of what is happening on the ground in all our systems. The framework uses comprehensive data to keep track of hospital pressures, and this year we are expanding its scope to mental health, community care and 111. Fourthly, we are continuing to support systems that are struggling the most through the urgent and emergency care tiering programme. Those are direct interventions to help systems get back on their feet and make the necessary improvements in performance.

Fifthly, we are providing targeted, clinically-led support to 19 of the most pressured hospital sites across the country, to help long waits in A&E and avoidable admissions over winter. Those measures are in addition to the aforementioned meetings that I hold with NHS England and UKHSA every fortnight. I am chairing every one of those meetings to ensure that we identify risks as soon as they arise, while supporting NHS England to mitigate them.

The party of the hon. Member for North Shropshire has called on the Government to set up a winter taskforce to prepare for an NHS winter crisis. Some might describe what we are doing as a taskforce; I actually think that is my job and the Secretary of State’s job, which, as I have outlined, is why we meet regularly with NHSE. I know that the hon. Member and others are sincere in their efforts to be constructive. I am happy to take away any specific suggestions about what we are not doing to help the NHS, because we all want the system to work well.

[Dr Chambers]

There has been no mention of increasing social care packages. Today, I spoke to the CEO of Hampshire hospitals trust, which runs Winchester hospital, and she said the single biggest thing that would make a difference over winter for that hospital, and probably every other one in the country, would be increasing the number of social care packages and ensuring that those well enough to leave hospital can be treated and cared for elsewhere. Why is that not the main focus of the winter measures that the Minister is talking about?

[Karin Smyth]

I will come on to social care, but I will make the broader point that every system is different, and the pressures in every system are different. Some systems suffer worse from poorer levels of primary or community care. Others, particularly those across borders, struggle with discharges and packages of care. One thing I am keen to do, and we are doing it, is try to understand the different drivers of performance in different parts of the system. I think we all have a role to play in that.

I very much support constructive advice from local Members of Parliament, in consultation with their local trusts, about the real drivers in their systems, because we know that some systems are performing much better. We as a new Government want to address that issue, to ensure that taxpayers’ money is being directed to the best place to make the system work better. That is something for the hon. Member for Winchester to take back. The flow is affected for different reasons in different parts of the system.

Several hon. Members have mentioned vaccinations. A key part of winter planning is the annual vaccination campaign, which began on 3 October. I thank the hon. Member for North Norfolk (Steff Aquarone), the hon. Member for Winchester and the Opposition spokesperson, the hon. Member for Meriden and Solihull East, for mentioning their support for vaccination programmes, which is absolutely welcome.

People talk about verifying the figures, but my understanding—I am happy to be corrected—is that we cannot verify the actual figures now. We have started different vaccination rates at different times, so the figures are not directly comparable. We will not really know that until the year works through, which I think people understand. It is too early in the vaccination season to draw firm conclusions, but we all have a role to play in driving and encouraging people to uptake vaccinations across the piece. I recently visited a local hospital in my city of Bristol which has staff hubs and encourages staff to go into the clinics. All Members’ efforts to help with that is really helpful. Vaccination programmes play an essential role in protecting people, particularly the elderly, children and the clinically vulnerable from serious illness during the winter months and in relieving pressures on hospitals and the wider system.

Data from the UK Health Security Agency shows that last year people who received a covid vaccine were around 45% less likely to be admitted to hospital compared with those who did not receive one. That is why we are delivering our usual campaigns for covid and flu for the clinically vulnerable in addition to the RSV work that is going on.

With regard to elective activity, for patients who are referred to a hospital we want to do everything we can to bring down waiting lists, which stood at over 7.5 million in August. The NHS is prioritising patient safety, urgent and cancer care and will continue to do its best to maintain appointments and elective procedures by separating elective care facilities and diagnostics wherever possible. In the longer term, we are going to return to 92% of patients waiting no longer than 18 weeks from referral to treatment in our first term, a standard that has not been met consistently for patients for a decade.

Our hospitals do not operate in isolation. Improving resilience across the whole system, including social care, is essential to winter planning. On 17 September we wrote to all local authorities setting out our priorities for improving resilience across social care ahead of winter, emphasising the importance of close partnerships and joint planning between the NHS and local authorities. We want people to have fair access to locally delivered services that start at home and support them to live independently for as long as possible. That will include building bridges between the NHS and social care services, getting people home from hospital as soon as they are ready, and providing much-needed support to families and friends who are involved in a loved one’s care. We will also work to ensure that people are not stuck in hospital beds when they are well enough to go home.

We cannot forget that the backbone of social care is carers. We have made it clear to all local health and care systems that they must continue to support people providing care for their family and friends throughout the winter. I am sure all hon. Members will join me in supporting the Chancellor’s Budget announcement today to support our carers more widely. We want to make sure that carers can access the support they need to look after their own health and wellbeing, not just that of the people they care for. The better care fund includes funding that can be used for short breaks and respite services for carers. The Government are clear that people who draw on care and support, and their families and carers, should be closely involved in decisions about their care. However, in the long term we clearly need reform. That is why the Secretary of State has called for a new national consensus on social care.

The Government are committed to building a national care service. My hon. Friend the Minister for Care is introducing the first ever fair pay agreement for care workers. Again, we have seen today our commitment to further support carers with improvements to carer’s allowance. That is a start, but we know we have a long way to go.

We are working radically to reform the NHS through the 10-year plan, building a health service that is fit for the future and ready to face every winter confidently. Lord Darzi gave us the diagnosis; the cure can be found in shifting the NHS from treatment to prevention, hospital to home and analogue to digital. That is why last week we launched an extensive engagement exercise with the public, staff and stakeholders to inform that plan. Some right hon. and hon. Members might be keen to see some of the public’s wilder ideas, perhaps, but alongside some of those we have already had many considered and thoughtful responses, and we look forward to outlining our specific plans in the spring.

With regard to the point made by the hon. Member for Strangford (Jim Shannon) about individual training and bursaries and the large number of suggestions about the important issue of recruiting and retaining our staff, we will look closely at the long-term workforce plan—we are already doing that. We are open to suggestions. We need to build a workforce for the future that lines up with our three shifts. It will be a tough process to get right and to keep up with modern technology, but all those ideas will inform that.

I commend the hon. Member for North Shropshire for securing the debate today and colleagues for shining a spotlight on the difficulties that our constituents face. I hope colleagues are reassured. As someone who has worked on winter planning in the NHS, I am fully aware of the challenges that we face. That is why we have taken a strong grip of it from the get-go. I know we cannot go on as we have done for the past 14 years, limping from one winter crisis to the next, improvising and making do with sticking plasters. The Government are winter-proofing the NHS with long-term reform, but until that day we will put every hand on deck to tackle the problems as they arise this winter.

15:39

[Helen Morgan]

I thank you, Sir Roger, the Minister, the shadow Minister, all my Liberal Democrat colleagues and the hon. Member for Strangford (Jim Shannon) for coming to this debate on a very busy day. I am grateful for all their contributions, which were positive and constructive, as always. I thank the Minister in particular for her comprehensive response. It is reassuring to hear that she has considerable expertise in this area.

