Westminster Hall

Tuesday 10th December 2024 Westminster Hall

Tuesday 10 December 2024

[Dr Rupa Huq in the Chair]

Rare Autoimmune Rheumatic Diseases

Tuesday 10th December 2024 Westminster Hall

00:00

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered rare autoimmune rheumatic diseases.

It is a pleasure to serve under your chairship, Dr Huq. I have done so many times, and it is always a pleasure to be here and to see you fully in control. It is also a pleasure to see the Minister in his place. I was hoping that it would be this Minister, so when he walked through the door, I was especially pleased to see him in person. By the way, I would have been pleased to see any Minister—I do not want to offend anybody. The shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), is in his place as well. He and I talked last night about this issue.

This debate is, by its very nature, a niche debate. Dr Huq, if you have a constituent who has an autoimmune rheumatic disease or you know somebody with one, you will be here to represent them, but not everybody has, because only a small number of people across the United Kingdom of Great Britain and Northern Ireland have one of these diseases. However, I look forward very much to having the debate.

I was chatting beforehand to the Liberal Democrat spokesperson, the hon. Member for Mid Sussex (Alison Bennett), and she was telling me—she will refer to this herself when the time comes—of the important case of her constituent, a good friend. I will leave it to the hon. Lady to put forward that case.

I have always had a deep interest in any health issues. I am my party’s health spokesperson, and if there are any health debates anywhere, in Westminster Hall or in the main Chamber, I make it my business to attend those debates and to contribute to them, whether by speeches or questions. That is really important. I have a particular interest in rare diseases, and that came through a constituent who lives down the Ards peninsula. I have probably known him all his life. When you get to my age, Dr Huq, there are many people you have known all their lives; that is just a fact. The point is that he married a young girl from the area. She had a rare disease, and my interest came through contact between her and the family and me across the Ards peninsula. Across Strangford, this became a massive issue, and that lady and that family today fly the flag for rare diseases in the Ards peninsula and in Strangford.

I thank the Backbench Business Committee for granting this debate. I think we start from the NHS point of view. I am an advocate for the NHS—always have been and always will be—as we all are in this House. I am one who believes in the foundation of our NHS and the people who hold it together—the people whom we may not meet, but who are the glue and the gel that keeps it going and keeps it together. I am aware of the stress and strain on the NHS, and give my full support as the Government attempt to make the changes that are necessary for the NHS to survive. I very much welcome the Government’s commitment. I think they have committed £26.3 billion to the NHS, and that is a massive contribution. It shows confidence on the part of the Government; we welcome that. My starting position is praise for the people behind those three little letters, N-H-S.

We are beginning to look at NHS restructuring—the Secretary of State has confirmed that, and the Ministers are all committed to it. There are lots of priorities that the Government have to get to, but amongst that is the restructuring. A vital component is that the NHS provides high-quality, equitable care for all people, regardless of how rare or complex their condition is. If you—when I say “you”, Dr Huq, I really mean me or anyone else across the United Kingdom—do not have a rare disease, you may not understand what it means to have one, and how rare or complex a particular condition is, but that tells me that we need to be aware of this issue. We need to reach out and we need to help. The Government have a commitment to rare diseases as well. Although they may not be mathematically or statistically numerous, they represent individuals, families—relatives—and friends, who all understand the issue very well.

I have been interested in rare diseases since I was in the Northern Ireland Assembly, before I came here. We had contact with ladies down the Ards peninsula who were very much aware of rare diseases and the issues, so we started a rare diseases group in the Assembly, which we have continued here over the years. I will use this opportunity to speak on their behalf about some complex, rare diseases—rare autoimmune rheumatic diseases.

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

I congratulate my hon. Friend on securing the debate. Does he agree that because so few people are impacted by rare diseases, raising awareness among health professionals is a key aspect of helping those people, who may often feel overlooked simply because of the very small number who come into the ambit of the subject matter we are discussing?

[Jim Shannon]

As my hon. Friend often does in these debates, he brings forward a reminder of why this debate is important and why we need to raise awareness. It is about giving confidence to people out there who may have these diseases and may think that they are fighting this battle all on their own, but are not. We need to raise awareness among NHS staff. It is impossible to know about every rare disease, but it is good to recognise the symptoms and to be able to point people in the right direction.

Rare autoimmune rheumatic diseases are a range of chronic, currently incurable conditions in which the body’s immune system damages its own tissues, often in multiple organs throughout the body simultaneously. That is a lot of words but, to use a phrase that we would say back home, it means that they come at a person from all sides. They can lead to tissue or organ damage that, in some cases, can be fatal. We cannot ignore the fact that that can be fatal and the importance of responding in a positive fashion.

At present, the outcomes are not good enough for people living with rare autoimmune rheumatic diseases: they wait too long for a diagnosis, have variable access to specialist care and cannot always access help and support when they need it. In any debate that we have about ill health, we often say that early diagnosis is important, but so is having access to specialist care. It is important that NHS workers are able to notice something that may be unusual and not something that they see every day. It is also important that the care, help and support that people need is available when they need it. Preliminary data from the Rare Autoimmune Rheumatic Disease Alliance’s soon-to-be-released 2024 patient survey found that the average time to diagnose from symptom onset was two and a half years—it is that long before anything happens. In those two and a half years, people suffer, worry themselves sick and wonder, “Am I going to get out the other side?” The data shows that 30% of patients waited five years for a diagnosis from symptom onset.

Rare autoimmune rheumatic diseases impact on around 170,000 people in the United Kingdom of Great Britain and Northern Ireland. Hon. Members may not recognise some of the diseases, but they include Behçet's disease, lupus, myositis, scleroderma, Sjögren’s syndrome and vasculitis. They can affect many parts of the body—the joints, the skin, the lungs, the kidneys or the heart—and often require cross-medical expertise. That is just a small number of the things that come the way of 170,000 people across the United Kingdom. Unlike the vast majority of rare diseases, the conditions occur predominantly in adult life and are predominantly non-genetic. That means that people do not need to have a history of them: they can come out of the blue.

The Rare Autoimmune Rheumatic Disease Alliance, a group made up of clinicians and charities, such as Lupus UK, Vasculitis UK, Scleroderma & Raynaud’s UK and Sjögren’s UK, has set out a number of key solutions to improve care for RAIRDs. They include strengthening existing specialised networks and setting out what good care looks like through a rare disease equality standard. It has also stressed that it is vital that rare disease is not forgotten in upcoming policies such as the NHS’s 10-year plan, which I will refer to later. In that plan, it is really important that we—by which I mean the Government and the Minister—can give hope to people who suffer from those diseases, and it is really important that they do not think they are on their own. The evidential base response from the Minister would give them that assurance, and it is important that the progress made to date by the UK rare diseases framework is built on. That is my first question: is the rare diseases framework part of the NHS 10-year plan?

I want to share an example that has been highlighted to me of someone who has felt the personal impact of rare autoimmune rheumatic disease. Zoi lives with a life-threatening RAIRD, granulomatosis with polyangiitis vasculitis. In her words, she is “lucky” because she had a relatively short journey to diagnosis. When she looks at others, she thinks she is lucky. I would like everybody who suffers from these diseases to have the same luck—if luck is the word. I do not believe in luck; my personal opinion is that everything is predestined. I am interested in how we make it better.

The quick diagnosis came only because Zoi’s GP recognised her symptoms and knew to refer her right away. Does every doctor have that knowledge? I hope they have, but they might not have the personal observation of that doctor. The difference was that he had had a friend who had died of the disease, so he knew what to look out for and red-lighted those symptoms.

Despite Zoi’s positive experience of diagnosis, however, her experience of care since has been variable—that is the second stage. Following diagnosis of the disease, the care system works its way out. She has faced long waits for appointments and poor communication between teams responsible for her care. In one instance, she received a letter from a consultant four months after the date of the appointment. Was that the fault of the Royal Mail? I do not know. It was not Zoi’s fault that she did not know about the appointment until it was too late. It meant that she had been taking a medication unnecessarily for months longer than needed.

It is about early diagnosis, treatment going forward and speed and urgency in the process to make it happen. Zoi works for a charity that supports other people living with vasculitis. She describes it as “heartbreaking” that hers is one of the best diagnostic journeys one will hear of. She has been diagnosed and gone through the NHS process to get out the other side and try to be better. As she says, hers is one of the best diagnostic journeys, but how can the rest be improved?

How do we improve care? Speedy diagnosis should not be down to Zoi’s word “luck”. People such as Zoi living with serious rare diseases should be able to access vital care when they need it. That is why I am calling on the Minister to consider the following recommendations advocated by RAIRDA. It is important to be aware of the issues.

The first recommendation is to ensure that rare diseases are a focus of the NHS 10-year plan. I am always pleased to see the Minister in his place. I mean that genuinely, not to give the Minister a big head. He comes with an understanding that we all greatly appreciate— I do and am sure everybody else does. Will there be a focus in the 10-year plan on rare diseases? I am pretty sure the answer will be yes, but we need confirmation of that in Hansard today. We need to reassure our constituents who are struggling with disease and are unsure what the future means for them.

The UK rare diseases framework, introduced just three years ago in 2021, has been a significant step forward in securing equity of treatment for rare diseases. I welcome that, but sometimes the system does not work as well as it should. It is crucial that the Government do not lose sight of the work done to date to drive change for people living with rare conditions. Good work has been done, and I always like to recognise good work. It is important that we give encouragement to those who are working hard, and it is important sometimes to think, when we are ploughing away, what we are getting for it. Many of us—all of us in this room, for instance—appreciate what our NHS does. The good work that has happened for those with rare conditions needs to continue with the same zest, enthusiasm and fervour as it has done in the past.

It is particularly important that the working groups on the NHS 10-year health plan consider how improvements in rare disease care will be championed in that plan. In addition, it is important that the plan considers how the work plan of the UK rare diseases framework will be continued past the framework’s end point in 2026. That is my second ask. I am sure that within the 10-year plan the Government are committed to that continuation, but I need to personally reassure my constituents and we need to reassure the nation. We need to reassure those 170,000 individuals and their families and friends.

The framework has been an important tool in co-ordinating methods to improve care for rare diseases, and not just in England. I understand that health is a devolved matter, but this is how it works: whatever happens here, health-wise, is the next stage for us back in Northern Ireland, through the Health Minister. I was talking to another Health Minister on the tube coming here, and we were saying how important that co-ordination across all four regions is. It is good to push for that here, and to see it received back home.

The framework has been an important tool in co-ordinating methods to improve care for rare diseases, not just in England but across the United Kingdom of Great Britain and Northern Ireland. The numbers of people suffering in Northern Ireland may seem small numerically, because we are a region of 1.9 million people, but the impact is huge. I am overtly aware that health is a devolved matter, but I am also aware that the standard can and should be UK-wide. The Minister always gives me and those from other parts of this great United Kingdom reassurance on the co-ordination between here and the Northern Ireland Assembly. I know he has met the Health Minister, Mike Nesbitt, and I am sure they will meet again in the foreseeable future.

How do we develop a standard of care? The National Institute for Health and Care Excellence quality standards consist of defined, measurable statements that can be audited to reduce variations in cases throughout the country. A rare disease quality standard would help to incentivise an increased focus on delivering high-quality care and treatment for rare conditions in the NHS, including rare autoimmune rheumatic diseases. That is my third ask: to develop the standard of care we need to have a quality standard, which would help to incentivise all the regions—all the parts of England, Scotland, Wales and Northern Ireland collectively; better together.

Work in this area is already well under way. RAIRDA has been working hard with organisations across the rare disease community to understand what good care looks like for people living with rare disease, and how that should be reflected in quality statements. Has the Minister had the opportunity to talk to the alliance? I am sure he has; I do not doubt that for a second. It would be good to have that liaison to help to bring together the ideas from the alliance and the Government. It is important that the current work to develop quality statements is built on in a timely way, with the swift development of a rare disease quality standard.

On my fourth request, it is clear that we need development in IT capacity in the fight for diagnosis, to ensure that more people can experience a quick diagnosis, like Zoi did. We need to increase funding for research into the diagnostic journey for rare autoimmune rheumatic diseases, to aid the development of diagnostic technology. It is really important that we look towards the next stage on research and development. How do we do that?

To sidestep slightly, today’s paper—I think it was the Express—said that the Government should be doing something to look at dementia as the numbers rise. Although we are talking about rare diseases that will be well down the Government’s to-do list, early diagnosis is important, as is research and development to improve the capacity to find a cure, to lessen the pain and to lengthen the time that people have in this world. Again, any indication of what is happening with research and development would be greatly appreciated.

Investment in research would help to identify blockers to rapid diagnosis, as well as supporting the development of digital tools for faster and more accurate diagnoses. Some months ago my colleague, the hon. and learned Member for North Antrim (Jim Allister), asked the Secretary of State for Health and Social Care a question in the Chamber about the report on the way forward for the NHS. He mentioned the need for digital data tools, and the Secretary of State replied very positively, so I think the Government are looking into this, but it is important that we have the digital tools in place. With better data and more accuracy, we can help to speed up the process and find a better way forward.

Because of their rarity, it is unrealistic to expect every hospital to have clinicians with expert knowledge of rare autoimmune rheumatic diseases. I understand that, as we cannot know everything. Clinicians may have a small portion of knowledge, but this subject requires expert knowledge, so we need another way of doing it. A 2024 survey found that 29% of respondents were not very, or not at all, confident that the specialist healthcare professionals providing their care understood their condition. How do we improve that? I understand that we are in difficult, financially straitened times, and the Government have rightly committed a large sum of money to the NHS and health services—as they should, and I support that entirely—but we need improvement. My fifth ask of the Minister is: how can we do better? If 29% of respondents are not very confident, or not at all confident, we need to address that.

I believe that improvement can be achieved by developing specialised networks for rare autoimmune rheumatic conditions. Such networks would allow health professionals to access the knowledge and expertise of tertiary specialists, while also developing the capability and capacity to provide more care and treatment locally. I feel that would be the answer to my fifth question, and I am interested to hear the Minister’s thoughts.

Networks already exist, with an excellent example being the Eastern Network for Rare Autoimmune Disease, established in 2016. We have a system in place, so let us look at it—not in a judgmental way—to see what it is doing and where improvements can be made. The network was formed to maximise patient access to relevant expertise while keeping their care as close to home as possible. This has been achieved by setting up excellent communication and cascading training to enable much better co-ordination, digital data sharing and contact between specialised centres and local trusts.

The network lead has calculated that the network’s creation has saved the NHS money, so it has to be considered. The network runs at a cost of between £70,000 and £100,000, but it has generated annual savings estimated at between £150,000 and £200,000. That means that for every £1 spent, the NHS has saved £2, over a seven-year period, through a reduction in the use of inappropriate high-cost drugs.

On my sixth ask, networks throughout the country, like ENRAD, are run on the good will of clinicians. That is not sustainable, and it never can be. I respectfully ask the Minister to perhaps look at the ENRAD scheme, which is run on the good will of clinicians and has been very effective in how it responds, to see how such networks can be better helped to expand. If it saves money—if every £1 saves the NHS £2—then the financial equation is clear, and it should be pursued across all of this great United Kingdom of Great Britain and Northern Ireland.

To address this issue, the Government must provide the necessary financial support for networks to be developed and maintained. That funding would enable the creation of vital posts, such as meeting co-ordinators, and allow clinicians to be reimbursed for their time. Again, I feel that would be the right incentive. Good will is good to have, and there is much of it across this great nation, but, at the same time, there may be better ways of doing things. Such support would ensure that benefits for patients, and the NHS’s budget, could be realised throughout the country. With the £25.3 billion committed to the NHS—I think that is the figure, but the Minister will correct me if I am wrong—this is another way to save money in the NHS, and it really should be done.

My last request is about specialist nurses, who can play a crucial role in supporting people living with rare autoimmune rheumatic diseases. The preliminary results from the 2024 survey show that respondents with access to a specialist nurse were more likely to report that they had access to enough information and support about their condition, compared with those who did not have any access to a specialist nurse. But less than three in 10 respondents—some 28%—had accessed information from a specialist nurse, and this varied widely by condition group. Wow: how important is the role of specialist nurses? I would be reassured if the Minister came back to me in respect of the critical role they play, perhaps exclusively. If only 28% of people have access to information from a specialist nurse and it should be more, what can be done to improve that?

Finally, when developing the NHS workforce plans, will the Minister consider what more can be done to recruit more specialist nurses to support people with rare autoimmune rheumatic diseases? We must always consider the fact that although the chances of getting a rare disease may be one in 10,000, the reality is that the patient deserves all the help we can offer, from diagnosis to treatment and support. I ask the Minister—very kindly, sincerely and humbly—to clarify whether that is this Government’s goal. I believe that it is, but it is not about me today; it is about the people we represent in this House, collectively, together, across this great nation. I believe we have an important role to play.

RAIRDA, with all the clinicians and all the charities, has brought together some positive ideas that can help us together. This is not about blame—it is is never, ever about blame; it is about how we do it better. On behalf of my constituents who have contacted me, and others who will speak shortly, and for the shadow Minister and the Minister, we put forward our case and look forward to support from Government.

[Dr Rupa Huq (in the Chair)]

I remind Members that they should bob if they want to be called in the debate.

09:59

[Peter Dowd (Bootle) (Lab)]

It is a pleasure to see you in the Chair, Dr Huq. I thank the hon. Member for Strangford (Jim Shannon) for bringing this issue before us today, because it is one of those subjects that does not get the attention that it needs. It is really important to tease out some of the issues, because there is a danger that they could be forgotten if we do not. The hon. Gentleman pushes this matter time and again.

The whole question of rare autoimmune rheumatic disease needs to be set in the context of the wider issue of rare diseases, which are conditions that affect less than one in 2,000 people. There are 7,000 rare diseases, affecting one in 17 people, which is 3.5 million people. They can be of a genetic or non-genetic origin and they affect adults and children. Some 75% of rare diseases affect children and more than 30% of children with a rare disease die before their fifth birthday. That is a sobering statistic.

We have to put the issue into that context: it affects the lives of so many people, not just those who are directly affected by the particular disease, but their family members and friends. A disease can also have an impact on someone’s work-life balance and their job, as well as more broadly. There are challenges, but I thank the Rare Autoimmune Rheumatic Disease Alliance for bringing those groups together to push for this issue. It believes, as we all do, that getting together gives us more strength. I support that, and I have no doubt that the Minister supports that too.

We do not want rare diseases, particularly this type of disease, to be left at the back of the queue. The Government acknowledge that, so I am not pointing the finger at them, or at health professionals. Many people with this type of disease say that they do not get the support they need, but they do not blame individual clinicians, practitioners or healthcare workers; they blame the system in so far as it does not bring those professionals together in, for example, the clinical networks that the hon. Member for Strangford referred to. This is not a finger-pointing exercise, but it is important that where we can identify, and have identified, problems in the system, it is our responsibility to try to fix those problems.

The hon. Gentleman also touched on the need for defined, measurable and identified standards to reduce inequalities in healthcare provision. RAIRDA is working with others to set out key statements that it believes will form the quality standards for the future. It has set out the challenges, such as the challenge of focusing on this issue and the points that the hon. Gentleman raised that the time from symptoms to diagnosis can be from two and a half years to as much as five years, and potentially beyond.

There is also a challenge with access to specialist knowledge and expertise, and the hon. Gentleman’s valid point, which I repeat, about the need for those specialist networks. There is the challenge of getting support out to the people—the professionals—dealing with our constituents in one way fashion or another. I know the UK rare diseases framework, and the England rare diseases action plan in my case, has been trying to help patients to get a diagnosis faster but we need to do more.

There has been a push to raise awareness among professionals, but we need to do more there. We need better co-ordination of care and improved access to specialist care, treatment and drugs. We also need to focus on the needs of the various nations. Although they all face similar problems, it is important to have a focus at a national and potentially regional level.

I support the hon. Gentleman, who made important points. We will no doubt come back to this issue. I know that the Minister will respond, as he always does, constructively and positively, so I look forward to hearing what he and Members from other parties have to say. I will finish by saying to the hon. Gentleman that at no point during my contribution did I mention either Shakespeare or Sophocles.

10:04

[Alison Bennett (Mid Sussex) (LD)]

It is a pleasure to serve under your chairmanship, Dr Huq. I thank the hon. Member for Strangford (Jim Shannon) for bringing forward this debate on a subject that all too often does not get enough attention, but that is important and affects millions of people. I also thank the hon. Member for Bootle (Peter Dowd) for his contribution.

More than 160,000 people in the UK live with rare autoimmune rheumatic diseases. Identifying, treating and caring for those people is complex. Yesterday, my constituent Carrie told me about her experience. She suffers from a number of conditions and has done since she was diagnosed 30 years ago. Interestingly, for someone who has carried those conditions for 30 years, she considers herself fortunate to have been diagnosed with Raynaud’s and lupus at a young age, because it allowed her to start treatment early and receive consistent care. She knows from experience that early diagnosis and treatment makes a real difference, a point that has already been made by hon. Members.

While Carrie believes that she has been lucky and has received good care, she stressed that many people face years of misdiagnosis or dismissal, and poor or almost non-existent care. Those failures only exacerbate their symptoms further down the line. Sadly, one of those less fortunate than Carrie is her own mother, who lives not in Sussex but in Yorkshire, and also has multiple autoimmune conditions. Contrastingly, however, she has always been made to feel like a hypochondriac—not an unusual experience for those seeking help with rare autoimmune rheumatic diseases.

Carrie’s mother was eventually diagnosed after many unnecessary years of suffering. She suffered for longer and to a greater degree simply because no one believed her or was able to diagnose her. Carrie told me that a postcode lottery exists in the quality of care for those with these conditions. It really is down to the specific medics and practitioners who an individual meets as to how well their condition is identified and whether treatment can begin.

