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House of Commons Hansard
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Westminster Hall
28 March 2017
Volume 624

Westminster Hall

Tuesday 28 March 2017

[Mrs Cheryl Gillan in the Chair]

Preventing Avoidable Sight Loss

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I beg to move,

That this House has considered preventing avoidable sight loss.

I thank the Backbench Business Committee for allocating me this debate, the Chairman of Ways and Means for approving it and you, Mrs Gillan, for being in the Chair. I am also grateful to all the MPs who supported my application and to Lord Low of Dalston, my co-chair on the all-party parliamentary group on eye health and visual impairment, who, with his passion and experience of these issues, is a fantastic source of knowledge and support for the group. I believe that he is with us today in the Gallery.

The latest information from local authorities, which is from 2014, shows that almost 300,000 people in England and many thousands in Northern Ireland, Wales and Scotland are formally registered as blind or partially sighted. Many thousands more suffer from sight difficulties without being registered with their local authority. I thank the Royal National Institute of Blind People for its support as the secretariat of the all-party group, which I have the honour of chairing. The RNIB estimates that almost 2 million people in the UK live with sight loss. It is predicted that that will double to around 4 million by 2050 due to our ageing population and the fact that more people will live with conditions, such as diabetes, that can lead to visual impairment.

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My hon. Friend talks about sight loss increasing in the future. Does she agree that obesity, which has the knock-on effect of causing type 2 diabetes, is one of the causes of sight loss? Children in their teens are being diagnosed with type 2 diabetes, so we really need to think about how we tackle and prevent that in the long term.

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I definitely agree that we need to think about the long term and look at childhood obesity and diabetes, which are on the rise. I would like to put on the record that my application for this debate—I applied for a debate in the main Chamber—was supported by the right hon. Member for Leicester East (Keith Vaz), who chairs the all-party parliamentary group on diabetes.

It is estimated that half of sight loss is potentially avoidable. Glaucoma is the single biggest cause of preventable sight loss. Some 600,000 people in the UK have glaucoma, but half are undiagnosed. If it is detected and treated early, around 90% of people with glaucoma retain useful eyesight for life.

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Does the hon. Lady agree that one of the most important features of this situation is that at least half a million schoolchildren are affected, one way or another, by sight problems, if I may use that expression? Some 100,000 people in the west midlands, of which my constituency is a part, are probably also affected.

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Of course. I will go on to mention children and the fact that it is necessary for them to be tested earlier than we previously believed they should be.

Wet age-related macular degeneration affects the retina and causes changes to central vision. In October last year, Jean Rugg’s eye clinic consultant told her that she needed follow-up treatment. She was told by the receptionist to expect the appointment in the post, but nothing arrived. By December, Jean was continually contacting the booking department and being turned away. She was told that she would not be booked in because the department was just too busy. Time passed. Jean noticed changes in her vision and was extremely worried about permanent damage to her sight. She was getting nowhere, so she contacted her consultant’s secretary and, after much urging, managed to secure an appointment with him to discuss her sight.

By that time, three months had passed. Jean’s consultant was alarmed that she had not received treatment sooner and explained that her vision could well have deteriorated due to the delay, as there had been further leakage of fluid into her eye. Jean needed an urgent course of injections, so the consultant took her to the booking department to try to secure an appointment that same week. They were both told that there were simply no spaces in the injection clinic. After repeatedly explaining the urgency of the matter, the consultant was eventually able to obtain an appointment for Jean the following week.

I am sure that the Minister agrees that that is just not good enough. That delay and lack of responsibility and urgency is just not acceptable. There are many more Jeans across the country. A 2014 survey by the Royal National Institute of Blind People showed that 86.5% of the public were more fearful of losing their sight than any other sense. As I said, 50% of all sight loss is potentially avoidable if treated early, yet NHS England does not give eye health the profile it deserves. There is no overarching NHS England-led strategy to govern it and push for more prevention of avoidable sight loss. There are equivalent strategies for hearing loss and dementia.

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The hon. Lady mentioned dementia, which is a growing problem, especially among elderly people, although not all elderly people. Sight loss can exacerbate or even mask symptoms for people with dementia. Correcting vision loss can help reduce the impact of dementia, at least in the early stages, and improve quality of life. Does she agree that policy makers and commissioners must seek to prioritise addressing sight loss for people who have dementia or are suffering its early onset?

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I agree. We most definitely need to prioritise sight loss for all vulnerable people, including older people, who might also have mental health illnesses.

There are eye health strategies in place in Scotland, Wales and Northern Ireland; England is an anomaly. I therefore ask the Government to consider developing and implementing a national strategy for eye health in England. That would not require additional funding, but would be a commitment to improving the efficiency of eye care services and ensuring consistency across the country. It would enable the development of improved clinical leadership at clinical commissioning group level to prevent eye health from slipping down local commissioning agendas, enable closer partnerships between CCGs and local eye health networks, and aid commissioners to identify eye health priorities that respond to the needs of local populations.

The Department of Health and NHS England already do great work to support the voluntary sector-led England Vision strategy, but that is, by definition, limited in its ability to bring together all the relevant organisations in a joined-up way. In response to a written question that I tabled last week, the Department rightly explained that England’s size

“and the diversity of the health needs of different communities”

mean that commissioning is best “owned and managed locally”. I completely agree, but that should not be incompatible with strategic thinking from above by people who see the bigger picture, or establishing principles that local areas can fit to their circumstances.

Local commissioning must be coupled with national leadership. Leaving things to local commissioners is not working as well as it should. There is significant variation in the quality and quantity of services. For example, someone in Luton will wait for 15 days between their first attendance at a hospital out-patient clinic and their cataract surgery, but if they were in Swindon, they would wait not 15, 50 or even 150 days, but 180 days. That is a shocking difference. No doubt the Minister agrees that, again, that is just not good enough.

Small changes to guidelines and legislation would streamline the process for many patients. For example—my hon. Friend the Member for Twickenham (Dr Mathias) may have to help me out with my pronunciation—allowing orthoptists to sign hospital eye service spectacle prescriptions, rather than requiring ophthalmologists to sign them, would allow the delivery of effective patient care and reduce the number of appointments required to access spectacles.

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rose

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I hope that the hon. Gentleman does not intend to make a quip about my pronunciation.

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The hon. Lady’s pronunciation is not as bad as mine. I would support a national strategy. More importantly, however, the cost of drugs for treatment is an area that creates difficulties. In 2014-15, the cost of two drugs alone to treat age-related macular degeneration was £287 million. There is room for discussion between the Government and the drug companies on the cost of drugs to treat people with eye problems.

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Order. I gently remind Members that interventions are supposed to be short. We seem to have plenty of time, but we have quite a few speakers, so I would like interventions to be short.

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I thank the hon. Gentleman for his intervention. I hope that the Minister will respond to that and that we can tackle the postcode lottery in treatment and care across the country.

More generally, sustainability and transformation plans are an exciting opportunity to bring different parts of the NHS together, with greater efficiency and greater outcomes. They are designed to ensure that health and social care services in England are built around the needs of local populations. However, of the 44 STPs, only 22 mention ophthalmology. There is a gap in local plans, which could be narrowed by a national strategy. No doubt the Minister will share my disappointment that half of all STPs do not mention ophthalmology.

It is also worth noting that there are national strategies for other health conditions, in which local commissioners play a role alongside national leadership. The cancer strategy for England, for example, was developed by an independent cancer taskforce, including a number of charities. As a result, NHS England’s national cancer transformation board subsequently published an implementation plan. If there was a need for national leadership on cancer, dementia and strokes among other things, why does the same not apply to eye heath? If the Minister needs to look elsewhere for places where there are national eye health strategies, he could even look to Zimbabwe, which has one.

Professor Tim Briggs’s review of ophthalmology services in his capacity as national director for clinical quality and efficiency is warmly welcomed, but his review focused predominantly on secondary care. A national eye care strategy would cover all stages of the patient pathway, from prevention and early diagnosis to effective treatment and management, and high-quality rehabilitation and social care.

Early diagnosis is an important part of prevention, and it hinges on awareness. Eye health must be seen as a public health priority rather than in isolation from wider health and wellbeing issues. For example, too many people see eye tests simply as a way of identifying refractive error, but their purpose is wider: to identify eye conditions that could lead to loss or deterioration of sight at a later date and prevent that before it happens. Anyone entitled to a free eye test must know that they are entitled to it.

Vision defects in children include amblyopia, which can be mild but becomes more serious if left untreated or if the sight in the other eye is lost or damaged. In December 2013, the UK national screening committee recommended that screening should be offered to all children aged 4 to 5 years. However, children’s vision screening in schools has yet to be implemented across all local authorities. Some, where it does not exist, are not commissioning it, and some are decommissioning existing programmes. The national guidelines provide a population-based examination of all children, ensuring that at-risk and vulnerable children in the population are reached. How does the Minister see the future of eye treatment and screening for children, and how does that fit into wider healthcare plans? I know that NHS England is working with CCGs, general practitioners, patients and the public to improve patient choice in all secondary care services by 2020, not least to increase awareness and achieve improvements in patient outcomes and experience. That is extremely welcome, but will the Minister outline how that applies to ophthalmic services in particular?

When early diagnosis is achieved, referral processes must be equally efficient: straight to hospitals, rather than via GPs as happens in some areas, which is inefficient for patients, GPs and hospitals alike. I would be grateful if the Minister provided information on how optometrists and other service providers are encouraged to follow referral guidelines issued by the National Institute for Health and Care Excellence and professional bodies.

Preventing avoidable sight loss relies on timely access to treatment for eye conditions. The latest hospital episode statistics for ophthalmology show a picture of missed and delayed appointments across England. In the High Weald Lewes Havens CCG, which covers my constituency, 6.47% of ophthalmology appointments were cancelled by hospitals in 2015-16. In Sutton, that figure leapt to 26.17%. Cancelled appointments put people at risk of losing their sight unnecessarily, so I would welcome the Minister setting out how his Department works with hospitals and CCGs to ensure that such cancellations are as rare as possible.

As I draw to a close, I will briefly mention the UK’s work on global eye health. In May, the World Health Organisation will discuss how countries are delivering on the avoidable blindness plan. The UK is a signatory to that and also one of the largest supporters of aid to combat the neglected tropical diseases that often cause blindness. Some 90% of blindness is in the developing world, and 80% of cases can be cured or prevented. I pay tribute to the Sussex-based non-governmental organisation Sightsavers, which the Department for International Development supports to deliver British goals for the reduction of blindness abroad. I thank the Government for their international leadership on this important issue.

Back home, I pay tribute to all the work done by Lord Low, the co-chair of the all-party parliamentary group. I asked him what sight loss is like and what obstacles have to be overcome. He said that we cannot underestimate or understand the hurdles, time and energy it takes just to try to live independently and have access to services that the rest of us do to enable us to live a full life. There is also the importance of technology in this area, and how it must be harnessed to support people with sight loss.

Will the Minister explain how much work is being done to harness technology to help people with sight loss and how much work, commitment and finances are put into research? The eye research charity Fight for Sight has done so much commendable work in research. We cannot deal with some sight conditions, but the right amount of investment may help us tackle and stem the rise in sight loss in our ageing population.

Blindness and partial sight in the adult population costs the UK about £28 billion a year—not the £28 million mentioned in the House of Commons Library research paper. However, it costs so much more than that: opportunities are missed and careers stall. While disability employment in general is increasing, the one exception is eye disabilities. Family and relationships are challenged. I know the Government and the Minister are committed to reducing avoidable sight loss, improving the quality of life for people with sight loss and addressing persisting health inequalities. I finish by thanking the Minister for the work he does in this area and encouraging him to keep going.

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It is a pleasure to serve under your chairmanship, Mrs Gillan. I congratulate the hon. Member for Wealden (Nusrat Ghani) on securing the debate. To lose one’s sight partially or wholly, gradually or rapidly, is a life-changing experience. Ordinary, everyday activities that were once straightforward become increasingly complicated, with simple tasks taking longer, and people create their own adaptations in order to cope. The number of people who live with sight loss in the UK is predicted to double to about 4 million by 2050. Due to our ageing population, more people are living with conditions that can lead to visual impairment, such as diabetes.

Loss of sight is more prevalent in my constituency, which is having a dramatic impact on quality of life, particularly among older people, yet we are failing to provide sufficient access to preventive treatment. In October last year, Northern Lincolnshire and Goole NHS Foundation Trust was found to have nearly 22,500 appointments overdue at its three hospitals. More than 12,500 of those were at the Diana, Princess of Wales hospital in Great Grimsby, with hundreds of people at least eight months overdue for appointments. Across all three hospitals, the department most affected was ophthalmology, with 2,200 appointments overdue in Grimsby alone.

By 2030, there are expected to be 7,050 people in north-east Lincolnshire living with sight loss, an increase of 32.5%, and 980 living with severe sight loss, an increase of 38%. That increase is largely because we have an ageing population and, generally, the older someone is, the more likely they are to suffer from loss of sight. That is important, because visual impairment has a considerable impact on our psychological wellbeing, which means that older people are three times more likely to experience depression caused by sight loss, not to mention isolation and loneliness.

Yet as the RNIB and the hon. Member for Wealden have pointed out, nearly half of sight loss is avoidable. Timely access to treatment, including follow-up appointments and the effective monitoring and management of eye conditions, is vital to preventing unnecessary loss of or deterioration in sight. It is important because successful treatment of many conditions is time-dependent. That is why it was so shocking to learn in late October last year that up to 800 patients in the eye department of Northern Lincolnshire and Goole NHS Trust who are potentially at risk of harm were left waiting—many of them for months on end—to be told what treatment they needed. Additional clinics were arranged to deal with the backlog, but patients should never have been left for such an extensive period of time without any check-ups or assessment of their condition.

In that area of the world there is a shortage of clinicians across the board, but particularly in ophthalmology, which adds to the strain on the system. When asked about the backlog of patients, the leadership at Northern Lincolnshire and Goole Trust said that they knew about it and saw it grow, yet they failed to draw up a coherent plan to address it, despite it being a year on from the tragic 2015 case of Brian Critten, a patient at Scunthorpe general hospital, which is run by the trust. In an investigation that was launched after Mr Critten alleged a failure in duty of care, the hospital acknowledged that there might have been an opportunity to identify his cancer earlier if a cataract operation had not been cancelled and subsequent appointments not repeatedly postponed.

We cannot continue with a situation where preventive treatment is missed. The NHS must work with stakeholders, including the RNIB and other charities, to develop and implement a strategy that ensures adequate eye care services across England. I was contacted by Scartho Eyecare, an optician in my constituency, and informed that we are one of the few areas with no optical enhanced services—services that can ease the burden on GPs and on hospital ophthalmology services. There is apparently capacity to help at a lower cost to the NHS, but it has not been taken up. Perhaps the Minister will reflect on that in his speech.

It seems irresponsible that eye care strategies exist in Scotland, Wales and Northern Ireland, but that England does not have a strategy to meet the future needs that have been highlighted. Surely now is the time to get that right.

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It is a pleasure to serve under your chairmanship, Mrs Gillan. I commend my hon. Friend the Member for Wealden (Nusrat Ghani) for securing this important debate; there have already been useful contributions. I want to make a short speech. I declare an interest: before I was a Member of Parliament, I worked in the NHS as an ophthalmologist.

I hope that the Government can achieve their own 20/20 vision for eye care in England. I hope that the Minister will go away with knowledge of what that should mean for the Government. We have heard about delays in the NHS. The figure from the Royal College of Ophthalmologists is that 20 people a month in England experience sight loss because of delays with appointments. I do not know about anyone else, but I have found that the hairdresser and dentist are better at telling me about appointment times than the NHS. It is the 21st century, and I believe that that is negligence—I do not know if lawyers would call it wilful negligence. It is one thing for a doctor in a clinic to have to tell a patient, “I am sorry, there is nothing I can do for you,”—it is the worst part of the job—but it is even worse to have to say, “If you had come to me a month ago, I might have been able to help you.” That is England today. The NHS and Government need to be transparent about where they are letting patients down.

The other 20 in my 20/20 plea to the Government—I have mentioned it to the Minister—concerns the £20 million cap that NHS England is talking about for the annual cost of new NHS drugs. The Minister is aware that for dry macular degeneration—the commonest form of macular degeneration, accounting for 90% of cases—there is currently no treatment. Those are among the sad cases in clinics when people are told, “There may be nothing we can do.” However, a phase 3 trial is being undertaken of a drug that may help with dry macular degeneration. If everyone present were to have an examination, I am sure that there would be people here now with signs of dry macular degeneration—perhaps even the Minister himself. The drug will be an exciting change in medicine. It is not about just preventing sight loss; it is about maintaining independence. I do not believe that the £20 million cap takes into account the cost when someone loses their central vision, through losing independence and depending more on social care or family members who may take time off work to help.

The Government need 20/20 vision. We need to be transparent with patients. We heard about the case of Jean Rugg, who was losing her sight because of delays with appointments. A lady who came to my constituency surgery told me she was getting private treatment for her husband, because she realised that the delay in the monthly appointment for an injection for wet macular degeneration would cost him his sight. She was not angry; she just wanted me to be informed. If there is a £20 million cap, every MP will have people in their surgery saying, “I am trying to sell what I have to save my family member’s sight.” The £20 million cap must not apply to sight-saving treatments. I hope that there will be other speeches—it is a wide field—but that is my plea for the Government to have 20/20 vision.

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It is a pleasure to serve under your chairmanship, Mrs Gillan. I thank the hon. Member for Wealden (Nusrat Ghani), who as always made a thorough and insightful speech. She put on the map what needs to be done about preventable sight loss. Given that that is what it is—preventable or avoidable—it is incumbent on the Government to have policies that ensure that patients get access to treatment. Those patients are our constituents and members of our community. We must support their access to treatment, because it will make a huge difference to their lives.

From my background in psychology, I can say that people with sensory impairment often lack confidence. They may become depressed or, if they have sight difficulties, be isolated because they worry about going outside and tripping or falling over. That has an impact on the whole wellbeing of the individual and therefore also that of family members. We must also consider cost-effectiveness. We have heard today that people who require care sometimes cannot get access to it. I know from other hon. Members that there are anecdotal reports of cataract operations being rationed. Such things are not particularly cost-effective ways of using resources. Obviously people who experience preventable sight loss will have falls and require NHS treatment. They may then require hip surgery as well as surgery for their sight loss. These things tend to exacerbate each other. I would like the Government to look at both the treatment that people should have, and deserve to have, and why preventive care is at the heart of a cost-effective NHS.

My grandmother required a number of cataract operations, and the difference I noticed in her following those operations was remarkable. It was almost as if she had her lease on life back. She was able to get out to the shops. She was an individual who really liked to be out and about because it kept her mood up and her spirits high, which is something I would like for everybody who requires it—particularly older adults. My understanding is that, by 2021, 40% of the Scottish population will be over 50—I actually have to include myself in that figure. A significant proportion of sight loss is related to age, and one in eight over-75s and one in three over-90s will suffer significant sight loss. We have an ageing population and we are going to have to look at this issue extremely seriously, in terms of services right across the UK.

The Scottish Government are committed to keeping NHS services free at the point of delivery, and prescriptions and eye tests are currently free of charge, which has resulted in a 29% increase in the number of tests undertaken. That is important, because my understanding is that one of the barriers to preventing avoidable sight loss is that people are not accessing care, which is particularly linked to areas of deprivation. If the UK Government looked at making eye tests free, people in areas of deprivation in particular might not have to choose between a sight test and a meal on the table at the end of the day. In these times of austerity, those are some of the choices that some families unfortunately have to make.

I understand that the Christie Commission report looked at the future of public spending and estimated that 40% of public service spending could be avoided by using a preventive approach. Once again, I emphasise that it is not only morally right and our absolute responsibility to our constituents to ensure that avoidable and preventable sight loss is avoided and prevented, but that doing so is also cost-effective. International research indicates a fourfold return on investment in early eye care intervention, so this absolutely makes sense. Early diagnosis is key.

Let me end by saying that long-term planning is needed. We have made significant steps in policy in Scotland, but I do not want to see a postcode lottery for the rest of the UK. The Minister should look at making sure the policy is commensurate and gives the very best in evidence-based practice for constituents right across the UK.

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I have 27 minutes to speak. I jest, by the way; I am not going to speak for 27 minutes.

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Mr Shannon, you have plenty of time to speak. I feel I should declare an interest as I am wearing glasses to read my papers.

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It is always a pleasure to serve under your chairmanship, Mrs Gillan. I give special thanks to the hon. Member for Wealden (Nusrat Ghani), who very capably set the scene for us all on a subject that is obviously close to her heart; I believe it is close to the hearts of those of us who are here to participate in the debate as well.

As someone who has needed glasses from eight years of age—I am over 50; well over 50, let me tell you—I have never really known any other way; that is the fact of it. I can well remember those first glasses, with those round circles of glass like milk bottle bottoms. Those were the prescription glasses I wore in the ’60s; we have come a long way to the perfection of eyesight and glasses today. In my case, I wear varifocals, and others in this Chamber probably have the same. I look down to read and look up to look away. Varifocals give that better vision, and it is good to have that.

I certainly have compassion for those whose sight is deteriorating or lost completely. I think losing sight is probably one of the worst things that can happen to anyone. How much do we all appreciate seeing things in colour and all around us? There are some who cannot. My dad lost his sight at a late age in life, and I know it is one of the things that he particularly missed. He used to read his Bible in braille in the last few years of his life. To understand that sight loss can be prevented in some cases is something that we must all work towards achieving, and we must play our part in the House.

The Library pack has been quite helpful, and some of the information it gives is particularly applicable. The fact that sight loss costs the UK economy £28 billion is something that cannot be ignored when it comes to adding equations; we understand and appreciate that we have to balance the books, but when balancing the books we should sometimes do the necessary preventive action that the hon. Member for Wealden referred to.

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Only yesterday in my surgery some folk came to see me about sight loss, the lack of appointments and the length of time they had to wait. We have been given the figure this morning of 20 people per month losing their sight, which is a precious thing. If there is a drug that can help to prevent that, surely the onus is on the Government to give people the gift of sight? That is worth pursuing.

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It absolutely is. The hon. Member for Wealden referred to England in her introduction, but Scotland, Wales and Northern Ireland have taken some steps in that direction. At the end of the day, we can certainly do this much better.

Sight loss affects people of all ages, but older people are more likely to experience a sight-threatening condition. That is clearly understandable. Having celebrated another birthday on Saturday past—I have stopped counting birthdays, which I think is probably the best idea; I try to forget about it, but the family keep reminding me that I am of a certain age—I certainly feel a deterioration process in action. That old saying that the spirit is willing but the flesh is weak becomes more and more a reality as I mow the lawn at home and carry out maintenance on the farm.

My glasses prescription has changed greatly over the years, and not for the better. That, again, is part of the ageing process. I am also a type 2 diabetic, so I have to be particularly careful with my eyesight. The former health Minister, now the Financial Secretary to the Treasury, replied to a question I asked about diabetes, and I think the hon. Member for Wealden referred to diabetes in her speech. The hon. Member for Erewash (Maggie Throup) also mentioned it in an intervention. We need to be aware of the complications of diabetes. Early diagnosis is very important.

It is critical to have regular appointments with an optician. I am not sure if everybody has one as regularly as they should. In Northern Ireland, I see my optician twice a year—probably because I am a diabetic. Others probably do it at least on a 12-month cycle. It is important to do so, because an optician can spot things in someone’s eyesight and signs affecting other parts of the body. It is important that the role of the optician is encouraged.

