Westminster Hall

Tuesday 28th October 2025 Westminster Hall

Tuesday 28 October 2025

[Clive Efford in the Chair]

Obesity and Fatty Liver Disease

Tuesday 28th October 2025 Westminster Hall

09:30

[Dr Beccy Cooper (Worthing West) (Lab)]

I beg to move,

That this House has considered obesity and fatty liver disease.

It is a pleasure to serve under your chairship, Mr Efford, alongside my parliamentary colleagues who have kindly come along this morning to debate and highlight the public health emergency that is obesity and fatty liver disease.

The vast majority of us do not often think about the health of our livers. If we do, our biggest concern is how many units of alcohol we drink every week and whether our livers can keep up. But we do talk about our weight a fair amount, either in terms of how we look and how our clothes fit, or, if we are linking it to disease, whether we are blocking up our arteries and risking a heart attack. Today I want to make the case for linking our concerns about being overweight and sedentary with the very real risk of developing fatty liver disease. Before I give the alarming statistics about the huge increase in liver disease in the UK, I want us all to hold on to the fact that a weight loss of 10% can halt and even reverse fatty liver disease progression, and the way to help us all to do that is not to point fingers and tell individuals to try harder. There are much more effective public health solutions than that.

Now for the alarming statistics that should give us all pause for thought: after heart disease, liver disease is the biggest cause of premature mortality and lost working years of life in the UK. In stark contrast with other killer diseases where the mortality rate has gone down, deaths from liver disease have increased by 400%—yes, 400%—over the past two decades. Every year we are seeing 18,000 deaths from liver disease. It is now the biggest killer of 35 to 49-year-olds in the UK. In two to three years it is set to surpass heart disease as the leading cause of premature death in the UK.

Today’s debate matters because fatty liver disease is becoming one of the defining public health challenges of our generation—a disease that already affects as many as one in five adults in the UK, equating to about 1 million people, but one that hardly anyone knows about. When I asked my parliamentary colleagues to speak in today’s debate, they said, “Fatty liver disease? What’s that?” So hopefully this debate will highlight this alarming disease.

Closely linked to our ongoing struggles with obesity, fatty liver disease—for the record, its clinical name is metabolic dysfunction-associated steatotic liver disease; that is the last time I am going to say that today—is deeply rooted in our broken food systems and the stark health inequalities that our communities face.

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

I congratulate the hon. Lady on securing the debate. She is outlining very clearly the importance of the issue. It is vital that people are aware of it. Does she agree that if we do not deal with the issue, the NHS waiting lists over the coming years will be compounded even further than they have been already?

[Dr Cooper]

I thank the hon. Member for making that excellent point. He is absolutely right. The issues of the NHS waiting lists are pertinent and stark. Reducing them will mean that we have to get the left shift right as well as invest in acute services.

Our policies have failed the population for decades. This debate is an opportunity to make the urgent case for a national liver strategy, joined-up public health work and profound reform of the conditions that stop us all living well. Because we have failed to build an environment where healthy food is affordable and accessible, two thirds of UK adults are now overweight or obese, and one in three children in England are above a healthy weight when they leave primary school.

Fatty liver disease is a silent killer, often asymptomatic until at a very advanced stage, meaning many patients are diagnosed too late for effective intervention. Left untreated, as too many are, fatty liver disease can progress to liver inflammation, fibrosis, cirrhosis, liver failure or liver cancer. Fatty liver disease also increases significantly the risk of heart attacks, stroke and heart failure. It is projected to overtake alcohol as the leading cause of liver transplants within a decade.

How do we treat fatty liver disease? Despite high and rising mortality rates, there are limited treatment options for patients with this disease. As I have said, weight loss and lifestyle change are essential.

[Clive Jones (Wokingham) (LD)]

I thank the hon. Member for bringing this very important subject to Westminster Hall. She is absolutely right. Fatty liver disease is the fastest rising cause of liver cancer death in the UK and highlights the risk of developing a less survivable cancer for people living with obesity. Does the hon. Member agree that improvements to diagnosis of and treatment for fatty liver disease should be covered in the national cancer plan, which I called for a year ago and the Government are to announce early next year?

[Dr Cooper]

I thank the hon. Member for his excellent intervention. I absolutely agree that the national cancer strategy is essential. We must make sure that liver cancer is integrated into it, and that diagnosis and treatment are a key part of it and are funded across the country, to make sure that the inequalities that I am going to talk about are addressed sufficiently.

Before we get to the issue of diagnosis and treatment, weight loss and lifestyle change are essential. We know that a Mediterranean diet plus exercise improves liver function and that reducing ultra-processed foods reduces intrahepatic fat. However, for those whose disease has progressed to scarring of the liver, or liver fibrosis, there is an urgent need for therapies that directly target the liver.

Currently, no drugs are licensed to treat fatty liver disease in the UK. We have fallen behind the United States and Europe, as our market is too small for prioritisation. If I might get a bit more political, that is driven in part by our decision to leave the European single market. But this is a rapidly advancing field and we are approaching a potential breakthrough in treatment. With adequate planning, co-ordinated action, investment and leadership, we can ensure that our national health system is patient-ready to deliver the next generation of medications, and that all patients, regardless of postcode, can benefit.

Early diagnosis offers significantly better outcomes and a wider range of treatment options, but despite fatty liver disease being medically recognised in the 1980s, clinical and public awareness of it remains far too low. We urgently need to increase public understanding and encourage early liver checks, particularly for those at higher risk because of obesity or type 2 diabetes. What is more, we have seen primary care systemic failures to improve early detection, such that three quarters of people are diagnosed with cirrhosis at hospital in an emergency, when it is too late for effective treatment or intervention.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I, too, congratulate my hon. Friend on an excellent and really important debate. May I take her back to what she was saying about the food industry, wider population prevention measures and what this means for school meals and for our poorer communities, who are reliant on food supporters, such as the Trussell Trust and others, in terms of the type of food made available to them?

[Dr Cooper]

I thank my hon. Friend for that excellent intervention. She is absolutely right. With her public health expertise, she highlights the very real problems that lead to fatty liver disease: our broken food system, the issue with access to good, nutritious food for children in school, and the need to ensure that our stark health inequalities are addressed. I will come to that later in my speech.

To go back to the issue of diagnosis and treatment, we should note that a staggering 80% of England currently has no effective detection and treatment pathway—yes, a staggering 80%. The British Liver Trust, whose representatives are here today, is rightly calling for an end to this postcode lottery, so a key ask raised in this debate is that every integrated care board, every regional and national health area that we have, should have a full pathway for early detection of liver disease.

There is some excellent, innovative work out there that can help us to get to a much better place in tackling this disease. I recently met the team at Predictive Health Intelligence—whose representatives I think are also here today—who have developed hepatoSIGHT, which is a great name; well done. That is an inspiring example of how technology can transform early detection. The system uses existing NHS data to identify people at risk of liver disease before symptoms develop, allowing GPs proactively to invite patients for screening and support. I am delighted to say it is now being implemented across NHS South West. It is proof that, with genuine support from senior NHS management, clinical and digital teams at all levels can come together for the good of patients. That system is exactly the kind of innovation we need in order to make early diagnosis and prevention the norm and not the exception.

I now come to prevention. Screening and early diagnosis are vital but, as for all population health issues, as my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) rightly highlighted, we must have a laser focus on preventing the root causes of fatty liver disease.

[Steve Yemm (Mansfield) (Lab)]

I thank my hon. Friend for raising this debate. We are calling obesity the enemy, but the liver does not count in pounds or kilograms. The real culprit is not body weight; it is metabolic dysfunction, as she points out—insulin resistance, poor diet, genetic risk and so forth. Lean people also get fatty liver disease, not always people who are overweight. Does my hon. Friend agree that we should talk less about obesity and more about screening early, taxing junk food and treating metabolic disorders and disease rather than strictly BMI? If we chase the scales, we might miss the science.

[Dr Cooper]

I thank my hon. Friend for that excellent point and agree absolutely. In our society, we focus on how people look for many reasons, cultural and commercial, but this is purely about health. This is about keeping people healthy on the inside and allowing them to live good quality lives. My hon. Friend is absolutely right in that sense.

Poor diet is now the leading risk factor for death and disability. It is responsible for millions of preventable deaths each year. In the UK, almost two thirds of adults are overweight or are living with obesity, increasing the risk of fatty liver disease, cardiovascular disease and a multitude of cancers. In my job as a public health consultant, I see a lot of data and read many papers, but this statistic shocked me: four in 10 children with obesity may already have fatty liver disease. That demonstrates the urgent need to act now to prevent an even greater epidemic of disease in future.

That has not happened by accident; it is the result of a broken food system, which has made the UK Europe’s third most obese country and one of the world’s biggest consumers of ultra-processed food. We have a system that makes the unhealthy choice the cheapest, easiest and most available choice. Healthier food now costs more than twice as much per calorie as unhealthy food. That is £10.24 per 1,000 kilocalories compared with £4.50. For fruit and vegetables, the cost is even more at £11.90 per 1,000 kilocalories.

For the lowest income households, following a recommended healthy diet would swallow half or more of their disposable income. It is no surprise that obesity and fatty liver disease hit hardest in poorer communities. As I said at the beginning, this is not about personal failure. As hon. Members have said, sometimes people feel that that they are failing to lose weight and failing to keep themselves healthy. This is not about personal failure; it is a political failure. It is our collective failure to create a food environment that protects rather than undermines public health. If we are serious about prevention, we must be serious about reform—the right type—with stronger fiscal and regulatory measures to reduce the availability and marketing of foods that are high in fat, salt and sugar, and to rebuild a food system that serves public health and not profit.

Why have we not addressed this yet? Weighted against the commercial gain of the food and drink industry, our obesogenic environment is killing our population and costing the taxpayer billions. Economic analysis last year suggests that excess weight costs the economy £126 billion a year. A Budget is coming up next month; I am fairly sure that our Chancellor would like £126 billion a year. That figure takes in wider factors, such as lost productivity, care costs and lost years of healthy life. The direct NHS cost of obesity is projected to rise from £6.5 billion to £9.7 billion by 2050. We cannot separate our health and our wealth, and we cannot hope to achieve economic growth without tackling issues such as obesity and fatty liver disease.

Since 1990, there have been nearly 700 policies proposed by Government to reduce obesity. Imagine having 700 policies about your life! Past strategies fell short because they targeted behaviour change—individual choice—rather than the structural and commercial drivers of diet. Many lacked delivery plans, timelines or evaluation frameworks, leading to fragmented progress and limited long-term impact.

What can we do now to ensure that this public health emergency is addressed? My key asks for our Health Minister, who is kindly listening here today, are as follows. First, there is a clear need for a national liver strategy, ensuring increased public awareness, early liver checks and primary care pathways. As stated earlier, every integrated care board should have a pathway for the early detection of liver disease.

Secondly, we need strong planning and co-ordination to be ready to deliver the next generation of medication for liver disease. Thirdly, if we truly mean to deliver the left shift to prevention, promised in the 10-year health plan for England, then we have to change the environment that is driving poor health. There is strong consensus about the necessity of upstream interventions to regulate the unhealthy food and drink environment. We can build on that strong consensus to extend the levy model to high-sugar and high-salt foods; to enforce the 9 pm watershed for high fat, salt and sugar advertising, closing brand mark loopholes; to provide stable funding for local food partnerships, so that councils can act on local needs; to reinstate the full childhood obesity plan; and to address food affordability via fiscal reform.

None of this is easy or it would have been done already, but right now our environment is draining our health service of billions each year and weighing heavily on the nation’s health—no pun intended. Let us not keep repeating our mistakes, but rather embed food policy as a national health priority. Through our work on preventing obesity and fatty liver disease, let us support and finally see the long-discussed and essential shift towards prevention and a healthier, wealthier country.

[Clive Efford (in the Chair)]

I remind Members to bob in their places if they intend to speak.

[Several hon. Members rose—]

[Clive Efford (in the Chair)]

Right, that gives me a better idea. We will bring in the Front Benchers at 10.28 am, so that gives an idea of how much time there is for the six or seven Members who wish to speak.

09:49

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairship, Mr Efford. I thank the hon. Member for Worthing West (Dr Cooper), who is co-chair of the all-party parliamentary group on liver disease and liver cancer, for setting the scene incredibly well. I thank her for the detail and for her requests to the Minister. It is, as always, a pleasure to see the Minister in her place. I wish her well and I look forward to her answers. I also thank the British Liver Trust and the Foundation for Liver Research, which supplied me with a briefing that made clear the excellent work at the Roger Williams Institute of Liver Studies, which continues to drive world-leading research into metabolic liver disease to shape how it is diagnosed and treated.

Liver disease is a growing cause of premature mortality and lost years of working life in all four nations of the United Kingdom. It has been estimated that some 4,878 potential years of life were lost due to chronic liver disease in Northern Ireland. It is clear that the UK is in the midst of a liver disease crisis, to which the hon. Lady referred. It is as serious as that, and we should all take note. While premature mortality rates from other major diseases have fallen over the past two generations, deaths from liver disease have risen 400% since the 1970s. There are more than 18,000 deaths from liver disease and liver cancer each year in the United Kingdom.

[Clive Efford (in the Chair)]

Order. Members are asking that you speak into the microphone, Mr Shannon, so that they can hear you.

[Jim Shannon]

That has never been a problem in the past, Mr Efford. Do I need to lift it up to my mouth? I thought it was good enough to carry my voice; apologies if it is not. This would be the first time it has not worked.

Two thirds of adults are overweight or living with obesity, and one in three children are classified as overweight or obese when they leave primary school. Sadly, four in 10 children with obesity may already have liver disease. One in five people are affected by liver disease and liver cancer in the UK, and as many as 12% of those—more than 1 million people—go on to develop the more severe form of fatty liver disease.

The stats for Northern Ireland are unreal. That is not the Minister’s responsibility, but it gives a flavour for the debate. Some 64% of adults in Northern Ireland were overweight or obese, a marked increase from 23% in 2010-11. My goodness me—if ever we needed a reality check, that is one for us. Shockingly, Northern Ireland has the highest rate of overweight or obese primary 1 children in the UK, with 25.3% of children fitting that category. In my constituency of Strangford, 27% of year 8 children were overweight or obese. It is estimated that 70% of adults and 40% of children who are overweight or obese have fatty liver disease, so urgent work must be done to prevent this health crisis in the making.

Shockingly, 37 million extra sick days are estimated to be taken by people living with obesity, harming economic output on a massive scale—a figure of 1% to 2% of UK GDP as estimated by the Institute for Government. The NHS alone is expected to shoulder an estimated £10 billion per year obesity bill by 2050, with obese patients costing twice as much as those of a healthy weight. Reducing obesity prevalence by 10% could save £6 billion per year in the UK economy.

Let me tell a personal story. I am a type 2 diabetic. Some 16 or 17 years ago, I realised that I needed to drastically change my eating habits. I was 17 stone. To be honest, to put it very starkly, I was a big fat pudding. I realised that if I did not lose weight for my diabetes, I was going to be in trouble, so I reduced my weight quite substantially, by 4 stone. I have managed, by and large, to keep at that reduced level. First, it was down to stress but, secondly, it was down to Chinese takeaways five nights a week with two bottles of Coca Cola. That just does not work; when it is added up, you just get fatter and fatter. I took that away and tried to reduce my chocolate intake.

My hon. Friend the Member for East Londonderry (Mr Campbell) has said that he is reducing his sugar intake—well done to him; he does not need to, but it is definitely a good purpose to have. The point I am making is that not everyone can. For those who cannot, it is important to look towards the weight-reduction injections, to which I will refer in a moment. I have been able to control my diabetes for the last 10 years by tablets. I take nine tablets in the morning and five at night to keep everything under control.

Newly released weight-management drugs such as Ozempic and Mounjaro have been shown to reduce the weight of patients by an average of 5%, reducing the risk of a variety of health effects, including fatty liver disease. However, although those drugs are available for those who obesity and type 2 diabetes, they are not for those with fatty liver disease. Making that happen would be my one request of the Minister. If someone has a body mass index of over 40, and does not yet have those comorbidities, unfortunately they will not qualify.

There is a new generation of drugs targeting advanced fatty liver disease. Resmetirom has recently been approved by the US Food and Drug Administration and is expected to be approved in the UK within 12 to 18 months. Could the Minister give us an indication of where those drugs are in the system? Those new drugs—some of which improve liver function and some of which enable weight loss—can reverse fatty liver disease and must be made available in a timely fashion to save lives. The NHS needs to ensure that services are ready to support that, as previously no treatment has been available for those patients.

The UK faces a very challenging commercial environment for drug pricing. Lilly recently announced that it will increase the price of Mounjaro by as much as 170% in response to pressure from the US Government and historic pricing inconsistencies. My second question to the Minister is about what has been done to ensure that the price of drugs is reduced or kept controlled in a way that can make a difference.

Thirdly, I say to the Minister that ICBs must have an effective pathway for the early detection of liver disease. A new nationally endorsed pathology pathway to improve early diagnosis of liver disease is essential. Every community diagnostic centre should also have a fibroscan to assess fibrosis.

Finally, I say to the Minister that patients with advanced liver disease and cancer need access to weight management services in line with access for people with type 2 diabetes. This is a ticking timebomb, but there are scientific breakthroughs there to address it. I believe in my heart that the Government need to cut that wire and stop that timebomb now.

09:56

[Dr Simon Opher (Stroud) (Lab)]

I thank my hon. Friend the Member for Worthing West (Dr Cooper) for securing this very important debate. I also thank the British Liver Trust and the Foundation for Liver Research for providing me with a lot of data and information. As a GP, I have learned quite a lot from preparing this speech—we will come to that a little later.

As my hon. Friend said, what we really need is the right type of reform. My Government are proposing three shifts in care. Probably the most important is from cure to prevention, and this issue fits in very well with that. It also fits into the other shifts that we want. We want to get out of hospitals and into the community, and a lot of work around fatty liver disease can be done in the community. We also need to use data properly to target people and to look at the digital ways in which we can identify high-risk people.

Fatty liver disease affects 20% of the population. I do not want to repeat all the statistics that we have heard, but 12% of those people go on to develop very severe disease, and that is 90% preventable. That is a perfect example of our being able to prevent disease rather than just allowing it to happen.

As GPs, we often do a liver function test—often if someone is on a statin or something similar—as a screening test, and we find that the alkaline phosphatase is slightly raised. We then do an ultrasound scan and, lo and behold, people who are overweight often have fatty liver disease. That is often as far as it goes in GP land, so we need to change that pathway. There is an obesity epidemic and two thirds of adults are overweight. As my hon. Friend the Member for Worthing West said, children also carry a great burden of obesity and overweightness—by year 6, 32% of children are obese.

As my hon. Friend also said, there has been a massive increase. Most diseases are going down in frequency, but there has been a 400% increase in fatty liver disease. That leads first to fibrosis, then cirrhosis and even liver cancer. As she pointed out, detection is often at the acute stage when people are admitted to hospital with cirrhosis and sometimes hepatic failure. That is a sign of a poor medical system. We are failing those people.

Where I come from in Stroud, we have the fourth-highest hospital admission rate for liver disease in the whole south-west, and Gloucestershire has the highest. We need to get on and start dealing with fatty liver disease. How do we do that? As we have heard, prevention is probably the single most important thing, so I urge the Government to grab that ethos of preventing disease and really go for it. We have a national food strategy—there is plenty in there, which I will not talk about now—and ultra-processed foods are obviously causing a lot of harm. There are also some exciting options in the 10-year plan in relation to supermarkets, such as how they need to keep their data and about starting to sell healthier foods, rather than foods that are high in fat, sugar and salt. The plan also refers to the reformulation of some products.

I will point out two other things: first, free school meals reduce obesity in children; and secondly, as a Government, we are bringing in rules about advertising unhealthy food before the 9 o’clock watershed, which I welcome. We also need to halt brand advertising before that time, because when people see a sign saying “McDonald’s”, they do not think about salads, do they? That is also important.

Screening needs to be data driven. In general practice, we know that a lot of people with a BMI of over 27, for example, should get near-patient testing for liver function, and those who have raised liver function should then have a fibroscan in their neighbourhood practice. That would be a fantastic community response to the problem: neighbourhood practices could take hold of the issue and start screening properly, reducing the burden of disease on our population.

Training is also important. I am a standard sort of GP, and I did not know as much before preparing this speech as I do now. We need to educate GPs on the importance of detection.

Lastly, although GLP-1 agonists are not authorised for treating fatty liver disease, we are certain that they are effective at reducing weight and would certainly reduce fatty liver disease. We must invest in weight-management services to wrap around that treatment. We have a great opportunity to prevent disease.

10:02

[Peter Dowd (Bootle) (Lab)]

It is a pleasure to see you in the Chair, Mr Efford. I find it difficult to believe that the hon. Member for Strangford (Jim Shannon) was a big fat pudding, but I suspect that even if he was, no one would have really noticed, given his charm and personality—I say that in all sincerity, as he knows.

I thank my hon. Friend the Member for Worthing West (Dr Cooper) for being the driving force behind today’s debate. She has indicated that

“people do better in more equal societies.”

To some extent, as she made clear, that goes to the heart of what we are discussing. I will not repeat what she and other Members have said, but I will briefly discuss inequality in relation to my constituency. I also thank the British Liver Trust for its comprehensive and incredibly enlightening briefing on the issues that we face, which put into context the impact of those issues on our constituents. We are talking about individuals—mothers, fathers, sons, daughters and children—whose lives can be destroyed by this dreadful condition. My hon. Friend set the scene in relation to that. Time and again, the trust reinforced that fatty liver disease is a silent killer that is on the increase and clearly has been for a considerable time.

To put that into context—some figures have been mentioned—there are about 19,000 deaths each year across the country. If my maths is right, that is about 52 deaths every day. In my constituency, that would equate to about 29 deaths a year, but I suspect the figure would be much higher if health inequalities were factored in, given that the rate of the disease is five times as high in the most deprived areas, of which mine is one. The figure in my constituency might be five times that amount —100 or 150 deaths a year.

We should take into account that the average age of death is 61 for men and 62 for women, which, in this day and age, is really no age at all. In men, the chance of death is twice as high as in women. In that context, it is also important to emphasise that nine out of 10 cases of liver disease could be prevented.

I hope that this debate will enable the calls to action by the British Liver Trust and by hon. Members to be heard in relation to prevention, early diagnosis, treatment and tackling inequalities. Perhaps the most sobering issue, which my hon. Friend the Member for Worthing West touched on, is the level of fatty liver disease in our children. She indicated that as many as 40% of children are affected in the more deprived areas, whereas in less deprived areas it is more like 14%—and even 14% is far too high.

I am pleased that my hon. Friend has enabled us to look at this issue in more depth. I look forward to the responses from the Opposition spokespeople, the hon. Members for Sleaford and North Hykeham (Dr Johnson) and for Winchester (Dr Chambers), and of course my hon. Friend the Minister.

10:06

[Lorraine Beavers (Blackpool North and Fleetwood) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Efford. I thank my hon. Friend the Member for Worthing West (Dr Cooper) for securing this vital and timely debate.

Liver disease is quietly stealing lives in every corner of our country. It is now the second-biggest cause of early death in England and Wales. Deaths have risen by more than 40% since 2001, which is in stark contrast to deaths from heart disease and cancer, which have declined. What makes it so heartbreaking is that 90% of liver disease cases are preventable.

In my constituency of Blackpool North and Fleetwood, this crisis is felt deeply. Blackpool has the second-highest rate of liver disease deaths in the entire country, with over 41 deaths per 100,000 people—almost double the national average. Childhood obesity rates are among the worst in England, meaning that many of our young people are already on the path to serious illness before they have even left school.

This is not about blaming people for their weight or lifestyle; it is about the world we live in—one where the cheapest food is often the least healthy, and where families in struggling communities have fewer choices and less support. Across England, people in the most deprived areas are more than six times as likely to die early from fatty liver disease. In parts of the north-west, people are dying 10 years younger than those in the wealthier areas. That is not right and it is not fair. Behind every statistic is a family torn apart.

Jamia and Stuart, in my constituency, were together for 35 years and cared for two disabled children. Stuart was fit and kind. When his stomach began to swell, he did not realise it was a warning sign. By the time he was diagnosed with fatty liver disease, it was too late. He passed away just eight weeks later. Their children still wake up at night looking for their dad. No family should go through that, but, tragically, they are not alone. The British Liver Trust has shared similar stories. Stephen, for example, was diagnosed far too late after years of missed opportunities for testing.