Carrie’s Raynaud’s is particularly debilitating in winter. She told me that more awareness of the issues around the conditions and how symptoms can be alleviated is vital. Often, solutions can be as simple as helping with buying things such as thermal gloves or socks.

Another major challenge has been the impact of her autoimmune conditions on her teeth, particularly with the Sjögren’s that she suffers from. Carrie has spent thousands and thousands of pounds on private dental care over the years—the only option as NHS treatment was not available. Despite that money, Carrie now thinks that it is not long until she will have very few teeth left.

Carrie thinks that the current system is disjointed, with her dentist not understanding the issues surrounding her conditions, and her rheumatologist likewise not understanding the impact her conditions have on her dental health. She believes that a more co-ordinated, multidisciplinary approach to treating the conditions would help. It is clear from my conversation with Carrie that we simply must do better on this issue.

We must tackle the postcode lottery, exemplified by Carrie and her mother at opposite ends of the country; build a more joined-up system; and take rare autoimmune rheumatic diseases seriously so that we can start diagnosing earlier and more consistently. While the problems seem daunting, I believe that by collaborating—for example, with organisations such as RAIRDA—we can find solutions to the problems that Carrie told me about.

It is already Liberal Democrat policy to ensure that everyone with long-term health conditions has access to a named GP. We must also do better on dentistry, both generally, by sorting out the NHS contract and ensuring that we have a proper workforce plan for dentistry, and specifically, for people with those rare diseases that have a massive impact on dental health. As well as having access to a named GP, the Liberal Democrats are campaigning for the Medicines and Healthcare products Regulatory Agency to have greater capacity, which would help to speed up the process by which new treatments reach patients—a potential game changer for those suffering with such conditions.

We need change so that we can help the people living with those complex, long-term and debilitating conditions. The diseases may be complex, but I believe the solutions need not be. I am encouraged by the words of hon. Members today, and together, we can effect the change that Carrie, her mother and so many others need and deserve.

[Dr Rupa Huq (in the Chair)]

I call the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), to speak for His Majesty’s loyal Opposition.

10:10

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

It is a pleasure to serve under your leadership, Dr Huq, and thank you for the introduction.

I thank the hon. Member for Strangford (Jim Shannon) for his detailed canter through a subject that needs to be highlighted. He hit the nail on the head in relation to improving clinical pathways. We, as a House, need to think about the best way to do that, and to help the NHS to do that. He exemplified that by telling Zoi’s story.

As the hon. Member for Bootle (Peter Dowd) rightly highlighted, the impact on patients is the crux of the matter, which was also personified by the hon. Member for Mid Sussex (Alison Bennett) with her story about Carrie—what she and her mother have to go through, and the difficulties they are living and breathing every single day. The co-ordination of care is so important. The hon. Member for East Londonderry (Mr Campbell), who is no longer in his place, made a timely and pointed intervention about clinicians, awareness and training.

Being a clinician, and bringing that experience to the House, I believe it is difficult to identify the issues because they are often masked by other conditions. A random screening test may conclude rheumatoid factor, anti-CCP antibodies, ESR, CRP, ANA, ANCA, and even anti-ro and anti-la. All those may be positive or negative, and can be indicative of, but not definitive about, some of those conditions. That is part of the problem we have with those rare diseases. With 170,000 people affected, they are uncommon but common enough for us to see them. I certainly have treated several patients with conditions such as systemic lupus erythematosus, Sjögren’s or Raynaud’s.

When we think about these conditions, we need to break them into two distinct groups: the connective tissue disorders, such as lupus, scleroderma, myositis and Sjögren’s, and vasculitis disorders, such as ANCA-associated vasculitis, giant cell arteritis and Behçet’s. By their nature, because they are rare, they are hard to diagnose. I hope that in the future, we may well have artificial intelligence to help clinicians to identify, or at least to think about, the differential diagnosis when it comes to dealing with those patients.

It is a broad and difficult topic to break down, so it will be helpful to look in turn at the framework to address rare diseases, the research behind it, the diagnosis, the workforce, and, finally, the treatment. A framework to help the approach is important, so under the previous Government, the UK rare diseases framework was published in 2021 to set out a vision to improve the care for people with rare diseases. It set out four priorities: delivering early diagnosis, increasing awareness among health professionals, improving access to a specialist team and providing co-ordinated care. In essence, that is the care pathway.

The framework was designed to improve the speed of diagnosis, the co-ordination of care and the access to treatment. As RAIRDA said:

“The UK rare disease framework (2021) has been a significant step in securing equity of treatment for rare diseases, and going forwards, it is crucial that the Government does not lose sight of the work done to date to drive changes for people living with rare conditions.”

Therefore, I ask the Minister my first question: how do the Government intend to build on the UK rare diseases framework to ensure that it remains adequately funded and relevant?

Next, we need the research, and that is the hardest part. As I mentioned, some of the tests cannot even diagnose conditions such as Behçet’s syndrome; it is often a clinical diagnosis. The establishment of the Genomics England project, further mapping the genetic codes of individuals with rare conditions, was a move hailed by researchers worldwide. The programme, although ostensibly broad, directly benefits patients with rare autoimmune rheumatic diseases by identifying genetic markers and enabling targeted treatments. My second question to the Minister is: what progress has been made in expanding genetic research to uncover new treatment options for such diseases?

Earlier this year, the Government published an action plan that includes significant new commitments against each of those four framework priorities, including the health inequalities that we have heard so expertly talked about today. The action plan highlighted the significant investment in driving research on the diseases, including £14 million to the Rare Disease Research UK platform. That facilitates greater collaboration between academics, clinical and industry research, as well as people living with rare diseases, research charities and other stakeholders to try to accelerate the understanding, diagnosis and therapy of these diseases. I was pleased to stand on a manifesto commitment to take forward the rare disease action plan.

I fully accept that more needs to be done, and the new Government must work closely with their delivery partners on the matter. I was pleased that in a recent written response, the Government reiterated their support for research into rare diseases. They further highlighted that the Department for Health and Social Care has invested £2.2 million to enable the National Institute of Health and Care Research to carry out research programmes related to rare genetic diseases, and of course the £340 million to Genomics England.

I did my medical training at the University of Birmingham medical school, which has the University of Birmingham Centre for Rare Disease Studies, a collaboration to try to pull together all the academic research. That is translational research. As we keep saying, these diseases are rare so, by definition, to do the trials, we need to have a wide pool to pull people together to try to work things out. I hope the hon. Member for Strangford will be interested in the fact that that university has joined with the Queen’s University Belfast to research and collaborate across the four nations, including with Newcastle University. In 2015, I had the privilege of visiting that centre, and this is a note for him to look into that. Will the Government continue to increase funding specifically for rare autoimmune rheumatic diseases, especially within the Medical Research Council’s care for rare disease programme?

Then we need to look at workforce and testing capacity. Over the last few years, the Government have allocated £2.3 billion to community diagnostic centres, of which there are almost 170 across the country. Those are really important for doing blood tests, ultrasounds, MRI scans and CT scans. In my constituency, I am lucky enough to have had £24 million invested; one is being built as we speak. That is revolutionary for our area, because for too long people had to travel to the likes of the George Eliot Medical Centre or to Leicester. Now they can have these tests in their community, providing swifter access. I hope that that will help people like Zoi, about whom we have heard, by making sure that she is one of the lucky ones who gets swift access.

Within that, we also need the people who can do the tests and understand the specialisms, so will the Minister tell us whether the Government will be expanding the network of CDCs any further? On staffing, the last Government brought forward the NHS workforce plan. How are this Government looking at addressing rheumatology and radiology in that plan to make sure there are no gaps?

Treatment is the one thing we are looking for. We have the diagnosis, but we need the treatment. Innovative drugs are coming, including immunotherapies, but they often come with high price tags. NICE is looking at how to speed things up, but will the Government commit to accelerating the processes so that we can make sure people get these innovative drugs as quickly as possible? We should not forget that standard drugs are used as well, including methotrexate. They can be quite dangerous, so I ask the Government what they are doing to ensure safe use of such drugs. Disease-modifying medications are important, but they can have high toxicity if not used properly, so they can cause harm. Safety is really important.

The previous Government’s legacy is one of frameworks being established, investment being made and a road to improve lives. For the 2024 general election, RAIRDA published a manifesto that called on the Government to ensure that rare diseases remain a priority, to develop a quality standard for rare diseases and to develop better support for specialist networks. How will the Government work to consider and address those points? I hope this debate has highlighted exactly those calls, because we unanimously agree that this is what we need: research, networks, support and treatments for the individuals who are suffering.

10:19

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

It is a pleasure to serve under your chairmanship, Dr Huq. I thank the hon. Member for Strangford (Jim Shannon)—I want to call him an hon. Friend because he is a friend, but convention dictates that I must call him an hon. Member—and I welcome the fact that he cares so much about health-related issues. I now see him more than I see my wife, because he is always in debates about a whole range of health conditions, and he brings so much passion to those debates. Importantly, he highlights rare diseases. I thank him for the way he made his case this morning, and for speaking about Zoi’s experience. When we humanise these things, we make them all the more impactful.

I thank my hon. Friend the Member for Bootle (Peter Dowd) for his contributions, and I thank the Liberal Democrat spokesperson, the hon. Member for Mid Sussex (Alison Bennett), for humanising the issue through Carrie’s story; that is crucial. The shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), brings his professional experience to this debate, and that cannot be underestimated. I confess that I am not a medical professional, but in health debates it is important to listen to the expertise of those who work in the sector and on the frontline. I thank him genuinely for the way he has approached the debate. This is not a party political, knockabout debate; it is something on which we all want to see progress. The beauty of Westminster Hall is that we can leave the knockabout to the main Chamber, and in this room we can get into the detail of important subjects that are often overlooked. I pay tribute to those who are affected by rare disease, including rare autoimmune rheumatic diseases, and to their families.

The work of patient organisations such as RAIRDA is vital in raising awareness and campaigning to improve the lives of people who are living with rare diseases, and I thank those who dedicate their lives to this community. It is important to make the point that although rare diseases are individually rare, they are collectively common. One in 17 people will be affected by a rare condition over their lifetime. People living with rare diseases may face additional challenges in accessing health and social care. As the hon. Member for Mid Sussex said, this applies to a whole range of health services, including dentistry, and I hope that the Minister responsible for dentistry will pick that up. I will ensure that he receives her comments, because dentistry is often overlooked when it comes to people with rare conditions.

We are committed to improving the lives of people who are living with rare conditions. As the hon. Member for Strangford mentions, the UK rare diseases framework outlines four priorities to achieve this aim: helping patients to get a final diagnosis faster; increasing awareness of rare diseases among healthcare professionals; bettering co-ordination of care; and improving access to specialist care, treatments and drugs. Rare diseases are a priority for the Government. In England, we publish a rare diseases action plan annually, which details the specific steps we are taking to meet the shared priorities of the framework. Each action has an owner, desired outcomes and detail about how we will measure and report on progress. This Government are committed to delivering on the priorities framework, and we are working to publish the next England action plan in early 2025.

The UK rare diseases framework comes to an end in 2026, and I know that the rare disease community would like the policy to continue, to maintain the momentum and progress made over the lifetime of the previous framework. It is UK-wide and agreed across the devolved nations, and I am more than happy to discuss it further with colleagues in Wales and Scotland and, for the hon. Member for Strangford, with Mike Nesbitt, the Health Minister in Northern Ireland. I am the UK Health Minister with responsibility for engagement with the devolved Administrations when it comes to health and social care; indeed, we have a meeting with them and with the Secretary of State tomorrow to discuss a whole range of subjects. I am more than happy to discuss this issue further with colleagues to see if we can maintain four-nation co-ordination in this area. I believe that if we can do so, we should. I give the hon. Member for Strangford my commitment that I will take the matter up with the devolved Health Ministers to see if we can continue the four-nation approach.

In England, I am committed to working towards the four priorities of the framework, which were identified through the 2019 national conversation on rare diseases. Alongside the evaluation of England’s rare disease action plans commissioned through NIHR, the Department will undertake engagement next year to inform future policy decisions. The Government are committed to providing the best diagnosis and care for rare diseases, as set out in the UK rare diseases framework. Good diagnosis should be timely and accurate, and I know that people living with rare diseases often face journeys that are years long—diagnostic odysseys—before they receive an answer.

As the shadow Minister set out, many health professionals are involved in a patient’s journey, from those in specialist testing and genetic screening to GPs and primary care professionals. Raising awareness of rare conditions among those professionals is one way in which we can help to speed up diagnosis. I know that every experience of living with a rare disease is unique, and, with more than 7,000 identified rare diseases, we focus on addressing shared challenges across all rare diseases.

Although the increasing use of genetic testing is an groundbreaking tool in diagnosis, many conditions, including rare rheumatic autoimmune diseases, do not have an identified genetic component, so it is important that overall awareness, diagnostics and quality of care continue to serve all people living with rare conditions. NHS England is working to improve awareness of rare diseases among healthcare professionals, including those in primary care, through the NHS England genomics education programme, which includes non-genetic rare diseases. The GEP provides education and training to support the specialist and wider workforce to diagnose rare conditions early and to know how to deliver the best possible care for patients and families—the shadow Minister mentioned that. Working with partners such as Medics 4 Rare Diseases, the GEP has created genomic notes for clinicians, GeNotes, an innovative digital educational resource for healthcare professionals. The GEP works to provide information to GPs where and when they need it—for example, by presenting at primary care educational events, producing blended learning modules for GP trainees or ensuring regular reviews of the curriculum of the Royal College of General Practitioners.

The shadow Minister rightly mentioned research. I reassure him that the Department of Health and Social Care—this started on the previous Government’s watch, and we rightly are continuing the progress—supports research into rare diseases through the NIHR. The NIHR is the nation’s largest funder of health and care research, and it welcomes funding applications for research into any aspect of human health, including rare diseases. The usual practice of the NIHR and other research funders is not to ringfence funds for expenditure on particular topics. The “Rare Diseases Research Landscape Project Report” described investment of almost £630 million from MRC and NIHR programmes in rare disease research over five years. We are now working with the rare diseases community to further understand the gaps and the priorities, and to get them into those research pathways so that we can, we hope, fill the gaps.

As many rare diseases are chronic and affect multiple body systems, those living with rare disease face complex condition management, and interact with many specialists and providers of health and social care. That can include travelling across the country to access highly specialised care from experts. All of that can add up to a significant emotional and physical burden, and deepens existing inequalities. Co-ordination of care is essential to ensure that care is effectively managed, that the burden on patients and their carers is minimised and that healthcare professionals are working together to provide the best possible joined-up and high-quality care.

Last year, we hosted a workshop with RAIRDA to explore how best to support people living with “non-genetic” rare diseases. That highlighted the importance of specialised networks of care in delivering high-quality care at value for money. As we heard from the hon. Member for Strangford, networks, such as the Eastern Network for Rare Autoimmune Disease, are an example of best practice. I encourage integrated care boards to consider similar models across the whole country for types of rare diseases. I am more than happy to look closely at how we can seek to spread that best practice across the country, across different rare disease types and across ICBs, because patients with rare conditions deserve the same quality, safety and efficacy in medicines as other patients with more common conditions.

NICE, the MHRA and NHS England are working to understand and to address challenges preventing treatments for rare conditions from reaching patients who need them. I take on board precisely the points that the shadow Minister raises about the new drugs, how we ensure faster access and how we create the environment whereby clinical trials are more readily available in the United Kingdom. I want to assure Members that that is a central part not just of our health mission but of the Government’s economic mission, because we want the United Kingdom to be a base for investment in life sciences, in medtech and in access to clinical trials, so that our patients win as well as our economy. We have to ensure that safety is foremost in our deliberations. Safety is paramount, and we must ensure, in whatever regulatory regime that we have to encourage the life sciences, medtech and data industries into the UK, that safety is never compromised. I take on board fully the comments made by the shadow Minister.

NICE has also been working with RAIRDA to create a quality standard for rare diseases. That will find commonalities across the more than 7,000 identified rare diseases to develop standards that will drive quality improvement across multiple rare disease groups. Although the majority of rare diseases are genetic, others, such as rare autoimmune rheumatic diseases, do not yet have an identified genetic cause, as I said. A study by Genetic Alliance UK suggests that such conditions often have higher prevalence, impacting on a significant number of people, so it is important that both genetic and non-genetic conditions are considered.

Approximately 3.5 million people in the UK live with a rare condition, and addressing shared challenges across all conditions will be central to this Government’s approach. In addition, shared challenges across the health and social care system are often exacerbated for people living with rare diseases, such as access to mental health support—something else that the hon. Member for Mid Sussex mentioned. A central mission of this Government is to build a health and care system fit for the future.

The hon. Member for Strangford referred to our 10-year health plan. I reassure the House that that is intended to focus on the three shifts needed to deliver a modern NHS—not just fixing our NHS, but making it fit for the future, for the next 10, 20 or 30 years, putting it on a modernised footing as well as fixing the fundamentals. The three shifts are moving from hospital to community, from analogue to digital and from sickness to prevention. Those shifts offer opportunities to improve time to diagnosis and care for people living with rare diseases. Many highly specialised services for rare diseases must be delivered in hospitals to ensure the high standards of expert care that we want to see, but we can improve co-ordination of care to deliver better treatments closer to where people live, where possible. While many rare diseases are not preventable, early diagnosis can lead to interventions that improve health outcomes.

On the point made by the shadow Minister about community diagnostic centres, the Government’s commitment is to continue that programme. Indeed, I have seen the benefits of it myself—I got to open the new CDC at Crownpoint in Denton in my constituency in July. It is already having a game-changing impact on the local community, giving faster diagnosis and getting people into treatment more quickly, with better outcomes and better patient experiences for those who access the facilities.

The 10-year plan will ensure a better health service for everyone, regardless of condition or service area. On 21 October, we launched a national conversation on the future of the NHS, inviting views from across the country on how to deliver a health service fit for the future. Patients, staff and organisations can make themselves heard by logging on to the online portal, change.nhs.uk. I encourage hon. Members to do the same and to encourage their constituents to do likewise, if they have not done so already.

Unmet need remains, however, for people living with rare diseases, including rare autoimmune rheumatic conditions. I reaffirm that I am deeply committed, as is this Government, to working across the health and care system and with the rare disease community to address that need.

Finally, on workforce, the hon. Member for Strangford and other Members asked if the goal of the Government is to ensure that a patient gets the treatment, and that we get that treatment with the workforce we have. Getting that right workforce will be key. I reassure Members that the goal of the Government is to ensure that the patient, as they deserve, gets all the help that the NHS can offer in treatment, care and support.

The 10-year health plan will deliver those three big shifts on hospitals to community, analogue to digital, and sickness to prevention. To support delivery of the plan, the Secretary of State has confirmed that next summer we will refresh the NHS long-term workforce plan. That will help to ensure that the NHS has the right people in the right places with the right skills to deliver the care that patients need when they need it, not just today but in the future. The shifts we want to see in the delivery of healthcare will require us to rethink the kind of workforce we need in 10 years’ time.

[Dr Luke Evans]

I am grateful to the Minister for acknowledging the workforce, and for looking at the workforce plan. I was aware of the Health Secretary’s plan to revisit this, and the Minister talks about it being done next year. Does he have a timescale for how long the review will take? The danger, especially in healthcare, is that modernisation happens so quickly that, by the time we review something, it is already out of date and needs another review. This is always a chicken-and-egg situation. I would be grateful for a timescale.

[Andrew Gwynne]

We will refresh it next summer, and the Department is already beginning to think about whether this is what the shifts are intended to bring about, and whether these are the outcomes we want to see as a result of those shifts. If we are to have a neighbourhood health service that delivers much more in a community setting, how do we ensure we have the right skills and the right workforce to deliver that?

Particularly with the shift from analogue to digital, we will need a lot more tech-savvy clinicians, too. How do we build in some of the massive advances in artificial intelligence into medical devices and medical technology? We will be doing that concurrently with the 10-year plan to make sure that the workforce plan refresh is ready to go. This will allow us to embed the future, not just today’s practices, into the training and recruitment processes for the immediate future. The refresh will begin next summer, but it is a chicken-and-egg situation. We need to work out what the future of the NHS will look like, and then we have to ensure that we have the skills to meet that ambition—not just for today, but for the future.

In closing, I again thank my friend, the hon. Member for Strangford, for raising such an important matter, and I thank the rare diseases community for their continued and constructive engagement with the Government to help bring about meaningful change. I hope I have reassured the hon. Gentleman both on cross-UK working—and I take up his challenge to try to get colleagues across the devolved Administrations to agree to continue a UK-wide approach—and on my specific responsibility here in England. We will take forward the four areas identified in the UK plan. We will have a new plan for England, and we will seek to make the significant progress that I believe all Members of this House want to see happen.

I am more than happy to work collegiately with Members across the House, whose role is to scrutinise the Government, to hold our feet to the coals and to make sure we do what is in the plan at the best speed and pace for people living with these conditions. I also accept that I am not the sole fount of all wisdom in this area.

[Dr Luke Evans]

No!

[Andrew Gwynne]

I know the shadow Minister is surprised by that. Genuinely, whatever people bring to the table, whether it is personal experience, professional expertise or their constituents’ stories, we need to share that knowledge so that we can improve how we deliver the outcomes we want to see for people living with rare diseases. I stand willing and ready to work with hon. Members across the House, and indeed with organisations that champion this area, so we can get the best outcomes that people deserve.

10:44

[Jim Shannon]

I thank all hon. Members for their contributions. I refer first of all to the hon. Member for Bootle (Peter Dowd). It is always a pleasure to hear him make his contribution. Even when there are things that are said in other debates which I may challenge, he always delivers his contribution in a lovely way and not many people can do that. Today he delivered something that we all agree with. I thank him for that and I mean that sincerely, but he knows that. He referred to the effect upon the family. He is right, and also right that those who want to work are not able to. He said he did not want to see these diseases at the back of the queue and he is right on that as well. All those things are pertinent to the debate.