One of the lesser-known reasons for sight loss is leber hereditary optic neuropathy. It is an ultra rare and very disabling disease that leads to blindness in approximately 80% of those affected within one year of the onset of symptoms. It affects just one in 50,000 people and is caused by a disorder of the mitochondria; it usually strikes young men aged between 15 and 35. Again, it can be prevented by early diagnosis, but there are no treatment options routinely available to patients with it in the UK. I often look with envy towards Scotland, because Raxone is currently undergoing a review there, whereas in England it was not selected by the National Institute for Health and Care Excellence. That is a bit of a disappointment. If the Minister does not mind me asking, perhaps he could respond to me on that as well when he gets a wee chance. It is most important.

I will give a Northern Ireland perspective, but I will not be taking the time that we talked about at the beginning. In Northern Ireland, the 2011 census reported that, out of a population of 1.8 million, a total of almost 31,000 people self-reported a long-term condition related to blindness or partial sight loss, representing some 1.7% of the population. However, the figure is set to increase dramatically in the future, as the population ages.

I am not sure if anyone has mentioned this yet, but we have an ageing population. We are getting older, and people are living longer, so this issue will become a bigger factor than ever before. Recent population statistics from 2016 reveal how the age structure in Northern Ireland is projected to change. I will give an example. The population aged 65 and over is projected to increase by 74.5% to almost 500,000 people from mid-2014 to mid-2039, with the result that one in four people—24.7%—will be in that age category. The population aged 85 and over is projected to increase by 157.3% to 88,600 people over the same period, which will see that share of the population increase from 1.9% to 4.4%.

The reason for giving those stats is simple: there will be greater demand on the NHS. The increasing prevalence of sight loss over the next decades requires additional planning, a long-term strategy and policy development now in order that the Government best respond to people’s needs and concerns. That is what we are asking of the Minister, for whom we have the utmost respect, and I know he will reply with conviction and a desire to answer our questions.

I wonder whether this could be done better together, through a UK strategy. I am a great believer in the Union of Great Britain and Northern Ireland. I have been told off this morning for saying that once or twice too often, but I continue to say it because it is important, as it is for my colleagues close to me in the Chamber.

In Northern Ireland we face a particular challenge in relation to timely and responsive ophthalmology treatment. In recent years, many new treatments have been developed, saving the sight of thousands of people who previously would have gone blind. One of our universities in Northern Ireland has been involved in perfecting new drugs and systems to prevent sight loss. An enormous amount of work is going on behind the scenes. Those new treatments are an enormous and welcome step forward.

Some conditions, such as dry age-related macular degeneration, can cause permanent sight loss in a matter of weeks or months. That is why early diagnosis and treatment is vital if a person’s sight is to be saved. It is no surprise that delays to treatment can have a severe impact on patient outcomes. Everybody who has spoken so far has said that, as will those who speak after me.

Many new treatments for sight-threatening conditions require frequent follow-up appointments for monitoring and re-treatment. That has caused a rapid increase in demand for services. Northern Ireland faces a waiting list crisis across a number of specialties, including ophthalmology. I know this is a devolved matter, but I want to give some stats. As of 31 December 2016, some 23,000 people were waiting for a first out-patient appointment in ophthalmology, while 14,221 patients—approximately 62%—were waiting longer than 18 weeks. Statistics also show that patient numbers within ophthalmology are increasing year by year. On 31 March 2013, there were more than 8,000 patients waiting for first consultant-led outpatient appointments, compared with 23,000 in December 2016. That is an increase of 184%.

Severe financial constraints on the health service mean that increased demand for eye care services has not been met with increased resources. That has led to some patients losing sight unnecessarily because they are not seen within clinically safe timeframes. That is the core point we are all trying to make. In March 2016, the Royal College of Ophthalmologists released preliminary findings from a national study indicating that at least 20 patients per month suffer severe and unnecessary sight loss due to appointment delays. That is avoidable—if it is avoidable, for goodness’ sake let us try to address that issue.

The situation in Northern Ireland is similar to that in other parts of the United Kingdom; urgent action is needed so that preventable sight loss is avoided and people do not come to harm while waiting to be seen. With more than 14,000 Northern Ireland patients waiting 18 weeks for an initial appointment with a consultant, and more than 30,000 planned appointments missed due to hospital cancellations or the patient’s failure to attend, now is the time to address the provision of eye care services. This is putting an enormous strain on busy hospital eye departments and overworked NHS staff.

To conclude, while the lessons learned in Northern Ireland must be shared and there must be central learning for all the United Kingdom’s devolved Assemblies and the Government’s Developing Eyecare Partnerships strategy, it is important to resource and implement that strategy if effective change is to happen. We are looking for effective change, because without it, this debate will have failed. We are here to be positive, but we need Government assistance to make this happen.

While additional resources are needed, the reconfiguration or development of services does not necessarily need resources; it just needs a more effective way of approaching services. We cannot wait any longer, as each month of waiting for proper funding and implementation is a month in which people are losing their sight unnecessarily. I have said before that I have the greatest respect for the Minister. I look to him for UK-wide action now, and for the Government to work in conjunction with the devolved Administrations.

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Unless anybody else wishes to speak, we will move on to the Front-Bench contributions. I am pleased to call Marion Fellows.

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Thank you, Mrs Gillan; it is a great pleasure to serve under your chairmanship. I commend the hon. Member for Wealden (Nusrat Ghani) for working so hard to secure this Backbench Business debate.

I must start by declaring a personal interest in this debate: I have been diagnosed with cataracts and also have an issue with the macula in my left eye. I would like to thank the Doorkeepers, who are always present, for writing down the names of all Members for me so that I can refer to them properly in my speech. I simply could not do it without them.

Like a lot of people, no matter how hard I listen at hospital appointments, I cannot always absorb everything that is said to me, so I do not know exactly what is wrong, but I am due another appointment soon. I am fortunate that as a result of visiting my local optician for my regular free eye test, the optometrist saw what was wrong and referred me to a local hospital for further investigation, and then on to a hospital in Glasgow. My husband has also benefited from free eye tests and is receiving treatment. We are really grateful to the Scottish Government that we have free eye tests.

The Cabinet Secretary for Health committed last year to a review, to consider an even more joined-up strategy and ensure that practices already taking place in parts of Scotland are spread across the country. The chair of Optometry Scotland has said that the review, which will look at existing models of good practice, could really change what is happening.

As the hon. Member for Wealden said, almost 2 million people are living in the UK with sight loss, and the number is expected to double to 4 million by 2050 because of the ageing population, which many speakers have referred to. I am one of those older people, so I have a dog in this fight. I do not want people across the UK to wait any longer than necessary for proper treatment. The hon. Lady also referred to glaucoma, which is the most prevalent cause of preventable sight loss. As she pointed out, there is no overarching eye strategy for England, but there are strategies in place for Scotland, Wales and Northern Ireland.

Almost 300,000 people are registered with sight loss in England, and that figure will double. The voluntary sector in England is supported on this, but the Department of Health recognises that local solutions are better. Indeed, the hon. Lady made an impassioned plea for that. She referred to small changes to guidelines. A national strategy is vital to plug local gaps. She called for the screening of all children between four and five, which has been recommended but not yet implemented; I had not recognised that previously, but I do not think anyone in this Chamber would not support that.

The hon. Lady said that early diagnosis is really important and must be followed by speedy treatment, and that missed and cancelled appointments should be minimised. Finally, she looked at the international landscape and the good work done by DFID. She also mentioned that the cost of vision loss in the UK is £28 billion per annum, which could be mitigated by changing the type and speed of treatment that people receive. That was echoed by other speakers.

The hon. Member for Great Grimsby (Melanie Onn)—what a wonderful name for a constituency—talked about quality of life, especially for older people. That was echoed by my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who said that the difficulties experienced by older people lead to things such as falls, which impacts on the national health service across the UK, but especially in England. It also leads to isolation and loneliness, of which my hon. Friend has great professional experience and also family experience with her own grandmother. As the hon. Member for Great Grimsby said, patients should not be left waiting. She referred to problems with Northern Lincolnshire and Goole NHS Foundation Trust, which has been sued as a result of delay in treatment.

The hon. Member for Twickenham (Dr Mathias) referred to her career as an ophthalmologist. I must say that ophthalmologists do great work, because it was my local ophthalmologist that started my long referral for treatment. The hon. Lady hopes that the Government will achieve their own 20/20 vision for England; indeed, I think we all hope that. Delays are affecting 20 people a month. It gets to the stage where people turn up for appointments but nothing can then be done. No one should be happy with that situation, and no one is. I make a plea to the Minister to ensure that he looks at it.

The hon. Member for Wealden referred to the case of Jean Rugg and the fact that people are now going private across the UK to try to prevent sight loss. I am sorry, Mrs Gillan: I get a bit emotional about this issue because of my own fear. I have not been wearing glasses from such a young age as the hon. Member for Strangford (Jim Shannon)—I was 11 when I started—but I think I can safely say that I can give him a good few years, so I have been wearing them for a long time. For someone who already has sight problems, the thought of losing their sight is something that they live with daily, and when it is flagged up that there might be something wrong, that causes great personal distress.

A really important point is that free eye tests, which we have in Scotland, encourage people to attend regularly to have their eyesight checked, which, as I said, leads to better treatment earlier. We really do not want a postcode lottery anywhere in the UK but, as hon. Members said, there is a postcode lottery in England: people need to live in the best place to get the best treatment.

The hon. Member for Strangford talked about the role of the optician. He said that 30,000 people in Northern Ireland—1.7% of the population—are affected at present. However, as is the case for the whole United Kingdom, this will be an ongoing and serious issue as populations age. My hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow painted a vivid picture of how people can be affected psychologically by sight loss—loss of vision. It is awful.

I want to ask the Minister about the cost of drugs and the £20 million cap that NICE has implemented in England. Does he consider the new cap an appropriate measure, given the Conservatives’ manifesto promise to speed up the introduction of new medicines into the NHS? It seems counterintuitive, when we can save the NHS money through early treatment, that we stop treatment that will help to prevent people from suffering falls and psychological illnesses and costing the NHS even more in the long run. Prevention is always better than cure. We really should be looking at that. In Scotland we do our best to do that. There is a different ideological focus. I have talked many times in this Chamber about how we do things better in Scotland. Hon. Members across the Chamber do not always agree with me, so it has been comforting, and indeed pride making, to hear them agree with me on this issue. A national strategy is needed in England as well as in the rest of the UK—in the devolved Assemblies and in the Scottish Parliament. Can the Minister give some comfort this morning to my colleagues who represent English constituencies?

It is a privilege to be able to talk here about the good work that we are doing in Scotland and that has been done in other parts of the UK. I again ask the Minister to look at the £20 million cap and at providing for the NHS in England a strategy that can help prevent avoidable sight loss.

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It is a pleasure to serve under your chairmanship, Mrs Gillan. I thank the hon. Member for Wealden (Nusrat Ghani) for securing this important debate, which is long overdue. I also pay tribute to the excellent work that she does on the APPG to reduce sight loss; I was privileged to attend a recent meeting, and she is doing sterling work, for which I applaud her.

We are fortunate also to have the expertise of the hon. Member for Twickenham (Dr Mathias); I am sure that we were all interested to hear her expert opinion. We also heard very human stories from hon. Members representing constituents all over the country. They made very powerful cases. As I said, a debate on this subject was long overdue. Given the scale of the problem, to which many hon. Members alluded, the fact that it barely gets a mention in Parliament from one month to the next is quite shocking.

It has been said already, but is worth stressing, that more than 2 million people in the UK are living with sight loss. This is not a problem that affects a small number of people; it is a major problem. One in five people over 75 and one in two people over 90 are living with sight loss. With regard to the impact on the wider NHS, every year there are 2.6 million GP appointments for eye-related conditions and 270,000 accident and emergency visits for acute eye problems. And the problem is not going to go away. We have heard that the number of over-85s will double over the next two decades and that problems with sight loss are also set to double. Research by the Royal College of Ophthalmologists shows that there has been a 37% increase in eye clinic attendances in the UK over the past 10 years, and demand is growing year on year, making it the specialism with the second highest out-patient attendance. New treatments as yet unimagined will inevitably add to that demand.

For me and, I am sure, most Members in the Chamber, the most alarming statistic is that more than 20 people go blind unnecessarily every month in England. That is 20 people who did not need to lose their sight. It is a really shocking statistic. Many Members, including the hon. Member for Motherwell and Wishaw (Marion Fellows) and my hon. Friend the Member for Great Grimsby (Melanie Onn)—I only represent great Burnley—have alluded to the horrors of blindness. Particularly affected are the elderly, people with dementia and people suffering from diabetes.

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I have a very good friend back home in my constituency who has diabetes. He decided to go for laser treatment to correct his short-sightedness and, as a result, he lost sight in both eyes. There can be complications for diabetics who try to improve their sight. For my friend, that became a horror story rather than a good story. People who are diabetic need to take special cognisance of the possibility of complications before they do anything. I apologise, Mrs Gillan, for intervening for a wee bit longer than usual.

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I am grateful to the hon. Gentleman for that important intervention. Diabetes brings its own special problems, which we need to be widely aware of and build into any future strategy.

Some 20 people every month in this country—one of the richest countries in the world—go blind unnecessarily; it is not because we lack the ophthalmic expertise to save sight. On the contrary, we have many leading centres of excellence. Indeed, the Manchester Royal eye hospital that serves my constituency is one of the finest centres in the whole of Europe. People are going blind because capacity in the service is failing to keep pace with demand. For many eye conditions, including glaucoma and macular degeneration, early diagnosis and regular treatment are vital if sight is to be retained. For example, if glaucoma is diagnosed early, good sight can be retained, but in the overstretched and under-resourced system that we have now, 17% of those diagnosed lose their sight.

Currently, fewer than half the patients requiring multiple appointments are seen within the optimum timeframe, and the statistics given by my hon. Friend the Member for Great Grimsby about the effect on her constituents are truly shocking. Research shows that more than half a million appointments in England were cancelled by eye departments in 2015-16. It is therefore not really surprising that the Royal National Institute of Blind People reports that 50% of the incidences of blindness could have been avoided. It is undoubtedly a source of misery for the individuals affected, causing untold suffering, restrictions on lifestyle and a host of missed opportunities. In addition, as has been referred to, it places massive additional pressures on social care services and the wider NHS. I think that we all agree, on both sides of the House, that services need to improve.

There are already many examples of pockets of good practice—deploying mobile units and the multi-skilling of staff—where experts are desperately trying to compensate for a lack of resources to deal with increased demand. Clearly, the knowledge that demand will continue to grow means that there cannot continue to be business as usual. The clinical professionals have identified four areas that need to improve. They have said clearly that there is a need for an overall strategy—a direction from above and from Government. It is significant, as the hon. Member for Wealden pointed out, that in Zimbabwe there is a national strategy to prevent sight loss and retain sight, but in England we do not have such a strategy—I am shocked. The professionals also call for improved access to data to make their job easier and more efficient; to avoid duplication and ensure that they have access to the best possible information about their patients in a timely fashion.

In addition, the professionals call for services to be provided locally. That is particularly important because many of the patients are elderly. The current system of geographically distanced centres seems to be in direct contradiction to the aims of the five year forward view, which asks for treatments to be delivered locally. Current financial constraints must also be reduced to increase capacity. That makes sound economic sense, as we heard from the hon. Member for Motherwell and Wishaw, because it is estimated that the failure to tackle this problem actually costs the UK economy a shocking £28 billion—no wonder the parliamentary researchers got the figure wrong. Like me, they probably could not believe the figure when they saw it; £28 million sounds like a lot, but the cost to the UK economy of failing to act on this issue is actually £28 billion.

I want to pick up on some of the other points made by hon. Members today, most notably on prevention. Early diagnosis and prevention are extremely important, and it is a fact that in many areas across England school eye tests are becoming a thing of the past. Most of us will have had our eyes tested in school as children and had difficulties picked up then, but many areas are choosing not to commission such tests. In deprived communities, such as those in my constituency, many people simply cannot afford eye tests that are charged for and therefore choose not to prioritise them. As eye sight deteriorates with age, many people make do with cheap, over-the-counter spectacles. The point has been powerfully made that people do not just visit their optometrist so that they can read more efficiently; they also need to check and make sure that there are no early signs of other diseases. That is really important.

I totally agree with the point made by the hon. Member for Twickenham about treatment. How can an expert look a patient in the eye knowing that a treatment is potentially being developed but that, for reasons of resources, in one of the richest countries in the world, it is not a priority for us? I ask the Minister to consider all these points. STPs have been mentioned, and they are an exciting opportunity to address some of the issues raised today. Like the hon. Member for Wealden, I have looked at many of the STPs for many reasons; worryingly, even in the ones that do mention sight loss and eye care services, it is a passing mention—a tick-box exercise—and I hope that the Minister will address that. Today we look to the Minister to outline the action that the Government will take to address the many issues that have been raised, and to address what has become a national scandal.

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It is a pleasure to serve under your chairmanship, Mrs Gillan. I congratulate my hon. Friend the Member for Wealden (Nusrat Ghani) not only on leading the charge today but on her work on the APPG more generally. A number of Members have made the point this morning that we have not debated eyes and sight in this place very much over the past few years. It is good that we have the time to put that right today, so I congratulate her on doing so.

I start by acknowledging what a number of Members have said—that 50% of sight loss is preventable. I think my hon. Friend said that 85% of people regard sight as the most precious of all our senses. Frankly, I am surprised that the figure was not higher than that. This is clearly massively important. We can debate numbers—the hon. Member for Burnley (Julie Cooper) just talked about £28 billion—but the key figure is the statistic that my hon. Friend the Member for Twickenham (Dr Mathias) started with. Some 20 people a month are losing their sight, whether due to lack of prevention or lack of early treatment, in ways that are preventable. That is not acceptable, and we need to work collectively to address it—I will try to set out the Government response to it now.

I will talk first about prevention and the need for early detection and improved treatment. We heard about waiting lists in Great Grimsby, which I will come to. I will also talk about the social exclusion that can occur, and the mental health issues that can come from that. As I go through, I will try to address the points raised during the debate by Members on both sides of the House. If I do not, I am sure Members will remind me that I have not; in any event, we will write on any points that are not directly addressed.

The UK vision strategy was produced jointly with the RNIB, which does a lot of extremely good work in this space, for which the Government are grateful. Both the Department of Health and NHS England fully support that strategy, and need to continue to drive it forward. We also support global issues; Members have talked about the WHO global plan, which intends to eliminate preventable sight loss by 2020, and my hon. Friend the Member for Wealden talked about some of the work we do globally. She talked about patient choice and the referral process—whether it is via GPs or direct—which is an interesting point that I will come to. She talked about STPs, as did the hon. Member for Burnley, cancelled appointments and the need for a national strategy in England. I will come back on those points, if I do not get to them during my remarks.

To frame the issue, 2 million people in the UK have sight loss—because sight loss is so related to age, 4 million people will almost certainly be affected by 2050—and 80% of those are over 60 years old. Several Members cited statistics illustrating the demographic changes, including the hon. Member for Strangford (Jim Shannon), who spoke about Northern Ireland. As we debate these things across health and social care, we have to recognise the incredibly significant changes to our demography.

When the national health service was set up in 1948, one person in four lived to be over 65. We have totally fixed that, in the sense of increasing longevity. In the last 10 years, our population has increased by 10% and our population of over-85s has increased by nearly 28%. That trend will continue and accelerate, which gives us all challenges, including resourcing and all that that means. I heard a very apposite phrase recently: “We have done a good job of increasing quantity of life, but we haven’t yet increased quality of life to the same extent.” That is true of sight loss. As we heard, 148,000 people are certified blind in this country, with all that that means in terms of benefits and tax changes. That figure has been fairly stable—indeed, it has gone down slightly in the past three years—but nevertheless, it presents us with a big challenge.

In responding to those changes, we have to look at prevention and understand the risk factors. I have just covered the first risk factor, which is age. We cannot do a great deal about that, other than note that we are all getting older. Like the hon. Member for Strangford, I am over 50—considerably so—and the fact is that the sight loss numbers are driven by age. Smoking and obesity also play a big part in eye health, as they do in other aspects of health. Our tobacco control strategy will be produced imminently. We have done a good job in this country of reducing smoking, but we need to go further and faster, and I hope that the strategy will be a big part of that. There will be specific targets by age group for what we need to achieve. Obesity is equally and possibly more important; it is a risk factor for all sorts of things. I perhaps did not fully understand that obesity affects people’s chances of getting cancer, dementia and suffering from sight loss as much as it does. We need to drive home the potential benefits of the obesity strategy that we published, which aims for a 20% sugar reduction by 2020.

Hon. Members, including the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), mentioned cataracts. Obesity doubles the probability of getting a cataract. That is an extraordinary statistic given that it is not intuitive that those are linked, even though they clearly are. I do not want this debate to be about money—what we are talking about is more important than money—but the cost to the country of obesity and diabetes put together means that we now spend more in the NHS on treating them than we do on the police service, the judiciary and the Prison Service combined. That puts into perspective the magnitude of the cost and what we need to achieve.

On prevention, we have not talked about the screening programme that we have introduced for diabetic eye disease, which was the principal cause of blindness in working-age people until recently. As a result of the programme, which involved offering a digital photograph to all people with diabetes over the age of 12, something like 2 million people were screened last year. For a screening programme, there was a very high uptake—over 80%—and some evidence shows that it has resulted in significant progress in preventing that type of blindness. This is the first year for which we have those figures, and diabetic eye disease is no longer the principal cause of blindness in working-age adults. That has largely been achieved through that very effective screening programme.

Let me talk briefly about the four most common causes of blindness, which are cataracts, age-related macular degeneration, glaucoma—that is the most prevalent, as we have heard—and diabetic eye disease. All of those can be treated most effectively through early diagnosis—frankly, that applies in most areas of health, but it is particularly true of eye health—and the first part of that is timely sight tests. Sight tests are free for children at school, although parents have to arrange them. They are also free for the over-60s, for anybody who is in a high-risk group, including those with diabetes or glaucoma, and for people on various income-supported benefits. There were 13 million eye tests last year, which was an increase of 2%. There is always a case for doing more, and I say to anyone who is listening to this debate, even if they are not of such an advanced age as me or the hon. Member for Strangford, that these things are worthwhile.

Treatment is CCG-led in this country. The principal reason relates to some of the issues that we heard about from the hon. Member for Great Grimsby (Melanie Onn), who spoke well about the large numbers of people on the waiting list of the Northern Lincolnshire and Goole NHS Foundation Trust and the extra clinics that had to be put on. That is a CCG responsibility. With national strategies, there is a choice about whether something should be locally focused, with local commissioners having the resources and money—although resources are a different issue—or whether there should be an overarching national plan.

I was struck by what the hon. Lady said about the actions that were taken. Those were local actions, which were completely appropriate. In England, we produce a public health outcomes framework—I do not think that is the case in Scotland, notwithstanding the excellent speeches by the Scottish National party Members about what is done in Scotland. The framework sets out for every local authority area in the country the extent to which there is glaucoma, diabetic eye disease and age-related macular degeneration, and the total number of people who are certified blind. Those data are tracked over the years and ought to inform local commissioners, and indeed, local health and wellbeing boards in the priority areas. There are striking differences and clusters of different types of blindness and different issues in different areas.