We welcome the investment that was announced in the Budget, including significant investment in day-to-day NHS spending, capital investment and investment to deal with the repairs backlog, which needs urgent attention. We called for the Government to address the backlog in our general election campaign, because we recognise its importance. However, the very nature of the Budget statement means that we have been a bit light on detail today, and that is why we want to provide constructive opposition and ideas to move this forward.

I reiterate my concerns about social care. Little was said about it today, but many social care providers are small businesses that will be heavily impacted not only by the increase in the minimum wage, which is welcome for carers, but by the increase in employer national insurance contributions. We risk a real crisis in those companies and in local government budgets, which are perilously stretched, if we do not have a plan to fund those carers and their wages. I leave the Minister with that thought, and thank everybody for attending.

Question put and agreed to.

Resolved,

That this House has considered NHS readiness for winter 2024-25.

15:41

Sitting suspended.

COP29 and International Climate Finance

Wednesday 30th October 2024 Westminster Hall

16:00

[Ellie Chowns (North Herefordshire) (Green)]

I beg to move,

That this House has considered COP29 and international climate finance.

Thank you very much for calling me to speak—do I refer to you as Mr Speaker?

[Sir Roger Gale (in the Chair)]

Sir Roger.

[Ellie Chowns]

Thank you, Sir Roger—I am still learning the ropes. I thank the Minister for coming to respond to the debate. It is my pleasure to introduce this debate on international climate finance, and I particularly appreciate the presence of so many colleagues, given that it is an extraordinarily busy day when, with the Budget, we are discussing domestic finance. I may have one or two words to say on that in a moment.

This debate is particularly important, because we are in the run-up to COP29—the conference of the parties—in Baku. It is supposed to be the finance COP, because it is crucial that we mobilise the necessary finance to tackle the global climate crisis. My purpose in securing this debate is to encourage the Government to put a bit more flesh on the warm words that we have heard so far. I recognise those warm words: for example, the Foreign Secretary saying that he wanted to put climate change “at the centre” of foreign policy—that is welcome—and the commitments from the Secretary of State for Energy Security and Net Zero on domestic investment. However, there is still much more to do.

I will give the Minister advance notice of the topics on which I would love her response. At COP29, we are looking for the international community to agree a new collective quantified goal for climate finance in the trillions of dollars, not the billions. That is the scale of the challenge that we face. Do the Government recognise that, and are they prepared to play their part in leading from the front to ensure that there is collective commitment to the goal?

International climate finance needs to tackle mitigation, as well as the urgent need to invest to reduce emissions of greenhouse gases. It needs to tackle adaptation, because an enormous amount of global warming is already built into the climate system through historical emissions. It also needs to tackle loss and damage: the costs that are already being borne particularly by the most vulnerable in the poorest countries, and are due to the historical debt that early industrialising countries built up through our burning of fossil fuels.

[Bambos Charalambous (Southgate and Wood Green) (Lab)]

For some low-income countries, one of the biggest factors is debt through private creditors, which I think is greater than the other debt that a lot of those countries owe. Does the hon. Lady agree that the matter of debt owed to private creditors must also be addressed to tackle the need for more funding for climate emergencies?

[Ellie Chowns]

The hon. Member raises an important point. There is a history of multilateral and bilateral efforts by Governments to tackle debt crises, and there is a role for government to play in regulating the private finance sector to prevent vulture finance, effectively, from preying on countries in that way. There is a key need for international co-operation to address that issue, because the lenders are from all over the world. If a country has debt relief through one process, it is crucial that it does not then find itself stuck in a debt crisis in relation to another lender. I would be glad to hear the Minister’s proposals on debt relief.

My third point is that it is essential that international climate finance comes largely in the form of grants, not loans. The UK Government generally have a good record: roughly 85% of the climate finance we have committed has been through the form of grants, and I believe that commitment is in place until 2026. Will the Minister commit to that figure remaining a floor? Will she seek to increase it, so that the vast majority of climate finance is provided in such a way that it does not build up debt repayment problems for the future?

[Sam Rushworth (Bishop Auckland) (Lab)]

I welcome the point the hon. Lady is making. Thirty-four countries in Africa are spending more on debt interest than on health and education. If we are to talk about a just transition, it is simply not right that the poorest people in the world should be paying for it. That gives force to what she is saying. Will she comment more on ensuring that this is a just transition?

[Ellie Chowns]

Absolutely. The hon. Member makes a very important point, which relates to the one I made at the beginning: we cannot avoid the fact that we in the UK have an historical responsibility to take action on climate finance. We need to ensure that we are not storing up further problems for the future by providing climate finance in the form of loans, which make things harder for the poorest people in the poorest countries. Frankly, it is a scandal that, as he says, so many people in the poorest countries find that their Governments are spending more on debt repayments than they are on investment in crucial health and education, which build what we sometimes call the human capital that is so essential to sustainable development in such countries. I very much hope that the Government will lead on this issue and ensure that climate finance is in the form of grants—all of it, if possible, but at least the very largest proportion of it.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing this debate. I spoke to her beforehand, and the subject is incredibly important. According to international climate finance reports, 14 programmes have been initiated to support farmers across the globe to improve their access to clean energy. As she rightly said, that is an objective not only internationally, but at home. Does she agree that the Government must do more to assist farmers domestically across the United Kingdom of Great Britain and Northern Ireland with incentives for greener and cleaner farming?

[Ellie Chowns]

I thank the hon. Member for making that point. This debate is on international climate finance, but I am happy to address his question about the interaction between domestic policy and the climate crisis that we face. I was disappointed not to hear in the Budget statement any commitment on climate or nature. Indeed, reading the detail on page 37 of the Budget, we will have a real-terms 2% decrease in the Department for Environment, Food and Rural Affairs budget over the next two years. Investment, however, is vital. Nature-friendly farming in the UK is one of the crucial ways to reduce our own emissions and get a little closer to doing our fair share of mitigating climate change. Another issue close to my heart is the role of DEFRA in tackling water pollution, and again we are not seeing that. I agree that investment domestically in nature-friendly farming and environmental policies is crucial. We have to put our money where our mouth is, and we have to ensure that we ourselves are on track to meet our climate goals.

At COP28 last year, the stocktake found that the world is off track to meet the 1.5° target. In itself, that commits us to serious effects already. In real life, we see increasing drought and wildfires, and the increasing frequency and severity of flooding in our own country. We know that climate change is happening. We have to do everything possible domestically to tackle it.

My fourth point is that international climate finance must be additional to aid. In recent years, we have seen not only a shameful, in my view, reduction in the overseas development assistance budget—I strongly urge the Government to bring that back up to 0.7% as soon as possible—but the wrapping of all sorts of other costs into the ODA budget. A real risk, if we put international climate finance into the ODA budget, is less money to spend on health, education and all those policies that are so essential to tackling international poverty and inequality. International climate finance must be treated separately from ODA.

My fifth point is about where the money should come from. Again, that is an important topic on Budget day, and indeed I will digress slightly to comment on the Budget. One policy we have seen today is a retention of the fuel duty freeze, which is effectively a subsidy for fossil fuels. That is clearly incompatible with the Government’s rhetoric on climate change. We should lead the way as a country in pushing for “polluter pays” taxes to generate the finance necessary to meet what I hope will be strong and ambitious international climate finance goals, because—to recap—this is urgent. 2024 is on track to be the hottest year ever on record. This change is going only one way. I do not know how many economists and scientists we need to tell us that the investment must come early—as soon as possible—because the transition will get more and more expensive. The longer we leave it, the costlier it will be, not just financially, but in terms of the effect on human lives. COP29 is a crucial moment in the international climate negotiations.