These stories are painful reminders that three quarters of people with cirrhosis are diagnosed only when they turn up at A&E, when it is often too late for treatment. We can change that. Early testing can save lives. Simple, painless scans, such as fibroscans, enhanced liver fibrosis testing, or the new intelligent liver function testing pathway, can spot liver damage long before the symptoms appear. Pilots of those tests have shown a 43% increase in early diagnosis and major savings for the NHS. Every community diagnostic centre, including the one on Whitegate Drive in Blackpool, should be able to offer those tests. Early diagnosis makes liver disease largely reversible and gives people the chance to act before it is too late.

We also need to tackle obesity at its roots, not by lecturing people but by making it easier to be healthy. That means fair prices for good food, limits on junk food advertising aimed at children, and continued action such as the soft drinks industry levy, which cut sugar content by nearly 30% across the market without hurting sales, and even reduced childhood obesity among girls in year 6. We need stronger measures to make the healthy choice the easy choice: reformulation of ultra-processed foods, a comprehensive 9 pm watershed on junk food advertising and a level playing field for businesses that want to do the right thing. Such structural changes, not finger pointing, can reshape the food system for good.

Finally, we must make sure that the NHS is ready for the new medicines that are coming. Medicines that target liver scarring directly and other treatments that improve weight loss and metabolic health could be transformative, but those new therapies, which could stop liver disease in its tracks, must be available on the NHS to everyone, not just to those who can pay privately. That means planning for workforce capacity, diagnostics and equitable access because if we fail to prepare, we risk widening the health inequalities that have already cost too many lives in towns such as mine.

Liver disease may be a silent killer but we do not have to stay silent about it. If we work together across parties, communities and the NHS we can stop this pandemic before it claims another life like Stuart’s. We can give families hope, and give our children the healthy future that they deserve.

10:12

[Ms Marie Rimmer (St Helens South and Whiston) (Lab)]

It is a pleasure to serve under your chairmanship again, Mr Efford. I thank my hon. Friend the Member for Worthing West (Dr Cooper) for securing this important debate. It is a pleasure to follow all the hon. Members who have spoken; we are all concerned about what is happening in our constituencies. This issue was brought to my attention by a constituent whose father had died—I will go into her human story later. After speaking to her in Portcullis House, I wrote to every practice in my constituency highlighting the facts of St Helens, in case they did not know them—and that is no disrespect to our medical professionals.

Before I go into some facts, I thank the British Liver Trust and the Foundation for Liver Research, which have worked closely to prepare a joint debate briefing for MPs. I also recognise the excellent work by the Foundation for Liver Research at the Roger Williams Institute of Liver Studies, which continues to drive world-leading research in metabolic liver disease to help to shape how it is diagnosed and treated.

Sadly, St Helens has the highest rate of deaths from liver disease in England, at 43.5 per 100,000, and the second-highest rate of deaths from fatty liver disease. The north of England consistently has the highest rates of liver disease and obesity, and premature mortality from liver disease is as much as six times higher than in the least deprived areas of the country. My constituency suffers at the knife-edge of this crisis: premature death rates from liver disease in St Helens were the worst in the country in 2023, at 43.5 per 100,000—double the England average of 21.9 per 100,000. Premature death rates from fatty liver disease in St Helens were twice the national rate, and the rate of overweight or obese year 6 children is 41.2%, which is markedly higher than the national average of 35.6%.

The NHS Cheshire and Merseyside integrated care board that covers my constituency has in place only a partial pathway for the early detection of liver disease, despite the north of England having the highest rates of death and hospitalisation from liver disease. As of 2023, it did not have a named person responsible for liver disease, and only Liverpool carries out proactive case-finding for patients at high risk of liver disease. The inconsistencies in care that face my constituents and many more people are played out across England, placing thousands of patients at high risk of developing serious liver outcomes.

I will turn now to the human impact of obesity and fatty liver disease, speaking on behalf of one of my constituents, Sara, the young lady I met with her widowed stepmum. They have asked me to speak out and share their story. Sara’s dad, Stephen, was diagnosed with type 2 diabetes in 2000 and told he had a fatty liver in 2014, but not to worry about it. He received a liver scan two years later, after which no further action was taken. It was only when Stephen was admitted to hospital in 2024, for an unrelated condition, that he was diagnosed with advanced fatty liver disease, and he sadly died from the disease a few weeks later, aged 62.

Sara said:

“I know everyone thinks their dad is amazing, but mine really, really was. He was a gentleman in every sense of the word and was so kind, loving and generous. To say we’re shocked, devastated and heartbroken at his death due to MASLD (metabolic dysfunction-associated steatotic liver disease) and HE (hepatic encephalopathy) is an understatement. He was just 62 and had so much to look forward to.

My dad Stephen wasn’t a drinker, but liked a sweet treat every now and then when he was diagnosed with type 2 diabetes in 2000. His diabetes was well managed and he didn’t need much in way of medication due to his healthy lifestyle. Dad especially loved cycling and walking in the Lake District. He did everything right, but it wasn’t enough.

In 2014 blood tests revealed deranged LFTs and in his annual diabetic reviews my dad was told he had an abnormal liver but not to worry about it. He was never referred to anyone and the only scan I can see in his medical notes was in 2016, then nothing.

In April 2023 he was feeling really lethargic which his doctors thought was an iron deficiency and prescribed tablets. He told my sister his blood results had come back fine, adding: ‘Nothing to worry about, love, I have a fatty liver, but I’ve always had a fatty liver’. By September Dad was quite withdrawn, forgetful, slurring his words, and kept going back to bed. The doctors were doing lots of tests and thought it might be something neurological like Parkinson’s Disease, but still weren’t looking at his liver. By December my dad was like a zombie and I thought could it be depression. If only we had known then that they were mild HE episodes.”

As Stephen’s family come to terms with their loss, his daughter Sara and widow Dorothy have been campaigning with the British Liver Trust to raise awareness of fatty liver disease and its causes, and the urgent need for early diagnosis and effective national liver care pathways. It is those two ladies who brought this issue to my attention. One of their key asks is as follows:

“We need assurance from government that the NHSE Liver Transformation Programme will be extended (as NHSE transition into Department of Health) and that the programme will be properly funded and resourced to ensure consistent care and early detection across England.”

I will add to that a request for ICBs to look at the illnesses in their area and focus their attention on their community and our constituents.

10:20

[Dr Danny Chambers (Winchester) (LD)]

It is a pleasure to serve under your chairmanship, Mr Efford. I thank the hon. Member for Worthing West (Dr Cooper) for securing this really important debate.

We have a lot of medical professionals in the room. It might surprise colleagues that, although I am a rudimentary vet, we treat fatty liver disease quite commonly in animals as well. It is most commonly seen in very large, fat cats that are really cuddly and people like to have on their lap. It is really common for them to get fatty liver disease if they stop eating, and it is genuinely very serious and takes intense treatment. The other time we see it commonly in animals is in cows that are in good body-weight condition, immediately after they give birth; often, they end up with hepatic lipidosis, which can be quite difficult to manage.

My first charity visit as an MP—it was the week after I was elected—was to the British Liver Trust in Winchester. I met Pam Healy, its chief executive officer, who is here today. It is a brilliant organisation. I thank everyone for all the briefings we were given; the hon. Member for Stroud (Dr Opher) mentioned how much he learned from them, despite being a trained GP. On that note, I know he is doing some social prescribing—when is the comedy show?

[Dr Opher]

It is on 20 November, with Jonathan Pie, and it is on investigating men’s health.

[Dr Chambers]

Fantastic. Hopefully it will improve people’s mental health—and if they leave halfway through, it will probably improve their physical health, too. That is a fantastic initiative.

Other Members have talked about the soaring rate of liver deaths, which has shot up in the last 20 years. The hon. Member for Worthing West talked about it costing the NHS £6.9 billion directly, and some studies show that it has cost the economy over £100 billion in other ways, such as from people being off work.

[Ben Coleman (Chelsea and Fulham) (Lab)]

I suggest to the hon. Member that one of the principal reasons that non-alcoholic fatty liver disease has shot up so radically in recent years is the increasing prevalence of food that is simply bad for people and is causing them damage—in particular, food that is high in fat, sugar and salt. For that reason, the Health and Social Care Committee, of which I am a member, is currently doing an inquiry on food. Does the hon. Member agree that the Government need to focus on making healthy food more affordable and accessible, and to tackle the advertising and marketing of so much of the unhealthy food that is out there?

[Dr Chambers]

I completely agree—that is hugely important. The sugar levy has been a huge success: between 2015 and 2019, the amount of sugar in soft drinks reduced by about a third, which reduced sugar intake in our collective diet by 48,000 tonnes. If we expect the Government to pay for people’s treatment when they are sick, as we rightly do, there is also an onus on them to help people to maintain their health. That is both a moral and an economic imperative.

It is often not noted that as well as the direct implications of obesity, diabetes and liver issues related to genetics and diet, there are also indirect costs that affect the NHS, such as the number of hip replacements and knee replacements, and other types of expensive and intense interventions that could probably be significantly avoided if we had healthier diets.

As we know, the issue with many liver problems is late diagnosis. The liver can take a huge amount of abuse in many forms until it stops functioning to the level at which it appears compromised. When symptoms are finally seen, there has often been sustained damage for quite a long period of time. The scanning that is done by the British Liver Trust and others—I encourage everyone to get their liver scanned when they come into Parliament—can pick up diseases such as fatty liver disease before the clinical symptoms are seen, which is absolutely key.

The UK ought to be one of the healthiest countries in the world, but we know we are not. Winchester is a relatively wealthy constituency, yet 54% of adults are overweight or obese, along with 27% of children. We are a country with a long history of world-leading medical research, grassroots sport and high-quality food production, yet over the last 14 years people have been becoming sicker for longer. That is multi-factorial, but it is in part due to the gradual erosion of public health funding by the previous Conservative Government.

The issue of improving health is multifaceted, and obesity is certainly an example of that. Factors such as poor mental health and the broken food system contribute towards the growing numbers of people who are overweight or obese. The hon. Member for Stroud talked about the importance of free school meals in helping to reduce childhood obesity, the hon. Member for Blackpool North and Fleetwood (Lorraine Beavers) talked about inequality and poverty levels, and the hon. Member for Bootle (Peter Dowd) highlighted the issues of different demographics and incomes. I spent seven very happy years in Liverpool and have very happy memories; ironically, my liver probably does not, as I was a student there for many years.

There has been a political failure. As has been said, over the past 30 years successive Governments have proposed more than 700 policies to tackle obesity, yet none has ever been successful. We have never had a coherent strategy. We cannot underestimate the scope that must be taken into account when discussing how we tackle obesity. We need to look at every intervention possible, including having a robust, well-supported food production system, ensuring that everyone can afford good-quality, locally produced food, and ensuring that we expand free school meals even further to help to keep children healthy.

The Tobacco and Vapes Bill is a really good example. When Chris Whitty gave evidence to the Bill Committee, he said not only that it was the biggest piece of public health legislation in 30 years, but that it is probably going to be the most significant piece of legislation to help to address inequalities, because smoking rates are one of the most significant reasons why there is such a difference in life expectancy between some of the more deprived postcodes and the wealthier ones. That type of intervention is not only good for health but really good for addressing inequality.

As other Members have said, we cannot tackle this problem without also ensuring that food is produced to high enough standards, that we have limits on junk food advertising, and that we force big food manufacturers to reduce salt and sugar in their products and have a much better labelling system, so that people can make more informed and affordable choices.

I am so impressed with the hon. Member for Strangford (Jim Shannon) for being able to lose 4 stone. I have put on the best part of a stone in the last 18 months, since I was elected, partly because of my increased food intake since I have been here and also because the strange hours mean that I lack time for exercise. I used to have a fairly active job, which I do not really have any more.

Yesterday I went to the Winchester Boxing Club, where a guy called Glyn Parkin gave me a really good workout—I can still feel it today. I did the Compton 10K and the Alresford 10K this year—both big fundraising 10-kilometre events. Despite trying to keep up my exercise, however, it is really hard if I am not focused on food, because about 80% of weight loss is due to diet. At best, perhaps 20% is down to exercise. I am aware that if I do not get on top of my weight, it will affect everything from knees to hips, and in some ways, exercise will become more difficult. If I end up with knee or hip pain, I will end up exercising less—and when I exercise less, I make worse dietary choices as well. We need to encourage people to stay healthy and keep exercising, but if we do not get the diet right, those two things are almost impossible to achieve.

I again thank the hon. Member for Worthing West for securing this hugely important debate, and I thank the British Liver Trust for all that it does. I encourage everyone to go and get scanned by the British Liver Trust when it next comes to Parliament.

10:31

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

It is a pleasure to serve under your chairmanship this morning, Mr Efford. I congratulate the hon. Member for Worthing West (Dr Cooper) on securing this important debate, and I thank the British Liver Trust and others who provided information and reading material in advance of today’s debate.

Fatty liver disease, as has been said, is often asymptomatic in its early stages. Even when symptoms do occur, they can initially be non-specific symptoms such as tiredness and feeling generally unwell. Initially, the fat deposits in the liver; in the next stage the fat causes inflammation, which causes metabolic dysfunction-associated steatohepatitis. It can then progress to fibrosis and then cirrhosis. As mentioned earlier, liver deaths have increased substantially in the last 50 years, but early detection can help to prevent them. What is the Minister doing to ensure that liver function tests and fibroscans are more available? Does she regret having to delay her workforce plan? Will that have an impact on the treatment of liver disease?

As many have said, fatty liver disease is caused by obesity. Two thirds of adults are now overweight or obese, but obesity starts in childhood. As an NHS consultant paediatrician, I have in my time seen a 12-year-old weighing 120 kg and a nine-year-old weighing over 90 kg—around three times the weight of an average nine-year-old. That has a serious cost in terms of life expectancy, taking three to 10 years off a person’s life. It also has an economic cost to the state of about £11.4 billion on the NHS, estimated at £75 billion per year when taking into account the wider economic factors.

We all know someone who has struggled with their weight and who has had huge success recently, including Members of this House who have talked about it in other debates, using Ozempic, Wegovy or Mounjaro. That is great, but do we want a future where a substantial proportion of the population are dependent on medication to maintain their weight?

[Ben Coleman]

If I may bring the hon. Member back to childhood obesity, does she agree that there is a serious problem with sugar being pumped into so much baby food? Does she therefore welcome what the Government have finally done after many years of the issue’s sitting unaddressed? They are giving the industry 18 months to take the sugar out of baby food and to stop marketing basically unhealthy products, which no one should buy, as healthy or healthier. Does she welcome what the Government are doing here?

[Dr Johnson]

I certainly think it is wise to ensure that people get off to a good start in infancy and that unhealthy products are not advertised as healthy if they are not, although the definition of healthy is somewhat elusive and difficult to pin down. It is also important that we do not routinely feed little babies under one high-sugar foods, although I do not want to see them fed artificial sweeteners, either. It is about making things less sweet, so the reformulation will need to be done carefully. That is my personal view.

Going back to the medications, we know they can be very helpful for some and can improve their health. They may be able to help with fatty liver disease as well, although they are not licensed yet. Can the Minister update us on when the Government expect applications to be approved and whether the NHS is ready to deliver for all eligible patients? We have heard about the prevalence and burden of the condition across the country and the number of people affected. What is she doing to ensure that the NHS is ready so that, when these drugs are licensed, it has the capacity, workforce and money to provide them?

We have seen that drug prices can change quite dramatically. In August, Eli Lilly announced a huge price increase for Mounjaro. What plans does the Minister have to guard against that? Will she update the House on negotiations on the voluntary scheme for branded medicines pricing and access?

We understand she is reviewing the National Institute for Health and Care Excellence quality threshold; when does she plan to reach a conclusion? We have seen investment in this country’s life sciences sector by companies such as Merck and AstraZeneca being withdrawn from the United Kingdom or paused due to the environment created by the Government. We need urgent action to support that sector. Will the Minister update the House on discussions she has had with industry and the Treasury on that?

Medications are part of the issue, but there are also surgical implications. Many people who have lost large quantities of weight require surgery for excess skin, which can cause further medical problems. What is the Minister doing to ensure there is an assessment of demand for post-weight loss surgery? Are surgeons and capacity available to deliver it where medically indicated?

As many have said, prevention is better than cure. We know that fewer than one in three people eat five portions of fruit and veg a day, and that that is falling. We also know that starting early is important and have talked about children and infants. What is the Minister doing to ensure that school food is healthy and good for children? What work is she doing with the Department for Education on food choices and preparation, particularly advice on food that can be made in advance or quickly? We know that many young people will become adults in households where there are two working parents, where one of the largest challenges is not just the money needed to buy food, but the time required after returning from work to prepare and deliver it to children before they do their homework and go to bed.

We have talked about reformulation. The soft drinks industry levy has reduced sugar per 100 ml by 47.4%, but I am concerned that is leading to an increase in artificial sweeteners rather than a reduction in the sweetness of the product, ultimately meaning that people are still hooked on the sweetness. What does the Minister think of that? Some hon. Members talked about the advertising ban on less healthy food. Will the Minister tell us why that has been delayed until next year?

Why have the Government added the brand exemption? Do they think the addition of the brand exemption will make it harder for new market entrants, compared with well established brands? If I whistled the short tune for one food brand—I will not—it would be immediately recognised, without further introduction. That would be more difficult for advertising new entrants to the market.

The 10-year plan talks about mandatory healthy food sales reporting. Will the Minister update us on what she defines as healthy? There are also mandatory targets on healthiness of sales. What does that mean and when will it be implemented? We understand there is a planned update to the nutrient profile. Some are concerned that the free sugars that that includes mean that items such as date paste will fall under unhealthy sugars. Will the Minister provide information on that? Has she made an assessment of the Conservative Government’s step of informing people by adding calories to menus? What effect has that had on consumption and food portion sizes in the restaurant sector?

Exercise is also important. We know that physical exercise strengthens joints, increases weight loss and helps in the reduction of diabetes, depression and dementia. The previous Government gave £1 billion to support the sports and leisure industry during the pandemic so that it could continue, and had a school sports action plan, guaranteeing at least two hours of PE and supporting after-school clubs.

The current Government have pledged £400 million for new sports facilities, but delivery of that money seems to be at a standstill. Will the Minister update us on that? Many grassroots sports facilities need that money. Will she also update the House on what the Government are doing to improve girls’ attendance in sports? We know that teenage girls in particular are not taking the advised amount of exercise.

In summary, we need an NHS pathway to detect liver disease in the early stages so that it can be treated; an NHS that is ready to deliver the new treatments that are becoming available; and action to tackle obesity to prevent liver disease in the first place. There has been an emphasis throughout the debate on what the Government can do to prevent obesity and on state culpability in that regard. It is important that people recognise that they have agency and do not need to wait for the Government to do something about this. People do not need to wait for the soft drinks industry levy or for changes to regulations. They have the agency to help themselves; they can do that.

[Ben Coleman]

Will the hon. Member accept that there is now a general body of opinion that it is time to stop blaming people for not having the willpower not to eat bad food when they are constantly bombarded with advertising and marketing? Some £6.4 billion a year will be spent by the food industry on advertising and marketing to people, and in many areas it is very difficult to get food that is both affordable and healthy. Is it not time to stop blaming people for being fat and to support them to tackle obesity in the ways that I and many of my hon. Friends here have described? Is it not time to stop sticking up for the food industry and to start sticking up for ordinary people?

[Dr Johnson]

I do not think it is sticking up for the food industry to suggest that people have agency over what they eat. I will give an example. I saw a very small patient—about five years old—who was very obese. I asked the mum what sort of things the child was being fed, and the answer was, “Well, Doctor, he eats lots of crisps all the time.” But there is a simple point there: where was he getting those crisps from? He was getting the crisps from the cupboard without asking, but the crisps did not get in the cupboard because the five-year-old put them there. It is a question of making sure that what is available is healthy and what is being fed to children is healthy.

I have seen even in the last few weeks patients who have low vitamin D levels, critically low vitamin B12 levels and critically low iron levels as a result of the diet that they are getting. It is not just a case of, “It’s all the Government’s fault. The state must make sure that everyone eats healthily.” People have a responsibility of their own as well. This is about working together.

There are wider policy impacts as well. The hon. Member for Chelsea and Fulham (Ben Coleman) talked about food pricing and food security. This Government want to cover Lincolnshire—the breadbasket of the UK, where a third of the country’s fruit and vegetables are produced—in glass solar panels. That is what his Government want to do, so there is a wider policy framework about food affordability. Food inflation is going up hugely under this Government, so they need to look in the mirror and see what they are doing to reduce food prices for people. We need to work together: it is a combination of what the Government can do and what the individual can do.

10:42

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Mr Efford. I congratulate my hon. Friend the Member for Worthing West (Dr Cooper) on securing the debate. We have veered quite a long way into the public health arena in the last while, but that demonstrates how important it is. I pay tribute to the expertise that my hon. Friend brings to this House and everything that she is doing to promote public health, including sharing the news about the winter flu vaccine—I will get that in while I am here, Mr Efford, because it is so important.

As has been said by many, including the resident GP on these Benches, my hon. Friend the Member for Stroud (Dr Opher), we have all learned from this debate. Well done to the British Liver Trust for its fantastic campaigning and briefing, which has clearly paid dividends. My hon. Friend the Member for Worthing West has given me the chance to update the House on the Government’s efforts to tackle the obesity crisis. I am here on behalf of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for West Lancashire (Ashley Dalton), who is responsible for public health, but this issue concerns us all. Many of us have been involved in this area for some time, and it is one of the defining public health challenges of our time.

We heard today some of the facts. Obesity is a major risk factor for both fatty liver disease and cardiovascular disease; there are common risk factors such as high blood pressure, high cholesterol and type 2 diabetes. Non-alcoholic fatty liver disease now affects about one in three adults in the UK. Prevalence has increased with the rise in obesity rates. Currently, almost two thirds of the adult population in England are overweight or obese, and almost 29%—almost 13 million people—are living with obesity. When children in England start school, just over one in five of them are overweight or obese, and that rises to more than one in three by the time they leave primary education. Children living with obesity are five times more likely than other children to live with obesity as adults.

We have heard that there are major inequalities in how obesity is distributed across the United Kingdom. That was highlighted brilliantly by my hon. Friend the Member for Bootle (Peter Dowd), and by my hon. Friend the Member for Blackpool North and Fleetwood (Lorraine Beavers), who talked about the loss of her constituent Stuart. My hon. Friend the Member for St Helens South and Whiston (Ms Rimmer) spoke eloquently for Sara and her stepmother Dorothy on their loss of Stephen, which brought home to all of us the real impact of this disease on people’s lives.

Kids in deprived areas are twice as likely to struggle with obesity as those in the least deprived, so this is an extremely serious matter. We are effectively hobbling the life chances of a little boy or girl before they have had a fair start. The Government cannot and will not look the other way as a generation of kids miss out on the best start in life. The points made by my hon. Friend the Member for Worthing West make sense, given that we both stood on a manifesto that committed to halve the gap in healthy life expectancy between the richest and poorest regions in England, and reverse the legacy left to us by the last Government. We share that goal. The question is: how do we get there?

On my hon. Friend’s calls for a liver strategy and a childhood obesity plan, our 10-year health plan sets out decisive action—we have heard about some of it in this debate—on prevention to tackle the obesity crisis head on and create a fairer, healthier food environment. We are looking at people as a whole: where they live, what services they need and how to prevent illnesses in their communities. That will help us to be better prepared for the changing nature of the disease and allow our services to focus more on the management of chronic long-term conditions. I will talk more about prevention later.

On my hon. Friend’s call to extend the levy model, we are taking steps to ensure that the soft drinks industry levy, which the Lib Dem spokesman, the hon. Member for Winchester (Dr Chambers), discussed eloquently and which colleagues know as a sugar tax, remains fit for purpose. On the request that my hon. Friend the Member for Worthing West made for an ICB pathway, we are working with partners including the British Liver Trust to raise awareness and address the stigma related to hazardous and harmful levels of alcohol use and viral hepatitis, which are key drivers of liver disease. We will continue to work with communities and help those most affected by liver disease through the community liver health checks programme.

[Peter Dowd]

This must be one of the safest places in the Palace, with at least three medics and a vet in the Chamber. My constituency has been designated a pride in place area. One of the aims of that programme is to create safer, healthier environments. Does my hon. Friend agree that there is a great opportunity in those areas, which include an area of her constituency, for funding to be used in a lateral way for local community initiatives such as those that have been highlighted during the debate? There is real opportunity for those initiatives to be tested out, with local people making local decisions.