To cite a few of those differences, Barnsley has three times the national average of age-related macular degeneration and twice the national average of people who are certified blind. To me, that suggests that the commissioners in Barnsley should, in particular, be putting effort and resources into treating AMD. London has something like 20% more diabetic eye disease than other parts of the country. That may be to do with the large south Asian population in parts of London and the diabetes that that implies. Those sensible decisions should be taken by local commissioning groups in the knowledge of the facts. I commend the public health outcomes framework to hon. Members, who may not have looked at it for their own constituencies and patches. That should be considered and understood, because for this and other issues, it tells us where the priorities ought to be.

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If CCGs are to focus on providing more support for a particular service, it prompts the question, “What will support be taken away from?” The trust in my constituency has now gone into financial special measures. There is only so much give in the system. What does the Minister think is the solution?

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I did say, when I was making the point, that I was not talking about priorities in terms of total resource there. We must make choices. I will come to the point about the £20 million budget.

The hon. Member for East Kilbride, Strathaven and Lesmahagow mentioned concerns that cataract operations were being rationed. In response, the Secretary of State requested that NICE issue guidelines this year rather than next year, and we will pursue that. However, I make the point that 17% more cataract operations are being done in England now than five years ago. That does not imply rationing to me, but we need to be careful. Operations should not be rationed, and we want NICE guidelines in place to ensure that they are not.

I will address some of the points made by hon. Members. My hon. Friend the hon. Member for Wealden mentioned referral pathways. She is right to say that different CCGs do things differently. Some CCGs will require an optician to refer a patient to a GP, who then refers onward to the hospital or ophthalmologist; around 11% of CCGs do not do so, which is quite odd. I will ask officials to investigate why. The principle is that CCGs are responsible for setting their own pathways. It is not for the Government to tell them what to do, but it is possible—indeed, likely—that some might not have wholly addressed the issue.

There is a general drive right across the health service to do more things in the community and fewer things in hospitals. Part of that involves using opticians in the best way possible, and not just on this issue. Although it has not been mentioned in this debate, I would like to see opticians used much more for glaucoma monitoring and other such things that, at the moment, tend to happen in hospitals, because as we have heard, there is a great deal of strain on a number of hospitals. We will try to make progress on that issue. I am happy to sit down with my hon. Friend and the Royal National Institute of Blind People, as she asked, to talk about it in more detail.

My hon. Friend mentioned shared delivery plans. She said that only 50% of STPs include a coherent eye strategy, and the hon. Member for Burnley said that some of those looked like tick-box exercises. I accept that, and I have two points to make. One is that an STP is not an organisation but a planning document, which must be put in place to begin to establish planning areas across the country where we can marry up prevention, primary care and secondary care. Not all STPs have yet addressed all the issues that they should; they are a process, not an event. I say to the people concerned about that that they should keep lobbying their local STP leadership, who are responsible for addressing it. Frankly, many STPs have a long way to go to become coherent plans, and eye health is just one area on which we need to make more progress.

We heard about the issue of cancelled appointments. They are a particular problem with eye appointments, which can be time-critical; the figure of 20 avoidable sight losses a month was quoted. The principles governing missed appointments across the NHS apply in exactly the same way to eyes as they do to all other things. The NHS constitution sets out an 18-week limit. I have heard speakers in this debate mention clinics where 50% of appointments are not attended. Such numbers are completely unacceptable. What is hard to understand in that context is that in the last five years we have increased the number of consultant ophthalmologists across the patch by around 27%. That does not imply that the problem is staffing, but I will take the issue away and consider it. I reiterate that the same provisions that apply to all aspects of our NHS apply to eyes and to national waiting lists. People who fail to get appointments for which they are clinically ready should be on a national waiting list. We should performance manage it in that way.

My hon. Friend the Member for Wealden mentioned choice, rightly saying that people are entitled to choice in their secondary care. The same principle applies to eye care as to all other types of care, but there is more that we can and must do to build awareness.

I will touch briefly on the issue of an eye strategy. I have asked why NHS England feels that it is better for it to be owned and controlled locally; I made the point previously about the degree of local variation. We heard some instances from Northern Ireland, where there is an eye strategy, that show that it is not a panacea. As a Minister, I have a general view. There are a lot of strategies, but many fewer clear action plans with deliverables and accountabilities. It is rather like what we heard about in Great Grimsby. My preference is to work with NHS England and with Health Education England, if it is a question of getting more people into roles and all that goes with that. Having said that, I am happy, as I said, to talk to my hon. Friend the Member for Wealden and the RNIB more generally, but overall, across the health system, I do not see a lack of strategies. I sometimes see a lack of action plans with accountabilities and clear deliverables. My bias is towards the latter, not the former.

On the point about rationing, the NICE process is an attempt to create, across the whole health system, coherent guidelines and structured ways to evaluate different medicines. Broadly speaking, a cost of £20,000 per quality-adjusted life year is used by NICE to decide whether a drug should be offered or not. However, the point about the £20 million cap is slightly different. The cap is being introduced, potentially, for new drugs; it would not apply to any existing treatment. We are accelerating new drugs coming into the system. The cap would act as a trigger point: after £20 million has been spent, a renegotiation with the manufacturer would take place. On that point, I will sit down and allow my hon. Friend to sum up.

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I have only a few minutes for my winding-up speech. It has taken a long time to discuss sight loss here in Parliament, but I am pleased that the Minister has responded so positively. Of course the all-party parliamentary group, the RNIB and I look forward to holding a meeting with him. We agree that the lack of local action, accountability and deliverables must be addressed. We are still convinced that it requires a national strategy, but we are more than happy to discuss that with him.

Fundamentally, the population is growing older, and more and more health problems are coming our way. The number of those with sight loss will increase from 2 million to 4 million. We need to do more on screening, research into treatments, prevention and ensuring that, regardless of where in England people live, they are treated equally and with dignity, within a period of time that ensures that preventable sight loss does not happen. Some 50% of current sight loss could have been prevented. That is not a statistic that we want to repeat.

Question put and agreed to.

Resolved,

That this House has considered preventing avoidable sight loss.

Children’s Health: Access to Milk

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I beg to move,

That this House has considered children’s health and access to milk in educational settings.

It is a great honour to speak under your chairmanship, Mrs Gillan. School milk is an issue that cuts across three Departments—the Department of Health, the Department for Environment, Food and Rural Affairs, and the Department for Education—but I am glad that the Minister for Vulnerable Children and Families is here today to respond to the debate.

I want to highlight the importance of school milk because it is fundamental to children’s health and is a nutritious source of energy during the school day. I thank the School and Nursery Milk Alliance for all its good work and for the information it has supplied for the debate. I am also grateful to Tetra Pak for sharing with me a copy of its forthcoming report, “Making More of Milk”, which will be formally launched on 5 April and which contains information particularly pertinent to the debate.

Milk has been an important part of our diet for hundreds of years. It is a natural healthy option for children that contains vitamins and minerals vital for good dental health and bone development. It also plays a key role in a healthy diet, helping efforts against childhood obesity and dental decay.

The Health Secretary has identified childhood obesity as a public health priority. It is estimated that 29.2% of children between the ages of two and 10 in England are either overweight or obese. Excess weight during childhood often precedes the development of cardiovascular disease, hypertension, insulin resistance and other diseases. Overweight and obese children are more prone to become obese adults.

The latest data from the Health and Social Care Information Centre show that 34% of 12-year-olds and 46% of 15-year-olds exhibit tooth decay. As well as being unpleasant for children, treating tooth decay is a significant cost to the NHS. Cow’s milk contains micronutrients, such as calcium and vitamins B3, B12 and B2, that reduce the risk of tooth decay, bleeding gums and mouth sores.

Statistics released only last week by the faculty of dental surgery at the Royal College of Surgeons showed that more than 9,000 tooth extractions were performed on young children last year, including 47 extractions performed on babies under one year old. The dean of the faculty, Professor Hunt, described the figures as “shocking” and as attributable to the amount of sugar that children consume. Sadly, although the figures were widely reported in the media and although the new soft drinks levy will exclude milk products that contain at least 75% milk, there was no mention of the fact that drinking milk as a healthy alternative to sugary drinks can help children to develop strong teeth.

In 2016, Northumbria University published a review of the available research on the impact of milk on children’s development. The evidence reviewed by the researchers suggested that milk consumption greatly improves children’s nutritional status. The review, which was drawn primarily from cross-sectional studies, reported that children who regularly drink milk have lower body mass indices, lower body fat percentages and lower waist circumferences than children who rarely drink it. That is probably due to the unique combination of essential nutrients that it contains. In particular, the evidence suggests that milk contributes to body mass control and body composition in children—possibly because of the high satiety effect, which makes it an ideal mid-morning snack—and contains multiple nutritional properties that protect against dental decay and promote good dental health.

The nursery milk scheme was subject to a lengthy consultation during the last Parliament about whether it could be made more cost-effective, possibly by giving a single large company the contract to provide milk to all settings across the country. The scheme was left in place untouched, but the problem with it is that children are no longer entitled to milk once they turn five, whenever in their reception year that happens. This confusing system not only creates extra work for teachers but seems very unfair on little children. Tetra Pak’s “Making More of Milk” report has found that 89% of parents and 93% of teachers think that school milk should be made available to all reception children, regardless of when they turn five. Will the Minister commit to changing the scheme and making free school milk available for all reception children?

The Government have given assurances that until we leave the EU we will continue to participate in the European school milk scheme, through which over-fives can receive a subsidised portion of milk, but schools and parents need to know the Government’s plans for the future. Can the Minister offer us any further information or assurances about the future of subsidised school milk for children over five?

Another worrying factor is that Public Health England’s “Eatwell Guide”, which was published in March 2016, reduced the content of milk and dairy products in the recommended daily diet from 15% to 8%. Although the guidance includes recommendations of healthier drinks for the first time, the reduced role of milk and dairy products could limit alternatives for children and young people who are unwilling to drink water or unsweetened beverages.

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I congratulate the hon. Lady on securing this debate and on highlighting the many health benefits of drinking milk. I represent a constituency that produces a great deal of milk. It is fantastic to see her advocating those health benefits; I hope that the Government will listen and, more generally, that people around the country will realise that the more milk they drink, the healthier they will be.

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I thank the hon. Gentleman for his intervention. He expresses a sentiment that will be shared by many people around the country.

Milk can play a role in keeping children hydrated. The British Nutrition Foundation’s healthy hydration advice for children puts milk second only to water as a drink that they should consume. Although greens are important in everyone’s diet, it is worth knowing that a 200 ml glass of milk provides the same calcium as 63 Brussels sprouts or 11 servings of broccoli—quite a thought.

The “Eatwell Guide” caused great concern among stakeholders in the dairy industry, who did not feel that they had been properly consulted during its development. Although Public Health England published information last December on the process of developing the guide, it did not make it clear why the recommendations to reduce the level of dairy were introduced. Can the Minister offer reassurances that the new guide will not discourage children from drinking milk? Will he commit to involving the full range of stakeholders next time any important public health guidance is being revised?

Finally, I would like to raise the issue of school food standards. The school milk sector was broadly positive about their introduction in January 2015, but the School and Nursery Milk Alliance has highlighted the fact that there is no clear evaluation or monitoring of them. To ensure that we make the most of the standards, schools not only need to provide milk, they need to provide it in a way that is appealing to children and that encourages them to drink it. Does the Department for Education have any plans to evaluate the implementation and impact of the standards?

Today, school milk tends to be chilled and served in individual cartons—a big contrast to the warm milk that some MPs may remember from their childhood—but there are other factors that affect whether children want to drink it. For example, milk is more appealing at the mid-morning break than at lunchtime, because its high satiety effect means that it does not make a good accompaniment to a meal. A mid-morning break is also a good time to have a healthy snack, to help children to get through until lunch, particularly if they did not eat a proper breakfast.

Evidence shows that many children drink only skimmed or semi-skimmed milk at home, so if they are given full-fat milk at school, they tend not to like the taste. The school food standards will be revised as part of the childhood obesity plan and it is important that the requirement to provide milk is retained. Can the Minister provide any details about the plans to update the standards as part of the childhood obesity plan? As part of the childhood obesity plan, a new health rating scheme for primary schools will be introduced in September this year. It would be helpful if it covered access to milk in schools, including how it is offered to children. Will milk be included at least once a day?

Ofsted is also planning to produce guidance for schools following its thematic review of obesity, healthy eating and physical activity in schools. It would be helpful for this guidance to include information on milk, including best practice on how to serve it. Academies established between June 2010 and September 2014 are not required to implement the school food standards, although we understand that many of them do so voluntarily. Are there are any plans to make compliance compulsory for all schools?

There are a wide range of issues impacting on school milk today. I look forward to hearing the Minister’s response to this debate. As these issues cut across a number of Departments, I hope he will be able to tell us how they are working together to ensure that children are able to access milk in schools for the benefit of their health, for now and for their lifetime.

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As ever, Mrs Gillan, it is an absolute pleasure to serve under your chairmanship.

I begin, in the customary way, by congratulating the hon. Member for North Tyneside (Mary Glindon) on securing this debate. It goes without saying that, like her, we want to ensure that all pupils are healthy and well-nourished. To that end, we promote and encourage a healthy, balanced diet and healthy life choices, through school funding, legislation and guidance—the tools at our disposal. We use our legislative frameworks, such as the school food standards, to ensure that children receive a healthy, balanced diet within all educational settings.

We know, of course, that most adults and children in the United Kingdom eat too much sugar. That is why the Government recommend that we reduce our intake by eating fewer sugary foods and drinks, such as sweets, cakes and biscuits. We also know that the earlier that eating and drinking habits are ingrained, the harder it is to disrupt them and put people on a different dietary path in the future.

It is in such a context that this debate is timely, as it gives me the opportunity to explain how we are promoting a healthy, balanced diet and milk consumption within educational settings, particularly among those children who are most in need. For example, children under the age of five who attend a day care or early years setting receive milk via the nursery milk scheme, which the hon. Lady referred to. That scheme is funded by the Department of Health, so it is a cross-Government scheme, but we work together to ensure that it reaches the children who need it most. It has actually been in existence since the 1940s, so it is a very well-established route to ensure that those children who perhaps would not enjoy that level of milk consumption at the early age they need it are able to do so.

Indeed, I suspect that I was a beneficiary of that scheme in the 1970s, believe it or not, when I was at Mrs Batsen’s nursery in Wilmslow, where—from memory—I was first faced with the reality of needing to learn to share with others and not just think about myself. I was very excited on the day I was asked to be the milk monitor. The job was to go downstairs with another child—my fellow milk monitor—to collect a crate of small milk bottles for distribution upstairs among our peers. Now, we knew that there were two children absent that day, so we concocted a plan to drink two of the bottles downstairs and then bring the remaining bottles upstairs, where we would then be able to consume another bottle, knowing that there should be two bottles spare. Unfortunately, the plan did not turn out to be the grand plan that we had hoped it would be, as a number of bottles had already been taken out of the crate by the staff, who recognised that they needed to reduce the number of bottles to reflect the level of attendance. So we were caught red-handed and I was never made milk monitor again.

Consequently, when I visited Beechwood school in my constituency in 2011, on what was World School Milk Day, it was something of a surprise to be made an honorary milk monitor. That gave me an opportunity to reflect on the role that milk has played in my life, both in learning life lessons and in being able to access what is an important part of a healthy diet in those formative years as we grow up.

That is why the Government promote a healthy, balanced diet to children, using legislative frameworks such as the school food standards. Those standards, which apply to the overwhelming majority of maintained schools as well as to maintained nurseries, restrict the amount of fat, sugar and salt that can be served during the day. I heard what the hon. Lady said about the fact that there are some academies formed between September 2010 and 2014 to which those school food standards do not apply. We encourage those schools to follow the standards, but of course we keep this matter under review and in the future we will look to see how we can ensure a greater level of engagement with those standards, as they reflect exactly what we want to see happen in schools for the good of children.

The benefits of providing a healthy school meal and milk to the most disadvantaged children are well-recognised. Currently, around 1.15 million of the most disadvantaged children are eligible for and claim a free and nutritious meal. As for milk specifically, we promote its consumption as part of a healthy, balanced diet through funding, legislation and guidance.

Why do we do that? As the hon. Lady rightly highlighted, we know that milk is excellent for children’s growth and development, which is why the school food standards require lower-fat or lactose-reduced milk to be available for children who want it during school hours, and it is offered free to disadvantaged pupils. We also provide significant funding to schools to support the provision of milk, through the European Union, which I will move on to in a moment, as well as through top-up and nursery milk schemes, as part of free school meals, and more recently through universal infant free school meals, which benefit 1.4 million infants.

The hon. Lady made it clear that we have continued our commitments to the European Union scheme during our period of membership of the EU. Of course, like all areas of policy that will be moving into a domestic arena, we will carefully consider how we will continue to support schools, so that we can fulfil our obligation to provide children with a healthy and balanced diet. I cannot say at this stage where that consideration will lead us, but the fact that we can go back to the 1940s to see how Governments have provided help and support in this area is an indication of where we may want to take the evidence in future, when we come to make those decisions in a few years’ time.

Notably, we provide around £60 million each year, outside the EU arrangement, to reimburse costs for the nursery milk scheme, which is targeted at children under the age of five, to ensure that they get the important nutrients they need in those important years of development.

The hon. Lady asked about the over-fives who are still at nursery school. I will look carefully at what she said and discuss it with my ministerial colleagues. However, it is worth pointing out that over-fives who are entitled to receive a free school meal do so, and where they are entitled to a free meal they also receive free milk. Also, under the universal infant free school meals scheme that I referred to a few moments ago, free milk is available to infants if it is served as part of their lunch. We will look at the impact that is having as part of our consideration of where we go next with our commitment in this area.

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I thank the Minister for giving way, and it was very entertaining to hear about his time as a milk monitor. I just wanted to emphasise the issue of children having free milk throughout reception, rather than the current situation, where a child stops getting free milk the moment they are five, even though they will obviously be in a class with other children who are younger than they are. That is the point I want to emphasise. If free milk could be guaranteed to children while they are in a reception class, it would make life a lot easier for the teachers and it would seem fairer to the little children themselves.

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As I have said, I will look carefully at what the hon. Lady has said, but there are a number of routes that I have described whereby children over the age of five in a nursery setting are able to access free milk, whether that is through free school meals or universal infant free school meals. There will be a continuation of the policy in the deliberations by different Government Departments about where it goes next, and clearly that issue will be part of future discussions.

The scheme we support—the nursery milk scheme—has extensive reach, providing milk to 1.5 million children, and it should not be forgotten that it saves families about £400 a year and ensures regular milk consumption. Because milk is a valuable source of a range of nutrients, including calcium, protein and B vitamins, the Government recommend the consumption of lower-fat milks for the general population aged over five years, and promote that through the “Eatwell Guide” the nation’s food model and the Change4Life social marketing campaign, which recommends swapping sugary drinks for water, lower-fat milks, and diet, sugar-free or no-added-sugar drinks. The “Eatwell Guide” has been distributed to all primary, secondary and independent schools in England. I hear what the hon. Lady says about the guide and the advice, but the advice was set after a review of all the evidence, including the recommendations of the Scientific Advisory Committee on Nutrition on the basis of a full public consultation. The intention is absolutely not to discourage children from drinking milk but to encourage them to do so as part of a healthy, balanced diet. That important message should be taken away from the debate.

I turn to the early years foundation stage framework, which sets out the regulatory standards for all early years providers. The framework requires early years settings to

“promote the good health of children attending the setting”,

and to provide meals, snacks and drinks that are “healthy, balanced and nutritious”. About 40,000 childcare settings are currently registered with the nursery milk scheme in their fulfilment of that responsibility. Such settings must also help children to make healthy food and drink choices, so that they can formulate healthy lifestyle habits early on. In line with our commitment in the childhood obesity plan, we will publish and promote example menus for early years settings in England, to help them meet the latest Government dietary recommendations. I am sure that the hon. Lady will be interested in looking at those.

We are also committed to improving young children’s oral health. That is a Public Health England priority, and it has established a child oral health improvement programme board, with a substantial programme of work and a wide range of partners, to improve the oral health of children under the age of five. In fact, only a few months ago, in December, Public Health England and the Department for Education—another example of cross-Government working—published a toolkit for early years providers, to support those considering setting up a supervised teeth-brushing scheme. In addition, Government measures to reduce sugar consumption, as set out in the childhood obesity plan, are designed to have a positive effect, and they include the soft drinks industry levy announced last year and wider measures to reduce sugar in food and drink products.

Although it is encouraging that the data published by Public Health England show that over the past two years the number of tooth extractions for children in hospital has reduced, there is no let-up in doing all we can to improve children’s oral health. Public Health England and the National Institute for Health and Care Excellence have published evidence-based guidance and toolkits to support local authorities, and NHS England is also working up plans to test, in 10 high-need areas, more creative ways of using commissioning expenditure to improve children’s oral health. I understand that those areas will be announced shortly. The Department of Health is working with NHS England to test the NHS dental contract focus on improving oral health, particularly in children.

This is about promoting not just milk but other physical activity that can be undertaken by children, at home or at school, to support a healthy, balanced diet. As part of the work to tackle childhood obesity, we are also committed to updating the school food standards, to align them with the latest scientific advice on sugar. We are in the process of scoping out the timeliness of that work, and I hope further information will be available later in the year. We will take into account the hon. Lady’s points about who the standards apply to and will ensure that the standards best reflect what we know works for children in instilling good, healthy lifestyle choices, including the regular consumption of milk as they grow up.

Sugar consumption is a major factor in childhood obesity, and sugar-sweetened soft drinks are now one of the biggest sources of dietary sugar for children and teenagers. The introduction of the soft drinks industry levy is a clear indication of our determination to address that vital issue. The levy will generate significant funding for a variety of initiatives announced in the childhood obesity plan, including the doubling, from September 2017, of the primary physical education and sport premium from £160 million to £320 million a year, the provision of £10 million a year to fund breakfast clubs in up to 1,600 schools, targeting pupils most in need—milk could play a part in those clubs—as well as £415 million towards the creation of a new healthy pupils capital programme, supporting schools to pay for facilities for PE, after-school activities and healthy eating. There is an opportunity there to use significant new money to promote the cause that the hon. Lady has articulated so well.

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On the levy, I asked the Minister whether the Government would consider it a good idea to promote drinking milk as opposed to sugary drinks, since not all children like water or unsweetened beverages. That is my key point on the issue; the Government should say, “Milk is good for you. Drink it” instead of a glass of sugary pop.

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At the risk of harking back to the halcyon days of the 1970s and 1980s, I remember the adverts, “Gotta lotta bottle” and “Nice cold, ice cold, milk”, which did a lot to promote milk consumption, not just within educational settings but in the wider community. I think I have given a strong message today about the Government’s support for the continuation of milk as a central tenet of a child’s dietary upbringing. Through the various schemes that we still support and also the new money that we have announced, there is an opportunity to help that to infiltrate even further into our education system.

However, we still have a lot of educating of parents to do. Last year a survey in Scotland showed that a third of parents still did not think it an issue if their child had tooth decay by the time they were a teenager. There are some perceptions and societal norms that we would not want to support, and there is work to do to bust them as we strive to improve the health of our nation. The Government want to help children to achieve a healthy, balanced diet and to encourage them to make the right food choices, and I want to reassure the hon. Lady that we will continue to encourage the consumption of dairy products, including milk.

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It is useful to hear about the role the Minister sees for his Department in promoting the drinking of milk. Does he see a wider role in promoting an affinity with farming, to encourage children to have a greater interest in the provenance of their food? That might be a catalyst for healthier eating and for support for the UK’s agricultural industries.