My hon. Friend the Member for East Londonderry (Mr Campbell) referred to awareness and training. Again, a very salient intervention for which I thank him. The Minister is right that there is no better way of telling a story than giving an example, and the hon. Member for Mid Sussex (Alison Bennett) told of her good friend, Carrie, and the effect upon her and upon her mummy as well. Sometimes they were wondering what it was all about when the condition worsened, and how the health service responds is critically important.

The shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), brings to any debate his wealth of knowledge—from his own personal experience and from his vocation as well—and he does so sincerely. He referred to the two groups: those with tissue and those with vasculitis. He referred to the vision for the rare disease framework and the new action plan. I did not previously know about the tie-up between Birmingham, Newcastle and Queen’s University Belfast for research and development and I was really interested to hear about it. I know about some of the things Queen’s University do but I did not know about that specifically and so I thank him for that, and for the wee reminder of how to get onto that as well. That has really been helpful.

I am encouraged by what I have heard today. I referred to research networks and support, and working collectively to make this situation better. Disease modification drugs need to be regulated. This is a wee reminder of some of the things to be done—it is not always straightforward by the way, either.

This debate was never about me or about any of us here. It is about patients and our constituents; about those who we serve in this place. Today I think the Minister has developed a very positive response. All of those out there—my constituents, and those of the hon. Member for Mid Sussex and of the hon. Member for Hinckley and Bosworth—will be encouraged, because they will be listening to this debate and they will want to know what the Government are going to do. They will be encouraged by the things the Minister referred to: highlighting the rare diseases, the personal stories, to raise awareness. That the diseases are rare but collectively they are common was a salient and poignant comment. On measuring and reporting progress, he referred to the 2026 end of the framework but the Minister gave us assurance—he referred to a mission and to contacting the four nations so they can approach it together and commit together. I think that is also an answer to one of the questions I asked. That is what the Minister has committed himself to doing and we should be reassured by that.

Diagnosis should be timely and accurate, and the Minister referred to GeNotes and the digital improvements. That is really important as well. He also referred to NICE, to encourage research and development for rare diseases because we have to look forward to someday hopefully finding a solution. He also referred to the ENRAD, which is a good model for all to follow. Government will put this idea to the fore, where there has been a good example. The Minister is right about the economic and health commitment for clinical trials, so that our patients win each time. He also made encouraging comments about training and workforce—early prevention, faster diagnosis, better outcomes. I think those who have rare diseases—170,000 across this great United Kingdom of Great Britain and Northern Ireland, and all the families of those people—will today be encouraged by this debate and the contributions from all sides. Most importantly, I say a sincere thank you to the Minister.

Question put and agreed to.

Resolved,

That this House has considered rare autoimmune rheumatic diseases.

10:49

Sitting suspended.

Cleve Hill Solar Park

Tuesday 10th December 2024 Westminster Hall

10:59

[Dr Rupa Huq (in the Chair)]

I will call Helen Whately to move the motion, and then I will call the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention with these 30-minute wonders.

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

I beg to move,

That this House has considered the impact of Cleve Hill Solar Park on communities in Faversham and Mid Kent constituency.

For centuries, the view from Graveney church tower has been spectacular, looking across miles of marshland to the Swale beyond. In the summer, there are wide-open blue skies and sheep grazing in the sunshine among the rushes going down to the sparkling water of the estuary. In the winter, still beautiful if bleak, there are clouds scudding across a grey horizon, down to the froth of white horses on galloping waves, accompanied by the cries of seabirds, calling as they circle overhead, buffeted by wind and rain.

This epic landscape inspired great British writers such as Charles Dickens and Daniel Defoe. Since then, it has continued to inspire countless visitors and locals alike—the backdrop for walkers travelling the ancient Saxon Shore way, a haven for birdwatchers and the seabirds they have travelled to see, or just a place to find peace and tranquillity in our otherwise busy lives. But no more.

In 2020, planning permission was granted to build Cleve Hill solar park. In 2021, the park was acquired by Quinbrook Infrastructure Partners, a US investment fund based in Texas. In 2023, construction began. Now, as we near the end of 2024, the work is nearly done. Soon, the village of Graveney in my constituency will host the UK’s largest solar power plant, generating 373 MW of electricity. Alongside the solar array, the developers have permission for a large-scale battery installation, with up to 700 MWh of capacity. The concrete base for the batteries is being constructed, and the batteries themselves are now in the country, soon to be installed. The plant is set to become operational early next year.

As I speak about this huge solar installation in my constituency, hon. Members should make no mistake: I recognise climate change as one of the greatest threats to our planet and way of life. I want us to continue our shift to renewable energy, reduce our carbon footprint and improve our energy security, and that includes solar. I welcome solar on factory and warehouse roofs, housing developments, brownfield sites and even out-of-the-way pockets of poor-quality land. But Cleve Hill is altogether different. When complete, the solar park will cover more than 700 acres—an area larger than the town of Faversham itself. It will have not far off 1 million solar panels, each the height of a double-decker bus. No amount of natural screening can prevent this huge installation from dominating the landscape.

It is not just about the views. The marshes were home to rare species, including Brent geese, golden plover, marsh harriers and the red-listed lapwing. The humble dormouse and water voles also thrived in the dykes and field margins. Before the Cleve Hill solar team arrived, there was a totally different vision for this spot. The Environment Agency planned to restore the marshes to a wetland, which would have provided a haven for the wildlife, sequestered carbon and acted as a natural flood defence.

As someone who has stood knee-high in flood water in my own home, I do not take the risk of flooding lightly. As many as 17,000 homes are at risk from rising sea levels along the north Kent coast. Unfortunately, the planning inspector considered the solar development only against the agriculture land use at the time. Instead of Graveney’s marshland being transformed into a haven for nature and a release for rising sea water, it has been transformed into an industrial zone.

Over the years since the solar scheme was announced, I have received hundreds of letters and emails from people asking me to stop it. I have worked with Graveney’s excellent parish council, the Save Graveney Marshes campaign group and the GREAT campaign. All have worked hard to give the community a voice in the planning system, but to no avail. As a nationally significant infrastructure project, the final decision was taken away from local residents and our local council. I am told that when planning inspectors recommended that the development go ahead, there was little room for the Secretary of State to go against their recommendation, even though only 15 out of 867 public representations supported the project. Like many people, I was gutted when it was approved but we are where we are.

Since then, my focus, like the campaign groups, has switched to trying to reduce the harm and risks to the local community, and trying to claw back some benefit. That is why I have secured this debate. I am here to raise the three main areas of concern expressed by my constituents: safety, disruption and damage, and compensation for the community, who now have an industrial site on their rural doorstep. This is important to my constituents, but important to communities around the country facing large-scale solar developments; they, too, will want to hear what reassurances the Minister can offer.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing this debate. The issue of disruption is incredibly important. I have a number of quarries in my constituency, and I know only too well the damage and enhanced wear and tear that such sites can cause on smaller countryside roads—I do not know the hon. Lady’s constituency, but I presume that that issue will affect it as well. Does she agree that the road safety implications of heavy goods vehicle traffic using these roads over a number of years must be a priority for the construction company? The only way to address that is to have open communication with the local community and a point person to deal with issues as they arise. Has the hon. Lady been able to persuade the construction company to do that?

[Helen Whately]

The hon. Gentleman makes an important point, which I will address in a moment. First, I want to talk about safety, because the safety of the large-scale battery installation is the biggest worry for my community.

To give a sense of the scale, Cleve Hill’s battery capacity will be equivalent to half the output of a small gas-fired power station. Large-scale battery storage systems carry risks including overheating and fire, which can produce toxic fumes and water contamination. To date, more than 65 fires and explosions have been reported in similar battery storage systems across the world.

In March, I hosted a public meeting about battery safety, which was attended by Matthew Deadman, an assistant director at Kent Fire and Rescue Service and the National Fire Chiefs Council lead officer for alternative fuel and energy systems. Almost 50 Graveney residents attended the meeting, which demonstrates the considerable local concern. Matthew Deadman provided some reassurance by outlining the steps that the developer is taking to put in place the safety features set out in the project’s battery safety management plan, but that has not allayed residents’ fears.

Battery fires are notoriously difficult to extinguish, and people at the meeting found it hard to believe that the fire and rescue team at Faversham fire station—fabulous though they are—or even teams across east Kent more widely, would have the specialist equipment required. There is also the question of the contamination of land and water in the event of a fire.

Another outstanding concern was the lack of an evacuation plan in the event of a fire. The rationale we heard was that no evacuation would be needed, because toxic fumes and smoke would dissipate and it would be sufficient to close windows. However, residents and parents whose children attend the local school remain unconvinced.

Added to that is the potential for a fivefold expansion of the battery proposal found in the site’s battery safety management plan. Although that may or may not happen in practice, physicist and former vice-chair of the Faversham Society, Professor Sir David Melville CBE, warns that the site does not have adequate space for such an increase in battery capacity while maintaining the 6-metre spacing between battery units that is advised by the National Fire Chiefs Council. In fact, the Kent Fire and Rescue Service was only satisfied with the site’s battery safety management plan on the basis of the 6-metre gap being adhered to.

I am not alone in raising these concerns formally. Swale borough council scrutinised and rejected the battery safety management plan earlier this year, but its rejection has been overturned by the Planning Inspectorate, leaving the community with unanswered questions and a feeling that they have no say in the matter.

I am not the first Member to raise these concerns. Just over a year ago, a former Energy Minister said the Government intended to consult on including battery storage systems in the environmental permitting regulations at the earliest opportunity. I take that to be an acknowledgment that the current system is not up to the job. In a written question in September, I asked Ministers for an update on the timetable for the consultation, and I received the following response:

“The Government agrees with the need to have robust measures in place to manage the risks associated with facilities that use large numbers of lithium-ion batteries. Defra is considering further options, including environmental permitting, for managing the environmental and public health risks from fires at BESS sites.”

When she sums up, will the Minister advise me whether the Government will be adding battery storage systems to the environmental permitting regulations? If so, when will the consultation take place? If not, what approach to ensuring the safety of large-scale batteries do the Government intend to take? In the meantime, could the Minister tell me what agency is responsible for ensuring the safety of this development? Who will be inspecting it before it is switched on, and how will she ensure that these batteries are safe? I have been in her shoes, albeit in a different brief, and that is a question I would have been asking myself.

This issue is important not just for Graveney, but for the whole country. Large-scale batteries look likely to be an important part of our future energy infrastructure, which means we need to do this properly. Residents’ concerns cannot be brushed aside as an inconvenience. We need a proper process that takes these worries seriously and ensures that large-scale battery installations are safe.

[Sojan Joseph (Ashford) (Lab)]

My neighbouring constituency of Ashford has a big solar farm planned for it. I have recently listened to experts who have highlighted the risk of fire and toxic fumes from large batteries. Some of these farms are planned for rural areas that fire engines may not be able to access. These are genuine concerns. Does the hon. Lady agree that local concerns need to be addressed before planning permission is approved?

[Helen Whately]

The hon. Gentleman makes an important point. The issue is clearly of great concern to my constituents in the village of Graveney and the nearby town of Faversham, who are living close to the solar plant and the battery installation. We need to get it right in Graveney, and then we can use the same approach to get it right in other places, because this is not the one and only large-scale battery installation we expect to see. As I have said, these installations are likely to be part of our future energy infrastructure, so we must get it right in Graveney and across the country.

The second area of concern, which was referred to by the hon. Member for Strangford (Jim Shannon), is the impact of construction on local residents and, in my constituency, on the village of Graveney itself. Residents and schools have put up with many months of heavy construction traffic. It is down to the hard work of the community and people such as Mike Newman, the parish council chair, sitting down with the developer, that we now have an effective traffic management plan. That has mitigated the impact, and I recognise that the developer has played its part—for instance, by restricting lorry movements at certain times to accommodate the school—but even when construction ends, residents will be left with the consequences. Some houses have cracks in their walls thanks to the huge lorries thundering past day after day, and the lane through the village will need resurfacing. The community is looking to the developer and hoping that it will stick to its word and make good any damage, but the worry hangs over the village all the same, not least because no such requirement was part of the planning process, and nor is it set out in law.

That brings me to the final outstanding concern. When an unpopular planning decision is made locally, there is at least the silver lining of a section 106, or a community infrastructure levy contribution, which can go towards a new school, a GP surgery or a similar community facility, but not so with a nationally significant infrastructure project. I know that one of our challenges as a country is the time and cost required to build any new infrastructure, and I have no appetite to make that worse, but it is hard to stomach the fact that a small village such as Graveney could find itself hosting a power station, in effect, and have nothing by way of compensation.

I am grateful to the developer for indicating that it will make a significant community contribution, and I know there is a discussion about the potential for a longer-lasting approach that could support the community over the lifetime of the project, as an alternative to a one-off. However, that begs the question of why the community is left relying on the good will of the developer. The Minister’s Government intend a big overhaul of the planning process, with the objective, rightly, of ensuring that we get better at building infrastructure. I suggest that one way to do that is to ensure that there is something in it for the local community, especially when, as is the case here, it bears the brunt, with no discernible local benefit.

I will sum up to give the Minister time to reply. With regret, I accept the reality of Cleve Hill solar, the UK’s largest solar installation, and the large-scale battery storage that comes with it. What I do not accept is the failure to address residents’ concerns about safety, the failure to give residents certainty about repairing the damage from construction, and the feeling that the community is on its own, negotiating compensation from the developer for the industrialisation of the marshland it holds so dear.

On all three counts, I seek the Minister’s assurance and action. To be clear, I am not advocating more red tape. This is about doing something better, not making it harder. If we get this right, we can improve how we build energy infrastructure in this country. That is important because we need more renewable energy generation capacity to meet our future energy needs, in a world where economic growth is likely to be dependent on energy-intensive computing power. All our futures depend on that, so let us ensure that we get it right, starting right here, right now, with Cleve Hill solar.

11:16

[The Parliamentary Under-Secretary of State for Energy Security and Net Zero (Kerry McCarthy)]

It is always a pleasure to see you in the Chair, Dr Huq. I begin by congratulating the hon. Member for Faversham and Mid Kent (Helen Whately) on securing the debate and giving us a chance to discuss an important topic, not just for her constituents. I hope she will understand, however, that due to the quasi-judicial role that my right hon. Friend the Secretary of State plays in taking decisions on applications for development consent for energy infrastructure proposals, it would not be appropriate for me to comment on matters related to any specific proposals.

Although the development consent order for Cleve Hill solar park was granted by the previous Government in 2020, as she said, the Department for Energy Security and Net Zero may still be involved in any proceedings relating to the implementation of that order. As a result, I cannot comment today on the details of that project. The reasons for the decision and details of supporting plans are available on the Planning Inspectorate’s website, as the hon. Lady knows. I am afraid I cannot elaborate or speculate on that published material.

The hon. Member spoke eloquently about the importance of the site to her constituents—the views, the biodiversity and the birds, and the importance of wetlands. My colleagues in the Department for Environment, Food and Rural Affairs and I are working closely on nature-based solutions to climate change, and wetlands play an important role. I am also glad that the hon. Member acknowledged the importance of reaching our net zero objectives, with that mission for clean power, by 2030.

As I said, I cannot speak specifically about Cleve Hill, but I hope I can reassure her by speaking in general terms about Government policy. First, it ensures that all local impacts are considered in the planning process. Secondly, it makes a steadfast commitment that those who host clean-energy infrastructure should benefit from it. In order to achieve our goal of clean power by 2030, we will need to deploy various renewable energy sources. According to the recent National Energy System Operator clean power pathway report, we need to increase solar deployment from 15 GW to 47 GW. Along with onshore wind, solar is the cheapest clean power option available to us right now, making it an essential part of the UK’s energy mix. Without a substantial increase in solar deployment, the clean power mission becomes very difficult.

That is why my right hon. Friend the Secretary of State relaunched the solar taskforce earlier this year. It is also the reason that the Under-Secretary of State for Energy Security and Net Zero, my hon. Friend the Member for Rutherglen (Michael Shanks), who has this portfolio, cannot reply to the debate, because he is at a meeting of the solar taskforce. The taskforce brings together the industry and Government to discuss the actions needed to rapidly increase the deployment of solar panels on rooftops and in solar farms, and it will publish its recommendations in a solar road map very soon.

We should never lose sight of the core motivation behind our clean energy mission. Clean power generated here in Britain will reduce our dependence on volatile imported fossil fuels. It will provide lower bills in the long term and create thousands of highly skilled future-proofed jobs across the country. Delivering those benefits for the British people requires the development of new infrastructure. We accept that a top priority should be the deployment of solar on rooftops. That is why we are bringing forward new standards to ensure that all newly built houses and commercial buildings are fit for a net zero future. We will encourage the installation of solar panels on those buildings where appropriate.

But we know that our mission will require more ground-mounted solar too, and decisive reform to the planning system is urgently needed to support that. As the Prime Minister said last week, we will streamline the approval process in the forthcoming planning and infrastructure Bill. As part of the new plan for change, in which the Prime Minister set out the milestones in how the Government will deliver on our national missions, we will work towards the new target of 150 major infrastructure projects, including energy projects. That will mean tripling the number of decisions on national infrastructure, compared with the previous Parliament. We recognise the impact that such new energy projects can have on local communities and the environment. The Government are committed to striking the right balance between those considerations when delivering the clean power mission.

All proposed solar projects are subject to a robust planning process. Most projects are assessed by local planning authorities themselves, and those assessments are governed by the national planning policy framework, which encourages developers to engage with local communities before submitting an application. Local planning authorities will continue to seek representations from local communities and will continue to weigh local considerations against the need for renewable energy.

As the hon. Member for Faversham and Mid Kent said, larger projects such as the Cleve Hill solar park are decided centrally through the nationally significant infrastructure regime. That is a rigorous process. Developers whose projects qualify for the assessment must complete considerable community engagement before any decision is taken, and decision makers take into account its level and quality.

We recognise that new infrastructure can have an impact on the local community, and the planning system is designed to take account of the social, cultural, economic and environmental effects. Indeed, all large-scale solar developers are legally obliged to complete an environmental statement as part of any application for development consent. The hon. Members for Faversham and Mid Kent and for Strangford (Jim Shannon) raised disruption, which will be considered as part of the environmental statement.

The statement requires the developer to consider the potential environmental impact of a project, not just during the construction phase but during its life. It spans pre-development, construction and operation, all the way to decommissioning. The statement is a helpful tool that allows planning authorities to review any significant effects on biodiversity or the environment. I know the hon. Member for Faversham and Mid Kent is committed to improving the natural environment, and she spoke eloquently about her vision for that part of her constituency. There is some evidence to suggest that solar can improve biodiversity when installed and managed appropriately. The environmental management plan for Cleve Hill includes commitments to build a habitat management area of 56 hectares, which is predicted to increase on-site biodiversity by 65%.

I want to touch briefly on the use of agricultural land for solar. I hope I can reassure the hon. Lady that the Government recognise that food security is linked to national security, and that we will always back British farming. In previous years, we worked together on the all-party parliamentary group for fruit and vegetable farmers, which she chaired, so I gained some knowledge of the importance she attaches to standing up for farmers in her constituency.

Planning guidance makes it clear that developers should situate their projects on brownfield or industrial sites whenever possible. Where the development of agricultural land is shown to be necessary, developers are steered away from using the best and most versatile land, and we have no plans to change that. We do not believe, however, that the accelerated deployment of solar power poses a threat to food security. The total area of land devoted to solar farms nationally is very small. Even in the most ambitious scenarios, less than 1% of the UK’s agricultural land would be occupied by solar farms. My colleagues at the Department for Environment, Food and Rural Affairs are developing a land use framework, which will consider issues such as food security and how we can expand nature-rich habitats. The framework will work hand in hand with the strategic spatial energy plan.

May I just ask, Dr Huq, will the hon. Member for Faversham and Mid Kent be given a minute to respond?

[Dr Rupa Huq (in the Chair)]

Not in a 30-minute debate.

[Kerry McCarthy]

Okay.

I come on to the issue of battery safety. I note that the hon. Member for Faversham and Mid Kent said that members were given some reassurance at the community meeting she held but still have significant concerns about fire safety. As she knows, batteries are regulated by the Health and Safety Executive. The framework requires battery designers, installers and operators to take the necessary measures to ensure health and safety through all stages of the system’s construction, operation and decommissioning.

The Government have updated the planning practice guidance to encourage battery storage developers to engage with local fire and rescue services and for local planning authorities to refer to guidance published by the National Fire Chiefs Council, which I note the hon. Lady said was represented at the meeting she held. The health and safety framework for batteries is kept under review to respond to changing circumstances. In 2018, the Department for Business, Energy and Industrial Strategy set up an industry-led electricity storage health and safety governance group, whose members include the National Fire Chiefs Council, the Environment Agency and DEFRA. That group is responsible for ensuring that an appropriate, robust and future-proofed health and safety framework is sustained. My Department worked with it to develop and publish health and safety guidance for grid-scale batteries that aims to improve the understanding of existing health and safety standards, which the battery storage industry should apply to its own processes.

The hon. Member for Faversham and Mid Kent mentioned DEFRA. As I understand, DEFRA is considering further options, including environmental permitting, for managing the environmental and public health risks from fire at grid-scale sites. I am happy to speak to my colleague in DEFRA who is responsible for that and get back to the hon. Lady on her specific question—she will appreciate that I cannot answer on their behalf today. If her constituents require any further reassurances on the safety issue, my hon. Friend the Member for Ashford (Sojan Joseph) will be happy to follow up on that in writing.