I very much look forward to hearing from the Minister how she will ensure that the UK plays a leading role, putting our money where our mouth is and doing everything possible to influence international partners to ensure that climate finance is sufficient to address the challenge that we face.

16:11

[The Minister for Development (Anneliese Dodds)]

It is a real pleasure to serve in this Chamber with you in the Chair, Sir Roger. I am grateful to the hon. Member for North Herefordshire (Ellie Chowns) for securing this debate and speaking so powerfully. I will do my very best to answer her questions in setting out the Government’s approach to this genuinely critical area, which is so important for all our futures, particularly those of the poorest people in the world.

This Government are getting on with reconnecting Britain to the world and modernising our approach to international development in a spirit of genuine partnership and respect, as I set out in a speech at Chatham House a couple of weeks ago. That speech built on the Foreign Secretary’s lecture at Kew Gardens, in which he reiterated our view that action on the climate and nature crisis must be at the heart of everything that we do. I am grateful to the hon. Member for North Herefordshire for making reference to that; it is a genuine and important commitment. We believe that action on the climate crisis is critical to grow our economy and bring opportunities to people across our country and globally, and we know that our partners around the world share that ambition. When I was in Indonesia, for example, I was pleased to sign an agreement on critical minerals with the Government there, working on the climate crisis and green growth with them. We have a strong shared agenda, and we need to solidify that partnership globally.

[Mr Toby Perkins (Chesterfield) (Lab)]

I congratulate the hon. Member for North Herefordshire (Ellie Chowns) on securing this important debate. We have already heard that the UN has identified a need for £600 billion of additional private finance if we are to tackle climate change. Does my right hon. Friend the Minister agree that in the UK, due to the expertise of the City, we are uniquely placed to lead on that? Does she also agree that the UK delegation to COP in Baku must make an ambitious new goal for private investment in the climate a major priority?

[Anneliese Dodds]

As ever, I absolutely agree with my hon. Friend on every point. With your permission, Sir Roger, I will come back to the subject of private finance in a moment, as well as to the precise contours of our engagement around leadership in the COP system and, more broadly, in innovation in this area. I am grateful to my hon. Friend for raising those points.

We are clear that situations of extreme humanitarian need globally are so often driven by conflict and climate crisis—in fact, they are often driven by the two intertwined. I unfortunately saw that for myself in South Sudan, at the Bentiu camp for internally displaced people. People escaping the horrific civil war in Sudan are managing to make it to the IDP camp, but they are surrounded by floodwater. It is now a permanently flooded area, making an already horrendous situation worse. We need to recognise the fundamental impact that the climate crisis is having right now, as the hon. Member for North Herefordshire rightly underlined.

My hon. Friend the Member for Chesterfield (Mr Perkins) rightly mentioned the COP system. I will come to the climate COP in a moment, but the UK team is currently hard at work at the biodiversity COP—COP16—in Cali, Colombia. They are working with partners from around the world, from indigenous people to the presidency of next year’s climate COP in Brazil.

[Mr Perkins]

I am grateful to the Minister for giving way a second time. I have just returned from Colombia with a delegation from the United Kingdom at the biodiversity COP. I can report to her that there was huge support from across the world for the definitive action that the Government are taking and the leadership they are showing on nature and biodiversity. That should give her all the more confidence to make a strong case to those going to Baku.

[Anneliese Dodds]

I am glad to hear that. It appears that we are making strong headway in protecting and restoring the wonders of the natural world, both land and sea, including at that COP meeting. As the Foreign Secretary has said, we must consider nature along with climate when we face up to the problems and opportunities that arise from this situation. Nature holds so many of the essential, cost-effective solutions that can help us to meet many shared goals, including building climate resilience. It is important to consider both.

I am very pleased to be heading to Baku for the climate COP alongside the Prime Minister and the Foreign Secretary, who attended previously when in opposition. As well as coming forward with our own ambitious, nationally determined contribution for the UK at COP29, we are determined to support others to scale up their ambition and action. That includes initiatives such as the global clean power alliance, which the hon. Member for North Herefordshire may have heard mention of. That is a strong commitment from the new UK Government. We are determined to deliver greater political momentum.

The hon. Member for North Herefordshire talked about the relationship between domestic and international policy. For the first time, the UK is able to speak with credibility on this because of the new Government’s stating that we will not grant new oil and gas licences, removing the ban on onshore wind and introducing other measures. It shows that we are not just talking the talk—we are walking the walk. That kind of credibility is critical in these negotiations.

When speaking with our friends based on small islands and in fragile and vulnerable states, such as many of those the UK Government met with at the Commonwealth Heads of Government meeting in Samoa, we hear very loudly and clearly how difficult it is for them to access the finance that they need, especially climate finance. Very little of it is getting to those who need it, particularly fragile and conflict-affected states. The UK is determined to work with our partners to change that. I have prioritised, including at the World Bank annuals last week, trying to push hard for sources of climate finance and adaptation finance to be available. I am grateful to the hon. Member for Strangford (Jim Shannon) for mentioning the role of farmers. The proportion of climate finance that reaches farmers in the most fragile and conflict-affected states is minuscule, particularly for adaptation. That must change urgently.

I agree with the hon. Member for North Herefordshire that we must increase the level of dedicated climate finance from all sources across the causes and impacts of the climate crisis. We are determined to agree an ambitious new collective quantified goal; that is absolutely pivotal to our negotiations and vital to maintaining the global consensus of the Paris agreement and keeping 1.5° of warming within our reach. The UK is working extremely hard on this. The Department I am based in and the Department for Energy Security and Net Zero are working closely together and with our new climate and nature representatives. We have been carrying that forward at every opportunity.

[Ellie Chowns]

Will the Minister put a number on what she is talking about?

[Anneliese Dodds]

Of course, that collective quantified goal needs to be agreed. From the UK’s point of view, we are determined to exercise leadership. I am delighted that the Secretary of State for Energy Security and Net Zero, who was engaged in this 16 years ago and managed to achieve great things then, is working with my Department, our representatives and so many contacts from all across the world to say, “How can we put forward the overall figure that is needed?” It has to be jointly agreed, as the hon. Member knows. The most important thing is that we get a figure out at the end because if those negotiations do not succeed, we will be taking a step backwards when we are in a situation of such urgent need.

[Ellie Chowns]

Might the Minister be able to put a number on what she would consider UK leadership to be financially?

[Anneliese Dodds]

As the hon. Member rightly mentioned previously, the UK has traditionally been a funder in this area, focusing particularly on the quality of climate finance and ensuring that there is sufficient grant and concessional finance. That is something we are determined to continue to do.

I go back to the fact that it has to be a collectively agreed goal, but the hon. Member could not see a team working harder on this matter. We want to ensure that we get to an agreement. Of course, many forces do not particularly want to see the global north agreeing with the global south on this—we believe we can come together. In fact, at the Commonwealth Heads of Government meeting we saw the agreement within the Commonwealth around plastics pollution. We need to take that same spirit forward when it comes to this goal.