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As a Member of Parliament with a strong dairy industry in my constituency, I am always keen to find ways of bringing children closer to the land and helping them to understand the importance of the industry and its produce to them and their health as they grow up. My hon. Friend’s suggestion is helpful. The more we can do to bind those things together, the better.

Through the likes of the nursery milk scheme, we can ensure that children under the age of five receive free milk every day. In addition, through the early years foundation stage, we are ensuring that early years settings are promoting good health choices and providing meals, drinks and snacks that are healthy, balanced and nutritious. We are always open to suggestions and evidence that point towards other approaches to help us tackle what is, as the hon. Lady said, and as the Secretary of State for Health has said on many occasions, a public health issue. I thank the hon. Lady for using the debate to do just that, and I hope that she has been reassured by the Government’s continued commitment to ensuring that children can grow up and have a healthy and fulfilling life, in which milk plays a prominent part.

Question put and agreed to.

Sitting suspended.

National Spitfire Project

[Philip Davies in the Chair]

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I beg to move,

That this House has considered funding for the National Spitfire Project.

A national monument to the iconic Spitfire is long overdue, and in moving this debate, I hope the House will also consider the 100th anniversary of the Royal Air Force. It is a pleasure to serve under your chairmanship, Mr Davies. The Spitfire, like me, was made in Southampton—I always have to get that in. The prototype was designed by the famous aeronautical engineer—he was also one of the country’s most successful apprentices—R. J. Mitchell, at the Supermarine factory in Woolston, which is situated in the east of the city and the heart of my Southampton, Itchen constituency.

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While Reginald Mitchell was one of Southampton’s most famous apprentices, he was one of my constituency’s most famous residents. Does the hon. Gentleman agree that we have an opportunity for a national celebration of Reginal Mitchell’s contribution?

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I agree with the hon. Lady that it is a national monument that we seek. I acknowledge that R. J. Mitchell was born in Stoke-on-Trent. In fact, it was where he started his apprenticeship. However, he designed the iconic Spitfire in my constituency of Southampton, Itchen, which is where I think the monument should be situated.

The Spitfire completed its maiden flight from Eastleigh airport, latterly renamed Southampton airport, on 5 March 1936. With a powerful and instantly recognisable Rolls-Royce Merlin engine and eight machine guns, it was a formidable fighting aircraft in its day. So impressed were the Royal Air Force with the prototype that the Air Ministry ordered 310 Spitfires to be produced at the Woolston factory in Southampton. By 1940, the factory was at full production, employing thousands of technicians and engineers to manufacture the Spitfire. The aircraft had to be built quickly to replace the many being lost during the battle of Britain, so the factory was working flat out. The Nazis knew that, and they also knew they had to stop it. The luftwaffe had been taking catastrophic losses—they estimated that they had lost nearly 1,200 aircraft between July and September 1940 due to allied action—so it was imperative for them to prevent the manufacture of British fighter aircraft.

September 1940 was Southampton’s darkest period of the war. On 15 September the Woolston factory was attacked by 15 luftwaffe bombers dropping 23 bombs. Fortunately, on that occasion they missed their target, but on 24 September 17 enemy bombers managed to reach the south coast and attacked the Itchen and Woolston factories. Two days later the Nazis redoubled their efforts and two waves of bombers got past the British air defences and dropped 60 bombs on the two Supermarine complexes. Both factories were destroyed, and as a result 110 people lost their lives and many more were injured.

The blitz on Southampton was devastating, and the city was hit over and over again, not just because of its Spitfire production, but because of its docks and many other strategic targets. There were 57 attacks documented in all, dropping more than 2,300 bombs. Nearly 45,000 buildings were damaged or destroyed, with most of the city’s High Street devastated. There were reports that the glow of the firestorm as Southampton burned could be seen from as far away as Cherbourg.

After the awful attacks on the Woolston Supermarine factory, the Nazis thought they had succeeded in halting production of the Spitfire. However, they underestimated the British spirit and stoicism, and not for the first time. Under the instructions of Lord Beaverbrook, production was dispersed to sites around Southampton, Hampshire and Wiltshire.

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I commend my hon. Friend for securing this debate and for the powerful case he is making. He may be aware that production of the Spitfire was distributed to bus depots, laundromats and all sorts of improvised mechanical workshops around Southampton. In that way, thousands of Spitfires were produced, touching the lives of almost every family in Southampton. Does he agree that the monument would be a tribute not just to the air force and the plane itself, but to the enterprising spirit of the people of his home town?

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I agree with everything my hon. Friend has just said. In fact, I was about to come on to that very point.

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I am sure the hon. Gentleman will accept that when he talks about Southampton, he means both sides of the city. Indeed, it is a pleasure for me to be here this afternoon to support him in what he is saying about the Spitfire, provided that the word “Southampton” is completely underlined in proceedings so far as the national monument is concerned.

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I am happy to agree with the hon. Gentleman, my neighbour and friend. Southampton is the home of the Spitfire. It just so happens that the Supermarine factory was located in my constituency. However, I am referring to Southampton in general.

Returning to the comment made by my hon. Friend the Member for Richmond (Yorks) (Rishi Sunak), sheds, garages, bus stations, industrial units and a hotel were used for production in and around Southampton—including Hendy’s garage, Seaward’s garage, Sunlight laundry, which were in the constituency of the hon. Member for Southampton, Test (Dr Whitehead), and the Hants and Dorset bus depot—before the aircraft were assembled and test flown at Eastleigh airport.

Within a few weeks, the Spitfire was back in production all over Southampton and the neighbouring towns and villages, including Salisbury, Reading, Newbury and Trowbridge. It was an enormously challenging business building the Spitfire in that way, and we should not underestimate that. The work was carried out at the height of the blitz, often by unskilled labour. A large part of the workforce was women, girls and retired men, because most eligible men were in the armed forces fighting for their country.

The effects of the war touched the lives of almost every family in Southampton, and they continue to do so today. In fact, Flight Lieutenant James Brindley Nicolson was awarded the Victoria Cross in 1940 for his bravery in a dog fight over Southampton. His bravery has been studied and recognised by children from Sholing Junior School in my constituency. The pupils designed and raised funding for a memorial to commemorate his achievements.

Once assembled, the Spitfire was delivered to air bases across the country by the Air Transport Auxiliary. Many of those pilots were women. One of note is Mary Ellis, who celebrated her 100th birthday last month. Her extraordinary milestone was marked by a flight in an extraordinary aircraft, the Spitfire, one of the aircraft types she flew during the war. In 1943 the women of the Air Transport Auxiliary were awarded equal pay to their male colleagues, making the ATA the first equal opportunities employer.

On 1 April 2018 the Royal Air Force will celebrate its centenary, commemorating 100 years of devotion and duty to our country. As a former Royal Air Force engineer, I am enormously proud to be standing in this place today promoting the National Spitfire Project and the tribute to the Royal Air Force in the shape of the Spitfire monument. Perhaps the RAF’s finest hours—they were certainly those of the Spitfire—were during the battle of Britain, when against the odds our brave pilots and engineers repelled the might of the largest air force the world had ever seen. I do not think anyone would say that the battle of Britain won the war, but it certainly prevented a German invasion and was a turning point in the fortunes of Hitler and his ambitions to occupy Great Britain.

The Spitfire played a central role throughout world war two, and our British pilots were joined by allied pilots from all over the world. In fact, up to 20% of pilots who flew in the battle of Britain were not British. Most notably, the Royal Air Force was joined by Poles, Czechs, New Zealanders, Belgians, Canadians, Australians, Norwegians, Greeks, Swedes, Italians, Indians and Pakistanis. Tomorrow the Prime Minister will write to Donald Tusk, the President of the European Council, informing him of the UK’s intention to leave the European Union. One of the first priorities of our withdrawal negotiations must be the status of European Union nationals living in this country and British nationals living in European Union countries. As the negotiations begin, it is important to take a moment to remember the significant contribution that those countries of the European Union made to our war effort.

A total of 145 Polish fighter pilots served in the RAF during the battle of Britain, making up the largest non-British contribution. By the end of the war, around 19,500 Poles were serving in the Polish Air Force in the UK and in the RAF. One Polish pilot of note was Stanislaw Skalski, who came to England after the fall of Poland. While flying with 501 Squadron, he shot down seven enemy aircraft before being shot down himself. After recovering in hospital, he joined 306 Squadron in February 1941 and by October he had claimed a further five enemy fighters.

Of course, this country produced its own heroes and the pilot credited with bringing down the most enemy aircraft from the cockpit of a Spitfire was Air Vice-Marshal Johnnie Johnson, who had 38 confirmed kills—that might well have been more, if he had not missed the beginning of the battle of Britain due to a rugby injury. Flight Lieutenant Eric Lock became the RAF’s most successful battle of Britain pilot, shooting down 16 German aircraft. In one week alone, Flight Lieutenant Lock managed to shoot down eight German aircraft—an impressive tally that earned him the Distinguished Flying Cross.

In November 2016 a new memorial was unveiled in Grimbergen, Belgium to honour the fallen Norwegians who flew Spitfires during the war. In the UK we have many monuments, including that to the women of world war two on Whitehall, the RAF Bomber Command memorial in Green Park and the National Memorial Arboretum in Staffordshire. It would therefore be fitting to further commemorate, in the Royal Air Force’s centenary year, those who dedicated their lives to protecting our freedoms.

In order to celebrate the fantastic achievements of the RAF over the past 100 years, the RAF 100 committee has a selection of events planned. Those national events will raise the profile of the RAF across the whole of our nation, enhance its reputation and promote a better understanding of what it does. It will showcase the RAF’s people, their depth of talent and their diversity. The events will celebrate the history of the RAF, but they will also demonstrate why it remains, and will continue to remain, vital to the security and prosperity of the UK. The national tribute to the Royal Air Force will be the only physical legacy to recognise and commemorate the RAF’s centenary. It will serve to remind everyone who visits the monument what a significant contribution the RAF and the Spitfire have made far into the next 100 years.

The project for the Spitfire monument has been led for many years by my very good friend and colleague, Councillor John Hannides. He is joined in his endeavours by retired Air Commodore Gordon Moulds, Paul Lester and Tony Edwards, and the president of the trust, Sir Ralph Robins.

Everyone in Southampton has grown up knowing the story of our brave pilots and the iconic Spitfire. As a constant reminder, a fully functioning Spitfire is still the major attraction at the excellent Solent Sky aviation museum in Southampton, run by the determined and dedicated curator Squadron Leader Alan Jones. The legend of the Spitfire lives on in countless films, documentaries, essays and books. My right hon. Friend the Member for New Forest East (Dr Lewis), who is unable to be here today due to his duties chairing the Defence Committee, is a keen supporter of the project and has himself written an acclaimed account about a highly decorated pilot, Kink Kinkaid, who died in Southampton water trying to break the airspeed record in a forerunner of the Spitfire, the Supermarine S.5.

We now have a site on Southampton’s historic waterfront, generously donated by Southampton City Council, where the more than 1.8 million passengers on one of the 450 cruise ships that visit Southampton each year will pass. We have a detailed design for a stainless steel monument 1.5 times the size of the original Spitfire, which will soar 130 feet above the ground—nearly as high as the Statue of Liberty and twice as high as the Angel of the North—and be visible for miles around. We also have all the planning permissions in place. All that is missing now is the funding required to bring the project alive.

Since 2012, the Government, through the Financial Conduct Authority, have levied fines on the banks of more than £973 million for fixing LIBOR rates. Much of that has been allocated to worthy causes, and rightly so. The Chancellor has made clear his intention to use the remaining fines for armed forces and emergency services charities. I completely agree with that approach and I suggest that this project fits those criteria perfectly.

Sir Winston Churchill, one of our nation’s greatest ever leaders, summed up the debt of gratitude we owe to the Royal Air Force, when he said:

“Never in the field of human conflict was so much owed by so many to so few.”—[Official Report, 20 August 1940; Vol. 364, c. 1167.]

It is time for the many now properly to honour the few, and what better way than to immortalise them and their most famous aircraft in a fitting monument to the Spitfire.

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It is a pleasure to serve under your chairmanship, Mr Davies—and may I assure you that I am at least one of your Twitter followers who does not hate you?

I declare my interest in this subject. Both my parents were in the Royal Air Force during world war two—indeed, they met there, which is why I am here now. My father was an engineer. He maintained the Merlin engines on the Spitfires, Hurricanes, Lancasters and Mosquitos. He always said thereafter that he got very bored when jet engines came along, because the Merlin was such a beautiful and sophisticated engine to maintain, whereas jet engines were too simple for him.

In an iconic fashion, the Spitfire represents the common endeavour of these islands in their crusade against evil. With a nod back to last week, that is something that we should always remember. In expressing my interest in the subject, and as a member of the Scottish National party, I want to say that the Spitfire represented something for all these islands and for all the people of these islands—for the common people, for working people and for members of the services. The importance of the prospective Spitfire monument embraces not just the aircraft, but the human endeavour that lies behind it. I think we could all agree on that, which is why I am so serious that we must finish the project. As most people here know, the project has been a long time in gestation—far too long—and it is time that we make sure that next year, the 100th anniversary of the RAF, is the year that it actually happens.

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I thank the hon. Gentleman for giving way, and also you, Mr Davies, for your chairmanship. It is a pleasure to serve under you. I also love you on Twitter—and everywhere else too.

It is great to hear a member of the SNP being so positive about something. That is something of a revelation to me, sitting on this side of the Chamber. I hope the Minister is taking notice of the cross-party support at this point for the memorial. I was involved in the Sir Keith Park memorial campaign, as were others here, and I was helped by some of those who my hon. Friend the Member for Southampton, Itchen (Royston Smith) mentioned. It is great to see the project finally coming to fruition, but it does now need the Government to step up to the plate.

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I am happy to reinforce the sentiment to the Minister that the support comes from all over the islands. I want to underpin that with a little bit of extra history on the Spitfire, which I think all of us will do this afternoon.

The Merlin engines were largely manufactured at the Rolls-Royce shadow factory at Hillington, just outside Glasgow. Some 160,000 people worked at that factory and it provided the engines not just for the Spitfires, but for many of the other aircraft that served the RAF. That was part of what happened in world war two, and people did that selflessly. However, there is an interesting side to the Hillington experience of building the Merlin, because large numbers of the people making the engines were women. Initially, they were not paid the same as men; they were not even paid the same as the ordinary labouring workers were. That led to a lot of industrial unrest and, in 1943, to a major strike. Of course, that was a very difficult thing to contemplate in the middle of world war two. The feeling in the factory was that we were not just fighting against evil, but fighting for a new, democratic society, so they took industrial action—very regrettably, but they took it. The result was that for the first time in these islands a major engineering factory granted equal pay to men and women. We should weave into the Spitfire story the fact that the fight for equal pay began with the Spitfire, strange as it may seem.

I will not keep Members long, but I want to add another couple of Scottish contributions. I do so not to be sectarian, but to underline the fact that this would be a common monument and would represent all of these islands.

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The hon. Gentleman is making a powerful speech. His parents worked on the Spitfire, as did my grandparents. Does he agree that, without the combined resources and ingenuity of all the nations of the United Kingdom, the Spitfire would surely have never flown, and that the Spitfire is a powerful reminder to us today that we truly are stronger together?

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It is self-evident that we have to defend these islands together. What divides us at the moment and in times past is how we organise our democracy, and I think we are mature enough to have that discussion. What the SNP bring, and have always brought, to the table is the idea that we will share the common defence of these islands. That has never been in question. Indeed—my hon. Friend the Member for Argyll and Bute (Brendan O’Hara) might say this in a brief moment—we often have discussions about defence issues because we do not think the Government protect these islands adequately, but that is a debate that we can have elsewhere. Our division on how we organise our democracy in these islands should not get in the way of the fact that we have a common interest in defending them. The history of the Spitfire and the second world war is an exemplar of that.

I will be very brief, as other Members want to speak. There is one other person who needs to be mentioned today with respect to the Spitfire and the battle of Britain: the man who was the head of Fighter Command, Hugh Dowding. We have all seen the film “The Battle of Britain”, which, for all its faults, I still love—when the music comes up I still get excited—and we have all seen Laurence Olivier play Hugh Dowding. There is just one slight problem—it is the same problem I had when Laurence Olivier played Earl Haig in “Oh! What a Lovely War”. Earl Haig was a crusty Scot, with a deep Scottish accent, which Laurence Olivier definitely did not have, and Hugh Dowding happened to be born in Moffat in Dumfries and Galloway. His father was a teacher at Fettes school in Edinburgh. The unity of these islands in the Spitfire story goes all the way to Hugh Dowding from Moffat, who was head of Fighter Command in those dark days. There is a large and very simple, but I think poignant, monument to Hugh Dowding, head of Fighter Command, in his home town of Moffat. That underlines the fact that the Spitfire monument in Southampton has been a long time coming.

I will finish with this. My wife was born and bred in Southampton—I know it well—and her image of the city is the bombed-out Southampton of the 1950s, so these islands are interconnected. We can have a serious debate about how we do our democracy. I grant no ground on that—Scotland will be independent—but we will all stand together in tough times. We share these islands; we will defend these islands together.

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May I say on behalf of all Conservative Members that we are delighted that the hon. Member for East Lothian (George Kerevan) made such a telling case for the Union—not only for the Union of the United Kingdom, but the union of the Kerevan household, in which England and Scotland are clearly united, as they are in my family? My parents, like his, served in the Royal Air Force during the second world war. My mother was a Scottish Borderer. I come from a long line of rapers and pillagers—I have a lot of Border reiver blood in me. My father was a Lancastrian. They met in Ceylon, where my father was serving on Mountbatten’s staff as a Royal Air Force liaison officer. One of his jobs was to vet material being submitted to the Royal Air Force journal for publication. He had to go and check this stuff, and he thought this WAAF sounded rather interesting, so he went up country to check her out. Five weeks later, they were married, and their marriage lasted 40 years.

My mother had a lifelong passion for the Spitfire, which I have inherited. I can tell my hon. Friend the Member for Southampton, Itchen (Royston Smith), who made a great case in opening this debate, that she was at Netley hospital and witnessed the bombing of the Woolston factory in 1940. She then went to Rednal, where she worked on Spitfires, and she wrote an article in Royal Air Force Parade called “The It in the Spit”. I have inherited all that Royal Air Force blood, and I have had the privilege to be a pilot for getting on for 52 years.

For those of us who fly, the Spitfire is unquestionably one of the most iconic aircraft ever developed. What a man R. J. Mitchell was. Yes, he was born in Stoke-on-Trent, but he designed his aeroplane down in the south. I went to Southampton University, so I have a huge association with the Spitfire. It was an iconic aeroplane. It was born of a competition, of course—the Schneider trophy. It went on to do such sterling work throughout the second world war, and it continued afterwards and was in service until the 1950s.

The greatest privilege for me was when my 65th birthday came up—a short while ago—and my wife gave me a surprise present. I did not know until the week before that we were going to the Goodwood Revival festival. I said, “What should I wear?”—people are supposed to wear 1950s attire—and she said, “I think you should wear your flying suit.” I wore my flying suit, and we had a celebratory lunch and drink in the golf club at Goodwood, of which both my sons are members. The champagne was passed round, and I held up my empty glass and said, “What about my glass?” She said, “Well, you’re not drinking.” I said, “Why am I not drinking?” “Because you’re flying.” I said, “What am I flying?” I had the privilege of flying a Spitfire.

I do not know how many other Members of Parliament have had the privilege of flying a Spitfire. I have flown quite a few aircraft types—only as a private pilot, in the Royal Air Force Volunteer Reserve and in Southampton University Air Squadron—but there is unquestionably something completely special about the Spitfire. Some colleagues do not seem to understand that machines can have human attributes, but the Spitfire does. It is the most gentle of aeroplanes to fly. It is incredibly sensitive. On the south coast of England as sunset was approaching on Battle of Britain Sunday, there I was patrolling in a Spitfire.

Willy Hackett, the Royal Air Force officer testing the F-35, was flying in the front seat, because I could not fly it solo unless I had done the conversion course, which costs £40,000. He said, “I’ll do the takeoff,” and at 350 feet I had control. He let me roll it—rolling a Spitfire is a fabulous experience—and he did the landing.

The Spitfire is such an iconic aeroplane, and it is so much a part of the history of these islands and the defence against tyranny. Of course there were other aeroplanes, notably the Hurricane, but the Spitfire is so beloved of pilots. Having flown it myself, I can certainly respect that.

We have sadly very few battle of Britain pilots left. Among them is Geoffrey Wellum, who wrote “First Light”—a fantastic guy—and Tom Neil, who is still alive. They will be celebrating the battle of Britain on the south coast in July. Then there are great men such as Tony Iveson. Tony was not only in the battle of Britain, but in 617 Squadron and responsible for the sinking of the Tirpitz. Captain Eric “Winkle” Brown, born in Melrose, was probably the most celebrated naval aviator who has ever lived. He died only last year, at 97. It was a privilege to know him. Eric flew more aircraft types than any other man in the world—487, I think, which will never be exceeded—with 2,500 deck landings; no man has flown that many deck landings. He also flew the Spitfire.

The Spitfire has a fantastic history, which is so bound up with the history of these islands that I believe it deserves this monument supported by my hon. Friend the Member for Southampton, Itchen. He is joining forces with the hon. Member for Southampton, Test (Dr Whitehead), so the whole city of Southampton will be behind it. There can be no fitter monument for the centenary of the Royal Air Force.

My hon. Friend rightly pointed out that so many of the Spitfire pilots were not from the United Kingdom. One was an American, with an English mother and American father, John Gillespie Magee. Some will know his poem, “High Flight”, which he wrote as he was taking a Spitfire mark V up to 30,000 feet on the 3 September 1940. They are some of the most magical words in the English language:

“Oh! I have slipped the surly bonds of earth,

And danced the skies on laughter-silvered wings;

Sunward I’ve climbed, and joined the tumbling mirth

Of sun-split clouds—and done a hundred things

You have not dreamed of—Wheeled and soared and swung

High in the sunlit silence. Hov’ring there

I’ve chased the shouting wind along, and flung

My eager craft through footless halls of air...

Up, up the long, delirious, burning blue

I’ve topped the wind-swept heights with easy grace

Where never lark or even eagle flew—

And, while with silent lifting mind I’ve trod

The high untrespassed sanctity of space,

Put out my hand, and touched the face of God.”

The Spitfire—I congratulate my hon. Friend.

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It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate the hon. Member for Southampton, Itchen (Royston Smith) on securing the debate and on his work on this matter.

As a piece of engineering excellence, the Spitfire has long been considered in a league of its own. Its speed and agility is legendary, and we just got a flavour of that from the hon. Member for Aldershot (Sir Gerald Howarth). Surely there can be no better way than the proposal of the National Spitfire Project to remember that incredible piece of history, a monument on the waterfront of the city that built the Spitfire. The Spitfire project is warmly welcomed.

We have been discussing the funding of the project, and I pay tribute to those who have supported the crowd-funder effort to take it forward. At the height of the war, the public donated their pots and pans to be melted down for their Spitfire project—literally, to create and build the aircraft—and it is important that now the public find a way to put money into a national project that will properly recognise the Spitfire’s contribution.

To me the Spitfire is familiar, and it has become part of my weekly commute: I see a Spitfire, or at least a replica of one, at the entrance to Edinburgh Turnhouse airport most Mondays on my way down here. The particular model that I am so familiar with is painted in the colours of the 603 (City of Edinburgh) Squadron, which was said to be one of the most effective units in the battle of Britain, which we have heard so much about this afternoon.