In the few minutes I have left, I turn to community benefits. We absolutely understand that we need to fully engage with communities and bring them along with us on our clean power mission, which includes public engagement and consultation. The hon. Member for Faversham and Mid Kent asked specifically about community benefits. We know that communities are providing a service to the country as a whole when they host clean energy infrastructure, so there need to be benefits for them. Sometimes there is a direct benefit where the infrastructure is owned by the community—the benefit goes straight back into the community, whether it is through solar panels on a village hall or one of many other examples—but we are considering how best to deliver those community benefits to host communities. That includes looking at existing examples in Europe and further afield to see what has worked well.

A wide variety of community benefits can be delivered, including funding for local projects, investment in the local area, direct benefits to individuals and, as I said, opportunities for community ownership. Great British Energy will build on existing community energy schemes, helping communities to unlock opportunities through the local power plan. In the hon. Lady’s constituency, up to 1,400 homes are powered by Orchard Community Energy, which is a community-owned solar farm near Sittingbourne that provides power to Swale and Medway. That puts communities at the heart of the energy transition and gives them a stake in the transition to net zero as owners and partners in clean energy projects.

As I said, the Secretary of State for Energy Security and Net Zero, my right hon. Friend the Member for Doncaster North, is today at the meeting of the solar taskforce, which brings together industry and Government. It is considering the question of how a community can benefit from the infrastructure that is hosted on their patch, and its recommendations will be published in the solar road map.

To conclude, the Government are committed to considering the interests of local communities affected by proposed energy infrastructure. I thank the hon. Member for Faversham and Mid Kent for securing the debate and for giving me the opportunity to set out the Government’s vision. We will work to balance the local impact of new projects with the delivery of our clean power mission. The renewable energy transition will always be done through co-operation rather than coercion, ensuring that all parties benefit on our journey to net zero.

Question put and agreed to.

11:29

Sitting suspended.

Lobular Breast Cancer

Tuesday 10th December 2024 Westminster Hall

[Valerie Vaz in the Chair]

14:30

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

I beg to move,

That this House has considered the treatment of lobular breast cancer.

It is a pleasure to see you in the Chair, Ms Vaz. I secured this debate in memory of my constituent, who was also my close friend, Heather Cripps. I welcome Heather’s husband David and her sister Jenny to the Public Gallery. I will come to Heather’s story shortly, but I also want to welcome to the Public Gallery my mother-in-law Cressida, who survived lobular breast cancer 22 years ago, as well as several others whose lives have been touched by lobular breast cancer. Many of them have provided me with briefings in preparation for the debate, for which I am grateful.

I met Heather in 2016 when, as someone who had pretty much never run for a bus before, I was roped into a free 5 km parkrun at 9 am on Saturday mornings in Dulwich park. Heather was a serious runner, and running was a huge part of her life. She took pity on me and decided that her inexperienced local MP needed a friend to run with, and she became that friend. We worked out that we lived close to each other, and it was not long before I was picking her up to go to the parkrun, and we would run together most weeks.

Heather was a dedicated public servant, spending her whole life working in the Home Office. It is a testament to her professionalism that she never spoke with me about the content of her work. What she did speak about as we ran was her family, her husband David and two precious daughters. Heather was an amazing mum. She spent so much of her time thinking about what her girls would enjoy, planning birthday parties and holidays and, earlier this year, plotting a trip to Wales to culminate in the surprise collection of a new puppy.

In 2020, at the height of the covid-19 pandemic, Heather started to get terrible back pain. For several months this was treated as a musculoskeletal issue. She was given pain medication, but it got worse and worse. Eventually, she was diagnosed with stage 4 invasive lobular breast cancer. The back pain was the result of the cancer having spread to her spine. For three years, chemotherapy held the cancer at bay but, when Heather came to Parliament almost exactly a year ago to campaign on lobular breast cancer, she mentioned to me that she once again had back pain, which she thought could be the cancer recurring.

[Jim Shannon (Strangford) (DUP)]

The hon. Lady brings forward a very personal story. In this House, we know that personal stories are always the hardest to tell, but the ones that have more impact. I commend the hon. Lady for what she is doing today. We would all say that, but we mean it.

[Helen Hayes]

I thank the hon. Gentleman—who is my hon. Friend—very much indeed for that intervention.

Heather died in St Christopher’s hospice near her home on 30 August. She was 48 years old. Shortly before she died, Heather’s daughter, who was due to start secondary school in September, visited her mummy in the hospice, so that she could see her in her school uniform. In that unbearable heartbreaking detail is why we must do better on lobular breast cancer: better on awareness of symptoms and better at research into treatments.

The heartbreak of Heather’s story and the impact on her family and friends is sadly replicated for too many women and their loved ones throughout the UK. Lobular breast cancer is the second most common type of breast cancer, accounting for 15% of all breast cancers, and 22 women a day are diagnosed with lobular breast cancer in the UK. It behaves differently from other forms of the disease, mostly strikingly because it does not cause lumps, and it is often completely invisible on a mammogram.

[Melanie Ward (Cowdenbeath and Kirkcaldy) (Lab)]

I thank my hon. Friend for securing this debate on such an important topic, and for so movingly sharing the story of her friend Heather. I want to raise the case of my constituent from Dalgety Bay. Just days before her surgery for lobular breast cancer, a mammogram was still unable to pick it up, exactly as my hon. Friend describes. It could not pick up the existence of her cancer at all. Does my hon. Friend agree that this is a perfect example of why we so badly need more research and better diagnosis and treatment of lobular breast cancer for women across the UK?

[Helen Hayes]

I thank my hon. Friend for bringing the story of her constituent to this debate. This is exactly the reason why we need to find better means of diagnosis and treatment for lobular breast cancer. I will come talk about some of those means shortly.

Currently, there are no treatments specific to lobular breast cancer. This must change. The issues have been well documented by Dr Susan Michaelis, founder of the Lobular Moon Shot Project. Susan was 50 when she noticed a small, pale, 1 mm mark on her left breast in 2012. She had no lump and both a mammogram and an ultrasound were reassuring. Six months later, the small mark had become redder and Susan had a biopsy that confirmed she had invasive lobular breast cancer. Susan’s cancer had spread to her neck, the back of her head, the eye area and her ribs. She is now on her sixth line of treatment.

Dr Michaelis is a qualified air accident investigator. She focuses on how accidents can be prevented by learning from past mistakes, and has used these skills to look at how treatments have failed her. In doing so, she has identified the need for a new approach.

[Helen Grant (Maidstone and Malling) (Con)]

I congratulate the hon. Lady on securing this really important debate. Does she agree that specific forms of cancer like lobular breast cancer require specific funding, research and treatment, and that a one-size-fits-all approach is going to fail millions of women? I declare an interest in asking this question in that last year I was diagnosed with lobular breast cancer. I am cancer-free now, thank God, as a result of the help of the Royal Marsden hospital. Tragically, that is not the case for many, many women in this country.

[Helen Hayes]

I thank the hon. Lady very much for that intervention and for sharing her personal story.

I pay tribute to Dr Michaelis for her research and campaigning on lobular cancer. I hope that all Members have received their Dr Susan Michaelis rose this week, named in her honour, and will plant it as a reminder of the urgency of her work.

There are so many other stories. Katie Swinburne was 47 when she was diagnosed with invasive lobular cancer in her left breast, leading to a double mastectomy, radiotherapy and 10 years of targeted chemotherapy. She writes:

“It is very hard to accept that none of my treatment is specific to lobular breast cancer and no one can tell me if it is working or has been effective…I find myself living in fear of recurrence. I deserved to have an early diagnosis. I did not get this. I deserve a specific treatment; I do not have this. I have three young children; they deserve to have a mum. I deserve effective follow up; I do not get this. I need you to change this for me, my husband, my family, all the women with a lobular diagnosis and all the women who will be diagnosed in the future.”

Emma Hunwick writes:

“I was a happy, healthy and relatively fit 49-year-old professional woman when I noticed a tiny pull in my right nipple. No lump, no other obvious external changes. An annual medical and referral just 12 days later resulted in a clear mammogram and a clear second 3D mammogram. An ultrasound then reported an area of 2 cm of concern. I rapidly went from ‘caught early’ to borderline stage 2 breast cancer. After my mastectomy I was informed that I was in fact stage 3c invasive lobular breast cancer…I am now at high risk with predicted survival outcomes at 10 and 15 years of approximately 45% and 30% respectively...I need to know that the vital scientific research into lobular breast cancer is being done now. Not next year or in 10 years but starting now, so that I might survive longer and continue to work with less worry about whether the standard monitoring tests that missed my first cancer, will miss a recurrence.”

Kirstin Spencer’s story is also typical. Diagnosed in 2018, she and had a double mastectomy, but was warned that, especially in the first two years afterwards, the disease could recur in areas such as the scar tissue, chest wall and surrounding skin. She was told that vigilance and well-managed medical follow-up were everything. Within a year of her diagnosis, she developed red-flag symptoms that were repeatedly dismissed by her breast specialist. She was refused follow-up treatment and sent for psychological counselling. By the time that a new GP listened to her concerns, substantial recurrence was confirmed, with extensive metastatic disease.

My mother-in-law Cressida’s story is very different from Heather’s, and we are all so grateful to the doctors who treated her and for the subsequent 22 years of health that she has had and continues to enjoy. Cressida did not have any grandchildren when she was diagnosed, but a prompt diagnosis meant that she has been able to be closely involved in the lives of eight subsequent grandchildren, as a much-loved granny. But Cressida’s outcome was about luck rather than design, so much so that it was only very recently, when reviewing her medical notes, that she found out that the type of cancer she had was lobular.

Breast cancer survival rates are directly impacted by the stage of diagnosis. Late diagnosis, which is all too common for lobular breast cancer, leads to far worse outcomes. To improve this situation, we need much better awareness of the full range of breast cancer symptoms, including the very small skin changes that are typical of lobular cancer. Not all cancers cause lumps. A clear mammogram does not provide absolute reassurance, because lobular cancer typically does not show on a mammogram. We need lobular-specific research and treatments.

Staff at Manchester Breast Centre have stated that they are able to do the research to understand the complete pathology of lobular breast cancer—research that has never been done—to pave the way for bespoke treatments to be developed. This will take five years and cost £20 million—moonshot funding that will be recouped many times over in the tax revenue paid by women like Heather, who would be able to continue working, and in the NHS costs that will be saved.

Hundreds of MPs in the last Parliament and this one have listened to the stories of constituents affected by lobular breast cancer and pledged their support for the Lobular Moon Shot Project. Lobular cancer is the sixth most common cancer in women. It is more common than ovarian, brain, central nervous system, non-Hodgkin lymphoma, pancreatic and kidney cancers. I know that the Minister cares deeply about women’s health equality and I put it to her that lobular cancer is a women’s health equality issue.

[Mary Kelly Foy (City of Durham) (Lab)]

I thank my hon. Friend for raising this very important issue. I was diagnosed with, treated for and cured of breast cancer this year, in a very timely way. I was very grateful to be told that it was one of the best cancers to have, because there is so much research into it and treatment for it. It is unimaginable that someone could be treated for a different type of breast cancer for which the research and treatment are not available. I am sure my hon. Friend will agree that this situation needs to be addressed immediately, because we cannot have these inequalities. Lobular cancer should be on a par with other breast cancers in terms of treatment.

[Helen Hayes]

I thank my hon. Friend for that intervention. She makes the point extremely well. How can it be that there are so few targeted programmes to improve the diagnosis and treatment of a cancer that affects 15% of breast cancer patients? How can it be that such poor information is provided to women that does not empower them to seek help when the symptoms of lobular cancer recur? How can it be that women are lured into a false sense of security when they receive a clear mammogram, or are fobbed off when they raise concerns?

We need to do better for women affected by lobular breast cancer, in memory of Heather and many more women like her who will not live to see their children grow up. We need to do better for women like Dr Susan Michaelis, who are living today with their lobular cancer being held just about at bay by generic breast cancer treatments, but who live with the constant anxiety that one day the treatment will stop working. We need to do better for the 22 women today and the 22 women tomorrow—the 22 women every single day—who are diagnosed with lobular cancer.

I have a number of asks to make of the Minister. Will she commit to investigate why there are so few targeted programmes to improve diagnosis, research and treatment of a cancer that affects 15% of breast cancer patients? Will she confirm that lobular cancer will remain a priority in the Government’s women’s health strategy? Will she take steps to address the lack of information given to women about mammograms, so that every woman is reminded to remain vigilant for non-lump changes in their breasts, including very small changes? Will she take steps to improve the education of primary care doctors on the symptoms of lobular breast cancer, so that women are not provided with false reassurance, but promptly referred for diagnostic tests?

For patients treated for ductal breast cancer, the first five years are critical, but for lobular breast cancer the risk will remain for 10 years and sometimes beyond, yet lobular patients are typically released from surveillance care after only five years. Will the Minister take steps to ensure that there is a specific follow-up pathway for lobular breast cancer? Will she support Manchester Breast Centre’s call for Lobular Moon Shot funding—£20 million over five years—to enable the basic pathology of lobular cancer to be fully understood as the foundation for developing bespoke treatments? Will she look at the fairness of the distribution of research funding to ensure that this funding can be identified without further delay?

I know the heartbreak that Heather's death has caused for all who knew and loved her, and most especially for her family. We can act to ensure that, in future, women like Heather who are diagnosed with lobular cancer can live to see their children grow up, and it is imperative that we do so.

14:46

[Clive Jones (Wokingham) (LD)]

It is a pleasure to serve under your chairmanship, Ms Vaz. I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for securing this debate, and for her very moving speech. I have to make a declaration of interest: I am a governor at the Royal Berkshire hospital in Reading and I have a family member who has shares in a medical company.

I would like to start by giving my sincerest thanks to Dr Susan Michaelis: first, for her rose, which I have to say I first thought was a delivery of parliamentary stationery to my office—but it was not; and for her passion and diligence in running the Lobular Moon Shot Project. I am proud to have pledged my support to the campaign, which will hopefully change the lives of millions. I will relentlessly champion the need for improving cancer research in this House, because cancer research is so important for securing earlier diagnosis and delivering more effective treatment. However, the existing system has numerous challenges that need to be overcome.

Funding is certainly one of the research barriers, but there are wider concerns that the existing pressures on our cancer and wider health service are acting as a barrier to research. The Government have committed to developing a national cancer plan. This could be a real turning point, because cancer services are simply not delivering for their patients. The Government are determining what the cancer plan will look like, and they are fortunate that Cancer Research UK has already produced a comprehensive report titled “Leading on Cancer”, which sets out some of the key recommendations that they should consider on all matters of a cancer plan. I will highlight some of their points regarding research, which I suspect would significantly improve the chances of making the Lobular Moon Shot Project a reality.

Cancer Research UK makes it clear that the Government’s cancer plan needs to cover workforce planning, and physical and digital infrastructure. That would give NHS services the capacity to carry out clinical research and would reverse the current trend whereby clinical research is seen as a “nice to have”, rather than as something that is deeply integrated into cancer outcomes. Cancer Research UK’s report also makes it clear that long-term planning is important in giving healthcare systems notice of innovations coming down the track so that the adoption and implementation of those new treatments can be planned for appropriately.

The Government will need to support staff with the right kind of training, and provide the right equipment to deliver innovations. They must not fall into the trap of talking only to themselves. The Department for Science, Innovation and Technology needs to work as one to ensure that cancer research is given the priority it needs. The Cancer Research UK report addresses those points in far more detail. I urge the Minister to read it if she has not done so already, and I would be incredibly grateful if she would meet me and Cancer Research UK to discuss its findings.

I pay tribute to the cancer centre at my local hospital, the Royal Berkshire. The King Edward ward provides constituents with chemotherapy, and the Adelaide ward provides care for oncology patients. Its staff are among the very best in the NHS. Can the Government assure me that when they publish their plans for the rebuild of the Royal Berkshire hospital—following the new hospital building programme review, which I fear is already dragging on quite a bit—they will include appropriate digital and physical infrastructure to fully realise and implement new technologies in future years?

14:52

[Daniel Francis (Bexleyheath and Crayford) (Lab)]

It is an honour to serve under your chairmanship, Ms Vaz. I thank my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) for securing this debate, and I concur with my hon. Friend the Member for City of Durham (Mary Kelly Foy) about health outcomes for those diagnosed with cancer.

One of my most difficult days was when my wife was diagnosed with cancer. She has now thankfully recovered but, looking back at her cancer and her diagnosis, the fact that it was caught early and was seen as a cancer with greater success outcomes shows the disparity of outcomes—particularly for those with lobular breast cancer, as my hon. Friend the Member for Dulwich and West Norwood described.

I pay tribute to the Lobular Moon Shot Project, which aims to give lobular cancer the attention and funding it needs, so that it can be better understood. Lobular breast cancer is the second most common form of breast cancer and, as has been said, accounts for about 15% of all breast cancers, yet there is still not enough research being undertaken.

My hon. Friend mentioned my constituent Emma, who is in the Public Gallery. Emma recently attended my constituency surgery and told me of her experiences with lobular breast cancer. Because of the way it presents, it was not picked up by a mammogram, and it took an MRI—facilitated through a routine private healthcare check—for it to be diagnosed. As has been said, it was initially thought to be a stage 2 cancer, but it was in fact stage 3. Following her diagnosis, she underwent a double mastectomy, followed by chemotherapy for six months, and then 15 sessions of radiotherapy. In Emma’s case, her cancer is likely to return, which leaves her with a very uncertain future for years ahead.

On the current data collection framework on lobular breast cancer, there is a lack of documented research about outcomes for and recurrences of lobular breast cancer. Indeed, there is currently just one trial available in the UK for lobular breast cancer patients. This leaves women like Emma unprepared for the potential impacts that the cancer will have on them further down the line. Given this position, I would be grateful if the Minister could address not only the points raised by my hon. Friend the Member for Dulwich and West Norwood in her asks, but her comments on what can be done to secure more regular MRIs—as was shown in Emma’s case, having more regular MRIs is the only thing that will pick this up—and to ensure that there is greater data collection and transparency on the effects of lobular breast cancer.

14:54

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairship, Ms Vaz. I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for her story on behalf of her dear friend and for leading the debate. We have been very privileged to hear contributions from courageous hon. Ladies to my right and to my left, who have told their own personal stories, which contribute to this debate. It probably also humbles us to have those contributions. Every person who has come here today to make a contribution will have an example of someone they love who has been affected.

Westminster Hall is a great place, as the Chamber would be, to raise awareness and to discuss these matters. I am sure that many will not be fully aware of this insidious brand of cancer, or of its specifics. I am personally grateful to be able to give one example, but also to discuss these issues.

As my party’s health spokesperson, these issues are incredibly important to me. Indeed, they are important to us all; we are all here for the same purpose and it is vital for us all to be here. I know that we will all have had some journey experiencing cancer within our family or close to home. Not long ago, I met in my office a constituent of mine who was diagnosed with lobular breast cancer. I think that, whenever we meet someone who has come through that journey and thankfully is on the other side and alive today, we thank God, as the hon. Member for Maidstone and Malling (Helen Grant) did. Ultimately—I say this respectfully to everyone here —that is where the power lies for healing: with our God.

The hon. Lady explained that there is not enough research into the specifics of this cancer, let alone more access to medication that lessens the impacts of the suffering. Perhaps the Minister will have an opportunity, through civil servants, to check what research and development there is on this specific lobular cancer to help save more lives, make lives better and give people hope for the future. Ultimately, in this House, we are tasked to give hope—not because of our words, because our words are not important—to those out there who face this reality of what the future will hold for them.

Invasive lobular breast cancer is the second most common type of breast cancer. It is also known as invasive lobular carcinoma. Around 15 in every 100 breast cancers are invasive lobular breast cancer. The most recent figures show that, in 2016, 6,765 people were diagnosed with lobular breast cancer in England, including 6,754 women and 11 men. There may be those who think that it is not a disease that can affect men; but although it is a very low number, it still does. My hon. Friend the Member for Wokingham (Clive Jones) is one of those survivors. I think we should thank God that he is here today as well. It is important to note that, although it is less common for men to get this form of cancer, they are still able to get it and it can impact them just the same.

There were 7,566 cases of female breast cancer diagnosed during 2018 and 2022 in Northern Ireland. On average, there were 1,513 cases per year. I want to put the figures and stats on record because they illustrate clearly how critical, dangerous and invasive this cancer can be. In Northern Ireland, the breast cancer incidence rate was 156.7 cases per 100,000 females. The odds of developing female breast cancer before the age of 85 was one in eight. It is clear that there is a major concern in Northern Ireland and throughout this great United Kingdom.

This specific type of cancer often goes undetected, as it spreads in straight lines, as opposed to lumps. Furthermore, although the cancer grows slowly compared with other cancers, the tumours can be large by the time they are detected. In addition, some 3.75 million people will be diagnosed with this cancer in the next 10 years, which is why it is important to discuss it, so I thank the hon. Member for Dulwich and West Norwood for securing this debate.

[Carla Lockhart (Upper Bann) (DUP)]

I associate myself with what we have heard in this very powerful debate. I commend the hon. Member for Dulwich and West Norwood (Helen Hayes), and I commend the family who are sitting in the Gallery. Cancer is a thief in many homes, and I commend them for their bravery.

Does my hon. Friend the Member for Strangford (Jim Shannon) agree that, across the UK, we need more investment, more research and more clinical trials, and that it is for this Government to step into the breach and do just that?

[Jim Shannon]

My hon. Friend is right. We are fortunate that Labour has set aside £26.3 billion for the NHS. We have to recognise that commitment, and I hope the Minister will be able to tell us that money will be set aside for the very invasive disease to which my hon. Friend refers.

ILC currently has no specific treatment and, for those who have been diagnosed, it behaves very differently from the more common type of breast cancer. As we look ahead to the next 10 years, it has been great to learn more about the Lobular Moon Shot Project, which has been supported by this Government, the last Government and hundreds of Members. Everyone in this room supports it, everyone in the Gallery supports it, and everyone outside this room supports it too.