[Karin Smyth]

My hon. Friend is absolutely right. The pride in place programme does just as it says on the tin, and it is important. The Government’s drive is to make sure that those communities, which know best what they need, are the drivers of how that is done. We will think laterally and bring together all that they know about why there is that level of deprivation in those communities. I know that, with his experience as chair of a primary care trust and as a local councillor, my hon. Friend is well placed to see what needs to happen for us to bring things together and think laterally. In my community, the legacy of the tobacco industry is the source of so much of the long-standing inequality.

The ICBs need to be tied into that community work and support it, and make sure that community health checks proactively identify people suitable for liver cancer surveillance. More widely, as my hon. Friend the Member for Stroud said, our shifts, and particularly the transfer to community and neighbourhood health, absolutely support that agenda. I know that hon. Members will make sure that that agenda is well delivered. This disease lends itself very much to that drive, which we are determined to make happen.

My hon. Friend the Member for Worthing West asked for us to be patient-ready for the next generation of liver disease medications. If my hon. Friend the Minister for Innovation, Lord Vallance, were here now, he would happily chew her ear off about everything that the Government are doing to ensure that the next generation of life sciences discovery is available to NHS patients. I will touch briefly on medicines later.

My hon. Friend also asked about local food partnership funding and action on food affordability. I cannot go into those points in detail here, but we absolutely recognise them, and we are working closely with my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs to develop DEFRA’s cross-Government food strategy to provide healthier and more easily accessible food, particularly in deprived areas. I encourage my hon. Friend to ensure that she is completely aligned with that agenda, as I am sure she is. We want to make that work. On her call to enforce the 9 pm watershed, I will update the House on where we are in delivering our manifesto commitments.

Prevention is clearly an important part of this work, and our manifesto specifically promised to restrict advertising of junk food to children, along with banning the sale of high-caffeine energy drinks to under-16s. We are consulting until 26 November on that ban, and the restrictions on junk-food advertising will take legal effect on 5 January. I thank the advertisers and broadcasters who are doing the sensible thing in getting ahead of the regulations by applying the restrictions already.

We have also restricted volume price promotions such as “buy one, get one free” on less healthy food and drinks, and given local councils stronger powers to block new fast-food outlets near schools. We will go further. Current promotion and advertising restrictions on less healthy food and drinks use an outdated nutrient profile model. That was formulated under the previous Labour Government, almost 20 years ago, because we also took this agenda seriously when we were last in government. We will update the standards that apply to the restrictions, and we will consult on their implementation in the coming year.

In a world first, as per our 10-year plan, by the end of this Parliament all large food businesses will be required to report against standardised metrics on sales of healthier food. That means that the large food companies will have to tell us regularly how healthy the food they are selling is, and whether that is improving. That will set full transparency and accountability around the food that businesses are selling, and it will encourage healthier products. We will also set new targets to increase the healthiness of food sales in all communities. Finally, with regard to liver disease, we are exploring innovative approaches to early detection, such as intelligent liver-function testing, to reach more people at a stage when liver damage can better be reversed.

Our focus is prevention—we have the shining example of the hon. Member for Strangford (Jim Shannon)—but we do need to treat the millions of people who already live with obesity in the UK, so let me say what we are doing for them. First, we are building relationships with the biggest pharmaceutical companies to expand access to weight-loss services and treatments across the NHS.

Secondly, obesity drugs can be game changers in supporting weight loss, and we are entering what could be a golden age for obesity drugs, with many more in the pipeline. Over the summer, the NHS started its roll-out of the weight-loss injection Mounjaro through GPs. About 220,000 people, prioritised by clinical need, are expected to receive Mounjaro on the NHS over the next three years.

Thirdly, our obesity pathway innovation programme, supported by industry, is testing new ways of delivering that care, including through pharmacy-led services in the community and through digital services—again, part of our shifts. We recognise that these drugs are not a replacement for good diet and exercise, as exemplified by the hon. Member for Winchester, and they are not the first thing for patients or the NHS to try. That is why we have committed to doubling the number of people who can access the NHS digital weight-management programme.

On hospital to home, we are providing treatment options for children by shifting care from hospital to community. That comes back to the point made by my hon. Friend the Member for Worthing West about the left shift. Earlier this year, the Government announced that we would support thousands of severely obese children to lose weight and live healthier lifestyles, thanks to the roll-out of specialist NHS clinics and new digital smart technology to deliver expert care at home. That game-changing tool is helping our specialists support and keep track of children’s weight-loss programmes, without those children needing to leave home, while offering regular advice to them and their parents to help build healthier habits.

I have set out how the Government are tackling the obesity crisis head on, especially when it comes to safeguarding our children’s future, but while we are shifting the focus of our NHS to prevention, we are also doing more to help people who are already affected by obesity and fatty liver disease, especially through medicines and new technologies and by shifting care from hospital to home. We remember that we stood on a manifesto that committed to tackle the root causes of ill health and to close the gap between the richest and the most deprived areas. That is exactly what we are focusing on through our 10-year health plan. This Government will not sit by and let ill children become ill adults—not on our watch. I thank my hon. Friend the Member for Worthing West for securing this debate.

10:54

[Dr Cooper]

Thank you, Mr Efford, for chairing the debate this morning. I thank the Minister for her excellent remarks, and all the parliamentary colleagues who have taken the time to be here. I thank the British Liver Trust and everybody who came to hear the debate. I hope they found it edifying and useful.

I have no particular further remarks; I think most points have been covered. There is a lot of work to do. As has been said, 90% of liver disease is preventable. That is a serious amount of disease that we do not need to face in this country, which is incredibly important to remember.

Our obesogenic environment—my hon. Friend the Member for Chelsea and Fulham (Ben Coleman) told me to say that slowly; it basically means it is hard for us to do healthy things and keep well—encourages us, consciously and subconsciously, to do things that are not great for our bodies. The Opposition spokesperson, the hon. Member for Sleaford and North Hykeham (Dr Johnson), said that we have agency. Of course we do, but we are humans in an environment that is telling us all sorts of things all the time. Our job as parliamentarians, as representatives of our residents, as members of the party that is governing the country, is to make sure that the messages and signals that we send, and the legislation that we pass, encourage a healthy environment for our residents to live in. Within that healthy environment, people can make their own choices.

To those who accuse me and other public health consultants of being part of a nanny state, I say, frankly, the nanny we have in this state right now is not a great nanny. It is one that allows us to eat things that make us ill, that encourages us to not exercise, that makes our children sick and that means we die earlier than we need to. I do not want to live in a nanny state, but I do want to live in a healthy environment that allows our children to live well and allows all of us to live the lives that we want to lead—one that makes the healthy choice the easy choice, the affordable choice and the normal choice, and one where, if we want to do things that make us ill, we really have to try hard. I thank everybody for their time today.

Question put and agreed to.

Resolved,

That this House has considered obesity and fatty liver disease.

10:57

Sitting suspended.

Family Farming in Northern Ireland

Tuesday 28th October 2025 Westminster Hall

11:00

[Carla Lockhart (Upper Bann) (DUP)]

I beg to move,

That this House has considered the impact of agricultural property relief and business property relief on family farming in Northern Ireland.

It is a pleasure to serve under your chairmanship, Mr Efford. I am very grateful for the opportunity to bring forward this debate on an issue that cuts right to the heart of rural Northern Ireland and indeed Britain.

The proposed changes to agricultural property relief and business property relief will have devastating consequences for family farms across our nation. Agriculture is not just another sector in our economy; for Northern Ireland it is our very foundation. It sustains our rural communities, feeds over 10 million people annually, underpins our agrifood industry and provides work for tens of thousands of families. I make no apology for repeating a comment that I have made previously, and that my grandfather tells me every Sunday at the dinner table: if the farmer is not doing well in this country, no one is.

In Northern Ireland we have over 26,000 farms. They form the backbone of our rural life—

[Jim Shannon (Strangford) (DUP)]

I commend my hon. Friend for that point. She is absolutely right to underline the impact on family farms of the Chancellor’s proposals. In tandem with decisions being made by the Department of Agriculture, Environment and Rural Affairs Minister in Northern Ireland, they will leave many farmers feeling that their generational family farms have no future. My hon. Friend will probably have seen “Countryfile” on Sunday. It highlighted two things for farmers: first, the mental health impact and that there have been suicides; secondly, the generational loss of the farms. If farms are not working, they are not viable, do not produce the food and the impact is great. The Government really need to sit down, take account of where we are and change the decision.

[Carla Lockhart]

I thank my hon. Friend for his consistent voice on this issue. I will come to “Countryfile” later in my speech.

The vast majority of our farms in Northern Ireland are family run, often handed down proudly through several generations. The farm is not just a business: it is a home, a heritage and a legacy. That is why any policy that affects how farms are passed on to the next generation goes to the very core of who we are as rural people. For many families, the dream is simple: to see the next generation take over, work the same land and continue the proud tradition of stewardship. The reality of that dream is now under threat like never before.

Agricultural property relief has existed for a reason. It recognises that farming is asset-rich but cash-poor, or as we would say in Northern Ireland, “We are asset-rich but penny-poor.” A farm may be worth millions on paper, but that value is tied up in land, livestock, machinery, buildings and—most concerningly for many farmers—debt. Farmers spend money and they thrive in advancing. But for what—when they see what this Government are doing to them?

[Robbie Moore (Keighley and Ilkley) (Con)]

With over 26,000 farms in Northern Ireland, the value of farmland is incredibly high, if not higher, than in any other part of the United Kingdom. Does the hon. Lady agree that the negative impacts of changes to APR and BPR on Northern Ireland farmland will be much higher for those farming families than anywhere else across the United Kingdom?

[Carla Lockhart]

I agree with the hon. Member. I thank him for using his intervention to speak up for Northern Ireland farmers, because they will be hard hit because of the land values.

When a farmer dies, there is not the liquid cash available to meet a large inheritance tax bill. That is precisely why successive Governments introduced and retained APR, so that farms would not have to be sold off bit by bit, just to pay the tax man. It was a recognition that the nation needs farms to continue and not be broken up at the point of succession. The change is being dressed up as modernisation or rebalancing, but in reality it is an attack on the very concept of family farming. I am pleased to say that colleagues from every party in Northern Ireland have been absolutely united in our opposition to the policy.

[Gavin Robinson (Belfast East) (DUP)]

rose—

[Jim Allister (North Antrim) (TUV)]

Does the hon. Lady agree that although the Government say that the effect of the inheritance tax on farms will be pro-growth, it will actually be anti-growth? In order to prepare for the day when a huge tax bill will have to be met, rather than investing in growing their enterprise, farmers are holding back so that they can hopefully make some contribution towards the exorbitant demands that are made upon death.

[Carla Lockhart]

The hon. and learned Member is right; the policy is stifling growth. As I have said before, farmers want to advance and grow, and they want to spend money.

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

The hon. Lady is making an important point. To follow up on the previous intervention, I wonder whether she has noticed in Northern Ireland, as I have in Cumbria, that farmers are holding money back. If they need a drystone wall fixing, they are not paying for that. If they need a new tractor, they are not investing in it. If they need to upgrade a barn for animal welfare purposes, they are not doing it. The policy is damaging not only farms but the rural communities that service those farms, and, as the hon. and learned Member for North Antrim (Jim Allister) said, constricting growth.

[Carla Lockhart]

I agree with the hon. Member. I need to give way to the leader of my party at this point.

[Gavin Robinson]

I congratulate my hon. Friend on securing this debate. It is quite right that she took the last two interventions because she was talking about cross-party support for Northern Ireland farms. She is blessed to have a constituency with some of the most fertile and therefore valuable agricultural land in Northern Ireland, with an average of around £30,000 per acre. Although there may be a policy intention in relation to the industrialisation of farms or people shielding their wealth through farms, would she like the Government to recognise that that is not the case in Northern Ireland, and even a small family holding of 30 acres could get caught by the policy change?

[Carla Lockhart]

Absolutely. It does not take much arithmetic to work out the facts of that scenario.

In a recent joint letter to the Chancellor, signed by all MPs and peers from Northern Ireland, we set out a clear position:

“Agriculture is not simply an economic sector; it is a way of life. The removal or restriction of Agricultural Property Relief will place an unfair and unsustainable burden on family farms, jeopardising their ability to pass on their farms to the next generation and threatening the future of family farming.”

Those are not my words alone. They are the voices of rural Northern Ireland, speaking in unison in the House today.

[Robin Swann (South Antrim) (UUP)]

I congratulate the hon. Member on securing a debate that focuses specifically on Northern Ireland. Does she agree that what the Treasury and the Government have missed in the proposal is the unique nature of farms in Northern Ireland, where 99% are actually family owned? Even that promise of the opportunity to spread the tax bill over 10 years restricts families who want to invest in their farms, and puts pressure on not only the older generation who are concerned about the farm they are leaving, but the younger generation who are looking to the future.

[Carla Lockhart]

I agree with the hon. Member.

According to an estimate from the Department of Agriculture, Environment and Rural Affairs in Northern Ireland, the policy will impact a third of all farms and three quarters of dairy farms. Think about that for a moment. Three quarters of our dairy farms—the heart of our agrifood export industry—could be hit by a tax change that would make succession financially impossible.

The knock-on effects will be vast. Meat factories will face reduced throughput and rising costs, forcing scale-back and possibly relocation. Feed and supply companies will see demand collapse, threatening jobs and investment. It is not just farms that will be hit, and this is not a matter of large estates or wealthy landowners. The average Northern Ireland farm is about 40 hectares. Land values in some counties, including my own, are in excess of £30,000 per acre. It does not take much arithmetic to see that many modest family farms would easily surpass the £1 million threshold.

[Ben Goldsborough (South Norfolk) (Lab)]

The hon. Lady is making an extremely good point about the impact on Northern Irish farms, and a similar thing will happen in South Norfolk. I would like to present solutions to this problem. I posit—and she may want to comment on this later on—that the Centre for Tax Reform’s policy would actually raise the amount of income for the Treasury by 71%. I also encourage the hon. Lady to look at separating APR and BPR, pausing the process and looking at whether we can raise revenues and protect the family farm.

[Carla Lockhart]

I commend the Member for the stand he is taking and for encouraging the Minister in this way. We are not talking about millionaires; we are talking about hard-working family farmers who live modestly and work from dawn to dusk to feed us all. If these proposals proceed, we will inevitably see forced sales of land simply to pay the tax liability when a family member dies. That means the fragmentation of farms, the loss of viable holdings and the disappearance of many small-to-medium sized family farms.

The Government talk about a fair and balanced approach, but what about the 80-year-old who has not got time to plan? Did my brother think my dad would pass away at age 66? Absolutely not. Does a family think they are going to lose a son or a daughter at age 40, 41 or 42? They do not.

This will deter young farmers from taking on the responsibility of a business that leaves them saddled with debt before they have even begun. We cannot afford to drive the next generation away from farming. Once that chain of succession is broken, it is almost impossible to restore.

This debate is not just about fairness for rural families: it is about food security, which is a matter of national importance. We have learned through recent global shocks—the pandemic, supply-chain disruption and now inflationary pressures—that domestic food production is essential. To undermine family farming through ill-judged taxation would be a profound mistake that this Government will rue. Certainly, rural MPs will rue it in the days and weeks to come. It would make us more dependent on imports and less resilient to crisis, while sending a terrible message to those who feed our nation.

The policy is being advanced in the name of fairness, but there is nothing fair about it. Farming families have worked their land for generations, paid their taxes and cared for the countryside. They are not speculators; they are custodians. APR is not, as it is presented in public discourse, a loophole; it is a lifeline that allows farms to pass from parent to child without having to be broken apart. To impose a new tax burden at the point of bereavement is not reform; it is punishment for choosing to farm.

Let us be clear: the yield from this policy—even in Treasury terms—would be marginal compared to the cost it would impose on rural communities and the wider economy. In short, it is bad economics and bad morality. Across Northern Ireland, opposition to this proposal is widespread and heartfelt. From the Ulster Farmers’ Union, who are here today, the National Sheep Association and the Dairy Council to the agrifood processors, the message is the same—this change must be reconsidered.

At rallies and meetings across my constituency and beyond, farmers have told me they feel under siege, squeezed by rising costs, regulatory pressures and now this looming tax threat. They want the Government to work with them, and not against them, which is why I have described this policy as a “farm tax heist”. That is how it feels to those who have given their lives to feeding our people.

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

Does my hon. Friend agree that the Government need to understand that Northern Ireland represents around 3% of the population of the UK, but produces a multiple of that in terms of food produce for the rest of the United Kingdom? If that was recognised, there might be more recognition in terms of what she is trying to achieve through this debate.

[Carla Lockhart]

I thank my hon. Friend for his comments, and I wholeheartedly agree. I urge the Treasury and the Department for Environment, Food and Rural Affairs to pause, and engage in genuine consultation with the farming community. Sit with us and talk to us. They have refused every meeting request.

We need a review that recognises the unique structures of Northern Ireland farming, made up of predominantly family-run farms and regional variations. Many suggestions have been made that are worth exploration, including in the latest Centre for the Analysis of Taxation report, as has been noted. I am not saying that it is a silver bullet, but we should sit down, talk about it and start to engage in the conversation.

At its heart, this debate is about how we as a society value those who feed us. We speak often in this House about sustainability and food strategy, but sustainability begins with sustaining the people who produce our food. We cannot say we care about the environment and rural life on one hand and on the other make policies that threaten to strip families of the land they have cared for over generations. I say to the Exchequer Secretary, with the full force of rural Northern Ireland behind me: think again. Listen to the voices of those who know the land and who understand the realities of farming life. Do not create a policy that will devastate small family farms in pursuit of a marginal tax return. Agriculture is a national asset, not a target for revenue generation.

The changes to agriculture property relief are not reform. They are an attack on our family farming. They form part of a wider Labour agenda that is anti-rural, anti-farmer and anti-common sense. That is how it is seen out in rural Britain, and it is somewhat similar to the direction of travel of our own Agriculture, Environment and Rural Affairs Minister in Northern Ireland. While our producers face rising costs and red tape, Labour’s response is more tax and more barriers. Their net zero plans are driving good farmland out of production and into solar panels and their planning rules are choking rural life and pushing young families off the land.

On national TV this week, the reality was laid bare. I can still see Charles Rees in my mind as he said

“if something doesn’t change by next April I’d probably top myself.”

If that does not send a shiver down every spine in this place today, we are not in touch with the public. I ask Labour to stop, halt, talk to us, engage, get it right. Do not go on this collision course. I urge the Government to scrap this farm tax and rethink.

11:16

[The Exchequer Secretary to the Treasury (Dan Tomlinson)]

It is a pleasure to serve under your chairmanship, Mr Efford, for my first time speaking from this position in this fantastic Westminster Hall. I congratulate the hon. Member for Upper Bann (Carla Lockhart) on securing the debate, and she spoke with passion and with personal insight from her own family farming background. She spoke clearly about the impact on jobs and employment and on communal life in Northern Ireland, about how essential farmers are to so many of the villages, towns and communities in Northern Ireland and across the whole country, and of course about the importance of farming to family life.

The decision to reform agricultural property relief and business property relief from next April was not one the Government took lightly. Over the past 12 months, the Government have listened to the concerns of the hon. Member for Upper Bann, of other hon. Members and of external organisations. The Government and I recognise the strength of feeling on this topic in Northern Ireland and elsewhere across the country. But having listened and discussed the question with a range of stakeholders, the Government believe that the approach set out at the Budget last year is the appropriate one.

I recognise and deeply respect the contribution that small businesses and farms make to the economy in Northern Ireland and across the United Kingdom, but I and the Government also recognise the need to restore economic stability, fix our public finances and contribute to funding our public services. As well as all this, we need to make sure we raise taxes in a way that is fair for all of us.

[Tim Farron]

Will the Minister take a look at the University of Cumbria report that shows that upland farmers in all four corners of the United Kingdom will, at the end of the transition, will be earning only on average 55% of the national minimum wage—barely half the living wage? Those are the same farms, often worth £2 million or £3 million on paper, that may have to spend £20,000 a year to pay off the tax. How does he think that is fair and how does it raise money for the Government coffers in a sustainable way?

[Dan Tomlinson]

I will happily look at any report any Member recommends I read, so I encourage the hon. Gentleman to send it my way.

Since we took office, the Government have taken a range of decisions to seek to restore economic stability and raise revenue to help support our public services, because it was vital to attempt to sort out the mess we inherited, so that we can invest again in the future. The decision to reform APR and BPR was one of the decisions that enabled us to do that.

Under the current system, the 100% relief on business and agricultural assets is heavily skewed towards the very wealthiest estates. According to data from His Majesty’s Revenue and Customs for 2021-22, almost half of agricultural property relief across the UK—40%—was claimed by just 7% of the estates that made claims. That is £219 million in tax foregone from just over 100 estates.

It is a similar picture for business property relief, which is linked and is treated in the same way under the reforms, with more than 50% of business property relief claimed by just 4% of estates. That is £558 million in tax foregone from just 158 estates. That contributes to the very largest estates paying much lower tax rates than smaller estates and everyday people up and down the country.

[Jim Allister]

In that context, does the CenTax report not make evident sense? If we impose the full-blooded inheritance tax on the top end—on those above £10 million—are we not reaping the same tax return, while at the same time not punishing and driving out of existence those at the bottom end? Is that not logical, and is that not right?

[Dan Tomlinson]

The hon. and learned Member raises the CenTax report, and it is worth noting some points about the analysis in that report. First, the Government have consistently said that around 520 farms would be paying additional inheritance tax as a result of the reforms announced at the Budget last year.

Members from all parties have been turning to the CenTax report as an independent analysis of the Government’s reforms. That report agrees with us on the number of farms that will be affected. That independent analysis conducted separately from the Government comes out with the same conclusion on the number of farms that will be affected and it says that its proposal—the minimum share proposal, which the hon. and learned Member for North Antrim mentions—would more than double the number of estates that would pay additional inheritance tax. I do not think the right way forward is to have the number of estates that would be affected increase from about 500 to, I think, about 1,200. I have looked at the report, which has been raised by Members from all parties, but I do not think it is the silver bullet that others have concluded it could be.

The context I just set out is why we are changing how we target agricultural property relief and business property relief from April next year. We are doing so in a way that maintains a significant relief for estates, including smaller farms and businesses. Individuals will still get 100% relief for the first £1 million of combined business and agricultural assets. I know that Members know this, but it is worth setting out the position again. On top of that amount, there will be a 50% relief. That means that inheritance tax will be paid at a rate of up to 20% rather than the standard 40%.

[Robbie Moore]

A £1 million threshold is nothing when we take into account the value of farmland, a cottage, a farmhouse, growing crops, stocks in store, livestock and machinery valuations—all of which will be taken into account at the valuation of an estate on death. A £1 million threshold is nothing before a 20% IHT liability is put on that estate. I urge the Minister to look at this again. Farmland values are significantly higher in Northern Ireland, and I reiterate my point that Northern Ireland farmers will see a greater impact from the £1 million threshold.

[Dan Tomlinson]

I do not agree that £1 million is nothing. It is a significant increase and a significantly higher threshold than that for anyone who does not have access to APR or BPR. I understand the point about land values in Northern Ireland, but at the same time, as far as I am aware, farms in Northern Ireland are smaller than those elsewhere. It is also worth bearing in mind that the £1 million relief comes on top of the spousal exemptions and nil-rate bands, so, depending on individual circumstance, up to £3 million can be passed on by two people, free of inheritance tax, and, as has been mentioned, the payment can be spread over 10 years, interest free. That policy design is not seen anywhere else in the inheritance tax system.

[Carla Lockhart]

The Minister is certainly sticking to the script, but can he give us even an opening through the door of the Treasury? Will he open that door and speak with the farming unions across the nation?

[Dan Tomlinson]

I thank the hon. Lady for that intervention and hope that today we have been able to have that open and public discussion to share the different views on this policy. I would be happy to continue the discussion with her and others who think that the issue is important. Just last week, I made sure to speak to individual farmers to understand their perspectives on the policy. I will continue to engage with people who will be affected by the changes, and with Members in this place. I hope that we can continue those conversations across the aisle.