My constituency has its own tale to tell of its history with the Spitfire and with flight more generally. Stirling was the home of the Barnwell brothers, Harold and Frank. They were aircraft pioneers who built their first glider two years after the Wright brothers’ flight. The Barnwells’ first prototype, built in 1908, failed to take off—no pun intended—but, undeterred, the brothers successfully took to the skies on 28 July 1909 in the shadow of the National Wallace monument at Causewayhead, Stirling. Reportedly “soaring” at an altitude of 4 metres and travelling the grand distance of 80 yards, that small but significant step was Scotland’s first powered flight and marked the beginning of an important relationship between Scotland and the skies.

The Barnwells’ feat has been marked with an elegant plaque in Balfron, where the brothers hailed from, and with a granite sculpture by what is now the Causewayhead roundabout, the site of their flight—I also understand that the brothers won £50 for their success in completing the first one-mile flight in Scotland. Although those memorials may not be on the scale of the one under discussion today, they are to achievements that are still worthy of recognition in the story of powered flight.

In Scotland, we feel a strong bond with the servicemen and women who have served us through the years, and I am sure that we all agree that their service must never be forgotten. That is part of the reason why I think the Spitfire project is particularly appropriate. As we have heard, we have just had the 75th anniversary of the battle of Britain—Scotland’s First Minister was down here in London alongside Prince Charles and the Defence Secretary to mark that date—and last year Stirling commemorated 100 years since the formation of the 43 (Fighter) Squadron, initially a unit of the Royal Flying Corps, in the Carse below Stirling castle.

In my research for this debate, in seeking to tie the story of the Spitfire to my own constituency, I was delighted to find an account given to the BBC’s Mhairi Campbell by Campbell Chesterton for the “WW2 People’s War” site. In 2005 he wrote:

“During WW2 while my father was in the army overseas my mother and I stayed with my uncle and aunt (her sister) Mr and Mrs Blyth on their farm, Hill of Drip three miles NW of Stirling…During the second world war the carse of Stirling was used by the RAF for low fly training as low as thirty foot was permitted, this was very exciting for a young boy, one day we saw a spitfire aircraft and the tail of another over Dunblane. We heard that one crashed in Callander, there were many accidents. A hurricane fighter landed in the next farm with its wheels up, we managed to get a seat in it before the guard arrived.”

That gives us a flavour of just how dangerous flight was in those days. It is a lot safer now. There used to be a lot of accidents and casualties even in training.

For such memories to be preserved is important, and the National Spitfire Project aims to educate the next generation, an aim that I wholeheartedly welcome. There can be no better way to tell the 100-year story of the Royal Air Force to future generations than with the backdrop of the Spitfire rising 130 feet above Southampton Water. I also echo the sentiments of Members who have made the point that we must commemorate not only the pilots but the hard work of the engineers at home who supported the RAF fighters in the battle of Britain and through the 100-year history of the Royal Air Force.

Part of the reasoning behind the memorial is to commemorate the history of the RAF, and in doing so we remember the individuals who have served in the force. It is worth pointing out that the average age of an RAF pilot in the battle of Britain was 20 years—people who were not yet old enough to vote, many of them, were old enough to lay down their lives so that we could have the democratic debates we have in this place in the manner that we do.

I also want to make special reference in my contribution to the non-British RAF personnel who have been mentioned by a couple of the speakers so far. The Ministry of Defence cites Fighter Command in the second world war as a “cosmopolitan mix” of 141 Poles, 87 Czechs, 24 Belgians and 14 free French among its servicemen and women. Each individual was prepared to make the ultimate sacrifice during the conflict to protect our freedom and way of life, and Scotland and our friends throughout the UK and beyond will never forget that.

I again thank the hon. Member for Southampton, Itchen for the debate. The Spitfire project is an important one, and I wholeheartedly support it. I sincerely look forward to visiting the national project in Southampton on its completion, commemorating the iconic Spitfires.

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It is a pleasure to join the debate on the funding of the National Spitfire Project, and I congratulate my hon. Friend the Member for Southampton, Itchen (Royston Smith), whose constituency neighbours mine, on securing it. It feels particularly poignant, as I spent this morning with one of my youngsters at the Churchill museum in the War Rooms, which I urge people to find time to enjoy.

I found the input of my hon. Friend the Member for Aldershot (Sir Gerald Howarth) touching. He said so much of what we need to hear in the debate. I have the RAF yacht club in Hamble, and its members would have loved to hear the words he said. Also in my constituency, the Royal Victoria country park at Netley includes a very touching graveyard, where it can be seen that people from around the globe gave their souls to make the world a better place for us. I urge the Government to listen to my hon. Friend the Member for Southampton, Itchen and to everyone with Southampton in their address. The cause is a worthy one for the LIBOR fund. In fact, many people work at Southampton airport, which some people still call Eastleigh airport, and rightly so. Many of the people who live in my constituency work nearby at NATS in Fareham. There is a strong association with the aircraft and the industry.

Perhaps we can raise money to help the Government match the funds. Perhaps hon. Friends will join us at Eastleigh— or Southampton—airport in the very early dawn on 25 June for the airport run, which is a chance for us to raise money for the Hampshire and Isle of Wight air ambulance. South Hampshire has had flights for more than 100 years, and aviation is an important backbone to our communities.

I join my hon. Friend the Member for Southampton, Itchen and other hon. Members in hoping to secure this much-needed monument. It will certainly put Eastleigh airport on the map, although I may find myself in trouble with Southampton airport for bringing that name up.

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I rise briefly to support the hon. Member for Southampton, Itchen (Royston Smith) in his debate this afternoon, which I congratulate him on securing. I also congratulate him on his tenacity in pursuing this aim of a national monument for the Spitfire in Southampton. The bottom line of what we are talking about today is a request for money. We need the money—ideally from the Government. The hon. Gentleman’s suggestion for where that money might come from would be an appropriate source for the rest of the funds. Many people have already contributed small and varying amounts to the fund to secure the aim of a memorial for the Spitfire on Southampton Water.

Why is the memorial so important? There are three things we might say along with all the other things that have been said about the Spitfire. In this context, I want to offer the story of my father, who was an aeronautical engineer with the Fleet Air Arm. He spent most of the war repairing aircraft, never leaving these shores. Unfortunately, the story does not neatly end with Spitfires, because he worked on Swordfish. As some hon. Members may know, Swordfish were in service at the same time as the Spitfire, but they looked like a completely different generation of aircraft. They were held together with bits of string, sealing wax and various other things. Although they did a good job, if we put the Spitfire next to the Swordfish, the Spitfire design appears to have been from the future and an imagination from I do not know where. They brought this amazing aircraft into being at a time when those aircraft were the staple—

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On that point, it is worth remembering that R. J. Mitchell also designed the Walrus biplane seaplane, which picked up so many downed RAF pilots. It looked as antediluvian as the Swordfish, but equally it was very efficient.

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Indeed. That underlines what I was about to say: R. J. Mitchell designed a plane that was never equalled throughout the whole of the second world war. Not only did the Spitfire save our bacon during the Battle of Britain but it went on to play all sorts of other roles across Europe and the world as the second world war progressed, due to its unique capacities and design and the way it stood head and shoulders above any other aircraft. Later in the war it was not only employed in a fighting capacity but was the first effective reconnaissance aircraft for the RAF. It could fly high at speed and take reconnaissance photographs. Indeed, it got the first reconnaissance photograph of German radar, the first photographs of the Peenemünde works for the V-1 rockets, and was instrumental as the war progressed in all sorts of other fields as well as in the battle of Britain.

Secondly, hon. Members have paid tribute today to the few who fought in the battle of Britain and the fact that they were an international cohort of pilots. Hon. Members have mentioned the large number of Polish pilots: 15% or so of the total number of pilots. They not only made a great contribution, but I understand that the particular way in which they flew the Spitfires was unlike anybody else’s, and they tested the aircraft to destruction. It did not get destroyed, it still flew, and the things they could do with that plane, as was proved throughout the war, is another tribute to the genius of the aircraft design.

Thirdly, for all those reasons, Southampton as a city is proud of its heritage as the progenitor and manufacturer of the Spitfire. As the hon. Member for Southampton, Itchen has said, the Spitfire was not only manufactured at the Supermarine works in Woolston. There was a remarkable arrangement subsequently whereby shops, factories and sheds produced that amazing aircraft literally in people’s back gardens in and around Southampton. The people from the city worked so hard to get the aircraft in the air and doing the job that they knew it could do.

So Southampton has an indelible and deep bond with the Spitfire. It is therefore absolutely appropriate that the site that has been chosen for the memorial faces out to Southampton Water, exactly under the path where the Spitfire pilots flew the planes from Southampton—or Eastleigh—airport, depending on your point of view. They flew over Southampton Water, absolutely at the centre of everything that happened that was part of the Spitfire legacy. The idea of a monument with a Spitfire soaring above Southampton Water seems absolutely the right use for the money that I hope will come in for that monument.

I congratulate the hon. Member for Southampton, Itchen on his efforts to make sure that the money comes our way. I am confident that his further efforts and hopefully those of the Members gathered here today will nudge the Government in the direction of making sure the money is available and will lead to an early and successful conclusion to this project. I will be first to applaud the successful completion of a long mission to get a monument to provide the recognition for the Spitfire that we in Southampton know is absolutely deserved, which can then go to a wider world.

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It is a pleasure to serve under your chairmanship this afternoon, Mr Davies. May I be the latest to add my congratulations to the hon. Member for Southampton, Itchen (Royston Smith) on securing this debate on a subject that I know is dear to his heart and to those of many of his constituents? He spoke movingly about the sacrifice made by those in the Woolston and Itchen areas of Southampton where the Spitfires were originally built. I agree that the monument would be a fitting tribute to the memory of those who died when the luftwaffe destroyed the factories in September 1940.

It has been an excellent debate and there have been many first-class contributions. That all-too-rare beast, cross-party consensus, seems to have emerged. That tells the Minister that we believe the memorial is important and should be built, and that there is no more appropriate location than Southampton. I agree with my hon. Friend the Member for East Lothian (George Kerevan) that it is right for the monument to be seen as common to everyone in these islands. Regardless of what the future holds for their constitution, we have a shared history and the Spitfire is a central part of that. I commend the words of my hon. Friend the Member for Stirling (Steven Paterson), who was right to highlight the role that Scotland, and indeed his constituency, played in the development of the Spitfire. I could not—I would not dare—attempt to match the eloquence of the hon. Member for Aldershot (Sir Gerald Howarth), but I share the sentiment he expressed.

It is remarkable that in 2017 we are discussing with such obvious affection and warmth an aeroplane that ceased production 65 years ago. The Spitfire has almost uniquely embedded itself in the collective consciousness of the country, and has a unique place in popular culture. Apart from the Titanic I cannot think of many other objects that have taken up so many reels of celluloid—starting in 1942 with “The First of the Few”, starring and directed and produced by Leslie Howard, and co-starring the great David Niven. Then, of course, came “Malta Story”, in which Alec Guinness and Jack Hawkins told how the Spitfire provided the main defence for the island of Malta. My hon. Friend the Member for East Lothian mentioned “Battle of Britain”, which had a stellar cast—Laurence Olivier, Michael Caine, Christopher Plummer, Ralph Richardson, Michael Redgrave and Susannah York. The one that stands head and shoulders above them all is “Reach for the Sky”, the 1956 classic with Kenneth More playing the part of Douglas Bader. I saw it as a child, and have seen it many times since.

I am sure that we all have personal anecdotes from family and friends that link us directly or indirectly to the Spitfire. My story comes from my time as a youthful barman in the Royal Air Force Association club in Ashley Street, Glasgow, in the early 1980s. Back then the RAF club was a busy, thriving establishment with a loyal clientele of former RAF service personnel and their families. The walls were adorned with photographs and memorabilia, but pride of place was reserved for the Spitfire. The majority of members had not flown in them, but none the less the Spitfire emerged as the symbol that unified them as a group of RAF veterans.

I fondly recall how many an evening on a quiet weekday shift I would sit at the end of the bar listening to some of those remarkable men, who, at the same age at which I was pulling pints, were clambering into planes to defend the skies of the UK and Europe from the Nazis. With hindsight, a bit of life experience, a slightly more cynical disposition and an ability to count, I am now convinced that at least one or two of those men sharing stories of derring do with a highly impressionable teenager must have had their Royal Air Force career thrust on them by dint of national service, and been more—how shall I put it?—Kenneth More than Douglas Bader. However, at the time it was a fascinating insight.

Regardless of whether they flew or not, the fact remains that everyone loved the Spitfire, and everyone who could be associated with it—however loosely, in some cases—wanted that association. It is without doubt a source of great pride for many, and a permanent memorial to remember those who built, designed, fought in and maintained the planes is well deserved. I am sure that when the memorial is built it will commemorate the immense contribution of the chief designer, R.J. Mitchell, the chief draughtsman, Joe Smith, and the chief test pilot, Jeffrey Quill, whose contribution to the success of the Spitfire it is impossible to overstate.

We have heard much of the role of the Spitfire in the battle of Britain, and it is worth remembering, as the hon. Member for Southampton, Test (Dr Whitehead) did, that it played a hugely important role throughout the second world war. He mentioned its use in photo-reconnaissance of the factories that were building the V-2. As I mentioned earlier, it played a crucial part in protecting Malta, and it was also involved in the Pacific theatre, defending Singapore in the early part of the war and, as part of the final push, driving Japan out of Burma. It played a crucial role in defending the city of Darwin in Australia from attacks by the Japanese. This country was not alone in using the Spitfire. I recall that the Soviet Union ordered 1,000, and they were used, in smaller numbers, admittedly, by the Americans and the Yugoslav Air Force. After the war they were still in production and were seen regularly in India, Ireland, Holland and Egypt, which all made good use of them.

The hon. Member for Southampton, Itchen was right to say that the role played by the Spitfire in the battle of Britain ensured that it would leave an indelible mark on the collective consciousness. Although, as the hon. Member for Aldershot said, they were fewer than the Hawker Hurricane—a plane that suffered far greater losses in the battle of Britain—it is the Spitfires’ role that has been preserved in the country’s collective memory, and rightly so.

However, let it be a true memory, because we were not alone in fighting the Nazis in the 1940s. The United Kingdom gave refuge to those fleeing fascism, and welcomed those, wherever they came from, who were willing to help defeat it. I hope that when the monument opens we shall not forget the 30 Australian, 30 Belgian, 84 Canadian, 90 Czech and Slovak, 13 French, two Caribbean, 10 Irish and 135 New Zealand pilots, the 30 from Southern Africa and, of course, the 147 Poles, who shot down more than 200 enemy aircraft.

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I am sorry to interrupt a fantastic speech, to which I was listening with enthusiasm. I was waiting to hear whether the hon. Gentleman would add to his list of those who should be recognised by the memorial the factory workers who built the Spitfires. Workers such as my grandmother spent many hours in factories. They were asked to work longer hours—six and seven-day weeks—to make sure that Britain’s war production was kept up. Should they not also be recognised in the memorial?

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I thank the hon. Gentleman. I did make the point earlier in my speech that the memorial would be for the workers, designers, test pilots and everyone involved in the Spitfire’s success. I absolutely concur with what he says.

I will conclude by thanking the hon. Member for Southampton, Itchen for securing the debate, and for the work that he is doing to secure a permanent memorial to the Spitfire and all those who designed, tested, built, flew, repaired and maintained that iconic aircraft. I and my hon. Friends wish him extremely well in his endeavour.

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It is always a pleasure to debate under your stewardship, Mr Davies—and particularly on this occasion. Regrettably, I do not have any stories to tell about R.J. Mitchell’s connection with my constituency or with Liverpool, but there is a story about a Spitfire that crashed in October 1942 in Birkenhead park. It flew over the Mersey and the pilot, who had baled out, landed on the Liverpool maternity hospital. It took until 2007 to recover the Spitfire. It was said that the engine was still in beautiful condition, which is a tribute to its engineering.

Hon. Members have referred to many aspects of the matter, and I want to comment on the speech of the hon. Member for Southampton, Itchen (Royston Smith). I thank him for bringing this important matter before the House, and for his tribute to the people of Southampton; they deserve it. He referred to the role of women in the factories and the whole range of people who were involved in building and servicing the Spitfire.

The hon. Member for East Lothian (George Kerevan) talked about the Spitfire being an iconic symbol of these islands, about people’s endeavour in fighting Nazism and fascism, and about the role of women in manufacturing Spitfires. The hon. Member for Aldershot (Sir Gerald Howarth) talked about his and, more importantly, his mother’s passion for the Spitfire. We will have to take his word for it that he flew the Spitfire with sobriety; I am sure that he did. The hon. Member for Stirling (Steven Paterson) talked about how the Spitfire helps with bonds between servicemen and servicewomen across the country and made reference to 43 Fighter Squadron commemorating 100 years at Stirling castle. There is no better way to tell the story of the Spitfire than by looking at the role of those people in that. The hon. Member for Eastleigh (Mims Davies) joined us all in supporting this proposal.

My hon. Friend the Member for Southampton, Test (Dr Whitehead) asked clearly and unambiguously for the money right up. He, too, talked about Southampton’s proud role in the story of the Spitfire and its deep bonds with it, and about how he is looking forward to seeing the monument over Southampton water. The hon. Member for Argyll and Bute (Brendan O’Hara) said that he, too, looks forward to going down to have a look at the Spitfire over Southampton Water. All those contributions were fantastic. This is a matter of substance, honour and pride, about which many Members spoke in detail, and I have tried simply to echo what they said.

As the hon. Member for Argyll and Bute indicated, people of a certain age, including me, used to watch the black and white movies of the 1940s and ’50s. Those were part of my staple diet on a Sunday afternoon after my lunch. One of the pictures he referred to was “The First of the Few”, which was released in this country in 1942. Its title in the United States was “Spitfire”, and it was released there in 1943, just days after the main actor, Leslie Howard, who played R. J. Mitchell, was himself shot down by the luftwaffe. It is perhaps fair to say that that picture was the first memorial or monument to the Spitfire. However, no matter how iconic it might be, the Spitfire needs more than a pictorial monument.

The story of the Spitfire is replete with stories of bravery, commitment, honour, valour, stubbornness, will power, camaraderie, self-deprecation and, above all, modesty. How else could people have got through without all those virtues and that approach to duty? The story of the Spitfire is legendary, but legends are often untrue—not this one. If anything, it has been underplayed. We all have family members who fought or were injured or killed in the two world wars, and who may have died thereafter as a result of the trauma. They command—that is not a word that they would use, but they do—our attention, our thanks and our commitment to their memory. Who could argue with that? None of us would argue with that.

Many of the comings and goings of the battle of the Atlantic—a literal nom de guerre given to it by Winston Churchill—occurred in my home town of Bootle and in Liverpool. The battle was conducted from Derby House and was the longest of the last war. It started on the day war broke out and concluded on the day the war finished—it was five years, eight months and five days. At Pier Head in Liverpool we have a memorial to those who were involved in the battle of the Atlantic and a monument to a brave man, Johnny Walker, who went across the seas after U-boats and is one of the most successful U-boat hunter commanders in history.

There are quite rightly monuments elsewhere, but we have a monument in Merseyside, symbolically next to the water from which many never returned, to celebrate their memory. As the monument says, they have no grave but the sea. I say “celebrate” because I, for one, do celebrate those who fought for our freedom against the most evil of regimes. Those who lost their lives in the battle of Britain and other air combat, and those who were willing to give their lives freely, are equally important and also deserve a monument to celebrate their sacrifices. The Spitfire personifies those men and women. It was a stalwart of the war and beyond, as were those who built, serviced and flew it.

The National Spitfire Project website sums up the issue as follows:

“Even after the bombing of the Supermarine factory, the people of Southampton continued to produce the Spitfire, dispersed to locations throughout the city, for the duration of the war. The Spitfire and Southampton are inseparable and it is the attitude of perseverance, ingenuity and patriotism that really does embody the Spirit of the Spitfire.”

We really do need a Spitfire monument, and it needs to be near the fulcrum of its design and build; near where, under siege and bombing, brave people fought on in more ways than one. I do not think that is too much to ask. It should be a monument that does our nation proud, does our democracy proud and, more importantly, does our heroes and the people of Southampton and its environs proud. There are only a few of the few left. Time is not on their side. We really should try to stop the clock now and, with good will, help to resolve this issue.

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It is a pleasure to serve under your chairmanship, Mr Davies. What a wide-ranging, erudite and evocative debate we have had. It is always a pleasure to hear colleagues on both sides of the House speak with passion about issues they really care about. I particularly congratulate my hon. Friend the Member for Southampton, Itchen (Royston Smith), who, as we heard, is an RAF man himself, on the vigour with which he promoted the National Spitfire Project.

We have heard from many colleagues with connections to both the RAF and the Spitfire. The shadow Minister, the hon. Member for Bootle (Peter Dowd), had an anecdote, and I came very close to having my own Spitfire anecdote to contribute. I visited Dover last Monday, which was the 100th birthday of Dame Vera Lynn. It was planned that that anniversary of a very British icon would be marked with a fly-past by two other British icons: two Spitfires. Sadly, that was put off for 24 hours by similarly iconic British weather, which closed in at the last minute and prevented anything from leaving the ground, so it all happened on Tuesday and I missed it. That is a shame, because although, as a London MP, I have seen Spitfires go overhead on several occasions on days of national commemoration, it would have been nice to be a little closer.

The National Spitfire Project is of particular significance in the constituency of my hon. Friend the Member for Southampton, Itchen and, as we have heard, across the city of Southampton, which played such an integral part in the birth of that iconic fighter plane. But its significance is not limited to Southampton—as many colleagues said, R. J. Mitchell’s exceptional design, powered by the mighty Merlin engine, was instrumental in winning the battle of Britain—so I endorse everything that my hon. Friend and others said about the national and international importance of remembering the plane.

I represent a very international constituency, so I welcome the comments from both sides of the House about the plane’s significance, not just to the British but in Europe and across the Commonwealth. It was wonderful to hear many people remind us of the multinational nature of the corps that took to the skies to defend Britain. Friends and allies joined British pilots in flying these planes with such courage and bravery. We also heard from my hon. Friend about the courage and bravery of the people of Southampton, who displayed great stoicism in the face of the Nazi onslaught on the city as they continued to produce this plane that was so integral to our war effort. I admire him for his involvement in the National Spitfire Project and congratulate everyone who got it to where it is today. I wish them continued success.

Let me turn to the money and the call that my hon. Friend made for money to be granted from the proceeds of LIBOR fines. As hon. Members will be aware, LIBOR funding has been allocated to supporting a wide range of armed forces and emergency services charities and good causes. Since 2012, in fact, more than £700 million of LIBOR funding has been allocated. That includes nearly £20 million at the last autumn statement alone, which is being used to support museums and memorials.

The shadow Minister mentioned doing our heroes proud. It is worth noting that more than £15 million has been allocated towards RAF museums and memorials, including the Battle of Britain memorial, the Lincoln Bomber Command memorial, Bentley Priory Museum and the Battle of Britain bunker at Uxbridge.

At the autumn statement, my right hon. Friend the Chancellor confirmed that, to mark the 100-year anniversary of the RAF, £2.4 million of LIBOR money is being provided to the RAF for its RAF100 programme, allowing many other events to take place. Some of that money is being committed to the RAF Museum to prepare for 2018 to tell the compelling story of those 100 years of the Royal Air Force, helping to share that story with more and more people as the human connection in terms of the generation of people who were around at the time is gradually lost. It was touching to hear some of the personal memories from within people’s families of those connections. It will be more and more important that we support the RAF in telling the story and keeping it alive, to ensure that down the generations people are aware of the RAF’s role in guaranteeing us the security and freedom that we are privileged to enjoy today and perhaps have had cause to reflect on more in the past few days than in usual times.