The project was set up in 2023, which is fairly recent. At my age, the years go incredibly fast, but 2023 feels like yesterday. The project seeks to lobby the Government to secure the research funding needed to understand the biology of lobular breast cancer. The project has stated that a major research package is estimated to cost some £20 million over five years, but it has not been prioritised as it should have been. I reiterate what the hon. Member for Dulwich and West Norwood said, and I ask that the research is prioritised. The Minister may not be able to tell us about everything that is happening, but we need to hear that commitment.

Some fantastic charities undertake amazing work to support those living with breast cancer, and I have met them both in Westminster and at home in my office, and their work is instrumental in helping people to cope with the physical, mental and emotional side of dealing with a cancer diagnosis. One person will have the cancer, but their family and friends are also affected, as the hon. Lady said.

With this type of cancer, there is a risk of recurrence or spread. Up to 30% of early-stage primary patients will experience spread to their organs, which can be a number of years after the initial diagnosis. This highlights again the need for greater research and funding to ensure early detection and to prevent the cancer’s spread.

The shadow Minister spoke in a debate this morning about research undertaken between Birmingham University, Newcastle University and Queen’s University Belfast. He was talking about rare autoimmune rheumatic diseases, but Queen’s University Belfast has partnerships with other organisations to try to find cures for cancer. Many universities across this great United Kingdom of Great Britain and Northern Ireland are carrying out research, and the Government’s approach to that is vital.

I have gone on a bit longer than I had hoped, but there is more work to be done on researching most cancers. Breast cancer, and specifically lobular breast cancer, impacts the lives of thousands of people every year. It is time to do more as a collective. Today, collectively, Members on both sides of the Chamber are committed to trying to find a cure and trying to find hope for those who have cancer, and who will hopefully survive it, and for their families as well, by undertaking the important research into this awful disease. We are also committed to making men and women across the country aware of the warning signs.

I look to the Minister and her Labour Government, which is my Government—whether you are a Labour person or not, it is our Government and they are trying to do the best they can, and I think they deserve support for their commitment to do so—with sincerity and honesty, perhaps beseechingly, to ensure that the devolved nations are not left behind in terms of a strategy. I look forward to action from the Minister and to her replying to all the requests.

15:05

[John Milne (Horsham) (LD)]

I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for raising this vital issue. Breast cancer is the leading cause of cancer death for women worldwide, and many, if not all, Members will know somebody who has faced the frightening prospect of breast cancer treatment, which is unfortunately all too common and impacts the lives of millions, whether directly or indirectly. What is fortunate is the progress in detection and treatment, which has provided many patients with positive outlooks and a healthy future life with their loved ones.

Sadly, this prospect is often not afforded to the 15% of breast cancer sufferers diagnosed with invasive lobular cancer. Survival prospects for those with ILC can be relatively good, but only for those who are diagnosed early, before the cancer has spread. I repeat the calls of other Members and Breast Cancer Now to publish the findings of the UK national cancer screening review into breast cancer risk stratification. If improvements are made so that we can detect more elusive forms of breast cancer, tens of thousands of lives could be saved. However, improved detection is not enough by itself. Women diagnosed with ILC face another issue: the treatments they are provided are not tailored or specific to their cancer. In short, they are treated for a disease they do not have.

One of those women, as has been mentioned, is Dr Susan Michaelis, who lives in my constituency of Horsham, where I met her earlier this year. Susan is an incredible woman who has campaigned tirelessly on invasive lobular cancer treatment and research. She was diagnosed with lobular cancer in 2013, but the treatment she then received was designed for ductal cancer, which is the most common form of breast cancer. As a result, Susan’s condition evolved and became resistant to the treatments now available.

Someone less determined might have given up looking for answers, but instead Susan went out and started the Lobular Moon Shot Project and, yes, I have already planted my Susan Michaelis rose. She met research experts to build an idea of the cost of research into the basic biology of invasive lobular cancer in the hope of improving outcomes for those yet to be diagnosed. The Institute of Cancer Research has deemed that £20 million is enough to make significant progress, and Rob Clarke of the Manchester Breast Centre will head up that work in conjunction with world leading experts. That is all agreed.

Since then, Susan and the Lobular Moon Shot Project have lobbied MPs and Government Departments. Hundreds of MPs have supported the application for funding. In the last Parliament, the number was 247; there have already been almost 200 in the current term, and I am sure that many more will join the call. The team at the project should be commended for all their hard work and amazing, ceaseless energy.

Given the Government’s recent announcements about taking a firm business approach to funding within Departments, research into lobular cancer makes for a strong business case as well. Breast Cancer Now research shows that the cost of breast cancer to the UK economy is £2.6 billion. That is set to rise to £3.6 billion by 2034. Ongoing cancer treatment is expensive, with each patient requiring approximately £10,000 a year, whereas the £20 million research request equates to £240 per lobular cancer patient over the next 10 years.

Early detection and better treatment can reduce the overall time the NHS needs to support patients. Put simply, research into lobular cancer saves both lives and money. If the human arguments are not enough for the Government to commit to this vital research, then let us talk about the money. The previous Government included lobular cancer research in their women’s health strategy for England 2024 and acknowledged that there was an urgent, unmet clinical need. I ask the new Secretary of State to renew that commitment and to fund the Lobular Moon Shot Project’s call for research, which will enable the NHS to offer specific treatment to lobular cancer patients and end the one-size-fits-all approach. Dr Susan Michaelis and the lobular ladies hope that they will be the last generation to go through the experience of insufficient treatment and poor outcomes, and I hope that this Government can make that a reality.

15:10

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve with you in the Chair, Ms Vaz. I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for bringing this really important debate to the Chamber and for her excellent speech, which told the story of her friend Heather and the stories of Katy, Emma, Kirstin and Cressida, who have suffered a pernicious type of disease that we are currently unable to treat effectively 100% of the time.

I thank my hon. Friend the Member for Wokingham (Clive Jones), the hon. Member for Bexleyheath and Crayford (Daniel Francis), the hon. Member for Strangford (Jim Shannon), and my hon. Friend the Member for Horsham (John Milne) for their speeches, which were all excellent. I also thank the hon. Members for Maidstone and Malling (Helen Grant) and for City of Durham (Mary Kelly Foy) for sharing their own stories, which were very helpful to the discussion. I thank Dr Susan Michaelis for the bare-root rose—when we received it in the MPs’ offices, we were all a bit stumped by what the enormous box might be for—and, more importantly, for her tireless campaigning to secure funding for research into lobular breast cancer.

The speeches today have been excellent and detailed, and I wish to avoid repetition. As we have heard, 22 people a day in the UK—mostly women—and 1,000 women globally are diagnosed with invasive lobular breast cancer. It is the second most common type of breast cancer, so it is really important that we support the Lobular Moon Shot Project. Liberal Democrats will fully support that project, which is run with the Manchester Breast Centre. Some £20 million over five years to better understand the diagnosis and treatment of this disease is not really a significant investment for the Government, but it would have an enormous and meaningful impact for those people—mostly women, but, as I said, there are some men—who are affected by it every single day.

Research funding is such an important part of investment in the early detection and treatment of cancer—particularly for lobular breast cancer—which is better for everyone, including the patients who have been diagnosed. Receiving a diagnosis of any type of cancer is a really difficult moment for any individual and their family, but receiving a diagnosis of a cancer for which there is not a clear treatment pathway is even more concerning. It is really important that we try to address the problem that these women face. It is better for them and for the NHS, because, as we all know, early treatment tends to be more successful and quicker. Because of that, it is also better for the taxpayer. It is entirely consistent with the recently announced Government strategy of rewiring the NHS to focus resources on early prevention, detection and treatment to ensure that people are kept healthy, rather than treated when they are sick.

As other speakers have pointed out, this disease is the sixth most common cancer in women, and it needs to be treated as a distinct disease. We must ensure that women who face this diagnosis are given the treatment for the disease that they have, not for one that they do not have. It is really important that that is built into the Government’s new cancer strategy, which they have committed to work on. The last Government did not have a 10-year cancer plan, although they did include lobular breast cancer in their women’s health strategy, so I was really pleased to see that in a debate led by my hon. Friend the Member for Wokingham, this Government committed to a national cancer strategy. That is a really important step forward, and we are really pleased that the Government felt able to make that step. I hope that for people who have been diagnosed with lobular breast cancer and, indeed, any other type of cancer that the Government are able to deliver on the strategy as soon as possible.

One of my key concerns is the dreadful waiting times for scans and for results from MRI scans, which are the best way of detecting lobular breast cancer, and other types of CT scan. In my constituency of North Shropshire, which is part of the Shropshire, Telford and Wrekin integrated care board, we have some of the worst records in the country for scan interpretation. As a result, I have been contacted by constituents who have had devastating outcomes, where scan results have been delivered to them, only for them to find out that they have been on the wrong type of treatment in the meantime, sometimes for many months. We need to avoid that happening in the future. The leadership team has shown that it can address the problem, and I am pleased to report that it is beginning to do so in Shropshire.

I hope that the cancer strategy will identify where there are shortages of radiologists and of the machinery needed to carry out those scans and to ensure that we hit the 62-day waiting-time target for people who need to start urgent cancer treatment. Part of the capital expenditure plan announced by the Government is critical to that, and I look forward to hearing the details from the Minister.

The Liberal Democrats also want the Government to pass a cancer survival research Act that requires the Government to co-ordinate and ensure funding for less survivable and less common types of cancer, and for types of cancer that are not currently treated as distinct or treated appropriately. We want the time it takes for new treatments to reach patients to be halved, which would mean expanding the capacity of the Medicines and Healthcare products Regulatory Agency. That would ensure that patients with cancers that do not respond to current standard treatments can access new treatments much more quickly as they come online.

I echo the request of the hon. Member for Dulwich and West Norwood and the other hon. Members who have spoken so powerfully today. The Lobular Moon Shot Project would change the lives of 8,500 women in the UK every year. In developing the national cancer strategy, I hope the Minister will consider some of the proposals that we have put forward collectively today, which are aimed at improving detection, treatment and survival rates for people with invasive lobular cancer and all other types of cancer.

15:16

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

It is a pleasure and an honour to serve under your stewardship, Ms Vaz, and even more of an honour to be part of this debate. I pay tribute to the hon. Member for Dulwich and West Norwood (Helen Hayes). Not only was her speech emotional, but it was powerful. Cressida, I am sure, is incredibly proud and Heather would be even more proud. That is because the hon. Lady has really done the subject justice today, not only by securing this debate but by bringing the whole room together and highlighting the most salient points. Often in these debates, there is a lot to cover, and the hon. Lady has done it with aplomb.

I also thank my hon. Friend the Member for Maidstone and Malling (Helen Grant) and the hon. Member for City of Durham (Mary Kelly Foy) for speaking up about their personal experiences. That is tough to do, and it is a testament to their constituents that they have put on record, in public, the trials and tribulations they have been through. It is important that people feel they can advocate in this space and lead by example in doing so.

That leads me on to the hon. Member for Bexleyheath and Crayford (Daniel Francis), who talked about his wife. He is an example of how important it is to have a powerful advocate. Partners and families do exactly that: they advocate for patients who are going through treatment. The fact that he is doing that here as well is incredibly powerful.

The hon. Member for Strangford (Jim Shannon) and I are starting to have regular conversations about health in Westminster Hall debates, with an hour and a half this morning and another hour and a half this afternoon. His passion for health topics is probably only superseded by the volumes of Hansard content he accounts for. He talked about networks, and in research it is important to make sure that we are bringing together the best brains from across the field for the biggest possible research pools. That is much needed.

I congratulate the hon. Member for Horsham (John Milne) on highlighting hope. The danger is that we spend too much time talking about difficulties, when over the past couple of decades, breast cancer actually provides a good story of how far advances have been made and survival rates improved. It is important that we point that out, so that not all is doom and gloom. There are fantastic survival rates for breast cancer, for example.

The hon. Gentleman paid tribute to Dr Susan Michaelis, as did the hon. Member for Wokingham (Clive Jones). As MPs, we are lobbied a lot, so to have got so many MPs signed up and to have secured debates here repeatedly, month on month and year on year, is an incredible testament to the character of Dr Michaelis.

The Lib Dem spokesperson, the hon. Member for North Shropshire (Helen Morgan), rightly highlighted access. When it comes to making sure we get diagnoses, access is key. The last Government rolled out community diagnostic centres—almost 170 of them. When it comes to diseases such as breast cancer, I hope that new MRI and CT scanners will become available, allowing us to have better screening pathways, because that is what often limits a screening programme. That access is now being widened so dramatically, with the Government confirming this morning that they are continuing with it, is a sign of great cross-party working, which we all know the NHS needs.

Much has been said about lobular breast cancer in this debate, and for me it matters because of the way it presents. One can take the doctor out of medicine but not the medicine out of the doctor, so I will use this opportunity to ensure that people are aware that they should regularly check their breasts. They should look for lumps but also for skin changes, or what we call peau d’orange—it looks a little like orange peel—on the breast. They should also look for slight changes, a little bit of discharge or blood. Lumps, bumps and discharge do not mean an individual has cancer; it simply means they need to be assessed.

One of the great things about the set-up in this country is that it is quick and accessible—a good success story—but we need to ensure that people feel comfortable and able to come forward. Cases have been highlighted where clinicians did not seem to trust women. It is important that clinicians trust women’s instincts. Women know their own breasts, and when they are aware of changes, they must be taken seriously. We have a chance through clinical pathways to do that, which is important.

We heard that 22 women a day in the UK are diagnosed with lobular breast cancer. As someone who has given that diagnosis, my next piece of advice for anyone unfortunate enough to receive a diagnosis of breast cancer is to ask whether it is lobular or ductal. That is often forgotten. As a clinician, I have never been asked that question, but it would help to change the narrative of expectations about what treatments may be available, and promote understanding. If a patient speaks to someone else with breast cancer, they might wonder why their treatment is different. It is important to educate people, not in a condescending way, but to appreciate the general difference. Treatments are becoming so specialised and nuanced that all will not be the same, and that can be quite disconcerting.

I pay tribute to those who are battling lobular cancer, the cancer survivors and the campaigners from Lobular Breast Cancer UK for their tireless work in raising the issue. Of course, the ultimate goal is to have a cure for lobular breast cancer. Advances in medical research and treatment options are moving us closer to that goal. In 2022, the Government invested £29 million into the Institute for Cancer Research and the Royal Marsden biomedical research centre to support research into cancer, including lobular breast cancer. That included a £1.3 million project to determine whether abbreviated forms of breast MRI can detect breast cancers missed in screening. That links to the point about having more MRI scanners, which might well enable better research to determine the way to pick these things up and improve the ability to deliver.

I am pleased the previous Government supported, through the National Institute for Health and Care Research clinical research network, 10 further lobular breast cancer-related studies. I am also reassured by the Lobular Moon Shot Project, which we have heard a lot about. I pay tribute to the former Member for Horsham, Sir Jeremy Quin, who did a lot to raise that issue. I am pleased to see the new hon. Member for Horsham standing in his shoes to raise it now. It would be useful to know if the £20 million for the five-year study is being looked at by the Government. It was raised several times with the previous Government, but an election got in the way and power changed hands. It would be interesting to see if the proposals have been reviewed and merit the Government taking them forward.

A key measure that has been missed to some extent is guidelines. Lobular Breast Cancer UK is to launch a campaign calling for national breast cancer guidelines to be updated to recognise lobular breast cancer. Will the Minister commit to reviewing and updating the guidelines with the National Institute for Health and Care Excellence? We have also heard about devolved powers. Scotland, for instance, has the Scottish Intercollegiate Guidelines Network. It would be useful to know whether the Minister will raise this issue with the devolved nations to ensure we have a joined-up approach, without any cross-boundary difficulties.

I do not want to turn this into a political battle because this is not the place, but I put it gently to the Minister that we have heard about the need for support, a lot of which comes from charities. The changes in national insurance contributions for employers have hit charities, including the likes of Breast Cancer Now, Macmillan and Marie Curie. They are not shielded from the rises. I will be grateful if the Minister considers raising with Treasury what can be done to help support those crucial nurses, advice lines and workers, so as to make sure that when people are going through these difficulties—we have heard how complex the scene can be, particularly in breast cancer—advice is accessible to all.

I thank all those who took part in this debate, and I remind people to regularly examine their breasts. If there is a change, seek help. If a diagnosis of cancer is given, ask if it is lobular or ductal. Finally, remember that no one is alone. As we have heard today, many people suffer from cancer and there is support out there—from the NHS, charities, family and friends—so do not be fearful. Speak out and get that support.

15:25

[The Minister for Secondary Care (Karin Smyth)]

It is a real pleasure to serve under your chairship, Ms Vaz. I add my thanks to all hon. Members for their contributions and to my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes). First let me say how sorry I am to hear about her friend. Those are very precious friendships and I think my hon. Friend articulated that well today. My deepest sympathies to Heather’s loved ones who are with us today and to her wider family group. It is a really difficult time and this is a very recent bereavement to be talking about. My hon. Friend has used her voice as a parliamentarian to good effect, as she always does, and I congratulate her on doing that. I hope I can go some way to answering the questions she raised at the end of her speech. If I do not and she is not satisfied, I will make sure officials get back to her on the specifics.

I also echo the words of the hon. Member for Hinckley and Bosworth (Dr Evans) about hon. Members raising their personal experiences and the importance of support from partners and wider family members for people who are going through diagnosis, treatment and sadly, often, death.

We know that too many cancer patients are being failed. They are waiting too long for life-saving treatments and receiving a diagnosis too late. As my right hon. and learned Friend the Prime Minister reiterated last week, we have inherited a broken NHS but it is not beyond repair. We know it needs to be fixed and there is not a single solution. To ensure that more people survive cancer, including lobular breast cancer, we have to take a multi-pronged approach—catching it earlier so more treatments are available, raising awareness of its specific symptoms, and investing in equipment and research, as many hon. Members have raised today. All those actions are part of our plan to put the NHS on the road to recovery.

As we have heard today, according to Cancer Research UK lobular breast cancer is the second most common type of breast cancer. Also known as lobular carcinoma, it impacts the lives of many—around 15 in every 100 breast cancers are invasive lobular. Treatments for lobular breast cancer are broadly similar to those for other breast cancers. Surgery and radiotherapy are effective for most patients with primary invasive types, meaning those which have not spread to other parts of the body. Systemic therapy such as chemotherapy, hormonal treatment, targeted therapy or immunotherapy are usually offered based on the stage at which the NHS catches that cancer.

Another factor which can determine clinicians’ decisions on the best treatment option is how the cancer has spread or developed in each patient’s case and we understand that is different for different patients. Sadly my understanding is that when cancer is growing in more than one location, as is more common in lobular breast cancer, treatment is more challenging. The same is true when a cancer has spread to other parts of the body. To improve outcomes in such challenging cases, NHS England funded an audit into both primary and metastatic breast cancer that has spread. The scoping for this audit began in October 2022 and the results were published in September this year. NHS England are hopeful that the results will help to improve the consistency of treatments offered, as well as stimulate improvements.

We know that for far too many women, lobular breast cancer is diagnosed at a later stage, which means that treatment options are more limited. The key to improving survival must lie in raising awareness, and early detection and diagnosis. I am not sure I can do it as well as the shadow Minister, but I want to use this opportunity to raise awareness of the fact that not all breast cancers form a firm lump. I think he articulated really well what women should be looking for. Lobular breast cancer patients are more likely to have thickened areas of breast tissue. Possible symptoms include an area of swelling, a change in the nipple or a change in the skin, such as dimpling. I encourage everyone to check their breasts regularly and to consult their GP straightaway if they have any concerns. While more people are surviving breast cancer than ever before, we know that lobular breast cancers can be particularly hard to detect.

Another measure to support earlier diagnosis of breast cancer is screening before people notice symptoms. Our screening programme sends women their first invitation at the age of 50. To support detection, the NHS carries out approximately 2.1 million breast cancer screens each year in hospitals and mobile screening vans, usually in convenient community locations, but—this is a really shocking figure that I learned recently in another debate in Westminster Hall, which shows how important it is that Members raise these issues—take-up of breast cancer screening is currently below 70%. That is worryingly low, and we are determined to improve it. Every effort that hon. Members here and people listening to this debate can make to improve that take-up rate will help save lives. If someone is eligible for screening, they should come forward and take up that important offer.

Unfortunately, even for those women who come forward for a mammogram, we know that lobular breast cancer can be more difficult to catch than other types of breast cancer. We have heard some shocking stories and examples today. To ensure that women survive, we need to be relentless in researching every possible avenue of treatment and diagnosis. Examples of innovation supported by my Department include £1.3 million invested in a Bristol-based FAST MRI project, which will determine whether different types of scans can help detect cancer in a cost-effective manner. The FAST MRI project focuses on an abbreviated MRI, which is a shortened version of a breast MRI. This type of imaging can help to detect the most aggressive forms of breast cancer sometimes missed by screening through mammography, including lobular breast cancer.

My Department is also working closely with UK Research and Innovation and the Medical Research Council. These bodies are responsible for studies that look to understand the basic mechanisms of disease. Combined, they spend £125 million on cancer research each year. My officials also meet regularly with partners to discuss a wide range of our research investments and ways to stimulate new proposals. These include those for lobular breast cancers.

Through the National Institute for Health and Care Research, my Department will continue to encourage and welcome applications for new research in this area. I hope this addresses the shadow Minister’s point, but funds for research are still available through the NIHR. Funds are awarded through open competition informed by expert peer review, with active involvement of patients and the public. The Department and NIHR also advise the campaign on the Lobular Moon Shot Project. It has already contracted £29 million, which I think is the figure the shadow Minister referred to, to the Institute of Cancer Research and its partner at the Royal Marsden. This proposal included work on lobular breast cancer. I hope I have addressed that point, but if I have not, then please let me know.