Let me make progress—I can see the time is slipping away from us. Overall, the reforms are expected to result in up to around 520 estates claiming UK agricultural property relief, including those also claiming BPR, paying more inheritance tax in 2026-27. Almost three quarters of such estates will not pay any more tax as a result of the changes, based on the data. As I have already mentioned, CenTax has looked at the Government’s figures and has reached a similar conclusion. Its work concludes that of the estates that are affected, half will see an increase in their effective inheritance tax rate of less than 5 percentage points, and 86% of those estates could pay their entire inheritance tax bill out of non-farm assets.

[Ben Goldsborough]

I congratulate the Minister on his first appearance in Westminster Hall. My question is about that 5 percentage point change. This year has been a terrible year for yields, especially in South Norfolk with the droughts. That hits the profitability of farming, which is non-existent—there is not enough profitability in farming. Will the Minister share what investigations the Treasury has done on that fluctuation in profitability and the ability of our farmers to pay the 5 percentage point increase he mentioned?

[Dan Tomlinson]

The figures that I raised were from research carried out by an independent organisation, CenTax. Profitability and incomes change from year to year, of course, and can change for different types of farms—we can see that beef prices, for example, are higher this year than they have been in the past, and the Government are aware of that.

Overall, we understand that the reforms to inheritance tax generate strong views from Members from Northern Ireland and from all over the country, who are here to represent their constituents. I understand that, and I respect and admire the work of Members on both sides of the House in bringing their residents’ concerns to this place.

I know that the questions about inheritance and family businesses are deeply personal, and I do not pretend that such changes are not difficult, but I believe that the reforms get the balance right between supporting farms and businesses and funding our public services. They mean that assets will be taxed at a lower rate than most others, and, in this tough context, I think that the Government have made the right decision. I thank the hon. Member for Upper Bann again, as well as all the Members who have intervened today.

Question put and agreed to.

11:29

Sitting suspended.

Connected and Automated Vehicles

Tuesday 28th October 2025 Westminster Hall

[Valerie Vaz in the Chair]

14:30

[Sarah Coombes (West Bromwich) (Lab)]

I beg to move,

That this House has considered connected and automated vehicles.

It is a pleasure to serve under your chairmanship, Ms Vaz. Yesterday, I jumped in a car with a couple of other people near King’s Cross station. It was a pretty normal journey. We watched the world go by, chatted and got stuck in a bit of traffic. The journey was completely ordinary, except for one thing: the car was driving itself. That 20-minute journey represents the future of what our roads could look like, which is why I am pleased to be leading today’s debate. I originally applied for this debate for reasons related to road safety. I have met too many families in my constituency who have lost a husband or a mother through other people’s dangerous driving. I am fascinated by how automation and technology could help us to eradicate road danger and death, but getting deeper into this topic, my speech will focus on not only safety but accessibility and economic growth.

Turning first to safety, in the UK, 30,000 people are killed or seriously injured on our roads each year. If we speak to the police, they will say that most deadly crashes are caused by the “fatal five”—speeding, drink and drug driving, mobile phone use, antisocial driving, and not wearing a seatbelt. I do not need to be a machine learning expert to know that automated vehicles, trained by safe, expert drivers and programmed to comply with the strict rules of the road, could avoid all five of those issues and the needless death they cause. A self-driving car is not going to be drunk, high or scrolling through TikTok. During the passage of the Automated Vehicles Act 2024, the last Government rightly put safety at the heart of the regulation, stating that a self-driving vehicle should be at least as safe as a competent and careful driver. There are still some questions about what exactly that means.

In the US, where the roll-out of autonomous vehicles and robotaxis is far ahead of here, the safety statistics on automated versus human-driven vehicles look impressive. Waymo, the Google-owned company that runs self-driving taxis there, claims that its vehicles have 80% fewer injury-causing crashes compared with the average human driver, but within the human average there will be drivers who are neither careful nor competent, so these figures are quite hard to compare. What progress has the Minister made on expanding the safety expectations for automated and connected vehicles, and what is the timeline on the remaining regulations that need to be set out? Furthermore, what do the Government hope the safety gains from automated vehicles could be?

Proving the reliability and safety of automated vehicles is essential for public acceptance of this new technology. Lots of people might feel reticent to get in a self-driving car because they do not feel safe, but I found my own experience yesterday in a Wayve autonomous vehicle reassuring. During the journey, we had cyclists jumping red lights, pedestrians walking out on to the road and other drivers cutting across our right of way. The car dealt with it all. The whole journey felt safe and smooth the whole time. Some critics say that these cars cannot handle British roundabouts because they were made for American grid cities. I can confirm that the Wayve car handled the roundabouts with ease. We had a safety driver sat ready to take the wheel if any issues arose, but none did.

Other areas of safety are important to mention too. In a world where cyber-attacks are becoming more common and more devastating, there is a fear that fully connected and autonomous vehicles could be hacked. Could the Minister say more about that and the protections that are being put in place? Another key element is data sharing, particularly in the event of a collision involving cars that are either fully automated or have advanced autopilot systems. The latter is where a vehicle can steer itself, but drivers must keep their eyes on the road, ready to assume control if needed.

Many of these driver-assist functions are important safety enhancers, and these functions, including things such as lane assist, should not be so easily turned off. However, in other countries, there have been examples of cars in self-driving modes where collisions have occurred, and companies have refused to share all the data with families and authorities. Is the Minister confident that we will not have the same issue here?

My personal campaign this year has been to address the wild west that is the British number plate regulation system. The traditional number plate, as the public identifier or passport of a vehicle, has been mandatory since the Motor Car Act 1903, but they are still as important as ever—even more so for determining ownership in the era of driverless cars. Can the Minister, who is in charge of the Driver and Vehicle Licensing Agency, reassure me that he is looking at the gaping holes in regulation of number plates and the sale of vast numbers of illegal ghost and cloned plates?

[Rachael Maskell (York Central) (Ind)]

I am grateful to the hon. Member for looking into this subject. It is something we all have to learn a lot about. The University of York has the Institute for Safe Autonomy, which is really interested in how the Government will monitor the initial pilots of this scheme, and how lessons will be learned and then, of course, fed into the regulator. Does she believe that we need to have a proper framework for how we do that data collection before the roll-out of such a programme?

[Sarah Coombes]

Definitely. Safety has to be paramount. Britain is a leader in universities and institutes such as the Institute for Safe Autonomy, to ensure that as this new technology rolls out, it is safe and has public confidence.

On accessibility, 30% of my constituents in West Bromwich do not have a car; they rely on buses, bikes, trams, trains, taxis, lifts and legs. We also have bad congestion problems. We do not want to see that made worse by a massive increase in vehicles on our roads. The dream is that autonomous vehicles could help us on both counts if we shape the future right. The Royal National Institute of Blind People has welcomed Waymo coming to London, saying that it will give those with visual impairments more scope for independent and spontaneous travel. Transport for West Midlands is interested in how we could integrate autonomous technology with our public transport system. How could we use driverless cars to fill in the gaps that buses and trains do not reach?

I keep thinking about the possibilities of an automated dial-a-ride service—larger, disabled-accessible autonomous vehicles that can be ordered easily and work out optimum routes to drop off passengers. The staff on existing services offer valuable support and care to passengers with additional needs. This is not about replacing them; it is about adding extra capacity.

[Dan Aldridge (Weston-super-Mare) (Lab)]

The success of automated and autonomous vehicles will depend on infrastructure—not just roads but connectivity, data and mapping systems—but if the infrastructure is upgraded only in big cities, we will have a two-tier system and leave behind towns such as Weston-super-Mare. Does my hon. Friend agree that this should be a national project that supports innovation and, importantly, accessibility across the whole country, with a special focus on coastal communities and city centres?

[Sarah Coombes]

I absolutely agree that the infrastructure needs to be in place and the benefits of autonomous vehicles need to be felt across the whole country—in coastal areas, but also in urban areas and towns, such as those that I represent.

Car clubs have never reached their full potential in the UK—I think that is because of the cost and lack of density of vehicles—but if people could order an AV to their home and it was cost-effective, safe and reliable, I can see a world in which families do not necessarily need a second car, or perhaps a car at all. What plans do the Government have to harness the power of autonomous vehicles to complement, rather than replace, public transport and how could we use it to fill in the gaps?

The main issue that I want to talk about is growth and the potential benefits that technology and automation on our roads could bring to the UK economy. The Government estimate that the automated car industry could add £42 billion to the UK economy by 2035, not least through 38,000 new jobs. This is a difficult topic because I know that many people who drive for a living are worried about potentially losing their jobs as a result of self-driving vehicles.

[Tulip Siddiq (Hampstead and Highgate) (Lab)]

Even though my hon. Friend’s constituency and mine are very different, the car industry is also critical to the livelihoods of constituents in Hampstead and Highgate. Recently I have had a huge number of emails from local cab drivers who are facing severe delays when it comes to renewing their driving licence, which obviously impacts their financial security. Could my hon. Friend comment on the fact that it is of course important to create the jobs of tomorrow, but it is also important to protect the jobs of today?

[Sarah Coombes]

Absolutely. I represent many professional drivers myself, so I completely agree about the importance of the current systems working for them, as well as future systems working. I want to be clear about this. Given that full vehicle automation is decades away, I hope that we can provide reassurance that mass redundancy of drivers is not around the corner. People who drive for a living do much more than an automated vehicle could do, whether that is by supporting vulnerable passengers, protecting freight as a heavy goods vehicle driver or managing antisocial behaviour on bus services.

[Edward Morello (West Dorset) (LD)]

Many moons ago, I was listening to a futurologist on the radio, a job that seems to involve mainly sitting on beanbags. He was talking about autonomous vehicles and was asked, “Is there anything that you think people should be thinking about on autonomous vehicles?” He said, “We’ve got to get used to the idea that grandma is going to turn up dead, because right now when you have a medical emergency, whether it be in a taxi or in a car, you’ll crash the car and get some kind of medical intervention as a result of that, but with autonomous vehicles, grandma will unfortunately arrive back at the house.” When we talk about the importance of cab drivers or vehicle-led driving, we also need to think about the unintended consequences of automated vehicles.

[Sarah Coombes]

It is absolutely about creating a safe system for the future. If AVs are involved in an incident, will they be able to get to hospital? All those questions have to be talked about, as we begin to see fully driverless vehicles on our roads.

One person who has benefited from new employment in the AV industry is our safety driver at Wayve yesterday. He told me how thrilled he was to have secured a job there. He spends at least six hours a day training and testing their cars around the streets of London, having formerly worked as a delivery driver.

[Rosie Wrighting (Kettering) (Lab)]

My hon. Friend is making an excellent speech. Northamptonshire has the skills, location and ambition to play a massive part, with our logistic sector being right next to Milton Keynes, which is already testing these vehicles. Does she agree that we are perfectly placed to be part of the growth she talks about?

[Sarah Coombes]

I agree that exciting pilots are going on. I am sure Kettering and many other parts of the country could benefit. Wayve is an example of a company leading the way in helping the UK to become a global leader in this technology. Although the company was founded out of the University of Cambridge and is now based in King’s Cross, there is an unmissable opportunity for industry up and down the country. My own region of the west midlands is an automotive manufacturing heartland. Jaguar Land Rover produces the Jaguar I-PACE, the vehicle used by Waymo robotaxis. Some of the factories in my constituency make parts for Nissan, which has announced a partnership with Wayve for new AI driver software.

[Dan Aldridge]

As my hon. Friend mentioned JLR, it is important to reflect on the necessity for cyber-resilience. Do she and the Minister agree that we cannot progress with such technologies without a national push towards cyber-resilience?

[Sarah Coombes]

It was very important that the Government intervened after JLR suffered a cyber-attack and went into full shutdown, because many businesses in my area rely on JLR. I agree that cyber-resilience has to be at the heart of this.

I want the west midlands to feel the benefit of manufacturing the hardware and the vehicles that will be the self-driving cars of the future. What discussions has the Minister had with the Secretary of State for Business and Trade about how to ensure that the west midlands and the whole UK realise the benefits of the autonomous vehicle boom? So far, the regulatory environment in Britain is very attractive to companies in this space because it is safe and sensible. The UN is responsible for much of the international vehicle safety regulations. Will the Minister reassure us that Britain will not diverge, putting us at a disadvantage, and that the remaining regulations being consulted on will not be delayed and hold us back?

In San Francisco, robotaxis, as they are called, are a tourist draw. People travel from all over to see the future in action. Waymo has announced that the vehicles are coming to London but I would love Birmingham and the Black Country to be an early adopter of driverless taxi pilots too. Birmingham is the youngest city in Europe, full of innovation and entrepreneurship. Previous automotive revolutions have started there. Frederick Lanchester built what is considered to have been Britain’s first four-wheel petrol car in Birmingham in 1895. There is a reason why Birmingham is often called the workshop of the world. There have already been driverless cars zipping up the M6 through my constituency, training the vehicles on highway driving. I would love local people to experience that at first hand.

I will finish, as I know others want to speak. Yesterday, I experienced the future of driving. As the automated steering wheel turned itself and we manoeuvred deftly and safely around packed and unpredictable London streets, it felt as if that future was being built on firm ground. As with any new technology, there are risks that must be managed, but the safety, accessibility and economic benefits could be huge. The UK Government have been leading the way. I know the Minister is certainly not in auto-pilot mode as we continue to shape the self-driving century that is upon us.

14:43

[Jim Shannon (Strangford) (DUP)]

It is as always a pleasure to serve under your chairship, Ms Vaz. It is nice to see you again and catch up. I thank the hon. Member for West Bromwich (Sarah Coombes) for leading today’s debate and I congratulate her for doing well. I am not a petrolhead but I love a gear stick—I love going through the gears, one to six. I love the smell of the car and the roar of a diesel engine.

The hon. Member for West Bromwich is right to bring this matter to the House for consideration, but I am afraid I will never get an electric car. That is just me. A driverless car? I like to be in charge of the steering wheel. I am not sure I could sit in a car like the one Arnold Schwarzenegger sits in in that film, where a wee model thing, with a head that spins round, tells him where he is going. I do not think I could ever do that, but the hon. Lady is right to bring this to us for consideration.

There is a need for technology and a need to move forward. My son, who has an electric car and is not afraid of the future—unlike his dad, perhaps—is willing to consider the technology that there will be. Someday there will be driverless cars; I am sure of that. One thing that I would love to see in the future—this is not about cars—is something like the device in “Star Trek” where they say, “Beam me up, Scotty.” The day they do that will be the day I would be convinced that is the right way to go, because I could be in my office at 9 o’clock on a Tuesday morning, and then be over here at five past 9—

[Valerie Vaz (in the Chair)]

Be careful what you wish for!

[Jim Shannon]

Now, will that ever happen? Who knows? But we are talking about driverless cars.

I want to refer to Northern Ireland, of course. First, the Automated Vehicles Act 2024 does not apply to Northern Ireland and, furthermore, there is as of yet no comprehensive legislative framework in Northern Ireland for automated vehicles. I believe it will come, because technology is moving on, the future is moving on, and people will want to be part of that.

That situation means that there is some confusion about the use of a self-driving vehicle authorised under the GB regime in Northern Ireland; the hon. Member for West Bromwich is right about that. There would also be implications for those coming across the border from the Republic of Ireland, as the vehicle would be operating without clear legal responsibility. It is always a joy to see the Minister in his place, and we look forward to some clarification on what it would mean if a self-driving vehicle from the mainland or the Republic of Ireland came to Northern Ireland, where we do not have any legislation in place. If it works, it has to work everywhere, so my question to the Minister would be about how that might happen.

Some pilot schemes are emerging back home. For example, there was an eight-seater Harlander shuttle bus operating in the Titanic quarter in Belfast. There was always a safety operator, of course, but it did give a little taste of the future of driverless vehicles in Northern Ireland. Sometimes it is a step into the unknown that people are a wee bit concerned about. A recent survey carried out by CompareNI highlighted that out of 800 motorists, some 75% would not feel safe travelling in a driverless vehicle—I am probably one of that 75%. I am in the majority, by the way; at least in Northern Ireland. The lack of public trust must be looked at. If this is the future, more must be done to instil public trust as that could be a barrier to progression.

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

On the question of trust in automated vehicles, does my hon. Friend agree that one issue that people will be concerned about is the cost of car insurance? When we are consulted and approached by constituents and we write to insurance companies, we usually hear that the number of accidents occurring is increasing insurance costs. Does he agree that it would be right to be somewhat sceptical? If there is going to be a significant reduction in accidents—I think there will be—we would like to see a significant reduction in the cost of car insurance, but I will not hold my breath.

[Jim Shannon]

My hon. Friend always brings pertinent points to the debate. Insurance in Northern Ireland is more expensive than it is anywhere else in the United Kingdom, so we would love to see those advantages.

The big question that many people have about insurance is who would be liable in the case of a crash or a road traffic accident? Would it be the driver, manufacturer or software provider? One of the three has to be accountable. On the other hand, human error causes a large percentage of road traffic accidents. Although I have said I like to be in charge of the steering wheel, if there is driver error or something goes wrong, it is the driver at the wheel who is to blame, and perhaps with a driverless car, the chances of an accident will be reduced dramatically. I think my hon. Friend the Member for East Londonderry (Mr Campbell) was referring to that, and the stats probably do as well. However, there is just the unknown question of where we are moving to. Whether it is about ill-judgment, drink driving, fatigue or distraction, there is perhaps an argument for the introduction of driverless cars on the grounds that it will be safer but, personally, I think it is the loss of control that worries people. How do we instil confidence into those who, like me, want to ensure that it is completely safe to drive a car?

There have also been reports that the introduction of driverless cars will be pivotal in transforming mobility for elderly people and the disabled. That is obviously a plus factor as well. It could give people who have been prohibited from driving manually, or are unable to obtain a driving licence because of their disability, the independence, flexibility and opportunity to have a life outside of the home. I see the advantages of that, and I hope the Minister will reply on that point. It will be interesting to see how this progresses over time, and whether we can do more to support it.

As Northern Ireland and the rest of the United Kingdom look to the future of transport, driverless vehicles present both a challenge and an opportunity. It is only fair for me to give my opinion, but there is an opportunity—and I am not against opportunity or technology moving forward. It may not be what I want to do, but the opportunity has to be there for everyone else.

We do not yet have a dedicated legal framework for automated vehicles, which is the big question for the Minister. I asked him at the beginning, but I will ask him again: will the Minister ensure that when we move forward, all the regions come together? There are implications for drivers from the Republic of Ireland coming across the border, so will the Minister ensure that we are all on the same page? Although it could create uncertainty, it also gives us the chance to design a system that reflects our needs. The hon. Member for West Bromwich passionately put that case forward. I look forward to engaging on this issue further in the future, and I hope that the views of the general public can also be taken into consideration. Once again, I say well done to the hon. Member for West Bromwich.

14:51

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

It is a pleasure to speak under your chairship, Ms Vaz. I thank my hon. Friend the Member for West Bromwich (Sarah Coombes) for securing this timely and insightful debate.

The advent of automated passenger services as a new pillar of our transport infrastructure is a huge opportunity to transform the lives of disabled people. Turning travel from an exhausting gauntlet into a predictable door-to-door experience would be transformational. For too many people right now, travel is a lottery. A ramp that does not arrive, or a lift that is out of order: when supporting my wife, who lives with sight loss, I see at first hand what that means to her. The stress is in not just the journey but the uncertainty. APS can flip that around on its head, and provide reliable, bookable and predictable journeys with accessibility built in rather than just being bolted on.

If we design the vehicles, the pick-up points and the booking systems around real lives, APS can deliver something really quite remarkable but simple and profound, which most of us take for granted: the confidence for someone to get where they want to go every single time. Designing it around real lives means universal design as standard: kerb-level boarding; audio, haptic and visual cues; secure wheelchair spaces; induction loops; seats that can be reserved; and booking systems, in-app and by phone, that work for blind and partially sighted people.

[Rosie Wrighting]

I lost my driving licence because I was having seizures when I was 19 years old. Will my hon. Friend also talk about the fact that this would help people who cannot drive due to seizures?

[Lee Pitcher]

I 100% agree with my hon. Friend. My wife was born with full sight, but over the years her degenerative condition has meant that she had to lose her licence. I know that it was almost like ripping her heart out; the independence she lost was huge. Anybody who experiences that independence—having the ability to go where they want, when they want—will know that it is so difficult to lose. APS should help many more people who experience that.

We have the chance, for the first time in history, to develop a system with the needs of disabled people entrenched from the beginning; not as an afterthought or adaptation, but built for the right purpose from day one. That means co-development, not just consultation, for although disabled people are poised to benefit most from the technology, they are also the most vulnerable if we get it wrong. Co-development means having disabled people in the room with engineers, coders and operators from the first day. It means trials where users co-write the test plan, safety cases published in plain English and feedback loops that actually change the service.

Trust is the prerequisite for adoption. We will not win it with glossy brochures. We will win it by working with disabled people to design safeguards and standards that resonate with them. That is how you build a service that people can have confidence in. Clear rules and accountability must back that up with independent safety audits, black box-style incident logging, a human in loop for edge cases, and transparent performance data for on-time pick-ups, successful ramp deployments, and complaint resolutions, published route by route. APS should knit together the network, not replace accessible buses and trains. Think real-time handovers, shared tickets and guaranteed connections, with compensation when the system fails.

New technology can mean a new lease of life for tens of thousands of people by giving them independence, dignity and the confidence to get where they want to go every single time. We have a genuine once-in-a-generation chance to get this right. I call on the Minister to enshrine the principles of accessibility by design from the very start and ensure service user co-creation from this point on. If we do not do that, we will spend years playing catch up, and the opportunities missed by those who stood to benefit the most will never come again.

14:56

[Dr Al Pinkerton (Surrey Heath) (LD)]

It is a pleasure to serve under your chairmanship, Ms Vaz. I thank the hon. Member for West Bromwich (Sarah Coombes) for securing this important debate. To the hon. Member for Strangford (Jim Shannon), I say: automated vehicles—

“It’s life, Jim, but not as we know it”.

Connected and automated vehicles offer the prospect of a safer, more efficient and more sustainable public transport system. They hold particular potential for areas such as my constituency, Surrey Heath, where public transport remains inadequate, with slow, disconnected bus routes, poor rail links to London and limited options for those without a private vehicle. If implemented effectively and securely, this technology could transform mobility by giving greater independence to older residents and—as the hon. Member for Doncaster East and the Isle of Axholme (Lee Pitcher) said—to those with disabilities or medical conditions. That would reduce isolation and improve access to essential services. It could also help us to meet our net zero goals by cutting reliance on private cars and encouraging cleaner, shared modes of travel, while improving road safety for all users, including cyclists and pedestrians. In semi-rural areas, connected and automated vehicles could link villages where bus services are unreliable, while easing congestion. Congestion is a major issue in Surrey Heath, which has the second-highest car dependency rate of any in the country, with 1.64 cars per household.

However, the transition will only succeed if the public’s trust in the digital infrastructure that underpins it is enhanced. Connectivity must go hand in hand with security. Our vehicle identification systems—our number plates—cannot be the weak link in an otherwise forward-looking transport agenda. In the past, I have raised concerns about the fragility of automated number plate recognition technology. In an age of connected technology and digital identifiers, it is troubling that we still rely on what is largely an analogue process for our security on the roads. Number plates should be the cornerstone of road safety, yet they have become a point of vulnerability: easily cloned, exploited and poorly protected.

When ANPR fails or is undermined by cloning or ghosting, that is not a minor inconvenience but a failure of public protection. One Surrey Heath resident was fined thousands of pounds after criminals cloned her number plate. She faced bailiff threats and months of stress with little support. Another resident received 42 penalty notices for the same reason. Both spent many hundreds of pounds replacing their number plates, not because of any wrongdoing on their part but because the system meant to protect them failed. Those are not isolated cases. A recent parliamentary written question revealed that in 2024 the DVLA received over 10,000 reports from people across the country disputing responsibility for private vehicles that they did not recognise when they were challenged—a 42% increase since 2020.

To realise the potential benefits of connected and automated vehicles, our security infrastructure and legislation must evolve in lockstep with advancing technologies. The Government should legislate for tighter registration controls, stronger supply verification and a digital audit trail to prevent tracing and cloning. Transport innovation must not outpace regulation; as vehicles become smarter, the systems that identify them must become smarter, too. Only then can we protect motorists, build and maintain public confidence, and ensure that connected and automated vehicles deliver safer roads, lower emissions and greater mobility for all.