That is alongside a wide range of other projects. Money has also gone towards helping former and current armed forces personnel and their families, air ambulances and children’s hospitals. All in all, more than £260 million has been committed in this Parliament, and more than £700 million in total since 2012. As the Chancellor confirmed in August 2016, any further money from LIBOR will continue to be used to support military and emergency services charities and other related good causes that demonstrate the very best value.

Let me turn to the application process for those funds, if I may take the debate in a more prosaic direction for a moment. With regard to the possibility for further applications to the fund, the last round ran in August and September last year and generated more than 550 expressions of interest. The Chancellor has yet to confirm whether there will be further opportunities to apply for support from LIBOR fines. With £700 million paid out to date, the funds remaining are dwindling and we do not anticipate further significant receipts from the Financial Conduct Authority. However, if there are, we will publish any future LIBOR public funding opportunities in the usual way. I know that my hon. Friend the Member for Southampton, Itchen and those he is working with on the project will want to monitor the usual channels, such as gov.uk, for such opportunities carefully.

Despite the inspiring flights of oratory this afternoon, my Treasury feet are—predictably, perhaps—very much on the ground, and never more so than when I turn to the issue of governance and how funds are allocated, which is important to touch on. The allocation of LIBOR funding follows a robust governance process and adheres strictly to the mandated minimum standards for Government grants, which were introduced last year following the Government’s response to the report by the Public Administration and Constitutional Affairs Committee on Kids Company. We all remember the nature of that news at the time.

Under the current LIBOR governance process, each applicant is required to submit an application form, which is assessed by an independent team of grant-making experts, checked with the Charity Commission and reviewed by the Government’s new grants advice panel before final consideration by the Treasury. Each application is considered both individually and holistically for any impact across its particular sector. Specifically, the assessment team examines the governance of the charity or organisation, working closely with the Charity Commission to do so. The team also does a full assessment of the feasibility of a project, its value for money and any risks to its delivery.

I know that some of that has been touched on in conversations between Treasury officials and my hon. Friend. We are always happy to give more information about how the process can be followed and helpful steers on how that path can be taken, if that is of use to those involved with the project. In summary, I want to thank my hon. Friend.

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The LIBOR fund, which was developed by our right hon. Friend the Member for Tatton (Mr Osborne), was a splendid initiative that has done a tremendous amount of good work. I was rather involved in the Bomber Command memorial, which was put together by a tiny group of people. This is a stunning and long overdue memorial to commemorate the 55,573 men who gave their lives in Bomber Command. In the end, Prime Minister David Cameron knocked a few heads together in Whitehall and we got some money to cover the costs of policing on that day of three quarters of a million pounds, which otherwise would have had to have come from the charity itself.

I suggest to my hon. Friend the Minister that it might be a good idea to be slightly ahead of the game. This is quite an emotional and iconic issue. It is not just a question of pounds, shillings and pence; it is also a question of our national identity and, in the centenary of the Royal Air Force, marking what was a special, iconic contribution to the maintenance of the freedom of these islands.

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I assure my hon. Friend that that has not been lost on me this afternoon. Rarely have I sat through a debate with such genuine passion felt across the House. His point about timeliness and the anniversary is well made, and as I said, we have already made moneys available to mark that for the RAF. I look forward to seeing some of those projects come to maturity. His point is extremely well made. I assure him that I will make the Under-Secretary of State for Culture, Media and Sport, my hon. Friend for Chatham and Aylesford (Tracey Crouch), who is responsible for sport, tourism and heritage, fully aware of both the project—I am sure she is aware of it already—and the ambitious plans to mark our heritage; and, indeed, of the passion expressed for the project today in Westminster Hall.

I hope that all hon. Friends will understand that the process for allocating LIBOR funding must be transparent and objective. There is a process that all bids must take, so although I know that friends and colleagues would wish me to go further, sadly I cannot commit further at this stage.

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I appreciate that the Minister is in some difficulty as far as allocating funds off the cuff is concerned, and I would not advocate a further banking scandal in order to try to release more funds for that purpose. Will she indicate, today or in future, and in particular to my colleague the hon. Member for Southampton, Itchen (Royston Smith), whether she can think of any other avenues in her area of competence that might be used to facilitate the process of, shall we say, coughing up for this monument? I am sure that she will be happy to undertake that with the hon. Gentleman for the good cause that we have all talked about this afternoon.

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I am more than happy to commit to talk to my colleague in the Department for Culture, Media and Sport, who is the lead Minister on heritage, about the debate and to relay that request. I will reflect on whether there is more we can do in due course to direct my hon. Friend the Member for Southampton, Itchen to other sources of funding that might be available. I will reflect on whether it is possible for me to do that subsequent to the debate, or indeed to ask another Minister to do that from sources other than LIBOR funding.

However, I reassure all colleagues that, should further LIBOR funding opportunities arise, any application from the National Spitfire Project that falls within the published scope will be given full consideration along with other applications. In the meantime, I extend my good wishes to my hon. Friend and all involved with this project in its noble aim of creating a lasting memorial to a truly British icon.

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I am grateful to right hon. and hon. Members for their contributions, which were made on a cross-party basis. To ever achieve anything, it is better to have everyone lined up in a row, rather than anyone thinking, “It’s not a great idea.” To have the support of Members from across the House has been really helpful, and I am grateful to everyone for that. I am grateful to the Minister for her words of support. I am heartened by her encouragement to continue and to put in an application in the way that she describes. I will pass that back to the trustees of the project.

It is interesting that in some debates people start to repeat the same things over and over again, whereas in this debate we could probably have talked for hours and never needed to repeat any of the anecdotes that we all have or the stories that we hold so dear about something as iconic as the Spitfire. I think that says as much about how important the Spitfire is and how important it has been in our nation’s history as anything else could.

Why now? To further commemorate 100 years of exemplary service and commitment of our Royal Air Force personnel, both past and present. Why the Spitfire? Because the Spitfire was, as one person described it, a symbol of defiance, unity and hope, and because the war would have ended very differently but for the iconic Spitfire and the brave pilots who flew it and, as everyone has said, those who maintained it, built it, designed it and test flew it. Why Southampton? Because the symbol of freedom that the Spitfire has become was designed, built and test flown there. In a world divided and troubled, the Spitfire reminds us of a time when we stood up against all the odds and against evil—and we prevailed.

Question put and agreed to.

Resolved,

That this House has considered funding for the National Spitfire Project.

Hereditary Peers

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I beg to move,

That this House has considered Government policy on hereditary peers in the House of Lords.

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Order. I hope right hon. and hon. Members will leave quietly. This is an important debate, and I am sure we should give the right hon. Gentleman the courtesy of being heard. If Members could leave quietly it would be much appreciated.

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As a fellow member of the Justice Committee in another life, it is a pleasure to serve under your chairmanship, Mr Davies.

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I suspect the right hon. Gentleman has detected a certain discourtesy. May I assure him that none was intended whatever? I am sure he has brought a really important debate, and I assure him that he will be listened to with great interest, as always.

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I am grateful to the hon. Gentleman; I knew perfectly well that that would be the case.

I start by welcoming the Minister to his place and by saying what the debate is not about. It is not about abolishing the House of Lords; we will have views on that—I have always voted to abolish the Lords—but the debate is not about the abolition of the Lords. It is not about the role of bishops sitting in the House of Lords or not; we might debate at some point whether the Church of England or other faiths should be represented, but it is not about that. It is not about how we appoint peers to the House of Lords—whether by Prime Ministers, commissions or in other ways. It is not about the method of appointment or the existence of the House of Lords per se; we can debate and discuss the second Chamber and whether we need one or not another time.

The debate is about a simple question: should the hereditary principle be present in our legislative Chamber in the 21st century? That question is simple. Should we perpetuate the current anomaly, by which 92 hereditary peers are chosen to sit in Parliament by each other—or on occasion, as last week, the whole House—on the basis of whom their ancestors were, rather than personal merit? Should those individuals remain in this Parliament?

I know that the Minister is a historian; in fact, only this week I bought a copy of his book, “Bosworth” for further discussion. He will know that history is about change and campaigning for change, so I simply ask him to look at this issue, as I know he will have done and will do in future. If I said that we were going to discuss the Russian Parliament, and if members of that Parliament were the grandchildren of Lenin, for the simple reason that they were his grandchildren, I suspect that he would make noises to the Russian embassy to improve its parliamentary democracy.

If I spoke to the Minister about the South African Parliament, and there were people there for the simple reason that their grandfather was Nelson Mandela, I think the Minister would ask the South African Government what was going on with their democracy. I know that you take a great interest in European matters, Mr Davies. Last Saturday was the 60th anniversary of the founding of the European Union. If I came to this Chamber and said that there were people in the European Parliament simply because their fathers—in most cases—were signatories to the treaty of Rome in 1957, I think we would all have something to say about that.

However, in the Houses of Parliament today, we have people still in the House of Lords for no reason other than their great-grandfathers, great-great-grandfathers or a further distant relative served some purpose at some time for the Government of the day and received a peerage that was then handed down week in, week out, year in, year out to their ancestors. That matters because, even within that, election to be one of the 92 hereditary peers is restricted to people who previously sat in this Parliament as a hereditary peer. As a historian, the Minister will know that that is not a tenable basis for democracy across this country or any other. That matters; it is not a game. It is about a seat in Parliament. It is about the right to vote on legislation, to hold Ministers to account, to express an opinion and to make choices on behalf of somebody. The question is who that somebody is.

Lord Lyell, who sat in this House as a hereditary peer, sadly died earlier this year. A by-election was held last week, in which the only candidates could be hereditary peers whose families had served the state or royalty or somebody in the past. Of those who could apply, 27 did. None of my constituents could apply; perhaps Lord Mostyn, who owns Mostyn Hall in my constituency and who was a candidate for that election, was at one point from my constituency, but none of my constituents could apply. I am not sure many of your constituents could, Mr Davies, and I am not sure many of the Minister’s could.

However, 27 people applied, and it was restricted to those people. I will give a flavour of some of the candidates, if I may: the 5th Baron Bethell, an old Etonian; the 5th Baron Biddulph, who owns 1,000 acres on the banks of the Tweed; the 4th Baron Gainford, aged 92, who promised in his manifesto not to attend the Lords casually; the 7th Baron Hampton; the 3rd Baron Hankey; the 7th Baron Harlech, another old Etonian; the 8th Earl of Harrowby, another old Etonian; Viscount Hood who—surprise, Mr Davies; which school did he go to?—went to Eton. I have no objection at all to people who go to Eton being elected to the Houses of Parliament. The former Prime Minister, the right hon. David Cameron, went to Eton, and I have no objection to him getting into this Parliament.

However, it is wrong in the 21st century to have a small pool of people for the 27 candidates who had, for example, given service to the previous monarch and included the 4th Earl Lloyd-George; the 4th Viscount Mountgarret; Lord Somerleyton; and the Earl of Stockton, whose father was Prime Minister. The relatives of two former Prime Ministers and lots of people from Eton were fighting for a place in Parliament, in an election in which none of my constituents could stand.

[Mark Pritchard in the Chair]

Welcome to the Chair, Mr Pritchard. In the by-election that followed the sad death of Lord Lyell, the whole House of Lords could vote, because he was one of the specially promoted of the 92 remaining hereditary peers. Some 346 votes were cast out of a potential 803 for a seat in this Parliament.

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I congratulate the right hon. Gentleman on securing this debate. We have an absurd situation where the upper House is about 200 Members larger than our House. Does he agree that a simple, easy way of helping to restore the balance would be to scrap all the hereditary peers in one fell swoop, at least as an initial step, so that purely appointed peers are left?

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The hon. Gentleman is seven minutes ahead of me in my speech. That is a very good point. I do not see this as a party political argument; I see it as a matter of central democracy. I will return to that point later.

Lord Colgrain, who won the election last week, won with 143 votes and will take his seat in the House of Lords in due course. The turnout was 346, and as I have said, the total electorate is 803. The winning share of the total vote was 17%, and the turnout—even in this election, among such highly tuned political minds as the electorate of the House of Lords—was only 43%.

Lord Colgrain is a Conservative peer; I hold no objection to that. His peerage comes from the 1st Baron Colgrain, who died in 1954. I have no objection to him having a grandfather who worked for a bank and was president of the British Bankers’ Association, director of the National Provincial Bank and involved in London Assurance. I have no objection to that being his ancestor; that is a matter for him and his family. What I have an objection to is him being allowed to be on the ballot paper in an election in which only 27 people could participate as nominators and only 346 people ultimately voted to give him a seat in this Parliament.

Lord Colgrain has said that he wants to bring his experience of farming and finance to his membership of the Lords—fine. He is a governor at £34,000-a-year Sevenoaks School—fine. However, if we look at the hereditary peers, they are not drawn from the range of society that we might want reflected in this great, diverse Parliament that we have here today. That might seem ludicrous, but let me look at Lord Thurso, who was elected last year. Members will also know him as John Thurso. He served as a Member of this House for 14 years. He got elected when he was thrown out of the House of Lords with Labour’s first tranche of hereditary peers in 1999. He had a miraculous blood transfusion and removed his blue blood to stand as an ordinary mortal, and he got elected. At the last general election, he lost his seat in Parliament to a member of the Scottish National party. He was ejected from this House, yet Lord Thurso could stand at the first opportunity in a hereditary peer by-election.

The electorate in that case was a massive three electors—the three other Liberal Democrat hereditary peers. The election was due to the terrible death of Lord Avebury, whose work I had a lot of admiration for. The three electors for this post in Parliament were the Earl of Oxford and Asquith, the relative of the former Prime Minister; the Earl of Glasgow; and Lord Addington. There were six other candidates for this three-vote election: Earl Lloyd-George of Dwyfor, the great grandson of a former Prime Minister; Lord Calverley; the Earl of Carlisle; Lord Kennet; Earl Russell; and Lord Somerleyton. I have no objection to any of those individuals per se, but they obviously did not have the weight to carry the three voters, because in an election with 100% turnout, Lord Thurso got elected with 100% of the vote.

I put it to the Minister that if we were in a foreign democracy, staring across the vast ocean and looking at the United Kingdom in the 21st century, and said, “Here we have an election where only people whose great-great-great-great grandparents or other relatives were peers can stand. Here we have an election where only three people can vote, and here we have an election where 100% of those three people voted to put one person into the House of Lords,” we might look on with ridicule. If it were a foreign country, we might be looking at representations in the United Nations, sanctions for lack of democracy or pressure on that Government.

It is well and good, I hear you say. We removed in 1999 all but 92 hereditary peers from the House of Lords, and those 92 remained as a guarantee for the second stage of Lords reform. The Minister will know that the second stage of Lords reform is a long time coming. Irrespective of that, we have an opportunity to look at what we can do now.

If we look at this from outside, coldly, we see that of the 92 hereditary peers, 91 are male and only one is female. Again, I have no objection to their belonging to certain political parties, but 48 are Conservatives, 32 are Cross Benchers, four are Labour, four are Liberal Democrats, two are non-affiliated and one represents the UK Independence party. That is hardly diverse. What do they bring, in terms of diversity, to our society, apart from their accident of birth and their status?

How do these hereditary peers get their titles? I will give but three examples. Lord Abingdon’s ancestor, James Bertie, was awarded the title of Earl of Abingdon for his loyalty to the royalists during the English civil war. His father had the title of 2nd Earl of Lindsey, which he would have inherited if it was not for King James II. Lord Fairfax of Cameron is an ancestor of Thomas Fairfax, who was granted his title because he was one of the first Englishmen to go to Scotland to swear allegiance to the new King James I. I do not know about you, Mr Pritchard, but I happen to think that in the 21st century, we owe more to our democracy than to give a seat in Parliament and a vote on my constituents’ issues to someone whose ancestor happened to be the quickest person to get to Scotland from London at that time.

Lord Thurlow’s ancestor, Edward Thurlow, was granted his title in 1792. He was a Tory MP for Tamworth and Solicitor General in the Government of Lord North. That might be fine. When Lord North was in power, we had only just lost America, and yet today I believe the Minister will stand and defend—I may be wrong, and I hope I am—the idea that the ancestor of someone who was given their peerage just after we lost America should be able to make decisions that affect the people I represent. I have fought elections since 1987, winning some and losing some, to get a seat in this Parliament, and yet on the basis of a handful of votes, Lord Thurlow can sit here.

Perhaps the worst example of all, which cuts me to the quick, is the current Conservative peer Earl Attlee. He inherited his peerage as the grandson of one of the greatest Prime Ministers of all time, Clement Attlee, who fought for a Labour Government and for massive social change. Now, through the hereditary peerage, his grandson, Earl Attlee, sits in the other place and votes in a way that I know his grandfather, although I never had the privilege of meeting him, would not approve of or endorse. He would not want his grandson to vote in that way, yet under the ludicrous system that we have, that is what happens.

Following the general election, there were five by-elections before the one last week, so this is happening all the time. I say to the Minister in the four or so minutes in which I will continue to speak before handing over to him that the Government have a choice. As in all things, the Government have a choice. They could allow this to continue. They could say, “We are going to wait until we have reform of the House of Lords. We will not do anything until we get wholesale reform of the Lords.” I suspect that that is what the Minister may say today. We could, however, adopt one of two other solutions.

The noble Lord Grocott, who sits in the House of Lords as a life peer and who sat in this House for many years as your neighbouring Member of Parliament, Mr Pritchard, in Tamworth—

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Telford.

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Yes. Bruce Grocott was the Member for Lichfield and Tamworth originally and then came back as the Member for Telford in due course. Lord Grocott has introduced in the other place the House of Lords Act 1999 (Amendment) Bill, which says that we should stop the elections for hereditary peers now. It is a reasonable measure. Had it been implemented in 2015, the five by-elections to which I referred, plus last week’s by-election, would not have happened. This point relates to the conclusion of the hon. Member for Central Suffolk and North Ipswich (Dr Poulter): these peers could perhaps die off or retire and not be replaced. Lord Grocott has a live Bill in the other place. It has been discussed and debated and, surprisingly, hereditary peers tried to talk it out, but it is an option for the Minister to consider.

The Minister will know that I have in this House tabled a formal Bill, the House of Lords (Exclusion of Hereditary Peers) Bill, which adopts Lord Grocott’s proposal to allow an end to hereditary peer elections now, and includes a sunset clause date for when the hereditaries will be removed from the other place. I have given them notice that on a day in two and a half to three years’ time they will cease to be Members of that place—of the Houses of Parliament.

The Minister therefore has three choices. He could certainly leave the situation as it is, but he could also look at just stopping the by-elections or at using a sunset clause. There may be other options that I have not thought of, because those two seem to me very sensible and logical.

To go back to the contention of the hon. Member for Central Suffolk and North Ipswich, if the Government have decided that there will be fewer Members of Parliament—some 600—after the next election, which it is in the Government’s gift to do, but there are now some 843 Members of the House of Lords, of whom 92 are there because of their ancestors, not because of their own intrinsic merits, I think that it is time for change, and there is the potential for change there. I am talking about removing the peers and reducing the House of Lords membership. As I said in my opening comments, without abolishing the Lords, changing the method of election, touching the bishops or doing anything else, we could remove 92 peers in a very simple way by accepting Lord Grocott’s Bill or, indeed, my own.

I pray in aid the Lord Speaker, Lord Fowler, who said in The House magazine that reform had been

“hanging over the House like a cloud”.

He insisted that there was no way the Lords could defend its current size of more than 800 peers when the Prime Minister was set to reduce the size of the Commons to 600 MPs:

“I don’t think that we can justify a situation where you have over 800 peers at the same time as you’re bringing down the Commons to 600 MPs.”

He said:

“What we have to do first is to literally decide ‘what’s the number?’”

I want today to help the Minister, the Lord Speaker and the Houses of Parliament; the number could be, at the very least, 92 fewer by removing the hereditary peers or giving them notice and stopping their election, or, if the Minister wishes to maintain that policy, keeping them as they are.

As I said, the Minister is a historian. He has the chance today to make history. If he does not make history today, he will wake up one day and find himself on the wrong side of history. He should take the chance now, grab it, make a name for himself and remove hereditary peers from the House of Lords.

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I thank you, Mr Pritchard, and Mr Davies for chairing the debate so effectively and efficiently. I also thank the right hon. Member for Delyn (Mr Hanson) for raising this matter today. I am incredibly flattered that he has bought my book on Bosworth—I would sign it for him if that would not devalue the copy. I began my postgraduate research at university by looking at the new Tudor nobility—creations to the nobility—in the mid-15th century. If I had thought then that more than 15 years later I would be here today, responding on the Government’s behalf on the hereditary peerage, I would have worn a wry smile.

I do not doubt the right hon. Gentleman’s conviction and passion when he talks about this subject. I was there for his speech on 19 October in the House of Commons during the Opposition day debate on the House of Lords. I know that his private Member’s Bill ran out of time last Friday and that he brought a ten-minute rule Bill to the main Chamber in April 2016. I was going back through his political career just to test his commitment to and consistency on the issue of the House of Lords, which we are debating today. I can go as far back as when he was a 26-year-old candidate standing in Eddisbury on the Labour party’s 1983 manifesto, in which it stated very clearly that it would take action to abolish the House of Lords as quickly as possible and, as an interim measure, introduce a Bill in the first Session of Parliament to remove its legislative powers. All credit to the right hon. Gentleman for remaining consistent throughout his career and in his voting pattern to the manifesto commitment that he stood on in 1983.

With that in mind, I am sure that he will respect my decision to stick to the manifesto commitment that I stood on in 2015. I would like to place this on the record. It is on page 49 of the Conservative party manifesto. We stated:

“While we still see a strong case for introducing an elected element into our second chamber, this is not a priority in the next Parliament. We have already allowed for expulsion of members for poor conduct and will ensure the House of Lords continues to work well by addressing issues such as the size of the chamber and the retirement of peers.”

We added:

“We will ensure that the House of Lords fulfils its valuable role as a chamber of legislative scrutiny and revision”.

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I am not asking the Minister to break that manifesto pledge. Everything I have said would fit in with that pledge. I have talked about allowing retirements and not having elections. I am not asking for a change in elections; I am just asking him to look at retirements.

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The right hon. Gentleman makes a particular point about a manifesto commitment, but he ignores the fact that it is not a priority for this Government.

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My hon. Friend is a very able Minister for the Constitution, which is a subtle change of title from the previous Minister for Constitutional Reform—I am glad that an element of conservatism is seeping through the Cabinet Office. Surely the greater constitutional abomination of the other place at the moment, rather than the hereditary peers, is its recent tendency to attempt to defy the Salisbury convention.

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There have clearly already been debates and issues raised about the primacy of the elected Chamber. It remains the Government’s commitment that the primacy of the elected Chamber must remain paramount. Many peers have reflected the fact that that is an important consideration. With the article 50 Bill becoming the article 50 Act, we saw that peers understand the primacy of the elected Chamber, and we hope that that arrangement will continue.

I would like to dwell on what reform has meant over the past couple of years. As we have seen in the past, if reform of the House of Lords is to succeed, parliamentarians in both Houses must be able to work constructively together to make progress. It is clear from recent debates on the matter in the Lords that there are strong feelings on both sides. Although there might be agreement on certain issues, there is not yet clear consensus on the way forward.