For our part, as well as co-chairing the global green climate fund, we are working towards making good on the UK’s pledge to get help to those who need it. We want robust roles to be agreed for article 6 on how countries co-operate to reduce emissions. We need real follow-through from the global stocktake on commitments such as tripling renewable power and doubling energy efficiency globally by 2030, and we need implementation of the national adaptation plans as we scale up finance in support. We have committed £100 million to the taskforce on access to climate finance that the UK co-chairs with Rwanda, and we are working with the World Bank and the board of the new fund for those facing devastating loss and damage; the hon. Member was right to mention that as being important.

There is a huge amount to do. A few days ago, as my right hon. Friend the Chancellor headed to the International Monetary Fund, I was at the World Bank in Washington pressing it to shoulder more risk so it can do more to unlock hundreds of billions of dollars and help the poorest and most vulnerable. To go back to the point mentioned by my hon. Friend the Member for Southgate and Wood Green (Bambos Charalambous), that has to include unlocking private finance, which is incredibly important, and we need to see innovation, too.

The hon. Member for North Herefordshire rightly referred to the fact that we need to be front-loading this funding right now. There is interesting innovation going on with some of the multilateral development banks, and we are pushing them to deliver on making that finance available as quickly as possible; when it comes to mitigation in particular, now is the time we need to be acting. We are championing financial innovation, including insurance and guarantees. Under the new Government, the UK has been pushing particularly for climate-resilient debt clauses.

I will finish on that subject of debt, which I know is of huge concern to many, and my hon. Friends the Members for Southgate and Wood Green and for Bishop Auckland (Sam Rushworth) were right to mention it. We have been pushing the G20 process for more action on debt. It is positive to see Zambia going through that process, but we need to see more action. That is why we are pushing hard on this and in the Paris club because it cannot be acceptable that we see such high levels of spending on debt rather than on health, education and, indeed, the kind of issues we are talking about.

[Ellie Chowns]

I refer back to the figure that the hon. Member for Chesterfield (Mr Perkins) mentioned—the UN’s finding that we need £600 billion of international climate finance per year to address the challenge that we face. That is actually the same amount that is invested in oil and gas every year. Does the Minister agree that we must put a complete end to all public subsidy or support for fossil fuel industries right now? Can she comment on the role that the UK could and should play in ending all such subsidies?

[Anneliese Dodds]

I am grateful to the hon. Lady for making that point. She may have heard the Chancellor state today that this new Government will ensure that what was described as a windfall tax on oil and gas companies, but did not operate as one because of the numerous loopholes, will be tightened up. We will ensure that support for decarbonisation is incentivised, rather than disincentivised, as it was under the previous approach to taxation, so big changes are taking place.

Now is the time for the global action that the hon. Lady rightly focused on. I was in New York for the UN General Assembly with some representatives of small island developing states, which are particularly hard hit. They said that their slogan used to be, “1.5 to stay alive,” but it is becoming, “1.5 and we might survive”. This really is urgent, and the new UK Government are determined to do all we can to exercise leadership, working in partnership with others.

Question put and agreed to.

16:26

Sitting suspended.

Roadworks: Journey Times

Wednesday 30th October 2024 Westminster Hall

16:30

[Lewis Cocking (Broxbourne) (Con)]

I beg to move,

That this House has considered the impact of roadworks on journey times.

It is a pleasure to serve under your chairmanship, Sir Roger. I declare an interest as a Hertfordshire county councillor. I am pleased to have secured this debate on a very important topic for my constituents. When I describe the constituency of Broxbourne to those who are not familiar with it, I often say that it is a collection of places without a dominant centre. Instead, many of the towns and villages that make up Broxbourne are connected by two main roads: the A10 and the high street, or the old A1170, which extends from Waltham Cross in the south to Hoddesdon in the north. Demand on those roads, as the main arteries between the residential and urban areas, is extremely high. If works are taking place at any location on our roads, the traffic standstill can affect almost the entirety of Broxbourne. That is a serious problem and, frustratingly, one that is not often discussed.

According to INRIX, a transportation data analytics company, the average driver in the UK lost 61 hours to traffic congestion last year alone—four hours more than the 2022 figure. Those delays are costing UK drivers on average £558 each. Staggeringly, that means that the cost of traffic delays to the country overall is an eye-watering £7.5 billion—yes, £7.5 billion. People wanting to enjoy their hard-earned cash are unable to spend as much time as they would wish at local shops. Small business owners and traders struggle to make appointments on time. The less time people have to earn or spend, the harder it is for our country and economy to grow. The Chancellor said today that economic growth will be her mission for this Parliament, so I hope the Government will recognise that point.

The economic cost is especially damaging in the constituency of Broxbourne, where more people use a car or van to get to work than the national average. Hundreds of my constituents have completed my survey to share their experiences of the roadworks and how they affect them locally. They have made it extremely clear how disruptive long waits in traffic caused by roadworks are to their daily lives. I have heard about delays in reaching elderly parents, carers finding it difficult to carry out their vital duties and children missing out on the start of the school day. It is not just car journeys; for many of my constituents, the bus service is a lifeline, and when roadworks have left our local roads gridlocked, buses are inevitably delayed. Pensioners in my constituency have told me that they have simply given up even trying to go out. The knock-on effects of missing serious medical appointments and of social isolation are obvious.

My constituents’ anger and frustration are made even worse by the fact that so often when they drive past roadworks, no one is working on them—and it can be the case that no one is working on them for days, or even weeks. We are told that the problem is urgent and the barriers and traffic lights are in place as an emergency measure, but can it really be an emergency if no workers are on site for such long periods of time? My constituents feel that there has to be a way for the vital work to be carried out quicker and more logically. Local authorities and utility companies must communicate much better between themselves to co-ordinate works in a sensible and cost-effective way. It cannot be right that the same stretch of road is dug up time and again, sometimes by different companies, but sometimes by the same company. Those organisations have to improve how they communicate with the public. It should be easier to find out why disruption is taking place and exactly how long it will be for. We cannot let it be the case, as my constituents have experienced, that residents wake up to find a four-way traffic light diversion in place, making it even harder to leave their house, get to school and go to work. We should use technology much better and come up with innovative ways to avoid static traffic where we can.

Here is an example. Someone drives up to a four-way traffic light, which is on the main road, but there is a side street with a few houses. All the lights will go green and red in sequence. We should be able to use technology so that the light only goes green down the cul-de-sac when a car is waiting to go. That is a small change that would make roadworks a lot easier for my constituents and others across the country to move about.

I welcome the fact that the previous Government set out plans for drivers and consulted on several policies to make it easier for everyone to use our roads. That included helping local authorities to establish lane rental schemes. Those schemes allow a highway authority to charge up to £2,500 per day for works on the busiest roads at the busiest times, with charges applying only to works carried out by utility companies and highway authorities.

The cost incentives to those organisations to move their works and carry them out at less busy times, or engage in joint working with others, are obvious. Around 95% of charges are avoided by taking those steps, meaning that disruption for drivers is minimised, without additional costs being placed on them by the firms responsible. Just four schemes are currently in operation, covering less than 10% of the road network in London and counties in the south of England.