14:59

[Alex Mayer (Dunstable and Leighton Buzzard) (Lab)]

It is a pleasure to serve under your chairship, Ms Vaz. I commend my hon. Friend the Member for West Bromwich (Sarah Coombes) for securing this important debate.

I have no doubt that one day autonomous vehicles will be the norm on our buses, and I am perfectly okay with that, because I am fairly sure that any robot would be better at driving a bus than I would be. I am keen to hear from the Minister whether he has a timescale for the publication of the automated passenger services permitting scheme consultation.

Technology has moved at pace over the last two decades; LiDAR—light detection and ranging—tech, radar and cameras all working together so that autonomous buses can handle junctions and roundabouts, and keep pace with the general traffic. I thank Ian Pulford, who has recently been telling me about the self-driving shuttles in Milton Keynes that have transported thousands of passengers without incident. I also thank a pair of Dans—Dan and Dan—who talked me through the Connector project. When I travelled on that, I found that it worked rather well, albeit that it had perhaps been programmed to be a little too cautious; it felt a bit like the 21st-century equivalent of having a man with a red flag walking along in front of the bus. Particularly when we sat waiting to turn left into oncoming traffic, I felt that basically we needed braver autonomous buses.

I think that passengers will be just fine with AV buses. After all, people travel happily on the driverless docklands light railway or airport shuttles without a second thought. Indeed, research from the University of the West of England has found that in the main passengers’ desire for a safety driver is not so much about the technology within the vehicle, but more about other aspects of safety, for instance personal security.

However, there is still some way to go. The Oxfordshire Mi-Link team freely admit that they had not fully anticipated quite how tightly controlled roadside vegetation has to be for their autonomous buses to work, and sometimes on windy days the buses get confused by moving branches, which they regard as hazards. The Connector team also told me that rain sometimes disrupted the sensors on their buses—while tech might be changing rapidly, I do not think that British weather is going to. Also, if potholes frustrate people today, imagine the outcry if the faded white lines along the side of the road stopped buses altogether. Council maintenance regimes would have to change radically; indeed, they would require a complete overhaul.

Then there is the question of the highway code. The current one was obviously written for human beings, for our reaction times and our capacity to make judgments in complex situations. I am sure there will have to be an update of the highway code and that it will have to be more than just a basic legal update; there will need to be an entirely conceptual update. Does the Minister envisage that we will need two sets of rules, one for human drivers, and one for the robo-buses of the future?

Finally, I turn to cost. Large-scale commercial deployment will mainly rest on cost. The main cost saving with autonomous vehicles is on driver hours, although a human being must still be present under current legislation, of course. I note that the Scottish trial between Edinburgh and Fife’s park-and-ride system seems to have met many of its technical goals. The problem was that, as with many other kinds of buses, the buses in this trial did not attract enough passengers. As we all know, buses outside London have bit of an image problem and many people who could use buses do not use them, not because of the service itself, but because of the perception.

As the Minister knows, it has always been my mission to get more fare-paying and probably middle-class passengers on to buses, because increased farebox revenue is the key to sustainable services. However, I wonder whether we need to think more about what autonomous buses of the future will look like, because we seem to be going down two different paths. The ones being deployed in places such as Edinburgh, Oxford and Cambridge look and feel much more like a regular bus or minibus: they have a steering wheel that is moving, albeit no one has to turn it. The Milton Keynes example, which is also being used in Suffolk and in Birmingham at the National Exhibition Centre, has no steering wheel; it is a little shuttle thing that feels a bit more futuristic.

Is this the moment that we could be using to grow passenger numbers? We could attract people who might never in a million years think about catching the bus. It may be that we cannot persuade them to catch a bus, but if it were billed as exciting, technological and futuristic, they might happily get aboard a “zog-pod” or something like that.

15:05

[Martin Wrigley (Newton Abbot) (LD)]

It is a pleasure to serve under your chairship, Ms Vaz. I congratulate the hon. Member for West Bromwich (Sarah Coombes) not only on securing this debate, but on her positive and optimistic vision of the future, which I really like.

I think many of us have long had a vision of autonomous vehicles based on science fiction. Reality is not quite there yet, but it is moving fast towards it. We have seen the progress on autonomous cars, and the various pilot sites in the USA—and closer to home, as we have heard.

Fully autonomous cars in Newton Abbot are, I suspect, quite some way off. Drivers who have not grown up with our Devon lanes find them hard enough, and we can only dream of having white lines on the edge of the road. In well-defined urban environments, it is quite another matter, largely dependent on the legal and insurance issues that we heard about earlier. We could easily see AVs soon beyond the trial stages that we have today. However, we have some issues in running trials of uncrewed maritime and air connected and autonomous vehicles.

I recently met with a retired navy air traffic controller, who told me of his latest work using aerial drones to deliver test samples from Scottish islands to mainland hospital labs, Project CAELUS, which had excellent success. We could use that sort of technology to get samples between our hospitals in Devon, which would be good—it would avoid the summer traffic. However, it took eight months to get the flight path agreed and approved, and it required a special use airspace application for beyond visual line of sight uncrewed air system operations under civil air publication 1616. I ask the Minister, or perhaps his colleagues, to seek speed from the Civil Aviation Authority in reforming CAP1616, including a more proportionate approach to BVLOS airspace, to improve clarity, efficiency and transparency while maintaining safety.

Additionally, a couple of weeks ago, as part of the armed forces parliamentary scheme, we visited the Royal Navy in Portsmouth and saw a connected uncrewed boat doing tests in the harbour. It was being controlled by a team on land—essentially, it is a standard 5-metre rigid inflatable boat with a remote skipper. Following it was a crewed Navy boat, which is required by maritime regulations to constantly escort uncrewed 5-metre RIBs. The Navy fleet of the future described in the strategic defence review is highly dependent on the use of uncrewed vessels to supplement and complement the existing Navy ships. We must be able to develop them and test them in a more effective way, as we are doing with cars on land.

I urge the Minister, or perhaps his team, to see what exemptions and exceptions may be made. Marine guidance note 705(M) exemptions are limited to boats less than 4.5 metres and at 6 knots or slower. That does not cover what the Navy needs to do. Unless we can find a way to rapidly and safely regulate, and not prevent, tests of remote air and marine craft, we will struggle to get to where we need to be. The Chair of the Ukrainian Parliament, on his recent visit, stated that their drone technology lasted about three months, by which time they had developed a whole new set-up. We need to speed up.

15:08

[Tom Hayes (Bournemouth East) (Lab)]

It is a pleasure to serve under your chairpersonship, Ms Vaz. I thank my hon. Friend the Member for West Bromwich (Sarah Coombes) for securing this debate. In this debate, I want to talk about place and the role of connected autonomous vehicles within it—but before I do, I want to follow on from my hon. Friend the Member for Doncaster East and the Isle of Axholme (Lee Pitcher), who talked movingly and importantly about the role of accessibility. This year marks the 30th anniversary of the campaign for civil rights by disabled people, which culminated in the Disability Discrimination Act 1995, and a key part of that campaign was for accessible public transport. Thirty years on, as we look to the future, we must think about how we can have accessible transport with all these technological changes.

I am thinking about what Bournemouth’s future roads will look like. Will we see self-driving cars going anywhere anytime soon? By what date this side of 2050 might a majority of driving miles in Bournemouth be completed by machines and not humans? At what point in the future might the Minister’s car become a museum piece? When we talk about technology, we think about novelty in the future. Bournemouth has not just lived a sense that technology is advancing faster than society can keep up; it has even helped to engineer the feeling. Bournemouth University has published important research into topics such as cyber-security and connected autonomous vehicles. We are a town with remarkable scientific minds and technological innovators, and we want to contribute towards that new future.

Indeed, the future is usually with us for a long time before society sees the recognisable breakthrough of a certain technology. With the onset of motorisation, early cars were referred to as horseless carriages and many shared features with horse-drawn predecessors, while others used technology from the bicycle industry. With the onset of electrification in the early 20th century, the petrol-powered car was briefly less common than either steam or electric-powered ones. The electric car disappeared by the 1930s, reappeared in the 60s, slipped back and then reappeared with gusto in the last decade.

Thinking of autonomous vehicles, General Motors sponsored Norman Geddes to design the Futurama exhibition at the New York World’s Fair in 1939, where he depicted the first driverless car. In the 1960s, the Slough-built Citroën DS19 was trialled in the UK as an autonomous vehicle. This issue has been with us for a while and we politicians have a duty to think about what that means. We have a duty to make choices before the disruptions that such technologies cause reverberate throughout our daily lives—the good, the bad and the ugly.

Issues such as how we get around will affect our lives and the future prosperity of the communities that we represent—and we are often behind the curve: it was only compulsory for rear view mirrors to be fitted to cars from 1 January 1932; driving tests were only introduced under the Road Traffic Act 1934 and were made mandatory in January 1935; driving licences were introduced by the Motor Car Act 1903, yet cars have been around since 1895. Are we keeping pace with change?

We must also think about some of the negative side effects. In 1894, The Times estimated that by 1950, every street in every British city would be buried nine feet deep in horse manure because of the horse’s dominance of transport. That did not quite turn out to be the case, but it brings me to the point with which I want to close in a couple of minutes: are the Government looking properly at how technology is changing? Where in Government are we thinking about those changes? How are we developing laws and policies that are as smart as the cars that are going to be on our roads? Do we have a Parliament filled with people who have the knowledge, the experience, the expertise, the access and the contacts to shape the laws that will ensure that our prosperity is secured and that our roads are being cared for?

When we look at polls, on balance, British citizens tend to lack trust in autonomous vehicles—partly because they have a lack of knowledge. That is unsurprising, given that AVs are theoretical and elusive; only a small number of self-driving vehicles are on our roads today, mostly test vehicles unavailable to the riding public. As AVs become more commonplace, they could become more popular as people become more educated. As MPs, we clearly have a role in helping to achieve that.

I will close by considering a few ways that we must think about AVs, because of the impact they will have on how we use our streets. Pedestrians will discover that AVs can halt when they detect human movement, and many may feel confident to cross the street anywhere. What might that mean for the smoothest flow of traffic through our streets? I recently discovered that, because of people’s tendency to look at their phones at traffic lights, some places are installing silent light-emitting diode strips on the ground so that people can see when a traffic light is being indicated, because they are often not paying attention to the noise.

Technology is already changing. How do we think about that with AVs? An AV can drop a person off, circle around Bournemouth, then come to pick them up wherever they want. If people think that Bournemouth’s roads and streets are choking on congestion—and they are—just wait until somebody goes to a meeting in the town centre, tells their AV to drive around continually and then calls for it to come and pick them up.

AV use will free up space currently reserved for parking for entirely new purposes, which will prompt local authorities to think about how they will generate income from the parking they provide. What do we do with the space that is made available? Do we turn that into housing, playgrounds or green space? How does that change our urban landscape? Wider use of AVs could risk increasing traffic congestion by drawing people out of other types of transport and into private car use. What does it mean for cycling, which we know helps people to get around their towns and cities and enhances their physical health? What will it mean for bus travel? Pool shuttles might become more important in order to avoid single-passenger AVs congesting our roads and fixed-schedule services could become a harder thing to sustain. There may be a move to on-demand services. Park and rides will become more important, because AVs could arrive at the outskirts of towns or cities and people could disembark to board shuttles that will take them to work. Indeed, AVs could communicate with park and rides or even public shuttles, relegating waiting around to the history books and ensuring non-stop journeys. Just as we relied on a mix of horses, trams, bikes, buses and cars during the first half of the last century, we could see a similar rivalry again during the first half of this century—a rivalry between human-controlled cars, semi and fully automated vehicles, bikes and buses.

What is the new hierarchy of transport? How society draws the balance will be critical. The Government and Parliament have a critical role to play because we cannot leave it to councils, even though councils cover geographies larger than our constituencies. We need national laws and frameworks that provide consistency across all the places we represent. We need foresight and we need to pre-empt potential future disruption. We must continue to improve the machinery of Government so that it can look to the future and make changes in response to technology. If we maximise the benefits, we minimise the costs and when our grandchildren look back on our decisions they will be able to believe that we made them with future generations in mind.

15:16

[Olly Glover (Didcot and Wantage) (LD)]

It is a pleasure to serve under your chairship, Ms Vaz. I thank the hon. Member for West Bromwich (Sarah Coombes) for bringing up this very important topic, which as a species we have been grappling with for a couple of decades, so that we can talk about how to deal with it in the UK. It was interesting to hear of her experience of using Wayve in London and her finding it miraculous. She made an interesting point about the potential for autonomous vehicles to act as a form of demand-responsive transport—a point also made by my hon. Friend the Member for Surrey Heath (Dr Pinkerton). They may be interested in the discussions of demand-responsive transport in the recent Transport Committee inquiry report called “Buses connecting communities”, the response to which we eagerly anticipate from the Government.

The hon. Member for Strangford (Jim Shannon) talked of his great enthusiasm for diesel fumes and gear sticks. Hon. Members will be surprised to learn that he has not already encountered the transporter room in “Star Trek”, as it appears to many of us that he has already been subject to an accident using said technology; that would explain his ability to appear in multiple places in Parliament at once.

The hon. Member for Doncaster East and the Isle of Axholme (Lee Pitcher) correctly highlighted the need to get regulation and monitoring right—more on that shortly. The hon. Member for Dunstable and Leighton Buzzard (Alex Mayer) once again showed her knowledge and passion for all forms of buses in the widest sense of the term. She highlighted some existing examples of driverless transport, including the docklands light railway, although all DLR trains have a member of staff on board precisely to address the issue that she rightly highlighted: needing to ensure that people still have a strong sense of personal safety and security in such vehicles.

The hon. Lady was also quite right to highlight the challenges of vegetation and white lines management. White lines are a major issue for today, let alone for autonomous vehicles—it is a major issue even for those of us who use the very primitive form of transport known as a bicycle. The presence of a white line makes cycling on unlit roads enormously easier compared with roads without white lines—we seem to have a completely arbitrary mix of the two. That has relevance for tomorrow’s debate on headlight dazzle, because drivers can lock their eyes on white lines when they are suffering from that. I make that point only to show that sometimes historical solutions are applicable to new problems.

My hon. Friend the Member for Newton Abbot (Martin Wrigley) also talked about the importance of white lines, and quite rightly suggested that the challenges of introducing autonomous and connected vehicles are going to be rather different for rural roads than for urban roads. The hon. Member for Bournemouth East (Tom Hayes) took us through the history of transport and what we consider normal. He rightly made the point that it is important for local authorities and all of us to have knowledge of these things. I am a complete luddite about artificial intelligence, and that is certainly one of the challenge of our jobs: we are expected to know everything about everything, whereas really the key challenge is to know enough about the key topics.

The Liberal Democrats were pleased to support the Automated Vehicles Act 2024, which was introduced by the previous Conservative Government. Automated vehicles represent the next step towards safer and more sustainable transport.

In my Oxfordshire constituency of Didcot and Wantage, I was pleased to see Milton Park trialling an autonomous bus—not just within the park estate, which is a reasonably contained business-park environment, but covering the couple of miles between Milton Park and Didcot Parkway railway station. The United Kingdom has a strong tech sector and a real opportunity to lead the development of self-driving vehicle technology, which is an opportunity to attract the investment and innovation that we all know our country needs.

Autonomous vehicles have the potential to play a major role in improving road safety, given that the majority of traffic accidents are caused by human error. They also have the potential to help move us towards net zero by reducing the need for individual car ownership and promoting the more efficient use of vehicles. However, public confidence is essential for the success of automated transport.

As one who worked in rail before coming to this place, it is a mystery to me that there is relatively little driverless and automated technology in the sector, despite it being a self-contained, heavily regulated environment that in theory ought to be the more promising place to try it. It is true that Paris has automated some metro lines, but in a job I did before coming to this place, UK rail experts—believe it or not—were dispatched to Canada to help work on a new automated metro system in Montréal, known as the Réseau express métropolitain, which was entirely driverless. It all seemed to work perfectly in trials, but at peak times, during large-scale operations and at times of major computer failure, the whole system, lacking staff, completely collapsed. We were sent there to suggest how they could come up with ways of managing such major disruption better. That is one of my points of scepticism.

I am sure that the hon. Member for West Bromwich is right that Wayve cars operating in London have anticipated all the normal difficulties, such as pedestrians, cyclists, whether or not they go through red lights and so on, but we do not know whether, if every car were autonomous, they would be quite so resilient. We can only find out by doing more trials and research, looking at that data and exploring it with great care. Safety for all road users, especially cyclists and pedestrians, must continue to be a top priority.

Early international trials, such as those in San Francisco, show encouraging signs of safety improvements, but any single serious incident could damage public trust. As is so often the case with these things, one very bad thing will negate nine very good things. It is the same with customer service in a restaurant or a hotel. Clear communication about the purpose and limits of trials is vital, and the interaction between human control and automation must be carefully managed.

Issues seen in overseas trials, such as autonomous vehicles blocking emergency vehicles or stopping in cycle lanes, must be addressed to ensure public confidence in UK deployments. A strong and transparent safety network is needed to govern how automated vehicles are tested and introduced on public roads. Automated vehicles should meet or exceed the safety standards of careful and competent human drivers.

The shift provides an opportunity to not just maintain but significantly improve the overall safety and accessibility of road networks. The success of AVs will depend on adequate infrastructure. Poor road conditions, including pot holes, could affect vehicle performance and public safety. Therefore, minimum road-quality standards and sufficient resources for local authorities will be essential to support their introduction.

As hon. Members have already said, accessibility must remain at the heart of automation. Older and disabled people often rely on drivers for assistance, including in terms of boarding the vehicle. That is one area where we need to think carefully before designating this as the solution to some of the accessibility challenges. Automated taxis or public transport must continue to provide appropriate support for vulnerable users. Ensuring inclusivity will be key to public acceptance.

The real challenge is that, once autonomous vehicles become owned on a large scale in the same way that cars are now, what sounds like a great opportunity will also come with some risks. Presumably, they would not initially be cheap, just as electric vehicles are not cheap now. Something that has the potential to erode public transport ridership could also erode public transport viability, which is likely to still be essential for those who would not necessarily be able to afford to own such a vehicle. The cost aspect needs to be carefully considered.

Data protection and privacy are also critical concerns. We need to consider how processing large amounts of data, including potentially sensitive personal information, will be handled, and the strong safeguards needed to prevent the misuse or monetisation of personal data. Insurance arrangements must also be clear and fair, and cyclists and pedestrians involved in incidents must have access to fair and timely compensation, particularly as many of those will not hold personal insurance.

In conclusion, although there is a huge opportunity for automated vehicles to make travel safer, more efficient and more accessible, we need to adequately consider the risks. Some of those have been well covered in this debate, but others may not have been—for example, the potential for job losses, the need to manage cyber-security carefully and the potential health impacts. I do not mean health impacts from the vehicles themselves, but we are already struggling to encourage walking and cycling in this country; were these developments to further erode those activities, our current issues with obesity and other health inequalities might worsen.

The UK can lead in this field if it embraces innovation responsibly and brings the public with it. I look forward to hearing from the Minister about how we can do just that.

15:26

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

It is lovely to appear before you today, Ms Vaz. I join everyone in congratulating the hon. Member for West Bromwich (Sarah Coombes) on securing this interesting and important debate. She rightly focused on the three main issues, one of which, of course, is safety—a potential enormous benefit of the developing technology. Another is accessibility, which I will talk about in my comments. She also spoke of the potential for significant economic growth, while accepting that through any economic and technological transition, there are losers as well as winners. A responsible Government ought to take proper account of that.

The only other contributor who I will reference specifically is the hon. Member for Strangford (Jim Shannon), who has never missed an opportunity to contribute to a debate. I have never heard a more heartfelt elegy for the diesel motorcar than his. I say it was elegiac, because there is, I think, a fin de siècle element to this technology, as we move towards more fuel-efficient cars, then ultimately to self-driving cars. It is so unlike the hon. Gentleman to be hesitant about boldly going where no passengers have been before. I am sure he will catch up when he gets the opportunity—as the hon. Member for West Bromwich has done, having already had the experience of going in a driverless car. I look forward to the opportunity myself.

The last Conservative Government took a clear decision to support the introduction of autonomous vehicles on our roads, and to pass the Automated Vehicles Act 2024 to establish the regulatory framework to allow AV technology to flourish in the United Kingdom. The Act defined the legal framework for the authorisation of AV use on our roads through the creation of the concept of the statement of safety principles, as well as subsequent legal responsibility that would be used to govern AV actions—for example, the imposition of a legal liability on a corporate entity, the provider of the technology, as opposed to it being on the driver of a car. That is a novel legal concept on our roads that will clearly be necessary for autonomous vehicles, because who is in command? Who is in control? It is no longer the driver, and that has a knock-on impact on insured risk. The Act also sought to deal with that because it included appropriate sanctions for situations in which a vehicle fails to drive either legally or safely.

The Act set out the ability for the Government to set regulations—secondary legislation—requiring organisations to report certain safety-related data to the authorisation authority, of which it anticipates the creation, and the in-use regulator. It sought to protect customers by prohibiting misleading marketing: only vehicles that meet the safety threshold can be marketed in the future as “self-driving”. Finally, it set out the approach to the policing and seizure of non-compliant AVs.

As far as they went, the last Government did a great job. They brought forward practical, legislative proposals, which generated confidence in the sector, and they set out the structure that allowed the sector to grow and invest in this country. Modelling put forward by the Government suggests that there is the potential to create 38,000 jobs in the sector in the next nine years, generating value of £42 billion—I always have a healthy degree of scepticism when we are told that future industries will be enormously valuable, and I slightly wonder how people come up with such figures. Nevertheless, that optimism is shared by serious organisations such as Goldman Sachs, which has predicted significant increases in ridership, particularly in the US, following considerable growth over the last few years. It is therefore right that the UK, at the very least, does not block such technological advances and supports its tech sector as it seeks to develop AVs and the software behind them.

The Opposition recognise that these developments go well beyond merely economics, as the hon. Member for West Bromwich said. Automated systems can help improve driving quality, reduce congestion, increase the more efficient use of fuel and help with elements of accessibility. Rural pensioners may not have to move into a town when they are too old or infirm to drive. Vehicles as a service can reduce costs for lower-income families. Efficient fuel use and lane discipline can reduce congestion and the environmental impact of driving. On safety, we are told that 88% of all road accidents are contributed to by human error. If AVs can improve that statistic, the societal benefits of this technology could be profound.

Waymo, the market leader in the US, claims that compared with the figures for the average human driver over the same distance in its operating cities, the reduction in crashes resulted in 91% fewer serious injuries, with 80% fewer injury-causing crashes of any description. Those are startling statistics. Even though we are at an early stage, those assertions, backed by millions of miles of AV driving—albeit in US conditions—do create cause for optimism. We want to see this technology benefit the British people by making our lives on the road both easier and safer.

So far, so good—we all agree—but this is where the consensus is at risk of ending. When technological development is at stake, time is the issue. The 2024 Act was enabling—it anticipated a host of secondary legislation to put meat on the statutory bones—but we are yet to see concrete action from this Government. Where is the secondary legislation around data sharing for insurance purposes? Does the Minister have a timeframe for the introduction of that regulation?

While the Minister is looking through his notes to see if he has the answer to that question, where is the legislation on cyber-security? We only have to look at the recent experience at JLR to realise that this is not a theoretical threat—it could be absolutely central to the viability of this technology and its adoption in this country. Where is the secondary legislation on data integrity and resilience against hacking or system failure? That is anticipated in the 2024 Act, and the Government need to take the next step. They have not yet.

I do not want to throw too many bricks—well, I do really, but I will restrain myself and ask the Minister for an update: where is the detailed definition of the statement of safety principles? Where are the regulations allowing for competition within the sector, while still maintaining robust safety standards? That is not going to happen by itself; it requires the Government to act. We need an update from the Minster.

We have the Government’s industrial strategy, which was published in June. It commits to making AVs commercially viable in the UK, but it did not say when. Perhaps the Minister can provide that answer. The Government are supposed to be seeking to harmonise international regulations on self-driving, and enabling pilots of self-driving vehicles by the spring of 2026. We have some movement on that, but can the Minister update the House on his progress?

We all agree that AVs represent a big opportunity for society and business. I welcome the Government’s wholesale adoption of the Conservative approach to this sector. The issue is not party political; we all appear to agree on the same objectives. But there needs to be a sense of urgency from this Administration, and I look forward to the Minister’s response demonstrating that urgency.

15:34

[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 my hon. Friend the Member for West Bromwich (Sarah Coombes) on raising this important issue. What a fascinating and thought-provoking debate this has been.