We know that we must do more to rise to the growing challenge that cancers including lobular breast cancer represent, but for our efforts in detecting and understanding this complicated disease to be effective, we need to back fundamental reform in the health service. That is why we have launched the biggest national conversation about the future of the NHS since its birth to shape the 10-year plan. We need suggestions from hon. Members on how to go further in preventing cancer where we can. I urge everyone to visit the website change.nhs.uk to do so.

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

The risk of all breast cancers in women is reduced by 4.3% for every 12 months of breastfeeding, but the UK has one of the lowest breastfeeding rates in the western world: only 1% of children are still exclusively breastfed at six months. Does the Minister agree that community initiatives to encourage women to breastfeed for longer support the Government’s mission to reduce the risk of breast cancers and improve health outcomes overall?

[Karin Smyth]

I thank the hon. Lady for that really important point. She highlights another important issue affecting the health of women and children, and I agree with her.

My hon. Friend the Member for Dulwich and West Norwood spoke about women’s health overall, which is an important priority for this Government, as are these forms of cancer and the wider preventive agenda. That is another point that can be made on the change.nhs.uk website, which I will keep plugging. The issues that have been raised on it by the public and staff are really interesting and informative.

My right hon. Friend the Secretary of State has been clear that there should be a national cancer plan. The hon. Member for Wokingham (Clive Jones) made helpful points about that opportunity. I will not take up his invitation for a meeting; his point would be better made by being inputted into the process with the organisations he is in touch with. That would help to shape the national cancer plan, which we can all buy into as a country. The plan will include more details about how to improve outcomes for all tumour types, including lobular breast cancer, and ensure that patients have access to the latest treatments and technology. We are now in discussions about what form that plan should take and what its relationship with the 10-year health plan and the Government’s wider health missions should be. We will provide updates on that in due course.

I thank my hon. Friend the Member for Dulwich and West Norwood for bringing this important matter to the House.

[Dr Evans]

I want to draw the Minister’s attention to the point about guidelines. Will she consider speaking to the devolved nations and, in England, to NICE, about guidance on lobular breast cancer?

[Karin Smyth]

I was going to come to that. I am not fully au fait with the change in guidelines that the hon. Gentleman referred to, so I will happily take that point away. He made a wider point about aligning across the devolved regions. Obviously, some of these issues are devolved and we have to respect the devolution arrangements. On the wider research, we should learn from each other, understanding that we have similar patient cohorts. There is lots of good medical work going on, and the Government are determined to work respectfully across the devolved nations. I will ensure that the hon. Gentleman gets a written answer on the specifics of his question.

Heartbreaking stories such as Heather’s remind us that diseases such as lobular breast cancer are complex. They are hard to catch, and therefore treat. Such tragic losses are a wake-up call for us all, and I commend all hon. Members for raising those stories. For people listening in, as well as those who have attended the debate, they are an important way to raise awareness. We are grateful to those who have shared their personal stories, which help us get the NHS back on its feet so that we can better serve the people who need it.

Improving cancer survival requires a multi-pronged approach to ensure that patients have timely access to effective treatments, built on the foundations of world-class research. We have already taken immediate steps to allow cancer patients to benefit from the most up-to-date technology. Through the recent Budget, we committed to surgical hubs and scanners to allow for 30,000 more procedures each year, and we are increasing capacity for tests. We have also committed another £70 million for radiotherapy machines. Lots of hon. Members have raised those points. I have outlined several measures today, and I assure Members that improving outcomes for cancer patients, including those with lobular breast cancer, remains a top priority for this Government.

15:39

[Helen Hayes]

I thank all hon. Members who have contributed. They have brought their constituents’ stories and their own personal experiences to the debate. We have many issues to work on in this House, but there is a particular responsibility when an issue presents itself in a personal way through a devastating story, whether that is through a constituent, somebody we know or our own personal experience. When we see an opportunity for things to be done, it is imperative for us all to bring that to this place. I am grateful to hon. Members for the spirit in which the debate has been conducted, the high level of consensus and the high level of commitment to see change for patients with lobular cancer.

I am grateful to the Minister for her engagement with the debate. I know she is committed to this area. In closing, I ask that she looks in further detail at two issues. The first is the proportional allocation of the funding available through the NIHR for research into breast cancer. We have heard again and again today that lobular cancer accounts for 15% of all breast cancers, yet currently attracts only a tiny fraction of dedicated research. We know that the improvements we have seen in treatments and outcomes for different types of cancer diagnosis always hinge on the investment put into research to find the cures. There is a disproportionality there that can and must be changed.

The second area I ask the Minister to look at in a little more detail is the advice and guidance given to clinicians in primary care, to make sure that there is a consistent understanding of the symptoms of lobular cancer and its distinctiveness as a disease compared with ductal cancer, and to make sure that every woman presenting to her GP is able to access accurate advice and swift onward referral. It is important across the whole range of women’s health conditions that women are trusted and listened to when they present with symptoms to their GP, and this is an area where I believe primary care can do better, be more consistent and deliver better outcomes as a consequence.

I pay tribute once again to Dr Susan Michaelis and all those who campaign on this issue on the basis of their deeply difficult personal experiences. I give my commitment that for as long as I have a voice in this place, I will continue to work on this issue until we see the changes that are needed.

[Valerie Vaz (in the Chair)]

I thank everyone who took part in and attended this debate.

Question put and agreed to.

Resolved,

That this House has considered the treatment of lobular breast cancer.

15:42

Sitting suspended.

Telegraph Poles: Birmingham

Tuesday 10th December 2024 Westminster Hall

16:23

[Preet Kaur Gill (Birmingham Edgbaston) (Lab/Co-op)]

I beg to move,

That this House has considered telegraph poles in Birmingham.

It is a pleasure to serve under your chairmanship, Ms Vaz, and I welcome the Minister to his place. I want to thank him, as I know he has been working extremely hard on the issue by meeting MPs and working with the industry and regulators. The installation of telegraph poles is an issue that has been landing in the inboxes of MPs across the House and from across the country. In view of that, I hope he does not mind my summoning him to Westminster Hall to take more questions.

I pay tribute to the many constituents I have worked with on the issue over the past two years, including the residents of Vernon Road, Montague Road in Edgbaston, Chad Road, Clarendon Road, Gravel Bank in Bartley Green, and Perrott’s Folly near the Waterworks tower. In particular, I pay tribute to the campaigning of my constituent Lizzy Jordan, who has left no stone unturned in trying to engage with the provider, Brsk, about which I will say more in a moment. Lizzy and our local residents have been a powerhouse. Last year, we managed to convince Brsk to move a pole in front of Perrott’s Folly and the Waterworks tower. This has a huge significance to our heritage, as the towers inspired JRR Tolkien in “The Lord of the Rings”.

We have been pushing Brsk to do right by the residents in our area, but it is exhausting work. Over the past two years, I have engaged with, sent numerous emails to and met Brsk’s west midlands representatives. I joined a resident-led protest against Brsk installing poles outside Perrott’s Folly in my North Edgbaston ward. I have convened and attended a meeting between residents and Brsk about Vernon Road, Clarendon Road and Montague Road. I have written to the last Government and this on several occasions, and submitted evidence ahead of MPs’ roundtables on the issue. I have raised my concerns with Ofcom through letters, and I continue to support my constituents with casework. I think we all agree that it should not take a well-organised community campaign and an active local MP to get a provider to meet its statutory duties, and that is why I have called today’s debate.

I want to say that I and the vast majority of my constituents support the roll-out of new broadband infrastructure. The importance of improving broadband speeds and access to the internet should not be underestimated. Nearly all aspects of our everyday lives —education, work, communication, entertainment—are made possible by the continuous expansion and upgrading of telecoms networks. There are significant digital dark spots in my constituency, such as in North Edgbaston and parts of Harborne, Quinton, Edgbaston and Bartley Green especially. In several areas, superfast broadband coverage is among the worst 10% of areas in the UK. According to recently published House of Commons Library data, 3.8% of lines across my constituency do not even have 10 megabits per second download speeds, with notable clusters of poor coverage in the most deprived areas, such as Bartley Green, and I have asked Brsk to focus on that area.

I am not quick to forget how damaging the pandemic was for many of our children. Particularly in deprived areas with poor connections, we were unable to access remote learning. I and the vast majority of my constituents understand that the roll-out will provide a boost to our economy and set Britain up for the rest of this digital century. This infrastructure will provide opportunities and lower prices, and it can improve people’s lives, but there are ways of going about it. First, we should focus on areas that do not have coverage, not those that do.

As the Minister has himself acknowledged, while the majority of providers are trying to do right by local people by making efforts to consult and not put up poles, some providers in my constituency such as Brsk have occasionally behaved like cowboys by not using existing infrastructure, failing to consult residents with the adequate 28 days’ notice, failing to observe the Disability Discrimination Act 1995 requirements to ensure that pathways are clear and accessible until they are told to do so, failing to secure the right council permits for works, and putting up poles everywhere as the only means to address coverage. Given that Brsk’s business is communications, it is ironic how poor it has been at communicating with its stakeholders. The crux of the issue is that such companies are not exploring alternatives to poles or using existing infrastructure when they can. To give some of many examples—

[Valerie Vaz (in the Chair)]

Order. The sitting is suspended for 15 minutes.

16:23

Sitting suspended for a Division in the House.

16:40

On resuming—

[Valerie Vaz (in the Chair)]

Order. The debate may now continue until 5.08 pm.

[Preet Kaur Gill]

The crux of the issue is that these companies are not exploring alternatives to poles or using existing infrastructure when they can. I will give some of many examples. Freedom of information requests to our local council revealed that Brsk did not need to put up poles on Clarendon Road in my constituency, because it could have utilised existing ducts—but it did so anyway, ignoring that fact. Vernon Road is another example; BT installed full-fibre to St Paul’s school for girls at that location without any requirement for poles, yet a constituent came to my surgery on Friday to tell me that another pole had gone up, with a notice on the council’s planning portal appearing only after the pole had been erected. That is even after the Minister’s meeting with Brsk.

I have met Brsk and exchanged exhaustive correspondence on these issues. What has struck me in my dealings with the firm is the lack of policy or strategy for work in my constituency. Poles are supposed to be a last resort, but even where they are not needed, like on Vernon Road, several go up anyway. There are now four on that road. Frequently, when issues are raised, they are not listened to. I asked Brsk for a map of where it is planning to roll out poles in my constituency, and it could not give me one. There is either a plan that it will not share or there really is no strategic focus on where the infrastructure is needed.

My constituents have had similar experiences. An elderly constituent wrote to me earlier this year, deeply worried that a Brsk telegraph pole on an adjoining road, installed less than a metre from her back garden fence, was so close that it could easily provide burglars with access to her property. She told me she lives in perpetual fear that her house could be broken into. More importantly, that was avoidable. Had Brsk simply made an effort to engage first with residents about changes in their community, she would not have been left in that situation.

[Mark Garnier (Wyre Forest) (Con)]

I thank the hon. Member for allowing me to intervene. She makes a powerful point on behalf of her constituents. In my constituency, we have a similar situation in Stourport-on-Severn, where firms are using permitted development rights in areas where residents are not even allowed to put up a garden fence because of planning approvals. Does she agree that it is a cynical attempt by many of these providers to build an infrastructure that provides capital value that can be sold on? That is less to do with delivering full-fibre broadband than with making money in the short term for those operators.

[Preet Kaur Gill]

I thank the hon. Member for that important point about the business model. There are alternative ways to implement the infrastructure. In areas like his, this activity does not respect the environment, heritage or planning laws, and we end up with poles erected. Some of them do not even have any lines going through them, which just goes to show that the existing infrastructure meant there was no need for that, but, as he says, it is clearly quite a lucrative business model to sell on the new infrastructure.

[Tahir Ali (Birmingham Hall Green and Moseley) (Lab)]

I thank my hon. Friend and constituency neighbour for giving way. We had similar issues with Brsk when it went on to an unadopted road in a conservation area and started erecting poles. My constituents, Dr Carole McKeown —the secretary for Reddings and Amesbury Road residents association—and her neighbour came to see me. Following the intervention of the Minister, Brsk has agreed to remove the poles, but the point remains that the consultation with and notification of the residents did not happen. These are not isolated incidents. Does my hon. Friend agree that there needs to be tougher action against companies that go about their business without any adherence to the code of conduct?

[Preet Kaur Gill]

I know that the Minister, in summing up, will address that point, because he has been proactive in meeting the regulator and the companies tasked with installing this infrastructure. He has already given them a clear indication of where the Government will go next if they do not adhere to the code. I also know that he has met Brsk since the previous debate on the issue; I thank him for that.

I was interested to read confirmation that Brsk now has guaranteed access to BT Openreach infrastructure to install broadband lines underground, so why is it not doing so? It is not its business model—that is why it is not doing it. I would be interested to learn from the Minister when that was agreed, because Brsk has not been taking advantage of that in my constituency to date.

Some providers are much better at this. I want to ensure that not everybody is painted with the same brush. There are some very good providers. Last year, broadband infrastructure carried out by Pipeline Utilities on behalf of Grain Connect left Willow Avenue in my constituency with some dreadful retarmacking, as well as broken and cracked paving slabs. When I wrote to the organisation about this, it confirmed that the site was inspected, and agreed to replace and relay the broken paving slabs and tarmac. That is exactly how we should be proceeding.

My experience with Brsk has been very different. Repeatedly, it will arrive in an area to erect new broadband infrastructure poles without properly consulting residents or me. We have seen that behaviour on Vernon Road, Clarendon Road, Chad Road and Stirling Road. The company’s idea of consultation appears to be to put up a notice stating its intention to put up another pole—in some cases, with little to no consultation period. Sometimes, I am told, a notice has not gone up at all, despite my best efforts and those of my constituents to raise concerns about the siting of the poles. We have been ignored. This means that the infrastructure ends up causing issues that could have been foreseen or avoided if there were proper consultation.

Poles have been erected in the middle of pavements, obstructing prams, wheelchairs and people with mobility issues. There have been attempts to erect unsightly poles in front of listed buildings, instead of exploring other options. Some roads are being peppered with poles, even when we are told they are a last resort. It is time for stronger action. Clearly, Brsk is not heeding Government advice.

As we all know, since the rules were changed by the previous Government in 2016, there is no requirement for planning permission for poles up to 15 metres in height, and there is no legal requirement for consultation with local residents and businesses. Good practice asks telecoms communications operators to notify the council of their intention to install a pole, as well as to advertise their development proposal within the vicinity of the site, usually via a site notice, but in reality there is no real opportunity to object to an installation. There needs to be a strategy that targets areas of need and uses existing infrastructure.

We are all familiar with the fact that the Electronic Communications Code (Conditions and Restrictions) Regulations 2003 require that, among other things, operators must share apparatus where possible, and use underground rather than overground lines where they can—yet that is not happening in practice. I know roads where as many as five or six poles have been erected. It is ugly, disruptive and excessive, and it impacts on house prices.

As these issues are a matter for the regulator, Ofcom, I seek the Minister’s clarification on what monitoring of these requirements is being carried out to ensure that network providers collaborate and share network infrastructure, and what action Ofcom has been taking against providers who have been found to not comply. When I wrote to Ofcom, it said its role is

“limited to enforcement of the Regulations”

and that, under those,

“operators have significant flexibility…to put up their own poles.”

I know that the Minister has been looking at a revision of the code of practice. We would be grateful if he could say more on that. I also welcome that he has stated that he reserves the right to change the law in this area.

It strikes me that stronger adherence to the regulations on sharing infrastructure is one of those rare examples where stronger regulation will actually save companies and consumers money. Surely it is cheaper for companies to co-ordinate with one another over the sharing of infrastructure than to erect new poles every time they need a new node for their network. It is baffling and frustrating that providers such as Brsk have not been more proactive in anticipating the concerns of the public before Ofcom has had to get involved. Fundamentally, my constituents of Birmingham Edgbaston are asking for respect: respect to influence decisions, and to ensure that broadband infrastructure is implemented in a way that respects their local environment, heritage and public interest.

I would be grateful if the Minister could provide an update on work to amend and strengthen the code of practice, so that operators respond to and engage in good faith with residents. I would also be keen to hear the outcome of his recent engagement with Brsk, having shared with him my experience of dealing with it, and to understand what more we can do to ensure that providers work together to share infrastructure, and that the requirements under the 2003 regulations are adhered to and enforced. I thank the Minister for his attention and look forward to working with him.

16:49

[The Minister for Data Protection and Telecoms (Chris Bryant)]

It is a great delight to sit under your chairpersonship, Ms Vaz. I warmly congratulate my hon. Friend the Member for Birmingham Edgbaston (Preet Kaur Gill) on securing this debate. I think she knows that she is one of my favourite MPs; we have canvassed together often in variety of places, so it is a great delight to hear from her.

My hon. Friend speaks of being an active constituency MP, and that is precisely what she has evidenced. She is not alone on this issue. The list of MPs who want to talk to me about ducts and poles is quite long, because a lot of people are concerned. They fully understand, as she has laid out, that we want to roll out better infrastructure. If we are going to have the digital economy that we want for the future and if we are to compete with other countries around the world, we certainly have to get digital infrastructure rolled out. Obviously, the Government are not going to pay for all of that—that would be a very big ticket item—so we want as much of this as possible to happen on a commercial basis, and I will refer in a moment to the comments of the hon. Member for Wyre Forest (Mark Garnier) about the business model that people may be adopting.

We also do not want to have a single operator delivering for the whole country, which is why it is important to have a degree of competition. When I was in opposition, I was very opposed to the idea of monopoly in provision through Openreach or, for that matter, any other player simply because monopoly does not tend to be good for consumers. It tends also to make an incumbent lazy, and it can lead to anti-competitive practices.

For all those reasons, we have ended up with the system that we have, and we want to roll out gigabit-capable broadband to as much of the country as possible. The Government will intervene in the areas where that will not happen commercially, but I say to the hon. Member for Wyre Forest and my hon. Friend the Member for Birmingham Edgbaston that we have to be a bit careful about saying, “It’s disgraceful that these people are making money”, because if they did not make money, they would not be rolling it out on a commercial basis and then we might have to intervene a great deal more in the market. But there is a countervailing argument: if operators behave in a way that lacks compassion or sensitivity to the local situation, it is extremely unlikely that anybody in that local community is going to buy their products, so it could destroy their commercial agendas and business strategies if they are so high-handed in their approaches to local communities when it comes to the siting of poles and so on.

[Mark Garnier]

I thank the Minister for his letter, which was incredibly helpful; I am grateful to him for engaging on this. The point I was making was not that the business model is about a cash flow revenue coming from the delivery of broadband, but that some of these businesses are cynically creating a capital asset that they then want to sell off. It is the infrastructure asset, not the cash flow, that they are after. That is where we get this competition of people building out the poles to create a capital value asset, not a cash flow value asset.

[Chris Bryant]

I do not know whether that is right or not, so I will reserve judgment, if the hon. Gentleman does not mind. It is certainly true that there may be some consolidation in the market in the next 18 months to two years. Some people have been expecting that before now. Whether that would apply to Brsk or not, I have not the faintest idea, but the point remains that, if these organisations are to have a successful business model, in the end they do need to be able to sell take-up.

One thing that is missing from this whole conversation is an explanation to the public of why on earth anybody might need fibre. Notwithstanding the areas in the constituency of my hon. Friend the Member for Birmingham Edgbaston where they do not even have 10 megabits per second, which I hope we might be able to do something about in the near future, lots of people say, “Well, I’ve already got 100 megabits per second, so why on earth would I need a gigabit per second? Incidentally, I don’t know what a megabit per second is anyway.” In that world, we have to do a great deal more education about what the future is going to look like. It is certainly true that all the apps and the IT that the country and the Government are increasingly relying on are increasingly hungry for bandwidth; there is no way of avoiding that. My hon. Friend is absolutely right in saying that we need to develop this infrastructure.

This Government have been very clear, and the previous Government were relatively clear, that we wanted this infrastructure to progress in a way that was sensitive to local communities. That meant that we had to have proper consultation and to be careful about the siting of poles. We wanted to encourage co-operation and collaboration between different players in the market, so that roads were not dug up two years in a row or three months after the last company dug it up, for example. All that was laid out in the original guidance in 2016. Incidentally, that guidance was provided not by the Government but by the industry. This is an important point: the industry is currently looking at revising that code. It is very close to a revised version. I do not think that that is quite ready yet, but I anticipate that it might come in the new year.

The simple point that I have made repeatedly to all the operators in this field is that if they want people to take up their service and buy their product, they have to take people with them. At our meeting with Brsk last week, Brsk made it clear that if all the members of a community, especially one cut off from everywhere else and not on the way to another place, said, “Look, we don’t want this,” it would work out that there was no point putting in poles, digging up the road or whatever, because there would not be any take-up of its services from that community in future. It would simply say, “All right, fine. We’re not going there.”

As I say, the difficulty lies where one road leads—as is often the case—to another, and the people on the next bit of road still want the roll-out even if the people on the first bit do not.

[Tahir Ali]

I thank the Minister for his intervention with Brsk and for getting the officers in for a chat with MPs last week, and I welcome what has happened since in my constituency. Does he agree that where existing underground infrastructure is already available, companies should be forced to use that rather than erecting poles that no one really wants or likes?

[Chris Bryant]

Let me be 100% clear: where there is existing infrastructure—ducts under the road or whatever —that can be used. In fact, it should be used and different companies should collaborate to make that happen. I am 100% clear that existing infrastructure should and must be used.

There are a few caveats, as the companies themselves would advance. Sometimes people think there is a duct when there is only a cable that has been laid straight into the mud underneath. Alternatively, the pavement might now be so full of different things, including gas connections, water connections, electricity connections and so on, that there is no space for anything else to be ducted through, or the duct sleeve is so full that nothing else can be put in and another sleeve cannot be put in either. I know that is quite a long set of caveats, but those are the realities of the situation.