Expanding those schemes across the country would raise significant funds for local authorities. As the previous Government proposed, at least 50%—I would suggest 100%—of the surplus funds should be directed to the repair of potholes, so that drivers can benefit from smoother journeys. I urge the Minister to publish the findings of that consultation, which closed on 11 March 2024, and introduce those measures.

[Mr Mark Francois (Rayleigh and Wickford) (Con)]

I congratulate my hon. Friend on securing this important debate. In the previous Parliament, I introduced a ten-minute rule Bill about the regulation of roadworks, which I am reintroducing next week. I am honoured to say my hon. Friend has agreed to be a sponsor, as has the Opposition spokesman, the hon. Member for Mid Buckinghamshire (Greg Smith). Does my hon. Friend agree that a key element is the handing-out of permits by highway authorities, which I am trying to tighten up on? If we could tighten that up, we could help to prevent many of the overruns that my hon. Friend so eloquently described.

[Lewis Cocking]

I completely agree with my right hon. Friend. There is a problem with a highway authority issuing permits. There is also a problem when utility companies use emergency legislation, where they do not even have to notify the highway authority of the works taking place. Residents can wake up, get in their car to go to work or school, drive to the end of their road and see the road being dug up, without any communication having been made with them.

We need to take a two-pronged approach. I am happy to support my right hon. Friend’s ten-minute rule Bill, to tighten up some of the regulation on this. We need to ensure that highway authorities are responsible when they issue permits. We also need to ensure that, when utility companies use that emergency legislation, they get someone working on site as quickly as possible to get that emergency fixed. Do not dig up a road, under claims of an emergency, put traffic lights in place and then allow our constituents to sit in traffic for hours on end while no one works on that site.

I am pleased to support my right hon. Friend and his Bill, which will include increasing the fixed-penalty notices for utility companies whose roadworks overrun, which is another important issue. As I have said, the threat of financial penalties for those undertaking these works can make a difference, so penalties for work that overruns should be increased in line with inflation, especially for regular offenders. I have said before that sometimes when the same stretch of road is dug up, it is dug up by different utilities. If those utilities worked together, it would save them money. It is absolutely extraordinary—and there are examples of this in my constituency—that the same utility company digs up the same stretch of road, virtually at the same point, just a couple of weeks after they finished digging it up. They really need to forward-plan and look at how they do such work.

These changes, along with lots of others, would bring down costs for consumers, so that we could spend our money where we want to in the economy and get to work or school on time. I hope that the Government will listen and take the side of my constituents and many ordinary working people across the country.

16:40

[Lee Pitcher (Doncaster East and the Isle of Axholme) (Lab)]

It is a pleasure to serve under your chairmanship today, Sir Roger, and I thank the hon. Member for Broxbourne (Lewis Cocking) for securing this important debate.

In this debate, I want to highlight the fact that cars are not the only vehicles affected by roadworks. Bus services are just as severely impacted, if not more so. Bus networks and timetables are highly sensitive to disruption. They can rarely change routes to avoid the impact of roadworks. A point of disruption that might result in a five-minute delay for a car will have a repeated and accumulating effect on a bus service over the course of a day, adding mounting disruption each time the bus service runs its route, until the whole timetable can just fall apart, along with the plans of the bus passengers.

Working to a timetable makes it extremely challenging for service users to adjust their journey plans when things happen in this way. Fixed capacities mean that even if people try to catch an earlier bus, they may well find that it is full. Delays on bus routes can have knock-on effects for transfers to other services or modes of transport, adding even more chaos and frustration to people’s journeys.

To give a recent example that affected my constituents in Doncaster East and the Isle of Axholme, one route experienced a 5% drop in service use due to roadworks, even though two additional buses had been added to alleviate the disruption. Although a 5% drop might seem minor, over the course of just a few weeks it translates to hundreds and potentially thousands of missed journeys, and the additional cost of putting on extra buses, combined with the loss in the number of fares, can have an impact on the funding of other services.

In another case, a bus service was subject to a 10% reduction in punctuality for weeks while roadworks persisted. I have heard of constituents who now walk an hour each day to use their nearest train station, rather than stopping for the bus right outside their door because they fear delays, cancellations and not getting to their appointments on time. Although it may be an option for some people to walk three miles a day there and back, many people, particularly the elderly, the disabled and those with small children, simply cannot add a three-mile trek to their journey.

We all know the frustration of sitting in traffic and the stress of watching the clock tick by as we get closer and closer to the start-time for work, knowing that we are going to be late. There is not much that can make sitting there in that situation more pleasant and allow people some comfort, but there is the thought that at least once the works are done, they are done. The problem is that such hope is quickly dashed, because a month later the same road is dug up again, as the hon. Member for Broxbourne has said.

Roads need to be repaired; no one disputes that. Utility companies need to lay new pipes and gain access to their infrastructure; no one disputes that. However, when a road is resurfaced one month and then dug up again two months later for the installation of new cables, and new pipes go in a few months after that, it is easy to see why people become frustrated. What is hugely important is how we get greater co-ordination between local authorities and utility companies. What we all want to see is frequent and reliable bus travel, so let us work together to make that happen for my constituents in Doncaster East and the Isle of Axholme and for people right across our country.

16:39

[John Cooper (Dumfries and Galloway) (Con)]

It is a pleasure to serve under your chairmanship today, Sir Roger, and I congratulate my hon. Friend the Member for Broxbourne (Lewis Cocking) on securing this very important debate.

Tonight, drivers in my constituency of Dumfries and Galloway will set what I think is a record. At the stroke of 8 pm, traffic cones will close the A75 road to motorists and force them to undertake a 96-mile—yes, 96-mile—diversion. That must surely be among the longest diversions ever forced on drivers. The overnight closure between Newtown Stewart and Castle Douglas is not a one-off; it is just the latest in a round of closures that will continue into November. A journey that normally takes 40 minutes will become a two and a half hour epic.

Although transport is devolved to the Scottish Parliament, I raise this issue in this Chamber because the A75, which is grandly titled the “Euro route” although it is often more akin to a cart-track, has significance for every one of our constituents. Sir Peter Hendy’s Union connectivity review identified the A75 as the key link between Northern Ireland, Scotland and England, as it serves the busy ferry port of Cairnryan in my constituency. It is of UK-wide importance. Estimates vary, but perhaps as much as 60% of Northern Ireland’s trade grinds along that road. Maintenance, as we have heard, is welcome and vital, but diversions such as the one I mentioned treat the public with contempt. Surely we can do better.

The other road that services the port of Cairnryan is the A77. It too could be a record breaker, for it had, according to the A77 action group, three closures for road accidents and 161 for works—and that is only between January and September of this year. It was shut on Monday and again on Tuesday; once for a lorry on fire and once for a lorry off the road. Further, the A77 still hangs by a thread in Glen App, where literally years of roadworks have failed to cure a landslip risk.

Scotland’s First Minister has agreed to visit Galloway to discuss roads from hell, which are screaming out for investment beyond mere patch-ups, and the £5 million in today’s Budget for the A75 is a start. I have invited the Secretary of State for Scotland to drive the A75 and the A77 too. He says his busy schedule will not allow it, but might someone from the Department for Transport make time to see how awful those unenviable record-breaking roads are? We hear boasts that Labour has reset relations with the SNP, so perhaps they could share a car with the First Minister.