Establishing our new regulatory framework for automated vehicles provides a once-in-a-lifetime opportunity to harness the transformative impact that artificial intelligence could have on our roads. Not only will the framework strengthen our position as a global AI superpower, but automated vehicles can also be a key enabler of our plan for change. They can make transport safer, more convenient and more accessible. They could increase choice for non-drivers, including disabled people and older people. Self-driving vehicles that are zero emission can support cleaner, more efficient transport, particularly when paired with the transition to electric, helping us on our way to our net zero goals. By better enabling freight to be transported outside peak hours, they may also reduce congestion, making journeys to work easier and quicker. In doing that, automated vehicles could improve the lives of millions of people.

Although the UK’s roads are safe by global standards, every road death and injury is a tragedy for the families involved. In 2023, collisions cost medical and ambulance services an estimated £2.2 billion. Every collision prevented will improve the safety of our communities and support our NHS to get on a more sustainable footing. As many hon. Members have referenced, 88% of collisions involve human driver error as a contributing factor, and automated vehicles can be a major player in tackling that challenge. They have a faster reaction time and the ability to learn from vast amounts of driving data, and so could help reduce those numbers. Unlike human drivers, automated vehicles do not get tired, get distracted or drive under the influence. That gives them strong potential to improve road safety.

Although vehicle technologies have already provided significant advances in road safety and will continue to do so, technology is not foolproof. The UK has a heritage of world-leading intelligent regulation. Our new framework must uphold that standard and capture the opportunities while safeguarding against new risks that may arise. We have already made big achievements in this space, with the Automated Vehicles Act 2024 establishing one of the most comprehensive legal frameworks of its kind in the world.

We also play a leading rule in harmonising international rules on safety and assurance at the UN, ensuring that consistent approaches are adopted globally. That has involved close working throughout, and I am grateful for the expertise shared by industry, road safety groups, accessibility advocates, trade unions and academia to develop our thinking.

Passenger safety remains vital, and the Government intend that any organisation wishing to deploy a self-driving passenger service must have robust policies to ensure that their passengers are kept safe throughout their journey. We will continue to learn from best practice internationally, including from world-leading autonomous ride-hailing companies, to help us to achieve our safety mission.

The future of self-driving vehicles will be shaped by the public’s level of trust in their safety. Trust depends on transparency, regulation and performance. That is why the Government recently consulted on protecting marketing terms associated with automated vehicles to ensure that only genuinely self-driving vehicles can be marketed as such. In 2026, we will also consult on safety principles to ensure that all automated vehicles meet or exceed human driving standards. The Government have backed the setting-up of Partners for Automated Vehicle Education United Kingdom. PAVE UK brings together industry, academia and non-profits to provide clear and accurate information to the public on automated vehicles.

Ensuring the security of UK data is a priority for the Government. The UK has strong safeguards to ensure that data is collected and handled responsibly and securely. Companies registered in the UK are subject to our legal framework and regulatory jurisdiction. Personal data transfers abroad are subject to a high level of legal protection. We actively monitor threats to UK data and will not hesitate to take the necessary action to protect our national security.

We want to harness this sector’s huge potential to kick-start economic growth by providing the right conditions to unlock an industry that will be worth £42 billion by 2035 and will create up to 38,000 new skilled jobs. These services can also open up new opportunities in fields such as software, safety assurance, vehicle engineering, logistics and customer service.

Self-driving vehicles are not about replacing current forms of transport, but about complementing and improving them. Traditional driving roles will remain vital, and some people will continue to have a preference and choose to use human-driven services. This is about growing and improving transport options, not revolutionising things overnight.

The automated passenger services permitting scheme—I think my hon. Friend the Member for Dunstable and Leighton Buzzard (Alex Mayer) went into this—can help to facilitate pilots of commercial self-driving passenger services with no safety driver. Following our recent consultation, we are analysing responses and intend to implement the scheme from spring 2026. At present, no changes to the highway code are anticipated, although we will keep that under review.

We are delighted that Waymo has signalled its intention to bring automated passenger services to London next year under our proposed piloting scheme—subject to meeting vital safety and local authority consent requirements. Cutting-edge investment such as that is helping to deliver our mission to be a world leader in new technology and spearhead national renewal that delivers real change in our communities. Waymo’s announcement, and the previously announced ambition of other companies such as Uber with UK start-up Wayve, are evidence of the impact of the UK’s leading role in self-driving-vehicle regulation. Following the recent closure of the consultation on our permitting scheme, we will announce next steps soon.

I will touch on ghost vehicle registration plates; I know that tackling those is a passion of my hon. Friend the Member for West Bromwich. The safety of all road users is a top priority for the Government. As part of the development of our road safety strategy, we are considering a range of policies relating to motoring offences, and we will set out our next steps for the strategy in due course. Officials are also considering options to ensure we have a more robust, auditable register of number plate suppliers process, which would enable tighter checks on number plate suppliers. On-road enforcement for offences relating to the display of plates is of course a matter for the police.

I have time to touch on a few other points raised by Members. In terms of this being a complementary form of public transport, self-driving vehicles are not about replacing current forms of transport, but about complementing and improving. There was some concern about potential job losses and impact on the taxi industry. I think the initial deployments under the pilots are likely to be pretty small in scale. Where a taxi or private hire-like service is proposed, local licensing authorities will need to give consent to the permitting of those services. That may include consideration of the right mix of automated and other services in their area.

We have touched on cyber-security, which is at the heart of the Government’s priorities for the roll-out of self-driving vehicles. The Automated Vehicles Act allows for obligations to be placed on the authorised self-driving entity—the entity for ensuring that the vehicle continues to drive safely and legally—to maintain vehicle software and ensure that appropriate cyber-security measures are in place throughout the vehicle’s life.

Very importantly, coming back to accessibility, we recently closed the consultation on the proposed automated passenger services permitting scheme. That provided an opportunity for accessibility advocates to provide their views on the proposed approach. Just before I came to this debate, I chaired a roundtable with representatives from across the accessibility community to enhance our understanding and grow awareness of the risks and benefits that this new mode of transport can offer. We are continuing to review the need for further research, which includes consideration of how older and disabled people in particular can be involved. Examples of previous research include work undertaken to understand the extent of driver roles in supporting people to make journeys and the implications in emergency situations. We are considering developing guidance on accessibility for APS and are working to establish a group of accessibility experts to support its creation and ensure meaningful learnings from the pilot deployments. We obviously want to see the benefits realised across the country. The pilots are a decision of developers, as it stands, in collaboration with local transport authorities.

The hon. Member for Strangford (Jim Shannon) raised some interesting points. Let me first cling on to the bit about “Star Trek”. [Hon. Members: “No!”] I spent at least 30 minutes thinking of that—no, not really. I am quite relieved that I am not responsible for transport at this time, although who knows in the future? We do not legislate for Northern Ireland in this area, rightly respecting Northern Ireland’s role in legislating for its road traffic laws. Northern Ireland has not sought to replicate the Automated and Electric Vehicles Act 2018 within its legislation, so an authorised EV under a GB scheme could be driven only as a conventional vehicle in Northern Ireland.

Very briefly, because I have to wrap up, my hon. Friend the Member for Dunstable and Leighton Buzzard touched on autonomous buses. The automated passenger services permitting scheme facilitates the piloting of bus-like services. For example, the Government have supported the trialling of self-driving bus-like services currently under way on the outskirts of Cambridge. If the operators believe that the vehicle is capable of meeting the threshold that we will set for self-driving capability, the permitting scheme will be available for it. The larger scale of buses may make these things more challenging, but through our funded trials we hope to provide a route to building the required capacity while remaining safe.

The hon. Member for Newton Abbot (Martin Wrigley) mentioned autonomous aviation and maritime. I am afraid I can only reassure him that the applicable Minister, the Minister for Aviation, Maritime and Decarbonisation, will have heard his point on that loud and clear. The same applies to the Minister for Rail and the comments from the Liberal Democrat spokesman, the hon. Member for Didcot and Wantage (Olly Glover), on rail.

I once again thank hon. Members for the wide range of comments. I hope they will be reassured that the Government are committed to realising the very real benefits of self-driving vehicles, particularly where they can catalyse our road safety ambitions, open up travel for many and support our national renewal efforts.

15:47

[Sarah Coombes]

We have heard about all the different parts of this issue today: sharing the benefits of the future autonomous revolution UK-wide; the importance of public trust and uptake; accessibility and independence; and security and safety. We need the benefits to be shared nationwide—in Strangford, Weston-super-Mare, Kettering and beyond.

The hon. Member for Newton Abbot (Martin Wrigley) made the good point that we need to look at regulation for autonomous vehicles beyond just that for road-based ones. My hon. Friend the Member for Bournemouth East (Tom Hayes) made important comments about his university’s contribution in this space and the fact that we are often behind the curve on many of these things.

On public trust and uptake, although I do not agree with the hon. Member for Strangford (Jim Shannon) about how nice the roar of a diesel engine is, I absolutely agree that people are unsure about this development in the future. We need to address public trust issues and bring people with us on this journey. My hon. Friend the Member for Dunstable and Leighton Buzzard (Alex Mayer) made a very good point about making buses sexy for the public, and this issue is definitely part of that, and a way to increase uptake.

The Lib Dem spokesperson, the hon. Member for Didcot and Wantage (Olly Glover), talked about demand-responsive transport, which is very interesting in the area of autonomous vehicles. On accessibility, my hon. Friend the Member for Doncaster East and the Isle of Axholme (Lee Pitcher) spoke movingly about his wife and the experience of sight loss, about how autonomous vehicles can improve independence and be transformational and about how APS will knit together the network for the future.

On security and safety, I am glad to have found a kindred spirit in the hon. Member for Surrey Heath (Dr Pinkerton), who spoke about the importance of the humble number plate in this country and all the deficiencies of the system. The 10,000 cloning incidents he mentioned show how much we need change in the system.

On insurance, the point was made that, ideally, if safety went up, costs and insurance premiums would go down. The Motor Insurers’ Bureau thinks that connected vehicles, which would mean that we could have a new system to detect whether cars are insured, could be helpful on that. There is also the issue of the number of cars with no registered keeper on our roads shooting up. That is driving up all our insurance premiums, because no one can work out who owes the money.

In summation, I appreciate the Minister’s comments and the hope and opportunity we have in front of us. The Conservative spokesperson, the hon. Member for Broadland and Fakenham (Jerome Mayhew), is right that the previous Government laid good groundwork here. We need to build on it. We need to fix ghost plates and things like that in the current system. The UK is a leader in AI. We have always been leaders in automotive. Let’s embrace that, bring the two together and lead in the self-driving future.

Question put and agreed to.

Resolved,

That this House has considered connected and automated vehicles.

15:49

Sitting suspended.

Lasting Power of Attorney

Tuesday 28th October 2025 Westminster Hall

15:59

[Valerie Vaz (in the Chair)]

I remind Members that they may make a speech only with prior permission from the Member in charge of the debate and the Minister. As is the convention for a 30-minute debate, there will not be an opportunity for the Member in charge to wind up.

[Fabian Hamilton (Leeds North East) (Lab)]

I beg to move,

That this House has considered lasting power of attorney.

Thank you for that introduction, Ms Vaz; it is a pleasure to speak this afternoon under your chairship. This debate has been secured at an extremely important time, as lasting powers of attorney continue to be granted across the country. Although it is clear that the vast majority of attorneys act in the best interests of the donor, there is still considerable abuse among the very small minority who do not.

Since the campaign, in which I have been involved, to end the abuse of lasting powers of attorney began, I have received hundreds of testimonies from across the country in respect of vulnerable people who have had their funds stolen or used for purposes not in the interests of the donor. Most of the campaign’s focus has been on the abilities of the Office of the Public Guardian and the implementation of its powers, but it is important to look at the root cause of the abuses and why they are able to occur in the first place.

The abuse often begins following interactions with banks. There is no getting away from the fact that the digitisation of lasting powers of attorney processes has opened the door to abuse from a very small minority of unscrupulous individuals who have taken advantage of the ease with which an attorney can gain access to a donor’s bank accounts. The lack of legislation and duties placed on banks has resulted in an uneven implementation of safeguarding when it comes to lasting powers of attorney. That is why our campaign has called for the implementation of Government-regulated safeguarding procedures for all banks in how they deal with LPAs and the accounts of donors.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for all his hard work in the House. I do not think anybody in this House is not impressed by his dedication, interests and commitment, and this debate is another example.

In Northern Ireland, the enduring power of attorney is a legal document that lets us choose someone to make decisions about our property and financial affairs if we lose mental capacity. Unlike in England and Wales, there is no equivalent of the lasting power of attorney for health and welfare in Northern Ireland. Instead, a separate process is available, through the Royal Courts of Justice, to appoint a controller if no EPA exists. Does the hon. Gentleman agree that the processes both here and back home must be streamlined and accessible, while still ensuring that safeguards are in place to protect people from the abuse of power?

[Fabian Hamilton]

The hon. Member will hear later in my speech how I intend to address the issue of safeguarding, which is one of the most important parts of the process. Let us be clear that, as I said, the vast majority of lasting powers of attorney have no difficulty, problems or issues whatsoever. We need to concentrate our efforts on the small minority who cause the grief, in respect of whom people need to be safeguarded from abuse.

The Government-regulated safeguarding procedures that I mentioned, in respect of all banks in dealing with LPAs and the accounts of donors, would include a requirement to contact the donor or a GP before an LPA is activated, and the monitoring of spending prior to and after its activation.

I am afraid abuse is rife in a small minority of cases, and the recorded increases do not scratch the surface, given that most cases are undetected, not thoroughly investigated and not reported as often as they should be. The Office of the Public Guardian’s annual report made that clear last year. For example, there has been a 6.5% increase in the number of concerns about abuse raised with the OPG, but a slight decrease, from 34.5% to 33.9%, in the proportion leading to a full investigation. That change might seem small, but a lot of people are affected, and every individual concerned has a family, relatives and friends who are deeply concerned.

Two weeks ago, alongside UK Finance, I hosted a roundtable for banks that administer lasting powers of attorney. They verified that the figures cited have been seen in their work on vulnerability, with the OPG admitting that approximately 65% of potential financial abuses are being disregarded simply because the donor is deemed to have capacity. Let us be clear: someone may have capacity, but that does not mean that they cannot be coerced or financially abused.

[Alex Easton (North Down) (Ind)]

In the light of the projection that 1.4 million people will be living with dementia in the UK in 2040, does the hon. Member agree that we need sufficient safeguards to protect vulnerable people?

[Fabian Hamilton]

With the increase in dementia and with Alzheimer’s projected to rise incrementally, the hon. Gentleman is right that safeguarding needs to be far tighter. I will come on to say what I think that would involve.

At our meeting, several banks highlighted clear failings in safeguarding procedures and investigations by the Office of the Public Guardian. Given that the OPG will not investigate any case in which the donor is deemed to have capacity, and that it has no powers to access the financial records of attorneys, investigations are toothless at best. The banks then face a back and forth with the OPG, as both urge the other to investigate what they claim to be a “civil matter”. Banks regularly ask the OPG whether they should act on an account that is under investigation, but are told it is up to them to decide whether to do so. That begs the question: “What is the purpose of the OPG and why does it lack the powers to act?”

One of the banks raised the example of a single individual to whom tens of LPAs were registered, but UK Finance was not aware, so no investigations took place until concerns were raised and a bank conducted a vulnerability check on the donor, by which time it was too late and the individual had already gathered the funds of several people. That case is sadly not an isolated incident.

[Chris Bloore (Redditch) (Lab)]

I thank my hon. Friend for his dedicated work on this subject. Does he agree that, given that over 6 million people in the UK hold lasting power of attorney agreements, mandatory safeguarding procedures for all Government staff who handle LPAs, alongside clear guidance for banks, is essential to protect vulnerable people and communities such as mine in Redditch?

[Fabian Hamilton]

My hon. Friend is absolutely right, and that is what the campaign has been arguing for since it began. The publicity given to the cases that I raised on the Floor of the House last November, when I introduced my ten-minute rule Bill, led to a large number of people bringing forward cases from up and down the country, often through their local MPs, asking to be added to the list of abuses. In total, the number of abuses may not amount to more than a fraction of a percentage of the total number of LPAs granted; nevertheless, my hon. Friend mentioned 6 million people, and I believe it is more like 8 million, and a small percentage of 8 million is still an enormous number of people.

The issues go much further. Whistleblowers at the OPG have told me that no potential attorney is ever vetted, and that it is extremely easy to walk away with a signed document stating that someone is the attorney. Let me repeat that: no attorney is ever vetted. That is rather worrying. There is evidence of abusers producing fake religious documents to help them to claim they are married to people who are decades older than they are and who clearly lack capacity. Technically, that is still not against the law so, despite it being utterly immoral, there is very little that the OPG can do about it.

As I have said, hundreds of cases of potential abuse have been raised with me since I introduced the Powers of Attorney Bill to Parliament last November. I will highlight some more of them now, in addition to the cases I raised last year. Azhar Hayat lost his life savings as a donor through the granting of a lasting power of attorney. An alleged investment of £126,000 was transferred to his attorney, with most of the funds going directly into a company of which the attorney was the sole director. Mr Hayat’s funds were then converted into shares in the attorney’s name, and he subsequently lost everything in one fell swoop. In the same year, the attorney closed the company, leaving with all the funds. That has left Mr Hayat having to seek an order for the sale of his own home in order to survive financially.

The OPG took over four months to terminate the LPA, and by then, as ever, it was too late. It was only after an intervention from his Member of Parliament that Mr Hayat was able to seek to recover funds via insolvency. I am afraid that route failed, so he did not recover any of those funds.

[Rachel Gilmour (Tiverton and Minehead) (LD)]

Minehead has a very large elderly and deprived population. Could we, as Members of Parliament, help the hon. Gentleman in his best endeavours by encouraging our constituents, particularly if we live in or represent constituencies with large elderly populations, to come forward and talk to us as their MPs, so that we can pass on their representations to him, because he is doing an excellent job?

[Fabian Hamilton]

Yes, indeed. My constituency office in Leeds North East is trying to compile a list of all the cases that have come to us. Every one of them is different but they all have a common theme: unscrupulous individuals who have taken advantage of a lasting power of attorney in order to gain the donor’s funds as quickly as possible for their own nefarious purposes. That tragedy is part of the ongoing trend of the abuse of older people, which we have to stop. As parliamentarians, we have a duty to do just that.

Another victim, Nicola, wrote to me to outline her family’s tragic case. Nicola is not alone when she describes the interaction between banks and prospective attorneys as “a tick box exercise”. In her case, the bank’s representative queried a change to the power of attorney that had occurred a few months earlier. The bank asked only for an affidavit from the solicitor to ensure the capacity of the donor. Later, however, court evidence showed that the solicitor had a conflict of interest in respect of the subject and their business manager.

Around the time of the bank’s involvement, the donor had received a diagnosis of Alzheimer’s disease, which had been confirmed by a CT scan nine months earlier. The donor’s deteriorating health was clear, with the LPA activated on health grounds having been actioned a year earlier. The LPA for finance was invoked following the specialist diagnosis. The donor was isolated, away from her brother, whom she had originally appointed as the attorney to protect her interests. The solicitor removed the safeguard of unanimity without advising her brother until months later, when it was far too late.

[Tessa Munt (Wells and Mendip Hills) (LD)]

I understood that someone could execute a power of attorney only if they had capacity, so if there had been a diagnosis of Alzheimer’s, that would not have been possible. Am I incorrect?

[Fabian Hamilton]

No, the hon. Lady is not incorrect, but an LPA can be executed in advance of any potential diagnosis. When somebody starts to feel that they are losing the capacity to make financial decisions or decisions about their future health, they can execute the lasting power of attorney to be implemented or actioned once the diagnosis is made or capacity is lost completely or irreversibly. That is my understanding, but I am sure the Minister will correct me if I am wrong.

The brother was then removed as an attorney two months later when he challenged the withholding of the donor’s income and clawing back of historical expenses. He was replaced by the donor’s accountant.

Nicola told me:

“The donor in this case had a long standing history with the bank both in her personal and business capacity. The bank would have been aware of the manager taking over the management of her personal banking affairs going back years. This may have started as a convenience for the donor, but later became a necessity.”

That partly answers the hon. Lady’s question. Nicola went on:

“This casual arrangement apparently accepted by the bank allowed financial abuse to follow.”

Obviously, in that case, the Office of the Public Guardian did not have a role, although it will later in the story. The business manager and the accountant both admitted in court that they had withheld income from the subject for the preceding year and continued to withhold income until the donor’s death seven years later.

Nicola has rightly called for banks to have annual face-to-face meetings with their elderly clients to establish their ability to manage their affairs on their own without outside influence. Any changes to LPA documents and wills within a year of a diagnosis of a cognitive illness, such as dementia, should also be treated with caution and investigated thoroughly before they are granted.

There is also serious anxiety about this issue within the industry. I have spoken to sources in the Office of the Public Guardian and trading standards who highlighted their concerns regarding the lack of the use of powers and the systemic failure to protect people. An officer with more than 30 years’ experience in trading standards told me that they are seeing the numbers of this type of abuse climb to levels they have never seen before, but they can never prosecute because of the lack of assistance from the OPG.

Furthermore, the officer had suspicions that a certificate provider was selling LPAs for far more than the usual registration fee, but when the evidence started to mount, the OPG and the Competition and Markets Authority failed to provide the crucial information needed to prosecute. I would be keen for the Minister to look into what steps are taken to verify that a certificate provider is genuine and not making profits from its work.

Another experienced officer from the Office of the Public Guardian told me about their utter frustration at the processes. They cited a four-month backlog that is allowing abuse to continue. In a lot of cases, that gives the abuser ample time to move money around to escape justice. When grounds-to-investigate processes begin, they are not acted on for weeks, with timeframes set for investigations only after that has taken place.

OPG staff say that since the introduction of digital applications for LPAs, demand for investigations has increased. They suggested that best practice is for the Court of Protection to give consent if the donor has lost capacity and the attorney wants to gift a substantial amount of money. However, that is being applied inconsistently among banks as there are no regulations that ensure they follow it through, and banks are simply taking an attorney’s word that a donor has lost capacity.

A staff member pointed to declining morale at the OPG because of the rise in cases, with little to no safeguarding training. They even expressed concern about the dehumanisation of the people they deal with. These are some of the most vulnerable people in the country, and some are clearly being coerced or abused.

Members of this House have previously looked closely at the lasting power of attorney. In 2004, the Health Committee endorsed the recommendations of the Joint Committee on the draft Mental Incapacity Bill relating to the lasting power of attorney. It recommended that there be clarification of the extent and limitation of an attorney’s powers, as well as adequate guidance and training for donors; that there be further guidance to warn donors of the potential for conflict; and that an additional safeguard be included in codes of practice as a mechanism by which the Court of Protection or the public guardian could monitor the use of LPAs with a view to preventing the abuse and exploitation of an attorney’s powers. It also recommended that an express duty of care should be incorporated into law for attorneys acting under an LPA, in that a greater degree of accountability should be required, with specific requirements in the form of a standard of conduct that should be included in the codes of practice. Attorneys should also be under an obligation to notify the donor, the bank and the public guardian that the donor lacks capacity, or is losing capacity, thereby putting that information on the public record and opening it up to challenge.

I thank the Minister for meeting me earlier this year following the introduction of my Bill. I know that she takes these issues extremely seriously, and I am pleased to see her in her place. I am also grateful to the victim-survivors of this horrendous financial abuse who shared their stories with me. Each story has similar patterns, but each has its own victim who is often coerced and robbed of their life savings and assets.

Finally, I am struck by the commitment of those who have reached out to me. Ending this injustice for other families and vulnerable people is their driving force, and I cannot commend them enough for their selfless and committed campaigning on an issue that could impact any single one of us. I look forward to the Minister’s comments.

16:21

[The Minister of State, Ministry of Justice (Sarah Sackman)]

It is a pleasure to serve under your chairship, Ms Vaz. I thank my hon. Friend the Member for Leeds North East (Fabian Hamilton) for continuing to raise awareness on this extremely important subject.

While I cannot speak to the individual cases that my hon. Friend raises, I send my deepest sympathies to those individuals impacted by the behaviours and abuse he describes, which were directed at them by people who had been selected to protect them and trusted with lasting power of attorney. I recognise the personal and financial impact on those affected people, and the impacts that are more widely felt by families.