The Committee stage of Lord Grocott’s Bill, to which the right hon. Gentleman referred, which would have removed the by-election system for replacing hereditary peers, clearly demonstrated that there was a level of disagreement and not a clear consensus on the way forward. With that in mind, and with so many other pressing legislative priorities to deliver over this Parliament—not least the fact that article 50 will be triggered tomorrow—the Government do not consider comprehensive reform of the Lords to be a priority. That is in line with our 2015 manifesto commitment.

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I am sure that my hon. Friend the Minister will acknowledge that the manifesto commitment was to look at the size of the House of Lords and at some of its composition. There was a commitment to reforming the Chamber; clearly, a Chamber that has 200 more Members than the House of Commons presents an issue. We recognise that the House of Commons is currently too large with 650 Members, so we are reducing the number to 600.

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My hon. Friend is absolutely right. As I have stated, the second part of the manifesto commitment was to

“ensure the House of Lords continues to work well by addressing issues such as the size of the chamber and the retirement of peers.”

That is not to say that the Government are unsympathetic to the case put forward by the right hon. Member for Delyn. In the last Parliament, under the previous Administration, the Government introduced a Bill that would have made 80% of the eligible membership of the House of Lords elected. Both he and I were in the same Lobby on Second Reading of that Bill, which would indeed have removed hereditary peers. It was ultimately unsuccessful, not because of a lack of commitment to reform, but because of a lack of political consensus on the form that reform should take and the process by which it should be enacted. However, that does not mean that we cannot make pragmatic and measured progress today, above all by achieving the consensus that was lacking in 2012.

To return to the point made by my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), the Government are clear that we want to work constructively with Members and peers to look at the pragmatic ideas for reducing the size of the Lords that can command broad consensus, just as we attempted to do in the last Parliament. On certain measures we worked with both Houses to introduce some focused, important reforms. With Government support, the House of Lords Reform Act 2014 enabled peers to retire permanently for the first time and provided for peers to be disqualified when they do not attend or are convicted of serious offences. Already more than 50 peers have chosen to take that step of eventual retirement. We also supported the House of Lords (Expulsion and Suspension) Act 2015, which provided the House with the power to expel Members in cases of serious misconduct, as well as the Lords Spiritual (Women) Act 2015.

I believe that by making pragmatic, incremental reforms that can command consensus, real progress can be made. The right hon. Member for Delyn mentioned being on the right side of history. Looking at the historical processes of constitutional change, we see that those are often developed, constructed and effectively delivered by measured and manageable reform.

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Will the Minister please say after me—so that it is on the record—that the current UK Government support the principle whereby three people can vote for a Member of Parliament? Will he just say that for me? That is what he is saying.

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A debate in Westminster Hall is not the place for hypothetical questions, and it is certainly not the place for hypothetical answers. The UK Government are determined to enact the Conservative party’s 2015 manifesto commitments, which clearly state that Lords reform is not a priority in this Parliament, but that where we can work constructively to address the size of the House and the retirement of peers, we will do so.

It is by making pragmatic, incremental reforms that command consensus that progress can be made. That is why the Government welcome the work of the Lord Speaker’s cross-party Committee of Back-Bench peers—the right hon. Gentleman mentioned him—to explore practical and politically viable methods by which the size of the House of Lords can be reduced. On 20 December 2016, the Speaker in the House of Lords announced that he was establishing the Lord Speaker’s Committee

“to examine the possible methods by which the House could be reduced in size.” —[Official Report, House of Lords, 20 December 2016; Vol. 777, c. 1541.]

That followed a debate on 5 December in which the House of Lords unanimously agreed that its size should indeed be reduced.

The Committee’s remit is to

“explore methods by which the size of the House can be reduced, commensurate with its current role and functions.”

Specifically, it is instructed

“to examine practical and politically viable options that might lead to progress on this issue; analyse their implications; and set out any outstanding questions that may need to be answered in order for any proposals to command broad consensus across the House.”

Following its deliberations, there was a consultation exercise that closed on 20 February; I am sure that right hon. and hon. Members have taken the opportunity to respond to that. The Committee will offer advice to the Lord Speaker on potential next steps. It is expected to conclude its work by early summer.

The Committee considers that its remit requires it to work within the following constraints: first, that there is no change to the House’s role and powers or to the primacy of the Commons, and that deals with the point that my hon. Friend the Member for Hazel Grove (William Wragg) made; secondly, that Members continue to be appointed, but with a ceiling on the total size of the House; thirdly, that there is no increase in the cost of the House; fourthly, that there is a guaranteed percentage or minimum number of Cross-Bench peers; and fifthly, that no single party is to have a political majority. I note that in the questions that were put as part of that consultation exercise, the Committee sought suggestions about how to achieve two overarching aims: first, to reduce the House from its current size to a target number or range; and secondly, to keep the House at that target size or range afterwards. It stated:

“In considering different options, it may be helpful to factor in the following points.”

One of those includes:

“Any consequential implications for the Lords Spiritual (the Bishops), the future of hereditary peers in the House, and automatic appointments of certain office-holders.”

I am sure the right hon. Member for Delyn has taken the opportunity to make his views heard as part of that consultation.

Although there may be no consensus on this matter—the right hon. Gentleman is right to have predicted that the Government are committed to looking at measured and manageable reform, but that comprehensive reform of the House of Lords is not a priority in this Parliament—we look forward to hearing the independent Committee’s recommendations and to future discussions with colleagues across both Houses about where and when that consensus might be found. May I just say that it has been a delight to have this opportunity for discussion and debate today? It is important that these views are aired and put on the record and that I, as the Minister responsible for the policy, can come to the House to defend the Government’s position. I thank the right hon. Gentleman for securing this debate today.

Question put and agreed to.

Resolved,

That this House has considered Government policy on hereditary peers in the House of Lords.

Rare Diseases Strategy

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I beg to move,

That this House has considered implementing the UK Strategy for Rare Diseases.

It is a pleasure to serve under your chairmanship, Mr Pritchard. Since taking over as chairman of the all-party parliamentary group on rare, genetic and undiagnosed conditions in 2015, I have had the great privilege of meeting and helping patients, children and their parents and families. To explain the enormity of the situation, one in 17 people will be affected by a rare disease at some point in their life. That equates to approximately 3.5 million people in the UK. There are currently between 6,000 and 8,000 rare diseases that have been identified, with patients affected at all ages. However, for those who have a known rare disease, the picture is slightly better than for those whose disease is not known. Many children and adults who I have met do not have a diagnosis. That is both deeply distressing and prevents adequate care from being provided fully. It results in a wide range of issues for patients and parents, who are often desperate to find the answers. Despite the scale of the issue, unfortunately a significant proportion of people with a rare, genetic or undiagnosed condition still do not have access to adequate care and treatment.

Given the enormity of the problem, the Government published their rare diseases strategy in 2013. It was heralded by the rare diseases and medical communities as a major breakthrough. While symptoms vary from condition to condition, there are a number of issues that patients and families affected by rare diseases face collectively—for example, the difficulties associated with accessing a timely and accurate diagnosis and the appropriate co-ordination of care. The publication of “The UK Strategy for Rare Diseases” should have heralded a new era of treatment and care for rare diseases patients in England, Scotland, Wales and Northern Ireland. Containing 51 commitments, the strategy aims to ensure that health and social care systems across the nations provide those living with rare conditions with the highest quality of evidence-based care and treatment, regardless of where they live in the UK.

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I thank the hon. Gentleman for bringing this important issue to Westminster Hall for consideration. There are some 60 different types of muscular dystrophy, and 1,000 children and adults for every 1 million of the population are affected—70,000 people are affected by a muscle-wasting condition in the UK. Does he share my concern that our current strategy helps those who live a life of suffering because of those terrible diseases, and does he believe that we are offering the best, or enough, support to their carers at this time?

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The hon. Gentleman and I have discussed rare diseases many times in this Chamber. I pay tribute to his work and that of his party on pushing this agenda in Northern Ireland; that also has implications for England. I agree with what he said and I will come on to evidence given to the all-party group—he mentioned a range of different things—including that of Muscular Dystrophy UK. I hope hon. Members find that report and the evidence that we refer to beneficial.

Without wishing to go into too much detail about the 51 recommendations, given the limited time that we have, the UK strategy aims to

“ensure no one gets left behind just because they have a rare disease”.

Features include setting a personal care plan for every patient, bringing together health and social care services; ensuring that patients, their families and carers have the information that they need and are listened to and consulted; and improving diagnosis and intervention and strengthening research to improve personalised approaches to healthcare for those with a rare disease.

The four countries in the UK were given a deadline of 2020 to implement the commitments. Although the Health Departments in the devolved nations have all published country-specific implementation plans to reflect their respective health services, structures and priorities, the Department of Health in England has not yet co-ordinated a plan for England.

At this point, I want to pause to thank all the charities and organisations across the country—including the Centre for Rare Diseases in Birmingham, the Birmingham children’s hospital, Lupus UK and Muscular Dystrophy UK—that have not only submitted evidence to our report, but done so in advance of this debate. Although I cannot name a million and one organisations, given the limited time, I—and, I think, the whole Chamber—wish to thank them for all their work on helping patients with rare, genetic and undiagnosed conditions.

As has been referred to, between October 2016 and January 2017, the all-party group on rare, genetic and undiagnosed conditions conducted an inquiry into the implementation of the UK strategy for rare diseases in England. It held three hearings with the Department of Health and its arm’s length bodies. More than 300 patients, family members, patient organisations, clinicians and industry representatives also submitted evidence. I thank all those who did so and all colleagues who took part in the evidence sessions, which were very interesting. Overall, the findings were that the strategy is working well and being implemented effectively in some areas. However, where the strategy is failing to be implemented, the problems it was designed to fix are in some cases getting worse or, at best, failing to get better. I will detail the findings of our report and ask the Minister a number of questions.

I was pleased with the response to a question I asked during Health questions last Tuesday. The Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood)—she is sadly unavailable for this debate, but I thank the Minister here today for stepping in at short notice—said that

“the UK strategy for rare diseases needs to be translated into an implementation plan”.—[Official Report, 21 March 2016; Vol. 623, c. 772.]

She also said that that was one of her prime commitments, and I was pleased to hear that from her at the Dispatch Box. However, the evidence we received for the report suggested that the Department of Health does not intend to develop an implementation plan and believes that NHS England should assume responsibility for doing that, so will the Minister confirm who will introduce the implementation plan, as promised last week?

NHS England also suggested in evidence that it does not intend to develop an implementation plan and has neither the remit nor the capacity to influence all 51 commitments in the strategy. Given that evidence, will the Minister commit to finding a way either for the Department of Health to deliver that agenda or for NHS England to be given direction to do so?

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I thank the hon. Gentleman for being gracious in giving way. He will be aware of the neuromuscular complex care centre that was set up in Queen Square in London in September 2014. Will he encourage the Minister to visit that centre to see the benefits of co-ordinated, specialist, multidisciplinary care delivery that could be replicated across the United Kingdom of Great Britain and Northern Ireland?

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I am sure that the Minister heard that and will pass it on to the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon.

We also saw evidence of poor communication between the organisations responsible for implementing individual commitments and other stakeholders involved in the strategy. What plans does the Minister have to better co-ordinate that communication? Many patients do not have access to the appropriate treatment or information about their condition, and the barriers to accessing information about a condition begin as soon as a diagnosis is made. Unfortunately, that leads to patient care continuing to be poorly co-ordinated.

I know that the Minister is a superb champion for those with rare diseases, and given the rare condition that the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon, has, I hope that he provides more information about the Government’s commitment from last week. Hopefully they can commit to the Department of Health developing a comprehensive implementation plan that describes actions for its arm’s length bodies in particular. An implementation plan would offer direction to bodies involved in rare disease patients’ care, so that they can take action to improve the services that patients need. It would help patients to understand what progress is being made and to ask the right questions when it is not. It would also help to ensure that the needs of rare disease patients and their families are considered in decisions about patient care and access to treatments taken by bodies involved in the strategy.

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I congratulate the hon. Gentleman on securing this important debate. I welcome the recommendations in the strategy, although I am concerned that the recent announcement on capping NHS drug prices will influence implementation. Muscular Dystrophy UK has said that it would have a major impact on drugs for muscular dystrophy and other rare diseases. Newcastle is fortunate enough to be home to the John Walton Muscular Dystrophy Research Centre, but support could be improved further by providing specialist psychological support for people with muscle-wasting conditions. Does the hon. Gentleman agree that such support needs to be an integrated part of service provision for muscular dystrophy and other rare diseases?

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I am really pleased that the hon. Lady raised that point, and I again pay tribute to the work done by Muscular Dystrophy UK to support patients. A key recommendation from our inquiry addressed the fact that part of the rare diseases strategy suggests that we should look at things on a much more integrated level. Patients are not just the medical condition that is attributed to them; they are also an entire person, who is part of a collective family. The rare diseases strategy has implications not just for those individuals, but for their families, carers and so on, across the board. We have seen a number of instances where the rare diseases strategy is simply not doing what it should have been doing, so I hope that in the Minister’s summation he will address taking a holistic approach, rather than just looking at the individual.

Further recommendations in the APPG report include that NHS England should be more proactive in implementing the commitments it can influence and dedicate more resources to improving the co-ordination of care, as the hon. Member for Newcastle upon Tyne Central (Chi Onwurah) said. It recommended that the Department of Health should improve its processes to both engage and communicate with stakeholders in the strategy. It also recommended that the Department of Health and the UK National Screening Committee should work together to establish robust programmes for identifying and preventing rare diseases, and that training for frontline medical staff on rare diseases and their impact on patients should become widely available and incentivised. The APPG is very much encouraged by the number of programmes that have been developed in response to the strategy that complement its aims, such as the 100,000 Genomes Project. Those programmes are amazing in themselves; none the less, those developments should not necessarily be considered as actions resulting from the UK strategy for rare diseases.

The time to act is now. I am sure that the Minister can guess my final point, which is about the changes to the National Institute for Health and Care Excellence’s highly specialised technologies programme. Commitment 13 of the strategy—lucky for some—is to ensure

“that there are appropriate procedures for evaluating the costs and benefits of treatments for patients.”

NICE’s recent decision to implement an upper funding threshold for its HST programme, made despite widespread condemnation from the rare diseases community, conflicts with that aim. The upper limit will vary according to the lifelong impact of the technology on the patient, varying from £100,000 per quality-adjusted life year for treatments that deliver less than 10 QALYs to the patient in their lifetime, up to a maximum of £300,000 for treatments that deliver more than 30 additional QALYs to the patient in their lifetime.

Unfortunately, the programme has been beset by delays. Only four medicines for the treatment of rare diseases have been evaluated since the HST programme began, averaging just one a year, despite a capacity for three treatments a year. The four medicines evaluated to date have been shown to bring tremendous value to the patients eligible to receive them. They are life-saving, life-lengthening treatments with the potential to lift the burden on whole families of a rare genetic condition.

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I thank the hon. Gentleman for securing this debate and for his leadership on the issue. On that particular point, does he agree that, as well as being a kick in the teeth for the rare and ultra-rare disease community—families, medical staff and charities—the plans make no sense? They have no bearing on the effectiveness of the drugs, which surely should be the basis for decisions, and they threaten new drugs that could change and save people’s lives, as well as some of the drugs that we joined families, medical staff and campaigners to get in the first place.

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I thank the hon. Gentleman for his intervention and pay tribute to him for his work on rare diseases over the years. One of the first events I ever went to in Parliament was on rare diseases and was hosted by him. I could not have put it better myself. I will come later to my view that the issue needs to be thought about in a more timely way, potentially in a consultation and through some sort of implementation plan, which has been missing. It will impact not just people with muscular dystrophy, for example, but all those with the different conditions that he has championed in the past.

The four medicines evaluated to date have shown tremendous benefits to patients, and are life-saving and life-extending treatments. They are some of the most powerful and effective treatments for rare diseases ever seen, and the highly specialised technology evaluation committee recommended them for funding in England, but none of those life-changing medicines would have been able to raise the lower threshold significantly, and none would have been approved under the new regime.

If implemented, the plans will significantly affect patients with rare diseases and their ability to access life-changing treatment, at a time when we should be expanding access routes rather than limiting them further. The changes contradict the positive recommendations made in the accelerated access review and will restrict any attempt through the industrial strategy to position the UK as a centre for the development of innovative medicine. England already has extremely slow and limited access to treatments for rare genetic conditions; further narrowing of access routes will shut the door to innovation for our community of patients and families. It is unacceptable to implement such drastically damaging proposals just 18 days after they were announced. I therefore join the sector in calling for a pause in implementing the proposals and for a consultation and impact assessment.

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I thank the hon. Gentleman for his kindness in giving way once again. The John Walton Muscular Dystrophy Research Centre was named after a peer, now sadly deceased, who also founded Muscular Dystrophy UK and saw over a long lifetime the importance of the UK’s role in innovative science and research techniques, and its economic benefits to the research sector and, more widely, our international reputation. The changes proposed to NHS England will do much to undermine that.

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I think the sector agrees on that point, from patient groups to the constituents whom the hon. Lady represents, as well as all the people with an undiagnosed condition who might access the services of that facility in future and many others throughout the country. The Government need to rethink the implementation and ultimately introduce an impact assessment on that basis.

I know that several hon. Members want to speak, so I will conclude by welcoming the commitment and dedication of this Minister and the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon, in providing a solution to our long-standing problems with the implementation of the rare diseases strategy in England. Following the publication of our report, I hope that the Minister will be able to provide clarity on the questions that I have asked. The UK is doing superb work and leading internationally on rare diseases.

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I commend my hon. Friend on securing this important debate. My constituent Will Newman contacts me regularly about his granddaughter Ellie, who lives outside my constituency. He wanted me to come to this debate and thank my hon. Friend and the Minister for the work that they are doing. We think that rare diseases do not affect many people, but those whom they affect, they affect hugely. Does he, like me, take heart from the Prime Minister’s words in September? She said at Prime Minister’s questions:

“We are committed to ensuring that patients with rare conditions get access to the latest medicines”. —[Official Report, 7 September 2016; Vol. 614, c. 334.]

As she also said, we are taking the necessary steps to get those to them.

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I thank my hon. Friend for that intervention. He is a great champion for his constituents. I share his hope in the Prime Minister’s commitment, made at an early stage in her office, and in a Minister who obviously understands rare diseases, having one herself, and who has made a clear personal commitment to resolve the issue. Having worked alongside the Department of Health for many years, I have been wanting to see this come to fruition. I am glad that we now have a leadership commitment in place to deliver it for the first time, at least in my memory of working alongside the NHS.

The UK is doing superb work and leading internationally on rare diseases. I hope that our all-party parliamentary group’s report will make a significant difference and help to steer the Department of Health to a place conducive to both the Minister’s requirements and ours. I look forward to hearing his response.

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Before I call Margaret Ritchie, I will give some guidance. I am sure that hon. Members are aware that the spokesman for the Scottish National party will have five minutes, as will the shadow Minister. The Minister will have 10 minutes. This debate is due to finish at 5.30.

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It is a pleasure to serve under your chairmanship, Mr Pritchard. I congratulate the hon. Member for Bath (Ben Howlett) on his thoughtful contribution and on securing this important debate. He has given leadership on the issue, drawing on his professional field and as chair of the all-party parliamentary group, for which we are particularly grateful.

Those who suffer from rare diseases struggle for recognition, funding and resources, but rare diseases collectively are not rare; there are over 6,000 of them, and many Members here have constituents who are among the 3 million people throughout the UK affected by such diseases. The range of rare diseases is wide, but they have in common an impact on the lives of those who suffer from them and on those of their families and carers. In October last year, I chaired the annual general meeting in Northern Ireland on Behçet’s disease, a very rare disease that affects suffers with listlessness and muscular atrophy. They cannot get close to a level of diagnosis that comes with a clear medical plan for dealing with their particular disease.

Having a rare disease presents its own unique challenges. The testing experience of ill health is exacerbated by the difficultly of diagnosis and the subsequent struggle to access medicine and treatment. Other sufferers of rare diseases in my constituency have told me of the need for a co-ordinated approach to diagnosis and implementation of a treatment plan across all medical disciplines, which is sometimes sadly lacking.

I come to the issue from a Northern Ireland perspective. The hon. Member for Bath referred to an implementation plan for the nations and regions within the UK. A constituent who has a rare disease, as does her son, suggested to me that they originally received a considerable level of co-ordinated treatment here in Great Britain, but not in Northern Ireland. That issue must be addressed under our own singular plan.

Of course, proving the safety and effectiveness of treatments and medicines is an added difficulty in rare diseases with complex data, or perhaps even a dearth of data. I echo the vision of the Northern Ireland Rare Disease Partnership: no one should be disadvantaged because of the rarity of their condition. People with rare diseases should be able to expect access to the safe, effective and affordable drugs and treatments that they need.

Other hon. Members have mentioned muscular dystrophy in their interventions, specifically Duchenne muscular dystrophy, which affects more than 2,500 children and adults in the UK. Assisted ventilation is required to help older Duchenne patients to breathe, which necessitates 24-hour care, and some patients undergo a tracheostomy procedure. I have heard worrying reports that medical centres that conduct clinical trials for Duchenne muscular dystrophy and other muscle-wasting conditions are facing a lack of capacity and resources and are having to turn studies away, which risks thwarting the development of promising new drugs and the search for effective treatments that the hon. Member for Bath referred to.

As a Member of Parliament who represents a constituency in Northern Ireland, I was pleased that the then Northern Ireland Executive published their rare diseases implementation plan in October 2015, some two years after the report here was published. The plan identified four priorities: Northern Ireland’s participation in the 100,000 Genomes Project; a commitment to review communications and information; a review to establish a Northern Ireland rare diseases registry; and training needs analysis for medical professionals. The next steps, of course, are to monitor the outcomes of those reviews and to listen closely to the people who are directly affected by the actions of the Department of Health. One of my principal regrets is that we do not currently have a Northern Ireland Executive; civil servants are monitoring the issues but do not have the authority or directives to drive policies forward.

The founding principles of the NHS—that care should be free at the point of delivery and in accordance with need—must be observed. This debate is important because we need to find ways to ensure that those who suffer from rare conditions, for which proving safety and effectiveness is not easy, are not disadvantaged simply because their condition is rare or because the statistics are complicated. The Northern Ireland Rare Disease Partnership told me yesterday that it is not convinced that the latest efforts in that regard from NICE and NHS England are the final answer or even a good answer. It wants NHS England and NICE to look at the testimony of patients who are directly affected, and think about what “need” actually means in today’s world. It cannot just mean paracetamol for headaches; it must mean life-saving or life-altering treatment.

I fear that delays in the progress of implementation will be another unacceptable result of the political situation that we currently face. It is important that we have a political driver—a political authority—to implement our rare diseases strategy fully. I will continue to be guided by the judgment and first-hand knowledge of constituents who have a rare disease, and to measure the success of our local strategy by their experience of how it is implemented.

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It is a pleasure to serve under your chairmanship, Mr Pritchard. I congratulate the hon. Member for Bath (Ben Howlett) on securing this debate and on his excellent work as chair of the all-party group.

My interest in this subject has been stimulated by visiting a number of key research sites in and around Cambridge, where vital work is being done to develop new treatments. The Sanger Institute has the world-famous and world-leading 100,000 Genomes Project and works closely with the adjoining European Bioinformatics Institute. Because of Brexit, both institutes face major problems with retaining key staff and ensuring data flows, although that is a debate for another day. We also have the National Institute for Health Research’s biomedical research centre, which is led by Dr John Bradley and based at Addenbrooke’s hospital.