Finally, I want to make an early plea that should anyone suggest a traffic cone tsar, we should instead call the position the cone arranger.

[Sir Roger Gale (in the Chair)]

That was terrible.

16:46

[Andy MacNae (Rossendale and Darwen) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Roger, and thank you for allowing me to speak. I congratulate the hon. Member for Broxbourne (Lewis Cocking) on securing this important debate.

This is a matter of a disturbing level of cross-Bench consensus, I fear, because we are all largely saying the same thing. In my constituency of Rossendale and Darwen, single trunk roads serve the vast majority of the constituency and residents and businesses are delayed and constrained daily by the incessant roadworks they face, to the extent that several of the major employers in the valley, on which we are entirely reliant, are threatening to leave or considering leaving the area because of the costs to their business that the relentless roadworks impose.

The situation is a constraint on growth and on people’s everyday lives. It would be fair to say that there is a complete consensus that something must change, yet we are constrained by the previous legislation—I think the last Act was the Traffic Management Act 2004—and it limits what we can do. There is a limit on the amount that can be charged as fixed-penalty notices for street works that overrun or do not follow their permits and a limit on the approach to lane rental schemes to 5% of a given local authority’s road network, but those are relatively straightforward things to change. I hope that, with this level of cross-Bench consensus, the Government’s imperative on growth and the recognition of the impact on everyday lives, we can make what I hope will be relatively straightforward changes and give our communities and our businesses the boost they need for roadworks that are properly managed and regulated, with proper and effective penalties for overruns that are, in many cases, inexcusable.

16:49

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairmanship, Sir Roger. May I congratulate the hon. Member for Broxbourne (Lewis Cocking) on setting the scene so well? I will not delay the House very long, but I want to make a contribution from Northern Ireland, highlighting some points and then putting forward a couple of solutions.

I live in a rural community and the only way of getting to where we want to be on a regular basis is to jump in the car and drive up the road. The Ards peninsula, where I live, has a road going down one side and up the other and one going through the middle, so accessibility to certain roads means that if one closes, we have severe problems. I am used to the journey into town being a wee bit longer than I would like it to be. To give one example, the roadworks in Belfast, which have been there for some time, have led to people missing flights, being late for GP appointments, late for work and even missing NHS operations in the Ulster hospital. It is hard to comprehend how that can happen. Even the buses cannot get through, as the hon. Member for Broxbourne (Lewis Cocking) mentioned earlier. Even the fast buses cannot get along the road.

To give some perspective of where we are in Northern Ireland, I see problems for small businesses, particularly when roads are habitually closed. One in particular is McClements’ garage on the Portaferry Road, Newtownards. The roads service cannot do anything about having to close the road. Insurance means that vehicles cannot travel up and down the road during major works, which means that the business closes and the garage owner has lost business over a period of maybe eight to 10 weeks. That has an impact on him because he does not get the traffic and passing trade. Can more be done to help businesses that are directly impacted by such works?

We need better co-ordination. Let me give two examples: Mill Street in Newtownards and Loughries Road. This was a few years ago, to be fair. Northern Ireland Water came and dug the road up, then filled it in. The gas guys came along, dug the road up and filled it in. Then the third one, British Telecom, came along. It dug the road up as well—in the very same place, the same hole in the ground. The three utilities could have been better co-ordinated and could have done it better together. We need better co-ordination; that is No. 1.

I want to give a second solution, if I can. I know that the roads service in Northern Ireland has done this. The Sydenham bypass carries a vast number of vehicles—thousands every day. It is a major thoroughfare, bringing people up from the Ards peninsula and Bangor right into Belfast, so that road is really important. The roads service came up with a solution, which was to do the work at the weekend. That meant that when people were going to work from Monday to Friday, the roads were available, but on Saturday and Sunday they were not.

How did we do it better? We asked the roads service to work more at the weekends. I understand that it is difficult in times of financial stringency, but none the less it is not impossible for work to be done at nighttime when fewer people are on the roads and there is less impact. So, there are two solutions to consider, including doing the roadworks in the evenings and at weekends, as has been done in Northern Ireland. It is successful.

I have one more quick point. Whenever the roads are closed, there really has to be a better way of letting vehicle owners and those who are travelling on the road know exactly what is going on.

16:53

[Mr Paul Kohler (Wimbledon) (LD)]

It is a pleasure to serve under your chairmanship, Sir Roger. I thank the hon. Member for Broxbourne (Lewis Cocking) for securing this important debate. I know from my own inbox and those of my colleagues that this impacts many of our constituents’ lives, work and businesses. Just this weekend in my own constituency, there has been large-scale disruption from roadworks. On the A3, which runs through Wimbledon, roadworks caused huge congestion not just in south-west London but across much of Surrey and Hampshire. It was particularly severe because the disruption was compounded by South Western Railway’s decision to cancel trains on the same route due to planned engineering works on the line, something to which I will return.

A lack of investment in our roads has left many in a dire state, with less than half the local road miles in England and Wales now classified as being in good structural condition. Urgent work to repair our roads is vital, particularly as delays in maintenance compounds the problems, leading to higher costs and greater disruption.

As transport spokesman, I am of course the most important person on the Lib Dem Front Bench as I am the lead on that staple of every Lib Dem Focus leaflet, the ubiquitous pothole. I consequently welcome the Chancellor’s announcement today of additional funding to fix potholes, as I know the Minister will as well. However, before we get carried away by this bounty, let us not lose sight of the fact that it comes against the backdrop of a real-terms cut to the Department for Transport budget, which I will cover in more detail in a subsequent Budget speech.

Clearly, the roadworks needed to fix such problems inevitably cause disruption to the road network, leading to longer journey times, which are not only frustrating but economically damaging. In 2021, National Highways estimated that delays on the strategic road network, of which at least 15% were due to roadworks, cost the economy around £3 billion a year.

It is therefore vital that when roadworks are planned, disruption to the wider network is minimised. That requires communication across the sector to co-ordinate matters. However, it is sadly all too apparent that there is a lack of joined-up thinking, and that there is too much fragmentation across our transport system to achieve that co-ordination. On the London to Portsmouth route last weekend, for example, it should surely have been possible to ensure that planned work on the A3 and the rail line did not coincide. That is the type of problem that we need to avoid. I trust that the Department for Transport’s promised long-term strategy addresses such issues.

In addition to roadworks to maintain and improve our roads, another source of delay, frustration and cost is street works: utility companies digging up our roads. There is a great deal of congestion in Wimbledon town centre at the moment. Wimbledon Hill Road is completely shut because of emergency work on a collapsed sewer, which is leading to major disruption to bus routes and traffic jams in surrounding roads, significantly increasing journey times in much of my constituency. Of course, an emergency is an emergency—I understand that—but it does not excuse utility companies not doing all they can to ensure that disruption is kept to a minimum, as the hon. Member for Broxbourne said.