The commercial reality is that inserting a new duct—that is, digging up the road and putting everything underground —might be very attractive to everybody in the community, but it is nine or 10 times more expensive than putting things on poles. If we want commercial operators to roll things out, there are certain situations where there are going to be poles. I cannot hide that from anybody; it is a simple reality.

As I was saying earlier, the cabinet siting and pole siting code of practice was issued in November 2016. It sets out guidance on best practice relating to deployment, encouraging operators to site apparatus responsibly and to engage proactively with local authorities and the local community. However, some of the things that I have seen being put in—including by Brsk; not often by many other operators—are clearly in the middle of a pathway or driveway, or in other places that are completely inappropriate.

As I understood it in our meeting last week, and indeed in the exchange of letters after that meeting, Brsk committed to change its policy in such situations. At that meeting, Brsk also undertook to engage in far more proper consultation with people. It will not just put up a sign saying, “We are about to put a pole here,” and then put a pole up the next day; it will engage in proper consultation, which means going door to door and explaining things to people. In many areas, Brsk will bring the local community together for a public meeting.

One Member who came to that meeting with Brsk last week said that there had been such a public meeting in their constituency. It had been very effective and people understood the quid pro quo, which was that if there was no means of doing something by ducting, there would have to be poles; if people did not want poles, they would not get the roll-out of fibre; and other operators were not operating in that field. People said, “Okay, well in that set of circumstances, we still want this roll-out to happen, so we will live with poles.” I think most people can live with that model, but even when that is agreed, we still have to make sure that we do not put poles in the middle of someone’s driveway or where they will obstruct people and not meet the requirements of the disability measures in the Equality Act 2010.

As I said earlier, I know the industry has been working together closely. It is not easy or simple to get commercial operators that have their own investors and shareholders in competition with one another to sit down to agree a new guide and a new code of practice, so I pay tribute to everybody at the Independent Networks Co-operative Association for engaging in that way. The vast majority of the altnet companies engaged in that activity are absolutely determined. They want to take the community with them because they want to be able to sell their product, and because they are responsible players in the market. I pay tribute to them where they have managed to do that.

As Brsk knows, we will hold its feet to the fire on all the commitments that it has made in private meetings with me, in the meetings with MPs that we held last week, and in writing. Before it starts rolling out in a particular area, it needs to explore far more thoroughly what ducting might be available, which might be through BT Openreach or Virgin. It will consult properly in a local area where people lobby and argue that the siting of a pole is particularly inappropriate. It will look at moving it in so far as it possibly can.

[Freddie van Mierlo (Henley and Thame) (LD)]

Does the Minister agree that the siting of poles is particularly important when we consider national landscapes? It needs to take into account the broader context. Does he also agree that, where local communities are willing to engage with operators and local authorities to fund undergrounding, that would be a good approach?

[Chris Bryant]

That is the first time that anybody has come to me and said that a local community would fund the ducting, which is an expensive business. All sorts of competition issues might then arise. I am hesitant to advance a yes or a no to that, because one would have to explore whether that was in effect a state subsidy, how that would be provided and what kind of contract there would be for maintenance of the duct—I can foresee all sorts of problems. I am not trying to be a part of the blob, but simply to be as clear as I can about what is possible and what is not.

The hon. Member makes an important point about the desirability of poles in areas of natural beauty and whether we can or cannot have poles. I have seen many different instances—I have tried to go through as many of them as possible as a Minister—such as where people thought the issue was about a duct that somebody was refusing to use, and it turns out it is not a duct at all but a cable laid in sand, so I am quite hesitant about holding forth on where we can or absolutely cannot have a pole.

In case anybody thinks I am being nimbyish, I have poles in my street, and I am about to have another set of poles in my street. I am relatively chilled about that, but I fully understand the issue where someone has never had a pole in their street. Part of the area’s beauty is that it looks remarkably like it did in the 18th or 19th century, and people want to preserve it that way. The downside is that commercially they will probably not get gigabit-capable and fibre-based broadband, which might be more of a problem for the community than having the poles.

I think I have exhausted the subject, unless anybody else wants to have a go at me. I pay tribute to my hon. Friend the Member for Birmingham Edgbaston. I am sure that we will return to the issue as many times as necessary if Brsk refuses to fulfil its promises. I believe that when we sat down with the senior management, they were sincere and honest in the commitment that they were making, and that they did not have as full an understanding of people’s feelings in some communities as they needed to have. As I promised my favourite MP—I cannot say that too often—I will hold the company’s feet to the fire throughout.

Question put and agreed to.

17:04

Sitting suspended.

Rural Cycling Infrastructure

Tuesday 10th December 2024 Westminster Hall

17:04

[Freddie van Mierlo (Henley and Thame) (LD)]

I beg to move,

That this House has considered cycling infrastructure in rural areas.

It is a pleasure to serve under your chairship, Ms Vaz. I thank the Minister for being here to listen to this important debate, and I draw attention to my entry in the Register of Members’ Financial Interests. I am a member of Oxfordshire county council.

During my time living in the Netherlands as a young student, not so many years ago, I experienced at first hand the ease of cycling. Villages and towns are interconnected by safe cycle routes, which make taking a bike the obvious choice. I fondly remember cycling from my university in Leiden to the beach in Katwijk. Never once did I feel concerned about the quality of roads or any danger; never once did I feel the need to take a car.

Later, living in Brussels, I saw the stark differences between the traditionally cycle-friendly Flemish region and the car-dominated capital city. However, conscious policy decisions are changing cities. Brussels, like many capital cities across Europe, including our own, is now reclaiming road space from private motor vehicles and giving it over to active travel.

I am proud to be part of the administration in Oxfordshire that pedestrianised the famous Broad Street, much to the criticism of local Conservatives, and is rolling out further measures across the city. These policy decisions in cities demonstrate that there is no natural order to transport infrastructure. Transport choices are made consciously and by design. Although much more needs to be done in cities and towns, rural areas risk being left behind, and the consequences are paid in lives lost and lives ruined.

[Layla Moran (Oxford West and Abingdon) (LD)]

I am grateful to my hon. Friend and constituency neighbour for giving way, and I congratulate him on securing this debate. He talked about connecting villages. In Oxford West and Abingdon we have Botley and Eynsham, which are both growing in population, but whenever designs are put forward, they are often missing the pots of money. Even though we tried to get a design linked to the expansion of the A40, we were told that we could not, because if we did, that bid would fail. That is entirely the opposite of what we would expect from a modal shift. Does my hon. Friend agree that the funding pots available and how they connect are at odds with what the Government say they want to do, particularly regarding a modal shift towards biking and other forms of active travel?

[Freddie van Mierlo]

My hon. Friend is absolutely right that funding is key to resolving these issues. In particular, slashing the active travel fund from £200 million to £50 million, as the Conservatives did in 2023, was shameful.

While much more needs to be done in towns and cities, more also needs to be done in rural areas. Mortality rates on rural roads are 2.7 times higher per mile cycled than on urban roads. If the Government continue to ignore rural areas in policy development, it could have devastating consequences.

[Andrew Cooper (Mid Cheshire) (Lab)]

I congratulate the hon. Member on securing this debate. I am very lucky that my constituency is interconnected by a series of rivers and canals, the Mid Cheshire waterways ring. When I am among council officers, I refer to it as “the fellowship of the ring”, just so they remember. It runs 26 miles around my constituency and is crying out to be used as a cycleway. It is far safer to use canal towpaths than traditional cycleways. They are already traffic-free, and it is much cheaper to develop the infrastructure and implement it. That potential no doubt exists nationwide. Does he agree that there is significant untapped potential for rolling out a cycle network across our canal towpath network?

[Freddie van Mierlo]

I thank the hon. Member for that intervention. I agree that we could make better use of the significant infrastructure that is already in place, whether that is canal towpaths or former railways and other such infrastructure.

I am calling on the Government today to commit to investing in safe, off-road cycling routes and segregated cycle lanes in rural areas. In Oxfordshire, I am pleased to share with this Chamber that the Liberal Democrat-led administration is taking steps to link up towns and villages that are characteristic of the stunning Chilterns national landscape, Oxford green belt and wider open countryside. The county has adopted Vision Zero, the ambition to eliminate deaths and serious injuries on our roads by 2030. It has already developed a strategic active travel network that draws lines on the map of prioritised cycle routes that would connect towns and villages to one another and to Oxford and cities of the surrounding counties. Yet for now, they remain just lines on a map, unfunded. The county adopted a new model to replace the old car-centric “predict and provide” methodology for deciding infrastructure and replaced it with “decide and provide”. Oxfordshire has decided, but it lacks the central Government funding needed to provide.

Even getting a simple project off the ground is a challenge. The Thame to Haddenham greenway is a project that has been mooted for more than 20 years. It would connect the market town of Thame, the largest settlement in the Henley and Thame constituency, to the nearby village of Haddenham in Buckinghamshire, just two miles away. Crucially, Haddenham is host to the Thame and Haddenham Parkway rail station that links the town to London. Cycling from Thame to Haddenham currently requires a high degree of confidence and a tolerance for risk to mix in alongside the heavy traffic of the A418.

The wildly popular Phoenix trail from Thame to Princes Risborough already proves high demand for off-road rural cycle infrastructure, but it is not just funding that is stifling the rural cycling revolution. Compulsory purchase powers are often wielded to make progress on road projects but are not used to deliver cycle infrastructure. This means that most projects barely get beyond the idea phase.

A cycleway that links Chinnor to Watlington via the village of Lewknor in my constituency, which sits just next to the M40, would transform the lives of thousands of people by providing an active travel link to London and Oxford via the Oxford tube. However, ideas never make it beyond a general agreement that it would be quite nice, because local landowners oppose it. I urge the Government to break free from the visionless Conservative legacy and take on these barriers to change. The Government must stop the lip service of the past.

In 2017, a walking and cycling strategy aimed to make active travel a natural choice. The Department for Transport active travel fund was set up to reallocate road space to cyclists and pedestrians and create an environment that is safer for walking and cycling. But words are cheap and here we are, seven years later. In rural areas, active travel is far from the natural choice.

In 2023, the Conservative Government, in a fit of reactionary culture wars, slashed the already paltry active travel budget from £200 million to just £50 million. Under this Government, I therefore welcome the increase in that budget to £150 million. However, let us not pretend that that will create a step change. The Conservatives had the budget at £200 million just three years ago. The Government should deliver on their promise to invest at unprecedented levels in active travel.

I hope that as a result of this debate, the Minister will consider increasing funding levels further for the 2025-26 period during the Department’s current planning discussion. I ask that because cycling in rural areas as a mode of transport will deliver concrete benefits for the economy, the environment, health and wellbeing. For every pound spent on cycling and walking schemes, £5.62-worth of wider benefits is achieved. In 2022, active travel contributed £36 billion to the economy. Cycling networks give rise to tourism and flourishing local businesses, encouraging institutions and services to set up in or return to areas.

It is a privilege and a joy to live surrounded by nature in the villages and towns of my constituency, but it can also be isolating. Many villages lack places to exercise and few have regular buses to the places that do. The latest data for Oxfordshire shows that 58% of people in the county are overweight, and one in three year 6 children are overweight or abuse. Cycling is an obvious means to increase physical activity in areas where small populations can make commercial or council-supported leisure centres unviable.

If we truly believe that there is a climate emergency, and I do, rural Britain must be part of the transformation, too. Reduced motor traffic limits carbon dioxide emissions and reduces nitrogen dioxide and particulate matter, with both gases linked to respiratory failure, stroke, heart disease, dementia and premature death. Do not think that just because rural areas are surrounded by fields that the risk is not present in the countryside, too. Historic towns can create choke points, quite literally, as vehicles move through them. Watlington’s Couching Street has been an air quality management area since 2009, as traffic passes through in search of the M40. Again, cycling must be part of the picture, and that is before we talk about the mental health benefits, which I will perhaps leave others to touch on.

We have a golden opportunity over the next five years to see the transformation needed. I am willing to work cross-party with anyone in Government, and MPs and councillors across Oxfordshire, Buckinghamshire and Berkshire, to seize it. I hope others will join me.

[Valerie Vaz (in the Chair)]

I expect to call the Liberal Democrat spokesperson at 5.46 pm, so given the number of Members wishing to speak, there will be an informal time limit of between four and five minutes.

17:17

[Ben Obese-Jecty (Huntingdon) (Con)]

It is a pleasure to serve under your chairship, Ms Vaz. Cycling infrastructure in rural areas across my constituency is poor and, in most cases, non-existent. Too many of our towns and villages lack the connectivity required to make them easily reachable by bike, often including roads that cannot be cycled on and no feasible alternative routes. Even as a keen and confident sports cyclist, there are a number of routes in Huntingdon that I avoid using because they are objectively too dangerous to cycle on. That is evident when considering the impracticality of travelling into Huntingdon and St Ives by bicycle from many of our surrounding villages, which makes commuting by bike for work or school too difficult for too many.

St Ives is a town that desperately needs people to work and shop within it, yet it is largely reliant upon people driving into it. There are persistent traffic problems approaching the town from the east, with the Harrison Way roundabout a constant issue during peak times. Yet the Needingworth Road, which connects Colne, Bluntisham, Earith and Needingworth itself to St Ives, is the A1123—fast and arrow-straight, not well lit, and a road I would not advise anyone to cycle on.

Approaching St Ives from the north, we have the Somersham Road. Although only a B road, it is again arrow-straight and very fast, with significant use by lorries. It also includes the Wheatsheaf crossroads, which has seen a number of road traffic accidents. The county council is yet to spend the money that it has allocated to upgrade the junction and make it safer.

Huntingdon is particularly poorly served. In theory, the town has a cycle path around the ring road, but it is a shared cycle path with pedestrians that, in places, is no wider than a single individual. The tragic death of cyclist Celia Ward in 2020, who fell into the road after an altercation with a pedestrian on the cycle path, illustrates its unsuitability.

Approaching Huntingdon from villages to the north, towards the Wyton roundabout on the A141 into Hertford, is again a journey fraught with danger, and not one I would expect any cyclist to undertake as part of their daily commute. The A141 is one of the busiest and fastest roads in the constituency. In response to the recent consultation, I made it clear that cycling infrastructure must be considered in any new plans.

Meanwhile, there is only one current cycling infrastructure project under discussion in the constituency. As part of its plans to improve the national cycle network, Sustrans has proposed a quietway, closing the Grafham Road to motor vehicles between the villages of Grafham and Brampton. I regularly use that road as a cyclist, but it is also a vital lifeline between the two villages, and it reduces the need to take the more circuitous routes to the north and south that involve dual carriageways.

Opposition to the scheme from local residents, including those who are cyclists, has been significant, with many well-attended local parish meetings held to discuss it. The road is not busy, so a more sensible decision would be to reduce the speed limit from the current national speed limit to a more realistic 20 mph, thereby making the route far friendlier to pedestrians, cyclists and equestrians alike, without the need to ban motor vehicles and cut the village off.

In Tilbrook, the parish council is working hard to establish a feasibility assessment for the proposed “Kim Valley Way” cycle path, linking the villages of Tilbrook and Kimbolton and eliminating the need to cycle on a fast and sweeping country road with poor visibility on bends for those wishing to travel between the two villages by bike. It is schemes such as these—designed by locals, for locals—that we should invest our time and effort into delivering, rather than top-down diktats that lack local buy-in.

We must ensure that when cycling infrastructure is proposed, it is done so sympathetically and with the needs of local communities in mind. Attempting to railroad through a proposal because it looks good on paper is where schemes such as the Grafham quietway have gone wrong. A lack of engagement, a lack of understanding of rural needs and a lack of strategic planning are the reasons that we have reached the point where, in a constituency like Huntingdon, cycling is not considered to be viable for so many in rural communities.

17:21

[James MacCleary (Lewes) (LD)]

It is a pleasure to serve under your chairship, Ms Vaz. Please accept my apologies, because I am likely to have to leave before the conclusion of the debate as I am hosting an event elsewhere on the estate. I congratulate my hon. Friend the Member for Henley and Thame (Freddie van Mierlo) on securing this debate. It is a privilege to speak on a matter that is of great relevance to communities like those in my Lewes constituency.

While cycling is often associated with urban transport solutions, it holds untapped potential to transform rural areas, if we address the challenges that prevent it from being a viable option for many. Two weeks ago, I had the pleasure of attending the Cycle Lewes annual general meeting. That dedicated group has been advocating for safer, more accessible cycling in Lewes and surrounding villages since 1998. Their work, from installing new cycle racks to critiquing transport plans that prioritise cars over active travel, is a testament to the power of local campaigning. However, as was made clear at the AGM, piecemeal progress cannot overcome the systemic barriers to cycling that rural communities face.

[Dr Simon Opher (Stroud) (Lab)]

I thank the hon. Gentleman for giving way, and I thank you for your chairmanship, Ms Vaz. I am from Stroud and for the past six years, even before I became a politician, I have been trying to get a greenway established in the village of Dursley that would run for about six miles to the train station. I found that there was not even funding for a feasibility study, so at the moment, we cannot get it off the ground. So I want to ask the Minister whether there will be a fund to make feasibility studies of new routes.

[James MacCleary]

Not being the Minister, I do not know, but I am sure that he will respond accordingly, and I hope that the answer will be yes, because that would be a fantastic thing to do. I know that county councils and other authorities have really struggled to find the funding for active travel undertakings across the country. We have certainly seen that in East Sussex, as the hon. Member for Stroud (Dr Opher) has in his area.

Cycling is more than a recreational activity. It is an essential mode of transport that can improve public health, reduce carbon emissions and ease the financial burden of transport for households. Nationally, cycling directly contributes an estimated £5.4 billion annually to the economy, including £4.1 billion from reduced mortality, air pollution, and congestion. Every pound invested in walking and cycling infrastructure generates more than £5 in benefits. Cycling also promotes land-use efficiency, requiring far less space than roads or car parks—a critical consideration for creating greener, more liveable communities. For predominantly rural areas like mine, that represents an opportunity to create healthier, greener and more connected communities. Without serious investment, rural residents will continue to face unsafe roads, insufficient cycling facilities and limited transport options.

In communities like mine, the reality is stark. Public transport options are patchy and many depend on cars for short journeys. Safe and accessible cycling infrastructure could provide an alternative that is not only affordable, but sustainable. Where we have dedicated cycle routes, such as the outstanding separated cycling routes alongside the A27 between Lewes and Polegate in my constituency, they are often unconnected to any ongoing routes, which limits the number of people that can use them.

Better road maintenance is required. We need to create conditions in which cycling is a realistic option for commuting, shopping and even leisure—not just for the young, pale and male but for everybody. Inclusivity must be central to our approach. Whether it is for children cycling to school, older residents using e-bikes or families making short trips, cycling infrastructure should cater to a diverse range of needs. It is about ensuring that everybody can benefit from the independence, affordability and health benefits that cycling offers.

The Liberal Democrats have been clear in our commitment to reverse funding cuts and in pushing for a nationwide active travel strategy. In rural areas, that includes prioritising safe cycling routes, linking active travel to public transport and ensuring that local councils have the resources to tackle potholes and maintain pavements and cycleways, as well as to invest in active travel infrastructure. I urge the Government to recognise that cycling is not just a solution for urban areas, but a vital tool for rural communities. By investing in cycling infrastructure, we can reduce transport poverty, improve public health and build a greener future for areas like Sussex. Let us not miss this opportunity to make cycling safe, accessible and inclusive for all.

[Valerie Vaz (in the Chair)]

It is customary to wait to hear what the Minister says—you might be delighted.

17:25

[Clive Jones (Wokingham) (LD)]

It is a pleasure to serve under your chairship, Ms Vaz. I thank the hon. Member for Henley and Thame (Freddie van Mierlo) for securing the debate.

Wokingham is a semi-rural constituency where it is possible to cycle between villages and towns, and to railway stations, schools and shops. National and local surveys tell us that the majority of people would be willing to do this, but they do not consider it to be safe. It is a difficult issue to resolve on narrow and busy country roads. Reducing speed limits can help, and the council is looking at some of them, but ultimately we need to invest in cycle routes away from the roads. The previous Government were funding such schemes, up until they decided that their electoral interest demanded otherwise, but since 2022 the funding available to local authorities has been wholly inadequate, and it remains so.

Shifting just a small proportion of local rural traffic from car to bike will help to solve many problems, including congestion, parking and air-quality issues in towns. There are mental and physical health benefits for those who cycle. The House of Commons Library has been helpful in pointing out a University of Oxford study that demonstrates the environmental benefits of active travel. Published in 2021, it found that switching just one trip a day from driving a car to cycling can reduce a person’s carbon footprint by 0.5 tonnes a year. As demonstrated by the Elizabeth line, if the infrastructure is there, people will use it. Across Europe, the benefits are being embraced, while the UK fails to recognise the return on investment that is waiting to be realised.

The former Secretary of State for Transport, the right hon. Member for Sheffield Heeley (Louise Haigh), stated that her Department would deliver “unprecedented levels of funding” for active travel; will the new Secretary of State commit to the same promise? Wokingham borough council has previously bid for an off-road route between Charvil and Twyford station; will the Minister commit to review the business case for investment in such cycling schemes?

17:28

[Edward Morello (West Dorset) (LD)]

It is a pleasure to serve under your chairship, Ms Vaz. I thank my hon. Friend the Member for Henley and Thame (Freddie van Mierlo) for securing this important debate on rural cycling infrastructure.

Members present appreciate the unique challenges faced by cyclists in rural areas, and the need to ensure their safety if we are to promote greater accessibility for cycling as a mode of transport. Rural roads present unique risks: they are typically narrower, less well maintained, and shared with fast-moving vehicles. In places in my West Dorset constituency roads are also shared with horse riders, who are similarly desperately in need of safety infrastructure.