I recently joined Dr Bradley and Professor Lucy Raymond, professor of medical genetics at Cambridge, to celebrate Rare Disease Day at an illuminating roundtable with patients and practitioners. We heard case studies that highlighted some of the very difficult challenges that patients with rare diseases face, including practical difficulties with the benefits system. I was particularly struck by meeting a patient who suffered from lupus. She explained that she had good days and bad days—something that the welfare system just cannot cope with, making her already difficult life even harder. The message that I came away with—apart from the important links to the genetic sequencing work being done at the Sanger and the need to identify the right people to test—was that research into rare diseases not only helps with those diseases, but leads to discoveries with a much wider application.

I will focus my comments on new treatments and on how to ensure ready access to them. As we have heard, this debate is very timely because it comes hot on the heels of recent NICE guidance that introduces a financial cap for access to new medicines. NICE is proposing an upper limit for costs per quality-adjusted life year, above which it will not recommend funding for highly specialised technology treatments. That decision could have a profound impact on people affected by rare diseases in the UK. On Thursday, when I asked the Leader of the House for a debate on the matter, he replied that

“decisions about individual medicines are taken by a body such as NICE, where clinical judgment is to the fore, rather than being subject to political pressure”.—[Official Report, 23 March 2017; Vol. 623, c. 966.]

None the less, I am glad to have the opportunity to raise the matter today. I agree that it should be for NICE to decide, but this is a significant change from medical efficacy to financial rationing. Such a highly political change should be debated here, not outsourced.

We must listen to what charities such as Alzheimer’s Research UK and Cancer Research UK are saying. They warn that lives will be lost because of this new rationing system. I was particularly struck by the words of the MPS Society, which provides support to people affected by mucopolysaccharide diseases. It said that the decision by NICE and NHS England

“will affect the most vulnerable in UK Society and confirms that children and young adults with ultra-rare diseases going forward are economic pawns in a failing NHS and cheaper dead than alive.”

Those are very strong words. They are not mine, but they show how people feel, and I am sure that the Minister will have noted them.

Genetic Alliance UK said:

“NICE, in close collaboration with NHS England, are sending a clear message that they are unwilling to fund new innovative treatments for rare diseases. This is a real slap in the face for patients and families with rare diseases, and contrary to the founding principles of the NHS.”

It has also suggested that, as we have already heard, none of the four rare disease medicines that have so far been approved would have been approved under the new proposals, which it believes will cause a

“drastic reduction in access to innovative treatments for very rare diseases in England”.

It is also worth mentioning that the guidance will have an impact not only on people affected by rare diseases, by closing off their access to innovative treatments, but on the UK’s vital life sciences sector more broadly, as it risks curtailing investment in new medicines. As the BioIndustry Association says, it sends

“an immediate, stark, negative signal to the global life science investors and companies that the UK needs to attract in the Brexit era.”

The reaction from patient groups, as well as from industry, demonstrates the broad concern about the adverse impact that NICE and NHS England’s decision will have on patients. The UK strategy for rare diseases published in 2013 has the laudable aims of raising awareness of rare diseases and improving diagnosis, research and access to services for people affected, but there is a real risk that those aims will be undermined by the new guidance.

I echo the calls from the hon. Member for Bath and other hon. Members for the Department of Health to publish an implementation plan for the UK strategy for rare diseases, because until we see a coherent plan, progress on the strategy’s objectives will continue to stall. As the all-party group has rightly summarised:

“An implementation plan…is a tool for delivery, coordination, collaboration, communication and monitoring.”

Such a plan would also enable stakeholder groups to have a clear idea of which institutions they could work with to influence the implementation of the strategy.

We have already heard today that the Minister responsible for public health and innovation, the hon. Member for Oxford West and Abingdon (Nicola Blackwood), has made a personal commitment that the UK rare diseases strategy should be translated into an implementation plan. I applaud her for that commitment, but I hope the Minister will confirm that the Department will follow through on it, because last year the then Health Minister, the hon. Member for Mid Norfolk (George Freeman), stated in a written answer:

“There are no plans to consult on the implementation plan”.

The Government have described the UK strategy for rare diseases as

“a long term strategic vision for improving the lives of all those with rare diseases and conditions”

and have committed

“to ensuring that patients with rare and ultra-rare diseases in England are able to access effective treatments.”

I fear that recent decisions will mean that access to those effective treatments will be shut off. The Government must act urgently if they want their strategy to move beyond paper and reach the patients and people it aims to help.

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It is a pleasure to serve under your chairmanship today, Mr Pritchard, and I am grateful to the hon. Member for Bath (Ben Howlett) for securing the debate, for his informative speech and indeed for the work that he has undertaken with the all-party group.

As we have heard, rare disease affects considerably more people than we would at first imagine, with over 3 million people across the UK likely to suffer from a rare disease at some point in their lives. The Scottish Government’s implementation plan for rare diseases in Scotland recognises this fact in its title: “It’s Not Rare to Have a Rare Disease”.

My own constituency has had, as I am sure every other constituency has had, several fairly high-profile rare disease cases. These cases attract media attention and affect entire communities, not just the family directly affected; often, communities have to raise funds to help with treatments and raise awareness. Such a case was that of Kirsty Reid from Whitburn. In 2015, after being diagnosed with pseudomyxoma peritonei—it is one of those conditions where the acronym, PMP, is slightly easier to say—Kirsty raised over £7,000 to help others diagnosed with the rare condition, which affects only two people per million.

We also have a charity called Shavon’s Journey, which was set up in 2012 following the death of Shavon Morton from Grangemouth after a long fight with aplastic anaemia, a condition in which bone marrow does not produce sufficient new cells to replenish blood cells. I could go on with other examples, but I think we all get the point— rare diseases touch the lives of many, and therefore the importance of raising awareness, and of improving diagnosis and ultimately the services and treatments to sufferers, cannot be overstated.

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I thank my hon. Friend for giving way and I congratulate the hon. Member for Bath (Ben Howlett) on securing this debate. The Teddington Trust, which is jointly run by one of my constituents, supports people living with xeroderma pigmentosum, who lack the DNA repair mechanism necessary to repair damage caused to the skin by exposure to ultraviolet sunlight. Does my hon. Friend join me in commending the work of the Teddington Trust and the work of many other rare disease charities in supporting those living with rare diseases and keeping rare diseases on the political agenda?

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I do indeed join my hon. Friend in commending the work of so many good charities and organisations in this field.

The Scottish Government’s implementation plan, which I have mentioned, sets out the Scottish approach to delivering the UK strategy commitments. Key to the plan is recognising the importance of timely and accurate diagnosis, and allowing treatments to start as soon as possible. The Scottish Government have substantially increased access to new medicines, particularly for cancer, due to reforms and investment in recent years, which has led to a marked increase in uptake of orphan, ultra-orphan and end-of-life medicines.

Last year, the Scottish Government launched a review of the way drugs are assessed for NHS use, which was led by the former NHS Fife medical director, Dr Brian Montgomery. His review looked at how changes made to the Scottish Medicines Consortium process in 2014 had affected access to medicines for rare and end-of-life conditions. The review’s recommendations set out how the process for appraising medicines can be made more open, transparent and robust, and the Scottish Government have committed to implement all 28 of its recommendations, such as a new approval pathway, outwith the standard SMC process, for these high-cost medicines for very rare conditions.

The Scottish Government’s peer-approved clinical system, or PACS, has helped to give patients and clinicians a better say in which new medicines are approved by the SMC for use in NHS Scotland, particularly those used for rare or life-limiting conditions. PACS was first piloted in Glasgow in 2015 and has been successfully rolled out across Scotland, and a second tier of PACS will now be introduced to replace and build on the existing individual patient treatment request system. A new national appeals process will be introduced through this new tier of PACS, which will include consideration of equity of access with other parts of the UK as a material part of the decision-making process.

It is also perhaps worth saying at this point that the Scottish Government are happy to work with the National Institute for Health and Care Excellence, and indeed with any other countries, to improve access to medicines in Scotland and to obtain a fair price from the pharmaceutical industry. I emphasise that last point, because we now need the pharmaceutical companies to do their bit by bringing forward fairer prices for new medicines, so that access can be as wide as possible.

Finally, we know that the Health Secretary has said that he does not expect the UK to remain within the European Medicines Agency, which raises a number of concerns about potential delays in new drugs reaching patients in the UK. Sir Alasdair Breckenridge, who was the chairman of the UK’s drug regulator—the Medicines and Healthcare Products Regulatory Agency—for almost a decade, said last month:

“The UK market compared to the European market of course is small and they may decide not to come to the United Kingdom. So therefore there will be delay in getting new drugs—important new drugs, anti-cancer drugs, anti-infective drugs—for patients in the UK.”

He is not alone in saying that; David Jefferys, vice-president of Japanese drugs firm Eisai, has also warned that UK patients could face delays of up to two years. I would be grateful if the Minister could advise in his response to the debate how these dire warnings can be prevented from becoming a reality.

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It is a pleasure to serve under your chairmanship this afternoon, Mr Pritchard.

I welcome this important debate and I thank the hon. Member for Bath (Ben Howlett) for securing it and for his excellent introduction to it, although I am sorry that I missed the start of his speech because it started four minutes early before my hon. Friends and I were in our places.

I also thank other hon. Members for their contributions this afternoon, including the hon. Member for South Down (Ms Ritchie), my hon. Friend the Member for Cambridge (Daniel Zeichner) and the hon. Member for Linlithgow and East Falkirk (Martyn Day), the spokesman for the Scottish National party, who all made excellent and insightful speeches.

As others have said, here in the UK one in 17 people will be affected by a rare disease at some point in their life, which equates to approximately 3.5 million people in the UK. It cannot go unsaid that those 3.5 million people have a wide range of symptoms, which vary from condition to condition, some of which we have heard about this afternoon. It is clear that there are common experiences that people with these conditions all share. As Rare Disease UK has estimated that it takes on average four years for a patient to receive a diagnosis, it is clear that there are many missed opportunities to help those people living with rare diseases. Each and every person who suffers from a rare disease deserves the necessary support to live a fulfilling life.

That is why it was welcome that in 2013 the coalition Government published their UK-wide strategy for rare diseases, which was seen as heralding a new era in the treatment and care of rare disease patients across all four home nations. The 51 recommendations are all to be welcomed, as they each take us a step further in addressing concerns about the care and treatment of rare diseases, and the strategy’s aim is to make sure that no one gets left behind just because they have a rare disease. It is an aim that Labour welcomes wholeheartedly.

Most of my contribution to this debate will focus on the issues with the implementation of the strategy, but I will take a moment to mention some of the positives. It is welcome to see that the National Institute for Health Research has launched the Rare Diseases Translational Research Collaboration—I will use the acronym, RD-TRC, as it is much easier to say—which aims to empower patients to engage and become involved with research and research funding decisions. To date, the NIHR has invested £4 million in the RD-TRC, and the programme is expected to continue for another five years, with a £5 million investment.

Work has also been done by Public Health England on data recording, to bolster diagnosis and early intervention, and we have also seen Health Education England collaborate with the National School of Healthcare Science to produce two educational videos for healthcare professionals, in order to raise awareness of the problems faced by families who have a child with an undiagnosed condition and the importance of considering whether it is a rare disease. All this work is to be welcomed and should not go unnoticed.

Yet the sticking point in all of this, and the reason why we are here today to debate this issue, is that the Government are digging their heels in and not getting on with drafting an implementation plan, while the other home nations’ Health Departments are making significant strides. That betrays not only those patients living in England who wish this strategy to be properly implemented but the strategy itself, which stated that all four home nations must see the vision behind the strategy become a reality by 2020. It also undermines all the excellent work that I mentioned previously to implement the recommendations.

The strategy was published in 2013 and we are now just three years from the date set for the vision to be realised. However, the all-party group that the hon. Member for Bath so ably chairs has discovered that the Department of Health does not intend to publish an implementation plan, believing that it should be published by the NHS. Yet the NHS has said that it does not intend to do this either, as it does not have responsibility for other arm’s length bodies of the Department of Health. I want to ask the Minister why. I want to know why we are seeing patients and their families caught in this dispute between the NHS and the Department of Health. This situation cannot continue; there are people suffering right now who need this strategy to be implemented correctly.

I have briefly mentioned the report by the all-party group on rare, genetic and undiagnosed conditions on the lack of an implementation plan, but I know that it covers other issues as well, and I will take a moment to touch on some of them. One of the main issues raised was the lack of communication between organisations responsible for implementing the various aspects of the plan, and the failure to provide patients, families, doctors, industry experts and patient organisations with updates on progress of the strategy. That is deeply worrying, as it is important that people are made aware of the issues that affect them so personally. Therefore, it is not surprising that the all-party group heard from more than 300 patients that widespread disillusionment and disappointment had become the common feeling about the strategy, despite the optimism felt when it was published five years ago. The sting in the tail is that there are implementation plans for the strategy across the UK, with the exception of here in England. I share the frustration of the many others who are affected by the Government’s complacency. The Department’s rationale for not providing updates on progress is that patient organisations can disseminate information to patients and families, but it sadly fails to grasp that those organisations and charities are often very small and do not have the resources to pull together updates and send them out.

Also, issues that have not been worked on since the strategy was published have been identified, including prevention and identification of rare diseases, improving care pathways and failing to implement structures that would facilitate collaboration between the four home nations. In his response, I would be grateful if the Minister could provide us with an update on those points and tell us what his Department plans to do to see the recommendations through.

The strategy is now five years old, and although there has been work to see it realised, it has not gone far enough. The failure here is that the Department of Health in England is not fulfilling its duty to draft an implementation plan to realise the visionary goals in the strategy, which undermines the work already under way and hinders any future work. The Minister must set that right, and I hope he plans to do so today. He has the power to rectify the situation and he cannot be complacent when it comes to supporting people living with rare diseases.

We are not talking about a handful of people; many of our own constituents are being failed by the Government, and all they ask for is that the Department of Health do what Departments in the other home nations are doing and provide an implementation plan to enable the strategy to be fully realised and make the impact it was intended to have. I once more thank the hon. Member for Bath. I hope that the debate will make the Minister think again about the Government’s opposition to taking responsibility for a plan, and that he will honour the whole vision of the strategy, instead of cherry-picking from it.

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If the Minister does not use all the time allocated—10 minutes is a guide, but clearly there is more time on the clock—it will allow me to call the hon. Member for Bath for a brief winding up, but that is entirely in the Minister’s gift.

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Mr Pritchard, I am grateful for your generosity and guidance. You are chairing the debate admirably, as usual. I congratulate my hon. Friend the Member for Bath (Ben Howlett) and the other members of the all-party group on rare, genetic and undiagnosed conditions on securing the debate and on producing a timely and informative report. My hon. Friend rightly pointed out that the Under-Secretary of State for Public Health and Innovation would have been the Minister responding to the debate, but I am sure he will understand why she cannot be here: she was invited to accompany the Prime Minister elsewhere today. I regret, for him, that that proved an invitation hard to resist. It has, however, given me the opportunity to learn more about rare diseases and I am grateful to my hon. Friend for that. I hope to be able to address some of the comments that he and other hon. Members have made.

As has been acknowledged, the UK strategy for rare diseases was published in 2013 and set out a high-level framework that aimed to improve the lives of those affected by rare diseases. The Government remain committed to implementing the strategy by 2020 and are aware that the real test of success will be tangible improvements experienced by patients with rare diseases and their families. Last month’s publication of the all-party group report is a timely reminder that there is still much to do, as has been mentioned by all speakers today. However, it is important not to forget just how much we have achieved.

NHS England has been actively working to raise the priority given to rare diseases. In particular, advances in genomics are already having a positive impact on patients with rare diseases. NHS England has embarked on a world-leading project to establish genomics in mainstream healthcare, establishing a network of 13 genomic medicine centres that will underpin the delivery of genetic medicine over the years to come. The Government have also made a clear commitment to developing genomics, and that is best demonstrated by the £500 million investment in the 100,000 Genomes Project, which is the biggest national sequencing project of its kind in the world.

The full potential for genomics can be realised only with continued research into rare diseases, and the National Institute for Health Research has established a Rare Diseases Translational Research Collaboration to make maximum use of its significant research infrastructure. I welcome the support given by the Opposition spokesperson, the hon. Member for Washington and Sunderland West (Mrs Hodgson), to that initiative. It is supported by a £20 million investment and has already recruited more than 15,000 patients to support 56 projects related to rare diseases.

I am pleased to say that the UK is a recognised leader on many rare diseases. We are an active member of the International Rare Diseases Research Consortium and have been actively involved in the establishment of 24 European reference networks—ERNs—for rare disease, six of which we are leading on. I was at an informal meeting of EU Ministers early last week, where our role in punching above our weight for the ERNs was widely acknowledged.

An important element of our plans will be to continue to look for ways in which the UK can work with international partners. The all-party group, along with hon. Members present in the debate and a number of external groups in the rare diseases community, have raised concerns about the perceived impact of the planned changes to the methods used by the National Institute for Health and Care Excellence for the evaluation of highly specialised technologies. That is one of a set of proposals being introduced by NHS England and NICE following the recommendation in last year’s Public Accounts Committee report on specialised services that the Department of Health and our arm’s length bodies should better consider affordability when making decisions, including on rare diseases. NICE and NHS England have consulted on the proposals, and I can assure hon. Members that they have listened carefully to the responses and made substantive changes.

The planned changes to NICE’s methods, as amended following the consultation, recognise the unique position of patients with very rare diseases and the need to pay a premium for their treatments. The changes introduce a clearer framework for the assessment of drugs for very rare diseases, which will better enable commercial discussions between NHS England and the pharmaceutical companies, in line with the recommendations of the accelerated access review. The consultation originally proposed the introduction of a threshold of £100,000 per quality-adjusted life year. In response to feedback, that single threshold has been replaced by a sliding scale, which means it will be possible for transformative treatments that offer significant health gains to be approved up to £300,000 per QALY. That is 10 times greater than NICE’s threshold for treatments considered by its mainstream technology appraisal process.

My hon. Friend the Member for Bath can speculate, but I gently say to him that it is not possible to predict how likely any individual new drug is to be recommended by NICE under the changes in the future, and we cannot retrospectively apply the new framework to past decisions. Furthermore, it is important to stress that even when NICE is not able to recommend a drug for the full patient population, NHS England may still be able to fund a drug for a subgroup of patients who will most benefit from treatment.

The hon. Member for Linlithgow and East Falkirk (Martyn Day) referred to the co-operation of Scotland, along with the other devolved nations, in collaborative work. We acknowledge and welcome that, and we acknowledge that Scotland has published an implementation plan. My hon. Friend the Member for Bath referred to four examples of drugs that NICE had approved for use for rare diseases in England, and they are available for use in Northern Ireland. The hon. Member for South Down (Ms Ritchie) asked about that. In particular, Translarna was approved for Duchenne muscular dystrophy, which she referenced. I gently say to the hon. Member for Linlithgow and East Falkirk that those four drugs are not yet available in Scotland—at least, not according to my briefing—other than one that is available for restricted use. Although we wish to continue co-operating with Scotland, the system in England has some advantages thus far.

I am confident that the planned changes create a framework that will enable truly transformational new drugs for patients with rare diseases to be made available where companies are willing to set prices that fairly reflect the added benefit they bring.

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I congratulate the hon. Member for Bath (Ben Howlett) on securing this debate. I welcome the progress that the Minister has described, but one thing that has been touched on in several speeches is the difficulty people have as a result of the nature of rare diseases. When they are trying to get a diagnosis in the first instance, medical practitioners often have no experience of the disease. As he develops his speech, or as the Department develops the policies and framework for delivering more services, will consideration be given to how that knowledge can be more widely spread?

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The right hon. Gentleman anticipates something that I will come to shortly in my speech, but we acknowledge that challenge and we recognise that there will continue to be concerns among patient groups and Members. I hope that my hon. Friend the Member for Bath in particular will understand that the proposed changes are intended to put in place a fairer, more transparent framework for the evaluation of technologies for very rare diseases as they are developed.

I want to respond specifically to the challenge posed by my hon. Friend and the shadow Minister on the real need to ensure that the commitments set out in the UK rare disease strategy are fully realised. It is right that last week in the House, my hon. Friend the Under-Secretary of State for Public Health and Innovation made a personal commitment to that effect in her response to my hon. Friend’s oral question, and I am happy to reiterate that commitment today. I can confirm to the House that I have agreed with the chief executive of NHS England that by the end of this year he will deliver an implementation plan for those of the 51 commitments of the UK strategy for rare diseases for which NHS England has lead responsibility. For those commitments that fall outside NHS England’s remit, the Department will work collaboratively across stakeholders to contribute to the implementation plan. I am sure my hon. Friend will agree that the development of that plan will be a significant step in the journey.

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indicated assent.

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I welcome my hon. Friend’s acknowledgement of that. We are absolutely clear that we need to ensure that the proposals are used to drive real action and make tangible improvements for patients affected by rare diseases. It is not only about having a plan but about ensuring that the plan has effect for sufferers of these conditions. That is why we have recently reconfigured and strengthened the governance arrangements and formed a more streamlined UK rare disease policy board to monitor and co-ordinate progress in implementing the strategy.

In addition, we have strengthened the patient voice with the appointment of two patient representatives to the policy board. To make our work more transparent, a broad online stakeholder forum will operate in collaboration with the policy board to allow a more meaningful dialogue with the rare disease community. The rare disease policy board will be supported by clearly defined task and finish groups to examine progress objectively and to consider in particular the diagnostic odyssey that my hon. Friend referred to, which can be so frustrating for those who are still unable to determine their condition. That issue is a considerable worry for anyone affected by a rare disease, who will be familiar with the problem.

I will conclude slightly ahead of schedule by confirming that the lives of patients with rare diseases can be improved only by means of concerted and co-ordinated action. I take this opportunity to reaffirm the Government’s aims to drive real improvements in the care and treatment of those affected by rare diseases by working with stakeholders to deliver the standard of care and treatment that all patients deserve and to ensure that the implementation plan for England is delivered by the end of this year.

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I will be brief. I thank the Minister for his response. The news about the implementation plan being brought in before the end of the year is incredibly welcome, and I thank him for taking leadership on that. That is a message to go back to my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood) while she is with the Prime Minister. I appreciate that it is potentially a lot nicer to be with the Prime Minister than here. Nevertheless, the Government’s position is welcome.

I thank all Members for contributing to the debate. I particularly thank the hon. Members for South Down (Ms Ritchie), for Cambridge (Daniel Zeichner), for Linlithgow and East Falkirk (Martyn Day) and for Washington and Sunderland West (Mrs Hodgson) for their supportive comments. The time is now. The all-party parliamentary group, working with Genetic Alliance UK and Rare Disease UK, which provide the secretariat to the APPG, will be monitoring the progress that the Minister, the Department and NHS England make over the next few months. Progress will be incredibly welcome. The Minister referred to the highly specialised technology change and explained how the consultation has operated, and I appreciate that, but I reiterate that there is concern within the sector. The Ministers may be able to reassure people that that concern is being taken into consideration.

For a long time I have said that the accelerated access to medicines review might be a good pathway for rare diseases in the future. The work that the former Minister for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman)—he is now chair of the Prime Minister’s policy unit—has done and continues to do will be incredibly important. Thank you, Mr Pritchard, for chairing the debate. I thank the Minister for updating the House, and I also thank Members and all those who gave evidence and support to the APPG in its inquiry.

Question put and agreed to.

Resolved,

That this House has considered implementing the UK Strategy for Rare Diseases.

Sitting adjourned.