Companies are obliged to return the roads to the state in which they found them, but they often do not, as many people in my constituency know. Yes, utility companies can theoretically be fined up to £10,000 a day for delays, but many roads have fines capped at £250, and even that level of enforcement is problematic. The Lib Dems strongly believe that local authorities need to be given more powers to ensure that utility companies minimise the disruption they cause and do not act with impunity. The previous Government consulted on increasing their powers, including raising the level of FPNs that can be issued for certain street work offences and allowing overrun charges to apply at weekends and bank holidays, but the results were never published. The Minister has said that the results will be released in due course, and I hope that she might take this opportunity to tell us when that will be.

We all know that our road network is crucial to constituents and businesses. The Government could be doing more to keep the traffic flowing, people travelling and the economy growing.

16:57

[Greg Smith (Mid Buckinghamshire) (Con)]

It is a pleasure to serve under your chairmanship, Sir Roger. I congratulate my hon. Friend the Member for Broxbourne (Lewis Cocking) on securing this important debate.

The consensual nature of the debate shows that if there is one thing on which we on the Opposition Benches and those in His Majesty’s Government can agree, it is that nobody likes road closures and traffic jams and the misery that comes with them. In urban and suburban areas, they often mean unwanted congestion and pollution. As the hon. Member for Doncaster East and the Isle of Axholme (Lee Pitcher) said, they often mean delays not just for private motorists but for buses and hauliers. I gently suggest to him that after this afternoon’s Budget and the Chancellor increasing bus fares from the £2 cap that we brought in, people will be paying more to sit on the bus in a traffic jam under a Labour Government.

In rural areas such as my Mid Buckinghamshire constituency, and that of the hon. Member for Strangford (Jim Shannon), a 100-yard road closure can often mean a 5 to 10-mile diversion. That is before I even start talking about Government-sponsored programmes such as High Speed 2, for which the road closures seem to go on indefinitely and forever. Fixing that is in the Government’s gift. Likewise, we heard from my hon. Friend the Member for Dumfries and Galloway (John Cooper) about the intolerable problems on the A77 and A75, which the Scottish Government simply must fix.

Of course, in some cases road closures are not necessarily a bad thing—they are the result of getting things done—but how we manage them is important. Utility companies must be held to account. Whether action is taken by local government or by national Government through National Highways or another agency, it must be taken responsibly. The relevant authorities must remember that they are causing significant inconvenience to real people, their businesses, their school runs and their trips to the doctor, hospital or other medical appointments. If we can manage the situation, everybody will be much happier.

Let us not forget that it is only through economic growth that car ownership, and indeed other forms of transport, became affordable and grew for many. As part of our plan for drivers, the previous Government took action—we can discuss how to go further—on the critical problem of road closures that stick around for longer than necessary. We introduced a performance-based street works regime to ensure that utility companies resurfaced roads to the best possible standard, and a lane rental scheme, through which utility companies can be charged up to £2,500 a day for street works. That programme enabled the delivery of more than 2 million street works between 2022 and 2023.

In January, the previous Government launched a street works consultation, the results of which were clear. We therefore doubled fines in some instances from £500 to £1,000 for utility companies found to have breached the conditions of their jobs. We introduced charges of £10,000 a day for companies if their works overrun into weekends and bank holidays, which are the busiest days on the road network. We gave a direction for at least 50% of the money generated by lane rental schemes to be used for the improvement of roads and the repair of potholes. That money is already filtering down to local authorities.

In my own constituency, Buckinghamshire council’s “pothole pro” is making light work of what has historically been an incredibly time-consuming and labour-intensive task. The pothole pro effectively recycles and reuses damaged tarmac for resurfacing works, and roads are therefore being fixed more quickly and efficiently. That ultimately saves taxpayer money and reduces the time that people spend stuck in traffic or diverting around road closures. Technology is our friend. It can get repairs done so much quicker.

Conservatives are firmly on the side of drivers. What will the Minister and the Government do to improve the experience of Britain’s motorists, those who travel on our buses and that those who require the use of the road network to make deliveries and to get their goods around the country? What will the Minister do to meet the challenges set out by my hon. Friend the Member for Broxbourne? What reforms will the Government introduce to build on what is already in place to hold those who dig up our roads to account?

It would be a good start for the Government to support the ten-minute rule Bill of my right hon. Friend the Member for Rayleigh and Wickford (Mr Francois), which the Opposition already support. That would bring about real action to improve the lot of all motorists. Will the Minister confirm the Government’s stance on that Bill, which we also saw in the previous Parliament? Britain’s motorists deserve to know.

The state of our roads is important, as right hon. and hon. Members have said. Will the Minister confirm whether the Government will maintain the £4.7 billion of funding, much of which was to be used to fill potholes across the north and the midlands over the next seven years, that the previous Government put in place in February through the local transport fund? Will it be put to good use in the way that the previous Government intended? Will the Government retain the £8.3 billion of funding for highways maintenance, which was announced in October 2023 in “Network North” and should last until 2033?

Will the new Labour Government continue that exact amount of spending? I fear that the Chancellor’s announcement in the Budget today of £500 million for potholes will simply not touch the sides of the problem we face as a country. Looking at my own constituency, where Buckinghamshire council has a £105 million road repair fund for one county alone, I do not think that that £500 million sum of money will go far enough to challenge and fix the problems facing Britain’s motorists. It seems that both sides of the House agree on the problem. Labour is now in government; will the Minister confirm precisely what it will do?

17:05

[The Parliamentary Under-Secretary of State for Transport (Lilian Greenwood)]

It is a pleasure to serve under your chairmanship again, Sir Roger. I congratulate the hon. Member for Broxbourne (Lewis Cocking) on securing this debate on the impact of roadworks on journey times, and I thank all Members who have contributed to what has been an informative and interesting discussion.

People use our roads to make journeys every day, and how we manage them has a direct impact on everyone’s lives. The frustration caused by congestion and the poor condition of our roads are recurring themes that my Department and I are focused on. I am sure that we all, as Members of Parliament, hear the concerns that have been exposed today every time we knock on a door, frankly.

I recognise the point made by the hon. Member for Broxbourne about growing traffic congestion. That is one reason why the Government are acting to enable more people to choose public transport or active travel. We need to tackle that congestion and to think about it in the round. We are determined to deliver a transport network that works for all road users, whether they are drivers, bikers, cyclists, bus passengers, pedestrians or horse riders.

The challenge of congestion will only grow, given that over the coming years the number of roadworks will increase because of new housing developments, the continued roll-out of broadband and the need to meet our targets for installing electric vehicle charge point infrastructure to deliver the Government’s commitment to net zero. We also all need the services provided by utility companies, and we want them to maintain and improve their infrastructure. More than 2.2 million works take place in England each year, and the congestion created costs around £4 billion.

In addition, the Government are determined to tackle the problem of potholes and other road defects on our networks. As the hon. Member for Broxbourne will know, we have a manifesto commitment to fix 1 million more potholes a year, every year of this Parliament. I am pleased to say that we have already made a start by announcing, in today’s Budget, a £500 million funding increase for local authorities in 2025-26, which is an increase of almost 50% from 2024-25 levels. I am more than aware that authorities and Members alike will be interested to know how their areas and communities will benefit from that funding, and specific allocations will be announced in due course.