My hon. Friend drew attention to the risk of abusers misusing lasting powers of attorney, and he highlighted the Office of the Public Guardian’s important role in investigating such concerns when they arise. His strong, ongoing commitment to raising awareness of those issues is welcome. As many hon. Members will know, he tabled a ten-minute rule Bill on this subject at the end of last year. That Bill has not yet reached Second Reading, but I know that he continues to engage across the mental capacity sector to raise awareness of it. As he noted, we met and discussed the Bill and his work in this space, and I welcome that engagement. I know that he has also engaged directly with the Office of the Public Guardian so that they can work together. Today’s debate is another demonstration of his dedication to the issue.

For context, the Mental Capacity Act 2005 provides the legal framework for supporting individuals who may lack capacity to make specific decisions. It ensures that any decisions made on a donor’s behalf are in their best interests, and that their rights and autonomy are respected. A lasting power of attorney is a legal document that allows a person—the donor—to appoint one or more trusted persons to make decisions on their behalf if they lose mental capacity. In that sense, at its best, it is a source of empowerment for individuals.

As my hon. Friend rightly points out, we need to set the very real issue of financial and economic abuse in context. The evidence demonstrates that the incidence of such abuse is thankfully relatively rare. At the end of 2024-25, the Office of the Public Guardian had 9.3 million lasting powers of attorney on its register. A total of 11,300 concerns were received by the Office of the Public Guardian during 2024-25. Some 96% of those concerns were responded to within five working days. Of those concerns, 3,800 cases led to a full investigation by the OPG, and 24% of completed investigations resulted in court action.

That does not for one second diminish the significance of the impact of abuse in individual cases, but it tells us that cases of abuse are rare in the context of a powerful and empowering tool for many. We want the LPA to be accessible, affordable and empowering. Indeed, I was advised by my officials that we should all take one out—obviously, through the proper processes and with the proper safeguards. It is important to set this discussion, which centres on the role that banks and financial institutions play, in the context of the existing regime and its safeguards.

LPAs must be registered with the Office of the Public Guardian before they can be used, and there are safeguards in place to protect against abuse. A lasting power of attorney must contain a certificate, signed by a person with relevant skill and expertise or by someone who has known the donor for at least two years. That person confirms that the donor understands the LPA, and that no fraud or undue pressure was applied in the making of it. That confirmation is an important protection against the coercion and abuse that we have been discussing. There is also an existing statutory right for attorneys and persons named in the LPA to object to its registration if they have concerns about how the LPA has been made. Once the LPA is registered, anyone—any third party—can raise an objection about how it is being used for the Office of the Public Guardian to consider. Those are the concerns that I spoke about, which in 3,800 cases last year led to an investigation and, in many cases, to court enforcement.

As I have said, the abuse of LPAs can have serious financial and personal consequences. The OPG plays an important role in identifying and responding to such cases. It investigates concerns raised about an attorney’s actions. It has powers to request information from individuals and organisations such as banks, care providers and medical professionals. It can ask attorneys to explain their decisions and to provide records. If the investigation reveals serious concerns, the Office of the Public Guardian can apply to the Court of Protection to suspend, restrict or remove an attorney.

The Court of Protection plays a crucial role in protecting individuals from the abuse or misuse of powers under a lasting power of attorney. It can order the revocation or suspension of LPAs or the removal or replacement of attorneys if it determines that the attorney is acting contrary to the donor’s best interest. If a donor has lost capacity when a lasting power of attorney is revoked and there is no other attorney to act, the Court of Protection can step in and appoint a deputy to manage the donor’s affairs. It can also issue orders to protect the donor, such as freezing bank accounts or prohibiting certain actions by attorneys. If an attorney’s behaviour raises concerns but does not breach the criminal law, the OPG can still order remedial actions.

The point I seek to make is that we have a regime that contains a sequence of safeguards designed to guard against the very abuse that my hon. Friend the Member for Leeds North East raises. It is also important that we scrutinise and hold the Office of the Public Guardian to account. That is the job of the Ministry of Justice, so I take very seriously the cases that my hon. Friend has raised, particularly where there are suggestions that the Office of the Public Guardian has not been as proactive as it might have been. That ongoing performance review of the OPG is critical.

I want to look ahead to the future. I am not for one second seeking to minimise the severity of what my hon. Friend described, nor seeking to suggest that there is not room for improvement or that we cannot strengthen those safeguards, because that will be a critical part of modernising the lasting power of attorney. As others have mentioned, such powers are only going to become more critical in an ageing society with growing numbers of people losing mental capacity through conditions such as Alzheimer’s or dementia.

As a Government, however, we are committed to going further and modernising the service to increase the safeguards in the lasting power of attorney process and to improve access to them. The Powers of Attorney Act 2023 introduced several provisions to enable a modernised system. To combat fraud and abuse, the Act will facilitate the introduction of further identity checks for parties making an LPA. The Act also lays the groundwork for reforms to the objection process so that any third party—typically organisations already involved with vulnerable adults, such as local authorities or the police—can object to an LPA being registered. Those reforms, which are in train, are designed to make the LPA system more secure, providing greater protection for individuals appointing attorneys to manage their affairs.

I am conscious of time but I will say something quickly about banks. My hon. Friend will understand that the Treasury leads on the regulation of the banking sector and on safeguards for vulnerable consumers, including those with LPAs. I am not a Treasury Minister but I want to reassure my hon. Friend that the Government work closely with the Financial Conduct Authority, which is the independent regulator, on vulnerable customers, including vulnerable donors of LPAs. In 2023, the FCA introduced the consumer duty. Banks, of course, are also subject to the financial abuse code, the Equality Act 2010—

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

World Stroke Day

Tuesday 28th October 2025 Westminster Hall

16:30

[Munira Wilson (Twickenham) (LD)]

I beg to move,

That this House has considered World Stroke Day 2025.

It is a pleasure to serve under your chairmanship, Ms Vaz. I thank all the hon. Members who have come to Westminster Hall today to mark World Stroke Day, which is tomorrow. This year, recovery is in the spotlight, and this debate provides a timely opportunity to consider the life-changing impact a stroke can have both on a survivor and their loved ones and how the NHS can better support patients’ recovery beyond the acute phase of treatment in the early days following a stroke.

Every day in the UK, another 240 people wake up to the catastrophic impact of a stroke. There are currently more than 1.4 million stroke survivors in the UK. On 9 May this year, my mother was one of those people, and that is the primary reason why I secured this debate. Her experiences over the past six months are still too raw and too devastating for us as a family for me to talk about today. Sadly, too many stories shared with me in recent weeks reflect exactly what my mum has been through and is still going through.

I will endeavour to use the short time available to highlight some of those stories and to call on the Minister to prioritise stroke rehabilitation in particular. Not only is that the right thing to do for the patient and for their family, but it makes a lot of financial sense. Ultimately, it would save the taxpayer money in healthcare and social care costs and enable those of working age to continue to work and to be active in their communities.

The Stroke Association estimates that, without Government action, stroke is expected to cost £75 billion by 2035. Approximately 100,000 people have a stroke each year in the UK, with 59% of them occurring in older generations. There are 38,000 stroke-related deaths every year, which makes it the fourth single leading cause of death in the UK. It is also the leading cause of complex adult disability in the UK, with around 60% of stroke patients leaving hospital with a disability. Stroke causes brain damage and can leave survivors unable to move, see, speak or even swallow. It can leave people doubly incontinent and lead to personality changes as well as depression. The NHS is rightly lauded for the care it provides, particularly in hospital, often delivering world-class support to those who need it when the unexpected happens.

[Afzal Khan (Manchester Rusholme) (Lab)]

In my constituency, Manchester royal infirmary’s ward 31 provides outstanding acute and rehabilitative stroke care, supported by dedicated community health champions who promote prevention and early intervention to reduce the risk of stroke. Will the hon. Member join me in thanking both our dedicated hospital staff and community health champions, and support sustained investment in prevention, staffing and rehabilitation so that we can save lives and help survivors recover fully?

[Munira Wilson]

Of course I am very happy to congratulate the staff in the hon. Gentleman’s local hospital. Through my personal experience with my mother, I have seen how amazing hospital staff are, and where community services are available, I am sure those staff are brilliant, but the crux of my speech is about how poor the rehab services are in some parts of the country and how we really need to staff and boost them if we want to help people to have a good quality of life.

I have heard time and again from those who have lived experience that support for community rehabilitation is simply not good enough and often collapses six weeks post discharge from hospital. In some cases, support even six weeks post discharge is not available, depending on which integrated care board or local authority is responsible.

[Steve Darling (Torbay) (LD)]

In Torbay, in Devon, we have the third highest prevalence of strokes in the United Kingdom, and yet, within the last 12 months, we have seen cuts to support for the local stroke association. That has left people who are suffering from strokes feeling isolated and abandoned. Does my hon. Friend agree that we need to see more investment at the grassroots to support sufferers of strokes?

[Munira Wilson]

I 100% agree. The post-stroke support is critical, and I will share some stories about people who have felt abandoned and isolated in exactly the way that my hon. Friend describes.

Despite guidelines from the National Institute for Health and Care Excellence, the Chartered Society of Physiotherapy says that 20% of people do not receive the minimum specialist rehabilitation required in the first five days following a stroke, and 68% do not have an assessment for rehabilitation, which is required after discharge. The reality is that those who want to regain a level of independence need to be able to fund support privately.

I pay tribute to Richard Sealy, who runs the Neuro Rehab Practice in Hampton, which is in my constituency. He and his whole team are doing brilliant work in trying to fill that gap. Over the summer, I had the privilege of visiting the practice and speaking to stroke survivors and their carers about their experiences. What runs through so many of their stories—I am sure Members will have heard similar—is the cliff edge that people fall off when they leave hospital, and the devastating knock-on impact that can have.

I would like to share some of their testimonies. One stroke survivor said:

“I felt lost, like I had been thrown out of the boat, not knowing what to do or where to find help”.

Another survivor’s family member said:

“Although the NHS took care of her while she was in hospital, we felt that after the six weeks had finished, it was very much goodbye. You’re now on your own”.

Another, when asked what happened when the NHS rehab ended and whether they were given any further options, simply replied, “Nothing.”

Those survivor stories are far from unique, and that is unacceptable. According to the Stroke Association, only 17% of community-based rehab services have appropriate access to each core therapy—physiotherapy, speech and language therapy and occupational therapy. The Right to Rehab campaign argues for the simple idea that rehabilitation should be accessible to everyone who needs it, for as long as they need it.

We know that stroke survivors continue to make incremental improvements over many months, even years, so I welcome the Government’s ambition to rebuild our NHS through transitioning care from hospital to the community, and to improve integration of rehabilitation. While the Government target to reduce stroke and heart attack deaths by a quarter in the next 10 years is also welcome, given the devastating impact that stroke can have and the struggle to recover faced by many, the scope of that target must be widened to also reducing disability.

Take Miriam, a resident of Twickenham, who at just 21 years old suffered a stroke only three months after graduating with a BA in music. After spending four days in hospital without diagnosis or treatment, where she suffered two more strokes, she was unable to play an instrument or even grasp a pencil. She suffered significant challenges, including depression and isolation, but through therapy and determination, she was able to rebuild her life. Miriam is now a neurological music therapist, working with children and adults with learning disabilities, and I believe she is here, watching today’s debate.

Chris Stirling, who suffered a stroke in his 60s, was told by doctors after six months in hospital that he should go into a care home. He left hospital in a wheelchair, unable to shower. Thanks to privately funded neuro physiotherapy and the support of his family, he is now able to play golf, one-handed. Not everyone is as lucky as Chris to have both the means and the family support.

Miriam and Chris’s stories, and the testimonies I shared earlier in my speech, show just how important it is to get both stroke diagnosis and rehabilitation right.

[Carla Lockhart (Upper Bann) (DUP)]

The hon. Member is making a powerful speech. Family friend Hannah Garrity, who is now in her 20s, took her stroke at the age of eight. She was a little girl, who woke up one day and took a severe headache, and out of that, she had a very severe stroke. She is an inspiration. She is now teaching art in schools. She is a Sunday school teacher in her local church, and she gives so much back to society. Would the hon. Member agree that more research is needed, particularly in relation to strokes in young people and children, given the increase in the number of them who are taking strokes?

[Munira Wilson]

Absolutely. I am sure that in stroke, as in so many other areas of medicine, more research would be welcome, particularly into how we can prevent stroke in younger people. It is shocking to hear that a child so young suffered a stroke.

The stories that I have shared today demonstrate the impact that good care and rehab can have on quality of life, regaining independence and restoring people’s identity. The moral, social, health and economic cases for better rehab support are overwhelming. Will the Minister therefore commit to expanding the Government target to cut deaths caused by stroke and heart attack to include reducing disability? With stoke and cardiovascular disease a trailblazer for the modern service framework, what discussions is he having in the Department and with the Treasury to resource implementation and ensure there is a lead in the Department on this area? With 40% of physiotherapists saying that insufficient staffing is leading to their patients experiencing increased levels of pain and ill health, what work is he undertaking to expand the physio workforce? Will he look at ensuring that integrated care boards’ data plans capture and report on performance and rehabilitation, including in relation to populations who are not accessing rehabilitation?

On this World Stroke Day, stroke survivors and their carers are not asking for the impossible: a concrete plan to make stroke rehabilitation accessible across the country, no matter what someone earns or where they live. As the Secretary of State himself said only at the start of this year,

“Whether in the NHS or in social care, we definitely need to do more on rehabilitation, because rehabilitation is often secondary prevention.”—[Official Report, 6 January 2025; Vol. 759, c. 608.]

He was right, and now that needs to be delivered. I look forward to the Minister’s response. I would welcome the opportunity to meet him to discuss these issues alongside patient groups and representatives.

16:41

[Uma Kumaran (Stratford and Bow) (Lab)]

I thank the hon. Member for Twickenham (Munira Wilson) for securing such an important debate ahead of World Stroke Day. I send her mum our best wishes; I know how hard it is to speak about these personal issues in the House.

A stroke happens every five minutes. That means that each year 100,000 people in Britain will have a stroke. One in seven of those stroke patients die in hospital, and six in 10 will leave hospital with a disability. Until last year, those were all simply statistics to me. I knew that stroke was a major cause of disability and that people suffered strokes, but to me those people were always much older.

Since then, my understanding has changed drastically. Last year, on my first day in Parliament, my husband, Jacob, suffered a stroke. While other colleagues were queuing to be sworn in, I raced across London to find him in an intensive care ward. Learning what had happened was terrifying. It was totally unexpected. Jacob is young and healthy, and does not drink or smoke, but stroke does not discriminate. I learned quickly that what happened to him is not as rare as we thought: one in four strokes happen to people of working age. Stroke has the ability to turn someone’s life upside down. Simple, everyday tasks become difficult, and the jobs people once did may become alien to them. Stroke does not discriminate in who it strikes or where it strikes, but the care stroke patients receive across the country does. There are severe inequalities, and we must end the postcode lottery in access to treatment and rehabilitation.

When it comes to acute treatment, we absolutely know what works. Thrombolysis and thrombectomy save lives. The Prime Minister has spoken about the power of artificial intelligence to help doctors find blood clots in seconds. We also know that, too often, where someone lives impacts the quality of care and their quality of life after a stroke.

[Irene Campbell (North Ayrshire and Arran) (Lab)]

Currently, no Scottish hospital offers 24/7 emergency thrombectomy. For example, there is no night-time provision of mechanical thrombectomy, and in Glasgow emergency thrombectomy is available only Monday to Friday. There are severe gaps in the system. Does my hon. Friend agree that that is just not good enough?

[Uma Kumaran]

I absolutely agree with my hon. Friend. Thrombectomy is highly effective and can transform recovery, massively reducing the chances of a disability. I hope that the Minister will respond to that point about care in my hon. Friend’s community.

Recent statistics show that while in London more than 10% of patients receive a thrombectomy, in the east of England, only 1% of stroke patients underwent this potentially lifesaving treatment. I apologise that I do not have the statistics for Scotland.

[Dr Scott Arthur (Edinburgh South West) (Lab)]

Will my hon. Friend give way?

[Uma Kumaran]

Does my hon. Friend have the statistics?

[Dr Arthur]

I do. I thank my hon. Friend for giving way, and wish her husband well—I am sure that he is incredibly proud of her. In Scotland in 2024, only 212 thrombectomies took place, which accounts for 2.2% of all eligible cases. Those are statistics that should shame us. If we compare it with Ireland, a comparably sized country, the number is five times higher. Does my hon. Friend agree that we can always do better?

[Uma Kumaran]

I absolutely agree with my hon. Friend, and thank him for having the statistics and always being a voice for Scotland. As we discussed, these inequalities have real-world consequences. Gaps in care and inequality in access jeopardise lives—in the most extreme cases they cost lives. While previous Governments have left stroke care underfunded and under-prioritised, I am proud to see this Labour Government tackling it head on. They are getting on with delivering the changes that we need to see so that the NHS can prevent strokes, and act fast when they strike, making the most of digital innovation, and delivering the best quality care for everyone as they recover.

While I am pleased to say that, after heart surgery this summer, Jacob is fully recovered, his stroke has absolutely transformed our family’s life—it changed it forever. But every day, hundreds of families across the UK face the same reality. That is why I can say that this Government’s target to slash stroke mortality in a decade is not just a statistic; it is lives saved and lives changed. I use this opportunity to thank the Minister, my hon. Friend the Member for Glasgow South West (Dr Ahmed), for both his professional and personal support to Jacob and I during this time in our lives. We will never forget his kindness and fast thinking.

I join hon. Members from across the House in calling on this Government to do all they can to ensure that their 10-year health plan delivers for stroke patients, no matter their age, postcode or what region they live in. Every stroke survivor must get the care that they need to thrive.

[Several hon. Members rose—]

[Valerie Vaz (in the Chair)]

Order. If Members stick to between three and four minutes, we should be able to get all the listed speakers in—there are a few more standing. There will be a Division at 5 pm.

16:46

[Brian Leishman (Alloa and Grangemouth) (Ind)]

It is a pleasure to serve under your chairship, Ms Vaz. I thank the hon. Member for Twickenham (Munira Wilson) for securing this important debate and sharing her mum’s story.

One of the best bits of being an MP is meeting individuals and organisations that do so much good across Alloa and Grangemouth, like when I met the Clackmannanshire Stroke Support Group earlier this year. Their courage, spirit and determination in the face of serious adversity was truly inspiring.

I will focus on the relationship between deprivation and having a stroke. In Scotland, approximately 13,000 people have a first stroke each year. There are an estimated 150,000 stroke survivors in the country, and recent data shows that people in the most deprived areas are twice as likely to have a stroke as people from the most affluent areas.

The relationship between deprivation and stroke mortality is over five times higher for those in the 10% most deprived areas compared with the 10% least deprived, in the under-65 age group. There is a significantly higher risk of dying within a year of having a stroke for those people from more deprived areas. These patients are less likely to receive recommended treatments such as blood thinners for atrial fibrillation, and are more likely to be given less effective alternatives.

Chest Heart and Stroke Scotland works hard in communities across Scotland to deliver prevention and support recovery, and to enable people to self-manage their condition. But it cannot be up to organisations to fight this alone. They need help from the Scottish Government, and there must be a much more proactive approach adopted in how healthcare services are delivered. The postcode lottery in what treatment someone receives in Scotland because of where they live really must end.

16:48

[Adam Dance (Yeovil) (LD)]

It is a pleasure to serve with you in the Chair, Ms Vaz. I thank my hon. Friend the Member for Twickenham (Munira Wilson) for securing this debate and sharing her stories.

I start by sending my best wishes to my constituent John Falconer, who recently suffered a mini stroke. John has been campaigning tirelessly to reopen the hyperacute stroke unit at Yeovil district hospital—he was campaigning before he had the stroke. In 2024, Somerset ICB decided to close the unit as it could not sustain a full service. Instead, patients are now treated at Musgrove Park hospital or Dorchester county hospital.

While I understand the reasoning, I remain deeply concerned about the impact that has, particularly the long travel times. When someone has a stroke, every minute matters. The target for patients with a clot stroke is to receive treatment within 180 minutes of 999 being called, but data collected by John and the Quicksilver Community Group shows that that would be met for only 13% of Yeovil patients taken to Taunton and 30% taken to Dorchester, compared with 74% when treated at Yeovil. Although staff at Taunton and Dorchester can provide treatment for people from Yeovil, there is real concern that some patients may not get there in time, with consequences, as we have heard today.

My constituents want to know why greater resources cannot be invested to maintain a full, sustainable service in Yeovil. I am calling on the Somerset ICB to run a trial—as I have previously asked—comparing outcomes for patients in the Yeovil HASU and those taken outside the constituency.

16:50

Sitting suspended for a Division in the House.

17:05

On resuming—

[Adam Dance]

I call on Somerset ICB to run a trial comparing outcomes for patients in the Yeovil HASU and those taken outside the constituency. Staff in Yeovil hospital would welcome that, and it would give peace of mind to know that the decision was based on clear evidence.

When it comes to stroke care, speed saves lives. My priority is to ensure that every person in Yeovil can get the treatment that they need, as quickly as possible. With one in four of us at risk of having a stroke in our lifetime, we must make sure that our health services are safe, local and accessible.

[Several hon. Members rose—]

[Valerie Vaz (in the Chair)]

Order. We have five more Back-Bench speakers and we expect the winding-up speeches to start at 5.23 pm.

17:06

[Jas Athwal (Ilford South) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Vaz. I, too, thank the hon. Member for Twickenham (Munira Wilson) for securing this important and timely debate and for sharing her personal stories.

We have heard the statistics: stroke is the UK’s fourth biggest killer and the single largest cause of complex disability. Stroke survivors’ lives are completely altered. Some are left paralysed, their fondest memories are lost and old personality traits and mannerisms are erased by new, unfamiliar ones. Loved ones experience the heartbreak of seeing someone they love become a shell of their former self.

The aftermath of a stroke often extends beyond the physical changes. Many survivors are left with the trauma and grief of being sick and of losing within a matter of minutes the ability to do some of the things they were once able to do, and overwhelmed by the fear they might experience stroke all over again.

However, there is a reason to be hopeful. How fast we act when someone experiences a stroke can have a profound impact on their journey to recovery. The minutes and hours after a stroke can be the difference between a good and a poor quality of life, and even between life and death. That is why I was very pleased that last November the NHS expanded its FAST stroke campaign, reminding us of the key signs of stroke: F for face, A for arm, S for speech and T for time to act. By recognising those warning signs, we can act and improve survivors’ futures. The NHS campaign demonstrates that stroke signs can be less pronounced, like someone being unable to finish reading a bedtime story to their grandchild or someone suddenly feeling that they are unable to smile.

I was particularly pleased to hear that the new campaign has been making its way to ethnic minority TV channels and on to social media to raise awareness. Researching for this debate, I came across an alarming study revealing that ethnic minority patients tend to have strokes about five years earlier and are at least twice as likely to face serious complications or death. The study highlighted the fact that that disparity co-exists with many chronic health conditions such as increased rates of diabetes, a condition that also increases the risk of stroke.

That is why this World Stroke Day we need to focus our efforts on prevention and awareness. We need to continue promoting a healthy lifestyle to all, and ensuring that those from ethnic minorities have the same awareness about stroke, so that they can benefit from better health outcomes. World Stroke Day provides us with the opportunity to pay tribute to carers at home and in the NHS, to raise awareness of the signs of stroke—remember the FAST acronym—and to acknowledge the bravery and perseverance of stroke survivors. I say to the Minister, “Please end the postcode lottery and improve the care in the community.” Stroke strikes indiscriminately, so the 10-year plan must address the inadequacies and differences across the country. I appeal to the Minister to reach out.

17:09

[Lillian Jones (Kilmarnock and Loudoun) (Lab)]

It is a pleasure to serve under your chairship, Ms Vaz. I thank the hon. Member for Twickenham (Munira Wilson) for securing this important debate.

During the past year in Ayrshire, 852 people’s lives changed in an instant when they suffered a stroke, the outcome of which depended on the speed and quality of care that they received. Stroke is a medical emergency; “Every Minute Counts” is not just a slogan, but a theme of this year’s World Stroke Day. That is because for every minute that a stroke goes untreated, the brain loses nearly 2 million cells. Time is brain. Yet within NHS Ayrshire & Arran, just over 55% of stroke patients received the full stroke care bundle, a package of interventions proven to improve survival and recovery. That is way below the SNP Government’s own target of 80%.