The road conditions make cycling on roads disproportionately dangerous. Statistics show that cyclists are almost twice as likely to be killed on a rural road as on an urban one. For my constituency the challenge is clear: only 1.7% of people cycle to work, and that figure is well below the already appallingly low national average of 2.1%. Both figures reflect the deterrent effect of unsafe rural roads and the lack of cycling infrastructure, but also the wider picture of cycling in this country.

Cycling can provide an affordable, sustainable and accessible alternative for shorter journeys, not to mention the benefits to the environment and to physical and mental wellbeing. In West Dorset, 50% of people drive to work, 14% of households do not own a car and 30% of residents travel less than 10 km to work. That distance is more than achievable by bicycle for most individuals. Between Bridport and West Bay, the old railway has been repurposed as a cycling and walking path, with many residents hoping that it can be extended all along the old line to Maiden Newton to avoid their having to use country lanes. Similarly, an alternative cycle route between Bridport and Chideock would mean that residents and tourists alike could avoid the main coast artery of the A35, with its heavy goods vehicles.

Public transport in West Dorset is limited and irregular. Congestion on our few A roads and many country lanes causes delays and disruption in our villages. Cycling would reduce congestion, provide people with greater freedom to travel independently, reduce the environmental impact and support healthier lifestyles. I urge the Government to take immediate steps to address these issues and support rural constituencies such as West Dorset by making cycling a safer and more viable option.

17:31

[Ben Maguire (North Cornwall) (LD)]

It is a pleasure to serve under your chairmanship, Ms Vaz. I thank my hon. Friend the Member for Henley and Thame (Freddie van Mierlo) for securing what is an important debate for rural constituencies such as his and mine. Too often, only urban areas attract the focus for funding and infrastructure when it comes to active travel, yet the benefits to physical and mental health and wellbeing and in reducing carbon dioxide emissions and improving air quality are just as applicable, if not more so, in rural areas such as my North Cornwall constituency.

Cornwall is a region with very poor transport infrastructure and high car dependence. The Cornwall local transport plan sets out an ambition for at least 50% of journeys under 5 miles to be completed via active travel by 2030, which is only five years from now. A road network sufficiently free from harm and fear of harm supports wider environmental and public health ambitions and encourages and sustains the adoption of healthier, active modes of travel.

We have in my constituency one of the most popular off-road multi-use trails in the country—the Camel trail. Recent data shows that each year the existing trail attracts more than 400,000 users, of whom more than 50% are residents of Cornwall, and two thirds of these users are cyclists. Currently, only 1% of these trips are used to commute to work. However, with the growing popularity of e-bikes, this use has huge potential to grow.

Early feasibility work by Sustrans shows that there are two ways that the current trail could be significantly expanded to deliver cycling networks that are sufficiently free from risk or fear of harm to make the option of active travel, and especially cycling, an attractive alternative to using the car. I discussed the first expansion option with the Minister recently, so I hope he will bear with me as I set it out once again. The trail, which utilises a redundant railway line that follows the River Camel, could be extended inland to make its final destination the old market town of Camelford—providing much-needed regeneration and giving the residents who live there greater access to the countryside and a viable non-car commuter route to the larger towns of Bodmin and Wadebridge and elsewhere. That not only would help to meet Cornwall’s active travel ambitions, but could provide the Government with an opportunity to meet one of their manifesto promises—to improve responsible access to nature and create nine new national river walks.

The second option would be to introduce a network of quiet lanes across the wider rural area, which would provide connectivity between outlying villages and the Camel trail, offering local people viable options for active travel for their day-to-day living needs. A feasibility study for that has already been conducted by local councillor Dominic Fairman.

The key design principles for rural quiet lanes are as follows. There is the introduction of 30-mph speed limits on roads that already have low motor vehicle flows. People walking, running, cycling and, where appropriate, horse riding should feel safe and comfortable to use the routes, and all users should be aware of those with whom they are sharing the surface of the lane or road, with signage and markings where appropriate. Quiet lanes are a key solution to connect people in rural areas. On many routes, there is insufficient space to build cycle tracks and other infrastructure next to roads. Quiet lanes can also help facilitate a rural modal shift by making people feel safer when using what are already light-traffic lanes for walking and cycling.

We need greater investment to start addressing rural transport poverty. We should make schemes such as those I have outlined a reality and deliver transport infrastructure fit for the carbon-neutral world to which we are aspiring. If the Government really are serious about their claim that they will cut GP appointments by millions by delivering unprecedented investment in our cycling and walking infrastructure, they must consider schemes such as the Camel trail connect project. We do not have a single main line train station in my North Cornwall constituency, but we already have a world-class cycle trail. Now is the time to expand it and fund that shovel-ready plan.

17:35

[Cameron Thomas (Tewkesbury) (LD)]

It is an honour to serve under your chairship, Ms Vaz. I commend my hon. Friend the Member for Henley and Thame (Freddie van Mierlo) for securing this debate, and the hon. Member for Mid Cheshire (Andrew Cooper) for his excellent pun.

My home constituency of Tewkesbury is a patchwork of rural towns and villages. Public transport is either scarce or entirely absent, so cycling is an oft relied-upon mode of transport. Safe, managed cycle routes are vital for many of my constituents as a means to connect with our cathedral city of Gloucester to our south, the cultural centre of Cheltenham to our east, and the medieval town of Tewkesbury to our west. Only in those larger population centres can many of my constituents access their hospitals, schools, stores or social clubs.

Cycling in our rural communities comes at significant risk. As has already been stated, according to at least one study, cyclists involved in collisions on rural roads are more than twice as likely to suffer mortality than those on urban roads. There are several factors for that, including the time it takes for emergency services to arrive from major hospitals to our rural villages. Another factor seems to be that cycling infrastructure and roads in rural areas are poorly funded or neglected. Apparently, cycling routes are rarely considered alongside major highways infrastructure projects. There must be joined-up thinking to such projects to improve the viability of cycling as an environmentally friendly and healthy alternative to driving.

The Gloucestershire cycle spine is an ambitious plan to link Gloucestershire’s major population centres with some of our emerging population centres. The plan was initially met with significant public support, but several shortcomings with it have since caused outcry. Issues cited by residents in Longlevens including the fact that the camber of the cycleway draws water away from drainage and floods their properties with rainwater. In Churchdown, the road has been so narrowed to accommodate the cycleway that larger vehicles can now barely pass each other in places. A clear opportunity to link a cycleway to our heritage railway was missed.

This is not a pitch against such schemes; it is a call to keep the public engaged and ensure the projects are implemented not piecemeal but as a joined-up infrastructure plan so that the “so whats” are asked and answered ahead of the works. I am disappointed to learn that a shortfall in the central Government funding for Gloucestershire county council could mean a significant drop in the allocation for the Gloucestershire cycle spine. Consequently, the 14,000 residents of Bishop’s Cleeve will remain cut off from it.

Like other transport networks, cycling needs to be treated as a vital part of our infrastructure. It must be planned strategically and funded sustainably for the long term.

[Valerie Vaz (in the Chair)]

If no other Members wish to speak, I call the Lib Dem spokesperson, Steff Aquarone.

17:39

[Steff Aquarone (North Norfolk) (LD)]

It is a pleasure to serve under your chairship, Ms Vaz. I congratulate my hon. Friend the Member for Henley and Thame (Freddie van Mierlo) on securing this debate on such an important issue. He is a great champion of this cause. I know that he and his Liberal Democrat colleagues across Oxfordshire will continue to push for progress in their area.

I refer Members to my declaration in the Register of Members’ Financial Interests as a member of Norfolk county council, but I must declare an even more important interest, which is that I am a rural cyclist. It is for that reason that I am so pleased to respond to today’s debate for the Liberal Democrats.

In my area, we have some fantastic cycling routes. In Wells and Holkham, people can join national cycle network route 1 and travel through the north of the constituency as part of the Norfolk-wide rebellion way. Towards North Walsham, we have the Weavers way, which takes in much of the track bed of the former Midland and Great Northern joint railway.

The Liberal Democrats and I are ambitious for the future of rural cycling across the country. We want to see new cycle networks, and locally Liberal Democrats are working with communities to deliver on new cycling schemes in their local areas. It is a great shame that the previous Conservative Government did not match our ambition or enthusiasm for the future of cycling. They ruthlessly cut £200 million from the active transport budget, just after so many of us rediscovered our love for walking and cycling during lockdown.

That neglect for walking and cycling seems endemic within the Conservatives. Our Conservative-led county council has sunk £50 million into the white elephant that is the 6 km western link road. The legal and exploratory costs alone could have instead funded high-quality cycle super-highways six times the eventual proposed distance of that road. With attitudes like that, it is easy to see how our rural cycling infrastructure has deteriorated so badly over the previous decade, with Norfolk losing many of its routes from the national cycle network in 2020 after years of neglect and lack of upkeep.

Cycling will play a key part in the rural transport revolution, which so many parts of our country desperately need. We must make sure that cycling routes join up with public transport networks, so that people can safely and easily cycle to their nearest train or bus station. In my rural area, we have one of the highest levels of road per person in the country, and we cannot afford to maintain them all. Is it not time that we looked to convert underused and under-classified roads into access-only roads that prioritise walking and cycling? I am sure that many people would far rather hear the dinging of bike bells nearby than large lorries clattering through small country lanes.

I am passionate about seeing an improvement in rural cycling infrastructure across Norfolk and the rest of the country. Making cycling more accessible and attractive has only benefits. It keeps us healthier, it reduces carbon emissions and it gives us greater opportunity to explore and enjoy our natural environment. I very much hope that we hear from the Minister that the Government will match the passion and ambition of Liberal Democrats across the country to deliver better cycling infrastructure for us all.

[Valerie Vaz (in the Chair)]

I call the Opposition spokesperson.

17:42

[Jerome Mayhew (Broadland and Fakenham) (Con)]

It is lovely to see you in the Chair, Ms Vaz, and I congratulate the hon. Member for Henley and Thame (Freddie van Mierlo) on securing the debate. We have heard from many of the speakers today about the enormous benefits of cycling, and let us start with the most important one: it is enjoyable. It is healthy, and it gives people cardiovascular exercise, which leads to a better quality of life. Then there are the public sector aspects of it, which are reduced traffic congestion, reduced public transport crowding and reduced emissions in our hunt for net zero. However, it is not all positive, as there are a couple of negatives. One is the examples of road entitlement that we get from some aspects of the cycling community. I am a member of that community, and I hope I am not too entitled when I am on my saddle. The worst one, of course, is that we are exposed to MAMILs around our constituencies. I threatened my right hon. Friend the Member for New Forest West (Sir Desmond Swayne) that I would namecheck him in that regard, because I saw him just this morning in his Lycra.

However, on balance, it is a huge net positive to us as individuals and to us as a society that we encourage cycling. That is exactly what the last Conservative Administration did, despite the brickbats thrown at them in a number of the speeches we have heard this afternoon. For example, the Liberal Democrat spokesman, my neighbour the hon. Member for North Norfolk (Steff Aquarone), said that there were ruthless cuts to the active travel budget. However, he did not give credit to the previous Government for creating the fund in the first place, back in 2017. Yes, as the current Administration are beginning to find out, there is a need to take difficult decisions—I have heard that phrase more than once in the past few weeks—about how to spend public money, because it can only be spent once, but the previous Government invested £6.6 billion from central Government funding into active travel from 2016 to March 2025. That helped to create the national cycle network, which is some 12,000 miles of specialist cycle routes, but there is more to do. In my constituency, we have great cycle routes such as Marriott’s way, the Weavers’ way and the Peddars way—which was not mentioned earlier, but also links into our local community—but there are also frustrations. At the moment, we are dualling the section of the A47 in my constituency. A cycle route has been planned beside the dual carriageway, but with just a few hundred yards from North Burlingham, it could be linked into Acle and a much wider network. There is definitely more work to be done, because that was not part of the original scheme.

I welcome the Budget announcement that £100 million will go into cycling and walking infrastructure, but I am slightly concerned that that will happen only if the funding is confirmed in the Department for Transport’s business planning process. The same goes for any funding over the two years after that. What will happen as a result of the spending review? I should be very grateful if the Minister would expand on his commitment to be a strong advocate for active travel with His Majesty’s Treasury when it comes to the spending review. Can he confirm that that is one of his Department’s key objectives?

It is not just cycle routes, though; we also use roads in the rural community. In fact, the vast majority of us who cycle regularly in the countryside use our roads—typically our B roads—as the mechanism for doing so. Because of changing weather patterns, potholes are an ever-increasing scourge. The last Administration spent £8.3 billion on road repairs, but I am the first to admit that there is plenty more work to be done. Potholes have a particular impact on cyclists, who typically ride towards the edge of the carriageway; that can be a real challenge for us as riders. Can the Minister also give reassurance that he will continue to advocate for increased investment in road infrastructure to support active travel and safer, well-maintained roads for all users, including cyclists?

I again congratulate the hon. Member for Henley and Thame. He is right to highlight the benefits and challenges of cycling in the rural community, and I look forward to the Minister’s response, in which he will no doubt tell us all the things he will do to support that important activity.

17:47

[The Parliamentary Under-Secretary of State for Transport (Simon Lightwood)]

It is a pleasure to serve with you in the Chair, Ms Vaz. I congratulate the hon. Member for Henley and Thame (Freddie van Mierlo) on raising this important issue. He represents a constituency in a very beautiful part of rural England that, despite its proximity to the capital, is largely rural in nature. I thank the hon. Member for Oxford West and Abingdon (Layla Moran) and my hon. Friend the Member for Mid Cheshire (Andrew Cooper) for their interventions, and I thank the hon. Members for Huntingdon (Ben Obese-Jecty), for Lewes (James MacCleary), for Wokingham (Clive Jones), for West Dorset (Edward Morello), for North Cornwall (Ben Maguire), for Tewkesbury (Cameron Thomas) and for North Norfolk (Steff Aquarone) and my hon. Friend the Member for Stroud (Dr Opher) for their contributions. In my speech, I will try to cover the points they have raised.

The hon. Member for Henley and Thame is right to highlight the fact that there can be particular challenges in designing safe routes for cyclists in rural areas. There are many country lanes and B roads where the national speed limit applies and where there is clearly no room for a separate cycle lane. Such roads can be intimidating places for all but the most experienced of cyclists, with the constant risk of being close-passed at high speeds by inconsiderate drivers. By definition, narrow country roads also tend to have far less room on them than wide urban streets, where a segregated cycle lane can offer cyclists protection from other road users.

There has also perhaps been a perception, rightly or wrongly, that successive Governments of whatever colour have only really been interested in promoting active travel in urban areas, and have tended to ignore the very different needs of rural areas. I can assure the hon. Member for Henley and Thame, however, that this Government are determined to ensure that active travel—whether walking, wheeling or cycling—can address the transport needs of people in both urban and rural communities. I will come on to the different ways in which we intend to do so in a few moments, but let me first set out the broader context.

As we all know, active travel is a great way of improving people’s health that can in turn ease pressure on our NHS. It has other benefits, including supporting economic growth, reducing congestion and helping to decarbonise transport. All of this matters just as much in rural areas as it does in our towns and cities.

Funding for decent infrastructure is critical. In the Budget, the Government underlined our commitment to active travel by announcing an additional £100 million of capital funding for active travel infrastructure in the financial year 2025-26. That reversed the previous Government’s funding reduction.

In the very near future, Active Travel England will announce further details of the Government’s investment plans for this year and next. I am confident that some of that investment will enable the delivery of high-quality active travel infrastructure in rural areas. However, I am afraid that the hon. Member for Henley and Thame will have to wait just a little bit longer to hear further details on that.

The Government will then set out what further funding for active travel will be available in future years, following the spending review. We will do so alongside producing a new cycling and walking investment strategy, which we anticipate will be published next year.

Wherever cycling infrastructure is built, it must be delivered to the right standard. In particular, it should comply with the Department’s cycling infrastructure design guidance. Active Travel England provides training to local authority officers across the country on how best to design safe and accessible cycling and walking infrastructure, and it is developing specific guidance for the application of good practice in rural areas.

[Layla Moran]

The Minister has moved on to the “how”, but I wonder whether it is worth reflecting for slightly longer on the “why”. With my Chair of the Health and Social Care Committee hat on, I wonder whether he noted that the chief medical officer’s annual report last year on an ageing society mentioned cycling 13 times, in the context of meeting the needs of an ageing population. He might also have noted that rural areas age faster than urban areas because of demographic shifts. And he might also have noted that in the 2022 annual report, cycling was mentioned 88 times in the context of air pollution.

I note that the Government’s life mission is for people to live “well for longer.” To what extent is the Minister’s Department planning to be part of the delivery of that mission, and how is he making that happen?

[Simon Lightwood]

I thank the hon. Member for that intervention. I can assure her that the Department for Transport is working closely with Departments across Government; we want to break down the silos of Departments and work on our collective missions. I have already had discussions with the Department of Health and Social Care and Sir Chris Whitty regarding our contribution, and I will continue to have such discussions. I absolutely recognise that active travel can be fundamental when it comes to tackling people’s health issues and to removing barriers to opportunity and economic growth.

Ensuring that infrastructure is safe must be our overriding concern. Over 60% of respondents to the Department for Transport’s national travel attitudes survey said that safer roads would encourage them to cycle more. As I have said, rural roads can be more dangerous for cyclists, because there is faster-moving traffic and no space for segregated cycle lanes. That is why supporting local authorities to design and deliver high-quality active travel infrastructure that is safe and compliant with the relevant design standards is a key part of Active Travel England’s remit. It is also why funding provided by the Department for Transport for walking and cycling schemes comes with the clear requirement to comply with relevant design standards.

As the hon. Member for Henley and Thame may be aware, Oxfordshire county council has been successful in securing funding for active travel schemes in a number of rural areas. That includes nearly £1.5 million for a scheme in Abingdon and nearly £2 million for a scheme in Witney. The scheme in Abingdon will create a safe walking, wheeling and cycling route, providing new crossings and other improvements to overcome a significant barrier to active travel between Oxford and Abingdon, and onwards to Didcot and beyond.

Another example of a new scheme, which opened in the last few weeks, is in Wycombe, just across the county border from the constituency of the hon. Member. Buckinghamshire council completed an Active Travel England-funded improved pathway to support walking, wheeling, cycling and horse riding in Keep Hill wood, near High Wycombe.

The money for all these schemes has come from various dedicated pots of funding for active travel that have been announced by Active Travel England in recent years. In total, almost £650 million of funding has been provided for local authority infrastructure since covid. In addition, Active Travel England has worked with National Parks England to provide £1 million funding to allow the 10 national park authorities in England to develop inclusive active travel plans, as well as supporting activities, such as scheme planning and design, and how best to make sure local stakeholders are engaged. All 10 projects are due to be completed by next summer. I gather, too, that there was a petition last year concerning a proposed off-road cycle route in the hon. Member’s constituency. If they have not already done so already, I encourage representatives from Oxfordshire county council to contact Active Travel England about that scheme if it is a viable possibility.

I will try to address some points made by hon. Members. As I said, Active Travel England provided £1 million grant funding to national parks, and is currently working on guidance for authorities on how to design and build safe infrastructure for walking, wheeling and cycling in rural areas, including villages and market towns. We expect publication in late 2025. Active Travel England is currently engaging with stakeholder groups to support that work, including both potential route users such as Disabled Ramblers, Cycling UK, the British Horse Society and so on, and guidance users including local authorities, Highways England and bodies such as the National Trust and national parks.

I will conclude by saying a big thank you again to all Members who contributed and to the hon. Member for Henley and Thame for raising this important issue. I look forward to continuing to work with him—I thank him for his offer to work on a cross-party basis towards achieving our active travel ambitions—and all other hon. Members to enable more people to choose to walk, wheel and cycle, irrespective of where they live.

17:56

[Freddie van Mierlo]

Thank you, Ms Vaz, for calling me again. I thank all hon. Members for their contributions.

A number of issues were touched on, but I would like to zoom in on speed limits. My constituency has done an excellent job of embracing lower speed limits. Villages had the opportunity, under an innovative scheme run by the county council, to reduce speeds to 20 mph on many rural roads. That has had a really positive impact, with Oxfordshire seeing the largest reduction in collisions in the whole country. Research shows that a 1 mph reduction leads to a 6% reduction in collisions. Not everybody drives to the speed limit. As I tell my residents, if we set the expectation that everyone drives at 19.9 mph then we will see the scheme as a failure, but for the most part residents are law-abiding and respect the speed limit, and that has had tremendous benefits.

Several hon. Members spoke on the importance of bottom-up planning and not having a one-size-fits-all approach. Rural areas are unique and different—they are not all the same. Off-road infrastructure along canal paths and former railways, or the introduction of quiet lanes using existing road infrastructure, is all extremely valuable.

Some Members spoke about the importance of maintaining roads for all road users, whether vehicular or active travel. The previous Government left a £16 billion backlog in road maintenance. In my county, officers inform me that they receive only £15 million a year for highway maintenance, but that it costs the county upwards of £45 million to keep roads safe and that residents would only see meaningful benefit if there was an increase to £80 million. The Minister spoke about investment in active travel in terms of millions; I would like to see him shift his vernacular from “m” to “b” and see billions of pounds invested over a number of years.

Members spoke about the importance of inclusivity. That is particularly important to me, having learned how communities approach cycling in the Netherlands. There, you will see people cycling in a leisurely way and carting all sorts of things. An approach where we have more children, more women, more vulnerable people and even disabled people taking part in cycling would be a fantastic culture shift in the UK. When I was living in the Netherlands, I would even cycle 50 metres to the nearest post box from my house. That is the kind of culture shift I hope we can achieve, in both urban and rural settings.

Question put and agreed to.

Resolved,

That this House has considered cycling infrastructure in rural areas

18:00

Sitting adjourned.