In total, the Department for Transport will invest about £1.6 billion in local highway maintenance in the next year. That includes additional funding on top of that already provided to city mayors through the city region sustainable transport settlements, to help local councils to maintain and renew their local highway network. Future capital investment in our infrastructure, including roads, rail and other things, will of course come in the spending review in the spring.

I enjoyed the contribution from the hon. Member for Dumfries and Galloway (John Cooper), and I hope that the Scottish Cabinet Secretary for Transport enjoyed it, too, as that is a matter for her and the Scottish Government.

The pressure on our road networks caused by works is not going away. However, we want to find the right balance between allowing necessary works to go ahead and minimising the disruption for everyone using our roads.

[Mr Francois]

The Minister’s opposite number in the previous Government kindly granted me a meeting about my Bill, which unfortunately ran out of parliamentary time. As I have 10 minutes to fill next week, will she allow me as part of my speech to say that we have discussed this today and that she has kindly agreed to meet me to discuss the merits of my Bill and whether the Government might be prepared to adopt it in whole or in part?

[Lilian Greenwood]

The appropriate thing for me to do is to listen to the right hon. Member’s speech next week and to the arguments that he makes. I am sure that we will find an opportunity to discuss it in the future.

I assure the hon. Member for Wimbledon (Mr Kohler) that National Highways always works closely with Network Rail to ensure that works on our national networks are co-ordinated. If that does not happen, I hope that he would draw it to my attention, and I would certainly seek to raise those issues with them.

There is already a great deal of scope for works to be planned, managed and co-ordinated more effectively—as the hon. Member for Broxbourne called for—and, importantly, for the public to be told when works are happening and to be warned about the impact that those might have on their journeys. The responsibility of the local highways authority is to co-ordinate any works taking place on their roads, including their own works. In doing so, councils must take account of the needs of everyone using the road, consider the implications of works for their network and that of neighbouring authorities, and act to minimise or prevent problems. Utility companies also have a duty to co-operate with the authority.

Street works permit schemes are now in use by all but one local authority. They provide councils with the proactive tools to improve the management of all works in the street, as well as offering incentives to minimise disruption. To support the transition to permits, the Department for Transport set up Street Manager, which is our online service for planning and managing road and street works in England. Since 2020, all local authorities, utility companies and their contractors, have had a single view of the street, with visibility of the whole network to help them plan and co-ordinate works for the benefit of road users. It enables better forward planning and more joint works. We also stream open data about live and planned works that apps and websites make available to the public. We have a commitment to continue improving the service to ensure that it meets users’ needs.

As the hon. Member for Broxbourne highlighted, lane rental is another tool to help local highways authorities to reduce the impact of works taking place on the busiest roads at the busiest times. Such schemes allow authorities to charge utilities up to £2,500 a day for works on those roads. The hon. Member for Strangford (Jim Shannon) expressed the hope that roadworks would be planned for periods when they cause least disruption. Such issues are devolved in Northern Ireland, but his point is well made.

Lane rental charges act as an incentive to encourage those who plan works to complete them as quickly as possible, to carry out their works outside peak periods, or to consider alternative locations to minimise disruption. Lane rental schemes also encourage joint works, as that can attract discounts or charges can be waived. Any surplus revenue can be spent by the council on ways to reduce the impact of works on congestion.

Highways authorities that want to set up schemes can bid to the Secretary of State for approval, and we have provided bidding guidance on how they can do that. As the hon. Member for Broxbourne said, four lane rental schemes are in operation: on Transport for London’s network in London, and in Kent, Surrey and West Sussex. The Secretary of State has recently approved a scheme in East Sussex, which is due to begin in 2025. Many more local councils are developing schemes and this Government want to support them. We want to make the lane rental scheme application process as easy as possible for local authorities, and I am reviewing the application and approval process with my Department to see what improvements can be made.

On the issue of fines and penalties, local authorities can already issue overrun charges of up to £10,000 per day for works that exceed the duration agreed as part of the permit. For a range of offences such as breaching permit conditions or working without a permit, fixed penalty notices can also be issued. As my hon. Friend the Member for Rossendale and Darwen (Andy MacNae) said, these powers can and should be used to improve the daily lives of our constituents, who rely on the roads. As I grew up in his constituency, many of those roads are very familiar to me.

As has been said several times, the Department for Transport consulted earlier this year on proposals to apply overrun charges at weekends and to increase fixed penalty notice charges. I am fully aware that the Department’s response to that consultation is eagerly awaited. I am considering the proposals, and we will publish our response shortly. As I said, I look forward to listening closely to the comments from the right hon. Member for Rayleigh and Wickford (Mr Francois) about his forthcoming ten-minute rule Bill.

In addition to the existing range of powers available for use by authorities to manage roads on their network, I hope and expect that we will all see improvements in how utility companies carry out their works as more authorities operate lane rental schemes. My Department is determined to put people at the heart of everything that we do, so as we continue our work, we will constantly look at how we regulate roadworks to see if further improvements can be made for the benefit of everyone who uses our roads—drivers, bikers, cyclists, pedestrians, and so on. We plan, for example, to look at how urgent or emergency works, which I recognise cause particular difficulties, can be planned and co-ordinated more effectively, especially when they affect traffic and cause disruption, including for buses.

My hon. Friend the Member for Doncaster East and the Isle of Axholme (Lee Pitcher) set out clearly how roadworks can affect the punctuality of the bus services that our constituents rely on. My constituents in Nottingham will very much recognise that, as we have some major roadworks in our city centre. While I am on the subject of buses, which are important road users, I gently point out to the Opposition spokesman, the hon. Member for Mid Buckinghamshire (Greg Smith), that the previous Government funded their bus fare cap only until the end of the year. We are extending the cap and investing in better bus services across England. I am also surprised that he did not mention the fuel duty freeze, but there we go.

I thank the hon. Member for Broxbourne for raising these important issues, which affect the daily lives of our constituents and all of us. I am determined to keep people moving and to deliver the cleaner, greener, smoother and less congested roads that all our constituents want to travel on.

17:17

[Lewis Cocking]

I thank the Minister for her reply and thank all the hon. Members who have taken part in the debate. I also thank the hundreds of my constituents who replied to my survey online to tell me about their experiences.

I will make a few final points. We really need to tackle the emergency works. As I said, they turn up unannounced. Most of our constituents can understand that if there is a real emergency, we should get the works done as quickly as possible, but when roads are dug up by utilities, which is quite often the case under emergency legislation, and residents drive past day after day and see no one working on the site, it is a real frustration. I will not repeat the language that I use when I am in the car by myself and I see that occurring in my constituency. Even worse than that, we drive past cones and traffic lights, but there will not even be a hole dug in the road—so not only have we had no one working on the site, but works have not even been started, even though cones have been put out what seems like weeks before, which causes disruption and makes people sit in traffic.

As for planned works, because lots of organisations are involved, sometimes the left hand does not know what the right hand is doing. It is like someone sat down and said, “We want to plan all these works all at the same time, so that you cannot move anywhere around the local area”. We really need to get better at planning all those works through the highways authority and the utility companies, particularly for emergency works. If we want to unlock economic growth in this country and get the economy growing at a really rapid speed, we will do that by keeping Britain moving.

Question put and agreed to.

Resolved,

That this House has considered the impact of roadworks on journey times.

17:19

Sitting adjourned.