The situation becomes even more critical during out-of-hours periods, which are weekdays from 5.30 pm to 8.30 the next morning, and the entire duration of weekends and public bank holidays, when GP practices are closed. Although thrombolysis, the clot-busting drug, must be administered within four and a half hours of symptom onset, access to the treatment can be delayed at night or on weekends.

The new thrombectomy service at the Queen Elizabeth university hospital in Glasgow is a welcome step, but the programme is still in a phased roll-out. Shockingly, to date only 10 patients from Ayrshire and Arran have received a thrombectomy, despite its being one of the most effective treatments for large vessel occlusion strokes. Yes, it is good that 10 lives have potentially been saved, but it is concerning that many more people might have missed out due to limited access and timing. Many patients who suffer a stroke outside standard hours face a postcode lottery, in terms of not just geography, but time, with the result being delayed treatment, poorer outcomes and a higher risk of long-term disability.

I have a 23-year background in the NHS, so I know that we must do better. Stroke care must be prioritised. Our NHS across Scotland must have the vital investment to be able to deliver stroke services 24/7, ensuring rapid access to thrombectomy for my constituents in Kilmarnock and Loudoun, and indeed throughout Scotland. The SNP Government must acknowledge the urgency and recognise stroke as a medical emergency by adequately funding our NHS with the vital resource to be able to deliver stroke services 24/7 to people in Scotland, regardless of where they live.

17:11

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairmanship, Ms Vaz.

I thank the hon. Member for Twickenham (Munira Wilson), both for setting the scene and for sharing the story of her mum, because such stories always give a very honest and true perspective. My own mother is now 94. When she was 93, she had a number of transient ischemic attacks, or TIAs. I remember being in the ambulance with her and in the hospital as she waited to be admitted. Ultimately, unfortunately, it led to physical disabilities. Although she is compos mentis and really sharp in her mind, even at 94, physically she will never be able to do the things that she once did—so I understand, and I thank the hon. Lady for sharing her story.

World Stroke Day is a day that sticks out for so many people—we would struggle to find someone who does not know an individual affected by the impact of stroke. Of course there is more to be done, and I am very pleased to be here today to discuss that.

I welcome the Minister to his place; I understand that this might be the first Westminster Hall debate as a Minister. Last night, he was in an Adjournment debate in the main Chamber; today, he is in Westminster Hall, so he is seeing great things on the tour of Westminster, and I wish him well in all that he does.

Statistics from the Stroke Association highlight that every day in the UK another 240 people suffer the catastrophic impact of a stroke. Two thirds of people who survive a stroke find themselves living with a disability and six in 10 survivors rely on the help of a carer, often a family member or friend.

This year, World Stroke Day aims to focus on the truth surrounding post-stroke recovery. Whether it is a short-term or long-term process of physical, behavioural or emotional rehabilitation, it begins in hospital, but can be lifelong, requiring support for months or even years in the community through carers and family.

[Alex Easton (North Down) (Ind)]

Unfortunately, Northern Ireland, where the hon. Member and I live, has the second highest rate of stroke across the UK, with something like 4,700 strokes each year. Does he agree that we need to share best practice and research, which is emerging from certain parts of the UK, right across the board?

[Jim Shannon]

I thank the hon. Member for his intervention, and he is right.

Whether it is our lifestyle, what we eat, the way we live, or whatever it may be, it is really important that we address these things. Recovery can take years and some people find it completely life-altering. Over the past 10 years, there has been a 23% increase in the number of people who are registered with their GP for chest, heart and stroke conditions. The figures are serious. It is crucial that support is available to those who require it. Those organisations, which offer fantastic support to families, ultimately take on a large amount of caring responsibility—and therapy, whether it is physical, occupational or speech therapy, should be accessible and helpful to all.

In conclusion, I remind hon. Members of the importance of the FAST strategy—face, arms speech and time—which is imperative in noticing the signs of stroke. This World Stroke Day, let us focus on recovery care and giving people the support they need to rehabilitate, get back on track and learn to cope with their new normal. I urge the Minister to work with the regional Administrations of Scotland, Wales and Northern Ireland; these are things that we can do better together.

17:15

[Chris Bloore (Redditch) (Lab)]

It is a pleasure to serve under your chairship, Ms Vaz. I thank the hon. Member for Twickenham (Munira Wilson) for securing this important debate and for sharing her personal story and those of her constituents. That is exactly why this is such an important issue for us to speak about. Stroke can happen to anyone, at any time, in any family.

Stroke is the leading cause of complex adult disability in the UK, yet too often it remains underfunded, understaffed and under-prioritised. Recovery does not end when someone leaves hospital—for many, that is just the beginning. Relearning to walk, to speak, to eat or simply to live independently again takes extraordinary strength and proper support. Physiotherapy, occupational therapy and speech and language therapy can transform lives, but right now only 17% of community services have access to all three.

In Redditch, there are around 2,000 stroke survivors. I thank everyone who has contacted me, from Redditch to the Lenches, from Harvington to Wychbold, to share their stories and experiences. This issue cuts across every age, every background and every family. I have spoken to people in their 30s and 40s whose lives were turned upside down overnight. Stroke affects not only individuals, but their loved ones, their workplaces and their communities.

I thank the organisers of the Redditch stroke support group for everything they do to help local stroke survivors and their families.

[Peter Dowd (Bootle) (Lab)]

Does my hon. Friend agree that organisations such as the one he mentioned, the Stroke Association and others have a vital role to play in bringing these matters to the attention of this House for as long as it takes?

[Chris Bloore]

I wholeheartedly agree with my hon. Friend. The work of those organisations—the listening, guidance and encouragement—is often what helps people to take the first steps back towards confidence, independence and hope. They are a vital part of our community and I am deeply grateful for their dedication.

The Government’s 10-year health plan is an opportunity to do better: to shift our focus from hospital to community and from sickness to prevention. We know that nine in 10 strokes are linked to preventable risk factors such as high blood pressure and heart disease. Prevention saves lives, but it must be matched by proper rehabilitation and support for those already living with stroke, because one in four stroke survivors will have another stroke within five years.

As we mark this World Stroke Day, I pay tribute to the Stroke Association, to our incredible NHS staff and, above all, to all survivors and carers, who show every day what courage and recovery looks like. With the right help, life after stroke is not just possible; it can be full of purpose, love and dignity.

17:18

[Terry Jermy (South West Norfolk) (Lab)]

It is a pleasure to serve with you in the Chair, Ms Vaz. I thank the hon. Member for Twickenham (Munira Wilson).

As it is for a number of speakers today, this debate is deeply personal to me. My dad had a severe stroke with no warning in 2013. He was just 55 years old. He lived with the aftermath of that stroke for 10 further years. In December 2022, he was hit by both pneumonia and covid and was placed in a medically induced coma, during which time he had a further stroke from which he never recovered. He died in January 2023, aged just 65.

That experience was one of the main reasons I decided to stand for Parliament. As it happens, stroke is a major issue in my constituency, where there are currently 2,868 stroke survivors. Of the 543 English constituencies, we rank 469th. Being disabled in a rural community such as mine comes with significant additional challenges. Many disabled people are unable to drive because of their disability. With inadequate public transport options, getting to basic medical appointments—or simply going on shopping trips—becomes either really difficult or really expensive. Loneliness and isolation are particular concerns and often worsen underlying mental health challenges.

In Norfolk, my constituents have to contend with a hospital that ranked 134th out of 134 in a recent NHS league table, making it the worst in the country; the worst ambulance service in the country, with the East of England ambulance service placing 10th out 10; and the Norfolk and Suffolk mental health trust, which ranks 57th out of 61, making it almost the worst in the country. The cumulative impact of so many failing health services cannot be overstated. The ICB funds the Stroke Association to provide a “life after stroke” service in west Norfolk. I was very concerned to hear recently that the service may have come to an end in September. I wrote to the ICB to outline my concerns, and I am pleased that the service has been temporarily re-funded until March 2026, but there is no certainty after that point. I very much hope that that important service can be continued, given the clear need in the west of our county.

The Government’s 10-year health plan provides a great opportunity to improve our whole national health service. As we do so, I hope that stroke prevention and services for people who have experienced stroke or cardiovascular disease more generally will be given the support they need. I welcome the ICB’s wider review of stroke services in Norfolk, which is backed by £3 million of growth funding. That includes projects to find and treat people at increased risk of stroke, such as those with undiagnosed high blood pressure. That shift from reactive care to prevention is a key Government priority, and I hope that it will result in fewer families going through what my family has gone through with my late father’s stroke.

17:21

[Helen Maguire (Epsom and Ewell) (LD)]

It is a pleasure to serve under your chairship, Ms Vaz. I thank my hon. Friend the Member for Twickenham (Munira Wilson) for securing this important and timely debate and for her personal and emotive speech. I send her mum my best wishes. I thank all other Members for their speeches and for their personal stories.

Over the summer, a constituent wrote to tell me that, after having a stroke, he was looking for a support group to aid in his recovery. He reached out to the closest group he could find, but they informed him that the council services were drastically cut about 12 years ago under the Conservatives, leaving only volunteer-led groups. The stroke left him with limited mobility, so he is unable to travel the distance from his house to the nearest volunteer-run group and he is therefore unable to access a vital support network.

We have heard just how quickly lives can change following a stroke. They leave people to navigate a whole new reality, which has been made even harder by the stripping of local services under the Tories. That is why I urge the Government to invest in prevention, community care and rehabilitation, including by restoring the public health grant to 2015 levels, and to empower local communities to co-design health initiatives that address their specific needs.

More must also be done to support social prescribing and community projects that tackle loneliness and improve mental and physical wellbeing—key factors in stroke recovery and prevention that would make a direct difference to people in my constituency and across the country. We know that preventive action and early intervention are key to increasing survival rates and improving outcomes for those affected. The Sentinel Stroke National Audit Programme at King’s College London found that 57% of people believe that they should have two to three symptoms of a stroke before calling 999, despite just one being a sign of a medical emergency. Furthermore, nearly two thirds of respondents said that they would not call 999 as their first course of action if they noticed that someone was suddenly struggling to smile.

Although I welcomed the launch of a new NHS stroke awareness campaign last year and this Government’s preventive policies, including regulations on the advertising of less healthy food and drink and the measures in the Tobacco and Vapes Bill, far more needs to be done. The most common risk factors for cardiovascular diseases, including strokes, are environmental and behavioural. They include smoking, diet and weight, physical inactivity, excessive alcohol consumption and air pollution. That is why it is imperative that we get more people moving and encourage healthy eating, including by closing loopholes in the soft drinks levy by extending it to milk and juice drinks that are high in sugar. There is also scope to go further by requiring better labelling of junk food and restricting the advertising of products that are high in fat, salt and sugar.

Furthermore, encouraging some form of exercise throughout people’s lives improves not only their physical outcomes but their mental health. To make a real difference, the Government must invest more in public health budgets to enable active travel, supporting local clubs and making cycling and walking routes more accessible. We also cannot ignore the social differences that dictate stroke survival outcomes. People in the most deprived 10% of the population are almost twice as likely as those in the least deprived 10% to die prematurely. No one in this country should be subject to poorer health outcomes just because of where they live or how much money they make.

For the 240 people who wake up every day in the UK to the life-changing impact of a stroke, and the 60% of survivors who leave hospital with a disability, we must go further to reduce the environmental and health risk factors of strokes, to educate people on the signs of a stroke and empower them to act immediately, and to provide easy, accessible rehabilitation and support services for survivors and families. We cannot leave more people, such as my constituent, alone to navigate the complexities of post-stroke life. The Government must invest in prevention, community care and rehabilitation, and undo the Conservatives’ devastating cuts to public health funding.

17:25

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

It is a pleasure to serve under your chairmanship, Ms Vaz. I congratulate the hon. Member for Twickenham (Munira Wilson) on securing this important debate.

Strokes are life-threatening medical emergencies that affect more than 100,000 people in the UK every year, taking over 38,000 lives and leaving many survivors with life-changing disabilities. A study in The Lancet Healthy Longevity estimated their annual cost to be £8 billion, comprising public spending on care and lost economic productivity. The number of cases is rising—in England, stroke admissions increased by 28% from 2005 to 2024—and, as the Stroke Association has said, demographic reality makes it all the more urgent for the Government to take action today to improve stroke care and reduce modifiable risk factors. As we have heard, when stroke care is delayed, the typical victim loses 1.9 million neurones for each minute they are untreated. Of course, delay is measured not just in brain cells, but in lost independence, lost potential and, all too often, lost lives.

The Government cannot just acknowledge the challenge; they must act. The previous Government designated stroke as a national priority area in the 2019 NHS long-term plan, with several commitments to improve prevention, treatment and care. We set out to increase the proportion of people receiving clot-removing thrombectomy to end their stroke, improve post-hospital stroke rehab models for patients, and enhance the Sentinel Stroke National Audit Programme. That important work was led by a network of 20 integrated stroke delivery networks, which were established in 2021, with a national service model setting out best practice. The previous Government also invested more than £57 million in mechanical thrombectomy, and by the end of 2023, 24 centres were open and delivering mechanical thrombectomy across England. Do the Government have a delivery plan to create more of those centres, or do they think there are enough?

Prior to the general election, the previous Government began work on a major conditions strategy to improve the prevention, diagnosis and treatment of six major conditions, including stroke, but rather than see it through, this Labour Government chose to take an axe to progress, pausing the scheme in August 2024 and, a year later, announcing a service framework for cardiovascular diseases in the 10-year plan. Have the Government incorporated the strategy’s findings in the 10-year plan? The plan mentions stroke just twice, and only in the context of smoking and obesity.

I am pleased that the Government have shown an interest in reducing modifiable risk factors. Prevention is always better than cure. Those categorised as obese face an elevated risk of stroke—64% higher than those of healthy weight—and one in five children leaves primary school obese. We spoke about obesity in this morning’s debate, but I did not get answers to most of my questions. I appreciate that the Minister is covering for someone this afternoon, but will he undertake to get answers not just to the questions asked in this debate, but to those asked in this morning’s?

I am encouraged to see Ministers showing an interest in furthering the previous Government’s work to tackle smoking, a habit to which one in four strokes is directly attributable, but it seems to be taking quite a long time. Just yesterday, health leaders warned that more than 120,000 young people have started smoking since the Tobacco and Vapes Bill was introduced. Will the Minister assure us that the Government will prioritise the Bill and pass it without delay?

High blood pressure remains the single biggest risk factor for strokes, and it is generally asymptomatic, which is why it is so important that tests are carried out in locations that are convenient for people. Last year, community pharmacies in England delivered more than 140,000 blood pressure checks and diagnosed nearly 11,000 cases of hypertension. As the Government complete the latest round of pharmacy negotiations, will the Minister commit to expanding that service further, so that pharmacies can detect more cases and prevent more strokes?

The Government’s delay to the NHS workforce plan is particularly concerning. We need enough doctors to train to perform thrombectomy and care for patients, and enough physios, occupational therapists, nurses, speech therapists and so on to support rehabilitation. After the Government cancelled the major conditions strategy last summer, their 10-year plan promised a service framework, as I said. Given that they have now delayed the workforce plan, the cancer plan, the neonatal and maternity plan and the HIV plan, will the Minister assure the House that they will not also delay the service framework for cardiovascular disease? We need action and not just words, so will the Minister explain what the Government have done materially to improve early stroke diagnosis since they came to office?

Stroke care is not only about medical interventions. For many survivors, recovery starts when they return home and have to re-learn to walk, speak and carry out daily tasks, so access to physiotherapy, occupational therapy, speech and language therapy and other support is vital. How do the Government plan to improve that provision, and what are they doing to provide psychological support to the families of stroke victims and victims themselves, especially in cases where there is a change of personality or emotional disturbance?

Prevention is better than cure. Work on smoking, obesity and high blood pressure are important. In the event of a stroke, every minute counts. Every minute the Government spend perfecting plans instead of putting things into action is a minute of suffering that could have been spared.

17:30

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Zubir Ahmed)]

It is a pleasure to serve under your chairmanship, Ms Vaz. I thank the hon. Member for Twickenham (Munira Wilson) for securing this timely debate and wish her mother well in her recovery. It is not easy to channel personal pain for the greater good, but the hon. Member has done so, along with my hon. Friends the Members for Stratford and Bow (Uma Kumaran) and for South West Norfolk (Terry Jermy). They can be assured that their articulation in this place of their personal experience will prevent strokes and lead to their faster treatment. Often, debates such as this can increase awareness and reduce the threshold at which people contact the NHS and the ambulance service for help.

The hon. Member for Twickenham asked me to address a number of issues, and I will do so before I get into the bulk of my speech. One was about data capture. Although I am responding on behalf of the public health Minister, my hon. Friend the Member for West Lancashire (Ashley Dalton), I am the Minister responsible for digital health and data, so I can assure the hon. Member that the interconnectivity of data among primary care, secondary care and social care is important to me, both for ease of access for the patient and for learnings and auditing. She can be assured of my personal commitment that that is the way forward in the new iteration of a modern health service.

The hon. Member also asked about physiotherapy and disability reduction. I can reassure her that, through the workforce plan and our upgrading of the digital architecture, we are working intensively to see how we can bring world-class physiotherapy to all and not just to some. Part of disability reduction is timely access to cutting-edge treatments, which no longer involves clot-busting; it now involves clot removal, in the form of thrombectomy. Thrombectomy services are planned to be totally universal in England by April 2026. I hope that answers some of the questions the hon. Member for Sleaford and North Hykeham (Dr Johnson) asked about those services.

[Euan Stainbank (Falkirk) (Lab)]

Does my hon. Friend agree that we need a plan in Scotland to install 24/7 emergency thrombectomy care across the country as soon as possible? I believe the objective is 2031, but we should be pushing the Scottish Government to go further and faster on that.

[Dr Ahmed]

My hon. Friend must have read my mind. As I was saying, our plan is only for England. Hon. Friends have already articulated the fact that in Scotland, despite the best efforts of clinicians in Glasgow, Edinburgh and Dundee, there has not been the ability—or the intent from the Scottish Government—to bring forward a proper 24/7 stroke thrombectomy service. That means that the time of day that Scottish patients have a stroke determines the outcome. They are literally being dealt a roulette wheel of care: 20th-century care out of hours and 21st-century care within office hours. It is simply unacceptable, and the UK Government stand ready to assist the Scottish Government in any way, shape or form they require to make sure that access to the highest quality of care is as available to patients in Scotland as it is to those in England.

[Dr Caroline Johnson]

I am grateful to the Minister for answering the question and talking about universal services being available from next year. Can he confirm whether they will be 24/7 and what he means by “universal”? If someone is living in a rural area, what is the greatest distance or time they should expect to travel to get to their local thrombectomy centre?

[Dr Ahmed]

What I mean by “universal” is indeed 24/7. As the hon. Member well knows, there are always challenges in delivering stroke care and heart attack care to rural communities. She, as a clinician, knows that we try our best, through the ambulance service and other forms of repatriation, to try to make sure there is equitable access wherever we can achieve it.

I thank my hon. Friend the Member for Stratford and Bow again for her kind words about the very small part that I played in her husband’s diagnosis. I am glad that he continues to do so well. I want to pay tribute to some of the charities involved in this space, because they have been instrumental in the innovation in stroke care over the past 20 to 30 years. I thank the Stroke Association, Different Strokes and Chest, Heart and Stroke Scotland for the incredible work that they do, including in my own constituency.

As the fourth largest cause of death for adults, stroke has a devastating impact on patients, families and the wider community. About one third of people who suffer a stroke will be left with some form of long-term disability. This is an important inequalities issue, as has already been discussed in this debate. Cardiovascular disease hits hardest in the most deprived parts of our country, including in parts of my own constituency, where people are more likely to smoke and less likely to have access to decent food and open green spaces. This Government were elected on a manifesto to tackle the biggest killers, including cardiovascular disease, and our health mission is committed to reducing deaths from heart disease and strokes by a quarter in the next 10 years.

I want to set out our reforms to the NHS, especially those which are part of our 10-year health plan, which will drive down rates of disease while helping people to live well for longer. Many Members in this Chamber are familiar with our three shifts: moving more care into the community, advancing the cause of digital health, and prioritising prevention over treatment.

On prevention, as much as I love my job as a surgeon I am still rooting for the public health Minister to put me out of business. She is taking forward strong preventive measures in her brief, through our Tobacco and Vapes Bill and by beefing up the NHS health check, which is England’s flagship cardiovascular prevention programme. That programme helps to target the abnormalities common to heart disease, to stroke, sometimes to diabetes and to kidney disease, and in many cases even to dementia through behavioural and clinical interventions. Each year, the programme engages 1.3 million people, preventing around 500 heart attacks or strokes. To improve access and engagement, we are developing the NHS health check online so that people can use it at home. That is being piloted by three local authorities until December.

We have already begun trialling more than 130,000 lifesaving heart health checks in the workspace—in offices, shop floors and commercial areas—all across the country. That will also help to reduce the risk of stroke. The hon. Member for Sleaford and North Hykeham asked about community pharmacy. Community pharmacy can and will continue to provide free blood pressure check services for anyone over the age of 40.

On rehabilitation, the stroke quality improvement for rehabilitation programme has increased the percentage of patients discharged from hospital to community stroke services from just under 66% when this Government took office to almost 70%. There is much more to be done, of course, but I believe that we are moving in the right direction.

As hon. Members are aware, the NHS fell behind in the last 14 years—certainly behind the private sector—in using digital technology. That was an appalling inequity, so let me come to our shift from analogue to digital. Half of all people who experience a stroke in England are now recovering thanks to revolutionary scanners that mean patients can avoid the risk of serious disability. The world-first technology that is coming online will analyse CT scans of stroke patients arriving in hospital, identifying them within 60 seconds. That means that the average time between a patient arriving at a hospital and starting life-saving and life-changing treatment is shortened from 140 minutes to only 79, resulting in less disability and a greater quality of life. I am pleased to update the House that since the roll-out last summer, the tool has been used to interpret the brain scans of more than 60,000 patients.

This Government believe that working people have the right to expect the same level of rehabilitative services as the wealthy. That is why we are so gladdened by the new state-of-the-art rehab gym hub at Montagu hospital in Doncaster, which is a perfect example of the best of the NHS that we wish to bring to the rest of the NHS. The suite relies on robotic therapies, which are otherwise provided only in private healthcare. The machines combine robotics with gamified, interactive activities to enhance both physical and cognitive recovery following a stroke—an example of what the seamless integration of physiotherapy and investment in digital health can achieve for stroke patients.

We are also forging partnerships with medtech companies to deliver the next generation of healthcare for patients. Reneural, which has partnered with Hillingdon Hospitals NHS foundation trust, is bringing virtual reality stroke rehabilitation to patients, and enabling therapists to remotely deliver and monitor stroke rehabilitation. Our shift from analogue to digital is supporting both in-hospital and community-based therapy, and, in many ways, allowing equality between rural and urban communities.

I am not saying that everything is perfect—far from it—or that there will not be bumps along the way. However, in a few short months, we have improved the outcomes of more than 60,000 patients, which is a testament to the actions of this Government. Through focus, and by delivering on the promises of digital and bringing the best of the NHS to the rest of the NHS, we can, and we will, do better for stroke patients and their loved ones.

17:40

[Munira Wilson]

I thank all hon. Members who have taken part in the debate, particularly the hon. Members for Stratford and Bow (Uma Kumaran), for Strangford (Jim Shannon) and for South West Norfolk (Terry Jermy), for sharing their personal stories. I also thank everyone for their good wishes for my mum, which I will pass on when I speak to her next.

I am grateful for the Minister’s response. I am encouraged by what he said about data, prevention, the digital tools that will come into play, and the fact that we are trying to make thrombectomies universal during that acute phase when somebody is blue lighted somewhere. However, I come back to one of my key asks, which was to widen the target for stroke and cardiovascular disease to prevent disability, not just to save lives.

Of course, saving lives is crucial. Thanks to those interventions, many lives are saved, but the disability that goes with that is incredible. Yes, we can use robots and all sorts of other new technology, but, ultimately, physios, occupational therapists and speech and language therapists are desperately needed. Frankly, community-based rehab is withering on the vine, and I have been personally quite shocked by how patchy it is. My plea is for the Minister to take the need to build up those services to the public health Minister, and I hope that she will be willing to meet me, as well as patient groups and patients.

Question put and agreed to.

Resolved,

That this House has considered World Stroke Day 2025.

17:42

Sitting adjourned.